TMD Flashcards

Question

11 differential diagnosis for TMD to rule out

Answer 1

* Dental pain * Sinusitis * Ear pathology * Salivary gland pathology * Referred neck pain * Headache * Atypical facial pain * Trigeminal neuralgia * Angina – small area of skin on boder of mandible has same innervation * Condylar fracture * Temporal arteritis – worrying/serious, doctor sees, severe pain in temporal region

Answer 2

pt education * **counselling** - no quick fix, takes time and understanding electromyographic recording jaw exercises - physical therapy, massage/heat, acupuncture, relaxation/mindfulness TENS CBT and hypnotherapy Splints * bite raising appliances * anterior repositioning splint medications

Answer 3

NSAIDs Muscle relaxants Tricyclic antidepressants * Has muscle relaxant in Botox * Paralysis muscle, help reduce clenching habit – reset chance to break habit * Not standard approach – last resort Steroids

Answer 4

Occlusal adjustment * Rarely done – no evidence of benefit1 TMJ surgery *rare* * Arthrocentesis * Arthroscopy * Disc-repositioning surgery * Disc repair/removal * High condylar shave * Total joint replacement

Answer 5

need to tx underlying cause of TMD or problem with recur

Answer 6

* **Reassurance** * Soft diet * Masticate bilaterally * No wide opening * No chewing gum * Don’t incise foods * Cut food into small pieces * Hobbies – reduce clenching e.g. wind instrument * Stop parafunctional habits e.g. nail biting, grinding * Support mouth on opening e.g. yawning

Answer 7

Wenvac – soft rubbery, 1-2mm Michigan splint – upper jaw, made by lab, hard heat cure acrylic Essex retainer - too thin for TMD pts Full lower – better as less aesthetic so can wear day and night Need to cover all the biting surfaces for all of one of the arches * Otherwise DAHL effect – intrusion/extrusion of some teeth and disrupt occlusion – *not Lucia jig* The exact mechanism behind the success of bite raising appliances (BRAs) is unknown and there is little scientific evidence to support their use * Theoretically, BRAs stabilize the occlusion and improve the function of the masticatory muscles, thereby decreasing abnormal activity. * They also protect the teeth in cases of tooth grinding Patients may need to wear their splint for several weeks before a benefit is felt. The splint should be worn at the time of parafunction

Answer 8

Patients with internal derangement of the TMJ may present with a painful clicking TMJ Joint clicking is due to lack of coordinated movement between the condyle and the articular disc The condyle has to overcome the mechanical obstruction before full joint movement can be achieved. Clicks may occur on opening or closing and can be classified as early, middle or late

Answer 9

anterior disc displacement with reduction

Answer 10

disc is intially displaced anteriorly by the condyle during opening until disc reduction occurs

Answer 11

jaw tightness/locking i.e. jaw movement is impaired for a short period of time until the disc reduces The mandible may initially deviate to the affected side before returning to the midline. If left untreated, may eventually progress to osteoarthritis

Answer 12

**Counselling** Limit mouth opening Bite raising appliance Surgery occasionally may be required If painless, no treatment required Reassure

Answer 13

Can occur after even minor ‘traumatic’ events, will usually resolve spontaneously: * IDB * Prolonged dental treatment * Infection If no resolution after acute phase: * Physiotherapy * Therabite® Jaw Motion Rehabilitation System * Jaw screw - incisors at narrow end and screw turn will widen gap between incisors * tongue depressors – inc each day number Haematoma in medial pterygoid muscle (likely) causing restricted opening

TMD Flashcards

(37 cards)