Constancy of clinical signs in patients with mandibular dysfunction

Repeated clinical examinations were performed 6 weeks apart on 34 patients with mandibular dysfunction to estimate the consistancy of clinical signs. The clinical examination of the patients included the masticatory muscles, the temporomandibular joint (TMJ) and the mandibular movement capacity. The clinical dysfunction index (Di) was calculated as a measure of the degree of mandibular dysfunction. The highest agreement between examinations was found for maximal mouth opening and protrusion. The agreement for palpation tenderness of the masticatory muscles and TMJ, limited movement of the TMJ, TMJ sounds, and pain during movement was considerably lower. The lowest agreement within 6 weeks was found for the clinical dysfunction index. No statistically significant difference could be detected between the two examinations for any of the clinical signs, as a result of given information and counseling before the 6-week period. It was concluded that all clinical signs, except maximal mouth opening and maximal protrusion, showed low consistancy.     

Symptoms and signs of mandibular dysfunction in 70-year-old men and women in Gothenburg, Sweden.

A representative systematic selection of 30% of all 70-year-olds in Gothenburg were invited to a population study. Forty percent of the sample (384 persons) were subjected to a comprehensive dental examination. The participation rate was 84%. The aim of the present study was to describe the function and dysfunction of the masticatory system of the 70-year-olds. 41% reported no symptoms of dysfunction while 46% had severe dysfunction according to HELKIMO'S Anamnestic Dysfunction Index. The clinical examination revealed that only 14% had no signs of dysfunction. 32% had moderate or severe dysfunction according to Helkimo's Index. In more than half of the subjects the masticatory muscles were tender to palpation and in 37% TMJ sounds were diagnosed. Several of the clinical findings were more common in the women than in the men but only concerning tenderness of the TMJ and the masseter muscle were the differences significant. The degree of dental invalidity was measured by Eichner's Index. The Index showed no or only weak relation to the Anamnestic and Clinical Dysfunction Indices. Neither did the degree of dysfunction in complete denture wearers vary with the condition of their prostheses.     

Symptoms of mandibular dysfunction in complete denture wearers

Recent epidemiological studies have shown that symptoms of mandibular dysfunction are very common, but prosthodontists have thought that complete denture wearers are spared such complications. However, in recent reported series of patients who have sought advice for mandibular dysfunction complete denture wearers have been included. According to epidemiological data individuals with few remaining natural teeth had more symptoms of dysfunction than those with most of their natural teeth, and complete denture wearers had more symptoms of mandibular dysfunction than subjects with natural teeth. Mandibular and temporomandibular joint dysfunction symptoms have a heterogeneous background, but occlusal instability is an important aetiological factor. In complete denture wearers with mandibular dysfunction, symptoms often disappear after improvement of the occlusion.     

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.     

Two-year longitudinal study of signs of mandibular dysfunction in adolescents

Signs of mandibular dysfunction in adolescents were studied longitudinally from the age of 17 to 19 years. Totally, 27 subjects dropped out, leaving 258 for the longitudinal intraindividual comparisons. TMJ sounds were found in about one-fifth of the adolescents and were recorded significantly more often in girls than boys from the age of 18 years. The frequency of muscles tender to palpation fluctuated somewhat between the annual examinations. At the first and second examination muscle tenderness was statistically significantly commoner in girls than in boys. Except for TMJ sounds and muscle tenderness signs of mandibular dysfunction were rare. About half of the subjects had signs of mandibular dysfunction, mostly of mild character. Girls regularly had significantly higher dysfunction index (Di) values than boys. No change between the annual recordings was noted in 60% of the individuals, and impairment and improvement had occurred about equally often. In 29%, signs were recorded all years.     

Depression, hassles and somatic symptoms in mandibular dysfunction syndrome patients

Thirty-seven patients with mandibular dysfunction syndrome (MDS) and 30 age-, sex- and education-matched dental outpatient controls were assessed using the Beck Depression Inventory, the Hassles Scale and a symptom checklist derived from the DSM-III criteria for somatization disorder. MDS patients had higher levels of depressive symptoms than control patients (P < 0.05), though only five out of 37 (13.5 per cent) of the MDS patients had depression intensity levels suggesting clinically significant psychopathology. No significant differences were found between MDS patients and controls on the Hassles Scale, which fails to support the stress-induced muscular hyperactivity theory for the aetiology of MDS syndrome. MDS patients reported having a past history of more somatic symptoms than did controls (P < 0.05). MDS patients were divided by a clinician into ‘physical’ and ‘functional’ groups based on their clinical history. Contrary to expectation, there were no between-group differences on any of the above-mentioned psychological variables.     

A prevalence study of the clinical signs associated with mandibular dysfunction

A prevalence study was made of the most common clinical signs of mandibular dysfunction in a sample population of 1,000 patients in a general dental practice. Palpable joint irregularities (joint sounds) were found in about a third of the sample. All other frequencies were relatively low. Females had consistently higher frequencies than males, although the differences were generally not significant. A methodology that was quantified for the first time in relation to muscle palpation was used. Results of this study would indicate that the prevalence of the major clinical signs of mandibular dysfunction in the population expected to be seen in a general dental practice is not high and, furthermore, that their occurrence in the absence of pain does not necessarily indicate a need for treatment.     

Mandibular function and dysfunction in patients with mandibular prognathism

There are indications that in patients with mandibular prognathism there is a great risk of mandibular dysfunction symptoms. The present study was undertaken to verify this and to investigate whether surgical correction of the sagittal discrepancy would improve the functional abilities. The material comprised a group of 28 untreated patients with mandibular protrusion and another group of 44 patients who were operated on 10 years ago. The functional status and subjective symptoms were recorded according to the principles introduced by Helkimo. The results indicate a great reduction of the subjective symptoms in the treated group, and even the objective evaluation shows a reduction of the dysfunctional symptoms in the treated persons, particularly in relation to the movement capacity of the mandible. The number of occluding teeth was significantly greater in the treated persons, and the number of occlusal interferences was smaller. Thus, it seems that a repositioning of the mandible to a correct sagittal position will improve function. A normal anatomic foundation may therefore be an important factor in securing normal mandibular function.     

Association between primary dentition wear and clinical temporomandibular dysfunction signs.

Dental wear facets often are considered indicators of temporomandibular dysfunction (TMD). Dental wear facets are common in children, but their association with TMD signs is unknown. A reproducible, clinical evaluation of TMD signs for young children shows no statistically significant association between primary dentition wear facets and clinical signs of TMD (P less than or equal to 0.05). Wear facets in young children do not appear to warrant TMD evaluation or treatment.     

Diagnostics of mandibular articulation disorders in TMJ dysfunction patients

Diagnostics of disorders of mandibular articulation of 95 patients with TMJ dysfunction were described. Collecting the data from transcranial x-ray examination, CT, MRT and computerized axijgraphy of TMJ typical disorders of articulation of the mandibular at 4 base clinio-roentgenogical forms of TMJ dysfunction were found.     

An investigation of the stress factor in the mandibular dysfunction syndrome

A study of mandibular dysfunction syndrome (MDS) patients over a period of five years revealed that in the majority of cases no occlusal problems were present. Many of the cases appeared to be related to a stress factor. However, it is usually difficult to demonstrate this with any degree of confidence. It is known that stress induces alterations in the levels of circulating hormones, particularly cortisol. The investigation showed raised urinary cortisol : creatinine ratios in the study group.     

Observer variation in the clinical diagnosis of mandibular pain dysfunction syndrome

In preparation for a survey to investigate the prevalence of mandibular pain dysfunction syndrome (MDS) in a non-hospital group of individuals, the measure of agreement obtained by two observers when recording signs and symptoms of MDS in the same subjects was investigated. The criteria used for this purpose are defined. Two groups of subjects, 50 MDS patients and 50 individuals not complaining of the condition, were examined independently. Considerably more agreement between the two observers was reached with regard to patients than contrast subjects. Both observers showed more agreement in assessment during the opening movement of the mandible. It was suggested, therefore, that in order to reduce the observer error inevitably present during a survey, the signs and symptoms which manifest themselves during the opening movement of the mandible should be used to diagnose MDS rather than a more elaborate time-consuming technique.     

Presenting clinical features of mandibular pain dysfunction patients

The distribution between males and females of defined pretreatment clinical characteristics of mandibular pain dysfunction syndrome (MDS) are compared. Males and females were not found to differ substantially and dysfunction was the most frequent symptom found. The similarities between patients and subjects in epidemiological studies are noted with suggestions for future work.     

The prevalence of mandibular dysfunction. Part I: Sex and age distribution of related signs and symptoms

This study concludes the following: 1. Mandibular dysfunction is extensive. 2. Age and sex differences are apparent with various signs and symptoms. 3. Women and younger patients tend to respond positively more often than men and older patients to questions relating to subjective TMJ and muscle symptoms. 4. Objective TMJ and occlusal signs show little age or sex differentiation. 5. Positive responses to questions regarding bruxism were more common in men. 6. Age and sex differences in the prevalence of mandibular dysfunction may be influenced by the method of investigation (anamnestic versus clinical examination) and by the signs and symptoms selected to be representative of this disorder. When compared with the findings of earlier investigations, the conclusions suggest that social, cultural, psychologic, sex, and age differences contribute to the responses to questions pertaining to mandibular dysfunction. However, this may not be an accurate reflection of the prevalence of mandibular dysfunction since the objective signs do not show the age and sex differences that the subjective symptoms indicate. Therefore, additional studies are needed to correlate all data to establish a more reliable profile of both signs and symptoms of mandibular dysfunction.     

The mandibular pain dysfunction syndrome: an assessment of its treatment

Almost all clinicians claim successful results with their treatment of the mandibular pain dysfunction (MPD) syndrome, but longer term follow-up studies are relatively few. One hundred and nine patients whose treatment had been completed some time previously replied to a postal questionnaire which enquired into their experience of pain, limitation of jaw opening, clicks and evenness of ‘bite’. The results indicated that many patients experienced a return of discomfort, and clicking of the joints responded poorly to treatment. Limitation of jaw opening, on the other hand, showed a successful response to treatment.