Impact of TMJ radiographs on clinician decision making.

Objectives: This study examined the influence of lateral and frontal temporomandibular joint tomograms on the initial diagnosis and treatment plan of patients having facial or preauricular pain or temporomandibular joint disorders.

Study Design: Five or six general dentists, all with experience in treating patients with disorders of the temporOmandibular joint, examined records of 105 patients from a university-based orofacial pain clinic. The examiners proposed a diagnosis and treatment plan for each patient without the benefit of tomograms. They then repeated this procedure after study of the radiographs. The impact of the radiographs was measured as the change in pre- versus postradiographic diagnosis and treatment plan.

Results: The availability of temporomandibular joint tomograms changed or modified diagnosis in 65% of the judgments and influenced treatment recommendations in 40%. These changes were substantive for 21% of the diagnoses and 22% of the treatment plans. The strongest correlation to changes in both diagnosis and treatment plan was with radiographic detection of osseous changes. New information about condyle position had less effect on clinical decisions.

Conclusions: These findings indicate that temporomandibular joint tomograms play a valuable role in influencing clinician's diagnosis and treatment plan of patients with disorders of the temporomandibular joint.