Temporomandibular disorders, otologic symptoms and depression levels in tinnitus patients

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

Tinnitus as a comorbidity to temporomandibular disorders—A systematic review

The aim of this systematic review was to evaluate the prevalence of tinnitus in patients with temporomandibular disorders (TMD) and the possible effects of TMD treatment on tinnitus symptoms. A search of the PubMed, Web of Science and Cochrane databases from inception of each database up to January 2017 found 222 articles. After independent screening of abstracts by two of the authors, we assessed 46 articles in full text. The inclusion and exclusion criteria reduced these to 25 articles of which 22 studies reported prevalence based on 13 358 patients and 33 876 controls, and eight studies reported effect of TMD treatment on tinnitus based on 536 patients and 18 controls. The prevalence of tinnitus in patients with TMD varied from 3.7% to 70% (median 42.3%) whereas the prevalence in control groups without TMD varied between 1.7% and 26% (median 12%). The eight treatment studies indicated that treatment of TMD symptoms may have a beneficial effect on severity of tinnitus. However, only one treatment study included a control group, meaning that the overall level of evidence is low. The finding that tinnitus is more common in patients with TMD means that it can be regarded as a comorbidity to TMD. However, in view of the lack of evidence currently available, further well‐designed and randomised studies with control groups are needed to investigate whether possible mechanisms common to tinnitus and TMD do exist and whether TMD treatment can be justified to try to alleviate tinnitus in patients with TMD and comorbidity of tinnitus.     

Signs and symptoms of temporomandibular disorders and the incidence of tinnitus

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

Are temporomandibular disorders and tinnitus associated?

The current study aimed to research the prevalence of temporomandibular disorders (TMD) in patients with subjective tinnitus, as compared to controls, and the association between symptoms of TMD, tinnitus, and chronic pain. Two hundred patients were divided into two groups, according to the presence (experimental) or not (control) of subjective tinnitus. The subgroups were determined according to the RDC/TMD criteria. The Pain Pressure Threshold (PPT) values of the masseter and temporalis muscles were recorded bilaterally, and a Visual Analog Scale (VAS) was used to address subjective pain. The most prevalent TMD subgroups in the tinnitus patients (p < 0.05) were myofascial pain with limited opening (39.0%), disc displacement with reduction (44.33%), and arthralgia (53.54%). The severity of tinnitus was significantly associated with the severity of chronic pain (p = .000). The PPT values were lower (p > 0.05), while the Visual Analog Scale (VAS) was statistically higher (p = .000) for the tinnitus patients. These results suggest that an association exists between TMD and subjective tinnitus.     

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.     

Prevalence of otologic complaints in patients with temporomandibular disorder

The prevalence and rank of order of 4 otologic complaints in 200 temporomandibular disorder (TMD) patients, as well as the relationship between the complaints and TMD subgroups, were investigated and compared with an asymptomatic control group. No subjective otologic complaints were reported by 45 (22.5%) TMD patients; the remaining 155 (77.5%) patients had at least 1 otologic complaint. Otalgia, tinnitus, vertigo, and hearing loss were reported by 63.6%, 59.1%, 50%, and 36.4%, respectively, of the subjects with myofascial pain and dysfunction; by 46.1%, 44.2%, 32.5%, and 22% of the patients with internal derangement; and by 62.5%, 45.8%, 41.6%, and 20.8% of the patients with both myofascial pain and dysfunction and internal derangement. However, the incidence of otalgia (8%), tinnitus (26%), vertigo (14%), and hearing loss (14%) was found to be lower for the control group. Statistically, the control group had fewer otologic complaints. Patients in the TMD groups had high incidences of otologic complaints compared with the control subjects without TMD signs or symptoms. Aural symptoms in patients with internal derangement or myofascial pain and dysfunction, or their combination, were nonspecific.     

Treatment received, treatment demand, and treatment need for temporomandibular disorders in 35-year-old subjects

An epidemiological sample of 114 subjects was followed longitudinally from the age of 15 to 35 years with regard to treatment received, treatment demand, and treatment need for temporomandibular disorders (TMD). Some kind of TMD treatment had been provided to 18% of the subjects during the 20-year follow-up period. Eighty-five percent of those who had received previous TMD treatment reported that the treatment had had a positive effect on their symptoms. The estimated present need for treatment was 11%, but, in line with several other investigations, the active demand for such treatment was much less (3%). From age 15 to 25 years, a small but gradual increase of clinical signs of dysfunction was found. From the age of 25 to 35 years, however, a significant reduction of such signs was noted. One explanation for this reduction of clinical signs and symptoms of TMD might be the stomatognathic treatment received. It was concluded that 18% of the subjects had received some TMD treatment during the 20-year follow-up period. Only 3% still had a demand for such treatment at age 35.     

Otologic symptoms of temporomandibular disorder and effect of orofacial myofunctional therapy

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

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

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

ASSESSMENT OF TEMPOROMANDIBULAR DISORDER AND OCCLUSION IN TREATED CLASS III MALOCCLUSION PATIENTS

Objective:

The aims of this study were to compare the prevalence of temporomandibular disorders (TMD) in individuals submitted to either orthodontic or ortho-surgical Class III malocclusion treatment and to assess the influence of occlusal aspects on TMD severity.

Material and methods:

The sample consisted of 50 individuals divided into two groups, according to the type of treatment (orthodontic or orthodontic with orthognathic surgery). The presence of signs and symptoms of TMD was evaluated by an anamnestic questionnaire and a clinical examination, including TMJ and muscle palpation, active mandibular range of motion, joint noises and occlusal examination.

Results:

Based on the anamnestic questionnaire, 48% had no TMD, 42% had mild TMD and 10% had moderate TMD. The presence and severity of TMD did not show any relationship with the type of orthodontic treatment (p>0.05). The chi-square test showed a positive association (p<0.05) between TMD and non-working side occlusal interferences.

Conclusion:

Based on the methodology used and the results obtained, it may be concluded that Class III orthodontic treatment was not associated with the presence of TMD signs and symptoms and the non-working side contacts can be occlusal factors of risk. There was no significant difference in TMD prevalence between the studied groups (orthodontically treated patients and patients treated with orthodontics followed by orthognathic surgery).     

Symptom relief after treatment of temporomandibular and cervical spine disorders in patients with Meniere's disease: a three-year follow-up

This study describes the coordinated treatment of temporomandibular disorders (TMD) and cervical spine disorders in patients diagnosed with Meniere's disease. The aim was to follow up treatment outcomes for three years with regular follow-up examinations every six months. Of the 31 patients with Meniere's disease who participated in a controlled comparative study on the signs and symptoms of TMD, 24 participated in a subsequent controlled comparative study on the signs and symptoms of cervical spine disorders (CSD). These 24 Meniere's disease patients (ten males and 14 females) agreed to participate in this longitudinal study. At each follow-up, their symptoms were evaluated using self-administered questionnaires and visual analog scales (VAS). The results of the coordinated treatment showed simultaneous decreases in the intensities of vertigo, nonwhirling dizziness, tinnitus, feeling of fullness in the ear, pain in the face and jaws, pain in the neck and shoulders, and headache that were both longitudinal and highly significant. Significant longitudinal reductions in the frequencies of vertigo, nonwhirling dizziness, and headache were also reported by the patients as well as a complete disappearance of pain located in the vertex area. A significant relief of TMD symptoms and a decrease in nervousness was also achieved. The results showed that a coordinated treatment of TMD and CSD in patients with Meniere's disease is an effective therapy for symptoms of this disease. The results also suggested that Meniere's disease has a clear association with TMD and CSD and that these three ailments appeared to be caused by the same stress, nervousness, and muscular tension.     

The potential etiologic factors influencing tinnitus intensity in patients with temporomandibular disorders

Objectives: To investigate the potential relationships between the intensity of tinnitus associated with temporomandibular disorders (TMD) and potential etiologic factors, including age, gender, freeway space, sleep bruxism (SB), joint clicking, and headache.

Methods: The sample was comprised of 90 patients without any hearing loss, as confirmed by otorhinolaryngology, who self-reported subjective tinnitus and simultaneous TMD, based on the Research Diagnostic Criteria for TMD (RDC/TMD).

Results: The results showed a positive, weak correlation between the intensity of tinnitus and age (r = 0.225, p = 0.033). The presence of SB and headache were seen in higher proportions in the present sample, at 75.5% (n = 68) and 66.6% (n = 60), respectively.

Conclusions: In a population of patients with subjective tinnitus and TMD, no significant associations were found between tinnitus intensity and age, freeway space, SB, clicking presence, and headache, though gender did show a weak correlation with tinnitus intensity.     

Otological findings and other symptoms related to temporomandibular disorders in young people

In a prospective, observational study between April and November 2017 we evaluated the correlation between temporomandibular disorder (TMD), and otological signs and other symptoms in a sample of 251 patients. First, a simplified anamnestic questionnaire was applied for the diagnosis of TMD and the following symptoms were recorded: otalgia, tinnitus, vertigo, pruritus of the ear, feeling of hearing loss, fullness in the ear, headache, pain in the eye, neck pain, back pain, and dizziness. Some degree of TMD was detected in 177 of the participants (70.5%). Among the otological symptoms studied, significant associations were found with tinnitus (<0.001), ear pain (<0.001), feeling of hearing loss (<0.001), and vertigo (<0.001). There were also significant associations with non-otological symptoms, the most common being back pain (<0.001), headache (<0.001), neck pain (<0.001), pain in the eye (<0.001), and dizziness (0.001). Our findings show that the higher incidence of both otological and non-otological symptoms was associated with a progressive increase in the severity of TMD.     

Influence of tinnitus on pain severity and quality of life in patients with temporomandibular disorders

Objective

The aim of this cross-sectional study was to evaluate the relationship among pain intensity and duration, presence of tinnitus and quality of life in patients with chronic temporomandibular disorders (TMD).

Material and Methods

Fifty-nine female patients presenting with chronic TMD were selected from those seeking for treatment at the Bauru School of Dentistry Orofacial Pain Center. Patients were submitted to the Research Diagnostic Criteria anamnesis and physical examination. Visual analog scale was used to evaluate the pain intensity while pain duration was assessed by interview. Oral Health Impact Profile inventory modified for patients with orofacial pain was used to evaluate the patients'' quality of life. The presence of tinnitus was assessed by self report. The patients were divided into: with or without self report of tinnitus. The data were analyzed statistically using the Student''s t-test and Pearson''s Chi-square test, with a level of significance of 5%.

Results

The mean age for the sample was 35.25 years, without statistically significant difference between groups. Thirty-two patients (54.24%) reported the presence of tinnitus. The mean pain intensity by visual analog scale was 77.10 and 73.74 for the groups with and without tinnitus, respectively. The mean pain duration was 76.12 months and 65.11 months for the groups with and without tinnitus, respectively. The mean OHIP score was 11.72 and 11.74 for the groups with and without tinnitus, respectively. There was no statistically significant difference between groups for pain intensity, pain duration and OHIP scoreS (p>0.05).

Conclusion

Chronic TMD pain seems to play a more significant role in patient''s quality of life than the presence of tinnitus.     

Attributes of Tinnitus that May Predict Temporomandibular Joint Dysfunction

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

A study of the influence of occlusal factors and parafunctional habits on the prevalence of signs and symptoms of TMD

PURPOSE: The purpose of this study was to investigate the prevalence of the clinical signs and symptoms of temporomandibular disorders (TMD) and the relationship between occlusal factors, parafunctional habits, and TMD in a young adult nonpatient population. MATERIALS AND METHODS: A questionnaire including data from a history and clinical functional examination was used in the study. All 230 subjects were male recruits, from 19 to 28 years of age (mean 21.3 years). RESULTS: Thirty-eight percent of the subjects reported at least one symptom, while in 45% of the subjects at least one sign of TMD was recorded. Temporomandibular joint clicking (40%) and pain on palpation (34%) were the most commonly recorded signs. Multivariate logistic regression analysis showed several weak but statistically significant correlations between the occlusal factors, parafunctional habits, and TMD in this nonpatient population. TMD signs were thus weakly correlated with malocclusion traits (angle Classes II/1, II/2, III, and cross bite), interferences in retruded contact position, midline discrepancy > or = 2 mm, < or = 10 contacts during maximal biting pressure, nonworking-side interferences, horizontal overlap > or = 5 mm, and parafunctional habits (teeth clenching and teeth grinding). CONCLUSION: Some association between occlusal factors and TMD signs was found. However, this association cannot be considered unique or dominant in defining subjects with TMD in the population.     

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.     

Changes in signs and symptoms of temporomandibular disorders following treatment with implant-supported fixed prostheses: a prospective 3-year follow up

PURPOSE: The aim was to investigate whether the replacement of lost teeth with implant-supported fixed prostheses (IFP) had any influence upon the signs and symptoms of temporomandibular disorders (TMD). MATERIALS AND METHODS: The subjects comprised 78 consecutive patients referred to a specialist clinic for treatment with IFPs. All were examined with respect to the presence of signs and symptoms of TMD before the start of treatment and after 1 and 3 years. RESULTS: Before treatment began, 21% of the patients were found to have moderate (15%) or severe (5%) clinical signs of dysfunction according to the Helkimo index. These figures decreased numerically but not statistically significantly to 10% and 1%, respectively, at the 3-year follow up. Nearly half of the patients (45%) reported one or more subjective symptoms of TMD at the first examination. The anamnestic index used had decreased statistically significantly at the 3-year follow up, when the 5 variables composing the index had improved, but the improvement was statistically significant only for the variables joint sounds and pain when opening the mouth wide. All patients were satisfied with the treatment received. CONCLUSION: The results from the present investigation show that treatment with IFPs has a good and lasting effect on the functional status of the masticatory system as well as on subjective symptoms of TMD and chewing ability in the vast majority of patients treated.     

Individual prediction of treatment outcome in patients with temporomandibular disorders. A quality improvement model

The general aim of this thesis was to create and evaluate a quality improvement model for prediction of treatment outcome in patients diagnosed with Temporomandibular Disorders (TMD) of either Muscle or Mainly TMJ (Temporomandibular Joint) origin, treated with interocclusal appliances and/or occlusal adjustment. The model was assumed to generate negative predictors of treatment outcome through evaluating all patients predicted Good reaching an objective treatment goal but not having an improvement of 50% or more. The model was created and evaluated by one TMD specialist. The questions were: (I) Was it possible for the TMD specialist to predict treatment outcome individually in patients diagnosed with TMD and, from the results, create a quality improvement model? (II) Was it possible for eight TMD-trained general dental practitioners, under the supervision of the TMD specialist, to treat TMD patients with similar results to the TMD specialist if the TMD specialist had examined, treatment planned, and individually predicted the treatment outcome? (III) Was it possible for the TMD specialist to improve the possibility to predict individual treatment outcome overtime? (IV) Was it possible for one TMD-trained general dental practitioner to copy the clinical part of the model and achieve the same results as the TMD specialist, in patients selected by the TMD specialist? Out of 5165 patients subjected to a functional examination of the masticatory system, 3602 were diagnosed with TMD and subgrouped as either Muscle or Mainly TMJ symptoms. The patients were predicted to have a Good, Dubious, or Poor possibility to have an improvement of 50% or more after treatment. Patients predicted Poor were not offered any treatment. A correct prediction of actual treatment outcome Good was defined as an improvement of 50% or more for muscle and/or TMJ symptoms. A total of 2625 patients began treatment at the specialist clinic for TMD and 2128 completed the full course of treatment. The patients were treated with counseling, interocclusal appliances and/or occlusal adjustment. Treatment outcome was evaluated at an objective treatment goal as improvement in percent using a verbal Numeric Rating Scale ranging from 0 to 100. The results suggest that (I) individual treatment outcome can be predicted in patients with TMD treated by one specialist in TMD and a quality improvement model could be created, (II) eight TMD-trained general dental practitioners could, under the supervision of the TMD specialist, treat TMD patients with similar results to the TMD specialist, (III) the TMD specialist could improve the possibility to predict individual treatment outcome over time, and (IV) the clinical part of the model could be copied by one TMD-trained general dental practitioner with similar results to the TMD specialist. In conclusion, the model works in the hand of one TMD specialist and the clinical part for one general dental practitioner, but it needs to be evaluated by other clinics/clinicians before it can be claimed to be generalizable. The model has identified new negative predictors for treatment outcome in patients with TMD. These predictors need to be investigated further in well controlled clinical trials. The created model is a PDSA cycle.     

Occurrence of clinical signs of temporomandibular disorders in adult Finns

AIMS: To study the age- and gender-related prevalence of signs of temporomandibular disorders (TMD) in the Finnish adult population. METHODS: A clinical health examination was performed as a part of a Health 2000 Health Examination Survey in 2000 and 2001. A nationally representative sample included 8,028 Finns at least 30 years of age, of whom 79% participated also in an oral health investigation, including examination of the stomatognathic system in order to assess the presence of certain TMD signs: maximum interincisal distance < 40 mm, pain in temporomandibular joints or masticatory muscles, and sounds in temporomandibular joints (crepitation, clicking). RESULTS: Thirty-eight percent of the subjects had at least 1 sign of TMD. All the signs studied were more common in women than men. Overall, signs of TMD were also associated with age; the older the subject, the higher the prevalence of the TMD signs. However, when stratified by gender, the association with age was not as clear, and gender differences were observed in the prevalence of the single TMD signs at different ages. CONCLUSION: Signs of TMD may be more common among the elderly than is usually reported.