Tmd I

Front 1

The following muscles are active during jaw closure (elevation of the mandible) with the exception of:
a. superficial Masseter muscle
b. superior portion of Lateral Pterygoid muscle
c. inferior portion of Lateral Pterygoid muscle
d. Medial Pterygoid muscle
e. anterior portion of Temporalis muscle

Back 1

c. inferior portion of Lateral Pterygoid muscle

Front 2

The term “Temporomandibular Disorders” describes:
a. a pain in the TMJ due to infection or inflammation
b. psychological pain disorders
c. a group of disorders primarily involving the TMJs and/or the masticatory muscles
d. noises in the TMJs such as popping and clicking

Back 2

c. a group of disorders primarily involving the TMJs and/or the masticatory muscles

Front 3

The prospective longitudinal evaluation of the number of the cases acquiring a disease over a specific period.
a. Incidence
b. Cross-sectional Analysis
c. Prevalence
d. Outcome Assessment
e. Range

Back 3

a. Incidence

Front 4

During mandibular opening of a subject with healthy joints the articular disc follows the condyle in its movement as a result of:
a. contraction of the superior Lateral Pterygoid muscle
b. the biconcave morphology of the disc
c. the pull of elastic fibers in the bilaminar zone
d. a and b
e. b and c

Back 4

b. the biconcave morphology of the disc

Front 5

In the general, non-patient population:
Among the subjects presenting signs and symptoms of TMD, a small number consider their situation bad enough to seek treatment.

Back 5

True

Front 6

TMD has a multifactorial etiology:
Which means that the different factors should be evaluated in respect to their relative importance in each clinical case and addressed accordingly.

Back 6

True

Front 7

TMDs can be episodic and self-limiting or they may be progressive and disabling.

Back 7

True

Front 8

According to Dr. Bell - The most important single step in the management of
TM Disorders is:
a. Screening the patient for TMD
b. Completing the comprehensive History
c. Making an accurate Diagnosis
d. Completing the Clinical Examination

Back 8

c. Making an accurate Diagnosis

Front 9

There is good scientific data to prove the cause and effect relationships of specific
factors and the development of TM Disorders.

Back 9

False

Front 10

Those factors that increase the risk of a patient developing a TM Disorder are
called:

a. Initiating Factors
b. Predisposing Factors
c. Perpetuating Factors
d. Psychological Factors

Back 10

b. Predisposing Factors

Front 11

The causes of TM Disorders are:
a. Multifactorial
b. Complex
c. Individual – Patient specific
d. All of the above
e. None of the above

Back 11

d. All of the above

Front 12

The purpose of screening patients for TMD is to:
a. Identify the appropriate Tx for the TMD patient
b. Identify the cause of the pain
c. Identify patients with signs and symptoms of masticatory dysfunction
d. Identify the TM disorders that are present- diagnosis

Back 12

c. Identify patients with signs and symptoms of masticatory dysfunction

Front 13

The prevalence of TM Disorder in the general population is High. Every dental patient should be screened for TMD regardless of the need or lack of need for treatment.

Back 13

Both statements are true

Front 14

According to McNeil – The five most common findings for TMD include all of the following except:
a. Pain
b. Muscle tenderness to palpation
c. TMJ – sounds – clicking ,popping
d. Limitation of jaw movement
e. Subluxation/Dislocation
f. Referred Pain

Back 14

f. Referred Pain

Front 15

A complete examination of the Stomatognathic System includes:
a. Screening for TMD
b. Clinical exam of the teeth and periodontium
c. Analysis of the Dental Occlusion and Articulation
d. All of the above
e. a & b only

Back 15

d. All of the above

Front 16

A “symptom”:
a. has roughly the same significance as a “sign”
b. is a subjective manifestation of a disorder
c. is detected by clinical examination, imaging or measurement

Back 16

b. is a subjective manifestation of a disorder

Front 17

Myofascial pain is often characterized by all the following except:
a. Pain (local or generalized)
b. Deviation on opening
c. Limited range of motion
d. Psychophysiologic somatic expression
e. None of the above

Back 17

b. Deviation on opening

Front 18

A patient shows maximum opening of 32 mm. Vertical opening for this patient is:
a. normal
b. increased from normal
c. decreased from normal

Back 18

c. decreased from normal

Front 19

Pure rotational guided opening of the mandible, without translation, can occur up to:
a. 10 mm of opening
b. 16 mm of opening
c. 23 mm of opening (20-25)
d. 30 mm of opening

Back 19

c. 23 mm of opening (20-25)

Front 20

During a protrusive excursion, the mandibular condyles progress in which of the following directions?
a. forward and upward
b. forward and downward
c. backward and upward
d. backward and downward

Back 20

b. forward and downward

Front 21

The main signs and symptoms of TMD are:
a. Pain in the periauricular area, the ear and the face; joint sounds during mandibular movements; mandibular dysfunction
b. Pain in the periauricular area, the ear and the face; joint sounds during mandibular movement; occlusal disharmonies
c. Headaches; joint sounds during mandibular movement; occlusal disharmonies

Back 21

Pain in the periauricular area, the ear and the face; joint sounds during mandibular movements; mandibular dysfunction

Front 22

According to epidemiologic data presented by Okeson- what % of the population have signs and symptoms of dysfunction of the Stomatognathic System
a. 5-10%
b. 10-30%
c. 30-40%
d. 40-50%
e. 50-60%

Back 22

e. 50-60%

Front 23

With pain disorders – as much as 70-80% of the information needed to make a diagnosis will come from the:
a. TMD Screening
b. TMD History
c. TMD Exam
d. Mounted Study casts
e. All of the above

Back 23

b. TMD History

Front 24

The effectiveness and success of treatment for patients with TMDs rests in the ability of the dentist to arrive at the correct diagnosis.
a. True
b. False

Back 24

a. True

Front 25

Among the various Temporomandibular Disorders, which muscle disorder(s) is (are) considered to be a normal physiologic response?
a. Myalgia
b. Local Muscle Soreness
c. Myofacial Pain
d. Protective Co-contraction
e. All of the above

Back 25

d. Protective Co-contraction

Front 26

Emotional Stress can be an initiating and perpetuating factor in which TMD(s)?
a. Local Muscle Soreness
b. Myofacial Pain
c. Protective Co-contraction
d. All of the above

Back 26

d. All of the above

Front 27

When antagonistic muscles fire during jaw movement in an attempt to prevent injury or to protect and injured part – The diagnosis is:
a. Local Muscle Soreness
b. Myofacial Pain
c. Protective Co-contraction
d. Centrally mediated myalgia
e. Myospasm

Back 27

c. Protective Co-contraction

Front 28

When examining a patient for range of motion – the patient can open 35 mm without pain but can open 45 mm with gentle stretching of the muscles that close the jaw.
1. This is described as a “soft end feel”
2. This condition is usually associated with TM muscle disorders
b. Both statements are true
c. Both statements are false
d. Statement #1 is true, Statement #2 is False
e. Statement #2 is true, Statement #1is False

Back 28

b. Both statements are true

Front 29

Supportive Therapy is helpful in managing numerous TMDs and includes the following item(s):
a. Hot/Cold Compresses – as needed
b. Narcotic analgesics or muscle relaxants– short term
c. Restricted jaw movement and Soft Diet
d. Some of the above
e. All of the above

Back 29

e. All of the above

Front 30

Protective co-contraction is a CNS induced muscle response.
Local Muscle soreness is a change in the local muscle tissues.
a. Both statements are true
b. Both statements are false
c. Statement #1 is true, Statement #2 is False
d. Statement #2 is true, Statement #1is False

Back 30

a. Both statements are true

Front 31

Unaccustomed use or overuse of a muscle and increased levels of emotional stress is associated with which TMD?
a. Myospasm
b. Local Muscle Soreness
c. Myofacial Pain
d. Protective Co-contraction
e. Centrally Mediated Myalgia

Back 31

b. Local Muscle Soreness

Front 32

Disc displacement with reduction is not always painful

Back 32

True

Front 33

A patient who complains of sudden limitation of mouth opening, acute pain, deviation to the painful side on opening, and has a history of clicking, but no TMJ noise at the time of the examination, is likely to suffer from:

Back 33

Disc dislocation without reduction

Front 34

Osteoarthrosis is a condition:

Back 34

True
When bony changes are active, the condition is called osteoarthritis. As remodeling occurs the condition can become stable, yet the bony morphology remains altered. This condition is referred to as osteoarthrosis.

Front 35

You have been performing an operative procedure that has lasted longer than you expected. When you remove the rubber dam you ask the patient to close gently in order to adjust the occlusion on the freshly placed restoration. The patient cannot close her mouth or talk and she lets you know that it hurts. The most likely diagnosis is:

Back 35

Bilateral anterior condyle dislocation over the articular emminence

Front 36

The term “closed lock” is synonymous to:

Back 36

Anterior displacement without reduction

Front 37

A 35 year-old female presents with bilateral TM joint pain, maximum opening of 25mm, crepitus, and she reports pain and dysfunction of other joints. She also complains that a “space” is present between her upper and lower front teeth that is progressively getting worse and that was not there 3-4 years ago. The most likely diagnosis is:

Back 37

Rheumatoid arthritis

Front 38

A patient with a disc-interference disorder presents in your office. When the patient is asked to open her mouth, a deviation in opening occurs at 12 mm. Upon closure, a deviation can be observed at 12-mm inter-incisal distance. The most likely diagnosis is:

Back 38

Deviation in form (alteration in opening occurs at same point during opening and closing)

Front 39

In a typical case of disc displacement with reduction, the following statements apply:
a. History of trauma to the joint is common?
b. Reciprocal clicking is present?
c. Clicking is always painful?

Back 39

Yes
Yes
No

Front 40

Which of the below represent diagnostic criteria of Osteoarthritis?
a. Inflammation?
b. Crepitus?
c. Radiographic evidence of structural bony change?
d. Absence of pain?

Back 40

Yes
Yes
Yes
No

Front 41

Which items represent diagnostic criteria of Osteoarthrosis?
a. Inflammation?W
b. Crepitus?
c. Radiographic evidence of structural bony change?
d. Absence of pain?

Back 41

No
Yes
Yes
Yes

Front 42

TMD is as complex disorder that often has a multi-factorial etiology.

Back 42

True

Front 43

Increased levels of emotional stress can affect muscle function.

Back 43

True

Front 44

Treatment that is intended to directly eliminate or alter the causes of a disorder is called:

Back 44

Definitive Treatment

Front 45

TMD patients can have more that one disorder at a time.
One TM disorder can contribute to the development or perpetuation of another disorder.

Back 45

a. Both statements are true

Front 46

Treatment that results in permanent changes is considered:

Back 46

Surgical

Front 47

The following personality trait is most likely to develop TMD:

Back 47

Charlie Brown, or other emotionally stressed out individuals.

Front 48

An essential component of treatment for the TMD patient is to establish a patient awareness of:

Back 48

Emotional Stress and Muscle Hyperactivity

Front 49

Testing for levels of anxiety, frustration and anger is helpful in selecting the appropriate treatment for the TMD patient.

Back 49

While TMD patients are more likely to have anxiety, frustration and anger, testing for these conditions is not beneficial when selecting appropriate treatment.

Front 50

A technique that assists the patient in regulating bodily functions that are normally controlled unconsciously is called:

Back 50

Biofeedback or Physical Self Regulation

Front 51

Treatment that is directed al altering the patient’s symptoms and often has no effect on the cause of the disorder is called:

Back 51

Supportive Treatment

Front 52

Treatment for TMD may include postural training

Back 52

True (A forward head posture can lead to muscular and cervical symptoms. Training the patient to keep the head in a more normal relationship with the shoulders may be helpful in reducing TMD symptoms)

Front 53

The initial response of a muscle to altered sensory or proprioceptive input, to injury or to the threat of injury is called:

Back 53

Protective co-contraction or protective muscle splinting

Front 54

Among the TMD, which muscle disorder is considered a physiological and non-pathological response

Back 54

Protective Co-Contraction

Front 55

Protective co-contraction is a CNS induced muscle response.
Local muscle soreness is a change in the local muscle tissues.

Back 55

Both statements are true

Front 56

A history of increased emotional stress can be associated with which TMDs:

Back 56

Protective co contraction
Local muscle soreness
Myofacial pain
Nocturnal bruxism

Front 57

What is your diagnosis for a patient who has:
-Decreased range of motion – soft end feel
-Minimal pain at rest
-Increased pain to function or parafunction
-patient says muscles feel “tired”

Back 57

Protective Co-Contraction

Front 58

What is your diagnosis for a patient who has:
-Marked decrease in the range of motion
-Minimal pain at rest – increased pain with function
-Muscle weakness present
-Tenderness to palpation of muscle

Back 58

Local Muscle Soreness

Front 59

What is your diagnosis for a patient who has:
-A decrease in the range of motion
-Referred pain is present – even at rest
-Decreased velocity of jaw movement
-Trigger points – provocation increases the referred pain

Back 59

Myofacial Pain

Front 60

If a patient has been diagnosed with local muscle soreness and has not improved after 3-4 weeks of supportive and conservative therapy, you should:

Back 60

Reevaluate Your Diagnosis

Front 61

If a TMD patient with local muscle soreness awakes with significant pain and has minimal or no pain by the afternoon or evening, which treatments would be the most appropriate initially:

Back 61

Nightguard

Front 62

Only joint sounds associated with pain should be considered for treatment.
a. True
b. False

Back 62

a. True

Front 63

Success in treatment of TMJ disorders depends upon:
a. Implementation of conservative therapy
b. Realizing that these disorders are self-limiting and resolve with time
c. Making the correct diagnosis
d. Understanding the natural course of the disorder
e. c and d above

Back 63

e. c and d above

Front 64

This TMJ disorder represents an early stage of disc derangement problems:
a. Adhesions
b. Disc displacement with reduction
c. Disc displacement without reduction
d. Disc perforation
e. None of the above

Back 64

b. Disc displacement with reduction

Front 65

Derangements of the condyle-disc complex are caused by:
a. Macro-trauma
b. Bruxism
c. Orthopedic instability
d. Hypoxia-perfusion injuries
e. all of the above

Back 65

e. all of the above

Front 66

A patient has a reciprocal click in the right TMJ following a recent fall. It is painful to eat and talk and is not getting better. Treatment should include
a. Anterior positioning splint
b. Stabilization splint
c. Pivoting splint
d. Soft diet, NSAIDs, Patient education
e. a and d

Back 66

e. a and d

Front 67

The cause of disc dislocation with reduction is trauma [macro or micro]
The cause of disc dislocation without reduction is trauma [macro or micro]
a. Both statements are true
b. Both statements are false
c. First statement is true; Second statement is false
d. Second statement is true; First statement is false

Back 67

a. Both statements are true

Front 68

A patient with a recent sudden limitation of jaw opening following a history of clicking and catching in the left TMJ but presents without joint sounds is consistent with this diagnosis.
a. Disc dislocation with reduction
b. Disc dislocation without reduction
c. Myofacial pain
d. Local muscle soreness

Back 68

b. Disc dislocation without reduction

Front 69

A patient with a limitation of jaw opening [25mm] and restricted movement to the right side with normal movement to the left side and the absence of joint sounds is consistent with this diagnosis.
a. Disc dislocation with reduction
b. Disc dislocation without reduction
c. Myofacial pain
d. Local muscle soreness

Back 69

b. Disc dislocation without reduction

Front 70

A patient presents to your office with a “Closed Lock”. Manual distraction of the TMJ to reduce a displaced disc is appropriate:
a. At any time
b. Within 1 week of the dislocation
c. Within 2 weeks of the dislocation
d. Within 3 weeks of the dislocation
e. Manual distraction is not indicated for this disorder

Back 70

b. Within 1 week of the dislocation

Front 71

A patient presents to your office with a “Closed Lock”. Definitive treatment could include:
a. Manual manipulation
b. Anterior Repositioning Splint
c. Surgical TMJ Therapy
d. Supportive Therapy
e. All of the above except b

Back 71

e. All of the above except b

Front 72

Perforation of the articular disc can be visualized best by means of:
a. Transcranial radiograph
b. Panoramic view
c. Arthrography
d. MRI

Back 72

c. Arthrography

Front 73

It is feasible to visualize the articular disc with all the techniques mentioned below, except:
a. MRI
b. Arthroscopy
c. Arthrography
d. Tomography

Back 73

d. Tomography

Front 74

When the disc-condyle complex is to be evaluated, the least invasive technique to be used is:
a. MRI
b. Arthroscopy
c. Arthrography

Back 74

a. MRI

Front 75

Which of the following techniques does not use ionizing radiation?
a. Transcranial projection
b. Arthroscopy
c. Arthrography
d. Corrected Tomography

Back 75

b. Arthroscopy

Front 76

Which of the following statements about MRI is wrong:
a. It allows us to visualize disc perforation
b. It uses non-ionizing radiation
c. It allows visualization of disc position and morphology
d. It is a non-invasive procedure

Back 76

a. It allows us to visualize disc perforation