Lecture 6: Temporomandibular Dysfunction Flashcards by Manpreet Singh

Describe the 2 separate motions involved in opening the jaw and which axis each is on?

Rotation about a RT/LF (transverse axis)
Anterior glide (over the articular disc)

How well did you know this?

Not at all

Perfectly

Which 3 muscles of mastification close the jaw tightly?

Temporalis m.
Masseter m.
Medial ptergoid m.

How well did you know this?

Not at all

Perfectly

Which muscle of the mouth approximates and compresses lips?

Orbicularis oris m.

How well did you know this?

Not at all

Perfectly

Which muscles of the mouth raise the lateral angle of the mouth (smile)?

Zygomaticus major

How well did you know this?

Not at all

Perfectly

Which muscle of the mouth approximates lips and draws lips and corners of mouth lateral (grimace)

Risorius

How well did you know this?

Not at all

Perfectly

What are some of the common signs/sx’s someone with TMJ issues may complain about?

CC of Cephalgia (HA)
May or may not mention jaw problems
May describe as dull ache —> worse w/ chewing
Tinnitus

How well did you know this?

Not at all

Perfectly

The audible click associated with TMJ dysfunction is almost always do due?

Disc displacement after disc thin/stretched

How well did you know this?

Not at all

Perfectly

A person with osteoarthritis is more likly to have what sound associated with the jaw?

Crepitus

How well did you know this?

Not at all

Perfectly

A direct blow to a pt with a closed mouth results in what type of injury to the TMJ?

Posterior capsule injury

How well did you know this?

Not at all

Perfectly

What are 4 types of trauma which may be etiologies for TMJ dysfunciton?

Direct blow
Whiplash injury
3rd molar extraction
Intubation

How well did you know this?

Not at all

Perfectly

What is a class 1 malocclusion of the jaw?

1st molars normal, problem elsewhere

How well did you know this?

Not at all

Perfectly

What is a class 2a vs. class 2b malocclusion of jaw?

2a = lower 1st molar posterior to upper mandibular retrustion (overbite)
2b = lower 1st molar posterior to upper to greater degree (larger overbite)

How well did you know this?

Not at all

Perfectly

What is a class 3 malocclusion of the jaw?

Lower 1st molar anterior to upper mandibular protrusion (underbite)

How well did you know this?

Not at all

Perfectly

What devleopmental abnormality is associated with TMJ dysfunction?

Condylar hypoplasia/agenesis

How well did you know this?

Not at all

Perfectly

Which mood disorders may be associated with TMJ dysfunction?

What have some studies showed?

Anxiety
Depression
PTSD
Hx of Abuse
Some studies show association btw chronic TMD and these mood disorders

How well did you know this?

Not at all

Perfectly

What are 2 metabolic causes of TMJ dysfunction?

Endocrine abnormalities
Hypocalcemia

What are 6 pathologies of intracapsular TMJ dysfunction?

Infection
RA
Ostoarthritis
Gout
Metastatic CA
Articular disc displacements

Extracapsular cause of TMJ dysfunction?

Myofascial pain of masticatory muscles

What are some of the risk factors associated with TMJ dysfunction?

Hyperlaxity (controversial)
Neck trauma (i.e., whiplash)
Femal hormones
Bruxism and clenching
Pyschological abnormalities

Which country has the highest prevalence of TMJ dysfunction?

Germany > Netherlands

Which age/sex is TMJ dysfunction more common in?

Young women

What should be evaluated during the OSE of someone with TMJ pain/dysfunction?

Cranial
C-spine
Scoliosis
Leg length —> Innominate, Sacrum, SI joint

Normal functional opening (ROM) of TMJ is how many mm?

Suspect TMJ dysfunction if

Normal = 35-55 mm
Susepct TMJ dysfunction if <25 mm and very often associated w/ pain

What is a PE finding associated with Bruxism?

Signs of wear and tear on teeth

What are 8 differential diagnoses for TMJ dysfunction?

1. **Migraine related disorder** --\> Carotodynia 2. **Inflammatory Dz** --\> local infection, RA, giant cell arteritis 3. **Dental problems** --\> posterior teeth support loss 4. **Neuralgias** --\> Trigeminal or Glossopharyngeal 5. **Parotid gland disorders** 6. **Lymphoproliferative disorders** 7. **Medication SE's** 8. **Eagle's Syndrome (stylohyoid syndrome)**

*C. tetani* is associated w/ what TMJ dysfunction?

Lockjaw

What are 2 medications which may be associated with SE's related to TMJ dyfunction?

1) **Steroids** --\> Avascular necrosis 2) **Bisphosphonates** --\> Osteonecrosis of jaw

What is Eagle's Syndrome?

Elongated **Styloid Process**

When should radiological examination be used for TMJ dysfunction?

- Usually **NOT** helpful - Use when you **suspect dental problems** or concern for alternative cause - Pt with **severe sx's** that **don't improve** w/ conservative tx tactics - Recent, severe trauma

What imaging modality is the procedure of choice for TMJ dysfunction? Why?

MRI - allows to see position and shape of disc

What is the level 1 intervention for TMJ dysfunction?

**Cognitive behavioral therapy** for chronic TMJ reduces activity interference, pain an drepression

What are level 2 interventions for TMJ dysfunction?

- Meds --\> Amitriptyline, glucosamine (for OA of TMJ), Benzo, Botox - Accupuncture - Oral habit reversal Tx - OMT - Therapeutic exercises

What are the level 3 intervention for TMJ dysfunction?

- OMT: biofeedback alone - Surgery - Occlusal splints: including athletic mouthguards - Occlusal adjustment - Intra-articular corticosteroid inj. - Physical therapy + counseling

What is the minimum goal of treatment of TMJ dysf. for opening the jaw?

Able to **fit knuckles** of the **index and middle finger** btw the teeth

Using the holistic approach to the plan for TMJ dysfunction the goal is to eliminate?

Jaw stress

Oral devices/occlusal splints for TMJ dysfunction should be avoided in patients with what?

Sleep apnea