Clinical evaluation of temporomandibular disorders in children and adolescents: a review of the literature.

AIM The abbreviation TMD (temporomandibular disorders) has been used to signify the variety of symptoms, signs and combinations that have often been assigned to the TMJ (temporomandibular joint) and its related structures (muscles, bone and facial structures). The prevalence of temporomandibular disorders in children and adolescents varies widely in literature. The most common signs and symptoms of TMD are: temporomandibular joint sounds, impaired movement of the mandible, limitation in mouth opening, preauricolar pain, facial pain, headaches and jaw tenderness on function. Many studies have shortcomings in their method of assessing or measuring TMD: the problem is probably due to the fact that temporomandibular disorders have multiple aetiological factors. The aim of this article is a review of the literature about the diagnostic procedures used to assess signs and symptoms of temporomandibular disorders in children and adolescents. MATERIALS AND METHODS Literature was searched using Medline, Embase, and Cochrane Library from 1992 to February 2008. Only articles written in English were included in the study. The key words and mesh used were: temporomandibular disorders, mandibular dysfunction, children, adolescents. The inclusion criteria were: symptoms and signs of TMD, questionnaire, clinical protocol examination. Clinical studies as well as cross-sectional studies, longitudinal and epidemiological researches were considered. The articles reviewed were grouped according to the diagnostic procedure used. RESULTS Out of the 37 articles selected, the Helkimo Clinical Dysfunction Index was used in 6 studies (16.22%), the CMI Index in 1 (2.70%), the RCD/TMD in 9 (24.33%) and a clinical protocol examination in 21 (56.75%) articles. CONCLUSION The review of the literature shows that clinical examination protocols without reproducible items and a measurable and reproducible classification into diagnostic subgroups was the type of investigation used in most of the cases. This ended in a multitude of different results depending on the criteria used and the method of data collection. Such methodological problems should be acknowledged in studies relating to TMD in order to obtain a reliable diagnostic procedure.