Temporomandibular joint disorders (TMJ or TMD) are not just a single condition, it’s a blanket label that describes many different related conditions. The symptoms of the condition can vary widely among people, as can the way it affects their bodies. Now a new study shows that the diversity of the condition might mean that bone imaging with cone beam computed tomography (CBCT) might not be useful in diagnosing TMJ.
Bone Changes Aren’t Related to Symptoms
CBCT is basically like a series of x-rays that are taken from many different angles. These x-rays are then assembled by a computer into a 3D image of what the x-rays reveal. Because x-rays mostly show bones, this is what CBCT is best at, too.
For this study, researchers wanted to know what CBCT said about the relationship between joint bone changes and TMJ symptoms. They looked at 120 CBCT images, 60 from people reporting TMJ symptoms, and 60 from people without symptoms. Overall, 90% of people with TMJ symptoms and 86.7% of people without TMJ symptoms had bone changes in their temporomandibular joints. The difference was not statistically significant.
Researchers also looked at the frequency of specific changes to the joint, comparing those with symptoms vs. those without symptoms:
- Flattening: 73.3% vs. 75%
- Irregularity: 36.7% vs. 48.3%
- Sclerosis 20% vs. 8.3%
- Cyst: 3.3% vs. 3.3%
- Erosion: 13.3% vs. 21.7%
- Hypoplasia: 3.3% vs. 5%
- Ankylosis: 1.7% vs. 0%
- Osteophyte: 43.3% vs. 40%
- Decreased joint space: 3.3% vs. 3.3%
- Increased joint space: 5% vs. 5%
None of the differences were statistically significant. This lead researchers to conclude that bone changes were not related to TMJ symptoms, and, therefore, CBCT scans might not be necessary or useful in diagnosing TMJ.
This Doesn’t Mean Symptoms Aren’t Real
We understand that a lot of people with TMJ are sensitive to any kind of evidence they think might be used to say that their symptoms aren’t the result of a physical disorder. Many of our patients have gone through years of having their symptoms denied or downplayed by doctors or dentists. That isn’t what this study says.
Instead, this study is showing us that for most people the problem isn’t in their bones, at least not initially. People with TMJ might initially have normal bone structure in their jaw joints. However, symptoms of TMJ often manifest themselves elsewhere: muscles, nerves, and teeth, for example.
This is something we already knew, to some extent. We know that most TMJ symptoms, such as jaw pain and headaches, are related to tension and stress in the muscle, especially early in the disorder. This study reminds us that tools focused on the bones might not be useful in diagnosing TMJ.
A Detailed Clinical Exam will Detect Your TMJ
Researchers in this article reassert the importance of clinical exams for detecting TMJ. Feeling the tension in the muscle, detecting where the pain is and what causes it, watching the movements of the jaw joint and listening to its sounds all remain crucial to diagnosing the condition.
Detroit area TMJ dentist Dr. Jeffrey S. Haddad is well-trained and has extensive experience in the clinical diagnosis of TMJ. In addition, he has tools that help him gauge the effects of TMJ in the muscles and other soft tissues. The K-7 suite of diagnostic tools allows Dr. Haddad to measure the tension in your jaw muscles, precisely track the movements of your jaw, and listen to the function of your jaw joint so that he can identify aspects of your TMJ that won’t show up in CBCT or x-ray.
If your doctor is trying to tell you that your TMJ isn’t real because it doesn’t show up in x-rays or CBCT, we can help. We can diagnose your TMJ and get you proper treatment for the relief of your symptoms.
To learn how we can help, please call (248) 825-8277 today for an appointment at the Michigan Center for TMJ and Sleep Wellness in Troy, MI.