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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
TMJ and RA
-more likely to develop TM pain
26
Unilateral TMJ problem symptoms
- cephalgia--misdiagnosed as migraines - otalgia - neck pain - eye pain - shoulder and back pain
27
Most common signs and symptoms of TMD
- 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
More TMD symptoms
- 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
Jaw clenching
- 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
Types of TMJ dysfunction
- 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
Causes of TMJ click
- 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
TMD history
- 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
TMJ evaluation
- 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
PE findings with compelling signs of TMD
- abnormal mandibular movements | - decreased ROM of TMJ--normal functional opening is 35-55 mm; functional opening in TMD usually
35
Disc displacement
- symptoms of TMJD: MRI showed displaced disc in 84% of patients - no symptoms of TMJD: 33% had displaced disc
36
TMD differential diagnosis
- 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
TMD treatment
- 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
TMD medication
- 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
TMD surgical correction
- 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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