Temporomandibular Joint Syndrome Workup

  • Author: Vivian Tsai; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Jan 13, 2012
 

Laboratory Studies

  • No laboratory studies are specifically indicated to rule in temporomandibular joint (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
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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 effective in evaluating patients with internal derangement of the TMJ.[6]
    • Plain radiographs may demonstrate resting and hinge movement of the TMJ.
    • CT scan may reveal greater detail of bones than radiographs alone.
    • MRI is the test of choice when looking for disk displacement or pathology.
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Other Tests

The auriculotemporal branch of the trigeminal nerve provides the sensory innervation of the TMJ. A diagnostic nerve block of the auriculotemporal nerve can be helpful in differentiating whether the unilateral orofacial pain originates in the TMJ capsule.[7]

  • Diagnostic anesthesia block: Use a 25- to 30-gauge needle, inject 0.5 mL of short-acting anesthetic about 0.5 inches below the skin just inferior and lateral to the mandibular condyle.
  • If the patient does not experience pain relief with the nerve block, consider other causes of the orofacial pain.
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Contributor Information and Disclosures
Author

Vivian Tsai  MD, MPH, Assistant Professor of Emergency Medicine, Mount Sinai School of Medicine, Queens Hospital Center

Vivian Tsai is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Richard H Sinert, DO  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.

Specialty Editor Board

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.

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

Disclosure: Medscape Salary Employment

Gino A Farina, MD, FACEP, FAAEM  Associate Professor of Clinical Emergency Medicine, Albert Einstein College of Medicine; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center

Gino A Farina, MD, FACEP, FAAEM 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.

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  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

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

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Joshua Parnes, MD, to the development and writing of this article.

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. Tallents, RH, Katzberg, RW, Murphy W, Proskin, et al. Magnetic resonance imaging findings in asymptomatic volunteers and symptomatic patients with temporomandibular disorders. J Prosthet Dent. 1996;75:529. [Medline].

  3. 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. Jan 2012;13(1):21-31. [Medline]. [Full Text].

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

  5. 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].

  6. 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].

  7. American Academy of Family Physicians. Temporomandibular join (TMJ) pain. Am Fm Physician. Nov 2007;76(10):1483-4. [Medline].

  8. [Guideline] American Society of Temporomandibular Joint Surgeons. Guidelines for diagnosis and management of disorders involving the temporomandibular joint and related musculoskeletal structures. Cranio. Jan 2003;21(1):68-76. [Medline].

  9. 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].

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

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

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

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

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

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

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

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

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

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

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

 
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