Can A Panorex Dental X-ray Detect TMJ Problems?

Yes and no.

TMJ problems such as slipped discs (clicking or popping noises) or complete disc dislocation (can’t open your mouth very far) doesn’t always show up on radiographs until the condition has been going on for a few weeks, months or even years.

Clicking, popping or locking of a jaw joint happens when the cartilage disc or cushion has been torn off the bone. The noise is the cartilage disc getting pushed around in the joint.

Knees and spinal discs can make noise and still be in place. The noises in other joints are typically caused by compression of air that is in the cartilage in other body joints. The TMJ is the only joint with a disc that is fibrocartilage, unlike the rest of the body. It shouldn’t and doesn’t click or pop in normal movements. Any consistent noises in your TMJ indicate significant, permanent damage.

When the disc is out of place, the bones in the TMJ may rub together. Over time this causes arthritis, changes in the joint position (that cause your bite to feel uneven). The muscles around the jaw and neck also tighten, as a protective reflex. The reflex adds more pressure to the damaged TMJ and accelerates the arthritic damage.

TMJ’s can have varying degrees of arthritic damage that may not be seen on standard dental panoramic radiographs. [1] Experienced TMJ specialists can detect TMJ problems on standard panoramic imaging however, cone beam imaging is considered “standard of care” for TMJ diagnosis and treatment, sometimes in conjunction with MRI (if surgery is being considered).

Clinical measurement of TMJ mobility, palpation of the joints both lateral and posterior can provide a high degree of accuracy for disc displacement but not arthritic changes or misalignment.

Virtually all non-traumatic TMJ pathology stems from an unequal growth of the upper and lower jaws, typically influenced to the negative by enlarged tonsils, adenoids, short lingual frenum, and the associated Myofunctional problems that develop because of all of these factors.

Medical doctors aren’t familiar with the subtle signs of altered growth, pre-clinical TMJ compression, etc., and rarely recommend screening by a TMJ specialist until obvious symptoms or signs are present.

If your jaw joints make noise, don’t move well or lock, or if you feel a shift in your bite, you likely have a TMJ problem developing. It may take time to become obvious, but the damage is progressive and never “fixes itself”.

Early intervention offers the best opportunity for a more stable rehabilitation.

[1] Diagnostic accuracy of panoramic radiography & MRI… AGD General Dentistry, July/Aug 2018. Kaimal, et al.

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