Summary
There is a need to expand the current temporomandibular disorders' (TMDs) classification to include less common but clinically important disorders. The immediate aim was to develop a ...consensus‐based classification system and associated diagnostic criteria that have clinical and research utility for less common TMDs. The long‐term aim was to establish a foundation, vis‐à‐vis this classification system, that will stimulate data collection, validity testing and further criteria refinement. A working group members of the International RDC/TMD Consortium Network of the International Association for Dental Research (IADR), members of the Orofacial Pain Special Interest Group (SIG) of the International Association for the Study of Pain (IASP), and members from other professional societies reviewed disorders for inclusion based on clinical significance, the availability of plausible diagnostic criteria and the ability to operationalise and study the criteria. The disorders were derived from the literature when possible and based on expert opinion as necessary. The expanded TMDs taxonomy was presented for feedback at international meetings. Of 56 disorders considered, 37 were included in the expanded taxonomy and were placed into the following four categories: temporomandibular joint disorders, masticatory muscle disorders, headache disorders and disorders affecting associated structures. Those excluded were extremely uncommon, lacking operationalised diagnostic criteria, not clearly related to TMDs, or not sufficiently distinct from disorders already included within the taxonomy. The expanded TMDs taxonomy offers an integrated approach to clinical diagnosis and provides a framework for further research to operationalise and test the proposed taxonomy and diagnostic criteria.
Summary
It is a difficult undertaking to design a classification system for any disease entity, let alone for oro‐facial pain (OFP) and more specifically for temporomandibular disorders (TMD). A ...further complication of this task is that both physical and psychosocial variables must be included. To augment this process, a two‐step systematic review, adhering to PRISMA guidelines, of the classification systems published during the last 20 years for OFP and TMD was performed. The first search step identified 190 potential citations which ultimately resulted in only 17 articles being included for in‐depth analysis and review. The second step resulted in only 5 articles being selected for inclusion in this review. Five additional articles and four classification guidelines/criteria were also included due to expansion of the search criteria. Thus, in total, 14 documents comprising articles and guidelines/criteria (8 proposals of classification systems for OFP; 6 for TMD) were selected for inclusion in the systematic review. For each, a discussion as to their advantages, strengths and limitations was provided. Suggestions regarding the future direction for improving the classification process with the use of ontological principles rather than taxonomy are discussed. Furthermore, the potential for expanding the scope of axes included in existing classification systems, to include genetic, epigenetic and neurobiological variables, is explored. It is therefore recommended that future classification system proposals be based on combined approaches aiming to provide archetypal treatment‐oriented classifications.
The development of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) (1)
involved expanding the taxonomy for all TMDs (2) in order to propose for future validation DC for empirically ...supported TMDs that were not part of the DC/ TMD structure. This expanded taxonomy offers an integrated approach to clinical diagnosis and provides
a framework for operationalising and testing the proposed taxonomy and diagnostic criteria in future research. During expansion of the taxonomy, researchers identified several challenges in the diagnosis of some disorders, so the International RDC/TMD Consortium
Network planned a workshop to discuss criterion improvements for five of the disorders and the biobehavioural domain.
The aims of the present position paper by the Committee on Nutrition of the French Society of Paediatrics were to summarize the recently published data on vitamin D in infants, children and ...adolescents, i.e., on metabolism, physiological effects, and requirements and to make recommendations on supplementation after careful review of the evidence. Scientific evidence indicates that calcium and vitamin D play key roles in bone health. The current evidence, limited to observational studies, however, does not support other benefits for vitamin D. More targeted research should continue, especially interventional studies. In the absence of any underlying risk of vitamin D deficiency, the recommendations are as follows: pregnant women: a single dose of 80,000 to 100,000IU at the beginning of the 7th month of pregnancy; breastfed infants: 1000 to 1200IU/day; children less than 18 months of age, receiving milk supplemented with vitamin D: an additional daily dose of 600 to 800IU; children less than 18 months of age receiving milk not supplemented with vitamin D: daily dose of 1000 to 1200IU; children from 18 months to 5 years of age: 2 doses of 80,000 to 100,000IU every winter (November and February). In the presence of an underlying risk of vitamin D deficiency (dark skin; lack of exposure of the skin to ultraviolet B UVB radiation from sunshine in summer; skin disease responsible for decreased exposure of the skin to UVB radiation from sunshine in summer; wearing skin-covering clothes in summer; intestinal malabsorption or maldigestion; cholestasis; renal insufficiency; nephrotic syndrome; drugs rifampicin; antiepileptic treatment: phenobarbital, phenytoin; obesity; vegan diet), it may be justified to start vitamin D supplementation in winter in children 5 to 10 years of age as well as to maintain supplementation of vitamin D every 3 months all year long in children 1 to 10 years of age and in adolescents. In some pathological conditions, doses of vitamin D can be increased. If necessary, the determination of 25(OH) vitamin D serum concentration will help determine the level of vitamin D supplementation.
L’objectif de cette mise au point du Comité de nutrition de la Société française de pédiatrie est de résumer les connaissances récemment acquises chez l’enfant et l’adolescent et de proposer des recommandations de prescription. En l’absence de risque particulier, les recommandations sont les suivantes : femme enceinte : dose de charge unique de 80 000 à 100 000UI au début du 7emois de grossesse ; nourrisson allaité : 1000 à 1200UI/j ; enfant moins de 18 mois, recevant un lait enrichi en vitamine D : complément de 600 à 800UI/j ; enfant moins de 18 mois recevant un lait de vache non enrichi en vitamine D : 1000 à 1200 UI/j ; enfant de 18 mois à 5 ans et adolescent de 10 à 18ans : 2 doses de charge trimestrielle de 80 000 à 100 000 UI en hiver (novembre et février). En présence d’un risque particulier (forte pigmentation cutanée ; absence d’exposition au soleil estival ; affection dermatologique empêchant cette exposition ; port de vêtements très couvrants en période estivale ; malabsorption digestive, cholestase, insuffisance rénale, syndrome néphrotique ; certains traitements rifampicine ; traitement antiépileptique: phénobarbital, phénytoine ; obésité ; régime aberrant végétalisme), il peut être justifié de poursuivre la supplémentation toute l’année chez l’enfant de 1 à 5ans et chez l’adolescent, et de la maintenir entre 5 et 10ans. Dans certaines situations pathologiques, les doses peuvent être augmentées. Si nécessaire, le dosage de la 25(OH) vitamine D guidera la prescription de vitamine D.
Summary This 2·5‐day workshop was organized by the International RDC/TMD Consortium Network of the International Association for Dental Research and the Orofacial Pain Special Interest Group of the ...International Association for the Study of Pain. Workshop participation was by invitation based on representation within the field, which included the Consortium Network, the Orofacial Pain Special Interest Group, the National Institute for Dental and Craniofacial Research, American Academy of Orofacial Pain, the European Academy of Craniomandibular Disorders, and the International Headache Society; other disciplines included radiology, psychology, ontology, and patient advocacy. The workshop members were divided into workgroups that reviewed core literature describing the properties of the RDC/TMD, provided recommendations for revision, and suggested relevant research directions. The goals of this workshop were to (i) finalize the revision of the RDC/TMD into a Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), which would be more appropriate for routine clinical implementation, (ii) provide a broad foundation for the further development of suitable diagnostic systems for not only TMD but also oro‐facial pain as well, and (iii) provide research recommendations oriented towards improving our understanding of TMD and oro‐facial pain. This report provides the full description of the workshop and Executive Summary, and it acknowledges the participants and sponsors.
Summary
Self‐management (SM) programmes are commonly used for initial treatment of patients with temporomandibular disorders (TMD). The programmes described in the literature, however, vary widely ...with no consistency in terminology used, components of care or their definitions. The aims of this study were therefore to construct an operationalised definition of self‐management appropriate for the treatment of patients with TMD, identify the components of that self‐management currently being used and create sufficiently clear and non‐overlapping standardised definitions for each of those components. A four‐round Delphi process with eleven international experts in the field of TMD was conducted to achieve these aims. In the first round, the participants agreed upon six principal concepts of self‐management. In the remaining three rounds, consensus was achieved upon the definition and the six components of self‐management. The main components identified and agreed upon by the participants to constitute the core of a SM programme for TMD were as follows: education; jaw exercises; massage; thermal therapy; dietary advice and nutrition; and parafunctional behaviour identification, monitoring and avoidance. This Delphi process has established the principal concepts of self‐management, and a standardised definition has been agreed with the following components for use in clinical practice: education; self‐exercise; self‐massage; thermal therapy; dietary advice and nutrition; and parafunctional behaviour identification, monitoring and avoidance. The consensus‐derived concepts, definitions and components of SM offer a starting point for further research to advance the evidence base for, and clinical utility of, TMD SM.
The diagnosis of cows' milk protein allergy (CMPA) requires first the suspicion of diagnosis based on symptoms described in the medical history, and, second, the elimination of cows' milk proteins ...(CMP) from the infant's diet. Without such rigorous analysis, the elimination of CMP is unjustified, and sometimes harmful. The elimination diet should be strictly followed, at least until 9-12 months of age. If the child is not breast fed or the mother cannot or no longer wishes to breast feed, the first choice is an extensively hydrolysed formula (eHF) of CMP, the efficacy of which has been demonstrated by scientifically sound studies. If it is not tolerated, an amino acid-based formula is warranted. A rice protein-based eHF can be an alternative to a CMP-based eHF. Soya protein-based infant formulae are also a suitable alternative for infants >6 months, after establishing tolerance to soya protein by clinical challenge. CMPA usually resolves during the first 2-3 years. However, the age of recovery varies depending on the child and the type of CMPA, especially whether it is IgE-mediated or not, with the former being more persistent. Once the child reaches the age of 9-12 months, an oral food challenge is carried out in the hospital ward to assess the development of tolerance and, if possible, to allow for the continued reintroduction of CMP at home. Some children with CMPA will tolerate only a limited daily amount of CMP. The current therapeutic options are designed to accelerate the acquisition of tolerance thereof, which seems to be facilitated by repeated exposure to CMP.
Background
Since in children and adolescence prevalence is assessed mainly on self‐reported or proxy‐reported signs and symptoms; there is a need to develop a more comprehensive standardised process ...for the collection of clinical information and the diagnosis of TMD in these populations.
Objective
To develop new instruments and to adapt the diagnostic criteria for temporomandibular disorders (DC/TMD) for the evaluation of TMD in children and adolescents.
Method
A modified Delphi method was used to seek international consensus among TMD experts. Fourteen clinicians and researchers in the field of oro‐facial pain and TMD worldwide were invited to participate in a workshop initiated by the International Network for Orofacial Pain and Related Disorders Methodology (INfORM scientific network) at the General Session of the International Association for Dental Research (IADR, London 2018), as the first step in the Delphi process. Participants discussed the protocols required to make physical diagnoses included in the Axis I of the DC/TMD. Thereafter, nine experts in the field were added, and the first Delphi round was created. This survey included 60 statements for Axis I, and the experts were asked to respond to each statement on a five‐item Likert scale ranging from ‘Strongly disagree’ to ‘Strongly agree’. Consensus level was set at 80% agreement for the first round, and at 70% for the next.
Results
After three rounds of the Delphi process, a consensus among TMD experts was achieved and two adapted DC/TMD protocols for Axis I physical diagnoses for children and adolescents were developed.
Conclusion
Through international consensus among TMD experts, this study adapted the Axis I of the DC/TMD for use in evaluating TMD in children and adolescents.
The Delphi process included three round and was used to was used to seek international consensus for Axis I assessment among 23 TMD experts. Thanks to this Delphi study, experts developed new instruments that aim to assess physical diagnoses (Axis I) of TMDs in children and in adolescents, by modifying the DC/TMD for adults.
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