Remote physical examination for temporomandibular disorders

Exposto, Fernando G; Castrillon, Eduardo E; Exposto, Cristina R; Costa, Dyna Mara F; Gøkhan, Muhammed A; Svensson, Peter; Costa, Yuri M

ABSTRACT: There is a need to further develop telemedicine approaches due to the immediate and perhaps long-term consequences of the coronavirus disease 2019. Thus, a remote protocol for assessment of patients with temporomandibular disorders (TMD) was developed, and the agreement of this protocol was compared to the guidelines of the diagnostic criteria for temporomandibular disorders (DC/TMD). A total of 16 individuals were first assessed by a reference standard examination (RSE) and three other examinations applied in a random order by three examiners: standard physical examination (standard examination), physical examination keeping 2 m distance (physical distanced examination) and examination done with the aid of video communication technology (video communication examination). The primary outcomes were the diagnoses of myalgia of the masseter and temporalis muscles, and arthralgia. The diagnoses of intra-articular joint disorders were considered secondary outcomes because of less impact on psychosocial functioning and quality of life when compared with the pain-related diagnoses. The Fleiss kappa coefficient and its 95% confidence interval were computed to determine the level of agreement in diagnoses between each examination protocol and the RSE. There was substantial to almost perfect agreement between the RSE and all the examination protocols for the diagnoses of myalgia (0.86 to 1.00) and arthralgia (0.86 to 0.87) (p<0.001). On the other hand, there was an overall poor agreement (0.30 to 0.58) between the RSE and all the protocols for the diagnosis of disc displacement with reduction. Remote assessment of patients with pain-related TMD is feasible and presents a high degree of accuracy.