TMJ Flashcards
1
Q
What % of the general population has TMD?
A
25%
2
Q
What % of TMD pts develop severe disorders and chronic pain?
A
10%
3
Q
Are males or females more likely to be affected by TMD?
A
Females
4
Q
What age is most affected by TMD?
A
20-50 yo
5
Q
T/f: recent head cold or sinus infection can contribute to TMD
A
True
6
Q
The TMJ is a synovial joint lined with what kind of cartilage?
A
Fibrocartilage
7
Q
What is the difference bw fibrocartilage in the TMJ and the usual hyaline cartilage in joints?
A
Fibrocartilage has a blood supply and can therefore repair
8
Q
What divides the TMJ into upper and lower jt spaces?
A
The interposed biconcave disc
9
Q
What are the two components of opening and closing the mouth?
A
Rotary and translatory phases
10
Q
What are the movts of the TMJ?
A
Elevation (closing)
Depression (opening)
Protrusion
Retrusion
Lateral deviation
11
Q
T/f: if one TMJ moves, the other moves too
A
True
12
Q
What jt space is responsible for the gliding phase?
A
The superior portion
13
Q
What jt space is responsible for the rotation?
A
The inferior portion
14
Q
What structures make up the superior jt space?
A
The articulation eminence and the superior disc
15
Q
What structures make up the inferior jt space?
A
The condyles and inferior aspect of the disc
16
Q
Which jt space moves first?
A
The inferior jt space
17
Q
Does the roll or glide happen first in the TMJ?
A
The roll (inferior jt space) then the glide (superior jt space)
18
Q
How large is the articular disc of the TMJ?
A
1-3mm
19
Q
T/f: there is dense connective tissue in the central portion of the TMJ articular disc
A
True
20
Q
What is the articular disc of the TMJ firmly attached to medially and laterally?
A
The poles of the condyle
21
Q
What is the articular disc of the TMJ firmly attached to anteriorly?
A
The lateral pterygoids and capsule
22
Q
What is the articular disc of the TMJ firmly attached to posteriorly?
A
The bilaminar retrodiscal pad
23
Q
When the jaw is closing, the motion is controlled eccentrically by what?
A
The superior lateral pterygoid
24
Q
What is the first thing we should do with any pt with jaw pain?
A
Clear the neck!
25
What factors may be involved in a pts PMH with TMD?
Previous trauma
Nose vs mouth breathing
Missing teeth, malocclusion, appliances, orthodontia (from braces), painful teeth/gums
Hearing loss
Difficulty swallowing
Forward head posture
26
Why may fwd head posturing affect the TMJ?
Fwd head posture puts the ant Ms on stretch and pulls on the TMJ
27
What are the TMD associated symptoms?
Malocclusion
Locking
HAs (temporal type)
Dizziness, nausea
Ear pain, fullness
Tinnitus
Toothache
Cervical pain
Hyperalgesia
Allodynia
28
T/f: all the s/s of TMD are also s/s of HA so we need to take a good history
True
29
What things should we observe for with TMD?
Cervical posture
Vertical dimensions (distance from eye to mouth=distance from nose to chin)
Malocclusion
Parafunctional habits
30
What is a type one occlusion?
Normal relationship be maxillary and mandibular teeth
31
What is a type two occlusion?
Overbite
Mandibular teeth are more posterior
32
What is a type three occlusion?
Underbite
Mandibular teeth are more anterior
33
What is a cross bite?
Premature contact of the teeth on one side of the mouth before the other
34
What is the freeway space?
The normal resting gap bw incisors (2-4mm) achieved by resting the tongue on the hard palette
35
What are the parafunctional habits we may observe in pts with TMD?
Clenching/bruxism (teeth grinding)
Nail, cheek, tongue biting
Intentional jaw clicking, popping
Unusual postural habits
Occupation related activities (talking a lot)
36
100% of those with severe TMD s/s have how many parafunctional habits?
3 or more
37
What is the most common misalignment pattern in head, jaw, and neck pain?
Forward head posture
38
With fwd head posturing, what space is closed down?
The occipitoatlantal space in the posterior c spine
39
How does fwd head posturing contribute to mandibular retrusion?
Bc the jaw goes backward from shortening of the upper cervical ms and their changed length tension relationship causing them to not fxn properly
40
T/f: changes in head and neck posture have an immediate effect on mandibular movt, occlusional contact, breathing, and swallowing
True
41
What is normal opening of the mouth?
40-50mm (3 finger widths)
42
How many finger widths of jaw opening is required for normal fxning?
2
43
How much opening is normal in the rotation phase?
25mm
44
What occurs during the rotation phase of opening? Where does it occur? Is this the first or second phase of opening?
Rotation occurs in the inferior jt space
Anterior rotation of the condyle on the disc
This is the first phase of opening
45
What occurs during the gliding phase of opening? Where does it occur? Is this the first or second phase of opening?
Gliding occurs in the super jt space
Translation of the disc-condyle complex anteriorly along the articular eminence
Second phase of opening
46
What structure restricts excessive anterior translation of the disc-condyle complex on the articular eminence?
The inferior lamina of the retrodiscal pad
47
What should we palpate for in the TMJ?
Gapping, clicking, mobility, and comparing BL
48
What is a deviation?
A “corrected” movt
Movt that deviates and comes back to midline
Disc displacement with reduction, hypermobility, muscular TMD
49
What are the two curves that may occur with deviation of the jaw?
C-curve or S-curve
50
What is deflection?
“Uncorrected” movt
Deviation that doesn’t return to midline
Disc displacement without reduction, capsular hypomobility
51
What are the phases of jaw closing?
Translation posterior followed by rotation of the condyle posteriorly on the disc
52
What is mandibular protrusion and retrusion?
Translation of the condyle and disc along the articular eminence without rotation
53
What is the only jt space involved in protrusion and retrusion?
The superior jt space
54
What is the only phase of motion involved in protrusion/retrusion?
Translation
55
T/f: normal motion of protrusion/retrusion allows the upper and lower teeth to approximate edge to edge
True
56
What is the normal amount of retrusion?
3mm
57
Retrusion is limited by what structures?
The TMJ ligament and retrodiscal tissue
58
Left lateral deviation produces ___ condyle spin and __ condyle anterior glide
L, R
59
Right lateral deviation produces ___ condyle spin and __ condyle anterior glide
R, L
60
What is the normal amount of mandibular lateral deviation?
10-15 mm
The width of the central upper incisors
61
How do we measure protrusion/retrusion and lateral deviations?
With a tongue depressor or ruler
62
If there is limited R anterior translation, what may be restricted, what may we see?
Restricted L deviation
R deviation in opening
63
If there is limited L anterior translation, what may be restricted, what may we see?
Restricted R deviation
L deviation in opening
64
How do we perform distraction of the TMJ?
Stabilize the head
Pull inferiority on the jaw to pull the condyle off the fossa
65
What motions are improved by distraction of the TMJ?
All TMJ motions
66
How do we perform anterior glides of the TMJ?
Stabilize the head
Apply some distraction and pull forward on the mandible
67
What motions are improved by anterior glide of the TMJ?
Protrusion and lateral deviation
68
How do we perform lateral glide of the TMJ?
Stabilize the head
Put your thumb bw their incisors and pull the mandible side to side
69
What motion is improved by lateral glides?
Lateral deviation
70
How do we document muscle testing for the TMJ?
Strong vs weak
Painful vs painless
71
What is involved in the upper quadrant myotomal scan?
Cervical motion
Shoulder p, elbow, and wrist motion
72
How do we test mandibular depression (opening)?
Stabilization at the forehead or occiput
Gentle isometric resistance at the underside of the chin as the pt is asked to open
73
How do we test mandibular elevation (closing)?
Stabilization at the forehead or occiput
2 fingers make intra-oral or chin contact on the bottom incisors while grasping the underside of the chin with the other fingers as the pt is asked to close against gentle isometric resistance
74
How do we test mandibular lateral deviation?
Stabilization along the temporal region
Gentle isometric resistance along the mandible with the pts mouth slightly open
75
What are the rules of the mandible?
If the muscle is outside of the mandible, it ipsilaterally deviates
If the muscle is inside of the mandible, it contralaterally deviates
76
How do we test mandibular protrusion?
Stabilization at the occiput
Gentle isometric resistance with hand contact at the anterior chin with the mouth slightly open from resting position
77
What muscle is tested when we test mandibular protrusion?
The lateral pterygoids
78
How do we palpate the external auditory canals?
Palpating just anterior to the tragus
79
What extraoral muscles should we palpate with TMD?
Temporalis
Masseter
Medial pterygoid
Digastric
Cervical muscles
80
What intra-oral muscles should we palpate for TMD?
Medial pterygoid
Lateral pterygoid
81
How can we palpate the medial pterygoid intra-orally? Extra-orally?
Intraorally-bw teeth and cheek
Extra-orally- under the jaw
Confirm by having pt clench their jaw
82
How can we palpate the lateral pterygoid?
By feeling just beyond the last tooth in the mouth
Confirm by having the patient protrude their jaw
83
T/f: age related changes to the TMJ are a given as we get older
False
84
T/f: degenerative changes seen on imaging in age related changes to the TMJ are not necessarily associated with symptoms or dynsfxn
True
85
What is the most common inflammatory cause of TMD?
RA
86
RA is the most common cause of TMD, but what other inflammatory conditions can cause it?
Other arthritic conditions
87
T/f: inflammatory changes in the TMJ may diminish mandibular depression
True
88
When inflammatory conditions of the TMJ are unresolved, what can it lead to?
Adhesions with restrictions of disc motions
Capsular fibrosis
89
What is capsular fibrosis of the TMJ?
Unresolved/chronic inflammatory conditions cause an overproduction of fibrous connective tissue
90
What things in a pts hx may contribute to capsular fibrosis?
Hx of jaw pain
Hx of prolonged immobilization, trauma (direct or indirect) , arthritis
91
What behavior modifications are involved in management of TMD?
Avoiding mouth breathing
Maintaining freeway space (avoid clenching)
Mandibular rest position (tongue on roof of mouth)
Soft food diet
Possible use of appliances
Avoiding gum chewing
Encouraging the use of appliance if they have one
POSTURAL RE EDUCATION
92
What are the 6 Rocabado exercises to manage TMD?
Mandibular rest position (tongue on roof of mouth with or without tongue clicking)
Controlled mandibular rotation (opening/closing)
Rhythmic stabilization techniques (resisted jaw movt)
Cervical jt liberation (clasp hands behind neck and fwd bend)
Axial extension (chin tucks)
Should girdle retractions (pinch shoulder blades together)
93
What should we be careful to monitor for with chin tucks in the Rocabado exercises?
exacerbation of HAs
94
When a pt with TMD is stiffness dominant, what can we do to manage it?
Preparatory/supportive modalities
STM
Jt mobs of the TMJ and c spine
Home exercises and self mobilization program
95
What is involved in a home exercise and self mobilization program?
Tongue blades (stack up tongue depressors to put between incisors for a LLLD stretch)
Therabite device
Self stretch
96
Would we see clicking with a disc displacement condition with or without reduction?
With reduction
97
Would we see limited opening or closing with a disc displacement condition with or without reduction?
Without reduction
98
What things can contribute to opening clicking?
Lateral pterygoid dysfunction, trigger point, or hypertrophy
99
When the disc is placed too far anteriorly, does this cause an opening or closing click?
Opening click
100
When the disc is placed too far posteriorly, does the cause an opening or closing click?
Closing click
101
Why does an anteriorly placed disc cause an opening click?
Bc the condyle clicks on the disc before it can translate
102
T/f: the more anteriorly placed the disc is, the later the opening click will occur in the motion
True
103
What things can contribute to closing clicking?
Hyper trophy or dysfxn of the pterygoids
104
What is a reciprocal click?
When the condyle clicks on the disc with opening and then clicks off the disc with closing
105
In a disc displacement with reduction, does the deviation correct itself?
Yes
106
In a disc displacement with reduction, is there often full ROM?
Yes, even excessive ROM sometimes
107
With a disc displacement without reduction, is there usually full ROM?
No
108
What is a disc displacement condition without reduction?
Persistent marked limitation in opening (<35mm)
Deflection to the affected side in opening that doesn’t correct
Marked limitation in lateral excursion to the CL side
109
Is the rotary or translatory phase the issue in disc displacement without reduction?
The translatory phase
110
In a closed lock jaw, the disc has migrated so far ____ that the condyle can’t get on the disc and the disc blocks opening
Anteriorly
111
In an open locked jaw, the disc is so far ____ that the condyle can’t get back on it and the disc blocks closing
Posteriorly
112
What are the principles of intervention for disc displacement conditions?
Combo of pain vs stiffness dominant interventions
Education and behavior modification
Relaxation, biofeedback
STM, LLLD stretching
Modalities
Jt mobs, lock reduction
Dental appliance (we don’t prescribe these)
Surgery
