Long-term follow-up of early treatment of unilateral forced posterior cross-bite with regard to temporomandibular disorders and associated symptoms.

Forty-four subjects, who at the age of 4 years had been treated for unilateral forced cross-bite by grinding or by maxillary arch expansion, were 16-19 years later followed-up by means of a questionnaire about their present condition with regard to temporomandibular disorders (TMD). Twenty-two of them had received only early treatment (early questionnaire group) and 22 had received late treatment (late questionnaire group). Fourteen of the subjects who received late treatment also received early treatment. Twenty-nine of the subjects were also examined clinically. Eighteen of these had only received early treatment at 4 years of age (early clinical group), whereas 11 of them also received later treatment in the mixed or permanent dentition because of relapse (late clinical group). No significant differences were found between the early and late groups with regard to signs and symptoms of TMD. Most of the young adults who had undergone orthodontic treatment had well-functioning masticatory systems, and severe TMD signs and symptoms were rare. The results of this study suggest that relapse of early orthodontic treatment and further need of treatment does not influence the later status of subjective symptoms or clinical signs of TMD in young adults.     

A 20-year follow-up of signs and symptoms of temporomandibular disorders and malocclusions in subjects with and without orthodontic treatment in childhood

This investigation analyzes the influence of orthodontic treatment on signs and symptoms of temporomandibular disorders (TMDs) and different malocclusions during a 20-year period. Originally, 402 randomly selected 7-, 11-, and 15-year-old subjects were examined clinically and by means of a questionnaire for signs and symptoms of TMDs. The examination was repeated after five and ten years. After 20 years, 320 subjects (85% of the traced subjects) completed the questionnaire. The oldest age group,now 35 years of age, was invited to a clinical examination, and 100 subjects (81% of the traced subjects) were examined. The correlations between signs and symptoms of TMD and different malocclusions were mainly weak, although sometimes statistically significant. Lateral forced bite and unilateral crossbite were correlated with TMD signs and symptoms at the 10- and 20-year follow-ups (r = 0.38, P < .05 and r = 0.34, P < .01, respectively). Subjects with malocclusion over a long period of time tended to report more symptoms of TMD and to show a higher dysfunction index, compared with subjects with no malocclusion at all. There were no statistically significant differences in the prevalence of TMD signs and symptoms between subjects with or without previous experience of orthodontic treatment. This 20-year follow-up supports the opinion that no single occlusal factor is of major importance for the development of TMD, but a lateral forced bite between retruded contact position (RCP) and intercuspal position (ICP), as well as unilateral crossbite, may be a potential risk factor in this respect. Furthermore, subjects with a history of orthodontic treatment do not run a higher risk of developing TMD later in life, compared with subjects with no such experience.     

Long-term follow-up of early treatment of unilateral forced posterior crossbite with regard to temporomandibular disorders and associated symptoms

Forty-four subjects, who at the age of 4 years had been treated for unilateral forced cross-bite by grinding or by maxillary arch expansion, were 16-19 years later followed-up by means of a questionnaire about their present condition with regard to temporomandibular disorders (TMD). Twenty-two of them had received only early treatment (early questionnaire group) and 22 had received late treatment (late questionnaire group). Fourteen of the subjects who received late treatment also received early treatment. Twenty-nine of the subjects were also examined clinically. Eighteen of these had only received early treatment at 4 years of age (early clinical group), whereas 11 of them also received later treatment in the mixed or permanent dentition because of relapse (late clinical group). No significant differences were found between the early and late groups with regard to signs and symptoms of TMD. Most of the young adults who had undergone orthodontic treatment had well-functioning masticatory systems, and severe TMD signs and symptoms were rare. The results of this study suggest that relapse of early orthodontic treatment and further need of treatment does not influence the later status of subjective symptoms or clinical signs of TMD in young adults.     

A longitudinal study on malocclusion in relation to signs and symptoms of cranio-mandibular disorders in children and adolescents

Two-hundred-and-thirty-eight subjects in three different age-groups (7, 11, and 15 years) were followed over a period of 4-5 years in respect of morphological malocclusions, and signs and symptoms of functional disturbances. About half of the 7-year-olds had at least one of the morphological malocclusions registered while the corresponding figure was 38 per cent at the age of 20. Some subjects had received corrective orthodontic treatment. When compared with subjects without such treatment, there were no differences in prevalences of occlusal interferences, nor in signs or symptoms of craniomandibular disorders (CMD). The associations between CMD and different morphological malocclusions were low. Nevertheless, some malocclusions were found to be more important than others. In a long-term perspective cross-bite, both uni- and bilateral, anterior open bite, post-, and prenormal occlusion had some association with the development of CMD.     

A longitudinal study of occlusal interferences and signs of craniomandibular disorder at the ages of 12 and 15 years

Occlusal interferences and signs of craniomandibular disorder (CMD) were studied longitudinally in 167 Finnish adolescents at the ages of 12 and 15 years in order to evaluate their importance for orthodontic diagnosis. Of the adolescents sampled 16.8 per cent had received orthodontic treatment. The results showed that occlusal interferences and signs of CMD are quite common. Of the 12-year-olds 25.7 per cent and 30.5 per cent of the 15-year-olds showed palpatory tenderness of the muscles of mastication. Clicking sounds were recorded for 6 per cent of the 15-year-olds. Opening capacity increased with age. Only tow of the adolescents at the age of 12 and none at the age of 15 fulfilled the criteria of functionally optimal occlusion. The number of occlusal interferences increased between 12 and 15 years of age. Both occlusal interferences and clinical signs of CMD were inconsistent in nature. Mediotrusion contracts and protrusion interferences were found to be the most stable occlusal interferences at adolescence. As to pain on mouth opening, the symptom group at the age of 15 consisted of entirely new individuals. No single sign or CMD symptom, nor combination of them, was consistent enough for inclusion in orthodontic screening indices. However, even though the symptomatology changed, only a few of those considered to be symptomatic at the age of 12 were asymptomatic at the age of 15. In accordance with the present state of knowledge, it would thus seem appropriate to add a general statement about the presence or absence of CMD signs and/or symptoms to orthodontic screening indices.(ABSTRACT TRUNCATED AT 250 WORDS)     

A survey of craniomandibular disorders in 800 15-year-olds. A follow-up study of children with malocclusion.

Seven-hundred-and-ninety-one 15-year-olds were subjected to an anamnestic and clinical examination of craniomandibular disorders. These individuals had been examined at the age of 12 years and this is one section of an extensive longitudinal investigation into the effects of malocclusion, and the effectiveness of orthodontic treatment. The children were originally selected on the basis of presence of malocclusion. Signs of CMD were found in about half of the subjects. The proportion of individuals without any signs of CMD had decreased during the 4-year period. However, the number of subjects with severe signs remained very small. Changes in severity of CMD according to Helkimo's index of clinical dysfunction were mainly attributed to an increased prevalence of impaired TMJ function. An increase in prevalence of reported symptoms was found involving headache and joint sounds. The other recorded symptoms did not show any significant increase in prevalence. Mandibular mobility showed only minor changes from 12 to 15 years of age.     

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.     

Predictors of signs and symptoms of temporomandibular disorders: a 20-year follow-up study from childhood to adulthood

The aim of this study was to find possible predictors of signs and symptoms of temporomandibular disorders (TMD) in a long-term perspective. Baseline questionnaire and clinical examinations focusing on function and dysfunction of the masticatory system were performed in a sample of 402 subjects 7, 11, and 15 years old. After 20 years, 320 subjects (80% of the original sample) completed a similar questionnaire as at baseline. From the oldest age group, now aged 35 years, 100 subjects (74% of the original sample) also attended a clinical examination. Three variables from the 20-year follow-up were chosen as dependent variables in logistic regression analyses, with independent variables selected from the baseline examinations. Three variables at baseline were significant predictors for reported TMJ clicking at the 20-year follow-up, tooth wear index being the strongest (odds ratio = 4.3). Reported TMJ clicking at the start was the only significant predictor for TMD symptoms without clicking 20 years later (odds ratio = 2.3). The third logistic regression model, using the Helkimo Clinical Dysfunction Score as dependent variable, resulted in four significant predictors from the baseline examinations (bruxism, oral parafunctions, TMJ clicking, and deep bite). The results indicated that some signs and symptoms might predict TMD signs and symptoms in a long-term perspective. However, it cannot be concluded from this study whether these symptoms recorded in childhood--oral parafunction, tooth wear, TMJ clicking, and deep bite--can be used for predicting manifest TMD in adult age.     

Predictors of signs and symptoms of temporomandibular disorders: a 20-year follow-up study from childhood to adulthood

The aim of this study was to find possible predictors of signs and symptoms of temporomandibular disorders (TMD) in a long-term perspective. Baseline questionnaire and clinical examinations focusing on function and dysfunction of the masticatory system were performed in a sample of 402 subjects 7, 11, and 15 years old. After 20 years, 320 subjects (80% of the original sample) completed a similar questionnaire as at baseline. From the oldest age group, now aged 35 years, 100 subjects (74% of the original sample) also attended a clinical examination. Three variables from the 20-year follow-up were chosen as dependent variables in logistic regression analyses, with independent variables selected from the baseline examinations. Three variables at baseline were significant predictors for reported TMJ clicking at the 20-year follow-up, tooth wear index being the strongest (odds ratio = 4.3). Reported TMJ clicking at the start was the only significant predictor for TMD symptoms without clicking 20 years later (odds ratio = 2.3). The third logistic regression model, using the Helkimo Clinical Dysfunction Score as dependent variable, resulted in four significant predictors from the baseline examinations (bruxism, oral parafunctions, TMJ clicking, and deep bite). The results indicated that some signs and symptoms might predict TMD signs and symptoms in a long-term perspective. However, it cannot be concluded from this study whether these symptoms recorded in childhood - oral parafunction, tooth wear, TMJ clicking, and deep bite - can be used for predicting manifest TMD in adult age.     

Long-term effects of orthodontic treatment, including extraction, on signs and symptoms attributed to CMD.

The prevalence of signs and symptoms attributed to craniomandibular disorders (CMD) was established in an orthodontically treated sample. The effect of orthodontic therapy upon this prevalence was studied by monitoring three groups of patients whose treatment procedures were different. The first group was treated with functional appliances, the second with Begg light wire, and the third with chin cups. In addition, the effect of extraction upon the prevalence was studied by monitoring three groups in which different extraction decisions had been made: four first premolars extracted, all other types of extraction, and no extraction. Based upon the finding of similar prevalences after 20 years of observation, it appears that neither orthodontic treatment nor extraction has a causal relationship with the signs and symptoms of CMD recorded during this study.     

Multidimensional evaluation of craniomandibular dysfunction. I: Symptoms and correlates

To standardize clinical history taking, a comprehensive anamnestic questionnaire was developed (Screen). Screen includes questions about (i) pain, (ii) other symptoms of CMD, (iii) correlates of CMD, (iv) psychosocial factors, and (v) general health. Variables discriminating between subgroups of clinical cases and controls were described successively. This study was performed to assess whether subgroups of patients with signs and symptoms of craniomandibular dysfunction (CMD), and a control group of dental patients with and without signs and symptoms of CMD, can be characterized by differential report of signs and symptoms of CMD, as reported in Screen. Results indicate that Screen can be used to discriminate between (i) subgroups of subjects with signs or symptoms of CMD (both clinical cases and controls) and controls without signs or symptoms of CMD; (ii) subgroups of clinical cases and controls with signs and/or symptoms of CMD; and (iii) patients with CMD with mainly a myogenous component and patients with CMD with mainly an arthrogenous component. Differences between patients and controls are interpreted with regard to the correct classification of patients with CMD with mainly a myogenous component and patients with CMD with mainly an arthrogenous component, and with regard to the subjective treatment need for CMD. The results of logistic regression analyses indicate that subsets of items of Screen correctly classified up to 80% of patients with myogenous or arthrogenous CMD. Implications for further research were discussed.     

A prospective long-term study of signs and symptoms of temporomandibular disorders in patients who received orthodontic treatment in childhood

This investigation analyzed the influence of orthodontic treatment performed in childhood on the long-term development of signs and symptoms of temporomandibular disorders (TMDs). The original sample consisted of 50 consecutive patients (27 girls and 23 boys) with different morphological malocclusions, who were to receive orthodontic treatment. Their mean age at start of treatment was 12.9 years. Seventeen (range 15-18) years after completion of orthodontic treatment, 40 former patients (89% of the traced subjects) completed and returned a questionnaire, and 31 subjects (69% of the traced subjects) were also examined clinically. A great majority of the participants were pleased with the result of the orthodontic treatment. Relapses of morphological malocclusions were very uncommon. The prevalence of signs and symptoms of TMD was low both before and after the active phase of orthodontic treatment, as well as at the long-term follow-up after 15 to 18 years. The incidence per year of manifest TMD requiring treatment was approximately 1%. The result of the present investigation supports the opinion that orthodontic treatment in childhood does not entail an increased risk to develop either signs or symptoms of TMD later in life.     

Signs and symptoms of craniomandibular disorders in two groups of 19-year-old individuals, one treated orthodontically and the other not

Fifty-one individuals (28 girls and 23 boys) who had received orthodontic treatment were compared as to signs and symptoms of craniomandibular disorders with 47 individuals (19 girls and 28 boys) without such treatment. All were 19 years old. An average of 5 years had elapsed since the termination of the treatment. The examinations enabled calculations of the anamnestic, the clinical dysfunction, and the occlusal indices of Helkimo. There were no statistically significant differences between the groups except with regard to the anamnestic index. Subjects who had not received orthodontic treatment reported most symptoms, but none were severe. In conclusion, there were no substantial differences as to signs and symptoms of craniomandibular disorders in these two groups of individuals.     

Influence of complete denture renewal on craniomandibular disorders: a 1-year follow-up study

summary Great individual variation in the signs and symptoms of craniomandibular disorders (CMD) and in the adaptability of the masticatory system is evident among complete denture wearers. The masticatory system of 64 edentulous patients (41 women, 23 men; mean age 59 years, range 41-80 years), who came to the Institute of Dentistry for renewal of their complete dentures, was examined before prosthetic treatment and after a 1-year follow-up period. The degree of CMD was assessed using the anamnestic and clinical dysfunction indices of Helkimo. The results show that few complete denture wearers had severe signs and symptoms of CMD. No statistically significant correlation was noted between CMD and either the duration of edentulousness or the number of sets of dentures.     

Ten-year follow-up study of signs and symptoms of craniomandibular disorders in adults with intact and restored dentitions

summary Signs and symptoms of craniomandibular dysfunction (CMD) and oral parafunctions were reexamined in subjects, 25–26 years of age, 10 years after the first examination. Forty subjects had restored dentitions at both examinations (group F), 18 subjects with previously intact dentitions had had fillings in their teeth during the follow-up period (group FI), and 11 subjects had intact dentitions at both examinations (group I). Signs and symptoms of CMD were more common among the subjects in group F than in the original group of subjects with intact teeth (group 10). In accordance with the first study most of the symptoms were mild and of low frequency. However, frequent symptoms were only found among the subjects in group F1 and group F and more severe frequent symptoms only in group F. There was an increase of the symptoms in group FI and group F. Frequent tooth clenching and frequent tongue pressing were more common in group F and there was a statistically significant increase in group FI concerning tooth clenching and tooth grinding and in group F concerning tooth grinding, tooth clenching and tongue pressing. Together with the correlations found between tooth clenching and signs and symptoms of CMD, the findings in this study and the personality study indicate a possible causal relationship between oral parafunctions, signs and symptoms of CMD, personality and fillings. A hypothesis for the possible mechanisms is presented. However, the findings are not conclusive and more studies are necessary, and for further interpretation of the results, studies from other research centres would be of interest.     

Prevalence of Modalities of Headaches and Bruxism Among Patients with Craniomandibular Disorder

This study compared the presence of headache and bruxing behavior among 133 craniomandibular disorder patients (CMD) referred to the The Center For the Study Of Craniomandibular Disorders and to the presence of headache and bruxing behavior occurring in 133 controls seeking routine dental care. Both patients and controls were consecutive referrals to the clinic occurring over a three year period. The mean age of the CMD group was 38 years (range 28–42), and the mean age of the controls was 37 years (range 25–44). The information gathered included questionnaire and clinical examination. Different types of headaches, signs and symptoms of CMD, and bruxing behavior were assessed both in the CMD group and in the corresponding control group. Results of this study showed that bruxing behavior and headache pain were significantly more prevalent in the CMD group (57%, 76%) than in the corresponding control group (37%, 49%). Of the three types of headache observed, tension and combination headaches were more prevalent in the CMD group (n=48=36% and n=37=28%). Migraine headache was more prevalent in the CMD group (n=16=12%) than in the control group (n=3=2%). It was concluded that headache and bruxing behavior predominated in CMD patients. This data reinforces the need to assess headache pain and signs and symptoms of bruxing behavior in CMD patients, particularly in those suffering chronic facial pain and headache.     

Malocclusion and temporomandibular disorder: a comparison of adolescents with moderate to severe dysfunction with those without signs and symptoms of temporomandibular disorder and their further development to 30 years of age

A total of 1018 subjects were examined at the age of 11 years, 791 were reexamined at 15 years, 456 at 19 years, and 337 at 30 years. Anamnestic and clinical recordings of temporomandibular disorder (TMD) were made. Morphology, including calculation of peer assessment rating (PAR) scores, was recorded. Previous history of orthodontic treatment was assessed. Muscular endurance was recorded. The subjects completed four psychological measures. The malocclusion prevalence, occlusal contacts, psychological factors, and muscular endurance in subjects with no recorded signs and symptoms of TMD were compared with those with the most severe dysfunction at 19 years of age. The further development of TMD to 30 years of age was followed. PAR scores were significantly higher in the subjects with the most severe dysfunction. Apart from crowding of teeth, no other significant differences were found between the groups with regard to separate malocclusions, tooth contact pattern, orthodontic treatment, or extractions. A greater proportion of subjects with low endurance were found in those with TMD. Significant associations between TMD and general health and psychological well-being as well as the personality dimension of neuroticism and self-esteem were found. During the period from 19 to 30 years, the prevalence of muscular signs and symptoms showed considerable reduction, whereas clicking showed a slight increase. Locking of the joint showed a decrease from 19 to 30 years. One-quarter of the TMD subjects showed complete recovery. Thus, orthodontic treatment seems to be neither a major preventive nor a significant cause of TMD.     

A survey of craniomandibular disorders in 1000 12-year-olds. Study design and baseline data in a follow-up study

One-thousand-and-eighteen 12-year-old children were chosen by use of preselected screening criteria, and disproportionate sampling to participate in a longitudinal study into the dental and social effects of malocclusion. The data has now been used to investigate the effects of malocclusion and orthodontic treatment on craniomandibular disorders. The sampling method was designed to create sub-groups large enough to study effectively the whole range of malocclusion, even those which have a low prevalence. This report will give baseline data in a longitudinal study. Intra-observer variability on recordings of signs of craniomandibular disorders was tested and reproducibility was found to be on an acceptable level. Almost half the children had signs of CMD, but few of these were severe and overall, only a very small minority of children in this sample required treatment. A preliminary examination has been made into possible relationships between the signs and symptoms of CMD, and significant associations were found between headache and several clinical signs.     

Craniomandibular disorders and orthodontic treatment need in children

summary Two hundred and forty subjects (113 boys and 127 girls), divided in three age groups, 7, 11, and 16 years were interviewed and clinically examined to estimate the prevalence of CMDs and the need for functional treatment, and to compare the functional status of the stomatognatic system in two subgroups: those judged to need orthodontic treatment and those judged not to need orthodontic treatment. Signs and symptoms of craniomandibular disorders were quite common and, in most cases, mild. There were significant differences in prevalence of CMDs between sexes. Only 3.7% of the patients were judged to need some functional treatment for CMDs. Trauma to the facial area and headaches were significantly associated with signs and symptoms of CMDs. No indication was found that oral parafunctions produce CMDs. No greater prevalence of CMDs signs and symptoms was found in subjects who needed orthodontic treatment than in subjects who did not need orthodontic treatment. In conclusion, preliminary results of this ongoing study support the contention that the high prevalence of signs and symptoms of CMDs is not really a measure of masticatory dysfunction, and that malocclusion does not appear to cause CMDs and/or to increase craniomandibular treatment need in a young population.     

Mandibular function before orthodontic treatment.

Two-hundred-and-forty-five consecutive prospective orthodontic patients and 245 controls matched for age, sex, and residence, but with minor need of orthodontic treatment, were examined. The functional examination of the masticatory system was made according to Carlsson and Helkimo (1972), and Helkimo (1974). According to dysfunction index (Helkimo, 1974), 33.5 per cent of the patients and 21.6 per cent of the controls had a moderate, and 18.9 and 7.8 per cent respectively, a severe dysfunction. The corresponding figures for symptoms were 16.7 and 4.9 per cent respectively. In the patient group the frequency of signs and symptoms was higher in the older age group and in the girls. Orthodontic patients appeared to be at greater risk of craniomandibular disorders (CMD) than individuals with minor need of treatment.