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Flashcards in TMD OMFG Deck (86):
1

What kind of device moves the Jaw Forward?

Upper Splint with a Flange

*aka Anterior Positioning Device

2

NTI alleviates what?

Myalgia

3

Whiplash can cause TMD

True

*cause

4

Nerve pain is never alleviated by what class of drug?

Beta blockers

*anything LOL

5

Carbamazapine/Tegretol can treat Migraine

False

*this is an Anti-convulsant
*the only anti-convulsants that Tx Migraine are Topomax and Depicote

6

Highest standard of TMJ imagery:

Minimum standard:

Not diagnostic:

Conebeam CT

Tomography

Pano

7

Imaging that shows disc position:

MRI

8

What are the master cells for Pain in the brain?

Glial Cells

9

Superior Capsulitis will feel better if you bite on what side?

Lateral Capsulitis will feel bette if you bite on what side?

Same side

Opposite side

10

Most common cause of Trigeminal Neuralgia

Vessel impingement in the brain

*happens more in older people

11

% population w/ at least 1 sign of TMD dysfunction:

% population w/ at least 1 symptom:

% population that need Tx

Ratio Females:Males

75%

33%

5-7%

4:1

12

If TMD, % internal derangement:

% arthritis

% masticatory muscle disorder

31%

39%

30%

13

There is no specific cause to TMD, but there are contributing factors

Predisposing factors

Initiating factors

Perpetuating factors

True

14

5 Predisposing factors for TMD:

Systemic hypermobility (needs more evidence)

Psychosocial factors

Hx of injury

Oral habits

Dental occlusion (rare, 15%)

15

2 Initiating factors TMD

Direct trauma

Repetitive micro trauma (clenching, grinding, fingernail biting)

16

3 Perpetuating Facors TMD:

Psychosocial factors (stress)

Oral habits

Poor Occlusion

17

6 Contributing Factors TMD:

Direct extrinsic trauma

Hyperfunction

Psychosocial factors

Anatomic factors

Systemic disease

Hyperextension

18

What is the best image for seeing the disc?

What is the best image for imaging bone?

What is the best for arthritis/bone?

MRI

X-ray

X-ray

19

When a jaw deflects to one side, is this muscle or joint?

Joint

*ADD w/o reduction

20

Poor occlusion is a common cause of TMD

False

*15%

21

NTI is used for what?

Myalgia (muscle pain)

*anterior bite has less muscle contraction, but it will still put pressure on the condyles

22

If the occlusion on a stabilization splint is balanced by a splint, but the pain is locking/knocking/popping and painful what is the correct option?

Reposition Forward with a Flange (anterior repositioning device)

*listed for other info

23

Are bite changes usually necessary for TMD Tx?

No

24

What is the most important part of the Exam?

Hx

25

What is the main function of the Lateral Pterygoid?

Protrusion

Lateral excursions

*also depressor

26

Does Anterior disc displacement w/ reduction limit opening?

No

*only w/o

27

If you have a joint problem can you also have a muscle problem?

Of course

*most pts have 4-5

28

If you have a limited opening with a soft infeel you have a...

Muscle problem

29

When you have referred pain, what is the name for what's going on in the brain?

What nucleus?

Convergence

Trigeminal nucleus adelas

30

Know the anatomy of where the mm. are on a diagram

Fo sho

31

Tissue covering the superior surface of the condyle

Tissue making up the disc

Fibrocartilage

Dense fibrous CT

32

Which mm. are elevators?

Which are depressors?

Temporalis, masseter, medial pterygoid

Infrahyoid, suprahyoid, lateral pterygoid

33

What is the 1st Tx for severe muscle pain?

Home instructions (moist heat, relaxation, stretching, etc)

34

Sharp pain can be what?

Nerve or joint

35

Which type of pain is electric shock?

What pain can be sharp?

Muscle pain is normally...

Nerve only

Nerve or Joint

Dull

36

Migraine/neurovascular pain is usually perpetuated by what?

Pounding/heartbeat

37

Myofascial pain

Myalgia

Myositis

Spasm

Referred

Muscle (not referred)

Trauma

Intense

38

Tooth w/ pain post-RCT, what should you do?

(extraction, refer, topical...)

Topical anesthetic

39

If the occlusion on a stabilization splint is balanced but the pain has recently increased w/ popping/locking, the next treatment:
Balance the splint
Add pivot
Make the splint thinner
Reposition forward with a flange

Reposition forward with a Flange

*this is an Anterior Repositioning Device

40

How far forward do you bring an Anterior Repositioning Device?

(forward w/ flange)

enough to where they aren't popping

41

A splint that tries to distract the condyle bilaterally but is not effective b/c of the position of the Masseter muscle is what?

Bilateral Pivot

*never use

42

A splint that repositions the Mandible forward to relieve pressure on the posterior attachment

Anterior Positioning Appliance

*for some reason referred to as the forward w/ flange

43

A splint that has been shown to successfully reduce clenching pressure and masseter pain but is NOT appropriate for relieving joint pain

Anterior Bite Appliance/NTI

*also relieves headaches

44

A splint that creates even contact, covers all the teeth, and relieves both joint and muscle conditions?

Stabilization Appliance

*aka nightguard, CR appliance

45

Tx of long term, with normal Tx, w/o response, you should:
put on opioids
re-assess diagnosis
Surgery
Ortho

Re-assess

*very difficult, most practitioners take Dx and try different Tx for it

46

What tests diagnose Superior Capsulitis?

????? WTF?????

47

What class of meds do we use for joint/tendon pain?

Anti-inflammatories

48

Migraine meds can be Beta blockers, ending in...

and which 2 Anticonvulsants?

LOL

Topomax, Depicote

49

Powerful Narcotics can be used for ____ days

side effect:

3-14 days

Constipation

50

Powerful Narcotics can be used for ____ days

side effect:

3-14 days

Constipation

51

Name 5 muscle relaxants to Tx Muscle Pain:

Flexeril

Zanaflex

Skelaxin

Baclofen

Robaxan

52

3 meds for Non-blockable/sympathetically blockable Neuropathic Pain

Elavil (amitriplyline)

Pamelor (nortryptyline)

Alpha blockers (Clonidine, Prazocin, Hytrin)

53

Neuropathic pain can be treated with Lidocaine

True

54

6 meds for Blockable Neuropathic pain:

note: combos also used

Tegretol (carbamzepine)

Liorisal (Baclofen)

Depakote (Valproate)

Dilantin (Phynytoin)

Konopin (Clonazepam)

Topomax

55

11 meds for Neuropathic Pain:

Tegretol

Depakote

TCA's

Gabapentin (Neurontin)

Baclofen

Hytrin/minipress

Gabatril

Topamax

Trileptal

Lamotrigine

Dilantin

56

11 meds for Neuropathic Pain:

Tegretol

Depakote

TCA's

Gabapentin (Neurontin)

Baclofen

Hytrin/minipress

Gabatril

Topamax

Trileptal

Lamotrigine

Dilantin

57

Abortive migraine meds include what class?

his fave Beta Blocker:

Ca channel blocker:

2 anti-convulsants:

SNRI w/ TCA:

Triptans

Inderal (lol)

verapamil

topamax, depakote

pemelor

58

Abortive migraine meds include what class?

his fave Beta Blocker:

Ca channel blocker:

2 anti-convulsants:

SNRI w/ TCA:

Triptans

Inderal (lol)

verapamil

topamax, depakote

pemelor

59

What is the best/most specific imaging for disc/TMJ

MRI

60

If a jaw deviates to one side, it is joint and...

ADD w/o reduction

61

Whiplash causes TMD

yes

62

NTI is for

Myalgia

63

Pt has popping/locking, what splints?

Anterior repositioning

Unilateral splint w/ flange

64

CR to CO slide greater than _____, TMJ problem

over 2mm

65

soft end feel:

hard end feel:

pry open, goes more (Muscle)

pry open, goes no further (ADD w/o reduction or coronoid locked over zygoma)

66

What kind of pain can refer?

Myofascial

67

Temporalis trigger points:

Masseter:

SCM:

Trap/posterior cervicalis:

Lat Pterygoid:

Mx ant, PM's, molars

ear, lower molars, above rt eye

ear, above eye, eye, occiput

temple, ear, eye

zygoma, TMJ, eye

68

Intrinsic TMJ ligament:

2 Extrisics:

Temporomandibular

Stylomandibular, Sphenomandibular

69

Stylomandibular:

Sphenomandibular:

Temporomandibular:

Styloid process, angle Mn

Spine of sphenoid, Lingula

prevents Mn from being pushed back

70

Condyle articulates in what zone?

Intermediate

71

measurements: Posterior zone:

anterior zone:

intermediate zone:

3mm

2mm

1mm

72

Most TMD cases are both joint and muscle

True

73

Stabilization appliances reduce forces by ___%

but do not increase _____

70%

joint space

74

Stabilization appliances reduce forces by ___%

but do not increase _____

70%

joint space

75

What type of movement pain is Joint?

Closing

76

___% of the population has 1 sign

__% has 1 symptom

__% needs Tx

75%

33%

5-7%

77

__% pts in office will have non-tooth related pain

40%

78

rotation:

sliding/displacement:

inferior

superior

79

Lateral ROM:

Protrusion:

opening:

10-12mm

8-10 mm

over 40 mm

80

Use pain meds for migraine

false

81

use propanolol/beta blockers/inderall for nerve pain

False

*migraine only

82

Tegretol/carbmazeinipine is not used for what?

used for?

Migraine

trigem neuralgia

*this is an anticonvulsant

83

What splint for Superior Capsullitis?

What splint for Posterior Capsulitis?

Use bilateral pivot for what?

unilateral pivot

anterior repositioning splint/unilateral w/ flange

never

84

A lateral slide of more than ___mm is significant

2mm

85

Anterior bruxing, anterior open bite, sudden changes in occlusion cause TMD

False

*all PREDISPOSE

86

Penny: Best bone image:

best for soft tissue:

CT (not x-ray)

MRI

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