TMD Flashcards
Where is the temporomandibular joint?
Anterior to ear tragus
What two bones make up the TMJ?
Temporal and mandible (condyle) bones
What is the disc vascularity?
Avascular except at periphery
What is the function of fibrocartilage?
Shock absorption
stability
Guides motion
What is the disc attached to?
Muscles
capsule
condyle
ligament
What are the joint structures, disc and direct contacting muscles of the TMJ mostly innervated by?
The branches of the trigeminal nerve
What are the 8 areas of trigeminal nerve symptoms?
Ears
Tongue
Eyes
Teeth
Neck
Head
Face
Jaw
What is the capsule attached to?
Muscle
Disc
What does the sphenomandiular ligament prevent? What does it help with?
Excessive opening, recoils for closing
What does the temporomandibular or lateral ligament prevent?
Posterior condyle displacement
What does the temporomandibular or lateral ligament initiate?
Opening
What does the stylomandibular ligament restrain?
NO MOTION RESTRAINT
What is the resting or closed packed position?
Lips closed, teeth not touching and tongue resting on roof of mouth
What amount of overbite is a resting position?
2mm
What is the amount of overjet or overjut beyond overbite in a resting position?
≥ 2mm
What is the closed packed position of the TMJ?
Unknown
What is the function of fibrocartilage?
Shock absorption, stability, guides motion
What is the disc attached to in the TM joint?
Muscles
capsule
condyle
ligament
What is the capsule attached to in the TMJ?
Muscle
Disc
What directions do the mandibular condyles move together in?
The same or different directions
What are the arthrokinematics of the TMJ?
Mandibular Condyle is convex on the concave temporal fossa
What rule do the TMJ arthrokinematics follow?
Kaltenborn’s rule
What do the arthrokinematics of the TMJ allow?
Multiple functions
What is opening the mouth also known as?
Mandibular depression
What is closing the mouth also known as?
Mandibular elevation
What are the Norms with opening of the mouth?
~3 knuckles width
What is an urgent referral with opening of the mouth?
If only ≤ 1 knuckle, refer to a dentist/oral surgeon
What happens with the mandibular condyles when the mouth is opened?
Mandibular condyles glide anterior
What kind of clicking is considered normal upon opening the mouth?
Bilateral clicking
What muscles are used to open the mouth?
Digastric
lateral pterygoid
hyoids
What is the MAIN opener of the mouth?
Digastric
What do the mandibular condyles do upon closing of the mouth?
Glide posterior
What muscles are involved in the closing of the mouth?
Temporalis
Masseter
Medial Pterygoid
Lateral Pterygoid
What muscles are involved with lateral deviation of the TMJ?
Masseter
Pterygoids
Temporalis
What is unique about the pterygoids with lateral deviation of the TMJ?
Same side medial and lateral pterygoids primarily act to move the mandible medial for grinding food
What are the S&S of Temporomandibular disorder regarding oral habit history?
- thumb sucker
- nail / ice biter
- excessive teeth grinder
- gum/ smokeless tobacco chewer
How do we know if someone is an excessive teeth grinder?
Indicated by AM HA that goes away with ADLs
What is the difference between a HA from grinding teeth and a HA from cervical dysfunction?
from grinding teeth goes away with ADLs, with cervical dysfunction likely worse with ADLs
What is normal with sleep?
Some grinding, some sleep stages have it happen
What are S&S we’d find in observation?
FHP
Where would we find pain and crepitis with TMJ?
Localized
What can we look for with observation of opening and closing?
Presence and timing of deviation(s)
What can become sensitive with TMJ?
Trigeminal nerve - possibly
Can hypermobility limit motion?
Yes, if off axis
What is earlier deviation WITHOUT loss of functional opening due to?
Greater laxity with hx of trauma
Will we have pain with earlier deviation without loss of functional opening?
Minimal to no pain unless irritated
What can indicate a hypermobile TMJ with an earlier deviation without loss of functional opening?
Deviation away from unilateral hypermobile TMJ
What does a click at the end range indicate? (me)
Larger displacement
What is end range deviation without loss of functional motion due to?
due to gradual onset from FHP and less laxity/trauma
Will we have pain with end range deviation without loss of functional motion?
Minimal to no pain unless irritated
What will we see with end range deviation without loss of functional motion?
Deviation with bilateral hypermobile TMJ, possibly inconsistent
What does a click at end range indicate with end range deviation without loss of functional motion?
Larger displacement
What is earlier deviation WITH a loss of functional opening due to?
Acute with recent trauma or chronic with fibrotic TMJ
What are the S&S of acute earlier deviation WITH a loss of functional opening?
- Deviation toward painful TMJ
- Limitation due to inflammation/unwillingness to move
What are S&S of chronic TMJ due to earlier deviation WITH a loss of functional opening?
- Deviation toward hypomobile TMJ
- Limitation due to joint hypo-mobility
What does early unilateral clicking upon opening indicate?
Smaller displacement
What does inconsistent clicking indicate?
Hypermobility
What does reciprocal clicking indicate?
Condyle moves ahead of disc on opening and behind disc on closing
What does crepitus indicate in the TMJ?
TMJ and/or disc damage
Why is FHP an issue with surrounding musculature?
Increase tension on digastric/hyoid muscles, hyoid bone becomes further away from mandible and clavicles
Why can FHP lead to mouth opening?
Tongue drops off roof of mouth, may cause someone to become a mouth breather, makes it hard to keep the neutral position
What ligament can FHP increase tension on?
Sphenomandibular ligament
What can displace due to FHP? Where?
Mandibular condyle may displace anterior to disc
What can we do to assess FHP?
- Have patient swallow in neutral and in FHP
- If WNL, no excessive neck motion
- Excessive neck motion indicates cervical hypermobility/instability
What does excessive neck motion in with swallowing indicate?
Hypermobility/instability
IF WNL opening in neutral in and FHP should be….
the same
If opening is less in FHP compared to neutral, what does it indicate?
possible posterior displacement
What happens with a posterior displacement of the TMJ?
Condyle posteiror to the disc
What will we find in the hx for a posterior displacement?
Trauma with sudden closing
What are the S&S of a posterior displacement?
Likely pain and limitation on opening
Full closing
What is the rx for a posterior displacement?
- distraction with anterior glide to reposition mandibular condyle anteriorly to disc
- sleep with small neck roll for slight neck ext
- avoid excessive or hard chewing / grinding
What orthotics could be considered for a posterior TMJ displacement?
night splint to maintain slight opening
What is the purpose of MET for posterior displacement of the TMJ?
stabilization of TMJ and neck
What is an anterior displacement of the TMJ?
Condyle anterior to the disc
What is the hx for an anterior displacement?
- Prolonged opening such as from FHP or mouth breathing
- trauma with sudden opening
- excessive opening such as yawning or from dentistry
What are S&S of an anterior displacment?
- Full opening / no deviation
- likely pain and limitation upon closing
What is the rx for an anterior displacement?
- distraction with a posterior glide to reposition the mandibular condyle posteriorly to disc
- Avoid wide opening with diet/yawning
- sleep with neck flexed and chin tucked
- correct posture
What is the purpose of MET for anterior displacements?
Stabilization of TMJ and neck
Is an upper or lower TMJ disorder more common?
upper > lower
What is the PT rx for TMJ disorders?
POLICED
Postural education
What specific aspects of POLICED should we use with TMJ patients?
STM - intra and extraorally
Modalities for pain/guarding
What are some aspects of postural education we need to keep in mind with TMJ?
Sit tall
Maintain open packed position
What kind of breathing can help with TMJ?
Diaphragmatic breathing training
What are some activity modifications that can help with TMJ?
- Oral habit alterations
- Dietary changes
- motion extremes
- sleep modifications
What kind of MT can we do for TMJ?
JMs / oscillations of TMJ and neck for hypomobility and displacement reductions
What other MET can we do for PT rx for TMJ disorders?
- Isometrics, plus neck exercises
- practice resting and talking with cork in between teeth
- Cervical stabilization
What will the dentist/MD do for TMJ disorder?
Splints
Orthodontics
Sx
What is the prognosis for TMJ disorders?
Very good if proper mechanics, posture, stabilization and breathing patterns restored
