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Module 4 > Mastication and Occlusion > Flashcards

Mastication and Occlusion Flashcards

1
Q

What is the TMJ?

A

Temporomandibular joint

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2
Q

What type of joint connects the temporal bone and the mandible?

A

Synovial joint

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3
Q

In a synovial joint what is the name given to the cartilage that surrounds the bone?

A

Hyaline articular cartilage

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4
Q

Where does the condyle sit in the TMJ?

A

In the glenoid fossa

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5
Q

What is the glenoid fossa bounded by?

A

articular eminence
tympanic plate of temporal bone

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6
Q

How many layers does the joint capsule have?

A

2
outer fibrous layer
inner synovial membrane

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7
Q

What is the purpose of the synovial membrane?

A

secretes synovial fluid to fill the joint spaces

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8
Q

what movements does the lateral ligament restrict?

A

posterior, lateral and inferior movement

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9
Q

what are the 3 accessory ligaments?

A

pterygomandibular raphe
stylomandibular ligament
sphenomandibular ligament

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10
Q

What does the articular disc do?

A

divides the joint into 2 compartments; lower - hinge, upper - slide

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11
Q

what are the 5 zones of the articular disc?

A

anterior extension
posterior extension
anterior band
intermediate zone
posterior band

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12
Q

what nerve innervates the TMJ?

A

Trigeminal nerve V3

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13
Q

what supplies blood to the tmj?

A

superficial temporal artery
maxillary artery

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14
Q

what is the result of an anterior disc displacement with reduction?

A

clicking jaw

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15
Q

Where would the condyle be to cause a dislocation of the TMJ?

A

anterior to the articular eminence

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16
Q

What is mastication?

A

chewing

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17
Q

What is the purpose of mastication?

A

preparation for swallowing
increase surface area for chemical digestion
release of chemicals for sense of taste

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18
Q

Where do masticatory movements take place?

A

TMJ

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19
Q

What are the 3 groups of muscles involved in mastication?

A

skull-mandible
mandible-hyoid
hyoid stabiliser

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20
Q

What are the muscles involved the skull-mandible group?

A

massester
temporalis
medial pterygoid
lateral pterygoid

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21
Q

what is the origin and insertion of the superficial masseter muscle?

A

origin: zygomatic arch/bone
insertion: angle/ramus of mandible

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22
Q

what is the action of the superficial masseter?

A

jaw elevation (closing)
minor protrusive

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23
Q

what is the origin and insertion of the deep masseter muscle?

A

origin: inner aspect of zygomatic arch
Insertion: angle/ramus of mandible

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24
Q

What is the action of the deep masseter muscle?

A

jaw elevation (closing)

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25
Q

What is the origin and insertion of the temporalis?

A

origin: inferior temporal line and fascia
insertion: coronoid process

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26
Q

What is the action of the temporalis?

A

(anterior fibres) jaw elevation
(posterior fibres) retrusion

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27
Q

what is the origin and insertion of the upper head part of lateral pterygoid?

A

origin: surface of greater wing of sphenoid
insertion: capsule and articular disc of TMJ

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28
Q

what is the origin and insertion of the lower head part of lateral pterygoid?

A

origin: lateral aspect of lateral pterygoid plate
insertion: pterygoid fovea below head of condyle

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29
Q

what is the action of the lateral pterygoid?

A

inferior head: pulls condyle forward, protrusion, assists opening, lateral excursion
superior head: restrusion and closing

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30
Q

what is the origin and insertion of the medial pterygoid?

A

origin: medial aspect of lateral plate and maxillary tuberosity
insertion: medial aspect of ramus/angle of mandible

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31
Q

what is the action of the medial pterygoid?

A

jaw elevation
protrusion and lateral excursions

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32
Q

What are the muscles involved the mandible-hyoid group?

A

geniohyoid
mylohyoid
digastric (anterior)

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33
Q

what is the origin of the geniohyoid?

A

inferior mental spine + inferior genial tubercle

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34
Q

what is the action of the geniohyoid?

A

(hyoid fixed): jaw opening and retrusion
(hyoid not fixed): raise and forward hyoid

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35
Q

what is the origin of the mylohyoid?

A

median raphe

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36
Q

what is the action of the mylohyoid?

A

(hyoid fixed): jaw opening
(hyoid not fixed): raise hyoid and FOM

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37
Q

What is the origin of the anterior belly of digastric?

A

digastric fossa

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38
Q

what is the action of the anterior belly of digastric?

A

(hyoid fixed): jaw opening
(hyoid not fixed): raise hyoid

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39
Q

what are the muscles involved in the hyoid stabilisers group?

A

infrahyoids (sternohyoid, omohyoid, thyrohyoid)
posterior digastric
stylohyoid

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40
Q

what other muscles are involved in mastication?

A

buccinator
obicularis oris

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41
Q

Detection of a mechanical stimuli through a peripheral receptor is called.

A

mechanoreception

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42
Q

Which type of reception gives us information about how things coming into contact with the body?

A

Exteroception

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43
Q

Which type of reception gives us information about our self, such as awareness of position?

A

Proprioception

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44
Q

What are the main oro-facial mechanoreceptors?

A

mucosa (and skin)
periodontal ligament
muscles
joint receptors

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45
Q

what do mucosa (and skin) mechanoreceptors tell us?

A

food texture

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46
Q

what do PDL mechanoreceptors tell us?

A

forces on teeth

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47
Q

what do muscle mechanoreceptors tell us?

A

muscle spindles tell us muscle length

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48
Q

What are the 2 classifications of mechanoreceptors?

A

physiological
anatomical

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49
Q

What is the receptive field?

A

The area/space where a stimulus will affect the receptor

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50
Q

Ruffini nerve endings are best found where in the oral cavity

A

PDL

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51
Q

Are the periodontal ligament mechanoreceptors afferent or efferent?

A

Afferent, Alpha beta axons

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52
Q

Where do the cell bodies of the periodontal ligament mechanoreceptors reside to?

A

V ganglion, then to the mesencephalic nucleus

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53
Q

Innervation density is at its highest, in which region of the periodontal ligament

A

higher at apex

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54
Q

Tooth must move around a what? to detect adequate stimulus?

A

fulcrum

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55
Q

Which region of the tooth would you expect to find slowly adapting, low threshold mechanoreceptors?

A

apically

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56
Q

Which region of the tooth would you expect to find rapidly adapting, high threshold mechanoreceptors?

A

Cervically

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57
Q

What are the 4 stages of the sensory pathway?

A

Sage 1: mechanoreception
Stage 2: Processing at first synapse
Stage 3: Processing in thalamus
Stage 4: conscious perception

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58
Q

What happens at stage 1 of the sensory pathway?

A

mechanoreceptors have been stimulated and propagation along primary afferent nerve

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59
Q

What happens at stage 2 of the sensory pathway?

A

sensory stimulus are processed at the first synapse at the trigeminal nuclei.

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60
Q

What happens at stage 3 of sensory pathway?

A

Sensory stimulus is processed in the thalamus.

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61
Q

What happens in stage 4 of sensory pathway?

A

Sensory stimulus is processed in the cerebral cortex for conscious perception.

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62
Q

At what stage does the sensory stimulus leave the peripheral nervous system and enter the central nervous system?

A

During stage 2, at its first synapse

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63
Q

What is proprioception?

A

A feedback system that allows us to be aware of our own movement

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64
Q

What are the 3 receptors involved in proprioception

A

Muscle spindles
Golgi tendon organs
joint receptors

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65
Q

What are extrafusal muscle fibres?

A

skeletal standard muscle fibres that are innervated by alpha motor neurons and generate tension by contracting, thereby allowing for skeletal movement.

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66
Q

What are intrafusal muscle fibres?

A

skeletal muscle fibres that serve as specialized sensory organs (proprioceptors) that detect the amount and rate of change in length of a muscle

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67
Q

how are afferents activated?

A

by stretch

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68
Q

What do secondary (flower-spray) nerve endings detect?

A

length of fibres

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69
Q

what do primary (annulo-spiral) nerve endings detect?

A

length of fibres and speed of change of length

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70
Q

what is the role of muscle spindles?

A

gives us information about muscle length
act to maintain muscle length

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71
Q

Where are the masticatory muscle spindles cell bodies located?

A

Trigeminal mesencephalic nucleus

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72
Q

Were do muscle spindle afferents synapse?

A

V motor nucleus

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73
Q

What happens when the muscle shortens?

A

Muscle contracted – shortens.

74
Q

Gamma (y) motor neurones cause contraction of which muscle fibres?

A

Intrafusal fibres

75
Q

What is the purpose of gamma motor neurones?

A

Maintain tension in spindle and maintain spindle afferent activity

76
Q

Pacinian, Golgi and Ruffini are example of receptors located where?

A

the joint

77
Q

What is occlusion?

A

The contact relationship of teeth or equivalent

78
Q

What is articulation?

A

The dynamic relationships of teeth when in sliding contact

79
Q

What is jaw relationship?

A

Positional relationship which the mandible bears to the maxilla

80
Q

Vertical jaw relationship and dimensions – our teeth when they are slightly apart by few mm is best known as what position?

A

Rest/postural position

81
Q

Vertical jaw relationship and dimensions – our teeth when they are together and fully interdigitated?

A

Intercuspal position (ICP)

82
Q

Is the Intercuspal position stable or not and why?

A

Not a stable position because, if you were to lose a tooth then the positions would change.

83
Q

Is the rest/postural position a stable position or not and why?

A

It is a stable position because, it is maintained by minimal muscle activity.

84
Q

In a retruded contact position, describe the position of the condyle?

A

The condyle is retruded in the glenoid fossa.

85
Q

What is the only muscle that will retract/move back/retrude the jaw?

A

Temporalis muscle

86
Q

What is the occlusal vertical dimension (OVD)

A

the face height with the teeth in ICP

87
Q

What two arbitrary points are used to measure the occlusal vertical dimension?

A

Nose and lower chin

88
Q

What is the rest/postural vertical dimension (RVD)?

A

face height with the mandible in rest/postural position

89
Q

what two arbitrary points are used to measure the rest/postural vertical dimension?

A

The nose and the mandible

90
Q

What is used to measure OVD and RVD?

A

Willis gauge

91
Q

What is the free way space?

A

gap between your teeth
The difference between teeth in rest position and ICP

92
Q

how do you work out a persons free way space?

A

RVD-OVD=FWS

93
Q

The restriction of the TMJ is governed by the positioning of the teeth. How does the positioning of the incisors restrict the mandibles movement?

A

At rest, the incisors will exhibit a slight overbite and overjet, which help restrict movement.

94
Q

The restriction of the TMJ is governed by the positioning of the teeth. How does the positioning of the cusps restrict the mandibles movement?

A

The Intercuspal position.

95
Q

A wide opening of the jaw exhibits what two movements?

A

Hinge and slide

96
Q

What does the movement from the ICP to the RCP represent on the border movement graph?

A

It represents the ICP overcoming the overbite and overjet.

97
Q

From RCP to the next point what does that represent?

A

This represents the pure hinge (small opening)

98
Q

From RCP to maximum opening what movement would the condyle exhibit?

A

Hinge and slide

99
Q

What muscle is responsible for moving the muscle forwards?

A

Lateral pterygoid

100
Q

Is the working side the side to which the teeth move or the side away from which the teeth move?

A

the side to which the teeth move

101
Q

what is canine guidance?

A

disocclusion of all the teeth by the contact of unilateral maxillary and mandibular canines only in lateral excursion movement

102
Q

what is group function?

A

the anterior and posterior teeth have full contact on the working side but no contact on the non-working side

103
Q

what is the position of the condyle on the non working side during excursion?

A

moves downwards, forwards over eminence, moves medially

104
Q

what is the position of the condyle on the working side during excursion?

A

rotates around the vertical axis
lateral bodily movement

105
Q

what is the balanced occlusion concept?

A

tooth contact during excursions at both working and non working sides

106
Q

what is bennet movement?

A

a complex lateral movement or lateral shift of the mandible resulting from the movements of the condyles along the lateral inclines of the mandibular fossae during lateral jaw movement.

107
Q

What is bennett angle?

A

The angle formed by the spatial coordinates of the condyles shifts and the sagittal plane

108
Q

how long does the chewing cycle take?

A

0.5-1.2 secs

109
Q

what are the phases of the chewing cycle?

A

opening
fast closing
slow closing
intercuspal phases

110
Q

Would there be greater or lesser lateral movements during the chewing cycle if the food was brittle

A

Lesser lateral movements

111
Q

Would there be greater or lesser lateral movements during the chewing cycle if the food was tougher?

A

Greater lateral movements

112
Q

What is the sequence of muscle activation in the opening chewing cycle?

A

mylohyoid
digastric
lateral pterygoid

113
Q

What is the sequence of muscle activation in the closing chewing cycle?

A

temporalis
masseter
medial pterygoid (lateral pterygoid also active)

114
Q

What is a reflex?

A

Predictable response to a given stimulus

115
Q

Why is jaw reflex important?

A

We may bite our tongue and the jaw reflex will help prevent us from ripping off the tongue.

116
Q

What is the stages of jaw unloading reflex?

A

Stimulus: sudden closure following hard biting
Response: inactivation of jaw closing muscles and activation of jaw opening muscles
Result: Teeth do not crash together

117
Q

Which centre sends a pattern of codes to the motor nucleus which activates specific nerves in a specific pattern which drives the masticatory movement?

A

Chewing centre

118
Q

Which centre allows us to voluntarily control chewing pattern, through the motor nucleus?

A

Higher centres

119
Q

What are the three type of reflexes?

A

Stretch reflex

Protective reflex

Unloading reflex – jaw

120
Q

Which reflex system is the simplest form?

A

Stretch reflexes

121
Q

Why are stretch reflex the simplest form?

A

Because it usually is mono-synaptic, meaning it has to synapse once

122
Q

A knee jerk reflex is an example of what type of reflex?

A

Stretch reflex

123
Q

What is reflex latency?

A

It is the time taken from the stimulus to the effector. That is usually the length of the pathway.

124
Q

What is the minimum synaptic delay?

A

0.2 seconds per synapse.

125
Q

Are synapses faster then action potentials

A

No

126
Q

Muscle spindles act as what in the muscles?

A

Receptor (afferent, action potentials)

127
Q

What are Temporomandibular Disorders (TMD)?

A

A group of conditions affecting the temporomandibular joint and/or the muscles of mastication

128
Q

What percentage of people suffer with TMD?

A

10-15%

129
Q

What age group is most commonly affected by TMD?

A

18-44

130
Q

Is TMD more common in males or females?

A

Females

131
Q

What factors make up the aetiology of TMD?

A

Biological
Psychological
Behavioural

132
Q

What is important to look at when examaning for TMD?

A

Pain
Noises
Movement
Habits
Trauma

133
Q

How can stress, anxiety and depression all increase the risk of TMD?

A

Can cause you to grind your teeth more

134
Q

What are 3 co-morbidities that can contribute to TMD?

A

Fibromyalgia
Chronic pain
Psychological factors

135
Q

What are the stages of a TMD examination?

A

Palpate the TMJ - lateral pole
Check for noises
Palpate the muscles (temporalis and masseter)
On opening check for deviation and the extent of opening

136
Q

What else could you use to investigate TMD?

A

CBCT
MRI

137
Q

TMD diagnosis is split into 2 groups, what are they?

A

Pain related TMDs
Intra-articular TMDs

138
Q

Pain related TMDs are split into 2 groups, what are they?

A

Myalgia
Arthralgia

139
Q

How does disc displacement with reduction present?

A

with clicking

140
Q

How does disc displacement without reduction with limited opening present?

A

Characterised by a history of previous clicking which stops at the same time as the onset of restricted mouth movement

141
Q

What is the TMD classification criteria?

A

Description
History
Examination

142
Q

How does TMD- Myalgia description present?

A

Pain of muscle origin provoked when testing of the masticatory muscles

143
Q

How does history of TMD-Myalgia present?

A

Pain in jaw, temple, infront of ear/in ear
AND
modified with jaw movement or function

144
Q

What does examination of TMD-Myalgia look like?

A

pain in temporalis or masseter muscle
This pain is reciprocated when:
palpating temporalis or masseter
OR
maximum unassisted or assisted opening movements

145
Q

What are the sub types of TMD-myalgia?

A

Local myalgia
Myofascial pain
Myofascial pain with Referral

146
Q

How does local myalgia present?

A

pain is localised to the site of palpation

147
Q

How does myofascial pain present?

A

pain extends beyond site of palpation but still within the boundaries of the muscle being palpated

148
Q

how does myofascial pain with referral present?

A

The pain extends beyond the boundaries of the muscle being palpated

149
Q

what is arthralgia?

A

pain of joint origin affected by jaw movement and replicated by testing of the TMJ

150
Q

What is disc displacement with reduction?

A

in closed mouth position disc is in an anterior position relative to condylar head and disc reduces on mouth opening

151
Q

What is disc replacement without reduction?

A

the disc is in an anterior position relative to the condylar head and does not reduce with opening - mouth will not open all the way

152
Q

what is jaw lock

A

when the mouth does not open all the way

153
Q

what is degenerative joint disease in the absence of pain termed?

A

osteoarthrosis

154
Q

what is degenerative joint disease with arthralgia accompanying crepitus known as?

A

osteoarthritis

155
Q

what is crepitus?

A

a popping, clicking or crackling sound in a joint.

156
Q

what is subluxation

A

open lock
disc condyle complex lies anterior to articular eminence and cannot be returned to normal position without a manipulative manoeuvre

157
Q

if a patient can manoeuvre the joint back into position what is this called?

A

subluxation

158
Q

if a patient can’t manoeuvre the joint back into position and requires assistance of a clinician, what is this called?

A

luxation

159
Q

Conservative management of TMD?

A

rest and relaxation
modify diet
avoid wide mouth opening
regular application of gentle heat - chronic conditions
regular application of cold pack - acute onset pain &/ or restricted mouth opening
Jaw excercises
NSAIDS
diazepam - helps muscle spasms

160
Q

what does FLAT stand for?

A

Fear of pain
Low mood
Avoidance of functional activities
Thinking the worst

161
Q

what is the purpose of a splint?

A

Splints are used to allow the muscles and ligaments in the mouth and jaw to relax, and as a result, the facial muscles are able to relieve some of the tension and tightness that may be caused clenching and grinding teeth.

162
Q

what is the purpose of a splint?

A

Splints are used to allow the muscles and ligaments in the mouth and jaw to relax, and as a result, the facial muscles are able to relieve some of the tension and tightness that may be caused clenching and grinding teeth.

163
Q

what is the aim of a michigan splint?

A

for maxillary arch
to create:
- canine guidance on lateral excursions
- anterior guidance on protrusion
- posterior disclusion on excursion

164
Q

what is a tanner appliance?

A

similar to michigan splint but for mandibular arch

165
Q

are stabilisation splints usually worn during the day or at night?

A

night time

166
Q

how do you make a splint to help with TMD

A

record when condyle comes forward and jaw protrudes, using hard wax, soften it up and get patient to bite down with their jaw

167
Q

Why should partial coverage splints not be used?

A

they can cause over eruption on the anterior teeth and a posterior open bite

168
Q

why is the glenoid fossa thin?

A

so that the forces go through the teeth and not the joint

169
Q

what guides the movement of the condyle?

A

articular eminence

170
Q

what is canine guidance?

A

the load is on one tooth

171
Q

what is group function?

A

the load is shared

172
Q

mandibular moments are guided by what?

A

TMJ
Teeth

173
Q

what type of articulator is often used in ortho for retainers?

A

hand held casts

174
Q

what is the downside of hand held casts?

A

good for simple analysis but you need sufficient teeth
can only be analysed in iCP

175
Q

What is good about a simple hinge articulator?

A

it relocates the teeth, so is better in a case with a lot of missing teeth

176
Q

what is the downside of a simple hinge articulator

A

not a good device for simulating anatomical movement

177
Q

what is an advantage of a plane line articulator?

A

the hinge is more anatomically correct and sturdy than the hand held casts and simple hinge articulator

178
Q

what is the disadvantage of the plane line articulator?

A

the hinge is still arbitrary - not a simulator of movements

179
Q

What is an advantage of the average value articulator?

A

has 2 hinges - we have 2 condyles
has a mounting plate - fixed relationship between the glenoid fossa and the jaw

180
Q

what is an advantage of the semi adjustable articulators?

A

closest relationship to the real anatomy

181
Q

what is required to set up an articulator

A

face bow/ear bow

182
Q

what do rapidly adapting receptors give information about?

A

change and only fires when that change happens

Module 4 (9 decks)

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