Effect of turban use on temporomandibular joint problems

The aim of this study was to evaluate the effects of daily turban wear on temporomandibular joint (TMJ) problems. This cross-sectional study was carried out on 249 female patients. Of these, 119 patients were using turban daily, while 130 patients did not use. Patients were asked questions to ascertain the signs of TMJ problems. Thereafter, the TMJ region was examined clinically. Cross-tabulations and Chi-square statistics were computed in accordance with Bonferroni correction for multiple comparisons. To investigate the association between continuous turban wear and temporomandibular disorder symptoms, logistic regression analysis was performed. Limited mouth opening, deviation, pain on TMJ palpation and mouth opening were not affected with turban usage. However, turban users more frequently demonstrated pain during palpation of the masticatory muscles than non-users (P = 0.001). Duration of the turban usage did not affect clinical examination findings except pain on masticatory muscles during palpation (P = 0.001). Complaint of pain on masticatory muscles are more frequently seen among the turban users.     

Comparison of algometry and palpation in the recognition of temporomandibular disorder pain complaints

AIMS: To determine the construct validity of algometry and to compare it with that of palpation, and to compare tenderness of masticatory muscle sites and the temporomandibular joint (TMJ) on palpation and on algometry. Methods: Two hundred fifty subjects, 148 with temporomandibular disorder (TMD) pain complaints, underwent a standardized blinded physical examination that included pain-intensity measures on palpation and pressure pain threshold measures on algometry of masseter muscle sites, temporalis muscle sites, and the TMJ. Results: Logistic regression analysis indicated that the recognition of TMD pain complaints based on pressure algometry was comparable to that of palpation (R2 = 0.22 and R2 = 0.21, respectively). The masseter muscles were most tender to palpation and algometry, followed by the TMJs and the temporalis muscles. Conclusion: Construct validity of algometry in the recognition of TMD pain complaints is comparable to that of palpation, and differences in tenderness on palpation and on algometry are found between masticatory muscle sites and the TMJ.     

Signs and symptoms of temporomandibular disorders and the incidence of tinnitus

In a cross-sectional analysis of data from the Study of Health in Pomerania (SHIP 0), temporomandibular disorders (TMD) were the strongest predictors for tinnitus beside headache. The aim of this study was to investigate whether signs and symptoms of TMD can be identified as risk factors for developing tinnitus. The SHIP 1 is a population-based 5-year longitudinal study intended to systematically describe the prevalence of and risk factors for diseases common in the population of Pomerania in northern Germany. A total of 3300 subjects (76% response) were reevaluated after 5 years for tinnitus and signs and symptoms of TMD using the same questionnaires and examination tools as baseline. To estimate the relative risk (RR) appropriately, a modified Poisson regression was used. After exclusion of prevalent cases with diagnosed tinnitus, 3134 subjects were analysed. Among the 191 exposed subjects with palpation pain in the temporomandibular joint (TMJ), 24 subjects (12·6%) received diagnosed tinnitus after 5 years, whereas among the 2643 unexposed subjects 142 subjects (5·8%) received tinnitus yielding a risk difference of 7·7% (95% confidence interval [CI]: 3·0%-12·5%) and a risk ratio of 2·60 (95% CI: 1·7-3·9). The risk ratio was 2·4 (95% CI: 1·6-3·7) after adjustment for gender, age, school education and frequent headache. Pain on palpation of the TMJ, however, did not worsen the prognosis for tinnitus in prevalent tinnitus cases (RR = 0·8, P = 0·288). Signs of TMD are a risk factor for the development of tinnitus.     

Oral parafunctions and association with symptoms of temporomandibular disorders in Japanese university students

We examined whether oral parafunctions are associated with symptoms of temporomandibular disorders (TMD) in 3557 Japanese university students, aged between 18 and 26 years. Participants completed a questionnaire regarding various oral parafunctions and subjective symptoms related to TMD, and underwent a dental examination. The prevalence of temporomandibular joint (TMJ) noise, TMJ pain and impaired mouth opening was 41.7, 16.0 and 16.3%, respectively. The most prevalent parafunction was sleeping on one side (60.2%), followed by supporting the jaw by leaning on the palm of the hand (44.8%). Mean age, decayed, missing and filled teeth, and number of teeth were not significantly different between TMD positive and negative groups according to unpaired t-test. The chi-squared test revealed that the ratio of females was significantly higher among students with TMD than without TMD. Multiple logistic regression models adjusted for age and gender demonstrated that chewing on one side caused an increased risk of TMJ noise [odds ratio (OR) = 1.52, P < 0.001], TMJ pain (OR = 1.54, P < 0.001), and impaired mouth opening (OR = 2.00, P < 0.001). Tooth clenching also increased the risk of TMJ noise (OR = 1.86, P < 0.001), TMJ pain (OR = 1.79, P = 0.001) and impaired mouth opening (OR = 1.88, P < 0.001). Further prospective cohort studies, including other potential risk factors, are required to clarify these relationships.     

Comorbidity of internal derangement of the temporomandibular joint and silent dysfunction of the cervical spine

The aim of this evaluation was to examine correlations between internal derangement of the temporomandibular joint (TMJ) and cervical spine disorder (CSD). A prospective controlled clinical study was carried out. Thirty patients with signs and symptoms of internal derangement but without any subjective neck problems and 30 age- and gender-matched control subjects without signs and symptoms of internal derangement were examined. The investigation of the temporomandibular system was carried out using a 'Craniomandibular Index'. Afterwards an examiner-blinded manual medical investigation of the craniocervical system was performed. This included muscle palpation of the cervical spine and shoulder girdle as well as passive movement tests of the cervical spine, to detect restrictions in the range of movement as well as segmental intervertebral dysfunction. The internal derangement of the TMJ was significantly associated with 'silent' CSD (t-test, P < 0.05). Patients with raised muscle tenderness of the temporomandibular system exhibited significantly more often pain on pressure of the neck muscles than patients without muscle tenderness of the temporomandibular system (t-test, P < 0.05). As a result of the present study, for patients with internal derangement of the TMJ an additional examination of the craniocervical system should be recommended.     

Association between sociodemographic, behavioral, and medical conditions and signs of temporomandibular disorders across gender: results of the study of health in Pomerania (SHIP-0)

PURPOSE: To examine whether there is a gender-dependent risk profile for signs of temporomandibular disorders (TMD) in a population-based sample. MATERIALS AND METHODS: Sociodemographic, behavioral, and medical factors were checked for associations with TMD in a cross-sectional study of 3,567 subjects aged 25 to 74 years in Germany. Data were collected from clinical examinations, interviews, and questionnaires. Logistic regression analyses were used to estimate factors associated with signs of TMD across gender. TMD signs included tenderness or pain on palpation of 3 or more masticatory muscles and tenderness or pain on palpation in 1 or both temporomandibular joints (TMJs). RESULTS: In women, muscle tenderness or pain was found to be significantly associated with general arthrosis/arthritis and lower back pain. In men, muscle tenderness or pain was significantly associated with school education > 11 years, various categories of loss of occlusal support, lip/tongue/cheek biting, and general arthrosis/arthritis. In women, TMJ tenderness or pain was associated with widowed status, bruxism, general arthrosis/arthritis, lower back pain, and sex-hormone replacement. In men, TMJ tenderness or pain was associated with multiple losses of posterior supporting zones, gout, and lower back pain. In women, there were inverse associations between loss of occlusal support in 3 posterior zones and muscle and TMJ tendernes. CONCLUSION: Except for some general health conditions and bruxism, the hypothesis of a gender-dependent risk profile for signs of TMD is partly supported. The results of this study indicate that TMD is a complex disorder associated with mixed etiologic factors between genders.     

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.     

Otologic symptoms of temporomandibular disorder and effect of orofacial myofunctional therapy

The aim of this study was to investigate the frequency of otologic symptoms and their relationship to orofacial signs and symptoms of temporomandibular disorder (TMD), and the effect of orofacial myofunctional therapy. The study was conducted on eight asymptomatic subjects (Group C) and 20 subjects with articular TMD, randomly distributed over two groups: one treated using orofacial myofunctional therapy (OMT Group) and a control group with TMD (Group CTMD). Patient selection was based upon the Research Diagnostic Criteria for TMD (RDC/TMD). All subjects submitted to a clinical examination with self-reporting of symptom severity, and to orofacial myofunctional and electromyographic evaluation at diagnosis and again, at the end of the study. Correlations were calculated using the Pearson test and inter- and intragroup comparisons were made (p < 0.05). In the diagnosis phase, subjects with TMD reported earache (65%), tinnitus (60%), ear fullness (90%), and 25% of the asymptomatic subjects reported tinnitus. The otologic symptoms were correlated with tenderness to palpation of the temporomandibular muscles and joints and with orofacial symptoms. Only the OMT group showed a reduction of otologic and orofacial symptoms, of tenderness to palpation and of the asymmetric index between muscles. OMT may help with muscle coordination and a remission of TMD symptoms.     

Cervical spine alignment and hyoid bone positioning with temporomandibular disorders

The relationships between temporomandibular joint (TMJ) disorders and cervical structure dysfunctions have already been demonstrated. The aim of the present study was to investigate functional and structural alterations of the head and neck of 17 individuals with TMJ disorders (TMD group), compared with a control group of 17 asymptomatic subjects in a cross-sectional design. The outcome variables included pain on palpation of the sternocleidomastoideus, superior trapezius and subocciptal muscles, as well as radiographic measures of alignment of the cervical spine and positioning of the hyoid bone. Cervical alignment, determined by measures of the cervical curvature angle, was investigated by the Cobb method. Independent Student t-tests were used to investigate differences between groups for all outcome variables (alpha < 0.05). The results demonstrated that individuals with TMJ disorders, when compared with asymptomatic subjects, presented higher levels of perception of pain in all cervical muscles (P < 0.0001). No significant differences were found between groups for the cervical alignment measures. In the TMD group, the position of the hyoid bone in relation to the cervical spine did not appear to be different from the control group.     

Clinical signs of craniomandibular disorders in patients with psoriatic arthritis

Abstract – 110 patients with psoriatic arthritis (PA) and 110 individually matched control subjects were examined for clinical signs of craniomandibular (CM) disorders. Patients with PA differed significantly from control patients as regards the range of mandibular movements, tenderness to palpation of the masticatory muscles and TMJs, arid the frequency of TMJ sounds and painful mandibular movements. In the PA-group clinical signs of CM disorders correlated with the duration, extent and severity of PA.     

Prevalence of tinnitus according to temporomandibular joint disorders and dental pain: The Korean National Population‐based Study

Some studies have reported that temporomandibular joint disorder (TMD) is related to tinnitus. However, there is no study of the relationship and prevalence of dental pain and tinnitus. We evaluated the associations between the prevalence of tinnitus and TMD and dental pain by analysing the Korean national health survey. We analysed totally 11 745 participants. The presence of tinnitus, TMD symptoms and dental pain was surveyed by self‐assessment questionnaires from all the participants. Multivariable regression analysis was applied to acquire odds ratios (OR) and 95% confidence intervals (CI). The prevalence of tinnitus was higher in the subjects with dental pain (21.1%), TMD (22.5%) and both symptoms (31.2%) than subjects without those symptoms (19.6%). After adjusting for all covariates, subjects with TMD had tinnitus 1.6 times more than subjects without TMD. In the subanalysis, age group more than 65 years, women, and obese subjects had tinnitus more than men, age group <65, and non‐obese subjects, respectively. TMD alone and both dental pain and TMD were associated with tinnitus (OR = 1.389 and 95% CI 1.054‐1.832 and 2.206 and 1.637‐2.974, respectively). Subjects with TMD had more tinnitus than subjects without TMD. Moreover, subjects with dental pain in addition to TMD had increased prevalence of tinnitus than TMD alone.     

The role of dental loss and denture status on clinical signs of temporomandibular disorders

Studies concerning the role of denture status on in temporomandibular disorders (TMD) are scarce. The aim of this study was to evaluate the association of tooth loss and denture status with clinical findings of TMD. The data were obtained from 6316 subjects aged ≥30 years from the Finnish Health 2000 Survey. The associations between clinically assessed TMD findings and number of teeth, wearing of removable dentures, need for denture repair and age of the dentures were analysed by means of chi‐square test and logistic regression. Among women after adjusting for age, having fewer teeth or wearing complete dentures associated with restricted maximum interincisal distance and pain on palpation of the temporomandibular joints (TMJ) and masticatory muscles. After adding education level and depression in the model, the associations between TMJ pain and explanatory variables were weakened. Among men, having a higher number of teeth associated with occurence of TMJ crepitation. Subjective need for repair of dentures and having a denture aged ≥5 years associated with pain on palpation in masticatory muscles among women. Among men, both the objective and subjective need for denture repair and having at least one denture aged ≥5 years or been repaired during the past 5 years associated negatively with the presence of TMJ crepitation. It can be concluded that edentulousness, wearing of complete dentures and poor condition of dentures associate with pain‐related TMD findings among women. Psychosocial factors have a modifying effect on these associations.     

颞下颌关节紊乱病患者与健康人群颌面部机械疼痛敏感性的比较

目的 利用定量触诊仪对受试者双侧咬肌区及关节区进行触诊,比较和分析疼痛性颞下颌关节紊乱病（TMD）患者与健康人群口颌面部机械疼痛敏感性的差异。 方法 选取患有单侧咬肌区或关节区疼痛的TMD患者各40例作为试验患者组,40例健康人作为对照组。利用定量触诊仪在受试者双侧咬肌区或关节区进行触诊,通过口述疼痛模拟评分法（NRS）获得受试者不同检测位点的机械疼痛感觉,绘制机械疼痛敏感性地图,并计算熵值和重心坐标。利用两因素方差分析法分析性别和检查侧（患者组：健患侧;对照组：左右侧）对各组熵值和重心坐标的影响;利用三因素方差分析法分析性别、检查侧和检测位点对各组NRS评分的影响。 结果 TMD患者咬肌区及关节区健患侧熵值均有统计学差异（咬肌：P＜0.001,关节：P=0.006）,且患侧NRS指数显著高于健侧（咬肌：P＜0.001,关节：P＜0.001）;但对照组咬肌区及关节区双侧熵值及NRS指数无明显统计学差异（P≥0.071）。 结论 机械疼痛敏感性地图技术在提供标准化触诊的基础上可以作为区分疼痛性TMD患者及正常人的有效辅助工具,并为该技术应用于TMD患者治疗效果评估的可行性提供了依据。     

Temporomandibular disorders in the active phase of orthodontic treatment

summary Subjective symptoms and clinical signs of temporomandibular disorders (TMD) as well as presence of headache, bruxism and occlusal interferences were examined in 50 patients (mean age 12.9 years) before, during and immediately after orthodontic treatment. The prevalences of signs and symptoms of TMD were high before the treatment in comparison with subjects in an epidemiological study. Except for TMJ sounds, signs and symptoms of TMD as well as presence of headache decreased during the treatment. The major factor for decrease of the dysfunction index during the treatment compared with before the treatment, was tenderness to palpation of the masticatory muscles. Although there was a high prevalence of occlusal interferences during treatment, they seemed to have little importance for development of TMD. One explanation may be that the orthodontically moved teeth are sensitive to contact resulting in a decrease of oral parafunctions. Such a decrease was also reported by the patients.     

Attributes of Tinnitus that May Predict Temporomandibular Joint Dysfunction

A collection of 1002 patients with severe tinnitus, drawn from the Tinnitus Data Registry, were retrospectively surveyed to determine which traits or attributes of tinnitus could indicate the possibility of temporomandibular joint dysfunction (TMD) as the cause of tinnitus. The patients were divided into two groups: (1) a TMD group, consisting of 69 patients for whom there was no known cause of tinnitus except for one or more temporomandibular joint (TMJ) indicators, and (2) a comparison group with mixed etiologies (n = 860). Seventy-three patients were eliminated due to excessive complications relating to cause. The two groups were compared seeking those attributes of tinnitus that significantly separated them. No single benchmark standard was discovered that exclusively indicated tinnitus from TMJ origins. However, a total of 10 “TMJ Indicators” were discovered. The data for each of these indicators is presented and discussed. In addition, the attributes that did not significantly separate the two groups are listed. The study concludes with a recommendation for TMJ referral for those tinnitus patients with unknown etiology who demonstrate any three or more of the TMJ indicators.     

Temporomandibular disorders, otologic symptoms and depression levels in tinnitus patients

The aim of this study was to determine the prevalence of signs and symptoms of temporomandibular disorders (TMD) and otologic symptoms in patients with and without tinnitus. The influence of the level of depression was also addressed. The tinnitus group was comprised of 100 patients with tinnitus, and control group was comprised of 100 individuals without tinnitus. All subjects were evaluated using the research diagnostic criteria for temporomandibular disorders (RDC/TMD) to determine the presence of TMD and depression level. Chi-square, Spearman Correlation and Mann-Whitney tests were used in statistical analysis, with a 5% significance level. TMD signs and symptoms were detected in 85% of patients with tinnitus and in 55% of controls (P≤0·001). The severity of pain and higher depression levels were positively associated with tinnitus (P≤0·001). It was concluded that tinnitus is associated with TMD and with otalgia, dizziness/vertigo, stuffy sensations, hypoacusis sensation and hyperacusis, as well as with higher depression levels.     

Clinical, microscopical and biochemical investigation of synovial fluid from temporomandibular joints

Abstract – The aim of this study was to investigate the relationship between pain and tenderness to palpation of the temporomandibular joint (TMJ), radiographic changes of the joint and signs of inflammation in the synovial fluid. Saline was injected into and aspirated from the TMJ of 29 patients with painful and tender TM joints and from five individuals with healthy joints. In another two patients synovial fluid could be aspirated without saline. The aspirated fluid was analyzed for inflammatory cells and for plasma proteins. A clinical examination of the stomatognathic system and a radiographic examination of the TMJ were performed before the aspiration. Besides tenderness to palpation of the TMJ, pain on mandibular movement and tenderness to palpation of the masticatory muscles were common. Erosion of the cortical outline of the joint surfaces was the most common radiographic finding. Inflammatory cells were present in the fluid of three patients but in none of the healthy individuals. Plasma proteins of inflammatory type could be detected in the fluid from seven of the patients. The results show that radiographic, cellular or biochemical signs of inflammation can frequently be found in the TMJ of patients with longstanding pain and tenderness of this joint.     

Association of dietary habits with symptoms of temporomandibular disorders in Bangladeshi adolescents

The prevalences of signs and symptoms of temporomandibular disorder (TMD) in Bangladeshi adolescents and their associations with intake of various hard food items were investigated. A group of 1200 randomly selected high school students aged 12-17 years from three communities (rural, semi-urban and urban) completed a questionnaire on dietary habits and presence of TMD symptoms and were examined clinically. In bivariate analysis, no significant relationship was observed between TMD symptoms and eating of hard foods. However, in logistic regression analysis, clicking showed a significant correlation with consumption of hard vegetable and fruits more than three times per week (P < 0.05). A statistically significant correlation was also observed between consumption of all hard food items (at least one item in each of the four categories of hard food) more than 12 times per week and pain in the temporomandibular joint (TMJ) (P < 0.05). A positive association was found between pain in the TMJ and older age (15-17 years) (P < 0.001). The prevalence of pain in the TMJ was significantly higher in males (P < 0.01). Prevalences of clicking and pain in the TMJ were significantly higher in subjects living in a rural area than in subjects living in an urban area (P < 0.01 and P < 0.01, respectively). Subjects having one or more decayed, missing and filled teeth (DMFT) showed significantly higher prevalences of clicking (P < 0.01) and restricted mouth opening (P < 0.01). The results suggest that prevalence of TMD symptoms are related to prolonged consumption of hard food items.     

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??Objective    To investigate the relationship between the depth of curve of Spee??COS?? and temporomandibular joint disorders??TMD?? in elderly patients. Methods    Eighty-nine elderly patients with TMD visiting the Hospital of Stomatology of China Medical University from January 2013 to June 2013 were recruited in the study by random number table. Muscle pain and temporomandibular joint??TMJ??sounds were examined according to Research Diagnostic Criteria for TMD??and the depth of COS were measured on the dental casts. The mean depth of COS of patients without muscle pain and patients with pain at all levels were compared??and the unilateral depth of COS of patients with and without TMJ sounds were compared. Related data were analyzed statistically with one-way analysis of variance and t-test. Results           The depth of ipsilateral COS of patients with TMJ sounds was significantly smaller than those of patients without TMJ sounds??left??P < 0.001??right??P = 0.008????while the depth of contralateral COS of patients with TMJ sounds had no significant differences with those of patients without TMJ sounds??left??P = 0.481??right??P = 0.905??. In addition??there were no significant differences between the mean depth of COS of patients without muscle pain and patients with pain at all levels??P = 0.327??. Conclusion    TMJ sounds are closely associated with COS??and the depth of ipsilateral COS of patients with TMJ sounds is smaller??and the COS is flatter. There is no significant association between the mean depth of COS and muscle pain.