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.     

Myofascial pain-dysfunction: subjective signs and symptoms

Dental patients were classified by experienced dentists as MPD or non-MPD patients. Apart from the symptoms often used as criteria for such a classification, there is a broad range of symptoms and patient characteristics associated with MPD. Because of procedural and methodologic problems, little is known about the strength of these associations. Because reliable knowledge about symptoms and characteristics of MPD is needed for MPD etiology and for adequate treatment evaluation, the present study tried to establish which subjective signs and symptoms differentiate MPD from non-MPD patients. Results of a questionnaire show that 10 items classified 86% of the patients correctly. Among them, restricted mouth opening and sounds at jaw movement had the highest discriminative power. Pain in the jaw area also showed a highly significant difference between the patient groups. When patient selection is based on these criteria, approximately the same patient groups are obtained by a time-consuming dental examination and by a low-cost questionnaire. Results also showed that reported oral habits such as chewing on hard or tough objects and lip-tongue-cheek biting do not differentiate the two groups. Symptoms related to ears and eyes discriminate the groups only marginally. Sleep-related symptoms, with awakening with stiff or painful jaws as the most important item, differentiate patients in a more substantial way. The suggestion from a great number of studies that stress and tension are etiologic factors in MPD is not supported by the present results.(ABSTRACT TRUNCATED AT 250 WORDS)     

Oral signs and symptoms in the diagnosis of bulimia

Bulimia is an eating disorder disease that presents difficulties in its diagnosis, primarily because of the secretive nature of the person with the disease. The disease is most common in young females, and there is an average of a 4-year delay between the onset of the disease and the patient's self-referral for treatment. Objective oral signs and symptoms of bulimia do exist and their presence can facilitate a diagnosis of bulimia during routine examination. The realization that five oral signs and symptoms of bulimia--enamel erosion, salivary gland enlargement, xerostomia, oral mucosal erythema, and cheilosis--are associated with the disease can eliminate some laboratory tests as well as facilitate an earlier diagnosis of bulimia.     

Oral signs and symptoms in 160 Greek HIV-infected patients

One hundred and sixty HIV-infected Greek patients were prospectively examined and the oral signs and symptoms were recorded. At the time of oral examination, 76 patients were asymptomatic seropositive, 47 were in ARC stage and 37 had AIDS. One or more oral findings were recorded in 90.6% of the patients while a total of 33 different lesions were observed. The more common oral lesions (highly suspicious) were candidiasis (61%), hairy leukoplakia (24%), periodontitis (19%), necrotizing gingivitis (11%) and Kaposi's sarcoma (12%). In addition some unclassified lesions or symptoms (xerostomia 26%, burning mouth syndrome 19%, patchy depapillated tongue 16%, hairy tongue 10%, exfoliative cheilitis 4%), were common while submandibular and cervical lymph node enlargement were found in 49% of the patients. Interestingly in 16 patients (10%) the suspicion of HIV infection was exclusively based on oral lesions. Our findings show that oral signs and symptoms are common and some times early manifestations of HIV infection and it is in association to those reported in previous studies.     

Prevalence study of signs and symptoms of temporomandibular disorders in a Turkish population

AIM: The aim of this study was to evaluate the prevalence of signs and symptoms of temporomandibular disorders (TMD) in a population of 792 Turkish adults ranging in age from 15- to 72-years-old. METHODS AND MATERIALS: Subjects were examined objectively and subjectively for signs and symptoms of TMD through the distribution of frequency of the data obtained from a questionnaire and a physical examination using a similar methodology of previous studies. RESULTS: This study determined the prevalence of signs and symptoms of TMDs in subjects from male and female subgroups in a Turkish adult population. Both signs and symptoms of TMDs were generally more prevalent in females than in males. CONCLUSION: The prevalence of signs and symptoms were generally greater than in previous studies of other populations.     

No heritability of temporomandibular joint signs and symptoms

The causes of temporomandibular joint (TMJ)-related signs and symptoms are largely unknown. We tested the hypotheses that these signs and symptoms, as well as oral parafunctional habits, are substantially heritable. Questionnaire and clinical data were collected from 494 twins, including pairs of reared-apart and reared-together monozygotic (MZ) and dizygotic (DZ) twins. A history of joint-area pain, joint noises, and clenching and grinding habits was scored as present or absent. Twenty-nine percent of the population experienced at least one sign or symptom. Nearly one-quarter of subjects clenched or ground their teeth, and 8.7% reported a history of joint-area pain. Pain was associated with clenching, grinding, and joint noises. MZ twins were no more similar than DZ twins for any outcome, suggesting that genetic factors do not influence these traits in the population. Reared-together MZ twins were no more similar than reared-apart MZ twins, suggesting a negligible effect of the family environment on these outcomes. Environmental factors unique to each twin appeared to be the major determinants of variation in this population.     

Prevalence of signs and symptoms of temporomandibular disorders in a young male Saudi population

SUMMARY The aim of the present study was to investigate the prevalence of temporomandibular disorders (TMD) in a selected young male Saudi population. The material comprised 105 dental students having a mean age of 23 years within the range of 20–29 years. A functional evaluation of the stomatognathic system was performed using the Helkimo anamnestic and clinical dysfunction index. Almost two-thirds of the individuals had no sings and symptoms of TMD. Thirty per cent of the individuals reported mild dysfunction (A_i I) and 6% had severe symptoms (A_i II). Thirty—three per cent showed mild clinical signs of dysfunction (D_i I) and 3% had signs of moderate dysfunction (D_i II). Only 1% exhibited severe clinical signs (D_i III). While the individuals represented a non-Western population, the prevalence of signs and symptoms of temporomandibular disorders compared favourably to that found in Western countries, at least as regards to reported symptoms.     

Management of dental trauma in a child with Xeroderma Pigmentosa

Xeroderma Pigmentosa is a rare dermatological autosomal recessive disorder that manifests itself early in life as severe sunburn usually after a short exposure to sunlight. The prime characteristic features include photosensitivity, hyperpigmentation and ichthyosis in sun exposed areas, and an increase in the risk of basocellular and squamous cell carcinomas and melanomas of the skin and eyes. The case report highlights the preventive treatment options along with all necessary precautions that should be taken to protect the patient from any iatrogenic inadvertent exposures that may be deleterious to his present state. The purpose of the report is also to discuss the important role of dental professionals when dealing with debilitating medical conditions.     

Relationship between signs and symptoms of mandibular dysfunction in adolescents

Abstract The relationship between signs and symptoms of mandibular dysfunction was studied in 285 17-yr-old adolescents living in the municipality of Skellefteå, Sweden. Of the sample 62% had either some sign or symptom of dysfunction, and there was a positive correlation (P<0.05) between the two indices used. Neither morphologic nor functional malocclusions were related to the anamnestic dysfunction index. Signs of mandibular dysfunction were significantly more frequently found in those with a feeling of fatigue in the jaw (P<0.001). TMJ sounds were related to palpation tenderness in the lateral pterygoid muscle and to impaired horizontal mobility of the mandible. The most frequent symptom related to various signs of mandibular dysfunction was feeling of fatigue in the jaws which suggests that this is an early symptom of muscular origin that should be observed more closely. The study supports the view that even a moderate reduction of mouth opening capacity may indicate mandibular dysfunction and we recommend that this variable be routinely recorded.     

Anamnestic index severity and signs and symptoms of TMD

The aim of this study was to determine the frequency and to characterize the symptoms and clinical signs of temporomandibular disorders (TMD) related to each severity category of Fonseca's anamnestic index in a sample of Brazilian young adults (mean age 21.61+/-1.91 years, 87% females and 13% males), by the application of an anamnestic index proposed by Fonseca (1992) and by clinical examination considering mandibular range of motion and tenderness to palpation of stomatognathic system structures. A significant number of participants were classified with mild TMD (43.2%) and moderate TMD (34.8%). Pain frequency during mastication, temporomandibular joint (TMJ) pain, and TMJ sounds were shown to be good predictors of TMD severity. Neck pain, headache, difficulty during mouth opening and lateral deviation, and tenderness to palpation of masticatory sites and during protrusion accompanied the TMD severity but failed to demonstrate differences between moderate and severe groups, showing a poor ability to determine TMD severity progression. This study suggests that not only the frequency of signs and symptoms of TMD should be determined, but also symptom severity and its relationship to the presence of clinical signs in order to discriminate patients with real treatment needs in nonpatient samples.     

Association between signs of trauma from occlusion and periodontitis

The purpose of this study was to evaluate the association between signs of trauma from occlusion, severity of periodontitis and radiographic record of bone support. The maxillary first molars of 300 individuals were independently evaluated by two examiners for signs of trauma from occlusion, pattern or occlusal contacts and severity of periodontitis. Each site was also evaluated radiographically by an independent third examiner. The results indicated that: teeth with either bidigital mobility, functional mobility, a widened periodontal ligament space or the presence of radiographically visible calculus had a deeper probing depth, more loss of clinical attachment and less radiographic osseous support than teeth without these findings, teeth with occlusal contacts in centric relation, working, nonworking or protrusive positions did not exhibit any greater severity of periodontitis than teeth without these contacts, teeth with both functional mobility and radiographically widened periodontal ligament space had deeper probing depth, more clinical attachment loss and less radiographic osseous support than teeth without these findings and given equal clinical attachment levels, teeth with evidence of functional mobility and a widened periodontal ligament space had less radiographic osseous support than teeth without these findings.     

Perceived malocclusion and other teeth-associated signs and symptoms in temporomandibular disorders

This article reports the results of a clinical study that evaluated adjunctive teeth-associated signs and symptoms before and after nonsurgical temporomandibular disorder therapy. Eighty-nine patients were referred to a private prosthodontic practice in the Washington, DC metropolitan area. Of the 89 patients, 75 were selected for the clinical study after completing the interview, history, and clinical examination. The major signs and symptoms were recorded, along with adjunctive teeth-associated signs and symptoms. The treatment included an anterior programming device, a centric relation occlusal device, and, when indicated, a selective occlusal equilibration. The results were recorded after five treatment visits. Of 75 patients, 67 made good-to-excellent improvement in the signs and symptoms of their major temporomandibular disorder. Patients with adjunctive teeth-associated signs and symptoms demonstrated a marked reduction in these signs and symptoms as assessed by their mental perception and verbal feedback. The symptoms of perceived awareness of malocclusion were not resolved with centric relation occlusal device therapy in 22 of the 24 patients with this symptom. However, excellent improvement was noted in this symptom when occlusal device therapy was followed by a selective occlusal equilibration. Thirty-eight patients in this study had difficulty in making lateral gliding articulation movements with the occlusal device out of the mouth. This problem was resolved in 36 patients after removal of eccentric occlusal interferences. It is suggested that adjunctive teeth-associated signs and symptoms be initially recorded and addressed in patients, especially if extensive or invasive dental therapy is planned. Although this clinical study in a private practice was carefully performed, it does not meet the criteria of evidence-based research, because a control group was not included.     

Odontogenic signs and symptoms as predictors of odontogenic infection: a clinical trial

BACKGROUND: The authors conducted a study to determine if odontogenic signs and symptoms in the emergency department predicted the development of overt odontogenic infection at a follow-up dental visit. METHODS: One hundred ninety-five patients with odontalgia, but without overt signs of infection, were enrolled in a prospective, double-blind, randomized clinical trial. Data included dental diagnosis, pain characteristics, presence of caries and restorations, presence and size of periapical radiolucencies and other diagnostic test results. RESULTS: Thirteen of 134 subjects for whom data were available had signs of infection at the follow-up visit. Subjects in the follow-up infected (FU-I) group had larger baseline radiolucencies than did subjects in the follow-up noninfected (FU-NI) group, and restorations were more prevalent for involved teeth in the FU-I group than in the FU-NI group. CONCLUSIONS: A relationship exists between radiolucency size and the presence of amalgam restorations in patients who develop clinical signs of infection. Penicillin did not appear to influence this progression. CLINICAL IMPLICATIONS: Antibiotics are not effective in preventing the development of odontogenic infection when definitive dental therapy cannot be provided for acute pain in the absence of clinical signs of infection. Although the overall risk of developing infection is low, early treatment is indicated for teeth with larger periapical radiolucencies, amalgam restorations or both.     

Periodontal signs and symptoms associated with vertical root fracture

This report describes the clinical presentation of three cases of vertical root fractures in adult patients where an initial diagnosis of localized periodontitis had been considered. Loss of the affected tooth occurred in all of these patients. The effects of endodontic therapy and the provision of post-retained restorations are considered in relation to their potential effect of weakening the root and predisposing the tooth to vertical fracture. The last case presents an unrestored molar tooth with a complete vertical root fracture.     

Risk factors for signs and symptoms of TMD in a rural adult southeast Tanzanian population

The aim of this study was to determine some risk factors for signs and symptoms of temporomandibular disorders (TMD) in a rural adult population of Southeast Tanzania. Two hundred and eighteen adults aged 40+ years participated in the study. Joint clicking was significantly higher (p < 0.024) in the adults aged 60+ years than in the younger age group. Limited jaw opening was higher in females than males (chi2 = 46.4 on 2 df; p < 0.001), and there was a significant association between the type of toothbrush and limitation in jaw opening (chi2 = 156.6 on 4 df; p < 0.001). The results suggest that the use of miswaki (chewing sticks) and advanced age are risk factors for the high prevalence of signs and symptoms of TMD in this rural population. Further studies are recommended to control for other confounding factors such as socio-economic status.     

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.