Extraoral Exam Part 2

Question 1

Submental-

Answer 1

Just below the chin

Question 2

Submandibular-

Answer 2

3-6 nodes, beneath the body of the mandible

Question 3

Tonsillar/Jugulodigastric-

Answer 3

Tends to be some of they largest lymph
nodes in the cervical chain due to their significant lymphatic
drainage. It does decrease in size with age in a cancer free patient.

Question 4

Anterior cervical chain-

Answer 4

nodes that lie both on top and beneath the
sternocleidomastoid muscles (SCM) on either side of the neck, from
the angle of the mandible to the top of the clavicle

Question 5

Supraclavicular-

Answer 5

in the hollow above the clavicle, just lateral to

where it joins the sternum.

Question 6

Posterior cervical chain-

Answer 6

extends in a line posterior to the SCM but

in front of the trapezius.

Question 7

Infected lymph nodes tend to be – (5)

Answer 7

firm, tender, enlarged and warm.

Inflammation can spread to the overlying skin, causing it to appear reddened

Question 8

Maligancies may also involve the lymph nodes-

either (2)

Answer 8

primary (e.g.. Lymphoma), or as a site of

metastasis

Question 9

These nodes tend to be- (5)

Answer 9

firm, 
non-tender, 
matted (stuck to each other), 
fixed (not freely mobile but attached to underlying tissue) 
and increase in size over time

Question 10

TMD vs TMJ

Answer 10

TMD is a disease

TMJ is the joint

Question 11

TMD is a collection of

Answer 11

symptoms

Question 12

who does TMD affect

Answer 12

20% of the US

85.4% women

Question 13

TMD is a common condition in adults but becoming more prevalent in

Answer 13

adolescents and children

Question 14

TMD symptoms (6)

Answer 14

 Joint pain
 Headaches
 Tinnitus–ringing in the ears
 Insomnia
 Neck ache
 Teeth become sensitive to hot, and cold-this is one of the 1st signs of  bruxism

Question 15

Causes of TMD (7)

Answer 15

Bruxism
Clenching
Stress
Malocclusion
Arthritis
Trauma
Stimulants

Question 16

3 broad diagnostic classes of TMD

Answer 16

Muscles
Soft tissue of the joint
Hard tissues of the joint

Question 17

Muscles of mastication (3)

Answer 17

Temporalis
Masseter
Pterygoids-medial and lateral

Question 18

tenderness scale
0=
10=

Answer 18

0= no discomfort 
1-= extreme sensitivity

Question 19

Temporalis = generally causes pain of the

Answer 19

ant teeth

Question 20

Masseter = generally causes pain of the

Answer 20

post teeth

Question 21

skipped

TMJ screening questions (9)

Answer 21

Do you have difficulty, pain or both when opening your mouth wide (yawning, etc)?
Does your jaw get “stuck,” “locked,” or “go out”?
Do you have difficulty, pain or both when chewing, talking or using your jaws?
Are you aware of noises in the jaw joints?
Do you have pain in or around the ears, temples, or cheeks?
Does your bite feel uncomfortable or unusual?
Do you have frequent headaches?
Have you had a recent injury to your head, neck, or jaw?
Have you previously been treated for a jaw joint problem? If so, when?

Question 22

TMJ palpation (3 steps)

Answer 22

palpate bony prominence just anterior to the ear and ask if there is any discomfort
then have patient open and close (any discomfort?)
then palate all around the joint

Question 23

TMJ diagnostic exam (3)

Answer 23

1. Measure range of motion
2. opening
3. right and left lateral
4. Palpate for crepitus
   (grinding) & clicking while
   opening and closing.
5. Palpate for tenderness in
   the masseter and temporalis
   muscles.

Question 24

TMD exam (6)

Answer 24

Excessive tooth mobility
Widened PDL seen radiographically
Migration in the absence of perio ds
Buccal mucosal ridging
Lateral tongue scalloping.
Inspect symmetry and alignment of 
• face, 
• jaws, 
• dental arches.

Question 25

Treatment of TMD

Answer 25

night guards/bruxism splints

Question 26

Night guards/Bruxism splints-used to: (3)

Answer 26

1. Redistribute occlusal forces
2. Relax the masticatory muscles and stabilize the joint.
3. Protect dentition and dental work

Question 27

Treatment of TMD with medication (3)

Answer 27

NSAIDs
anti anxiety
muscle relaxers

Question 28

Anti-inflammatory (NSAIDs)-

Answer 28

used for joint pain, inflammation, and stiffness. Tend to be inexpensive, easily accessible and well tolerated.

Question 29

Anti-anxiety-

Answer 29

help relieve the stress that may aggravate TMD

Question 30

Muscle relaxers-

Answer 30

relax muscles and decrease spasms

Question 31

botox for treatment of TMD

Answer 31

lasts 3-4 months and no FDA approved

Question 32

physical therapy for TMD

Answer 32

Helps ease pain and increase
movement and normal jaw
function

Question 33

surgery for TMD

Answer 33

very rare

Question 34

skipped

treatment of TMD (6)

Answer 34

Joint rest and reducing jaw movement.  
Keeping teeth slightly ajar.
Soft-food diet
Medications to relieve pain and/or relax muscles
Hot or cold  compresses
TMJ physical therapy
Wearing of a night guard/splint