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Course OutlineGeorge Langer, D.D.S., M.S.D.

TMD: Temporomandibular Disorders

TMD Examination and Assessment

As stated earlier, 50 60% of the general population exhibit some signs orsymptoms of TMD

As clinicians, we need to identify and assess these signs and symptomsin order to determine the nature of the disorder (proper diagnosis),whether or not treatment is necessary (triage), what specific treatment

plan is appropriate for the specific disorder (treatment planning) and what

is the chance that treatment will be successful (prognosis.)

ScreeningA general TMD screening should be done on every patient

Sample screening questions:o Any difficulty or pain in opening your mouth?

o Does your jaw every get stuck, lock, or go out of its normal

position?o Any difficulty or pain in chewing, talking, or otherwise using your

mouth?o Do your jaws or jaw joints make noises?

o Does your mouth or jaws regularly feel stiff or tired?o Do you have pain in the area of your ears, temples or cheeks?

o Do you get frequent headaches, neckaches, backaches or

toothaches?o Have you had a recent injury or blow to your head, neck or mouth?

o Are you aware of any recent changes to your bite?

o Have you ever been treated for facial pain or jaw problems?

Short screening examination

Observation

Palpation

If any questions are answered positively or if examinational findings aresignificant, you can investigate more thoroughly and formally

IN DEPTH ASSESSMENTHistoryIn treating TMD, especially those situations involving pain, most of the infoneeded to diagnose and treat the disorder is gotten from a thorough history

Conversational

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Written questionnaire

Combination -best

Chief complainto Location of pain or discomfort

o Onset of pain or discomforto Characteristics of pain or discomfort

Quality

Type

Behavior of pain

Temporal

Duration

Localization

Intensity

Concomitant symptoms

Aggravating and alleviating factors

Cranial nerve evaluation

Trigeminal nerve 5th cranial nerve

Facial nerve 7th cr. n.

Acoustic nerve (vestibulocochlear) 8th c. n.

Glossopharyngeal and vagus nerves 9th and 10th c. n.

Muscle examination

Palpation

Masseter

Temporalis Sternocleidomastoid

Posterior cervical muscles

Functional manipulationo Inferior lateral pterygoid

o Superior lateral pterygoid

o Medial pterygoid

Functional examination

Maximum opening

End feel Soft end feel

Hard end feel

Lateral mandibular movement

Opening pathway

Deviation

Deflection

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TMJ examination

Palpation

Oscultation

Imaging

Very little can be learned about joint disorders using standard imaging Arthrography

CT scan

MRI with contrast

Intraoral examinationLook for evidence of parafunctional activity

Psychological and behavioral assessment

Psycho-behavioral checklist

Inconsistent, inappropriate or vague reports of pain

Overdramatization of symptoms

Significant pain of greater than 6 months duration

Repeated failures with conventional therapies

Inconsistent response to medication

History of other stress related disorders

Major life event change coincident with onset

Evidence of drug abuse

Clinical anxiety or depression