TMJ Evaluation

Here is a sample TMD evaluation form that we use at Freedom Physical Therapy Services.
Click to see larger image

tmj evaluation form

Social History

Daily parafunctional activities such as smoking, bruxism, chewing gum, snoring, leaning on chin, biting nails, lip biting, clenching teeth can all cause or create symptoms. Work, household responsibilities, hobbies and/or recreational activities may involve repetitive stress and prolonged postures, e.g. computer work, that add to or exacerbate the presenting symptoms. Emotional stress can trigger nervous habits or poor postural responses, which can lead to TMJ symptoms.

Diagnostic Imaging

Diagnostic imaging helps provide added information. It is very important to make sure the clinical objective findings correlate with any diagnostic imaging. For example, disc displacement is common in non symptomatic subjects, MRI evidence of disc displacement is not considered significant unless ROM is restricted or a nonreducing disc is suspected clinically.


tmj dental panoramic radiograph


tmj xrays


tmj tomogram


tmj bone scan


tmj cone beam scan


tmj cone beam scan


tmj mri scan


This section is intended to capture the most commonly used assessment for TMD. It is not intended to be either inclusive or exclusive of assessment tools.


Opening and closing of mouth

Teeth normally close symmetrically, the jaw is normally centered
tmj mouth opening

Alignment of teeth

Note cross bite, under or over bite
tmj teeth alignment

Symmetry of facial structures

Eyes, nose, mouth, length of mandible
tmj facial asymmetry


Forward head posture, rounded shoulders and scapular protraction is common
tmj posture

Breathing pattern

Diaphragmatic breathing or accessory pattern, mouth breathing, short upper lip
tmj breathing pattern

Tongue or lip frenulum restriction

tmj tongue lip
tmj hypermobility

ROM – Range of Motion

AROM: measure from top tooth edge to bottom tooth edge Opening and closing of mouth Normal opening ~ 40-50 mm Functional opening or necessary for most dental procedures ~ 36 mm or at least 2 knuckles between teeth
tmj range of motion

Listening for joint noises, clicks, pops or crepitus

tmj jaw click pop

Protrusion of mandible

Normal ~ 10 mm • Lateral deviation of mandible Normal ~ 10 mm • Note asymmetrical movements, snapping, clicking, popping or jumps
tmj protrusion of mandible

Record deviations

Lateral movements with return to midline. The opening pathway is altered but returns to midline, usually indicative of a disc displacement WITH reduction or could be neuromuscular dysfunction.
tmj deviations

Record deflections

Lateral movements without return to midline. 
Deflections are usually associated with Disc Dislocations without reduction or a unilateral muscle restriction.

tmj deflections

Cranial Loading of Mandible provides additional valuable information

PROM: apply overpressure at the end range of AROM to assess end feel
tmj cranial loading


Assess muscles of mastication, deep cervical flexors and scapular stabilizers.


Assess upper quadrant dermatomes, C1, C2, C3, cutaneous nerve supply of the face, scalp and neck, cranial nerves V – XII

Reflex Testing

jaw jerk reflex

Joint Mobility

Long axis distraction, Medial and Lateral glide
tmj joint mobility

Dynamic Loading

Load contralateral TMJ – bite on cotton roll/tongue blade

tmj dynamic loading

Functional Activities

Assess chewing, swallowing, coughing, and talking. Either have patient demonstrate task or ask for patient’s subjective report. Include changes the patient has made to their own diet to accommodate for their pain and dysfunction.


Determine which movements cause pain, including opening or closing of mouth, eating, yawning, biting, chewing, swallowing, speaking, or shouting. The patient may also present with headaches and cervical pain. Pain may also be present in the distribution of one of the three branches of the trigeminal nerve.

Other Complaints

These may include the feeling of fullness of the ear, tinnitus and/or vague dizziness. These symptoms are seen in approximately 33-40% of patients with TMJ and usually resolve after treatment.

Cervical Spine and Upper Quadrant Screen

Assess cervical A/PROM, muscle length including deep cervical flexors, myotomes, dermatomes and reflexes.
cervical range of motion screen
c1c2 rotation restrictions

Upper Extremity Reflexes

upper extremity reflexes


tmj palpations

Physical Therapy palpation of the muscles of mastication

Watch this video to learn how Physical Therapist palpate or find the muscles of mastication (chewing) including the temporalis, masseter and pterygoid pair.  Treating these muscles helps reduce myofascial pain and TMJ issues.

Rocabado Synovial Pain Map

pdfView Rocabado pain map for evaluating TMD

TMJ: compare bilaterally, assess joint integrity and structural deviations
Muscles of mastication: compare bilaterally, assess for pain and/or muscle spasm
This is only a partial list of which muscles are palpated and assessed

Vicinity oflateral pterygoid (intraorally) Temporalis (Externally) insertion of temporalis (intraorally) medial pterygoid (externally) meidial pterygoid (internally) masseter (externally/internal