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Dentistry Module 4 > Mastication And Occlusion > Flashcards

Mastication And Occlusion Flashcards

1
Q

What is mechanoreception?

A

Detection of mechanical stimuli

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2
Q

What tooth tissue contains lost of mechanoreceptors?

A

The PDL

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3
Q

Define, exteroception.

A

Give information about things coming into contact with the body

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4
Q

Define, proprioception.

A

Awareness of position of body parts in relation to each other and surroundings

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5
Q

What four structures are oro-facial mechanoreceptors found in?

A
  • mucosa
  • PDL
  • muscles
  • joint receptors (TMJ)
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6
Q

In what two ways are mechanoreceptors physiologically classed?

A
  1. Adaptation properties
  2. Receptive field size
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7
Q

What is a ‘receptive field’?

A

The area/space where a stimulus will affect the receptor

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8
Q

What is the key difference between rapidly adapting and slowly adapting mechanoreceptors?

A

Slowly adapting continue responding to a stimulus, whereas rapidly adapting receptors respond only at the onset of stimulation.

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9
Q

what class of mechanoreceptor has rapid adaptation and a small receptive field?

A

RA I

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10
Q

what class of mechanoreceptor has rapid adaptation and a large receptive field?

A

RA II

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11
Q

what class of mechanoreceptor has slow adaptation and a large receptive field?

A

SA II

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12
Q

what class of mechanoreceptor has slow adaptation and a small receptive field?

A

SA I

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13
Q

Which receptor field has lots of receptors in a specific area and is therefore more detailed? Small or large?

A

Small receptor field

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14
Q

What are the four separate types of mechanoreceptors?

A
  1. Meissner’s Corpuscle
  2. Pacinian Corpuscle
  3. Merkel Cells
  4. Ruffini Ending
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15
Q

What are the two types of rapidly adapting mechanoreceptors?

A
  1. Meissner’s Corpuscle
  2. Pacinian Corpuscle
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16
Q

What are the two types of slowly adapting mechanoreceptors?

A
  1. Merkel Cells
  2. Ruffini Ending
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17
Q

Which type of mechanoreceptor is rapidly adapting and has a small receptive field, and is therefore referred to as an RA I mechanoreceptor?

A

Meissner’s Corpuscle

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18
Q

Which type of mechanoreceptor is slowly adapting and has a small receptive field, and is therefore referred to as an SA I mechanoreceptor?

A

Merkel Cells

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19
Q

Which type of mechanoreceptor is rapidly adapting and has a large receptive field, and is therefore referred to as an RA II mechanoreceptor?

A

Pacinian Corpuscle

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20
Q

Which type of mechanoreceptor is slowly adapting and has a large receptive field, and is therefore referred to as an SA II mechanoreceptor?

A

Ruffini Ending

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21
Q

What are the type of mechanoreceptive nerve endings found in PDL?

A

Ruffini endings

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22
Q

What type of nerve axon makes up PDLM’s?

A

A-beta axons

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23
Q

What does PDLM’s stand for?

A

Periodontal Ligament Mechanoreceptors

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24
Q

What main property of PDLM’s allows for easy localisation of pain?

A

They have no branched axons between adjacent teeth

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25
Q

Why are the nerves at the apex of a tooth activated the most?

A

Because this is where most tension within the PDL is

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26
Q

What direction of applied force on a tooth will cause most tension and action potential firing in a slowly adapting manner?

A

Mesially

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27
Q

Within the PDL, where are slowly adapting, low threshold mechanoreceptors found?

A

Apically

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28
Q

Within the PDL, where are rapidly adapting, high threshold mechanoreceptors found?

A

Cervically

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29
Q

how many microns of tooth movement is enough to activate PDL mechanoreceptors?

A

10 microns

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30
Q

What function do PDLM’s control?

A

Fine motor control

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31
Q

Where in the CNS do mechanoreceptors initially synapse?

A

Trigeminal nucleus

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32
Q

what are the three receptors involved in proprioception and where are they found?

A
  1. Muscle spindles (within body of muscle)
  2. Golgi tendon organs (within tendons)
  3. Joint receptors (within joint)
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33
Q

What movement of the jaw are muscle spindles involved with? Closing of jaw, opening of jaw, or both?

A

Closing of jaw

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34
Q

what are the two different types of fibres found in muscle?

A
  1. Extrafusal
  2. Intrafusal
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35
Q

What muscle fibre is described here:

Specialised muscle spindles within a capsule

A

Intrafusal muscle fibres

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36
Q

What muscle fibre is described here:

Bulk of the muscle fibres and is contractile

A

Extrafusal fibres

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37
Q

What part of the Intrafusal fibres is able to be stretched to activate nerve afferents?

A

Non-contractile central portion

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38
Q

What nerve endings within the Intrafusal fibre only detect the length of fibres?

A

Secondary (flower-spray) nerve endings

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39
Q

What nerve endings within the Intrafusal fibre detect the length of fibres and speed of change of length?

A

Primary annuli-spiral nerve endings

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40
Q

What type of motor neurone is an efferent nerve fibre, innervating Intrafusal fibres?

A

Gamma motor neurone

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41
Q

What motor neurones supply extrafusal fibres?

A

Alpha motor neurones

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42
Q

What happens to spindle activity if a muscle becomes more stretched?

A

It increases

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43
Q

What is the role of muscle spindles?

A

They give information about and maintain muscle length, as well as providing load compensation

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44
Q

Where are muscle spindle cell bodies found?

A

In the trigeminal mesencephalic nucleus

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45
Q

What motor neurones cause contraction of intrafusal fibres?

A

Gamma motor neurones

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46
Q

What does alpha-gamma coactivation ensure?

A

That the muscle spindles maintain sensitivity to stretch over a wide range of muscle lengths

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47
Q

What is the innervation and action of the masseter muscle?

A

Innervation: masseteric nerve (Vc)
Action: jaw close, assist protrusion and lateral movement

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48
Q

What are the main muscles of mastication with the skull?

A

Masseter
Temporalis
Medial pterygoid
Lateral pterygoid

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49
Q

What are the three main muscles of mastication that attach to the hyoid muscle?

A

Geniohyoid
Mylohyoid
Anterior belly of digastric

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50
Q

What is the Innervation and action of the temporalis muscle?

A

Innervation: deep temporal nerve (Vc)
Action: jaw close, retrude and assist lateral movement

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51
Q

What is the Innervation and action of the medial pterygoid muscle?

A

Innervation: nerve to medial pterygoid (Vc)
Action: jaw close, assist protrusion, and lateral excursion

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52
Q

What is the Innervation and action of the lateral pterygoid muscle?

A

Innervation: nerve to lateral pterygoid (Vc)
Action: protrude, assist wide open , and lateral excursion

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53
Q

What is the Innervation of the geniohyoid muscle?

A

C1

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54
Q

What is the Innervation of the mylohyoid muscle?

A

Nerve to mylohyoid (Vc)

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55
Q

What is the Innervation of anterior belly of digastric muscle?

A

Nerve to mylohyoid (Vc)

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56
Q

What type of joint is the TMJ?

A

Synovial joint

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57
Q

what are the two movements the TMJ is capable of?

A

Hinge and slide movements

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58
Q

What bone is the glenoid fossa within?

A

Temporal bone

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59
Q

What are the two layers that make up the joint capsule of the TMJ?

A
  1. Outer fibrous layer
  2. Inner synovial membrane
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60
Q

what layer of the joint capsule within the TMJ, secretes synovial fluid to fill the joint spaces?

A

Inner synovial membrane

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61
Q

what are the three accessory ligaments of the TMJ?

A
  1. Stylomandibular ligament
  2. Sphenomandibular ligament
  3. Pterygomandibular ligament
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62
Q

What are the three main zones of the articular disc of the TMJ?

A
  1. Anterior band
  2. Intermediate zone
  3. Posterior band
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63
Q

what nerves innervate the TMJ?

A

Vc: auriculotemporal, masseteric and deep temporal

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64
Q

What arteries supply the TMJ?

A

Superficial temporal artery and maxillary artery

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65
Q

What is intercuspal position?

A

The position of the jaws when the maxillary and mandibular teeth are in maximum intercuspation

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66
Q

In what clinical situation would you commonly assess a patient’s inter-cuspal position (ICP)?

A

To check bite after placing a restoration to ensure that the bite is not too high

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67
Q

What are the three complications that can arise if ICP is too high after placing a restoration, and not fixed?

A
  • can be painful for patient as they will overload the tooth when they bite down
  • The restoration may fracture
  • will change the bite, so surrounding teeth may move out of position
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68
Q

At what point in daily life are teeth most likely in ICP?

A

While eating

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69
Q

Define occlusion

A

The contact relationships of teeth or equivalent

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70
Q

What is, the dynamic relationships of teeth when in sliding contact, referred to as?

A

Articulation

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71
Q

What are the three vertical jaw relationships?

A
  1. Rest/postural position
  2. Intercuspal position (ICP)
  3. Retruded contact position (RCP)
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72
Q

What are the three vertical jaw dimensions?

A
  1. Occlusal vertical dimension (OVD)
  2. Rest vertical dimension (RVD)
  3. Freeway space (FWS)
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73
Q

At rest/postural position, what position are the teeth in?

A

Teeth are apart

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74
Q

What is rest/postural position governed by?

A

Muscle elasticity

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75
Q

what does RCP stand for?

A

Retruded contact position

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76
Q

What is Retruded contact position also known as?

A

Ligamentous position

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77
Q

what vertical jaw relationship gives a reproducible relationship between the maxilla and the mandible?

A

Retruded contact position (RCP)

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78
Q

Describe the retruded contact position

A

Condyles retruded in glenoid fossa and teeth are in contact

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79
Q

Which muscle is going to pull mandible back into RCP?

A

The temporalis muscle

80
Q

Clinically, what would you tell a patient to do in order to bring their occlusion into RCP?

A

Ask patient to curl tongue back to the roof of their mouth towards the soft palate and then close their mouth, this should allow for RCP.

81
Q

What is occlusal vertical dimension (OVD) in regards to jaw relationships?

A

The face height with the teeth in ICP

82
Q

What piece of equipment can be used to measure OVD of jaw relationship?

A

Willis gauge

83
Q

What is the freeway space (FWS)?

A

The space between teeth in rest position OR difference between RVD and OVD on a Willis gauge

84
Q

What is the normal measurement of FWS?

A

2-5mm

85
Q

If a patient is edentulous, using a Willis gauge, how would you decide what height to restore occlusion to?

A

You would measure RVD and then subtract FWS

86
Q

What are the 5 border movements of the mandible?

A
  1. ICP
  2. RCP
  3. Lower extent of retruded hinge arc
  4. Maximum opening
  5. Maximum protrusion
87
Q

What is incisal guidance?

A

The influence on mandibular movements provided by contacting surfaces of the maxillary and mandibular anterior teeth

88
Q

When moving the jaw laterally, what is the side called to which the teeth move?

A

The working side

89
Q

When moving the jaw laterally, what is the side called to which the teeth move away from?

A

The non-working side

90
Q

What is group function?

A

Lateral force spread to a number of teeth

91
Q

Normally teeth do not contact on the non-working side, in what scenario will there be non-working side contact?

A

If the patient has a cross bite

92
Q

What is more favourable, canine guidance or group function, and why?

A

Group function, as the load is spread over more teeth

93
Q

What is the lateral bodily movement of the working side condyle called, where it rotates around vertical axis?

A

Bennett movement

94
Q

Which muscle drives lateral excursion?

A

Lateral pterygoid

95
Q

What does F/F dentures stand for?

A

Full upper/full lower dentures

96
Q

What does P/P dentures stand for?

A

Partial upper/partial lower dentures

97
Q

What does TMD stand for?

A

Temperomandibular Disorders

98
Q

Define TMD’s?

A

A group of conditions affecting the temperomandibular joint and/or the muscles of mastication

99
Q

What is the annual average incidence of TMD?

A

4%

100
Q

what is the prevalence of TMD?

A

10-15%

101
Q

When would pain due to TMD be expected to exacerbate?

A

Upon eating (particularly hard foods) and attempted wide mouth opening

102
Q

What is clicking, snapping or popping of the the TMJ indicative of?

A

Anterior disc displacement

103
Q

What is crepitus?

A

Grinding/crunching noise upon joint movement

104
Q

What are three co-morbidities of TMD?

A
  • fibromyalgia
  • chronic pain
  • psychological factors
105
Q

How would you palpate the temporalis muscle when examining for TMD?

A

Palpate with patients teeth clenched, palpate above the ear and forwards above the eye

106
Q

How would you palpate the masseter muscle when examining for TMD?

A

Bimanual palpation, where you place two fingers inside patients cheek and two fingers on outside of patients cheek

107
Q

What is the measurement of opening of the jaw, that would be deemed as abnormal? And suggestive of TMD.

A

Less than 40mm including vertical incisal overlap

108
Q

What signs on the intra-oral soft tissues are suggestive of a habit such as tooth clenching, grinding or tongue thrusting?

A
  • ridging buccal mucosa at level of occlusal plane
  • Scalloping of borders of tongue (wavy tongue edges)
109
Q

What type of radiograph could be taken, if a patient has suspected degenerative changes in their TMJ?

A

CBCT

110
Q

What type of radiograph can be taken if disc displacement of the TMJ is suspected?

A

MRI

111
Q

What are the two main groups that TMD disorders are split into?

A
  1. Pain related TMD’s
  2. Intra-articular TMD’s
112
Q

What are the two subtypes of pain related TMD’s?

A
  • myalgia
  • arthralgia
113
Q

What is myalgia? And what is a chronic condition associated with it?

A

Disorders related to muscle pain and myofascial pain.

114
Q

what is myofascial pain?

A

A chronic condition that causes pain in the musculoskeletal system

115
Q

What is arthralgia? And what symptom would indicate this in regards to TMD?

A

Disorders related to joint pain, and a headache related to TMD.

116
Q

What are the four categories of intra-articular TMD’s?

A
  1. Disc displacement with reduction
  2. Disc displacement with reduction with intermittent locking
  3. Disc displacement without reduction with limited opening
  4. Disc displacement without reduction without limited opening
117
Q

Name two associated conditions of intra-articular TMD

A
  1. Degenerative joint disease
  2. TMJ subluxation
118
Q

What is subluxation?

A

A condition where the condyle translates anteriorly of the articular eminence during jaw opening and briefly catches in an open position before returning to the fossa spontaneously

119
Q

What is disc displacement with reduction characterised by?

A

Clicking jaw joint

120
Q

What is disc displacement without reduction with limited opening characterised by?

A

A history of previous clicking which stops at the same time as onset of restricted mouth opening

121
Q

What are the two provocation tests you could carry out to examine for myalgia?

A
  1. Palpation of temporalis or masseter muscle
    OR
  2. Maximum unassisted to assisted opening movements
122
Q

Provocation testing of what anatomical structure is required to examine a patient with suspected arthralgia?

A

Provocation testing of the TMJ

123
Q

What intra-articular TMD involves no reduction of the anterior disc and persistent limited mandibular opening (closed lock)?

A

Disc displacement without reduction with limited opening

124
Q

A degenerative disorder involving the joint characterised by deterioration of articular tissue with associated osseous changes in the condyle and/or articular eminence.

A

Degenerative joint disease

125
Q

In degenerative joint disease, when arthralgia is present accompanying crepitus, what is the term used to describe this?

A

Osteoarthritis

126
Q

Upon examination of the TMJ, what characterises degenerative joint disease?

A

Crepitus detected with palpation during either opening, closing, right or left lateral or protrusion movements

127
Q

For subluxation to be termed as such, who is required to move TMJ joint back into position, the patient or the clinician?

A

The patient. It is termed luxation if assistance of the clinician is required

128
Q

What is the common manipulative manoeuver required to return jaw from subluxation?

A

Patient moves jaw from side to side

129
Q

What is the conservative management recommended to patients with chronic TMD conditions?

A

Regular application of gentle heat

130
Q

What is the conservative management recommended to patients with acute onset pain and/or restricted mouth opening due to TMD?

A

Regular application of cold pack

131
Q

If a patient presents with muscle spasm or disc displacement without reduction with limited opening, what medication would appropriate to prescribe for them, and for what length of time?

A

Diazepam 5 day course so long as not contra-indicated

132
Q

When would you refer a patient with TMD?

A
  1. Chronic symptoms lasting more than 3 months
  2. Persistent or worsening symptoms despite treatment
  3. An uncertain diagnosis
  4. Marked psychological distress
  5. Unexplained persistent pain
133
Q

What model is useful for highlighting patients at risk of chronic TMD symptoms? And what does it stand for?

A

FLATS.

Fear of pain
Low mood
Avoidance of functional activities
Thinking the worst
Social impact

134
Q

How many teeth do you require for sufficient masticatory function?

A

5-5 teeth (at least 20 teeth)

135
Q

What movement of the TMJ occurs on normal jaw opening?

A

Hinge

136
Q

What movement of the TMJ occurs on wide jaw opening?

A

Hinge and slide

137
Q

What movement of the TMJ occurs on jaw protrusion?

A

Slide

138
Q

In lateral excursion, what is the movement of the non-working side condyle?

A

It moves downwards, forwards over the articular eminence, and medially

139
Q

what is the movement of the working side condyle?

A

Rotates around vertical axis, completing a lateral bodily movement known as Bennett movement

140
Q

what is the average duration of a chewing cycle?

A

0.5-1.2 seconds

141
Q

What are the four stages of a chewing cycle?

A
  1. Opening
  2. Fast closing
  3. Slow closing
  4. Intercuspal phases
142
Q

In what stages of the chewing cycle does food breakdown occur?

A

Slow closing and intercuspal phase

143
Q

What is the sequence of muscle activation for jaw opening in the chewing cycle?

A
  1. Mylohyoid
  2. Digastric
  3. Lateral Pterygoid
144
Q

What is the sequence of muscle activation for jaw closing in the chewing cycle?

A
  1. Temporalis
  2. Masseter
  3. Medial pterygoid
145
Q

What are the three levels of control of mastication?

A
  1. Reflex
  2. Pattern generator
  3. Voluntary
146
Q

What happens during pattern generator control of mastication?

A

Action potentials are fired to different muscles in a certain pattern to cause certain movements (activates muscle at the right time)

147
Q

What is the pattern generator within the brain stem?

A

The chewing centre

148
Q

What does the motor nucleus, in the brain stem supply?

A

Muscles

149
Q

Where is the chewing centre situated in the brain stem?

A

Medial to trigeminal mesencephalic nucleus

150
Q

What are two common examples of reflex?

A
  1. Knee jerk reflex
  2. Jaw jerk reflex
151
Q

What does reflex latency mean?

A

The time that elapses between application of a stimulus and the start of a reflex response

152
Q

Why is reflex latency shorter for jaw-jerk reflex compared to knee-jerk reflex?

A

Because the distance from the masseter to the brain is much shorter than the knee to the quadriceps femoris

153
Q

Rest/postural position for jaws is not reproducible throughout life. True or false?

A

False, it’s remains reproducible throughout life in both dentate and edentulous subjects

154
Q

What is the role of stretch reflexes during running?

A

They stabilise the jaw during vigorous head movements

155
Q

What are the roles of inhibitory jaw reflexes?

A
  1. Prevent overloading of the masticatory system
  2. To facilitate opening
156
Q

Closing teeth together causes an inhibitory jaw reflex. True or false?

A

True

157
Q

What measurement of tooth movement in microns is enough to produce inhibitory reflex effects in the masseter muscle?

A

Around 9 microns

158
Q

What is the jaw unloading reflex?

A

The reflex inhibition of the muscles of mastication which occurs when food or other material between the jaws suddenly breaks or collapses and which helps stop the jaws forcefully coming together

159
Q

Why would you choose to supply a patient with a soft splint?

A

If they grind their teeth at night

160
Q

What are three types of splints to manage craniomandibular disorders (CMD)?

A
  • soft splints
  • full coverage hard splints
  • repositioning splints
161
Q

What type of splint is described:

Hard splint which aims to give an ideal occlusion by retruding the jaw so that RCP is the same as ICP

A

Stabilisation splint

162
Q

What type of stabilisation splint is for the maxillary arch?

A

Michigan splint

163
Q

what is the advantage of a Michigan splint over a soft splint?

A

A Michigan splint is harder and therefore less likely to be worn down by bruxism

164
Q

What is the complication of stabilisation splints?

A

Hard to make

165
Q

what stabilisation splint is for the mandibular arch?

A

Tanner appliance

166
Q

What is a thermoformed splint?

A

A stabilisation splint that is soft on the inside and hard on the outside, this is usually comfortable to wear for patient.

167
Q

What would you make an anterior repositioning splint for?

A

For patients who suffer with disc displacement with reduction, often used to reduce pain.

168
Q

What dental arch does the anterior repositioning splint fit onto?

A

Mandibular arch

169
Q

Why should you be very hesitant to place an anterior repositioning splint on a young person (16-17)?

A

Because the condyle is most likely not sitting high in the glenoid fossa, it will grow and the mandible may remain protruded even without the splint

170
Q

What type of splint should never be used due to risk of over-eruption?

A

Partial coverage splints

171
Q

What are the five types of articulators?

A
  1. Hand held
  2. Simple hinge
  3. Plane line
  4. Average value
  5. Semi-adjustable-denar
172
Q

What are simple hand held casts used for?

A

Orthodontic analysis and to analyse occlusion in ICP

173
Q

Which type of articulator could be used for a simple denture to assess only ICP?

A

Plane line articulator

174
Q

Which type of articulator is used for simple fixed prosthesis for teeth not involved in guidance and also removable prostheses?

A

Average value articulator

175
Q

What are the two types of semi-adjustable articulators?

A
  • Dentatus articulator called a non-arcon articulator
  • Denar Mark II Articulator called an arcon articulator
176
Q

What is the difference between a non-arcon and an arcon articulator?

A

Non-arcon condyle is part of maxillary component, whereas arcon condyle is part of mandibular component

177
Q

What is a face bow and what is it used for?

A

A dental instrument used in the field of prosthodontics. It’s purpose is to transfer functional and aesthetic components from patients mouth to the dental articulator. Specifically it transfers the relationship of maxillary arch and temperomandibular joint to the casts.

178
Q

Which articulators are face bows used in conjunction with?

A

Average value and Semi adjustable articulators

179
Q

Is an average value articulator non-arcon or arcon?

A

Non-arcon

180
Q

What articulator would you use for restoration of teeth that are involved in guidance, advanced restorative work- e.g. bridges, implants and occlusal reorganisation?

A

Semi-adjustable articular, specifically an arcon articulator.

181
Q

What is a class 1 incisor relationship?

A

The lower incisor edges occlude with the upper central incisor central plateaus

182
Q

What is a class 2 division 1 incisor relationship?

A
  • The lower central incisor edges sit POSTERIORLY relative to the upper central incisor central plateaus.
  • The upper central incisors are either PROCLINED or of an enlarged incilination
  • Often an increased overjet
183
Q

What is a class 2 division 2 incisor relationship?

A
  • The lower central incisor edges sit POSTERIORLY relative to the upper central incisor central plateaus.
  • The upper central incisors are RETROCLINED
  • Often a minimal overjet
184
Q

What is a class 3 incisor relationship?

A
  • The lower central incisor edges sit ANTERIORLY relative to the upper central incisor central plateaus.
  • the overjet is reduced or reversed
185
Q

what are molar relationships also referred to as?

A

Angle’s classification

186
Q

What is a class 1 molar relationship?

A

Mesiobuccal cusp of maxillary molar sits in buccal groove of mandibular molar

187
Q

What is a class 2 molar relationship?

A

Disto buccal cusp of maxillary molar sits in buccal groove of mandibular molar

188
Q

What position is the mandible in a class 2 molar relationship?

A

Backwards

189
Q

What is a class 3 molar relationship?

A

Mandibular molar is anterior to the maxillary molar (sits a whole unit forward)

190
Q

what position will the mandible be in a class 3 molar relationship?

A

Forwards

191
Q

what is meant by ‘skeletal base’?

A

The relationship between the mandible and maxilla

192
Q

according to the BULL rule, what cusps should not be in contact in the maxillary arch?

A

Buccal cusps of teeth

193
Q

In the mandibular arch, which cusps should not be in contact with other teeth?

A

Lingual cusps

194
Q

In an ideal occlusion, which teeth are the only ones in the mouth to contact both an anterior and posterior tooth?

A

Maxillary canines

195
Q

Which teeth are the only ones to not occlude with two other teeth in the mouth?

A

Mandibular central incisor and maxillary third molars

Dentistry Module 4 (20 decks)

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