Centric relation–intercuspal position discrepancy and its relationship with temporomandibular disorders. A systematic review

Objective: The objective of this study is to assess the relationship between centric relation-intercuspal position discrepancy (CR-ICP discrepancy) and temporomandibular disorders (TMDs), by systematically reviewing the literature.

Materials and methods: A systematic research was performed between 1960 and 2016 based on electronic databases: PubMed, Cochrane Library, Medline, Embase, Scopus, EBSCOhost, BIREME, Lilacs and Scielo, including all languages. Analytical observational clinical studies were identified. Two independent authors selected the articles. PICO format was used to analyze the studies. The Newcastle-Ottawa Scale (NOS) was used to verify the quality of the evidence.

Results: Four hundred and sixty-seven potentially eligible articles were identified. Twenty studies were analyzed, being grouped according to intervention in studies in orthodontic patients (n?=?3) and studies in subjects without intervention (n?=?17). Quality of evidence was low, with an average score of 3.36 according to Newcastle-Ottawa Scale. In most studies, the presence of CR-ICP discrepancy is associated with the presence of muscle (pain) and joint disorders (noise, disc displacement, pain, crepitus, osteoarthritis and osteoarthrosis). However, the lack of consistency of the results reported reduces the validity of the studies making it impossible to draw any definite conclusions.

Conclusions: Because of the heterogeneity of the design and methodology and the low quality of the articles reviewed, it is not possible to establish an association between CR-ICP discrepancy and TMD. The consequence of CR-ICP discrepancy on the presence of TMD requires further research, well-defined and validated diagnostic criteria and rigorous scientific methodologies. Longitudinal studies are needed to identify CR-ICP discrepancy as a possible risk factor for the presence of TMD.     

Temporomandibular disorders in growing patients after treatment of class II and III malocclusion with orthopaedic appliances: a systematic review

Objective: To determine if the use of orthopaedic appliances in growing patients applied to correct Class II and III malocclusion is related to the development of temporomandibular disorders (TMD).

Material and methods: A systematic review was conducted between 1960 and July 2017, based on electronic databases: PubMed, Cochrane Library, Embase, Medline, Scopus, EBSCOhost, Scielo, Lilacs and Bireme. Controlled clinical trials (CCTs) and randomized controlled trials (RCTs) were identified. The articles were selected and analyzed by two authors independently. The quality of the evidence was determined according to the guidelines of the Cochrane Risk Bias Assessment Tool and the Cochrane Quality Study Guide.

Results: Seven articles were included, four CCTs and three RCTs. The studies were grouped according to malocclusion treatment in (a) class II appliances (n?=?4) and (b) class III appliances (n?=?3). The quality of evidence was low due to the high risk of bias, independent of the association reported. All studies concluded that the use of orthopaedic appliances would not contribute to the development of TMD.

Conclusions: The quality of evidence available is insufficient to establish definitive conclusions, since the studies were very heterogeneous and presented a high risk of bias. However, it is suggested that the use of orthopaedic appliances to correct class II and III malocclusion in growing patients would not be considered as a risk factor for the development of TMD. High-quality RCTs are required to draw any definitive conclusions.     

Long-term treatment outcome for adolescents with temporomandibular pain

Objectives: This study aims to evaluate long-term, self-perceived outcome in adulthood for individuals treated as adolescents for temporomandibular disorder (TMD) pain in two previous randomized controlled trials (RCTs).

Materials and methods: The study included 116 subjects (81% females) treated for frequent TMD pain in two separate RCTs 5–21 (M?=?14.8, SD =4.9) years previously. Treatment consisted of occlusal appliance (OA) (n?=?41, 35.3%) or relaxation training (RT) combined with information for the control (Co) group (n?=?50, 43.1%), both compared to non-responders receiving additional, sequential treatment (ST) in a crossover study (n?=?25, 21.6%). Participants answered a questionnaire on their experience of frequency and intensity of TMD pain impaired chewing capacity and daily social activities, help-seeking behaviour and treatment, general health, other pain, and depressive symptoms.

Results: Older participants reported lower levels of frequency and intensity of TMD pain, impairment, and depressive symptoms, as well as better general health. Females reported more frequent and more intense TMD pain, greater impairment and more often reported ‘other pain’ compared to males. Non-responders receiving ST experienced significantly more TMD, and other pain and higher impairment levels compared to other groups. Those treated with an OA had sought additional treatment significantly less often since the RCTs than ST and RT/Co-treated individuals.

Conclusions: Adolescents treated with OA showed somewhat better sustained improvement over the extended follow-up period than those treated with RT/Co. Non-responders to treatment and females exhibited a poorer outcome. These groups need particular attention and extended or different treatments to achieve a better long-term outcome.     

Are occlusal features associated with different temporomandibular disorder diagnoses in bruxers?

Aims:

The present study was designed to test the hypothesis that dental occlusion may have a role in mediating the effects of bruxism in temporomandibular disorders (TMD) patients. It aimed to answer the clinical research question: in a population of TMD patients with clinically diagnosed clenching-type bruxism, are the different TMD diagnoses associated with different occlusal features?

Materials and methods:

A total of 294 TMD patients (73% females, mean age 38·3±9·2 years) who were positive for a clinical diagnosis of clenching-type bruxism underwent an assessment in accordance with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis I, as well as a recording of nine occlusal features. Statistical analyses were performed to test the null hypotheses that: (1) no differences existed between the patients with or without the various occlusal features as for the prevalence of the various single and combined RDC/TMD group diagnoses (single variable analysis), and (2) having any specific occlusal feature makes no difference in distinguishing within the RDC/TMD diagnoses (multiple variable analysis).

Results:

The distribution of the different combination of RDC/TMD axis I diagnoses was significantly different in patients with laterotrusive interferences with respect to those without such interferences (chi-square?=?15·209; P?=?0·033) as well as in patients with a slide from retruded contact position (RCP) to maximum intercuspation (MI) >2 mm with respect to those without such slide (chi-square?=?4·029; P?=?0·012) and in those with or without molar class asymmetry (chi-square?=?17·438; P?=?0·015). Multinomial regression analysis showed that the model including the various occlusal features account for 20·4% of the variance for RDC/TMD diagnoses (Nagelkerke R²?=?0·204) and allowed the rejection of the null hypothesis that having such specific occlusal features makes no difference in distinguishing within the RDC/TMD diagnoses.

Conclusions:

Within the limitations of this study, it can be suggested that in a population of patients with TMD and clinically-diagnosed clenching-type bruxism, the patterns of TMD diagnoses may be influenced, at least in part, by the presence of some features of dental occlusion, namely, slide RCP-MI, laterotrusive interferences, and molar asymmetry.     

Role of psychosocial factors on treatment outcome of temporomandibular disorders

Objectives: The aim of this randomized controlled study was to investigate the effect of depressive and non-specific physical symptoms on treatment outcome of temporomandibular disorders (TMD).

Material and methods: Eighty TMD patients were randomly assigned to splint group (n?=?39) and control group (n?=?41). The patients were classified in terms of depressive and non-specific physical symptoms as normal, moderate or severe using Research Diagnostic Criteria for Temporomandibular Disorders Axis II protocol. The effect of depressive and non-specific physical symptoms on the intensity of facial pain, as measured with visual analogue scale (VAS) was estimated with linear mixed models. The patients’ subjective estimates of the effects of treatment and TMD symptom severity were inquired at 1-year follow-up.

Results: At baseline and during the follow-up there were no significant differences in VAS scores between patients in different Axis II subscales. According to the mixed linear regression, depressiveness or nonspecific physical symptoms separately were not significantly associated with the VAS during the study. The association of VAS with depressive (p?=?.073) and nonspecific physical symptoms (p?=?.088) approximated statistical significance. Patients with moderate or severe nonspecific physical symptoms (with pain items) at baseline had more frequently moderate, severe or intolerable TMD symptoms after the treatment compared to those who were classified in normal subgroup.

Conclusions: The present study gave some indication of a possible negative effect of depressive and nonspecific physical symptoms (with pain items) on TMD treatment response. However, the results should be regarded as preliminary, and further studies with larger sample size are needed to confirm the results.     

Knowledge and competence in temporomandibular disorders among Swedish general dental practitioners and dental hygienists

Objective: The aim of this study was to investigate knowledge and competence in temporomandibular disorders (TMD) among dentists and dental hygienists working in the public dental service (PDS) in Sweden.

Materials and methods: The study population comprised all general dentists (n?=?110) and dental hygienists (n?=?80) working in the PDS in two Swedish counties: Kronoberg (K) and Blekinge (B). The participants filled out a questionnaire comprised of 15 questions.

Results: The results of these questions are presented. The overall response rate for the general dentists was 87%, while the rate for the dental hygienists was 71%. Statistically significant differences between the general dentists in the two counties were found regarding the following: education in the field of TMD over the last 5 years (K: 37%, B: 73%), evaluation of occlusion when examining patients with suspected TMD (‘always’: K: 61%, B: 82%), and a desire for consultation of the OFP (orofacial pain)/TMD specialist by telephone (K: 71%, B: 44%). Regarding the dental hygienists, there was a statistically significant difference concerning the use of the treatment modality ‘reassurance’ (K: 41%, B: 7%).

Conclusions: The majority of the dental care providers in both counties – irrespective of professional category – had a positive attitude towards patients with TMD. Knowledge and competence in the field are sparse and require postgraduate education. There is a great need of an OFP/TMD specialist for more complicated patients and a need to implement updated knowledge and competence in the PDS in these two counties.     

A bibliometric analysis of the 103 top-cited articles in endodontics

Objective: The purpose of this study was to identify the 100 top-cited articles in endodontics and analyse their bibliometric characteristics.

Material and methods: The Web of Science database was reviewed to identify the relevant articles.

Results: One hundred and three articles were included because the last four articles had the same number of citations. The top-cited article received 2115 citations. The articles were published in 28 different journals, with the most popular publication being the Journal of Endodontics (n?=?36). The most prolific country was the United States (n?=?41), followed by Sweden (n?=?17) and Switzerland (n?=?8). The most prolific author and institution were M. Torabinejad (n?=?12) and Umeå University (n?=?9), respectively. The majority of articles were of a basic science nature (n?=?55), while endodontic microbiology (n?=?24) was the most frequent subspecialty. The most common study design used in clinical articles was non-randomized experimental study (n?=?5). Half of the clinical articles (n?=?11) had a level III evidence score.

Conclusions: The present citation analysis provides insights into the historical progress and current trends in endodontics.     

The effect of supervised exercise on localized TMD pain and TMD pain associated with generalized pain

Objectives: To evaluate the effect of a supervised exercise program in patients with localized/regional temporomandibular disorder (TMD) pain and with TMD associated with generalized pain.

Material and methods: Consecutively referred patients with localized/regional TMD pain (n?=?56; 46 women and 10 men, mean age 44 years) and TMD associated with generalized pain (n?=?21; 21 women, mean age 41 years) participated. Patients underwent a 10-session structured supervised exercise program over 10–20 weeks that included relaxation, and coordination and resistance training of the jaw and neck/shoulders. The outcomes were jaw pain intensity on the Numerical Rating Scale, endurance time for jaw opening and protrusion against resistance and chewing, and effect of pain on daily activities.

Results: After the exercise program, a reduction in jaw pain was reported by the local (p?=?.001) and general (p?=?.011) pain groups. There were no significant differences in jaw pain intensity between the groups, before (p?=?.062) or after treatment (p?=?.121). Endurance time increased for both groups for jaw opening/protrusion (both p?<?.001) and chewing (both p?=?.002). The effect of jaw pain on daily activities decreased after exercise compared to baseline for both the local (p?<?.001) and general (p?=?.008) pain groups.

Conclusions: Supervised exercise can reduce TMD pain and increase capacity in patients with TMD. The results suggest that activation of the jaw motor system with exercise has a positive effect in patients with localized/regional TMD pain and TMD associated with generalized pain.     

Patients’ experiences of supervised jaw-neck exercise among patients with localized TMD pain or TMD pain associated with generalized pain

Objective: To evaluate temporomandibular disorder (TMD) patients’ experiences of a supervised jaw-neck exercise programme.

Materials and methods: The study used a mixed method design. All patients were diagnosed with myalgia according to the Research Diagnostic Criteria for TMD and divided into local myalgia (n?=?50; 38 women, mean age 43 yrs, SD 14), and myalgia with generalized pain (n?=?28; 27 women, mean age 43 yrs, SD 13). Patients participated in a ten-session supervised exercise programme that included relaxation, coordination and resistance training of the jaw, neck and shoulders. After the 10 sessions an evaluation form was filled out including both open- and closed-ended questions. The quantitative analysis was based on closed-ended questions concerned experience, adaptation and side-effects from the exercise programme. The qualitative analysis was employing inductive content analysis of open-ended questions.

Results: Patients reported similar positive overall experiences of exercise regardless of diagnosis, although more individuals in the general pain group experienced pain during training (57%) compared to the local pain group (26%; p?=?.015). Patients in both groups shared similar experiences and acknowledged the possibility to participate in an individualized and demanding exercise programme. They expressed feelings of being noticed, taken seriously and respectful care management to be key factors for successful treatment outcome. The exercise programme was acknowledged as a valuable part of treatment.

Conclusion: The hypothesis generated was that individualized and gradually demanding exercise in the rehabilitation process of TMD stimulates self-efficacy and confidence in chronic TMD patients regardless of whether the pain was localized or combined with wide-spread pain.     

Association between posterior crossbite and/or deep bite and temporomandibular disorders among Palestinian adolescents: A sex comparison

ABSTRACT

Objective: To assess the prevalence of temporomandibular disorders (TMDs) and posterior crossbite and/or deep bite and any possible association between them.

Methods: One thousand-nineteen adolescents responded to a questionnaire regarding oral habits and TMD symptoms. Afterwards, they were diagnosed according to the Axis I of the DC/TMD and underwent a dental examination. The chi-square test was used for statistical analysis.

Results: A significant association was found between posterior crossbite and some TMD diagnosis, but no association was found between deep bite and TMD, nor between occlusal diagnosis and bruxism. TMDs were more prevalent in girls. There was a significant sex difference (more among females) in the prevalence of painful TMDs.

Conclusion: Posterior crossbite in the adolescent population analyzed may be related to TMDs, in contrary to deep-bite. The presence of posterior crossbite may have different impact on TMD findings between the sexes.     

Similar treatment outcome in myofascial TMD patients with localized and widespread pain

Objective: To study the outcome of oral appliance treatment in myofascial Temporomandibular disorder (TMD) patients with and without comorbid pain using pain site drawings.

Material and methods: This randomized, controlled multicentre study comprised 65 myofascial TMD patients diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders. Pain-site drawings were filled in at the baseline examination. The patients were treated with oral appliances. Treatment outcome was followed up for 1 year and analysed according to the recommendations by the Initiative on Methods, Measurement and Pain assessment in Clinical Trials (IMMPACT) on an intent-to-treat basis. The data were analysed for two pain profiles, localized pain (face and head, n?=?26) versus widespread pain group (pain sites outside the face and head, n?=?39).

Results: Statistically significant improvement was registered within both groups for all outcome variables (characteristic pain intensity, 30% pain reduction of worst reported pain, graded chronic pain, depression, and somatization scores) during the follow-up with only small differences between the groups.

Conclusions: Oral appliance treatment had a positive effect on all outcome measures during the 1-year follow-up in patients suffering from myofascial TMD pain, regardless of whether the pain was localized or widespread. Multiple pain sites seemed to have surprisingly little influence on the outcome variables. However, some indications of more challenges when treating patients with widespread pain compared to local pain could be observed. Pain-site drawings seem to be useful in the clinical situation and could support the clinicians in decision-making regarding treatment planning.     

A survey on the potential relationships between TMD,possible sleep bruxism,unilateral chewing,and occlusal factors in Turkish university students

Objective: To evaluate whether there is a relationship between possible sleep bruxism (PSB), temporomandibular disorders (TMD), unilateral chewing (UC), and occlusal factors in university students recruited from Cumhuriyet University in Turkey.

Methods: For this cross-sectional survey, 519 (223 males, mean age 21.57 ± 2.3 years, 296 females, mean age 21.02 ± 2 years) university students who admitted to the Department of Oral and Maxillofacial Radiology of the Faculty of Dentistry, Cumhuriyet University for dental care between 2012 and 2014 were selected randomly. Students were asked to complete a questionnaire form including questions about TMD, PSB and UC. Presence and direction of malocclusion were recorded during clinical examination. Chi-square test was used for statistical analysis.

Results: It was found that 96.6% of the students with PSB had TMD (p < 0.05). The prevalence of severe TMD was high among students with PSB. There was a significant association between UC, PSB and TMD (p < 0.05). No statistically significant association was found between occlusal factors and PSB and TMD (p > 0.05).

Conclusion: Sleep bruxism, which heavily depends on self-report, is significantly associated with TMD. Unilateral chewing seems to be a common factor for development of SB and TMD. However, further studies are needed to corroborate this finding. Additionally, this study supports the hypothesis that occlusal factors are not related to self-reported sleep bruxism.     

Painful temporomandibular disorders (TMD) and comorbidities in primary care: associations with pain-related disability

Objective: We studied whether primary care temporomandibular disorder (TMD) patients reporting different levels of pain-related disability differ in terms of comorbid pains, general health conditions and quality of life.

Material and methods: Consecutive TMD pain patients (n?=?399) seeking treatment in primary care completed a questionnaire on comorbid pains and their interference and the Finnish version of the RAND-36-item quality of life questionnaire. Medical diagnoses confirmed by doctors were recorded. The patients were classified according to the Graded Chronic Pain Scale (GCPS) of the Research Diagnostic Criteria for TMD (RDC/TMD). The patients were classified: no disability group (0 disability points), low disability group (1–2 disability points) and high disability group (3–6 disability points).

Results: Compared to patients in the no-disability group, patients in the high- and low-disability groups reported more comorbid pain conditions (p?<?.001), and experienced these as more intense and interfering more with daily life (p?<?.05). Patients in the high-disability group reported more general health-related medical diagnoses than patients in the no-disability group (p?<?.05). Furthermore, patients with low or high pain-related disability indicated poorer quality of life in all RAND-36 subscales than those with no disability (p?<?.05).

Conclusions: The findings suggest that GCPS-related disability scoring can be used as a simple screening instrument to identify TMD patients with different degrees of health burdens.     

Widespread mechanical pain hypersensitivity in patients with chronic migraine and temporomandibular disorders: relationship and correlation between psychological and sensorimotor variables

Objective: This study aimed to assess mechanical hyperalgesia in the trigeminal and extra-trigeminal regions in patients with chronic migraine (CM) and temporomandibular disorders (TMD) in comparison to asymptomatic subjects and to determine the association between sensorimotor variables and psychological and disability variables and evaluate the prediction of a sensorimotor variables though psychological and disability variables in patients with CM and TMD.

Material and methods: A total of 52 subjects with concomitant CM and TMD and 30 asymptomatic subjects were included in the study. The pressure pain threshold (PPT), maximal mouth opening (MMO) and a series of self-reported factors were compared.

Results: There were 52?CM and TMD (92.3% women and 7.7% men; age?=?46.2?±?9.5) and 30 asymptomatic subjects (80% women and 20% men; age?=?47.4?±?10). Differences were found between patients with CM and TMD and asymptomatic participants (p?<?.01) when comparing the PPTs in the trigeminal and extra-trigeminal regions. The PPT for the trigeminal region was predicted by depressive symptoms (variance of 18%) as well as disability and craniofacial pain (variance of 20%). The extra-trigeminal region PPT was predicted by depressive symptoms (variance of 10%), and pain-free MMO was predicted by disability and craniofacial pain (variance of 24%).

Conclusions: This study suggests that patients with CM and TMD present with generalized mechanical hyperalgesia. In addition, an association between sensorimotor, psychological and disability variables was observed.     

Treatment of temporomandibular disorders – knowledge,attitudes and clinical experience among general practising dentists in Sweden

Objective: The aim of the study was to investigate the self-perceived level of knowledge, attitudes and clinical experience in treatment of temporomandibular disorders (TMD) among general practising dentists (GPDs).

Material and methods: A web-based questionnaire was sent to all GPDs in the public dental health service in the County of Uppsala in 2010 (n?=?128) and 2014 (n?=?113). The GPDs were asked to answer questions in the following categories: Demographic information, Quality assurance, Clinical experience and treatment, Need for specialist resources in the field of TMD and Attitudes. Between the two questionnaires, the GPDs were offered TMD education and an examination template including three TMD questions was introduced in the computer case files. The results were also compared with a previous questionnaire from 2001.

Results: The response rate was 71% (2010) and 73% (2014). The majority of the GPDs were women (70% in 2010 and 72% in 2014). The reported frequency of taking a case history of facial pain and headache increased between 2010 and 2014. In 2014, the GPDs were more secure and reported higher frequency of good clinical routines in treatment with jaw exercises and pharmacological intervention compared to 2001. Interocclusal appliance was the treatment with which most dentists felt confident and reported good clinical routines.

Conclusions: The GPDs felt more insecure concerning TMD diagnostics, therapy decisions and treatment in children/adolescents compared to adults. There is a high need for orofacial pain/TMD specialists and a majority of the GPDs wants the specialists to offer continuing education in TMD.     

A high prevalence of TMD is related to somatic awareness and pain intensity among healthy dental students

Objective: Dental students have been identified as a group with high risks of developing both temporomandibular disorders (TMD) and psychosocial conditions. Our primary aim was to evaluate the cross-sectional prevalence of TMD diagnoses, as defined in the Diagnostic Criteria (DC)/TMD, among dental students. The secondary aim was to evaluate the prevalence and association of behavioural and psychosocial factors in relation to DC/TMD diagnoses.

Materials and methods: The study was conducted among undergraduate dental students during the second semester of their third year at the Department of Odontology, Medical Faculty, Umeå University, Sweden. Three consecutive cohorts were recruited during August in 2013, 2014, 2015. In total, 54 students were included and examined according the DC/TMD procedure.

Results and conclusions: The prevalence of any DC/TMD diagnosis was 30%. The most prevalent TMD diagnosis was myalgia. Individuals with a TMD-pain diagnosis (i.e. myalgia or arthralgia) reported significantly higher pain intensity levels according to the Graded Chronic Pain Scale (GCPS) as compared to individuals without TMD-pain (Fisher’s exact test p?p?p?=?.005) as compared to individuals without TMD. The psychosocial factors evaluated did not differ between individual with or without a TMD diagnosis. The majority of the dental students reported symptoms that are already identified as risk factors for developing TMD and pain conditions. However, longitudinal data are needed to evaluate how this evolves over time.     

The potential etiologic factors influencing tinnitus intensity in patients with temporomandibular disorders

Objectives: To investigate the potential relationships between the intensity of tinnitus associated with temporomandibular disorders (TMD) and potential etiologic factors, including age, gender, freeway space, sleep bruxism (SB), joint clicking, and headache.

Methods: The sample was comprised of 90 patients without any hearing loss, as confirmed by otorhinolaryngology, who self-reported subjective tinnitus and simultaneous TMD, based on the Research Diagnostic Criteria for TMD (RDC/TMD).

Results: The results showed a positive, weak correlation between the intensity of tinnitus and age (r = 0.225, p = 0.033). The presence of SB and headache were seen in higher proportions in the present sample, at 75.5% (n = 68) and 66.6% (n = 60), respectively.

Conclusions: In a population of patients with subjective tinnitus and TMD, no significant associations were found between tinnitus intensity and age, freeway space, SB, clicking presence, and headache, though gender did show a weak correlation with tinnitus intensity.     

Diagnostic accuracy of three screening questions (3Q/TMD) in relation to the DC/TMD in a specialized orofacial pain clinic

Objective: To determine the diagnostic accuracy of three screening questions (3Q/TMD) in relation to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), in a specialized clinic.

Material and methods: Consecutive patients,?>18 years, referred with a possible TMD complaint to the Orofacial Pain and Dysfunction clinic, Academic Centre for Dentistry Amsterdam, the Netherlands, were included in the study. All patients (n?=?449; mean age 44 years; 72% females), answered the 3Q/TMD and the DC/TMD questionnaire before a DC/TMD examination. The 3Q/TMD constitutes of two questions on weekly pain from the jaw, face and temple region (Q1), and on function (Q2), and one function-related question on weekly catching and/or locking of the jaw (Q3). Q1 and Q2 were evaluated in relation to a DC/TMD pain diagnosis and Q3 in relation to a subgroup of DC/TMD intra-articular diagnosis, referred to as the reference standard.

Results: In total, 44% of patients received a pain-related DC/TMD diagnosis and 33% an intra-articular reference DC/TMD diagnosis. Sensitivity for the two pain screening questions was high (0.83–0.94), whereas specificity was low (0.41–0.55). For the function-related question, sensitivity was low (0.48), whereas specificity was high (0.96).

Conclusions: In a specialized pain clinic, the two pain questions (Q1, Q2) are positive in most patients with pain-related TMD. Therefore, in case of a positive response, further diagnostic procedures for TMD pain are warranted. For the functional screening question (Q3), a positive response is indicative for an intra-articular DC/TMD diagnosis, while in case of a negative outcome, an intra-articular TMD might still be present.     

Validity of self‐reported sleep bruxism among myofascial temporomandibular disorder patients and controls

Sleep bruxism (SB), primarily involving rhythmic grinding of the teeth during sleep, has been advanced as a causal or maintenance factor for a variety of oro‐facial problems, including temporomandibular disorders (TMD). As laboratory polysomnographic (PSG) assessment is extremely expensive and time‐consuming, most research testing this belief has relied on patient self‐report of SB. The current case–control study examined the accuracy of those self‐reports relative to laboratory‐based PSG assessment of SB in a large sample of women suffering from chronic myofascial TMD (n = 124) and a demographically matched control group without TMD (n = 46). A clinical research coordinator administered a structured questionnaire to assess self‐reported SB. Participants then spent two consecutive nights in a sleep laboratory. Audiovisual and electromyographic data from the second night were scored to assess whether participants met criteria for the presence of 2 or more (2+) rhythmic masticatory muscle activity episodes accompanied by grinding sounds, moderate SB, or severe SB, using previously validated research scoring standards. Contingency tables were constructed to assess positive and negative predictive values, sensitivity and specificity, and 95% confidence intervals surrounding the point estimates. Results showed that self‐report significantly predicted 2+ grinding sounds during sleep for TMD cases. However, self‐reported SB failed to significantly predict the presence or absence of either moderate or severe SB as assessed by PSG, for both cases and controls. These data show that self‐report of tooth grinding awareness is highly unlikely to be a valid indicator of true SB. Studies relying on self‐report to assess SB must be viewed with extreme caution.