Reiter Shoshana, Jazmawi Samah, Winocur Ephraim, Arias Orit Winocur, Kats Lazar, Manor Yifat
Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, The Maurice and Gabriela Goldschleger School of Dental Medicine, the Faculty of Medical and Health Sciences, Tel Aviv University, 6934228 Tel Aviv, Israel.
The Maurice and Gabriela Goldschleger School of Dental Medicine, the Faculty of Medical and Health Sciences, Tel Aviv University, 6934228 Tel Aviv, Israel.
J Oral Facial Pain Headache. 2024 Dec;38(4):76-84. doi: 10.22514/jofph.2024.040. Epub 2024 Dec 12.
Temporomandibular disorder (TMD) is considered a complex disorder that follows the biopsychosocial model. The current study aimed to explore the effect of clinic location and referring physicians on the distribution of Axis I diagnoses according to the Diagnostic Criteria for TMD (DC/TMD). Eighty-eight patients from a dental school Orofacial Pain Clinic (DentalOFP) and 104 patients from a hospital Orofacial Pain Clinic (HospitalOFP) were examined by the same dentist who was certified as a DC/TMD examiner and compared. Significant differences between the two clinics were noted, including age ( = 0.002), gender ( = 0.019), symptom duration ( < 0.001), and referring physician's profile ( < 0.001). While 55.7% of referring physicians were dentists in the DentalOFP clinic, only 13.5% of referring physicians were dentists in the HospitalOFP clinic. DentalOFP clinic presented with characteristics of a tertiary clinic, as to female: male ratio and longer symptom duration. Significant differences were found as to intra-articular disorders (IAD) ( = 0.019), degenerative joint disorder (DJD) ( = 0.041), and subluxation ( = 0.015). There were no significant differences as to local myalgia ( = 0.128), myofascial pain with referral ( = 0.389), and arthralgia ( = 0.096). Multiple parameters, such as age, gender, symptom duration, primary tertiary clinic, clinic location, and referring physicians may affect the overall DC/TMD Axis I profile. This study supports abandoning the term TMD. It is suggested to assess each Axis I diagnosis separately, and for each Axis I diagnosis, to follow the International Classification of Orofacial Pain (ICOP), as to primary secondary etiologies, and acute chronic conditions, to provide appropriate treatment.
颞下颌关节紊乱病（TMD）被认为是一种遵循生物心理社会模型的复杂疾病。本研究旨在探讨临床机构位置和转诊医生对根据颞下颌关节紊乱病诊断标准（DC/TMD）得出的轴I诊断分布的影响。来自一所牙科学院口腔颌面疼痛诊所（牙科口腔颌面疼痛诊所）的88名患者和来自一家医院口腔颌面疼痛诊所（医院口腔颌面疼痛诊所）的104名患者由一名获得DC/TMD检查认证的同一位牙医进行检查并比较。注意到两家诊所之间存在显著差异，包括年龄（P = 0.002）、性别（P = 0.019）、症状持续时间（P < 0.001）和转诊医生的特征（P < 0.001）。在牙科口腔颌面疼痛诊所，55.7%的转诊医生是牙医，而在医院口腔颌面疼痛诊所，只有13.5%的转诊医生是牙医。牙科口腔颌面疼痛诊所呈现出三级诊所的特征，如女性与男性比例以及更长的症状持续时间。在关节内紊乱（IAD）（P = 0.019）、退行性关节病（DJD）（P = 0.041）和半脱位（P = 0.015）方面发现了显著差异。在局部肌痛（P = 0.128）、伴有牵涉痛的肌筋膜疼痛（P = 0.389）和关节痛（P = 0.096）方面没有显著差异。年龄、性别、症状持续时间、一级/三级诊所、临床机构位置和转诊医生等多个参数可能会影响整体DC/TMD轴I特征。本研究支持摒弃TMD这一术语。建议分别评估每个轴I诊断，对于每个轴I诊断，遵循国际口腔颌面疼痛分类（ICOP），针对一级/二级病因以及急性/慢性病症，以提供适当的治疗。
