20225 Health Library | Health and Wellness | Wellmont Health System
  • Diagnosis of Temporomandibular Disorders (TMD)

    TMD is usually diagnosed when your doctor listens to your description of symptoms and performs a thorough physical exam.
    A careful physical exam may be completely normal despite symptoms, or may reveal:
    • Jaw or muscle tenderness
    • Muscle spasm in the area of the temporomandibular joint (TMJ)
    • Clicking, popping, or grating sounds and sensations when you open or close your jaw
    • Misalignment of the jaw or of the bite
    • Difficulty fully opening the mouth
    There are no specific tests available that can definitively diagnose TMD. If your symptoms are extreme, your healthcare provider may try the following:
    • Jaw x-ray —Unfortunately, these aren’t usually helpful in diagnosing TMD. An x-ray may sometimes reveal problems, such as fractures or dislocations, and is commonly used to exclude other conditions that might mimic TMD.
    • Arthrography—This is a test in which dye is injected into a joint in order to better visualize it on an x-ray. It’s rarely ordered for diagnosing TMD, although it can be helpful in situations where you are having extreme pain that doesn’t improve despite treatment.
    • Magnetic resonance imaging (MRI)—Like arthrography, this test is reserved for patients who have severe pain that persists despite treatment.
    • Ultrasound—This test can provide a good view of the joint and is useful when the dentist or doctor thinks that pain is coming from within the joint. (Pain in TMD most commonly originates outside the joint, primarily in muscles.) Ultrasound can, however, provide a view of the muscles adjacent to the joint.
    • CT scan —This test is commonly used, especially when TMD ultrasound is not available.

    References

    Cummings CW. Otolaryngology: Head & Neck Surgery . 4th ed. St. Louis, MO: Mosby; 2005.

    Dambro MR. Griffith’s 5-Minute Clinical Consult . 2006 edition. Philadelphia, PA: Lippincott Williams & Wilkins; 2006.

    Okeson, Jeffrey. Clinical Management of Temporomandibular Disorders and Occlusion. 6th ed. St. Louis, MO: Mosby 2007.

    Puri P, Kambylafkas P, Kyrkanides S, Katzberg R, Tallents RH. Comparison of Doppler sonography to magnetic resonance imaging and clinical examination for disc displacement. Angle Orthod. 2006;76(5):824-829.

    Siccoli MM. Facial pain: a clinical differential diagnosis. Lancet Neurology . 2006;5:257-267.

    Tognini F, Manfredini D, Melchiorre D, Bosco M. Comparison of ultrasonography and magnetic resonance imaging in the evaluation of temporomandibular joint disc displacement. J Oral Rehabil. 2005;32(4):248-253.

    TMD/TMJ (temporomandibular disorders). American Dental Association website. Available at: http://www.ada.org/ . Accessed September 17, 2008.

    TMJ. American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/HealthInformation/tmj.cfm . Accessed September 17, 2008.

    TMJ (temporomandibular joint and muscle disorders). National Institute of Dental and Craniofacial Research website. Available at: http://www.nidcr.nih.gov/OralHealth/Topics/TMJ/ . Updated August 2008. Accessed September 17, 2008.

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