Temporomandibular Disorders Workup

Updated: Feb 22, 2017
  • Author: Joseph Rios, MD; Chief Editor: Robert A Egan, MD  more...
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Workup

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

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. [10]

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. [11]

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

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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