Unit 1 Week 3 TMJ Flashcards
(39 cards)
what is orofacial pain?
pain in the face and jaw/mouth region
what are the 4 proposed classifications of patients with orofacial pain?
- primary headache/non-cervicogenic headache
- TMJ dysfunction
- masticatory muscle disorder
- cervicogenic headache
what are the 6 contributing factors of TMD?
- microtrauma
- malocclusion (misalignment of dentition)
- cervical spine (regional interdependence)
- hypermobility
- bad habits (bruxism (grinding teeth), mouth breathing, nail biting)
- psychosocial factors (stress, anxiety, anger, depression)
what are the arthrokinematics of the TMJ?
inferior - rotation
superior - translation
during opening of the mouth the first 11mm comes from the inferior joint. translation does the rest.
what are the physiological motions of the TMJ?
opening - rotation + translation
protraction - translation
lateral deviation - translation (R) + spin (L)
what are the 6 classifications of TMJ dysfunctions?
- arthralgia (TMJ pain)
- disc derangement with reduction (DDWR)
- disc derangement without reduction (DDWOR)
- capsular adhesions (single joint)
- osteoarthritis
- hypermobility
what is typically seen with disc dislocation with reduction?
deviation with opening
opening click + closing click (reciprocal click)
ROM grossly WNL
history of hypermobility
what is the typical progression of the disc when dislocating with reduction?
- resting in dislocation
- disc reduced during opening (click)
- stays in correct position during opening
- at some point before maximal closing the disk slips anteriorly (click)
what is typically seen with disc dislocation without reduction?
deflected mandible with opening
no click, possible crepitus
hypomobile stage
25-35mm opening
decreased laterotrusion
history of clicking (no longer there)
what is the typical progression of the disc when dislocating without reduction?
throughout the cycle of opening and closing the disk remains anteriorly dislocated
what is typically seen with TMJ hypermobility/subluxation?
loud clunking, popping
“out of place feeling”
excessive motion of lateral pole (palpable)
unilateral deviation to the contralateral side
opening greater than 50mm
open locking
what is typically seen with TMJ inflammatory conditions?
capsulitis, retrodiscitis, arthritis
periarticular pain without referral
TMJ loading (+) - retrusive overpressure, contralateral pain with force biting
mandibular mobility normal to slightly limited
no deflection or deviation
what is typically seen with TMJ myofascial disorders?
masticatory musculature (and cervical)
trigger points
(+) ipsilateral forced biting test
deviations in mandibular movements
mild limitation of joint mobility
no clicking
what two main questions should be added to a TMJ evaluation?
- have you had pain or stiffness in the face, jaw, temple, in front of the ear, or in the ear in the past month?
- have you ever had your jaw catch or lock so that it would not open/close all the way?
what should you be listening for during a psychological screen?
reports of: stress overload, malaise, anxiety, sleep disturbance, changes in eating patterns, weight changes, fatigue, and other signs of depression
what 2 screening questions should be included in a psychological screen?
over the past two weeks, how often have you been bothered by:
1. feeling down, depressed, or hopeless?
2. little interest or pleasure in doing things?
scale - 0 not at all, 1 several days, 2 more than half the days, 3 nearly every day
what posture is typically seen with patient with TMD?
forward head posture
tight suboccipital muscles rotate cranium posteriorly, mandibular mechanics are affected, lengthened masseter and temporalis
what should you be looking at when assessing facial symmetry and vertical dimension?
corner eye-corner mouth
corner mouth-center chin
alignment of center points
clenching teeth
mouth breathing
what is the difference between overbite and overjet?
overbite: how far (in the frontal plane) the top teeth are over the bottom
overjet: when top teeth are further anterior than bottom (in sagittal plane)
what could clicking or popping of the jaw be caused by?
anterior displaced disk, condyle hitting eminence
hypermobility
muscle incoordination
what could crepitus and crackling of the jaw be caused by?
arthritis
what muscles should be palpated during a TMJ evaluation?
masseter, temporalis, lateral pterygoid, trapezius, SCM
what test looks at functional opening of the TMJ?
3-knuckles test (3-fingers)
what should be the ratio of opening to lateral excursion?
4:1
