This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Lund, J.P. Articles by Feine, J.S. Search for Related Content PubMed PubMed Citation Articles by Lund, J.P. Articles by Feine, J.S. Social Bookmarking                         What's this?

Validity of Diagnostic and Monitoring Tests Used for Temporomandibular Disorders

Faculty of Dentistry, McGill University, 740 Dr. Penfield Avenue, Monteal, Quebec, Canada H3A 1A4, and Centre de recherche en Sciences Neurologiques, Universite de Montreal

C.G. Widmer

Department of Oral and Maxillofacial Surgery, Box 100416, JHMHSC, University of Florida, Gainesville, Florida 32610-0416

J.S. Feine

Départment de dentisterie de restauration, Faculte de medecine dentaire, Universite de Montreal, C.P. 6128, succursale A, Montreal, Quebec, Canada H3C 3J7

Currently, diagnosis of temporomandibular disorders (TMD) depends on a comprehensive history and physical examination, supplemented, when indicated, by images of hard and soft tissues. However, there are electronic diagnostic devices being marketed to acquire other measures described as relevant to TMD and to use these for diagnosis of TMD and for monitoring the effects of treatment. This paper reviews the capacity of several devices to measure these variables accurately and reliably and to assess the theoretical basis of each of these tests. Diagnostic ability was established, when possible, according to the commonly accepted measures of sensitivity, specificity, and positive predictive values. It was found that many tests lack theoretical validity, that measurement validity tends to be poor, and that diagnostic ability can be even worse than chance, because of a high percentage of false-positive diagnoses. Based on these findings, the use of these instruments in clinical practice is inappropriate at this time and may lead to the treatment of large numbers of subjects who have no disorder.

Key Words: temporomandibular disorders (TMD) • diagnosis • electronic instruments • measurement reliability • measurement validity • sensitivity, specificity • positive predictive value

REFERENCES

• Ariyaratnam S., Rood JP ( 1990). Measurement of facial skin temperature. J Dent 18:250-253.[CrossRef][Medline] [Order article via Infotrieve]
• Balkhi KM, Tallents RH (1991). Error analysis of a magnetic jaw-tracking device. J Craniomandib Disord Facial Oral Pain 5:51-56.[Medline] [Order article via Infotrieve]
• Begg CB ( 1986). Statistical methods in medical diagnosis. Crit Rev Med Inform 1:1-22.[Medline] [Order article via Infotrieve]
• Berry DC, Yemm R. ( 1971). Variations in skin temperature of the face in normal subjects and in patients with mandibular dysfunction. Br J Oral Surg 8:242-247.[Medline] [Order article via Infotrieve]
• Berry DC, Yemm R. ( 1974). A further study of facial temperature in patients with mandibular dysfunctions. J Oral Rehabil 1:255-264.[Medline] [Order article via Infotrieve]
• Brekelmans CT, Collette HJ, Collette C., Fracheboud J., de Waard F. (1992). Breast cancer after a negative screen: follow-up of women participating in the DOM Screening Programme. Eur J Cancer 28A:893-895.
• Carlson KE, Alston W., Feldman DJ (1964). Electromyographic study of aging in skeletal muscle. Am J Phys Med 43:141-145.[Medline] [Order article via Infotrieve]
• Clark RM (1992). Benign and malignant breast pathology. Curr Opin Obstet Gynecol 4:601-607.[Medline] [Order article via Infotrieve]
• Cooper BC, Rabuzzi DD (1984). Myofacial (sic) pain dysfunction syndrome: a clinical study of asymptomatic subjects. Laryngoscope 94:68-75.[Medline] [Order article via Infotrieve]
• Cooper BC, Alleva M., Cooper DL, Lucente FE (1986). Myofacial (sic) pain dysfunction: an analysis of 476 patients. Laryngoscope 96:1099-1106.[Medline] [Order article via Infotrieve]
• Dao TTT, Feine JS, Lund JP ( 1988). Can electrical stimulation be used to establish a physiologic occlusal position? J Prosthet Dent 60:509-514.[Medline] [Order article via Infotrieve]
• Dao TTT, Lavigne GJ, Charbonneau A., Feine JS, Lund JP ( 1994). The efficacy of oral splints in the treatment of myofascial pain of the jaw muscles: a controlled clinical trial. Pain 56:85-94.[Medline] [Order article via Infotrieve]
• Dawson PE (1989). Evaluation, diagnosis and treatment of occlusal problems. St. Louis: C.V. Mosby.
• de Leeuw R., Boering G., Stegenga B., De Bont LGM (1994). Clinical signs of TMJ osteoarthritis and internal derangement 30 years after nonsurgical treatment. J Orofacial Pain 8:18-24.[Medline] [Order article via Infotrieve]
• Dixon DC (1991). Diagnostic imaging of the temporomandibular joint. Dent Clin North Am 35:53-74. Dorfman LJ, McGill KC (1988). AAEE minimonograph #29: automatic quantitive electromyography. Muscle Nerve 11:804-818.[Medline] [Order article via Infotrieve]
• Dworkin SF (1991). Illness behavior and dysfunction: review of concepts and application to chronic pain. Can J Physiol Pharmacol 69:662-671.[Medline] [Order article via Infotrieve]
• Dworkin SF, LeResche L. (1993). Temporomandibular disorder pain: epidemiologic data. APS Bull April/May:22. Dworkin SF, LeResche L, DeRouen T ( 1988). Reliability of clinical measurement in temporomandibular disorders. Clin J Pain 4:88-99.
• Dworkin SF, Huggins KH, LeResche L., Von Korff MR, Howard J., Truelove E., et al. (1990a). Epidemiology of signs and symptoms in temporomandibular disorders: clinical signs in cases and controls. J Am Dent Assoc 120:273-281. Dworkin SF, LeResche L., DeRouen T., Von Korff MR (1990b). Assessing clinical signs of temporomandibular disorders: reliability of clinical examiners. J Prosthet Dent 63:574-579. Eriksson L., Westesson P-L., Sjoberg H. (1987). Observer performance in describing temporomandibular joint sounds. J Craniomandib Pract 5:32-35.
• Farman AG (1989). Electronic thermography in the diagnosis of atypical odontalgia: a pilot study. Oral Surg Oral Med Oral Pathol 68:472-481.[Medline] [Order article via Infotrieve]
• Farrar WB (1978). Characteristics of the condylar path in internal derangements of the TMJ. J Prosthet Dent 39:319-323.[Medline] [Order article via Infotrieve]
• Farrar WB, McCarty WL Jr (1979). Inferior joint space arthrography and characteristics of condylar paths in internal derangements of the TMJ. J Prosthet Dent 41:548-555.[CrossRef][Medline] [Order article via Infotrieve]
• Feine JS, Lavigne GJ (1994). The challenge of measuring the efficacy of treatment of chronic trigeminal myofascial pain. In: Biological and psychological aspects of orofacial pain. Stohler CS, Carlson DS, editors. Craniofacial Growth Series, Center for Human Growth & Development. Ann Arbor: The University of Michigan, pp. 113-132.
• Feine JS, Hutchins MO, Lund JP ( 1988). An evaluation of the criteria used to diagnose mandibular dysfunction with the mandibular kinesiograph. J Prosthet Dent 60:374-380. Finney JW, Holt CR, Pearce KB (1986). Thermographic diagnosis of temporomandibular joint disease and associated neuromuscular disorders. Postgrad Med (Spec Ed):93-95.
• Gallo LM, Airoldi R., Ernst B., Palla S. (1991). TMJ sounds:
• Quantitative spectral analysis of asymptomatic subjects (abstract). J Dent Res 70:371.
• Gay T., Bertolami CN (1988). The acoustical characteristics of the normal temporomandibular joint. J Dent Res 67:56-60. Goodman P., Greene CS, Laskin DM (1976). Response of patients with myofascial pain-dysfunction syndrome to mock equilibration. J Am Dent Assoc 92:755-758.[Medline] [Order article via Infotrieve]
• Goulet J., Clark GT (1990). Clinical TMJ examination methods. J CA Dent Assoc 18:25-33.
• Gratt BM, Sickles EA (1993). Thermographic characterization of the asymptomatic temporomandibular joint. J Orofacial Pain 7:7-14.[Medline] [Order article via Infotrieve]
• Gratt BM, Pullinger AG, Sickles EA, Lee JJ (1989). Electronic thermography of normal facial structures: a pilot study. Oral Surg Oral Med Oral Pathol 68:346-351.[Medline] [Order article via Infotrieve]
• Gratt BM, Sickles EA, Ross JB ( 1991). Electronic thermography in the assessment of internal derangement of the temporomandibular joint. Oral Surg Oral Med Oral Pathol 71:364-370.[Medline] [Order article via Infotrieve]
• Gratt BM, Sickles EA, Wexler CE (1993). Thermographic characterization of osteoarthrosis of the temporomandibular joint. J Orofacial Pain 7:345-353. Greene CS, Laskin DM (1988). Long-term status of TMJ clicking in patients with myofascial pain and dysfunction. J Am Dent Assoc 117:461-465.[Abstract]
• Gross AJ, Gale EN ( 1983). A prevalence study of the clinical signs associated with mandibular dysfunction. J Am Dent Assoc 107:932-936.[Medline] [Order article via Infotrieve]
• Hansson TL, Nilner M. (1975). A study of the occurrence of symptoms of diseases of the temporomandibular joint masticatory musculature and related structures. J Oral Rehabil 2:313-324.
• Harrison AA (1994). Harrison's principles of internal medicine. 13th ed. New York: McGraw-Hill Book Company. Howard J. (1990). Imaging techniques for the diagnosis and prognosis of TMD. J CA Dent Assoc 18:61-71.
• Ishigaki S., Bessette RW, Maruyama T. (1993a). Vibration of the temporomandibular joints with normal radiographic imagings: comparison between asymptomatic volunteers and symptomatic patients. J Craniomandib Pract 11:88-94. Ishigaki S., Bessette RW, Maruyama T. (1993b). A clinical study of temporomandibular joint (TMJ) vibrations in TMJ dysfunction patients. J Craniomandib Pract 11:7-13.
• Ishigaki S., Bessette RW, Maruyama T. (1993c). Vibration analysis of the temporomandibular joints with meniscal displacement with and without reduction. J Craniomandib Pract 11:192-201.
• Ishigaki S., Bessette RW, Maruyama T. (1993d). Vibration analysis of the temporomandibular joints with degenerative joint disease. J Craniomandib Pract 11:276-283. Jankelson RR (1990). Neuromuscular dental diagnosis and treatment. St. Louis: Ishiyaku EuroAmerica, Inc.
• Jankelson B., Sparks S., Crane PF, Radke JC (1975a). Neural conduction of the myo-monitor stimulus: a quantitative analysis. J Prosthet Dent 34:245-253.
• Jankelson B., Swain CW, Crane PF, Radke JC (1975b). Kinesiometric instrumentation: a new technology. J Am Dent Assoc 90:834-840.[Medline] [Order article via Infotrieve]
• Johansson A., Kopp S., Haraldson T. (1985). Reproducibility and variation of skin surface temperature over the
• temporomandibular joint and masseter muscle in normal individuals. Acta Odontol Scand 43:309-313.
• Kassirer JP, Pauker SG (1978). Should diagnostic testing be regulated? N Engl J Med 299:947.[Medline] [Order article via Infotrieve]
• Kircos LT, Ortendahl DA, Mark AS, Arakawa M. (1987). Magnetic resonance imaging of the TMJ disc in asymptomatic volunteers. J Oral Maxillofac Surg 45:852-854. Kopp S., Haraldson T. (1983). Normal variation in skin surface temperature over the temporomandibular joint and masseter muscle. Scand J Dent Res 91:308-311.[Medline] [Order article via Infotrieve]
• Large RG, Lamb AM ( 1983). Electromyographic (EMG) feedback in chronic musculoskeletal pain: a controlled trial. Pain 17:167-177.[Medline] [Order article via Infotrieve]
• Laskin DM, Block S. (1986). Diagnosis and treatment of myofascial pain-dysfunction (MPD) syndrome. J Prosthet Dent 56:75-84.[Medline] [Order article via Infotrieve]
• Lederman KH, Clayton JA (1982a). Restored occlusions: Part II: the relationship of clinical and subjective symptoms to varying degrees of TMJ dysfunction. J Prosthet Dent 47:303-309. Lederman KH, Clayton JA (1982b). Patients with restored occlusions. Part I: TMJ dysfunction determined by a pantographic reproducibility index. J Prosthet Dent 47:198-205.[Medline] [Order article via Infotrieve]
• Linebaugh ML (1990). The effects of spray and stretch on the TMJ dysfunction parameters recorded by pantographic reproducibility index (PRI) and present pain intensity (thesis). Ann Arbor: University of Michigan.
• Lund JP ( 1995). Pain and the control of muscles. In: Orofacial pain and temporomandibular disorders. Fricton JR, Dubner R, editors. New York: Raven Press, pp. 103-115.
• Lund JP, Stohler CS (1994). Effect of pain on muscular activity in temporomandibular disorders and related conditions. In: Biological and psychological aspects of orofacial pain. Stohler CS, Carlson D, editors. Ann Arbor: The University of Michigan, pp. 75-91.
• Lund JP, Widmer CG (1989). An evaluation of the use of surface electromyography in the diagnosis, documentation and treatment of dental patients. J Craniomandib Disord Facial Oral Pain 3:125-137.[Medline] [Order article via Infotrieve]
• Lund JP, Widmer CG, Schwartz G. (1989). What is the link between myofascial pain and dysfunction? In: Electromyography of jaw reflexes in man. Van Steenberghe D, De Laat A, editors. Belgium: Leuven University Press, pp. 427-444.
• Lund JP, Donga R., Widmer CG, Stohler CS (1991). The pain-adaptation model: A discussion of the relationship between chronic musculoskeletal pain and motor activity. Can J Physiol Pharmacol 69:683-694.[Medline] [Order article via Infotrieve]
• Lund JP, Stohler CS, Widmer CG (1993). The relationship between pain and muscle activity in fibromyalgia and similar conditions. In: Progress in fibromyalgia and myofascial pain. Vaeroy H, Merskey H, Editors. Amsterdam: Elsevier Science Publishers B.V., pp. 307-323. Lundh H., Westesson P-L., Kopp S. (1987). A three year follow-up of patients with reciprocal temporomandibular joint clicking. Oral Surg Oral Med Oral Pathol 63:530-533. Magnusson T., Enbom L. (1984). Signs and symptoms of mandibular dysfunction after introduction of experimental balancing-side interferences. Acta Odontol Scand 42:129-135. Mahan PE, Alling CC III (1991). Facial pain. 3rd ed.
• Philadelphia: Lea and Febiger.
• Manns A., Zuazola RV, Sirhan R., Quiroz M., Rocabado M. (1990). Relationship between the tonic elevator mandibular activity and the vertical dimension during the states of vigilance and hypnosis. J Craniomandib Pract 8:163-170. McFadden D. (1993). A speculation about the parallel ear asymmetries and sex differences in hearing sensitivity and otoacoustic emissions. Hearing Res 68:143-151.[Medline] [Order article via Infotrieve]
• McNeil BJ, Keeler E., Adelstein SJ (1975). Primer on certain elements of medical decision making. N Engl J Med 293:211-215.[Abstract]
• McNeill C., Mohl ND, Rugh JD, Tanaka T. (1990). Temporomandibular disorders: diagnosis, management, education, and research. J Am Dent Assoc 120:253-263. Mohl ND ( 1993). Reliability and validity of diagnostic modalities for temporomandibular disorders. Adv Dent Res 7:113-119.[Abstract/Free Full Text]
• Mohl ND, Dixon DC (1994). Current status of diagnostic procedures for temporomandibular disorders. J Am Dent Assoc 125:56-64.[Abstract]
• Mohl ND, McCall WD Jr, Lund JP, Plesh O. ( 1990). Devices for the diagnosis and treatment of temporomandibular disorders. Part I: Introduction, scientific evidence, and jaw tracking. J Prosthet Dent 63:198-201.[CrossRef][Medline] [Order article via Infotrieve]
• Newton JP, Abel RW, Robertson EM, Yemm R. ( 1987). Changes in human masseter and medial pterygoid muscles with age: a study by computed tomography. Gerodontics 3:151-154.[Medline] [Order article via Infotrieve]
• Obrez A., Zhang X., Stohler CS (1993). The effect of experimental muscle pain on mandibular range of motion (abstract). J Dent Res 72:372.
• Pogrel MA, Yen C.-K, Taylor RC (1989). Infrared thermography in oral and maxillofacial surgery. Oral Surg Oral Med Oral Pathol 67:126-131.[Medline] [Order article via Infotrieve]
• Praemer A., Furner S., Rice DP ( 1992). Musculoskeletal conditions in the United States. Park Ridge, IL: American Academy of Orthopaedic Surgeons.
• Rieder CE, Martinoff JT, Wilcox SA (1983). The prevalence of mandibular dysfunction. Part I: Sex and age distribution of related signs and symptoms. J Prosthet Dent 50:81-88. Schiffman E., Anderson GC, Fricton J., Burton K., Schellhas K. (1989). Diagnostic criteria for intraarticular TM disorders. Community Dent Oral Epidemiol 17:252-257.[Medline] [Order article via Infotrieve]
• Schwartz GE, Fair PL, Salt P., Mandel MR, Klerman GL (1976a). Facial muscle patterning to affective imagery in depressed and nondepressed subjects. Science 192:489-491.[Abstract/Free Full Text]
• Schwartz GE, Fair PL, Salt P., Mandel MR, Klerman GL (1976b). Facial expression and imagery in depression: an electromyographic study. Psychosomat Med 38:337-347. Sherman RA (1985). Relationships between jaw pain and jaw muscle contraction level: Underlying factors and treatment effectiveness. J Prosthet Dent 54:114-118.[Medline] [Order article via Infotrieve]
• Shields JM, Clayton JA, Sindledecker LD (1978). Using pantographic tracings to detect TMJ and muscle dysfunctions. J Prosthet Dent 39:80-87.[Medline] [Order article via Infotrieve]
• Smythe H. (1986). Tender points: evolution of concepts of the fibrositis/fibromyalgia syndrome. Am J Med 81:2-6.[Medline] [Order article via Infotrieve]
• Steed PA (1991). The utilization of contact liquid crystal thermography in the evaluation of temporomandibular dysfunction. J Craniomandib Pract 9:120-128.
• Swets JA (1988). Measuring the accuracy of diagnostic systems. Science 240:1285-1293.[Abstract/Free Full Text]
• Tassinary LG, Cacioppo JT, Geen TR ( 1989). A psychometric study of surface electrode placements for facial electromyographic recording: I. The brow and cheek muscle regions. Psychophysiology 26:1-16.[Medline] [Order article via Infotrieve]
• Throckmorton GS, Finn RA, Bell WH ( 1980). Biomechanics of differences in lower facial height. Am J Orthod Dentofac Orthop 77:410-420.
• Truelove E., LeResche L., Sommers E., Dworkin SF, Huggins KH, Reay B. ( 1987). Reliability of TMJ sounds in patients and controls (abstract). J Dent Res 66:336.
• Tsolka P., Preiskel HW (1993). Kinesiographic and electromyographic assessment of the effects of occlusal adjustment therapy on craniomandibular disorders by a double-blind method. J Prosthet Dent 69:85-92.[Medline] [Order article via Infotrieve]
• Tsolka P., Woelfel JB, Man WK, Preiskel HW (1992). A laboratory assessment of recording reliability and analysis of the K6 diagnostic system. J Craniomandib Disord Facial Oral Pain 6:273-280.[Medline] [Order article via Infotrieve]
• Turk DC, Melzack R. (1992). The measurement of pain and the assessment of people experiencing pain. In: Handbook of pain assessment. Turk DC, Melzack R, Editors. New York: The Guilford Press, pp. 3-12.
• Turk DC, Rudy TE, Sorkin BA (1993). Neglected topics in chronic pain treatment outcome studies: determination of success. Pain 53:3-16.[CrossRef][Medline] [Order article via Infotrieve]
• Velasco J., Tasaki T., Gale EN ( 1991). Study of pantographic tracings of TMD patients and asymptomatic subjects
• (abstract). J Dent Res 70:371.
• Visser SL, De Rijk W. (1974). Influence of sex and age on EMG contraction pattern. Eur Neurol 12:229-235.[Medline] [Order article via Infotrieve]
• Weinstein SA, Weinstein G., Weinstein EL, Gelb M. ( 1991). Facial thermography, basis, protocol, and clinical value. J Craniomandib Pract 9:201-211.
• Westesson P-L., Eriksson L., Kurita K. (1989). Reliability of a negative clinical temporomandibular joint examination: Prevalence of disk displacement in asymptomatic temporomandibular joints. Oral Surg Oral Med Oral Pathol 68:551-554.[CrossRef][Medline] [Order article via Infotrieve]
• White SC (1992). 1992 assessment of radiation risk from dental radiography. Dentomaxillofac Radiol 21:118-126.[Abstract]
• White SC, Frey NW ( 1977). An estimation of somatic hazards to the United States population from dental radiography. Oral Surg Oral Med Oral Pathol 43:152-159.[Medline] [Order article via Infotrieve]
• Widmalm SE, Westesson P-L., Brooks SL, Hatala MP, Paesani D. (1992). Temporomandibular joint sounds: correlation to joint structure in fresh autopsy specimens. Am J Orthod Dentofac Orthop 101:60-69.[Medline] [Order article via Infotrieve]
• Widmer CG (1995). Physical characteristics associated with temporomandibular disorders. In: Temporomandibular disorders and related pain conditions, progress in pain research and management. Vol. 4. Sessle BJ, Bryant PS, and Dionne RA, editors. Seattle: IASP Press (in press). Widmer CG, Lund JP, Feine JS (1990). Evaluation of diagnostic tests for TMD. J CA Dent Assoc 18:53-60.
• Yunus MB (1988). Diagnosis, etiology and management of fibromyalgia syndrome: an update. Comp Ther 14:8-20.

Journal of Dental Research, Vol. 74, No. 4, 1133-1143 (1995)
DOI: 10.1177/00220345950740041501


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				G. D. Klasser and J. P. Okeson The clinical usefulness of surface electromyography in the diagnosis and treatment of temporomandibular disorders. J Am Dent Assoc, June 1, 2006; 137(6): 763 - 771. [Abstract] [Full Text] [PDF]

				Th.J.B. Kropmans, P.U. Dijkstra, B. Stegenga, R. Stewart, and L.G.M. de Bont Smallest Detectable Difference in Outcome Variables Related to Painful Restriction of the Temporomandibular Joint Journal of Dental Research, March 1, 1999; 78(3): 784 - 789. [Abstract] [PDF]

				R. L. Braham and S. E. Widmalm Letters to the Editor Journal of Dental Research, September 1, 1995; 74(9): 1532 - 1533. [PDF]

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Lund, J.P. Articles by Feine, J.S. Search for Related Content PubMed PubMed Citation Articles by Lund, J.P. Articles by Feine, J.S. Social Bookmarking                         What's this?