Correspondence between Temporomandibular Disorder Symptoms and Clinical Examination Findings

측두하악장애 환자에서 주관적 증상과 임상검사 소견 간의 일치성

  • Im, Yeong-Gwan (Department of Oral Medicine, School of Dentistry, Chonnam National University) ;
  • Baek, Hey-Sung (Department of Pediatrics, School of Medicine, Hanyang University) ;
  • Kim, Byung-Gook (Department of Oral Medicine, School of Dentistry, Chonnam National University)
  • 임영관 (전남대학교 치의학전문대학원 구강내과학교실) ;
  • 백혜성 (한양대학교 의과대학 소아청소년과학교실) ;
  • 김병국 (전남대학교 치의학전문대학원 구강내과학교실)
  • Received : 2010.02.03
  • Accepted : 2010.02.26
  • Published : 2010.03.30


Objectives: This study aimed to assess the characteristics of temporomandibular disorder (TMD) symptoms and to determine the correspondence between TMD symptoms and clinical examination findings. Material and methods: A total of 218 patients (143 females and 75 males; age=$31.3{\pm}14.0$) were enrolled in this study who completed a questionnaire and underwent a clinical examination and radiographic assessment. Patients were asked about all the symptoms and complaints, including onset or duration, and locations of the symptoms. Clinical examination included amounts of mouth opening, palpable temporomandibular joint (TMJ) sounds, and tenderness to palpation of the TMJ and all masticatory muscles. Tenderness scores obtained from palpation of the masticatory system were summated to define the variables for further analysis. Results: Pain was the most frequently reported symptom (78.9%), followed by joint sounds (45.4%), and limitation in mouth opening (17.0%). Jaw pain comprised 91.9% of pain complaints. The subjective intensity of jaw pain was low to medium in most patients (93.7%), but it was poorly correlated with the sum of tenderness scores of the TMJ and masticatory muscles (Kendall tau = 0.084). In contrast, the side in which pain was reported by patients was well associated with the clinical examination results (pain of the right side, p < 0.001, and left side, p < 0.001). There was moderate agreement in TMJ sounds between the side identified by patients as symptomatic and clinical examination findings (kappa = 0.482). Finally, patients who complained of restricted mouth opening showed about a 10 mm less opening in all three measurements, compared to other patients (p < 0.001). Conclusion: The most frequent symptoms reported by TMD patients were jaw pain, TMJ sounds, and mouth opening limitation. The side of jaw pain, the side of TMJ sounds, and the presence of opening limitation were highly concordant between symptom reports and examination findings.

목적: 측두하악장애 환자에서 다양한 증상의 양상을 평가하고, 측두하악장애 증상과 임상검사 소견 간의 일치 정도를 평가하고자 하였다. 재료 및 방법: 총 218명의 환자(여자 143명, 남자 75명, 평균 연령 $31.3{\pm}14.0$세)를 대상으로 하였으며, 설문지 작성, 임상검사 및 방사선 검사를 수행하였다. 증상의 발생 시기 및 위치를 포함하여 주소와 관련된 모든 증상을 문진하였다. 임상검사로는 개구량 측정, 악관절 잡음 촉진, 악관절 및 저작근 촉진 검사를 하였다. 촉진에 의한 압통검사 결과수치를 이용하여 압통점수합을 구하였다. 결과: 통증이 가장 흔한 증상이었으며(78.9%), 다음으로 악관절 잡음(45.4%), 그리고 개구 제한(17.0%) 순으로 흔하였다. 턱의 통증이 통증 증상 부위의 91.9%를 차지하였다. 주관적인 턱의 통증 강도는 대부분의 환자에서 낮거나 중등도였으며 (93.7%), 이것과 악관절과 저작근의 압통 점수 합과의 상관성은 낮았다(Kendall tau = 0.084). 이와 대조적으로 환자가 보고하는 통증의 좌우측 위치는 임상검사 결과와 관련성이 높았다(우측 통증 p<0.001, 좌측 통증 p<0.001). 악관절 잡음은 환자가 증상으로 인지하는 측과 임상검사 소견 간에 상당한 일치를 보였다(kappa = 0.482). 개구제한을 호소하는 환자는 세가지 개구량 측정값 모두에서 그렇지 않은 환자보다 약 10 mm가 적은 개구량을 보였다(p<0.001). 결론: 턱의 통증, 악관절 잡음 및 개구제한은 측두하악장애 환자의 주소와 관련된 주요한 증상이었다. 환자가 보고하는 통증 부위와 악관절 잡음 및 개구제한이 임상검사 결과와 중등도 내지 높은 일치성을 보임으로서 가장 신뢰할 만한 항목으로 평가되었다.


  1. McNeill C. Temporomandibular Disorders. Guidelines for Classification, Assessment and Management. London: The Academy of Orofacial Pain, Quintessence, 1993.
  2. Kohler AA, Helkimo AN, Magnusson T, Hugoson A. Prevalence of symptoms and signs indicative of temporomandibular disorders in children and adolescents. A cross-sectional epidemiological investigation covering two decades. Eur Arch Paediatr Dent 2009;10 Suppl 1:16-25.
  3. Nilsson IM. Reliability, validity, incidence and impact of temporormandibular pain disorders in adolescents. Swed Dent J Suppl 2007:7-86.
  4. Choi YS, Choung PH, Moon HS, Kim SG. Temporomandibular disorders in 19-year-old Korean men. J Oral Maxillofac Surg 2002;60:797-803.
  5. Gesch D, Bernhardt O, Alte D, Schwahn C, Kocher T, John U, et al. Prevalence of signs and symptoms of temporomandibular disorders in an urban and rural German population: results of a population-based Study of Health in Pomerania. Quintessence Int 2004;35:143-150.
  6. Schiffman EL, Fricton JR, Haley DP, Shapiro BL. The prevalence and treatment needs of subjects with temporomandibular disorders. J Am Dent Assoc 1990; 120:295-303.
  7. Nassif NJ, Al-Salleeh F, Al-Admawi M. The prevalence and treatment needs of symptoms and signs of temporomandibular disorders among young adult males. J Oral Rehabil 2003;30:944-950.
  8. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992;6:301-355.
  9. Kleinknecht RA, Mahoney ER, Alexander LD, Dworkin SF. Correspondence between subjective report of temporomandibular disorder symptoms and clinical findings. J Am Dent Assoc 1986;113:257-261.
  10. Cooper BC, Kleinberg I. Examination of a large patient population for the presence of symptoms and signs of temporomandibular disorders. Cranio 2007;25:114-126.
  11. Hesse JR, van Loon LA, Naeije M. Subjective pain report and the outcome of several orthopaedic tests in craniomandibular disorder patients with recent pain complaints. J Oral Rehabil 1997;24:483-489.
  12. Wanman A, Agerberg G. Relationship between signs and symptoms of mandibular dysfunction in adolescents. Community Dent Oral Epidemiol 1986;14:225-230.
  13. Winocur E, Littner D, Adams I, Gavish A. Oral habits and their association with signs and symptoms of temporomandibular disorders in adolescents: a gender comparison. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:482-487.
  14. de Felicio CM, Melchior Mde O, Ferreira CL, Da Silva MA. Otologic symptoms of temporomandibular disorder and effect of orofacial myofunctional therapy. Cranio 2008;26:118-125.
  15. Lam DK, Lawrence HP, Tenenbaum HC. Aural symptoms in temporomandibular disorder patients attending a craniofacial pain unit. J Orofac Pain 2001; 15:146-157.
  16. Nilsson IM, List T, Drangsholt M. The reliability and validity of self-reported temporomandibular disorder pain in adolescents. J Orofac Pain 2006;20:138-144.
  17. Travell JG. Myofascial Trigger Points: Clinical View. In: Bonica JJ, Albe-Fessard D (eds). Advances in Pain Research and Therapy. New York: Raven Press, 1976:919-926.
  18. Jacobs JW, Geenen R, van der Heide A, Rasker JJ, Bijlsma JW. Are tender point scores assessed by manual palpation in fibromyalgia reliable? An investigation into the variance of tender point scores. Scand J Rheumatol 1995;24:243-247.
  19. Benoliel R, Sharav Y. Tender muscles and masticatory myofascial pain diagnosis: how many or how much? J Orofac Pain 2009;23:300-301.
  20. Langemark M, Olesen J. Pericranial tenderness in tension headache. A blind, controlled study. Cephalalgia 1987;7:249-255.
  21. Inoue E, Maekawa K, Minakuchi H et al. The relationship between temporomandibular joint pathosis and muscle tenderness in the orofacial and neck/shoulder region. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:86-90.
  22. Gallo LM, Svoboda A, Palla S. Reproducibility of temporomandibular joint clicking. J Orofac Pain 2000;14:293-302.
  23. Leader JK, Boston JR, Rudy TE, Greco CM, Zaki HS. The influence of mandibular movements on joint sounds in patients with temporomandibular disorders. J Prosthet Dent 1999;81:186-195.
  24. Okeson JP. Signs and symptoms of temporomandibular disorders. Management of Temporomandibular Disorders and Occlusion. St. Louis: Mosby, 2003:191- 234.