Electric toothbrush application is a reliable and valid test for differentiating temporomandibular disorders pain patients from controls

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Background. Current methods for identifying patients with pain hypersensitivity are sufficiently complex to limit their widespread application in clinical settings. We assessed the reliability and validity of a simple multi-modal vibrotactile stimulus, applied using an electric toothbrush, to evaluate its potential as a screening tool for central sensitization. Methods. Fourteen female temporomandibular disorders (TMD) subjects with myofascial pain (RDC/TMD Ia or Ib) and arthralgia (RDC/TMD IIIa) were compared to 13 pain-free controls of matched age and gender. Vibrotactile stimulus was performed with an electric toothbrush, applied with 1 pound pressure for 30 seconds in four locations: over the lateral pole of the temporomandibular joint, masseter, temporalis, and mid-ventral surface of forearm. Pain intensity (0-10) was recorded following the stimulus at 0, 15, 30, and 60 seconds. Test-retest reliability was assessed with measurements from 8 participants, taken 2-12 hours apart. Case versus control differentiation involved comparison of area under the curve (AUC). A receiver operating characteristic (ROC) curve was used to determine cutoff AUC scores for maximum sensitivity and specificity for this multi-modal vibrotactile stimulus. Results. Test-retest reliability resulted in an ICC of 0.87 for all 4 pooled sites. ROC-determined AUC cutoff scores resulted in a sensitivity of 57% and specificity of 92% for all 4 pooled sites. Conclusion. The electric toothbrush stimulus had excellent test-retest reliability. Validity of the scores was demonstrated with modest sensitivity and good specificity for differentiating TMD pain patients from controls, which are acceptable properties for a screening test.

Original languageEnglish (US)
Article number94
JournalBMC Musculoskeletal Disorders
Issue number1
StatePublished - 2009

Bibliographical note

Funding Information:
Thanks to Amanda Jackson, Pat Lenton, and Linda Kingman for assistance in managing the research participants, and Mary Haugan for assistance in data management. Thanks also to Linda Bergstedt-Cleveland for English editing and Dr. Anne Marie Weber-Main for critical review and editing of manuscript drafts. This study was supported by University of Minnesota School of Dentistry and NIH grants K12-RR023247, U01-DE013331, N01-DE22635, and R01-DE011252.


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