Final Exam Flashcards by Maggie Rodriguez

In patients with an intracapsular restriction, what type of alterations will be seen in range of motion of eccentric movements?

A. Contralateral movement will be normal, and ipsilateral movement will be restricted
B. Both contralateral and ipsilateral eccentric movements will be greatly restricted
C. Contralateral movements will be restricted, and ipsilateral movement will be normal
D. No change in range of motion will be seen

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In cases of heterotopic pain presentation, what clinical observations will follow local provocation and anesthetic blockage at the SITE of the pain (not the source)?

A. Local provocation at site - no reduction or effect on pain; Anesthetic blockade at site - no noticeable pain reduction
B. Local provocation at site - increased pain at the source; Anesthetic blockade at site - elimination of pain at the source
C. Local provocation at site - increased pain at the site; Anesthetic blockade at site - elimination of pain at both the source & site
D. Local provocation at site - increased pain across entire face; Anesthetic blockade at site - elimination of all bodily pain

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Which of the following are among the 6 general rules for diagnostic injections discussed in Chapter 10?

A. The clinician should have a sound knowledge of the anatomy of all structures in the region
B. The clinician should have a sound knowledge of the pharmacology of all solutions to be used
C. The clinician should avoid injecting into inflamed or diseased tissues
D. The clinician should maintain strict asepsis at all times
E. The clinician should always aspirate before injecting all of the solution
F. All of the above are among the rules for diagnostic injections

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What is the most commonly fractured cusp in the mouth due to laterotrusive interferences?

A. Distolingual cusp of mandibular first molar
B. Distolingual cusp of mandibular second molar
C. Mesiolingual cusp of mandibular first molar
D. Mesiolingual cusp of mandibular second molar

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Generally, for every 1 mm of interocclusal separation between the maxillary and mandibular posterior teeth, the anterior teeth separate:

A. 2 mm
B. 3 mm
C. 4 mm
D. 5 mm

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Which of the following statements is true?

A. Patients can generally detect differences as slight as .0005 to .001 inches (10-20 microns)
B. If pain is present in the right joint due to an interference, the interference is probably on the left
C. Ethyl chloride is helpful in relieving muscle spasms
D. A mandibular appliance doesn’t impact speech as much as a maxillary appliance
E. All of the above are true

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If a restricting muscle is located _________ to the TMJ (as with the masseter), deflection upon opening will be to the _________ side; whereas, if the restricting muscle is located _________ to the TMJ (as with the medial pterygoid), deflection will be to the __________ side.
A. Medial, ipsilateral; lateral, contralateral
B. lateral, contralateral; medial, ipsilateral
C. lateral, ipsilateral; medial, contralateral
D. Medial, contralateral; lateral, ipsilateral

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Of the following, what is the best way to functionally manipulate the inferior lateral pterygoid muscle?

A. Ask the patient to clench
B. Ask the patient to open as wide as comfortably possible
C. Ask the patient to retrude their mandible
D. Ask the patient to protrude their mandible against resistance

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Information about a patient’s TMD history can be obtained in which of the following ways?

A. Conversing directly
B. Written questionnaire
C. Clinical examination
D. Both A and B are possible ways to obtain TMD history.

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According to the book, with pain disorders, as much as \_\_\_\_\_\_\_% of the information needed to make the diagnosis can come from the history of the disorder.
A. 20-30%
B. 40-50%
C. 70-80%
D. 100%

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Which of the following muscles exhibits pain on clenching, pain on clenching on a separator, AND pain when opening during functional manipulation??

A. Medial Pterygoid
B. Superior Lateral Pterygoid
C. Inferior Lateral Pterygoid
D. Sternocleidomastoid

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Which functional manipulation test will enable you to tell apart an Inferior lateral pterygoid disorder from an Intracapsular disorder?

A. Have patient open widely and protrude their jaw
B. Have patient simply clench on a separator unilaterally
C. Have patient clench on a separator unilaterally AND protrude against resistance
D. Have patient clench in Maximum ICP

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When a patient reports previous treatments such as an occlusal appliance, it is not advised to ask the patient to bring the appliance to the evaluation appointment. This is because success of previous treatment is irrelevant, given that the patient is still presenting with symptoms for treatment in your office.

a. The first statement is true. The second statement is false
b. The second statement is true. The first statement is false
c. Both statements are true
d. Both statements are false

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The normal range of mouth opening when measured interincisally is between:

A. 33-40mm
B. 43-50mm
C. 49-52mm
D. 53-58mm

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Some of the most common complaints of patients who come to the dental office is tooth sensitivity and pulpitis?
True
False

true

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What is the only structure that can retract the disc posteriorly?

A. Superior Retrodiscal Lamina
B. Superior Lateral Pterygoid
C. Inferior Retrodiscal Lamina
D. Inferior Lateral Pterygoid

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In primary pain the source and the site are in the same location. In heterotopic pain the source is remote from the site.

A. Both statements are true
B. The first statement is true the second statement is false
C. The first statement is false the second statement is true
D. Both statements are false

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Which are the 3 most commonly administered diagnostic nerve blocks used by dentists to determine the site from the source of pain in TMJ-related conditions?

A. Dental Nerve Blocks, Sternocleidomastoid Injection, Infraorbital Nerve Block
B. Dental Nerve Blocks, Auriculotemporal Nerve Block, Retrodiscal tissue injections
C. Dental Nerve Blocks, Auriculotemporal Nerve Block, Infraorbital Nerve Block
D. Intracapsular injections, Auriculotemporal Nerve Block, Infraorbital Nerve Block

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According to the book, which nerve is responsible for the primary innervation of the TMJ?

A. Posterior deep temporal nerve
B. Auriculotemporal nerve
C. Glossopharyngeal nerve
D. Vagus nerve

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Injecting a muscle can be valuable in determining the source of a pain disorder?
True
False

true

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According to the book, which of the following injections is used mostly for therapeutic reasons and not for diagnostic reasons?

A. Auriculotemporal nerve block
B. Intracapsular injections
C. Sternocleidomastoid injection
D. Infraorbital block

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Which of the following correctly describes the difference between disorders with a “hard-end” versus a “soft-end” feel?

A. Hard-end feel is associated with muscular disorders, while Soft-end feel is associated with intracapsular disorders
B. Hard-end feel is associated with intracapsular disorders, while Soft-end feel is associated with muscular disorders
C. Both Hard-end and Soft-end feel are associated with muscular disorders
D. Both Hard-end and Soft-end feel are associated with intracapsular disorders

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According to the book, which of the following is not a typical clinical characteristic of myofascial pain (trigger point myalgia)?

A. Structural dysfunction
B. Pain at rest
C. Local muscle tenderness
D. Increased pain with function

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According to the book, which of the following represents a sudden forward movement of the condyle moving beyond the crest of the articular eminence during the latter phase of mouth opening?

A. Disc dislocation without reduction
B. Subluxation (hypermobility) of the TMJ
C. Spontaneous dislocation (open lock)
D. Disc displacement

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What is the most important factor for successful treatment of TMD? A. Proper diagnosis B. Knowing how to polish a splint C. Nerve injections to relax the muscles D. Knowing how the lab fabricates the splint.

Equilibration is defined as: “The modification of occlusal forms of teeth with the intent of equalizing occlusal stress, producing simultaneous occlusal contacts, or harmonizing cuspal relations.” True False

true

Which of the following is the “operational” definition of centric relation? A. The maxillo-mandibular relationship in which the condyles articulate with the thinnest articular portion of their respective discs in the anterior-superior position against the posterior slope of the articular eminentia. B. A closed-pack relationship of the condyle, articular disc, and fossae as determined by the mandibular muscles during function. (ie, the compression or functional loading of the articular structures during chewing and swallowing). C. A border position at the hinge axis of the jaw independent of tooth contact…with the condyles braced in the most anterosuperior direction against the posterior slopes of the eminentia.

Prior to comprehensive occlusal adjustment of the occlusion, it is critical to determine if the jaw relationship is stable and if the condyles are seated in the fossae. True False

true

Which of the following is the “anatomic” definition of centric relation? A. The maxillo-mandibular relationship in which the condyles articulate with the thinnest articular portion of their respective discs in the anterior-superior position against the posterior slope of the articular eminentia. B. A closed-pack relationship of the condyle, articular disc, and fossae as determined by the mandibular muscles during function. (ie, the compression or functional loading of the articular structures during chewing and swallowing). C. A border position at the hinge axis of the jaw independent of tooth contact…with the condyles braced in the most anterosuperior direction against the posterior slopes of the eminentia.

True or False: One of the goals of Equilibration Treatment is to achieve bilateral, simultaneous, and stable CO contacts in CR (BSS). True False

true

All of the following statements are true concerning selective tooth grinding and equilibration EXCEPT one. Which is the exception? A. Maintenance requires very little planning in that only a limited number of teeth and/or restorations are adjusted to an established, acceptable occlusal scheme. B. Modification suggests that prior to the occlusal adjustment slight to moderate adjunctive therapy is required, such as minor tooth movement or opposing tooth restoration or replacement. C. It is considered less prudent and biologically more invasive to build up a severely worn or abraded canine to improve guidance before adjusting the posterior teeth in excursive mandibular movements. D. The jaw relationship must be stabilized and painful or pathologic conditions treated prior to full-mouth equilibration. E. The pretreatment period may last from weeks to months depending on the amount of instability, dysfunction, and/or pathology within the tissues of the masticatory system.

Which could be considered a sign or symptom of occlusal imbalance and masticatory overload. a. Tooth wear b. Tooth mobility c. Muscle pain d. Ear pain e. TMJ pain f. Headache g. Pulpitis h. Dry mouth i. All of the above j. All except h.

The dentist attempting to manage a TMD patient must appreciate the major etiologic factors that may be associated with the condition. True False

true

Match the following terms with the correct descriptions. a. Predisposing factors b. Initiating factors c. Perpetuating factors 1. Factors that increase risk of TMD 2. Factors that cause the onset of TMD 3. Factors that interfere with healing or enhance the progression of TMD

Predisposing factors = Factors that increase risk of TMD Initiating factors = Factors that cause the onset of TMD Perpetuating factors = Factors that interfere with healing or enhance the progression of TMD

Which is not listed in scientific literature as a major factor associated with TMD? a. trauma b. emotional stress c. deep pain input d. ethnicity e. parafunctional activities f. occlusal condition

Whether these factors influence the onset of TMD is determined by the patient's a. Economic status b. Geographic location c. Individual adaptability d. Education level

The role of occlusion as an etiologic factor in TMD is not the same in all patients. True False

true

When occlusal instability at tooth contact level exists, orthopedic instability at TM joint and muscle levels may occur as a result of a. clenching teeth b. bruxing of teeth c. hydration in diet d. all of the above e. a. and b. only

Which is not a parafunctional habit? a. chewing b. clenching c. bruxing d. nail biting e. cheek biting

When occlusal instability exists, the possibility of it becoming an initiating factor in the development of a TMD is related to which aspects of clenching? a. Frequency b. Duration c. Sleep quality d. Intensity e. all of the above f. a., b., and d. only

Trauma can be an etiologic factor in TMD. Which are common signs and symptoms associated with trauma induced TMD? a. protective co-contraction of the muscles of mastication b. pain c. edema within the joint capsule d. altered function and avoidance e. all of the above f. a,b,and c only

According to Okeson, the two major symptoms that can be observed in masticatory muscle disorders are a. tooth mobility. b. attrition. c. pain. d. dysfunction. e. all of the above. f. a and b g. c and d

Pain felt in muscle tissue is called a. myospasm b. myalgia c. myositis d. myopia

Muscle pain is far more complex than simple overuse and fatigue. It is now appreciated that muscle pain can be greatly influenced by central mechanisms. True False

true

Dysfunction of the masticatory muscles is usually seen as a. a decrease in range of mandibular movement. b. an acute malocclusion. c. a periodontal access. d. all of the above. e. a and b only f. b and c only

According to Okeson, of the five types of masticatory muscle disorders ( protective co-contraction [muscle splinting], local muscle soreness, myofascial (trigger point) pain, myospasm, and chronic centrally mediated myalgia), those most commonly seen in the dental office are a. all of those listed. b. the first three listed. c. the last two listed. d. all of those listed plus fibromyalgia.

Local factors represent any event that acutely alters sensory or proprioceptive input in the masticatory structures. Which are considered local factors? a. the fracture of a tooth b. a new restoration in supraocclusion c. tissue damage from a dental injection d. chewing unusually hard food e. chewing for a long time f. opening the mouth too wide g. all of the above

Systemic factors may also represent events that can interrupt normal muscle function. Which are considered systemic factors? a. emotional stress b. acute illness or viral infections c. "constitutional factors" e.g., age, gender, diet, genetics d. all of the above e. c only

The most common clinical feature of myofascial pain is the presence of local areas of firm, hypersensitive bands of muscle tissue called trigger points. True False

true

Match the local perpetuating factors and systemic perpetuating factors contributing to chronic muscle pain. a. Local perpetuating factors b. Systemic perpetuating factors 1. Continued emotional stress, sleep disturbances, learned behavior, secondary gain, depression 2. Protracted cause, recurrent cause, therapeutic mismanagement

Local perpetuating factors = protracted cause, recurrent cause, therapeutic mismanagement Systemic perpetuating factors = continued emotional stress, sleep disturbances, learned behavior, secondary gain, depression

Centrally mediated myalgia (chronic myositis) is a chronic, continuous muscle pain disorder originating predominantly from CNS effects and involving the afferent neuronal release of nociceptive neurotransmitters that are felt peripherally in the muscle tissues. A more accurate term for this process/symptom, according to Okeson, is a. afferent owie b. neurogenic inflammation c. nociceptive afferentitis d. neurotic bradykinosis

The effectiveness and success of treatment is best achieved after establishing a. payment arrangements. b. a treatment plan. c. blood pressure and respiratory rate. d. a proper diagnosis.

It is extremely important that each sign and symptom be identified by means of a. a thorough history and examination procedure. b. assessing the patient's mental stability. c. recording the patient's social status. d. a complete bood workup.

A general rule in the effort to identify masticatory pain is that jaw function usually aggravates or accentuates the problem. True False

true

According to Okeson, since the prevalence of TMDs is very high, it is not necessary that every patient who comes to the dental office be screened for these problems regardless of the apparent need or lack of need for treatment. True False

false

A new patient exam should include which screening procedures? a. inspection of the facial symmetry b. assessment of pain or tenderness during the exam c. restriction or irregular mandibular movements d. all of the above e. b and c only

According to Okeson, when the clinician is examining a patient for dental disease (e.g., caries), most of the information needed for diagnosis will come from the examination. With pain disorders, as much as 70% to 80% of the information needed to make the diagnosis will come from the patient's history. a. The first statement is true, the second is false. b. Both statements are false. c. Both statements are true. d. The first statement is false, the second is true.

Which features should be included in a thorough orofacial pain history? a. Location of the pain b. Onset of the pain c. Characteristics of the pain d. Aggravating and alleviating factors e. Relationship to other pain complaints f. All of the above g. All except e.

If a patient reports discomfort during palpation of a specific muscle, it can be deduced that the muscle tissue has been compromised by either trauma or fatigue. True False

true

The range of motion of the mandible can be affected by a. intracapsular problems b. extracapsular problems c. both a. and b. d. neither a. or b.

Since pain can be a symptom related to many physical illnesses and disorders, it is essential that the patient's past and present medical condition be carefully evaluated. True False

true

Which masticatory muscles are impossible or nearly impossible to palpate manually and require functional manipulation to evaluate for pain and tenderness? a. masseter b. lateral pterygoid. c. temporalis. d. medial pterygoid e. b and d only f. c and d only

Intracapsular disorders can confuse functional manipulation findings. Which are the most common intracapsular disorders that must be considered when diagnosing pain using functional manipulation? a. protrusive occlusal interferences b. functional dislocation of the disc c. inflammation/capsulitis d. all of the above e. b and c only

According to Okeson, a normal maximum interincisal opening distance in healthy young adults should be equal to or greater than a. 55 mm. b. 30 mm. c. 25 mm d. 40 mm

Extracapsular disorders are generally related to a disc derangement disorder, whereas intracapsular disorders are generally related to masticatory muscle disorders. True False

false

The exam finding in a patient who reports a prior history of TM joint clicking, but now has a limited opening and no clicking with a "hard end feel" that is detected on attempting to stretch the interincisal opening to a more normal range of opening, is often indicative of a. lateral pterygoid spasm b. disc dislocation without reduction c. laterotrusive interferences d. all of the above

Crepitation is a multiple gravel-like sound described as grating and complicated, and is most commonly associated with a. the fracture of a tooth. b. intrinsic staining. c. laterotrusive interferences. d. osteoarthritic changes within the joint.

A patient presents in acute pain in the left jaw and face, limited and painful opening, lack of posterior tooth contact on the left side, and premature contact upon closing in the right canines. There is no history of clicking in either jaw joint. What is your initial diagnosis? a. masseter muscle spasm on the left side. b. masseter muscle spasm on the right side. c. lateral pterygoid muscle spasm on the right side. d. lateral pterygoid muscle spasm on the left side.

A patient presents with limited inter-incisal opening of 25 mm and a prior history of clicking in the right TM joint. History includes waking up two weeks ago and unable to open mouth normally and pain in the right joint on trying to stretch or force more opening. The clicking had stopped and has not been present for two weeks. The mandibular midline deviates to the right 4mm upon attempting opening. What is your initial diagnosis? a. subluxation of the condyle over the articular eminence. b. arthritic degeneration in the right TM joint. c. dislocation without reduction of the right TM joint disc. (closed lock) d. dislocation without reduction of the left TM joint disc. (closed lock)

A patient presents with concerns about grinding or gravel-like noises in his left jaw joint. Pain in that joint is present during mastication and other jaw functions. A normal range of motion is observed, but there is some hesitancy in opening due to the pain. What is your initial diagnosis? a. osteoarthritis in the left TM joint. b. recurrent disc dislocation with reduction c. subluxation of the condyle in the affected joint d. none of the above

According to Okeson, panoramic views can be used as screening devices for general assessment of bony abnormalities and osteoarthritic changes of the temporomandibular joints. True False

true

Which directional forces are especially prone to elicit cellular breakdown of the periodontal ligament? a. axial b. horizontal c. apical d. vertical

According to Okeson, tooth pain is the most common pain that brings a patient to the dental office. True False

true

The term tension-type headache is used to describe headache pain that has its origin in a. neurovascular structures b. muscle tissues c. skeletal impingement d. all of the above

The dentist attempting to manage a TMD patient must appreciate the major etiologic factors that may be associated with the condition. True False

true

Whether certain factors influence the onset of TMD is determined by the patient's a. economic status. b. geographic location. c. individual adaptability. d. education level.

The role of occlusion as an etiologic factor in TMD is not the same in all patients. True False

true

When occlusal instability at the tooth contact level exists, orthopedic instability at TM joint and muscle levels may occur as a result of a. clenching teeth b. bruxing of teeth c. hydration in diet d. all of the above e. a. and b. only

Which is not a parafunctional habit? a. chewing b. clenching c. bruxing d. nail biting e. cheek biting

According to Okeson, the two major symptoms that can be observed in masticatory muscle disorders are a. tooth mobility b. attrition c. pain d. dysfunction e. all of the above f. a and b g. c and d

Muscle pain is far more complex than simple overuse and fatigue. It is now appreciated that muscle pain can be greatly influenced by central mechanisms. True False

true

Systemic factors may also represent events that can interrupt normal muscle function. Which are considered systemic factors? a. emotional stress b. acute illness or viral infections c. "constitutional factors" e.g., age,gender, diet, genetics d. all of the above e. c only

The most common clinical feature of myofascial pain is the presence of local areas of firm, hypersensitive bands of muscle tissue called trigger points. True False

true

Which two factors can lead to tooth mobility? a. loss of bony support within its socket b. unusually heavy occlusal forces c. high fluoride levels in toothpaste d. all of the above e. a. and b. only

The loss of bony support is primarily the result of a. the fracture of a tooth. b. a new restoration in supra occlusion. c. tissue damage from a dental injection. d. periodontal disease

Please match the following terms with the appropriate definition. a. Primary traumatic occlusion b. Secondary traumatic occlusion c. Parafunctional occlusal activity d. Migraine headache 1. Nail biting, cheek and lip biting, tongue thrusting 2. Mobility of a tooth resulting from normal or heavy occlusal forces on a tooth that is compromised by periodontal disease 3. Usually unilateral in nature 4. Mobility of a tooth resulting from heavy occlusal forces on a basically normal tooth

a. Primary traumatic occlusion = mobility of a tooth resulting from heavy occlusal forces on a basically normal tooth b. Secondary traumatic occlusion = mobility of a tooth resulting from normal or heavy occlusal forces on a tooth that is compromised by periodontal disease c. Parafunctional occlusal activity = nail biting, cheek and lip biting, tongue thrusting d. Migraine headache = usually unilateral in nature

Pulpitis usually includes which? a. pain of short duration b. hot or cold sensitivity c. usually reversible d. all of the above

Irreversible pulpitis usually culminates in necrosis of the pulp. True False

true

The most common sign associated with functional disturbance of the dentition is a. the fracture of a tooth b. intrinsic staining c. wear facets d. marginal gingivitis

According to Okeson, tooth wear has not been found to be strongly associated with TMD symptoms. True False

true

Most often, the muscles of mastication become compromised through increased activity. True False

true

Extracapsular disorders are generally related to a disc derangement disorder, whereas intracapsular disorders are generally related to masticatory muscle disorder. True False

false

Studies report that the incidence of TMD symptoms in a population of orthodontically treated patients is greater than that in the untreated general population. True False

false

Which structure that can retract the disc posteriorly? a. superior retrodiscal lamina b. discal collateral ligaments c. superior lateral pterygoid d. condyle

There is a simple cause and effect relationship explaining the association between occlusion and development of TMD. True False

false

What does prolonged exposure to emotional stressors do to the autonomic nervous system? a. It upregulates it, compromising an individual’s ability to fight diseases. b. It upregulates it, increasing an individual's ability to fight diseases. c. It downregulates it, compromising an individual’s ability to fight diseases. d. It downregulates it, increasing an individual's ability to fight diseases.

We should tell patients that the goal of therapy for TMD is to manage pain, not to cure it completely. True False

true

Which is/are central mechanism/s that can contribute to pain transitioning from an acute to a chronic state? a. Altered HPA-axis function b. Increased central sensitization c. Decreased descending inhibition d. All of the above

Once patients have transitioned into a state of chronic TMJ pain, attempts to manage the etiologic factors may no longer be adequate. True False

true

Which statements describe the dynamic functional relationship between occlusion and TMDs? a. The occlusal condition affects orthopedic stability of the mandible as it loads against the cranium. b. Acute changes in the occlusal condition can influence mandibular function. c. Parafunctional habits are the primary cause of all occlusal disharmony. d. a and b only

What are the two main factors that determine whether or not an intracapsular disorder will develop? a. The degree of orthopedic stability and the amount of loading b. The degree of muscle hyperactivity and degree of occlusal disharmony c. The degree of muscle hyperactivity and amount of loading d. The degree of orthopedic stability and degree of occlusal disharmony

In a healthy patient, the interarticular pressure provided by elevator muscles normally maintains the condyle on which portion of the articular disc? a. The anterior border b. Thinner intermediate zone c. The posterior border d. The Retrodiscal tissues

In cases where the mandibular condyle becomes dislocated anterior to the articular eminence, which describes the method & directionality whereby the clinician could guide the condyle back into the fossa? a. Apply downward and posterior pressure with thumbs on retromolar pad. b. Apply upward and posterior pressure with thumbs on retromolar pad. c. Apply upward and anterior pressure with thumbs on retromolar pad. d. Apply downward and anterior pressure with thumbs on retromolar pad.

The only healthy physiologic movement that should occur between the condyle itself and the articular disc is translation. True False

false

Increased tonicity of which is primarily responsible for anterior displacement of the articular disc in unhealthy joints? a. Anterior capsular ligaments b. Inferior lateral pterygoid c. Superior lateral pterygoid d. Superior retrodiscal lamina e. Discal collateral ligaments

Which statement is false? a. An adherence is a temporary sticking of the articular surfaces b. Clicks due to adherences occur following a period of static loading. c. If an adherence remains for a long period of time, fibrous tissue can develop to produce a true adhesion. d. An adhesion is a temporary sticking of the articular surfaces.

A splint must be stable and the occlusal contacts properly managed in order to avoid it becoming the next occlusal imbalance. True False

true

The accuracy of the alginate impressions and stone models is key to a successful delivery of the dental splint. True False

true

Which needs to be ruled out as a cause for pulpitis before traumatic occlusion can be determined as the likely cause? a. caries b. recent dental procedure c. periodontitis d. both a and b

Chronic pain is considered to be pain that has been present for ______ or longer. a. 3 months b. 6 months c. 9 months d. 12 months

42% of patients with ______ also report TMD-like symptoms. a. myositis b. fibromyalgia c. muscle splinting d. myofacial pain