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OSIV Midterm Exam > Lecture 6: Temporomandibular Dysfunction > Flashcards

Lecture 6: Temporomandibular Dysfunction Flashcards

1
Q

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

A
  • Rotation about a RT/LF (transverse axis)
  • Anterior glide (over the articular disc)
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2
Q

Which 3 muscles of mastification close the jaw tightly?

A
  • Temporalis m.
  • Masseter m.
  • Medial ptergoid m.
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3
Q

Which muscle of the mouth approximates and compresses lips?

A

Orbicularis oris m.

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4
Q

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

A

Zygomaticus major

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5
Q

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

A

Risorius

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6
Q

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

A
  • CC of Cephalgia (HA)
  • May or may not mention jaw problems
  • May describe as dull ache —> worse w/ chewing
  • Tinnitus
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7
Q

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

A

Disc displacement after disc thin/stretched

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8
Q

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

A

Crepitus

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9
Q

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

A

Posterior capsule injury

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10
Q

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

A
  1. Direct blow
  2. Whiplash injury
  3. 3rd molar extraction
  4. Intubation
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11
Q

What is a class 1 malocclusion of the jaw?

A

1st molars normal, problem elsewhere

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12
Q

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

A
  • 2a = lower 1st molar posterior to upper mandibular retrustion (overbite)
  • 2b = lower 1st molar posterior to upper to greater degree (larger overbite)
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13
Q

What is a class 3 malocclusion of the jaw?

A

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

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14
Q

What devleopmental abnormality is associated with TMJ dysfunction?

A

Condylar hypoplasia/agenesis

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15
Q

Which mood disorders may be associated with TMJ dysfunction?

What have some studies showed?

A
  • Anxiety
  • Depression
  • PTSD
  • Hx of Abuse
  • Some studies show association btw chronic TMD and these mood disorders
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16
Q

What are 2 metabolic causes of TMJ dysfunction?

A
  • Endocrine abnormalities
  • Hypocalcemia
17
Q

What are 6 pathologies of intracapsular TMJ dysfunction?

A
  • Infection
  • RA
  • Ostoarthritis
  • Gout
  • Metastatic CA
  • Articular disc displacements
18
Q

Extracapsular cause of TMJ dysfunction?

A

Myofascial pain of masticatory muscles

19
Q

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

A
  • Hyperlaxity (controversial)
  • Neck trauma (i.e., whiplash)
  • Femal hormones
  • Bruxism and clenching
  • Pyschological abnormalities
20
Q

Which country has the highest prevalence of TMJ dysfunction?

A

Germany > Netherlands

21
Q

Which age/sex is TMJ dysfunction more common in?

A

Young women

22
Q

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

A
  • Cranial
  • C-spine
  • Scoliosis
  • Leg length —> Innominate, Sacrum, SI joint
23
Q

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

Suspect TMJ dysfunction if

A
  • Normal = 35-55 mm
  • Susepct TMJ dysfunction if <25 mm and very often associated w/ pain
24
Q

What is a PE finding associated with Bruxism?

A

Signs of wear and tear on teeth

25
Q

What are 8 differential diagnoses for TMJ dysfunction?

A
  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)
26
Q

C. tetani is associated w/ what TMJ dysfunction?

A

Lockjaw

27
Q

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

A

1) Steroids –> Avascular necrosis
2) Bisphosphonates –> Osteonecrosis of jaw

28
Q

What is Eagle’s Syndrome?

A

Elongated Styloid Process

29
Q

When should radiological examination be used for TMJ dysfunction?

A
  • 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
30
Q

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

Why?

A

MRI - allows to see position and shape of disc

31
Q

What is the level 1 intervention for TMJ dysfunction?

A

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

32
Q

What are level 2 interventions for TMJ dysfunction?

A
  • Meds –> Amitriptyline, glucosamine (for OA of TMJ), Benzo, Botox
  • Accupuncture
  • Oral habit reversal Tx
  • OMT
  • Therapeutic exercises
33
Q

What are the level 3 intervention for TMJ dysfunction?

A
  • OMT: biofeedback alone
  • Surgery
  • Occlusal splints: including athletic mouthguards
  • Occlusal adjustment
  • Intra-articular corticosteroid inj.
  • Physical therapy + counseling
34
Q

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

A

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

35
Q

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

A

Jaw stress

36
Q

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

A

Sleep apnea

OSIV Midterm Exam (14 decks)

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