Association of malocclusion and functional occlusion with signs of temporomandibular disorders in adults: results of the population-based study of health in Pomerania

The objective of this study was to determine whether associations exist between occlusal factors and signs of temporomandibular disorders (TMD) in adults using the population-based Study of Health in Pomerania (SHIP), Germany. A representative sample of 4310 men and women aged 20 to 81 years (response 68.8%) was investigated for TMD signs, malocclusions, functional occlusion factors, and sociodemographic parameters. Multiple logistic regression analysis, adjusted for sex, age, and socioeconomic status, was used. The results were compared with other population-based studies identified by a systematic review. Few malocclusions and no factors of functional occlusion except socioeconomic parameters were associated with TMD signs, and these associations were mostly weak. Only bilateral open bite up to three mm appeared to be clinically relevant and was associated with TMD signs (odds ratio [OR] = 4.0). This malocclusion, however, was of rare occurrence, with a prevalence of 0.3% (n = 9), and this finding was not confirmed by other representative studies. Occlusal factors examined in this study explained only a small part of the differences between normal subjects and those with TMD signs. This and other population-based studies indicate that malocclusions and factors of functional occlusion surveyed should be seen as merely cofactors in the sense of one piece of the mosaic in the multifactorial problem of temporomandibular dysfunction. Single occlusal factors that showed significant effects throughout several studies could not be detected. In view of the large number of occlusal variables already investigated, other variables including nonocclusal ones probably also play a role and should be looked at more intensely.     

Gender differences in associations between occlusal support and signs of temporomandibular disorders: results of the population-based Study of Health in Pomerania (SHIP)

PURPOSE: The aim of this study was to investigate whether gender-dependent associations exist between signs of temporomandibular disorders (TMD) and occlusal support. MATERIALS AND METHODS: Stratified by gender, the data of 2,963 35- to 74-year-old participants from the epidemiologic Study of Health in Pomerania were used in logistic regression analyses with temporomandibular joint (TMJ) tenderness and muscle tenderness as the dependent variables. Occlusal support was classified according to the Eichner index, a classification system based on occluding pairs of teeth. The final model was adjusted for bruxism, age, and various sociodemographic data. RESULTS: Logistic regression analyses revealed increased odds ratios for TMJ tenderness in men with loss of all four molar and premolar supporting zones (odds ratio 3:9) and without antagonist contact (odds ratio 2:7). Significant relationships in men were also found between muscle tenderness and loss of one (odds ratio 2:1), three (odds ratio 2:1), or four supporting zones (odds ratio 2:7), and loss of any tooth contact (odds ratio 2:3). In women, significant associations between occlusal support and TMD signs were absent. Subjects with bruxism were more likely to have TMJ tenderness (odds ratio women 2:0, men 1:9). In women, an additional relationship existed between bruxism and muscle tenderness (odds ratio 1:7). The following habits showed no significance: gum chewing, unilateral chewing, and lip/tongue/cheek biting. CONCLUSION: Only in men was the loss of occlusal support significantly associated with muscle and TMJ tenderness. The association between bruxism and TMD signs supports the theory that repetitive adverse loading of the masticatory system may cause functional disturbances.     

Self-reported chewing side preference and its associations with occlusal, temporomandibular and prosthodontic factors: results from the population-based Study of Health in Pomerania (SHIP-0)

Summary  This study investigated the prevalence of a preferred chewing side (PCS) and associations between a PCS and signs of temporomandibular disorders (TMD), antagonist contact and prosthetic restoration. A population representative sample of 4086 adults of the cross-sectional epidemiologic 'Study of Health in Pomerania' (SHIP-0) (age range 20–80 years, female 50·2%) was divided in two groups by the presence or absence of a PCS. PCS was evaluated by a questionnaire. Chi-squared tests and multiple logistic regression were used to determine the impact of the relation between a PCS and signs and symptoms of TMD as well as dental factors. The prevalence of a PCS was 45·4%. Women between 40 and 69 years reported more frequently a PCS. There was a preference for the right side (64%). The following independent variables were significantly associated with a PCS: subjective unilateral pain in the temporomandibular joint (TMJ), odds ratio (OR) 2·4; subjective unilateral joint clicking, OR 1·7; unilateral TMJ/muscle pain on palpation, OR 1·6/OR 1·3; loss of one supporting zone (Eichner-Classification), OR 1·9; loss of both supporting zones on one side, OR 2·2, one supporting zone left, OR 1·4; presence of a removable partial denture, OR 1·6; presence of an attachment restoration, OR 1·5. A PCS was found in almost half the study population and was associated with unilateral signs of TMD, most of all TMJ pain and asymmetrical loss of antagonist contact. Despite replacement of lost teeth not all restorations seemed to support bilateral mastication.     

Association between generalized joint hypermobility and signs and diagnoses of temporomandibular disorders

The aim of this study was to analyze whether generalized joint hypermobility (GJH) is a risk factor for temporomandibular disorders (TMD). We examined 895 subjects (20–60 yr of age) in a population‐based cross‐sectional sample in Germany for GJH according to the Beighton classification and for TMD according to the Research Diagnostic Criteria for TMD (RDC/TMD). After controlling for the effects of age, gender, and general joint diseases using multiple logistic regression analyses, hypermobile subjects (with four or more hypermobile joints on the 0–9 scale) had a higher risk for reproducible reciprocal clicking as an indicator for disk displacement with reduction (Odds Ratio (OR) = 1.68) compared with those subjects without hypermobile joints. Concurrently, subjects with four or more hypermobile joints had a lower risk for limited mouth opening (< 35 mm; OR = 0.26). The associations between GJH and reproducible reciprocal clicking or limited mouth opening were statistically significant in a trend test. No association was observed between hypermobility and myalgia/arthralgia (RDC/TMD Group I/IIIa). In conclusion, GJH was found to be associated with non‐painful subtypes of TMD.     

Association between oral habits and signs/symptoms of temporomandibular disorders in Flemish adolescent girls

The influence of oral habits on the development of signs and symptoms of temporomandibular disorders (TMD) and pain is unclear. The prevalence and nature of such oral habits may also vary geographically. The aim of the present study was to assess the prevalence of parafunctions in Flemish adolescent girls and to study the interrelationship with TMD. A group of 261 school girls (15–16 years of age) participated. A questionnaire used in a similar study ( Gavish et al., 2000 ) was translated and inquired for oral habits (chewing of gum, nails or foreign objects, eating of seeds, crushing of ice or food, continuous leaning on the arm, daytime or night‐time grinding or clenching, jaw play, unilateral chewing) and TMD symptoms (joint noises, catching or locking, joint or muscle pain, tension or fatigue in the muscles). A brief clinical examination was performed by a single examiner: active and passive maximal mouth opening, presence of joint sounds, palpation tenderness of the lateral poles of the joints and of the masseter and anterior temporalis muscles, extent of abrasion of the canines, tongue or cheek imprints. Statistical evaluation used Spearman correlation, chi‐squared analysis and multiple regression analysis. The intra‐examiner reproducibility was moderate to high (κ 0·6–0·8 – Spearman Correlation 0·99 for maximal mouth opening). The frequency of reported oral habits was high: leaning on the arm (98%), gum chewing (89%, mean duration 3 h day^?1), lip‐ (62·1%) and cheek‐biting (41%), ice‐crushing (30%). There was a significant (P < 0·0001) but weak (0·30) positive correlation between the number of oral habits and the number of symptoms. Internal derangements were significantly (P < 0·0001) but weakly (0·25) correlated with jaw play and other oral habits. There was no relation between tooth clenching and myogenous pain (χ², P=0·31, but only 27% power). Multiple regression analysis showed that the number of symptoms increased by 52% if the subject reported ‘jaw play’, by 24% if chewing gum more than 2 h day^?1, by 28% while cheek biting and by 25% if chewing unilaterally.     

Prevalence of signs and symptoms of temporomandibular disorders in an urban and rural German population: results of a population-based Study of Health in Pomerania.

OBJECTIVE: Based on a randomized, population study (Study of Health in Pomerania [SHIP]), the objective of the present study was to determine incidence of signs and symptoms of temporomandibular disorders (TMD) in adults 20 years or older and to compare the data with TMD prevalence of other exclusively random sample studies that fulfilled criteria similar to those of this study (age > or = 20 years, age range > or = 40 years, sample size > or = 500 subjects, equal gender distribution). METHOD AND MATERIALS: Men and women (n = 7,008) 20 to 79 years of age from mid- and small-sized towns in a rural region in northeast Germany were randomly sampled from resident registry office files. The response rate was 68.8%. Adults between the ages of 20 and 81 years (n = 4,289) were clinically and anamnestically examined. RESULTS: Half of the subjects (49.9%) had one or more clinical signs of TMD, but only 2.7% were subjectively aware of temporomandibular joint (TMJ) pain symptoms. Women showed higher frequency for all signs and symptoms of TMD than men. However, these differences were not significant for all signs and symptoms in all age groups. The influence of age on TMD signs and symptoms was less pronounced. The prevalence for the following variables found in the present study compared to those of other comparable, random sample studies was: clinical examination; (TMJ) tenderness to palpation (5% versus 2% to 6%); masticatory muscle tenderness (15% versus 19% to 21%); joint sounds (25% versus 15% to 25%); limited maximum mouth opening < 40 mm (9% versus 5% to 8%); pain upon movement of the mandible (1% versus 1% to 3%); irregular jaw movements (deviation, deflection) (28% versus 28%); interview: subjective joint sounds (9% versus 11% to 13%); and subjective TMJ pain (3% versus 4% to 7%). CONCLUSION: The TMD incidence in the current study agreed quite well with the other studies based on random samples with similar subjects and design. The large range of prevalence for signs and symptoms of TMD documented in reviews and meta-analyses could therefore not be confirmed.     

Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children

Neck accessory respiratory muscles and mouth breathing suggest a direct relationship among asthma, Temporomandibular (TMD) and Cervical Spine (CSD) Disorders. This study was performed to evaluate and correlate TMD, CSD in asthmatic and non-asthmatic. Thirty asthmatic children (7.1 +/- 2.6 years old), 30 non-asthmatic predominantly mouth breathing children (Mouth Breathing Group - MBG) (8.80 +/- 1.61 years) and 30 non-asthmatic predominantly nasal breathing children (Nasal breathing Group - NBG) (9.00 +/- 1.64 years) participated in this study and they were submitted to clinical index to evaluate stomatognathic and cervical systems. Spearman correlation test and Chi-square were used. The level of significance was set at p < 0. 05. Significant frequency of palpatory tenderness of temporomandibular joint (TMJ), TMJ sounds, pain during cervical extension and rotation, palpatory tenderness of sternocleidomastoids and paravertabrae muscles and a severe reduction in cervical range of motion were observed in AG. Both AG and MBG groups demonstrated palpatory tenderness of posterior TMJ, medial and lateral pterygoid, and trapezius muscles when compared to NBG. Results showed a positive correlation between the severity of TMD and CSD signs in asthmatic children (r = 0.48). No child was considered normal to CSD and cervical mobility. The possible shortening of neck accessory muscles of respiration and mouth breathing could explain the relationship observed between TMD, CSD signs in asthmatic children and emphasize the importance of the assessment of temporomandibular and cervical spine regions in asthmatic children.     

Association between sleep bruxism and temporomandibular disorders: a polysomnographic pilot study

The aim of this study was to verify the association between sleep bruxism (SB) and temporomandibular disorders (TMD) in a sample of 14 TMD patients and 12 healthy control subjects. All participants were evaluated using a clinical questionnaire, visual analog scale (VAS) for TMJ/muscle palpation, and by functional examination. The experimental group was divided into three TMD subgroups: joint sounds and pain, muscular tenderness, and mixed diagnosis. All participants underwent polysomnographic recording (PSG). A second clinical examination was then carried out to verify the relationship between rhythmic masticatory muscle activity and pain/tenderness on the following morning. The experimental and control groups presented VAS mean scores of 36.85 +/- 23.73 mm and 0 mm, respectively. The presence of SB was neither associated with TMD (p > 0.05) nor with pain on palpation (p > 0.05). Further research with a more representative sample of each TMD subgroup is necessary to elucidate its interaction with SB.     

Relationship between signs and symptoms of temporomandibular disorders and orthodontic treatment: a cross-sectional study

The aim of this study was to evaluate the prevalence of temporomandibular disorders (TMD) in individuals before and after orthodontic treatment. The sample comprised 200 individuals divided into four groups according to the type of malocclusion (class I or II) and the orthodontic treatment accomplished. An anamnestic questionnaire, comprising questions regarding the most frequent symptoms of TMD, was used to classify the sample according to the TMD presence and severity. A clinical examination, including TMJ and muscle palpation, mandibular range of motion, and joint noise analysis was performed. Based on the anamnestic questionnaire, 34% of the sample was considered as having mild TMD, whereas 3.5% had moderate TMD. A higher TMD prevalence was found in females. Joint noises (15.5%) followed by headache (13%) constituted the most frequent reported symptoms. The presence and severity of TMD have not shown any relationship with either the type of orthodontic mechanics or extraction protocols. On the other hand, a positive association was found between TMD and parafunctional habits and reported emotional tension. Orthodontic treatment is not associated with the presence of signs and symptoms of TMD.     

Eating disorders and signs and symptoms of temporomandibular disorders: a matched case-control study

The aim of the study was to examine signs and symptoms related to temporomandibular disorders (TMD) in patients with eating disorders (ED) and to compare the prevalence with that in sex- and age-matched controls. During a 12-month period, all patients (n = 65) who accepted and initiated psychiatric/medical outpatient treatment in an Eating Disorder Clinic/Erikbergsg?rden, Orebro, Sweden were invited to participate in the study. Of the ED patients, 54 (83%) accepted participation. ED patients and controls underwent a comprehensive TMD questionnaire and clinical examination. Reported symptoms such as headache, facial pain,jaw tiredness, tongue thrusting, and lump feeling in the throat as well as dizziness, concentration difficulties and sleep disturbances were all significantly more prevalent among ED patients compared to controls. There was also a significantly higher prevalence of clinical TMD signs in the ED patients. Analyses within the ED group showed that those who reported self-induced vomiting reported significantly more heavy feeling in the head, nausea and snoring. Those with binge eating reported significantly more heavy feeling in the head, facial pain, dizzy feeling and concentration difficulties. No significant differences regarding subjective symptoms and clinical signs of TMD were found within the ED group with respect to duration of ED. In conclusion, orofacial pain and TMD related signs and symptoms are significantly more common in ED patients than in matched control subjects. Special emphasis should be made to those who reports vomiting and/or binge eating behaviors.     

Longitudinal study of signs of temporomandibular disorders (TMD) in orthodontically treated and nontreated groups.

This study measured the prevalence and incidence of signs of temporomandibular (TM) disorders in both a group undergoing orthodontic treatment in the University of Florida graduate orthodontic program and a control group. A questionnaire pertaining to the patients' reports of signs and symptoms of TM disorder and a clinical examination were administered by a trained dental examiner. Data collection sessions occurred at baseline (before treatment) and at 12-month intervals to 24 months. Data were also collected for the control group at the same time intervals. There were 102 patients (43 boys, 59 girls) mean age 15.3 years. An untreated control group of 41 nonorthodontically treated subjects mean age 16.2 years was used. The incidence of TM signs for the treatment group and control group were not significantly different. Preliminary results are in agreement with the contention that orthodontically treated patients are not more likely to develop TM signs while undergoing treatment. Results underscore the changing, inconstant, and ephemeral nature of TM signs in many persons over the course of time.     

Prevalence study of signs and symptoms of temporomandibular disorders in university students

The aim of this study was to evaluate the prevalence of signs and symptoms of temporomandibular disorders (TMD) in university students from 19 to 25 years old, male and female, through the distribution of frequency of the data obtained from a questionnaire and physical examination. The results showed that 68% of the subjects exhibited some degree of TMD, and the women were the most affected. Signs and symptoms such as articular sounds, pain to palpation of the masticatory, cervical and scapular girdle musculature, subjective sensation of emotional stress, and postural and occlusal changes were more evident in the group with TMD, although they were also present in subjects classified as TMD-free. Limitations in the mandibular movements were not found. The association of the obtained data allowed identifying a high prevalence of signs and symptoms of TMD in the Brazilian university population.     

Signs of temporomandibular disorders in tinnitus patients and in a population-based group of volunteers: results of the Study of Health in Pomerania

The literature has documented a controversial discussion on the possible relationship of otogenous symptoms and craniomandibular dysfunction since the 1920s. Therefore, an investigation was conducted which consisted of two parts: a case study with population-based controls and a cross-sectional study. The aim of the first study was to screen a group of patients suffering from acute or chronic tinnitus for temporomandibular disorders (TMD) in comparison with a population-based group of volunteers without tinnitus. To this end, 30 patients (13 females and 17 males, age 18-71 years) suffering from acute hearing loss associated with tinnitus, isolated acute tinnitus, and chronically transient tinnitus were examined for symptoms of craniomandibular dysfunction. The results were compared with those of clinical functional analysis from 1907 subjects selected representatively and according to age distribution from the epidemiological 'Study of Health in Pomerania' (SHIP); the occurrence of tinnitus was ruled out in these control subjects. Statistical analysis was performed with Chi-square and Mann-Whitney U-tests. Sixty per cent of the tinnitus patients and 36.5% of the control subjects exhibited more than two symptoms of TMD (P = 0.004). Tinnitus patients had significantly more muscle palpation pain (P < 0.001), temporomandibular joint (TMJ) palpation pain (P < 0.001), and pain upon mouth opening (P < 0.001) than the general population group. No statistical differences were found in TMJ sounds, limitation of mandibular movement, or hypermobility of the TMJ. Furthermore, 4228 subjects of the population group examined in the epidemiological study were screened for co-factors of tinnitus with the help of a multivariate logistic regression model which was adjusted for gender, age, and a variety of anamnestic and examined data. Increased odds ratios (OR) were found for tenderness of the masticatory muscles (OR = 1.6 for one to three painful muscles and OR = 2.53 for four or more painful muscles), TMJ tenderness to dorsal cranial compression (OR = 2.99), listlessness (OR = 2.0) and frequent headache (OR = 1.84) A relationship between tinnitus and TMD was established in both examinations. Tinnitus patients seem to suffer especially from myofascial and TMJ pain. A screening for TMD should be included in the diagnostic survey for tinnitus patients.     

Prosthodontic status among old adults in Pomerania,related to income,education level,and general health (results of the Study of Health in Pomerania,SHIP)

PURPOSE: The aim of the study was to evaluate associations among prosthetic status, socioeconomic factors, and general health of subjects aged 55 to 79 years. The data were taken from the Study of Health in Pomerania (SHIP). MATERIALS AND METHODS: Socioeconomic information (age, sex, education level), medical information (number of diseases), and details on smoking and alcohol consumption were obtained. Prosthetic status in the maxilla and mandible was classified into complete denture (CD), removable partial denture (RPD), > or = 10 natural teeth or teeth replaced with fixed prosthodontics (10T+), and < or = nine natural teeth including fixed prosthodontics (9T-). RESULTS: The data of 1,877 subjects were evaluated. CDs in the maxilla were more frequent than in the mandible. RPDs were more frequent in the mandible and in the group aged 65 to 74 years. Of the individuals with a low education level, 47% had a CD in the maxilla, and only 21% had 10T+. However, of subjects with a high education level, 22% had a CD in the maxilla, and 54% had 10T+. The odds ratio of having a CD in the maxilla increased to 11.9 at the age of 75 to 79 years, compared to 0.6 at the age of 55 to 59 years. Logistic regression analyses showed that the risk of wearing a CD was significantly associated with old age, low education level, low income, smoking, and alcohol abuse, whereas the number of diseases (used as an indicator of general health) was not. CONCLUSION: Alcohol abuse, smoking, low education level, low income, and old age were significant predictors of wearing CDs.     

Epidemiology of signs and symptoms in temporomandibular disorders: clinical signs in cases and controls

An epidemiologic study of clinical signs and symptoms of temporomandibular disorders (TMD) was conducted with a probability sample of adults enrolled in a major health maintenance organization (HMO). This report presents data from a first wave field examination and interview conducted by trained, calibrated dental hygienist field examiners. Significant gender differences for vertical jaw opening measures were observed but no significant age differences were found for the distribution of clinically relevant findings. Clinic cases showed smaller amounts of vertical range of jaw motion but did not differ from community cases or controls on extent of lateral, protrusive, or retrusive mandibular movements; on classification of occlusion; or on dentally related variables. Clinic cases had more pain during all jaw excursions as well as during muscle and joint palpation. Joint clicking sounds were also observed more frequently in clinic cases.     

Association between temporomandibular disorders and pain in other regions of the body

The pain from temporomandibular disorder (TMD) is often associated with physical symptoms of other chronic pain disorders and comorbidities, such as generalised muscle and joint pain. However, this association is not widely studied. To evaluate the prevalence of comorbid pain in joints, specifically in the knees, hips, ankles, shoulders, wrists and elbows, in individuals with and without TMD. We evaluated 337 patients from a public hospital in the city of Rio de Janeiro, Brazil. The Research Diagnostic Criteria for TMD questionnaire were used for the diagnosis of TMD. To assess the presence of other joint pain, the patients were asked to answer questions considering: the presence of pain in the knee, hip, ankle, shoulder, wrist and elbow joints and time duration of pain. Individuals with TMD are 5·5 times more likely to present with other joint pain compared with those without the disorder. TMD muscle disorders were most associated with a higher number of pain at the other locations. There was a significant association between the presence of pain at the other locations, muscle (P < 0·001) and joint disorders (P = <0·001), as well as age advance, in TMD participants, showed to be a covariate factor for pain at the other locations. Individuals with TMD showed a high prevalence of pain in other joints of the body when compared with individuals without the disorder, and knee pain was the most prevalent pain complaint.