Prevalence of temporomandibular disorders (TMD) among Finnish prisoners: cross-sectional clinical study

Objective: The aim of the present study was to evaluate the prevalence of self-reported temporomandibular disorders (TMD) symptoms and clinically diagnosed TMD among Finnish prisoners.

Material and methods: Altogether 100 prisoners from the Pelso Prison, Vaala, Finland, underwent dental and TMD clinical examinations performed by a calibrated and well-trained dentist. Symptom Questionnaire and clinical examination according to a Finnish pre-final version of the DC/TMD (Diagnostic Criteria for Temporomandibular Disorders) Axis I protocol were used to evaluate the prevalence of TMD sub-diagnoses.

Results: The most common TMD symptoms were facial pain (54.0%), temporomandibular joint noises (43.0%) and headache (37.0%). The prevalence of joint-related TMD diagnoses was four and a half times higher than diagnoses attributed with pain (76.0% vs. 17.0%). The most common TMD diagnoses were degenerative joint disease (33.0%) and disc displacement with reduction (33.0%).

Conclusions: The prevalence of self-reported TMD symptoms and clinical assessed TMD, especially join-related TMD diagnoses, is high among Finnish prisoners. Examination and treatment of TMD should become a common practice also in prison dental care.     

DC/TMD推荐心理量表在颞下颌关节紊乱病诊疗中的应用

目的: 采用新版DC/TMD推荐的心理量表,评估颞下颌关节紊乱病（temporomandibular disorders, TMD）患者焦虑、抑郁及躯体症状等心理状况,探讨新版量表作为TMD心理轴诊断依据的临床意义。方法: 选择100例TMD初诊患者作为实验组,100例无TMD症状的普通门诊患者作为对照组。收集2组患者的一般信息,包括年龄、性别、受教育程度、个人收入等。采用广泛性焦虑症量表（GAD-7）、抑郁症状量表（PHQ-9）和健康问卷量表15（PHQ-15）对患者心理因素进行评估。采用SPSS 20.0软件包对数据进行统计学分析。结果: <30岁组和30~50岁组TMD发病率显著高于50岁以上年龄组（P<0.05）。实验组高学历者比例显著高于对照组（P<0.05）,而收入水平不是罹患TMD的危险因素（P=0.642）。实验组焦虑发生率与平均得分显著高于对照组（P<0.05）,而两组间抑郁和躯体症状得分无统计学差异（P>0.05）。疼痛性TMD患者的焦虑和抑郁程度显著高于关节疾病患者（P<0.05）,而两组间躯体症状无显著差异（P>0.05）。结论: 性别（女）、年龄（<50岁）和高学历（本科及以上）是罹患TMD的高危因素,而与收入水平无关。TMD患者的焦虑发生率和评分均高于普通口腔门诊患者,但抑郁和躯体症状与普通患者的发生率无显著差异。     

Masticatory muscle disorders diagnostic criteria: the American Academy of Orofacial Pain versus the research diagnostic criteria/temporomandibular disorders (RDC/TMD)

Summary In this study, relevant cases were retrospectively reviewed to identify patients who were diagnosed as suffering from myofascial pain only according to the research diagnostic criteria/temporomandibular disorders (RDC/TMD) criteria, in order to examine whether or not they could fulfil the American Academy of Orofacial Pain (AAOP) diagnostic criteria for TMD‐related masticatory muscle disorders. One hundred and twenty‐seven patients, diagnosed according to the RDC/TMD criteria as having myofascial pain with or without limited jaw opening only, were allocated to two groups according to their answers to the RDC/TMD ‘jaw disability checklist’. The two groups were compared for Axis I and II data taken from the RDC/TMD questionnaire. Thirty‐eight of the patients (29·9%) did not associate their symptoms with jaw functions (e.g. chewing and yawning). This group was characterised by increased range of motion (ROM) and older average age. The AAOP diagnostic criteria for TMD require pain on function in all subtypes of TMD‐related muscle disorders. An association between pain and jaw function is common and research is needed to determine whether this should be categorised differently to muscle pain unrelated to jaw function. There may well be different pathophysiological mechanisms and consequently different management strategies for these two pain conditions.     

Research diagnostic criteria for temporomandibular disorders (RDC/TMD) axis I diagnoses in an Italian patient population

The aim of this work was twofold: to evaluate the prevalence of different Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) diagnosis in an Italian population of subjects seeking TMD treatment in a tertiary clinic; and to compare data with those from similar studies in the literature. Participants in this study were 433 consecutive patients seeking TMD treatment at the Section of Prosthetic Dentistry, Department of Neuroscience, University of Pisa, Italy; mean age of patients was 38.8 years, with a female:male ratio of 2.6:1 (276 females, 73.2%; 101 males, 26.8%). RDC/TMD guidelines for examination were adopted to assign axis I diagnosis. The prevalence of RDC/TMD diagnoses was 38.2% (144/377) for group I disorders (muscle disorders), 52.3% (197/377) for group II disorders (disc displacements), and 52.6% (198/377) for group III disorders (arthralgia, osteoarthritis, osteoarthrosis). The present investigation provided findings that, compared and integrated with literature data, can be useful to create a world-wide database, in accordance with the nature of the RDC/TMD classification system.     

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颞下颌关节紊乱病的咬合病因至今存在很大争议。本文介绍了我们关于该病的咬合病因研究成果,包括临床病例咬合分析、动物实验、生物力学分析、下颌运动轨迹描记以及咬合治疗措施等五个方面的内容,提出并初步论证了渐进性咬合紊乱可作为独立的致病因素导致颞下颌关节退行性改变的论点,并对今后的研究提出展望。     

Prevalence of symptoms associated with temporomandibular disorders in a Turkish population

Despite numerous studies having been published, the epidemiology of temporomandibular disorders remains uncertain and controversial. The aim of this study was to estimate the prevalence and distribution of symptoms commonly associated with such disorders among a sample of adults in Istanbul, Turkey. A total of 1253 individuals aged 18 years were identified by using a random-digit dialing technique. They were asked standard questions about joint and jaw muscle pain, jaw opening, and joint sounds. Additional questions on tooth grinding and clenching, sleep patterns, and treatment-seeking behaviour were posed. Jaw pain was reported by 31% of the population. Women were more likely, than men, to respond positively to the questions concerning jaw pain. No gender- and age-related differences in prevalence of difficulty opening, clicking, tooth grinding/clenching and being poorly rested were found.     

Diagnostic accuracy of three screening questions (3Q/TMD) in relation to the DC/TMD in a specialized orofacial pain clinic

Objective: To determine the diagnostic accuracy of three screening questions (3Q/TMD) in relation to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), in a specialized clinic.

Material and methods: Consecutive patients,?>18 years, referred with a possible TMD complaint to the Orofacial Pain and Dysfunction clinic, Academic Centre for Dentistry Amsterdam, the Netherlands, were included in the study. All patients (n?=?449; mean age 44 years; 72% females), answered the 3Q/TMD and the DC/TMD questionnaire before a DC/TMD examination. The 3Q/TMD constitutes of two questions on weekly pain from the jaw, face and temple region (Q1), and on function (Q2), and one function-related question on weekly catching and/or locking of the jaw (Q3). Q1 and Q2 were evaluated in relation to a DC/TMD pain diagnosis and Q3 in relation to a subgroup of DC/TMD intra-articular diagnosis, referred to as the reference standard.

Results: In total, 44% of patients received a pain-related DC/TMD diagnosis and 33% an intra-articular reference DC/TMD diagnosis. Sensitivity for the two pain screening questions was high (0.83–0.94), whereas specificity was low (0.41–0.55). For the function-related question, sensitivity was low (0.48), whereas specificity was high (0.96).

Conclusions: In a specialized pain clinic, the two pain questions (Q1, Q2) are positive in most patients with pain-related TMD. Therefore, in case of a positive response, further diagnostic procedures for TMD pain are warranted. For the functional screening question (Q3), a positive response is indicative for an intra-articular DC/TMD diagnosis, while in case of a negative outcome, an intra-articular TMD might still be present.     

Diagnostic criteria for temporomandibular disorders (DC/TMD): interexaminer reliability of the Finnish version of Axis I clinical diagnoses

Recently, updated diagnostic criteria for temporomandibular disorders (DC/TMD) were published to assess TMD in a standardised way in clinical and research settings. The DC/TMD protocol has been translated into Finnish using specific cultural equivalency procedures. To assess the interexaminer reliability using the Finnish translations of the DC/TMD‐FIN Axis I clinical diagnostic assessment instruments. Reliability assessment data were collected during a 1‐day DC/TMD Examiner Training Course at the University of Turku, Finland, in collaboration with the International DC/TMD Training and Calibration Center in Malmö University. Clinical TMD examinations according to the Finnish pre‐final version of the DC/TMD Axis I assessment protocol were performed by four experienced TMD specialists on altogether 16 models. Kappa coefficient, overall percentage agreement (%A) as well as positive (PA) and negative (NA) agreements were used to define the reliability. Myofascial pain with referral, headache attributed to TMD and disc displacement (DD) without reduction without limited opening showed excellent kappa values (range 0·87–1·00). Fair‐to‐good reliability was observed for diagnoses of myalgia (k = 0·67), arthralgia (k = 0·71) and DD with reduction (k = 0·64). The PA was high for all pain‐related diagnoses and DD without reduction without limited opening (medians ≥83%), and acceptable for DD with reduction (median 67%). The NA was high (medians ≥87%) for all DC/TMD diagnoses, except for myalgia which showed acceptable NA (median 75%). The %A was high for all assessed diagnoses (medians >85%). The findings of this study showed DC/TMD‐FIN Axis I to demonstrate sufficiently high reliability for pain‐related TMD diagnoses.     

Prevalence of myofascial temporomandibular disorder in US community women

This study estimates the prevalence of the myofascial subtype of temporomandibular disorders (M-TMD) defined by Research Diagnostic Criteria (RDC), and relates that prevalence to the surveyed report of facial pain. From among 20 000 women selected at random in the NY metropolitan area who completed a telephone survey of facial pain, 2000 were invited for an RDC/TMD examination; 782 examinations were completed. Prevalence was estimated in analyses that were weighted to correct sampling biases. Differences among demographic strata were evaluated with logistic regression. The prevalence of M-TMD was estimated to be 10.5% (95% CL = 8.5-13.0%). Prevalence was significantly higher among younger women, among women of lower socio-economic status, among Black women, and among non-Hispanic women. The report of facial pain in the telephone survey (10.1%) had high specificity for M-TMD diagnosis (94.7%), but low sensitivity (42.7%). M-TMD is a fairly common disorder among American women. Among those reporting facial pain during the last month, half met RDC palpation criteria for M-TMD; thus, a formal physical examination is imperative to establish this diagnosis. Prevalence varies with age, socio-economic status, race and Hispanic ethnicity. A substantial number of RDC-diagnosed cases of M-TMD did not report facial pain in the survey; the reason for this requires further study.     

Validity of three screening questions (3Q/TMD) in relation to the DC/TMD

Temporomandibular disorders (TMD) are common but seem to be largely undetected within general dental care. To improve dentists’ awareness of these symptoms, three screening questions (3Q/TMD) have been introduced. Our aim was to validate 3Q/TMD in relation to the diagnostic criteria for TMD (DC/TMD), while taking into account the severity level of the symptoms. The study population consisted of 7831 individuals 20–69 years old, who had their routine dental check‐up at the Public Dental Health Service in Västerbotten, Sweden. All patients answered a health declaration, including the 3Q/TMD regarding frequent temporomandibular pain, pain on movement and catching/locking of the jaw. All 3Q‐positives (at least one affirmative) were invited for examination in randomised order. For each 3Q‐positive, a matched 3Q‐negative was invited. In total, 152 3Q‐positives and 148 3Q‐negatives participated. At examination, participants answered 3Q/TMD a second time, before they were examined and diagnosed according to DC/TMD. To determine symptom's severity, the Graded Chronic Pain Scale and Jaw Functional Limitation Scale‐20 (JFLS‐20) were used. In total, 74% of 3Q‐positives and 16% of 3Q‐negatives met the criteria for DC/TMD pain or dysfunction (disc displacements with reduction and degenerative joint disorder were excluded). Fifty‐five per cent of 3Q‐positives had a TMD diagnosis and CPI score ≥3 or a JFLS‐20 score ≥5, compared to 4% of 3Q‐negatives. The results show that the 3Q/TMD is an applicable, cost‐effective and valid tool for screening a general adult population to recognise patients in need of further TMD examination and management.     

Expanding the taxonomy of the diagnostic criteria for temporomandibular disorders

There is a need to expand the current temporomandibular disorders' (TMDs) classification to include less common but clinically important disorders. The immediate aim was to develop a consensus‐based classification system and associated diagnostic criteria that have clinical and research utility for less common TMDs. The long‐term aim was to establish a foundation, vis‐à‐vis this classification system, that will stimulate data collection, validity testing and further criteria refinement. A working group [members of the International RDC/TMD Consortium Network of the International Association for Dental Research (IADR), members of the Orofacial Pain Special Interest Group (SIG) of the International Association for the Study of Pain (IASP), and members from other professional societies] reviewed disorders for inclusion based on clinical significance, the availability of plausible diagnostic criteria and the ability to operationalise and study the criteria. The disorders were derived from the literature when possible and based on expert opinion as necessary. The expanded TMDs taxonomy was presented for feedback at international meetings. Of 56 disorders considered, 37 were included in the expanded taxonomy and were placed into the following four categories: temporomandibular joint disorders, masticatory muscle disorders, headache disorders and disorders affecting associated structures. Those excluded were extremely uncommon, lacking operationalised diagnostic criteria, not clearly related to TMDs, or not sufficiently distinct from disorders already included within the taxonomy. The expanded TMDs taxonomy offers an integrated approach to clinical diagnosis and provides a framework for further research to operationalise and test the proposed taxonomy and diagnostic criteria.     

Prevalence study of signs and symptoms of temporomandibular disorders in university students

The aim of this study was to evaluate the prevalence of signs and symptoms of temporomandibular disorders (TMD) in university students from 19 to 25 years old, male and female, through the distribution of frequency of the data obtained from a questionnaire and physical examination. The results showed that 68% of the subjects exhibited some degree of TMD, and the women were the most affected. Signs and symptoms such as articular sounds, pain to palpation of the masticatory, cervical and scapular girdle musculature, subjective sensation of emotional stress, and postural and occlusal changes were more evident in the group with TMD, although they were also present in subjects classified as TMD-free. Limitations in the mandibular movements were not found. The association of the obtained data allowed identifying a high prevalence of signs and symptoms of TMD in the Brazilian university population.     

Signs and symptoms of temporomandibular disorders in Ecuadorian Indians

The purpose of this study was to determine the prevalence of signs and symptoms of temporomandibular disorders (TMD) in indigenous South American Indians. A total of 140 consecutive indigenous Indians (69 Quechua and 71 Colorado) attending a mobile dental health caravan in the Santo Domingo region of Ecuador were examined objectively and subjectively for signs and symptoms of TMD using a method similar to that used in previous studies. There was a prevalence of up to 41% of at least one symptom. The Quechua Indians reported a significantly higher prevalence of difficulty in opening of the mouth and pain in front of the ears than the Colorado Indians. There was a prevalence of up to 63% of at least one sign. The objective findings in the Colorado Indians were similar to those found to be present in a Scandinavian population and an Arab population in previous studies using similar methods. Signs and symptoms of TMD are common in Latin American Indians. Differences occur between different populations in the same geographical area.     

The prevalence and treatment needs of symptoms and signs of temporomandibular disorders among young adult males

A temporomandibular disorder (TMD) screening history and screening examination was performed on 523 young adult males. The screening forms were similar to those TMD forms developed and formulated under the auspices of the American College of Prosthodontists. In turn, the substance of the latter forms was initially derived from the recommendations of the President's TMD Conference of the American Dental Association, with 62 eminent researchers, educators and clinicians as participants. Each subject was given a TMD self-administered screening history form to complete, formatted in a check - the block format. It included all items considered to be classic TMD symptoms. The screening examination was performed extraorally and included (i) range of jaw movement, (ii) digital palpation of selected masticatory muscles and palpation over the pre-auricular temporomandibula joint (TMJ) area and (iii) digital palpation for TMJ sounds during jaw movement. The subjects were categorized into the following four categories: 0 = no symptoms/signs, 1 = insignificant moderate symptoms and/or signs, 2 = significant moderate symptoms and/or signs, and 3 = severe symptoms and/or signs. The overall results showed that 75% of the subjects had TMD symptoms and/or signs. There were 6.9% in category 1, 51.4% in category 2, and 16.7% in category 3. It was recommended that subjects in category 2 and 3 should have a comprehensive TMD evaluation, in order to further identify the recommended need for TMD Therapy.     

The prevalence of signs and symptoms of temporomandibular disorders in very old subjects

Previous studies on the prevalence of signs of temporomandibular disorders (TMD) in elderly people have used non-standardized and invalidated examination protocols. The prevalence of the different signs of TMD in this group is therefore still unclear. The aim of this study was to evaluate the prevalence of signs of TMD in subjects of advanced aged, using a standardized and validated examination protocol. Additionally, young subjects were examined as a control group. Fifty-eight old peoples' home inhabitants and 44 young subjects were examined using a standardized and validated examination protocol. Differences between the groups were assessed using Mann-Whitney U-test or t-test. Geriatric subjects more often exhibited objective symptoms of TMD (38% exhibited joint sounds on opening), but rarely suffered from pain (pain at rest: 0%, joint pain: 0%, muscle pain: 12%). In contrast, young subjects rarely exhibited objective symptoms (joint sounds: 7%), but suffered more frequently from pain (facial: 7%, joint pain: 16%, muscle pain: 25%). The mandibular range of motion was higher in young subjects. Differences between the groups with respect to joint sounds, muscular palpation pain and mandibular range of motion were significant. Although older subjects more frequently exhibited objective signs (joint sounds) of TMD, they rarely suffered from pain. In contrast, younger subjects rarely exhibited objective TMD signs but more frequently suffered from subjective signs (muscular pain on palpation) and facial pain.