The Prescription of Diagnostic Images for Temporomandibular Joint Disorders

The selection of the appropriate imaging modality for the diagnosis of various disorders of the temporomandibular joint (TMJ) can be difficult, due in part to recent development of imaging modalities. Practitioners responsible for the diagnosis and treatment of temporomandibular disorders may not be fully aware of the strengths and weakness of each modality; nor does the profession have the benefit of years of experience in the application of these new modalities. For those practitioners who are not intimately involved with diagnostic imaging of the TMJ, an available set of guidelines concerning the application of diagnostic imaging to disorders of the TMJ would be useful. In the absence of clear research and long-term experience with new imaging modalities the production of a set of guidelines is challenging and may ultimately be based on the various experiences of the authors. Also, there is a danger inherent in the formulation of guidelines. Guidelines may promote a cookbook-like approach, which lacks the judgment necessary for the prescription of imaging based on the merits of each specific case. The application of imaging to an individual patient should be based on the information provided by the clinical features and, in some cases, may be based on something as ethereal as a hunch. In this respect, diagnosis may be more an art than a science. However the production of guidelines is a beginning point and can be helpful as long as these guidelines are never viewed as being infallible but, rather, are open to challenges. Changes should occur with further advances in knowledge, experience, and technology. To date, the most comprehensive document, which does not purport to be a set of guidelines but instead is a position paper, has been produced by the American Academy of Oral and Maxillofacial Radiology.' This document provides excellent information about the application of diagnostic imaging to various diseases and abnormalities of the TMJs. There are many factors that should be considered in attempting to create a set of guidelines. The cost of each imaging modality and thus the total financial burden upon society and upon the individual patient should be considered. Is there a less expensive method that can provide the necessary information? The radiation dose may be a consideration, especially in situations where diagnostic imaging is being employed as a screening tool. Research findings indicating the sensitivity and specificity of a particular imaging modality should also be considered. However, these studies often fail to consider the practical overriding parameters, which include the quality of the images and the experience and knowledge of those who analyze the images. The guidelines must have a clear, clinical application. Lastly, the guidelines must be continually tested and challenged by considering the accuracy of differing imaging modalities and whether the findings were useful in both the development of treatment plans and in treatment outcomes.

temporomandibular joint imaging; modalities; selection criteria; guidelines