The clinical assessment of TMJ sounds by means of auscultation, palpation or both

Abstract

Anterior disc displacements are an important diagnostic subgroup (Group II) of TM disorders according to the Research Diagnostic Criteria (RDC; Dworkin & LeResche, 1992). Although the RDC yields clear-cut criteria for the diagnosis of a disc displacement, the interobserver reliability for the clinical recognition of joint sounds is highly variable. This high variance may be caused by the fact that the clinical assessment of joint sounds is difficult. In many previous studies, auscultation with a stethoscope was used. This technique is often claimed to be the most reliable one. However, it is unclear whether in these studies, auscultation was performed without simultaneous palpation of the contralateral joint. Therefore, the aim of the present study was to test the interobserver reliability of the clinical assessment of TMJ sounds by means of auscultation, palpation or both. A total of 220 undergraduate students (100 men; 120 women; mean age 21·9 ± 3·6 years) was examined independently by two calibrated dentists for the presence, probable presence or absence of sounds caused by anterior disc displacement, hypermobility, or another cause. The 79 students underwent auscultation only (i.e. without contralateral manual palpation); 87 students underwent bilateral palpation; the remainder (54 students) was subjected to both auscultation and palpation. The results show that the combination technique yields the highest reliability (Cohen's κ=0·53). For other techniques, κ-values of 0·46 (auscultation) and 0·48 (palpation) were found. It was concluded that the combination of auscultation and palpation yields the highest interobserver reliability for the recognition of TMJ sounds, although the differences with other techniques were small. (Supported by the IOT)