Diagnosis of Temporomandibular (TMJ) Disorders

The diagnosis of temporomandibular (TMJ) disorders typically includes a doctor conducting a physical examination and evaluating the medical history along with diagnostic test results. Invasive diagnostic techniques may be needed in some cases.


Physical Examination and Medical History

The first step in diagnosing TMJ disorders requires a doctor visit, which includes:

  • A physical examination. In a physical examination, the doctor typically checks for:
    • Movement of the mandible in relation to the TMJ while opening and closing the jaw
    • Relationship of the upper and lower jaws and teeth
    • Symmetry of the jaws and presence of jaw sounds
    • Tenderness and/or swelling on palpating (gently applying pressure) the joint and surrounding muscles
  • Review of medical history. Collecting information on medical history includes the doctor asking about:
    • Occurrence of headaches and facial pain
    • Location of other pain areas including neck, shoulder, and/or upper back
    • Jaw symptoms, such as jaw sounds, stiffness, and/or pain
    • Previous treatments/surgeries, history of trauma, and any other associated symptoms

This step may also involve a dentist checking for wearing of teeth, recent changes in bite, and/or faulty fillings in one or more teeth.

Advanced Diagnostic Tests for TMJ Disorders

Advanced diagnostic tests for TMJ disorders typically involve medical imaging techniques. In some cases, invasive diagnostic techniques may be prescribed.

  • Medical imaging for TMJ disorders. Medical imaging of the TMJ includes one or more of the following:
    • X-ray: Panoramic x-ray and/or corrected tomography are useful in analyzing the teeth and bony structures of the jaws and TMJs.
    • Ultrasound: Ultrasounds are useful in the evaluation of the cartilage, articular disc, and/or fluid accumulation in the TMJ.
    • Computed tomography (CT) scan: CT scans are useful in evaluating the bony elements and adjacent soft tissues of the TMJ.
    • Magnetic resonance imaging (MRI): MRIs are useful in evaluating the discs, cartilage, ligaments, and/or muscles of the TMJ.
    • Cone-beam computed tomography (CBCT): CBCT is an advanced radiographing imaging that allows the TMJ to be visualized in a 3-dimensional manner. These tests are useful in checking articular disc issues or joint dysfunction in TMJ disorders.
  • Invasive diagnostic tests for TMJ disorders. While physical examination and imaging tests can be sufficient in diagnosing some TMJ disorders, more invasive diagnostic methods may be necessary in other cases. Invasive diagnostic procedures for TMJ disorders include:
    • TMJ arthroscopy. TMJ arthroscopy is a diagnostic test performed surgically. The test involves insertion of an arthroscope (small device with a lens and light) in the TMJ area. The arthroscope is connected to a video screen and monitor, which enables the doctor to view the inner structures and diagnose the disorder. This procedure may also be used to surgically treat TMJ disorders.
    • TMJ arthrography. TMJ arthrography is an imaging technique involving injection of a radiopaque contrast into the TMJ under fluoroscopic guidance. The flow of the contrast in the joint helps in the evaluation of the articular disc and/or presence of adhesions in the TMJ.

In rare cases, advanced diagnostic approaches involving the use of biomarkers, such as synovial tissue from the TMJ or genotyping to identify individuals with a genetic risk, may be performed to diagnose TMJ disorders.


Differential Diagnosis

Other conditions may have symptoms similar to TMJ disorders. So, it is important to obtain an accurate diagnosis. Some examples include trigeminal neuralgia, migraine headaches, temporal arthritis, chronic ear infection, tooth pain, salivary gland disorders, and central nervous system disturbances. Distinguishing between TMJ disorders and other conditions with similar symptoms is important to start an effective treatment program for the underlying cause.