[Matched case control study for investigating of the association between psychosocial factors and TMJDS]

A 1:1 matched case control study was carried out in 81 cases with temporomandibular joint dysfunction syndrome (TMJDS) who came to a TMJ clinic of a tertiary dental centre for help and 81 controls without TMJDS to investigate the association between psychosocial factors and TMJDS. The results showed that anxiety and depression might be one of the risk factors of TMJDS. Trait anxiety and Eysenck's neuroticism might be the inherent personality factor of anxiety, and the later might be the basis of depression. Life events and social support might be the external factors of TMJDS.

Temporomandibular joint dysfunction in children

Sixteen pediatric patients with temporomandibular joint (TMJ) dysfunction were successfully diagnosed following appropriately selected imaging methods. The role of radiography in diagnosis of TMJ dysfunction is essential in distinguishing between the osteogenic and non-osteogenic etiologies. Computed tomography (CT) was found to be a valuable imaging method, with advantages over plain film radiography. The treatment modalities considered were: non-invasive therapy, occlusal therapy and surgical treatment. The treatment of choice was dependent on the osteogenic or non-osteogenic etiology. Surgery was considered only when the non-invasive or occlusal therapies were ineffective.

Cluster-like signs and symptoms respond to myofascial/craniomandibular treatment: a report of two cases

Two cases with pain profiles characteristic of cluster-like headache, both within and outside the trigeminal system, are reported. One male patient would typically awaken from sleep with severe unilateral temporal head pain and autonomic signs of ipsilateral lacrimation and nasal congestion. A female patient exhibited severe unilateral boring temporal and suboccipital head pain with associated ipsilateral lacrimation and rhinorrhea. In addition, both patients presented with signs and symptoms of masticatory and/or cervical disorders. These two cases illustrate possible treatment alternatives, as well as possible influences from cervical and masticatory structures in the development of cluster or cluster-like headache.

A clinical study of the relationship between occlusal curvature and craniomandibular disorders

The occlusal curvature should be harmonized with stomatognathic function, but excessive occlusal curvatures are found in some craniomandibular disorder patients. Forty healthy subjects and 95 patients with craniomandibular disorder (50 with clicking, 25 with locking, and 20 with myofascial pain dysfunction syndrome) were evaluated to investigate the functional significance of the occlusal curvature. Anteroposterior and lateral occlusal curvature were measured using the least-square approximation of the mandibular buccal cusps in a second-order quadratic and modification of Monson's 4-inch sphere. "Clicking" and "locking" groups had significantly greater occlusal curvatures than healthy subjects. There appeared to be a relationship between occlusal curvature and craniomandibular disorders.

Higher levels of orthodontic and dental excellence

In the past, providers of orthodontic services were solely concerned with esthetic/cosmetic considerations of the teeth. In more recent years emphasis has been placed on the interdigitation of the teeth in centric occlusion combined with the absence of occlusal interferences in sliding/gliding jaw movements with the teeth in partial contact with each other (protrusive, cuspid disclusion, etc.). Still more recently true jaw function, or, function of the entire stomatognathic system, as opposed to the more limited functional movement of the teeth as influenced by their inclined planes when in partial occlusion, has come to the fore. And rightly so. This necessarily required consideration of the health or pathology of the temporomandibular joint/s because some patients could open their mouths more than others. Some opened straight up and down, while others deflected to the left or right and some made various noises and jerky movements. Others opened noiselessly and smoothly and were in moderate to severe pain and pointing their finger at the orthodontic provider.

[Critical review of the various treatments of temporomandibular joint pain-dysfunction syndrome. What will be the psychosomatic approach to these patients?]

A multitude of theoretical, etiologic and therapeutic approaches to temporomandibular joint (TMJ) dysfunction have been developed. In spite of all the efforts for combined therapy that have proliferated over the last years, the therapeutic options proposed for these patients are extraordinarily diversified and vary with the different schools. The different opinions are rarely in agreement. Everyone appears to be satisfied with such an extremely divergent approach to treatment where some patients undergo surgery of the TMJ while relaxation is proposed for others! In view of these very diverging opinions, we raise the question as to whether the results obtained with a truly psychosomatic approach using well-coordinated team work between stomatologists and psychotherapists might have a theoretical basis.

A comparison of ICAGD (immediate complete anterior guidance development) to mock ICAGD for symptom reductions in chronic myofascial pain dysfunction patients

The purpose of this study is to assess what impact shortening disclusion time to less than .5 seconds during right and left mandibular excursions has on myofascial pain(s) symptoms present in a dental student population. Twenty-five dental students, who exhibited symptomatology consistent with myofascial pains patient, were divided into a treatment, control, and an untreated group. They participated in an occlusal adjustment study which measured changes in disclusion time, as well as, myofascial pains muscular symptom remissions resultant from treatment. The treated group of ten subjects received ICAGD occlusal adjustments to shorten their disclusion time to less than .5 seconds per mandibular excursion. The goal of this therapy was to totally disclude the posterior teeth in a measurable time frame of .5 seconds or less. The control group of eight subjects received mock ICAGD with tooth polishing. The goal of this therapy was to simulate ICAGD adjustments for possible placebo effect on symptom remissions. The untreated group had their disclusion times measured but received no treatment to adjust, or to simulate adjustment to their occlusion. The goal of analyzing an untreated group was to attempt to show that mock treatment (performed on the control subjects), or no treatment (performed on the untreated subjects), resulted in no measurable change in the disclusion time in either of these two subject groups. Each subject was recalled for disclusion time measurement four to five times in a one-year period of observation, at which time, they were required to report their myofascial pains symptom status by answering an ordinal scale questionnaire. The results suggest that shortening disclusion time to less than .5 seconds per mandibular excursion can induce remissions of many muscular myofascial pains symptoms. Additionally, mock ICAGD occlusal adjustments did not appear to be a factor in the control subjects treatment response, as this group showed no statistically significant symptom remissions.

Controversies in the aetiology of temporomandibular disorders. Part 1. Temporomandibular disorders: all in the mind?

The aetiology of temporomandibular disorders (TMDs) is now considered to be multifactorial but the relative importance of individual aetiological factors is still controversial. Psychosocial factors play an important role in the aetiology of TMDs, in adaptation to pain and eventual recovery. TMD patients exhibit a variety of psychological and behavioural characteristics including increased somatization, stress, anxiety and depression. Subcategorisation of TMD patients into joint-related and muscle-related groups reveals psychological differences. Myogenic patients have increased severity of pain and suffer enhanced psychological distress. Within this group of patients are a minority of refractory cases who show marked overlap with those suffering from chronic pain syndrome; such patients benefit from psychiatric assessment and treatment. However, no common TMD personality profile has emerged from the psychometric test research. Recent knowledge of the molecular pathways induced by stress and the evaluation of stress-response substances may, in the future, provide diagnostically valuable biochemical markers of disease susceptibility. The role of psychological factors in the development of TMDs in the general population is critically examined.

Epidemiology of temporomandibular disorders: implications for the investigation of etiologic factors

Epidemiology is the study of the distribution, determinants, and natural history of disease in populations. Epidemiology has several uses in addition to its traditional role of documenting the public health significance of a condition. Notably, epidemiologic methods and data can be used to identify and verify causes of disease. This article reviews the epidemiologic data on pain in the temporomandibular region, and on signs and symptoms associated with specific subtypes of temporomandibular disorders, with the aim of identifying possible etiologic factors for these conditions that deserve further study. Despite methodologic and population differences, several consistencies are apparent in the epidemiologic literature. Pain in the temporomandibular region appears to be relatively common, occurring in approximately 10% of the population over age 18; it is primarily a condition of young and middle-aged adults, rather than of children or the elderly, and is approximately twice as common in women as in men. This prevalence pattern suggests that etiologic investigations should be directed at biologic and psychosocial factors that are more common in women than in men, and diminish in older age groups. Most signs and symptoms associated with particular temporomandibular disorders (e.g., joint sounds, pain in the joint) also appear to be more prevalent in women than in men, although age patterns for these signs and symptoms are not as clear as for temporomandibular pain. The available data highlight the need for further research on etiologic factors associated with temporomandibular pain and with specific diagnostic subtypes of temporomandibular disorders.

[Disturbance syndrome of temporomandibular joint in cleft lip and palate patients with crossbite]

The function of temporor-mandibular joint in unilateral cleft lip and palate (UCLP) palients with crossibite was studied in this paper. 29 UCLP patients with crossbite were examined clinically and with Mandibular Kinesiography and X-ray. The results were as bellow (1) Insidence of TMJDS in UCLP patients with crossbite was 75.8%. (2) The condyle of 17.8% patients moved distally and 35.7% of patients moved distally asymmetry. (3) The distance of mandibular border movements in cleft patients were in normal range. We conclude that insidence of TMJDS in UCLP patients were high and we should take it into consideration in the orthodontic treatment.

Temporomandibular disorders in the medical practice

Patients suffering with various orofacial pain conditions are likely to seek advice and treatment from a family physician. Temporomandibular disorders (TMD) are common in the general population, and the clinician should be aware of the common associated signs and symptoms so that proper therapy can be provided. The family physician can often provide initial therapies that are effective in reducing TMD symptoms. In some instances, it is appropriate for the family physician to refer the patient to a dentist for a more comprehensive evaluation of the masticatory system. This article describes the common patient complaints associated with TM disorders. A few simple therapies are discussed along with suggestions regarding the appropriate time for referral to a dentist for a thorough dental evaluation.

Craniomandibular dysfunction in children with clefts and noncleft children with and without unpleasant life events: a comparative study

An epidemiologic study was conducted to investigate any difference in the prevalence of signs and symptoms of craniomandibular dysfunction on children with clefts and noncleft children with and without unpleasant life events. The experimental group consisted of thirty white children six to ten years of age with unilateral cleft lip and cleft lip and palate. On the basis of the sex and age distribution of the experimental group 30 out of 25 white children without unpleasant life events and 30 out of 105 white children with unpleasant life events were selected as control group I and control group II, respectively. The results showed statistically significant difference in the prevalence of temporomandibular joint tenderness between experimental and control group I, while the difference between experimental and control group II was not significant. Statistically significant difference in the frequency of temporomandibular joint tenderness was also revealed between the control groups. With respect to the severity of the symptoms, the only statistically significant difference was that of the anamnestic dysfunction index with severe symptoms (AiII) between the experimental and control group I. The other differences were not significant. The present study suggests that children with clefts and those with unpleasant life events run a greater risk of developing temporomandibular joint tenderness.

The prevalence of temporomandibular disorder in patients referred for orthodontic assessment

A total of 301 unselected orthodontic referrals were assessed for temporomandibular disorder, using a standardized questionnaire and clinical examination protocol. The mean age of the patients was 13.4 years. Over one-third of the 301 patients were found to exhibit at least one sign of TMD, and two-thirds had a mandibular dysfunction index (MDI) score of 1, 2 or 3, indicating mild to moderate dysfunction. Only five patients were found to have severe temporomandibular dysfunction. Statistically significant relationships were found between patient age and mandibular opening, and temporomandibular joint noises. No relationship was found between signs detected by clinical examination and symptoms reported by the patients.

[Clinical aspects of cranio-mandibular disorders. II. Symptom profiles of subgroups]

The more frequent clinical variables of cranio-mandibular disorders in a sample of 406 patients of both sexes, aged between 9 and 78 (mean age 30.47), were used to classify the different pathologies of the stomatognatic dysfunction. Radiological imaging completed and improved the diagnostic assessment. The breakdown of the total patient population into diagnostic subgroups was: functional disorders, with a mainly myogenous component (19.7%); disk displacement with reduction (24.1%); disk displacement without reduction (11.7%); osteoarthrosis (10.8%); synovitis of various origin (8.8%); growth disorders (0.9%). A mixed group consisted of many patients displaying signs of internal derangement and contemporary pronounced muscular disorders (20.4%); finally some subjects did not show true disturbances of the masticatory system (3.6%). Considerable differences were found among the subgroups and the findings formed the basis of specific symptom profiles, that mainly considered the chief complaints as masticatory algia, earache, cephalalgia, migraine and neck and shoulders postural disturbances. The prevalence of specific pathogenetic factors confirmed the multifactorial aetiology and the need of a more directed choice of treatment.

[The stomatognathic electromyographic aspects in spasmophilia]

The study intends to statuate the theoretical foundations concerning the etiopathogenesis (of endocrinological origin--tetany) of the myofacial pain dysfunction (MPD). We want to demonstrate this affirmation knowing that there is a very important correlation between the endocrine glands and the muscular stomatognathic activity. The EMG exam in tetany for the masticatory muscles proves that there is a repetitive asymmetric bioelectric activity even for the rest positions.

The reporting of pain, somatic complaints, and anxiety in a group of patients with TMD before and 2 years after treatment: sex differences

The aim of this study was to assess possible gender differences regarding the reporting of pain, somatic complaints, and anxiety in a group of patients suffering from temporomandibular disorders (TMD). The group consisted of 40 females and 13 males who received conservative TMD treatment comprising counseling, muscle exercises, and a stabilization splint. Before and 2 years after treatment, the patients answered three questionnaires (McGill Pain Questionnaire [Norwegian version] including a six-point scale, the Present Pain Intensity; a Somatic Complaints Questionnaire; and the trait part of Spielberger's State-Trait Anxiety Inventory. Before treatment, females reported greater present pain intensity than did males. Two years after treatment, females reported less sensory and emotional pain than at the initial stage; males presented no reduction in these pain scores. There were no gender differences at either stage regarding somatic complaints or anxiety level scores.

[Clinical aspects of cranio-mandibular disorders. III. Principles of elective therapy]

The therapeutic approaches on 406 patients of both sexes, agent between 9 and 78 (mean age 30.47) and suffering from cranio-mandibular disorders, have been analyzed, in order to evaluate the more frequent measures of treatment and to improve the management of pain and dysfunction of the stomatognathic system. Having confirmed the multifactorial aetiology, an individual treatment plan was worked out. Of the initial therapies, active gymnastics (63.58%), bland aspecific drugs (21.02%), assisted relaxation practices (7.17%) were of particular importance. As occlusion measures, stabilisation splint (44.61%) had precise instruction for use; in case of mandibular dislocation, a repositioning splint was constructed in articulator, in order to achieve a new therapeutic position (30.51%); sometimes, only a vertical dimension increase of previous prosthesis was made (14.35%). The specific symptom profiles of the diagnostic subgroups in which the sample was subdivided induced to adopt considerably different procedures, due to the basic pathology. The final therapy considered above all prosthetic (35.64%) and orthodontic (25.12%) rehabilitations, whether structural changes were necessary; moreover occlusal adjustment (5.64%); only few cases (2.05%) required a surgical consultation. A deliberate choice of conservative approach was evident in a remarkable number of patients (26.15%), treated in an absolutely reversible way.

Signs and symptoms of temporomandibular disorder (TMD) and craniofacial form

Signs and symptoms attributed to temporomandibular disorder (TMD) were registered in 170 persons at an average age of 12.5 years. One hundred and ten were reexamined at an average age of 26.4 years. Craniofacial form was defined on standardized lateral cephalograms, taken at the time points mentioned, by 22 linear and 8 angular measurements. The symptoms, clicking and pain, never appeared to be associated with craniofacial form. The signs, clicking and crepitation, in children did not appear to be associated with craniofacial form either. However, adults with signs were characterized by horizontal facial deficiencies. Adults with clicking joints had a saggitally shorter maxilla and mandibular diagonal, whereas adults with crepitating joints had, in addition, a shorter anterior and posterior cranial base and pharynx. This sagittal "shortness" could already be demonstrated for many of the reported dimensions at the corresponding cephalograms taken about the age of 12.5 years, and did not appear to have changed much over time. It is concluded that the reported TMD signs in adults were associated with a sagittal shorter midface. Part of the typical structure associated with signs antedated the actual detection of these signs by 14 years. This implies that not all TMD signs in adults can be regarded as the exclusive result of some etiologic factor operating after the teenage period. This finding of an association cannot be interpreted as a causal relationship.

The condylar asymmetry-age relationship in determining myogenous or arthrogenous origin of pain in patients with temporomandibular disorders

The relation of age to asymmetry index of the condyles of the temporomandibular joint differs for groups of patients with a myogenous and arthrogenous origin of pain. It was decided to investigate if this has clinical diagnostic significance. Twenty-eight patients complaining of temporomandibular disorders (TMD) were included in this study. All were dentate with a maximum of five missing teeth including third molars allowed. Condylar asymmetry was measured according to the method of Habets, and this was used to compute the expected patient age for both curves. The patient was assigned to the group with computed age closest to true age. The association between category derived from graphs and that from clinical diagnosis was studied. There was agreement clinically and graphically in 25 of 28 patients. The Kappa statistic to explore the agreement between the two methods gave a value of 0.78, which allows rejection of the hypothesis that agreement was based on chance alone.

Temporomandibular joint dysfunction and flat lateral guidances: a clinical association

Temporomandibular joint alterations have been associated with abnormal mandibular movements in the open/close cycles and in the laterotrusive border movements. The quantitative analysis of these movements could allow a better or earlier diagnosis for patients and offer some insight into the pathophysiology of the disorder. Maximum opening and mandibular laterotrusive border movements were studied and measured in a group of 165 patients with a considerable lateral deviation (equal to or greater than 5mm) in maximum opening. Movements were directly performed by the patients and recorded with a mandibular kinesiography. The slope of the lateral guidance (frontal plane projection) was measured in the first millimeters of motion and started from the maximum intercuspal position. On average, slopes were significantly flatter on the same side with the opening deviation. These slopes were significantly flatter than previously published physiologic ranges, whereas contralateral slopes were similar to normal references. The results may be explained by a correlation between the insufficient lateral protection and a temporomandibular mandibular joint dysfunction (ipsilateral low mobility).

Signs of temporomandibular dysfunction related to edentulousness and complete dentures: an anamnestic study

Symptoms of temporomandibular dysfunction (TMD) are prevalent among elderly individuals with complete dentures. In the agrarian areas of middle Finland it was, as recently as a few decades ago, almost a tradition to extract teeth during young adulthood. Women who today are in post-menopausal age are the last sizable age group in Finland where the problems of edentulousness can be investigated. The purposes of this study were twofold. First, postmenopausal women who are edentulous in the maxilla or totally edentulous were studied to determine if they differ from women with natural teeth in both jaws in terms of subjective TMD symptoms. Second, these subjective symptoms were examined to discover any correlation with duration of edentulousness, age of the dentures, or difficulties in wearing them. The results suggest that for postmenopausal women, clicking noises in the temporomandibular joint and tension in the neck are more common complaints among denture wearers than among those who still have natural teeth. Factors that make the wearing of complete dentures more difficult may also predispose the wearer to TMD symptoms. Duration of edentulousness is not, however, related to the prevalence of anamnestic TMD symptoms.

Twin Block appliance. Part II

The main purpose of the Twin Block is to advance the mandible and to correct moderate to severe overjets. When the first molars are encouraged to erupt, the Twin Block also results in a partial correction of the overbite. The Rick-A-Nator or Rick-A-Nator 2 Appliances are utilized to hold the mandible in a forward position and also to help erupt the bicuspids to complete the orthopedic correction of the overbite. It is vital that the total treatment time for the active phase with the Twin Block and the support phase with the Rick-A-Nator be a minimum of 15 to 18 months to allow for permanent muscular, skeletal and dental changes to be accomplished.

Understanding occlusion as it relates to the temporomandibular joint--the fourth molar paradigm

In the typical dental office, at least one third of the patients present with indications for an occlusal appliance. Eighty percent of craniomandibular patients observed in general practice can and should be treated by the general practitioner. Unfortunately, because of time constraints in dental school curricula and prevailing controversies concerning occlusion, many dentists lack the skills and confidence necessary to provide these services. In this article, the authors use the Fourth Molar Paradigm and the Dental Joystick Paradigm to facilitate an understanding of how occlusion relates to the temporomandibular joint and craniomandibular disorders. This knowledge is necessary to correctly interpret temporomandibular radiographs, diagnose and treat craniomandibular disorders, and plan and execute any dental therapy that alters the mandibular position. In addition, in the absence of scientific research to confirm or disqualify the Occlusion Hypothesis, which states that malocclusion is a risk factor for craniomandibular disorders, the authors offer the stated paradigms to support the Occlusion Hypothesis.

Synergistic effect of malocclusion and oral parafunctions on craniomandibular dysfunction in children with and without unpleasant life events

An epidemiological study was conducted on 386 children aged 6-10, with and without unpleasant life events, to investigate the synergistic effect of malocclusion and oral parafunctions on craniomandibular dysfunction. The results showed that the synergistic effect of certain occlusal factors and oral parafunctions was significantly correlated with clicking and symptoms of dysfunction in both groups and with TMJ and muscle tenderness in subjects without unpleasant life events. In children with unpleasant life events TMJ and muscle tenderness were not correlated with any combination of malocclusion and oral parafunction. The present study suggests that the synergistic effect of malocclusion and oral parafunctions is a 'sufficient' cause for development of clicking and symptoms of dysfunction in both groups and TMJ and muscle tenderness in subjects without unpleasant life events. Also, in children with unpleasant life events, other aetiologic factor(s) can be responsible for the development of TMJ and muscle tenderness.

Assessment of pain (distribution and onset), Symptoms, SCL-90-R Inventory responses, and the association with infectious events in patients with chronic orofacial pain

A visual analog pain scale and scalar responses to 13 pain/symptom indicator Symptom Checklist-90-Revised (SCL-90-R) questions were used to assess symptom prevalence and pain severity in 43 chronic orofacial muscle pain patients and 40 control subjects. The orofacial muscle pain group reported pain in an axial skeletal distribution; neurocognitive, gastrogenitourinary, and musculoskeletal symptoms; infectious events at or preceding onset; similar symptoms in sexual partners; and low prevalence of trauma. Sudden onset was reported by 30.2% of pain patients. Strong associations were found between chronic orofacial muscle pain and (1) onset-related infectious-like events (67.4%); (2) a higher prevalence of history of respiratory and gastrogenitourinary infectious events; and (3) high prevalences of similar pain symptoms in long-term sexual partners. The SCL-90-R somatization scores (> 62) had a higher prevalence in the chronic pain group. No prevalence differences or associations with pain/symptom indicators were found for depression or anxiety dimension scores. These data suggest that patients with recurrent systemic infectious events have a higher prevalence of reporting of chronic orofacial muscle pain compared with control subjects, and these infectious events are associated with the onset of chronic orofacial muscle pain in 67% of patients.

Forward head posture: its structural and functional influence on the stomatognathic system, a conceptual study

An extensive conceptual analysis to establish the primary role a forward head posture plays in the appearance of some craniomandibular dysfunctions and internal derangements of the temporomandibular joints, associated to craniocervical postural disturbances. The analysis is based on findings contributed by scientific investigations in the field of dentofacial orthopedics and dysfunction. Special emphasis has been put on the influence of forward head posture on the craniofacial growth as it can determine a morphoskeletal and neuromuscular pattern leading to a dysfunctional condition. A correlation is established between Class II Occlusion, forward head posture, and craniomandibular dysfunction. The concept of craniocervical postural position is defined, as well as its close relation to the mandibular postural position.

Incidents of symptomatic temporomandibular (TM) joint disorders in female population with missing permanent first molar(s)

In the literatures, the relationship between missing teeth or malocclusion and the symptoms of temporomandibular joint disorder such as frequent headaches, earaches, sinus pain, and jaw pain, has been documented. However, there were no specific details as to which teeth were missing to cause these symptoms. In this project the relationship between missing first molars in adult female subjects to the previously mentioned symptoms was studied using one group of 65 subjects with missing one, two, three, or four first molars and a control group of 67 subjects with no missing first molars. The study revealed a significant relationship of missing first molar(s) and the occurrence of headaches, earaches, sinus pain, and jaw pain.

Imaging of the temporomandibular joint

Recent advances in imaging technology have greatly contributed to the understanding of diseases of the temporomandibular joint (TMJ). MRI is now the modality of choice in the evaluation of TMJ-related symptoms. This article describes normal anatomy and MRI characteristics of diseases affecting the TMJ including internal derangement, inflammation, and tumors.

Treatment of edentulous patients with temporomandibular disorders with implant-supported overdentures

Treatment of edentulous patients who have temporomandibular disorders is difficult because of the poor stability of their conventional complete dentures. With an implant-supported bar and a clip-to-bar overdenture, mandibular dentures can be stabilized. The results of a prospective clinical study of 10 edentulous patients with temporomandibular disorders and treatment with implant-supported overdentures in mandibles are presented. Before and after 3 years of wearing the implant-supported overdentures, patients were interviewed and a clinical functional analysis was taken. Patients with displacement of the articular disc or bone destruction of the joints had a decrease in pain, an enhanced mobility of the mandible, and a decrease in temporomandibular joint sounds. Patients with pain of muscular genesis as a result of bruxism suffered after 3 years from the same pain and did not show an improvement of muscle or joint sensitivity.

Oral parafunctions as temporomandibular disorder risk factors in children

Oral parafunctions are generally considered to be important factors in the etiology of temporomandibular disorders (TMDs) and many reports have been published about their prevalence in adults and schoolchildren. However, few have included significant numbers of children below the age of 7. The aim of this study was to examine the association between parafunctions and oral/facial TMD-related pain in preschool children. Bruxism, nail biting, and thumb sucking were found to be significantly associated with important oral/facial pain symptoms of clinical interest in the diagnoses of TMD indicating that those parafunctions are risk factors. The study included 525 4- to 6-year-old African-American and Caucasian children, mean age 5.1 +/- 0.65 (SD). An alpha level of 5% was chosen for comparison with a Pearson Chi-Square test. Bonferroni correction was made and a p-value of < 0.005 was accepted as significance level. Only 28% of the children had no history of any parafunction. More girls (82%) than boys (63%) in the Caucasian subgroup had at least one parafunction (p approximately 0.00017). No such difference was found in the African-American subgroup where the corresponding figures were 71% for girls and 73% for boys. Thumb sucking was reported by 57% of the children, more often by Caucasian girls (69%) than by Caucasian boys (43%) (p < 0.00001). Thirty percent still had the habit. Forty-one percent had a history of nail biting. Bruxism was noted in 20% of the children, but occurred mostly in combination with other parafunctions and was seldom (in 3.4%) the only parafunction. Of the 10 pain variables, bruxism was significantly associated with eight, thumb sucking with three, and nail biting with two. Analysis with logistic regression confirmed the results. Association does not, however, tell if a parafunction is the cause or the consequence of pain, or if a third factor is causing both pain and increased prevalence of oral parafunctions. Further prospective longitudinal studies including higher age groups are needed to clarify those relations and to determine if there are long-term effects of childhood parafunctions.

Psychologic aspects of patients with symptoms presumed to be caused by electricity or visual display units

Psychologic factors were studied in 10 patients with symptoms presumed to be caused by electricity (EG) and in 10 patients with symptoms presumed to be caused by visual display units (VG) and compared with a sex- and age-matched control group (CG). Psychologic differences between the EG and VG were also measured. The symptoms presumed to be caused by electricity or visual display units were registered, and the personality, psychologic functioning, and quality of life were determined by using the Karolinska Scales of Personality (KSP), an additional Personality Scale (PS), a Psychological Functioning Scale (PFS), and a quality of Life Scale (QLS). The results showed that the commonest general symptoms in the EG/VG were skin complaints, fatigue, pain, and dizziness, and the commonest oral symptoms were gustatory disturbance, burning mouth, and temporomandibular joint dysfunction. The patients in the EG described more different types of both general and oral symptoms than those in the VG. The result showed that the VG scored significantly higher only in the KSP Somatic Anxiety and Muscular Tension scales, and the EG scored significantly lower in the KSP Socialization scale and significantly higher in the Somatic Anxiety, Muscular Tension, and Psychasthenia scales. In addition, only the EG differed significantly on the PS, PFS, and QLS. The EG differed significantly in such psychologic aspects as being more fatigued in the PS, in having more difficulty in concentrating, in taking the initiative, and in getting on with people in the PFS and experiencing inactivity and visiting other people rarely in the QLS. The conclusion was that patients with symptoms presumed to be caused by electricity and visual display units differed from each other psychologically and, therefore, should be handled clinically in different ways. The need for an interdisciplinary approach to these patients is emphasized.

Depressive symptoms associated with symptoms of the temporomandibular joint pain and dysfunction syndrome

This paper discusses the findings in the 1012 55-year-old inhabitants of Oulu (a medium-sized Finnish town), 780 of whom (77%) were examined. The purpose was to determine the possible associations between depressive symptoms and subjective and clinical symptoms of the temporomandibular joint pain and dysfunction syndrome (PDS). The PDS symptoms were determined using Helkimo's Clinical Dysfunction Index. Depressive symptoms in 768 subjects were determined using Zung's self-rating depression scale. The prevalences of high rates of depressive symptoms, subjective symptoms of PDS, and clinical symptoms of PDS in the population were 12.2%, 12.0%, and 4.9%, respectively. Subjective symptoms of PDS were more common in depressed dentate men and women than in nondepressed dentate men and women. There was a significantly higher prevalence of subjective symptoms of PDS in depressed edentulous women than in nondepressed edentulous women. There were significantly more moderate or severe clinical symptoms of PDS in depressed dentate women than in nondepressed dentate women. A similar trend was seen in dentate men. An integrated approach is of crucial importance in the diagnosis and treatment of depression and the temporomandibular joint pain and dysfunction syndrome.

Temporomandibular disorders after early Class II treatment with bionators and headgears: results from a randomized controlled trial

Symptoms and signs of temporomandibular disorders were assessed in children enrolled in a randomized controlled trial of early treatment for Class II malocclusion. Children (mean age of 9.8 years) were assigned to a treatment protocol (bionator, n = 60; observation, n = 60; headgear/bite plane, n = 71) using randomized block stratification. Temporomandibular joint (TMJ) sounds, joint capsule pain to palpation, and muscle pain to palpation were scored as binary responses (present/absent in a subject). Determinations were made by blinded, calibrated examiners initially (DC1) and after a Class I molar correction was achieved or 2 years had elapsed (DC3). Univariate relationships among explanatory factors (group assignment, gender, age, time interval between DC1 and DC3, Class II severity, mandibular plane angle, preparatory treatment, whether Class I molar relation was achieved) and binary responses were explored using Chi square tables and ANOVA methods. Logistic regression modeled the relationship between binary responses and the explanatory variables. At DC1, the 3 groups were equivalent in the explanatory variables (P > .05). Subjects with a TMJ sound, joint pain, and/or muscle pain at follow-up were more likely those who had the sign at baseline (P < .01). Early treatment with bionators and headgear/bite planes did not place healthy children without these signs at risk for developing these signs. Only increasing age (for the development of sounds, P < .04) and failure to achieve a Class I molar relation (for development of muscle pain, P < .04) placed sign-free children at greater risk. Subjects with TMJ pain at baseline were 7 times more likely to have pain at follow-up if they had been treated with a headgear/bite plane or observed than if they had been treated with a bionator (P = .007). We conclude that an immediate benefit or risk for children receiving early Class II treatment with bionators and headgear/bite planes with respect to temporomandibular joint function does not exist with the prospect that Class II children with TMJ capsule pain may benefit from bionator therapy.

Occlusal interferences in retruded contact position and temporomandibular joint sounds

In 193 non-patient adolescents, unilateral contacts in retruded contact position (RCP) were seen more often in girls than in boys (P < 0.001) and were more frequent in subjects with than without general joint instability (P < 0.05). A negative correlation (r = -0.70***) was found between the side of the temporomandibular joint sound and the side of unilateral contact in RCP. Boys with unilateral contacts in RCP had more non-reciprocal clicking than girls. No signs were found indicating that a unilateral contact in RCP is an aetiological factor for development of temporomandibular disorders. Unilateral contacts in RCP may in adolescents be considered a predictive factor for temporomandibular joint disturbance. Contradictory causes may determine the sagittal distance between RCP and ICP.

Odds ratio in the estimation of the significance of occlusal factors in craniomandibular disorders

The usage of odds ratios for estimating the significance of occlusion is based on the assumption that the aetiological factors are additive and interchangeable in several different composite causes. If the factor studied is a necessary causal factor, odds ratios cannot be used in risk estimation. The present study analysed odds ratios in a sample of children half of whom had undergone an annual prophylactic elimination of occlusal interferences. The sample consisted of 178 children followed up for 5 years from the baseline age of 5 or 10. The distribution of interferences was computed for children with tenderness of the masticatory muscles ('cases'), and for children without ('controls'). Although the increase in the number of children free from interferences was not remarkable, the overall result was statistically significant (P < 0.01). None of the children free from interferences showed muscular tenderness at any of the annual examinations. Therefore, odds ratios could not be calculated in our study sample. It is concluded that estimation by means of odds ratios of the significance of occlusal factors in CMD may be misleading.

Temporomandibular disorders in the active phase of orthodontic treatment

Subjective symptoms and clinical signs of temporomandibular disorders (TMD) as well as presence of headache, bruxism and occlusal interferences were examined in 50 patients (mean age 12.9 years) before, during and immediately after orthodontic treatment. The prevalences of signs and symptoms of TMD were high before the treatment in comparison with subjects in an epidemiological study. Except for TMJ sounds, signs and symptoms of TMD as well as presence of headache decreased during the treatment. The major factor for decrease of the dysfunction index during the treatment compared with before the treatment, was tenderness to palpation of the masticatory muscles. Although there was a high prevalence of occlusal interferences during treatment, they seemed to have little importance for development of TMD. One explanation may be that the orthodontically moved teet are sensitive to contact resulting in a decrease of oral parafunctions. Such a decrease was also reported by the patients.

Experimental occlusal interferences. Part I. A review

This review shows that experimental occlusal interferences (prematurities) may cause changes in the myoelectric contraction patterns of the human jaw muscles, and changes in the translatory motion patterns of the human mandible. However, it has not been unequivocally established that the observed changes have specific long-term detrimental effects. On the other hand, it is apparent that experimental occlusal interferences are associated with short-term clinical symptoms and signs, such as jaw muscle fatigue and pains, headaches, pains and clickings in the temporomandibular joints. This review suggests that new paradigms involving experimental occlusal interferences should be introduced.

Influence of variation in jaw posture on sternocleidomastoid and trapezius electromyographic activity

This study was conducted in order to determine the influence of variation in the occlusal contacts on electromyographic (EMG) cervical activity in 20 patients with myogenic cranio-cervical-mandibular dysfunction. EMG recordings during maximal voluntary clenching were performed by placing surface electrodes on the left sternocleidomastoid and upper trapezius muscles in the following conditions: intercuspal position; edge to edge left laterotrusive contacts (ipsilateral); edge to edge right laterotrusive contacts (contralateral); edge to edge protrusive contacts; and retrusive occlusal contacts. A significant higher EMG activity was recorded in both muscles during maximal voluntary clenching in retrusive occlusal contact position, whereas no significant differences in EMG activity were observed between intercuspal position, ipsilateral, contralateral and protrusive contact positions. The EMG pattern observed suggests that a more frequent intensity and duration of tooth clenching in retrusive occlusal contact position could result in more clinical symptomatology in these cervical muscles in patients with myogenic cranio-cervical-mandibular dysfunction.

Craniomandibular disorders, edentulousness and the clinically estimated size of the masseter muscle

A total of 355 postmenopausal women were classified according to the degree of edentulousness, and anamnestic information on masticatory dysfunction symptoms was recorded. Five masticatory muscles were palpated, and the subjects were classified according to size of the masseter muscle. This simple classification for the clinical inspection of the masseter muscle was tested. In agreement with previous reports, decreasing functional exercise of the jaws was found to diminish the size of the masticatory muscles making them more disposed to dysfunction symptoms. The three-level classification of size of the masseter muscle is useful in normal clinical practice for determining the condition of this muscle.

Examination and occlusal analysis of the masticatory system

Analysis of the occlusion and function of the masticatory system should be part of a thorough examination of the patient. This is especially important when signs or symptoms of functional disturbances are present or when planning extensive occlusal restorations. This article has strived to present (1) indications for occlusal analysis; (2) how to perform occlusal analysis and diagnostic aids that can be helpful in occlusal analysis; and (3) how information gained through occlusal analysis can be used in differential diagnosis of the three most common functional disturbancies of the masticatory system: trauma from occlusion, parafunction, and TM disorders.

Relationship between craniomandibular dysfunction and oral parafunctions in Caucasian children with and without unpleasant life events

An epidemiological study was conducted to investigate the relationship between craniomandibular dysfunction and oral parafunctions in 386 children aged 6-10 years with and without unpleasant life events. The results showed statistically significant correlations between grinding, clenching, lip/cheek biting and muscle tenderness or pain, and clicking in subjects without unpleasant life events. Also, significant correlations were found in the same group between these parafunctions and difficulties in opening wide and pain on movements. When the definitional symptoms of craniomandibular dysfunction were aggregated, the chi-square test revealed significant correlations between them and the same oral parafunctions. The correlations in subjects with unpleasant life events between grinding, clenching, lip/cheek biting and each sign and symptom of craniomandibular dysfunction were close to the significance level. No significant correlations were detected between the definitional symptoms and these parafunctions in this group. The present study suggests that in patients without unpleasant life events grinding, clenching, and lip/cheek biting cannot be considered 'necessary' but can be 'sufficient' cause for the development of craniomandibular dysfunction. In subjects with unpleasant life events the origin of signs/symptoms of the dysfunction can be attributed to muscle tension or to another unknown aetiological factor.