TMJ

Question 1

2nd most common source of facial pain

Answer 1

TMJ

Question 2

Highest incidence of TMJ disorder is between __ yo and ___

Answer 2

20-40 yo

Question 3

Men have a higher incidence of TMJ disorder

Answer 3

FALSE
women 4:1 because of laxity caused by the variations in hormones

Question 4

Name the 6 possible movements of the mandible

Answer 4

Depression
Elevation
Lateral L
Lateral R
Protraction
Retraction

Question 5

Name the 3 ligaments of the TMJ

Answer 5

• Capsular ligament
• Stylo-mandibular ligament
• Spheno-mandibular ligament

Question 6

Name the 4 important musles of the TMJ

Answer 6

Temporalis
Masseter
Medial pterygoid
Lateral pterygoid

Question 7

Origin/insertion of temporalis

Answer 7

Temporal fossa
Coronoid process and ramus of mandible

Question 8

Action of temporalis
(bilateral vs unilateral)

Answer 8

Bilateral: elevation of mandible (closing mouth)

Unilateral: ipsilateral lateral deviation

Question 9

Action of masseter (bilateral vs unilateral)

Answer 9

Bilateral: elevation of mandible (closing mouth)

Unilateral: ipsilateral lateral deviation

Question 10

Location of medial vs lateral pterygoid

Answer 10

Medial = internal angle of ramus of mandible

Lateral = inside the mouth near the condyle of the mandible

Question 11

Action of medial pterygoid (bilateral vs unilateral)

Answer 11

Bilateral: elevation & protrusion

Unilateral: contralateral lateral deviation

Question 12

Action of lateral pterygoid (bilateral vs unilateral)

Answer 12

Bilateral: depression & protrusion

Unilateral: contralateral lateral deviation

Question 13

3 muscles that do depression of the mouth

Answer 13

Lateral pterygoid
Suprahyoid
Infrahyoid

Question 14

3 muscles that do elevation of the mouth

Answer 14

Temporalis
Masseter
Medial pterygoid

Question 15

3 muscles that do protrusion

Answer 15

Masseter (superf.)
Lateral pterygoid
Medial pterygoid

Question 16

2 muscles that do retrusion

Answer 16

Temporalis
Masseter (deep.)

Question 17

3 muscles that do side-to-side movements (grinding & chewing)

Answer 17

Temporalis on same side
Pterygoid on opposite side
Masseter

Question 18

4 suprahyoid muscles

Answer 18

Mylohyoid
Geniohyoid
Stylohyoid
Digastric

Question 19

4 infrahyoid muscles

Answer 19

Sternohyoid
Sternothyroid
Thyrohyoid
Omohyoid

Question 20

3 categories of TMJ dysfunction

Answer 20

MPD syndrome (myofascial pain dysfunction)
Internal derangement
Degeneration joint disease

Question 21

What is the MPD syndrome?

Answer 21

Primarily involving muscles of mastication, and frequently provoked by somatic dysfunctions elsewhere in the body

Question 22

What is internal derangement injury?

Answer 22

Abnormal relationship between articular disc and mandibular condyle, including acute disc displacement and chronic recurrent dislocations

Question 23

What is DJD?

Answer 23

A degeneration of the articular surfaces with the TMJ

Question 24

Which muscles is most affected du to stress and tension?

Answer 24

Lateral pterygoid

Question 25

Sympathetic facilitated segments for the head and neck are found at what levels in the spine?

Answer 25

T1-T4

Question 26

Possible cause of internal derangement (2)

Answer 26

Dental procedures such as aggressive tooth extractions Contact to the mandible

Question 27

What is the most common cause of Id?

Answer 27

Anterior disc displacement

Question 28

Anterior disc displacement vs Anterior disc dislocates

Answer 28

Anterior disc displacement reduces with opening causing an opening click Anterior disc dislocates again with closing causing a closing click

Question 29

Some causes of DJD (3)

Answer 29

OA Rheumatoid arthritis Infections to the bone or joint

Question 30

TMJ has both ____ and ____ motion, making it the most complex joints in the body

Answer 30

Hinge and gliding motion

Question 31

Articular disc - with the mouth closed, the THIN or THICK part separates articular surfaces

Answer 31

THICK

Question 32

Articular disc - with the mouth open, the THIN or THICK part separates articular surfaces

Answer 32

THIN

Question 33

What might a patient report in clinical history

Answer 33

Facial pain Restricted jaw ROM Jaw noise Headaches Neck pain Ear aches History of jaw trauma Acute/chronic buxism

Question 34

When the jaw is open, the condyle moves ____

Answer 34

Forward

Question 35

When the jaw is open, the disc slides ___

Answer 35

Forward

Question 36

Average opening of the mouth is ____ (usually wide enough to fit ___ )

Answer 36

40 mm 3 knuckles between the upper and lower incisors

Question 37

Treat muscles that close the jaw (elevation)

Answer 37

The patient is supine with the mouth open and the therapist is seated at the head of the table. *  The therapist places two fingers against the chin and asks the patient to try to close the mouth and the therapist resists this. *  This cycle is repeated 3 – 5 times or until no new barriers are encountered. *  The patient is re-assessed.

Question 38

Treat the muscles that open the jaw (depression)

Answer 38

The patient is supine with the mouth closed and the therapist is seated at the head of the table. *  The therapist places two fingers under the chin and asks the patient to try to open the mouth and the therapist resists this. *  This cycle is repeated 3 – 5 times or until no new barriers are encountered. *  The patient is re-assessed

Question 39

Treat the muscles that control lateral glide

Answer 39

The patient is supine with the mouth slightly open and the jaw moved away from the affected side to engage the barrier and the therapist is seated at the head of the table. *  The therapist places the palms of both hands against the mandible asks the patient to try to move the jaw toward the dysfunctional side (toward the side of the deviated chin) and the therapist resists this. *  This cycle is repeated 3 – 5 times or until no new barriers are encountered. *  The patient is re-assessed

Question 40

Treat the medial and lateral pterygoid

Answer 40

The patient is supine with the mouth slightly open and the jaw moved into retrusion. *  The therapist stabilizes the head with one hand and applies retrusion to the restrictive barrier with the other hand. * The patient is asked to push jaw into protrusion. * This cycle is repeated 3 – 5 times or until no new barriers are encountered. *  The patient is re-assessed