Flashcards in TMD OMG Deck (85):
*brings one side down
Migraine Headach is hereditary, has multiple triggers, and is Hypersensitivity of what?
Trigeminal nerve pain associated with TMD is highly associated with what hereditary hyperexcitability disorder?
A Pivot Splint creates a teeter totter effect side to side that can pull down the ________ on one side to alleviate ________
Anterior Repositioning Appliance does what?
Moves jaw forward
Posterior capsulitis/locking on the disc
What kind of test can we do to determine Nerve Pain location?
What is the most common type of headache?
*gets better w/ activity
*migraine does NOT get better w/ activity
Use peripheral topical anesthetic for...
This wouldn't help for...
Peripheral nerve pain
Which muscle would limit side to side movement?
Severe unilateral orbital headache that makes you want to bang head against the wall
Nerve pain is more likely to be what type?
Sharp, shooting, electric
Infection pain is more likelyto be...
Drug class that can Tx Migraine AND Nerve pain:
Light touch pain associated w/ Migraine
5 Tx's for TTH (tension type headaches)
Trigger point injections
3 Tx's for Migraines:
Reduce body response to triggers (biofeedback/meds)
Topomax used for what?
What drug is good at stopping Migraines?
4 Prophylactic Tx's for Migraines:
Ca channel blockers
4 abortive Tx's for Migraine:
Symptomatic relief for Migraines can be from aspirin, acetaminophen, codeine, etc
Beta Blockers can be used for Migrain and Nerve pain
What is the only anti-seizure med to Tx migraine?
Triptans are a _______ therapy for Migraines
They are not a _____ med
Hormones, CO, sensory overload, foods/beverages, drugs, stress, etc
Triggers for Migraine
Tx for TTH (tension type headaches)
TCA, trigger point injections
Tx for Migraine
Reduce all triggers
Reduce body's response to triggers (biofeedback, meds)
Abortive Tx's. (meds/interventions)
If you have more than ____ migraines/month, consider Prophylaxis
3 categories of pharmacologic relief for migraines
*for test, should be able to name some in each category
Large, myelinated, tactile, proprioceptive nerve types:
Small myelinated, pain pricking, touch warmth, cold
Unmyelinated, pain, burning, itch, warm, cold nerve type
5 comorbidities of Sleep Apnea
Large neck (15/17)
Persistent headaches w/ no obvious cause
TTH must have 2 of what 3 symptoms?
Physical activity doesn't aggravate
Nausea/vomiting and photophobia aren't associated with what type of headache?
TTH have no evidence of organic disease and is fewer than 15 days/month
Migraine w/o aura lasts how long?
Aggravated by what?
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)
If topical doesn't work, you might have Neuritis, Traumatic neuralgia, and Neuroma
Beta blockers are used for Migraine but not ________
*otherwise, similar Tx
4 "favorite" drug used for Migraines:
Inderal 20 mg
Verapamil 40 mg
Pamelor (TCA, Na blocker, noradrenergic, seritonergic)
Topamax 15 mg
Cluster Headache is ______ and lasts _______
And has 1 of the following: conjuctival infection, facial swelling, lacrimation, miosis, nasal congestion, ptosis, rhinorrhea, eyelid edema
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
5 diagnostic Red Flags for Headaches:
Focal neurologic disease
What is the most accepted theory on migraine pathogenesis?
People w/ certain types of untreated malocclusion are more likely to develop TMD
What types of occlusion predispose to TMD?
Vertical/horizontal overjets greater than 3mm
Lateral slided greater than 3mm
If you get an Aura, this is always migrain
Cluster headache will often wake you up in middle of night
Sinus headache is really rare, when is the only time you get?
Fever, gunk coming out of nose
People with excessive incisal guidance or no incisal guidance are more likely to develp TMD
False (this is a myth)
The only 2 Anticonvulsants used for migraines:
(Others used for nerve pain)
As dentists you can prescribe these things for Migraines as long as you are competent
People with gross maxillomandibular skeletal disharmoniesa are more likely to develop TMD
Can but are NOT more likely to predispose to TMD
Pivot is the Teeter-Totter effect, pulls down and is for what disorder?
Sometimes tinnitis can be addressed by making a splint than moves the condyles forward
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
***Ortho Tx is Contraindicated, remember
Ortho Tx, when properly done, usuallly reduces the likelihood of subsequently developing TMD
*doesn't cause, doesn't cure
Finishing ortho cases according to specific functional occlusal guidelines will reduce the likelihood of developing TMD
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
Although, devices CAN aggravate pre-existing TMJ condition
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
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
Distalization of the mandible causes articualr disks to slip forward off the condyles, resulting in internal derangements, especially clicking
***comment: Posterior condyle position Predisposes for anterior disc displacement with reduction but not for pain/arthritic changes
Posterior/distalization of the mandible predisposes for what?
but not for what?
anterior disc displacement with reduction
Controlled studies fail to demonstrate any association between _______ and TMD signs/symptoms
However, new research indicates a ____% relationship
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
Occlusal guidance patterns are not associated with TMD symptom provocation or conversely health
Parafunction appears to be universal and is not associated with TMD development or symptomology in healthy individuals
With what exception?
Anterior bruxing is a Predisposing factor
Sudden changes in occlusion can often cause TMD
*like a crown
Dental attrition is not associated with TMD, with what exception?
4 Parameters of Normal Occlusion:
No anterior open or crossbite
Overjets less than 5mm, Slides less than 2 mm
No notable attrition
Parameters of Occlusion for TMD prediction in patients
Anterior Open Bite
over 2mm slides, over 5mm overjet
5 or more missing/unreplaced Posterior Teeth (excluding 3rd Molars)
Morphologic malocclusion is often a consequence of TMD
intracapsular TMJ diseases
There is no evidence for Prophylactic TMD Tx
There is no evidence for Phrophylactic occlusal therapy
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
Stabilization appliance is a Nightguard
What 3 adverse effect do all appliances have?
Soft tissue health
Anterior positioning appliance does what?
Anterior Bite appliance, aka NTI, disoccludes where?
This has what 4 adverse effects?
Anterior open bite from Posterior eruption, increase joint loading, ant mobility, aspiration
also used for what?
Anterior Bite Appliance
Posterior Bite Appliance has what 2 potential Adverse effects?
intrusion of posterior teeth
change in condylar position
A pivot appliance may _____ the pivot tooth
Resilient appliance is a protective Athletic appliance than may have what 2 adverse effects?
irritate soft tissue
Distraction appliance increases discal space/recaptures displaced disc and may _____ the teeth