TMD Exam 1

Question 1

Another name for clicking

Answer 1

anterior disc displacement with reduction

Question 2

Ant displacement w/o reduction

Answer 2

*LIMITS from Opening

Question 3

Ant displacement with reduction (clicking)

Answer 3

*Clicking does NOT limit opening

Question 4

Should clicking interfere with how wide you open?

Answer 4

No

Question 5

closed lock with ADD without reduction does it interfere with opening?

Answer 5

yes

Question 6

stylomandibular ligament

Answer 6

i. extrinsic
ii. is a thickening of the fibrous capsule of the parotid gland
iii. runs from the styloid process to the angle of the mandible
iv. connects mandible to the cranium, but does NOT strengthen joint

Question 7

sphenomandibular ligament

Answer 7

i. extrinsic
ii. runs from spine of sphenoid to the lingula of the mandible
iii. connects mandible to the cranium, but does NOT strengthen joint

Question 8

lateral (temporomandibular) ligament

Answer 8

i. intrinsic
ii. a thickening of the articular capsule forms this ligament
iii. strengthens joint and prevents dislocation

Question 9

lateral pterygoid

Answer 9

i. opens mouth
ii. acting together: protrude mandible
iii. acting alternatively: grinding action

Question 10

Masseter

Answer 10

i. closes jaw by elevating mandible

Question 11

temporalis

Answer 11

i. closes jaw and elevates mandible

ii. posterior fibers retract the mandible

Question 12

medial pterygoid

Answer 12

i. elevates mandible and closes jaw
ii. acting together: protrude mandible
iii. acting alone: protrudes one side
iv. acting alternatively: grinding action

Question 13

capsulitis

Answer 13

inflammation of joint similar to sinovitis

Question 14

Osteoarthritis (most common)

Answer 14

i. “wear and tear” arthritis

ii. Next most common is rheumatoid arthritis

Question 15

internal derangements

Answer 15

clicking and popping

Question 16

systemic arthritis

Answer 16

i. every systemic arthritis you have in the body can be in the TMJ
1. ex: rheumatoid arthritis, psoriatic arthritis, gouty arthritis, etc.

Question 17

traumatic arthritis

Answer 17

joint is inflamed b/c of injury

Question 18

Differential diagnosis is important so ….

Answer 18

treatment can be focused on Joint or muscle

Question 19

Most TMD cases are a combination of joint and muscle are?

Answer 19

multifactorial

Question 20

Most important thing when screening patient

Answer 20

HISTORY

Note: only thing for immediate treatment is ADD without replacement

Question 21

How to utilize diagnosis?

Answer 21

1) Initial diagnosis
- Capsulitis and myalgia

2) Sub diagnosis
- superior capsulitis

3) lateral pterygoid myalgia
4) masseter myalgia

Question 22

Make distinction between capsulitis and myalgia

-maybe sneak superior capsulitis question in there and how to treat

Answer 22

1) put pivot on one side

2) Initial treatment is maxillary stabilization, PT & biofeedback

Question 23

MOST common pivot?

Answer 23

Unilateral pivot

• Single posterior ‘bump’ on splint to bring down ipsilateral condyle

Question 24

Masseter trigger points?

Answer 24

i. Ear
ii. Lower Molars
iii. Above Right Eye

Question 25

Temporalis trigger points?

Answer 25

i. Upper Ant. Teeth 1. Anterior Temp ii. Upper Bicuspids 1. Middle Temp iii. Upper Molars 1. Posterior Temp

Question 26

SCM trigger points?

Answer 26

i. Ear ii. Eye iii. Above Eye 1. Can be Contralateral Occiput (Refers to mostly the sinus area, the eye, and above the eye

Question 27

Posterior Cervicals trigger points?

Answer 27

i. Temple 1. Pain comes from trapezius rather than the temporalis ii. Eye iii. Ear

Question 28

Lateral Pterygoid trigger points?

Answer 28

i. TMJ ii. Eye iii. Zygoma **(Hard to palpate)

Question 29

Temporalis Tendon trigger points?

Answer 29

Mimics TMJ and Masseter pain (hard to tell the difference)

Question 30

1) % population has at least one sign of joint dysfunction 2) % has at least one symptom 3) % of population needs treatment

Answer 30

1) 75% 2) 33 % 3) 5-7 %

Question 31

opening pain muscle or joint?

Answer 31

Can be muscle or joint - Check location - Check referred pain

Question 32

Closing pain muscle or joint?

Answer 32

Usually joint

Question 33

Chewing muscle or joint?

Answer 33

Muscle or Joint

Question 34

Moving the head muscle or joint?

Answer 34

Neck

Question 35

Sharp pain =

Answer 35

Sharp pain = joint

Question 36

Dull pain =

Answer 36

= muscle

Question 37

Pain associated w/ clicking

Answer 37

joint

Question 38

Side to Side Movement

Answer 38

Usually joint pain

Question 39

Limited Opening without deviation

Answer 39

Usually muscle

Question 40

Limited opening w/ deflection to one side

Answer 40

probable ADD w/o reduction on side of deflection

Question 41

Protrusion

Answer 41

deflection to one side indicates ADD w/o reduction on same side of deflection

Question 42

% patients that come for pain are non tooth pain

Answer 42

40%

Question 43

___________ is inferior, hinge movements of depression and elevation occur in inferior compartment

Answer 43

rotation

Question 44

___________ is superior, gliding movements of protrusion and retrusion occur in superior compartment

Answer 44

sliding

Question 45

Jugular vein does not go through ?

Answer 45

TMJ

Question 46

Dentist treat...

Answer 46

TMD, Sleep apnea, Headache/migraine, Neuropathic pain, Non-dental tooth pain, movement disorders

Question 47

over 40 mm ________ motion

Answer 47

Vertical

Question 48

10-12 mm ____ motion

Answer 48

Lateral

Question 49

Protrusion =

Answer 49

= 8-10 mm

Question 50

i. referred pain from a tender point to a distant site ii. Treated with stretching, heat/cold, and rest iii. Muscle relaxants can be helpful

Answer 50

Myofascial pain

Question 51

i. Muscle inflammation due to trauma or infection ii. Treated differently than muscle tightness/Myalgia 1. NSAIDS 2. Steroids 3. Rest 4. No stretching

Answer 51

Myositis

Question 52

i. Jaw snaps shut - Is not just tight or sore but is a forceful, painful contraction ii. look for systemic cause 1. could be due to low potassium or other minerals, or hormonal imbalance iii. may be due to virus or other medical problem

Answer 52

Spasm

Question 53

i. Localized muscle soreness ii. tender to palpation iii. most common muscle pain iv. doesn’t refer to a distant site v. responds to stretching

Answer 53

Myalgia

Question 54

i. muscle tighten to protect joints/other muscles ii. need to find the cause of the need to protect iii. treat the cause and use muscle relaxants, rest, and stretching

Answer 54

protective splinting

Question 55

i. muscle has undergone degenerative change that causes contracted state to persist ii. usually due to injury or infection iii. calcified contracture (rare) iv. can be hereditary

Answer 55

myofibrotic contracture

Question 56

Formation of ‘pseudo-disc’ over several weeks with an appliance is much more common than permanent change in disc placement... Unloading... best treatment... its like a..

Answer 56

- Unloading it for a while and gradually loading again - This is the best treatment instead of surgery - It's like a callus in the joint