Examination methods

Basis

In order to tread the person concerned with consideration - as valid to all medical science – there should not be a full diagnosis at the beginning, but rather a step by step escalating examination procedure. Furthermore, the principle of all examinations validates that the diagnosis also should lead to therapy and is not executed as a means of itself.
(www.dzz.de/beitragpdf/pdf_1309.pdf).

The examinations should also adhere sensibly, practically and performable to the principle. Provision of the diagnosis of CMD – as advised in all medical science – is an extensive medical consultation with thorough anamnesis. There should be a standardised questionnaire or – schemata as well as a psychological pain questionnaire on regular basis for early detection of psychosocial impairment.

The basis is a “normal” dental examination with identification and inspection of teeth, their fillings, crowns and dentures. Included is the search for decay, a vitality check (mostly known as “cold test”) and PSI (Parodontitis Screening Index) test to identify parodontitis.
A mandatory part is also a x-ray of the whole jaw region (panoramic radiograph) in order to exclude dental and/or a dental operative cause of disease (e. g. displaced teeth, chronic infections of teeth roots, hidden decay or bone deterioration caused by parodontitis).

Panoramic radiograph with displaced tooth (tooth 48 = right wisdom tooth) -red arrow-
of chronic apicale parodontitis of teeth 46 and 47 -green arrows-
and also an indication of differences in jaw joints -blue arrows-

If the suspicion substantiates, then further dental examinations are necessary: Instrumental model analyses with occlusion and myocentric bite analyses and articulator programming. The articulator consists of a chewing and jaw movement simulator and allows the specialist to detect which factors disturb the bite. If applicable, a MRT (magnet resonant tomopraph) of the jaw joints will show evidence. Other specializations should be consulted in case of complex disease patterns e.g. exclusion of neoplasm – most likely the concerned person has been to possible specialists and are detached from differential diagnosises.

Summary
The specialized dental examination is completed according to “triple A” scheme (acc. to the German terms):

- Listening and questioning
- Scanning by fingertips and touching
- Measuring and calculating

References for standard examination for further interest:

MFA or rather MSA according to Bumann (www.p-s-t.net/de/3/manuellestrukturanalyse.html)

Advantage: Clearly structured result, main emphasis on joint result.
Disadvantage: Musculare result could be more extensive.

CMD-test according to Ahlers (www.prodente.de/test-und-checklisten/cmd-test.html)
Formblätter: www.dentaconcept.de/Formblaetter/Basis-Set.shtml

Advantage: Clearly structured result, extensive transfer questionaire for consulting specialists.
Disadvantage: Muscular result could be more extensive.

RDC-Test (ubwp.buffalo.edu/rdc-tmdinternational/wp-content/uploads/sites/58/2017/01/RDC-German.pdf)

Advantage: The applied strength of examining fingers is too weak in order to get a reaction of most CMD patients. (CMD-patients often do not recognize slight pain signals during examination, because they have experienced pain for years); Muscular results fall short.

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Model analysis:

Conclusions can be made from atypical chewing areas and other surfaces of the teeth for possible dysfunctions. However, minimum prerequisite is the arbitrary practiced articulation of the model (meaning: using a so called orthodontic headgear, the model is approaching the jaw joint axle to be set in articulation).

Advantage: Easy performance
Disadvantage: The position of the jaw is only recorded in its habitual biting position.

Recording of the joint course:

The movement of the jaw and its joints is recorded while using appropriate electronical aids.

Advantage: Reproduceable to the greatest possible extend, the designated joint axle is at most times readjustable, positive diagnostical information, very suitable for documentation
Disadvantage: Very elaborate, does not indicate any reference directly to the therapy or respectively to the therapeutic situation of the bite. Does not determine the correct dental occlusion.

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Identification of dental occlusion:

Manual
This is the best reproduced dental occlusion, since it pushes the lower jaw joint (e. g. Dawson grab) to the upper bone margin of the joint cavern (dorso-cranial position). However, this is not a physiological position (these joint surfaces are most often the infected joint parts caused by overstressing) but is determined through treatment.

Advantage: Reproduceable.
Disadvantage: Results in a pathological vertical position of the jaws to each other.

Habitual
Reflects the present – often pathological – position of the jaws to each other and is in most cases reproduceable.

Advantage: Easy to determine, mostly reproduceable.
Disadvantage: Reflects the present pathological position of the jaws to each other.

(www.ncbi.nlm.nih.gov/pubmed/10632846?dopt=Citation)

Myofunctional
The desired jaw relation is represented with elaborate examination technology and can compare the IS-Position due to the position of teeth.

Advantage: Properly reproduceable, the ascertained difference of dental occlusion and muscle manipulated desired position of the jaws is balanced and CMD can be treated successfully.
Disadvantage: Elaborate.

Possible examination methods:
Pen brace
www.ipr-original.de
www.ncbi.nlm.nih.gov/pubmed/11757325?dopt=Citation
www.ncbi.nlm.nih.gov/pubmed/19089144...