INITIAL DIAGNOSIS for the GENERAL MEDICAL OR DENTAL PRACTITIONER
Specific TMD diagnosis is often difficult and challenging due to the diverse range of signs and symptoms but a good starting point is identifying and differentiating between an extra- and intra-articular disorder.There may be a psychogenic or a centralised element to the patient's pain as well.
A few questions to the patient can help differentiate these issues.
Where is the pain?
A good gauge in differentiating the primary pathology is the location of pain. If your patient points(with their finger) to the jaw joint, often the pathology will lie within the joint capsule. If your patients has difficulty localising the pain and uses there palm to locate the pain then often a myofacsial or combined problem exists.
Have you ever had locking of the jaw(closed or open lock)?
These reported symptoms indicate internal derangement of the TMJ. The orthopedic and rheumatologic definition is any intra-articular condition that interferes with smooth joint function. The dental definition tends to focus on a displaced articular disc.
Limited mouth opening can indicate a displaced disc and chronic inflammation within the joint itself. An acute or chronic closed lock warrants surgical consultation and investigation. Studies have indicated that earlier intervention for anatomic derangements leads to better long term outcomes like other disease processes.
Has there ever been trauma to the face?
Trauma to the TMJ is a common cause of internal derangment and can lead to post-traumatic arthritis. Chronic pain can develop if not addressed early. These are common occurences in our practice. Surreptitiously, a prolonged dental visit or general anaesthesia can also cause this with tearing and rupture of ligaments a possible cause.
Do you notice yourself clenching or has your partner told you that you grind your teeth at night?
Microtrauma to the joint is also a common aetiologic factor in the TMJ disease. Clenching or bruxism can overload the joint and lead to chronic inflammation, synovitis, a displaced articular disc and degenerative joint disease.
Do you often have associated headaches with your jaw joint problem?
Headaches and other vague symptoms are commonly associated with internal derangement and joint problems.
In spite of clear evidence of the difference between TMJ and myofacial pain, studies and "experts" continue to group these as one entity and may be due to some patients presenting with both. Currently, it is quite clear that the term TMD is an umbrella classification and not a specific diagnosis.
The TMJ is an orthopedic joint like other joints in the body. It has synovium, a meniscus, is filled with synovial fluid and is prone to overuse and trauma. Despite many "expert" opinions regarding the TMJ behaving differently to other joints, any pathology that can affect other joints can affect the TMJ. Ie: arthritis, degenerative joint disease and disc perforations.
This site will concentrate mainly on surgical conditions of the TMJ and their management. Internal Derangement and Osteoarthritis are the most common reasons for surgical referral.
Below is one of many classification systems for TMDs which are all similar.
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