TMJ Assessment Techniques Quiz

Temporomandibular Joint (TMJ) Assessment

• Temporomandibular Joint Disorders (TMJD): A clinical presentation of problems in the TMJ, including pain, clicking. and restriction of movement.
• Dental Occlusion: The way the upper and lower teeth meet when the jaw is closed.
• Temporomandibular Joint Assessment: Comprehensive examination process to diagnose TMJD.
• Diagnostic Techniques:
  • Overview of diagnosis and examination methods
  • TMJ examination
  • Temporomandibular joint dysfunction overview
  • Muscles of mastication examination
  • Examination of occlusal relationships of teeth
  • Additional diagnostic tests
• Important Data Gathering: A critical component to success in Temporomandibular assessments, involves gathering all necessary information
• History:
  • Identification data
  • Chief complaint
  • History of chief complaint
  • Past medical history
  • Past dental history
  • Psychological assessment
• Clinical Examination Methods:
  • The senses (sight, hearing, taste, touch, smell) are used to examine functions
  • Inspection (looking at or examining)
  • Palpation (feeling gently)
  • Percussion (tapping)
  • Probing (using tools)
  • Auscultation (listening to sounds)
  • Olfaction (smelling)
  • Aspiration (drawing out fluid)
• TMJ Examination (Inspection & Observation):
  • Assess symmetry of face and mandible
  • Observe opening and closing path of mandible
  • Examine the degree of mouth opening (normal is 40-55 mm)
  • Observe harmonious lateral movement
• TMJ Examination (Palpation):
  • Bilateral palpation of TMJ in front of patient
  • Positioning of index fingers below external auditory meatus
  • Palpate through external auditory canal with little fingers facing anteriorly
  • Asking patient to perform function movements
• TMJ Dysfunction Overview:
  • Joint sounds (clicks, crepitation)
  • Joint restrictions
• Joint Sounds (Description):
  • Clicks: Short, sharp sounds
  • Crepitation: Rough, grating sounds associated with osteoarthritis.
• Joint Sounds (Assessment):
  • Place fingertips over TMJ surfaces
  • Ask patient to open and close mouth
  • Use stethoscopes or joint sound recording devices for more sensitive assessment but decreased sensitivity may not always be clinically significant
  • Record character of joint sounds, degree of mandibular opening, and if sound occurs during opening or closing
  • Absence of sounds does not indicate normal disc position
• Joint Restrictions (Details):
  • Observe mandibular movements for irregularities and restrictions
  • Note any restricted movements or unusual pathway characteristics
  • Document key findings of muscle and TMJ examinations on treatment outcome forms
• Muscles of Mastication Examination:
  • Masseter, Temporalis, Medial Pterygoid, Lateral Pterygoid, Digastric
• Masseter Muscle (Detailed):
  • Origin: Zygomatic process of maxilla and anterior 2/3 of zygomatic arch
  • Insertion: Angle and lower half of lateral surface of mandible ramus
  • Function: Elevates and protrudes mandible
  • Innervation: Masseteric branch of mandibular nerve
  • Blood supply: Masseteric artery
  • Palpation: Origin, insertion, body using thumb and index fingers
  • Procedure: Ask patient to clench teeth, palpate Masseter's anterior border from intra-orally, feeling for tenderness at zygomatic origin
• Temporalis Muscle (Detailed):
  • Origin: Lateral aspect of skull to superior temporal line
  • Insertion: Coronoid process and anterior border of mandible ramus
  • Function: Elevates and retracts mandible
  • Innervation: Deep temporal nerve
  • Blood supply: Anterior, posterior, superficial temporal arteries
  • Palpation
• Medial Pterygoid Muscle (Detailed):
  • Origin: Medial surface of lateral pterygoid plate and grooved surface of palatine bone
  • Insertion: Medial surface of mandible ramus and angle
  • Function: Elevates and protrudes mandible
  • Innervation: Mandibular branch of trigeminal nerve
  • Blood supply: Pterygoid branch of maxillary artery
  • Palpation
• Lateral Pterygoid Muscle (Detailed):
  • Origin: Lateral surface of lateral pterygoid plate
  • Insertion: Neck of mandibular condyle
  • Function: Protrudes mandible, lateral movements and opening
  • Innervation: Pterygoid branch of trigeminal nerve
  • Blood supply: Pterygoid branch of maxillary artery
  • Palpation
• Examination of Occlusal Relationship of Teeth:
  • Focus on missing teeth, wear facets, bruxism evidence, occlusal disharmony and poorly fitting dentures
• Additional Diagnostic Tests:
  • CBCT, Panoramic Radiography, MRI, Bone Scintigraphy, Mounted Cast, Electromyography, Mandibular Tracking Devices, Thermography