School of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples "Federico II", Naples, Italy.
Faculty of Odontology, Malmö University, Malmö, Sweden.
J Oral Rehabil. 2019 May;46(5):450-459. doi: 10.1111/joor.12769. Epub 2019 Feb 14.
Diagnostic criteria reported in the expanded taxonomy for temporomandibular disorders include a standardised clinical examination and diagnosis (DC/TMD 3.B) of temporomandibular joint (TMJ) damage in patients with juvenile idiopathic arthritis (JIA); however, their validity is unknown.
To assess the validity of DC/TMD 3.B for the identification of TMJ damage in JIA-patients, using magnetic resonance imaging (MRI) as gold standard, and to investigate the relation between clinical findings and TMJ damage.
Fifty consecutive JIA patients (9-16 years) were recruited. DC/TMD 3.B were compared with TMJs MRI (100 TMJs) performed maximum at 1 month from the visit. The severity of TMJ damage was scored in four grades. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), logistic regression models with odds ratio of DC/TMD 3.B and clinical findings respect to MRI were calculated.
The DC/TMD 3.B were inadequate in the identification of TMJ damage (sensitivity = 0.15, specificity = 0.92, PPV = 0.85, NPV = 0.28, P = 0.350). Chin deviation and TMJ crepitus were associated with worse TMJ damage (P = 0.006; P = 0.034). Reduced mouth opening (OR = 3.91, P = 0.039) and chin deviation (OR = 13.7, P = 0.014) were associated with the presence of TMJ damage. Combining "pain" (history of pain, TMJ pain, pain during movements) and "function" (TMJ crepitus, reduced mouth opening, chin deviation) clinical findings, the sensitivity and the specificity were 0.88 and 0.54.
DC/TMD 3.B present a low sensitivity to diagnose TMJ damage. Chin deviation, reduced mouth opening and TMJ crepitus are associated with TMJ damage. We suggest combining "pain" and "function" findings for the evaluation of TMJ damage in JIA patients.
扩大的颞下颌关节紊乱分类学中报告的诊断标准包括对青少年特发性关节炎（JIA）患者的颞下颌关节（TMJ）损伤进行标准化的临床检查和诊断（DC/TMD 3.B）；然而，其有效性尚不清楚。
使用磁共振成像（MRI）作为金标准，评估 DC/TMD 3.B 对 JIA 患者 TMJ 损伤的诊断价值，并探讨临床发现与 TMJ 损伤之间的关系。
招募了 50 名连续的 JIA 患者（9-16 岁）。将 DC/TMD 3.B 与在就诊后 1 个月内进行的最大 TMJ MRI（100 个 TMJ）进行比较。TMJ 损伤的严重程度分为四级。计算 DC/TMD 3.B 和临床发现相对于 MRI 的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、优势比（OR）的逻辑回归模型。
DC/TMD 3.B 在识别 TMJ 损伤方面不够充分（敏感性=0.15，特异性=0.92，PPV=0.85，NPV=0.28，P=0.350）。颌偏斜和 TMJ 弹响与更严重的 TMJ 损伤相关（P=0.006；P=0.034）。张口受限（OR=3.91，P=0.039）和颌偏斜（OR=13.7，P=0.014）与 TMJ 损伤的存在相关。结合“疼痛”（疼痛史、TMJ 疼痛、运动时疼痛）和“功能”（TMJ 弹响、张口受限、颌偏斜）的临床发现，敏感性和特异性分别为 0.88 和 0.54。
DC/TMD 3.B 对诊断 TMJ 损伤的敏感性较低。颌偏斜、张口受限和 TMJ 弹响与 TMJ 损伤相关。我们建议结合“疼痛”和“功能”发现来评估 JIA 患者的 TMJ 损伤。
