TMJ PATHOLOGY & DIAGNOSIS: PATIENT CASES

Question 1

Pain History: depends on how you ask
your question determines Diagnosis
ACUTE:
(6)

Answer 1

1. Onset: Pain is present < 3 months
2. Locking: Is jaw Closed & cannot open?
3. Is Jaw Open and cannot close?
4. How many seconds, minutes, hours, or
   days for locking? Frequency?
5. Malocclusion: was it gradual or sudden?
   Date first noticed & activity caused it.
6. Acute sudden malocclusion- diagnoses
   myospasm, myositis, fracture, tumor

Question 2

Pain History: depends on how you ask
your question determines Diagnosis
CHRONIC:
(3)

Answer 2

1. Onset: Pain is present > 3 months
   ◦ Ask pt if they have had this pain before.
   If YES ask when it began
   ◦ 2. Jaw locking > 3 months
   ◦ 3. Gradual Malocclusion > 3 months:
   likely arthritis or osteochondma

Question 3

TMD Diagnostic Criteria

Answer 3

◦ You MUST MEMORIZE and KNOW the 7 MOST COMMON temporomandibular disorders
listed on the next slide for all examinations, clinical TMD consultations, and TMD OSCE
examinations.
◦ General Dentists are expected to know how to diagnose these 7 TMD disorders and
treat or refer to an Orofacial Pain Specialist, Physical Therapist, Oral Surgeon or Primary
Care Physician.

Question 4

myalgia
1. one or more of the following (3)
2.

Answer 4

a. muscle pain report
b. muscle pain on opening
c. muscle pain on excursion

muscle pain on palpation that does not refer to a different location

Question 5

myofascial pain
(2)

Answer 5

regional dull, aching muscle pain aggravated by mandibular fxn
tripper points are present that increase the pain complaint and refer the pain

Question 6

arthralgia
1. one or more of the following (3)
2.
3.
4.

Answer 6

a. joint pain report
b. joint pain on opening
c. joint pain on excursion

joint pain on palpation
absence of crepitus noise
absence of degenerative changes on pano or other imaging of TMJ

Question 7

osteoarthritis
1. one or more of the following (3)
2.
3.
4.

Answer 7

a. joint pain report
b. joint pain on opening
c. joint pain on excursion

joint pain on palpation
crepitus in joint during any movement MAY be present
degenerative changes are evident on pano or other imaging of TMJ

Question 8

anterior disc displacement with reduction
(3)

Answer 8

click on opening and or closing
corrected deviation of mandible to affect side on mouth opening/closing (if unilateral)
MRI would reveal an anteriorly displaced disc which reduces (seats onto condyle) with mouth opening

Question 9

anterior disc displacement without reduction
(3)

Answer 9

limited mouth opening of <35 mm
deflection of mandible to affected side on mouth opening (if uni)
MRI Would reveal an anteriorly displaced disc which does NOT reduce (seat onto condyle) with mouth opening