Oral medicine
Research diagnostic criteria for temporomandibular disorders: a systematic review of axis I epidemiologic findings

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Objectives

The aim of this study was to summarize and systematically review the literature on the prevalence of different research diagnostic criteria for temporomandibular disorders (RDC/TMD) version 1.0 axis I diagnoses in patient and in the general populations.

Study design

For each of the relevant papers, the following data/information were recorded for meta-analysis and discussion: sample size and demographic features (mean age, female-to-male ratio); prevalence of the assigned diagnoses; prevalence of the diagnoses assigned to the left and right joints, if available; prevalence of the diagnoses assigned to the 2 genders, if available; prevalence of the different combinations of multiple diagnoses, if available; and prevalence of TMD (only for community studies).

Results

Twenty-one (n = 21) papers were included in the review (15 dealing with TMD patient populations and 6 with community samples). The studies on TMD patients accounted for a total of 3,463 subjects (mean age 30.2-39.4 years, female-to-male ratio 3.3), with overall prevalences of 45.3% for group I muscle disorder diagnoses, 41.1% for group II disc displacements, and 30.1% for group III joint disorders. Studies on general populations accounted for a total of 2,491 subjects, with an overall 9.7% prevalence for group I, 11.4% for group IIa, and 2.6% for group IIIa diagnoses.

Conclusions

Prevalence reports were highly variable across studies. Myofascial pain with or without mouth opening limitation was the commonest diagnosis in TMD patient populations, and disc displacement with reduction was the commonest diagnosis in community samples.

Section snippets

Search strategy

On March 7, 2010, a systematic search in the National Library of Medicine's Pubmed Database was performed to identify all peer-reviewed papers in the English-language literature using the RDC/TMD to assess the prevalence of axis I diagnoses.

The search strategy consisted of 4 steps: 1) a word terms search within Pubmed; 2) a search within Pubmed to articles related to the selected ones; 3) a search within the reference lists of the selected articles; and 4) a manual search within some selected

Results

Fifteen of the included papers were based on patient populations,7, 8, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55 and 6 dealt with data gathered from community samples.33, 56, 57, 58, 59, 60 The studies on patients referred to populations of Italians,8, 49, 51, 53 Israeli,43, 44, 50 Chinese,46, 52, 54 USA Americans,37, 55 Germans,47, 48 Swedes,37 and Brazilians,45 and the studies on general populations were performed on Swedes,56, 58 Germans,57, 60 Finns,33 and USA Americans.37

The 15

Discussion

Since the time of their introduction, the RDC/TMD have been used to classify TMD patients according to their physical diagnosis (axis I) and pain-related disability and psychologic status (axis II).9 The RDC/TMD provide researchers and clinicians with a standardized system that can be used for examining, diagnosing, and classifying the most common subtypes of TMD. One of the primary aims of this classification system was to implement diagnostic standardization and to enable cross-population

Conclusions

In the present systematic review, a large variability of findings was noticed, particularly regarding the joint disorders (group II and III diagnoses). If RDC/TMD version 1.0 was used, muscle disorders were diagnosed in about one-half of the TMD patients, being the commonest diagnosis. Disc displacements and inflammatory-degenerative disorders were diagnosed in 41.1% and 30.1% of patients, respectively. In community populations, disc displacement with reduction was the commonest diagnosis,

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