Abstract
The aim of this study was to evaluate the correlation between patient complaints, clinical diagnosis of temporomandibular disorder (TMD) based on the diagnostic criteria for TMD, and morphology of the mandibular condyle obtained by cone-beam computed tomography (CB-CT). Data were collected from 40 patients. The anatomy of the mandibular condyle was assessed using CB-CT, the diagnosis of TMD according to diagnostic criteria for TMD, and patients' complaints was registered at the appointment. Data were explored and all statistical references were completed in bicaudal tests, with 95% confidence level (α=0.05). The Chi-squared test was used with Bonferroni correction (z-tests). Main complaints found were grouped as muscular, articular, muscular and articular, or headache and articular symptoms. Clinical diagnosis of TMD involved myalgia, local myalgia, myofascial pain, myofascial pain with reference, myofascial pain with arthralgia, arthralgia, or disc displacement with reduction. At least one joint showed condylar flattening, erosion, sclerosis, or osteophytes. No correlation was observed between main complaints, clinical diagnosis, and morphology of the mandibular condyle in all comparisons. The findings suggest that due to the absence of clinical and morphological correlation, CB-CTs should be requested only in specific cases, when doubt remain after careful TMD diagnosis, to avoid their over-indication.
Highlights
Temporomandibular disorder (TMD) is an umbrella term applied to dysfunctions associated with the temporomandibular joint (TMJ) and related muscles
The inclusion criteria involved data from patients who had been examined as follows: patients evaluated with the original version of the diagnostic criteria for TMD protocol [7] by a single trained examiner; temporomandibular joints examined with cone beam computed tomography (CB-Computed tomography (CT)) with closed mouth (80 TMJs) after referral from the TMD department; patients’ that main complaints were registered
Patients were excluded if they presented associated syndromes, if TMJ exams were insufficiently detailed or performed with open mouth, if their clinical records were incomplete, or if they failed to attend the diagnostic criteria for TMD protocol clinical evaluation
Summary
Temporomandibular disorder (TMD) is an umbrella term applied to dysfunctions associated with the temporomandibular joint (TMJ) and related muscles. The National Institutes of Health cited many factors that “may be implicated” in the etiology of TMD, including age, sex, stress, depression, somatic symptoms, orthodontic treatment, occlusal or masticatory dysfunction, extraction of third molars, facial trauma, and degenerative arthritis [1]. TMD is a significant problem of public health that affects 5% to 12% of the population and it is the second most common musculoskeletal condition resulting in pain and incapacitation, which the incidence is only lower than lower back pain. TMD when associated to pain can affect the patient’s activities of daily living, as well as their psychological function and quality of life [2]. Patients usually consult their clinicians for TMD, if associated to pain. Morphological changes and degenerative pathological processes may affect the mandibular condyle, which may present faceting, osteophyte formation, pseudocysts, erosions, and bone scleroses, among others [4]
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