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osomop 4th > TMD > Flashcards

TMD Flashcards

1
Q

where is and what is the temporomandibular joint?

A

> Anterior to the tragus of the ear.

> Articulation between the condyle and glenoid fossa

> Biconcave intraarticular disk

> Surrounded by a ligamentous capsule lined by a synovial membrane

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2
Q

what are movements of the TMJ produced by?

A

> the muscles of mastication

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3
Q

what muscles open the TMJ?

A

> Lateral pterygoid

> Geniohyoid

> Mylohyoid

> Digastric

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4
Q

what muscles close the TMJ?

A

> Temporalis

> Masseter

> Medial pterygoid

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5
Q

what is temporomandibular disorder? (TMD)

A

> Group of musculoskeletal and neuromuscular disorders

> Major cause of non dental pain in orofacial region

> Patients will frequently initially present to GDP/GMP

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6
Q

what is the epidemiology of TMD?

A

> Most common cause of non-dental orofacial pain

> Third most common chronic pain

> Peak incidence is 2nd – 3rd decade

> F>M

> Significant cost associated with TMD (eg time out of work, time finding cause)

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7
Q

what factors are associated with the development of TMD?

A

> Multifactorial =

  • Predisposing (susceptibility)
  • Precipitating (things that trigger an attack)
  • Perpetuating (maintain problem once its started)

(Can also occur in the absence of these factors)

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8
Q

what precipitating factors are associated with the development of TMD?

A

> strong = parafunction (day time), nutrition, smoking, sleep disorders

> moderate = dental interventions, occlusions

> low = orthodontic treatment

> no association = parafunction (night time)

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9
Q

what predisposing factors are associated with the development of TMD?

A

> strong = gender

> moderate = age, genotype

> low = ethnicity

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10
Q

what perpetuating factors are associated with the development of TMD?

A

> strong = endogenous pain modulation, peripheral/ central sensitisation, catastrophising, fibromyalgia

> moderate = stress, depression, childhood events, headache, lower back pain, IBS, chronic wide spread pain

> low = personality disorders

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11
Q

how is TMD classified?

A
  1. Muscular diagnosis
    a. myofascial pain
    b. myofascial pain with limited opening
  2. Disk displacement
    a. disk displacement with reduction
    b. disk displacement without reduction and with limited opening
    c. disk displacement without reduction and without limited opening
  3. Arthralgia, osteoarthritis and osteoarthrosis
    a. arthralgia
    b. TMJ osteoarthritis
    c. TMJ osteoathrosis
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12
Q

what is the difference between acute and chronic TMD?

A

> ACUTE
- identifiable cause
- short duration
- identifiable trigger
- resolves

> CHRONIC
- pain exceeds three months
- becomes biopschosocially destructive
- chronic pain behaviour

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13
Q

how does TMD present to a clinician ?

A

> Vary in presentation

> Often involve more than one component of masticatory system

> Four major signs/symptoms

  1. Pain
  2. Limited range of motion
  3. TMJ sounds
  4. Headache related to temporalis pain
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14
Q

what are the clinical features of TMD?

A
  1. Pain
    > Pre-auricular region
    > Head, neck, shoulders
  2. Muscular tenderness
    > Face (masseter, temporalis, posterior digastric, mylohyoid)
    > Mouth (medial or lateral pterygoids)
    > Neck and shoulder (? Cervical problems)
  3. Joint noises
    > Clicking
    > Crepitus (grinding)
  4. Locking
    > Open
    > Closed
  5. Ear complaints
    > Otalgia
    > Tinnitus
  6. Non-specific toothache or sensitivity
  7. Psychosocial effects
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15
Q

what are key questions to ask when you’re considering TMD to be a cause?

A
  1. Have you had pain in your face, jaw, temple, in front of the ear, in the ear in the last month? – Indicative of TMD
  2. Have you had any clicking or grinding noises from your jaw joint in front of your ear – Disc disorder or arthritides
  3. Have you ever had your jaw lock or catch so it won’t open all the way ? – Disc displacement without reduction
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16
Q

when carrying out a medical history what is important to find out regarding TMD?

A

> Conditions =
- Other chronic pain conditions
- Systemic conditions
- Hypermobility
- Growth disturbances

> Medications
- Antidepressants

17
Q

when carrying out a social history what is import to find out regarding TMD?

A

> Occupation

> Lifestyle

> Habits

18
Q

when carrying out an extra oral examination on a patient with suspected TMD what are checking ?

A

> Asymmetry

> Opening/pathway

> TMJ/MOM

> Lymph nodes

> Cranial nerves

19
Q

when carrying out an intraoral examination in a patient suspected to have TMD what are you looking out for ?

A
  1. Hard tissues
    - Occlusion
    - Attrition
    - Abfraction
    - Wear facets
  2. Soft tissues
    - Tongue scalloping
    - Linea alba
  3. Tori
  4. TMD, Migraine > Controls
20
Q

what conditions may mimic TMD?

A

> dental conditions - caries, cracked tooth, dry socket

> giant cell arteritis

> migraine headache

> neuropathic conditions - glossopharyngeal neuralgia, postherpetic neuralgia, trigeminal neuralgia

> salivery stone

> sinusitis

21
Q

what special investigations are used for aiding diagnosis of TMD?

A

> used in Adjunct with each other

> Radiographic changes consistent with degenerative joint disease often doesn’t correlate with symptomology

> OPT

> MRI

> US

22
Q

how many patent require treatment for TMD?

A

> 5-10%

> 40% of patient resolve problems spontaneously

23
Q

how do we manage TMD?

A

> multidisciplinary approach

> Do not cause harm to the patient

> Encourage self management

> goal = Reduce the (impact of) pain

> Decrease functional limitation

24
Q

when treating TMD what model is usually applied?

A

> Biopschosocial Modell of illness

> medical factors + psychological factors + social factors

> all managed at once

25
Q

what are the 3 categories of management for a TMD patient?

A

> conservative

> pharmacological

> surgery

26
Q

what is the first thing you should do when you suspect they have TMD?

A

> provide them with information

> Explanation

> Aetiology

> Self limiting condition

> Patient information leaflets

27
Q

what self management techniques are recommended to patients?

A

> Sleep hygiene

> Caffeine consumption

> Smoking cessation

> Avoidance of parafunctional activities/habits

> Relaxation techniques

> Local measures

> Strategies on how to manage exacerbations of symptoms

28
Q

is physical therapy good as a management for TMD?

A

> yes and no

> Evidence - weak

> Active v passive techniques

> Improves muscle strength

> Coordination

> Relaxation

> Range of movement

29
Q

Is physical excercise good as a management of TMD?

A

> yes

> Graded physical exercise
- Aerobics, Tai chi, Yoga, Pilates, Stretching

> Reduces pain

> Improve function and wellbeing in other chronic musculoskeletal conditions with similarities to TMD

30
Q

is acupuncture good as a management of TMD?

A

> can be used Alone or as an adjunct

> 15-30 mins; 6-8 sessions

> Systematic review suggests it may help to:
- reduce pain intensity
- masseteric tenderness

31
Q

what is an occlusal splint?

A

> retainer which can reduce TMD symptoms aswell as stop -ve problems associated with parafunctional habits

> need appropriate design, hard? soft? hard-soft?

> upper = michigan, lower = tanner

32
Q

what are the functions of an occlusal splint?

A

> Stabilise joint

> Protect teeth

> Redistribute forces

> Relax elevator muscles

> Reduce bruxism

> Decrease joint loading

> Masticatory muscle relaxation

33
Q

what drugs/ phmarcotherapy will you use for acute onset TMD?

A

> NSAIDS

> Paracetamol

> Benzodiazepines

34
Q

what drugs/ pharmacotherapy will you use for chronic TMD?

A

> Antidepressants

> Muscle relaxants

> Gabapentinoids

> Botox

35
Q

when would you refer someone for surgery with TMD?

A

> Non surgical therapy has been ineffective

> Moderate to severe pain/dysfunction that is disabling

> Articular disorders

> Disc derangement

36
Q

when should you refer patients to a specialist?

A

> Multiple unsuccessful treatments

> Psychological distress

> Trismus

> Chronic widespread pain

> Disc displacement without reduction

37
Q

How should you manage a person at the initial presentation of temporomandibular joint disorder?

A
  1. If serious pathology is suspected or there is markedly limited mouth opening refer the person urgently to secondary care
  2. For other people with temporomandibular disorders:
    > Exclude an odontogenic cause
    > Explainthat the condition is benign and that symptoms often resolve with advice and symptomatic treatment.

3.Advisethe patient to:
> Eat soft foods, avoid foods that need a lot of chewing, and avoid wide yawning, singing, chewing gum, and biting their nails or chewing pencils.
> Massage affected muscles and apply gentle heat (for example a heat pad, hot towel, or hot-water bottle; being careful to avoid burns).
> Identify sources of stress (stress management programs)

  1. If necessary, advise or prescribe simple analgesia for short-term use(for example paracetamol, or a non-steroidal anti-inflammatory drug such as ibuprofen)
  2. If symptoms are severe, consider a short course of a benzodiazepine(for example diazepam 2mg to 5mg at night or up to three times daily; for a maximum of 2weeks).
  3. Watch out for any potentially harmful habits (such as teeth grinding or jaw clenching) and try to stop them (splint).
  4. Refer patients to secondary care if symptoms persist for six or more weeks

osomop 4th (18 decks)

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