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Aims: The aims of this critical review were to: (i) assess the factors that differentiate acute from chronic temporomandibular disorders (TMD) pain; (ii) assess the risk factors associated with the transition from acute to chronic TMD pain; and (iii) summarize and appraise the studies. Method: The databases used were MEDLINE, Embase, and Cochrane Database of Systematic Reviews. Eligible studies included articles comparing acute to chronic TMD pain, and cohort studies assessing the risk factors implicated in the transition from acute to chronic TMD pain. Results: Seven articles were selected: one case‐control study, three cross‐sectional studies, and three cohort studies. These studies found that psychological factors were more common in chronic than acute TMD pain patients; however, these factors did not increase the transition risk in the multivariable model. Myofascial and baseline pain intensity were associated with the transition from acute to chronic TMD pain at a 6‐month follow‐up. Due to methodological weaknesses in the available literature, more research is required to establish the risk factors implicated in the transition from acute to chronic TMD pain. Conclusion: This review found some evidence that myofascial pain is associated with the transition risk from acute to chronic TMD pain at a 6‐month follow‐up and that pain intensity at baseline is associated with more intense TMD pain 6 months later. There is insufficient evidence to draw conclusions about the role of demographics and psychological disorders as independent risk factors. [ABSTRACT FROM AUTHOR]

The temporomandibular joint (TMJ) is located in the lower jaw. Abnormalities of the TMJ that cause pain during chewing and other facial movements are receiving increasing attention. Guidelines regarding TMJ disorders have been developed recently for dentists and include principles for the diagnosis and care and treatment of TMJ disorders as well as educational guidelines for the profession. Epidemiological studies have revealed much information about the signs and symptoms of TMJ disorders, the prevalence of these disorders, and populations more likely to be affected. The American Dental Association has developed a classification system using epidemiological information that includes diagnostic criteria for TMJ disorders. Further research is needed to establish the reliability of these proposed criteria, but they promise to be very useful to dentists. Advances have also been made in the understanding of chronic pain affecting the face and jaw. This type of pain is continuous and has no apparent biological cause, in contrast with the acute pain that is most often associated with TMJ disorders. People who suffer from chronic pain tend to experience more problems in their lives. While these problems can result from the constant pain, they may also be caused in part by lifestyle issues. Research has indicated that chronic pain tends to involve biological, psychological and social factors, rather than being a simple medical problem, and therefore treatment must include consideration of these other aspects as well. Recent breakthroughs in understanding the mechanisms of pain have led to more complete treatments. Dentists must keep abreast of advances in the field of TMJ disorders and orofacial pain so that they can provide their patients with the best possible care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Disorders of the temporomandibular joint (TMJ), the joint between the jaw bone and the skull, are characterized by pain and dysfunction of jaw motion. There are few reports on the incidence of temporomandibular joint disorders (TMD) and the need for treatment. Specific diagnostic criteria were used to determine the incidence and the severity of muscle and TMJ disorders in 269 female nursing students. The subjects completed a questionnaire and were given a clinical examination. The most frequently reported symptom was noise on TMJ motion. Although 69 percent of the students exhibited clinical signs of TMD, symptoms were severe enough to warrant treatment in only 6 percent. There was a high incidence of pathosis, or abnormal condition, but a correspondingly low level of symptomatology. Clicking sounds in the TMJ represent a benign condition in asymptomatic patients. The major source of pain appears to be the jaw muscles. These findings support conservative management before considering surgery for TMD. (Consumer Summary produced by Reliance Medical Information, Inc.)

Aims: To conduct a systematic review with meta-analysis of randomized controlled trials (RCTs) that have assessed the efficacy of intraoral orthopedic appliances to reduce pain in patients with temporomandibular disorders affecting muscle and joint (TMJD) compared to subjects receiving placebo control, no treatment, or other treatments. Methods: A search strategy of MEDLINE, the Cochrane Library, the Cochrane CENTRAL Register, and manual search identified all English language publications of RCTs for intraoral appliance treatment of TMJD pain during the years of January 1966 to March 2006. Two additional studies from 2006 were added during the review process. Selection criteria included RCTs assessing the efficacy of hard and soft stabilization appliances, anterior positioning appliances, anterior bite appliances, and other appliance types for TMJD pain. Pain relief outcome measures were used in the meta-analyses, and the QUORUM criteria for data abstraction were used. A quality analysis of the methods of each RCT was conducted using the CONSORT criteria. The review findings were expressed both as a qualitative review and, where possible, as a mathematical synthesis using meta-analysis of results. Results: A total of 47 publications citing 44 RCTs with 2,218 subjects were included. Ten RCTs were included in two meta-analyses. In the first meta-analysis of seven studies with 385 patients, a hard stabilization appliance was found to improve TMJD pain compared to non-occluding appliance. The overall odds ratio (OR) of 2.46 was statistically significant (P = .001), with a 95% confidence interval of 1.56 to 3.67. In the second meta-analysis of three studies including 216 patients, a hard stabilization appliance was found to improve TMJD pain compared to no-treatment controls. The overall OR of 2.15 was positive but not statistically significant, with a 95% confidence interval of 0.80 to 5.75. The quality (0 to 1) of the studies was moderate, with a mean of 55% of quality criteria being met, suggesting some susceptibility to systematic bias may have existed. Conclusion: Hard stabilization appliances, when adjusted properly, have good evidence of modest efficacy in the treatment of TMJD pain compared to non-occluding appliances and no treatment. Other types of appliances, including soft stabilization appliances, anterior positioning appliances, and anterior bite appliances, have some RCT evidence of efficacy in reducing TMJD pain. However, the potential for adverse events with these appliances is higher and suggests the need for close monitoring in their use. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the quality of methods used in randomized controlled trials (RCTs) of treatments for management of pain and dysfunction associated with temporomandibular muscle and joint disorders (TMJD) and to discuss the implications for future RCTs. Methods: A systematic review was made of RCTs that were implemented from 1966 through March 2006, to evaluate six types of treatments for TMJD: orthopedic appliances, occlusal therapy, physical medicine modalities, pharmacologic therapy, cognitivebehavioral and psychological therapy, and temporomandibular joint surgery. A quality assessment of 210 published RCTs assessing the internal and external validity of these RCTs was conducted using the Consolidated Standards of Reporting Trials (CONSORT) criteria adapted to the methods of the studies. Results: Independent assessments by raters demonstrated consistency with a mean intraclass correlation coefficient of 0.63 (95% confidence interval). The mean percent of criteria met was 58%, with only 10% of the RCTs meeting the four most important criteria. Conclusions: Much of the evidence base for TMJD treatments may be susceptible to systematic bias and most past studies should be interpreted with caution. However, a scatter plot of RCT quality versus year of publication shows improvement in RCT quality over time, suggesting that future studies may continue to improve methods that minimize bias. [ABSTRACT FROM AUTHOR]

Aims: The operational definitions for the Craniomandibular Index (CMI) were redesigned to conform precisely to those of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), resulting in a single examination protocol, the Temporomandibular Index (TMI). The objectives were to evaluate interexaminer reliability of the TMI as well as its criteria and construct validity for measurement of TMD severity. Methods: Interexaminer reliability of the TMI was assessed on 12 subjects. Criterion validity of the TMI was evaluated relative to the CMI, the latter having established validity. Construct validity of the TMI was evaluated for its capacity to differentiate TMD patients (n = 79) from normal subjects (n = 20) and to detect changes in severity over time. Results: The examiners' average TMI scores were 0.27 ± 0.19 (SD) and 0.26 ± 0.20. Agreement was excellent, with an intraclass correlation coefficient (ICC) of 0.93. The scores for the TMI and the CMI correlated highly, with an ICC of 0.97. Statistical contrasts between the symptomatic groups and the normal subjects were highly significant (P < .001). In 20 TMD patients who underwent treatment for their disorder, their mean change of 0.12 from their pretreatment TMI scores was highly significant (P < .001). Conclusion: This study has provided statistical evidence for the clinical reliability and validity of the TMI, which indicates that the RDC examination protocol is appropriate for determining TMD severity by the TMI algorithm, and diagnosis of TMD subtypes by the RDC algorithm. [ABSTRACT FROM AUTHOR]

This paper discusses the critical issues that surround the development of an orofacial pain program in a dental school and suggests strategies to address them. Since the University of Minnesota has an established orofacial pain program involved in both predoctotal and postdoctoral teaching, clinical and basic research, and interdisciplinary patient care over the past 20 years, this article uses this as a model for development of an orofacial pain program. The proposal includes overall goals, background and rationale, specific aims, and program activities, including teaching, research, patient care, and financial and resource needs. These features may be of assistance to those considering the development of such programs in the United States and elsewhere in the world. [ABSTRACT FROM AUTHOR]

The author discusses a report in the issue on various kinds of atypical orofacial pain in which the authors argued for the creation of new categories of diseases to account for undiagnosed idiopathic diseases. This method would not actually produce a clear etiology of the disorders, and could cause diseases to be misdiagnosed.

The article focuses on the challenges facing the practice and teaching of temporomandibular diseases and suggestions on how dental schools could possibly overcome it. The authors focus on the need for clinicians to have a proper understanding of the manifestation of these diseases and consider that the bemusing condition of psychological and somatic manifestations makes things complicated for clinicians. As a solution, it suggests several changes in dental curriculums.

Copyright of Journal of Craniomandibular Disorders is the property of Quintessence Publishing Company Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A total of 102 consecutive patients with chronic TMJ and craniofacial pain were evaluated in an outpatient interdisciplinary pain program. The program integrates a dentist, psychologist, physical therapist, and an information system in an evaluation and management system that is based on the biopsychosocial medical model and self-care with general systems theory and cybernetics as the conceptual framework. Of the patients, 73 completed the program, 18 participated (but did not complete the program), and 11 were evaluated but did not participate in the program. Sixty-seven (92%) completers, 14 (77%) noncompleters, and 11 (100%) no-treatment controls answered an identical self-report questionnaire 1 yr after the initial questionnaire. The results show that completers improved in symptom severity, use of health care, daily behaviors, and attitudes as compared to non-completers and no treatment controls. This study suggests that patient status can be improved within an interdisciplinary program that, if well defined, can be both efficient and effective. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Orofacial Pain is the property of Quintessence Publishing Company Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article discusses the guidelines available in postdoctoral education for temporomandibular disorders (TMD) and orofacial pain. It focuses on the reasons for the emergence of the discipline, that includes the recognition of orofacial and TMD as significant clinical problems and demand for trained clinicians. It also puts up few suggestions like full-time tenured positions for faculty and establishment or interdisciplinary TMD and orofacial pain clinics.

The article presents information related to the effects of an insurance coverage mandate for treatment of temporomandibular disorders (TMD) in Minnesota. As reported, despite the availability of high-quality and cost-effective care, patients continue to have difficulty receiving reimbursement for treatment of TMD. As a result of this, a law was enacted in 1987 that mandates medical coverage for care of TMD by the Minnesota Legislature.