Temporomandibular joint assessment: What university didn’t teach you!

Temporomandibular Joint (TMJ) assessment can feel like an afterthought in many university courses—often tacked onto the end of the cervical spine modules with little focus.

This can leave physios lacking the confidence to properly assess and treat Temporomandibular joint Dysfunction (TMD) clinically. Luckily, Dr. Alana Dinsdale’s Practical on TMD assessment helps to fill this knowledge gap! While every assessment should be guided by what you uncover in the subjective and initial objective examination, I’ve outlined some key steps taken from Alana’s Practical to help you get started:

If you’d like to see exactly how expert physio Dr. Alana Dinsdale assesses TMD, watch her full Practical HERE. With Practicals, you can be a fly on the wall and see exactly how top experts assess and treat specific conditions – so you can become a better clinician, faster. Learn more HERE.

Where to start?

Like any objective assessment, begin with observation and Active Range Of Motion (AROM). Start by observing key features such as jaw symmetry, overbite/underbite, noticeable swelling or bruising, and overall sitting posture.

Next, assess cervical AROM, noting any restrictions or symptom changes. When it comes to TMJ AROM, be sure to include:

• Opening/closing
• Protrusion
• Laterotrusion (side-to-side movement)
• Retrotusion (depending on the patient)

Alana notes there are three approaches she uses to assess AROM:

1 – Observe

Simply watch the patient as they complete movements. Look for any deviations or deflections to one side as the jaw opens, as well as clicking or clunking sounds. Once you’ve assessed all movements and noted any symptom reproduction, you’re ready to move on to the next phase.

2 – Measure

Now, it’s time to gather objective measurements that can be reassessed over time. Use a standardised approach to ensure consistency across sessions. For example, when measuring side-to-side movement, first check if the patient’s top and bottom teeth align. If they don’t, measure the discrepancy and adjust your measurement accordingly by adding or subtracting the difference. Alana demonstrates measuring opening AROM in the below video from her Practical:

3 – Feel

Once you’ve gathered your measurements, palpating the TMJ can provide valuable insight into how the joint moves, and at what stage clicking or clunking occurs. Compare side-to-side to assess differences in mobility, tension, or symptoms. See Alana demonstrate this in the below snippet from her Practical:

Finally, you can try some treatment-directed testing, which involves adapting the patient’s posture and re-assessing the problem movement(s) to observe any changes in AROM or symptoms.

Where to from there?

Now it’s time to palpate the structures around the neck and TMJ—a step that can be challenging for physios who don’t regularly treat TMJ patients. Your assessment should include both extra- and intra-oral palpation, as some key structures—particularly the medial and lateral pterygoid muscles—cannot be assessed externally, despite being frequent contributors to TMD.

With your patient supine, you can begin extra-oral palpation of the patient’s:

• TMJ
• Mandible
• Cheek bone and temple
• Masseter
• Temporalis
• Suprahyoid muscles
• Cervical spine
• Suboccipitals
• Scalenes
• Sternocleidomastoid

Intra-oral assessment can include:

• Observing for signs of scalloping on the tongue
• Observing for signs of teeth grinding
• Palpation of medial and lateral pterygoid
• Palpation of masseter

Alana expertly demonstrates her palpation of all these structures, as well as an anatomy refresher in her Practical, so be sure to check it out!

What next?

Well, that depends on what you’ve found so far—but while performing an intra-oral assessment, it’s useful to evaluate the TMJ itself. The key focus here is identifying hypo- or hypermobility and assessing symptom reproduction.

You can assess joint translation with a Posterior-Anterior glide of the TMJ extra-orally with your patient in side-lying. Your intra-oral assessment should include both joint distraction and lateral glide techniques. Watch Alana demonstrate joint distraction in the snippet below from her Practical:

Wrapping up

The TMJ is one of the few joints physios often shy away from, typically focusing more on the cervical spine than diving into a full TMJ assessment. And it’s understandable—unless you’ve had additional training through professional development or other courses, your exposure to TMJ assessment was probably limited to a brief practical session at university. Hopefully, this little guide gives you a solid starting point and boosts your confidence in assessing the TMJ!

If you want to learn how the pros assess TMD, then be sure to watch Dr. Alana Dinsdales full Practical HERE.