Term
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Definition
| Peripheral, protective and localized, pain is a symptom, appropriately relieved. Anxiety usually dissipates. |
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Term
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Definition
| Peripheral + Central Sensitization. No useful benefit, CNS-Oriented Changes, its own disease. (NT Changes, changes in size of receptor field in sensory cortex), neuroplasticity changes, assoc with psychological problems. |
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Term
|
Definition
1) Preparatory
2) Oral
3) Pharyngeal
4) Esophageal Transport |
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Term
| Tension produced by a group of muscle fibers depends on |
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Definition
1) Cross sectional area
2) Amount of EMG recruitment |
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Term
| Signs and symptoms of Bruxism |
|
Definition
Sensitive painful teeth
Occlusion related periodontal pain
Worn/Cracked/Fractured teeth and restos
Abnormal tooth mobility
WIDENED PDL
Fremitus
Muscles are resistant to fatigue and pain goes away quickly |
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Term
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Definition
| Condyle re-establishes a normal anatomic relationship with disc during condylar translation. Common in asx volunteers (TMJ clicking, normal ROM, no pain). Normal biological variation unless outside RFs are present. |
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Term
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Definition
More problematic clicking: condyle catches, cant get past disc, impeded for seconds/minutes, muscles relax, then click -> rest of ROM is comfortable.
Episodic difficulty/pain with possible disc, synovium or capsule impingement. Pain at time condyle re-establishes normal anatomical relationship with disc. |
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Term
| Acute Disc Displacement w/o R |
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Definition
Condyle fails to re-establish a normal anatomical relationship with disc during condylar translation/rotation, occurs within the last 3 months going from clicking -> abrupt loss of clicking and movement.
Joint pain is provoked by function, limited ROM because condyle can't get past disc.
MARKED LIMITED LATEROTRUSION to the contralateral side. Chronic is more than 3 months. |
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Term
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Definition
Localized joint pain provoked by palpation, loading or function. Fluctuating swelling w/ separation of posterior occlusion. Probable marked decrease in mobility. Possible radiographic increase in superior joint space.
Secondary to infection, trauma, or cartilage degradation. |
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Term
|
Definition
Localized joint pain provoked by joint distraction or exterior/extended function. Fluctuating swelling with separation of posterior occlusion. Probable marked decrease in mobility, possible radiographic increase in joint space.
Secondary to infection, trauma or cartilage degradation. |
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Term
|
Definition
Localized joint pain provoked by palpation, loading or function. Bilateral joint inflammation and structural changes secondary to a general systemic polyarthritic condition. Probable marked decrease in mobility, possible decreased joint space and crepitus.
Pt needs blood panel and serology tests to look for markers of RA/Lupus. Joint is cupped out , top 2/3rd of condyle is missing, round part of articular eminence is gone, joint becomes shorter by 6-7mm -> anterior open bite. |
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Term
|
Definition
Painful inflammatory degenerative condition characterized by progressive deterioration and abrasion of the articular surfaces. Usually self-limiting.
Jt pain at rest and function, crepitus, limited ROM with deflection secondary to pain. possible changes in posterior occlusion. Radio: Loss of cortical integrity, possible bone spurs, subchondral bone cysts, narrowed superior jt space. |
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Term
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Definition
| Nonpainful, non-inflammatory degenerative condition characterized by degeneration of articular tissues due to the overload of the remodeling system. Condyle is melting down and we can't figure out why the jaw keeps falling back down despite elastics. |
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Term
| Juvenile Idiopathic Arthritis |
|
Definition
Spontaneous lytic event -> condyle becoming rapidly and progressively smaller and in some cases disappears. Pt becomes severely retrognathic due to rapid resorption of bone in 2-3mos. Typically painful but not always.
66% malocclusion
30% micrognathia
No association between radiographic findings and symptom severity. Condylar resorption. If left condyle is abnormal, then the mandible will shift to the left. |
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Term
|
Definition
Open lock secondary to hypermobility, condyle remains positioned anterior to the articular eminence, usually influenced by increased muscle activity and ligamentous laxity.
CP: Inability to close, jt pain at time of [term], usually with a history of doing so. |
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Term
|
Definition
| Nonpainful restricted ROM with deflection to affected side, resulting from adhesions/bony proliferations, usually secondary to trauma, polyarthritides or surgery. Marked limited lateral movement to contralateral side + absences of condylar translation. |
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Term
| Etiology of Peripheral Sensitization |
|
Definition
1) Ischemia with prolonged muscle contraction <-- Metabolites: Lactic Acid, ATP, ADP, pH changes.
2) Tissue injury --> Inflammation --> Nociceptor excitation.
3) Spontaneous activation of deep nociceptors -> increase in NGF, glutamate, SP, Histamine |
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Term
| Etiology of Central Sensitization |
|
Definition
1) Sympathetic hemodynamic change (stress)
2) Increase in nociceptive afferent barrages -> increase in SNC. Increase in excitatory AAs and neuropeptides.
3) Decrease in descending anti-nociceptive modulation: serotonin, NA, endogenous opioids. |
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Term
|
Definition
| Muscle tenderness in palpation. |
|
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Term
|
Definition
| Provoke referred pain to other structures via palpation |
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Term
|
Definition
aka Trismus. Acute, sudden, involuntary tonic contraction of muscle (usually medial pterygoid). Acute onset of pain, pain at rest w/ function, increased EMG activity at rest.
May be associated with myositis or local infections.
E: Multiple injections, prolonged stretch/overuse of unconditioned muscles, abrupt/unusual movements. |
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Term
|
Definition
Tendinous infection secondary to direct trauma, repetitive strain, or injury. Acute pain, extreme tenderness with palpation, limited ROM.
Prolonged recovery, slow responders. |
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Term
|
Definition
| Muscular tissue inflammation usually secondary to direct trauma or spreading infection. Constant, acutely painful muscle with diffuse tenderness, edema, erythema and increased temperature + limited ROM. |
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Term
|
Definition
Painless shortening of the muscle, and chronic resistance to passive stretch as a result of FIBROSIS of supporting tendons, ligaments or the myofibers themselves.
Limited ROM, hard-end feel, little to no pain unless forcefully lengthened.
E: Long periods of limited ROM, muscle infection, direct trauma, scarring, surgery or radiation therapy. |
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Term
|
Definition
| Affects more than 5 joints in 1st 6 months. 75% of patients have radiographic TMJ damage. |
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Term
|
Definition
| Affects 4 or less joints in 1st 6 months. 20% of patients have radiographic TMJ damage. |
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Term
|
Definition
Inflammatory cells invade the TMJ + Hyperplasia of synovial tissues, shows classic features of RA.
Increase in estrogen and relaxin leads to increase cartilage degradation via MMPs.
Decrease in estrogen leads to increase in bone lysis due to increase in osteoclast activity, number and size. Increase in remodeling rate, increase in trabecular spaces and decrease in trabecular connectivity. |
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Term
|
Definition
|
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Term
|
Definition
| Pain to non-painful stimuli |
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Term
|
Definition
|
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Term
|
Definition
| increased awareness of physical symptoms. |
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Term
|
Definition
| A-Delta and C fibers (plus A-Beta when it gets confused with the trigeminal) via the lateral and medial spinothalamic tract. |
|
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Term
|
Definition
1) Central sensitization: Release of excitatory NTs (Substance P, Glutamate, CGRP) sensitizing secondary WDR neurons. in CNS
2) Peripheral: Releasing excitatory AAs (Substance P, NMDA, ATP) occurs at the Trigeminal Ganglion, increasing activity and pain. |
|
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Term
|
Definition
Midbrain: Periaqueductal Grey
Pons: Locus Coerulus
Medulla: Nucleus Raphe Magnus
Release inhibitory NTs: Endogenous opiates, NA, Serotonin, GABA, NMDA, Substance P Antagonists. |
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Term
|
Definition
| Unilateral conjunctivitis, lacrimation, rhinorrhea, miosis, ptosis, eyelid edema |
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Term
|
Definition
| Temporal artery becomes dilated -> pain upon palpation + jaw pain secondary to claudication. Ischemic optic nerve -> blindness in 1/3rd of patients. |
|
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Term
| Intercranial headaches warning signs and symptoms |
|
Definition
Constant/dramatically worsening pain
Sensory/motor neurological deficits
Pain unrelated to physical findings, provocation or function.
Decrease in general health, complaints or multiple failures.
Severe pain with sudden onset |
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Term
| Headache attributed to cervical region |
|
Definition
| Cervical facets, C1,2,3 peripheral nerves, cervical muscles. Common. |
|
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Term
|
Definition
| Attributed to TMD: Myalgia, myofascial pain, arthralgia with secondary myalgia. |
|
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Term
|
Definition
1) Trigeminal
2) Glossopharyngeal (Rare)
3) Occipital
4) Nevus Intermedius, Superior Laryngeal (rare) |
|
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Term
| Trigeminal Episodic Neuralgia |
|
Definition
Unilateral icepick pain, sudden, sharp with severe intensity, seconds to 2 minutes, >50yo, F>M, no neurological deficits, no pain in between episodes, treat with:
Membrane stabilizers
Baclofen
Klonopin, Surgery |
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Term
|
Definition
1) Neuroma
2) Persistent Idiopathic facial pain |
|
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Term
|
Definition
Persistent pain from compression/irritation. Occurs at the end of injured nerve fibers as a form of ineffective/unregulated nerve regeneration.
Tx: LAs and corticosteriods, surgical ablation. |
|
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Term
| Persistent Idiopathic Facial Pain |
|
Definition
Nervous system injury/dysfunction, occurs in absence of tissue damage -> chronic pain. Associated with PN/CN sensitization.
EG Burning mouth syndrome w/ taste dysfunction. 30-40 yos, mod to severe constant pain for months-years, repeated dental failures |
|
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Term
| Neuropathic pain risk factors for Post-Traumatic Trigeminal Neuralgias |
|
Definition
History of chronic pain disease
Pre-Treatment pain
Fear of Pain
Incomplete Anesthesia
Constant persistent pain related to dental treatment (2-5% of endo pts) |
|
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Term
|
Definition
| Lower and upper molar teeth, gingivae, and maxilla. Assoc with sinus headache? |
|
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Term
|
Definition
Noxious stimuli -> Subnucleus caudalis -> Thalamus -> Sensory cortex.
Temporalis and tooth-associated pain -> Lamina 3 in subnucleus caudalis. |
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Term
|
Definition
| Forward along supraorbital ridge and maxillary incisors |
|
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Term
|
Definition
| Temple and maxillary molars |
|
|
Term
| Temporalis (intermediate) |
|
Definition
| Up to mid-temple area and down to maxillary bicuspids. |
|
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Term
|
Definition
| Diffusely to mouth, below and behind TMJ and ear, NOT TO TEETH. Jaw and Face. |
|
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Term
|
Definition
| Deeply to TMJ and maxillary sinus. NOT TO TEETH. Jaw, sinus, paranasal regions |
|
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Term
|
Definition
| 4 mandibular incisors and alveolar ridges. |
|
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Term
|
Definition
| Vertex on same side (Top of head) |
|
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Term
|
Definition
| Forward to temple and forehead over eye, temporal region |
|
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Term
|
Definition
| Up along posterolateral neck to mastoid process, temple, back of orbit, angle of jaw. |
|
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Term
|
Definition
| Up more posteriorly than posterolateral neck to mastoid process, temple, back of orbit, angle of jaw. |
|
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Term
|
Definition
| Superior cervical region, adjacent to mastoid area and acromion. |
|
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Term
|
Definition
| Laterally and diffusely over the back of head and through cranium causing intense pain deep into orbit |
|
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Term
|
Definition
| Cheek, maxilla, over supraorbital ridge, deep within orbit, face |
|
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Term
|
Definition
| Top of head and posterior auricular regions |
|
|
Term
| Types of neuogenic (primary) headaches |
|
Definition
1) Migraine HA
2) Migraine variant HA
3) Tension-Type HA (with and without pericranial muscle tenderness)
4) Cluster HA and other autonomic cephalgias |
|
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Term
|
Definition
Primarily adult females around 30yo, at least 20 shorter acting attacks with more than 5/day. Severe unilateral, orbital, supraorbital and/or temporal pain for 2-30 mins. Assoc w/ at least 1 of Horner's Signs.
Female version of cluster headaches.
Med: Indomethacin. |
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Term
|
Definition
Truama, no association between severity of injury and severity of HA, associated with faintness, poor concentration/memory, anxiety, insomnia.
Interruption of EEG signals -> lowered reaction times. |
|
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Term
|
Definition
Benzodiazepines (Clonazepam)
Muscle Relaxants (Flexeril)
Tricyclics (Pamelar, Doxepin)
Anticonvulsants (Gabapentin)
Botox
Occlusal splints/nightguards. |
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