TMJ-related pain and dysfunction often go undiagnosed. Most people who suffer from TMJ dysfunction will not have all of these symptoms. Also, most of these symptoms may be TMD related, related solely to other medical problems, related to multiple causes, or may be cross related to both TMD and something else, and they can both aggravate each other.

• One-Minute TMD Screening - use to assess a patient for potential TMJ disorder
• Additional symptoms that may be TMJ/TMD related

  • Retro-orbital pain
  • Tinnitus
  • Other symptoms

One-Minute TMD Screening

Ask:

• Does either jaw joint make noise (grating, grinding, clicking, or popping)?
• Does the jaw ever catch or lock?
• Is there frequent pain in any of the following areas?
  • Ear
  • Face
  • Head
  • Neck
  • Shoulder
  • Jaw

Examine:

• Palpate the TMJs while the patient opens and closes.
  • Place your little fingers in the ear canals and apply pressure to the anterior walls of the canals. You will be able to palpate the lateral 1/3 of the condyles.
  • Normal: smooth movement, no noise, no jumping, no pain
• Measure mandibular range of motion.
  • Normal opening: 48-52mm intrinsically with no pain. (Equivalent of first three fingers on edge between front teeth)
  • Lateral movements: 10mm or greater. No dyskinesia
• Palpate muscles for tenderness:
  • Temporalis?
  • Masseter?
  • Sternocleidomastoid?
  • Posterior cervicals?

Though not all patients presenting signs or symptoms of a TMJ disorder should necessarily proceed with further diagnosis and treatment, most will benefit from careful work up and, if indicated, proper management. This is especially true if no other specific medical diagnosis can be made. We welcome your professional inquiries and hope this screening is helpful to you in the management of your patients with temporomandibular joint dysfunction and/or craniofacial pain.

Retro-orbital pain (blurred vision) may be causally related to the foreshortening of the Sphenomandibularis muscle. This relatively newly found muscle was discovered and named in 2000 by Dr.'s Gary Hack and Gwendolyn Dunn during discection at the University of Maryland in Baltimore. The Wall Street Journal asked "How can a new muscle be found?" "It's like seeing an elephant for the first time that's been there in your kitchen for your entire life." The muscle attaches to the greater wing of the ethmoid plate of the Sphenoid bone and inserts at the oblique angle of the mandible. As the muscle spasms or foreshortens the mandible achors it and it Torque and rotates the Sphenoid causing vision to blurr, and/or pain retro-orbitally. As the muscle relaxes and approaches its normal resting lenght, pressure on the osseous structure lessens and the symptoms ameliorate. Thus, blurred vision from TMD is diagnostically differentiated from true occular visual disturbancer by its vascilating nature. To ascertain this marcaine may be injected at the angle of the mandible.

There are multiple categories of tinnitus, which have various causalities.  Some are definitely unrelated to TMD.  You can easily see how others may either be directly a result of TMD or may be exacerbated by it, or in some instances brought out of a sub clinical state into one with noticeable symptomotology.

Tinnitus types: 

1. Tinnitus aurium, a subjective sensation of noises in the ears.
2. Clicking tinnitus, a clicking sound occuring in the ear in chronic catarrhal otitis media, it may be heard by others than the patient.
3. Leudet's tinnitus, a cracking sound in the ear, audible also to an observer, produced by involuntary contraction of an internal muscle coinciding with a tic of some of the fibers of the mandibular divison of the Trigeminal (fifth cranial) nerve.
4. Nervous tinnitus that which arises from some disturbance of the otic nerve or its central connection.
5. Nonvibratory tinnitus, tinnitus which is produced by biochemical changes occuring in the nerve mechanism of hearing. 
6. Objective tinnitus, abnormal or pathological sounds originating within the body of the patient, in the region of the ear, which are audible to others than the patient.
7. Vibratory tinnitus, tinnitus resulting from transmission to the cochlea of vibrations originating in adjacent tissues of the body.  Dorlands Medical Dictionary documents these Tinnitus types while Cecil's Textbook of Medicine describes objective tinnitus wherein the patient hears a sound arising external to the auditory system, a sound that can usually be heard by the examiner with a stethoscope. 
8. Objective tinnitus usually has benign causes such as noise from Temporomandibular joints, opening of Eustachian tubes, or repetitive muscle contractions. (Note the possible relation of all three to TMJ posturing muscles as well as fluid within the TM Joint)

Other Symptoms

Since so many of these symptoms caused by TMJ can also be related to other medical problems, a thorough, comprehensive, multidisciplinary evaluation can pin point the various possible causes and simultaneously provide overlapping treatment.  Often by correlating the missing links of treatment, successful control of pain is more readily achieved.