Diagnostic accuracy of the short-form Fonseca Anamnestic Index in relation to the Diagnostic Criteria for Temporomandibular Disorders

Brazilian Portuguese Version of the Diagnostic Criteria for Temporomandibular Disorders Axis II: Translation, Cross-Cultural Adaptation and Measurement Properties

BACKGROUND

The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) is a biaxial tool for TMD assessment. To implement a translated version in the Brazilian context, standardised adaptation and validation are necessary.

OBJECTIVE (S)

To translate, adapt and verify the measurement properties of the DC/TMD Axis II instruments Pain Drawing (PD), Graded Chronic Pain Scale (GCPS), Jaw Functional Limitation Scale (JFLS) and Oral Behaviours Checklist (OBC).

METHODS

The translation and cross-cultural adaptation processes of orofacial-related Axis II instruments followed the Guidelines for Establishing Cultural Equivalency. The validation research was carried out with 117 Brazilians with TMD, in two assessment days. Structural validity, internal consistency, test-retest reliability, measurement error, construct validity-hypothesis testing, and ceiling and floor effects were tested.

RESULTS

PD showed substantial reliability (Kappa 0.63), and GCPS, JFLS and OBC showed excellent reliability over time (intraclass correlation coefficient > 0.85). The internal consistency was adequate for all instruments (Cronbach's alpha > 0.77) except for the functional activities domain of OBC (Cronbach's alpha = 0.48). Construct validity was good for all instruments (75% hypotheses confirmed), except for the OBC total score. Regarding parameters of structural validity, GCPS showed Goodness of Fit Index = 0.98 for the solution with two domains. JFLS and OBC presented Goodness of Fit Index < 0.90 for the solutions with three and two domains, respectively.

CONCLUSION

The Brazilian Portuguese version of DC/TMD Axis II can be used in Brazil, but more studies are necessary to find an adequate structure for JFLS and OBC in a Brazilian sample.

Dimensionality of the Fonseca Anamnestic Index and validation of its short-form derivative

OBJECTIVES

Recently, the Short-Form Fonseca Anamnestic Index (SFAI) was shown to have high diagnostic accuracy when compared to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) in patient samples. This study investigated the dimensionality of the parent instrument (Fonseca Anamnestic Index [FAI]) and validated its main component using Rasch analysis in non-patient populations.

METHODS

FAI data from a total of 901 participants from Singapore and Indonesia with a mean age 19.30 ± 1.48 years (65.0% women) were examined. Of these, 53.8% were FAI positive and 46.2% were FAI negative. Principal Component Analysis (PCA) was performed to extract the main component of the FAI using an eigenvalue > 1.0 and direct oblimin rotation with item loading of > 0.40. Rasch analysis was subsequently carried out on the items of the main component.

RESULTS

The FAI was found to be multidimensional with the main component involving items F1, F2, F3, F6, and F7 which were the items of the SFAI. The SFAI had moderate internal consistency (Cronbach alpha = 0.63) and fitted the Rasch model with person and item infit/outfit mean square (MnSq) values of 0.98/0.96 and 1.00/0.96 logits respectively. The infit/outfit MnSq of the SFAI items ranged from 0.82 to 1.06 logits with Item F2 (side-movement difficulty) being the most difficult and item F3 (muscle pain) the easiest.

CONCLUSIONS

The FAI is multidimensional with the main component comprising the five items of the SFAI that fitted the Rasch model. With its good Rasch validity, separation, and reliability, the SFAI is a promising tool for TMD screening.

The Depression, Anxiety, Stress Scales-21: Principal component analysis and evaluation of abbreviated versions in young adults with temporomandibular disorders

BACKGROUND

The Depression, Anxiety, Stress Scales-21 (DASS-21) contain three subscales measuring depression, anxiety, and stress. Several abbreviated DASS-21 versions have been developed, demonstrating better clinical utility and measurement properties than the original instrument. This study explored the factor structure of various abbreviated DASS-21 versions and identified/validated the optimal one for assessing young adults with temporomandibular disorders (TMDs).

METHODS

A total of 974 university-attending young adults were recruited in two waves (wave 1: 519; wave 2: 455). Demographic information, the DASS-21, and quintessence five TMD symptoms (5Ts) of the Diagnostic Criteria for TMDs were collected. Principal component analysis (PCA) was employed to condense the DASS-21 (wave 1 data), while confirmatory factor analysis (CFA) was used to determine maximum likelihood estimates and compare different abbreviated DASS-21 versions (wave 2 data). Known-group, concurrent (criterion) validity and reliability were subsequently evaluated.

RESULTS

The mean age of the study participants was 21 (SD = 0.1) years and 80.4% were women. Twelve DASS-21 items were identified from the PCA. However, the Korean DASS-12 provided the best-fit model (χ2/df = 2.07, CFI = 0.975, TLI = 0.960, RMSEA = 0.049, SRMR = 0.033) among the seven abbreviated versions in the CFA. The Korean DASS-12 showed good known-group and concurrent (rs = 0.959) validity and reliability when contrasted to the DASS-21.

CONCLUSION

The Korean DASS-12 possessed a good fit, known-group, as well as concurrent (criterion) validity and reliability, and was the best abbreviated DASS-21 version for screening young adults with TMD symptoms for psychological distress.

The synergism of occlusal splints along with therapeutic exercise on individuals with temporomandibular joint disorders - A pilot study

AIM

Aberrative occlusal contacts were associated with Temporomandibular disorder (TMD), but whether stabilization splints with therapeutic exercises alleviate the symptoms is unclear. Hence, this study aims to compare the short-term efficacy of occlusal splint therapy and the synergistic effect of therapeutic exercise with occlusal splint therapy for 3 weeks in individuals with TMD.

SETTINGS AND DESIGN

in-vivo observational pilot study.

MATERIALS AND METHODS

Fourteen participants were grouped based on the type of treatment: Group A, assigned with combination therapy, stabilization splint with therapeutic exercises, and Group B, with only stabilization splint therapy. Surface electromyography (EMG) was taken to evaluate the masseter and temporalis muscle activity at baseline and 2nd week. The patient's perception of TMD was evaluated using the Fonseca questionnaire at baseline, 48 h, 14th, and 21st days.

STATISTICAL ANALYSIS

Chi-square statistical analysis was applied to the quantitative data obtained from the Fonseca questionnaire and EMG analysis, with P < 0.05 as significant.

RESULTS

Fonseca questionnaire revealed a significant difference between the two groups at 48 h (P < 0.05). EMG outcome showed no significant difference between the groups at baseline and 14th day (P > 0.05). However, the mean muscle activity recorded at the masseter in Group B was increased on 14th day (56.5 ± 3 μV) and an isotonic muscle pattern was observed in Group A.

CONCLUSION

Combination therapy, which included stabilization splint and home care exercises for moderate to severe TMD patients, led to earlier curative changes in the temporomandibular joint and improved functional jaw movements, along with a reduction in pain. An isotonic muscle activity pattern was also observed, confirming the effect of combination therapy.

Psychometric properties of the Malay Fonseca Anamnestic Index for temporomandibular disorders

OBJECTIVE

This study translated/cross-culturally adapted the Fonseca Anamnestic Index (FAI) for temporomandibular disorders (TMDs) into Malay and psychometrically tested the Malay-FAI (FAI-M).

METHODS

The FAI-M was created according to international guidelines. Internal consistency/test-retest reliability were assessed with Cronbach's alpha/intra-class correlation (ICC) coefficients. Construct and convergent validity were appraised by relating the FAI-M to the Global Oral Health (GOH) questionnaire and Short-form Oral Health Impact Profile (S-OHIP) using Kruskal-Wallis and Spearman's rho correlation (α = 0.05).

RESULTS

Of the 243 participants enrolled, 54.7% (n = 133) had no TMDs, while TMDs were present in 45.3% (n = 110). The FAI-M presented very good internal consistency (α = 0.90) and test-retest reliability (ICC = 0.99). Theoretically predicted FAI-M score patterns matched the GOH categories, and strong correlations were discerned between FAI-M and S-OHIP (rs = 0.71).

CONCLUSION

The FAI-M exhibited good psychometric properties and can be applied in Malay-speaking populations.

The "5Ts" screening tool: Enhancements and threshold values for effective TMD identification

OBJECTIVE

This study aimed to enhance the quintessential "five temporomandibular disorder (TMD) symptoms" (5Ts) screener by incorporating frequency options and distinguishing between TMJ and muscle pain. The diagnostic accuracy along with cut-off points for the effective identification of TMDs was also established.

METHODS

Participants, aged ≥18 years, were recruited from a university-based hospital. After completing surveys encompassing demographic data and the enhanced 5Ts (with frequency options [5Ts-F] and differentiation of TMJ/muscle pain [6Ts-F]), protocolized interviews and clinical examinations were performed following DC/TMD. The diagnostic accuracy and best cut-off points were determined with the area under the receiver operating characteristic curves (AUCs).

RESULTS

324 participants were recruited (mean age 30.0 ± 11.4 years). Among these, 86.4% had TMDs. 5Ts exhibited high diagnostic accuracy for detecting all TMDs (AUC = 0.92) with sensitivity/specificity values of 83.9%/88.6%. Both 5Ts-F and 6Ts-F had slightly better accuracy (AUCs = 0.95/0.96), comparable sensitivity, and superior specificity (97.7%) compared to 5Ts. The best cut-off points were 1.5 for 5Ts and 2.5 for 5Ts-F/6Ts-F.

CONCLUSIONS

Although all three TMD screeners presented high diagnostic accuracy, 5Ts-F/6Ts-F had notably improved specificity. 5Ts scores of >1.5 and 5Ts-F/6Ts-F scores of >2.5 are to be applied for screening the presence of TMDs.

Prevalence of temporomandibular disorders and their associated factors in Confucian heritage cultures: A systematic review and meta-analysis

BACKGROUND

Temporomandibular disorders (TMDs) may be an 'idiom' of psychological distress in Confucian heritage cultures (CHCs).

OBJECTIVES

This systematic review/meta-analysis estimated the prevalence of TMDs in CHCs and compared the differences in TMD occurrence between time periods and age groups. Additionally, the associated biopsychosocial risk factors were also examined.

METHODS

The study protocol was developed a priori following the PRISMA guidelines and Joanna Briggs Institute systematic review methodology (CRD42021245526). Electronic searches of seven databases were conducted from January 2002 to Dec 2021. Reference lists of identified studies were hand-searched for additional articles. Study selection, quality assessment, and data extraction were done. Meta-analysis was performed using the RevMan 5.4 software.

RESULTS

Forty-eight articles were included in the systematic review. Overall prevalences were: TMDs-15% (95% CI: 15-16%); TMD pain-8% (95% CI: 7-9%); TMJ sounds-24% (95% CI: 21-27%); and TMJ locking-7% (95% CI: 1-13%). While TMD prevalence appeared to have declined from 2002 to 2011 to 2012-2021, the occurrence of TMD pain, TMJ sounds, and locking increased marginally or remained constant. TMD prevalence in children/adolescents was 18% (95% CI: 14-22%) and 17% (95% CI: 16-18%) among adults. Significant associations between TMDs and bruxism/psychological distress/education levels were specified by 73%/90%/88% of the relevant studies.

CONCLUSIONS

TMDs are prevalent in CHCs and a slight increase in TMD pain (2%) and TMJ sounds (8%) were discerned over the past two decades. TMDs are related to a myriad of biopsychosocial variables, particularly psychological distress, and these factors must be addressed within the cultural context of patients.

The association between chronotype profile and temporomandibular disorders among college students

BACKGROUND

Temporomandibular joint disorders (TMDs) are common in young adults, and the link between chronotype profile and TMDs is unclear.

OBJECTIVE

This study examined TMD prevalence and chronotype distribution and explored the relationship between chronotype and TMDs in young adults.

MATERIALS AND METHODS

A total of 663 students from Sichuan University completed questionnaires. Chronotype profiles were assessed using the Morningness-Eveningness Questionnaire, and TMDs were screened using the Fonseca Memory Index. To validate the findings, 68 TMD patients and 136 controls were enrolled.

RESULTS

The prevalence of TMDs was 69.7%, with significant differences among chronotype profiles. The intermediate profile was the most common chronotype. Eveningness profile was associated with higher TMDs prevalence and severity. Muscle pain and side movement difficulty scores were higher in eveningness and intermediate profiles. Female gender (OR 2.345; 95% CI 1.668-3.297) was a TMD risk factor, while morningness profile (OR 0.537; 95% CI 0.297-0.970) was protective. Validation with TMD patients and controls supported these findings, showing higher eveningness profile prevalence in the TMD groups.

CONCLUSIONS

TMDs have a high prevalence in college students, chronotype profiles shown to be associated with TMDs. Morningness is the protection factor in TMDs and PT, eveningness is a risk factor for IT.

Fonseca's Questionnaire Is a Useful Tool for Carrying Out the Initial Evaluation of Temporomandibular Disorders in Dental Students

Background: Temporomandibular disorders (TMDs) represent a prevalent multifactorial condition that impacts a significant portion of the global population. The objective of this study was to employ Fonseca's questionnaire for an initial assessment of TMDs. Methods: A cross-sectional study was conducted on a sample of 250 undergraduates from the Dental School of the University of Perugia, Italy. The chi-square test, with a significance level set at p < 0.05, was used to evaluate a statistically significant relationship between TMDs and several variables such as gender, age, employed/unemployed, and physically active or not. Results: The data obtained through the questionnaire indicated that a considerable percentage of students (78%) exhibited signs consistent with TMDs. The most frequently reported signs and symptoms included psychological stress (49.6%), dental clenching and grinding (34%), joint clicking (33.6%), frequent headaches (15.2%), and neck pain (23.2%). Notably, when considering moderate to severe symptoms of TMDs, females were more significantly affected than males. Furthermore, factors such as age, employment status, and physical activity did not appear to influence the prevalence of TMDs. Conclusions: The high prevalence of TMDs identified within this young population (university students), as measured by this questionnaire (albeit warranting validation through more rigorous methodologies) underscores the necessity for the implementation of new preventive strategies that specifically address this demographic.

Pain-free bite force in a healthy population: Within-session test-retest reliability in different sitting positions

BACKGROUND

Pain-free bite force (PFBF) is a promising measure to evaluate bite function in temporomandibular disorders (TMDs), yet the reliability of the measure is unknown.

OBJECTIVES

Establish the (1) within-session test-retest reliability of PFBF in a healthy population for a single and mean of three trials in supported and unsupported sitting; (2) standard error of measurement (SEM) and minimal detectable change (MDC).

METHODS

Thirty healthy participants (n = 15 female, mean [SD] age = 34.4 [11.0] years) completed two sessions (30-60 min apart) comprising three PFBF trials on each side, in both supported and unsupported sitting, to provide data for 60 (30 participants × two sides) test-retest assessments. Test-retest reliability for the first trial and mean of three trials in each position were determined using intraclass correlation coefficients (ICCs), before calculating the corresponding SEM and MDC for males (M) and females (F) respectively.

RESULTS

Within-session reliability was considered excellent for a single trial in supported sitting (ICC = 0.85; SEM M/F = 99/84 N; MDC M/F = 275/232 N) and unsupported sitting (ICC = 0.91; SEM M/F = 72/59 N, MDC M/F = 200/163 N), and for a mean of three trials in supported sitting (ICC = 0.89; SEM M/F = 66/79 N, MDC M/F = 182/220 N) and unsupported sitting (ICC = 0.92; SEM M/F = 64/59 N, MDC M/F = 177/164 N).

CONCLUSION

Single and a mean of three trials in supported and unsupported sitting appear reliable methods to measure PFBF in a healthy population. Testing PFBF using a mean of three trials in unsupported sitting appears superior over other methods though due to higher test-retest reliability, and lower SEM and MDC. Future studies should examine the reliability of PFBF in TMD populations.

Impact of Fear of COVID-19, Depression, Anxiety and Stress on Temporomandibular Disorders in Peruvian Dental Students in the Post-Pandemic Period: A Multivariable Regression Analysis

Background: Dentists, who frequently encounter potentially infected patients, have experienced significant changes worldwide due to the COVID-19 pandemic. The aim of this study was to evaluate the impact of the fear of COVID-19, depression, anxiety and stress on the presence of temporomandibular disorders (TMD), taking into account possible confounding variables, in Peruvian dental students during the post-pandemic period. Methods: This analytical cross-sectional study assessed 607 Peruvian dental students from two regions of Peru. The study utilized the Depression Anxiety Stress Scales-21 (DASS-21), the Fear of COVID-19 Scale (FCV-19S) and the Short Form of the Fonseca Anamnestic Index (SFAI). Possible confounding variables were sex, age, year of study, marital status, place of origin, area of residence, history of mental illness and living with people vulnerable to COVID-19. For the multivariable analysis, we utilized a Poisson regression model with an adjusted robust variance. The significance level was set at p < 0.05. Results: The rates of depression, anxiety, stress, fear of COVID-19 and temporomandibular disorders were 47.0%, 50.4%, 35.9%, 30.6% and 54.2%, respectively. Moreover, the study revealed that students with depression and anxiety were 38% and 75% more likely to have temporomandibular disorders compared to those without depression (APR = 1.38, 95% CI: 1.15-1.66) and anxiety (APR = 1.75, 95% CI: 1.44-2.13), respectively. Similarly, the likelihood of presenting temporomandibular disorders was 55% higher in women than in men (APR = 1.55, 95% CI: 1.28-1.87). Furthermore, we found that stress and fear of COVID-19 did not determine the development of temporomandibular disorders (p > 0.05). Conclusions: Almost half of the dental students experienced depression, anxiety and TMD in the post-pandemic period. In addition, depression and anxiety were influential factors in the occurrence of TMDs, with the female gender being a risk factor. However, factors such as fear of COVID-19, stress, age, year of study, marital status, place of origin, area of residence, history of mental illness or living with people vulnerable to COVID-19 were not significant.

Psychometric properties of the Indonesian Fonseca anamnestic index and the presence/severity of temporomandibular disorders among Indonesian young adults

OBJECTIVE

The psychometric properties of the Indonesian FAI (FAI-I) and presence/severity of temporomandibular disorders (TMDs) among Indonesian young adults were explored.

METHODS

The FAI-I was developed following the INfORM guidelines and used to determine the presence/severity of TMDs. Internal consistency/test-retest reliability were examined with Cronbach's alpha/intra-class correlation (ICC) coefficients. Construct/criteria validity were established by correlating (Spearman) the FAI-I to the five major TMD symptoms (5 Ts) and OHIP-14 (p < 0.05).

RESULTS

Five hundred-one participants (mean age 19.73 ± 1.27 years; 75.2% women) were recruited from a local University. Of these, 40.7% had no TMD, while 49.9%, 8.8%, and 0.6% had mild, moderate, and severe TMD. While Cronbach's α = 0.57 and ICC = 0.72, correlation coefficients to total 5 Ts and OHIP-14 were 0.53 and 0.47, respectively.

CONCLUSION

The FAI-I had low internal consistency, good test-retest reliability, and good validity. Moderate-to-severe TMD was experienced by 9.4% of the young adults examined.

Temporomandibular disorder and somatic symptoms: Relations to 'fear of missing out' and other negative emotional states

OBJECTIVE

The association between the 'fear of missing out (FOMO)' and physical symptoms has not been widely explored. This study aimed to investigate the relationship between FOMO and other negative emotions with Temporomandibular disorder (TMD) and somatic symptoms in young adults. The correlations between the various physical and emotional variables were also established.

MATERIAL AND METHODS

TMD and somatic symptoms were appraised with the Short-form Fonseca Anamnestic Index, quintessential five TMD symptoms of the Diagnostic Criteria (DC)/TMD, and Patient Health Questionnaire-15. FOMO and other negative emotional states were assessed with the FOMO Scale and Depression, Anxiety, Stress Scales-21 (DASS-21). Data were evaluated using non-parametric tests/correlation and regression analysis (α = 0.05).

RESULTS

While only negative affectivity (total DASS), anxiety, and stress differed significantly between those without and with TMDs, significant variances in FOMO and all DASS-21 constructs were discerned between individuals without and with somatization.  Conclusions: Individuals with orofacial pain and more severe somatic symptoms have higher levels of negative emotions including FOMO. While somatization increased the prospect of TMDs, being female, presence of TMDs, and negative affectivity were risk factors for somatization in young adults.

CLINICAL RELEVANCE

Asian young adults appear to be disposed to somatization, and TMDs may be a form of functional somatic syndromes. Recognition of somatic symptoms and emotional distress, including FOMO, is essential for person-centric TMD care.

Evaluation of IL-1β and CRP mRNA expression levels by RT-PCR in postorthodontic treatment patients with temporomandibular joint disorders: a cross-sectional Study

Aim

Temporomandibular joint disorder (TMD), which affects the masticatory muscles, temporomandibular joint, and surrounding tissues, can manifest as inflammation. This study aims to explore the expression levels of the inflammatory biomarkers, interleukin (IL)-1β and C-reactive protein (CRP), in TMD patients who have undergone orthodontic treatment.

Materials and Methods

Buccal swabs from 105 postorthodontic treatment patients were analyzed using real-time polymerase chain reaction to assess the expression levels of IL-1β and CRP in each group after messenger ribonucleic acid extraction. Patients were also examined using the Diagnostic Criteria for TMD (DC/TMD) to determine if they met the criteria for a TMD diagnosis. The TMD group was subdivided into three categories based on the DC/TMD.

Results

The study included 37 patients who did not develop TMD (group 0) and 68 participants who developed TMD after orthodontic treatment, including 17 with pain-related TMDs (group 1), 29 with intra-articular TMDs (Group 2), and 22 with combined pain-related and intra-articular TMDs (group 3). CRP expression was higher than IL-1β in groups 1 and 2, and IL-1β expression was higher than CRP in group 3. The Kruskal-Wallis test showed that IL-1β and CRP expression levels in groups 1, 2, and 3 were not statistically different. Sex and adult age had considerable effects on the occurrence of TMD in patients after orthodontic treatment.

Conclusions

Higher IL-1β expression was found in postorthodontic treatment patients with more complex TMD. This study strengthens the evidence of inflammation through IL-1β and CRP expression in individuals with TMD, especially after orthodontic treatment.

A Meta-Analysis of the Global Prevalence of Temporomandibular Disorders

Background: This meta-analysis aims to evaluate the proportion of people with TMDs in different studies, considering factors such as geographical region, patient age, and sample size. Methods: The search yielded 6984 articles on the incidence of TMDs. Finally, 74 studies with 172,239 subjects and 35,259 with TMDs were selected for final analysis. Analyses were performed using the R statistical language. Results: The incidence of TMDs in the world population was 34%. The age group 18-60 years is the most exposed to TMDs. From the data presented, we observed that for each continent, the female group was 9% to 56% larger than the male group. The highest female-to-male ratio (F:M) was reported in South America (1.56), whereas the lowest F:M ratio was reported in Europe (1.09), suggesting an almost equal distribution of males and females. Conclusions: This suggests that geographical location may play a role in the results of the studies. The prevalence of TMDs was significantly higher in South America (47%) compared to Asia (33%) and Europe (29%). Larger epidemiological studies of TMDs in African and Australian populations are recommended. In conclusion, both visual and statistical assessments suggest that the results of our meta-analysis are robust and unlikely to be significantly affected by publication bias. This suggests that geographical location may play a role in the prevalence of TMDs.

Psychological characteristics of young adults with temporomandibular disorders, somatization and combined conditions: A multidimensional evaluation

BACKGROUND

Temporomandibular disorders and somatization have shown interrelation in many studies. The physical and psychological factors which contributed to the occurrence and relation of both conditions are yet to be determined.

OBJECTIVES

The personality traits, coping styles and psychological distress of young adults with temporomandibular disorder (TMD) and somatic symptoms were characterized together with the determination of psychological risk factors for TMDs, somatization and combined conditions.

METHODS

Participants were recruited from university-attending young adults. TMD and somatic symptoms were appraised with the short-form Fonseca Anamnestic Index and Patient Health Questionnaire-15. Psychological variables were assessed with the Big Five Personality Inventory-10, Brief-COPE Inventory and Depression, Anxiety, and Stress Scales-21. Data were evaluated using chi-squared/non-parametric tests and logistic regression analyses (α = .05).

RESULTS

Among the 507 participants (mean age 22.2 ± 1.5 years), 46.4% reported no TMD/somatic symptoms (NS) while 7.5%, 34.5% and 11.6% had TMDs only (TS), somatization only (SS) and combined TMDs-somatization (CS), respectively. Significant differences in conscientiousness (NS > SS), agreeableness (NS, TS > CS; NS > SS), dysfunctional coping, general distress, depression, anxiety and stress (CS ≥ SS > NS) were discerned. Multivariate analyses indicated that the odds of TS were increased by anxiety (OR = 1.10; 95% CI = 1.01-1.21), while the odds of SS/CS were affected by anxiety (OR = 1.15; 95% CI = 1.06-1.25/OR = 1.34; 95% CI = 0.19-1.52) and problem-focused coping (OR = 0.71; 95% CI = 0.56-0.89/OR = 0.55; 95% CI = 0.39-0.78).

CONCLUSION

Though individuals with TMDs and somatization have dissimilar psychological profiles, anxiety constantly increased their likelihood. Problem-focused coping strategies may help alleviate psychosocial and physical stressors associated with TMDs and somatization.

DC/TMD Axis I diagnostic subtypes in TMD patients from Confucian heritage cultures: a stratified reporting framework

OBJECTIVES

This study proposed a conceptual framework for reporting Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I conditions and investigated the prevalence of TMD subtypes/categories in patients from Confucian heritage cultures. Variances in gender, age, and TMD chronicity between Chinese (CN) and Korean (KR) patients were also explored.

MATERIALS AND METHODS

Subjects were recruited from consecutive patients seeking care at two University-based centers in Beijing and Seoul. Eligible patients completed a demographic survey as well as the DC/TMD Symptom Questionnaire and were clinically examined according to the DC/TMD methodology. Axis I diagnoses were subsequently rendered with the DC/TMD algorithms and documented using the stratified reporting framework. Statistical evaluations were performed with chi-square, Mann-Whitney U tests, and logistic regression analysis (α = 0.05).

RESULTS

Data of 2008 TMD patients (mean age 34.8 ± 16.2 years) were appraised. Substantial differences in female-to-male ratio (CN > KR), age (KR > CN), and TMD duration (KR > CN) were observed. Ranked frequencies of the most common Axis I diagnoses were: CN - disc displacements (69.7%) > arthralgia (39.9%) > degenerative joint disease (36.7%); KR - disc displacements (81.0%) > myalgia (60.2%) > arthralgia (56.1%). Concerning TMD categories, notable differences in the prevalence of intra-articular (CN 55.1% > KR 15.4%) and combined (KR 71.8% > CN 33.4%) TMDs were discerned.

CONCLUSIONS

Though culturally similar, the two countries require disparate TMD care planning/prioritization. While TMJ disorders in children/adolescents and young adults should be emphasized in China, the focus in Korea would be on TMD pain in young and middle-aged adults.

CLINICAL RELEVANCE

Besides culture, other variables including socioeconomic, environmental, and psychosocial factors can influence the clinical presentation of TMDs. Chinese and Korean TMD patients exhibited significantly more intra-articular and combined TMDs respectively.

The association between problematic smartphone use and the severity of temporomandibular disorders: A cross-sectional study

OBJECTIVE

To evaluate the prevalence of different types of temporomandibular disorders (TMD) symptoms in young adults and determine their associations with problematic smartphone use (PSU).

METHODS

The data of the study were collected from local university students through an online questionnaire survey. Demographic information, Fonseca Anamnestic Index (FAI), Smartphone Addiction Scale-Short Version (SAS-SV), and Patient Health Questionnaire-4 (PHQ-4) responses were gathered electronically and analyzed using multiple logistic regression analysis.

RESULTS

There were 163 male and 307 female respondents were participated in this study. The prevalence of PSU and TMD were 83.6% and 66.4%, respectively. There was a moderate statistical correlation between PSU and TMD among young adults (r = 0.31, p < 0.01). The logistic regression model revealed that the risk of TMD was 1.77 times higher in people with PSU than in those without PSU (OR = 1.77; 95% CI 1.04-3.06). PSU is a risk factor for pain-related TMD (OR = 1.81; 95% CI 1.08-3.04) but not intra-articular TMD.

CONCLUSION

Subjects showed high prevalence of both TMD and PSU. People with PSU experienced more severe and frequent pain-related rather than intra-articular TMD symptoms than those without PSU. By reducing the problematic smartphone use, the risk factor of TMD might be avoided.

Viability of the quintessential 5 temporomandibular disorder symptoms as a TMD screener

OBJECTIVE

This study explored the viability of using the 5 temporomandibular disorder (TMD) symptoms (5Ts) of the Diagnostic Criteria for TMDs (DC/TMD) as a TMD screener.

STUDY DESIGN

A total of 1039 adults (≥18 years old) with a mean age of 32.65 ± 12.95 years (77.4% women) from a tertiary dental hospital were enrolled. The 5Ts questionnaire (involving items on TMD/facial pain, headaches, temporomandibular joint noises, and closed- and open-locking) was administered, and TMD diagnoses were derived through clinical interviews and examinations, radiographic investigations, and the DC/TMD diagnostic algorithms and diagnostic tree. Diagnostic accuracy of the 5Ts was assessed using the area under the receiver operating characteristics curve and various measures, including sensitivity, specificity, predictive values, and likelihood ratios.

RESULTS

Among the participants, 80.2% (n = 833) were 5Ts-positive, and 19.8% (n = 206) were 5Ts-negative, whereas 51.3% and 85.7% received at least 1 pain-related and intra-articular DC/TMD diagnosis, respectively. The 5Ts showed high accuracy for detecting all TMDs, pain-related and intra-articular, with area under the receiver operating characteristics curves of 0.98, 1.00, and 0.98, respectively. Sensitivity ranged from 96.1% to 99.2%, whereas specificity was 100.0%.

CONCLUSIONS

The 5Ts demonstrated high diagnostic accuracy for identifying pain-related and/or intra-articular disorders.

Predictability and Accuracy of the Short-Form Fonseca Anamnestic Index in Relation to the Modified Helkimo Index for the Diagnosis of Temporomandibular Disorders: A Cross-Sectional Study

Aim

The aim of this study was to evaluate the predictability and accuracy of the Short-Form Fonseca Anamnestic Index (SFAI) in relation to the modified Helkimo Index for the diagnosis of temporomandibular disorders (TMDs).

Materials and Methods

A cross-sectional, prospective, and analytical predictive study was conducted in 240 students of a public institute of higher technological education in Ica, Peru during the months of February to May 2018. The SFAI of 10 closed questions and the Helkimo Index modified by Maglione (gold standard) were used as instruments to diagnose TMDs. For the analysis of concordance between both instruments, Cohen's Kappa Index was applied. To evaluate the association according to gender and age group, Pearson's chi-square test was used. For validity of the SFAI in relation to accuracy, sensitivity and specificity were calculated, and they were verified by receiver operating characteristics (ROC) to determine the best cutoff points (area under the curve [AUC]) considering a P value < 0.05. Regarding the predictability of the SFAI, the positive and negative predictive value was calculated by applying Bayes' theorem.

Results

The SFAI was highly significantly associated with the modified Helkimo Index according to gender (P < 0.001), age group (P < 0.001), and overall (P < 0.001) moderate overall agreement (k = 0.416; 95% confidence interval [CI] = 0.287-0.545); better concordance was obtained in individuals older than 20 years (k = 0.490, CI = 0.302-0.679) and women (k = 0.565, CI = 0.371-0.759). The ROC curve analysis of the SFAI showed good accuracy (0.852, CI = 0.800-0.905) and was highly significant (P < 0.001), with an optimal cutoff point of 17.5 and good sensitivity (80.10%) and specificity (74.36%). In addition, a very good positive predictive value (PPV) (94.15%) and a fair negative predictive value (NPV) (42.02%) were obtained.

Conclusions

Although there was moderate concordance between the SFAI and the modified Helkimo Index for the diagnosis of TMDs, the SFAI obtained good accuracy in the overall analysis of sensitivity and specificity. In addition, it demonstrated a high predictive efficacy for detecting positive TMD cases, whereas its ability to rule out positive cases was fair.

The Short Form of the Fonseca Anamnestic Index for the Screening of Temporomandibular Disorders: Validity and Reliability in a Spanish-Speaking Population

The Short Form of the Fonseca Anamnestic Index (SFAI) is a simple and quick questionnaire used for screening temporomandibular disorders (TMDs). The present study aimed to validate the Spanish version of the SFAI in patients with TMDs. The study sample comprised 112 subjects (50 TMDs and 52 controls). Test–retest reliability, factorial validity, internal consistency, concurrent validity, and the SFAI’s ability to discriminate between TMDs subjects and healthy controls were analyzed using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD protocol) as the reference. Factor analysis showed a single factor that explained 63% of the total variance. Cronbach’s alpha was 0.849. The reliability of the items measured with the Kappa index showed values from 0.767 to 0.888. Test–retest reliability was substantial (intraclass correlation coefficient = 0.837). The total SFAI score showed a significant correlation with orofacial pain, vertigo, and neck disability measurements. For a cut-off point of >10 points, the SFAI showed a sensitivity of 78% and specificity of 78.85% at differentiating between TMDs patients and healthy subjects, with an area under the curve (AUC) of 0.852. The Spanish version of the SFAI is a valid and reliable instrument for diagnosing people with TMDs and shows generally good psychometric properties.

Patient-Reported Outcome Measurements in Temporomandibular Disorders and Headaches: Summary of Measurement Properties and Applicability

INTRODUCTION

Several patient-reported outcome measurements (PROMs) are available in the literature to support the evaluation and diagnosis of temporomandibular disorders and headaches. However, clinicians and researchers usually complain that they had no education on PROMs and low overall knowledge about PROMs.

OBJECTIVE

This study aimed to summarize, describing the measurement properties and clinical applicability of the main condition-specific PROMs available in the literature to the assessment of patients with Temporomandibular Disorders and Headaches.

METHODS

The current manuscript reviewed 10 PROMs commonly used in the field. Four instruments about functioning and disability: 1. Mandibular Function Impairment Questionnaire (MFIQ), 2. Craniofacial Pain and Disability Inventory (CF-PDI), 3. 8-item and 20-item Jaw Functional Limitation Scale (JFLS), and 4. Manchester Orofacial Pain Disability Scale (MOPDS). Two instruments about headache-related disability: 5. Headache-Related Disability Index (HDI) and 6. Headache Impact Test-6 (HIT-6). Three instruments focused on TMD and headache screening: 7. 3Q/TMD, 8. Short-Form Anamnestic Fonseca Index (SFAI), 9. Headache Screening Questionnaire. In addition, one instrument about maladaptive beliefs regarding pain and injury: 10. Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK-TMD).

CONCLUSIONS

The knowledge about the limitations and applicability of the PROMs commonly used to assess TMDs and Headaches can help clinicians and researchers to obtain reliable and valid outcomes to support the decision-making process. The current review recognizes the importance of using patient-reported outcome measures in research and clinical practice. However, our findings call the attention that further studies on the measurement properties of such instruments are imperative.