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Aims: To determine via a prospective investigation whether the
presence of neuropsychologic or cognitive deficiencies could be
identified in patients with temporomandibular disorders (TMD)
and used to predict treatment outcome. This was based on the theory
that measurable reductions in neuropsychologic and cognitive
function might have a negative impact on treatment outcome in
patients with essentially nontraumatic TMD, as has been shown
for patients with posttraumatic TMD. Methods: Various neuropsychologic,
psychosocial, and clinical parameters (including
but not limited to the Peterson-Peterson Consonant Trigram Test
and the California Verbal Learning Test) were used to pretest
patients suffering from TMD prior to treatment. Patients were
then entered into treatment, after which determination of treatment
success was made both by the use of visual analog scales for
pain and global transitional outcome measures (eg, “better,”
responders versus “same/worse,” nonresponders). After determination
of treatment success was made, treatment response was
correlated with the various clinical, cognitive, and neuropsychologic
test scores. Results: Overall, the nonresponders did worse in
both the neuropsychologic and psychosocial assessments, with
greater memory deficits, sleep disturbances, depression, and
fatigue and lower energy levels as compared to responders. Among
the best predictors of treatment outcome were the Peterson-
Peterson Consonant Trigram Test scores, as well as the scores on
the California Verbal Learning Test (ie, poorer test outcomes predicted
nonresponse). Neither responders nor nonresponders could
be distinguished from one another based on clinical parameters of
maximum interincisal opening or muscle tenderness. Three psychosocial
variables were also found to be predictors of poor outcome:
sleep disturbance, fatigue, and income. Pretreatment pain
on chewing was also found to be a reliable predictor of poor treatment
outcome. Conclusion: We conclude that various neuropsychologic,
psychosocial, and some clinical parameters may provide
pretreatment prediction of treatment outcome in an idiopathic
TMD population.
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