Prevalence of diagnosed temporomandibular disorders among Saudi Arabian children and adolescents

The prevalence of chronic pain in children and adolescents: a systematic review update and meta-analysis

ABSTRACT

Chronic pain, defined as persistent or recurring pain or pain lasting longer than 3 months, is a common childhood problem. The objective of this study was to conduct an updated systematic review and meta-analysis on the prevalence of chronic pain (ie, overall, headache, abdominal pain, back pain, musculoskeletal pain, multisite/general pain, and other) in children and adolescents. EMBASE, PubMed, CINAHL, and PsycINFO were searched for publications between January 1, 2009, and June 30, 2023. Studies reporting population-based estimates of chronic nondisease related pain prevalence in children or adolescents (age ≤ 19 years) were included. Two independent reviewers screened articles based on a priori protocol. One hundred nineteen studies with a total of 1,043,878 children (52.0% female, mean age 13.4 years [SD 2.4]) were included. Seventy different countries were represented, with the highest number of data points of prevalence estimates coming from Finland and Germany (n = 19 each, 4.3%). The overall prevalence of chronic pain in children and adolescents was 20.8%, with the highest prevalence for headache and musculoskeletal pain (25.7%). Overall, and for all types of pain except for back pain and musculoskeletal pain, there were significant differences in the prevalence between boys and girls, with girls having a higher prevalence of pain. There was high heterogeneity (I 2 99.9%). Overall risk of bias was low to moderate. In summary, approximately 1 in 5 children and adolescents experience chronic pain and prevalence varies by pain type; for most types, there is higher pain prevalence among girls than among boys. Findings echo and expand upon the systematic review conducted in 2011.

Temporomandibular disorder symptoms in the university context

OBJECTIVE

To assess the impact of the university context of different academic fields and class times and the sociodemographic context on the symptoms of temporomandibular disorder (TMD).

METHODS

A total of 2912 university students, divided into 26 undergraduate courses distributed in the fields of biology and exact and human sciences in the day and night participated in this study. The symptoms of orofacial pain and TMD were assessed using a self-explanatory questionnaire for screening, as recommended by the American Academy of Orofacial Pain. The data were analyzed using frequency distribution tables and multiple logistic regression at a 5% significance level.

RESULTS

There was a significant association between the female sex and the attended class time. Women and undergraduates of night courses were 1.60 times more likely to present symptoms related to TMD compared to women studying during the day.

CONCLUSION

It was concluded that, within the university context, women and undergraduate students enrolled in night courses were more likely to present with TMD symptoms.

The Role of Malocclusion and Oral Parafunctions in Predicting Signs and Symptoms of Temporomandibular Disorders-A Cross-Sectional Study

BACKGROUND

The aim of this study was to examine to what extent malocclusion and parafunctional habits contribute to the development of signs and symptoms associated with temporomandibular disorders (TMD) in schoolchildren with mixed dentition in Croatia in a sample of 338 children, aged 9 to 15 years.

METHODS

TMD signs and symptoms assessed by the clinician were joint function and pain, masticatory muscles tenderness, range of mandibular motion, and joint sounds. To evaluate subjective symptoms and parafunctions, children and parents were asked about the presence of headaches, jaw locking, temporomandibular joint (TMJ) sounds, pain during mouth opening, or bruxism, as well as parafunctions like biting pencils or nails, chewing hard candies or ice, daily gum chewing, opening bottles with teeth, engaging in jaw play, thumb-sucking, and clenching/grinding teeth.

RESULTS

At least one symptom of a TMD was pronounced in 142 participants (42.0%). The most commonly reported parafunction was pencil or nail biting, present in 25.1% of participants. Class II malocclusion increased the likelihood by 2.6 times, pencil or nail biting by 2.34 times, and clenching/grinding teeth by 8.9 times that the subject would exhibit at least one TMD symptom.

CONCLUSIONS

Every child with mixed dentition should undergo a brief examination of the TMJ, especially in cases of Class II malocclusion, pencil or nail biting, and teeth clenching or grinding, as these have all been identified as significant risk factors that increase the likelihood of experiencing TMD symptoms. This highlights the need for proactive screening and assessment by healthcare providers to reduce the risk and prevalence of TMDs in affected children and ensure timely diagnosis and treatment.

Temporomandibular involvement in children and adolescents with juvenile idiopathic arthritis: a 2-year prospective cohort study

This study aimed to clinically evaluate temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA) and the ability to identify and/or predict development of TMJ-deformities over time using cone beam computed tomography (CBCT). The predictive value of self-reported TMJ pain was also assessed. A prospective longitudinal cohort study comprising 54 children with JIA, 39 girls and 15 boys, was performed. All children had active disease at baseline, 50% with the subtype oligoarthritis. Repeated clinical orofacial and CBCT examinations were performed over a two-year period. At baseline, 39% had radiographic TMJ deformities (24% unilateral, 15% bilateral), at 2-year follow-up, 42% (p > 0.05). Both progressing and improving TMJ deformities were observed. An association was found between TMJ-deformities and self-reported TMJ pain at baseline (p = 0.01). Maximum unassisted mouth opening (MUO) was smaller for children with TMJ-deformities (p < 0.05). The prevalence of palpatory muscle pain was high (48-59%) but not predictive of development of TMJ-deformities. TMJ noises increased over time and crepitations were associated with TMJ-deformities (p < 0.05). In conclusion, in children with JIA, self-reported TMJ pain and dysfunction were common and predictive of TMJ deformities. TMJ deformities were associated with smaller MUO and palpatory TMJ pain as well as crepitations. Trial registration. ClinicalTrials.gov Protocol id: 2010/2089-31/2.

Prevalence of temporomandibular disorders in clear aligner patients using orthodontic intermaxillary elastics assessed with diagnostic criteria for temporomandibular disorders (DC/TMD) axis II evaluation: A cross-sectional study

BACKGROUND

The objective of this investigation is to assess the relationship between the utilisation of orthodontic intermaxillary elastics and temporomandibular disorder (TMD) symptoms in clear aligner patients and to examine the correlation between the elastic usage time with the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD)-Axis II Evaluation Forms.

METHODS

This study was carried out on a total of 40 clear aligner patients using intermaxillary elastics in the experimental group and 30 clear aligner patients who did not use any intermaxillary elastics in the control group. The data were evaluated using the Mann-Whitney U, chi-square, Fisher's exact chi-square, and Fisher Freeman Halton exact chi-square tests.

RESULTS

The characteristic pain intensity, mastication, mobility, communication, global and PHQ-9 scores of the experimental group were significantly higher than those of the control group (p < .05). The characteristic pain intensity score, interference score and chronic pain grade score of patients using Class III elastics were statistically significantly higher than those of patients using Class II elastics (p < .05). Patients who used elastics for less than 6 months had statistically significantly higher PHQ-9 scores than those who used elastics for more than 6 months (p < .05).

CONCLUSIONS

Orthodontic treatment may affect occlusion, bite force and jaw movement, which may cause or worsen TMD symptoms, and the DC/TMD questionnaires can determine if orthodontic patients acquire TMD by assessing their psychosocial state and pain-related problems.

Effectiveness of anterior repositioning splint versus other occlusal splints in the management of temporomandibular joint disc displacement with reduction: A meta-analysis

BACKGROUND

Disc displacement with reduction (DDwR) is among the common disc disorders of temporomandibular joint (TMJ), which can be managed conservatively by splint therapy. Anterior repositioning splint (ARS) is the most commonly prescribed splint by dental practitioners, but not getting a normal disc-condyle relationship always and other side effects lead to need of comparing with other occlusal splints. This review will help in informed decision-making by clinicians in choosing an appropriate splint type for patients.

AIM

The aim is to compare the effectiveness of ARS in the management of DDwR with other occlusal splints for TMJ and muscle pain, TMJ noise, any adverse effects, regaining normal disc-condyle relationship.

MATERIALS AND METHODS

We followed published protocol in the International prospective register of systematic reviews. Databases were searched till May 2023 using different search strategies as per the database. Title and abstract screening, followed by full-text screening and data extraction with risk of bias, was done by two independent reviewers in Covidence. Outcomes were reported as risk ratio (RR) or mean difference (MD) for dichotomous or continuous outcomes, respectively, using RevMan 5.4 (Review Manager 5.4) software. We used a random effect model for statistical analysis. Certainty of evidence was assessed using the Grading of Recommendation, Assessment, Development, and Evaluation Guideline Development Tool (GRADEpro GDT) software.

RESULTS

A total of 1145 reports were found from a database search. After screening, four studies were included for systematic reviews. Other occlusal splints reported were sagittal vertical extrusion device and mandibular ARS, full hard stabilization splint of canine or centric stabilization type. Data of only two studies could be used for meta-analysis having 30 participants received ARS and 40 received other occlusal splints. We did not find evidence of any difference between ARS and other occlusal splints for TMJ clicking in short term (RR 1.25, 95% confidence interval [CI] 0.91-1.72) but a small difference in favor of other occlusal splint in long term (RR 2.40, 95% CI 1.04-5.55). No evidence of any difference was found between both treatments for TMJ pain in short term (MD-5.68, 95% CI-17.31-5.95) and long term (MD 0.00, 95% CI-2.86-2.86) and muscle pain in short term. The certainty of evidence for comparison of two treatments for different outcomes was of low or very low level.

CONCLUSION

Evidence is uncertain that other occlusal splints reduced TMJ clicking slightly in comparison to ARS. For the remaining outcomes, no evidence of any difference was found between the two splints and it may be biased due to selection bias, inadequate blinding of participants, and outcome assessor.

Patients' experience with teledentistry compared to conventional follow-up visits in TMD clinic: A pilot study

OBJECTIVES

Teledentistry has been used in many dental specialties including temporomandibular joint disorders (TMD). Studies have measured patients' experience with teledentistry visits. Thus, this study aimed to assess the experience of patients seen using teledentistry compared to the traditional Orofacial Pain (OFP) and TMD visits.

METHODS

An interventional study was conducted on 25 patients following up at the TMD clinic. The first follow-up occurred in person at the hospital clinic, where patients were given a survey at the end of the visit. A questionnaire included the following sections: socio-demographic information, patient experience of the visit, preferred online platforms, and patients' familiarity with these platforms. Patients had teledentistry visits via ZOOM Premium. After the visit, patients were given a second survey highlighting their experience towards the virtual visit and sections from the first survey. The study compares patients' satisfaction between conventional and virtual follow-up visits and compares patient experience differences based on their demographics.

RESULTS AND CONCLUSION

Twenty-five patients completed both surveys. Over half of the participants were younger than 35 years old (64 %), and the majority were female (80 %). A total of 76 % had used virtual platforms prior to the study, and 74 % of them were convenient. Regarding patients' experience, only a borderline difference existed among the age groups of the study in effectively using teledentistry in the follow-ups compared to conventional visits (p = 0.05). Other results revealed no significant differences in patients' experience between virtual and conventional visits, indicating that high-quality dental care services can be provided remotely. Therefore, teledentistry could be integrated into the OFP and TMD Clinic flow without adversely affecting patient experience or quality of care.

CLINICAL SIGNIFICANCE

Virtual follow-up visits could save patients' time, effort, and travel costs compared to conventional visits. Waiting lists are increasing in almost all dental; thus, integrating virtual follow-up visits would shorten these lists.

Diagnostic criteria for temporomandibular disorders-INfORM recommendations: Comprehensive and short-form adaptations for adolescents

BACKGROUND

The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for use in adults is in use worldwide. Until now, no version of this instrument for use in adolescents has been proposed.

OBJECTIVE

To present comprehensive and short-form adaptations of the adult version of DC/TMD that are appropriate for use with adolescents in clinical and research settings.

METHODS

International experts in TMDs and experts in pain psychology participated in a Delphi process to identify ways of adapting the DC/TMD protocol for physical and psychosocial assessment of adolescents.

RESULTS

The proposed adaptation defines adolescence as ages 10-19 years. Changes in the physical diagnosis (Axis I) include (i) adapting the language of the Demographics and the Symptom Questionnaires to be developmentally appropriate for adolescents, (ii) adding two general health questionnaires, one for the adolescent patient and one for their caregivers and (iii) replacing the TMD Pain Screener with the 3Q/TMD questionnaire. Changes in the psychosocial assessment (Axis II) include (i) adapting the language of the Graded Chronic Pain Scale to be developmentally appropriate for adolescents, (ii) adding anxiety and depression assessment that have been validated for adolescents and (iii) adding three constructs (stress, catastrophizing and sleep disorders) to assess psychosocial functioning in adolescents.

CONCLUSION

The recommended DC/TMD, including Axis I and Axis II for adolescents, is appropriate to use in clinical and research settings. This adapted first version for adolescents includes changes in Axis I and Axis II requiring reliability and validity testing in international settings. Official translations of the comprehensive and short-form to different languages according to INfORM requirements will enable a worldwide dissemination and implementation.

Characterization of Migraine in Children and Adolescents With Generalized Joint Hypermobility: A Case-Control Study

Background and Objectives

The prevalence of generalized joint hypermobility (GJH) is 5-65% in children and adolescents. The hypothesis of this study was to see whether there is an association between headache characteristics and GJH in children and adolescents with migraine.

Methods

We performed a primary retrospective case-control analysis of an established database of patients with headache aged 5-17 years.

Results

We included 5435 participants. Approximately 31.6% of participants (1,719/5,435) were diagnosed with GJH (Beighton score ≥ 6). Nausea (73.1% vs 67.5%, χ2 with 1 degree of freedom = 17.0, p < 0.0001), phonophobia (87.3% vs 78.8%, χ2 with 1 degree of freedom = 18.0, p < 0.0001), and the PedMIDAS score (48.2 ± 52.5, 95% CI 45.7-50.6 vs 41.6 ± 51.2, 95% CI 40.0-43.3, effect size = 0.13, p < 0.0001) were noted to be more severe in participants with GJH than those without GJH.

Discussion

Youths with GJH and migraine were noted to have more severe migraine characteristics.

Prevalence of Temporomandibular Disorders Based on a Shortened Symptom Questionnaire of the Diagnostic Criteria for Temporomandibular Disorders and Its Screening Reliability for Children and Adolescents Aged 7-14 Years

The prevalence and adequacy of diagnostic approaches for temporomandibular disorders (TMD) in children and adolescents are still matters of debate. This study aimed to determine the prevalence of TMD and oral habits in children and adolescents aged 7-14 years and evaluate the consistency between self-reported TMD symptoms and clinical findings using a shortened Axis I of Diagnostic Criteria for TMD (DC/TMD). Children (aged 7-10) and adolescents (aged 11-14) of both sexes were invited to participate in this study (n = 1468). Descriptive statistics for all observed variables and Mann-Whitney U-Tests for the clinical examination were performed. A total of 239 subjects participated in the study (response rate 16.3%). The self-reported prevalence of TMD was found to be 18.8%. The most frequently reported oral habit was nail biting (37.7%), followed by clenching (32.2%) and grinding (25.5%). Self-reported headache increased with age, while clenching and grinding decreased. Based on the answers to the DC/TMD Symptom Questionnaire, subgroups of asymptomatic and symptomatic participants (n = 59; 24.7%) were established and randomly selected for the clinical examination (f = 30). The shortened Symptom Questionnaire showed a sensitivity of 0.556 and a specificity of 0.719 for pain during the clinical examination. Although the Symptom Questionnaire exhibited high specificity (0.933), its sensitivity (0.286) for temporomandibular joint sounds was low. Disc displacement with reduction (10.2%) and myalgia (6.8%) were the most common diagnoses. In conclusion, the self-reported prevalence of TMD in children and adolescents in this study was comparable to that reported in the literature for adults. However, the accuracy of the shortened Symptom Questionnaire as a screening tool for TMD-related pain and jaw sounds in children and adolescents was found to be low.

Temporomandibular disorders in children and adolescents: A review

BACKGROUND

Temporomandibular disorders (TMD) are generally observed in individuals between the ages of 20 and 40 years. TMD have also been described in children and adolescents but are still not widely detected and treated in routine practice. Through a literature review, this work aims to improve the diagnosis and management of TMD in children and adolescents by dentists.

METHODS

This literature review was performed by a computerized search of the database PubMed for published articles on TMD in children and adolescents. Articles evaluating the prevalence, etiologies and risk factors, diagnosis, signs, and symptoms as well as the comorbidities of TMD, published between 2001 and 2022, were included in this review.

RESULTS

A total of 51 articles were included. Most of studies reported a prevalence of over 20%, with a higher prevalence in females. The two most common diagnoses were myofascial pain and disk displacement with reduction. Headaches were often associated with the condition. The management of TMD in children and adolescents has been poorly studied.

CONCLUSION

TMD frequently affect children and adolescents. Therefore, for prevention purposes, an examination of the masticatory system should be included in the dental check-up. Early diagnosis is essential in order to limit effects on their growth, development, and quality of life. TMD management is not currently validated for children and adolescents. Noninvasive and reversible care should be preferred.

The Impact of Benign Jawbone Tumors on the Temporomandibular Joint and Occlusion in Children: A Ten-Year Follow-Up Study

This study aimed to provide a complex analysis of the modifications in craniofacial skeleton development that may arise following the diagnosis of pediatric benign jaw tumors. A prospective study was undertaken involving 53 patients younger than 18 years of age, who presented for treatment at the Department of Maxillo-Facial Surgery, University of Medicine and Pharmacy, Cluj-Napoca, with a primary benign jaw lesion between 2012 and 2022. A total of 28 odontogenic cysts (OCs), 14 odontogenic tumors (OTs), and 11 non-OTs were identified. At follow-up, dental anomalies were identified in 26 patients, and overjet changes were found in 33 children; lateral crossbite, midline shift, and edge-to-edge bite were found in 49 cases; deep or open bite were found in 23 patients. Temporomandibular disorders (TMDs) were found in 51 children, with unilateral TMJ changes identified in 7 cases and bilateral modifications found in 44 patients. Degenerative changes in the TMJ were also diagnosed in 22 pediatric patients. Although benign lesions could be associated with dental malocclusions, a direct etiological factor could be not identified. The presence of jaw tumors or their surgical treatment could, however, be linked to a change of the occlusal relationships or the onset of a TMD.

Prevalence of Temporomandibular Disorders Between 2015-2021: A Literature Review

The prevalence of temporomandibular disorder (TMD) is significantly high around the world. We conducted a literature review to determine the prevalence of TMD globally and in Saudi Arabia based on published studies. This review article collected 35 full-text articles after searching PubMed for TMD prevalence between 2015-2021. Assessing the prevalence of TMDs is important for several reasons, including providing an overview of the incidence of such disorders, educating the community, clarifying the gender and age group with the highest prevalence, establishing a program to prepare specialists to treat these disorders, and identifying the appropriate number of specialists by comparing TMD prevalence to Saudi Arabia's census. Out of 35 selected articles, thirty studies were done outside Saudi Arabia, and five were local. Less than 40% prevalence of TMD has been reported with associated factors such as gender, psychological status, and age. The female gender has shown a higher TMD rate than the male gender. Some authors have suggested conducting a temporomandibular joint (TMJ) assessment in the pediatric clinic. Moreover, TMD screening is an important tool for every patient visiting the dental clinic to assess TMJ status and treat TMD at early stages, especially in non-painful cases.

Maximum bilateral bite strength and RMS EMG for the diagnosis of myogenic TMD

Aim: The study aimed to evaluate the accuracy of the maximum bilateral molar bite force and the Root Mean Square (RMS) Electromyography (EMG) index of the masticatory muscles in the maximum bilateral molar bite (MMBMax) of women with myogenic Temporomandibular Disorder (TMD) and asymptomatic. Methods: This is a cross-sectional study, composed of 86 women allocated to the TMD Group (n=43) and Control Group (n=43) diagnosis through the Diagnostic Criteria for Temporomandibular Disorders. The maximum bilateral molar bite force was evaluated using a bite dynamometer and the RMS EMG index of the masticatory muscles (anterior temporalis, masseter) during 5 seconds of the MMBMax task. Student t-test was used for data comparison between accuracy of the bite force and RMS EMG of masticatory muscles during the MMBMax. Results: The maximum bilateral molar bite force showed high accuracy (AUC=0.99) for the diagnosis of women with myogenic TMD and asymptomatic women, and the RMS EMG index evaluated during the MMBMax showed a moderate level of accuracy for all masticatory muscles (AUC=0.70 to 0.75). Conclusion: The bilateral bite dynamometer with a surface EMG during bilateral bite can be used to diagnose TMD in young women.

Knowledge and awareness of physical therapy role in evaluating and treating temporomandibular disorders among physical therapists in Saudi Arabia

Background

Practitioners, including physical therapists, are not proficiently trained to evaluate and treat individuals with temporomandibular disorders. The purpose of this study is to evaluate the knowledge and awareness of examining and treating temporomandibular disorders among physical therapists in Saudi Arabia.

Methods

An online questionnaire was distributed to physical therapists on different social media platforms. The survey covered demographics characteristics and knowledge of examining and treating temporomandibular disorders. Descriptive statistics were used for data analysis.

Results

A total of 143 participants with a mean of age of 30 (± 6.6) years participated in this study. The majority of participants (n = 109; 76.2%) did not take educational courses on temporomandibular disorders; more than half (n = 84; 58.7%) had never evaluated or treated individuals with temporomandibular disorders. Most physical therapists were aware that they could treat individuals with temporomandibular disorders (n = 121, 84.6%). The most common evaluation methods were temporomandibular joint palpation, jaw movement during opening and closing, and palpation of the masticatory muscles (n = 56, 95%); (n = 49, 83%); (n = 48, 81%), respectively. The common methods used for treatment were therapeutic exercise strengthening, manual therapy, and patient education (n = 49; 83%; n = 46; 78%; n = 33; 56%), respectively. Thirty-one participants (53%) referred patients to other practitioners.

Conclusion

This preliminary study indicates there is a fair level of knowledge, low confidence, low education, and low clinical experience for physical therapists in the evaluation and treatment of temporomandibular disorders in Saudi Arabia. More attention is needed on physical therapy education programs and post-graduate education courses on temporomandibular disorders.

Diagnostic criteria for temporomandibular disorders-INfORM recommendations: Comprehensive and short-form adaptations for children

BACKGROUND

The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) are used worldwide in adults. Until now, no adaptation for use in children has been proposed.

OBJECTIVE

The aim of this study was to present comprehensive and short-form adaptations of Axis I and Axis II of the DC/TMD for adults that are appropriate for use with children in clinical and research settings.

METHODS

Global Delphi studies with experts in TMDs and in pain psychology identified ways of adapting the DC/TMD for children.

RESULTS

The proposed adaptation is suitable for children aged 6-9 years. Proposed changes in Axis I include (i) adapting the language of the Demographics and the Symptom Questionnaires to be developmentally appropriate for children, (ii) adding a general health questionnaire for children and one for their parents, (iii) replacing the TMD Pain Screener with the 3Q/TMD questionnaire and (iv) modifying the clinical examination protocol. Proposed changes in Axis II include (i) for the Graded Chronic Pain Scale, to be developmentally appropriate for children, (ii) adding anxiety and depression assessments that have been validated in children and (iii) adding three constructs (stress, catastrophising and sleep disorders) to assess psychosocial functioning in children.

CONCLUSION

The recommended DC/TMD, including Axis I and Axis II, for children aged 6-9 years, is appropriate for use in clinical and research settings. This adapted the first version for children includes changes in Axis I and Axis II changes requiring reliability and validity testing in international settings. Official translations to different languages according to INfORM requirements will enable a worldwide dissemination and implementation.

Sleep analysis results of portable polysomnography in patients with acute and chronic temporomandibular disorder

OBJECTIVE

This study aimed to investigate portable polysomnography (PSG)-based 'sleep' and pre-diagnosis of obstructive sleep apnoea (OSA) in acute temporomandibular disorder (TMD) and patients with chronic TMD.

METHODS

Randomly selected 25 patients with acute TMD (mean age, 42.58 ± 18.77 years; 14 females) and 26 age-and sex-matched patients with chronic TMD (mean age, 49.24 ± 17.52 years, 19 females) were enrolled.

RESULTS

The eight psychological subscales of SCL-90R had significantly higher values in the chronic TMD group than in the acute TMD group (all p < 0.05). There was no significant group difference in the respiratory event index examined using a portable PSG. OSA was observed in 57.7% in acute TMD, and 68.0% in chronic TMD, respectively. From the multiple regression analysis, palpation index was the strongest predictor of pre-diagnosis of OSA (OR = 17.550). Among the contributing factors for TMD, psychological stress (OR = 12.226), self-reported sleep problems (OR = 10.222), and above-average value of DEP (OR = 1.443) were followed.

CONCLUSION

Patients with chronic TMD were psychologically more vulnerable than those with acute TMD, and the existence of subjectively perceived sleep problems or objective sleep indices examined by portable PSG could affect TMD symptom severity in different ways.

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

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

Malocclusion Complexity in Patients with Myofascial Pain with or without Mouth-Opening Limitation: A Case-Control Study

Background

This study is aimed at determining the association between myofascial pain with or without mouth-opening limitation and malocclusion complexity.

Methods

A prospective, cross-sectional, case-control study was conducted. The Research Diagnostic Criteria were used to evaluate the presence of myofascial pain, chronic pain, and depression. The Index of Complexity, Outcome, and Need (ICON) was applied to quantify malocclusion complexity. A total of 96 patients with myofascial pain were grouped into two: subjects without mouth-opening limitation (n = 76, group A) and subjects with mouth-opening limitation (group B, n = 20). Both groups were compared with 231 controls (group C). A Chi-squared test and a multinomial logistic regression (p ≤ 0.05) were used to identify associations between the variables.

Results

Statistically significant associations were found between myofascial pain and the variables gender, malocclusion complexity, and depression (p ≤ 0.05). Age was not significantly associated (p = 0.327). Concerning malocclusion complexity, 77.9% of the controls were distributed in the first three ICON levels; however, 76.5% of group A subjects and 90% of group B were in the last three (p < 0.001). The multinomial logistic regression showed a significant association between malocclusion complexity in group A (p < 0.05) and an association between depression and group B (p < 0.05). Group B had the highest grades of chronic pain.

Conclusions

Females had greater risk of myofascial pain without mouth-opening limitation. As the complexity of the malocclusion increases, so do the odds of presenting myofascial pain without mouth-opening limitation. Myofascial pain with mouth-opening limitation frequently coexists with depression and chronic pain.

Effects of visual input on changes in the bioelectrical activity of the cervical and masticatory muscles in myopic subjects

The study aimed to analyze the changes within the bioelectrical activity of the cervical spine and masticatory muscles during the change of visual stimulus—open and closed eyes test. After applying the inclusion criteria, 50 subjects were included in the study, with visual impairment ranging from −0.5 to −5.75 Diopters. Four muscle pairs were analyzed: the anterior part of the temporalis muscle (TA), the superficial part of the masseter muscle (MM), the anterior belly of the digastric muscle (DA), and the middle part of the sternocleidomastoid muscle (SCM) belly during rest, teeth clenching, teeth clenching on dental cotton rollers, and active mouth opening. Statistical analysis showed a significant decrease in the bioelectrical activity during teeth clenching of all analyzed muscles during the closed eyes test. Significant decreases of electromyographic values were also observed during resting activity within TA muscles, during teeth clenching with dental cotton rollers within SCM and DA muscles, and during active mouth opening within the right masseter. Changing the visual stimulus from open eyes to closed eyes in people with myopia affects the bioelectrical activity of the masticatory and cervical spine muscles.

College Students with Oral Habits Exhibit Worse Psychological Status and Temporomandibular-Related Quality of Life: A Correlational Study

Purpose

To evaluate the relationship between oral habits, psychological status, and temporomandibular-related quality of life among college students.

Materials and Methods

An online questionnaire was sent to college students who were willing to participate in this anonymous survey, which contained questions about the demographic characteristics of the participants, the Patient Health Questionnaire for Depression and Anxiety (PHQ-4), the Fonseca Anamnestic Index (FAI), and the Oral Health Impact Profile for temporomandibular disorders (OHIP-TMDs).

Results

A total of 505 valid questionnaires were collected from 200 males and 305 females (a mean age of 21.81 ± 2.81 years). The prevalence of oral habits in college students was 58% (294/505). Female gender (odds ratio (OR) 1.786) and having oral habits (OR 1.893) were associated with depression and anxiety. Medical students had significantly less depression and anxiety (OR 0.459) than nonmedical students. The possibility of suffering from temporomandibular disorder (TMDs) as evidenced by the OHIP-TMDs score was associated with female gender (OR 1.989) and having oral habits (OR 3.482). Students with oral habits had higher OHIP-TMDs scores.

Conclusion

More than half of the college students surveyed had specific oral habits, with a higher prevalence in women than in men. Having oral habits was related to a worse psychological status, higher risk of TMD, and worse temporomandibular-related quality of life.

The Association Between Psychological Symptoms and Self-Reported Temporomandibular Disorders Pain Symptoms in Children and Adolescents

Background: Several studies have reported an association between temporomandibular disorder pain (TMD-P) and emotional disorders in children and adolescents. However, no studies have reported if self-reported TMD-P in Saudi Arabia is associated with psychosocial symptoms. Therefore, the current study aimed to evaluate the association between self-reported TMD-P with depression, anxiety and somatic problems in children and adolescents in Saudi Arabia. The hypothesis was that there is an association between self-reported TMD-P and psychological symptoms among children and adolescents.

Materials and Methods: The included participants were randomly selected boys and girls aged between 10 and 18 years, with a mean (SD) age of 14.0 (2.3) years. Out of 633 children and adolescents that were invited to participate, 509 voluntarily agreed to participate, and 466 completed all questionnaires. The questionnaires included items retrieved from the Youth Self Report (YSR) and Axis II of the Research Diagnostic Criteria for TMD (RDC/TMD) besides demographic data, medical history, and presence of oral parafunctions. To assess the presence of self-reported TMD-Pain, each participant was verbally asked two validated questions regarding the presence of TMD-P and dysfunction (2Q-TMD).

Results: Self-reported TMD-P in children and adolescents was significantly associated with anxiety, depression, somatic symptoms, and social problems (P < 0.0001). Further, the frequencies of anxiety, depression, and somatic disorders were more evident among children and adolescents who suffered from TMD-P (P < 0.0001). The odds of reporting TMD-P in children and adolescents was 1.4 times for border line and clinical diagnosis scores for anxiety and withdrawal depression domains, and 2.6 times for the somatic symptoms' domains. However, in the multiple regression model after controlling for possible confounders, only somatic symptoms and social scores were significant. Moreover, self-reported TMD-P was twice as prevalent among girls compared to boys.

Conclusion: This study reports a significant association between psychosocial burden and presence of self-reported TMD-Pain, with a stronger impact on girls than boys. There were significantly higher number of participants with self-reported TMD-P reporting a poor oral and general health. In addition, self-reported TMD-P was higher among those with borderline and clinically diagnosed anxiety/depression scores. Based on this finding, the current study supports that an early approach and recognition of children and adolescents with anxiety, depression, somatic symptoms, and TMD problems. This could result in a lesser burden for these children and adolescents both in regard to pain and psychosocial implications with increased quality of life.

Relationship of Malocclusions with Disorders of the Temporomandibular Joint in Children of CALI-Colombia

OBJECTIVE

 The aim of this study was to determine the relationship of malocclusion with the presence and severity of temporomandibular disorders (TMDs) in children.

MATERIALS AND METHODS

 A clinical examination was performed in 87 patients (from 4 to 14 years of age) who attended the dentistry clinics of Universidad del Valle.

RESULTS

 The 77 patients studied had malocclusions; 55 patients had TMD and 67.3% were female. The most frequent symptom of TMD was articular unilateral noise with 33.8%, followed by pain in at least one masticatory muscle with 26%. TMJ pain was observed in 24.7% of the patients. There was a statistically significant relationship between the presence and severity of TMD with type of dentition and transverse malocclusion, respectively.

CONCLUSION

 The presence of TMD in children with malocclusion presented in a high frequency. TMD depends on the type of dentition and its severity is dependent on transverse malocclusion.

Temporomandibular joint involvement in children with juvenile idiopathic arthritis-Symptoms, clinical signs and radiographic findings

BACKGROUND

Although many children with juvenile idiopathic arthritis (JIA) develop arthritis and deformity of the temporomandibular joint (TMJ), many go undetected.

OBJECTIVE

This study investigates whether findings from patient history and clinical examination using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) can be used to diagnose TMJ involvement.

METHODS

As a part of the screening program, 59 consecutive JIA patients age 7-14 years underwent a clinical examination according to RDC/TMD including self-reported orofacial pain and pain related to jaw function, and cone beam computer tomography (CBCT). Data were obtained from the patient's medical charts. Patients were divided into two groups based on the presence or absence of TMJ deformities on CBCT.

RESULTS

Self-reported TMJ symptoms before inclusion were reported by 52% of children with and 18% of children without TMJ deformities on CBCT (p = .020). On a group level, the maximum unassisted (mouth) opening (MUO) with and without pain was within the normal range, but children with TMJ deformities showed a significantly smaller MUO with pain (p = .035). A diagnosis of osteoarthritis and osteoarthrosis was more prevalent in children with TMJ deformities.

CONCLUSION

Although there were few differences between children with and without radiographic TMJ deformities, self-reported previous TMJ symptoms and reduced MUO with pain could indicate the presence of TMJ involvement. However, radiographic examinations are needed to confirm TMJ involvement. Thus, this study indicates that the RDC/TMD protocol is a blunt tool when targeting TMJ involvement in JIA.

Relationship between horizontal condylar angle and radiographically detectable morphological changes of the condyle in asymptomatic and symptomatic patients with TMD

Background

The relationship between horizontal condylar angle (HCA) measurements and radiographically detectable morphological changes of the condyle in patients with temporomandibular disorder (TMD) is an area of controversy in dentistry.

Aim

This study sought to determine the effect of the HCA on radiographically morphological changes in the condyles of asymptomatic and symptomatic patients with TMD.

Material & methods

Cone beam computed tomography (CBCT) scans were used of patients with 146 temporomandibular joints (TMJ) with and without symptoms of TMD. The reconstructed axial plane was adjusted to depict the condyle in maximum width. The HCA was established and measured as the angle formed between the condylar long axis intersecting with the coronal plane. Each condyle long axial was determined independently from the other joint by two oral and maxillofacial radiologists. The average of the readings from the two examiners was used for statistical analysis.

Results

Based on the clinical symptoms, the mean of the HCA in the symptomatic joint was 27.69°, which was slightly greater than the angle measured in asymptomatic patients of 25.6°; however, this was not a statistical difference. No significant differences existed in the mean of the HCA between the joint with and without radiographic arthritic findings in both groups. In both groups, none of the arthritic findings manifested in the affected joint that had influenced the HCA.

Conclusion

The HCA was increased in the symptomatic group but had no direct influence on joint's morphological changes in the asymptomatic and symptomatic patients.

The Organ of Vision and the Stomatognathic System-Review of Association Studies and Evidence-Based Discussion

The stomatognathic system is a functional complex of tissues and organs located within the oral and craniofacial cavities. The craniofacial anatomical factors and the biomechanics of the temporomandibular joints affect many systems throughout the body, including the organ of vision. However, few scientific reports have shown a relationship between the organ of vision and the stomatognathic system. The purpose of this review is to provide an overview of connections along neural, muscle-fascial, and biochemical pathways between the organ of vision and the stomatognathic system. Based on the literature presented in this review, the connections between the organ of vision and the stomatognathic system seem undeniable. Understanding the anatomical, physiological, and biochemical interrelationships may allow to explain the interactions between the mentioned systems. According to the current knowledge, it is not possible to indicate the main linking pathway; presumably, it may be a combination of several presented pathways. The awareness of this relationship among dentists, ophthalmologists, physiotherapists, and optometrists should increase for the better diagnosis and treatment of patients.

Painful and non-painful comorbidities associated with short- and long-term painful temporomandibular disorders: A cross-sectional study among adolescents from Brazil, Canada, and France

BACKGROUND

Temporomandibular disorder (TMD) pain is common among adolescents. The association between painful TMD and other comorbidities has been demonstrated. However, the difference between short-term (<6 months) and long-term (≥ 6 months) painful TMD is not yet clear.

OBJECTIVE

The aim of this study was to assess the association between comorbidities and short- and long-term painful TMD among adolescents.

METHODS

In this cross-sectional study, adolescents were recruited from Montreal (Canada), Nice (France), and Arceburgo (Brazil). Self-reported painful TMD, comorbidities, school absence, and analgesic intake were assessed using reliable instruments. Multivariable logistic regression analyses were conducted to assess the study aims.

RESULTS

The prevalence of short- and long-term painful TMD was estimated at 22.29% and 9.93%, respectively. The number of comorbidities was associated with short- (OR = 1.71, 95%CI = 1.53-1.90) and long-term painful TMD (OR = 1.79, 95%CI = 1.55-2.08) compared to controls. Frequent headaches (OR_short-term = 4.39, 95%CI = 3.23-5.98, OR_long-term = 3.69, 95%CI = 2.45-5.57) and back pain (OR_short-term = 1.46, 95%CI=1.06-2.03, OR_long-term  = 1.69, 95%CI = 1.11-2.59) were associated with both painful TMD groups. Frequent neck pain (OR = 2.23, 95%CI = 1.53-3.26) and allergies were only associated with short-term painful TMD (OR = 1.54, 95%CI = 1.13-2.10). Frequent stomach pain was related to long-term (OR = 2.01, 95%CI = 1.35-3.26), and it was the only comorbidity significantly more frequent among the long than short-term TMD (OR = 1.82, 95%CI: 1.14-2.90). These analyses were adjusted by sex, age, and city.

CONCLUSION

In this multi-center study, both short- and long-term painful TMD are associated with frequent headaches and back pain, whereas frequent neck pain and allergies are related to only short-term, and frequent stomach pain with long-term painful TMD.

Association between primary headaches and temporomandibular disorders: A systematic review and meta-analysis

BACKGROUND

The primary objective of this systematic review was to answer the following question systematically: Is there any association between primary headaches (PHs) and temporomandibular disorders (TMDs) in adults?

TYPES OF STUDIES REVIEWED

The protocol was registered with the International Prospective Register of Systematic Reviews. The authors performed the search in 7 main databases and 3 gray literature sources. The included articles had to have adult samples. PHs must have been diagnosed using the International Classification of Headache Disorders, and TMDs must have been diagnosed using Research Diagnostic Criteria for Temporomandibular Disorders, Diagnostic Criteria for Temporomandibular Disorders, or International Classification of Orofacial Pain. Risk of bias was evaluated using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument tools. The meta-analysis was performed using Review Manager software, Version 5.4. Certainty of evidence was screened according to Grading of Recommendations Assessment, Development and Evaluation.

RESULTS

Eight of 2,574 articles reviewed met the inclusion criteria for qualitative analysis and, of these, 6 met the inclusion criteria for quantitative analysis. Odds ratios (ORs) for painful TMD and tension-type headache (OR, 3.16; 95% CI, 1.80 to 5.54 to OR, 13.06; 95% CI, 2.79 to 61.12), migraines (OR, 5.35; 95% CI, 3.04 to 9.40 to OR, 6.22; 95% CI, 3.81 to 10.14), and chronic headaches (OR, 40.40; 95% CI, 8.67 to 188.15 to OR, 95.93; 95% CI, 12.53 to 734.27) were calculated. Articular TMDs without pain were evaluated in only 1 article, in which ORs of 1.78 (95% CI, 0.90 to 3.51) for migraines and 1.04 (95% CI, 0.53 to 2.06) for tension-type headache were reported. Three studies were classified as moderate risk of bias and 5 as low risk of bias. The certainty of evidence varied between very low and low.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Recognizing the positive association between painful TMD and PHs can help dentists and physicians treat the pain and avoid it, or recommend the patient to a specialist.

Internalizing problems are associated with oral health-related quality of life in early childhood: Outcomes from an Asian multi-ethnic prospective birth cohort

Oral health status ideally warrants for a holistic biopsychosocial approach to health and wellness. Little is known about the impact of behavioral problems on oral health-related quality of life (OHRQoL) in children due to the paucity of studies in early childhood, particularly in Asian multi-ethnic populations. This study evaluated the relationship between early child's socioemotional factors and OHRQoL, as well as its association with orofacial pain (OFP) and early childhood caries (ECC) in the Asian GUSTO birth cohort. Mother-child dyads were postnatally assessed at 3 time points. The Child Behavior Checklist (CBCL) was used to assess the child's socioemotional and behavioral problems at age 4-4.5 years together with other validated questionnaires to evaluate maternal anxiety and depression. ECC detection was performed at age 5, and OHRQoL (primary) and OFP (secondary) outcomes were assessed at age 6 from a total of 555 mother-child dyads. After a univariate regression analysis was performed to identify potential predictors and confounders, a multivariate regression model was run with predisposing factors (CBCL internalization and externalization problems, OFP, ECC) and adjusted for confounders (maternal psychosocial states, maternal education) to determine associations with OHRQoL. Results showed an association between CBCL internalization scores and poorer OHRQoL (RR = 1.03, p = 0.033, 95% CI 1.01 to 1.05), although the limited risk ratio may not have a practical applicability in psychosocially healthy children, alike the majority of those evaluated in this cohort. The average OHRQoL overall score among children with OFP was 2.39 times more than those without OFP (OR = 2.39, p < 0.001, 95% CI 2.00 to 2.86). Thus, in early childhood, OFP, and to lesser extent internalizing behaviors, may negatively impact OHRQoL. This study therefore highlights the complex relationship between OHRQoL and its predisposing socioemotional and somatic pain factors, and demands further investigations in clinically relevant populations.

Temporomandibular Myofascial Pain Syndrome-Aetiology and Biopsychosocial Modulation. A Narrative Review

This review elaborates on the aetiology, diagnosis, and treatment of temporomandibular (TMD) myofascial pain syndrome (MPS) regulated by psychosocial factors. MPS impairs functioning in society due to the accompanying pain. Directed and self-directed biopsychosocial profile modulation may be beneficial in the treatment of MPS. Moreover, nutrition is also a considerable part of musculoskeletal system health. A fruit and vegetable diet contributes to a reduction in chronic pain intensity because of its anti-inflammatory influence. Cannabidiol (CBD) oils may also be used in the treatment as they reduce stress and anxiety. A promising alternative treatment may be craniosacral therapy which uses gentle fascia palpation techniques to decrease sympathetic arousal by regulating body rhythms and release fascial restrictions between the cranium and sacrum. MPS is affected by the combined action of the limbic, autonomic, endocrine, somatic, nociceptive, and immune systems. Therefore, the treatment of MPS should be deliberated holistically as it is a complex disorder.

Diagnostic criteria for temporomandibular disorders (DC/TMD) for children and adolescents: An international Delphi study-Part 1-Development of Axis I

Background

Since in children and adolescence prevalence is assessed mainly on self‐reported or proxy‐reported signs and symptoms; there is a need to develop a more comprehensive standardised process for the collection of clinical information and the diagnosis of TMD in these populations.

Objective

To develop new instruments and to adapt the diagnostic criteria for temporomandibular disorders (DC/TMD) for the evaluation of TMD in children and adolescents.

Method

A modified Delphi method was used to seek international consensus among TMD experts. Fourteen clinicians and researchers in the field of oro‐facial pain and TMD worldwide were invited to participate in a workshop initiated by the International Network for Orofacial Pain and Related Disorders Methodology (INfORM scientific network) at the General Session of the International Association for Dental Research (IADR, London 2018), as the first step in the Delphi process. Participants discussed the protocols required to make physical diagnoses included in the Axis I of the DC/TMD. Thereafter, nine experts in the field were added, and the first Delphi round was created. This survey included 60 statements for Axis I, and the experts were asked to respond to each statement on a five‐item Likert scale ranging from ‘Strongly disagree’ to ‘Strongly agree’. Consensus level was set at 80% agreement for the first round, and at 70% for the next.

Results

After three rounds of the Delphi process, a consensus among TMD experts was achieved and two adapted DC/TMD protocols for Axis I physical diagnoses for children and adolescents were developed.

Conclusion

Through international consensus among TMD experts, this study adapted the Axis I of the DC/TMD for use in evaluating TMD in children and adolescents.

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.

Vitamin D and Temporomandibular Disorders: What Do We Know So Far?

Background and aims. Vitamin D is synthesized in the skin with the aid of ultraviolet-B radiation, playing a variety of roles in the body. Temporomandibular disorders (TMDs) are a group of pathological conditions involving the temporomandibular joints as well as the masticatory muscles and othersurrounding tissues. In the present narrative review, we investigated the potential role of vitamin D in the etiology of temporomandibular disorders in order todetermine whether the current knowledge supports 25-hidroxyvitamin D (25-OHD) supplementation in temporomandibular disorders associated with insufficient or deficient levels of vitamin D. Methods. A literature research was performed in PubMed, Scopus, Science Direct, and Google Scholar databases, and a total of 10 articles were included for analysis. Results.Among the observational studies published to date, investigating the role for vitamin D in the etiology of TMDs, six of them suggest that there is a connection between the two aspects. In this context, patients suffering from TMD, with deficient levels of vitamin D (<30 ng/mL), are most likely to benefit from supplementation, whereas individuals with vitamin D level >50ng/mL probably have little benefit from supplementation.Conclusion.Vitamin D might be a safe, simple, and potentially beneficial way to prevent TMDs or to reduce pain; however, more randomized and placebo-controlled trials are required before any firm conclusions can be drawn.

Masticatory muscles electrical activity, stress and posture in preadolescents and adolescents with and without temporomandibular dysfunction

OBJECTIVE

To verify the difference between the masticatory muscles' electrical activity, stress signals and the posture of preadolescents and adolescents with and without temporomandibular dysfunction (TMD).

METHODS

24 preadolescents and adolescents aged between 11 and 18 years old were divided into two groups, TMD group (TMDG) and control group (CG). All subjects were submitted to anthropometric measurements, psychological stress analysis, temporomandibular joint clinical evaluation and TMD verification; postural evaluation and masseter and temporal muscles electrical activity analysis during chewing. For statistical analysis, the Student's t-test or Mann-Whitney U test were used according to data distribution.

RESULTS

There was a significant difference between the groups for the electrical activity of the right temporal muscles (7.43% ± 2.92 vs. 11.71% ± 5.37) and left (7.70% ± 4.04 vs.11.44% ± 4.03) in the inactive period of chewing between CG and TMDG, respectively. There was no difference in stress or posture variables between groups.

CONCLUSIONS

During the inactive period of chewing, there was greater activation of the temporal muscles in the TMDG. Female gender was prevalent in TMDG. The study participants showed signs of stress, regardless of the group. The posture and TMD relationship still need to be studied.

Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis

OBJECTIVES

The aim of this systematic review was to evaluate the prevalence of temporomandibular joint disorders (TMJD) among the general population.

MATERIALS AND METHODS

Five main electronic databases and three grey literature were searched to identify observational studies in which TMJD was diagnosed using the research diagnostic criteria (RDC/TMD) or diagnostic criteria (DC/TMD). The studies were blindly selected by two reviewers based on eligibility criteria. Risk of bias (RoB) was assessed using the Joanna Briggs Institute Critical Appraisal Checklist, and the "R" Statistics software was used to perform meta-analyses.

RESULTS

From 2741 articles, 21 were included. Ten studies were judged at low RoB, seven at moderate, and four at high. The TMJD investigated were as follows: arthralgia, disk displacement (DDs) with reduction (DDwR), DDwR with intermittent locking, DDs without reduction (DDwoR) with limited opening, DDwoR without limited opening, degenerative joint disease (DJD), osteoarthritis, osteoarthrosis, and subluxation. The main results from prevalence overall meta-analyses for adults/elderly are as follows: TMJD (31.1%), DDs (19.1%), and DJD (9.8%). Furthermore, for children/adolescents are as follows: TMJD (11.3%), DDs (8.3%), and DJD (0.4%). Considering the individual diagnosis meta-analyses, the most prevalent TMJD is DDwR for adults/elderly (25.9%) and children/adolescents (7.4%).

CONCLUSIONS

The overall prevalence of TMJD was approximately 31% for adults/elderly and 11% for children/adolescents, and the most prevalent TMJD was DDwR.

CLINICAL RELEVANCE

Knowledge about the frequency of TMJD can encourage dentists to consider appropriate strategies for early and correct diagnosis and, if need be, correct management.

Comparison of the pattern of activation of the masticatory muscles among individuals with and without TMD: A systematic review

OBJECTIVE

To verify the characteristics of the electromyographic signal of masticatory muscles in individuals with TMD and asymptomatic individuals.

METHODS

A systematic review was carried out, selecting cross-sectional studies with at least one electromyographic parameter (FM; iEMG; RMS) of the masticatory muscles (anterior temporal, bilateral masseter, and suprahyoid muscles) of individuals with TMD compared to asymptomatic individuals.

RESULTS

This review identified 1656 titles, of which 30 articles were included in the final analysis. It was observed that the data referring to the pattern of activation of masticatory muscles in the rest, isometry, and isotonic conditions of individuals with TMD are heterogeneous. This fact may be related to variability in the methods and analyses applied in the studies.

CONCLUSION

Data referring to the pattern of activation of masticatory muscles in the rest and isometry conditions and in the mastication cycle of individuals with TMD and asymptomatic individuals are diverse.

Level of awareness of dentists about the role of physiotherapy in temporomandibular disorders: a pilot study in Riyadh, Saudi Arabia

Background

Physiotherapy (PT) is a distinguished developing profession. It has a crucial role in treating temporomandibular disorders (TMD) as an effective intervention to reduce pain and improve TMD symptoms. Not all dentists are aware of the importance of collaboration with physiotherapists (PTs).Therefore, this study aimed to assess the level of dentists’ awareness about the role of PT in treating TMD, identify dentists’ willingness to collaborate with PTs, and create collaboration awareness. This cross-sectional study included Saudi dentists in Riyadh. An online survey was used to assess dentist’s awareness and their readiness to collaborate with PTs.

Results

Out of 1500 dentists, only 162 participated in the survey. About 46.9% of dentists were aware that PT can treat TMD. Generally, there was lack of awareness about the benefits of PT among dentists (61.8%), and 59.9% was not aware that the evidence suggested that PT can improve TMD symptoms. Only 29% referred patients to PT. Upon the completion of the survey, almost all dentists (97.5%) were likely to refer patients with TMD to PT, and 90.7% of them showed interest to learn more about collaborating with PTs.

Conclusion

The study concluded that, although 46.9% of the dentists are aware about the role of PT in treating TMD, there is a lack of awareness about the benefits of PT among the majority of them. The study helped to extend the awareness of surveyed dentists about the collaboration and multidisciplinary approach.

Content and construct validity of the Diagnostic Criteria for Temporomandibular Disorders Axis I for children

OBJECTIVE

To perform the content and construct validation of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I, for children 7-11 years old.

MATERIALS AND METHODS

A Delphi process was used to perform the content validity of the DC/TMD Axis I. One hundred eighty-nine 7- to 11-year-old children were assessed with the adapted instrument. Confirmatory factor analysis (CFA) was used to investigate construct validity of the DC/TMD for children. A baseline one-factor model was compared against a two-factor (Model 2) and a seven-factor (Model 3) models based on the original DC/TMD. Root mean squared error of approximation (RMSEA), comparative fit index (CFI), chi-square, change in chi-square and Cronbach's α were used to analyse the data. All analyses were performed in STATA^© version 13.0.

RESULTS

Items of the DC/TMD were reduced, "history time" was changed to 2 weeks, pain intensity was assessed through a face scale, and language was adapted to be better understood by children. The amount of muscle pressure was maintained as in the original DC/TMD Axis I. The CFA led to a two- and a seven-factor model, with good fit. The internal consistency of Model 2 was .91 and of Model 3, .94.

CONCLUSION

The results of this study provide evidence to support a seven-factor representation of the DC/TMD Axis I for 7- to 11-year-old children, as well as a two-factor structure. Such findings will begin to provide researchers with confidence in the properties of this instrument when considering its inclusion in clinical research.

Association of oral parafunctional habits with anxiety and the Big-Five Personality Traits in the Saudi adult population

Background

Oral parafunctional habits are related to any abnormal hyperactivity of the oromandibular system. They are prevalent in all societies in varying intensity and have potential physical and psychological implications. The aim of this study was twofold: (1) to determine the prevalence of various types of oral parafunctional habits in the Saudi adult population, and (2) to examine their association with and the level of anxiety and personality factors.

Methods

This cross-sectional study was conducted with an electronic data collection form distributed to the public through social media. The questionnaire comprised of the following: (a) demographic information, (b) the Hamilton Anxiety Rating Scale (HAM-A), (c) the Ten-Item of Big-Five Personality Traits, (d) a list of oral parafunctional habits. Data were analysed using a Pearson’s Chi square and binary logistic regression.

Results

The participants reported several parafunctional habits including daily gum chewing (86%), lip/object biting (59%), clenching (45%), nail biting (36%) and grinding (32%). Males were 3 [2.3–3.7] times and younger age groups were 1.5 [1.1–2.0] times more likely to be associated with nail biting compared to their counter groups (adj.P < 0.001 and adj.P = 0.007). Lip/object biting was significantly 1.3 [1.1–1.7] times more prevalent in males (adj.P = 0.015). Participants who reported being extroverts were more likely to be associated with clenching (46.4%) (P = 0.024). An emotionally stable person was significantly less likely to be associated with nail biting (28.4%), grinding (24.9%), clenching (35.8%), and lip/object biting (48.4%) (P < 0.001each). Participants who reported conscientiousness and emotional stability were significantly less associated with TMD (P = 0.007, P < 0.001).

Conclusion

Oral parafunctional habits are highly prevalent in the Saudi adult population in varying degrees. Possible risk factors include males, younger age groups, single people, and being financially constrained.

Prevalence of anamnestic symptoms and clinical signs of temporomandibular disorders in adolescents-Results of the epidemiologic LIFE Child Study

BACKGROUND

Prevalence values for symptoms and signs of temporomandibular disorders (TMD) in adolescents vary within the literature due to differences in set-ups of examination protocols.

OBJECTIVES

The objective was to present prevalence values for symptoms and signs of TMD in German adolescents that were observed within a standardised examination. Prevalence values comparing gender or pubertal status should be investigated.

METHODS

A cross-sectional sample of the LIFE Child Study aged 10 to 18 was examined. A questionnaire gathering anamnestic symptoms of TMD was completed, and an examination according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) was performed by trained dentists. Pubertal status according to Tanner stages was documented. Descriptive statistics, Mann-Whitney U and Wilcoxon signed-rank tests were performed.

RESULTS

A total of 1.116 participants (mean age 12.9 years, 51.4% female) were consecutively recruited. Most prevalent anamnestic symptoms were headaches (55.7%) and temporomandibular joint (TMJ) sounds (17.6%). The major clinical sign was TMJ sounds (31.9%). Both the examination of muscles or TMJs showed that pain to palpation was statistically significantly higher than familiar pain (P < .001). Gender comparisons revealed higher prevalence values and an increase in TMD symptoms and signs during pubertal development in females.

CONCLUSION

The prevalence of self-reported headaches, as well as anamnestic and clinical TMJ sounds, was high in German adolescents. Prevalence values for pain to palpation and familiar pain obtained relevant differences. Considering the DC/TMD, females are more affected by TMD signs and symptoms that increase during pubertal development, than male adolescents.

Comorbid conditions associated with painful temporomandibular disorders in adolescents from Brazil, Canada and France: A cross-sectional study

BACKGROUND

Painful temporomandibular disorder (TMD) is common among adolescents. Presence of painful comorbidities may worsen painful TMD and impact treatment effectiveness.

OBJECTIVE

The aim of this study was to assess the association between painful TMD and comorbidities.

METHODOLOGY

In this cross-sectional study, adolescents were recruited in Montreal (Canada), Nice (France) and Arceburgo (Brazil). Reliable instruments were used to assess painful TMD and comorbidities. Multivariable logistic and linear regression analyses were conducted to assess the study aims.

RESULTS

The prevalence of self-reported painful TMD was estimated at 31.6%; Arceburgo (31.6%), Montreal (23.4%) and Nice (31.8%). Painful TMD was more common among girls than boys (OR = 1.96). Painful TMD was associated with a higher number of comorbidities (OR = 1.77); Arceburgo (OR = 1.81), Montreal (OR = 1.80) and Nice (OR = 1.72). A stronger association was found between painful TMD and headaches (OR = 4.09) and a weaker one with stomach pain (OR = 1.40). Allergies were also related to painful TMD (OR = 1.43).

CONCLUSION

Painful TMD was associated with comorbidities. Headaches were consistently associated with painful TMD. Other associations were modified by sex and/or covariates related to the cities where participants were recruited.

Association of Temporomandibular Disorder Symptoms with Anxiety and Depression in Saudi Dental Students

BACKGROUND

Temporomandibular dysfunction (TMD) is a term that encompasses a set of chronic painful conditions, and dysfunction in the orofacial region involving the muscles of mastication, the temporomandibular joints (TMJ) and related structures. It can affect individuals of any age.

AIM

We investigated the prevalence of temporomandibular disorder (TMD) and its association with anxiety and depression.

METHODS

Cross sectional study that conducted among 105 dental students (age 20-35 years). The assessment instruments were the Fonseca Anamnestic Questionnaire and the Hospital Anxiety and Depression Scale.

RESULTS

TMD was present in 52 (49.5%) students, and anxiety or depression was present in 53 (50.5%) students. The results of the HAD scale showed that 92 (83.4%) students had some level of anxiety or depression, 38 (36.2%) were border line for anxiety or depression, and 80 (76.2%) were diagnosed with anxiety or depression while regarding to the association of TMD with gender, 9 of 48 (17.3%) were males and 39 (82.7%) were females (P-value = 0.001).

CONCLUSION

Our study revealed a high prevalence of TMD. The women had a higher prevalence of TMD. Also, we reported the higher prevalence of anxiety and depression among TMD students.

Effect of arthrocentesis on the clinical outcome of various treatment methods for temporomandibular joint disorders

Background

We evaluated the improvement of pain and the increase in mouth opening after temporomandibular joint arthrocentesis and the possible association with various factors such as previous splint treatment, medication, and diagnosis.

Results

We studied 57 temporomandibular joint disorder patients who underwent arthrocentesis at Korea University Anam Hospital. These patients (24 males and 33 females, aged between 15 and 76 years) underwent arthrocentesis that was performed by one surgeon. The degree of mouth opening (assessed using the maximum mouth opening: MMO) and pain (assessed using the visual analog scale: VAS) were assessed pre- and post-arthrocentesis. The study also investigated whether treatment modalities other than arthrocentesis (medication and appliance therapy) were performed. Statistical analysis revealed that there was a significant difference in mouth opening and pain after temporomandibular joint arthrocentesis. Preoperative appliance therapy affected the results of arthrocentesis, but it was not statistically significant. With regard to pain relief, preoperative diagnosis did not show a significant difference. However, with regard to maximum mouth opening, patients with disc displacement without reduction with limited mouth opening (closed lock) showed the highest recovery (11.13 mm).

Conclusion

The average of MMO increase after arthrocentesis was 9.10 mm, and patients with disc displacement without reduction with locking (closed lock) showed most recovery in maximum mouth opening and it was statistically significant. The average pain relief of patients after arthrocentesis was 3.03 in the VAS scale, and patients using anterior repositioning splint (ARS) preoperatively showed the most pain relief.

Signos y síntomas asociados a trastornos temporomandibulares en niños y adolescentes. Cali, Colombia

Los trastornos temporomandibulares (TTM) en pacientes pediátricos se han estudiado poco. Realizar un diagnóstico oportuno, hace que exista mayor interés por parte de los investigadores para orientar a los odontólogos. El objetivo del estudio fue identificar la presencia de trastornos temporomandibulares registrados en las historias clínicas de pacientes atendidos en la clínica de Odontopediatría de la Universidad del Valle. Se realizó un estudio observacional descriptivo y transversal para evaluar presencia de trastornos temporomandibulares en pacientes, en edades entre 4 a 14 años, que asistieron a las clínicas de Odontopediatría de la Universidad del Valle (Cali-Colombia), durante 2013 y 2016. Se revisaron, 712 historias; 56% de sexo masculino y 44% de  sexo femenino. El 18,11% reportaron la presencia de al menos. Los signos y síntomas asociados con los TTM, los más frecuentes fueron el click bilateral (36,4%), la desviación y deflexión mandibular (27,1%) y dolor a la palpación (24,0%). La subluxación (1,6%) y el chasquido articular en apertura (0,8%) fueron los de menor presencia. Se concluyó que los trastornos de la ATM cada vez son mayores, es importante, realizar investigaciones que involucren los factores de riesgo y/o desencadenantes, la intervención oportuna y el manejo multidisciplinario de esta alteración. 

Impact of Temporomandibular Joint Complaints on Tinnitus-Related Distress

There is increasing evidence of associations between the presence of temporomandibular joint (TMJ) disorders and tinnitus. It has been recently proposed that tinnitus patients with TMJ complaints could constitute a subtype, meaning a subgroup of tinnitus patients responsive to specific treatments. Tinnitus patients with TMJ complaints are often young women with somatosensory features of their tinnitus. Here, we investigate the socio-economic factors, phenotypic characteristics and psychological variables of tinnitus subjects from the Swedish Tinnitus Outreach Project, with (n = 486) or without (n = 1,996) TMJ complaints. The prevalence of TMJ complaints was greater in tinnitus subjects with severe tinnitus (36%) when compared to those with any tinnitus (19%), strongly indicating the contribution of TMJ problems to the severity of tinnitus. Comparing subgroups with or without TMJ complaints in the whole sample, differences were found regarding a large number of socioeconomic, phenotypic, and psychological characteristics. Subjects with TMJ complaints were more often women, more often reported stress as the cause of tinnitus, were more severely affected by tinnitus, scored worse in measures of psychological well-being and life quality, and were more often affected by problems tolerating sounds, headache, vertigo/dizziness, and neck pain. In addition, they more often reported pulsating and tonal tinnitus, somatic modulation of tinnitus, and aggravation of tinnitus by loud sounds and stress. When focusing the analysis in subjects with tinnitus as a big problem using the Tinnitus Functional Index cut-off ≥ 48, or with severe tinnitus according to the Tinnitus Handicap Inventory cut-off ≥ 58, the impact of somatosensory modulations and stress on tinnitus were greater in subjects with TMJ complaints in comparison to those without. In light of these results, we hypothesize that stress could contribute to the co-occurrence of TMJ problems and tinnitus and also to the development of severe tinnitus. Our study supports the need of involving dental care and stress management in the holistic treatment of patients with severe tinnitus.

Oral diseases and oral health related behaviors in adolescents living in Maasai population areas of Tanzania: a cross-sectional study

Background

Oral diseases, such as dental caries, tooth wear, dental erosion and periodontal diseases are major health problems in many societies. The study aim was to explore the association between oral health related behaviors and the presence of oral diseases in adolescents living in Maasai population areas in the northern part of Tanzania.

Methods

A cross sectional study was conducted in 2016 using one stage cluster sample design. A total of 989 adolescents were invited and 906 (91.6%; (Maasais n = 721, non Maasais n = 185) accepted the invitation and completed an interview and clinical oral examination in a school setting (mean age 13.4 years, SD 1.2, range 12–17 years). Chi-square test, bivariate analysis and logistic regression were performed to analyze data.

Results

Logistic regression revealed that: adolescents with low frequency of tooth cleaning (OR = 10.0, CI 4.3–20.0) was associated with poor oral hygiene and that more regular tooth cleaning (OR = 0.1, CI 0.04–0.14) and the use of plastic type of tooth brush (OR = 0.7, CI 0.53–0.99) were associated with less gingival bleeding. High consumption of biscuits (OR = 2.5, CI 1.7–3.8) was associated with presence of dental caries and the use of magadi (OR = 24.2, CI 11.6–50.6) as a food additive was the covariate for more severe dental fluorosis (TF grade 5–9). Regular intake of carbonated soft drinks (OR = 1.6, CI 1.1–2.5) and regular tooth cleaning (OR = 1.7, CI 1.1–2.6) were independently associated with dental erosion. Using teeth as a tool for: biting nails (OR = 1.9, CI 1.4–2.4), opening soda (OR = 1.8, CI 1.4–2.4) and holding needles (OR = 1.6, CI 1.3–2.1) were covariates for tooth wear. Adolescents who reported to clench/grind their teeth (OR = 2.3, CI 1.5–3.7) was the only covariate for TMD. In several of the investigated factors, there were significant differences between the Maasai and non Maasai ethnic groups.

Conclusion

Oral health related behaviors have a significant impact on oral diseases/conditions among adolescents attending primary schools in Maasai population areas with obvious differences in behavior between the Maasai and non Maasai ethnic groups. There is a need for addressing oral health and to encourage behaviors that promote good oral health and dental care service utilization in this society.