Most population-based studies of TM disorders report a discrepancy between the frequency of symptoms and the frequency of signs of functional disturbances of the temporomandibular joint. In addition, studies have reported varying relationships between subjectively perceived symptoms and signs found on clinical examination. This study examines this relationship in 148 Canadian adults who were part of a larger sample of 677 subjects who completed a telephone administered symptom questionnaire. Symptoms were reported by 63.5% and signs were found in 88.1%. While a degree of discordance was observed, there was a close and statistically significant association between symptoms and signs. This was the case whether summary variables or individual symptoms and signs were used as the dependent variable and whether proportions with or absolute numbers of symptoms and signs were examined. The validity of the symptom questionnaire was examined in order to assess its ability to identify "cases" of TMD. Validity tests showed a sensitivity of 81.4% and a specificity of 48.3%. When "false" positives and "true" positives were compared, the former were found to be significantly less likely to report pain.
This study investigated the frequency and distribution of clinical signs of temporomandibular joint (TMJ) internal derangement in an adult non-TMJ patient population. Four hundred three persons who participated in an epidemiologic investigation were examined for clinical signs of TMJ internal derangement by four examiners who followed a standardized form. Clinical signs of internal derangement were found in 76 persons (19%). Twenty-nine persons (7%) had reciprocal clicking and 47 (12%) had a history of clicking replaced by limitation of mouth opening with deviation to the affected side. Reciprocal clicking was associated with TMJ pain during mouth opening and with limitation of jaw movement. A history of clicking replaced by limitation of mouth opening with deviation to the affected side was associated with pain during mouth opening, limitation of opening, and palpatory tenderness of the TMJ. The study indicates that clinical signs of TMJ internal derangement are present in nearly one fifth of non-TMJ patients. Those with clinical signs of internal derangement frequently also have subjective symptoms but they have not sought treatment for these symptoms.
This study evaluated the efficiency of a questionnaire as compared to a brief clinical examination for identification of clinically assessed craniomandibular disorder cases. 706 Danish children 14-16 yr old answered a self-administered questionnaire concerned with dysfunction symptoms and oral habits. In addition they were subjected to a clinical examination of signs of dysfunction from the masticatory system. Based on the present study a self-administered questionnaire for screening purposes used in an a priori healthy population of teenagers cannot be recommended. The answers to the questionnaire showed a low reproducibility and their ability to predict clinically assessed signs of dysfunction was inadequate. The most favorable combinations of single questions were calculated in order to optimize sensitivity, specificity, and predictive value of the questionnaire. A maximum of 65% of the clinically diseased subjects were identified by the questionnaire and only 41% of the test positive subjects had their subjective diagnoses confirmed at the clinical examination. The brief clinical screening procedure succeeded in identifying 92% of children with severely disturbed function. The subjects testing positively according to the brief clinical examination were children with either moderate or severe disturbances except for only one case. Based on a cost to benefit consideration a brief clinical examination is preferred to a self-administered questionnaire as a routine procedure for detection of craniomandibular disorders.
The prevalences of subjective symptoms and clinical signs of craniomandibular (CM) disorders, orofacial parafunctions, and occlusal conditions were determined in a series of Finnish children (n = 166). All were first interviewed, and then 156 of them were examined clinically. Fifty-two per cent of the children reported at least one subjective symptom, and 75% at least one parafunctional habit. Clinical signs were common but rarely severe in accordance with Helkimo's clinical dysfunction index (Di). Both the number of subjective symptoms (p less than 0.001) and the number of orofacial parafunctions (p less than 0.05) correlated with the clinical dysfunction index.