Examination

Physical examination may reveal the following:

• myofascial pain
  • dull, diffuse, cyclic pain seen in several sites of the head and neck (1,2)
  • pain is worse in the morning in cases where the patient have been clenching or grinding (bruxism) their teeth while asleep (2)
  • diffuse muscle tenderness around the joint with limited jaw function (2)
  • wear facets on the dentition in bruxism (2)
• internal derangement
  • pain is continuous, localized to the temporomandibular joint and is exacerbated by jaw movement (1)
  • mandible movement is restricted with deviation of the joint during opening and closing (1)
• osteoarthritis
  • crepitus or grating sounds
  • pain or swelling localized to the TMJ can indicate intra-articular inflammation (2)

Examination of the TMJ and masticatory muscles (3)

• this should include careful palpation of all structures
• determining myospasm and myofascial trigger points
  • this may be done by palpation of the masseter or sternocleidomastoid muscles
  • it can be performed by placing a finger over the TMJ or into the ear canal while the patient opens and closes the mouth
  • a clicking or popping sensation that occurs when mouth opening may indicate displacement of the intra-articular disk during mandibular movement
    • clicking is a common symptom
    • it is part of the diagnostic criteria for TMJ disorders
    • it does not correlate well with pain severity or functional limitation
    • the absence of clicking sounds is not a reliable symptom
• pain or swelling localized to the TMJ can indicate intra-articular inflammation

Reference:

• (1) Dimitroulis G. Temporomandibular disorders: a clinical update. BMJ. 1998;317(7152):190-4
• (2) American Association of Oral and Maxillofacial Surgeons 2010.  Statement by the American Association of Oral and Maxillofacial Surgeons Concerning the Management of Selected Clinical Conditions and Associated Clinical Procedures. Temporomandibular Disorders
• (3) Jennifer J. Buescher. Temporomandibular Joint Disorders. Am Fam Physician 2007;76:1477-82, 1483-84.