Orofacial pain, jaw function, and temporomandibular disorders in women with a history of juvenile chronic arthritis or persistent juvenile chronic arthritis

OBJECTIVES: We sought to study the long-term outcome of juvenile chronic arthritis (JCA) in the temporomandibular joint (TMJ). STUDY DESIGN: Temporomandibular disorders, including TMJ involvement, were assessed in 42 women with pauciarticular or polyarticular JCA--on average 25.8 years from disease onset--and compared with those found in matched control subjects. Disease-related parameters associated with temporomandibular disorders were identified. RESULTS: The TMJ was involved in 66.7% of the patients, most severely in extended pauciarticular JCA. Temporomandibular disorders were more frequent in the patients than in the control subjects, especially in those with persistent disease. The TMJ involvement was positively correlated with disease duration and negatively correlated with jaw opening and occlusal support. Duration of active JCA and history of functional pain were identified as predictors of present TMJ involvement. CONCLUSION: In a long-term follow-up, TMJ involvement proved frequent in the studied patients and was associated with long disease duration and previous pain on jaw opening. The findings suggest that patients with JCA should undergo orofacial evaluation on a regular basis.     

Symptoms and signs of temporomandibular disorders and oral parafunctions among Saudi children

This study aimed to record the prevalence of signs and symptoms of temporomandibular disorders (TMD) and oral parafunctions among Saudi children. A questionnaire and a clinical examination of signs and symptoms of TMD were performed on 1940 stratified randomly selected schoolchildren. The sample was divided into three groups, 505 with primary, 737 with mixed and 734 with permanent dentition. The prevalence of TMD signs was found to be 20.7% and the most common sign of TMD was joint sounds (11.8%). The second most common sign was restricted mouth opening (5.3%). Muscle and temporomandibular joint (TMJ) pain as well as deviation upon jaw opening appeared infrequently. TMJ sounds were significantly increasing with age (P < 0.05). TMD symptoms as reported by the parents were evident in 24.2% of the returned questionnaires (1113). The most common symptoms were headache (13.6%) and pain on chewing (11.1%). The incidence of headache was found to be significantly increasing from primary to permanent dentition (P < 0.01). No sex difference in the prevalence of any symptom was reported. Nail biting was the most common oral parafunction (27.7%) while bruxism was the least common (8.4%). All parafunctions except bruxism were significantly related to age. Cheek biting and thumb sucking were reported more in females than in males. The importance of a screening examination for symptoms and signs of TMD should not be overlooked in the clinical assessment of the pediatric patient.     

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.     

Prevalence of signs and symptoms of temporomandibular disorders in an urban and rural German population: results of a population-based Study of Health in Pomerania.

OBJECTIVE: Based on a randomized, population study (Study of Health in Pomerania [SHIP]), the objective of the present study was to determine incidence of signs and symptoms of temporomandibular disorders (TMD) in adults 20 years or older and to compare the data with TMD prevalence of other exclusively random sample studies that fulfilled criteria similar to those of this study (age > or = 20 years, age range > or = 40 years, sample size > or = 500 subjects, equal gender distribution). METHOD AND MATERIALS: Men and women (n = 7,008) 20 to 79 years of age from mid- and small-sized towns in a rural region in northeast Germany were randomly sampled from resident registry office files. The response rate was 68.8%. Adults between the ages of 20 and 81 years (n = 4,289) were clinically and anamnestically examined. RESULTS: Half of the subjects (49.9%) had one or more clinical signs of TMD, but only 2.7% were subjectively aware of temporomandibular joint (TMJ) pain symptoms. Women showed higher frequency for all signs and symptoms of TMD than men. However, these differences were not significant for all signs and symptoms in all age groups. The influence of age on TMD signs and symptoms was less pronounced. The prevalence for the following variables found in the present study compared to those of other comparable, random sample studies was: clinical examination; (TMJ) tenderness to palpation (5% versus 2% to 6%); masticatory muscle tenderness (15% versus 19% to 21%); joint sounds (25% versus 15% to 25%); limited maximum mouth opening < 40 mm (9% versus 5% to 8%); pain upon movement of the mandible (1% versus 1% to 3%); irregular jaw movements (deviation, deflection) (28% versus 28%); interview: subjective joint sounds (9% versus 11% to 13%); and subjective TMJ pain (3% versus 4% to 7%). CONCLUSION: The TMD incidence in the current study agreed quite well with the other studies based on random samples with similar subjects and design. The large range of prevalence for signs and symptoms of TMD documented in reviews and meta-analyses could therefore not be confirmed.     

Craniomandibular disorders with special reference to orthodontic treatment: an evaluation from childhood to adulthood.

The purpose of the present study was to reexamine a group of children and adolescents with respect to signs and symptoms of craniomandibular disorders (CMD) and to evaluate whether any differences could be found between persons who had received orthodontic treatment earlier and those who had not. A total of 402 children in three age groups (7, 11, and 15 years) had participated in a cross-sectional study on the relationship between malocclusion and signs and symptoms of CMD. Ten years later they were asked to answer a questionnaire. In the youngest age groups (now 17 and 21 years old) 190 (76%) subjects answered the questionnaire. In the oldest age group (now 25 years old) completed questionnaires were received from 103 (84%) subjects, and 83 (62%) of those subjects appeared for a clinical examination. Subjects with a history of orthodontic treatment had a lower prevalence of subjective symptoms of CMD (TMJ sounds included) than those without any experience of orthodontics. Although the differences were small, it was more evident for the oldest age group. The clinical examination has shown that persons who had undergone orthodontic treatment had a significantly lower clinical dysfunction index than those who had not.     

Non-surgical treatment of sports-related temporomandibular joint disorders in basketball players

Abstract –  In this study, 18 basketball players (11 female, seven male; age range 14–32 years) with temporomandibular joint (TMJ) problems who had a history of sport injuries related to head or jaw region were evaluated and the results of the treatment were presented. A standardized functional examination of the masticatory system was performed including measurement of maximal jaw movements, recording of joint sounds, pain on movement of the jaw as well as tenderness to palpation of the both TMJ or masticatory muscles. Patients were also evaluated periodontally. Diagnosis was made according the criteria, described by Okeson, and appropriate treatment was applied using different kind of splints. At the end of treatment only one patient continued with right TMJ reduction with slight pain. Except for that patient, none of the patients had pain after treatment. The maximum opening of the jaws and the maximal jaw movements were statistically increased after treatment. Patients with TMJ problems also showed periodontal problems, most likely due to inadequate oral hygiene because of the limited jaw movements and pain. Periodontal parameters including probing depth (PD), Plaque index (PI), and Sulcus Bleeding Index (SBI) improved after treatment. Sports-related TMJ injuries may result in complex problems such as pain, TMJ sounds, limitation in maximal jaw movements and maximum opening of the mouth, difficulty in chewing. With the appropriate diagnosis this could be treated non-surgically in 6–8 months. This study also showed that the TMJ disorders may cause periodontal problems, which may affect all teeth and also the general health of the athlete.     

青少年类风湿性关节炎伴颞颌关节损伤患者的口颌生理功能研究

目的研究颞颌关节损伤对患有青少年类风湿性关节炎(JCA)患儿的口颌功能的影响。方法研究组选择8例患有青少年类风湿性关节炎并且伴有颢下颌关节损伤的儿童，均为女性，分为两个阶段，第1阶段平均12岁，第2阶段平均14岁。对照组选择8例患有青少年类风湿性关节炎不伴有颞颌关节损伤的儿童，相同的性别、年龄。通过EMG，颌运动状况及颞颌关节功能检查，分析口颌功能所受的影响。用t检验检查两组之间的差异，卡方检验检查对照两组两个阶段颌功能的不同。结果研究组病人的口颌生理功能明显的低于对照组。结论患有青少年类风湿性关节炎伴有颞颌关节损伤儿童的口颌功能明显低下是影响颌面部发育的重要因素。     

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.     

Relationship between pathogenic factors and the prevalence of temporomandibular joint dysfunctions in children

PurposeThe purpose of the research is to study the relationship between the certain pathogenic factors and the prevalence of functional disorders of TMJ in children and adolescents with mental development delay (MDD), in practically healthy persons of similar age living in children’s homes and in a family.MethodsThe study was carried out using the method of observation, systematization, analysis and synthesis of the results obtained in the course of laboratory experiments.ResultsSymptoms of TMD include decreased mandibular range of motion, muscle and joint pain, joint crepitus, and functional limitation or deviation of jaw opening. The mentioned symptoms were revealed in 40.1% of children and adolescents with MDD, less frequently in 32.62% of children and adolescents living in children’s homes, and in 35.32% of practically healthy persons living in families and their rate increased with ageing. More often it was revealed in girls.ConclusionsAccording to the results of the study, the authors found that children and adolescents with MDD, symptoms of TMJ dysfunctions occur more often and begin at an earlier age than in practically healthy ones.     

Association of caries and treatment experiences with subjective symptoms of temporomandibular disorders in female adolescents

A 2-year cohort study of subjective symptoms of temporomandibular disorders (TMD) was performed. A total of 229 female adolescents, all 15 years of age, completed questionnaires and underwent dental examinations at baseline, 1- and 2-year follow-up surveys. The questionnaire included questions on typical TMD symptoms; i.e. temporomandibular joint (TMJ) noise, tiredness in jaws, pain on jaw movements, and difficulty in mouth opening. The relative risk was computed to determine the relationships of the baseline number of filled teeth (FT) and decayed, missing and filled teeth (DMFT) increment with the incidence of TMD. The percentage of subjects with one or more subjective symptoms at 17 years of age was 30.6%, significantly higher than the percentages at 15 (17.0%) and 16 (19.7%) years of age (P < 0.01). The symptom-emerging rate of TMJ noise during the 2-year period was 13.5%, which was the highest among the rates of possible subjective symptoms. Individuals with a 2-year increment in DMFT of > or =2 had a 2.14-times increased risk of experiencing mild symptoms, and individuals with baseline FT of > or =3 had 2.41-times increased risk of experiencing mild or severe subjective symptoms. The results of this study showed that TMD symptoms occurred in a relatively high percentage of female adolescents during the 2-year period and suggested that DMFT is one factor affecting the incidence of TMD.     

Jaw function status in an elderly community sample

Abstract The purpose of this study was to assess jaw function status and disability in an elderly population. The sample consisted of 429 Medicare recipients dwelling in the community (mean age = 74.4±5 yr; 58% female and 42% male) who were enrolled in an HCFA-sponsored prevention demonstration project. An evaluation of TMJ and jaw muscle status was conducted at the completion of a general dental examination. This included assessment of joint sounds (clicking or crepitus), joint and jaw muscle tenderness to palpation, and measurement of maximum opening. Pain or disability during jaw use and history of TMD problems were assessed by self-report. The prevalence of TMJ clicking was 16%, crepitus 19%, TMJ tenderness 8%, jaw muscle tenderness 13%, and opening < 40 mm 22% Pain on jaw use was reported by 6.5%, and 12% reported a history of TMD problems. There was no significant relationship between TMD signs and symptoms and dental status. The lack of consistent relationship between TMD signs and symptoms and health status measures suggests that TMD is a localized disease process and not an extension of a general condition such as arthritis or depression, nor does it have major impact on activities of daily living. Examiner referral for treatment was low (1%) indicating that TMD was not a significant treatment concern in this sample of the elderly.     

Signs and symptoms of mandibular dysfunction in shortened dental arches

In this study subjects with shortened dental arches (SDA, n = 60), characterized by the absence of molar support, are compared with subjects with a complete dentition (n = 72) with respect to signs and symptoms of mandibular dysfunction. The subjective examination consisted of questions related to pain, noises within the joints and mobility of the lower jaw. The objective examination consisted of the registration of clicking of the temporomandibular joint (TMJ) by bilateral palpation and measuring the maximal mouth opening. In spite of the finding that significantly more subjects of the SDA group under 40 years of age reported pain in or around the TMJ, it is concluded that in the population studied no convincing evidence was found that a SDA provokes signs and symptoms of mandibular dysfunction.     

Is there a trend of decreasing prevalence of TMD-related symptoms with ageing among the elderly?

Objective. Older adults have not been studied as much as younger ones regarding prevalence of TMD-related symptoms. The aim was to assess the prevalence of TMD-related symptoms in two population samples, 70 and 80 years old. Materials and methods. Identical questionnaires were in 2012 sent to all subjects born in 1932 and 1942 living in two Swedish counties. The response rate was 70.1%, resulting in samples of 5697 70- and 2922 80-year-old subjects. The questionnaire comprised 53 questions. Answers to questions on problems regarding TMD-related symptoms and awareness of bruxism were analysed. Results. Twelve per cent of the women and 7% of the men in the 70-year-old group reported some, rather great or severe problems regarding TMD pain. In the 80-year-olds the prevalence was 8% and 7%, respectively. Subjects who had problems with TMJ sounds reported difficulty to open the jaw wide 6-times and TMJ pain 10–13-times more frequently than subjects without such problems. Changes of taste and awareness of bruxism were the only variables significantly associated with TMD symptoms in both age groups. Number of teeth was not significantly associated with any of the TMD-related symptoms. Conclusions. Most of the elderly subjects had no severe problems with TMD-related symptoms, but 12% of the 70-year-old women reported some, rather great or severe problems. The marked gender difference at age 70 had disappeared in the 80-year-old group. The prevalence was lower among the 80- compared with the 70-year-old subjects of both sexes. The results support the comorbidity between TMD-related symptoms and general health problems.     

Prevalence of self-reported symptoms related to temporomandibular disorders in an Italian population

The aim of this study was to estimate the prevalence of temporomandibular disorders (TMD) symptoms in an Italian population sample, focusing on gender and age differences. We selected 2005 individuals by telephone survey and asked them about TMD symptoms like difficulty in jaw movement, jaw pain and joint sounds. Also, tooth-clenching and/or tooth-grinding habits were investigated. Of the study population, 8·1% reported limitations in jaw movements, 5·1% reported jaw pain and 33·3% reported joint sounds. Furthermore, 37·3% reported tooth-clenching/tooth-grinding. Confidence intervals of proportions were calculated. Significant gender differences were found for jaw limitation and pain (chi-square test; P < 0·05). Symptoms reduced with increasing age. The prevalence of TMD symptoms in the Italian population was consistent with data reported from similar studies. Gender and age differences were found for jaw pain and limitation in jaw movements.     

Temporomandibular joint status, occlusal attrition, cervical erosion and facial pain among substance abusers.

STATEMENT OF THE PROBLEM: Drug addiction or substance abuse is an endemic habit globally. At present there is no data available regarding the temporomandibular joint status, occlusal and cervical tooth wear and facial pain among substance abusers from the Saudi Arabia. PURPOSE: The aim of the study was to investigate the temporomandibular joint status, occlusal and cervical tooth wear and facial pain among the drug abusers from narcotics control prison, Riyadh, Saudi Arabia. MATERIALS AND METHODS: One hundred subjects were included in the study as a convenience sample. Male comprised of 56 and female 44. An interview and clinical examination were performed. RESULTS: The age ranged from 20-65 years with mean (31.4 +/- 8.9). Smoking, drinking and chewing habits were most common modes of drug used. 98.0% were smokers, 61.0% alcohol drinkers and 41.0% were cannabis user. The duration of drug abuse was more than 5 years among most of the candidates. TMJ status revealed that clicking was reported by 40.0%, tenderness by 9% and reduced jaw mobility 0.0%. Occlusal enamel wear (attrition) was reported by 16.1% of male and 18.1% of female. However, the occlusal dentine exposure was among female only (18.1%). Cervical erosion abrasion was common among 16.1% male and 54.5% female. Facial pain was experienced by 6.0% and facial numbness by only 1.0% of the subjects. CONCLUSION: Smoking, alcohol and cannabis were common among the studied population. Only 9.0% of the subjects had tenderness in TMJ, occlusal enamel wear was among 17.0% of subjects. Only female subjects had dentinal exposure. Facial pain was common among up to only 6.0% of the studied population. From public health point of view, smoking cessation programs and oral health education should be introduced to adolescents to prevent unhealthy illicit substance abusing habits in future. Further studies are needed to assess the oral mucosal changes, dietary pattern, oral hygiene behavior, quality of life and level of satisfaction among the substance abusers from Saudi Arabia.     

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

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

A 20-year longitudinal study of subjective symptoms of temporomandibular disorders from childhood to adulthood

The aims were to study the development over 20 years of reported temporomandibular disorders (TMD) symptoms in an epidemiologic sample and to analyze possible correlations between these symptoms and some other variables. Four hundred and two randomly selected 7-, 11- and 15-year-old subjects were originally examined by means of a questionnaire with regard to symptoms of TMD. The investigation was repeated after 4 5, 10, and 20 years, using the same method. After 20 years, when the original group had reached the age of 27 to 35 years, 378 individuals (94%) could be traced, and they were sent a questionnaire. Three hundred and twenty subjects (80% of the original sample, 85% of the traced subjects) completed and returned the questionnaire. There was a substantial fluctuation of reported symptoms over the 20-year period. Progression to severe pain and dysfunction of the masticatory system was rare. On the other hand, recovery from frequent symptoms to no symptoms was also rare. At the last examination 13% reported one or more frequent TMD symptom. The prevalence of bruxism increased with time, but other oral parafunctions decreased. Women reported TMD symptoms and headache more often than men. Correlations between the studied variables were mainly weak. The highest correlations found (rs = 0.4-0.5) were those between reported tooth clenching and tooth grinding and jaw fatigue. It can be concluded that in this epidemiologic sample, followed over 20 years from childhood to adulthood, a substantial fluctuation of TMD symptoms was found. Severe symptoms were rare, but 1 of 8 subjects reported frequent TMD symptoms at the last exam.     

Changes in signs and symptoms following temporomandibular joint disc repositioning surgery.

Fifty-one subjects with documented intra-articular pathology refractory to non-surgical therapy underwent temporomandibular joint (TMJ) disc repositioning surgery. Following surgery, subjects were evaluated for 6 months to 6 years by clinical examinations and questionnaires at designated times, and by postsurgical joint imaging. Significant decreases were noted in pain (headache, TMJ pain, ear pain, and neck/shoulder pain), the incidence of joint sounds and locking, and the presence of dietary restrictions. However, 35% of the subjects continued to have residual TMJ pain, and a similar percentage continued to need periodic nonsteroidal anti-inflammatory drugs for analgesia. Some degree of dietary restriction remained in approximately 50% of the subjects, and joint sounds persisted in a similar percentage following surgery. Mean mouth opening was improved by 8 mm, although lateral movements were increased by less than 0.5 mm. Surgery did not decrease the occurrence of jaw deviation, and disc position was unchanged in 86% of the joints imaged at an average of 2 years following surgery. Although TMJ disc repositioning surgery significantly improved pain and dysfunction in TMJ surgery patients, the improvement in disc position was not maintained in most subjects following surgery.     

Relationship between overbite/overjet and clicking or crepitus of the temporomandibular joint

AIMS: Since occlusal variables such as overbite and overjet have been thought to be associated with temporomandibular disorders (TMD), and joint sounds are some of the most prevalent signs of TMD, the aim of this study was to determine whether overbite and overjet are risk factors for temporomandibular joint (TMJ) sounds. METHODS: A population-based cross-sectional study of 3,033 subjects (age range, 10 to 75 years; 53% female) was conducted in Germany. Overbite/overjet, reproducible reciprocal clicking (RRC) during open-close jaw movements that did not occur in the protrusive jaw position, and joint crepitus were assessed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). RESULTS: When age and gender were controlled for, high or low values of overbite and overjet were not associated with a greater risk of RRC and crepitus as compared to a reference category of a normal overbite and overjet of 2 to 3 mm (multiple logistic regression; odds ratios 0.7 to 1.3; P > .05 for all). CONCLUSION: This study showed that higher or lower overbite or overjet jaw relationships, even extreme values, are not risk factors for TMJ sounds as assessed by clinical examination.     

Centers of rotation during jaw movements

Anatomists consider the articulation of movable joints to be complex, involving movable instantaneous centers of rotation (ICR). However, prosthodontists often treat the temporomandibular joint (TMJ) as a model of a simple hinge. The aim of this study was to examine the case for a movable ICR during habitual opening and closing jaw movements. Young, dentate subjects were examined with a kinesiograph. Jaw movements were performed and recorded. The center of rotation of each movement pattern was identified, and its location related to the position of the TMJ. The results showed that opening and closing jaw movements were predominantly non-coincident, with a movable ICR located at a variable distance and direction from the TMJ. There was no evidence to suggest that the TMJ functioned as a simple hinge during jaw movements.