Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
96 Cards in this Set
- Front
- Back
|
lateral movement - normal adult range and limited
|
normal = 9-10 mm
<8 mm = limited |
|
|
opening movement
|
40-60 mm
6 yr old kids need to compensate for vertical overlap and opening movement is typicall >40 mm |
|
|
opening movement pathology;
1- if <40 mm ... 2- if 10-40 mm ... 3- 25-30 mm unilateral ... |
1- restricted opening
2- muscular restriction 3- intracapsular locking |
|
|
potential traumatic injury sites that can lead to TMD - macro trauma
|
mucosa
buccinator muscle medial ptyergoid |
|
|
micro trauma examples that lead to TMD
|
parafunction
bruxing lip biting nail biting extensive dental procedures |
|
|
TMD and Occlusion - what is the link
|
-recent studies (Sept 2009) do not strongly support role of occlusion as primary etiology of TMD
-extensive vertical overlap of anterior teeth is associated w/ joint sounds and masticatory muscle tenderness -reduced overbite (ant. open bite) is associated w/ condylar changes and w/ rheumatoid arthritis -unilateral max posterior lingual crossbite is more common in TMD pts |
|
|
components of TMJ stability
|
1. teeth - MICP
2. muscles of mastication - temporalis, masseter, lateral pterygoid, medial pterygoid (all brace condyle in Anterior/Superior position) 3. temporomandibular disc - dense collagenous connective tissue; thick posterior/anterior w/ thin intermediate zone 4. ligaments - restrict excessive mandibular posterior movement; prevent excessive rotation and forces translation on wide opening 5. soft and hard tissue - retrodiscal tissue or bilaminar zone |
|
|
what is the most optimal position of the TMJ
|
Centric Relation -relation of mandible to cranium when condyles articulate w/ thinnest avascular portion of their respective discs in their most anterior superior position against the slopes of the articular eminence regardless of tooth contact
-extremely stable position even under considerable joint stress; repeatable over defined treatment period |
|
|
what is MICP
|
the complete intercuspation of the opposing teeth independent of condylar position
|
|
|
tooth wear factors
|
attrition - tooth/tooth
erosion - tooth/chemical abrasion - tooth/mechanical abfraction - occlusion? theoretically |
|
|
reasons for occlusal appliance therapy
|
-decrease parafunctional activity
-treat muscle hyperactivity -fixed prosthodontics w/ treatment position at centric relation |
|
|
non-TMD conditions that cause TMD like symptoms
|
1. vasculitis - inflammation of blood vessels; if temporal arteritis seems like TMD; early detection and immediate treatment to prevent vision loss; FEVER, anemia, fatigue, weight loss are TMD distinguishing features
2. neurogenic pain disorder/atypical odontalgia - tooth is very painful, but no apparent reason why (even after clinical exam); often tooth is "treated" (RCT or extraction) only to have pain return later; try nerve block and if no pain reduction or results are ambiguous...atypical odontalgia considered |
|
|
protective co-contracting (muscle splinting)
|
-central nervous system response to injury or threat of injury
-activity of muscles is altered to protect injured site -occurs when CNS increases activity of antagonist muscles during contraction; elevator muscles contract to prevent opening, depressor muscles contract to prevent closing -dental example: high restorations, pericornitis (3rd molar inflammation) -etiology: constant deep pain, inc. emotional stress |
|
|
TMD caused by local muscle soreness: etiology and treatment
|
etiology: change in environment, protective co-contration, trauma, bruxing, gum chewing
treatment - occlusal appliance to keep teeth apart at night, and tell pt to keep teeth apart in day (rest the muscles) |
|
|
myofascial pain - trigger point myalgia
|
- trigger point elicits pain when palpated
- not well understood, possible accumulation of algogenic substances (serotonin, histamine, bradykinins) - STABILIZATION APPLIANCES USUALLY WILL NOT HELP - eliminate source of deep pain and reduce emotional stress, maybe low doses of tricyclic antidepressants |
|
|
disc dislocation w/ reduction
-define reduction |
the action of remedying a dislocation or fracture by returning the affected part of the body to its normal position
-in TMD, the disc is "displaced" (click) and goes back to its original position as the condyles continue to move on opening; a stubborn disc that stays in place rather than moving with condyle to provide padding |
|
|
define disc dislocation w/ reduction
when do we treat (w/ pain vs. w/out) |
-collateral ligaments elongate and the disc displaces
-as pt opens, condyles translate and "reduction" of disc occurs; during closing, disc again displaces -also called reciprocal CLICKING - clicking on opening AND closing -protrusive opening usually eliminates clicking -fibrotic tissue will eventually form (or pseudo-disc forms) and pain subsides -treatment may or may not lead to pain relief; if pt has pain, make stabilization appliance -Pain - stabilization appliance while sleeping if clenching or bruxing suspected |
|
|
anterior repositioning appliance
when used and effects thereof |
used during sleeping and during day PRN to control pain
-may cause permanent joint changes if used for extended time |
|
|
disc dislocation w/o reduction
acute vs. chronic |
-on opening, pt deviates towards affected side (unilateral)
-collateral ligaments elongate even further, disc remains anteriorly displaced; articular disc may lose its normal anatomical shape -disc and condyle no longer articulate; 25-30mm opening -previous history of clicking -acute = recapture of disc by manual manipulation (push down on pts jaw to move condyles back over the disc) -chronic = tissue loses elasticity and ability to retract, disc may be malformed and nonfxnal; make stabilization appliance, surgery only if SA fails and to reduce pain |
|
|
in general, based on epidemiological studies, the risk of TMD progressing into a pts elderly years is...
|
less for all pts
|
|
|
for a TMD pt, the initial choice of radiographs would be...
|
panoral
|
|
|
what is the most important information from teh pt that helps us in the understanding of TMD pt...
|
pt history of their TMD
|
|
|
reversible pulpitis is frequently characterized by the following...
|
no radiographic findings
associated many times w/ gingival recession many times associated w/ thermal changes in sweet or acidic foods pain diminishes quickly upon removal of stimulus |
|
|
a TMD that is muscle related would commonly be characterized by...
|
bilateral pain/discomfort
|
|
|
T/F there are many cervical problems that reflect pain (refer) into the head and neck area
|
true
|
|
|
what dictates the position of the centric relation at the joint level...
|
muscles, ligaments, soft tissue, bone
NOT TEETH |
|
|
when palpating the TMJ, you detect pulse on the pt; this is ...
|
completely normal
|
|
|
in TMJ anatomy, we learned the lateral pterygoid do what...
|
inferior lateral pterygoid attaches to the condyle primarily and minor attachments to the TM disc
|
|
|
normal mandibular opening should be approximately...
|
40-60 mm; avg = 53-58 mm
a significant percentage of the population is <40mm |
|
|
a pts mandibular opening is 30 mm unassisted, w/ your assistance the pt can open to 45 mm, this would indicate a tentative diagnosis of
|
muscle dysfxn
|
|
|
if the condyles are not in CR, and it is caused by working interferences ...
|
the joint would most likely adapt w/ no further treatment
|
|
|
you completed the preparation, impression and provisionals of crowns 2, 12, and 23; assuming the pt has adequate intercuspation, your next step would be..
-take MICP record -take CR relation record -take both -take none |
take none - how many of you had to take MIC record to mount your lab models
|
|
|
seating crown 10 and 9, you failed to check occlusion, cement the crowns and send the pt home; later, pt calls office with "sore front teeth', your likely diagnosis is...
|
heavy anterior contacts
|
|
|
erosion can be differentiated from attrition by all of the following except...
-wear on contacting/occluding surfaces -concavities on smooth surface enamel -raised restorations (tooth wear around the restoration) -pulp exposure in children |
wear on contacting/occluding surfaces
|
|
|
you examine a pt w/ advanced wear; you find advanced wear w/ extensive loss of enamel lingually on teeth 6-11, your tentative diagnosis is...
|
bulimia
|
|
|
all of the following are true of abfractures...
a- V-shaped cervical notches b- lateral interferences are present c- hypersensitivity is possible d- none of above, these related to bruxing e- A, B, and C are true |
e- A, B, and C are true
|
|
|
you examine a pt w/ heavy wear on 23-26, opposing maxillary porcelain crowns; your initial diagnosis is ...
|
bruxism
|
|
|
which of the following tissues are potential injury sites w/ a traditional mandibular alveolar nerve block:
mucosa muscles of mastication buccinator TM ligament TMJ capsular ligament medial ptyergoid |
mucosa, buccinator, medial pterygoid
|
|
|
which of the following could be considered as a primary etiological cause TMD:
professional boxing occlusion parafunction 5 hour crown preparation appointment more than one of above |
more than one of above
|
|
|
by not adjusting your cars head rest properly, you could be at risk for developing TMD if in a car accident; in most pts, occlusion has been identified as a primary etiological factor in TMD
-first statement vs second |
first statement is true
second statement false |
|
|
which of the following occlusal conditions have been identified as having strong associations w/ TMD:
1- lateral interferences 2- protrusive interferences 3- non-working interferences 4- angles class 2, div. 2 occlusion 5- anterior open bite 6- angles class 2, div 1 w/ 6 mm horizontal overlap 7- left maxillary molar/premolar lingual cross-bite 8- missing all max PMs and molars |
answers 4, 5, 6, 7, and 8
|
|
|
which of the following is False regarding disc dislocation w/ reduction
-elongation of collateral ligaments -reduction of the TMJ disc on closing -reciprocal clicking on opening and closing of the mandible -opening and closing the mandible in a protrusive posture, eliminates reciprocal clicking |
reduction of the TMJ on closing
|
|
|
joint sounds are very common in TMD joints; therefore, treatment is generally indicated that directed towards diagnosing and treatment of TMJ noises
1st vs 2nd statement |
both are false
|
|
|
the primary goal in acute dislocation w/ reduction w/ pain is therapy directed towards reducing intracapsular pain reduction; the secondary goal in an acute dislocation w/ reduction w/ pain is therapy directed towards reducing the dislocated disc
1st vs 2nd statement |
first statement is true; 2nd statement is false
|
|
|
disc derangement disorders result from...
|
elongation of capsular ligaments
elongation of discal ligaments thinning of articular disc commonly result from either macrotrauma or microtrauma |
|
|
it is clear that anterior repositioning appliances can be helpful in reducing pain of dislocated TMJ disc and should be used routinely; the problem w/ these appliances is they can result in dental instability
1st vs. 2nd statement |
1st = false
2nd = true |
|
|
if a pt w/ painful disc displacement w/ reduction is treated w/ an appliance and pain still remains, the explanations for this are...
|
adaptive process not complete and orthopedic instability is present
|
|
|
supportive therapy in disc displacements w/ reduction w/ pain include:
1- eat softer foods 2- slower chewing 3- smaller bites 4- when possible, do not allow joint to click 5- take NSAID's for pain 6- moist heat or ice usage 7- active excercises are not recommended 8- stretching excercises |
1, 3, 5, and 7
|
|
|
numerous factors determine the length of time an appliance needs to be worn; these factors often relate to the amt of time necessary for the retrodiscal tissues to adapt adequately; when the main cause is macrotrauma, the length and success of appliance therapy depend on 3 conditions...
|
acuteness of injury
extent of injury age and health of pt |
|
|
pts need to be treated individually according to their unique circumstances; the therapist should keep in mind that fewer complications occur when the appliance is used for shorter periods of time
1st vs. 2nd statements |
1st = true
2nd = true |
|
|
if pt deviates jaw to right on opening, based solely on appearance, tentative diagnosis would be...
|
restricted right mandibular movement
|
|
|
the articular disc is attached to the medial and lateral poles of the condyle head by...
|
collateral ligaments
|
|
|
the initial x-ray for you TMD pt should be...
|
panoral
|
|
|
when adjusting an anterior stop (the lab project step you just completed), the contact area on the mandibular centrals should be...
|
over the incisal edge of centrals
|
|
|
the stabilization appliance you will fabricate in lab is completed in two steps; the first step is completed w/ the 2nd step to be completed in lab; what is the purpose of the 2nd step - the addition of posterior acylic
|
to prevent posterior tooth extrusion
|
|
|
a burning type of pain is most consistent w/ ...
|
trigeminal neuralgia
|
|
|
the appliance we will make in lab, when fabricated for pts should have which of the following criteria...
-deep posterior indentations to provide stable occlusion -canine guidance -no anterior guidance, which will lock the pt in -deep indentations in the anterior to provide a good centric stop |
canine guidance
|
|
|
on wide opening, pt deviates to right, this could possibly be caused by...
|
right disc displacement
muscle dysfunction of right temporalis and masseters |
|
|
statement vs. statement:
The outcome of conservative muscle treatment with disck displaced joints is generally poor; therefore, more aggressive treatment is usually warranted. |
both statements false
|
|
|
the treatment goals of a stabilization appliance are...
|
-condyles should be in their musculoskeletally stable position (CR), the disc should be properly interposed
-teeth should have even simultaneous contact directing forces through the long axis of the teeth -anterior guidance should have eccentric contacts on the anterior teeth -occlusion ideals are the posterior teeth contact heavier than anterior teeth |
|
|
which of following is TRUE regarding disc dislocation w/ reduction:
-disorder usually requiring anterior positioning or surgical consult -opening and closing the mandible in a retruded posture, eliminates reciprocal clicking -elongatino of collateral ligaments -reduction of TMJ disc on closing -more than one of the above |
elongation of collateral ligaments
|
|
|
what most differentiates a disc dislocation w/out reduction from a disc dislocation w/ reduction
|
loss of normal disc anatomy
|
|
|
which muslce disorder is characterized by heterotopic pain (referred pain)
|
myofascial pain
|
|
|
a pt is in your office for TMD pain; you ask the pt to directly point to the effected area and they point to the right TMJ area; a tentative conclusion could be made that the pt has...
|
a joint problem AND joint pain
|
|
|
statement vs. statement
In the acute pain pt, the problems are generally quite visible; where as in the chronic pain pt, often we don't find what we are expecting to find. |
1st - true
2nd - true |
|
|
the stabilization phase in the construction of a stabilization appliance includes all of below except...
-provides optimal occlusion -prevents posterior tooth eruption -group function occlusion -lateral balance on excursive movements |
group function occlusion
|
|
|
you are about to deliver crown #18 to your pt; after you remove the provisional restoration and clean the preparation, your next step should be...
|
verify contacts are acceptable
|
|
|
pt reports to your office w/ the following signs and symptoms: 30mm mandibular opening, previous history of bilateral TMJ clicking, scar on chin from car accident 1 year ago, initiall pain in joints but pt says "I have had no pain for the past 3 months - about a month ago, it was very hard to open to eat normally, but I can open better now", no signs of parafunction. Your treatment recommendations for the pt would be...also, what is the diagnosis
|
monitor the condition - it is self limiting and healing
diagnosis = Chronic anterior displaced w/out reduction |
|
|
pain in frontal sinusitis most commonly occurs in the _______ and ________ as the day progresses
|
morning; decreases
|
|
|
what type of headaches are referred to as "suicide headaches" and associated w/ excruciating pain of short duration (30-90 minutes)
|
cluster headaches
|
|
|
when adjusting a new crown #9, the occlusion should be adjusted so that...
|
it lightly contacts the incisal edge of #24
|
|
|
muscle condition associated w/ chronic global musculoskeletal problems is...
|
fibromyalgia
|
|
|
pt assigned to you by emergency; health hx and exam reveal: injury to jaw this past weekend, pain in both TMJs, mandibular opening of 10mm, no history of TMJ-clicking; tentative diagnosis is...
initial treatment would be... |
-acute disc dislocation w/out reduction
-recapture the disc |
|
|
teeth most effected due to GERD most likely appears as all of the following except
-extent of wear similar on both arches -all maxillary linguals -lingual asymmetrical wear -extensive wear lingually on mandibular anteriors |
extensive wear linguallly on mandibular anteriors
|
|
|
attrition can be differentiated from erosion by:
-concavities on smooth surfaces -cupped-like concavities on cusp tips -pulp exposure in adults -raised restorations -none of the above |
none of the above
|
|
|
pt has chief complaint of burning throbbing pain, sensitive to chewing, sensitivity to palpation for the past several months in areas of 2, 3, 4, and 5; periodontal exam reveals pocket depths of 4 and 5mm generally w/ #15 having pocket of 6mm; periapical radiographs reveal moderate to deep restorations on all teeth indicated w/ #4-RCT-post and core-crown-no apparent radiographic apical pathology
-tentative diagnosis would be... -etiology of chief complaint would be... -treatment of pt would most likely be... |
-atypical odontalgia
-nerve de-afferentation -medical referral |
|
|
which does not fit the criteria for stabilization appliance...
-canine guidance -anterior guidance -moderately deep occlusal indentations for a stable "appliance" maximal intercuspation -complete posterior occlusal coverage |
moderately deep occlusal indentations for a stable "appliance" maximal intercuspation
|
|
|
in appropriate situation in which an anterior repositioning appliance is prescribed, the instructions to the pt on wearing should be...
|
wear only when sleeping and during day time to control pain as needed
|
|
|
posterior clearance between the mandibular last molar and the maxillary substructure for the lab project should be at least...
|
2-4 mm
|
|
|
in general, the incident in developing TMD decreases for...
|
all pts, male and female
|
|
|
throbbing, pulsing, pounding pain is typically associated w/ which condition...
|
vascular pain
|
|
|
pt opens 20mm unassisted; you can increase their opening to 40mm by pressing down on mandibular centrals
this represents... |
muscle restriction of mandible
|
|
|
TMJ discs are held in place by...
|
collateral ligaments and discal ligaments
(if you have to pick one, pick collateral ligaments) |
|
|
are "soft" appliances contraindicated for bruxers, and why
|
YES - will intrude teeth
|
|
|
statement vs. statement
it is generally accepted that most TMD is caused by occlusal relationships; equilibration or grinding of the occlusion is thus justified in the initial treatment phase |
both statements false
|
|
|
what is associated w/ "trigger points"
|
myofascial pain
|
|
|
trigger point clinical characteristics are
-consistent patterns of referral -palpation relieve pain -constant burning-type ache |
consistent patterns of referral
|
|
|
cluster headache
|
pain in and around eye
tearing, bloodshot eye nasal discharge and redness of affected side of head |
|
|
occlusal indentation on a stabilization appliance should be...
|
flat to allow muscles to guide closure and condylar position
|
|
|
headache that has a central mechanism similar to that of migraine headaches...
|
tension-type
|
|
|
which neuro-chemical mediator is associated w/ migrain headaches
|
serotonin
|
|
|
primary goal in treatment of disc dislocation w/ reduction w/ pain is...
|
reduce intracapsular pain
|
|
|
which of the following muscle disorders is not commonly seen in the muscles of mastication
-protective co-contraction -local muscle soreness -muscle spasms -myofascial pain -fibromyalgia |
muscle spasms
|
|
|
treatment indications for the use of a stabilization appliance include...
|
-decrease parafunctional activity
-local muscle soreness -retrodiscitis secondary to trauma -fixed prosthodontics w/ treatment position at CR |
|
|
disadvantage of a complete MANDIBULAR coverage stabilization appliance is...
|
possible heavy anterior contact over time causing maxillary anterior teeth to move
|
|
|
what determines position of centric relation
|
ligaments and TMJ disc
|
