TMD Exam 1 Flashcards
Another name for clicking
anterior disc displacement with reduction
Ant displacement w/o reduction
*LIMITS from Opening
Ant displacement with reduction (clicking)
*Clicking does NOT limit opening
Should clicking interfere with how wide you open?
No
closed lock with ADD without reduction does it interfere with opening?
yes
stylomandibular ligament
i. extrinsic
ii. is a thickening of the fibrous capsule of the parotid gland
iii. runs from the styloid process to the angle of the mandible
iv. connects mandible to the cranium, but does NOT strengthen joint
sphenomandibular ligament
i. extrinsic
ii. runs from spine of sphenoid to the lingula of the mandible
iii. connects mandible to the cranium, but does NOT strengthen joint
lateral (temporomandibular) ligament
i. intrinsic
ii. a thickening of the articular capsule forms this ligament
iii. strengthens joint and prevents dislocation
lateral pterygoid
i. opens mouth
ii. acting together: protrude mandible
iii. acting alternatively: grinding action
Masseter
i. closes jaw by elevating mandible
temporalis
i. closes jaw and elevates mandible
ii. posterior fibers retract the mandible
medial pterygoid
i. elevates mandible and closes jaw
ii. acting together: protrude mandible
iii. acting alone: protrudes one side
iv. acting alternatively: grinding action
capsulitis
inflammation of joint similar to sinovitis
Osteoarthritis (most common)
i. “wear and tear” arthritis
ii. Next most common is rheumatoid arthritis
internal derangements
clicking and popping
systemic arthritis
i. every systemic arthritis you have in the body can be in the TMJ
1. ex: rheumatoid arthritis, psoriatic arthritis, gouty arthritis, etc.
traumatic arthritis
joint is inflamed b/c of injury
Differential diagnosis is important so ….
treatment can be focused on Joint or muscle
Most TMD cases are a combination of joint and muscle are?
multifactorial
Most important thing when screening patient
HISTORY
Note: only thing for immediate treatment is ADD without replacement
How to utilize diagnosis?
1) Initial diagnosis
- Capsulitis and myalgia
2) Sub diagnosis
- superior capsulitis
3) lateral pterygoid myalgia
4) masseter myalgia
Make distinction between capsulitis and myalgia
-maybe sneak superior capsulitis question in there and how to treat
1) put pivot on one side
2) Initial treatment is maxillary stabilization, PT & biofeedback
MOST common pivot?
Unilateral pivot
- Single posterior ‘bump’ on splint to bring down ipsilateral condyle
Masseter trigger points?
i. Ear
ii. Lower Molars
iii. Above Right Eye
Temporalis trigger points?
i. Upper Ant. Teeth
1. Anterior Temp
ii. Upper Bicuspids
1. Middle Temp
iii. Upper Molars
1. Posterior Temp
SCM trigger points?
i. Ear
ii. Eye
iii. Above Eye
1. Can be Contralateral
Occiput (Refers to mostly the sinus area, the eye, and above the eye
Posterior Cervicals trigger points?
i. Temple
1. Pain comes from trapezius rather than the temporalis
ii. Eye
iii. Ear
Lateral Pterygoid trigger points?
i. TMJ
ii. Eye
iii. Zygoma
**(Hard to palpate)
Temporalis Tendon trigger points?
Mimics TMJ and Masseter pain (hard to tell the difference)
1) % population has at least one sign of joint dysfunction
2) % has at least one symptom
3) % of population needs treatment
1) 75%
2) 33 %
3) 5-7 %
opening pain muscle or joint?
Can be muscle or joint
- Check location
- Check referred pain
Closing pain muscle or joint?
Usually joint
Chewing muscle or joint?
Muscle or Joint
Moving the head muscle or joint?
Neck
Sharp pain =
Sharp pain = joint
Dull pain =
= muscle
Pain associated w/ clicking
joint
Side to Side Movement
Usually joint pain
Limited Opening without deviation
Usually muscle
Limited opening w/ deflection to one side
probable ADD w/o reduction on side of deflection
Protrusion
deflection to one side indicates ADD w/o reduction on same side of deflection
% patients that come for pain are non tooth pain
40%
___________ is inferior, hinge movements of depression and elevation occur in inferior compartment
rotation
___________ is superior, gliding movements of protrusion and retrusion occur in superior compartment
sliding
Jugular vein does not go through ?
TMJ
Dentist treat…
TMD, Sleep apnea, Headache/migraine, Neuropathic pain, Non-dental tooth pain, movement disorders
over 40 mm ________ motion
Vertical
10-12 mm ____ motion
Lateral
Protrusion =
= 8-10 mm
i. referred pain from a tender point to a distant site
ii. Treated with stretching, heat/cold, and rest
iii. Muscle relaxants can be helpful
Myofascial pain
i. Muscle inflammation due to trauma or infection
ii. Treated differently than muscle tightness/Myalgia
1. NSAIDS
2. Steroids
3. Rest
4. No stretching
Myositis
i. Jaw snaps shut - Is not just tight or sore but is a forceful, painful contraction
ii. look for systemic cause
1. could be due to low potassium or other minerals, or hormonal imbalance
iii. may be due to virus or other medical problem
Spasm
i. Localized muscle soreness
ii. tender to palpation
iii. most common muscle pain
iv. doesn’t refer to a distant site
v. responds to stretching
Myalgia
i. muscle tighten to protect joints/other muscles
ii. need to find the cause of the need to protect
iii. treat the cause and use muscle relaxants, rest, and stretching
protective splinting
i. muscle has undergone degenerative change that causes contracted state to persist
ii. usually due to injury or infection
iii. calcified contracture (rare)
iv. can be hereditary
myofibrotic contracture
Formation of ‘pseudo-disc’ over several weeks with an appliance is much more common than permanent change in disc placement… Unloading… best treatment… its like a..
- Unloading it for a while and gradually loading again
- This is the best treatment instead of surgery
- It’s like a callus in the joint
