ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Clinical Exam with Finger Palpation Better than Magnetic Resonance Imaging For Diagnosing Disc Displacement
Clinical Question In patients being seen for a possible temporomandibular disorder, is use of an MRI to detect disc displacement with reduction (DDR) better than palpation with fingers?
Clinical Bottom Line For patients being seen for a possible temporomandibular disorder, palpation with fingers, including palpation for TMJ noise, is better for detecting disc displacement than MRI.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 18486451Manfredini/2008116 patients (88 females, 28 males; mean age 48.6, range 18–65) Diagnosis Study
Key resultsUsing MRI, 35% and 44% of TMJs were detected as having DDR and being normal, respectively; from RDC/TMD assessment 26% and 60% of TMJs were detected as having DDR and being normal, respectively. Despite the percentages not being the same, it was concluded that RCD/TMD assessment findings and MRI findings are similar, and that MRI diagnosis only can result in over-diagnosis or false positives. The proportion of observed agreement, proportion of chance-expected agreement, and k-value between RDC/TMD and MRI was 0.86, 0.56, and 0.69, respectively for diagnoses of the patients with DDR.
#2) 18276055Manfredini/2008194 patients seeking treatment for potential TMD with a mean age of 55.3; range 18-72Diagnosis Study
Key resultsClinical assessment found 45.6% with DDR while MRI found 25.3% with DDR. Absence of clicking was associated with a normal disc position, and while this particular study found no association of presence of clicking with DDR, it cited and made admissions that other studies had found a click sound to be positively associated with DDR, so much that it is considered an accurate indicator of DDR. “Joints with normal disk position showed to be negatively associated with the presence of click, MR[I] diagnosis of DDR does not show any significant association (positive or negative) with click presence.”
#3) 15125597Usumez/200440 patients with TMJ complaints with a mean age of 32.6 yearsDiagnosis Study
Key results“The overall agreement between the clinical diagnoses and MRI was 76•25%” and there was a diagnostic agreement of 72% between clinical and MRI diagnoses in joints with DDR. “Diagnostic accuracy of the clinical examination was 83% for determining normal disc-condyle relationship, 72% for diagnosing anterior disc displacement with reduction.” From the results it was concluded that proper clinical examination alone is sufficient to reach an accurate diagnosis.
Evidence Search "Magnetic Resonance Imaging"[MeSH] AND "Temporomandibular Joint"[MeSH] AND "humans"[MeSH] AND "dislocations"[MeSH] AND "diagnosis"
Comments on
The Evidence
For each respective study, the same patient groups were used for comparison of the different diagnostic methods. Since one study was more focused on finding the level of agreement between the two detection methods, clinical RDC/TMD was assumed to be the standard of reference. Additionally, another study chose to set MRI as the gold standard, but in the end it concluded that “not all patients with TMD symptoms require magnetic resonance imaging examination before treatment”. Studies were single-blinded so that patients received both diagnostic tests but examiners were unaware of the results of the tests they did not conduct. A major limitation is that none of the evidence provided data on the specificity or sensitivity of the diagnostic tests being used.
Applicability Palpation for clicking is a good method of detecting a disc displacement with reduction, and the additional cost and patient inconvenience of having an MRI is not warranted.
Specialty/Discipline (General Dentistry)
Keywords Magnetic Resonance Imaging, Temporomandibular Joint, Palpation, Diagnosis
ID# 2179
Date of submission: 04/02/2012spacer
E-mail tongm@livemail.uthscsa.edu
Author Michael Tong
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Edward F. Wright, DDS, MS
Faculty mentor/Co-author e-mail
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Christopher Beard and Mackenzi McAfee (San Antonio, TX) on 11/28/2017
Both PubMed and TRIP searches were conducted in November 2017, neither resulting in more recent research on the comparison of palpation with fingers vs. MRI as methods for diagnosis of temporomandibular disorder. This CAT reflects the highest level of evidence on the clinical question at this time. In fact, the only other relevant research found was a critical abstract of a systematic review from 2009, which concluded that there was no clear evidence of a relationship between clinical and MRI diagnosis of temporomandibular disease.
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