Temporomandibular Joint Disorder Diagnosis and Assessment

Patient History and Clinical Examination

A comprehensive patient history for TMJ disorder diagnosis should include timing details, pain characteristics, aggravating and relieving factors, and associated symptoms, such as taste changes, clenching or bruxing habits, and locking or clicking of jaw joint 1
A standardized orofacial examination approach should include visual inspection, palpation of muscles of mastication and head and neck muscles, TMJ movement evaluation, and cranial nerve examination 1
The examination should also assess teeth for decay, mobile teeth, excessive wear facets, occlusion, and ability to open and close properly, as well as examine oral mucosa for soft tissue lesions 1

Panoramic radiography is useful for initial assessment of bony structures and to rule out dental pathology 2
Computed Tomography (CT)/CBCT is the gold standard for bone lesion assessment and is indicated for severe dysmorphoses, impacted teeth, bone anomalies, serious facial asymmetries, and condylar aplasia or hypoplasia 2
Magnetic Resonance Imaging (MRI) is the gold standard for soft tissue assessment and is best for detecting active TMJ inflammation, disc displacement, and ligament and articular capsule evaluation 2, 3

Validated questionnaires, such as the Brief Pain Inventory, Beck Depression Inventory, Hospital Anxiety and Depression Scale, McGill Pain Questionnaire, and Oral Impacts on Daily Performance (OHIP), should be used to help in assessment and monitoring 1

Clinicians should be aware of potential comorbid conditions, such as giant cell arteritis, progressive neuropathic pain, and neurological symptoms, and consider referral to a specialist if diagnosis remains unclear or symptoms are severe/persistent 1
Psychosocial factors, such as depression, anxiety, and stress, should be assessed as they can significantly impact TMD 1, 4
Failure to use standardized examination protocols can lead to inaccurate diagnosis, and overtreatment should be avoided before attempting conservative management 3, 4