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DMD3 sem 2 > TMJ arthritis > Flashcards

TMJ arthritis Flashcards

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1
Q

Does the condyle articulate directly with the glenoid fossa?

A

Glenoid fossa at base of temporal bone

No contact between the condyle and the post glenoid surface even during retrusion

Articular disc forms cap around the head of the condyle

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2
Q

How are the mandibular condyles shaped?

A

Mandibular condyles are olive shaped and the axis is not straight lined. Lateral pole is anteriorly placed and medial pole is posteriorly placed.

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3
Q

What is the articular disc of the TMJ?

A

Articular disc is a biconcave fibrous structure that divides upper and lower compartment of the TMJ. It fits around the condyle like a cap and in front of the condyle. Between the 2 bands is an avascular thin area.

Disc is attached to the neck of the condyle on the posterior condyle and elastic tissue fuses with the squamotympanic fissure

Anteriorly some fibers fuse with the capsule and some fibers superior head of the lateral pterygoid muscle.

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4
Q

What movements do the different compartments allow?

A

Superior compartments allows translatory movements

Inferior compartment allows hinge movements

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5
Q

What are the attachments of the joint capsule of the TMJ?

A

Medial and lateral poles of the condyle beneath the articular disc as well as laterally along the roots of the zygomatic process and medially along the medial aspect of the glenoid process

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6
Q

What ligaments improve TMJ stability?

A

Strengthened laterally by a band of fibrous tissue called the lateral ligament preventing lateral dislocation of the joint.

Sphenomandibular ligament and stylomandibular ligament help to stabilize the TMJ

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7
Q

What are the roles of the synovial membrane?

A

Lubrication

Nutrition

Removal of wastes

protection

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8
Q

What is arthritis?

A

Inflammation of the articular surfaces of the joint

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9
Q

How common is arthritis in Australia?

A

> 3.1 million people self-report arthritis

1.6 million affected by osteoarthritis

> 428000 suffer from Rheumatoid arthritis

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10
Q

How does age affect arthritis?

A

Prevalence of arthritis increases with age most common in people over 45 years of age. Higher in females of older age groups

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11
Q

What are the types of arthritisi that can affect the TMJ?

A

Degenerative

Traumatic

Infectious

Metabolic

Immune-mediated

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12
Q

What is osteoarthritis?

A

Inflammatory condition affecting the articular cartilage of synovial joints.

Affected by mechanical loading, physical stress and traumatic injury of the joints

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13
Q

How does osteoarthritis affect the TMJ?

A

Most common disease affecting the TMJ

May be present in TMJ in absence of other joints

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14
Q

What are the subtypes of osteoarthritis?

A

Primary of unknown aetiology

Secondary due to macrotrauma or chronic microtrauma

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15
Q

What is osteoarthrosis?

A

Non-inflammatory condition that produces similar degenerative changes to O. However, this is now a redundant term and is just called osteoarthritis.

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16
Q

What are the symptoms of osteoarthritis of the TMJ?

A

Pain during chewing and worse in late afternoon or evening.

Masticatory muscles are hyperactive to protect the TMJ

Masticatory muscle fatigue.

Limited mouth opening and decreased range of motion

Crepitation

Other symptoms of referred pain like headaches.

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17
Q

What radiographic imaging should be used for TMJ arthritis?

A

No general consensus as to which imaging modality should be gold standard.

OPG is often not enough for diagnosis of TMJ arthritis

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18
Q

What is the radiolucency seen in the head of the condyle on CT in arthritis?

A

Subchondral cyst formation which is a difference in attentuation of the beam in that area not a true cyst

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19
Q

What are the radiological findings of arthritis on CT?

A

Birds beak appearance of glenoid fossa due to osteophyte appearance

Subchondral cyst

Reduction in joint space

Irregularities of the bone

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20
Q

What is used for diagnosis of osteoarthritis?

A

Clinical findings + Radiographic features

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21
Q

What are the DDx for OA?

A

Rheumatoid arthritis

Myofascial pain

Internal derangement

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22
Q

What is the prognosis for OA?

A

Symptoms most severe for the first 4 - 7 months. Worst at 8 - 9 months and least painful at 10 -12 months

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23
Q

How is TMJ OA managed?

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A

Treat symptomatic OA not radiographic changes

Supportive therapy (education and reassurance, habit reduction, etc)

Medications (Analgesics and NSAIDs)

Intra-articular treatments

Surgery (arthroseptesis, arthroplasty)

Dental treatment indicated if bite has changed.

24
Q

What is traumatic arthritis?

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A

Secondary to sudden acute macrotrauma

Depends on severity of trauma to the joint. If severe enough can cause haemarthrosis and damage to the synovial membrane with inflammatory response leading to fibrosis contractions and adhesions in the joint space with fibrous ankylosis). Minor trauma can cause dislocation of the disc.

In severe cases can cause degenerative joint disease and joint asymmetry.

25
What are the clinical symptoms of traumatic arthritis?
Severe pain at rest and with movement Joint tender to palpation, occassionally swollen Decreased ROM Posterior open bite on affected side
26
What are the clinical and radiographic findings of traumatic arthritis?
Severe pain at rest and with movement Joint tender to palpation occassionally swollen Decreased ROM Posterior open bite on affected side Radiograph shows oedema and swelling of intracapsular and capsular structures, and late changes such as a degenerative joint disease or bony ankylosis
27
How is traumatic arthritis managed?
Rule out mandibular fractures Supoprtive therapy such as education and reassurance, jaw rest, habit reduction, physical therapy, and exercises at home may be useful. Stabilisation appliance is given occassionally. Analgesia and NSAIDs
28
What is Rheumatoid arthritis?
Chronic, systemic, slowly progressive inflammatory disease Predominantly affects the peri-articular tissue such as the synovial membrane Progressive destruction of articular and periarticular soft tissue. Extra articular manifestations can form. Bones and cartilage can slowly erode.
29
What are the stages of RA?
Stage 1: Synovitis where synovial membrane is thickened and bones + cartilage erode Stage 2: Pannus formation with extensive cartilage loss and exposed and pitted boney surfaes Stage 3: Fibrous ankylosis Stage 4 is bony ankylosis
30
What causes RA?
Unknown aetiology Seen in 2.5% of population F>M Peak onset at 40 - 60 years of age
31
How common is TMJ involvement in RA patients?
50 - 70% of patients with RA have TMJ involvement
32
What are the clinical symptoms ofTMJ RA?
Deep, dull aching pain in preauricular area espeially during chewing Profile alterations Limited range of motion Morning stiffness (can be present) Crepitus Otalgia
33
What labwork can allow diagnosis of RA?
FBC, RF, ANA, anti-CCP, ESR, and CRP
34
What are the differential diagnoses for RA?
OA Psoriatic arthritis Ankylosing spondylitis Gout
35
How can RA be seen radiographically?
Joint space loss Condylar flattening Synovial proliferation and condylar destruction
36
How is RA managed?
Medication: Noncurative but reduce until remission: NSAIDs Disease modifying Anti-Rheumatoid Drugs / biologics Corticosteroids Dental: Supportive therapy, monitor for occlusal changes clinically Other: Psych support Surgery Imaging
37
What is juvenile idiopathic arthritis?
Clinically heterogeneous inflammatory joint disease of unknown aetiology in children especially female children. Onset is after 16 years of age. Can be a systemic, polyarticular or oligoarticular disease
38
How commonly is the TMJ involved in JIA?
80% of cases but asymptomatic in 70% of these cases
39
What are the clinical manifestations of JIA?
Pain and TMJ tenderness Stiffness Decreased ROM Joint crepitation Otalgia Late manifestations Micrognathia
40
What imaging modality is commonly used for JIA?
MRI as children would be sensitive to too much radiation from a CT Better soft tissue resolution in MRI.
41
What are the radiographic features of JIA?
Pannus formation No bony change Thinning of the articular disc Condylar and articular eminence flattening Diffuse articular surface flattening
42
What are the goals of JIA management?
Early recognition Prevention of damage Suppressing disease
43
How is JIA managed?
NSAIDs DMARDs/Biologics Corticosteroids SAME AS RA Dental management: Supportive therapy Monitor for occlusal changes Stabilisation splint is usually utilized. Other: Imaging Psychological support Surgery
44
What is psoriasis? How often does psoriasis affect joints?
Psoriasis is a chronic inflammatory dermatologic disease Joints are affected in up to 30% of patients. TMJ involvement is uncommon but TMD is common in these patients
45
What are the clinical features of psoriatic arthritis?
Unilateral sudden onset episodic clinical course Pain and tenderness of joint and masticatory muscles Morning stiffness Jaw fatigue Crepitus Occassional painful TMJ capsule swelling Painful mandibular movements with progressive decrease of opening In severe cases can cause ankylosis
46
Who most commonly gets ankylosing spondylitis?
M > F (10:1 ratio) 0.4 - 1.6% prevalence in caucasian population 20 - 30 years old TMJ can be affected several years after onset reported that 4 - 50% have TMJ involvement
47
How can infectious arthritis of the TMJ arise?
TB Syphilis Gonorrhea Lyme disease Actinomycosis Spread of local odontogenic infection through spread through pterygomandibular space. (Odontogenic infections, osteomyelitis, parotid, ear, nose, throat infections) Direct infection through trauma or joint surgery
48
What risk factors increase chance of infectious arthritis?
RA Diabetes mellitus IV drug use HIV Immunosuppressives
49
What are the clinical features of infectious arthritis?
Prodromal period of primary systemic disease Join pain and tenderness Limited ROM
50
How is infectious arthritis managed?
Primary = treatment of infection Secondary = supportive therapy Important to increase range of motion of TMJ to avoid ankylosis or fibrosis.
51
What is metabolic arthritis?
Inflammation of joint tissues due to deposition of microcrystals in synovium can be in the form of Gout or pseudogout
52
Who often gets gout?
Possible genetic inheritance Usually in men >40 years of age
53
What is pseudogout?
Common disease seen in individuals with other metabolic problems such as diabetes. Seen in M = F and people >40 years of age.
54
Does TMJ get affected often by metabolic arthritis?
Yes but rarely.
55
What are the clinical findings of metabolic arthritis?
Restricted mouth opening Mild pain Joint noises
56
What are the radiographic findings of metabolic arthritis?
Several years after onset leading to joint deposits. Pseudogout deposits in joint more quickly
57
What are the lab findings of gout?
Elevated serum uric acid levels Joint fluid aspirate showing opalescent fluid and polarised light shows monosodium urate crystals on microscopy

DMD3 sem 2 (69 decks)

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