title: Inter-examiner reliability in the clinical examination of temporomandibular disorders: influence of age.
abstract: OBJECTIVE
  The aim of this study was to investigate the influence of the age of the subject on inter-examiner reliability of the clinical signs of temporomandibular disorder (TMD).
  
  
  METHODS
  Forty-three elderly (ES) and 44 younger adults (YS) were selected. The female/male distribution was almost the same in the two groups. All participants underwent clinical examination according to the Research Diagnostic Criteria for TMD, performed successively by two clinicians.
  
  
  RESULTS
  For metric measurements - with the exception of unassisted opening - the ES gave a significantly lower range of motion with both examiners and significantly worse percentage agreement between the examiners. A remarkable inter-examiner disagreement in the elderly was found with laterotrusion and protrusion movements. The prevalence of joint sounds was rated inconsistently by the examiners. The reliability of detection was not different in the two groups. The prevalence of tender muscle sites was also inconsistent. The overall percentage agreement for subjects with at least one tender muscle point was not age dependent. Because of the very low prevalence in ES, further statistical assessment of reliability is not possible.
  
  
  CONCLUSIONS
  The age-dependent lower range of motion and the inferior reliability of metric measurements in the elderly could lead to wrong diagnoses. The reliability of detecting joint sounds and tender muscles was not age dependent within the limitations of the study.
authors.affiliation: Poliklinik für Zahnärztliche Prothetik, Heidelberg, Germany. alexander.hassel@med.uni-heidelberg.de
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Hassel
authors.forename: Peter
authors.initials: P
authors.lastname: Rammelsberg
authors.forename: Marc
authors.initials: M
authors.lastname: Schmitter
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005157:Facial Pain / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000503:physiopathology; D008410:Masticatory Muscles / Q000503:physiopathology; D008875:Middle Aged; D009068:Movement; D015588:Observer Variation; D010865:Pilot Projects; D016059:Range of Motion, Articular / Q000502:physiology; D015203:Reproducibility of Results; D013016:Sound; D013704:Temporomandibular Joint / Q000503:physiopathology; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis* / Q000503:physiopathology