Association between posterior crossbite and/or deep bite and temporomandibular disorders among Palestinian adolescents: A sex comparison

ABSTRACT

Objective: To assess the prevalence of temporomandibular disorders (TMDs) and posterior crossbite and/or deep bite and any possible association between them.

Methods: One thousand-nineteen adolescents responded to a questionnaire regarding oral habits and TMD symptoms. Afterwards, they were diagnosed according to the Axis I of the DC/TMD and underwent a dental examination. The chi-square test was used for statistical analysis.

Results: A significant association was found between posterior crossbite and some TMD diagnosis, but no association was found between deep bite and TMD, nor between occlusal diagnosis and bruxism. TMDs were more prevalent in girls. There was a significant sex difference (more among females) in the prevalence of painful TMDs.

Conclusion: Posterior crossbite in the adolescent population analyzed may be related to TMDs, in contrary to deep-bite. The presence of posterior crossbite may have different impact on TMD findings between the sexes.     

Management of painful temporomandibular disorders: Methods and overview of The National Dental Practice-Based Research Network prospective cohort study

BackgroundPatients often seek consultation with dentists for temporomandibular disorders (TMDs). The objectives of this article were to describe the methods of a large prospective cohort study of painful TMD management, practitioners’ and patients’ characteristics, and practitioners’ initial treatment recommendations conducted by The National Dental Practice-Based Research Network (the “network”).MethodsParticipating dentists recruited into this study treated patients seeking treatment for painful TMDs. The authors developed self-report instruments based on well-accepted instruments. The authors collected demographics, biopsychosocial characteristics, TMD symptoms, diagnoses, treatments, treatment adherence, and painful TMDs and jaw function outcomes through 6 months.ResultsParticipating dentists were predominately White (76.8%) and male (62.2%), had a mean age of 52 years, and were general practitioners (73.5%) with 23.8% having completed an orofacial pain residency. Of the 1,901 patients with painful TMDs recruited, the predominant demographics were White (84.3%) and female (83.3%). Patients’ mean age was 44 years, 88.8% self-reported good to excellent health, and 85.9% had education beyond high school. Eighty-two percent had pain or stiffness of the jaw on awakening, and 40.3% had low-intensity pain. The most frequent diagnoses were myalgia (72.4%) and headache attributed to TMDs (51.0%). Self-care instruction (89.4%), intraoral appliances (75.4%), and medications (57.6%) were recommended frequently.ConclusionsThe characteristics of this TMD cohort include those typical of US patients with painful TMDs. Network practitioners typically managed TMDs using conservative treatments.Practical ImplicationsThis study provides credible data regarding painful TMDs and TMD management provided by network practitioners across the United States. Knowledge acquired of treatment recommendations and patient reports may support future research and improve dental school curricula.     

Pharmacotherapeutic agents used in temporomandibular disorders

Depending on the source and character, pharmacotherapy is one of the most commonly used methods to treat temporomandibular disorders in addition to the use of appliances, physiotherapy, behavioral therapy, and surgical interventions. To decide on the appropriate treatment approach for the treatment of temporomandibular disorders, pharmacotherapeutics should be understood in great detail. As for other pain treatments, pharmacotherapy can be used as a monotherapy or combined with other treatment options in temporomandibular disorders. The aim of the present review is to overview the primary analgesics and myorelaxants used in temporomandibular disorders.     

Occlusion,prosthodontic treatment,and temporomandibular disorders: a review

The purpose of this article is to review the literature on the relationship between occlusal discrepancies and temporomandibular disorders (TMD) and to summarize the guidelines of treating TMD by prosthetic rehabilitation. To date, the relationship between occlusal condition and TMD has not been confirmed, although there is a current trend toward making a weak correlation between occlusal interference and TMD. Furthermore, several types of occlusal discrepancies have been considered as variable features of the norm. But unstable occlusion in the intercuspal position may cause TMD. In cases of restored dentition, the problem is probably different and iatrogenic TMD are not rare. Namely, malformed occlusal surfaces, defects in anterior guidance, occlusal curvature, and vertical dimension may lead to some TMD trouble. According to these recent concepts the treatment modalities of TMD have been changed. Conservative treatments such as counseling, behavioral modification, physical therapy, pharmacotherapy, and interocclusal appliances should be the first choice, and treatments that lead to drastic changes of occlusion are not recommended.     

Is there a higher prevalence of tinnitus in patients with temporomandibular disorders? A systematic review and meta‐analysis

The aim of this study was to determine whether there exists a higher prevalence of tinnitus in patients with temporomandibular disorders (TMDs) than in patients without TMDs. A systematic review was conducted in PubMed/MEDLINE for articles published between January 1992 and April 2018 in accordance with the PRISMA statement. Studies were included in this review only if they assessed TMDs using the research diagnostic criteria (RDC)/TMD or DC/TMD. A total of five studies were included in the systematic review, and a random‐effects meta‐analysis of three of the studies was conducted. In all of the selected studies, the prevalence of tinnitus was higher in patients with TMDs (35.8% to 60.7%) than in patients without TMDs (9.7% to 26.0%). The odds ratio of suffering from tinnitus among patients with TMDs was 4.45 (95% CI 1.64‐12.11. P = 0.003). Thus, despite the limitations of the included studies, this review demonstrates that the prevalence of tinnitus in TMD patients is significantly higher than that in patients without TMD.     

咬合干扰与颞下颌关节紊乱病的相关性研究

目的:通过临床检查分析安氏Ⅱ类1分类颞下颌关节紊乱(temporomandibular disorders,TMD)患者的咬合特点,探讨咬合干扰与颞下颌关节紊乱的相关性。方法:选取安氏Ⅱ类1分类TMD患者60例为实验组,无TMD安氏Ⅱ类1分类患者60例为对照组。采用目前国际上通用的视觉模拟尺分级评分测量法(visual analog scale VAS)对口面部不舒适程度进行评价;按照Fricton指数所包括的内容计算颞下颌功能障碍指数(temporomandibular dysfunction index DI),[DI=(MM+JN+JP)/26(0~1)],该指数包括下颌运动(MM)、关节杂音(JN)及关节压诊(JP)等。结果:实验组有咬合干扰者45例,对照组有咬合干扰者42例,二组间差异无显著性(P>0.05);实验组中存在咬合干扰的患者与无咬合干扰患者相比较,DI指数以及疼痛相关视觉模拟分数(VAS)均偏高,二者间差异有统计学意义(P<0.01),其中女性患者DI指数高于男性。结论:咬合干扰(occlusal interferences,OI)与TMD虽无直接联系,但OI与TMD共存可加重TMD患者临床症状,OI的存在对口颌系统的健康可能构成威胁。     

Attitude of Chinese orthodontists towards the relationship between orthodontic treatment and temporomandibular disorders

OBJECTIVE: To determine the attitude of some Chinese orthodontists towards the relationship between orthodontic treatment and temporomandibular disorders (TMDs). SUBJECTS AND METHODS: 25 orthodontists, in six public hospitals (Xi'an, the capital of Shaanxi Province, China), were asked to complete a 10-item questionnaire concerning orthodontics/TMD. RESULTS: 84% of orthodontists often asked their patients about the signs and symptoms of TMD before orthodontic treatment and 92% reported examining the TMJ region. 76% of orthodontists thought orthodontic treatment may possibly lead to a greater incidence of TMD, while 84 per cent claimed that orthodontic treatment might prevent TMD. Methods of orthodontic treatment, patient's age, and occlusal interference were regarded as risk factors leading to increased incidence of TMD. CONCLUSIONS: Some Chinese orthodontists realise the importance of the relationship between orthodontic treatment and TMD. Most thought that unsuitable orthodontic treatment might increase the development of TMD and that orthodontic treatment could prevent TMD.     

Temporomandibular disorders in growing patients after treatment of class II and III malocclusion with orthopaedic appliances: a systematic review

Objective: To determine if the use of orthopaedic appliances in growing patients applied to correct Class II and III malocclusion is related to the development of temporomandibular disorders (TMD).

Material and methods: A systematic review was conducted between 1960 and July 2017, based on electronic databases: PubMed, Cochrane Library, Embase, Medline, Scopus, EBSCOhost, Scielo, Lilacs and Bireme. Controlled clinical trials (CCTs) and randomized controlled trials (RCTs) were identified. The articles were selected and analyzed by two authors independently. The quality of the evidence was determined according to the guidelines of the Cochrane Risk Bias Assessment Tool and the Cochrane Quality Study Guide.

Results: Seven articles were included, four CCTs and three RCTs. The studies were grouped according to malocclusion treatment in (a) class II appliances (n?=?4) and (b) class III appliances (n?=?3). The quality of evidence was low due to the high risk of bias, independent of the association reported. All studies concluded that the use of orthopaedic appliances would not contribute to the development of TMD.

Conclusions: The quality of evidence available is insufficient to establish definitive conclusions, since the studies were very heterogeneous and presented a high risk of bias. However, it is suggested that the use of orthopaedic appliances to correct class II and III malocclusion in growing patients would not be considered as a risk factor for the development of TMD. High-quality RCTs are required to draw any definitive conclusions.     

Effects of sagittal split ramus osteotomy on temporomandibular disorders in seventy‐two patients

Preoperative and postoperative temporomandibular disorders (TMDs) were observed in 72 patients before surgical‐orthodontic treatment and about 2 years after bilateral sagittal split osteotomy. Prevalence and degree of TMD were assessed using the modified clinical dysfunction index of Helkimo. A total of 49 women and 23 men (mean age 32 years) were included in the study. To find out which patients benefit most from the treatment, the sample was classified into subgroups—myogenous, arthrogenous, or both components of TMD. The prevalence of clicking and headache decreased significantly with the treatment, while the incidence of crepitation increased. In general, severity of the dysfunction was greatly reduced. Furthermore, multiple regression analysis showed that patients with excessive overjet and previous occlusal splint therapy benefit most from orthognathic treatment. In addition, patients with signs of mainly myogenous origin got more relief from their dysfunction than patients with mainly arthrogenous components of TMD. The results suggest that in patients with severe maxillomandibular discrepancy surgical‐orthodontic therapy is a good choice of treatment for reducing myogenous TMD pain and discomfort.     

Prevalence of temporomandibular disorders in patients seeking orthodontic treatment: A systematic review

The objective of this systematic review was (a) to establish the prevalence of temporomandibular disorders (TMDs) in patients seeking orthodontic treatment and (b) to determine the association between the presence of TMD and sex, age and malocclusion. A systematic literature search was performed according to PRISMA guidelines from 1969 to 2019 using the PubMed and LIVIVO databases. Eight study articles met the inclusion and exclusion criteria. An additional three contributions were identified through manual searching of the reference lists of retrieved articles. The methodological quality of the 11 articles was assessed with the Joanna Briggs Institute Critical Appraisal Checklist for prevalence studies. TMD prevalence ranged from 21.1% to 73.3%. The frequency of painful TMD signs/symptoms varied from 3.4% to 65.7%, while non-painful signs/symptoms ranged from 3.1% to 40.8%. The percentage of males and females presenting with TMD varied from 10.6% to 68.1% and 21.2 to 72.4%, respectively. In all studies, TMD prevalence was higher among females. The majority of articles reported more TMD signs/symptoms in individuals older than 18 years as compared to younger ones (≤18 years). While in four studies no association between TMD and malocclusion was found, another three investigations indicated that TMD may be related to certain occlusal traits. The TMD prevalence in patients seeking orthodontic treatment was high, with many individuals presenting painful TMD signs/symptoms. Female and older patients appear to have a greater occurrence of TMD. Although no strong association between TMD and malocclusion was established, several occlusal traits were implicated.     

咬合板对颞下颌关节紊乱病相关颌面部疼痛的影响

颞下颌关节紊乱病（temporomandibular disorders, TMD）是口颌面部慢性痛的主要来源,严重干扰日常活动。咬合板是颞下颌关节紊乱病的最常用的治疗方法之一,但其疗效尚未完全明了。学者们多年来致力于对咬合板的作用机制、疗效的研究,但至今尚未得出统一的结果。该文将对咬合板的作用机制、咬合板的分类、TMD相关疼痛的种类与咬合板的选择、TMD的其他保守治疗与咬合板的关系四个方面对于咬合板治疗颞下颌关节紊乱病相关颌面部疼痛的疗效进行进行综述。     

Occlusal interferences: how can this concept influence the clinical practice?

This brief review discusses the role of occlusal interferences on the development and progression of temporomandibular dysfunction (TMD) and postural disorders. The eligible literature is described and critically presented to demonstrate that occlusal interferences are an important factor in the risk of TMD. Several studies have demonstrated through their findings that the use of occlusal adjustments, whether or not associated with restorative procedures, might avoid the development of articular problems in vulnerable patients. The occlusal interferences caused by restorative procedures or orthodontic treatment can cause TMDs in susceptible patients, and occlusal adjustments can be an alternative in the treatment of these TMDs.     

Temporomandibular disorders in children and adolescents: a survey of dentists' attitudes, routine and experience

The aim of this study was to survey the experience and routine of, attitudes toward, and need for specialist resources in the treatment of temporomandibular disorders (TMD) in children and adolescents among public dentists. A questionnaire study was conducted in three counties in Sweden: Osterg?tland, V?stmanland, and G?teborg. The questionnaire was sent to 286 Public Dental Service dentists. It contained questions on demographic issues, quality assurance, clinical experience and expertise, attitudes, and the need for specialist resources. Eighty-seven per cent (250) of the dentists answered the questionnaire. The dentists in the three areas reported good routine and safety in occlusal splint treatments (74%-81%), occlusal equilibration (28%-55%), jaw exercise (25%-29%), and medication treatments (3%-55%). Good experience concerning diagnostics and therapy decision was reported by 25%-50% of the dentists. A significantly greater portion of the dentists in V?stmanland had attended courses in TMD compared with the two other counties (p = 0.001). Registrations of quality variables such as verbal and/or written case histories with questions on facial pain and tension-type headache (1%-39%) and measurements of jaw openings were performed less frequently in the three counties (0%-5%). Fifty-five per cent of the dentists had a positive attitude toward the care of children and adolescents with TMD. A large need for specialist resources with the possibility to send referrals or to consult was reported by 98%-100% of the respondents, to participate in continuing education by 97%-98%, and to do auscultation by 61%-82%. In conclusion, many of the dentists lacked routines for making diagnoses, deciding therapy, and judging treatment results. Good routines were reported only in occlusal splint therapy. The majority of the dentists had a positive attitude toward the care of children and adolescents with TMD-related symptoms. The majority of the dentists reported a great need for TMD specialists.he     

����ؽ����Ҳ�ҧ�ϲ����о���չ

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。     

Need for occlusal therapy and prosthodontic treatment in the management of temporomandibular disorders. Part II: Tooth loss and prosthodontic treatment

The second part of this review, evaluating the literature on the relationship between dental occlusion and temporomandibular disorders (TMDs), focuses on the aetiological importance of tooth loss and the place of prosthodontic replacement in the treatment of TMD. Loss of teeth and lack of posterior occlusal support seem to have little influence on the development of TMD, which calls into question the use of prosthodontic restoration as prevention or treatment for TMD. In addition, there are practically no studies assessing the benefit of instrumental analysis in diagnosis or comparing the outcome of prosthodontic treatment with simple reversible methods in the management of TMD. There is a trend in the current literature to abandon any treatment, including positioning appliances and prosthodontic measures, to 'recapture the disk' in patients with disk displacements because of the favourable, long-term results achieved after using more simple methods. It is concluded that prosthetic therapy in TMD patients is not appropriate for initial TMD treatment and should only be carried out on prosthodontic indications after reversible treatment has alleviated pain and dysfunction.     

Effectiveness of occlusal splint therapy in the management of temporomandibular disorders: network meta-analysis of randomized controlled trials

A network meta-analysis (NMA) of randomized controlled trials (RCTs) was performed to assess the effectiveness of various types of occlusal splint in the management of temporomandibular disorders (TMDs) and to rank them according to their effectiveness. An electronic search was undertaken to identify RCTs published until August 2019. Predictor variables were control, non-occluding splint, hard stabilization splint (HSS), soft stabilization splint (SSS), prefabricated splint, mini-anterior splint, anterior repositioning splint (ARS), and counselling therapy (CT) with or without HSS. Outcome variables were pain improvement, post-treatment pain intensity, improvement in mouth opening, and disappearance of temporomandibular joint (TMJ) sounds. Forty-eight RCTs were included. There was a significant decrease in post-treatment pain intensity in arthrogenous TMDs after ARS (low quality evidence), CT + HSS (moderate quality evidence), mini-anterior splints (very low quality evidence), and HSS alone (low quality evidence), when compared to the control. There was a significant decrease in post-treatment pain intensity in myogenous TMDs with mini-anterior splints (very low quality evidence), SSS (very low quality evidence), CT alone (moderate quality evidence), CT + HSS (moderate quality evidence), and HSS alone (moderate quality evidence), when compared to control. ARS and CT were superior in decreasing TMJ clicking than control and HSS alone. The three highest-ranked treatments for post-treatment pain reduction in arthrogenous TMDs were ARS (92%, very low quality evidence), CT + HSS (67.3%, low quality evidence), and HSS alone (52.9%, moderate quality evidence). For myogenous TMDs, they were mini-anterior splints (86.8%, low quality evidence), CT + HSS (61.2%, very low quality evidence), and HSS alone (59.7%, moderate quality evidence). Based on this NMA of 48 RCTs, there is moderate to very low quality evidence confirming the effectiveness of occlusal splint therapy in the treatment of TMDs. Multimodal therapy consisting of CT + HSS may produce the maximum improvement for TMD patients.     

The dental occlusion as a suspected cause for TMDs: epidemiological and etiological considerations

The relationship between the dental occlusion and temporomandibular disorders (TMDs) has been one of the most controversial topics in the dental community. In a large epidemiological cross-sectional survey - the Study of Health in Pomerania (Germany) - associations between 15 occlusion-related variables and TMD signs or symptoms were found. In other investigations, additional occlusal variables were identified. However, statistical associations do not prove causality. By using Hill's nine criteria of causation, it becomes apparent that the evidence of a causal relationship is weak. Only bruxism, loss of posterior support and unilateral posterior crossbite show some consistency across studies. On the other hand, several reported occlusal features appear to be the consequence of TMDs, not their cause. Above all, however, biological plausibility for an occlusal aetiology is often difficult to establish, because TMDs are much more common among women than men. Symptom improvement after insertion of an oral splint or after occlusal adjustment does not prove an occlusal aetiology either, because the amelioration may be due to the change of the appliance-induced intermaxillary relationship. In addition, symptoms often abate even in the absence of therapy. Although patients with a TMD history might have a specific risk for developing TMD signs, it appears more rewarding to focus on non-occlusal features that are known to have a potential for the predisposition, initiation or perpetuation of TMDs.     

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.     

伴有颞下颌关节紊乱病的女性开患者的咬合力分析研究

目的探讨咬合因素对女性开!患者中颞下颌关节紊乱病（ TMD）发病的影响。方法选取女性开!患者102名,根据TMD的有无分为两组,伴有TMD的试验组有59名患者;不伴有TMD的对照组有43名患者。采用咬合力测试仪对两组患者进行咬合力、咬合接触面积、每一咬合接触点上的平均咬合压强和咬合重心的测试,并通过SPSS 11.0软件进行统计学分析。结果试验组的咬合力和咬合接触面积均小于对照组,两组间每一咬合接触点上的平均咬合压强和咬合重心的偏移无统计学差异。结论咬合力不足与开!女性TMD的发病有关。     

Need for occlusal therapy and prosthodontic treatment in the management of temporomandibular disorders. Part I. Occlusal interferences and occlusal adjustment

This review, divided into two parts, evaluates the literature on the relationship between dental occlusion and temporomandibular disorders (TMD) and the need for occlusal therapy in the management of TMD. The first part of the review focuses on the aetiological importance of occlusal interferences and the place of occlusal adjustment in the management and prevention of signs and symptoms of TMD. This has long been a controversial issue, which has not yet been resolved. The literature does not give strong support for the role of occlusion in the aetiology of TMD. Experienced clinicians also repudiate the need for occlusal adjustment in the management of TMD, whereas (less experienced) general dentists adhere to a concept focusing on the occlusion in diagnosis and treatment of TMD. There is a consensus that generalized prophylactic occlusal adjustment is not justified. There is an obvious need for research with evidence-based methods, to be able to answer the many remaining questions in this field.