Axis I diagnosis profile according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD): comparison between hospital-based orofacial pain clinic and dental academic-based orofacial pain clinic.

Abstract

Temporomandibular disorder (TMD) is considered a complex disorder that follows the biopsychosocial model. The current study aimed to explore the effect of clinic location and referring physicians on the distribution of Axis I diagnoses according to the Diagnostic Criteria for TMD (DC/TMD). Eighty-eight patients from a dental school Orofacial Pain Clinic (DentalOFP) and 104 patients from a hospital Orofacial Pain Clinic (HospitalOFP) were examined by the same dentist who was certified as a DC/TMD examiner and compared. Significant differences between the two clinics were noted, including age (p = 0.002), gender (p = 0.019), symptom duration (p < 0.001), and referring physician's profile (p < 0.001). While 55.7% of referring physicians were dentists in the DentalOFP clinic, only 13.5% of referring physicians were dentists in the HospitalOFP clinic. DentalOFP clinic presented with characteristics of a tertiary clinic, as to female: male ratio and longer symptom duration. Significant differences were found as to intra-articular disorders (IAD) (p = 0.019), degenerative joint disorder (DJD) (p = 0.041), and subluxation (p = 0.015). There were no significant differences as to local myalgia (p = 0.128), myofascial pain with referral (p = 0.389), and arthralgia (p = 0.096). Multiple parameters, such as age, gender, symptom duration, primary vs. tertiary clinic, clinic location, and referring physicians may affect the overall DC/TMD Axis I profile. This study supports abandoning the term TMD. It is suggested to assess each Axis I diagnosis separately, and for each Axis I diagnosis, to follow the International Classification of Orofacial Pain (ICOP), as to primary vs. secondary etiologies, and acute vs. chronic conditions, to provide appropriate treatment.