CPITN Scores Research Articles

Hyperlipidemia in Patients with Periodontitis

Periodontitis is a bacterial infection, which has been classified as a local chronic inflammation. This, as well as cardiovascular disease, may share common risk factors such as smoking, diabetes, behavioral factors, aging, and male gender. The aim of this study was to evaluate the association between hyperlipidemia and periodontitis. The levels of plasma lipids in 40 subjects with periodontitis (CPITN score III or IV, pocket depth 4 mm) with mean age 32.3 +/-1.2 years were measured and compared with those obtained from 40 age and sex matched controls. Both groups were systemically healthy according to their medical history. Total cholesterol (CHL) and triglycerides (TG) were significantly higher in the case group (P=0.045 and P=0.016, respectively). HDL and LDL cholesterols were higher in patients but did not have any significant differences with controls. The frequency of persons with pathologic values of TG and CHL were significantly higher in cases compared with controls. These results showed hyperlipidemia may be associated with periodontitis in healthy people. However, it is unclear whether periodontitis causes an increase in levels of serum lipids or hyperlipidemia is a risk factor for both periodontitis and cardiovascular disease.

Periodontal treatment needs of patients with renal disease receiving haemodialysis

The aim of this study was to perform periodontal assessment, using the CPITN index, on patients undergoing renal dialysis. The periodontal conditions of 342 subjects undergoing renal dialysis from eight renal dialysis centres were examined using CPITN. Subjects were distributed into four age groups, 16-19, 20-34, 35-44 and > or =45 years. The study was conducted during a 6-month period. All clinical examinations were performed by one examiner. There was a significant positive relationship between the CPITN scores and age (r=0.164, p=0.002) and dialysis duration (r = 0.240, p=0.000). There was no statistically significant difference between male and female patients (p>0.05). None of the age groups had healthy sextants. The 35-44 year-age group had a higher number of sextants with deep pockets (0.19) than the other age groups and edentulous sextants were the highest among the oldest age group (1.89). A very small portion of the renal dialysis population is affected by severe forms of periodontitis requiring complex periodontal treatment. However, all such patients should be given oral hygiene education as a priority.

Intra‐oral pattern of tooth and periodontal bone loss between the age of 50 and 60 years. A longitudinal prospective study

Objective: In a 10‐year prospective study we analyzed (i) the intra‐oral pattern of and (ii) potential risk factors for tooth and periodontal bone loss in 50‐year‐old individuals. Methods: A randomized subject sample of 50‐year‐old inhabitants in the County of Värmland, Sweden, was examined at baseline and after 10 years. Data from full‐mouth clinical and radiographic examinations and questionnaire surveys of 309 (72%) of the individuals who were dentate at baseline were available for analysis. Non‐parametric tests and binary logistic multiple regression models were used for statistical analysis of the data. Results: 4.1% of the 7,101 teeth present at baseline, distributed among 39% of the subjects, were lost during the 10‐year interval. The incidence of tooth loss was highest among mandibular molars (7.5%) and lowest among canines (1.8%). The relative risk (RR) for tooth loss for endodontically compromised teeth was 4.1 and for furcation‐involved molars 2.4–6.5, depending on tooth position. Logistic regression analysis identified baseline alveolar bone level (ABL), endodontic conditions, CPITN score (Community Periodontal Index of Treatment Needs), tooth position, caries, and educational level as risk factors for tooth loss. The overall mean 10‐year ABL change was −0.54 mm (S.E. 0.01). On a tooth level the ABL change varied between −0.35 mm (mandibular molars) and −0.79 mm (mandibular incisors). Smokers experienced a greater (20–131% depending on tooth type) mean bone loss than non‐smokers. The logistic regression model revealed that tooth position, smoking, and probing pocket depth ≥4 mm were risk factors for bone loss of >1 mm. No pertinent differences were observed with respect to risk factors for ABL change in the subgroup of non‐smokers compared to the results of the analysis based on the entire subject sample. Conclusion: Tooth loss was more common in the molar than in the anterior tooth regions, while periodontal bone loss had a random distribution in the dentition. The predominant risk factors identified with regard to further radiographic bone loss were ‘probing pocket depth ≥6 mm’ and ‘smoking’.

Relationship between cigarette smoking and oral health status

The purpose of the study was to examine the relationship between the smoking habit and oral health status, while adjusting for age and some aspects of dental health behavior. The data used were based on a cross-sectional study on dental checkup in the worksite, which included a self-reported questionnaire and oral examination by a dentist. The oral health status variables were CPITN scores, missing teeth/filled teeth/decayed teeth, and self-reported gum bleeding. In addition, the subjects reported in a questionnaire concerning their smoking habit and dental health behavior. Of a total of 7,713 of workers, 5,232 (67.8%) participated in the dental checkup of the worksite. From the population, only the data for 3,303 men were analyzed. We used multiple logistic regression to calculate the odds ratio (OR) for each oral health status according to the smoking habit. Current smokers, compared to subjects who had never smoked, had a higher risk of periodontal disease (OR = 2.3; 95% CI: 1.9-2.7), missing teeth (OR = 1.6; 95% CI: 1.3-1.9) and decayed teeth (OR = 1.5; 95% CI: 1.3-1.8), but they had a reduced risk of gum bleeding (OR = 0.7; 95% CI: 0.6-0.8). Dose response relationships between smoking and these variables were also observed. The results indicated that cigarette smoking was associated with oral health status independent of some aspects of dental health behavior.

On the association between hypercholesterolemia, cardiovascular disease and severe periodontal disease.

Premature death in men is known to be significantly associated with coronary heart disease (CHD). More and more studies are pointing toward a possible association between periodontal disease and increased risk of cardiovascular disease. The association of poor oral hygiene and atherosclerosis can be explained by the effect of chronic inflammatory disease on blood rheology. The purpose of the present study was to assess the relationship between CHD and periodontal disease. The study population included 1094 Israeli army service men aged 26-53 years (mean: 39+/-5 years). The study group comprised 151 subjects classified as having coronary heart disease CHD, i.e., myocardial infarction, and or anginal syndrome with angiographic evidence of significant coronary disease, or suffer from atherosclerotic risk factors, i.e., diabetes (fasting glucose) and HTN according to strict, well-established criteria. Blood levels of cholesterol and triglycerides were also determined. The severity of periodontal disease was assessed by the aid of CPITN. The control group comprised 943 healthy subjects. Statistical analysis was performed with chi2 test. Statistical analysis showed a significant association of CPITN score 4 with hypercholesterolemia and a possible association with CHD. The generation of higher cholesterol blood levels is proposed as a possible link between chronic periodontal inflammation and atherosclerosis.

Elevated blood glucose levels in patients with severe periodontal disease.

The rôle of diabetes mellitus in various forms of periodontal disease was investigated intensively in the past; some studies have also indicated an impact of periodontal inflammation on diabetic balance. The purpose of this study was to evaluate the reciprocal relationship between abnormal serum glucose levels and elevated CPITN scores in non-diabetic patients. 10,590 subjects were analyzed for normal and abnormal (higher than 120 mg/dl) serum glucose levels, their periodontal status reflected as CPITN was correlated with their glucose level category. The results of the present study reflect a significant association between elevated blood glucose levels (higher than 120 mg/dl) and CPITN scores of 4.5 with an odds ratio of 2.46. A strong association exists between abnormal serum glucose level and periodontal disease as manifested by CPITN score.

Prevalence and determinants of periodontal disease in Portuguese adults: results from a multifactorial approach

The purpose of the present investigation was to study prevalence of periodontal disease among 30 to 39-years-old from Oporto in the north of Portugal. In addition, an attempt was made to elucidate possible periodontal disease determinants in this population. A random sample consisting of a total of 322 individuals was drawn based on electoral lists. The attendance rate was 61%. The CPITN index was used and the results indicate a high prevalence of periodontal disease and a substantial need for periodontal treatment in this population, with 41% of the individuals investigated having one or more sites with a CPITN score 4 (pockets deeper than 5.5 mm). Dental visiting habits, gender (lower CPITN scores for females) and oral hygiene were the determinants most significantly associated with variation in CPITN scores.

A cross-sectional study on the relationship of plasma fibrinogen concentration and age, physical fitness, lifestyle and health examinations of healthy Japanese males

The intention of this study was to examine the determinants of plasma fibrinogen concentrations in healthy Japanese male workers. A cross-sectional study was conducted in 1998 among 1,044 (male 975, female 69) employees aged 30-59 years in Osaka, Japan. The overall mean value of plasma fibrinogen concentration was 236.4 +/- 47.6 mg/dl. There was a dose-response relationship between cigarette smoking and plasma fibrinogen concentration. Plasma fibrinogen concentration was associated with age, body weight, body mass index, white blood cell count and CPITN score, and inversely associated with serum HDL cholesterol in male nonsmokers. Plasma fibrinogen was not related to physical exercise, alcohol consumption or dietary factors. This study confirms the relationship of known coronary risk factors to plasma fibrinogen concentration in Japanese male factory workers, and suggests that smoking and periodontal disease are related to plasma fibrinogen concentrations.

Associations of medical status and physical fitness with periodontal disease.

To determine the possible associations of medical status and physical fitness with periodontal disease, a cross-sectional study was conducted. The subjects were 517 males and 113 females aged 23 to 83 years who participated in a multiphasic health test at the Aichi Prefectural Center of Health Care, Japan, from 1992 to 1997. Their periodontal status was assessed by means of the CPITN scoring system. To assess the strength of associations between the examined factors and the score, odds ratios were computed using ordinal logistic models. Conventional risk factors such as old age, smoking habits, and higher fasting plasma glucose and simplified debris index increased the risk of periodontal disease. Hypertension, hematuria, leucocytosis or thrombocytosis, positive C-reactive protein and higher serum alkaline phosphatase were positively associated with the score, whereas higher serum high-density lipoprotein cholesterol was related to a lower risk. Poor physical fitness affecting aerobic capacity, foot balance and reaction was associated with a higher CPITN score. These associations were independent of the conventional risk factors. Although these new potential risk factors should be further investigated for their causal relationship, our findings suggested a close relationship of oral health to medical status and physical fitness.

Oral health status of children and adults in the Republic of Niger, Africa

The present study was undertaken in order to describe the oral health status of children and adults in the Republic of Niger and to provide baseline data for the organisation and evaluation of systematic oral health promotion programmes in the country. The WHO pathfinder sampling procedures were applied to obtain representative samples of the following age groups: 6 years (n = 373); 12 years (n = 400); 18 years (n = 300) and 35-44 years (n = 400). Data were collected in 1997 according to the WHO methods, including information on dental caries and CPITN. In 6-year-olds, 56 per cent had caries and a mean score of 1.3 DMFT was observed among the 12-year-olds; the 35-44-year-olds had an average score of 5.7 DMFT. Differences in dental caries prevalence were found according to sex, province and urbanisation. Ninety-nine per cent of individuals at age 18, and 87 per cent at age 35-44 had maximum CPITN score 2 (calculus). Where 6- and 35-44-year-olds are concerned, the data may indicate increasing levels of dental caries. The implementation of primary prevention and community-based oral health education is therefore a matter of urgency.

A "case control" study on the rôle of HLA DR4 in severe periodontitis and rapidly progressive periodontitis. Identification of types and subtypes using molecular biology (PCR.SSO).

HLA DR4 antigens have been considered as a risk factor in periodontal disease. The aim of this "case control" study was to verify and to provide fuller clarification of such data. "Cases" or patients had to be aged between 20 and 48 years. They presented at least 5 sites spread over several teeth with an attachment loss equal or greater than 6 mm, and 10 sites spread over several teeth with periodontal pockets equal to or greater than 5 mm. Verification with a WHO probe showed an individual CPITN score of 4. Moreover, subjects whose average CPITN score for the 6 sextants was less than 3 were excluded from the study. Among these "severe periodontitis" patients, a subgroup was distinguished composed of subjects aged 20-35 years who presented, in accordance with the cases by Katz and co-workers, 5 or more teeth showing pocket depths of 6 mm or more. The dental chartings of these subjects showed an attachment loss of more than 3 mm on certain teeth over an inter-exam period of 1-3 years. They all displayed obvious loss of bony support in the affected sites. This constituted the "rapidly progressive periodontitis" subgroup. The "controls" were all over 20 years of age, and it was clinically verified that they were free of periodontal disease. There were 48 "cases" and 55 "controls". HLA typing of patients and controls was performed using "sequence oligoprobe hybridization after polymerase chain reaction" in accordance with the 11th International Workshop. This method allowed the detection of DR4 alleles as well as DR4 subtypes. The ethno-geographic origin of the subjects, considered as a confounding variable, was neutralized by stratified analysis. Subtypes 0401, 0404, 0405 and 0408 tended to be more frequent (p=0.08) in the cases (Severe Periodontitis). Focusing on analysis of "rapidly progressive periodontitis" in subjects aged 20-35 years, a very significant Mantel-Haenszel chi2 was obtained (p=0.0058) which led to a Mantel-Haenszel standardized odds ratio (OR) equal to 17. The 95% confidence interval was 1.03<0.R.<180.10. In conclusion, this supports previous reports and gives further clarification: in particular subtypes 0401, 0404, 0405 and 0408 can be considered as a risk factor for "rapidly progressive periodontitis". It should be noted that these determinants have been implicated in rheumatoid arthritis.

Epidemiological Study on Association of Periodontal Disease and Total and Differential Leukocyte Counts.

Periodontal disease is defined as inflammation that is caused by bacteria in dental plaque. This disease is liable to be a factor contributing to the high leukocyte count over an extended period. Furthermore, a number of prospective epidemiologic studies have shown that the leukocyte count is a good predictor of ischemic heart disease (IHD). However there have been few epidemiological studies of the relationship between periodontal disease and the leukocyte count. The purpose of this study was to investigate the relationship between the total and differential leukocyte counts and oral conditions of Japanese factory workers who were classified according to their smoking habits. The 1,167 subjects were male factory workers employed with a chemical factory in Osaka, Japan. The oral conditions recorded were periodontal status (Community Periodontal Index of Treatment Needs, CPITN). The relationship between the total and differential leukocyte counts and the CPITN score of subjects who were classified according to their smoking habits was investigated in 1996 and 1997. In both the current smokers and nonsmokers, the subjects with severe periodontal disease, in contrast to the normal subjects, exhibited total leukocyte, neutrophil and monocyte counts that were significantly high for 1 year during follow-up studies. The periodontal disease is shown that causes the total leukocyte and neutrophil counts related to the development of IHD to remain at a high level.

Relationship between smoking and dental status in 35-, 50-, 65-, and 75-year-old individuals.

The aim of the present study was to examine the dental status and smoking habits in randomized samples of 35-, 50-, 65-, and 75-year-old subjects (n = 1093), recruited for a cross-sectional epidemiological study in the County of Värmland, Sweden. The following clinical variables were recorded by 4 well-calibrated dentists: number of edentuolous subjects, number of missing teeth, probing attachment level, furcation involvement, CPITN scores, DMF surfaces, plaque and stimulated salivary secretion rate (SSSR). In addition, the subjects reported in a questionnaire their tobacco habits, oral hygiene habits, dietary habits etc. The percentage of smokers in 35-, 50-, 65-, and 75-year-olds was 35%, 35%, 24% and 12%, respectively. In 75-year-olds, 41% of the smokers were edentulous compared to 35% of non-smokers. The difference in number of missing teeth between smokers and non-smokers was 0.6 (p=0.15), 1.5 (p=0.013), 3.5 (p=0.0007) and 5.8 (p=0.005) in the 4 age groups. Smokers had the largest mean probing attachment loss in all age groups. The differences between smokers and non-smokers in mean attachment level were 0.37 (p=0.001), 0.88 (p=0.001), 0.85 (p=0.001) and 1.33 mm (p=0.002) in the 35-, 50-, 65-, and 75-year-olds, respectively. Treatment need assessed by CPITN was in all age groups greatest among smokers. The number of intact tooth surfaces was fewer in 35-, 50-, and 75-year-old smokers than in non-smokers. The number of missing surfaces (MS) was higher in 50-, 65-, and 75-year-old smokers than in non-smokers. In addition, 35-year-old smokers exhibited a significantly larger number of decayed and filled tooth surfaces (DFS) than non-smokers. Male smokers had significantly higher SSSR than non-smoking males (p=0.012). Plaque index and oral hygiene were similar in smokers and non-smokers. Smokers reported a more frequent intake of sugar containing soft drinks (p=0.000) and snacks (p=0.003) than non-smokers. The opposite was reported for consumption of fruit (p=0.003). It was concluded that smoking is a significant risk indicator for tooth loss, probing attachment loss and dental caries.

Efficacy of CPITN sextant scores for detection of periodontitis disease activity

The relationship between CPITN sextant scores and periodontitis recurrence at individual tooth sites was evaluated in a longitudinal study in 83 treated adult periodontitis patients receiving systematic 3-month maintenance care. At baseline and semi-annual examinations over 36 months, CPITN scores were assigned to each dentition sextant using probing depths and gingival index scores, and relative periodontal attachment level was assessed at individual tooth sites using an occlusal reference stent. Periodontitis recurrence was defined as any periodontal site exhibiting either a probing depth increase of > or = 3 mm from baseline, or a probing depth increase of > or = 1 mm from baseline together with a loss of relative periodontal attachment of > or = 2 mm from baseline. 49 (59.0%) subjects developed periodontitis recurrence in 147 (29.8%) sextants at 181 (2.2%) individual periodontal sites during the 36-month study period. Baseline CPITN scores of 4 were more common in disease-active subjects than clinically-stable subjects (p = 0.003, t-test), and were associated with a statistically significant 1.66 relative risk of periodontitis recurrence within 36 months. CPITN sextant scores of 3 or 4 showed low specificity and low positive predictive values as indicators of periodontitis recurrence at > or = 1 individual sites within the affected sextant. In comparison, low CPITN sextant scores (0-2) provided high specificity (96.2-100%), high positive predictive values (99.5-100%), and a summary odds ratio of 24.2 as an indicator of clinical stability at all periodontal sites within a given dentition sextant. Changes in sextant scores for CPITN over 6-month periods showed no relationship with periodontitis recurrence at individual periodontal sites. This study suggests that while CPITN is inadequate for detection of periodontitis recurrence, low CPITN scores provide rapid presumptive identification of clinically-stable sextants in adult periodontitis patients on maintenance care.

Periodontal status among male industrial workers in southern Finland with or without access to subsidized dental care.

The association between subsidized dental care and periodontal status was studied in male industrial workers in southern Finland in 1994. Clinical examinations and a multiple-choice questionnaire were completed for 325 workers (age, 38-65 years) with access to subsidized dental care and 174 controls without access. The CPITN scores based on full-mouth recordings were analyzed, using both the individual and sextant as units of analysis. Overall, 6% of the subsidized group and 2% of the control group had no periodontal treatment need (p < 0.05). Deep pockets > or = 6 mm were found in 5% of the subsidized workers and 11% of the controls (p < 0.05). In the logistic regression analyses the probability of calculus was negatively associated with access to subsidized dental care. Smoking was the strongest independent factor affecting periodontal status. Our findings show a positive relationship between access to subsidized dental care and periodontal status.

Oral health status of a population of community-dwelling older Canadians.

A sample of 170 responsive residents of seniors housing centres in Winnipeg, Canada, were studied, (>65 years, mean 82 years), with the objectives of relating their dental state to their perception of need and uptake of service. Only 6% rated their oral health as poor, 46% reported a dental visit within the previous year and 68% felt they needed dental treatment. A lack of perceived need (88%) was the primary reason why dental care was not sought more frequently. Hygiene practices revealed that only 7% brushed < 1 time/day, 60% never flossed, 14% cleaned their dentures <1 time/day, and 42% slept with their dentures. Dental histories showed that examination (94%), prosthodontic treatment (76%), and restorative services (65%) were the most commonly sought treatments. Perceived dental needs included prosthodontic treatment (39%), periodontal/prophylactic treatment (10%), restorative treatment (9%) and pain relief (9%). Study subjects had 2.8 decayed teeth, a DMFT of 25.1, and a Root Caries Index of 38%. CPITN scores of 3 or 4 in at least one sextant were found in 80% of subjects. Of the 41% edentulous, all wore complete dentures but 15% of complete upper dentures and 51% of complete lower dentures fitted poorly. Of the partial dentures, 20% fitted poorly. Soft tissue anomalies were seen in 67% of subjects and 47% had TMJ anomalies. Overall, 77% of edentulous subjects and all dentate subjects required some dental treatment even though 46% had seen a dentist within the preceding year. It is concluded that appropriate management of such people needs further attention.

Relationship between CPITN and periodontal attachment loss findings in an adult population.

This study investigates the relationship between CPITN findings and the prevalence and severity of periodontal attachment loss in a rural Kenyan population comprising 1131 persons aged 15-65 years. All persons were examined for calculus, gingival bleeding, pocket depths and attachment loss levels on 4 sites of each tooth present. Recordings of bleeding, calculus and pocket depths were used to compute CPITN scores based on the 10 index teeth originally proposed, and these CPITN scores were subsequently related to the attachment loss findings derived from the full-mouth assessment. In most cases, persons with a CPITN score < or = 1 did not have attachment loss > or = 4 mm. However, among 40+ year-old persons with CPITN score 2 over 90% had attachment loss > or = 4 mm and over 50% of the 50+ year-olds with CPITN score 3 had attachment loss > or = 6 mm. Less than 20% of the 15-29 year-olds with CPITN score 3 had attachment loss > or = 6 mm, and usually the attachment loss levels ranged between 0 and 3 mm. Beyond the age of 35 years over 10% of the sextants with CPITN score 0 had attachment loss > or = 4 mm. Below the age of 35 years more than one third of all sextants with CPITN score 3 had attachment loss levels < or = 3 mm. Thus, the CPITN findings overestimate both prevalence and severity of periodontal attachment loss among the younger age groups and underestimate these parameters among elderly subject.

Periodontal treatment needs in 12 and 15 to 19‐year‐old school children in the Caribbean island of Antigua, 1990

A national survey was undertaken in 1990 to investigate the periodontal treatment needs in 12 and 15 to 19-year-olds residing in urban and rural areas of Antigua. Using the CPITN procedure, examination of 246 12 year-old children and 456 adolescents (15-19 years) revealed that the CPITN scores of healthy, gingival bleeding, calculus, 4 or 5 mm and > or = 6 mm periodontal pockets were distributed similarly in urban and rural areas. Calculus was the most commonly recorded score, with a prevalence of 46% in 12-year-olds and 56% in 15-19 year-olds. 4 or 5 mm pockets were found in 14% of adolescents, affecting on average less than one sextant per subject, but deep pockets were uncommon, 26% of 12-year-olds and 14% of adolescents had periodontally healthy mouths. Scaling and oral hygiene instruction were the predominant treatment needs in both age groups, but the requirement for complex periodontal care in adolescents was low -3% only.

Periodontal conditions in medically compromised elderly subjects: assessments of treatment needs.

Periodontal conditions were studied in 42 dentate elderly subjects (mean age, 84.1 +/- 8.0 years). None of them had received recent dental care or was routinely seen by a dentist. Overall, they had 20.2 +/- 7.1 teeth (range, 6-32). The CPITN was used to assess periodontal status. Twenty-nine percent of all sextants were either edentulous or had only one remaining tooth. The overall oral hygiene was poor (Plaque Index, 1.8 +/- 0.5) and gingival inflammation severe (Gingival Index, 1.9 +/- 0.8). Significant correlations were found between: Gingival and Plaque Indices (r = 0.82, p < 0.001), and pocket depth and Gingival Index (r = 0.38, p < 0.05). Plaque Index was negatively correlated to the number of remaining teeth (r = -0.43, p < 0.050). Age and remaining teeth were negatively correlated (r = -0.38, p < 0.05). Thirty percent of the posterior sextants had a CPITN score of "4," and 75% of the posterior sextants had at least one site with a pocket depth 4 mm. Only 2.9% of all sites demonstrated pocket depth 6 mm and these sites were distributed among 67% of the subjects. The CPITN index was correlated to the mean pocket depth for the various sextants, the correlation varying between r = 0.67, p < 0.001 (upper right posterior) and 0.36, p < 0.05 (upper left posterior) sextants. The total manpower estimated to complete initial therapy for 42 patients was approximately 63 hours by a dentist and 85 hours by a dental hygienist.

A preliminary study into the dental health status of multiple sclerosis patients.

Multiple sclerosis (MS) is an inflammatory disease of unknown etiology involving the central nervous system. Since MS affects the whole body, orofacial aspects of the disease must be expected, particularly since loss of muscular coordination may result in a diminished ability to maintain oral hygiene. This preliminary study examined the dental health status of 22 volunteer MS patients. A questionnaire collected data regarding medical and dental histories and socio-demographic information. Extra- and intra-oral examinations were carried out on all subjects to determine the particular dental treatment needs of this special group. The DMFT and CPITN scores for this group did not indicate that MS patients were more susceptible to dental caries or periodontal disease. However, the prevalence of trigeminal neuralgia and symptoms of TMJ dysfunction in the group studied indicated that these conditions may be manifest in MS patients and warrant further investigations.