DH 308 final/quiz lec 6

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Questions and Answers

What is a common symptom associated with temporomandibular disorders (TMD)?

Loss of taste sensation

Painful clicking of the joint during function (correct)

Increased salivation

Swelling of the cheeks

Which muscle-related disorder is included in the group of muscle and fascial disorders of the masticatory system?

Ankylosis

Neoplasms

Bruxism (correct)

Arthritis

What condition can lead to limitations in mandibular mobility?

Bruxism

Arthralgia

Polymyalgia

Dyskinesia (correct)

Which of the following is NOT a primary symptom of temporomandibular disorders (TMD)?

Pain in the lumbar region Signup and view all the answers

Which inflammatory condition is known to affect the TMJ and produce dull, aching pain?

Osteoarthritis Signup and view all the answers

What sign might indicate occlusal trauma in periapical radiographic images?

Widening of the periodontal ligament Signup and view all the answers

Which joint sound is associated with a disruption of normal condyle movement in TMD?

Click or pop Signup and view all the answers

Which condition is characterized by the resorption of bony support due to excessive occlusal forces?

Widening of the periodontal ligament Signup and view all the answers

Which of the following is an example of primary occlusal trauma?

High restoration causing excessive occlusal forces Signup and view all the answers

What characterizes secondary occlusal trauma?

Normal forces exceeding the capability of compromised periodontium Signup and view all the answers

What symptom is NOT typically indicative of temporomandibular disorders (TMD)?

Severe tooth decay Signup and view all the answers

Which of the following is a common cause of temporomandibular disorders?

Psychologic problems and stress Signup and view all the answers

What is one of the main diagnostic categories for temporomandibular disorders?

Muscle dysfunction Signup and view all the answers

Which sign is associated with occlusal trauma diagnosis?

Widening of the periodontal ligament (PDL) Signup and view all the answers

What would be a plausible first step in managing occlusal trauma?

Selectively grinding occlusal surfaces Signup and view all the answers

Which of the following techniques is used in occlusal therapy?

Selective grinding Signup and view all the answers

Which of the following is NOT classified as a pharmacologic therapy for temporomandibular disorders?

Surgical interventions Signup and view all the answers

What approach is considered irreversible in the treatment of temporomandibular disorders?

Occlusal adjustment Signup and view all the answers

Which symptom is commonly associated with temporomandibular disorders?

Jaw pain and fatigue Signup and view all the answers

In managing patients with TMD, why are shorter dental hygiene appointments preferred?

To minimize trauma to the masticatory muscles and joint Signup and view all the answers

What is one of the recommended tools to aid oral hygiene for patients with limited opening due to TMD?

Interdental brushes Signup and view all the answers

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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