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DMD 5221 > 6 - TMJ/TMD (complete) > Flashcards

6 - TMJ/TMD (complete) Flashcards

1
Q

What bones and structures articulate in the TMJ

A

the squamous portion of the temporal bone
the condyle of the mandible
the articular disk
ligaments

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2
Q

What type of joint is the TMJ

A 
ginglynmoarthroidal joint
(synovial joint that hinges and glides)
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3
Q

how does the TMJ classify as a compound joint

A

a compound joint is a joint with 3 or more bones, the TMJ classifies because the articular disk counts as well and the mandible and temporal bone

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4
Q

What is the articular eminence

A

the strong bony prominence anterior to the mandibular fossa

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5
Q

What is the mandibular fossa

A

the depression into which the condyle sits

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6
Q

What is the squamotympanic fissure

A

the postglenoid tubercle (posterior to the mandibular fossa), this serves as a point of attachement for the joint capsule and retrodiscal pad

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7
Q

What forms the articular surface of the condyle of the mandible

A

avascular fibrous connective tissue (not hyaline like usual)

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8
Q

which part of the articular surface of the condyle is the main load-bearing area

A

the lateral portion

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9
Q

What is unique about the histology of the mandibular condyle

A

it contains a rare fibrocartilaginous zone which allows it to repair itself

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10
Q

What is the zone in the condyle of the mandible that allows it to repair itself

A

the fibrocartilaginous zone

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11
Q

What is the articular disk

A

a disk of dense fibrous connective tissue that lies between the mandibular fossa and mandibular condyle.

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12
Q

What are the three bands of the articular disk

A

Anterior band = thick
Intermediate band = thin
Posterior band = thick

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13
Q

What are the three bands of the articular disc

A

anterior - anterior to the condyle and thick
intermediate - right on the articular eminence and thin
posterior - posterior to the condyle and thick

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14
Q

What attaches to the anterior of the disk

A

the joint capsule and the superior head of the lateral pterygoid

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15
Q

What attaches to the lateral and medial sides of the disc

A

medial and lateral collateral ligaments hold the disc to the condyle

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16
Q

what attaches to the posterior of the disc

A

the bilaminar zone, which is contiguous with the joint capsule

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17
Q

What is the bilaminar zone

A

a structure attached to the posterior articular disc, that is highly distortable while opening

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18
Q

what are the three components of the bilaminar zone

A

superior lamina - attaches the posterior superior part of the disc to the capsule and bone
retrodiscal pad - vascular and innervated elastic fibers
inferior lamina - attaches the inferior posterior part of the disk to the condyle

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19
Q

What are the two compartments of the TMJ

A

superior - between temporal bone and articular disc, this allows for translational movement
inferior - between articular disc and condyle, this allows for rotational movement

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20
Q

What is the TMJ capsule

A

fibrous connective tissue that is lined by a synovial membrane and that completely encloses the articular surface and the condyle. contains nociceptors

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21
Q

What are the ligaments of the TMJ

A 
lateral collateral
medial collateral 
temporomandibular 
stylomandibular
sphenomandibular
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22
Q

What are the characteristics of the temporomandibular ligament

A

attaches the temporal bone to the lateral posterior part of the condyle, preventing lateral and posterior displacement of the condyle.

23
Q

What are the two bands of the temporomandibular ligament

A

outer oblique - limits opening of the mandible

inner horizontal - limits posterior movement of disc and condyle

24
Q

what are the characteristics of the styolomandibular ligament

A

it goes from the styloid process to the posterior mandibular ramus and prevents it from protruding too much

25
Q

what are the characteristics of the sphenomandibular ligament

A

goes from the sphenoid spine to the lingula of the mandible. it maintains the same amount of tissue during opening and closing, causing it to acts as a pivot for the mandible. it is the remnant of meckels cartilage

26
Q

What arteries supply the TMJ

A

superficial temporal artery
deep auricular artery
anterior tympanic artery

27
Q

What veins drain the TMJ

A

superficial temporal vein

maxillary vein

28
Q

What nerves innervate the TMJ

A

auriculotemporal nerve
masseteric nerve
posterior deep temporal nerve

29
Q

What is the basic sensory pathway of the TMJ

A

1st order neuron = from TMJ to trigeminal nucleus of the brainstem via CN V
2nd order neuron = from trigeminal nucleus it decussates across the brainstem to the contralateral Trigeminal Thalamic Tract which makes the trigeminal lemniscus which travels to the thalamus
3rd order = from thalamus (ventral posteromedial nucleus) to the primary somatosensory cortex

30
Q

Which muscles open the mouth

A

lateral pterygoid
suprahyoid
infrahyoid

31
Q

Which muscles close the mouth

A

temporalis
masseter
medial pterygoid

32
Q

which muscles protrude the mandible

A

masseter
lateral pterygoid
medial pterygoid

33
Q

which muscles retrude the mandible

A

temporalis

masseter (deep fibers)

34
Q

which muscles do side to side movements of the mandible

A

ipsilateral temporalis
contralateral pterygoid
masseter

35
Q

which muscles attach to the disc, and what is their function

A

superior part of upper head of lateral pterygoid
midmedial muscle bundle of temporalis

they pull the disc anterior and medial to steady it during mastication

36
Q

What are the two movements of the TMJ and when do they occur

A

Rotation is the initial movement and it occurs in the lower TMJ compartment. it is initiated by the lateral pterygoid and stops at about 2mm of opening
Translation is the second movement and it occurs in the upper TMJ compartment, and it allows for maximum mandibular opening

37
Q

Common symptoms of TMD include all of the following except

Pain
Limited range of mandibular movement
TMJ sounds
Dysphagia

A

Common symptoms of TMD include all of the following except:

Pain
Limited range of mandibular movement
TMJ sounds
Dysphagia*

38
Q 
According to the Research Diagnostic criteria for TMD (RDC-TMD) the prevalence of TMD in the general population ranges from
3% to 13%
9% to 13%  
9% to 23%
9% to 33%
A 
According to the Research Diagnostic criteria for TMD (RDC-TMD) the prevalence of TMD in the general population ranges from
3% to 13%
9% to 13%  *
9% to 23%
9% to 33%
39
Q 
TMD commonly affects  young & middle aged adults; TMD is more common in males than females
True; false 
True; true
False; false
False; true
A 
TMD commonly affects  young & middle aged adults; TMD is more common in males than females
True; false *
True; true
False; false
False; true
40
Q 
Moderately symptomatic TMD’s often progress to more serious conditions; Treatment for TMD’s should be as aggressive as possible in order to prevent its progression to a more serious condition
True; false 
True; true
False; false 
False; true
A 
Moderately symptomatic TMD’s often progress to more serious conditions; Treatment for TMD’s should be as aggressive as possible in order to prevent its progression to a more serious condition
True; false 
True; true
False; false *
False; true
41
Q

Best available evidence indicates which single etiology for TMD

Abnormal position of mandibular condyle within the glenoid fossa
A single etiological factor has not been identified
malocclusion
Cervical acceleration-deceleration injury (CAD)

A

Best available evidence indicates which single etiology for TMD

Abnormal position of mandibular condyle within the glenoid fossa
A single etiological factor has not been identified *
malocclusion
Cervical acceleration-deceleration injury (CAD)

42
Q

A 43 year old female presents to your dental practice with a chief complaint of Right jaw pain and Right temporal headache. She describes pain as dull and achy. On examination you note a normal mandibular range of motion free of noises and no pain with function. You find tenderness to palpation of the Right masseter muscle that replicates her chief complaint and refers pain to the Right temporal region, worsening her headache. What is the most likely diagnosis?

Masticatory myofascial pain
Acute porcelain deficiency
Psychosomaticism
Myositis

A

A 43 year old female presents to your dental practice with a chief complaint of Right jaw pain and Right temporal headache. She describes pain as dull and achy. On examination you note a normal mandibular range of motion free of noises and no pain with function. You find tenderness to palpation of the Right masseter muscle that replicates her chief complaint and refers pain to the Right temporal region, worsening her headache. What is the most likely diagnosis?

Masticatory myofascial pain *
Acute porcelain deficiency
Psychosomaticism
Myositis

43
Q

What is the most appropriate treatment for the patient in question #6
Myomonitoring to determine the correct jaw position (Stage I), followed by full mouth reconstruction to establish this new position (Stage II)
Full arch acrylic night guard
Physical medicine & rehabilitation modalities (heat, spray and stretch, trigger point injection)
Removal of all mercury amalgam restorations followed by oil pulling

A

What is the most appropriate treatment for the patient in question #6
Myomonitoring to determine the correct jaw position (Stage I), followed by full mouth reconstruction to establish this new position (Stage II)
Full arch acrylic night guard
Physical medicine & rehabilitation modalities (heat, spray and stretch, trigger point injection) *
Removal of all mercury amalgam restorations followed by oil pulling

44
Q

Which of the following is the most common disc-condyle complex disorder
Retrodiscitis
Oromandibular dystonia
Anterior disc displacement with reduction
Subluxation

A

Which of the following is the most common disc-condyle complex disorder
Retrodiscitis
Oromandibular dystonia
Anterior disc displacement with reduction *
Subluxation

45
Q

The Research Diagnostic Criteria for TMD (RDC-TMD) recommends treatment for TMD’s be
Accomplished via full course orthodontic treatment
Attempted via occlusal equilibration prior to full mouth rehabilitation
Attempted after extraction of teeth with old amalgam restorations
Conservative and reversible

A

The Research Diagnostic Criteria for TMD (RDC-TMD) recommends treatment for TMD’s be
Accomplished via full course orthodontic treatment
Attempted via occlusal equilibration prior to full mouth rehabilitation
Attempted after extraction of teeth with old amalgam restorations
Conservative and reversible *

46
Q

Of the following, what is the most common reason that TMD patient don’t get better?
Incorrect diagnosis
Raising vertical dimension too fast during full mouth reconstruction
Patients unable to stop sleeping on their side
Malnutrition

A

Of the following, what is the most common reason that TMD patient don’t get better?
Incorrect diagnosis *
Raising vertical dimension too fast during full mouth reconstruction
Patients unable to stop sleeping on their side
Malnutrition

47
Q 
Of the following, what medication is the most appropriate for TMD joint pain?
Ibuprofen 
Acetaminophen
Tricyclic antidepressant
Opioids
A 
Of the following, what medication is the most appropriate for TMD joint pain?
Ibuprofen *
Acetaminophen
Tricyclic antidepressant
Opioids
48
Q 
Electrogalvanic stimulation (EGS) and transcutaneous electrical nerve stimulation (TENS) have been shown to provide a long term benefit to TMD patients; ultrasound therapy has been shown to relieve TMD pain
True; false 
True; true
False; false 
False; true
A 
Electrogalvanic stimulation (EGS) and transcutaneous electrical nerve stimulation (TENS) have been shown to provide a long term benefit to TMD patients; ultrasound therapy has been shown to relieve TMD pain
True; false 
True; true
False; false *
False; true
49
Q

Local trigger point injections work best when using what medication?
Botulinum toxin
Amide local anesthetic without epinephrine (lidocaine)
Ester local anesthetic without epinephrine (Procaine)
Therapeutic effect is from the needling, not the anesthetic

A

Local trigger point injections work best when using what medication?
Botulinum toxin
Amide local anesthetic without epinephrine (lidocaine)
Ester local anesthetic without epinephrine (Procaine)
Therapeutic effect is from the needling, not the anesthetic *

50
Q

All of the following are important in stabilization appliance therapy for TMD except
Covering all teeth in one arch
Adjusted to a “neuromuscularly determined” position
Preferably used during sleep only
Proper adjustment to establish a stable physiologic mandibular posture

A

All of the following are important in stabilization appliance therapy for TMD except
Covering all teeth in one arch
Adjusted to a “neuromuscularly determined” position *
Preferably used during sleep only
Proper adjustment to establish a stable physiologic mandibular posture

51
Q 
All of the following are risks of using partial-coverage appliances except
Risk of malocclusion
Risk of aspiration
Possible risk of internal TMJ changes
Tooth fracture
A 
All of the following are risks of using partial-coverage appliances except
Risk of malocclusion
Risk of aspiration
Possible risk of internal TMJ changes
Tooth fracture *
52
Q

TMJ surgery is most likely indicated for
TMJ ankylosis
Anterior disc displacement without reduction (closed lock), less than 2 weeks
Anterior disc displacement without reduction (closed lock), more than 2 weeks
Chronic joint pain

A

TMJ surgery is most likely indicated for
TMJ ankylosis *
Anterior disc displacement without reduction (closed lock), less than 2 weeks
Anterior disc displacement without reduction (closed lock), more than 2 weeks
Chronic joint pain

53
Q

TMJ Arthrocentesis is really cool and you should perform it on your TMD patients
Only after residency training in orofacial pain or oral surgery
Only after specific online continuing education
Only after thoroughly reading about the procedure
Because you’re a Doctor and you know Doctor stuff

A

TMJ Arthrocentesis is really cool and you should perform it on your TMD patients
Only after residency training in orofacial pain or oral surgery *
Only after specific online continuing education
Only after thoroughly reading about the procedure
Because you’re a Doctor and you know Doctor stuff

54
Q

A 45 year old female presents to your office with a chief complaint of a loud “popping” noise when she opens and closes her mouth. She reports no discomfort or pain, but is embarrassed in social situations when other people hear it. On examination, you find a normal mandibular range of motion. Based on this information, what is your diagnosis and treatment plan?

Anterior disc displacement with reduction; stabilization splint
Anterior disc displacement with reduction; no treatment recommended, the chief complaint will get better with time
Anterior disc displacement without reduction; stabilization splint
Anterior disc displacement without reduction; no treatment recommended, the chief complaint will get better with time
Malocclusion; Find her ideal jaw position using any number of fancy hi-tech gadgets, then rebuild her bite to accommodate this new jaw position.
TMD; Valium, then surgery if not resolved in 6 weeks
I don’t know, just give her antibiotics and narcotics.
I don’t know, just do a root canal
I don’t know, just do an extraction

A

A 45 year old female presents to your office with a chief complaint of a loud “popping” noise when she opens and closes her mouth. She reports no discomfort or pain, but is embarrassed in social situations when other people hear it. On examination, you find a normal mandibular range of motion. Based on this information, what is your diagnosis and treatment plan?

Anterior disc displacement with reduction; stabilization splint
Anterior disc displacement with reduction; no treatment recommended, the chief complaint will get better with time *
Anterior disc displacement without reduction; stabilization splint
Anterior disc displacement without reduction; no treatment recommended, the chief complaint will get better with time
Malocclusion; Find her ideal jaw position using any number of fancy hi-tech gadgets, then rebuild her bite to accommodate this new jaw position.
TMD; Valium, then surgery if not resolved in 6 weeks
I don’t know, just give her antibiotics and narcotics.
I don’t know, just do a root canal
I don’t know, just do an extraction

DMD 5221 (10 decks)

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