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In USA konkrete Verbesserungen für Diagnosekriterien RDC/TMD vorgelegt

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Erstellt am Donnerstag, 05. Januar 2012 14:20
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Während in Deutschland die letzten Schlafmützen noch über die angebliche Notwendigkeit der "instrumentellen Funktionsanalyse" bei der Diagnose von TMD (in Deutschland noch CMD) schwafeln, wie hier noch im Bayerischen Zahnärzteblatt nachzulesen ist, geht die US-amerikanische RDC/TMD Diagnoseliste bereits in die Revision 2.0 . Dazu muss man wissen, dass die erste Ausgabe der RDC/TMD Kriterien bereits 1992 von den Wissenschaftlern Samuel Dworkin und Linda LeResche in Seattle, US Bundesstaat Washington, veröffentlicht wurden und seitdem einen - nach meinem (Joachim Wagner, Zahnarzt) Kenntnisstand - unangefochtenen Siegeszug weltweit als DIE Kriterien für die Einordnung von Schmerzen im Bermuda Dreieck Schläfe, Hals und Gesicht angetreten haben.

Wir besitzen jetzt schon hunderte von epidemiologischen Studien (= Nachzählstudien, wie der Schmerz nach RDC/TMD einzustufen ist) an vielen zigtausenden Menschen aus allen Teilen der Welt.  Und alle sagen ähnliches: Die Verteilung der Schmerzen um das Ohr verteilt sich weltweit in ganz bestimmten Verhältnissen auf die Gruppen römisch I (muskuläre TMD) die  Gruppe II (Gelenksfälle) und dem kleineren Rest.

Die deutsche Zahnmedizin hat bis etwa 2005 geglaubt, diese Diagnosekriterien von jenseits des großen Teiches völlig ignorieren zu können und weiter die eigene altbackene "CMD" Zahnklempner-Folklore durch allerlei Marketingtricks wie "CMD-Clinic", "CMD Tage", "CMD-Fortbildung" am Leben zu halten. Gottseidank sind aber endlich auch einige  Universitätsprofessoren aufgewacht und haben gemerkt, dass das auf Dauer in einer üblen wissenschaftlichen Sackgasse enden wird. So z.B. Leute aus der Leipziger  Uniklinik, Abteilung Prothetik, die darum 2006 die Eindeutschung der RDC/TMD vorgenommen haben.

Die USA RDC/TMD Forschergemeinde hat nun ihrerseits im Laufe der 20 Jahre gesehen, dass die ursprünglichen Formulierungen der Kriterien nicht mehr den neuesten Erkenntnissen entsprechen. Die nachfolgenden Verbesserungsvorschläge wurden Ende 2010 von einer Arbeitsgruppe um Dr. Gary C. Anderson, Universität Minnesota veröffentlicht. Mit dabei war auch ein enger Mitarbeiter des Ur-Teams um Dr. S. Dworkin aus Seattle, nämlich Dr. Edmont L. Truelove. Wir können also beruhigt davon ausgehen, dass die hier vorgeschlagenen Änderungen in wenigen Jahren zum Kanon des revidierten RDC/TMD Katalogs gehören.

Wer heute also wissen will, wie im Jahr 2020 international die Schmerzen im Bereich um die Ohren eingeteilt und bezeichnet werden, der kann das hier bereits lesen.

 

Die folgenden beiden Tabellen ("Table") 1 und 2 beziehen sich auf die Diagnose Achsen 1 und 2 der RDC/TMD. Ganz grob bedeutet das, dass die rein biologisch/anatomische Betrachtung des Patienten in der Achse 1 erscheint und die psychisch/soziale in der Achse 2. Darum werden in der Tabelle 2 viele aus der Allgemeinmedizin kommende Untersuchungs Fragebögen, z.B. der SCL-90, aufgeführt. Das sind planmäßige Erfassungsinstrumente zur Feststellung der gegenwärtigen Lebensqualität, Sorgen, Nöte etc.

Ich, Joachim Wagner, Zahnarzt, lege großen Wert darauf, dass hier besonders meine Kollegen/innen nachlesen können, dass eine korrekte Beurteilung von TMD Patienten ohne die Achse 2 Fragenkataloge keinen richtigen Sinn ergibt. Es reicht eben nicht aus, sich nur ein Bild von den Schmerzen oder womöglich nur vom "stomatognathen System" (= hochtrabende Bezeichnung für den Mund mit allem drum und dran) zu machen. Für die betroffenen Frauen spielt die aktuelle Lebensqualität eine viel wichtigere Rolle und da wirken ganz andere Faktoren hinein, wie z.B. eine Depression, die sich beispielsweise mit dem SCL-90 zuverlässig erkennen läßt.

 

From:
J Orofac Pain. Author manuscript; available in PMC 2011 August 17.
Published in final edited form as:
 J Orofac Pain. 2010 Winter; 24(1): 79–88.

Table 1
Proposed Outline for an Expanded Axis I: Clinical TMD Conditions
Modifications to the original Axis I, including additional diagnostic subgroups and terminology changes, are italicized. A designates diagnoses validated by the RDC/TMD Validation Project; B designates conditions with analysis in progress, using the RDC/TMD Validation Project data set.
Group I: Muscle Disorders
  • I.a. Myofascial Pain A
  • I.b. Myofascial Pain with Limited Opening A
  • I.c. Myofascial Pain with ReferralB
  • I.d.Temporalis TendonitisB
Group II: Disc Displacements
  • II.a. Disc Displacement with Reduction A with imaging
  • II.b. Disc Displacement without Reduction without Limited Opening A with imaging
  • II.c. Disc Internal Derangement with Reduction with Transient Limited OpeningB with imaging
  • II.d. Disc Internal Derangement without Reduction with Limited OpeningA with imaging
Group III: Arthralgia/Arthritis/Arthrosis
  • III.a. Arthralgia A/Arthritis
  • III.b. Osteoarthritis A with imaging/Degenerative Joint Disease
  • III.c. Osteoarthrosis A with imaging/Degenerative Joint Disease
Group IV: Temporomandibular Joint Hypermobility
  • IV.a. Subluxation/LuxationB
Group V: Tension-type Headache with Temporalis Muscle Tenderness
  • V.a. Infrequent Episodic Tension-type Headache Involving the Temporalis MuscleB
  • V.b. Frequent Episodic Tension-type Headache Involving the Temporalis MuscleB
  • V.c. Chronic Tension-type Headache Involving the Temporalis MuscleB
From:
J Orofac Pain. Author manuscript; available in PMC 2011 August 17.
Published in final edited form as:
 J Orofac Pain. 2010 Winter; 24(1): 79–88.

Table 2
Proposed Outline for an Expanded Axis II: Pain and Biobehavioral Status
The Axis II instruments are designed to screen for biobehavioral status and pain. They are not diagnostic instruments. Constructs and/or instruments proposed as additions or modifications to the original RDC/TMD are italicized. A designates instruments validated for TMD by the RDC/TMD Validation Project; B designates measurements with data analysis for TMD in progress; C designates instruments validated in other settings; D designates proposed instruments fulfilling the recommendations of IMMPACT.
2.1 General Screeners
  • 2.1.1 Emotion: Depression (Symptom Checklist 90-Revised [SCL-90-R] derived)5A
  • 2.1.2 Physical Functioning: Pain-related Disability (Graded Chronic Pain Scale [GCPS])5A
  • 2.1.3 Comorbid Symptoms: Nonspecific physical symptoms (SCL-90-R derived)B
  • 2.1.4 Oral Behaviors ChecklistB, D
2.2 Pain
  • 2.2.1 Pain Intensity: Characteristic Pain Intensity (from GCPS)5A
  • 2.2.2 Pain Affect: from Short Form McGill Pain Questionnaire-Revised (SF-MPQ-R)51B
  • 2.2.3 Temporal Patterning of Pain: instrument to be developedB, D
2.3 Physical Functioning
  • 2.3.1 Disease-specific Functional Limitation: Jaw Functional Limitation Scale32,52C, D
  • 2.3.2 Oral Health-related Quality of Life: Oral Health Impact Profile53C, D
  • 2.3.3 Health-related Quality of Life: Short Form (SF)-12 (or SF-36)54–56B, D
  • 2.3.4 Sleep: Pittsburgh Sleep Quality Index (PSQI)57B, D
2.4 Emotional Functioning
  • 2.4.1 Anxiety, Anger (SCL-90-R derived)B, C, D
  • 2.4.2 General Emotions: Profile of Mood States (POMS)58C, D
2.5 Global Status Rating
  • 2.5.1 Patient Global Impression of Change (PGIC)59C, D

 

 

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1. Anderson GC, Gonzalez YM, Ohrbach R, u. a. The Research Diagnostic Criteria for Temporomandibular Disorders. VI: future directions. J Orofac Pain. 2010;24(1):79-88.

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