TMJ Flashcards
70% of TMJ disorders involve what
mal positioning of the disc (internal derangement)
Primary pathology at TMJ
OA
TMJ is what type of joint
Modified ball and socket
synovial joint
Runs behind the TMJ
Blood supply to dura
Middle Meningeal artery
Muscles of the TMJ
Temporalis
Masseter
Pterygoid
Hyoid muscles
SCM
Platysma
covers the lateral area like a fan
a powerful muscle in biting
temporalis
a main muscle involved in chewing
masseter
when both sides work together, they push chin out and/or depress the chin. unilaterally they produce the side to side chin movements
lateral pterygoid
helps to elevate and close the jaw. working together they protrude the mandible, working unilaterally it produces a grinding motion
medial pterygoid
biomechanics - opening
anterior roll and anterior glide of the condyle
biomechanics - closing
posterior roll and posterior glide
does the TMJ follow convex/concave rule?
no
normal opening of the mouth is
35-55mm or 2-3 fingers in the mouth
normal daily use of the TMJ requires
25-35 mm
Specific history questions
- grinding teeth
- clicking/locking/popping
- pain with functional movement of jaw- recent dental work
- surgeries
- medical conditions
- lymph node swelling, tonsillitis, sinus infections
- hearing and balance issues
- headaches
Profile of a mouth breather
tired eyes
restless sleep and snoring
set back jaw
leaning forward
poor head posture
narrow palate
lower Co2 and oxygenation
higher BP
stress activation
profile of a nose breather
alert eyes
jaw and cheekbone definition
deeper sleep
higher CO2
parasympathetic relaxation
wide palate
spine support
good tongue posture
lower BP
alpaca whisperer
Wilkes Stages of internal derangement - name them
normal
ID-reducing
ID-non-reducing
normal internal derangement
normal anatomical position of articulating disc with respect to condyle and surfaces of articulation
ID-reducing
anteriorly displaced disc returning to normal position upon maximal opening
stage II - early stage III
ID non-reducing
anteriorly displaced disc during closed and maximal opening positions with disc thickening present
Stage III - stage IV
sounds heard for ID reducing vs non reducing
reducing will hear more clicking/popping
non-reducing will hear more grinding from rubbing
Wilkes 5 stages to classifying ID - Stage I
painless clicking in early opening and late closing unrestricted motion
Wilkes 5 stages to classifying ID - Stage II
occasional pain with clicking, intermittent locking, orofacial pain
Wilkes 5 stages to classifying ID - Stage III
frequent orofacial pain, as locking becomes more frequent and mandibular becomes restricted
Wilkes 5 stages to classifying ID - Stage IV
contours begin to change, chronic pain and restricted mandibular opening
Wilkes 5 stages to classifying ID - Stage V
similar to stage 4 but with more severe symptoms (chronic pain, crepitus, significant ROM restrictions)
trigeminal neuralgia vs TMJ dysfunction
trigeminal neuralgia is unilateral, acute and stabbing pain,no pain at night, short burst of pain
VS
TMJ dysfunction is bilateral pain, continuous and dull, pain present at night, long lasting duration
Pain is at temples, in front of ears
TMJ
Pain is behind frontal bone and/or cheekbones
Sinus
Pain is in and around one eye
Cluster
Pain is like a band squeezing the head
Tension
Pain, nausea and visual changes are typical symptoms of a classic form of:
Migraine
Pain is at the top and/or back of head
Neck
which 2 types of pain/location are more cervicogenic
tension and neck
Bell’s Palsy
damage or inflammation of the CN VII (facial)
sudden paralysis of one side of your face
S/S of Bell’s palsy
drooling
eye problems
loss of ability to taste
pain in or behind your ear
numbness in the affected side of your face
increased sensitivity to sound
TMJ functional movement
biting
chewing
swallowing
coughing
talking
2 causes of restricted opening when ROM testing
muscle spasm
disc displacement
Crepitus of the TMJ could indicate what 2 things
possible OA
possible disc displacement
what is Chvostek’s sign
Damage of the Facial Nerve (CNVII)
Test:tap the parotid gland overlying the masseter muscle
+ive = facial muscle twitch
chvostek’s sign is used for what
to help determine if there is a pathology of the 7th cranial nerve (facial)
Cervical spine affecting TMJ - flexion
posterior neck muscles tighten and mandible gets pulled up and forward
Cervical spine affecting TMJ - extension
the mandible gets pulled down and backward
what can you make your patient do to verify if the cervical spine is affecting the TMJ
can they do full neck flexion and extension with the mouth closed
