Longitudinal Outcome of Temporomandibular Disorders: A 5-year Epidemiologic Study of Muscle Disorders Defined by Research Diagnostic Criteria for Temporomandibular Disorders

Aims: To investigate the course of myofascial pain defined by Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) over a period of 5 years, and to identify prognostic factors from baseline data. Methods: Subjects were 155 consecu-tive patients and 80 community cases identified from an age-strati-fied representative population sample; all met the primary selec-tion criterion of reporting pain in the temporomandibular joint (TMJ) or masticatory muscles. The 2 groups were combined to yield a total sample of 235 subjects (50 male, 185 female; mean age = 39 years). Subjects were evaluated at baseline, 1 year, 3 years, and 5 years by trained examiners using standardized, reli-able methods. Psychological and behavioral factors were assessed by self report. Results: According to RDC/TMD criteria, 50 (31%) of the 165 subjects presenting with myofascial pain (MFP) at baseline continued to have their disorder over a period of 5 years; 55 (33%) remitted, and 60 (36%) were recurrent cases. Bivariate statistics and multivariate logistic regression analyses indicated that baseline pain frequency, number of painful palpa-tion sites, and total number of body sites with pain were signifi-cant predictors of persistent vs remitted and recurrent cases. No predictors that distinguished remission vs recurrence could be identified. Thirty subjects from the 70 without a diagnosis of MFP at baseline developed a new MFP. A high baseline somatization score (without pain items) was a significant risk factor for onset of MFP. Conclusion: Muscle disorders classified by RDC/TMD are predominantly chronic or fluctuating pain conditions, with a mod-est probability (31%) of remission.

epidemiology; myofascial pain; temporomandibular disorders; diagnosis; longitudinal study

1. Dworkin SF, LeResche L, DeRouen T, VonKorff M. Assessing clinical signs of temporomandibular disorders: Reliability of clinical examiners. J Prosthet Dent 1990;63:574–579.

2. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: Review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992;6:301–355.

3. Zaki H, Rudy T, Turk D, Capirano M. Reliability of Axis I Research Diagnostic Criteria for TMD [abstract 676]. J Dent Res 1994;73(special issue):186.

4. List T, Dworkin SF. Comparing TMD diagnoses and clinical findings at Swedish and U.S. TMD centers using Research Diagnostic Criteria for Temporomandibular Disorders. J Orofac Pain 1996;10:240–253.

5. Dworkin SF. Behavioral, emotional, and social aspects of orofacial pain. In: Stohler CS, Carlson DS (eds). Biological and Psychological Aspects of Orofacial Pain. Ann Arbor, MI: Center for Human Growth and Development, 1994:93–112.

6. Dworkin SF. Behavioral characteristics of chronic tem-poromandibular disorders: Diagnosis and treatment. In: Sessle BJ, Bryant PS, Dionne RA (eds). Temporo-mandibular Disorders and Related Pain Conditions. Seattle: IASP Press, 1995:175–192.

7. Ohrbach R, Dworkin SF. Five-year outcomes in TMD: Relationship of changes in pain to changes in physical and psychological variables. Pain 1998;74:315–326.

8. Dworkin SF, Von Korff MR, LeResche L. Multiple pains and psychiatric disturbance: An epidemiologic investigation. Arch Gen Psychiatry 1990;47:239–244.

9. Von Korff M, Dworkin SF, LeResche L, Kruger A. An epi-demiologic comparison of pain complaints. Pain 1988; 32:173–183.

10. Derogatis LR. SCL-90-R: administration, scoring and procedures manual - II for the revised version. Towson, MD: Clinical Psychometric Research, Towson MD, 1983.

11. Von Korff M, Dworkin SF, LeResche L. Graded chronic pain status: An epidemiologic evaluation. Pain 1990;40: 279–291.

12. LeResche L. Epidemiology of temporomandibular disorders: Implications for the investigation of etiologic factors. Crit Rev Oral Biol Med 1997;8:291–305.

13. Nordström G, Eriksson S. Longitudinal changes in craniomandibular dysfunction in an elderly population in northern Sweden. Acta Odontol Scand 1994;52:271–279.

14. Wänman A. Longitudinal course of symptoms of cran-iomandibular disorders in men and women. A 10-year follow-up study of an epidemiologic sample. Acta Odontol Scand 1996;54:337–342.

15. Clark GT, Lanham F, Flack VF. Treatment outcome results for consecutive TMJ clinic patients. J Cranio-mandib Disord 1988;2:87–95.

16. Garofalo JP, Gatchel RJ, Wesley AL, Ellis E 3rd. Predicting chronicity in acute temporomandibular joint disorders using the research diagnostic criteria. J Am Dent Assoc 1998;129:438–447.

17. Magni G, Moreschi C, Rigatti-Luchini S, Merskey H. Prospective study on the relationship between depressive symptoms and chronic musculoskeletal pain. Pain 1994; 56:289–297.

18. Von Korff M, LeResche L, Dworkin SF. First onset of common pain symptoms: A prospective study of depression as a risk factor. Pain 1993;55:251–258.

19. Wilson L, Dworkin SF, Whitney C, LeResche L. Somatization and pain dispersion in chronic temporo-mandibular disorder pain. Pain 1994;57:55–61.

20. McCreary CP, Clark GT, Oakley ME, Flack V. Predicting response to treatment for temporomandibular disorders. J Craniomandib Disord 1992;6:161–169.