Reliability and diagnostic validity of joint vibration analysis
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The use of electronic devices for the diagnosis of temporomandibular disorders (TMD) has been a subject of controversy for decades. Methodological limitations of the existing body of literature led to the current American Association of Dental Research (AADR) policy statement which reports that none of the current technological devices show the sensitivity and specificity required to separate normal subjects from TMD patients or can distinguish among types of TMD. This observational study was designed to evaluate the clinical reliability and diagnostic validity of the Joint Vibration Analysis (JVA) in patients with disc displacement with reduction. Subjects who had undergone a magnetic resonance imaging (MRI) for their temporomandibular joints (TMJs) within the last two years were recruited. The JVA was used to record two tracings from each individual at an interval of 30 minutes apart to determine the short term reliability of the vibration phenomenon. In order to assess the diagnostic validity, MRI was used as the reference standard. The short term reliability of the JVA outcome variables showed excellent results, the Intraclass correlation coefficients (ICCs) ranged from 0.63 to 0.90. A sensitivity of 48% and specificity of 94% was obtained for the correct identification of subjects with and without disc displacement with reduction. Based on high specificity, the JVA instrument is able to identify the normal joints. It has the potential to be used in the selection of patients that do not need further TMJ imaging of the soft tissues. This would reduce the associated costs to the healthcare system and the concomitant discomfort to the patient. In addition, at the research level, this instrumentation could be useful to monitor the joint status in order to evaluate the clinical course of disc displacements and what impact they have on in jaw function.