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39 Cards in this Set

  • Front
  • Back
________________ was associated with joint sounds and masticatory muscle tenderness.
Extensive vertical overlap of anterior teeth

(Extreme vertical overlap tends to be highly associated with TMD. Class II div II patients statistically have problems with TMD.)
_________ is very uncommon in a healthy non-patient population
Horizontal overlap >5mm

(Class II div I w/extreme overjet)
______________, has been associated with condylar changes and with rheumatoid arthritis.
Reduced overbite (anterior open bite)

(we see this a lot in patients with rheumatoid arthritis. Ther anterior open bite is likely caused by the arthritis - when arthritis gets to the joint, some of the condylar head breaks off and the muscles seat the condyle up higher, resulting in an open bite.)
______________ was found to be more common in TMD patients.
Unilateral maxillary posterior lingual crossbite
________ >/= 5 missing posterior teeth
Masticatory efficiency
(Loss of posterior support - this is something we often see with denture patients. Acrylic teeth in the posterior wear easier, and vertical dimension can start to collapse, resulting in clicking and pain in the jaw. This is one of the reasons our treatment plans should always address missing teeth, whether the patient thinks it is a concern or not.)
Loss of posterior support may lead to TMJ symptoms
Tx plans should always address missing teeth, whether the patient requests it or not.
What is a result of direct trauma? Can directly cause muscle damage and TMJ damage. i.e. if you hit the mandible on something, causes retrusion of the mandible and damages some of the soft tissues in the joint.
Macro Trauma
What kind of trauma can an IA block lead to?
Macro Trauma
Needle penetrates many types of tissues, as well as the medial pterygoid muscle and sphenomandibular ligament; patients can call back after receiving an IA and complain that they are having trouble opening.
What are some potential injury sites in an IA block?
Buccinator Muscle
Connective Tissue
Adipose Tissue
(medial pterygoid muscl, sphenomandibular ligament)
What are examples of Direct microtrauma?
Postural habits (phone bracing, dentists, musical instruments)
Very small traumatic events that are repetitive and over a long period of time accumulate to cause trauma.
What is important to consider when using mouth props?
Remove mouth props every so often to give the patient's muscles a break. They stretch the muscles and can cause problems after a while.
Occlusal problems are NOT a Primary cause of TMD
Although there may be a relation
What is important to do if malocclusion is suspected?
Mount the casts and analyze the occlusion
What types of occlusion might cause TMD problems?
Naturally occurring occlusion (no restorations, but naturally occurring interferences)
Altered occlusion (dentist)
Parafunctional habits (change occlusion)
Can we place implants in patients with unstable occlusion?
No, we would need to stabilize the occlusion first.
What are the new terms for Overjet and Overbite?
Overjet = Horizontal Overlap
Overbite = Vertical Overlap
Why is it important to address missing teeth in treatment planning?
Loss of Posterior support
collapsed vertical dimension can result in clicking and pain in the jaw
What are the Patho-physiologic factors involved in the Etiology of TMD?
Vascular disorders
What should you do if your TMD etiologic factor does not improve?
Re-evaluate in 3-4 weeks using a panoral radiograph
What are the Psychosocial Factors that affect TMD?
Anxiety and Depression = increased bruxism
What are 4 different classifications of occlusion?
1. Theoretically Ideal Occlusion of Untreated Natural Teeth (Adheres to predetermined standards)
2. Physiologic Occlusion (Shows variability from predetermined standards, but does not require Tx)
3. Non-Physiologic Occlusion (May require Tx if patients are breaking teeth)
4. Therapeutic Occlusion (structural modification of a non-physiologic occlusion to convert the patient to physiologic occlusion)
What needs to be present in a Theoretically Ideal Occlusion?
Maxilla & Mandible
Temporomandibular Joints & Discs
Muscles of Mastication
Angle's Class 1
Forces over the long axis of the posterior teeth
Fill in the Blank
Heavy anterior occlusion can cause 5 things.
1. Wear
2. Fracture
3. Movement (shifting in the position of a tooth)
4. Development of mobility
5. Painful/symptomatic
Can be a combination of all these problems
How do we clinically manage Anterior Occlusion?
Remove enamel from the lingual.
Use Shim Stock
Adjust occlusion so that you can pull the shim stock out from an MICP position without ripping it
How thick is shim stock?
12.7 - 40 Microns
Which teeth stop mandibular closure in ideal occlusion?
Posterior teeth
What are the components of Theoretically ideal occlusion?
1. Patient satisfied with esthetics, speech and masticatory function
2. Low muscle activity at rest
3. Minimal parafunction
4. Intact periodontium
5. No occlusal awareness
What type of wear is most likely if it is found on the linguals of Maxillary anterior teeth?
What occurs when patients pass from one dentist to another seeking Tx to correct their bite. They cannot get used to the occlusion with crown/bridge/dentures.
Phantom Bite Syndrome
In Theoretically Ideal Occlusion the patient has Bilateral balanced occlusion, Canine guidance, and Group function.
What is the definition of group function?
Teeth on the working side contact and teeth on the non-working side do not.
Why might we build canine guidance into some TMD appliaces when patients are have muscle pain?
Canine disclusion separates the posterior teeth - This is when we get the Least Amount of Muscle Contraction
When the patient moves anteriorly, the posterior teeth disclude and their should be no contacts. It is important to have disclusion of the posterior teeth because this provides the least amount of muscle activity (canine protected articulation).
Contact of the canines decrease the muscle activity?
It is NOT the Contact of the Canines that Decreases the Activity, But the Elimination of Posterior Contacts
Explain why missing teeth can result in a compromised occlusal plane.
All teeth should be present to prevent supraeruption and/or drifting. Opening of interproximal contacts producing food impaction and development of periodontal pockets. This results in increased difficulty in restoring caries. Caries form apical to the normal contact point/root caries develop.
What is MCP and where should it be in Theoretically Ideal Occlusion?
Muscle Contact Position. MCP = MICP
When you tell a patient to close, can they put their teeth together? The image at the bottom shows a patient who cannot close together.
In theorectically Ideal Occlusion where should MICP be?
MICP should be at or near CR.
CR is the most stable position of the joint. Adequate interocclusal space is usually not a problem unless dealing with partials and dentures.
Do we need to treat patients who are in physiologic Occlusion?
They show variability from the predetermined standards, but does not require Tx
What conditions can be included in physiologic occlusion?
Movement of Teeth
Cracking/fracture of teeth
Symptomatic teeth
Abfraction formation
What should we do with a patient who only has contacts on the 2nd molars. Pt can eat ok and speak ok?
Leave it alone and monitor the patient.
If this is something that has recently developed, then it is something we want to take a closer look at.