dysaesthesia + tmd Flashcards
What is oral dysaesthesia?
An abnormal sensory perception in the absence of abnormal stimuli
What are the 2 types of oral dysaesthesia?
Somatoform - perception and understanding of information is wrong
Neuropathic - abnormal sensory stimulus and nerves function incorrectly
Give 4 examples of common dysaesthesias
Burning or nipping feeling
Dysgeusia - foul, salty or metallic taste
Paraesthetic feeling
Dry mouth feeling
Give 4 predisposing factors for oral dysaesthesia
Deficiencies - haematinics, zinc, vitamin B1 and B6
Fungal and viral infections - ensure pt doesn’t have a treatable medical condition
Anxiety and stress
Gender - woman more likely to present than men
What is burning mouth syndrome most associated with?
Haematinic deficiency
Why is the site of burning mouth important?
Lips and tongue most likely to be parafunction
Multiple other sited most likely to be dysaesthesia
What is dysgeusia?
Bad taste, bad smell
Nothing detected by practitioner
Nothing found on examination
What is touch dysaesthesia and what should be done?
Pins and needles feeling
Normal sensation to objective testing despite pins and needles feeling
Cranial nerves must be tested
MRI is essential to check for demyelination or tumour
Describe a dry mouth dysaesthesia and what should be done
Most common oral dysaesthesia
Patient complains of debilitating dry mouth
Patient eats okay
Worse when waken at night
Usually associated with anxiety disorders
Investigate as if patient has Sjögren’s - salivary flow, autoantibodies - should get no positive findings
How are dysaesthesias managed?
Explain condition to patient - mouth may be normal, but the way you’re feeling isn’t normal
Assess degree of anxiety
Patient must have control and understand the condition
Anxiolytic medication eg - nortriptyline, mirtazepine, vortioxetine
Neuropathic medication eg - Gabapentin, pregabalin, clonazepam
How are patients with TMD classed?
Joint degeneration - pain on use and crepitus
Locking open or close
No joint pathology
How can you guess if a patient has TMJ joint pathology or not?
If joint pathology, patient will often put a single finger directly on the TMJ
If no pathology, patient will use many fingers or open palm to show where pain is
Give 4 possible causes of TMD
Occlusion
Grinding
Clenching
Stress
Give 4 physical signs of TMD
Any fromL
- clicking joint
- locking with reduction
- limiting of opening mouth
- tenderness of masticatory muscles
- tenderness of cervical-cranial muscles
- scalloped tongue
- linea alba
Give 4 common examination findings in TMD
Any from:
- joint noise
- deviation on opening
- dental occlusion upset
- focal muscle tenderness - masticatory, SCM and trapezius
- tenderness of TMJ
- limited opening
