Pain Resource Center's TMJ Scale™

Ringing or buzzing in the ear-A Case Presentation

admin — Sat, 13 Aug 2011 19:35:52 +0000

A 45-year-old white female was referred for tinnitus (ringing or buzzing) in the left ear and facial pain that had been present for the previous two years. She had first sought treatment from her family doctor and an Ear, Nose, and Throat specialist. Both doctors had told her nothing could be done. She then went to a periodontist who thought her problem might be TMJ. An arthrogram (dye injected into the TM joint and an X-ray taken) was performed on the left TM joint and showed a disk perforation. The disk is a small piece of cartilage that cushions the upper part of the jaw bone as it meets the skull. The patient was then referred to several dentists and told that surgical treatment was necessary. The patient and her husband both had psychiatric treatment for depression earlier. The TMJ Scale Report for this patient reflected elevated overall TMJ symptoms, as well as heightened pain, pain on pressing, joint noises, and the teeth feeling ill-fitting. In addition, emotional problems, stress and the propensity for chronic illness were all highly elevated. A physical examination confirmed that multiple facial muscles and the TM joint were painful to the touch, and that both joints produced clicking at about 15 mm of opening. Crepitation or joint grinding sounds were also noted. These finding, combined with TMJ Scale results, led to a diagnosis of MPD–myofacial pain dysfunction, anterior disk displacement with perforation and tinnitus (see Glossary) Comment: This is an example of multiple TM disorders complicated by emotional factors and stress. This patient was undergoing treatment with a TMJ specialist. (Published in the TMJ Scale Manual)

Do Psychological Factors Affect Teatment Outcome in TMDs

admin — Tue, 17 May 2011 20:23:58 +0000

There has been considerable controversy over the years regarding the importance of psychological factors in the diagnosis, etiology, progression and response to treatment in the field of temporomandibular disorders (TMDs). Few studies have looked carefully at the influence of psychological factors on different components of TMDs. For example, on disorders primarily involving the TM joint versus those involving primarily the muscles and soft tissues. The study described below offers some interesting insight into this question.

"TMD Treatment Outcomes: A Statistical Assessment of the Effects of Psychological Variables"

Dr. Pamela Steed, DDS, MSD

Jour of Craniomandib Practice, (16)3: 138-42, 1998

This study analyzes the degree to which pretreatment psychosocial factors (psychological dysfunctions and stress) effect outcome in 269 consecutive temporomandibular disorder (TMD) patients at the completion of treatment. Employing the TMJ Scale, a validated measure of TMD symptoms, it is found that pretreatment TMD pain and overall symptom levels (excluding internal derangement symptoms) are weakly but nevertheless, significantly related to pretreatment psychological dysfunction and stress. However, the latter appeared totally unrelated to four treatment outcome measures. Additionally, the data supports the hypothesis that both initial and post-treatment intrascapular symptoms (TMJ Scale, Joint Dysfunction sub-scale) are unrelated to psychosocial factors. Data from this study call into question the value of categorizing the TMD patients by means of psychosocial "profiling" and "dual-axis" classification methods proposed by some researchers.

A Study of the Importance of Psychological Factors in Treatment Results for Temporomandibular Disorders

admin — Sun, 01 May 2011 23:38:17 +0000

Psychological Factors and Temporomandibular Treatment Outcomes

Wexler Gerald B and Steed Pamela A,

Jour of Craniomandib Practice, (16)2: 72-77, 1998.

This study examines the effect of psychological dysfunction as an etiological factor in temporomandibular disorder (TMD). It employs a thoroughly validated psychometric measurement system, the TMJ Scale (Pain Resource Center, Inc., Durham, North Carolina), to determine the effects of pretreatment stress and psychological dysfunction upon presenting symptom levels. The study also addresses these parameters for the eventual treatment outcome. During the course of this study, 2,074 patients were evaluated. Seven hundred and fifty-four by Dr. Steed and 1,320 by Dr. Wexler. Both practices address essentially identical patient populations and focus special interest in craniofacial pain and the diagnosis and Phase I treatment of temporomandibular dysfunction. Of the patients in the study who were found to have clinically treatable temporomandibular disorders, 561 consecutive patients completed treatment and were deemed to have reached Maximum Medical Improvement (MMI). The TMJ Scale was re-administered to this post-treatment population. This study summarized findings pertinent to the four primary issues: 1. pre-treatment psychological factors and stress, which seem to be moderately related to presenting pain levels and overall TMD levels (excepting joint function); 2. treatment outcomes which appeared to be unrelated to the initial psychosocial symptom severity; 3. physical symptoms outcomes and psychosocial outcomes which appeared to be significantly related and; 4. intracapsular symptom improvement which appeared to be unrelated to psychological functioning changes but mildly related to stress.

Are Temporomandibular Joint Disorders (TMDs) Self-Limiting?

admin — Fri, 22 Apr 2011 18:24:58 +0000

There has been much contorversary and confusion over the years regarding the question as to whether temporomandibular joint (TMJ) disorders are self-limiting or not. This is a complicated issue of great concern to both patients and healthcare providers. The authors in the study below have found some prior studies attempting to address this issue to contain "major methodological limitiations." Their study investigated 274 consecutive patients in five diagnostic categories involving TMDs and a 25 patient comparison group. Their research supports the hypothesis that TMDs are not self-limiting and that active treatments result in statistically significant symptom improvement while untreated patients did not.

Wexler GB, McKinney MW, Temporomandibular Treatment Outcomes within Five Diagnostic Categories, Jour of Craniomandib Practice, (17)1: 30-37, 1999

Abstract

This study of temporomandibular disorder (TMD) treatment outcomes examines 274 consecutive patients in five diagnostic categories and a 25 patient comparison group to determine relative levels of symptom improvement. Employing a psychometric outcome measure, the TMJ Scale, it was found that patients receiving active TMD treatments manifest statistically significant symptom improvements. Untreated patients reported minor and statistically insignificant symptom variations. Patients with intracapsular TM joint dysfunctions exhibited higher levels of improvement in pain and other TMD symptoms than patients presenting with primarily muscle symptoms. This research supports the hypothesis that TMDs are not self-limiting and require active treatment interventions. It is suggested that some studies cited to show that TMDs are self-limiting have major methodological limitations, relying upon unvalidated and subjective assessments of symptom levels. This research also outlines a procedure for TMD practitioners to measure treatment efficacy and the relative effectiveness of differing treatment modalities in a valid, consistent and unbiased manner.

A Study of 10,000 Patients to Determine the Clinical Efficacy of the TMJ Scale and Explore Symptom Characteristics in the TMD Patient Population

admin — Sun, 10 Apr 2011 19:25:07 +0000

Validating the TMJ Scale in a National Sample of 10,000 Patients: Demographic and Epidemiologic Characteristics.

Levitt SR, McKinney MW, Jour of Orofacial Pain, 8(1):25-25, 1994.

The accuracy and reliability of the TMJ Scale were originally determined in cross-validation studies on large, research-based patient samples. It had been assumed that the demographic characteristics and test responses of these research-based samples would be representative of the clinical population in which the TMJ Scale would ultimately find use. The present study on more than 10,000 patients that were evaluated for temporomandibular disorders in clinical practice demonstrates that the test scores, demographic variables, and the patterns of symptom severity that characterize the original TMJ Scale research sample accurately represent the general temporomandibular disorder patient population in which the TMJ Scale is now being used. The results suggest a high degree of confidence in the clinical efficacy of this assessment tool. The overall symptom severity of temporomandibular disorders was found to be normally distributed in the patient population. Women with temporomandibular disorders report a higher level of severity of all physical and psychological symptoms than men. This may explain the high female-to-male ratio in patients seeking treatment. However, a higher percentage of male temporomandibular disorder patients has clinically significant psychological and stress-related problems than do women. The severity and prevalence of symptoms associated with joint dysfunction and range of motion limitation are lower in older age groups, and the overall symptom severity of temporomandibular disorders is not higher in older age groups. However, the severity and prevalence of symptoms associated with joint dysfunction are greater in groups in which temporomandibular disorders have existed for longer durations, although pain levels do not follow this trend. There is also an association between time duration of the temporomandibular disorder and the severity of psychological problems and chronicity. Patients with chronic problems are symptomatically more impaired than those with acute problems.

TMD Resulting From Trauma vs Non-Trauma-A Large Scale Research Study

admin — Sun, 03 Apr 2011 17:00:15 +0000

Steed PA, Wexler, GB, Temporomandibular Disorders-Traumatic Etiology vs. Nontraumatic Etiology: A Clinical and Methodological Inquiry into Symptomatology and Treatment Outcomes

Jour of Craniomandib Practice, (19)3: 188-194, 2001

Abstract

The purpose of this research is to investigate the distinctions relating to Presenting Symptoms and Treatment Outcomes between patients suffering temporomandibular disorder (TMD) as a result of traumatic versus nontraumatic etiology. A geographically diverse cohort of 1,842 patients diagnosed with TMD was investigated with special emphasis placed on the following criteria: 1. The distribution of demographic and symptom characteristics of patients with trauma as an immediate precipitating factor versus those with other nontraumatic etiologies; 2. The relationship between nontrauma status and treatment outcomes; 3. The interrelationships between nontrauma status, psychosocial factors, and treatment outcomes. Trauma patients tended to be younger, less educated, and more likely to be male than the nontrauma patients. For this group the reported length of the TMD problem was, as expected, of shorter duration when compared to the nontrauma patient group. Length of treatment did not differ between the two groups. In comparison, trauma patients reported higher initial overall symptoms including pain and range of motion limitations. However, symptoms related to joint dysfunction did not vary appreciably. Treatment outcomes are complicated by the fact that TMD encompasses several different diagnostic entities. Trauma patients reported significantly higher percentages of improvement in palpation pain and perceived malocclusion. No significant differences were found for pain report, joint dysfunction, stress, and overall TMD symptomatology, as measured by the TMJ Scale's Global domain. Trauma patients manifested higher psychological dysfunction levels (excepting stress) and showed significantly more improvement in both psychosocial function and stress than the nontrauma group.

A Large Prospective Research Study Addressing the Questions: Does Treatment for TMD Produce Symptom Improvement, Does Relapse Occur and Do Untreated Patients Improve Spontaneously Over Time?

admin — Sun, 27 Mar 2011 18:53:20 +0000

This is an example of a longitudinal, prospective research study using the TMJ Scale on a large number of patients in multiple clinical settings. This study was designed to investigate whether treated patients achieve both clinically and statistically significant levels of improvement relative to non-treated patients and whether there is any symptom relapse after treatment is completed. Another question addressed was whether or not untreated TMJ patients improve spontaneously over time.

Brown DT, Gaudet EL, Jr, Temporomandibular Treatment Outcomes: Second Report of a Large-Scale Prospective Clinical Study, Jour of Craniomandib Practice, (20)4: 244-253, 2002.

Abstract:

Longitudinal studies of outcomes for temporomandibular disorder (TMD) treatment are rarely done and even when conducted often suffer methodological weaknesses. These may include the lack of valid outcome measures for symptom changes. This second report of a long-term multi-site study of 2104 treated, 250 untreated, and 44 long-term treated TMD patients is part of a continuing effort to study TMD treatment efficacy in a very large patient population. A validated symptom measurement system, the TMJ Scale, assured a valid and uniform assessment of treatment outcomes across a large number of practices. Data indicate that untreated TMD patients do not improve spontaneously over time and that patients treated with a variety of active modalities achieve clinically and statistically significant levels of improvement with no evidence of symptom relapse after treatment completion. The use of anterior repositioning appliance therapy produced better results than flat plane splint therapy.

Research Study in Iraq using the TMJ Scale

admin — Sun, 20 Mar 2011 17:11:53 +0000

In addition to previous posts on published international research studies involving the TMJ Scale in countries like Japan, Canada and Brazil, the following study was conducted in Iraq:

Abstract

Qasim WF, The Effectiveness of Occlusal Splint Therapy in Treatment of Iraqi Temporomandibular Disorder (TMD) Patients, J Med J, (40) 4:1-6, 2006.

The effectiveness of an occlusal splint as a conservative non-invasive treatment modality of
temporomandibular joint disorders evaluated clinically with the design of full coverage, flat, maxillary
occlusal splint. Twenty-eight temporomandibular disorder treated patients were evaluated with the
Temporomandibular Joint scale (TMJ Scale) before and after treatment. A group of twenty-six similar
patients identified as having temporomandibular disorders, but they did not obtained treatment, were
used as a control group. It was found that this splint design had a significant effect on improvement of
physical signs related to temporomandibular disorder, but it had no significant effect on the elimination
of temporomandibular joint clicking at the end of final evaluation period. Accordingly, its indication was
limited for myogenic facial pain and not for repositioning purposes.

International Research Study in Brazil Involving the TMJ Scale-another in a series of published studies

admin — Mon, 14 Mar 2011 00:48:49 +0000

In addition to the many published research studies over the years in the U.S. involving the TMJ Scale, studies in other countries and cultures have also been ongoing. Many have expressed an interest in reading about such studies. Therefore, this is one example of a study done in Brazil.

Nasr MK, Bataglion C, Nunes L de J, Bataglion SAN, Paiva AF, "Application of the TMJ Scale and Electromyography in Masseter and Anterior Temporal Muscles in Subjects with Temporomandibular Joint Dysfunction With and Without Orthodontic Treatment and Operative Dentistry Restorative Treatment: Comparative Study", Jornal Brasileiro de Oclusao, ATM e Dor Orofacial, 2(5): 34-43, 2002.

This research had as its objective to verify in subjects at university all presenting temporomandibular joint dysfunctions and with operative restorative dentistry, divided in two groups, with and without orthodontic treatment, the electromyographic activity of the masseter and anterior temporal muscles in different mandibular positions, and the validity of the anamnestic questionnaire TMJ Scale. The results showed that, at the rest position and in maximum habitual intercuspation, the group of the subjects with orthodontic treatment showed less electromyographic activity in relation to the group that had not received orthodontic treatment, however the activities were shown more balanced. In the right and left movement, in both groups, there was a greater activity in the ipsilateral temporal muscles, in relation to the contralateral muscle. The TMJ Scale showed that this questionnaire appeared to be reliable and that it can be applied to the practice of dentistry, either in private or in epidemiologic studies.

International Research Studies Involving the TMJ Scale-Canada

admin — Sat, 05 Mar 2011 18:56:14 +0000

Wexler GB, McKinney MW. Assessing Treatment Outcomes in Two TMD Diagnostic Categories Employing a Validated Psychometric Test. Jour of Craniomandib Practice, 13(4):256-263, 1995.

Publication Abstract:

This study measures the effects of treatment interventions on two classes of temporomandibular disorder (TMD) patients in a dental practice in Ottawa, Canada. Other studies of TMD treatment outcome have employed subjective, largely qualitative and nonquantitative measures of symptom levels to make this type of assessment, rendering such research largely incapable of being replicated. The current study employs the TMJ Scale, a validated and psychometrically-developed symptom inventory, to measure symptom levels before and after treatment. The study first determined the sensitivity (92.1%) and specificity (88.1%) of the TMJ Scale for 219 patients in the practice population. One hundred and eleven consecutive TMD patients completed TMJ Scales prior to treatment, and then were retested after the completion of treatment. Results indicate that patients with symptoms of internal joint derangement reported more symptomatic improvement than those with predominantly muscular symptomology, despite the fact that the latter manifested lower symptom levels initially. Patients with internal derangement symptoms initially presented with lower levels of psychological symptoms than patients with muscular symptoms. Substantial improvements in both groups were noted, employing TMJ Scale percentile rank changes as outcome measures. This study can serve as a model for future research toward establishing baselines for expected TMD symptom improvement.