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Diagnosis of TMD and Orofacial Pain

Because of the complex anatomy of the head and neck orofacial pain presents the most difficult challenge in pain diagnosis.

Patients often present having years of pain, having seen numerous dentists and physicians and spending thousands of dollars months of time on treatment without success.

The most important factor in diagnosing Orofacial Pain is that the specialist has the knowledge and the time to spend with the patient.

The following should always be included in a facial pain examination:


Subjective history

Before examining the patient. It is important to factor in the following: age, gender, medical history, dental history, duration of pain, onset of pain, factors making the pain worse or better, pain intensity, limited opening, joint sounds, headache, neurological symptoms, change in bite,

sleep quality, work and recreational habits, history of stress, anxiety, or depression. The history alone will often direct the dentist to the correct diagnosis.



Some imaging is necessary with all Orofacial Pain patients. It can be simple screening imaging such as Panorex x-ray after this CT may also be ordered and in a minority of patients MRI.



The Orofacial Pain dentist has an extensive knowledge of the anatomy and physiology of the head and neck beyond most dentists. Painful structures will be identified with controlled pressure (palpation).

Your neck and posture will be evaluated and movement of your head and mouth measured to detect any abnormality.   Any joint sounds will also be evaluated. Load testing of the joints will also be performed to determine if an oral appliance would benefit you and how this should be designed.  There will examination of your teeth, any unusual lesions in the mouth, your occlusion (bite), and your airway (throat). 

In some patients, to further identify the source of the pain local anesthetic may be injected for precise diagnosis. 

Evaluation of your salivary glands and a neurological screening are also done.

They will test releasing the forces on the jaw joints to see if pain can be reduced and in some instances. To confirm the exact source of pain  the dentist may do local diagnostic anesthesia to see if they can reduce or eliminate pain.  

All of the above will direct the dentist to an accurate diagnosis. This examination should be painless. Elaborate testing or instrumentation is not needed .

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