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- Durham, Justin, et al.
(författare)
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Constructing the brief diagnostic criteria for temporomandibular disorders (bDC/TMD) for field testing
- 2024
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842. ; 51:5, s. 785-794
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite advances in temporomandibular disorders' (TMDs) diagnosis, the diagnostic process continues to be problematic in non-specialist settings.Objective: To complete a Delphi process to shorten the Diagnostic Criteria for TMD (DC/TMD) to a brief DC/TMD (bDC/TMD) for expedient clinical diagnosis and initial management.Methods: An international Delphi panel was created with 23 clinicians representing major specialities, general dentistry and related fields. The process comprised a full day workshop, seven virtual meetings, six rounds of electronic discussion and finally an open consultation at a virtual international symposium.Results: Within the physical axis (Axis 1), the self-report Symptom Questionnaire of the DC/TMD did not require shortening from 14 items for the bDC/TMD. The compulsory use of the TMD pain screener was removed reducing the total number of Axis 1 items by 18%. The DC/TMD Axis 1 10-section examination protocol (25 movements, up to 12 sets of bilateral palpations) was reduced to four sections in the bDC/TMD protocol involving three movements and three sets of palpations. Axis I then resulted in two groups of diagnoses: painful TMD (inclusive of secondary headache), and common joint-related TMD with functional implications. The psychosocial axis (Axis 2) was shortened to an ultra-brief 11 item assessment.Conclusion: The bDC/TMD represents a substantially reduced and likely expedited method to establish (grouping) diagnoses in TMDs. This may provide greater utility for settings requiring less granular diagnoses for the implementation of initial treatment, for example non-specialist general dental practice.
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| 2. |
- Durham, Justin, et al.
(författare)
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Self-management programmes in temporomandibular disorders : results from an international Delphi process
- 2016
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 43:12, s. 929-936
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Forskningsöversikt (refereegranskat)abstract
- Self-management (SM) programmes are commonly used for initial treatment of patients with temporomandibular disorders (TMD). The programmes described in the literature, however, vary widely with no consistency in terminology used, components of care or their definitions. The aims of this study were therefore to construct an operationalised definition of self-management appropriate for the treatment of patients with TMD, identify the components of that self-management currently being used and create sufficiently clear and non-overlapping standardised definitions for each of those components. A four-round Delphi process with eleven international experts in the field of TMD was conducted to achieve these aims. In the first round, the participants agreed upon six principal concepts of self-management. In the remaining three rounds, consensus was achieved upon the definition and the six components of self-management. The main components identified and agreed upon by the participants to constitute the core of a SM programme for TMD were as follows: education; jaw exercises; massage; thermal therapy; dietary advice and nutrition; and parafunctional behaviour identification, monitoring and avoidance. This Delphi process has established the principal concepts of self-management, and a standardised definition has been agreed with the following components for use in clinical practice: education; self-exercise; self-massage; thermal therapy; dietary advice and nutrition; and parafunctional behaviour identification, monitoring and avoidance. The consensus-derived concepts, definitions and components of SM offer a starting point for further research to advance the evidence base for, and clinical utility of, TMD SM.
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| 3. |
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| 4. |
- Pigg, Maria, et al.
(författare)
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Distinguishing pulpal from periapical pain by pain characteristics : National Dental PBRN
- 2016
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective Root canal treatment (RCT) is often initiated upon pain caused by inflammation of pulpal or periapical tissues. To explore to what extent certain clinical signs and symptoms differ between these two conditions, we compared pain of pulpal and periapical origin with regard to symptoms, clinical signs and diagnostic findings. Methods 62 dentists within the National Dental PBRN (www.NationalDentalPBRN.org) enrolled consecutive patients requiring RCT. Preoperative data were collected from patients (symptoms, pain characteristics) and dentists (examination findings) by questionnaires. Patients with average pain intensity >0 (0–10 numeric rating scale; NRS) for >1 day in the week preceding treatment were eligible. The definition for pain of pulpal origin was tooth pain with bleeding within the pulp chamber in the absence of periapical radiolucency. The definition for pain of periapical origin was tooth pain without bleeding pulp and presence of radiolucency. Pearson's chi-square test and t-test compared groups, and sensitivity and specificity were calculated. Results 370 patients met criteria; 234 (63%) exhibited pulpal pain and 136 (37%) had periapical pain. Patients with pain of pulpal origin more often reported sharp (p=0.004), dull (p=0.039), or shooting pain (p=0.026), provoked pain onset (p=0.002), pain aggravated by cold/hot food or drink (p<0.001) and prolonged response to cold (p<0.001). Patients with pain of periapical origin more often had tenderness to percussion (p<0.001) and biting pressure (p<0.001), as well as swelling (p<0.001). To identify pain of pulpal origin, prolonged response to cold had 71% sensitivity and 92% specificity. To identify pain of periapical origin, tenderness to percussion had 89% sensitivity and 38% specificity and for biting pressure, 81% sensitivity and 42% specificity. Conclusion Clinical characteristics and symptoms clearly differed between conditions. Although no single factor had adequate validity to be used as an indicator of the source of pain, several should be considered for inclusion in future diagnostic algorithms.
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| 5. |
- Pigg, Maria, et al.
(författare)
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New International Classification of Orofacial Pain : What Is in It For Endodontists?
- 2021
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Ingår i: Journal of Endodontics. - : Elsevier. - 0099-2399 .- 1878-3554. ; 47:3, s. 345-357
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Tidskriftsartikel (refereegranskat)abstract
- Pain is a common symptom in endodontic conditions, but differential diagnostic procedures are often needed to exclude other pain origins. General dentists and endodontists thus need to be aware of alternative painful orofacial conditions, and be able to identify them. The new International Classification of Orofacial Pain (ICOP, 2020) is the first comprehensive classification that uniquely deals with orofacial pain. The ICOP is a hierarchical classification, modelled on the International Classification of Headache Disorders (ICHD-3) and covers pain in dentoalveolar and anatomically related tissues, muscle pain, temporomandibular joint (TMJ) pain, neuropathic pain affecting cranial nerves, pain resembling primary headaches, and idiopathic pain in the orofacial region. A description of each condition is given, and structured diagnostic criteria for each condition are proposed based on research data when available. This narrative review aims to (i) give an overview and brief explanation of the ICOP system, (ii) describe and give examples of how it can be of use to general dentists and endodontists with special attention to differential diagnosis of tooth pain, and (iii) highlight how endodontic research can contribute to validation and improvement of the classification. A comparison to other classification and diagnostic systems is also included.
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| 6. |
- Pigg, Maria, et al.
(författare)
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Validity of preoperative clinical findings to identify dental pulp status : A National Dental Practice-Based Research Network Study
- 2016
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Ingår i: Journal of Endodontics. - : Elsevier. - 0099-2399 .- 1878-3554. ; 42:6, s. 935-942
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Endodontic diagnostic tests are often used clinically to assess pulp status as a basis for the diagnosis and determination of whether root canal treatment (RCT) is indicated. Response to cold and pain on percussion are 2 common tests, yet their validity in identifying nonvital pulp in regular dental practice has not been reported. METHODS: We assessed the validity of cold and percussion tests to identify nonvital pulp in teeth requiring RCT in a dental practice setting performed by 46 general dentists and 16 endodontists in the National Dental Practice-Based Research Network. The influence of patient-, tooth-, and dentist-related characteristics was investigated. Observed bleeding from the pulp chamber was the clinical reference. Sensitivity (SN), specificity (SP), overall test accuracy (TA), positive (PPV) and negative (NPV) predictive values, and likelihood and diagnostic odds ratios (LR+, LR-, dORs) were calculated for each single test and the combined cold and percussion tests. RESULTS: Seven hundred eight patient teeth were included. Cold test showed high validity to identify a nonvital pulp status (SN = 89%, SP = 80%, TA = 84%, PPV = 81%, NPV = 88%, LR+ = 4.35, LR- = 0.14, dOR = 31.4), whereas pain on percussion had lower validity (SN = 72%, SP = 41%, TA = 56%, PPV = 54%, NPV = 60%, LR+ = 1.22, LR- = 0.69, dOR = 1.78). Combining the 2 tests did not increase validity, whereas preoperative pain, medication intake, patient age and sex, and dentist training level affected test validity significantly. CONCLUSIONS: In regular dental practice, the cold test exhibits higher validity to discriminate between vital and nonvital pulp than the tooth percussion test.
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| 7. |
- Sharma, Sonia, et al.
(författare)
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Challenges in the clinical implementation of a biopsychosocial model for assessment and management of orofacial pain
- 2020
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 47:1, s. 87-100
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Tidskriftsartikel (refereegranskat)abstract
- Distress, suffering and care-seeking behaviour are characteristics of pain-related disease and illness. Pain that transitions from an acute to a chronic phase carries with it the potential of further effects: these include a worsening of the disease or illness; high-impact chronic pain; and substantial personal, societal and economic burden. The biopsychosocial model directly addresses these multiple processes, yet clinical frameworks supporting this model are not universally implemented. This paper explores barriers to clinical implementation of a full biopsychosocial framework for temporomandibular disorders (TMD) and other oro-facial pain (OFP) conditions. In June 2016, INfORM invited OFP researchers to a workshop designed to optimise the DC/TMD Axis-II. Workshop groups identified five sources of implementation barriers: (1) cultures and societies, (2) levels-of-care settings, (3) health services, (4) cross-cultural validity of self-report instruments and (5) provider and patient health literacy. Three core problems emerged: (A) mental health aspects are seldom fully considered, thus impairing the recognition of illness, (B) training in use of validated multi-axial assessment protocols is under-rated and insufficiently used, and (C) clinical assessment often fails to recognise that sensory and emotional dimensions are fundamental aspects of pain. To improve patient care, these barriers and problems require action. Most importantly, TMD/OFP educators and researchers need to coordinate globally and (i) be educated in the biopsychosocial model, (ii) implement evidence-based biopsychosocial guidelines for assessment and management of OFP conditions at their institutions, (iii) incorporate this model in undergraduate and postgraduate dental curricula and (iv) be responsive to stakeholders, including regulatory authorities and practitioners.
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