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Background: Conduct a systematic review and meta-analysis on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts., Methods: A panel of experts convened by the American Dental Association Council on Scientific Affairs conducted a search of PubMed (MEDLINE) and Embase for randomized controlled trials of SRP with or without the use of adjuncts with clinical attachment level (CAL) outcomes in trials at least 6 months in duration and published in English through July 2014. The authors assessed individual study bias by using the Cochrane Risk of Bias Tool and conducted meta-analyses to obtain the summary effect estimates and their precision and to assess heterogeneity. The authors used funnel plots and Egger tests to assess publication bias when there were more than 10 studies. The authors used a modified version of the US Preventive Services Task Force methods to assess the overall level of certainty in the evidence., Results: The panel included 72 articles on the effectiveness of SRP with or without the following: systemic antimicrobials, a systemic host modulator (subantimicrobial-dose doxycycline), locally delivered antimicrobials (chlorhexidine chips, doxycycline hyclate gel, and minocycline microspheres), and a variety of nonsurgical lasers (photodynamic therapy with a diode laser, a diode laser, neodymium:yttrium-aluminum-garnet lasers, and erbium lasers)., Conclusions and Practical Implications: With a moderate level of certainty, the panel found approximately a 0.5-millimeter average improvement in CAL with SRP. Combinations of SRP with assorted adjuncts resulted in a range of average CAL improvements between 0.2 and 0.6 mm over SRP alone. The panel judged the following 4 adjunctive therapies as beneficial with a moderate level of certainty: systemic subantimicrobial-dose doxycycline, systemic antimicrobials, chlorhexidine chips, and photodynamic therapy with a diode laser. There was a low level of certainty in the benefits of the other included adjunctive therapies. The panel provides clinical recommendations in the associated clinical practice guideline., (Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Introduction: Pain present six months following root canal treatment (RCT) may be either of odontogenic or non-odontogenic origin. This is important because treatments and prognoses are different; therefore, the aim of this study was to provide specific diagnoses of patients reporting pain six months after receiving initial orthograde RCT., Methods: We enrolled patients from the Midwest region of an existing prospective observational study of pain after RCT. Pain at six months was defined as ≥ 1 day of pain and average pain intensity of at least 1/10 over the preceding month. An endodontist and an orofacial pain practitioner independently performed clinical evaluations, which included periapical and cone-beam computed tomograph (CT) radiographs, to determine diagnoses., Results: Thirty-eight out of the 354 eligible patients in the geographic area (11%) met the pain criteria, with 19 (50%) consenting to be clinically evaluated. As the sole reason for pain, 7 patients (37%) were given odontogenic diagnoses (4 involving the RCT tooth, 3 involving an adjacent tooth). Eight patients (42%) were given non-odontogenic pain diagnoses (7 from referred temporomandibular disorder [TMD] pain, 1 from persistent dentoalveolar pain disorder [PDAP]). Two patients (11%) had both odontogenic and non-odontogenic diagnoses, while 2 (11%) no longer fit the pain criteria at the time of the clinical evaluation., Conclusion: Patients reporting "tooth" pain 6 months following RCT had a non-odontogenic pain diagnosis accounting for some of this pain, with TMD being the most frequent non-odontogenic diagnosis. Dentists should have the necessary knowledge to differentiate between these diagnoses to adequately manage their patients.

Objectives: Parafunctional habits such as clenching or grinding (bruxism) during daytime and at night are considered to have a great impact on the etiopathogenesis of temporomandibular disorders (TMD). However, the size of the effect and how daytime activities interact with nocturnal activities is not yet clear. The aim of this study was to assess the association of TMD pain with both awake and sleep bruxism in adults., Materials and Methods: In this case-control study, data of a consecutive sample of 733 TMD patients (cases; mean age ± SD: 41.4 ± 16.3 years; 82% women) with at least one pain-related TMD diagnosis according to the German version of the Research Diagnostic Criteria for TMD (RDC/TMD) and of a community-based probability sample of 890 subjects (controls; mean age ± SD: 40.4 ± 11.8 years; 57% female) without TMD were evaluated. Clenching or grinding while awake and/or asleep was assessed with self-reports. Association of TMD pain with awake and sleep bruxism was analyzed using multiple logistic regression analyses and controlled for potential confounders. Odds ratios (OR) with corresponding 95% confidence intervals (CI) were calculated., Results: While 11.2% of the controls reported clenching or grinding while awake, this proportion was significantly higher in TMD patients (33.9%; p < 0.001). Nocturnal clenching or grinding was reported by 23.5% of the controls and 49.4% of the TMD patients (p < 0.001). Risk for TMD pain did not differ substantially for the separate reports of awake (OR 1.7; CI 1.0-2.7) or sleep bruxism (OR 1.8; CI 1.4-2.4). However, risk for TMD pain substantially increased in cases of simultaneous presence of awake and sleep bruxism (OR 7.7; CI 5.4-11.1)., Conclusion: When occurring separately, awake and sleep bruxism are significant risk factors for TMD pain. In case of simultaneous presence, the risk for TMD pain is even higher.

Background: A panel of experts convened by the American Dental Association Council on Scientific Affairs presents an evidence-based clinical practice guideline on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts., Methods: The authors developed this clinical practice guideline according to the American Dental Association's evidence-based guideline development methodology. This guideline is founded on a systematic review of the evidence that included 72 research articles providing clinical attachment level data on trials of at least 6 months' duration and published in English through July 2014. The strength of each recommendation (strong, in favor, weak, expert opinion for, expert opinion against, and against) is based on an assessment of the level of certainty in the evidence for the treatment's benefit in combination with an assessment of the balance between the magnitude of the benefit and the potential for adverse effects., Practical Implications and Conclusions: For patients with chronic periodontitis, SRP showed a moderate benefit, and the benefits were judged to outweigh potential adverse effects. The authors voted in favor of SRP as the initial nonsurgical treatment for chronic periodontitis. Although systemic subantimicrobial-dose doxycycline and systemic antimicrobials showed similar magnitudes of benefits as adjunctive therapies to SRP, they were recommended at different strengths (in favor for systemic subantimicrobial-dose doxycycline and weak for systemic antimicrobials) because of the higher potential for adverse effects with higher doses of antimicrobials. The strengths of 2 other recommendations are weak: chlorhexidine chips and photodynamic therapy with a diode laser. Recommendations for the other local antimicrobials (doxycycline hyclate gel and minocycline microspheres) were expert opinion for. Recommendations for the nonsurgical use of other lasers as SRP adjuncts were limited to expert opinion against because there was uncertainty regarding their clinical benefits and benefit-to-adverse effects balance. Note that expert opinion for does not imply endorsement but instead signifies that evidence is lacking and the level of certainty in the evidence is low., (Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Introduction: Pain present 6 months after root canal treatment (RCT) may be of odontogenic or nonodontogenic origin. This is important because treatments and prognoses are different; therefore, the aim of this study was to provide specific diagnoses of patients reporting pain 6 months after receiving initial orthograde RCT., Methods: We enrolled patients from the Midwest region of an existing prospective observational study of pain after RCT. Pain at 6 months was defined as ≥1 day of pain and average pain intensity of at least 1 of 10 over the preceding month. An endodontist and an orofacial pain practitioner independently performed clinical evaluations, which included periapical and cone-beam computed tomographic radiographs, to determine diagnoses., Results: Thirty-eight of the 354 eligible patients in the geographic area (11%) met the pain criteria, with 19 (50%) consenting to be clinically evaluated. As the sole reason for pain, 7 patients (37%) were given odontogenic diagnoses (4 involving the RCT tooth and 3 involving an adjacent tooth). Eight patients (42%) were given nonodontogenic pain diagnoses (7 from referred temporomandibular disorder pain and 1 from persistent dentoalveolar pain disorder). Two patients (11%) had both odontogenic and nonodontogenic diagnoses, whereas 2 (11%) no longer fit the pain criteria at the time of the clinical evaluation., Conclusions: Patients reporting "tooth" pain 6 months after RCT had a nonodontogenic pain diagnosis accounting for some of this pain, with temporomandibular disorder being the most frequent nonodontogenic diagnosis. Dentists should have the necessary knowledge to differentiate between these diagnoses to adequately manage their patients., (Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

The aim of this study was to determine the association between more advanced stages of temporomandibular joint (TMJ) intra-articular disorders ("TMJ intra-articular status"), representing a transition from normal joint structure to TMJ disc displacement with and without reduction (DDwR and DDwoR) to degenerative joint disease (DJD), and patient-reported outcomes of jaw pain, function, and disability ("TMD impact"). This cross-sectional study included 614 cases from the RDC/TMD Validation Project with at least one temporomandibular disorder (TMD) diagnosis. TMJ intra-articular status was determined by 3 blinded, calibrated radiologists using magnetic resonance imaging and computed tomography as one of normal joint structure, DDwR, DDwoR, or DJD, representing the subject's most advanced TMJ diagnosis. TMD impact was conceptualized as a latent variable consisting of 1) pain intensity (Characteristic Pain Index from the Graded Chronic Pain Scale [GCPS]), 2) jaw function (Jaw Functional Limitation Scale), and 3) disability (Disability Points from GCPS). A structural equation model estimated the association of TMJ intra-articular status with the latent measure TMD impact as a correlation coefficient in all TMD cases (n = 614) and in cases with a TMD pain diagnosis (n = 500). The correlations between TMJ intra-articular status and TMD impact were 0.05 (95% confidence interval [CI], -0.04 to 0.13) for all TMD cases and 0.07 (95% CI, -0.04 to 0.17) for cases with a pain diagnosis, which are neither statistically significant nor clinically relevant. Conceptualizing worsening of TMJ intra-articular disorders as 4 stages and characterizing impact from TMD as a composite of jaw pain, function, and disability, this cross-sectional study found no clinically significant association. Models of TMJ intra-articular status other than ours (normal structure → DDwR → DDwoR → DJD) should be explored., (© International & American Associations for Dental Research.)

Objectives: Treatment effects should be large and long-lasting. The aim of this study was to describe for patients treated with fixed dental prostheses (FDP), removable dental prostheses (RDP), and complete dentures (CD) how they perceived their oral health over a period of two years using the concept oral health-related quality of life (OHRQoL)., Methods: In this prospective clinical study, a consecutive sample of 272 adult patients receiving prosthodontic treatment was recruited. The Oral Health Impact Profile (OHIP-G) was used at baseline before prosthodontic treatment, 4-6 weeks, and 6, 12, 18, and 24 months after therapy. The OHRQoL of the prosthodontic patients were compared with findings from a general population-based study (N=811), and OHRQoL changes were compared to the minimal important difference of the OHIP., Results: At baseline, mean OHIP sum score was 31.1 points, indicating substantially lower OHRQoL than for general population subjects. After a substantial treatment-induced drop of OHRQoL impairment in all treatment groups, OHIP scores increased slowly, but did not reach pretreatment levels after 24 months. While full treatment effect was already present 4-6 weeks after treatment in the FDP and RDP groups, OHRQoL improvement continued until the 12-month assessment in the CD group. When follow-up OHIP scores of the entire sample were compared to baseline scores, all changes were statistically significant, but the magnitude exceeded the OHIP's MID (6 points) only in the assessments at 4-6 weeks, 6 months, and 12 months., Conclusion: Effects of prosthodontic interventions on patients' perception seem to last for at least 2 years., Clinical Significance: Taking into consideration that prosthodontic treatment is only one factor for the oral health of a patient, prosthodontic rehabilitation seems to have a substantial influence on a patient's oral health trajectory., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Purpose: Prosthodontic treatment has a positive effect on oral health-related quality of life (OHRQoL); however, there is a paucity of studies assessing the impact of OHRQoL based on where in the mouth ("location") the treatment is performed. This exploratory study investigated the association of the location (anterior, posterior region) of prosthodontic treatment with magnitude and nature of OHRQoL changes., Methods: In this non-randomized prospective clinical study, 190 adult patients (17-83 years) were recruited at baseline and 104 were available for the follow-up analyses. Of those, 50 patients received treatment only in the posterior segment and 54 patients in both anterior and posterior regions. Treatment included conventional fixed partial prostheses, removable prostheses or a combination of both. OHRQoL was assessed with the German language version of the 49-item Oral Health Impact Profile (OHIP) at baseline and the questionnaire was repeated 4-6 weeks post-treatment. Magnitude and effect size of changes in summary and sub-scale scores were calculated and data analyzed., Results: Patients experienced a substantially impaired OHRQoL (mean OHIP score: 32.3 points) at baseline and an improvement in OHRQoL of 6.8 OHIP points following treatment. This study showed a greater improvement in OHRQoL in patients treated in both regions compared to those treated in the posterior region alone, especially in the function and aesthetic domains., Conclusions: This explorative study suggests that OHRQoL improvement is affected by where prosthodontic treatment is performed in the mouth. Greater understanding of qualitative aspects of reconstructive therapies is needed for improved treatment planning and patient consent., (Copyright © 2014 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.)

Aims: The original Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms have been demonstrated to be reliable. However, the Validation Project determined that the RDC/TMD Axis I validity was below the target sensitivity of ≥ 0.70 and specificity of ≥ 0.95. Consequently, these empirical results supported the development of revised RDC/TMD Axis I diagnostic algorithms that were subsequently demonstrated to be valid for the most common pain-related TMD and for one temporomandibular joint (TMJ) intra-articular disorder. The original RDC/TMD Axis II instruments were shown to be both reliable and valid. Working from these findings and revisions, two international consensus workshops were convened, from which recommendations were obtained for the finalization of new Axis I diagnostic algorithms and new Axis II instruments., Methods: Through a series of workshops and symposia, a panel of clinical and basic science pain experts modified the revised RDC/TMD Axis I algorithms by using comprehensive searches of published TMD diagnostic literature followed by review and consensus via a formal structured process. The panel's recommendations for further revision of the Axis I diagnostic algorithms were assessed for validity by using the Validation Project's data set, and for reliability by using newly collected data from the ongoing TMJ Impact Project-the follow-up study to the Validation Project. New Axis II instruments were identified through a comprehensive search of the literature providing valid instruments that, relative to the RDC/TMD, are shorter in length, are available in the public domain, and currently are being used in medical settings., Results: The newly recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for detecting any pain-related TMD as well as valid diagnostic criteria for differentiating the most common pain-related TMD (sensitivity ≥ 0.86, specificity ≥ 0.98) and for one intra-articular disorder (sensitivity of 0.80 and specificity of 0.97). Diagnostic criteria for other common intra-articular disorders lack adequate validity for clinical diagnoses but can be used for screening purposes. Inter-examiner reliability for the clinical assessment associated with the validated DC/TMD criteria for pain-related TMD is excellent (kappa ≥ 0.85). Finally, a comprehensive classification system that includes both the common and less common TMD is also presented. The Axis II protocol retains selected original RDC/TMD screening instruments augmented with new instruments to assess jaw function as well as behavioral and additional psychosocial factors. The Axis II protocol is divided into screening and comprehensive self report instrument sets. The screening instruments' 41 questions assess pain intensity, pain-related disability, psychological distress, jaw functional limitations, and parafunctional behaviors, and a pain drawing is used to assess locations of pain. The comprehensive instruments, composed of 81 questions, assess in further detail jaw functional limitations and psychological distress as well as additional constructs of anxiety and presence of comorbid pain conditions., Conclusion: The recommended evidence-based new DC/TMD protocol is appropriate for use in both clinical and research settings. More comprehensive instruments augment short and simple screening instruments for Axis I and Axis II. These validated instruments allow for identification of patients with a range of simple to complex TMD presentations.

Previous exploratory analyses suggest that the Oral Health Impact Profile (OHIP) consists of four correlated dimensions and that individual differences in OHIP total scores reflect an underlying higher-order factor. The aim of this report is to corroborate these findings in the Dimensions of Oral Health-Related Quality of Life (DOQ) Project, an international study of general population subjects and prosthodontic patients. Using the project's Validation Sample (n = 5022), we conducted confirmatory factor analyses in a sample of 4993 subjects with sufficiently complete data. In particular, we compared the psychometric performance of three models: a unidimensional model, a four-factor model and a bifactor model that included one general factor and four group factors. Using model-fit criteria and factor interpretability as guides, the four-factor model was deemed best in terms of strong item loadings, model fit (RMSEA = 0·05, CFI = 0·99) and interpretability. These results corroborate our previous findings that four highly correlated factors - which we have named Oral Function, Oro-facial Pain, Oro-facial Appearance and Psychosocial Impact - can be reliably extracted from the OHIP item pool. However, the good fit of the unidimensional model and the high interfactor correlations in the four-factor solution suggest that OHRQoL can also be sufficiently described with one score., (© 2014 John Wiley & Sons Ltd.)

Aims: To assess whether trait anxiety as a person's general disposition to be anxious is a risk factor for temporomandibular disorder (TMD) pain., Methods: A total of 320 adult TMD patients with at least one pain-related TMD diagnosis according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were included in the study. Subjects from the general population without pain-related TMD were used as controls (n = 888). All study participants completed the State-Trait Anxiety Inventory (STAI). The association between the level of trait anxiety (STAI-Trait scores) and case-control status (patients diagnosed with pain-related TMD and controls) was analyzed using logistic regression analysis. Odds ratios (OR) with 95% confidence intervals (CI) were computed., Results: The level of trait anxiety was associated with the subject status (case vs control). A one-point increase in STAI-Trait sum scores (range: 20 to 80) was related to an increase of the odds for pain-related TMD by the factor 1.04 (CI: 1.02-1.05; P < .001). Severe trait anxiety (above the 90th percentile of general-population subjects) doubled the odds (OR: 2.05; CI: 1.42-2.98; P < .001). Analyses adjusted for age, gender, and level of education did not change the results., Conclusion: Trait anxiety is significantly associated with diagnoses of TMD pain.

Although oral health-related quality of life (OHRQoL) as measured by the Oral Health Impact Profile (OHIP) is thought to be multidimensional, the nature of these dimensions is not known. The aim of this report was to explore the dimensionality of the OHIP using the Dimensions of OHRQoL (DOQ) Project, an international study of general population subjects and prosthodontic patients. Using the project's Learning Sample (n = 5173), we conducted an exploratory factor analysis on the 46 OHIP items not specifically referring to dentures for 5146 subjects with sufficiently complete data. The first eigenvalue (27·0) of the polychoric correlation matrix was more than ten times larger than the second eigenvalue (2·6), suggesting the presence of a dominant, higher-order general factor. Follow-up analyses with Horn's parallel analysis revealed a viable second-order, four-factor solution. An oblique rotation of this solution revealed four highly correlated factors that we named Oral Function, Oro-facial Pain, Oro-facial Appearance and Psychosocial Impact. These four dimensions and the strong general factor are two viable hypotheses for the factor structure of the OHIP., (© 2014 John Wiley & Sons Ltd.)

We reported the development and psychometric evaluation of a Swedish 14-item and a five-item short form of the Oral Health Impact Profile. The 14-item version was derived from the English-language short form developed by Slade in1997. The five-item version was derived from the German-language short form developed by John et al. in 2006. Validity, reliability and normative values for the two short form summary scores were determined in a random sample of the adult Swedish population (response rate: 46%, N = 1366 subjects). Subjects with sufficient OHRQoL information to calculate a summary score (N = 1309) were on average 50·1 ± 17.4 years old, and 54% were women. Short form summary scores correlated highly with the 49-item OHIP-S (r ≥ 0.97 for OHIP-S14, r ≥ 0.92 for OHIP-S5) and with self-report of oral health (r ≥ 0.41). Reliability, measured with Cronbach's alpha (0.91 for OHIP-S14, 0.77 for OHIP-S5), was sufficient. In the general population, 50% of the subjects had ≥2 OHIP-S14 score points and 10% had ≥11 points, respectively. Among subjects with their own teeth only and/or fixed dental prostheses and with partial removable dental prostheses, 50% of the population had ≥2 OHIP-S14 score points, and 10% had ≥11 points. For subjects with complete dentures, the corresponding figures were 3 and 24 points. OHIP-S5 medians for subjects in the three population groups were 1, 1 and 2 points. Swedish 14-item and 5-item short forms of the OHIP have sufficient psychometric properties and provide a detailed overview about impaired OHRQoL in Sweden. The norms will serve as reference values for future studies., (© 2014 John Wiley & Sons Ltd.)

The literature presents conflicting findings on whether health-related quality of life (HRQoL) measures have sufficient evaluative properties to assess changes caused by dental interventions. The aim of our study was to compare sensitivity to change in HRQoL and OHRQoL in prosthodontic patients. In this prospective intervention study, a total of 165 consecutively recruited patients completed the Short Form-36 (SF-36) and the 49-item Oral Health Impact Profile (OHIP), as self-administered questionnaires, before prosthodontic treatment and 1 month after treatment was finished. Differences in SF-36 and OHIP scores between baseline and follow up were tested for statistical significance using paired t-tests. Effect sizes (Cohen's d) were calculated. Health-related quality of life improved during prosthodontic treatment, indicated by a slight, but statistically significant, increase in the SF-36 physical component (difference: 1.0 points), whereas perceived mental health did not change substantially (difference: −0.5 points). Improvement in OHRQoL (difference in OHIP sum score: −6.7 points) was statistically significant. Although the OHIP effect size (of 0.2) was considered as small, according to guidelines, it was greater than for the SF-36 component scores (physical: 0.1; mental: 0.1). Sensitivity to change in quality of life measures was greater for OHRQoL than for HRQoL, limiting the usefulness of HRQoL as an outcome measure in dentistry.

This study reports the findings and challenges of the assessment of oro-facial aesthetics in the Swedish general population and the development of normative values for the self-reporting Orofacial Esthetic Scale (OES). In a Swedish national sample of 1406 adult subjects (response rate: 47%), OES decile norms were established. The influence of sociodemographics (gender, age, and education), oral health status and general health status on OES scores was analysed. Mean ± standard deviation of OES scores was 50.3 ± 15.6 units (0, worst score; 70, best score); <1% of the subjects had the minimum score of 0, and 11% had the maximum score of 70 OES units. Orofacial Esthetic Scale score differences were (i) substantial (>5 OES units) for subjects with excellent/very good versus good to poor oral or general health status; ii) small (2 units), but statistically significant for gender (P = 0.01) and two age groups (P = 0.02), and (iii) absent for subjects with college versus no college education (P = 0.31) or with and without dentures (P = 0.90). To estimate normative values for a self-reporting health status, instrument is considered an important step in standardisation, and the developed norms provide a frame of reference in the general population to interpret the Orofacial Esthetic Scale scores., (© 2013 John Wiley & Sons Ltd.)

Background: This study assessed the dimensional structure of sleep quality with the Pittsburgh Sleep Quality Index (PSQI) and investigated its psychometric properties in cases with temporomandibular disorders (TMD)., Methods: A convenience sample of 609 TMD cases (age: 37.1 ± 13.1 yrs, 18-67 yrs, 85% female) of the multi-center Validation Project meeting Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and with sufficient PSQI data were included in this study. To investigate PSQI scores' dimensionality, exploratory factor analysis was used. Factors were identified using the Scree plot. To investigate internal consistency, Cronbach's alpha was calculated. Analyses were separately performed for TMD cases with (N = 496) and TMD cases withouta pain-related diagnosis (N = 113)., Results: The mean PSQI score for all TMD cases was 7.1 ± 4.0 units, range: 0-19. The exploratory factor analysis identified one factor for cases with at least one pain-related TMD diagnosis as well as one factor for cases with a pain-free TMD diagnosis that explained 41% of the variance in cases with pain-related TMD and 37% in cases with pain-free TMD. Internal consistency for PSQI scores was alpha of 0.75 in cases with pain-related TMD, alpha of 0.66 in cases with pain-free TMD and alpha = 0.75 for all TMD cases., Conclusions: Sleep quality in TMD patients is a unidimensional construct and can therefore be represented by one summary score; a finding that is in line with previous reports in TMD patients.

Purpose: A desideratum of oral health-related quality of life (OHRQoL) instruments - such as the Oral Health Impact Profile (OHIP) - is that they accurately reflect the structure of the measured construct(s). With this goal in mind, the Dimensions of Oral Health-Related Quality of Life (DOQ) Project was proposed to investigate the number and nature of OHRQoL dimensions measured by OHIP. In this report, we describe our aggregate data set for the factor analyses in the project, which consists of responses to the 49-item OHIP from general population subjects and prosthodontics patients from 6 countries, including a large age range of adult subjects and both genders., Materials and Methods: The DOQ Project's aggregate data set combines data from 35 individual studies conducted in Croatia, Germany, Hungary, Japan, Slovenia, and Sweden., Results: The combined data set includes 10778 OHIPs from 9348 individuals (N=6349 general population subjects, N=2999 prosthodontic patients). To elucidate the OHIP latent structure, the aggregated data were split into a Learning Sample (N=5173) for exploratory analyses and a Validation Sample (N=5022) for confirmatory analyses. Additional data (N=583) were assigned to a third data set., Conclusion: The Dimensions of Oral Health-Related Quality of Life Project contains a large amount of international data and is representative of populations where OHIP is intended to be used. It is well-suited to assess the dimensionality of the questionnaire., (Copyright © 2013 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.)

Aims: To build an understanding of the patient's experience and from this identify recurring themes that could form part of an item pool for further testing of persistent dentoalveolar pain disorder (PDAP)., Methods: Proven cases of PDAP were identified from a clinical database, and a purposive maximum variation sample was drawn. Semi-structured interviews were conducted with the sample by a single trained interviewer. Interviews were digitally recorded and transcribed verbatim. Data collection and analysis occurred until data saturation (n = 20), with no new themes emerging. Analysis of the data was an iterative and inductive process broadly following the principles of the constant comparative method., Results: Recurrent themes emerging from the data were: difficulty in responding to history taking; duration and magnitude of pain; complex and confounding descriptors; common exacerbating factor; well-localized pain; deep pain; pressurized or pressure feeling., Conclusion: Several common experiences that can be considered items were identified in the data. These items will add to the limited pre-existing item pool in the literature and allow testing of this item pool to determine those items best suited to form an adjunctive self-report diagnostic instrument for PDAP.

Objectives: Psychosocial assessment needs to be integrated into the diagnosis of chronic pain conditions; however, it is not clear how this assessment should be performed with minimal patient and health care provider burden. The aim of this study was to assess the diagnostic accuracy of a single-item questionnaire to detect psychosocial distress in temporomandibular disorder (TMD) patients., Methods: Presence of psychosocial distress was measured in 126 TMD patients using Research Diagnostic Criteria for TMD Axis II measures (depression, somatization, dysfunctional chronic pain). A newly developed single-item questionnaire served as a test to detect psychosocial distress. The association between the presence of distress and test results was analyzed using generalized linear models (GLM). Diagnostic accuracy of the one-item test was assessed., Results: The GLM revealed a statistically significant association between the presence of psychosocial distress and a positive test result (p < 0.001). Psychosocially distressed patients were 70 % more likely to indicate psychosocial distress in the single-item questionnaire than patients without distress. However, diagnostic test accuracy of the single-item questionnaire was low (sensitivity 73.0 %, specificity 55.7 %). The resulting positive likelihood ratio (1.65) indicated that the single-item test is an inadequate measure for detecting psychosocial distress., Conclusions: The single-item questionnaire was not sufficiently accurate for detecting TMD patients' psychosocial distress and may therefore not be useful as an assessment tool for the various dimensions of psychosocial distress in TMD patients., Clinical Relevance: Health care providers should not trust in TMD patients' responses to a single question regarding psychosocial distress. Nevertheless, this questionnaire may constitute a first step into a more profound patient-provider communication on psychological issues relevant to TMD.

Objectives: The aim of this study was to determine the magnitude of the association between perceived oral and general health-related quality of life (O/HRQoL) in the German general population and to compare it with the correlation of both constructs in dental patients., Methods: OHRQoL was assessed using the OHIP-49 and HRQoL using the SF-36 in a sample (N=811) representative of the adult general population of Germany (age: 18-99 years), and in a sample (N=313) of consecutive adult dental patients at least 18 years of age seeking prosthodontic care or attending their annual checkup. Correlation between OHRQoL and HRQoL was computed using structural equation modelling-based confirmatory factor analysis and path analysis. Based on the correlation coefficients, the coefficients of determination (r(2)) were calculated., Results: Correlation between OHRQoL and HRQoL after partialling out effects of age, gender and level of depression in general population subjects was rho=0.28 resulting in an explanation of the variance of HRQoL by OHRQoL of 7.8%. In dental patients the correlation coefficient was somewhat lower (rho=0.24) corresponding to an explanation of the variance of HRQoL by OHRQoL of 5.6%. Difference between correlation coefficients was not significant (p=0.514)., Conclusion: Our findings provide evidence for the inseparable, intertwined relationship between perceived oral and general health., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objectives: To investigate the impact of chronic periodontitis on oral health-related quality of life (OHRQoL) using the full version of the Oral Health Impact Profile (OHIP-49) and the Oral Health Quality of Life-UK (OHQoL-UK) questionnaires., Methods: 89 patients with chronic periodontitis and 89 age- and gender-matched patients without chronic periodontitis were recruited. OHIP-49 and OHQoL-UK were self-completed by participants and mean scores were calculated for each item, domain and the overall summary score (additive method) for each instrument in each group., Results: The mean age of participants was 47 ± 9 years, and the periodontitis patients had, on average, 33 ± 23 sites demonstrating probing depths ≥ 5 mm. OHRQoL was significantly poorer in the periodontitis patients compared to the periodontally healthy patients, when assessed by either instrument. When considering OHIP-49, fourteen of the forty-nine items indicated significantly poorer OHRQoL in the periodontitis group, and the overall OHIP-49 summary score was 48.6 ± 32.0 for periodontitis patients compared to 36.8 ± 29.8 in periodontally healthy patients (p<0.01). When considering OHQoL-UK, fifteen of the sixteen items indicated significantly poorer OHRQoL in the periodontitis group, and the overall OHQoL-UK summary score was 47.1 ± 9.7 for periodontitis patients compared to 53.1 ± 11.3 in periodontally healthy patients (p<0.01). Overall, those items with the greatest differences between periodontitis patients and the healthy group related to psychological concerns, halitosis, pain and aesthetics., Conclusion: Subjects with periodontitis report substantial functional, physical, psychological, and social OHRQoL impacts., Clinical Significance: This study has identified that patients with chronic periodontitis report significantly poorer oral health-related quality of life (OHRQoL) than age- and gender-matched periodontally healthy patients, with significant functional, social and psychological impacts. Clinicians should be aware of the impacts that periodontitis may have on OHRQoL, including psychological concerns, halitosis, pain and aesthetics., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: Interpretation of scores from oral health-related quality of life (OHRQoL) instruments, such as the Oral Health Impact Profile (OHIP) is challenging. It was the aim of this study to determine how many oral impacts correspond to one point of the 49-item OHIP using a new approach which translates numeric problem counts into the traditionally used ordinal OHIP response categories., Methods: A sample of 145 consecutively recruited prosthodontic patients seeking treatment or having a routine examination completed the German version of the 49-item OHIP with the original ordinal response format as a self-administered questionnaire. In addition, the numerical frequencies of impairment during the previous month were requested in personal interviews. Based on a multilevel mixed-effects linear regression, we estimated the mean difference with 95% confidence interval (CI) in numerical frequency between two adjacent ordinal responses., Results: A numerical frequency of 15.2 (CI: 14.8 - 15.7) impacts per month corresponded to one OHIP point. This translates to approximately one impact every other day in the past month., Conclusions: The oral problem count per day that corresponds to one OHIP-49 point can be used to interpret this instrument's scores in cross-sectional and longitudinal studies. This number can help to better understand OHRQoL burden for patients, clinicians, and researchers alike.

The assessment of changes in oral health-related quality of life (OHRQoL) is challenging because individuals' concepts and internal standards of OHRQoL may change over time. The aim of this study was to detect response shifts in OHRQoL assessments made using the Oral Health Impact Profile (OHIP). Oral health-related quality of life was assessed in a consecutive sample of 126 patients seeking prosthodontic care. Patients were asked to rate their OHRQoL before treatment started and 1 month after treatment was finished, using the German 49-item version of the OHIP. When rating their OHRQoL after treatment, patients were also asked to rate their pre-treatment OHRQoL without having access to their baseline data. The response shift was calculated as the difference in OHIP summary scores between the initial assessment and the retrospective baseline assessment. The OHIP mean scores decreased from 31.8 at the initial baseline assessment to 24.4 after treatment. The retrospective baseline assessment resulted in an OHIP mean score of 38.1, corresponding to a response shift of 6.3 OHIP points. The effect size (Cohen's d = 0.21) of the response shift was considered small. The response shift phenomenon and its magnitude have important implications for dental practice, where patients and dentists often assess perceived treatment effects retrospectively., (© 2012 Eur J Oral Sci.)

Background: The Orofacial Esthetic Scale (OES) is an eight-item instrument to assess how patients perceive their dental and facial esthetics. In this cross-sectional study we investigated dimensionality, reliability, and validity of OES scores in the adult general population in Sweden., Methods: In a random sample of the adult Swedish population (response rate: 39%, N=1159 subjects, 58% female, mean age (standard deviation): 49.2 (17.4) years), dimensionality of OES was investigated using factor analytic methods to determine how many scores are needed to characterize the construct. Reliability of scores was calculated using Cronbach's alpha. Score validity was determined by correlating the OES summary score with a global indicator of orofacial esthetics (OE)., Results: Factor analyses provided support that a single score can sufficiently characterize OE. A Cronbach's alpha of 0.93 indicated excellent reliability. A validity coefficient of r=0.89 (95% confidence interval: 0.87-0.90) indicated that OES summary scores correlated highly with a global OE assessment., Conclusions: The OES is a promising instrument to measure the construct OE. Factor analyses supported that this construct can be assessed with one score, offering a feasible and acceptable standardized assessment of OE. The present study extends the OES use to the general population, an important target population for assessment of orofacial esthetics.

Aims: We assessed and compared the diagnostic accuracy of two sets of diagnostic criteria for headache secondary to temporomandibular disorders (TMD)., Methods: In 373 headache subjects with TMD, a TMD headache reference standard was defined as: self-reported temple headache, consensus diagnosis of painful TMD and replication of the temple headache using TMD-based provocation tests. Revised diagnostic criteria for Headache attributed to TMD were selected using the RPART (recursive partitioning and regression trees) procedure, and refined in half of the data set. Using the remaining half of the data, the diagnostic accuracy of the revised criteria was compared to that of the International Headache Society's International Classification of Headache Diseases (ICHD)-II criteria A to C for Headache or facial pain attributed to temporomandibular joint (TMJ) disorder., Results: Relative to the TMD headache reference standard, ICHD-II criteria showed sensitivity of 84% and specificity of 33%. The revised criteria for Headache attributed to TMD had sensitivity of 89% with improved specificity of 87% (p < 0.001). These criteria are (1) temple area headache that is changed with jaw movement, function or parafunction and (2) provocation of that headache by temporalis muscle palpation or jaw movement., Conclusion: Having significantly better specificity than the ICHD-II criteria A to C, the revised criteria are recommended to diagnose headache secondary to TMD.

Aims: To test whether patients with temporomandibular disorder (TMD) pain differ from subjects from the general population with regard to their stress-related coping styles., Methods: Consecutive adult TMD patients (n = 70) and adult subjects of a regional general population sample (n = 868), examined according to the German version of the Research Diagnostic Criteria for TMD (RDC/TMD), were included in this study. The inclusion criterion for TMD patients was at least one pain-related diagnosis according to the RDC/ TMD, while general-population subjects were excluded if they had any pain-related TMD diagnosis. Coping styles were assessed using a common and well-accepted German 114-item stress-coping questionnaire ("Stressverarbeitungsfragebogen" SVF 114). The coping style-TMD pain relationship was investigated using logistic regression analyses adjusted for possible confounders (age, sex, level of education), as well as the influence of psychosocial measures (RDC/TMD Axis II). Odds ratios (OR) with 95% confidence intervals (CI) were calculated., Results: Study participants who used fewer adaptive coping styles (OR = 0.47, CI: 0.26-0.83) and more maladaptive coping styles (OR = 1.55, CI: 1.05-2.29) were at greater risk for TMD pain. After adjustment for sociodemographic confounders, the coping style-TMD pain relationship changed only slightly in magnitude. In an analysis adjusted for sociodemographic confounders and psychosocial RDC/TMD Axis II measures, adaptive coping styles were even more profoundly related to TMD pain (OR: 0.27, 95 CI: 0.09-0.83), but maladaptive coping styles were less related to TMD pain (OR: 1.17, 95% CI: 0.51-2.72)., Conclusion: Differences in the applied stress-related coping styles of TMD patients and subjects without TMD may have implications for clinical decision making and choosing among treatment alternatives.

Aims: To investigate the relationship of headache frequency with patient-reported physical functioning and emotional functioning in temporomandibular disorder (TMD) subjects with concurrent temple headache., Methods: The Research Diagnostic Criteria for TMD (RDC/TMD) Validation Project identified, as a subset of 614 TMD cases and 91 controls (n = 705), 309 subjects with concurrent TMD pain diagnoses (RDC/TMD) and temple headache. The temple headaches were subdivided into infrequent, frequent, and chronic headache according to the International Classification of Headache Disorders, second edition (ICHD-II). Study variables included self-report measures of physical functioning (Jaw Function Limitation Scale [JFLS], Graded Chronic Pain Scale [GCPS], Short Form-12 [SF-12]) and emotional functioning (depression and anxiety as measured by the Symptom Checklist-90R/SCL-90R). Differences among the three headache subgroups were characterized by increasing headache frequency. The relationship between ordered headache frequency and physical as well as emotional functioning was analyzed using linear regression and trend tests for proportions., Results: Physical functioning, as assessed with the JFLS (P < .001), SF-12 (P < .001), and GCPS (P < .001), was significantly associated with increased headache frequency. Emotional functioning, reflected in depression and anxiety, was also associated with increased frequency of headache (both P < .001)., Conclusion: Headache frequency was substantially correlated with reduced physical functioning and emotional functioning in subjects with TMD and concurrent temple headaches. A secondary finding was that headache was precipitated by jaw activities more often in subjects with more frequent temple headaches.

The aims of this study were to develop a German version of the Child Perceptions Questionnaire (CPQ11-14, a measure of oral health-related quality of life in 11-14-year-old children) and to assess the instrument's reliability and validity in German children ages 11-14. The English original version of the CPQ11-14 questionnaire was translated into German (CPQ-G11-14) by a forward-backward translation method. Reliability was investigated in 1,061 subjects aged 11-14 years from a regional sample (Wernigerode, Saxonia-Anhalt, Germany) who were recruited during the annual dental public health examination. The subjects completed the CPQ-G11-14 and were clinically examined for the presence of dental caries, plaque accumulation, and malocclusion. In the reliability assessment, questionnaire summary score test-retest reliability was excellent (intraclass correlation coefficient, 95% confidence interval (CI) = 0.83, 0.73-0.94) and internal consistency was satisfactory (Cronbach's alpha, lower limit of CI = 0.87, 0.86). Validity of the CPQ-G11-14 questionnaire was supported by correlations with global ratings of oral health and overall well-being that were moderate in magnitude and met expectations (r = 0.35; 95% CI, 0.30-0.40 and r = 0.30; 95% CI, 0.24-0.35, respectively). In conclusion, the German version of the CPQ11-14 was reliable and valid in a general population of 11-14-year-old German children.

The aim of this study was to evaluate the psychometric characteristics of three versions of the Dutch Oral Health Impact Profile (OHIP-NL), for clinical use with temporomandibular disorder (TMD) patients. To that end, two abbreviated OHIP versions (OHIP-NL14 and OHIP-NL5) were developed by respectively selecting 14 and five items from the officially translated and culturally adapted original 49-item OHIP-NL questionnaire. A total of 245 consecutive patients, referred by their dentist to the TMD clinic of the Academic Centre for Dentistry Amsterdam (77% women; mean age ± s.d. = 41·0 ± 14·9 years), completed the Research Diagnostic Criteria for TMD (RDC/TMD) axis II questionnaire and the OHIP-NL. Reliability and validity of all three OHIP versions were compared, and their associations with four psychological axis II variables, indicating the level of impairment of patients with TMD, were examined. According to guidelines for clinical application, internal consistency scores were sufficient for OHIP-NL and OHIP-NL14, but insufficient for OHIP-NL5. Test-retest reliability (n = 64) was excellent for OHIP-NL and OHIP-NL14 and fair to good for OHIP-NL5. For all three versions, there was evidence for score validity: associations between OHIP summary scores on the one hand and validation variables and other RDC/TMD axis II variables on the other hand met the expectations and were statistically significant (P < 0·001). In conclusion, the OHIP-NL and OHIP-NL14 both performed comparatively well and better than the OHIP-NL5. When the length of the questionnaire (i.e. the time needed for its completion) is an issue, the OHIP-14 would therefore be the preferred version., (© 2011 Blackwell Publishing Ltd.)

The study investigated the validity of the response format of the Oral Health Impact Profile 49 (OHIP-49). The OHIP-49 was completed by 145 consecutive prosthodontic patients. For each OHIP item, subjects completed the standard ordinal response format (with responses given as never, hardly ever, occasionally, often, or very often, and scored from 0 to 4, respectively). Subjects also separately reported the absolute frequency of impacts for each item (numerical response format) in a personal interview. Response codes for the standard ordinal response format (0-4) and for the numerical response format were summed to give two separate OHIP summary scores. The reliability and validity of the scores generated from each response format were compared using the numerical response format as the standard. Score reliability was high and almost identical for both response formats. Score validity was also satisfactory with a high correlation of scores between response methods. There was also a moderate correlation of scores from both response methods with a single global rating of perceived oral health. These data support the validity of the standard ordinal response format of the OHIP and suggest the use of the numerical response format in order to help capture impacts on oral health when they are infrequent., (© 2011 Eur J Oral Sci.)

The present study examined the association of denture quality and health-related quality of life (HRQoL) in patients with removable dentures. In a study of 171 consecutive patients with removable partial dentures or complete dentures (mean age: 68·0 ± 9·3 years) at a university-based prosthodontic clinic, dentists rated two aspects of denture quality (stability and aesthetics) using a 100-mm visual analog scale (VAS). HRQoL was evaluated using the mental and physical component summary (MCS and PCS) scores of the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36). Oral health-related quality of life (OHRQoL) was evaluated using the Oral Health Impact Profile-Japanese version (OHIP-J). The associations among denture quality, OHRQoL, and HRQoL were examined by linear regression models. Bivariable linear regression analyses revealed that denture stability was significantly associated with the SF-36 MCS [regression coefficient = 0·52 for a 10-unit increase in denture stability on a 0-100 VAS, 95% confidence interval (CI): 0·03-1·00, P = 0·04], but not with the PCS (0·11, 95% CI: -0·49 to 0·70). Denture aesthetics was not related to the PCS or the MCS (0·22, 95% CI: -0·44 to 0·88 or 0·07, 95%CI: -0·47 to 0·62). When OHIP-J was added to the regression model, this variable was substantially and significantly associated with the MCS and PCS summary scores; in addition, the regression coefficient for denture quality decreased in magnitude and was statistically nonsignificant in all analyses. The quality of removable dentures had a minimal effect on HRQoL in patients with removable dentures, and this association was mediated by OHRQoL., (© 2011 Blackwell Publishing Ltd.)

Objective: The aim of this study was to determine the frequency of oral health-related quality of life (OHRQoL) impairment and to establish norm values for the German version of the Child Perceptions Questionnaire (CPQ-G11-14, 35 questions) in the general population aged 11 to 14 years., Subjects and Methods: Data were collected in a national survey (n=1,597, mean age: 12.5 ± 1.2 years, 49.3% female) and subjects sampled using a multistage technique. OHRQoL was measured with the CPQ-G11-14, which was presented in a personal interview. Norm values were computed for the CPQ-G11-14 summary score (simple sum of all item responses). The CPQ-G11-14 summary score distribution was described by empirical cumulative distribution functions. Because orthodontic treatment was closely associated with CPQ-G11-14 summary scores, percentile-based norms were stratified by this variable., Results: The CPQ-G11-14 mean was 12.6 ± 15.9 units. There was no influence of age (p>0.05) or gender (p>0.05) on the CPQ-G summary scores, but the summary scores varied according to orthodontic treatment status (p<0.001). Among the general population sample, CPQ-G11-14 scores of the 50% less-impaired subjects were ≤7. The same percentage of subjects undergoing orthodontic treatment had scores of ≤13 and those without orthodontic treatment had scores of ≤5. We observed scores of ≤32 points in 90% of the population. That figure was ≤50 points for subjects undergoing orthodontic treatment and ≤21 points for those without orthodontic treatment. The most frequent problems the children and adolescents reported (CPQ-G answers "often" and "very often") were "breathing through the mouth" (13.0%), "mouth sores" (4.4%) and "bad breath" (4.3%)., Conclusion: The norm values we present provide a frame of reference for future cross-sectional studies in the general population and in patient populations with specific oral conditions when measuring OHRQoL by CPQ-G11-14 in children and adolescents aged 11 to 14 years old.

Introduction: Dental pain originating from the maxillary sinuses can pose a diagnostic problem. Periapical lesion development eliciting inflammatory changes in the mucosal lining can cause the development of a sinusitis. The purpose of this study was to describe the radiographic characteristics of odontogenic maxillary sinusitis as seen on cone-beam computed tomography (CBCT) scans and to determine whether any tooth or any tooth root was more frequently associated with this disease., Methods: Eighty-two CBCT scans previously identified as showing maxillary sinus pathosis were examined for sinusitis of odontogenic origin in both maxillary sinuses., Results: One hundred thirty-five maxillary sinusitis instances with possible odontogenic origin were detected. Of these, 37 sinusitis occurrences were from nonodontogenic causes, whereas 98 instances were tooth associated with some change in the integrity of the maxillary sinus floor. The average amount of mucosal thickening among the sinusitis cases was 7.4 mm. Maxillary first and second molars were 11 times more likely to be involved than premolars, whereas either molar was equally likely to be involved. The root most frequently associated with odontogenic sinusitis is the palatal root of the first molar followed by the mesiobuccal root of the second molar., Conclusions: Changes in the maxillary sinuses appear associated with periapical pathology in greater than 50% of the cases. Maxillary first or second molar teeth are most often involved, and individual or multiple roots may be implicated in the sinusitis. The use of CBCT scans can provide the identification of changes in the maxillary sinus and potential causes of the sinusitis., (Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Background: The oral health of military populations is usually not very well characterized compared to civilian populations. The aim of this study was to investigate two physical oral health characteristics and one perceived oral health measure and their correlation in the Japan self-defense forces (JSDF)., Methods: Number of missing teeth, denture status, and OHRQoL as evaluated by the Japanese 14-item version of the Oral Health Impact Profile (OHIP-J14) as well as the correlation between these oral health measures was investigated in 911 personnel in the JSDF., Results: Subjects did not have a substantial number of missing teeth and only 4% used removable dentures. The mean OHIP-J14 score was 4.6 ± 6.7 units. The magnitude of the correlation between the number of missing teeth with OHIP-J14 scores was small (r = 0.22, p < 0.001). Mean OHIP-J14 scores differed between subjects with and without dentures (8.6 and 4.4, p < 0.001)., Conclusions: Compared to Japanese civilian populations, personnel of the JSDF demonstrated good oral health. Two physical oral health characteristics were associated with perceived oral health.

The study aimed to rank the Oral Health Impact Profile (OHIP-49) items by relevance to temporomandibular disorders (TMD). A modified version of the OHIP-49 was completed by 110 patients with TMD and by age- and gender-matched TMD-free individuals. Patients were diagnosed using the Research Diagnostic Criteria (RDC) for TMD. The modified OHIP included a reference to the 'jaw' and a 1-month reference period. The difference in item prevalence for problems reported fairly/very often (FOVO) between the two groups was calculated for each OHIP item. The FOVO prevalence differences were ranked to reveal the most relevant problems for TMD. Patients' total OHIP scores were higher (60.6, SD = 31.6) than those of controls (17.1, SD = 18.1). Patients scored higher on all items, with 41 items showing a statistically significant difference between the patient score and the control score. The patient-control difference in FOVO item prevalence varied considerably between different items, ranging from 1 to 67%. Substantial differences were noted between patients and controls for a number of specific items, including those relating to pain and physical impact. Smaller differences across most items were also noted, even those not expected to have an impact. The OHIP provides a starting point for a measure of TMD treatment outcome, once items less attributable to TMD are excluded., (© 2011 Eur J Oral Sci.)

The relationship of the frequency of temple headache to signs and symptoms of temporomandibular joint (TMJ) disorders (TMD) was investigated in a subset of a larger convenience sample of community TMD cases. The study sample included 86 painful TMD, nonheadache subjects; 309 painful TMD subjects with varied frequency of temple headaches; and 149 subjects without painful TMD or headache for descriptive comparison. Painful TMD included Research Diagnostic Criteria for Temporomandibular Disorders diagnoses of myofascial pain, TMJ arthralgia, and TMJ osteoarthritis. Mild to moderate-intensity temple headaches were classified by frequency using criteria based on the International Classification of Headache Disorder, 2nd edition, classification of tension-type headache. Outcomes included TMD signs and symptoms (pain duration, pain intensity, number of painful masticatory sites on palpation, mandibular range of motion), pressure pain thresholds, and temple headache resulting from masticatory provocation tests. Trend analyses across the painful TMD groups showed a substantial trend for aggravation of all of the TMD signs and symptoms associated with increased frequency of the temple headaches. In addition, increased headache frequency showed significant trends associated with reduced PPTs and reported temple headache with masticatory provocation tests. In conclusion, these findings suggest that these headaches may be TMD related, as well as suggesting a possible role for peripheral and central sensitization in TMD patients., (Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.)

Objectives: Prosthodontic treatment affects not only oral health, but also general health. However, whether prosthodontic patients actually perceive a change in their general health has not been well studied. This study aims to compare self-reported general-health status in patients before and after prosthodontic treatment., Methods: Self-reported general-health status was measured using a single-item questionnaire in a consecutive sample of 500 prosthodontic patients. Responses were recorded using a five-point scale ranging from "poor" to "excellent.", Results: After treatment, patients' self-reported general-health status was slightly but statistically significantly improved. Perceived general health improved in 2.3% of patients treated with fixed partial dentures, in 11.3% of patients treated with removable partial dentures, and in 4.1% of patients treated with complete dentures. Changes in self-reported general-health status were not related to age or gender., Conclusion: Prosthodontic treatment appears to have a positive effect on perceived general health., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Objectives: To describe the prevalence of impaired oral health-related quality of life (OHRQoL) in the adult Hungarian population and to determine population-based norms for three Hungarian versions of the Oral Health Impact Profile (OHIP-H)., Material and Methods: In a survey of 1059 randomly selected subjects, OHIP responses, age, gender, and denture status [natural dentition or fixed partial dentures (FPDs), removable partial dentures (RPDs), or complete dentures (CDs)] were collected. Study outcomes were item prevalence and OHIP summary score frequency ('norms')., Results: The prevalence of OHIP items ranged from 2% to 43%, with a mean item prevalence of 14%. The distribution of summary scores was characterized by decile norms. Median scores for OHIP-H49, the 49-item questionnaire, were 6 OHIP units for subjects with FPDs, 10 OHIP units for subjects with RPDs, and 6 OHIP units for subjects with CDs. The median scores were 0, 0, and 1 OHIP units for the 14-item OHIP-H, and 0, 0, and 0 OHIP units for the five-item OHIP-H., Conclusions: Our sample demonstrates substantial OHRQoL impact in the Hungarian general population. The derived norms provide a framework for interpretation of data in future studies using the Hungarian OHIP versions, as well as data on how oral conditions and cultural factors affect perceived oral health when compared with international findings.

A Dutch-language version of the Oral Health Impact Profile, a questionnaire by means of which the impact of oral health on the quality of life of patients can be determined, was developed and subsequently psychometrically tested among a group of patients with complaints concerning missing dentition or their dentures. In addition, a shortened version of this so-called OHIP-NL49, the OHIP-NL14, was psychometrically tested among a group of patients with temporomandibular disorders. The psychometrical characteristics of both the OHIP-NL49 and the OHIP-NL14 were very good: both the reliability and the validity were high. The conclusion was, that the OHIP-NL49 and the OHIP-NL14 are well suited for determining the impact of oral health on the quality of life.

The influence of the administration method used to collect oral health-related quality of life (OHRQoL) data is largely unknown. Therefore, the aim of this study was to determine whether OHRQoL information obtained using the Oral Health Impact Profile (OHIP) differed with different methods of collection (personal interview, via telephone or as a self-administered questionnaire). The OHRQoL was measured using the German version of the OHIP. The instrument was administered to each of 42 patients using three different methods, in a randomized order, about 1 wk apart. The test-retest reliability coefficient for the repeated OHIP assessment across the three methods of administration, and the magnitude of the variance component for administration method, were determined, characterizing the degree of OHIP score variation that is caused by this factor. Whereas OHIP mean score differences of 3.9 points were present between administration methods, the reliability coefficient of 0.90 (95% CI, 0.85-0.95) indicated that 90% of the OHIP score variation was caused by differences between subjects (and not by the administration method or measurement error). The variance component for administration method explained 0.5% of the OHIP score variation. In conclusion, the method of administration (personal interview, telephone interview or self-administered questionnaire) did not influence substantially OHIP scores in prosthodontic patients., (© 2011 Eur J Oral Sci.)

Article Title and Bibliographic Information: Facial trauma: how dangerous are skiing and snowboarding?. Tuli T, Haechl O, Berger N, Laimer K, Jank S, Kloss F, Brandstätter A, Gassner R. J Oral Maxillofac Surg 2010;68(2):293-9. REVIEWER NAME: Mike T. John, DDS, MPH, PhD., Purpose/question: To compare the prevalence of maxillofacial injury types in individuals who sustained snowboarding and skiing accidents., Source of Funding: Information not available., Type of Study/design: Retrospective case series., Level of Evidence: Level 2: Limited-quality, patient-oriented evidence., Strength of Recommendation Grade: Not applicable., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Background: Few methods exist to study central nervous system processes following dentoalveolar tactile stimulation using functional magnetic resonance imaging (fMRI), likely due to inherent technical difficulties. Our primary goal was to develop and perform feasibility testing of a novel device capable of delivering valid and reliable dentoalveolar stimuli at dental chair-side and during MRI. Details of a device designed to deliver dentoalveolar dynamic pressure stimuli are described. Device testing took place in three settings: a) laboratory testing to assess range of stimulus force intensities, b) dental chair-side to assess reliability, validity and discriminant ability in force-pain relationship; and c) MRI to evaluate magnetic compatibility and ability to evoke brain activation in painfree subjects similar to those described in the literature., Results: A novel device capable of delivering valid and reliable dentoalveolar somatosensory stimulation was developed (ICC = 0.89, 0.78-1 [95% CI]). Psychophysical data analysis showed high discriminant ability in differentiating painfree controls from cases with chronic dentoalveolar pain related to deafferenting dental procedures (sensitivity = 100%, specificity = 86.7%, area under ROC curve = 0.99). FMRI results of dentoalveolar dynamic pressure pain in painfree subjects revealed activation of brain areas typically associated with acute pain processing including thalamus, primary/secondary somatosensory, insular and prefrontal cortex., Conclusions: A novel psychophysical method to deliver dynamic dentoalveolar pressure stimulation was developed and validated, allowing non-invasive MRI-based exploration of central nervous system function in response to intraoral somatosensation., Background: The organization of the trigeminal system is unique as it provides somatosensory innervation to the face, masticatory and oral structures, the majority of the intracranial contents 1 and to specialized structures (tongue, nasal mucosa, auricle, tympanic membrane, cornea and part of the conjunctiva) 2. Somatic sensory information transmitted by the trigeminal nerve is crucial for normal orofacial function; however, the mechanisms of many chronic pain conditions affecting areas innervated by this sensory system are not well understood 345. The clinical presentation of chronic intraoral pain in the area of a tooth or in a site formally occupied by a tooth with no clinical or radiological signs of pathology, referred to as atypical odontalgia (AO) 67, is one such chronic pain condition of particular interest to dentists that is difficult to diagnose and manage. Recent research suggests both peripheral and central nervous system mechanisms being involved in AO pathophysiology 8910, but the majority of mechanism-based research of patients with AO has focused on the "peripheral aspect" 7.Functional magnetic resonance imaging (fMRI) is an established research technique to study the central aspects of pain 11. Of existing neuroimaging techniques, fMRI provides good spatial resolution of cortical and subcortical structures critical in the processing of nociception, acceptable temporal resolution, does not involve ionizing radiation, and can be performed using most MRI systems that already exist in research centers and the community. For these reasons, we sought to develop a protocol that allows us to use this tool to investigate the central mechanisms involved in the processes of intraoral pain arising from the dentoalveolar region. Using this device, our long-term objective is to improve our understanding of the underlying mechanisms of persistent dentoalveolar pain.In the past few years several studies used fMRI to investigate the human trigeminal system 1213, with a limited subset focusing on intraoral stimulation - specifically on the dentoalveolar processes, such as lip, tongue and teeth stimulation 14 or only teeth 151617. Some reasons for scarce literature on this topic may be the technical challenges involved in delivering facial/intraoral stimulation inside a MR scanner 1718: possibility of magnetic interference, detriment of image quality, subject discomfort and reduced working space between the subject's head and the radiofrequency coil. As a consequence a MR-compatible device would need to not only overcome these challenges but also be capable of delivering a controlled and reproducible stimuli 19, as reliability/reproducibility is a necessary feature of sensory testing 20.Existing MR-compatible methods of dentoalveolar stimulation are limited and do not adequately deliver stimuli across a range of non-painful to painful intensities and/or cannot be adjusted to reach posterior aspects of the dentoalveolar region. Therefore our goal was to develop and test the feasibility of a device able to: 1) provide reliable and valid dentoalveolar stimuli, 2) deliver such stimulation within the restricted space of an MR head coil, 3) be compatible for use within an MR environment, and 4) produce brain activation in painfree controls consistent to those observed by others using fMRI.

Background: One of the most immediate and important functional consequences of many oral disorders is a reduction in chewing ability. The ability to chew is not only an important dimension of oral health, but is increasingly recognized as being associated with general health status. Whether perceived chewing ability and oral health-related quality of life (OHRQoL) are correlated to a similar degree in patient populations has been less investigated. The aim of this study was to examine whether perceived chewing ability was related to OHRQoL in partially dentate patients., Methods: Consecutive partially dentate patients (N = 489) without signs or symptoms of acute oral disease at Tokyo Medical and Dental University's Prosthodontic Clinic participated in the study (mean age 63.0 ± 11.5, 71.2% female). A 20-item chewing function questionnaire (score range 0 to 20) was used to assess perceived chewing ability, with higher scores indicating better chewing ability. The 14-item Oral Health Impact Profile-Japanese version (OHIP-J14, score range 0 to 56) was used to measure OHRQoL, with higher scores indicating poorer OHRQoL. A Pearson correlation coefficient was calculated to assess the correlation between the two questionnaire summary scores. A linear regression analysis was used to describe how perceived chewing ability scores were related to OHRQoL scores., Results: The mean chewing function score was 12.1 ± 4.8 units. The mean OHIP-J14 summary score was 13.0 ± 9.1 units. Perceived chewing ability and OHRQoL were significantly correlated (Pearson correlation coefficient: -0.46, 95% confidence interval [CI]: -0.52 to -0.38), indicating that higher chewing ability was correlated with lower OHIP-J14 summary scores (p < 0.001), which indicate better OHRQoL. A 1.0-unit increase in chewing function scores was related to a decrease of 0.87 OHIP-J14 units (95% CI: -1.0 to -0.72, p < 0.001). The correlation between perceived chewing ability and OHRQoL was not substantially influenced by age and number of teeth, but by gender, years of schooling, treatment demand and denture status., Conclusion: Patients' perception of their chewing ability was substantially related to their OHRQoL.

The classification of temporomandibular disorders (TMD) is still controversial. Consensus methods such as the Delphi technique, a method that polls experts' anonymous opinion in an iterative process with controlled feedback and statistical aggregation of group response, could be valuable to improve this challenging topic. The article illustrates the application of the Delphi technique for deciding whether the terms myalgia or myofascial pain should be used in a TMD classification system and discusses the technique's potential for TMD classification in general. In three Delphi rounds, 14 TMD experts from the Division of TMD and Orofacial Pain of the University of Minnesota reached a consensus about which TMD diagnoses should be included in a TMD classification system. They preferred the term myofascial pain over myalgia. The Delphi technique has the potential to provide answers to complex questions in TMD classification, e.g., TMD nomenclature and range as well as scope of conditions included in a future TMD classification system., (© 2010 Blackwell Publishing Ltd.)

Introduction: Little is known about ill-defined pain that persists after endodontic procedures, including an estimate of the problem's magnitude. We conducted a systematic review of prospective studies that reported the frequency of nonodontogenic pain in patients who had undergone endodontic procedures., Methods: Nonodontogenic pain was defined as dentoalveolar pain present for 6 months or more after endodontic treatment without evidence of dental pathology. Endodontic procedures reviewed were nonsurgical root canal treatment, retreatment, and surgical root canal treatment. Studies were searched in four databases electronically, complemented by hand searching. A summary estimate of nonodontogenic tooth pain frequency was derived using random-effects meta-analysis., Results: Of 770 articles retrieved and reviewed, 10 met inclusion criteria, and nine had data on both odontogenic and nonodontogenic causes of pain. A total of 3,343 teeth were enrolled within the included studies and 1,125 had follow-up information regarding pain status. We identified 48 teeth with nonodontogenic pain and estimated a 3.4% (95% confidence interval, 1.4%-5.5%) frequency of occurrence. In nine articles containing data regarding both odontogenic and nonodontogenic causes of tooth pain, 56% (44/78) of all cases were thought to have a nonodontogenic cause., Conclusions: Nonodontogenic pain is not an uncommon outcome after root canal therapy and may represent half of all cases of persistent tooth pain. These findings have implications for the diagnosis and treatment of painful teeth that were previously root canal treated because therapy directed at the tooth in question would not be expected to resolve nonodontogenic pain., (Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Little is known about the frequency of persistent pain after endodontic procedures even though pain is a core patient-oriented outcome. We estimated the frequency of persistent pain, regardless of etiology, after endodontic treatment., Methods: Persistent tooth pain was defined as pain present > or = 6 months after endodontic treatment. Endodontic procedures included in the review were pulpectomy, nonsurgical root canal treatment, surgical root canal treatment, and retreatment. Four databases were searched electronically complemented by hand searching. Two independent reviewers determined eligibility, abstracted data, and assessed study quality. A summary estimate of persistent all-cause tooth pain frequency was established by using a random-effects meta-analysis. Using subgroup analyses, we explored the influence of treatment approach (surgical/nonsurgical), longitudinal study design (prospective/retrospective), follow-up rate, follow-up duration, initial treatment versus retreatment, and quality of reporting (Strengthening the Reporting of Observational Studies in Epidemiology rankings) on the pain frequency estimate., Results: Of 770 articles retrieved and reviewed, 26 met inclusion criteria. A total of 5,777 teeth were enrolled, and 2,996 had follow-up information regarding pain status. We identified 168 teeth with pain and derived a frequency of 5.3% (95% confidence interval, 3.5%-7.2%, p < 0.001) for persistent all-cause tooth pain. High and statistically significant heterogeneity among studies (I2 = 80%) was present. In subgroup analysis, prospective studies had a higher pain frequency (7.6%) than retrospectives studies did (0.9%). Quality of study reporting was identified as the most influential reason for study heterogeneity., Conclusions: The frequency of all-cause persistent tooth pain after endodontic procedures was estimated to be 5.3%, with higher report quality studies suggesting >7%., (Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Background: The aim of this study was to develop a short diagnostic test for pain-related craniomandibular disorders (CMD) based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD)., Material and Method: Participants included 1,177 CMD patients and 896 general population subjects who were examined according to the RDC/TMD. This new diagnostic short test consisted of a combination of the least amount of RDC/TMD items that distinguished between patients and subjects with a sensitivity of > or =70% and a specificity of > or =90%. The diagnostic test items were selected from all available RDC/TMD items using best subset logistic regression., Results: The question about the presence of facial pain achieved a sensitivity of 96% and a specificity of 95%. The lower limits of the confidence interval for test accuracy measures exceeded the postulated thresholds specified for test development. Assuming a CMD pain prevalence of 10% in the general population this short test resulted in a positive predictive value of 80% and a negative predictive value of >99%., Conclusion: A single question about facial pain is a strong predictor for a pain-related CMD disorder and could provide an effective CMD short test.