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

Disfunção temporomandibular em adolescentes e sua relação com hábitos parafuncionais

Disfunção temporomandibular (DTM) é um termo que engloba uma série de problemas que afetam a articulação temporomandibular (ATM) e/ou os músculos da mastigação e estruturas associadas. A DTM pode manifestar-se na forma de dor na face e/ou região das ATM, comprometendo significativamente a qualidade de vida do seu portador. Fundamentada na teoria multifatorial da DTM, a literatura evidencia como fatores causais: trauma, hábitos parafuncionais, fatores estruturais, psicológicos e posturais. Embora a DTM possa afetar pacientes de todas as faixas etárias e de ambos os gêneros, seu mecanismo de ação e sua evolução são pouco explorados na fase da adolescência. Assim, este trabalho se propõe a realizar uma revisão da literatura sobre a DTM e sua relação com hábitos parafuncionais em pacientes adolescentes, abrangendo os sinais e sintomas mais prevalentes e o gênero mais atingido por essas disfunções. Foram revisados 67 artigos científicos e livros, utilizando as bases de dados PubMed, LILACs, MEDLINE, ScieELO e Google Acadêmico e as palavras-chave Síndrome da Disfunção da Articulação Temporomandibular; Hábitos e Adolescente; e seus respectivos termos em inglês. De acordo com os artigos revisados, pôde-se concluir que a DTM possui elevada prevalência na população jovem, principalmente no gênero feminino, embora sua fisiopatologia nessa faixa etária ainda seja pouco estudada. Além disso, hábitos parafuncionais, fatores estruturais, psicológicos e posturais podem aumentar a probabilidade de desenvolver sinais e sintomas de 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