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J Am Dent Assoc, Vol 135, No 8, 1119-1125. © 2004 American Dental Association

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JADA Continuing Education

Recent advances

Background. The authors compiled information about recent advances in screening for psychosocial risk factors considered to be yellow flags for potentially poor outcomes among patients with chronic orofacial pain (most commonly temporomandibular disorders).

Types of Studies Reviewed. The authors conducted MEDLINE searches for the period 1995 through 2002 using the terms "temporomandibular disorders," "assessment" and "psychological," as well as "primary care," "screening" and "psychological disorders." They also searched personal files for relevant articles.

Results. Psychosocial dysfunction is prevalent among patients with chronic orofacial pain. Yellow flags include high levels of disability; psychological disorders; and prolonged or excessive use of opiates, benzodiazepines, alcohol or other drugs. The authors identified several reliable, valid and brief patient self-administered questionnaires that can be used to screen for these yellow flags. Some of these are the Research Diagnostic Criteria/ Temporomandibular Disorders Axis II, Alcohol Use Disorders Identification Test and Patient Health Questionnaire.

Clinical Implications. Dentists can improve the quality of care for patients with chronic orofacial pain by screening for psychosocial risk factors and by referring patients with risk factors for psychological or psychiatric assessment and treatment.

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