Form 29 - Occlusion_TMJ Examination

Occlusion and Temporomandibular Joint Examination Form

Anamnestic Dysfunction Index (Helkimo 1974)¹

• A, O – denotes complete absence of subjective symptoms of dysfunction of the masticatory system
• A, I – denotes mild symptoms such as temporomandibular joint sounds (clicking, crepitation), feeling of stiffness or fatigue of the jaws
• A, II – denotes severe symptom of dysfunction. One or more of the following symptoms reported: difficulty opening the mouth wide, locking, luxations, pain on movement, facial and jaw pain

Date

Clinical Dysfunction Index – Based on evaluation of five common symptoms

A. Impaired range of movement/mobility index

• Normal range of movement – 0
• Slightly impaired mobility – 1
• Severely impaired mobility – 5

B. Impaired TM joint function

• Smooth movement without TM joint sounds and deviation on opening/closing movements < 2 mm – 0
• TM joint sounds in one or both joints and/or deviation ≥ 2 mm on opening/closing movements – 1
• Locking and/or luxation of the TM joint – 5

Masticatory System Function and Dysfunction Survey

Anamnestic Dysfunction Index

C. Muscle pain

• No tenderness to palpation in masticatory muscles – 0
• Tenderness to palpation in 1–3 palpation sites – 1
• Tenderness to palpation in 4 or more palpation sites – 5

D. Temporomandibular joint pain

• No tenderness to palpation – 0
• Tenderness to palpation laterally – 1
• Tenderness to palpation posteriorly – 5

E. Pain on movement of the mandible

• No pain on movement – 0
• Pain on 1 movement – 1
• Pain on 2 or more movements – 5

F. Sum A + B + C + D + E = dysfunction score (0–25 points)

G. Clinical dysfunction index, Code:

• 0 points – clinically symptom free – D, O
• 1–4 points – mild dysfunction – D, I
• 5–9 points – moderate dysfunction – D, II
• 10–25 points – severe dysfunction – D, III

Present occlusal scheme: ______

Clinical Examination of Occlusion and Mandibular Movement

Mandibular Range of Motion and Deviation

1. Max. opening in mm __________
2. Max. opening at active stretch __________
3. Deviation on opening
4. Movement to Right / Left / Protrusion
5. Slide from RCP to ICP
   • Anterior component __________ mm
   • Vertical component __________ mm
   • Horizontal component ______ mm R or L

Occlusal Analysis and Terminal Hinge Position

Terminal Hinge Axis Initial Contact

18	17	16	15	14	13	12	11	21	22	23	24	25	26	27	28
48	47	46	45	44	43	42	41	31	32	33	34	35	36	37	38

Intercuspal Position Contacts

18	17	16	15	14	13	12	11	21	22	23	24	25	26	27	28
48	47	46	45	44	43	42	41	31	32	33	34	35	36	37	38

Laterotrusive Contacts

18	17	16	15	14	13	12	11	21	22	23	24	25	26	27	28
48	47	46	45	44	43	42	41	31	32	33	34	35	36	37	38

Mediotrusive Interferences

18	17	16	15	14	13	12	11	21	22	23	24	25	26	27	28
48	47	46	45	44	43	42	41	31	32	33	34	35	36	37	38

Protrusive Contacts

18	17	16	15	14	13	12	11	21	22	23	24	25	26	27	28
48	47	46	45	44	43	42	41	31	32	33	34	35	36	37	38

Bruxofacets

18	17	16	15	14	13	12	11	21	22	23	24	25	26	27	28
48	47	46	45	44	43	42	41	31	32	33	34	35	36	37	38

Fremitus at Intercuspal Position

18	17	16	15	14	13	12	11	21	22	23	24	25	26	27	28
48	47	46	45	44	43	42	41	31	32	33	34	35	36	37	38

Fremitus in Lateral Excursions

18	17	16	15	14	13	12	11	21	22	23	24	25	26	27	28
48	47	46	45	44	43	42	41	31	32	33	34	35	36	37	38

In the final assessment as to whether or not the patient has a problem related to occlusion, consider the following questions:

1. Can the patient breathe properly? ________________________________________________________
2. Can the patient chew adequately? ________________________________________________________
3. Is the patient aesthetically satisfied? ________________________________________________________
4. Is the phonetic pattern acceptable? ________________________________________________________
5. Is the patient in periodontal health? ________________________________________________________
6. Is the patient free of TMJ signs and symptoms? ________________________________________________________
7. Is there an absence of retrograde patterns and wear? ________________________________________________________
8. Is there a negative occlusal sense? ________________________________________________________

Clinician Signature:	Clinician ID:	Date:
Supervisor Signature: (If student clinician)	Supervisor ID:

Footnotes

1. Original PDF page 1: Form 29 - Occlusion TMJ Examination, p.1 ↩