TMD Exam 2 Flashcards

(63 cards)

1
Q

Myth: People with certain types of _________malocclusion are more likely to develop TMD

  • Comment in 2006. They now identified ___ types of occlusion that predisposes to TMD
    1. Vertical or horizontal overjets over ______
    2. Lateral slides over _____
A

untreated…some.. 3mm …3mm

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2
Q

Myth: People with excessive _________guidance or no ________guidance are more likely to develop TMD

A

incisal..incisal

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3
Q

Myth:
People with gross maxillomandibular skeletal ________ are more likely to develop TMD.
-Comment in 2006, Gross _______ can predispose to TMD

A

disharmonies… disharmonies

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4
Q

Myth: Pretreatment radiographs of both TMJs should be taken to determine the _____ of the condyles in the fosse, and the orthodontic treatment should be directed toward getting the condyles in concentric relation to their _____

A

position…fossa

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5
Q

Myth: Orthodontic treatment when properly done, usually______ the likelihood of subsequently developing TMD

A

reduces..

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6
Q

Finishing orthodontic cases according to specific functional occlusal guidelines, will _____ the likelihood of developing TMD

A

reduce

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7
Q

Myth: The use of certain _______ procedures (bicuspid extraction, incisor retraction, etc.) or appliances (headgear, chin cups, Class II elastics, etc.) may increase the likelihood of developing TMD
-Comment in 2006. These devices can ______a pre-existing TMJ condition.

A

traditional….aggravate

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8
Q

Myth: Adult patients who have _______ TMD symptoms and some form of occlusal “problem” require some type of occlusal correction in order to get well and stay well

A

concurrent…

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9
Q

Myth: The retrusion of the mandible because of ______causes (deep overbite, distalizing occlusal contacts) or iatrogenic procedures (chin cups, incisor retraction, retention during growth spurts) is a ____factor in the development of TMD

A

natural…major

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10
Q

Myth: ______of the mandible causes articular disks to skip forward off the condyles, resulting in internal derangements, especially clicking.
-Comment in 2006. Research shows that posterior condyle position _____ for anterior disc displacement with reduction but NOT for pain or arthritic changes.

A

Distalization …predisposes

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11
Q

a. If you have a unilateral pivot, then it will pull the condyle down (condyle with the pivot) and give relief to the capsulitis inside
b. Dr. Sears bilateral doesn’t know anatomy
c. Unilateral pivot point diagram

A

Pivot splint

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12
Q

If you want to move jaw forward use:

A

a. Anterior repositioning appliance
b. Indications for moving jaw forward:
i. posterior capsulitis
ii. painful pop or lots of locking

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13
Q

if you have a patient that has tooth pain and you weren’t sure if that tooth pain is infection or nerve, what test will determine abscess or nerve pain?

A

a. Topical anesthesia
i. if pain goes away then it is a peripheral neuralgia
ii. LA block will get abscess or nerve so don’t do that

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14
Q

Which muscle will limit side to side movement

A

lateral pterygoid

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15
Q

If there is nerve pain it is likely to be:

A

electric

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16
Q

If you have an Infection it is likely to be:

A

dull achy pain

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17
Q

It is important to study medications, the difference between migraine and nerve pain meds
-TCA?

A
  • used to treat both migraine and nerve

- Blocks ion channels

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18
Q

Topamax

A
  • ONLY anti-seizure used for migraines
  • Anti-seizures- used to treat nerve pain also
  • Sodium channel blocker and enhances gaba
  • Watch for narrow angle glaucoma, kidney stones, short term memory loss, loss of appetite
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19
Q

Beta blockers used for what?

A

migraines

*not used to treat nerve pain

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20
Q

Medication used to treat nerve pain:

-Non blockable or sympathetically blockable

A
  1. Antidepressants
    a. Elavil
    b. Pamelor
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21
Q

Medication used to treat nerve pain:

-Alpha Blockers (antihypertensives)

A

a. Catapres
b. Minipress
c. Hytrin

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22
Q

Medication used to treat nerve pain:

Lidocaine - Repeated sympathetic blocks

A

a. IV

b. Tablets, mexiletine hydrochloride

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23
Q

Blockable Pain:

-Anticonvulsant and mood stabilizer

A

a. Tegretol

b. Depakote

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24
Q

Blockable Pain:

Dilantin and Topamax are __________

A

Anticonvulsant

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25
Lioresal ?
Muscle relaxant
26
Klonopin
Sedative
27
What are Neuropathic Pain Medications?
1. Tegretol 2. Depakote 3. TCAs 4. Neurontin 5. Bacleofen 6. Hyr
28
Medication that is used to treat migraines ?
i. Topamax (anticonvulsant) ii. Imitrex iii. Inderal (beta blocker) iv. Verapamil (calcium channel blocker) v. Pamelor
29
what do dentists can do for nerve pain that neurologists don’t do?
a. Local anesthetic Injected (Inferior Alveolar Nerve blocks) blocks continuous/episodic burning to calm nerve down preventing permanent damage b. Topical anesthetics over the area of neuralgia i. Place a plastic stent and add topical anesthetic + capsaicin -->the cell that produces pain secretes substance and eventually runs out, which eliminates the nerve pain.
30
Episodic Tension-Type Headache | -headache pain is accompanied by 2 of the following symptoms?
* MOST COMMON 1. pressing/tightening (non-pulsating) quality 2. bilateral location 3. not aggravated by routine physical activity
31
Episodic Tension-Type headache pain is accompanied by both of the following symptoms?
1. no nausea/vomiting 2. photophobia and phonophobia absent or only one present ii. fewer than 15 days per month w/ headache iii. no evidence of organic disease
32
most headaches are tension-type ______%, _____ not _____. dull/achy feels like _____ band around head activity improves ____
80-90%...bilateral...throbbing...tight...headache
33
Which headache? i. lasting 4-72 hours ii. 2 of the following: 1. unilateral location 2. pulsating quality 3. moderate or severe intensity 4. aggravation by routine physical activity i. At least 1 of the following: 1. nausea and/or vomiting 2. photophobia & phonophobia ii. at least 5 attacks fulfilling A, B, and C iii. no evidence of organic disease
Migraine without aura
34
Which headache pain is preceded by at least 1 of the following neurologic symptoms? 1. visual a. scintillating scotoma b. fortification spectra c. photopsia 2. sensory a. paresthesia b. numbness c. unilateral weakness d. speech disturbance (aphasia) ii. no evidence of organic disease
Migraine with aura
35
Which headache is severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 minutes ii. at least 1 of the following on the headache side: 1. conjunctival injection (swelling around eye) 2. facial sweating 3. lacrimation 4. miosis 5. nasal congestion 6. ptosis 7. rhinorrhea 8. eyelid edema iii. no evidence of organic disease iv. usually in men who drink/smoke v. laying down makes it worse - person will be pacing b/c it’s so severe
a. Cluster Headache
36
What is the headache medication category that is not a pain medication that gets rid of migraines immediately?
Triptans- not a pain med but treats migraines
37
What is Abortive Therapy ?
Abortive Therapy (used to manage infrequent migraine, less than 5-6 per month) 1. Ergotamine/caffeine 2. Ergotamine derivatives 3. Isometheptene 4. Sumatriptan (Imitrex)
38
Triggers for migraines
a. carbon monoxide b. MSG c. cashews d. aged cheese e. red wine f. dairy products g. food allergies h. stress, anxiety, depression i. hunger j. altitude k. sleep disturbance l. dehydration m. diet n. environmental and sensory stimuli o. hormones/changes in estrogen levels in women p. Drugs q. Pain in the trigeminal system:
39
What is the pain in the trigeminal system?
i. Tooth pain ii. Jaw pain (can also cause tension type headache) iii. Neck pain (can also cause tension type headache) iv. TMJ v. Eye vi. Ear
40
______ is the nerve center associated with migraines and also tooth pain, oral pain.
Nucleus caudalis (CN V)
41
Most accepted theory of migraine etiology is ________
neurovascular
42
Know the differences between the headaches? | Know the diagnostic red flags
i. Rash, meningeal signs or fever ii. onset after 50 iii. onset in person w/ HIV or cancer iv. abrupt onset v. worsening pain vi. signs of focal neurologic disease vii. worst headache ever viii. first severe headache
43
______ most effective,specific and sensitive image for disc
MRI
44
images are best for bone changes
CT
45
Tomograms are...
diagnostic
46
Standard of care is NOT the ____(not diagnostic quality)
pano
47
Transcranial, transpharyngeal and pano are not ______
diagnostic
48
_____most accurate for TMJ
CBCT
49
Anterior Reposition Splint (MX)
Temporary recapture of anteriorly displaced disc, allowing it to heal
50
Disc Recapture
Usually no need, unpredictable and unstable
51
i. Interrupts nerve transmissions so you can’t clench too tight ii. Long term use can alter bite iii. Temporary relief iv. Tie floss to it so your patient doesn't swallow it
NTI
52
Seating appliances: i. No _______ ii. Not too _____ iii. ____ contact in the anterior iv. _____ contacts v. Cuspid guidance vi. Polish very smooth vii. Reeval every ____ weeks
rocking.. tight....lighter ..Balanced....2-4
53
Unilateral Pivot
distracts one condyle as intended
54
Sears Pivot
a. bad “Dr. Sears needs to go back to dental school and take anatomy again” i. Hits only in posterior but doesn't distract both condyles due to anterior position of masseters
55
Why..stay away from soft splints?
i. Compressible ii. Easily Destroyed by clenching iii. Encourages chewing habit with splint in iv. Can move teeth
56
Moderate to severe or advancing anterior attrition severity is strongly associated with all _______ TMD models
intracapsular
57
Occlusal Features of TMD (risk factors?): Sudden changes in _____ (high crown, etc) can cause TMD problems (Cohen’s opinion)
occlusion
58
Occlusal Features of TMD (risk factors?): a. ____ or more missing posterior teeth i. Orthodontic _____ of premolars within safety threshold ii. adaptive and compensatory mechanisms ____ harmful effects iii. Association to Osteoarthrosis may be only _____ to aging iv. Excludes 3M’s
5..extraction....reduce....secondary
59
Occlusal Features of TMD (risk factors?): - Overjet ____ - Overjets above____seen in TMD patients - Sensitivity is.. - Could be consequences of ..
>5mm...5mm... rare....disease
60
Occlusal Features of TMD (risk factors?): RCP-ICP slides > ____ i. Not usually.... ii. Could be due to....
2mm... sensitive disease
61
Occlusal Features of TMD (risk factors?) a. Anterior ____ Bite b. Anterior ____
open..bruxism
62
What are the "visual" symptoms with migraine w/ aura?
a. scintillating scotoma b. fortification spectra c. photopsia
63
What are the "sensory" symptoms with migraine w/ aura?
a. paresthesia b. numbness c. unilateral weakness d. speech disturbance (aphasia)