The effective management of Temporomandibular disorders requires first of all a diagnosis based on a complete history and thorough physical examination.
The following tests can aid in determining the intracapsular pathological conditions:
· Dynamic loading of one joint:
Ask the patient to forcefully bite the cotton roll or a tongue blade on one side. This procedure loads the contralateral temporomandibular joint and thus elicits pain.
· Posterior compression or loading of both the Temporomandibular joints:
Hold the mandible with both the hands placing the thumb on the distal molars with the fingers beneath the mandible. The mandible is then tipped down and back to compress the joints. The mandible will also be moved forward or backward to localize tenderness in the posterior or inferior parts of the joint.
· Unloading (distraction) or caudal traction:
Using the same hand positioning as mentioned above, the distraction of both the joints is performed at the same time or caudal traction of each joint is performed. The incisors are not aligned, with the mandible being deviated to one side. To check the relation of this deformity to the patient's symptoms, the therapist passively attempts to correct the deformity. If the deviation is a protective deformity, then the test will increase the pain.
· Plain Film Radiography
On the anteroposterior view, the examiner should look for condylar shape and normal contours. On the lateral view, the examiner should look for the condylar shape and contours, the position of condylar heads in the opened and closed positions, amount of the condylar movement (closed versus open) and the relation of temporomandibular joint to other bony structures of the skull and cervical spine.
· Magnetic Resonance Imaging
This technique is used to differentiate the soft tissue of the joint, the disc from the structures.
· Roentgenography and electromyography,
Electromyography can reveal how a muscle acts at any point during mandibular movements and procedures. Some researchers believe that electromyography is more reliable diagnostic tool than roentgenography for temporomandibular joints.