Classifying degenerative joint disease by the RDC/TMD and by panoramic imaging: a retrospective analysis

Evaluation of the relationship between the degenerative changes and bone quality of mandibular condyle and articular eminence in temporomandibular disorders by cone beam computed tomography

Objective: To evaluate whether there was a relationship between the degenerative bone changes and bone quality of the mandibular condyle and articular eminence in patients with temporomandibular disorder (TMD).Methods: The study group consisted of 100 patients with TMD. "Diagnostic Criteria/TMD" was used to identify the pathologies. Degenerative bone changes and bone qualities were detected by cone beam computed tomography; the bone qualities were classified using the Bone Quality Index (BQI) scale.Results: No statistically significant difference was found between degenerative bone changes and bone quality of the temporomandibular joint (TMJ) according to gender (p > 0.05). However, degenerative bone changes were more frequent than articular eminence in the mandibular condyle. BQI Type III was the most common bone quality among all types of degenerative bone changes.Discussion: Although no causality relationship was found between the bone quality and degenerative bone changes, low bone quality was found in TMD patients.

Long-term Changes of Temporomandibular Joint Osteoarthritis on Computed Tomography

This study aimed to understand long-term changes of the osteoarthritic temporomandibular joint (TMJ) condyle using computed tomography (CT) and to verify its correlation with clinical characteristics of temporomandibular disorders. Eighty-nine patients (152 joints; 76 female, 13 male) who had taken follow-up CTs (mean follow-up period: 644.58 ± 325.71 days) at least once in addition to their initial evaluation were selected. Cross-sectional demographic and clinical data and longitudinal CT images were collected. Data were analyzed by analysis of variance and logistic regression. Overall destructive change index (number of TMJ condyle sections in which destructive change was observed) decreased from 1.56 to 0.66. Improvement was seen in 93 joints (61.2%) and 27 joints (17.8%) worsened. In the pain positive group, both initial and final destructive change index were significantly higher compared to the pain negative group (p = 0.04). Occlusal stabilization splint therapy and nonsteroidal anti-inflammatory drug administration showed a significant effect on improving the prognosis of TMJ osteoarthritis (p = 0.015 and 0.011). In conclusion, TMJ osteoarthritis showed long-term improvement in the majority of cases. TMJ osteoarthritis accompanied by pain showed unfavorable prognosis with additional bone destruction. Occlusal stabilization splint and nonsteroidal anti-inflammatory drug administration were beneficial on the prognosis of TMJ osteoarthritis.

Association of radiographic and clinical findings in patients with temporomandibular joints osseous alteration

OBJECTIVES

To characterize the relationship between radiographic and clinical characteristics of patients with temporomandibular joint (TMJ) osseous changes.

MATERIALS AND METHODS

TMJ cone beam computed tomography (CBCT) images of 73 patients (142 joints) with changes in osseous component of TMJ were included in this study. Based on both clinical and radiographic findings, each TMJ was diagnosed as either non-degenerative joint disease (non-DJD) or degenerative joint disease (DJD) according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) criteria. The DJD group was further classified into two subgroups of osteoarthritis and osteoarthrosis. The data were analyzed using t test and Pearson's correlation. Level of statistical significance was set at 0.05.

RESULTS

Statistically significant relationships were found between TMJ crepitation sound and 4 radiographic characteristics of DJD. DJD group demonstrated statistically significant higher CBCT bone change score (BCS) and age. In contrast, there was no significant difference of BCS between osteoarthrosis and osteoarthritis groups within the DJD group.

CONCLUSIONS

Crepitation sounds and osseous changes in TMJ radiograph are confirmed to be important diagnostic criteria for TMJ DJD. However, degree of TMJ osseous changes does not correlate significantly with clinical pain symptom.

CLINICAL RELEVANCE

For TMJ DJD diagnosis, dentists should consider both clinical examination for TMJ crepitation and radiographic assessment for TMJ bony changes.

Relation between osteoporosis and radiographic and clinical signs of osteoarthritis/arthrosis in the temporomandibular joint: a population-based, cross-sectional study in an older Swedish population

OBJECTIVE

The aim was to elucidate the relation between osteoporosis and osteoarthritis/arthrosis (OA) in the temporomandibular joint (TMJ).

BACKGROUND

General epidemiological data support the hypothesis that osteoporosis and OA are inversely correlated but is not conclusively investigated in the TMJ.

MATERIALS AND METHODS

A group of 114 representative elderly women and men, randomised from a comprehensive population study in Gothenburg, Sweden, had bone mineral density established with whole-body, dual-energy X-ray absorptiometry (DXA) as part of a health survey. In addition, dental examinations were performed, including panoramic radiographs exposed as an overview of the TMJ's and jaws. In 88 of the 80-year-old participants (48 women and 40 men), a clinical orofacial examination according to the RDC/TMD system was performed.

RESULTS

A diagnosis of osteopenia/osteoporosis was found in 36% of the 114, with a statistically different greater proportion of women. Condylar alterations evaluated from panoramic radiographs were observed in 34%, with no significant gender difference. No significant differences were found in the proportion of individuals with osteopenia/osteoporosis and any condylar radiographic alteration or not. Forty-one of the clinically examined subjects, 47%, fulfilled the criteria for an RDC/TMD diagnosis with no gender difference. All participants graded the orofacial pain as low chronic pain. An opening capacity of <40 mm denoted a higher risk of having pain in the temporomandibular system. No association was found between clinical diagnosis of RDC/TMD and osteopenia/osteoporosis.

CONCLUSION

The prevalence of osteopenia/osteoporosis appears not to be of importance for radiological or clinical findings of OA in the TMJ.

Digital panoramic radiography for diagnosis of the temporomandibular joint: CBCT as the gold standard

Three-dimensional imaging modalities have been reported to be more accurate than panoramic radiographs (PR) for the assessment of bone components of the temporomandibular joint (TMJ). No exact prior information is available that demonstrates which specific limitations occur in terms of TMJ diagnosis when using PR for this purpose. This study aimed to assess the clinical validity of digital panoramic radiography (DPR) when diagnosing morphological disorders of the TMJ using cone-beam computed tomography (CBCT) images as the gold standard. A sample composed of TMJ images (N = 848), including 212 DPR and 212 CBCT images obtained from the same patient, was used to assess any morphological changes in the TMJ. Four appraisers diagnosed all of the DPR images, whereas the CBCT images were used to establish the gold standard. The reliability of each appraiser's response pattern was analyzed using the Kappa test (κ), and diagnostic tests were performed to assess each appraiser's performance using a significance level setting of 5% (α = 0.05). Reliability of each appraiser's response pattern compared to the gold standard ranged from a slight-to-moderate agreement (0.18 ≤ κ ≤ 0.45); and among the different appraisers, the response pattern showed a fair agreement (0.22 ≤ κ ≤ 0.39). Diagnostic tests showed a wide range among the different possible morphological changes diagnosed. DPR does not have validity when diagnosing morphological changes in the TMJ; it underestimates the radiological findings with higher prevalence, and thus, it cannot be used effectively as a diagnostic tool for bone components within this region.

Comparison of TMJ vibration frequencies under different joint conditions

OBJECTIVE

To compare 10 Hz wide segments of the 0 to 1000 Hz frequency distributions of vibrations recorded from five stages of internally deranged and asymptomatic temporomandibular joints (TMJs).

METHODS

TMJ vibrations were recorded from 236 patients with five stages of TMJ dysfunction: (1) reducing partial disc displacement (PDDR, n=39); (2) acute reducing complete disc displacement (A-DDR, n=39); (3) chronic reducing complete disc displacement (C-DDR, n=55); (4) un-adapted, non-reducing, complete disc displacement (DDUA, n=57); and (5) well adapted, non-reducing, complete disc displacement (DDWA, n=46). A totally asymptomatic control group with quiet TMJs (AQ, n=43) and a group with vibrating TMJs (AWV, n=93), but otherwise asymptomatic were also recorded. Frequency distributions were calculated for each group using discrete Fourier transform methods in 10 Hz increments (0-10 Hz, 10-20 Hz,…, 990-1000 Hz). The 10 Hz segments were compared between the seven groups using Student's t test with Bonferroni adjustment.

RESULTS

There were significant differences (P<0.05) in all 21 comparisons for the three segments between 80 Hz and 110 Hz, in 20 of 21 comparisons between 180 and 200 Hz, in 19 of 21 comparisons between 110 and 180 Hz and between 50 and 80 Hz.

DISCUSSION

The segments of the frequency distributions from 80 to 110 Hz provided the best differentiation between all seven groups.

Diagnostic validity (sensitivity and specificity) of panoramic X-rays in osteoarthrosis of the temporomandibular joint

OBJECTIVE

To establish the diagnostic validity of panoramic X-rays (PRx) in temporomandibular osteoarthrosis (OA) using the clinical and imaging criteria (magnetic resonance imaging, MRI) of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) as gold standards.

METHODS

Eighty-four patients with full clinical records (RDC/TMD), PRx, and MRI scans were selected. Two stomatologists evaluated the PRx for OA. The MRI findings were derived from the radiologist report. Intra/inter-examiner concordance was established. The diagnostic concordance between clinical signs and MRI was determined. Both were used as gold standards to calculate the validity of PRx in OA.

RESULTS

The diagnostic validity of PRx with MRI as gold standard was sensitivity=69.0% and specificity=67.9%. The diagnostic validity of PRx with clinical criteria as gold standard was sensitivity=61.6% and specificity=57.9%.

DISCUSSION

Panoramic X-rays have scant diagnostic validity in temporomandibular osteoarthrosis when taking MRI or clinical criteria of RDC/TMD as gold standards.

Distribution of diagnoses in a population of patients with temporomandibular disorders

OBJECTIVES

The objective of this study was to describe the frequency of TMD diagnoses in a patient population for comparison with the available literature.

METHODS

Five hundred twenty consecutive patients seeking TMD treatment underwent a Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) assessment. The prevalence and age distribution of the different RDC/TMD axis I and II diagnoses were described.

RESULTS

Muscle disorders, disk displacements, and other joint disorders were diagnosed respectively in 56.4%, 42.0%, and 57.5% of patients. Sixty percent of patients had depression symptoms, 76.6% had somatization, and 21.8% presented high levels of pain-related impairment. Disk displacements were more frequently diagnosed in the younger-aged, other joint disorders in the older-aged, and muscle disorders in the middle-aged subjects (ANOVA for mean age comparison, F = 3.355; P = .002).

CONCLUSIONS

These distribution frequencies of TMD diagnoses provide insight into the epidemiology of this disease.

Self-reported bruxism and temporomandibular disorders: findings from two specialised centres

The aims of this investigation were to report the frequency of temporomandibular disorders (TMD) diagnoses and the prevalence of self-reported awake and sleep bruxism as well as to describe the possible differences between findings of two specialised centres as a basis to suggest recommendations for future improvements in diagnostic homogeneity and accuracy. A standardised Research Diagnostic Criteria for TMD (RDC/TMD) assessment was performed on patients attending both TMD Clinics, viz., at the University of Padova, Italy (n=219; 74% women) and at the University of Tel Aviv, Israel (n=397; 79% women), to assign axis I physical diagnoses and to record data on self-reported awake and sleep bruxism. Significant differences were shown between the two clinic samples as for the frequency of TMD diagnoses (chi-square, P<0·001) and the prevalence of at least one positive response to bruxism items (chi-square, P<0·001). The more widespread use of TMJ imaging techniques in one clinic sample led to a higher prevalence of multiple diagnoses, and the higher prevalence of self-reported bruxism in patients with myofascial pain alone described in the other clinic sample was not replicated, suggesting that the different adoption of clinical and imaging criteria to diagnose TMD may influence also reports on their association with bruxism. From this investigation, it emerged that the features of the study samples as well as the different interpretation of the same diagnostic guidelines may have strong influence on epidemiological reports on bruxism and TMD prevalence and on the association between the two disorders.

Correlation of RDC/TMD axis I diagnoses and axis II pain-related disability. A multicenter study

As part of an ongoing multicenter investigation involving four highly specialized tertiary clinics for temporomandibular disorders (TMD) treatment, retrospective analysis of Research Diagnostic Criteria for TMD (RDC/TMD) axis I and axis II data gathered on clinic and community cases were assessed with a twofold aim: (1) to search for a correlation between axis I diagnoses and axis II pain-related disability, and (2) to identify clinical (axis I) and psychosocial (axis II) predictors of high pain-related disability. Two samples of patients seeking treatment for TMD (clinic cases, N = 1,312) and a sample of general population subjects (community cases, N = 211) underwent a thorough assessment in accordance with the RDC/TMD version 1.0 [1] guidelines to receive both axis I and axis II diagnoses. Spearman's test was performed to assess the level of correlation between axis I diagnoses and Graded Chronic Pain Scale (GCPS) pain-related disability. A stepwise multiple logistic regression model was used to identify the significant associations between 12 clinical and psychosocial predictors and the presence of high pain-related disability. Axis I findings were related with pain-related impairment (GCPS scores) in the overall study sample including both clinic community cases (Spearman correlation = 0.129, p = 0.000), but the results of the correlation analyses performed on the clinic sample alone were not significant (Spearman correlation = -0.018, p = 0.618). Predictors for high disability were related to axis II findings (severe depression and somatization) or psychosocial aspects related to the pain experience (pain lasting from more than 6 months; treatment-seeking behavior), while none of the axis I diagnoses remained in the final logistic regression model. The final model predicted the level of pain-related impairment at a fair level (R(2) = 26.7%). The correlation between axis I diagnoses and pain-related impairment is not significant in the patients populations. Treatment-seeking behavior and other factors related with the pain experience are likely to be more important than the physical findings to determine the degree of psychosocial impairment.