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

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

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

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

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

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

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

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

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

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

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.     

Temporomandibular dysfunction in adult patients with myotonic dystrophy (DM1)

Myotonic muscle dystrophy is a systemic disease with early engagement of the facial muscles. Our aim was to study dysfunction of the temporomandibular system in patients with ‘classic’ dystrophia myotonica (DM1) and compare it with TMD patients and healthy controls. The study included 27 referred patients with DM1, 18 women and nine men, aged 30–62 years, and two matched control groups: patients with temporomandibular disorders symptoms (TMD) and healthy controls, both groups were consecutive patients. The patients answered questions regarding facial pain, jaw function and dysfunction. A clinical examination of the temporomandibular system including the occlusion was performed, and the maximum bite force and finger forces were measured. Among the DM1 patients, 33% reported difficulty biting off, and 22% had difficulty chewing, avoiding foods like meat and raw vegetables, and 37% of the DM1 patients scored their pain and discomfort as moderate to fairly severe. Their main complaints were TMJ clicking and locking, difficulty opening wide and tiredness. They had more clinical signs of dysfunction compared with the controls (P < 0·001), but no statistically significant difference to the TMD patients. The maximum bite force in DM1 patients was impaired compared to both the TMD patients and the controls (P < 0·001). Significantly more occlusal interferences were found in DM1 patients and were associated with chewing difficulties (P < 0·001). In conclusion, patients suffering from DM1 had an increased prevalence of TMD symptoms, reported impaired chewing function and had a decreased maximum bite force.     

The effect of supervised exercise on localized TMD pain and TMD pain associated with generalized pain

Objectives: To evaluate the effect of a supervised exercise program in patients with localized/regional temporomandibular disorder (TMD) pain and with TMD associated with generalized pain.

Material and methods: Consecutively referred patients with localized/regional TMD pain (n?=?56; 46 women and 10 men, mean age 44 years) and TMD associated with generalized pain (n?=?21; 21 women, mean age 41 years) participated. Patients underwent a 10-session structured supervised exercise program over 10–20 weeks that included relaxation, and coordination and resistance training of the jaw and neck/shoulders. The outcomes were jaw pain intensity on the Numerical Rating Scale, endurance time for jaw opening and protrusion against resistance and chewing, and effect of pain on daily activities.

Results: After the exercise program, a reduction in jaw pain was reported by the local (p?=?.001) and general (p?=?.011) pain groups. There were no significant differences in jaw pain intensity between the groups, before (p?=?.062) or after treatment (p?=?.121). Endurance time increased for both groups for jaw opening/protrusion (both p?<?.001) and chewing (both p?=?.002). The effect of jaw pain on daily activities decreased after exercise compared to baseline for both the local (p?<?.001) and general (p?=?.008) pain groups.

Conclusions: Supervised exercise can reduce TMD pain and increase capacity in patients with TMD. The results suggest that activation of the jaw motor system with exercise has a positive effect in patients with localized/regional TMD pain and TMD associated with generalized pain.     

Does adolescent self-reported TMD pain persist into early adulthood? A longitudinal study

Abstract

Objective: To follow up 2209 individuals in a longitudinal study and assess self-reported TMD pain, painful and non-painful comorbid conditions, and pain-related disability.

Material and methods: During 2012–2014, questionnaires were sent to 2209 eligible individuals who had been screened for TMD pain each year during 2000–2003. The two screening questions were (1) Do you have pain in the temple, face, jaw joint, or jaws once a week or more often? and (2) Do you have pain when you open your mouth wide or chew once a week or more often? If the patient answered ‘yes’ to one or both of the questions, TMD pain was recorded. Non-respondents received reminders; telephone interviews were offered a randomised group. The questionnaire queried TMD pain, and painful and non-painful comorbid conditions.

Results: The overall response rate was 36.5%. Individuals were placed into one of four pain groups defined by their pain experience at baseline and at the follow-up: no TMD pain (69.0%), new TMD pain (13.0%), previous TMD pain (9.9%), and persistent TMD pain (8.1%). Based on the self-report surveys, significantly more responders with TMD pain at follow-up had had pain as adolescents than not. Of adolescents with TMD pain, 45.1% had pain at follow-up as young adults, while 15.8% had pain at follow-up without a previous history of TMD pain. Individuals with persistent TMD pain had high frequencies of comorbid pains (p?<?.001), 45.2% reported moderate-severe depression scores (p?<?.001), and 13.0% had moderate pain-related disability (GCPS).

Conclusions: Based on self-report surveys, TMD pain in adolescence appears to triple the risk of TMD pain in young adulthood, and persistent pain increased comorbid pain and psychosocial distress.     

The implementation of a decision-tree did not increase decision-making in patients with temporomandibular disorders in the public dental health service

Objective: Many patients with temporomandibular disorders (TMD) seem to go undetected within primary dental health care. Primarily we evaluated if the implemented intervention increased the clinical decision-making for TMD patients; secondarily we evaluated if other factors could be identified that predicted performed or recommended TMD treatment.

Material and Methods: This case–control study was carried out within the Public Dental Health service in Västerbotten County, Sweden. An intervention based on a decision-tree with three screening questions for TMD (3Q/TMD) was implemented during 2015 in four clinics and compared with the remaining county. A total of 400 individuals were selected—200 3Q-positives and 200 3Q-negatives. The 3Q/TMD consists of Q1—frequent jaw pain, Q2—frequent pain on function, and Q3—frequent catching and/or locking of jaw. The 3Q/TMD answers were analyzed in relation to TMD treatment and any TMD related decision that was collected from the digital dental records.

Results: The intervention did not increase the frequencies of traceable clinical decisions among patients with TMD.

Conclusions: Despite the implemented intervention aimed, the indicated undertreatment of patients with TMD remains. Future studies are still needed to gain a deeper understanding of the clinical decision-making process for TMD patients in general practice dentistry.     

A comparative clinical and radiographic study on patients with chronic facial pain with and without temporomandibular disorder presenting to an otolaryngology clinic

ABSTRACT

Objective: Facial pain associated with temporomandibular disorder (TMD) is considered a component of Costen’s syndrome. However, prior to the current study, no previous clinical and radiographic studies have addressed facial pain in patients with TMD.

Methods: The study included 212 patients with chronic facial pain examined in an otolaryngology clinic. These were stratified into 132 patients with TMD and 80 patients without TMD. Clinical and radiographic findings were documented in both groups.

Results: Forty-eight patients in the TMD group had normal endoscopic findings and clear CT scans and had their facial pain directly attributable to TMD.

Conclusion: In patients presenting with facial pain, where nasal endoscopy reveals no abnormality, TMD should be specifically addressed, especially if CT scans of the paranasal sinuses are clear.     

Amyotrophic lateral sclerosis presenting as the temporomandibular disorder: A case report and literature review

Background: Spasticity and pain in the masticatory muscles or mouth opening limitation have been reported as early signs and symptoms of amyotrophic lateral sclerosis (ALS). These signs and symptoms are also frequently seen in, and thus mistaken for, temporomandibular disorders (TMD).

Clinical presentation: The authors report a case of ALS initially presenting with signs and symptoms of TMD. The TMD was followed by dysarthria of insidious onset, leading to the diagnosis of ALS. This case highlights the importance of considering TMD as a potential early form of presentation of ALS, requiring multidisciplinary treatment, especially by dental professionals.

Conclusion: A review of the literature was conducted to elucidate the oral and facial signs and symptoms of ALS and to identify ways of improving the quality of life of patients through a multidisciplinary approach.     

Effects of trait anxiety,somatosensory amplification,and facial pain on self-reported oral behaviors

Objectives

Oral behaviors are activities, like gum chewing, teeth clenching, and biting of objects, that go beyond normal functioning demands and contribute to the onset of temporomandibular disorders (TMD). Somatosensory amplification refers to the tendency to experience somatic sensations as intense, noxious, and disturbing and is related to bodily hypervigilance. Clinical experience suggests that individuals with bodily hypervigilance also present with occlusal hypervigilance and continuously check their occlusion. This study aimed at investigating whether somatosensory amplification and trait anxiety, a characteristic correlated with hypervigilance, are associated with a greater incidence of oral behaviors, and verifying how self-reported facial TMD pain affect this relationship.

Materials and methods

The State-Trait Anxiety Inventory, the Somatosensory Amplification Scale, the Oral Behavior Checklist (OBC), and the TMD-Pain Screener Questionnaire were filled out by 255 University students with self-reported facial TMD pain (PAIN group; 47 subjects, 24.8 ± 4.2 years) and without pain (CTR group; 208 subjects, 26.0 ± 4.8 years) using a web survey.

Results

Trait anxiety, somatosensory amplification, and OBC scores were greater in the PAIN than CTR group (all p < 0.05). Trait anxiety and somatosensory amplification were positively associated with the frequency of oral behaviors, as measured with the OBC (all p < 0.05). A significant effect of the interaction study group*trait anxiety (p = 0.028) on OBC scores was found.

Conclusions

Individuals with greater trait anxiety and somatosensory amplification report more frequent oral behaviors. The relationship between anxiety and oral behaviors is affected by concurrent facial pain.

Clinical relevance

Individuals with increased trait anxiety and concurrent facial pain report more frequent oral behaviors than those without pain. Clinicians should evaluate patients’ anxiety and somatosensory amplification before starting dental treatment.

     

Prevalence among adolescents in Bergen,Western Norway,of temporomandibular disorders according to the DC/TMD criteria and examination protocol

Objective: The aims of this study were to assess the prevalence of temporomandibular disorders (TMD) among adolescents and to contrast the prevalence of TMD according to the DC/TMD clinical examination protocol versus the prevalence of pain related to TMD according to two screening questions.

Material and methods: Two hundred and ten adolescents living in the county of Bergen, Norway, were offered an additional examination for TMD in connection with their regular dental check-up appointment. Five dental clinics were selected with differing socio-economic patient populations, as reflected by stratification of average levels of DMFT, and an equal number of girls and boys were invited to participate. The participants answered two screening questions for pain related to TMD followed by a clinical examination according to the DC/TMD protocol by five calibrated examiners.

Results: Acceptable calibration results were obtained. Approximately 80% of eligible participants consented to partake. According to the criteria of DC/TMD, the prevalence of TMD among the study participants was 11.9%, with a peak at 16 years of age. According to the self-reported screening questions for pain related to TMD, 7.2% responded positively. Only seven participants with a TMD diagnosis established according to the DC/TMD clinical examination protocol reported also pain related to TMD based on answering the two screening questions.

Conclusion: The prevalence of TMD is higher for girls than for boys and the prevalence of TMD established according to the DC/TMD criteria was higher than the prevalence of pain related to TMD estimated by use of two screening questions for self-reported pain.     

Associations between craniomandibular disorders,sociodemographic factors and self-perceived general and oral health in an adult population

Objective. The aim of this study was to analyze the relationships between pain in the craniomandibular region and jaw dysfunction, respectively, to sociodemographic factors and self-perceived general and oral health in a middle-aged and elderly population in Västerbotten County, Sweden. Materials and methods. Six hundred individuals, 35-, 50-, 65- and 75 years old, from inland and 600 individuals from coastal areas were randomly selected in 2002. Of these, 987 individuals completed a questionnaire and 779 participated in a clinical examination. Thirty-five- and 50-year-olds together constituted a middle-aged group and the rest an elderly group. Results. Among the middle-aged, craniomandibular pain was associated with impaired general health status, signs of temporomandibular disorder (TMD) pain were associated with female gender and living alone, jaw dysfunction symptoms were associated with university degree and chewing with caution; and signs of TMD dysfunction were associated with female gender and living in the more densely populated coastal region. Among the elderly, craniomandibular pain was more common among those living in the inland region, craniomandibular pain and signs of TMD pain were associated with impaired general health status, jaw dysfunction symptoms were associated with higher education level and self-perceived impaired general health and oral health; and signs of TMD dysfunction were associated with female gender and living in the coastal region. Dental status was not associated with craniomandibular pain. Conclusions. Socioeconomic factors and impaired general state of health were related to signs and symptoms indicative of CMD. These factors may influence demand for treatment among the affected.     

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

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

Association between temporo mandibular disorders and oral parafunctions in Saudi children.

The purpose of the present investigation was to determine the relationship between oral parafunctions and the development of temporomandibualr disorders (TMD). A group of 1,976 children aged 3-15 years old, were randomly selected and underwent an examination that consisted of palpation and assessment of the temporomandibular joints and associated muscles for tenderness and joint sounds. Maximum vertical opening and deviation during jaw opening were also recorded. The parents were requested to complete a questionnaire contained questions regarding symptoms of TMD and history of oral parafunctions. Results showed significant correlations between cheek biting, nail biting, bruxism, thumb sucking and most of TMD signs and symptoms. The results of the study support the concept that oral parafunctions have a significant role in the aetiology of TMD and should be tackled by the paediatric dentists to minimise their effects on the stomatological system.     

Treatment of temporomandibular disorders – knowledge,attitudes and clinical experience among general practising dentists in Sweden

Objective: The aim of the study was to investigate the self-perceived level of knowledge, attitudes and clinical experience in treatment of temporomandibular disorders (TMD) among general practising dentists (GPDs).

Material and methods: A web-based questionnaire was sent to all GPDs in the public dental health service in the County of Uppsala in 2010 (n?=?128) and 2014 (n?=?113). The GPDs were asked to answer questions in the following categories: Demographic information, Quality assurance, Clinical experience and treatment, Need for specialist resources in the field of TMD and Attitudes. Between the two questionnaires, the GPDs were offered TMD education and an examination template including three TMD questions was introduced in the computer case files. The results were also compared with a previous questionnaire from 2001.

Results: The response rate was 71% (2010) and 73% (2014). The majority of the GPDs were women (70% in 2010 and 72% in 2014). The reported frequency of taking a case history of facial pain and headache increased between 2010 and 2014. In 2014, the GPDs were more secure and reported higher frequency of good clinical routines in treatment with jaw exercises and pharmacological intervention compared to 2001. Interocclusal appliance was the treatment with which most dentists felt confident and reported good clinical routines.

Conclusions: The GPDs felt more insecure concerning TMD diagnostics, therapy decisions and treatment in children/adolescents compared to adults. There is a high need for orofacial pain/TMD specialists and a majority of the GPDs wants the specialists to offer continuing education in TMD.     

Evaluation of signs,symptoms, and occlusal factors among patients with temporomandibular disorders according to Helkimo index

Objective: This study sought to assess the clinical signs and subjective symptoms of TMD, including the occlusal condition.

Methods: Recruited individuals included 123 patients (58 men, 65 women) aged 15 to 65 years (mean 38.6 years) who had been referred to the TMD department. Helkimo dysfunction, occlusal, and anamnestic indices were used to assess signs of TMD, occlusal condition, and symptoms, respectively. Relationships of occlusal factors with signs and symptoms of TMD were evaluated by Spearman’s correlation test. Associations of TMD with sex and age distributions were assessed by Mann–Whitney and Spearman’s test, respectively.

Results: The prevalence of signs and symptoms was as high as 75%. Occlusal factors had significant associations with signs and symptoms of TMD.

Conclusion: Prevalence of TMD in the study population was high, without preference for age or sex. Occlusal factors may play a role in the etiology of TMD.     

Prevalence of whiplash trauma in TMD patients: a systematic review

The purpose of this systematic review was to describe the prevalence of whiplash trauma in patients with temporomandibular disorders (TMDs) and to describe clinical signs and symptoms in comorbid TMD/whiplash compared with TMD localised to the facial region. A systematic literature search of the PubMed, Cochrane Library and Bandolier databases was carried out for articles published from 1 January 1966 to 31 December 2012. The systematic search identified 129 articles. After the initial screening of abstracts, 32 articles were reviewed in full text applying inclusion and exclusion criteria. Six studies on the prevalence of neck trauma in patients with TMD met the inclusion criteria and were included in the review. Two of the authors evaluated the methodological quality of the included studies. The reported prevalence of whiplash trauma ranged from 8·4% to 70% (median 35%) in TMD populations, compared with 1·7–13% in the non‐TMD control groups. Compared with patients with TMD localised to the facial region, TMD patients with a history of whiplash trauma reported more TMD symptoms, such as limited jaw opening and more TMD pain, and also more headaches and stress symptoms. In conclusion, the prevalence of whiplash trauma is higher in patients with TMD compared with non‐TMD controls. Furthermore, patients with comorbid TMD/whiplash present with more jaw pain and more severe jaw dysfunction compared with TMD patients without a history of head–neck trauma. These results suggest that whiplash trauma might be an initiating and/or aggravating factor as well as a comorbid condition for TMD.     

Anamnestic Index Severity and Signs and Symptoms of TMD

Abstract

The aim of this study was to determine the frequency and to characterize the symptoms and clinical signs of temporomandibular disorders (TMD) related to each severity category of Fonseca’s anamnestic index in a sample of Brazilian young adults (mean age 21.61±1.91 years, 87% females and 13% males), by the application of an anamnestic index proposed by Fonseca (1992) and by clinical examination considering mandibular range of motion and tenderness to palpation of stomatognathic system structures. A significant number of participants were classified with mild TMD (43.2%) and moderate TMD (34.8%). Pain frequency during mastication, temporomandibular joint (TMJ) pain, and TMJ sounds were shown to be good predictors of TMD severity. Neck pain, headache, difficulty during mouth opening and lateral deviation, and tenderness to palpation of masticatory sites and during protrusion accompanied the TMD severity but failed to demonstrate differences between moderate and severe groups, showing a poor ability to determine TMD severity progression. This study suggests that not only the frequency of signs and symptoms of TMD should be determined, but also symptom severity and its relationship to the presence of clinical signs in order to discriminate patients with real treatment needs in nonpatient samples.     

Association between oral habits and signs/symptoms of temporomandibular disorders in Flemish adolescent girls

The influence of oral habits on the development of signs and symptoms of temporomandibular disorders (TMD) and pain is unclear. The prevalence and nature of such oral habits may also vary geographically. The aim of the present study was to assess the prevalence of parafunctions in Flemish adolescent girls and to study the interrelationship with TMD. A group of 261 school girls (15–16 years of age) participated. A questionnaire used in a similar study ( Gavish et al., 2000 ) was translated and inquired for oral habits (chewing of gum, nails or foreign objects, eating of seeds, crushing of ice or food, continuous leaning on the arm, daytime or night‐time grinding or clenching, jaw play, unilateral chewing) and TMD symptoms (joint noises, catching or locking, joint or muscle pain, tension or fatigue in the muscles). A brief clinical examination was performed by a single examiner: active and passive maximal mouth opening, presence of joint sounds, palpation tenderness of the lateral poles of the joints and of the masseter and anterior temporalis muscles, extent of abrasion of the canines, tongue or cheek imprints. Statistical evaluation used Spearman correlation, chi‐squared analysis and multiple regression analysis. The intra‐examiner reproducibility was moderate to high (κ 0·6–0·8 – Spearman Correlation 0·99 for maximal mouth opening). The frequency of reported oral habits was high: leaning on the arm (98%), gum chewing (89%, mean duration 3 h day^?1), lip‐ (62·1%) and cheek‐biting (41%), ice‐crushing (30%). There was a significant (P < 0·0001) but weak (0·30) positive correlation between the number of oral habits and the number of symptoms. Internal derangements were significantly (P < 0·0001) but weakly (0·25) correlated with jaw play and other oral habits. There was no relation between tooth clenching and myogenous pain (χ², P=0·31, but only 27% power). Multiple regression analysis showed that the number of symptoms increased by 52% if the subject reported ‘jaw play’, by 24% if chewing gum more than 2 h day^?1, by 28% while cheek biting and by 25% if chewing unilaterally.     

Diagnoses based on the Research Diagnostic Criteria for Temporomandibular Disorders in a biracial population of young women

AIMS: To compare the clinical characteristics of diagnostic subtypes of temporomandibular disorders (TMD) based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) in terms of physical findings (Axis I) and psychosocial findings (Axis II) among Caucasian and African American young women. An ancillary goal was to assess the value of using self-reported TMD pain as a screening tool compared to RDC/TMD examinations. METHODS: A biracial community sample (n = 830) of young women 19 to 23 years old was screened for facial pain with the Chronic Pain Grade questionnaire. Patients were considered to be putative cases of TMD if they reported facial pain present within the last 6 months; putative controls had no facial pain history or jaw symptoms. Women with facial pain more than 6 months ago and jaw symptoms (jaw symptom-past pain, JSPP group) were added. 129 women were clinically examined for TMD diagnosis for final confirmation of case-control status. RESULTS: 41 of 43 Caucasian and 11 of 18 African American putative cases were confirmed as cases; 9 of 27 Caucasians, but 0 of 17 African Americans from the JSPP group were confirmed as cases. All 24 putative controls were confirmed as controls. Based on RDC/TMD Axis I, 80% of 61 cases were muscle-related diagnoses, 33% as disc-related diagnoses, and 48% as arthralgia/arthritis/arthrosis. Based on Axis I, there were no significant differences in diagnoses between African American and Caucasian women. Based on Axis II, cases had significantly greater depression (P = .002) and somatization with pain (P < .001) than controls as expected. African Americans had significantly greater somatization with pain than Caucasians (P = .020). There were no other significant racial differences. CONCLUSION: Among young women reporting facial pain, clinical TMD subtypes, pain impact, treatment utilization, and additional characteristics other than somatization with pain were similar between races. A high percentage of these young non-clinical cases presented severe depression and somatization.