Benefits of implementing pain-related disability and psychological assessment in dental practice for patients with temporomandibular pain and other oral health conditions

C.M. Visscher; L. Baad-Hansen; J. Durham; J.P. Goulet; A. Michelotti; C. Roldán Barraza; B. Häggman-Henrikson; E.C. Ekberg; K.G. Raphael

doi:10.1016/j.adaj.2017.12.031

Benefits of implementing pain-related disability and psychological assessment in dental practice for patients with temporomandibular pain and other oral health conditions

C.M. Visscher
, L. Baad-Hansen
, J. Durham
, J.P. Goulet
, A. Michelotti
, C. Roldán Barraza
, B. Häggman-Henrikson
, E.C. Ekberg
, K.G. Raphael

Orofacial Pain and Dysfunction

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Background: Evidence in the field of dentistry has demonstrated the importance of pain-related disability and psychological assessment in the development of chronic symptoms. The Diagnostic Criteria for Temporomandibular Disorders offer a brief assessment for the diagnostic process in patients with orofacial pain (Axis II). The authors describe relevant outcomes that may guide general oral health care practitioners toward tailored treatment decisions and improved treatment outcomes and provide recommendations for the primary care setting. Methods: The authors conducted a review of the literature to provide an overview of knowledge about Axis II assessment relevant for the general oral health care practitioner. Results: The authors propose 3 domains of the Axis II assessment to be used in general oral health care: pain location (pain drawing), pain intensity and related disability (Graded Chronic Pain Scale [GCPS]), and psychological distress (Patient Health Questionnaire-4 [PHQ-4]). In the case of localized pain, low GCPS scores (0-II), and low PHQ-4 scores (0-5), patients preferably receive treatment in primary care. In the case of widespread pain, high GCPS scores (III-IV), and high PHQ-4 scores (6-12), the authors recommend referral to a multidisciplinary team, especially for patients with temporomandibular disorder (TMD) pain.
Conclusions: The authors recommend psychological assessment at first intake of a new adult patient or for patients with persistent TMD pain. The authors recommend the pain-related disability screening tools for all TMD pain symptoms and for dental pain symptoms that persist beyond the normal healing period. Practical Implications: A brief psychological and pain-related disability assessment for patients in primary care may help the general oral health care practitioner make tailored treatment decisions.

Original language	English
Pages (from-to)	422-431
Journal	Journal of the American Dental Association
Volume	149
Issue number	6
DOIs	https://doi.org/10.1016/j.adaj.2017.12.031
Publication status	Published - 2018

Bibliographical note

With an accompanying online continuing education activity.

Funding

Ultimately, the proposed patient-tailored treatment decisions are expected to increase patient satisfaction with the care provided by the general oral health care practitioner. Patient satisfaction is an important outcome measure for treatment evaluation. Knowledge of factors that influence patient satisfaction, including information that may guide the practitioner possibly to avoid treatment in certain situations, may improve treatment outcomes further in patients with TMD. 49 On the basis of the evidence reviewed in this article, Box 1 summarizes the recommendations given in this article. Dr. Baad-Hansen is an associate professor, Section of Orofacial Pain and Jaw Function, and deputy head, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark, and an associate professor, Scandinavian Center of Orofacial Neurosciences (SCON), http://www.sconresearch.eu . Dr. Durham is a professor, Orofacial Pain, Centre for Oral Health Research, Institute of Health and Society, and School of Dental Sciences, Newcastle University, and an honorary consultant oral surgeon, Newcastle-Upon-Tyne Hospitals' NHS Foundation Trust, Newcastle, Tyne & Wear, UK. Dr. Goulet is an emeritus professor, Faculty of Dental Medicine, Section of Somatology, University Laval, Quebec, Canada. Dr. Michelotti is a dentist, orthodontist, and associate professor, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy. Dr. Roldán Barraza is an assistant professor, J.W. Goethe Universität, Frankfurt am Main, Germany. Dr. Häggman-Henrikson is an associate professor, Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden. Dr. Ekberg is a professor and specialist, Stomatognathic Physiology, Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden. Dr. Raphael is a professor, Department of Oral Pathology, Radiology & Medicine, New York University College of Dentistry, and a professor, Department of Psychiatry, New York University School of Medicine, New York, NY.

Funders
Institute of Health and Society
Health Research
Heart of England NHS Foundation Trust
Newcastle University

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Visscher, C. M., Baad-Hansen, L., Durham, J., Goulet, J. P., Michelotti, A., Roldán Barraza, C., Häggman-Henrikson, B., Ekberg, E. C., & Raphael, K. G. (2018). Benefits of implementing pain-related disability and psychological assessment in dental practice for patients with temporomandibular pain and other oral health conditions. Journal of the American Dental Association, 149(6), 422-431. https://doi.org/10.1016/j.adaj.2017.12.031

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title = "Benefits of implementing pain-related disability and psychological assessment in dental practice for patients with temporomandibular pain and other oral health conditions",

abstract = "Background: Evidence in the field of dentistry has demonstrated the importance of pain-related disability and psychological assessment in the development of chronic symptoms. The Diagnostic Criteria for Temporomandibular Disorders offer a brief assessment for the diagnostic process in patients with orofacial pain (Axis II). The authors describe relevant outcomes that may guide general oral health care practitioners toward tailored treatment decisions and improved treatment outcomes and provide recommendations for the primary care setting. Methods: The authors conducted a review of the literature to provide an overview of knowledge about Axis II assessment relevant for the general oral health care practitioner. Results: The authors propose 3 domains of the Axis II assessment to be used in general oral health care: pain location (pain drawing), pain intensity and related disability (Graded Chronic Pain Scale [GCPS]), and psychological distress (Patient Health Questionnaire-4 [PHQ-4]). In the case of localized pain, low GCPS scores (0-II), and low PHQ-4 scores (0-5), patients preferably receive treatment in primary care. In the case of widespread pain, high GCPS scores (III-IV), and high PHQ-4 scores (6-12), the authors recommend referral to a multidisciplinary team, especially for patients with temporomandibular disorder (TMD) pain. Conclusions: The authors recommend psychological assessment at first intake of a new adult patient or for patients with persistent TMD pain. The authors recommend the pain-related disability screening tools for all TMD pain symptoms and for dental pain symptoms that persist beyond the normal healing period. Practical Implications: A brief psychological and pain-related disability assessment for patients in primary care may help the general oral health care practitioner make tailored treatment decisions.",

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note = "With an accompanying online continuing education activity.",

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Visscher, CM, Baad-Hansen, L, Durham, J, Goulet, JP, Michelotti, A, Roldán Barraza, C, Häggman-Henrikson, B, Ekberg, EC & Raphael, KG 2018, 'Benefits of implementing pain-related disability and psychological assessment in dental practice for patients with temporomandibular pain and other oral health conditions', Journal of the American Dental Association, vol. 149, no. 6, pp. 422-431. https://doi.org/10.1016/j.adaj.2017.12.031

Benefits of implementing pain-related disability and psychological assessment in dental practice for patients with temporomandibular pain and other oral health conditions. / Visscher, C.M.; Baad-Hansen, L.; Durham, J. et al.
In: Journal of the American Dental Association, Vol. 149, No. 6, 2018, p. 422-431.

Research output: Contribution to Journal › Article › Academic › peer-review

TY - JOUR

T1 - Benefits of implementing pain-related disability and psychological assessment in dental practice for patients with temporomandibular pain and other oral health conditions

AU - Visscher, C.M.

AU - Baad-Hansen, L.

AU - Durham, J.

AU - Goulet, J.P.

AU - Michelotti, A.

AU - Roldán Barraza, C.

AU - Häggman-Henrikson, B.

AU - Ekberg, E.C.

AU - Raphael, K.G.

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AB - Background: Evidence in the field of dentistry has demonstrated the importance of pain-related disability and psychological assessment in the development of chronic symptoms. The Diagnostic Criteria for Temporomandibular Disorders offer a brief assessment for the diagnostic process in patients with orofacial pain (Axis II). The authors describe relevant outcomes that may guide general oral health care practitioners toward tailored treatment decisions and improved treatment outcomes and provide recommendations for the primary care setting. Methods: The authors conducted a review of the literature to provide an overview of knowledge about Axis II assessment relevant for the general oral health care practitioner. Results: The authors propose 3 domains of the Axis II assessment to be used in general oral health care: pain location (pain drawing), pain intensity and related disability (Graded Chronic Pain Scale [GCPS]), and psychological distress (Patient Health Questionnaire-4 [PHQ-4]). In the case of localized pain, low GCPS scores (0-II), and low PHQ-4 scores (0-5), patients preferably receive treatment in primary care. In the case of widespread pain, high GCPS scores (III-IV), and high PHQ-4 scores (6-12), the authors recommend referral to a multidisciplinary team, especially for patients with temporomandibular disorder (TMD) pain. Conclusions: The authors recommend psychological assessment at first intake of a new adult patient or for patients with persistent TMD pain. The authors recommend the pain-related disability screening tools for all TMD pain symptoms and for dental pain symptoms that persist beyond the normal healing period. Practical Implications: A brief psychological and pain-related disability assessment for patients in primary care may help the general oral health care practitioner make tailored treatment decisions.

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DO - 10.1016/j.adaj.2017.12.031

M3 - Article

SN - 0002-8177

VL - 149

SP - 422

EP - 431

JO - Journal of the American Dental Association

JF - Journal of the American Dental Association

IS - 6

ER -

Benefits of implementing pain-related disability and psychological assessment in dental practice for patients with temporomandibular pain and other oral health conditions

Abstract

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Funding

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