GENERAL CONSIDERATIONS IN THE TREATMENT OF TEMPOROMANDIBULAR DISORDERS

Question 1

What are the two categories of TMD treatment methods?

Answer 1

• definitive treatments
• supportive therapy

Question 2

T/F: etiologic factors contributing to TMDs are easily eliminated or controlled

Answer 2

False–difficult to eliminate or control
ex: emotional stress!

Question 3

What are definitive treatments?

Answer 3

• directed to controlling or eliminating the etiologic factors that created the disorder

etiology: the cause, set of causes, or manner of causation of a disease or condition

Question 4

which category of TMD treatment does this fall under?

Restoring wear or fractured teeth

Answer 4

Definitive Treatment

Question 5

What are supportive therapys?

Answer 5

• treatment methods directed toward altering patient symptoms but often do not affect the etiology
• helpful in providing immediate relief of symptoms
• ONLY symptomatic and NOT replacement for definitive therapy

etiology: the cause, set of causes, or manner of causation of a disease or condition

Question 6

What type of TMD treatment is related to the CAUSE of the disease?

Answer 6

Definitive Treatment

Question 7

What are common events that cause TMD?

Answer 7

local trauma or increased emotional stress

TMDs result when normal activity is interrupted by an event

Question 8

What is the second influencing effect of occlusion?

Answer 8

orthopedic instability

wear=different movement than normal –> muscle pain

Question 9

What are some etiologies of TMD?

Answer 9

• local trauma
• increased emotional stress
• orthopedic instability
• parafunctional activity**
• diurnal or noctural
• bruxing or clenching

Question 10

All initial treatments for TMD should be…

Answer 10

conservative, reversible, and noninvasive

then refer to a specialist!

Question 11

What is occlusal therapy?

Answer 11

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

–more stability
–better positioning

Type of Definitive Treatment

Question 12

What is the best type of reversible occlusal therapy?

Answer 12

occlusal appliance

Question 13

What do occlusal appliances provide?

Answer 13

orthopedic stability

–when appliance is worn an occlusal contact pattern is established that is in harmony with the optimum condyle-disc fossa relationship–providing orthopedic stability

Question 14

What is reversible occlusal therapy?

Answer 14

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

–when appliance is worn an occlusal contact pattern is established that is in harmony with the optimum condyle-disc fossa relationship–providing orthopedic stability

Question 15

What is this an example of?

Answer 15

Reversible Occlusal Therapy using an occlusal appliance

Question 16

What is this an example of?

Answer 16

Irreversible Occlusal Therapy

Question 17

What is irreversible occlusal therapy?

Answer 17

permanently alters the occlusal condition and/or mandibular position

ex: selective grinding (equil typodont) or restorative procedures

Question 18

What are examples of irreversible occlusal therapy?

Answer 18

selective grinding or restorative procedures

make a list of adjustments made on cast then do to pt

Question 19

When a patient responds successfully to reversible occlusal therapy, what does this indicate?

Answer 19

that irreversible occlusal therapy may also be helpful

Question 20

How does increased levels of emotional stress affect muscle function?

Answer 20

by increasing the resting activity and/or increasing bruxism

(parafunctional activity)

Question 21

What are the types of emotional stress therapy?

Answer 21

• refer them to a trained therapist (when psych therapy is indicated)
• educate the patient regarding the relationship between emotional stress, muscle hyperactivity, and the problem..once they understand the problem, anxiety reduced, which often reduces the problem

Question 22

What should you tell a patient to change if they have TMD?

Answer 22

• diet (eat softer food, smaller butes, and chew slowly)
• if feel teeth contact when not chewing, talking, swallowing, immediately disengage them
• do not bite on objects
• do not chew ice
• no heavy gum chewing

can all aggravate TMD symptoms

Question 23

What are the two types of relaxation therapy?

Answer 23

substitutive
active relaxation

Question 24

Name 4 disorders that may activated the Autonomic Nervous System…how do these contribute to TMD?

Answer 24

-Irritable Bowel Syndrome
-Premenstrual Syndrome
-Intestinal Cystitis
-Fibromyalgia

Greater levels of emotional stress = increased parafunctional activity in masticatory system/muscle hyperactivity –> TMD

Question 25

Name some diseases that make patient's cases more challenging

Answer 25

-ocd -ptsd -those suffering from phys/sex abused -depression

Question 26

What is substitutive relaxation therapy?

Answer 26

- a *substitution* for stressful events or an interposition between them (activities they enjoy, regular exercise)

Question 27

What is active relaxation therapy?

Answer 27

- therapy that *directly reduces muscle activity* (relax symptomatic muscles, biofeedback, negative biofeedback)

Question 28

When high levels of emotional stress in a pt's life are suspected as an etiologic factor contributing to a disorder, ____should be initiated

Answer 28

Stress Reduction Therapy

Question 29

An effective way to start a stress reduction therapy is _______________

Answer 29

to establish a positive doctor-patient relationship

Question 30

What should you present as a factor for TMD treatment early in the treatment plan?

Answer 30

Present stress as a factor so the pt can appreciate the relationship between pain, emotional stress, and dental procedures that may be offered --it is helpful to provide written info and instructions the pt can take home, read, and more fully appreciate

Question 31

Should you use definitive treatment in the case of macrotrauma?

Answer 31

NO, it would be of little use since the trauma is no longer present ## Footnote ex: Pt was in a car crash 5 years ago

Question 32

Should you use definitive treatment in the case of microtrauma?

Answer 32

Yes, it is necessary to stop the trauma (develop orthopedic stability) --there is no correlation between the amount of bruxing activity and pain ## Footnote microtrauma=keeps happening

Question 33

# Definitive Therapy Considerations for Trauma-- Patient education on TMD should begin by informing them that:

Answer 33

the teeth should only contact during chewing, speaking, and swallowing

Question 34

# Definitive Therapy Considerations for Trauma-- What is nocturnal bruxism? What factors influence it? Can any treatment help it?

Answer 34

--involuntary grinding or clenching of teeth during sleep --influenced by factors such as emotional stress levels and sleep paterns --sometimes can be reduced with occlusal appliance therapy

Question 35

Is Supportive Therapy a suitable replacement for Definitive Therapy?

Answer 35

NO! ## Footnote ONLY symptomatic and NOT replacement for definitive therapy

Question 36

What are the two types of supportive therapy?

Answer 36

- pharmacological therapy - physical therapy

Question 37

# Supportive Therapy Types: pharmacological therapy What are the most common types of pharmacologic agents used in management of TMD?

Answer 37

- analgesics - antiinflammatories - muscle relaxants - anxylotics - antidepressants - anticonvulsives

Question 38

# Supportive Therapy Types: What is physical therapy?

Answer 38

group of supported activites that is instituted *in conjuction with definitive treatment*

Question 39

What are the types of physical therapy for TMD?

Answer 39

- thermotherapy - coolant therapy - ultrasound therapy - electrogalvanic therapy - transcutaneous electrical nerve stimulation (TENS) - manual techniques - muscle conditioning - assisted muscle stretching - acupuncture

Question 40

# Supportive Therapy Types: Modalities of Physical Therapy --Heat is the prime mechanism --based on the premise that it increased circulation to the applied area

Answer 40

Thermotherapy

Question 41

# Supportive Therapy Types: Modalities of Physical Therapy -cold encourages the relaxation of muscles that are in spasm --> relieves pain --ice should NOT be left on the tissues for longer than **5 to 7 Minutes** (can burn skin)

Answer 41

Coolant Therapy

Question 42

# Supportive Therapy Types: Modalities of Physical Therapy -method of producing an increase in temp at the interface of of the tissues and therefore affects DEEPER tissues than does surface heat (vasodilation= inc blood flow) -it has been suggested that it be used in conjunction with surface heat, esp when **treating a post trauma patient**

Answer 42

Ultrasound Therapy

Question 43

# Supportive Therapy Types: Modalities of Physical Therapy -utilizes the principle that an electric current will cause a muscle to contract -a rhythmic electrical impulse is applied to the muscle, creating repeated involuntary contractions and relaxations

Answer 43

Electrogalvanic Therapy

Question 44

# Supportive Therapy Types: Modalities of Physical Therapy -continuous stimulation of cutaneous nerve fibers at a sub-painful level -uses a low voltage, low amperage current of varied frequency

Answer 44

transcutaneous electrical nerve stimulation (TENS)

Question 45

# Supportive Therapy Types: Modalities of Physical Therapy Two Types of Manual Techniques:

Answer 45

1) Soft tissue mobilization 2) Joint Mobilization

Question 46

# Supportive Therapy Types: Physical Therapy--Manual techniques Soft Tissue Mobilization

Answer 46

Superficial and deep massage

Question 47

# Supportive Therapy Types: Physical Therapy--Manual techniques Joint Mobilization

Answer 47

Gentle distraction of the joint

Question 48

# Supportive Therapy Types: Physical Therapy Exercises that can help restore normal function and range of movement

Answer 48

Muscle Conditioning ## Footnote ex: PT can't open wide..work into it little by little

Question 49

# Supportive Therapy Types: Physical Therapy --Used when there is a need to regain muscle *length* --should never be sudden or forceful

Answer 49

Assisted Muscle Stretching

Question 50

# Supportive Therapy Types: Physical Therapy Stimulation of certain areas that *cause release of endogenous opioids* which reduces painful sensations

Answer 50

acupuncture