(Test #1) TMJ Dysfunction Syndrome Lecture Flashcards
Anatomy of the Joint
• ONLY SYNOVIAL JOINT in Cranium!!!!!!
- Mandible condyle is BI-CONVEX!!!!!
- Temporal bone portion is SADDLE SHAPED!!!!
• Meniscus helps stabilize:
– Translates anteriorly during depression of mandible
– Innervated at PERIPHERY
– aneural and AVASCULAR at force bearing zones
Muscles of the Mouth
• BUCCINATOR
‐ approximates lips and compresses cheeks (blowing)
• DEPRESSOR LABII INFERIOR
‐ protrudes lower lip (pouting)
• DEPRESSOR ANGULI ORIS and PLATYSMA ‐ draw corner of mouth down
• MENTALIS:
‐ draws tip of chin upward
• ORBICULARIS ORIS:
‐ approximates and compresses lips
- “Kiss Face”
• ZYGOMATIC MINOR:
‐ protrudes upper lip
- “Duck Face”
• LEVATOR ANGULI ORIS:
‐ lifts upper border of lip on one side without raising lateral angle (snarl)
• ZYGOMATICUS MAJOR:
‐ Raises lateral angle of mouth (smile)
•RISORIUS:
‐ Approximates lips and draws lips and draws corners lateral (grimace)
Intracapsular vs Extracapsular
INTRACAPSULAR: • Infection • RA • OA • Gout • metastatic CA • articular disc displacements
EXTRACAPSULAR:
• (TMJ myofascial pain syndrome, TMJ dysfunc. synd, TMJ syndrome)
• NIH Preferred terminology:
– TMJD
i) Temporomandibular muscle and joint disorder
Etiology
1) TRAUMA:
• Direct, or by whiplash injury
• If direct blow with closed mouth, posterior capsule injury
2) MALOCCLUSIONS: Deviation from nl contact of maxillary & mandibular teeth
• Class1: 1st molars NORMAL, prob 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)
Etiology Cont
1) MUSCLE STRAIN:
– oral habits (tobacco, gum, etc)
– postural/work related (singers, phone operators, musicians)
– sports (trauma, mouthguard)
2) MUSCULOSKELETAL PROBLEMS:
- Developmental abnormalities
i) Condylar hypoplasia/agenesis
- Somatic Dysfunction
i) Temporal bone dysfunction
ii) Compensatory changes
iii) Short leg syndrome, scoliosis, etc.
3) MOOD DISORDERS:
- Anxiety
- Depression
- Post‐traumatic stress disorder
- History of abuse
Epidemiology
1) Affects about 20% of American population
• > common in young women
• #2 cause of facial pain (HA = #1)
2) More recent data suggest a 12‐15% prevalence, with 5% seeking tx due to pain/disability
3) Pts w/ RHEUMATOID ARTHRITIS (RA)
– more likely to develop temporomandibular pain
– prevalence of TMD in patients with RA ranges from 53 % to 94 %
– 1 observational study, individuals with more severe RA (erythrocyte sedimentation rate ≥32.08 mm/hour) at increased risk for TMD.
Symptoms
Unilateral Pain
UNILATERAL PAIN: – Cephalgia ‐ misdiagnosed as migraines – Otalgia – Neck pain – Eye pain – Shoulder and back pain
Most Common Signs and Symptoms
- Pain (96.1 %)
- Ear discomfort or dysfunction (82.4 %)
- Headache (79.3 %)
- TMJ discomfort or dysfunction (75.0 %)
Symptoms
- Pt may c/o cephalgia, and mention jaw problems, or not mention jaw props
- May describe as a dull ache – worse with chewing
- Tinnitus
- Difficulty opening mouth
• Click,CREPTANS
‐jaw click usually present w disc displacement, but by itself non‐diagnostic
- Lateral deviation of jaw
- Spasm within facial muscles
- Onset of sx may correspond with onset of stress
Other Symptoms
- Neck pain — trauma, bad posture, and musculoskeletal tension in cervical area
- Eye pain — Orbital/periorbital pain often described as unilateral, constant, and “boring”
- Arm/back pain —shoulder pain that radiates down arm +/‐ tingling or numbness
- Dizziness — associated with ear pain and stuffiness or cervical muscle strain and tension
Nocturnal Bruxism
• 78 % of pts had tooth grinding
Jaw Clenching
- Often due to anxiety and psychosocial stress
- Does not interfere w/tx in most cases, although a severely disturbed capacity for interpersonal relationships assoc with poor prognosis
Types of TMJ Dysfunction
- Opening click
- Closing click (reciprocal clicking)
- Inability to fully open jaw (close‐locked)
- Inability to close ‐ if bilateral
- Crepitus and grating
- Fusion of the joint (ankylosis)
Causes of Click
• Almost always due to disc displacement
– after disc thin/stretched
- Adhesions
- Uncoordinated muscle action of pterygoids
- Tear or perforation of disc
• Osteoarthritis
– more likely to have crepitans
• Occlusional imbalance (lesslikely)
Evaluation
1) Palpate joints for crepitans/clicks
2) Palpate ms of mastication (2‐3 lbs pressure)
- 1 side may be tender v other
3) Range of Motion
– Active ‐ pt opens mouth 3‐6 cm, laterally 1‐2 cm, and then retracts and protrudes mandible
– Observe jaw movements for deviation
4) Passive ROM
‐w/ gloves, move pt’s jaw medially and laterally:
i) Compare ROM on both sides
‐ Feel muscles inside mouth
i) check for TTA
