Prevalence of signs of temporomandibular disorders among elderly inhabitants of Helsinki, Finland

Retrospective evaluation of the duration of arthrocentesis in the treatment of temporomandibular joint diseases

OBJECTIVE

This study investigated the duration of arthrocentesis in treatment of patients with different diagnoses of temporomandibular disorders.

METHODS

This retrospective study evaluated the duration of arthrocentesis used for 65 patients who were diagnosed with osteoarthritis (OA), disc displacement with reduction (DDWR), or disc displacement without reduction (DDWoR), in accordance with the Research Diagnostic Criteria for Temporomandibular Disorders protocol.

RESULTS

Mean operation times were 423.79 (± 66.77) seconds in OA patients, 459.92 (± 56.67) seconds in DDWR patients, and 609.00 (± 106.88) seconds in DDWoR patients; these significantly differed among groups (P < 0.001). In addition, post hoc analyses revealed statistically significant differences in mean operation times between DDWoR and OA (P<0.05) and DDWoR and DDWR (P<0.05).

CONCLUSION

The appropriate duration of arthrocentesis may vary among joint disorders, and the duration of arthrocentesis in DDWoR treatment is longer than that in DDWR and OA treatments. In addition there was no relationship between the age or gender and operation time of the patients. Changes in anatomic structures due to temporomandibular diseases are presumed to influence the duration of arthrocentesis treatment.

Correlation of Condylar Translation During Maximal Mouth Opening with Presence of Signs of Temporomandibular Joint Disorders in an Asymptomatic Population of 18-25 Years Age Group of Northern India

Objective(s):

The objective of this study was to determine the frequency of “subluxation” and presence of clinical signs of Temporomandibular Joint Disorder (TMD) in asymptomatic individuals and its distribution according to age and sex.

Materials and Methods:

The material investigated comprised of 200 asymptomatic subjects with 400 joints. The subjects were divided into two groups of 18-25 years and 50-60 years of age consisting of equal number of males and females. Clinical examination involved measurement of maximal inter-incisal distance, joint sounds and deviation. For radiological examination, Temporomandibular Joint (TMJ) open mouth close mouth view option (TMJ1/2) was used on a Digital Panoramic Machine. All the radiographs were traced to assess subluxation and anterior translation of the condyle. The statistical analysis was carried out using Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, version 15.0 for Windows).

Results:

The prevalence of the signs of TMDs in the asymptomatic population was found to be very high and more predominant in females as compared to males. Furthermore, the older age group had comparatively less signs of TMDs. It was of interest that the subjects presenting with clinical signs of TMD were significantly less as compared to the subjects presenting with subluxation. The value of anterior translation was found to be more in females in the younger age group as compared to the males. Similarly, it was more in males as compared to females in older age group. But the mean anterior translation difference in females in 18-25 years and 50-60 years showed a statistically significant difference with P-value 0.017.

Conclusion:

Subluxation is a very common feature found in almost all the subjects in this study with a high prevalence. Hence, we may assume that the increased incidence of TMDs could be a direct result of the phenomena of subluxation. The decrease in mandibular length could be the cause of decreased mouth opening and increased subluxation.

Early intra-articular injection of alendronate reduces cartilage changes and subchondral bone loss in rat temporomandibular joints after ovariectomy

This study investigated the effects of intra-articular injection of alendronate on the mandibular condyle in ovariectomized rats. Sixty rats were divided into five groups: ovariectomy with vehicle treatment alone, early alendronate treatment at ovariectomy, late alendronate treatment at 4 weeks after ovariectomy, sham-operation with vehicle treatment, and normal controls. The changes in cartilage and subchondral bone were evaluated by micro-computed tomography, histology, tartrate-resistant acid phosphatase (TRAP) staining, immunohistochemistry, and real-time quantitative polymerase chain reaction. Compared with late alendronate treatment, early alendronate treatment completely inhibited cartilage thickening (727.6±39.3 vs. 1013.3±51.6; P=0.017) and improved microstructural properties of the subchondral bone, with a higher bone volume ratio (46.4±2.5 vs. 37.5±2.1; P=0.038), trabecular thickness (47.3±1.7 vs. 34.6±1.4; P=0.029), and trabecular number (8.5±0.6 vs. 6.2±0.3; P=0.041) and lower trabecular separation (30.2±1.6 vs. 37.7±2.6; P=0.034). Fewer TRAP-positive cells (4.2±0.2 vs. 6.8±0.4; P=0.019) and a higher OPG/RANKL ratio (0.38±0.01 vs. 0.25±0.03; P=0.043) in the subchondral bone were observed in the animals with early treatment compared to late treatment or ovariectomy/vehicle treatment. In addition, early alendronate treatment blocked the up-regulation of matrix metalloproteinase (MMP)-13 expression in the chondrocytes, whereas late alendronate treatment attenuated the up-regulation of MMP-13 expression. Our results suggest the therapeutic potential of intra-articular alendronate injection in the treatment of osteoporosis-associated temporomandibular disorders.

The study of relationship between reported temporomandibular symptoms and clinical dysfunction index among university students in Shiraz

Background:

This study was designed to evaluate the correlation between subjective data obtained from a questionnaire and clinical examination among students in Shiraz university of medical sciences.

Materials and Methods:

In this cross-sectional prospective study, the samples consisted of 200 subjects, with equal distribution between males and females. Subjects’ ages ranged from 18 to 30 years (24.07±2.93). A functional evaluation was performed using the Helkimo clinical dysfunction (Di) and anamnestic (Ai) indices. Data were evaluated by the Chi-square test between gender and clinical dysfunction index (Di) and correlation coefficient between Di and Ai (the level of significance was set at P<0.05).

Results:

Among the total study population, 30% reported mild symptoms (Ai I) while 2% had severe (Ai II). In the clinical examination, 71% showed some degree of dysfunction. These degrees were as follows: 50% were classified as mild (Di I), 13% moderate (Di II) and 8% severe signs and symptoms (Di III).

With respect to gender, women (80%) were more affected than men (62%). A significant relationship was found between gender and the occurrence of temporomandibular disorder (TMD) (P<0.05). The correlation coefficient (r) between the reported symptoms (Ai) and recorded signs (Di) was 0.53. There were positive correlation coefficient between Di and Ai. They were statistically significant (P<0.001).

Conclusions:

A high prevalence of signs and symptoms of TMD among students in Shiraz University of Medical Sciences was seen, which was greater in women. Despite suffering from TMD, students were not aware of their disorders.

Comparison of temporomandibular disorders in Iranian dental and nondental students

AIM

The aim of this study was to define the prevalence and severity of temporomandibular disorders (TMD) among Iranian dental and nondental students who attended Shiraz University of Medical Sciences.

MATERIALS AND METHODS

The samples consisted of 200 subjects, 100 dental and 100 nondental students (equal distribution between males and females). Subjects ages ranged from 18 to 30 years (24.07 ± 2.93). A functional evaluation was performed using the Helkimo dysfunction index (Di). Data were evaluated by the Chi-square test.

RESULTS

Among the total study population, 71% showed some degree of dysfunction. Prevalence ratio in dental students was 80%, while in nondental students was 62% (p > 0.05, odds ratio = 0.679). With respect to gender, women (80%) were more affected than men (62%). A significant relationship was found between gender and the occurrence of TMD (p > 0.05).

CONCLUSION

A high prevalence of signs of TMD in Iranian university students was seen which was greater in dental students and women.

CLINICAL SIGNIFICANCE

The results of this study showed that the prevalence of TMD among dental students and women was significantly higher than nondental students and men. These findings might be due to poor postural style or emotional stress during dental practice.

Effect of lengthy root canal therapy sessions on temporomandibular joint and masticatory muscles

Background and aims

Trauma is one of the major factors associated with temporomandibular joint disorders (TMD). These disorders result from macro-trauma or micro-trauma. Macro-trauma might be iatrogenic; for example, from intuba-tion procedures, third molar extraction procedures, and lengthy dental appointments. The aim of this study was to evaluate the effect of lengthy root canal therapy (more than 2 hours) on TMJ and its supporting structures.

Materials and methods

Eighty patients whose root canal therapy session lasted more than 2 hours were examined for the status of TMJ and masticatory muscles. After one week the second part of the examination was carried out for TMJ problems and pain and tenderness levels of masticatory muscles. Data was analyzed using Wilcoxon statistical test.

Results

Women showed more pain compared to men. There was a significant increase in pain in the external acoustic meatus examination one week after root canal therapy. Patients who were treated for their posterior teeth suffered more pain than those who were treated for the anteriors and premolars. Other aspects of the examination were not affected significantly by lengthy root canal therapy.

Conclusion

Lengthy dental treatments can harm TMJ and masticatory muscles and wide opening of the mouth during such appointments can worsen the situation. Therefore, it is wise to break the appointment into shorter intervals and let the patients rest during treatment to close their mouth to prevent iatrogenic damage to TMJ.

Temporomandibular disorders and oral health-related quality of life. A systematic review

OBJECTIVE

Oral health-related quality of life (OHRQoL) is considered an important aspect of different oral conditions. It has also gained increased attention in temporomandibular disorders (TMDs) in recent years. The purpose of this study was to systematically review the literature on OHRQoL and TMDs.

MATERIAL AND METHODS

A systematic search of the dental literature was performed using the Medline and Cochrane Library databases, supplemented by a hand search. Various combinations of search terms related to OHRQoL and TMDs were used. Among numerous titles found in Medline, abstracts and eventually full papers of potential interest were reviewed. Twelve papers fulfilled the inclusion criteria and were included in the review.

RESULTS

Most studies used the Oral Health Impact Profile, an instrument with good psychometric properties, for evaluation. All articles described a substantial impact on OHRQoL in TMD patients. Only a small proportion of all patients, a few percent, reported no impact at all. The difference between men and women was small and not significant. The impact appeared to be more pronounced in patients with more signs and symptoms. The perceived impact of pain on OHRQoL seems to be substantial. Two studies found that the impact increased with age among TMD patients.

CONCLUSIONS

The reviewed studies convincingly demonstrated that OHRQoL was negatively affected among TMD patients.

Sexual dimorphism and temporomandibular disorders (TMD)

Numerous studies suggest a sexual predilection for temporomandibular disorders. The purpose of this article is to review and summarize patient-oriented and basic science studies that address the topic of a female predilection for temporomandibular disorders. The information presented provides oral and maxillofacial surgery practitioners with evidence-based data to suggest a female predilection for temporomandibular disorders based on biologic, genetic, and behavioral/psychosocial factors.

Long-term outcome after treatment of temporomandibular joint osteoarthritis with exercise and manual therapy

In a previous study, exercise and manual therapy demonstrated a 90% success rate in patients with osteoarthrosis of the temporomandibular joints in the short-term. The aim of this follow-up study was to assess the long-term effect of these treatment modalities. Seventeen patients were evaluated. All patients suffered from osteoarthrosis of the temporomandibular joints with pain in the temporomandibular joint at baseline and were treated successfully in a prior short-term study. The parameters were pain at rest and at chewing, impairment in daily life, and mouth opening. At follow-up, 11 patients (65%) experienced no pain and 13 patients (76%) had no pain at rest (Fisher's Exact Test: p<0.02). Thirteen patients (76%) had a normal incisal edge clearance, and ten patients (59%) felt no impairment due to the disease (Fisher's Exact Test: p=0.01). Thirteen patients (76%), who had been treated once successfully, have not needed treatment within the three years after cessation of their therapy. Exercise therapy is an effective tool to treat osteoarthrosis of the temporomandibular joints.

An investigation of the effectiveness of exercise and manual therapy in treating symptoms of TMJ osteoarthritis

The background and purpose of this investigation was to evaluate the use of a treatment protocol which included active and passive jaw movements, manual therapy techniques, correction of body posture, and relaxation techniques for the treatment of temporomandibular joint (TMJ) osteoarthrosis (OA). Twenty consecutive patients suffering from TMJ OA participated in this study.

INCLUSION CRITERIA

a. pain in the temporomandibular region; b. symptoms lasting at least three months; and c. radiologically proven OA. All patients were assigned to a waiting list, serving as a no treatment control period. Nineteen patients completed the study. No adverse effects occurred. During the control period (mean duration 35 days), the parameters did not change significantly. After treatment (mean duration 46 days) pain, impairment, and incisal edge clearance improved significantly (Wilcoxon test p < 0.001). At follow-up, pain and impairment were further reduced. The number of patients experiencing no pain at rest (80%), chi-square test p = 0.02) and stress (47%), chi-square test p = 0.03), and no impairment (37%), chi-square test p = 0.05) increased significantly. This therapeutic treatment protocol seems to be useful treatment for the symptoms of clinical dysfunction in OA of the TMJ.

Exercise therapy for craniomandibular disorders

OBJECTIVE

To evaluate the use of exercise therapy for the treatment of craniomandibular disorders (CMDs).

DESIGN

Before-after trial. All patients were assigned to a waiting list, serving as a no-treatment control period.

SETTING

Outpatient clinic for physical medicine and rehabilitation of the University of Vienna.

PATIENTS

Thirty consecutive patients suffering from CMD with anteridr disc displacement with reduction who were consulting a CMD service.

INCLUSION CRITERIA

(1) symptoms lasting at least 3 months, (2) pain in the temporomandibular region, (3) a positive axiography, and (4) evidence of postural dysfunction. Twenty-six patients completed the study; no adverse effects occurred.

INTERVENTIONS

Active and passive jaw movement exercises, correction of body posture, and relaxation techniques.

MAIN OUTCOME MEASURES

(1) Pain at rest, (2) pain at stress, (3) impairment, and (4) mouth opening at baseline, before and after treatment, and at 6-month follow-up.

RESULTS

During the control period, no changes occurred. After the treatment, pain and impairment were significantly reduced (Wilcoxon test, p < .001). Four patients had a restricted mouth opening, in contrast to 15 before treatment (chi2 test, p < .005). Joint clicking vanished in 13.3% and was reduced in another 13.3% (chi2 test, p < .01). These results did not change until follow-up. Seventy-five percent of the patients were treated successfully.

CONCLUSION

Exercise therapy seems to be useful in the treatment of anterior disc displacement with reduction.

The effect of surgical treatment of the temporomandibular joint: a survey of 70 patients

Most patients with temporomandibular disorders (TMD) can be successfully treated by conservative methods, but approximately 10-20 percent have persistent symptoms. The aim of this study was to evaluate the signs and symptoms of TMD in patients treated with open surgery of the TMJ. Seventy-two patients (13 men, 59 women, mean age 37 years, range 14-68 years) were evaluated during an eight-year period. Altogether 45 right TMJs and 39 left TMJs were treated, including both TMJs during the same operation in eight of the cases. The patients were evaluated at follow-up in 1997. The degree of TMD at follow-up was assessed using the anamnestic and clinical dysfunction Helkimo indices. Most of the patients reported at the follow-up that they were subjectively satisfied with the surgical treatment. The main clinical findings in the post surgical patients at follow-up were TMJ sounds and deviation of the mandible during opening. The tenderness in the masticatory muscles and TMJs on palpation was reduced significantly and the ranges of mandibular movement were improved for all the patients. The mean anamnestic and clinical indices decreased with a statistical significance from the shortest follow-up group (Group I) to the longest on group (Group IV) (p = 0.000). The conclusion of this study was that after open surgical treatment of the TMJ, the patients have significantly better functioning of the masticatory system and reduced signs and symptoms of TMD in the long term.

Changes of cancellous bone mass in rat mandibular condyle following ovariectomy

Changes in cancellous bone of the rat mandibular condyle following estrogen deficiency were histomorphometrically examined with 120-day-old female Fischer rats. Sixty-four animals were either ovariectomized bilaterally (ovx) or subjected to sham surgery (sham), and eight from each group were killed at 7, 14, 30, and 60 days after surgery. Seven intact animals were killed on day 0. Before killing, tetracycline and calcein were administered to all animals. Following histological observation, bone histomorphometry of the mandibular condyle was done using a confocal laser scanning microscope and an image analyzer. The sampling site was divided into two regions for analysis: (1) a "subchondral region," formed by the region connected to cartilage; and (2) a "central region," formed by the region beneath the former. The changes in these two regions were analyzed separately. In the sham group's condyle, the bone volume of the subchondral and central regions increased with the passage of time, although the bone turnover became low. This bone gain could be due to the effects of growth and the mechanical stimulus by occlusal load. In the subchondral region of the ovx group's condyle, the bone volume decreased significantly at 7 days, but recovered to reach approximately the same value as the sham group from 14 days onward. In the central region of the ovx group's condyle, the bone volume was unchanged, but revealed a significantly lower value than that of the sham group at 60 days (p < 0.01). Thus, ovariectomy inhibited bone gain, which was observed in the sham group's condyle even though there was no bone loss. On the other hand, the trabecular separation in the ovx's condyle of both the subchondral and central regions increased considerably and small marrow cavities interconnected to form a large bone marrow. Therefore, the ovx rat mandibular condyles dynamically altered their structures under the effects of estrogen deficiency and occlusal loads. Consequently, estrogen deficiency induced transient subchondral bone loss and recovery, whereas, in the central region, it inhibited bone gain. This suggests that mechanical loading modulates the normal ovx-induced bone loss found in other parts of the skeleton.

Occlusal imbalance and temporomandibular disorders in the elderly

The prevalence of the anamnestic symptoms and clinical signs of temporomandibular disorders (TMD) in 76-, 81-, and 86-year-old subjects was studied, on the basis of Helkimo's anamnestic (Ai) and clinical (Di) dysfunction indexes. Occlusal status was recorded by means of the Eichner index: class A has a maximum of four supporting zones (minimum of one tooth contact between the antagonist jaws in the premolar and molar region on each side), class B has one to three supporting zones or tooth contact in the frontal area only, and class C has no supporting zones. The Eichner index was recorded with two kinds of variations: supporting zones with and without removable prostheses. In the population studied 8% were classified as Eichner class A, 22% as class B, and 70% as class C. Including occlusal supporting zones of the removable dentures, the percentages were 75% in Eichner class A, 21% in class B and 4% in class C. When the groups with and without removable prostheses were compared, no differences were found in the Ai or Di. In conclusion, among the elderly population the severity of TMD does not depend on the supporting zones of the dentition alone, and removable prostheses do not relieve the problem.

Orthodontic treatment and temporomandibular disorders

The relationship between orthodontic treatment and temporomandibular disorders (TMDs) has long been of interest to the practicing orthodontist, but only during the past decade have a significant number of clinical studies been conducted that have investigated this association. This interest in orthodontics and TMD in part was prompted in the late 1980s after litigation that alleged that orthodontic treatment was the proximal cause of TMD in orthodontic patients. This litigious climate resulted in an increased understanding of the need for risk management as well as for methodologically sound clinical studies. The findings of current research investigating the relation of orthodontic treatment and TMD can be summarized as follows: (1) signs and symptoms of TMD may occur in healthy persons; (2) signs and symptoms of TMD increase with age, particularly during adolescence, until menopause, and therefore TMDs that originate during orthodontic treatment may not be related to the treatment; (3) in general, orthodontic treatment performed during adolescence does not increase or decrease the chances of development of TMD later in life; (4) the extraction of teeth as part of an orthodontic treatment plan does not increase the risk of TMD; (5) there is no increased risk of TMD associated with any particular type of orthodontic mechanics; (6) although a stable occlusion is a reasonable orthodontic treatment goal, not achieving a specific gnathologic ideal occlusion does not result in signs and symptoms of TMD; and (7) thus far, there is little evidence that orthodontic treatment prevents TMD, although the role of unilateral posterior crossbite correction in children may warrant further investigation.

The effect of stomatognathic treatment: a clinical follow-up study

Temporomandibular disorders (TMD) are common but complex problems in dentistry. Most patients can be treated using relatively simple methods, such as counselling, splint therapy, and occlusal adjustment. Patients who do not respond to conservative treatment may benefit from surgical treatment. Ninety-two patients (68 women, 24 men, mean age 36 years, range 14-74 years) were treated between 1988 and 1990 in the Department of Prosthetic Dentistry and Stomatognathic Physiology. Sixty-two patients of which 15 were surgically treated, attended for clinical follow-up in 1994. Success of treatment was evaluated using the anamnestic and clinical dysfunction indices of Helkimo. All patients reported that they had benefitted from their treatment. Symptoms of TMD were also noted to be clinically less than before. The results of the study reported show that the effects of stomatognathic treatment are beneficial in long-term, i.e. the patients were subjectively satisfied, and symptoms recorded clinically on follow-up were statistically significantly less than before.