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M4: Occlusion > TMDs/CMDs > Flashcards

TMDs/CMDs Flashcards

1
Q

When taking a history of TMD what should you consider with regards to:

  • pain?
  • noises?
A

Pain:

  • character
  • site: jaw, ear, in front of ear, temple
  • affected by: jaw movement, function, parafunction

Noises:

  • clicking, snapping, popping, crepitus (grinding/crunching)
  • on jaw movement
  • in past 30 days
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2
Q

When taking a history, what should you consider with regards to:

  • movement?
  • habits?
  • trauma?
  • co-morbidities?
A

Movement:

  • restricted opening
  • interfering with ability to eat
  • locking - intermittent/persistent, open, closed, able to release with manoeuvre?
  • deviation

Habits: clenching, grinding, chewing or biting habits, musical instruments, singing

Trauma: past history

Co-morbidities:

  • fibromyalgia
  • chronic pain
  • psychological factors: stress, anxiety, depression
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3
Q

How do you examine the TMJs?

What else should you palpate?

A
  • palpate lateral pole: appl gentle pressure to one side, then the other, ask pt if any pain or discomfort
  • open and close 3 times, any pain/discomfort
  • feel for any clicking, crunching, grinding, snapping, popping noises

Does palpation elicit patients familiar pain?

Temporalis: palpate when teeth clenched, above the ear and forwards above the eye

Masseter: stand infront of patient, bimanual palpation (2 fingers inside cheek, 2 outside), open mouth slightly to relax muscle, palpate origin, midpoint and insertion

Mouth opening:

  • deviation on opening
  • extent of opening - unassisted and assisted (gently place 2 fingers between upper and lower teeth gradually moving them apart), 40mm including incisal overlap
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4
Q

What should you examine of the intra-oral soft tissues?

What investigations can you carry out?

A
  • ridging buccal mucosa at level of occlusal plane
  • scalloping of borders of tongue - habitual
  • tooth wear - may determine whether historical or ongoing - take impressions and cast models frequently

Investigations:

  • plain radiographs not normally indicated
  • CBCT - degenerative disease suspected
  • MRI - disc displacement suspected
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5
Q

What are the two classifications of diagnosis of TMDs?

A

Pain related TMDs

  • myalgia (local, myofascial, myofascial with referral)
  • arthralgia - headache related to TMJ

Intra-articular TMDs

  • disc displacement with reduction / with limited opening (presents with a clicking TMJ)
  • disc displacement without reduction with limited opening (previous clicking which stops at same time as onset of restricted opening)/ not limited opening
  • degenerative joint disease
  • subluxation - open lock
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6
Q

For myalgia, give:

  • description:
  • history:
  • examination:
  • sub-types
A
  • description: pain of muscle origin, affected by jaw movement, function or parafunction, replication of this pain on palpation of masticatory muscles
  • history: pain in jaw, temple, infront of ear or in ear, and modified with jaw movement, function or parafunction
  • examination: confirmation of pain localisation in the temporalis or masseter and familiar pain on palpation or maximum unassisted or assisted opening movements

Subtypes:

  • local: localised to site of palpation
  • myofascial: pain extends beyond site of palpation but still within boundaries of muscle being palpated
  • myofascial pain with referral - on palpation pain extends to sites beyond boundaries of muscle being palpated
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7
Q

For arthralgia:

  • description:
  • history:
  • examination:
A
  • description: pain of joint origin affected by jaw movement, function or parafunction and replicated by provocation testing of the TMJ
  • history: identical to myalgia
  • examination: confirmation of pain location in area of TMJs, and familiar pain on papation of lateral pole or on maximal unassisted or assisted opening, right or left lateral or protrusive movements
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8
Q

Disc displacement with reduction:

  • description:
  • history:
  • examination:
A
  • description: disc is in an aterior position relative to the condylar head and the disc reduces on mouth opening (back into correct position)
  • history: noise in past 30 days in movement/function or patient report of any noise during examination
  • examination: clicking, popping and/or snapping on opening and/or closing, and right or left lateral protrusive movements at least one of three times on examination
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9
Q

Disc displacement wothout reduction with limited opening:

  • description:
  • history:
  • examination:
A
  • description: disc does not reduce with opening, persistent limited mandibular movement which does not reduce when the patient or clinician performs a manouevre = closed lock
  • history: jaw locked so mouth will not open fully, limitation in jaw opening interfering with ability to eat
  • examination: maximum assisted opening (passive stretch) movement <40mm including vertical incisal overlap
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10
Q

Degenerative Joint Disease:

  • description:
  • history:
  • examination:
A
  • description: characterised by deterioration of articular tissue with concomitant osseous change in the condyle and/or articular eminence
  • history: noise in past 30 days on jaw movement or function or noise during examination
  • examination: crepitus detected with palpation during one of the following: opening, closing, right, left or protrusive movements

Absence of pain: osteoarthrosis

Pain present: osteoarthritis

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11
Q

Subluxation:

  • description:
  • history:
  • examination:
A
  • description: hypermobility of disc condyle complex and articular eminence, open mouth, disc condyle complex completely anterior to articular eminence and unable to return to a normal closed position without a manipulative manouevre
  • history: past 30 days locking or catching in a wide open position, even for a moment so could not close without a manipulative manouevre (move from side to side)
  • examination: may be no findings at present time
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12
Q

How are TMDs managed?

A
  • reversible and conservative
  • explanation to patient
  • advice focussing on self-management/home physiotherapy
  • analgesia only when necessary
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13
Q

What can the patient do at home to manage TMDs?

A
  • rest and relaxation
  • modify diet
  • avoid wide mouth opening
  • regular application of heat pack - chronic conditions
  • regular application of cold pack - acute onset of pain and/or restricted mouth opening
  • jaw exercises
  • NSAIDs - 14 day course if no contra-indications
  • muscle spasm or disc displacement without reduction with limited opening: diazepam 5 day course if no contra-indications
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14
Q

When should a referral to secondary care be made?

A
  • symptoms lasting more than 3 months
  • persistent or worsening symptoms despite primary care treatment
  • an uncertain diagnosis
  • marked psychological stress associated with symptoms and/or occlusal preoccupation (persistent hyperawareness or hypervigilance of their bite)
  • unexplained persistent pain or chronic widespread pain
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M4: Occlusion (7 decks)

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