TMJ dysfunction Flashcards
TMJ joint - convex articular condyl of the manidble and the concave articular fossa on the squamous portion of the temporal bone make up this ____ joint
gliding
3 parts of meniscus of teh TMJ
thick anterior band
thin intermediate zone
thick posterior band
when the mouth is closed, the condyle is separated from the articular fossa of the temporal bone by
the thick posteiror band portion of the meniscus
when the mouth is open, the condyle is separated from the articular eminence of the temporal bone by
the thin intermediate zone
muscles the depress the mandible INITIALLY
digastric
suprahyoid
opens the mouth
infrahyoid stabilizes the hyoid
move mandible lateral and forward to the right
left lateral and medial pterygoids
close jaw tightly
temporalis
masseter
medial pterygoid
approximates lips and compresses cheeks
buccinator
protrudes lower lip (pouting)
depressor labii inferior
draw corner of the outh down in a frown
depressor anguli oris and platysma
draws tip of chin upwards
mentalis
approximates and compresses lips
orbicularis oris
protrudes upper lip
zygomatic minor
lifts upper border of lip one side without raising lateral angle
snarl
levator anguli oris
raises lateral angle of the mouth into a smile
zygomaticus major
approximates lips and draws lips and corners lateral into a grimace
risorius
signs/symptoms of TMJ disorder
pt may c/o cephalgia, jaw problems, dull ache worse with chewing, tinnitus
difficulty opening mouth - click, crepitans
lateral deviation ofjaw
spasm within facial muscles
onset of TMJ may correspond with onset of stress
ear discomfort
types of TMJ dysfunction
opening click
closing click (reciprocal)
inability to fully open jaw (close-locked)
inability to close if TMJ symptoms are bilateral
creptius and grating
fusion of the joints (ankylosis)
causes of click
ALMOST ALWAYS D/T DISC DISPLACEMENT
also - adhesions, uncoordinated muscle action of pterygoids, tear or perforation fo disc, osteoarthritis, occlusion imbalances
etiology of TMJ SD
trauma - direct/whiplash/third molar extraction/intubation
direct blow to closed mouth === ____ injury
posterior capsule injury
maloclussions a 2a 2b 3
1 - 1st molar normal, problem elsewhere for malocclusion
(crowded)
2a - lower 1st molar posterior to upper - RETRUSION
2b - lower 1st molar posterior to upper to great degree - GREATER RETRUSION - OVERBITE
3 - lower 1st molar anterior to upper mandibular protrusion - UNDERBITE
mood disorders assocaited with TMD
anxiety
depression
PTSD
history of abuse
endocrine causes of TMD
hypocalcemia
chvostek sign and trousseaussight
intracapsular causes of TMD
infection RA OA gout metastatic CA articular disc displacements
extracapsular causes of TMD
myofascial pain of masticatory msucles
TMJD is NIH term for TMD
factors NOT associated with increased risk of TMD
genetics
orthodontics
epi of TMD
20% of americans affected
more common in young women
#2 cause of facial pain
patients with whta dz are more likely to develop TMD
RA
prevalence for TMD comorbidity 53-94%
OSE for TMD includes
cranial C spine scoliosis leg length innominate, sacrum, si
evaluation of TMJ
palapate joints for crepitans/click
palpate masticaitno muscles w/ 2-3 lbs of pressure
check range of motion
active - pt opens mouth 3-6 cm laterally 1-2 cm, retract and protrudes mandible
observe jaw movements for deviation
when should you suspect TMD
abnormal mandibualr movements decreased ROM of TMJ muscles of mastication tenderness pain with dynamic loading bruxism postural asymmetry neck and shoulder tenderness normal CN exam
are radiological exams usually needed
no
only use when supsecting dental problems, severe symptoms that dont imrpove with conservative tx, alternative cause suspected, recent/severe trauma
what is the radiological exam of choice for examining the TMJ
MRI
how might the CBT effect chronic TMJ
reduces activity interference, pain and depressino at 1 year
TMJ level 2 interventions
amitriptyline glucosamine suflate for OA bendoziazepine botox acupuncture OMT therepeutic exercise phsycial self regultaion cognitive behavrioal skills training plus biofeedback oral habit reversal treatment hypnorelaxation NSAIDs
TMJ level 3 interventions
OMT - biofeedback alone
surgery - arthrocentesis/scopy/orthgnathic surgery/joint replacement
occlusal splints/mouth guard
intra-articular corticosteroid injection
what is the rule of thumb for the distance the jaw should be able to open
enought to fit the index and middle finger knuckles between the teeth
most important part of a holistic approach to treating TMD
eliminate jaw stress
