Temporomandibular Disorders (Part of Facial pain + HA)
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Functional - extra-articular (muscle imbalance - Trps in masticatory muscles)
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Structural - intra-articular (tears of the disc, arthritis) - TRUE TMD
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Psychological factors - Bruxism
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Occulusal disturbances
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Female
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Bruxism
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Gum Chewing
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Jaw Play - stretching/moving jaw alot
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Arm leaning
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Somatisation
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Life Dissatisfaction
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Negative Psychologial symptoms
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Tight
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Weak
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Elevators & Protruders
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Depressors & Retractors
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Masseters
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Digastric
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Medial & Lateral Pterygoid
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Suprahyoid muscles
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Temporalis
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New/Abrupt onset of pain >50y
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Progressively severe
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Sleep loss due to pain
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Systemic symptoms
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Neurological S&S
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Trauma
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Rule out other pathologies
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Dental pain
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Neck Pain + headaches
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Clicking
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ROM
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Bruxing
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Parafunctional habits
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Ear disorders
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Hx of trauma (Transient capsulitis)
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Physical Exam
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ROM (normal = 45-55mm)
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Movement patterns
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Condylar exclusion
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Centric relation test (pain in joint = intra-articular pathology)
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Palpate muscles of mastication
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Occulsion/dentition
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Cx spine - look for upper crossed
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Advice:
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Treatment
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Soft diet
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NSAIDs/Paracetamol
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Avoid Stimulants
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SMT, Mobilisation of the TMD
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Keep lips together, teeth apart + tongue up
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Release tight muscles (PIR, TPT, MFR)
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Upright posture - head retracted
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Stabilisation exercises
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Chew bilaterally
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Correction of posture
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Avoid gum chewing & grinding
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Advanced
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Avoid prone sleeping
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Splint therapy
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Avoid excessive mouth opening, lip biting, self manipulation, jaw stretching, fingernail biting
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Relaxation therapy
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Acupuncture
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Special Imaging
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Occlusal therapy
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Anterior Disc Displacement
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Recapture of an anteriorly displaced disc
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Causes - clicking + lateral deviation
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Sometimes, condyles cannot recapture the disc - reduced ROM
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OA
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RA
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Occlusional imbalance
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Disc tear/crack
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Sleep Apnoea (Dry mouth causes teeth grinding to create saliva)
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Alcohol and stimulants
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Tobacco
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Stress/Anxiety
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Sleep disturbance
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Abnormal occlussion
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Normal
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Abnormal
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Tip of chin moves in a continous, smooth line
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Tip of the chin - moves in a non-smooth, non-continous line
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Goes inferiorly & Posteriorly
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Protrusive movement/lack of posterior glide
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