TMD - Final Flashcards
(202 cards)
1
Q
Angle formed between the sagittal plane and
the average path of the advancing condyle as
viewed in the horizontal plane during lateral mandibular movements
A
Bennett angle
2
Q
Imaginary anteroposterior line around which the mandible may rotate when viewed in the frontal plane
A
Sagittal axis
3
Q
Imaginary line around which the mandible may rotate through the horizontal plane
A
Vertical axis
4
Q
Imaginary line around which the mandible may rotate within the sagittal plane
A
Transverse horizontal axis
5
Q
Anteroposterior curve
A
Spee curve
6
Q
Anatomic curve established by the occlusal alignment of the teeth, beginning with the cusp tip of the mandibular canine and following the buccal cusp of the premolar and molar teeth, continuing through the anterior border of the mandibular ramus, ending with the anterior-most portion of the mandibular condyle
A
Spee curve
7
Q
Mediolateral curve
A
Wilson curve
8
Q
Curvature of the cusps as projected on the frontal plane expressed in both arches
A
Wilson curve
9
Q
The curve in the lower arch = concave
The curve in the upper arch = convex
A
Wilson curve
10
Q
Any plane parallel to the long axis of the body and at right angles to the median plane, thus dividing the body into front and back parts
A
Frontal plane (coronal)
11
Q
Any plane passing through the body at right angles to both the median and frontal planes, thus dividing the body into upper and lower parts
A
Horizontal plane
12
Q
Any vertical plane or section parallel to the median plane of the body that divides a body into right and left portions
A
Sagittal plane
13
Q
The static and dynamic contact relationship between the occlusal surfaces of the teeth during function
A
Articulation
14
Q
Form of mutually protected articulation in which the vertical and horizontal overlap of the canine teeth disengage the posterior teeth in the excursive movements of the mandible
A
Canine guidance
15
Q
When the posterior teeth prevent excessive contact of the anterior teeth in MIP, and the
anterior teeth disengage the posterior teeth in all mandibular excursive movements
A
Mutually protected articulation
16
Q
Multiple contact relations between the
maxillary and mandibular teeth in lateral movements on the working side
A
Group function
17
Q
Normal occlusion or neutrocclusion
A
Class I
18
Q
Normal anteroposterior relationship of the jaws, as indicated by correct interdigitation of
maxillary and mandibular 1st molars
A
Class I
19
Q
Distocclusion
A
Class II
20
Q
Mandibular dental arch is posterior to the maxillary dental arch in one or both lateral
segments; mandibular 1st molar is distal to the maxillary 1st molar
A
Class II
21
Q
Which division of Class II?
Narrow maxillary arch and protruding maxillary incisors
A
Divison 1
22
Q
Which division of Class II?
Normal maxillary arch with maxillary centrals and excessive vertical overlap
A
Division 2
23
Q
Messiocclusion
A
Class III
24
Q
Mandibular arch is anterior to the maxillary
arch in one or both lateral segments; mandibular 1st molar is mesial to the maxillary 1st molar
A
Class III
25
Mandibular incisors are usually in anterior cross bite
Class III
26
Range of motion of the mandible
Posselt's envelope of motion
27
The shape of Posselt's envelope varies depending on the plane, but it generally resembles what 3 things?
Beak
Shield
Diamond
28
mandibular movement in the sagittal plane, frontal plane, and horizontal plane (look at slides 5-7 for pics)
29
What are the 2 movements for mouth opening?
Rotation
Translation
30
Occurs in inferior join cavity
Rotation
31
Opening of 20-25mm
Rotation
32
Occurs in superior joint cavity
Translation
33
Opening of 25-35mm
Translation
34
How many mm is maximum opening?
45-55mm
35
How many mm is lateral movement?
10-12mm
36
How many mm is protrusive movement?
8-10mm
37
All normal, proper or characteristic movements of the mandible made during speech, mastication, yawning, swallowing, and other associated movements
Functional mandibular movements
38
Trauma to the periodontium from functional or
parafunctional forces causing damages to its
attachment by exceeding its adaptive and reparative capacities
Occlusal trauma
39
Forces acting on teeth w/ normal periodontal support
Primary occlusal trauma
40
Forces acting on teeth with decreased periodontal support
Secondary occlusal trauma
41
Disordered function like clenching/grinding
Parafunction
42
Parafunctional grinding of teeth
Bruxism
43
Oral habit of involuntary rhythmic or spasmodic non-functional gnashing, grinding, or clenching of teeth; may lead to occlusal trauma
Bruxism
44
The influence of the contacting surfaces of anterior teeth on tooth limiting mandibular
movements
Anterior guidance
45
The steepness of the lingual surfaces of max
anterior teeth determines the amount of vertical movement of the mandible
Anterior guidance
46
Mandibular guidance generated by the condyle and articular disc traversing the contour of the
glenoid fossa; depends on the steepness of the articular eminence
Condylar guidance
47
Contacts of teeth made on the side of the articulation toward which the mandible is moved during working movements
Working side contacts
48
Undesirable contacts of the opposing occlusal surfaces on the nonworking side (which interferes with the working side occlusal contacts)
Non-working side contacts
49
One of the features of ideal occlusion is absence of ____________ interferences
posterior
50
The modification of the occlusal form of the teeth with the intent of equalizing occlusal stress, producing simultaneous occlusal contacts or harmonizing cuspal relations
Occlusal equilibration
51
With the condyles in CR (musculoskeletal stable position) and the articular discs properly interposed, all possible posterior teeth contact evenly and simultaneously between centric ___________ and opposing ____________
cusp tips; flat surfaces
52
When excursive movements happen, laterotrusive contacts on the anterior teeth ____________ the posterior teeth
disocclude
53
When the mandible is protruded, contacts on the anterior teeth _______________ the posterior teeth
disocclude
54
Mechanical instrument that represents the
TMJs and jaws, to which maxillary and mandibular casts may be attached to simulate some or all mandibular movements
Articulator
55
Instrument used to record the spatial
relationship of the maxillary arch to some anatomic reference point or points (condyles
horizontal axis and one other selected anterior point) and then transfer the relationship to an articulator
Facebow
56
Which articulator classification?
Only vertical motion is possible
Class I
57
Which articulator classification?
Accepts a single static registration
Class I
58
Which articulator classification?
Permits horizontal and vertical motion, but does not orient the motion to TMJs
Class II
59
Which articulator classification?
Instrument that stimulates condylar pathways by using averages of mechanical equivalents for all or part of the motion
Class III
60
Which articulator classification?
Semi-adjustable
Class III
61
Which articulator classification?
Instrument that will accept 3D dynamic registrations, allow for orientation of the casts to the TMJs, and stimulate mandibular movements
Class IV
62
Which articulator classification?
Fully adjustable
Class IV
63
What part of the articulator?
Lateral and horizontal condylar inclination- represents the posterior determinants
Condylar guidance
64
What part of the articulator?
Rigid rod attached to one member contacting the anterior guide table of the opposing member; maintains vertical separation
Anterior guide pin
65
What part of the articulator?
Where the anterior guide pin rests to maintain VDO and influence articulator movements. It influences the degree of separation of the casts in all relationships
Anterior guide table
66
What part of the articulator?
Upper member holds maxillary cast and lower member holds mandibular cas
Member
67
What part of the articulator?
Removable metal or resin devices that attaches to the superior and inferior members of the articulator which are used to attach casts to articulator
Mounting plate
68
What are the skeletal components of the TMJ?
Maxilla
Mandible
Temporal bone
69
What are the 5 ligaments involved with the TMJ?
Collateral (discal)
Capsular
Temporomandibular
Sphenomandibular
Stylomandibular
70
What are the muscles of mastication involved with the TMJ?
Masseter
Temporalis
Lateral pterygoid
Medial pterygoid
71
Composed of dense fibrous CT; it is very slightly innervated
Disc
72
The articular surface of the condyle is located on the _____________ zone of the disc
intermediate
73
T/F: The disc maintains morphology unless destructive forces or structural changes occur in the joint
True
74
T/F: The morphology of the disc can be irreversibly altered, producing biomechanical changes
True
75
The disc acts as a _____________ bone contributing to both joint systems
non-ossified
76
The disc functions as a true ____________ ____________ in both joint systems
articular surface
77
Both joint cavities are filled with what?
Synovial fluid
78
Synovial fluid serves as a ___________ btwn the articular surfaces during function
lubricant
79
Since the articular surfaces are ___________, the synovial fluid acts a medium for providing _____________ requirements to these tissues
non-vascular; metabolic
80
Loose CT that attaches to the posterior part of the disc
Retrodiscal tissue
81
Highly vascularized and innervated
Retrodiscal tissue
82
What nerve provides innervation to the TMJ?
Trigeminal nerve V3
(auriculotemporal nerve)
83
T/F: The TMJ is an extremely complex joint system
True
84
T/F: Both TMJs connect to the mandible, so they can't act without influencing the other
True
85
What do the following describe?
1. Tissues that surround the inferior synovial cavity (condyle + articular disc; rotational)
2. Condyle-disc complex functioning against the surface of the mandibular fossa (translation)
2 joint systems of the TMJ
86
What is the disc and its attachment to the condyle called?
Condyle-disc complex
87
What is responsible for rotational movement in the TMJ?
Condyle-disc complex
88
___________ occurs in this superior joint cavity btwn the disc and mandibular fossa
Translation
89
The articular surfaces of the joint have no structural attachment or ________, yet contact must be maintained constantly for ________ __________
union; joint stability
90
What is stability of the TMJ maintained by?
Constant activity of muscles
91
What is the only structure capable of retracting the disc posteriorly on the condyle?
Superior retrodiscal lamina
92
Which muscle is attached to the anterior border of the disc?
Superior lateral pterygoid
93
When the superior lateral pterygoid is active, which way are the fibers pulled?
Anterior + medially
94
Which muscle attaches to the neck of the condyle?
Lateral pterygoid
95
What muscle is inactive when the inferior lateral pterygoid is protracting the condyle forward?
Superior lateral pterygoid
96
Which muscle activates during mandibular closure?
Superior lateral pterygoid
97
The mechanism by which the disc is maintained with the translating condyle is dependent on what?
Morphology of disc and interarticular pressure
98
What are the 3 important principles of biomechanics of the TMJ?
1. Ligaments do NOT actively participate in normal function of TMJ
2. Ligaments elongate (they do NOT stretch!)
3. Articular surfaces of the TMJ must maintain constant contact (produced by muscles of mastication (elevator))
99
Occurs as movement within the inferior cavity of the joint; between the superior surface of the condyle and the inferior surface of the articular disc
Rotation
100
Rotation occurs in all 3 planes. Name them
Horizontal
Sagittal
Frontal
101
20-25 mm
Rotation
102
Occurs when the mandible moves forward; it happens within the superior cavity of the joint between the superior surface of the articular disc and the inferior surface of the articular fossa
Translation
103
40-60 mm max opening
Translation
104
Collective term embracing several clinical problems that involve the masticatory
musculature, the TMJ and associated structures or both.
TMD
105
Identified as a major cause of non-dental pain
TMD
106
What are the most common symptoms of TMD?
Pain
TMJ sounds
Limited/asymmetric mandibular movements
Headaches, earaches, jaw pain, facial pain
107
What often coexists with other craniomandibular and orofacial pain conditions?
TMD
108
What % of people have at least 1 sign of joint dysfunction?
40-75%
109
What % of people have at least 1 symptom of TMD?
33%
110
What % of people have joint sounds?
50%
111
What % of people have mouth opening limitations?
5%
112
T/F: Adults experience more TMD problems than children
True
113
Who experiences more TMD problems: women or men?
Women
(studies show 3:1 and 9:1)
114
Who seeks treatment for TMD more often: women or men?
Women
115
T/F: It is estimated that only 3.6-7% of people with TMD need treatment
True
116
Factors that increase the risk of TMD
Predisposing factors
117
Factors that cause the onset of TMD
Initiating factors
118
Factors that interfere with healing or enchance progression of TMD
Perpetuating factors
119
What was labeled "Important" for the etiology of TMD?
Long term successful management
120
Any force applied to mastication structures that exceeds normal function load
Trauma
121
What are the 3 types of trauma?
Direct
Indirect
Micro
122
Which type of trauma?
Direct blow to structures
Produces injury via impact
Inflammation
Structural failure
Loss of function
Onset occurs within 24-72 hrs of the trauma
Direct
123
Which type of trauma?
Sudden blow w/o direct contact to affected structures
Whiplash injury
Pathways of pain from cervical area to trigeminal area
Not uncommon to see symptoms of TMD following injury to neck w/o direct trauma to face or jaw
Indirect
124
Which type of trauma?
Sustained and repetitious adverse loading of the masticatory system through postural imbalance or parafunctional habits
Micro
125
Which type of trauma?
Intensity and frequency of parafunctional jaw activity may be exacerbated by stress and anxiety, sleep disorders, and meds
Micro
126
Which type of trauma?
Intense and persistent parafunction can also occur in pts w/ neurologic disorders such as cerebral palsy, orofacial dyskinesia, and epilepsy
Micro
127
Which type of trauma?
Related to postural habits
Micro
128
What are the 2 main anatomic factors that play a role in TMD?
Skeletal relationships
Occlusal relationships
129
Skeletal malformations, arch discrepancies, past injuries to teeth, steepness of articular eminence
Skeletal relationships
130
T/F: Literature does not support the role of occlusion in etiology of TMD
True!
131
Associated w/ more joint sounds and muscle tenderness
Overbite
132
Associated w/ condylar changes and rheumatoid arthritis
Anterior open bite
133
Associated w/ TMD symptoms and osteoarthritic changes
Overjet
134
More common in TMD patients
Unilateral posterior crossbite
135
Associated w/ internal derangement and osteoarthritc changes
Missing posterior teeth
136
Systemic factors of TMD need to be managed in cooperation with a __________
physician
137
What are the 7 pathophysiologic factors of TMD?
Degenerative
Endocrine
Infectious
Metabolic
Neurologic
Rheumatologic
Vascular disorders
138
Include individual, interpersonal, and situational variables that impact the pt's capacity to function adaptively
Psychosocial factors
139
May alter the pt's perception and tolerance of physical symptoms
Psychosocial factors
140
What are 2 psychosocial factors of TMD?
Anxiety
Depression
141
What is chronic TMD defined by?
More than 4 months in pain
142
T/F: Clinical reports suggest that the psychologic conflicts and emotional distress of preexisting psychiatric conditions may contribute to the etiology and exacerbation of TMD conditions
True
143
The use of what 3 things can contribute to the chronicity of many TMD pts?
Alcohol
Tranquilizers
Narcotics
144
Upper facial skeleton
Maxilla
145
Made up of 2 maxillary bones fused at midpalatal suture
Maxilla
146
Has dentoalveolar support and bony attachment to skull
Maxilla
147
Composed of body and ramus
Mandible
148
Lower facial skeleton
Mandible
149
Has dentoalveolar support, but no bony attachment to the skull
Mandible
150
Has muscle and ligament suspension and is mobile
Mandible
151
What are the 2 processes of the ramus of the mandible?
Coronoid process
Condylar process
152
Supports the mandible at articulation with the cranium
Temporal bone
153
Portion of the mandible that articulates with cranium bilaterally
Mandibular condyles
154
Made of condyle and condylar neck
Condylar process
155
Has medial and lateral poles
Condyle
156
What are the dimensions of the mandibular condyles?
Medio-lateral (18-23 mm)
Antero-posterior (8-10 mm)
157
Site of mandibular condyle articulation
Glenoid fossa
158
Oval depression on inferior aspect of temporal bone
Glenoid fossa
159
Anterior to external auditory meatus
Glenoid fossa
160
Forms anterior limit of the mandibular fossa
Articular eminence
161
Convex prominence of thick dense bone
Articular eminence
162
The articular eminence has variable degree of _________, which dictates the ____________ path of mandibular condyle
convexity; protrusive
163
Complex diarthrodial joint with 2 functional movements
TMJ
164
The TMJ has ____________ movement in the __________ compartment between the mandibular condyle and articular disc
rotational; inferior
165
The TMJ has ____________ movement in the ___________ compartment between the disc and temporal component
translational (sliding); superior
166
Divides the TMJ space into superior and inferior compartments
Articular disc
167
The ____________ compartment is between the disc and mandibular fossa
superior
168
The ____________ compartment is between the disc and condyle
inferior
169
What type of CT is the articular disc made up of?
Avascular dense fibrous CT
170
What shape is the articular disc?
Biconcave + oval
171
Has anterior and posterior bands with an intermediate zone in between
Articular disc
172
Has medial and lateral attachments
Articular disc
173
Posterior attachment zone
Retrodiscal tissue
174
Known as bilaminar zone
Retrodiscal tissue
175
Loose neurovascular CT bordered by 2 lamina
Retrodiscal tissue
176
What is the attachment for the superior lamina of the retrodiscal tissue?
Temporal posterior attachment
177
What is the attachment for the inferior lamina of the retrodiscal tissue?
Condylar posterior attachment
178
Fibrous, non-elastic membrane surrounding the TMJ
TMJ capsule
179
TMJ ligaments are thick, fibrous tissue that limit what?
Joint movement
180
Function is to create a seal for joint space and provide stability
TMJ capsule
181
Limits separation and range of movement of articular components; prevents tissue damage and lateral + medial dislocation of joint
TMJ capsule
182
Muscles of mastication maintain ___________ position of ____________ at rest against grvity
postural; mandible
183
TMD frequently involves pain in which muscles?
Muscles of mastication
184
Which accessory muscles of mastication?
Digastric
Stylohyoid
Mylohyoid
Geniohyoid
Suprahyoid
185
Which accessory muscles of mastication?
Omohyoid
Sternohyoid
Sternothyroid
Thyrohyoid
Infrahyoid
186
What are the other 3 accessory muscles of mastication? (not in suprahyoid or infrahyoid categories)
Platysma
Orbicularis oris
Buccinator
187
Which muscle?
Quadrilateral in shape, covers lateral aspect of ramus
Masseter
188
Which part of masseter?
Origin = inferior border of anterior 2/3 of zygomatic arch
Insertion = angle of mandible
Superior part of masseter
189
Which part of the masseter?
Actions:
Elevation, bilateral
Excursion, ipsilateral
Protrusion, bilateral
Superior part of masseter
190
Which part of masseter?
Origin = inferior border of posterior 1/3 and internal aspect of zygomatic arch
Insertion = lateral superior ramus
Deep head of masseter
191
Which part of masseter?
Actions:
Elevation, bilateral
Excursion, ipsilateral
Retrusion, bilateral
Deep head of masseter
192
Which muscle?
Fan shaped
Temporalis
193
Which muscle?
Origin = inferior temporal line of skull, temporal fossa
Insertion = coronoid process
Temporalis
194
Which muscle?
Actions:
Elevation, bilateral
Retrusion (posterior fibers)
Temporalis
195
Which part of medial pterygoid?
Origin = pterygoid fossa btwn lateral and medial pterygoid plates
Deep head of medial pterygoid
196
Which part of medial pterygoid?
Origin = pyramidal process of palatine bone, maxillary tuberosity
Superficial head of medial pterygoid
197
Which muscle?
Insertion = angle of mandible medial ramus
Medial pterygoid
198
Which muscle?
Actions:
Elevation, bilateral
Contralateral excursion, unilateral
Protrusion, bilateral
Medial pterygoid
199
Which part of lateral pterygoid?
Origin = greater wing of sphenoid bone, inferior aspect
Insertion = TMJ capsule, disc, anterior condylar neck
Superior head of lateral pterygoid
200
Which part of lateral pterygoid?
Action:
Stabilize disc position
Superior head of lateral pytergoid
201
Which part of lateral pterygoid?
Origin = lateral pterygoid plate of sphenoid bone
Insertion = condylar neck
Inferior head of lateral pterygoid
202
Which part of lateral pterygoid?
Actions:
Protrusion, bilateral
Contralateral excursion, unilateral
Depression, bilateral
Inferior head of lateral pterygoid
