Validation of clinical tests for patients with long-lasting painful temporomandibular disorders with anterior disc displacement without reduction

Objective: To evaluate the validity of single clinical tests and cluster of tests used to identify anterior disc displacement without reduction (ADDWOR).

Methods: Treatment-seeking patients with temporomandibular pain and limited mouth-opening were recruited among patients from health-professionals in the region of Oslo in 2012. Thirty-five persons, aged 18-70 years, with 58 symptomatic joints or pain in surrounding area were included. The examinations were performed by one experienced manual therapist. Magnetic resonance imaging (MRI) was used as reference standard. Sensitivity, specificity, false positive, false negative and likelihood-ratios (LRs) with 95% confidence intervals (CIs) were calculated for single and cluster of tests. Receiver Operating Curve - ROC analysis were used to see how well pain provocation tests discriminated between positive and negative ADDWOR.

Results: The main result is that a cluster of 7 clinical tests (5 positive) can be used to diagnose ADDWOR with an accuracy of 71%. The dental stick test is the best single test with equal sensitivity as the cluster, but with lower specificity.

Conclusion: To reveal ADDWOR in patients with TMD, we recommend using the cluster of the dental stick test, the isometric test, the joint provocation test, the joint sound test, the deviation test, the laterotrusion test and joint mobility test.

Practice and implications: The tests require no advanced equipment, they are easy to perform and suitable for use in clinical settings. MRI can be seen as more of a supplement to the clinical tests than a necessity to start a clinical intervention.