[MUSIC] The next part of our examination is a temporomandibular joint examination. Occasionally patients will come to dentist complaining of pain in and around and their jaw. After a tooth has been ruled out as a source of pain, often the next spot to look for that source of pain might be the temporomandibular joint complex and this could be associated with the jaw joint or the jaw muscles. For this examination we often will ask the patient go through a series of range of motion exercises with their jaw. We will measure their range of motion by placing a little ruler specially performed to see how wide the patient can open and in this patient's case, the patient is able to open a normal range of jaw motion, over fifty millimeters. We'll also ask the patient to be able to move their jaw left and right, where we'll line it up with the mid line of their front teeth to make sure that they're able to go in a right and a left pattern. During the range of motion examination, we'll ask the patient, if they have any discomfort in doing so, as that may signify that there is some pain in the temporomandibular joint complex, specifically in the joint itself. After we've performed the range of motion exercise, we'll actually listen or gently hold our fingers over the patient's jaw and we'll ask the patient to open and close. At this point, we will notice if there's any click in the patient's jaw, or any popping or, in fact, if there's any crepitus in the jaw. This will suggest that the patient has either a discal problem, a temporomandibular disc problem, or in fact, they have an arthritide in their temporomandibular joint. Traditionally, we were using a stethoscope to listen to the jaw and in many cases, we would hear that the patient's skin moving across the stethoscope and it would be actually too sensitive to be able to report if there were sounds in the jaw joint. However light touch we'll be able to discriminate if in fact there's a click and or pop in the jaw joint itself. Next is we want to actually palpate the patient's temporomandibular joint. Now what I'd like to do is show you exactly where we place our finger. It is immediately in front of the tragus of the ear, and we'll ask the patient to open and close, at which time we're pressing over the lateral pole of the temporomandibular joint, and we'll ask the patient, is that associated with any discomfort or any pain? >> No. >> Next we'll place our pinky, our little finger, our fifth digit, in the patient's ear pressing interiorly as we place a finger in the ear, and once again ask the patient to open and close. Once again we'll be able to palpitate if there is any click, but we will also be able to ask the patient was that associated with any discomfort? >> No. >> If those areas are associated with discomfort it often suggests that there is a problem within the jaw joint itself. Once again, when we're palpitating the jaw joint, either in the pretragal area or inside the ear area, we'll ask the patient to not only to open and close wide, we'll ask the patient to maneuver their jaw In a protrusive position, a forward position, as well as to move left and right and we'll notice if they have any discomfort. Finally in a temporomandibular examination, we also want to get a sense of the patient's musculature and we want to know If in fact the patients muscles are contributing to the pain. In many temporomandibular disorders a patient will have muscular pain. Firstly they may complain of a headache a temporal headache. So we will palpitate both the interior and posterior temporalis muscles as I am doing right now. We'll also palpate the masseter origin, which is just inferior to the patient's cheekbone, or zygomatic arch. As well as the body of the masseter muscle, which continues down from the cheekbone to the lower jaw. We will also palpate the patient's neck muscles, both the trapezius muscle and the sternal colloidal mastoid muscle. And we'll ask the patient if these are associated with any pain. Finally, we'll press on the patient's occipital area and once again in the trapezius muscle, as these muscles tend to be associated with patients that have a muscular temporal mandibular problem. For the remainder of this examination, we're able to palpate muscles from the oral cavity itself.
