Dentist

We obtained data from two convenience samples (Figure 1, page 1186). The first sample consisted of 732 adults at three academic health centers in the Research Diagnostic Criteria for TMD (RDC-TMD) Validation Project whom we characterized by using the expanded RDC-TMD assessment protocol.^{10 (link)} Case status was based on consensus by two dentists at each site (among them Y.M.G. and R.O. at the University at Buffalo, N.Y., E.S. at the University of Minnesota, Minneapolis, and E.L.T. at the University of Washington, Seattle) using calibrated technique.^{10 (link)} We recruited putative control participants on the basis of absence of pain in the facial area during the preceding six months. At the time of participants’ enrollment, we evaluated them according to history, clinical examination and panoramic radiographic findings to exclude people with any possibility of odontogenic pain. We used this first sample for initial item development. Among the participants with TMD, we included 65 in a reliability assessment, with an interval of two to seven days between survey administrations to evaluate temporal stability.^{11 (link)}For validity testing, we divided the 732 participants into four groups. We defined the target group, those having pain-related TMD, as those having a diagnosis of pain-related TMD (that is, myofascial pain, arthralgia or both) (as described by Schiffman and colleagues^{10 (link)}). We identified two comparison groups without pain. One of them consisted of healthy control participants, defined as not meeting criteria for a diagnosis of TMD; exclusion criteria at enrollment permitted only low-severity headaches (per International Classification of Headache Disorders, second edition [ICHD-II], criteria^{12 (link)}) that were not affected by masticatory function. The second comparison group consisted of those with a nonpainful TMJ disorder, defined as a TMJ disorder (such as disk displacement or osteoarthrosis) identified via magnetic resonance imaging or computed tomography, and this group served as a comparison for reporting of masticatory system symptoms. Participants in this latter group may have had jaw pain symptoms, but we required that those symptoms be insufficient to meet criteria for a diagnosis of TMD pain. We identified a third comparison group—those with headache in the temple region—by means of an algorithm from the ICHD-II criteria.^{12 (link)} This group was a subset of the healthy control participants and those with nonpainful TMJ disorders, and we selected it on the basis of the absence of a diagnosis of TMD pain. Consequently, these participants represented those with regional headache without TMD pain and served as a comparison for pain symptom reporting. To create groups with similar sample sizes, we randomly selected a subset of the participants with pain-related TMD and retained it for analyses.
Another pain group, that with odontalgia, consisted of 80 participants whose chief complaint was toothache and odontogenic disease confirmed by means of clinical examination and radiographs. We did not determine the presence or absence of TMD in this group owing to logistic limitations, so we used these data for secondary analyses to determine the false-positive rate associated with a competitive pain condition.

DPBRN includes dental practitioners (dentists and hygienists) from Alabama, Florida, Georgia, Minnesota, Mississippi, Oregon, Washington, and Scandinavia. To become a member, practitioners must first complete a 101-item enrollment questionnaire. This questionnaire, which is located at http://www.DPBRN.org, queries information on practitioner characteristics, practice characteristics, and patient characteristics. Some items on the questionnaire were designed to be similar to the ADA Survey. DPBRN will re-administer the questionnaire periodically to ensure that the information collected is up-to-date. From 2002–2004, practitioners completed the questionnaire as a paper form; since 2005 practitioner-investigators have completed the questionnaire on-line. As of April 2, 2007, 1086 dentists (and 25 hygienists who were excluded from the current analyses) from the five participating regions have completed the questionnaire. The regions consist of: Alabama/Mississippi, Florida/Georgia, HealthPartners/Minnesota, Permanente Dental Associates, and the Scandinavian countries of Norway, Denmark, and Sweden.
For two DPBRN regions, collaborations were established with two organizations, HealthPartners (HP) of Minneapolis, Minnesota, and Permanente Dental Associates (PDA) of the greater metropolitan Portland, Oregon area. HP is a prepaid, multi-specialty group that provides comprehensive health care. The HP Dental Group is staffed by 58 dentists at 16 clinic locations that serve about 100,000 enrollees. The HP/Minnesota DPBRN region also has a small but growing number of dentists in private practice in the Minneapolis, Minnesota area. PDA is a multi-specialty dental group that contracts with Kaiser Permanente Northwest (KPNW) to provide dental services for KPNW prepaid comprehensive health plan members. PDA includes 110 dentists in 14 dental clinics that serve about 180,000 members with dental benefits. A DPBRN region in Norway, Sweden, and Denmark also exists, which is administratively based at the University of Copenhagen.
In addition to comparing all dentists enrolled in DPBRN with dentists who completed the ADA survey, a comparison was also made with the DPBRN practitioners who completed the first study. This was done to see if there were any significant differences between the dentists who completed the ADA survey and DPBRN practitioners who are actively participating in the studies, since our data will come from this subset. To have been eligible to participate in the first DPBRN study (DPBRN Study 1: “Assessment of Caries Diagnosis and Caries Treatment” questionnaire) a dentist must have been a general dentist, pediatric dentist, or do at least some restorative dentistry, as well as have completed the enrollment questionnaire. Of the 970 practitioners who were eligible for Study 1, 523 completed the Study 1, including 493 general practitioners. Table 1 provides the distribution, by region, of participants who completed the enrollment questionnaire and general practitioners who completed the enrollment questionnaire and Study 1.