Question 1

Describe temporomandibular disorders (TMD)

Accepted Answer

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

Question 2

Describe TMD epidemiology

Accepted Answer

- Common cause of pain - Annual average incidence 4% - Prevalence 10-15% - F > M - Peak incidence 18 to 44 years of age

Question 3

TMD aetiology continued

Accepted Answer

Multifactorial - Biological - Psychological - Behavioural Biopsychosocial

Question 4

Describe TMJ examination

Accepted Answer

palpate just in front of ear (where the jaw clicks) - Palpate lateral pole Does palpation elicit the patient's familiar pain? 3 repetitions each of opening, closing, lateral, protrusive movements - Any noises palpable? - Any noises audible to the patient?

Question 5

describe TMD palpation of muscles (temporalis and masseter)

Accepted Answer

- Does palpation elicit the patient's familiar pain? (Temporalis) - palpate when teeth clenched above the ear and forwards above the eye (masseter) - Bimanual palpation (two fingers inside the mouth pressing cheek other two fingers pressing outer cheek

Question 6

describe TMD mouth opening

Accepted Answer

- deviation on opening - extent of opening - unassisted and assisted 40mm including incisal overlap

Question 7

describe TMD (Intra-oral) soft tissues

Accepted Answer

- Ridging buccal mucosa at level of occlusal plane - Scalloping of borders of tongue - Tooth wear

Question 8

What are the TMD investigations?

Accepted Answer

- Plain radiographs not normally indicated - Cone Beam Computed Tomography (CBCT) - Magnetic Resonance Imaging (MRI)

Question 9

Describe TMD diagnosis

Accepted Answer

- Pain related TMDs Myalgia: - Local myalgia - Myofascial pain - myofascial pain with referral Arthralgia - Headache related TMD - Intra-articular TMDs Disc displacement with reduction disc displacement with reduction with intermittent locking Disc displacement without reduction with limited opening Disc displacement without reduction without limited opening Degenerative joint disease Subluxation

Question 10

TMD - Myalgia

Accepted Answer

Description: Pain of muscle origin, affected by jaw movement, function or parafunction Replication of this pain on provocation testing of the masticatory muscles History: Pain in jaw, temple, in front of the ear or in the ear and Modified with jaw movement, function or parafunction Examination: Confirmation of pain location (s) in the temporalis or masseter muscle and familiar pain in masseter or temporalis muscle with at least one of the following provocation tests: palpation of temporalis or masseter muscle or maximum unassisted or assisted opening movements

Question 11

What are the subtypes of myalgia

Accepted Answer

- Local Myalgia - Myofascial pain - Myofascial pain with referral

Question 12

TMD - Arthralgia

Accepted Answer

Description Pain of joint origin affected by jaw movement, function or parafunction and replicated by provocation testing of the TMJ History Pain in the jaw, temple, ear or in front of the ear in the past month AND Pain modified with jaw movement, function and parafunction On examination: Confirmation of pain location in area of TMJ (s) and familiar pain: on palpation of lateral pole or on maximum unassisted or assisted opening, right or left lateral or protrusive movements

Question 13

TMD - disc displacement with reduction

Accepted Answer

description: Intracapsular biomechanical disorder involving the condyle-disc complex. In the closed mouth position the disc is in an anterior position relative to the condylar head and the disc reduces on mouth opening. Clicking, popping snapping noises may occur with disc reduction History: History of 'noise' in past 30 days in movement/function or patient report of any noise during examination

Question 14

Continued

Accepted Answer

On examination - clicking popping and or snapping during opening and closing movements on palpation during at least one of three repetitions of jaw opening and closing or clicking popping and or snapping during opening or closing movements on palpation during at least one of three repetitions of jaw opening and clicking popping and or snapping during at least one of three repetitions of left or right lateral or protrusive movements

Question 15

TMD - disc displacement without reduction with limited opening

Accepted Answer

Description the disc does not reduce with opening. Persistent limited mandibular movement which does not reduce when the patient or clinician performs a manoeuvre. Closed lock History Jaw locked so that the mouth would not open all the way Limitations in jaw opening significant to limit jaw opening and interfere with ability to eat Examination Maximum assisted opening (passive stretch movement <40mm including vertical incisal overlap

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Temporomandibular Disorders (TMD) Flashcards

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