The Orofacial Pain Examination Flashcards
The Pain History: Subjective
(5)
- CC (Patient’s Chief PAIN Complaint) –
treatment? IN THE PATIENT’S OWN WORDS - HPI (History of Present Illness)
- PMHx (Past Medical History) that is pertinent to PAIN CONDITION –
- Psych/Soc (Psychosocial History)-
- ROS (Review of Medical Systems)-
- CC (Patient’s Chief PAIN Complaint) –
why is patient seeking
treatment? IN THE PATIENT’S OWN WORDS
- HPI (History of Present Illness)
Facial Pain (location, chronicity,
quality, frequency, duration, triggers, modifying factors),
associated trauma, and Habits- NOT MEDICAL HISTORY
- PMHx (Past Medical History) that is pertinent to PAIN CONDITION – (2)
surgical history, medications
- Psych/Soc (Psychosocial History)- (2)
anxiety, depression
skipped
5. ROS (Review of Medical Systems)-
includes an assessment of
appetite, sleep patterns, activity levels, energy levels, headache
history, ear, eye, sinus problems, jaw dysfunction including
noises, locking history, cervical dysfunction and pain, back pain,
lung, heart, GI, GU, Liver, Kidney problems, neurological and
other musculoskeletal problems.
Is there arthritis, fibromyalgia, migraines that may contribute or cause the pain
skipped
Screening Questions for TMD
Ask your patient if she/he experiences:
(10)
- Difficulty &/or pain with mouth opening
- Jaw locking, sticking or the jaw going out of joint
- Pain with chewing, talking or using jaw
- Jaw joint noises
- Stiffness, tightness or tiredness in the jaw
- Pain in or near the ears, temples, or cheeks
- Frequent headaches, neck aches or toothaches
- Recent changes in your bite
- Recent injury to the jaw, neck or head
- Past treatment for facial pain or a jaw joint problem
Comprehensive History for
Orofacial Pain
If the patient responded positively to any of the screening
questions, it may require a …
Your decision as a dentist to complete a TMD comprehensive
exam should be based on the
comprehensive history and clinical
TMD examination
patient’s level of concern and
clinically significant findings from your oral exam and
extraoral exam
HPI (History of Present
Illness):
(5)
Date of Onset of Pain
Pain Problem (i.e. Facial pain, toothache)
Pain Location (ask pt to point, i.e. Left TMJ)
Pain Quality
Pain Severity
HPI (History of Present
Illness):
(6)
Duration of pain
Frequency of pain
Variability: continuous or intermittent (ask pt if pain
is there every minute all day long or does it
come and go); is pain spontaneous or
triggered
Habits- clenching, biting on lips/cheeks, pens,
fingernails, chewing gum
Aggravating and ameliorating factors
24 hour variation (i.e. worse on awakening
or during day)
HPI (History of Present
Illness):
(4)
Joint noises
Jaw locking vs catching (“sticky disc”)
Past Treatment (i.e. medications, physical therapy,
nightguard and effectiveness)
Current Treatment (i.e. nightguard (soft or hard),
medication (dosing) and is it helpful)
skipped
TMD Consult
Needed if patient has:
(7)
Limited mouth opening < 35mm
Clicking, popping or grinding
noises in TMJ with PAIN
Change in occlusion
Masticatory Muscle pain
TMJ pain or locking
Abnormal pain in face, teeth or
headache esp. following
extraction, RCT, surgery or
implant
Panorex shows degenerative
changes on TMJ, Fracture or other
abnormality
Range of Motion
Normal Opening:
Normal R./L. Lateral:
Note pain — with all
movements
With passive stretch, note …
Feel the TMJ’s on opening. Do they
both —?
40-60mm
9-12 mm
location
“end feel” – is it soft or hard?
translate
Maximum Pain Free Opening
Maximum Pain Free Opening =
20mm
+ overbite
Maximum Unassisted Opening:
ask pt to open as wide as they can
even if painful
41mm + overbite
