TMD Flashcards
(88 cards)
1
Q
Where is the temporomandibular joint?
A
Anterior to ear tragus
2
Q
What two bones make up the TMJ?
A
Temporal and mandible (condyle) bones
3
Q
What is the disc vascularity?
A
Avascular except at periphery
4
Q
What is the function of fibrocartilage?
A
Shock absorption
stability
Guides motion
5
Q
What is the disc attached to?
A
Muscles
capsule
condyle
ligament
6
Q
What are the joint structures, disc and direct contacting muscles of the TMJ mostly innervated by?
A
The branches of the trigeminal nerve
7
Q
What are the 8 areas of trigeminal nerve symptoms?
A
Ears
Tongue
Eyes
Teeth
Neck
Head
Face
Jaw
8
Q
What is the capsule attached to?
A
Muscle
Disc
9
Q
What does the sphenomandiular ligament prevent? What does it help with?
A
Excessive opening, recoils for closing
10
Q
What does the temporomandibular or lateral ligament prevent?
A
Posterior condyle displacement
11
Q
What does the temporomandibular or lateral ligament initiate?
A
Opening
12
Q
What does the stylomandibular ligament restrain?
A
NO MOTION RESTRAINT
13
Q
What is the resting or closed packed position?
A
Lips closed, teeth not touching and tongue resting on roof of mouth
14
Q
What amount of overbite is a resting position?
A
2mm
15
Q
What is the amount of overjet or overjut beyond overbite in a resting position?
A
≥ 2mm
16
Q
What is the closed packed position of the TMJ?
A
Unknown
17
Q
What is the function of fibrocartilage?
A
Shock absorption, stability, guides motion
18
Q
What is the disc attached to in the TM joint?
A
Muscles
capsule
condyle
ligament
19
Q
What is the capsule attached to in the TMJ?
A
Muscle
Disc
20
Q
What directions do the mandibular condyles move together in?
A
The same or different directions
21
Q
What are the arthrokinematics of the TMJ?
A
Mandibular Condyle is convex on the concave temporal fossa
22
Q
What rule do the TMJ arthrokinematics follow?
A
Kaltenborn’s rule
23
Q
What do the arthrokinematics of the TMJ allow?
A
Multiple functions
24
Q
What is opening the mouth also known as?
A
Mandibular depression
25
What is closing the mouth also known as?
Mandibular elevation
26
What are the Norms with opening of the mouth?
~3 knuckles width
27
What is an urgent referral with opening of the mouth?
If only ≤ 1 knuckle, refer to a dentist/oral surgeon
28
What happens with the mandibular condyles when the mouth is opened?
Mandibular condyles glide anterior
29
What kind of clicking is considered normal upon opening the mouth?
Bilateral clicking
30
What muscles are used to open the mouth?
Digastric
lateral pterygoid
hyoids
31
What is the MAIN opener of the mouth?
Digastric
32
What do the mandibular condyles do upon closing of the mouth?
Glide posterior
33
What muscles are involved in the closing of the mouth?
Temporalis
Masseter
Medial Pterygoid
Lateral Pterygoid
34
What muscles are involved with lateral deviation of the TMJ?
Masseter
Pterygoids
Temporalis
35
What is unique about the pterygoids with lateral deviation of the TMJ?
Same side medial and lateral pterygoids primarily act to move the mandible medial for grinding food
36
What are the S&S of Temporomandibular disorder regarding oral habit history?
- thumb sucker
- nail / ice biter
- excessive teeth grinder
- gum/ smokeless tobacco chewer
37
How do we know if someone is an excessive teeth grinder?
Indicated by AM HA that goes away with ADLs
38
What is the difference between a HA from grinding teeth and a HA from cervical dysfunction?
from grinding teeth goes away with ADLs, with cervical dysfunction likely worse with ADLs
39
What is normal with sleep?
Some grinding, some sleep stages have it happen
40
What are S&S we'd find in observation?
FHP
41
Where would we find pain and crepitis with TMJ?
Localized
42
What can we look for with observation of opening and closing?
Presence and timing of deviation(s)
43
What can become sensitive with TMJ?
Trigeminal nerve - possibly
44
Can hypermobility limit motion?
Yes, if off axis
45
What is earlier deviation WITHOUT loss of functional opening due to?
Greater laxity with hx of trauma
46
Will we have pain with earlier deviation without loss of functional opening?
Minimal to no pain unless irritated
47
What can indicate a hypermobile TMJ with an earlier deviation without loss of functional opening?
Deviation away from unilateral hypermobile TMJ
48
What does a click at the end range indicate? (me)
Larger displacement
49
What is end range deviation without loss of functional motion due to?
due to gradual onset from FHP and less laxity/trauma
50
Will we have pain with end range deviation without loss of functional motion?
Minimal to no pain unless irritated
51
What will we see with end range deviation without loss of functional motion?
Deviation with bilateral hypermobile TMJ, possibly inconsistent
52
What does a click at end range indicate with end range deviation without loss of functional motion?
Larger displacement
53
What is earlier deviation WITH a loss of functional opening due to?
Acute with recent trauma or chronic with fibrotic TMJ
54
What are the S&S of acute earlier deviation WITH a loss of functional opening?
- Deviation toward painful TMJ
- Limitation due to inflammation/unwillingness to move
55
What are S&S of chronic TMJ due to earlier deviation WITH a loss of functional opening?
- Deviation toward hypomobile TMJ
- Limitation due to joint hypo-mobility
56
What does early unilateral clicking upon opening indicate?
Smaller displacement
57
What does inconsistent clicking indicate?
Hypermobility
58
What does reciprocal clicking indicate?
Condyle moves ahead of disc on opening and behind disc on closing
59
What does crepitus indicate in the TMJ?
TMJ and/or disc damage
60
Why is FHP an issue with surrounding musculature?
Increase tension on digastric/hyoid muscles, hyoid bone becomes further away from mandible and clavicles
61
Why can FHP lead to mouth opening?
Tongue drops off roof of mouth, may cause someone to become a mouth breather, makes it hard to keep the neutral position
62
What ligament can FHP increase tension on?
Sphenomandibular ligament
63
What can displace due to FHP? Where?
Mandibular condyle may displace anterior to disc
64
What can we do to assess FHP?
- Have patient swallow in neutral and in FHP
* If WNL, no excessive neck motion
* Excessive neck motion indicates cervical hypermobility/instability
65
What does excessive neck motion in with swallowing indicate?
Hypermobility/instability
66
IF WNL opening in neutral in and FHP should be....
the same
67
If opening is less in FHP compared to neutral, what does it indicate?
possible posterior displacement
68
What happens with a posterior displacement of the TMJ?
Condyle posteiror to the disc
69
What will we find in the hx for a posterior displacement?
Trauma with sudden closing
70
What are the S&S of a posterior displacement?
Likely pain and limitation on opening
Full closing
71
What is the rx for a posterior displacement?
- distraction with anterior glide to reposition mandibular condyle anteriorly to disc
- sleep with small neck roll for slight neck ext
- avoid excessive or hard chewing / grinding
72
What orthotics could be considered for a posterior TMJ displacement?
night splint to maintain slight opening
73
What is the purpose of MET for posterior displacement of the TMJ?
stabilization of TMJ and neck
74
What is an anterior displacement of the TMJ?
Condyle anterior to the disc
75
What is the hx for an anterior displacement?
- Prolonged opening such as from FHP or mouth breathing
- trauma with sudden opening
- excessive opening such as yawning or from dentistry
76
What are S&S of an anterior displacment?
- Full opening / no deviation
- likely pain and limitation upon closing
77
What is the rx for an anterior displacement?
- distraction with a posterior glide to reposition the mandibular condyle posteriorly to disc
- Avoid wide opening with diet/yawning
- sleep with neck flexed and chin tucked
- correct posture
78
What is the purpose of MET for anterior displacements?
Stabilization of TMJ and neck
79
Is an upper or lower TMJ disorder more common?
upper > lower
80
What is the PT rx for TMJ disorders?
POLICED
Postural education
81
What specific aspects of POLICED should we use with TMJ patients?
STM - intra and extraorally
Modalities for pain/guarding
82
What are some aspects of postural education we need to keep in mind with TMJ?
Sit tall
Maintain open packed position
83
What kind of breathing can help with TMJ?
Diaphragmatic breathing training
84
What are some activity modifications that can help with TMJ?
- Oral habit alterations
- Dietary changes
- motion extremes
- sleep modifications
85
What kind of MT can we do for TMJ?
JMs / oscillations of TMJ and neck for hypomobility and displacement reductions
86
What other MET can we do for PT rx for TMJ disorders?
- Isometrics, plus neck exercises
- practice resting and talking with cork in between teeth
- Cervical stabilization
87
What will the dentist/MD do for TMJ disorder?
Splints
Orthodontics
Sx
88
What is the prognosis for TMJ disorders?
Very good if proper mechanics, posture, stabilization and breathing patterns restored
