Validity of temporomandibular disorder examination procedures for assessment of temporomandibular joint status.
BACKGROUND
This hypothesis-generating study was performed to determine which items in the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and additional diagnostic tests have the best predictive accuracy for joint-related diagnoses.


METHODS
One hundred forty-nine TMD patients and 43 symptom-free subjects were examined in clinical examinations and with magnetic resonance imaging (MRI). The importance of each variable of the clinical examination for correct joint-related diagnosis was assessed by using MRI diagnoses. For this purpose, "random forest" statistical software (based on classification trees) was used.


RESULTS
Maximum unassisted jaw opening, maximum assisted jaw opening, history of locked jaw, joint sound with and without compression, joint pain, facial pain, pain on palpation of the lateral pterygoid area, and overjet proved suitable for distinguishing between subtypes of joint-related TMD. Measurement of excursion, protrusion, and midline deviation were less important.


CONCLUSIONS
The validity of clinical TMD examination procedures can be enhanced by using the 16 variables of greatest importance identified in this study. In addition to other variables, maximum unassisted and assisted opening and a history of locked jaw were important when assessing the status of the TMJ.
Department of Prosthodontics, University of Heidelberg, Heidelberg, Germany. Marc_Schmitter@med.uni-heidelberg.de
Marc
M
Schmitter
Bodo
B
Kress
Michael
M
Leckel
Volkmar
V
Henschel
Brigitte
B
Ohlmann
Peter
P
Rammelsberg
D000328:Adult; D001314:Auscultation; D016022:Case-Control Studies; D003627:Data Interpretation, Statistical; D003663:Decision Trees; D003936:Diagnosis, Computer-Assisted; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010147:Pain Measurement; D010808:Physical Examination; D016059:Range of Motion, Articular; D012015:Reference Standards; D015203:Reproducibility of Results; D012984:Software; D019224:Temporomandibular Joint Disc / Q000473:pathology; D013705:Temporomandibular Joint Disorders / Q000145:classification* / Q000175:diagnosis*