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Aims: To document National Dental Practice-Based Research Network (PBRN) practitioner treatment recommendations for patients with painful temporomandibular disorders (TMDs) and to identify practitioner/practice- and patient-related factors contributing to treatment recommendations made at the initial clinical visit. Methods: This prospective single-sample cohort study formed groups based on treatment recommendations made by 185 dental practitioners who treated 1,901 patients with painful TMDs. At the baseline visit, which this article describes, practitioners provided patients with their diagnoses and a treatment plan and then completed a comprehensive questionnaire. Results: Self-care, an intraoral appliance, medication, and practitioner-recommended jaw exercises were the most frequently recommended treatments. Practitioners recommended multiple treatments to most patients. TMD signs, symptoms, and diagnoses were primary considerations in treatment planning, but the practitioner's expectations for improvement were only significant for intraoral appliances and self-care. Female practitioners and those with expertise in TMDs more frequently recommended patient-directed and multidisciplinary treatments compared to their counterparts. Conclusions: Practitioners used a wide range of treatments for patients with few consistent patterns. The propensity to use TMD signs, symptoms, and diagnoses when making treatment recommendations suggests a tendency to conceptualize patients using the biomedical model. Infrequent referral to nondental providers suggests a lack of availability of these providers, a misunderstanding of the complexity of TMDs, and/or discomfort with assessment of psychosocial factors. Implications include the need for comprehensive training in the assessment and management of TMD patients during dental school and participation in TMD continuing education courses following evidence-based guidelines. [ABSTRACT FROM AUTHOR]

Aims: To assess differences in biopsychosocial factors between participants with masticatory myofascial pain with referral (MFPwR), with myalgia without referral (Mw/oR), and community controls without TMDs. Methods: Study participants were diagnosed with MFPwR (n = 196), Mw/oR (n = 299), or as a non-TMD community control (n = 87) by two calibrated examiners at each of three study sites. Pain chronicity, pain on palpation of masticatory muscle sites, and pressure pain thresholds (PPT) at 12 masticatory muscle, 2 trigeminal, and 2 nontrigeminal control sites were recorded. Psychosocial factors assessed included anxiety, depression, and nonspecific physical symptoms (Symptom Checklist-90 Revised); stress (Perceived Stress Scale); and health-related quality of life (Short Form Health Survey). Comparisons among the three groups were adjusted for age, sex, race, education, and income using multivariable linear regression. The significance threshold was set at P = .017 (.05 / 3) for subsequent pairwise comparisons. Results: Compared to the Mw/oR group, the MFPwR group had significantly greater pain chronicity, number of painful muscle sites, anxiety, depression, nonspecific physical symptoms, and impaired physical health (P < .017). The MFPwR group also had significantly lower PPTs for masticatory sites (P < .017). Both muscle pain groups differed significantly from the non-TMD community control group for all outcome measures (P < .017). Conclusion: These findings support the clinical utility of separating MFPwR from Mw/oR. Patients with MFPwR are more complex from a biopsychosocial perspective than Mw/oR patients, which likely affects prognosis and supports consideration of these factors in case management. [ABSTRACT FROM AUTHOR]

Aims: The aims of this critical review were to: (i) assess the factors that differentiate acute from chronic temporomandibular disorders (TMD) pain; (ii) assess the risk factors associated with the transition from acute to chronic TMD pain; and (iii) summarize and appraise the studies. Method: The databases used were MEDLINE, Embase, and Cochrane Database of Systematic Reviews. Eligible studies included articles comparing acute to chronic TMD pain, and cohort studies assessing the risk factors implicated in the transition from acute to chronic TMD pain. Results: Seven articles were selected: one case‐control study, three cross‐sectional studies, and three cohort studies. These studies found that psychological factors were more common in chronic than acute TMD pain patients; however, these factors did not increase the transition risk in the multivariable model. Myofascial and baseline pain intensity were associated with the transition from acute to chronic TMD pain at a 6‐month follow‐up. Due to methodological weaknesses in the available literature, more research is required to establish the risk factors implicated in the transition from acute to chronic TMD pain. Conclusion: This review found some evidence that myofascial pain is associated with the transition risk from acute to chronic TMD pain at a 6‐month follow‐up and that pain intensity at baseline is associated with more intense TMD pain 6 months later. There is insufficient evidence to draw conclusions about the role of demographics and psychological disorders as independent risk factors. [ABSTRACT FROM AUTHOR]

Palpation of the jaw joint is more effective than an MRI scan for diagnosing temporomandibular joint disorder, according to a study of 85 patients. MRI often showed fluid in the joint, but the presence of fluid did not always correspond to pain upon palpation.

Patients with masticatory myofascial pain (MFP) may benefit from a range of therapies. MFP is muscular jaw pain characterized by tender spots called trigger points. The initial treatment recommended for MFP is self management, which relieves symptoms in 60% to 90% of patients. Self management includes applications of moist heat or ice, dietary changes, using over-the-counter anti-inflammatory drugs, resting the chewing muscles, and correcting stressful oral habits. Nonresponsive patients may benefit from stretching exercises, massage, or trigger point compression taught by a dentist or physical therapist. Trigger point injections rapidly and temporarily decrease symptoms in treatment-resistant cases. Acupuncture is an effective intervention, although the benefits wane over time. Patients who have contributing behavioral or psychosocial factors are candidates for biofeedback, relaxation therapy, and stress management. Combined therapies seem to produce the greatest symptom relief.

Disorders of the temporomandibular joint (TMJ), the joint between the jaw bone and the skull, are characterized by pain and dysfunction of jaw motion. There are few reports on the incidence of temporomandibular joint disorders (TMD) and the need for treatment. Specific diagnostic criteria were used to determine the incidence and the severity of muscle and TMJ disorders in 269 female nursing students. The subjects completed a questionnaire and were given a clinical examination. The most frequently reported symptom was noise on TMJ motion. Although 69 percent of the students exhibited clinical signs of TMD, symptoms were severe enough to warrant treatment in only 6 percent. There was a high incidence of pathosis, or abnormal condition, but a correspondingly low level of symptomatology. Clicking sounds in the TMJ represent a benign condition in asymptomatic patients. The major source of pain appears to be the jaw muscles. These findings support conservative management before considering surgery for TMD. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abstract Background Current methods for identifying patients with pain hypersensitivity are sufficiently complex to limit their widespread application in clinical settings. We assessed the reliability and validity of a simple multi-modal vibrotactile stimulus, applied using an electric toothbrush, to evaluate its potential as a screening tool for central sensitization. Methods Fourteen female temporomandibular disorders (TMD) subjects with myofascial pain (RDC/TMD Ia or Ib) and arthralgia (RDC/TMD IIIa) were compared to 13 pain-free controls of matched age and gender. Vibrotactile stimulus was performed with an electric toothbrush, applied with 1 pound pressure for 30 seconds in four locations: over the lateral pole of the temporomandibular joint, masseter, temporalis, and mid-ventral surface of forearm. Pain intensity (0–10) was recorded following the stimulus at 0, 15, 30, and 60 seconds. Test-retest reliability was assessed with measurements from 8 participants, taken 2–12 hours apart. Case versus control differentiation involved comparison of area under the curve (AUC). A receiver operating characteristic (ROC) curve was used to determine cutoff AUC scores for maximum sensitivity and specificity for this multi-modal vibrotactile stimulus. Results Test-retest reliability resulted in an ICC of 0.87 for all 4 pooled sites. ROC-determined AUC cutoff scores resulted in a sensitivity of 57% and specificity of 92% for all 4 pooled sites. Conclusion The electric toothbrush stimulus had excellent test-retest reliability. Validity of the scores was demonstrated with modest sensitivity and good specificity for differentiating TMD pain patients from controls, which are acceptable properties for a screening test.

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. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the quality of methods used in randomized controlled trials (RCTs) of treatments for management of pain and dysfunction associated with temporomandibular muscle and joint disorders (TMJD) and to discuss the implications for future RCTs. Methods: A systematic review was made of RCTs that were implemented from 1966 through March 2006, to evaluate six types of treatments for TMJD: orthopedic appliances, occlusal therapy, physical medicine modalities, pharmacologic therapy, cognitivebehavioral and psychological therapy, and temporomandibular joint surgery. A quality assessment of 210 published RCTs assessing the internal and external validity of these RCTs was conducted using the Consolidated Standards of Reporting Trials (CONSORT) criteria adapted to the methods of the studies. Results: Independent assessments by raters demonstrated consistency with a mean intraclass correlation coefficient of 0.63 (95% confidence interval). The mean percent of criteria met was 58%, with only 10% of the RCTs meeting the four most important criteria. Conclusions: Much of the evidence base for TMJD treatments may be susceptible to systematic bias and most past studies should be interpreted with caution. However, a scatter plot of RCT quality versus year of publication shows improvement in RCT quality over time, suggesting that future studies may continue to improve methods that minimize bias. [ABSTRACT FROM AUTHOR]

Aims: To estimate the criterion validity of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I TMD diagnoses. Methods: A combined total of 614 TMD community and clinic cases and 91 controls were examined at three study sites. RDC/TMD Axis I diagnoses were algorithmically derived from an examination performed by calibrated dental hygienists. Reference standards ("gold standards") were established by means of consensus diagnoses rendered by two TMD experts using all available clinical data, including imaging findings. Validity of the RDC/TMD Axis I TMD diagnoses was estimated relative to the reference-standard diagnoses (gold standard diagnoses). Target sensitivity and specificity were set a priori at ≥ 0.70 and ≥ 0.95, respectively. Results: Target sensitivity and specificity were not observed for any of the eight RDC/TMD diagnoses. The highest validity was achieved for Group Ia myofascial pain (sensitivity 0.65, specificity 0.92) and Group Ib myofascial pain with limited opening (sensitivity 0.79, specificity 0.92). Target sensitivity and specificity were observed only when both Group I diagnoses were combined (0.87 and 0.98, respectively). For Group II (disc displacements) and Group III (arthralgia, arthritis, arthrosis) diagnoses, all estimates for sensitivity were below target (0.03 to 0.53), and specificity ranged from below to on target (0.86 to 0.99). Conclusion: The RDC/TMD Axis I TMD diagnoses did not reach the targets set at sensitivity of ≥ 0.70 and specificity of ≥ 0.95. Target validity was obtained only for myofascial pain without differentiation between normal and limited opening. Revision of the current Axis I TMD diagnostic algorithms is warranted to improve their validity. [ABSTRACT FROM AUTHOR]

Aims: The purpose of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Validation Project was to assess the diagnostic validity of this examination protocol. The aim of this article is to provide an overview of the project's methodology, descriptive statistics, and data for the study participant sample. This article also details the development of reliable methods to establish the reference standards for assessing criterion validity of the Axis I RDC/TMD diagnoses. Methods: The Axis I reference standards were based on the consensus of two criterion examiners independently performing a comprehensive history, clinical examination, and evaluation of imaging. Intersite reliability was assessed annually for criterion examiners and radiologists. Criterion examination reliability was also assessed within study sites. Results: Study participant demographics were comparable to those of participants in previous studies using the RDC/TMD. Diagnostic agreement of the criterion examiners with each other and with the consensus-based reference standards was excellent with all kappas ≥ 0.81, except for osteoarthrosis (moderate agreement, κ = 0.53). Intrasite criterion examiner agreement with reference standards was excellent (κ ≥ 0.95). Intersite reliability of the radiologists for detecting computed tomography-disclosed osteoarthrosis and magnetic resonance imaging-disclosed disc displacement was good to excellent (κ = 0.71 and 0.84, respectively). Conclusion: The Validation Project study population was appropriate for assessing the reliability and validity of the RDC/TMD Axis I and II. The reference standards used to assess the validity of Axis I TMD were based on reliable and clinically credible methods. [ABSTRACT FROM AUTHOR]

Aims: To derive reliable and valid revised Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms for clinical TMD diagnoses. Methods: The multisite RDC/TMD Validation Project's dataset (614 TMD community and clinic cases, and 91 controls) was used to derive revised algorithms for Axis I TMD diagnoses. Validity of diagnostic algorithms was assessed relative to reference standards, the latter based on consensus diagnoses rendered by two TMD experts using criterion examination data, including temporomandibular joint imaging. Cutoff points for target validity were sensitivity > 0.70 and specificity > 0.95. Reliability of revised algorithms was assessed in 27 study participants. Results: Revised algorithm sensitivity and specificity exceeded the target levels for myofascial pain (0.82, 0.99, respectively) and myofascial pain with limited opening (0.93, 0.97). Combining diagnoses for any myofascial pain showed sensitivity of 0.91 and specificity of 1.00. For joint pain, target sensitivity and specificity were observed (0.92, 0.96) when arthralgia and osteoarthritis were combined as "any joint pain." Disc displacement without reduction with limited opening demonstrated target sensitivity and specificity (0.80, 0.97). For the other disc displacement diagnoses, osteoarthritis and osteoarthrosis, sensitivity was below target (0.35 to 0.53), and specificity ranged from 0.80 to meeting target. Kappa for revised algorithm diagnostic reliability was ≥ 0.63. Conclusion: Revised RDC/TMD Axis I TMD diagnostic algorithms are recommended for myofascial pain and joint pain as reliable and valid. However, revised clinical criteria alone, without recourse to imaging, are inadequate for valid diagnosis of two of the three disc displacements as well as osteoarthritis and osteoarthrosis. [ABSTRACT FROM AUTHOR]

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]

Aims: The primary aim was to determine new estimates for the measurement reliability of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms. A second aim was to present data on the reliability of key clinical measures of the diagnostic algorithms. Methods: Kappa (κ), computed by generalized estimate equation procedures, was selected as the primary estimate of interexaminer reliability. Intersite reliability of six examiners from three study sites was assessed annually over the 5-year period of the RDC/TMD Validation Project. Intrasite reliability was monitored throughout the validation study by comparing RDC/TMD data collections performed on the same day by the test examiner and a criterion examiner. Results: Intersite calibrations included a total of 180 subjects. Intersite reliability of RDC/TMD diagnoses was excellent (κ > 0.75) when myofascial pain diagnoses (Ia or Ib) were grouped. Good reliability was observed for discrete myofascial pain diagnoses Ia (κ = 0.62) and Ib (κ = 0.58), for disc displacement with reduction (κ = 0.63), disc displacement without reduction with limited opening (κ = 0.62), arthralgia (κ = 0.55), and when joint pain (IIIa or IIIb) was grouped (κ = 0.59). Reliability of less frequently observed diagnoses such as disc displacements without reduction without limited opening, and osteoarthrosis (IIIb, IIIc), was poor to marginally fair (κ = 0.31-0.43). Intrasite monitoring results (n = 705) approximated intersite reliability estimates. The greatest difference in paired estimates was 0.18 (IIc). Conclusion: Reliability of the RDC/TMD protocol was good to excellent for myofascial pain, arthralgia, disc displacement with reduction, and disc displacement without reduction with limited opening. Reliability was poor to marginally fair for disc displacement without reduction without limited opening and osteoarthrosis. [ABSTRACT FROM AUTHOR]

The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Validation Project has provided the first comprehensive assessment of reliability and validity of the original Axis I and II. In addition, Axis I of the RDC/TMD was revised with estimates of reliability and validity. These findings are reported in the five preceding articles in this series. The aim of this article is to present further revisions of Axis I and II for consideration by the TMD research and clinical communities. Potential Axis I revisions include addressing concerns with orofacial pain differential diagnosis and changes in nomenclature in an attempt to provide improved consistency with other musculoskeletal diagnostic systems. In addition, expansion of the RDC/TMD to include the less common TMD conditions and disorders would make it more comprehensive and clinically useful. The original standards for diagnostic sensitivity (≤ 0.70) and specificity (≤ 0.95) should be reconsidered to reflect changes in the field since the RDC/TMD was published in 1992. Pertaining to Axis II, current recommendations for all chronic pain conditions include standardized instruments and expansion of the domains assessed. In addition, there is need for improved clinical efficiency of Axis II instruments and for exploring methods to better integrate Axis I and II in clinical settings. [ABSTRACT FROM AUTHOR]

Aims: To determine whether Rocabado's 6 × 6 exercise program has an added benefit to self-care alone in reducing myofascial jaw pain and improving forward head posture (FHP) in subjects with myofascial pain and FHP at the end of 4 weeks. Methods: In this double-blinded trial, 45 subjects (43 female and 2 male, mean age 24 years) were randomly assigned to self-care or self-care + 6 × 6 exercises. The primary outcome measure was intensity of jaw pain on a numerical graphic rating scale (NGRS). Secondary outcome measures were jaw pain on a verbal rating scale (VRS), neck pain (NGRS and VRS), and change in head posture. Twenty-one subjects per group resulted in 80% power to detect a difference of 2 in the NGRS for intensity of jaw pain. Alpha was set at .05 for statistical significance. Results: Both groups showed significant statistical (P = .001) and clinical (> 2 on NGRS) improvement in jaw pain intensity. Jaw pain and neck pain improved significantly (P < .01) in both groups. There were no differences between groups for any of the measures. A significant change in head posture was not detected in either group. Conclusion: The 6 × 6 exercises were not significantly more beneficial in reducing the intensity of jaw and neck pain than self-care alone. Furthermore, they were not beneficial in improving head posture within the 4-week duration of this study. [ABSTRACT FROM AUTHOR]

Aims: To test in vitro and in vivo the reliability and accuracy of a new algometer, the pressure algometer for palpation (PAP), for measuring pressure pain thresholds (PPTs) and to compare its features with those of a commercially available pressure algometer. Methods: For in vitro accuracy testing, 6 repeated measurements were made at 8 defined test weights from 0.5 to 5 lb. In vivo validity testing compared the PAP to a standard instrument, the hand-held Somedic algometer, at 16 sites including the masticatory muscles, the temporomandibular joints, and the frontalis (as the control site) in 15 temporomandibular disorder (TMD) cases and 15 controls. Intraexaminer reliability was also assessed for both algometers. Results: In vitro reliability was high, with coefficients of variation of < 5% and a single-measurement standard deviation of 2.1 kPa. Accuracy was also high, with PAP measurements correlating with test weights at r = .99 (P < .001). Repeated measures reliability in vivo was high, with intraclass correlation estimates of 0.73 to 0.96 for the PAP and 0.78 to 0.99 for the Somedic algometer. PPT values correlated moderately between the 2 devices (r ranged from 0.38 to 0.66; P ≤ .05) and were consistently higher for the PAP at all sites (P < .001). Differences between controls and TMD cases were also significant for both algometers (P < .006). Conclusion: Both the PAP and the Somedic algometer showed high reliability. Concurrent validity was demonstrated by statistically significant correlations between the devices. Both showed equally high capacity for differentiating TMD cases from controls. The PAP yielded significantly higher PPTs than the Somedic algometer. [ABSTRACT FROM AUTHOR]

Aims: The operational definitions for the Craniomandibular Index (CMI) were redesigned to conform precisely to those of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), resulting in a single examination protocol, the Temporomandibular Index (TMI). The objectives were to evaluate interexaminer reliability of the TMI as well as its criteria and construct validity for measurement of TMD severity. Methods: Interexaminer reliability of the TMI was assessed on 12 subjects. Criterion validity of the TMI was evaluated relative to the CMI, the latter having established validity. Construct validity of the TMI was evaluated for its capacity to differentiate TMD patients (n = 79) from normal subjects (n = 20) and to detect changes in severity over time. Results: The examiners' average TMI scores were 0.27 ± 0.19 (SD) and 0.26 ± 0.20. Agreement was excellent, with an intraclass correlation coefficient (ICC) of 0.93. The scores for the TMI and the CMI correlated highly, with an ICC of 0.97. Statistical contrasts between the symptomatic groups and the normal subjects were highly significant (P < .001). In 20 TMD patients who underwent treatment for their disorder, their mean change of 0.12 from their pretreatment TMI scores was highly significant (P < .001). Conclusion: This study has provided statistical evidence for the clinical reliability and validity of the TMI, which indicates that the RDC examination protocol is appropriate for determining TMD severity by the TMI algorithm, and diagnosis of TMD subtypes by the RDC algorithm. [ABSTRACT FROM AUTHOR]

Aims: To compare the relative effectiveness of a benzodiazepine (clonazepam), a muscle relaxant (cyclobenzaprine), and a placebo for the treatment of jaw pain upon awakening, when each is combined with the recommended nonpharmacological components of initial medical management. Methods: Forty-one subjects were recruited with a diagnosis of myofascial pain based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). All subjects were given education about TMD and a self-care program. Subjects were randomized into 1 of 3 groups: clonazepam (0.5 mg/night), cyclobenzaprine (10 mg/night), or placebo. The primary outcome measure was the subjects' average intensity of jaw pain upon awakening over the prior week. This was recorded with a visual analog scale at pretreatment and at the completion of the 3-week trial. A secondary outcome measure was sleep quality based on the Pittsburgh Sleep Quality Index. Results: Within-group changes showed a statistically significant (P < .001) decrease in jaw pain upon awakening for all 3 groups. Betweengroup differences demonstrated a statistically significant difference (P < .016) between cyclobenzaprine and placebo, and between cyclobenzaprine and clonazepam. There was no significant effect on sleep quality in any group. Conclusion: This study suggests that cyclobenzaprine is statistically superior to either placebo or clonazepam when added to self-care and education for the management of jaw pain upon awakening. Based on the subjects' report of sleep quality, these medications failed to significantly improve sleep in the short term. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Craniomandibular Disorders 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 Craniomandibular Disorders 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.)

The objective of this study was to determine the diagnostic accuracy of panoramic radiography and magnetic resonance imaging (MRI) for detection of signs of temporomandibular joint (TMJ) degenerative joint disease (DJD). Panoramic radiography and bilateral MRI and computed tomography (CT) of the TMJs were performed for 705 subjects. Three calibrated board- certified radiologists who were blinded to the clinical findings interpreted all images. The diagnoses of DJD established using the panoramic radiographs and MRIs were compared to the reference standard diagnoses derived from the CTs. DJD was defined as the presence of at least 1 of the following 4 signs: a subcortical cyst, surface erosion, osteophyte formation, or generalized sclerosis. The target values for sensitivity and specificity were 70% or greater and 95% or greater, respectively. Compared to the reference standard CTs, the panoramic radiographs had the following sensitivity and specificity values: subcortical cysts, 14% and 100%, respectively; erosion, 20% and 100%, respectively; osteophytes, 12% and 100%, respectively; and sclerosis, 33% and 100%, respectively. The MRIs achieved the following sensitivity and specificity values: subcortical cysts, 32% and 100% respectively; erosion, 35% and 99% respectively; osteophytes, 71% and 98%, respectively; and sclerosis, 50% and 100%, respectively. The radiologists' interexaminer reliability was slight (K = 0.16) when using panoramic radiographs, moderate (K = 0.47) when using MRIs, and substantial when using CTs (K = 0.71) for diagnosis of signs of DJD. Panoramic radiographs and MRIs had below-target sensitivity but above-target specificity in detecting all CT-depicted signs of DJD with the exception of osteophytes, for which MRIs demonstrated adequate diagnostic accuracy. Use of CT for diagnosis of TMJ DJD is recommended to avoid the false-negative findings that can occur if panoramic radiographs and MRIs are used. [ABSTRACT FROM AUTHOR]

Aims: To test the effect of glucosamine hydrochloride (glucosamine-HCI) on the proteoglycan (PG) concentration of the articular disc of non-arthritic tern poromandibular joints (TMJs) in rabbits. Methods: Twenty-four of 48 New Zealand white 10- to 12-week-old male rabbits (2.2 kg average) were injected with the irritant chymopapain in the knee joint. Both groups of 24 rabbits were divided into 3 groups of 8 animals. The rabbits were fed a control diet or a diet supplemented with glucosamine-HCI incorporated at a level to provide 20 mg/kg (approximating the recommended dose 500 mg/tid/70 kg man) or 100 mg/kg, for 8 weeks. Sulfated glycosaminoglycans (GA Gs) were assayed in pro tease K digests of the TMJ articular disc by dimethylmethylene blue method to quantify PG concentration. The groups were corn pared with 2-way analysis of variance. Results: Glucosamine-HCI did not cause a significant change in the PG concentration of the TMJ articular disc (P > .8). There was also no detectable effect of chymopapain injection to the knee joint on the TMJ (P > .07) and no interaction between glucosamine-HCI treatment and chymopapain injection (P > .3). Conclusion: Glucosamine-HCI has no effect on PG concentration of the articular disc of non-arthritic TMJ in rabbits. [ABSTRACT FROM AUTHOR]