Prevalence and characteristics of referred pain in patients diagnosed with temporomandibular disorders according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) in Sharjah, United Arab Emirates

Abstract

Background: Referred pain often complicates and delays the diagnosis of temporomandibular disorders (TMD). Elaborating the prevalence and characteristics of TMD-associated referred pain as well as the distribution of referred pain in different TMD classes will significantly improve the diagnostic process. The objectives of the present study were to assess the prevalence and to evaluate the characteristics of referred pain associated with TMD diagnosed according to the DC/TMD. Methods: A total of 252 patients were evaluated using the DC/TMD Axes-I and –II assessment tools. Different modalities were used to treat the diagnosed TMD. Referred pain was diagnosed when the location of the perceived pain in response to palpation extended beyond the boundary of the structure that was examined. For pain locations that were perceived as deep, patients were asked to locate the surface of the area of pain. The result of the assessment was identified as positive if the patient described his perceived pain during the clinical examination as being familiar pain that was experienced in the same location in the last 30 days.  Results: TMD-associated referred pain was recorded in 153 patients (60.7%). The most common referred pain location was the temporal area (45.2%), followed by the ear (42.1%). The referred pain was recorded in disc displacement with reduction with intermittent locking and myofascial pain with referral in all patients (100%). The proportion of patients with referred pain was significantly different between the different TMD diagnostic subgroups (P < 0.001).  The recorded percentage of improvement in the referred pain following the treatment was 50.41% after 3 months and 56.65% after 6 months. Conclusions: Referred pain is a prominent feature of TMD. The prevalence of referred pain associated with TMD was 60.7%.  A strong strength association between the different diagnostic subgroups and the presence of referred pain existed.