TMD

Question 1

What are TMD?

Answer 1

A cluster of musculoskeletal disorders of the masticatory system that share many common symptoms. Characterised by jaw and face pain, temporal headaches, referred ear symptoms, limited opening, TMJ clicking, crepitus and locking. Usually fluctuates with time.

Question 2

What does TMD not include?

Answer 2

1. Iatrogenic trauma or infective causes
2. Neuropathic pain
3. Neoplasia
4. Non-parafunctional tooth wear

Question 3

What are the different classification of TMDs?

Answer 3

1. Joint pain
2. Joint disorders
3. Joint disease
4. Fracture
5. Congenital development disorders

Question 4

What are different classification of masticatory muscle disorders?

Answer 4

1. Muscle pain
2. Contracture
3. Hypertrophy
4. Neoplasm
5. Movement disorders
6. Systemic related conditions

Question 5

What is Dr. Wilkinsons classification of TMD?

Answer 5

1. Masticatory muscle disorders (75% of all TMD)
2. Hypertranslation (less than 10%)
3. Synovitis (15%)
4. Internal derangement (15%)

Question 6

What are previously held believes about the cause of TMD?

Answer 6

1. Occlsuion was the main factor - it is not, this is an old believe which has no merit

2.

Question 7

What are some factors that may be associated/contributing with TMD to look out for?

Answer 7

Take these with a grain of salt because it is sort of the chicken or the egg question:

1. Anterior open bite, overjet > 6-7 mm
2. Unilateral maxillary lingual crossbite
3. Missing posterior teeth > 5 or 6
4. CO-CR slides > 2mm

In general, occlusion has minimal impact on TMD.

Question 8

What some indications of TMD?

Answer 8

2 minute exam:

1. Lateral pole terderness
2. Limitations of opening
3. Clicking
4. Jaw muscle pain
5. Active facets

If any of these two are positive findings, please schedule a thorough examination.

Question 9

What should you ask when taking history of potential TMD?

Answer 9

PHECLFTPT

1. Pain history
2. Headaches
3. Ear symptoms
4. Clicking
5. Limitation of opening
6. Function
7. Trauma history
8. Parafunction
9. Treatments

Question 10

What are the parts of TMD examination?

Answer 10

1. Range of movement examination
2. Clicking assessment
3. Palpation of TMJ, muscle of mastication, digastric, sternomastoid, coronoid process
4. Occlusal assessment
5. Appliances assessment
6. Diagnostic images and tests

Question 11

What are the symptoms of muscle issues only?

Answer 11

1. Muscle and temporal pain
2. Tired masticatory muscles
3. temporalis headaches
4. Sore teeth/gums
5. Tooth soreness and wear
6. Cheek/tongue biting

Question 12

What are the symptoms of tmj hypertranslation?

Answer 12

1. Click over eminence
2. Open hesitation
3. Open locking

Question 13

What are the symptoms of synovitis?

Answer 13

1. Lateral pole tenderness
2. Limited opening
3. Ear symptoms
4. TMJ pain on function

Question 14

What are the symptoms of TMJ form deviation?

Answer 14

A matched reciprocal clicking

Question 15

What are the symptoms of degenerative joint disorders?

Answer 15

1. TMJ crepitus
2. Irregular TMJ radiograph

Question 16

What is post-exercise muscle soreness?

Answer 16

It is acute muscle pain and stiffness that arises the day after unaccustomed exercise or acute overuse. Such as: excessive chewing, talking, bruxism, playing muscial instrument and long dental visits.

Question 17

What is myofacial pain?

Answer 17

It is a chronic muscle condition of unknown origin resulting in regional pain. It usually has trigger points.

Question 18

What are some of the diagnostic way we can diagnose sleep bruxism?

Answer 18

1. PSG (polysanography) scoring using RMMA (rhythmic masticatory muscle activity) is gold standard
2. Tooth wear with no other causes
3. Soft tissue trauma
4. Masseter hypertrophy
5. Waking with transient pain, fatigue, limitation and headaches

Question 19

What factors are associated with bruxism?

Answer 19

1. genetic factors
2. Psychological factors
3. Neurochemical factors - clonazepam/diazepam reduce bruxism