Skip to main content

Abstract

For each temporomandibular disorder (TMD) patient, every diagnosis is preceded by a thorough data gathering process, which begins with the standardized history and targeted clinical evaluation. A clinical assessment should flow naturally from the initial components of the history and follow a consistent pattern so that nothing is left out. If done in such a systematic manner, the information obtained will help ascertain the patient’s current functional status, diagnosis, and necessary imaging studies to obtain and to help begin to formulate treatment strategies. Lastly, this chapter will introduce the value of including electromyography combined with motion-capture technology as standard evaluations in the TMD clinical exam.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bossuyt PM, Reistsma JB, Bruns DE, Gatsonis PP, Glasziou PP, Irwig LM, et al. Toward complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. Standards for Reporting of Diagnostic Accuracy. Clin Chem. 2009;49(1):1–6.

    Google Scholar 

  2. Feine JS, Hutchins MO, Lund JP. An evaluation of the criteria used to diagnose mandibular dysfunction with the mandibular kinesiograph. J Prosthet Dent. 1988;60:374–80.

    Google Scholar 

  3. Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet J-P, et al. Diagnostic Criteria For Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache. 2014;28(1):6–27.

    Google Scholar 

  4. Ohrbach R, Dworkin SF. The evolution of TMD diagnosis: past, present, future. J Dent Res. 2016;95(10):1093–101.

    Google Scholar 

  5. Peck CC, Goulet J-P, Lobbezoo F, Schiffman EL, Alstergren P, Anderson GC, et al. Expanding the taxonomy of the diagnostic criteria for temporomandibular disorders. J Oral Rehabil. 2014;41(1):2–23.

    Google Scholar 

  6. Ohrbach R, Gonzalez Y, List T, Michelotti A, Schiffman E. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Clinical Examination Protocol International RDC/TMD Consortium Network 2014. http://www.rdc-tmdinternational.org/Portals/18/protocol_DC-TMD/DC-TMD Protocol - 2013_06_02.pdf.

  7. Blau JN. How to take a history of head or facial pain. Br Med J. 1982;285:1249–51.

    Google Scholar 

  8. Johnson P. Psychological factors influencing headache. In: Tollison CD, Satterthwaite J, Tollison J, editors. Handbook of pain management. Philadelphia: Williams & Wilkins; 1994.

    Google Scholar 

  9. IASP. IASP taxonomy. 2011. http://www.iasp-ain.org/AM/Template.cfm?Section=Pain_Definitions2011 [updated 2011].

  10. Smith B, Ceusters W, Goldberg LJ, Ohrbach R. Towards an ontology of pain. In: Okada M, editor. Proceedings of the conference on logic and ontology. Tokyo: Keio University Press; 2011. p. 23–32.

    Google Scholar 

  11. Shah JP, Phillips TM, Danoff JV, Gerber LH. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol. 2005;99(5):1977–84.

    Google Scholar 

  12. Cohen M, Quintner J. The clinical conversation about pain: tensions between the lived experience and the biomedical model. In: Fernandez J, editor. Making sense of pain. Clinical and interdisciplinary perspectives. Oxford: Inter-Disciplinary Press; 2010.

    Google Scholar 

  13. Cohen M, Quintner J. The horse is dead: let myofascial pain syndrome rest in peace. Pain Med. 2008;9(4):464–5.

    Google Scholar 

  14. Dommerholt J, Gerwin RD. A critical evaluation of Quintner et al: missing the point. J Bodyw Mov Ther. 2015;19(2):193–204.

    Google Scholar 

  15. Quintner JL, Bove GM, Cohen ML. A critical evaluation of the trigger point phenomenon. Rheumatology. 2015;54(3):392–9.

    Google Scholar 

  16. Ohrbach R, Turner JA, Sherman JJ, Mancl LA, Truelove EL, Schiffman EL, et al. Research diagnostic criteria for temporomandibular disorders. IV: Evaluation of psychometric properties of the Axis II measures. J Orofac Pain. 2010;24(1):48–62.

    Google Scholar 

  17. Aaron LA, Turner JA, Mancl L, Brister H, Sawchuk CN. Electronic diary assessment of pain-related variables: is reactivity a problem? J Pain. 2005;6(2):107–15.

    Google Scholar 

  18. Ferrario VF, Sforza C. Coordinated electromyographic activity of the human masseter and temporalis anterior muscles during mastication. Eur J Oral Sci. 1996;104(5–6):511–7.

    Google Scholar 

  19. Leader JK, Boston JR, Rudy TE, Greco CM, Zaki HS, Henteleff HB. Quantitative description of temporomandibular joint sounds: defining clicking, popping, egg shell crackling and footsteps on gravel. J Oral Rehabil. 2001;28(5):466–78.

    Google Scholar 

  20. Ohrbach R, Greene C. Temporomandibular joint diagnosis: striking a balance between the sufficiency of clinical assessment and the need for imaging. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116(1):124–5.

    Google Scholar 

  21. Schiffman EL, Ohrbach R, Truelove EL, Tai F, Anderson GC, Pan W, et al. The research diagnostic criteria for temporomandibular disorders. V: methods used to establish and validate revised Axis I diagnostic algorithms. J Orofac Pain. 2010;24(1):63–78.

    Google Scholar 

  22. Nickel J, Spilker R, Iwasaki L, Gonzalez Y, McCall WD, Ohrbach R, et al. Static and dynamic mechanics of the temporomandibular joint: plowing forces, joint load and tissue stress. Orthod Craniofac Res. 2009;12(3):159–67.

    Google Scholar 

  23. Ferrario VF, Sforza C, Tartaglia GM, Dellavia C. Immediate effect of a stabilization splint on masticatory muscle activity in temporomandibular disorder patients. J Oral Rehabil. 2002;29(9):810–5.

    Google Scholar 

  24. Proffit WR, Fields HW, Sarver DM. Contemporary orthodontics. New York: Elsevier Health Sciences; 2014.

    Google Scholar 

  25. Pullinger AG, Seligman DA, Solberg WK. Temporomandibular disorders. Part II: occlusal factors associated with temporomandibular joint tenderness and dysfunction. J Prosthet Dent. 1988;59(3):363–7.

    Google Scholar 

  26. Michelotti A, Farella M, Gallo LM, Veltri A, Palla S, Martina R. Effect of occlusal interference on habitual activity of human masseter. J Dent Res. 2005;84(7):644–8.

    Google Scholar 

  27. Michelotti A, Cioffi I, Festa P, Scala G, Farella M. Oral parafunctions as risk factors for diagnostic TMD subgroups. J Oral Rehabil. 2010;37(3):157–62.

    Google Scholar 

  28. Michelotti A, Cioffi I, Landino D, Galeone C, Farella M. Effects of experimental occlusal interferences in individuals reporting different levels of wake-time parafunctions. J Orofac Pain. 2012;26(3):168–75.

    Google Scholar 

  29. Dworkin SF, LeResche L, DeRouen T, Von Korff M. Assessing clinical signs of temporomandibular disorders: reliability of clinical examiners. J Prosthet Dent. 1990;63(5):574–9.

    Google Scholar 

  30. Bertazzo-Silveira E, Stuginski-Barbosa J, Porporatti AL, Dick B, Flores-Mir C, Manfredini D, et al. Association between signs and symptoms of bruxism and presence of tori: a systematic review. Clin Oral Investig. 2017;21(9):2789–99.

    Google Scholar 

  31. Häggman-Henrikson B, Eriksson P-O. Disturbed jaw behavior in whiplash-associated disorders during rhythmic jaw movements. J Dent Res. 2002;81(11):747–51.

    Google Scholar 

  32. Ferrario VF, Sforza C, Dellavia C, Tartaglia GM. Evidence of an influence of asymmetrical occlusal interferences on the activity of the sternocleidomastoid muscle. J Oral Rehabil. 2003;30(1):34–40.

    Google Scholar 

  33. Häggman-Henrikson B, Eriksson P-O. Head movements during chewing: relation to size and texture of bolus. J Dent Res. 2004;83(11):864–8.

    Google Scholar 

  34. Sforza C, Rosati R, De Menezes M, Musto F, Toma M. EMG analysis of trapezius and masticatory muscles: experimental protocol and data reproducibility. J Oral Rehabil. 2011;38(9):648–54.

    Google Scholar 

  35. Gerwin RD, Shannon S, Hong C-Z, Hubbard D, Gevirtz R. Interrater reliability in myofascial trigger point examination. Pain. 1997;69(1):65–73.

    Google Scholar 

  36. Ohrbach R, Gale EN. Pressure pain thresholds, clinical assessment, and differential diagnosis: reliability and validity in patients with myogenic pain. Pain. 1989;39(2):157–69.

    Google Scholar 

  37. De Coster PJ, Van den Berghe LI, Martens LC. Generalized joint hypermobility and temporomandibular disorders: inherited connective tissue disease as a model with maximum expression. J Orofac Pain. 2005;19(1):47–57.

    Google Scholar 

  38. Fischer L, Clemente JT, Tambeli CH. The protective role of testosterone in the development of temporomandibular joint pain. J Pain. 2007;8(5):437–42.

    Google Scholar 

  39. LeResche L, Saunders K, Von Korff MR, Barlow W, Dworkin SF. Use of exogenous hormones and risk of temporomandibular disorder pain. Pain. 1997;69(1–2):153–60.

    Google Scholar 

  40. Wang W, Hayami T, Kapila S. Estrogen/relaxin induce while progesterone represses MMP expression in TMJ fibrochondrocytes. J Dent Res. 2007;86:1279.

    Google Scholar 

  41. Ferrando M, Andreu Y, Galdon MJ, Dura E, Poveda R, Bagan JV. Psychological variables and temporomandibular disorders: distress, coping, and personality. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;98(2):153–60.

    Google Scholar 

  42. Fricton J. Current evidence providing clarity in management of temporomandibular disorders: summary of a systematic review of randomized clinical trials for intra-oral appliances and occlusal therapies. J Evid Based Dent Pract. 2006;6(1):48–52.

    Google Scholar 

  43. Lindenmeyer A, Sutcliffe P, Eghtessad M, Goulden R, Speculand B, Harris M. Oral and maxillofacial surgery and chronic painful temporomandibular disorders—a systematic review. J Oral Maxillofac Surg. 2010;68(11):2755–64.

    Google Scholar 

  44. Sharma S, Crow HC, McCall WD Jr, Gonzalez YM. Systematic review of reliability and diagnostic validity of joint vibration analysis. J Orofac Pain. 2013;27(1):51–60.

    Google Scholar 

  45. Castroflorio T, Bargellini A, Rossini G, Cugliari G, Deregibus A, Manfredini D. Agreement between clinical and portable EMG/ECG diagnosis of sleep bruxism. J Oral Rehabil. 2015;42(10):759–64. https://doi.org/10.1111/joor.12320. Epub 2015 Jun 7. PMID: 26059761.

    Google Scholar 

  46. Gallo LM, Brasi M, Ernst B, Palla S. Relevance of mandibular helical axis analysis in functional and dysfunctional TMJs. J Biomech. 2006;39(9):1716–25.

    Google Scholar 

  47. Lötters FJ, Zwijnenburg AJ, Megens CC, Naeije M. Relationship between condylar and incisor point displacement during habitual maximum open-close movements. J Oral Rehabil. 1996;23(8):548–54.

    Google Scholar 

  48. De Felıcio CM, Mapelli A, Sidequersky FV, Tartaglia GM, Sforza C. Mandibular kinematics and masticatory muscles EMG in patients with short lasting TMD of mild-moderate severity. J Electromyogr Kinesiol. 2013;23(3):627–33.

    Google Scholar 

  49. Sessle BJ, Avivi-Arber L, Murray GM. Motor control of masticatory muscles. In: McLoon LK, Andrade F, editors. Craniofacial muscles: a new framework for understanding the effector side of craniofacial muscle control. New York: Springer; 2013. p. 111–30.

    Google Scholar 

  50. Bhaskaracharya M, Memon SM, Whittle T, Murray GM. Jaw movements in patients with a history of pain: an exploratory study. J Oral Rehabil. 2015;42(1):18–26.

    Google Scholar 

  51. Mapelli A, Galante D, Lovecchio N, Sforza C, Ferrario VF. Translation and rotation movements of the mandible during mouth opening and closing. Clin Anat. 2009;22(3):311–8.

    Google Scholar 

  52. Miyawaki S, Tanimoto Y, Inoue M, Sugawara Y, Fujiki T, Takano-Yamamoto T. Condylar motion in patients with reduced anterior disc displacement. J Dent Res. 2001;80(5):1430–5.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Cite this chapter

Tartaglia, G.M., Gianni, A., Ohrbach, R. (2019). Clinical Evaluation. In: Connelly, S.T., Tartaglia, G.M., Silva, R.G. (eds) Contemporary Management of Temporomandibular Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-99915-9_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-99915-9_8

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-99914-2

  • Online ISBN: 978-3-319-99915-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics