Clinical Examination of the Temporomandibular Joint; A Eurotmjoint Initiative

Bernd Koos¹, Peter Stoustrup², Lynn R. Spiegel³, Nikolay Tzaribachev⁴, Troels Herlin⁵, Thomas Klit Pedersen⁶ and Marinka Twilt⁷, ¹Orthodontics, University of Rostock, Rostock, Germany, ²Section of Orthodontics, University of Aarhus, Aarhus C, Denmark, ³Rheumatology/Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada, ⁴Pediatric Rheumatology, Center for Rheumatic Diseases, Bad Bramstedt, Germany, ⁵Department of Pediatrics, Århus University Hospital Skejby, Århus, Denmark, ⁶orthodontics, Aarhus University Hospital/Dental school, Aarhus, Denmark, ⁷Pediatric Rheumatology Clinic, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Arthritis, pediatric rheumatology and temporomandibular joint

Session Information

Date: Tuesday, November 10, 2015

Title: Pediatric Rheumatology - Clinical and Therapeutic Aspects Posters (ACR): Imaging and Novel Clinical Interventions

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose:

Arthritis of the temporomandibular joint (TMJ) in patients with Juvenile Idiopathic Arthritis (JIA) is increasingly recognized. In the last decade, studies report that the frequency of TMJ involvement in JIA patients is between 45-100% depending on the population examined and the diagnostic tool used. The gold standard to diagnose TMJ arthritis is use of Gadolinium-enhanced MRI. Clinical symptoms have been shown to be unreliable for diagnosis of TMJ arthritis, however their usefulness in monitoring during the disease course needs to be determined. This study was undertaken by the Clinical Recommendation group of euroTMjoint, an international network established in 2010 to enhance mutidisciplinary, multicenter TMJ research in JIA. This study describes the reliability and reproducibility of a clinical tool that can be implemented in any practitioner.

Methods:

A clinical tool was developed based on the results of a Delphi study and expert panel. The examined tool items were: TMJ pain reported by patient; TMJ tenderness on palpation; mandibular deviation at maximal mouth opening; maximal mouth opening capacity; vertical incisal overlap; frontal facial asymmetry; facial profile. 33 patients with JIA were examined eight times, twice by four independent examiners; 2 pediatric rheumatologists and 2 orthodontists with experience in clinical examination. An independent experienced orthodontist instructed all examiners on the use of the recommendation tool. The examiners were blinded to each other’s results.

Results:

The time to perform the examination differed significantly between investigators irrespective of their professional background (median 89-179 sec, p<0.0001), however all examiners were able to perform the exam within the 3 minutes limit. The intra- and inter-agreement was lower for questions, such as absence or present of pain, than objective measurements. Comparing pediatric rheumatologists with the more experienced orthodontists revealed a high reproducibility for the measurement items maximal mouth opening and vertical incisal overlap (Spearman rho respectively 0.81 and 0.55), indicating these items can be used by inexperienced examiners after instructions. Frontal facial asymmetry showed the least reproducibility among the items (kappa 0,23).

Conclusion:

Clinical signs and symptoms of TMJ arthritis remain controversial for diagnostic purposes; however this study does show a fair to moderate agreement for all items and a moderate to almost perfect agreement for the measured items. This study shows the possible applicability of this tool in the rheumatology clinic during the course of the disease.

Disclosure: B. Koos, None; P. Stoustrup, None; L. R. Spiegel, None; N. Tzaribachev, Pfizer, UCB and Roche, 2; T. Herlin, None; T. K. Pedersen, None; M. Twilt, None.

To cite this abstract in AMA style:

Koos B, Stoustrup P, Spiegel LR, Tzaribachev N, Herlin T, Pedersen TK, Twilt M. Clinical Examination of the Temporomandibular Joint; A Eurotmjoint Initiative [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/clinical-examination-of-the-temporomandibular-joint-a-eurotmjoint-initiative/. Accessed .

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