TMJ Flashcards
what are the two way a TMJ condition can occur
- extraarticular involvement
2. intraarticular involvement
what is extraarticular involvement
cervical involvement including myofascial, postural, or subluxation-related dysfunction, and dental abnormalities or pathologies
what is intraarticular involvement
synovitis, and capsulitis with the focus on the disc which is considered displaced or degenerated
how many people will develop some TMJ related symptom in their lifetime
85-90%
who is affected more: men or women?
women
TMJ problems are primary referrals from
neck and ear pain
where can TMJ also refer to
the head as in H/A’s, and into the eyes (focusing problems)
determine the cmoplaint
is it pain, clicking/popping, crepitus, inability to open fully, or close, or fatigue when chewing
note any history
of direct trauma, episodes of jaw locking, whiplash injuries, past diagnosis of arthritis, or dental pathologies
when taking history make sure to note any other signs and symptoms of
arthrtides
during elevation attempt to distinguish between
intraarticular and extraarticular
during elevation also determine
dental status
during elevation perform provocative maneuvers
- stretch= capsulitis
- compression = synovitis
- contraction= myofascial
what is the anatomy of the TMJ
a biconcave disc consisting of dense fibrous connective tissue which is not vascularized or pain sensitive, this sits on top of the condyle or head of the mandible, which sits into the gleaned fossa of the temporal bone
what is the retrodiscal tissue
located behind the disc and consists of a venous plexus covered with a synovial membrane
source of pain and synovial effusion
what stabilizes the disc
collateral ligaments and capsular ligaments which can elongate or damage allowing the displacement of the disc
what is one of the most common functional problems with TMJ
anterior displacement of the articular disc, which is posterior/superior condyle
what occurs with anterior displacement
the condyles starting position is behind the disc, with opening if the condyle can override the disc then the pop is often heard
what is occurring when the pop is heard or felt close to full opening
then anterior displacement of the disc with posterior ligament degeneration is commonly found
what is thought if grinding/crepitation is throughout the opening or closing
thought to be adhesions surrounding the capsule
what is one of the most common complaints of TMJ
overstitching of the capsule and ligaments which leads to distended join
what if TMJ becomes a chronic problem
the capsule and ligaments may poorly function leading to hyper mobility of the TMJ
what is the retordiscal area susceptible to
compression, both compassion and the resulting synovial fluid reaction increases pressure int he joint and this can cause pain
condylar compression due to anterior disc displacement can cause
retrodiscal tissues to compress
hypertonic temporalis muscle can
pull the condyle posterior
vertical height of the teeth (diminished, or loss) can lead to
superior/posterior displacement of the condyle
trauma in a superior/posterior direction may
jam the condyle into the retrodiscal tissue
was the blow direct/indirect?
what occurs with direct blows
stretch or compress the same side TMJ, anterior blow can cause a compressive type of injury with reactive synovitis, lateral blow stretches the joint capsule, resulting in capsulitis or disc deragement
micro trauma may be a result of
buxism
if pt has had diagnosis of inflammatory arthritis, RA, lupus, psoriatic, retirees, then the TMJ pain=
the inflammatory process of the disease
provocative maneuvers may help with narrowing the thourht process
clicking and popping= jaw clicks on opening=disc displacement with weakened posterior ligament
pt complains of locking= can’t open fully is called a
closed lock= the disc is anterior to the condyle during jaw opening
if the pt unable to close the mouth is called a
open lock=the anterior condyle has dislocated and may be a result of excessive joint laxity or blunt trauma
pain with excessive opening
capsulitis usually accompanied by pain with contralateral chewing and protrusion or lateral excursion of the mandible
pain with chewing=
dental disorder=TMJ involved=synovitis may be due to atypical chewing habits, chronic gum chewing, or impact injury (referral may be necessary)
