From the Guidelines
The best test to evaluate for temporomandibular joint (TMJ) disorders is magnetic resonance imaging (MRI), as it provides excellent visualization of both hard and soft tissues, including the articular disc position and morphology, joint effusion, and bone abnormalities. A comprehensive clinical examination should always be combined with appropriate imaging, including evaluation of jaw movement, palpation of the TMJ and associated muscles, assessment of joint sounds, and measurement of mouth opening capacity 1. For bone lesion assessment, computed tomography (CT) is considered the gold standard, while MRI is the gold standard for ligament and articular capsule structure analysis 1.
When considering the diagnostic approach, it's essential to note that:
- MRI is recommended for TMJ ligament-capsule tissue disorders 1
- CBCT or CT scan is indicated for TMJ bone disease 1
- Conventional radiographs like panoramic X-rays have limited diagnostic value and are not recommended for assessing joint components and ligament-capsule components 1
- Ultrasound can be useful for detecting joint effusion and disc displacement but is highly operator-dependent
The selection of appropriate diagnostic tests should be guided by the patient's clinical presentation, as TMJ disorders encompass a range of conditions affecting the jaw joint and surrounding muscles, each requiring specific diagnostic approaches 1.
From the Research
Evaluation of TMJ
To evaluate the temporomandibular joint (TMJ), several tests can be used, but the most effective one is magnetic resonance (MR) imaging. The following are some key points to consider:
- MR imaging is the best test to evaluate TMJ dysfunction, as it allows for the evaluation of the articular disk, or meniscus, in terms of its morphologic features and its location relative to the condyle in both closed- and open-mouth positions 2.
- Disk location is of prime importance because the presence of a displaced disk is a critical sign of TMJ dysfunction 2.
- MR imaging techniques can help detect early signs of dysfunction, avoiding the evolution of the condition to its advanced and irreversible phase, which is characterized by osteoarthritic changes such as condylar flattening or osteophytes 2.
Diagnostic Imaging
Diagnostic imaging, such as MRI, can be beneficial when malocclusion or intra-articular abnormalities are suspected 3.
- MRI can help evaluate the relationship between the disk and condyle before and after treatment 4.
- MRI can also help assess the displacement of the disc of the TMJ in different types of condylar fracture 5.
Clinical Examination
A clinical examination should be utilized together with other imaging methods to determine the relationship between the disk and condyle before and after treatment 4.
- A clinical examination alone often proves to be difficult due to the multifactorial etiology of temporomandibular joint dysfunction 4.
- The clinical examination should include an assessment of the patient's symptoms, such as jaw pain or dysfunction, earache, headache, and facial pain 3.
Treatment
Treatment of TMJ-related conditions is necessary when pain or dysfunction is present 4.
- Many surgical or nonsurgical methods of treatment have been reported, including the use of occlusal splints 4.
- The occlusal splint is one of the most widespread treatments, as it induces a slight vertical condylar distraction and eliminates the occlusal factor, which can be responsible for TMJ disturbances 4.