From the Guidelines
A plain x-ray is often not sufficient to fully evaluate jaw pain. While x-rays can identify some causes of jaw pain such as fractures, severe tooth decay, bone infections, or tumors, they have significant limitations, as noted in the study by 1. Many conditions that cause jaw pain involve soft tissues like muscles, ligaments, and the temporomandibular joint (TMJ) disc, which don't show up well on plain x-rays.
For comprehensive evaluation of jaw pain, additional imaging modalities may be necessary, such as panoramic x-rays, CT scans, MRI, or ultrasound, depending on the suspected cause. According to 1, an OPG (panoramic radiograph) has better sensitivity for detecting simple mandibular fractures than a standard 4-view mandibular imaging series. These advanced imaging techniques can better visualize soft tissues, joint spaces, and complex bone structures.
Before any imaging, a thorough clinical examination is essential, including assessment of jaw movement, muscle tenderness, joint sounds, and dental evaluation. The choice of imaging should be guided by the patient's specific symptoms, clinical findings, and suspected diagnosis, as unnecessary radiation exposure should be avoided when possible. Key considerations include:
- The sensitivity of OPG for detecting mandibular fractures, which is 86% to 92% as reported by 1
- The limitations of plain x-rays in visualizing soft tissues and complex bone structures
- The importance of a thorough clinical examination to guide the choice of imaging modality.
From the Research
Evaluation of Jaw Pain using X-Ray
- A plain x-ray may not be sufficient to evaluate jaw pain, as it has limitations in detecting certain types of lesions or fractures [(2, 3)].
- Computed Tomography (CT) scans are often used to evaluate maxillofacial trauma and reconstructive surgery, as they provide more detailed images of the jaw and surrounding structures [(2, 4, 3, 5)].
- The use of CT scans can help identify patients at high risk for facial fracture and limit unnecessary radiation exposure and costs 3.
- Intraoperative CT scans can provide real-time feedback during maxillofacial surgery, affecting intraoperative decision making 5.
Comparison of Imaging Techniques
- A study comparing panoramic radiographs, CT scans, and Magnetic Resonance Imaging (MRI) found that CT scans had a high detectability for bisphosphonate-associated osteonecrosis of the jaw (BONJ) lesions 6.
- However, both CT scans and MRI showed limitations in assessing the exact extent of BONJ lesions 6.
- The choice of imaging technique may depend on the specific condition being evaluated and the need for detailed images of the jaw and surrounding structures [(2, 4, 3, 5, 6)].