Simplifying the diagnostic process of TMJD pain for the general dentist

描述(申请人提供)：痛性颞下颌关节肌肉和关节紊乱(TMJD)是第二种最常见的肌肉骨骼疾病，影响大约3000万美国人，估计每年花费40亿美元。对于普通牙医来说，诊断TMJD患者是具有挑战性的，因为生理TMJD疼痛诊断缺乏预后价值-不像心理社会TMJD因素，后者为治疗选择和结果预测提供信息。然而，普通牙医并不经常使用TMJD的心理社会评估，而是主要依赖于TMJD的体检。因此，TMJD疼痛诊断需要有更好的临床实用性，以提高普通牙医对更复杂的患者进行专科护理的分诊。这一应用的中心研究假设是，当前的物理TMJD疼痛评估包含未使用但有价值的TMJD疼痛信息，这些信息与与TMJD相关的心理社会痛苦密切相关。使用这些信息将产生更有信息量的TMJD疼痛诊断，从而减少对TMJD患者进行心理社会评估的额外价值。TMJD影响到颌骨、关节和太阳穴的几个位置，但通常也会伴随牙科、口腔、耳朵、颈部和头痛。因此，TMJD疼痛具有位置和分布成分；事实上，并不是所有的疼痛部位对治疗结果都具有同等的重要性，疼痛部位的更广泛分布预示着不利的结果。目前，即使这种地理疼痛信息是在诊断过程中收集的，除了区分疼痛的TMJ和肌肉位置外，它没有被纳入诊断中。这项研究的目的是通过整合有关TMJD疼痛的位置和分布的现有信息来改进现有的TMJD疼痛诊断，并测试这些改进的诊断在预测心理社会痛苦方面是否优于现有的诊断。使用应用最广泛的TMJD诊断系统-TMJD研究诊断标准，来自最近完成的多中心RDC/TMJD验证项目(633例TMJD病例，91名对照受试者)和来自两个德国中心的416例病例的数据提供了一个经济高效的机会，通过应用地理信息系统(GIS)分析的创新方法来确定疼痛地理信息对TMJD诊断的贡献。具体目的是：(I)通过对TMJD疼痛位置数据的探索性数据分析，确定与新的TMJD疼痛诊断相对应的TMJD疼痛地理模式；以及(Ii)测试TMJD疼痛地理模式是否比现有的TMJD疼痛诊断更好地预测心理社会痛苦的测量。这个应用程序是创新的，因为它将TMJD概念化为一种“地理”疼痛状况，应用了地理学和公共卫生的复杂方法。这一应用具有重要意义，因为新的TMJD疼痛诊断将为普通牙医提供一个简单的筛查工具，使用常规收集的TMJD疼痛地理数据来识别患有心理社会痛苦的患者，并避免对那些不需要的患者进行心理社会评估。

DESCRIPTION (provided by applicant): Painful temporomandibular muscle and joint disorders (TMJD) are the second most common musculoskeletal condition, affecting approximately 30 million Americans with an estimated annual cost of $4 billion. For the general dentist, diagnosing TMJD patients is challenging because the physical TMJD pain diagnoses lack prognostic value - unlike psychosocial TMJD factors, which are informative for treatment selection and as outcome predictors. However, the psychosocial assessment for TMJD is not routinely, if ever, used by the general dentist, who instead relies primarily on physical TMJD examination. Therefore, TMJD pain diagnoses need to have better clinical utility to improve the general dentist's triaging of more complex patients for specialty care. The central research hypothesis of this application is that the current physical TMJD pain assessment contains unused but valuable "geographic" TMJD pain information that correlates well with the psychosocial distress associated with TMJD. Using this information would produce a more informative TMJD pain diagnosis and consequently reduce the additional value of psychosocial assessment of TMJD patients. TMJD affect several locations in the jaw, joint, and temple, but often dental, oral, ear, neck, and head pains are also associated. Accordingly, TMJD pain has a location and distribution component; in fact, not all pain sites have equal importance for treatment outcomes, and a wider distribution of pain sites predicts unfavorable outcomes. Currently, even if this geographic pain information is collected during the diagnostic process, it is not incorporated into the diagnosis except for distinguishing between the TMJ versus muscle location of the pain. This study's objective is to improve existing TMJD pain diagnoses by integrating available information about the location and distribution of TMJD pain and testing whether these improved diagnoses are superior to existing ones in predicting psychosocial distress. Using the most widely applied TMJD diagnostic system, the Research Diagnostic Criteria for TMJD, data from the recently completed multi-center RDC/TMJD Validation Project (633 TMJD cases, 91 control subjects) and 416 cases from two German centers provide a cost- effective opportunity for determining the contribution of pain geography information for TMJD diagnosis using an innovative methodological approach applying geographic information systems (GIS) analyses. The specific aims are: (i) to identify patterns of TMJD pain geography corresponding to new TMJD pain diagnoses using exploratory data analysis of TMJD pain location data; and (ii) to test whether patterns of TMJD pain geography predict measures of psychosocial distress better than existing TMJD pain diagnoses. This application is innovative because it conceptualizes TMJD as a "geographic" pain condition, applying sophisticated methods from geography and public health. This application is significant because the new TMJD pain diagnoses will provide general dentists with a simple screening tool using routinely collected TMJD pain geography data to identify patients with psychosocial distress and to avoid psychosocial assessment for those who do not need it.