TMD and Orofacial Pain Flashcards by Alex Stein

Axis 1 includes

Masticatory mm disorders
Disc displacements
Joint dysfunction

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Masticatory mm disorders includes

with normal openin

with limited opening

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Disc displaceemnt includes

With reduction
Without reduction without limited opening
Without reduction with limited opening

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Joint dysfunction includes

OA
Arthralgia
Osteoarthritis

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Masticatory muscles

Masseter
Temporalis
Lateral Pterygoid
Medial Pterygoid

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Necessary components of central sensitization

Abnormal inc of perceived pain in brain
Dec in brains input to inhibit pain
Hyperexcitability in spinal cord neurons
Repetitive firing of pain receptors in periheral NS

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Possible micro and macro trauma that could cause damage to disc

Dental procedure that requires pronlonged mouth opening
Parafunctional activites
Oral sex

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Most common position of displacement of the disc

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If the disc gets injured, prognosis for improvement?

Good - is vascularized and innervated

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DDWR

two clicks occur

Condyle rides on the middle part of the disc with mouth open and rolls off when mouth closes

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DDWR - if worsens what can happen

DDWOR

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If DDWOR occurs with limited opening, what happened

The disc moved so ant that the condyle rides up on the disc and biomechanically the TMJ cant fully open

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Arthralgia

Joint pain

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Osteoarthritis

Involves inflammatory process

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Osteoarthrosis

Does not involve inflammatory process but still have joint degeneration

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Axis 1 dx related to

muscle, disc, joint pathology

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Axis 2 dx related to

psychological issues that cause or maintain pain

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Other causes of orofacial pain that need to be ruled out besides axis 1 and 2

Cervical spine
Cranial nerves
Eyes, ears
Sinuses
Toothache or dental issues
Headaches 
Systemic problems RA
Peripheral neuralgias - trigeminal too

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What does complete exam for orofacial pain have to include

TMJ musculoskeletal eval
Psychological exam
Cranial nerve screen
Cervical screen
Systems screen
Heart attack can refer to face

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History

Have you had pain or stiffness in the face, jaw, temple, in front of the ear, or in the ear in the past month?
Are the symptoms altered by any of the following jaw activities: chewing, talking, singing, yawning, kissing, moving the jaw?
Have you ever had your jaw lock or catch so that it would not open all the way? If so, was this limitation in jaw opening severe enough to interfere with your ability to eat? Have you ever noticed clicking, popping, or other sounds in your joint?

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Examples of parafunctional activites

Gum chewing
Nail biting
Bruxism (grinding, clenching)

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Bx that could irritate TMJ

Leaning head on chin
Forward head posture
Eating hard food
Grinding teeth
Clenching jaw

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Scales to rule in/out psychological problems

Study These Flashcards

Patient health questionnaire for anxiety and depression

Graded chronic pain scale

Medical practitioners with whom you might communicate with

Study These Flashcards

Dentist
Oral surgeon
Speech therapist
Family med doc/internist
EMT
Psych
Nutritionist 
Neurologist 
Rheumatologist 
Ophthalmologist

Tests and measures to rule in/out disorders not in axis 1

``` Cranial nerve testing Psych exam Cervical screen Vital signs Palpation of temporal artery Observation ```

Central occlusion

Asking them to bite | Normal is mandible will go about half way down - touch equally at molars

Crossbite

Mandibular teeth are lateral to maxillary teeth on one side and medial on the other side

Underbite

Mandibular teeth are anterior to maxillary teeth

Overbite

Maxillary incisors extend below mandibular incisors when jaw is in central occlusion

Overjet

Measure of how far top incisor teeth are ahead of bottom incisors

Mobility - opening

``` Active without pain Active into pain End feel Resist opening and closing Measurement - 40 to 50 mm with firm capsular end feel 3-4 fingers btw teth ```

Limited opening may be cause by

mm tightness capsular tightness DDWR

Lateral movement with opening may indicate

restriction on one side, mm tightness or asymmetrical mm contraction of DDWR on one side

Mobility - closing

Teeth to teeth end feel

Lateral deviation

Perform AROM before pain, into pain, overpressure with endfell and measure Normal ROM - mandibular central incisors move lateral to maxilla central incisors 8-11 mm

Protrusion/Retrusion

AROM to pain, into pain, overpressure, end feel No measurement for normal ROM - madibular teeth should move past maxillary teeth Deflection will occur on side of joint pathology with protrusion

Palpation

TMJ - ant tragus of ear, lateral pole with mouth opening Cervical spine, boney prominences of face Mm of mastication

Joint noise - listening for clicks and pops

Palpate while moving through ROM | Can use stethoscope on TMJ

Differential Dx related to noise - clicking on opening and closing

DDWR (Sp = .90) or nothing is wrong

Differential Dx related to noise - Hx of noise that has now reduced

DDWOR with limited opening (Sp = .90) or normal opening

Differential Dx related to noise - Hx of noise that has reduced and now no pain

DDWR or DDWOR that has healed

Differential Dx related to noise - crepitus with pain

Joint arthralgia

Differential Dx related to noise - TMJ pain without crepitus

Joint arthralgia without joint degeneration

Temporalis

Attaches on coronoid process Palpate from temporal line of skull, post to ant to ear Palpate externally to mandibular ramus, slightly open mouth to be able to reach coronoid

Temporalis referral patter

to upper teeth, temporal area and area around the eye

Temporalis - intraoral palpation

Follow ant ramus of mandible sup to the coronoid process

Masseter

Zygomatic arch to ramus of mandible | Palpation of outer angle of mandible - clench teeth

Masseter trigger points refer to

lower teeth, lateral face, and around eye

Medial Pterygoid

Palpate externally on medial portion of inf mandible | Resist protrusion to palpate

Medial Pterygoid - trigger points refer to

ear, ant to ear and cervical spine just post to mandible

Lateral pterygoid

``` Unable to directly palpate REsist protrusion (inf portion) Clench teeth (sup portion) ```

Lateral Pterygoid - trigger points refer to

Ear, perauricular area, and lateral face

Joint mobility - ligament stress tests

Caudal glide - lateral TMJ ligament | Post glide - INtrinsic ligament - ipsilateral deviation with post glide

Joint mobility

Ant glide Post glide Medial and lateral glides

Special tests -

Power stroke Unilateral joint loading Joint compression VAS related to functional activity

Special tests - power stroke

Clenching teeth - biting bilaterally on tongue depressors - causes mm contraction but joint is somewhat unloaded May point to problems more in mm than in joint

TMD and Orofacial Pain Flashcards

(56 cards)