Temporomandibular Joint Assessment PDF

 Temporomandibular Joint Assessment 1602305 Dental Occlusion and Temporomandibular Joint disorders 7/12/2024 Fall Semester 2024/2025 Assistant Professor Week 9 Mostafa Mahmoud Yous...

 Temporomandibular Joint Assessment 1602305 Dental Occlusion and Temporomandibular Joint disorders 7/12/2024 Fall Semester 2024/2025 Assistant Professor Week 9 Mostafa Mahmoud Youssef “Nothing Is More Critical To Success Than Beginning With All The Necessary Data.” Today our lecture covers the following Overview Of Diagnosis & Examination Methods TMJ Examination Temporomandibular Joint Dysfunction Overview Muscles Of Mastication Examination Examination of Occlusal Relationship of Teeth Additional Diagnostic Tests Overview Of Diagnosis & Examination Methods Oral Diagnosis Dia= Thorough nosis= Knowledge Oral Diagnosis: is the art of using scientific knowledge to identify oral disease processes and to distinguish one disease from another.  Comprehensive Oral Diagnosis: Any comprehensive diagnostic procedure should include: 1- History taking. 2- Clinical examination (extra- and intra- oral). 3- Other investigations (if needed).  Items of History: A- Identification data B- Chief complaint C- History of chief complaint D- Past medical history E- Past dental history F- Psychologic assessment  Methods of clinical examination It all depends on your senses The common techniques are 7 1. Inspection. 2. Palpation. 3. Percussion. 4. Probing. 5. Auscultation. 6. Olfaction. 7.Aspiration  TMJ Examination  Inspection and observation: 1. Examination of TMJ and face should begin by observing: a. The degree of symmetry of the mandible and face. b. The path of excursion of mandible during opening and closing. (Ask the patient to open and close once or twice, Don’t over do it) and observe  Inspection and observation: 1. c. The degree of mouth opening (the normal inter-occlusal distance = 40 - 55 mm; which is equal to 3-4 fingers). ---→ Either the examiner does this while wearing an examination gloves or ask the patient to do it. d. The harmonious lateral movement. (move the mandible to the right and left) 2. Palpation: a. While standing in front of the patient, bilateral palpation should be carried out. b. The bulb of index fingers is placed slightly anterior and below external auditory meatus. 2. Palpation: c. Palpate through external auditory canal with the little fingers (the bulb of fingers facing anteriorly because of the S shape of the canal). d. Ask the patient to perform function movement (open, close, protrusive and lateral movement) Temporomandibular Joint Dysfunction Overview  Temporomandibular Joint Dysfunction Clicks Joint Crepitation Sounds Irregularities Joint Restrictions Restrictions  Clicks A single sound of short duration or a loud pop. Joint Crepitation Sounds A multiple gravel-like sound, often associated with osteoarthritic changes of the joint's articular surfaces  Can be perceived by placing fingertips over the lateral surfaces of the joint and having the patient open Joint and close. Sounds Stethoscopes or joint sound recording devices can be used for more sensitive examination, but increased detection may not always be clinically significant.  Recording the character of any joint sounds, the degree of mandibular opening associated with the sound, Joint and whether the sound Sounds occurs during opening or closing is important. The absence of joint sounds does not always mean normal disc position.  The dynamic movements of the mandible are observed for any irregularities or restrictions. Any mandibular movements that are restricted or have Joint unusual pathway characteristics Restrictions are noted. Key findings of both muscle and TMJ examinations are recorded on a treatment outcome form.  Muscles Of Mastication Examination (1) The Masseter (2) The Temporalis (3) The Medial Pterygoid (4) The Lateral Pterygoid (5) The Digastric Origin The zygomatic process of the maxilla and the anterior two thirds of the lower border of the zygomatic arch Insertion The angle and lower half of the lateral surface of the ramus of the mandible Function Elevates the mandible, contributes to protrusion Innervation Masseteric branch of the mandibular nerve of the trigeminal nerve Blood Supply Masseteric artery Palpation of the masseter muscle include: 1. Palpation of the origin. 2. Palpation of the insertion. 3. Palpation of the body with the thumb & index finger of one hand and the index finger of the other hand Procedure 1. Ask the patient to clench the teeth firmly together (muscular contraction). 2. The examining finger is run up the anterior border of the masseter intra-orally, counter pressure being exerted from the external surface. 3. When the examining finger reaches the zygomatic origin of the masseter muscle, tenderness become more evident and is shown by the patient’s reaction, & this is a common feature of myofacial pain dysfunction syndrome. 4. A similar test should be carried out on the opposite side. Origin The lateral aspect of the skull to the full extent of the superior temporal line. Insertion The anterior border of the coronoid process and the anterior border of the ramus of the mandible as far forward as the last molar tooth. Function Elevates the mandible, Contributes to retrusion. Innervation Deep temporal nerve from the mandibular branch of the trigeminal nerve. Blood Supply Anterior, posterior, and superficial temporal arteries Palpate over the temporal region of the skull. A fan-shaped muscle covered by a fascia sheet. The large fan-like portion attaches to the side of the skull and the smaller tapering portion attaches to the coronoid process of the mandible. Origin The medial surface of the lateral pterygoid plate and the grooved surface of the pyramidal process of the palatine bone. Insertion The inferior and posterior portion of the medial surface of the ramus and angle of the mandible, as high as the mandibular foramen. Function Elevates the mandible, Contributes to protrusion. Innervation Mandibular branch of the trigeminal nerve. Blood Supply Pterygoid branch of maxillary artery Procedure 1. The anterior part of the insertion can be palpated by inserting the index finger at a 45-degree angle in the floor of the mouth near the base of the relaxed tongue. 2. The opposite hand can be used extra-orally to palpate the posterior and inferior portions of the insertion. 3. The body of the muscle can be palpated by moving the index finger upward against the muscle to near its origin on the tuberosity. - Muscle tenderness is also a feature of myofascial pain dysfunction syndrome. Origin The lateral surface of the lateral pterygoid plate. Insertion The neck of the mandibular condyle. Function Protrudes the mandible, contributes to lateral movements and mouth opening. Innervation Pterygoid branch of the trigeminal nerve. Blood Supply Pterygoid branch of the maxillary artery Origin The lower part of the lateral surface of the great wing of the sphenoid and from the infratemporal crest. Insertion The neck of the mandibular condyle and into the front margin of the articular disc. Function Stabilizes the condyle and disc during mandible loading (i.e., unilateral chewing). Innervation Mandibular branch of the trigeminal nerve. Blood Supply Pterygoid branch of maxillary artery Procedure: 1. The muscles palpated by using the index or little finger and placing it lateral to the maxillary tuberosity and medial to the coronoid process. 2. The finger presses upward and inward and a painful response can be determined. 3. Since this is uncomfortable for the patient, the response requires evaluation. Examination of Occlusal Relationship of Teeth The examiner should pay particular attention to: 1. Missing teeth particularly molars or premolars (lack of posterior support). 2. Presence of wear facets. 3. Evidence of bruxism (gross occlusal attrition). 4. Occlusal disharmony. 5. Poorly articulating or unsatisfactory dentures.  Additional Diagnostic Tests 1. CBCT. 2. Panoramic Radiography. 3. MRI 4. Bone Scintigraphy. 1. Mounted Cast. 2. Electromyography. 3. Mandibular Tracking Devices 4. Thermography “Nothing Is More Critical To Success Than Beginning With All The Necessary Data.” THA NK YOU