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Oral anatomy and histology > test 2 > Flashcards

test 2 Flashcards

1
Q

Classification of muscle tissue

A

Skeletal - voluntary

Smooth - involuntary

Cardiac - Involuntary

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2
Q

what is the difference between voluntary and involuntary muscles

A

voluntary - we control it

involuntary - not consciously controlled, body controls it

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3
Q

Why do we study the muscles 3

A

Extra oral patient exams

Distinguish normal/abnormal

Understand source of muscle pain/loss of function

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4
Q

define origin and insertion

A

origin: Part of the muscle that does not move

insertion: attached to the more moveable structure

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5
Q

define belly

A

thicker, middle region of muscle between origin and insertion; located between 2 ends

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6
Q

define innervation

A

the supply of nerves to a specific body part; one to one relationship

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7
Q

what are the muscle groups

A

-Cervical muscles

-Muscles of facial expression

-Muscles of mastication

-Hyoid muscles (Suprahyoids and infrahyoids)

-Muscles of the tongue (Extrinsic and intrinsic muscles)

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8
Q

what are the clinical considerations for occlusal trauma 2

A

abfraction: loss of tooth structure at the cervical area (where tooth and gum meet)

attrition: gradual wear and loss of tooth structure due to the mechanical forces of chewing and grinding (tooth to tooth contact)

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9
Q

what are the cervical muscles

A

sternocleidomastoid and trapezius

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10
Q

sternocleidomastoid

origin

insertion

bellies

action

A

origin- clavicle and sternum

insertion- mastoid process of temporal and occipital bone

bellies- none

action- bends head to the side that contracts, flexes neck when both contract

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11
Q

trapezius

origin

insertion

bellies

action

A

origin - external surface of occipital bone; midline of cervical and thoracic regions

insertion - clavicle and scapula

bellies - none

action - lift clavicle and scapula when shoulders are shrugged

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12
Q

clinical considerations of cervical muscles 5

A
  • muscle malfunction may cause head to move to one side or the other
  • may not be able to raise chin during treatment
  • may not be able to sit in ergonomically correct position
  • usually from acute trauma such as vehicle/sport accidents or chronic stress via movement
  • possibly related with headaches in lower skull region
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13
Q

describe muscles of facial expression

A
  • paired
  • all origins originate from surface of the skull bone (rarely the fascia)
  • all insert on dermis of the skin
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14
Q

clinical considerations for muscles of facial expression

A
  • Facial paralysis: damage to CNVII; inhibits muscle movement on the side of nerve damage; loss of voluntary muscle action; temporary or permanent; can occur with stroke, bell palsy, or parotid salivary gland cancer; twitching/spasms/weakness may resolve over time
  • facial nerve within the parotid salivary gland can become anesthetized with an incorrectly administered inferior alveolar mandibular block leading to transient facial paralysis
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15
Q

epicranial muscle

origin

insertion

bellies

action

expression

A

origin - frontal belly originates at epicranial aponeurosis; occipital belly originates at occipital and temporal bones

insertion - frontal belly inserts at the eyebrow and root of the nose; occipital belly inserts at the epicranial aponeurosis

bellies - 2: frontal and occipital bellies separated by the epicranial aponeurosis

action - raise the eyebrows and scalp; the two bellies can act independently from eachother

expression - surprise

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16
Q

orbicularis oculi muscle

origin

insertion

bellies

action

expression

A

origin - orbital rim, frontal bone, and maxilla

insertion - lateral canthus

bellies - none

action - closes the eyelid, squints (crows feet)

expression - closing eye/ squint

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17
Q

orbicularis oris

origin

insertion

bellies

action/expression

A

origin - facial modiolus

insertion - labial commissure > diffusely in lip/nose; upper lip

bellies - none

action/expression - closing/pursing lips; pouting; grimacing; speech; press; tighten/thin; roll inward; thrust outward

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18
Q

buccinator

origin

insertion

bellies

action

A

origin - maxilla, mandible, pterygomandibular raphe

insertion - labial commissure (facial modiolus)

bellies - none

action/expression - compresses cheeks during chewing; pulls labial commissure laterally; shortens cheek vertically and horizontally; assists muscles of mastication

*pierced by parotid duct

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19
Q

risorius

origin

insertion

bellies

action

A

origin - fascia superficial to masseter muscle

insertion - labial commissure at facial modiolus

bellies - none

action/expression - stretches lips; widens mouth; stretches labial commissure laterally; grimace

*often underdeveloped, connected with platysma that stretches with it

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20
Q

levator labii superioris

origin

insertion

bellies

action

A

origin - maxilla

insertion - labial commissure of upper lip

bellies - none

action/expression - raises upper lip

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21
Q

levator labii superioris alaeque nasi

A

origin - maxilla

insertion - ala of nose; upper lip

bellies - none

action - raising upper lip and dilating/raises ala/nares with sneer/snarl

*Elvis muscle

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22
Q

zygomaticus major

A

origin - zygomatic bone

insertion - labial commissure

bellies - none

action/expression - smiling; elevates labial commissure laterally

*lateral to zygomaticus minor; genuine happiness is expressed when this muscles contracts WITH the orbicularis oculi

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23
Q

zygomaticus minor

A

origin - zygomatic bone

insertion - upper lip

bellies - none

action/expression - raising upper lip to assist in smile

*adjacent to insertion of levator labii superioris

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24
Q

levator anguli oris

A

origin - maxilla (canine fossa)

insertion - labial commissure

bellies

action/expression - assist in smiling, raises labial commissure

  • deep to zygomaticus major and minor; connects with zygomaticus major, depressor anguli oris and orbicularis oris
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25
Q

depressor anguli oris

A

origin- inferior border of mandible

insertion - labial commissure

bellies - none

action/expression - frowning, lowers labial commissure

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26
Q

depressor labii inferioris

A

origin - inferior border of mandible

insertion - lower lip

bellies - none

action/expression - depresses lower lip; exposes canines

*deep to depressor anguli oris

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27
Q

mentalis

A

origin - mandible

insertion - chin

bellies

action/expression - raises chin, protrudes lower lip, “peach pit dimple”

*could dislodge a complete lower denture in an edentulous patient who lost alveolar process height

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28
Q

platysma

A

origin - clavicle; shoulder

insertion - mandible; muscles of mouth; facial modiolus

bellies

action/expression - raises neck skin; assist in grimace by pulling labial commissures down; horror/disgust

  • creates platysma bands with age (turkey neck)
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29
Q

corrugator supercilii muscle

origin

insertion

bellies

action

expression

A

origin - supraorbital region of frontal bone

insertion - skin above the eyebrow

bellies - none

action - draws eyebrow inferiorly and medially

expression - anger/frowning

  • chemodenervation to alleviate glabellar/frown lines (botox)
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30
Q

describe the muscles of mastication 6

A
  • four paired muscles
  • deep to muscles of facial expression
  • all connect to the mandible at some point
  • masseter, temporalis, medial and lateral pterygoid muscles
  • may be involved w pathology associated with TMJ
  • embryonic derivatives of first branchial/mandibular arch
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31
Q

masseter

origin

insertion

bellies

action

clinical consideration

A

origin - zygomatic arch

insertion - angle and ramus of mandible

bellies/heads - 2 heads, superficial and deep head

action - during bilateral contraction it elevates the mandible

masseteric hypertrophy

*most powerful and superficial muscle of mastication

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32
Q

what is masseteric hypertrophy 6

A
  • enlargement of masseter muscle
  • caused by clenching/grinding/bruxism/gum chewing
  • asymptomatic, slightly firm when palpated
  • usually bilateral, can be unilateral
  • may be confused with dental infections and other diseases; however no symptoms of tenderness or pain are present
  • may be associated with TMJ pathology
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33
Q

temporalis

origin

insertion

bellies

action

A

origin - temporal fossa

insertion - coronoid process of the mandible ramus

bellies - none

action - maintains mandible in rest position, allows freeway space, bilateral contraction of entire muscle raises mandible; bilateral contraction of posterior portion retracts/retrudes mandible

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34
Q

medial pterygoid

origin

insertion

bellies

action

A

origin - Deep head: medial side of lateral pterygoid plate and pterygoid fossa of sphenoid Superficial head: maxillary tuberosity and palatine bone

insertion - both onto medial surface of mandibular angle/ramus

bellies - 2 heads

action - bilateral contraction elevates mandible

*works with masseter

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35
Q

lateral pterygoid

origin

insertion

bellies

action

A

origin - superior head: infratemporal crest of greater wing of sphenoid bone. inferior head: lateral side of lateral pterygoid plate

insertion - anterior surface of neck of mandibular condyle

bellies - none

action - unilateral contraction shifts mandible to opposite side (lateral deviation); bilateral contraction protrudes* mandible forward and depresses* when opening

*fills in temporal fossa

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36
Q

what are the suprahyoid muscles

A

digastric

mylohyoid

stylohyoid

geniohyoid

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37
Q

what are the infrahyoid muscles

A

omohyoid

sternohyoid

sternothyroid

thyrohyoid

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38
Q

what is the action of the suprahyoids

A
  • elevate the hyoid and larynx
  • occurs during swallowing
  • contraction of anterior suprahyoids depresses the mandible
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39
Q

what muscles are apart of the anterior group for suprahyoids

A

digastric (anterior belly)
mylohyoid
geniohyoid

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40
Q

what muscles are apart of the posterior group for suprahyoids

A

digastric (posterior belly)
stylohyoid

41
Q

digastric muscle

origin

insertion

bellies

action

anterior or posterior/ supra or infra

A

origin - anterior belly: intermediate tendon. posterior belly: mastoid notch of temporal bone

insertion - anterior belly: digastric fossa (medial surface of mandible). posterior belly: intermediate tendon

bellies: anterior and posterior

action: elevates hyoid bone or depresses mandible

both; anterior belly and posterior belly; suprahyoid

42
Q

mylohyoid muscle

origin

insertion

bellies

action

anterior or posterior/ supra or infra

A

origin - mylohyoid line (medial surface of mandible)

insertion - mylohyoid raphe and body of hyoid bone

bellies - none

action - elevates hyoid, depresses mandible, forms floor of mouth and elevates tongue

anterior; suprahyoid

43
Q

stylohyoid muscle

origin

insertion

bellies

action

anterior or posterior/ supra or infra

A

origin - styloid process

insertion - body of the hyoid bone

bellies - none

action - elevates and retracts hyoid bone

posterior; supra

44
Q

geniohyoid muscle

origin

insertion

bellies

action

anterior/posterior; supra/infra

A

origin - genial tubercles

insertion - body of hyoid bone

bellies - none

action - elevates or protrudes hyoid bone; depresses the mandible

anterior; supra

45
Q

general description of the infrahyoid muscles

A
  • 4 paired muscles
  • inferior to hyoid
  • depress hyoid bone
46
Q

omohyoid

origin

insertion

bellies

action

supra or infra

A

origin - inferior belly: scapula. superior belly: short tendon attached to inferior belly

insertion - inferior belly: short tendon to superior belly. Superior belly: lateral border of hyoid bone

bellies - superior and inferior belly

action - depresses hyoid bone

infra

47
Q

sternohyoid muscle

origin

insertion

bellies

action

supra or infra

A

origin - sternum and clavicle

insertion - body of hyoid bone

bellies - none

action - depresses hyoid bone

infra

48
Q

sternothyroid muscle

origin

insertion

bellies

action

supra or infra

A

origin - sternum and first rib

insertion - thyroid cartilage

bellies - none

action - depresses thyroid cartilage and larynx (doesn’t directly depress hyoid bone)

infra

*only hyoid muscle that doesn’t connect to hyoid bone

49
Q

thyrohyoid muscle

origin

insertion

bellies

action

supra or infra

A

origin - thyroid cartilage

insertion - body and greater cornu of hyoid

bellies - none

action - depresses hyoid, raises thyroid and larynx

infra

50
Q

what are the intrinsic muscles of the tongue

A

located entirely inside the tongue

superior longitudinal (most superficial); transverse; vertical; inferior longitudinal (close to ventral surface)

51
Q

superior longitudinal muscle

origin/ insertion

action

direction of muscle

A

origin/insertion - n/a (inside the tongue)

action - curls tongue superiorly; shortens and thickens tongue; works w inferior long. muscle

direction of muscle - runs oblique and longitudinal on the dorsal surface from base to apex

52
Q

transverse muscle

origin/ insertion

action

direction of muscle

A

origin/ insertion - n/a (inside the tongue)

action - narrows and elongates tongue

direction of muscle - transverse direction from median septum outwardly toward lateral surface of tongue

53
Q

vertical muscle

origin/ insertion

action

direction of muscle

A

origin/ insertion - n/a (inside the tongue)

action - flattens and broadens the tongue or both lengthens and narrows the tongue

direction of muscle - runs from dorsal surface to ventral surface of tongue body

54
Q

inferior longitudinal muscle

origin/ insertion

action

direction of muscle

A

origin/ insertion - n/a (inside the tongue)

action - curls the tongue superiorly or both shortens and thickens the tongue (works with superior)

direction of muscle - runs in a longitudinal direction on the ventral surface from base to apex

55
Q

what is the medium septum

A
  • also called lingual septum
  • vertical layer of fibrous tissue
  • extends through entire length of median plane of tongue
  • deep to the superficial median sulcus (learned in surface anatomy)
56
Q

what are the extrinsic tongue muscles

A

styloglossus
genioglossus
hyoglossus

57
Q

styloglossus muscle

origin

insertion

action

A

origin - styloid process of temporal bone

insertion - tongue

action - retracts tongue

58
Q

genioglossus muscle

origin

insertion

action

A

origin - genial tubercles (medial surface of mandible)

insertion - hyoid bone and tongue

action - protrudes tongue and depresses parts of it

59
Q

hyoglossus

origin

insertion

action

A

origin - greater cornu and body of hyoid bone

insertion - tongue

action - depresses tongue

60
Q

clinical considerations with impaired muscles

A
  • impairment of all these muscles can alter dental treatment because they are involved in speech and swallowing
  • strokes on the left side of the brain impact muscles on the right side and vice versa
  • dysphagia, mouth droop
  • may need extra dental suctioning to prevent choking
  • active tongues may need a mouth prop or relaxant
  • patience and adaptability are key factors
61
Q

what is dysphagia

A

difficultly swallowing

62
Q

what is mouth droop

A

inability to close the mouth

63
Q

which cranial nerve innervates the TMJ

A

mandibular branch of the trigeminal nerve (CN V)

cranial nerve five

64
Q

define joint

where is the TMJ located generally

what are the articulations of the TMJ (general)

what nerve innervates it

A

joint- site of junction/union between TWO BONES

both sides of the head

mandibular condyle articulates with temporal bone

trigeminal nerve (mandibular branch)

65
Q

what does the articulating portion of the temporal bone include 3

A
  • articular eminence: smooth rounded ridge that is ramp shaped
  • articular fossa: (glenoid fossa) posterior to articular eminence; oval shaped depression (actually articulating
  • post glenoid process: posterior to articular fossa
66
Q

direction of the condyle

A

strongly convex anteroposteriorly; slightly convex mediolaterally

67
Q

describe the joint capsule 3

A
  • fibrous joint capsule completely encloses the TMJ
  • Superiorly: wraps around the temporal bone’s articular eminence and articular fossa
  • Inferiorly: wraps around the mandibular condyle and neck
68
Q

describe the joint disc (6)

A
  • Located between the temporal bone and mandibular condyle; allowing articulation
  • attached to the lateral and medial poles of the mandibular condyle; not free; indirectly attached to the temporal bone through the capsule
  • shape conforms to adjacent articulating bones
  • Divides the TMJ into 2 synovial cavities; both lined with membranes that produce clear viscous synovial fluid (upper and lower division)
  • Disc can develop calcifications, be dislocated forward by injury to the posterior attachment, or can become thin/perforated during aging
  • attached to post glenoid process in upper division and neck of the condyle in lower division by an ELASTIC LAMINA
69
Q

what are the two areas/divisions of the joint disc 3

A
  • Upper Division of the posterior part of the disc: attached to the temporal bone at the post-glenoid process
  • Lower division of posterior part: attached at the neck of the condyle; where nerves and blood vessels enter the joint
  • disc blends with the capsule at these points
  • attached by elastic lamina
70
Q

the ______ is vascularized and innervated

the _____ area of the disc is avascular

A

periphery; central

71
Q

define ligament

A

band of fibrous tissue that connects bones

72
Q

what 3 ligaments are associated with the TMJ

A
  • temporomandibular ligament *
  • stylomandibular ligament
  • sphenomandibular ligament
73
Q

describe the temporomandibular ligament 4

A

-formed on lateral side of each TMJ forming a reinforcement of the lateral part of the joint capsule

-base attached to the zygomatic process of temporal bone

-apex attached to the lateral side of the neck of the condyle

-prevents excessive retraction or backward movement of the mandible

74
Q

describe stylomandibular ligament 3

A

-runs from the styloid process of the temporal bone to the angle of the mandible

-separates the parotid and submandibular salivary glands. don’t remember this

-becomes tight when the mandible is protruded

75
Q

describe the sphenomandibular ligament 4

A

-long band on the medial surface of the mandible runs from the angular spine of the sphenoid bone to the lingula which is near where the inferior alveolar nerve enters the medial aspect of the body of the mandible

-although not part of the TMJ it becomes tight when the mandible is protruded

*-is a landmark used for the inferior alveolar nerve block which anesthetizes the mandibular teeth

*- if not penetrated during the injection, it may prevent anesthesia

76
Q

what are the two basic movements of the TMJ

A

1.Gliding
- Allows the jaw to protrude (go forward) and retract (go backward)
- Aids in depression of the mandible (opening) and elevation of the mandible (closing)
- Aids in lateral movements
- occurs between disc and articular eminence in upper synovial cavity

2.Rotating-
- Aids opening and closing (depression&protrusion/elevation&retraction)
- Aids in lateral movements
- (chewing)
- occurs between disc and condyle in lower synovial cavity

77
Q

what muscles are responsible for protrusion and retraction in terms of “gliding”

A

Protrusion- bilateral contraction of lateral pterygoids

Retraction- bilateral posterior portions of the temporalis muscles

78
Q

combination of gliding and rotation allows____

A
  • opening, closing, and lateral movements
  • opening: depression and protrusion
  • closing: elevation and retraction
79
Q

lateral deviation: unilateral TMJ movement

A
  • Involves gliding and rotational movements
  • One disc/condyle glides forward and medially on the articular eminence in the upper synovial cavity while the other disc on the opposite side remains stable
  • Move jaw to left, right lateral pterygoid moves the right condyle/disc forward while the left side remains stable
  • Causing rotation around the stable joint
80
Q

anterior suprahyoid muscles are involved in _________ the mandible

A

depressing the mandible when they bilaterally contract

81
Q

protrusion of the mandible moving forward

  1. what temporomandibular joint movements are involved
  2. what are the associated muscles
A
  • gliding in both upper synovial cavities
  • lateral pterygoid with bilateral contraction
82
Q

retraction of mandible moving backward

  1. what temporomandibular joint movements are involved
  2. what are the associated muscles
A
  • gliding in both upper synovial cavities
  • posterior part of temporalis and/or suprahyoids with bilateral contraction
83
Q

elevation and retraction; closing jaw

  1. what temporomandibular joint movements are involved
  2. what are the associated muscles
A
  • gliding in both upper synovial cavities with rotation in both lower synovial cavities
  • masseter, temporalis, medial pterygoid with bilateral contraction
84
Q

depression and protrusion of mandible; open jaw

  1. what temporomandibular joint movements are involved
  2. what are the associated muscles
A
  • gliding in both upper synovial cavities with rotation in both lower synovial cavities
  • suprahyoids and lateral pterygoid with bilateral contraction
85
Q

lateral deviation of mandible; shifting to one side

  1. what temporomandibular joint movements are involved
  2. what are the associated muscles
A
  • gliding in one upper synovial cavity while the condyle and disc of other side spin around approx. vertical axis within upper synovial cavity
  • lateral pterygoid with unilateral contraction
86
Q

rest position of the mandible

A
  • interocclusal clearance/ freeway space
  • 2-4 mm between opposing teeth
  • joint disc is in upper most posterior portion of articular fossa
  • resting is not with the teeth biting together
87
Q

palpation of TMJ

A
  • feel anterior to EAM bilaterally
  • patient should open and close while feeling
  • patient should move laterally left/right w jaw
  • repeat with fingers IN the EAM bilaterally
88
Q

clinical considerations with TMJ

A

temporomandibular disorder
sublaxation > lock jaw
trismus > reduced opening of the jaw

89
Q

what is TMD 4

A
  • can be cause by 30 different conditions
  • 2x more common in women (ages 35-44) textbook says 20-40 years of age
  • can be seen alone or in combination with other disorders such as sleep dysfunction, chronic headaches, and irritable bowel diseases
  • 11-12 million adults experience pain in that region
90
Q

what are the 3 main categories of TMD disorders, explain them

A

1.Myofascial Pain
- the most common disorder

  1. Internal Derangement of the Joint
    - Displaced Disc
    - Dislocated Jaw
    - Injury to the condyle
  2. Arthritis-degenerative/inflammatory disorders
    - can include osteo or rheumatoid arthritis
91
Q

t/f just because you have jaw clicking doesnt mean you have TMD

A

true: 40-60% of people experience jaw clicking/popping without TMD

92
Q

TMD causes

A

Trauma:
- Macrotrauma- car accident or injury
- Microtrauma- parafunctional habits like bruxism (more common)

Disease:
Osteoarthritis

93
Q

what is subluxation (slides)

A
  • can occur in some patients when they open too wide and are stuck open
  • Due to the head of the condyle moving too far anteriorly on the articular eminence
  • Can be treated by carefully moving the
    mandible downward and backward
    *lock jaw
94
Q

what is limited opening

A
  • TMD produces a limited opening of the mandible and
    make treatment very challenging
  • Patients with a history of TMD may require the use of a bite block to gently hold the mandible open during
    appointments
  • Limit appointment times with patients who have a history of TMD
95
Q

symptoms of TMD

A
  • Radiating pain in face , neck, or jaws
  • Jaw muscle stiffness
  • Limited opening or locking of jaw
  • Painful clicking , popping or grating in the joint when
    opening or closing
  • Change in bite: Research does not support the belief that a bad bite or orthodontic braces cause TMDs.
96
Q

assessment of TMD

A

physical assessment (questionaire) > then Psychosocial assessment (assesses their pain)

97
Q

conservative/reversible TMD treatments

A
  • Soft foods/Ice pack
  • Avoid yawning, gum chewing or loud yelling
  • Stretching exercises
  • Stress reduction- Psychological Therapy
  • Behavior modification- biofeedback, meditation
  • Exercise and Diet modification-decrease caffeine and nicotine before bedtime
  • Stabilization splints—rigid not soft splint to prevent tooth destruction
  • Splints used primarily to prevent destruction of tooth
    structure > still should address underlying causes
  • Physical therapy and exercise-stretching and posture
  • Therapeutic Injections/Acupuncture- Trigger Point injection
  • Pharmacologic Therapy –NSAIDS, tricyclics and SSRIs, muscle relaxants
98
Q

Irreversible Procedures for TMD

A

Joint Surgery- usually as a last resort

Botox-does not help with TMD

Oral anatomy and histology (14 decks)

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