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OS III Final > Review: Temporomandibular Dysfunction > Flashcards

Review: Temporomandibular Dysfunction Flashcards

1
Q

Describe the TMJ

A

Gliding joint made up of: convex articular condyle of the mandible and concave articular fossa on squamous portion of temporal bone

Separated by a fibrocartilaginous articular disc — 3 parts of disc: thick anterior band, thin intermediate zone, thick posterior band

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2
Q

Describe TMJ changes in terms of the meniscus with mouth closed vs. mouth open

A

Meniscus with mouth closed: condyle is separated from the articular fossa of the temporal bone by the thick posterior band

Meniscus with the mouth open: condyle is separated from the articular eminence of the temporal bone by the thin intermediate zone

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3
Q

Muscles of mastication that depress mandible initially, then pterygoids take over

A

Digastric, suprahyoid

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4
Q

Action of left lateral and medial pterygoids

A

Move mandible lateral and forward to the right

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5
Q

Muscles of mastication responsible for tight jaw closure

A

Temporalis, masseter, medial pterygoid

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6
Q

Actions of buccinator, depressor labii inferior, depressor anguli oris and platysma, mentalis

A

Buccinator = approximates lips and compresses cheeks (blowing)

Depressor labii inferior = protrudes lower lip (pouting)

Depressor anguli oris and platysma = draws corners of mouth down

Mentalis = draws tip of chin upward

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7
Q

Actions of orbicularis oris, zygomatic minor, and levatror anguli oris

A

Orbicularis oris - approximates and compresses lips

Zygomatic minor - protrudes upper lip

Levator anguli oris - lifts upper border of lip on one side without raising lateral angle (snarl)

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8
Q

Actions of zygomaticus major and risorius mm

A

Zygomaticus major = raises lateral angle of the mouth

Risorius = approximates lips and draws lips and corners of mouth lateral (grimace)

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9
Q

Symptoms/signs of TMJ dysfunction

A

Most often c/o facial pain, HA, ear sxs, TMJ pain, or sxs of jaw dysfunction

Cephalgia, otalgia, neck pain, eye pain, shoulder/back pain, tinnitus, dizziness

May describe pain as a dull ache with difficulty opening mouth (click/crepitans), lateral jaw deviation, spasm within facial muscles, onset of TMJ symptoms may correspond with onset of stress or added stressors

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10
Q

Behavioral associations with TMJ

A

Nocturnal bruxism (controversial)

Jaw clenching (anxiety, stress)

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11
Q

Types of TMJ dysfunction

A

Opening click

Closing click (reciprocal clicking)

Inability to fully open jaw (close-locked)

Inability to close if TMJ symptoms are bilateral

Crepitus and grating

Fusion of the joint (ankylosis)

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12
Q

Causes of jaw clicking

A

Almost always d/t disc displacement (after disc is thin/stretched)

other causes: Adhesions, uncoordinated muscle action of pterygoids, tear or perforation of disc, osteoarthritis, occlusion imbalance

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13
Q

Important components of patient hx to ask about when pt c/o TMJ symptoms

A 
PMH of jaw trauma
Sleep habits/position
Symptoms of bruxism
Use of mouth orthotics
Occupation/hobbies
Symptoms of depression/anxiety
Recent stressful events

Also personal habits like usual posture, nail biting, or frequent gum chewing

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14
Q

General Etiologies of TMJ dysfunction

A

Trauma (direct, whiplash, third molar extraction, intubation)

Malocclusions of maxillary and mandibular teeth

Muscle strain (oral habits, postural/work, sports)

MSK problems or Somatic dysfunction

Compensatory changes (short leg syndrome, scoliosis)

Developmental abnormalities (condylar hypoplasia/agenesis)

Mood disorders (anxiety, depresion, PTSD, hx of abuse)

Endocrine, hypocalcemia (Chvostek’s sign, Trousseau sign)

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15
Q

What type of TMJ injury results from direct blow to the joint with a closed mouth?

A

Posterior capsule injury

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16
Q

Types of malocclusion

A

Class 1 = 1st molars normal, problems elsewhere

Class 2a = lower 1st molar posterior to upper mandibular retrusion (overbite)

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

Class 3 = lower 1st molar anterior to upper mandibular protrusion (underbite)

17
Q

Intracapsular problems

A 
Infection
RA
OA
Gout
Metastatic Ca
Articular disc displacements
18
Q

Extracapsular problems

A

Myofascial pain of masticatory muscles — TMJ myofascial pain syndrome, TMJ dysfunction syndrome, TMJ syndrome

NIH preferred terminology = temporomandibular muscle and joint disorder (TMJD)

19
Q

Epidemiology of TMJ dysfunction

A

2 cause of facial pain (HA is #1)

Affects about 20% of American population

MORE common in young women

More recent data suggest a 12-15% prevalence with 5% seeking tx due to pain/disability

Patients with RA are more likely to develop temporomandibular pain

20
Q

Components of OSE for TMJ complaints

A

Cranial (note facial asymmetry)
C-spine
Scoliosis
Leg length (innominate shear/rotation, sacrum, SI joints)

Palpate joints for crepitans/clicks, palpate mastication muscles w/ 2-3 lbs of presure for tenderness, ROM + observe for jaw deviation, observation for cavities, suspicious lesions in mouth, teeth alignment

21
Q

Components of ROM exam for TMJ complaint

A

Active — patient opens mouth 3-6 cm, laterally 1-2 cm, and then retracts and protrudes mandible — observe jaw movements for deviation

Passive — move pts jaw medially and laterally, with gloves feel muscles inside mouth and check for tissue texture asymmetry

[normal functional opening is 35-55 mm, functional opening in TMD pts is usually < 25 mm and often associated with pain]

22
Q

What PE findings might suggest TMD?

A

Abnormal mandibular movements

Decreased ROM of TMJ

Tenderness of muscles of mastication

Pain with dynamic loading

Bruxism (signs of tooth wear)

Postural asymmetry

Neck and shoulder muscle tenderness

Normal CN exam

23
Q

Differential diagnoses for TMD

A

Migraine-related disorders: carotodynia

Inflammatory dz: local infection, RA, giant cell arteritis

Dental problems: posterior teeth support loss

Neuralgias: trigeminal, glossopharyngeal

Parotid gland disorders

Lymphoproliferative disorders

Microbiology and pathology: C.tetani, odontogenic cysts, sclerosing osteomyelitis of Garre, monocystic fibrous dysplasia, acromegaly leading to prognathism

Medication side effects (steroids and avascular necrosis, bisphosphonates and osteonecrosis of the jaw)

Eagle’s syndrome (stylohyoid syndrome): elongated styloid process

24
Q

Radiological exam for TMD is usually not helpful. When would you choose to do it?

A

Suspect dental problems

Pt with severe symptoms that don’t improve with conservative tx

Concern for alternative cause

Recent, severe trauma

[periapical radiographs can r/o tooth problems]

25
Q

When radiological testing is done for TMD, what is the procedure of choice and why?

A

MRI — used to see position and shape of disc

[disc is commonly displaced in asymptomatic pts; MRI findings alone not significant unless TMJ movement is restricted or there is clinical suspicion for disc dislocation]

26
Q

EBM TMJ level 1 interventions

A

CBT for chronic TMJ reduces activity interference, pain, and depression at 1 year

27
Q

EBM TMJ level 2 interventions

A 
Amitriptyline
Glucosamine sulfate for OA of TMJ
Benzodiazepine
Botox
Accupuncture
OMT
Therapeutic exercise
Physical self-regulation
CBT + biofeedback
Oral habit reversal tx
Hypnorelaxation
NSAIDs (usually not adequate)
28
Q

EBM TMJ level 3 interventions

A 
OMT
PT + counseling
Occlusal adjustment
Biofeedback alone
Occlusal splints (mouth guard)
Surgery (arthrocentesis, arthroscopy, orthgnathic surgery, joint replacement)
29
Q

T/F: OMT used to tx TMJ has been associated with less NSAIDs and muscle relaxant use

A

True

30
Q

Types of OMT techniques used for the correction of structural imbalances with TMD

A 
Counterstrain
MET
Craniosacral
BMT/BLT
HVLA
31
Q

Non-pharmacologic holistic tx for TMD

A

Patient education — avoiding triggers, nature of condition, rationale for tx choice

Self-care aimed at improving pain and function — changing head posture, sleeping position, aggravating parafuncitonal oral behaviors (nail biting, pen chewing, etc.), eliminate jaw stress

Bite plate appliance may help, dental care PRN, adjust diet to easier foods to chew

MSK biofeedback, relaxation techniques

32
Q

What factors are associated with poorer prognosis with TMD?

A

High levels of disability

Prolonged or excessive use of opiates, benzodiazepines, alcohol, or other drugs

Pre-existing psychological distress

33
Q

When examining contours of the face, what are the landmarks for dividing the face into thirds to note asymmetry?

A

Hair line to bipupital line

Bipupital line to nose line

Nose line to chin line

34
Q

What muscles are you testing when you have the pt depress the jaw against mild resistance?

A

Digastric and suprahyoid

35
Q

5 models considerations for TMJ

A

Biomechanical: cranial, TMJ specific, cervical manipulation

Psych/behavioral: lifestyle changes to remove exacerbating factors (CBT)

Neurologic: CN V - mandibular division to mm of mastication, CN VII

Metabolic: r/o metabolic cause/tx underlying dz — Ca deficiency, renal dz, side effects of meds

Respiratory circulatory: lymphatic techniques

OS III Final (16 decks)

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