From the Guidelines
Diagnosing TMJ disorder typically involves a combination of clinical examination and sometimes imaging studies, with a focus on reviewing symptoms and medical history, performing a physical examination, and potentially ordering imaging tests like MRIs or CT scans. According to the most recent guideline 1, the diagnosis of TMJ disorders is based on subjective findings, and there is no widely accepted standard test available. The diagnostic criteria for each subtype of TMD are largely based on subjective findings, and it is common for patients to satisfy criteria for more than one subtype.
When diagnosing TMJ disorder, healthcare providers should start by reviewing symptoms and medical history, asking about jaw pain, clicking or popping sounds, limited jaw movement, and headaches 1. They will then perform a physical examination, checking for tenderness around the jaw, observing the jaw's range of motion, and listening for abnormal sounds when opening and closing the mouth. They may also examine the bite alignment and facial muscles.
In some cases, imaging tests like X-rays, CT scans, or MRIs may be ordered to visualize the joint structures and rule out other conditions 1. CT is considered the gold standard imaging technique for bone lesion assessment, while MRI is considered the gold standard for ligament and articular capsule structure analysis. The choice of imaging test depends on the specific diagnostic question and the sensitivity, specificity, and appropriateness of the technique.
Key factors to consider when diagnosing TMJ disorder include:
- Associated factors such as taste, salivary flow, clenching, bruxing habits, locking or clicking of the jaw joint, altered sensation, nasal, eye, or ear symptoms 1
- Psychological assessment, family history, social history, and significant life events 1
- Extraoral examination of the head and neck region, including visual inspection, palpation, and examination of the muscles of mastication, head and neck muscles, and cranial nerves 1
- Intraoral examination of the hard tissues and teeth, including obvious dental pathology, occlusion, and ability to open and fixed and removal appliances 1
From the Research
Diagnosis of TMJ Disorder
To diagnose TMJ disorder, the following methods can be used:
- Imaging tests such as magnetic resonance imaging (MRI) and computed tomography (CT) scans to evaluate the joint and surrounding tissues 2, 3
- MRI is considered the method of choice for diagnostic assessment of temporomandibular disorders (TMDs) 3
- The imaging findings of internal derangement and less common disorders of the joint can be reviewed and illustrated using MRI and CT scans 2
Imaging Findings
The imaging findings of TMJ disorders may include:
- Disk displacement, which is the most common disorder affecting the TMJ 2
- Degenerative changes such as flattening of the condyle heads and erosion of their cortical surfaces 3
- Osteophytes and bone marrow edema 3
- Effusion in synovial compartments 3
Recent Advances in MRI Techniques
Recent advances in MRI techniques, including dynamic and quantitative MRI techniques, have shown promising results in diagnosing and treating TMD 4
- Diffusion-weighted imaging, T2 mapping, and ultrashort/zero echo time are some of the novel MRI techniques that have been preliminarily investigated 4
- These techniques may provide more accurate and detailed information about the joint and surrounding tissues, leading to better diagnosis and treatment of TMJ disorders 4