MC book Qs Flashcards
Up to ___ of the population has at least one sign or symptoms of TMD.
75%
A healthy joint is a prerequisite for successful restorative work ( true or false)
true
true or false… the TMJ is the most complex joint in the body
true
The TMJ provides for ___ movements
hinging and sliding
the TMJ is classified as a compound joint, requiring the presence of ___
at least three bones
The articular disc is composed of ___
dense fibrous connective tissue
From an anterior view, the articular disc is thicker ___
medially
When the mandible opens, the inferior joint space ____
opens more posteriorly
The precise shape of the articular disc depends upon the morphology of ____
the mandibular fossa and the condyle
The retrodiscal tissue is…
located posterior to the articular disc
highly innervated
highly vascular
true or false… The articular surfaces of the condyle and mandibular fossa are lined with hyaline cartilage.
False
compared to fibrous CT, hyaline cartilage…
is more susceptible to the effects of aging
is more liable to break down
has less ability to repair
true or false… Synovial fluid in the TMJ acts as a medium providing metabolic requirements to the surrounding tissues.
true
the synovial fluid ____
acts as a lubricant
helps to minimize friction
No barrier exists between the synovium and the fluids present in the joint spaces because….
there is no epithelium or basement membrane
GAGs can produce a cushion to compressive loads by ___
causing the cartilage to imbibe extracellular water.
Requirements for healthy cartilage include…
plenty of water
proteoglycans
a collagenous mass
The functional ligaments that support the TMJ are ___
the collateral ligaments
the capsular ligament
the temporomandibular ligament
The accessory ligaments for the TMJ are ____
(A and B)
stylomandibular
sphenomandibular
The muscles of mastication include the….
(all of the above)
temporalis and masseter
lateral and medial pterygoid
anterior and posterior digastric
Temporomandibular disorders result from….
(A and B)
macrotrauma
microtrauma
Microtauma occurs as a result of…
(A and C)
sustained adverse loading
repetitive adverse loading
Inflammation of the joint space can be the result of…
(A and B)
unresolved ligamentous insertion injuries due to traumas
unresolved tendinous insertion injuries due to trumas
Capsulitis and synovitis may be associated with ….
(all of the above)
a disc displacement
hypermobility
dislocation
If a disc is reduced….
it can be recaptured
In cases with disc displacement without reduction, ____
the posterior lateral ligaments have been severely stretched
Mast cells release ____ as part of the inflammatory response
seratonin
Disc surface cracks can occur as a result of ___
compression
Bradykinin and substance P are ___
inflammatory neuropeptides
Abnormal rotation of the ilium can cause…
anterior rotation of the mandible
A comprehensive examination to determine if a patient has TMD must include ___
(all of the above)
a health history and review of chief complaints
a clinical examination
tests and imaging
true or false… when taking a patients medical history it is important to obtain information on pharmaceutical medications as well as homeopathic medicines and vitamins
true
the initial examination performed by the assistant should include….
(all of the above)
measurement of maximum jaw opening
measurement of degree of protrusion
measurement of CEJ to CEJ distance and lateral movement
The normal range for opening for a patient with a dolichofacial type is ___
42mm
The cervial range of motion is measured using ___
an arthroidal protractor
the articular disc is composed of ___
dense fibrous connective tissue
the joint vibration analysis works on the ___
principle of motion and friction
The temporals muscle should be palpated….
(B and C)
at rest
after the patient has clenched
(not with the patient clenching)
The superficial master muscle is palpated ____
(a and b)
While the muscle is contracting
with the patient clenching
true or false… the anterior digrastic muscle is palpated underneath the chin with the patients mandible in a protruded position
true
Morning headaches are a sign of ____
(a and b)
OSA
TMJ dysfunction
Initial X-rays taken will include…
(all of the above)
a pano
a sub-mental vertex raiograph
sagittal tomograms
The neck muscles that must be palpated include….
(all of the above)
the trapezius
the splenius capitus
the sternocleidomastoid
The ___ originates from the styloid process.
(all of the above)
styloglossus muscle
stylopharyngeal muscle
stylomandibular and stylohyoid ligaments
Muscles must be palpated….
(all of the above)
one at a time
one side at a time
bilaterally
The lateral TMJ is is palpated…
with the mouth closed
The corrected sagittal tomogram is ____
inherently more accurate than the trans cranial projection
The TMJ should not ____
(all of the above)
click
pop
produce a grating noise
The Epworth Sleepiness Scale ___
(all of the above)
is self-administered by the patient
assesses the amount and restfulness of sleep
assess the sleeping pattern
Following a full evaluation of patients, ___ should take place
(a and b)
a diagnosis
triage
One of the more common symptoms a TMD is ___
headaches
true or false… An injury to the TMJ has a more significant impact on the nervous system than a knee injury
true
___ involves the transmission of a noxious stimulus from a site in the body to the brain.
nociception
TMJ tissue damage results in the release of ___
inflammatory neuropeptides
Pain from a tooth travels ___ before ascending to the brain.
down into the patient’s neck
All noxious stimuli go through ___
the thalamus
Intra-capsular derangements of the TMJ can result from ___
(a and b)
macrotauma
microtrauma
An intra-capsular derangement is ___
(all of the above)
disc dislocation with reduction
disc displacement
disc dislocation without reduction
true or false… Extra-capsular pathology results in mandibular deflection on protrusion.
false
true or false… capsulitis and synovitis have the same clinical presentation
true
degenerative joint disease in the early stages will result in ___
a scratchy noise (crepitus)
Local inflammation of the outer fibrous layer is ___
capsulitis
Local inflammation of the inner synovial longing is ___
synovitis
in some cases, ___ is the only way to diagnose chronic disc dislocation
MRI
A patient with normal opening that is painful and that has had this problem for less than two weeks should….
receive oral appliance therapy
A patient with a primary headache should ___
be considered for oral appliance therapy
Temporal headaches may be due to ___
(a and b)
clenching
grinding
Disc displacements results in ____
(all of the above)
clicking of the TMJ during opening
clicking of the TMJ during closing
a normal range of movement
true or false… the cold spray technique is used as a diagnostic aid in patients with limited opening
true
true or false… intra-capsular pathology results in the patient being able to open wider with mild passive force
false
The ADA has adopted ___ AAOP guidelines for the evaluation and treatment of TMD
Okeson’s
Approximately ___ of patients can tolerate the mandible retruded to its most superior position
15%
Coincidence between centric relation and centric occlusion occurs in __ of the population
15%
It is currently agreed that the normal position is to have the condyles positioned ___
superanteriorly
bite registration methods include…
(all of the above)
the TENs bite
the swallow bite
the phonetic “S” bite
The disadvantage of the TENs bite is that the bite is taken ___
with decreased muscle tonus
The “S” sound…
(a and b)
produces a patent airway
corrects the mediolateral occlusal cant
taken properly, the neuromuscular bite results in….
substantial vertical change in the maxillomandibular relationship
Correcting the cant of the plane of occlusion is ____
essential in restoring equal muscle length
The swallow bite is ___
(a and b)
affected by inflammation
more of a vertical correction than AP correction
(it is NOT highly reliable)
a poetic “S” bite registration…
(all of the above)
gives the limit of AP movement
has the mandible forward of the habitual bite
has the mandible level
An Aqualizer is used to…
reduce nociceptive input
The phonetic “S” bite….
(all of the above)
it not subject to the patients will
results in higher freeway space than after swallowing with the mandible in a relaxed position
is reproducible
A phonetic “S” bite is best taken with…
reduced novicpetive input to the brain
during the phonetic “S” bite registration, the patient counts from ____
66-77
When applying bite registration material for a phonetic “S” bite, it should be ___
first applied to the anterior teeth
Depending upon the space, ___ can be used as a separating device during bite registration.
a microbrush
a disposable three-way syringe
a disposable saliva ejector
one of the above
one of the above
Prior to taking the patient’s bite, ___
(a and b)
The CEJ to CEJ distance should be measured
the overbite should be measured
true or false… all bite registrations record a static position
true
true or false… when making an AP correction, it is important to understand the limit for this without increasing muscle tonus.
true
True or false… All patients complaining of sleep disorders or pain disorders should be treated with appliances.
false
True or false… all patients with TMDs and headaches can be treated with oral appliances
false
Long-term stabilization can be achieved using
a - overlay partial dentures
b - orthodontics
c - fixed prosthodontics
d - combinations of a, b, and c
d - Combinations of a, b, and c
Day positioned appliances are intended for ___
therapeutic appliance therapy
An orthotic appliance is ____
(all of the above)
used to restore function
used to reduce symptoms
used to restore all injured components back to their original dimensions
The goals of orthotic appliance therapy for patients with disc displacement are….
(all of the above)
to provide the best possible condyle-fossa relationship at the time of treatment
to decompress the capsular inflammation
to restore proper muscle length bilaterally
A splint is…
(all of the above)
rigid or flexible
used to maintain a displaced or mobile part in position
used to keep an injured part in place or protected
Wearing orthotic appliances for long periods of time (long-term)….
can lead to changes in the position of the teeth
true or false.. Anterior bite planes spread the force of the elevator muscles over a larger area than other anterior programmers.
true
The goal of the OD 1 is….
(all of the above)
to create proper spacing between the condyle and fossa
to enable room for tissue movement and disc repositioning
to change the ligamentous relationships
True or false.. the objective of the OD 1 is to recapture all discs
false
true or false… compact and labial bow OD 1s may increase patient comfort
true
The Olmos Day Positioned orthotic is indicated for….
(a and b)
chronic dysfunction of intra-capsular origin (disc displacement)
skeletal and muscular asymmetry
Patients must be instructed…
(all of the above)
that the OD 1 is a functional appliance
that the appliance must be worn during all waking hours
how to clean the appliance
True or false… the use of an anterior bite plane may result in the development of undesired dental and osseous changes
true
Swallowing without wearing functional daytime appliances will ___
produce symptoms
An OD3 appliance is indicated instead of an OD 1 appliance if…
(all of the above)
the patient is allergic to metals
the arch form is very narrow
there is less than 1.5mm of space inter-occlusally
If an appliance does not fit, it may be due to…
(b and c)
poor impression or distorted models
improper or inadequate adjustments upon delivery
For a day orthotic intended to have only centric contacts…
(a and b)
all protrusive interferences must be removed
all non-working interferences must be removed
true or false… centric tomograms should be taken after placement of an orthotic to check positioning.
true
If the position was correctt but the patient complains that he or she is only hitting on one side…
the side where the patient is not hitting should be relined
the ON 4 appliance is ___
all of the above
True or false… perter and Gross found the repositioning therapy would reduce trauma to the distal ligament
true
The benefit of condyle-fossa positioning is…
(all of the above)
relief of joint pain
relief from tinnitus
correction of dysfunctional. posture
True or false… CT scans can be used to view condyle positioning
true
Indications for night orthotics include…
(all of the above)
clenching or grinding at night
sleep interrupted by temporal headaches
episodes of bruxism
The anterior deprogrammer (ON 1) is designed to ____
(all of the above)
reduce nocturnal clenching and grinding
change the fulcrum of the elevator muscles
reduce the patients ability to forcefully close
The Olmos Night Positioner is indicated for ____
(all of the above)
patients who lock in the supine position
stretched capsular and distal ligaments
to augment a day orthotic appliance
The ON 3 orthotic appliance ….
(all of the above)
holds the mandible forward by using a circular ramp
has a round hole that lets air pass to the oropharyngeal airway
improves the airway
The ON 3 orthotic appliance can be used in patients with…
a - inflammation of the joint capsule
b - airway obstruction
c - clench or grind their teeth
any combination of the above
About ___ Americans suffer from a sleep problem.
70 million
___ of men with moderate to severe obstructive sleep apnea have not been clinically diagnosed.
82 percent
Sleep-disorder breathing can be categorized as ___.
(all of the above)
snoring
upper airway resistance syndrome
OSA
A person is considered to have OSA if…
a complete cessation of breathing occurs at least 30 times during 7 hours of sleep
Cardiovascular symptoms associated with OSA are…
(all of the above)
systemic hypertension
coronary and ischemic heart disease
stroke
true or false… sleep bruxism may occur as a result of OSA
true
Sleep bruxism is defined as…
An oromotor movement disorder
Risk factors for obstructive sleep apnea include ___
(all of the above)
obesity
anatomic abnormalities of the upper airway
male gender
A general measure that can help if a patient is suffering from OSA is ___
(all of the above)
to lose weight
to sleep on your side
to avoid alcohol two or three hours prior to sleeping
Oral appliance therapy is recommended for patients with ____
(a and b)
Mild OSA
moderate OSA
Success rates using oral appliance therapy to treat OSA are as high as ___
76%
true or false… Boil-and-bite appliances specifically address the occlusal and TMJ relationship.
false
Guessing which patients may benefit from airway dilator therapy ____
is dangerous and can result in over-titration
The position for optimal airway patency can be determined ___
(a and b)
using a pharyngometer
using a rhinometer
The TAP2 T-TL appliance…
(all of the above)
allows for 25mm of lateral freedom
can be adjusted AP
can produce disc dislocation
The Silencer ____
(a and b)
allows for vertical adjustments
allows for AP adjustments
true or false… Appliance therapy is always a complete alternative to CPAP.
false
The OASYS Oral Airway System…
(all of the above)
Consists of a lower appliance
consists of an upper splint
is a mandibular repositioned and nasal dilator
Non-adjustable appliances…
(a and b)
hold the mandible in a fixed position
are non-adjustable
The key to success in oral appliance therapy is….
(all of the above)
appropriate patient selection
appropriate appliance selection
diligent case management
