TMJ Flashcards
What are the 3 ligaments of the TMJ
- Temporomandibular Ligament
- Sphenomandibular ligament
- Stylomandibular ligament
Identify features, functions, and locations of the following anatomical components of the TMJ: Condyle
articulating head on the mandible
Identify features, functions, and locations of the following anatomical components of the TMJ: Articular eminence
protuberance on the inferior aspect of zygomatic process of temporal bone, anterior to glenoid (articular) fossa
Identify features, functions, and locations of the following anatomical components of the TMJ: Glenoid/articular/mandibular fossa
aka: Articular fossa or mandibular fossa)-posterior to the articular eminence, depression on temporal bone
Identify features, functions, and locations of the following anatomical components of the TMJ: Articular disc
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
Identify features, functions, and locations of the following anatomical components of the TMJ: Synovial function
The membranes that line the inside of the joint capsule secrete synovial fluid that aids in lubricating the joint and fills the synovial cavities.
Identify features, functions, and locations of the following anatomical components of the TMJ: Fibrous capsule
completely encloses the TMJ, keeping the synovial fluid confined to the joint
Identify features, functions, and locations of the following anatomical components of the TMJ: Ligaments: TMJ
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
Identify features, functions, and locations of the following anatomical components of the TMJ: Retrodiscal tissues
posterior to the disc, loose CT where the blood supply (external carotid artery) and nerve supply (V-trigeminal) innervate
Identify features, functions, and locations of the following anatomical components of the TMJ: Ligaments: Sphenomandibular ligament
Function: Becomes taut when mandible is protruded; helps to control movement
Location: NOT PART of TMJ; Lies on medial side of mandible
Identify features, functions, and locations of the following anatomical components of the TMJ: Ligaments: Stylomandibular Ligament
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
Describe each mandibular excursion and the muscles involved
Notability
2 types of movement of TMJ
Gliding and rotational
allows the mandible to move forward and backward (protraction and retraction)
Forward movement = protraction of the mandible
Backward movement = retraction of the mandible
gliding TMJ
Occurs mainly between the disc and the condyle of the mandible in the lower synovial joint.
Allows for depression and elevation of the mandible.
Rotational Movement TMJ
Hinge means
rotation
Gliding means
translation
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)
Innervation: Mandibular Branch (V3) of Trigeminal Nerve (CN V)
Blood supply: various branches of external carotid artery
Recognize symptoms of TMD.
- 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
Recognize signs of TMD.
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
Describe the role of the dental hygienist in the examination, evaluation, and care of the TMD patient.
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?
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
Extra oral exam of the TMJ
Additional tools to examine the TMJ
- Stethoscope (auscultation)
- Flexible ruler (measurement of opening ability)
Three basic problems
Masticatory muscle disorder
Internal derangements
Combination of the above
Not in objectives: ^
Three basic problems
Masticatory muscle disorder
Internal derangements
Combination of the above
^problem is located outside the fibrous capsule (myo=muscle)
Masticatory muscle-problem
^Disc derangement- damage and displacement to the articular disc
Dislocation (Subluxation)-partial or full dislocation of joint
Hypomobility (Ankylosis)
Hypermobility
Internal derangements
^change or constriction of CT which leads to atrophy
Myofibrosis
^Muscle pain
Myalgia
^Spasm of muscles
Myospasm
^Inflammation of muscles
Myositis
^Etiology of TMD
- 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)
^2 types of TMJ surgery
Arthroscopic surgery
direct surgical approach
^Treatment Options
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
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
^Pain relief suggestiions for patients
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
^Clinical Care of Patients/Recommendations
A site of function or union between 2 or more bones
Joint
joint on each side of the head that allows the movement of the mandible faciliting speech and mastication
Temporomandibular joint
Mandibular condyle and temporal bone are separted by the ____ ____ or miniscus
articular disc
TMJ allows the condyle of the ___ to articulate with the glenoid fossa of the __ __
mandible
temporal bone
Glenoid fossa aka
mandibular fossa
Articular fossa
THE bony articulating surfaces of the TMJ are covered with a dense fibrous CT that has ___ ___ ___ ___ ___
no blood or nerve supply
what movement occurs mainly between the disc and the condyle of the mandible in the lower synovial joint
rotational movement
Innervation to TMJ
Blood supply to TMJ
Innervation Mandibular branch V3 of Trigeminal Nerve CN V
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
Subluxation
What is a long term treatment of subluxation
surgically decreasing the height of the articular eminence
