TMJ dysfunction

Question 1

TMJ joint - convex articular condyl of the manidble and the concave articular fossa on the squamous portion of the temporal bone make up this ____ joint

Answer 1

gliding

Question 2

3 parts of meniscus of teh TMJ

Answer 2

thick anterior band
thin intermediate zone
thick posterior band

Question 3

when the mouth is closed, the condyle is separated from the articular fossa of the temporal bone by

Answer 3

the thick posteiror band portion of the meniscus

Question 4

when the mouth is open, the condyle is separated from the articular eminence of the temporal bone by

Answer 4

the thin intermediate zone

Question 5

muscles the depress the mandible INITIALLY

Answer 5

digastric
suprahyoid
opens the mouth
infrahyoid stabilizes the hyoid

Question 6

move mandible lateral and forward to the right

Answer 6

left lateral and medial pterygoids

Question 7

close jaw tightly

Answer 7

temporalis
masseter
medial pterygoid

Question 8

approximates lips and compresses cheeks

Answer 8

buccinator

Question 9

protrudes lower lip (pouting)

Answer 9

depressor labii inferior

Question 10

draw corner of the outh down in a frown

Answer 10

depressor anguli oris and platysma

Question 11

draws tip of chin upwards

Answer 11

mentalis

Question 12

approximates and compresses lips

Answer 12

orbicularis oris

Question 13

protrudes upper lip

Answer 13

zygomatic minor

Question 14

lifts upper border of lip one side without raising lateral angle
snarl

Answer 14

levator anguli oris

Question 15

raises lateral angle of the mouth into a smile

Answer 15

zygomaticus major

Question 16

approximates lips and draws lips and corners lateral into a grimace

Answer 16

risorius

Question 17

signs/symptoms of TMJ disorder

Answer 17

pt may c/o cephalgia, jaw problems, dull ache worse with chewing, tinnitus
difficulty opening mouth - click, crepitans
lateral deviation ofjaw
spasm within facial muscles
onset of TMJ may correspond with onset of stress
ear discomfort

Question 18

types of TMJ dysfunction

Answer 18

opening click
closing click (reciprocal)
inability to fully open jaw (close-locked)
inability to close if TMJ symptoms are bilateral
creptius and grating
fusion of the joints (ankylosis)

Question 19

causes of click

Answer 19

ALMOST ALWAYS D/T DISC DISPLACEMENT
also - adhesions, uncoordinated muscle action of pterygoids, tear or perforation fo disc, osteoarthritis, occlusion imbalances

Question 20

etiology of TMJ SD

Answer 20

trauma - direct/whiplash/third molar extraction/intubation

Question 21

direct blow to closed mouth === ____ injury

Answer 21

posterior capsule injury

Question 22

maloclussions 
a
2a
2b
3

Answer 22

1 - 1st molar normal, problem elsewhere for malocclusion
(crowded)
2a - lower 1st molar posterior to upper - RETRUSION
2b - lower 1st molar posterior to upper to great degree - GREATER RETRUSION - OVERBITE
3 - lower 1st molar anterior to upper mandibular protrusion - UNDERBITE

Question 23

mood disorders assocaited with TMD

Answer 23

anxiety
depression
PTSD
history of abuse

Question 24

endocrine causes of TMD

Answer 24

hypocalcemia

chvostek sign and trousseaussight

Question 25

intracapsular causes of TMD

Answer 25

``` infection RA OA gout metastatic CA articular disc displacements ```

Question 26

extracapsular causes of TMD

Answer 26

myofascial pain of masticatory msucles | TMJD is NIH term for TMD

Question 27

factors NOT associated with increased risk of TMD

Answer 27

genetics | orthodontics

Question 28

epi of TMD

Answer 28

20% of americans affected more common in young women #2 cause of facial pain

Question 29

patients with whta dz are more likely to develop TMD

Answer 29

RA | prevalence for TMD comorbidity 53-94%

Question 30

OSE for TMD includes

Answer 30

``` cranial C spine scoliosis leg length innominate, sacrum, si ```

Question 31

evaluation of TMJ

Answer 31

palapate joints for crepitans/click palpate masticaitno muscles w/ 2-3 lbs of pressure check range of motion active - pt opens mouth 3-6 cm laterally 1-2 cm, retract and protrudes mandible observe jaw movements for deviation

Question 32

when should you suspect TMD

Answer 32

``` abnormal mandibualr movements decreased ROM of TMJ muscles of mastication tenderness pain with dynamic loading bruxism postural asymmetry neck and shoulder tenderness normal CN exam ```

Question 33

are radiological exams usually needed

Answer 33

no only use when supsecting dental problems, severe symptoms that dont imrpove with conservative tx, alternative cause suspected, recent/severe trauma

Question 34

what is the radiological exam of choice for examining the TMJ

Answer 34

MRI

Question 35

how might the CBT effect chronic TMJ

Answer 35

reduces activity interference, pain and depressino at 1 year

Question 36

TMJ level 2 interventions

Answer 36

``` amitriptyline glucosamine suflate for OA bendoziazepine botox acupuncture OMT therepeutic exercise phsycial self regultaion cognitive behavrioal skills training plus biofeedback oral habit reversal treatment hypnorelaxation NSAIDs ```

Question 37

TMJ level 3 interventions

Answer 37

OMT - biofeedback alone surgery - arthrocentesis/scopy/orthgnathic surgery/joint replacement occlusal splints/mouth guard intra-articular corticosteroid injection

Question 38

what is the rule of thumb for the distance the jaw should be able to open

Answer 38

enought to fit the index and middle finger knuckles between the teeth

Question 39

most important part of a holistic approach to treating TMD

Answer 39

eliminate jaw stress