Temporomandibular disorder (TMD) according to Rena de Leeuw is a collective term that includes a number of clinical problems which involve the masticatory muscles, the temporomandibular joint (TMJ), and the associated structures. Stanisław Majewski extended the scope of diagnostics-therapeutic treatment, connected with disorders analysed here, on the whole stomatognathic system. The most frequently reported symptom of TMD is pain in the temporomandibular region or in the masticatory muscles, and the pain is typically associated with chewing or other occlusal conditions of the lower jaw, provided that occlusion is understood as all static and dynamic conditions. While TMD pain is typically mild, it has a fluctuating character and can become quite severe. Other TMD symptoms include: limitation or deviations in the mandibular range of motion, and TMJ sounds during jaw function (clicking and/or crepitation). These three essential features (viz., pain, limitation in function, and TMJ sounds) are often called the “classic triad” of the symptoms of TMD.The aim of this study is to estimate:(1) intra-rater reliability of the Polish version of clinical examination and questionnaire of RDC/TMD; (2) inter-rater reliability of the Polish version of clinical examination of RDC/TMD; (3) intra-rater reliability of dynamic/static tests of the masticatory system; (4) inter-rater reliability of dynamic/static tests of the masticatory system; The study group was composed of 123 adult patients, 24 men and 99 women. They were all examined to see if they meet the following criteria: 1) willingness to participate in the study, after giving a written consent, 2) clinically confirmed one of subtypes of TMD diagnosis (in compliance with officially translated and culturally adapted Polish version of Reaserch Diagnostic Criteria of Temporomandibular Disorders and separately for dynamic/static tests evaluating pain in temporomandibular joint and masticatory muscles ), 3) no systemic disease influencing TMD (fibromyalgia, hypothyroidism, lapus erythematosus, scleroderma, Parkinson’s disease, lyme disease, dystonia), 4) no other orofacial disorders (neuropatic pain, tension type-headache, autonomic cephalalgias, migraines, psychogenic pain, myositis, infections and injuries), 5) over 18 years old, 6) a good understanding of the Polish language. Fifteen patients did not fulfill the inclusion criteria of the study. Seven of these patients, suffered from an endodontic pain, while eight of them did not report a pain complaint in the orofacial region but were referred to the Dental Institute because of limited mandibular movement or bruxism. Ten patients failed to return for the second examination. Thus, a total of 98 patients participated in the study. Their mean age (±SD) was 32.0 (± 13.5). The patients were examined during two sessions with the 10 days interval. During the first session, the patients were examined by one examiner, and during second session by two examiners ; independently (i.e. the study coordinator and a second specialist). During both sessions, the examination included the completion of the RDC/TMD questionnaire, the performance of standard examination tests according the RDC/TMD guidelines, and the performance of the dynamic/static tests of the masticatory system. Additionally, during the intake of the first session, a standardized oral history was taken (in compliance with the health record valid in Dental Institute of Jagiellonian University in Cracow). The intra-rater reliability of the pain-free opening, maximal unassisted opening, maximal assisted opening, horizontal movements to the left, to the right and protrusion is found to be excellent.The inter-rater reliability for most of the mandibular range of motion is excellent. Only for unassisted opening without pain, the inter-rater reliability ICC value could be considered as fair to good.The intra-rater reliability for clicking during opening, closing, laterotrusion, and protrusion is found to be excellent. The inter-rater reliability for most of the clicking sounds during mandibular movement is excellent. Only for clicking on ipsilateral site, the inter-rater reliability ICC value could be considered as fair to good.The intra-rater reliability and inter-rater reliability for most of the crepitation during mandibular movement are excellent. Only for crepitation on ipsilateral site, the inter-rater reliability ICC value could be considered as fair to good.The intra-rater reliability of palapation of posterior temporalis, middle temporalis, and anterior temporalis is poor. The palpation of the origin of masseter is characterized by the reliability as fair to good. Whereas reliability of palpation examination of the body of masseter and insertion of masseter is poor, similarly post mandibular region and lateral pole of TMJ. The pain during the palpation examination of submandibular region and posterior attachment of TMJ is too weak to determine ICC. Palpation examination of the intra-oral muscles is characterized by the reliability from fair to good and excellent. Intra-rater reliability of static tests is characterized by the reliability from fair to good. For two dynamic tests the ICC level is characterized by the reliability from fair to good. Whereas the closing ; dynamic test is characterized by the excellent reliability. For the case of inter-rater reliability of posterior temporalis, middle temporalis, anterior temporalis, origin of masseter, body of masseter, insertion of masseter, post mandibular region the ICC value is situated above 0.4 or equals 0.4, which corresponds to the reliability from fair to good. The pain during the palpation of submandibular region and posterior attachment of TMJ is too weak to determine ICC. The examination of lateral pole of TMJ is characterized by poor reliability. The intra-oral muscles examination is characterized by the fair to good reliability. For the case of inter-rater reliability of dynamic/static tests the results are the same as for intra-rater reliability. All static tests are characterized by fair to good reliability. In relation to two dynamic tests, the ICC level is characterized by fair to good reliability. Whereas the closing dynamic test is characterized by the excellent reliability. For the case of intra-rater reliability of RDC/TMD diagnoses, which was made according to the RDC/TMD guidelines, ICC values are situated below 0.4, which indicates poor reliability of diagnoses: myofascial pain and osteoarthritis. Reliability is fair to good for myofascial pain with limited mouth opening and for disc displacement without reduction; and excellent for disc displacement with reduction and disc displacement without reduction and without limited opening. For arthralgia, a proper reliability assessment could not be performed due to the low prevalence of this condition. The reliability of diagnoses made on the basis of dynamic/static tests is characterized by fair to good reliability. The case of inter-rater reliability for the diagnosis made according to RDC/TMD guidelines, ICC value of arthralgia diagnosis is situated below 0.4, which indicates poor reliability. Osteoarthritis diagnosis is characterized by fair to good reliability. Whereas the reliability of myofascial pain, myofascial pain with limited mouth opening, disc displacement with and without reduction, disc displacement without reduction and without limited opening, and osteoarthrosis is excellent. The reliability of myogenous pain diagnoses are excellent, the reliability of arthrogenous pain is fair to good. ; The reliability assessment of the scores that were recorded based on questionnaires is found to be excellent.Below mentioned conclusions are based on the conducted reliability of RDC/TMD examination and dynamic/static tests.1. Reliability of the officially translated and culturally adapted Polish version of clinical examination and history questionnaire of the Research Diagnostic Criteria of Temporomandibular Disorders is concurrent with similar research conducted in the world, therefore the usage of RDC/TMD is reasonable in Poland.2. Reliability of dynamic/static tests is concurrent with palpation tests, which supports the idea of including these tests in the improved version of RDC/TMD. 3. The conducted study confirms that performing technically difficult intra-oral palpation and high frequency of patients’ positive answers lead to mistakes in defining RDC/TMD diagnostic subtypes. Thus, this examination should be excluded from the new version of RDC/TMD. 4. The lower value of intra-rater reliability than the value of inter-rater reliability in relations to pain tests might show the fluctuation character of TMD so the patients are advised to undertake more reversible and conservative TMD therapies.5. Officially translated into Polish and culturally adapted RDC/TMD were accepted by international consortium engaged in defining diagnostic standards and treatment in this field. RDC/TMD constitute a valuable tool for comparing the efficiency of diagnostic-therapeutic methods that are used.
May 12, 2021
Nov 13, 2013
|ZB-118791||May 12, 2021|
Porter,Robert S. (ed -in-chief) Kaplan,Justin L.(senior assistant ed ).