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Questions and Answers
What is a common symptom associated with temporomandibular disorders (TMD)?
Which muscle-related disorder is included in the group of muscle and fascial disorders of the masticatory system?
What condition can lead to limitations in mandibular mobility?
Which of the following is NOT a primary symptom of temporomandibular disorders (TMD)?
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Which inflammatory condition is known to affect the TMJ and produce dull, aching pain?
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What sign might indicate occlusal trauma in periapical radiographic images?
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Which joint sound is associated with a disruption of normal condyle movement in TMD?
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Which condition is characterized by the resorption of bony support due to excessive occlusal forces?
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Which of the following is an example of primary occlusal trauma?
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What characterizes secondary occlusal trauma?
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What symptom is NOT typically indicative of temporomandibular disorders (TMD)?
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Which of the following is a common cause of temporomandibular disorders?
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What is one of the main diagnostic categories for temporomandibular disorders?
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Which sign is associated with occlusal trauma diagnosis?
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What would be a plausible first step in managing occlusal trauma?
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Which of the following techniques is used in occlusal therapy?
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Which of the following is NOT classified as a pharmacologic therapy for temporomandibular disorders?
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What approach is considered irreversible in the treatment of temporomandibular disorders?
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Which symptom is commonly associated with temporomandibular disorders?
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In managing patients with TMD, why are shorter dental hygiene appointments preferred?
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What is one of the recommended tools to aid oral hygiene for patients with limited opening due to TMD?
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Study Notes
Temporomandibular Disorders (TMDs)
- TMDs affect the masticatory system (muscles and joints involved in chewing)
- Extracapsular refers to disorders affecting the muscles.
- Intracapsular refers to disorders affecting the temporomandibular joint (TMJ).
- Causes of TMDs are multifactorial, involving stress, arthritis, psychological problems, and trauma (both single events and repetitive microtrauma).
Categories of TMDs
- Muscle and fascial disorders: Include myalgia, trismus, spasm, dyskinesia, bruxism, and other muscle problems
- Internal derangements: Conditions that disrupt the TMJ's mechanical function (e.g., displaced disc)
- Disorders of mandibular mobility: Ankylosis (joint fusion), muscular fibrosis, internal derangements, and joint adhesions
- Disorders of maxillomandibular growth: Neoplasms (tumors) and other non-neoplastic growth conditions
Common Symptoms of TMDs
-
Pain & Tenderness:
- In muscles of mastication
- In the TMJ
- Clicking: Painful clicking of the joint during chewing
- Limited Mandibular Motion: Difficulty opening or closing the jaw
Additional Symptoms of TMDs
- Uncomfortable bite
- Jaw incoordination (dyskinesia)
- Ringing in the ears (tinnitus)
- Muscle swelling
- Dental signs: Tooth wear, tooth mobility, tooth pain (pulpitis)
TMJ Pain (Arthralgia)
- Pain originates from the soft tissues surrounding the joint, as articular surfaces are not innervated
- Sharp, sudden, and associated with jaw movement
Joint Sounds in TMDs
- Clicking or popping: Single sounds caused by abnormal joint movement.
- Crepitus: Grating sound, also indicative of abnormal joint movement.
Inflammatory Joint Disorders in TMDs
-
Osteoarthritis and polyarthritis:
- Pain is dull, aching, and constant, worsened by jaw movement.
Radiographic Evaluation for TMDs
- Periapical radiographs can show:
- Widening of the periodontal ligament, due to bone resorption from excessive occlusal forces.
Behavioral Therapy for TMDs
- Stress and anxiety counseling
- Depression counseling
- Psychiatric therapy
Pharmacologic Therapy for TMDs
- Analgesic medications (pain relievers)
- Antianxiety drugs
- Antiinflammatory agents
- Muscle relaxants
- Local anesthetic medications
Irreversible Treatments for TMDs
-
Surgical treatments:
- Only indicated for a small percentage of patients.
- Permanent alterations of the TMJ or disc.
-
Occlusal adjustment:
- Reshaping of teeth to treat malocclusion.
- No evidence supports its effectiveness.
Dental Hygiene for TMD Patients
- Short, frequent appointments to minimize muscle and joint trauma.
- Use of bite-blocks to keep the mouth open, easing jaw fatigue and pain.
- Small-headed toothbrushes or interdental cleaning devices for easier hygiene with limited jaw opening.
Occlusal Trauma
-
Primary Occlusal Trauma:
- Injury to supporting tissues (periodontal ligament, cementum, bone) due to excessive forces on a tooth with healthy periodontium.
- Examples: High restorations, faulty restorations, fixed or removable prostheses, bruxism, clenching
-
Secondary Occlusal Trauma:
- Normal occlusal forces exceed the capacity of already compromised periodontium (periodontal disease).
- Examples: Severe periodontitis
Signs of Occlusal Trauma
- Tooth mobility
- Fremitus: Tooth vibration during chewing, detected by placing a finger on the tooth.
- Pain
- Tooth migration
- Attrition and abfraction (tooth wear)
- Muscle soreness, headache, neck and shoulder pain
- Widening of the periodontal ligament
Occlusal Therapy
- Selective grinding (Occlusal equilibration): Reshaping tooth surfaces to correct occlusal discrepancies.
- Control of habits (e.g., bruxism)
- Orthodontic tooth movement
- Splinting
- Restorative procedures
- Monitoring without treatment
Occlusal Trauma and Periodontal Disease
- Occlusal trauma does not cause gingivitis or periodontitis, but can accelerate periodontal destruction in the presence of inflammation.
- Secondary occlusal trauma can worsen bone loss.
- It's crucial to address both occlusal factors and inflammation for optimal periodontal health.
Checking for Occlusal Trauma
- Examine functional cusps on the mandible
- Check for fremitus
- Assess for recession, abfraction, muscle soreness, headache, neck pain, and shoulder pain.
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