From the Guidelines
Diagnosing temporomandibular joint (TMJ) disorders typically begins with a thorough clinical examination by a healthcare provider, as there is no widely accepted standard test available to correctly diagnose TMJ disorders 1. The provider will evaluate your jaw movement, listen for clicking or popping sounds, check for tenderness around the jaw joint, and assess your bite alignment. They may ask you to open and close your mouth repeatedly while feeling the joint and surrounding muscles. Common symptoms to report include:
- Jaw pain
- Limited jaw movement
- Facial pain
- Headaches
- Ear pain
- Clicking or locking of the jaw Imaging tests may be ordered to confirm the diagnosis, including:
- MRI to examine soft tissues and the disc position, which is recommended for TMJ ligament-capsule tissue disorders 1
- CT scans or CBCT for detailed bone evaluation, which is indicated for TMJ bone disease 1 It's essential to note that the diagnostic criteria for TMJ disorders are largely based on subjective findings, and patients may satisfy criteria for more than one subtype 1. The International Network for Orofacial Pain and Related Disorders Methodology (INFORM) group updated their diagnostic criteria in 2014 to include 12 subtypes of TMD, with myalgia being the most prevalent 1. However, the US National Institutes of Health acknowledged in 2017 that there is no widely accepted standard test available to correctly diagnose TMJ disorders 1. A combination of anamnetic, clinical, and radiological information about the TMJ is necessary for diagnosis, with radiological examination only indicated when insufficient information is obtained from the anamnestic-clinical examinations 1. Your medical history is also important, as factors like teeth grinding, jaw clenching, previous jaw injuries, arthritis, and stress can contribute to TMJ disorders. Keeping a symptom diary noting when pain occurs and what activities trigger it can help with diagnosis. Early diagnosis allows for more conservative treatment options before the condition potentially worsens.
From the Research
Diagnostic Criteria for Temporomandibular Joint (TMJ) Disorder
The diagnostic criteria for Temporomandibular Joint (TMJ) disorder involve a combination of clinical evaluation, patient history, and imaging studies. The following are some key points to consider:
- A thorough patient history and clinical examination are essential for guiding the diagnostic process 2.
- Magnetic Resonance Imaging (MRI) is considered the criterion standard imaging technique for visualization of the TMJ region and is useful for evaluating anterior disc displacement, degenerative changes, and other morphological changes 3, 4.
- MRI can be used to evaluate the disc-condyle relationship, which can serve as an important indicator in assessing anterior disc displacement 3.
- Other imaging modalities, such as panoramic radiographs, cone-beam computed tomography (CBCT), and conventional CT, may also be used to evaluate the TMJ, depending on the clinically suspected condition 5, 6.
- CBCT is particularly useful for visualizing the bony compartment and joint space, and can be used to evaluate treatment responses and assess skeletal abnormalities 6.
Imaging Studies for TMJ Disorder
Imaging studies play a crucial role in the diagnosis and treatment of TMJ disorder. The following are some key points to consider:
- MRI is the most commonly used imaging modality for evaluating TMJ disorders, particularly for assessing soft tissue changes and disc displacement 3, 4.
- CBCT is useful for visualizing the bony compartment and joint space, and can be used to evaluate osteoarthritis, remodeling, ankylosis, trauma, rheumatoid arthritis, synovial chondromatosis, and other intracapsular pathologies 6.
- Panoramic radiographs and conventional CT may also be used to evaluate the TMJ, particularly for assessing osseous changes and degenerative changes 5.
- The selection of imaging modality depends on the patient's complaint, history, and clinical findings, as well as the suspected condition 5.