Recognition of Temporomandibular Disorders validity and outcome of three screening questions (3Q/TMD)

Abstract: BackgroundPain and dysfunction in the temporomandibular region (Temporomandibular Disorders, TMD) arecommon conditions in the general population with an estimated treatment need of 5-15% in thegeneral population. However, in Sweden, traceable performed treatments are significantly lower. Thereasons for this indicated under-treatment are not known. To easily detect patients with a potentialTMD related condition, three screening questions, 3Q/TMD, have been introduced. The aim with thisproject was to evaluate the validity and outcome of the 3Q/TMD with the objective to recognizeindividuals with TMD and potential treatment need in the Public Dental Health service (PDHS).MethodsThe thesis is based on four study samples; three from the PDHS in the county of Västerbotten, Swedenand one sample from the specialized orofacial pain clinic at the Academic Centre for Dentistry, ACTA,Amsterdam, the Netherlands. The bases for all studies are individuals’ answers to the 3Q/TMD.Quantitative approaches were used in the analyses. The prevalence of affirmative answers wasevaluated in a large cross-sectional study over the lifespan. The validity of the 3Q/TMD in relation tothe Diagnostic Criteria for TMD (DC/TMD) as reference standard was established in two case-controlstudies. The outcome of the 3Q/TMD on TMD treatment within general practice was evaluated in acohort study.ResultsAffirmative answers to the 3Q/TMD increased during adolescence. Women answered affirmatively tothe 3Q/TMD significantly more often compared to men for all age groups expect for the first and lastparts of a one hundred-year lifespan. The highest prevalence was reported by women during theirfertile period in life. In a general population sample, 74% of individuals with an affirmative answerqualified for a DC/TMD pain or dysfunctional diagnosis, as compared to 64% in a specialist patientsample. In the general population sample, for the individual 3Q/TMD questions, as well ascombinations of questions, the negative predictive values were high (0.92-0.99). For the specialistsample, when at least one question was answered affirmatively the negative predictive value was high(0.90). The positive predictive value was high (0.89) when all three questions were positive. Therewas significantly more treatment performed or recommended for 3Q-positives (21.5%) compared to3Q-negatives (2.2%) (P<0.001). The odds ratio for TMD-related treatment for 3Q-positives versus3Q-negatives was 12.1 (95% CI: 6.3-23.4).ConclusionThe 3Q/TMD is a convenient and valid tool to recognize individuals who would benefit from a furtherTMD examination within an adult, general population. Within specialized orofacial pain clinics, thequestions are useful as guidance for further diagnostics. Although the 3Q/TMD was a factor related toTMD treatment, the majority of individuals with self-reported symptoms of TMD still did not receivetraceable assessment or treatment. Factors associated with dentists’ clinical decision-making inrelation to TMD warrants further research. The utilization of the 3Q/TMD as a part of a decision treefor the clinician can improve the health care for patients with TMD and is therefore recommendedwithin dentistry.