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Ministry of Health of Ukraine Ukrainian Medical Stomatolgical Academy Methodical Instructions for Independent Work of Students D

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Ministry of Health of Ukraine Ukrainian Medical Stomatolgical Academy Methodical Instructions for Independent Work of Students D Ministry of Health of Ukraine Ukrainian Medical Stomatolgical Academy Methodical Instructions for independent work of students during the training for the practical studies Academic discipline Surgical stomatology Module № 6 The topic of the stadies Arthritis, arthrosis, pain dysfunction syndrome of №6 temporomandibular joint. Ankylosis of TMJ. Plastic surgery of TMJ. Contractures and dislocations of the lower jaw. Diagnosis, surgical treatment and physiotherapy. Course V Faculty Foreign Students Training, Stomatological Poltava -2020 1. Relevance of the topic: Inflammatory and degenerative diseases of the TMJ belong to a rather common diseases are very difficult in its clinical course and difficult to treat, the frequency of which increases with age. Therefore, knowledge of the clinic, treatments and prevention of inflammatory and degenerative diseases of the TMJ is currently relevant in the study of this subject. 2. THE SPECIFIC AIMS: 2.1. To define what is arthritis, arthrosis, arthrito-arthrosis of the TMJ. 2.2. To analyze the etiology and pathogenesis arthritis, arthrosis, arthrito-arthrosis of the TMJ. 2.3. To suggest a plan of examination for patient with arthritis, arthrosis, arthrito- arthrosis of the TMJ. 2.4. To classify arthritis, arthrosis, arthrito-arthrosis of TMJ. 2.5. To list the main clinical features of acute TMJ arthritis. 2.6. To list the main clinical features of chronic TMJ arthritis. 2.7. To list the major clinical signs of osteoarthritis and TMJ arthritis. 2.8. To list the major clinical signs of TMJ osteoarthritis. 2.9. To appoint the treatment for patients with arthritis, arthrosis, arthrito-arthrosis of TMJ. 2.10. To analyze the data further diagnostic testing of patients with arthritis, arthrosis , arthritis, arthrosis of the TMJ. 3. BASIC KNOWLEDGE, ABILITIES, SKILLS, WHICH ARE NECESSARY FOR STUDY THEMES (intradisciplinary integration) Names of the previous The received skills disciplines 1. Ethics and deontology To establish psychological contact with the patient 2. Human anatomy. To know the anatomy of TMJ. 3. Normal physiology To know the functionality of the TMJ in the norm 4. Pathomorphology. Describe the morphological and functional changes in TMJ at different pathologies. 5. Propedeutic of internal Apply the methods of inspection of patient with medicine different types of pathology TMJ. 6. Radiology Be able to describe the radiographic images of TMJ 7. Clinical pharmacology To know indications, contraindications, dosage, administration schedule of drugs used in the treatment of pathologies of TMJ. 4. TASKS FOR INDIVIDUAL WORK DURING PREPARATION TO LESSON. 4.1. List of basic terms, parameters, characteristic, which a student must master at preparation to lesson: Term Definition 1. Acute arthritis It is an acute inflammatory disease of the joints 2. Chronic arthritis It is a chronic inflammatory disease of the joints, with periods of remission and exacerbation. 3. Arthrito- It is a chronic inflammatory-dystrophic diseases of joints arthrosis 4. Arthrosis It is a chronic dystrophic disease of joint 4.2. Theoretical questions for the lesson: 1. Etiology and pathogenesis of arthritis, arthrosis, arthrito-arthrosis of the TMJ. 2. Classification of inflammatory and degenerative diseases of the TMJ. 3. Clinical features and treatment of acute TMJ arthritis. 4. Clinical features and treatment of chronic TMJ arthritis. 5. Clinical features and treatment of TMJ arthrosis-arthritis. 6. Clinical features and treatment of TMJ osteoarthritis. 7. To suggest the treatment regimen of patients with arthritis, arthrosis, arthrito- arthrosis of TMJ. 8. To analyze the data additional diagnostic testing of patients with arthritis, arthrosis, arthrito-arthrosis of the TMJ. 4.3. Practical works (task) which are executed on lesson: 1. To examine patients with inflammatory and degenerative diseases of TMJ. 2. To describe the case history of patients with inflammatory and degenerative diseases of TMJ. 3. To assign examination plan for the patient with inflammatory and degenerative diseases of TMJ. 4. To make a plan of treatment for patients with inflammatory and degenerative diseases of TMJ. THE CONTENT OF THE TOPIC: The TMJ is a joint that connects themandible (jaw) to the temporal bone of the skull. It moves in three different directions. It acts as a hinge, allowing opening and closing of the mouth, and it also moves forward and backward, as in jutting the jaw, known as protrusion and retrusion respectively, and from side to side. The jaw joint is used in many different activities including chewing, talking, and yawning. Because of the frequency in which the jaw joint is used, TMJ syndrome can be extremely disruptive. The TMJ can be found just forward to and below the ears. If you place your fingers in this area and open and close your mouth, you can feel the joint moving. Rubbing in this area can be very painful in people suffering from TMJ syndrome. The TMJ is controlled by three muscles—the temporalis, the masseters, and inside the mouth, the medial andlateral pterygoids. These muscles are also known as the muscles of mastication or chewing muscles. Together they provide the greatest force per surface area of all human movements. Types of Arthritis The TMJ can be involved in both main types of arthritis. Osteoarthritis, the degenerative, ‘wear and tear’ type of arthritis, tends to come on slowly and is more common in later life. Rheumatoid, or inflammatory type arthritis of the TMJ, can develop rapidly, and at any age, in Juvenile, Psoriatic, Infective, Gout and Ankylosing Spondylitis. Pain is usually felt directly over the joints but can be in the ear, teeth, neck or head. The teeth may not seem to meet together properly and there may be pain on biting, chewing or swallowing. Mouth opening is usually reduced, and the jaw may veer off to one side, or refuse to glide smoothly to each side. It may be difficult to keep the mouth open for dental treatment. Jaw Clicking The jaw may also make clicking or crunching noises on movement. There are two causes of this noise. Bony crepitus where the joint cartilage has degenerated and the bony surfaces are rubbing together is actually quite uncommon. Most people hearing their own jaw click would probably feel that this is exactly what is happening. However this is quite unlikely, especially if the problem is recent. The commonest culprit when a jaw clicks is the disc. What you are usually hearing is the head of the jawbone clicking onto the disc and possibly off it again. The disc may be misshapen or the muscles out of sync, causing it to be in the wrong place. This is similar to the tracking problems we sometimes experience in the knee. The clicks from the TMJ usually sound much louder and more sinister as they are so close to the ear, and the head is very sensitive. It is also important to bear in mind that mild clicking, in the absence of pain is entirely normal. Without any other symptoms it is not something which requires treatment. Loud, persistent or painful clicking does need to be checked by your dentist, doctor or physiotherapist. Hypermobility People who do need to pay attention to clicking jaw joints are those who may be ‘double jointed’. Patients with Benign Joint Hypermobility Syndrome (BJHS, JHS or Ehlers Danlos Syndrome) have an increased ‘play’ in their soft tissues which allows more than the usual amount of movement in a joint. They are susceptible to damage or injury to the jaw joint because of the excessive movement, and could also be more likely to suffer from inflammatory type arthritis. Normal Jaw Movement When the jaw is open to its widest extent it should accommodate the tips of the index, middle and ring fingers of one hand, held out straight and together. Remember, it’s your own fingers, so whether measuring a child or a large adult, individual variations are taken into account. The lower jaw should be able to slide smoothly forward so it juts forward beyond the top teeth. It should also be able to glide to each side, at least to the outer edge of each central top tooth. Treatment Options Patients with inflammatory conditions, looking for additional pain relief may respond to TENS, using tiny dot electrodes. The area needs to be clean, flat and unblemished to ensure a good seal. The electrodes can be tried in various sites around the cheek area to find the most effective placement. Topical anti-inflammatory creams such as Nurofen or Feldene can be used over the jaw, but patients already on other medications or with pre-existing conditions would need to check with their doctor before using. Capsaicin cream is another pain relieving alternative, which has shown some success in clinical trials. It can be made up by a compounding pharmacist in an oral formula or as a cream, such as Zostrix or Capzasin. Self Help Strategies Jaw problems can be eased or prevented by avoiding the following activities: Nail biting Chewing pens and pencils Sleeping on your tummy Biting off sewing threads or fishing line Constantly chewing gum, Minties, Fantales or crunching ice Grinding the teeth and clenching the jaw Wide biting into huge apples, burgers, or overly chewy crusty bread. Biting into refrigerated chocolate with the front teeth Opening bottles with your teeth (ouch!) Constantly playing with the jaw or clicking it in and out. Rubbing too hard over the bony parts of your jaw- it can make them more tender Performing ‘party tricks’ (like ‘who can put a whole tennis ball in their mouth?’) Temporomandibular joint pain dysfunction syndrome This is the most common problem in and around the temporomandibular joint (TMJ) or the jaw joint. Jaw problems affect a person’s ability to speak, eat, chew, swallow and even breathe. Epidemiology Predominantly affects people aged between 20—40 years old.
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