Temporomandibular Disorder

Question 1

What are the causes of TMD?

Answer 1

• myofascial pain
• disc displacement (anterior with/without reduction)
• degenerative disease (osteoarthritis, rheumatoid arthritis)
• ankylosis
• hyperplasia
• neoplasia
• infection
• chronic recurrent dislocation

Question 2

what is the pathogenesis of TMD?

Answer 2

• inflammation of MoM or TMJ secondary to parafunctional habits
• trauma - either directly or indirectly (prolonged mouth opening)
• stress

Question 3

what are intraoral signs of parafunctional habits?

Answer 3

• cheek biting
• linea alba
• tongue scalloping
• occlusal non-carious tooth surface loss

Question 4

what are common clinical features of TMD?

Answer 4

• females > males
• age (most common 18-30)
• Intermittent pain, several months or years long
• Muscle/joint/ear pain
• trismus/locking
• clicking/popping joint noises
• headache
• crepitus indicates late degenerative changes

Question 5

what other conditions does TMD have similar clinical features as?

Answer 5

• dental pain
• sinusitis
• ear pathology
• Salivary gland pathology
• Trigeminal neuralgia
• atypical facial pain
• headache
• condylar fracture
• temporal arteritis

Question 6

what are the tx options in regards to educating the pt on TMD?

Answer 6

• counselling (reassure, soft diet, no wide opening, stop parafunctional habits)
• jaw exercises/physio

Question 7

what are medication options in regards to TMD?

Answer 7

• NSAIDs
• muscle relaxants
• tricyclic antidepressants
• steroids?

Question 8

what appliance can be given for TMD?

Answer 8

Bite raising appliance

Question 9

what is internal derangement TMD?

Answer 9

TMD where the condyle head has to overcome the mechanical obstruction before full joint movement can be achieved

(can cause pain, and cause clicking)

Question 10

what is anterior disc displacement with reduction?
+ signs/symptoms

Answer 10

• most common cause of TMJ clicking
• disc initially DISPLACED anteriorly by condyle head during opening until disc reduction occurs

Signs/symptoms:
- jaw tightness/locking (until disc reduces)
- mandible may deviate to affected side before returning to midline

Question 11

what are some ways you can get trismus?

Answer 11

• IDB
• Prolonged dental tx
• infection

Question 12

how can you treat more serious trismus that hasnt improved on its own?

Answer 12

• physiotherapy
• therabite
• jaw screw (opening mouth gradually)