TMD

Question 1

Typical age range?

Answer 1

20-40

Question 2

T or F: More common in women?

Answer 2

True

Question 3

What are the classifications of TMD?

Answer 3

Muscle disorders (45.3%), disc displacements (41.1%), Joint disorders (30.1%)

Question 4

What are some of the causes of TMD?

Answer 4

poor occlusion, trauma, parafunction/bruxism, ligamentous hyperlaxity, posture, psychological stress

Question 5

What are the four major components of the TMJ?

Answer 5

1. TMJ disc
2. Inferior joint space
3. Superior joint space
4. Retrodiscal pad

Question 6

Articular disc attachments

Answer 6

posterior: temporal bone through a section of loose retrodiscal tissue
anterior: capsule and superior lateral pterygoid muscle

Question 7

TMJ ligaments

Answer 7

Collateral ligs
stylomandibular ligament
sphenomandibular ligament

Question 8

Suprahyoid muscles (3)

Answer 8

Digastric
Mylohyoid
Stylohyoid

Question 9

Infrahyoid muscles (3)

Answer 9

Omohyoid
Thryrohyoid
sternohyoid

Question 10

Is the TMJ a synovial joint?

Answer 10

Yes! and it follows the rules of a typical synovial joint

Question 11

For every mm of lateral exursion you get how many mm of opening?

Answer 11

4 mm (same with 1 mm of protrusion= 4 mm of opening)

Question 12

T or F: You should treat the C spine in a patient with TMD.

Answer 12

True

Question 13

What kind of joint problem is present if the eye and mouth angle are elevated on the same side?

Answer 13

Craniovertebral problem

Craniomandibular if opposite eye and mouth angle are elevated

Question 14

What are the MOST important muscles to palpate with TMD?

Answer 14

Masseter (intra and extra oral), Medial pterygoid, Temporalis, Superior pharyngeal constrictor (intra oral- pterygoid mandibular raphe with buccinator)

Question 15

What are the important points of the pain map of Rocabado?

Answer 15

4 points of palpation: ant/post and sup/inf synovium

4 ligament joint stress test: TM lig, LCL, posterior lig, retrodisc insertion of post lig

Question 16

What are the most important clinical signs and symptoms in TMD ?

Answer 16

muscle and joint pain, limitations in mandibular movt, and joint sounds

Question 17

TMJ manual therapy

Answer 17

Long axis distraction
Lateral glides
myofascial mobilizations- deep head of the masseter, buccal wall/superior pharyngeal constrictor

Question 18

What is the dosage for therEx for the TMJ exercises such as controlled opening or hyperboloid?

Answer 18

6x/day/6 reps each time

Question 19

When instructing a patient in self mobs with the tubing for TMJ dysfunction, do you instruct them to move toward the side of pain or away?

Answer 19

Away- this may limit your TherEx options for pts with bilateral pain.

Question 20

From the Wright’s article on TMD: when should you refer a pt with TMD pain to a dentist?

Answer 20

Nocturnal pain
Hot/cold sensitivity
Spontaneous throbbing pain
Throbbing pain that awakens during sleep