OS - TMD Flashcards
(54 cards)
Name the origin (2) & Insertion (1) of the Masseter
origin x2
– zygomatic arch
- another origin on the underside of the zygomatic arch
insertion – angle of the mandible
Name the origin (1) & Insertion (1) of the Temporalis
Origin – temporal fossa
Insertion - Coronoid process (can extend down the anterior body of the ramus)
Name the origin (1) & Insertion (1) of the Medial Pterygoid
Origin – medial surface of lateral pterygoid plate
Insertion – medial side of the angle of the mandible (opposite to the masseter)
Name the origin (2) & Insertion (1) of the Lateral pterygoid
Origin 1 – Base of the skull
Origin 2 – lateral surface of the lateral ptergoid plate
Insertion – pterygoid fovea and some fibres extend into the capsule of the TMJ
What supplies the blood to the TMJ?
Deep auricular artery (branch of 1st part of the maxillary artery)
What supplies the innervation to the TMJ? (3)
auriculotemporal, masseteric, posterior (deep) temporal nerve
Why can patients with TMJ pain also experience discomfort in the ear?
as the auriculotemporal nerve also provides sensation to the external auditory meatus
List the 4 suprahyoid muscles (accessory MoM)
– Digastric
– Mylohyoid
– Geniohyoid
– Stylohyoid
List the 4 infrahyoid muscles (accessory MoM)
– Thyrohyoid
– Sternohyoid
– Omohyoid
– sternothyroid
How does TMJ pain arise and why?
when the articular disc slips forward the bilaminar area of the articular disc gets compressed by the condyle
- the bilaminar area has the nerve innervation
What are the causes of TMJ pain? (8)
- Myofascial pain (common)
- Disc displacement (common)
- Degenerative disease (less common)
- Chronic recurrent dislocation
- Ankylosis – condyle fused to the base of the skull (most people have a psudoankylosis)
- Hyperplasia – one condyle grows more than the other (can be bilateral but not as common)
- Neoplasia
- Infection – can result in ankylosis
What are the causes of myofacial (muscle) pain? (5)
- Inflammation secondary to parafunctional habits
- Trauma, either directly to the joint or indirectly
- Stress (muscles tense and px clench teeth)
- Psychogenic
- Occlusal abnormalities - although a restoration that is significantly “high” may cause muscle pain due to posturing
How do we identify a possible arthritic change in the TMJ?
Crepitus (crunching) during E/O TMJ assessment
What are intra-oral signs of parafucntional habits? (5)
- Cheek biting (morsicatio buccarum)
- Linea alba
- Tongue scalloping
- Occlusal non-carious tooth surface loss (toothwear)
- Hypertrophic muscles of mastication
What patients are most commonly affected by TMD (age and sex)?
Females
18-30
How do patients with TMD usually present? (5)
- Intermittent pain of several months or years duration
- Muscle / joint / ear pain, particularly on wakening
- Trismus / locking
- ‘Clicking/popping’ joint noises
- Headaches
What are other possible causes of similar symptoms? (11)
- Dental pain
- Sinusitis
- Ear pathology
- Salivary gland pathology
- Referred neck pain
- Headache
- Atypical facial pain (common in post menopausal women)
- Trigeminal neuralgia
- Angina – area of skin near the angle of the mandible is supplied by the same nerve as the heart
- Condylar fracture – hx of trauma
- Temporal arteritis
How do we treat TMD? 4 general Reversible options
Counselling
medication
Physical therapy
splints
What is involved in counselling of a TMD patient? (9)
- Reassurance
- Soft diet
- Masticate bilaterally
- No wide opening
- No chewing gum
- Don’t incise foods
- Cut food into small pieces
- Stop parafunctional habits e.g. nail biting, grinding
- Support mouth on opening e.g. yawning
What medications are used to manage TMD? (5)
- NSAIDs
- Muscle relaxants
- Tricyclic antidepressants (have muscle relaxant properties)
- Botox of masseter = prevents clenching (last resort tx)
- Steroids
What is involved in physical therapy of a TMD patient? (7)
- Physiotherapy
- Massage/heat
- Acupuncture
- Relaxation
- Ultrasound therapy (not used as much)
- TENS (Transcutaneous Electronic Nerve Stimulation)
- Hypnotherapy and CBT
What splints are used to manage a TMD patient? (2)
- Bite raising appliances
- Anterior repositioning splint e.g. wenvac or Michigan splint
How do bite raising appliances work? (2)
They stabilize the occlusion and improve the function of the masticatory muscles, thereby decreasing abnormal activity.
They also protect the teeth in cases of tooth grinding
What is the requirement for splints?
Must cover all of the teeth
