TMJ pain and dysfunction: relation between clinical and radiographic findings in the short and long-term

Clinical examination of the stomatognathic system and radiographic examination of the temporomandibular joints (TMJ), including the submentovertical, the oblique lateral transcranial and the transmaxillary projections, were performed in 104 patients with TMJ pain/dysfunction. Seven years later these patients had a new clinical examination and 54 of them were radiographed again. Another 20 patients not primarily radiographed were also recalled after 7 yr and examined clinically and radiographically. The radiographic findings were correlated with the reported symptoms and clinical findings. Only a few statistically significant correlations were found. The initial clinical dysfunction, estimated with the aid of the Helkimo dysfunction index, was positively correlated with the radiographic findings at the follow-up. The most important clinical variables in this respect were tenderness to palpation of the joint and decreased mobility. Crepitation was associated with changes in the structure and shape of the condyle. Clicking was correlated with a posterior displacement of the condyle. The number of occluding pairs of teeth was related to changes in the TMJ structure and shape also when age was considered as a confounding factor. Radiographic changes of the TMJ develop late and are often absent in the acute phase. An early radiographic examination is therefore of less diagnostic importance in this respect, but serves the purpose of excluding other pathologic conditions.