Article: The outcome of a temporomandibular joint compression test for the diagnosis of arthralgia is confounded by concurrent myalgia

Objective: Pain in the orofacial region may originate from different structures, and one challenge for the clinician is to determine the primary origin of pain reported by the patient. In clinical practice, it is important to discriminate between a temporomandibular joint (TMJ) pain disorder and jaw muscle pain; therefore, tests that are proposed for such purposes warrant evaluation. The aim of the present study was to evaluate the outcome of a TMJ compression test in relation to a Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) arthralgia diagnosis.

Methods: A study population (n = 300), randomly selected from the adult population in Västerbotten, Sweden, was examined according to the DC/TMD criteria and with a TMJ compression test. This test is comprised of forceful unilateral biting for 20 s on a wooden spatula in the first molar region. Familiar pain on the contralateral side to the clenching side was considered a positive test outcome.

Results: Positive contralateral outcome of the TMJ compression test was associated with an arthralgia diagnosis (B = 1.737; OR 5.7, 95% CI 3.3-9.9). This association was confounded by concurrent myalgia (B = 1.737 → B = 0.996, 42.7%).

Conclusion: In a general population, a negative TMJ compression test was strongly associated with the absence of a contralateral TMJ arthralgia diagnosis according to DC/TMD. The association between a positive TMJ compression test and a DC/TMD arthralgia diagnosis was confounded by the presence of myalgia.

Clinical Relevance: Concurrent myalgia renders the usefulness of the TMJ compression test for predicting an arthralgia diagnosis questionable.

Citing Articles

Myogenous Temporomandibular Disorders: Diagnostic Concepts and Prospective Pilot Study on Extracorporeal Shockwave Therapy.

Li D, Li K, Leung Y Diagnostics (Basel). 2023; 13(1).

PMID: 36611343 PMC: 9818132. DOI: 10.3390/diagnostics13010051.

References

1.

Dworkin S, LeResche L . Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord. 1992; 6(4):301-55. View

2.

Rollman A, Visscher C, Gorter R, Naeije M . Care seeking for orofacial pain. J Orofac Pain. 2012; 26(3):206-14. View

3.

Cairns B . Pathophysiology of TMD pain--basic mechanisms and their implications for pharmacotherapy. J Oral Rehabil. 2010; 37(6):391-410. DOI: 10.1111/j.1365-2842.2010.02074.x. View

4.

Schiffman E, Truelove E, Ohrbach R, Anderson G, John M, List T . The Research Diagnostic Criteria for Temporomandibular Disorders. I: overview and methodology for assessment of validity. J Orofac Pain. 2010; 24(1):7-24. PMC: 3157055. View

5.

Kumazaki Y, Kawakami S, Hirata A, Oki K, Minagi S . Ipsilateral Molar Clenching Induces Less Pain and Discomfort than Contralateral Molar Clenching in Patients with Unilateral Anterior Disc Displacement of the Temporomandibular Joint. J Oral Facial Pain Headache. 2016; 30(3):241-8. DOI: 10.11607/ofph.1405. View

6.

Sforza C, Zanotti G, Mantovani E, Ferrario V . Fatigue in the masseter and temporalis muscles at constant load. Cranio. 2007; 25(1):30-6. DOI: 10.1179/crn.2007.006. View

7.

Lovgren A, Visscher C, Haggman-Henrikson B, Lobbezoo F, Marklund S, Wanman A . Validity of three screening questions (3Q/TMD) in relation to the DC/TMD. J Oral Rehabil. 2016; 43(10):729-36. DOI: 10.1111/joor.12428. View

8.

Vilanova L, Rodrigues Garcia R, List T, Alstergren P . Diagnostic criteria for temporomandibular disorders: self-instruction or formal training and calibration?. J Headache Pain. 2015; 16:505. PMC: 4393828. DOI: 10.1186/s10194-015-0505-9. View

9.

Macfarlane G . The epidemiology of chronic pain. Pain. 2016; 157(10):2158-2159. DOI: 10.1097/j.pain.0000000000000676. View

10.

Koutris M, Visscher C, Lobbezoo F, Naeije M . Comorbidity negatively influences the outcomes of diagnostic tests for musculoskeletal pain in the orofacial region. Pain. 2013; 154(6):927-32. DOI: 10.1016/j.pain.2013.03.004. View

11.

Plesh O, Wolfe F, Lane N . The relationship between fibromyalgia and temporomandibular disorders: prevalence and symptom severity. J Rheumatol. 1996; 23(11):1948-52. View

The Outcome of a Temporomandibular Joint Compression Test for the Diagnosis of Arthralgia is Confounded by Concurrent Myalgia