Revision-Temporomandibular Disorders (TMD) and Orthodontic Treatment P1

Question 1

TMD etiology

Answer 1

TMD comprises a group of related disorders with multifactorial etiology including psychological , hormonal , genetic , traumatic , and occlusal factors .

• Research suggests that depression, stress, and sleep disorders are major factors in the etiology of TMD and that parafunctional activity can contribute to muscle pain and spasm .

Question 2

Orthofunction vs Pathofunction

Answer 2

Question 3

TMD may be associated with:

Answer 3

1. stressful habits
2. emotional disorders
3. structural malrelationships
4. trauma to the face or head
5. occlusal disharmonies
6. other medical problems

Question 4

TMD can be associated with:

Answer 4

1. headaches
2. non-painful muscle hypertrophy
3. abnormal occlusal wear
4. osseous alterations of the joints

Question 5

The most common clinical markers of TMD in the general population are:

Answer 5

1. limited range of mandibular motion
2. muscle and TMJ tenderness
3. TMJ sounds

Question 6

TMD can be divided into:

Answer 6

1. INTERNAL DERANGEMENTS OF THE DISC AND RELATED STRUCTURES
2. DISORDERS OF THE CHEWING MUSCLES
3. DEGENERATIVE JOINT AND BONE CONDITIONS
4. DEVELOPMENTAL ABNORMALITIES

Question 7

INTERNAL DERANGEMENTS OF THE DISC AND RELATED STRUCTURES

Answer 7

Sagittal view of the TMJ in a closed-mouth position

Question 8

INTERNAL DERANGEMENTS OF THE DISC AND RELATED STRUCTURES

Answer 8

Sagittal view of the TMJ in an open-mouth position

Question 9

INTERNAL DERANGEMENTS OF THE DISC AND RELATED STRUCTURES

Answer 9

Anterior disc displacement with reduction

Question 10

INTERNAL DERANGEMENTS OF THE DISC AND RELATED STRUCTURES

Answer 10

Anterior disc displacement without reduction

Question 11

INTERNAL DERANGEMENTS OF THE DISC AND RELATED STRUCTURES

Answer 11

Anteromedial disc displacement without reduction

Question 12

DISORDERS OF THE CHEWING MUSCLES

Which are the 4 paired muscles of mastication?

Answer 12

Question 13

DISORDERS OF THE CHEWING MUSCLES

Which muscle is shown?

Answer 13

The lateral pterygoid muscle

Question 14

DISORDERS OF THE CHEWING MUSCLES

Which muscles are shown?

Answer 14

Muscles of the suprahyoid region

Question 15

ETIOLOGICAL AND STRUCTURAL CLASSIFICATION OF MUSCULAR DISORDERS

Primary myofacial and muscle pain dysfunction

Answer 15

1. Myalgia due to localized acute muscular injury
2. Myalgia due to chronic sustaining parafunctional activity
3. Myalgia due to chronic sustaining postural factors

Question 16

ETIOLOGICAL AND STRUCTURAL CLASSIFICATION OF MUSCULAR DISORDERS

Secondary to internal TMJ derangement

Answer 16

1. Muscle tension
2. Muscle spasm/protective splinting
3. Muscle inflammation (myositis)
4. Myofascial pain and trigger points
5. Fibrosis/contracture
6. Atrophy

Question 17

consensus view regarding orthodontics and TMD

Answer 17

After considerable discussion in the literature, the consensus view is that orthodontic treatment , either alone or in combination with extractions, cannot be reliably shown to either “cause” or “cure” TMD .

Question 18

development of TMD & methods for prevention

Answer 18

1. The development of TMD cannot be predicted .
2. Once TMD is present, TMD cures cannot be assumed or assured .
3. No method of TMD prevention has been demonstrated.
4. TMD are primarily a pain management problem .

Question 19

Multiple strategies for controlling TMD pain:

Answer 19

1. teaching the patient how to reduce oral habits, stress and anxiety - biofeedback
2. applying physical therapy and exercises to restore function (neck, shoulders, TMJs)
3. using acetosalicylic acid or ibuprofen for their analgesic and anti-inflammatory effects
4. use of intraoral splints