TMJ Lecture Flashcards
1
Q
What does “occlusion” refer to in dental terms?
A
Occlusion is the functional relationship between the maxillary (upper) and mandibular (lower) teeth when the mouth is closed.
2
Q
What is maximal occlusion?
A
Maximal occlusion refers to the position where the upper and lower teeth are in complete contact and alignment, involving maximal intercuspation of the teeth. It is the point where the teeth fit together most tightly, but may not align with the jaw’s most stable position or the joint’s optimal function.
3
Q
What is bruxism?
A
Bruxism is the involuntary or habitual grinding of teeth, often occurring during sleep, which can cause wear on the teeth, jaw pain, and headaches.
4
Q
What causes clenching, and what are its effects?
A
Clenching is caused by overactive masseter and temporalis muscles, leading to increased compressive force between the teeth. It can cause tooth wear, jaw discomfort, and headaches.
5
Q
What is freeway space (FWS), and how much space is typical?
A
Freeway space (FWS) is the space between the occluding surfaces of the upper and lower teeth when the jaw is in a natural, relaxed resting position. The typical space is between 2 to 4 millimeters.
6
Q
What determines an overbite?
A
An overbite is determined by the portion of the mandibular center incisor that is covered by the maxillary center incisor when the mandible is in the maximally occluded position. The normal range is approximately one-third of the mandibular center incisor.
7
Q
What determines an overjet, and what is the normal range?
A
An overjet is determined by the horizontal distance between the maxillary and mandibular arches when the mandible is in its maximally occluded position. The normal range of an overjet measurement is 3 mm to 6 mm.
8
Q
What is an underbite?
A
An underbite occurs when the mandibular teeth sit further anterior than the maxillary teeth.
9
Q
What is a crossbite?
A
A crossbite is an occlusal irregularity where the mandibular and maxillary teeth are not in line with the center incisors. Either arch may shift to the lateral side during occlusion. This disharmony may or may not affect the TMJ.
10
Q
What is an open bite?
A
An open bite is when, in full occlusion, the molars are in approximation, but the front teeth do not touch.
11
Q
What is the shape of the articular disc in the TMJ?
A
The articular disc in the TMJ is biconcave, meaning it has a concave shape on both the upper and lower surfaces.
12
Q
What should the articular disc do during jaw movements?
A
The articular disc should move with the mandibular condyle throughout jaw movements such as opening and closing the mouth.
13
Q
What type of cartilage covers the articular disc?
A
The disc is covered in fibrocartilage, which helps cushion and protect the joint.
14
Q
Where does the disc attach posteriorly and anteriorly?
A
Posteriorly, the disc attaches to the retrodiscal tissue. Anteriorly, it attaches to the joint capsule and the superior lateral pterygoid muscle.
15
Q
What are the three divisions of the TMJ disc?
A
- Anterior: Vascular and neural. 2. Intermediate: Avascular and aneural. 3. Posterior: Vascular and neural.
16
Q
What are the two cavities created by the disc in the TMJ?
A
The disc divides the joint into two cavities: 1. Inferior cavity: Where rotation of the condyle occurs. 2. Superior cavity: Where translation (sliding) of the condyle occurs.
17
Q
How does the disc’s movement relate to muscle function?
A
The movement of the disc and condyle is directly linked to proper muscle function, as muscles control the disc’s position during jaw movements.
18
Q
What is the retrodiscal tissue and its functions?
A
The retrodiscal tissue is vascular (has blood supply) and nociceptive (sensitive to pain), meaning it plays a role in pain sensations if the joint is damaged.
19
Q
What muscles are involved in elevation (closing) of the jaw?
A
The muscles involved in elevation (closing) of the jaw are the masseter, temporalis, medial pterygoid, and the superior fibers of the lateral pterygoid (which stabilize the disk).
20
Q
What is the role of the superior fibers of the lateral pterygoid during jaw elevation?
A
The superior fibers of the lateral pterygoid help stabilize the disk during jaw elevation (closing).
21
Q
What could result from excessive mastication?
A
Excessive mastication can lead to overuse of the muscles involved in jaw elevation, including the masseter, temporalis, and medial pterygoid.
22
Q
What muscles are involved in depression (opening) of the jaw?
A
The muscles involved in depression (opening) of the jaw are the inferior fibers of the lateral pterygoid, suprahyoids, and infrahyoids (indirectly).
23
Q
What is the role of the inferior fibers of the lateral pterygoid during jaw depression?
A
The inferior fibers of the lateral pterygoid help in jaw depression (opening).
24
Q
How do the suprahyoids and infrahyoids contribute to jaw depression?
A
The suprahyoids and infrahyoids contribute indirectly to jaw depression by assisting in lowering the jaw.
25
What muscles are involved in protrusion of the jaw?
The muscles involved in protrusion of the jaw are the superficial masseter, medial pterygoid, and lateral pterygoid.
26
What muscles are involved in lateral excursion of the jaw?
The muscles involved in lateral excursion of the jaw are the ipsilateral temporalis and masseter, and the contralateral medial and lateral pterygoid.
27
What is the role of the suprahyoid muscles?
The suprahyoid muscles are responsible for depression and retrusion of the mandible during mouth opening when the hyoid bone is fixed.
28
What is the function of the infrahyoid muscles?
The infrahyoid muscles work to stabilize the hyoid bone, forming a firm base for the action of the suprahyoid muscles.
29
What functions do the suprahyoids and infrahyoids work together on?
Together with the suprahyoids, the infrahyoids are involved in speech, swallowing, and tongue movements.
30
Why are the lateral pterygoid muscles important?
The lateral pterygoid muscles are important because they help guide the disc during jaw movement.
31
What makes the lateral pterygoid unique in relation to the disc?
The lateral pterygoid is the only contractile tissue that attaches directly to the disc.
32
If there is disc dysfunction, which muscle is likely involved?
If there is a disc dysfunction, the lateral pterygoid is likely involved.
33
How do muscles that close the jaw compare to muscles that open the jaw?
Generally, muscles that close the jaw will be tight, whereas muscles that open the jaw will be weak or inhibited.
34
Which nerve is the mandibular branch of the trigeminal nerve?
The mandibular branch of the trigeminal nerve is Cranial Nerve V3.
35
What arteries supply blood to the temporomandibular joint?
The superficial temporal artery and maxillary artery supply blood to the temporomandibular joint.
36
What is the resting position of the disc in the TMJ?
The disc should sit slightly anterior to the condyle in the resting position.
37
What is the relationship between the condyle and the disc in arthrokinematics?
In arthrokinematics, the condyle is convex, and the disc is concave.
38
What are the two types of movement in the TMJ?
The two types of movement in the TMJ are roll/rotation and slide/translation.
39
What occurs during the early phase of TMJ opening?
During the early phase of TMJ opening, rotation occurs in the first 20-25 mm of motion.
40
What occurs during the late phase of TMJ opening?
During the late phase of TMJ opening, translation occurs, with condyles moving anteriorly and inferiorly, and the anterior mandible moving posteriorly and inferiorly.
41
What occurs during TMJ closing?
The condyles move posteriorly and superiorly, and the anterior mandible moves anteriorly and superiorly.
42
What occurs during lateral deviation of the TMJ?
During lateral deviation, there is unilateral rotation of the ipsilateral condyle and unilateral horizontal translation of the contralateral condyle.
43
What occurs during protrusion and retrusion of the TMJ?
During protrusion and retrusion, the condyle and disc follow the downward slope of the articular eminence. The mandible slides slightly downward during protrusion and slightly upward during retrusion.
44
What is the normal range for TMJ opening?
The normal range for TMJ opening is 40-60 mm, with 40-45 mm in males and 45-50 mm in females. A functional opening is 35 mm.
45
What is considered normal for TMJ closing?
Normal TMJ closing involves intercuspation (teeth coming together).
46
What is the normal range for lateral deviation of the TMJ?
The normal range for lateral deviation is about ¼ of the opening, approximately 10 mm.
47
What is the normal range for protrusion and retrusion of the TMJ?
Normal protrusion is 5-10 mm, and normal retrusion is about 3 mm.
48
What is a quick way to measure TMJ opening?
Opening should be approximately 4 fingers of the dominant hand. A functional opening is 3 fingers.
49
What are parafunctional habits that contribute to TMJ dysfunction?
Parafunctional habits include clenching/grinding of teeth (over-activation of masticatory muscles), gum chewing, and other oral fixation.
50
How can trauma or poor dentition contribute to TMJ dysfunction?
Trauma and poor dentition can lead to misalignment or strain on the TMJ, contributing to dysfunction.
51
How do postural changes and muscle imbalances affect the TMJ?
Postural changes and muscle imbalances in the cervical, thoracic, and upper quadrants can contribute to TMJ dysfunction.
52
What impact can chemical-induced jaw muscle pain have on the TMJ?
Chemically induced jaw muscle pain can cause a 700% increase in cervical muscle tone, which may affect the TMJ (Svensson et al. Pain, 2004).
53
How are psychosocial factors connected to parafunctional habits?
Psychosocial factors such as anxiety and depression are connected to parafunctional habits, which may contribute to TMJ dysfunction.
54
What is the relationship between chronic pain and psychosocial factors?
There is a high prevalence of anxiety and depression in the chronic pain population, especially in those with Fibromyalgia. These factors are also correlated with patients with high disability (Balasubramaniam 2007).
55
What is the pathoanatomy of Anterior Disc Displacement with Reduction (ADDwR)?
In ADDwR, the disc lies anterior to the condyles at rest.
56
What happens during opening in ADDwR?
During opening, the condyles reduce over the posterior region, which can cause an opening click, followed by normal function.
57
What happens during closing in ADDwR?
During closing, the disc and condyle translate together posteriorly. At the end of the closing range, the disc displaces anteriorly again due to excessive contraction of the lateral pterygoid, potentially causing a closing click.
58
What types of clicks are associated with ADDwR?
Clicks can include an opening click, closing click, both (reciprocal clicks), or none at all.
59
Why does Anterior Disc Displacement with Reduction (ADDwR) occur?
ADDwR can occur if there is an issue with the guide wires, such as the superior lateral pterygoids and superior retrodiscal lamina, which affect the positioning of the disc.
60
What morphological issues can contribute to ADDwR?
Morphological issues with the collateral ligaments or retrodiscal tissue can affect the interarticular disc pressure, contributing to ADDwR.
61
Can manual treatments change the morphology in ADDwR?
While manual treatments cannot change morphology, they can address proper disc position by treating the muscles that affect interarticular pressure.
62
What is the pathoanatomy of Anterior Disc Displacement without Reduction (ADDwoR)?
In ADDwoR, elasticity is lost in the ligaments and retrodiscal tissue, preventing the condyles from gliding over the disc.
63
What happens if there is limited opening in ADDwoR?
If there is limited opening, the disc is blocking the condylar head in ADDwoR.
64
What happens if there is no limitation in opening with ADDwoR?
If there is no limitation in opening, the disc is completely displaced anteriorly in ADDwoR.
65
Are clicks associated with ADDwoR?
No clicking occurs with ADDwoR.
66
What are the two subcategories of Group I: Masticatory Muscle Disorders?
(Ia) with normal opening, (Ib) with limited opening
67
What are the three types of disc displacements in Group II?
(IIa) Disc displacement with reduction, (IIb) Disc displacement without reduction with limited opening, (IIc) Disc displacement without reduction without limited opening
68
What are the three types of joint dysfunctions in Group III?
(IIIa) Arthralgia, (IIIb) Osteoarthritis, (IIIc) Osteoarthrosis
69
What classification system does this table modify?
The Diagnostic Criteria for Temporomandibular Disorders (TMD)
70
What are the types of Masticatory Muscle Disorders?
Myofascial pain disorder syndrome, Trismus (muscular lock jaw), Myositis, Myospasm, Dystonia, Myofibrotic contracture, Neoplasm
71
What are the types of Joint Dysfunction?
OA, RA, Psoriatic arthritis, Capsulitis, Synovitis
72
What are some associated conditions with temporomandibular disorders (TMD), and why do they occur?
Headaches, Ear issues (such as ringing or fullness), Vertigo/dizziness, Swallowing/speech disorders, Psychological effects (such as stress and anxiety), Trigeminal Neuralgia, Temporal Arteritis, Post Herpetic Neuralgia, Meniere's disease, Cervical/postural contributions (poor posture affecting the jaw and neck), and Chronic pain conditions like Fibromyalgia.
73
Why is it important to screen for neck pain and headaches when evaluating TMJ issues?
Neck pain and headaches are highly correlated with temporomandibular joint (TMJ) disorders due to shared musculature and nerve pathways. Identifying these issues helps in diagnosing and treating TMJ dysfunction more effectively.
74
What eating-related questions should be asked when assessing TMJ issues?
Ask about pain while chewing or swallowing, difficulty chewing tough meats, crunchy/hard textures (nuts, apples, raw carrots), recent dental work, and use of dental appliances like night guards or retainers.
75
Why ask about jaw popping, clicking, or locking during a TMJ assessment?
Popping or clicking can indicate disc displacement in the TMJ, while jaw locking (in either an open or closed position) may suggest a more severe joint dysfunction.
76
Why is it important to ask about ear ringing (tinnitus) in TMJ assessments?
Ear ringing can be indicative of TMJ dysfunction and/or cervical spine issues due to the close connection between the jaw, ear, and upper neck structures.
77
What does a change in voice suggest in a TMJ evaluation?
A change in voice may be indicative of muscle spasm affecting the jaw, throat, or vocal structures.
78
Why is it important to ask about recent stressful situations in a TMJ assessment?
Stress can lead to jaw clenching, teeth grinding (bruxism), and increased muscle tension, all of which can contribute to TMJ dysfunction.
79
What should be assessed in a seated TMJ examination without gloves?
Open/close motion analysis, resting occlusion (Overbite, Overjet, Underbite), TMJ palpation, jaw opening asymmetry, auscultation for crepitus, and sagittal plane observation.
80
What does a C-shaped opening pattern indicate in a TMJ assessment?
A C-shaped opening pattern suggests a capsular restriction, where the jaw deviates toward the restricted side.
81
What does an S-shaped opening pattern indicate in a TMJ assessment?
An S-shaped opening pattern suggests a lack of motor control and possible neuromuscular dysfunction.
82
What does deflection of the jaw during opening suggest?
Deflection (where the jaw moves toward one side without returning to midline) suggests anterior disc displacement, typically towards the side of the displaced disc.
83
Why is auscultation important during a TMJ assessment?
Listening for crepitus (grinding or crackling sounds) during opening and closing helps identify joint degeneration or disc displacement.
84
What should be observed in the sagittal plane during a TMJ examination?
A protrusive opening pattern, where the jaw moves forward excessively, may indicate abnormal movement mechanics or compensations.
85
What is the purpose of the cotton roll test in a TMJ assessment?
The cotton roll test helps differentiate between muscular and joint-related pain by having the patient bite on an object on the painful side molars.
86
What does it mean if pain increases during the cotton roll test?
If pain increases, it suggests a muscular origin of the pain.
87
What does it mean if pain decreases during the cotton roll test?
If pain decreases, it suggests a joint-related issue.
88
How can the cotton roll test be confirmed using the non-painful side?
If the pain is joint-related, biting on the non-painful side should still result in pain.
89
What is assessed with the jaw jerk reflex?
The jaw jerk reflex tests for hyperreflexia, which could indicate central nervous system involvement.
90
Why is a cranial nerve (CN) screen important in TMJ evaluation?
A CN screen helps assess neurological function, which can be affected by TMJ dysfunction or other neurological conditions.
91
Why should the cervical and thoracic spine be screened in a TMJ evaluation?
The cervical and thoracic spine can contribute to TMJ dysfunction due to postural compensations and shared musculature.
92
What postural aspects should be evaluated in a TMJ assessment?
Cervicothoracic posture and scapular positioning should be evaluated, as poor posture can contribute to TMJ dysfunction.
93
Why is the assessment of the 1st ribs important in TMJ evaluation?
Dysfunction of the 1st ribs can impact cervical mobility and posture, indirectly affecting TMJ function.
94
Which muscles should be palpated during a TMJ assessment?
Masseter and Temporalis muscles should be palpated to assess for tenderness, tightness, or trigger points.
95
Why is joint assessment of the cervical spine important in TMJ evaluation?
Cervical spine dysfunction can contribute to TMJ issues due to shared muscular and neural connections.
96
Which muscle group should be tested for strength in a TMJ assessment?
Deep neck flexors should be tested for strength, as they play a role in cervical stability and jaw function.
97
Why are muscle length tests important in TMJ assessment?
Muscle length tests help identify tightness or restrictions that may contribute to postural imbalances affecting TMJ function.
98
Which muscles should be assessed for length in a TMJ evaluation?
Pectoralis major, Pectoralis minor, and Latissimus dorsi should be assessed for tightness, as they can impact posture and contribute to TMJ dysfunction.
99
Why perform Mandibular Neurodynamic Testing (MDNT)?
MDNT is performed when a neural origin of pain is suspected, helping differentiate nerve involvement from musculoskeletal dysfunction.
100
What is the patient’s position during MDNT?
The patient lies supine on a plinth with arms by their side and hands resting on their abdomen.
101
How is the patient’s head positioned during MDNT?
The patient’s head is positioned over the end of the plinth, resting against the clinician’s abdomen.
102
How does the clinician support the patient’s head during MDNT?
The clinician supports the patient’s head with both hands at the occipital area and places both thumbs on the mandibular angles.
103
What is capital cervical flexion in MDNT?
The clinician flexes the cervical spine at the upper C-spine (C0-C2), isolating motion at the occipital-atlantal (OA) joint and atlanto-axial (AA) joint.
104
What is contralateral lateral flexion in MDNT?
The clinician laterally flexes the upper cervical spine to the opposite side of the initial movement to assess upper cervical structures.
105
What is the goal of MDNT?
To optimally load intracranial structures like the brainstem and nerve roots without causing pain or discomfort.
106
How are the cervical movements performed during MDNT?
Both cervical movements are performed as far as possible to load intracranial structures but without provoking any pain or discomfort.
107
What is the technique for Mandibular Neurodynamic Testing (MDNT)?
A lateral glide movement of the mandible towards the contralateral side is performed while maintaining the patient's head position.
108
What must the patient do during the lateral glide movement in MDNT?
The patient’s masticatory muscles and tongue must be relaxed during the lateral glide movement.
109
What is the recommended mouth position during the lateral glide movement in MDNT?
It is recommended to perform the lateral glide movement with the mouth opened 1 cm, as this is when the range of lateral glide is maximal.
110
Why is the mouth opened 1 cm during MDNT?
To achieve the maximal range of lateral glide in this position.
111
How does structural differentiation occur during MDNT?
The maneuver is compared with a lateral glide movement with the cervical spine in a neutral position, while neural structures are not preloaded.
112
What is included in the Supine Examination-Gloves for the TMJ assessment?
Range of motion (ROM), joint play, muscle palpation, and various specific tests for the masticatory muscles.
113
What movements are assessed for ROM in the TMJ exam?
Opening, closing, lateral deviation, protrusion, and retrusion.
114
What is assessed in joint play during the TMJ examination?
The clinician evaluates the movement and mobility of the temporomandibular joint to assess for restrictions or dysfunction.
115
What is the method for palpating the medial pterygoid?
Intraoral: Slide finger along the mandibular teeth until you feel a rope-like bundle just posterior to the back molar.
116
What is the method for palpating the lateral pterygoid?
Intraoral: This method is questionable due to the gag reflex, but extraoral palpation can be done by placing fingers inside the external auditory meatus and having the patient open and close their mouth.
117
Why is lateral pterygoid palpation challenging intraorally?
The gag reflex can interfere with the ability to palpate the lateral pterygoid muscle inside the mouth.
118
What is the Centric Relation Provocation Test (CRPT) used for?
To identify discal issues in the temporomandibular joint (TMJ).
119
How do you perform the CRPT?
Grasp the lower mandible with index and ring fingers externally gripping the angle of the mandible, and place the thumb on top of the mandibular teeth. Keep the jaw slightly open while ‘scooping’ the jaw into the joint space.
120
What force is applied during the CRPT?
Moderate anterior-superior force is applied to the jaw.
121
What is a positive result for the CRPT?
Pain recreated anterior to the tragus, indicating structural pathology of the disc complex.
122
When should the CRPT be performed in a sequence of tests?
The CRPT should be tested last, especially if you suspect disc issues, as it’s considered similar to meniscal testing.
123
What is assessed during the Prone Examination?
Joint assessment of the cervical thoracic (CT) and thoracic regions.
124
What is the focus of the joint assessment in the Prone Examination?
To evaluate the mobility, alignment, and potential dysfunction of the CT and thoracic joints.
125
What is the purpose of the "Resist Closing" technique in Muscle Energy Techniques (METs)?
It is used to increase jaw opening by engaging the muscles that close the jaw.
126
How is the "Resist Closing" technique performed?
Place the thumb on the bottom teeth and grasp the lower jaw. Keep the cervical spine neutral with the other hand, and depress the mandible to the muscle barrier without moving the cervical spine.
127
What command is used during the "Resist Closing" MET?
The clinician uses the command “don’t let me move you” to encourage the patient to resist the force, while the patient actively tries to close their jaw against the clinician’s resistance.
128
What is the purpose of the "Resist Protrusion" technique in Muscle Energy Techniques (METs)?
It is used to address protrusion of the jaw and improve its mobility or alignment.
129
How is the "Resist Protrusion" technique performed?
Grasp the lower jaw with all fingers under the mandible, and position the thumb behind the bottom lip at the bottom of the teeth.
130
What does the patient do during the "Resist Protrusion" MET?
The patient is instructed to move their jaw towards the ceiling (protrusion), while the clinician applies light force towards retrusion (pulling the jaw back).
131
What is the purpose of the "Resist Cervical Extension" technique in Muscle Energy Techniques (METs)?
It is used to improve mobility and function of the upper cervical spine, focusing on cervical extension.
132
How is the "Resist Cervical Extension" technique performed?
The patient is supine at the barrier of upper cervical flexion. The clinician instructs the patient to look up as far as they can, using only their eyes, during contraction.
133
What should the patient do during relaxation in the "Resist Cervical Extension" MET?
On relaxation, the patient takes a deep breath and looks down with their eyes while exhaling.
134
What happens after relaxation in the "Resist Cervical Extension" MET?
The clinician takes the cervical spine to a new barrier and the process is repeated.
135
What is the purpose of the "Resist Lateral Excursion" technique in Muscle Energy Techniques (METs)?
It is used to improve lateral jaw mobility by resisting lateral excursion of the jaw.
136
How is the "Resist Lateral Excursion" technique performed?
Place your hand at the lower mandible to resist the motion as the patient is instructed to glide their jaw to the side.
137
What is the purpose of the "Resist Opening" technique in METs?
It is used to improve jaw opening range and function.
138
How is the "Resist Opening" technique performed?
Place your hand below the patient's chin and instruct them to open their mouth maximally without pain or clicking. Apply gentle pressure while the patient matches your resistance.
139
How is the patient positioned for mobilizations of the TMJ?
The patient can be either supine or sitting.
140
What should be done if the patient is sitting and the therapist is female?
If the patient is sitting and the therapist is female, a pillow should be placed between the therapist and the patient (no boobie touching)
141
Where does the PT stand during mobilizations?
The PT stands contralateral to the side of the hypomobile joint.
142
How is the therapist's hand positioned during TMJ mobilizations?
The therapist inserts their thumb in the patient's mouth, resting on the mandibular teeth, and uses the ring finger and/or middle finger to grasp behind the angle of the jaw.
143
What is done before performing any mobilization?
Distraction should be performed before all mobilizations to ensure effective joint mobilization.
144
What are the types of mobilizations used for the TMJ?
Anterior mobilization, lateral mobilization, and anteromedial mobilization.
145
What effect does adding rotation to mobilizations have?
Adding rotation is thought to assist with anterior disc displacement by creating more room for the disc.
146
What is the purpose of distraction in TMJ mobilizations?
Distraction helps to relieve joint compression and can be performed unilaterally or bilaterally to improve joint mobility.
147
What is included in soft tissue massage for TMJ treatment?
Soft tissue massage can include extraoral techniques for masseters and intraoral techniques for masseters and the medial pterygoid.
148
Why is cervical manipulation performed in TMJ treatment?
Dysfunction in the cervical spine may affect TMJ function
149
What other manual therapy techniques may be used in TMJ treatment?
CT (cervicothoracic) and thoracic manual therapy (MT) can be used as needed to address related dysfunction.
150
What does TUTALC stand for in TMJ and cervical spine exercises?
Tongue up on the roof of the mouth, Teeth apart, Lips closed. These guidelines should be followed at all times when not chewing, talking, or exercising.
151
What is the recommended cervical spine position during exercises?
The cervicothoracic spine should be kept in a neutral position during exercises.
152
What additional education is important prior to exercise?
Review pertinent ergonomics, including desk posture and other habits related to the patient’s daily activities.
153
What is the purpose of self-manual therapy for TMJ?
Self-manual therapy techniques such as METs, soft tissue massage, and muscle activation can help improve TMJ function and alleviate pain.
154
How is masseter soft tissue massage performed in self-manual therapy?
The patient makes fists and places their knuckles at the top of the masseter. The patient then slowly opens their mouth while applying pressure through their knuckles and dragging their fists down the cheeks.
155
What is the purpose of unilateral closing exercises with a tongue depressor?
The patient bites down on a stack of tongue depressors to increase closing strength if there are unilateral deficits in the jaw.
156
How is lateral excursion performed with a tongue depressor?
The patient bites down on a stack of tongue depressors held together by rubber bands, then slides the mandible side to side to improve lateral excursion.
157
How is protrusion/retrusion exercised using a tongue depressor?
The patient bites down on a stack of tongue depressors held together by rubber bands and slides the mandible forwards and backwards to improve protrusion and retrusion.
158
What is the TUTALC position for controlled opening exercises?
The patient should position their tongue on the roof of the mouth, keep their teeth apart, and lips closed during the exercise.
159
How is the TUTALC controlled opening exercise performed?
The patient starts by opening their mouth while maintaining the tongue on the roof of the mouth and keeping the lips closed.
160
How should the exercise progress?
The exercise can progress to opening the lips as the patient tolerates or if they are no longer experiencing clicking.
161
What is the goal of the Midline Assist neuro re-education exercise?
The goal is to help the patient maintain jaw midline during opening movements.
162
How is the Midline Assist exercise performed?
The patient sits in front of a mirror and practices opening their mouth while using their hand to assist in keeping the midline. They push towards the midline to correct any deviation.
163
How does the exercise progress as the patient improves?
As the patient improves, they switch the position of their hand to the opposite side of the jaw, encouraging them to push in the opposite direction.
164
What is the next progression after the hand assistance?
The next progression is to open the jaw using only the visual cue from the mirror to keep the midline, without tactile cueing.
165
What is the purpose of the ADDwR exercise?
The ADDwR exercise is designed to improve jaw function by addressing disc displacement and reducing clicking during opening.
166
How is the ADDwR exercise performed?
The patient opens their mouth maximally until the opening click occurs, then closes along a protruded path. The clinician contacts the teeth at the protruded position, as the disc is thought to be on top of the condyle.
167
What does the patient do after the protruded path in the ADDwR exercise?
The patient is instructed to carefully retrude the condyle to the position just before the closing click occurs.
168
What is the final step of the ADDwR exercise?
The patient opens their mouth maximally again, this time without experiencing an opening click.
169
What is the purpose of the Condylar Remodeling exercise?
The exercise is used with ADDwR to help position the disc correctly in the temporomandibular joint (TMJ).
170
How is the Condylar Remodeling exercise performed?
The patient uses tubing (surgical or theraband tubing) between the teeth and is asked to deviate laterally to the contralateral side of the symptomatic joint.
171
What is done if the lateral deviation is pain-free?
If the lateral deviation is pain-free, the patient is instructed to add a bite as they deviate laterally and then release at the end range of the lateral deviation.
172
What happens if the lateral deviation with bite is pain-free?
If this is pain-free, the patient repeats the movement but maintains the bite until returning to the midline.
173
What is the next progression after lateral deviation with bite?
If pain-free, the same steps are repeated for protrusion to further promote condylar remodeling.
174
What is the purpose of Suprahyoid Facilitation Exercises?
These exercises are easy to incorporate into other exercises and help with coordinated movements of the jaw and tongue.
175
What is involved in the "Tongue Clucking" exercise?
The tongue is pushed superiorly on the palate with the mouth open while making the "N" sound while depressing the jaw. The exercise is performed for 6-8 seconds, 6-8 reps, 6-8 times per day. Only the jaw should move, not the cervical spine.
176
How is the "Tongue Rolls" exercise performed?
The patient maintains good posture and, as they open their jaw, rolls the tongue across the roof of their mouth from anterior to posterior (A->P). The exercise can progress from lips open to lips closed.
177
Why should posture be addressed in TMJ patients?
Improving posture in TMJ patients decreases pain and improves jaw opening range of motion (ROM) (Journal of Oral Rehabilitation, 1999).
178
What effect does forward head posture have on the jaw?
Forward head posture places the jaw at a mechanical disadvantage and can facilitate related dysfunction (Skaggs, 2000).
179
What happens if spinal dysfunction is not addressed in TMJ patients?
Spinal dysfunction can create a vicious cycle of dysfunctional activity, leading to reflex changes in the orofacial region and upper body, which may follow predictable patterns (Janda, The Journal of Prosthetic Dentistry, 1986).
180
What is the purpose of the chin tuck exercise for postural strengthening?
The chin tuck helps activate the deep neck flexors and improve posture by realigning the cervical spine.
181
How is the mid/low trap facilitation exercise performed?
The patient is prone with hands open, palms facing the ground. They retract and depress the scapulae while externally rotating the hands. The cervical spine must remain relaxed.
182
What is the goal of diaphragmatic breathing in postural strengthening?
The goal is to promote proper breathing mechanics, using the diaphragm and preventing abdominal contraction. The patient should feel pressure around the umbilicus while breathing normally.
183
How is crocodile breathing performed?
The patient lies prone on a firm surface with hands supporting the head. They are instructed to feel for pressure around the umbilicus during normal breaths and imagine filling a balloon with air in their pelvis. The lumbar spine should rise, and the pelvis should counternutate.
184
What have studies shown about the effects of dry needling, lidocaine injections, and Botulinum toxin A in TMD patients?
Several studies have demonstrated similar clinical outcomes with trigger point dry needling, lidocaine injections, or Botulinum toxin A in patients with temporomandibular disorders (TMD).
185
Does the effect of needling interventions mainly come from the mechanical effect of the needle?
The effect may not primarily be due to the mechanical effect of the needle, but rather due to the substance being administered, though the exact mechanisms are still debated.
186
Why is pain science education important for TMD patients?
Pain science education is important because TMD is often tied to central sensitization, which can lead to maladaptive thoughts and behaviors that need to be addressed.
187
Why is it important to understand Rocabado's exercise protocol?
It is important to understand Rocabado’s exercises because you may encounter it and need to justify why you do not blindly follow it.
188
What is the 6x6x6 protocol in Rocabado's exercises?
The 6x6x6 protocol involves 6 sets, 6 reps, performed 6 times per day. Though the evidence for its effectiveness is poor, it has shown good anecdotal success.
189
What are some components of Rocabado's exercise protocol?
Components of Rocabado’s exercises include tongue clucking, control of TMJ rotation, rhythmic stabilization, upper cervical distraction, axial extension of the cervical spine, and shoulder retraction.
190
Why might ultrasound be effective at the TMJ?
Ultrasound may be effective at the TMJ due to the superficiality of the joint and associated muscles.
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What is the takeaway regarding the use of ultrasound at the TMJ?
While ultrasound may provide temporary relief, it doesn’t offer significant long-term benefits.
192
How are heat and ice considered for TMJ treatment?
Heat and ice could be more effective at the TMJ due to the superficiality of the joint, but the takeaway is similar to ultrasound—temporary relief with minimal lasting effect.
