History Taking

Hanzara Panol
 Objectives

1. To identify the key elements to proper history taking.

2. Discuss the philosophy and purpose of obtaining the history of present illness
3. Discuss getting the chief complaint and others in order of importance
4. Describe the psychology of patient interviews and the questions needed to
help obtain the correct history
5. Discuss non-masticatory disorders that may negatively impact TMD
treatment response
6. Discuss medical and dental disorders that can mimic some aspects of TMD,
but may be differentiated through history and identifying aggravating and
relieving patterns
 Diagnosing Pain
Location Category Pain Disorder
Where is the pain? Clinical characteristics Matches behavior
Understand Know the symptoms
genesis/mechanism

History Physical and Supporting

Psych exam Tests

Chief
Complaint
Location
Onset
Characteristics
Aggravating
Alleviating
Past Consultation
and Txs
Assessment and
Analysis
“A Delicious PIE”

Diagnosis

Planning

Implementation

Evaluation
 Assessment
 Gather information: History and Examination
 Data includes: Physical and Psychological
 Accuracy

Physical and Supporting

History
Psych exam Tests
Chief
Complaint
Past and
Location
Onset
Fmly Hx
Characteristics
Aggravating
Alleviating
Past Consultation
and Txs
 Interview
 Rapport-communication
• Continue interview
 Display Confidence • Referral
 Data collection • Planning
 What is Pain for the Patient

 Specific description
 McGill Pain Questionnaire

Sensory Affective Evaluative Miscellaneous

1-10 11-15 16 17-20
Describe Reaction Intensity General
discomfort description

 Rank Value for each descriptor based on position in the

word set
 PRI(Pain Rating Index)= ∑ rank values
 PPI(Present Pain Intensity) based on scale from 0-5

http://anesthesiology.pubs.asahq.org/article.aspx?ar
 History

•Space for Inquiring

Oral •Relays heavily on
memory

•Time saver
Written
•Frustrating to patient
Chief Complaint
Temporal
Quality Duration
 Location Behavior Localization
Intensity
 Onset Concomitant
 Characteristics Flow
Aggravating and Alleviating Factors

 Effect on functional activities

 Effect on physical modalities
 Medications
 Emotional stress
 Sleep quality
 Litigation
 History

 Past Consultations and Treatments

 Relationship to other pain complaints
 Past medical History: Review of Systems
 Psychologic Assessment

Multidimensional Symptom
Pain Inventory Checklist 90(SCL-
(MPI) 90)

Adaptive Depression
Coping Scale

Interpersonal Somatization
Distress Subscale

Dysfunctional
Chronic Pain

IMPATH Scale
TMJ Scale
Objectives….

 Discuss non-masticatory disorders that may negatively impact TMD

treatment response
 Discuss medical and dental disorders that can mimic some aspects of TMD,
but may be differentiated through history and identifying aggravating and
relieving patterns
 Masticatory Muscle Disorders
Symptoms
 Cyclic Muscle Pain, myalgia
 Headaches
 Dysfunction: Mandibular movements, acute malocclusion

Protective co -contraction
Local muscle soreness
Myofascial pain
Myospasm
Chronic centrally mediated myalgia
Fibromyalgia
Clinical Model of Masticatory Muscle
Pain
 Chronic Muscle Pain: considerations
Perpetuating
Factors

Local Systemic

Downregulation
Therapeutic Continued Sleep
Protracted Recurrent of descending
Mismanagement Emotional Stress disturbances
inhibitory system

Learned Behavior Secondary Gain Depression

 Chronic Systemic
Myalgic Disorder
Chronic Centrally
Mediated Myalgia
• Continuous muscle pain
• Neurogenic Inflammation
NOT myositis
• Antidromic effect on
afferent peripheral
neurons
• Continuity vs Duration
• Ask-Viral Infection?
Trauma?
 Functional Disorders of
the TMJ

PAIN DYSFUCNTION

Arthralgia Disruption of normal condyle disc

movements

Discal, capsular, and retrodiscal Click ,pop, crepitus

ligaments

Sharp, sudden, intense, R/T joint Catching or lock, R/T jaw movement
movement
 Derangements of condyle-disc
complex
 Functional disc displacement
 Internal derangement
 Reciprocal click
 Functional dislocation of the disc
 Functional dislocation with reduction and without reduction
 Closed lock
 Trauma

Macrotrauma Microtrauma
Direct Trauma Chondromalacia
Indirect Trauma Muscle hyperactivity
Orthopedic instability
 Structural Incompatibility of the
Articular Surfaces
 Adherence
 Subluxation
 Spontaneous dislocation
 Predisposing Factors to Disc
Derangement Disorders
 Steepness of articular eminence
 Morphology of condyle and fossa
 Joint laxity
 Hormonal factors
 Attachment of superior lateral pterygoid muscle
 Inflammatory Joint Disorders

 Synovitis
 Capsulitis
 Retrodiscitis
 Arthritides
 Continuum

Normal Joint==>Functional displacement of disc==>Functional Dislocation of disc==>Impingement

of retrodiscal tissue==> Retrodiscitis and tissue breakdown==>Osteoarthritis
 Other Signs and Symptoms associated
with TMD
 Headache
1. Migraine
2. Tension Type h/a

 Otologic Symptoms
 Functional Disorders of the Dentition

 Mobility
 Pulpitis
 Tooth wear
References

1. Bell’s OFP. Chap 9. Principles of Pain Diagnosis. Pg 135-144

2. AAOP Guidelines. Chap 2. General Assessment of the Orofacial Pain
Patient. Pg 25-32
3. Okeson’s TMD. Chap 9. History of and Examination for Temporomandibular
Disorders. Pg 170-174
4. Okeson’s TMD. Chap 8. Signs & Symptoms of TMD. Pg 129-160
5. Orofacial Pain and Headache Sharav, Yair and Benoliel, Rafael.
Quintessence. 2015. Chapter 1.