Smallest detectable difference of maximal mouth opening in patients with painfully restricted temporomandibular joint function
Abstract
Changes in maximal mouth opening reflect the impact of temporomandibular disorders and the effect of a therapeutic intervention. No information about the amount of change in maximal mouth opening with regard to reasoned decision-making is available. The smallest detectable difference, as a measure of reliability assessment, provides this information and is expressed in the unit of the measurement instrument. Twenty-five consecutive patients (5 males, 20 females) with a painfully restricted temporomandibular joint participated in this study. Measurements of maximal mouth opening were performed by two well-trained observers on two separate measurement days, one week apart. The maximal mouth opening measurements were repeated three times. Inter-observer, intra-observer, and test-retest reliability varied between 0.90 and 0.96. Inconsistency in measurement results analyzed in terms of absolute error variance, i.e. the measurement facets plus all the interactions, represented 11% of total variance. The smallest detectable difference of maximal mouth opening varied from 9 to 6 mm. For being successful in painfully restricted temporomandibular joint patients, statistically as well as clinically, the clinician has to measure at least 9 mm of improvement in maximal mouth opening. To reduce the smallest detectable difference from 9 to 6 mm, repeated measurement is necessary.
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In the study of Kropmans et al., improvement in the pain status was deemed significant when the pain was reduced by at least 1.90 points.
“In that study improvement in the pain status was deemed significant when the pain was reduced by at least 1.90 points [36].”
Maximal mouth opening using a range of motion scale demonstrates good inter-rater reliability and intra-rater reliability.
“Maximal mouth opening using a ROM scale demonstrates good inter-rater reliability and intra-rater reliability,29,30 and the MCID for MMO is ∼2.5 mm.31”
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Cook, J., Hislop, J., Adewuyi, T., Harrild, K., Altman, D., Ramsay, C., Fraser, C., Buckley, B., Fayers, P., Harvey, I., et al. (2014) · Health Technology Assessment · doi:10.3310/hta18280 · Cited by 194 · see citing works
Kalamir, A., Graham, P. L., Vitiello, A. L., Bonello, R., & Pollard, H. (2013) · Chiropractic & Manual Therapies · doi:10.1186/2045-709x-21-17 · Cited by 76 · see citing works
Lam, A. C., Liddle, L. J., & MacLellan, C. L. (2023) · Archives of Rehabilitation Research and Clinical Translation · doi:10.1016/j.arrct.2022.100242 · Cited by 14 · see citing works
Aklar, A., Bal, B., Taşdelen, N., İnal, H. S., & Ertaş, G. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14082544 · Cited by 2 · see citing works
“In that study improvement in the pain status was deemed significant when the pain was reduced by at least 1.90 points [36].”
Influential
- Authors
- Kropmans, T., Dijkstra, P., Stegenga, B., Stewart, R., & De Bont, L.
- Affiliations
- University Medical Center Groningen (NL)
- University of Groningen (NL)
- Venue
- European Journal of Oral Sciences
- Publisher
- Wiley
- Published
- 2000-02
- Volume
- 108
- Issue
- 1
- Pages
- 9-13
- ISSN
- 0029-845X (ISSN-L)
- 0909-8836
- 1600-0722
- OpenAlex
- W2066250672
- Cited by
- 77
- References
- 0
- Citations by year
- 2026: 9 · 2025: 6 · 2024: 9 · 2023: 3 · 2022: 4 · 2021: 5 · 2020: 5 · 2019: 2 · 2018: 2 · 2016: 2 · 2015: 3 · 2014: 7 · 2013: 3 · 2012: 4
- FWCI
- 0.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal Of Oral Sciences (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Topics
- Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Reliability and Agreement in Measurement
- Health Sciences › Dentistry › Orthodontics › Orthodontics and Dentofacial Orthopedics
- Keywords
- temporomandibular disorders, maximum mouth opening, minimal detectable change, measurement reliability, inter-rater reliability, intra-rater reliability, test-retest reliability, treatment outcome assessment
- MeSH terms
- Adult, Analysis of Variance, Female, Humans, Male, Pain Measurement, Temporomandibular Joint Disorders, Reproducibility of Results, Linear Models, Range of Motion, Articular, Outcome Assessment, Health Care, Statistics, Nonparametric
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