4/24: General Considerations in the Treatment of Temporomandibular Disorders

Question 1

What needs to be considered in the evaluation and treatment of patients?

Answer 1

The interrelationship of various TMJ disorders

Question 2

What can trauma to any structure of the masticatory system cause or contribute to?

Answer 2

Most TMDs

Question 3

Where is support for the appropriate treatment modalities found in?

Answer 3

Evidence based literature

Question 4

Some etiologic factors that contribute to TMDs are difficult to __________ or _________ (e.g., emotional stress)

Answer 4

eliminate; control

Question 5

What kind of therapies seem to report similar success rates on a long term bases?

Answer 5

Conservative and non conservative therapies

Question 6

What two groups do treatment methods for TMDs be categorized into?

Answer 6

Definitive treatments
Supportive therapy

Question 7

What are definitive treatments?

Answer 7

Directed to controlling or eliminating the etiologic factors that created the disorder

Question 8

What is supportive therapy?

Answer 8

Treatment methods directed toward altering patient symptoms but often do not affect the etiology

Question 9

When do TMDs result when?

Answer 9

Normal activity is interrupted by an event

Question 10

What are common events that can cause TMD?

Answer 10

Local trauma or increase in emotional stress

Question 11

What is the second influencing effect of occlusion?

Answer 11

Through orthopedic instability

Question 12

What is another common etiology of TMD?

Answer 12

Increased emotional stress

Question 13

What is any source of deep pain responsible of?

Answer 13

Creating the TMD

Question 14

What is the last etioloy?

Answer 14

Parafunctional activity, diurnal or nocturnal, bruxing or clenching

Question 15

All initial treatment should be _________, ________, and ___________

Answer 15

Conservative, reversible, and noninvasive

Question 16

What is occlusal therapy considered to be?

Answer 16

Any treatment that is directed towards altering the mandibular position and/or occlusal contact pattern of the teeth

Question 17

What does reversible occlusal therapy alter?

Answer 17

The patient’s occlusal condition only temporarily and is best accomplished with an occlusal appliance

Question 18

What happens when the occlusal appliance is worn?

Answer 18

An occlusal contact pattern is established that is in harmony with optimum condyle-disc fossa relationship

Question 19

What does an occlusal contact pattern is established that is in harmony with optimum condyle-disc fossa relationship provide?

Answer 19

Orthopedic stability

Question 20

What does irreversible occlusal therapy permanently alter?

Answer 20

The occlusal condition and/or mandibular position

Question 21

What are examples of irreversible occlusal therapy?

Answer 21

Selective grinding or restorative procedures

Question 22

What are indications if a patient responds successfully to reversible occlusal therapy?

Answer 22

Irreversible occlusal therapy may be helpful

Question 23

What can increased levels of emotional stress affect?

Answer 23

Muscle function by increasing the resting activity, increasing bruxism, or both

Question 24

What are other disorders that may activate the autonomic nervous system?

Answer 24

• irritable bowel syndrome
• premenstrual syndrome
• intestinal cystitis
• fibromyalgia

Question 25

What does evidence suggest about greater levels of emotional stress and what it can create?

Answer 25

Increased parafunctional activity in the masticatory system

Question 26

What is a correlation drawn between?

Answer 26

Increased levels of anxiety, fear, frustration, and anger and muscle hyperactiviy

Question 27

What do more challenging patients suffer from?

Answer 27

OCD, PTSD, patients that suffered from physical or sexual abuse, depression

Question 28

What happens when psychologic therapy is indicated?

Answer 28

The patient should be referred to a properly trained therapist

Question 29

What should the first treatment be when a patient comes to the dentist with symptoms closely related to muscle hyperactivity?

Answer 29

Educate the patient regarding the relationship between emotional stress, muscle hyperactivity and the problem

Question 30

What happens once the emotional stress problem is understood?

Answer 30

Anxiety will be reduced, which often reduces pain

Question 31

What is a general rule?

Answer 31

"if it hurts, don't do it"

Question 32

What does "if it hurts, don't do it" mean?

Answer 32

The diet should be altered The patient is encouraged to eat softer foods, take smaller bites, and generally chew slowly

Question 33

What should a patient do if they find their teeth contacting, other than swallowing, chewing or speaking?

Answer 33

Immediately disengage them

Question 34

What are other habits that can aggravate TMD symptoms?

Answer 34

Biting on objects, chewing on ice, or heavy gum chewing

Question 35

What are the two types of relaxation therapy?

Answer 35

Substitutive Active relaxation

Question 36

What is substitutive therapy?

Answer 36

A substitution for stressful events or an interposition between them (activities that they enjoy, regular exercise)

Question 37

What is active relaxation therapy?

Answer 37

Therapy that directly reduces muscle activity (pt is trained to relax the symptomatic muscles, biofeedback, negative biofeedback)

Question 38

The evaluation of levels of emotional stress in a patient's life is extremely __________

Answer 38

Difficult

Question 39

When high levels of emotional stress are suspected as an etiologic factor contributing to a disorder, _____________ should be initiated

Answer 39

Stress reduction therapy

Question 40

What is a very effective way of starting a stress reduction therapy?

Answer 40

Establishing a positive doctor patient relatinoship

Question 41

When should a stress reduction therapy approach be presented?

Answer 41

Early in the tx plan so the patient can appreciate the relationship between pain, emotional stress, and the dental procedures that may be offered

Question 42

What therapy is of little use in the case of macrotraums?

Answer 42

Definitive therapy since the trauma is no longer present

Question 43

What therapy is of necessary in the case of microtraums?

Answer 43

Definitive therapy that consists on developing orthopedic stability

Question 44

There is no correlation between the amount of __________ and _________

Answer 44

Bruxing activity; pain

Question 45

What should patient education begin by?

Answer 45

Informing the patient that the teeth should only contact during chewing, speaking, and swallowing

Question 46

What is nocturnal bruxism influences by?

Answer 46

Factors such as emotional stress levels and sleep paterns

Question 47

What can nocturnal bruxism be reduced with?

Answer 47

Occlusal appliance therapy

Question 48

What is supportive therapy directed toward?

Answer 48

Altering the patients symptoms, often has no effect on the etiology of the disorder

Question 49

What is supportive therapy extremely helpful in?

Answer 49

Providing immediate relief on the symptoms

Question 50

Supportive therapy is only ____ and not replacement for _____ therapy

Answer 50

Symptomatic; definitive

Question 51

What are the two types of supportive therapy?

Answer 51

1. Pharmacological therapy 2. Physical therapy

Question 52

What are the most common classes of pharmacologic agents for the management of TMDs?

Answer 52

- analgesics - antiinflammatories - muscle relaxants - anxyolitics - antidepressants - anticonvulsives

Question 53

What is physical therapy?

Answer 53

Group of supported activities that is instituted in conjunction with definitive treatment

Question 54

What are modalities of physical therapy?

Answer 54

Thermotherapy Coolant therapy

Question 55

What is thermotherapy?

Answer 55

Heat is the prime mechanism, Based on the premise that it increases the circulation to the applied area

Question 56

What is coolant therapy?

Answer 56

Cold encourages the relaxation of muscles that are in spasm, and thus relieves pain **ice should not be left on the tissues for longer than 5-7 min

Question 57

What is ultrasound therapy?

Answer 57

Method of producing an increase in temperature at the interface of the tissues and therefore affects deeper tissues than does surface heat

Question 58

What is ultrasound therapy used in conjunction with?

Answer 58

Surface heat, especially when treating a post trauma patient

Question 59

What principle does electrogalvanic therapy use?

Answer 59

Electric current will cause a muscle to contract

Question 60

How does electrogalvanic therapy work?

Answer 60

Rhythmic electrical impulse is applied to the muscle, creating repeated involuntary contractions and relaxations

Question 61

What is transcutaneous electrical nerve stimulation?

Answer 61

Continuous stimulation of cutaneous nerve fibers at a subpainful levels

Question 62

What does transcutaneous electrical nerve stimulation use?

Answer 62

A low voltage, low amperage current of varies frequency

Question 63

What are manual techniques?

Answer 63

Soft tissue mobilization Joint mobilization

Question 64

What is soft tissue mobilization?

Answer 64

Superficial and deep massage

Question 65

What is joint mobilization technique?

Answer 65

Gentle distraction of the joint

Question 66

What is muscle conditioning?

Answer 66

Exercises that can help restore normal function and range of movement

Question 67

When is assisted muscle stretching used?

Answer 67

When there is a need to regain muscle length Should never be sudden or forceful

Question 68

What is accupuncture?

Answer 68

Stimulation of certain areas that causes the release of endogenous opioids which reduces painful sensations