The jaw, chewing muscles, and posture are interconnected. This article describes how we systematically examine the temporomandibular joints and chewing muscles before planning treatment – to ensure the underlying cause of symptoms is not overlooked.
Structured functional diagnostics of the temporomandibular and musculoskeletal system as the basis for treatment planning.
Continuous Diagnostics of the Temporomandibular and Musculoskeletal System (TMS/MSS)
Why Thorough Diagnostics Extend Beyond the Teeth
Before orthodontic treatment begins, one question must be clarified: Are the temporomandibular joints in a relaxed, healthy position — or does the bite force the lower jaw into an unfavorable position? If an unrecognized dysfunction of the temporomandibular joint (medical term: temporomandibular disorder, abbreviated TMD) is overlooked, it can jeopardize the success of the entire treatment. This publication describes how such a dysfunction is systematically identified — and why not only the teeth but the entire body plays a role.
The reason: The temporomandibular joint is closely connected to the neck and back muscles and body posture through muscle and fascial chains. A disorder in the jaw can extend to the neck, shoulders, and back — and vice versa. Pain often does not appear where the cause lies. Therefore, modern functional diagnostics examine the temporomandibular system (jaw joint and chewing muscles) together with the musculoskeletal system (posture and movement apparatus).
The First Step: Brief Screening
The process begins with a brief screening test that is useful for every patient before treatment — for adults as well as in orthodontics for children and adolescents. Six points are examined:
- asymmetric mouth opening,
- restricted mouth opening,
- abnormal (“traumatic”) bite,
- joint sounds or joint pain,
- pain when palpating the chewing muscles,
- a difference between the habitual bite and the relaxed jaw position (so-called cotton roll test).
If two or more of these points are abnormal, comprehensive functional diagnostics follow immediately.
Comprehensive Examination of the Temporomandibular Joint and Chewing Muscles
In the in-depth diagnostics, several areas are systematically assessed and documented on a standardized examination form:
Mobility of the Lower Jaw
The maximum mouth opening (the distance between the incisal edges), lateral movements, and protrusion of the lower jaw are measured. The movement pattern during opening is also important: Does the lower jaw deviate to the side and return (deviation), or does it remain deflected (deflection)? Such patterns provide clues about the position of the articular disc (meniscus).
Palpation of the Temporomandibular Joints
The joints are gently palpated both externally (in front of the ear) and through the ear canal. This allows for comparative assessment of joint sounds such as clicking or grinding, pressure pain, swelling, and mobility of the condyles on both sides. Palpation through the ear canal in particular permits very precise evaluation of the sensitive area behind the condyle.
Examination of the Muscles
The chewing, temporal, neck, and shoulder muscles are systematically palpated. Particular attention is given to so-called trigger points—small, tense muscle areas that can radiate pain to other regions. These are treated first, as they often significantly shape the clinical picture.
Bite in different positions
The tooth contacts in the habitual bite are compared with those in a more relaxed, physiological jaw position—determined using the simple cotton roll test. If there is a clear difference, this is an important clue: every treatment should be oriented to the relaxed joint position, not the forced habitual bite.
Looking at the whole body
Next, the postural and musculoskeletal system is examined. This includes assessing the rotation of the cervical and thoracic spine, differences in leg length, and special manual tests (e.g., the Prien hip abduction test). Facial symmetry is also evaluated, as a lack of support in the posterior teeth on one side can be reflected in a slight facial asymmetry.
The crucial test: Do these physical findings improve when the lower jaw is temporarily brought into a more relaxed position using cotton rolls? If so, this suggests that the bite is indeed contributing to complaints in the neck, back, or hip—a so-called “descending” chain. If there is no improvement, the cause likely lies elsewhere, and medical or orthopedic evaluation is advisable.
From diagnosis to treatment
Only when this complete picture is available can a meaningful decision be made about how to proceed. If the history and examination reveal indications of a treatable dysfunction, the precise, relaxed jaw position is first determined—we describe how this is achieved in the article on determining the therapeutic jaw position. On this basis, a gentle preliminary treatment with an occlusal splinttypically follows, and after successful follow-up treatment , the jaw position can be permanently stabilized.
The sequence is important: first understand, then treat. Orthodontic correction that begins without this diagnostic work runs the risk of cementing an unfavorable jaw position rather than resolving it.
What systematic diagnostics means for treatment
Thorough functional diagnostics are the foundation of every successful treatment for temporomandibular disorders. They combine detailed examination of the temporomandibular joint and chewing muscles with an assessment of posture and the musculoskeletal system—making visible what a purely dental examination would miss. This allows finding the right, individually tailored treatment path for each patient.
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