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In temporomandibular
disorder (TMD) patients, the pressure pain threshold (PPT) is
not adequate to diagnose and screen orofacial pain.
A recent study depicted that in TMD patients experiencing orofacial pain, the PPT is not an efficient approach for screening and evaluating pain. For such patients, it should not be utilized as the only diagnostic tool.
A systematic review was carried out to determine the usefulness and efficacy of the PPT approach for screening and assessing orofacial pain. From 1 December 2017 through 12 January 2018, a literature search was conducted, and data were procured from Medline (EBSCO), PubMed, ScienceDirect, Dentistry and Oral Sciences Source, ProQuest, and Scopus databases.
Notably, the search yielded 123 articles. After screening of abstracts and elimination of duplicate articles, 32 articles were chosen for further assessment. For evaluating the studies, the Cochrane Collaboration tool for assessing the risk of bias was utilized.
Overall, 4403 adult patients (aged 16-62), 30 children were included in this analysis to explore the validity and reliability of the PPT (measured by a pressure algometer) in TMD individuals. In relation to the menstrual cycle, headache, oral contraception, occlusal interference, and occlusal appliances, the PPT was evaluated.
Notably, the risk of bias was small to unclear. A small sample size and short duration of the testing involved were some of the structural limitations inherent in the studies. There was a paucity of consistency in study design and patient management in the evaluated studies.
From 20 kPa/s to 50 kPa/s and from 0.5 kg/cm2/s to 2 kg/cm2/s, the pressure increase values varied.
From very precise and repeatable to a simple listing of anatomical points, the descriptions of the PPT examination points also varied. The number of measurements was found to range from 1 to 5 at each visit. The intervals varied from 5 seconds to 15 minutes.
The pressure algometer was found to be a useful tool for assessing the source of orofacial pain in some studies. However, there is a requisition of additional well-designed clinical trials of the PPT to validate it.
Thus, the PPT approach is not a useful tool to diagnose and manage orofacial pain.
Occupational Therapy International
The Usefulness of the Pressure Algometer in the Diagnosis and Treatment of Orofacial Pain Patients: A Systematic Review
Agata Kamińska
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