The Validity of Clinical Findings for Diagnosing Temporomandibular Disorders in Patients from Different Age and Gender Groups
Purpose : This study was to clarify the diagnostic accuracy of clinical findings for internal derangement of the temporomandibular joint(TMJ)compared with that of magnetic resonance imaging. Patients and methods : A series of 4559 patients(879 male and 3680 female, mean age 32.7 years ; range 8-85 years ;)with temporomandibular disorders were clinically examined by un unspecified number of dentists. All patients underwent magnetic resonance imaging(MRI) . The clinical findings that characterize
... disc displacement, anterior disc displacement with reduction(ADDwR)and anterior disc displacement without reduction(ADDwoR)are pain, clicking sound and limitation of maximum mouth opening. These clinical findings were compared to the MRI interpretation, which was used as the gold standard for diagnosis of temporomandibular disorders to define the diagnostic accuracy, specificity, sensitivity, positive predictive value and negative predictive value of clinical findings. Results : The prevalence of clinical finding was 3990 joints (43%) with pain, 2775 joints(30%)with clicking sound and 1731 patients(38%)with limitation of opening. Three thousands forty seven joints were diagnosed as having a normal disc position, 510 joints with sideways disc displacement, 2312 joints with ADDwR, 3239 joints with ADDwoR on MR image. The sensitivity of clinical findings was considerably low : sensitivity was 0.48 for pain versus internal derangement, 0.51 for clicking sound versus ADDwR, 0.62 for limitation of opening versus ADDwoR. The sensitivity was higher in the younger group for clicking sound versus ADDwR, but sensitivity was higher in the older group for limitation of opening versus ADDwoR. The diagnostic accuracy based on clinical findings of internal derangement of TMJ was found to be correlated with age. Conclusion : This study has been that the overall diagnostic accuracy of the clinical findings to determine the status of the joint is about 50 -60%. The status of the joint could not be accurately determined by clinical findings. MR image should be performed when an accurate differential diagnosis is needed to determine the treatment methods.