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Aims: To examine the long-term prognosis of 46 previously examined atypical odontalgia (AO) patients. Methods: In 2002 and 2009, AO patients completed validated instruments measuring pain characteristics (pain frequency and intensity), physical functioning (Graded Chronic Pain Severity, GCPS) and emotional functioning (Symptoms Checklist, SCL-90R). The main outcome was global improvement. Baseline data on quantitative somatosensory testing and responsiveness to lidocaine injection were available for a subgroup of patients. Paired tests compared baseline and follow-up data, and logistic regression explored the possible prognostic value of baseline data. Results: Data from 37 patients (80%) were obtained. Thirteen patients (35%; 95% confidence intervals [CI] 20.2%-52.5%) rated their overall pain status as significantly improved, 22 (60%; 95% CI 42.1%-75.3%) as a little improved or unchanged, and two patients (5%; 95% CI 0.7%-18.2%) as worse. Five patients (14%; 95% CI 4.5%-28.8%) were pain-free, indicated by a characteristic pain intensity score of 0. Average pain intensity decreased (from 5.7 ± 2.0 to 3.5 ± 2.4; P < .001). Pain frequency (P < .001) and GCPS (P < .001) also decreased, whereas SCL-90R scores remained unchanged and 26 of the 37 patients reported ongoing treatment. Low baseline pain intensity was the only factor predictive of favorable outcome. Conclusion: A third of the AO patients improved considerably over time, but for many of the patients, AO was a persistent and treatment-resistant condition. [ABSTRACT FROM AUTHOR]

Aims: To assess intraoral inter- and intraexaminer reliability of three qualitative measures of intraoral somatosensory function and to compare these measures between patients with atypical odontalgia (AO) and healthy controls. Methods: Thirty-one AO patients and 47 healthy controls participated. Inter- and intraexaminer reliability was tested on a subgroup of 46 subjects (25 AO; 21 healthy). Sensitivity to touch, cold, and pinprick stimuli was evaluated on the painful gingival site and the corresponding contralateral site in AO patients, and bilaterally on the gingiva of the first maxillary premolars in controls. Patients were asked to report hypersensitivity, hyposensitivity, or normal sensitivity to stimuli on the painful site compared with the nonpainful site. Kappa values were calculated, and chi-square and Fisher's exact tests were used to compare frequencies between groups. Results: Kappa values ranged between 0.63 and 0.75. The frequency of hypersensitivity to either modality was significantly higher in patients (29% to 61%) than in controls (9% to 17%) (P < .015), whereas reports of hyposensitivity were similar between groups (2% to 16%) (P > .057). Only 3.2% of the AO patients had no reports of abnormal sensitivity on any of the tests, compared with 59.6% of the healthy subjects (P < .001). Conclusion: Intraoral qualitative somatosensory testing can detect intraoral sensory disturbances in AO patients, and the reliability is sufficient for initial screening of orofacial somatosensory function. [ABSTRACT FROM AUTHOR]

Background and aims: Conditioned Pain Modulation (CPM) is a measure of pain inhibition-facilitation in humans that may elucidate pain mechanisms and potentially serve as a diagnostic test. In laboratory settings, the difference between two pain measures [painful test stimulus (TS) without and with the conditioning stimulus (CS) application] reflects the CPM magnitude. Before the CPM test can be used as a diagnostic tool, its reliability on the same day (intra-session) and across multiple days (inter-session) needs to be known. Furthermore, it is important to determine the most reliable anatomical sites for both the TS and the CS. This study aimed to measure the intra-session and inter-session reliability of the CPM test paradigm in healthy subjects with the TS (pressure pain threshold-PPT) applied to three test sites: the face, hand, and dorsum of the foot, and the CS (cold pressor test-CPT) applied to the contralateral hand. Methods: Sixty healthy participants aged 18–65 were tested by the same examiner on 3 separate days, with an interval of 2–7 days. On each day, testing was comprised of two identical experimental sessions in which the PPT test was performed on each of the three dominant anatomical sites in randomized order followed by the CPM test (repeating the PPT with CPT on the non-dominant hand). CPM magnitude was calculated as the percent change in PPT. The Intraclass Correlation Coefficient (ICC), Coefficient of Variation (CV), and Bland-Altman analyses were used to assess reliability. Results: PPT relative reliability ranged from good to excellent at all three sites; the hand showed an intra-session ICC of 0.90 (0.84, 0.94) before CPT and ICC of 0.89 (0.83, 0.92) during CPT. The PPT absolute reliability was also high, showing a low bias and small variability when performed on all three sites; for example, CV of the hand intra-session was 8.0 before CPT and 8.1 during CPT. The relative reliability of the CPM test, although only fair, was most reliable when performed during the intra-session visits on the hand; ICC of 0.57 (0.37, 0.71) vs. 0.20 (0.03, 0.39) for the face, and 0.22 (0.01, 0.46) for the foot. The inter-session reliability was lower in all three anatomical sites, with the best reliability on the hand with an ICC of 0.40 (0.23, 0.55). The pattern of absolute reliability of CPM was similar to the relative reliability findings, with the reliability best on the hand, showing lower intra-session and inter-session variability (CV% = 43.5 and 51.5, vs. 70.1 and 73.1 for the face, and 75.9 and 78.9 for the foot). The CPM test was more reliable in women than in men, and in older vs. younger participants. Discussion: The CPM test was most reliable when the TS was applied to the dominant hand and CS performed on the contralateral hand. These data indicate that using the CS and TS in the same but contralateral dermatome in CPM testing may create the most reliable results. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the impact of temporomandibular disorder (TMD) pain by age and gender in adolescents, with assessments of this impact specifically on school absence, medication consumption, perceived need for treatment, jaw function limitation, depressive symptoms scores and somatic complaints, and graded chronic pain scale. Methods: In a population-based sample, a mailed questionnaire was sent to 350 patients with self-reported TMD pain (group 1) and 350 healthy age- and sex-matched individuals (group 2) aged 12 to 19 years 2 to 4 weeks after their annual dental examination. The groups were divided into younger (age 12 to 15) and older (age 16 to 19) groups. Descriptive statistics and 95% confidence intervals were used, and chi-square and t-tests were calculated for analyzing group differences. Odds ratios were estimated using logistic regression. Results: As expected, groups 1 and 2 differed significantly in most variables related to psychosocial and behavioral factors. For adolescents reporting TMD pain once a week or more, no gender or age differences in pain intensity were seen. Jaw function limitation, depressive symptoms scores, somatic complaints, graded chronic pain, and perceived need for TMD treatment were all significantly higher in girls than in boys. Older girls reported higher analgesic consumption and school absences than older boys. Conclusion: Girls reporting TMD pain had significantly greater impact on behavioral and psychosocial factors than boys. Almost one third of older girls, compared to one out of 10 older boys, reported school absences and analgesic consumption because of their TMD pain. [ABSTRACT FROM AUTHOR]

Aims: To estimate the incidence of temporomandibular disorder (TMD) pain among Swedish adolescents by age and gender and to describe the temporal patterns of TMD pain. Methods: This 3-year longitudinal study was carried out at all Public Dental Service clinics in a Swedish county from 2000 to 2003. All individuals aged 12 to 19 years in the county who visited the clinics for annual examinations were eligible for the study. Results: Overall, the incidence of TMD pain among all adolescents was 2.9% annually among 2,255 participating adolescents. Incidence among girls was significantly higher than in boys, 4.5% versus 1.3%, respectively. Incidence increased with age in girls and boys, although less so in boys (3.0% to 6.9% versus 1.7% to 2.6%). These adolescents were re-examined annually for 3 years, and a fluctuating pattern of TMD pain was common. Overall, 11.4% of all subjects reported TMD pain on at least 1 occasion; 88.6% of the cohort remained pain-free. Of those reporting TMD pain, 4.7% could be defined as intermittent cases, 3.1% were single-incident cases, 0.9% were recurrent cases, and 0.9% had continuing pain for 1 or 2 years. Conclusion: The incidence of self-reported TMD pain among Swedish adolescents aged 12 to 19 years increased with age, particularly among girls. The pattern of pain in most adolescents fluctuated over time. Less than 1% of the cohort had continued pain over each year, and the majority of these subjects were girls. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the reliability and validity of self-reported pain associated with temporomandibular disorders (TMD) in adolescents and to determine how this validity may change over time. The authors' hypothesis was that self-reported pain can be used to reliably and accurately detect adolescents with TMD pain. Methods: One hundred twenty adolescents, 60 with self-reported TMD pain and 60 age- and gender-matched controls without TMD pain, were examined twice. At the first examination at a Public Dental Service clinic, self-reported TMD pain was recorded for each patient. At the second examination, a clinical examination was completed, blind to the patients' self-report of pain symptoms, after which self-reported TMD pain was again recorded. The clinical examination was based upon the Research Diagnostic Criteria for TMD (RDC/TMD). Self-reported TMD pain in this investigation was based upon the subjects' responses to 2 questions: (1) Do you have pain in your temples, face, temporomandibular joint (TMJ), or jaws once a week or more? and (2) Do you have pain when you open your mouth wide or chew once a week or more? Results: Test-retest reliability of .83 (kappa) was found for the 2 questions. The sensitivity was .98 (95% CI, .90 to 1.0) and specificity was .90 (95% CI, .81 to .95) for comparison of assessments made on the same day. Sensitivity was .96 (95% CI, .85 to .99) and specificity .83 (95% CI, .72 to .90) for assessments made 2 to 4 weeks apart. Conclusion: Very good reliability and high validity were found for the self-reported pain questions. A short time interval between the screening question and examination slightly increased the accuracy of the measure. In adolescent populations, the questions in this study can be used to screen for TMD pain. [ABSTRACT FROM AUTHOR]

Aims: Since occlusal variables such as overbite and overjet have been thought to be associated with tern porornandibular disorders (TMD), and joint sounds are sorne of the rnost prevalent signs of TMD, the airn of this study was to deterrnine whether overbite and overjet are risk factors for tern porornandibular joint (TMJ) sounds. Methods: A population-based cross-sectional study of 3,033 subjects (age range, 10 to 75 years; 53% fernale) was con- ducted in Gerrnany. Overbite/overjet, reproducible reciprocal clicking (RRC) during open-close jaw rnovernents that did not occur in the protrusive jaw position, and joint crepitus were assessed according to the Research Diagnostic Criteria for Tern porornandibular Disorders (RDC/TMD). Results: When age and gender were controlled for, high or low values of overbite and overjet were not associated with a greater risk of RRC and crepi- tus as corn pared to a reference category of a norrnal overbite and overjet of 2 to 3 rnrn (rnultiple logistic regression; odds ratios 0.7 to 1.3; P > .05 for all). Conclusion: This study showed that higher or lower overbite or overjet jaw relationships, even extrerne val- ues, are not risk factors for TMJ sounds as assessed by clinical exarnination. J OROFAC PAIN 2005;19:218-225 [ABSTRACT FROM AUTHOR]

Aims: To assess the prevalence of temporomandibular disorder (TMD) pain in Swedish adolescents, to evaluate whether there are differences in TMD pain in regard to age, gender, and place of residence (urban or rural), and to evaluate treatment for TMD pain and corn pare it with documented treatment for teeth with caries. Methods: All youths aged 12 to 19 years in Östergötland County were eligible to participate in the investigation, which took place at public dental clinics during annual examinations in 2000. The subjects were asked 2 questions: (1) "Do you have pain in your temples, face, jaw joint, or jaws once a week or more?" and (2) "Do you have pain when you open your mouth wide or chew once a week or more?" Two hundred dental records of patients with TMD pain and 100 records of patients with documented caries were randomly selected from the population. These records were used to corn pare the treatment of TMD pain to the treatment of caries. Results: Among the 28,899 youths participating, 4.2% reported TMD pain. The prevalence increased with age, and a significant difference was seen between boys (2.7%) and girls (6.0%) (P < .001). In 43% of the patients with TMD pain, the TMD condition was noted in the record. TMD-related treatment was given to 34% of patients with TMD pain in dental clinics, whereas 100% of the patients with caries received restorative treatment. The most common treatment modalities for the TMD group were occlusal splints and information about TMD. Conclusion: The prevalence of self-reported TMD pain was relatively low, increased with age, and was higher among girls than boys. One third of the patients with TMD pain received some form of TMD treatment in the dental clinics. [ABSTRACT FROM AUTHOR]

The collection of conditions affecting the temporomandibular joint (TMJ) and masticatory muscles, the so-called temporomandibular disorders, can be classified according to the Research Diagnostic Criteria for Temporomandibular Disorders. Of the 3 subgroups—muscle disorders (Group I); disc displacements (Group II); and arthralgia, arthritis, and arthrosis (Group III)— the muscle disorders are most frequently seen in community samples; Group II and Group III diagnoses are less prevalent. This may explain the relative scarcity of studies involving intracapsular TMJ disorders. In this review, new insights into the functional anatomy, imaging, and pathology of disorders of the TMJ are presented. Studies of TMJ dynamics may provide insight into the functional anatomy of the TMJ and thereby into the consequences of Group II and Group III disorders. The clinical use of imaging modalities such as computed tomography and magnetic resonance imaging for the TMJ and related structures remains controversial. Nevertheless, imaging is regularly used in the diagnosis of some Group II and Group III disorders. Magnetic resonance imaging may be of use not only for the visualization of disc displacements but also for the study of bone mineral density of the condyle. Cytokines such as interleukin-1 (IL-1) and tumor necrosis factor alpha (TNFα) play an important role in TMJ pathology. For example, IL-1β, which has been associated with TMJ pain, hyperalgesia, and anterior bite opening, is mostly absent in the synovial fluid of healthy joints. Since both IL-1 and TNFα are involved in the development of chronic pain and joint destruction, they may be the targets for specific treatments. While the advances reviewed in this paper are significant, multidisciplinary efforts and formation of international research collaborations will be necessary to continue advancement in the understanding of TMJ pathology and diagnosis. [ABSTRACT FROM AUTHOR]