The diagnosis of temporomandibular joint disorder (TMD) is usually not a problem for a well-trained neuromuscular dentist. Unfortunately, many patients spend a great of time in medical offices before diagnosis and referral to a dentist trained to treat TM joint disorders.
TMD is often difficult to diagnose for dentists because there is no single underlying cause resulting in pain. There are many factors that lead to problems with the temporomandibular joint (TMJ) and the surrounding tissues, which in turn may cause secondary signs and symptoms. These signs and symptoms may point to other underlying causes as well. TMJ disorders are frequently referred to as the “great imposter” because of frequently missed diagnosis as dentist and untrained dentists pursue the cause of the signs and symptoms.
It is not uncommon for root canal therapy or extractions to be done for tooth pain when the pain is actually referred from the muscles. MPD or Myofascial Pain and Dysfunction may be responsible for as much as 90-95% of all pain. It is hallmarked by referred pain. All too frequently, patients are treated repeatedly with antibiotics for non-existent sinus or ear infections. This often leads to antibiotic resistant bacterial infections and secondary yeast (candida) infections.
Signs and Symptoms
Many of the signs and symptoms of TMD are similar to signs and symptoms of other conditions. They include:
Many of these symptoms can present themselves in other parts of the head and neck. Migraine headaches have shown to be linked to the trigeminal nerve, which innervates approximately 40 percent of the brain and head functions. Treating TMD has in some cases helped relieve or prevent instances of migraine headaches.
The initial interview and review of medical records is absolutely essential for diagnosing patients with complex problems. It is not uncommon for 1-2 hours of exam and review of medical history to be done prior to beginning the hands-on examination.
This examination will usually include muscle and joint palpation, evaluation of joint function and range of motion, review of systems, and posture evaluation.
The neuromuscular dentist will perform a physical exam which involves feeling the jaw joint as you move it around, looking for the following:
- Clicking or popping
- Limited motion and locking
A thorough examination of the muscles is also essential in understanding the causes of pain and dysfunction. Palpation of muscles not only helps the dentist determine the health of a patient’s muscles but also can help determine referral patterns of muscle pain.
Approximately 90 percent of diagnoses are made using the patient interview and physical exam. However, additional tests are needed in some cases.
Diagnostic tests are usually put off until some conservative treatments have been tried. Traditional tests like x-rays are not usually helpful in diagnosing TMD and more expensive tests are required. They are usually ordered when pain persists over time and proves resistant to treatment. These tests include:
- Arthrography (a joint x-ray with radioactive dye) rarely used currently
- MRI (magnetic resonance imaging)
- Tomography—While not diagnostic, it is helpful in determining the relation of the bones and showing anatomical abnormalities
- Panoramic radiography
- Cone beam or CT scan evaluation
Neuromuscular Testing and Diagnosis
Additional diagnostic tools used by the neuromuscular dentist are EMG and to evaluate muscle function and symmetry and MKG or CMS (computerized mandibular scan or mandibular kenesiograph) utilized with the ULF TENS (ultra-low frequency transcutaneous electrical nerve stimulation). These tools are used both diagnostically and therapeutically to establish healthy treatment positions.
The use of these modalities allows the neuromuscular dentist a more objective and thorough understanding of the patient’s disorder. These are also used to guide the dentist to the most effective methods of treating each individual patient.