Department of Prosthodontics and Materials Science, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany.
Carinthia University of Applied Sciences, Europastr. 4, 9500, Villach, Austria.
Clin Oral Investig. 2021 Oct;25(10):5641-5647. doi: 10.1007/s00784-021-03866-z. Epub 2021 Mar 16.
The objective was to describe the physical and psychosocial features of patients attending a specialized consultation hour for temporomandibular disorders (TMD). This investigation focused on those patients who did not receive a diagnosis according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD).
From 2004 to 2017, patients seeking care during a TMD-specialized consultation hour were consecutively recruited. Each patient completed a TMD-related questionnaire, psychosocial questionnaires (Graded Chronic Pain Scale, Hospital Anxiety and Depression Scale, Beschwerden-Liste), and the Oral Health Impact Profile-49. The clinical examination was performed according to the RDC/TMD.
The mean age of the 1020 patients was 43.3 years (75.3% female). According to the RDC/TMD decision trees, 351 patients were categorized without a TMD diagnosis (NoTMDdx). The most frequent reasons for seeking care were orofacial pain/TMJ pain or headaches revealing an OR of 1.89 (for TMDdx group). A relevant proportion of patients was categorized as positive for anxiety (NoTMDdx/TMDdx 30.8/41.2%; p = 0.072), depression (20.8/23.9%; p = 0.433), non-specific physical symptoms (31.4/44.1%; p < 0.001), or dysfunctional chronic pain (11.5/18.2%; p < 0.001). In both patient groups, the oral health-related quality of life was impaired (42.9/52.7 points; p < 0.001), and the frequency of therapy measures prior to the consultation hour was high.
Patients seeking care from TMD specialists were usually referred with TMD-associated symptoms. Of those, a relevant proportion did not receive a diagnosis according to RDC/TMD decision trees.
Psychosocial screening and the avoidance of overtreatment are recommended for patients with TMD-related symptoms.
描述就诊于颞下颌关节紊乱（TMD）专科就诊时间的患者的躯体和心理社会特征。本研究重点关注那些根据颞下颌关节紊乱的研究诊断标准（RDC/TMD）未获得诊断的患者。
2004 年至 2017 年，连续招募在 TMD 专科就诊时间就诊的患者。每位患者完成了与 TMD 相关的问卷、心理社会问卷（慢性疼痛分级量表、医院焦虑和抑郁量表、Beschwerden-Liste）和口腔健康影响量表-49。临床检查按照 RDC/TMD 进行。
1020 例患者的平均年龄为 43.3 岁（75.3%为女性）。根据 RDC/TMD 决策树，351 例患者未被诊断为 TMD（NoTMDdx）。寻求治疗的最常见原因是口腔颌面部疼痛/TMJ 疼痛或头痛，表明 TMDdx 组的 OR 为 1.89。相当一部分患者被归类为焦虑阳性（NoTMDdx/TMDdx 为 30.8/41.2%；p=0.072）、抑郁（20.8/23.9%；p=0.433）、非特异性躯体症状（31.4/44.1%；p<0.001）或功能性慢性疼痛（11.5/18.2%；p<0.001）。在两个患者组中，口腔健康相关生活质量均受损（42.9/52.7 分；p<0.001），且在就诊前治疗措施的频率较高。
就诊于 TMD 专家的患者通常因 TMD 相关症状就诊。其中，相当一部分患者未根据 RDC/TMD 决策树获得诊断。
建议对 TMD 相关症状的患者进行心理社会筛查，并避免过度治疗。
