[Disturbed sleep, anxiety and stress are possible risk indicators for temporomandibular disorders with myofascialpain]

OBJECTIVE

To explore the relationship betweensleep/psychological distress and temporomandibular disorders (TMD) and to discuss the possibility of disturbed sleep and psychological distress as risk indicators in relation to TMD in a Chinese population.

METHODS

The standardized and validated self-reported Chinese version questionnaires including Pittsburgh sleep quality index (PSQI) and depression, anxietyandstress scales-21 (DASS-21) were used to measure sleep quality and psychological distress. A total of 755 TMD patients (172 males and 583 females)with a mean age (29.99 ± 13.60) years were included in the study. The patients were divided into 7 diagnostic groups based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), including Group I(exclusively myofascial pain), Group II(exclusively disc displacement), Group III (exclusively arthralgia or degenerative joint disease), Group IV (myofascial pain plus disc displacement), Group V (myofascial pain plus arthralgia or degenerative joint disease), Group VI (disc displacement plus arthralgia or degenerative joint disease) and Group VII (myofascial pain plus disc displacement plus arthralgia or degenerative joint disease). For statistical analysis, the patients were subsequently grouped into those with (181 patients) and without (574 patients) myofascial pain. Chi-square tests, independent-samples t test, partial correlation as well as stepwise Logistic regression analysis were used to analyze the data, using software SPSS 20.0 and P<0.05 was of significance.

RESULTS

The prevalence of moderate to (extremely) severe disturbed sleep and psychological distress was significantly higher in the myofascial pain group (27.1%, 28.7%, 60.8% and 32.0%) than in the non-myofascial pain group (disc displacement and arthralgia or degenerative joint disease, 11.1%, 10.1%, 27.4% and 11.0%, P<0.05).The comorbidity of self-reported disturbed sleep and psychological distress was significantly higher in the myofascial pain patients than those without myofascial pain (P<0.05). Stepwise logistic regression analysis demonstrated that disturbed sleep (OR=1.74), more specifically, subjective sleep quality (OR=1.69) and sleep disturbance (OR=1.63) respectively, anxiety (OR=3.14) and stress (OR=2.15) were possible risk indicators for myofascial pain, and the results were still significant even after controlling for age, sex, educational level, disease duration, sleep quality, depression, anxiety and stress respectively (P<0.05).

CONCLUSION

Disturbed sleep and psychological distress symptoms are common in TMD patients. Disturbed sleep, anxiety and stress are possible risk indicators for myofascial pain, compared with disc displacement and arthralgia or degenerative joint diseases.

Self-Reported Migraine and Chronic Fatigue Syndrome Are More Prevalent in People with Myofascial vs Nonmyofascial Temporomandibular Disorders

AIMS

To compare the number of comorbidities and the prevalence of five specific comorbidities in people who have temporomandibular disorders (TMD) with or without myofascial pain.

METHODS

This cross-sectional study included 180 patients seeking TMD treatment in Boston and Montreal hospitals. A self-administered questionnaire was used to collect information on sociodemographic and behavioral factors, as well as the presence of the following five comorbidities: migraine, chronic fatigue syndrome, irritable bowel syndrome, interstitial cystitis, and restless leg syndrome. TMD was diagnosed using the Research Diagnostic Criteria for TMD. Chi-square and Student t tests were used for categorical and continuous variables, respectively, to test for differences between myofascial (n = 121) and nonmyofascial (n = 59) TMD groups. Multiple logistic regression analysis was used to compare the type and number of self-reported comorbidities in both groups, controlling for confounding variables.

RESULTS

The following were found to be significantly higher in the myofascial TMD group than in the nonmyofascial TMD group: self-reported migraine (55% vs 28%, P = .001), chronic fatigue syndrome (19% vs 5%, P = .01), and the mean total number of comorbidities (1.30 vs 0.83, P = .01).

CONCLUSION

Individuals with myofascial TMD had a higher prevalence of self-reported migraine and chronic fatigue syndrome than those with nonmyofascial TMD.

Prevalence of Temporomandibular Disorders in an Adult Brazilian Community Population Using the Research Diagnostic Criteria (Axes I and II) for Temporomandibular Disorders (The Maringá Study)

PURPOSE

The primary objective of this study was to assess the prevalence of temporomandibular disorders (TMDs) and comorbid factors (sleep bruxism and headaches). This study was a cross-sectional population survey in the city of Maringá, state of Paraná, Brazil.

MATERIALS AND METHODS

Axes I and II of the Research Diagnostic Criteria for TMD (RDC/TMD) were used for assessment of TMD signs and symptoms. The population was users of the Brazilian public health system (SUS), of both sexes, between the ages of 20 and 65 years, and not seeking treatment for TMD.

RESULTS

The selected population (N = 1,643) was composed mostly of (a) women (65.9%), (b) married or single individuals (90.6%), (c) Caucasians (70.1%), (d) individuals aged 32.7 ± 10.3 years, (e) individuals earning a medium income (75.1%), and (f) those who had completed a high school education or higher (79.9%). According to the chronic pain grade classification (CPG) in the RDC/TMD Axis II, 36.2% of the population had some degree of TMD pain (CPG I to IV); however, only 5.1% had severe limitation due to pain (CPG III or IV). In the RDC/TMD Axis I diagnoses, 29.5% presented with muscle disorders (group I), 7.9% with disk displacements (group II), and 39.1% with other joint disorders (group III). Headaches were present in 67.9% and awake and sleep bruxism in 30% and 33.4% of the population, respectively.

CONCLUSION

The prevalence of signs and symptoms of TMD was high in this population, but with low disability; however, the proportion of patients in need of treatment was much lower.

[Frequency of signs and symptoms of temporomandibular joint disorders, vertical orthodontic anomalies and their relationships based on screening of a large population]

Altogether 4606 volunteers (2923 vomen, 1683 men) participated in the representative national epidemiological study to screen the alterations of temporomandibular joint (TMJ). The characteristic clinical signs and subjective complaints according to TMJ were evaluated by medical history taking and physical examination. Regarding the orthodontic anomalies, the vertical abnormalities (deep bite and open bite) were specifically noted. Clinical signs showing functional problems of TMJ were found in 45.19% of the screened population, mainly in the group of 35-44 year olds. The frequency of clicking and crepitation of TMJ was significantly higher in women compared to men (p < 0.05). The highest rate of clinical signs of TMJ disorders was found in the South-Transdanubian region, the lowest rate in the Middle-Transdanubian region, between these regions it was a significant difference regarding the frequency of deviation/deflexion (p < 0.05). Of the vertical abnormalities, deep bite occured most frequently in the 35-44 ys old age group. The prevalence of deep bite was higher among males than females in the whole screened population, but the difference was not statistically significant. Significant relationship was detected between deep bite and TMJ pain, deep bite and noises in the joint in the majority of the population. The most frequent anomaly in the South-Transdanubian region was deep bite, while the open bite occured most frequently in south middle part of Hungary. Conclusion: the Hungarian population needs well organized specific programs to improve the oral health including TMJ and orthodontic aspects.

Bruxism and TMD disorders of everyday dental clinical practice

Bruxism, as an etiological factor for the development of TMD, includes different disorders of the TMJ and the masticatory muscles, exhibiting pain and disruption of the stomatognathic functions. Our goal was to study patients with bruxism and TMD from everyday dental clinical practice, in terms of diagnosis, identification of etiological factors, classification and treatment of these disorders. We treated 120 patients, divided into 2 groups of 60 patients. The first group had disorders of the TMJ, and the second of the masticatory muscles. The groups were divided into subgroups of 20 patients with dislocation of the articular disk with or without reduction and inflammation of TMJ. The second group was organized from patients with myofascial pain, myositis and muscular trismus. Our conservative treatment consisted of patient education, NSAID, myorelaxants, fabrication of prosthetics, repositioning and stabilization splints. The progress of the patients was followed immediately after the delivery of the prosthetics and the splint, after 1, 6 and 12 months. The results showed that in patients with disorders of the TMJ there were visible signs of recovery after 6 months in 68.3% patients, and in 85% after 12 months. In the second group we achieved faster results with the elimination of symptoms. Patients with afflictions of the muscles in 88.3% of cases noticed relief of symptoms even after 6 months and in 98.3% after 12 months. As therapists we concluded that timely treated complications of bruxism and TMD prevent the destruction of the TMJ, masticatory muscles and the entire stomatognatic system.

Masticatory muscle and temporomandibular joint pain in Croatian war veterans with posttraumatic stress disorder

The aim of this study was to investigate the prevalence and intensity of masticatory muscle and temporomandibular joint (TMJ) pain in Croatian war veterans with posttraumatic stress disorder (PTSD). The examined group consisted of 100 Croatian war veterans, in whom PTSD had previously been diagnosed. Patients were compared with 92 subjects who had not taken part in the war and in whom PTSD was excluded by psychiatric examination. The clinical examination consisted of palpation of the masticatory muscles, the prominent neck musculature, and TMJ. The examination technique used and the definition of items were previously tested for reliability and validity. 93% of the subjects with PTSD had masticatory muscle tenderness compared to 45.65% of the subjects in the control group (chi2 = 51.46, p < 0.0001). The most frequent painful location in the subjects with PTSD was the left lateral pterygoid site in 88%, and in subjects of the control group the right lateral pterygoid site in 28.26% of cases. The most painful location in the PTSD group was the left lateral pterygoid site in 72%, and in the control group the left posterior digastric in 4.35% of cases. 58% of the subjects with PTSD had TMJ tenderness compared to 3.26% of subjects in the control group (chi2 = 66.23, p < 0.0001). The most frequent painful location of TMJ in both groups was the left posterior capsule; in the PTSD group 38% and in subjects in the control group 2.17% of cases. The most painful location was the left posterior capsule in 28% of subjects with PTSD, while not one subject in the control group reported severe painful sensitivity. The very high frequency and intensity of pain in subjects with PTSD confirms the effect of stress on muscle and joint sensitivity, i.e. perception of pain.

Temporomandibular joint and muscle disorder-type pain and comorbid pains in a national US sample

AIMS

To compare prevalences of self-reported comorbid headache, neck, back, and joint pains in respondents with temporomandibular joint and muscle disorder (TMJMD)-type pain in the 2000-2005 US National Health Interview Survey (NHIS), and to analyze these self-reported pains by gender and age for Non-Hispanic (NH) Whites (Caucasians), Hispanics, and NH Blacks (African Americans).

METHODS

Data from the 2000-2005 NHIS included information on gender, age, race, ethnicity, education, different common types of pain (specifically TMJMD-type, severe headache/migraine, neck, and low back pains), changes in health status, and health care utilization. Estimates and test statistics (ie, Pearson correlations, regressions, and logistic models) were conducted using SAS survey analysis and SUDAAN software that take into account the complex sample design.

RESULTS

A total of 189,977 people (52% female and 48% males, 73% NH Whites, 12% Hispanic, 11% NH Blacks, and 4% "Other") were included. A total of 4.6% reported TMJMD-type pain, and only 0.77% overall reported it without any comorbid headache/migraine, neck, or low back pains; also 59% of the TMJMD-type pain (n = 8,964) reported ⋝ two comorbid pains. Females reported more comorbid pain than males (odds ratio [OR] = 1.41, P < .001); Hispanic and NH Blacks reported more than NH Whites (OR = 1.56, P <.001; OR= 1.38, P <.001, respectively). In addition, 53% of those with TMJMD-type pain had severe headache/migraines, 54% had neck pain, 64% low back pain, and 62% joint pain. Differences in gender and race by age patterns were detected. For females, headache/migraine pain with TMJMD-type pain peaked around age 40 and decreased thereafter regardless of race/ethnicity. Neck pain continued to increase up to about age 60, with a higher prevalence for Hispanic women at younger ages, and more pronounced in males, being the highest in the non-Whites. Low back pain was higher in Black and Hispanic females across the age span, and higher among non-White males after age 60. Joint pain demonstrated similar patterns by race/ethnicity, with higher rates for Black females, and increased with age regardless of gender.

CONCLUSION

TMJMD-type pain was most often associated with other common pains, and seldom existed alone. Two or more comorbid pains were common. Gender, race, and age patterns for pains with TMJMD-type pain resembled the specific underlying comorbid pain.

Temporomandibular disorder pain in adult Saudi Arabians referred for specialised dental treatment

The aim of this study was to determine the frequency of Temporomandibular Disorders (TMD) pain in Saudi Arabians,aged 20-40, who were referred to the Specialist Dental Centre in Makkah. The material included 325 patients (135 males,190 females) who answered a history questionnaire. Patients reportingTMD pain in the last month were offered a clinical examination. History questionnaires and clinical examinations were done according to the Arabic version of the Research Diagnostic Criteria for TMD (RDC/TMD). Fifty-eight patients (18%) reported TMD pain; 46 were clinically examined. Mean age of clinically examined TMD pain patients was 30 +/- 7 years with a male-female ratio of 1:6 (P < 0.001). All TMD pain patients had a diagnosis of myofascial pain, and 65% had diagnoses of arthralgia or osteoarthritis. Headaches or migraines in the last 6 months and headaches in the last month were reported in high frequencies in the TMD pain group, 93% and 71% respectively, with differences (P < 0.001) between the TMD pain and non-TMD pain groups. Graded Chronic Pain Scale assessments classified 45% of the TMD pain patients in grade 1, 53% in grade II, 2% in grade III, and 0% in grade IV. Severe depression scores were found in 38% of the TMD pain patients and severe somatisation scores in 60% with differences (P < 0.001) between the TMD pain and non-TMD pain groups. In conclusion, the study found a frequency of TMD pain in this Saudi Arabian cohort of 18%. The TMD pain group presented high scores of depression and somatisation but low disability grades on the Graded Chronic Pain Scale.

Prevalence of signs and symptoms of temporomandibular disorders in children and adolescents with and without crossbites

This study investigated the prevalence of signs and symptoms of temporomandibular disorders (TMD) in 1,134 orthodontically untreated children and adolescents (593 boys, 541 girls; age range 5 to 15 years) with and without crossbites. The sample with crossbites was further grouped according to the type (anterior, posterior, unilateral, or bilateral). The TMD symptoms bruxism (obvious active attrition/myalgia), joint sounds (clicking/crepitation), deviation during opening, reduced functional movements (maximum opening <40 mm), and myopain (originating in the masticatory muscles/related to masticatory functions) were evaluated based on the standardized RDC/TMD protocol (Research Diagnostic Criteria for Temporomandibular Disorders) and compared among the various groups. Girls had a significantly higher prevalence of myopain than boys (x(2)=3.882, P<.05). Furthermore, individuals with posterior unilateral crossbites showed a significantly higher prevalence of TMD symptoms (x(2)=33.877, P<.001) and reduced functional movements (x2 = 10.800, P<.05) than any other group. In conclusion, sex and type of crossbite play a role in the prevalence of TMD signs and symptoms.

Role of psychosocial factors in the etiology of temporomandibular disorders: relevance of a biaxial diagnosis

AIM

The prevalence of temporomandibular disorders (TMD) is higher among women than men, indicating a multifactorial role for gender-related differences in the etiology of TMD: physiological hormonal differences, inflammatory response to stress, and sociocultural differences in response to pain. The aim of this study was to draw a biobehavioral picture of the TMD patient based on Research Diagnostic Criteria for TMD (RDC/TM) Axis II diagnosis and analysis of gender-related differences.

METHODS

Between January 2006 and January 2008, 362 subjects were consecutively enrolled from patients who presented at the Clinic for Temporomandibular Disorders, School of Dental Medicine, University of Pavia, because of orofacial pain, limitation or joint sounds on mandibular movement. Of the 362 subjects evaluated, 308 met the inclusion criteria.

RESULTS

The average age of the study population was 41 years; the female: male ratio was 4:1. When stratified according to chronic pain intensity grade and gender, 26% of the women had grade I, 36.4% grade II, 17% grade III, and 9.7% grade IV; 34.4% of the men had grade I, 32.8% grade II, 6.5% grade III, and 3.3% grade IV. Depression was moderate in 35 women and in 6 men and severe in 138 women and in 24 men; somatization was moderate in 59 women and in 20 men and severe in 143 women and in 19 men.

CONCLUSIONS

Gender-related differences may be considered risk factors for TMD; psychological characteristics, including somatization, depression, and anxiety related to gender, appear to have a significant impact on the prevalence of TMD.

Sleep disorders and their association with laboratory pain sensitivity in temporomandibular joint disorder

STUDY OBJECTIVES

We characterized sleep disorder rates in temporomandibular joint disorder (TMD) and evaluated possible associations between sleep disorders and laboratory measures of pain sensitivity.

DESIGN

Research diagnostic examinations were conducted, followed by two consecutive overnight polysomnographic studies with morning and evening assessments of pain threshold.

SETTING

Orofacial pain clinic and inpatient sleep research facility.

PARTICIPANTS

Fifty-three patients meeting research diagnostic criteria for myofascial TMD.

INTERVENTIONS

N/A.

MEASUREMENTS AND RESULTS

We determined sleep disorder diagnostic rates and conducted algometric measures of pressure pain threshold on the masseter and forearm. Heat pain threshold was measured on the forearm; 75% met self-report criteria for sleep bruxism, but only 17% met PSG criteria for active sleep bruxism. Two or more sleep disorders were diagnosed in 43% of patients. Insomnia disorder (36%) and sleep apnea (28.4%) demonstrated the highest frequencies. Primary insomnia (PI) (26%) comprised the largest subcategory of insomnia. Even after controlling for multiple potential confounds, PI was associated with reduced mechanical and thermal pain thresholds at all sites (P < 0.05). Conversely, the respiratory disturbance index was associated with increased mechanical pain thresholds on the forearm (P < 0.05).

CONCLUSIONS

High rates of PI and sleep apnea highlight the need to refer TMD patients complaining of sleep disturbance for polysomnographic evaluation. The association of PI and hyperalgesia at a nonorofacial site suggests that PI may be linked with central sensitivity and could play an etiologic role in idiopathic pain disorders. The association between sleep disordered breathing and hypoalgesia requires further study and may provide novel insight into the complex interactions between sleep and pain-regulatory processes.

Prevalence of temporomandibular disorders in obstructive sleep apnea patients referred for oral appliance therapy

AIMS

To evaluate the prevalence of pain associated with temporomandibular disorders (TMD) in obstructive sleep apnea syndrome (OSAS) patients referred for oral appliance therapy.

METHODS

Eighty-seven patients (46 men and 41 women), between 18 and 65 years of age, with an apnea-hypopnea index (AHI) of > 5 and < 30 (events by sleep hour), and body mass index (BMI) of =or< 30 Kg/m(2) were evaluated according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) to determine the presence of signs and symptoms of TMD. Statistical analyses included correlations assessed by Pearson's test.

RESULTS

Fifty-two percent of patients presented symptoms of TMD. Thirty-two patients (average age 47 +/- 11 years, AHI 17.3 +/- 8.7, BMI 25.9 +/- 3.8 kg/m(2)) completed the study. According to the Scoring Protocol for Graded Chronic Pain (Axis II-RDC/TMD), 75% of the patients presented chronic pain related to TMD, categorized as low disability grade I (< 50 points for pain intensity, and < 3 disability points). The most common TMD diagnosis was myofascial pain with and without limited mouth opening and arthralgia (50%).

CONCLUSION

The high prevalence of TMD in the current study indicates that patients with OSAS referred for oral appliance therapy require specific evaluation related to TMD.

Magnetic resonance imaging evaluation of temporomandibular joint derangement in symptomatic and asymptomatic patients

OBJECTIVE

To highlight the importance of MRI in evaluation of the tempromandibular joint (TMJ).

METHODS

The MRI examination was performed at King Khalid University Hospital, Riyadh, Saudi Arabia with the approval from the local ethics committee, on 34 patients (68 joints) between January 2006 and November 2007, in which 10 were considered asymptomatic subjects (control). The remaining had symptoms and signs of TMJ pain or dysfunction, including limitation of movement and clicking. All our subjects were examined in both closed and open mouth position. Images were obtained by 1.5-T MRI system, in oblique sagittal plane utilizing 3 pulse sequences including T1 and T2 spin-echo, and spoiled gradient recall sequences. The evaluation of the meniscal disc configuration and position was carried out by 2 radiologists.

RESULTS

Sixteen out of 20 joints of asymptomatic subjects were normal. In the other 2 asymptomatic subjects, the MRI showed anterior disc displacement with reduction in 3 joints, and degenerative changes in 2 joints. Out of the 48 symptomatic joints, 26 (45%) joints were considered normal, while the other 22 joints showed anterior dislocation without reduction. Degenerative joint disease was also seen in 18 joints.

CONCLUSION

The MRI with the use of surface coils markedly improves the delineation of internal derangement of the TMJ, therefore, it enhanced the capability of detecting certain abnormalities, which proved to have a statistical significance in symptomatic patients.

A review of temporomandibular joint disorders (TMD's) presenting at the Lagos University Teaching Hospital

OBJECTIVE

To evaluate the patterns of presentation of Temporomandibular joint Disorders (TMDs) in our institution in a 6 year period.

PATIENT AND METHODS

A retrospective study of patients who presented in the Oral Medicine and Oral and Maxillofacial surgery clinics of the Lagos University Teaching Hospital (LUTH) between January 2000 and December 2005 with TMDs was done. Case files of these patients were retrieved and data collected included patients' age, sex, presenting complains and history of associated risk factors. Also collected were findings on clinical examination and mode of treatment. The data collected were evaluated and descriptive analysis was used as appropriate.

RESULT

A total of 94 patients were seen. There were 55 males (58.5%) and 39 female (41.5%), male to female ratio was ratio was 1.5:1. The age ranged from 13 to 98 years (mean age 42.7 +/- 16.4 years). Majority, 59 (62.8%) of the patients seen were between the ages of 20 and 49 years. Nine (9.6%) had a previous history of stress, 18 (19.1%) a previous history of trauma while 5 (5.3%) had a history of associated habits. Pain was the most common presenting complaint. It occurred as a singular presenting complaint in 66 (70.2%) patients and in association with other complaints in 10 (10.6%) patients. Conservative management was the treatment of choice in all cases.

CONCLUSION

Most patients with TMD in the studied environment are middle aged in agreement with the literature. However, there were more reported cases in males in contrast to previous studies. Previous history of trauma and stress were important risk factors elicited from patients with TMD in this study.

Temporomandibular joint and muscle disorder-type pain in U.S. adults: the National Health Interview Survey

AIMS

To compare prevalences of self-reported temporomandibular joint and muscle disorders (TMJMD)-type pain in the 2002 U.S. National Health Interview Survey (NHIS) by age and gender for non-Hispanic whites (Caucasians) and non-Hispanic blacks (African Americans).

METHODS

Data from the 2002 NHIS included information on gender, age, race, ethnicity, education, and TMJMD-type pain. Rao-Scott survey chi-square and survey logistic regression analyses using sampling weights and accounting for the complex design were used to analyze variables relating to prevalences.

RESULTS

A total of 30,978 people, 17,498 females and 13,480 males, 20,389 non-Hispanic whites and 4179 non-Hispanic blacks, were included. The overall prevalence of TMJMD-type pain was 4.6%, with 6.3% for women and 2.8% for men. However, based on age, a significant but modest racial/ethnic difference emerged after adjusting for socioeconomic status. For non-Hispanic white women up to age 50, the prevalence was approximately 7% to 8%, but it decreased after age 55. Non-Hispanic black women had much lower prevalence at younger ages (approximately 4% at 25 to 34 years), which increased thereafter up to 55 to 64 years of age. A similar racial pattern seemed to emerge for non-Hispanic black men, with the lowest prevalence at ages 25 to 34 years, while non-Hispanic white men had higher prevalences. Overall, however, age seemed to play more of a role in women than men.

CONCLUSION

This is the first report of findings from a nationally representative US sample for TMJMD-type pain by age and race/ethnicity. TMJMD-type pain differed significantly by race, age, and gender after adjusting for socioeconomic status.

Association between experience of stressful life events and muscle-related temporomandibular disorders in patients seeking free treatment in a dental hospital

OBJECTIVES

Psychological factors are known to play an important role in the etiology and maintenance of temporomandibular disorders. Since there have been very few studies on this issue in Asian countries, the study was aimed to investigate the relationship between various stressful life events and temporomandibular disorders in patients seeking free treatment in a Dental Hospital, Bangladesh.

MATERIALS AND METHODS

Five hundred and twenty Bangladeshi adults (370 males and 150 females; mean age, 30.9 +/- 8.2 years) participated in this study. The subjects were given a questionnaire to evaluate their stress status in the last 12 months. The Research Diagnostic Criteria for TMD (RDC/TMD) was used as TMD diagnostic system by three standardized examiners. Two hundred and thirty-six patients were RDC/TMD-defined TMD-positive and were subsequently classified into 7 groups: group I, myofacial pain only; group II, disk displacement only; group III, joint pain only; group IV, myofacial pain and disc displacement; group V, myofacial pain and joint pain; group VI, disc displacement and joint pain; and group VII, myofacial pain, disk displacement and joint pain. Two hundred and eighty-four subjects were RDC/TMD-defined TMD-negative subjects (controls). Adjusted odds ratios were calculated by multiple logistic regression analysis.

RESULTS

Logistic regression analysis revealed that patients diagnosed with myofacial pain (group I) and a combination of myofacial and joint pain (group V) had significantly higher levels of financial and job stress than did the controls. Self-health-related stress and stress related to a spouse or deaths of a relative were also identified as predisposing factors for myofacial pain (group I).

CONCLUSION

This study suggests that myofacial pain is more common in individuals with various types of psychological stress. When treating patients with facial pain, dentists should consider the possible presence of psychological factors.

Back pain in relation to musculoskeletal disorders in the jaw-face: A matched case–control study

Back pain and temporomandibular disorders are both common conditions in the population with influence on the human motor system, but a possible co-morbidity between these conditions has not been fully investigated. The aim of this study was to test the hypothesis of an association between long-term back pain and pain and/or dysfunction in the jaw-face region. Back pain was defined as pain in the neck, shoulders and/or low back. The study-population comprised 96 cases with long-term back pain and 192 controls without back pain. We used a screening procedure, a questionnaire and a clinical examination of the jaw function. The questionnaire focused on location, frequency, duration, intensity and impact on daily life of symptoms in the jaw-face and back regions. The analysis was conducted on 16 strata, matched by age and sex for case vs. control, using Mantel-Haenszel estimates of matched odds ratio (OR) and 95% confidence interval (CI) as well as the corrected Mantel-Haenszel chi(2) test. The overall prevalence of frequent symptoms in the jaw-face region, as reported in the questionnaire, was 47% among cases and 12% among controls. The difference was statistically significant (P<0.0001) with a sevenfold odds ratio (CI: 3.9-13.7). Moderate to severe signs from the jaw region were clinically registered among 49% of the cases and 17% of the controls (P<0.0001, OR: 5.2, CI: 2.9-9.2). The results showed statistically significant associations between long-term back pain and musculoskeletal disorders in the jaw-face and indicate co-morbidity between these two conditions.

The prevalence of myofascial pain and its association with occlusal factors in a threshold country non-patient population

The objective of the study is to assess the prevalence of myofascial pain in a threshold country and to isolate occlusal risk factors. One hundred and seventy-one randomized selected women were examined by a trained examiner in accordance with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) examination procedure. Subscales of the SCL 90-R, graded chronic pain status, and anamnestic questionnaires were also used. Logistic regression was performed to compute the odds ratios for six common occlusal features with regard to the presence of myofascial pain, in accordance with the RDC/TMD criteria. Fifteen subjects (15 / 151 = 9.93%) suffered from myofascial pain. Results from logistic regression analysis showed that non-occlusion (posterior teeth, at least one side) and open bite increased the risk of myofascial pain. The prevalence of myofascial pain in this study is comparable with that in another study, in a highly industrialized environment, in which the RDC/TMD was used. The role of occlusion in a non-patient population seems to be restricted to serious alterations of normality. This article presents the prevalence of myofascial pain and its association with occlusal factors. This issue will help the clinicians to assess the influence of occlusion in myofascial pain patients and to send the patient to the appropriate specialist.

Reliability, validity, incidence and impact of temporormandibular pain disorders in adolescents

The first aim of this thesis was to investigate the prevalence of temporomandibular disorder (TMD) pain in adolescents an a Swedish county and whether there were differences in patient age and gender and in treatment given for TMD pain by dentists in Public Dental Service (PDS) clinics. The epidemiological variable TMD-S was introduced in the PDS in Ostergötland County, Sweden, in 2000 and is recorded for all adolescents aged 12-19 at the annual routine examination. Self-reported TMD pain in this investigation was based upon the response of the subjects to two questions: (1) Do you have pain in your temples, face, temporomandibular joint, or jaws once a week or more? and (2) Do you have pain when you open your mouth wide or chew, once a week or more? Dental records of 200 patients with TMD pain were randomly selected from the population to evaluate treatment given for TMD. Among 28,899 participating adolescents, 4.2% reported TMD pain. Prevalence increased with age, a significant difference was seen between boys and girls, and 34% of patients with TMD pain received TMD-relared treatment in dental clinics. The second aim was to evaluate the reliability and validity of self-reported TMD pain in 120 adolescents, 60 with self-reported TMD pain and 60 age- and sex-matched controls without TMD pain. All adolescents were examined twice at a PDS clinic. At the first examination, self-reported TMD pain was recorded for each patient. At the second examination, a clinical examination was made blind to the patients' self-report of pain symptoms, after which self-reported TMD pain was again recorded. The clinical examination was based upon the Research Diagnostic Criteria for TMD (RDC/TMD). Test-retest reliability of 0.83 (kappa) was found for the two questions. Sensitivity was 0.98 and specificity 0.90 for assessments made on the same day and 0.96 and 0.83, respectively, for assessments made 2-4 weeks apart. The third aim was to evaluate incidence, by age and gender, and temporal patterns of TMD pain in adolescents. This 3-year longitudinal study was carried out at all PDS clinics from 2000 to 2003. All individuals aged 12-19 years in the county who visited the clinics for annual examinations were eligible for the study. Overall, the annual incidence of TMD pain among 2255 participating adolescents was 2.9%. Incidence among girls (4.5% was significantly higher than in boys (1.3%). Incidence increased with age in girls and boys, although less so in boys. These adolescents were re-examined annually for 3 years, and a fluctuating pattern of TMD pain was common. The fourth and final aim was to investigate gender and age differences in pain behavior, jaw function, and psychosocial status in adolescents with self-reported TMD pain. A postal questionnaire was sent to 350 consecutive patients with self-reported TMD pain and 350 healthy age- and sex-matched individuals aged 12-19 years 2-4 weeks after their annual dental examination. The groups were divided into younger (age 12-15) and older (age 16-19) groups. The TMD and control groups differed significantly in most variables related to pain characteristics and psychosocial and behavioral factors. Multiple pain sites were significantly more common in the TMD than in the control group, but there were no gender differences. For adolescents reporting pain once a week or more, no gender differences were seen in pain intensities. Jaw function limitation, depression scores, and perceived need for TMD treatment were significantly higher overall in girls than in boys. Almost one-third of older girls, compared to one out of ten older boys, reported school absences and analgesic consumption because of their TMD pain. Older girls had significantly higher Graded Chronic Pain Scale scores than older boys. In conclusion, TMD pain increases with increasing age in adolescents and is more common in girls than in boys. A fluctuating pain pattern can be seen. TMD-S, with two self-report questions, has very good reliability and validity, and can be recommended for screening adolescents for TMD pain. TMD pain seems to have a greater Impact on girls than boys. particularly in ages 16-19 years.

[The prevalence of craniomandibular disorders in the military population of the Republic of Serbia]

INTRODUCTION

The aim of this study was to determine the prevalence of craniomandibular dysfunction (CMD) in the military personnel of the Republic of Serbia, as well as the distribution of sings and symptoms of CMD in this population group.

MATERIAL AND METHODS

The epidemiological investigation included 284 male persons between 18 - 25 years of age. The sample consisted of Military Academy students, and soldiers from different regions of the Republic of Serbia. A questionnaire was designed using Helkimo's clinical dysfunction index and sings and symptoms of CMD were evaluated, namely the anamnestic index (Ai) and the dysfunction index (Di).

RESULTS

According to the anamnestic dysfunction index (Ai), 85% of persons among the examined group presented without any symptoms of CMD (Ai = 0), 14% had mild symptoms (Ai =1) and 1% had severe symptoms of CMD (Ai = 5). Functional analysis of the orofacial system in the examined group (evaluation of dysfunction index - Di) revealed, however, that 70% of solders had at least one sign of CMD, precisely a dysfunction index Di > 0. The analysis of signs and symptoms of CMD revealed that disturbances in mandibular kinematics were the most prevalent sign of CMD in this population group, which was confirmed in 56% of examined persons. Disturbed functions of temporomandibular (TM) joints (click, and reciprocal click, deviation and deflection during mandibular opening) were established in 31% of examined persons, and sensitivity of TM joints and masticatory muscles during palpation in 4% of examined persons. Pain during mandibular movements was established only in 1% of examined persons.

CONCLUSION

The results of this investigation point to significant prevalence of craniomandibular disorders in the examined population group. The incidence of TMJ and masticatory muscle pain in 4% of examined persons and of pain during mandibular movements only in 1% of examined persons, points to presence of mild or initial types of CMD in this population group.

Prevalence, intensity, and correlation of different TMJ symptoms in Lebanese and Italian subpopulations

AIM

The aim of this study was to compare self reported joint related temporomandibular disorder (TMD) symptoms in Lebanese and Italian dental and non-dental students and to detect any correlation between different symptoms.

METHODS AND MATERIALS

A questionnaire was distributed in Sardinia (Italy) to dental and psychology students and in Lebanon to dental, physical therapy, and biology students to investigate the prevalence, intensity, and correlation of four temporomandibular joint (TMJ) symptoms.

RESULTS

Prevalence of earache varied among the groups from 10.1% to 29.2%, ear stuffiness from 22.5% to 30.8%, TMJ pain from 13.2% to 21.2%, and TMJ sounds from 18.4% to 46.2%.

DISCUSSION

Different prevalence and intensity of earache and TMJ sounds were found in the examined sub-populations diverse in cultural background and education. However, prevalence and intensity of ear stuffiness and TMJ pain were similar. Association between TMJ sounds and TMJ pain was detected in selected sub-populations, and correlation between one symptom on one side of the head with the same symptom on the contralateral side were noted suggesting most of these symptoms are bilateral.

CONCLUSION

The results of the study might be useful to anticipate the possible occurrence of associated symptoms or the same symptom on both sides of the head. Correlations with cultural background and education are difficult to establish.

Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis I diagnoses in an Italian patient population

The aim of this work was twofold: to evaluate the prevalence of different Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) diagnosis in an Italian population of subjects seeking TMD treatment in a tertiary clinic; and to compare data with those from similar studies in the literature. Participants in this study were 433 consecutive patients seeking TMD treatment at the Section of Prosthetic Dentistry, Department of Neuroscience, University of Pisa, Italy; mean age of patients was 38.8 years, with a female:male ratio of 2.6:1 (276 females, 73.2%; 101 males, 26.8%). RDC/TMD guidelines for examination were adopted to assign axis I diagnosis. The prevalence of RDC/TMD diagnoses was 38.2% (144/377) for group I disorders (muscle disorders), 52.3% (197/377) for group II disorders (disc displacements), and 52.6% (198/377) for group III disorders (arthralgia, osteoarthritis, osteoarthrosis). The present investigation provided findings that, compared and integrated with literature data, can be useful to create a world-wide database, in accordance with the nature of the RDC/TMD classification system.

Sleep and depression as risk indicators for temporomandibular disorders in a cross-cultural perspective: a case-control study

PURPOSE

We conducted this case-control study to determine the role of 2 neuropsychologic variables (sleep and depression) as possible risk indicators for the development of temporomandibular disorders (TMD).

MATERIALS AND METHODS

Neuropsychologic tests, traditional signs and symptoms of TMD, and social and economic variables were analyzed. Seventy-two predominantly muscle-related TMD patients (Research Diagnostic Criteria for TMD groups Ia, Ib, and IIIa) and 30 age- and sex-matched pain-free controls were included in the population.

RESULTS

Overall, TMD patients had statistically significantly higher sleep and depression scores on the Sleep Assessment Questionnaire and on the Brazilian Portuguese version of the Beck Depression Inventory, with odds ratios of 5 and 1.6, respectively. These results remained unchanged even after controlling for 8 confounders in the logistic regression analysis. Spontaneous pain and pain on palpation (grade 2 or higher) were also statistically significantly worse in TMD patients. In the forward-step logistic regression analysis, we also found that the combination of our best TMD predictors (ie, sleep, cigarettes, alcohol) had a better predictive value (percent agreement = 78.69%) than when the variables were analyzed alone.

CONCLUSION

Sleep and depression are considered important risk indicators for the development of TMD.

Temporomandibular disorders in association with scuba diving

OBJECTIVE

To determine the prevalence of temporomandibular disorders (TMD) in scuba divers and to identify the risk factors for the development of pain in the stomatognathic system before and after diving by the use of a questionnaire.

DESIGN

: Retrospective cohort study based on questionnaires.

PARTICIPANTS

A total of 296 active divers, aged 18 to 65 years, participating in scuba diving meetings in Heidelberg, Germany.

INTERVENTIONS

Each diver answered a questionnaire containing 29 questions, predominantly on symptoms of TMD.

MAIN OUTCOME MEASURES

The data collected from the divers were calculated by the use of logistic regression tests. Risk factors for the development of TMD were evaluated.

RESULTS

Clenching seemed to be the greatest risk factor for pain while holding the mouthpiece and for pain in the masticatory muscle system after diving. Limited mouth opening and clenching were responsible for the development of pain in the temporomandibular joint after the dive. The prevalence of TMD-related symptoms was higher in women before, during, and after the dive.

CONCLUSIONS

Individuals exhibiting TMD-related symptoms seem to be at the greatest risk of developing pain in the masticatory muscle system and/or the temporomandibular joint during or after the dive.

[Masticatory pain-dysfunction syndrome apropos of 60 cases]

Costen syndroma or temporo-mandibular joint disorders is not welknow in the ENT service, despite the common presentation with otalgia. We therefore present 60 cases diagnose in our hospital and present clinical and therapeutic aspect.

The prevalence of signs and symptoms of temporomandibular disorders in very old subjects

Previous studies on the prevalence of signs of temporomandibular disorders (TMD) in elderly people have used non-standardized and invalidated examination protocols. The prevalence of the different signs of TMD in this group is therefore still unclear. The aim of this study was to evaluate the prevalence of signs of TMD in subjects of advanced aged, using a standardized and validated examination protocol. Additionally, young subjects were examined as a control group. Fifty-eight old peoples' home inhabitants and 44 young subjects were examined using a standardized and validated examination protocol. Differences between the groups were assessed using Mann-Whitney U-test or t-test. Geriatric subjects more often exhibited objective symptoms of TMD (38% exhibited joint sounds on opening), but rarely suffered from pain (pain at rest: 0%, joint pain: 0%, muscle pain: 12%). In contrast, young subjects rarely exhibited objective symptoms (joint sounds: 7%), but suffered more frequently from pain (facial: 7%, joint pain: 16%, muscle pain: 25%). The mandibular range of motion was higher in young subjects. Differences between the groups with respect to joint sounds, muscular palpation pain and mandibular range of motion were significant. Although older subjects more frequently exhibited objective signs (joint sounds) of TMD, they rarely suffered from pain. In contrast, younger subjects rarely exhibited objective TMD signs but more frequently suffered from subjective signs (muscular pain on palpation) and facial pain.

The relationship of somatization and depression to experimental pain response in women with temporomandibular disorders

OBJECTIVE

Patients with temporomandibular pain disorders (TMD) have greater experimental pain perception when compared with pain-free controls. Common psychological features of TMD include somatization and depression. The impact of depression on experimental pain perception has received considerable attention. However, the role of somatization on experimental pain in a chronic pain population has not been explored.

METHODS

Fifty-six women with TMD and 59 pain-free controls underwent three experimental pain procedures, including palpation at fixed amounts of pressure, pressure pain thresholds, and an ischemic pain task. Levels of depression and somatization were assessed using the Research Diagnostic Criteria for TMD. Multiple regression analyses were performed to determine the extent to which depression and somatization were associated with experimental pain response.

RESULTS

After controlling for characteristic pain intensity and depression, somatization explained a significant proportion of variance in numbers of masticatory sites rated as painful (R2 change = 6.7%, p = .046) with the full model explaining 16.4% of the variance (p = .024). This did not meet an adjusted level of statistical significance (p = .008). After controlling for characteristic pain, only depression added significantly to the model predicting ischemic pain threshold and tolerance. The full models including characteristic pain and depression explained 49% and 20% of the variance in ischemic pain threshold and tolerance, respectively.

CONCLUSIONS

These findings suggest that depression and somatization are associated with different measures of experimental pain. Somatization may be related to more attentional and perceptual measures of clinically relevant pain while depression may be related to more behavioral measures of pain.

The prevalence of temporomandibular joint dysfunction in the mixed dentition

A functional and articular examination was carried out of 136 children (70 boys, 66 girls) aged from 6 to 12 years (6 years 1 month to 12 years 9 months), all presenting with a malocclusion in the mixed dentition and who had not yet received orthodontic treatment. The aim of the study was to examine the prevalence of signs of temporomandibular joint dysfunction (TMD) in this population and to evaluate the possible relationship between certain 'individual' parameters and TMD signs. The results showed an elevated prevalence of muscle tenderness, particularly in the lateral pterygoid muscle, which was found to be sensitive in 80.9 per cent of patients. Muscle tenderness had a tendency to increase with age and was greater on the right side. Temporomandibular joint sounds were present in 35.3 per cent of the subjects and more frequent in girls and in older children. Of the children who presented a mandibular deviation on maximal opening (19.8 per cent), 13.2 per cent had a predominance of opening deviation towards the left. Retruded contact position interferences were present in 57.4 per cent of the children and 72.1 per cent presented lateral and protrusive interferences. Assessment of the maximal amplitudes of mandibular movements did not reveal any limitations. These results indicate that few relationships exist between individual parameters and TMD signs.

Prevalence of temporomandibular dysfunction in a group of scuba divers

BACKGROUND

Temporomandibular dysfunction (TMD) has been reported to be a common problem in divers, with a prevalence of up to 68%. No evidence for this is available.

OBJECTIVE

To investigate the prevalence of TMD in divers.

METHOD

Sixty three subjects were asked to retrospectively complete a questionnaire on symptoms of TMD after diving in warm and cold water areas and in daily life.

RESULTS

The prevalence of TMD was greater in female divers. The prevalence of TMD while diving was about 26%, comparable to that experienced in daily life.

CONCLUSION

Improvements in mouthpiece design and lighter demand valves mean that TMD is now probably exacerbated by diving rather than caused by it.

The normal range of mouth opening in an Irish population

The aims of this study were to estimate the average maximum mouth opening and range of mouth opening in a representative sample of the Irish adult population, to compare mouth opening in patients with and without signs or symptoms of temporomandibular joint (TMJ) dysfunction syndrome and to investigate the association between mouth opening and stature among populations. As part of the Irish National Survey of Adult Oral Health, maximum mouth opening was measured and questionnaire data collected for 1513 adults, aged 16-99 years. The average maximum mouth opening was 43 mm for males and 41 mm for females. Mouth opening was found to reduce with age, independent of gender. No link was found between reduced mouth opening and TMJ dysfunction or between mouth opening and stature in populations.

Gender issues and oral health in elderly Indians

OBJECTIVES

Gender disparity in health and diseases is increasingly being recognised. Therefore, it was decided to investigate gender differences in the elderly subjects (60+years) from a community-based study. The study was undertaken to evaluate the oral health status and treatment needs of urban and rural elderly and to study the impact of socio-demographic variables on them.

STUDY DESIGN

An urban area in South Delhi and its adjoining four villages was selected. A modified WHO-Oral Health Survey proforma and Rup-Nagpal's scale were used to record oral health and socio-demographic data respectively. In addition, diet pattern (vegetarian/non-vegetarian) and body mass index (BMI) were also recorded. Chi square test and p values were calculated for each of the studied parameters.

RESULTS

There were significant differences for socio-economic status, literacy level, marital and family status between elderly men and women (p<0.0001). A higher percentage of elderly women were vegetarian and overweight than elderly men (p<0.01). However, there were few differences found in the prevalence of dental caries, periodontal diseases and edentulousness between male and female elderly (p>0.01). The only difference found was in the evidence of previous dental treatment received. Elderly men had a higher percentage of filled teeth and denture wear compared to elderly women (p<0.01).

CONCLUSIONS

Women's oral health is significantly influenced by social, economic and psychological factors.

[Dental occlusion and subjective temporomandibular joint symptoms in men and women. Results of the Study of Health in Pomerania (SHIP)]

Aim of the study was to determine whether associations exist in men as well as in women between occlusal factors like malocclusions or factors of functional occlusion and subjective temporomandibular joint (TMJ) symptoms, based on the population-based Study of Health in Pomerania (SHIP-0). A representative sample of 4310 men and women (response rate 68.8%) aged 20 to 81 years was examined for subjective temporomandibular joint symptoms, malocclusions (incl. normal occlusion), factors of functional occlusion and for sociodemographic parameters. Men and women were analyzed separately with multiple logistic regression analyses, adjusted for age. The results were compared to other population-based studies from an own systematic review on this subject. In men and women, none of the 48 occlusal factors under survey (malocclusions or functional occlusion) was significantly more frequently associated with the dependent variable "subjective temporomandibular joint symptoms". In contrast, the parafunction "frequent clenching" was associated more frequently and clinically relevant with TMJ symptoms in both sexes (for men, odds ratio = 4.2, prevalence 4.9%; for women OR = 2.9, prevalence 5.6%). Malocclusions and functional occlusion factors only explained a smaller part of the differences between the male and female population with and without subjective TMJ symptoms. Compared to other population-based studies only few and inconsistent associations between occlusal factors and subjective temporomandibular symptoms were ascertainable in both sexes.

Temporomandibuläre Funktionsbefunde nach Dysgnathieoperationen im Vergleich zu einer bevölkerungsrepräsentativen Studie

AIM

The temporomandibular function of patients after orthognathic surgery was evaluated with the Helkimo index (D 0-III) and compared with a normal population.

PATIENTS AND METHODS

Temporomandibular disorders (TMD) were evaluated with the Helkimo index (D 0-III) in a group of patients (n=105, F=69, M=36) after osteotomies. The average follow-up time was 47 months (9-141 months). The osteotomies performed were as follows: 58 bilateral sagittal split osteotomies, 12 Le Fort I osteotomies, 22 bimaxillary osteotomies, and 13 segment-osteotomies. A control group (n=202, F=114, M=88, age 20-39 years) was examined in an epidemiological study. The statistical analysis was performed using Windows software SPSS 10.0.

RESULT

In 82.8% of the patients no symptoms or mild dysfunction were found. The comparison between the patient group (31.4%) and the control group (31.7%) revealed a similar frequency. The most frequent dysfunction was a reduced mobility of the mandible, which determined the statistical significance (p<0,05) between the patients and the control group for the dysfunction group D II and D III. The chi-square test could not detect any difference between sex and the kind of osteotomy with regard to dysfunction.

The epidemiology of self-reported TMJ sounds and pain in young adults in Israel

OBJECTIVES

We investigated the prevalence of self-reported temporomandibular joint sounds (TMJS), masticatory muscle pain (MMP), and their interrelation in a young adult population.

METHODS

A large sample (n = 20,869) of young soldiers aged 18-21 years who attended dental clinics were asked about their experience of TMJ sounds and pain.

RESULTS

The overall prevalence of TMJS was 8.4 percent (8.9% in females and 8.2% in males) and for masticatory pain was 4.0 percent for both males and females (P < .001 under chi-square test). Twenty-five percent of patients reporting positive TMJS also reported positive MMP compared to 2 percent in the negative TMJS group (P < .001). Fifty-three percent of patients reporting positive MMP also reported positive TMJS, compared to 6.5 percent in the negative MMP group (P < .001).

CONCLUSIONS

The low prevalence of TMJ sounds and pain found in these study might be attributed to the different cultural and social environment, as well as to the uniformity in age of the study group.

TMD prevalence in rural and urban Native American populations

The purpose of this study was to assess the prevalence of TMD in a consecutive sample of 102 subjects from the Native American population living in an urban setting and 90 subjects living in a rural setting. The study utilized a clinical examination and standardized questionnaires. The sample age ranged from five to 84 years of age. The subjects were asked to estimate pain frequency, severity and daily pattern of jaw pain, difficulty in opening, joint clicking, and sleeping problems. Examination was performed on joint, masticatory, and cervical muscles, as well as occlusion. Data was collected and statistically analyzed. Statistically significant differences were found; however, the only statistically significant difference that might have clinical significance was more facial pain in the urban population.

Risk factors for diagnostic subgroups of painful temporomandibular disorders (TMD)

Temporomandibular Disorders (TMD) encompass several entities, which may have differing etiologies. To test this hypothesis, we investigated risk factors for three diagnostic subgroups of painful TMD. Ninety-seven subjects with myofascial pain only, 20 with arthralgia only, 157 with both myofascial pain and arthralgia, and 195 controls without TMD pain met criteria for study eligibility. Investigated risk factors included both physical and psychological variables. Adjusted odds ratios were calculated by multiple logistic regression analyses. Myofascial pain occurring alone was significantly associated with trauma (Odds Ratio [OR] = 2.0), clenching (OR = 4.8), third molar removal (OR = 3.2), somatization (OR = 3.7), and female gender (OR = 4.2). Myofascial pain with arthralgia was significantly associated with trauma (OR = 2.1), clenching (OR = 3.3), third molar removal (OR = 4.0), somatization (OR = 5.1), and female gender (OR = 4.7). No significant associations were found for the small-arthralgia-only group.

Prevalence of temporomandibular dysfunction and its association with malocclusion in children and adolescents: an epidemiologic study related to specified stages of dental development

A sample of 4724 children (2353 girls and 2371 boys) (5-17 years old) were grouped not only by chronological age but also by stage of dental development (deciduous, early mixed, late mixed, and permanent dentition). The registrations included functional occlusion (anterior and lateral sliding, interferences), dental wear, mandibular mobility (maximal opening, deflection), and temporomandibular joint and muscular pain recorded by palpation. Headache was the only symptom of temporomandibular dysfunction (TMD) reported by the children. The results showed that one or more clinical signs were recorded in 25% of the subjects, most of them being mild in character. The prevalences increased during the developmental stages. Girls were in general more affected than boys. Significant associations were found between different signs, and TMD was associated with posterior crossbite, anterior open bite, Angle Class III malocclusion, and extreme maxillary overjet.

The relationship of bruxism with craniofacial pain and symptoms from the masticatory system in the adult population

The association of bruxism with craniofacial pain and symptoms of dysfunction of the masticatory system was assessed in a sample of 483 adult subjects, aged 18-75 years and selected from the general population living in the municipality of Segrate, a metropolitan area in northern Italy. Subjects were interviewed by a questionnaire about oral conditions, occurrence of symptoms of masticatory disturbances, craniofacial and neck pain. The overall prevalence of bruxism was 31;4% (95% confidence interval (CI): 27;3-35;5%). At univariate analysis bruxism was significantly associated with craniofacial pain, difficulty in closing the mouth, difficulty in opening the mouth wide or in locking the mouth, temporomandibular joint sounds, pain on movement, a feeling of stiffness or fatigue of the jaws, and neck pain. After adjustment for reciprocal influences and confounding variables, logistic regression analysis disclosed a strong independent association of bruxism with difficulty in closing the mouth (adjusted odds ratio, (OR): 2;84, 95% CI: 1;68-4;48), and a weaker relationship with craniofacial pain (adjusted OR: 1;84, 95% CI: 1;16-2;93) and temporomandibular joint sounds (adjusted OR: 1;64, 95% CI: 1;00-2;69). The findings show that in the general adult population there is a complex connection among bruxism, craniofacial pain and symptoms of masticatory disturbances. Furthermore, they suggest that the most direct relationship of bruxism may be with difficulties in mouth movements, but also an independent association may exist with craniofacial pain and other symptoms of temporomandibular disorder.

A longitudinal epidemiologic study of signs and symptoms of temporomandibular disorders from 15 to 35 years of age

AIMS

To study the development over 20 years of signs and symptoms of temporomandibular disorders (TMD) in an epidemiologic sample and to analyze possible correlations between these signs and symptoms and some other variables.

METHODS

The original group comprised 135 randomly selected 15-year-old subjects who were examined clinically and by means of a questionnaire for signs and symptoms of TMD. The examination was repeated after 5, 10, and 20 years by the same methods. After 20 years, when the original group had reached the age of 35 years, 124 individuals (92%) could be traced, and they were sent a questionnaire and invited for a clinical examination. The response rate was high: 114 subjects (92%) completed and returned the questionnaire, and 100 subjects (81%) attended the clinical examination.

RESULTS

There was a substantial fluctuation of both reported symptoms and clinically recorded signs over the 20-year period, but progression to severe pain and dysfunction of the masticatory system was rare. In both the 15-year-old and 35-year-old subjects, 13% reported 1 or more frequent TMD symptoms. At age 35, only 3 subjects (3%) were classified as having severe or moderate clinical signs of dysfunction according to the Helkimo Index, fewer than in previous investigations. Women reported TMD symptoms and headache and had muscle tenderness and joint sounds more often than men. Correlations between the studied variables were mainly weak. Among the highest correlations found (rs = 0.4) were those between reported clenching and bruxing habits and TMJ sounds and jaw fatigue.

CONCLUSION

In this epidemiologic sample followed from age 15 to 35 years, a substantial fluctuation of TMD signs and symptoms was found over time. Progression to severe pain and dysfunction was extremely rare.

Prevalence of temporomandibular dysfunction in Turkish children with mixed and permanent dentition

This study was carried out to determine the prevalence of temporomandibular joint (TMJ) dysfunction in mixed and permanent dentition and to evaluate the sex distribution in Turkish children. One hundred and eighty-two children with mixed dentition and 212 with permanent dentition were selected for the study, which used a questionnaire and clinical examination. Children with one or more signs (TMJ sounds, TMJ tenderness, muscle tenderness, restricted mouth opening) and/or symptoms (TMJ pain during mastication and mouth opening, restriction of the jaw opening and TMJ sounds) met the criterion of TMJ dysfunction. The total prevalence of signs and symptoms of TMJ dysfunction in the studied population was 68% (68% in girls and 68% in boys) in mixed dentition and 58% (61% in girls and 56% in boys) in permanent dentition. The Z-test and analysis of variance (ANOVA) were used for statistical analysis of the difference between the results. The total prevalence of signs and symptoms of TMJ dysfunction in mixed dentition was found to be higher than in permanent dentition (P < 0.05). No statistically significant difference was found in the total prevalence of TMJ dysfunction between girls and boys.

Is use of exogenous estrogen associated with temporomandibular signs and symptoms?

BACKGROUND

Studies of historical data suggest a link between exogenous estrogen use and referral for treatment for temporomandibular disorders, or TMDs. The purpose of the authors' study was to determine the association between exogenous estrogen use and signs and symptoms of TMD assessed by direct physical examination in a randomly selected community sample of primarily postmenopausal women.

METHODS

A calibrated clinical examiner examined a stratified random sample of 510 women aged 37 to 82 years using the Craniomandibular Index, or CMI. All medications that subjects were taking at the time of the examination were identified by interview and examination of subjects' medication containers on two occasions. One hundred seventy-four subjects were taking medications containing estrogen, and 336 were taking no such medications.

RESULTS

The muscle and joint signs and symptoms of women taking and not taking estrogen were not significantly different after the authors controlled for sociocultural, demographic and health care utilization variables. Estrogen use also failed to distinguish women receiving relatively high and low scores on the CMI.

CONCLUSION

Estrogen replacement therapy does not place women at increased risk of developing TMDs.

CLINICAL IMPLICATIONS

Clinicians need not be concerned that patients taking oral contraceptives or replacement estrogens are at increased risk of developing TMDs.

Clinical implications of sex in acute temporomandibular disorders

BACKGROUND

Previous research on temporomandibular disorders, or TMDs, has been somewhat limited, with studies having low numbers of subjects, restricting the focus to women or looking at patients already diagnosed with chronic TMD. Because early intervention is beneficial, it is important to understand the symptoms that men and women have in the acute stage of TMD.

METHODS

A total of 233 patients (161 women, 72 men) with acute TMD symptoms were assessed with a battery of biopsychosocial measures. Patients were diagnosed as having TMD on the basis of research diagnostic criteria, or RDC, or RDC, for TMD. After six months, patients were reassessed to determine whether they continued to have pain, thus classifying them as having chronic TMD. The authors found that 153 patients (47 men, 106 women) had developed a chronic condition, while 80 patients (25 men, 55 women) no longer reported pain (nonchronic).

RESULTS

Female and male patients who developed chronic TMD differed significantly from patients who had acute symptoms that subsided. Women who developed chronic TMD exhibited significantly more psychosocial distress and impairment than women who did not develop chronic TMD, in terms of Diagnostic and Statistical Manual, Fourth Edition, or DSM-IV, diagnoses; Beck Depression Inventory, or BDI, scores; Minnesota Multiphasic Personality Inventory scores; Multidimensional Pain Inventory, or MPI, scores; and physical and psychological measures assessed with the RDC for TMD. Men who developed chronic TMD differed significantly from men who did not develop chronic TMD, in that they exhibited more impairment in terms of DSM-IV diagnoses and BDI and RDC measures.

CONCLUSIONS

These findings provide evidence that significant differences exist between men and women in regard to acute TMD symptoms.

CLINICAL IMPLICATIONS

The biopsychosocial differences between men and women suggest that some treatments may be more beneficial for women than for men.

Prevalence of signs and symptoms of temporomandibular disorders in young Nigerian adults

The objective of this study was to determine the prevalence of signs and symptoms of TMD in young Nigerian adults and to establish a baseline for comparison with other studies. It consisted of a cross-sectional study at Obafemi Awolowo University, Ile-Ife, Nigeria in 1997. The subjects consisted of 308 medical and dental students (207 males and 101 females) randomly selected from a Nigerian University. Their ages ranged from 17 to 32 years with a mean age of 23 +/- 3.0 years. They were assessed according to the criteria of Helkimo (1974). Whilst 26.3 per cent of the subjects reported mild symptoms (Ai I) of TMD, only 2.9 per cent reported severe symptoms (Ai II). Similarly, 46 per cent showed mild dysfunction signs (Di I), whilst 16.5 and 0.3 per cent exhibited moderate (Di II) and severe (Di III) signs of TMD, respectively. No significant relationships were found between sex, anamnestic index, and the clinical dysfunction index scores. However, there were low but significant correlations between ananmestic index scores (Ai) and the recorded signs (Di), as well as the clinical dysfunction scores (CDS). There is some evidence to show that signs and symptoms of TMD occur amongst Nigerians, although restricted lateral and protrusive mandibular movements contributed significantly to clinical dysfunction scores. This report contrasts with what is found in western societies regarding the low prevalence of TMJ pain. Refereed Scientific Paper

[An assessment of Helkimo index in 88 orthodontic patients before treatment]

OBJECTIVE

The prevalence of temporomandibular joint disorders(TMJDs) was studied in orthodontic patients before orthodontic treatment.

METHODS

The functional examination of the masticatory system was made with Helkimo index in 88 young patients with general malocclusion.

RESULTS

According to the dysfunction index, 50 percent of the patients was free of anamnestic dysfunction, and 44.32% and 5.68% of the patients had a mild and a severe anamnestic dysfunction respectively, 32.95 percent of patients was free of clinical dysfunction, and 51.14% and 14.77% of patients had a mild and a moderate clinical dysfunction respectively, only 1.14 percent of patients had a severe clinical dysfunction. The dysfunction of masticatory muscles and sounds of temporomandibular joint were most common in the signs and symptoms of TMJDs.

CONCLUSION

There were no significant differences in the distribution of Ai and Di in different gender and between Angle's Class I and II malocclusion, and there was a relationship between Ai and Di.