Prevalence and associated factors for temporomandibular disorders in a group of Mexican adolescents and youth adults

Sociodemographic Profile: A Forgotten Factor in Temporomandibular Disorders? A Scoping Review

The literature on Temporomandibular Disorders (TMD) incidence commonly reports sociodemographic factors such as gender and age. However, the role and prevalence of other sociodemographic factors in TMD are not well defined. Therefore, this scoping review aimed to report the prevalence of sociodemographic factors in TMD patients. A systematic search was conducted in the PubMed and Web of Science databases to identify clinical trials in adult populations, using the Research Diagnostic Criteria for TMD (RDC/TMD) or the Diagnostic Criteria for TMD (DC/TMD) and reporting sociodemographic data in TMD patients. Twenty-seven studies meeting the criteria were included in this review. The most commonly reported sociodemographic factors assessed in the included studies were age, race, education, job, income, and marital status. TMD prevalence was observed to be higher among younger and divorced individuals among the included studies. However, conflicting results were found for education level, and employment was not considered a risk factor for TMD. Although this review has methodological limitations, it suggests an association between TMD incidence and certain sociodemographic factors; nevertheless, further studies are needed to establish this relationship more conclusively.

Prevalence of temporomandibular disorders in the Brazilian population: A systematic review and meta-analysis

This systematic review aimed to assess the prevalence of temporomandibular disorders (TMD) in the Brazilian population, with studies that used the RDC/TMD or DC/TMD as diagnostic tools. A total of 6365 people from 11 studies were included. Sample mean age ranged from 12 to 69.5 years. The pooled prevalence of TMD was 33.6% (95% CI 31.5-35.8; I2 = 37.2). Prevalence of TMD was higher in females (37.0%) than in males (29.3%). Our results indicate that TMD is a prevalent condition across Brazil's territories. The results from this meta-analysis can help calculate more accurate sample sizes for future studies.

Malocclusion complexity as an associated factor for temporomandibular disorders. A case-control study

OBJECTIVE

To evaluate the association between temporomandibular disorders (TMD) and malocclusion complexity using the Index of Complexity Outcome and Need (ICON) levels.

METHODS

A prospective, cross-sectional, case and control study was done. Cases and controls were matched in a one-to-one relationship (179 subjects each). The Research Diagnostic Criteria was used to evaluate the presence of TMD, and the ICON was used to quantify malocclusion complexity. A binary logistic regression (p < 0.05) was used to identify associations between variables.

RESULTS

TMD presence was associated with gender and malocclusion complexity (p < 0.05). The largest proportion of controls were in the lowest three levels of ICON complexity, while most cases were in the three highest levels (p < 0.001). Higher malocclusion complexity indicated a greater TMD risk.

CONCLUSION

The results indicate that TMD is associated with malocclusion complexity. As malocclusion complexity increases, so do the odds of presenting with TMD.

The Impact of Temporomandibular Disorders on Orthodontic Management: A Systematic Review and Meta-Analysis

The literature on the impact of temporomandibular disorders (TMDs) on orthodontic management or vice versa lacks clarity. This study presents a review that aims to evaluate the influence of TMDs on orthodontic management and explore the association between TMDs and various aspects of orthodontic treatment. A systematic search was conducted across multiple databases to identify relevant articles documenting the correlation between TMD incidence and orthodontic treatment to achieve the objectives. The selection process followed predefined criteria, and the selected studies underwent bias assessment using the AXIS tool and Cochrane risk of bias (RoB) tool. Among the articles identified, nine studies were deemed suitable for inclusion in the review. The findings from the subsequent meta-analysis indicated a significant overall effect, suggesting that orthodontic treatment may increase the risk of developing TMD. Furthermore, the analysis revealed that patients with TMD had higher odds of experiencing orthodontic issues than those without TMD. Subgroup analysis further demonstrated that orthodontic treatment could have a negative impact on the psychological well-being of TMD patients, while its effect on TMD incidence was found to be negligible. The results highlight the need for additional research to gain a better understanding of the underlying mechanisms and develop appropriate interventions aimed at minimizing the risk of TMD in patients undergoing orthodontic treatment. Clinicians should be aware of TMD as a potential complication of orthodontic treatment and implement appropriate monitoring strategies.

Research progress in effect of chewing-side preference on temporomandibular joint and its relationship with temporo-mandibular disorders

Chewing-side preference is one of the risk factors for temporomandibular disorders (TMD), and people with chewing-side preference is more prone to have short and displaced condyles, increased articular eminence inclination and glenoid fossa depth. The proportion of TMD patients with chewing-side preference is often higher than that of the normal subjects. Clinical studies have shown a strong correlation between chewing-side preference and TMD symptoms and signs; and animal studies have shown that chewing-side preference can affect the growth, development, damage and repair of the mandible. After long-term unilateral mastication, changes in the stress within the joint cause the imbalance of temporomandibular joint (TMJ) structural reconstruction, the transformation and even destruction of the fiber structure of masticatory muscle, resulting in uncoordinated movement of bilateral muscles. The joint neurogenic diseases caused by the increase of neuropeptide substance P and calcitonin-gene-related-peptide (CGRP) released locally by TMJ may be the mechanism of TMD. This article reviews the research progress of the influence of chewing-side preference on the structure of TMJ, the relationship between chewing-side preference and TMD, and the related mechanisms.

FitJaw Mobile, a virtual reality device applied to dentistry: An analysis based on two patient treatments

STATEMENT OF PROBLEM

Virtual reality (VR) has improved significantly in the last decade and has been applied to different fields, including medicine, dentistry, and physiotherapy. VR has been used for the innovative treatment of painful conditions, especially when traditional exercise therapies were unsuccessful because of patient noncompliance.

PURPOSE

The purpose of this study was to analyze the use of VR as an aid when using exercises to manage temporomandibular disorders (TMDs).

MATERIAL AND METHODS

Two White women diagnosed with TMDs of muscular origin (one with muscular pain and the other with reduced mouth opening) were referred to the Department of Prosthodontics of the University of Seville, where they were enrolled in an exercise program using the VR software program FitJaw Mobile. Both had been treated the previous year with an occlusal device for TMD of muscular origin, but their symptoms had not improved.

RESULTS

For both patients, the functional movement limitation and the chronic pain improved noticeably.

CONCLUSIONS

The use of VR when doing jaw exercises can improve outcomes and compliance.

Updating The General Practitioner on The Association Between Teeth Loss and Temporomandibular Disorders: A Systematic Review

The belief about a possible association between the absence of one or more teeth and the presence of temporomandibular disorders (TMD), although old, is still present among the dental class. Although evidence points to a lack of association between loss of posterior support and the presence of TMD, we do not have critical studies on the extent, quantity, or location of these losses. In this sense, this systematic review aims to investigate the association between tooth loss and the presence of TMD signs or diagnostic subgroups. Search strategies using a combination of keywords tooth loss and TMDs were performed in six databases (PubMed, Embase, Web of Science, Livivo, Lilacs, and Scopus) and gray literature from August to September 2020. Observational studies that investigated the association between tooth loss in TMD were considered. The risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Assessment Checklist for cross-sectional analytical studies, case-control, and cohort studies. Finally, the level of certainty measured by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was assessed. Six articles were included in the review according to the eligibility criteria. Of these, five had a high risk of bias and one had a moderate risk. Only one study showed an association between the loss of posterior teeth and the presence of joint sounds and joint pain, the others found no significant association with sign or TMD subgroups diagnostic.There is no scientific evidence to support the association between one or more tooth loss and the presence of TMD signs and symptoms or diagnostic subgroups.

Genetic overlap between temporomandibular disorders and primary headaches: A systematic review

Primary headache disorders (PHD), specifically migraine, are strongly associated with temporomandibular disorders (TMD), sharing some patterns of orofacial pain. Both disorders have significant genetic contributions already studied. PRISMA guidelines were followed to conduct this systematic review, which comprehensively summarize and discuss the genetic overlap between TMD and PHD to aid future research in potential therapy targets. This review included eight original articles published between 2015 and 2020, written in English and related to either TMD and/or PHD. The genes simultaneously assessed in PHD and TMD studies were COMT, MTHFR, and ESR1. COMT was proved to play a critical role in TMD pathogenesis, as all studies have concluded about its impact on the occurrence of the disease, although no association with PHD was found. No proof on the impact of MTHFR gene regulation on either TMD or PHD was found. The most robust results are concerning the ESR1 gene, which is present in the genetic profile of both clinical conditions. This novel systematic review highlights not only the need for a clear understanding of the role of ESR1 and COMT genes in pain pathogenesis, but it also evaluates their potential as a promising therapeutic target to treat both pathologies.

Celecoxib in the treatment of orofacial pain and discomfort in rats subjected to a dental occlusal interference model

Purpose:

To evaluate the effect of a selective cyclooxygenase 2 (COX-2) inhibitor on trigeminal ganglion changes and orofacial discomfort/nociception in rats submitted to an experimental model of dental occlusal interference (DOI).

Methods:

Female Wistar rats (180-200 g) were divided into five groups: a sham group (without DOI) (n=15); and four experimental groups with DOI treated daily with 0.1 mL/kg saline (DOI+SAL), 8, 16, or 32 mg/kg celecoxib (DOI+cel -8, -16, -32) (n=30/group). The animals were euthanized after one, three, and seven days. The bilateral trigeminal ganglia were analyzed histomorphometrically (neuron cell body area) and immunohistochemically (COX-2, nuclear factor-kappa B [NFkB], and peroxisome proliferator-activated receptor-y [PPARy]). A bilateral nociception assay of the masseter muscle was performed. The number of bites/scratches, weight, and grimace scale scores were determined daily. One-way/two-way analysis of variance (ANOVA)/Bonferroni post hoc tests were used (P < .05, GraphPad Prism 5.0).

Results:

DOI+SAL showed a reduction in neuron cell body area bilaterally, whereas DOI+cel-32 exhibited a significative increase in neuron cell body area compared with DOI+SAL group (P < 0.05). The ipsilateral (P=0.007 and P=0.039) and contralateral (P < 0.001 and P=0.005) overexpression of COX-2 and NFkB and downregulation of PPARy (P=0.016 and P < 0.001) occurred in DOI+SAL, but DOI+cel-32 reverted this alteration. DOI+SAL showed increase in isplateral (P < 0.001) and contralateral (P < 0.001) nociception, an increased number of bites (P=0.010), scratches (P < 0.001), and grimace scores (P=0.032). In the group of DOI+cel-32, these parameters were reduced.

Conclusions:

Celecoxib attenuated DOI-induced transitory nociception/orofacial discomfort resulting from trigeminal COX-2 overexpression.

Prevalence of signs and symptoms of temporomandibular disorder in the metropolitan region of Rio De Janeiro: A population-based cross-sectional study

OBJECTIVE

Temporomandibular disorder (TMD) is a group of heterogeneous pathological conditions that affect the temporomandibular joint (TMJ), mastication muscles, and some associated structures. The aim of this study was to measure the prevalence of signs and symptoms of dysfunction, including knowledge of TMD in a stratum of the population.

METHODS

A population extract from Rio de Janeiro subdivided by conglomerates was interviewed through an online form.

RESULTS

The results showed that only 19% of the participants had no symptoms related to TMD.

CONCLUSION

The results showed that the symptom prevalence is directly related to knowledge and practices about the disorder and that its presence may be under-reported.

The relationship between orthodontic treatment and temporomandibular disorders: A dental specialists' perspective

Introduction:

The relationship between temporomandibular disorders (TMDs) and orthodontic treatment/malocclusion has changed from a cause-and-effect association to an idea without sufficient evidence.

Objective:

This survey was designed to assess the beliefs of different disciplines - orthodontists, oral surgeons, and oral medicine specialists - on the relationship between TMDs and orthodontic treatment, with regard to treatment, prevention and etiology of TMDs.

Method:

A survey in the form of questionnaire was designed and distributed to 180 orthodontists, 193 oral surgeons and 125 oral medicine specialists actively involved in treating TMDs. The questionnaire aimed to collect basic information about each participant and their beliefs, and clinical management of patients with TMDs.

Results:

Halve of the responding orthodontists and most of the oral surgeons (69.9%) were male participants, whereas the majority of oral medicine specialists (83.3%) were female respondents. The participants’ age ranged from 29 to 58 years. The majority of orthodontists believes that there is no relationship between orthodontic treatment and TMDs, and that orthodontic treatment does not provoke TMDs or prevent the onset of the disorder. However, oral surgeons and oral medicine specialists have different and conflicting opinions. Most surgeons tended to treat those patients, while most of the other two disciplines tended to seek an interdisciplinary approach. Chi-square test was done to find an association between the referral status and specialists’ experience, and to compare between the different disciplines’ belief.

Conclusions:

Orthodontist’s beliefs were in accordance with the scientific evidence, whereas most oral surgeons and oral medicine specialist believed that orthodontic treatment may provoke TMDs. Therefore, continuing program series development is important to embrace the concept of the multidisciplinary team approach and improve the health care and quality of life for those patients.

Effect of temporomandibular disorders on cortisol concentration in the body and treatment with occlusal equilibrium

Background:

Temporomandibular disorders (TMDs) are a group of symptoms concerning the temporomandibular joints, masticatory muscles, and occlusion, which include pain, restricted mouth opening and movement, joint tenderness, and intermittent joint noises. Women are more likely to suffer from temporomandibular problems than men. Patients with TMDs show a wide range of behavioral and psychosocial symptoms, including increased stress, anxiety, sadness, and somatization.

Materials and methods:

The patient group in this case–control research comprised 60 patients from the Department of Prosthodontics at Shri Dharmasthala Manjunatheswara College of Dental Sciences in Dharwad. Female subjects aged between 33 and 45 years, who were educated, had two children, and were housewives were included in the study. Only 96 individuals of those screened met the inclusion criteria, and these 96 patients were given a hair cortisol test. After 1, 2, and 3 months, cortisol testing was performed.

Results:

There were no significant differences between the groups at the start of the study; but after 30 min of the modified trier test, there was a statistically significant main effect across groups, as well as a significant main effect of salivary cortisol over time.

Conclusion:

The etiopathogenesis of TMD is complicated by psychosocial stress. When compared to men, women have a higher risk of TMD.

A comparative study of condyle position in temporomandibular disorders patients with chewing side preference using cone-beam computed tomography

BACKGROUND

Chewing side preference (CSP) could cause structural and morphological changes of temporomandibular joint (TMJ) and has been suggested as one etiology of temporomandibular disorders (TMDs), but the condylar position in TMD patients with CSP is unknown.

OBJECTIVE

To compare the condylar position in the TMD patients with and without CSP.

METHODS

Ninety TMD patients with unilateral symptom (69 with CSP and 21 without CSP) and 20 asymptomatic participants received cone-beam computed tomography. The condylar position was determined based on the measurements of sagittal joint spaces. Intergroup and intragroup comparisons of the condylar position were performed.

RESULTS

The condyles in asymptomatic participants located nearly randomly in anterior, centric, and posterior positions. Patients without CSP had significantly more posterior condyles than asymptomatic participants (57.1% vs 30.0%, P<0.05). In patients with CSP, 50.7% of the condyles on the preferred chewing side and 42.0% on the unpreferred side located posteriorly, reaching no significant level compared with the asymptomatic participants and patients without CSP (P>0.05). The symptomatic joints and asymptomatic joints in patients with CSP and without CSP showed no significant differences in condylar position. While patients without CSP had significantly more posterior condyles in symptomatic joints than asymptomatic participants (P<0.05), patients with CSP showed a trend towards more posterior condyles in symptomatic joints compared with the asymptomatic participants (53.6% vs 30.0%, P=0.054).

CONCLUSION

Condylar position is not a strong indicator to differentiate CSP-related TMDs from none-CSP-related TMDs. Posterior condyle could not be viewed as one indicator of TMD.

Cone-beam computed tomographic assessment of the inclination of the articular eminence in patients with temporomandibular disorders and chewing side preference

Background

Chewing side preference (CSP) has been proposed as one etiology of temporomandibular disorders (TMDs) as it can induce the structural changes of the temporomandibular joint. But its association with the inclination of the articular eminence (IAE) is unknown. This study aimed to compare IAE between patients with CSP and without CSP.

Methods

Cone-beam computed tomography images of 90 patients with TMD (mean age of 45.6 years, 69 with CSP, 21 without CSP) and 20 participants without TMD and CSP (mean age of 41.3 years) were measured to compare IAE and depth of the glenoid fossa (DGF)

Results

IAE and DGF showed a positive correlation among all the participants. Compared with the participants without TMD and CSP, the TMD patients without CSP presented a similar IAE but with a significantly higher value of DGF (p < 0.05); in contrast, the TMD patients with CSP presented a significantly greater IAE and DGF (p < 0.05). No bilateral differences in IAE and DGF were observed in all the participants. Except the male patients with CSP had a deeper fossa than did the female, no differences in IAE and DGF according to gender were observed.

Conclusions

TMD patients with CSP seem to have a deep glenoid fossa with steep eminence which might be considered one characteristic imaging feature.

Association between psychological factors and temporomandibular disorders in adolescents of rural and urban zones

Background

Temporomandibular disorders (TMD) are related to psychological factors. Adolescence is one of the stages in life with more psychosocial vulnerability, which is dissimilar in rural and urban zones. Thus, the aim of this investigation was to evaluate the association between psychological factors (symptoms of anxiety, depression and somatization) and TMD in adolescents between 12 and 15 years, belonging to urban and rural zones of Colombia.

Methods

180 subjects aged 12–15 years (mean 13.8, SD 1.2), enrolled in public schools in the rural (n = 90) and urban (n = 90) zones were included. All subjects were evaluated using the DC/TMD instrument; the Axis I was applied for the clinical examination and the Axis II for the psychological evaluation. Data were analyzed by means of T-student, Mann–Whitney, Kruskall–Wallis tests, Pearson Chi square and multiple-variable analysis with logistic regression.

Results

Forty percent of the included subjects presented some type of TMD. TMD related to pain were the most common (25.5% of the studied adolescents), being myalgia the most common (20% of the adolescents in urban zone and 31.1% of the adolescents in the rural zone). There was no difference between the TMD present in males and females, but there were differences in the symptoms of Anxiety, and Somatization (p < 0.05). TMD and psychological factors were more prevalent in children with 13 years of age. A statistically significant association between TMD and symptoms of Anxiety (Pearson Chi squared 25.57, p = 0.04), depression (Pearson Chi squared 33.28, p = 0.03) and somatization (Pearson Chi squared 25.79, p = 0.04) was found in subjects from rural zones. No associations between psychological aspects and TMD were found in subjects from urban zones, but overall all psychological factors significantly influenced TMD.

Conclusion

This study indicates Myalgia to be the most prevalent TMD in studied Colombian adolescents. Pain-related TMDs are associated with psychological factors in the adolescent population of rural Colombia. Symptoms of anxiety, depression and somatization were found to be associated to TMD, even when the frequency was not necessarily severe.

Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis

OBJECTIVES

The aim of this systematic review was to evaluate the prevalence of temporomandibular joint disorders (TMJD) among the general population.

MATERIALS AND METHODS

Five main electronic databases and three grey literature were searched to identify observational studies in which TMJD was diagnosed using the research diagnostic criteria (RDC/TMD) or diagnostic criteria (DC/TMD). The studies were blindly selected by two reviewers based on eligibility criteria. Risk of bias (RoB) was assessed using the Joanna Briggs Institute Critical Appraisal Checklist, and the "R" Statistics software was used to perform meta-analyses.

RESULTS

From 2741 articles, 21 were included. Ten studies were judged at low RoB, seven at moderate, and four at high. The TMJD investigated were as follows: arthralgia, disk displacement (DDs) with reduction (DDwR), DDwR with intermittent locking, DDs without reduction (DDwoR) with limited opening, DDwoR without limited opening, degenerative joint disease (DJD), osteoarthritis, osteoarthrosis, and subluxation. The main results from prevalence overall meta-analyses for adults/elderly are as follows: TMJD (31.1%), DDs (19.1%), and DJD (9.8%). Furthermore, for children/adolescents are as follows: TMJD (11.3%), DDs (8.3%), and DJD (0.4%). Considering the individual diagnosis meta-analyses, the most prevalent TMJD is DDwR for adults/elderly (25.9%) and children/adolescents (7.4%).

CONCLUSIONS

The overall prevalence of TMJD was approximately 31% for adults/elderly and 11% for children/adolescents, and the most prevalent TMJD was DDwR.

CLINICAL RELEVANCE

Knowledge about the frequency of TMJD can encourage dentists to consider appropriate strategies for early and correct diagnosis and, if need be, correct management.

Temporomandibular disorders: a review of current concepts in aetiology, diagnosis and management

Temporomandibular disorders (TMD) is a collective term for a group of musculoskeletal conditions involving pain and/or dysfunction in the masticatory muscles, temporomandibular joints (TMJ) and associated structures. It is the most common type of non-odontogenic orofacial pain and patients can present with pain affecting the face/head, TMJ and or teeth, limitations in jaw movement, and sounds in the TMJ during jaw movements. Comorbid painful and non-painful conditions are also common among individuals with TMD. The diagnosis of TMD have significantly improved over time with the recent Diagnostic Criteria for TMD (DC/TMD) being reliable and valid for most common diagnoses, and an efficient way to communicate in multidisciplinary settings. This classification covers 12 most common TMD, including painful (myalgia, arthralgia and headache attributed to TMD) as well as the non-painful (disc displacements, degenerative joint disease and subluxation) TMD diagnoses. Recent studies have demonstrated that the pathophysiology of common painful TMD is biopsychosocial and multifactorial, where no one factor is responsible for its development. Importantly, research has suggested different predisposing, initiating and perpetuating factors, including both peripheral and central mechanisms. This is an active field of investigation and future studies will not only seek to clarify specific causal pathways but translate this knowledge into mechanism-directed diagnosis and treatment. In accordance with this complex aetiology, current evidence supports primarily conservative multidisciplinary treatment including self-management strategies, behavioural therapy, physical therapy and pharmacotherapy. The aim of this review is to present an overview of most recent developments in aetiology, pathophysiology, diagnosis and management of TMD.

Temporomandibular disorders in North Indian population visiting a tertiary care dental hospital

Background:

The terminology “temporomandibular disorders” (TMDs) encompasses a wide spectrum of conditions. Several hypothesized causes are occlusal disharmony, muscle hyperactivity, central pain mechanisms, psychological distress, and trauma. In day-to-day practice, TMDs had become more prevalent in Indian population due to changed dietary pattern and food habits, excessive stress of modern life, and other environmental causes. This study is an attempt to find the prevalence of TMDs in North Indian population.

Aims:

The present study is taken into account to determine the prevalence of TMDs on the basis of signs and symptoms based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD).

Materials and Methods:

The present cross-sectional study was conducted in the Department of Oral Medicine and Radiology. A total of 1009 patients aged between 6 and 80 years with a mean age of 42.04 ± 16.8 years seeking dental treatment from January 2016 to June 2017 were included in the study. All the patients were screened for TMD sign and symptoms. The demographic data and the signs and symptoms of TMDs were recorded in designed structured questionnaires which were based on the RDC/TMD criteria.

Results:

The study population consisted of 1009 patients aged between 6 and 80 years. In the present study population, based on RDC/TMD criteria, the incidence of clicking sound (42.5%) was highest in TMD joint followed by deviation of mandible on mouth opening (40.8%), internal derangement (36.8%), myofacial pain dysfunction syndrome (33.7%), osteoarthritis (29.5%), crepitus (25.8%), joint tenderness (5.8%), and pain on mouth opening (4.8%).

Conclusion:

Clicking sound was the most common sign of TMD disorders in Indian population.

Prevalence of temporomandibular joint disorder in the Lebanese population, and its association with depression, anxiety, and stress

Background

The objectives of this study were to study the prevalence of temporomandibular joint disorder (TMD) and its association with anxiety, depression, and stress among the general Lebanese population as well as in a sample of patients recruited from an otolaryngologist clinic.

Methods

A cross-sectional study was conducted between September 2018 and December 2019, which enrolled 459 participants from all districts of Lebanon (sample 1) and 37 patients from the otolaryngologist clinic at the Eye and Ear Hospital (sample 2). The temporomandibular disorder screening checklist was used to screen for temporomandibular joint disorder. The Fonseca’s anamnestic index was used to assess for temporomandibular joint disorder related signs and symptoms, as well as for symptoms severity.

Results

The results showed that 19.7% of the general Lebanese population had TMD, from which 55.9% were female. In contrast, 59.5% of patients in the sample recruited from the clinic were found to have TMD. Higher stress, anxiety, and depression scores were associated with higher temporomandibular disorder severity score (B = 0.23; B = 0.10 and B = 0.10 respectively). Patients in the sample recruited from the clinic had higher mean stress (20.75 vs 11.43), anxiety (12.46 vs 5.78), depression (13.24 vs 6.52), and temporomandibular disorder severity scores (59.5% vs 19.7%) than the general population.

Conclusion

Temporomandibular joint disorder appears to be associated significantly with depression, anxiety, and stress and remains largely underdiagnosed in the general population.

Association Between -1607 1G/2G Polymorphism of MMP1 and Temporomandibular Joint Anterior Disc Displacement with Reduction

Anterior disc displacement with reduction (DDWR) is considered one of the most common disorders within the temporomandibular joint (TMJ), with a prevalence of 41% in adults. Matrix metalloproteinases play an important role in the degradation of the TMJ and the matrix metalloproteinase 1 (MMP1) 1607 1G/2G polymorphism increases the local expression of MMP1 thus leading to accelerated degradation of the extracellular matrix. The objective of this study was to evaluate the association between the 1607 1G/2G polymorphism of MMP1 gene and DDWR in a group of Mexican individuals from western Mexico. A total of 67 unrelated individuals, between the ages of 18 and 36 years, of both genders, were included in this study. Study participants with DDWR were required to meet the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), while a second control group of 90 individuals without DDWR were also included. Both groups were required to have paternal and maternal ancestry (grandparents) of the same geographic and ethnic region. Genotypes were determined using the nested PCR technique. The 1G/2G polymorphism was found in 68.7%, followed by 2G/2G in 25.4% and 1G/1G in 6.0% of the cases group. While the prevalence in the control group was 55.5% for the 1G/2G polymorphism, 26.6% for 1G/1G and 17.7% for 2G/2G. An association was found between the 2G allele of the 1607 1G/2G polymorphism of MMP1 gene and the presence of DDWR in the patients of western Mexico.

Association between bruxism and temporomandibular disorders in children: A systematic review and meta-analysis

BACKGROUND

Bruxism in children and its relation to the development of temporomandibular disorders (TMD) has not been clearly determined yet.

AIM

The objective of this systematic review was to evaluate the possible association between bruxism and TMD in children.

DESIGN

Seven databases were searched, and 497 articles were assessed. Methodological quality was assessed through Newcastle-Ottawa Scale. The meta-analysis was performed with the articles in which extraction of data was possible and the summary effect measure through odds ratio (OR) and respective 95% confidence intervals (CIs). Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the certainty of evidence.

RESULTS

Ten cross-sectional studies were included in the systematic review. Of these, 8 showed a statistically significant association between bruxism and TMD. Seven studies however presented a high risk of bias. The meta-analysis was performed with 3 articles and obtained an OR of 2.97 (95% CI ranging from 1.72-5.15), indicating that children with bruxism are 2.97 times more likely to present TMD, with very low level of certainty defined by GRADE.

CONCLUSIONS

Although the studies showed high risk of bias, the qualitative analysis of individual studies showed that the children with bruxism have greater chance of developing TMD.

Malocclusion Generates Anxiety-Like Behavior Through a Putative Lateral Habenula-Mesencephalic Trigeminal Nucleus Pathway

Malocclusion is an important risk factor for temporomandibular disorder (TMD), a series of disorders characterized by dysfunction in the orofacial region involving the temporomandibular joint (TMJ) and jaw muscles. We recently showed that experimental unilateral anterior crossbite (UAC) produced masseter hyperactivity through a circuit involving the periodontal proprioception, trigeminal mesencephalic nucleus (Vme), and trigeminal motor nucleus (Vmo). Anxiety is a common complication in patients with TMD. The lateral habenula (LHb) is involved in emotional modulation and has direct projections to the Vme. Therefore, the present research examined whether UAC facilitates excitatory input from the LHb to the Vme and, subsequently, anxiety-like behaviors in rats. The LHb activation was evaluated by the electrophysiological recording, assessment of vesicular glutamate transporter-2 (VGLUT2) mRNA expression, and measurement of anxiety-like behaviors. The effects of LHb activity on Vme were evaluated by electrophysiological recording from Vme neurons and local changes in VGLUT2 protein density. UAC produced anxiety in modeled rats and increased neuronal activity in the LHb. VGLUT2 mRNA expression was also increased in the LHb. Further, VGLUT2-positive boutons were observed in close apposite upon parvalbumin (PV)-labeled Vme neurons. VGLUT2 protein expression was also increased in the Vme. Significantly, injection of VGLUT2-targeted shRNA into the LHb reduced the expression of VGLUT2 protein in the Vme, attenuated UAC-associated anxiety-like behaviors, and attenuated electrophysiological changes in the Vme neurons. In conclusion, we show that UAC activates the LHb neurons as well as the periodontal proprioceptive pathway to provide excitatory input to the Vme and produce anxiety in rats. These findings provide a rationale for suppressing activity of the LHb to attenuate both the physical and psychological effects of TMD.

Prevalence and treatment strategies regarding temporomandibular disorders in children and adolescents-A systematic review

AIMS

Temporomandibular disorders (TMD) in children/adolescents are very common. Yet, there is a lack of consensus regarding which clinical interventions are appropriate. The aim of this systematic review was to gather and assess the quality of the available literature on the prevalence and evidence-based treatment strategies in children and adolescents suffering from TMD.

METHODS

A systematic literature review was conducted including articles from 1992 to 2016. A total of 2293 articles were found. Eight were included, six regarding prevalence and two regarding treatment. Simple or multiple conjunctions of different search words: "temporomandibular disorder", "temporomandibular joint disorder", "prevalence", "children" "adolescents", "occlusal appliance", "jaw exercise" and "relaxation" were used on the databases PubMed and Web of Science. Inclusion criteria were (a) scientific articles or randomised controlled clinical trials evaluating prevalence, choice of therapy and treatment outcome for children and/or adolescents with TMD published in Swedish or English and (b) a TMD diagnosis according to the Research Diagnostic Criteria for TMD or Diagnostic Criteria for TMD.

RESULTS

Prevalence (ages 10-19 years) varied between 7.3 and 30.4%, and the most common diagnoses were myofascial pain and anterior disc displacement with reduction. Only two articles were found regarding treatment in adolescents (ages 12-18 years). The stabilising occlusal appliance had superior treatment outcome compared to relaxation therapy or brief information.

CONCLUSION

The general absence of standardised studies concerning children/adolescents with TMD pain states the evident need for further systematic prevalence and treatment evaluations. Considering this, it is not possible to achieve any evidence-based treatment strategies or guidelines for children and adolescents with TMD.

Prevalence of temporomandibular disorders and oral parafunctions in adolescents from public schools in Southern Italy

Objective: The aim of this cross-sectional epidemiologic study was to estimate the prevalence of temporomandibular disorders (TMDs) and oral parafunctions in Italian adolescents and to assess the associations between age, gender, oral habits, and TMD. Methods: Three hundred sixty-one adolescents, aged 14-18 years, were examined for TMDs according to the Research Diagnostic Criteria for TMD. Furthermore, oral habits were explored by means of a written questionnaire. Results: Almost one-third of the sample (27.4%) showed at least one TMD diagnosis, with myofascial pain being the most prevalent. Gum chewing was the most prevalent oral habit. The female gender and oral habits were significantly associated with TMD. Conclusion: TMD in adolescents, although lower than in adults, are significantly prevalent. General practitioners should include TMD screening methods in their routine dental examinations of adolescent patients. Adolescents should be instructed on how to avoid incorrect oral behaviors that might predispose them to the onset of TMD.

Oral diseases and socio-demographic factors in adolescents living in Maasai population areas of Tanzania: a cross-sectional study

Background

Oral diseases may cause serious health problems, especially in socially disadvantaged populations and in low-income countries. In populations living in the rural areas of Tanzania there is paucity of reports on oral health. The study aim was to estimate the prevalence, severity and socio-demographic distribution of oral diseases/conditions in adolescents living in Maasai population areas of Tanzania and to compare oral diseases/conditions between Maasai and non-Maasai ethnic groups.

Methods

A total of 23 schools were randomly selected from 66 rural public primary schools in Monduli and Longido districts, Tanzania. All pupils in the selected classes, 6th grade, were invited to participate in the study. A total of 989 were invited and 906 (91.6%) accepted the invitation and completed an interview and a clinical oral examination.

Results

Out of 906 study participants (age range 12–17 years), 721(79.6%) were from Maasai and 185 (20.4%) from non-Maasai ethnic groups. Prevalence of poor oral hygiene, gingival bleeding, dental caries experience (DMFT> 0), dental fluorosis TF grade 5–9, dental erosion (into dentin), tooth wear (into dentin) and TMD was 65.6, 40.9, 8.8, 48.6, 1.9, 16.5 and 11.8%, respectively. Multiple variable logistic regression analysis revealed that, girls (OR = 2.0) and participants from Longido (OR = 2.6) were more likely to present with good oral hygiene (p < 0.05). Adolescents from Monduli (OR = 1.7), males (OR = 2.1), being born within Arusha region (OR = 1.9) and Maasai (OR = 1.7) were more likely to present with gingival bleeding (p < 0.05). DMFT> 0 increased by age (OR = 2.0) and was associated with non-Maasai ethnic group (OR = 2.2), (p < 0.05). Adolescents from Monduli district (OR = 10.0) and those born in Arusha region (OR = 3.2) were more likely to present with dental fluorosis (p < 0.05). Dental erosion was more common among non-Maasais (OR = 2.0) as well as having mother with high education (OR = 2.3), (p < 0.05).

Conclusions

Oral diseases like dental caries and dental erosion were less common, but gingival bleeding, dental fluorosis, tooth wear and TMD were common findings in adolescents attending primary schools in the Maasai population areas of Tanzania. Notable differences between Maasai and non-Maasai ethnic groups and certain correlations to sociodemographic factors were detected. Our findings can be utilized by policy makers in the planning of oral health programs in public primary schools of Maasai population areas of Tanzania.

Diagnostic ultrasound assessment of temporomandibular joints: a systematic review and meta-analysis

OBJECTIVES:

The purpose of this systematic review was to determine the diagnostic capability of ultrasound to assess TMJ alterations as disc displacement (DD), joint effusion (JE) and condylar changes (CC) using 3D imaging modalities as reference standard.

METHODS:

Studies were gathered by searching several electronic databases and partial grey literature up to January eighth, 2018 without restrictions of language and time. The risk of bias was evaluated using the second version of Quality Assessment Tool for Diagnostic of Accuracy Studies-2 (QUADAS-2). The grading of Recommendation, Assessment, Development and Evaluation (GRADEpro system) instrument was applied to assess the level of evidence across the studies.

RESULTS:

After applying the eligibility criteria, 28 studies were identified and synthesized. All studies were methodologically acceptable presenting low applicability concerns, although none of them fulfilled all QUADAS-2 criteria. The quantitative analysis included 22 studies, 2829 joints in total. The quality of the evidence evaluated by GRADE system suggested moderate confidence in estimating the outcomes.

CONCLUSION:

This systematic review demonstrated the ultrasound has acceptable capability to screen for DD and JE in TMD patients. For screening of condylar changes, ultrasound needs further studies using CT or CBCT as reference standard to support its use. More advanced imaging such as MRI can thereafter be used to confirm the diagnosis if deemed necessary.

Tratamento para disfunções temporomandibulares: uma revisão sistemática

RESUMO Introdução: A disfunção temporomandibular (DTM) é complexa e multifatorial. São encontrados, na literatura, estudos que comparam diferentes métodos de tratamento. Objetivo: Investigar estudos sobre o tratamento das disfunções temporomandibulares (DTMs) nas diversas áreas da saúde, avaliando a eficácia das técnicas empregadas, principalmente no que se refere ao uso da terapia miofuncional orofacial. Estratégia de pesquisa: Os artigos compilados neste estudo foram selecionados por meio da base de dados PubMed, utilizando os descritores “temporomandibular disorders and oral motor therapy”, “orofacial myofunctional therapy and temporomandibular disorders” e “temporomandibular disorders and myofunctional rehabilitation”. O levantamento realizado limitou-se aos artigos publicado nos idiomas Inglês e Português, entre janeiro de 2006 e dezembro de 2016. Critérios de seleção: Foram incluídos artigos sobre os tratamentos das DTMs associados aos exercícios musculares e/ou terapias manuais. Publicações sem acesso completo, repetidas por sobreposição das palavras-chave, revisões de literatura, cartas ao editor e não relacionadas diretamente ao tema foram excluídas. Resultados: Dos 102 estudos selecionados, 22 atenderam aos critérios estabelecidos. Em geral, a maioria dos tratamentos descritos apresentou efeitos benéficos para pacientes com DTMs. Foi observada grande variabilidade da metodologia adotada para a aplicação e verificação dos efeitos dos tratamentos e somente poucos estudos fizeram uso de grupo controle. Conclusão: Apesar do crescimento no número de pesquisas sobre DTMs, ainda não é possível estabelecer qual a melhor técnica de tratamento. Após análise dos artigos selecionados, observou-se que as técnicas combinadas de terapia (ex.: exercício associado ao uso de equipamento para redução da dor) produzem melhores resultados, com maior redução da dor e melhora da mobilidade mandibular.

A Study to Determine the Prevalence of Temporomandibular Disorders in a Young Adult Population and its Association with Psychological and Functional Occlusal Parameters

PURPOSE

To determine the prevalence of temporomandibular disorders (TMD) in medical university students and to analyze the relationship of TMD with psychological and functional occlusal parameters.

MATERIALS AND METHODS

200 students (mean age 21.81 ± 1.99) were screened for TMD with the TMD Pain Screener. Clinical examinations identified the participants with TMD. Based on their diagnostic criteria for TMD (DC/TMD) axis I diagnosis, participants were divided into three groups: group 1- non-TMD, group 2- pain related TMD and headaches, and group 3- intra-articular joint disorders. Further study was continued involving patients diagnosed with TMD as the study group, and an equal number of age- and sex-matched participants were selected in control group. Among these, emotional distress was evaluated using the "hospital anxiety and depression scale" (HADS). Occlusal evaluations were done by using the T-Scan computerized occlusal analysis system. Occlusion time, left lateral disclusion time, right lateral disclusion time, and protrusion disclusion time were measured with T-Scan III. These parameters were compared among the groups with ANOVA test at a significance level of 0.05.

RESULTS

17% of the population were affected by TMD. The mean HADSd (depression) and HADSa (anxiety) scores were significantly higher (p < 0.05) in group 2 (7.67 ± 3.68; 10.60 ± 3.33) and group 3 (6.89 ± 3.23; 9.26 ± 4.05) as compared to group 1 (3.18 ± 2.33; 5.29 ± 3.21). The mean values of occlusion time, left lateral disclusion time, right lateral disclusion time, and protrusion-disclusion time were also higher for group 2 and group 3 as compared to group 1.

CONCLUSIONS

This study found that the prevalence of TMD in this university student population was 17%. There were significant associations of TMD with psychological parameters and functional occlusal parameters.

Temporomandibular clinical exploration in Italian adolescents

OBJECTIVE

This study investigated the prevalence of the signs and symptoms of temporomandibular disorders (TMD) among Italian adolescents.

METHODS

The data were recorded from 567 subjects (246 males and 321 females; age range 11-19 years), grouped according to age and molar class relationship.

RESULTS

Forty-four point one percent of subjects showed at least one sign or symptom of TMD, which were significantly more frequent in the 16-19 year-old group (52.9%) in respect to the 11-15 year-old group (39.8%) (χ ² = 8.78; p = 0.003). Signs and/or symptoms were about 1.6 times more frequent in subjects with Class II/1 malocclusion (χ ² = 13.3, p = 0.0003), mostly for TMJ sounds (χ ² = 1.444; p = 0.036). Myalgia was more frequent in females than in males (χ ² = 3.882; p = 0.049).

CONCLUSION

TMD signs and/or symptoms among Italian adolescents seem diffused (44.1%). Therefore, all adolescents should be screened thorough medical history and clinical examination.

Sleep and awake bruxism in adults and its relationship with temporomandibular disorders: A systematic review from 2003 to 2014

OBJECTIVE

In order to establish a relationship between bruxism and temporomandibular disorders (TMDs), a systematic review was performed.

MATERIALS AND METHODS

A systematic research was performed based on PubMed, Cochrane Library, Medline, Embase, BIREME, Lilacs and Scielo data bases, between 2003 and 2014 including all languages. Descriptive clinical cases were identified. Two independent authors selected the articles. PICO format was used to analyse the studies and the Newcastle-Ottawa Scale (NOS) was used to verify the quality of the evidence.

RESULTS

Thirty-nine studies (n = 39) were analysed in this review. According to bruxism diagnosis, articles were grouped as follows: polysomnographic diagnosis (PSG) (n = 7), clinical diagnosis (n = 11) and survey/self-report (n = 21). Thirty-three articles (n = 33) established a positive relation between bruxism and TMD and six (n = 6) did not. Quality of evidence was low to moderate. In general, the most part of the studies showed shortcomings on their design with bias risk, and also had a low sensitivity on bruxism diagnosis.

CONCLUSIONS

The evidence based on PSG was not as conclusive as the studies that used surveys and clinical exam to diagnosis bruxism, when bruxism was related to TMD. Sleep bruxism could be associated with myofascial pain, arthralgia and joint pathology as disc displacement and joint noises. Although the evidence at present is inconclusive and does not provide information according to the type of bruxism (bruxism sleep and wakefulness), it is possible to suggest that bruxism would be associated with TMD.

Prevalence and Severity of Temporomandibular Disorders among Undergraduate Medical Students in Association with Khat Chewing

INTRODUCTION

The aim of this study was to assess the prevalence and severity of temporomandibular joint disorders (TMDs) among undergraduate medical students in the presence of khat chewing over a period of time.

MATERIALS AND METHODS

Totally, 186 medical college students (age < 20 years) were randomly selected for the present study. The study subjects were divided into two groups according to age, under 20 and above 20 years. The study was based on Fonseca's anamnestic index and its questionnaire, which is composed of 10 questions and classifies the severity of TMDs. The obtained data were coded and entered into Statistical Package for the Social Sciences (SPSS) program for analysis using chi-square test at significance level of 5%.

RESULTS

Most of the participants were male (68.8%) students and older than 20 years (63%). Those who reported with khat chewing comprised 31.7%. From the total samples, only 38.0% was classified as having mild TMD and 0.50% were classified as having severe TMD. Poor dental articulation, grinding of teeth, headaches, tense personalities, and temporomandibular joint (TMJ) clicking were the most common clinical findings. The mean scores showed no significant difference among gender (p < 0.29) and the khat chewing (p < 0.531) groups for the 10 questions. However, it showed significant difference among age groups (p < 0.025).

CONCLUSION

The majority of subjects complained of mild TMD, while only a few cases showed a moderate TMD among different age groups. The most frequently reported dysfunctions were related to poor dental articulation and grinding of the teeth, frequent headaches, the clicking of joint, and tense personalities. No significant difference was found between gender and khat and nonkhat chewing groups.

CLINICAL SIGNIFICANCE

Khat chewing is a parafunctional habit and affects dental occlusion (especially cuspal wear) in terms of anterior guidance. Such alterations in occlusion are known to be one of the causative (predisposing) factors of TMD.

Effects of cervical mobilization and exercise on pain, movement and function in subjects with temporomandibular disorders: a single group pre-post test

Objective

To investigate the effect of a rehabilitation program based on cervical mobilization and exercise on clinical signs and mandibular function in subjects with temporomandibular disorder (TMD). Material and Methods: Single-group pre-post test, with baseline comparison.

Subjects

Twelve women (22.08±2.23 years) with myofascial pain and mixed TMD according to the Research Diagnostic Criteria for Temporomandibular Disorders.

Outcome measures

Subjects were evaluated three times: twice before (baseline phase) and once after intervention. Self-reported pain, jaw function [according to the Mandibular Functional Impairment Questionnaire (MFIQ)], pain-free maximum mouth opening (MMO), and pressure pain thresholds (PPTs) of both masseter and temporalis muscles were obtained. Baseline and post-intervention differences were investigated, and effect size was estimated through Cohen’s d coefficient.

Results

Jaw function improved 7 points on the scale after the intervention (P=0.019), and self-reported pain was significantly reduced (P=0.009). Pain-free MMO varied from 32.3±8.8 mm to 38±8.8 mm and showed significant improvement (P=0.017) with moderate effect size when compared to the baseline phase. PPT also increased with moderate effect size, and subjects had the baseline values changed from 1.23±0.2 kg/cm² to 1.4±0.2 kg/cm² in the left masseter (P=0.03), from 1.31±0.28 kg/cm² to 1.51±0.2 kg/cm² in the right masseter (P>0.05), from 1.32±0.2 kg/cm² to 1.46±0.2 kg/cm² in the left temporalis (P=0.047), and from 1.4±0.2 kg/cm² to 1.67±0.3 kg/cm² in the right temporalis (P=0.06).

Conclusions

The protocol caused significant changes in pain-free MMO, self-reported pain, and functionality of the stomatognathic system in subjects with myofascial TMD, regardless of joint involvement. Even though these differences are statistically significant, their clinical relevance is still questionable.

A survey on the potential relationships between TMD, possible sleep bruxism, unilateral chewing, and occlusal factors in Turkish university students

OBJECTIVE

To evaluate whether there is a relationship between possible sleep bruxism (PSB), temporomandibular disorders (TMD), unilateral chewing (UC), and occlusal factors in university students recruited from Cumhuriyet University in Turkey.

METHODS

For this cross-sectional survey, 519 (223 males, mean age 21.57 ± 2.3 years, 296 females, mean age 21.02 ± 2 years) university students who admitted to the Department of Oral and Maxillofacial Radiology of the Faculty of Dentistry, Cumhuriyet University for dental care between 2012 and 2014 were selected randomly. Students were asked to complete a questionnaire form including questions about TMD, PSB and UC. Presence and direction of malocclusion were recorded during clinical examination. Chi-square test was used for statistical analysis.

RESULTS

It was found that 96.6% of the students with PSB had TMD (p < 0.05). The prevalence of severe TMD was high among students with PSB. There was a significant association between UC, PSB and TMD (p < 0.05). No statistically significant association was found between occlusal factors and PSB and TMD (p > 0.05).

CONCLUSION

Sleep bruxism, which heavily depends on self-report, is significantly associated with TMD. Unilateral chewing seems to be a common factor for development of SB and TMD. However, further studies are needed to corroborate this finding. Additionally, this study supports the hypothesis that occlusal factors are not related to self-reported sleep bruxism.

Prevalence of temporomandibular disorders in postmenopausal women and relationship with pain and HRT

The prevalence of temporomandibular disorders (TMD) is higher in females, reaching their high peak during reproductive years, probably because of the action of some female hormones, which alter pain threshold. This study aimed to investigate the prevalence of TMD in postmenopausal women and its relationship with pain and hormone replacement therapy (HRT). In total, 284 patients were evaluated and classified using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Pain was measured using the Visual Analogue Scale (VAS), and patients were also asked about the use of HRT. All data was analyzed using analysis of variance (ANOVA) and chi-square test. In total, 155 subjects did not have TMD and 129 had TMD; TMD group patients were classified according to RDC/TMD axis I classification as follows: muscle disorder group (1.6%), disk displacement group (72.87%), and arthralgia, osteoarthritis, and osteoarthrosis group (37.98%). Pain was registered in 35 patients who belonged to the TMD group, while 48 patients reported the use of HRT. There was a similar percentage of TMD and non TMD patients; moreover, the use of exogenous hormones was no associated with TMD, suggesting that there is no influence on the pain threshold.

Sex differences in jaw muscle duty factors during exercise in two environments: A pilot study

It is unknown if females and males use jaw muscles similarly during exercise. This pilot study assessed jaw elevator muscle duty factors (DFs=time of muscle activity/total recording time) at repeated sessions to test if DFs are reliable and different between sexes during exercises in two environments. Ten female and seven male subjects recruited from university soccer teams provided informed consent. Surface electromyography was recorded from masseter and temporalis muscles during biting and leg-extension laboratory exercises. Average activities to produce 20N bite-forces for each muscle and subject determined thresholds (5-80%·T20N) for subject-specific DF calculations during exercises performed in laboratory and natural environments. Subjects self-recorded via portable electromyography equipment during in-field leg-extension and weight-lifting exercises. Effects of variables on DFs were assessed via ANOVA (α=0.05) and simple effects testing (Bonferroni-adjusted p⩽0.012). All subjects used jaw muscles during exercises in both environments. DFs between laboratory sessions were reliable (R=0.84). During laboratory exercises, male temporalis DFs were significantly higher than female DFs from both muscles (p⩽0.001). During in-field exercises females had higher DFs during weight-lifting while males had higher DFs during leg-extensions. In-field sex differences were significant at most thresholds and showed larger effect sizes for leg-extension compared to weight-lifting exercises.

Prevalence of diagnosed temporomandibular disorders among Saudi Arabian children and adolescents

Background

Studies have indicated that the prevalence of symptoms and signs of temporomandibular disorders (TMD) are rare early in childhood, but become more prevalent in adolescents and adulthood. To our knowledge, no study has investigated the prevalence of TMD-diagnoses in children in the general population. The aim was thus to investigate the prevalence of TMD-diagnoses among children and adolescents in the general population using the Research Diagnostic Criteria for TMD (RDC/TMD).

Methods

The current cross-sectional study consisted of 456 children and adolescents, aged between 10 and 18, randomly enrolled from 10 boy’s- and 10 girl’s- schools in Jeddah. The participants first answered two validated questions about TMD-pain, followed by a clinical examination according to RDC/TMD.

Results

One hundred twenty-four participants (27.2 %) were diagnosed with at least one TMD-diagnosis. Myofascial pain was the most common diagnosis (15 %) followed by disc displacement with reduction, arthralgia, myofascial pain with limited mouth opening and osteoarthrosis. Children diagnosed with myofascial pain more often reported orofacial pain, headache and tooth clenching (p < 0.05), whereas children with arthralgia more often reported orofacial pain and tooth grinding than those without a TMD-diagnosis (p < 0.05). Only 18 % of the subjects in the TMD group had sought a dentist or physician for their pain.

Conclusion

TMD was common among children and adolescents in Saudi Arabia. Self-reported orofacial pain and headache as well as bruxism were associated with a TMD-pain diagnosis and disc displacement. A surprisingly low percentage of children and adolescents sought treatment by a dentist or physician for their pains.

The associations between psychosocial aspects and TMD-pain related aspects in children and adolescents

Background

Temporomandibular disorders (TMD) in children and adolescents is prevalent with pain as a common component, and has a comorbidity with psychosocial problems such as stress, depression, anxiety as well as somatic complaints. Therefore, the aim of the study was to investigate if psychosocial problems in children and adolescents are associated with TMD with pain (TMD-pain) and TMD without pain (TMD-painfree) when compared to children and adolescents without TMD.

Methods

This cross-sectional study consisted of 456 randomly selected children and adolescents, enrolled from 10 boy’s- and 10 girl’s- schools in Jeddah, between 10 and 18 years of age. On the examination day, prior to the clinical examination according to Research Diagnostic Criteria for TMD Axis I and II, the participants first answered two validated questions about TMD pain, and after that the Arabic version of the Youth Self Report scale. According to their clinical examination and diagnosis the participants were divided into three groups; non-TMD group, TMD-pain group, and TMD-painfree group.

Results

The TMD-pain group presents a higher frequency of the internalizing problems anxiety, depression and somatic complaints than non-TMD group (p < 0.05). Regarding externalizing problems the only significant association found was for aggressive behavior in the TMD-pain group (p < 0.05). The TMD-pain group also shows a higher frequency of social problems than the non-TMD group. However, no such difference was found when compared to the TMD-painfree group. There was also a significant association with a higher frequency of thought problems in the TMD-pain group (p < 0.05). The children’s and adolescents’ physical activities were within border line clinical range for all three groups, whereas the social competence was within the normal range. There were no significant associations between any of the groups in this respect.

Conclusions

TMD-pain in children and adolescents does not seem to affect the social activities. However, TMD-pain seem to have a strong association to emotional, behavior and somatic functioning, with higher frequencies of anxiety, depression, somatic problems, aggressive behavior and thought problems, than children and adolescents without TMD-pain. With respect to the biopsychosocial model the present study indicates that there are significant associations to psychosocial, somatic and behavioral comorbidities and TMD-pain in children and adolescents in the Middle East region.

Investigation of the relationship between psychosocial stress and temporomandibular disorder in adults by measuring salivary cortisol concentration: A case-control study

Background/Purpose of the Study:

Psychological factors, particularly psychosocial stress, have been implicated as risk indicators for temporomandibular disorder (TMD). The aim of this study was to assess any differences in salivary cortisol concentration, scores of perceived stress scale (PSS), and scores of depression and distress between TMD patients and matched controls.

Materials and Methods:

This case-control study comprised two groups; the patient group consisted of 60 patients attending the Department of Fixed Prosthodontics at the Faculty of Dentistry who met the inclusion criteria (42 females and 18 males aged 19–44), whereas the control group was selected to match the patient group in number, age and sex. Two questionnaires were used for stress assessment: The PSS 10 and the psychosocial measure of Research Diagnostic Criteria (RDC) for TMD axis II. Salivary cortisol levels were measured by a competitive immunoenzymatic colorimetric method. Data were analyzed using SPSS 17. Descriptive statistics, one-way ANOVA test, and independent t-test were used.

Results:

This study showed statistically significant differences between the patient group and the control group at the three measures of psychosocial stress (P < 0.05). Increased occurrence of this disorder in women has been observed.

Conclusion:

Psychosocial stress plays an important role in the etiopathogenesis of TMD. Women are at increased risk of TMD when compared to men. Sub-types TMD patients approximately have the same level of stress. Muscle disorders were the most common.

Parafunctional habits are associated cumulatively to painful temporomandibular disorders in adolescents

This cross-sectional study was designed to evaluate the effect of sleep bruxism, awake bruxism and parafunctional habits, both separately and cumulatively, on the likelihood of adolescents to present painful TMD. The study was conducted on a sample of 1,094 adolescents (aged 12-14). The presence of painful TMD was assessed using the Research Diagnostic Criteria for Temporomandibular Disorders, Axis I. Data on sleep bruxism, awake bruxism and parafunctional habits (nail/pen/pencil/lip/cheek biting, resting one's head on one's hand, and gum chewing) were researched by self-report. After adjusting for potential demographic confounders using logistic regression, each of the predictor variables (sleep bruxism, awake bruxism and parafunctional habits) was significantly associated with painful TMD. In addition, the odds for painful TMD were higher in the concomitant presence of two (OR=4.6, [95%CI=2.06, 10.37]) or three predictor (OR=13.7, [95%CI=5.72, 32.96]) variables. These findings indicate that the presence of concomitant muscle activities during sleep and awake bruxism and parafunctional habits increases the likelihood almost linearly of adolescents to present painful TMD.

Analysis of Helkimo index for temporomandibular disorder diagnosis in the dental students of Faridabad city: A cross-sectional study

Aim and Objectives:

The aim of the study was to evaluate the prevalence of temporomandibular disorder (TMD) by the use of Helkimo's index (anamnestic [Ai] and clinical dysfunction [Di] component) in the nonpatient population (dental students) of Faridabad college.

Settings and Design:

A questionnaire-based survey was carried out among students of dental college for signs and symptoms of TMD and also clinical examination was done. The results were scored and according to scoring severity of TMD were assessed in the specified population.

Materials and Methods:

About 580 students were assessed for TMD by the use of Helkimo's index (Ai and Di component). Descriptive statistical analysis was done.

Results:

Among the study group, 15% were found to have TMDs. Out of the affected students, 79% females and 21% males were having symptoms. Out of the signs and symptoms present, 7% students were found to have sound in temporomandibular joint followed by pain in 3% and fatigue in 2% of students. On clinical examination, limited mouth opening was found in 6% students followed by locked mandible in 1%, deviation of jaw in 0.6%, and jaw rigidity of mandible in 0.6% of individual.

Conclusion:

To summarize, Helkimo index is a well-founded index to assess TMD in a specified population. Signs and symptoms of TMD were present among students although low prevalence of TMD was found in the students.

[Association between craniofacial structures adolescents and temporomandibular disorders]

Objective To determine the association between craniofacial structures and the presence of TMD in adolescents. Material and Methods Cases-control study. 46 patients aged 10 to 16 years old were evaluated with their respective lateral cephalometric X-rays (23 cases and 23 controls matched for age and sex). The TTM was evaluated with the research diagnostic criteria for temporomandibular disorders (RDC/TMD). Results The comparison between cases and controls of the craniofacial structures did not show significant differences, however the lower facial height, facial axis and the mandibular plane were slightly higher in the group of cases. In the two-way analysis of ANOVA (diagnosis and age), facial convexity presented differences between the adolescent with and without temporomandibular disorders (p=0,002). Conclusion Craniofacial structures are not associated with the diagnosis of TMD in adolescents. However, changes occur in relation to the former location of the jaw, resulting in a skeletal pattern class II and an elongated shape of the face.

Disfunção Temporomandibular segundo o Nível de Ansiedade em Adolescentes

RESUMOO objetivo do estudo foi determinar a prevalência de sinais e sintomas de disfunção temporomandibular (DTM), segundo o nível de ansiedade de adolescentes da cidade de São Roque-SP. Foi utilizado o Índice de Fonseca para determinar a presença e o grau de severidade da DTM. Para avaliar o nível de ansiedade, foi utilizado o Inventário de Ansiedade Traço-Estado. Os participantes foram 3538 adolescentes entre 10 e 19 anos. Os resultados revelaram que 73,3% dos adolescentes apresentavam DTM e 72,7%, apresentavam ansiedade. Foram observadas associações estatisticamente significativas entre a presença de DTM e a presença de ansiedade, mas apenas com o sexo feminino, e correlação positiva, embora baixa, entre o grau de DTM e o nível de ansiedade. Conclui-se que adolescentes do sexo feminino apresentam maior chance de desenvolver DTM que os do sexo masculino, e quanto maior o nível de ansiedade do adolescente, maior a chance de desenvolver DTM.