Highlights
- •Chronic painful temporomandibular disorders with validated diagnoses includes 4 disorders.
- •Chronic temporomandibular disorder pain includes multiple comorbid symptoms, headache and neck pain.
- •Fibromyalgia has substantial somatic and symptom overlap with temporomandibular disorders.
- •Injury risk may increase with chronic pain-related loss of normal jaw movement.
- •Further research should especially focus on protective factors.
Abstract
The classification of temporomandibular disorders (TMD) has progressed substantially
over the past 25 years owing to the strategic implementation of an initial classification
system based on core taxonomic principles. In this article, we describe the development
of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and its translation
into the multidimensional Analgesic, Anesthetic, and Addiction Clinical Trial Translations
Innovations Opportunities and Networks–AAPT for chronic pain disorders. The initial
scientific classification system (Research Diagnostic Criteria for Temporomandibular
Disorders) relied on a boot-strapping process that did not attempt to solve all known
clinical problems but, rather, focused on problems that could be solved at that time.
The core design principles included using epidemiologic data, operationalized concepts,
reliable methods, and the incorporation of the biopsychosocial model into a dual axis
system. This system led to sufficient data collection internationally that the system
itself could be revised, first by critical evaluation of all aspects, second by review
from invited experts, and third by the construction of a revised taxonomy (DC/TMD)
that maintained the core design principles of the Research Diagnostic Criteria for
Temporomandibular Disorders. The resultant disorders with pain as a dominant feature
exhibit substantial sensitivity and specificity, and they have been translated into
the AAPT framework. The AAPT TMD criteria are part of an evidence-based classification
system providing a systematic structure that includes 5 dimensions: diagnostic criteria,
common features, comorbidities, consequences, and putative mechanisms. Future research
will attempt to extend this AAPT domain from solely TMDs to include other orofacial
pain conditions.
Perspective
The painful TMDs have well-established sensitivity and specificity, as based on the
DC/TMD; their translation to the AAPT framework for chronic pain conditions provides
a structure for consistent clinical application within the broader health care settings
and for future research on the TMDs.
Key words
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Article info
Publication history
Published online: April 18, 2019
Accepted:
April 1,
2019
Received in revised form:
December 24,
2018
Received:
June 10,
2018
Footnotes
The authors have no conflicts of interest to declare.
Identification
Copyright
© 2019 by the American Pain Society
