Temporomandibular clinical exploration in Italian adolescents

Do symptoms and signs of temporomandibular disorders have an association with breathing pattern: a cross-sectional study on Turkish children and adolescents

BACKGROUND

This paper aimed to explore the prevalence of temporomandibular disorders (TMDs) signs/symptoms, and to investigate the possible link between signs/symptoms of TMDs and mouth breathing (MB) by evaluating along with other risk factors, in a Turkish subpopulation of children and adolescence.

METHODS

This study was conducted with the archival data of the patients who applied with orthodontic complaints. Data on demographic characteristics, family-related factors, systemic status, occlusion, breathing patterns, oral habits, and bruxism were retrieved from the archival records.

RESULTS

Nine hundred forty-five children and adolescents with a mean age of 14.82 ± 2.06 years were included in the study. Of the participants, 66% were girls, 60.4% were delivered by C-section, 8.4% of the participants had at least one systemic disease, 9.2% of the participants had allergy, and 4.3% of the participants' parents were divorced, 18.7% have an oral habit, 6.6% have bruxism, 29.8% have malocclusion and 14.1% have MB. Eight-point-five percent of participants have signs/symptoms of TMD. Among them 2.9% have pain, 3.7% have joint sounds, 1.4% have deflection, and 3.9% have deviation. Evaluation of the risk factors revealed a significant relation between the signs/symptoms of TMD and bruxism (OR 8.07 95% CI 4.36-14.92), gender (OR 2.01 95% CI 1.13-3.59), marital status of parents (OR 2.62 95% CI 1.07-6.42), and MB (OR 3.26 95% CI 1.86-5.71).

CONCLUSIONS

According to the study's findings, girls and those with bruxism, divorced parents, and MB behavior are more likely to have signs/symptoms of TMD. Age found to have significant effect on the occurrence of the signs/symptoms of TMD alone, but together with other factors the effect of the age is disappeared. Early screening and intervention of MB as well as the signs/symptoms of TMD can help to limit detrimental effects of these conditions on growth, and quality of life of children and adolescents.

Evaluation of signs and symptoms of temporomandibular disorders and incisal relationships among 7-10-year-old Turkish children with sleep bruxism: A cross-sectional study

OBJECTIVE

To study the signs and symptoms of temporomandibular disorders (TMDs) and incisal relationships related to sleep bruxism and parafunctional habits among children.

METHODS

The study consisted of 106 children (53 with and 53 without bruxism) between the ages of 7 and 10. A general questionnaire and Diagnostic Criteria for Temporomandibular Disorders Axis I examination form were used for each child.

RESULTS

There were significant differences between children according to pain, headache, midline deviation, opening pattern, temporomandibular joint noise, overjet, overbite, corrected deviation, and pain disorders (p < 0.05). According to the logistic regression, the higher scores of "mouth breathing" and "horizontal incisal overjet" were independent risk factors for TMDs. The lack of "bruxism" and "sleeping with open mouth" were protective factors for TMDs.

CONCLUSION

Children with bruxism showed signs and symptoms of TMDs and divergence in incisal relationships.

Temporomandibular joint disorders and associated factors in a Turkish pediatric population

OBJECTIVE

To explore the presence and severity of temporomandibular disorders (TMD) signs and symptoms in a Turkish pediatric population, as well as their relationship to parafunctional behaviors, bruxism, malocclusion, anxiety, and sociodemographic traits.

METHODS

A cross-sectional study was conducted with patients between the ages of 5-15. Demographic variables, TMD signs and symptoms, parafunctional habits, bruxism, and malocclusion were evaluated by clinical examination. Fonseca Anamnestic Index (FAI) was used to determine the presence and severity of TMD. State-Trait Anxiety Scale for Children (STAI-C) was used to evaluate the anxiety. Student t, Mann-Whitney U, chi-square tests, and logistic regression were used for statistical analysis.

RESULTS

One hundred sixty-two participants (85 girls, 77 boys) with a mean age of 10.03 ± 1.88 years were included. The frequency of the participants who reported signs/symptoms of TMD was 19.7% according to FAI scores. Logistic regression analysis with the associated factors showed a significant relationship between the presence of the signs/symptoms of TMD and parafunctional habits (OR 4.24, 95% CI 1.64-10.93), and the presence of signs/symptoms of anxiety (OR 1.09, 95% CI 1.02-1.16).

CONCLUSIONS

Children and adolescents who exhibit parafunctional behaviors and anxiety had a higher likelihood of having TMD signs/symptoms of varying degrees of severity.

Evaluation of the relationship between sleep bruxism and sleeping habits in school-aged children

OBJECTIVE

To evaluate the relationship between sleep habits and sleep bruxism (SB) in schoolaged children.

METHODS

Survey data were collected from the parents of 500 children (267 males and 233 females; age range 6-12 years). The American Academy of Sleep Medicine diagnostic criteria were used to evaluate SB. A Children's Sleep Habits Questionnaire was conducted to determine sleep habits. The chi-square test was used for statistical evaluation.

RESULTS

SB was observed in 160 children (32%). SB awareness was 5.4%. The presence of SB in other family members, mothers' education ≤8 years, and income below minimum wage were found as family risk factors. The presence of sleep disorders was 61.4% and observed to be statistically higher in those with SB.

CONCLUSION

SB is a prevalent disorder that might be associated with sleep disorders. The parents of children with SB had inadequate knowledge and awareness pertaining to SB.

Full-Digital Workflow for TMDs Management: A Case Series

Temporomandibular joint disorders (TMDs) have always been the subject of studies due to the difficult management of symptoms and the complex stabilization of the so-called therapeutic position. In this effort, digital technologies open new opportunities for such planning, allowing the clinician to digitally assess the situation and verify the stability of the new position from a functional point of view. The present case series shows examples of preliminary full-digital planning of treatment in TMDs patients made with the preliminary evaluation of the kinematic activity of the mandible through a digital device (Tech in motion™, ModJaw, Villeurbanne, France). Three TMD clinical cases are analyzed with full-digital techniques and workflow. A personalized treatment for each case was digitally planned on the base of proper kinematic tracings recorded for each patient, and intraoral appliances were digitally customized through a full-digital or semi-digital workflow. The digitalization of mandibular kinematic gave us the possibility of making a more “aware” diagnosis, especially in a dynamic key, and then it allowed a faster realization and execution of the intraoral appliance through a digital workflow, memorizing the therapeutic position and early checking the device, before its realization, on the real kinematics of the patient.

Prevalence of temporomandibular disorders and its association with malocclusion in children: A transversal study

This study investigated the prevalence of temporomandibular disorders (TMDs) in a sample of children and adolescents and evaluated the correlation with occlusal variables. TMD signs and symptoms were recorded in 411 subjects (age range 7-15 years), divided into two groups: 214 subjects treated in Chieti (Italy) CG group and 197 in Murcia (Spain) MG group. Once the Angle dental class was identified, it was recorded if there were signs and symptoms of temporomandibular disorders (TMDs) and occlusal interferences. The percentages of signs and symptoms were compared to determine the differences among the groups for TMDs, bruxism, joint sounds, deviation during the opening, reduced opening/lateral/protrusive movements, malocclusions, and myofascial pain. There is no statistically significant difference between the two groups (χ² = 1.057, p > 0.05). Subjects with Angle Class I (37.37%), deep bite (43.43%), and increased overjet (41.41%) showed a higher prevalence of TMD symptoms.

Rare case of skeletal third class in a subject suffering from Solitary Median Maxillary Central Incisor syndrome (SMMCI) associated to panhypopituitarism

Background

The median solitary maxillary central incisor syndrome (SMMCI) is a rare malformative syndrome consisting of multiple defects, mainly found on the body midline. It can be correlated to the etiopathological and phenotypic pattern of panhypopituitarism. This case-report describes the rare case of a patient suffering from SMMCI and panhypopituitarism, showing an unusual craniofacial morphology.

Case presentation

From the cephalometric analysis, a skeletal class III was identified (despite the other cases described in literature described as skeletal class II), derived from hypomaxillia and mandibular protrusion. A convex lip profile, with tendency to mandibular hyper-divergency, airway patency, anterior and posterior cross-bite were observed. At the clinical examination, a maxillary cant was evident on the frontal plane that appeared asymmetric, with the prevalence of the third lower part of the face. There were some dysmorphic signs such as: small nose, rectilinear eyelid line and reduced interocular distance.

Conclusions

The present clinical case shows how, despite the literature, SMMCI can be associated with a III skeletal class, with maxillary hypoplasia and mandibular protrusion. The interdisciplinary collaboration between dentist and pediatrician is therefore important for the early interception of the malocclusions associated with these syndromes.

An Analysis of the Temporomandibular Joint Range of Motion and Related Factors in Children and Adolescents

This study was designed to establish safe guidelines for pediatric dental practice regarding temporomandibular joint (TMJ) range of motion (ROM) and mouth area (MA). A total of 438 children aged 3–15 years old of homogenous ethnicity participated in the study; the distribution of participants was approximately equal (sex; n = 15; age, n = 30). Maximum mouth opening (MMO), body height, weight, and age of each participant were recorded, and the TMJ ROM including anterior and lateral movements, MA, and mouth width were documented. Males showed higher mouth width, MMO, and MA values than females. MMO and MA increased with age, height, and weight in a statistically significant manner. MMO of 40 mm is reached by the age of 5.2 years, at a height of 105.9 cm and a weight of 18.6 kg. MMO showed a moderate correlation with age, height, weight, and mouth width, and MA moderately correlated with mouth width. Anterior and lateral movements did not show any close relation to these aforementioned factors. The findings of this study suggest that forcible mouth opening over 40 mm should be more cautiously considered, especially in children shorter than 105 cm, lighter than 18 kg and in children under 5 years old.

Electromyography-Guided Adjustment of an Occlusal Appliance: Effect on Pain Perceptions Related with Temporomandibular Disorders. A Controlled Clinical Study

Background: The purpose of this study is to evaluate the effect of an electromyography-guided adjustment of an occlusal appliance on the management of Temporomandibular disorder-related pain. Methods: Data from 40 adult patients (20 males and 20 females), who underwent treatment with occlusal appliances, were recorded. A total of 20 appliances were adjusted according to electromyographic data (group 1), while the others were adjusted by a clinical conventional procedure (group 2). Muscle pain to palpation, pain during articular movements and headache were recorded by a VAS score (from 0 to 100) before the beginning of treatment (T0), at T1 (4 weeks) and T2 (8 weeks). Results: Results showed a reduction of pain in both groups, with a better trend for group 1, where better results were achieved at T1 and maintained stability at T2, with an improved mean value regarding all parameters studied. After 8 weeks, only small recurrences started to occur in muscle pain to palpation in group 2. Conclusions: An occlusal appliance seems to be able to achieve a clinical improvement of Temporomandibular disorder (TMD)-related pain and headache, independently from the adjustment procedure adopted. However, the use of a surface electromyographic activity of masticatory muscles (sEMG) device as an aid in the calibration procedure seems to allow a better trend because the improvement of symptoms was obtained before, after the first four weeks, with an improvement in percentages of all the variables investigated. While the conventional procedure obtained later the improvement.

A Female Psoriatic Arthritis Patient Involving the TMJ

Psoriatic arthritis (PsA) is an inflammatory chronic arthritis associated with psoriasis. Currently, data about gender differences in clinical manifestation and therapeutic outcomes of PsA are limited. Frequently, women manifest a peripheral disease while men have an axial localization. Moreover, women display higher disease activity and physical activity limitations, if compared to men. Although the involvement of the temporomandibular joint (TMJ) is quite rare, it can seriously impact the quality of life. The morpho-functional peculiarities of TMJ require a multidisciplinary approach to perform a correct diagnosis and a successful treatment. Here, we report a case of a woman affected by PsA involving TMJ treated by combining pharmacological therapy and an occlusal splint. The coordination between different specialties led to a complete remission of clinical symptoms and a regression of lesions.

Awake bruxism frequency and psychosocial factors in college preparatory students

OBJECTIVE

To assess the frequency of reported masticatory muscles activity during wakefulness (i.e., awake bruxism [AB]), levels of anxiety, depression, stress, and the oral health-related quality of life (OHRQoL) in college preparatory students.

METHODS

Sixty-nine college preparatory students participated in the study. AB was evaluated by the Oral Behaviors Checklist (OBC) and a smartphone-based ecological momentary assessment (EMA; [Bruxapp®]). Anxiety and depression were measured by the Hospital Anxiety and Depression Scale, stress was evaluated by the Perceived Stress Scale, and OHRQoL was obtained by The Oral Health Impact Profile-14. Data were analyzed by Pearson's correlation coefficient (α = 0.05).

RESULTS

The average EMA-reported frequency of AB behaviors was 38.4%. Significant correlations were found between AB and the OBC, anxiety, depression, stress, and OHRQoL (p < 0.001).

CONCLUSION

College preparatory students demonstrated moderate frequency of AB, which was significantly correlated with psychosocial factors.

Early Treatment of Anterior Crossbite with Eruption Guidance Appliance: A Case Report

The purpose of this investigation was to show how to manage an anterior crossbite in early mixed dentition with an eruption guidance appliance (EGA). The analyzed clinical case reported an anterior crossbite, a bimaxillary retrusion tendency, and a horizontal growth pattern. The anterior crossbite was an unfavorable occlusal condition that could lead to a class III malocclusion growth pattern. An early treatment approach was suggested to reach a correct sagittal jaw relationship. Hence, the selected approach acted on the dentoalveolar sector, aiming to have effects on the posterior vertical dimension and to improve the sagittal jaw's relation. An EGA was selected to treat the patient in early mixed dentition. After 7 months of therapy with night-time use, the dental malocclusion was completely resolved. The patient continued to be treated with the same device, used as active retention. With the EGA treatment, the erupting forces, rather than the active forces, were used to resolve the dental malocclusion. This approach allowed a low compliance requirement and had a minimum psychosocial and psychological impact on the patient. The early treatment was essential to give a functional occlusion and a good balance of the soft perioral tissues and muscles.

Evaluation of Lower Dental Arch Crowding and Dimension after Treatment with Lip Bumper versus Schwarz Appliance. A Prospective Pilot Study

Aim: The treatment of patients with mixed dentition, with inferior moderate dental crowding (the so-called borderline cases, between extraction and expansion) is not yet clear. Two examples of widely used appliances for increasing lower dental arch dimensions are the Schwarz’s appliance and lip bumper. The aim of this prospective study was to compare dental crowding and arch dimensions from pre- to post-treatment with lip bumper versus Schwarz’s appliance. Subjects and Methods: Pre- and post-treatment orthodontic records of twenty subjects (10 males and 10 females) were analyzed in the present study. Inclusion criteria were: first/second molar class malocclusion; crowding of the mandibular arch, from mild to moderate (4–6 mm); mixed dentition; age ≤ 9 years at the beginning of the treatment; stage CS1 or CS2 of maturation of the cervical vertebrae analysis (CVM) at the beginning of the treatment. Ten subjects were treated with a lip bumper, and ten with the removable Schwarz appliance. The primary outcomes were the variations in dental crowding and arch dimensions from pre- to post-treatment. Results: Both the two appliances caused a statistically significant mean improvement/reduction in crowding, of 3.5 mm and 2.9 mm, for the Schwarz appliance and lip bumper, respectively. The Schwarz appliance resulted more effective in increasing arch dimension at the intercanine level, and arch perimeter, while the lip bumper achieves a higher increase in arch length. Conclusions: A lip bumper and Schwarz appliance are both useful in reducing crowding in mixed dentition. This improvement is due to the increase in dental arch dimensions, although the distribution of space resulted slightly differently between the two appliances.

Oral Hygiene in a Sample of Children/Adolescents Living in Family-Homes from the Province of Milan (Italy): A Pilot Study

Objective: This pilot study is a prospective controlled clinical trial, designed to evaluate the short-term clinical results (the plaque index) of an educational/motivational program for home oral hygiene, directed to children and adolescents who live in family-homes. Methods: The setting of the project was the province of Milan (Italy), where two family-homes were selected. The study group included 26 children (16 females and 10 males) aged between 7 and 15 years, of Italian nationality, from the family-home communities. The control group included 26 children (15 females and 11 males, aged between 7 and 15 years) of Italian nationality, matched for age and gender distribution with the study group, that were not in a socially disadvantaged condition. Collection of the plaque index (PI) was performed at t0. Then, all basic oral hygiene instructions were given to all children/adolescents and their educators. Education and motivation were repeated in the same way after 4–7 weeks (T1), and after 10–12 weeks (T2). The PI was taken also at T1 and T2. Results: An improvement in the PI was generally found in both groups, but there was no statistically significant difference between the two groups over time. Multivariate analysis of variance (MANOVA) revealed a statistically significant effect of time [F (1, 52) = 90.73, p < 0.001], regardless of the assignment group, in consequence of which the plaque index presented a moderate and significant improvement. Conclusion: The present data confirm the validity of the educational/motivational program to improve oral hygiene in children/adolescents, regardless of the assignment group.

Management of a Facilitated Aesthetic Orthodontic Treatment with Clear Aligners and Minimally Invasive Corticotomy

Accelerating orthodontic tooth movement has become a topical issue and the corticotomy seems to be the only effective and safe technique reported in the literature. Simultaneously, aesthetic orthodontic treatment with removable clear aligners has become commonly requested. The aim of this paper is to illustrate the management of facilitated aesthetic orthodontic treatment, a combined approach including piezocision corticotomy and clear aligners for orthodontic treatment. Orthodontic planning for traditional clear aligners should be modified to take advantage of the corticotomy technique in order to facilitate the most difficult orthodontic movements needed to achieve treatment completion, where each aligner will be used for four days rather than 15 days for a total time of four months. A corticotomy with a modified minimally invasive flapless piezocision technique should be performed in both jaws at the same time, before the time window of the orthodontic treatment, where the most difficult orthodontic movements are planned. Treatment planning where difficult orthodontic movements, such as anterior open-bite closure and extraction space closure, are easily managed with clear aligners and are presented as examples of facilitated aesthetic orthodontic treatment application. The combination between aesthetic treatment with clear aligners and modified piezocision corticotomy, if carefully planned, seems to represent a synergy that achieves the current goals of orthodontic treatment. The primary objectives of this combination should be facilitating difficult orthodontic movements and reducing treatment duration.

Socioeconomic Factors and Oral Health-Related Behaviours Associated with Dental Caries in Preschool Children from Central Italy (Province of Ascoli Piceno)

Background

Dental caries is a serious oral health concern with high prevalence in preschool children.

Aim

To assess the association among oral health-related behaviors, socioeconomic factors, and dental caries in Italian preschool children.

Design

513 preschool children from 3 to 6 years of age, enrolled in nursery schools in central Italy, represent the population of the present study. The children underwent dental clinical examination and were divided on the basis of their caries experience in the primary dentition (“Yes” or “No”). Nonparametric analysis and univariate and multivariate logistic regression models were applied to evaluate the contribution of oral health-related behaviors and socioeconomic factors to the caries experience in the primary dentition.

Results

419 children were caries free, and 94 children had caries experience in the primary dentition, corresponding to the 18.4% of participants. Different oral health-related behaviors and socioeconomic factors resulted to be associated with caries development. In particular, the mother's foreign nationality results in a strong predictive factor.

Conclusions

The multivariate logistic model revealed factors significantly affecting caries experience in the primary dentition, which were the mother's nationality, the number of dental visits in a year, and the personal impression by the mother.

Obstructive sleep apnea severity and dental arches dimensions in children with late primary dentition: An observational study

Objective: The aim of this study was to compare the dimensions of the upper and lower arches in children affected by OSAS with different levels of severity of obstruction.Methods: Twenty-seven Caucasian children (14 males, 13 females; mean age 6, range 5.2-6.1 years) with a diagnosis of OSAS determined by polysomnography were enrolled in this study. The dimensions of both dental arches were measured, and the data were compared among children affected by severe, moderate, and mild OSAS.Results: Statistically significant differences among the three groups revealed that children with severe OSAS had the highest values of upper intercanine and intermolar distances in the sample.Discussion: A severe OSAS grade (AHI > 10) is associated with statistically significantly higher upper intercanine and intermolar distances compared with mild and moderate grades. An early approach to OSAS in children with late primary dentition is auspicated in order to prevent an influence on dental arches growth.

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.

Three-dimensional volumetric analysis of mandibular condyle changes in growing subjects: A retrospective cross-sectional study

OBJECTIVE

The purpose of this study is to analyze the mandibular condylar volumein a sample of subjects 11-26 years old.

METHODS

CBCT condylescans from 94 patients (mean age 18.2 ± 4.5 y) acquired with areconstructed layer thickness of 0.5 mm and a 512×512 matrix were examined. Data on condylar volume were compared among three groups with different age ranges: 11-16 years, 17-21years, and 22-26 years. Condylar volumetric measurements were performed with Mimics™ software.

RESULTS

A significant increase in condylar volume from puberty to young adulthood was detected (p < 0.01). Females showed a higher condylar volume in the 17-21 y group compared with the 11-16 y group. Males showed differences among all three groups.

CONCLUSION

The mandibular condyle growth seems to continue at least until 17-21 years in males but seems to stop before 17 years in females.

Bilateral Central Giant Cell Granuloma of the mandibular angle in three females from the same family

In literature there are few reports about multiple CGCG. But this is the first report of bilateral CGCG of the mandibular angles in three females from the same family.This report describes three cases of females from the same family - a mother and two young daughters - with bilateral CGCG in their jaw angles. All the lesions were surgically removed and the histopathologic diagnosis was always identical: giant cell central granulomas, with patterns that were absolutely superimposable between them and with that of the mother.The hypothesis is that this presentation of CGCG may be defined as hereditary bilateral CGCG of the mandibular angles (or also, cherubism-like lesions).

Association of Visual Defects and Occlusal Molar Class in Children

Purpose

The purpose of this cross-sectional study is to evaluate the presence of any correlations between dysfunctions related to visual impairments and dental occlusion.

Methods

The test group included 34 subjects (21 males and 13 females; mean age 11 ± 2 years) randomly selected with the following inclusion criteria: absence of any diagnosis for problems at visual level except those related to refractive defects, visual acuity of at least 1.0, absence of any syndrome or malformation in the craniofacial area, good general health, and absence of any systemic disease able to influence the vision or the craniofacial growth. They underwent visual clinical tests to evaluate the presence of fusional vergence defects and amplitude. Each patient underwent an orthodontic clinical exam and the occlusal molar relationship of each subject was recorded and considered as occlusal variable. A statistical analysis with Chi-Squared test was performed in order to analyze the associations between the visual defects and the occlusal variable.

Results

A statistically significant association between the molar occlusal relationship and the occurrence of exodeviations was observed. The percentage of subjects presenting fusional amplitudes with convergence lower of the cut-off value was statistically significantly higher in the group of occlusal molar second class.

Conclusions

The results obtained show that there is an association between occlusal second molar class and fusional vergence defects.