Journal of Oral & Facial Pain and Headache, 02/2007

Aim: To provide a systematic description of clinical findings and psychosocial factors in patients suffering from atypical odontalgia (AO). Methods: Forty-six consecutive AO patients (7 men and 39 women; mean age, 56 years; range, 31 to 81 years) were compared with 35 control subjects (11 men and 24 women; mean age, 59 years; range, 31 to 79 years). Results: The pain of the AO patients was characterized by persistent, moderate pain intensity (mean, 5.6 ± 1.9) with long pain duration (mean, 7.7 ± 7.8 years). Eighty-three percent reported that onset of pain occurred in conjunction with dental treatment. No significant difference was found between the groups in number of remaining teeth or number of root fillings. Temporomandibular disorder (TMD) pain (P .001), tension-type headache (P .002), and widespread pain (P .001) were significantly more common among AO patients than controls. Significantly higher scores for somatization (P .01) and depression (P .01) and limitations in jaw function (P .001) were found for the AO group compared with the control group. Significant differences between groups were found in 4 general health domains: role-physical (P .001), bodily pain (P .001), vitality (P .004), and social functioning (P .001). Conclusion: A majority of the AO patients reported persistent, moderately intense intraoral pain that in most cases had an onset in conjunction with dental treatment. AO patients had more comorbid pain conditions and higher scores for depression and somatization. Significant limitation in jaw function and significantly lower scores on quality of life measures were found for AO patients compared with controls. Keywords: neuropathic pain, orofacial pain, pain characteristics, psychosocial status, quality of life

Aims: (1) To use psychometrically sound measures to characterize the pain levels and pain-related interference associated with recurrent aphthous ulcers (RAU); (2) to determine whether subjects with RAU report clinically significant psychologic symptoms; and (3) to examine the relationships between physical characteristics and self-reported psychologic symptoms, pain, and pain-related interference. Methods: Forty-seven subjects with RAU and an active ulcer completed the Graded Chronic Pain Scale and the Symptom Checklist-90R (SCL-90R). Ulcers were photographed for measurement, and subjects rated pain levels on a 0-to-10 scale before and after swabbing of the ulcer with a saturated solution of sodium chloride and distilled water. Results: Mean characteristic pain intensity was 4.76, with a pain-related interference score of 1.21. None of the average SCL-90R subscale scores were considered elevated. In the model predicting pain intensity after swabbing, pain intensity before swabbing explained 43.6% of the variance (P = .000). Neither the addition of physical characteristics (R2 change = .04; P = .28) nor psychologic characteristics (R2 change = .09; P = .83) contributed significantly to the model. In contrast, only psychologic characteristics contributed to the variance explained in the model predicting pain-related interference (R2 change = .505; P = .007). Conclusions: RAU is a moderately painful condition causing some impairment in functioning. Self-reported pain intensity of a sore does not appear to be influenced by psychologic characteristics. However, pain-related interference appears to be related to psychologic and not physical characteristics. Keywords: pain, psychology, recurrent aphthous ulcers

Aim: To evaluate temporomandibular disorder (TMD) patients for differences between masticatory muscle (MM) and temporomandibular joint (TMJ) pain patients in the prevalence of post-traumatic stress disorder (PTSD) symptoms and evaluate the level of psychological dysfunction and its relationship to PTSD symptoms in these patients. Methods: This study included 445 patients. Psychological questionnaires included the Symptom Check List-90-Revised (SCL-90-R), the Multidimensional Pain Inventory, the Pittsburgh Sleep Quality Index, and the PTSD Check List Civilian. The total sample of patients was divided into 2 major groups: the MM group (n = 242) and the TMJ group (n = 203). Each group was divided into 3 subgroups based on the presence of a stressor and severity of PTSD symptoms. Results: Thirty-six patients (14.9%) in the MM group and 20 patients (9.9%) in the TMJ group presented with PTSD symptomatology (P = .112). Significant differences were found between the MM and the TMJ group in several psychometric domains, but when the presence of PTSD symptomatology was considered, significant differences were mostly maintained in the subgroups without PTSD. MM and TMJ pain patients in the "positive PTSD" subgroups scored higher on all SCL-90-R scales (P .001) than patients in the other 2 subgroups and reached levels of distress indicative of psychological dysfunction. TMJ pain patients (58.3%; P = .008) in the positive-PTSD subgroups were more often classified as dysfunctional. Both positive-PTSD subgrounps of the MM and TMJ groups presented with more sleep disturbance (P .005) than patients in the other 2 subgroups. Conclusion: A somewhat elevated prevalence rate for PTSD symptomatology was found in the MM group compared to the TMJ group. Significant levels of psychological dysfunction appeared to be linked to TMD patients with PTSD symptoms. Keywords: prevalence, post-traumatic stress disorder, psychological dysfunction, sleep disturbances, temporomandibular disorders

Aim: To compare the development of symptoms of temporomandibular disorders (TMD) in a sample of patients with juvenile arthritis (JA) and a matched control sample. Methods: In 1986, 40 patients with JA (28 girls and 12 boys; mean age ± SD, 18 ± 4.5 years) and an age- and sex-matched control sample were examined for signs and symptoms of TMD. Fifteen years later in 2001, a questionnaire concerning symptoms of TMD was sent to these subjects. Twenty-eight individuals (68%) in the JA sample (20 women and 8 men; mean age ± SD, 35 ± 5.2 years) and 26 controls (19 women and 7 men; 34 ± 4.0 years) were available for the follow-up. Results: The overall prevalence of symptoms of TMD increased between the 2 examinations in both groups. The prevalence of reported TMD symptoms, such as jaw pain, fatigue in the jaws, and difficulty opening the jaws wide, as well as awareness of tooth clenching, headaches, neck and shoulder pains, was significantly greater among the JA sample than among the controls at the follow-up. Conclusion: The study indicates that prevalence of pain and dysfunction in the craniofacial or cervical regions of JA patients is increased more than 20 years after the onset of JA compared to healthy individuals. Keywords: epidemiology, juvenile arthritis, longitudinal study, orofacial pain, temporomandibular joint

Aim: 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. Keywords: cohort studies, epidemiology, pain, sex factors, temporomandibular joint disorders

Aim: To determine intra- and interrater agreement of the pressure pain threshold (PPT) values for children reporting orofacial pain related to temporomadibular disorders and symptom-free subjects when the mean of 3 consecutive measurements or the mean of the last 2 consecutive measurements was considered. Methods: Fourteen children reporting pain in masticatory muscles or the temporomandibular joint and 16 symptom-free children were selected at random from a sample of 100 children. Two trained raters used an algometer to obtain 3 consecutive measurements of PPT of the masticatory system sites. The children were evaluated in 3 sessions after a minimum period of 3 days after the initial evaluation. The intraclass correlation coefficient (ICC) was used to evaluate the levels of agreement. Results: Excellent intra- and interrater agreement was observed (ICC > 0.75) for most of the structures evaluated in symptom-free children, and excellent and moderate agreement was obtained for the symptomatic group. Discarding the first of the 3 measurements increased the number of sites with ICC values classified as excellent in both groups. For evaluations performed on different days, this procedure reduced significantly the percentage of sites with ICC values classified as excellent only for the interrater agreement for the symptomatic group. Conclusion: The lower levels of reproducibility for the measurements obtained on different days in the children who reported pain may have been related to instability of their clinical signs and symptoms, and a PPT assessment based on the mean of 3 consecutive measurements or the procedure of discarding the first measure should be considered for such evaluations, especially when they are conducted by different raters. Algometry was shown to be a reliable tool for the evaluation of pain threshold in the masticatory structures of children. Keywords: agreement, children, orofacial pain, pain report, pressure pain threshold, temporomandibular disorders

Aim: To analyze the bone mineral density (BMD) in a group of young female patients with a disc displacement in at least 1 temporomandibular joint (TMJ) as well as in a group of age-matched young females with a normal condyle-disc relationship. Methods: Fifty-six young female patients with anterior disc displacement based on magnetic resonance imaging (MRI) and 40 age- and gender-matched controls with asymptomatic TMJs were recruited for this study. Subjects between 18 and 30 years were recruited. Based on the MRI findings, 10 of the 40 subjects in the control group also had anterior disc displacement. In all, 16 subjects had an anterior disc displacement with reduction (DDwR), 50 had an anterior disc displacement without reduction (DDw/oR), and 30 had a normal condyle-disc relationship. BMD was measured in the lumbar area by means of dual-energy x-ray absorptiometry. The relationship between the 3 types of condyle-disc relationship and BMD was then analyzed. Results: Patients with a DDw/oR had a significantly lower mean BMD value in the lumbar area than the subjects with a normal condyle-disc relationship (P .05, analysis of variance, post-hoc with Bonferroni test). Twenty-two (44%) of 50 patients with DDw/oR had osteopenia. Conclusion: Low BMD is often associated with DDw/oR in young Taiwanese female patients. Keywords: anterior disc displacement, bone mineral density, internal derangement, temporomandibular joint