Psychological factors and the incidence of temporomandibular disorders in early adolescence

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.

Association of stress, anxiety, and depression levels with sleep quality in patients with temporomandibular disorders

OBJECTIVE

To examine the psychological symptoms of TMD and their effects on sleep quality in patients with temporomandibular disorders.

METHODS

The study was carried out with 425 consecutive TMD patients who sought care at the oral and maxillofacial surgery clinic of a faculty of dentistry. Perceived Stress Scale-14, Beck Anxiety Scale, and Beck Depression Scale were used to evaluate the psychological state. Sleep quality was evaluated with the Pittsburgh Sleep Quality Index.

RESULTS

The mean sleep score of all participants was 6.52. As the level of anxiety and depression increased, the scores of both total sleep quality and sleep quality components increased significantly p < 0.01. On the other hand, those with poor sleep quality had significantly higher stress, anxiety, and depression levels than those with good sleep quality p < 0.01.

CONCLUSION

Negative emotional situations such as stress, anxiety, and depression seriously impair sleep quality in TMD patients.

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.

[On the role of psychological disorders in the development of the syndrome of pain dysfunction of the temporomandibular joint]

There are significant disagreements related to the understanding of the etiopathogenesis of the syndrome of pain dysfunction of the temporomandibular joint. This review article examines the role of patient's psychological status as a significant factor influencing the occurrence and complications of this pathology, as evidenced by an increase in stress, anxiety, and depression in patients with the dysfunction. The need for a multidisciplinary and individual approach to the diagnosis and treatment is also discussed, which can significantly alleviate the severity of the disease, reduce complications, and shorten the rehabilitation time.

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.

Effects of estradiol hormone in menopausal women on anterior disc displacement of temporomandibular joint

Anterior disc displacement is a condition when the articular disc is in the anterior normal position. Epidemiological research shows that the prevalence of TMD is higher in women than in men. Women have a dominant hormone that is not owned by men, the hormone estradiol. Estrogen receptors and the hormone progesterone are found in articular joints in humans. Joint structure, extracellular matrix remodeling, and bone volume modification can be affected by sexual hormones. It was thought to cause changes in connective tissue in the TMJ structure. This study aims to determine the effect of the level of the hormone estradiol in menopausal women on anterior temporal disc displacement of the temporomandibular joint. Subjects were 40 postmenopausal women who were examined for temporomandary joints. The diagnosis of anterior disc displacement was made using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC / TMD) method. Subjects were grouped into subjects with normal tempromandibular joints and subjects with anterior disc displacement. Estradiol hormone was examined by the immunoassay method. This study’s conclusion is estradiol hormone in menopausal women with anterior disc displacement is higher than menopausal women without anterior disc displacement.

The study of facial morphology in patients with vertical growth pattern (hyperdivergent) lacking or showing temporomandibular disorders symptoms

AIM

According to the large number of studies, there seems to be a significant relation between hyperdivergence growth pattern and temporomandibular disorders. However, it is not clearly scrutinized which morphological factors can contribute to the development of temporomandibular disorders. The aim of this study was to investigate the relation between some skeletal and facial morphologic features of hyperdivergent facial growth pattern patients and temporomandibular disorders.

MATERIALS AND METHODS

This case-control study was performed on a population of 50 patients including 25 patients with temporomandibular disorder and 25 non- temporomandibular disorder individuals aged between 15-30 years with hyperdivergent growth pattern (Frankfurt Mandibualr plane angle between 28 and 35 degree). Two groups of symptomatic and asymptomatic patients (case and control) were matched for age and gender. In order to evaluate the skeletal and dental variables, lateral cephalometries was taken and traced after obtaining written consent from the patients. The measured variables were A point to Nasion to B point, Frankfurt plane to Nasion to Pogonion, Nasion to A point to Pogonion, Sella to Gnathion to Frankfurt plan, Articular point to Gonion-Menton, Sella to Articular point to Gonion, Palatal plane to Mandibular plane, and Articular point to Gonion angles. The intervals of Basion to Nasion, Sella to Basion, Gonion to Menton, and amounts of Anterior facial height meas, Upper Anterior facial height ratio to Lower Anterior facial height, posterior facial height, overjet, and overbite Data were analyzed by Chi² test, t-test, and multivariate test.

RESULTS

According to the descriptive statistics, the age of the control and case groups averaged 21.12±1.99 and 21.63±1.58 years respectively. Among the people referred to the dental school, the frequency of males and females in the control and case groups were 6, 7 and 19, 18 respectively. The results of t-test and multivariate tests indicated significant differences between the two variables of overbite and mandibular length.

CONCLUSION

The present study revealed increased overbite (dental feature) and mandibular length (skeletal feature) is more likely to be associated with a higher risk of temporomandibular disorders joint disease in patients with hyperdivergent facial growth pattern.

CLINICAL SIGNIFICANCE

Treatment of the deep bite condition can be helpful in improving temporomandibular disorder.

Conhecimento de cirurgiões-dentistas sobre a relação entre disfunção temporomandibular e fatores oclusais

Resumo Introdução As evidências científicas atuais têm demonstrado que o tratamento para disfunção temporomandibular deve seguir uma abordagem conservadora e adaptada ao estado psicossocial do paciente. Entretanto, tratamentos visando às alterações oclusais foram utilizados durante anos pelos cirurgiões-dentistas e o abandono destes paradigmas é essencial para o desenvolvimento da Odontologia. Objetivo Objetivou-se avaliar o conhecimento de cirurgiões-dentistas (CD) sobre a relação entre disfunção temporomandibular (DTM) e fatores oclusais. Material e método Foi enviado, por e-mail, um questionário previamente publicado para os CD registrados no Conselho Regional de Odontologia do Piauí, Brasil (n = 2.500) com dados sobre o profissional, sua formação e seu conhecimento sobre DTM e fatores oclusais. O consenso da literatura atual, “padrão-ouro”, foi comparado com as respostas obtidas. Os dados foram analisados descritivamente e através dos testes qui-quadrado e odds ratio (p<0,05). Resultado Quinhentos e cinco CD responderam e 434 compuseram a amostra. A maioria dos participantes era mulher (72,3%), com 7,2 (±6,63) anos de formados, e trabalhava no setor público-privado (39,0%). Os CD foram divididos em dois grupos: GEsp.: especialistas em DTM, Prótese Dentária e/ou Ortodontia (n=234) e GClín.: clínicos gerais e demais especialistas (n=200). GEsp. e GClín. apresentaram respostas similares para a metade das perguntas. Quatro (de seis) perguntas foram respondidas em desacordo com o padrão-ouro: fatores oclusais, interferências em lado de não trabalho, terapia ortodôntica e ajuste oclusal mostraram ser assuntos pouco conhecidos. GEsp. apresentou maior conhecimento com diferença significativa em relação a GClín. acerca da DTM e das interferências oclusais [odds ratio = 2,341 (1,305-4,202), p=0,004]. Conclusão Pode-se concluir que os CD da amostra estudada apresentaram deficiências acerca do conhecimento da relação entre DTM e fatores oclusais. Especialistas em DTM, Prótese Dentária e/ou Ortodontia não demonstraram um maior nível de conhecimento quando comparados aos demais.

Using the child behavior checklist to determine associations between psychosocial aspects and TMD-related pain in children and adolescents

BACKGROUND

Since children and adolescents are frequently experiencing emotional and behavioral consequences due to pain, their parents should be aware of this emotional and behavioral status. Therefore, the aim of this study was to analyze and describe the parents' reports of the emotional and behavioral status of children and adolescents with different types of temporomandibular disorders using the Child Behavior Checklist.

METHODS

This Cross-sectional study comprises of 386 randomly selected children and adolescents that ages between 10 and 18 years in Jeddah. One day prior the clinical examination according to Research Diagnostic Criteria for temporomandibular disorders (TMD) Axis I and II, Arabic version of the Child Behavior Checklist scale was distributed to the parents of participant. According to the diagnosis, the participants were divided into three groups; non-TMD group, TMD-pain group, and TMD-painfree group.

RESULTS

In regard to internalizing problems, the parents to the children and adolescents in the TMD-pain group rated a higher frequency of anxiety, depression and somatic complaints in their children than the parents of children in the non-TMD group (p < 0.05). Only one significant association regarding the externalizing problems was found for the aggressive behavior in the TMD-pain group.

CONCLUSION

The parents rated that their children with TMD-pain suffer from emotional, somatic and aggressive behavior to a higher degree than healthy control subjects. Also, the parents believed that TMD-pain influenced their children's physical activities but not social activities.

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 temporomandibular disorders discovered incidentally during routine dental examination using the Research Diagnostic Criteria for Temporomandibular Disorders

OBJECTIVES

The aim of this study was to assess the prevalence of temporomandibular disorders (TMDs) discovered incidentally during routine dental examination, identify disease patterns, and evaluate patients' attitude toward accepting treatment.

STUDY DESIGN

A total of 3009 patients were examined at the University Dental Hospital Sharjah (Sharjah, United Arab Emirates). Research Diagnostic Criteria for TMD (RDC/TMD) Axes I and II were used for assessment. Patients with acute/serious dysfunction symptoms underwent cone beam computed tomography examination. Magnetic resonance imaging was used to confirm the diagnosis of disk displacement.

RESULTS

Non-self-reported TMD prevalence was 10.8% (n = 325). Among patients with TMDs, women were diagnosed more often (65.85%) (P < .05) and those between ages 25 and 45 years (65.54%) (P < .05). Axis I assessment revealed disk displacement with reduction (group IIa) was the most common (40.92%). Axis II chronic pain grade showed that 32.62% of patients with TMDs experienced chronic pain, whereas 66.77% had mild disability. Interest in pursuing treatment was indicated by 92.31% of patients. Cone beam computed tomography and magnetic resonance imaging assessments changed the primary diagnosis in 26.08% and 18.47% of cases, respectively.

CONCLUSIONS

TMD screening during routine dental examination led to the diagnosis of non-self-reported TMDs, most commonly related to disk displacement with reduction. Radiographic assessment was important to confirm TMD diagnosis. Patients diagnosed with TMD during dental screening expressed interest in pursuing treatment.

Assessment of risk factors for oro-facial pain and recent developments in classification: implications for management

Oro-facial pain research has during the last decades provided important novel insights into the basic underlying mechanisms, the need for standardised diagnostic procedures and classification systems, and multiple treatment options for successful rehabilitation of the patient in pain. Notwithstanding the significant progress in our knowledge spanning from molecules to chair, there may also be limitations in our ability to integrate and interpret the tremendous amount of new data and information, in particular in terms of the clinical implications and overriding conceptual models for oro-facial pain. The aim of the present narrative review is to briefly summarise some of the current thoughts on oro-facial pain mechanisms and recent attempts to identify biomarkers and risk factors leading to the proposal of a new risk assessment diagram for oro-facial pain (RADOP) and a provocative new concept based on stochastic variation between multiple risk factors. Finally, the implications for novel management strategies will briefly be discussed.

The associations between psychosocial aspects and TMD-pain related aspects in children and adolescents

Background

Temporomandibular disorders (TMD) in children and adolescents is prevalent with pain as a common component, and has a comorbidity with psychosocial problems such as stress, depression, anxiety as well as somatic complaints. Therefore, the aim of the study was to investigate if psychosocial problems in children and adolescents are associated with TMD with pain (TMD-pain) and TMD without pain (TMD-painfree) when compared to children and adolescents without TMD.

Methods

This cross-sectional study consisted of 456 randomly selected children and adolescents, enrolled from 10 boy’s- and 10 girl’s- schools in Jeddah, between 10 and 18 years of age. On the examination day, prior to the clinical examination according to Research Diagnostic Criteria for TMD Axis I and II, the participants first answered two validated questions about TMD pain, and after that the Arabic version of the Youth Self Report scale. According to their clinical examination and diagnosis the participants were divided into three groups; non-TMD group, TMD-pain group, and TMD-painfree group.

Results

The TMD-pain group presents a higher frequency of the internalizing problems anxiety, depression and somatic complaints than non-TMD group (p < 0.05). Regarding externalizing problems the only significant association found was for aggressive behavior in the TMD-pain group (p < 0.05). The TMD-pain group also shows a higher frequency of social problems than the non-TMD group. However, no such difference was found when compared to the TMD-painfree group. There was also a significant association with a higher frequency of thought problems in the TMD-pain group (p < 0.05). The children’s and adolescents’ physical activities were within border line clinical range for all three groups, whereas the social competence was within the normal range. There were no significant associations between any of the groups in this respect.

Conclusions

TMD-pain in children and adolescents does not seem to affect the social activities. However, TMD-pain seem to have a strong association to emotional, behavior and somatic functioning, with higher frequencies of anxiety, depression, somatic problems, aggressive behavior and thought problems, than children and adolescents without TMD-pain. With respect to the biopsychosocial model the present study indicates that there are significant associations to psychosocial, somatic and behavioral comorbidities and TMD-pain in children and adolescents in the Middle East region.

Jaw disorders in the pediatric population

PURPOSE

This article will review the etiology, risk factors, history, and physical assessment of temporomandibular joint disorders (TMDs). In particular, this article discusses the role of the pediatric provider in diagnosing and beginning the initial treatment of TMDs, as well as the appropriate treatment plans. It also reveals some of the controversies regarding etiology and treatment of TMDs, as well as the paucity of research specific to TMDs in pediatrics.

DATA SOURCES

A computerized search in PubMed and Ovid Medline, from 2006 to 2012, was conducted. A few seminal articles were included that were published before 2006. Hand searching was also performed, which included a few articles between 2012 and 2015.

CONCLUSIONS

Although TMDs are mostly found in adults, it is also a finding in pediatrics, which increases in prevalence during adolescence. More research specific to pediatric patients with TMDs needs to be conducted so that pediatric-specific care can be provided.

IMPLICATIONS FOR PRACTICE

TMD is a condition found in the pediatric population, and it is important for providers to take an adequate history and physical examination that incorporates the temporomandibular joint (TMJ) and muscles of mastication. It is also critical that providers begin initial education and management, followed by appropriate referrals.

Prevalence and association of self-reported anxiety, pain, and oral parafunctional habits with temporomandibular disorders in Japanese children and adolescents: a cross-sectional survey

Background

Associations between temporomandibular disorder (TMD) and psychological variables, pain conditions, and daily activities have been reported more commonly in middle-aged individuals than in children. However, to determine factor-specific preventive programs for TMD, it is important to evaluate the associations between multiple factors and TMD symptoms during childhood. The aim of this study was to assess the relationship between TMD symptoms and other orofacial pain conditions, daily activities, and trait anxiety in a population-based cross-sectional survey of Japanese children and adolescents.

Methods

A total of 1,415 subjects (11–15 years old) self-reported their TMD symptoms, headache, neck pain, and toothache, and completed questionnaire scales that assessed 15 daily activities. Trait anxiety was assessed using the State Trait Anxiety Inventory for Children-Trait (STAIC-T) scale. Subjects were dichotomized into a TMD group or control group, based on whether they reported at least 1 TMD symptom: the TMD group (≥1 TMD symptom, n = 182) and the control group (no TMD symptoms, n = 1,233). Data were analyzed using the chi-square test and multivariate logistic regression analysis.

Results

The prevalence rates for headache and neck pain were significantly higher in the TMD group than in the control group (44.0% vs. 24.7% and 54.4% vs. 30.0%, respectively; both P < 0.001). The odds ratios for TMD symptoms in subjects with neck pain and frequent diurnal clenching were 2.08 (P < 0.001) and 3.69 (P = 0.011), respectively. Moreover, high STAIC-T scores were weakly associated with TMD symptoms.

Conclusions

In this young Japanese population, TMD symptoms were associated with other orofacial pain conditions, particularly neck pain, although they were only weakly associated with trait anxiety. Diurnal clenching was strongly associated with TMD symptoms. Health professionals should carefully consider these factors when developing appropriate management strategies for TMD in children and adolescents.

A cohort study of patients with juvenile idiopathic arthritis and arthritis of the temporomandibular joint: outcome of arthrocentesis with and without the use of steroids

The purpose of this study was to evaluate the effects of intra-articular temporomandibular joint (TMJ) treatment in patients with juvenile idiopathic arthritis (JIA). The inclusion criteria were met by 21 patients (38 joints). Joints were randomly selected for either arthrocentesis alone (n=17) or arthrocentesis with the additional use of triamcinolone hexacetonide (n=21) using a closed single-needle system. Measurements of pain and function were performed at baseline and at follow-up after 3 and 8 months. Pain on opening and lateral excursion improved significantly after injections. Pain decreased significantly from baseline to first and second control on a visual analogue scale (VAS) for overall pain (49-18-8) and overall function (41-19-4). Significant improvement was recorded for pain on palpation of muscles and joints. There was no statistically significant difference between the treatment modalities, with or without glucocorticoid injection. Arthrocentesis in the TMJ treatment of patients with JIA may be beneficial and steroids had no additional effect. Further studies are needed to evaluate the long-term effects on the TMJ structures and on condylar growth from arthrocentesis and intra-articular steroid injections.

A cross-sectional study of the relationship between serum sexual hormone levels and internal derangement of temporomandibular joint

Temporomandibular disorders (TMD) are defined as clinical conditions that involve the masticatory muscles, temporomandibular joint (TMJ) or both. The aim of this study was to evaluate serum 17β-oestradiol and progesterone levels in menstruating women affected by internal derangement of the TMJ. A total of 142 women (mean age 30·2 ± 6·7) who referred to medical diagnostic laboratory of Iranian Academic Centre for Education, Culture and Research (ACECR), Mashhad Branch, were enrolled during 2007 and 2008. Forty-seven individuals had disc displacement with reduction (Group IIa) according to Research Diagnostic Criteria (RDC)/TMD Axis I diagnosis. Radioimmunoassay was used for the detection of serum 17β-oestradiol and progesterone levels in all 142 subjects. The mean progesterone level was significantly higher in control group (11·6 ± 10·4 ng mL(-1) ) compared to women with TMD (8·4 ± 6·8 ng mL(-1) , P = 0·03). No significant difference was found in two groups regarding 17β-oestradiol level. Lower progesterone level in women with TMD can suggest the more important role of this hormone in the development of the disorder.

Influence of sociodemographic factors upon pain intensity in patients with temporomandibular joint disorders seen in the primary care setting

Objective: A study is made of the influence of gender, educational level, marital status, income, social support, and perceived general and oral health upon pain intensity in a sample of patients with temporomandibular joint disorders (TMJD) explored in primary care (AP). Design: A review was made of 899 patients from Córdoba Healthcare District (Spain) referred to the primary care TMJD Unit by their primary care physician and/or dentist. Of these subjects, 151 failed to meet the inclusion criteria. The remaining 748 subjects were explored according to the corresponding research diagnostic criteria (RDC/TMJD). A bivariate analysis was made the association of pain intensity to the demographic and psychological characteristics of the patients, and to perceived general and oral health, followed by a multivariate linear regression analysis to explain pain intensity as a function of the rest of the variables. The SPSS version 19.0 statistical package was used. Results: The patient age ranged from 18-86 years, with a mean of 45.8 years (± 15.8), and a female predominance of 5:1. The characteristic pain intensity (CPI) score was almost 15 points higher on average in women than in men (p<0.05). A lower educational level, and separation or divorce, were correlated to an increased intensity of pain. Social support, depression and general and oral health also explained part of pain intensity. The regression model established with these variables accounted for 13.3% of the variability of pain (R2 = 0.133). Conclusions: Women suffer more intense pain than men. Perceived health partially explains the variability of the CPI score. However, it is empirically seen that the variables gender, educational level and marital status exert an important and independent influence upon pain intensity.

Key words:Cranial-mandibular disorders, age, gender, educational level, primary care, research diagnostic criteria for temporomandibular joint disorders (RDC/TMD).

Prevalence and risk indicators of temporomandibular disorder signs and symptoms in a pediatric population with spastic cerebral palsy

OBJECTIVE

To determine risk indicators for signs and symptoms of temporomandibular disorders (TMD) in children with cerebral palsy (n = 60) and control subjects (n = 60).

STUDY DESIGN

The subjects were assessed by means of questionnaire and clinical exam: 1) signs and symptoms of TMD; 2) malocclusions [Dental Aesthetic Index (DAI)]; 3) harmful habits; and 4) bio-psychosocial characteristics. Statistical analysis involved the chi-square, Fisher's exact tests (p < or = 0.05) and multivariate logistic regression (forward stepwise procedure). Variables that achieved a p-value < or = 0.20 were used as potential predictors of signs and symptoms of TMD and applied as co-variables in the multivariate analysis.

RESULTS

The prevalence of at least one sign and/or symptom of TMD in the present sample was 1.7% (n = 1) among the individuals in the control group and 13.3% (n = 8) among the individuals with cerebral palsy. The presence of cerebral palsy (Odds Ratio: 9.08; p = 0.041), male gender (OR: 6.21; p = 0.027), severity of the malocclusion (OR: 4.75; p = 0.031), mouth breathing (OR: 5.40; p = 0.022) and mixed dentition (OR: 4.73; p = 0.035) were identified as risk indicators for signs and symptoms of TMD.

CONCLUSIONS

It was concluded that children with cerebral palsy had a significantly greater chance of developing signs and symptoms of TMD.

Evaluating oral health-related quality of life measure for children and preadolescents with temporomandibular disorder

BACKGROUND

Oral health-related quality of life (OHRQoL) in children and adolescents with signs and symptoms of temporomandibular disorder (TMD) has not yet been measured. This study aimed to evaluate the validity and reliability of OHRQoL measure for use in children and preadolescents with signs and symptoms of TMD.

METHODS

Five hundred and forty-seven students aged 8-14 years were recruited from public schools in Piracicaba, Brazil. Self-perceptions of QoL were measured using the Brazilian Portuguese versions of Child Perceptions Questionnaires (CPQ)8-10 (n = 247) and CPQ11-14 (n = 300). A single examiner, trained and calibrated for diagnosis according to the Axis I of the Research Diagnostic Criteria for TMD (RDC/TMD), examined the participants. A self-report questionnaire assessed subjective symptoms of TMD. Intraexaminer reliability was assessed for the RDC/TMD clinical examinations using Cohen's Kappa (κ) and intraclass correlation coefficient (ICC). Criterion validity was calculated using the Spearman's correlation, construct validity using the Spearman's correlation and the Mann-Whitney test, and the magnitude of the difference between groups using effect size (ES). Reliability was determined using Cronbach's alpha, alpha if the item was deleted and corrected item-total correlation.

RESULTS

Intraexaminer reliability values ranged from regular (κ = 0.30) to excellent (κ = 0.96) for the categorical variables and from moderate (ICC = 0.49) to substantial (ICC = 0.74) for the continuous variables. Criterion validity was supported by significant associations between both CPQ scores and pain-related questions for the TMD groups. Mean CPQ8-10 scores were slightly higher for TMD children than control children (ES = 0.43). Preadolescents with TMD had moderately higher scores than the control ones (ES = 0.62; p < 0.0001). Significant correlation between the CPQ scores and global oral health, as well as overall well-being ratings (p < 0.001) occurred, supporting the construct validity. The Cronbach's alphas were 0.93 for CPQ8-10 and 0.94 for CPQ11-14. For the overall CPQ8-10 and CPQ11-14 scales, the corrected item-total correlation coefficients ranged from 0.39-0.76 and from 0.28-0.73, respectively. The alpha coefficients did not increase when any of the items were deleted in either CPQ samples.

CONCLUSIONS

The questionnaires are valid and reliable for use in children and preadolescents with signs and symptoms of temporomandibular disorder.

Validation of the multimedia version of the RDC/TMD axis II questionnaire in Portuguese

OBJECTIVE

The aim of the study was to validate the multimedia version of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis II Questionnaire in Portuguese language.

MATERIAL AND METHODS

The sample comprised 30 patients with signs and symptoms of temporomandibular disorders (TMD), evaluated at the Orofacial Pain Control Center of the Dental School of the University of Pernambuco, Brazil, between April and June 2006. Data collection was performed using the following instruments: Simplified Anamnestic Index (SAI) and RDC/TMD Axis II written version and multimedia version. The validation process consisted of analyzing the internal consistency of the scales. Concurrent and convergent validity were evaluated by the Spearman's rank correlation. In addition, test and analysis of reproducibility by the Kappa weighted statistical test and Spearman's rank correlation test were performed.

RESULTS

The multimedia version of the RDC/TMD Axis II questionnaire in Portuguese was considered consistent (Crombrach alpha = 0.94), reproducible (Spearman 0.670 to 0.913, p<0.01) and valid (p<0.01).

CONCLUSION

The questionnaire showed valid and reproducible results, and represents an instrument of practical application in epidemiological studies of TMD in the Brazilian population.