Deck 10: Orofacial Pain and Diseases Affecting the Temporomandibular Joint

Question 1

Which statement about the articular disc in the TMJ joint is true?

A) It is attached to the anterior and posterior aspects of the condyle.
B) It is attached to the inferior belly of the medial pterygoid muscle.
C) The disc is highly vascular.
D) The disc is surrounded and protected by the fibrous connective tissue joint capsule.

Answer 1

The disc is surrounded and protected by the fibrous connective tissue joint capsule.

Question 2

The most common systemic conditions that affect the TMJ are

A) Sjögren syndrome and scleroderma.
B) rheumatoid arthritis and juvenile rheumatoid arthritis.
C) gout and Reiter syndrome.
D) ankylosing spondylitis and mixed connective tissue disease.

Answer 2

rheumatoid arthritis and juvenile rheumatoid arthritis.

Question 3

During opening of the jaw

A) rotational movement precedes translation.
B) rotational movement follows translation.
C) only rotational movement occurs; translation occurs only during closure.
D) only translational movement occurs; rotation occurs only during closure.

Answer 3

rotational movement precedes translation.

Question 4

Which dental radiographic procedure is best for examining disc position, function, form, and the presence of joint effusions?

A) Panoramic imaging
B) Transcranial imaging
C) Computerized tomography (CT)
D) Magnetic resonance imaging (MRI)

Question 5

Temporomandibular dysfunction (TMD) can be caused by disorders of the muscles of mastication or by internal derangements of the components of the joint. Three cardinal features that suggest TMD include orofacial pain, joint noise, and restricted jaw function.

A) Both statements are true.
B) Both statements are false.
C) The first statement is true; the second is false.
D) The first statement is false; the second is true.

Question 6

Which dental radiographic imaging is best for identifying bone abnormalities such as osteophytes, condylar erosion, fractures, ankylosis, and condylar hyperplasia?

A) Panoramic imaging
B) Transcranial imaging
C) Computerized tomography (CT)
D) Magnetic resonance imaging (MRI)

Question 7

Which statement is characteristic of a patient with osteoarthritis?

A) It is characterized by pain that is worse in the morning.
B) It is characterized by pain that is worse in the evening.
C) It is an inflammatory, autoimmune disorder of the joints.
D) Approximately 50% to 75% of patients have involvement of the TMJ during the course of the disease.

Question 8

Trauma affecting the TMJ is classified as direct, indirect, and secondary to parafunctional habits. Which is an example of a parafunctional habit?

A) Whiplash injury
B) Assault
C) Surgery
D) Clenching

Question 9

Opening, or depressor function, of the mandible is accomplished primarily by the _____________ muscle.

A) medial pterygoid
B) lateral pterygoid
C) masseter
D) temporalis

Question 10

Which choice represents an indirect form of trauma affecting the TMJ?

A) Clenching, bruxism
B) Whiplash injury
C) Psychosocial factors
D) Osteoarthritis

Question 11

Caution is recommended with long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) because of what complications?

A) Gastrointestinal
B) Cardiovascular
C) Psychiatric
D) Arthritis

Question 12

While up to _____% of the adult population has at least one sign and/or symptom of a temporomandibular disorder (TMD), most studies suggest that clinically significant TMD-related jaw pain, dysfunction, or both affects about _____% of the general population.

A) 90; 10
B) 75; 13
C) 50; 10
D) 25; 5

Question 13

An open lock of the TMJ that the patient cannot reduce is termed

A) subluxation.
B) dislocation.
C) ankylosis.
D) myofascial pain.

Question 14

The TMJ exhibits ginglymoarthrodial, or __________, movement.

A) rotational and translational
B) opening
C) closing
D) maximal interdigitation

Question 15

The purpose of the synovial fluid is to

A) provide nourishment and lubrication.
B) divide the space into upper and lower compartments.
C) govern mandibular movement.
D) separate forces resulting from movement.

Question 16

Tenderness over the lateral pole of the condyle is indicative of

A) crepitus.
B) capsulitis.
C) trismus.
D) auscultation.

Question 17

Hypermobility in which the patient is able to relocate the mandible back into the glenoid fossa is referred to as

A) subluxation.
B) dislocation.
C) ankylosis.
D) myofascial pain.

Question 18

Clicking and popping most commonly reflect

A) parafunctional habits such as bruxism and clenching.
B) disc displacement with reduction.
C) malocclusion.
D) trismus.

Question 19

All are benign tumors that arise in the condyle except one. Which is the exception?

A) Osteoblastoma
B) Synovial chondromatosis
C) Osteoma
D) Chondroblastoma

Question 20

The temporomandibular joint (TMJ) is the articulation between the condyle of the mandible and the

A) zygomatic process of the temporal bone.
B) glenoid fossa of the temporal bone.
C) external acoustic meatus.
D) spine of the sphenoid bone.

Question 21

The TMJ is the articulation between the mandibular condyle and which other structure?

A) Zygomatic process
B) Sphenoid bone
C) Glenoid fossa of the temporal bone
D) Occipital bone

Question 22

What is the most common systemic condition that may affect the TMJ?

A) Lupus
B) Gout
C) Arthritis
D) Scleroderma

Question 23

Children are _____ prone to TMJ ankylosis than adults because of greater osteogenic potential and _____ development of the joint meniscus.

A) more; more
B) more; less
C) less; more
D) less; less

Question 24

About _____% of all TMJ ankylosis cases result from joint infection, usually after trauma.

A) 10
B) 30
C) 50
D) 70

Question 25

____________ ankylosis is the most common type seen in the TMJ.

A) Fibrotic intraarticular
B) Bony intraarticular
C) Fibrotic extraarticular
D) Bony extraarticular

Question 26

What is the demographic group that typically presents with temporomandibular disorders (TMD)?

A) Children
B) Females, age 20-40
C) Males, age 40
D) Senior citizens

Question 27

Of the various surgical techniques used to treat TMDs, __________ involves surgical repositioning of the condyle.

A) arthrocentesis
B) arthroscopy
C) condylotomy
D) open joint surgery

Question 28

Approximately what percentage of persons with rheumatoid arthritis will have involvement of the TMJ?

A) <10%
B) 20-30%
C) 50-75%
D) Nearly 100%

Question 29

Three cardinal features for TMD include all except one. Which is the exception?

A) Restricted jaw function
B) Orofacial pain
C) Previous dental surgery
D) Joint noise

Question 30

Which term describes the condition where one or both of the condyles translate anterior to the articular eminence, resulting in an open lock that the patient cannot reduce?

A) Dislocation
B) Degenerative
C) Displacement
D) Odontogenic

Question 31

What is the most likely cause of TMD?

A) Stress
B) Trauma
C) Malocclusion
D) Third molar extractions

Question 32

The three elevator muscles of mastication that when activated, close the mandible, include the masseter, the medial pterygoid, and the ___________.

A) lateral pterygoid
B) temporalis
C) anterior digastric
D) mylohyoid

Question 33

During a dental appointment, dental hygienists can help a patient with TMD by doing which procedure?

A) Set the patient up slowly after the appointment.
B) Maintain a shorter appointment time.
C) Schedule the patient the first time of the day.
D) Avoid loud background music in the office.

Question 34

From the choices below, which type of radiographic imaging would be least helpful in diagnosing TMJ disease?

A) MRI
B) CBCT
C) Panoramic imaging
D) Arthrography

Question 35

Which muscle of mastication is responsible for opening the mandible?

A) Temporalis
B) Medial pterygoid
C) Masseter
D) Lateral pterygoid

Question 36

Which muscle of mastication is most superior in its location?

A) Temporalis
B) Lateral pterygoid
C) Masseter
D) Medial pterygoid

Question 37

Which term describes a procedure induced inadvertently by a health care provider or by medical treatment or a diagnostic procedure?

A) Sign
B) Symptom
C) Iatrogenic
D) Auscultation

Question 38

Which term describes the inability to fully open the mouth?

A) Trismus
B) Articulation
C) Fusion
D) Crepitus

Question 39

Tumors arising in the TMJ area are common. The most common benign tumors that arise in the condyle include the osteochondroma.

A) Both statements are true.
B) Both statements are false.
C) The first statement is true; the second statement is false.
D) The first statement is false; the second statement is true.

Question 40

Synovial _____________ is the most common benign neoplasm of the synovium.

A) osteoblastoma
B) chondroblastoma
C) osteoma
D) chondromatosis

Question 41

For each vocabulary word below, select the corresponding definition from the list provided.
Auscultation

A)Method for evaluating and manipulating a joint via the insertion of a camera and instruments
B)Dry, crackling sound
C)Surgical puncture of a joint followed by lavage of joint space
D)Physical examination using pressure of the hand or fingers
E)Inability to fully open the mouth
F)Radiography of a joint after injection of opaque contrast material
G)Noninvasive diagnostic technique that uses radio waves to produce computerized images of internal body tissues
H)Listening to sounds within the body, using a stethoscope
I)Subjective evidence of disease or a physical disorder that is observed by the patient
J)Objective evidence of disease that can be observed by a health care provider rather than by the patient
K)Joint
L)Induced inadvertently by a medical or dental care provider or by medical treatment or a diagnostic procedure

Question 42

For each vocabulary word below, select the corresponding definition from the list provided.
Palpation

A)Method for evaluating and manipulating a joint via the insertion of a camera and instruments
B)Dry, crackling sound
C)Surgical puncture of a joint followed by lavage of joint space
D)Physical examination using pressure of the hand or fingers
E)Inability to fully open the mouth
F)Radiography of a joint after injection of opaque contrast material
G)Noninvasive diagnostic technique that uses radio waves to produce computerized images of internal body tissues
H)Listening to sounds within the body, using a stethoscope
I)Subjective evidence of disease or a physical disorder that is observed by the patient
J)Objective evidence of disease that can be observed by a health care provider rather than by the patient
K)Joint
L)Induced inadvertently by a medical or dental care provider or by medical treatment or a diagnostic procedure

Question 43

For each vocabulary word below, select the corresponding definition from the list provided.
Arthroscopy

A)Method for evaluating and manipulating a joint via the insertion of a camera and instruments
B)Dry, crackling sound
C)Surgical puncture of a joint followed by lavage of joint space
D)Physical examination using pressure of the hand or fingers
E)Inability to fully open the mouth
F)Radiography of a joint after injection of opaque contrast material
G)Noninvasive diagnostic technique that uses radio waves to produce computerized images of internal body tissues
H)Listening to sounds within the body, using a stethoscope
I)Subjective evidence of disease or a physical disorder that is observed by the patient
J)Objective evidence of disease that can be observed by a health care provider rather than by the patient
K)Joint
L)Induced inadvertently by a medical or dental care provider or by medical treatment or a diagnostic procedure

Question 44

For each vocabulary word below, select the corresponding definition from the list provided.
Symptom

A)Method for evaluating and manipulating a joint via the insertion of a camera and instruments
B)Dry, crackling sound
C)Surgical puncture of a joint followed by lavage of joint space
D)Physical examination using pressure of the hand or fingers
E)Inability to fully open the mouth
F)Radiography of a joint after injection of opaque contrast material
G)Noninvasive diagnostic technique that uses radio waves to produce computerized images of internal body tissues
H)Listening to sounds within the body, using a stethoscope
I)Subjective evidence of disease or a physical disorder that is observed by the patient
J)Objective evidence of disease that can be observed by a health care provider rather than by the patient
K)Joint
L)Induced inadvertently by a medical or dental care provider or by medical treatment or a diagnostic procedure

Question 45

For each vocabulary word below, select the corresponding definition from the list provided.
Crepitus

A)Method for evaluating and manipulating a joint via the insertion of a camera and instruments
B)Dry, crackling sound
C)Surgical puncture of a joint followed by lavage of joint space
D)Physical examination using pressure of the hand or fingers
E)Inability to fully open the mouth
F)Radiography of a joint after injection of opaque contrast material
G)Noninvasive diagnostic technique that uses radio waves to produce computerized images of internal body tissues
H)Listening to sounds within the body, using a stethoscope
I)Subjective evidence of disease or a physical disorder that is observed by the patient
J)Objective evidence of disease that can be observed by a health care provider rather than by the patient
K)Joint
L)Induced inadvertently by a medical or dental care provider or by medical treatment or a diagnostic procedure

Question 46

For each vocabulary word below, select the corresponding definition from the list provided.
Iatrogenic

A)Method for evaluating and manipulating a joint via the insertion of a camera and instruments
B)Dry, crackling sound
C)Surgical puncture of a joint followed by lavage of joint space
D)Physical examination using pressure of the hand or fingers
E)Inability to fully open the mouth
F)Radiography of a joint after injection of opaque contrast material
G)Noninvasive diagnostic technique that uses radio waves to produce computerized images of internal body tissues
H)Listening to sounds within the body, using a stethoscope
I)Subjective evidence of disease or a physical disorder that is observed by the patient
J)Objective evidence of disease that can be observed by a health care provider rather than by the patient
K)Joint
L)Induced inadvertently by a medical or dental care provider or by medical treatment or a diagnostic procedure

Question 47

For each vocabulary word below, select the corresponding definition from the list provided.
Articulation

A)Method for evaluating and manipulating a joint via the insertion of a camera and instruments
B)Dry, crackling sound
C)Surgical puncture of a joint followed by lavage of joint space
D)Physical examination using pressure of the hand or fingers
E)Inability to fully open the mouth
F)Radiography of a joint after injection of opaque contrast material
G)Noninvasive diagnostic technique that uses radio waves to produce computerized images of internal body tissues
H)Listening to sounds within the body, using a stethoscope
I)Subjective evidence of disease or a physical disorder that is observed by the patient
J)Objective evidence of disease that can be observed by a health care provider rather than by the patient
K)Joint
L)Induced inadvertently by a medical or dental care provider or by medical treatment or a diagnostic procedure

Question 48

For each vocabulary word below, select the corresponding definition from the list provided.
Arthrocentesis

A)Method for evaluating and manipulating a joint via the insertion of a camera and instruments
B)Dry, crackling sound
C)Surgical puncture of a joint followed by lavage of joint space
D)Physical examination using pressure of the hand or fingers
E)Inability to fully open the mouth
F)Radiography of a joint after injection of opaque contrast material
G)Noninvasive diagnostic technique that uses radio waves to produce computerized images of internal body tissues
H)Listening to sounds within the body, using a stethoscope
I)Subjective evidence of disease or a physical disorder that is observed by the patient
J)Objective evidence of disease that can be observed by a health care provider rather than by the patient
K)Joint
L)Induced inadvertently by a medical or dental care provider or by medical treatment or a diagnostic procedure

Question 49

For each vocabulary word below, select the corresponding definition from the list provided.
Sign

A)Method for evaluating and manipulating a joint via the insertion of a camera and instruments
B)Dry, crackling sound
C)Surgical puncture of a joint followed by lavage of joint space
D)Physical examination using pressure of the hand or fingers
E)Inability to fully open the mouth
F)Radiography of a joint after injection of opaque contrast material
G)Noninvasive diagnostic technique that uses radio waves to produce computerized images of internal body tissues
H)Listening to sounds within the body, using a stethoscope
I)Subjective evidence of disease or a physical disorder that is observed by the patient
J)Objective evidence of disease that can be observed by a health care provider rather than by the patient
K)Joint
L)Induced inadvertently by a medical or dental care provider or by medical treatment or a diagnostic procedure

Question 50

For each vocabulary word below, select the corresponding definition from the list provided.
Trismus

A)Method for evaluating and manipulating a joint via the insertion of a camera and instruments
B)Dry, crackling sound
C)Surgical puncture of a joint followed by lavage of joint space
D)Physical examination using pressure of the hand or fingers
E)Inability to fully open the mouth
F)Radiography of a joint after injection of opaque contrast material
G)Noninvasive diagnostic technique that uses radio waves to produce computerized images of internal body tissues
H)Listening to sounds within the body, using a stethoscope
I)Subjective evidence of disease or a physical disorder that is observed by the patient
J)Objective evidence of disease that can be observed by a health care provider rather than by the patient
K)Joint
L)Induced inadvertently by a medical or dental care provider or by medical treatment or a diagnostic procedure

Question 51

For each vocabulary word below, select the corresponding definition from the list provided.
Arthrography

A)Method for evaluating and manipulating a joint via the insertion of a camera and instruments
B)Dry, crackling sound
C)Surgical puncture of a joint followed by lavage of joint space
D)Physical examination using pressure of the hand or fingers
E)Inability to fully open the mouth
F)Radiography of a joint after injection of opaque contrast material
G)Noninvasive diagnostic technique that uses radio waves to produce computerized images of internal body tissues
H)Listening to sounds within the body, using a stethoscope
I)Subjective evidence of disease or a physical disorder that is observed by the patient
J)Objective evidence of disease that can be observed by a health care provider rather than by the patient
K)Joint
L)Induced inadvertently by a medical or dental care provider or by medical treatment or a diagnostic procedure

Question 52

For each vocabulary word below, select the corresponding definition from the list provided.
MRI

A)Method for evaluating and manipulating a joint via the insertion of a camera and instruments
B)Dry, crackling sound
C)Surgical puncture of a joint followed by lavage of joint space
D)Physical examination using pressure of the hand or fingers
E)Inability to fully open the mouth
F)Radiography of a joint after injection of opaque contrast material
G)Noninvasive diagnostic technique that uses radio waves to produce computerized images of internal body tissues
H)Listening to sounds within the body, using a stethoscope
I)Subjective evidence of disease or a physical disorder that is observed by the patient
J)Objective evidence of disease that can be observed by a health care provider rather than by the patient
K)Joint
L)Induced inadvertently by a medical or dental care provider or by medical treatment or a diagnostic procedure

Question 53

What is the function of the synovial fluid inside the joint?

A) To provide nourishment and lubrication of avascular structures
B) To allow the bones to fit together properly
C) To absorb shock
D) To allow for correct palpation of the joint area

Question 54

For each vocabulary word below, select the corresponding definition from the list provided.
The temporomandibular joint (TMJ) is the articulation between the condyle of the mandible and the

A) zygomatic process of the temporal bone.
B) glenoid fossa of the temporal bone.
C) external acoustic meatus.
D) spine of the sphenoid bone.

Question 55

Which statement about the articular disc in the TMJ joint is true?

A) It is attached to the anterior and posterior aspects of the condyle.
B) It is attached to the inferior belly of the medial pterygoid muscle.
C) The disc is highly vascular.
D) The disc is surrounded and protected by the fibrous connective tissue joint capsule.

Question 56

During opening of the jaw

A) rotational movement precedes translation.
B) rotational movement follows translation.
C) only rotational movement occurs; translation occurs only during closure.
D) only translational movement occurs; rotation occurs only during closure.

Question 57

Which choice represents an indirect form of trauma affecting the TMJ?

A) Clenching, bruxism
B) Whiplash injury
C) Psychosocial factors
D) Osteoarthritis

Question 58

Clicking and popping most commonly reflect

A) parafunctional habits such as bruxism and clenching.
B) disc displacement with reduction.
C) malocclusion.
D) trismus.

Question 59

Which dental radiographic procedure is best for examining disc position, function, form, and the presence of joint effusions?

A) Panoramic imaging
B) Transcranial imaging
C) Computerized tomography (CT)
D) Magnetic resonance imaging (MRI)

Question 60

An open lock of the TMJ that the patient cannot reduce is termed

A) subluxation.
B) dislocation.
C) ankylosis.
D) myofascial pain.

Question 61

Which statement is characteristic of a patient with osteoarthritis?

A) It is characterized by pain that is worse in the morning.
B) It is characterized by pain that is worse in the evening.
C) It is an inflammatory, autoimmune disorder of the joints.
D) Approximately 50% to 75% of patients have involvement of the TMJ during the course of the disease.

Question 62

The purpose of the synovial fluid is to

A) provide nourishment and lubrication.
B) divide the space into upper and lower compartments.
C) govern mandibular movement.
D) separate forces resulting from movement.

Question 63

Trauma affecting the TMJ is classified as direct, indirect, and secondary to parafunctional habits. Which is an example of a parafunctional habit?

A) Whiplash injury
B) Assault
C) Surgery
D) Clenching

Question 64

The most common systemic conditions that affect the TMJ are

A) Sjögren syndrome and scleroderma.
B) rheumatoid arthritis and juvenile rheumatoid arthritis.
C) gout and Reiter syndrome.
D) ankylosing spondylitis and mixed connective tissue disease.

Question 65

Temporomandibular dysfunction (TMD) can be caused by disorders of the muscles of mastication or by internal derangements of the components of the joint. Three cardinal features that suggest TMD include orofacial pain, joint noise, and restricted jaw function.

A) Both statements are true.
B) Both statements are false.
C) The first statement is true; the second is false.
D) The first statement is false; the second is true.

Question 66

Tenderness over the lateral pole of the condyle is indicative of

A) crepitus.
B) capsulitis.
C) trismus.
D) auscultation.

Question 67

Caution is recommended with long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) because of what complications?

A) Gastrointestinal
B) Cardiovascular
C) Psychiatric
D) Arthritis

Question 68

All are benign tumors that arise in the condyle except one. Which is the exception?

A) Osteoblastoma
B) Synovial chondromatosis
C) Osteoma
D) Chondroblastoma

Question 69

Which dental radiographic imaging is best for identifying bone abnormalities such as osteophytes, condylar erosion, fractures, ankylosis, and condylar hyperplasia?

A) Panoramic imaging
B) Transcranial imaging
C) Computerized tomography (CT)
D) Magnetic resonance imaging (MRI)

Question 70

Hypermobility in which the patient is able to relocate the mandible back into the glenoid fossa is referred to as

A) subluxation.
B) dislocation.
C) ankylosis.
D) myofascial pain.

Question 71

The TMJ exhibits ginglymoarthrodial, or __________, movement.

A) rotational and translational
B) opening
C) closing
D) maximal interdigitation

Question 72

Opening, or depressor function, of the mandible is accomplished primarily by the _____________ muscle.

A) medial pterygoid
B) lateral pterygoid
C) masseter
D) temporalis

Question 73

While up to _____% of the adult population has at least one sign and/or symptom of a temporomandibular disorder (TMD), most studies suggest that clinically significant TMD-related jaw pain, dysfunction, or both affects about _____% of the general population.

A) 90; 10
B) 75; 13
C) 50; 10
D) 25; 5

Question 74

____________ ankylosis is the most common type seen in the TMJ.

A) Fibrotic intraarticular
B) Bony intraarticular
C) Fibrotic extraarticular
D) Bony extraarticular

Question 75

About _____% of all TMJ ankylosis cases result from joint infection, usually after trauma.

A) 10
B) 30
C) 50
D) 70

Question 76

Children are _____ prone to TMJ ankylosis than adults because of greater osteogenic potential and _____ development of the joint meniscus.

A) more; more
B) more; less
C) less; more
D) less; less

Question 77

Of the various surgical techniques used to treat TMDs, __________ involves surgical repositioning of the condyle.

A) arthrocentesis
B) arthroscopy
C) condylotomy
D) open joint surgery

Question 78

Synovial _____________ is the most common benign neoplasm of the synovium.

A) osteoblastoma
B) chondroblastoma
C) osteoma
D) chondromatosis

Question 79

The three elevator muscles of mastication that when activated, close the mandible, include the masseter, the medial pterygoid, and the ___________.

A) lateral pterygoid
B) temporalis
C) anterior digastric
D) mylohyoid

Question 80

Which term describes the inability to fully open the mouth?

A) Trismus
B) Articulation
C) Fusion
D) Crepitus