Frequency of temporomandibular disorder signs and symptoms among call center employees

Objective: The current study aimed to investigate the frequency of signs and symptoms of temporomandibular disorders (TMD) among call center employees.

Methods: Workers from four call centers (CC) were invited to participate in this study. The examination was based on the Research Diagnostic Criteria for Temporomandibular Disorder (RDC/TMD). The tenderness of the masticator muscles was assessed on both sides by bilateral palpation. The mobility of the mandible was measured with a plastic millimeter ruler on opening, lateral excursions, and protrusion.

Results: In total, 124 call center employees with a mean age of 28.61 ± 4.71 (between 22 and 47 years of age) were enrolled in this study. There was no statistically significant relation between the numbers of calls answered in a day and teeth clenching, teeth grinding, earache, tinnitus, or pain on yawning/chewing. Only protrusive movement pain and joint noise were significantly higher among employees who answered more than 140 calls/day (p < 0.01). An evaluation of the TMD signs and symptoms in relation to job stress level revealed that job stress level significantly affected the incidence of headaches among call center employees (p < 0.01).

Conclusion: The present study demonstrated no statistically significant relation between TMD signs and symptoms and call center employees except protrusive movement pain and joint noise. This relation was seen only in the employees who answered more than 140 calls per day. Headache, teeth clenching, and TMJ noise were the signs and symptoms encountered most often in this study. Multicentered studies in different geographic locations should be conducted to eliminate the limitation of this study.     

Reliability of mandibular movement assessments depending on TMD

Objective: This study determines the effect of temporomandibular disorders (TMD) on the reliability of mandibular movement assessments.

Methods: The vertical and horizontal jaw movements, as well as overjet and overbite, were measured twice in 56 consecutively recruited adult subjects with TMD according to the RDC/TMD and 29 controls without TMD diagnosis by experienced dentists utilizing a millimeter ruler. The reliability was determined by intraclass correlation coefficient (ICC).

Results: Neither statistically nor clinically relevant differences in the repeatability between both subgroups could be detected (all p ≥ 0.077). The mouth opening and overjet proved an excellent reliability (ICC 0.85–0.92). Overbite and laterotrusion showed good to excellent reliable results (ICC 0.74–0.82). The second measurement of the vertical jaw movement resulted in systematically higher values (p < 0.003).

Discussion: The assessment of the mandibular movement with a millimeter ruler is a reliable procedure irrespective of TMD. To decrease the variances in the mouth opening measurements, the patient should be asked beforehand to practice this movement.     

Computerized analysis of the distribution of occlusal contacts in individuals with Parkinson's disease and temporomandibular disorder

The aims of the present study were to determine the prevalence of temporomandibular disorder (TMD) in a sample of patients with Parkinson's disease (PD) and to analyze the distribution of occlusal contacts.

Method: The sample was composed of patients with PD aged 50–75 years. Temporomandibular disorder was evaluated using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The distribution of occlusal contacts was determined using the portable T-Scan III^® occlusal analysis system during maximum voluntary clenching. Fisher's exact test was used to test the association between TMD and occlusal contact symmetry.

Results: Forty-two individuals with PD were analyzed. The prevalence of TMD was 23.8%. No statistically significant association was found between TMD and occlusal contact symmetry. Moreover, no significant difference in the distribution of occlusal contacts was found between the groups with and without TMD.

Discussion: The present data suggest no association between TMD and occlusal contact asymmetry in individuals with PD.

Conclusion: The results of this study identified a prevalence of 23.8% of TMD signs in subjects with PD and a high frequency of occlusal asymmetry in this sample.     

Cervical posture analysis in dental students and its correlation with temporomandibular disorder

Objective: To evaluate the relationship between temporomandibular disorders (TMD) and craniocervical posture in the sagittal plane measured from lateral radiographs of the head.

Methods: The sample was comprised of 80 randomly selected students of dentistry at the Federal University of Rio Grande do Norte. Research Diagnostic Criteria for TMD (RDC/TMD) was used to evaluate the signs and symptoms of TMD. Lateral radiographs of each individual were used to measure the position of the hyoid bone, the craniocervical angle, and the occiput–atlas distance. A chi-square test was used to evaluate the relationships between craniocervical posture measures and TMD.

Results: No relationship was found between TMD and the craniocervical posture measured by the positioning of the hyoid bone, head rotation, and the extension/flexion of the head (p > 0.05).

Conclusion: It can be concluded, therefore, that no relationship exists between cervical posture in the sagittal plane and TMD.     

Relationship between anxiety and temporomandibular disorders in dental students

Objective: To evaluate the prevalence of temporomandibular disorder (TMD) in dental students and its correlation with anxiety.

Methods: After probability sampling, 105 students were selected. The diagnosis of TMD was carried out using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) – Axis I; the anxiety level was obtained by the State-Trait Anxiety Inventory (STAI). Data from TMD and anxiety were calculated through frequency and Chi-square test to assess the association between TMD and anxiety, considering a significance level of 5%.

Results: TMD was present in 36.2% of the students; disc displacement (42.1%), and arthralgia (42.1%) were the most prevalent subtypes. The majority of students presented both traits (57.1%) and state (65.7%) anxiety in mild levels, followed by moderate levels. No statistical association between TMD and anxiety was found (p > 0.05).

Conclusion: Joint TMD was the most prevalent subtype of TMD in dental students and was not associated with anxiety levels.     

A survey on the potential relationships between TMD,possible sleep bruxism,unilateral chewing,and occlusal factors in Turkish university students

Objective: To evaluate whether there is a relationship between possible sleep bruxism (PSB), temporomandibular disorders (TMD), unilateral chewing (UC), and occlusal factors in university students recruited from Cumhuriyet University in Turkey.

Methods: For this cross-sectional survey, 519 (223 males, mean age 21.57 ± 2.3 years, 296 females, mean age 21.02 ± 2 years) university students who admitted to the Department of Oral and Maxillofacial Radiology of the Faculty of Dentistry, Cumhuriyet University for dental care between 2012 and 2014 were selected randomly. Students were asked to complete a questionnaire form including questions about TMD, PSB and UC. Presence and direction of malocclusion were recorded during clinical examination. Chi-square test was used for statistical analysis.

Results: It was found that 96.6% of the students with PSB had TMD (p < 0.05). The prevalence of severe TMD was high among students with PSB. There was a significant association between UC, PSB and TMD (p < 0.05). No statistically significant association was found between occlusal factors and PSB and TMD (p > 0.05).

Conclusion: Sleep bruxism, which heavily depends on self-report, is significantly associated with TMD. Unilateral chewing seems to be a common factor for development of SB and TMD. However, further studies are needed to corroborate this finding. Additionally, this study supports the hypothesis that occlusal factors are not related to self-reported sleep bruxism.     

WHO-5 well-being index as screening instrument for psychological comorbidity in patients with temporomandibular disorder

Objectives: The aim of the study was to compare the WHO-Five Well-Being Index (WHO-5) with the Oral Health Impact Profile-49 (OHIP-49) questionnaire as screening tools to detect psychological comorbidity in TMDs.

Methods: A TMD group (92 patients, 42.8 ± 17.1 yrs) and a control group (90 patients of the Department of Prosthetic Dentistry, 38.9 ± 10.1 yrs) completed the WHO-5 and the OHIP-49 questionnaire.

Results: The patients with TMD reported significantly greater OHIP-49 sum scores than controls (47.5 ± 34.7 vs. 7.7 ± 12.1; p < 0.001). The mean raw score of the WHO-5 was significantly less, with 45.6 ± 20.6 points for patients with TMD than the 73.2 ± 15.6 points found for controls (p < 0.001). The OHIP sum score and the WHO-5 raw score were significantly associated (r = 0.705, p < 0.001). Both instruments exhibited excellent internal consistency (Cronbach’s α = 0.967 and 0.883, respectively).

Conclusions: WHO-5 proved to be an effective and economic screening instrument to detect psychological comorbidity in TMDs. Implementing WHO-5 in standard care could contribute to more individualized interdisciplinary psychotherapy and/or functional therapy.     

Comparison of excursive occlusal force parameters in post-orthodontic and non-orthodontic subjects using T-Scan® III

Objective: Published studies indicate that orthodontically treated patients demonstrate increased posterior occlusal friction contributing to temporomandibular disorder (TMD) symptoms. This study investigated measured excursive movement occlusal contact parameters and their association with TMD symptoms between non- and post-orthodontic subjects.

Methods: Twenty-five post-orthodontic and 25 non-orthodontic subjects underwent T-Scan® computerized occlusal analysis to determine their disclusion time (DT), the excursive frictional contacts, and occlusal scheme. Each subject answered a TMD questionnaire to determine the presence or absence of TMD symptoms. Statistical analysis compared the within group and between group differences (p < 0.05).

Results: Statistically significant differences were observed in the disclusion time: DT = 2.69 s in the post-orthodontic and 1.36 s in the non-orthodontic group. In the non-orthodontic group, 72.7% working and 27.3% non-working side contacts were seen, while in the post-orthodontic group, (near equal) 54.7% working and 45.3% non-working side contacts were seen. Presence of canine guidance was seen in 60% of the non-orthodontic group and 24% in the post-orthodontic group. Seventy-two percent of the post orthodontics subjects presented with one or more TMD symptoms.

Conclusion: Significantly longer disclusion time, higher posterior frictional contacts, and more TMD symptoms were observed in the post-orthodontic group, suggesting that orthodontic treatment increases posterior tooth friction. Computerized occlusal analysis is an objective diagnostic tool determining the quality of excursive movements following orthodontic treatment.     

The role of occlusal factors on the occurrence of temporomandibular disorders

Aims:

The aim of this study was to investigate the relationship between occlusal factors and temporomandibular disorders (TMD).

Methodology:

One hundred patients were selected among those who sought medical or dental care in public practice in Recife, Brazil. The presence of malocclusions and absence of five or more posterior teeth were evaluated by the clinical exam. TMD diagnosis was given using Research Diagnostic Criteria (RDC/TMD). Statistics were carried out using Fisher and Mann–Whitney methods with 5% significance level, as well as multiple logistic regression analysis.

Results:

The sample was mainly comprised of women (83%), individuals over 30 years old (57%) and singles (53%). The percentage of TMD and malocclusion in total sample was 42% and 50%, respectively, while in TMD subjects, malocclusion was present in 38·1%. There was no association between TMD and the occlusal factors studied.

Conclusion:

It can be concluded that malocclusion and loss of five or more posterior teeth does not contribute to TMD.     

Temporomandibular disorder treatment in a patient wearing removable prostheses: A case report

Aim: The purpose of this intervention was to treat the patient, a 51-year-old woman, who was wearing a maxillary denture and a mandibular bilateral distal-extension partial denture (both unfit) and was suffering from temporomandibular disorder (TMD).

Methodology: The treatment suggested was to construct a superior repositioning splint (SRS), and after remission of the symptomatology, fabricate new dentures.

Results: The occlusal splint was effective and the symptomatology ceased after about five months of treatment. The new dental prostheses were made and followed up for 10 years with no return of the pain.

Conclusions: SRS and subsequent construction of new dentures after remission of the symptomatology was an effective treatment for TMD in the case described.     

Do TMJ symptoms improve and last across time after treatment with red (660 nm) and infrared (790 nm) low level laser treatment (LLLT)? A survival analysis

Objective: Temporomandibular disorder (TMD) is a variety of clinical problems that originate from the area of the temporomandibular joint (TMJ), masticatory muscles, and surrounding tissues. There are different treatment options; however, there is no evidence that low level laser treatment (LLLT) will last about six months. The aim of this study was to determine the survival rate of treatment with red (660 nm) and infrared (790 nm) laser in cases of TMDs.

Methods: In 19 subjects, one side of the face (half face) was randomly selected to receive intervention, in a total of 116 sensitive points. Pain was measured at baseline and time intervals of 24 h, 30, 90, and 180 days after treatment. Laser irradiation with 4 j/cm² in the TMJs and 8 j/cm² in the muscles was used in three sessions. Kaplan–Meier survival analysis and logistic regression were performed.

Results: Both treatments showed statistically significant results (p < 0.001). The survival rate for red and infrared laser was 0.24 and 0.30, respectively, at 180 days. Grinding teeth and headache were associated with recurrent pain.

Discussion: Both lasers were effective in the treatment of TMD symptoms and had a low survival rate at 180 days.     

Orthognathic treatment of dentofacial disharmonies: its impact on temporomandibular disorders,quality of life,and psychosocial wellness

Aim: The objective of this literature review was to assess the effect of orthognathic surgical treatment on temporomandibular disorders (TMD), quality of life (QoL), and psychosocial wellness.

Methods: Journal articles and systematic reviews published in English between 1982 and 2015 were searched using PubMed, MEDLINE, and Cochrane database using the search terms “orthognathic,” “temporomandibular disorders,” “quality of life,” and “psychosocial.” The articles were then reviewed and discussed.

Results: Both objective and subjective parameters play a role in orthognathic treatment outcome satisfaction and QoL. Psychological factors and TMD exerted a stronger influence on patients’ QoL more than objective treatment outcome measures.

Conclusion: A paradigm shift in clinical mindset from solely objective measures to a more holistic, patient-centric approach of addressing patients’ expectations and improving QoL is warranted when treating patients with dentofacial disharmonies.     

Disc displacement without reduction: a retrospective study of a clinical diagnostic sign

Objective: The purpose of this retrospective study is to evaluate a clinical diagnostic sign for disc displacement without reduction (DDWR), the absence of additional condylar translation during opening compared with protrusion.

Method: Thirty-eight electronic axiographic and magnetic resonance imaging (MRI) examinations of the TMJ were analyzed in order to compare the opening/protrusion ratio of condylar translation between non-painful DDWR and non-DDWR.

Result: According to the Mann-Whitney U test, the opening/protrusion ratio in non-painful DDWR differs significantly from non-DDWR (p < 0.0001).

Discussion: Among non-painful DDWR, there is no additional condylar translation during opening in comparison with protrusion, and this is probably also the case for DDWR without limited opening, which is a subtype that has not been validated by the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Comparative condylar palpation can analyze this sign, and therefore, further comparative investigations between MRI and clinical examination are needed to validate the corresponding clinical test.     

Therapeutic effectiveness of a combined counseling plus stabilization appliance treatment for myofascial pain of the jaw muscles: A pilot study

Objective: This study aims to assess changes over time in pain intensity (VAS) and in pressure pain threshold (PPT) of the anterior temporalis and masseter muscles with a treatment protocol combining counseling and stabilization appliance as well as its effects on psychosocial factors.

Methods: Twenty individuals with myofascial pain of jaw muscles lasting from at least six months were selected for an uncontrolled before-after study. Counseling was performed by giving information on myofascial pain and advice on self-management. Stabilization appliances were delivered one week after the first counseling session. A number of outcome variables (i.e. visual analogue scale [VAS], pain pressure threshold [PPT] and Research Diagnostic Criteria for Temporomandibular Disorders axis II [RDC/TMD]) were assessed at different evaluation points during a six-month follow-up. ANOVA for repeated measures and Pearson’s correlation test were used to evaluate changes in the outcome variables over time.

Results: Compared to baseline data, a significant positive change was found at the 1st week, 1st, 3^rd, and 6th month evaluations for VAS values (P < 0.0001) and at the 1st week, 3^rd, and 6th month evaluations for PPT values (P < 0.05). RDC/TMD axis II values were significantly different (P < 0.05) from baseline to all evaluations points.

Conclusion: The association of counseling and stabilization appliance is effective in the management of chronic myofascial pain of jaw muscles. Future controlled studies are required to get deeper into the assessment of the relative effectiveness of counseling and stabilization appliances.     

Comparison of masticatory muscle myofascial pain in patients with and without a chief complaint of headache

Objectives:

Headaches are a common complaint in temporomandibular disorder (TMD) patients. However, few studies have compared the symptom characteristics between TMD patients with and without a complaint of headache. The aim of this study was to compare subjective symptoms and treatment outcomes between myofascial TMD patients who had a chief complaint of headache and those who did not.

Methods:

One hundred sixty one patients underwent comprehensive examinations and scored their pre- and post-treatment symptoms on a form (4 items assessing pain intensity and 1 assessing sleeping difficulty). On the basis of the primary diagnosis, patients were divided into two groups: myofascial pain with and without a chief complaint of headache (MPH and MP).

Results:

Before treatment, patients in the MPH group scored significantly higher with respect to pain intensity and level of sleeping difficulty than did patients in the MP group (jaw/face pain, P = 0·015; headache, P < 0·001; neck pain, P < 0·001, and difficulty in sleeping, P = 0·005; Mann-Whitney U-test). Patients in the two groups demonstrated similar treatment outcomes, except for neck pain.

Conclusion:

Significant differences in symptom characteristics and outcomes were observed between primarily myofascial TMD patients with and without a chief complaint of headache.     

Influence of the mandibular position on the active cervical range of motion of healthy subjects analyzed using an accelerometer

Objective: The aim of this study is to analyze the influence of the mandibular positions (habitual rest position, habitual maximum intercuspation, habitual maximum intercuspation with clenching, and mandibular position with cotton rolls) on the active cervical range of motion (ROM) (flexion-extension, lateroflexions, rotations) using an accelerometer in a sample of healthy subjects.

Methods: A total of 21 (14 M, 7 F) healthy volunteers aged from 18 to 27 years (mean age 23.88 ± 2.34 years; mean weight 67.86 ± 11.38 kg; mean height 172.52 ± 9.00 cm) underwent a cervical range of movement examination using a 9-axis accelerometer. A one-way ANOVA analysis was performed in order to statistically evaluate the effective influence of the mandibular position on the recorded parameters.

Results: The analysis showed no statistically significant differences (all p-values > 0.1) with variations smaller than three degrees among the different mandibular positions.

Discussion: The mandibular position seems to have no influence on the active cervical ROM in healthy subjects. Further studies are needed to assess the usefulness of the accelerometer in the cervical analysis of temporomandibular disorder subjects.     

Motor behavior of masticatory muscles in individuals with unilateral trans-incisive foramen cleft lip and palate*

Objective: To investigate whether children with complete unilateral cleft lip and palate (CLP) have altered control of masticatory muscles.

Methods: The muscular activity of 66 children with CLP (n = 33) and without CLP (n = 33), aged 6–12 years was assessed during different tasks (rest, isometry, mastication) using electromyography.

Results: The activation for the analyzed muscles was higher in children with CLP at rest (R) and inactive period (IP) (p < 0.05). The muscles of children with CLP remained active for longer than those without CLP (p < 0.05), and the length of the masticatory cycle was higher in children with CLP (p < 0.05).

Conclusion: Children with CLP have longer muscle activation and increased cycle time during the chewing cycle, which might be a consequence of malocclusion, resulting in difficulty chewing.