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.     

Malocclusions and Clinical Signs or Subjective Symptoms of Temporomandibular Disorders (TMD) in Adults

AIM AND METHOD: The objective was to determine with reference to a representative sample of 4310 men and women aged 20 to 81 (response rate 68.8%) drawn from the population-based Study of Health in Pomerania (SHIP-0) whether associations exist between malocclusions and temporomandibular dysfunctions in adults. Besides clinically investigated signs, subjectively perceived symptoms of temporomandibular disorders (TMD) were studied in each individual together with malocclusions (plus normal occlusion), functional occlusion factors, and sociodemographic parameters. A multivariate logistic regression analysis was used, adjusted for age and discriminated for gender. The results were compared with those of other population-based studies identified by a systematic review undertaken by the present authors. RESULTS: Some malocclusions were associated with signs or symptoms of TMD but tended to occur only rarely: unilateral open bite, negative overjet, and unilateral scissors-bite in men, and edge-to-edge bite in women. However, malocclusions (and functional occlusion factors) accounted for only a small part of the differences between the control population and the study population with signs or symptoms of TMD. In terms of the multifactorial problem of temporomandibular disorders they should be seen as cofactors. The results, together with those of other population-based studies, revealed no specific, i.e. recurring malocclusions (or other occlusal factors) presenting as risk markers.     

Correlation of Occlusal Factors and Condyle Position Asymmetry with Signs and Symptoms of Temporomandibular Disorders in Young Adults

The role of the occlusion in the etiology and prevalence of temporomandibular disorders (TMD) has not been conclusively demonstrated. Occlusal factors and condyle position asymmetry as deduced from computed tomography (CT) axial scans were correlated with signs and symptoms of TMD in 49 young adults (mean age 24 years, range 15–33 years) with complete or almost complete dentition. A statistically significant correlation was noted between these signs and symptoms and occlusal variables describing asymmetry (the amount and lateral deviation of the slide from the retruded contact position (RCP) to the intercuspal position (IP), deviation of protrusion and asymmetry in bilateral cuspid occlusion). It seems that occlusal discrepancy can be a predisposing factor to TMD, especially when it is asymmetrically expressed.     

Association of Symptoms of TMD and Orofacial Pain with Alexithymia: An Epidemiological Study of the Northern Finland 1966 Birth Cohort

Alexithymia is a term denoting a deficit in the ability to differentiate emotional from physical states and to identify and describe one's feelings, as well as a preference for external oriented thinking. Alexithymia has been linked with various somatic and psychosomatic diseases, especially with chronic pain. The aim of this study was to evaluate the association between alexithymia and symptoms of temporomandibular disorders (TMD) as well as oro-lingual and dental pain, in a large representative population sample of young adults. The study was a part of the 31-year follow-up study of the Northern Finland Birth Cohort originally consisting of 12058 live births in the year 1966. In 1997, 4893 subjects living in northern Finland or in the capital area, who participated in a field study of the project and later returned a postal questionnaire, made up the sample of this study. Information concerning symptoms of TMD and oro-lingual and dental pain was collected from the subjects. To assess alexithymia, the Toronto Alexithymia Scale-20 (TAS-20) was used. In addition, information about depression, marital status and self-rated health was collected. The proportion of alexithymics (TAS score over 60) was higher in subjects with the most orofacial symptoms than in asymptomatic subjects. In men, alexithymia associated significantly with facial pain, difficulties in mouth opening, oro-lingual pain and dental pain, and in women with pain on jaw movement and dental pain. After adjusting for depression, marital status, and self-rated health, a significant association remained between alexithymia and the symptoms mentioned, except for facial pain in men. It can be concluded that alexithymia is connected with orofacial symptoms. Clinicians treating these symptoms should be familiar with the concept of alexithymia.     

Temporomandibular Disorders and Occlusion: An Appliance to Treat Occlusion Generated Symptoms of TMD in Patients Presenting with Deficient Anterior Guidance

Temporomandibular disorders (TMD) are of multifactorial origin. If it is determined that the patient's occlusal scheme is a contributing factor to their TMD symptoms, it is accepted that reversible, noninvasive procedures be instituted at the outset of treatment. Splint therapy conforms to this guideline, offering temporary, reversible alteration of the occlusal scheme in order to provide this relief. In a mutually protected occlusion, the posterior teeth accept the occlusal force of closure, while the anterior teeth separate the dentition during excursive movements. The purpose of the disclusion splint described in this article is to eliminate muscle hypertonicity, along with its ensuing problems. This is accomplished by establishing a mutually protected occlusion via the guide planes created by the acrylic portions of the splint, but not compromising the patient's “freeway” space.     

Bite force, endurance and masseter muscle fatigue in healthy edentulous subjects and those with TMD

It is well known that bite force and EMG activity are considerably reduced in edentulous patients, but the susceptibility of their jaw-closing muscles to localized fatigue is less certain. This information is even less clear for edentulous subjects who have TMD. Eleven healthy edentulous subjects and 10 edentulous subjects with TMD participated in this study. Maximum bite force was measured first, with the transducer placed on the canine-first premolar region bilaterally, and then two rapid relaxations were made from a brief voluntary clench to 50% of maximum. A sustained voluntary clench of 50% of maximum was then maintained and endurance time was noted. EMG was recorded from both masseter muscles and the median frequency of the power spectrum of the EMG from 2 s at the beginning of the sustained clench and 2 s at the end was subsequently calculated. Two more rapid relaxations from brief clenches were performed immediately after the sustained clench. The mean maximum bite force in the healthy group was 115 N (SD +/-41) and in the TMD group was 75 N (SD +/-22), this difference being significant (P = 0.0013). The mean endurance time in the healthy group was 86 s (SD +/-51) and in the TMD group was 63 s (SD +/-20). The percentage change in the median frequency in the healthy group as a result of the sustained contraction was 6% (left) and 8.6% (right) and in the TMD group was 13.9% (left) and 12.8% (right). The percentage change in the mean relaxation half time for the healthy group was 28.5% and for the TMD group was 72%, a significant difference (P = 0.0046). It was apparent that the maximum bite force was low in edentulous subjects and was further reduced in edentulous TMD subjects; endurance time was reduced in TMD subjects; fatigue resistance of the masseter muscles was reduced in TMD subjects.     

Clinical and MRI Findings of the Temporomandibular Joint in Relation to Occlusion in Young Adults

Magnetic resonance imaging (MRI) is excellent for visualizing soft tissues of the temporomandibular joint (TMJ). Because it has no harmful effects, it can be used in asymptomatic subjects. MRI and clinical findings relating to TMJs were correlated with findings relating to occlusion in 20 medical and dental students (13 women, 7 men) who volunteered to participate in our study. Subjects with clinically evident joint signs such as clicking, crepitation or tenderness on palpation also exhibited pathological MRI findings, especially in regards to configuration, position and function of the disk, and, often, disturbances of occlusal relationships between the upper and lower teeth.     

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.     

Role of Temporomandibular Disorders (TMD) in Facial Pain: Occlusion,Muscle and TMJ Pain

Temporomandibular disorders (TMD) which comprise myogenic and arthralgic components have been reported to predispose subjects to headache and facial pain. The aim of this study was to evaluate the role of these components in patients with facial pain and to investigate the influence of treatment of TMD on pain of these patients. The subject group consisted of 25 patients suffering from facial pain. The clinical stomatognathic examination was performed before conservative treatment of TMD, and one-two weeks, three months and one year after treatment. The severity of TMD was assessed using the anamnestic (AI) and clinical dysfunction (DI) indices of Helkimo. The intensity of pain was evaluated on a numerical rating scale (NRS). According to clinical findings the patients were classified to following diagnostic subgroups: TMD myo (mainly myogenic), TMD arthro (mainly arthrogenous) and TMD comb (both myogenic and arthrogenous components involved). Fifteen patients were classified in the TMD myo group, nine in the TMD comb group and one in the TMD arthro group. The DI index decreased significantly one-two weeks after treatment and remained at this level at three month and one year follow-up examinations. At the first examination the TMD myo group had the highest level of NRS index, which decreased significantly during the time of follow-up, while no significant changes were found in other groups. Bruxism reported by the patient had a positive correlation with the amount of painful muscles on the right side at first examination. The results show that facial pain combined with TMD may be mostly of myogenic origin, and myogenic pain seems to have most favorable response to conservative treatment of TMD.     

Mechanism of Class II correction in prepubertal and postpubertal patients with Twin Force Bite Corrector

Objective:To compare the dentoskeletal effects and treatment efficiency of the Twin Force Bite Corrector (TFBC) appliance in Class II correction of patients treated before or after the pubertal growth spurt.Materials and Methods:Forty-one normodivergent Class II patients treated with the TFBC appliance were divided into two groups based on their cervical vertebral maturation stage (CVMS). Group 1 (G1) consisted of 23 patients (mean age 12.44 ± 1.59 years) where treatment was initiated before the pubertal growth spurt (CVMS I and II), while group 2 (G2) consisted of 18 patients (mean age 13.76 ± 1.44 years) where treatment was started after the pubertal growth spurt (CVMS III to V). Dentoskeletal measurements were made on lateral cephalograms taken before (T1) and after orthodontic treatment (T2).Results:During treatment, G1 had significantly greater skeletal correction than G2, with more dentoalveolar effects being observed in G2 than G1. However, on comparing both groups at the end of treatment (T2) when growth is complete, no differences in the parameters measured were observed. Overall, treatment time was significantly longer for G1 (3.67 ± 1.45 years) compared to G2 (2.75 ± 1.07 years).Conclusions:There is no difference in overall dentoskeletal effects obtained at the end of treatment by the TFBC appliance in normodivergent prepubertal vs postpubertal patients. However, treatment efficiency based on treatment timing is significantly greater for the postpubertal group.     

Association of Body Mass Index and Waist Circumference With Dental Caries and Consequences of Untreated Dental Caries Among 12- to 14-Year-old Boys: A Cross-Sectional Study

ObjectiveTo evaluate the association between body mass index (BMI) and waist circumference (WC) and dental caries (DC), and the clinical consequences of untreated dental caries (U-DC) among 12- to 14-year-old male public-school adolescents in the Northern Province, Saudi Arabia.MethodsThe demographic and anthropometric measurements of 302 boys 12 to 14 years of age (mean: 12.5 years) were recorded. BMI and central obesity (based on WC) were measured. The decayed-missing-filled teeth (DMFT) index was used to record DC. The pulp involvement, ulceration, fistula, abscess (PUFA) index was used to quantify the clinical consequences of U-DC. Multiple logistic regression analysis was performed to evaluate the risk factors related to DC and clinical consequences of U-DC.ResultsA high prevalence of DC was found in adolescents who were underweight according to BMI and nonobese based on WC (46.7% vs 34.5%). The association between underweight (BMI) and obese (WC) with DC (odds ratio [95% CI]) was 1.91 (0.87, 4.18) and 0.34 (0.18, 0.63), respectively, while with PUFA (adjusted odds ratio [AOR]; 95%CI), it was 1.76 (0.76, 4.09) and 0.19 (0.06, 0.63) respectively. The logistic regression model showed that consuming sugar more than once a day led to a 2.87-fold greater likelihood of DC (AOR [95% CI] = 2.87 [1.68, 4.88]) and a 3.91-fold greater likelihood of mean PUFA score (AOR [95% CI] = 3.91 [2.05, 7.44].ConclusionHigh risks for DC and clinical consequences of U-DC were observed among underweight and nonobese adolescent males. The frequency of sugar consumption was significantly associated with both conditions.     

The relationship between oral health status and Body Mass Index among older people: a national survey of older people in Great Britain

AIMS: To assess the relationship between oral health status and Body Mass Index. MATERIAL AND METHODS: This paper relates to the free-living sample (participants who lived in their own home, rather than an institution) of the National Diet and Nutrition Survey: people aged 65 years and older. SUBJECTS: 629 adults. DATA COLLECTION: A probability random national sample of adults who had a dental examination, an interview and an anthropometric examination. DATA ANALYSIS: Fisher's exact test and multivariate logistic modeling. FINDINGS: Being underweight was relatively uncommon in this population. People without teeth were significantly (P=0.05) more likely to be underweight than those with 11 or more teeth; 12.3% and 2.9%. A highly statistically significant (P=0.001) difference was observed in BMI between dentate people with 1-10 teeth and with more than 10 teeth; 24% and 2.9% were underweight. Dentate people with less than 21 natural teeth were on average more than 3 times more likely to be obese than those with 21-32 teeth (P=0.036). There was no significant difference in both the proportion of overweight and obese adults between those who were edentulous and dentate with 21 or more teeth. A similar pattern was observed when the number of posterior occluding pairs was compared with BMI categories. Results of multiple logistic regression were adjusted for the confounding effects of age, social class, region of origin and partial denture wearing. CONCLUSIONS: Older people in Britain with more than 20 teeth are more likely to have a normal Body Mass Index.     

体重指数、颈围及颅面特征与阻塞性睡眠呼吸暂停综合征的关系

目的　研究阻塞性睡眠呼吸暂停综合征 (OSAS)及鼾症患者人体体重指数、颈围、颅面结构特征与呼吸暂停及低通气指数 (AHI)的关系。方法　 15 9名欧洲白种OSAS鼾症患者。OSAS诊断标准为AHI>15次 /小时 ,AHI 15次 /小时者为鼾症。每位患者拍摄自然头位X线头颅侧位片 ,临床检查 (体重指数、颈围 )及多导睡眠仪检查。患者又依体重指数 (BMI)分组 ,BMI >2 5 2 5为正常 ,BMI >2 5为超重。统计分析为t检验 ,相关分析及多因素逐步回归。结果　OSAS及鼾症患者之间的体重指数及颈围大小无显著性差异。男性OSAS患者的软腭长度大于鼾症者。相关分析结果为AHI与患者的颈围、体重指数、下颌位置、下颌平面角相关。多因素回归分析结果表明在超重OSAS患者中AHI与颈围及下颌平面角相关 ,而体重正常的OSAS患者 ,AHI与气道宽度、软腭长度相关。超重OSAS患者按性别分组后 ,男性组AHI与体重指数相关 ,女性组AHI与颈围大小相关。结论　在OSAS与鼾症患者之间存在一些气道结构上差异。男性、女性及超重、正常体重AHI的不同的相关关系表明 ,它们之间存在一些病生理上的差异。     

The Need for Treatment and Satisfaction with Dental Appearance among Young Finnish Adults with and without a History of Orthodontic Treatment

The aim of this investigation was to evaluate orthodontic treatment need and patient satisfaction among young adults living in a city where free-of-charge orthodontic treatment was provided. A total of 281 18- to 19-year-old subjects randomly selected from the population register of the city of Vantaa took part in the study. The drop-out rate was 30%. Treatment need was clinically assessed according to the Index of Orthodontic Treatment Need (IOTN), consisting of a Dental Health Component (DHC) and an Aesthetic Component (AC). Information on previous orthodontic treatment was based on the patient records. Satisfaction of the subjects with their dental appearance and with the orthodontic treatment received was obtained using a questionnaire. The rate of orthodontic treatment among the subjects was 46% (54% for the females and 37% for the males, p < 0.05). 4% had discontinued treatment. A definite need for treatment (DHC 4 to 5/AC 8 to 10) was assessed in 15% of the subjects, and borderline/moderate need (DHC 3/AC 5 to 7) in 36%. No difference in IOTN scores between the treated and untreated subjects was found. Females had significantly more often no treatment need (DHC 1 to 2/AC 1 to 4) compared with males (p < 0.05). The majority of subjects (89%) reported that they were very or quite satisfied with their dental appearance. The odds of being satisfied were significantly higher for the treated subjects (OR = 2.71, p < 0.05) and lower for those at the non-attractive end of the AC scale (OR = 0.14, p < 0.01). Neither gender nor DHC grade significantly affected the odds of being satisfied among the subjects. The results indicate that the majority of young adults in this study were satisfied with their dental appearance regardless of objective treatment need of various degrees. The high treatment rate in relation to unnoticed treatment need calls for reevaluation of priorities in patient selection. Zusammenfassung: Ziel dieser Untersuchung war es, den kieferorthopädischen Behandlungsbedarf und die Zufriedenheit junger Erwachsener zu bewerten, die in einer Stadt leben, in der eine kostenlose kieferorthopädische Behandlung angeboten wurde. Insgesamt nahmen an dieser Studie 281 18- bis 19-jährige Personen teil, die nach dem Zufallsprinzip aus dem Bevölkerungsverzeichnis der Stadt Vantaa ausgewählt wurden. Die Ausfallsrate betrug 30%. Der Behandlungsbedarf wurde gemäß dem "Index of Orthodontic Treatment Need" (IOTN) bewertet, der sich aus dem "Dental Health Component" (DHC) und einem "Aesthetic Component" (AC) zusammensetzt. Anamnestische Daten der Patienten gaben Aufschluss über eine vorangegangene kieferorthopädische Behandlung. Die Zufriedenheit der Personen mit dem ästhetischen Erscheinungsbild ihrer Zähne und mit der kieferorthopädischen Behandlung wurde mittels eines Fragebogens festgestellt. Der Anteil der Personen mit kieferorthopädischer Behandlung betrug 46% (54% Frauen und 37% Männer, p < 0,05). 4% hatten die Behandlung abgebrochen. Ein eindeutiger Behandlungsbedarf (DHC 4 bis 5/AC 8 bis 10) wurde bei 15% der Untersuchten festgestellt, ein grenzwertiger/mäßiger Behandlungsbedarf (DHC 3/AC 5 bis 7) bestand bei 36%. Bei den behandelten und unbehandelten Personen stellte man keinen Unterschied bei den IOTN-Kriterien fest. Bei Frauen bestand wesentlich seltener Behandlungsbedarf (DHC 1 bis 2/AC 1 bis 4) als bei Männern (p < 0,05). Die Mehrheit der Untersuchten (89%) sagte aus, dass sie mit dem ästhetischen Erscheinungsbild ihrer Zähne sehr oder ziemlich zufrieden wären. Die Zufriedenheitsrate war bei den behandelten Personen deutlich höher (OR = 2,71, p < 0,05) und niedriger bei denen, die am unattraktiven Ende der AC-Skala standen (OR = 0,14, p < 0,01). Weder das Geschlecht noch der DHC-Grad beeinflusste signifikant die Zufriedenheitsrate der Untersuchten. Das Ergebnis deutet darauf hin, dass die Mehrheit der jungen Erwachsenen dieser Studie, unabhängig von einem objektiven Behandlungsbedarf verschiedenen Ausmaßes, mit ihrer dentalen Ästhetik zufrieden war. Die hohe Behandlungsquote in Beziehung zu einem nicht begründeten Behandlungsbedarf erfordert eine Neueinschätzung der Prioritäten bei der Auswahl der Patienten.     

Association between disk position and degenerative bone changes of the temporomandibular joints: an imaging study in subjects with TMD

The aim of this study was to determine the frequency and relationship between disk position and degenerative bone changes in the temporomandibular joints (TMJ), in subjects with internal derangement (ID). MRI and CT scans of 180 subjects with temporomandibular disorders (TMD) were studied. Different image parameters or characteristics were observed, such as disk position, joint effusion, condyle movement, degenerative bone changes (flattened, cortical erosions and irregularities), osteophytes, subchondral cysts and idiopathic condyle resorption. The present study concluded that there is a significant association between disk displacement without reduction and degenerative bone changes in patients with TMD. The study also found a high probability of degenerative bone changes when disk displacement without reduction is present. No association was found between TMD and condyle range of motion, joint effusion and/or degenerative bone changes. The following were the most frequent morphological changes observed: flattening of the anterior surface of the condyle; followed by erosions and irregularities of the joint surfaces; flattening of the articular surface of the temporal eminence, subchondral cysts, osteophytes; and idiopathic condyle resorption, in decreasing order.