A review of temporomandibular disorder diagnostic techniques,☆☆,,★★,

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Abstract

The American Dental Association has approved several devices as aids in the diagnosis of temporomandibular disorders. Concerns remain, however, about their safety and effectiveness. This article reviews the validity and use of several instruments that claim to serve as aids in the detection of masticatory muscle pain, trismus, joint noises, and limitation of jaw motion. A review of data from 62 published articles indicated that, although commercial devices that measure jaw muscle tenderness, muscle activity levels, joint noises, and jaw motion are safe and can document these phenomena, cost-benefit analyses of these devices have not yet been conducted. Moreover, these devices have not been shown to have stand-alone diagnostic value and, when tested, they have demonstrated unacceptable sensitivity and specificity levels. None of the instruments reviewed in this article can be said to provide more than ancillary documentation. (J Prosthet Dent 2001;86:184-94.)

Section snippets

Pressure algometry and muscle tenderness

Pressure algometric devices have been used in several studies to measure the threshold of first reported pain with an increasing level of pressure. This point is called the pressure-pain threshold (PPT). The difficulty with this method is that the pain threshold varies greatly depending the rate of pressure being applied, and this rate is difficult to control accurately. Two commercial devices—a hand-held, spring-based pressure algometer and an electronic pressure algometer—may help eliminate

Surface EMG to detect muscle pain

Jankelson19 has argued that there is reasonable and sufficient scientific rationale for the use of surface EMG to measure postural activity in dental patients. The unstated assumption of his argument was that elevated postural activity is an analog of muscle pain and therefore is of substantial diagnostic value. Jensen et al20 reported that the reproducibility of repeat measurement of surface EMG yields a coefficient of intraindividual variation within the same examination near 14%. If there

Detection of joint noises with joint sound-vibration devices

One of the characteristic features of many patients with temporomandibular disorders is joint sound. A widely used method for joint sound detection is the clinical examination of the joint with light finger palpation of the TMJ during motion and stethoscope auscultation as needed. Even though joint sound is an important symptom in the patient with temporomandibular disorder, several studies have indicated that clinical detection of TMJ sounds frequently provides inaccurate data.

One reliability

Jaw tracking for the detection of trismus or closed jaw locking

In patients with trismus or true intracapsular disk dysfunction, the range of active motion of the jaw is reduced from normal. The differentiation between a muscular cause of limited jaw movement versus a true intracapsular restriction is an important diagnostic distinction to be made among patients with temporomandibular disorders. The primary clinical diagnostic test is a passive stretch test. The passive stretch test may be aided by first spraying the masseter and temporalis muscles with a

Summary

There is a clear need for additional research on all ancillary documentation procedures, instruments, and devices that are used to supplement clinical examinations. This research should be directed at the test-retest precision of these methods and instruments. Comparative cost-benefit analyses of all ancillary documentation methods are needed. Despite its shortcomings, the only gold standard for temporomandibular disorder is a global clinical examination performed and a thorough history taken

Supplementary Files

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    aAssistant Professor, Department of Removable Prosthodontics, Graduate School, Tokyo Medical and Dental University.

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    bAssistant Professor, Department of Removable Prosthodontics, Faculty of Dentistry, Kyushu University.

    cPostgraduate student, Department of Removable Prosthodontics, Graduate School, Tokyo Medical and Dental University.

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    dProfessor and Chair, Section of Orofacial Pain and Oral Medicine, UCLA School of Dentistry.

    Reprint requests to:, Dr Glenn T. Clark, UCLA School of Dentistry, Section of Orofacial Pain and Oral Medicine, Center for Health Sciences, 10833 Le Conte Ave, Los Angeles, CA 90095-1668, Fax: (310)206-5539, E-mail: [email protected]

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