Evaluation of temporomandibular joint sounds. Diagnostic analysis and clinical implications

This literature review and survey highlights the controversies surrounding the significance of joint sounds in general, the problems and pitfalls of joint sound analysis and interpretation, and the degree of importance given peripheral and temporomandibular joint sounds by physicians and dentists. The instrumentation and devices currently proposed for use in the detection and interpretation of joint sounds may not meet the standards of validity, reliability, sensitivity, and specificity, and as pointed out by one investigator, "The only objectivity currently associated with these instruments is their ability to record sounds of undetermined origin." In addition, no solid evidence is available that these particular sounds, when detected, are both repeatable over time and distinctly characteristic for particular disorders or significant pathologic changes. Some degree of caution should be used, therefore, when interpreting joint sounds in the absence of significant signs and symptoms of temporomandibular disorders. The clinical significance of these same sounds may become more or less apparent relative to the information obtained in a comprehensive temporomandibular disorder evaluation and examination including both subjective and objective pain assessments, mandibular range of motion measurements, and the interpretation of radiologic findings.