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Interexaminer reliability for tomographic findings in temporomandibular joint degenerative disease and its agreement with clinical diagnosis: a blinded controlled cross sectional study
Abstract
Objectives
The aim of this study was to evaluate the interexaminer reliability for tomographic findings in degenerative temporomandibular joint disease and its agreement with clinical diagnosis.Methods
Women aged 18 and 60 years were invited to participate in this research. All participants were evaluated by a single experienced examiner according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Group 1 was comprised of TMJs with Degenerative Joint Disease (DJD). Group 2 was comprised of healthy TMJs, without any signs and/or symptoms of TMD. All CBCT images were evaluated by 2 calibrated examiners for the image evaluation criteria but blinded for the clinical diagnosis.ResultsFrom the 194 women evaluated, 41 were included, with a mean age of 35.23 (± 14.06) years. Group 1 was comprised of 26 TMJs with DJD and group 2 of 36 asymptomatic TMJs. The interexaminer reliability was κ = 0.706 (p < 0.000), while agreement between clinical and tomographic findings were κ = 0.301 (p = 0.01) and κ = 0.273 (p = 0.02) for each examiner. The use of CBCT as a diagnostic test had shown sensitivity and specificity values of 61.5% and 75%, respectively.Conclusions
The interexaminer reliability for tomographic findings was strong. However, the agreement between clinical and tomographic findings was reasonable, for both examiners.
... (Wiese et al., 2008, Palconet et al., 2012, Al-Ekrish et al., 2015, Hilgenberg-Sydney et al., 2018, Bianchi et al., 2021 The present findings do not suggest any morphologic change as a risk factor for painful DJD. Also, Hilgenberg-Sydney et al. (Hilgenberg-Sydney et al., 2022) found that abnormal tomographic findings had no significant difference in the diagnosis of TMJ osteoarthritis. Their study showed 'fair' sensitivity and specificity values of 61.5 % and 75 % respectively, for the use of CBCT as a diagnostic exam for TMJ DJD. ...
... The interexaminer reliability for tomographic findings was strong, however, the agreement between clinical and tomographic findings was reasonable. (Hilgenberg-Sydney et al., 2022) The present results have also shown that even clinically healthy patients may present some degenerative bone changes, such as condylar erosion, which is certainly not expected for asymptomatic individuals. (Schiffman et al., 2014, Hilgenberg-Sydney et al., 2018 The use of CBCT images of DJD patients, with and without TMJ pain, as a diagnostic tool should be used with additional precaution, as already suggested by previous studies. ...
temporomandibular joint (TMJ) morphology among patients with degenerative joint disease (DJD) with or
without arthralgia, as well as a control group. Methods: Thirty-one patients and their respective CBCT TMJ
exams were assessed. These individuals were selected from an Orofacial Pain Service and classified into three
groups based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD): group 1 (10 patients with
TMJ DJD and arthralgia), group 2 (11 patients with TMJ DJD without pain), and group 3 (the control group,
consisting of 10 healthy individuals without any signs or symptoms of TMD). A second examiner, who was
calibrated and blinded for the patient’s diagnosis, evaluated the CBCT images. Results: Group 1 showed a statistically
significant association with the variables of erosion (p = 0.003) and osteophyte (p = 0.04) on the
condyle surface, as well as concentric condyle position with reduced joint space (p = 0.01). The Kappa
concordance index between the clinical diagnosis of DC/TMD and CBCT images was k = 0.134 (p ≤ 0.001).
Conclusion: The presence of erosion, osteophyte, and concentric condyle position with reduced joint space was
statistically associated with DJD and ongoing TMJ joint pain.
... Correspondingly, the kappa values for inter-reader agreement were high for the distinction normal or abnormal joint. Other studies describe inter-reader agreement for bony lesions of the TMJ as fair to moderate for PAN [34] and good for CBCT [35]. ...
Aims:
To evaluate the association between clinical signs/symptoms and bone changes on CBCT images in patients with degenerative joint disease (DJD) of the temporomandibular joint (TMJ).
Methods:
An electronic literature search of the MEDLINE, PubMed, EMBASE, Scopus, and Web of Science databases, as well as Google Scholar for gray literature, was conducted to identify relevant articles on February 26, 2021. Risk of bias was evaluated using the Joanna Briggs Institute critical appraisal tools. The GRADEpro (Recommendation, Assessment, Development, and Evaluation) system instrument was applied to assess the level of evidence across studies.
Results:
Nine papers assessing clinical signs/symptoms and CBCT findings were included. TMJ pain (arthralgia) and TMJ noises carried the strongest associations with various CBCT findings, each of which were supported by four studies with significant associations. Only one study found significant associations between masticatory myalgia (muscle pain) and CBCT findings. Range of motion carried no significant associations with CBCT findings in the included studies. Based on the GRADEpro system, the certainty of evidence is low for said associations.
Conclusion:
The results suggest that TMD patients with TMJ arthralgia and joint noises may benefit from CBCT imaging. There would be less benefit in TMD patients exhibiting primarily myalgia or limited range of motion, and therefore these patients should not be prescribed routine CBCT radiographs unless indicated by other clinical findings. The heterogeneity of reporting in the included studies suggests that embracing universal clinical (DC/TMD) and radiographic diagnostic criteria for TMJ-DJD would benefit both research and clinical outcomes.
Objectives
To develop and evaluate an educational web‐based program for temporomandibular joint (TMJ) assessment using cone‐beam computed tomography (CBCT).
Methods
A web‐based educational program was designed for TMJ assessment using CBCT images. Fifteen CBCT cases of the TMJ (three‐dimensional reconstructed volumes) and an assessment module based on image analysis criteria in the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) were added to the program. Thirty‐six undergraduate dental students were invited to test the program by assessing all cases twice: before and after 2 months of training. Participants submitted written subjective evaluations of the program.
Results
The web‐based program can be accessed on Malmö University webpage (www.cbct-tmj.mau.se). Despite limited CBCT learning in their undergraduate training and not using the program in the 2‐month interval, the students were able to correctly diagnose 80% of the cases at the second assessment. Their diagnoses, however, did not differ significantly from the first assessment. Overall, the students were satisfied with the program and considered it user friendly.
Conclusion
The web‐based educational program that was developed in the present study and tested by dental students could be a useful educational tool for TMJ assessment using CBCT.
Objectives: To compare the volume and voxel intensity of articular disc and lateral pterygoid muscle (LPM) between a group of migraine patients and a control group (those without history of headache) by using magnetic resonance imaging (MRI).
Patients and methods: MRI scans of 17 migraine patients and 15 healthy controls subjects were ana- lysed and processed, using ITK-SNAP software, by a single investigator, for calculation of volumes and voxel intensity of articular disc and superior and inferior head of LPM.
Results: There were statistically significant differences between migraine patients and controls regard- ing the volume and voxel intensity of articular disc and inferior head of LPM, increasing in migraine patients. Intra-rater was highly consistent and reproducible (intra-class correlation coefficient [ICC] 1⁄4 1).
Conclusions: Higher voxel intensity in disc and inferior head of LPM of MRI scans was linked to the increased volume of articular disc, inferior head of LPM and migraine.
Objectives
The purpose of this systematic review was to evaluate evidence about the prevalence of degenerative joint disease (DJD) of the temporomandibular joints (TMJ).
Materials and methods
We performed search on electronic databases and gray literature from their inception to January 2018. Studies reporting prevalence data of DJD on TMJ were included. DJD was assessed through clinical and imaging diagnosis. Studies risk of bias was evaluated using the Critical Appraisal Checklist for Studies Reporting Prevalence Data.
Results
From 1082 studies, 32 were identified, and the sample size included 3435 subjects. They were clustered into two groups: the first comprised studies that reported prevalence of DJD in TMJ secondary to rheumatic systemic diseases like juvenile idiopathic arthritis (JIA) and rheumatoid arthritis (RA) and the second group comprised studies that reported prevalence of DJD on temporomandibular disorder patients. The prevalence of DJD on JIA patients ranged from 40.42% (n = 47) to 93.33% (n = 15) and on RA patients from 45.00% (n = 20) to 92.85% (n = 56). Among TMD patients, the prevalence of DJD reported according to patients ranged from 18.01% (n = 1038) to 84.74% (n = 118) and reported according to joints ranged from 17.97% (n = 178) to 77.23% (n = 224).
Conclusion
This review attempts to high prevalence of DJD in patients with systemic rheumatic disease and a less prevalent, but still high, occurrence in patients with TMD without systemic involvement.
Clinical relevance
Specialist doctors and dentists should be alert to not underestimate and to correctly diagnose DJD of the TMJ early in patients with rheumatic disease and TMD.
Objectives:
The aim of this systematic review was to answer the focus question: "In subjects with Degenerative Joint Disease (DJD) of the Temporomandibular Joint (TMJ), what is the diagnostic validity of Computed Tomography (CT) or Cone-Beam Computed Tomography (CBCT) compared with clinical protocols"?
Methods:
DJD should be assessed through clinical diagnosis according to RDC/TMD or DC/TMD. Search strategies were specifically developed to the following electronic databases: Cochrane, Latin American And Caribbean Health Sciences (LILACS), PubMed (including Medline), Scopus and Web of Science. Furthermore, partial grey literature search through Google Scholar, OpenGrey and ProQuest was performed. The risk of bias was evaluated using the second version of Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2).
Results:
The databases search revealed 454 records. After applying the eligibility criteria, four studies were included in this review. All studies were methodologically acceptable, although none of the them fulfilled all criteria of risk of bias according to QUADAS-2. Despite there were some high values for sensitivity and specificity, they were not homogeneous between studies. Regarding specificity outcomes, there were three studies with poor values and only one considered as excellent.
Conclusions:
CBCT could be a good image to evaluate DJD progression over time, but should not be used as a screening tool in healthy individuals.
Aims
Temporomandibular disorder (TMD) is believed to be co-morbid with rheumatologic conditions such as Osteoarthritis (OA). We determine 30-day prevalence and cumulative incidence, and risk factors for facial pain in a cohort of subjects who either had or were at risk of developing symptomatic radiographic knee osteoarthritis (SRKOA).
Methods
Poisson regression models examined whether age, sex, race, Center for Epidemiologic Studies-Depression Scale (CES-D) score, number of painful joints, and presence of SRKOA were risk factors for facial pain in 4,423 subjects at baseline and in 3,472 subjects at 24 and/or 48 months follow-up.
Results
At baseline, 30-day period prevalence of facial pain was 9.25%; and 30-day cumulative incidence at 24-months and at 48-months was 5.9% and 4.9%, respectively. Factors associated with prevalence and incidence of facial pain were: younger age, female sex, (CES-D) score, and a larger number of painful joints. For each increase in age of one year, the incidence of facial pain decreased by 1%. Women had a 96% higher incidence than men, and each unit increase of (CES-D) score was associated with a 2% increase in the incidence of facial pain. For every additional painful joint, there was a 21% increase in the incidence of facial pain. Subjects with SRKOA had a 33% increase in the incidence of facial pain compared to those with risk factors for SRKOA.
Conclusion
OA and TMD share several risk factors. The risk factors identified in cross-sectional analysis of prevalence are similar to those identified in longitudinal analysis on incidence.
Objectives:
The aim of the present study was to compare cone-beam computerized tomography (CBCT) findings and joint space measurement in temporomandibular disorder (TMD) and non-TMD joints, and to correlate these findings with the clinical diagnosis.
Methods:
The study was conducted on patients diagnosed with temporomandibular joint (TMJ) osteoarthritis or closed lock according to the Research Diagnostic Criteria for TMDs (Group IIb, IIc, and III). CBCT and clinical records of non-TMD patients who sought treatment for purposes other than TMD were used retrospectively as a control. The following radiographic criteria were assessed: flattening, osteophyte, Ely's cyst, condylar surface irregularities, and joints' space measurements.
Results:
Osteoarthritic joints had significantly more condylar irregularities (P50.0), osteophytes (P50.0), and condylar flattening (P50.003) than non-TMD joints. Osteoarthritic joints had significantlymore superior surface irregularities (P50.0) and osteophytes (P50.006) than closed lock joints.Non-TMDjoints had significantlymore joint space (5.64+1.88) compared with osteoarthritic joints (4.57+1.97), (P50.025). The correlation among TMD, osteophytes, and flattening of the condylar surface was statistically significant (r50.331, Pv0.000).
Discussion:
Cone-beam computerized tomography findings are significantly associated with the clinical diagnosis of TMD. Osteophytes and flattening of the condylar surface are common features of TMD.
Objective:
The purpose of this systematic review is to evaluate the diagnostic value of biological markers (exhaled breath condensate, blood, salivary and urinary) in the diagnosis of OSA in comparison to the gold standard of nocturnal PSG.
Methods:
Studies that differentiated OSA from controls based on PSG results, without age restriction, were eligible for inclusion. The sample of selected studies could include studies in obese patients and with known cardiac disease. A detailed individual search strategy for each of the following bibliographic databases was developed: Cochrane, EMBASE, MEDLINE, PubMed, and LILACS. The references cited in these articles were also crosschecked and a partial grey literature search was undertaken using Google Scholar. The methodology of selected studies was evaluated using the 14-item Quality Assessment Tool for Diagnostic Accuracy Studies.
Results:
After a two-step selection process, nine articles were identified and subjected to qualitative and quantitative analyses. Among them, only one study conducted in children and one in adults found biomarkers that exhibit sufficiently satisfactory diagnostic accuracy that enables application as a diagnostic method for OSA.
Conclusion:
Kallikrein-1, uromodulin, urocotin-3, and orosomucoid-1 when combined have enough accuracy to be an OSA diagnostic test in children. IL-6 and IL-10 plasma levels have potential to be good biomarkers in identifying or excluding the presence of OSA in adults.
Objective:
To assess 3D morphological variations and local and systemic biomarker profiles in subjects with a diagnosis of temporomandibular joint osteoarthritis (TMJ OA).
Design:
Twenty-eight patients with long-term TMJ OA (39.9 ± 16 years), 12 patients at initial diagnosis of OA (47.4 ± 16.1 years), and 12 healthy controls (41.8 ± 12.2 years) were recruited. All patients were female and had cone beam CT scans taken. TMJ arthrocentesis and venipuncture were performed on 12 OA and 12 age-matched healthy controls. Serum and synovial fluid levels of 50 biomarkers of arthritic inflammation were quantified by protein microarrays. Shape Analysis MANCOVA tested statistical correlations between biomarker levels and variations in condylar morphology.
Results:
Compared with healthy controls, the OA average condyle was significantly smaller in all dimensions except its anterior surface, with areas indicative of bone resorption along the articular surface, particularly in the lateral pole. Synovial fluid levels of ANG, GDF15, TIMP-1, CXCL16, MMP-3 and MMP-7 were significantly correlated with bone apposition of the condylar anterior surface. Serum levels of ENA-78, MMP-3, PAI-1, VE-Cadherin, VEGF, GM-CSF, TGFβb1, IFNγg, TNFαa, IL-1αa, and IL-6 were significantly correlated with flattening of the lateral pole. Expression levels of ANG were significantly correlated with the articular morphology in healthy controls.
Conclusions:
Bone resorption at the articular surface, particularly at the lateral pole was statistically significant at initial diagnosis of TMJ OA. Synovial fluid levels of ANG, GDF15, TIMP-1, CXCL16, MMP-3 and MMP-7 were correlated with bone apposition. Serum levels of ENA-78, MMP-3, PAI-1, VE-Cadherin, VEGF, GM-CSF, TGFβ1, IFNγ, TNFα, IL-1α, and IL-6 were correlated with bone resorption.
Imaging of the temporomandibular joint (TMJ) is continuously evolving with advancement of imaging technologies. Many different imaging modalities are currently used to evaluate the TMJ. Magnetic resonance imaging is commonly used for evaluation of the TMJ due to its superior contrast resolution and its ability to acquire dynamic imaging for demonstration of the functionality of the joint. Computed tomography and ultrasound imaging have specific indication in imaging of the TMJ. This article focuses on state of the art imaging of the temporomandibular joint. Relevant normal anatomy and biomechanics of movement of the TMJ are discussed for better understanding of many TMJ pathologies. Imaging of internal derangements is discussed in detail. Different arthropathies and common tumors are also discussed in this article.
AIMS: The original Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms have been demonstrated to be reliable. However, the Validation Project determined that the RDC/TMD Axis I validity was below the target sensitivity of ≥ 0.70 and specificity of ≥ 0.95. Consequently, these empirical results supported the development of revised RDC/TMD Axis I diagnostic algorithms that were subsequently demonstrated to be valid for the most common pain-related TMD and for one temporomandibular joint (TMJ) intra-articular disorder. The original RDC/TMD Axis II instruments were shown to be both reliable and valid. Working from these findings and revisions, two international consensus workshops were convened, from which recommendations were obtained for the finalization of new Axis I diagnostic algorithms and new Axis II instruments.
METHODS: Through a series of workshops and symposia, a panel of clinical and basic science pain experts modified the revised RDC/TMD Axis I algorithms by using comprehensive searches of published TMD diagnostic literature followed by review and consensus via a formal structured process. The panel's recommendations for further revision of the Axis I diagnostic algorithms were assessed for validity by using the Validation Project's data set, and for reliability by using newly collected data from the ongoing TMJ Impact Project-the follow-up study to the Validation Project. New Axis II instruments were identified through a comprehensive search of the literature providing valid instruments that, relative to the RDC/TMD, are shorter in length, are available in the public domain, and currently are being used in medical settings.
RESULTS: The newly recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for detecting any pain-related TMD as well as valid diagnostic criteria for differentiating the most common pain-related TMD (sensitivity ≥ 0.86, specificity ≥ 0.98) and for one intra-articular disorder (sensitivity of 0.80 and specificity of 0.97). Diagnostic criteria for other common intra-articular disorders lack adequate validity for clinical diagnoses but can be used for screening purposes. Inter-examiner reliability for the clinical assessment associated with the validated DC/TMD criteria for pain-related TMD is excellent (kappa ≥ 0.85). Finally, a comprehensive classification system that includes both the common and less common TMD is also presented. The Axis II protocol retains selected original RDC/TMD screening instruments augmented with new instruments to assess jaw function as well as behavioral and additional psychosocial factors. The Axis II protocol is divided into screening and comprehensive self report instrument sets. The screening instruments' 41 questions assess pain intensity, pain-related disability, psychological distress, jaw functional limitations, and parafunctional behaviors, and a pain drawing is used to assess locations of pain. The comprehensive instruments, composed of 81 questions, assess in further detail jaw functional limitations and psychological distress as well as additional constructs of anxiety and presence of comorbid pain conditions.
CONCLUSION: The recommended evidence-based new DC/TMD protocol is appropriate for use in both clinical and research settings. More comprehensive instruments augment short and simple screening instruments for Axis I and Axis II. These validated instruments allow for identification of patients with a range of simple to complex TMD presentations.
The complexity of structure and functions of the Temporomandibular Joint (TMJ) make the diagnosis of its diseases/disorders difficult. Remarkable progress made in the field of imaging of this joint led us to compare four imaging modalities viz. plain radiographs, CT scan, MRI and ultrasound. We found that MRI was most specific and sensitive for interpretation of soft tissue and inflammatory conditions in the joint, whereas CT examination produced excellent image for osseous morphology and pathology. Plain X-rays are useful for destructive bony changes and sonography is a good in aid in diagnosing disc derangement and is very economical.
The aim of this study was to assess bone changes and mobility in temporomandibular joints (TMJs) using cone beam CT (CBCT) in a population sample in Recife, PE, Brazil.
The TMJ images of patients treated by a radiologist at a private dental radiology service over a period of 1 year were retrieved from the computer database and assessed using a computer with a 21-inch monitor and the iCAT Cone Beam 3D Dental Imaging System Workstation program (Imaging Sciences International, Hatfield, PA). The Pearson χ(2) test was used to analyse the differences in percentage of bone changes among the categories of mobility (p ≤ 0.05). The McNemar test was used to compare the presence of bone changes in TMJs on the right and left sides (p ≤ 0.05).
An adjusted logistic regression model was used to assess the effect of age and gender on the occurrence of bone changes (p ≤ 0.05). Bone changes were present in 227 (71%) patients. Age group and gender showed a statistically significant association with presence of bone changes (p ≤ 0.05). There was no significant difference between the right and left sides (p = 0.556) and in condylar mobility (p = 0.925) with regard to the presence of degenerative bone changes.
There is a high prevalence of degenerative bone alteration in TMJs, which is more frequent in women and mostly located in the condyle. The prevalence of degenerative bone changes increases with age. There is no correlation between condylar mobility and the presence of degenerative bony changes in TMJs.
In the current version (I) of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), imaging of the temporomandibular joint (TMJ) is not required for a diagnosis. Research has shown that radiological findings of the TMJ do not always support the clinical findings of the RDC/TMD diagnosis. But imaging should only be performed when it is known that it could contribute to (i) a proper diagnosis and (ii) treatment with a better prognosis. Several techniques are used to image the TMJ: panoramic radiography, plain radiography, conventional and computed tomography (CT), digital volume tomography or cone-beam computed tomography (CBCT), arthrography and magnetic resonance imaging (MRI). Osseous changes are best visualized in tomography, and the newly developed CBCT is a promising method but must be evaluated in a comparative analysis with other tomographic techniques. And although MRI is the method of choice for imaging the disc, a systematic review found the evidence grade for the diagnostic efficacy of MRI to be insufficient. Today, there is no clear evidence for when TMD patients should be examined with imaging methods. Future research designs should be randomized controlled trials where various radiological examination findings are analysed in relation to therapeutic outcome. In future versions of the RDC/TMD diagnostic system, recommended radiographic techniques must be evaluated and defined, diagnostic criteria well defined and observers calibrated.
Radiation doses were determined to balance risks against usefulness of the different modalities available for the imaging of the facial skeleton.
An Alderson Rando Phantom, armed with lithium fluoride thermoluminescent dosemeters (TLDs) was exposed using a set of four conventional radiographs (orbital view, modified Waters view, orthopantomography, skull posterior--anterior 0 degrees ), two different cone beam computed tomography (CBCT) (NewTom 9000 and Siremobil Iso-C3D), and multislice computed tomography (CT) modalities (Somatom VolumeZoom and Somatom Sensation 16). TLDs from 14 well defined anatomical sites lying within the primary beam as well as the TLD corresponding to the thyroid gland were evaluated.
Multislice CT showed the highest exposure values. Exposure levels of the CBCT systems lay between CT and conventional radiography. Dose measurement for the 16-slice CT revealed nearly the same radiation exposure as the 4-slice system when adapted examination protocols were used.
Selection of the most appropriate imaging modality should be performed in view of the delivered doses, required image quality and information and the clinical circumstances.
In this article, we have discussed the basic knowledge to calculate sensitivity, specificity, positive predictive
value and negative predictive value. We have discussed the advantage and limitations of these measures and
have provided how we should use these measures in our day-to-day clinical practice. We also have illustrated
how to calculate sensitivity and specificity while combining two tests and how to use these results for our
patients in day-to-day practice.
Background:
In this executive summary, the authors describe a protocol for assessing patients with temporomandibular disorder (TMD). It is based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for clinical and research applications.
Methods:
The DC/TMD was developed using published Axis I physical diagnoses for the most common TMDs. Axis I diagnostic criteria were derived from pertinent clinical TMD signs and symptoms. Axis II consists of psychosocial and behavioral questionnaires already in the public domain. A panel of experts vetted and modified the Axis I and Axis II diagnostic protocols. Recommended changes were assessed for diagnostic accuracy by using the Validation Project's data set, which formed the basis for the development of the DC/TMD.
Results:
Axis I diagnostic criteria for TMD pain-related disorders have acceptable validity and provide definitive diagnoses for pain involving the temporomandibular joint (TMJ) and masticatory muscles. Axis I diagnostic criteria for the most common TMJ intra-articular disorders are appropriate for screening purposes only. A definitive diagnosis for TMJ intra-articular disorders requires computed tomography or magnetic resonance imaging. Axis II questionnaires provide valid assessment of psychosocial and behavioral factors that can affect management of TMD.
Conclusions:
The DC/TMD provides a questionnaire for the pain history in conjunction with validated clinical examination criteria for diagnosing the most common TMDs. In addition, it provides Axis II questionnaires for assessing psychosocial and behavioral factors that may contribute to the onset and perpetuation of the patient's TMD.
Practical implications:
The DC/TMD is appropriate for use in clinical and research settings to allow for a comprehensive assessment of patients with TMD.
Objective Osteoarthritis (OA) of the temporomandibular joint (TMJ) is generally thought to be an age-related disease like those of other joints. This study aims to investigate the incidence of computed tomographic (CT) OA changes in Korean temporomandibular disorder (TMD) patients diagnosed by the Research Diagnostic Criteria for TMD (RDC/TMD). Materials and methods The clinical records and radiographs of 1038 TMD patients (297 men and 741 women with mean age 31.1 ± 17.4 and 34.0 ± 16.2, respectively) diagnosed based on RDC/TMD Axis I in 2010 were reviewed. Results The incidence rate of OA changes in TMD patients is estimated to 27.3%, and higher in women than in men (15.5% in men and 32.0% in women) by 2.3 odds (p < 0.001). It has no correlation with age, showing an almost flat incidence rate throughout the age from the 2nd decade and has no correlation as well with pain or disc displacement diagnosed according to RDC/TMD, while arthrosis/arthritis diagnosis based on RDC/TMD supplemented by plain radiographs shows high risk of OA changes on CT by 38.8 odds (p < 0.05). Conclusions These results imply that the OA changes in young Korean TMD patients are as common as in the old and have no correlation with clinical pain and noise. Considered with high prevalence of TMDs known in the young population, the overall/absolute OA changes in the TMJ can be even higher in the young than in the old population, not like in other joints.
Incomplete reporting has been identified as a major source of avoidable waste in biomedical research. Essential information is often not provided in study reports, impeding the identification, critical appraisal, and replication of studies. To improve the quality of reporting of diagnostic accuracy studies, the Standards for Reporting Diagnostic Accuracy (STARD) statement was developed. Here we present STARD 2015, an updated list of 30 essential items that should be included in every report of a diagnostic accuracy study. This update incorporates recent evidence about sources of bias and variability in diagnostic accuracy and is intended to facilitate the use of STARD. As such, STARD 2015 may help to improve completeness and transparency in reporting of diagnostic accuracy studies.
The aim of this study was to evaluate the presence of degenerative bone changes of the temporomandibular joint (TMJ) in individuals suffering from sleep bruxism (SB), associating these characteristics with the quality of sleep. For this, we followed the International Classification of Sleep Disorders for the diagnosis of SB, in addition to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for the classification of TMD and cone beam computed tomography. It was found that 97.7% of the individuals with bruxism had at least 1 RDC/TMD group III diagnosis, 75.6% of the subjects considered their sleep quality as poor, and the largest group (23%) had centric bruxism. There was no significant association between the pattern of sleep quality (P = 0.36), the type of SB (P = 0.277), and the presence of degenerative changes of the TMJ. Regardless of the quality of sleep and the type of bruxism presented, the prevalence of degenerative bone disorders was high (67%) among women with a mean age of 46 years and a clinical diagnosis of SB.
To compare the prevalence of temporomandibular joint (TMJ) osteoarthritic changes in cone beam computed tomography (CBCT) images of temporomandibular disorder (TMD) and non-TMD patients.
A retrospective analysis of CBCT images of the joints of TMD and non-TMD patients was performed. The presence or absence of osteoarthritic changes (condylar erosion, osteophyte, subcortical cyst, or generalized sclerosis) in each TMJ was evaluated. The prevalence within the two study groups were compared by using Chi-square statistics.
At least one type of osteoarthritic change was present in78.6% of joints in the TMD group and 79.7% in the non-TMD group. No significant difference was found in prevalence of osteoarthritic changes between the TMD and non-TMD groups in the overall study sample or within the subsets of gender and age in the groups.
The lack of a significant difference in prevalence of TMJ osteoarthritic changes in TMD and non-TMD patients highlights the equivocal relationship between osseous TMJ morphology and degenerative bone disease.
Copyright © 2015 Elsevier Inc. All rights reserved.
The performance of a diagnostic test in the case of a binary predictor can be evaluated using the measures of sensitivity and specificity. However, in many instances, we encounter predictors that are measured on a continuous or ordinal scale. In such cases, it is desirable to assess performance of a diagnostic test over the range of possible cutpoints for the predictor variable. This is achieved by a receiver operating characteristic (ROC) curve that includes all the possible decision thresholds from a diagnostic test result. In this brief report, we discuss the salient features of the ROC curve, as well as discuss and interpret the area under the ROC curve, and its utility in comparing two different tests or predictor variables of interest.
As part of the Multisite Research Diagnostic Criteria For Temporomandibular Disorders (RDC/TMD) Validation Project, comprehensive temporomandibular joint diagnostic criteria were developed for image analysis using panoramic radiography, magnetic resonance imaging (MRI), and computerized tomography (CT).
Interexaminer reliability was estimated using the kappa (kappa) statistic, and agreement between rater pairs was characterized by overall, positive, and negative percent agreement. Computerized tomography was the reference standard for assessing validity of other imaging modalities for detecting osteoarthritis (OA).
For the radiologic diagnosis of OA, reliability of the 3 examiners was poor for panoramic radiography (kappa = 0.16), fair for MRI (kappa = 0.46), and close to the threshold for excellent for CT (kappa = 0.71). Using MRI, reliability was excellent for diagnosing disc displacements (DD) with reduction (kappa = 0.78) and for DD without reduction (kappa = 0.94) and good for effusion (kappa = 0.64). Overall percent agreement for pairwise ratings was >or=82% for all conditions. Positive percent agreement for diagnosing OA was 19% for panoramic radiography, 59% for MRI, and 84% for CT. Using MRI, positive percent agreement for diagnoses of any DD was 95% and of effusion was 81%. Negative percent agreement was >or=88% for all conditions. Compared with CT, panoramic radiography and MRI had poor and marginal sensitivity, respectively, but excellent specificity in detecting OA.
Comprehensive image analysis criteria for the RDC/TMD Validation Project were developed, which can reliably be used for assessing OA using CT and for disc position and effusion using MRI.
This paper presents a general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies. The procedure essentially involves the construction of functions of the observed proportions which are directed at the extent to which the observers agree among themselves and the construction of test statistics for hypotheses involving these functions. Tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interobserver agreement are developed as generalized kappa-type statistics. These procedures are illustrated with a clinical diagnosis example from the epidemiological literature.
Guidelines for Assessment, Diagnosis and Management
- R De Leeuw
- G D Klasser
- Orofacial Pain
De Leeuw R, Klasser GD. Orofacial Pain. Guidelines for Assessment, Diagnosis and Management.. 6th ed. Hanover Park: Quintessence; 2018.
Association of volume and voxel intensity of the articular disc and lateral pterygoid muscle in migraine patients: a study with magnetic resonance imaging
- A A Barbieri
- Alf Costa
- Perez Gomes
- J P Ricardo
- Alf Braz-Silva
- P H Lopes
- AA Barbieri
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