TMJ Exam & Interventions

Question 1

Name 3 common functional limitations that pts will indicate in the pt interview.

Answer 1

Chewing
Eating
Talking
Sleeping
Work Tasks (clenching with prolonged sitting for example)

Question 2

Name 4 symptoms associated TMD.

Answer 2

1 Headaches (potential visual aura)
2 Dizziness/Nausea
3 Paresthsia/anesthesia
4 Tinnitus

Question 3

Name 3 OMs that evaluate TMD.
green leafy veggies for one

Answer 3

1) PSFS
2) Tampa Scale of Kinesiophobia for TMD
3) Temporomandibular Pain Disorder Screening Instrument

Question 4

You perform an intra-oral inspection and see this: What is this abnormality called?

Answer 4

Scalloping

(teeth indentation around tongue d/t tongue overworking to keep lower jaw in place)

Question 4

Part of a visual inspection is assessing these planes. Name each plane.

Answer 4

refer to pic

Question 5

Part of a visual inspection also is assessing the vertical division of the face. Name each division.

Answer 5

refer to pic

Question 6

What are 3 types of malocclusions?

Answer 6

1) open bite
2) retrognathism
3) prognathism

Question 7

Name this malocclusion.

Answer 7

retrognathism (overjet)

Overjet describes horizontal diff b/w rows of teeth. Overbite describes the vertical diff b/w rows of teeth

Question 8

Name this malocclusion.

Answer 8

prognathism (lower jaw protrusion)

Question 8

Proposed mechanism for fwd head posture involves passive tension by __ & __ muscles which alters position of __ & pulls the mandible inferiorly & postieriorly.

Answer 8

1&2) supra & infra-hyoid muscles
3) mandibular condyles/mandible

Question 9

Gross TMJ AROM includes opening, __, & __.

Answer 9

1) clenching
2) protrusion
don’t forget to look for joint noises & deviations/corrections (S & C curves)

Question 10

1) What can cause a C-Type curve?
2) What about S-Type curve?

Answer 10

1) ipsilateral joint hypomobility
2) muscular imbalance or medial displacement

Question 11

What TMJ motions are evaluated for ROM (not gross)?

Answer 11

Opening, protrusion, retraction, lateral deviation

Question 12

What are directions/glides you should examine for TMJ joint mobility? Which 2 can be done intra-orally + extra-orally?

Answer 12

1) caudal, ventral, medial, lateral
2) Medial and lateral glide

Question 13

Name 3 confirmation tests for TMD.

Answer 13

1) Auscultation of TMJ with stethoscope during AROM
2) Provocation Test: Retrodiscal Material
3) Unilateral tongue depressor biting

Question 14

How do you perform the provocation test for retrodiscal material?

Answer 14

-Unilateral in sequence: distraction, retrusion, cranial displacement, protraction
this causes compression of tissue b/w condyle & the fossa.

Question 15

During unilateral tongue depressor biting, ipsilateral provocation is d/t ___ loading/lesion (most likely caused by muscle stretch) or teeth pain. Contralateral provocation is d/t __ loading on the joint.

Answer 15

1) tensile
2) compression

Question 16

Interventions for TMD include reassuring the pt, occlusal appliances, and pt edu. Name 3 pieces of info you would include in pt edu?

Answer 16

1) Activity Modification: Avoid loading of the joint & control parafunction.
Ex: Sleep position, maintain resting position of TMJ, eating soft foods, avoid gum chewing
2) Diagnosis, Prognosis, Goals, POC
3) Relaxation Techniques

Question 16

Exercises for treatment include TMJ AROM, muscle coordination training, & NM ctrl exercises. What are 2 more exercises that may be used to treat TMD?

Answer 16

1) Postural: Mid & Lower trap, deep cervical flexor, & thoracic extensor coordination training
2) Upper quarter stretching (corner stretching, etc.)

Question 17

1) T/F: Most TMD patients may require surgery to intervention.
2) Name 2 surgeries these patients may undergo.

Answer 17

1) False (~20%)
2) Arthroplasty & Orthognathic surgery

Question 18

T/F: There is good evidence for tx of TMD by manual therapy combined with exercises.

Answer 18

True
LONG TERM, not short term tx!!