title: Clinical Predictability of Temporomandibular Joint Disc Displacement Headache and Temporomandibular Disorders: Evidence for Diagnostic and Behavioural Overlap Reliability of clinical temporomandibular disorder diagnoses The prevalence of myofascial pain and its association with occlusal factors in a threshold country non-patient population Symptoms, signs, and clinical diagnoses according to the research diagnostic criteria for temporomandibular disorders among Finnish multiprofessional media personnel. Prevalence of myofascial temporomandibular disorder in US community women. Development of Temporomandibular Disorders Is Associated With Greater Bodily Pain Experience Adapting the diagnostic definitions of the RDC/TMD to routine clinical practice: a feasibility study.
abstract: Single items from a typical clinical examination have proved disappointing in their predictive value for temporom and ibular joint ( TMJ ) disc displacement . Only one criterion ( the 12 o'clock ) is used to diagnose normal disc position . According to this criterion , the posterior b and of the disc should be located at the top of the condyle , at the 12 o'clock position . The purpose of this study was to determine which signs and symptoms provide a valid prediction of the condition of the joint based on 4 magnetic resonance imaging ( MRI ) criteria used to define normal disc position . Sagittal MRI and clinical findings of 137 temporom and ibular disorder patients and 23 normal asymptomatic volunteers were used . Three calibrated and blinded observers interpreted the images . Disc position with the mouth closed was evaluated based on 4 MRI criteria : 12 , 11 , 10 o'clock , and the intermediate zone . Disc position with the mouth open was determined based on one criterion . It was considered normal if the intermediate zone of the disc was located between the condyle and the articular eminence . Joints were classified as normal or as having disc displacement with or without reduction . The sensitivity and specificity of multiple clinical parameters for predicting the condition of the joint established by each of these 4 gold-st and ard MRI criteria were then determined . Regarding disc displacement with reduction , significant differences were observed in the sensitivity and specificity of all of the clinical parameters used to predict the imaging diagnosis established by each of the criteria . Concerning disc displacement without reduction , no significant differences were observed . The intermediate zone criterion was the criterion that most accurately reflected the condition of the joint . The clinical predictability of the disorder diagnosed according to this criterion suggests that clinical findings alone are too often nonspecific as predictors of the imaging stage of disc displacement . However , we found that combining the most sensitive clinical items to predict the disorder and using an overall criterion for positivity to interpret the results led to an impressive increase in the specificity of the combination , enabling false-positive diagnoses to be excluded To assess the diagnostic and behavioural overlap of headache patients with temporom and ibular disorders ( TMD ) , individuals recruited from the general population with self-described headaches were compared with non-headache controls . The examination and diagnostic procedures in the Research Diagnostic Criteria ( RDC ) for TMD were applied to both sets of subjects by a blinded examiner . Following their examination , subjects used experience sampling methods to obtain data on pain , tooth contact , masticatory muscle tension , emotional states and stress . Results showed that a significantly higher proportion of the headache patients received an RDC/TMD diagnosis of myofascial pain than non-headache controls . Headache patients also reported significantly more frequent and intense tooth contact , more masticatory muscle tension , more stress and more pain in the face/head and other parts of the body than non-headache controls . These results are similar to those reported for TMD patients and they suggest that headache patients and TMD patients overlap considerably in diagnosis and oral parafunctional behaviours & NA ; Temporom and ibular disorders ( TMD ) diagnoses can be viewed as the most useful clinical summary for classifying subtypes of TMD . The Research Diagnostic Criteria for TMD ( RDC/TMD ) is the most widely used TMD diagnostic system for conducting clinical research . It has been translated into 18 language s and is used by a consortium of 45 RDC/TMD‐based international research ers . While reliability of RDC/TMD signs and symptoms of TMD has been amply reported , the reliability of RDC/TMD diagnoses has not . The aim of the study was to determine the reliability of clinical TMD diagnoses using st and ardized methods and operational definitions contained in the Research Diagnostic Criteria for Temporom and ibular Disorders ( RDC/TMD ) . Data came from reliability assessment trials conducted at 10 international clinical centers , involving 30 clinical examiners assessing 230 subjects .  Intraclass correlation coefficients ( ICC ) were calculated to characterize the reliability . The reliability of the diagnoses was fair to good . Median ICCs for the diagnoses myofascial pain with and without limited opening were 0.51 and 0.60 , respectively . Median ICC for arthralgia was 0.47 and 0.61 for disc displacement with reduction . RDC/TMD diagnoses of disc displacement without reduction , osteoarthritis and osteoarthrosis were not prevalent enough to calculate ICC 's , but percent agreement was always > 95 % . The reliability of diagnostic classification improved when diagnoses were grouped into pain versus non‐pain diagnoses ( ICC=0.72 ) and for detecting any diagnosis versus no diagnosis ( ICC=0.78 ) . In clinical decision‐making and research , arriving at a reliable diagnosis is critical in establishing a clinical condition and a rational approach to treatment . The RDC/TMD demonstrates sufficiently high reliability for the most common TMD diagnoses , supporting its use in clinical research and decision making The objective of the study is to assess the prevalence of myofascial pain in a threshold country and to isolate occlusal risk factors . One hundred and seventy-one r and omized selected women were examined by a trained examiner in accordance with the Research Diagnostic Criteria for Temporom and ibular Disorders ( RDC/TMD ) examination procedure . Subscales of the SCL 90-R , grade d chronic pain status , and anamnestic question naires were also used .  Logistic regression  was performed to compute the odds ratios for six common occlusal features with regard to the presence of myofascial pain , in accordance with the RDC/TMD criteria . Fifteen subjects ( 15 / 151 = 9.93 % ) suffered from myofascial pain . Results from logistic regression analysis showed that non-occlusion ( posterior teeth , at least one side ) and open bite increased the risk of myofascial pain . The prevalence of myofascial pain in this study is comparable with that in another study , in a highly industrialized environment , in which the RDC/TMD was used . The role of occlusion in a non-patient population seems to be restricted to serious alterations of normality . This article presents the prevalence of myofascial pain and its association with occlusal factors . This issue will help the clinicians to assess the influence of occlusion in myofascial pain patients and to send the patient to the appropriate specialist AIMS To apply the Finnish version of the Research Diagnostic Criteria for Temporom and ibular Disorders ( RDC/TMD ) Axis I to assess the occurrence of symptoms , signs , and specific subgroups of TMD , and to study the associations between the most common diagnoses and categoric demographic characteristics ( gender , age group , marital status , type of work ) . METHODS All 30- to 55-year-old employees of the Finnish Broadcasting Company with at least 5 years at their current employment received postal question naires ( n = 1784 ) . Of the 1339 respondents ( 75 % ) , a r and omly selected one fifth were clinical ly examined according to the RDC/TMD Axis I ( n = 241 , males 48 % ) . RESULTS Pain symptoms in the face or jaw regions were perceived by 14.9 % and pain with 1 or more jaw movements by 9.1 % . Diagnoses by the RDC/TMD criteria were : Group I : myofascial pain in 12.9 % , myofascial pain with limited opening in 0.4 % ; Group II : disc displacement with reduction in the right temporom and ibular joint ( TMJ ) in 9.1 % and in the left TMJ in 10.8 % ; Group III : arthralgia in 0.4 % and 0.8 % , osteoarthritis in 0 % and 0.4 % , and osteoarthrosis in 1.2 % and 1.2 % , respectively , in the right and left TMJs . The most common diagnoses were found more often among women than among men . No TMD diagnosis based on the RDC/TMD was obtained in 73 % of the subjects . CONCLUSION The RDC/TMD appear to be of benefit in diagnosing TMD among these multiprofessional media personnel and thus may be suggested for use among nonpatient population This study estimates the prevalence of the myofascial subtype of temporom and ibular disorders ( M-TMD ) defined by Research Diagnostic Criteria ( RDC ) , and relates that prevalence to the surveyed report of facial pain . From among 20 000 women selected at r and om in the NY metropolitan area who completed a telephone survey of facial pain , 2000 were invited for an RDC/TMD examination ; 782 examinations were completed . Prevalence was estimated in analyses that were weighted to correct sampling biases . Differences among demographic strata were evaluated with logistic regression . The prevalence of M-TMD was estimated to be 10.5 % ( 95 % CL = 8.5 - 13.0 % ) . Prevalence was significantly higher among younger women , among women of lower socio-economic status , among Black women , and among non-Hispanic women . The report of facial pain in the telephone survey ( 10.1 % ) had high specificity for M-TMD diagnosis ( 94.7 % ) , but low sensitivity ( 42.7 % ) . M-TMD is a fairly common disorder among American women . Among those reporting facial pain during the last month , half met RDC palpation criteria for M-TMD ; thus , a formal physical examination is imperative to establish this diagnosis . Prevalence varies with age , socio-economic status , race and Hispanic ethnicity . A substantial number of RDC-diagnosed cases of M-TMD did not report facial pain in the survey ; the reason for this requires further study Objectives The aim of this study is to examine the difference in the report of bodily pain experienced by patients who develop temporom and ibular disorders ( TMD ) and by those who do not develop TMD over a 3-year observation period . Methods This is a 3-year prospect i ve study of 266 females aged 18 to 34 years initially free of TMD pain . All patients completed the Symptom Report Question naire ( SRQ ) at baseline and yearly intervals , and at the time they developed TMD ( if applicable ) . The SRQ is a self-report instrument evaluating the extent and location of pain experienced in the earlier 6 months . Statistical analysis was carried out using repeated measures ANOVA . Results Over the 3-year period , 16 patients developed TMD based on the Research Diagnostic Criteria for TMD . Participants who developed TMD reported more headaches ( P=0.0089 ) , muscle soreness or pain ( P=0.005 ) , joint soreness or pain ( P=0.0012 ) , back pain ( P=0.0001 ) , chest pain ( P=0.0004 ) , abdominal pain ( P=0.0021 ) , and menstrual pain ( P=0.0036 ) than Participants who did not develop TMD at both the baseline and final visits . Participants who developed TMD also reported significantly more headache ( P=0.0006 ) , muscle soreness or pain ( P=0.0059 ) , and other pains ( P=0.0188 ) when they were diagnosed with TMD compared with the baseline visit . Discussion The development of TMD was accompanied by increases in headaches , muscle soreness or pain , and other pains that were not observed in the Participants who did not develop TMD . Participants who developed TMD also report higher experience of joint , back , chest , and menstrual pain at baseline UNLABELLED The Research Diagnostic Criteria for Temporom and ibular Disorders ( RDC/TMD ) is a well-known diagnostic tool for clinical trials on TMD . OBJECTIVES This study aims to assess the reliability , validity and feasibility of a new method of physically diagnosing temporom and ibular disorders ( TMD ) , design ed for routine clinical use . This version , known as Clinical Examination Protocol -TMD ( CEP-TMD ) , was compared to the gold st and ard original RDC/TMD . METHODS A total of 49 subjects ( 41 referred TMD patients and 8 symptom free subjects ) were examined using both RDC/TMD and CEP-TMD versions . Three examiners , with varying levels of experience in diagnosing TMD , worked in pairs . Each member of a pair saw the same patient twice , once for the RDC/TMD and once for the CEP-TMD examination . The examination order was r and omized . Each patient 's examinations alternated between examiners to reduce the memory effect . Examinations could yield single , multiple or no diagnosis . Kappa statistics were calculated to estimate reliability . RESULTS There was substantial overall agreement between the CEP-TMD and the RDC/TMD ( kappa=0.70 ) . Intra-examination agreements were substantial in both RDC/TMD ( kappa=0.70 ) and CEP-TMD ( kappa=0.90 ) . For examination and diagnosis , the CEP-TMD was almost 3 min faster than the RDC/TMD ( p<0.05 ) . CONCLUSIONS It was concluded that the CEP-TMD 's diagnosis is comparable to the RDC/TMD thus providing a convenient and intuitive approach for dentists to physically diagnose TMD in clinical practice . The well-established RDC/TMD remains the gold st and ard for research diagnosis of TMD
target: Myofascial pain with or without mouth opening limitation was the commonest diagnosis in TMD patient population s , and disc displacement with reduction was the commonest diagnosis in community sample
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