Diagnosis of TMJ

A proper diagnosis always begins with a thorough examination. This is especially true in TMJ. Often patients suffering from the “Great Imposter” wander from office to office seeking help for their problems.

The most severe case that I have found in the medical/dental literature is a lady who had seen 103 different doctors including 32 dentists, 20 neurologists and 15 family physicians. She also was admitted to the hospital 12 times for testing. Her documented medical bills exceeded $300,000! Today she is living pain-free because a proper examination and diagnosis was made.

Detailed Medical/Dental History:

A proper medical history should include all past medical dental problems and treatments, any history of trauma, especially to the head and neck region, specific questions about your symptoms and the nature and duration of any pain and jaw problems.

Physical Examination:

This consists of several parts and may take up to two hours to complete. A complete exam should include the following (see text below the images provided by Dr. James E. Carlson and the Acculiner Corp):

This consists of several parts and may take up to two hours to complete. A complete exam should include the following:

1. Postural exam to discover any musculoskeletal problems that either contribute to or are the result of TMJ problems. This includes scoliosis, lower back pain, and short leg syndrome among others. The human body functions best when aligned at right angles to the center of gravity.
2. A cranial examination will evaluate the planes of the skull including the dental plane of occlusion.
3. Dental Examination to evaluate the shape of the dental arches, swallowing patterns, wear or fractures of teeth, missing teeth and existing dental restorations and numerous other clues to what is happening in the patients body. The dentist will usually make models of the mouth so that the teeth and the dental arches may be more closely examined.
4. Neurologic examination to test for nerve or brain damage that may cause symptoms of TMJ. Certain brain tumors will mimic TMJ symptoms.
5. TMJ Examination to look at the ranges of motion, gait, speed and smoothness of jaw movements. The TMJoints will be palpated to check for internal joint inflammation, pain and the presence of joint sounds.
6. Joint Vibrational Analysis records the vibrations made by joint tissues during movement. JVA technology, based on that used in US Navy submarines, records vibrations, not sounds. All sounds are vibrations, but not all vibrations are sounds. The JVA is much more accurate than palpation, a stethoscope or even the patient self-reports, when it comes to recording vibration in the joints. The patterns and the electronic signature of your joints are compared to known standards for healthy joints. This technology also provides important objective (factual) documentation so vitally important in personal injury lawsuits and for filing insurance claims.

7. Radiographic (x-ray) Examination of the joints allows the doctor to see many important structures and conditions hidden from view. Common x-rays are a panoramic x-ray that is useful only for screening for fractures, tumors and severe breakdown of the joints. Tomographs provide the best view of the TMJoints. Tomographs are x-ray slices of structures in the body. This technique allows the doctor to look at specific structures in great detail. The TMJoint tomographs accurately depict the position of the condyle in the fossa, and show degenerative and traumatic changes in the bones of the joints.

8. Other special tests include electromyography, which is a cousin of the electrocardiogram. As the electrocardiogram measures the muscular activity of dysfunctions of the heart muscle, electromyography measures the activity and dysfunction of head and neck muscles. This information is important in treatment planning and for documentation purposes. Computerized jaw tracking is another important diagnostic and treatment tool. Using a small, powerful magnet stuck to the gums below the lower front teeth, movements of the jaw can be measured with unprecedented accuracy. The jaw tracker can be combined with the JVA to provide the most comprehensive diagnostic and treatment information available today.

9. Psychometric tests are standardized questionnaires that compare patient’s response to questions about their condition. This information is very helpful to the doctor in the evaluation of the severity and chronicity of TMJ problems. The most common and accurate test is the TMJ Scale.

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