Print this page

Evaluation and Diagnosis

The keystone to the successful treatment of a TMD is an accurate evaluation and diagnosis. Temporomandibular disorders are often misdiagnosed. When a TMD is suspected, the patient should be assessed by a clinician skilled in the assesment of TMD and other facia pain disorders. A detailed medical/dental history, comprehensive head and neck (and sometimes general) physicial examination, and radiographic studies are routine. Other tests, such as laboratory tests, and psychological assessments are sometimes indicated.

The history of the problem is often the most important part of the assessment. Important factors include date an manner of onset, progression of symptoms, related disorders, family history, and response to past treatments are discussed. Of particular importance is the relationship between symptoms and injuries.

The detailed physicial examination included muscles, bones, nerves and blood vessels of the head and neck. Special emphasis is placed on the dentition.

Imaging of the TM joints and associated structures is necessary to establish the presence or absence of a TMD and the stage of the disease in order to select the appropriate treatment, to assist in prognosis, and assess patient response to therapy. While imaging results often influence treatment strategies, symptoms most often drive treatment decisions. Incipient symptoms are often diagnosed and treated without xrays. If symptoms persist and do not respond to initial therapy, imaging then can be done. Imaging studies are usually bilateral because of the significant incidence of bilateral joint disease. Panoramic radiographs are available in many dental offices and demonstrate gross glenoid fossa and condylar anatomy. Additional detail is obtained from corrected tomograms. The disk and associated soft tissues can be assessed with MRI scans (magnetic resonance imaging). MRI scans have largely replaced the more invasive arthrogram. CT scans are useful to detect fine body changes such as sclerotc, degenerative, traumatic, dysplastic or nedoplastic changes.

Laboratory studies are rarely indicated for ID/OA. In other suspected conditions of the TMJ, for example rheumatoid arthritis, the appropriate tests should be order

Other Studies

To evaluate other sources of pathology adjacent to or related to the TMJ, other head and neck imaging studies may be necessary. A panoramic radiograph is a valuable screening test for assessing sources of facial pain that are often confused with TMJ pain, such as dental infections, neoplasms, sinus pathology and Eagle’s syndrome. Plain radiographs, such as transcranial views, are useful for general determinations of condylar morphology and position in the fossa. In instances where more information is required, tomography is recommended. Diagnostic arthroscopy permits obtaining synovial fluid for analysis and specimens for biopsy.

There are two elements to diagnosis. The first is a comprehensive history and clinical examination. The second is a series of diagnostic studies. Each practitioner has his or her own favorites which they rely on, and which may be used either singly or in any combination. In general, the diagnostic studies available for TM Joint diagnosis and evaluation are:

  • X-rays of the TM Joints & Skull
  • MRI (Magnetic Resonance Imaging)
  • Electromyography (studies of muscle function)
  • Motion Performance Studies
  • Joint Vibration Analysis (a form of ultra-sound sonography)
  • Diagnostic Study Casts of the Mandible & Maxilla
  • X-rays of the Dentition

Previous page: What Causes TMJ/TMD?
Next page: TMJ Treatment