THE RELIABILITY OF CLINICAL METHODS FOR RECORDING TEMPOROMANDIBULAR-JOINT SOUNDS

Measurement errors in recording temporomandibular joint sounds may ori ginate from variation between observers and from variation in the phen omenon. Laboratory settings enable various procedures to be used to mi nimize both sources of variation. These procedures yield some excellen t intra- and inter-examiner reliabilities, but this does not imply tha t dentists in a clinical setting are likely to evaluate temporomandibu lar joint sounds in a comparable way. This study was designed to evalu ate clinical joint sound assessment methods (palpation and stethoscopy ) without using special precautions to minimize variance. An attempt w as made to quantify the signal variance. Within- and between-examiners agreement is estimated for both methods in a sample of 44 non-patient s. The results show that two clinically experienced craniomandibular d isorders specialists were able to reach fair to good agreement on the identification of (the number of) temporomandibular joint sounds. Ther e was some disagreement with respect to the number of reciprocal click s. Compared with the palpation technique, stethoscopy is more sensitiv e, especially with regard to crepitation. Based on the electronically recorded sounds, both examiners appeared to be overconsistent. It is c oncluded that the use of both palpation and stethoscopy in clinical se ttings can be justified but that both methods have limitations. When, in a given clinical setting, these limitations are acceptable, there a ppears to be no need for extra-sensitive but expensive electronic reco rding devices.