title: Clinical orofacial characteristics associated with risk of first-onset TMD: the OPPERA prospective cohort study.
abstract: Case-control studies have documented clinical manifestations of chronic temporomandibular disorder (TMD), whereas clinical predictors of TMD development are largely unknown. We evaluated 41 clinical orofacial characteristics thought to predict first-onset TMD in a prospective cohort study of U.S. adults aged 18 to 44 years. During the median 2.8-year follow-up period, 2,737 people completed quarterly screening questionnaires. Those reporting symptoms were examined and 260 people were identified with first-onset TMD. Univariate and multivariable Cox regression models quantified associations between baseline clinical orofacial measures and TMD incidence. Significant predictors from baseline self-report instruments included oral parafunctions, prior facial pain and its life-impact, temporomandibular joint noises and jaw locking, and nonspecific orofacial symptoms. Significant predictors from the baseline clinical examination were pain on jaw opening and pain from palpation of masticatory, neck, and body muscles. Examiner assessments of temporomandibular joint noise and tooth wear facets did not predict incidence. In multivariable analysis, nonspecific orofacial symptoms, pain from jaw opening, and oral parafunctions predicted TMD incidence. The results indicate that only a few orofacial examination findings influenced TMD incidence, and only to a modest degree. More pronounced influences were found for self-reported symptoms, particularly those that appeared to reflect alterations to systems beyond the masticatory tissues.
  
  
  CONCLUSIONS
  OPPERA's prospective cohort study identifies predictors of first-onset TMD comprising self-reported orofacial symptoms and examination findings. The results suggest a complex pattern of TMD etiology that is influenced by disorders locally, in masticatory tissues, and systemically, in pain-regulatory systems.
authors.affiliation: Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York. Electronic address: ohrbach@buffalo.edu.
authors.forename: Richard
authors.initials: R
authors.lastname: Ohrbach
authors.forename: Eric
authors.initials: E
authors.lastname: Bair
authors.forename: Roger B
authors.initials: RB
authors.lastname: Fillingim
authors.forename: Yoly
authors.initials: Y
authors.lastname: Gonzalez
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Gordon
authors.forename: Pei-Feng
authors.initials: PF
authors.lastname: Lim
authors.forename: Margarete
authors.initials: M
authors.lastname: Ribeiro-Dasilva
authors.forename: Luda
authors.initials: L
authors.lastname: Diatchenko
authors.forename: Ronald
authors.initials: R
authors.lastname: Dubner
authors.forename: Joel D
authors.initials: JD
authors.lastname: Greenspan
authors.forename: Charles
authors.initials: C
authors.lastname: Knott
authors.forename: William
authors.initials: W
authors.lastname: Maixner
authors.forename: Shad B
authors.initials: SB
authors.lastname: Smith
authors.forename: Gary D
authors.initials: GD
authors.lastname: Slade
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D005157:Facial Pain / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D010147:Pain Measurement; D011446:Prospective Studies; D012307:Risk Factors; D057566:Self Report; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis* / Q000453:epidemiology
keywords: Temporomandibular disorder; cohort studies; pain; parafunction; trauma