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How to differentiate between a joint derangement and muscle problem

So when you're trying to decide if your patients have an internal derangement or an occlusal muscle problem, how do we go about doing that?

First part is the screening questions you ask before you start to testing.

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Listen to the patient and then start testing

Find out where their pain, tension, and tenderness is and ask them to point. Just listen to what they have to say, so then as we get into the clinical exam, we're going to be looking at things like range of motion. Does the patient have range of motion that goes straight open and closed or are they deviating to a side? Typically, if they're deviating to the side, it's the affected side.

Are there clicks or pops? Where is the click and pop? Something else that you want to look at is going to be muscle palpation. Lots of muscles of mastication can get tight and tender whenever you have someone who's a clencher, grinder, or has an occlusal muscle problem.

Load testing is key

Bimanual ManipulationBut the biggest, most clinically relevant way of finding out if someone has an internal derangement while they're in your office is by doing our centric relation load test. Bimanual manipulation in three distinct levels of loading will allow us to determine if a patient has an issue.

So on your lightest level of loading with bimanual manipulation seating the joint, if a patient experiences any sorts of tightness, tenderness, tension, pain, discomfort in their jaw joint, you're pretty much going to be sure that there's something else going on inside the capsule versus someone who can accept firm load without any signs of tension or tenderness.

So a lot of our patients who come in saying that they have a TMJ problem, actually will have an occlusal muscle problem. And once you do your load test, you're going to find that.

Learn how to perform bimanual manipulation, view the range of motion, and more, register for an upcoming Examination and Records hands-on course in Florida, Virginia, Illinois, Colorado, or New Jersey. 

How to recognize and treat TMJ issues

Picture of Dr. Shannon Johnson

Shannon Johnson, DMD is an associate faculty member at the Dawson Academy. She also leads two Dawson Study Clubs and teaches the Core Curriculum. Dr. Johnson owns and operates her practice in Louisville, KY.