When it comes to TMJ disorder, there really is no contest here. The Xray AND the MRI are critical to a really good diagnosis. First of all, when the jaw joints pop or click upon opening and closing, it is likely that the articular discs are out of place. The discs are made of soft tissue, basically like cartilage, so only an MRI would tell you if they are in the proper position or out of place. Over the years I have learned that the MRI is quite difficult to get done properly unless the MRI center has a lot of experience at doing this. I only allow our patients to go to Novant imaging for that reason. They have a dedicated Tesla coil for this imaging and know what I expect. In addition, I only have my colleague, Dr. Nick Patronas, do the reading. I really do not allow any other radiologist to look at the MRIs because I have found that Dr. Patronas does the best, most concise reading that I have ever seen. And this is what allows me to know the status of the discs in the joints. This is the view of the ‘soft’ tissue.
The view of the ‘hard’ tissue, i.e. the bone, is done through the xray. Xrays are designed to view hard tissue and will not allow you to see the disc tissue. The distinction is quite important. Xrays are indeed radiation so you want to limit how much you allow in exposure to the patient. The MRI, however, is magnetism so really no worries there. When it comes to xrays, you want to be sure you get a lot of bang for your buck here- i.e. minimal radiation exposure but maximal information gain. For this reason, I am luck to have the VA Tech i3D machine. It basically does 3-D imaging of the head/neck region so I can view not only the jaw bones (the condyles) but I can also see the cranial bones and the cervical spine. This is a lot of information that helps in the diagnosis and treatment for our patients.
So as you can see, dear readers, the twain are indeed not at battle with each other, yet they must coexist together on the same plane (wow, that was rather eloquent if I must say!). With both the xray and the MRI, we are able to view both the hard and the soft tissues in the jaw joints and the skull. With this knowledge comes a better understanding of what is happening in the TM joints and then we can better formulate a plan to help you. I often have people ask why they cannot just do an MRI, or just an xray, and this is because the two work together – i.e. no battle!