Valid diagnostic criteria for classifying pain-related temporomandibular disorders (TMDs) exist and can be applied with high interexaminer reliability to patients. However, adoption in most clinical settings, generalist and specialist, remains limited due to the examination complexity and time constraints in clinics. To address this limitation, we created a simplified examination protocol, and we test it here against reference standards based on the Diagnostic Criteria for TMD (DC/TMD). DC/TMD assessments include multiple provocation tests, 5 range-of-motion tasks, and 40 palpation points, as well as imaging for definitive joint diagnoses. We tested the simplified protocol using data from 2 multicenter studies: the TMJ Impact Project (n = 401) and OPPERA (n = 547). Examiners were trained and assessed annually for reliability, supporting generalizability. Diagnostic validity was assessed by area under the curve, sensitivity, specificity, and likelihood ratios (positive and negative). By using 2-s palpation at the full muscle (bilateral temporalis, masseter) and TMJ lateral pole, results showed high diagnostic performance for identifying painful TMD: area under the curve = 0.93, sensitivity = 0.88, and specificity = 0.98. Targeted single-band palpation within each muscle yielded comparable results. Adding other joint pain provocation procedures to the index test did not improve diagnostic accuracy. For acute closed lock, other disc-based TMDs, and degenerative joint disease, sensitivity remained ≤0.12 while specificity was ≥0.92. For subluxation, sensitivity/specificity was 0.81/0.97. Based on the likelihood ratios, clinical decision-making guidelines were developed for brief DC diagnoses. In conclusion, a simplified and shortened version of the DC/TMD protocol demonstrates excellent validity for identifying painful TMDs and is feasible for clinical practice. This approach reduces examination time while maintaining diagnostic accuracy, potentially improving patient care across broader clinical settings.

Background: The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) is a biaxial tool for TMD assessment. To implement a translated version in the Brazilian context, standardised adaptation and validation are necessary. Objective (s): To translate, adapt and verify the measurement properties of the DC/TMD Axis II instruments Pain Drawing (PD), Graded Chronic Pain Scale (GCPS), Jaw Functional Limitation Scale (JFLS) and Oral Behaviours Checklist (OBC). Methods: The translation and cross-cultural adaptation processes of orofacial-related Axis II instruments followed the Guidelines for Establishing Cultural Equivalency. The validation research was carried out with 117 Brazilians with TMD, in two assessment days. Structural validity, internal consistency, test–retest reliability, measurement error, construct validity—hypothesis testing, and ceiling and floor effects were tested. Results: PD showed substantial reliability (Kappa 0.63), and GCPS, JFLS and OBC showed excellent reliability over time (intraclass correlation coefficient > 0.85). The internal consistency was adequate for all instruments (Cronbach's alpha > 0.77) except for the functional activities domain of OBC (Cronbach's alpha = 0.48). Construct validity was good for all instruments (75% hypotheses confirmed), except for the OBC total score. Regarding parameters of structural validity, GCPS showed Goodness of Fit Index = 0.98 for the solution with two domains. JFLS and OBC presented Goodness of Fit Index < 0.90 for the solutions with three and two domains, respectively. Conclusion: The Brazilian Portuguese version of DC/TMD Axis II can be used in Brazil, but more studies are necessary to find an adequate structure for JFLS and OBC in a Brazilian sample.

BACKGROUND: The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) is a biaxial instrument used worldwide for TMD assessment.

OBJECTIVE: To translate, cross-culturally adapt, and assess the criterion validity and reliability of the Brazilian Portuguese version of the DC/TMD Axis I.

METHODS: The translation and cross-cultural adaptation of Axis I into Brazilian Portuguese followed the recommendations of the International Network for Orofacial Pain and Related Disorders Methodology. For the formal assessment, 117 Brazilians with TMD completed the translated version of the TMD Pain Screener, the Symptom Questionnaire, and the Numeric Pain Rating Scale for orofacial pain intensity assessment. Subsequently, a standardized clinical examination was performed. Fifty-one participants were examined by two raters for interrater reliability, and 53 participated on a second assessment day for intrarater reliability analyses. TMD Pain Screener criterion validity was assessed through sensitivity, specificity, and ROC curve. Kappa and intraclass correlation coefficient (ICC) were used to analyze reliability for categorical and continuous data, respectively.

RESULTS: The translated version achieved language equivalency. High accuracy was found for the Brazilian Portuguese version of the TMD Pain Screener short form (AUC = 0.95) compared to the long form, as well as high intrarater reliability (ICC 0.88). Moderate to almost perfect reliability was found for painful TMD diagnoses and disc displacement with reduction.

CONCLUSIONS: The Brazilian Portuguese version of the DC/TMD Axis I is valid and reliable for screening painful TMD and for painful DC/TMD diagnoses.

BACKGROUND: Proinflammatory cytokines are central to disease mechanisms and important therapeutic targets in inflammatory chronic diseases. This exploratory study aimed to compare cytokine concentrations in saliva, serum, and temporomandibular joint (TMJ) synovial fluid in children with juvenile idiopathic arthritis (JIA) and controls.

METHODS: In this cross-sectional study, we included consecutive children with JIA and TMJ arthritis, planned for a TMJ corticosteroid injection, and non-JIA controls from three different centers in Norway. Data on demographics, disease activity, presence of TMJ arthritis, and medication were obtained. Samples of unstimulated saliva, serum, and TMJ synovial fluid were collected. The amount of recovered synovial fluid in each sample, collected by the push-and-pull technique, was quantified with the hydroxocobalamin method. Cytokine levels were analyzed using Luminex xMAP technology.

RESULTS: Fifteen patients with JIA and TMJ arthritis (JIA-TMJ) (median age 15.0 (interquartile range (IQR) 11.0-16.0) years) and 34 controls (median age 13.0 (IQR 9.8-15.0) years) were consecutively recruited. Samples of saliva (JIA-TMJ, n = 13, and controls, n = 28), serum (JIA-TMJ, n = 11, and controls, n = 16), and TMJ synovial fluid (JIA-TMJ, n = 8) were collected. In saliva from JIA-TMJ, we found significantly higher levels of the cytokines IL-1β, IL-4, IL-5, IL-9, IL-10, IL-12, IL-13, IL-17, Eotaxin, FGF basic, GM CSF, PDGF bb, TNF, and RANTES, while IP-10 was found in significantly lower concentration compared to controls. In serum, there were no significant differences in these cytokine concentrations between JIA-TMJ and controls. Three TMJ synovial samples fulfilled the strict sampling criteria and were included in the analysis. The level of detected cytokines in TMJ synovial samples was higher in JIA-TMJ compared to controls, as described in a previous Nordic study.

CONCLUSIONS: In this exploratory study, several proinflammatory cytokines were found in higher concentrations in saliva in JIA-TMJ compared to saliva from the controls. No differences were seen in serum between the groups. Some pro- and anti-inflammatory cytokines detected in JIA-TMJ synovial fluid were found in higher concentrations compared to TMJ synovial fluid from healthy adult reference data.

OBJECTIVES: This paper studies the treatment effect of total joint replacement (TJR) of the temporomandibular joint (TMJ) with alloplastic joint prosthesis regarding function, symptoms and health-related quality of life compared to other surgical and non-surgical treatments in patients with TMJ disorders.

METHODS: Three databases (PubMed, Cochrane Library and Web of Science) were searched up to 11 March 2025. Studies in which TJR was compared with other surgical or non-surgical methods were searched and analyzed. Data extraction and quality assessments were performed by at least two investigators independently. Risk of bias was assessed with the ROBINS-I-tool. Certainty of evidence was assessed with GRADE.

RESULTS: A total of 2,891 studies were identified in the search. One study met the criteria with comparison of TJR with a control group consisting of patients treated with another surgical method, namely, interpositional arthroplasty. The study investigated the outcome variables such as pain reduction and improvement in mouth opening and had a moderate risk of bias. No significant difference between the groups was found after regression analysis. Quality of life assessment was not the objective of this study. No meta-analysis could be performed from this literature search, for obvious reasons.

CONCLUSION: TMJ reconstruction with alloplastic prostheses is rapidly evolving, with new systems continually entering the market. This review highlights the urgent need for further scientific efforts, including well-designed trials capable of demonstrating the comparative effectiveness of alloplastic TJR against other treatment modalities, ideally randomized trials with controls.

Background/AimPersistent idiopathic facial pain (PIFP) is a rare condition with a lifetime prevalence of approximately 0.03%. It is characterized by persistent daily facial pain without identifiable cause and presents diagnostic and therapeutic challenges due to unknown pathophysiology, symptom overlap with other painful disorders, and limited evidence-based treatments. The aim of this Delphi study was to establish international consensus-derived guidelines for the management of patients with PIFP.MethodsA three-round Delphi study was conducted with 16 international pain experts, each with ≥10 years of clinical experience in pain management and extensive peer-reviewed publications. The first round involved open-ended questions, and the qualitative data were analyzed using systematic text condensation, resulting in a quantitative questionnaire with 42 statements. Subsequent rounds employed Likert-scale responses to these statements. Consensus was defined as ≥80% agreement or disagreement. In addition, if 11-12 (68-75 percent) out of the 16 experts agreed or disagreed, consensus was not reached, but a majority was considered to have a particular opinion.ResultsConsensus was reached in 35 out of the 42 statements (83%), emphasizing multidisciplinary collaboration and avoidance of invasive procedures in the treatment of PIFP. In an additional three statements (7%) a majority of the experts agreed with each other. In four statements (10%), no consensus or majority was reached. Pharmacological treatments, including tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and gabapentinoids, may be considered; however, opioids should generally be avoided in the treatment of PIFP. Patient education and behavioral therapies are important interventions, and the most important measure of therapeutic success is improved quality of lifeConclusionThe present Delphi study has established internationally derived consensus guidelines and recommendations for the evaluation and comprehensive management of patients with PIFP. This is a first step in gathering knowledge for future evidence-based guidelines and more specific treatment recommendations. These international expert consensus guidelines recommend a multi- or interdisciplinary approach in managing PIFP, avoiding invasive interventions and prioritizing patient-centered outcomes.

BACKGROUND: Conventional treatment for reducing pain is not always successful in patients with chronic orofacial myalgia.

OBJECTIVE: The objective of this study was to investigate the pain-reducing efficacy of two botulinum toxin A injections in patients with chronic orofacial myalgia who had already received conservative treatment.

METHODS: The patients included were 18 years or older and diagnosed with myalgia according to the Diagnostic Criteria for Temporomandibular Disorders. Their pain had persisted for more than six months in spite of previous conservative treatment. The design was a randomised, double-blind, placebo-controlled, multicenter, parallel group study. Participants received two injections of botulinum toxin A or saline at an interval of three months. Follow-up visits were conducted at one, three, four, six and nine months after the first injection.

RESULTS: Seventy-two patients were enrolled and sixty-nine completed the study. Between baseline and all follow-up visits, there was a significant decrease in VAS pain intensity for both groups, but the difference between groups was not significant.

CONCLUSION: The use of botulinum toxin A in managing chronic orofacial myalgia did not offer any additional pain relief compared with saline at any of the follow-up occasions.

Background: Despite advances in temporomandibular disorders' (TMDs) diagnosis, the diagnostic process continues to be problematic in non-specialist settings.

Objective: To complete a Delphi process to shorten the Diagnostic Criteria for TMD (DC/TMD) to a brief DC/TMD (bDC/TMD) for expedient clinical diagnosis and initial management.

Methods: An international Delphi panel was created with 23 clinicians representing major specialities, general dentistry and related fields. The process comprised a full day workshop, seven virtual meetings, six rounds of electronic discussion and finally an open consultation at a virtual international symposium.

Results: Within the physical axis (Axis 1), the self-report Symptom Questionnaire of the DC/TMD did not require shortening from 14 items for the bDC/TMD. The compulsory use of the TMD pain screener was removed reducing the total number of Axis 1 items by 18%. The DC/TMD Axis 1 10-section examination protocol (25 movements, up to 12 sets of bilateral palpations) was reduced to four sections in the bDC/TMD protocol involving three movements and three sets of palpations. Axis I then resulted in two groups of diagnoses: painful TMD (inclusive of secondary headache), and common joint-related TMD with functional implications. The psychosocial axis (Axis 2) was shortened to an ultra-brief 11 item assessment.

Conclusion: The bDC/TMD represents a substantially reduced and likely expedited method to establish (grouping) diagnoses in TMDs. This may provide greater utility for settings requiring less granular diagnoses for the implementation of initial treatment, for example non-specialist general dental practice.

BackgroundStress in patients with Juvenile Idiopathic Arthritis (JIA) has been found to be associated with orofacial pain, psychological distress, jaw dysfunction and loss of daily activities in a cross-sectional study. The aim of this study was to investigate the relations between stress and change of stress over time versus changes in orofacial pain, psychosocial factors and jaw function over a two-year period in patients with JIA.MethodsThis is a two-year prospective follow-up study involving 40 JIA patients. At baseline (2015) the median age was 12 years and at two-year follow up (2018) 14 years. The JIA patients were examined clinically and with questionnaires at baseline and follow-up with the diagnostic criteria for temporomandibular disorders (DC/TMD) and completed the same set of DC/TMD questionnaires regarding orofacial pain symptoms and psychosocial factors.ResultsChange in stress was associated with change in catastrophizing, psychological distress as well as limitation in general function and jaw function.ConclusionsThis study emphasizes the importance of maintaining a low stress level in patients with JIA since an increase in stress level over a two-year period seems to impair jaw function as well as psychological distress and catastrophizing.