European Archives of Paediatric Dentistry

, Volume 15, Issue 2, pp 135–142 | Cite as

Reproducibility of 6- and 4-category faces pain scale to the assessment of temporomandibular joint pain and muscle in school-age children

  • T. C. ChavesEmail author
  • A. M. Turci
  • H. M. Nagamine
  • L. M. de Souza
  • A. S. de Oliveira
  • D. B. Grossi
Original Scientific Article



The aim of this study was to compare the levels of reproducibility between two Faces Pain Scales (FPS) of 6 and 4 categories to the assessment of pain intensity on children with and without Temporomandibular joint and muscle pain.

Material and methods

A total of 29 children were recruited: 13 symptomatic (9.79 ± 1.36 years old) and 16 asymptomatic (8.69 ± 0.87 years old). One previously-trained examiner applied manual palpation to evaluate orofacial structures, and FPS to assess pain intensity. All children were initial evaluated using 6-category FPS and after 3 days using 4-category FPS. The children were assessed after a seven day time interval from initial and second sessions. Weighted Kappa coefficient was used to verify reproducibility levels.


Similar levels of reproducibility (moderate and fair kappa values) have been verified with the application of the 6-category FPS on symptomatic and asymptomatic children. Similar results were verified using 4-category FPS on symptomatic and asymptomatic children (poor and fair kappa values).


Higher levels of reproducibility were verified with the application of the 6-category FPS in both groups and considering symptomatic and asymptomatic as single group. In this way, the 6-category FPS should be preferred over the 4-category FPS to assess pain intensity on children’s orofacial structures.


Reproducibility Pain scale Children Temporomandibular disorders 



The authors acknowledge FAPESP (São Paulo State Research Foundation) for financial support to this study (Grants #2003/07771-0) and CAPES (Master degree scholarship).


  1. American Dental Association. Report of the president’s conference on the examination, diagnosis and management of temporomandibular disorders. JADA. 1983;106(1):75–7.Google Scholar
  2. Atwood MJ, Dixon DC, Talcott GW, et al. Comparison of two scales in the assessment of muscle and joint palpation tenderness in chronic temporomandibular disorders. J Orofac Pain. 1993;7(4):403–7.PubMedGoogle Scholar
  3. Bieri D, Reeve RA, Champion GD, et al. The FPS for the self-assessment of the severity of pain experienced by children: development, initial validation, and preliminary investigation for ratio scale properties. Pain. 1990;41:139–50.PubMedCrossRefGoogle Scholar
  4. Bonjardim LR, Gavião MBD, Carmagnani FG, et al. Signs and symptoms of temporomandibular joint dysfunction in children with primary dentition. J Clin Pediatr Dent. 2003;28(1):53–8.PubMedGoogle Scholar
  5. Castelo PM, Gavião MB, Pereira LJ, et al. Relationship between oral parafunctional/nutritive sucking habits and temporomandibular joint dysfunction in primary dentition. Int J Paediatr Dent. 2005;15(1):29–36.PubMedCrossRefGoogle Scholar
  6. Chambers CT, Giesbrecht K, Craig KD, et al. A comparison of faces scales for the measurement of pediatric pain: children’s and parents’ ratings. Pain. 1999;1:25–35.CrossRefGoogle Scholar
  7. Chaves TC, Nagamine HM, de Sousa LM, et al. Intra- and interrater agreement of pressure pain threshold for masticatory structures in children reporting orofacial pain related to temporomandibular disorders and symptom-free children. J Orofac Pain. 2007;21(2):133–42.PubMedGoogle Scholar
  8. Conti PC, de Azevedo LR, de Souza NV, et al. Pain measurement in TMD patients: evaluation of precision and sensitivity of different scales. J Oral Rehabil. 2001;28(6):534–9.PubMedCrossRefGoogle Scholar
  9. Decruynaere C, Thonnard JL, Plaghki L. How many response levels do children distinguish on faces scales for pain assessment? Eur J Pain. 2009;13(6):641–8.PubMedCrossRefGoogle Scholar
  10. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord. 1992;6:301–55.PubMedGoogle Scholar
  11. Fonseca DM, Bonfate G, Valle AL, et al. Diagnóstico pela anamnese da disfunção craniomandibular. Rev Gaucha Odontol. 1994;42:23–8.Google Scholar
  12. Hicks CL, Von Baeyer CL, Spafford PA, et al. The FPS—revised: toward a common metric in pediatric pain measurement. Pain. 2001;93:173–83.PubMedCrossRefGoogle Scholar
  13. Kay DJ, Rosenfeld RM. Quality of life for children with persistent sinonasal symptoms. Otolaryngol Head Neck Surg. 2003;128:17–26.PubMedCrossRefGoogle Scholar
  14. Landis RJ, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.PubMedCrossRefGoogle Scholar
  15. LeResche L, Burgess J, Dworkin SF. Reliability of visual analog and verbal descriptor scales for “objective” measurement of temporomandibular disorder pain. J Dent Res. 1988;67(1):33–6.CrossRefGoogle Scholar
  16. List T, Helkimo M, Falk G. Reliability and validity of a pressure threshold meter in recording tenderness in the masseter muscle and the anterior temporalis muscle. Cranio. 1989;7:223–9.PubMedGoogle Scholar
  17. Mohl ND. Standards for testing new diagnostic strategies for temporomandibular disorders. In: Fricton JR, Dubner RB, editors. Orofacial pain and temporomandibular disorders. Advances in pain research and therapy. New York: Raven Press; 1994.Google Scholar
  18. Reid KI, Gracely RH, Dubner RA. The influence of time, facial side, and location on pain-pressure thresholds in chronic myogenous temporomandibular disorder. J Orofac Pain. 1994;8:258–65.PubMedGoogle Scholar
  19. Schiffman EL, Truelove EL, Ohrbach R, et al. The research diagnostic criteria for temporomandibular disorders. I: overview and methodology for assessment of validity. J Orofac Pain. 2010;24(1):7–24.PubMedCentralPubMedGoogle Scholar
  20. Sim J, Wright CC. The kappa statistic in reliability studies: use, interpretation, and sample size requirements. Phys Ther. 2005;85(3):257–68.PubMedGoogle Scholar
  21. Stanford EA, Chambers CT, Craig KD. The role of developmental factors in predicting young children’s use of a self-report scale for pain. Pain. 2006;120(1–2):16–23.PubMedCrossRefGoogle Scholar
  22. Stinson JN, Kavanagh T, Yamada J, et al. Systematic review of the psychometric properties, interpretability and feasibility of self-report pain intensity measures for use in clinical trials in children and adolescents. Pain. 2006;125(1–2):143–57.PubMedCrossRefGoogle Scholar
  23. Vanderas AP, Papagiannoulis L. Multifactorial analysis of the etiology of temporomandibular dysfunction in children. Int J Paediatr Dent. 2002;12:336–46.PubMedCrossRefGoogle Scholar
  24. Vierola A, Suominen AL, Ikavalko T, et al. Clinical signs of temporomandibular disorders and various pain conditions among children 6 to 8 years of age: the PANIC study. J Orofac Pain. 2012;26(1):17–25.PubMedGoogle Scholar
  25. Visscher CM, Lobbezoo F, Naeije M. Comparison of algometry and palpation in the recognition of temporomandibular disorder pain complaints. J Orofac Pain. 2004;18:214–9.PubMedGoogle Scholar
  26. von Baeyer CL, Forsyth SJ, Stanford EA, et al. Response biases in preschool children’s ratings of pain in hypothetical situations. Eur J Pain. 2009;13(2):209–13.CrossRefGoogle Scholar
  27. Wahlund K, List T, Dworkin SF. Temporomandibular disorders in children and adolescents: reliability of a questionnaire, clinical examination, and diagnosis. J Orofac Pain. 1998;12:42–51.PubMedGoogle Scholar
  28. Wong DL, Baker CM. Pain in children: comparison of assessment scales. Pediatr Nurs. 1988;14:9–17.PubMedGoogle Scholar

Copyright information

© European Academy of Paediatric Dentistry 2013

Authors and Affiliations

  • T. C. Chaves
    • 1
    Email author
  • A. M. Turci
    • 2
  • H. M. Nagamine
    • 2
  • L. M. de Souza
    • 2
  • A. S. de Oliveira
    • 3
  • D. B. Grossi
    • 3
  1. 1.Department of Neurosciences and Behavioral Sciences, Ribeirão Preto School of Medicine, University of São Paulo, Faculdade de Medicina de Ribeirão PretoUniversidade de São Paulo, USPRibeirão Preto (SP)Brazil
  2. 2.Ribeirão Preto School of MedicineUniversity of São Paulo, USPRibeirão PretoBrazil
  3. 3.Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Ribeirão Preto School of MedicineUniversity of São Paulo, USPRibeirão PretoBrazil

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