• Daniele ManfrediniEmail author
  • Rosa Arboretti
  • Eleonora Carrozzo
  • Luca Guarda-Nardini
Part of the SpringerBriefs in Statistics book series (BRIEFSSTATIST)


This chapter, introductory in nature, is likely the core part of the book. It summarizes the available knowledge on temporomandibular disorders (TMD), a heterogeneous group of orofacial pain conditions that are the main subject of most investigations described and commented throughout the book. TMD are gaining attention from several medical professions, with more than 15,000 citations listed in the medline database at the end of the year 2013. This specific field of expertise is going through an epochal change because, after decades of mechanicistic approaches to their diagnosis and treatment, which were based on the correction of dental occlusion abnormalities, there is now consensus that TMD are musculoskeletal disorders requiring a multidimensional approach. Consequently, such a very complex field may reflect in several different types of investigations depending on the aims that are pursued. Also, the validity of findings is conditioned by the validity of the statistical design. In particular, several strategies can be identified to perform studies on the etiology, diagnosis, and treatment of the disease. In this chapter, a brief introduction to the importance of choosing the right statistical approach in the design of dental research is followed by the description of the current concepts on TMD clinics. This may serve as a fundamental basis for the readers to get through the different example investigations strategies that are described in the following chapters with more specific contents.


Sample Size Calculation Myofascial Pain Sham Acupuncture Orofacial Pain Visual Analogue Scale Rating 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Bland M. An introduction to medical statistics. 2nd ed. Oxford: Oxford Medical Publications; 1995.Google Scholar
  2. Clark GT, Lanham F, Flack VF. Treatment outcome results for consecutive TMJ clinic patients. J Craniomandib Disord. 1988;2:87–95.Google Scholar
  3. Dao TTT, Lavigne GJ, Feine JS, Tanguay R, Lund JP. Power and sample size calculations for clinical trials of myofascial pain of jaw muscles. J Dent Res. 1991;70:118–22.CrossRefGoogle Scholar
  4. De Boever JA, Nilner M, Orthlieb JD, Steenks MH. Recommendations by the EACD for examination, diagnosis, and management of patients with temporomandibular disorders and orofacial pain by the general dental practitioner. J Orofac Pain. 2008;22:268–78.Google Scholar
  5. De Laat A, Stappaers K, Papy S. Counseling and physical therapy as treatment for myofascial pain of the masticatory system. J Orofac Pain. 2003; 17:42–9.Google Scholar
  6. De Leeuw R. Internal derangements of the temporomandibular joint. Oral Maxillofac Surg Clin North Am. 2008a;20:159–68.CrossRefGoogle Scholar
  7. De Leeuw R. The American academy of orofacial pain. Orofacial pain: guidelines for assessment, diagnosis, and management. Chicago: Quintessence Publishing; 2008b.Google Scholar
  8. Dionne RA. Pharmacologic treatment of acute and chronic orofacial pain. Oral Maxillofac Surg Clin North Am. 2000;12:309–20.Google Scholar
  9. Dodson TB. A guide for preparing a patient-oriented research manuscript. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104:307–15.CrossRefGoogle Scholar
  10. Dolwick MF, Dimitroulis G. Is there a role for temporomandibular joint surgery? Brit J Oral Maxillofac Surg. 1994;32:307–13.CrossRefGoogle Scholar
  11. Duncan GH, Bushnell MC, Lavigne GJ. Comparison of verbal and visual analogue scales for measuring the intensity and unpleasantness of experimental pain. Pain. 1989;37:295–303.CrossRefGoogle Scholar
  12. Dworkin SF, Leresche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord. 1992;6:301–55.Google Scholar
  13. Ekblom A, Hansson P. Pain intensity measurements in patients with acute pain receiving afferent stimulation. J Neurol Neurosurg Psychiatry. 1988;51:481–6.CrossRefGoogle Scholar
  14. Feine JS, Dao TTT, Lavigne GJ, Lund JP. Is treatment success due to faulty memory of chronic pain? J Dent Res. 1989; 68:1018 (abstract).Google Scholar
  15. Freiman JA, Chalmers TC, Smith H, Kuebler RR. The importance of beta, the type II error, and sample size in the design and interpretation of the randomized controlled trial: survey of 71 “negative” trials. N Engl J Med. 1978;299:690–4.CrossRefGoogle Scholar
  16. Gatchel RJ, Stowell AW, Wildenstein L, Riggs R, Ellis E. Efficacy of an early intervention for patients with acute TMD-related pain: a one-year outcome study. J Am Dent Assoc. 2006;137:339–47.CrossRefGoogle Scholar
  17. Gavish A, Winocur E, Astandzelov-Nachmias T, Gazit E. Effect of controlled masticatory exercise on pain and muscle performance in myofascial pain patients: a pilot study. Cranio. 2006;24:184–90.CrossRefGoogle Scholar
  18. Goddard G, Karibe H, McNeill C, Villafuerte E. Acupuncture and sham acupuncture reduce muscle pain in myofascial pain patients. J Orofac Pain. 2002;16:71–6.Google Scholar
  19. Greene C. Concepts of TMD etiology: effects on diagnosis and treatment. In: Laskin DM, Greene CS, Hylander WL, editors. TMDs: an evidence-based approach to diagnosis and treatment. Chicago: Quintessence Publishing; 2006a. p. 219–28.Google Scholar
  20. Greene CS. Science transfer in orofacial pain. In: Lund JP, Lavigne GJ, Dubner R, Sessle BJ, editors. Orofacial pain: from basic science to clinical management. Chicago: Quintessence Publishing; 2006b. p. 281–86.Google Scholar
  21. Guarda-Nardini L, Stifano M, Brombin C, Salmaso L, Manfredini D. A one-year case series of arthrocentesis with hyaluronic acid injections for temporomandibular joint osteoarthritis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103:e14–22.CrossRefGoogle Scholar
  22. Guarda-Nardini L, Manfredini D, Ferronato G. Temporomandibular joint total replacement prosthesis: current knowledge and considerations for the future. Int J Oral Maxillofac Surg. 2008;37:103–10.CrossRefGoogle Scholar
  23. Jekel J. Epidemiology, biostatistics and preventive medicine. Philadelphia: W.B. Saunders Company; 1996.Google Scholar
  24. Klasser GD, Greene CS. Oral appliances in the management of temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009a;107:212–23.CrossRefGoogle Scholar
  25. Klasser GD, Greene CS. The changing field of temporomandibular disorders: what dentists need to know. J Can Dent Assoc. 2009b;75:49–53.Google Scholar
  26. Koh H, Robinson PG. Occlusal adjustment for treating and preventing temporomandibular joint disorders. Cochrane Database Syst Rev. 2003;(1):CD003812.Google Scholar
  27. Kropmans TJB, Stegenga B, Dijkstra PU, Van Veen A. The smallest detectable difference of mandibular function impairment in patients with a painfully restricted temporomandibular joint. J Dent Res. 1999;78:1445–9.CrossRefGoogle Scholar
  28. Laskin DM. Etiology of the pain-dysfunction syndrome. J Am Dent Assoc. 1969;79:147–53.Google Scholar
  29. Lund JP, Widmer CG, Feine JS. Validity of diagnostic and monitoring tests used for temporomandibular disorders. J Dent Res. 1995;74:1133–43.CrossRefGoogle Scholar
  30. Machin D, Campbell MJ, Fayers PM, Pinol APY. Sample size tables for clinical studies. 2nd ed. Oxford: Blackwell Science; 1997.Google Scholar
  31. Magnusson T, Egermark I, Carlsson GE. A prospective investigation over two decades on signs and symptoms of temporomandibular disorders and associated variables. A final summary. Acta Odontol Scand. 2005;63:99–109.Google Scholar
  32. Manfredini D. Fundamentals of TMD management. In: Manfredini D, editor. Current concepts on temporomandibular disorders. Berlin: Quintessence Publishing; 2010a. p. 305–18.Google Scholar
  33. Manfredini D. Integration of research into the clinical practice. In: Manfredini D, editor. Current concepts on temporomandibular disorders. Berlin: Quintessence Publishing; 2010b. p. 459–68.Google Scholar
  34. Manfredini D, Tognini F, Biondi K, Bosco M. Sample size calculation for studies on temporomandibular disorders. Minerva Stomatol. 2003;52:309–19.Google Scholar
  35. Manfredini D, Chiappe G, Bosco M. Research diagnostic criteria for temporomandibular disorders (RDC/TMD) axis I diagnosis in an italian patients population. J Oral Rehabil. 2006;33:551–8.CrossRefGoogle Scholar
  36. Manfredini D, Piccotti F, Ferronato G, Guarda-Nardini L. Age peaks of different RDC/TMD diagnoses in a patient population. J Dent. 2010;38:392–9.CrossRefGoogle Scholar
  37. Manfredini D, Castroflorio T, Perinetti G, Guarda-Nardini L. Dental occlusion, body posture, and temporomandibular disorders: where we are now and where we are heading for. J Oral Rehabil. 2012a;39:463–71.CrossRefGoogle Scholar
  38. Manfredini D, Winocur E, Guarda-Nardini L, Lobbezoo F. Self-reported bruxism and temporomandibular disorders: findings from two specialised centers. J Oral Rehabil. 2012b;39:319–25.CrossRefGoogle Scholar
  39. Manfredini D, Favero L, Michieli M, Salmaso L, Cocilovo F, Guarda-Nardini L. Assessment of jaw kinesiography to monitor temporomandibular disorders: correlation of treatment-related kinesiographic and pain changes in patients undergoing TMJ injections. J Am Dent Assoc. 2013a;144:397–405.CrossRefGoogle Scholar
  40. Manfredini D, Winocur E, Guarda-Nardini L, Paesani D, Lobbezoo F. Epidemiology of bruxism in adults: a systematic review of literature. J Orofac Pain. 2013b;27:99–110.CrossRefGoogle Scholar
  41. Moher D, Dulberg C, Wells G. Statistical power, sample size, and their reporting in randomized controlled trials. JAMA. 1994;272:122–4.CrossRefGoogle Scholar
  42. Nitzan DW, Dolwick MF, Martinez GA. Temporomandibular joint arthrocentesis: a simplified treatment for severe, limited mouth opening. J Oral Maxillofac Surg. 1991;49:1163–7.CrossRefGoogle Scholar
  43. Okeson JP. The classification of orofacial pains. Oral Maxillofac Surg Clin N Am. 2008;20:133–44.CrossRefGoogle Scholar
  44. Pandis N, Polychronopoulou A, Eliades T. Sample size estimation: an overview with applications to orthodontic clinical trial designs. Am J Orthod Dentofacial Orthop. 2011;140:141–6.CrossRefGoogle Scholar
  45. Pocock SJ, Hughes MD, Lee RJ. Statistical problems in the reporting of clinical trials: a survey of three medical journals. N Engl J Med. 1987;317:426–32.CrossRefGoogle Scholar
  46. Price DD, McGrath PA, Rafii A, Buckingham B. The validation of Visual Analogue Scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17:45–56.CrossRefGoogle Scholar
  47. Pullinger A, Seligman D. Quantification and validation of predictive values of occlusal variables in temporomandibular disorders using a multifactorial analysis. J Prosthet Dent. 2000;83:66–75.CrossRefGoogle Scholar
  48. Rollmann GB, Gillespie JM. The role of psychosocial factors in temporomandibular disorders. Curr Rev Pain. 2000;4:71–81.CrossRefGoogle Scholar
  49. Schiffmann E, Fricton JR, Harley D, Shapiro BL. The prevalence and treatment needs of subjects with temporomandibular disorders. J Am Dent Assoc. 1990;120:295–304.Google Scholar
  50. Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, List T, Svensson P, Gonzalez Y, Lobbezoo F, Michelotti A, Brooks SL, Ceusters W, Drangsholt M, Ettlin D, Gaul C, Goldberg LJ, Haythornthwaite JA, Hollender L, Jensen R, John MT, De Laat A, de Leeuw R, Maixner W, van der Meulen M, Murray GM, Nixdorf DR, Palla S, Petersson A, Pionchon P, Smith B, Visscher CM, Zakrzewska J, Dworkin SF. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the international RDC/TMD consortium network* and orofacial pain special interest group†. J Oral Facial Pain Headache. 2014;28:6–27.Google Scholar
  51. Stohler C, Zarb G. On the management of temporomandibular disorders: a plea for low-tech, high-prudence therapeutic approach. J Orofac Pain. 1999;13:255–61.Google Scholar
  52. Turp JC, Schindler HJ. Occlusal therapy of temporomandibular pain. In: Manfredini D, editor. Current concepts on temporomandibular disorders. Berlin: Quintessence Publishing; 2010. p. 359–82.Google Scholar
  53. Turp JC, Greene CS, Strub JR. Dental occlusion: a critical reflection on past, present and future concepts. J Oral Rehabil. 2008;35:446–53.CrossRefGoogle Scholar
  54. Von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147:573–7.CrossRefGoogle Scholar
  55. Wittes J. Sample size calculations for randomised controlled trials. Epidemiol Rev. 2002;24:39–53.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2014 2014

Authors and Affiliations

  • Daniele Manfredini
    • 1
    Email author
  • Rosa Arboretti
    • 1
  • Eleonora Carrozzo
    • 1
  • Luca Guarda-Nardini
    • 1
  1. 1.University of PadovaPadovaItaly

Personalised recommendations