Clinical Assessment, Diagnosis, and Imaging
What you must know
Structure the evaluation: chief complaint, pain history (onset, location, quality, intensity, duration, triggers, relieving factors), medical and psychosocial history, and a focused examination. Examination includes palpation of muscles and joints, range-of-motion measurement, joint loading, and neurologic screening (cranial nerves, sensory testing, reflexes). Use validated tools such as a numeric rating scale and Axis II screeners.
Imaging
Choose imaging by question: panoramic radiograph for gross bony and dental pathology; CBCT for bony detail and impacted teeth; MRI for disc position, soft tissue, and suspected pathology; CT for acute trauma. Imaging does not diagnose pain - it informs a clinical diagnosis. Incidental findings are common and should not automatically become the diagnosis.
Traps
Do not order imaging before a clinical examination and a clear clinical question. Do not diagnose TMD from a panoramic radiograph alone. Do not confuse a finding (e.g., disc displacement, degenerative change) with a pain diagnosis - many asymptomatic people have these findings. Neurologic red flags (sensory loss, weakness, cranial nerve deficits) require escalation.
Worked example
A patient has unilateral jaw pain and clicking. The clinical examination localizes pain to the joint with loading and a click on opening. MRI is only indicated if the diagnosis remains uncertain or surgery is considered; routine imaging is not required for a straightforward clinical diagnosis.
Rule of thumb
Ask the clinical question first, then pick the modality: bone → CBCT/CT; soft tissue/disc → MRI; broad survey → panoramic.