TMJ Disorders Flashcards
Whats TMJ?
A bilateral synovial joint formed by the articulation of the temporal bone of the cranium and the mandibular condyle.
What movements are performed by TMJ?
Hinge type
Gliding Movements
Define Articular Disc and some of its anatomy?
A fibrocartilage disc made up of dense collagen fibres and occupies the space between the fibrocartilage coverings of the condyle and the mandibular fossa.
It is primarily avascular and has little sensory nerve innervation.
It is attached by ligaments to the medial and lateral aspects of the condyle.
The normal disc is thinnest in the intermediate zone and thickens to form anterior and posterior bands.
Whats retrodiscal tissue?
Mass of soft tissue occupying the space behind the disc and the condyle and is referred to as the posterior attachment.
It has superior and inferior lamina
Unlike the articular disc Retrodiscal tissue is ……. and …..
Vascular And Highly Innervated
What are Temporomandibular Ligaments?
CAPSULAR LIGAMENT
LATERAL TEMPOROMANDIBULAR LIGAMENT
SPHENOMANDIBULAR LIGAMENT
STYLOMANDIBULAR LIGAMENT
Muscles Of Mastication?
MAJOR?
Masseter,Temporalis,Medial Pterygoid,Lateral Pterygoid
Muscles Of Mastication? MINOR?
Contraction of the anterior belly of diagastric produces depression and the retropositioning of the mandible.
Mylohyoid and geniohyoid also contribute to depressing and retrusion of the mandible.
Buccinator helps positioning the cheek during chewing movements.
Whats Vascular Supply Of masticatory system structures?
External carotid artery
Bifurcates at the level of condyle into the superficial temporal and internal maxillary artery which supplies the muscles of mastication and the TMJ
Whats the nerve supply of TMJ?
Mandibular Division of Trigeminal Nerve (V3)
│
├── Motor Innervation
│ ├── Muscles of Mastication
│ └── Anterior Belly of Digastric
│
└── Sensory Innervation to TMJ
├── Auriculotemporal Nerve (MN)
│ └── Sensory to TMJ
└── Deep Temporal & Masseteric Nerves
└── Sensory to Anterior Portion of TMJ
Whats the maximum opening of the mouth?
40 to 45mm
Whats Freeway space?
The normal freeway space (also called interocclusal rest space) during TMJ resting is typically about:
👉 2 to 4 mm
This is the small vertical space between the upper and lower teeth when the mandible is at rest — meaning the muscles are relaxed and the teeth are not in contact.
ARTICULAR COVERING: It is thickest at the areas of greatest functional load T/F?
T
Cause Of Disc Displacement is ?
Injury to the inferior lamina of the posterior attachment is thought of as the cause of disc displacement.
Symptoms during TMDS?
->JOINT NOISES: TMJ clicking might be due to ADD, condylar hypermobility, enlargement of the lateral pole of the condyle, structural irregularity of the articular eminence, loose intra-articular bodies, and dysfunctional movement patterns or inco-ordination.
->NERVE ENTRAPMENT
->EAR SYMPTOMS ASSOCIATED WITH TMDs: Ear ache, tinnitus, and fullness or a feeling of stiffness.
Etiology of TMDs?
->Premature occlusal contacts
->Masticatory muscle hyperactivity- sleep bruxism and awaking parafunction
->Parafunctional behaviors
->Psychological distress
->Trauma
->Rheumatic disorders
TMDS are common is males T/F?
F
TMDs are most prevalent between the ages of
20-40 YEARS
The most common symptoms related to TMD is ——-. Other complains include
PAIN
restricted jaw movement, painful or loud TMJ clicking or crepitus, and jaw locking.
Problem List of Domains and Specific Factors Contributing to Persistence and Symptom Amplification in Temporomandibular Disorders
Lifestyle Factors:
Diet
Sleep
Alcohol
Smoking
Overwork
Emotional Factors:
Prolonged anger
Anxiety
Excessive worry
Depression
Cognitive Factors:
Negative self-image
Unrealistic expectations
Inadequate coping
Other illnesses
Biologic Factors:
Past trauma
Past jaw surgery
Social Factors:
Work stresses
Unemployment
Family stresses
Litigation
Financial difficulty
T/F Masticatory muscle tenderness on palpation is the most consistent examination feature present in TMDs.
?
T
Physical Examination of TMDS include?
Inspection, Mandibular Range Of motions, TMJ NOISES, Palpation for pain,assessment for consequences because of parafunctional habits, Intraoral Examination (for attrition , scalloped tongue margins)
Difference between Remission,Persisting and recurring symptoms?
Sure! Here’s a breakdown of the terms remission, recurring symptoms, and persisting symptoms, especially as they’re used in medical or clinical contexts:
✅ Remission
- Definition: A period during which symptoms of a disease reduce or disappear completely.
- Can be:
- Partial: Some symptoms remain but are less severe.
- Complete: No signs or symptoms are present.
- Common in: Chronic conditions (e.g., cancer, autoimmune diseases, TMJ disorders)
> 💡 Example: A TMJ disorder patient may experience remission where jaw pain and clicking temporarily disappear.
🔁 Recurring Symptoms
- Definition: Symptoms that go away and come back over time.
- The condition may seem controlled for a while, but symptoms reappear later (also called relapsing).
- Often seen in: Migraines, herpes, chronic TMJ dysfunction
> 💡 Example: Jaw pain flares up every few months after periods of relief — this is a recurring symptom pattern.
📌 Persisting Symptoms
- Definition: Symptoms that do not go away and are constantly present.
- Indicates a chronic or ongoing condition.
- Requires long-term management.
> 💡 Example: Continuous jaw stiffness and pain for several months without relief = persisting symptoms.
Let me know if you want these in chart or table form for quick reference!
Whats the management of Myalgia and myofascial pain of Muscles?
Education and information
Self management:
muscle stretching,
use of thermal agents,
avoidance of strain or overuse while chewing.
Parafunctional behavior control
Physiotherapy: active and passive modalities (ultrasound, cold laser, and transcutaneous electrical nerve stimulation)
Drugs for TMDS?
NSAIDs, acetaminophen, muscle relaxants, anxiolytics, tricyclic anti-depressants.
Acetaminophen is preferred over NSAID because of less side effects.
Tricyclic antidepressants are prescribed in night because of its side effect: DROWSINESS
Whats management of TMDS?
Intra oral appliances: splints, orthotics, orthopaedic appliances, night guards, bite guards
Pharmacotherapy: NSAIDs, acetaminophen, muscle relaxants, anxiolytics, tricyclic anti-depressants.
Behavioral therapy: relaxation techniques (autogenic training, meditation, progressive muscle relaxation), biofeedback, hypnosis, CBT
Trigger point therapy: spray and stretch therapy, injection of local anesthetic
Restorative dental procedures in TMD patients
Most common disc displacement is ——— TO the condyle
Anterior And Medial
Types Of Articular Disc Disorders (ADD)based on stages?
ADD with reduction
ADD with intermittent locking
ADD without reduction
Whats ADD With reduction and its management?
An articular disc that has been displaced from its position on top of the condyle.
The disc is displaced (commonly anteriorly) but returns to its normal position during jaw opening.
almost normal mouth opening
Clicking and popping sounds during all mandibular movements.
Repositioning and restabilization splints.
Whats ADD without reduction/Closed lock and its management?
The disc remains displaced and does not return to its normal position during jaw movements.
Clinical Signs:
Limited mouth opening (often <35 mm).
Deviation of the jaw toward the affected side upon opening.
Absence of joint sounds.
Goals of successful treatment are to eliminate pain, restore function, and increase the range of mandibular motion.
Occlusal stabilization appliance, medications, arthrocentesis, arthroscopy.
Whats arthrocentesis and arthroscopy?
Sure! Here’s a quick summary of arthrocentesis vs arthroscopy for TMJ:
🟦 Arthrocentesis
- What it is: Joint lavage (washing) using two needles.
- Purpose: Removes inflammation, improves mobility.
- Anesthesia: Local.
- Use when: Early TMJ issues like disc displacement without reduction (closed lock).
- Pros: Simple, outpatient, low risk.
🟩 Arthroscopy
- What it is: Minimally invasive surgery using a tiny camera and tools.
- Purpose: Diagnoses and treats joint problems directly (e.g., disc repositioning).
- Anesthesia: General.
- Use when: Persistent or complex TMJ problems not resolved by arthrocentesis.
- Pros: Direct view of joint, broader treatment options.
Let me know if you want a visual version or flashcard-style notes!
Explain Posterior Disc Displacement?
Condyle slipping over the anterior rim of the disc and it being caught and brought backward.
Prevents full mouth closure
Sudden inability to achieve maximal occlusion
Pain in the affected joint
Forward displacement of the mandible
Restricted lateral movement
No restriction of mouth opening
Jaw clicking————->_____
Jaw Locking————>______
AD with reduction
AD without reduction
Degenerative joint diseases,types,risk factors, thier symptoms, findings?
A disorder of articular cartilage and subchondral bone, with secondary inflammation of the synovial membrane.
Can be categorized as primary or secondary
Risk factors include gender, diet, genetics and psychological stress.
Pain over the condyle, limitation of opening, crepitus, stiffness AFTER INACTIVITY
Narrowing of the joint space, , irregular joint space, flattening of the articular surfaces, osteophyte formation, anterior lipping of condyle, subchondral cysts
Rhematoid Arthritis Of TMJ?
Primarily affects periarticular tissue and secondarily bone
Involved bilaterally
Morning stiffness, joint sounds, tenderness and swelling in the area.
Uncommon benign disorder characterized by synovial metaplasia and presence of multiple cartilaginous nodules of synovial membrane that free float in the joint.
Synovial chondromatosis
Causes of septic arthritis?
Previously existing joint disease, diabetes, immunosuppressive drugs, long term corticosteroid use, infections.
Gonococci, Staphylococcus aureus
Septic arthritis featurers and signs and symptoms?
Trismus, deviation of the mandible, severe pain on movement, inability to occlude.
Redness and swelling, large, tender cervical lymph nodes
Culture
Osteomyelitis of the temporal bone, BRAIN ABSCESS, and ankylosis.
Management of septic arthritis ?
Surgical Drainage, Joint Irrigation, Antibiotics
In TMDS what are developmental disturbances?
Condylar hyperplasia
Condylar hypoplasia
Agenesis of the condyle
Pain and edema over the joint area and limitation and deviation on opening to the injured site.
in ——— TMDS
Fractures
Management Of chronic recurring TMJ dislocations?
bone grafting to the eminence, lateral pterygoid myotomy, eminence reduction, eminence augmentation, shortening the temporalis tendon, plication of the joint capsule, repositioning of the zygomatic arch.
Ankylosis and its management?
Fusion of the head of the condyle to the temporal bone
Limited mandibular movement, deviation of the mandible to the affected side on opening, and facial asymmetry.
Gap arthroplasty using interpositional materials between cuts
Whats Oral Dyskinesia And Dystonia and its management?
Abnormal, involuntary movements of the tongue, lips and jaw.
Complete loss of teeth, ill fitting dentures, lack of replacement.
Emphasis is on management.
Oromandibular dystonia produces involuntary and excessive contractions of tongue, lip and jaw muscles.
Botulinum toxin and neurosurgical intervention
