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Examination

The physical examtnation consists of an evaluation of the entire masticatory system. The head and neck should be  inspected for soft tissue asymmetry or evidence of rnus- .cular hypertrophy. The- patient should be observed for signs of jaw clenching or other habits. The masticatorymuscles should be systematically examined. The muscles should be palpated for the presence of tenderness, fascicuiations, spasm, or trigger points (Fig. 30-1).
The TMJs are examined for tenderness  and noise (Fig. 30-2). The location of the joint tenderness (e.g., lateral: posterior) should be noted. If the joint is more painful during different areas of the opening cycle or with different
types of functions, this should be recorced. The most common forms of [oint noise are clicking (a distinct . sound) and crepitus (i.e., multiple scraping or grating sounds). Many joint sounds can be easily heard without
special instrumenta ion or can be felt during palpation of the [oint. However in some cases auscultation with a stethoscope may allow less obvious joint sounds, such as mild crepitus, to be appreciated. . The mandibular range of motion should be determined. Normal range of movement of-an adult’s mandible is about 45 mm vertically (l.e., interincisally) and 10 mm  protrusively and laterally (Fig. 30-3). The normal movement i straightand symmetric. In some cases tenderness in the joint or muscle areas may prevent opening. The clinicianshould attempt to ascertain not only the painless . voluntary opening but also the .maximum .opentng that can be achieved with gentle’ digital pressure. In some cases the patient may appear to have a mechanical obstruction in the joint causing limited opening but with gentle pressure may actually be able to achieve near nor -rnal opening. This may suggest muscular rather than intracapsular problems.
The dental evaluation is also important. Odontogenic sources of pain should be eliminated. The teeth should be examined for wear facets, soreness, and mobility, which may be evidence of bruxism. Although the significance of
occlusal abnormalities is controversial, the ‘occlusal relationship should”be evaluated and documented. Missing’ teeth should be noted, and dental and skeletal classification  should be determined. The clinician should note any
centric relation and centric occlusion discrepancy or significant
posturing by the patient. The examination findings can be summarized on a TMD evaluation form and included in the patient’s chart. In many cases a more detailed chart note may be necessary to adequately document
all of the history and examination findings described previously

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