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TMJ Flashcards

1
Q

TMJ joins it a ___ going

A

Gliding

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2
Q

Describe the TMJ joint

A

Convex articular condyle of the mandible

Concave articular fossa on the squamous portion of temporal bone

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3
Q

The TMJ joint is separated by a what

A

Fibrocartilaginous articular disc (meniscus)

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4
Q

What are the three parts of the fibrocartilaginous articular disc

A

Thick anterior band
Thin intermediate zone
Thick posterior band

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5
Q

Meniscus of TMJ with mouth closed

A

The condyle is separated form the articular fossa Kd the temporal bone by the thick posterior band

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6
Q

Meniscus with mouth open

A

The condyle is separated from the articular eminence of the temporal bone by the thin intermediate zone

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7
Q

Muscles of mastication

A

Digastric, suprahyoid, left lateral and medial pterygoids, temporalis, masseter

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8
Q

What do digastric, suprahyoid do

A

Depress mandible (infrahyoid stabilizes hyoid bone) initially, then pterygoids depress jaw

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9
Q

What do left lateral and medial teratoid do

A

Move mandible lateral and forward to the right

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10
Q

What do temporalis, masseter, medial pterygoids do

A

Close jaw tightly

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11
Q

What does buccinator do

A

Approximates lips and compresses cheeks (blowing)

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12
Q

What does depressor labii inferior do

A

Protrudes lower lip (pouting)

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13
Q

What does depressor anguli oris and platysma do

A

Draw corner of mouth down

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14
Q

What does mentalis do

A

Draws tip of chin upward

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15
Q

What does orbicularis oris do

A

Approximates and compresses lips

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16
Q

What does zygomatic minor do

A

Protrudes upper lip

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17
Q

What does levator anguli oris do

A

Lifts upper border of lip on one side without raising lateral angle (snarl)

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18
Q

What does zygomaticus major do

A

Raises lateral angle of mouth to smile

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19
Q

What does risorius do

A

Approximates lips and draws lips and draws corners lateral

Grimace

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20
Q

Frontal belly of occipitofrontalis

A

Wrinkle forehead, raise eyebrows

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21
Q

Platysma

A

Tense skin of neck

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22
Q

Signs symptoms

A

Cpehalgia-misdiagnosed as migraines

Otalgia

Neck pain

Eye pain

Shoulder and back pain

Tinutis

Dull ache worse with chewing

Difficulty opening mouth

Click crepitans(jaw click usually present with disc displacement, but by itself non diagnostic)

Lateral deviation of jaw

Spasm within facial muscles

Onset of TMJ symptoms may correspond with onset of stress or added stressors

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23
Q

1 retrospective study of 4528 patients with TMD with pain, ear discomfort, headache, TMJ discomfort or dysfunction

A

Other symptoms
Neck pain
Eye pain

Arm back pain
Dizziness

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24
Q

TMJ and nocturnal bruxism

A

Controversial

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25
Jaw clenching
Anxiety and psychosocial stress Does not interfere with treatment in most cases -although a severely distributed capacity for interpersonal relationships is associated with poor prognosis
26
Types of TMJ dysfunction
Opening click Closing click (reciprocal clicking) Inability to fully open jaw (close locked) Inability to close if TMJ symptoms are bilateral Crepitus and grating Fusion of joint (ankylosis)
27
What causes jaw click
*Disc displacement after disc thins or is stretched Adhesions Uncoordinated muscle action of pterygoid Tear or perforation of disc Osteoarthritis(more likely to have crepitus) Occlusion imbalance (less likely
28
Where will we be interfering for TMJ dysfunctions
Pterygoids, masseter, temporalis
29
Trauma to cause TMJ dysfunction
Direct, whiplash, third molar extraction, intubation
30
Left deviation
Right medial and lateral pterygoid dysfunction
31
Right deviation jaw
Left medial and lateral pterygoid
32
A direct blow with closed mouth
Posterior capsule injury
33
Malocclusions
Deviation from nl contact of maxillary and mandibular teeth
34
Class 1 malocclusions
1st molars nl, problem elsewhere
35
Class 2a malocclusions
Lower 1st mo;at post to upper to greater degree (larger overbite)
36
Class 3 malocclusions
Lower 1st molar ant to upper get mandibular protrusion (underbite)
37
Why get malocclusions
Muscle strain (oral habits, postural/work, sports) MSK problems SD TMJ Compensatory changes Developmental abnormalities (condylar hypoplasia/agenesis) Mood disorders (anxiety, depression, PTSD, history of abuse) Endocrine Hypocalcemia (chvostesks and trosseau)
38
Intracapsular
``` Infection RA OA Gout Metastatic CA Articular disc displacement ```
39
Extracapusular
Myofascial pain of mastication muscles - TMJ myofascial pain syndrome - TMJ dysfunction syndrome - TMJ syndrome NIH preferred terminology -TMJD-temporaomandibular muscle and joint disorder
40
Possible risk factors TMK
Contradictory association with hyperlaxity Neck trauma(severe TMD symptoms in 89% of patients c/o whiplash associated symptoms compared to 18% of controls Female hormones Bruxism and clenching Contradictory evidence about associated with occlusion Up to 75% of TMD may suffer from psychogical abnormalities
41
Factors not associated with risk of TMJ
Genetics, orthodontics
42
Epidemiology TMJ
Affect 20% of Americans Women #2 cause of facial pain (HA is 1)
43
What population gets TMJ more
RA 53094%
44
Osteopathic evaluation for TMJ
Cranial C spine Scoliosis Leg length (innominate, sacrum, SI joint)
45
Palpate joitns for ___
Crepe tans/clicks
46
Palpate mastication muscles
1 side may be tender
47
Ranges of motion
Active-patient opens mouth 3-6 cm, laterally 1-2 cm, and then retracts and protrudes mandible Observe jaw movements for deviation
48
Passive ROM
Gloves-move pots jaw medially and laterally(compare ROM on both sides)
49
Observation TMJ
Cavities, suspicious lesions in mouth, teeth alignment (tongue blade for bite) Facial asymmetry
50
LOOK FOR SYMMETRY
Ok
51
When should you suspect TMJ
Abnormal mandibular movements Decreased ROM of TMJ (Normal functional opening is 35-55 mm. Functional opening on TMD puts usually <25 mm and very often associated with pain) Muscles of mastication tenderness Pain with dynamic loading Bruxism(look for signs of tooth wear) Postural asymmetry (observe posture, assessing for slouching or a preference to lean to one side) Neck and shoulder muscle tenderness Normal cranial nerve examination
52
Differential diagnosis TMJ
Migraine related disorders (Carotodynia) Inflammatory diseases (infection, RA, giant cell arteritis) Dental problems (posterior teeth support loss) Neuralgia (trigeminal , glossopharyngeal) Parotid gland disorders Lymphoproliferative
53
Microbiology and pathology TMJ
``` C tetani-lock jaw Odontogenic cysts Sclerosing osteomyelitis of garre Monocystic fibrous dysplasia Acromegaly-enlarged jaw-prognatism ```
54
Medical side effects TMJ
Steroids-avascular necrosis | Bisphosphonates-osteonecrosis of the jaw
55
Eagles syndrome(stylohyoid syndrome)
Elongated styloid process
56
MOTHRR
``` Medication OMM Testing Holistic/humanistic Referrals Return visit ```
57
Radiology for TMJ
``` Not helpful really But do if suspect dental problems Patient with severe symptoms that don’t improve with conservative treatment tactics Concern for alternative cause Recent, severe trauma ```
58
Peripheral radiographs can r/o _ problems
Tooth
59
MRI
See position and shape of disc MRI alone not significant unless TMJ movement is restricted or there is clinical suspicion for a disc out MRI not for evaluation of muscle pain -disc commonly displaced in asymptomatic patients
60
Disc displacement Sx
MRI showed
61
No Sx of TMJD
33% had displaced discs
62
Level 1 TMJ interventions
Cognitive behavioral therapy for chronic TMJ reduces activity interference, pain and depression at 1 year
63
TMJ level 2 interventions
OMT, exercise emitriptyline, glucosamine sulfate for OA of tmj, benzodiazepine, Botox, acupuncture, OMT, NSAIDS, hypnorelaxation, oral habit reversal treatment, cognitive behavioral skills training plus biofeedback,, physical self regulation, therapeutic exercise
64
Level 3 TMJ intervention
``` OMT Biofeedback alone Surgery Occlusal splints Occlusal adjustment Intra articular corticosteroid inj PT ```
65
OMT help TMJ
Didn’t improve it | But OMT associated with less NSADIS and muscle relaxant use
66
How can we holistically fix
Change head posture, sleeping position , aggravating parafunctional oral behaviors (nail biting, pen chewing)
67
THE MINIMUMGOAL FOR OPENING THE JAW IS TO BE ABLE TO FIT THE KNUCKLES OF THE INDEX AND MIDDLE FINGER BETWEEN THE ___
TEETH
68
Retraining
Place the pads of your fingers over your chin Open your mouth comfortable and slid your jaw forward as far as it will comfortable go Press your jaw into your finger pads with a gentle pressure Hold this as you inhale deeply Upon exhalation allow your mouth to close comfortable Repeat 3-5 times and do it at least 3 times a day
69
Retraining lateral deviation
Place hand on mandible on side toward which the jaw deviates Place the other hand on the opposite cheek bone Apply enough pressure on these areas to illicit a gentle stretch as you open your mouth Then close your mouth maintaining the same pressure Do daily until full relief is obtained, then perform it 2-3 times a week
70
Acupressure
Insert your clear pinky finger into your mouth between your cheek and gum Slide your finger along your gum line, above your teeth, until your finger falls into a deeper recess behind your teeth, but in line your gums Lean your head upon your finger until you experience a sligh discomfort This discomfort will subside and you will be able to lean more and more into your finger Do this 2-3 times a day until the symptoms have gone
71
Deep presssure
Sometimes you may find very sensitive tender points in the cheek muscles By applying a deep and steady pressure these points will disappear You don’t haven’t massacre yourself to be successful just press on the point to illicit the feathers adage of pain and follow that edge until it disappears
72
Self massage
Use the pads of your fingers to feel around your cheeks above the engles of your jaw with a kneading, circular motion Any tension or Robey sensation that you feel you should massage away
73
Temporalis self treatment
Use hot packs or a scarf to warm area for 12-30 minutes Stretch with pinky finger pads placed firmly just behind the hairline and the rest of the fingers in the hair around the ears, apply traction towards the sky Open and close the mouth slowly while maintaining the traction 5 times Repeat 2-5 times
74
Acupressure
Apply pressure to the feathers edge of discomfort
75
Temporalis retraining
Open your jaw maximally Press your index finger pads down against your jaw in an effort to open it more Close your mouth gently against your fingers for 5 sec Upon relaxing allow your fingers to draw your jaw open more Repeat 3-5 times
76
How can adjust diet for TMJ
Decrease chewing with different foods
77
Referred
Dental surgeon Oral devices Surgery
78
Surgery /arthroscopy indication
Significant pain and dysfunction | Exhausted all conservative measures
79
Poor prognosis
Psychiatric factors | -have prolonged use of opiates, benzodiazepines, alcohol, other drugs

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