TMD

Question 1

what artery supplies the TMJ area

Answer 1

great auricular artery
(branch of 1st part of maxillary artery)

Question 2

what nerves supply the TMJ area

Answer 2

auriculotemporal, masseteric, posterior (deep) temporal

Question 3

why may patients complain of earache when infact they have TMD

Answer 3

auriculotemporal nerve provides somatosensory innervation to the posterior TMJ and the external auditory meatus

Question 4

what are the 4 suprahyoids

Answer 4

geniohyoid
mylohyoid
stylohyoid
digastric

Question 5

what are the 4 infrahyoids

Answer 5

thyrohyoid
sternohyoid
sternothyroid
omohyoid

Question 6

discuss the posterior regio of the articular disc

Answer 6

only innervated part of the articular disc
Also known as bilaminar zone or retrodiscal tissue

Question 7

what separates the upper and lower tempero mandibular joint cavities

Answer 7

articular disc

Question 8

discuss pterygoideus externus

Answer 8

its the insertion of the lateral pterygoid which goes partly into condyle and partly into articular disc

Question 9

name 5 potential causes of TMD

Answer 9

• myofascial pain - problems relating to muscles and fascia
• disc displacement
• degenerative disease - arthritis
• chronic recurrent disclocation
• ankylosis (condyle diffuse to base of skull - rare)
• hyperplasia (one condyle larger than the other)
• neoplasia - rare in TMJ area
• infection - rare

Question 10

what degenerative diseases may cause TMD

Answer 10

localised disease - osteoarthritis
systemic - rheumatoid

Question 11

discuss anterior disc displacement with and without reduction

Answer 11

with reduction - disc able to slip back to its proper position at some point (reduce back)
without reduction - disc permanently stuck in front of condyle

Question 12

Name four aetiological factors for myofascial pain

Answer 12

• inflammation of MOM or TMJ secondary to parafunctional habits
  Trauma - either direct to joint or indirectly e.g sustained opening during dental treatment
  Stress - tense muscles and clenching
  Psychogenic
  Occlusal abnormalities - limited evidence supporting this

Question 13

why is social history particularly important when investigating TMD

Answer 13

may identify cause for stress or habit/ hobby putting extra strain on MOM
should enquire about occupation, home circumstances, sleeping pattern, recent bereavement, relationships, habits, hobbies
Anything that causes a patient to repeatedly bring their teeth together can contribute to TMD

Question 14

where is mouth opening measured

Answer 14

incisor edges
use willis bite gauge

Question 15

name 3 intra oral signs of parafunctional habits

Answer 15

linea alba
tongue scalloping
attrition

Question 16

what special investigations may be done if pathology of TMJ suspected

Answer 16

CBCT
MRI
arthrography
ultrasound

Question 17

what demographic does TMD most commonly affect

Answer 17

females ages 18-30

Question 18

name 3 common clinical features of TMD

Answer 18

intermittent pain for several months or years
muscle, joint or ear pain - particularly when wakening due to overnight clenching
trismus
clicking/ popping joint
headaches - pain from temporalis
crepitus - indicates late degenerative changes

Question 19

name 4 examples of possible differential diagnoses of TMD

Answer 19

sinusitis
dental pain
ear pathology
salivary gland pathology (parotid in close proximity)
headache
atypical facial pain
trigeminal neuralgia
temporal arteritis
angina (small portion of skin near joint supplied by same nerve as heart)
condylar fractures

Question 20

name 4 reversible treatments of TMD

Answer 20

patient education
medications
physical therapy
splints

Question 21

name 2 irreversible treatments of TMD

Answer 21

occlusal adjustment (no evidence of benefit)
TMJ surgery

Question 22

what does patient education for TMD involve

Answer 22

counselling - reassurance, soft diet, no wide opening, no chewing gum, masticate bilaterally, stop parafunctional habits

Question 23

name 3 medications that may be given for TMD

Answer 23

NSAIDS (ibuprofen,naproxen)
muscle relaxants (cyclobenzaprine)
tricyclic antidepressants (amitriptyline)
botox (massetter)
steroid injections

Question 24

name 3 examples of physical therapy for TMD

Answer 24

massage
heat
acupuncture
relaxation
hypnotherapy
TENS (transcutaneous electronic nerve stimulation)

Question 25

what is the theory behind using a splint for TMD

Answer 25

‘bite raising appliances)
stabilise occlusion and improve function of MOMs therefore decreasing abnormal activitty
also protect the teeth during grinding

Question 26

name 2 examples of splints that may be used in treating TMD

Answer 26

hard splint
soft splint
michigan splint

Question 27

internal derangement of TMJ

Answer 27

disc displacement

Question 28

what is the anatomical cause of a painful clicking TMJ

Answer 28

disc slipping (reducing) back to correct location over the condylar head

Question 29

signs and symptoms of disc displacement with reduction

Answer 29

clicking TMJ
jaw tightness/ locking
initial deviation of mandible

Question 30

treatment for disc displacement with reduction

Answer 30

if painless, no treatment required, give reassurance
limiting mouth opening
counselling
bite raising appliance (splint)
surgery very occasionally required

Question 31

most likely pathology causing trismus post trauma

Answer 31

haematoma in medial pterygoid

Question 32

what equipment may be used to aid mouth opening in a patient experiencing trismus

Answer 32

jaw screws
stacking wooden sticks
therabite