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Clinical vs. Arthrographic Diagnosis of TMJ Internal Derangement

TMJ and Craniofacial Pain Clinic, School of Dentistry, University of Minnesota, 515 Delaware St. SE, Minneapolis, Minnesota 55455

E.L. Schiffman

TMJ and Craniofacial Pain Clinic, School of Dentistry, University of Minnesota, 515 Delaware St. SE, Minneapolis, Minnesota 55455

K.P. Schellhas

Center for Diagnostic Imaging, 5775 Wayzata Blvd., Suite 190, St. Louis Park, Minnesota 55416

J.R. Fricton

TMJ and Craniofacial Pain Clinic, School of Dentistry, University of Minnesota, 515 Delaware St. SE, Minneapolis, Minnesota 55455

Internal derangements of the temporomandibular joint (TMJ) have gained increased recognition as a potential source of pain and dysfunction of the masticatory system. The objective of this study was to evaluate the reliability of clinicians in predicting an arthrographic diagnosis of articular disc position in a typical patient population presenting for TMJ arthrographic evaluation. Two clinicians utilized a brief history, clinical examination (including evaluation of mandibular movement and TMJ auscultation), and tomographic TMJ imaging in evaluating 60 patients. The radiologist subsequently performed the arthrographic procedures on 102 TMJs (18 unilateral and 42 bilateral). Diagnostic agreement was determined for all possible diagnostic categories including: normal disc position, TMJ internal derangement with reduction, TMJ internal derangement without reduction/acute, TMJ internal derangement without reductionlchronic, and osteoarthrosis. The significance of the diagnostic agreement between the clinicians and arthrography was evaluated with a Kappa Statistical Test, which showed good reliability. For epidemiological studies, it was concluded that clinical and tomographic evaluation would provide sufficient reliability for determination of the presence and stage of TMJ internal derangement. However, in a specific clinical situation, a difficult diagnostic problem may require the use of arthrography, depending on the impact of the diagnosis on subsequent treatment decisions.

Journal of Dental Research, Vol. 68, No. 5, 826-829 (1989)
DOI: 10.1177/00220345890680051501


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