A review of temporomandibular disorder diagnostic techniques☆,☆☆,★,★★,♢
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
References (62)
- et al.
Pressure-pain threshold in human temporal region. Evaluation of a new pressure algometer
Pain
(1986) Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold
Pain
(1987)- et al.
Pressure pain thresholds in normal muscles: reliability, measurement effects, and topographic differences
Pain
(1989) - et al.
Cephalic muscle tenderness and pressure pain threshold in a general population
Pain
(1992) - et al.
Reliability of the pressure algometer as a measure of myofascial trigger point sensitivity
Pain
(1986) - et al.
Pressure pain thresholds, clinical assessment, and differential diagnosis: reliability and validity in patients with myogenic pain
Pain
(1989) - et al.
Sensory dysfunction in fibromyalgia patients with implications for pathogenic mechanisms
Pain
(1996) - et al.
Muscle tenderness and pressure pain thresholds in headache. A population study
Pain
(1993) - et al.
Quantitative surface EMG of pericranial muscles. Reproducibility and variability
Electroencephalogr Clin Neurophysiol
(1993) Relationships between jaw pain and jaw muscle contraction level: underlying factors and treatment effectiveness
J Prosthet Dent
(1985)
The effect of experimental jaw muscle pain on postural muscle activity
Pain
Facial expressions of pain and emotions in chronic TMD patients
Pain
Effects of experimental muscle pain on muscle activity and co-ordination during static and dynamic motor function
Electroencephalogr Clin Neurophysiol
Electromyographic recordings of low back pain subjects and non-pain controls in six different positions: effect of pain levels
Pain
Quantitative surface EMG of pericranial muscles in headache. A population study
Electroencephalogr Clin Neurophysiol
The use of electromyography and muscle palpation in the diagnosis of tension-type headache with and without pericranial muscle involvement
Pain
Clinical work posture for the dentist: an electromyographic study
J Am Dent Assoc
Assessing clinical signs of temporomandibular disorders: reliability of clinical examiners
J Prosthet Dent
The acoustical characteristics of the normal and abnormal temporomandibular joint
J Oral Maxillofac Surg
Evaluation of a technique for recording temporomandibular joint sounds
J Prosthet Dent
Does clicking in adolescence lead to painful temporomandibular joint locking?
Lancet
A prevalence study of the clinical signs associated with mandibular dysfunction
J Am Dent Assoc
Sommers Epidemiology of signs and symptoms in temporomandibular disorders: clinical signs in cases and controls
J Am Dent Assoc
Internal derangement of the temporomandibular joint: correlation of arthrographic imaging with surgical findings
Int J Oral Maxi Surg
An evaluation of temporomandibular joint sounds
J Am Dent Assoc
Patterns of mandibular movements in subjects with craniomandibular disorders
J Prosthet Dent
Horizontal plane jaw movements in controls and clinic patients with temporomandibular dysfunction
J Prosthet Dent
The effects of pain from the mandibular joint and muscles on masticatory motor behaviour in man
Arch Oral Biol
Report on acceptance of TMD devices. ADA Council on Scientific Affairs
J Am Dent Assoc
A comparison of pressure pain thresholds in different tissues and body regions. Long-term reliability of pressure algometry in healthy volunteers
Scand J Rehab Med
Clinical TMJ examination methods
J Calif Dent Assoc
Cited by (43)
Occlusion, temporomandibular disorders, and orofacial pain: An evidence-based overview and update with recommendations
2018, Journal of Prosthetic DentistryCitation Excerpt :As indicated, interdisciplinary and multidisciplinary care should be practiced. For patients who present with orofacial pain or TMD concerns, thorough examinations, evaluations, assessments, differential diagnoses, and prognoses are the cornerstones of contemporary care.169-171 Patient history information obtained from screening forms and interviews are an indispensable starting point, with practitioner and team beliefs contributing significantly to outcomes.172
Elongated styloid process in patients with temporomandibular disorders — Is there a link?
2018, Annals of AnatomyCitation Excerpt :Much more frequent complaints associated with ESP are dysphagia (Murtagh et al., 2001), recurrent headache (Cullu et al., 2013), otalgia (Becker and Pfeiffer, 2013) orofacial pain (Balcioglu et al., 2009; Eagle, 1962; Weidenbecher et al., 2006) and pain in the TMJ (Prasad et al., 2002). Similar clinical symptoms are found in patients with temporomandibular disorders (TMD) (Baba et al., 2001; de Andrade et al., 2012; Oltramari-Navarro et al., 2017). This dysfunctional condition, which is elicited by alterations of the temporomandibular joint or the chewing muscles, may be confused with ESP, leading to insufficient treatment (de Andrade et al., 2012).
Occlusal stability
2014, Dental Clinics of North AmericaCitation Excerpt :The clinician faces an added dilemma when there is an underlying TMD, and the patient’s occlusion needs to be restored, or when teeth need to be replaced (Tables 6–8). Arriving at a diagnosis and treatment plan requires a determination of whether there are intracapsular or extracapsular considerations.119,124–136 Pain of dental origin along with any psychological overlay should be included in the differential diagnosis and management tree.137–140
Accuracy of infrared thermography of the masticatory muscles for the diagnosis of myogenous temporomandibular disorder
2013, Journal of Manipulative and Physiological TherapeuticsElectromyography in diagnosing temporomandibular disorders
2012, Journal of the American Dental AssociationCitation Excerpt :Although clinicians and researchers have used EMG extensively in dentistry, its usefulness as a clinical tool to diagnose TMD has been controversial. Several authors have conducted studies and reviews of EMG and TMD27,28,29,30,49,50; however, to date, there is no agreement with regard to its diagnostic utility.7,27,29,30,59,60,61,62,63,64,65 Because none of the researchers in any of the above reviews27,28,29,30 investigated this important issue of diagnostic utility systematically, we decided to address this issue by performing a systematic evaluation of the existing evidence regarding the accuracy of EMG to diagnose TMD.
- ☆
aAssistant Professor, Department of Removable Prosthodontics, Graduate School, Tokyo Medical and Dental University.
- ☆☆
bAssistant Professor, Department of Removable Prosthodontics, Faculty of Dentistry, Kyushu University.
- ★
cPostgraduate student, Department of Removable Prosthodontics, Graduate School, Tokyo Medical and Dental University.
- ★★
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]