BASIC ASSESSMENT TESTS AND THEIR CLINICAL SIGNIFICANCE - FOR DENTISTS

Test: Active Range of Motion

Measured by:

Vernier Calipers (0.0mm)

Normal:

45-55mm opening, 10-12mm lateral excursion

Significant Error:

<35mm indicates significant dysfunction

Deviation/deflections from midline indicate internal derangement

Reciprocal clicking: can measure point in open and closing range clicking occurs

>55mm indicates hypermobility

Influenced by:

Pain, muscle spasm/tightness, capsule/ligament length, disc position

 

Test: Differentiation of movement: Tongue vs Jaw Muscles

Measurement:

Place tongue on roof of mouth and independently open and close jaw and/or move jaw side to side without letting the tongue move from the top of the mouth

Normal:

Ability open and close or move jaw side to side without involving/moving the tongue from the roof of the mouth

Significant Error:

Tongue continually drops off the roof of the mouth during opening,

Tongue actively moves in the same lateral direction the jaw is moving in,

Jaw moves in the opposite direction as instructed by the physiotherapist,

Over-active facial muscles or neck/infrahyoid muscles

Indicates:

Tongue thrusting parafunction, overactive masseters (clenching behaviour)

Inability to activate the appropriate stability muscles, particularly pterygoids

 

Test: Differentiation of movement: Neck vs jaw function

Measurement:

Assess range and strength of depression and lateral deviation of jaw with head supported in supine, then repeat jaw movements with head unsupported, eg lying supine with head over edge of bed

Normal:

No change in strength, range or joint sounds in different positions

Significant Error:

Decreased range of motion or increased joint sounds, pain or difficulty in unsupported position

Indicates/Influenced By:

Weakness in upper cervical spine causing compensatory parafuncton in jaw to support weight of head. It is often associated with a head forward posture. 

 

Test: Capsule length test (Long Axis Distraction)

Measurement:

End Feel Resistance in physiological and accessory planes of jaw movement determined by manually stretching the jaw joint with therapist controlling directional force.

Normal:

Soft, elastic, pain free end feel

Significant Error:

Painful or hard end feel

Can be associated with loss of translation and clicking on ipsilateral side

Indicates/Influenced By:

Ligament injury or shortening, muscular spasm

Loss of vertical joint space causing compression force on in resting position, usually associated with joint derangement e.g. anterior displacement of disc

 

Test: Capsule length test (Lateral deviation)

Measurement:

End Feel Resistance in physiological and accessory planes of jaw movement determined by manually stretching the jaw joint with therapist controlling directional force.

Normal:

Soft, elastic, pain free endfeel

Significant Error:

Painful or hard endfeel

pain in contralateral jaw

Indicates/Influenced By:

Ligament injury or shortening, muscular spasm

Pain in contralateral jaw indicates contralateral medially displaced disc

Loss of congruency of lateral fibres of capsule and disc clicking

Tongue stroking

 

Test: Palpation of Muscles

Measurement:

Patients’ response to gentle and/or firm digital pressure, tone in muscles

Normal:

Pain free

Significant Error:

“Knots” or pain in muscle, 

Referred pain from palpation into teeth, ear, temple face etc

Increased pain when pressure combined with active movement

Indicates/Influenced By:

Overactive/compensatory function in tender muscle group(s)

Inflammatory pain from overuse

Combination of pain in masseters with loss of tongue function and weakness in pteryoid function strong indicator for clenching/grinding habitual behaviour

        

Test: Palpation of Joint

Measurement:

Patients’ response to gentle and/or firm digital pressure in capsule

Feel for loss of natural Temporomandibular rhythm e.g. decreased translation

Point in range deviation/deflection occurs

Clicking/joint sounds

Normal:

Pain free, even condylar movement left and right

Significant Error:

Exquisite pain in posterior joint line

reduced/uneven translation

Indicates/Influenced By:

Uneven translation and clicking indicates internal derangement

Exquisite pain in posterior joint line not responding to treatment indicates occlusal/splint review is necessary