Incidence and prevalence of temporomandibular joint pain and dysfunction. A one-year prospective study of university students

OBJECTIVE: The aims of this study were to investigate the incidence and recovery of temporomandibular joint (TMJ) pain and dysfunction during a 1-year period, and to examine factors associated with TMJ signs and symptoms. MATERIAL AND METHODS: The study population comprised 371 dental students examined at the start of education, out of which 308 were re-examined after 1 year. Case histories were collected with the aid of a questionnaire. The clinical examination involved TMJ mobility, TMJ pain, TMJ sounds, morphological and functional dental occlusion. RESULTS: The 1-year incidence of TMJ signs and/or symptoms was 12%, with no statistically significant difference between men and women. Reported TMJ sounds (10%) and clinically registered TMJ pain (8%) reached the highest incidence rates. Approximately a quarter of those who had TMJ signs and/or symptoms at baseline had recovered at follow-up. Subjects with a non-symptomatic TMJ were significantly more often found among men and among those with bilateral contacts in centric relation, a normal transverse inter-maxillary relationship, and a stabile mandibular position in centric occlusion. CONCLUSION: The 1-year incidence of TMJ pain and/or dysfunction was high among 1st-year university students. The persistence of signs and symptoms during the observation period was related to gender, while incidence and disappearance of symptoms were not. Dental occlusion was not rejected as a possible concurrent factor in relation to TMJ pain and/or dysfunction among university students.     

Associations between occlusal characteristics and signs and symptoms of TMJ dysfunction in children and young adults

Cross-sectional data were obtained from 1,342 subjects 6 to 17 years of age and analyzed for the prevalence of (1) specific types of occlusion, and (2) subjective symptoms and clinical signs of TMJ dysfunction. The results, as they pertained to occlusion and clinical signs, were as follows: functional shift was negatively associated with TMJ and muscle tenderness; open bite was positively associated with TMJ and muscle tenderness; excessive or negative overjets were more likely to have joint tenderness; older subjects with a cusp-to-cusp or a Class II molar relationship were more likely to experience TMJ and muscle tenderness, and restricted opening; and buccal crossbites had a significantly higher prevalence of joint sounds in older children. Results pertaining to occlusion and subjective symptoms were as follows: Class II molar relationship was positively associated with joint noise in the 6 to 8 and 15 to 17-year age groups; and subjects with negative overjet were more likely to report joint noise. Our conclusions were that (1) statistical associations exist between certain features of occlusion and TMJ signs/symptoms, and (2) such associations are greater in the older groups tested.     

A comparison of the signs of temporomandibular joint dysfunction and occlusal discrepancies in a symptom-free population of men and women

To date, there has been no conclusive explanation for the predominance of female patients with temporomandibular joint (TMJ) dysfunction. The purpose of this study was to survey a normal population without symptoms for the presence of certain putative signs of TMJ dysfunction in association with certain signs of occlusal discrepancy and to determine the presence of any gender variation. The subjects (217 men and 217 women) were examined for the presence of three putative signs of TMJ dysfunction: limited mandibular opening (under 37 mm), deviation on opening, and joint sounds. The subjects were also examined for the presence of four signs of occlusal discrepancy: an anterior slide from centric relation (CR) to centric occlusion (CO), lateral slide from CR to CO, nonworking occlusal contacts, and working disclusive contacts distal to the canines. CR is the mandibular position at which the condyles are in their most superior position on the posterior aspect of the articular tubercles. CO is the mandibular position at which the mandibular and maxillary teeth are in maximum intercuspation. There were no significant differences in the prevalence of the putative signs of TMJ dysfunction and occlusal discrepancy between men and women. It was concluded that factors other than the presence of these signs of TMJ dysfunction and occlusal discrepancy are responsible for the high predominance of female patients with TMJ dysfunction.     

Prevalence of temporomandibular joint disorder among North Saudi University students

The aim of the current investigation was to study the prevalence of temporomandibular disorder (TMD) among university students of North Saudi Arabia.

Methods:A specifically constructed questionnaire was distributed to 489 university students to investigate the prevalence of temporomandibular joint (TMJ) findings among them. The study sample consisted of 346 males and 143 females (age range was 18–25?years). The data were analyzed, and probability values were set at p?≤?0.05.

Results:A total of 49.7% of participants had at least one sign or symptom of TMD. Clicking was the most reported finding. Pain in or about the ears/cheeks was the second most common finding. In all, 24.3% of the participants reported one TMJ finding; meanwhile, 0.4% reported the presence of five concurrent TMJ signs and symptoms. Females reported more TMJ signs and symptoms than males (p?p?Discussion:University students in north Saudi Arabia reported high prevalence of TMD. Also, students from science and health colleges reported higher prevalence of TMD findings than humanitarian college students. Clicking and pain are the most prevalent findings of TMD among university students. The results of this investigation highlight the need for additional research to shed more light on the risk factors and findings related to TMD. This will facilitate drawing adequate guidelines for prevention and management of TMD.     

Prevalence, intensity, and correlation of different TMJ symptoms in Lebanese and Italian subpopulations

AIM: The aim of this study was to compare self reported joint related temporomandibular disorder (TMD) symptoms in Lebanese and Italian dental and non-dental students and to detect any correlation between different symptoms. METHODS AND MATERIALS: A questionnaire was distributed in Sardinia (Italy) to dental and psychology students and in Lebanon to dental, physical therapy, and biology students to investigate the prevalence, intensity, and correlation of four temporomandibular joint (TMJ) symptoms. RESULTS: Prevalence of earache varied among the groups from 10.1% to 29.2%, ear stuffiness from 22.5% to 30.8%, TMJ pain from 13.2% to 21.2%, and TMJ sounds from 18.4% to 46.2%. DISCUSSION: Different prevalence and intensity of earache and TMJ sounds were found in the examined sub-populations diverse in cultural background and education. However, prevalence and intensity of ear stuffiness and TMJ pain were similar. Association between TMJ sounds and TMJ pain was detected in selected sub-populations, and correlation between one symptom on one side of the head with the same symptom on the contralateral side were noted suggesting most of these symptoms are bilateral. CONCLUSION: The results of the study might be useful to anticipate the possible occurrence of associated symptoms or the same symptom on both sides of the head. Correlations with cultural background and education are difficult to establish.     

Posterior bilateral condylar displacement: its diagnosis and treatment.

One type of condylar displacement (posterior bilateral) was discussed as an etiologic factor in TMJ dysfunction. Joint noise, tenderness on muscle palpation, and acute TMJ pain are all considered signs of TMJ dysfunction. Any joint noise is considered to be an early dysfunctional symptom because of its higher incidence in association with palpable muscle pain or acute TMJ dysfunction. Sometimes the joint noise will immediately precede acute muscle pain and/or fluctuate with the painful symptoms. The treatment of bilateral posterior condyle displacement has been described. The mandibular anterior teeth were shortened and the maxillary posterior occlusion adjusted so that the mandible could be respositioned in an anterior position without increasing the vertical dimension of occlusion. A silver-plated maxillary cast was obtained and mounted on a semiadjustable articulator (Hanau) with a face-bow. The mandibular cast was mounted in the dysfunctional (retruded) centric relation. The articulator was moved into a protrusive position by the amount of anterior correction that is needed to reposition the condyles into the middle of the fossae symmetrically on both sides. The original TMJ radiographs provide the necessary information for this clinical judgment. Acrylic resin was placed in the space created between the condylar sphere and stop on the articulator. An acrylic resin temporary repositioning prosthesis constructed on the metal cast has two functions. It provides a therapeutic trial for the anterior condylar respositioning, and it holds the mandible in the therapeutic position while TMJ radiographs confirm the corrective position of the condyles in the fossae. After a successful 6 to 8 week trial period with remission of symptoms, a gold prosthesis was constructed on the same cast in the same therapeutic position. It remains to be seen whether, after several years, the condylar suspension system changes from a dysfunctional centric relation to a new functional centric relation in which the patient can no longer return to the posterior displaced condylar position in the fossa. Only with painstaking observations, accurate TMJ radiographs, complete documentation, and after-care can a more scientific approach to the diagnosis and treatment of TMJ dysfunctional pain syndrome be achieved.     

Relationship Between Habitual Occlusal Position and Flat Bite Plane Induced Occlusal Position in Volunteers With and Without Temporomandibular Joint Sounds

Abstract

The aim of this study was to assess whether temporomandibular joint (TMJ) sounds are associated with the difference between the habitual occlusal position (HOP) and the bite plane induced occlusal position (BPOP). Fifteen dental technician school students who had complete natural dentition, normal occlusion and who exhibited TMJ sounds were compared with fifteen healthy control subjects. HOP was recorded by voluntary jaw closing while in an upright position, and BPOP was recorded after wearing an anterior bite plane for a short period of time. Three interocclusal records were obtained in both positions with a vinyl polysiloxane material, and the recorded maxillomandibular relations were analyzed three-dimensionally and compared. Subjects with TMJ sounds had statistically larger differences between HOP and BPOP than controls (p<.05). Within this study population, an association was found between TMJ sounds and the difference between HOP and BPOP.     

Prevalence of mandibular dysfunction in young adults.

A sample of students (739) were questioned and examined for symptoms and signs associated with mandibular dysfunction. The most frequently mentioned symptoms were headache, TMJ sounds, and pain in the face or neck. No significant differences were found between men and women with symptoms other than headache. The most common dysfunctional signs were dull occlusal sounds on repeated, firm closure of the teeth, tenderness of muscles in the jaw or head, and sounds on condylar movement. Women had a higher prevalence of these signs. Subjects who were aware of bruxism (7.9%) were more likely to have tenderness of the masseter muscle and limited mouth opening. Limited mouth opening was associated with dull occlusal sounds, pain on opening the mouth, and sounds in TMJs. Headaches were associated with tenderness in muscles and joints. Subclinical signs associated with dysfunction occurred more frequently than did awareness of symptoms.     

Signs and symptoms of TMJ disorders in adults after adolescent Herbst therapy: A 6-year and 32-year radiographic and clinical follow-up study

Objective:To analyze radiographic signs of temperomandibular joint (TMJ) osteoarthritis and clinical TMJ symptoms in patients 6 years and 32 years after treatment with a Herbst appliance.Materials and Methods:Fourteen patients were derived from a sample of 22 with Class II division 1 malocclusions consecutively treated with a banded Herbst appliance at the age of 12–14 years old (T1-T2). The subjects were reexamined after therapy at the ages of 20 years (T3) and 46 years (T4). The TMJs of the 14 patients were analyzed radiographically (conventional lateral tomography at T3 and cone-beam computed tomography at T4) and clinically/anamnestically at T3 and T4.Results:Six years after Herbst therapy, signs of osteoarthritis were seen in one patient. At the 32-year follow-up, two additional patients had developed signs of osteoarthritis. At the 6-year follow-up, TMJ clicking was present in two patients, though none of the patients reported TMJ pain. At the 32-year follow-up, six patients had TMJ clicking and one patient had TMJ pain.Conclusions:This longitudinal very-long-term follow-up study after Herbst therapy revealed only minor problems from the TMJ. The TMJ findings 6 years and 32 years after Herbst treatment corresponded to those in the general population. Thus, in the very long term, the Herbst appliance does not appear to be harmful to the TMJ.     

Prevalence of temporomandibular dysfunction in Turkish children with mixed and permanent dentition

This study was carried out to determine the prevalence of temporomandibular joint (TMJ) dysfunction in mixed and permanent dentition and to evaluate the sex distribution in Turkish children. One hundred and eighty-two children with mixed dentition and 212 with permanent dentition were selected for the study, which used a questionnaire and clinical examination. Children with one or more signs (TMJ sounds, TMJ tenderness, muscle tenderness, restricted mouth opening) and/or symptoms (TMJ pain during mastication and mouth opening, restriction of the jaw opening and TMJ sounds) met the criterion of TMJ dysfunction. The total prevalence of signs and symptoms of TMJ dysfunction in the studied population was 68% (68% in girls and 68% in boys) in mixed dentition and 58% (61% in girls and 56% in boys) in permanent dentition. The Z-test and analysis of variance (ANOVA) were used for statistical analysis of the difference between the results. The total prevalence of signs and symptoms of TMJ dysfunction in mixed dentition was found to be higher than in permanent dentition (P < 0.05). No statistically significant difference was found in the total prevalence of TMJ dysfunction between girls and boys.     

Temporomandibular joint findings in pediatric populations and young adults: a critical review

The etiology, diagnosis and treatment of temporomandibular joint (TMJ) pain and dysfunction is a controversial subject. There are varying opinions regarding the contribution of occlusion (malocclusion) to the development of mandibular dysfunction and further, the contribution of occlusal alterations (orthodontic and restorative) to the development of pain and dysfunction. Epidemiologic investigations suggest there is a high incidence of subjective and objective symptoms in the pediatric population. Observations on incisal relationships, condyle position and joint sounds, and comparisons to controls seem to suggest that these factors are not the cause of pain or dysfunction. The purpose of this review is: (1) to bring the clinician's attention existing published information reporting the presence of symptoms in children, (2) to evaluate selected information in young adults, (3) to question anecdotal information on the etiology of TMJ problems. It is not in the purview of this paper to determine the overall etiology of TMJ dysfunction.     

The role of occlusal curvatures and maxillary arch dimensions in patients with signs and symptoms of temporomandibular disorders

Objective:To identify differences in occlusal curvatures and maxillary arch dimensions between subjects with signs and symptoms of temporomandibular disorders TMDs and asymptomatic subjects.Materials and Methods:One hundred subjects 78 female and 22 male who consented to participate in this research were examined for signs and symptoms of TMDs according to the guidelines of the Research Diagnostic Criteria for Temporomandibular Disorders RDCTMD. In addition, occlusal measurements were performed for all subjects on plaster models. All statistical analyses were performed with SPSS version 19.Results:Significant associations were revealed between the depth of the curve of Spee COS and temporomandibular joint TMJ sounds. Furthermore, maxillary arch width was negatively correlated to the steepness of the curve of Wilson. No differences were found between subjects with and without a history of orthodontic treatment.Conclusions:Subjects with TMJ sounds tend to have a flatter COS compared to subjects without TMJ sounds.     

Relationship between psychological factors and symptoms of TMD in university undergraduate students

Temporomandibular disorders is a collective term used to describe a number of related disorders involving the temporomandibular joints, masticatory muscles and occlusion with common symptoms such as pain, restricted movement, muscle tenderness and intermittent joint sounds. The multifactorial TMD etiology is related to emotional tension, occlusal interferences, tooth loss, postural deviation, masticatory muscular dysfunction, internal and external changes in TMJ structure and the various associations of these factors. The aim of this study was to evaluate the prevalence of the relationship between signs of psychological distress and temporomandibular disorder in university students. A total 150 volunteers participated in this study. They attended different courses in the field of human science at one public university and four private universities. TMD was assessed by the Research Diagnostic Criteria (RDC) questionnaire. Anxiety was measured by means of a self-evaluative questionnaire, Spielberger's Trait-State anxiety inventory, to evaluate students'state and trait anxiety. The results of the two questionnaires were compared to determine the relationship between anxiety levels and severity degrees of chronic TMD pain by means of the chi-square test. The significance level was set at 5%. The statistical analysis showed that the TMD degree has a positive association with state-anxiety (p = 0.008; p < 0.05) and negative with trait-anxiety (p = 0.619; p < 0.05). Moreover a high TMD rate was observed among the students (40%). This study concluded that there is a positive association between TMD and anxiety.     

A technique for evaluation of centric relation tooth contacts. Part II: Following use of an occlusal splint for treatment of temporomandibular joint dysfunction

The purpose of this study was to determine the effect of TMJ dysfunction on the recording of centric relation. Centric relation was recorded using an anterior occlusal stop and by bimanual manipulation. Changes in occlusal contacts were recorded before and after occlusal splint therapy in six subjects with TMJ dysfunction. The pantographic reproducibility index and clinical signs and symptoms were used to determine the presence or absence of dysfunction. Use of the anterior occlusal stop resulted in a more posterior, superior initial tooth contact position when compared with bimanual manipulation. Occlusal contact positions were less consistent in TMJ dysfunction subjects than in control subjects. Initial occlusal contacts changed toward centric relation as the dysfunction disappeared. Final occlusal contact was found on the side where clinical signs and symptoms occurred. The condyle on the affected side appeared to be repositioned posteriorly and superiorly in most instances. Occlusal splint therapy was more effective when the splint was adjusted weekly. This study indicates the need to eliminate TMJ dysfunction before recording centric relation or adjusting the occlusion. Occlusal interferences found with TMJ dysfunction are not the same as occlusal interferences found when TMJ dysfunction is absent. Abnormal features on pantographic tracings may aid in indicating the presence of occlusal interferences. Occlusal adjustment in the presence of TMJ dysfunction would result in erroneous occlusal reduction.     

Risk factors associated with incidence and persistence of frequent headaches

Objective. Headaches represent a significant public health problem, but the knowledge of factors specifically related to incidence and persistence of headaches is still limited. The aim of this study was to evaluate whether gender, self-reported bruxism and variations in the dental occlusion contribute to onset and persistence of frequent headaches. Materials and methods. The study population comprised 280 dental students, examined annually in a 2-year prospective study with a questionnaire and a clinical examination of the jaw function. In the analysis subjects were dichotomized into cases with frequent (once a week or more) or without frequent headaches (controls). The 2-year cumulative incidence was based on subjects without frequent headaches at baseline. Cases with 2-year persistent headaches reported such symptoms at all three examinations. Self-reported bruxism and factors in the dental occlusion at baseline were used as independent variables in logistic regression analyses. Results. The 2-year cumulative incidence of frequent headaches was 21%. Female gender (OR = 2.6; CI = 1.3–5.4), self-reported bruxism (OR = 2.3; CI = 1.2–4.4) and mandibular instability in intercuspal position (OR = 3.2; CI = 1.4–7.5) were associated with incidence of frequent headaches. Persistent headaches during the observation period were present in 12 individuals (4%) and significantly related to mandibular instability in intercuspal position (OR = 6.1; CI = 1.6–22.6). Conclusions. The results indicate that female gender, self-reported bruxism and mandibular instability in intercuspal position are of importance in the development of frequent headaches. In management of these patients a multidisciplinary approach including dentists may be important and, thus, advocated.     

Orthodontic treatment and temporomandibular joint disorders.

The overall objective of this project was to study the relationship between orthodontic treatment and temporomandibular joint (TMJ) disorders. This relationship has been and remains an important and complex issue in orthodontics. The objectives of the study were to determine the incidence of TMJ pain and dysfunction in a group of orthodontic patients who were symptom-free on entering treatment, and to assess and characterize the level of pain and dysfunction in patients with symptoms, and track changes in these parameters during the course of orthodontic treatment. Standardized functional indices and physical measurements were used to describe and assess TMJ pain and dysfunction. The results of this study showed that of 451 patients without symptoms undergoing treatment at our university clinic during the 18-month project, no patient developed signs and symptoms of TMJ disorders during that time. In addition, for the 11 patients who presented with signs and symptoms of TMJ disorders at the time of their entry into the treatment program, no clear or consistent changes in levels of pain and dysfunction occurred longitudinally during the treatment period followed in this study. On the basis of these findings, a relationship between either the onset of TMJ pain and dysfunction and the course of orthodontic treatment or the change in TMJ pain and dysfunction and the course of orthodontic treatment could not be established in this particular patient population.     

Temporomandibular disorders. Part I: Functional status, dentomorphologic features, and sex differences in a nonpatient population

Freshman dental and dental hygiene students, 120 men and 102 women (mean age 23.9 years), were assessed for the presence of masticatory pain or dysfunction by questionnaire, clinical examination, and evaluation of dental casts according to strict criteria. The purpose was to identify and analyze the level of signs and symptoms in a nonpatient population and describe occlusal variation. The prevalence of TMJ signs and symptoms was notable even though two thirds reported only mild or early symptoms, with only 3% reporting severe symptoms. This population was noted for the absence of locking, the low frequency of severe pain or severe TMJ dysfunction, and the low prevalence of restricted ranges of mandibular movement and TMJ crepitation. Women showed significantly more headache, TMJ clicking and tenderness, and muscle tenderness than men. Men were noted for the absence of severe and widespread muscle tenderness and severe TMJ tenderness. TMJ clicking was not always clinically confirmable in subjects with widespread muscle tenderness. This group was considered compatible with previous epidemiologic findings, and also matches the age range of most subjects seeking treatment for TMJ disorders. Therefore, the subjects in the study were considered a representative group of young adults and suitable for study of the possible associations between early signs of TMJ disorders and variables of morphologic malocclusion, which are discussed in Parts II and III of this article.     

Associations between craniomandibular disorders,sociodemographic factors and self-perceived general and oral health in an adult population

Objective. The aim of this study was to analyze the relationships between pain in the craniomandibular region and jaw dysfunction, respectively, to sociodemographic factors and self-perceived general and oral health in a middle-aged and elderly population in Västerbotten County, Sweden. Materials and methods. Six hundred individuals, 35-, 50-, 65- and 75 years old, from inland and 600 individuals from coastal areas were randomly selected in 2002. Of these, 987 individuals completed a questionnaire and 779 participated in a clinical examination. Thirty-five- and 50-year-olds together constituted a middle-aged group and the rest an elderly group. Results. Among the middle-aged, craniomandibular pain was associated with impaired general health status, signs of temporomandibular disorder (TMD) pain were associated with female gender and living alone, jaw dysfunction symptoms were associated with university degree and chewing with caution; and signs of TMD dysfunction were associated with female gender and living in the more densely populated coastal region. Among the elderly, craniomandibular pain was more common among those living in the inland region, craniomandibular pain and signs of TMD pain were associated with impaired general health status, jaw dysfunction symptoms were associated with higher education level and self-perceived impaired general health and oral health; and signs of TMD dysfunction were associated with female gender and living in the coastal region. Dental status was not associated with craniomandibular pain. Conclusions. Socioeconomic factors and impaired general state of health were related to signs and symptoms indicative of CMD. These factors may influence demand for treatment among the affected.     

Two year longitudinal study of the fluctuation of clinical signs of TMJ dysfunction in Japanese adolescents

Signs of TMJ dysfunction syndrome were monitored longitudinally from the age of 12 to 14 years in 160 junior high students and 15 to 17 years in 480 senior high school students. Thirty-one percent of the junior high school students and 39.6% of the senior high school students presented with one or multiple signs of TMJ dysfunction syndrome at least once during the examination period. The percentage of subjects presenting continuously with one or multiple signs at all examinations was 8.9% among junior high school students and 12.9% among senior high school students. The predominant sign in the subjects, who continuously presented with one or multiple signs of TMJ dysfunction syndrome was TMJ sounds. The number of subjects presenting with TMJ clinical signs for the first time at the third examination (third year student) was high compared to the other examinations. When intra-individual longitudinal results were examined in subjects, who at least once during the examination period presented with one or multiple signs of TMJ dysfunction syndrome was found to be high (75.0% among junior high school students and 86.5% among senior high school students). In the subjects presenting with one or multiple signs of TMJ dysfunction syndrome continuously over the two year period, the percentage of subjects, who at least once presented with multiple signs was 90.9% among junior high school students and 22.0% among senior high school students.     

Analysis of the mandibular relationship of TMJ dysfunction patients using the Mandibular Kinesiograph

Analyses of the relationship between centric relation and centric occlusion were performed using the Mandibular Kinesiograph to show the abnormality of mandibular positions of the TMJ dysfunction patients. The distance between centric relation and centric occlusion in antero-posterior, left, and linear direction showed significant differences between the normal subjects and the TMJ dysfunction patients. In the TMJ dysfunction patients, the number of the subjects who showed larger deviation between centric relation and centric occlusion increased remarkably when compared with normal subjects. It is suggested that the slide between centric relation and centric occlusion can be one of the causes of the TMJ dysfunction.