TMJ & Thermography

Temporomandibular joint syndrome (TMJ) is a common problem encountered in clinical practice. Signs and symptoms of TMJ syndrome can include pain on opening the mouth, trismus, joint clicking and noises, pain when chewing, headache, TMJ tenderness to palpation, auriculotemporal paresthesias, pain in the neck, pain/fullness sensation in the ear, and tinnitus. Pain may be unilateral or bilateral with palpable tenderness.

TMJ syndrome may occur as a result of the cervical acceleration/deceleration syndrome, as well as other structural problems such as posture, stress, with or without bruxism, malocclusion, leg-length discrepancy, and blunt trauma.

Diagnostic imaging of TMJ includes radiographs of the TMJ, open and closed mouth, as well as panorex views. MRI may be helpful to diagnose structural abnormalities such as torn temporomandibular ligaments or an anteriorly displaced disc.
A cost effective, noninvasive, risk free, imaging tool that may be utilized is thermography.

While x-ray and MRI can show structural/morphological aspects of the TMJ syndrome, thermography can show heat gradients and hot spots which may be the sign of physiological problems with reference to dysautonomia associated with TMJ, as well as, myofascial pain dysfunction (MPD) and trigger points.

Diagnosis through measuring the heat given off by tissues in the body may also have broader applications in medicine and dentistry. Dentists can use thermography to assess facial pain, TMJ conditions, implants, root canals, facial nerve injuries and other ailments. Suspected pathology of teeth or gums, which may not be identified clinically or radiographically, can possibly be shown as heat variances through DITI, warranting further investigation with other diagnostic tools.

In a paper published in the Clinical Journal of Pain in 1987, a TMJ protocol was described for thermographic imaging of the facial area in patients with TMJ syndrome. In their study of 30 patients with TMJ symptoms, they found a 95 percent correlation between anatomical distribution of symptoms and thermographic findings.

In a study published by Pamela Steed, D.D.S., and published in the Journal of Craniomandibular Practice, she found thermography to be useful in the diagnosis and management of TMJ syndrome. She found a 94.5 percent sensitivity using thermography for TMJ syndrome, which correlates well with the Weinstein Study. After treatment, thermography was able to assess the successful outcome of treatment in 80 percent of the cases. She was also able to find a pattern that could differentiate acute vs. chronic TMJ dysfunction.

Conclusion
Thermography may be a useful diagnostic imaging tool available to the treating doctor to differentially diagnose this multifaceted complex syndrome from other conditions with similar symptoms. The TMJ syndrome has a distinct thermal pattern. Thermography is also useful to help follow the patient's response to treatment.