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Article ; Online: A Controlled Study of Biopsychosocial Differences Observed in Masticatory Myalgia With and Without Pain Referral.

Varun, Saranya / Anderson, Gary C / Hodges, James S / Zhang, Lei / Schiffman, Eric L

Journal of oral & facial pain and headache

2023 Volume 37, Issue 2, Page(s) 131–138

Abstract: Aims: To assess differences in biopsychosocial factors between participants with masticatory myofascial pain with referral (MFPwR), with myalgia without referral (Mw/oR), and community controls without TMDs.: Methods: Study participants were ... ...

Abstract	Aims: To assess differences in biopsychosocial factors between participants with masticatory myofascial pain with referral (MFPwR), with myalgia without referral (Mw/oR), and community controls without TMDs. Methods: Study participants were diagnosed with MFPwR (n = 196), Mw/oR (n = 299), or as a non-TMD community control (n = 87) by two calibrated examiners at each of three study sites. Pain chronicity, pain on palpation of masticatory muscle sites, and pressure pain thresholds (PPT) at 12 masticatory muscle, 2 trigeminal, and 2 nontrigeminal control sites were recorded. Psychosocial factors assessed included anxiety, depression, and nonspecific physical symptoms (Symptom Checklist-90 Revised); stress (Perceived Stress Scale); and health-related quality of life (Short Form Health Survey). Comparisons among the three groups were adjusted for age, sex, race, education, and income using multivariable linear regression. The significance threshold was set at P = .017 (.05 / 3) for subsequent pairwise comparisons. Results: Compared to the Mw/oR group, the MFPwR group had significantly greater pain chronicity, number of painful muscle sites, anxiety, depression, nonspecific physical symptoms, and impaired physical health (P < .017). The MFPwR group also had significantly lower PPTs for masticatory sites (P < .017). Both muscle pain groups differed significantly from the non-TMD community control group for all outcome measures (P < .017). Conclusion: These findings support the clinical utility of separating MFPwR from Mw/oR. Patients with MFPwR are more complex from a biopsychosocial perspective than Mw/oR patients, which likely affects prognosis and supports consideration of these factors in case management.
MeSH term(s)	Humans ; Myalgia ; Quality of Life ; Research Design ; Pain Threshold ; Control Groups ; Myofascial Pain Syndromes
Language	English
Publishing date	2023-06-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2762048-7
ISSN	2333-0376 ; 2333-0384
ISSN (online)	2333-0376
ISSN	2333-0384
DOI	10.11607/ofph.3317
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Article ; Online: Practitioner/Practice- and Patient-Based Factors Contributing to Dental Practitioner Treatment Recommendations for Patients with Pain-Related TMDs: Findings from the National Dental PBRN.

Riley, Joseph L Iii / Rindal, D Brad / Velly, Ana Miriam / Anderson, Gary C / Johnson, Kimberly S / Gilbert, Gregg H / Schiffman, Eric L

Journal of oral & facial pain and headache

2023 Volume 37, Issue 3, Page(s) 195–206

Abstract: Aims: To document National Dental Practice-Based Research Network (PBRN) practitioner treatment recommendations for patients with painful temporomandibular disorders (TMDs) and to identify practitioner/practice- and patient-related factors contributing ... ...

Abstract	Aims: To document National Dental Practice-Based Research Network (PBRN) practitioner treatment recommendations for patients with painful temporomandibular disorders (TMDs) and to identify practitioner/practice- and patient-related factors contributing to treatment recommendations made at the initial clinical visit. Methods: This prospective single-sample cohort study formed groups based on treatment recommendations made by 185 dental practitioners who treated 1,901 patients with painful TMDs. At the baseline visit, which this article describes, practitioners provided patients with their diagnoses and a treatment plan and then completed a comprehensive questionnaire. Results: Self-care, an intraoral appliance, medication, and practitioner-recommended jaw exercises were the most frequently recommended treatments. Practitioners recommended multiple treatments to most patients. TMD signs, symptoms, and diagnoses were primary considerations in treatment planning, but the practitioner's expectations for improvement were only significant for intraoral appliances and self-care. Female practitioners and those with expertise in TMDs more frequently recommended patient-directed and multidisciplinary treatments compared to their counterparts. Conclusions: Practitioners used a wide range of treatments for patients with few consistent patterns. The propensity to use TMD signs, symptoms, and diagnoses when making treatment recommendations suggests a tendency to conceptualize patients using the biomedical model. Infrequent referral to nondental providers suggests a lack of availability of these providers, a misunderstanding of the complexity of TMDs, and/or discomfort with assessment of psychosocial factors. Implications include the need for comprehensive training in the assessment and management of TMD patients during dental school and participation in TMD continuing education courses following evidence-based guidelines.
MeSH term(s)	Humans ; Female ; Dentists ; Prospective Studies ; Cohort Studies ; Professional Role ; Temporomandibular Joint Disorders/diagnosis ; Pain
Language	English
Publishing date	2023-11-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	2762048-7
ISSN	2333-0376 ; 2333-0384
ISSN (online)	2333-0376
ISSN	2333-0384
DOI	10.11607/ofph.3263
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Article ; Online: Occurrence and Predictors of Postoperative Preauricular and Masticatory Muscle Pain Symptoms After Surgical Removal of Third Molars: A Single-Blind Randomized Controlled Trial Comparing Dental Assistants Supporting the Mandible and the Restful Jaw Device.

Uppgaard, Rachel / Nadeau, Robert / Schiffman, Eric L / Stiharu, Tudor / Johnson, Kimberly S / Hodges, James S / Velly, Ana Miriam

Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons

2023 Volume 82, Issue 1, Page(s) 6–18

Abstract: Background: During third molar removal, the mandible is supported by a dental assistant (DA) to counter downward forces during surgery, and with sedation, to maintain airway patency. The Restful Jaw device (PEP Design; Saint Paul) provides this support ... ...

Abstract	Background: During third molar removal, the mandible is supported by a dental assistant (DA) to counter downward forces during surgery, and with sedation, to maintain airway patency. The Restful Jaw device (PEP Design; Saint Paul) provides this support instead of the DA. Purpose: This study compared the occurrence of postoperative preauricular and masticatory muscle pain symptoms (PMMPS) between the device and DAs providing mandibular support, using two outcome measures. Secondary aims identify predictors of outcome and providers' opinions of the device. Study design, setting, sample: In this multisite, single-blind, two-arm parallel randomized trial, participants without preoperative PMMPS had surgical removal of third molars, with sedation and bite blocks were randomly assigned to manual support or the device. Exposure variable: The exposed group was randomly assigned to the device and the nonexposed group to manual support. Main outcome variable(s): The primary outcome was patient-reported PMMPS. Two secondary outcomes were pain assessed with the temporomandibular disorder Pain Screener and providers' views on the device. Outcomes were assessed at 1-, 3-, and 6-month postsurgery. Covariates: The covariates are baseline demographics (eg, sex), clinical characteristics (eg, eruption status), and third molar surgeries. Analyses: For occurrence of pain, generalized estimating equations assessed differences between groups. Logistic regression analysis assessed predictors of pain at 1 month, per the Screener. The level for statistical significance was 5%. Results: Enrollment was 86 and 83 participants in the device and DA groups, respectively. The average age was 20.8 years; the majority were female (65%) and Caucasian (66%). The retention rate was ≥95.9%. The groups did not differ significantly for occurrence of pain using the primary and secondary outcome measures at any follow-up (P ≥ .46). Fully impacted molars were associated with occurrence of pain (odds ratio = 3.44; 95% confidence interval 1.49-7.92; P = .004). Conclusion and relevance: Occurrence of pain using the primary and secondary outcome measures did not differ significantly between groups at any follow-up and was associated with removal of fully impacted third molars. Four out of five surgeons reported wanting to use the device on a regular basis when performing this procedure in sedated patients.
MeSH term(s)	Female ; Humans ; Male ; Young Adult ; Dental Assistants ; Mandible/surgery ; Masticatory Muscles ; Molar, Third/surgery ; Pain, Postoperative/etiology ; Single-Blind Method ; Tooth Extraction/methods ; Tooth, Impacted/surgery
Language	English
Publishing date	2023-10-05
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	392404-x
ISSN	1531-5053 ; 0278-2391
ISSN (online)	1531-5053
ISSN	0278-2391
DOI	10.1016/j.joms.2023.09.021
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Article ; Online: Temporomandibular Joint Disorders and Orofacial Pain.

Ahmad, Mansur / Schiffman, Eric L

Dental clinics of North America

2015 Volume 60, Issue 1, Page(s) 105–124

Abstract: Temporomandibular disorders (TMD) affect 5% to 12% of the United States population. This article discusses common conditions related to temporomandibular joints, including disc displacements, inflammatory disturbances, loose joint bodies, traumatic ... ...

Abstract	Temporomandibular disorders (TMD) affect 5% to 12% of the United States population. This article discusses common conditions related to temporomandibular joints, including disc displacements, inflammatory disturbances, loose joint bodies, traumatic disturbances, and developmental conditions. Also addressed are the appropriate imaging modalities and diagnostic criteria for TMD.
MeSH term(s)	Facial Pain ; Humans ; Joint Loose Bodies ; Temporomandibular Joint/pathology ; Temporomandibular Joint Disorders/diagnosis
Language	English
Publishing date	2015-10-21
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	392075-6
ISSN	1558-0512 ; 0011-8532
ISSN (online)	1558-0512
ISSN	0011-8532
DOI	10.1016/j.cden.2015.08.004
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Article: Effect of Shortened Dental Arch on Temporomandibular Joint Intra-articular Disorders.

Reissmann, Daniel R / Anderson, Gary C / Heydecke, Guido / Schiffman, Eric L

Journal of oral & facial pain and headache

2018 Volume 32, Issue 3, Page(s) 329–337

Abstract: Aims: To investigate whether a shortened dental arch (SDA), as identified by reduced posterior occlusal contacts, is a risk factor for the progression of temporomandibular joint (TMJ) intra-articular disorders (ID), as identified using imaging ... ...

Abstract	Aims: To investigate whether a shortened dental arch (SDA), as identified by reduced posterior occlusal contacts, is a risk factor for the progression of temporomandibular joint (TMJ) intra-articular disorders (ID), as identified using imaging techniques. Methods: This multisite, prospective observational study with a mean follow-up period of 7.9 years had a sample of 345 participants with at least 1 temporomandibular disorder (TMD) diagnosis at baseline. SDA was defined as reduced occlusal posterior support due to lack of occlusal intercuspal contacts in the molar region on the left and/or right side. SDA was assessed at baseline and at follow-up with metalized Mylar Tape. The presence or absence of a TMJ ID and the specific TMJ ID diagnoses for baseline and follow-up images were established by a calibrated, blinded radiologist at each of three sites by using bilateral magnetic resonance imaging for soft tissue imaging for disc displacement and by bilateral multidetector computed tomography or cone beam computed tomography for hard tissue imaging for degenerative joint diseases. Wilcoxon rank sum test and linear regression analyses were used to test for an impact of SDA on TMJ ID status. Results: At baseline, TMJ ID status of either side was not significantly affected by the presence of SDA on the ipsilateral or contralateral side of the jaw (all P > .05). Furthermore, the presence or absence of SDA at baseline was also not a significant predictor for progression of the TMJ ID status between baseline and follow-up (all P > .05). Conclusion: The findings of this study suggest that there is no significant effect of SDA on progression of TMJ ID.
MeSH term(s)	Adult ; Dental Arch/abnormalities ; Disease Progression ; Female ; Humans ; Male ; Prospective Studies ; Risk Factors ; Temporomandibular Joint Disorders/epidemiology ; Temporomandibular Joint Disorders/etiology
Language	English
Publishing date	2018-07-20
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Observational Study
ZDB-ID	2762048-7
ISSN	2333-0376 ; 2333-0384
ISSN (online)	2333-0376
ISSN	2333-0384
DOI	10.11607/ofph.1910
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Article ; Online: Acute and Chronic Temporomandibular Disorder Pain: A critical review of differentiating factors and predictors of acute to chronic pain transition.

Sabsoob, Omar / Elsaraj, Sherif M / Gornitsky, Mervyn / Laszlo, Elise / Fricton, James R / Schiffman, Eric L / Velly, Ana M

Journal of oral rehabilitation

2021 Volume 49, Issue 3, Page(s) 362–372

Abstract: Aims: The aims of this critical review were to: (i) assess the factors that differentiate acute from chronic temporomandibular disorders (TMD) pain; (ii) assess the risk factors associated with the transition from acute to chronic TMD pain; and (iii) ... ...

Abstract	Aims: The aims of this critical review were to: (i) assess the factors that differentiate acute from chronic temporomandibular disorders (TMD) pain; (ii) assess the risk factors associated with the transition from acute to chronic TMD pain; and (iii) summarize and appraise the studies. Method: The databases used were MEDLINE, Embase, and Cochrane Database of Systematic Reviews. Eligible studies included articles comparing acute to chronic TMD pain, and cohort studies assessing the risk factors implicated in the transition from acute to chronic TMD pain. Results: Seven articles were selected: one case-control study, three cross-sectional studies, and three cohort studies. These studies found that psychological factors were more common in chronic than acute TMD pain patients; however, these factors did not increase the transition risk in the multivariable model. Myofascial and baseline pain intensity were associated with the transition from acute to chronic TMD pain at a 6-month follow-up. Due to methodological weaknesses in the available literature, more research is required to establish the risk factors implicated in the transition from acute to chronic TMD pain. Conclusion: This review found some evidence that myofascial pain is associated with the transition risk from acute to chronic TMD pain at a 6-month follow-up and that pain intensity at baseline is associated with more intense TMD pain 6 months later. There is insufficient evidence to draw conclusions about the role of demographics and psychological disorders as independent risk factors.
MeSH term(s)	Case-Control Studies ; Chronic Pain/etiology ; Cross-Sectional Studies ; Facial Pain/etiology ; Humans ; Systematic Reviews as Topic ; Temporomandibular Joint Disorders/complications ; Temporomandibular Joint Disorders/epidemiology
Language	English
Publishing date	2021-12-02
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	187079-8
ISSN	1365-2842 ; 0305-182X
ISSN (online)	1365-2842
ISSN	0305-182X
DOI	10.1111/joor.13283
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Article: Diagnostic accuracy of panoramic radiography and MRI for detecting signs of TMJ degenerative joint disease.

Kaimal, Shanti / Ahmad, Mansur / Kang, Wenjun / Nixdorf, Donald / Schiffman, Eric L

General dentistry

2018 Volume 66, Issue 4, Page(s) 34–40

Abstract: The objective of this study was to determine the diagnostic accuracy of panoramic radiography and magnetic resonance imaging (MRI) for detection of signs of temporomandibular joint (TMJ) degenerative joint disease (DJD). Panoramic radiography and ... ...

Abstract	The objective of this study was to determine the diagnostic accuracy of panoramic radiography and magnetic resonance imaging (MRI) for detection of signs of temporomandibular joint (TMJ) degenerative joint disease (DJD). Panoramic radiography and bilateral MRI and computed tomography (CT) of the TMJs were performed for 705 subjects. Three calibrated board-certified radiologists who were blinded to the clinical findings interpreted all images. The diagnoses of DJD established using the panoramic radiographs and MRIs were compared to the reference standard diagnoses derived from the CTs. DJD was defined as the presence of at least 1 of the following 4 signs: a subcortical cyst, surface erosion, osteophyte formation, or generalized sclerosis. The target values for sensitivity and specificity were 70% or greater and 95% or greater, respectively. Compared to the reference standard CTs, the panoramic radiographs had the following sensitivity and specificity values: subcortical cysts, 14% and 100%, respectively; erosion, 20% and 100%, respectively; osteophytes, 12% and 100%, respectively; and sclerosis, 33% and 100%, respectively. The MRIs achieved the following sensitivity and specificity values: subcortical cysts, 32% and 100% respectively; erosion, 35% and 99% respectively; osteophytes, 71% and 98%, respectively; and sclerosis, 50% and 100%, respectively. The radiologists' interexaminer reliability was slight (κ = 0.16) when using panoramic radiographs, moderate (κ = 0.47) when using MRIs, and substantial when using CTs (κ = 0.71) for diagnosis of signs of DJD. Panoramic radiographs and MRIs had below-target sensitivity but above-target specificity in detecting all CT-depicted signs of DJD with the exception of osteophytes, for which MRIs demonstrated adequate diagnostic accuracy. Use of CT for diagnosis of TMJ DJD is recommended to avoid the false-negative findings that can occur if panoramic radiographs and MRIs are used.
MeSH term(s)	Cross-Sectional Studies ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Radiography, Panoramic ; Reproducibility of Results ; Sensitivity and Specificity ; Temporomandibular Joint/diagnostic imaging ; Temporomandibular Joint Disorders/diagnosis ; Temporomandibular Joint Disorders/diagnostic imaging
Language	English
Publishing date	2018-07-25
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	603650-8
ISSN	0363-6771
ISSN	0363-6771
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Article: Predictors of Long-Term Temporomandibular Disorder Pain Intensity: An 8-Year Cohort Study.

Kapos, Flavia P / Look, John O / Zhang, Lei / Hodges, James S / Schiffman, Eric L

Journal of oral & facial pain and headache

2018 Volume 32, Issue 2, Page(s) 113–122

Abstract: Aims: To investigate, in individuals with pain-related temporomandibular disorder (TMD), the association of long-term pain intensity with baseline health-related quality of life (HRQoL) and jaw functional limitation.: Methods: Of 513 cases with ... ...

Abstract	Aims: To investigate, in individuals with pain-related temporomandibular disorder (TMD), the association of long-term pain intensity with baseline health-related quality of life (HRQoL) and jaw functional limitation. Methods: Of 513 cases with baseline pain-related TMD (masticatory muscle and/or temporomandibular joint [TMJ] pain), 273 were reevaluated after 8 years, and 258 of them had complete baseline data for Jaw Functional Limitation Scale (JFLS) scores and HRQoL measured by the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the 12-item Short Form Health Survey and follow-up data for Characteristic Pain Intensity (CPI) from the Graded Chronic Pain Scale. Secondary analyses of existing data quantified the effects of primary (PCS, MCS) and secondary (JFLS) predictors on follow-up CPI by using multivariable linear regression. Sensitivity analyses considered differences between the included participants (n = 258) and those who were not included (n = 255) by using inverse probability weighting. Interactions of baseline predictors with age, sex, and baseline CPI were evaluated using multivariable linear regression. Results: The score for baseline PCS, but not MCS or JFLS, was associated with follow-up CPI (P = .012). One standard deviation (SD = 9.0)-higher baseline PCS score predicted an overall 3.2-point-lower follow-up CPI (95% confidence interval -5.8 to -0.7) after adjusting for age, sex, MCS, JFLS, and baseline CPI scores. However, the effect of PCS score was not uniform: the association between PCS and follow-up CPI scores was statistically significant for participants with baseline CPI ≥ 51.3/100 and clinically significant for participants with baseline CPI ≥ 68.7/100. Adjustment for TMD treatments and sensitivity analyses had negligible effect. Conclusion: In participants with moderate to severe baseline TMD pain intensity, higher baseline physical HRQoL predicted lower TMD pain intensity at 8 years follow-up. PCS score could contribute to a multifactorial long-term TMD pain prediction model.
MeSH term(s)	Adolescent ; Adult ; Aged ; Facial Pain/diagnosis ; Facial Pain/psychology ; Facial Pain/therapy ; Female ; Humans ; Male ; Middle Aged ; Outcome Assessment (Health Care)/statistics & numerical data ; Pain Measurement/statistics & numerical data ; Psychometrics/statistics & numerical data ; Temporomandibular Joint Dysfunction Syndrome/diagnosis ; Temporomandibular Joint Dysfunction Syndrome/psychology ; Temporomandibular Joint Dysfunction Syndrome/therapy ; Young Adult
Language	English
Publishing date	2018-04-25
Publishing country	United States
Document type	Journal Article ; Validation Studies
ZDB-ID	2762048-7
ISSN	2333-0376 ; 2333-0384
ISSN (online)	2333-0376
ISSN	2333-0384
DOI	10.11607/ofph.1819
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Article ; Online: Authors' response.

Leon-Salazar, Vladimir / Morrow, Leesa / Schiffman, Eric L

Journal of the American Dental Association (1939)

2013 Volume 144, Issue 2, Page(s) 133–136

MeSH term(s)	Arthralgia/etiology ; Bruxism/complications ; Humans ; Male ; Somatosensory Disorders/complications ; Temporomandibular Joint Disorders/etiology ; Temporomandibular Joint Dysfunction Syndrome/etiology ; Tooth Abrasion/complications ; Toothache/complications
Language	English
Publishing date	2013-01-30
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	220622-5
ISSN	1943-4723 ; 0002-8177 ; 1048-6364
ISSN (online)	1943-4723
ISSN	0002-8177 ; 1048-6364
DOI	10.14219/jada.archive.2013.0090
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Article: Interaction Between Awake and Sleep Bruxism Is Associated with Increased Presence of Painful Temporomandibular Disorder.

Reissmann, Daniel R / John, Mike T / Aigner, Annette / Schön, Gerhard / Sierwald, Ira / Schiffman, Eric L

Journal of oral & facial pain and headache

2017 Volume 31, Issue 4, Page(s) 299–305

Abstract: Aims: To explore whether awake and sleep bruxism interact in their associations with painful temporomandibular disorders (TMD) and whether the interaction is multiplicative or additive.: Methods: In this case-control study, all participants (n = 705) ...

Abstract	Aims: To explore whether awake and sleep bruxism interact in their associations with painful temporomandibular disorders (TMD) and whether the interaction is multiplicative or additive. Methods: In this case-control study, all participants (n = 705) were part of the multicenter Validation Project and were recruited as a convenience sample of community cases and controls and clinic cases. Logistic regression analyses were applied to test for the association between self-reported bruxism (sleep and/or awake) and the presence of painful TMD, and odds ratios (ORs) with 95% confidence intervals (95% CIs) were computed. Regression models included an interaction term to test for multiplicative interaction, and additive interaction was calculated as the relative excess risk due to interaction (RERI). Results: Based on logistic regression analyses adjusted for age and gender, the main effects for both awake (OR = 6.7; 95% CI: 3.4 to 12.9) and sleep (OR = 5.1; 95% CI: 3.1 to 8.3) bruxism were significant. While the multiplicative interaction (OR = 0.57; 95% CI: 0.24 to 1.4) was not significant, the results indicated a significant positive additive interaction (RERI = 8.6; 95% CI: 1.0 to 19.7) on the OR scale. Conclusion: This study has demonstrated that awake and sleep bruxism are associated with an increased presence of painful TMD, and that both types of bruxism are not independently associated, but interact additively. As such, the presence of each factor amplifies the effect of the other.
Language	English
Publishing date	2017-10-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2762048-7
ISSN	2333-0376 ; 2333-0384
ISSN (online)	2333-0376
ISSN	2333-0384
DOI	10.11607/ofph.1885
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