TMJ

Question 1

what sort of cartilage are the TMJ and disk covered in?

Answer 1

fibrocartilage

Question 2

in which cavities do rotation and translation occur in?

Answer 2

rotation occurs in inferior cavity; translation occurs in superior cavity

Question 3

which portion of the disc is aneural?

Answer 3

the intermediate (middle)

Question 4

what are the unilateral and bilateral contraction results of the masseter?

Answer 4

uni: slight lateral deviation to same side
bi: elevation of mandible

Question 5

unil and bil contraction results of temporalis?

Answer 5

unil: deviation to same side
bi: elevate and retract mandible

Question 6

unil and bil contraction results of lat pterygoid?

Answer 6

unil: contralateral excursion
bil: protrusion

Question 7

action of suprahyoid muscles?

Answer 7

depression and retrusion of the mandible during closing

Question 8

infrahyoid muscle action?

Answer 8

stabilize hyoid bone to form a firm base for the suprahyoids

Question 9

unil and bil function of medial pterygoid

Answer 9

unil: contralateral deviation
bil: elevation and protrusion

Question 10

normal ROM for depresion is…

Answer 10

between 40-45 mm for males and 45-50 mm for females

approx 4 fingers width of the nondominant hand

Question 11

functional ROM for depression is…

Answer 11

~35 mm or 3 fingers width

Question 12

normal lateral excursion is…

Answer 12

1/4 of opening range

Question 13

normal protrustion and retrusion are…..

Answer 13

6-9 mm protrusion; 3 mm retrusion

Question 14

key findings in ADDwoR

Answer 14

no clicking noise during opening/closing with possible limited opening (disc blocking condylar head) or no limitation opening (disc completely displaced anteriorly)

Question 15

key findings in ADDwR

Answer 15

click on both opening and closing (clicks on to the disk in opening and off the disc in closing)

Question 16

diff between overbite and overjet?

Answer 16

overbite: how much overlap there is between the top teeth and bottom teeth (top to bottom measurement)
overjet: how the top teeth are in front of the bottom teeth (front to back measurement)

Question 17

what do a C curve and S curve usually represent?

Answer 17

C curve = capsular pattern, S curve = lack of motor control

Question 18

what is deflection?

Answer 18

mandible deflects to one side without returning to center at end range (usually occurs when a disk is anteriorly displaced)

Question 19

what are the 3 classes of occlusion?

Answer 19

1: normal
2: excessive overjet (over 6mm) - the layman’s “overbite”
3: underbite

Question 20

what is the most prevalent cause of TMD?

Answer 20

myofascial pain disorder (complete with trigger point referral patterns)

Question 21

conditions that can be associated with TMD?

Answer 21

HAs, Ear sx, Vertigo, swallowing/speech difficulty, psychological affect, trigeminal neuralgia, temporal arteritis, atypical odontalgia (phantom tooth pain), post-herpetic neuralgia (herpez zoster), meniere disease

Question 22

what is temporal arteritis?

Answer 22

subacute inflammation of the superficial temporal artery and the vertebral artery - causes severe unilat or bilat headache or scalp-temporal artery region; jaw claudication with pain/stiffness during chewing is indicative of this - must refer for ophthalmologic eval

Question 23

what clinical findings may indicate nocturnal bruxism?

Answer 23

scalloping of the tongue or irregularity on the buccal tissues

Question 24

which muscle of mastication is not palpable?

Answer 24

lateral pterygoid

Question 25

describe the cotton roll test

Answer 25

the pt bites down on a cotton roll with back molars on the side of the complaint; if pain increases, the cause of sx may be muscular in origin - if pain decreases, the cause may be joint related; then have them bite on the cotton roll with the opposite molars - if it is joint pain; then the pain will increase

Question 26

what is trismus?

Answer 26

an acute closed lock (usually caused by spasm of masseter after prolonged jaw opening such as is needed after a dental procedure)

Question 27

how can myofasical pain disorder be dx'd?

Answer 27

palpation of trigger points, pt sx, and release of sx with the spray and stretch technique

Question 28

how often is the rocobado 6x6 program supposed to be carried out?

Answer 28

every 2 hrs regardless of sx

Question 29

describe the spray and stretch technique

Answer 29

put the irritated muscle on stretch - spray ethyl-chloride or fluori-methane vapo coolant spray from 24 cm away at a rate of 10 cm/sec about 4 times; then warm the muscle with your hands and apply further stretching

Question 30

specific interventions for Ant disc displacement

Answer 30

pt education about proper head/neck/jaw position, avoidance of parafunction and clicking/popping of the joint, modalities, exercises (condylar remodeling, practicing closing the mouth along a protruded path once the disk is reduced); mobilization

Question 31

describe the condylar remodeling exercise program

Answer 31

surgical tubing b/w incisors - deviate laterally to contralateral side of symptomatic joint; many phases of progression including adding a bite, then adding protrustion, then rhythmic stabilization

Question 32

what is a good joint mob for restoring an anteriorly displaced disc?

Answer 32

longitudinal distraction, add ulnar deviation of the hand then go into anterior translation

Question 33

when would you recommend a stabilization splint vs an anterior repositioning splint?

Answer 33

stabilization splint: intended to relax masticatory muscles (appropriate for ADDwoR); anterior repositioning splint: for ADDwR and is required to be worn 24 hours a day