The temporomandibular joint (TMJ) is most functionally useful for eating and talking through the movements possible at this complex: depression, elevation, lateral deviation (left and right), retrusion, protrusion and various combinations of these movements.
The TMJ is a bi-arthroidal hinge joint that allows these complex movements. The TMJ between the condylar head of the mandible and the mandibular fossa of the temporal bone. This TMJ complex is made up of the TMJ, teeth and soft tissue. Read more regarding TMJ anatomy here: TMJ Anatomy.
A thorough subjective examination is likely to provide the key elements to help best diagnose and treat a patient’s TMJ issue. Assessment should include ascertaining the following
- Location and onset of symptoms
- mechanism of injury (if appropriate)
- severity of symptomology
- level of irritability
- aggravating and easing factors
- joint crepitus, clicking or locking
- Significant history (previous fractures or trauma, dental history, bruxism, etc.)
- Timing of symptoms
- Red and yellow flag identification
- Referral area questions (neck pain, dizziness, headaches, migraines or other neurological symptoms)
- Facial symmetry
- Swelling or deformation
- muscle bulk
- jaw position at rest
- audible joint noise
- cervical spine disposition
Range of motion
- Compare all motions of the TMJ left to right and active to passive.
- Therabite tool to measure can be used.
- If indicated assess cervical spine including combinations of TMJ range of motion.
- Areas of tenderness and or swelling
- Sensitivity and distribution of symptoms
- Muscular assessment
- Cervical spine screening
Special Tests & Outcome measures
1. Tongue blade test
This test is used to screen the patient as to whether they require diagnostic imaging. It is not dissimilar to the Ottawa rules for the ankle. The patient holds the tongue depressor between their teeth whilst the practitioner tries to snap it. The test is positive should this manoeuvre illicit a discomfort that forces the patient to let go of the tongue depressor before it snaps as seen in the following video.
2. Oral Behaviours checklist (OBC)
This checklist assists in objectively recording whether any accessory behaviours induced by circumstances such as stress and anxiety are contributing to the condition.
- Gil-Martínez A, Paris-Alemany A, López-de-Uralde-Villanueva I, La Touche R. Management of pain in patients with temporomandibular disorder (TMD): challenges and solutions. Journal of pain research. 2018;11:571.
- Armijo-Olivo S, Silvestre RA, Fuentes JP, da Costa BR, Major PW, Warren S, Thie NM, Magee DJ. Patients with temporomandibular disorders have increased fatigability of the cervical extensor muscles. Clin J Pain. 2012 Jan;28(1):55-64.