Diagnostic criteria for temporomandibular disorders in children and adolescents: An international Delphi study-Part 2-Development of Axis II

Roberto Rongo; EwaCarin Ekberg; Ing-Marie Nilsson; Amal Al-Khotani; Per Alstergren; Paulo Cesar Rodrigues Conti; Justin Durham; Jean-Paul Goulet; Christian Hirsch; Stanimira I Kalaykova; Flavia P Kapos; Christopher D King; Osamu Komiyama; Michail Koutris; Thomas List; Frank Lobbezoo; Richard Ohrbach; Tonya M Palermo; Christopher C Peck; Chris Penlington; Claudia Restrepo; Maria Joao Rodrigues; Sonia Sharma; Peter Svensson; Corine M Visscher; Kerstin Wahlund; Ambrosina Michelotti

doi:10.1111/joor.13301

Diagnostic criteria for temporomandibular disorders in children and adolescents: An international Delphi study-Part 2-Development of Axis II

J Oral Rehabil. 2022 May;49(5):541-552. doi: 10.1111/joor.13301. Epub 2022 Feb 23.

Authors

Roberto Rongo¹, EwaCarin Ekberg², Ing-Marie Nilsson^{2

3}, Amal Al-Khotani^{4

5}, Per Alstergren^{2

4

6}, Paulo Cesar Rodrigues Conti^{7

8}, Justin Durham⁹, Jean-Paul Goulet¹⁰, Christian Hirsch¹¹, Stanimira I Kalaykova¹², Flavia P Kapos¹³, Christopher D King^{14

15

16}, Osamu Komiyama¹⁷, Michail Koutris¹⁸, Thomas List^{2

4}, Frank Lobbezoo¹⁸, Richard Ohrbach¹⁹, Tonya M Palermo^{20

21}, Christopher C Peck²², Chris Penlington⁹, Claudia Restrepo²³, Maria Joao Rodrigues²⁴, Sonia Sharma^{2

19}, Peter Svensson^{2

4

6

25}, Corine M Visscher¹⁸, Kerstin Wahlund²⁶, Ambrosina Michelotti¹

Affiliations

¹ Department of Neurosciences, Reproductive Sciences and Oral Sciences, School of Orthodontics, University of Naples Federico II, Naples, Italy.
² Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.
³ Center for Oral Rehabilitation, FTV Östergötland, Norrköping, Sweden.
⁴ Scandinavian Center for Orofacial Neurosciences, Jeddah, Sweden.
⁵ East Jeddah Hospital, Ministry of Health, Jeddah, Saudi Arabia.
⁶ Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden.
⁷ Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.
⁸ Bauru Orofacial Pain Group, University of São Paulo, Bauru, Brazil.
⁹ School of Dental Sciences, Newcastle University, Newcastle-Upon-Tyne, UK.
¹⁰ Faculty of Dental Medicine, Laval University, Quebec City, Quebec, Canada.
¹¹ Clinic of Pediatric Dentistry, University of Leipzig, Leipzig, Germany.
¹² Department of Oral Function and Prosthetic Dentistry, College of Dental Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
¹³ Department of Epidemiology, University of Washington, Seattle, Washington, USA.
¹⁴ Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
¹⁵ Center for Understanding Pediatric Pain (CUPP), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
¹⁶ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
¹⁷ Division of Oral Function and Rehabilitation, Nihon University School of Dentistry at Matsudo, Matsudo, Japan.
¹⁸ Department of Orofacial pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
¹⁹ Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York, USA.
²⁰ Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
²¹ Seattle Children's Research Institute, Seattle, Washington, USA.
²² Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia.
²³ CES-LPH Research Group, Universidad CES, Medellin, Colombia.
²⁴ Institute for Occlusion and Orofacial Pain Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
²⁵ Section for Orofacial Pain and Jaw Function, School of Dentistry and Oral Health, Aarhus, Denmark.
²⁶ Department of Stomatognathic Physiology, Kalmar County Hospital, Kalmar, Sweden.

PMID: 34951729
DOI: 10.1111/joor.13301

Abstract

Background: Unlike the psychosocial assessment established for adults in the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), a standardised psychosocial assessment for children and adolescents with TMD complaints has not yet been established.

Objectives: To develop a new standardised instrument set to assess the psychosocial functioning in children and adolescents by adapting the psychosocial status and pain-related disability (Axis II) of the adult DC/TMD and by including new instruments.

Methods: A modified Delphi method was used to survey 23 international TMD experts and four international experts in pain-related psychological factors for consensus regarding assessment tools for psychosocial functioning and pain-related disability in children and adolescents. The TMD experts reviewed 29 Axis II statements at round 1, 13 at round 2 and 2 at round 3. Agreement was set at 80% for first-round consensus level and 70% for each of the second and third rounds. The psychological experts completed a complementary Delphi survey to reach a consensus on tools to use to assess more complex psychological domains in children and adolescents. For the psychological experts, the first round included 10 open-ended questions on preferred screening tools for depression, anxiety, catastrophising, sleep problems and stress in children (ages 6-9 years old) and adolescents (ages 10-19 years old) as well as on other domains suggested for investigation. In the second round, the psychological experts received a 9-item questionnaire to prioritise the suggested instruments from most to least recommended.

Results: The TMD experts, after three Delphi rounds, reached consensus on the changes of DC/TMD to create a form to evaluate Axis II in children and adolescents with TMD complaints. The psychological experts added tools to assess depression and anxiety, sleep disorders, catastrophising, stress and resilience.

Conclusion: Through international expert consensus, this study adapted Axis II of the adult DC/TMD to assess psychosocial functioning and pain-related disability in children and adolescents. The adapted Axis II protocols will be validated in the target populations.

MeSH terms

Adolescent
Adult
Anxiety / diagnosis
Anxiety / psychology
Child
Delphi Technique
Humans
Pain
Sleep Wake Disorders*
Temporomandibular Joint Disorders* / diagnosis
Temporomandibular Joint Disorders* / psychology
Young Adult

Abstract

MeSH terms

Grants and funding