Search

A randomized controlled trail method is used to find out competence of traditional, nonsplint and low-cost therapies to treat temporomandibular disorders. Outcomes of this suggest implementation of low-cast nonsplint self-care therapy for patients.

The information about the advances in screening for psychosocial risk factors considered to be yellow flags for potentially poor outcomes among patients with chronic orofacial pain is compiled. Psychosocial yellow flags indicate an increased risk of failure of standard treatments and matching patients to treatments based on these risk factors can optimize the treatment outcomes.

Biofeedback and behavior changes may play a role in the treatment of temporomandibular disorders (TMD). TMD involves pain or dysfunction of the temporomandibular (jaw) joint and muscles. While behavior may not have caused TMD, behavioral changes may reduce the chronic pain associated with it. There may be psychological or emotional causes of TMD. Electronic stimulation of jaw muscles may be used in biofeedback. Biobehavioral therapy is noninvasive and relies on the patient's motivation to improve. Research is needed to assess the usefulness of biobehavioral interventions.

Temporomandibular disorder (TMD) may have characteristics of a chronic pain illness. TMD involves jaw pain, usually with some degree of dysfunction and clicking or popping sounds. The causes and treatment of TMD are not always straightforward, and pain may persist. Chronic pain from TMD may affect patients in ways similar to other chronic pain disorders such as tension headache or benign back pain. Psychosocial factors associated with chronic pain illnesses may be applicable to managing TMD pain. From 20% to 30% of TMD patients may have difficulty coping with pain, and may experience some degree of disability or psychological distress. However, TMD is not a progressive or degenerative disorder, and its prevalence does not increase with age. Some studies have reported successful treatment of TMD.

Treatment of temporomandibular disorders (TMD) may be hampered in patients pursuing litigation. Though the cause is unclear, there appears to be a relationship between litigation involving TMD and psychological, physical and demographic factors and subjective pain. Of 96 patients suffering from TMD due to trauma, 53 were involved in litigation. Those involved in litigation reported their symptoms differently than those who were not in litigation. They reported more pain sites, more facial pain and more sleep disturbances. The average treatment duration was 15 weeks. Litigating patients had more treatments over a longer period of time and indicated greater pain at the conclusion of treatments. Objective measurements of the range of motion and the pressure pain threshold, and the percentage of change after treatment, revealed little statistical difference between the two groups in these areas.

Diagnosis and treatment of temporomandibular disorders (TMD) is controversial. TMD are different types of joint and muscle disorders that affect the bones in the side of the head and the lower bone of the jaw. Among 386 dentists who were surveyed about the diagnosis and treatment of TMD, 205 were general dentists and 181 were specialists. The specialists were more likely to agree with TMD experts about the pathophysiology of TMD than the general dentists. The two groups of dentists agreed on the use of different types of treatment for TMD. They also agreed on the psychophysiological aspects of TMD, and their opinions did not differ significantly from those of TMD experts. More controversy surrounded the association between TMD and different psychiatric disorders.

Disorders of the temporomandibular joint (TMJ), the joint between the jaw bone and the skull, are the most common pain conditions of the face. TMJ disorders are characterized by pain, dysfunction of the jaw with limitation of motion, and clicking noises during movement. No epidemiologic studies concerning the signs and symptoms of this disorder have been reported. To define the epidemiology of TMJ disorders, identical methods were used to assess three groups: clinic patients who were seeking treatment for temporomandibular disorder (TMD), a randomly selected group from the community who reported TMD, and a control group who were without TMJ pain. The results revealed that women had a significantly smaller vertical range of TMJ motion than men. Clinic patients who sought treatment had less vertical motion than community members describing TMD; the community group had more restricted TMJ movement than the control group. The clinic patients experienced more pain during TMJ motion and muscle palpation than the other two groups. Joint sounds, detected by palpating the area and with a stethoscope, were described as clicking or popping; crepitus, a longer, rubbing or crunching sound; and grating. For all cases of TMD the clicking and popping sounds were most prevalent. Clinic patients exhibited more clicking than the other two groups. The major difference between patients and the control group was the symptom of pain. The incidence of clinically relevant findings, based on examination, were no different among symptomatic and asymptomatic individuals of all ages. TMJ pain was less prevalent in older people. (Consumer Summary produced by Reliance Medical Information, Inc.)

A historical perspective and a description of the current status of behavioral sciences in dental education are provided. One organizational approach for developing goals and objectives is suggested. Holistic health is seen as the broadest application of behavioral medicine. (MLW)

Aims: To evaluate the psychometric properties of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) biobehavioral (Axis II) screening instruments. Methods: Participants with Axis I TMD diagnoses (n = 626) completed the Axis II instruments (Depression, Nonspecific Physical Symptoms, Graded Chronic Pain) and other instruments assessing psychological distress, pain, and disability at three study sites. Internal consistency, temporal stability, and convergent/ discriminant validity of the Axis II measures were assessed. To assess criterion validity of Nonspecific Physical Symptoms and Depression instruments as screeners, 170 participants completed a structured psychiatric diagnostic interview. Results: The Axis II instruments showed very good to excellent internal consistency (Cronbach's alpha coefficients = 0.80 to 0.95). Their convergent (correlation range 0.3 to 0.9) and discriminant (range 0.0 to 0.6) validity were generally supported, although Nonspecific Physical Symptoms was more strongly associated with depressive than with somatic symptoms. Temporal stability was high for characteristic pain intensity (Lin's correlation concordance coefficient [CCC] = 0.91), interference (CCC = 0.89), and chronic pain grade (weighted kappa = 0.87), and fair to good for Depression and Nonspecific Physical Symptoms (CCC = 0.63 to 0.78). The Depression instrument normal versus moderate to severe cutoff point was good at identifying current-year depression and dysthymia diagnoses (sensitivity 87%, specificity 53%). Nonspecific Physical Symptoms did not have high utility for detecting psychiatric disorders (sensitivity 86%, specificity 31%). Conclusion: The Axis-II Depression and Graded Chronic Pain instruments have clinically relevant and acceptable psychometric properties for reliability and validity and utility as instruments for identifying TMD patients with high levels of distress, pain, and disability that can interfere with treatment response and course of Axis I disorders. [ABSTRACT FROM AUTHOR]

Aim: To provide a systematic description of clinical findings and psychosocial factors in patients suffering from atypical odontalgia (AO). Methods: Forty-six consecutive AO patients (7 men and 39 women; mean age, 56 years; range, 31 to 81 years) were compared with 35 control subjects (11 men and 24 women; mean age, 59 years; range, 31 to 79 years). Results: The pain of the AO patients was characterized by persistent, moderate pain intensity (mean, 5.6 ± 1.9) with long pain duration (mean, 7.7 ± 7.8 years). Eighty-three percent reported that onset of pain occurred in conjunction with dental treatment. No significant difference was found between the groups in number of remaining teeth or number of root fillings. Temporomandibular disorder (TMD) pain (P < .001), tension-type headache (P < .002), and widespread pain (P < .001) were significantly more common among AO patients than controls. Significantly higher scores for somatization (P < .01) and depression (P < .01) and limitations in jaw function (P < .001) were found for the AO group compared with the control group. Significant differences between groups were found in 4 general health domains: role-physical (P < .001), bodily pain (P < .001), vitality (P < .004), and social functioning (P < .001). Conclusion: A majority of the AO patients reported persistent, moderately intense intraoral pain that in most cases had an onset in conjunction with dental treatment. AO patients had more comorbid pain conditions and higher scores for depression and somatization. Significant limitation in jaw function and significantly lower scores on quality of life measures were found for AO patients compared with controls. [ABSTRACT FROM AUTHOR]

Aims: To develop a German-language version of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) through a formal translation/back-translation process, to summarize available data about their psychometric properties, and to provide new data about psychometric testing of components of the RDC/TMD. Methods: To cross-culturally adapt the instrument, the RDC/TMD were translated using a forward-backward method, except for measures of somatization and depression, because German-specific instruments of these already existed. The psychometric properties of the RDC/TMD were examined, and the literature on this topic was reviewed. Results: The available literature about reliability of clinical examination methods (4 studies) showed at least acceptable results, with a median intraclass correlation coefficient (ICC) of 0.60. Reliability of RDC/TMD components Jaw Disability List UDL) and Graded Chronic Pain Scale (GCPS) was sufficient (ICC for retest reliability [n = 27] was 0.76 for JDL and 0.92 for GCPS; Cronbach's alpha for internal consistency [n = 378] was 0.72 and 0.88, respectively). A priori hypothesized associations between GCPS or JDL summary scores and self-report of general health, oral health, oral health-related quality of life, or dysfunctional pain, which were measured by means of the Multidimensional Pain Inventory, were confirmed in a convenience sample of clinical TMD patients (n = 378). These correlations were interpreted as support for the validity of the GCPS and JDL. The original RDC/TMD include measures for somatization and depression (SCL-90-R); however, equivalent German instruments to assess these constructs ("Beschwerdenliste," "Allgemeine Depressionsskala") have well-established validity and reliability in the German cultural environment. Conclusion: The psychometric properties and international comparability of the German version of the RDC/TMD (RDC/TMD-G) make this instrument suitable for the assessment of TMD in Germany. [ABSTRACT FROM AUTHOR]

Aims: To describe the course of reported musculoskeletal pain in the temporornandibular region and other signs and symptoms of tern porornandibular disorders (TMD) as well as psychological dis- tress over the course of pregnancy and 1 year postparturn. Methods: Wornen with rnusculoskeletal oro facial pain (n = 19) and pain-free cornparison subjects (n = 16) in the first trirnester of pregnancy were selected through records review frorn the popula- tion of a large health rnaintenance organization. Subjects corn- pleted a self-adrninistered questionnaire assessing pain, depression, and sornatic syrnptorns; provided a sarnple of whole unstirnulated saliva; and underwent a standardized clinical exarnination during the third, sixth, and ninth rnonths of pregnancy and 1 year post- parturn. Results: At baseline (third rnonth of pregnancy), 16 of the 19 patients with rnusculoskeletal oro facial pain rnet criteria for an RDC/TMD diagnosis. Reported musculoskeletal oro facial pain dirninished significantly during the second or third trirnester of pregnancy and increased again postparturn. Measures of rnandibu- lar opening increased over pregnancy in both cases and cornpan- son subjects and rernained high postparturn. Depression and sornatic syrnptorns changed little over the course of pregnancy but were substantially lowered at 1 year postparturn for both groups. As expected, subjects with pain had higher levels of palpation pain, dirninished mandibular range of rnotion, and higher levels of psychological distress corn pared to subjects without oro facial pain. Conclusion: Musculoskeletal oro facial pain and related syrnptorns appear to irnprove over the course of pregnancy. This irnprovernent occurs in the presence of increased joint laxity and is not paralleled by irnprovernents in psychological distress. Thus, it was concluded that the irnprovernent in pain is rnost likely associ- ated with the drarnatic horrnonal changes occurring during preg- nancy. J OROFAC PAIN 2005;19:193-201 [ABSTRACT FROM AUTHOR]

Aims: Since cyclic effects on experimental pain response in women with temporomandibular disorders (TMD) have not been adequately studied, the aim of this study was to assess variations in experimental pain response at 4 phases of the menstrual cycle. Methods: Eighteen normally cycling women with TMD, 25 women with TMD and taking oral contraceptives (OC), 25 normally cycling pain-free controls, and 26 pain-free controls taking OC underwent 3 experimental pain procedures at 4 phases during each of 3 menstrual cycles. These procedures included algometer palpations at fixed amounts of pressure and pressure pain thresh-olds at several body sites, and an ischemic arm pain task. Repeated measures analysis of variance was used to compare cycle phase, TMD group, and OC status differences in experimental pain response. Results: Significant phase-related differences were seen for palpation intensity measures (P values < .05). Normally cycling women with TMD showed higher palpation pain intensity at menses and midluteal phases, while women with TMD taking OC showed stable palpation pain intensity ratings at menses, ovulatory, and midluteal phases, with increased intensity at the late luteal phase. TMD subjects had greater palpation pain and ischemic pain intensity and lower pressure pain thresholds compared to controls. Conclusion: Phase-related differences in experimental pain response were not strong and were more often found for experimental stimuli with greater clinical relevance (ie, palpation pain) compared with an ischemic pain task. [ABSTRACT FROM AUTHOR]

Aims: To use the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) to investigate the physical diagnoses, psychologic distress, and psychosocial dysfunction in Asian TMD patients. The RDC/TMD Axis I and II findings were compared to those of Swedish and American TMD patients. Methods: One hundred ninety-one patients (53 male and 138 female) referred to 2 institutionalized TMD clinics in Singapore were enrolled in the study. The mean age of the predominantly Chinese population (83.2%) was 33.6 ± 9.3 years. Data from a RDC/TMD history questionnaire and clinical examination were fed directly by patients and clinicians into a computerized diagnostic system (NUS TMDv1.1). Axis I and II findings were generated on-line, based on RDC/TMD rule engines. Data were automatically exported to SPSS for statistical analysis. Results: Group I (muscle) disorders were found in 31.4% of the patients; Group II (disc displacement) disorders were found in 15.1% and 15.7% of the patients in the left and right temporomandibular joints, respectively; and Group III (arthralgia, arthritis, and arthrosis) disorders were found in 12.6% and 13.0% of the patients in the left and right joints, respectively. Axis II assessment of psychologic status showed that 39.8% of patients experienced moderate to severe depression and 47.6% had moderate to severe nonspecific physical symptom scores. Psychosocial dysfunction was observed in only 4.2% of patients based on graded chronic pain scores. Conclusion: Axis I and II findings of Asian TMD patients were generally similar to their Swedish and American cohorts. In all 3 populations, women of child-bearing age represented the majority of patients. Muscle disorders were the most prevalent type of TMD. A substantial portion of TMD patients were depressed and experienced moderate to severe somatization. [ABSTRACT FROM AUTHOR]

Aims: To test the usefulness of tailoring cognitive-behavioral therapy (CBT) for patients with temporomandibular disorders (TMD) who demonstrated poor psychosocial adaptation to their TMD condition, independent of physical diagnosis. Methods: A randomized clinical trial compared a 6-session CBT intervention delivered in conjunction with the usual TMD treatment to the usual conservative treatment by TMD specialist dentists. For study inclusion, Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), Axis II criteria, were used to target patients with elevated levels of TMD pain-related interference with daily activities, independent of physical diagnosis (ie, Axis I). Results: At the post-treatment assessment, about 4 months after the baseline evaluations, the comprehensive care group, when compared to the usual treatment group, showed significantly lower levels of characteristic pain intensity, significantly higher self-reported ability to control their TMD pain, and a strong trend (P = .07) toward lower pain-related interference in daily activities. From post-intervention to 1-year follow-up, all subjects showed improvement. At the 1-year follow-up, the comprehensive care group, while not losing any of its early gains, was not significantly different from the usual care group with regard to reported levels of pain, ability to control pain, and levels of interference in activities. For many of these psychosocially disabled TMD patients, pain and interference 1 year after treatment remained at the same or higher levels than those observed at baseline among a group of patients selected for a separate randomized clinical trial on the basis of better psychosocial adaptation. Conclusion: The 6-session CBT intervention for patients with heightened psychologic and psychosocial disability was effective in improving pain-related variables over the course of the CBT in conjunction with usual treatment, but was too brief an intervention to result in further improvement after the sessions ended. Patient ratings of treatment satisfaction and helpfulness were high for both groups, but they were significantly higher for the comprehensive care group. [ABSTRACT FROM AUTHOR]

Purpose: This study assessed multiple pain conditions and their association with psychosocial functioning, psychologic distress, and somatization in patients with temporomandibular disorders (TMD) based on RDC/TMD Axis II findings. Nonspecific pain items examined included headaches, heart/chest pain, lower back pain, nausea/abdominal pain, and muscle pain. Materials and Methods: In this study, 202 TMD patients (58 men and 144 women) referred to two TMD clinics participated. The mean age of the predominantly Chinese patient population (82%) was 32.6 years (range 13 to 65). The RDC/TMD history questionnaire was input directly into computers by patients. Graded chronic pain and SCL-90 scales were generated online and automatically archived for statistical analysis. Data were subjected to Spearman's rank-order correlation and Kruskal-Wallis and Mann-Whitney tests at a significance level of .05. Results: Of the patients, 43% were moderately to extremely distressed by headaches. The percentage of patients who were distressed by heart/chest pain (7%), lower back pain (26%), nausea/abdominal pain (17%), and soreness of muscles (22%) was lower. Of the TMD patients, 16% experienced more than three pain items. Significant and positive correlations were observed between number of pain items experienced and graded chronic pain severity, depression, and somatization. Correlation coefficients ranged from .27 to .65 for graded chronic pain scales and somatization (without pain items) scores, respectively. Conclusion: Results suggest that the number of nonspecific pain conditions reported may be a predictor of psychosocial dysfunction, depression, and somatization. [ABSTRACT FROM AUTHOR]

Aims: To analyze the reliability, validity, and clinical utility of the depression, non-specific physical symptoms, and graded chronic pain scales comprising the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis 11. Methods: Data resulting from independent longitudinal and cross-sectional epidemiological studies as well as randomized clinical trials conducted at the University of Washington and the University at Buffalo were submitted to descriptive, correlational, and inferential statistical analyses to evaluate selected psychometric properties of the RDC/TMD Axis II scales. Results: Analyses of available data from both TMD clinical centers revealed good to excellent reliability, validity, and clinical utility for the Axis II measures of depression, somatization, and graded chronic pain. Specifically, data were presented comparing the RDC/TMD depression scale to the Beck Depression Inventory and the Center for Epidemiologic Studies Depression Scale; these data supported concurrent validity of the RDC/TMD measure and its use as a depression screening tool. Its clinical utility lies in its demonstrated usefulness for alerting TMD clinicians to potentially noteworthy depressive symptomatology in TMD patients. Others have shown that elevated somatization, the tendency to report non-specific physical symptoms as noxious or troublesome, is a predictor of poor TMD treatment outcome. The present analyses demonstrated that the RDC/TMD Axis II non-specific physical symptoms scale has acceptable reliability and that severe levels of somatization can potentially confound interpretation of the Axis I clinical examination. The graded chronic pain scale was demonstrated to have clinical utility for tailoring TMD treatment to levels of a patient's psychosocial adaptation. Conclusion: The major RDC/TMD Axis II measures demonstrate psychometric properties suitable for comprehensive assessment and management of TMD patients. [ABSTRACT FROM AUTHOR]

Aims: To carry out a randomized clinical trial (RCT) contrasting usual conservative treatment of TMD by clinical TMD specialists with a structured self-care intervention, targeted to clinic cases independent of TMD physical diagnosis, who were reporting minimal levels of psychosocial dysfunction; the intervention was delivered by dental hygienists in lieu of usual treatment. Methods: The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was used to target subjects who exhibited minimal TMD-related psychosocial interference. Criteria for study inclusion were: (1) self-report of facial and/or masticatory muscle pain discomfort for which usual care was prescribed by the clinic TMD specialist; (2) RDC/TMD Axis II graded scale of chronic pain (GCP) score of 0, I, or II-Low. (3) Age 18 to 70 years. Results: On 1-year follow-up, while both groups showed improvement in all clinical and self-report categories measured, patients in the tailored self-care treatment program compared to usual TMD treatment showed significantly: (a) decreased TMD pain, (b) decreased pain-related interference in activity; (c) reduced number of masticatory muscles painful; (d) fewer additional visits for TMD treatment. Groups were comparable with regard to measures of vertical range of motion. The self-care program was associated with consistent, but non-statistically significant, trends towards lower levels of depression and somatization. Ability to cope with TMD, knowledge concerning TMD and patient satisfaction was significantly enhanced for the self-care group. No participating patients experienced physical or personal adverse effects during the 1-year post-treatment follow-up period. Conclusion: Use of RDC/TMD psychosocial assessment criteria can contribute to successful clinical decision-making for the management of TMD. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to determine the prevalence of pain that is related to temporomandibular disorders (TMD), gender differences, and perceived treatment need in children and adolescents at a public dental clinic in Linköping, Sweden. Methods: A total of 862 children and adolescents aged 12 to 18 years received a questionnaire and their jaw opening was measured. Those who reported pain once a week or more in the masticatory system received a more comprehensive examination, including the Research Diagnostic Criteria for TMD and a neurologic examination (group 1). Group 2 reported pain less than once a week. Results: Seven percent of subjects (63/862) were diagnosed with TMD pain. Both genders exhibited similar distributions of TMD diagnoses, except that myofascial pain was significantly more common in girls than in boys. Prevalence of pain once a week or more was reported as: 21% in the head; 12% in the temples; and 3% in the face, temporomandibular joint, or jaws. The prevalence of TMD-related pain was significantly higher in girls than in boys. Self-reported TMD symptoms were significantly more common (P < 0.001) in group 1. No significant gender differences were found in group 1 for pain intensity, behavioral rating scale scores, medicine consumption, reported days of school absence, or perceived need for treatment. Conclusion: Overall, TMD-related pain was more common in girls than in boys. A majority of children and adolescents who experienced pain once a week or more perceived a need for treatment. Seven percent of the examined subjects were diagnosed with TMD pain. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to investigate the prevalence of temporomandibular disorders (TMD) in patients with primary Sjögren syndrome (1°SS), analyze the impact of the disease on mandibular function, and assess psychosocial diseases. Methods: Sixty-three subjects, 60 women and 3 men, participated in the study; 21 1°SS patients were compared with age-matched and gender-matched groups of TMD subjects and controls. Patients were examined according to the Research Diagnostic Criteria for Temporomandibular Disorders. Results: Results showed that the subjective, clinical, and radiographic signs of TMD are not more common in patients with 1°SS than in controls. The impact of the autoimmune disease on mandibular function, eg, speech and chewing ability, revealed limitations in oral functioning similar to those in patients with TMD pain. Conclusion: Both 1°SS and chronic TMD may be associated with appreciable physical discomfort and psychosocial dysfunction. However, the underlying mechanisms of the oral dysfunction of 1°SS and TMD are quite different and essentially unrelated. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Orofacial Pain is the property of Quintessence Publishing Company Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Orofacial Pain is the property of Quintessence Publishing Company Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Orofacial Pain is the property of Quintessence Publishing Company Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)