DIAGNOSIS OF TMD AND OSA

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As the signs and symptoms of TMD match various other disorders, patient evaluation starts with thorough oral and physical examination. The dentist also takes complete health history of the patient.

Dentist does the following oral examination in case of any suspicion of TMD:

  • Check jaw for pain or tenderness by palpating extra auricular area

  • Listen for clicks, pops, or grating sounds while patient moves the jaw

  • Evaluate the proper working of the jaw by placing small finger intra-auricular

  • Observe the range of motion in jaw

  • Extra –oral for facial symmetry, postural imbalances, nasal deviation, etc

  • Intra-oral for malocclusions, missing teeth, faulty dentures, tongue position, etc

After thorough oral examination, following diagnostic tests may be done for confirmed diagnosis of TMD:

  • Blood tests to rule out possible medical conditions as a cause of the problem.

  • X-rays and Panoramic Radiographs of jaws, temporomandibular joints and teeth - 

1. Lateral Cephalogram to look for airway patency, jaw placement and measure of lordosis(fig8)

2. OPG to look for the status of teeth(fig11)

3. TMJ View (left and right, open and close)(fig12)

  • MRI to find if the TMJ disc is in the proper position during jaw movement as it provides images of the disc as well as the muscles and other soft tissues surrounding the joint.

  • A CBCT scan to view the bony detail of the joint in case screening radiograph of the TM joint shows some bony changes

  • TMJ arthroscopy to view the TMJ and determine a diagnosis although its now not as used with NMD due to its sclerotic consequences

  • Scintigraphy (Bone scan) to find out whether a pathologic process is in an active or inactive state.

Patient may be referred a physiotherapist or ENT surgeon to rid the patient of any other ascending or descending causes of TMD.

Diagnosis of Obstructive sleep apnea

Diagnosis of OSA involves thorough physical examination and complete history taking of the patient. Physical examination includes:

  • Examination of the back of throat, mouth and nose for extra tissue or abnormalities

  • Measurement of the neck and waist circumference, weight imbalance

  • Lateral Cephalogram

  • 3D CT of Airway or Volumetric CT

  • STOP-BANG Questionnaire

  • Blood pressure measurement

  • All prospective OSA patients need to undergo a sleep study at night, where they need to sleep one night in a hospital or even at home with an ambulatory sleep study machine. The most important reading from this sleep report would be the AHI (apnoea-hypopnea index) and the number of desaturations.

In most of the cases, the doctor prefers to talk to the sleeping partner of the person to find out if the condition is OSA.

Patient may need to undergo Sleep study or Polysomnography (fig10 sleep study report) to confirm the diagnosis of OSA. Patient needs to spend a night in the sleep centre for sleep study. It involves overnight monitoring of the breathing and other body functions of the patient including:

  • Air flow

  • Blood oxygen levels

  • Breathing patterns

  • Electrical activity of the brain

  • Eye movements

  • Heart rate

  • Muscle activity

  • Snoring events