Orofacial Pain & Temporomandibular Disorders

Question 1

What should you evaluate during the general appearance of a TMD patient?

Answer 1

Facial symmetry, swelling, or erythema over the TMJ area

Question 2

What occlusal sign might indicate chronic TMD or bruxism?

Answer 2

Abnormal occlusal wear patterns

Question 2

What muscle should be checked for hypertrophy during a TMD exam?

Answer 2

Masseter

Question 3

What habitual postures may suggest chronic TMD adaptation?

Answer 3

Forward head posture or tilted jaw

Question 4

What is a useful patient interview tip when locating pain in TMD?

Answer 4

Ask the patient to “point with one finger” to the most painful or tender site

Question 4

What mandibular opening measurement suggests possible restriction?

Answer 4

Less than 40 mm

Question 5

What is the normal range for mandibular opening?

Answer 5

35–60 mm

Question 6

When should pain levels be documented during ROM assessment?

Answer 6

During opening, closing, and at end range

Question 6

What does a >5 mm increase with assisted opening suggest?

Answer 6

Muscular restriction

Question 7

What does a <5 mm gain with hard end-feel during assisted opening suggest?

Answer 7

Disc displacement without reduction, bony obstruction, or fibrosis

Question 8

What is the normal range for lateral mandibular movement?

Answer 8

8–12 mm to each side

Question 9

What does limitation in lateral movement suggest?

Answer 9

Disc derangement or muscle guarding on the contralateral side

Question 10

What is the normal range for protrusive mandibular movement?

Answer 10

6–9 mm

Question 11

What is jaw deviation during opening?

Answer 11

Jaw veers off center but returns to midline at maximum opening

Question 12

What might pain or limitation during protrusion indicate?

Answer 12

Retrodiscal tissue involvement

Question 13

What does deviation of the jaw suggest?

Answer 13

Muscle imbalance or early disc derangement with reduction

Question 14

What is jaw deflection during opening?

Answer 14

Jaw veers to one side and does not return to midline

Question 15

What does deflection of the jaw indicate?

Answer 15

Non-reducing disc displacement, ankylosis, adhesions, or a space-occupying lesion

Question 15

What should be combined with visual observation to confirm cause of deviation or deflection?

Answer 15

Palpation (to distinguish mechanical block vs. muscle resistance)

Question 16

Where should fingers be placed to palpate the TMJ?

Answer 16

Bilaterally over the preauricular region

Question 17

During which jaw movements should the TMJ be palpated?

Answer 17

Opening, closing, lateral, and protrusive movements

Question 18

What does an early click or pop in the TMJ suggest?

Answer 18

Anterior disc displacement

Question 19

What should be documented when pain is noted during TMJ palpation?

Answer 19

Side (unilateral/bilateral), intensity, and referral (e.g., to ear or temple)

Question 19

What does a late click or pop in the TMJ suggest?

Answer 19

Possible disc reduction

Question 20

What does coarse crepitus in the TMJ indicate?

Answer 20

Degenerative bone-on-bone contact

Question 21

What does fine crepitus in the TMJ suggest?

Answer 21

Tissue friction

Question 22

What tool can be used to amplify TMJ sounds during auscultation?

Answer 22

Stethoscope

Question 22

Which parts of the masseter should be palpated during TMD assessment?

Answer 22

Superficial and deep portions

Question 22

What are the three fiber groups of the temporalis muscle to palpate?

Answer 22

Anterior, middle, and posterior fibers

Question 22

Why should auscultation findings be interpreted cautiously?

Answer 22

False positives are common

Question 23

How is the medial pterygoid palpated during a TMD exam?

Answer 23

Extraorally and indirectly

Question 24

What are common referred pain areas from masticatory or cervical muscles?

Answer 24

Eye, ear, and jaw

Question 24

What cervical and accessory muscles should also be palpated?

Answer 24

Digastric (anterior and posterior bellies), sternocleidomastoid (SCM), and trapezius

Question 24

Why is direct palpation of the lateral pterygoid uncommon in hygiene practice?

Answer 24

It requires intraoral access, which is not typically performed by hygienists

Question 25

What should be recorded when palpating muscles during a TMD exam?

Answer 25

Tenderness (0–3 scale), trigger points, and referred pain patterns

Question 26

What is a trigger point in muscle palpation?

Answer 26

A localized band of tight muscle that may cause referred pain

Question 27

What does increased pain during the clench test suggest?

Answer 27

Muscle origin of pain (myalgia)

Question 28

What is the purpose of the TMJ loading test?

Answer 28

To assess for intra-articular pain (arthralgia)

Question 28

How is the loading test performed?

Answer 28

Patient bites bilaterally on posterior teeth

Question 29

What does increased TMJ pain during the loading test indicate?

Answer 29

Likely intra-articular source, such as arthralgia

Question 29

How is the resisted opening test performed?

Answer 29

Apply light finger resistance to the chin during mandibular opening

Question 29

What does pain during resisted opening suggest?

Answer 29

Lateral pterygoid dysfunction or joint inflammation

Question 29

What persistent ROM limitation warrants referral or imaging?

Answer 29

Range of motion <30 mm with pain or mechanical block

Question 30

What mandibular movement pattern with a hard stop is a red flag?

Answer 30

Deflection with a hard stop

Question 31

What external physical signs may indicate the need for imaging?

Answer 31

Preauricular swelling or asymmetry

Question 31

What systemic or neurological concerns are red flags for referral?

Answer 31

Suspicion of systemic involvement or neurologic deficit

Question 32

What change in joint sounds may signal a need for MRI or CBCT?

Answer 32

A previously clicking joint that becomes silent and now has limited opening

Question 33

What are some non-TMD orofacial pain conditions?

Answer 33

Burning Mouth Syndrome (BMS) Trigeminal Neuralgia Post-Traumatic Trigeminal Neuropathy Persistent Idiopathic Facial Pain Glossopharyngeal Neuralgia Bell’s Palsy