TMJ & Orthodontics

What is responsible for the “click” in the morning?

Say if these are muscles for elevation or depression of the mandible.

Name 3 of them, which are responsible for protrusion as well.

1. Masseter

2. Lateral pterygoid

3. Pterygoid medial

4. Mylohyoid

5. Temporalis

6. Digastric

7. Geniohyoid

If the patient refers pain and there are no signs on the radiograph and in the oral cavity, what do you have to think of?

Name 5 predisposing factors of TMJ dysfunction.

Which 6 orthodontic problems can be a predisposing factor for TMJ dysfunction?

How many mm is considered a normal mouth opening?

mouth opening

If the patient can only open the mouth 30-35mm, you need to suspect?

And with 20-30mm?

<20mm?

Which structure is mostly the reason for pain?

Where on the TMJ (number in the image) does pain show first?

Pain due to hypermobility is usually located where? (number)

Where is the pain located if it’s due to occlusal problems?

Where, when you retrude the condyles?

Pain triggered by posterior compression is usually located at?

Crepitus usually indicates…

Clicks are categorized into Type I, II, III and IV.

Order in which Type it fits:

• cartilage hypertrophy

• disc hypermobility

• disc displacement

• appears later during the opening and is louder

• condylar hypermobility

• patient has to make a condyle movement to recover the disc

• stronger click at the same point

How do these 3 look like?

Categorize into mild, moderate, severe throughout the movement and very severe.

• myositis

• myogenic

• synovitis

• acute intracapsular injury

• severe ankylosis

• capsulitis

• intracapsular

Crepitus with pain, you have to think of?

Crepitus without pain, you have to think of?

Capsulitis is defined by? (mm of mouth opening + …)

Hypoplasia - say if it is uni- or bilateral

• Pierre-Robin Syndrome

• Treacher-Collins

• Hallerman Streiff

• Goldenhar Syndrome

• Hemifacial microsomy

Name 5 features of Pierre-Robin-Syndrome.

What is “Treacher-Collins Syndrome”?

An association has been noted between cervical posture and dental occlusion such that children with an Angle Class II malocclusion then to have an exaggerated … of their cervical spines compared with children who have normal occlusion.

Osteoarthrosis vs Osteoarthritis

The most characteristic is pain. Which one has pain?

Which one is inflammatory and which one is a non-inflammatory process?

Which one has crepitus, which one crackling?

Name the 3 treatment options for each.

Muscle pain vs joint pain

Order to the correct one:

1. duration of pain intermittent / continuous

2. qualitative profile deaf / stabbing

3. spatial profile bilateral / unilateral

Muscle disorders

Myaliga, Myofascial pain, Myositis, Myospasm

Which one has almost everwhere +++?

Which one most of the time only at the trigger point?

Define and differ between:

1. Functional alteration

2. Skeletal alteration

3. Joint mobility alteration

In joint mobility alteration, the blockage is always in which direction?

Myalgia

Definition?

Diagnosis is confirmed if? (2)

What’s the difference between “myofascial pain” and “myofascial pain with referred pain”?

Arthralgia

Definition

Provocation test (2)

How’s disc displacement with reduction defined?

Are there medial/lateral displacements?

Clicks with or without history of blockage?

How’s disc displacement with reduction defined?

Are there medial/lateral displacements?

Clicks with or without history of blockage?

How’s disk displacement without reduction with limited opening defined? (2 aspects)

How’s disk displacement without reduction with no opening limitation defined? (2 aspects)

What’s degenerative joint disease?

What’s a subluxation?

Disc position?

Blockage?

Name 5 possible treatments for TMJ dysfunction.

Do clicks need to be treated?

Splints should be not used before the age of? Why?

How does the thickness differ between anterior and posterior part of the splint?

Do splints have a curative effect?

What happens in continued use?

Name 3 physiomechanics (functions) of the Michigan splint.

And 6 indications.

Opening: Order them correctly.

A.

1. 40-45mm

2. 30-35mm

3. 20-30mm

4. <20mm

B.

post-traumatic capsulitis

severe myogenic episodes

dislocation of the condyle

normal

bone ankylosis

acute capsulitis

fibrous ankylosis

trauma

trismus

acute blockage