Tmd Treatments

Front 1

TMD treatment goals

Back 1

Decrease pain
Decrease adverse loading
Restore function
Resume daily activities

Front 2

TMD natural evolution (frequency)

Back 2

Transient and self-limiting (often)

Front 3

TMD treatment categories

Back 3

Patient education and self-management
Cognitive behavioral
Pharmacologic
Physical therapy
Physical agents or modalities
Appliance
Surgery

Front 4

TMD self-management

Back 4

Limit function to within pain-free limits
Avoid heavy mastication, gum chewing, wide yawning, singing
Visual reminders against habits (clench/brux, tongue thrust, cheek bite, poor sleep posture, object biting, musical instruments)
Heat &/or ice
Gentle ROM exercises

Front 5

When not to use ice

Back 5

Poor circulation (diabetic, radiation, open wounds)

Front 6

When not to use heat

Back 6

Acute inflammation
Infection
<72 hours since injury

Front 7

TMD cognitive behavioral treatment components

Back 7

Habit reversal program
Lifestyle counselling
Progressive relaxation
Hypnosis
Biofeedback

Front 8

TMD cognitive behavioral treatment for nocturnal bruxism

Back 8

Combination of:
EMG biofeedback
Progressive relaxation
Self-directed changes in lifestyle

Front 9

TMD, when use opioids?

Back 9

Last resort
Acute pain
Time-limited use

Front 10

TMD and NSAIDs, how effective in inflammation

Back 10

Effective

Front 11

TMD and NSAIDs, how effective in myogenous pain

Back 11

May not be effective

Front 12

TMD and NSAIDs, how effective in arthrogenous pain

Back 12

May be effective

Front 13

TMD and NSAIDs, what do you do if one doesn't work?

Back 13

Try another

Front 14

TMD, when use corticosteroids?

Back 14

Acute, severe pain because of polyarthritides
Conservative treatment has been unsuccessful

Front 15

TMD, how use corticosteriods?

Back 15

Intracapsular methylprednisone
Limited basis

Front 16

TMD, when use benzodiazepines?

Back 16

Acute pain due to nocturnal bruxism

Front 17

TMD, how use benzodiazepines?

Back 17

Diazepam 5mg HS
1-2 weeks

Front 18

TMD, when use tizanidine?

Back 18

With chronic daily headache (except CTTH)

Front 19

TMD, when use cyclobenzaprine?

Back 19

For fibromyalgia
May decrease mandibular pain on opening

Front 20

TMD, when use Amitriptyline?

Back 20

Chronic TMJ dysfunction
Chronic muscular pain
Muscular headache
Stress associated with nocturnal bruxism
Poor sleep

Front 21

TMD, components of physical therapy

Back 21

Posture training
Exercise
Mobilization

Front 22

TMD, components of posture training

Back 22

Orthostatic posture
Teeth separated
Tongue on floor of mouth

Front 23

TMD, types of exercise

Back 23

Repetitive - coordinated, rhythmic muscular function
Isotonic - Increase ROM
Isometric - Increase muscle strength

Front 24

TMD, components of mobilization regimen

Back 24

Repeated manipulation
Before or with mobilization: heat, cold, ultrasound, TENS, local anesthetic
Manual manipulation, or voluntary maximal lateral exursion to unaffected, then open
Follow with appliance, relaxation therapy, and exercises

Front 25

TMD, possible TENS uses

Back 25

Spasm
Soft tissue edema
Trigger points
Decreased blood flow
Muscle reeducation
(lacks scientific support)

Front 26

TMD, when use ultrasound?

Back 26

Muscle contraction
Joint contracture
Tendonitis
Calcium deposits of bursitis
Chronic pain
(lacks scientific support)

Front 27

TMD, trigger point injection regimen

Back 27

Initially, 3-5 treatments at weekly intervals
Depending on effectiveness, either discontinued, or continued at longer intervals
2% Lidocaine without epi

Front 28

TMD, when use stabilization appliance?

Back 28

Myogenous TMD
Arthrogenous TMD
Unstable occlusion
Nocturnal bruxism with morning pain
Occasionally:
Clenching-induced earache, tooth pain, some temporal headaches

Front 29

TMD stabilization appliance schedule

Back 29

Acute - full-time for specified period
Night only as symptoms decrease

Front 30

TMD anterior positioning appliance, which arch?

Back 30

Maxillary usually more effective

Front 31

TMD anterior positioning appliance, design

Back 31

Minimal posterior occlusal indentations
Reverse guidance incline in anterior segment

Front 32

TMD anterior positioning appliance, when use it?

Back 32

Acute joint pain associated with DDwR

Front 33

TMD anterior positioning appliance, schedule for intermittent DDwoR on awakening

Back 33

Nocturnal wear

Front 34

TMD anterior positioning appliance, schedule for acute DDwoR

Back 34

Full-time wear 5-7 days
Once pain and dysfunction decreased, gradually reduce to night-time use only
If needed, replace with stabilization appliance

Front 35

TMJ surgery contraindications

Back 35

Pending litigation
Depression
Uncontrolled nocturnal bruxism
Did not try non-surgical methods (and find them ineffective)

Front 36

TMJ surgery indications

Back 36

Moderate to severe pain &/or dysfunction

Front 37

TMJ surgery post-op goals

Back 37

Decrease functional load
Eliminate or modify contributing factors
Psych and med support

Front 38

Arthrocentesis uses

Back 38

Intra-articular restrictions
Palliative for acute OA or RA
Relieve painful clicking

Front 39

Arthrocentesis scientific support

Back 39

Not confirmed

Front 40

Arthroscopy uses

Back 40

Painful joints
Hypomobility secondary to persistent nonreducing disc
Post-op pain
Intracapsular fibrosis

Front 41

Arthroscopy scientific support

Back 41

Supported

Front 42

Arthrotomy usually required for...

Back 42

Bony or fibrous ankylosis
Neoplasia
Severe chronic dislocations
Persistent painful disc derangement
Severe OA refractory to conservative treatment

Front 43

Arthrotomy less often indicated for

Back 43

Displaced condylar fractures
Agenesis of condyle
Severe, painful chronic arthridites