TMD Flashcards
(37 cards)
where is and what is the temporomandibular joint?
> 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
what are movements of the TMJ produced by?
> the muscles of mastication
what muscles open the TMJ?
> Lateral pterygoid
> Geniohyoid
> Mylohyoid
> Digastric
what muscles close the TMJ?
> Temporalis
> Masseter
> Medial pterygoid
what is temporomandibular disorder? (TMD)
> Group of musculoskeletal and neuromuscular disorders
> Major cause of non dental pain in orofacial region
> Patients will frequently initially present to GDP/GMP
what is the epidemiology of TMD?
> 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)
what factors are associated with the development of TMD?
> Multifactorial =
- Predisposing (susceptibility)
- Precipitating (things that trigger an attack)
- Perpetuating (maintain problem once its started)
(Can also occur in the absence of these factors)
what precipitating factors are associated with the development of TMD?
> strong = parafunction (day time), nutrition, smoking, sleep disorders
> moderate = dental interventions, occlusions
> low = orthodontic treatment
> no association = parafunction (night time)
what predisposing factors are associated with the development of TMD?
> strong = gender
> moderate = age, genotype
> low = ethnicity
what perpetuating factors are associated with the development of TMD?
> 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
how is TMD classified?
- Muscular diagnosis
a. myofascial pain
b. myofascial pain with limited opening - 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 - Arthralgia, osteoarthritis and osteoarthrosis
a. arthralgia
b. TMJ osteoarthritis
c. TMJ osteoathrosis
what is the difference between acute and chronic TMD?
> ACUTE
- identifiable cause
- short duration
- identifiable trigger
- resolves
> CHRONIC
- pain exceeds three months
- becomes biopschosocially destructive
- chronic pain behaviour
how does TMD present to a clinician ?
> Vary in presentation
> Often involve more than one component of masticatory system
> Four major signs/symptoms
- Pain
- Limited range of motion
- TMJ sounds
- Headache related to temporalis pain
what are the clinical features of TMD?
- Pain
> Pre-auricular region
> Head, neck, shoulders - Muscular tenderness
> Face (masseter, temporalis, posterior digastric, mylohyoid)
> Mouth (medial or lateral pterygoids)
> Neck and shoulder (? Cervical problems) - Joint noises
> Clicking
> Crepitus (grinding) - Locking
> Open
> Closed - Ear complaints
> Otalgia
> Tinnitus - Non-specific toothache or sensitivity
- Psychosocial effects
what are key questions to ask when you’re considering TMD to be a cause?
- Have you had pain in your face, jaw, temple, in front of the ear, in the ear in the last month? – Indicative of TMD
- Have you had any clicking or grinding noises from your jaw joint in front of your ear – Disc disorder or arthritides
- Have you ever had your jaw lock or catch so it won’t open all the way ? – Disc displacement without reduction
when carrying out a medical history what is important to find out regarding TMD?
> Conditions =
- Other chronic pain conditions
- Systemic conditions
- Hypermobility
- Growth disturbances
> Medications
- Antidepressants
when carrying out a social history what is import to find out regarding TMD?
> Occupation
> Lifestyle
> Habits
when carrying out an extra oral examination on a patient with suspected TMD what are checking ?
> Asymmetry
> Opening/pathway
> TMJ/MOM
> Lymph nodes
> Cranial nerves
when carrying out an intraoral examination in a patient suspected to have TMD what are you looking out for ?
- Hard tissues
- Occlusion
- Attrition
- Abfraction
- Wear facets - Soft tissues
- Tongue scalloping
- Linea alba - Tori
- TMD, Migraine > Controls
what conditions may mimic TMD?
> dental conditions - caries, cracked tooth, dry socket
> giant cell arteritis
> migraine headache
> neuropathic conditions - glossopharyngeal neuralgia, postherpetic neuralgia, trigeminal neuralgia
> salivery stone
> sinusitis
what special investigations are used for aiding diagnosis of TMD?
> used in Adjunct with each other
> Radiographic changes consistent with degenerative joint disease often doesn’t correlate with symptomology
> OPT
> MRI
> US
how many patent require treatment for TMD?
> 5-10%
> 40% of patient resolve problems spontaneously
how do we manage TMD?
> multidisciplinary approach
> Do not cause harm to the patient
> Encourage self management
> goal = Reduce the (impact of) pain
> Decrease functional limitation
when treating TMD what model is usually applied?
> Biopschosocial Modell of illness
> medical factors + psychological factors + social factors
> all managed at once
