Diagnostic Accuracy of a Temporomandibular Disorder Pain Screener in Patients Seeking Endodontic Treatment for Tooth Pain.

INTRODUCTION: This study assessed the accuracy of a TMD Pain Screener questionnaire in identifying patients with temporomandibular disorder (TMD) pain among those seeking endodontic treatment for tooth pain. It also investigated whether the screener accuracy could be improved by adding questions regarding putative predictors of TMD status. METHODS: One hundred patients seeking endodontic treatment for tooth pain were enrolled. Participants completed the 6-question TMD Pain Screener before treatment. A board-certified orofacial pain specialist/endodontic resident conducted endodontic and TMD examinations using validated Diagnostic Criteria for TMD (DC/TMD). The sensitivity (Se), specificity (Sp), and positive/negative predictive values (PPVs/NPVs) were calculated for the 6-question and 3-question versions of the TMD Pain Screener. Logistic regression and receiver operating characteristic curve (AUROC) analyses were performed to determine the screening accuracy. RESULTS: At the screening threshold of ≥3, TMD Pain Screener's sensitivity was 0.85, specificity 0.52, PPV 0.68, and NPV 0.75 for the 6-question version and 0.64, 0.65, 0.69, and 0.61, respectively, for the 3-question version. The AUROC was 0.71 (95% CL: 0.61, 0.82) and 0.60 (95% CL: 0.48, 0.71) for full and short versions, respectively. Adding a rating of current pain intensity of the chief complaint to the screener improved the AUROC to 0.81 (95% CL: 0.72, 0.89) and 0.77 (95% CL: 0.67, 0.86) for full and short versions, respectively, signifying useful overall accuracy. CONCLUSIONS: The 6-question TMD Pain Screener, combined with the patient's rating of current pain intensity of the chief complaint, could be recommended for use in endodontic patients with tooth pain for detecting painful TMD.

Prevalence of painful temporomandibular disorders in endodontic patients with tooth pain.

BACKGROUND: Pain from temporomandibular disorders (TMDs) may mimic endodontic pain, but its prevalence in endodontic patients is unknown. OBJECTIVES: This cross-sectional study investigated the prevalence of painful TMDs in patients presenting for endodontic treatment of a painful tooth. Contribution of TMD pain to the chief complaint and characteristics associated with TMD prevalence were also assessed. METHODS: Patients reporting tooth pain in the 30 days before attending university clinics for nonsurgical root canal treatment or retreatment were enrolled. Before endodontic treatment, they completed questionnaires and a board-certified orofacial pain specialist/endodontic resident diagnosed TMD using published Diagnostic Criteria for TMD. Log-binomial regression models estimated prevalence ratios to quantify associations with patient characteristics. RESULTS: Among 100 patients enrolled, prevalence of painful TMDs was 54%. In 26% of patients, TMD pain was unrelated to endodontic pain; in 20%, TMD contributed to their chief pain complaint; and in 8%, TMD was a sole aetiology for pain. TMD prevalence was associated with greater intensity, frequency and duration of the chief pain complaint; pain in more than one tooth; tenderness to tooth percussion and palpation; a diagnosis of symptomatic apical periodontitis; pain medication use; and psychological distress. CONCLUSION: A majority of patients with tooth pain seeking endodontic treatment had painful TMDs; one quarter had TMD as a component or sole cause of their pain. TMD prevalence was associated with more severe symptoms and signs of tooth pain and with psychological factors. The high frequency of TMD comorbidity warrants consideration in management of endodontic patients with history of toothache.

3-year Outcome of Patients with Persistent Pain after Root Canal Treatment: The National Dental Practice-Based Research Network.

INTRODUCTION: We measured the long-term outcomes of patients reporting persistent pain 6 months after root canal treatment (RCT) and assessed the characteristics differing patients with pain chronification from those with pain resolution. METHODS: Forty-five patients previously found to have persistent pain 6 months post-RCT from the National Dental Practice-Based Research Network were approached for a 3-year follow-up, and 27 participated in the survey. The frequency of self-reported pain, its impact on the ability to perform daily activities, and health care use were measured. The differences between patients whose persistent pain continued and those whose pain resolved were assessed. RESULTS: Five patients met criteria for pain at 3.4 years (range, 3.1-3.9 years) post-RCT, which was moderate in intensity, occurred for about 3 days in the preceding month, and kept 1 patient from usual activities. Additional health care was received by 4 of 5 patients whose pain continued compared with 7 of 22 patients whose pain resolved. A longer duration of preoperative pain and higher pain intensity and interference at 6 months were found among patients with pain chronification. Of 13 patients with specific diagnoses for the persistent pain derived at 65 ± 41 days (∼8 months) post-RCT, 10 improved regardless of the diagnosis or treatment, and 11 had a temporomandibular disorder and/or headache as comorbid diagnoses (6) or causes (6) of the persistent "tooth" pain. CONCLUSIONS: Progression of persistent post-RCT pain occurred in 19% of patients. The majority (56%) of patients improved without additional interventions. Both the group that improved and the group that continued to experience pain had a mixture of odontogenic and nonodontogenic etiologies.