eMedicine Specialties > Emergency Medicine > Rheumatology

Temporomandibular Joint Syndrome: Differential Diagnoses & Workup

Author: Joshua Parnes, MD, Staff Physician, Department of Emergency Medicine, Kings County Hospital Center
Coauthor(s): Richard H Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center; Steven M Heffer, MD, Consulting Staff, Department of Emergency Medicine, Greenwich Hospital
Contributor Information and Disclosures

Updated: Aug 7, 2009

Differential Diagnoses

Dental, Infections
Myopathies
Dislocations, Mandible
Otitis Media
Fractures, Mandible
Sinusitis
Gout and Pseudogout
Temporal Arteritis
Headache, Cluster
Tick-Borne Diseases, Lyme
Headache, Migraine
Trigeminal Neuralgia
Headache, Tension

Other Problems to Be Considered

Parotid gland disorders
Lesions of the oropharyngeal cavity
Tick-borne diseases
Lyme disease

Workup

Laboratory Studies

  • No laboratory studies are specifically indicated to rule in TMJ syndrome; however, appropriate laboratory samples may be drawn to help rule out other disorders.
    • Complete blood count (CBC), if infection is suspected
    • Calcium, phosphate, or alkaline phosphatase, for possible bone disease
    • Uric acid if gout is suspected
    • Serum creatine and creatine phosphokinase, indicators of muscle disease
    • Erythrocyte sedimentation rate if temporal arteritis is suspected and rheumatoid factor if rheumatoid arthritis is suspected

Imaging Studies

  • Imaging studies generally are not indicated in the ED, unless a fracture is suspected.
    • Panorex may show a fracture, evidence of osteoarthritis, or displacement of the articular disk. Ahn et al demonstrated that Panorex films can also be affective in evaluating patients with internal derangement of the TMJ.4
    • Plain radiographs may demonstrate resting and hinge movement of the TMJ.
    • CT scan may reveal greater detail of bones than radiographs alone.
    • MRI is inferior to Panorex and CT for bony pathology but is the best test when looking for disk pathology. If disk displacement is suspected, MRI is the test of choice in addition to CT and plain films.5

More on Temporomandibular Joint Syndrome

Overview: Temporomandibular Joint Syndrome
Differential Diagnoses & Workup: Temporomandibular Joint Syndrome
Treatment & Medication: Temporomandibular Joint Syndrome
Follow-up: Temporomandibular Joint Syndrome
References
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References

  1. Uyanik JM, Murphy E. Evaluation and management of TMDs, Part 1. History, epidemiology, classification, anatomy, and patient evaluation. Dent Today. Oct 2003;22(10):140-5. [Medline].

  2. Hegde V. A review of the disorders of the temporomandibular joint. J Indian Prosthodont Soc. 2005;5:56-61.

  3. Rammelsberg P, LeResche L, Dworkin S. Longitudinal outcome of temporomandibular disorders: a 5-year epidemiologic study of muscle disorders defined by research diagnostic criteria for temporomandibular disorders. J Orofac Pain. 2003;17(1):9-20. [Medline].

  4. Ahn SJ, Kim TW, Lee DY. Evaluation of internal derangement of the temporomandibular joint by panoramic radiographs compared with magnetic resonance imaging. Am J Orthod Dentofacial Orthop. Apr 2006;129(4):479-85. [Medline].

  5. Pharaboz C, Carpentier P. [MR imaging of the temporomandibular joints]. J Radiol. May 2009;90(5 Pt 2):642-8. [Medline].

  6. Fricton JR, Look JO, Schiffman E, Swift J. Long-term study of temporomandibular joint surgery with alloplastic implants compared with nonimplant surgery and nonsurgical rehabilitation for painful temporomandibular joint disc displacement. J Oral Maxillofac Surg. Dec 2002;60(12):1400-11; discussion 1411-2. [Medline].

  7. Dierks EJ. Temporomandibular disorders and facial pain syndromes. Otolaryngology. 1991;1:849-64.

  8. Dionne RA. Pharmacologic treatments for temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Jan 1997;83(1):134-42. [Medline].

  9. Ficarra BJ, Nassif NJ. Temporomandibular joint syndrome: diagnostician's dilemma--a review. J Med. 1991;22(2):97-121. [Medline].

  10. Greenberg SA, Jacobs JS, Bessette RW. Temporomandibular joint dysfunction: evaluation and treatment. Clin Plast Surg. Oct 1989;16(4):707-24. [Medline].

  11. Laskin DM. Etiology of the pain-dysfunction syndrome. J Am Dent Assoc. Jul 1969;79(1):147-53. [Medline].

  12. Laskin DM. Temporomandibular joint disorders. Arch Otolaryngol Head Neck Surg. 1993;2:1443-50.

  13. Mew JR. The aetiology of temporomandibular disorders: a philosophical overview. Eur J Orthod. Jun 1997;19(3):249-58. [Medline].

  14. Moore KL, Dalley AF. Clinically Oriented Anatomy. 4th ed. 1999.

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

  16. Weinerger BW. Introduction to the History of Dentistry. St. Louis: CV Mosby Co; 1948:390.

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Further Reading

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Keywords

temporomandibular joint dysfunction syndrome, TMJ syndrome, myofascial pain dysfunction syndrome, MPD syndrome, temporal mandibular joint, locked jaw, neck pain, movement of the jaw

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Contributor Information and Disclosures

Author

Joshua Parnes, MD, Staff Physician, Department of Emergency Medicine, Kings County Hospital Center
Disclosure: Nothing to disclose.

Coauthor(s)

Richard H Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Steven M Heffer, MD, Consulting Staff, Department of Emergency Medicine, Greenwich Hospital
Steven M Heffer, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Jerome FX Naradzay, MD, FACEP, Medical Director, Consulting Staff, Department of Emergency Medicine, Maria Parham Hospital; Medical Examiner, Vance County, North Carolina
Jerome FX Naradzay, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Gino A Farina, MD, Program Director, Associate Professor of Clinical Emergency Medicine, Department of Emergency Medicine, Long Island Jewish Medical Center, Albert Einstein College of Medicine
Gino A Farina, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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