Temperomandibular Disorders Flashcards
Anatomy - Bone
Temporal bone
Mandible and maxilla
Sphenoid and hyoid
Anatomy - joint
lined with fibrocartilage - can withstand large forces
All interaction occurs over the articular eminence
Thick articular surface - site of load bearing
Loose capsule which is innervated
Fibrocartilagenous Disc Anatomy
divides the TMJ into upper and lower - each with own synovial membrane
anteriorly - fused to capsule
posteriorly - attached to retrodiscal pad
Three band - posterior, intermediate and anterior
- intermediate thin compared to others
Movement of the TMJ
Rotation and translation
OPENING
- rotation of mandible relative to disc, occurs at lower part of joint
- translation of disc relative to temporal bone, upper part of joint
- rotation occurs first, then translation adds additional opening
CLOSING = reverse
Differential Diagnosis
Specific pathology - fracture, dislocation
Arthrogenic problems - (joint)
- mobility - too stiff, hypermobile, degenerative
- control - disc displacement issues, insufficient muscle control
Myogenic Problems - nociception
- increased sensitivity secondary to arthrogenic pain problem
Contributing Factors
Neuromodulatory changes - increased sensitivity
Dental occlusal issues - doesn’t close properly/teeth impact, changes forces through the TMJ
Hyoids - inextensibility of hyoid muscles, means have to work harder to keep mouth closed
Cervical spine abnormal mechanics/function
thoracic spine
General/Lifestyle
- consider what they do for work
- eating habits
- what they eat
Psychological
- stress? teeth grinding, jaw clenching
History
Clear localised pain
Clicking - elongation of disc, mandible has to slide over posterior band to return to sitting in intermediate band, results in click
Locking - closed - can’t resit in band, open - subluxed joint
Jaw clenching
Teeth grinding
dental work - sit with mouth open for extended perior
Recent trauma/surgery
stress
Physical Exam
thorough exam of cervical spine - could be referring pain - could be contributing to TMJ dysfunction are they able to disocciate the TMJ and the UCS assess tx and scapule function occlusal problems neuromodulatory dysfunction - allodynia? muscle palpation neural tissue function and sensitivity
Management - Psychological Factors
address any stress
provide clear explanation
provide clear plan
Management - general
look at occlusion eating habits work posture yawning?
Management - Local
Optimise mobility
- open without translation - can block mandible with hands
- want balanced lateral movement to either side
Optimise muscle function
- Gold Fish - tongue to roof of mouth, open and close mouth, prevents translation
- train controlled lateral movement
- train UCS and TMJ disocciation
Management - remote function
Address cervical, thoracic spine and scapula mechanics
