TMJ & Disorders Flashcards
What are the 5 components of a synovial joint:
-synovial membrane
-fibrous capsule
-synovial fluid
-articular cartilage
-space
Temporal and mandible are _______ bones
condyle
TMJ disc is avascular except at ______ like other fibrocartilage
periphery
Functions of TMJ disc?
resists tension (primary)
resists compression (secondary)
TMJ has multiplanar movements. T or F
True
2 main muscles of the TMJ and where do they attach?
masseter and lateral pterygoid
attach to disc
The function of the masseter, lateral pterygoid, capsule condyle, and post. elastic ligament?
guides motion resists compression and provides stability
TMJ structures are MOSTLY innervated by what nerve?
Trigeminal N. branches
TMJ capsule is attached to:
mm. and disc
Ligaments that blends w/capsule prevent:
excessive motion
Resting or OPP of TMJ:
lips closed, teeth not touched, and tongue resting on roof of mouth
2mm overbite
2+mm overjet or overjet beyond overbite
CPP is _____________
unknown
Mandibular condyles may move ____________ OR ___________ directions
together in the same OR different directions
The condyle is convex-concave or concave-convex
convex-concave fossa -allows multiple functions
Motions of the TMJ:
depression, elevation, lat. deviation, protrusion, retrusion
Opening norms :
3 knuckles width
If only ≤ 1 knuckle, then:
urgent referral to dentist/oral surgeon
Opening: mandibular condyles glides_______ as mandible goes ________
anterior ; posterior
grinding and bilateral clicking on opening is abnormal. T or F
False; normal
Opening mm for TMJ:
digastric -main opener
lateral pterygoid
hyoids
Swallowing mm. for TMJ
hyoids - main movers
digatric- stabilize
Closing mm. for TMJ
temporalis
masseter
medial pterygoid
lateral pterygoid - pulls disc
closing: mandibular condyle glide _________ as mandible goes __________
posterior ; anterior
The Function of Lateral Deviation
mm.?
masseter
pterygoid -same side medial and lateral (primarily act to move mandible medial for grinding food)
temporalis
S&S of TMJ Disorder:
Oral habit hx
Thumb sucking -overbite, change teeth position
Nail/ice biter - excessive compression force
Excessive teeth grinder -AM HA that goes away; if HA from neck it would get worse with ADL
Gum/smokeless tobacco chewer
S&S of TMJ Disorder:
-Observation:
-_________ P! and/or __________
-Trigeminal S&S?
FHP
localized P!; crepitus
tinnitus, HA, toothache
EARLIER deviation WITH loss of functional opening:
of capsular patterns?
acute w/recent trauma:
(2)
-deviation toward P!ful TMJ due to inflammation and willingness to move (ACUTE)
EARLIER deviation WITH loss of functional opening
-chronic with fibrotic TMJ:
due to past trauma
-deviation away from hypermobile TMJ (click may happen @end range)
-accessory motion limited on side of deviation
EARLIER deviation WITHOUT loss of functional opening
-hx of _______ resulting in ______
-minimal to no ______ unless ______
-deviation _________from ________ hypermobile side
-______ at end range hypermobile side indicates ____________
past trauma ; greater laxity
P! unless irritated
away from UNILATERAL
Click; larger displacement
END RANGE deviation WITHOUT loss of functional opening
no ____ of trauma
minimal to no _____ unless irritated
gradual and less _______ developed BILATERALLY due _______
hx
P!
hypermobility ; FHP
Click @ end range indicates ______________
larger displacement
-condyle + displacement has too much motion
FHP influence
-increased tension and lengthening of:
digastric/hyoid mm. mouth opens
posterior elastic ligament
FHP influence
-anterior mandibular condyle displacement to disc
excessive glide forward
FHP influence:
- impaired ___________ of mm.
length tension
FHP assessment:
opening in neutral and FHP should be the same
swallow in neutral and FHP; no excessive neck motion
anterior displacement =
condyle ant. to the disc
Hx of ant. displacement:
prolonged opening (FHP, mouth breather)
trauma w/sudden opening
excessive opening(yawning/dentistry)
Ant. Displacement S&S:
full opening/nodeviation
likely P! and limitation on closing
Ant. Displacement Rx:
distx w/ post. glide to reposition mandibular condyle post.
Ant. displacement Rx: in hopes of reversing creep of capsule and ligament pt. should:
avoid wide opening with diet/yawning
correct posture
sleep with neck flexed and chin tucked
TMJ MET focus:
stabilization of TMJ and neck
Other clicks and signs of hypermobility: (3)
early clicking upon opening indicates - a small displacement
inconsistent clicking
reciprocal clicking (consistent) condyle moves ahead of the disc on opening and behind on closing
crepitus =
TMJ and/or disc damage
posterior displacement =
condyle posterior to the disc
hx of post. displacement:
trauma w/ sudden closing
S&S of post. displacement:
-likely P! and limitation on opening
-full closing
opposite of what creates the problem
Posterior displacement Rx:
-distx with ant. glide to reposition mandibular condyle ant.
-sleep w/small neck roll for slight neck ext. and opening
-avoid excessive or hard chewing/grinding
Possible cervical dysfunction relating to TMJ disorder is greater in the upper or lower cervical?
Upper
General PT Rx for TMJ Disorder:
POLICED
Postural edu.
Oral habit modification
Diaphragmatic breathing training
Activity modifications -diet, motion, sleep)
MT for TMJ:
JMs and neck hypomobility and displacement reduction
MET for TMJ:
-typically isometrics, plus neck exercises
-practice resting and talking with cork in btw teeth
Dentist and/or MD Rx for TMJ:
-Splints
-Orthodontics
-Sx
The prognosis for TMJ:
very good if proper mechanics posture and breathing patterns restored
