Temporomandibular disorders among Brazilian adolescents: reliability and validity of a screening questionnaire

Temporomandibular disorders (TMD) screeners assume significant item overlap with the screening questionnaire proposed by the American Academy of Orofacial Pain (AAOP). Objective: To test the reliability and validity of the Portuguese version of AAOP questions for TMD screening among adolescents. Material and Methods: Diagnoses from Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I were used as reference standard. Reliability was evaluated by internal consistency (KR-20) and inter-item correlation. Validity was tested by sensitivity, specificity, predictive values, accuracy and receiver operating characteristic (ROC) curves, the relationship between the true-positive rate (sensitivity) and the false-positive rate (specificity). Test-retest reliability of AAOP questions and intra-examiner reproducibility of RDC/TMD Axis I were tested with kappa statistics. Results: The sample consisted of 1307 Brazilian adolescents (56.8% girls; n=742), with mean age of 12.72 years (12.69 F/12.75 M). According to RDC/TMD, 397 [30.4% (32.7% F/27.3% M)] of adolescents presented TMD, of which 330 [25.2% (27.6% F/22.2% M)] were painful TMD. Because of low consistency, items #8 and #10 of the AAOP questionnaire were excluded. Remaining items (of the long questionnaire version) showed good consistency and validity for three positive responses or more. After logistic regression, items #4, #6, #7 and #9 also showed satisfactory consistency and validity for two or more positive responses (short questionnaire version). Both versions demonstrated excellent specificity (about 90%), but higher sensitivity for detecting painful TMD (78.2%). Better reproducibility was obtained for the short version (k=0.840). Conclusions: The Portuguese version of AAOP questions showed both good reliability and validity for the screening of TMD among adolescents, especially painful TMD, according to RDC/TMD

Temporomandibular disorders among Brazilian adolescents: reliability and validity of a screening questionnaire

Temporomandibular disorders (TMD) screeners assume significant item overlap with the screening questionnaire proposed by the American Academy of Orofacial Pain (AAOP). Objective: To test the reliability and validity of the Portuguese version of AAOP questions for TMD screening among adolescents. Material and Methods: Diagnoses from Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I were used as reference standard. Reliability was evaluated by internal consistency (KR-20) and inter-item correlation. Validity was tested by sensitivity, specificity, predictive values, accuracy and receiver operating characteristic (ROC) curves, the relationship between the true-positive rate (sensitivity) and the false-positive rate (specificity). Test-retest reliability of AAOP questions and intra-examiner reproducibility of RDC/TMD Axis I were tested with kappa statistics. Results: The sample consisted of 1307 Brazilian adolescents (56.8% girls; n=742), with mean age of 12.72 years (12.69 F/12.75 M). According to RDC/TMD, 397 [30.4% (32.7% F/27.3% M)] of adolescents presented TMD, of which 330 [25.2% (27.6% F/22.2% M)] were painful TMD. Because of low consistency, items #8 and #10 of the AAOP questionnaire were excluded. Remaining items (of the long questionnaire version) showed good consistency and validity for three positive responses or more. After logistic regression, items #4, #6, #7 and #9 also showed satisfactory consistency and validity for two or more positive responses (short questionnaire version). Both versions demonstrated excellent specificity (about 90%), but higher sensitivity for detecting painful TMD (78.2%). Better reproducibility was obtained for the short version (k=0.840). Conclusions: The Portuguese version of AAOP questions showed both good reliability and validity for the screening of TMD among adolescents, especially painful TMD, according to RDC/TMD

Estudos sobre a relação entre disfunção temporomandibular e cefaléia primária: avaliações populacional e clínica

Cefaléia é uma experiência humana universal e pode representar a expressão final de uma ampla variedade de agressões ao sistema nervoso humano. Disfunção temporomandibular (DTM) refere-se a um conjunto de condições caracterizadas por dor na articulação temporomandibular (ATM), na área periauricular ou nos músculos da mastigação, sons articulares e desvios ou restrições dos movimentos mandibulares. Sindromicamente representa a consequência de várias disfunções no sistema mastigatório. Cefaleias são sintomas comuns entre indivíduos com DTM. Além de serem prevalentes e potencialmente incapacitantes, evidências limitadas também sugerem que tipos específicos de cefaleias e DTM são condições comórbidas. Os objetivos globais dos estudos aqui apresentados foram testar se há associação entre DTM e cefaléias primárias, se existe especificidade nessa associação e finalmente se há diferença na magnitude da associação de acordo com subtipos de DTM e classificação das cefaléias primárias. Os estudos foram conduzidos em duas amostras distintas, sendo uma populacional e a outra clínica. Os dados do estudo populacional foram coletados por meio de dois questionários aplicados durante ligações telefônicas. Um deles abordava as características das cefaleias e baseava-se nos critérios da Sociedade Internacional de Cefaleias. O outro questionava a existência de sintomas relacionados às DTMs. No estudo clínico, o mesmo questionário foi usado para coletar informações sobre as cefaleias, e as DTMs foram classificadas por meio da aplicação do Critérios Diagnósticos de Pesquisa em Disfunção Temporomandibular (RDC/TMD). Concluiu-se que, em ambas as amostras, as DTMs são mais comuns entre indivíduos...Headache is a nearly universal human experience, and may represent the final common expression of a wide variety of assaults upon the human nervous system. TMD refers to a group of conditions characterized by pain in the temporomandibular joint (TMJ), in the preauricular area or muscles of mastication, TMJ sounds, and by deviations or restriction in mandibular range of motion. Syndromically represents the consequences of several disorders into the masticatory system. Headaches have been seen as a common symptom among individuals with TMD. Beyond being prevalent and disabling disorders, limited evidence also suggest that specific headache disorders and TMD are comorbid. Controversies regarding this relation include the specificity of the association and the influence of severity of one on the other. The aims of the studies here presented were explore the relation between primary headaches and TMD focusing on prevalence of both in a populational sample, as well as to clarify the relation between TMD sub-types and TMD chronic pain severity on diagnostic and frequency of primary headaches. Sudies were conducted on two different samples, one of them a populational sample and the other a clinical sample. Data from the populational study was collected using two different questionnaires about TMD symptoms and headache features, based on International Headache Society criterias, applied by means a telephone call. On clinical study data related to headache was collected using the sample questionnaire, and TMD was classified using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). It was found that TMD symptoms are more common in migraine, episodic tension-type headache (ETTH) and chronic daily headache (CDH) relative to individuals without headache in both samples. Magnitude of association is higher... (Complete abstract click electronic access below)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Association between painful temporomandibular disorders, sleep bruxism and tinnitus

The present cross-sectional study was designed to investigate the association between sleep bruxism (SB), tinnitus and temporomandibular disorders (TMD). The sample consisted of 261 women (mean age of 37.0 years). The Research Diagnostic Criteria for Temporomandibular Disorders were used to classify TMD and self-reported tinnitus. SB was diagnosed by clinical criteria proposed by the American Academy of Sleep Medicine. The results showed an association between painful TMD and tinnitus (OR = 7.3; 95%CI = 3.50-15.39; p < 0.001). With regard to SB, the association was of lower magnitude (OR = 1.9; 95%CI = 1.16-3.26; p < 0.0163). When the sample was stratified by the presence of SB and painful TMD, only SB showed no association with tinnitus. The presence of painful TMD without SB was significantly associated with tinnitus (OR = 6.7; 95%CI = 2.64-17.22; p < 0.0001). The concomitant presence of painful TMD and SB was associated with a higher degree of tinnitus severity (OR = 7.0; 95%CI = 3.00-15.89; p < 0.0001). It may be concluded that there is an association between SB, painful TMD and self-reported tinnitus; however, no relationship of a causal nature could be established.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Influência de abordagens biopsicossociais e autocuidados no controle das disfunções temporomandibulares crônicas

BACKGROUND AND OBJECTIVES: Temporomandibular joint disorder (TMD), which is a musculoskeletal condition of the masticatory system, may become chronic and further worsen quality of life (QL) of patients. Due to the inter-relationship between physical and emotional symptoms, there is an increasing search for the integrative model, which includes psychosocial approaches for the treatment of painful conditions. This study aimed at reviewing in the literature the impact of education and simple self-care modalities on pain and disorders related to chronic painful TMD. CONTENTS: Psychosocial factors are often involved with pain chronicity, making bio-behavioral approaches increasingly more indicated to change pain perception and to decrease distress and psychosocial changes which go along with persistent pain. CONCLUSION: Current literature, although not extensive, indicates positive results of education and self-care methods for chronic painful TMD. Further studies are needed to reinforce such findings and spread the application of such approaches to control chronic and TMD pain.JUSTIFICATIVA E OBJETIVOS: A disfunção temporomandibular (DTM), condição musculoesquelética do sistema mastigatório, pode se tornar crônica, causando maior comprometimento na qualidade de vida (QV) dos pacientes. Devido à inter-relação entre sintomas físicos e emocionais, há uma crescente busca pelo modelo integrativo, o qual inclui abordagens psicossociais para o tratamento de condições dolorosas. O objetivo deste estudo foi realizar uma revisão de literatura sobre o impacto da educação e modalidades simples de autocuidados podem ter na dor e na disfunção relacionadas à DTM dolorosa crônica. CONTEÚDO: Os fatores psicossociais estão frequentemente envolvidos na cronificação da dor, tornando as abordagens biocomportamentais cada vez mais indicadas para mudar a percepção da dor, reduzir o sofrimento e as alterações psicossociais que acompanham as dores persistentes. CONCLUSÃO: A literatura existente, apesar de não ser vasta, indica resultados positivos da aplicação de métodos de educação e autocuidados em DTM dolorosa crônica. Mais estudos são necessários para reforçar tais achados e disseminar a aplicação de tais abordagens no controle da dor crônica e da DTM

Temporomandibular disorders among Brazilian adolescents: reliability and validity of a screening questionnaire

Temporomandibular disorders (TMD) screeners assume significant item overlap with the screening questionnaire proposed by the American Academy of Orofacial Pain (AAOP).Objective: To test the reliability and validity of the Portuguese version of AAOP questions for TMD screening among adolescents. Material and Methods: Diagnoses from Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I were used as reference standard. Reliability was evaluated by internal consistency (KR-20) and inter-item correlation. Validity was tested by sensitivity, specificity, predictive values, accuracy and receiver operating characteristic (ROC) curves, the relationship between the true-positive rate (sensitivity) and the false-positive rate (specificity). Test-retest reliability of AAOP questions and intra-examiner reproducibility of RDC/TMD Axis I were tested with kappa statistics. Results: The sample consisted of 1307 Brazilian adolescents (56.8% girls; n=742), with mean age of 12.72 years (12.69 F/12.75 M). According to RDC/TMD, 397 [30.4% (32.7% F/27.3% M)] of adolescents presented TMD, of which 330 [25.2% (27.6% F/22.2% M)] were painful TMD. Because of low consistency, items #8 and #10 of the AAOP questionnaire were excluded. Remaining items (of the long questionnaire version) showed good consistency and validity for three positive responses or more. After logistic regression, items #4, #6, #7 and #9 also showed satisfactory consistency and validity for two or more positive responses (short questionnaire version). Both versions demonstrated excellent specificity (about 90%), but higher sensitivity for detecting painful TMD (78.2%). Better reproducibility was obtained for the short version (k=0.840). Conclusions: The Portuguese version of AAOP questions showed both good reliability and validity for the screening of TMD among adolescents, especially painful TMD, according to RDC/TMD.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Relationship between levels of neuropeptide Substance P in periodontal disease and chronic pain: a literature review

The aim of the current review was to investigate the relationship between levels of neuropeptide Substance P in periodontal disease and chronic pain. Substance P is a neuropeptide that is directly related with pain. In periodontal disease, it is expressed during the inflammatory process, and is one of the factors responsible for bone resorption. Studies have shown that Substance P levels are highest in the gingival crevicular fluid from sites with active periodontal disease and bone loss. The persistence of these substances could be sufficient to stimulate neurogenic inflammation in susceptible tissues, and cause pain. The scientific literature shows that Substance P expressed during periodontal disease can be a risk factor for patients with systemic inflammatory pathologies, such as chronic arthritis or rheumatoid arthritis. Additional research is needed to confirm the participation of this substance in the origin of some types of chronic pain