TMJ dysfunction

Question 1

What nerve is TMD pain referred along and therefore what can it be mistaken for?

Answer 1

The auricolotemporal nerve and can be mistaken for ear pain

Question 2

What muscle is attached to the TMJ and helps with the translation movement?

Answer 2

Lateral pterygoid

Question 3

What is the term used to describe a patient when their articular disc moves too far anteriorly and doesn’t pop back into place?

Answer 3

Anterior disc displacement without reduction

Question 4

For anterior disc displacement with reduction, what sound would the patients TMJ make clinically?

Answer 4

A clicking sound

Question 5

What can be the main attributing reason (anatomically) as to why a patient’s isn’t moving as it normally should?

Answer 5

The loss of elasticity of the bilaminar zone

Question 6

What are some degenerative diseases which can cause TMD?

Answer 6

localised osteoarthritis
Rheumatoid arthritis

Question 7

When assessing a patient with TMD, the social history is very important. What are some questions that would be useful to learn the answers to?

Answer 7

Are they in a highly stressful time in their lives? job death etc?
Opera singers
Musical instruments

Question 8

In an E/O exam what would be the key things to be looking for?

Answer 8

Muscles of mastication
TMJ clicking with pain
TMJ crepitus (crunching sound, a key sign of degeneration of the joint)
Jaw movements
Asymmetry
Signs of parafunction mesenteric hyperplasia

Question 9

In an I/O exam what would be the key things to be looking for?

Answer 9

Signs of parafunction habits
- linea alba
- check biting
- tongue scalloping
-occlusal NCTSL

Question 10

What are some examples of Conservative Temporomandibular Dysfunction Advice?

Answer 10

• Soft Diet
• Masticate bilaterally
• Avoid wide opening
• Avoid chewing gum
• Avoid incising food – chop it up!
• Stop nail biting and grinding
• Stop chewing gum
• Putting head to the chest on yawning
• Bung a scarf on – more blood flow so less pain.
• Hot and cold on face

Question 11

What type of medications can be prescribed for TMD?

Answer 11

NSAID - ibuprofen (stopping inflammation)
Diazepam - relax muscle
Tricyclic antidepressants
steroids and botox of masseter

Question 12

What dose of ibuprofen would you prescribe for TMD and for how long?

Answer 12

400mg (2x200mg tablets) 3x daily for 2 weeks

Question 13

Examples of any physical therapy used for TMD?

Answer 13

Massage
Heat packs
Relaxation

Question 14

Which type of splint is thicker Essex or Michigan?

Answer 14

Michigan