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- Wiese, Mie, et al.
(författare)
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Influence of cross-sectional temporomandibular joint (TMJ) tomography on diagnosis and management of patients with temporomandibular disorders (TMD)
- 2008
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Konferensbidrag (refereegranskat)abstract
- Objectives: To describe changes in diagnosis and management of TMD patients after radiographic examination and to evaluate the associations between specific TMJ tomographic findings and changes in management. Methods: 204 adult patients (48 males, 156 females, mean age 40 years) with TMJ pain/sounds or problems with mandibular motion were examined according to the Research Diagnostic Criteria (RDC/TMD) by one of six calibrated orofacial pain specialists. Diagnoses and management strategy reached without the aid of radiographs were recorded. It was possible to select from seven management categories (pharmacology, physiotherapy, psychological, occlusal stabilization, surgical, other examinations and referrals) each with a number of sub-categories. Bilateral sagittal corrected TMJ tomograms in closed position were obtained using conventional film in a Cranex Tome or a Scanora tomographic X-ray unit. The tomograms were assessed for the presence of flattening, erosion, osteophyte and sclerosis in the TMJ components and the condyle-to-mandibular fossa relation by one of five calibrated oral radiologists blinded to the clinical diagnosis and initial management strategy. After gaining access to the results from the radiographic examination the orofacial pain specialists re-evaluated their diagnoses and management strategy. All changes were calculated. Logistic regression analyses (with odds ratio (OR) and significance level (p)) were performed with changes in management as the dependent variable and with age and radiographic findings as the independent variables. Results: 41% of the clinical arthralgia diagnoses were changed into osteoarthritis after radiographic examination and the number of osteoarthrosis diagnoses increased with 200% (from 13 to 39). One or more changes in the management strategy were found for 27% (55) of the patients. Most often changes occurred in pharmacology and physiotherapy (29 and 28 patients respectively) followed by changes in psychological (13 patients), occlusal stabilization (8 patients), referrals (7 patients), other examinations (6 patients) and surgical (2 patients). For pharmacology, physiotherapy and psychological the changes were adjustments within the sub-categories in 51 out of 70 patients. For the other management categories most of the changes were addition or omission of the management category (in 20 out of 23 patients). The chance of “any change” in management (removal or addition of one or more sub-categories in one or more management categories) was more than twice as high with a finding of flattening (OR=2.28) and erosion (OR=2.03) compared to not having these radiographic findings. Increased chance of “any change” in management was also found with >1 radiographic finding (regardless of type) (OR=2.64) compared to having no radiographic findings. The chance of change in pharmacology was increased more than three times with erosion (OR=3.60) and more than two times with flattening (OR=2.56). The chance of change in physiotherapy was increased with >1 radiographic finding (OR=2.79). No statistically significant (p≤0.05) associations between osteophyte, sclerosis and age and changes in management were found. Conclusion: 27% of the patients had changes in management after radiographic examination. Radiographic findings did increase the chance of changes in management. However, as the changes were mostly adjustments in sub-categories radiography may have a minor impact on management of most TMD patients.
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