TMJ Flashcards
what sort of cartilage are the TMJ and disk covered in?
fibrocartilage
in which cavities do rotation and translation occur in?
rotation occurs in inferior cavity; translation occurs in superior cavity
which portion of the disc is aneural?
the intermediate (middle)
what are the unilateral and bilateral contraction results of the masseter?
uni: slight lateral deviation to same side
bi: elevation of mandible
unil and bil contraction results of temporalis?
unil: deviation to same side
bi: elevate and retract mandible
unil and bil contraction results of lat pterygoid?
unil: contralateral excursion
bil: protrusion
action of suprahyoid muscles?
depression and retrusion of the mandible during closing
infrahyoid muscle action?
stabilize hyoid bone to form a firm base for the suprahyoids
unil and bil function of medial pterygoid
unil: contralateral deviation
bil: elevation and protrusion
normal ROM for depresion is…
between 40-45 mm for males and 45-50 mm for females
approx 4 fingers width of the nondominant hand
functional ROM for depression is…
~35 mm or 3 fingers width
normal lateral excursion is…
1/4 of opening range
normal protrustion and retrusion are…..
6-9 mm protrusion; 3 mm retrusion
key findings in ADDwoR
no clicking noise during opening/closing with possible limited opening (disc blocking condylar head) or no limitation opening (disc completely displaced anteriorly)
key findings in ADDwR
click on both opening and closing (clicks on to the disk in opening and off the disc in closing)
diff between overbite and overjet?
overbite: how much overlap there is between the top teeth and bottom teeth (top to bottom measurement)
overjet: how the top teeth are in front of the bottom teeth (front to back measurement)
what do a C curve and S curve usually represent?
C curve = capsular pattern, S curve = lack of motor control
what is deflection?
mandible deflects to one side without returning to center at end range (usually occurs when a disk is anteriorly displaced)
what are the 3 classes of occlusion?
1: normal
2: excessive overjet (over 6mm) - the layman’s “overbite”
3: underbite
what is the most prevalent cause of TMD?
myofascial pain disorder (complete with trigger point referral patterns)
conditions that can be associated with TMD?
HAs, Ear sx, Vertigo, swallowing/speech difficulty, psychological affect, trigeminal neuralgia, temporal arteritis, atypical odontalgia (phantom tooth pain), post-herpetic neuralgia (herpez zoster), meniere disease
what is temporal arteritis?
subacute inflammation of the superficial temporal artery and the vertebral artery - causes severe unilat or bilat headache or scalp-temporal artery region; jaw claudication with pain/stiffness during chewing is indicative of this - must refer for ophthalmologic eval
what clinical findings may indicate nocturnal bruxism?
scalloping of the tongue or irregularity on the buccal tissues
which muscle of mastication is not palpable?
lateral pterygoid
describe the cotton roll test
the pt bites down on a cotton roll with back molars on the side of the complaint; if pain increases, the cause of sx may be muscular in origin - if pain decreases, the cause may be joint related; then have them bite on the cotton roll with the opposite molars - if it is joint pain; then the pain will increase
what is trismus?
an acute closed lock (usually caused by spasm of masseter after prolonged jaw opening such as is needed after a dental procedure)
how can myofasical pain disorder be dx’d?
palpation of trigger points, pt sx, and release of sx with the spray and stretch technique
how often is the rocobado 6x6 program supposed to be carried out?
every 2 hrs regardless of sx
describe the spray and stretch technique
put the irritated muscle on stretch - spray ethyl-chloride or fluori-methane vapo coolant spray from 24 cm away at a rate of 10 cm/sec about 4 times; then warm the muscle with your hands and apply further stretching
specific interventions for Ant disc displacement
pt education about proper head/neck/jaw position, avoidance of parafunction and clicking/popping of the joint, modalities, exercises (condylar remodeling, practicing closing the mouth along a protruded path once the disk is reduced); mobilization
describe the condylar remodeling exercise program
surgical tubing b/w incisors - deviate laterally to contralateral side of symptomatic joint; many phases of progression including adding a bite, then adding protrustion, then rhythmic stabilization
what is a good joint mob for restoring an anteriorly displaced disc?
longitudinal distraction, add ulnar deviation of the hand then go into anterior translation
when would you recommend a stabilization splint vs an anterior repositioning splint?
stabilization splint: intended to relax masticatory muscles (appropriate for ADDwoR); anterior repositioning splint: for ADDwR and is required to be worn 24 hours a day
