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Table 1 Physical examination directed toward mandibular dysfunction

From: Orthognathic surgery and temporomandibular joint symptoms

Examination Observations
Inspection Facial asymmetry, swelling, and masseter and temporal muscle hypertrophy Opening pattern (corrected and uncorrected deviations, uncoordinated movements, limitations)
Assessment of range of mandibular movement Maximum opening with comfort, with pain, and with clinician assistance Maximum lateral and protrusive movements
Palpation examination Masticatory muscles Temporomandibular joints Neck muscles and accessory muscles of the jaw Parotid and submandibular areas Lymph nodes
Provocation tests Static pain test (mandibular resistance against pressure) Pain in the joints or muscles with tooth clenching Reproduction of symptoms with chewing (wax, sugarless gum)
Intraoral examination Signs of parafunction (cheek or lip biting, accentuated linea alba, scalloped tongue borders, occlusal wear, tooth mobility, generalized sensitivity to percussion, thermal testing, multiple fractures of enamel, restorations)
  1. From De Rossi S, Stern I, Sollecito TP. Disorders of the masticatory muscles. Dental clinics of North America 2013;57:449–64; and Data from references [4,6,111-115].