Summary Background Diagnostic criteria reported in the expanded taxonomy for temporomandibular disorders include a standardised clinical examination and diagnosis (DC/TMD 3.B) of temporomandibular joint (TMJ) damage in patients with juvenile idiopathic arthritis (JIA); however, their validity is unknown. Objectives To assess the validity of DC/TMD 3.B for the identification of TMJ damage in JIA‐patients, using magnetic resonance imaging (MRI) as gold standard, and to investigate the relation between clinical findings and TMJ damage. Methods Fifty consecutive JIA patients (9‐16 years) were recruited. DC/TMD 3.B were compared with TMJs MRI (100 TMJs) performed maximum at 1 month from the visit. The severity of TMJ damage was scored in four grades. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), logistic regression models with odds ratio of DC/TMD 3.B and clinical findings respect to MRI were calculated. Results The DC/TMD 3.B were inadequate in the identification of TMJ damage (sensitivity = 0.15, specificity = 0.92, PPV = 0.85, NPV = 0.28, P = 0.350). Chin deviation and TMJ crepitus were associated with worse TMJ damage (P = 0.006; P = 0.034). Reduced mouth opening (OR = 3.91, P = 0.039) and chin deviation (OR = 13.7, P = 0.014) were associated with the presence of TMJ damage. Combining “pain” (history of pain, TMJ pain, pain during movements) and “function” (TMJ crepitus, reduced mouth opening, chin deviation) clinical findings, the sensitivity and the specificity were 0.88 and 0.54. Conclusion DC/TMD 3.B present a low sensitivity to diagnose TMJ damage. Chin deviation, reduced mouth opening and TMJ crepitus are associated with TMJ damage. We suggest combining “pain” and “function” findings for the evaluation of TMJ damage in JIA patients.

BackgroundThe daily life of patients suffering from orofacial pain is considerably impaired as compared to healthy subjects. The aim of this study was to investigate the influence of different categories of orofacial pain on the habitual life of adult individuals.MethodsSeven hundred eighty-one individuals with orofacial pain were recruited from an initial sample of 1,058 patients. All the individuals were allocated to groups according to their diagnosis: myofascial pain (group A, 676 subjects, 525 females and 151 males; mean age ± SD = 35.2 ± 12.6), migraine (group B, 39 subjects, 29 females and 10 males; mean age ± SD 36.0 ± 10.7), and both myofascial pain and migraine (group C, 66 subjects, 56 females and 10 males, mean age ± SD = 35.6 ± 10.8). Characteristic pain intensity (CPI), disability days (DD), disability score (DS), and graded chronic pain intensity (GCPS) were calculated according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis II. Depression and somatization (nonspecific physical symptoms) scores were also calculated.ResultsA significant association between groups and GCPS categories was found (p < 0.0001). Post hoc tests showed a significant difference between groups A and B and between A and C, but not between B and C. In group A, the most frequent GCPS score was grade II. The most frequent GCPS score in groups B and C was grade III, indicating a moderate limiting impairment. This score was more frequent in group B (41%) than in the other groups (group A = 20.6%, group C = 34.8%). GCPS grade IV was more frequent in group C (19.7%) than in the other groups. Group C had significantly higher scores for nonspecific physical symptoms than group A (p < 0.05).ConclusionsMyofascial pain and migraine sensibly affect the common daily life of adult individuals. The comorbidity of both conditions determines a major impairment.

Patients with masticatory muscle pain and migraine typically report that the intensity of pain fluctuates over time and is affected by weather changes. Weather variables, such as ambient temperature and humidity, may vary significantly depending on whether the individual is outdoor or indoor. It is, therefore, important to assess these variables at the individual level using portable monitors, during everyday life. This study aimed to determine and compare the temporal patterns of pain in individuals affected with facial and head pain and to investigate its relation with weather changes. Eleven patients (27·3 ± 7·4 years) with chronic masticatory muscle pain (MP) and twenty (33·1 ± 8·7 years) with migraine headache (MH) were asked to report their current pain level on a visual analogue scale (VAS) every hour over fourteen consecutive days. The VAS scores were collected using portable data-loggers, which were also used to record temperature, atmospheric pressure and relative humidity. VAS scores varied markedly over time in both groups. Pain VAS scores fluctuate less in the MP group than in the MH group, but their mean, minimum and maximum values were higher than those of migraine patients (all P < 0·05). Pain scores <2 cm were more common in the MH than in the MP group (P < 0·001). Perceived intensity of pain was negatively associated with atmospheric pressure in the MP group and positively associated with temperature and atmospheric in the MH group. Our results reveal that patients with masticatory muscle pain and patients with migraine present typical temporal pain patterns that are influenced in a different way by weather changes.

Edefonti V, Bravi F, Cioffi I, Capuozzo R, Ammendola L, Abate G, Decarli A, Ferraroni M, Farella M, Michelotti A. Chronic pain and weather conditions in patients suffering from Temporomandibular disorders: a pilot study. Community Dent Oral Epidemiol 2012; 40 (Suppl. 1): 56–64. © 2012 John Wiley & Sons A/S Abstract –  Objectives:  Patients with temporomandibular disorders (TMDs) often report increased pain in response to changes in weather conditions. Nevertheless, scientific evidence supporting this relationship is scarce. The aim of this study was to assess a potential relationship between pain intensity and meteorological factors, through a newly developed, portable device, in patients affected by chronic masticatory muscle pain. Methods:  Seven female subjects were diagnosed with myofascial pain of the masticatory muscles, according to RDC/TMD criteria, were recruited, and participated in the study. Each patient was provided with a portable data logger that recorded and stored weather variables (atmospheric pressure, air humidity, temperature) every 15 min. Patients were asked to record the level of perceived pain on an electronic visual analogue scale (VAS) every hour. The relationship between meteorological variables and pain scores was investigated using separate generalized least squares regression models with a correlation structure estimated via autoregressive integrated moving average models. Results:  Individual VAS trajectories in the study period were different. The effect of meteorological factors on VAS scores was statistically significant in five subjects, with at least one main effect and/or one two‐way interaction between meteorological variables being significant. Conclusions:  The analyses suggest the existence of different interindividual responses to climatic changes. However, the identified putative role of meteorological variables and of their two‐way interactions suggests that further investigations on larger samples may be useful to assess the research question under examination.