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      Economic inequalities and temporomandibular disorders: A systematic review with meta‐analysis

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          Abstract

          Introduction

          Temporomandibular disorders (TMDs) are a common and debilitating condition that affects millions of people globally. Despite extensive research on TMDs, the exact causes of these conditions remain unclear. However, various factors, including genetics, injury and stress, have been implicated in their development. In addition to these traditional risk factors, the literature suggests that socioeconomic status (SES) may also play a role in the development and progression of TMDs. By synthesizing the available evidence, this review will provide a comprehensive understanding of the role of SES in TMDs and will inform the development of targeted interventions to reduce the burden of these disorders among individuals with lower SES.

          Methods

          We conducted this systematic review followed the recommendations of the Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) 2020. PubMed, Scopus and Lilacs were searched using the terms: ((socio‐economic status OR economic status) AND (temporomandibular disorders OR temporomandibular joint) from the inception until February 10, 2023. We applied the following questions: (P) Participants consisted of human subjects. (E) The Exposure consisted of low economic stats. (C) The Comparison: subjects reporting low economic status were compared to subjects reporting medium–high economic status. (O) The Outcome consisted of TMDs diagnosis. Review Manager version 5.2.8 (Cochrane Collaboration; 2014) software was applied to perform the pooled analysis.

          Results

          The included subjects in this review were 14 607. Among them, 631 reported a low economic income, 1880 a medium–high economic income, 4617 were blue‐collar workers and 7478 were white‐collar workers or entrepreneurs. Among those reporting a low economic income or belonging to the blue‐collar workers 12.93% (679/5248) presented sign/symptoms of TMD or a diagnosis of TMD whereas 10.6% (997/9358) of those with a high economic income/white‐collar worker.

          Conclusion

          We observed a slightly higher prevalence of TMD among individuals with a low economic income Further research is needed to better understand this relationship and to develop effective interventions to reduce the burden of TMD among individuals with low income.

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          Most cited references37

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          The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

          The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
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            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†.

            The original Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms have been demonstrated to be reliable. However, the Validation Project determined that the RDC/TMD Axis I validity was below the target sensitivity of ≥ 0.70 and specificity of ≥ 0.95. Consequently, these empirical results supported the development of revised RDC/TMD Axis I diagnostic algorithms that were subsequently demonstrated to be valid for the most common pain-related TMD and for one temporomandibular joint (TMJ) intra-articular disorder. The original RDC/TMD Axis II instruments were shown to be both reliable and valid. Working from these findings and revisions, two international consensus workshops were convened, from which recommendations were obtained for the finalization of new Axis I diagnostic algorithms and new Axis II instruments. Through a series of workshops and symposia, a panel of clinical and basic science pain experts modified the revised RDC/TMD Axis I algorithms by using comprehensive searches of published TMD diagnostic literature followed by review and consensus via a formal structured process. The panel's recommendations for further revision of the Axis I diagnostic algorithms were assessed for validity by using the Validation Project's data set, and for reliability by using newly collected data from the ongoing TMJ Impact Project-the follow-up study to the Validation Project. New Axis II instruments were identified through a comprehensive search of the literature providing valid instruments that, relative to the RDC/TMD, are shorter in length, are available in the public domain, and currently are being used in medical settings. The newly recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for detecting any pain-related TMD as well as valid diagnostic criteria for differentiating the most common pain-related TMD (sensitivity ≥ 0.86, specificity ≥ 0.98) and for one intra-articular disorder (sensitivity of 0.80 and specificity of 0.97). Diagnostic criteria for other common intra-articular disorders lack adequate validity for clinical diagnoses but can be used for screening purposes. Inter-examiner reliability for the clinical assessment associated with the validated DC/TMD criteria for pain-related TMD is excellent (kappa ≥ 0.85). Finally, a comprehensive classification system that includes both the common and less common TMD is also presented. The Axis II protocol retains selected original RDC/TMD screening instruments augmented with new instruments to assess jaw function as well as behavioral and additional psychosocial factors. The Axis II protocol is divided into screening and comprehensive self report instrument sets. The screening instruments' 41 questions assess pain intensity, pain-related disability, psychological distress, jaw functional limitations, and parafunctional behaviors, and a pain drawing is used to assess locations of pain. The comprehensive instruments, composed of 81 questions, assess in further detail jaw functional limitations and psychological distress as well as additional constructs of anxiety and presence of comorbid pain conditions. The recommended evidence-based new DC/TMD protocol is appropriate for use in both clinical and research settings. More comprehensive instruments augment short and simple screening instruments for Axis I and Axis II. These validated instruments allow for identification of patients with a range of simple to complex TMD presentations.
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              Identifying the PECO: A framework for formulating good questions to explore the association of environmental and other exposures with health outcomes

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                Author and article information

                Contributors
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                Journal
                Journal of Oral Rehabilitation
                J of Oral Rehabilitation
                Wiley
                0305-182X
                1365-2842
                August 2023
                May 18 2023
                August 2023
                : 50
                : 8
                : 715-723
                Affiliations
                [1 ] Multidisciplinary Department of Medical‐Surgical and Odontostomatological Specialties University of Campania “Luigi Vanvitelli” Naples Italy
                [2 ] Faculty of Dentistry Alexandria University Alexandria Egypt
                [3 ] Department of Biomedicine and Prevention University of Rome “Tor Vergata” Rome Italy
                [4 ] Department of Woman, Child and General and Specialist Surgery University of Campania “Luigi Vanvitelli” Naples Italy
                [5 ] School of Dentistry Department of Biomedical and Dental Sciences and Morphofunctional Imaging University of Messina Messina Italy
                [6 ] Department of Biomedical and Surgical and Biomedical Sciences Catania University Catania Italy
                Article
                10.1111/joor.13491
                37162279
                3b35f731-24ee-4efe-a038-1b2f556bf01b
                © 2023

                http://creativecommons.org/licenses/by/4.0/

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