Diagnostic criteria for temporomandibular disorders-INfORM recommendations: Comprehensive and short-form adaptations for adolescents.

BACKGROUND: The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for use in adults is in use worldwide. Until now, no version of this instrument for use in adolescents has been proposed. OBJECTIVE: To present comprehensive and short-form adaptations of the adult version of DC/TMD that are appropriate for use with adolescents in clinical and research settings. METHODS: International experts in TMDs and experts in pain psychology participated in a Delphi process to identify ways of adapting the DC/TMD protocol for physical and psychosocial assessment of adolescents. RESULTS: The proposed adaptation defines adolescence as ages 10-19 years. Changes in the physical diagnosis (Axis I) include (i) adapting the language of the Demographics and the Symptom Questionnaires to be developmentally appropriate for adolescents, (ii) adding two general health questionnaires, one for the adolescent patient and one for their caregivers and (iii) replacing the TMD Pain Screener with the 3Q/TMD questionnaire. Changes in the psychosocial assessment (Axis II) include (i) adapting the language of the Graded Chronic Pain Scale to be developmentally appropriate for adolescents, (ii) adding anxiety and depression assessment that have been validated for adolescents and (iii) adding three constructs (stress, catastrophizing and sleep disorders) to assess psychosocial functioning in adolescents. CONCLUSION: The recommended DC/TMD, including Axis I and Axis II for adolescents, is appropriate to use in clinical and research settings. This adapted first version for adolescents includes changes in Axis I and Axis II requiring reliability and validity testing in international settings. Official translations of the comprehensive and short-form to different languages according to INfORM requirements will enable a worldwide dissemination and implementation.

Diagnostic criteria for temporomandibular disorders-INfORM recommendations: Comprehensive and short-form adaptations for children.

BACKGROUND: The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) are used worldwide in adults. Until now, no adaptation for use in children has been proposed. OBJECTIVE: The aim of this study was to present comprehensive and short-form adaptations of Axis I and Axis II of the DC/TMD for adults that are appropriate for use with children in clinical and research settings. METHODS: Global Delphi studies with experts in TMDs and in pain psychology identified ways of adapting the DC/TMD for children. RESULTS: The proposed adaptation is suitable for children aged 6-9 years. Proposed changes in Axis I include (i) adapting the language of the Demographics and the Symptom Questionnaires to be developmentally appropriate for children, (ii) adding a general health questionnaire for children and one for their parents, (iii) replacing the TMD Pain Screener with the 3Q/TMD questionnaire and (iv) modifying the clinical examination protocol. Proposed changes in Axis II include (i) for the Graded Chronic Pain Scale, to be developmentally appropriate for children, (ii) adding anxiety and depression assessments that have been validated in children and (iii) adding three constructs (stress, catastrophising and sleep disorders) to assess psychosocial functioning in children. CONCLUSION: The recommended DC/TMD, including Axis I and Axis II, for children aged 6-9 years, is appropriate for use in clinical and research settings. This adapted the first version for children includes changes in Axis I and Axis II changes requiring reliability and validity testing in international settings. Official translations to different languages according to INfORM requirements will enable a worldwide dissemination and implementation.

Expectations and Experiences of Internet-Based Therapy for Adolescents with TMD Pain.

AIMS: To investigate expectations and experiences of internet-based therapy (IBT) in adolescents with temporomandibular disorder (TMD) pain. METHODS: Seven adolescents were strategically selected for this study. All patients had received IBT for their TMD pain in a previous randomized controlled trial. One-on-one interviews were conducted in a nonclinical setting. The interviews were semi-structured, following an interview guide with six domains. The recorded interviews were transcribed, and a qualitative inductive content analysis was then performed. RESULTS: Content analysis indicated that the expectations of the adolescents and their experiences of IBT as a treatment for TMD pain can be understood in light of three main categories: (1) To become better; (2) An ambivalent experience; and (3) A personal challenge. The adolescents expressed expectations of less TMD pain after treatment, but also of improvement in general well-being and everyday life. Although their experiences of IBT varied, adolescents described having mixed feelings about treatment and feeling that it was personally challenging. CONCLUSION: Gained understanding of expectations and experiences is a necessary basis for revising the IBT program to meet the demands of adolescents and to improve treatment adherence. Furthermore, the content of the three categories clarifies the values of adolescents, and this understanding can in turn contribute to the development of new patient-centered treatment programs.

Diagnostic criteria for temporomandibular disorders in children and adolescents: An international Delphi study-Part 2-Development of Axis II.

BACKGROUND: Unlike the psychosocial assessment established for adults in the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), a standardised psychosocial assessment for children and adolescents with TMD complaints has not yet been established. OBJECTIVES: To develop a new standardised instrument set to assess the psychosocial functioning in children and adolescents by adapting the psychosocial status and pain-related disability (Axis II) of the adult DC/TMD and by including new instruments. METHODS: A modified Delphi method was used to survey 23 international TMD experts and four international experts in pain-related psychological factors for consensus regarding assessment tools for psychosocial functioning and pain-related disability in children and adolescents. The TMD experts reviewed 29 Axis II statements at round 1, 13 at round 2 and 2 at round 3. Agreement was set at 80% for first-round consensus level and 70% for each of the second and third rounds. The psychological experts completed a complementary Delphi survey to reach a consensus on tools to use to assess more complex psychological domains in children and adolescents. For the psychological experts, the first round included 10 open-ended questions on preferred screening tools for depression, anxiety, catastrophising, sleep problems and stress in children (ages 6-9 years old) and adolescents (ages 10-19 years old) as well as on other domains suggested for investigation. In the second round, the psychological experts received a 9-item questionnaire to prioritise the suggested instruments from most to least recommended. RESULTS: The TMD experts, after three Delphi rounds, reached consensus on the changes of DC/TMD to create a form to evaluate Axis II in children and adolescents with TMD complaints. The psychological experts added tools to assess depression and anxiety, sleep disorders, catastrophising, stress and resilience. CONCLUSION: Through international expert consensus, this study adapted Axis II of the adult DC/TMD to assess psychosocial functioning and pain-related disability in children and adolescents. The adapted Axis II protocols will be validated in the target populations.

Diagnostic criteria for temporomandibular disorders (DC/TMD) for children and adolescents: An international Delphi study-Part 1-Development of Axis I.

BACKGROUND: Since in children and adolescence prevalence is assessed mainly on self-reported or proxy-reported signs and symptoms; there is a need to develop a more comprehensive standardised process for the collection of clinical information and the diagnosis of TMD in these populations. OBJECTIVE: To develop new instruments and to adapt the diagnostic criteria for temporomandibular disorders (DC/TMD) for the evaluation of TMD in children and adolescents. METHOD: A modified Delphi method was used to seek international consensus among TMD experts. Fourteen clinicians and researchers in the field of oro-facial pain and TMD worldwide were invited to participate in a workshop initiated by the International Network for Orofacial Pain and Related Disorders Methodology (INfORM scientific network) at the General Session of the International Association for Dental Research (IADR, London 2018), as the first step in the Delphi process. Participants discussed the protocols required to make physical diagnoses included in the Axis I of the DC/TMD. Thereafter, nine experts in the field were added, and the first Delphi round was created. This survey included 60 statements for Axis I, and the experts were asked to respond to each statement on a five-item Likert scale ranging from 'Strongly disagree' to 'Strongly agree'. Consensus level was set at 80% agreement for the first round, and at 70% for the next. RESULTS: After three rounds of the Delphi process, a consensus among TMD experts was achieved and two adapted DC/TMD protocols for Axis I physical diagnoses for children and adolescents were developed. CONCLUSION: Through international consensus among TMD experts, this study adapted the Axis I of the DC/TMD for use in evaluating TMD in children and adolescents.

Internet-based treatment for adolescents with symptomatic temporomandibular joint disc displacement with reduction. A randomized controlled clinical trial.

OBJECTIVE: To evaluate treatment outcome of a jaw exercise (JE) intervention program combined with an information/counselling program (IC) vs. information/counselling alone. MATERIALS AND METHODS: A clinical sample of 83 adolescents, experiencing painful clicking or catching/locking of the jaw, and diagnosed with symptomatic disc displacement with reduction according to RDC/TMD, were randomly assigned to JE/IC or IC program. Both programs were internet-delivered. The adolescents were examined clinically at baseline, at a 2-month mid-evaluation, and at 4months posttreatment by examiners blinded to which programs the adolescents were assigned to. RESULTS: The JE/IC group showed significantly more improvements of painful catching/locking (p = .017), eating ability (p = .006) and of their jaw function limitation (p = .026) compared to the IC group. Significantly more adolescents in the JE/IC group also reported a ≥50% improvement of the catching/locking of the jaw with pain (p = .024) and for eating ability (p = .034) based on a severity index. Treatment method credibility and satisfaction were also significantly higher in the JE/IC group. CONCLUSION: The internet-delivered JE/IC program showed a better outcome compared to IC alone. The former is thus a feasible and cost-effective treatment for adolescents with symptomatic disc displacement with reduction.

Does adolescent self-reported TMD pain persist into early adulthood? A longitudinal study.

Objective: To follow up 2209 individuals in a longitudinal study and assess self-reported TMD pain, painful and non-painful comorbid conditions, and pain-related disability.Material and methods: During 2012-2014, questionnaires were sent to 2209 eligible individuals who had been screened for TMD pain each year during 2000-2003. The two screening questions were (1) Do you have pain in the temple, face, jaw joint, or jaws once a week or more often? and (2) Do you have pain when you open your mouth wide or chew once a week or more often? If the patient answered 'yes' to one or both of the questions, TMD pain was recorded. Non-respondents received reminders; telephone interviews were offered a randomised group. The questionnaire queried TMD pain, and painful and non-painful comorbid conditions.Results: The overall response rate was 36.5%. Individuals were placed into one of four pain groups defined by their pain experience at baseline and at the follow-up: no TMD pain (69.0%), new TMD pain (13.0%), previous TMD pain (9.9%), and persistent TMD pain (8.1%). Based on the self-report surveys, significantly more responders with TMD pain at follow-up had had pain as adolescents than not. Of adolescents with TMD pain, 45.1% had pain at follow-up as young adults, while 15.8% had pain at follow-up without a previous history of TMD pain. Individuals with persistent TMD pain had high frequencies of comorbid pains (p < .001), 45.2% reported moderate-severe depression scores (p < .001), and 13.0% had moderate pain-related disability (GCPS).Conclusions: Based on self-report surveys, TMD pain in adolescence appears to triple the risk of TMD pain in young adulthood, and persistent pain increased comorbid pain and psychosocial distress.

Temporomandibular pain in adolescents with a history of preterm birth.

AIM: To evaluate the frequency of temporomandibular disorder (TMD) pain among adolescents with a history of preterm birth compared to a matched control group. METHODS: A group of 192 preterm-born adolescents was followed up at the age of 17-19 years and compared to matched controls. Self-report questionnaires included screening questions about TMD pain, chronic diseases, general health, depression, anxiety, anger, antisocial behaviour and self-concept. TMD pain was defined as answering "yes" to one or both of the following questions: "Do you have pain in the temple, face, temporomandibular joint or jaws once a week or more?" and "Do you have pain when you open your mouth wide or chew once a week or more often?" Data analysis was performed using chi-square test and logistic regression model with likelihood ratio test. RESULTS: A TMD pain frequency of 23% of preterm-born adolescents and 26% among the controls was found, with no significant differences between the groups. Neither were there differences regarding anxiety, depression, anger or self-confidence. Within the preterm group, adolescents with TMD pain registered tension and pain in the body, trouble sleeping, stomach pain and feelings of hopelessness about the future. The controls with TMD pain, more reported having a bad life, feeling like a failure and having bodily pain. Among tested background variables, only TMJ locking or intermittent locking once a week or more was found to explain TMD pain in adolescents. CONCLUSION: A high frequency of TMD pain was found in both groups, one possible explanation could be TMJ dysfunction.

Treatment Seeking and Self-Constructed Explanations of Pain and Pain Management Strategies Among Adolescents with Temporomandibular Disorder Pain.

AIMS: To explore adolescents' explanations of their temporomandibular disorder (TMD) pain, their pain management strategies for TMD pain, and their treatment-seeking behavior. METHODS: One-on-one interviews were conducted with 21 adolescents aged 15 to 19 years who had TMD pain and followed a semistructured interview guide. Subjects were strategically selected from patients referred to an orofacial pain clinic. All participants had been examined and received a pain diagnosis based on the Research Diagnostic Criteria for TMD. The interviews focused on the adolescents' experiences of TMD pain, their strategies for handling pain, and how they seek care. The interviews were recorded, transcribed verbatim, and analyzed using qualitative manifest content analysis. RESULTS: Qualitative manifest content analysis revealed two categories: (1) self-constructed explanations, with three subcategories (situation-based explanatory model, physical/biologic model, and psychological explanatory model); and (2) pain management strategies, with four subcategories (social support, treatment, relaxation/rest, and psychological strategies). Adolescents used physical activities and psychological and pharmacologic treatment to manage pain. Reasons for seeking treatment were to be cured, to obtain an explanation for their pain, and because their symptoms bother others. CONCLUSION: Adolescents living with TMD pain develop self-constructed explanations and pain management strategies. With access to these descriptions, dentists can be better prepared to have a dialogue with their adolescent patients about their own explanations of pain, the nature of pain, and in which situations the pain appears. Dentists can also explore adolescent patients' pain management strategies and perhaps also suggest new treatment strategies at an earlier stage.

Treating temporomandibular disorders in adolescents: a randomized, controlled, sequential comparison of relaxation training and occlusal appliance therapy.

AIMS: To compare the effects of occlusal appliance therapy (OA) and therapist-guided relaxation training (RT) on temporomandibular disorder (TMD) pain in adolescents, thereby replicating a previous randomized controlled trial, and to explore whether additional therapy administered in a crossover sequential design improves treatment outcomes. METHODS: The study involved 64 adolescents, aged 12 to 19 years, experiencing TMD pain at least once a week and diagnosed with myofascial pain in accordance with the Research Diagnostic Criteria for TMD. For phase 1 of the study, subjects were randomly assigned to OA or RT; nonresponders were offered the other treatment in phase 2. Self-reports of TMD pain and clinical assessments were performed before and after treatment in each phase and 6 months after the last treatment phase. Differences in outcomes between treatment groups across the different phases were analyzed by analysis of covariance (ANCOVA), and for differences in proportions, the chi-square test was used. RESULTS: After phase 1, a significantly higher proportion of adolescents treated with OA (62.1%) than those treated with RT (17.9%) responded to treatment, defined as a subjective report of "Completely well/Very much improved" or "Much improved." Similar differences in self- report of treatment effect occurred after phase 2. About two-thirds of all adolescents in both phases reported such an improvement level at the 6-month follow-up, including a somewhat higher proportion of phase 1 responders (79.2%) than phase 1 nonresponders (60%). CONCLUSION: The findings suggest that, for adolescents with TMD pain, use of standardized clinical treatment with OA is more effective than RT on self-evaluation of treatment improvement. For nonresponders, subsequent crossover treatment might be useful to improve subjective TMD pain.

Validity and reliability of OIDP and OHIP-14: a survey of Chinese high school students.

BACKGROUND: To determine the impact of oral diseases on everyday life, measures of oral quality of life are needed. In complementing traditional disease-based measures, they assess the need for oral care to evaluate oral health care programs and management of treatment. To assess the reliability and validity of the Oral Impact of Daily Performance (OIDP) and the short-form Oral Health Impact Profile (OHIP-14) among high school students in Xi'an, the capital of Shanxi province, China. METHODS: Cross-sectional one-stage stratified random cluster sample using high schools as the primary sampling unit. Students completed self-administered questionnaires at school. The survey included the OHIP-14 and OIDP inventories, translated and culturally adapted for China, and global oral health and socio-behavioral measures. RESULTS: A total of 5,608 students participated in the study, with a 93% response rate (mean age 17.2, SD 0.8, 52% females, 45.3% urban residents).The proportion experiencing at least one impact (at any frequency) during the previous six months was 62.9% for the OHIP-14 and 45.8% for the OIDP. Cronbach's alpha measured internal consistency at 0.85 for OHIP-14 and 0.75 for OIDP while Cohen's kappa varied between 0.27 and 0.58 for OHIP-14 items and between 0.23 and 0.65 for OIDP items. Kappa scores for the OHIP-14 and OIDP additive scores were 0.52 and 0.66, respectively. Both measures varied systematically and in the expected direction, with global oral health measures showing criterion validity. The correlation between OIDP and OHIP-14 was rs +0.65. That both measures varied systematically with socio-behavioral factors indicates construct validity. CONCLUSION: Both the OIDP and OHIP-14 inventories had reasonable reliability and construct validity in relation to subjective global oral health indicators among adolescents attending high schools in China and thus appear to be useful oral health -related quality of life measures in this context. Overall, the OHIP-14 and OIDP performed equally well, although OHIP-14 had superior content validity due to its sensitivity towards less severe impacts.

Adolescents with temporomandibular disorder pain-the living with TMD pain phenomenon.

AIMS: To acquire a deeper understanding of adolescents' experiences of living with temporomandibular disorder (TMD) pain. METHODS: Twenty-one adolescents with TMD pain, aged 15 to 19, were strategically selected from a group of patients referred to an orofacial pain clinic. The patients were examined and received diagnoses per the Research Diagnostic Criteria for TMD. One-on-one interviews that followed a semistructured protocol focused on the patient's experiences of living with TMD pain. The interviews were recorded and transcribed verbatim, followed by content analysis to obtain a deeper understanding of adolescents' experiences living with TMD pain. RESULTS: Content analysis led to the overall theme "Adolescents with TMD live with recurrent pain; physical problems and daily demands form a vicious circle that causes adolescents to oscillate between hope and despondency." The latent content forming the theme is grounded in three categories that evolved from 13 subcategories. For instance, five subcategories-headache; headache on awakening; jaw and tooth pain; constant thoughts of pain; and popping, cracking, clicking, and locking-formed the category that was labeled TMD pain is recurrent. The latent interpretation, ie, the meaning, of this category was that adolescents with TMD pain constantly thought about the pain, even when it was absent. CONCLUSION: TMD pain is a substantial problem for affected adolescents and has consequences for all aspects of their lives. In this study, the adolescents were able to talk openly and introduce issues outside of the interview protocol. Qualitative analysis deepens our understanding of the adolescent patient with TMD pain.

Impact of temporomandibular disorder pain in adolescents: differences by age and gender.

AIMS: To evaluate the impact of temporomandibular disorder (TMD) pain by age and gender in adolescents, with assessments of this impact specifically on school absence, medication consumption, perceived need for treatment, jaw function limitation, depressive symptoms scores and somatic complaints, and graded chronic pain scale. METHODS: In a population-based sample, a mailed questionnaire was sent to 350 patients with self-reported TMD pain (group 1) and 350 healthy age- and sex-matched individuals (group 2) aged 12 to 19 years 2 to 4 weeks after their annual dental examination. The groups were divided into younger (age 12 to 15) and older (age 16 to 19) groups. Descriptive statistics and 95% confidence intervals were used, and chi-square and t-tests were calculated for analyzing group differences. Odds ratios were estimated using logistic regression. RESULTS: As expected, groups 1 and 2 differed significantly in most variables related to psychosocial and behavioral factors. For adolescents reporting TMD pain once a week or more, no gender or age differences in pain intensity were seen. Jaw function limitation, depressive symptoms scores, somatic complaints, graded chronic pain, and perceived need for TMD treatment were all significantly higher in girls than in boys. Older girls reported higher analgesic consumption and school absences than older boys. CONCLUSION: Girls reporting TMD pain had significantly greater impact on behavioral and psychosocial factors than boys. Almost one third of older girls, compared to one out of 10 older boys, reported school absences and analgesic consumption because of their TMD pain.

Incidence and temporal patterns of temporomandibular disorder pain among Swedish adolescents.

AIMS: To estimate the incidence of temporomandibular disorder (TMD) pain among Swedish adolescents by age and gender and to describe the temporal patterns of TMD pain. METHODS: This 3-year longitudinal study was carried out at all Public Dental Service clinics in a Swedish county from 2000 to 2003. All individuals aged 12 to 19 years in the county who visited the clinics for annual examinations were eligible for the study. RESULTS: Overall, the incidence of TMD pain among all adolescents was 2.9% annually among 2,255 participating adolescents. Incidence among girls was significantly higher than in boys, 4.5% versus 1.3%, respectively. Incidence increased with age in girls and boys, although less so in boys (3.0% to 6.9% versus 1.7% to 2.6%). These adolescents were re-examined annually for 3 years, and a fluctuating pattern of TMD pain was common. Overall, 11.4% of all subjects reported TMD pain on at least 1 occasion; 88.6% of the cohort remained pain-free. Of those reporting TMD pain, 4.7% could be defined as intermittent cases, 3.1% were single-incident cases, 0.9% were recurrent cases, and 0.9% had continuing pain for 1 or 2 years. CONCLUSION: The incidence of self-reported TMD pain among Swedish adolescents aged 12 to 19 years increased with age, particularly among girls. The pattern of pain in most adolescents fluctuated over time. Less than 1% of the cohort had continued pain over each year, and the majority of these subjects were girls.

Reliability, validity, incidence and impact of temporormandibular pain disorders in adolescents.

The first aim of this thesis was to investigate the prevalence of temporomandibular disorder (TMD) pain in adolescents an a Swedish county and whether there were differences in patient age and gender and in treatment given for TMD pain by dentists in Public Dental Service (PDS) clinics. The epidemiological variable TMD-S was introduced in the PDS in Ostergötland County, Sweden, in 2000 and is recorded for all adolescents aged 12-19 at the annual routine examination. Self-reported TMD pain in this investigation was based upon the response of the subjects to two questions: (1) Do you have pain in your temples, face, temporomandibular joint, or jaws once a week or more? and (2) Do you have pain when you open your mouth wide or chew, once a week or more? Dental records of 200 patients with TMD pain were randomly selected from the population to evaluate treatment given for TMD. Among 28,899 participating adolescents, 4.2% reported TMD pain. Prevalence increased with age, a significant difference was seen between boys and girls, and 34% of patients with TMD pain received TMD-relared treatment in dental clinics. The second aim was to evaluate the reliability and validity of self-reported TMD pain in 120 adolescents, 60 with self-reported TMD pain and 60 age- and sex-matched controls without TMD pain. All adolescents were examined twice at a PDS clinic. At the first examination, self-reported TMD pain was recorded for each patient. At the second examination, a clinical examination was made blind to the patients' self-report of pain symptoms, after which self-reported TMD pain was again recorded. The clinical examination was based upon the Research Diagnostic Criteria for TMD (RDC/TMD). Test-retest reliability of 0.83 (kappa) was found for the two questions. Sensitivity was 0.98 and specificity 0.90 for assessments made on the same day and 0.96 and 0.83, respectively, for assessments made 2-4 weeks apart. The third aim was to evaluate incidence, by age and gender, and temporal patterns of TMD pain in adolescents. This 3-year longitudinal study was carried out at all PDS clinics from 2000 to 2003. All individuals aged 12-19 years in the county who visited the clinics for annual examinations were eligible for the study. Overall, the annual incidence of TMD pain among 2255 participating adolescents was 2.9%. Incidence among girls (4.5% was significantly higher than in boys (1.3%). Incidence increased with age in girls and boys, although less so in boys. These adolescents were re-examined annually for 3 years, and a fluctuating pattern of TMD pain was common. The fourth and final aim was to investigate gender and age differences in pain behavior, jaw function, and psychosocial status in adolescents with self-reported TMD pain. A postal questionnaire was sent to 350 consecutive patients with self-reported TMD pain and 350 healthy age- and sex-matched individuals aged 12-19 years 2-4 weeks after their annual dental examination. The groups were divided into younger (age 12-15) and older (age 16-19) groups. The TMD and control groups differed significantly in most variables related to pain characteristics and psychosocial and behavioral factors. Multiple pain sites were significantly more common in the TMD than in the control group, but there were no gender differences. For adolescents reporting pain once a week or more, no gender differences were seen in pain intensities. Jaw function limitation, depression scores, and perceived need for TMD treatment were significantly higher overall in girls than in boys. Almost one-third of older girls, compared to one out of ten older boys, reported school absences and analgesic consumption because of their TMD pain. Older girls had significantly higher Graded Chronic Pain Scale scores than older boys. In conclusion, TMD pain increases with increasing age in adolescents and is more common in girls than in boys. A fluctuating pain pattern can be seen. TMD-S, with two self-report questions, has very good reliability and validity, and can be recommended for screening adolescents for TMD pain. TMD pain seems to have a greater Impact on girls than boys. particularly in ages 16-19 years.

The reliability and validity of self-reported temporomandibular disorder pain in adolescents.

AIMS: To evaluate the reliability and validity of self-reported pain associated with temporomandibular disorders (TMD) in adolescents and to determine how this validity may change over time. The authors' hypothesis was that self-reported pain can be used to reliably and accurately detect adolescents with TMD pain. METHODS: One hundred twenty adolescents, 60 with self-reported TMD pain and 60 age- and gender-matched controls without TMD pain, were examined twice. At the first examination at a Public Dental Service clinic, self-reported TMD pain was recorded for each patient. At the second examination, a clinical examination was completed, blind to the patients' self-report of pain symptoms, after which self-reported TMD pain was again recorded. The clinical examination was based upon the Research Diagnostic Criteria for TMD (RDC/TMD). Self-reported TMD pain in this investigation was based upon the subjects' responses to 2 questions: (1) Do you have pain in your temples, face, temporomandibular joint (TMJ), or jaws once a week or more? and (2) Do you have pain when you open your mouth wide or chew once a week or more? RESULTS: Test-retest reliability of .83 (kappa) was found for the 2 questions. The sensitivity was .98 (95% CI, .90 to 1.0) and specificity was .90 (95% CI, .81 to .95) for comparison of assessments made on the same day. Sensitivity was .96 (95% CI, .85 to .99) and specificity .83 (95% CI, .72 to .90) for assessments made 2 to 4 weeks apart. CONCLUSION: Very good reliability and high validity were found for the self-reported pain questions. A short time interval between the screening question and examination slightly increased the accuracy of the measure. In adolescent populations, the questions in this study can be used to screen for TMD pain.

Prevalence of temporomandibular pain and subsequent dental treatment in Swedish adolescents.

AIMS: To assess the prevalence of temporomandibular disorder (TMD) pain in Swedish adolescents, to evaluate whether there are differences in TMD pain in regard to age, gender, and place of residence (urban or rural), and to evaluate treatment for TMD pain and compare it with documented treatment for teeth with caries. METHODS: All youths aged 12 to 19 years in Ostergötland County were eligible to participate in the investigation, which took place at public dental clinics during annual examinations in 2000. The subjects were asked 2 questions: (1) "Do you have pain in your temples, face, jaw joint, or jaws once a week or more?" and (2) "Do you have pain when you open your mouth wide or chew once a week or more?" Two hundred dental records of patients with TMD pain and 100 records of patients with documented caries were randomly selected from the population. These records were used to compare the treatment of TMD pain to the treatment of caries. RESULTS: Among the 28,899 youths participating, 4.2% reported TMD pain. The prevalence increased with age, and a significant difference was seen between boys (2.7%) and girls (6.0%) (P < .001). In 43% of the patients with TMD pain, the TMD condition was noted in the record. TMD-related treatment was given to 34% of patients with TMD pain in dental clinics, whereas 100% of the patients with caries received restorative treatment. The most common treatment modalities for the TMD group were occlusal splints and information about TMD. CONCLUSION: The prevalence of self-reported TMD pain was relatively low, increased with age, and was higher among girls than boys. One third of the patients with TMD pain received some form of TMD treatment in the dental clinics.