Screening for temporomandibular disorders in dental practice

Temporomandibular Disorder: a practical guide for dental practitioners in diagnosis and management

Temporomandibular disorder is a broad term encompassing pain and/or dysfunction of the masticatory musculature and the temporomandibular joints. Pain arising from a temporomandibular disorder is a common reason for seeking dental care. It is essential that dental practitioners are able to accurately diagnose and manage this condition. Identifying people at highest risk of developing a temporomandibular disorder and knowing which procedures are more likely to initiate or exacerbate a temporomandibular disorder, are important to reduce the likelihood of its acute and chronic presentation. The aim of this paper is to provide the dental practitioner with a clinical guideline for reference including practical tools to examine, diagnose and manage patients with temporomandibular disorder. In addition the risk profile of patients and procedures is explored to help minimize the occurrence of temporomandibular disorders and mitigate its symptoms. The scope of the dental practitioner in the management of acute and chronic temporomandibular disorders is presented, with guidance about when referral to a specialist is indicated.

Short clinical examination for temporomandibular symptoms in general practice

OBJECTIVE

The aims of the study are to assess the reliability of the short clinical examination, and to compare the information gained with a well-known and validated examination, the diagnostic criteria for temporomandibular disorders (DC/TMD).

MATERIALS AND METHODS

The study comprises 52 consecutive, newly referred patients at their first visit and examination to an Orofacial Pain and TMD Clinic, 15 years and older, mean age 44 years. The patients first answered three screening questions for reported symptoms. The clinical examination was performed using both the short examination and the DC/TMD and the result was compared. Another group of 40 newly referred patients, with similar inclusion criteria, was examined twice according to the short clinical examination by two examiners, and the inter-examiner variation was studied. The protocol of the short clinical examination is described.

RESULT

The overall agreement between the two methods was fairly good to excellent, as was the degree of agreement between repeated examinations and two examiners using the short clinical examination method. The sensitivity and specificity of the short examination for diagnoses were acceptable to high (with DC/TMD as the golden standard).

CONCLUSIONS

The short clinical examination has acceptable reliability and, together with three screening questions, provides enough information about the jaw function to decide whether there is a dysfunction.

Factors Associated with Masticatory Performance in Unilateral Distal Extension Removable Partial Denture Patients

PURPOSE

Masticatory performance of denture patients is an outcome of the intricate inter-relationship between patient characteristics and denture construction. This study aimed to identify both patient- and denture-related factors associated with masticatory performance in unilateral distal extension removable partial denture patients (RPDs).

MATERIALS AND METHODS

Seventy-two patients (25 male and 47 female, mean age 63.4 +/- 6.7 years) with unilateral distal extension RPDs were included in the study. The Mixing Ability Index (MAI) obtained from a chewing test using standard two-colored wax cubes, determined masticatory performance. The effect of each evaluated factor on masticatory performance was first determined by an independent t-test or one-way analysis of variance. The statistically significant factors were entered in a model of multivariate linear regression analysis to estimate the independent effect on MAI.

RESULTS

The MAI ranged from -3.06 to 0.80 (Mean -0.71 +/- 0.86). Univariate analyses identified male gender, high maximum bite force, more functional tooth units, and natural dentition opposing RPDs as patient factors increasing the MAI. Multivariate analysis (adjusted R(2)= 0.346) revealed that gender (p < 0.001), maximum bite force (p= 0.02), and number of functional tooth units (p= 0.03) were independent predictors for masticatory performance. None of the denture-related factors had a significant influence on MAI.

CONCLUSION

Gender, maximum bite force, and number of functional tooth units were the main factors influencing masticatory performance of unilateral distal extension RPD patients.

Prevalence of signs and symptoms of temporomandibular disorders in young Nigerian adults

The objective of this study was to determine the prevalence of signs and symptoms of TMD in young Nigerian adults and to establish a baseline for comparison with other studies. It consisted of a cross-sectional study at Obafemi Awolowo University, Ile-Ife, Nigeria in 1997. The subjects consisted of 308 medical and dental students (207 males and 101 females) randomly selected from a Nigerian University. Their ages ranged from 17 to 32 years with a mean age of 23 +/- 3.0 years. They were assessed according to the criteria of Helkimo (1974). Whilst 26.3 per cent of the subjects reported mild symptoms (Ai I) of TMD, only 2.9 per cent reported severe symptoms (Ai II). Similarly, 46 per cent showed mild dysfunction signs (Di I), whilst 16.5 and 0.3 per cent exhibited moderate (Di II) and severe (Di III) signs of TMD, respectively. No significant relationships were found between sex, anamnestic index, and the clinical dysfunction index scores. However, there were low but significant correlations between ananmestic index scores (Ai) and the recorded signs (Di), as well as the clinical dysfunction scores (CDS). There is some evidence to show that signs and symptoms of TMD occur amongst Nigerians, although restricted lateral and protrusive mandibular movements contributed significantly to clinical dysfunction scores. This report contrasts with what is found in western societies regarding the low prevalence of TMJ pain. Refereed Scientific Paper