Temporomandibular Disorders

Question 1

what is pain?

Answer 1

An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage

Question 2

what is orofacial pain?

Answer 2

refers to pain associated with the hard and soft tissues of the head, face, and neck.

Question 3

orofacial pain is caused by

Answer 3

• Diseases or disorders of regional structures
• Dysfunction of the nervous system
• Through referral from distant sources

Question 4

Orofacial Pain Includes:

Answer 4

▪ Musculoskeletal: Myogenous and Arthrogenous TMD
✓Myalgia, Arthralgia (TMJ)
▪ Neuropathic orofacial pain disorders: Neuralgia, neuropathy, orofacial movement disorders
✓Dyskinesias and dystonias
▪ Neurovascular orofacial pain disorders: various headache disorders
✓Migraine, Trigeminal Autonomic Cephalgias (TACs)
▪ Pain of nonorganic etiologies: Somatic Symptom Disorder

Question 5

the TMJ is what type of joint?

Answer 5

Ginglymoarthrodial Joint

Question 6

innervation of the TMJ area

Answer 6

Auriculotemporal nerve (branch of V3), deep temporal and masseteric nerves

Question 7

vascuclar supply of the TMJ area?

Answer 7

Superficial temporal artery (external
carotid artery), internal maxillary artery and middle meningeal artery

Question 8

muscles of the head neck and face

Answer 8

• Masseter
• Temporalis
• Medial pterygoid
• Lateral pterygoid
• Digastric
• Suprahhyoids
• Infrahyoids
  *sternocleidomastoid

Question 9

Masseter

Answer 9

Elevates the mandible, providing force for chewing

Question 10

Temporalis

Answer 10

Elevates and retracts the mandible

Question 11

Medial Pterygoid

Answer 11

Elevates and protrudes the mandible

Question 12

Lateral Pterygoid (Inferior)

Answer 12

Causes mandibular protrusion; unilateral contraction moves the mandible to the opposite side

Question 13

Lateral Pterygoid (Superior)

Answer 13

Active during power stroke (chewing against resistance)

Question 14

Digastric

Answer 14

Depresses the mandible

Question 15

Sternocleidomastoid (SCM)

Answer 15

Contributes to head posture and may refer pain to the TMJ

Question 16

Trapezius

Answer 16

Upper back and shoulder muscle; often involved in TMD-related pain

Question 17

Temporomandibular disorders (TMDs)

Answer 17

encompass a group of musculoskeletal and neuromuscular conditions that involve the temporomandibular joints (TMJs), the masticatory muscles and all
associated tissues

Question 18

what is the prevalence of TMD?

Answer 18

13% for masticatory muscle pain and 16% for disc derangement disorders
- only 3.6-7% warrant treatment
- peak occurrence between 20-40 yrs old
- 2:1 women to men

Question 19

what is the Etiology that leads to TMD?

Answer 19

• Acute trauma
• Trauma from hyper-extension: dental procedures, oral intubation,
  whiplash injuries
• Parafunctional habits: daytime clenching, nocturnal bruxing, lip or
  cheek biting
• Postural imbalances
• Psychological factors: stress, anxiety, depression
• Systemic factors: rheumatoid arthritis, fibromyalgia, generalized joint laxity (hypermobility)

Question 20

occlusal factors more prevalent in TMD patients

Answer 20

• Large overjet
• Anterior skeletal open bite
• Unilateral posterior crossbite
• Lack of posterior tooth contacts

Question 21

Clinical Evaluation of TMD: History of Present Illness (HPI): Key questions to assess

Answer 21

When did symptoms start?
Any precipitating factors (e.g., trauma, dental work)?
Pain type, intensity, location, aggravating/alleviating factors?
Presence of joint noises (clicking, crepitus)?
Any jaw locking (open or closed)?
Any headaches, ear pain, neck pain?
Clenching or grinding history?
Mental health factors (stress, sleep disturbances, anxiety)?

Question 22

Physical Examination: TMJ Palpation

Answer 22

Check for tenderness, pain, and movement restrictions

Question 23

Physical Examination: Joint Sounds

Answer 23

• Clicking: often due to disc displacement with reduction
• Crepitation (grating sound): suggests osteoarthritis.

Question 24

Physical Examination: Muscle Palpation

Answer 24

Identify pain and trigger points in masseter, temporalis, and pterygoids

Question 25

Physical Examination: Cervical Exam

Answer 25

neck posture and pain can contribute to TMD

Question 26

Physical Examination: Occlusal Exam

Answer 26

Checking for abnormal tooth wear, bite changes, and tongue scalloping (a sign of bruxism).

Question 27

Acute malocclusion: sudden change in the ICP

Answer 27

* Muscle spasms * Intracapsular disorders such as disc displacement, capsulitis, acute bony alterations

Question 28

Disc Displacement with Reduction

Answer 28

Clicking or popping, but normal function

Question 29

Disc Displacement without Reduction

Answer 29

Jaw may lock, reducing opening, pain

Question 30

Dislocation (Luxation)

Answer 30

Jaw gets stuck in an open position Referred to as subluxation/ partial dislocation when mouth closing is achieved by patient without the help of a clinician

Question 31

Osteoarthritis (DJD)

Answer 31

Degenerative joint disease with joint deterioration and crepitus

Question 32

Masticatory Muscle Disorders: Local Myalgia

Answer 32

Pain localized to a specific muscle.

Question 33

Masticatory Muscle Disorders: Myofascial Pain

Answer 33

Pain spreads to nearby areas, often with trigger points.

Question 34

conservative treatment: homecare

Answer 34

Avoid wide jaw opening. No gum chewing. Apply warm compresses. Maintain good posture.

Question 35

conservative treatment: behavioral therapy

Answer 35

Reduce stress and modify habits.

Question 36

conservative treatment: physical therapy

Answer 36

Jaw and neck exercises.

Question 37

conservative treatment: Occlusal Appliances (Night Guards)

Answer 37

Protect teeth from grinding.

Question 38

Pharmacotherapy:

Answer 38

NSAIDs (e.g., ibuprofen) for pain relief. Muscle relaxants for severe cases. Antidepressants if stress is a major factor.

Question 39

Minimally Invasive Procedures

Answer 39

- Trigger Point Injections – Local anesthetic or Botox for muscle pain. - Arthrocentesis – Flushing the joint with fluid to remove inflammation. - Intra-Articular Injections – Steroid injections to reduce inflammation.

Question 40

Surgical Interventions (For Severe Cases)

Answer 40

- Arthroscopy – Minimally invasive joint surgery. - Arthroplasty – Reshaping the TMJ. - Total Joint Replacement – Used in end-stage arthritis.