A key element of the Complete Exam and Treatment Planning process is determining the health of the TM Joint. The components of the TMJ-Occlusal exam are:
- Range of Motion Test
- Muscle Palpation
- Centric Relation Load Test
- Doppler Auscultation
- Determining signs of occlusal instability
- Imaging, if indicated
Range of Motion Testing is accomplished by using a simple, but very effective tool, the Therabite Range of Motion Scale by Great Lakes. It is used to measure vertical opening and lateral movement of the mandible.
Measuring Vertical Opening
For measuring vertical opening, the scale is self-explanatory. The notch is placed on the lower incisor midline (or substitute) and you ask the patient to open wide. It is important to measure the amount of overbite and add/subtract to amount of opening. The normal amount of vertical opening is 40-55 mm. Also observe how the mandible tracks during opening and closing. Is there deviation or deflection? Is there pain? Are there noises?
Measuring Lateral Movements
When measuring lateral movements, you place the arrow on the scale on the upper midline pointing towards the lower incisors. Notice the relationship to the lower midline, have the patient open slightly and move laterally. The normal lateral measurement is 8-12 mm. Again, any pain or noise?
The range of motion test has important information that needs to be correlated with the other components of the TMJ-Occlusal exam. The starting point for any treatment plan is assessing the health of the joint. If the Range of Motion is limited, what does it indicate? Is it a muscle issue or a joint issue or both?
Stay tuned for the next Blog on Limited Range of Motion.