| 1. |
- Wiese, Mie, et al.
(författare)
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Association Between Temporomandibular Joint Symptoms, Signs, and Clinical Diagnosis Using the RDC/TMD and Radiographic Findings in Temporomandibular Joint Tomograms
- 2008
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Ingår i: Journal of Orofacial Pain. - : Quintessence. - 1064-6655 .- 1945-3396. ; 22:3, s. 239-251
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To identify associations between clinical symptoms of temporomandibular joint disorders and radiographic findings. Methods: Two hundred four adult patients (156 women, 48 men, mean age 40 years) with temporomandibular joint (TMJ) pain/sounds or changes in mandibular motion were examined according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Bilateral sagittal corrected TMJ tomograms in closed and open positions were assessed fo the presence of flattening, erosion, osteophytes, and sclerosis in the joint components and the range of mandibular motion. Logistic regression analyses were performed with the radiographic findings as the dependent variables and the following clinical variables as independent variables: opening pattern, maximal jaw opening, TMJ sounds, number of painful muscle/TMJ sites, duration of pain, presence of arthritic disease, depression and somatisation scores, graded chronic pain, and age and gender. Resluts: Coarse crepitus on opening/closing (odds ratio [OR] ≥ 3.12), on lateral excursions (odds ratio ≥ 4.06), and on protrusion (OR ≥ 5.30) was associated with increased risk of degenerative findings in tomograms. A clinical diagnosis of osteoarthritis increased the risk of radiographic findings (OR ≥ 2.95) and so did increasing age (OR ≥ 1.03 per year) and the female gendera (OR ≥ 2.36). Maximal assisted opening and maximal opening without pain (< 40 mm) was associated with a posterior condyle-to-articular tubercle position (OR ≥ 2.60). No other significant associations were observed. Conclusion: Age, gender, and coarse crepitus, but no pain-related variables, were associated with increased risk of degenerative findings in TMJ tomograms. Maximal opening < 40 mm was associated with at posterior condyle-to-articular tubercle relation on opening.
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| 2. |
- Wiese, Mie, et al.
(författare)
-
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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| 3. |
- Wiese, Mie, et al.
(författare)
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Influence of cross-sectional temporomandibular joint tomography on daignosis and management decisions of patients with temporomandibular joint disorders
- 2011
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Ingår i: Journal of Orofacial Pain. - : Quintessence. - 1064-6655 .- 1945-3396. ; 25, s. 223-231
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To assess whether changes in diagnoses and management of temporomandibular joint disorder (TMJD) patients are influenced by radiographic findings and if there is an association between specific radiologic alterations and management strategy changes. METHODS: A total of 204 patients with TMJ symptoms were examined using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Diagnoses and management were first decided without the aid of radiographs. Management categories were: pharmacology, physiotherapy, counseling and behavioral treatment, occlusal stabilization, surgery, additional examinations, and referrals, each with subcategories. Sagittal TMJ tomograms were assessed for the presence of flattening, erosion, osteophyte, and sclerosis in the TMJ components. Diagnoses and management were reevaluated after gaining access to the radiographs and radiographic classifications. Logistic regression analyses were performed with changes in management as the dependent variable and age and radiographic findings as the independent variables. RESULTS: Diagnosis was changed for 56 patients, mainly from arthralgia to osteoarthritis. Management was changed for 55 patients. Most changes occurred in pharmacology and physiotherapy followed by counseling and behavioral treatment, occlusal stabilization, referrals, additional examinations, and surgery. Changes were mostly within the categories, and the highest number of changes was seen in pharmacology, physiotherapy, and counseling and behavioral treatment. Radiographic degenerative findings increased the chance of change (any change) (odds ratio [OR] ⋝ 2.03) and the chance of change in pharmacology (OR ⋝ 2.56) and physiotherapy (OR = 2.48) separately. No other significant associations were found. CONCLUSION: Radiographic degenerative findings increased the chance of changes in management strategy. However, 73% of the TMJD patients had no changes in management after radiographic examination. In cases with changes, these were mainly adjustments within management categories.
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| 4. |
- Wiese, Mie, et al.
(författare)
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Osseous changes and condyle position in TMJ tomograms : impact of RDC/TMD clinical diagnoses on agreement between expected and actual findings
- 2008
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Ingår i: Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. - : Elsevier BV. - 1079-2104 .- 1528-395X. ; 106:2, s. 52-63
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- The objective of this study was to evaluate the impact of clinical TMJ diagnosis, gender, and age on the agreement between expected and actual radiographic findings. STUDY DESIGN: A total of 204 patients with TMJ symptoms were examined using the Research Diagnostic Criteria (RDC/TMD). Expected radiographic findings were recorded. TMJ tomograms in closed and open mouth position were assessed for osseous changes and condyle position. Expected and actual findings were compared. Logistic regression analyses were performed with agreement on radiographic findings as the dependent variable and with clinical RDC/TMD diagnoses, gender and age as the independent variables. RESULTS: The number of radiographic findings was mostly underestimated. A clinical diagnosis of osteoarthritis and age increased the chance of overestimating osseous changes. Disc displacement and age decreased the chance of agreement on certain condyle positions. CONCLUSION: Tomography often revealed unexpected findings. It was not possible to select particular patient groups who would benefit more or less from a radiographic examination.
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