Investigations of TMD

Group F

Tutor : Dr. Diksha Agrawal

Sushant
Pandey
 Objectives
 To know about TMD
 To know the importance of history in investigation
 To know different types of physical examination involved
 To know about different types of radiographical
examinations involved
Temporomandibular Disorder:
TMD is the collective term embracing a number of clinical
problems that involve the masticatory musculature, the TMJ
and associated structures or both.

TMDs are characterized by :

1. Facial pain in TMJ region and/or the muscles of
mastication
2. Limitation or deviation in the mandibular range of motion
3. TMJ sound during jaw movements and functions
 History
The purpose of history taking is to identify patients with subclinical signs
and symptoms that the patients may not be able to relate but are
commonly associated with functional disturbances of masticatory system.

The screening history consists of several questions that will help orient the
clinician to any TMD.
We generally ask the patient questions regarding :

 Site of pain
 Duration of pain
 When is the pain worst ?
 Areas to which pain is radiated ?
 Pain while using the jaw
 Presence of jaw noise
 Past history of jaw injury or surgery
 Physical Examinations
It includes :
 Inspection
 Palpation
 Inspection

We observe :

Facial asymmetry

Facial asymmetry
Swelling
 Maximum mouth opening

Normal opening range = 35-50 mm

Lateral movements

Normal range = >7 mm

Occlusion
Openbite Crowding
Examination of other joints
Palpation

Masseter Temporalis
Lateral pterygoid Medial pterygoid
Palpation of TMJ
Intraoral examination

Bruxism Scalloped tongue

Radiological examination
OSSEOUES STRUCTURES
1. Panoramic Projection
2. Plain Film Imaging Modalities (Transpharyngeal, Transorbital, Transcranial)
3. Tomography

SOFT TISSSUE STRUCTURES

1. Arthrography
2. Magnetic Resonance Imaging (MRI)
 Panoramic Projections

Provides overall view of teeth and

jaws and helps in comparison of left
and right mandible.

Indication = Asymmetries, Fractures,

Extensive erosion
 Indication

Transcranial Lateral aspect of: TMJ pain syndrome, Internal derangement,

Glenoid fossa Clicking, mouth opening limitation
Articular eminence
Joint space
Condylar head

Transpharyngeal Lateral view of: TMJ pain syndrome, Osteoarthritis,

Condylar head & neck Rheumatoid Arthritis, Condylar head cyst,
Articular eminence Fracture of neck and condyle
Transorbital Anterior view of:
Condylar head & neck Trauma, Fracture
Articular eminence

Tomography All aspects of: Ankylosis

Glenoid fossa Neoplasms-bone involvement
Articular eminence
Joint space
Complex fractures
Condylar head
Arthrography
It is a technique in which an indirect image of the disk is obtained
by injecting a radiopaque contrast agent into the joint spaces
under fluoroscopic guidance.
Indication = TMJ pain dysfunction, jaw locking
Magnetic Resonance Imaging

It uses Magnetic field and radiofrequency pulses

It is used for viewing soft tissues.
Indication = Disk displacement, internal derangements
SUMMARY
 References
White and Pharoah Oral Radiology Principles and Interpretation 6th Edition
Burket's Oral Medicine 11th edition
QUESTIONS ??
Special thanks to our tutor

Dr. Diksha Agrawal