TMJ Diagnosis

History and Examination

A specific TMJ diagnosis is usually arrived at after a history and examination is performed.

The probing history will usually be quite revealing. You may be able to recall an onset occurring shortly after dental work, the use of orthodontic braces, a car accident or other trauma to the head, face and neck.

When arriving at a TMJ diagnosis, it is imperative that all conditions that could cause TMJ pain and dysfunction be considered. Some conditions that need to be ruled out before arriving at a diagnosis of TMJ dysfunction or myofacial pain syndrome (trigger points) are:

  • Tumors

  • Cysts
  • Bone disease
  • Fractures



History

Often a history and a simple examination will confirm a TMJ diagnosis of TMJ dysfunction. These are just some of the questions your dentist may ask you or that you need to ask yourself:

How and when did it start?

Was your TMJ problem the result of trauma such as a fall, automobile accident or sports injury? Or was the onset more insidious and developed gradually over a longer time frame and progressively worsened? A TMJ dysfunction onset is usually a gradual process.

Did you have dental work performed shortly before you noticed the signs and symptoms?

You may notice symptoms a few days or weeks following dental procedures.

The reason for an onset following dental work is because the dental patient's mouth is usually forced to remain open for too long a period. This extended time frame will cause muscular reaction in the form of spasm or trigger point development as a result of the muscular and joint stress. It may also be the case that you already had some degree of TMJ dysfunction and your dental visit was just an aggravating factor.

Of course trauma will usually result in a more sudden onset. With trauma you need to consider fractures, dislocations, sprains and strains. Always consult your dentist or other healthcare provider for any pain or problem of an unknown cause.

Where is the pain?

Is the pain just in the joint or does it cover a larger area? Does the pain go into the teeth, side of head, forehead or into the neck?

Because TMJ dysfunction involves trigger point there is almost always a referred pain pattern. This pain pattern may not be evident in the early stages but with a proper exam it will be elicited.

Tumors, infections or other bone and joint diseases can and will often refer pain beyond the area involved.

What is your pain level?

Use the 0 to 10 scale. A zero (0) level would indicate no pain. A pain level of ten (10) would be the most severe pain imaginable. If you rate your pain a ten (10) that would be so severe you would require  emergency care. A pain level of 10 would be very rare.

What actions cause pain?

Does it hurt with chewing and yawning? These action can produce pain regardless of the condition causing your TMJ problem. So it will not be specific to any one condition.

What makes it feel better?

Have you tried ice packs or heat treatments? Does it seem better with rest? Again the answers will not be specific for any one condition. It is still important to note as it may help you decide on what types of treatments to use.

Is pain constant, intermittent, rare, occasional?

Do you go days, weeks or even months with little or no pain? Or is the pain present everyday? Bone diseases will more often result in constant pain. Whereas, arthritis and TMJ dysfunction can cause pain to be more less constant.

Does it lock up with yawning or wide mouth opening?

Do you try to suppress your yawning and avoid taking big bites out of an apple? TMJ dysfunction is more likely to present with locking, but a joint cyst or disc disease can do the same.

Do you grind your teeth at night?

Do you awaken in the morning with more pain? If this is the case your problem is more likely one of dysfunction and/or trigger points. Nighttime teeth grinding (bruxism) can irritate the TMJ and cause morning pain.

Is your life extremely stressful?

Do you find yourself clenching your jaw during stressful events or when you are angry, upset or worried? Clenching will most likely aggravate or contribute to TMJ pain and dysfunction of a mechanical or muscular origin.

These questions will help your doctor decide if your symptoms are due to dysfunction of a mechanical and muscular condition.

A history will get you close to an accurate TMJ diagnosis. Now, all you need is a good examination and you and your doctor should then be able to arrive at a TMJ diagnosis with fairly good certainty.



Examination

  1. Observe the gross movement of the jaw when opening and closing of the mouth. Is there a tracking or lateral deviation to one side or the other. If so suspect muscular imbalance or joint degeneration.
  2. Listen for any clicking or popping sounds when opening or closing the month. Noise can indicate a fracture, arthritis, TMJ disc derangement or uneven motion.
  3. Observe for visual jump or sudden movement as opposed to a smooth motion when opening and closing the mouth that coincides with the popping. This also is a fairly good sign of joint disc problems. A muscular imbalance will create an uneven notion as well. This sign may be absent if your TMJ problem has a more recent onset. If you have had your problem for a longer period (several months) this jump or sudden shift will be more likely to be evident. Some times the abnormal motion is so slight that you may not easily notice it.
  4. Feel for tenderness of the joint. This can be done by gently pushing on the jaw joint that lies just anterior (front) to the ear opening. Tenderness, while not specific for any particular problem, will help you monitor progress.
  5. Evaluate for the presence of trigger points. By far this is the most common problem and the number cause of TMJ dysfunction and pain.

The information gathered from a history and examination should be enough to rule out serious pathology and arrive at a TMJ diagnosis of dysfunction or trigger points (myofascial pain syndrome).

These two TMJ diagnoses can usually be treated with home therapy.

If the clinical picture is still not clear and the information is inadequate an MRI and/or x-rays may be indicated. Your doctor should be able to determine if further testing is needed.

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