title: Electric toothbrush application is a reliable and valid test for differentiating temporomandibular disorders pain patients from controls.
abstract: BACKGROUND
  Current methods for identifying patients with pain hypersensitivity are sufficiently complex to limit their widespread application in clinical settings. We assessed the reliability and validity of a simple multi-modal vibrotactile stimulus, applied using an electric toothbrush, to evaluate its potential as a screening tool for central sensitization.
  
  
  METHODS
  Fourteen female temporomandibular disorders (TMD) subjects with myofascial pain (RDC/TMD Ia or Ib) and arthralgia (RDC/TMD IIIa) were compared to 13 pain-free controls of matched age and gender. Vibrotactile stimulus was performed with an electric toothbrush, applied with 1 pound pressure for 30 seconds in four locations: over the lateral pole of the temporomandibular joint, masseter, temporalis, and mid-ventral surface of forearm. Pain intensity (0-10) was recorded following the stimulus at 0, 15, 30, and 60 seconds. Test-retest reliability was assessed with measurements from 8 participants, taken 2-12 hours apart. Case versus control differentiation involved comparison of area under the curve (AUC). A receiver operating characteristic (ROC) curve was used to determine cutoff AUC scores for maximum sensitivity and specificity for this multi-modal vibrotactile stimulus.
  
  
  RESULTS
  Test-retest reliability resulted in an ICC of 0.87 for all 4 pooled sites. ROC-determined AUC cutoff scores resulted in a sensitivity of 57% and specificity of 92% for all 4 pooled sites.
  
  
  CONCLUSIONS
  The electric toothbrush stimulus had excellent test-retest reliability. Validity of the scores was demonstrated with modest sensitivity and good specificity for differentiating TMD pain patients from controls, which are acceptable properties for a screening test.
authors: Department of Diagnostic & Biological Sciences, School of Dentistry, Minneapolis, MN 55455, USA. nixdorf@umn.edu
authors: Donald R
authors: DR
authors: Nixdorf
authors: Azar
authors: A
authors: Hemmaty
authors: John O
authors: JO
authors: Look
authors: Eric L
authors: EL
authors: Schiffman
authors: Mike T
authors: MT
authors: John
mesh_terms: D018771:Arthralgia / Q000175:diagnosis* / Q000503:physiopathology; D016022:Case-Control Studies; D003742:Dental Devices, Home Care; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006930:Hyperalgesia / Q000175:diagnosis* / Q000503:physiopathology; D010147:Pain Measurement / Q000295:instrumentation* / Q000379:methods; D017288:Pain Threshold; D010812:Physical Stimulation / Q000295:instrumentation* / Q000379:methods; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis* / Q000503:physiopathology; D013706:Temporomandibular Joint Dysfunction Syndrome / Q000175:diagnosis; D014099:Toothbrushing / Q000295:instrumentation*; D014732:Vibration