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Flashcards in TMD OMG Deck (85):
1

Unilateral Splint

*brings one side down

Pivot Splint

2

Migraine Headach is hereditary, has multiple triggers, and is Hypersensitivity of what?

Trigeminal Nerve

3

Trigeminal nerve pain associated with TMD is highly associated with what hereditary hyperexcitability disorder?

Migraine

4

A Pivot Splint creates a teeter totter effect side to side that can pull down the ________ on one side to alleviate ________

Condyle

Capsulitis

5

Anterior Repositioning Appliance does what?

Treats what?

Moves jaw forward

Posterior capsulitis/locking on the disc

6

De-afferentation pain

Phantom pain

7

What kind of test can we do to determine Nerve Pain location?

Topical anesthesia

8

What is the most common type of headache?

*gets better w/ activity

Tension

*migraine does NOT get better w/ activity

9

Use peripheral topical anesthetic for...

This wouldn't help for...

Topcal =

Peripheral nerve pain

Abscess tooth

Nerve pain

10

Which muscle would limit side to side movement?

Lateral Pterygoid

11

Severe unilateral orbital headache that makes you want to bang head against the wall

*more men

Cluster headache

12

Nerve pain is more likely to be what type?

Sharp, shooting, electric

13

Infection pain is more likelyto be...

Dull, achy

14

Drug class that can Tx Migraine AND Nerve pain:

Tricyclic antidepressants

15

Cutaneous allodynia

Light touch pain associated w/ Migraine

16

5 Tx's for TTH (tension type headaches)

PT

Antidepressants (tricyclics)

Muscle relaxants

Biofeedback

Trigger point injections

17

3 Tx's for Migraines:

Reduce triggers

Reduce body response to triggers (biofeedback/meds)

Abortive (meds/interventions)

18

Topomax used for what?

Why?

Migraine

Anti-convulsant

19

What drug is good at stopping Migraines?

Triptans

20

4 Prophylactic Tx's for Migraines:

Amitriptlyline

Beta Blockers

Ca channel blockers

Clonidine/coproheptadine/methysergide/naproxen

21

4 abortive Tx's for Migraine:

Ertgotamine (caffeine)

Ergotamine derivatives

Isometheptene

Sumatriptan

22

Symptomatic relief for Migraines can be from aspirin, acetaminophen, codeine, etc

True

23

Beta Blockers can be used for Migrain and Nerve pain

False

***migraine only

24

What is the only anti-seizure med to Tx migraine?

Topomax

25

Triptans are a _______ therapy for Migraines

They are not a _____ med

Abortive

Pain

26

Hormones, CO, sensory overload, foods/beverages, drugs, stress, etc

Triggers for Migraine

27

Tx for TTH (tension type headaches)

PT

Biofeedback

TCA, trigger point injections

Muscle relaxants

28

Tx for Migraine

Reduce all triggers

Reduce body's response to triggers (biofeedback, meds)

Abortive Tx's. (meds/interventions)

29

If you have more than ____ migraines/month, consider Prophylaxis

6/month

30

3 categories of pharmacologic relief for migraines

*for test, should be able to name some in each category

Prophylactic

Abortive

Symptomatic

31

Large, myelinated, tactile, proprioceptive nerve types:

A alpha

B beta

A gamma

32

Small myelinated, pain pricking, touch warmth, cold

Nerve types

A delta

33

Unmyelinated, pain, burning, itch, warm, cold nerve type

C

34

5 comorbidities of Sleep Apnea

Overweight

Snore

Large neck (15/17)

Always tired

Persistent headaches w/ no obvious cause

35

TTH must have 2 of what 3 symptoms?

Non-pulsating pressing/tightening

Bilateral

Physical activity doesn't aggravate

36

Nausea/vomiting and photophobia aren't associated with what type of headache?

TTH

37

TTH have no evidence of organic disease and is fewer than 15 days/month

True

38

Migraine w/o aura lasts how long?

Location?

Quality?

Aggravated by what?

4-72 hours

Unilateral

Pulsating

Physical activity

39

Migraine WITH aura, headache is preceded by 1 symptom that is Visual (3):

Or sensory (4):

Scintillating scotoma, Fortification spectra, Photopsia

Paresthesia, numbness, unilateral weakness, speech disturbance (aphasia)

40

If topical doesn't work, you might have Neuritis, Traumatic neuralgia, and Neuroma

True

41

Beta blockers are used for Migraine but not ________

Nerve pain

*otherwise, similar Tx

42

4 "favorite" drug used for Migraines:

Inderal 20 mg

Verapamil 40 mg

Pamelor (TCA, Na blocker, noradrenergic, seritonergic)

Topamax 15 mg

43

Cluster Headache is ______ and lasts _______

And has 1 of the following: conjuctival infection, facial swelling, lacrimation, miosis, nasal congestion, ptosis, rhinorrhea, eyelid edema

Unilateral, 15-180

44

Develops most often in women in menarche or early 20's

Occurs at the time of menstruation for ____% of female sufferers

Affected by the life cycle events and therapeutic interventions and historically it is difficult to Tx

Menstrual Migraine

60%

True

45

5 diagnostic Red Flags for Headaches:

Rash/meningeal signs/fever

After 50

HIV/cancer

Worsening pain

Focal neurologic disease

46

What is the most accepted theory on migraine pathogenesis?

Neurovascular

47

People w/ certain types of untreated malocclusion are more likely to develop TMD

What types of occlusion predispose to TMD?

False

Vertical/horizontal overjets greater than 3mm

Lateral slided greater than 3mm

48

If you get an Aura, this is always migrain

True

*never TTH

49

Cluster headache will often wake you up in middle of night

True

50

Sinus headache is really rare, when is the only time you get?

Fever, gunk coming out of nose

51

People with excessive incisal guidance or no incisal guidance are more likely to develp TMD

False (this is a myth)

52

The only 2 Anticonvulsants used for migraines:

(Others used for nerve pain)

Depicote

Topamax

53

As dentists you can prescribe these things for Migraines as long as you are competent

True

54

People with gross maxillomandibular skeletal disharmoniesa are more likely to develop TMD

Modification...

False (myth!)

Can but are NOT more likely to predispose to TMD

55

Pivot is the Teeter-Totter effect, pulls down and is for what disorder?

Lateral

56

Sometimes tinnitis can be addressed by making a splint than moves the condyles forward

True

57

Pretreatment radiographs of both TMJ's should be taken to determine the position of the condyles/fossae, and ortho Tx should be directed toward getting condyles in concentric relation to their fossa

False (myth)

***Ortho Tx is Contraindicated, remember

58

Ortho Tx, when properly done, usuallly reduces the likelihood of subsequently developing TMD

False (myth)

*doesn't cause, doesn't cure

59

Finishing ortho cases according to specific functional occlusal guidelines will reduce the likelihood of developing TMD

False (myth)

60

The use of certain traditional procedures (bicuspid extraction, incisor retraction) or appliances (headgear, chin cups, class II elastics) may increase the likelihood of developing TMD

False (myth)

Although, devices CAN aggravate pre-existing TMJ condition

61

Adult pts who have concurrent TMD symptoms and some form of occlusal "problem" require some type of occlusal correction in order to get well and stay well

False (myth)

62

The retrusion of the mandible b/c of natural causes (deep overbite, distalizing occlusal contacts) or iatrogenic procedures (chin cups, incisor retraction, retention during growth spurts) is a major factor in the development of TMD

False (myth)

63

Distalization of the mandible causes articualr disks to slip forward off the condyles, resulting in internal derangements, especially clicking

False (myth)

***comment: Posterior condyle position Predisposes for anterior disc displacement with reduction but not for pain/arthritic changes

64

Posterior/distalization of the mandible predisposes for what?

but not for what?

anterior disc displacement with reduction

pain/arthritic changes

65

Controlled studies fail to demonstrate any association between _______ and TMD signs/symptoms

However, new research indicates a ____% relationship

occlusal interferences

15%

66

TMD conditions, other than condylar auto-repositioning secondary to intracapsular arthrosis, are not associated with any _______

However, slides greater than ___mm are significant

slide length or assymetries

3mm

67

Occlusal guidance patterns are not associated with TMD symptom provocation or conversely health

True

68

Parafunction appears to be universal and is not associated with TMD development or symptomology in healthy individuals

With what exception?

True

Anterior bruxing is a Predisposing factor

69

Sudden changes in occlusion can often cause TMD

True

*like a crown

70

Dental attrition is not associated with TMD, with what exception?

Anterior Bruxism

71

4 Parameters of Normal Occlusion:

Neutral

No anterior open or crossbite

Overjets less than 5mm, Slides less than 2 mm

No notable attrition

72

Parameters of Occlusion for TMD prediction in patients

*3 things

Anterior Open Bite

over 2mm slides, over 5mm overjet

5 or more missing/unreplaced Posterior Teeth (excluding 3rd Molars)

73

Morphologic malocclusion is often a consequence of TMD

However,

False

intracapsular TMJ diseases

74

There is no evidence for Prophylactic TMD Tx

There is no evidence for Phrophylactic occlusal therapy

True

True

75

Occlusal factors explain only a small part of TMD, contributing ___%

Etiologic interpretations can't be drawn from prevalence based models

Isolated single occlusal variables have little predictive value

TMD requires multiple sets of multifactorial models and factor combos are disease specific

15%

True

True

True

76

Stabilization appliance is a Nightguard

True

77

What 3 adverse effect do all appliances have?

Caries

Soft tissue health

psychological dependence

78

Anterior positioning appliance does what?

pulls forward

79

Anterior Bite appliance, aka NTI, disoccludes where?

This has what 4 adverse effects?

Posterior

Anterior open bite from Posterior eruption, increase joint loading, ant mobility, aspiration

80

NTI =

also used for what?

Anterior Bite Appliance

migraines

81

Posterior Bite Appliance has what 2 potential Adverse effects?

intrusion of posterior teeth

change in condylar position

82

A pivot appliance may _____ the pivot tooth

Intrude

83

Resilient appliance is a protective Athletic appliance than may have what 2 adverse effects?

increase bruxisim

irritate soft tissue

84

Distraction appliance increases discal space/recaptures displaced disc and may _____ the teeth

Intrude

85

Appliance that may irritate soft tissues and not last long

Hydrostatic appliance

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