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Dysfunction Indices for Disorders of Temporomandibular Joint and Masticatory System

Purpose: To determine dysfunction from a disorder of the masticatory system including the temperomandibular joint (TMJ) using the indices of Helkimo.

Description

Helkimo developed two indices for evaluating dysfunction associated with disorders of the masticatory system, include disorders of the temporomandibular joint (TMJ). The author was from the University of Goteborg in Sweden.


 

Indices:

(1) anamnestic (patient recall)

(2) clinical dysfunction

 

Subjective Symptoms of Anamnestic Dysfunction

Index

none (no subjective symptoms)

Ai0

mild symptoms

AiI

severe symptoms

AiII

 

where:

• Mild symptoms include (a) TMJ clicks or crepitation (b) feeling of stiffness or fatigue in the jaws

• Severe symptoms include difficulty in opening the mouth wide, locking, luxation, pain on movement, facial pain, jaw pain.

 

Parameters for the clinical dysfunction score:

(1) range of movement or mobility

(2) TMJ function

(3) muscle pain (tenderness on palpation of the masticatory muscles)

(4) TMJ pain (tenderness on palpation of the TMJ)

(5) pain on movement of the mandible

Parameter

Finding

Points

range of motion or mobility

normal range of motion

0

 

slightly impaired mobility

1

 

severely impaired mobility

5

TMJ function

smooth movement without TMJ joint sounds and deviation on opening or closing < 2 mm

0

 

TMJ sounds in one or both joints and/or deviation >= 2 mm on opening or closing movements

1

 

locking and/or luxation of the TMJ

5

muscle pain

no tenderness on palpation

0

 

tenderness at 1 to 3 palpation sites

1

 

tenderness at 4 or more palpation sites

5

TMJ pain

no tenderness to palpation

0

 

tenderness on palpation laterally

1

 

tenderness on palpation posteriorly

5

pain on movement of the mandible

none

0

 

pain on one movement

1

 

pain on two or more movements

5

 

where:

• It would be simple to modify the table to include moderate findings scored at 3 points.

 

dysfunction score =

= SUM(points for all 5 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 25

• The higher the score, the greater the dysfunction.

 

Dysfunction Score

Dysfunction Group

0

0

1 to 4

1

5 to 9

2

10 to 13

3

15 to 17

4

20 to 25

5

 

 

Dysfunction Index

Dysfunction Groups

Dysfunction Level

Di0

0

symptom free (none)

DiI

1

mild

DiII

2

moderate

DiIII

3, 4 or 5

severe

 


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Specialty

Objective

ICD-10