The challenge of ecological validity in temporomandibular disorders research.

OBJECTIVE: To review the ecological validity of outcomes from current research involving temporomandibular disorders (TMDs), with an emphasis on chronic myofascial pain and the precocious development of degenerative disease of the temporomandibular joint (TMJ). MATERIALS AND METHODS: Current approaches used to study TMDs in terms of neuromechanics, masticatory muscle behaviours, and the dynamics of the autonomic nervous system (ANS) were assessed for ecological validity in this review. In particular, the available literature was scrutinized regarding the effects of sampling, environmental and psychophysiological constraints and averaging data across biological rhythms. RESULTS: Validated computer-assisted numerical modelling of the neuromechanics used biological objective functions to accurately predict muscle activation patterns for jaw-loading tasks that were individual-specific. With respect to masticatory muscle behaviour, current findings refute the premise that sustained bruxing and clenching at high jaw-loading magnitudes were associated with painful TMDs such as myofascial pain. Concerning the role of the ANS in TMDs, there remains the need for personalized assessments based on biorhythms, and where the detection of dysregulated physiologic oscillators may inform interventions to relieve pain and restore normal function. CONCLUSIONS: Future human research which focuses on TMD myofascial pain or the precocious development and progression of TMJ degenerative joint disease requires experimental designs with ecological validity that capture objectively measured data which meaningfully reflect circadian and ultradian states.

Dental topographic proxies for ecological characteristics in carnivoran mammals.

Form-function relationships in mammalian feeding systems are active topics of research in evolutionary biology. This is due principally to their fundamental importance for understanding dietary adaptations in extinct taxa and macro-evolutionary patterns of morphological transformations through changing environments. We hypothesize that three-dimensional dental topographic metrics represent stronger predictors for dietary and other ecological variables than do linear measurements. To test this hypothesis, we measured three dental topographic metrics: Relief Index (RFI), Dirichlet Normal Energy (DNE), and Orientation Patch Count Rotated (OPCR) in 57 extant carnivoran species. Premolar and molar dental topographic indices were regressed against activity, diet breadth, habitat breadth, terrestriality, and trophic level variables within a phylogenetic framework. The results of this study showed significant correlations between RFI and the ecological variables diet breadth and trophic level. Weaker correlations are documented between OPCR and activity and between DNE and trophic level. Our results suggest that cusp height is strongly reflective of dietary ecology in carnivorans as a whole, and represents a proxy mainly for different degrees of hypercarnivory observed within this group of predatory mammals.

Immediate Effect of Ultrasound on Bilateral Masseter Myalgia: A Randomized Dose-Response Clinical Trial.

AIMS: (1) To determine the dose-response relationship of therapeutic ultrasound for TMD-related pain in the masseter muscle among four doses comprised of two intensities (0.4 W/cm2 and 0.8 W/cm2) and two duty cycles (50% and 100%); and (2) to determine if therapeutic ultrasound applied to the masseter muscle would elicit a segmental effect on the ipsilateral temporalis muscle. METHODS: A total of 28 adult women with bilateral myalgia were randomly allocated to one of the four intervention doses. Therapeutic ultrasound was applied on each side of the masseter sequentially for 5 minutes. The following outcomes were measured before and immediately after each intervention: self-reported pain score, pressure pain thresholds for the masseter and temporalis muscles, and intraoral temperature adjacent to the treated masseter. RESULTS: Self-reported pain scores showed neither significant main effects nor significant interaction among the intensity or duty cycle doses (all P > .05). The change in the pressure pain threshold of the masseter showed a significant interaction (P = .02) attributed to the 0.4 W/cm2 and 100% duty cycle dose. Intraoral temperature was significantly increased and associated with the duty cycle (P = .01). A significant segmental effect of the pressure pain threshold of the temporalis was found for intensity (P = .01). CONCLUSION: There was an increase in the pressure pain threshold of the painful masticatory muscles and an increase in intraoral temperature adjacent to the treated area immediately after the use of ultrasound at 0.4 W/cm2 with a 100% duty cycle.

Mechanobehavior and mandibular ramus length in different facial phenotypes.

OBJECTIVES: To test the hypotheses that mechanobehavior scores (MBS) were correlated with mandibular ramus lengths (Co-Go) and differed between facial phenotypes. MATERIALS AND METHODS: Subjects gave informed consent to participate. Co-Go (mm), mandibular plane angles (SN-GoGn, °), and three-dimensional anatomy were derived from cephalometric radiography or cone beam computed tomography. Temporomandibular joint (TMJ) energy densities (ED) (mJ/mm3) were measured using dynamic stereometry and duty factors (DF) (%) were measured from electromyography, to calculate MBS (= ED2 × DF,) for each TMJ. Polynomial regressions, K-means cluster analysis, and analysis of variance (ANOVA) with Tukey post-hoc tests were employed. RESULTS: Fifty females and 23 males produced replete data. Polynomial regressions showed MBS were correlated with Co-Go (females, R2 = 0.57; males, R2 = 0.81). Cluster analysis identified three groups (P < .001). Dolichofacial subjects, with shorter normalized Co-Go, clustered into two subgroups with low and high MBS compared to brachyfacial subjects with longer Co-Go. SN-GoGn was significantly larger (P < .03) in the dolichofacial subgroups combined (33.0 ± 5.9°) compared to the brachyfacial group (29.8 ± 5.5°). CONCLUSIONS: MBS correlated with Co-Go within sexes and differed significantly between brachyfacial and dolichofacial subjects.

A cross-sectional study of temporomandibular joint coronal plane disk position: imaging reliability and clinical utility.

OBJECTIVES: The aim of this study was to assess the reliability, frequency, and clinical significance of temporomandibular joint (TMJ) medial and lateral disk positions, observed in the coronal-oblique plane, to determine their importance in clinical diagnosis and for routine imaging. STUDY DESIGN: This cross-sectional study involved secondary data analysis (clinical and imaging) of 401 participants of the TMJ Impact Study. We used the χ2 statistic to evaluate the associations between coronal disk positions with (1) anterior disk displacements with reduction and without reduction; and (2) familiar TMJ pain resulting from excursive movements and palpation, range of motion, and joint sounds. RESULTS: Anterior disk displacements of any type occurred in 67.5% of joints; in contrast, medial and lateral disk positions occurred in 16% and 24% of joints, respectively. Radiologist reliability was as follows: sagittal posterior band position: right κ = 0.68, left κ = 0.60, average 84% agreement; and medial or lateral disk position: right κ = 0.36, left κ = 0.32, average 70% agreement. Medial and lateral disk positions were associated with sagittal displacements (P < .001). However, there were no associations between medial and lateral disk positions and familiar pain, range of motion, and joint sounds. CONCLUSIONS: Coronal disk position does not contribute to clinical symptomatology or findings and currently lacks sufficient evidence to support its inclusion into standard TMJ imaging protocols or into a clinical diagnostic category.

Psychosocial Scores and Jaw Muscle Activity in Women.

AIMS: To test whether women with temporomandibular disorder (TMD)-related pain showed higher psychosocial scores and higher awake- and sleep-time jaw muscle activities (characterized by duty factors) compared to pain-free controls and whether psychosocial scores and the jaw muscle duty factors were associated. METHODS: Subjects gave informed consent to participate. The Diagnostic Criteria for TMD (DC/TMD) were used for diagnosis of TMD pain, and 31 and 36 women were included in the TMD-related pain and control groups, respectively. DC/TMD Axis II instruments were used to determine psychosocial scores. Subjects self-recorded masseter and anterior temporalis electromyography (EMG) over 3 days and 3 nights. The duty factor (time of muscle activity/total recording time [%]) was quantified using subject-specific EMG/bite-force calibration via data recorded in the laboratory. Group differences (α = .05) were assessed for psychosocial scores and duty factors using chi-square and two-sample t tests. Linear regression assessed whether psychosocial scores were associated with duty factors. RESULTS: Average duty factors were ≤ 2.4% for awake and sleep times in both muscles, and between-group comparisons showed no significant differences. For physical symptom scores, there were significantly fewer TMD-related pain subjects in the normal category and significantly more in the moderate-severe category (all P < .01) compared to controls. Subjects with elevated compared to normal psychosocial scores showed significantly higher jaw muscle duty factors by ≥ 1.5-fold. CONCLUSION: A significantly larger proportion of TMD-related pain subjects compared to control subjects had moderate-severe physical symptom scores. Awake- and sleep-time jaw muscle duty factors were not different between groups and were generally low among all subjects. Additionally, higher than normal psychosocial scores were associated with significantly more low-magnitude jaw muscle activity.

Immediate Effect of Continuous Ultrasound vs Sham Ultrasound for Bilateral Masseter Myalgia: A Double-Blinded Trial.

AIMS: To investigate the local and segmental effects of therapeutic ultrasound at a dose of 0.4 w/cm2 with 100% duty cycle for 5 minutes compared to the effect of sham ultrasound on painful masticatory muscles. METHODS: A total of 20 adult female subjects with bilateral masseter myalgia diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) were included. Each subject was randomized to either an active ultrasound group or a sham ultrasound group. The intervention was applied to each masseter muscle for 5 minutes. Measures included pre- and post-self-reported pain intensity recorded on a verbal rating scale (VRS), pressure pain thresholds for the masseter (PPT-M) and temporalis (PPT-T) muscles, and intraoral temperature for the masseter muscle. Preintervention score was subtracted from the postintervention score for all measures to calculate mean change in pain, and nonparametric Mann-Whitney test was used to compare the groups. Statistical significance was set at P < .05. RESULTS: Changes in VRS did not show a significant difference between groups (P > .05). There were significant increases in PPT-M and intraoral temperature in the ultrasound group compared to the sham group (P < .05). There was no significant difference in PPT-T (P > .05), suggesting no segmental effect. CONCLUSION: Therapeutic ultrasound produced an immediate increase in PPT-M and intraoral temperature compared to sham ultrasound in female subjects with bilateral masseter myalgia.

Reliability and diagnostic validity of a joint vibration analysis device.

BACKGROUND: This observational study was designed to evaluate the reliability and diagnostic validity of Joint Vibration Analysis (JVA) in subjects with bilateral disc displacement with reduction and in subjects with bilateral normal disc position. METHODS: The reliability of selecting the traces was assessed by reading the same traces at an interval of 30 days. The reliability of the vibrations provided by the subjects was assessed by obtaining two tracings from each individual at an interval of 30 min. The validity compared the Joint Vibration Analysis parameters against magnetic resonance imaging as the reference standard. The data were analyzed with exploratory factor analysis. RESULTS: The short- term reliability of the Joint Vibration Analysis outcome variables showed excellent results. Implementing factor analysis and a receiver operating characteristic as analytical methods showed that six items of the Joint Vibration Analysis outcome variables could be scaled and normalized to a composite score which presented acceptable levels of sensitivity and specificity with a receiver operating characteristic of 0.8. CONCLUSION: This study demonstrated that the composite score generated from the Joint Vibration Analysis variables could discriminate between subjects with bilateral normal versus bilateral displaced discs.

Is There an Association Between Temporomandibular Joint Effusion and Arthralgia?

PURPOSE: The literature on joint effusion (JE) and its association with clinical and radiologic variables in patients with temporomandibular disorders (TMDs) is inconsistent and is characterized by multiple methodologic limitations. The primary aim of this investigation was to evaluate the association between magnetic resonance imaging (MRI) identified JE and temporomandibular joint (TMJ) arthralgia. The secondary aim of this investigation was to determine the association between JE and other clinical and MRI-identified soft tissue characteristics. MATERIALS AND METHODS: A retrospective cohort study was conducted. Clinical and soft tissue imaging assessments were carried out according to the Diagnostic Criteria for Temporomandibular Disorders guidelines. The dependent variable was JE and the primary independent variable was arthralgia. The secondary independent variables were TMJ pain-associated characteristics and MRI-identified variables. When applicable, Pearson χ2 or t test was used to determine the statistical associations between JE and clinical characteristics and between JE and MRI-identified variables. Furthermore, generalized estimating equation (GEE) modeling was conducted to determine which of the independent clinical and MRI-identified variables were associated with JE. RESULTS: Data for 158 participants, representing 312 joints, were extracted. The mean age of the female sample (59.4%) was 31 ± 11.1 years and that of the male sample (40.6%) was 29.8 ± 9.7 years. No association was found between JE and arthralgia. However, statistically significant associations were found between JE and lateral disc rotation (P = .001) and between JE and disc position in the coronal and sagittal planes (P = .001). The GEE model suggested that disc displacement with reduction (odds ratio = 2.5) was a statistically relevant contributing factor for JE in the absence of degenerative joint disease. CONCLUSION: Results associated JE with the position of the disc in the sagittal plane. No association was found between JE and arthralgia or TMJ pain-associated clinical characteristics in patients with TMDs.

Goldenhar Syndrome and Pain-Related Temporomandibular Disorders. A Case Report.

Goldenhar syndrome (GS) is a development syndrome, characterized by incomplete development of the craniofacial region. The involvement is mainly unilateral; it varies from being mild to severe; and it can range from malocclusion and facial asymmetry to a more complex phenotype with complete absence of the mandibular ramus and temporomandibular joint. However, orthopedic symptoms of orofacial pain and dysfunction have not generally been considered as part of the symptom complex in GS cases. The case presented here is of a 15-year-old Caucasian patient, who was referred for evaluation because of bilateral pain in the masticatory muscles and temporomandibular joints.

Assessment of knowledge on temporomandibular disorders among Mexican dental educators.

Temporomandibular disorders (TMDs) is an umbrella term that embraces a group of musculoskeletal and neuromuscular conditions that involve the temporomandibular joints, muscles and all associated tissues. Because of the relatively high number of patients with TMDs in the population, instruction in this area of health care should be included on all dental curricula. Although levels of knowledge among dentists have been evaluated in several countries, they have not been in Mexico. This study evaluates the dental faculty's range of knowledge about TMD at five dental schools in Puebla, Mexico. Using an observational design, a survey was administered to 161 educators in order to assess their knowledge of TMD. Four domains were assessed, including: a) pathophysiology; b) psychophysiology; c) psychiatric disorders; and d) chronic pain. Overall knowledge of TMD was measured using a consensus of TMD experts' answers as a reference standard1The results show that educators' overall knowledge had 55% agreement with the reference standard. Individually, the psychophysiological domain was correctly recognized by 77.7% of the educators; correct responses on the other domains ranged from 38% to 56%. This study demonstrates the need to incorporate standardized TMDs instruction into the dental curricula at Mexican Universities, without which graduating dentists will lack the necessary knowledge or experience to diagnose and manage their TMD patients.

Los Trastornos Témporomandibulares (TTM) incluyen un grupo de condiciones musculo-esqueléticas y neuromusculares que afectan a la Articulación Temporomandibular (ATM), los músculos masticadores y otros tejidos asociados. Debido al número relativamente alto de pacientes con TTM en la población, la educación en esta área de la salud debe ser incluida en las currículas de las escuelas de odontología. A pesar de que el nivel de conocimiento sobre TTM ha sido evaluado en diversos países, esto no ha sido realizado en México, por lo que el objetivo del presente estudio fue evaluar el nivel de conocimiento sobre los TTM de los profesores de odontología en cinco universidades de Puebla, México. Bajo un diseño observacional, se administró una encuesta a 161 docentes de odontología para evaluar el nivel de conocimiento sobre los TTM. La encuesta incluyó cuatro dominios: a) patofisiología; b) psicofisiología; c) trastornos psiquiátricos y d) dolor crónico. Se usaron las respuestas otorgadas con un consenso de expertos como estándar de referencia1 para evaluar el nivel global de conocimiento sobre los TTM. Los resultados mostraron que los docentes tuvieron un nivel global de conocimiento del 55% de acuerdo al estándar de referencia. El dominio psicofisiológico individualmente fue el mejor reconocido con el 77% de acuerdo con los expertos; las respuestas correctas en los otros dominios oscilaron entre el 38% y el 56%. El presente estudio demostró la necesidad de incorporar educación sobre los TTM estandarizada en la currícula de las escuelas o facultades de odontología en las universidades mexicanas. Hasta que esto suceda, las generaciones de odontólogos no tienen el conocimiento ni la experiencia necesarios para diagnosticar y manejar a los pacientes con Trastornos Temporomandibulares.

Assessment of knowledge on temporomandibular disorders among Mexican dental educators / Evauación del conocimiento sobre trastornos temporomandibulares en docentes de odontología en México

Temporomandibular disorders (TMDs) is an umbrella term that embraces a group of musculoskeletal and neuromuscular conditions that involve the temporomandibular joints, muscles and all associated tissues. Because of the relatively high number of patients with TMDs in the population, instruction in this area of health care should be included on all dental curricula. Although levels of knowledge among dentists have been evaluated in several countries, they have not been in Mexico. This study evaluates the dental faculty's range of knowledge about TMD at five dental schools in Puebla, Mexico. Using an observational design, a survey was administered to 161 educators in order to assess their knowledge of TMD. Four domains were assessed, including: a) pathophysiology; b) psychophysiology; c) psychiatric disorders; and d) chronic pain. Overall knowledge of TMD was measured using a consensus of TMD experts' answers as a reference standard1The results show that educators' overall knowledge had 55% agreement with the reference standard. Individually, the psychophysiological domain was correctly recognized by 77.7% of the educators; correct responses on the other domains ranged from 38% to 56%. This study demonstrates the need to incorporate standardized TMDs instruction into the dental curricula at Mexican Universities, without which graduating dentists will lack the necessary knowledge or experience to diagnose and manage their TMD patients.

Los Trastornos Témporomandibulares (TTM) incluyen un grupo de condiciones musculoes que léticas y neuromusculares que afectan a la Articulación Temporomandibular (ATM), los músculos masticadores y otros tejidos asociados. Debido al número relativamente alto de pacientes con TTM en la población, la educación en esta área de la salud debe ser incluida en las currículas de las escuelas de odontología. A pesar de que el nivel de conocimiento sobre TTM ha sido evaluado en diversos países, esto no ha sido realizado en México, por lo que el objetivo del presente estudio fue evaluar el nivel de conocimiento sobre los TTM de los profesores de odontología en cinco universidades de Puebla, México. Bajo un diseño observacional, se administró una encuesta a 161 docentes de odontología para evaluar el nivel de conocimiento sobre los TTM. La encuesta incluyó cuatro dominios: a) patofisiología; b) psicofisiología; c) trastornos psiquiátricos y d) dolor crónico. Se usaron las respuestas otorgadas con un consenso de expertos como estándar de referencia1 para evaluar el nivel global de conocimiento sobre los TTM. Los resultados mostraron que los docentes tuvieron un nivel global de conocimiento del 55% de acuerdo al estándar de referencia. El dominio psicofisiológico indivi dualmente fue el mejor reconocido con el 77% de acuerdo con los expertos; las respuestas correctas en los otros dominios oscilaron entre el 38% y el 56%. El presente estudio demostró la necesidad de incorporar educación sobre los TTM estandarizada en la currícula de las escuelas o facultades de odontología en las universidades mexicanas. Hasta que esto suceda, las generaciones de odontólogos no tienen el conocimiento ni la experiencia necesarios para diagnosticar y manejar a los pacientes con Trastornos Temporomandibulares.

Association of Masseter Muscle Activities during Awake and Sleep Periods with Self-Reported Anxiety, Depression, and Somatic Symptoms.

AIM AND BACKGROUND: The objective of this study was to determine if duty factors (DF) of low-magnitude MMA during awake and sleep periods were associated with self-reports of anxiety, depression, and somatic symptoms, and if so, whether or not any associations were modified by gender or the presence of pain. Limited information is currently available in the literature regarding the association of low-magnitude masseter muscle activities (MMA) in habitual environmental settings and the presence of psychological symptoms. MATERIALS AND METHODS: Sixty-eight consenting participants were classified using the Diagnostic Criteria for Temporomandibular Disorders examination and validated self-reporting psychological symptom evaluation questionnaires. Each subject also had masseter electromyography recordings during standardized biting tasks in 2 laboratory sessions to calibrate the in-field MMA collected during 3 awake and 3 sleep periods. RESULTS: During awake periods, subjects with self-reported depression and somatic symptoms had statistically high odds of having higher DF of low-magnitude MMA (defined by ≥ 75th percentile of sample). The association between high DF of low-magnitude MMA and self-reported depression symptoms was significantly augmented among male participants, whereas, the association between high DF of low-magnitude MMA and self-reported somatic symptoms was significantly increased among female participants without pain. CONCLUSION: These pilot data support associations of low-magnitude masseter muscle activities with self-reported depression and somatic symptoms during awake periods.

Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†.

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

Smoking cessation practices in the dental setting.

According to the US Centers for Disease Control, approximately 20.6% of the American adult population currently smokes cigarettes. There is no doubt that tobacco use has a negative effect on oral and general health. Dentists can be effective in assessing their patients' smoking status, health beliefs, and related behavior patterns. A total of 608 patients-smokers, former smokers, and nonsmokers-participated in this study. The Five A's protocol was utilized with follow-up interviews to assess smoking cessation (quit rates) among the patients. Of the 608 subjects, 170 (28%) were current smokers, 140 (23%) were former smokers, and 298 (49%) had never smoked. Females comprised 56% of the study group. Of the 170 smokers who were assessed at baseline, successful follow-ups were performed with 64 (38%). Based on a follow-up of these smokers, the 7-day abstinence quit rate was 22%. Among participants who received nicotine replacement therapy (NRT), 40% quit. Of the participants who did not receive NRT, 19% quit.

Adaptación transcultural de los criterios diagnósticos para la investigación de los trastornos temporomandibulares (CDI/TTM) / Cross-cultural adaptation of research diagnostic criteria for temporomandibular disorders (RDC/TMD)

Introducción: el objetivo de este trabajo fue establecer la adaptación transcultural de los criterios diagnósticos para la investigación de los trastornos temporomandibulares (CDI/TTM). Métodos: bajo un diseño de estudio prueba reprueba, fueron evaluadas las propiedades psicométricas de los CDI/TTM versión en español. Sujetos bilingües fueron evaluados para probar la congruencia entre las versiones en español e inglés del instrumento; incluidos ambos ejes I (grupo diagnóstico) y II (perfil psicosocial del paciente). Resultados: la confiabilidad del eje I prueba reprueba para la clasificación del diagnóstico fue excelente (Kappa: 1.0). El análisis de confiabilidad de la prueba reprueba del eje I para la clasificación de los diferentes diagnósticos fue excelente (Kappa: 1.0). Para el eje II, el coeficiente de correlación intraclase (CCI) fue calculado para la escala del grado de dolor crónico GDC (0,96), y para la lista de cotejo de la discapacidad mandibular LCDM (0,77), depresión(0,87) y síntomas físicos no específicos (0,98). Adicionalmente se calculó el Alpha de Cronbach para la LCDM (0,89). Correlaciones de Spearman entre los reactivos del eje II mostraron una mediana de la correlación de 0,50 (0,293-0,856) con valores altos entre la LCDM y la GDC. Dichas correlaciones proveen soporte para la consistencia interna de los CDI/TTM en español. Conclusión: la validez y confiabilidad de los CDI/TTM demostrada se soporta en sus propiedades psicométricas. Su adaptación transcultural permite el uso de dicho instrumento en las poblacioneshispanoparlantes con el objetivo de evaluar el papel de los TTM en esta población.

Introduction: the goal of this study was to establish the cross-cultural adaptation of Research Diagnostic Criteria forTemporomandibular Disorders (RDC/TMD). Methods: with a test-retest design, this study evaluated the psychometric properties of RDC/TMD intheir Spanish version. Bilingual subjects were evaluated in order to test consistency between the Spanish and English versions of the instrument,including axis I (clinical conditions of TMD) and axis II (psychosocial aspects related to TMD). Results: the reliability of axis I test re-test for diagnosis classification was excellent (Kappa = 1,0). The reliability analysis of axis I test-retest for classifying different diagnoses was also excellent(Kappa = 1,0). Concerning axis II, the intraclass correlation coefficient (ICC) was calculated for Graded Chronic Pain Scale (GCPS) (0,96) as well as for Jaw Disability Checklist (JDC) (0,77), depression (0,87), and nonspecific physical symptoms (0,98). Also, Cronbach’s Alpha for JDC wascalculated (0,89). Spearman correlations among axis II reagents showed a median of correlation of 0.50 (0.293 to 0.856) with high values between JDC and GCPS. These correlations provide support for internal consistency of RDC/TMD in Spanish. Conclusion: the demonstrated validity and reliability of the RDC/TMD lie in thier psychometric properties. The cross-cultural adaptation of this instrument allows its use in Spanish-speakingpopulations for the assessment of the role of TMD in this population.

Study protocol, sample characteristics, and loss to follow-up: the OPPERA prospective cohort study.

UNLABELLED: When studying incidence of pain conditions such as temporomandibular disorder (TMD), repeated monitoring is needed in prospective cohort studies. However, monitoring methods usually have limitations and, over a period of years, some loss to follow-up is inevitable. The OPPERA prospective cohort study of first-onset TMD screened for symptoms using quarterly questionnaires and examined symptomatic participants to definitively ascertain TMD incidence. During the median 2.8-year observation period, 16% of the 3,263 enrollees completed no follow-up questionnaires, others provided incomplete follow-up, and examinations were not conducted for one third of symptomatic episodes. Although screening methods and examinations were found to have excellent reliability and validity, they were not perfect. Loss to follow-up varied according to some putative TMD risk factors, although multiple imputation to correct the problem suggested that bias was minimal. A second method of multiple imputation that evaluated bias associated with omitted and dubious examinations revealed a slight underestimate of incidence and some small biases in hazard ratios used to quantify effects of risk factors. Although "bottom line" statistical conclusions were not affected, multiply-imputed estimates should be considered when evaluating the large number of risk factors under investigation in the OPPERA study. PERSPECTIVE: These findings support the validity of the OPPERA prospective cohort study for the purpose of investigating the etiology of first-onset TMD, providing the foundation for other papers investigating risk factors hypothesized in the OPPERA project.

Clinical orofacial characteristics associated with risk of first-onset TMD: the OPPERA prospective cohort study.

UNLABELLED: Case-control studies have documented clinical manifestations of chronic temporomandibular disorder (TMD), whereas clinical predictors of TMD development are largely unknown. We evaluated 41 clinical orofacial characteristics thought to predict first-onset TMD in a prospective cohort study of U.S. adults aged 18 to 44 years. During the median 2.8-year follow-up period, 2,737 people completed quarterly screening questionnaires. Those reporting symptoms were examined and 260 people were identified with first-onset TMD. Univariate and multivariable Cox regression models quantified associations between baseline clinical orofacial measures and TMD incidence. Significant predictors from baseline self-report instruments included oral parafunctions, prior facial pain and its life-impact, temporomandibular joint noises and jaw locking, and nonspecific orofacial symptoms. Significant predictors from the baseline clinical examination were pain on jaw opening and pain from palpation of masticatory, neck, and body muscles. Examiner assessments of temporomandibular joint noise and tooth wear facets did not predict incidence. In multivariable analysis, nonspecific orofacial symptoms, pain from jaw opening, and oral parafunctions predicted TMD incidence. The results indicate that only a few orofacial examination findings influenced TMD incidence, and only to a modest degree. More pronounced influences were found for self-reported symptoms, particularly those that appeared to reflect alterations to systems beyond the masticatory tissues. PERSPECTIVE: OPPERA's prospective cohort study identifies predictors of first-onset TMD comprising self-reported orofacial symptoms and examination findings. The results suggest a complex pattern of TMD etiology that is influenced by disorders locally, in masticatory tissues, and systemically, in pain-regulatory systems.

Systematic review of reliability and diagnostic validity of joint vibration analysis for diagnosis of temporomandibular disorders.

AIMS: To conduct a systematic review of papers reporting the reliability and diagnostic validity of the joint vibration analysis (JVA) for diagnosis of temporomandibular disorders (TMD). METHODS: A search of Pubmed identified English-language publications of the reliability and diagnostic validity of the JVA. Guidelines were adapted from applied STAndards for the Reporting of Diagnostic accuracy studies (STARD) to evaluate the publications. RESULTS: Fifteen publications were included in this review, each of which presented methodological limitations. CONCLUSION: This literature is unable to provide evidence to support the reliability and diagnostic validity of the JVA for diagnosis of TMD.

Burning mouth syndrome.

Pain in the tongue or oral tissues described as "burning" has been referred to by many terms including burning mouth syndrome. When a burning sensation in the mouth is caused by local or systemic factors, it is called secondary burning mouth syndrome and when these factors are treated the pain will resolve. When burning mouth syndrome occurs in the absence of identified risk indicators, the term primary burning mouth syndrome is utilized. This article focuses on descriptions, etiologic theories, and management of primary burning mouth syndrome, a condition for which underlying causative agents have been ruled out.