Signs and symptoms of Temporomandibular Disorders in the elderly

A systematic review of temporomandibular disorder diagnostic methods

Objective: To compile the screening tools used to study temporomandibular disorders (TMD), classify and analyze their potential application in the field of physiotherapy.Methods: All gathered data included randomized clinical trials on humans over 18 years of age pulled from three databases up to November 2019.Results: Nineteen articles were retained, in which the subjects included 1095 women and 385 men. The 32 valuation systems reported were classified as follows: direct, requiring observation and/or palpation in situ by a clinician, which can be subdivided into protocols and instrumental systems; and indirect, requiring neither observation nor palpation by a clinician, which can be subdivided into questionnaires and scales.Conclusion: In order to evaluate TMD, the best choice is to combine direct and indirect assessment methodologies. The valuation of pressure pain threshold with an algometer and Fonseca's Anamnestic Index in combination with Anamnestic Questionnaire CMD, respectively, seems to provide the best results.

Comparison of Clinical and Radiological Characteristics of Temporomandibular Joint Osteoarthritis in Older and Young people

Background and Objectives:

The relatively high prevalence of temporomandibular joint (TMJ) osteoarthritis (OA) in older people increases the necessity to investigate the specific characteristics of TMJ-OA in this particular population. This study aimed to analyze the longitudinal changes in clinical and radiological characteristics of TMJ-OA in older people.

Methods:

We retrospectively analyzed the clinical features and cone-beam computed tomography (CBCT) images of 76 participants with TMJ-OA. Participants were classified into two groups according to age. The older people group included 33 participants over 50 years of age, and the control group included 43 participants in their 15-29 years. We analyzed the differences in clinical features and the distribution of destructive bony changes on CBCT images between groups.

Results:

The duration of pain was significantly shorter in the older people group (P = .046); however, the treatment duration was significantly longer in the older people group (P = .001). There was a significant difference in the distribution of destructive bony features between groups (P = .005). In the older people group, “three or more features” (36.3%) were the most common, whereas in the control group, “erosion” (44.2%) was the most common. After treatment, there was little improvement in the frequency of “erosion” in the older people group. There was a significant difference in the proportion of erosion after treatment between the groups (P = .033).

Conclusion:

In older people with TMJ-OA, active treatment to effectively induce condylar remodeling should be considered.

Comparison of Clinical and Radiological Characteristics of Temporomandibular Joint Osteoarthritis in Older and Young people

Background and Objectives:

The relatively high prevalence of temporomandibular joint (TMJ) osteoarthritis (OA) in older people increases the necessity to investigate the specific characteristics of TMJ-OA in this particular population. This study aimed to analyze the longitudinal changes in clinical and radiological characteristics of TMJ-OA in older people.

Methods:

We retrospectively analyzed the clinical features and cone-beam computed tomography (CBCT) images of 76 participants with TMJ-OA. Participants were classified into two groups according to age. The older people group included 33 participants over 50 years of age, and the control group included 43 participants in their 15-29 years. We analyzed the differences in clinical features and the distribution of destructive bony changes on CBCT images between groups.

Results:

The duration of pain was significantly shorter in the older people group (P = .046); however, the treatment duration was significantly longer in the older people group (P = .001). There was a significant difference in the distribution of destructive bony features between groups (P = .005). In the older people group, “three or more features” (36.3%) were the most common, whereas in the control group, “erosion” (44.2%) was the most common. After treatment, there was little improvement in the frequency of “erosion” in the older people group. There was a significant difference in the proportion of erosion after treatment between the groups (P = .033).

Conclusion:

In older people with TMJ-OA, active treatment to effectively induce condylar remodeling should be considered.

Degenerative Changes in the Temporomandibular Joint in Elderly Patients with Posterior Edentulous Maxilla and Mandibula According to Cone-Beam Computed Tomography Data

Aim:

This study aimed at assessing the degenerative changes in the Temporomandibular Joint (TMJ)in elderly patients with posterior edentulous maxilla and mandibula according to Cone-Beam Computed Tomography (CBCT) data.

Materials and Methods:

The study included 32 patients (64 temporomandibular joints) aged from 50 to 81 years (mean age 62 ± 7.9 years; 16 males and 16 females). TMJs were visualized on reconstructed parasagittal, paracoronal, and axial sections of the joint. The following changes in bone tissue were evaluated: condyle flattening, erosion, sclerosis, subchondral cysts, osteophytes. Joint space was evaluated as well.

Results and Discussion:

100% of patients had at least one sign of degenerative changes in TMJ at least on one side. In 19 patients, degenerative symptoms were found only on one side. The most common sign was subchondral cysts. It was noted that the number of degenerative symptoms in male patients was statistically more than in the female group. On the right side, the anterior, superior, and posterior joint spaces had the following values: 2.35 mm, 2.95 mm, and 4.84 mm, respectively. On the left side, the anterior, superior, and posterior joint spaces had the following values: 2.14 mm, 2.3 mm, and 4.1 mm, respectively.

Conclusion:

Both edentulousness and aging affect the bone structure of TMJ in both genders.

Clinical Reasoning for the Examination and Physical Therapy Treatment of Temporomandibular Disorders (TMD): A Narrative Literature Review

The current narrative literature review aims to discuss clinical reasoning based on nociceptive pain mechanisms for determining the most appropriate assessment and therapeutic strategy and to identify/map the most updated scientific evidence in relation to physical therapy interventions for patients with temporomandibular disorders (TMDs). We will also propose an algorithm for clinical examination and treatment decisions and a pain model integrating current knowledge of pain neuroscience. The clinical examination of patients with TMDs should be based on nociceptive mechanisms and include the potential identification of the dominant, central, or peripheral sensitization driver. Additionally, the musculoskeletal drivers of these sensitization processes should be assessed with the aim of reproducing symptoms. Therapeutic strategies applied for managing TMDs can be grouped into tissue-based impairment treatments (bottom-up interventions) and strategies targeting the central nervous system (top-down interventions). Bottom-up strategies include joint-, soft tissue-, and nerve-targeting interventions, as well as needling therapies, whereas top-down strategies include exercises, grade motor imagery, and also pain neuroscience education. Evidence shows that the effectiveness of these interventions depends on the clinical reasoning applied, since not all strategies are equally effective for the different TMD subgroups. In fact, the presence or absence of a central sensitization driver could lead to different treatment outcomes. It seems that multimodal approaches are more effective and should be applied in patients with TMDs. The current paper also proposes a clinical decision algorithm integrating clinical diagnosis with nociceptive mechanisms for the application of the most appropriate treatment approach.

Overexpression of MMPs, cytokines, and RANKL/OPG in temporomandibular joint osteoarthritis and their association with joint pain, mouth opening, and bone degeneration: A preliminary report

OBJECTIVE

This study aimed to determine the expression of distinct matrix metalloproteinases, cytokines, and bone resorptive factors in temporomandibular joint osteoarthritis (TMJ-OA) patients and their association with joint pain, mouth opening, and subchondral bone degeneration.

MATERIALS AND METHODS

Twelve patients affected with TMJ-OA (n = 5), disk displacement without reduction (DDWoR) (n = 3), or disk displacement with reduction (DDWR) (n = 4) were selected. Joint pain was quantified by using visual analog scale, mouth opening was quantified at the maximum pain-free aperture, and bone degeneration was quantified using joint imaging. Synovial fluid samples were collected and immediately processed for cell and synovial fluid recovering. From cells, the MMP-1, MMP-2, MMP-8, MMP-13, IL-6, IL-23, and TNF-α expression was quantified by qPCR. From synovial fluid, the RANKL and OPG levels were quantified by ELISA.

RESULTS

Higher levels of MMP-1, MMP-8, MMP-13, IL-6, IL-23, TNF-α, and RANKL/OPG ratio were detected in TMJ-OA compared with DDWoR and DDWR patients (p < .05). Joint pain significantly correlated with TNF-α levels (r = .975, p = .029). Besides, imaging signs of bone degeneration significantly correlated with RANKL/OPG ratio (r = .949, p = .042). Conversely, mouth opening did not correlate with any of the analyzed mediators.

CONCLUSION

During TMJ-OA, a pathological response characterized by the overexpression of TNF-α and RANKL/OPG could be involved in joint pain and subchondral bone degeneration.

Bone changes in the temporomandibular joints of older adults: A cone-beam computed tomography study

AIMS

To assess the prevalence of degenerative bone changes in the temporomandibular joint (TMJ) of older adults using cone-beam computed tomography (CBCT), and to verify possible associations between these findings and patient health history.

METHODS

CBCT scans comprising both TMJs were acquired for 137 patients aged 65+, regardless of TMD status. Images were assessed by two oral radiologists and evaluated for the presence of flattening, erosion, sclerosis, subchondral cysts, and osteophytes in the TMJ bony components, and self-reported patient systemic health histories were retrieved from records.

RESULTS

There were 59 males, and the mean age was 73.35 ± 6.28. A total of 31.4% had bone changes in both TMJs, and 65.7% had bone changes in at least one side. Bone changes were more prevalent in females, with subchondral cysts (63.3%) and osteophytes (60%) the most common findings. There was a higher prevalence of osteoporosis/osteopenia (38.5%) and connective tissue disorders (39.8%) in patients with TMJ bone changes than in those with normal TMJs.

CONCLUSION

Degenerative bone changes of TMJ were prevalent among older adults, and females were more affected. There was a greater prevalence of osteoporosis/osteopenia and connective tissue disorders in patients with TMJ bone changes than in subjects with normal TMJs.

Factors associated with temporomandibular dysfunction in the elderly: an integrative literature review

Abstract Objective: To identify the factors associated with temporomandibular dysfunction among elderly persons. Method: An integrative literature review was carried out, evaluated by scientific publications indexed in five databases: MEDLINE/PubMed, SCOPUS, WEB OF SCIENCE, CINAHL and LILACS, without date or language restrictions. The adapted Newcastle-Ottawa Scale was used to evaluate the articles. Results: Of the 888 articles from the databases, four were considered eligible for this review. Risk of bias analysis classified one article as low risk and the other as intermediate risk. Conclusion: The factors associated with temporomandibular dysfunction in the elderly indicated by the studies were: female gender, age between 60-70 years, a low income, suffering from tinnitus, dizziness, depression, headache or bruxism; experience temporomandibular joint palpation, masticatory and cervical muscle pain, a low number of teeth and the use of complete dentures.

Temporomandibular Joint Disorders in Older Adults

OBJECTIVES

To review the literature and summarize the evidence of temporomandibualar joint (TMJ) disorders (TMDs) in older adults, focusing on clinical manifestations of TMDs in older adults, highlighting the incidence and sexual dimorphism of TMJ degeneration and the role of sex hormones in this process, and providing potential treatment options for TMD in older adults.

DESIGN

Two review authors performed the literature search, study inclusion, and data extraction. PubMed, Embase, and Google scholar were searched for literature until August 2017 (Figure ). We adopted a combination of Medical Subject Headings with related free text words for the search in PubMed and optimized the search in other search engines.

RESULTS

Traditionally, it was believed that TMDs predominantly affected women of childbearing age, but recent large studies in Europe and the United States have shown that the prevalence of TMD peaks after childbearing age (45-64) and then gradually decreases with age, although not much is known about the disease in older adults.

CONCLUSION

Most older adults have TMJ degeneration, which affects women more than men. In most older adults, the symptoms of TMD are mild and self-limiting and can usually be treated with self management.

Symptoms and signs of temporomandibular disorders among elderly Vietnamese

Background:

To assess the prevalence of the symptoms and signs of temporomandibular disorders (TMDs) and determine the prevalence of TMDs among elderly Vietnamese aged 65–74 years old.

Methods:

A cross-sectional study was conducted among 258 participants aged 65–74 years old (128 females and 130 males) using two strategies for TMD diagnosis: a clinical examination of the temporomandibular joint and its associated structures using the Diagnostic Criteria for Temporomandibular Disorders Axis I; and a set of 14 questions regarding TMD symptoms to obtain anamnestic data.

Results:

The prevalence of TMD symptoms was: headache 49.6%; temporomandibular joint noise 28.0%; orofacial pain 25.2%; jaw locking 3.1%; 62.5% of participants had at least one TMD symptom. Headaches were more prevalent in females than males ( p=0.009) and rural than urban residents ( p<0.001). The most frequent signs were temporomandibular joint crepitus (50.4%), clicking (48.1%) and mouth-opening deviation (37.6%). Temporomandibular joint crepitus and mouth-opening deviation were more frequent among rural than urban ( p=0.024 and p<0.001, respectively). TMD was found in 56.6% of the total sample. Of the TMD sufferers, 37.6% were diagnosed with disc displacement, 34.9% with degenerative joint disease, 3.5% with myalgia and 1.2% with arthralgia.

Conclusions:

More than half of elderly Vietnamese have at least one TMD symptom. TMD sounds were the most common clinical sign of TMD. There were no differences between the genders or place of residence and TMD diagnosis. Disc displacement and degenerative joint disease were most prevalent among elderly Vietnamese.

Influence of the presence of Temporomandibular Disorders on postural balance in the elderly

Purpose

To investigate the influence of the presence of Temporomandibular Disorders (TMD) on postural balance in elderly individuals.

Methods

The study sample consisted of 150 elderly: 103 women (67.7±5.0 years) and 47 men (69.3±5.5 years). Evaluation of the presence and severity of TMD included an anamnesis questionnaire, an evaluation of the temporomandibular joint (TMJ), and a muscular examination, which allowed the division of the elderly into 2 groups: G1 (experimental, n=95), with TMD; G2 (control, n=55), without TMD. Postural balance was assessed by means of the one-leg stance test (OLST) on a force platform (BIOMEC400), thus permitting the following measurements: center of foot pressure (COP); mean sway velocity (MV) and frequency (MF) of COP in both the anteroposterior (VAP and FAP) and medial/lateral (VML and FML) directions. The statistical analysis of data was performed using independent t-test, Variance Analysis, and Chi Square test (α=5%).

Results

Presence of TMD was observed in 63.3% of the individuals (Group 2), with different degrees of severity (mild: 42.7%, moderate: 14.7%, severe: 6%). Significantly higher TMD was observed for women (73.8%) compared with men (40.4%) (p=0.0002). No significant difference was found in between the groups for all balance parameters, e.g., presence and severity of TMD, presence of pain to palpation of TMJ and of masticatory and cervical muscles.

Conclusion

The presence and severity of TMD, in addition to the presence of pain to palpation of TMJ and masticatory and cervical muscles did not alter the variables related to postural balance in this population.