Oral parafunctions as risk factors for diagnostic TMD subgroups

Pain symptoms are associated with two-point discrimination threshold in patients with temporomandibular disorders

OBJECTIVE

This study aimed to explore the associations of orofacial two-point discrimination (2-PD) test result with pain symptoms and psychological factors in patients with Temporomandibular Disorders (TMDs).

METHODS

193 patients with TMDs were included in this study. Patients' demographics, pain intensity, and psychological status were recorded. The 2-PDs in the bilateral temporal, zygomatic, mandibular, and temporomandibular joint (TMJ) regions of the patients were measured. Statistical analyses were conducted to observe the associations between variables.

RESULTS

For Pain-related TMDs (PT) patients, Monthly Visual Analogue Scale (VAS-M) and Current Analogue Scale (VAS-C) were correlated with TMJ, zygomatic and temporal 2-PDs. Patients with PT tended to have higher TMJ 2-PDs[Right: β = 1.827 mm, 95%CI(0.107, 3.548), P = 0.038], zygomatic 2-PDs[Right: β = 1.696 mm, 95%CI(0.344, 3.048), P = 0.014], temporal 2-PDs[Left: β = 2.138 mm, 95%CI(0.127, 4.149), P = 0.037; Right: β = 1.893 mm, 95%CI(0.011, 3.775), P = 0.049]. Associations were also observed between VAS-C and TMJ 2-PDs[Left: β = 0.780, 95%CI(0.190, 1.370), P = 0.01; Right: β = 0.885, 95%CI(0.406, 1.364), P = 0.001], Zygomatic 2-PDs[Right: β = 0.555, 95%CI(0.172, 0.938), P = 0.005]; VAS-M and TMJ 2-PDs[Left: β = 0.812, 95%CI(0.313, 1.311), P = 0.002; Right: β = 0.567, 95%CI(0.152, 0.983), P = 0.008], zygomatic 2-PDs[Left: β = 0.405, 95%CI(0.075, 0.735), P = 0.016; Right: β = 0.545, 95%CI(0.221, 0.870), P = 0.001], and temporal 2-PDs [Left: β = 0.741, 95%CI(0.258, 1.224), P = 0.003; Right: β = 0.519, 95%CI(0.063, 0.975), P = 0.026].

CONCLUSION

TMJ, zygomatic, and temporal 2-PDs were significantly associated with PT and pain intensity. Age, gender and psychological factors were not associated with orofacial 2-PDs. PT patients exhibited weaker tactile acuity compared to Non-PT patients. Further discussion on the underlying mechanism is needed.

CLINICAL RELEVANCE

Orofacial tactile acuity of TMDs patients was associated with their pain symptoms, which researchers should take account into when performing 2-PD tests for TMDs patients. The 2-PD test can be considered as a potential tool along with the current procedures for the differentiations of PT and Non-PT.

Relationship between masseter muscle activity during wakefulness and temporomandibular disorder-related symptoms

BACKGROUND

Masseter muscle activity during wakefulness may be associated with temporomandibular disorder (TMD)-related symptoms, psychosocial status and pain-related disability; however, this relationship is unclear.

OBJECTIVES

This study aimed to determine the relationship between masseter muscle electromyography (EMG) burst/duration during wakefulness and TMD-related symptoms, psychosocial status and pain-related disability.

METHODS

Sixty participants were assessed masseter muscle activity during wakefulness using a data-logger-type ultraminiature EMG system and TMD-related symptoms, psychosocial status and pain-related disability through Axis I and II of the diagnostic criteria for TMD (DC/TMD). EMG bursts lasting longer than 0.25 s but less than 2.0 s and those lasting longer than 2.0 s were classified as phasic and tonic bursts, respectively.

RESULTS

Participants with palpation-related pain in the temporalis and masseter muscles, as assessed through the DC/TMD examination form in Axis I, had more bursts (number/h) (p = .035 and p = .009, respectively) and longer duration (time/h) (p = .013 and p = .004, respectively) of tonic bursts of the masseter muscle during wakefulness. Participants with palpation-related pain in the masseter muscles had higher oral behaviour scores during wakefulness using Axis II (p = .001), which affected the number and duration of tonic bursts of the masseter muscle activity during wakefulness (p = .011 and p = .007, respectively).

CONCLUSION

As tonic bursts mainly reflect clenching, individuals with pain in the masseter muscles by palpation may have a high frequency and longer duration of clenching, as well as a high frequency of oral behaviours during wakefulness.

Association Between Oral Behaviors and Painful Temporomandibular Disorders: A Cross-Sectional Study in the General Population

Background

Studies have reported correlations between various oral behaviors and painful temporomandibular disorders (TMD), yet comprehensive research on the independent effects of each oral behavior within the general population remains sparse.

Objective

This cross-sectional study aimed to investigate the association between painful TMD (PT) and various oral behaviors in general population.

Methods

A questionnaire survey was conducted with participants to collect data encompassing demographic characteristics, eight specific oral behaviors, and the 5 major TMD symptoms(5Ts) checklist. Participants were categorized into PT and non-PT (NPT) groups based on their responses to the 5Ts checklist. Those reporting TMJ/facial pain or headaches were assigned to the PT group, while all other participants constituted the NPT group. Both univariate and multivariate logistic regression analyses were employed to evaluate the association between individual oral behavior and the presence of PT, controlling for demographic confounders including age, sex, systemic diseases, and dental treatments history.

Results

A total of 441 valid questionnaires were received, including 156 males and 285 females. The prevalence of PT was identified to be 33.33%, with 61.00% of participants engaging in one or more types of oral behaviors. Each oral behavior was more frequently reported in the PT group compared to the NPT group. The univariate logistic regression analysis identified positive correlations between all eight oral behaviors and PT. In the multivariate logistic regression analysis, these associations persisted after adjustment for demographic confounders including age, sex, history of systemic diseases and dental treatments (P<0.01). The behaviors most strongly associated with PT were "Hold or jut jaw forward/to the side" (OR:4.478), "Hold, tighten or tense muscles without clench" (OR:3.343) and "Hold jaw in rigid or tense position" (OR:3.209).

Conclusion

The presence of oral behaviors has significant association with PT. Individuals exhibiting multiple oral behaviors are more likely to experience PT. Additional studies are needed to clarify the effects of reducing oral behaviors on pain-related symptoms.

Assessment of awake bruxism-Combinational analysis of ecological momentary assessment and electromyography

PURPOSE

No consensus exists regarding the examination methods and assessment criteria for awake bruxism (AB). In this study, masticatory muscle activity measured using electromyography (EMG) was recorded simultaneously with the ecological momentary assessment (EMA) of bruxism events. Data were collected to identify distinctive EMG parameters in AB.

METHODS

A total of 104 individuals were classified into the bruxism (BR) or control (CO) groups based on clinical findings. The participants recorded EMA on a tablet device under continuous EMG recording using a data log-type wireless EMG device. For EMA recording, a warning was randomly provided three times each hour for five hours. A receiver operating characteristic (ROC) curve was obtained based on EMA and EMG events. Maximum voluntary contraction (MVC) at the time of maximum bite force was set at 100%. The muscle activity was assessed as a relative value.

RESULTS

Based on discriminant analysis, analysis of participants who had four or more positive clenching EMA responses was appropriate. The assessed parameters for the EMG cutoff value determination procedure, which combined EMG and EMA, resulted in a cutoff value that enabled the distinction between the BR and CO groups. The area under the ROC curve was 0.77 and the cut-off value was 3.2 events/hour under the EMG of 20% MVC with a duration of ≥1 s.

CONCLUSIONS

This is the first study to report a combined analysis of the EMA and EMG. These results suggest its effectiveness as a cutoff value for AB screening.

Prevalence of awake bruxism in the adult population: a systematic review and meta-analysis

OBJECTIVES

To evaluate the prevalence of awake bruxism (AB) in the adult population.

MATERIALS AND METHODS

Six main electronic databases and three sources of grey literature were searched to identify cross-sectional studies in which AB was assessed. The studies were independently selected by two reviewers in two phases, based on their eligibility criteria. The first one consisted of reading titles and abstracts, and the second one involved reading the full articles. The study quality assessment was obtained by using the "Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data", and the "R Statistics" software was used to perform meta-analyses.

RESULTS

Seventeen out of 3086 identified studies were included. None of the studies scored high in methodological quality across all 9 items of the JBI checklist. However, "the use of valid methods to identify pathology" and "appropriate statistical analysis" were considered to have high methodological quality in all the studies. The overall pooled prevalence of the meta-analysis was 15.44% (99% confidence interval: 10.81 to 20.72%) and there was no difference for sex, sampling method and according to consensus-based classification.

CONCLUSIONS

The prevalence of AB in adults was low. There was substantial methodological variability, which highlights the need for standardized guidelines.

CLINICAL RELEVANCE

Prevalence data are useful for raising patients' and clinicians' awareness of the AB. Moreover, since AB can lead to possible pain and overload of the stomatognathic system, this knowledge can also guide dentists to achieve an early diagnosis of AB and to provide appropriate care management.

Validity of a Mobile Application to Diagnose Temporomandibular Disorders

This study aimed to assess the diagnostic accuracy of a mobile application by comparing its diagnoses to those of Orofacial Pain and Oral Medicine specialists and further imaging results (CBCT and MRI) in 500 patients with temporomandibular disorder (TMD). The research focused on three diagnostic categories: the initial specialist diagnoses, the final diagnoses after imaging, and the mobile app's diagnoses. The concordance rates, sensitivities, specificities, and positive predictive values of the diagnoses were examined, with further imaging serving as the gold standard. The mobile app demonstrated a high concordance rate compared to both the final (0.93) and the initial specialists' diagnoses (0.86). The sensitivities, specificities, and positive predictive values also indicated strong reliability, affirming the app's diagnostic validity. Although the concordance rate was slightly lower when comparing the app's diagnoses to the imaging results (CBCT and MRI), the specialists' diagnoses yielded similar results. The study suggests that user-friendly diagnostic mobile applications, based on the diagnostic criteria for TMD, could enhance the clinical management of TMD. Given the reliability of mobile applications for diagnostic purposes, their wider implementation could facilitate the provision of appropriate and timely treatments for patients with TMD.

The prevalence of bruxism and oral parafunction activities among Israeli juveniles with autism spectrum disorder: A preliminary study during the COVID-19 pandemic

OBJECTIVE

To evaluate the prevalence of oral habits, bruxism, and Temporomandibular Disorders (TMD) injuvenileswithautisticspectrumdisorder(ASD).

METHODS

Data included 165 juveniles diagnosed with ASD, allocated to younger group aged 6 21 (n=86) and older group aged 13-21 (n=79).

RESULTS

Sleep bruxism was reported by 26.7% in the younger group and by 5% in the older group. Awake bruxism was reported by 22% and 17.7%, respectively. Oral habits were reported by 43% of all participants, with similar rate in both groups. TMD related p ain was low in both groups (6.3% and 7% respectively). The influence of the COVID 19 pandemic on oral parafunction was moderate in the younger group (17.4%) and mild in the older group (8.6%), influence on bruxism was mild in both groups (5.8% and 2.5%, respectively).

CONCLUSION

The prevalence of bruxism and oral parafunctions was similar to the reported in the literature for the general population.

ASSOCIATIONS BETWEEN SCREENING FOR FUNCTIONAL JAW DISTURBANCES AND PATIENT REPORTED OUTCOMES ON JAW LIMITATIONS AND ORAL BEHAVIORS

OBJECTIVES

Temporomandibular disorders (TMDs) is a collective term for pain and functional disturbances related to the jaw muscles and the temporomandibular joint. In contrast to screening for orofacial pain, knowledge is limited on the association between patient-reported outcomes and screening for joint-related functional jaw disturbances. Therefore, our aim was to evaluate the association between a screening question for functional jaw disturbances, and disease-specific outcome measures for functional jaw limitations and oral behaviors.

METHODS

This study included 299 individuals (201 women; 20-69 years, median 37.0) in a general population sample from Västerbotten, Northern Sweden in 2014. A single screening question for functional jaw disturbances "Does your jaw lock or become stuck once a week or more?" was used to categorize individuals as cases or controls. Patient-reported outcomes on functional jaw disturbances were assessed with the 20-item jaw functional limitation scale (JFLS-20) and oral behaviors with the 21-item Oral Behaviors Checklist (OBC-21).

RESULTS

The strongest predictive probability to have a positive screening outcome was functional jaw limitations related to mobility (AUCboot=0.78, 95 CI:0.71-0.86, P < .001), followed by limitations related to communication (AUCboot = 0.74, 95 CI:0.63-0.80, P < .001) and mastication (AUCboot = 0.73, 95 CI:0.66-0.81, P < .001). The frequency of oral behaviors was not significantly associated with a positive screening outcome (AUCboot = 0.65, 95 CI:0.55-0.72, P = .223).

CONCLUSIONS

Self-reported functional limitations, but not oral behaviors, are strongly associated with a single screening question for frequent functional jaw disturbances. This finding provides support for incorporating a question on jaw catching/locking once a week or more in screening instruments for TMDs.

Wearables for personalized monitoring of masticatory muscle activity - opportunities, challenges, and the future

Wearable devices are worn on or remain in close proximity of the human body. The use of wearable devices specific to the orofacial region is steadily increasing. Orofacial applications of wearable devices include supplementing diagnosis, tracking treatment progress, monitoring patient compliance, and understanding oral parafunctional behaviours. In this short communication, the role of wearable devices in advancing personalized dental medicine are highlighted with a specific focus on masticatory muscle activity monitoring in naturalistic settings. Additionally, challenges, opportunities, as well as future research areas for successful use of wearable devices for precise, personalized care of muscle disorders are discussed.

Patient experience and satisfaction with different temporomandibular joint treatments: A retrospective study

This retrospective study aimed to evaluate patient satisfaction with different temporomandibular joint (TMJ) treatments. Patients were included in the study according to the following inclusion criteria: 1) arthrogenous and/or myogenous temporomandibular disorders (TMD); 2) Dimitroulis classification category between 1-4; 3) conservative treatment without any improvement at least for 3 months; 4) indication for one of the following TMD treatments: injection of botulinum toxin; arthrocentesis; arthroscopy, and open surgery without alloplastic material; and 5) age ≥16 years. An independent satisfaction questionnaire with 11 queries was applied via phone call to all patients, which included 6 questions using a 10-point Likert scale and 5 yes-or-no questions. The principal outcome was the overall satisfaction with the clinical result of the treatment, and the secondary outcomes were specific satisfaction with the following: 1) pain reduction; 2) range of mouth opening; 3) chewing ability; 4) postoperative recovery; 5) the fulfillment of expectations; 6) treatment choice; 7) treatment recommendation to a friend; and 8) the need for another intervention. Anxiety and depression were also included as variables. Data were analyzed using descriptive statistics, non-parametric Kruskal-Wallis and Spearman rank correlation coefficient tests. A total of 120 patients (mean age 41.20 ± 17.78 years) were enrolled, comprising 109 women (90%) and 11 men (10%). The overall clinical satisfaction of all patients was 8.24 ± 2.23 (mean ± SD), and 97 patients (80.8%) stated that they would repeat the treatment. Patients submitted to TMJ arthrocentesis and arthroscopy had higher overall clinical satisfaction (9.09 ± 0.971 and 9.03 ± 1.13, p = 0.021) followed by open surgery (8.38 ± 1.84). The authors observed three statistically significant correlations: 1) overall clinical satisfaction and patient expectations (r = 0.803; p < 0.0001); 2) overall clinical satisfaction and post-treatment pain (r = -0.299; p = 0.003); and (3) the presence of depression and the need for further TMJ treatment (r = 0.186; p = 0.043). Within the limitations of the study it seems that patient expectations should be addressed ad initium, and the presence of a diagnosis of depression with concomitant TMD must alert the clinical team and patient for the possible need of additional treatment.

Association between place of dental check-ups and work absenteeism among Japanese workers

OBJECTIVES

Dental check-ups at the workplace provide the opportunity for early detection of dental diseases. Dental check-ups during working hours could reduce the number of days of absence from work due to visits to dental clinics outside the workplace. Although health check-ups are provided to workers in Japan, dental check-ups is not mandatory. This study aimed to determine the association between the place of dental check-ups and absenteeism due to visits to the dental clinic.

METHODS

This cross-sectional study used data from an online self-reported worker survey conducted for 2 weeks in March 2017. We applied linear regression analysis with robust variance to determine the association between the place of dental check-ups and absenteeism due to dental clinic visits while adjusting for sociodemographic, health, and oral health covariates.

RESULTS

The average age of the 3930 participants was 43.3 ± 11.7 years, and 52.3% were male. The number of days of absenteeism due to dental clinic visits in the past year for those who received check-ups only at the dental clinic and at the workplace were 0.57 ± 2.67 days and 0.21 ± 1.20 days, respectively. After adjusting for covariates, it was found that those who received dental check-ups at the workplace had 0.35 (95% CI, 0.12-0.58) fewer days of absence than those who received dental check-ups at the dental clinic.

CONCLUSION

Workers who received dental check-ups at the workplace were associated with fewer days of absence due to dental visits than those who received at the dental clinic.

Pterygoid muscle activity in speech: A preliminary investigation

BACKGROUND

Speaking depends on refined control of jaw opening and closing movements. The medial pterygoid muscle (MPT), involved in jaw closing, and the lateral pterygoid muscle (LPT), involved in jaw opening, are two key mandibular muscles in mastication and are likely to be recruited for controlled movements in speech.

OBJECTIVES

Three hypotheses were investigated, that during speech the MPT and LPT: (1) were both active, (2) but exhibited different patterns of activity, (3) which fluctuated with the vowels and consonants in speech.

METHODS

Intramuscular EMG recordings were made from the right inferior head of the LPT and/or the right MPT in five participants during production of 40 target nonsense words (NWs) consisting of three syllables in the form /V₁ C₁ V₂ C₂ ə/ (V = vowel; C = consonant; ə = unstressed, reduced vowel), spoken by each participant 10 times per NW; analysis focussed on the target syllable, C₁ V₂ .

RESULTS

Both MPT and LPT exhibited robust increases in EMG activity during utterance of most NWs, relative to rest. Peak LPT activation was time-locked to the final part of the target consonant (C₁ ) interval when the jaw begins opening for the target vowel (V₂ ), whereas peak MPT activation occurred around the temporal midpoint of V₂ , when the jaw begins closing for C₂ . EMG amplitude peaks differed in magnitude between "high" vowels, i.e., for which the tongue/jaw are high (e.g., in SEEK), and "low" vowels, i.e., for which the tongue/jaw are low (e.g., in SOCK).

CONCLUSIONS

These novel findings suggest a key role for the LPT and MPT in the fine control of speech production. They imply that speech may impose major synergistic demands on the activities of the MPT and the LPT, and thereby provide insights into the possible interactions between speech activities and orofacial activities (e.g. mastication) and conditions (e.g. Temporomandibular Disorders) that involve the masticatory muscles.

Peripheral muscle oxygenation and symptoms of stress in adolescents with and without temporomandibular disorder

OBJECTIVE

To compare peripheral muscle oxygenation levels and the prevalence of psychological stress in adolescents with and without temporomandibular disorder (TMD).

METHODS

A cross-sectional study was performed with adolescents submitted into two groups: those diagnosed with TMD (DG) and control (CG). Muscle oxygenation was measured by near-infrared spectroscopy in the masseter and upper trapezius muscles. Symptoms of stress were assessed by Lipp's Stress Symptom Inventory for Adults or Child Stress Scale. A Student t-test was used for intergroup comparisons and association between categorical variables by chi-square test, phi coefficient of correlation, odds ratio, and two-way ANOVA.

RESULTS

Fifty-three adolescents were evaluated and a significant reduction was observed in the oxyhemoglobin level in the masseter muscle at rest (p = 0.04) and contraction (p = 0.02). A greater total hemoglobin level was found in the upper trapezius muscle at rest in DG (p = 0.03), with a significant difference in the tissue saturation index during contraction (p = 0.05) intergroup. Individuals in the DG were 4.523 times more likely to exhibit signs and symptoms of stress than in CG.

CONCLUSION

Adolescents from DG showed reduced masseter oxyhemoglobin values at rest and during contraction and showed more signs and symptoms of stress than healthy controls. In the upper trapezius, DG showed higher values of total circulating hemoglobin, essential for greater blood flow and efficient maximum voluntary contraction.

CLINICAL RELEVANCE

Changes in tissue oxygenation and stress in adolescents with TMD prompted the earlier treatment of this population to prevent disease progression into adulthood.

Temporomandibular Disorders and Bruxism among Sex Workers-A Cross Sectional Study

Sex workers are a highly underprivileged population which is present all around the world. Sex work is associated with negative social stigma which affects all aspects of the sex workers' lives including healthcare, service providers and police. The stigma may result in increased stress, mental health problems, feelings of isolation and social exclusion. In the present study, 36 sex workers (SW) and 304 subjects from the general population in Israel (GP) were evaluated for the presence of bruxism and Temporomandibular disorders (TMD), with the use of Diagnostic Criteria for Temporomandibular Disorders (DC/TMD- Axis I). When compared to the general population, sex workers presented larger maximal assisted mouth opening and higher prevalence of the following TMD diagnoses: Disc displacement with reduction, Myalgia, Myofascial pain with referral, Arthralgia (left and right) and Headache attributed to TMD. The odds of sex workers suffering from one of these diagnoses were twice to five times higher than those of the general population. The study shows that health problems of sex workers go beyond venereal diseases, HIV and mental disorders which are commonly studied. Oral health, TMD and oral parafunctions are some of the additional health issues that should be addressed and explored in this population.

Effects of patient education on the oral behavior of patients with temporomandibular degenerative joint disease: a prospective case series study

OBJECTIVE

To evaluate the effects of patient education and related factors on oral behaviors (OBs) in patients with temporomandibular joint degenerative diseases.

METHODS

Sixty-three patients were included. Temporomandibular joint specialists conducted clinical examinations, provided patient education, and administered the Oral Behavior Checklist (OBC) questionnaire at baseline. Patients were followed up at 6 months.

RESULTS

Eight OBs showed a high incidence among patients. At the 6-month follow-up, the incidence of 6 of the OBs decreased, all of which were high incidence OBs. The frequency of 9 OBs decreased, of which 8 were high incidence OBs. The average OBC score decreased from 22.97 ± 9.30 to 17.90 ± 9.28. Age, education level, and original OBC score had a significant effect on OB improvement.

CONCLUSION

Patient education and the corresponding treatment are conducive to OB improvement. The related factors affecting the improvement in patients' OBs were age, education level, and OB severity.

Associations between Bruxism, Stress, and Manifestations of Temporomandibular Disorder in Young Students

Bruxism is a repetitive activity of the masticatory muscles, which determine teeth grinding or clenching, associated with rigidity, bracing, or thrusting of the mandibula. The aim of this study was to determine the prevalence of possible bruxism in 328 students attending the Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, and its associations with stress and other manifestations of the temporo-mandibular disorder. This was a questionnaire-based study to collect information on self-evaluation of bruxism presence, frequency of specific episodes, stress, anxiety, and other manifestations of temporo-mandibular disorder. Self-evaluated bruxism was identified in 39.33% from the entire study group, allowing us to define two subgroups for further analysis. Sleep bruxism was present in 16.28% of participants; awake bruxism was present in 68.99%, while 14.73% of participants presented a combined form. The main manifestation of bruxism was reported as teeth grinding. Fatigue was identified as a common clinical sign of bruxism and temporo-mandibular disorder. Group distribution analysis (Chi-Square) indicated significant associations between bruxism and stress, panic, restlessness, or increased stress during the COVID-19 pandemic (p < 0.05). Bruxism, and especially awake bruxism, has increased in prevalence among young students, and it has been associated with increased levels of stress.

Effects of stabilization splints on the signs and symptoms of temporomandibular disorders of muscular origin: A systematic review

OBJECTIVE

To assess effects of stabilization splints on signs and symptoms of temporomandibular disorders of muscular origin compared to other treatments.

METHODS

A search for articles via six electronic databases and gray literature was conducted. The risk of bias was evaluated with the Cochrane Collaboration tool. The Grading of Recommendations Assessment, Development and Evaluation approach determined the certainty of evidence.

RESULTS

Ten articles were included. Stabilization splints (n = 160 subjects) were reported to be as effective as other treatments (n = 209 patients) on analyzed outcomes (pressure pain threshold, pain during chewing, mouth opening, spontaneous pain intensity and by palpation). Five studies were judged at low and five at some concerns of risk of bias. The certainty of evidence was very low for all outcomes.

CONCLUSION

Positive effect on signs and symptoms of temporomandibular disorders of muscular origin, when managed with stabilization splint, could not be confirmed or refuted.

Association of oral behaviours' frequency with psychological profile, somatosensory amplification, presence of pain and self-reported pain intensity

OBJECTIVE

To investigate the association of the frequency of oral behaviours with psychological (anxiety, depression) and psychosomatic factors (somatosensory amplification) as well as with pain presence (Temporomandibular disorders-pain (TMDp) patients and control (CTR) participants) and pain intensity (no_low pain intensity (nLPI)/high pain intensity (HPI)).

MATERIAL AND METHODS

Fifty-four TMDp patients (48 females and 6 males; 29.13 ± 10.46 years) and 46 controls (29 females and 17 males; 28.54 ± 9.71 years) were administered Oral Behaviours Checklist (OBC), Generalized Anxiety Disorder-7 Scale, Patient Health Questionnaire-9 for depression and Somatosensory Amplification Scale. Data were analysed with respect to the presence of TMD pain and to pain intensity. Mann-Whitney test and Spearman's rank correlation were used for analyses.

RESULTS

No significant differences in examined variables between TMDp patients and CTR individuals were found. The frequency of oral behaviors (OBC total score and sleep-related oral behaviours) as well as anxiety, depression and somatosensory amplification scores were higher in HPI group when compared to nLPI group (p < .05). In univariate correlations, oral behaviours were positively correlated with somatosensory amplification (p = .001), anxiety (p < .05), depression (p < .05), female sex (p < .05) and pain intensity (p < .05) but not with pain presence. Multiple linear regression models showed that predictors for the higher frequency of oral behaviours were anxiety and female sex.

CONCLUSIONS

Oral behaviours were associated with pain intensity but not with pain presence and were primarily influenced by anxiety and female sex, suggesting that therapeutic approach should consider both, reducing pain intensity and management of the impact of psychological factors.Trial registration: ClinicalTrials.gov NCT04694274. Registered on 01/04/2021.

Headache Because of Problems with Teeth, Mouth, Jaws, or Dentures in Chronic Temporomandibular Disorder Patients: A Case–Control Study

This study aimed to characterize self-reported headaches because of problems with the teeth, mouth, jaws, or dentures (HATMJD) in chronic patients with temporomandibular disorders (TMDs) in order to compare their results with those of TMD patients without such headaches and to investigate the associations of HATMJD with depression, anxiety, physical symptoms, oral behaviors, and sleep quality. We conducted a case–control study on consecutive chronic TMD patients referred to the University Medical Center of Ljubljana, Slovenia. A self-reported HATMJD was extracted from item #12 in the 49-item version of the Oral Health Impact Profile questionnaire. Axis II instruments of the Diagnostic Criteria for TMD (i.e., for screening of depression, anxiety, specific comorbid functional disorders, and oral behaviors) and the Pittsburgh Sleep Quality Index were used in this study. In total, 177 TMD patients (77.4% women; mean age: 36.3 years) participated in this study; 109 (61.6%) patients were classified as TMD patients with HATMJD. TMD patients with at least mild depressive and anxiety symptoms, with at least low somatic symptom severity, and a high number of parafunctional behaviors had more HATMJD. Parafunctional behavior and sleep quality were the most prominent predictive factors of the occurrence of HATMJD. TMD patients with HATMJD have more psychosocial dysfunction, a higher frequency of oral behaviors, and poorer sleep quality than TMD patients without such headaches.

Relationship between emotional state and masticatory system function in a group of healthy volunteers aged 18-21

OBJECTIVE

To determine the role of emotional state in the masticatory system function in a group of young adults.

METHODS

Ninety-six generally healthy randomly selected students aged 18-21 were examined. They were subjected to a questionnaire survey determining their emotional state, clinical examination, and instrumental diagnostics (EMG, Cadiax Compact, JVA).

RESULTS

The stress symptoms group revealed a greater intensity of neck and shoulder muscles pain (p < 0.05) and an increase of electrical potential of the masseter muscles in maximal voluntary clench (p < 0.05). They reported more often headache (p < 0.001), tension/contracture of the head, neck and nape (p < 0.05), and pain while opening the mouth wide (p < 0.05). The values of parameters obtained in the instrumental diagnostics did not reveal differences between the groups.

CONCLUSION

Stressful situations increase muscular tension but do not have a direct impact on the temporomandibular joints function.

Painful Temporomandibular Disorders, Bruxism and Oral Parafunctions before and during the COVID-19 Pandemic Era: A Sex Comparison among Dental Patients

Aim: To evaluate the effect of the current coronavirus pandemic on the prevalence of bruxism, oral parafunctions and painful Temporo-Mandibular Disorders (TMDs) and to evaluate the influence of the pandemic on both sexes. Methods: This retrospective study included 288 dental patients who underwent complete anamnesis and examination according to the Diagnostic Criteria for TMD. The study evaluated two patient populations according to the date of examination: (a) pre-COVID-19 pandemic era (108 patients); (b) COVID 19 pandemic era, where 180 patients were examined during the pandemic. Results: A significant increase in parafunction activity was found in both men and women (p < 0.001) during the COVID-19 pandemic. Awake bruxism (AB) and sleep bruxism (SB) was more prevalent during the COVID-19 pandemic solely in women (AB-p < 0.001; SB-p = 0.014). Conclusions: Men and women were affected by the ongoing stress due to the COVID-19 pandemic, yet women showed a higher influence as compared to men. The long-term exposure to elevated levels of anxiety and stress may aggravate or trigger stomatognathic detrimental conditions. Dentists should be aware and regularly monitor their patients regarding the possible existence and consequences of bruxism and TMD.

Polymorphisms in the HTR2A and HTR3A Genes Contribute to Pain in TMD Myalgia

Background: The aim of this study was to investigate if single nucleotide polymorphisms (SNPs) related to monoaminergic neurotransmission, in particular the serotonergic pathway, contribute to pain perception in patients with temporomandibular disorder (TMD) myalgia and if there is a correlation to jaw function as well as psychosocial factors such as stress, anxiety and depression.

Materials and Methods: One hundred and seventeen individuals with TMD myalgia were included. A venous blood or saliva sample was taken for genetic analyses and genotyped regarding HTR2A (rs9316233) HTR3A (rs1062613), HTR3B (rs1176744), SERT (5-HTTLPR) and COMT (rs4680). A clinical examination according to Diagnostic Criteria for TMD (DC/TMD) was performed and axis II data (psychosocial factors) were compared between participants with different genotypes for each gene using Kruskall–Wallis test. The characteristic pain intensity (CPI) was tested for correlations to scores for the Perceived Stress Scale, Generalized Anxiety Disorder, and Patient Health Questionnaires using Spearman's rank correlation test with Bonferroni correction for multiple testing. To further explore data factor analysis was performed to identify latent factors associated to the outcome variables.

Results: Participants carrying at least one copy of the rare allele of the HTR2A (rs9316233) and HTR3A (rs1062613) had higher CPI compared with the participants with the homozygous common genotype (P = 0.042 and P = 0.024, respectively). Correlation analyses showed several significant positive correlations between CPI on one hand, and self-reported psychosocial distress and jaw function on the other hand for several genotypes that mostly were weak to moderate. The factor analysis identified two latent variables. One was positively correlated to the HTR3B gene, jaw function and self-reported parafunctions, and the other was positively correlated to psychological distress and negatively correlated to SERT.

Conclusion: Taken together, the polymorphism rs1062613 in the HTR3A gene contributes to pain intensity in TMD myalgia. This together with positive interactions between pain variables and psychological factors in genotypes strengthens that pain and psychological distress are related. Further research is needed to explore this as well as the influence of gene-to-gene interactions on pain and psychological distress.

Association of visual display terminal time with prevalence of temporomandibular disorder among Japanese workers

OBJECTIVES

Visual display terminal (VDT) time has been reported to affect the development of temporomandibular disorders (TMDs). However, no study has investigated the association between VDT time at and outside of work with TMDs Adjusting for known TMJ risk factors. This study aimed to investigate whether TMDs were associated with VDT time at and outside of work after adjusting for various working conditions in Japanese workers.

METHODS

This cross-sectional study was based on an internet survey of 3930 workers (2057 men and 1873 women), The TMD Screening Questionnaire (SQ-TMD), occupational factors, VDT time at and outside of work, psychosocial factors, and habits were assessed. We applied logistic regression to estimate the odds ratio (OR) of VDT time on SQ-TMD with adjustment for confounders.

RESULTS

The mean age of the respondents was 43.3 ± 11.7 years, and 778 (19.8%) and 3152 (80.2%) subjects were at high and low TMD-related symptoms (TRS). Logistic regression analysis adjusting for all covariates (Model 2), the prevalence of high TRS was significantly higher among those with VDT time at work of 60-179 min (OR = 1.52, 95% CI 1.18-1.94), 180-359 min (OR = 1.27, 95% CI 1.00-1.62), and more than 360 min (OR = 1.44, 95% CI 1.10-1.88) compared to those with 0-59 min. However, there was no significant difference in the prevalence of high TRS for VDT time outside of work.

CONCLUSION

VDT time at work, but not VDT time outside of work, influences the prevalence of TRS. Since the association between VDT time at work and the prevalence of TRS was found even after adjusting for sociopsychological factors and habits generally associated with TMD, further investigation of other factors is needed.

Comparison of the Effects of Myotherapy in Patients with Myofascial Pain with and without Self-Reported Sleep Bruxism Using The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I Questionnaire

Background

This study aimed to compare the effects of myotherapy using sublingual relaxation splints and stretching exercises in 110 patients with myofascial pain with and without self-reported sleep bruxism using The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I Questionnaire.

Material/Methods

The study involved 110 patients with myofascial pain. The diagnosis was based on the RDC/TMD questionnaire. The number of painful muscle sites (PMS) and the range of maximum mouth opening (MMO) were assessed 2 times – at the first visit and after 3 months. Then, the influence of possible bruxism on the treatment was assessed.

Results

The mean age of the patients was 26.8 years (SD 5.4); 89% of the subjects were women; and 60.9% of the patients reported bruxism. Each patient was instructed to perform muscle stretching at the first visit and after 1 week all patients received a sublingual relaxation splint. The number of PMS decreased and the range of MMO increased in both groups after a period of 3 months of treatment (P<0.05). Significant differences were observed in the obtained treatment effects between the patients with and without possible bruxism.

Conclusions

This study evaluated the effectiveness of the sublingual relaxation splint and stretching exercises in patients with myofascial pain. Patients at a single center in Poland who reported myofascial pain that was not associated with self-reported sleep bruxism had a significantly better response to myotherapy when compared to patients with self-reported sleep bruxism.

Bone apposition at the mandibular angles as a radiological sign of bruxism: a retrospective study

Background

The main objective of this investigation was to determine on panoramic radiographs the prevalence of macroscopically visible alterations (bone apposition in combination with directional change) in the mandibular angle region in bruxism patients. Another aim was to describe and detect different morphological characteristics of the jaw angles.

Methods

Two hundred panoramic radiographs were studied: 100 images of adults with clinically diagnosed bruxism (73 women, 27 men, age range 21–83 years), 100 images of a comparison group consisting of adolescents (66 girls, 34 boys, age range 12–18 years).

Results

The morphological changes of the 400 jaw angles could be classified into four degrees. In the adult group, almost half of mandibular angles showed bone apposition. Conversely, the prevalence in the control group was zero. The localization of the appositions corresponds to the insertions of the masseter and medial pterygoid muscles at the mandibular angle.

Conclusions

The bone apposition at the mandibular angles should be interpreted as a functional adaptation to the long-term increased loads that occur during the contraction of the jaw closing muscles due to bruxism. Hence, radiologically diagnosed bone apposition may serve as an indication or confirmation of bruxism.

Oral behaviors, bruxism, malocclusion and painful temporomandibular joint clicking: is there an association?

The present cross-sectional case-control study aimed to determine if there is an association between specific oral behaviors, sleep bruxism (SB), awake bruxism (AB), and painful temporomandibular joint (TMJ) clicking. Ninety individuals were dived into three groups; Group 1 (n = 30): painful TMJ clicking; Group 2 (n = 30): painless TMJ clicking; and Group 3 (n = 30): control group. The following clinical data were studied: oral behaviors (unilateral chewing, gum chewing, nail biting, foreign objects biting, leaning with jaw against the hand, and sleeping in a position that pressures the jaw), SB, AB (including the frequency in 10 days, evaluated by ecological momentary assessment), and malocclusions investigated based on clinical inspections (anterior open bite, posterior cross-bite, abnormal overbite/overjet, occlusal guidance, mediotrusive and/or laterotrusive interferences, retruded contact position to maximum intercuspation slide, missing posterior teeth). All statistical tests (Kolmogorov-Smirnov, chi-square, and one-way ANOVA) were performed with a 5% significance level. Group 1 had the highest frequency of and a significant association with leaning with jaw in the hand, sleeping position that pressures the jaw, gum chewing, nail biting, and AB (p<0.05). Gum chewing, nail biting, and AB were associated with Group 2 only when compared to Group 3 (p<0.05). No significant difference among groups was found for other behaviors (unilateral chewing and foreign objects biting), SB, and all malocclusions (p>0.05). It can be concluded that patients with painful TMJ clicking had a higher frequency of and a significant association with some specific harmful behaviors and AB.

Are oral overuse behaviours associated with painful temporomandibular disorders? A cross-sectional study in Portuguese university students

BACKGROUND

Many different types of oral overuse behaviours occur frequently in adult populations with painful temporomandibular disorders (TMDs). Less is known regarding these behaviours and their associations with TMDs in university students.

OBJECTIVES

Test the association between frequency of different oral overuse behaviours evaluated by the Oral Behaviour Checklist (OBC) and the severity of painful TMDs.

METHODS

In this cross-sectional study, 1381 students from 19 universities in the Oporto District, Portugal, completed the Research Diagnostic Criteria for TMD (RDC/TMD) Personal History Questionnaire and the OBC, and they received an RDC/TMD clinical examination. The OBC sum score (ranging from 0 to 84 points) was classified as normal (0 ≤ 16 points), low overuse (17 ≤ 24) or high overuse (≥25). Painful TMD subtypes (myalgia, arthralgia or combined) were identified. Associations were tested using multivariable binary logistic regression models (α = .05), adjusted for age and sex, and referencing the normal parafunction group.

RESULTS

University students with high overuse were more likely to have a painful TMD: myalgia (OR = 1.9, 95% CL: 1.3-3.0); arthralgia (OR = 2.2; 95% CL: 1.4-3.4), combined (OR = 5.0; 95% CL: 3.1-8.1). Students with low overuse were more likely to have only the combined painful TMD (OR = 2.4; 95% CL: 1.4-4.0) but not the individual painful disorders. Of the 21 different behaviours, 13 were reported at least 50% of the time.

CONCLUSIONS

In this university student sample, oral overuse behaviours are widespread, and their overall extent exhibited a dose-response relationship with respect to severity of painful TMDs based on pain and chronicity. Only some behaviours were independently associated with painful TMDs, suggesting the value of further OBC instrument development.

Oral behaviours and wake-time masseter activity in patients with masticatory muscle pain

BACKGROUND

Little is known about wake-time masseter activity of patients with masticatory muscle pain in real-life settings.

OBJECTIVES

The aims of this study were (1) to assess wake-time masseter activity of women with masticatory muscle pain (MMP) and compare it with that of pain-free women; and (2) to investigate the association between objectively measured masseter contractions and self-reported oral behaviours.

METHODS

Adult women (N = 27) diagnosed with MMP were age-matched with pain-free women (N = 26). The electromyographic (EMG) activity of the masseter muscle when awake was recorded unilaterally for two consecutive days. The number of contraction episodes and relative contraction time (%) were calculated using cut-off thresholds of 3%, 5% and 10% of maximum voluntary contraction (MVC). Self-reported daytime oral activity was assessed using the Oral Behaviours Checklist (OBC, items 3-21). Data were analysed using univariate tests and mixed-model analyses.

RESULTS

The number of contraction episodes was similar between groups for all detection thresholds, but the relative contraction time at the lower detection thresholds (i.e. 3% MVC and 5% MVC) was significantly longer (1.5-fold) in the MMP than in the pain-free group. The OBC scores were significantly higher in the women with MMP than in controls, but no positive association could be found between EMG variables and OBC scores.

CONCLUSION

Women with MMP engage in low-level masseter muscle contractions, which last longer than those of pain-free controls. There was no relationship between self-reported oral behaviours and masseter activity when awake. These findings support the notion that prolonged low-level clenching when awake may play a role in the pathophysiology of MMP.

Association between waking-state oral behaviours, according to the oral behaviors checklist, and TMD subgroups

OBJECTIVES

To assess the association between waking-state oral behaviours and temporomandibular disorder (TMD) subgroups and to develop new scoring methods for the Oral Behavior Checklist (OBC).

METHODS

Patients with any TMD diagnosis, according to the diagnostic criteria for TMD (DC/TMD), were divided into subgroups: 'Dysfunctional-TMD' (n = 70), only mechanical dysfunction; 'Painful-TMD' (n = 204), only myalgia, arthralgia or both; and 'Painful-Dysfunctional TMD' (n = 95), combined pain and dysfunction. A group of individuals without TMD, 'Non-TMD' (n = 374), was used for testing associations. Participants completed the OBC. An exploratory factor analysis, followed by a confirmatory factor analysis of the OBC responses, identified 2 major factors, named non-functional activities (NFA) and functional activities (FA). Component total scores were computed. Differences among subgroups for OBC-MS (mean score) and NFA and FA factor scores were estimated using one-way ANOVA and Tukey post hoc tests. Significance was set at p < .05.

RESULTS

The OBC-MS in Non-TMD, Painful-TMD and Painful-Dysfunctional TMD subgroups was higher than in the Dysfunctional-TMD subgroup (p ≤ .001). NFA in Painful-TMD and Painful-Dysfunctional TMD subgroups were higher than in the Non-TMD group (p < .05); NFA in the Dysfunctional-TMD subgroup were lower than in the Painful-TMD subgroup (p = .034). In contrast, FA in Painful-TMD, Dysfunctional-TMD and Painful-Dysfunctional TMD subgroups were lower than in the Non-TMD group (p < .0001).

CONCLUSIONS

A new scoring method for the OBC results in item reduction and creation of meaningful subscales for functional and non-functional behaviours, which are differentially associated with painful and dysfunctional TMDs. This may help clinicians to better tailor treatment for the management of subtypes of TMD patients.

Profiling of Patients with Temporomandibular Disorders: Experience of One Tertiary Care Center

Objectives

The aim of this study was to assess typical and most prevalent characteristics of patients suffering from temporomandibular disorders (TMD) by a retrospective assessment of their medical records.

Material and Methods

Demographic data and data on the characteristics of TMD were collected from the existing medical documentation of 304 TMD patients (250 females and 54 males) who had been referred to the Department of Dentistry, Clinical Hospital Center Zagreb from October 2016 to October 2020 due to temporomandibular pain. For the purpose of analysis, three age groups were formed: i) "children and adolescents" (up to 19 years of age); ii) "middle age" (from 20 to 50 years of age); iii) "older age" (>50 year- olds). A two-step cluster analysis was performed with the aim of classifying TMD patients into homogenous groups.

Results

The mean age of patients whose data were included in the study was 33.8 ± 16.66, with a significantly higher age in the group of women (p<0.001). Most of the patients had chronic pain (67.4%), with the ratio in favor of chronic patients being significantly higher in women than in men (p=0.001). Data on parafunctional behavior were confirmed in 14.5% of patients. Data on the onset of symptoms during/just after orthodontic treatment were present in 14.5% of patients. Data on spontaneous pain, assessed with a visual analogue scale, were recorded in 87 patients, with a mean of 6.14 ± 1.79 and with the highest pain in the "older age" group. Physical therapy was the most common therapeutic modality (56.3%) followed by an occlusal splint (40.5%). The analysis revealed 5 different clusters in the TMD patient data set.

Conclusions

Our results are largely in line with current epidemiological knowledge on TMD. Women predominated in all age groups and most of the patients experienced chronic pain. Classifying patients into homogeneous groups using the clustering method could provide better identification of subgroups of conditions that mainly occur together in these patients, thus providing the basis for more specific management.

Sex Differences in the Temporalis Tendon-Aponeurotic Complex: An in vivo MRI Macroscopic Analysis in Children and Adolescents

The tendon-aponeurosis complex (TAC) of the temporalis dissipates forces produced during function. Abnormally reduced temporalis TACs have been found in individuals with chronic muscular temporomandibular disorders - a painful musculoskeletal condition that is more frequent in women than men. Whether there are sex differences in the temporalis TAC in healthy individuals is currently unknown. Here, we characterized and measured the temporalis TAC in healthy male and female young individuals between 5 and 15 years old to determine whether the volume of the temporalis TAC and the TAC-to-muscle ratio are different between males and females. We collected MRI studies from 90 healthy individuals, including equal numbers (15 M and 15 F) of young children (ages 5-7), children (9-11), and adolescents (13-15) and segmented the right temporalis and its TAC using software. Using general linear models, we tested the effect of sex, age, and their interaction on the volumes of the temporalis and its TAC, and the TAC-to-muscle ratio. The volumes of the temporalis and its TAC increased with age (both p < 0.001) and were not affected by sex (p = 0.252 and p = 0.179) or by the interaction sex-by-age (p = 0.079 and p = 0.095, respectively). The TAC-to-muscle ratio did not change significantly with age (p = 0.655) and was not affected by sex (0.438) or by the interaction sex-by-age (0.524). We provide, for the first time, volumetric data of the temporalis TAC in children and adolescents. The volumes of the temporalis TAC and the TAC-to-muscle ratio are not different between male and female individuals until the age of 15.

Association of Oral Behaviors with Anxiety, Depression, and Jaw Function in Patients with Temporomandibular Disorders in China: A Cross-Sectional Study

Background

The aim of this study was to investigate the association of oral behaviors (OBs) with anxiety, depression, and jaw function in patients with temporomandibular disorders (TMDs) in China.

Material/Methods

A total of 537 patients diagnosed with TMD were included in this study (average age, 31.5512.08 years; 86 men [16.0%] and 451 women [84.0%]). There were 31 cases of masticatory muscle pain, 459 cases of disc displacement, and 13 cases of arthralgia/arthrosis, and 34 cases were uncategorized. Patients were assessed using the Oral Behaviors Checklist (OBC), Jaw Functional Limitation Scale (JFLS), Generalized Anxiety Disorder-7 (GAD-7) scale, and Patient Health Questionnaire-9 (PHQ-9). The relationships between OBC scores and mouth opening, pain scores, JFLS, PHQ-9, and GAD-7 were evaluated with Spearmans correlation analysis. The median TMD symptom duration was 3 (0.5154) months; men and women did not differ significantly in symptom duration or in the number of episodes of depression and anxiety.

Results

The following OBs were common in patients with TMDs: putting pressure on the jaw (52.9%), chewing food on 1 side (47.5%), and holding teeth together during activities other than eating (33.3%). The OBC scores were significantly correlated with the JFLS, PHQ-9, and GAD-7 scores (P<0.01).

Conclusions

Patients with TMDs exhibit specific OBs, which are associated with depression, anxiety, and jaw function. It is necessary to further investigate the interaction of OBs with depression and anxiety in the development of TMDs.

Self-reported symptoms of temporomandibular pain and jaw dysfunction in adolescents are associated with exposure to violence

BACKGROUND

Temporomandibular disorders (TMDs) are multifactorial, and high levels of stress seem to increase symptoms. The association with exposure to violence has not been explored in adolescent populations.

OBJECTIVE

To examine the association of self-reported symptoms of temporomandibular pain and jaw dysfunction with child physical abuse, intimate partner violence, forced sexual intercourse, and bullying victimisation.

METHODS

An epidemiological, cross-sectional, school-based study was conducted in Olinda, northeast Brazil. The sample comprised 2,431 adolescents aged 14-19 years. TMD-related symptoms and exposure to violence were assessed with questions from the 3Q/TMD screener and queries on exposure to different forms of violence. Multilevel logistic regressions were conducted to evaluate how 3Q screen-positive responses are associated with self-reported exposure to violence.

RESULTS

Self-reported TMD-related symptoms had a prevalence of 40.5%. Significantly more females than males screened positive to all 3Q/TMD questions (p < .001). Adolescents experiencing intimate partner violence (p = .012) and bullying (p < .001) had significantly higher odds of 3Q positive responses than those who reported no exposure to violence. Significant associations of TMD-related symptoms with forced sexual intercourse (p = .014) and with bullying (p = .007) were observed.

CONCLUSION

Adolescents with self-reported symptoms of temporomandibular pain and jaw dysfunction were significantly more often exposed to some type of violence. The number of adolescents reporting TMD-related symptoms increased in a dose-response manner with the number of violence forms the individual had experienced.

Treatment responses in chronic temporomandibular patients depending on the treatment modalities and frequency of parafunctional behaviour

OBJECTIVES

(i) To evaluate the effect of three different interventions on treatment outcomes and (ii) to determine how the frequency of oral parafunction influences the effectiveness of the different therapeutic modalities.

METHODS

Forty-five participants were randomly assigned into three treatment groups [physical therapy (PT), stabilisation splint (SS) and control therapy (CT)]. According to Oral Behavior Checklist score, participants were divided into "high-frequency parafunction" (HFP) and low-frequency parafunction" (LFP) group. Primary (spontaneous pain and characteristic pain intensity) and secondary outcomes (range of mouth opening, anxiety symptoms, quality of life, perceived stress and global functional limitation) were evaluated during six-month treatment period.

RESULTS

Participants in PT group showed a significant reduction in characteristic pain intensity (p = .047, η²  = 0.243) when compared to SS and CT group, but significant improvement in spontaneous pain was found in all treatment groups. Patients treated with PT and SS exhibited significantly stronger improvement in pain-free mouth opening than patients in CT group (3rd month: p=.037, η2=0.258; 6th month: p = .005, η²  = 0.383). Within-group analyses showed significant decrease of perceived stress, anxiety symptoms and global functional limitation only in PT group over a six-month treatment period. Participants with HFP presented significantly greater levels of anxiety (3rd month: p = .009, η²  = 0.275; 6th month: p = .041, η²  = 0.176) than participants with LFP. Within-group analyses, however, showed significant improvement of anxiety, but also the decrease of perceived stress and improvement of global limitation for the HFP group but not for the LFP group.

CONCLUSION

Although no treatment can be marked as superior in terms of spontaneous pain relief, PT was more effective when observing relief of characteristic pain intensity. In HFP group the reduction of anxiety, stress and functional limitation was present regardless of the applied therapy.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04694274. Registered on 01/04/2021.

Associations among masticatory muscle activity, physical activity and self-reported oral behaviours in adult women

OBJECTIVES

To examine the relationship between masticatory muscle activity (MMA), self-reported oral behaviours (OBs) and overall physical activity (PA) in adult women.

MATERIALS AND METHODS

MMA and PA were assessed by a wearable electromyography (EMG) device and accelerometer respectively, worn over 2 non-consecutive days by 53 women (mean age 27.5 ± 6.4 years). Following the second recording day, self-reported OBs were assessed. MMA was assessed by the number, amplitude and duration of masseter contraction episodes. Masseter muscle EMG outcome measures were number of contraction episodes per hour (CEs/h) and the relative contraction time (RCT%). PA was assessed by time accumulated in moderate to vigorous physical activity (MVPA) and 10-min bouts of MVPA per hour. Data were analysed using mixed model analysis.

RESULTS

MMA in free-living conditions consisted mostly of low-amplitude (<10% maximum voluntary clenching) and short-duration (<10 s) contraction episodes. Masseter CEs/h were not associated with self-reported levels of OB. Masseter CEs/h were positively associated with time accumulated in MVPA (F = 9.9; p = 0.002) and negatively associated with 10-min bouts of MVPA/h (F = 15.8; p <0.001). RCT% was not significantly associated with either.

CONCLUSIONS

Objectively assessed MMA is not associated with self-reported OB in free-moving adult females. Moderate to vigorous exercise and physical inactivity are accompanied with an increase in the number of masseter muscle contractions and thus possibly tooth clenching activity.

CLINICAL RELEVANCE

OB can be influenced by the type and extent of PA. Subjective assessment of MMA by questionnaire and/or interviews may be invalid.

The Impact of Education and Physical Therapy on Oral Behaviour in Patients with Temporomandibular Disorder: A Preliminary Study

Patient education is important in the treatment of temporomandibular disorder (TMD), but little is known about its effect on oral behaviors. We aimed to determine the dominant oral behaviours in patients with TMD and assess the impact of education on such behaviours. Between July 2018 and April 2019, 54 patients diagnosed with TMD according to DC/TMD were recruited. They received physical therapy and were provided education on TMD and offered a list of recommendations for improving their oral behaviours. The patient education process usually lasted for 10–20 min. Of these patients, 48 were reexamined at the outpatient clinic, 3–9 months posttreatment. We recorded the Oral Behaviour Checklist (OBC) score, maximum painless mouth opening (mm), visual analogue scale (VAS) score for pain, and Jaw Functional Limitation Scale (JFLS) score pre- and posttreatment. Wilcoxon signed rank test and paired sample t-test were used for statistical analysis. Results showed that the most dominant oral behaviours included “putting pressure on the jaw” (59.3%); “chewing food on one side” (46.3%); “pressing, touching, or holding teeth together at times other than eating” (33.3%); and “eating between meals” (33.3%). Posttreatment, the patients reported a decrease in “chewing gum” (P = 0.002), “leaning with the hand on the jaw” (P = 0.013), “chewing food on one side” (P ≤ 0.001), and “eating between meals” (P = 0.007), but this change was not significant in subgroups with a follow-up interval of 9 months. We also observed a significant improvement in the maximum painless mouth opening (P ≤ 0.001), JFLS score (P ≤ 0.001), and VAS score (P ≤ 0.001) for pain, posttreatment. In conclusion, patient education can facilitate management of oral behaviours and should be targeted towards specific oral behaviours.

Is Biofeedback through an Intra-Aural Device an Effective Method to Treat Bruxism? Case Series and Initial Experience

Biofeedback was reported as an effective concept for bruxism treatment, through increasing patient’s awareness of the habit. During bruxing both ear canals become tighter, therefore, an in-ear device can provide biofeedback. The in-ear device is fitted to the ear canal in physiological status, during bruxing the ear-canal tightens resulting in stress on the canal walls and unpleasant feeling. Subsequently, patients stop their bruxing habit. The aim of this study is to provide first clinical evidence that in-ear devices have a positive impact on relieving bruxism in patients. Despite the low number of patients, this early study was designed as a controlled prospective study. The trial included seven female patients with a median age of 47.3 years (23–64 years). Only two patients implemented their devices for eight and seven months, respectively. One patient reported a relief in her symptoms, like headaches and pain intensity during the night, by 50% after three month and 80% after six months. Despite the limited number of participants, the study reflects a potential of Intra-aural devices as effective biofeedback devices in treating bruxism.

Evaluation of temporomandibular disorders, quality of life, and oral habits among dentistry students

Objective: To evaluate temporomandibular disorders (TMD), quality of life, and oral habits in dentistry students.Methods: The study was performed with 480 students (287 females, 193 males). The Fonseca Questionnaire, Oral Health Impact Profile-14 (OHIP-14), and Oral Behaviors Checklist (OBC) were used.Results: The mean scores of the fifth-year students from Fonseca TMD, OHIP-14, and OBC were statistically significantly higher than those of the students in other years of study. The mean Fonseca score of female students was higher than those of the males. There was a statistically significant difference regarding the OHIP-14 scores based on the Fonseca TMD scores. A statistically significant difference regarding OBC was present based on the Fonseca TMD scores.Conclusion: The prevalence of TMDs was higher among the senior dentistry students. Necessary measures should be taken in the dentistry educational system to raise students' quality of life, improve joint disorders, and eliminate current oral habits.

Clinical variables associated with the presence of articular pain in patients with temporomandibular joint clicking

OBJECTIVE

To study and estimate the impact of clinical, somatosensory, and psychosocial variables associated with the concomitant presence of temporomandibular joint (TMJ) pain in patients with TMJ clicking.

MATERIALS AND METHODS

Ninety-three individuals composed the sample: patients with painful TMJ clicking (n = 47) and patients with painless TMJ clicking (n = 46). Four categories of data were evaluated: clinical features (gender, maximal interincisal distance (MID), side of complaint, age); bruxism (sleep bruxism (SB), awake bruxism (AB)); somatosensory (mechanical pain threshold (MPT), wind-up ratio (WUR), pressure pain threshold (PPT), conditioned pain modulation (CPM)); and psychosocial (Pittsburgh Sleep Quality Index (PSQI), pain vigilance and awareness questionnaire (PVAQ), Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK/TMD), Oral Behaviors (OBs)).

RESULTS

Female gender, AB, WUR, CPM, PSQI, PCS, and OBs significantly (p < 0.05) increased the chance of the concomitant presence of TMJ pain in patients with TMJ clicking. On the other hand, MID, MPT, and PPT significantly (p < 0.05) decreased this chance. The other variables had no association.

CONCLUSION

It can be concluded that being a woman, having AB, hyperalgesia in WUR, less efficient CPM, poor sleep quality, pain catastrophizing, and harmful OBs significantly increased the chance of the concomitant presence of TMJ pain in patients with TMJ clicking. In the opposite, high figures of MID, MPT, and PPT decreased the chance.

CLINICAL RELEVANCE

Most patients with TMJ clicking usually postpone seeking treatment until the clicking truly disturbs or there is a concomitant presence of TMJ pain. Understanding the variables associated with this concomitance can be important in clinical practice.

The intensity of awake bruxism episodes is increased in individuals with high trait anxiety

OBJECTIVES

Trait anxiety is associated with an increased occurrence of awake bruxism episodes, a behavior characterized by clenching of the teeth contributing to temporomandibular disorders in some individuals. Here we measured the activity of the masseter and the intensity and duration of spontaneous wake-time tooth clenching episodes in healthy individuals with different levels of trait anxiety (TA).

MATERIALS AND METHODS

Two hundred fifty-five individuals completed a web survey. Using their TA scores, we allocated them in low (< 20^th percentile of the TA score distribution), intermediate (between 20^th and 80^th ), and high (> 80^th) TA groups. We analyzed the electromyographic (EMG) activity of the right masseter during a 15-min silent reading task in forty-three individuals with low (n = 12), intermediate (n = 17), and high TA (n = 14). We tested between-group differences in EMG activity of the masseter, as well as postural activity-the muscular activity that maintains mandibular posture, and amplitude and duration of spontaneous tooth clenching episodes.

RESULTS

The activity of the masseter (mean ± SEM %maximum voluntary contraction/MVC) was greater in the high TA (10.23 ± 0.16%MVC) than the intermediate (8.49 ± 0.16%MVC) and low (7.97 ± 0.22%MVC) TA groups (all p < 0.001). Postural activity did not differ between groups (all p > 0.05). The EMG amplitude of tooth clenching episodes was greater in the high TA (19.97 ± 0.21 %MVC) than the intermediate (16.40 ± 0.24%MVC) and low (15.48 ± 0.38 %MVC) TA groups (all p < 0.05). The cumulative duration of clenching episodes was not different between groups (p = 0.390).

CONCLUSIONS

Increased TA is associated with both increased masseter muscle activity and intensity of wake-time tooth clenching episodes.

CLINICAL RELEVANCE

TA may contribute significantly to masticatory muscle overload.

Music Modulates Awake Bruxism in Chronic Painful Temporomandibular Disorders

OBJECTIVE

In this experimental study, we aimed to determine whether guided music listening (GML) - a music intervention based on models of mood mediation and attention modulation - modulates masticatory muscle activity and awake bruxism in subjects with chronic painful muscular temporomandibular disorders (TMD myalgia, mTMD), a condition causing a significant burden to patients, their families, and healthcare systems.

BACKGROUND

Awake bruxism - a stress behavior characterized by clenching of the teeth - is a strong contributor to chronic mTMD. GML modulates psychological stress and motor responses and could thus reduce muscle activity in chronic musculoskeletal conditions, including mTMD.

METHODS

We recorded the electromyographic (EMG) activity in the right masseter of 14 women with chronic (>6 months) mTMD (median [IQR] = 39.5.3 [24.3] years) and 15 pain-free women (median [IQR] = 30.0 [3.5] years) during a GML session, including 3 music (stressful, relaxing, and participants' favorite music) and a no-music (pink noise) control blocks, each lasting 15 minutes. We measured the motor effort of the right masseter relative to the participants' maximum voluntary contraction (MVC), the muscular effort to maintain mandibular posture (EMG_posture ), and to produce spontaneous awake bruxism episodes (EMG_bruxism ), and the duration and frequency of spontaneous awake bruxism episodes. We tested between-group and within-group (between blocks) differences, as well as the effect of the interaction group by experimental block on these outcome measures.

RESULTS

In both groups, EMG_posture was significantly affected by the interaction group by experimental block (P < .001). Compared to pink noise [mean (95% CI); mTMD: 2.2 (1.6-2.8) %MVC; Controls: 1.1 (0.5-1.7) %MVC], EMG_posture increased during the stressful music block [contrast estimate (95% CI); mTMD: +0.8 (0.7-0.8) %MVC; Controls: +0.3 (0.3-0.4) %MVC; both P < .001], and decreased during the relaxing [mTMD: -0.4 (-0.5 to -0.4) %MVC; Controls: -0.3 (-0.4 to -0.3) %MVC; both P < .001] and favorite [mTMD: -0.5 (-0.6 to -0.5) %MVC; Controls: -0.5 (-0.5 to -0.4) %MVC; both P < .001] music blocks. EMG_posture was greater in mTMD individuals than controls during the favorite music [contrast estimate (95% CI): +1.1 (0.2-1.9) %MVC; P = .019] and the pink noise [+1.1 (0.2-2.0) %MVC; P = .014] blocks. EMG_bruxism was significantly affected by the interaction group by experimental block (P < .001). In mTMD participants, compared to the pink noise block [mean (95% CI); 23.8 (16.0-31.6) %MVC], EMG_bruxism increased during the stressful music block [contrast estimate (95% CI); +10.2 (8.6-11.8) %MVC], and decreased during the relaxing [-6.2 (-8.1 to -4.3) %MVC; P < .001] and favorite [-10.2 (-12.2 to -9.1) %MVC; P < .001] music blocks. These effects were not observed in the control group [mean (95% CI); pink noise: 19.3 (10.9-27.6); stressful: 21.2 (12.9-29.4) %MVC; relaxing: 21.6 (13.3-29.9) %MVC; favorite: 24.2 (15.8-32.7) %MVC; all P > .05]. EMG_bruxism was significantly greater in mTMD participants than controls during the stressful music block [contrast estimate (95% CI): +12.9 (1.6-24.2) %MVC; P = .026). GML did not affect the duration or the frequency of awake bruxism in either group (median [IQR], mTMD: 23.5 [96.7] s, range 1-1300 seconds; Controls: 5.5 [22.5], range 0-246 seconds; P = .108). The frequency of awake bruxism episodes was greater in the mTMD group compared to controls only during the pink noise block (median [IQR], mTMD: 5 [15.3] episodes, range 0-62 episodes; Controls: 1 [3] episode, range 0-27 episodes; P = .046). No significant between-group differences were found in either the overall time spent engaging in awake bruxism (median [IQR], mTMD: 23.5 [96.7] s, range 1-1300 seconds; Controls: 5.5 [22.5], range 0-246 seconds; P = .108), or during each block (all P > .05).

CONCLUSIONS

In subjects with chronic mTMD, relaxing music and the individual's favorite music decreased the muscular effort during spontaneous awake bruxism episodes by 26% and 44% (relative changes), respectively. In contrast, stressful music increases it by about 43%. Because of its positive effects on awake bruxism, GML with selected music could be a promising and non-invasive component of a multimodal approach for the management of chronic mTMD.

Impact of clear aligner therapy on tooth pain and masticatory muscle soreness

BACKGROUND

Clinical findings suggest that orthodontic treatment with clear aligners (clear aligner therapy/CAT) may cause masticatory muscle soreness in some patients.

OBJECTIVE

This multi-site prospective study investigated tooth pain and masticatory muscle soreness and tenderness in patients undergoing CAT and explored whether psychological traits affected these outcomes.

METHODS

Twenty-seven adults (22F, 5M; mean age ± SD=35.3 ± 17.6 years) about to start CAT were recruited at three clinics. During CAT, they reported on 100-mm visual analogue scales their tooth pain, masticatory muscle soreness and stress three times per day over 4 weeks (week 1 = baseline; week 2 = dummy aligner; week 3 = first active aligner; week 4 = second active aligner). Pressure pain thresholds (PPTs) were measured at the masseter and temporalis at baseline and after week 4. Mixed models were used to evaluate the outcome measures over time.

RESULTS

Clear aligner therapy caused mild tooth pain, which was greater with the passive than the first and second active aligners (both P < .001). Mild and clinically not relevant masticatory muscle soreness was produced by all aligners (all P < .05), with the first active aligner producing less soreness than the dummy aligner (P < .001). PPTs did not change significantly after 4 weeks. Both tooth pain and masticatory muscle soreness were affected by stress and trait anxiety, whilst muscle soreness was affected also by oral behaviours.

CONCLUSIONS

In the short term, CAT produces tooth pain and masticatory muscle soreness of limited significance. Frequent oral behaviours are related to increased masticatory muscle soreness during CAT. The medium- and long-term effects of CAT should be further explored.

Occlusal Features and TMJ Clicking: A 30-Year Evaluation from a Cohort Study

Occlusal features that deviate from normative values have been historically considered risk factors for temporomandibular joint (TMJ) disorders. Nowadays, a putative association between dental occlusion and TMJ disorders remains controversial, with research findings on associations being inconsistent and inconclusive. We hypothesized that putative occlusal features identified during adolescence are associated with TMJ clicking later in life. The Dunedin Multidisciplinary Health and Development Study is a longitudinal birth cohort study investigation of 1,037 children (48.4% female) born in Dunedin, New Zealand, between April 1, 1972, and March 31, 1973, and assessed repeatedly since then. Associations between posterior crossbite, overbite, and overjet at age 15, as well as both self-reported and clinically assessed TMJ clicking sounds at age 45, were studied. Data were analyzed using multivariate logistic regression, after controlling for sex, emotional style, self-reports of tooth clenching and sleep bruxism, and history of orthodontic treatment. Self-reported and examiner-reported TMJ clicking at age 45 affected 18.3% and 23.8% of the study sample, respectively, and were not associated with the presence of a posterior crossbite or abnormal overjet/overbite values during adolescence. Self-reported history of tooth clenching and emotional style were associated with self-reported TMJ clicking later in life. In addition, there is a suggestion that high overbite during adolescence is negatively associated with TMJ clicking later in life. A history of orthodontic treatment was not associated with TMJ clicking. Abnormal occlusal features, such as posterior crossbite and high and low overjet/overbite in adolescence, are not associated with higher prevalence of TMJ clicking later in life. Personality also appears to influence self-reports of TMJ clicking later in life.

Graded exposure and orthopedic manual physical therapy for kinesiophobia and function in chronic temporomandibular dysfunction: A case report

BACKGROUND

This case report describes the successful use of multi-modal physical therapy (PT), including orthopedic manual physical therapy (OMPT) and graded exposure, in a patient with chronic temporomandibular dysfunction (TMD).

CLINICAL PRESENTATION

A 41-yr old female presented with a five-year history of bilateral chronic myofascial TMD and comorbid neck/right arm pain. The patient was treated for 12 weeks with a focus on OMPT and graded exposure. The patient demonstrated clinically significant improvements on the Tampa Scale of Kinesiophobia-TMD, maximal mouth opening, Global Rating of Change, and Jaw Functional Limitation Scale.

CLINICAL RELEVANCE

Mechanisms underlying chronic TMD are complex. Current evidence supports PT management of physical impairments; however, neglecting central drivers or psychosocial factors may result in suboptimal outcomes. Physical therapists are able to address both peripheral and central mechanisms of pain, and future research should examine the utilization of multi-modal PT to improve kinesiophobia and function in patients with chronic TMD.

Occlusal tactile acuity in temporomandibular disorder pain patients: A case-control study

OBJECTIVE

To compare the smallest thickness that can be perceived between occluding teeth (occlusal tactile acuity, OTA) of temporomandibular disorder pain (TMD-P) patients with that of control (CTR) individuals.

METHODS

Twenty TMD-P patients (17 women and 3 men, mean age: 31.3 ± 10.4 years) diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) protocol and 20 age- and gender-matched controls (17 women and 3 men, mean age: 31.4 ± 10.5 years) were enrolled. The OTA was tested with 10 different thicknesses: 9 aluminium foils (8 µm-72 µm with a constant increment of 8 µm) and 1 sham test (without foil), each thickness being tested 10 times in random order (100 tests in total). The participants were instructed to close their mouth once and to report whether they felt the foil between their molar teeth. A between-group comparison (TMD-P vs CTR) was performed for each testing thickness (analysis of variance for repeated measurements, with Bonferroni multiple correction) (P < .005).

RESULTS

Significantly increased OTA was observed in the TMD-P group for the thicknesses between 8 µm and 40 µm, while no significant differences were found for the sham test and for the larger thicknesses tested (from 48 µm to 72 µm).

CONCLUSIONS

TMD-pain subjects presented an increased OTA as compared to controls.

Influence of Psychosocial Factors and Parafunctional Habits in Temporomandibular Disorders: A Cross-Sectional Study

INTRODUCTION

Temporomandibular disorders (TMDs) are abnormalities affecting the temporomandibular joint, jaw muscles, or both. An intrinsic relationship reportedly exists between TMDs and psychosocial factors, including stress. Parafunctional habits such as bruxism and clenching are also known to be responsible for TMDs.

OBJECTIVE

To determine the association of anxiety, depression, and bruxism with TMD symptoms and their relationship with age and sex.

METHODS

Patients included in the study reported, as their chief concern, pain lasting for more than a week in the temporomandibular joint area and/or masticatory muscles. The patients were divided into age groups as follows: Younger than 20 years, 21 to 30 years, 31 to 40 years, 41 to 50 years, 51 to 60 years, and above 60 years. Patients were examined clinically and were asked to complete an anamnestic questionnaire (modified version of Helkimo Anamnestic Index) and the Hospital Anxiety and Depression Scale (HADS).

RESULTS

Seventy-five patients (55 women, 20 men) were included in the study. The prevalence of TMDs was higher in female patients, of whom 33 (60%) had moderate to severe TMDs. Of the 20 male patients, 12 (60%) had signs and symptoms of moderate TMDs. Anxiety and depression scores were higher in female patients. No significant correlation was found between degree of malocclusion and TMDs.

DISCUSSION

We found correlations between the degree of TMD with age, sex, parafunctional habits, and psychosocial factors. Symptoms of TMD seemed to increase in patients with parafunctional habits, from younger to older age groups, and with increased anxiety and depression scores.

CONCLUSION

The degree of TMDs is higher in women, and TMDs are associated with higher anxiety and depression scores. Correlation between these factors paves the way for preventive actions aimed at those with moderate and severe signs of TMDs.

Correlations between Sleep Bruxism and Temporomandibular Disorders

The aim of this study was to identify correlations between sleep bruxism (SB) and temporomandibular disorders (TMD) as diagnosed by means of the research diagnostic criteria for temporomandibular disorders (RDC/TMD). Sleep bruxism was diagnosed on the basis of I) validated questionnaires, II) clinical symptoms, and III) electromyographic/electrocardiographic data. A total of 110 subjects were included in the study. Fifty-eight patients were identified as bruxers and 52 as nonbruxers. A psychosocial assessment was also performed. An RDC/TMD group-I diagnosis (myofascial pain) was made for 10 out of 58 bruxers, whereas none of the nonbruxers received a diagnosis of this type. No significant differences were found between bruxers and nonbruxers with regard to RDC/TMD group-II (disc displacement) and group-III (arthralgia, arthritis, arthrosis) diagnoses. Somatization was significantly more common among bruxers than nonbruxers. Multivariate logistic regression analysis revealed that somatization was the only factor significantly correlated with the diagnosis of myofascial pain. The results of this study indicate a correlation between myofascial pain, as diagnosed using the RDC/TMD, and somatization. It seems that somatization is a stronger predictor of an RDC/TMD diagnosis of myofascial pain than sleep bruxism is.

Quality of life of children with sleep bruxism

AIM

The aim of this study was to compare the Quality of life (QoL) of children with and without sleep bruxism in Chennai population.

MATERIALS AND METHODS

A cross-sectional study was conducted with participants of both genders assigned as bruxers (n = 36) and non-bruxers (n = 36) from different regions of Chennai with the age range of 6-12 years. Parents/Caregivers answered a questionnaire in the waiting room. The QoL was assessed using the Oral Health Impact Profile (OHIP-14). OHIP-14 was analyzed by Mann-Whitney U test.

RESULTS

The sociodemographic characteristics presented no significant differences between bruxers and non-bruxers (P > 0.005). There was a significant difference in QoL between the case and control group (<0.001). Bruxers had worse QoL than controls.

CONCLUSION

Sleep bruxism may be associated with a negative impact on QoL.

Evaluation of temporomandibular disorder symptoms and oral health-related quality of life in adolescent orthodontic patients with different dental malocclusions

Objective: To estimate the prevalence of temporomandibular disorders in adolescent orthodontic patients with different dental malocclusions and to assess the relationship between oral health-related quality of life.Methods: This study was carried out on 648 randomly selected individuals 14-19 years of age. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), Fonseca Questionnaire, and Oral Health Impact Profile-14 (OHIP-14) forms were used.Results: TheGCPS,TMDPain,Fonseca,OHIP-14, PHQ-9, GAD-7,OBC,andPHQ-15 mean scores of female participants were statistically significantly higher than males (p < 0.05).There was a significant difference among the malocclusion groups in terms of their mean scores in GCPS, Fonseca, and OHIP-14 (p < 0.05).The age values and JFLS, TMD Pain, Fonseca, OHIP-14, PHQ-9, GAD-7, and PHQ-15 were statistically significant correlations in the positive direction.Conclusion: The DC/TMD form allows both a physical assessment of Axis I and II that examines psychosocial status and pain-related disorders and a more comprehensive assessment. The mean OHIP-14 and Fonseca questionnaire scores of Class III groups were found to be significantly higher.