title: Influence of cross-sectional temporomandibular joint tomography on diagnosis and management decisions of patients with temporomandibular joint disorders.
abstract: OBJECTIVE
  To assess whether changes in diagnoses and management of temporomandibular joint disorder (TMJD) patients are influenced by radiographic findings and if there is an association between specific radiologic alterations and management strategy changes.
  
  
  METHODS
  A total of 204 patients with TMJ symptoms were examined using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Diagnoses and management were first decided without the aid of radiographs. Management categories were: pharmacology, physiotherapy, counseling and behavioral treatment, occlusal stabilization, surgery, additional examinations, and referrals, each with subcategories. Sagittal TMJ tomograms were assessed for the presence of flattening, erosion, osteophyte, and sclerosis in the TMJ components. Diagnoses and management were reevaluated after gaining access to the radiographs and radiographic classifications. Logistic regression analyses were performed with changes in management as the dependent variable and age and radiographic findings as the independent variables.
  
  
  RESULTS
  Diagnosis was changed for 56 patients, mainly from arthralgia to osteoarthritis. Management was changed for 55 patients. Most changes occurred in pharmacology and physiotherapy followed by counseling and behavioral treatment, occlusal stabilization, referrals, additional examinations, and surgery. Changes were mostly within the categories, and the highest number of changes was seen in pharmacology, physiotherapy, and counseling and behavioral treatment. Radiographic degenerative findings increased the chance of change (any change) (odds ratio [OR] ⋝ 2.03) and the chance of change in pharmacology (OR ⋝ 2.56) and physiotherapy (OR = 2.48) separately. No other significant associations were found.
  
  
  CONCLUSIONS
  Radiographic degenerative findings increased the chance of changes in management strategy. However, 73% of the TMJD patients had no changes in management after radiographic examination. In cases with changes, these were mainly adjustments within management categories.
authors.affiliation: Department of Oral Radiology, University of Aarhus. mwip@sund.ku.dk
authors.forename: Mie
authors.initials: M
authors.lastname: Wiese
authors.forename: Ann
authors.initials: A
authors.lastname: Wenzel
authors.forename: Hanne
authors.initials: H
authors.lastname: Hintze
authors.forename: Arne
authors.initials: A
authors.lastname: Petersson
authors.forename: Kerstin
authors.initials: K
authors.lastname: Knutsson
authors.forename: Merete
authors.initials: M
authors.lastname: Bakke
authors.forename: Thomas
authors.initials: T
authors.lastname: List
authors.forename: Peter
authors.initials: P
authors.lastname: Svensson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D019412:Anatomy, Cross-Sectional; D018771:Arthralgia / Q000000981:diagnostic imaging; D016009:Chi-Square Distribution; D003657:Decision Making; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging; D013704:Temporomandibular Joint / Q000000981:diagnostic imaging* / Q000473:pathology; D013705:Temporomandibular Joint Disorders / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult