The validity of clinical examination for diagnosing anterior disk displacement with reduction

Objective. The objective of this study was to evaluate the diagnostic accuracy of a clinical examination for diagnosing anterior disk displacement with reduction. Study Design. A series of 273 consecutive patients with temporomandibular disorders were clinically examined according to well-defined criteria. The patients were examined for clicking by digital palpation during maximal mouth opening and closing (the Clicking test). When clicking was identified, two additional tests were performed: one determined whether the clicking was eliminated at a protruded position, and the other determined whether the clicking became louder when the patient's mandible was manipulated toward the eminences. Bilateral magnetic resonance images were subsequently obtained from all patients; the clinical examination findings were then compared to the imaging-based diagnoses of the temporomandibular joint status to assess the diagnostic accuracy of the clinical findings. Results. Although the predictability of identifying anterior disk displacement with reduction by clicking was relatively low, it increased to an acceptable level when the additional tests were used. The overall accuracy for the Clicking test combined with either of the other tests was about 90%. Conclusion. Our results suggest that anterior disk displacement with reduction can be diagnosed with considerable accuracy through the use of a clinical examination only.