TMJ

Question 1

70% of TMJ disorders involve what

Answer 1

mal positioning of the disc (internal derangement)

Question 2

Primary pathology at TMJ

Answer 2

OA

Question 3

TMJ is what type of joint

Answer 3

Modified ball and socket
synovial joint

Question 4

Runs behind the TMJ
Blood supply to dura

Answer 4

Middle Meningeal artery

Question 5

Muscles of the TMJ

Answer 5

Temporalis
Masseter
Pterygoid
Hyoid muscles
SCM
Platysma

Question 6

covers the lateral area like a fan
a powerful muscle in biting

Answer 6

temporalis

Question 7

a main muscle involved in chewing

Answer 7

masseter

Question 8

when both sides work together, they push chin out and/or depress the chin. unilaterally they produce the side to side chin movements

Answer 8

lateral pterygoid

Question 9

helps to elevate and close the jaw. working together they protrude the mandible, working unilaterally it produces a grinding motion

Answer 9

medial pterygoid

Question 10

biomechanics - opening

Answer 10

anterior roll and anterior glide of the condyle

Question 11

biomechanics - closing

Answer 11

posterior roll and posterior glide

Question 12

does the TMJ follow convex/concave rule?

Answer 12

no

Question 13

normal opening of the mouth is

Answer 13

35-55mm or 2-3 fingers in the mouth

Question 14

normal daily use of the TMJ requires

Answer 14

25-35 mm

Question 15

Specific history questions

Answer 15

• grinding teeth
• clicking/locking/popping
• pain with functional movement of jaw- recent dental work
• surgeries
• medical conditions
• lymph node swelling, tonsillitis, sinus infections
• hearing and balance issues
• headaches

Question 16

Profile of a mouth breather

Answer 16

tired eyes
restless sleep and snoring
set back jaw
leaning forward
poor head posture
narrow palate
lower Co2 and oxygenation
higher BP
stress activation

Question 17

profile of a nose breather

Answer 17

alert eyes
jaw and cheekbone definition
deeper sleep
higher CO2
parasympathetic relaxation
wide palate
spine support
good tongue posture
lower BP
alpaca whisperer

Question 18

Wilkes Stages of internal derangement - name them

Answer 18

normal
ID-reducing
ID-non-reducing

Question 19

normal internal derangement

Answer 19

normal anatomical position of articulating disc with respect to condyle and surfaces of articulation

Question 20

ID-reducing

Answer 20

anteriorly displaced disc returning to normal position upon maximal opening
stage II - early stage III

Question 21

ID non-reducing

Answer 21

anteriorly displaced disc during closed and maximal opening positions with disc thickening present
Stage III - stage IV

Question 22

sounds heard for ID reducing vs non reducing

Answer 22

reducing will hear more clicking/popping
non-reducing will hear more grinding from rubbing

Question 23

Wilkes 5 stages to classifying ID - Stage I

Answer 23

painless clicking in early opening and late closing unrestricted motion

Question 24

Wilkes 5 stages to classifying ID - Stage II

Answer 24

occasional pain with clicking, intermittent locking, orofacial pain

Question 25

Wilkes 5 stages to classifying ID - Stage III

Answer 25

frequent orofacial pain, as locking becomes more frequent and mandibular becomes restricted

Question 26

Wilkes 5 stages to classifying ID - Stage IV

Answer 26

contours begin to change, chronic pain and restricted mandibular opening

Question 27

Wilkes 5 stages to classifying ID - Stage V

Answer 27

similar to stage 4 but with more severe symptoms (chronic pain, crepitus, significant ROM restrictions)

Question 28

trigeminal neuralgia vs TMJ dysfunction

Answer 28

trigeminal neuralgia is unilateral, acute and stabbing pain,no pain at night, short burst of pain VS TMJ dysfunction is bilateral pain, continuous and dull, pain present at night, long lasting duration

Question 29

Pain is at temples, in front of ears

Answer 29

TMJ

Question 30

Pain is behind frontal bone and/or cheekbones

Answer 30

Sinus

Question 31

Pain is in and around one eye

Answer 31

Cluster

Question 32

Pain is like a band squeezing the head

Answer 32

Tension

Question 33

Pain, nausea and visual changes are typical symptoms of a classic form of:

Answer 33

Migraine

Question 34

Pain is at the top and/or back of head

Answer 34

Neck

Question 35

which 2 types of pain/location are more cervicogenic

Answer 35

tension and neck

Question 36

Bell's Palsy

Answer 36

damage or inflammation of the CN VII (facial) sudden paralysis of one side of your face

Question 37

S/S of Bell's palsy

Answer 37

drooling eye problems loss of ability to taste pain in or behind your ear numbness in the affected side of your face increased sensitivity to sound

Question 38

TMJ functional movement

Answer 38

biting chewing swallowing coughing talking

Question 39

2 causes of restricted opening when ROM testing

Answer 39

muscle spasm disc displacement

Question 40

Crepitus of the TMJ could indicate what 2 things

Answer 40

possible OA possible disc displacement

Question 41

what is Chvostek's sign

Answer 41

Damage of the Facial Nerve (CNVII) Test:tap the parotid gland overlying the masseter muscle +ive = facial muscle twitch

Question 42

chvostek's sign is used for what

Answer 42

to help determine if there is a pathology of the 7th cranial nerve (facial)

Question 43

Cervical spine affecting TMJ - flexion

Answer 43

posterior neck muscles tighten and mandible gets pulled up and forward

Question 44

Cervical spine affecting TMJ - extension

Answer 44

the mandible gets pulled down and backward

Question 45

what can you make your patient do to verify if the cervical spine is affecting the TMJ

Answer 45

can they do full neck flexion and extension with the mouth closed