Show Menu
Cheatography

Temporomandibular Disorders (Part of Facial pain + HA)

Causes of TMD

Functional - extra-­art­icular (muscle imbalance - Trps in mastic­atory muscles)
Structural - intra-­art­icular (tears of the disc, arthritis) - TRUE TMD
Psycho­logical factors - Bruxism
Occulusal distur­bances

Risk Factors

Female
Bruxism
Gum Chewing
Jaw Play - stretc­hin­g/m­oving jaw alot
Arm leaning
Somati­sation
Life Dissat­isf­action
Negative Psycho­logial symptoms

Muscles of Mastic­ation + Trigger points

 

Masseter

Elevates Mandible

Temporalis

Attaches onto coronoid process - Elevates mandible

Medial Pterygoid

Elevates Mandible - forms a tendinous sling around the angle of mandible, Trp work done intra-­orally

Lateral Pterygoid

Protrusion + Anterior transl­ation of disc condyle - activates too early in opening of the jaw in TMD. Intraoral TrP therapy

Digastric

Depressor - posterior draw/s­tab­ili­sation of the TMJ
Undera­ctive in TMD

Muscles imbalances

Tight
Weak
Elevators & Protruders
Depressors & Retractors
Masseters
Digastric
Medial & Lateral Pterygoid
Suprahyoid muscles
Temporalis
 

RED FLAGS

New/Abrupt onset of pain >50y
Progre­ssively severe
Sleep loss due to pain
Systemic symptoms
Neurol­ogical S&S
Trauma

Examin­ation

Rule out other pathol­ogies
Dental pain
Neck Pain + headaches
Clicking
ROM
Bruxing
Parafu­nct­ional habits
Ear disorders
Hx of trauma (Transient capsul­itis)
Physical Exam
ROM (normal = 45-55mm)
Movement patterns
Condylar exclusion
Centric relation test (pain in joint = intra-­art­icular pathology)
Palpate muscles of mastic­ation
Occuls­ion­/de­ntition
Cx spine - look for upper crossed

Mana­gem­ent

Advice:
Treatment
Soft diet
NSAIDs­/Pa­rac­etamol
Avoid Stimulants
SMT, Mobili­sation of the TMD
Keep lips together, teeth apart + tongue up
Release tight muscles (PIR, TPT, MFR)
Upright posture - head retracted
Stabil­isation exercises
Chew bilate­rally
Correction of posture
Avoid gum chewing & grinding
Advanced
Avoid prone sleeping
Splint therapy
Avoid excessive mouth opening, lip biting, self manipu­lation, jaw stretc­hing, fingernail biting
Relaxation therapy
 
Acupun­cture
 
Special Imaging
 
Occlusal therapy

Joint distur­bances

Anterior Disc Displa­cement
Recapture of an anteriorly displaced disc
Causes - clicking + lateral deviation
Sometimes, condyles cannot recapture the disc - reduced ROM
 
OA
RA
Occlus­ional imbalance
Disc tear/crack

Causes of Bruxism

Sleep Apnoea (Dry mouth causes teeth grinding to create saliva)
Alcohol and stimulants
Tobacco
Stress­/An­xiety
Sleep distur­bance
Abnormal occlussion

Normal­/ab­normal movement patterns

Normal
Abnormal
Tip of chin moves in a continous, smooth line
Tip of the chin - moves in a non-sm­ooth, non-co­ntinous line
Goes inferiorly & Poster­iorly
Protrusive moveme­nt/lack of posterior glide
 

Comments

No comments yet. Add yours below!

Add a Comment

Your Comment

Please enter your name.

    Please enter your email address

      Please enter your Comment.

          More Cheat Sheets by Siffi

          Serious HA Cheat Sheet
          Common HA Cheat Sheet
          Facial Pain Cheat Sheet