Accuracy of the Fonseca Anamnestic Index for identifying pain-related and/or intra-articular Temporomandibular Disorders

Use of the Depression Anxiety Stress Scale-21 in young people with temporomandibular disorders: Reliability and dimensionality

OBJECTIVE

The reliability and dimensionality of the Depression Anxiety Stress Scale-21 (DASS-21) were explored in adolescents/young adults with temporomandibular disorders (TMDs).

METHODS

TMD presence was established with the Fonseca Anamnestic Index. Reliability of the DASS-21 for participants with (WT) and without (NT) TMDs was assessed by the Cronbach alpha test, while dimensionality was examined using exploratory factor analysis.

RESULTS

Data from 400 participants (mean age 18.8 ± 1.5 years; 52.2% women) comprising 47.0% with and 53.0% without TMDs were evaluated. Total-DASS and the 3 subscales showed acceptable to high internal consistencies for the WT and NT groups, with alphas of 0.78-0.94 and 0.66-0.92, respectively. Although 3 factors contributed to about half the variance for both groups, scalar and item discrepancies in the primary anxiety-stress factor existed.

CONCLUSION

The DASS-21 has good reliability but may comprise only 2 dimensions, specifically anxiety-stress and depression, instead of the 3 originally asserted.

Negative affectivity and emotions in youths with temporomandibular disorders across cultures

OBJECTIVE

The relationships between temporomandibular disorders (TMDs) and negative affectivity/emotions across cultures and the emotional predictors for TMDs in Southeast Asian youths were investigated.

METHODS

The presence of TMDs and negative affectivity/emotions were determined with the Fonseca Anamnestic Index (FAI) and Depression, Anxiety, Stress Scales-21 (DASS-21). Statistical evaluations were done with non-parametric and logistic regression analyses (α.

RESULTS

The total sample comprised 400 Singaporean and 501 Indonesian youths (mean age 19.30 ± 1.48 years; 65.0% women) of whom 47.0% and 59.3% had mild-to-severe TMDs, respectively. For both cultures, participants with TMDs had significantly greater negative affectivity, depression, anxiety, and stress than those with no TMDs. Indonesian youths also presented higher levels of emotional distress than their Singaporean counterparts. Correlations between FAI and anxiety/stress scores were moderately strong.

CONCLUSION

Cultural variations can influence the expression of TMDs and emotional distress. Being female and anxious increased the risk of TMDs.

Portuguese translation, cultural adaptation and psychometric properties of the temporomandibular joint scale: a cross-sectional study

BACKGROUND

The temporomandibular joint (TMJ) scale assesses the severity of temporomandibular joint disorders (TMD), yet a European Portuguese translation is lacking.

OBJECTIVES

To translate, cross-culturally adapt and to examine the psychometric properties (construct validity and reliability) of the TMJ scale.

METHODS

Translation and cultural adaptation were carried out according to international recommendations, including initial translation, evaluation of this translation and cultural adaptation by a panel of experts, and back translation. The final Portuguese version was used to examine the reliability and validity, and participants with TMD were recruited from a Portuguese outpatient clinic. Reliability measures included internal consistency with Cronbach's alpha and test-retest reliability with the intraclass correlation coefficient (ICC2,1). The Spearman correlation comparing the TMJ scale with the Fonseca and Helkimo indexes was used to assess the construct validity.

RESULTS

A total of 63 participants (23 ± 2 years; 61,9% female) were included. Similar internal consistency was observed between the two moments of application (0.921 and 0.918), and test-retest reliability was excellent, with an ICC2,1 = 0.998 (95%CI: 0.988-0.999). Robust positive correlations (rho 0.554-0.611, p < 0.001) were found between the TMJ scale and Fonseca and Helkimo indexes.

CONCLUSION

The European Portuguese version of TMJ scale is now available to improve the assessment of severity of TMD in routine clinical practice. This version is also reliable and valid.

Impact of applying different levels of threshold-based artifact correction on the processing of heart rate variability data in individuals with temporomandibular disorder

Although heart rate variability (HRV) is a valid method to evaluate the behavior of the autonomic nervous system in individuals with temporomandibular disorder (TMD), the measurement can easily be biased by factors involving the analysis methodology, such as the removal of artifacts. Therefore, the objective of this investigation is to evaluate the impact of using different levels of threshold-based artifact correction to process HRV data in individuals with TMD. This cross-sectional observational study. Adults aged 18 to 55 years old with a diagnosis of myogenic TMD, score ≥ 50 on the Fonseca Anamnestic Index (FAI) and pain ≥ 3 on the Numerical Pain Scale (NPS) participated. The HRV was registered in the supine position (short-term) using a Polar S810i. Kubios software was used for HRV analysis using all filters. One-way ANOVA with Tukey-Kramer post-hoc was used to test the differences in HRV using the different Kubios Software artifact correction filters. The effect size was calculated based on the Cohen d. The very strong filter was statistically different (p < 0.05) compared to the no filter in all overview and time domain variables. In the frequency domain, the variables VLF, LF, HF and Total Power showed statistical differences (p < 0.05) when using the very strong filter. The same occurred with the variables SD1, SD2 and DFA α2 of the non-linear analysis (p < 0.05). The most restrictive filter of the Kubios software (very strong) significantly impacts the quantification of HRV parameters in individuals with TMD.

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.

Temporary Hydrostatic Splint Therapy and Its Effects on Occlusal Forces

Background and objectives: This study analyzed and compared the distribution patterns of occlusal forces using T-Scan III before and after the hydrostatic temporary oral splint (Aqualizer Ultra) therapy in healthy subjects and subjects with temporomandibular disorders (TMDs). Materials and Methods: Fifty-one subjects were divided into groups based on anamnesis and responses to the Fonseca questionnaire. The first group, non-TMDs group (n = 19), and the second group, TMDs group (n = 32), had mild-to-severe TMDs, as identified by the Fonseca questionnaire. The non-TMDs group had an average age of 25.4 years (SD = 4.8, range 20-38) with 15 females (78.95%) and 4 males (21.05%). The TMDs group had an average age of 27.4 years (SD = 7.0, range 22-53) with 25 females (78.125%) and 7 males (21.875%). T-Scan III device was used for occlusal analysis before and after hydrostatic splint usage. Results: Significant differences were observed in the TMDs group for anterior and posterior right percentages of forces before and after hydrostatic splint usage. The analysis of force distribution per sector before and after hydrostatic splint therapy showed no significant differences in the non-TMDs group. Analysis of force distributions in the entire study population before and after hydrostatic splint therapy showed significant differences in the anterior and posterior right regions. Occlusal force increased by 32-56% in the front region and decreased in the posterior area after hydrostatic splint usage. Conclusions: Hydrostatic splint therapy is recommended as a part of full-mouth rehabilitation treatment for all patients regardless of the severity of TMDs.

Etiologic Factors of Temporomandibular Disorders: A Systematic Review of Literature Containing Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) from 2018 to 2022

This study aims to conduct a systematic analysis of literature published between 1 January 2018 and 1 September 2022, exploring factors influencing the progression or development of temporomandibular disorders (TMD), diagnosed using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) or Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Three electronic databases were reviewed to identify papers that examined TMD factors using DC/TMD or RDC/TMD. Inclusion criteria encompassed original research published in English between 1 January 2018 and 1 October 2022, online, and complete DC/TMD or RDC/TMD studies on human participants aged 18 or older. Two authors independently assessed the risk of bias using The Joanna Briggs Institute (JBI) Analytical cross-sectional studies' Critical Appraisal Tool. Of 1478 articles, 11 were included. The studies revealed strong associations between TMD and factors such as female, poor sleep quality, depression, oral parafunction, anxiety, somatization, and anatomical features. However, variables such as education, living conditions, socioeconomic status, marital status, chronic pain, and stress did not exhibit statistically significant correlations. Based on the obtained data, it can be concluded that the causes of TMD are largely related to psychological factors, which supports the biopsychosocial theory of the disorder.

Correlates between temporomandibular disorder severity, emotional distress, and eudaimonic well-being among young adults

OBJECTIVES

This study examined the correlates between severity of temporomandibular disorders (TMDs), emotional distress, and eudaimonic well-being.

SUBJECTS AND METHODS

TMD severity, negative emotions, and eudaimonia were assessed with the Fonseca Anamnestic Index (FAI), Depression, Anxiety, Stress Scales-21 (DASS-21), and Psychological Well-being Scale-18 (PWBS-18) in a cohort of community young adults. Statistical evaluations were done with non-parametric tests/correlation and multivariate regression analyses (α = 0.05).

RESULTS

Amongst the 873 participants (mean age 19.8 ± 1.66 years), 40.7%, 49.0%, and 10.3% had no (NT), mild (MT), and moderate-to-severe (ST) TMD, respectively. Significant differences in total-DASS, depression, anxiety, and stress were ST ≥ MT > NT. Significant variances in total-PWSB and self-acceptance were NT > MT > ST while that for environmental mastery, positive relations, and purpose in life were NT > MT, ST. An inverse relationship was discerned between total-DASS and total-PWBS (correlation coefficient = -0.54). The prospect of ST was increased by anxiety but reduced by positive relations and self-acceptance.

CONCLUSIONS

Young adults with mild and moderate-to-severe TMD experienced substantially higher emotional distress and lower eudaimonia than those with no TMD. As emotional distress and eudaimonic well-being are interrelated, positive psychological interventions may be beneficial for managing TMD-related psychosocial disabilities.

Development of a new category system for the profile morphology of temporomandibular disorders patients based on cephalograms using cluster analysis

OBJECTIVE

This study aims to develop a new category scheme for the profile morphology of temporomandibular disorders (TMDs) based on lateral cephalometric morphology.

METHODS

Five hundred and one adult patients (91 males and 410 females) with TMD were enrolled in this study. Cluster tendency analysis, principal component analysis and cluster analysis were performed using 36 lateral cephalometric measurements. Classification and regression tree (CART) algorithm was used to construct a binary decision tree based on the clustering results.

RESULTS

Twelve principal components were discovered in the TMD patients and were responsible for 91.2% of the variability. Cluster tendency of cephalometric data from TMD patients were confirmed and three subgroups were revealed by cluster analysis: (a) cluster 1: skeletal class I malocclusion; (b) cluster 2: skeletal class I malocclusion with increased facial height; (c) cluster 3: skeletal class II malocclusion with clockwise rotation of the mandible. Besides, CART model was built and the eight key morphological indicators from the decision tree model were convenient for clinical application, with the prediction accuracy up to 85.4%.

CONCLUSION

Our study proposed a novel category system for the profile morphology of TMDs with three subgroups according to the cephalometric morphology, which may supplement the morphological understanding of TMD and benefit the management of the categorical treatment of TMD.

Temporomandibular joint (TMJ) disorders prevalence and awareness of appropriate clinical practices, among Al-Madinah community in Saudi Arabia

Background:  Painful temporomandibular joint disorders (TMDs) are of musculoskeletal origin and are considered the most common cause of non-odontogenic pain in the orofacial region.  The purpose of this study was to investigate the prevalence and awareness of temporomandibular joint (TMJ) disorders in Almadinah Almunawwarah community. Methods: An observational cross-sectional study with convenience sampling was conducted. A translated Arabic version of Fonseca's questionnaire was employed. The questionnaire asked about the participant's personal information, if they thought they had TMDs, and who to visit for therapy if necessary. These were followed by 10 items from Fonseca's questionnaire, each with a three-point scale. Results: The questionnaire was completed by 598 people. Females made up 57.1% of the participants. TMDs were present in 61% of the population, with varying degrees of severity. Males (44.3%) were less affected than females (55.7%). The difference, however, was not statistically significant (P = 0.354). Out of the 61% TMDs Positive patients, 74.1% had mild TMDs symptoms, while 20.8% and 5.1%, respectively, had moderate and severe TMDs symptoms (P = 0.05). The severity of the symptoms was unaffected by demographic data (P > 0.05). Only 40% seek care, with 64.6% selecting for a dentist and 24.6% preferring for an orthopaedic specialist (P= 0.008). Conclusions: Participants from Al-Madinah had a greater prevalence of mild TMDs. The majority of the participants had no idea who to go to for treatment. The findings of this study highlight the importance of educational activities to enhance public awareness. Fonseca's Anamnestic Index could also be considered as a useful instrument for early identification and measuring the severity of TMDs in the general population.

Temporomandibular joint (TMJ) disorders prevalence and awareness of appropriate clinical practices, among Al-Madinah community in Saudi Arabia

Background:  Painful temporomandibular joint disorders (TMDs) are of musculoskeletal origin and are considered the most common cause of non-odontogenic pain in the orofacial region.  The purpose of this study was to investigate the prevalence and awareness of temporomandibular joint (TMJ) disorders in Almadinah Almunawwarah community. Methods: An observational cross-sectional study with convenience sampling was conducted. A modified version of Fonseca's questionnaire was employed. The questionnaire asked about the participant's personal information, if they thought they had TMDs, and who to visit for therapy if necessary. These were followed by 10 items from Fonseca's questionnaire, each with a three-point scale. Results: The questionnaire was completed by 598 people. Females made up 57.1% of the participants. TMDs were present in 61% of the population, with varying degrees of severity. Males (44.3%) were less affected than females (55.7%). The difference, however, was not statistically significant (P = 0.354). Out of the 61% TMDs Positive patients, 74.1% had mild TMDs symptoms, while 20.8% and 5.1%, respectively, had moderate and severe TMDs symptoms (P = 0.05). The severity of the symptoms was unaffected by demographic data (P > 0.05). Only 40% seek care, with 64.6% selecting for a dentist and 24.6% preferring for an orthopaedic specialist (P= 0.008). Conclusions: Participants from Al-Madinah had a greater prevalence of mild TMDs. The majority of the participants had no idea who to go to for treatment. The findings of this study highlight the importance of educational activities to enhance public awareness. Fonseca's Anamnestic Index could also be considered as a useful instrument for early identification and measuring the severity of TMDs in the general population.

Craniofacial Morphology of Orthodontic Patients with and without Temporomandibular Disorders: A Cross-Sectional Study

Purpose

We aimed to explore the relationship between temporomandibular disorders (TMDs) and craniofacial morphology in orthodontic patients.

Methods

Altogether, 262 orthodontic patients were included and divided into two groups according to their Fonseca Anamnestic Index (FAI) scores: a no-TMD group (control group, FAI < 20) and a TMD group (FAI ≥ 20). Cephalometric parameters including cranial, maxillary, mandibular, and dental parameters were traced on cephalograms. Craniofacial morphology was compared between TMD and control groups, followed by subgroup analyses based on TMD severity, gender, age, and temporomandibular joint (TMJ) symptoms.

Results

The prevalence of TMDs was 52.7% among included patients (138/262). The mean age of TMD patients was higher than that of the control group. No significant difference in gender distribution between the groups was observed. The most commonly reported FAI items were misaligned teeth, neck pain, and emotional tension. The Frankfort-mandibular plane angle (FMA) was larger in the TMD patients than in the control group, whereas no significant differences in other parameters were observed. Subgroup analysis based on TMD severity revealed that FMA and anterior facial height of moderate/severe TMD patients were significantly larger than those of mild or no-TMD patients. Among male patients, the anterior cranial base length was smaller, and the anterior facial height was larger in the TMD group. Among female patients, no significant differences in craniofacial morphology between the groups were observed. In juvenile patients, overjet and overbite were smaller in the TMD group. In adult patients, SNA, ANB, FMA, and gonial angle were larger in the TMD group. Within the TMD group, patients with TMJ pain or noises exhibited characteristic craniofacial features compared to patients without these symptoms.

Conclusions

Orthodontic patients with TMDs have specific craniofacial morphology, suggesting a relationship between TMDs and particular craniofacial features in orthodontic patients.

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.