Concordancia entre las Evaluaciones de la Articulación Temporomandibular Realizadas con los CDI/TTM y con Imágenes de Resonancia Magnética / Concordance between the Evaluations of the Temporomandibular Joint Performed with the RDC/TMD and with Images of Magnetic Resonance

Los Criterios Diagnósticos para la Investigación de los Trastornos Temporomandibulares (CDI/TTM) ofrecen un sistema estandarizado para evaluar la Disfunción Temporomandibular (DTM). Sin embargo, la validez del diagnóstico clínico obtenido con estos criterios al compararlo con el diagnóstico obtenido de las imágenes de Resonancia Magnética (RM) es controversial. El objetivo fue determinar la concordancia que existe entre la evaluación clínica realizada con los CDI/TTM e imágenes de RM de la articulación temporomandibular (ATM), de pacientes atendidos en la Clínica Integral del Adulto, de la Escuela de Odontología de la Universidad del Valle, en Cali, Colombia. Se evaluó clínicamente a 36 individuos, con edades comprendidas entre 18 y 60 años, utilizando los CDI/TTM y se les realizaron exámenes de RM. Las variables estudiadas fueron sexo, edad, signos y síntomas de la ATM, Posición Normal del Disco (PND), Desplazamiento Discal con Recaptura (DDCR) y Desplazamiento Discal Sin Recaptura (DDSR). Los datos obtenidos fueron sometidos a pruebas estadísticas para determinar el índice Kappa y características operativas de la prueba clínica. El Índice Kappa fue 0,53, con una concordancia entre las evaluaciones clínicas e imagenológicas moderada. De la población estudiada, 91,6% fue del sexo femenino, con 31 años como promedio de edad. El signo hallado con mayor frecuencia fue el ruido articular (77%) y el síntoma más frecuente fue el dolor facial (69%). La sensibilidad de los CDI/TTM para determinar la PND fue 0,52 y la especificidad 0,87; la sensibilidad para el DDCR fue 0,8780 y la especificidad 0,709; la sensibilidad para el DDSR fue 0,5714 y la especificidad 0,948. La DTM se presentó con mayor frecuencia en las mujeres, con edad promedio de 31 años. Los CDI/TTM pueden considerarse confiables, especialmente para el DDCR; sin embargo, tratamientos invasivos, permanentes o quirúrgicos, requerirían confirmación con un diagnóstico imagenológico para evitar falsos positivos.

The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) offer a standardized system to clinically evaluate the most common subtypes of Temporomandibular Disorders (TMD). However, the validity of the clinical diagnose obtained with these criteria when compared with the diagnose obtained from the images of Magnetic Resonance (MR) is controversial. The objective of this study was to determine the concordance existing between the clinical evaluation obtained from the RDC/TMD and that obtained from MR images of the temporomandibular joint (TMJ) of patients attending the Clínica Integral del Adulto ­ Clínica de ATM, of the Escuela de Odontología of the Universidad del Valle, Cali, Colombia. A population of 36 patients of both sexes, with ages between 18 and 60 years, were clinically evaluated with the RDC/TMD and MR. The variables considered were sex, age, signs and symptoms of the TMJ, Normal Disc Position (NDP), Disc Displacement with Reduction (DD-R) and Disc Displacement without Reduction (DD-NR). The data obtained were submitted to statistical tests to determine the Kappa Index and operative characteristics of the clinical evaluation. The Kappa Index obtained was 0.53, which shows that the concordance between the clinical and the imagenological evaluations is moderate. Of the total population studied, 91.6% were females, with 31 years as average age. The most frequent sign found was the joint sound (77%) and the most frequent symptom was facial pain (69%). The sensitivity of the RDC/TMD to determine NDP was 0.52 and the specificity 0.87; the sensitivity for the DD-R was 0.8780 and the specificity 0.709; the sensitivity for the DD-NR was 0.5714 and the specificity 0.948. The TMD were found most frequent in women, with average age of 31 years. The RDC/TMD can be considered reliable, especially for the DD-R; however, invasive, permanent or surgical treatments would require confirmation with imagenological diagnoses to avoid false positives.

Depression and TMD in the elderly: a pilot study / Depressão e DTM em idosos: estudo piloto

Temporomandibular dysfunction (TMD) is a painful syndrome that affects orofacial region, with deleterious effects in patients’ quality of life. Several aspects of TMD in the elderly are still controversial in the literature. The aim of this paper is to verify the prevalence of TMD among the elderly people in Taubaté – Brazil, and its possible association with other co-morbidities. Sixty-eight elderly individuals, presenting an average age of 69.5 years (SD 8.5), participated in this study, 37 of which were women. The Research Diagnostic Criteria for Temporomandibular Dysfunction (RDC/TMD) was used to verify TMD and its possible association with other co-morbidities. The studied sample presented a low prevalence of TMD according to RDC/TMD (10.3%). Women presented more non-specific physical symptoms – pain items included – than men (pain items included, p=0.016, x2 test). Depression and non-specific physical symptoms – pain items excluded – did not correlate with patients’ gender. Associations were found among depression and characteristic pain intensity (p=0.027, ANOVA), non-specific physical symptoms - pain items included (p<0.001), non-specific physical symptoms – pain items excluded (p=0.001) and chronic pain grade (p=0.004), whereas the more depressed the patients, the higher were their pain scores. One can conclude that psychological factors, such as depression, were associated with TMD prevalence, thus reinforcing the need for a multidisciplinary approach for TMD treatment.

A disfunção temporomandibular (DTM) é uma síndrome dolorosa que afeta a região orofacial, com efeitos deletérios na qualidade de vida dos pacientes. Diversos aspectos à respeito da DTM em idosos são controversos na literatura. O objetivo neste estudo foi verificar a prevalência de DTM em idosos da cidade de Taubaté – Brasil, e as possíveis associações com outras co-morbidades. Sessenta e oito indivíduos, apresentando idade media de 69,5 anos (DP 8,5), participaram neste estudo, sendo 37 mulheres. O Research Diagnostic Criteria for Temporomandibular Dysfunction (RDC/TMD) foi usado para verificar DTM e as possíveis associações com outras co-morbidades. A população estudada apresentou baixa prevalência de DTM de acordo com o RDC/TMD (10,3%). Mulheres apresentaram mais sintomas não específicos – itens de dor incluídos – que homens (itens de dor incluídos, p-0.016, x2 test). Depressão e sintomas físicos não específicos – itens de dor excluídos – não correlacionaram com o sexo do paciente. Associações foram encontradas entre depressão e a intensidade das características de dor (p=0.027, ANOVA), sintomas físicos não específicos – itens de dor incluídos (p<0.001), sintomas físicos não específicos – itens de dor excluídos (p=0.001) e a escala de dor crônica (p=0.004), sendo que paciente mais deprimidos apresentaram maiores escores para dor. Pode-se concluir que os fatores psicológicos, como a depressão, foram associados com a prevalência de DTM, reforçando assim a necessidade de uma abordagem multidisciplinar para o seu tratamento.