Podcast
Questions and Answers
What bones are involved in the articulation at the temporomandibular joint?
What bones are involved in the articulation at the temporomandibular joint?
- One temporal bone and one zygomatic bone
- Two occipital bones and two maxillae
- Two nasal bones and two sphenoid bones
- Two temporal bones and two mandibular condyles (correct)
Which part of the temporal bone articulates with the mandible at the TMJ?
Which part of the temporal bone articulates with the mandible at the TMJ?
- Squamous part
- Mandibular fossa (correct)
- Zygomatic process
- Mastoid process
What role does the disc of the joint play in the TMJ?
What role does the disc of the joint play in the TMJ?
- It permits the surface of one bone to move over another (correct)
- It creates a barrier against injury
- It increases the range of motion of the joint
- It strengthens the bones around the joint
Where is the postglenoid process located in relation to the articular fossa?
Where is the postglenoid process located in relation to the articular fossa?
Which part of the mandible is specifically involved in the articulation at the TMJ?
Which part of the mandible is specifically involved in the articulation at the TMJ?
What is the role of the sphenomandibular ligament during mandibular movement?
What is the role of the sphenomandibular ligament during mandibular movement?
Which movements are associated with the TMJ during the opening of the mouth?
Which movements are associated with the TMJ during the opening of the mouth?
Which of the following movements is NOT a function of the TMJ?
Which of the following movements is NOT a function of the TMJ?
What describes the function of the sphenomandibular ligament in clinical dental procedures?
What describes the function of the sphenomandibular ligament in clinical dental procedures?
What best describes TMD (temporomandibular disorder)?
What best describes TMD (temporomandibular disorder)?
What is the primary function of the articular disc in the TMJ?
What is the primary function of the articular disc in the TMJ?
Which ligament is NOT associated with the temporomandibular joint?
Which ligament is NOT associated with the temporomandibular joint?
What is the role of synovial fluid in the TMJ?
What is the role of synovial fluid in the TMJ?
Where is the articular eminence located in relation to the mandibular fossa?
Where is the articular eminence located in relation to the mandibular fossa?
What tissue composes the retrodiscal pad of the TMJ?
What tissue composes the retrodiscal pad of the TMJ?
What is the main function of the temporomandibular ligament?
What is the main function of the temporomandibular ligament?
The stylomandibular ligament connects which two structures?
The stylomandibular ligament connects which two structures?
What structure lines the cavities of the TMJ and secretes synovial fluid?
What structure lines the cavities of the TMJ and secretes synovial fluid?
What are common symptoms associated with temporomandibular disorders (TMD)?
What are common symptoms associated with temporomandibular disorders (TMD)?
During a TMJ assessment, which motion is NOT typically evaluated?
During a TMJ assessment, which motion is NOT typically evaluated?
What is the primary origin of symptoms in clients with TMD?
What is the primary origin of symptoms in clients with TMD?
What might cause TMJ sounds during jaw movement?
What might cause TMJ sounds during jaw movement?
What condition describes the inability to open the mouth normally?
What condition describes the inability to open the mouth normally?
What treatment is commonly suggested for managing bruxism?
What treatment is commonly suggested for managing bruxism?
What leads to an acute episode of TMD when opening the mouth too wide?
What leads to an acute episode of TMD when opening the mouth too wide?
In myofascial pain dysfunction (MPD), what is primarily responsible for increased pain at the TMJ?
In myofascial pain dysfunction (MPD), what is primarily responsible for increased pain at the TMJ?
What is a potential consequence of constant anterior displacement of the TMJ disc?
What is a potential consequence of constant anterior displacement of the TMJ disc?
Which of the following treatments is NOT usually recommended for TMD?
Which of the following treatments is NOT usually recommended for TMD?
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Study Notes
Temporomandibular Joint (TMJ)
- The TMJ is a joint on each side of the head that allows for movement of the mandible for speech and mastication.
- The TMJ is the articulation between the temporal bone and the mandible.
Bones of the Joint
- The temporal bone is a cranial bone.
- The mandibular fossa or articular fossa is an oval-shaped depression on the temporal bone.
- The mandibular condyle is the articulating part of the mandibular ramus.
- The mandible is a facial bone.
Joint Capsule
- A fibrous joint capsule completely encloses the TMJ.
- The joint is supported by the joint capsule and several ligaments.
Disc of Joint or Articular Disc
- The articular disc is a fibrous pad of collagen tissue located between the temporal bone and the mandible.
- The disc completely divides the TMJ into two compartments: upper and lower.
- The synovial cavities are lined with epithelium, which secretes synovial fluid.
Structure
- The articular eminence is a smooth, rounded ridge positioned anterior to the mandibular fossa.
- The retrodiscal pad is composed of loose connective tissue supplying blood and nerves to the joint.
Ligaments Associated with the Joint
- Three paired ligaments are associated with the TMJ:
- Temporomandibular ligament
- Stylomandibular ligament
- Sphenomandibular ligament
Temporomandibular Ligament
- Reinforces the lateral part of the joint capsule.
- Prevents the condyle from being displaced too far inferiorly and posteriorly.
- Prevents lateral displacement of the mandible.
Stylomandibular Ligament
- Runs from the styloid process of the temporal bone to the angle of the mandible.
- Separates the parotid and submandibular salivary glands.
Sphenomandibular Ligament
- Is not considered part of the TMJ.
- Helps control movement.
- Runs from the angular spine of the sphenoid to the lingual.
- Becomes taut when the mandible protrudes.
- May prevent diffusion of local anesthetic agents during an IA nerve block.
Movement in the TMJ
- The TMJ has two types of movement:
- Rotational - occurs in the lower synovial cavity between the disc and the condyle.
- Gliding - occurs as the jaw opens farther.
Gliding Movement
- Protrusion - anterior movement.
- Retrusion - posterior movement.
Rotational Movement
- Depression - lower the jaw.
- Elevation - raise the jaw.
Gliding and Rotational Movement
- Lateral Deviation - alternating protrusion and retrusion.
- Opening the mouth - protrusion and depression.
- Closing the mouth - retrusion and elevation.
TMJ Dysfunction (TMD)
- TMD may involve one or both TMJs.
- Symptoms include: chronic joint tenderness, swelling, painful muscle spasms, limited or deviated mandibular opening.
Assessing the TMJ for TMD
- Palpate the joint and its associated muscles bilaterally, just anterior to the external acoustic meatus of each ear.
- Ask the client to open and close the mouth, move the opened jaw left and right, and forward.
TMD
- Not all clients with TMD have abnormalities in the joint disc or the joint itself.
- Most symptoms originate from the muscles supporting the joint.
TMJ Sounds
- Clicking, popping, or grinding (crepitus) in the TMJ.
- Popping or clicking occurs when the disc is pulled too far forward on opening.
- If it pops on closing, it is called a "reciprocal pop or click."
- On palpation, the joint may "jump."
- The mandible may deviate/shift to one side on opening.
Disc Disengagement
- The cause of TMJ sounds may be the result of disc disengagement.
- In constant anterior displacement of the disc, permanent damage may occur.
- Treatment may require surgical intervention.
Trismus
- Inability to open the mouth normally.
TMJ Problem: Subluxation
- An acute episode of TMD can occur when the mouth opens too wide.
- The condyle glides too far forward and moves too far anterior to the height of the articular eminence.
- Contributing factors: deep condylar fossa, hypermobility, and muscle incoordination.
TMJ Problem: Bruxism
- Teeth grinding, typically during sleep, but some do it while awake.
- Causes tired and sore TMJ, wearing down of teeth.
- Treatment: night guard, relaxation medications.
TMJ Problem: Arthritis
- Inflammation and deterioration of the joint.
- Potentially caused by excessive wear of the joint.
- Treatment option: cortisone.
TMJ Problem: Myofascial Pain Dysfunction (MPD)
- Increased pain at the TMJ due to muscle tension and spasm.
- Believed to be a physical manifestation of psychological stress.
- No primary disorder of the joint itself is present.
TMD
- Most cases of TMD improve over time with conservative treatments, including pain control, relaxation therapy, stress management, habit control, moderate muscle exercises, and orofacial myology.
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