Joint crepitus:A grinding sound indicating structural issues within the joint.
[!example] Differential Diagnosis
==Muscle Pain: If symptoms appear muscular, they may be managed through standard clinical protocols first.==
==Degenerative Changes: Often described as “wear and tear” (similar to dental attrition). These changes do not always correlate directly with the severity of symptoms; a patient may have radiographic degeneration without significant pain or limitation.==
==Internal Derangement: This occurs when the disc is displaced out of the joint. This is often associated with degenerative changes and requires further investigation.==
Radiographic Evaluation[^13]
Describe the appearance and condition of the TMJs.
asymmetric condyles
Sclerotic bone towards articular surface of the left condyle
shows mostly signs of degenerative changes
Observed Degenerative Morphologies
==Flattening: Loss of convexity in the articular surface.==
==Osteophytic Changes: Often appears as “peaking” or Anterior Osteophytic Lipping (prominent bone growth on the anterior aspect of the condyle).==
==Subchondral Sclerosis: Increased bone density (opacity) close to the articular surface.==
==General Opacity: Increased radiopacity anterior to the condyle.==
Utility of the Orthopantomogram (OPG) in TMJ study
==Indications: Frequently used to assess TMJs, though it has limitations. It is justified primarily in trauma cases to rule out fractures.==
==Limitations: An OPG cannot visualize the disc or internal derangement. It primarily shows bony changes.==
Incidental Findings (Carotid Artery)
==Carotid Atheromatous Calcification: May be seen on OPGs, typically in elderly or middle-aged male patients.==
==Management: Correlate with medical history (e.g., high cholesterol, use of statins). If the patient is unaware, refer them to a GP for a cardiovascular workup or ultrasound/Doppler study.==
Advanced Imaging
Would you consider further imaging? Yes, specifically if symptoms persist or crepitus is present.
Specify which modality should be used and provide the clinical reasoning.
==MRI (Magnetic Resonance Imaging): This is the Gold Standard and the definitive imaging modality for all TMJ diseases and internal derangements.==
==Clinical Reasoning: Unlike OPG, MRI allows for the visualization of soft tissues, specifically the position and condition of the articular disc.==
Specialist Referral
==It is recommended to refer patients to Oral Medicine Specialists for diagnosis.==
==Benefits of Referral: Specialists can provide a definitive diagnosis and refer for MRIs under Medicare benefits, significantly reducing the cost for the patient.==
