Dental attrition models predicting temporomandibular joint disease or masticatory muscle pain versus asymptomatic controls.
OBJECTIVE
To determine whether patients with temporomandibular joint disease or masticatory muscle pain can be usefully differentiated from asymptomatic controls using multifactorial classification tree models of attrition severity and/or rates.


METHODS
Measures of attrition severity and rates in patients diagnosed with disc displacement (n = 52), osteoarthrosis (n = 74), or masticatory muscle pain only (n = 43) were compared against those in asymptomatic controls (n = 132). Cross-validated classification tree models were tested for fit with sensitivity, specificity, accuracy and log likelihood accountability.


RESULTS
The model for identifying asymptomatic controls only required the three measures of attrition severity (anterior, mediotrusive and laterotrusive posterior) to be differentiated from the patients with a 74.2 +/- 3.8% cross-validation accuracy. This compared with cross-validation accuracies of 69.7 +/- 3.7% for differentiating disc displacement using anterior and laterotrusive attrition severity, 68.7 +/- 3.9% for differentiating disc displacement using anterior and laterotrusive attrition rates, 70.9 +/- 3.3% for differentiating osteoarthrosis using anterior attrition severity and rates, 94.6 +/- 2.1% for differentiating myofascial pain using mediotrusive and laterotrusive attrition severity, and 92.0 +/- 2.1% for differentiating myofascial pain using mediotrusive and anterior attrition rates. The myofascial pain models exceeded the > or =75% sensitivity and > or =90% specificity thresholds recommended for diagnostic tests, and the asymptomatic control model approached these thresholds.


CONCLUSIONS
Multifactorial models using attrition severity and rates may differentiate masticatory muscle pain patients from asymptomatic controls, and have some predictive value for differentiating intracapsular temporomandibular disorder patients as well.
Seligman
D A
DA
Section of Oral Medicine and Orofacial Pain, Division of Oral Biology and Medicine, UCLA School of Dentistry, Los Angeles, CA 90024-1668, USA. donalds261@aol.com
Pullinger
A G
AG
D000293:Adolescent; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005157:Facial Pain / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008410:Masticatory Muscles / Q000503:physiopathology*; D008875:Middle Aged; D003765:Models, Dental; D010003:Osteoarthritis / Q000175:diagnosis / Q000503:physiopathology; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D019224:Temporomandibular Joint Disc / Q000503:physiopathology; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis* / Q000503:physiopathology; D013706:Temporomandibular Joint Dysfunction Syndrome / Q000175:diagnosis / Q000503:physiopathology; D019217:Tooth Attrition / Q000503:physiopathology*