Diseases of Temporomandibular Joint Short Question and Answers

Diseases of Temporomandibular Joint

Question 1. In disease-free TM joint, posterior end of the articular disc remains at what position?
Answer. At 9 O’clock position.

Question 1a. Name the joint which enables us to look toward right or left.
Answer. Atlanto-occipital joint.

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Question 1b. Name the developmental disorders of TM joint.
Answer.

• Hypoplasia of mandibular condyle
• Hyperplasia of mandibular condyle.

Question 2. What is hypoplasia of mandibular condyle?
Answer. Condylar hypoplasia is characterized by reduction in the size of condylar process of mandible due to disturbance in growth of the TM joint.

Question 3. Describe the features of hypoplasia of mandibular condyle.
Answer.

• Underdevelopment of ramus
• Deviation of mandible to the affected side during mouth opening
• Antegonial notch is deeper on the involved side
• Midline shift of dentition toward the affected side
• Masticatory insuffiiency
• Cosmetically poor appearance of the face.

Question 4. What is hyperplasia of mandibular condyle?
Answer. Condylar hyperplasia is a rare defect which is often characterized by a unilateral enlargement of the mandibular condyle with facial asymmetry.

Question 5. Describe the features of hyperplasia of mandibular condyle.
Answer.

• Deviation of chin to the opposite side during mouth opening
• Cross bite relationship of the jaw
• Excessive vertical lengthening of the ramus
• Occasional pain in the TM Joint.

Question 6. Name the traumatic disorders of TM joint.
Answer.

• Luxation and subluxation
• Ankylosis.

Question 7. What is luxation of TM joint?
Answer. Luxation or dislocation of TMJ occurs when the head of the condyle moves anteriorly over the articular eminence into such a position from where it cannot return back to its original position by itself.

Question 8. What is the difference between luxation and subluxation of TM joint?
Answer. When the condyle is completely dislocated, it is called luxation, while partial dislocation of the same is called subluxation.

Question 9. What are the causes of luxation or subluxation in TM joint?
Answer.

• Trauma to the TMJ
• Wide mouth opening for an extended period of time (during dental procedures, etc).

Question 10. Describe the clinical features of luxation or subluxation in TM joint.
Answer.

• Sudden locking of the jaw while closing the mouth
• Difficulty in eating and talking.

Question 11. What is ankylosis of the TM joint?
Answer. Ankylosis of the TMJ is characterized by lack of movement of the condylar head within the glenoid fossa due to fusion of the opposing components of the joint with obliteration of the joint space. It results in the limitation of mouth opening.

Question 12. Name the major causes of TMJ ankylosis.
Answer.

• Trauma
• Infections
• Systemic juvenile arthritis
• Neoplasm.

Question 12a. What is the most common cause of TMJ ankylosis?
Answer. Traumatic injury to the joint.

Question 13. Name the traumatic factors causing TMJ ankylosis.
Answer.

• Birth injury due to forceps delivery
• Intracapsular fracture with bleeding
• Accidental trauma to the mandible that pushes the head of the condyle into the glenoid fossa
• Lack of early mobilization after TMJ fracture
• Malunion of the condylar fractures
• Radiotherapy of the TMJ.

Question 14. Name the infective conditions which can cause TMJ ankylosis.
Answer.

• Otitis media
• Mastoiditis
• Congenital syphilis
• Osteomyelitis
• Pyogenic arthritis of TMJ from hematogenous infections.

Question 15. Name the different types of ankylosis of TM joint.
Answer. Types of ankylosis:

• False ankylosis
• True ankylosis (true bony ankylosis and true firous ankylosis).

Question 16. What is false ankylosis?
Answer. False ankylosis is extra-articular and it occurs due to firous or bony union between the coronoid process and maxilla or zygoma. Here the joint itself is not deformed or damaged.

Question 17. What is true bony ankylosis of TM joint?
Answer. It is an intra-articular defect of the TM joint characterized by complete obliteration of the joint space by deposition of bone with fusion of temporal fossa, meniscus and head of the condyle.

Question 18. What is true firous ankylosis of TM joint?
Answer. True firous ankylosis occurs when obliteration of the TM joint space occurs due to deposition of firous tissue mass (scar tissue).

Question 19. What is the basic difference between true firous ankylosis and true bony ankylosis of the TM joint?
Answer. In case of firous ankylosis, limited degree of mouth opening is possible; whereas in case of true bony ankylosis, complete loss of mouth opening is seen.

Question 20. Name the common clinical features of bilateral TM joint ankylosis.
Answer.

• Mostly seen in young people
• Partial or complete loss of mouth opening
• Microstomia with receding chin
• Difficulty in taking food and difficulty in speech.

Question 20a. Describe the features of unilateral ankylosis of TM Joint.
Answer.

• Facial asymmetry with fullness on the normal side of mandible
• Deviation of chin toward the affected side
• Prominent antegonial notch on the affected side.

Question 21. Describe the radiological features of ankylosed TM joint
Answer. In case of bony ankylosis, radiograph shows the loss of normal architecture of TMJ and obliteration of the joint space due to deposition of bone.

Question 22. Describe the treatment of ankylosed TM joint.
Answer. TMJ ankylosis is treated by surgical correction of the joint (gap arthroplasty). Costochondral grafting is done sometimes in young patients to facilitate the growth of mandible.

Question 23. What is ankylosing spondylitis?
Answer. Ankylosing spondylitis is a chronic inflmmatory disease of the connective tissue which primarily affects the axial skeleton and the central joints including the TMJ.

Question 24. Describe the clinical features of ankylosing spondylitis.
Answer.

• It is more common in men
• Stiffness resulting from immobility of the joint during sleep
• Stiffness is relieved by heat and exercise
• There may be slight facial asymmetry.

Question 25. What is osteoarthritis?
Answer. Osteoarthritis is a degenerative and destructive disease of the weight-bearing joints; although TM joint is not a weight-bearing joint, osteoarthritis can still occur in it due to the ageing process or trauma.

Question 26. Describe the clinical features of osteoarthritis in TM joint.
Answer.

• Clicking sounds in the TM joint while opening and closing the mouth
• Limitation of movements of the joint
• Sometimes there may be deep ache or pain in the joint
• Muscles of mastication are often tendered due to strain caused by non-use or restricted use of the painful joint.

Question 27. What are the radiographic changes seen in TM joint in osteoarthritis?
Answer. Radiograph shows osteophytic lipping or protruberance on the articular disc with flttening of the articular surfaces of the joint. In few cases, subarticular radiolucent areas (Ely’s cysts) can be seen. Narrowing of the joint space often occurs due to abnormal ossifiation.

Question 28. Rheumatoid arthritis of the TM joint usually occurs at what age?
Answer. The disease usually occurs in the third and forth decade of life and females are more commonly affected.

Question 29. Describe the clinical features of rheumatoid arthritis in TM joint.
Answer.

• Patients suffer from fever, malaise, fatigability, weight loss, anemia and raised ESR, etc. during the acute phase of the disease
• Pain, tenderness, stiffness and bilateral swelling in the joint
• The maximum feeling of stiffness is experienced in the early mornings and it diminishes gradually as the day progresses
• Occasional presence of crepitations in the joint with restricted jaw movements
• Development of clicking sounds in chronic cases
• There can also be presence of salivary gland swelling and dryness of mouth.

Question 29a. What is the common complication of rheumatoid arthritis in TM joint?
Answer.Development of firous ankylosis.

Question 30. What is myofacial pain dysfunction syndrome (MPDS)?
Answer. Myofacial pain dysfunction syndrome is a disease complex that disturbs the entire masticatory apparatus and is characterized by pain and limitation of movement of the TMJ.

Question 31. How myofacial pain dysfunction syndrome occurs?
Answer. The disease occurs due to defective neuromascular co-ordinations coupled with emotional stress which eventually results in masticatory muscle spasm and fatigue.

Question 32. Name the factors which might trigger the development of myofacial pain dysfunction syndrome.
Answer.

• Occlusal disharmonies like defective restoration, lack of posterior occlusion due to loss of molar teeth and faulty dentures
• Habitual grinding of teeth (bruxism)
• Anxiety, stress and personality disorders
• Minor injury to the TM joint due to violent yawning, laughing and strenuous dental treatment of long durations.

Question 33. Which people suffer from myofacial pain dysfunction syndrome?
Answer. More than 80 percent of the patients are females and they are usually aged between 20 and 30 years.

Question 34. Describe the clinical features of myofacial pain dysfunction syndrome.
Answer. Presence of unilateral radiating dull pain in the pre-auricular area or in the ear; which radiates to the angle of mandible and temporal region. The intensity of pain varies at different times of the day. The disease characteristically presents few positive and few negative features.

Question 35. What are the positive clinical features of myofacial pain dysfunction syndrome?
Answer.

• Pain in the TM Joint and adjacent areas
• Muscle tenderness
• Limitation of movements and deviation of the jaw
• Clicking sounds in the TMJ during opening and closing of the mouth.

Question 36. What are the negative clinical features of myofacial pain dysfunction syndrome?
Answer.

• Absence of any clinical, radiological and biochemical evidence of the organic change in the joint
• Absence of tenderness in the joint, when palpated through the external auditory meatus.