Anamnestic Index Severity and Signs and Symptoms of TMD

Abstract

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.     

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.     

A 5-year follow-up of signs and symptoms of TMD and radiographic findings in the elderly

PURPOSE: The aim was to clarify the associations among subjective symptoms, clinical signs of temporomandibular disorders (TMD), and radiographic findings in the mandibular condyles of elderly people during a 5-year follow-up. MATERIALS AND METHODS: As part of a comprehensive medical survey of a random sample born in 1904, 1909, and 1914 (Helsinki Aging Study), 364 subjects living in Helsinki participated in the dental part of the examination during 1990 and 1991; after 5 years, 103 of these were reexamined. Comprehensive data on TMD were available for 94 subjects, and radiographic data were available for 88. TMD were assessed by Helkimo's anamnestic and clinical indices, and radiographic status was assessed by panoramic radiographs. RESULTS: During the 5-year follow-up, reported anamnestic symptoms of TMD for men changed little (9%); among women, the change from baseline was 42%. When the unchanged indices were compared, the gender difference was obvious. At baseline, 5% of the women, but no men, had severe signs (clinical index III) of TMD. At the end of follow-up, none showed severe signs. Comparison of radiographic findings between baseline and follow-up showed no differences, nor did differences appear in associations between radiographic findings and anamnestic or clinical indices. CONCLUSION: During the 5-year follow-up, signs and symptoms of TMD in these elderly individuals became milder or vanished. The radiographic status of the condyles remained stable, and no association appeared between radiographic findings and signs and symptoms of TMD.     

Maximal bite force and its association with signs and symptoms of TMD, occlusion, and body mass index in a cohort of young adults

The purpose of this population-based cohort was to measure maximal bite force (MBF) in the molar and incisal regions and to examine whether MBF was associated with TMD, gender, occlusion (in terms of overjet, overbite, and total number of occluding contacts), and body mass index (BMI). MBF in the molar and incisal regions was measured using a calibrated method in 384 (196 males, 188 females) and 357 (181 males, 176 females) subjects, respectively. Two attempts in each region (right molar, left molar, and incisal) were made in random order. The subjects completed a multiple-choice questionnaire including subjective symptoms of TMD and were subsequently clinically examined. Helkimo's clinical dysfunction index and BMI were calculated. The mean MBF value in the molar region was significantly higher in males (878 N, SD 194) than in females (690 N, SD 175) (p < 0.001). The incisal forces were 283 N (SD 95) and 226 N (SD 86) (p < 0.001), respectively. According to multiple linear regression, TMJ discomfort was significantly negatively associated with MBF in the molar region (p < 0.05) and overjet was significantly negatively associated with maximal incisal bite force (p < 0.05). No significant associations between MBFs and body mass were found. The results demonstrate that in a population-based cohort of young adults signs, and symptoms of TMD and studied occlusal factors, unlike body mass, associate independently with MBF.     

Ultrasonography and electromyography of masticatory muscles in a group of adolescents with signs and symptoms of TMD

The thickness and electrical activity of masseter and anterior temporalis muscles were compared in adolescents with and without signs and symptoms of TMD. Forty individuals were selected using the Cranio Mandibular Index and a questionnaire. There was no significant correlation between thickness and activity (p > 0.05). However, there were correlations between thickness and weight and height (p < 0.05). The effect of signs and symptoms on muscle thickness and activity was weak, considering the low CMI scores found.     

Incidence of symptoms and signs of TMD following third molar surgery: a controlled, prospective study

Summary  The purpose of this prospective study was to investigate if third molar surgery is associated with the development of symptoms and signs of temporomandibular disorders (TMD) during a 6-month post-operative observation period using the Research Diagnostic Criteria for TMD (RDC/TMD) instrument. Seventy-two subjects eligible for third molar surgery under local anaesthesia (patients) were included. Patients were examined according to the RDC/TMD instrument at baseline, 1 week, 1 and 6 months after surgery. Twenty-five age- and sex-matched healthy non-operative control subjects (controls) were included and examined at baseline and at 6 months. In the patient group, we found: (i) reduced range of maximum jaw opening at one week after surgery ( P  < 0·001), (ii) increased characteristic pain intensity 1 week after surgery ( P  < 0·05), (iii) increased disability up to 1 month after surgery ( P  < 0·05), (iv) increased incidence of muscle pain on palpation up to 6 months after surgery ( P  < 0·05), (v) increased incidence of pain on palpation of the temporomandibular joint up to 6 months after surgery ( P  < 0·05) and (vi) increased incidence of painful TMD 6 months after surgery. But, when compared with untreated controls, subjects undergoing third molar surgery have a statistically insignificant increased incidence of TMD 6 months post-operatively.     

Interobserver variability in assessment of signs of TMD

PURPOSE: The aim of this report was to study the ability of examiners to measure reliably the clinical signs of temporomandibular disorders (TMD). Four examiners participated in this study of 11 TMD patients and 25 nonpatients. MATERIALS AND METHODS: Vertical and lateral excursions of the jaw were measured using a millimeter ruler. Joint sounds during vertical jaw movements were assessed using digital palpation. The reliability of delivering appropriate degrees of digital pressure to assess masticatory muscle pain was assessed using a manometer after training examiners to exert specified pressures. RESULTS: Intraclass correlation coefficients for the measurement of vertical and protrusive jaw movements were > or = 0.87, which was considered excellent. The intraclass correlation coefficient for measurements of left and right lateral jaw excursions varied between 0.73 and 0.85, which was considered acceptable. The interobserver agreement for detecting the joint sounds showed overall agreement across examiners of 78%. Kappa for every possible pair of examiners varied between .52 and .86 (median .75, interquartile range .18). Reliability for diagnostic categories from the Helkimo index and Research Diagnostic Criteria for Temporomandibular Disorders involving joint noises showed modest reliability. CONCLUSION: Point estimates and measures of spread for reliability measures of single clinical TMD signs as well as combinations of signs into diagnostic categories from the Helkimo index and Research Diagnostic Criteria for Temporomandibular Disorders involving joint noises were sufficient in a group of four examiners.     

A study of the influence of occlusal factors and parafunctional habits on the prevalence of signs and symptoms of TMD

PURPOSE: The purpose of this study was to investigate the prevalence of the clinical signs and symptoms of temporomandibular disorders (TMD) and the relationship between occlusal factors, parafunctional habits, and TMD in a young adult nonpatient population. MATERIALS AND METHODS: A questionnaire including data from a history and clinical functional examination was used in the study. All 230 subjects were male recruits, from 19 to 28 years of age (mean 21.3 years). RESULTS: Thirty-eight percent of the subjects reported at least one symptom, while in 45% of the subjects at least one sign of TMD was recorded. Temporomandibular joint clicking (40%) and pain on palpation (34%) were the most commonly recorded signs. Multivariate logistic regression analysis showed several weak but statistically significant correlations between the occlusal factors, parafunctional habits, and TMD in this nonpatient population. TMD signs were thus weakly correlated with malocclusion traits (angle Classes II/1, II/2, III, and cross bite), interferences in retruded contact position, midline discrepancy > or = 2 mm, < or = 10 contacts during maximal biting pressure, nonworking-side interferences, horizontal overlap > or = 5 mm, and parafunctional habits (teeth clenching and teeth grinding). CONCLUSION: Some association between occlusal factors and TMD signs was found. However, this association cannot be considered unique or dominant in defining subjects with TMD in the population.     

MRI分期与TMD临床症状相关性的分析

目的 评估颞下颌关节紊乱病(temporomandibular disorder,TMD)磁共振成像(MRI)分期与临床症状的相关性.方法 通过回顾性队列研究,收集2018年12月—2019年12月至我院颌面外科就诊的160例患者的基本信息、MRI影像、数据化测定(VAS)评分表以及张口度.将患者根据年龄分组(12～1...     

A clinical study of specific signs and symptoms of CMD in bruxers classified by the degree of severity

Two hundred and seventy-six CMD patients referred consecutively for diagnosis and treatment over a period of four years were assessed. Two hundred and eleven were classified as bruxers according to the use of a questionnaire and clinical examination. One hundred (47.39%) presented clinical characteristics of mild bruxers, 66 (31.27%) presented moderate bruxism and 45 (21.32%) demonstrated severe bruxism. Severe bruxers presented the lowest degree of jaw opening (39.21 mm) and highest prevalence of capsulitis (97.77%), retrodiskal pain (84.44%) and disk-attachment pain (48.88%). As compared to the mild and moderate groups, severe bruxers also demonstrated significantly higher prevalence of protective splinting and transient locking or recent history of intermittent locking, masticatory pain, reciprocal clicking and signs and symptoms of Myofascial Pain Dysfunction Syndrome (MPDS). Because higher prevalence of specific muscle and joint disorders were observed in bruxers and such prevalence was progressive from the mild to the moderate and severe group, it may be concluded that bruxing behavior is a significant factor in the etiology and progression of muscle and joint disorders. Based on the review of the literature, the analysis of our data in comparison to other studies allowed us to conclude that severe bruxers are more impaired by muscular and joint disorders as compared to mild and moderate bruxers.     

Association between temporomandibular joint symptoms, signs, and clinical diagnosis using the RDC/TMD and radiographic findings in temporomandibular joint tomograms

AIM: To identify associations between clinical symptoms of temporomandibular joint disorders and radiographic findings. METHODS: Two hundred four adult patients (156 women, 48 men, mean age 40 years) with temporomandibular joint (TMJ) pain/sounds or changes in mandibular motion were examined according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Bilateral sagittal corrected TMJ tomograms in closed and open positions were assessed for the presence of flattening, erosion, osteophytes, and sclerosis in the joint components and the range of mandibular motion. Logistic regression analyses were performed with the radiographic findings as the dependent variables and the following clinical variables as independent variables: opening pattern, maximal jaw opening, TMJ sounds, number of painful muscle/TMJ sites, duration of pain, presence of arthritic disease, depression and somatization scores, graded chronic pain, and age and gender. RESULTS: Coarse crepitus on opening/closing (odds ratio [OR] > or = 3.12), on lateral excursions (odds ratio > or = 4.06), and on protrusion (OR > or = 5.30) was associated with increased risk of degenerative findings in tomograms. A clinical diagnosis of osteoarthritis increased the risk of radiographic findings (OR > or = 2.95) and so did increasing age (OR > or = 1.03 per year) and the female gender (OR > or = 2.36). Maximal assisted opening and maximal opening without pain (< 40 mm) was associated with a posterior condyle-to-articular tubercle position (OR > or = 2.60). No other significant associations were observed. CONCLUSION: Age, gender, and coarse crepitus, but no pain-related variables, were associated with increased risk of degenerative findings in TMJ tomograms. Maximal opening < 40 mm was associated with a posterior condyle-to-articular tubercle relation on opening.     

Depressive symptoms in Asian TMD patients and their association with non-specific physical symptoms reporting

BACKGROUND: The expression of depression in Asian temporomandibular disorder (TMD) patients may differ from that of their Caucasian counterparts. This study examined the prevalence of depressive symptoms and their association with non-specific physical symptoms (NPSs) reporting in Asian patients. METHODS: Two hundred and fifty-five Asian TMD patients (68 males; 187 females) with a mean age of 33.0 years were selected for this study. Research diagnostic criteria (RDC)/TMD history questionnaire was input directly into computers by patients using the NUS TMDv.1.1 software. Symptom Checklist 90 (SCL-90) depression and NPS scales were generated online and automatically archived for statistical analysis. Data were subjected to ANOVA/Scheffe's test and Pearson's correlation at significance level 0.05 and 0.01, respectively. RESULTS: 43.1 and 50.6% of the patients scored moderate-to-severe on the depression and NPS scales, respectively. The percentage of patients with diffuse physical symptoms remained high (45.5%), even after pain items were excluded from the computation. NPS scores ranged from 0.34 to 1.64, while depression scores ranged from 0.27 to 1.21. A significant and positive correlation (r = 0.74) was observed between depression and NPS scores. CONCLUSIONS: The prevalence of depressive symptoms and NPSs was lower in Asian TMD patients. Psychological distress experienced by female Asian TMD patients was comparable to their male counterparts. Results also suggest that depressive symptomatology is associated with the reporting of multiple NPSs.     

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)     

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.     

Multivariate analysis of risk factors in relation to TMD symptoms

The epidemiological studies on risk factors for temporomandibular disorders (TMD) are still extremely lacking. Therefore, their aetiological significance has scarcely been documented. The aim of this study was to quantitatively investigate the relationship between hypothesized risk factors and the precipitation and perpetuation of TMD symptoms. The same 672 adults who participated in a previous study ( Matsuka et al., 1996 ) were selected for this study. All subjects had already answered a self‐administered questionnaire and the same questionnaire was sent to them 4 years after the first survey. The questionnaire failed to reach 58 subjects at the second survey. Of the remaining 614 subjects, 367 (166 males and 201 females with a mean age of 53·1 ± 14·2 years) returned the questionnaire, for a return rate of 59·8%. Information about three TMD symptoms [temporomandibular joint (TMJ) pain, limitation of mouth opening, TMJ noise] was obtained from the questionnaire, and fluctuation of these symptoms was assessed by comparing three pairs of answers between the first and second surveys. Information about 18 hypothesized risk factors for TMD (age, sex, trauma, bruxism, malocclusion, oral habit, etc.) were also obtained from the questionnaire at the first survey. To evaluate how strongly each risk factor was associated with precipitation and perpetuation of TMD symptoms, odds ratio of each risk factors for precipitating or perpetuating TMD symptoms was calculated by means of logistic regression analysis. Statistically significant risk factors for precipitating TMD symptoms were lip biting for TMJ pain (3·65) and trauma for limitation of mouth opening (3·20), and statistically significant risk factors for perpetuating TMD symptoms were female for TMJ pain (4·50) and TMJ noise (3·85) (odds ratio in parenthesis). The possible aetiological significance of these factors in TMD should be validated by future research.