Temporomandibular joint (TMJ) dysfunction, also known as TMJ disorders, refers to a cluster of problems associated with the temporomandibular joint and associated musculoskeletal structures. The etiology of TMJ disorders remains unclear and is believed to be multifactorial. TMJ disorders are often divided into two main categories: articular disorders (e.g., ankylosis, congenital or developmental disorders, disc derangement disorders, fractures, inflammatory disorders, osteoarthritis and joint dislocation) and masticatory muscle disorders (e.g., myofascial pain, myofibrotic contracture, myospasm, and neoplasia).
Symptoms attributed to TMJ dysfunction are varied. They may include clicking sounds in the jaw; headaches; closing or locking of the jaw due to muscle spasms (trismus) or displaced disc; pain in the ears, neck, arms, and spine; tinnitus; and bruxism (clenching or grinding of the teeth).
There are no generally accepted criteria for diagnosing TMJ disorders and it is often a process of exclusion. Diagnosis involves comprehensive clinical examination, a thorough medical history, and dental record review. Diagnostic testing is generally only recommended for individuals with severe and/or chronic symptoms.
The following diagnostic procedures in the diagnosis of TMJ dysfunction are considered medically necessary:
Diagnostic x-ray, including panoramic films
Cephalograms (x-rays of jaws and skull)
Pantograms (x-rays of maxilla and mandible)
Computed tomography (CT) scan for pre-surgical evaluation
Magnetic resonance imaging (MRI) for pre-surgical evaluation
The following diagnostic procedures in the diagnosis of TMJ dysfunction are considered investigational:
Electromyography (EMG), including surface EMG
Neuromuscular junction testing
Transcranial or lateral skull x-rays
Intra-oral tracing or gnathic arch tracing (intended to demonstrate deviations in the positioning of the jaws that are associated with TMJ dysfunction)
Standard dental radiographic procedures
Range of motion measurements
Computerized mandibular scan (this measures and records muscle activity related to movement and positioning of the mandible and is intended to detect deviations in occlusion and muscle spasms related to TMJ dysfunction)
Joint vibration analysis
Isotope bone scans
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We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits, or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
There is insufficient evidence to support the diagnostic procedures listed in the investigational policy statement to diagnosis TMJ dysfunction. Evidence is not available to show that these diagnostic procedures separate individuals with TMJ dysfunction from individuals without TMJ dysfunction.
American Association for Dental Research (AADR). (2007; Revised 2016). Policy statement: Temporomandibular joint disorders (TMD). Retrieved April 27, 2016 from http://www.aadronline.org.
American College of Radiology. (2013). ACR appropriateness criteria® headache. Retrieved April 27, 2016 from the National Guideline Clearinghouse (NGC: 010158).
American Dental Association® (Adopted 1996, reaffirmed 2015). Temporomandibular (craniomandibular) disorders. Retrieved February 17, 2017 from http://www.ada.org/en/science-research/dental-practice-parameters.
BlueCross BlueShield Association. Evidence Positioning System. (2:2018). Temporomandibular joint dysfunction (2.01.21). Retrieved November 5, 2018 from http://www.evidencepositioningsystem.com. (32 articles and/or guidelines reviewed)
Chaput, E., Gross, A., Stewart, R., Nadeau, G., and Goldsmith, C. (2012) The diagnostic validity of clinical tests in temporomandibular internal derangement: a systematic review and meta-analysis. Physiotherapy Canada, 64 (2), 116-134. (Level 2 evidence)
Dong, X., He, S., Zhu, L., Dong, T., Pan, S., Tang, L., & Zhu, Z. (2015). The diagnostic value of high-resolution ultrasonography for the detection of anterior disc displacement of the temporomandibular joint: a meta-analysis employing the HSROC statistical model. International Journal of Oral and Maxillofacial Surgery, 44 (7), 852-858. Abstract retrieved April 27, 2016 from PubMed database.
National Institute of Health, U.S. Department of Health and Human Services. (2015) National Institute of Dental and Craniofacial Research: T M J Disorders. Retrieved February 17, 2017 from www.nidcr.hih.gov.
Schiffman, E., & Ohrback, R. (2016). Executive summary of the diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications. Journal of the American Dental Association, 147 (6), 438-445. (Level 2 evidence)
Sharma, S., Crow, H., McCall, W. D. Jr. & Gonzalez, Y. M. (2013). Systematic review of reliability and diagnostic validity of joint vibration analysis for diagnosis of temporomandibular disorders. Journal of Orofacial Pain, 27 (1), 51-60. (Level 1 evidence)
Sinha, V. P., Pradhan, H., Gupta, H., Mohammad, A., Singh, R. K., Mehrotra, D., et al. (2012). Efficacy of plain radiographs, CT scan, MRI and ultra-sonography in temporomandibular joint disorders. National Journal of Maxillofacial Surgery, 3 (1), 2-9. (Level 4 evidence)
ORIGINAL EFFECTIVE DATE: 1/11/2014
MOST RECENT REVIEW DATE: 1/10/2019
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