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TMD > 3. Clinical Exam > Flashcards

3. Clinical Exam Flashcards

1
Q

Relevant dental history in the Dx of TMD is

A

trauma

parafunction

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2
Q

Relevant medical history in dx of TMD is

A

osteoarthritis

fibromyalgia

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3
Q

Relevant cheif complaints in Dx of TMD are

A
  • Joint sounds
  • Limited function
  • Sounds
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4
Q

What things should you ask the patient about their pain

A
  • Location
  • Intensity
  • Referral patterns
  • Quality
  • Duration
  • Frequency
  • Temporal pattern
  • Modifiers
  • Assoc. signs and symptoms
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5
Q

Why is location important?

A

Because the pain can be due to TMD or another systemic disease

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6
Q

As the number of bodily sites with pain increases what else increase

A

the risk of developing another pain disorder

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7
Q

What is required for pain location in fibromyalgia

A

-opposite quadrants and spinal area

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8
Q

T/F Most patients with TMD pain have localized pain

A

f- most have widespread pain

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9
Q

Compared to those suffering from localized pain, those with widespread pain have (higher/lower) general health (more/less) sleep dysfunction, (increased/decreased) ability to control pain and (greater/less) health care needs

A

lower
more
decreased
greater (higher depression)

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10
Q

How should the intensity of a patient’s pain be assessed

A
  • Baseline (before treatemnt
  • Followups after tx (with the same scale)
  • *Helps determine if the Dx was correct or not
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11
Q

How does the intensity of someones pain help you decide methods of treatment

A

the greater the pain the more aggressive the treatment

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12
Q

How does the quality of pain assist with Dx

A

can help you determine if the origin of the pain is muscular, joint or nerve

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13
Q

Describe the quality of pain for each of the three origins below

  • Muscle
  • Joint
  • Nerve
A
  • Muscle= Dull, aching, pressure, tight, stiff
  • Joint= sharp
  • Nerve= shock
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14
Q

Does the location, intensity, quality, etc of the pain have dx validity

A

no

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15
Q

Describe referral

A

when you palpate an area and the pain is in a different region

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16
Q

What can duration of pain tell you

A

similar to the quality of pain it can help you determine the origin

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17
Q

describe the duration of pain for each of the three origins listed

  • muscular
  • joint
  • nerve
A
  • Muscular= can hurt for long durations (hours)
  • Joint ~3 hr intervals (intermediate time)
  • Nerve= seconds
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18
Q

If the pain is alleviated by drugs like tylenol what may be the origin

A

musculoskeletal

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19
Q

If the pain is not alleviated with drugs and pain persists for 24hrs what may be the diagnossi

A

intracranial condition

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20
Q

Define temporal pattern

A

When you start with pain and the pain improves (even without treatment)

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21
Q

What are modifiers of pain

A

things that either make the pain feel better or worse

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22
Q

Associated signs and symptoms of TMD are

A
  • Fever
  • Blurred vision
  • Neusea
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23
Q

Patients with migraines and arthritis will also have blurred vision describe the difference between the two

A

migraine the blurred vision will improve as the migraine improves.

Arthritis the blurred vision doesn’t improve.

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24
Q

What is the difference between closed and open lock

A 
Closed= the mouth will not open 
Open= the mouth will not close
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25
Q

DX criteria for TMD are

A
  • Pain (jaw temple, ear, front of ear etc.)

- Headache (includes temple areas) in last 30 days

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26
Q

What activities may worsen a patients TMD associated pain and headache

A
  • Chewing hard or tough foods
  • Opening your mouth or moving your jaw forward or to the side
  • Other jaw activities (talking, kissing, or yawning)
  • Jaw habits such as holding teeth together, clenching/grinding or chewing gum
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27
Q

The clinical assessment consists of

A
  • Opening pattern
  • Vertical range of motion
  • Horizontal range of motion
  • Assessment of joint sounds (clicking and crepitus)
  • Muscles palpation
  • TMJs palpation
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28
Q

When asking patients to describe their past pain what time window should you give them and why

A

30 days because beyond that recall is unreliable

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29
Q

What reference lines are drawn where and for what reasons

A

-Horizontal line on lover incisor= Vertical overlap

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30
Q

What is HO used for

A

add to protrusive movement to determine the total horizontal movement of the patient

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31
Q

What are the different types of opening patterns

A
  • Straight
  • Corrected deviation
  • Deviation
32
Q

What are the different ranges of motion test in the clinical exam

A

Vertical

  • PFO
  • MUO
  • MAO

Horizontal

  • Lateral
  • Protrusive
33
Q

If the PFO is much less than the MAO what may be the origin of the pain and why

A

muscles because they can be stretched

34
Q

What needs to be considered when measuring lateral movements

A

midline deviation

35
Q

How should you clinically examin for joint sounds

A

place your fingers in front of the patient’s ears

36
Q

Why would you want to have the patient tap their teeth together before checking for joint sounds

A

reference noise that is not a click

37
Q

How much pressure is used for muscle and TMJ palpation

A

Lateral pole= 0.5 kilo

Everything else= 1 kilo

38
Q

How long should you hold your palpation for and why

A

5 sec… this is the minimal amount of time needed to elicit referral

39
Q

What should you ask the patient if they have pain on palpation

A

ask them if it is familiar to their headaches and if it is referred

40
Q

If you are palpating the anterior band of the temporalis and the patient is experiencing pain also in the posterior band of the temporalis is this referral

A

no

41
Q

Describe the 3 locations of palpation at the temporalis and masseter

A

Temporalis- posterior, middle, and anterior

Massetter= Origin (near the zygoma)

  • Body (middle)
  • Insertion (near mandibular body)
42
Q

What is the difference between palpating the lateral pole and around the TMJ are

A

-Lateral pole= static and around the TMJ you move your finger

43
Q

Where do you place your fingers to palpate the lateral pole and around the TMJ

A

Slightly open your mouth and protrude. Place finger in the depression

44
Q

When should TMJ imaging be done to supplement a clinical exam

A
  • Osseous abnormality
  • Mechanical abnormality
  • History of trauma
  • Sensory/motor abnormality
  • Significan change in occlusion
45
Q

Purpose of TMJ imaging is

A
  • Evaluate the integrity and relationships of the hard and soft tissues
  • Confirm extent or stage of progression in know disease
  • Evaluate the effects of treatment
46
Q

T/F Condylar eccentricity is a reliable indicator of the soft tissue status of the joint (why or why not)

A

F- it is NOT because the condylar head is not concentric to the shape of the fossa

47
Q

Do the left and right condyles need to be mirror images of each other to be considered “normal”

A

no

48
Q

What TMJ structures/pathology can be seen on a pan

A
  • Gross osseous changes (erosion, osteophytes, or fractures)
  • Other pathology that can be affecting the TMJ (i.e a tumor)
49
Q

what can’t you see on a pan of the TMJ tissues

A
  • No info about condylar position because the jaw is slightly open and protruded
  • Pan view doesn’t provide adequate examination of the hard tissues of the joints
50
Q

What is the Dx validity of pan X-ray in Dx of hard tissue abnormalities in Pan

A

-If you see it it is there if you don’t see it it doesn’t mean it isn’t there (high spec. low sens)

51
Q

Which helps you evaluate hard/soft tissue

  • MRI
  • CT
A

MRI= soft

CT (or CBCT)= Hard

52
Q

What are the different planes of view you get with CT and MRI

A

MRI= sagital and coronal

CT=axial and coronal (these can be manipulated to sagittal view also)

53
Q

In an MRI (sagital view) the normal position of the posterior band and intermediate zone of the disc is

A

posterior band= 11:30 -12:30

Intermediate zone= over the head of the condyle

54
Q

What is the gold standard for imaging fo soft and hard tissues

A

MRI (Soft)/CT (hard)

55
Q

MRI can be used to detect what abnormalities with the TMJ

A
  • Internal derangements
  • Effusion
  • Osseous changes
  • Rule out intracranial causes of pain in patients with neuropathic pain or headaches
56
Q

Dx accuracy and efficency of MRIs are (consistent/inconsistent)

A

inconsistent

57
Q

Look at the slides and article for the pictures of the disc and MRI

A

ok

58
Q

What is the difference between T1 and T2

A

T1= Proton weighted
-Good for osseous and discal tissue

T2=weighted pulse sequence
-Good for Inflammation and joint effusion

59
Q

Is there a relationship between inflammation and joint effusion

A

no

60
Q

What cuts are the easiest to see on MRI of the disc

A

the most central

61
Q

What two images are needed for TMJ Dx

A

opened and closed position

62
Q

How can you rule out if a patient has TMD or MS

A

take an MRI

63
Q

When the disc is anteriorly displaced the posterior band is (greater than/less than) 11:30

A

less than

64
Q

Will the intermediate zone of the disc be in contact with the head of the condyle in anteriorly displaced disc

A

no

65
Q

What view is needed to determine if the disc is medially/laterally displaced

A

coronal MRI

66
Q

In a CT scan what demonstrates a normal condyle

A

Round condyle head

well defined cortical margin

67
Q

T/F reliability of Dx of hard tissue status with CT is good

A

t

68
Q

What four parameters are being observed when performing jaw tracking

A

Looking at jaw movement parameters such as….

  • Amplitude of movement
  • Reproducibility of jaw movement
  • Velocity
  • Smoothness of jaw trajectories
69
Q

T/F Some jaw movements have dx validity

A

f- no differences between normal and TMD patients

70
Q

What is the JT-3D

A
  • Records incisor-point movements

- No dx validity

71
Q

What is electromyography

A

Standard method of recording muscle specific activity in skeletal muscles
-No evidence to support EMG use in evaluation or Dx of TMD (failed to discriminate between case and controls)

72
Q

Uses of joint vibration analysis

A

listen the the joint of the bones colliding upon vibration

73
Q

Uses of sonography and vibratography

A

-Recording and listening to jaw joint noises

74
Q

T/F Normal jaw doesn’t mean absence of sound

A

t

75
Q

Use of a T-scan

A

analyzes occlusal forces

76
Q

T/F unblanaced occlusion cause TMD

A

t

77
Q

Risks of using the following devices are

A
  • improper treatment

- Misdiagnosis

TMD (13 decks)

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