Factors associated with temporomandibular disorders pain in adolescents

The Link Between Temporomandibular Disorders and Jaw Functional Limitations Among Chinese Adolescents

BACKGROUND

Currently, there is still controversy surrounding the relationship between temporomandibular disorders (TMDs) symptoms and jaw functional limitations. We investigated the distribution of TMDs in senior high school students, including both the number and types of symptoms, and assessed their association with jaw functional limitations. Furthermore, we explored sex differences in these associations.

METHODS

This study was conducted at a public high school in Hefei, Anhui Province, China, with data collected from September to October 2022. All subjects completed questionnaires assessing the anamnestic symptoms of TMDs and the Jaw Functional Limitation Scale (JFLS), and examinations were performed by trained dentists according to the Diagnostic Criteria for TMD. Data were analysed using the Kruskal-Wallis, Mann-Whitney U, and Chi-square tests.

RESULTS

The mean age of the participants (N = 2890) was 17.2 ± 0.14 years and 38.9% were females (61.1% were males). Limitations in self-assessed jaw function were associated with the presence of TMDs (P < .05). Participants with more symptoms reported significantly high levels of functional limitations (P < .05). Compared to male adolescents, female adolescents more commonly experienced TMDs pain and tended to have more symptoms (P < .05). However, no sex differences were observed in most associations between TMDs and jaw functional limitations.

CONCLUSION

TMDs-positive symptoms are common in adolescents. Female adolescents were more affected by TMDs symptoms than male adolescents. Individuals with more TMDs symptoms have greater jaw functional limitations.

Genetically predicted major depression causally increases the risk of temporomandibular joint disorders

Objective

Observational studies have reported that mental disorders are comorbid with temporomandibular joint disorder (TMD). However, the causal relationship remains uncertain. To clarify the causal relationship between three common mental illnesses and TMD, we conduct this Mendelian Randomization (MR) study.

Methods

The large-scale genome-wide association studies data of major depression, bipolar disorder and schizophrenia were retrieved from the Psychiatric Genomics Consortium. The summary data of TMD was obtained from the Finn-Gen consortium, including 211,023 subjects of European descent (5,668 cases and 205,355 controls). The main approach utilized was inverse variance weighting (IVW) to evaluate the causal association between the three mental disorders and TMD. Five sensitivity analyses including MR-Egger, Maximum Likelihood, Weighted median, MR. RAPS and MR-PRESSO were used as supplements. We conducted heterogeneity tests and pleiotropic tests to ensure the robustness.

Results

As shown by the IVW method, genetically determined major depression was associated with a 1.65-fold risk of TMD (95% CI = 1.10-2.47, p < 0.05). The direction and effect size remained consistent with sensitivity analyses. The odds ratios (ORs) were 1.51 (95% CI = 0.24-9.41, p > 0.05) for MR-Egger, 1.60 (95% CI = 0.98-2.61, p > 0.05) for Weighted median, 1.68 (95% CI = 1.19-2.38, p < 0.05) for Maximum likelihood, 1.56 (95% CI = 1.05-2.33, p < 0.05) for MR. RAPS, and 1.65 (95% CI = 1.10-2.47, p < 0.05) for MR-PRESSO, respectively. No pleiotropy was observed (both P for MR-Egger intercept and Global test >0.05). In addition, the IVW method identified no significant correlation between bipolar disorder, schizophrenia and TMD.

Conclusion

Genetic evidence supports a causal relationship between major depression and TMD, instead of bipolar disorder and schizophrenia. These findings emphasize the importance of assessing a patient's depressive status in clinical settings.

Comparison of the efficacy of occlusal splint and botulinum toxin therapies in patients with temporomandibular disorders with sleep bruxism

PURPOSE

This study aims to evaluate the efficacy of occlusal splint and botulinum toxin (BTX) therapies for improving the pain scores and mouth opening in patients with temporomandibular disorders (TMD) with sleep bruxism (SB).

MATERIALS AND METHODS

A retrospective cohort study was conducted based on clinical record reviews of patients with TMD symptoms (e.g., temporomandibular joint [TMJ] pain, masticatory muscle pain, TMJ internal derangements, joint sounds, and limited mouth opening) and SB. The patients were divided into two groups: occlusal splint group and BTX group. Maximum unassisted mouth opening (MMO) and pain score on a visual analogue scale (VAS) before treatment and at 1‑, 3‑, and 6‑month follow-up were analyzed to evaluate the clinical outcomes.

RESULTS

A total of 60 patients (49 women and 11 men, mean age 34.63 ± 11.85 years) were enrolled. Each group had 30 patients. The comparisons of the groups at 1 and 3 months after treatment indicated that the BTX group had higher MMO values (P = 0.013 and 0.034, respectively) and lower VAS scores than the occlusal splint group (P = 0.000 and 0.001, respectively). No difference between the two groups was observed 6 months after treatment (P > 0.05).

CONCLUSIONS

Both occlusal splint and BTX treatment methods were successful in treating TMD with SB. BTX provided patients with rapid relief in the early period; therefore, BTX can be recommended as a primary treatment option in patients with greater pain.

The epidemiological profile of temporomandibular joint disorders in the Tunisian population: A cross-sectional study

Objective

This study aimed to explore the prevalence, signs, and symptoms of different types of TMD (Temporomandibular joint disorders) disorders in Tunisian patients.

Methods

A retrospective cross-sectional study was conducted using the clinical records of patients from the Department of Functional Exploration, Pain, and Orofacial Dysfunction of the Dental Clinic of Monastir.

Results

TMD is associated with a female predominance, with a peak prevalence among those aged between 20 and 40 years. Pain and a limited range of motion were significantly more prevalent in women (p = 0.019 and p = 0.012, respectively). Clicking sounds were the most frequent joint noises (38.2 %). Crepitus was more prevalent among older adults (33 %). Of the different types of TMD, disk displacement with reduction was the most prevalent (n = 216, 39 %). Sleep bruxism was more prevalent than awake bruxism (20.7 % VS 9.5 %). Due to the heterogeneous TMD signs and symptoms, patients tend to seek medical attention from various specialties (e.g. neurology and otolaryngology).

Conclusion

The prevalence of different types of TMD, and the different signs and symptoms varied depending on sociodemographic characteristics, such as sex, age and lifestyle. Diagnosis is challenging and TMD may be confused with other orofacial pain conditions.

Evaluation and management of temporomandibular disorders. Part 2: an orthopaedic physical therapy update on examination and clinical reasoning

Temporomandibular (TM) disorders afflict many people globally and, despite the presence of existing peer-reviewed material that assists conservative orthopedic providers, recent advances in knowledge indicate that updated resources are required for students, clinicians, and educators. This two-part series builds off previously published material to present newer supplementary information that can be useful during the evaluation and management processes. Content in Part 1 of this series includes a discussion about the factors that have been shown to contribute to TM disorders, an updated perspective of relevant pain science, a discussion of self-report outcome measures, and various different topics related to the examination of patients with TM disorders. Part 2 addresses information related to the temporomandibular joint disc, joint hypermobility, oral splints, and clinical reasoning. In combination with other available publications, this two-part series provides clinicians an opportunity to improve their delivery of effective and efficient clinical services for people diagnosed with TM disorders.

Evaluation and management of temporomandibular disorders. Part 1: an orthopedic physical therapy update on examination and clinical reasoning

Temporomandibular (TM) disorders afflict many people globally and, despite the presence of existing peer-reviewed material that assists conservative orthopedic providers, recent advances in knowledge indicate that updated resources are required for students, clinicians, and educators. This two-part series builds off previously published material to present newer supplementary information that can be useful during the evaluation and management processes. Content in Part 1 of this series includes a discussion about the factors that have been shown to contribute to TM disorders, an updated perspective of relevant pain science, a discussion of self-report outcome measures, and various different topics related to the examination of patients with TM disorders. Part 2 addresses information related to the temporomandibular joint disc, joint hypermobility, oral splints, and clinical reasoning. In combination with other available publications, this two-part series provides clinicians an opportunity to improve their delivery of effective and efficient clinical services for people diagnosed with TM disorders.

Narrative review of the prevalence and distribution of acute pain in children in the self-care setting

Acute pain among children is common, yet it may be underestimated and undertreated if the pain is not recognized. Assessing and managing pediatric pain can be complicated, and as such, measuring the prevalence of acute pain in children can be challenging. We sought to provide a consolidated review of the available data on the prevalence of commonly occurring acute pain in children in the self-care setting. An extensive literature search was performed to determine the prevalence of acute pain at multiple bodily locations in children aged between 3 months and 18 years. We considered the influence of age, sex, and sociodemographic factors on prevalence estimates. We also sought to identify some of the challenges involved in assessing and managing pediatric pain, thus shedding light on areas where there may be clinical and medical unmet needs. In general, a high prevalence of acute pain in children was detected, particularly headache, menstruation-related pain, and dental and back pain. Older age, female sex, and lower socioeconomic status were associated with increased pain prevalence. Risk factors were identified for all pain types and included psychological issues, stress, and unhealthy lifestyle habits. Owing to the heterogeneity in study populations, the prevalence estimates varied widely; there was also heterogeneity in the pain assessment tools utilized. The paucity of information regarding pain prevalence appears to be out of proportion with the burden of acute pain in children. This could indicate that clinicians may not be equipped with an optimal pain management strategy to guide their practice, especially regarding the use of developmentally appropriate pain assessment tools, without which prevalence data may not be captured. If acute pain is not accurately identified, it cannot be optimally treated. Further investigation is required to determine how the information from prevalence studies translates to the real-world setting.

Effectiveness of conservative therapeutic modalities for temporomandibular disorders-related pain: a systematic review

PURPOSE

The aim of this systematic review was to evaluate the effectiveness of conservative different therapeutic modalities for temporomandibular disorders (TMD) pain.

MATERIALS AND METHODS

An electronic systematic search was conducted in the MEDLINE (PubMed) database to identify the randomized clinical trials (RCTs) published between 2001 and 2021. The following, simple or multiple conjunctions, search keywords were selected: TMD pain, TMD management or conservative treatment or treatment strategies and TMD pain, therapeutic modalities or interventions and TMD. Studies included must have patients older than 18 years, with painful TMD, which diagnosis was performed by Research Diagnostic Criteria for TMD or Diagnostic Criteria for TMD. Outcome variables were pain relief and post treatment pain intensity reduction. Data were analysed with non-parametric tests and the level of significance was set at p<.05.

RESULTS

Out of 1599 articles obtained, 28 RCTs fulfilled all selection criteria and were included. The results of this study show that there was a significant decrease in short-term post-treatment TMD pain with the use of occlusal splint alone or in combination with other therapeutic modalities when compared with the control group. Statistically significant differences were also detected between laser and photobiomodulation group and the control, in short-term treatment TMD-related pain.

CONCLUSIONS

The primary findings of the present systematic review showed that the occlusal splint alone or combined with other therapeutic intervention presented positive effect on short-term TMD pain reduction. Secondary outcome suggests that laser and photobiomodulation therapy had, also, a significant role in short term pain relief.

Accuracy of Surface Electromyography in the Diagnosis of Pain-Related Temporomandibular Disorders in Children with Awake Bruxism

The study assessed masticatory muscle electromyographic (EMG) activity in both children diagnosed with pain-related temporomandibular disorders (TMD-P) and awake bruxism (AB) and in children without TMD, as well as the diagnostic value of surface electromyography (sEMG) in diagnosing TMD-P in subjects with AB. After evaluation based on the Axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), 30 children diagnosed with myofascial pain were included in the myofascial pain group and 30 children without TMD diagnosis comprised the control group (mean age of 9.49 ± 1.34 years). The activity of the anterior temporal (TA) and masseter (MM) muscle was assessed bilaterally using a DAB-Bluetooth device (zebris Medical GmBH, Germany) at rest and during maximum voluntary clenching (MVC). The receiver operating characteristic (ROC) curve was used to determine the accuracy, sensitivity, and specificity of the normalized sEMG data. Statistically significant intergroup differences were observed in TA and MM muscle EMG activity at rest and during MVC. Moderate degree of sEMG accuracy in discriminating between TMD-P and non-TMD children was observed for TAmean, left MM, and MMmean EMG muscle activity at rest. sEMG can be a useful tool in assessing myofascial TMD pain in patients with AB.

Diagnostic criteria for temporomandibular disorders (DC/TMD) in children and adolescents: an international Delphi study-Part 2-Development of Axis II

BACKGROUND

Unlike the psychosocial assessment established for adults in the diagnostic criteria for temporomandibular disorders (DC/TMD), a standardized psychosocial assessment for children and adolescents with TMD complaints has not yet been established.

OBJECTIVES

To develop a new standardized instrument set to assess the psychosocial functioning in children and adolescents by adapting the psychosocial status and pain-related disability (Axis II) of the adult DC/TMD and by including new instruments.

METHODS

A modified Delphi method was used to survey 23 international TMD experts and four international experts in pain-related psychological factors for consensus regarding assessment tools for psychosocial functioning and pain-related disability in children and adolescents. The TMD experts reviewed 29 Axis II statements at round 1, 13 at round 2, and 2 at round 3. Agreement was set at 80% for first-round consensus level and 70% for each of the second and third rounds. The psychological experts completed a complementary Delphi survey to reach a consensus on tools to use to assess more complex psychological domains in children and adolescents. For the psychological experts, the first round included 10 open-ended questions on preferred screening tools for depression, anxiety, catastrophizing, sleep problems, and stress in children (ages 6-9 years old) and adolescents (ages 10-19 years old) as well as on other domains suggested for investigation. In the second round, the psychological experts received a 9-item questionnaire to prioritize the suggested instruments from most to least recommended.

RESULTS

The TMD experts, after three Delphi rounds, reached consensus on the changes of DC/TMD to create a form to evaluate Axis II in children and adolescents with TMD complaints. The psychological experts added tools to assess depression and anxiety, sleep disorders, catastrophizing, stress, and resilience.

CONCLUSION

Through international expert consensus, this study adapted Axis II of the adult DC/TMD to assess psychosocial functioning and pain-related disability in children and adolescents. The adapted Axis II protocols will be validated in the target populations.

Skeletal Divergence and Condylar Asymmetry in Patients with Temporomandibular Disorders (TMD): A Retrospective Study

INTRODUCTION

This study was aimed at evaluating the association between vertical skeletal patterns, condylar height symmetry, and temporomandibular disorders in adults.

METHODS

The study sample consisted of 200 patients (ages 18-30 years old) retrospectively recruited: 100 with temporomandibular disorders (TMD) and 100 without TMD (control), diagnosed by Diagnostic Criteria for the Temporomandibular Disorders (DC/TMD). For each subject, skeletal divergence was assessed on lateral cephalograms, and condylar height symmetry was evaluated by orthopantomography (Habets' method).

RESULTS

Subjects with temporomandibular disorders showed a strong association with condylar asymmetry (p < 0.0001) and, for the skeletal pattern variables, hyperdivergence (p < 0.001). A correlation with the female sex was also found (p < 0.04), while there was no difference in terms of age in the 2 groups (p > 0.29).

CONCLUSIONS

Although it does not imply a direct cause-and-effect relationship, the present study suggests condylar asymmetry and hyperdivergent skeletal pattern are more likely to be associated with a higher risk of temporomandibular disorder joint diseases in adult patients.

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

Background

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

Methods

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

Results

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

Conclusion

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

The role of sleep dysfunction in temporomandibular onset and progression: A systematic review and meta-analyses

BACKGROUND

Painful temporomandibular (TM) disorders result in 4.3 billion dollars spent annually in the United States. The complex interplay of physiological processes in persistent pain and dysfunctional sleep has been established. Recently, dysfunctional sleep has been identified as a potential pathway to the onset of painful TM disorder.

OBJECTIVES

The aims were to (1) identify self-report outcome measures (SROMs) of sleep quality that are clinimetrically sound in patients with painful TM disorders and (2) determine whether sleep dysfunction has any diagnostic or prognostic value for this population.

METHODS

A systematic search following PRISMA guidelines was run in six databases: CINAHL, Dental, PsychALL, PubMed, Scopus and Web of Science. Any study involving minors was excluded. Risks of biases were examined in all studies. Diagnostic pooled findings were reported.

RESULTS

Of the identified articles (n = 681), 18 were included in this systematic review (n = 1 clinimetric studies, n = 11 diagnostic studies, n = 6 prognostic studies). Nine different assessment tools were used; only the Pittsburg Sleep Quality Index (PSQI) has been validated in patients with painful TM disorders. Overall, sleep dysfunction was diagnostic for painful TM disorders. The pooled relative risk of sleep dysfunction was 1.71 (95% CI 1.30. 2.26). When PSQI scores were greater than 5/21, the unadjusted hazard ratio for development of painful TM disorders was reported to be 2.1.

CONCLUSION

At present, the only SROM that has diagnostic and prognostic value in evaluating and managing patients with painful TM disorders is the PSQI.

Association of self-reported bruxism with temporomandibular disorders - Northern Finland Birth Cohort (NFBC) 1966 study

Objective: To investigate the prevalence of self-reported bruxism and its association with temporomandibular disorders (TMD). The hypothesis of the study was that self-reported bruxism is associated with TMD.Methods: The data were gathered from 1962 subjects who participated in a field study in 2012-2013, including a questionnaire concerning bruxism and TMD symptoms as well as clinical sub-diagnoses of TMD using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Statistical method was chi-square test. Bonferroni correction was made, and a p-value of <0.003 was considered as significant.Results: The prevalence of self-reported bruxism was 39.6%: 34.0% in men and 44.5% in women. Those who reported sleep bruxism (SB) or awake bruxism (AB) had significantly more pain-related TMD symptoms and signs compared to those not reporting bruxism.Conclusion: The prevalence of self-reported bruxism is high among middle-aged adults and is associated with TMD pain-related symptoms and signs, as well as TMD diagnoses.

Effectiveness of low-intensity pulsed ultrasound on osteoarthritis of the temporomandibular joint: A review

Loading is indispensable for the growth, development, and maintenance of joint tissues, including mandibular condylar cartilage, but excessive loading or reduced host adaptive capacity can considerably damage the temporomandibular joint (TMJ), leading to temporomandibular joint osteoarthritis (TMJ-OA). TMJ-OA, associated with other pathological conditions and aging processes, is a highly degenerative disease affecting the articular cartilage. Many treatment modalities for TMJ-OA have been developed. Traditional clinical treatment includes mainly nonsurgical options, such as occlusal splints. However, non-invasive therapy does not achieve joint tissue repair and regeneration. Growing evidence suggests that low-intensity pulsed ultrasound (LIPUS) accelerates bone fracture healing and regeneration, as well as having extraordinary effects in terms of soft tissue repair and regeneration. The latter have received much attention, and various studies have been performed to evaluate the potential role of LIPUS in tissue regeneration including that applied to articular cartilage. The present article provides an overview of the status of LIPUS stimulation used to prevent the onset and progression of TMJ-OA and enhance the tissue regeneration of mandibular condylar cartilage. The etiology and management of TMJ-OA are explained briefly, animal models of TMJ-OA are described, and the effectiveness of LIPUS on cell metabolism and tissue regeneration in the TMJ is discussed.

Obesity, sedentarism and TMD-pain in adolescents

BACKGROUND

Obesity is a chronic and prevalent disorder, affecting individuals of all age. Previous evidence suggests that it is associated with some types of chronic pain, especially musculoskeletal pain. In addition, sedentarism is also associated with an increase of the inflammatory factors and chronic pain. So, we conducted a cross-sectional study to evaluate the association between obesity, sedentarism and the presence of TMD-pain in adolescents.

METHODS

Temporomandibular Disorders were classified according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Obesity was assessed by the body mass index (BMI), bioimpedance (BIA), skinfold (triceps and subscapular) and circumferences (arm and abdominal). The level of physical activity was rated according to the instrument adopted by the Brazilian National School Health Survey. Descriptive statistics, univariate logistic regression and odds ratios (OR) with 95% confidence intervals (CI) were used to study the associations of interest.

RESULTS

The sample consisted of 690 individuals with a mean age of 12.7 (±0.76) years of whom 389 (56.4%) were girls. Of the total, 112 (16.2%) had TMD-pain, 110 (15.9%) were obese according to BMI, 74 (10.8%) according to BIA, and 127 (18.4%) following the skinfolds and circumferences assessments. There was no significant association between TMD-pain and obesity according to BMI (P = 0.95), BIA (P = 0.16), skinfold and circumference (P = 0.22), and neither with sedentarism (P = 0.94).

CONCLUSION

Obesity and sedentarism were not associated with the presence of TMD-pain in adolescents.

Oral parafunctions, personality traits, anxiety and their association with signs and symptoms of temporomandibular disorders in the adolescents

OBJECTIVES

To investigate the association between oral parafunctions, personality traits, anxiety and signs and symptoms of temporomandibular disorders in the adolescents.

METHODS

Two hundred and seventy adolescents were examined clinically for the signs and symptoms of temporomandibular disorders. Participants completed questionnaires about demographic variables, medical history, symptoms of temporomandibular disorders, parafunctional oral habits, Minnesota Multibasic Personality Inventory, and Spielberger State-Trait Anxiety Inventory.

RESULTS

Logistic regression analyses revealed that bruxism was associated with joint tenderness (Odds ratio (OR)=6.38, p < 0.01), joint noises (OR=6.02, p < 0.01) and masticatory muscle tenderness (OR=4.19, p < 0.05) to palpation. State anxiety showed increased risk of joint tenderness (OR=2.47, p < 0.05) and muscle tenderness (OR=3.25, p < 0.05) to palpation.

CONCLUSION

Within the limitations of this study, it was concluded that oral parafunctions, especially bruxism, state anxiety, depression and hysteria were associated with signs and symptoms of temporomandibular disorders in adolescents.

Prevalence of TMD and level of chronic pain in a group of Brazilian adolescents

AIMS

To determine the prevalence of temporomandibular disorders and associated factors in an adolescent sample from Recife, Brazil.

MATERIALS AND METHODS

A cross-sectional study was conducted with 1342 adolescents aged 10-17 years. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was used by calibrated examiners to evaluate the presence and levels of chronic pain. To evaluate the socioeconomic conditions, the subjects answered the Brazilian Economic Classification Criteria (CCEB) questionnaire. Data were analyzed by means of binary logistic regression in SPSS.

RESULTS

The results showed that 33.2% of the subjects had TMD irrespective of age (p = 0.153) or economic class (p = 0.653). Statistically significant associations were found between TMD and female gender (p = 0.017), headache/migraine in the past six months (p<0.001), chronic pain (p<0.001) and chronic pain level (p<0.001). In the final model, logistic regression showed that the level of chronic pain and the headache/migraine in the past six months were related to the presence of TMD.

CONCLUSIONS

The prevalence of TMD was considered high (33.2%) and adolescents with chronic pain and headache in the past six months were more likely to have TMD.

CLINICAL RELEVANCE

The data contribute to the understanding of TMD among adolescents and to the development of preventive measures and polices to identify the dysfunction promptly.

Assessing stress associated with temporomandibular joint disorder through Fonseca's anamnestic index among the Saudi physicians

The study aims to investigate signs and symptoms of temporomandibular disorders (TMD) among physicians in a tertiary health-care center. It has estimated the level of symptomatology, determined the association with demographic data, and identified the related occupational risk factors. A cross-sectional survey was used, and physicians of genders, all age groups, and nationalities from King Abdulaziz Medical City in Riyadh, Saudi Arabia, were recruited. Subjects who had rheumatic arthritis, osteoarthritis, trigeminal neuralgia, or temporomandibular joint (TMJ) trauma were excluded. The data were collected through a self-administered questionnaire that measured TMD severity and oral parafunctional behaviors. Fonseca's anamnestic index (FAI) and an oral validated behavior checklist were used to assess the signs and symptoms of TMD. A total of 282 physicians participated in the study, and the prevalence of TMD signs among physicians was 37% (106); among them, 88 (83%) were within the light dysfunction category. Female physicians reported significantly higher FAI than males for side-to-side mandibular movement (12% vs. 5%, P = 0.04), reporting ear pain (18% vs. 10%, P = 0.04), and noticing clicking when chewing or opening the mouth (35% vs. 20%, P = 0.006). Younger practitioners (28-31 years old) who reported clicking while chewing or opening the mouth tended to have reported higher TMD dysfunction (35%) than those aged 40 and above (13%; P = 0.007). Self-reported signs of TMD were 37% among our population. Information collected from FAI is useful in early diagnosis and prevention of TMD.

Is quality of life affected by temporomandibular disorders?

OBJECTIVE

To determine the impact of temporomandibular disorders in quality of life.

METHODS

A total of 102 volunteer patients (68 female) aged 19 to 86 years, who sought medical care in health clinics of the university and were evaluated in the period from September to December 2013. The subjects were examined according to the Research Diagnostic Criteria for Temporomandibular Disorders, using a mechanical algometer (Palpeter®) with standardized pressure of 0.5 and 1.0kg, and Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) questionnaire, to assess quality of life. The data were tabulated for statistical analysis and the variables were correlated with the clinical findings of the temporomandibular disorders and quality of life.

RESULTS

Fifty percent of patients were positive for temporomandibular disorders and 39.2% classified as myofascial pain group. The temporomandibular disorder group was significantly associated with uncomfortable bite (p=0.0000), temporomandibular joint clicking (p=0.0001) and tooth clenching (p=0.0001). The Mann Whitney test used to analyze the SF-36 revealed that the domains of pain (mean score of 47.80%; p<0.0001) and mental health (62.67%; p<0.05) were strongly associated with temporomandibular disorders.

CONCLUSION

The quality of life of individuals with temporomandibular disorders was negatively affected by the presence of pain and mental health disorders.

Gender differences in temporomandibular disorders in adult populational studies: A systematic review and meta-analysis

The objective of this study was to systematically evaluate gender differences in the prevalence of TMD. A systematic review was performed in PubMed, EMBASE, Web of Science and LILACS in duplicate by two independent reviewers. The inclusion criteria were cross-sectional studies that reported the prevalence of TMD for men and women and that used the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I group diagnostic criteria:(group I = muscle disorders; group II = disc displacements; group III = arthralgias/arthritis/arthrosis).To be eligible for inclusion, studies must include adult individuals (>18 years) from a non-clinical population (ie without pre-diagnosis of TMD); in other words, from population-based studies. There were no restrictions on the year and language of publication. The quality of the articles was assessed by an adapted version of the Newcastle-Ottawa Scale(NOS), and the publication bias was assessed by a funnel plot graph. Data were quantitatively analysed by meta-analysis using odds ratio (OR) as the measure effect. The electronic search retrieved a total of 6104 articles, of which 112 articles were selected for full-text reading according to the eligibility criteria. By means of manual search, one study was retrieved. Five articles were selected for meta-analysis with a combined sample of 2518 subjects. Women had higher prevalence of TMD in all RDC/TMD diagnostic groups. The meta-analysis yielded the following results: (a) OR = 2.24 for global TMD (groups I, II and III combined), (b) OR = 2.09 for group I, (c) OR = 1.6 for group II and (d) OR = 2.08 for group III. The importance of gender in the development of TMD has been demonstrated, with a two times greater risk of women to develop it as compared to men.

Musculoskeletal Disorders

Temporomandibular disorder (TMD), a type of musculoskeletal pain, is a main cause of pain in the orofacial region. It involves the masticatory muscles, temporomandibular joints (TMJs), and associated structures. The most common signs and symptoms are pain, limited range of motion, and TMJ sounds. TMD is a highly prevalent condition with a multifactorial etiology. Management aims to reduce pain and to improve function using a combination of therapeutic options. Noninvasive techniques are the first option and should be indicated considering the needs of each individual, the clinical features, and the mechanisms involved.

Anxiety and malocclusion are associated with temporomandibular disorders in adolescents diagnosed by RDC/TMD. A cross-sectional study

BACKGROUND

Temporomandibular Disorders (TMD) is a multifactorial condition, which could be associated to occlusal and psychological factors, such as anxiety.

OBJECTIVE

Investigate if anxiety and malocclusion are associated with the prevalence of TMD in adolescents.

METHODS

To ensure a population-based representative sample, 934 adolescents aged 10 to 14 years old from Curitiba-PR, Brazil were randomly selected and examined according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and malocclusion by a single-calibrated examiner (Kappa > 0.80). Anxiety was assessed according to trait anxiety (STAI-T), categorised as high, moderate and low levels. For occlusal exam, it was considered: Angel's molar relationship, anterior and posterior crossbite, excessive overjet, open and deep bite. The associations were analysed by the crude and adjusted prevalence ration (RP_a ) of TMJ, calculated by a Poisson multivariate regression with robust variance (α = 0.05).

RESULTS

The prevalence of at least one type of malocclusion was found in 52.3%. Anxiety was found in high level (12.2%), moderate (70.4%) and low (17.5%). Presence of high anxiety was significantly associated with the prevalence of TMD symptoms (RP_a  = 4.06, P < 0.001), as well as the prevalence of myofascial pain (RP_a  = 24.78; P < 0.001) and prevalence of disc displacement with reduction (RP_a  = 11.08, P < 0.001). Adolescents Class II had higher prevalence of myofascial pain (Class II RP_a  = 1.73; P < 0.015) than adolescents Class I. Adolescents Class III presented higher prevalence of myofascial pain (PR_a 2.53; P = 0.004) than adolescents Class I.

CONCLUSION

Anxiety is strongly associated with TMD in adolescents. Presence of Class II or III is associated with higher prevalence of myofascial pain in adolescentsPLESAE check and approve the edit made in the article title.

Association of temporomandibular disorder and high frequency of suicide ideation in Korean adolescents: a cross-sectional survey

BACKGROUND

This study investigated the association between psychological factors and temporomandibular disorder (TMD) in a representative sample using data from the Korean nationwide survey.

METHODS

The study included 1337 adolescents. Participants provided demographic, socio-economic and behavioural information, and responses to questionnaires assessing their mental health status including perceived stress, depressed mood and suicidal ideation in the presence of TMD. In univariate analysis, t-test was used to test the association between TMD and risk factors by gender in a complex sampling design. Multivariate logistic regression analyses were used to examine the association between TMD and psychological factors.

RESULTS

Male adolescents with TMD were highly engaged with depressed mood and suicidal ideation (p = .0006, p = .0223), however, no psychological factors were significant in female adolescents (p < .05). Male adolescents with both depressed mood and suicidal ideation had significantly high rates of TMD (p = .0024). The risks for experiencing depressed mood (OR: 3.07) and suicidal ideation (OR: 2.564) were significantly associated with TMD in male adolescents after adjusting confounders.

CONCLUSIONS

The results provide evidence that the depressed mood and suicidal ideation were associated with TMD in male adolescents. This study has important implications for enhanced screening and evaluation of mental health among patients with TMD according to gender.

Prevalence and risk indicators of pain-related temporomandibular disorders among Indonesian children and adolescents

OBJECTIVES

To assess the prevalence of pain-related temporomandibular disorders (TMDs) among Indonesian children and adolescents, and to investigate which risk indicators are associated with it.

METHODS

In this cross-sectional study, 1,800 questionnaires were distributed among pupils of schools in the greater Jakarta area. This was done for 2 samples: children with ages ranging from 7 to 12 years (parental report) and adolescents aged 13-18 years (self-report).

RESULTS

The prevalence rates for pain-related TMDs in Indonesian children and adolescents were 23.4% (95% CI = 20-27) and 36.9% (95% CI = 33-41), respectively. Regression models revealed that psychological factors and the presence of bodily pain were strongly associated with pain-related TMDs in both children and adolescents, next to oral habits (in children), and sleep and awake bruxism (in adolescents). On the other hand, the socioeconomic status of parents was not associated with pain-related TMDs in either sample.

CONCLUSIONS

Pain-related TMDs are common among the young Indonesian population. These findings corroborate those from earlier studies of young populations, namely that bruxism and oral habits, bodily pain complaints, and psychological factors are risk indicators for pain-related TMDs.

Temporomandibular Disorders among Dutch Adolescents: Prevalence and Biological, Psychological, and Social Risk Indicators

Aims

To assess the prevalence rates of pain-related temporomandibular disorders (TMDs) and temporomandibular joint (TMJ) sounds in a large group of Dutch adolescents, aged between 12 and 18 years and to determine if the same biological, psychological, and social risk indicators are related to both TMD pain and TMJ sounds.

Methods

In this cross-sectional questionnaire survey, 4,235 questionnaires were analyzed, with an about equal gender distribution.

Results

The overall prevalence of pain-related TMDs was 21.6% (26.1% for girls and 17.6% for boys) and that of TMJ sounds was 15.5% (19.3% for girls and 11.7% for boys). Logistic regression analyses revealed that the following variables appeared to be the strongest predictors of TMD pain: female gender, increasing age, sleep bruxism, biting on lips and/or cheeks, stress, and feeling sad. Regarding self-reported TMJ sounds, the multiple regression model revealed that female gender, increasing age, awake bruxism, and biting on lips and/or cheeks were the strongest predictors.

Conclusions

TMDs are a common finding among Dutch adolescents. Except for the psychological factors that appeared to be associated with TMD pain only, pain-related TMDs and TMJ sounds shared similar biological risk indicators.

Prevalence of diagnosed temporomandibular disorders: A cross-sectional study in Brazilian adolescents

Background

The prevalence of signs and symptoms of temporomandibular disorders (TMD) increases during adolescence and adulthood. Few studies have examined TMD prevalence in Brazilian adolescents.

Aim

To investigate the prevalence of TMD in Brazilian adolescents.

Methods

A representative population-based sample of 934 adolescents (10–14-years-old) was examined. TMD screening was performed using a questionnaire by the American Academy of Orofacial Pain. TMD diagnoses used research diagnostic criteria for temporomandibular disorders (RDC/TMD—Axis-I). Examinations were performed by a single calibrated examiner (kappa > 0.80).

Results

The prevalence of TMD symptoms was 34.9%; the most frequently reported symptoms were headache and neck ache (20.9%), followed by joint sounds (18.5%). Myofascial pain was the most prevalent type (10.3%), followed by disc displacement with reduction (8.0%) and arthralgia (3.5%). There was a significant association between sex and TMD symptoms; prevalence was significantly higher in girls (RP = 1.37; 95% CI = 1.14–1.65; p = 0.001). Myofascial pain of TMD and displacement with reduction were more prevalent in girls (RP = 1.76; p = 0.007 and RP = 2.06; p = 0.004, respectively).

Conclusion

TMD symptoms were present in 34.9% of adolescents, with myofascial pain being the most prevalent type (10.3%). TMD was significantly more common in girls. Routine pediatric dental care should include a TMD screening.

Temporal relationship between dysthymia and temporomandibular disorder: a population-based matched case-control study in Taiwan

Background

Numerous studies have reported a relationship between depression and temporomandibular disorders (TMD), but the conclusions remain undefined. The aim of this article was to examine the temporal relationship between depression and TMD.

Methods

In this retrospective matched case-control study, we recruited all samples from a randomsample sub-dataset of one million insured individuals for the year 2005 (Longitudinal Health Insurance Database (LHID2005)). All beneficiaries were enrolled in the National Health Insurance (NHI) programme in Taiwan. We used propensity scoring and matched the case and control groups (1:1) by ten confounding factors to detect the effect of different types of depression on TMD.

Results

The positive correlative factors of TMD included the total number of times medical advice was sought for an unspecified anomaly of jaw size plus malocclusion (TTSMA-JS, p = 0.045), the total number of times medical advice was sought for an anxiety state (TTSMA-AS, p = 0.000), and the total number of times medical advice was sought for a panic disorder (TTSMA-P, p = 0.009). Dysthymia (synonymous with chronic depression) had an effect on TMD. The odds ratio (OR) of dysthymia for TMD measured by multiple logistic regression was 1.91 (p = 0.008) after adjusting for demographic factors, psychiatric comorbidities, and maxillofacial confounders.

Conclusions

This study demonstrated the established temporal relationship between dysthymia and TMD. The inclusion of a psychiatrist on the TMD management team is appropriate.

Prevalence among adolescents in Bergen, Western Norway, of temporomandibular disorders according to the DC/TMD criteria and examination protocol

OBJECTIVE

The aims of this study were to assess the prevalence of temporomandibular disorders (TMD) among adolescents and to contrast the prevalence of TMD according to the DC/TMD clinical examination protocol versus the prevalence of pain related to TMD according to two screening questions.

MATERIAL AND METHODS

Two hundred and ten adolescents living in the county of Bergen, Norway, were offered an additional examination for TMD in connection with their regular dental check-up appointment. Five dental clinics were selected with differing socio-economic patient populations, as reflected by stratification of average levels of DMFT, and an equal number of girls and boys were invited to participate. The participants answered two screening questions for pain related to TMD followed by a clinical examination according to the DC/TMD protocol by five calibrated examiners.

RESULTS

Acceptable calibration results were obtained. Approximately 80% of eligible participants consented to partake. According to the criteria of DC/TMD, the prevalence of TMD among the study participants was 11.9%, with a peak at 16 years of age. According to the self-reported screening questions for pain related to TMD, 7.2% responded positively. Only seven participants with a TMD diagnosis established according to the DC/TMD clinical examination protocol reported also pain related to TMD based on answering the two screening questions.

CONCLUSION

The prevalence of TMD is higher for girls than for boys and the prevalence of TMD established according to the DC/TMD criteria was higher than the prevalence of pain related to TMD estimated by use of two screening questions for self-reported pain.

ENPP1 and ESR1 genotypes influence temporomandibular disorders development and surgical treatment response in dentofacial deformities

Dentofacial deformities are dys-morpho-functional disorders involving the temporomandibular joints (TMJ). Many authors have reported a TMJ improvement in dysfunctional subjects with malocclusion after orthodontic or combined orthodontic and surgical treatment particularly for the relief of pain. In particular, few studies have highlighted the demographic and clinical predictors of response to surgical treatment. To date, no genetic factor has yet been identified as a predictor of response to surgical treatment. The aim of this cohort study is therefore to identify single-nucleotide polymorphisms associated with postoperative temporomandibular disorders (TMD) or with TMJ symptoms after orthognathic surgery. Here, we found the AA genotype of SNP rs1643821 (ESR1 gene) as a risk factor for dysfunctional worsening after orthognathic surgery. In addition, we have identified TT genotype of SNP rs858339 (ENPP1 gene) as a protective factor against TMD in a population of patients with dentofacial deformities. Conversely, the heterozygous genotype AT was identified as a risk factor of TMD with respect to the rest of our population. All these elements are particularly important to bring new screening strategies and tailor future treatment.

PERSPECTIVE

This study allows us to identify sub-populations at high risk of developing postoperative temporomandibular disorders after orthognathic surgery procedures. Many other genes of interest could be potential factors influencing the dysfunctional response to orthognathic surgery, particularly genes of the Opera cohort.

Dysthymia increases the risk of temporomandibular disorder: A population-based cohort study (A STROBE-Compliant Article)

Numerous studies have investigated the relationship between depression and temporomandibular disorders (TMD), but the conclusions remain vague. The aim of this study was to examine the causal effect between depression and TMD.The reporting of this study conforms to the STROBE statement. In this retrospective cohort study, all samples were recruited from a representative subdataset of 1 million insured persons for the year 2005 Longitudinal Health Insurance Database, who were randomly selected from all beneficiaries enrolled in the National Health Insurance program of Taiwan. We used a propensity score and stratified 926,560 patients into 2 groups (propensity1 = 588,429 and propensity2 = 338,131) and 4 cohorts (propensity1 with depression = 18,038, propensity1 without depression = 570,391, propensity2 with depression = 38,656, propensity2 without depression = 299,475) to detect the development of TMD among the depressive and nondepressive patients between 2004 and 2013.The positive correlative factors of TMD included female, total number of times seeking medical advice (TTSMA) for anxiety state, TTSMA for generalized anxiety disorder, TTSMA for mandible fracture, and TTSMA for unspecified anomaly of jaw size. The propensity2 group was represented by elder and female-predominant patients who used more psychiatric health resources. Among 3 types of depression, only dysthymia (so-called chronic depression) had a causal impact on TMD in the propensity 2 group. In the propensity 2 group, the hazard ratio of dysthymia for TMD measured by Cox's regression was 1.64 (95% confidence interval 1.28-2.09), after adjusting for demographic factors, psychiatric comorbidities, and maxillofacial confounders. The first-onset mean time of TMD as the consequence of dysthymia was 3.56 years (sd = 2.74, min = 0.08, median = 2.99, max = 9.73).This study demonstrates that dysthymia increases the risk of TMD in elderly and female-predominant patients who use more psychiatric health resources.

Vertical Craniofacial Morphology and its Relation to Temporomandibular Disorders

Objectives

This study investigated the association between craniofacial morphology and temporomandibular disorders in adults. The influence of different craniofacial morphologies on painful temporomandibular disorders was also evaluated.

Material and Methods

A total of 200 subjects were selected, including 100 with temporomandibular disorders (TMD) and 100 without TMD (control), diagnosed by research diagnostic criteria for temporomandibular disorders. All subjects were submitted to lateral cephalometric radiographs, and classified as brachyfacial, mesofacial, or dolichofacial by Ricketts’ analysis. Data were analysed by Tukey-Kramer and Chi-square tests.

Results

No association between craniofacial morphology and TMD was found (P = 0.6622). However, brachyfacial morphology influences the presence of painful TMD (P = 0.0077).

Conclusions

Craniofacial morphology is not related to temporomandibular disorders in general.

Parafunctional habits are associated cumulatively to painful temporomandibular disorders in adolescents

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

Sleep bruxism in adolescents: a systematic literature review of related risk factors

BACKGROUND

Multiple risk factors have been associated to sleep bruxism (SB). Nevertheless, there are still many unsolved issues concerning the etiology of SB that have consequences on the clinical management strategies.

OBJECTIVE

Systematically review the literature to assess the relationship between risk factors and SB symptoms in adolescents (age 11-19 years).

SEARCH METHODS AND SELECTION CRITERIA

PubMed, Embase, Scopus, Cochrane Oral Health Group's Trial Register and Cochrane Register of Controlled Trials, Web of Science, LILACs, and SciELO were searched to identify all peer-reviewed articles potentially relevant to the review.

DATA COLLECTION AND ANALYSIS

The risk of bias was assessed according to the guidelines from the Cochrane handbook for systematic reviews of interventions, with reporting in agreement to the preferred reporting items for systematic reviews and meta-analyses guidelines.

RESULTS

Four out of the 4546 initially identified articles were selected. According to the grading of recommendations assessment, development and evaluation assessment (GRADE), the magnitude of agreement was almost perfect for all checklist items. Sleep disturbances, and snoring in particular, headache, jaw muscle fatigue, and tooth wear seem to be associated to SB in adolescents from 11 to 19 years old.

LIMITATIONS

Despite the large interest of the scientific community in the field of oral parafunctions, only four articles met the eligibility criteria. Furthermore only associations and not definite cause-effect relationships were highlighted in the selected articles.

CONCLUSIONS

Sleep disturbances presented the strongest association with SB while very few occlusal features had a moderate association. As a common sense the investigation of sleep respiratory disorders could be of great help in the management of SB in adolescents.

The knowledge level of dental surgeons regarding the relationship between occlusal factors and Temporomandibular Disorders (TMD)

AbstractIntroductionThe relationship between dental occlusion and temporomandibular disorders (TMD) remains a subject of disagreement. Many professionals erroneously base diagnosis and treatment strictly on the occlusal factor, despite the fact that current scientific evidence does not show such a relationship.ObjectiveTo evaluate the knowledge of dental surgeons (DSs) from João Pessoa (PB)-Brazil, regarding the relationship between occlusal factors and TMD.Materials and methodA sample of 100 DSs who do not have expertise in TMD and orofacial pain (CG Group) and seven DSs with this specialty (EG Group) completed a questionnaire that addresses issues concerning knowledge of TMD and its relationship with occlusal factors. The questionnaire also contained information used to characterize the sample, such as age, gender, and length of experience. The current literature's degree of consensus was established as the "gold standard" response for each statement and was compared with the responses of the specialists and non-specialists. Data were tabulated using the SPSS software package and analyzed descriptively (by percentage) and statistically using the chi-square and Fisher's exact tests (p < 0.05).ResultA wide divergence could be observed between the knowledge of DSs who do not specialize in TMD and orofacial pain and that of professionals who do.ConclusionThere was low agreement between specialists and non-specialists. The relationship between dental occlusion and TMD remains unclear for the vast majority of participating professionals, which may prove to be reflected in diagnostic behaviors and inappropriate occlusal treatment for the management of TMD.