Temporomandibular disorders, occlusion, and neck pain in subjects with facial pain: a case-control study

Association of Temporomandibular Disorder Symptoms with Physical Fitness among Finnish Conscripts

Studies on the role of physical fitness, physical activity and obesity as risk factors for temporomandibular disorders (TMD) are scarce. The aim of the present study was to evaluate the association of TMD symptoms with physical fitness, physical activity and body mass index (BMI) among Finnish conscripts. The study sample consisted of 8685 Finnish conscripts. Data on self-reported TMD symptoms were used as outcome variables. Physical activity (questionnaire), physical fitness (measured with physical tests: Cooper test, push-ups, sit-ups and standing long jump) and body mass index (BMI) were used as explanatory variables. The associations between TMD symptoms and explanatory variables were evaluated using Chi-squared test and logistic regression analysis. The prevalence of all TMD symptoms was significantly higher among those who exercised more rarely than weekly. Pain-related TMD symptoms were also significantly more frequent among those who were overweight (BMI ≥ 25). Poor push-up results and overweight (BMI ≥ 25) were significantly associated with jaw pain and TMJ pain at jaw rest. The present study showed that good physical fitness may be a protective factor against TMD pain. Dentists should also be prepared to motivate TMD patients to physical activity and regular exercise as part of the treatment.

Role of psychosocial factors on treatment outcome of temporomandibular disorders

OBJECTIVES

The aim of this randomized controlled study was to investigate the effect of depressive and non-specific physical symptoms on treatment outcome of temporomandibular disorders (TMD).

MATERIAL AND METHODS

Eighty TMD patients were randomly assigned to splint group (n = 39) and control group (n = 41). The patients were classified in terms of depressive and non-specific physical symptoms as normal, moderate or severe using Research Diagnostic Criteria for Temporomandibular Disorders Axis II protocol. The effect of depressive and non-specific physical symptoms on the intensity of facial pain, as measured with visual analogue scale (VAS) was estimated with linear mixed models. The patients' subjective estimates of the effects of treatment and TMD symptom severity were inquired at 1-year follow-up.

RESULTS

At baseline and during the follow-up there were no significant differences in VAS scores between patients in different Axis II subscales. According to the mixed linear regression, depressiveness or nonspecific physical symptoms separately were not significantly associated with the VAS during the study. The association of VAS with depressive (p = .073) and nonspecific physical symptoms (p = .088) approximated statistical significance. Patients with moderate or severe nonspecific physical symptoms (with pain items) at baseline had more frequently moderate, severe or intolerable TMD symptoms after the treatment compared to those who were classified in normal subgroup.

CONCLUSIONS

The present study gave some indication of a possible negative effect of depressive and nonspecific physical symptoms (with pain items) on TMD treatment response. However, the results should be regarded as preliminary, and further studies with larger sample size are needed to confirm the results.

A hemispherical contact model for simplifying 3D occlusal surfaces

STATEMENT OF PROBLEM

Currently, dental articulators can recreate mandibular movements and occlusal contacts. However, whether virtual articulators can also provide information about occluding dental surfaces, functional movements, and the mandibular condyles is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the occluding surfaces on dental casts obtained from a patient and approximate them to a hemispherical contact model. Both models were tested by digitizing the Dentatus ARL dental articulator.

MATERIAL AND METHODS

A combination of photogrammetry and structure from motion methods were used to scan a Dentatus ARL articulator and representative dental casts. Using computer-aided engineering and finite element analysis, contact points and action vectors to the forces on occluding surfaces and condyles were obtained for cast and hemispherical models. This experiment was performed using centric occlusion and 3 different condylar inclinations. The Kruskal-Wallis 1-way analysis of variance on ranks test was used to allow all pairwise comparisons between condylar inclination and mechanical action vector values in each location (α=.05).

RESULTS

Action vectors from the cast model and each location of the hemispherical model were calculated to show the mechanical consequences and the similarity among models. Overall, no significant differences were observed for action vectors (A20 versus A40 versus A60) at each location (dental cast/hemisphere, right condylar, and left condylar) in the analysis of dental casts and the hemisphere model (.382≤P≤.999).

CONCLUSIONS

This study provided graphical information that may assist the dental professional in determining which occlusal contacts should be modified to attain condylar and balanced centric occlusion.

Assessment of risk factors for oro-facial pain and recent developments in classification: implications for management

Oro-facial pain research has during the last decades provided important novel insights into the basic underlying mechanisms, the need for standardised diagnostic procedures and classification systems, and multiple treatment options for successful rehabilitation of the patient in pain. Notwithstanding the significant progress in our knowledge spanning from molecules to chair, there may also be limitations in our ability to integrate and interpret the tremendous amount of new data and information, in particular in terms of the clinical implications and overriding conceptual models for oro-facial pain. The aim of the present narrative review is to briefly summarise some of the current thoughts on oro-facial pain mechanisms and recent attempts to identify biomarkers and risk factors leading to the proposal of a new risk assessment diagram for oro-facial pain (RADOP) and a provocative new concept based on stochastic variation between multiple risk factors. Finally, the implications for novel management strategies will briefly be discussed.

Fatores associados à incidência de maloclusão na dentição decídua em crianças de uma coorte hospitalar pública do nordeste brasileiro

Objetivos: estimar a incidência de maloclusão na dentição decídua e fatores associados na primeira infância. Métodos: estudo longitudinal com crianças nascidas na cidade de Feira de Santana, Bahia, acompanhadas por 36 meses. Taxas de incidência de maloclusão e razões de densidade de incidência (RDI), com correspondentes intervalos de 95% de confiança, foram obtidas para avaliar associação entre maloclusão e fatores associados. Modelos de regressão de Poisson foram ajustados para controle de confundimento. Resultados: verificou-se que 34,4% das crianças apresentaram maloclusão leve e 23,3% maloclusão moderada ou grave, totalizando 57,8% com algum grau de maloclusão aos três anos de idade. A taxa global de incidência de maloclusão foi de 27,2 casos por 100 crianças-ano. As crianças que sugaram chupeta ou dedo apresentaram risco de maloclusão maior quando comparadas com as crianças que não desenvolveram tais hábitos de sucção (RDI=1,99; IC95%= 1,26 - 3,26). Crianças que não foram amamentadas de forma exclusiva ou predominante por período igual a quatro meses tiveram um risco de maloclusão 1,5 vezes maior (IC95%= 0,99 - 2,25) quando comparadas com as crianças que mamaram de forma exclusiva ou predominante por este período. Conclusões: alerta-se profissionais de saúde para a necessidade de estímulo ao aleitamento materno e medidas para prevenir as maloclusões na primeira infância.

Psychosocial aspects of temporomandibular disorders and oral health-related quality-of-life

OBJECTIVE

The aim of the study was to evaluate the association between psychosocial aspects of temporomandibular disorders (TMD) and oral health-related quality-of-life (OHRQoL) and, secondly, to investigate the gender differences in these associations using patient and non-patient groups.

MATERIALS AND METHODS

The sample of the study consisted of 79 patients with TMD and 70 non-patients. The data was collected by Finnish versions of the RDC/TMD Axis II profile and Oral Health Impact Profile (OHIP-14) questionnaires. The associations between Axis II profile sub-scales and OHIP prevalence were evaluated using chi-square tests, as stratified by group status (TMD patients and non-patient controls) and by gender. The association between OHIP prevalence and Axis II profile sub-scales were evaluated using logistic regression analysis, adjusted by age, gender and group.

RESULTS

OHIP prevalence (those reporting at least one problem) was 90.9% in the patient group and 33.3% in the non-patient group (p < 0.001, chi-squared test). OHIP prevalence was higher among those scoring higher on all RDC/TMD Axis II profile sub-scales, i.e. graded chronic pain status, depression and non-specific physical symptoms with pain items included and with pain items excluded. The associations were significant in the non-patient group. Women showed statistically significant associations of OHIP prevalence with all Axis II sub-scales. Among men, OHIP prevalence associated with GCPS and somatization. The logistic regression analysis showed that OHIP prevalence associated significantly with somatization and depression.

CONCLUSIONS

TMD associate with OHRQoL through multiple ways, linked with depression and somatization. These findings emphasize the importance of early and effective treatment of TMD.

Patients with temporomandibular disorders have increased fatigability of the cervical extensor muscles

OBJECTIVES

To determine whether patients with myogenous and mixed temporomandibular disorders (TMD) have greater fatigability of the cervical extensor muscles while performing a neck extensor muscle endurance test (NEMET) when compared with healthy controls.

METHODS

A total of 151 individuals participated in this study. Of these 47 were healthy controls, 57 patients had myogenous TMD, and 47 patients had mixed TMD. All patients performed the NEMET. The patients were instructed to maintain a prone lying position with the neck unsupported as long as possible, stopping at signs of fatigue or any discomfort. Electromyographic activity of the cervical extensor muscles during the NEMET and the holding time were collected for all patients and were compared across groups. A 1-way analysis of variance was used to evaluate the differences in holding time between patients with TMD and healthy controls. A mixed model analysis was used to evaluate the differences in normalized median frequency at different times (fatigue index) for the cervical extensor muscles while performing the NEMET between patients with TMD and controls.

RESULTS

There were statistically significant differences (P<0.05) in the slopes of the normalized median frequency between patients with TMD and healthy controls at 10, 30, 40, 50, 60, 70, 80, 90, and 100 seconds of the NEMET. Holding time was significantly reduced in both patients with myogenous TMD and mixed TMD when compared with healthy controls (P<0.05).

DISCUSSION

These results highlight the fact that alterations of endurance capacity of the extensor cervical muscles could be implicated in the neck-shoulder disturbances presented in patients with TMD.

Cervical spine dysfunction signs and symptoms in individuals with temporomandibular disorder

PURPOSE: To study the frequency of cervical spine dysfunction (CCD) signs and symptoms in subjects with and without temporomandibular disorder (TMD) and to assess the craniocervical posture influence on TMD and CCD coexistence. METHODS: Participants were 71 women (19 to 35 years), assessed about TMD presence; 34 constituted the TMD group (G1) and 37 comprised the group without TMD (G2). The CCD was evaluated through the Craniocervical Dysfunction Index and the Cervical Mobility Index. Subjects were also questioned about cervical pain. Craniocervical posture was assessed by cephalometric analysis. RESULTS: There was no difference in the craniocervical posture between groups. G2 presented more mild CCD frequency and less moderate and severe CCD frequency (p=0.01). G1 presented higher percentage of pain during movements (p=0.03) and pain during cervical muscles palpation (p=0.01) compared to G2. Most of the TMD patients (88.24%) related cervical pain with significant difference when compared to G2 (p=0.00). CONCLUSION: Craniocervical posture assessment showed no difference between groups, suggesting that postural alterations could be more related to the CCD. Presence of TMD resulted in higher frequency of cervical pain symptom. Thus the coexistence of CCD and TMD signs and symptoms appear to be more related to the common innervations of the trigeminocervical complex and hyperalgesia of the TMD patients than to craniocervical posture deviations.

Is maximal strength of the cervical flexor muscles reduced in patients with temporomandibular disorders?

OBJECTIVE

To determine whether there was a difference in maximal cervical flexor muscle strength in subjects with temporomandibular disorders (mixed and myogenous) compared with healthy subjects.

DESIGN

Cross-sectional study.

SETTING

Orthopedics/sports laboratory at the University of Alberta.

PARTICIPANTS

Subjects (N=149) of whom 50 were healthy, 54 had myogenous temporomandibular disorders (TMD), and 45 had mixed TMD.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Maximal cervical flexor strength, pain.

RESULTS

There was no statistically significant difference in maximal cervical flexor strength among groups (P>.05). Subjects' body weight was significantly associated with strength. No significant association between jaw disability with maximal cervical flexor strength was found. A significant but weak association between neck disability and maximal cervical flexors strength was found.

CONCLUSIONS

These results indicated that strength evaluation is one of several assessment factors that need to be addressed when evaluating musculoskeletal painful conditions such as TMD and neck disorders, but strength evaluation cannot be considered as a direct measure of disability. Future studies should explore evaluation of strength in other muscular groups such as cervical extensors, rotators, and lateral flexors, and also under different conditions such as rapid movements, and in patients with more severe jaw disability.

Reduced endurance of the cervical flexor muscles in patients with concurrent temporomandibular disorders and neck disability

Subjects with temporomandibular disorders (TMDs) have been found to have clinical signs and symptoms of cervical dysfunction. Although many studies have investigated the relationship between the cervical spine and TMD, no study has evaluated the endurance capacity of the cervical muscles in patients with TMD. Thus the objective of this study was to determine whether patients with TMD had a reduced endurance of the cervical flexor muscles at any level of muscular contraction when compared with healthy subjects. One hundred and forty-nine participants provided data for this study (49 subjects were healthy, 54 had myogenous TMD, and 46 had mixed TMD). There was a significant difference in holding time at 25% MVC between subjects with mixed TMD when compared to subjects with myogenous TMD and healthy subjects. This implies that subjects with mixed TMD had less endurance capacity at a lower level of contraction (25% MVC) than healthy subjects and subjects with myogenous TMD. No significant associations between neck disability, jaw disability, clinical variables and neck flexor endurance test were found.

Psychological factors and the incidence of temporomandibular disorders in early adolescence

The purpose of the present study was to evaluate the relationship between psychological variables and the clinical diagnosis of temporomandbular disorders (TMD) in 12-year-old adolescents. TMD pain was assessed by RDC/TMD examination (Research Diagnostic Criteria for Temporomandibular Disorders) (Axis I and II). Five-hundred and fifty-eight subjects (330 girls and 228 boys) were examined. Bivariate analyses were performed using the Chi-square test (chi(2)). The logistic regression models were adjusted estimating the Odds Ratios (OR), their 95% confidence intervals (CI), and significance levels. Only 2.19% of the boys and 8.18% of the girls presented one of the Axis I categories. All variables from axis II were related to TMD diagnosis (p < 0.001). Gender was significantly related to TMD diagnosis (p = 0.0028). The risk of TMD incidence for girls was 3.5 times higher than that for boys (Odds Ratio = 3.52, Confidence Interval 1.31-9.43). The individuals who presented the variable 'characteristics of pain intensity' (CPI) higher than 0 had 31 times more risk of TMD incidence (Odds Ratio = 31.361, Confidence interval 6.01-163.5). We concluded that psychological variables and female gender are important risk indicators related to TMD incidence, even in adolescents.

Facial pain: clinical differential diagnosis

Differential diagnosis of pain in the face as the presenting complaint can be difficult. We propose an approach based on history and neurological examination, which allows a working diagnosis to be made at the bedside, including aetiological hypotheses, leading to a choice of investigations. Neuralgias are characterised by stabs of short lasting, lancinating pain, and, although neuralgias are often primary, imaging may be needed to exclude symptomatic forms. Facial pain with cranial nerve symptoms and signs is almost exclusively of secondary origin and requires urgent examination. Facial pain with focal autonomic signs is mostly primary and belongs to the group of the idiopathic trigeminal autonomic cephalalgias, but can occasionally be secondary. Pure facial pain is most often due to sinusitis and the chewing apparatus, but also a multitude of other causes. The pain can also be idiopathic. Imaging as well as non-neurological specialist assessment is often necessary in these cases.

Are female patients with orofacial pain medically compromised?

BACKGROUND

Chronic pain has been linked to various medical conditions. The authors assessed whether certain medical conditions are more prevalent in female patients with orofacial pain than in age-matched controls.

METHODS

The study sample consisted of 87 female adult subjects from a university-based orofacial pain center (OPC) and 87 age-matched female subjects from a university-based undergraduate dental clinic (UDC). Subjects were evaluated between February 2003 and July 2003, and they completed a standardized, 78-question medical history questionnaire as part of routine clinical protocol. Using the subjects' medical histories, the authors compared 11 major medical categories and 77 individual conditions for both groups. For statistical analyses, the authors used nonparametric Kolmogorov-Smirnov Z tests and chi2 tests and calculated odds ratios (ORs).

RESULTS

The medical histories of subjects in the OPC group indicated a significantly greater number of medical conditions than did those of the subjects in the UDC group (Z = -4.411, P < .0001). Specifically, subjects in the OPC group reported having significantly more neurological (Z = -5.304, P < .0001), gastrointestinal (Z = -2.897, P = .004), pulmonary (Z = -2.298, P = .022), dermatologic (Z = -2.984, P = .003) and other conditions (Z = -2.885, P = .004) than did subjects in the UDC group. Subjects in the OPC group reported having 12 individual medical conditions significantly more often (P < .05, ORs ranged from 2.5 to 9.7) than did subjects in the UDC group.

CONCLUSIONS

Female patients with orofacial pain complaints appear to have more systemic problems than do female patients seeking routine dental care.

CLINICAL IMPLICATIONS

The presence of multiple medical conditions can influence orofacial pain management options and treatment outcomes. Patients with more medically complicated orofacial pain may require treatment on a multidisciplinary basis.