Correlation between oral parafunction and temporomandibular disorders and emotional status among saudi children.

Studies on association between temporomandibular disorders and oral parafunction in preschool children are few. The aim of the present study is to investigate the relationship between the subjective and objective signs and symptoms of temporomandibular disorders (TMD), oral parafunction and emotional status in preschool children. The study is based on a clinical examination and questionnaire. Five hundred and two Saudi children aged 3 to 7 years were examined for different signs and symptoms of TMD. In addition, the parents of the children were given a questionnaire to investigate the existence of oral parafunction and evaluate the emotional status of children. The results of the study showed significant association between attrition and temporomandibular joint (TMJ) pain, muscle tenderness and restricted opening, (P Values were 0.008, 0.019, 0.037 respectively). Significant association was found between habit of grinding and pain, while eating or opening the mouth (P<0.012). Significant association was found between emotional status and multiple signs and symptoms of TMJ tenderness, TMJ pain and muscle tenderness (P<0.042). Significant association was found between emotional status and pain, while eating or opening of the mouth (P<0.048). Close to positive association was found between oral parafunction and jaw lock. The association between TMD and oral parafunction as well as emotional status should direct the attention of the dentist to the importance of considering the emotional status, oral parafunction and TMD when examining and formulating treatment plan for the child patient.     

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.     

Anamnestic index severity and signs and symptoms of TMD

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.     

Prevalence of temporomandibular dysfunction in Turkish children with mixed and permanent dentition

This study was carried out to determine the prevalence of temporomandibular joint (TMJ) dysfunction in mixed and permanent dentition and to evaluate the sex distribution in Turkish children. One hundred and eighty-two children with mixed dentition and 212 with permanent dentition were selected for the study, which used a questionnaire and clinical examination. Children with one or more signs (TMJ sounds, TMJ tenderness, muscle tenderness, restricted mouth opening) and/or symptoms (TMJ pain during mastication and mouth opening, restriction of the jaw opening and TMJ sounds) met the criterion of TMJ dysfunction. The total prevalence of signs and symptoms of TMJ dysfunction in the studied population was 68% (68% in girls and 68% in boys) in mixed dentition and 58% (61% in girls and 56% in boys) in permanent dentition. The Z-test and analysis of variance (ANOVA) were used for statistical analysis of the difference between the results. The total prevalence of signs and symptoms of TMJ dysfunction in mixed dentition was found to be higher than in permanent dentition (P < 0.05). No statistically significant difference was found in the total prevalence of TMJ dysfunction between girls and boys.     

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.     

Counselling and self‐management therapies for temporomandibular disorders: a systematic review

The aim of this review was to investigate the effectiveness of counselling and other self‐management‐based therapies on muscle and temporomandibular joint (TMJ) pain relief and increasing the functional abilities of patients with temporomandibular disorders (TMD). A systematic literature review was conducted by three independent reviewers and included articles published up to 2012. PubMed and Cochrane Library electronic databases were used in addition to hand‐searching to assess clinical outcomes for counselling and self‐management approaches for TMD treatment. The review yielded 581 records that were narrowed down to 7. All included studies were classified as blind‐randomized controlled clinical trials. The selected articles analysed revealed that counselling was able to improve tenderness upon masticatory muscle palpation and maximum mouth opening with and without pain in patients with TMD, with similar results to those of interocclusal appliances approaches. Thus, counselling‐ and self‐management‐based therapies could be considered a conservative low‐cost and beneficial treatment alternative for treating TMD to potentially improve psychological domains and remove harmful behaviours for the control of the signs and symptoms of TMD.     

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.     

Multivariate analysis of risk factors in relation to TMD symptoms

The epidemiological studies on risk factors for temporomandibular disorders (TMD) are still extremely lacking. Therefore, their aetiological significance has scarcely been documented. The aim of this study was to quantitatively investigate the relationship between hypothesized risk factors and the precipitation and perpetuation of TMD symptoms. The same 672 adults who participated in a previous study ( Matsuka et al., 1996 ) were selected for this study. All subjects had already answered a self‐administered questionnaire and the same questionnaire was sent to them 4 years after the first survey. The questionnaire failed to reach 58 subjects at the second survey. Of the remaining 614 subjects, 367 (166 males and 201 females with a mean age of 53·1 ± 14·2 years) returned the questionnaire, for a return rate of 59·8%. Information about three TMD symptoms [temporomandibular joint (TMJ) pain, limitation of mouth opening, TMJ noise] was obtained from the questionnaire, and fluctuation of these symptoms was assessed by comparing three pairs of answers between the first and second surveys. Information about 18 hypothesized risk factors for TMD (age, sex, trauma, bruxism, malocclusion, oral habit, etc.) were also obtained from the questionnaire at the first survey. To evaluate how strongly each risk factor was associated with precipitation and perpetuation of TMD symptoms, odds ratio of each risk factors for precipitating or perpetuating TMD symptoms was calculated by means of logistic regression analysis. Statistically significant risk factors for precipitating TMD symptoms were lip biting for TMJ pain (3·65) and trauma for limitation of mouth opening (3·20), and statistically significant risk factors for perpetuating TMD symptoms were female for TMJ pain (4·50) and TMJ noise (3·85) (odds ratio in parenthesis). The possible aetiological significance of these factors in TMD should be validated by future research.     

Generalized joint laxity and its relation with oral habits and temporomandibular disorders in adolescent girls

A group of 248 girls, aged 15-16 years, were randomly selected and examined both clinically and by questionnaire with regard to the signs and symptoms of temporomandibular disorders (TMD), generalized joint laxity (GJL), range of mandibular opening, temporomandibular joint (TMJ) hypermobility and presence of oral parafunctions. The prevalence of GJL was 43% and that of TMJ hypermobility (TMJH) was 27.3%. A significant, albeit weak, correlation was found between the two. In the presence of joint click, both active and passive opening were significantly larger. When either muscle or joint sensitivity to palpation was present, the difference between the active and passive range of mouth opening increased significantly. The presence of reported clicks was negatively associated with GJL. This association was not valid in the presence of parafunction. Some of the signs and symptoms of TMD affected the range of mouth opening. In the presence of joint clicks, the mean active and passive mandibular opening were significantly larger. In the presence of joint and muscle sensitivity to palpation, the difference between passive and active mouth opening was larger. This was possibly because of the effect of pain on the full active range of opening, which was invalid in the registration of the passive mandibular opening. GJL, when present, did not seem to jeopardize the health of the stomatognathic system as expressed in the signs and symptoms of TMD. There was a negative association between GJL and the presence of reported joint clicks and catch. When a parafunction was present in addition to GJL, this association was invalid but not reversed, as has been previously reported.     

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

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

Temporomandibular disorders in 19-year-old Korean men.

PURPOSE: The purpose of this study was to determine the prevalence and the nature of the relationships between 3 temporomandibular joint disease (TMD) symptoms and symptoms of associated structures. MATERIALS AND METHODS: This study was designed to rule out the effect from the uneven composition of the samples on TMD symptoms. The samples were collected from subjects who were of the same age, gender, district, and race. Nineteen-year old men (n = 27,978) were selected and investigated by means of questionnaires and clinical examinations. The prevalence of each symptom was studied and tried to determine the effects of the TMD-associated signs on the TMD signs. The indices allocated to reflect the TMD signs and symptoms and the others were dichotomized for bivariate analysis. The predictor variables were headache, neck pain, referred pain, stress, past trauma history in the TMJ, past TMJ dislocation, bruxism, and clenching. The outcome variables were mouth opening limitation, TMJ pain on rest, and TMJ pain during function. RESULTS: The incidence of masticatory muscle stiffness was 17.8%; TMJ sounds, 14.3%; headache, 7.2%; neck pain, 13.5%; bruxism, 8.4%; and clenching, 9.9%. Stress occurred in 12.8%, past trauma history in 11%, and previous joint dislocation in 2.5%. The experience of dislocation in the TMJ was found to be the most important risk factor in terms of mouth opening limitation (odds ratio, 4.08, P <.0001), joint pain during function (odds ratio, 5.50, P <.0001), and joint pain in the rest state (odds ratio, 4.63, P <.0001). Referred pain and the experience of trauma in TMJ were the secondary risk factors in terms of joint pain and referred pain and the stress in terms of mouth opening limitation. Considering referred pain can be induced by TMD, stress may be more related to mouth opening limitation (odds ratio, 2.18, P <.0001), and the experience of trauma in TMJ may be more related to pain in the rest state (odds ratio, 2.56, P <.0001) and during function (odds ratio, 2.47, P <.0001). CONCLUSIONS: The prevalence of TMD signs and symptoms as determined by this examination was in accord with the findings in women or mixed samples of other workers. Prior experience of a dislocated disc was found to be the most risky factor in TMD. Stress was related to limitations of mouth opening, and the experience of trauma in the TMJ was found to be related to pain in the joint region. Bruxism may not be a direct risk factor in TMD, and the clenching habit found to be more harmful than bruxism.     

Temporomandibular joint involvement in rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis

The aim of the present study was to estimate the prevalence of temporomandibular joint (TMJ) symptoms and clinical findings in Albanian patients with rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis. The authors examined 124 consecutive hospitalized patients (88 with rheumatoid arthritis, 22 with systemic lupus erythematosus and 14 with systemic sclerosis) and 124 age- and gender-matched healthy controls using a questionnaire and an oro-facial clinical examination for assessing the presence of TMJ sounds, pain in the TMJ area, tenderness of masticatory muscles and limited mouth opening. Significantly more patients (67%) reported TMJ symptoms than controls (19%). A significantly higher proportion of patients (65%) exhibited clinical signs of temporomandibular dysfunction compared with controls (26%). The most frequent findings in rheumatoid arthritis were temporomandibular sounds and pain. Pain was found in a significantly higher proportion in patients with systemic lupus erythematosus compared with controls. Difficulty and limitation in mouth opening were observed in the majority of systemic sclerosis patients, and in only a minority of rheumatoid arthritis patients. This study supports the notion that TMJ examination should be encouraged in the rheumatology setting and clinicians should be able to provide pain management and patient support.     

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.     

Prevalence of symptoms of functional disturbances of the masticatory system in Swedish men

Subjective and clinical symptoms of mandibular dysfunction and cuspal interferences were studied in 389 Swedish men (median age 32 years). Impaired chewing function was noted in about 10%, different types of parafunction in 26%, frequent headaches in 5 %, TMJ or muscle pain in 3 % and difficulties in mouth opening in 10% of the men. Locking or luxation of the mandible was the most prevalent clinical symptom (24%), followed by reduced movement capacity and deviation on opening of the mandible, TMJ-sounds and muscle tenderness. Sixty per cent of the men had one or more clinical symptoms of dysfunction. Subjective symptoms of dysfunction were positively correlated with reduced movement capacity of the mandible and tenderness of the masticatory muscles and temporomandibular joints upon palpation. Positive correlations were found between subjective symptoms of dysfunction and non-working side interference as well as single tooth contact on the working side. Locking or luxation of the mandible and TMJ-sounds were positively correlated with single tooth contact on the working side and TMJ-sounds and muscle tenderness with interferences in the retruded position of the mandible.     

Symptoms of the stomatognathic system in temporomandibular and cervical spine disorders

This study was performed to assess the prevalance of signs and symptoms of temporomandibular disorders (TMD) in patients with cervical spine disorders (CSD) and to compare patients with CSD and subgroups of patients with TMD with regard to the results of orthopaedic tests of the stomatognathic system. A group of 103 consecutive patients with signs and symptoms of CSD and a group of 111 consecutive patients with TMD were examined. All subgroups of TMD patients showed a significantly smaller range of motion than the CSD patients. Patients with TMD had limited mouth opening (<40 mm) on active and passive mouth opening more often than CSD patients. TMD patients with myogenous problems reported oral habits more often than CSD patients, although no objective differences between CSD and TMD patients were found. Subgroups of TMD patients reported joint sounds, and pain on palpation and joint play tests of the temporomandibular joint (TMJ) more frequently than CSD patients. Joint sounds on active movements, pain on palpation of the TMJ, and pain on joint play tests correctly classified 82% of the patients with TMD and 72% of the patients with CSD. In spite of the biomechanical and anatomical relationship between the neck and the stomatognathic system, the results of the study show that CSD patients have signs and symptoms of TMD comparable with those of the adult Dutch population. It was concluded that the function of the masticatory system should be evaluated in patients with neck complaints in order to rule out a possible involvement of the masticatory system.     

A Study on Prevalence of Dental Attrition and its Relation to Factors of Age, Gender and to the Signs of TMJ Dysfunction

A study was planned to determine the severity of dental attrition in adults of both sexes in different age groups and its possible relationship to temporomandibular disorders. 500 subjects comprising of 260 females and 240 males in the age group of 18–55 years were clinically examined for bruxism, attrition, and signs of temporomandibular disorders. Tooth sensitivity, tooth or restoration fracture, scalloping of tongue, ridging of buccal mucosa, TMJ sounds, muscle tenderness, TMJ tenderness, referred pain, pain on mouth opening and limitation of mouth opening were recorded along with attrition score in a proforma. The basic data was then analysed to arrive at certain conclusions. A high prevalence of attrition (88.0%) with increase in age (P < 0.00) and was seen more in males as compared to females (P < 0.01). On comparing attrition with some of the signs of bruxism it was shown that tooth or restoration fracture and scalloping of tongue had no relation to the severity of attrition score. Whereas a significant relation was seen between attrition and tooth sensitivity (P < 0.00), and ridging of buccal mucosa (P < 0.05). Muscle tenderness (P < 0.00), pain on mouth opening (P < 0.05) and deviation of mandible on mouth opening (P < 0.00) had significant relation to attrition. Other signs of temporomandibular disorders such as joint tenderness, referred pain, joint sounds and limitation of mouth opening had no relation to attrition score. This study showed a limited association between the severity of attrition and TMJ dysfunction.     

Gender differences in associations between occlusal support and signs of temporomandibular disorders: results of the population-based Study of Health in Pomerania (SHIP)

PURPOSE: The aim of this study was to investigate whether gender-dependent associations exist between signs of temporomandibular disorders (TMD) and occlusal support. MATERIALS AND METHODS: Stratified by gender, the data of 2,963 35- to 74-year-old participants from the epidemiologic Study of Health in Pomerania were used in logistic regression analyses with temporomandibular joint (TMJ) tenderness and muscle tenderness as the dependent variables. Occlusal support was classified according to the Eichner index, a classification system based on occluding pairs of teeth. The final model was adjusted for bruxism, age, and various sociodemographic data. RESULTS: Logistic regression analyses revealed increased odds ratios for TMJ tenderness in men with loss of all four molar and premolar supporting zones (odds ratio 3:9) and without antagonist contact (odds ratio 2:7). Significant relationships in men were also found between muscle tenderness and loss of one (odds ratio 2:1), three (odds ratio 2:1), or four supporting zones (odds ratio 2:7), and loss of any tooth contact (odds ratio 2:3). In women, significant associations between occlusal support and TMD signs were absent. Subjects with bruxism were more likely to have TMJ tenderness (odds ratio women 2:0, men 1:9). In women, an additional relationship existed between bruxism and muscle tenderness (odds ratio 1:7). The following habits showed no significance: gum chewing, unilateral chewing, and lip/tongue/cheek biting. CONCLUSION: Only in men was the loss of occlusal support significantly associated with muscle and TMJ tenderness. The association between bruxism and TMD signs supports the theory that repetitive adverse loading of the masticatory system may cause functional disturbances.     

Anterior repositioning appliance therapy for TMJ disorders: specific symptoms relieved and relationship to disk status on MRI

Forty-eight (48) consecutive patients seeking treatment in a referral based practice for complex chronic painful temporomandibular joint (TMJ) disease were enrolled in a prospective study to assess specific symptom relief from anterior repositioning appliance (ARA) therapy and the relationship between specific symptom relief and the status of the TMJ disk. Each patient was assessed on 86 symptoms based upon whether each symptom was present before treatment and absent, better, unchanged or worse after Maximum Medical Improvement (MMI). The most common symptom was occipital cephalalgia (94%). The least common symptom was pain and burning of tongue (8%). A profile of a temporomandibular disorder (TMD) patient was developed. The typical TMD patient has cephalalgia, mainly in the occipital, temporal and frontal region, pain upon chewing food, pain upon opening and closing the mouth, TMJ pain, pain in the back of the neck and difficulty chewing food. Before treatment, patients with bilateral displaced disks had more symptoms than those with unilateral displaced disks and the opposite side normal. After MMI, the maximum benefit (percent of pretreatment symptoms relieved) was found in patients with normal or recaptured disks. The minimum occurred in patients whose disks did not recapture with therapy. ARA therapy improved or eliminated symptoms in all patients in the study.     

Emotional Stress and Craniomandibular Dysfunction in Children

This study investigated the relationship between craniomandibular dysfunction (CMD) and emotionally stressful states measured by the urinary catecholamines in 314 children aged six to eight years. The children were examined clinically and interviewed by the same investigator. During the clinical examination the following variables were recorded: maximal mouth opening with and without pain, deviation of the mandible in opening wide, muscle and temporomandibular joint (TMJ) tenderness or pain and sounds from the TMJ. The variables recorded during the interview were headaches, difficulties in opening wide, pain upon opening wide, and clicking. A questionnaire was distributed to the parents to collect information regarding socioeconomic factors. A 24-hour urine sample was collected for each subject and analyzed by the high performance liquid chromatography (HPLC) technique to assay the catecholamine content. The logistic multiple regression analysis was carried out to test whether craniomandibular dysfunction was affected by the studied variables. A 95% probability level was used. The results showed that epinephrine had a significant effect on TMJ tenderness, while norepinephrine and dopamine did not have a significant association with any of the signs and symptoms of CMD. The data suggest that emotionally stressful states increase the probability of developing TMJ tenderness in children of this age.     

Emotional stress and craniomandibular dysfunction in children

This study investigated the relationship between craniomandibular dysfunction (CMD) and emotionally stressful states measured by the urinary catecholamines in 314 children aged six to eight years. The children were examined clinically and interviewed by the same investigator. During the clinical examination the following variables were recorded: maximal mouth opening with and without pain, deviation of the mandible in opening wide, muscle and temporomandibular joint (TMJ) tenderness or pain and sounds from the TMJ. The variables recorded during the interview were headaches, difficulties in opening wide, pain upon opening wide, and clicking. A questionnaire was distributed to the parents to collect information regarding socioeconomic factors. A 24-hour urine sample was collected for each subject and analyzed by the high performance liquid chromatography (HPLC) technique to assay the catecholamine content. The logistic multiple regression analysis was carried out to test whether craniomandibular dysfunction was affected by the studied variables. A 95% probability level was used. The results showed that epinephrine had a significant effect on TMJ tenderness, while norepinephrine and dopamine did not have a significant association with any of the signs and symptoms of CMD. The data suggest that emotionally stressful states increase the probability of developing TMJ tenderness in children of this age.