BlueCross BlueShield of Tennessee Medical Policy Manual

Temporomandibular Joint (TMJ) Dysfunction: Diagnostic Studies


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.




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

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

BlueCross BlueShield Association. Evidence Positioning System. (2:2018). Temporomandibular joint dysfunction (2.01.21). Retrieved November 5, 2018 from (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

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)




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