Intro to TMD's Flashcards
(94 cards)
1
Q
What are TMD’s
A
Group of unreleated disease states with a common set of symptosm
2
Q
what are the common set of symptoms form TMD
A
Pain and jaw dysfunction
3
Q
why do dentist care about TMD
A
Patients may have a TMD
used to be treated by dentist in past
Dental health related to jaw
TMJ surgery remains under ORal maxofilogical surgery
4
Q
2 types of TMD’s
A
Extracapsular (non-joint related, usually muscaular)
Joint related
5
Q
what is true TMJ disease
A
Joint related TMD
6
Q
is all jaw pain/dysfunction TMD
A
No
7
Q
other sources of jaw pain/dysfunction
A
Neuralgias
Headache
Neurological/neuromuscular disease
Coronary artery disease
8
Q
what do we tend to mix symptoms with
A
mix symptoms such as muscle pain with diagnosis such as myofascial pain
9
Q
what do we confer causation on
A
structural appearance (i.e disc is the center of the TMJ universe)
10
Q
what are some misconceptions about TMS
A
assumption about causes
association with craizness
Mystery
11
Q
How does one deal with TMD’s
A
manageing the problem
12
Q
are TMD patients male or female
A
Most are female
13
Q
what often comes along with TMD
A
most have concomitant depression, anxiety, firbomyalgia, irritable bowel syndrom…
14
Q
treatment succes of TMD
A
some have very difficult problems and a few wont ever get well
15
Q
what is pain
A
An unpleasant sensory and emotion experience associated with actual or potential tissue damage, or described in terms of such damage
16
Q
what does pain include
A
an experience and knowing that it was bad
17
Q
How to define pain clinicaly
A
Location of symptom intensity of symptom (1-10) qualitiy of symptom (burning...) Onset of symptom + precipitat.ing factors Radiationof symptoms (show me where) associated symtpoms (sound...) Alleviating factors (avoid jaw function) Aggravating factors (singing.... which pain do you mean when you \_\_\_\_\_ [ what pain happens does it hurt before getting out of bed...
18
Q
how will a patient show well localized pain
A
one finger pointing
19
Q
how will a patient show ill-defined pain
A
moves fingers/palm across cheek and temple
20
Q
well localized pain is a symptom of what type of TMD
A
Joint pain
21
Q
Ill definied pain is a symptom of what type of TMD
A
Muscle pain
22
Q
masticatory muscle disorders from most common to least common
A
Local myalgia Myofascial pain Centrally mediated myalgia myospasm Myositis Myofibrotic contracture masticatory muscle neoplasia
23
Q
symptoms of local myalgia
A
stiff
sore
achy
cramp with chewing, opening wide, or awakening
24
Q
Causes of local myalgia
A
Ischemia Bruxism Fatigue Splinting delayed-onset muscle soreness
25
Diagnostic findings for local myalgia
Regional dull ache with function
No or minimal pain at rest
Local tenderness to palpation
absence of trigger points and pain referal patterns
26
Symptoms of Myofascial pain
Region dull, aching pain
Trigger points
OVerlap with tension-type headache
27
causes of myofascial pain
Not well understood
28
Diagnostic findings of myofascial pain
regional pain aggravated by function
trigger point palpation causes wider area pain with predictable referral
reduction of pain with trigger point treatment
soft end feel with stretch
29
what is splinting
when pain in a joint, muscles stiffen up to hold the joint
30
what is soft end feel
at end of stretch, can keep going but with pain
31
what is a trigger point
a sensitive palpable nodule within the body of muscle
32
what may associate with trigger points
A taut band strand of contracted muscle
33
do we all agree trigger points exist
contraversial due to histo not showing anything
| - may have high local levels of pain mediators
34
what can pressure to trigger points do
Cause pain referral in predictable patterns
35
how to treat trigger points
Injection (local anesthetic, corticosteroid, saline)
Dry needling
spray and stretch (Capocoolant spray)
36
symptoms of centrally mediated myalgia
Chronic, cont muscle pain
| no clinical inflammation
37
Causes of central mediated myalgia
Prolonged nociceptive input
chronic autonomic upregulation
stress
other deep pain input
38
Diagnostic finds of Centrally mediated myalgia
Prolonged, Cont. pain by history`
Dull ache at rest
Aggravated by function and palpation
may have trigger points
39
symptoms of myospas
Sudden involuntary tonic contracture
fasciculation
Cramping/tight feel
40
Causes of myospasm
Ischemia
Neuromuscular disease
Hypokalemia
41
Diagnostic findings fro myospsm
Acute onset of pain in function and rest
MArkedly reduced ROMO
increases EMG activiety
42
what is Spasticity
cramp up of muscle to feel tightness and pain
43
symptoms of myositis
Clinical inflammation over entire muscle
44
CAuses of myositis
Direct trauma
| Spreading infection
45
Diagnostic findings of myositis
```
PAin is continous
Diffuse tenderness
warmth
Edema
Moderate to severely limited ROM
```
46
Symptoms of myofibrotic contracture
Shortened muscle
| Painless unless stretch
47
Causes of myofibrotic contracture
Long immobilization
| infection or trauma causing fibrosis
48
Diagnostic findings of myofirotic contracture
Limited ROM
Unyielding stop (hard end feel)
little or no pain
49
symptoms of masticatory muscle neoplasia
Intramuscular swelling with or without pain
| limited movement
50
Causes of masticatory muscle neoplasia
intramuscular neoplasm
Benign or malignant
Primary of metastatic
51
Diagnostic findings of masticatory muscle neoplasia
Swelling
trismus
Paresthesia
Variable pain
52
what makes up the TMJ
```
Temporal bone
Mandible
Fibrous capsul
Lateral pterygoid msucle attachments
Interpositional fibrocarilage disk
```
53
what parts of the temporal bone are invovled in the TMJ
tympanic plate posterior
Glenoid (articular) fossa
Articular eminence
54
what part of the mandible is invovled in the TMJ
mandibular condyle
55
what binds the articular disk lateral and medialy
tightly bound to condyle laterally and medially
56
how does the Disk attach to the posterior wall
Loose retrodiscall attachment
57
what attaches the disk anterior and posteior
Loose conenctive tissue
58
what lines the anterior and posterior recesses of the TMJ
synovium lining
59
can the disk heal itself
Yes
60
is the articular disk a meniscus
No
61
roll of the retrodiscal zone
All the condyle to move forward by preventing a suction effect
62
How far can the TMJ rotate
20mm
63
how far can the TMJ translate
40-50mm
64
how far can the TMJ move laterally
Contralateral 7-10mm
65
what does protrusion do to the TMJ
translates both joints
66
where is the disk when the mouth is closed
On the back surface of the articular emienence on top of the condyl
67
where is the disk when the mouth is open
On top the condyl and underthe articular eminence
68
how common is anterior disc displacement
Very common (12-45% of people)
69
symptoms of anterior disc displacement
Frequenctly asymptomatic
70
pathology for Anterior disc displacment
Most agree not a pathological condition
some say class II malocclusion may be caused by ADD
all agree that ADD can become patholgy in some individuals
71
what id the noticiable differnec with an anterior displaced sidk
MAkes an audible pop with condyl snapping below it
72
possible problem with ADD
disc may obstrucut movement
| pop does no occur and joint becomes locked
73
are all displaced disc the same
No
74
how can displaced disks be classified
Based on clinical and radiographic findings
75
what happens to most people with Displaced discs
few jionts progress to the next stage
| Most adapt and heal
76
what happens if ADD doesn't heal
Degenerative changes in articular surface and bone
77
what is the degernation of articular surfaces and bone
Osteoarthrosis
78
is TMJ Disease mechanical
Not always, incomplete and inaccurate, must also include inflammatory preocesses
79
what are the pathways to osteoarthrosis
```
Inflmmation
endocrine
MEtabolic
Development
Biomech
```
80
how well do we undertsand arthralgia
Etiology is not well understood
81
what we know for why arthralgia happens
systemic factors influence disease cource in several, with little clincial predcitve value
82
What articular tissues can change
aritulcar fibrocartialge surfaces
Disc
Bone
83
how can mobility be impaired
```
Adhesions
Adhesive hypomobility (suction cup effect)
```
84
what are some of the things that can be patholgoical affected tissue
Articualr tissues
| Synovium
85
How does the articular surface degrade under pathology
softening
Vascularization
Fibrillation
bone exposure
86
Synovial pathology steps
```
Hypertrophy
Hyperemia
Capillary dilation
Microbleeding
GRanulation, fibrosis
```
87
adhesion types for pathogy
Light, filmy
Fibrous bands
Pseudowall
88
Disk patholgy
Neovascularization
Fibrillation
Perforation
89
Consequences of Hypomobility
Reduced disc movement
Reduced mandibular movement
Poor synovial fluid circulation
Declining joint health and function
90
what does poor synovial fluid circulation lead to
Focal hypoxia
Impaired nutrition
Increased friction
91
what does declining joint health and functino lead to
Inflammation
| degeneration becomes self-sustaining
92
treating pathology should have what characteristics
based on scientific validated diagnositic eval
Non-invasive
Reverse
93
Common initial tratment to TMD
couseling
Anti-inflammtion
Occclusal orthootic (not jaw position and occlusion altering
Physical therapy
94
what is done when non-surgical treatment fails fro intracapsular disease
do the least invasive surgical option likely to succeed
