Cooper, B.C. and Israel Kleinberg: Examination of a Large Patient Population for Presence of Symptoms and Signs of Temporomandibular Disorders. The Journal of Craniomandibular Practice April 2007; 25 (2): pages 114-126
mandibular Disorder (TMD) is a term generally applied to a condition or conditions characterized by pain and/or dysfunction of the masticatory apparatus. Its characterization has been difficult because of the large number of symptoms and signs attributed to this disorder and to variation in the number and types manifested in any particular patient. For this study, data on 4,528 patients presenting over a period of 25 years to a single examiner for treatment of TMD were available for retrospective analysis, and determination of whether the TMD care seeking patient can be profiled, particularly their pain difficulties.
All patients in this database filled out a questionnaire and were examined for the prevalence of a range of symptoms and clinical examination findings (signs) commonly attributed to TMD. There was no attempt in this study to assign patients to TMD diagnostic sub-categories. The data collected were analyzed to determine which of these symptoms and signs were sufficiently “characteristic of the TMD condition” that they might be used in diagnosis, research and treatment, especially in patients needing relief from pain and discomfort. All 4,528 patients reported symptoms and all but 190 of them also showed signs upon examination.
Symptoms most commonly reported on the questionnaire included (i) pain (96.1%), (ii) headache (79.3%), (iii) temporomandibular joint discomfort or dysfunction (75.0 %) and (iv) ear discomfort or dysfunction (82.4%). In the 4,338 patients that showed signs, the most prevalent was tenderness to palpation of the pterygoid muscles (85.1%) followed by tenderness to palpation of the temporomandibular joints (62.4%). Pain symptoms and signs were commonly accompanied by compromised mandibular movements, TMJ sounds and dental changes, such as incisal edge wear and excessive overbite. Clearly prevalence of pain disclosed by the symptoms and signs examinations was high. Patients showed variable prevalence and non-prevalence of 8 categories of painful symptoms and 7 categories of painful signs. Despite the variability, these might be developed in the future into TMD scores or indices for studying and unraveling the TMD conundrum.