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OS3 Test 1 > TMD > Flashcards

TMD Flashcards

1
Q

TMJ Anatomy

A
  • only synovial joint in the cranium
  • mandible condyle is bi-convex
  • temporal bone portion is saddle shaped
  • meniscus helps stabalize: translates anteriorly during depression of mandible; innervated at periphery; neural and avascular at force bearing zones
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2
Q

Digastric, suprahyoid

A

-depress mandible (infrahyoid stabalizes hyoid bone) initially, then pterygoids depress jaw

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3
Q

Left lateral and medial pterygoids

A

-move mandible lateral and forward to the right

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4
Q

Temporalis, masseter, medial pterygoid

A

-close jaw tightly

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5
Q

Buccinator

A

–approximates lips and compresses cheeks (blowing)

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6
Q

Depressor labii inferior

A

-protrudes lower lip (pouting)

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7
Q

Depressor anguli oris and platysma

A

-draw corner of mouth down

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8
Q

Mentalis

A

-draws tip of chin upward

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9
Q

Orbicularis oris

A

-approximates and compresses lips

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10
Q

Zygomatic minor

A

-protrudes upper lip

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11
Q

Levator anguli oris

A

-lifts upper border of lip on one side without raising lateral angle (snarl)

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12
Q

Zygomatic major

A

-raises lateral angle of mouth (smile)

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13
Q

Risorius

A

-approximates lips and draws tips and draws corners lateral (grimace)

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14
Q

Intracapsular TMJ pathology

A

-infection, RA, OA, gout, metastatic CA, articular disc displacements

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15
Q

Extracapsular TMJ pathology

A
  • Myofascial pain of masticatory muscles
  • TMJ myofascial pain syndrome, TMJ dysfunction syndrome, TMJ syndrome
  • TMJD: temporomandibular muscle and joint disorder
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16
Q

TMJ trauma

A
  • direct or by whiplash injury

- if direct blow with closed mouth, posterior capsule injury

17
Q

TMJ malocclusions

A

-deviation from normal contact of maxiallary and mandibular teeth

18
Q

TMJ malocclusions class1

A

-1st molars normal, problem elsewhere

19
Q

TMJ malocclusions class 2a

A
  • lower 1st molar posterior to upper

- mandibular retrusion (overbite)

20
Q

TMJ maloccusions class 2b

A

-lower 1st molar posterior to upper to greater degree (larger overbite)

21
Q

TMJ maloccusions class 3

A

lower 1st molar anterior to upper mandibular protrusion (underbite)

22
Q

TMJ muscle strain

A
  • oral habits (tobacco, gum, etc)
  • postural/work related (singers, phone operators, musicians)
  • sports (trauma, mouthguards)
23
Q

TMJ musculoskeletal problems

A
  • developmental abnormalities–condylar hypoplasia/agenesis

- somatic dysfunction–temporal bone dysfunction; compensatory changes (short leg syndrome, scoliosis, etc)

24
Q

TMJ Mood disorders

A

-anxiety, depression, post-traumatic stress disorder, history of abuse
some studies show association between chronic TMD and above disorders

25
Q

TMJ and RA

A

-more likely to develop TM pain

26
Q

Unilateral TMJ problem symptoms

A
  • cephalgia–misdiagnosed as migraines
  • otalgia
  • neck pain
  • eye pain
  • shoulder and back pain
27
Q

Most common signs and symptoms of TMD

A
  • pain, ear discomfort or dysfunction, headache, TMJ discomfort
  • patient may complain of cephalgia, and mention jaw problems or not mention jaw problems
  • may describe as a dull ache that is worse with chewing
  • tinnitus
28
Q

More TMD symptoms

A
  • difficulty opening mouth
  • click, crepitus=jaw click usually present with disc displacement, but by itself non-diagnostic
  • lateral deviation of jaw
  • spasm within facial muscles
  • onset of symptoms may correspond with onset of stress
  • neck pain–trauma, bad posture, and musculoskeletal tension nine cervical area
  • eye pain–orbital/perioribital pain ofen described as unilateral, constant, and boring
  • arm/back pain–shoulder pain that radiates down arm +/- tingling or numbness
  • dizziness associated with ear pain and stuffiness or cervical muscle strain and tension
29
Q

Jaw clenching

A
  • often due to anxiety and psychosocial stress
  • does not interfere with treatment in most cases, although a severely disturbed capacity for interpersonal relationships associated with poor prognosis
30
Q

Types of TMJ dysfunction

A
  • opening click
  • closing click (reciprocal clicking)
  • inability to fully open jaw (close locked)
  • inability to close–if bilateral
  • crepitus and grating
  • fusion of the joint (ankylossis)
31
Q

Causes of TMJ click

A
  • almost always due to disc displacement–after disc thin/stretched
  • adhesions
  • uncoorditated muscle action of pterygoids
  • tear or perforation of disc
  • osteoarthritis–more likely to have crepitus
  • occlusional imbalance–less likely
32
Q

TMD history

A
  • most often complains of facial pain, headache, ear symptoms, TMJ pain, or symptoms of jaw dysfunction
  • ask about history of jaw trauma, sleep habits/position, symptoms of nightime bruxism (jaw sore or HA in AM)
  • past/present use mouth orthotics
  • ask about occupation/hobbies; personal habits: usual posture, nail biting, or frequent gum chewing; symptoms of depression or anxiety; any recent stressful event
  • include usual ROS: fever/chills/weight loss/PMH etc
33
Q

TMJ evaluation

A
  • osteopathic exam (not just cranial bones)
  • complete evaluation, being especially careful to note symmetry/asymmetry-C spine; leg lengths
  • palpate joints for crepitans/clicks
  • palpate muscles of mastication
  • ROM
  • not facial asymmetry
  • observe for cavities; suspicious lesions in mouth; alignment of teeth
34
Q

PE findings with compelling signs of TMD

A
  • abnormal mandibular movements

- decreased ROM of TMJ–normal functional opening is 35-55 mm; functional opening in TMD usually

35
Q

Disc displacement

A
  • symptoms of TMJD: MRI showed displaced disc in 84% of patients
  • no symptoms of TMJD: 33% had displaced disc
36
Q

TMD differential diagnosis

A
  • inflammatory disease: local infection, RA, giant cell arteritis
  • dental problems: loss of posterior teeth support
  • Lymphoproliferative disorders
  • migraine related disorders–carotodynia
  • Eagle’s syndrome (stylohyoid syndrome)–elongated styloid process
  • Neurlagias: trigeminal, glossopharygeal
  • parotid gland disorders
37
Q

TMD treatment

A
  • nonpharmacologic: pt education; self-care aimed at improving pain and function (change head posture, sleeping position, and aggravated parafunctional oral behaviors
  • patients usually respond to these noninvasive conservative treatments
  • find cause and treat
  • eliminate jaw stress: bite plate appliance to decrease nocturnal bruxism/jaw clenching; dental care; decrease chewing
  • correct structural imbalances
  • heat for muscle spasms
  • jaw exercises
  • decrease stress
  • TENS unit
  • biofeedback, relaxation techniques, habit reversal
  • work with dentist
  • oral devices/occlusal splints
38
Q

TMD medication

A
  • muscle relaxants, TCAs–give at nighttime; continue 1 month until pain is gone
  • NSAIDS/analgesics usually not adequate
  • narcotics not indicated unless severe trauma
  • intraarticular steroids (once)
  • botulinum toxin injections
39
Q

TMD surgical correction

A
  • last resort!
  • TMJ prosthetic–attaches to mandible and skull
  • consider if inflammatory arthritis involving TMJ, recurrent fibrosis, bony
  • ankylosis, trauma, developmental abnormality, or pathologic lesion

OS3 Test 1 (7 decks)

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