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TMD Flashcards

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1
Q

Role of occlusion in TMD

A

Current understanding and evidence- based literatrue fail to demonstrate a causal relationship between these occlusal factors and TMD signs and symptoms

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2
Q

percentage of young adults that have detectable clicking that is not pathological
what do you with these patients

A

80%

- dont treat

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3
Q

do you treat joint noises?

A

NO — should be followed but do not require treatment

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4
Q

Etiology of TMD

definition plus 5 examples

A

A ‘collective term’ embracing a number of clinical problems that onvolve the masticatory musculature, the TMJ’s, and associated craniofacial structures

  1. Trauma
  2. Emotional Stress
  3. Deep pain input
  4. Parafunctional habits
  5. Occlusal Factors *
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5
Q

clinical signs of osteoarthritis

A

crepitis tendernous sometimes mal occlusion and limiting openeing

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6
Q

role of occlusion in TMD

A

occlusal interferences have been considered as a major risk factor for TMD’s

*OCCLUSAL EQUILIBRATIONS FOR AN IDEAL OCCLUSION TO TREAT TMD’s

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7
Q

Anterior open bite, increased overbite, excessive overjet, premature contacts (interferences), posterior cross bite, Centric relation and Centric occlusion differences are _____what to TMD

A

Role of occlusion in TMD and are considered potenetial RISK FACTORS but not direct causal for TMD’s

*subject with similar occlusal conditions may not develop similar disorders because there are many contributing factors

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8
Q

Current understanding in evidence for role of occlusion in TMD?

A

Current understanding and evidence based literature fail to demonstrate a causal relationship between these occlusal factors and TMD signs and symptoms

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9
Q

T/F changes in occlusion may cause muscular symptoms

A

TRUE – like improper crown and filling, changing occlusal vertical dimension, improper occlusal appliances and splints

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10
Q

improper stabilization splint implications?

A

may create muscle pain and TMJ pain due to sudden non-adjusted contacts

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11
Q

Capsulitis, synovitis, and retrodiscitits implication on occlusion?

A

can cause affects to occlusion – may cause open bite, occlusal discomfort

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12
Q

Osteoarthritis and RA implication on occlusion?

A

may cause open bite

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13
Q

Protective co-contraction of muscles implication on occlusion?

A

percieved a change in occlusion

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14
Q

what can osteoarthritis do to affect occlusion?

A

can increase overjet and can decrease overbite due osteoarthritis

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15
Q

T/F TMD may cause occlusal changes

A

TRUE – TMD may cause occlusal changes and therefore any dental treatment should be performed after the problem is resolved

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16
Q

list of TMD JOINT disorders (Five)

A
  1. disc displacement with reduction
  2. disc displacement without reduction
  3. inflammatory disease
  4. degenerative joint disease
  5. Dislocation TMJ - Subluxation
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17
Q

List of TMD MUSCLE disroders

A
  1. Protective Co-contraction
  2. Local muscle soreness
  3. Myofacial Pain (TrP)
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18
Q

List of TMD MUSCLE disroders

A
  1. Protective Co-contraction
  2. Local muscle soreness
  3. Myofacial Pain (TrP)
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19
Q

what do you do about joint noised without pain and dysfunction?

A

FOLLOW these patients - but do not require treatmnet

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20
Q

possible occlusal factors are?

A

risk factors for TMD

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21
Q

can TMD be observed in ideal occlusion?

A

yes

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22
Q

patient with non-ideal occlusion has TMD what is the correct order of tx?

A

do not recommend ortho tx right away - treat TMD then ortho (may result in not even needing ortho)

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23
Q

can TMD affect occlusion?

A

Yes

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24
Q

T/F TMD can cause occlusal problems that are more severe than non-ideal occlusions affect on TMD’s

A

TRUE
non-ideal occlusions can be considered more risk factors where as TMD disorders can have more implications on occlusion

so occlusal factors are NOT mostly related to TMD’s and any attempt to change the occlusion to treat TMD should be avoided

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25
full range of motion in adult TMJ
40-60 mm of opening less than 8mm upon protrusive and lateral excursions is also considered limited
26
disc displacement
disturbances of the normal anatomical relationship between the disc and the condyle
27
etiology of disc displacement - 4 major ones
1. trauma 2. parafunctin 3. spasm of the superior lateral pterygoid 4. disruption of lubrication system
28
effect of prolonged overload -- leads to what?
- affects disc VISCOELASTIC PROPERTIES - AFFECTS LUBRICATION SYSTEM - repeatative disc hesitation causes elongation --> disc displacement ANTERIORLY
29
disc displacement with reduction
``` Reciprocal click : opening and closing Pain MAY be present (joint movement) Deviation of mouth opening UNRESTRICTED maximal mouth opening *there is a click upon opening and closing ```
30
does disc displacement with reduction require treatment? | describe movements
if no pain -- no treatment unrestricted max opening normal excursive movements can deviate THIS IS AN ADAPTIVE CONDITION -- most of the time it DOES NOT progress to the next stage of disc displacement without reduction --90% Of these cases will not go to pain and need treatment but showed us case when there WAS PAIN AND CLICK -- have to treat deviation when opened
31
disc displacement without reduction | clinical features
limitation of mouth opening - less than 35 mm deviation to the EFFECTED side on mouth opening markedly limited contra-laterotrusion pain on forced mouth opening history of clicking - ceased affected TMJ tender to palpation LIMITED LATERAL EXCURSIVE MOVEMENT IS OBSERVED ON THE CONTRALATERAL SIDE CLICKING SOUNDS HAVE CEASED - do not occur
32
sounds when disc displacement without reduction
upon chewing
33
deviation
any shift of the midline during opening that disappears with the continued opening
34
deflection
any shift in the midline to one side that becomes greater with opening and DOES NOT disappear at max opening
35
describe lateral movements in pt. with disc displacement without reduction w/ pain on left side
Left lateral movement = normal Right lateral movement = LIMITED cases limit lateral excursive movement on the contralateral side
36
examples of inflammatory disorders
Synovitis and Capsulitis
37
synovial inflammation implication on occlusion and treatment?
Can cause alterations in the occlusion and any dental treatment should be avoided until the inflammtion is fully resolved. do NOT perform occlusal adjustments to comfort the patient NO DENTAL TREATMENT until the inflammation is resolved - no prophy
38
disc displacement with reduction usually displaces where?
TO AFFECTED side
39
can pts. with displacement without reduction translate?
NO that is also why we see limited lateral movements to the contralateral side because cannot translate
40
protrusive deflection to what side with disc displacement without reduction
restricted deviation to the left if the effected side is left TMJ
41
if patient clenches on tongue blade and has pain where is pain coming from?
Medial pterygoid muscle because muscle is contracting where as if the pain is relieved then we know it is TMJ issue
42
imprints of the upper teeth on an occlusal splint/ night guard?
this was a feature of a patient with an acute disc displacement without reduction -- NOT GOOD
43
Lateral movements restricted when?
when opposite side TMJ is messed up
44
inflammation of the synovial fluid and capsular ligament is called?
Synovitits and Capsulitis
45
diagnosis of inflammatory disorders
1. difficult to diagnose 2. usually follow trauma to the tissue 3. localized TMJ pain 4. pain ecacerbated by function, palpation, and joint loading 5. pain may be present at rest - limited range of motion 6. fluctuant swelling over affected TMJ
46
Retrodiscitis
inflammation in the retrodiscal tissue clenching will increase the pain and there can be limited jaw movement
47
where can you see malocclusion with patient who has retrodicitis
on IPSILATERAL side (same side) because
48
``` osteoarthritis definition what type of joint disease clinical signs radio-graphic signs ```
Type - degenerative joint disease Characterized by DESTRUCTIVE PROCESS by which the bony articular surfaces of the condyle and the fossa become altered Clinical signs TMJ pain is localized to the joint Tender to palpation Crepitus (grading sounds of the two bones) Limited range of motion Malocclusion (anterior open bite or one side open bite) radio-graphic signs Condylar deformaties, erosion, osteophytes (bone spurs), reduced joint space
49
two inflammatory disorders
1. synovitits and capsulitits | 2. retrodiscitis
50
crepitis indicates what
Oseoarthritis / or potentially Rheumatoid
51
Subluxation definition describe clinically
when the CONDYLE is positioned ANTERIOR to the articular eminence 1. jaw clicking AFTER opening 2. lateral pole can be observed 3. depression in the preauricular region
52
difference between dislocation and subluxation
Sublux- can close dislocation - pt. cannot close jaw and needs your help
53
dislocation definition describe clinically
AKA open-lock Inability to close the mouth without specific manipulation maneuver radiographic evidence reveals condyle well beyond the eminence pain at time of dislocation with mild residual pain after episode
54
what you see clinically with dislocated (open-lock) left TMJ
Severe pain assymetric mandible shifted to the right cannot close or open occlusal disharmony
55
where is condlye positioned in dislocation
ANTERIOR to articualr eminence
56
list of muscle disorders
1. protective co-contraction 2. Local muscle soreness 3. myofacial pain (trP)
57
Protective co-contraction
Muscle Disorder NOT a pathological condition but a physiologival response of the musculoskeletal system CNS response to injury following an event ** muscle contraction alters to protect the injured area from further injury will not resolve until the reason is eliminated (like hyperocclusion from porrly fitting crown)
58
dont resolve muscle co-contraction?
goes to local muscle soreness
59
causes of protective co-contraction?
``` poorly fitting crown long dental appointment wide opening dental injection constant deep pain input from tendons, ligaments, joints, teeth and muscles increased emotional stress ```
60
implications of protective co-contraction on occlusoin and range of opening?
patient perceives change in occlusion and range of opening decreases
61
local muscle soreness describe causes?
non-inflammatory myogenous pain disrorder often the first response of the muscle tissue to continued protective co-contraction- so have to treat the muscle too not just resolved when the reason is eliminated (like co-contraction) the tissues start reacting - not just CNS due to trauma, parafunction, and stress mostly
62
clinical symptoms of muscle soreness
1. dull, aching pain during function of affected muscle 2. no or minimal pain at rest 3. tenderness to palaptation 4. reduced range of motion, increase of pain on stretching and use
63
myofacial pain AKA | definition and characterization
triger point myalgia regional myogenous pain condition characterized by: 1. regional dull, aching muscle pain 2. presence of hypersensitive bands of muscle tissue known as trigger points
64
trigger points
localized hardening of muscle tissue that is hypersensative - which typically REFERS PAIN hypersensative bands of muscle tissues
65
trigger point in masseter refers?
to the teeth - so do a blcok
66
what type of response is protective co-contraction?
physiologic
67
can muscle pain and protective co-contraction cause occlusal changes?
yes
68
TMD symptoms are most prevelany in what ages?
15-25 years of age
69
frequency of re-screening
every 6 months
70
stabalization splints are what type?
permissive splints -- allow the teeth to move on the splint unimpeded, allows the condylar head and disk to function anatomically
71
aspects to the stabilization splint theory
1. decrease muscle activity - allow free centric and eccentric movements 2. easy to adjust occlusal surfaces 3. easy to repair 4. long term use (durability) 5. Stable, retentive (passive adaption) 6. NOT apply pressure to the teeth 7. cover all occlusal surfaces - even 3rd molars if present
72
``` occlusion with splint what you want during close during lateral during protrusive ```
when closed mouth - want bilateral contact lateral - contact only on working (canine guidance) protrusion - only contact in anterior - remove eccentric contacts, remove heavy contacts, only want light contacts in anterior - can be harder in posterior v shaped at canines

Occlusion (10 decks)

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