Ability of existing tests to distinguish between temporomandibular disorders questioned

shutterstock_51359269 dentist and patient looking at x-ray

The aim of this review was to summarize the research on accuracy of individual clinical diagnostic signs and tests for the presence of temporomandibular disorder (TMD), , and for the subclassifications affiliated with TMD.

The authors conducted  hand and computerised  searches  to identify articles on the diagnostic accuracy of clinical tests and signs.  The sources searched are not provided in the online abstract.  To be included studies had to  have an assessment of individual clinical measures of TMD, a report of the diagnostic accuracy of these measures, and an acceptable reference standard for comparison.  Study quality was assessed using QUADAS (Quality assessment of studies of diagnostic accuracy) with sensitivity , specificity and negative and positive likelihood ratios being  calculated for each diagnostic test described.

They found that seven  studies met the criteria  with 3 being of high quality as assessed using the  QUADAS tool. All 7 studies used tests to differentiate subclassifications of TMD. The 7 studies included (1) diagnostic tests/signs of joint sounds, (2) joint movements, or (3) clinically oriented pain measures. There were no studies that investigated TMD versus a competing, non-TMD condition.

The authors concluded

Because all of the included studies assessed diagnostic accuracy among subclassifications of individuals suspected of having TMD, the ability of any of these tests to distinguish between patients with TMD versus patients without TMD remains unknown. Because of the lack of clear findings indicating compelling evidence for clinical diagnosis of TMD, and because of the low quality of most of these studies, the data are insufficient to support or reject these tests.

Reneker J, Paz J, Petrosino C, Cook C. Diagnostic accuracy of clinical tests and signs of temporomandibular joint disorders: a systematic review of the literature. J Orthop Sports Phys Ther. 2011 Jun;41(6):408-16. Epub 2011 Feb 18. Review. PubMed PMID: 21335932.


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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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