TMD Flashcards
T or F: TMJ and TMD is the same thing
F: TMJ is the joint, TMD is the disorder
TMD is most commonly seen in…
20-40 y.o. females
*related to genetics, hormones, occupation
articulating surfaces of the TMJs are composed of what kind of cartilage
fibrocartilage
T or F: fibrocartilage is more susceptible than hyaline cartilage to sheer and loading forces
F: it is less suspectible
the mandibular _______ articulates with the mandibular ______ of the _______ bone to form the TMJ
condyle
fossa
temporal
what kind of joint is the TMJ
ginglymoarthrodial joint
hinge (lower) and glide (upper)
T or F: the TMJ is the most commonly used joint in the body
T
the capsule of the TMJ is attached to what? what does it prevent?
attached to superior temporal bone to the neck of the condyle and prevents end range condylar movement in all directions
T or F: the middle portion of the articular disc of the TMJ is avascular and aneural
T: extreme periphery is slightly innervated
How does the articular disc get blood supply and nutrients
retro-discal pad
*this is where pain is usually coming from
how is the articular disc of TMJ shaped
biconcave
what is the purpose of the articular disc of the TMJ
- increased congruency
- increased flexibility
- self-centtering
inferior joint cavity arthrokinematics
- condyle on disc
- roll/rotation in first 35-50% of opening
superior joint cavity arthrokinematics
- condyle/disc on the fossa
- translation for the final 50-65% of opening
the disc is rotated ______ on the condyle as the condyle is translated out of the fossa
posteriorly
what innervates the muscles of mastication
trigeminal nerve
what is the primary muscle of chewing
masseter
- elevates the mandible
how many heads does the masseter have
2 - superficial and deep
how many fibers does the temporalis have
3 - anterior (vertical), middle (oblique), and posterior (horizontal)
what does the temporalis do
- ipsilateral lateral excursion
- elevation and retrusion of mandible
how many heads of medial pterygoid
2 - deep and superficial
what does the medial pterygoid do
- contralateral lateral excursion
- elevation/closing
how many heads does lateral pterygoid have
2 (superior and inferior)
what does lateral pterygoid do
- contralateral lateral excursion
- protrudes mandible
what muscle helps stabilize the disc with elevation
superior head of lateral pterygoid
what do anterior and posterior digastrics do
- depression of mandible
- opening
what are the 3 muscles of the power stroke for TMJ
- masseter
- medial pterygoids
- temporalis
*these are elevators/closers
what are the 2 main muscles that open you mouth
lateral pterygoids
digastrics
what muscles cause lateral deviation of the jaw
ipsilateral temporalis
contralateral pterygoids
what are possible macrotraumas that can cause TMD
recent dental procedures, MVA, recreation
where are some common areas of pain associated with jaw function
- periauricular
- lateral face
- mastoid process
- ear
- headaches
T or F: to have TMD patients must have pain/stiffness in the TMJ area
T
T or F: hypermobility can play a role in TMD
T
occulusion
how teeth fit together
when palpating around the jaw start on the…
outside and work your way in
* also palpate TMJ with opening and closing
when assessing ROM for TMJ pain, what should you look for
- asymmetry with opening and closing
- quality of movement
- pt response to ROM
mandibular deviation makes an _____ curve while deflection makes a _____ curve
s
c
T or F: with mandibular deflection the jaw returns to neutral as it gets to end range
F: that’s deviation
for every 1mm of lateral excursion you want _____mm of opening
4
what is a functional amount of mandibular depression (mouth opening)
25-30mm
ideal = 40-50mm
if you have a pt bite on two separators and that reproduces pain, what is most likely involved
muscle
when you have a pt bite on one separator, what is happening to the joint
- ipsilateral distraction
- contralateral compression
how do you perform TMD joint compression? if this reproduces pain what structure is most likely involved
- glide mandible posterior and superior through mandibular angle
- retro-discal tissue
how do you perform TMD joint distraction
glide mandible posterior and inferior (ulnar deviation of wrist)
2 axis for diagnosing TMD
axis 1 = physical axis
axis 2 = psychosocial
3 groups of the physical axis
1 = myofascial disorders
2 = disc disorders
3 = joint dysfunction
T or F: with increased time with TMD, there is a shift towards axis 2
T
T or F: the c-spine and TMJ are very closely related
TRUE for sure
what are some things you often see with masticatory muscle disorder (axis 1 TMD)? These also help with disc dysfunction
- muscle guarding
- trigger point referral
- tendinitis/tendinosis
- headaches
- muscle pain
- dry needling
Your pt is a 26 y.o. female with complaints of jaw pain when eating. The jaw pain also sometimes wakes her up at night. She complains of a feeling of fullness in her ears. Upon exam, she has pain at end ROM and pain with resisted protrusion. Her muscles of mastication are tender to palpate. What may she have?
masticatory muscle disorder
what are some interventions for masticatory muscle disorder
- behavior changes (diet, ergonomics, sleep)
- stress management
- manual therapy
- postural retraining
- neuromusclar re-ed
what are some cues you can give pts to help with parafunction with TMD
- tongue at roof of mouth to keep teeth apart
- controlled mouth opening (Nnnnnnnice)
what is the most common type of disc displacement in TMD
anterior or anterior medial
what can be used to discern anterior disc displacement in TMD
clicking
*you must have a click to have disc displacement with reduction
if you have disc displacement with reduction there will be _____ but if there is not reduction there will be _______
clicking
locking
there must be a click with _____ out of ________ trials to be classified as disc displacement with reduction
1 out of 3
*clicking is eliminated on protrusive opening and closing
T or F: people with disc displacement with reduction may have normal ROM
T
what are typical subjective fundings with disc displacement without reduction
- limited opening (maybe)
- hx of clicking w/ or w/o intermittent locking
2 types of disc displacement without reduction
w/ or w/o limited opening
If someone has disc displacement without reduction with limited opening what will you observe when they open their mouth?
- they canot open more than 30mm and they deflect to the side of the involved joint
- protrusion and contralateral excursion in also limited
Your pt is a 30 y.o. female complaining of jaw pain. She is unable to open her mouth enough to eat her favorite foods and floss. She has a history of clicking. Upon exam, you find that she can only open her mouth 25 mm. She deflects to the right with both opening and protrusion. Her left lateral excursion is limited. What does she likely have?
right disc displacement without reduction with limited opening
if a pt has disc displacement without reduction without limited opening they can open their mouth more than ______mm unassisted
30
interventions for disc displacement with reduction
- pt ed
- treat pain/inflammation
- treat intermittent locking
- treat other sources (masticatory muscles, arthralgia, c-spine)
interventions for disc displacement without reduction
- increase condyle/disc translation
- manual
- address c-spine
- controlled mouth opening
- mandibular isometrics
- tongue depressor stretch
- modalities
T or F: disc displacement without reduction without limited opening requires no treatment other than education on what they are experiencing
T: treat it as disc displacement with reduction as needed
Your pt is a 40 y.o. female who is c/o pain in the jaw, temple, and front of the ear for the past month. The pain increases during the day with chewing and talking. She cannot open her mouth as much in the morning. When you have the pt open and close her mouth you observe crepitus while palpating B TMJs. What does she likely have?
TMD degenerative joint disease
to be classified as TMJ arthralgia, both of these criteria must be true
1 - confirmation of pain location in the area of the TMJ
2 - reproduction of pain with palpation around lateral pole OR maximum opening or protrusion
Your pt is a 20 y.o. female with jaw pain. She states when she opens her mouth wide her jaw “goes out”. Sometimes when she closes it catches. Upon exam, the pt has increased ROM of opening, a midline shift to the R at end of mouth opening, and you feel a jutter at the end of mouth opening and beginning of closing. What does the pt most likely have?
L hypermobile TMJ
interventions for TMJ arthralgia
- education (diet)
- address MMD
- modalities to decrease pain/inflammation
- mandibular mobs
- controlled mouth opening
interventions for TMJ hypermobility
- education (avoid end range)
- address MMD
- modalities to decrease pain/inflammation
- neuro re-ed (practice limiting range)
- isometrics
what modality MAY be considered for temporalis tendonities
iontophoresis?
