title: Temporomandibular joint disorders' impact on pain, function, and disability.
abstract: The aim of this study was to determine the association between more advanced stages of temporomandibular joint (TMJ) intra-articular disorders ("TMJ intra-articular status"), representing a transition from normal joint structure to TMJ disc displacement with and without reduction (DDwR and DDwoR) to degenerative joint disease (DJD), and patient-reported outcomes of jaw pain, function, and disability ("TMD impact"). This cross-sectional study included 614 cases from the RDC/TMD Validation Project with at least one temporomandibular disorder (TMD) diagnosis. TMJ intra-articular status was determined by 3 blinded, calibrated radiologists using magnetic resonance imaging and computed tomography as one of normal joint structure, DDwR, DDwoR, or DJD, representing the subject's most advanced TMJ diagnosis. TMD impact was conceptualized as a latent variable consisting of 1) pain intensity (Characteristic Pain Index from the Graded Chronic Pain Scale [GCPS]), 2) jaw function (Jaw Functional Limitation Scale), and 3) disability (Disability Points from GCPS). A structural equation model estimated the association of TMJ intra-articular status with the latent measure TMD impact as a correlation coefficient in all TMD cases (n = 614) and in cases with a TMD pain diagnosis (n = 500). The correlations between TMJ intra-articular status and TMD impact were 0.05 (95% confidence interval [CI], -0.04 to 0.13) for all TMD cases and 0.07 (95% CI, -0.04 to 0.17) for cases with a pain diagnosis, which are neither statistically significant nor clinically relevant. Conceptualizing worsening of TMJ intra-articular disorders as 4 stages and characterizing impact from TMD as a composite of jaw pain, function, and disability, this cross-sectional study found no clinically significant association. Models of TMJ intra-articular status other than ours (normal structure → DDwR → DDwoR → DJD) should be explored.
authors.affiliation: Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.
authors.forename: P
authors.initials: P
authors.lastname: Chantaracherd
authors.affiliation: Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA mtjohn@umn.edu.
authors.forename: M T
authors.initials: MT
authors.lastname: John
authors.affiliation: Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Hodges
authors.affiliation: Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.
authors.forename: E L
authors.initials: EL
authors.lastname: Schiffman
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005157:Facial Pain / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000175:diagnosis / Q000503:physiopathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008409:Mastication / Q000502:physiology; D010003:Osteoarthritis / Q000175:diagnosis / Q000503:physiopathology; D010147:Pain Measurement / Q000379:methods; D016059:Range of Motion, Articular / Q000502:physiology*; D019224:Temporomandibular Joint Disc / Q000473:pathology; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis* / Q000503:physiopathology; D013706:Temporomandibular Joint Dysfunction Syndrome / Q000175:diagnosis / Q000503:physiopathology; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: craniomandibular disorders; musculoskeletal system; myofascial pain syndromes; osteoarthritis; pain perception; temporomandibular joint dysfunction syndrome