Delaine Rodrigues-Bigaton

Intra and inter-rater reliability of infrared image analysis of masticatory and upper trapezius muscles in women with and without temporomandibular disorder

BACKGROUND Infrared thermography is an aid tool that can be used to evaluate several pathologies given its efficiency in analyzing the distribution of skin surface temperature. OBJECTIVES To propose two forms of infrared image analysis of the masticatory and upper trapezius muscles, and to determine the intra and inter-rater reliability of both forms of analysis. METHOD Infrared images of masticatory and upper trapezius muscles of 64 female volunteers with and without temporomandibular disorder (TMD) were collected. Two raters performed the infrared image analysis, which occurred in two ways: temperature measurement of the muscle length and in central portion of the muscle. The Intraclass Correlation Coefficient (ICC) was used to determine the intra and inter-rater reliability. RESULTS The ICC showed excellent intra and inter-rater values for both measurements: temperature measurement of the muscle length (TMD group, intra-rater, ICC ranged from 0.996 to 0.999, inter-rater, ICC ranged from 0.992 to 0.999; control group, intra-rater, ICC ranged from 0.993 to 0.998, inter-rater, ICC ranged from 0.990 to 0.998), and temperature measurement of the central portion of the muscle (TMD group, intra-rater, ICC ranged from 0.981 to 0.998, inter-rater, ICC ranged from 0.971 to 0.998; control group, intra-rater, ICC ranged from 0.887 to 0.996, inter-rater, ICC ranged from 0.852 to 0.996). CONCLUSION The results indicated that temperature measurements of the masticatory and upper trapezius muscles carried out by the analysis of the muscle length and central portion yielded excellent intra and inter-rater reliability.

Assessment of the Upper Trapezius Muscle Temperature in Women With and Without Neck Pain

OBJECTIVE The purpose of the study was to analyze the upper trapezius muscle temperature using thermography in women with and without neck pain. METHODS Thirty-six female university students were classified through the Neck Disability Index (NDI) into 2 groups: the neck pain group comprised 18 volunteers diagnosed with mild disability, and the control group, 18 healthy volunteers. All subjects were submitted to evaluation by thermography, which registered the skin surface temperature of the upper bilateral trapezius muscle. Student t test and Mann-Whitney U test were used for the comparison between the groups, and the Spearman correlation coefficient was used for the appropriate correlations between the NDI score and the temperature values. A significance level of 5% was set. RESULTS No significant difference was found between the groups regarding the temperature values of the upper left (P = .565) and right (P = .917) trapezius muscles, as well as in comparisons of temperature asymmetry (P = .542). In addition, no significant association was found between the study variables (P > .05). CONCLUSION Women with neck pain, diagnosed with mild disability by NDI, did not present with reduction or asymmetry of upper trapezius muscle temperature when compared with a group without neck pain.

Accuracy of Infrared Thermography of the Masticatory Muscles for the Diagnosis of Myogenous Temporomandibular Disorder

OBJECTIVE The purpose of this study was to evaluate the accuracy of infrared thermography of the central point of the masseter and anterior temporalis muscles for the diagnosis of myogenous temporomandibular disorder (TMD). METHODS This is an observational study of university women with and without TMD. Through the use of the Research Diagnostic Criteria for Temporomandibular Disorders, 104 women were divided into a TMD group (n = 52) and control group (n = 52). All volunteers had their masseter and anterior temporalis muscles evaluated by infrared thermography. The receiver operating characteristic (ROC) curve was used to determine the accuracy of diagnosis (area under the ROC curve), the best cut-off point, sensitivity, and specificity. RESULTS No significant differences were observed (P > .05) in the skin surface temperature of the masticatory muscles, when the groups were compared. With regard to the ROC curve, the area under the curve was lower than the recommended for all the muscles tested, ranging from 0.433 to 0.502. CONCLUSION The findings of this study suggest that infrared thermography of the masticatory muscles is not an accurate instrument for the myogenous TMD diagnosis.

Accuracy of two forms of infrared image analysis of the masticatory muscles in the diagnosis of myogenous temporomandibular disorder

The aim of the present study was to assess the accuracy of two forms of infrared image analysis (area and extension) of the masseter and anterior temporalis muscles in the diagnosis of myogenous temporomandibular disorder (TMD). A cross-sectional study was carried out involving 104 female volunteers from the university community. Following the application of the Research Diagnostic Criteria for Temporomandibular Disorders, the volunteers were divided into a TMD group (n = 52) and control group (n = 52), and evaluated using infrared thermography. The area and extension of the masseter and anterior temporalis muscles were measured on the images. The receiver operating characteristic (ROC) curve was used to determine diagnostic accuracy (area under the curve), best cutoff point, sensitivity and specificity. A significant difference in skin temperature between groups was only found in the measurement of the area of the left anterior temporalis muscle (p = 0.011). The area under the ROC curve was less than the reference values for all muscles evaluated in the analyses of area and extension. Thus, neither method of infrared thermography tested for the quantification of the masseter and anterior temporalis muscles (analysis of area and extension) is consistent with the RDC/TMD for the diagnosis of myogenous TMD in women.

Accuracy and reliability of infrared thermography in the diagnosis of arthralgia in women with temporomandibular disorder.

OBJECTIVE The purpose of this study was to determine the accuracy and reliability of infrared thermography in the diagnosis of arthralgia in women with temporomandibular disorder. METHODS Thirty women aged between 18 and 40 years were recruited for the study. The Research Diagnostic Criteria for Temporomandibular Disorders was used to allocate the volunteers to the control group (n = 15) and arthralgia group (n = 15). Both groups were submitted to infrared thermography of the temporomandibular joint (TMJ), followed by a punctual analysis of the images. The Mann-Whitney U test was used for the comparison of skin surface temperature between groups. The intraclass correlation coefficient was calculated to determine the reliability of the infrared image analysis. The receiver operating characteristic curve was used to determine the accuracy of the diagnosis. RESULTS Skin temperature was significantly greater over the left (P = .004) and right (P = .012) TMJ in the arthralgia group. The intraclass correlation coefficient ranged from 0.841 to 0.874. The area under the receiver operating characteristic curve ranged from 0.598 to 0.675. CONCLUSION Excellent intrarater and interrater reliability was found in the analysis of the infrared images of the TMJ. However, infrared thermography demonstrated a low accuracy in the diagnosis of arthralgia in women with temporomandibular disorder.

Accuracy of the surface electromyography RMS processing for the diagnosis of myogenous temporomandibular disorder

Due to the multifactor etiology of temporomandibular disorder (TMD), the precise diagnosis remains a matter of debate and validated diagnostic tools are needed. The aim was to determine the accuracy of surface electromyography (sEMG) activity, assessed in the amplitude domain by the root mean square (RMS), in the diagnosis of TMD. One hundred twenty-three volunteers were evaluated using the Research Diagnostic Criteria for Temporomandibular Disorders and distributed into two groups: women with myogenous TMD (n=80) and women without TMD (n=43). The volunteers were then submitted to sEMG evaluation of the anterior temporalis, masseter and suprahyoid muscles at rest and during maximum voluntary teeth clenching (MVC) on parafilm. The accuracy, sensitivity and specificity of the muscle activity were analyzed. Differences between groups were found in all muscles analyzed at rest as well as in the masseter and suprahyoid muscles during MVC on parafilm. Moderate accuracy (AUC: 0.74-0.84) of the RMS sEMG was found in all muscles regarding the diagnosis of TMD at rest and in the suprahyoid muscles during MVC on parafilm. Moreover, sensitivity ranging from 71.3% to 80% and specificity from 60.5% to 76.6%. In contrast, RMS sEMG did not exhibit acceptable degrees of accuracy in the other masticatory muscles during MVC on parafilm. It was concluded that the RMS sEMG is a complementary tool for clinical diagnosis of the myogenous TMD.

Effects of upper thoracic manipulation on pressure pain sensitivity in women with temporomandibular disorder: a randomized, double-blind, clinical trial.

Objective The aim of the present study was to evaluate the effects of upper thoracic manipulation on pain in subjects with temporomandibular disorder. Design Thirty-two women with a diagnosis of temporomandibular disorder were randomly allocated to an experimental group (n = 16), submitted to upper thoracic manipulation, and a placebo group (n = 16), submitted to a procedure in the thoracic region with no therapeutic effect. All volunteers underwent an evaluation of pain in the masticatory muscles and the temporomandibular joint using an algometer and the visual analog scale before and immediately after the procedure as well as after 48–72 hrs. Two-way repeated-measures analysis of variance was used for the intragroup and intergroup analyses, with the level of significance set to 5% (P < 0.05). Cohen d was calculated for the determination of the effect size. Results No significant group-by-time interaction was found (P > 0.05) for algometry in any analysis, and Cohen d revealed no significant effect of the treatment. Moreover, no significant group-by-time interaction was found for facial pain intensity determined using the visual analog scale (P > 0.05), and Cohen d also revealed no significant effect of the treatment regarding this variable. Conclusions On the basis of the present findings, upper thoracic spinal manipulation does not lead to a reduction in pain in women with temporomandibular disorder.

Accuracy of the Fonseca anamnestic index in the identification of myogenous temporomandibular disorder in female community cases

The aim of the present study was to evaluate the accuracy of the Fonseca anamnestic index (FAI) in the identification of myogenous temporomandibular disorder (TMD). Two hundred and three female volunteers participated in this study, 117 with myogenous TMD and 86 without TMD. The Research Diagnostic Criteria for Temporomandibular Disorders were first applied as the gold standard for the diagnosis. The volunteers then answered the 10 items on the FAI, which furnished a score ranging from 0 to 100 points. The receiver operating characteristic (ROC) was used to determine the accuracy of the diagnosis (area under the curve) and the best cutoff point of the tool. Thus, FAI demonstrated a high degree of accuracy for the diagnosis of myogenous TMD (area under the ROC curve of 0.940). The best cutoff point was a score of 47.50. Thus, a score ranging from 0 to 45 points corresponds to the absence of myogenous TMD and scores ranging from 50 to 100 points identifies individuals with the disorder. In conclusion, the high degree of diagnostic accuracy demonstrates that the FAI can be employed for the identification of myogenous TMD in female community cases.

Women with more severe degrees of temporomandibular disorder exhibit an increase in temperature over the temporomandibular joint

Aim The purpose of the present study was to correlate the degree of temporomandibular disorder (TMD) severity and skin temperatures over the temporomandibular joint (TMJ) and masseter and anterior temporalis muscles. Materials and methods This blind cross-sectional study involved 60 women aged 18–40 years. The volunteers were allocated to groups based on Fonseca anamnestic index (FAI) score: no TMD, mild TMD, moderate TMD, and severe TMD (n = 15 each). All volunteers underwent infrared thermography for the determination of skin temperatures over the TMJ, masseter and anterior temporalis muscles. The Shapiro–Wilk test was used to determine the normality of the data. The Kruskal–Wallis test, followed by Dunn’s test, was used for comparisons among groups according to TMD severity. Spearman’s correlation coefficients were calculated to determine the strength of associations among variables. Results Weak, positive, significant associations were found between FAI score and skin temperatures over the left TMJ (rs = 0.195, p = 0.009) and right TMJ (rs = 0.238, p = 0.001). Temperatures over the right and left TMJ were significantly higher in groups with more severe TMD (p < 0.05). Conclusion FAI score was associated with skin temperature over the TMJ, as determined by infrared thermography, in this sample. Women with more severe TMD demonstrated a bilateral increase in skin temperature.

Correlation between skin surface temperature over masticatory muscles and pain intensity in women with myogenous temporomandibular disorder.

BACKGROUND AND OBJECTIVE Pain is a common clinical manifestation in individuals with temporomandibular disorder (TMD). The literature report changes in microcirculation in this condition. The aim of the present study was to correlate skin surface temperature at the central point of the masticatory muscles with pain intensity in women with myogenous TMD. MATERIALS AND METHODS The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and the visual analogue scale (VAS) were used to divide 40 female university students into four groups: control group (n=10), mild pain group (n=10), moderate pain group (n=10) and severe pain group (n=10). Infrared thermography was used to assess the masticatory muscles. RESULTS No significant correlations were found between pain intensity and skin surface temperature over the left masseter (p=0.368), right masseter (p=0.618), left anterior temporalis (p=0.293) and right anterior temporalis (p=0.922) muscles. No correlations were found between pain intensity and asymmetry of the masseter (p=0.375) and anterior temporalis (p=0.090) muscles. Moreover, no significant difference in skin surface temperature (p> 0.05) was found among the different groups. CONCLUSION Pain intensity in women with myogenous TMD was not associated with skin surface temperature at the central point of the masseter and anterior temporalis muscles.