Abstract
ObjectivesThe objective was to describe the physical and psychosocial features of patients attending a specialized consultation hour for temporomandibular disorders (TMD). This investigation focused on those patients who did not receive a diagnosis according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD).Materials and methodsFrom 2004 to 2017, patients seeking care during a TMD-specialized consultation hour were consecutively recruited. Each patient completed a TMD-related questionnaire, psychosocial questionnaires (Graded Chronic Pain Scale, Hospital Anxiety and Depression Scale, Beschwerden-Liste), and the Oral Health Impact Profile-49. The clinical examination was performed according to the RDC/TMD.ResultsThe mean age of the 1020 patients was 43.3 years (75.3% female). According to the RDC/TMD decision trees, 351 patients were categorized without a TMD diagnosis (NoTMDdx). The most frequent reasons for seeking care were orofacial pain/TMJ pain or headaches revealing an OR of 1.89 (for TMDdx group). A relevant proportion of patients was categorized as positive for anxiety (NoTMDdx/TMDdx 30.8/41.2%; p = 0.072), depression (20.8/23.9%; p = 0.433), non-specific physical symptoms (31.4/44.1%; p < 0.001), or dysfunctional chronic pain (11.5/18.2%; p < 0.001). In both patient groups, the oral health-related quality of life was impaired (42.9/52.7 points; p < 0.001), and the frequency of therapy measures prior to the consultation hour was high.ConclusionsPatients seeking care from TMD specialists were usually referred with TMD-associated symptoms. Of those, a relevant proportion did not receive a diagnosis according to RDC/TMD decision trees.Clinical relevancePsychosocial screening and the avoidance of overtreatment are recommended for patients with TMD-related symptoms.
Highlights
Patients suffering from non-dental pain or complaints in the orofacial area are a challenge in daily dental practice due to the complexity of the diagnostics
Demographics, temporomandibular disorders (TMD)-related patient history, and physical characteristics wear,” and an odds ratios (OR) of 0.33 [95% confidence intervals (95% CI) 0.14, 0.77] for “tinnitus” were detected that suggest a lower chance to be categorized with an Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) diagnosis according to decision trees
Physiotherapy, and analgesics were used to a similar extent prior to the TMD-specialized consultation hour in both groups (p ≥ 0.076) (Table 1)
Summary
Patients suffering from non-dental pain or complaints in the orofacial area are a challenge in daily dental practice due to the complexity of the diagnostics. Within daily dental clinical routines, patients with orofacial pain are estimated to account for 19% of all patients [1]. When no dental-related reasons are obvious, general practitioners often refer these patients to specialists. The treatment cascade that follows basically involves ENT physicians, oral and maxillofacial surgeons and specialists on temporomandibular disorders (TMD) [1]. General practitioners estimate TMD to be the most frequent reason for orofacial pain symptoms [1, 2]. TMD has a complex etiopathology that is based on physical (axis I) and psychosocial (axis II) aspects. A validated classification and diagnostic system is required that can be utilized for these
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