PTBCCT – Certification Development of the Examination

Development of the examination was originally directed by Measurement Research Associates which is currently a business unit of the Data Recognition Corporation, an independent psycho-metric testing service for the dental and medical profession. Annual review and updating is performed according to periodic statistical analysis by clinical and scientific advances and to ensure parity with the specialty certification examination requirements of the APTA. Each successful candidate is designated as a “Certified Cervical and Temporomandibular Therapist” (CCTT) with their name, picture, practice location, biosketch and contact information posted within the member directory of the 501-C3 non-profit PTBCCT website (www.ptbcct.org) for those seeking a qualified physical therapist within this specialized field.

STUDY GUIDE

HOW TO PREPARE FOR THE EXAMINATION

  1. The 2021 examination consists of 125 multiple choice questions that must be completed within 3 hours.
  2. The examination blueprint and study guide that follows outlines the specific content areas of knowledge that are included in the examination.
  3. A few sample questions are provided and presented in the exact same format as those included in the examination.
  4. A suggested reading list of books and journal articles for review are included. Please note that the PTBCCT does not endorse any of the specific texts nor state that the list is entirely comprehensive. Furthermore, the list does not in any manner represent that questions on the examination have been taken directly from these sources.
Subject Areas Consist of the Following Categories: Items Percentage
Temporomandibular Epidemiology, Anatomy, and Biomechanics 29 23%
Cervical Epidemiology, Anatomy, and Biomechanics 15 12%
Dental Terminology and Oral Appliances 10 8%
Evaluation and Differential Dx. and Management of TMD, Orofacial Pain, and Dysfunction 41 33%
Temporomandibular Joint Surgery 10 8%
Evaluation and Differential Dx. and Management of Cervical/Upper 1/4 Pain and Dysfunction 20 16%

Recommended For Review

Please note that the following textbooks, chapters, cervical plus TMD course manuals and journal publications represent references that are continually updated by the examination development team of physical therapists, dentists, oral surgeons and the examination review committee in support of each test item.

Click on a category below to view it

Journal Articles

Items in bold are highly recommended for review.

  1. Leuwer R, Schubert R, Kucinski T, et al. The muscular compliance of the auditory tube: a model-based survey.Laryngoscope.112:1791-1795,  2002.
  2. Bailey DR. Sleep disorders: Overview and relationship to orofacial pain. Dental Clinics of No Am.41(2): 189-209, 1997.
  3. Carlson CR, Okeson JP, Falace DA, et al: Reduction of pain and EMG activity in the masseter region by trapezius trigger point injection. Pain 55: 397-400, 1993.
  4. Dvorak J & Panjabi MM. Functional Anatomy of the Alar Ligaments. Spine Vol 12, No 2, 1987.
  5. Mannheimer JS & Postoperative management for surgical procedures to the temporomandibular joint. Orthopedic Physical Therapy Clinics of No Am. 11(2): 235-261, 2002.
  6. Pollmann W, Keodel M & pfaffenrath V. Headache and the cervical spine: A critical review. Cephalgia 17(8): 801-816, 1997.
  7. Okeson JP & Falace DA: Nonodontogenic toothache. Dental Clinics of No Am 41(2), 367-383, 1997.
  8. De Leeuw R, Boerin, G, Stegenga B, et al. Clinical Signs of TMJ Osteoarthrosis and Internal Derangement 30 years After Nonsurgical Treatment. J Orofac Pain. 8(1): 18-24, 1994.
  9. Svensson and Graven-Nielson. Craniofacial Muscle Pain: Review of Mechanisms and Clinical Manifestations. J Orofac Pain. 15(2):117-45, 2001.
  10. Levine HL. Otorhinolaryngologic causes of headache. In Diamond S (ed). Headache. Medical Clinics of No Am. 75: 677-692, 1991.
  11. Murray GM, Phanachet I, Uchida S et al. The role of the human lateral pterygoid muscle in the control of horizontal jaw movements. J Orofacial Pain 15(4): 279-305, 2001.
  12. Shhati-Chafai-Leuwer S, Wenzel S, Bschorer R, et al. Pathophysiology of the eustachian tube- relevant new aspects for the head and neck surgeon. Craniomaxillofac Surg, 34: 351-354, 2006.
  13. Kumazaki Y, Kawakami S, Hirata A, et al. Ipsilateral Molar Clenching Induces Less Pain and Discomfort than Contralateral Molar Clenching in Patients with Unilateral Anterior Disc Displacement of the Temporomandibular Joint. Journal of Oral & Facial Pain and Headache. 30(3): 241-248, 2016.
  14. Landgraf M, Biebl J, Langhagen T, et al. Children with migraine: Provocation of headache via pressure to myofascial trigger points in the trapezius muscle? – A prospective controlled observational study. European Journal of Pain. 22(2): 385-392, 2018.
  15. Do TP, Heldarskard GF, Kolding LT, et al. Myofascial trigger points in migraine and tension-type headache. The Journal of Headache and Pain. 19(1), 2018.
  16. Teachey WS. Otolaryngic myofascial pain syndromes. Current Pain and Headache Reports. 8(6): 457-462, 2004.
  17. Naeije M, Kalaykova S, Visscher CM, et al. Evaluation of the research diagnostic criteria for temporomandibular disorders for the recognition of anterior disc displacement with reduction. British Dental Journal. 208(3): 113-113, 2010.
  18. Giraudeau A, Jeany M, Ehrmann E, et al. Disc displacement without reduction: a retrospective study of a clinical diagnostic sign. Cranio. 35(2): 86-93, 2016.
  19. Gil-Martinez A, Paris-Alemany A, López-De-Uralde-Villanueva I, et al. Management of pain in patients with temporomandibular disorder (TMD): challenges and solutions. Journal of Pain Research. Volume 11: 571-587, 2018.
  20. Julsvoll EH, Vøllestad NK, Robinson HS. Validation of clinical tests for patients with long-lasting painful temporomandibular disorders with anterior disc displacement without reduction. Manual Therapy. 21: 109-119, 2016.
  21. Kraus SL. Characteristics of 511 patients with temporomandibular disorders referred for physical therapy. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 118(4): 432-439, 2014.
  22. Kraus S, Prodoehl J. Disc displacement without reduction with limited opening: A clinical diagnostic accuracy study. Physiotherapy Theory and Practice. 33(3): 238-244, 2017.
  23. Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: Recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Groupdagger. Journal of Oral Facial Pain. 28: 6-27, 2014.
  24. Harrison AL, Thorp JN, Ritzline PD. A proposed diagnostic classification of patients with temporomandibular disorders: implications for physical therapists. Journal of Orthopaedic and Sports Physical Therapy. 44(3): 182-97, 2014.
  25. La Touche R, Paris-Alemany A, von Piekartz H, Mannheimer JS et al. The Influence of Cranio-Cervical Posture on Maximal Mouth Opening and Pressure Pain Threshold in Patients with Myofascial Temporomandibular Pain Disorders. Clinical Journal of Pain. 27(1): 48-55, 2011.
  26. La Touche, R, Paris-Alemany A, Mannheimer JS. et al. Does Mobilization of the Upper Cervical Spine Affect Pain Sensitivity and Autonomic Nervous System Function in Patients with Cervico-Craniofacial Pain?  A Randomized Controlled Trial. Clinical Journal of Pain. 29(3): 205-215, 2013.
  27. Kalaykova S, Lobbezoo F, Naeije M. Effect of chewing upon disc reduction in the temporomandibular joint. Journal of Orofacial Pain. 25(1): 49-55, 2001.
  28. Klasser GD, Greene CS. Oral Appliances in the management of temporomandibular disorders. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endontology. 107(2): 212-23, 2009.
  29. Ikeda R et al. Directional characteristics of incipient temporomandibular joint disc displacements: A magnetic resonance imaging study. Am J Orthodon & Dentofacial Orthop 149(1): 39-45. 2016.
  30. Suzuki, et al. Mandibular lateral translation during symmetric mandibular function in relation to patterns of intra-capsular derangement of the TMJ. J Stomat Occ Med 2:16-23, 2009.
  31. Visscher CM, et al. Diagnostic Accuracy of Temporomandibular Pain Tests. A Multicenter Study. J Orofac Pain 23(2):108-114, 2009.
  32. Visscher CM, et al. A reliability study of dynamic and static pain tests in temporomandibular disorder patients. J Orofac Pain: 21(1):39-45, 2007.
  33. Bogduk N et al. Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment. Lancet Neurol, 2009.
  34. Piovesan et al. Convergence of cervical and trigeminal sensory afferents. Current Pain and Headache Reports, 2003.
  35. Maarbjerg, S. Trigeminal neuralgia – diagnosis and treatment. Cephalalgia, 37(7), 648-657. 2017.
  36. Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders. 3rd Cephalalgia, 38(1) 1-211, 2018.
  37. Srivastava R, Jyoti B, Devi P. Oral splint for temporomandibular joint disorders with revolutionary fluid system. Dent Res J (Isfahan) 10(3): 307-313, 2013.
  38. Fricton J, et al. Systematic Review and Meta-analysis of Randomized Controlled Trials Evaluation Intraoral Orthopedic Appliances for Temporomandibular Disorders. JOP, 2010.
  39. Morita K, et al. Association between buccal mucosa ridging and oral or occlusal status among older people. Oral Dis, 2018.
  40. Sale H. Temporomandibular joints in asymptomatic and symptomatic nonpatient volunteers: a prospective 15 year follow-up clinical and MR imaging study. Radiology, 2013.
  41. Poluha, R et al. Temporomandibular joint disc displacement with reduction: a review of mechanisms and clinical presentation. J Applied Oral Science, 2019.
  42. Orstavik et al. Pain and small-fiber neuropathy in patients with hypothyroidism. Neurology, 2006.
  43. Nayak SR et al. Bilateral anomaly of rectus capitis posterior muscles in the suboccipital triangle and its clinical implication. Clin Ter, 2011.
  44. Pontell ME et al. The obliquus capitis inferior myodural bridge. Clin Anat, 2013.
  45. Scali F et al. Magnetic resonance imaging investigation of the atlanto-axial interspace. Clin Anat, 2013.
  46. Hack GD et al. Anatomic relation between the rectus capitis posterior minor muscle and the dura mater. Spine, 1995.
  47. Slade, G et al. Signs and symptoms of first-onset TMD and sociodemographic predictors of its development: the OPPERA prospective cohort study. J Pain, 2013.
  48. McNamara et al. Australian Dental Journal, 41(6), 1996
  49. Movahed R, Wolford LM. Protocol for concomitant TMJ custom-fitted total joint reconstruction and orthognathic surgery using computer-assisted surgical simulation. Oral and Maxillofacial Surgery Clinics of North America, 27(1):37-46, 2015
  50. Arthroscopic discoplexy is effective in managing temporo-mandibular joint internal derangement in patients with Wilkes stage II and III. J Oral Maxillofac Surg. 73(3):391-401, 2015.
  51. Yim et al. The laryngeal cough reflex in congenital muscular torticollis: is it a new finding? AM J Phys Med Rehabil, 2010.
  52. Yacovino DA et al. Clinical characteristics of cervicogenic related dizziness and vertigo. Seminars in Neurology, 2013.
  53. Cherchi M et al. Migraine associated vertigo. Otolaryngol Clin North Am. Apr;44(2):367-75.
  54. Simpson, AK et al. Assessment of Cervical Foramina with Oblique Radiographs: J Spinal Disord Tech, February 2009.
  55. Kuroda et al. Long-term stability of conservative orthodontic treatment in a patient with rheumatoid arthritis and severe condylar resorption. AM J Orthod Dentofacial Orthop, 2012.
  56. Lance and Anthony. Neck-tongue syndrome on sudden turning of the head. Journal of Neurology, Neurosurgery, and Psychiatry, 43: 97-101, 1980.
  57. Hu and Dougherty. Neck-Tongue Syndrome. Current Pain Headache Rep, 2016.
  58. Lee, SH et al. Macroscopic Innervation of the Dura Mater Covering the Middle Cranial Fossa in Humans Correlated to Neurovascular Headache. Frontiers in Neuroanatomy, 2017.
  59. Bidonde J et al. Aerobic exercise training for adults with fibromyalgia. Cochrane Database Syst Rev, Jun 2017.
  60. Frangos et al. Non-invasive Access to the Vagus Nerve Central Projections via Electrical Stimulation of the External Ear: fMRI Evidence in Humans. Brain Stimul, 2015.
  61. Clement C, Bravetti P, Plenat F, et al. Quantitative analysis of the elastic fibers in the human temporomandibular articular disc and its attachments. Int J Oral Maxillofac Surg 2006; 35: 1120-1126
  62. Turell J et al. Normal and abnormal findings in temporomandibular joints in autopsy specimens. J of Craniomandibular Disorders, 1987.
  63. Tanaka E et al. Effect of hyperactivity of the latereal pterygoid muscle on the TMJ disk. J Biomech Eng, 2007.
  64. Pons M et al. MR-guided navigation for botulinum toxin injection in the lateral pterygoid muscle. First results in the treatment of TMJ disorders. J Stomatol Oral Maxillofac Surg, 2019.
  65. Manfredini D. Etiopathogenesis of disk displacement of the temporomandibular joint: a review of the mechanisms. Indian J Dent Res, 2009.
  66. Yadav S and Karani JT. The Essentials of Occlusal Splint Therapy. International Journal of Prosthetic Dentistry, 2011.
  67. Jung et al. Magnetic resonance imaging – verified TMJ disc displacements in relation to sagittal and vertical jaw deformities. Int J Oral and Maxillofac Surg, 2013.
  68. Mercuri LG. Temporomandibular Joint Replacement. Oral and Maxillofacial Surgery, 924-925. 2018.
  69. Rajurkar SG et al. Use of Temporalis Fascia Flap in the Treatment of Temporomandibular Joint Ankylosis. Contemp Clin Dental, 2017.
  70. Rasheed RH et al. Temporalis Muscle Flap as a Mode of Treating Temporomandibular Joint Ankylosis (TMJA). Egyptian Dental Journal, 2009.
  71. De Farias JFG et al. Correlation between temporomandibular joint morphology and disc displacement by MRI. Dentomaxillofacial Radiology, 2015.
  72. Maizlin V et al. Displacement of the Temporomandibular Joint Disk: Correlation Between Clinical Findings and MRI Characteristics. J Can Dent Assoc, 2010.
  73. Wieckiewicz M et al. Reported concepts for the treatment modalities and pain management of temporomandibular disorders. The Journal of Headache and Pain, 2015.
  74. Miernik M et al. The Basic Conservative Treatment of Temporomandibular Joint Anterior Disc Displacement Without Reduction – Review. Adv Clin Exp Med, 2015.
  75. Ulmner M et al. Predictive factors in temporomandibular joint arthroscopy: a prospective cohort short-term outcome study. Int Journal of Oral & Maxillofacial Surgery, 2019.
  76. Barbieri AA et al. Association of volume and voxel intensity of the articular disc and lateral pterygoid muscle in migraine patients: a study with MRI. Acta Odontologica Scandinavica, 2019.
  77. Zhigui Ma et al. Can anterior repositioning splint effectively treat TMJ displacement? Nature, 2019.
  78. Mercuri LG. Temporomandibular joint replacement devices – dark past to challenging future. Stomatological Disease and Science, 2019.
Textbooks and Chapters

Items in bold are highly recommended for review.

  1. Travell J, Simons D, Myofascial Pain and Dysfunction: The Trigger Point Manual. 3rd Wolters Kluwer, 2019.
  2. Pertes R, Gross S:Clinical Management of Temporomandibular Disorders and Orofacial Pain. Quintessence, 1995.
  3. Mannheimer, JS (1995). Overview of physical therapy modalites and procedures. In Pertes RA & Gross SG ( eds ). Clinical Management of Temporomandibular Disorders and Orofacial Pain. Chicago. Quintessence.
  4. Boissonnault, WG (ed): Examination in Physical Therapy Practice. Screening for Medical Disease. 2nd edition, Churchill Livingstone, Philadelphia, Pa.1995.
  5. Kaplan & Assael. Temporomandibular Disorders: Diagnosis and Treatment. Saunders, Philadelphia, 1991.
  6. Kraus SL. Temporomandibular disorders. 2nd. Edition. Clinics in Physical Therapy, Churchill Livingstone, 1994.
  7. De Leeuw R. (ed). Orofacial Pain: Guidelines for Assessment, Diagnosis and Management. 6th ed. of the American Academy of Orofacial Pain. Quintessence Books, Chicago, 2018.
  8. Mannheimer JS, Kraus SL, Hesse, JR & Visscher  C.  Chapter 9: Cervicogenic Mechanisms of Orofacial Pain and Headaches.  Guidelines for Assessment, Diagnosis and Management  In: De Leeuw, R. (ed). Quintessence Books, Chicago, 2008.
  9. Fernández-de-las-Peñas C, Mesa-Jiménez J. Temporomandibular Disorders: Manual Therapy, Exercise, and Needling. Pencaitland, East Lothian, Scotland: Handspring Publishing Limited, 2018.
  10. Edeling J. Manual Therapy for Chronic Headache. Oxford: Butterworth Heinemann, 1994.
  11. Mannheimer JS & Dunn J. The Cervical Spine:  Its Evaluation and Relation to Temporomandibular Disorders.  In Kaplan, A. (ed).  Textbook of Craniomandibular Disorders. WB.Saunders, 1991.
  12. Mannheimer JS.  Prevention and Restoration of Abnormal Upper Quarter Posture. In Gelb, H & Gelb M (eds.) Postural Considerations in the Diagnosis and Treatment of Cranio-Cervical-Mandibular and Related Chronic Pain Disorders. Mosby, 1994.
  13. Dunn J & Mannheimer JS. The Cervical Spine.  In Pertes, R.A. (ed.) Clinical Management of Temporomandibular Disorders and Facial Pain. Quintessence Books, Chicago, 1995.
  14. Rocabado M, Iglarsh, ZA. Musculoskeletal Approach to Maxillofacial Pain. Philadelphia: J. B. Lippincott Company, 1991.
  15. Okeson, Jeffrey – Management of Temporomandibular Disorders and Orofacial Pain, 2007.
  16. Benoliel & Y. Sharay – Orofacial Pain and Headache, 2015
  17. Okeson, Jeffrey. Bell’s Orofacial Pains. Quintessence, 1995.
  18. Levangie, Pamela and Cynthia Norkin. Joint Structure and Function: A Comprehensive Analysis. FA Davis, 2011.
  19. De Leeuw, Reny and Gary Klasser, eds. Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management. 6th Quintessence, 2018.
  20. Mannheimer, JS. Clinical TENS. FA Davis, 1984.
  21. Wackenheim, Auguste. Cervico-Occipital Joint (RX,CT). Springer, 1985.
  22. Murphy, Donald, ed. Conservative Management of Cervical Spine Syndromes. McGraw-Hill, 2000.
  23. A Textbook of Head and Neck Anatomy. Mosby, 1988.
  24. Von Piekartz, Harry. Craniofacial Pain: Neuromusculoskeletal Assessment, Treatment, and Management. Elsevier, 2007.
  25. Occlusion: Principles and Assessment. Wright, 1991.
  26. Mahan PE. Temporomandibular joint in function and pathofunction. Temporomandibular Joint Problems, WK Solberg and GT Clark. Quintessence, 1980.
Educational Courses

The PTBCCT highly recommends taking any Cervical-TMD course by the following CCTT’s: 

Tom Eggleton, Bill Esser, Tim Gibbs, Todd Henkelmann, Jules Hesse, Michelle Finnegan, Michael Karegeannes, Steve Kraus, Dennis Langton, Jeff Mannheimer, Mariano Rocabado, Patricia Rudd, Mark Strickland/Jennifer Hobson,  Katherine Tan and Corine Visscher.

Sample Questions
1. The following reflex has strong validity regarding lesions affecting the upper motor neurons often associated with cervical myelopathy. This reflex, if positive, may denote spinal cord compression or intracranial pathology that should be fully evaluated by a radiologic work-up. A positive reflex sign is present if the patient’s index finger and thumb flex while the clinician snaps / flicks their middle finger. The name of this reflex is?

A. Upper Babinski Reflex
B. Hoffman’s Reflex
C. Torg-Pavlov Reflex
D. Sugarman’s Reflex

2. Eagles Syndrome is craniofacial pain produced by active cervical rotation compressing sensitive cervical spine structures against the elongation of which of the following processes?

A. Zygomatic process
B. Styloid process
C. Uncinate process
D. Mastoid process

3. Which of the following groups of cranial nerves travel with the spinal tract of trigeminal?

A. Olfactory, facial, oculomotor, vagus, and abducens
B. Facial, vagus, glossophayngeal, optic, and trochlear
C. Vagus, spinal accessory, facial, hypoglossal, and glossophyarngeal
D. Glossopharyngeal, vagus, acoustic, trochear, and oculomotor

4. In an MRI of the temporomandibular joint taken in the sagittal plane, the part of the temporomandibular disk that is located just behind the posterior band is the?

A. Bilaminar zone
B. Epimysium
C. Lateral pterygoid muscle
D. Temporomandibular ligament

5. A patient complains of sensibility loss of the skin of the temporal region and around the ear. Moreover, propriosepsis of the temporomandibular joint is affected. Which nerve is most probably affected?

A. Auriculotemporal
B. Spinal Accessory
C. Supraorbital
D. Facial

6. A physical therapist is manually palpating the area between the lateral border of the trapezius muscle and the posterior border of the sternocleidomastoid muscle, one centimeter below the suboccipital bone. Which muscular structure is she palpating?

A. Oblique Capitis Superior
B. Rectus Capitis Anterior
C. Rectus Capitis Lateralis
D.Splenius Capitis

7. In a patient presenting with posterior cranial rotation, the lateral cervical X-ray would likely disclose:

A. Narrowing of the C5-C6 interspace
B. Advanced degenerative joint disease
C. Multiple disc herniations
D. Decreased distance between the occiput and C1

8. A patient has a diagnosis of a displaced disc without reduction of the right temporomandibular joint. Which clinical sign would most likely be expected upon functional examination?

A. A deflection upon protrusive movement to the left
B. A deviation of the mandible throughout opening and closing
C. An intermediate “click” with opening and closing
D. A restriction of lateral movement to the left

9. A patient has an active mouth opening of 57 mm, a left deviation on opening, a clicking sound at the end of opening and at the beginning of closing, laterotrusion to the left side of 13 mm, and to the right side of 10 mm. She has no history of trauma. What is the most likely diagnosis?

A. Anterior disk displacement with reduction of the left temporomandibular joint
B. Anterior disk displacement with reduction of the right temporomandibular joint
C. Hypermobility of the left temporomandibular joint
D. Hypermobility of the right temporomandibular joint

10. A female patient complains of recurring headaches manifesting in attacks lasting one to two days. It has a unilateral character, a pulsating quality, and is associated with nausea, photophobia, and phonophobia. What type of headache is she suffering from?

A. Cervicogenic headache
B. Cluster headache
C. Migraine
D. Tension-type headache

11. A 60 year old female patient is sent to a physical therapist for treatment of myofascial jaw pain. On examination, tenderness of the masticatory muscles to palpation is found on both sides. In addition, with mandibular range-of-motion movements, the patient winces and complains of electric shock-like pains in her left cheek and upper jaw. In addition to myofascial pain, the most likely diagnosis is:

A. Atypical odontalgia
B. Glossopharyngeal neuralgia
C. Paroxysmal hemicrania
D. Trigeminal neuralgia

Answer Key: 1. ( b), 2. (b), 3. (c), 4. (a), 5. (a), 6. (d), 7. (d), 8. (d), 9. (d), 10. (c), 11. (d).