Temporomandibular Joint Dysfunction Treatments Question And Answers

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Temporomandibular Joint Important Notes

1. Myofascial pain dysfunction syndrome

  • Masticatory muscle tenderness
  • Pain in TMJ
  • Limitation of motion
  • Clicking noise present

Temporomandibular Joint Long Essays

Question 1. Describe the etiology, clinical features, differential diagnosis, and treatment of myofascial pain dysfunction syndrome.
Answer:

Myofascial pain dysfunction syndrome

  • It is a disorder characterized by facial pain limited to the mandibular function, muscle tenderness, joint sounds, absence of significant organic and pathologic changes in TMJ
  • It may be due to functional derangement of dental articulation, psychological state of mind, or physiological state of the joint
  • Coined by Laskin

Etiology:

  • Extrinsic factors
    • Occlusal disharmony
    • Trauma
    • Environmental influences
    • Habits
  • Intrinsic factors
    • Internal derangement of TMJ
    • Anterior locking of disc
    • Trauma

myofascial pain dysfunction syndrome  Features:

  • Unilateral preauricular pain
  • Dull constant sound
  • Muscle tenderness
  • Clicking noise
  • Altered jaw function
  • Absence of radiographic changes
  • Absence of tenderness in ext. auditory meatus

myofascial pain dysfunction syndrome Management:

  • Reassurance
  • Soft diet
  • Occlusal correction: 7 ‘R’s
    • Remove-extract the tooth
    • Reshape grind the occlusal surface
    • Reposition orthodontically treated
    • Restore conservative treatment
    • Replace by prosthesis
    • Reconstruct TMJ surgery
    • Regulate control habits
  • Isometric exercises
    • Opening and closing of mouth 10 times a day
  • Medicaments
    • Aspirin: 0.3-0.6 gm/ 4 hourly
    • NSAIDS: For 14-21 days
    • Pentazocine: 50 mg/ 2-3 times a day

Read And Learn More: Oral Medicine Question and Answers

  • Heat application
    • It increases circulation
  • Diathermy
    • Causes heat transmission to deeper tissues
  • LA injections
    • 2% lignocaine into trigger points
  • Steroid injection
    • As anti-inflammatory
  • Anti-anxiety drugs
    • Diazepam-2-5 mg * 10 days
  • Tens
  • Acupuncture

Question 2. Define trismus. Discuss various causes and management of trismus.
(or)
Define trismus. Discuss various causes and differential diagnoses of trismus.

Answer:

Trismus

It is a condition in which muscle spasm prevents the opening of the mouth

trismus Causes:

  • Orofacial infection
  • Trauma
  • Inflammation
  • Myositis
  • Tetany
  • Tetanus
  • Neurological disorders
  • Drug-induced
  • Extra articular fibrosis
  • Mechanical blockage

Pathogenesis:

Injection of inferior alveolar nerve block
↓
Bleeding at the site
↓
Haematoma
↓
Fibrosis
↓
Trismus

trismus Differential Diagnosis:

  • Internal derangement of TMJ
  • Fracture of mandibular condyle
  • TMJ dislocation
  • Septic arthritis
  • Osteoarthritis
  • Ankylosis
  • Hematoma
  • Acute infections

trismus Treatment:

  • May resolve on its own
  • Manipulation of the jaw by jaw stretcher

Temporomandibular Joint Short Essays

Question 1. Articular disc disorders of the temporomandibular joint.

Answer:

Articular disc disorders of the temporomandibular joint

In osteoarthritis, an articular disc of TMJ is affected

Etiopathogenesis:

Oral Medicine Temporomandibular Joint Etiopathogenesis

temporomandibular joint Types:

  1. Primary: Due to wear and tear
  2. Secondary: Due to local and systemic factors

temporomandibular joint Clinical Features:

  • Age: Older age
  • Site: common in TMJ

temporomandibular joint Presentation:

Unilateral painful joint
↓
Interference in biting and
mandibular movements
↓
Sensitive to palpation
↓
Crepitation of joint
↓
Spasm of muscle
↓
Limitation of joint movements

temporomandibular joint Management:

  • Elimination of cause
  • Relief of pressure
  • Physiotherapy
  • Myotherapy
  • Doxycycline

Question 2. Internal dearangement of temporomandibular joint.

Answer:

temporomandibular joint Definition:

It is the anteromedial displacement of the interarticular disc associated with the posterosuperior displacement of the condyle in the closed jaw position

temporomandibular joint Features:

  • Pain on biting
  • Clicking sound over the joint
  • Deviation of mandible
  • Restricted mouth opening due to pain

temporomandibular joint Management:

1. Anterior repositioning appliances

  • Placed on occlusal surfaces

2. Supportive therapy

  • NSAIDs to relieve pain
  • Heat application

3. Occlusal correction

Question 3. Ankylosis of temporomandibular joint.

Answer:

Temporomandibular Joint Classification:

  • False or true ankylosis
  • Extra articular or intra articular
  • Fibrous or bony
  • Unilateral or bilateral
  • Partial or complete

Etiology:

  • Trauma Congenital
  • Infections -Osteomyelitis
  • Inflammation osteoarthritis
  • Rare causes measles
  • Systemic diseases typhoid
  • Other causes of prolonged trismus

Temporomandibular Joint Pathogenesis:

Trauma
↓
Extravasation of blood into joint space
[haemarthosis]
↓
Calcification of joint space
↓
Obliteration of joint space
↓
Immobility of joint
↓
Ankylosis of joint

Temporomandibular Joint Features:

  • Unilateral:
    • Deviation of the chin on the affected side o Fullness of the face on the affected side
    • Flatness on the unaffected side
    • Crossbite
    • Angle’s class malocclusion
    • Condylar movements absent on the affected side
  • Bilateral:
    • Inability to open mouth
    • Neck chin angle reduced
    • Class 2 malocclusion
    • Protusive upper incisors
    • Multiple carious teeth

Temporomandibular Joint Management:

1. Condylectomy

  • Pre auricular incision given
  • Horizontal osteotomy cut given over condylar neck
  • The condylar head is separated
  • Smoothened the remaining structures
  • Close the wound in layers
  • If required bilateral condylectomy done

Oral Medicine Temporomandibular Joint Condylectomy Surgicak procedure

  1. Exposure of the condylar head via a preauricular incision
  2. Sectioning of condylar head,
  3. Breaking the fibrous adhesions
  4. Condylectomy complete
  5. Suturing the capsule
  6. Final skin suturing

1. Gap arthroplasty:

  • Two horizontal cuts are given
  • Removal of a bony wedge between the glenoid fossa and ramus

Oral Medicine Temporomandibular Joint Gap and Gap arthroplasty with coronoidectomy

  1. Interposition arthroplasty
    • Creation of gap
    • Insertion of barrier (autogenous or alloplastic)

Kaban’s Protocol:

  • Early surgical intervention
  • Aggressive resection
  • Ipsilateral colectomy
  • Contralateral colectomy
  • The lining of the glenoid fossa with temporalis fascia
  • Reconstruction of ramus with a costochondral graft
  • Early mobilization
  • Regular follow up

Kaban’s Protocol

Kaban’s  Complications:

  • Frey’s syndrome
  • Parotid fistula
  • Facial palsy

Question 6. Clinical features and management of degenerative arthritis.

Answer:

degenerative arthritis Clinical Features:

  • Age and sex: Older aged women are more affected
  • Site: Many joints are affected but it is not found often in TM]

Degenerative Arthritis Features:

  • Unilateral pain over the joint
  • It is sensitive on palpation
  • Pain on movement or biting
  • Pain aggravates during the evening
  • There is the deviation of the jaw towards affected side
  • The affected joint is swollen and warm to touch
  • There is the presence of crepitation of the joint
  • There is a limitation of jaw movements
  • It results in stiffness and locking of the jaw

Degenerative Arthritis Management:

  • Elimination of the causative agent:
    • Occlusal adjustment or grinding of teeth
    • Replacement of missing teeth
    • Replacement of ill-fitted denture
    • Treatment of caries and periodontal problems
  • Drugs
    • Analgesics and anti-inflammatory drugs are given.
  • Physiotherapy
  • Myotherapy
  • Arthroscopic lavage
  • A low dose of doxycycline
  • Others
    • Glucosamine
    • Chondroitin sulfate

Question 7. Rheumatoid arthritis.

Answer:

Rheumatoid arthritis

It is a systemic disease that usually affects many joints including the TMJ and the disease is characterized by progressive destruction of the joint structures

Rheumatoid arthritis Clinical Features:

  • Age and sex: women from 20-50 years of age are affected
  • Site: small joints of fingers and toes
  • Presentation
    • Bilateral stiffness
    • Crepitus
    • Tenderness and swelling over the joint
    • Fever, malaise, fatigue
    • Weight loss
    • Polyarthritis affecting large and weight-bearing joints
    • Formation of subcutaneous nodules on the pressure points
    • The joint may become red, swollen, and warm to touch
    • Muscle atrophy around the jaw
    •  Bursitis
  • TMJ involvement
    • Bilateral stiffness of the joint
    • Deep-seated pain and tenderness on palpation
    • Swelling over the joint
    • There is a limitation of mouth opening
    • Pain on biting is referred to the temporal region, ear, and angle of the mandible
    • There is a deviation of the jaw on opening
    • Inability to perform lateral movements
    • Anterior open bite
    • Fibrous ankylosis of the joint

Rheumatoid arthritis Complications:

  • Subluxation
  • Secondary arthritis
  • Muscular atrophy
  • Bird-like face

Rheumatoid arthritis – Radiographic Features:

  • Joint space is reduced
  • There is a flattening of the head of the condyle
  • Erosion of the condyle
  • Hollowing of the condylar cartilage
  • Bony destruction of the articular eminence
  • The condylar outline is irregular and ragged
  • Synovial lining resembles a “sharpened pencil” or “mouthpiece of the flute”
  • Subchondral sclerosis and flattening of articular surface may occur

Rheumatoid arthritis Management:

  • Supportive treatment:
    • Provide adequate rest
    • Advice soft diet
  • Medical
    • Local injection of methyl prednisone acetate
    • 20-80 mg for large joint
    • 4-10 mg for small joint
  • Salicylates for pain relief
  • NSAIDs
    • Phenylbutazone, indomethacin
  • Anti rheumatic
    • Hydroxyl chloroquine sulfate sulphasalazine: 500 mg/day
  • Local therapy
    • Diathermy
    • Jaw exercises
    • Mouth stretchers
  • Surgical
    • Synovectomy: for removal of synovial membrane

Oral Medicine Temporomandibular Joint Short Answers

Question 1. Myositis ossificans.

Answer:

Myositis ossificans

  • It is a condition in which fibrous tissue and hetero-tropic bone forms within the interstitial tissue/ muscle as well as in associated tendons and ligaments

Myositis ossificans Types:

  • Localized
  • Progressive

Oral Medicine Temporomandibular Joint Myositis ossificans Features, Localized and Proressive

Question 2. Laskins criteria for MPDS.

Answer:

  • Four cardinal signs
    • Unilateral pain – dull ache in the ear or preauricular area or angle of the mandible
    • Muscular tenderness
    • Clicking noise in TMJ
    • Limitation of jaw movements
  • Negative characteristics
    • No radiographic changes
    • No tenderness in TMJ on palpation

Oral Medicine Temporomandibular Joint Viva Voce

  1. Temporalis and geniohyoid are most often involved in MPDS

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