TMJ Evaluation
A comprehensive evaluation is essential for accurately diagnosing and effectively treating temporomandibular disorders (TMD)
Use a Structured TMD Evaluation Form
Ensures therapists don’t miss key symptoms (jaw noise, pain, locking, limited range of motion).
Guides the therapist to ask the right questions (sleep, headaches, posture, clenching, etc.).
Helps distinguish TMD from other orofacial or cervical conditions.
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
TRANSCRANIAL XRAY
TOMOGRAM
BONE SCAN
CONE BEAM SCAN
IMAGES OF CONE BEAM SCAN
MRI SCAN IMAGES
Scroll through imaging types
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.
Examination
Open-Mouth
ALIGNMENT OF TEETH
Note cross bite, under or over bite.
SYMMETRY OF FACIAL STRUCTURES
Eyes, nose, mouth, length of mandible.
BREATHING PATTERN
Diaphragmatic breathing or accessory pattern, mouth breathing, short upper lip.
TONGUE OR LIP FRENULUM RESTRICTION
HYPERMOBILITY SCREEN
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.
LISTENING FOR JOINT NOISES, CLICKS, POPS OR CREPITUS
PROTRUSION OF MANDIBLE
Normal ~ 10 mm • Lateral deviation of mandible Normal ~ 10 mm • Note asymmetrical movements, snapping, clicking, popping or jumps.
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.
RECORD DEFLECTIONS
Lateral movements without return to midline. Deflections are usually associated with Disc Dislocations without reduction or a unilateral muscle restriction.
CRANIAL LOADING OF MANDIBLE PROVIDES ADDITIONAL VALUABLE INFORMATION
PROM: apply overpressure at the end range of AROM to assess end feel.
Observation
Assess posture, jaw movement, facial symmetry, and muscle tension to help identify abnormal patterns or signs of dysfunction that may contribute to the patient’s condition.
STRENGTH
Assess the muscles of mastication, deep cervical flexors, and scapular stabilizers to evaluate overall neuromuscular balance, strength, and postural support relevant to temporomandibular and cervical function.
Strength
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strength3
SENSATION
Assess upper quadrant dermatomes, C1, C2, C3, cutaneous nerve supply of the face, scalp and neck, cranial nerves V – XII
REFLEX TESTING
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JOINT MOBILITY
DYNAMIC LOADING
The dynamic loading test is used to reproduce joint-related symptoms by increasing pressure within the TMJ, helping clinicians differentiate between joint and muscular sources of pain, and identify intra-articular issues such as disc displacement or arthralgia.
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.
PAIN
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
A thorough cervical spine assessment is essential in evaluating patients with head, neck, or jaw pain due to the strong biomechanical and neurological interconnections between the cervical spine and the craniofacial region. Dysfunction in the cervical region can refer pain to the jaw, mimic TMD symptoms, or exacerbate postural imbalances.
Cervical-Spine
cervical-range
cervical-range2
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UPPER EXTREMITY REFLEXES
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PALPATION
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
• 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.
