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33 Cards in this Set
- Front
- Back
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What are some contributing factors for TMD?
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1. predisposing = bruxism
2. initiating factors = trauma 3. perpetuating factor - parafunction is most common manage condition by allowing pt to heal. |
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What is a contributing or risk factor in TMD?
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Occlusion - we don't know exactly what role it plays.
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Why is hte role that occlusion plays in TMD an unanswered question?
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-Lack of well controlled clinical trials
-Non specific terminology - Non specific signs and symptoms -Non specific diagnosis -Potential for multiple causes |
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Describe the Pullinger TMD study
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-Asymptomatic control group vs. group of patients for TMD
-Cross sectional study -All pts in control group had CR - MIP less than 1 mm. Discrepancies greater than 2 mm were found only in diseased patients. Findings: anterior open bite is correlated with those with osteoarthrosis and myalgia. Which came first? Mean CR MIP slide for control was 0.4 mm. Mean CR MIP discrepancy with osteoarthritis is 0.8 mm. Weak correlation bet. occlusal factors in TMD. Occlusion can be explained for TMD for only 10-20% of patients, 80-90% could not explained by their occlusions. |
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What is TMJ diagnosis separated into?
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Intracapsular = in the joint or extra capsular = in the muscle
Most time the TMD we treat is in the muscle |
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Describe intracapsular diagnosis
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Synovitis and capsulitis = source of the pain is the joint.
-Localized pain that increases during function -Tenderness to palpation of the affected joint -Usually due to trauma: overt (more common - car accident) or microtrauma (falling) - extreme overuse of joint. inflammation will cause the pain. |
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Osteoarthrosis and osteoarthritis
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Degenerative disorder that causes morphologic changes in the condyle.
Arthosis - erroding of the joint and is painless Arthritis - same disease but its earlier stage occurred with pain. |
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What happens with most common intracapsular displacement: anterior disc displacement with reduction?
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Disc is too far forward. Condyle clicks as it opens up and its far forward. If there's a click on the way back, its called reciprocal click (usually not as loud)
Patients with displaced disc have retrodiscal tissues that undergo histologic changes, disk changes reshaped and creates fibrous tissue. Still functions though,and retrodiscal tissue takes over. Studies have shown that in some it goes away since posterior band flattens out. If this is the only problem pt has, its not treated. |
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Where does the condyle function for those with anterior disc displacement?
Difference between acute and chronic displacement? |
Condyle functions partially with the retrodiscal tissue and with posterior band.
For acute displacement, there is pain. For chronic displacement, its painless. |
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Describe disc displacement without reduction?
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Condyle cannot translate. Disc stops it, hardly any rotation and only very very little translation. Sometimes called a closed lock since jaw is locked.
Treatment: Force the condyle to go forward to flatten out the disk. Force the jaw to open. Normal opening between each incisal edge is 40-50 mm. If pt cannot open that wide, theres something wrong. |
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Sponteneuous dislocation of condyle/disc complex
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Entire disc assembly goes past the complex. Pt cannot close. Condyle goes way beyond the retrodiscal tissues. Some are anatomically predisposed to this. Sometimes called an open lock position.
Treatment: press down on the mandible, allows elastic fibers to slowly return the mandible back on its own. |
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Muscle splinting
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Protective muscle co contraction (muscle splinting)
Depressors are trying to open the mandible but the elevators, which are much more powerful, try to prevent this. If this happen over a long period of time, pt will have cyclic muscle pain. If pain is due to inflammation, give pt nsaids. If it lasts a long time, pt can develop cyclic muslce pain. Purpose is to get pt out of pi and t function again normally. |
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Local muscle soreness
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Due to trauma or unaccostumed use of the condyle.
-Post exercise or delayed muscle soreness. |
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Myospasm (acute involuntary contraction)
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Spasm occurs acutely and goes away quickly. Mostly not treated since they go away on their own.
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Myositis and trigger points?
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Inflammation of the muscle -
-trigger points (hypersensitive myofasical pain). Most common place is masseter to push on, and then pain is felt in ear. Causes referred pain. -can be stimulated by pressing and by parafunction. Source of pain is a trigger point and the remote site that it triggers is called "zone of reference"/ heterotopic pain. -Refer pain to many parts of the head. |
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Referred pain from muscles of mastication and cervical muscles..
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TMJs
Ears Various parts of the face Teeth |
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Describe the Celenza study
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30 patients had slide from CR to 0.02 mm MIP to 0.36 mm. Did this on an articulator.
-These patients had full recontruction of CR and MIP. None of the patients were having problems. No change in the treatment but change in the explanation. -Pts always reconstructed to CR.The only starting point you have. |
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Mongini study
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About condylar remodeling. Group of patients received some occlusal treatment for TMD.
Occulsal splints, etc. Flattened condylar lesion were noted in 11 / 22 pts. These lesions that were flatted were rounded off in 7/11 pts 1 year after occlusal therapy - assumed to be osteoarthosis. - No changes were noted in any of hte normally appearing condyles. -if we reconstruct to CR, it'll develop a new relationship between slide and MIP. |
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McDevitt study
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MRI study of CR. Purpose was to see if the disk position could be verified. CR can be verified if position of disc can be verified.
-For pts with normal craniomandibular articulatiorn, CR conincided with position described in definition. Condyle is high and forward against the thinnest part of the disc. -For those with disc displacemet, starndard clinical procedures could identify and record a comfortable, repeatable reference position. |
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What are some conservative therapy methods?
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Occlusal device therapy
Medication |
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Green and Laskin study
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All pts have TMD> Pt used three different occusal devices - first covered no palate 40%, 2nd w/ some anteior teeth coverage 50% , 3rd fully covered it 80% positive result.
However, these groups may include people that may have gotten better anyway. Did another study that did 2 mock occusal equilibration. 16/ 25 pt reported total or nearly totl remission of symptoms. Occlusa device usually coered all of maxillary teeth.Most literature says that 80% will get better anyways. |
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Occlusal device
1. success rate? 2. reversible? 2 main reasons for why occlusal devices work |
1. 80%
2. yes but not always How do they work? Main 2 reasons: reduce bruxism habits reduce contractile activity of elevator muscles |
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William and Lundquist study
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Anterior disclusion, and posterior teeth just occludes for occlusal device. Contractile forces shut down.
Lucia Jig - deprograms, serves anterior stop; holds VD. |
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Anterior repositioning device?
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Effects of occlusal devise may not be reversible. Brings the jaw forward and use it until pain goes away. It they use it long term, they may develop a posterior open bite.
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What causes intruded posterior teeth?
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Posterior open occlusion. The only way to help this is by putting crowns.
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What are some signs and symptoms of TMD?
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Orofacial pain
Joint sounds Impaired function |
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Multifactorial etiology - name 3 factors of TMD
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-Anatomic: some are more susceptible to this.
-Neuromuscular -Psychosocial - pain is not in the joint but in muscle. pain make its become worried.cn result from excessive parafunction. |
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Occurence of TMD in gender, kids, elderly
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-80% women of child bearing age (18-50 yrs)
-uncommon in kids -uncommon in those over 60 |
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What happens to the disc and condyle during opening? Where des the disc start when the patient is closed?
Who is the primary care provider for TMD? |
convexity of condyle is adapted to inferior concavity of disc = closed path position.
disc is in posterior relationship to condyle. as pt opens, condyle rotates and translates. as patient opens, disc opens. Prosthodontists are often primary care providers of TMD. |
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For many years, what was considered to be the cause of TMD?
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-inferior lateral pterygoid is always contracted.
- Costen suggested over closure of VDO. -lack of condylar centricity (retrodiscal tissues and posterior band are in fossa, not condyle in reality). - CR -MIP discrepancy: inferior heald of lateral pterygoid holds the condyle down. the muscle is always contracted in TMD and thats when u develop pain. but accordion to Gibbs and Lundeen , when avg MIP condyle is 13 hundredths away from CR. -Eccentric occlusal interferences may cause TMD. -Anterior open bite relationship -Excessive vertical overlap of anterior teeth -loss of posterior occlusal support |
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TMD
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Collective group of clinical problems and variety of signs = dentist sees, and symptoms = patient complains about.
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Use of pantographic tracing?
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Purprose of pantograph was to restore the occlusion for a patient using a fully adjustable articulator.
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Gibbs and Lundeen study
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IN good occlusion: you can envelope of motion.
- if anterior teeth prevent contact with posterior teeth when they eat. (good occlusion) -Canines slide past each other during eating. -If anterior teeth do not disclude posterior teeth. Woried about mechanical problems, this would be malocclusion. |
