After many years of work, the International RDC-TMD Consortium has released its updated version of the diagnostic criteria for TMJ. These new criteria consist of a short screening instrument and a longer diagnostic one. However, these criteria depend entirely on questionnaires, and the RDC-TMD recommends that they be followed up with CT or MRI scans for conclusive proof of TMJ.
Diagnosing Physical TMJ Symptoms
The new TMJ criteria include two axes of diagnosis. The first axis is dedicated to the specific physical symptoms of TMJ. The Axis I screener is very simple, and it consists of three questions focused on jaw pain and headaches. The questionnaire asks about recent pain, whether the pain is present at waking, is related to opening the jaw, chewing, or performing other jaw activities.
The more comprehensive diagnostic asks in more detail about:
- Jaw pain
- Closed locking of the jaw
- Open locking of the jaw
It also has an examiner form that allows the doctor to confirm symptoms objectively, including tracking of irregular jaw motions. The tool comes with very detailed and highly illustrated instructions for performing these exams.
The Axis I tool is intended to cover twelve common forms of TMJ, including temporomandibular joint arthralgia, myalgia, local myalgia, myofascial pain, myofascial pain with referral and headache, four different types of disc displacement (with reduction and with and without locking, and without reduction but with and without limited opening), degenerative joint disease, and subluxation.
Assessing Function, Psychological Distress, and Oral Habits
The second axis of the criteria attempts to assess a patient’s pain, disability, limited jaw function, psychological factors, and what oral habits may be contributing to TMJ. Even the basic screening tool for Axis II is fairly complex. It offers patients the opportunity to identify the location of all their pain and talk about the extent of their current pain.
The screener also asks about how much their TMJ has interfered with work, recreational, or social activities. It asks specifically about whether TMJ limits a patient’s ability to chew tough food, soft food, drink from a cup, swallow, yawn, talk, and smile. The Axis II criteria are considered less sensitive and specific, but provide a fuller picture of the patient and may give better direction for treatment protocols and goals.
It is good to know that the difficult problem of TMJ diagnosis is getting such serious attention and we hope that this will help more people get good treatment results for this condition.