Diagnosing & Managing Temporomandibular Joint Pain

Photo Credit: Alex Aviles

The TMD Pain Screener was useful for ruling out whether tooth pain presenting in patients to endodontists had temporomandibular joint disorders.

In a presentation at the 106th AAOMS Annual Meeting, Gregory M. Ness, DDS, FACS, reviewed the contemporary management of intra-articular temporomandibular joint disorders (TMDs) with a focus on trauma.

The session covered surgical management of condyle and head fractures, post-traumatic temporomandibular joint arthritis, and the relationship between facial trauma and psychiatric conditions.

Identifying Patients With TMDs

A related study not affiliated with the meeting emphasized the importance of identifying TMDs when tooth pain presents in patients.

“Dentists are skilled at identifying and treating odontogenic pain due to its prevalence. Dentists must consider non-odontogenic causes of pain when testing for dental pathology comes back negative for an odontogenic report,” wrote Nishath Sayed Abdul in Bioinformation. “There are some tools like TMD Pain Screener questionnaire and Dental Pain Questionnaire for identifying TMDs, but very few studies have been conducted to use these tools for identifying TMDs in patients seeking endodontic therapy.”

The study included 200 patients seeking dental care for tooth pain. The participants filled out the TMD Pain Screener, and clinicians used the responses to evaluate TMD pain not referred to teeth only, TMD pain referred to teeth only, and all types of TMDs.

Several factors precluded some patients from participating in the study, such as having a second diagnosis of orofacial pain or systemic diseases, like fibromyalgia or rheumatoid arthritis, which impact pain sensitivity.

Using the TMD Pain Screener Questionnaire

The TMD Pain Screener showed a high sensitivity for identifying all types of TMDs (0.94 (0.80-0.97)), teeth pain only (0.94 (0.64-1.00)), and not teeth pain only (0.94 (0.76-0.98)). The findings indicated that the screener’s specificity was slightly lower, at 0.61 (0.42-0.78) for all TMDs, 0.61 (0.42-0.76) for pain not related to teeth only, and 0.72 (0.58-0.86) for teeth pain only.

The screener demonstrated a positive predictive value of 0.72 (0.58-0.86) for all TMDs. This value was lower for pain not related only to the teeth (0.64 (0.46-0.79)), and lower still for pain related to teeth (0.46 (0.26-0.67)).

The questionnaire was more reliable at ruling out TMDs, with negative predictive values of 0.89 (0.68-0.96) for all TMD pain, 0.92 (0.72-0.98) for TMD pain not related to teeth, and 0.96 (0.78-1.00) for teeth pain.

“The best option for separating patients with odontogenic pain from those with TMD pain in clinical environments where TMD prevalence is not particularly low…is the 6-item TMD screener, which has a modest specificity and great sensitivity,” Abdul concluded.