TMJ

Question 1

What are the 3 ligaments of the TMJ

Answer 1

1. Temporomandibular Ligament
2. Sphenomandibular ligament
3. Stylomandibular ligament

Question 2

Identify features, functions, and locations of the following anatomical components of the TMJ: Condyle

Answer 2

articulating head on the mandible

Question 3

Identify features, functions, and locations of the following anatomical components of the TMJ: Articular eminence

Answer 3

protuberance on the inferior aspect of zygomatic process of temporal bone, anterior to glenoid (articular) fossa

Question 4

Identify features, functions, and locations of the following anatomical components of the TMJ: Glenoid/articular/mandibular fossa

Answer 4

aka: Articular fossa or mandibular fossa)-posterior to the articular eminence, depression on temporal bone

Question 5

Identify features, functions, and locations of the following anatomical components of the TMJ: Articular disc

Answer 5

Made of fibrous connective tissue
Moves with the mandibular condyle to accommodate for smooth movement
The disc divides the TMJ into two synovial cavities: Upper Synovial Cavity and Lower Synovial Cavity

Question 6

Identify features, functions, and locations of the following anatomical components of the TMJ: Synovial function

Answer 6

The membranes that line the inside of the joint capsule secrete synovial fluid that aids in lubricating the joint and fills the synovial cavities.

Question 7

Identify features, functions, and locations of the following anatomical components of the TMJ: Fibrous capsule

Answer 7

completely encloses the TMJ, keeping the synovial fluid confined to the joint

Question 8

Identify features, functions, and locations of the following anatomical components of the TMJ: Ligaments: TMJ

Answer 8

Function: Prevents the condyle from being displaced too far inferiorly (downward) and posteriorly (retraction) and provides some resistance to lateral displacement.

Location: Lateral to joint, forms reinforcement of TMJ capsule

Question 9

Identify features, functions, and locations of the following anatomical components of the TMJ: Retrodiscal tissues

Answer 9

posterior to the disc, loose CT where the blood supply (external carotid artery) and nerve supply (V-trigeminal) innervate

Question 10

Identify features, functions, and locations of the following anatomical components of the TMJ: Ligaments: Sphenomandibular ligament

Answer 10

Function: Becomes taut when mandible is protruded; helps to control movement
Location: NOT PART of TMJ; Lies on medial side of mandible

Question 11

Identify features, functions, and locations of the following anatomical components of the TMJ: Ligaments: Stylomandibular Ligament

Answer 11

Function: Becomes taut when mandible is protruded; helps to control movement

Location: NOT PART of TMJ; connects styloid process of temporal bone to angle of mandible

Question 12

Describe each mandibular excursion and the muscles involved

Answer 12

Notability

Question 13

2 types of movement of TMJ

Answer 13

Gliding and rotational

Question 14

allows the mandible to move forward and backward (protraction and retraction)
Forward movement = protraction of the mandible
Backward movement = retraction of the mandible

Answer 14

gliding TMJ

Question 15

Occurs mainly between the disc and the condyle of the mandible in the lower synovial joint.
Allows for depression and elevation of the mandible.

Answer 15

Rotational Movement TMJ

Question 16

Hinge means

Answer 16

rotation

Question 17

Gliding means

Answer 17

translation

Question 18

Identify CN V (trigeminal nerve) and external carotid artery as the nerve and blood supply to the TMJ (to be elaborated on in additional lectures)

Answer 18

Innervation: Mandibular Branch (V3) of Trigeminal Nerve (CN V)

Blood supply: various branches of external carotid artery

Question 19

Recognize symptoms of TMD.

Answer 19

• Patients may present with problems in one or both of the TMJs (tempromandibular disorder = TMD)
• Symptoms may include:
  Chronic joint tenderness
  Swelling
  Popping and clicking in joint
  Limitation of opening, closing, lateral excursive movements, may or may not be with pain
  Headaches, most often frontal and temporal
  Fullness or stuffiness feeling within ears
  Sudden occlusal discrepancies including tooth mobility (no periodontal involvement) with wear facets
  Pain or spasm of muscles

Question 20

Recognize signs of TMD.

Answer 20

Clicking, popping, or grating sounds in the joint (crepitus)—should not rely on noise alone to diagnose TMD!
Deviation of joint when opening
Pt may report pain on opening or closing

Question 21

Describe the role of the dental hygienist in the examination, evaluation, and care of the TMD patient.

Answer 21

In your role as clinician, you will be called upon by patients to advise them regarding their TMJ issues. The dentist will need a solid review of the patient’s symptoms in order to advise them properly. A thorough extra-oral exam will give you some insight as to the extent of their problems: for instance, are both sides involved? Is it a distinct popping or clicking such as you would find with crepitus? Does the patient experience symptoms continually or intermittently? Does pain accompany the noise?

Question 22

EOE: Palpation of the TMJ
Palpating the joint while having the patient open and close will allow the clinician to tactilely observe popping
Audible popping or clicking (crepitus) may not be present, but you will be able to feel non-smooth movements in your fingertips
Auscultation utilizing stethoscope can provide additional information

Answer 22

Extra oral exam of the TMJ

Question 23

Additional tools to examine the TMJ

Answer 23

• Stethoscope (auscultation)

- Flexible ruler (measurement of opening ability)

Question 24

Three basic problems

Answer 24

Masticatory muscle disorder
Internal derangements
Combination of the above

Question 25

Not in objectives: ^ | Three basic problems

Answer 25

Masticatory muscle disorder Internal derangements Combination of the above

Question 26

^problem is located outside the fibrous capsule (myo=muscle)

Answer 26

Masticatory muscle-problem

Question 27

^Disc derangement- damage and displacement to the articular disc Dislocation (Subluxation)-partial or full dislocation of joint Hypomobility (Ankylosis) Hypermobility

Answer 27

Internal derangements

Question 28

^change or constriction of CT which leads to atrophy

Answer 28

Myofibrosis

Question 29

^Muscle pain

Answer 29

Myalgia

Question 30

^Spasm of muscles

Answer 30

Myospasm

Question 31

^Inflammation of muscles

Answer 31

Myositis

Question 32

^Etiology of TMD

Answer 32

- Spasms in neck muscles, the muscles of mastication, as well as malocclusion may cause pain in the TMJ - Disk derangement may produce clicking and popping sounds in the TMJ, limit movement, and cause pain on opening and closing - A hole or perforation in the disk my produce crepitus (grinding noise) - Some conditions, such as trauma or rheumatoid arthritis may be severe enough to cause fusion within the joint and prevent movement (ankylosis)

Question 33

^2 types of TMJ surgery

Answer 33

Arthroscopic surgery | direct surgical approach

Question 34

^Treatment Options

Answer 34

Dependent upon etiology, and can range from conservative care to complex surgery Treatment may include: Short-term non-steroidal anti-inflammatory drugs for pain and muscle relaxation Occlusal/bite guards (splint) Occupational Therapy/Physical therapy Stress management counseling, yoga, etc. Chiropractic treatment If non-surgical treatment is unsuccessful, or there is clearly joint damage, surgery may be indicated

Question 35

``` Chew on the affected side Limit opening to width of the thumb Moist heat Try not to sleep with the jaw deviated TMJ splint/occlusal guard Avoid clenching and grinding No chewing gum Avoid chewy or hard foods ```

Answer 35

^Pain relief suggestiions for patients

Question 36

Take frequent breaks (body position and comfort) Limited opening OHI with electric or children’s toothbrush, floss aids Limit duration of appointments Frequent appointments limits time in chair Night guards (slightly open is easiest on joint) Exercises (recommend OT/PT consultation) Medications pre and post (NSAIDS if med hx allows) Occlusal adjustments Orthodontics Surgery *Mouth prop can make it worse

Answer 36

^Clinical Care of Patients/Recommendations

Question 37

A site of function or union between 2 or more bones

Answer 37

Joint

Question 38

joint on each side of the head that allows the movement of the mandible faciliting speech and mastication

Answer 38

Temporomandibular joint

Question 39

Mandibular condyle and temporal bone are separted by the ____ ____ or miniscus

Answer 39

articular disc

Question 40

TMJ allows the condyle of the ___ to articulate with the glenoid fossa of the __ __

Answer 40

mandible | temporal bone

Question 41

Glenoid fossa aka

Answer 41

mandibular fossa | Articular fossa

Question 42

THE bony articulating surfaces of the TMJ are covered with a dense fibrous CT that has ___ ___ ___ ___ ___

Answer 42

no blood or nerve supply

Question 43

what movement occurs mainly between the disc and the condyle of the mandible in the lower synovial joint

Answer 43

rotational movement

Question 44

Innervation to TMJ | Blood supply to TMJ

Answer 44

Innervation Mandibular branch V3 of Trigeminal Nerve CN V

Question 45

A condition in which the patient opens his/her mouth too wide and is unable to close again; or in which closing the mouth causes a popping back into place Condyle glides too far forward and moves too far anterior to the height of the articular eminence (area of the temporal bone in front of the mandibular fossa) The patient is unable to close because the muscles are tyring to pull up and back which prevents the condyle from moving posterioralyu

Answer 45

Subluxation

Question 46

What is a long term treatment of subluxation

Answer 46

surgically decreasing the height of the articular eminence