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Temporomandibular Disorders Workup

  • Author: Charles F Guardia, III, MD; Chief Editor: Robert A Egan, MD  more...
 
Updated: Jan 07, 2014
 

Laboratory Studies

If a systemic illness is suspected to be the cause of temporomandibular disorder (TMD), lab work is required. CBC may be done if infection is suspected. Rheumatoid factor (RF), ESR, antinuclear antibody (ANA), and other specific antibodies are checked if rheumatoid arthritis, temporal arteritis, or a connective tissue disorder is suspected. Uric acid should be checked for gout. Pseudogout has also been reported in the temporomandibular joint (TMJ). Arthrocentesis is required to demonstrate specific crystals.

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Imaging Studies

See the list below:

  • Conventional radiography is the most utilized imaging study. It is simple, evaluates bony structures, and in most cases is sufficient. It involves specific techniques and views such as modified Schuller views of each TMJ, both open mouth and closed mouth. Radiographic findings in TMJ depend on the etiology of TMD; in cases of rheumatoid arthritis and seronegative spondyloarthropathies, plain films show erosions, osteophytes, subchondral bony sclerosis, and condylar-glenoid fossa remodeling.
  • Dynamic high-resolution ultrasonography allows for visualization of the morphological elements and the functions of the TMJ, articular disk, mandibular condyle, and lateral pterygoid muscle. It is useful in the evaluation of internal derangements of the TMJ. One study found that the accuracy of prospective interpretation of high-resolution sonograms of internal derangement, disk displacement with reduction, and disk displacement without reduction was 95%, 92%, and 90%, respectively.[7]
  • CT scans can explore both bony structures and muscular soft tissues. Of interest, there is utility with cone beam computed tomography (CBCT). The patient is scanned with the mouth open and closed. Specifically, CBCT can aid in the diagnosis of osteoarthritis, rheumatoid arthritis, synovial chondromatosis, and neoplastic disorders.[8]
  • MRI should be used as the study of choice if an articular or meniscal pathology is suspected and an endoscopic or surgical procedure is contemplated, or in the case of traumatic TMD.
    • In one study, MRI was capable of identifying the meniscus in all cases, together with its morphology, signal, location, and movements during opening and closing of the mouth.
    • Disk dislocations were always identified correctly, and simultaneous study of both TMJ allowed the joints and their motion to be compared and asymmetries detected. The authors observed a high degree of agreement between MRI, arthroscopic, and surgical findings and concluded that MRI should be the study of choice in the evaluation of TMJ disease.
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Other Tests

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  • Quantitative analysis of occlusal strain and stress can be can be helpful by using photoplastic phenomenon of some polymers. Results of strain analysis can help harmonize static and kinematic occlusal patterns by detecting and eliminating prematurities and interferences. Stress analysis helps to understand the temporomandibular mechanical relationship.
  • Cephalometric analysis by the Delaire method allows for specific craniofacial morphotypic criteria to be defined.
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Procedures

Diagnostic arthroscopy is an invasive diagnostic approach and should be used mainly in patients suffering from internal TMJ derangements recalcitrant to conservative measures. MRI is suggested to be obtained prior to arthroscopy.

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Contributor Information and Disclosures
Author

Charles F Guardia, III, MD Instructor in Neurology, Department of Neurology, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth

Charles F Guardia, III, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, Radiological Society of North America, American Academy of Sleep Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Stephen A Berman, MD, PhD, MBA Professor of Neurology, University of Central Florida College of Medicine

Stephen A Berman, MD, PhD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Robert A Egan, MD Director of Neuro-Ophthalmology and Stroke Service, St Helena Hospital

Robert A Egan, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, North American Neuro-Ophthalmology Society, Oregon Medical Association

Disclosure: Received honoraria from Biogen Idec for speaking and teaching; Received honoraria from Teva for speaking and teaching.

Additional Contributors

Michael J Schneck, MD, MBA Vice Chair and Professor, Departments of Neurology and Neurosurgery, Loyola University, Chicago Stritch School of Medicine; Associate Director, Stroke Program, Director, Neurology Intensive Care Program, Medical Director, Neurosciences ICU, Loyola University Medical Center

Michael J Schneck, MD, MBA is a member of the following medical societies: American Academy of Neurology, American Society of Neuroimaging, Stroke Council of the American Heart Association, Neurocritical Care Society

Disclosure: Received honoraria from Boehringer-Ingelheim for speaking and teaching; Received honoraria from Sanofi/BMS for speaking and teaching; Received honoraria from Pfizer for speaking and teaching; Received honoraria from UCB Pharma for speaking and teaching; Received consulting fee from Talecris for other; Received grant/research funds from NMT Medical for independent contractor; Received grant/research funds from NIH for independent contractor; Received grant/research funds from Sanofi for independe.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Arun Chaudhary, MD; Jeffrey Appelbaum, DO; and Jennifer Ault, DO, DPT to the development and writing of this article.

References
  1. Alstergren P, Benavente C, Kopp S. Interleukin-1beta, interleukin-1 receptor antagonist, and interleukin-1 soluble receptor II in temporomandibular joint synovial fluid from patients with chronic polyarthritides. J Oral Maxillofac Surg. 2003 Oct. 61(10):1171-8. [Medline].

  2. Perri R, Huta V, Pinchuk L, Pinchuk C, Ostry DJ, Lund JP. Initial Investigation of the relation between extended computer use and temporomandibular joint disorders. J Can Dent Assoc. 2008 Sep. 74(7):643. [Medline].

  3. Rossetti LM, Pereira de Araujo Cdos R, Rossetti PH, Conti PC. Association between rhythmic masticatory muscle activity during sleep and masticatory myofascial pain: a polysomnographic study. J Orofac Pain. 2008 Summer. 22(3):190-200. [Medline].

  4. Sanders AE, Maixner W, Nackley AG, Diatchenko L, By K, Miller VE, et al. Excess risk of temporomandibular disorder associated with cigarette smoking in young adults. J Pain. 2012 Jan. 13(1):21-31. [Medline]. [Full Text].

  5. Gonçalves DA, Camparis CM, Speciali JG, Franco AL, Castanharo SM, Bigal ME. Temporomandibular disorders are differentially associated with headache diagnoses: a controlled study. Clin J Pain. 2011 Sep. 27(7):611-5. [Medline].

  6. Smith SB, Mir E, Bair E, Slade GD, Dubner R, Fillingim RB. Genetic Variants Associated With Development of TMD and Its Intermediate Phenotypes: The Genetic Architecture of TMD in the OPPERA Prospective Cohort Study. J Pain. 2013 Dec. 14(12 Suppl):T91-T101.e3. [Medline].

  7. Emshoff R, Jank S, Bertram S, Rudisch A, Bodner G. Disk displacement of the temporomandibular joint: sonography versus MR imaging. AJR Am J Roentgenol. 2002 Jun. 178(6):1557-62. [Medline].

  8. Tsiklakis K. Cone beam computed tomographic findings in temporomandibular joint disorders. Alpha Omegan. 2010 Jun. 103(2):68-78. [Medline].

  9. Borodic GE, Acquadro MA. The use of botulinum toxin for the treatment of chronic facial pain. J Pain. 2002 Feb. 3(1):21-7. [Medline].

  10. Kurtoglu C, Gur OH, Kurkcu M, Sertdemir Y, Guler-Uysal F, Uysal H. Effect of botulinum toxin-A in myofascial pain patients with or without functional disc displacement. J Oral Maxillofac Surg. 2008 Aug. 66(8):1644-51. [Medline].

  11. Schwartz M, Freund B. Treatment of temporomandibular disorders with botulinum toxin. Clin J Pain. 2002 Nov-Dec. 18(6 Suppl):S198-203. [Medline].

  12. Freund BJ, Schwartz M. Intramuscular injection of botulinum toxin as an adjunct to arthrocentesis of the temporomandibular joint: preliminary observations. Br J Oral Maxillofac Surg. 2003 Oct. 41(5):351-2. [Medline].

  13. von Lindern JJ, Niederhagen B, Berge S. Type A botulinum toxin in the treatment of chronic facial pain associated with masticatory hyperactivity. J Oral Maxillofac Surg. 2003 Jul. 61(7):774-8. [Medline].

  14. Manfredini D, Piccotti F, Guarda-Nardini L. Hyaluronic acid in the treatment of TMJ disorders: a systematic review of the literature. Cranio. 2010 Jul. 28(3):166-76. [Medline].

  15. Colen S, Haverkamp D, Mulier M, van den Bekerom MP. Hyaluronic acid for the treatment of osteoarthritis in all joints except the knee: what is the current evidence?. BioDrugs. 2012. 26:101-12. [Medline].

  16. Rigon M, Pereira LM, Bortoluzzi MC, et al. Arthroscopy for temporomandibular disorders. Cochrane Database Syst Rev. 2011 May 11. 5:CD006385. [Medline].

  17. Mercuri LG, Ali FA, Woolson R. Outcomes of total alloplastic replacement with periarticular autogenous fat grafting for management of reankylosis of the temporomandibular joint. J Oral Maxillofac Surg. 2008 Sep. 66(9):1794-803. [Medline].

  18. Al-Jabrah OA, Al-Shumailan YR. Prevalence of temporomandibular disorder signs in patients with complete versus partial dentures. Clin Oral Investig. 2006 Sep. 10(3):167-73. [Medline].

  19. Andreu Y, Galdon MJ, Dura E, Ferrando M, Pascual J, Turk DC, et al. An examination of the psychometric structure of the Multidimensional Pain Inventory in temporomandibular disorder patients: a confirmatory factor analysis. Head Face Med. 2006 Dec 14. 2:48. [Medline].

  20. Arcan M, Zandman F. A method for in vivo quantitative occlusal strain and stress analysis. J Biomech. 1984. 17(2):67-79. [Medline].

  21. Baggi L, Rubino IA, Zanna V, Martignoni M. Personality disorders and regulative styles of patients with temporo-mandibular joint pain dysfunction syndrome. Percept Mot Skills. 1995 Feb. 80(1):267-73. [Medline].

  22. Baltali E, Keller EE. Surgical management of advanced osteoarthritis of the temporomandibular joint with metal fossa-eminence hemijoint replacement: 10-year retrospective study. J Oral Maxillofac Surg. 2008 Sep. 66(9):1847-55. [Medline].

  23. Barkin S, Weinberg S. Internal derangements of the temporomandibular joint: the role of arthroscopic surgery and arthrocentesis. J Can Dent Assoc. 2000 Apr. 66(4):199-203. [Medline].

  24. Bedrune B, Jammet P, Chossegros C. [Temporomandibular joint pain-dysfunction syndrome after whiplash injury. Medico-legal problems in common law]. Rev Stomatol Chir Maxillofac. 1992. 93(6):408-13. [Medline].

  25. Blanchard P, Scheffer P, Lerondeau JC. [Craniofacial architecture and temporomandibular joint pain-dysfunction syndrome. The possibility of orthodontic treatment]. Rev Stomatol Chir Maxillofac. 1990. 91 Suppl 1:105-7. [Medline].

  26. Camparis CM, Formigoni G, Teixeira MJ, Bittencourt LR, Tufik S, de Siqueira JT. Sleep bruxism and temporomandibular disorder: Clinical and polysomnographic evaluation. Arch Oral Biol. 2006 Sep. 51(9):721-8. [Medline].

  27. Cascone P, Spallaccia F, Rivaroli A. [Arthrocentesis of the temporomandibular joint. Long-term results]. Minerva Stomatol. 1998 Apr. 47(4):149-57. [Medline].

  28. Chossegros C, Cheynet F, Blanc JL. [Diagnostic temporo-mandibular arthroscopy. Principle lesions, apropos of 50 case reports]. Rev Stomatol Chir Maxillofac. 1991. 92(3):141-8. [Medline].

  29. Costen JB. A syndrome of ear and sinus symptoms dependent upon disturbed function of the temporomandibular joint. 1934. Ann Otol Rhinol Laryngol. 1997 Oct. 106(10 Pt 1):805-19. [Medline].

  30. Cox KW. Temporomandibular disorder and new aural symptoms. Arch Otolaryngol Head Neck Surg. 2008 Apr. 134(4):389-93. [Medline].

  31. Cros P, Freidel M, Borie J. [15 years of treatment of temporomandibular joint algo-dysfunctional syndromes]. Rev Stomatol Chir Maxillofac. 1989. 90(6):409-14. [Medline].

  32. da Cunha SC, Nogueira RV, Duarte AP, Vasconcelos BC, Almeida Rde A. Analysis of helkimo and craniomandibular indexes for temporomandibular disorder diagnosis on rheumatoid arthritis patients. Braz J Otorhinolaryngol. 2007 Jan-Feb. 73(1):19-26. [Medline].

  33. de Filippis C, Osti L, Osti R. [Algodystrophic syndrome of the temporo-mandibular joint: a clinical experience]. Acta Otorhinolaryngol Ital. 1998 Apr. 18(2):111-5. [Medline].

  34. Diatchenko L, Slade GD, Nackley AG. Genetic basis for individual variations in pain perception and the development of a chronic pain condition. Hum Mol Genet. 2005 Jan 1. 14(1):135-43. [Medline].

  35. Esposito CJ, Panucci PJ, Farman AG. Associations in 425 patients having temporomandibular disorders. J Ky Med Assoc. 2000 May. 98(5):213-5. [Medline].

  36. Ey-Chmielewska H. [An attempt to use ultrasonic technique for confirming the diagnosis, planning and observation of long-term treatment results of painful temporo-mandibular joint dysfunction]. Ann Acad Med Stetin. 1998. 44:223-36. [Medline].

  37. Fassauer H, Bethmann W, Begemeier I. [Diseases of the temporomandibular joint--a clinical statistical study]. Stomatol DDR. 1977 Jun. 27(6):359-67. [Medline].

  38. Ferrari R, Schrader H, Obelieniene D. Prevalence of temporomandibular disorders associated with whiplash injury in Lithuania. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999 Jun. 87(6):653-7. [Medline].

  39. Gallucci M, Bozzao A, Splendiani A. [Magnetic resonance in condylo-meniscal incoordination pathology of the temporomandibular joint. Indications, diagnostic accuracy and optimization of study techniques]. Radiol Med (Torino). 1991 Apr. 81(4):404-11. [Medline].

  40. Gatchel RJ, Stowell AW, Buschang P. The relationships among depression, pain, and masticatory functioning in temporomandibular disorder patients. J Orofac Pain. 2006 Fall. 20(4):288-96. [Medline].

  41. Gatchel RJ, Stowell AW, Wildenstein L, Riggs R, Ellis E 3rd. Efficacy of an early intervention for patients with acute temporomandibular disorder-related pain: a one-year outcome study. J Am Dent Assoc. 2006 Mar. 137(3):339-47. [Medline].

  42. Glaros AG. Temporomandibular disorders and facial pain: a psychophysiological perspective. Appl Psychophysiol Biofeedback. 2008 Sep. 33(3):161-71. [Medline].

  43. Goddard G. Controversies in TMD. J Calif Dent Assoc. 1998 Nov. 26(11):827-32. [Medline].

  44. Granat O, Pharaboz C, Gerber S. [The diagnostic importance of different imaging technics in temporomandibular joint dysfunction]. Actual Odontostomatol (Paris). 1989 Sep. 43(167):417-32. [Medline].

  45. Huang GJ, Rue TC. Third-molar extraction as a risk factor for temporomandibular disorder. J Am Dent Assoc. 2006 Nov. 137(11):1547-54. [Medline].

  46. Irving J, Wood GD, Hackett AF. Does temporomandibular disorder pain dysfunction syndrome affect dietary intake?. Dent Update. 1999 Nov. 26(9):405-7. [Medline].

  47. Janson M, Janson G, Sant'Ana E, Nakamura A, de Freitas MR. Segmental LeFort I osteotomy for treatment of a Class III malocclusion with temporomandibular disorder. J Appl Oral Sci. 2008 Jul-Aug. 16(4):302-9. [Medline].

  48. Jedel E, Carlsson J, Stener-Victorin E. Health-related quality of life in child patients with temporomandibular disorder pain. Eur J Pain. 2007 Jul. 11(5):557-63. [Medline].

  49. Losapio PL, Amaddeo P. [A case of true congenital temporo-mandibular ankylosis]. Minerva Stomatol. 1989 May. 38(5):505-8. [Medline].

  50. Medlicott MS, Harris SR. A systematic review of the effectiveness of exercise, manual therapy, electrotherapy, relaxation training, and biofeedback in the management of temporomandibular disorder. Phys Ther. 2006 Jul. 86(7):955-73. [Medline].

  51. Meng QG, Long X. A hypothetical biological synovial fluid for treatment of temporomandibular joint disease. Med Hypotheses. 2008. 70(4):835-7. [Medline].

  52. Modica R, Mongini F. [Limitations in the opening of the mouth of an arthrogenic nature]. Minerva Stomatol. 1975 Jul-Dec. 24(4):163-76. [Medline].

  53. Ojima K, Watanabe N, Narita N, Narita M. Temporomandibular disorder is associated with a serotonin transporter gene polymorphism in the Japanese population. Biopsychosoc Med. 2007 Jan 10. 1:3. [Medline].

  54. Okeson JP, de Kanter RJ. Temporomandibular disorders in the medical practice. J Fam Pract. 1996 Oct. 43(4):347-56. [Medline].

  55. Ortega AO, Guimaraes AS, Ciamponi AL, Marie SK. Frequency of temporomandibular disorder signs in individuals with cerebral palsy. J Oral Rehabil. 2008 Mar. 35(3):191-5. [Medline].

  56. Plesh O, Crawford PB, Gansky SA. Chronic pain in a biracial population of young women. Pain. 2002 Oct. 99(3):515-23. [Medline].

  57. Reissmann DR, John MT, Schierz O, Wassell RW. Functional and psychosocial impact related to specific temporomandibular disorder diagnoses. J Dent. 2007 Aug. 35(8):643-50. [Medline].

  58. Reissmann DR, John MT, Wassell RW, Hinz A. Psychosocial profiles of diagnostic subgroups of temporomandibular disorder patients. Eur J Oral Sci. 2008 Jun. 116(3):237-44. [Medline].

  59. Sasaki J, Ariji Y, Sakuma S, et al. Ultrasonography as a tool for evaluating treatment of the masseter muscle in temporomandibular disorder patients with myofascial pain. Oral Radiol. 2006. 22:52-7.

  60. Scutellari PN, Orzincolo C, Ceruti S. [The temporo-mandibular joint in pathologic conditions: rheumatoid arthritis and seronegative spondyloarthritis]. Radiol Med (Torino). 1993 Oct. 86(4):456-66. [Medline].

  61. Seligman DA, Pullinger AG. Dental attrition models predicting temporomandibular joint disease or masticatory muscle pain versus asymptomatic controls. J Oral Rehabil. 2006 Nov. 33(11):789-99. [Medline].

  62. Soudant J, Lamas G. [Surgical treatment of temporomandibular joint dysfunctions by Myrhaug's technic. Apropos 60 interventions]. Rev Stomatol Chir Maxillofac. 1987. 88(3):208-12. [Medline].

  63. Speculand B, Goss AN, Hughes A. Temporo-mandibular joint dysfunction: pain and illness behaviour. Pain. 1983 Oct. 17(2):139-50. [Medline].

  64. Stam HJ, McGrath PA, Brooke RI. The effects of a cognitive-behavioral treatment program on temporo-mandibular pain and dysfunction syndrome. Psychosom Med. 1984 Nov-Dec. 46(6):534-45. [Medline].

  65. Tosato Jde P, Caria PH. Electromyographic activity assessment of individuals with and without temporomandibular disorder symptoms. J Appl Oral Sci. 2007 Apr. 15(2):152-5. [Medline].

  66. Truelove E, Huggins KH, Mancl L, Dworkin SF. The efficacy of traditional, low-cost and nonsplint therapies for temporomandibular disorder: a randomized controlled trial. J Am Dent Assoc. 2006 Aug. 137(8):1099-107; quiz 1169. [Medline].

  67. Tschopp K, Bachmann R. [Temporomandibular myoarthropathy syndrome--a frequent cause of facial pain]. Schweiz Rundsch Med Prax. 1992 Apr 7. 81(15):468-72. [Medline].

  68. Tsuyama M, Kondoh T, Seto K. Complications of temporomandibular joint arthroscopy: a retrospective analysis of 301 lysis and lavage procedures performed using the triangulation technique. J Oral Maxillofac Surg. 2000 May. 58(5):500-5; discussion 505-6. [Medline].

  69. Turner JA, Mancl L, Aaron LA. Short- and long-term efficacy of brief cognitive-behavioral therapy for patients with chronic temporomandibular disorder pain: a randomized, controlled trial. Pain. 2006 Apr. 121(3):181-94. [Medline].

  70. Uhac I, Kovac Z, Muhvic-Urek M, Kovacevic D, Franciskovic T, Simunovic-Soskic M. The prevalence of temporomandibular disorders in war veterans with post-traumatic stress disorder. Mil Med. 2006 Nov. 171(11):1147-9. [Medline].

  71. Valle-Corotti K, Pinzan A, Valle CV, Nahás AC, Corotti MV. Assessment of temporomandibular disorder and occlusion in treated class III malocclusion patients. J Appl Oral Sci. 2007 Apr. 15(2):110-4. [Medline].

  72. Wadhwa S, Kapila S. TMJ disorders: future innovations in diagnostics and therapeutics. J Dent Educ. 2008 Aug. 72(8):930-47. [Medline].

  73. Wakita T, Mogi M, Kurita K, Kuzushima M, Togari A. Increase in RANKL: OPG ratio in synovia of patients with temporomandibular joint disorder. J Dent Res. 2006 Jul. 85(7):627-32. [Medline].

  74. Zajko J, Satko I, Hirjak D. [Treatment of dysfunction of the temporomandibular joint by an occlusion splint]. Prakt Zubn Lek. 1990 Jun. 38(5):151-4. [Medline].

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