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Mandible > Temporomandibular Disorders > Flashcards

Temporomandibular Disorders Flashcards

1
Q

Temporomandibular disorders (TMDs)

A

Set of MSK d/o affecting TMJ, masticatory muscles, or both
Many diverse Dx w/ similar S/Sx
3-7% of population need Tx
M/c in women of childbearing age bc of role of estrogen
Etiology: multifactorial (genetic, trauma, stress)
Types: Articular and Muscle d/o’s
Tx: eliminate pain and restore fnc

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2
Q

Controversial causes of TMD

A

Bruxism (Grinding of teeth during sleep)
Whiplash (may be referred pain from SCM)
Disc displacement (most are Asx)

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3
Q

Presentation of TMDs

A

M/c complaints: jaw, face, head pain
Limited opening, catching/sticking, locking
Joint noises (clicking, popping, grating)
Global HA and neck and shoulder pain
Unexplained c/o tinnitus, ear fullness, hearing loss, and dizziness
C/o abnl tooth wear, tooth sensitivity, and teeth not meeting correctly

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4
Q

When to image for TMD

A

Abnl pain, dysfnc, or both not responsive to conservative short term Tx like NSAIDs and PT
Sudden change in bite or asymmetry of mandible

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5
Q

Tx of TMD

A 
Conservative: self care, meds, PT
Ultrasound (provides deep heat)
TENS (Transcutaneous electrical nerve stimulation)
Acupuncture
Biofeedback
Orthotic splint
Arthrocentesis, Arthroscopy
Surgery in < 5%
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6
Q

20 self care tips for TMD

A

The rest of muscles & joints allow healing
Soft food enable m&j to heal
Not chewing gum lessens m fatigue & j pain
Relax your facial muscles (lips relaxed, teeth apart)
No clenching; it irritates j & m
Yawning against pressure prevents locking open and j pain
Moist heat for 20 mins promotes healing and relaxation
Ice is for severe pain and new injuries (< 72 hrs)
Heat and ice (5 sec heat, 5 sec ice) for pain relief
Good posture; avoid head forward position
Sleeping position: side lying, good pillow support
Jaw exercise: open and close against finger pressure
Exercise: 20-30 mins, >= 3x/wk
Acupressure massage b/w thumb and forefinger
OTC meds: ibuprofen, ASA
Yoga and meds for stress reduction
Massage promotes healing and relaxation
Athletic mouthguard can give temporary relief
Avoid long dental appts
Don’t cradle phone; aggravates neck and jaw

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7
Q

Medications for TMD

A
  1. NSAIDs
  2. Muscle relaxants: flexeril (cyclobenzaprine)
  3. Low dose (10-50 mg) of TCAs (amitriptyline)
  4. Medrol dose pack for non-responding TMJ synovitis
  5. Opioids for chronic pain
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8
Q

PT for TMD

A

Heat and ice for pain
Jaw exercises to inc mobility, dec hypermobility, strengthen & coordinate muscles, & improve muscle endurance
Massage (inc blood flow, relaxation)
Posture

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9
Q

Splints for TMD Tx

A

Removable appliance usu made of acrylic plastic that fits over mandib or max teeth
Most often prescribed Tx for TMD
Should be used as adjunctive Rx
Varying levels of efficacy
Reduce role of occlusal factors, reduce load on joints, strong placebo effect
Reduce tooth damage
Complications: irreversible changes in occlusion esp if worn for prolonged periods

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10
Q

Arthrocentesis for TMD

A

Insertion of needle into superior joint space
Irrigate w/ saline +/- steroids
Effective in synovitis and limited opening due to anterior displaced disc w/o reduction

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11
Q

Surgery for TMD

A

Reserved for those who fail conservative Tx and have an identifiable structural defect correctable w/ surgery
All contributing factors must be addressed and controlled or the surg will fail
Pre and post-op PT is imp
Less invasive is just as efficacious

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12
Q

Types of Articular TMD’s

A 
TMJ synovitis
Disc displacement w/ reduction
Acute disc displacement w/o reduction
Chronic disc displacement w/o reduction
OA
Polyarthritides
Condylar dislocation
Fibrous ankylosis
Bony ankylosis
Condylar Fx
Neoplasia
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13
Q

TMJ synovitis

A

Inflam of synovial lining of TMJ
Localized pain inc w/ fnc and loading of TMJ
May c/o that post teeth not meeting on same side 2/2 TMJ swelling
TTP over condyle
Limited ROM (< 35 mm)
No xray changes; effusion on MRI
Tx: self-care, NSAIDs, PT, splint, acupuncture, arthrocentesis

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14
Q

Disc displacement with reduction

A

Ch by clicking jaw joint (audible or palpable)
50% of ppl have, most no pain so no Tx
Sx clicking (pain on clicking and loading) needs to be treated: self-care, NSAIDs, PT, splint, acupuncture, arthrocentesis
MRI shows anterior position of disc in a closed position and nl position when open
Pain is likely due to inflam of joint owing to the condyle pressing on retrodiscal tissues, synovitis, or capsulitis

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15
Q

Acute disc displacement w/o reduction

A

Closed lock
Marked limitation in opening (< 35mm)
Deflection of mandible to affected side on opening jaw
Sudden onset, painful or painless
No clicking felt/heard (although may have h/o clicking at one time)
Disc is ant to condyle blocking translation and opening of jaw
MRI: disc is ant to condyle in closed and open position
Tx: self-care, NSAIDs, PT, splint, acupuncture, arthrocentesis

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16
Q

Chronic disc displacement w/o reduction

A

Closed lock
Slightly limited opening (<40mm)
No clicking
+/- pain
Mandible deflects to affected side on opening
MRI: disc is ant often folded on self and pushed further ant on opening jaw
Tx: self-care, NSAIDs, PT, splint, acupuncture, arthrocentesis

17
Q

Osteoarthritis of TMJ

A 
Noninflammatory arthritic condition
Deterioration and abrasion of articular tissues
Remodeling of subchondral bone
Joint pain, crepitus
Joint stiffness often worse on awakening
Limited ROM
X-ray: degeneration of condyles
Synovitis often is present --> pain
Tx: self-care, NSAIDs, PT, splint, acupuncture, arthrocentesis
18
Q

Polyarthritides

A

Systemic polyarthritic d/o can affect TMJ (RA, JRA, AS, psoriatic arthritis, Reiter, infectious arthritis, gout, lyme dz)
TTP over TMJ
Pain w/ fnc
Limited ROM
Crepitus
Degeneration of condyles seen on xray
Tx: self-care, NSAIDs, PT, splint, acupuncture, arthrocentesis

19
Q

Condylar dislocation

A

Unable to close mouth; mouth fully open
Usu after yawn, eating w/ wide open mouth, after dental appt
Condyle is ant to the eminence
Tx: Manual in-office reduction using gloved thumb outside pt’s teeth, on the lateral border of mandible and distracting the mandible in a downward direction placing condyles back into fossa (may need muscle relaxant if spasm)
Post-op self-care, NSAIDs, and PT

20
Q

Fibrous ankylosis

A

Restricted mandibular mvmt w/ deviation to affected side on opening
2/2 fibrous adhesions attaching condyle to disc and disc to articular fossa
May be caused by bleeding into joint
H/o trauma to TMJ common
Marked limited opening (< 20 mm)
Not painful
Marked limited lateral mvmt to CONTRA side
Xr: absence of condylar translation
Tx: PT, arthrocentesis, surgery

21
Q

Bony ankylosis

A

Union of bones of mandib condyle & temporal fossa
Complete joint immobility
2/2 trauma and bleeding into joint
Marked limited opening (< 10 mm)
Not painful
Maked limited lateral mvmt to CONTRA
CT/MRI: connection b/w bony articulating surfaces
XR: absence of condylar translation and bone proliferation into joint space
Tx: PT, Arthrocentesis, Surgery

22
Q

Condylar Fx

A 
2/2 trauma
Limited opening (< 25 mm)
Swelling
Pain w/ fnc
Bleeding into joint --> sequela: adhesions, ankylosis, joint degeneration
Mandible deflects to affected side
Tx: Immobilization (MMF), soft diet, PT
Open joint surgery rarely needed
23
Q

Benign TMJ neoplasms

A 
Osteomas
Osteoblastomas
Chondromas
Benign giant cell tumors
Ossifying fibroma
Fibrous dysplasia
Myxoma
Synovial chondromatosis
24
Q

Malignant TMJ neoplasms

A

Rare
Chondrosarcomas
Fibrosarcomas
Synovial sarcomas

25
Q

Metastatic neoplasms to the TMJ

A 
M/c than primary tumors
1% of malignant neoplasms met to jaw
SCC of maxillofacial region
NP tumors
Parotid neoplasms
26
Q

Neoplasms of the masticatory muscles

A

Very rare
Malig or benign
Swelling +/- pain
Imaging and Bx

27
Q

Myofascial pain

A

Ch by regional, dull, aching muscle pain
Mild to mod
Aggravated by mandibular fnc
Often localized tender areas (trigger points)
Can refer pain as HA (tension type HA)
A/w tinnitus, vertigo, tooth ache
Sensation of muscle stiffness or tightness and teeth not meeting correctly
Inactivating the trigger points w/ local anesthesia, acupuncture, or a vapocoolant spray and muscle stretch often relieves the larger area of referred pain
Pathogenesis: changes in CNS responsible for hyperalgesia of the muscles
Tx: self-care, NSAIDs, PT, muscle relaxants, splint, acupuncture

28
Q

Myositis

A

Mod-severe pain that increases w/ mvmt
Redness
Swelling
2/2 direct trauma or infxn (s/p oral surgery)
Limited range of mandibular motion
Inc serum markers of inflam/infxn
Tx: self-care, NSAIDs, PT, muscle relaxants, splint, acupuncture

29
Q

Myospasm (Trismus)

A 
Muscle cramp
Continuous involuntary contraction
Severe pain at rest and w/ mvmt
Not a common finding in TMDs
Usu resolves w/in hrs
Tx: self-care, NSAIDs, PT, muscle relaxants, splint, acupuncture
30
Q

Contracture

A

Painless shortening of a muscle usu 2/2 period of limited ROM
Ch by unyielding firmness on passive stretch
Seen after wired jaws, jaw surgery, prolonged infxn, or w/ ant displaced disc w/o reduction that limits ROM for some time
Muscle undergoes fibrotic change and becomes hard
Tx: self-care, PT, splint, acupuncture

31
Q

Fibromyalgia

A

Generalized whole body muscle pain
Females 25-50 yo
Accompanied by fatigue, IBS, muscle stiffness, & sleep difficulties
Dx: TTP in 11 of 18 defined sites and pain in 3 of 4 body quadrants
20% of pts w/ “TMD” are really fibromyalgia
Tx: Self-care, PT, muscle relaxant, acupuncture

Mandible (3 decks)

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