Diagnosis Of Temporomandibular Disorders Research Articles

Temporomandibular disorder and generalized joint hypermobility: electromyographic analysis of the masticatory muscles

Aim: This study aimed to verify the presence of generalized joint hypermobility (GHJ) in individuals with temporomandibular disorders (TMD) and asymptomatic individuals and to compare the activity of their masticatory muscles. Methods: 61 female patients aged 18 to 35 years were evaluated: 34 with diagnosis of TMD by the Research Diagnostic Criteria for Temporomandibular Disorders constituted the TMD group and 27 constituted the asymptomatic group. The subgroups were classified according to the presence of GJH by the Beighton score. Electromyographic recordings of the masseter and anterior temporal muscles were acquired bilaterally at mandibular rest and in maximal intercuspal position. Results: GJH was present in 64.71% of the individuals with TMD and in 40.74% of the asymptomatic individuals. The electrical activity was significantly higher in the right masseter (p = 0.0111), left masseter (p = 0.0007) and right temporal (p = 0.0046) in the patients with TMD than in the asymptomatic individuals. The activity of the left masseter muscle was significantly higher (p=0.0072) in the volunteers with TMD and GJH compared with in the individuals with TMD but without hypermobility. Also, the right temporal muscle showed higher activity in subjects with GJH and TMD compared with asymptomatic individuals without hypermobility (p=0.0248). Conclusions: The electrical activity was higher at mandibular rest in TMD and TMD/ GJH patients. This result suggests that these muscles need to be recruited for the joint stabilization due to the low ligamentar resistance and a possible proprioceptive deficit. This recruitment appears to occur asymmetric and variedly among all muscles involved in this stabilization, which could compensate for the low ligamentar competence and a possible proprioceptive deficit in individuals with GJH. Both TMD and GJH seem to have influenced the muscular activity

Temporomandibular Disorders: A Position Paper of the International College of Cranio-Mandibular Orthopedics (ICCMO)

Purpose: Two principal schools of thought regarding the etiology and optimal treatment of temporomandibular disorders exist; one physical/functional, the other biopsychosocial. This position paper establishes the scientific basis for the physical/functional. The ICCMO Position: Temporomandibular disorders (TMD) comprise a group of musculoskeletal disorders, affecting alterations in the structure and/or function of the temporomandibular joints (TMJ), masticatory muscles, dentition and supporting structures. The initial TMD diagnosis is based on history, clinical examination and imaging, if indicated. Diagnosis is greatly enhanced with physiologic measurement devices, providing objective measurements of the functional status of the masticatory system: TMJs, muscles and dental occlusion. The American Alliance of TMD organizations represent thousands of clinicians involved in the treatment of TMD. The ten basic principles of the Alliance include the following statement: Dental occlusion may have a significant role in TMD; as a cause, precipitant and /or perpetuating factor. Therefore, it can be stated that the overwhelming majority of dentists treating TMD believe dental occlusion plays a major role in predisposition, precipitation and perpetuation. While our membership believes that occlusal treatments most frequently resolve TMD, it is recognized that TMD can be multi faceted and may exist with co-morbid physical or emotional factors that may require therapy by appropriate providers. The International College of Cranio-Mandibular Orthopedics (ICCMO), composed of academic and clinical dentists, believes that TMD has a primary physical/functional basis. Initial conservative and reversible TMD treatment employing a therapeutic neuromuscular orthosis that incorporates relaxed, healthy masticatory muscle function and a stable occlusion is most often successful. This is accomplished using objective measurement technologies and ultra low frequency transcutaneous electrical neural stimulation (TENS). Conclusion: Extensive literature substantiates the scientific validity of the physical/functional basis of TMD, efficacy of measurement devices and TENS and their use as aids in diagnosis and in establishing a therapeutic neuromuscular dental occlusion. Clinical Implications: A scientifically valid basis for TMD diagnosis and treatment is presented aiding in therapy.

Diagnostic Accuracy of Clinical Tests and Signs of Temporomandibular Joint Disorders: A Systematic Review of the Literature

Systematic review. To summarize the research on accuracy of individual clinical diagnostic signs and tests for the presence of temporomandibular disorder (TMD), and for the subclassifications affiliated with TMD. Diagnosis of TMD through clinical diagnostic measures has been reported in many studies; however, few of these studies have identified individual clinical tests or signs that can aid in the diagnosis of TMD or differentiate between the subclassifications of TMD. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for this review. Computerized and hand searches were completed to locate articles on the diagnostic accuracy of clinical tests and signs. To be considered for review, the study required (1) an assessment of individual clinical measures of TMD, (2) a report of the diagnostic accuracy of these measures, and (3) an acceptable reference standard for comparison. Quality assessment of studies of diagnostic accuracy (QUADAS) scores were completed on each selected article. Sensitivity and specificity and negative and positive likelihood ratios were calculated for each diagnostic test described. The search strategy identified 131 potential articles, which were narrowed down to 7 that met the criteria for this review. After assessment using the QUADAS score, 3 of the 7 articles were of high quality. All 7 studies used tests to differentiate subclassifications of TMD. The 7 studies included (1) diagnostic tests/signs of joint sounds, (2) joint movements, or (3) clinically oriented pain measures. There were no studies that investigated TMD versus a competing, non-TMD condition. Only 3 studies presented in this literature review were of high quality. Because all of the included studies assessed diagnostic accuracy among subclassifications of individuals suspected of having TMD, the ability of any of these tests to distinguish between patients with TMD versus patients without TMD remains unknown. Because of the lack of clear findings indicating compelling evidence for clinical diagnosis of TMD, and because of the low quality of most of these studies, the data are insufficient to support or reject these tests. Diagnosis, level 2a-.

Craniofacial pain: A neurosurgical outlook

Dear Sir, Myofacial Pain Dysfunction (MPD) is a musculoskeletal dysfunction involving a mal-relationship among the neuromuscular system, temporomandibular joints, and dental occlusion. The disease affects children and adults of all ages and both sexes. Patients complain of pain and / or dysfunction in the mandible, temporomandibular joints, ears, oral cavity, head, and neck. The temporomandibular joint (TMJ) is a paired synovial joint capable of both gliding and hinge movements, articulating mandibular condyle, articular disk, and squamous portions of the temporal bone; and temporomandibular disorders (TMD), as defined by the American Academy of Craniofacial Pain, are a number of clinical problems that involve masticatory muscles, the temporomandibular joint (TMJ) or even both. The etiological factors contributing to TMDs include trauma, anatomical factors, systemic factors, muscular hyperactivity, intra-articular pathology, and psychosocial factors.[1] The most common symptoms of TMJ / TMD include: Headaches (often misdiagnosed as migraines), pain (shoulder, neck, or back), trigeminal neuralgia, Bell's palsy, locking jaw, cracked teeth, numbness in the arms and fingers, facial pain, jaw pain, clicking or popping jaw, clenching or grinding teeth, ringing ears (tinnitus), vertigo, and congested ears. The diagnosis of TMDs includes precise clinical examination, medical and dental history, radiographs, cephalometric views, Computerized Axial Tomography (CAT) scan, and even Magnetic Resonance Imaging (MRI), to visualize more structures including TMJ disk and other soft tissues, dental models, and biometrics. In recent years much attention has been focused on neuromuscular dentistry — a new tool for diagnosing and treating TMD. Neuromuscular dentistry is the science of dentistry that embodies accepted scientific principles of pathophysiology, anatomy, form, and function. It objectively evaluates the complex relationship between teeth, temporomandibular joints, and the masticatory muscles, in order to achieve an occlusion that is based on the optimal relationship between the mandible and the skull — a neuromuscular occlusion. The goal of neuromuscular dentistry is to relax the muscles controlling the jaw position, to establish a true physiological rest position upon which treatment considerations are based.[2] The primary element that sets neuromuscular dentistry apart from traditional dentistry is that neuromuscular dentistry considers the nerves and muscles and the correct positioning of the jaw, whereas, traditional dentistry focuses on just the teeth and joints. The result is a more complete approach, which can resolve painful conditions such as temporomandibular joint disorders, and it provides more comfortable and longer lasting solutions to other dental needs such as dentures and smile makeovers. Neuromuscular dentistry utilizes modern technology to precisely determine the proper positioning of the jaw. It uses computerized instrumentation to measure the patient's jaw movements, via Computerized Mandibular Scanning (CMS) or Jaw Motion Analysis (JMA), muscle activity via electromyography (EMG), and temporomandibular joint sounds via Electro Sonography (ESG) or Joint Vibration Analysis (JVA), to assist in identifying the joint derangements.[2] Surface EMGs are used to verify pre-, mid- and post-treatment conditions before and after ultra-low frequency Transcutaneous Electrical Nerve Stimulator (TENS). By combining both CMS and JMA with ultra-low frequency TENS, the dentist is able to locate a ‘physiological rest’ position as a starting reference position to find a relationship between the upper and lower jaw along an isotonic path of closure up from the physiological rest position, in order to establish a bite position. We still require additional research that would lead toward the evidence necessary for choosing the appropriate treatment techniques. Most pain problems presented to dentists respond to treatment or resolve on their own. However, when pain is chronic and especially if it is associated with significant disability, it is important that the treating dentist screen for psychosocial factors that may affect the patient's pain, functioning, and response to treatment, regardless of the diagnosis and objective findings. Substantial evidence exists that psychosocial dysfunction is prevalent among patients with chronic orofacial pain, most commonly TMD. For chronic orofacial pain, just as for other chronic pain conditions (e.g., tension-type headache, low back pain), psychosocial variables have been found to be more strongly associated with pain intensity and activity interference than have clinical examination findings. Dentists may improve the quality of care provided to patients with oro-facial pain through psychotherapeutic management by referring patients with psychosocial counseling.[3]

Analgesic efficacy of diazepam and placebo in patients with temporomandibular disorders: A double blind randomized clinical trial

The aim of the study was to evaluate and compare the analgesic efficacy of placebo and diazepam in patients with temporomandibular disorder. Thirty-five patients were recruited with a diagnosis of temporomandibular disorder based on standard clinical diagnostic criteria for temporomandibular disorder. The patients were put in to one of the two groups: placebo or diazepam at random. The average pain intensity was recorded with visual analog scale (VAS) at pretreatment, at weekly interval till the completion of a three-week trial and at post-treatment visit on the eighth week from baseline. The secondary outcome measures were changes in masticatory muscle tenderness, viz. massater muscle, lateral pterygoid muscle, medial pterygoid muscle and temporalis muscle and changes in mouth opening. Intra-group comparison for analgesic efficacy and mouth opening was carried out by Wilcoxon's signed ranked test. Inter-group comparison for analgesic efficacy was also carried out using Mann-Whitney's test. A statistically significant (P<0.01) decrease in temporomandibular disorder pain in the placebo group (65%) and statistically highly significant (P<0.001) decrease in the diazepam group (72%) were observed on VAS after three weeks of treatment. The inter-group comparison demonstrated no statistically significant difference between the groups. This study suggests that the placebo can give near similar results as diazepam can. So the role of placebo should also be considered as one of the important management strategies. In the short term, reduction in the masticatory muscle tenderness and significant improvement in the mouth opening in both the groups were observed.

Influence of headache frequency on clinical signs and symptoms of TMD in subjects with temple headache and TMD pain

The relationship of the frequency of temple headache to signs and symptoms of temporomandibular joint (TMJ) disorders (TMD) was investigated in a subset of a larger convenience sample of community TMD cases. The study sample included 86 painful TMD, nonheadache subjects; 309 painful TMD subjects with varied frequency of temple headaches; and 149 subjects without painful TMD or headache for descriptive comparison. Painful TMD included Research Diagnostic Criteria for Temporomandibular Disorders diagnoses of myofascial pain, TMJ arthralgia, and TMJ osteoarthritis. Mild to moderate-intensity temple headaches were classified by frequency using criteria based on the International Classification of Headache Disorder, 2nd edition, classification of tension-type headache. Outcomes included TMD signs and symptoms (pain duration, pain intensity, number of painful masticatory sites on palpation, mandibular range of motion), pressure pain thresholds, and temple headache resulting from masticatory provocation tests. Trend analyses across the painful TMD groups showed a substantial trend for aggravation of all of the TMD signs and symptoms associated with increased frequency of the temple headaches. In addition, increased headache frequency showed significant trends associated with reduced PPTs and reported temple headache with masticatory provocation tests. In conclusion, these findings suggest that these headaches may be TMD related, as well as suggesting a possible role for peripheral and central sensitization in TMD patients.Subjects with painful temporomandibular disorders (TMD) showed significant trends for increased signs and symptoms of TMD associated with increased frequency of concurrent temple headaches.

Condylar metastasis from prostatic carcinoma mimicking temporomandibular disorder: a case report

Although metastatic carcinoma is the most common malignant tumor of the bone, less than 1% of all metastatic bone lesions are presented in the maxillofacial area. As the mandibular body is the most frequent localization, metastasis to the mandibular condyle is extremely rare. This report describes a rare case of prostate carcinoma metastatic to the mandibular condyle in a 75-year old man, who was referred because of persistent pain in the temporomandibular joint (TMJ) region and a limitation of opening, initially misdiagnosed and treated as temporomandibular disorder (TMD). Histopathological examination confirmed the suspected metastasis of prostate carcinoma and local radiation therapy was performed. TMD represent a diagnostic challenge and sometimes an interdisciplinary approach is required to prevent a delay of the correct treatment. Metastatic cancer should be included in the differential diagnosis of TMD, especially in patients with a malignant disease.

Temporomandibular disorders assessment: medicolegal considerations in the evidence‐based era

Summary Temporomandibular disorders (TMD) are a frequent finding in cases of facial trauma or dental malpractice, and legal claims for TMD damage have been increased over the years. Temporomandibular disorders assessment in the medical legal setting is complicated by the peculiarities of these disorders, whose symptoms are heterogeneous, fluctuant, and recognise a multifactorial origin. A systematic Medline search in the National Library of Medicine's PubMed database pointed out that, despite the medical legal aspects of the dental profession are gaining a growing attention, there is a paucity of literature dealing with patients with TMD assessment. For these reasons, evidence-based knowledge in the field of TMD diagnosis and treatment was summarised in this article with the aim of providing useful suggestions for a medical legal approach to TMD.

Evaluation of the Stomatognathic System In Patients with Rheumatoid Arthritis According to the Research Diagnostic Criteria for Temporomandibular Disorders

The aim of this study was to investigate the clinical features of stomatognathic dysfunction in patients with rheumatoid arthritis (RA). The study sample consisted of 40 patients with RA (34 female, 6 male), mean age 44 years, recruited at the Rheumatology Division of the Department of Internal Medicine, University of Pisa, Italy. The inclusion criteria were diagnosis of RA according to the criteria of the American Rheumatism Association (ARA). In the study, 82.5% (n=33) of patients affected by RA satisfied at least the criteria of one diagnosis of temporomandibular disorders (TMD), according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The results are in agreement with the literature and the prevalence of such involvement ranges between 53% and 94% of patients. Several studies reported an involvement of the stomatognathic system in RA. In fact, RA can affect the temporomandibular joint as much as any other synovial joint. A more thorough analysis is required for a multidisciplinary approach to gnathological patients, including assessment by a rheumatologist. This issue and its epidemiologic relevance need further scientific research. Dentistry has a fundamental role in this process since patients who present with a systemic disease such as RA can be recognized and intercepted and referred to medical specialists, i.e., rheumatologists, to provide a diagnosis and therapy.

Effect of Cigarette Smoking On Pain Intensity of TMD Patients: A Pilot Study

To evaluate the effect of cigarette smoking (CS) on pain intensity in a sample of temporomandibular disorder (TMD) patients, 352 clinical charts were reviewed. Subjects were first divided into two groups: smokers (YS) and nonsmokers (NS); then, YS were further divided into three subgroups: light smokers (LS), moderate smokers (MS), and heavy smokers (HS). Overall TMD pain intensity was higher in YS, compared to NS, and a correlation was found between pain intensity and the number of cigarettes smoked in a day by each subject. A significant difference was evident between NS and HS. The results were not evident in males; age was not correlated either with smoking or pain intensity, and the effect of CS on pain intensity was not correlated with any particular TMD diagnosis. CS seems to be a relevant factor affecting the intensity of TMD pain, thus, control of smoking habits should be considered when treating TMD patients.

Improving TMD classification using the Delphi technique

The classification of temporomandibular disorders (TMD) is still controversial. Consensus methods such as the Delphi technique, a method that polls experts' anonymous opinion in an iterative process with controlled feedback and statistical aggregation of group response, could be valuable to improve this challenging topic. The article illustrates the application of the Delphi technique for deciding whether the terms myalgia or myofascial pain should be used in a TMD classification system and discusses the technique's potential for TMD classification in general. In three Delphi rounds, 14 TMD experts from the Division of TMD and Orofacial Pain of the University of Minnesota reached a consensus about which TMD diagnoses should be included in a TMD classification system. They preferred the term myofascial pain over myalgia. The Delphi technique has the potential to provide answers to complex questions in TMD classification, e.g., TMD nomenclature and range as well as scope of conditions included in a future TMD classification system.

Living with Uncertainty

Temporomandibular disorders (TMDs) are a common group of chronic illnesses. There is evidence that health professionals find them difficult to diagnose and manage. A consequence of this difficulty in diagnosis might be that sufferers of TMDs have an experience of illness comparable with other chronic illnesses. To explore the sufferers’ experience of TMDs, we conducted a qualitative study with a purposive maximum variation sample of secondary care TMD patients. Semi-structured interviews were conducted with the sample and were recorded and transcribed verbatim. Data collection and analysis continued until data saturation (n = 19). For analysis, we broadly followed the constant comparative method and used frameworks to organize the data. The key finding was that a lack of diagnosis caused uncertainty over the nature of the cause of the sufferer’s complaint. This uncertainty reportedly caused negative impacts on sufferers’ daily lives. Clearly, diagnosis of TMDs needs to be encouraged at the first point of contact.

Temporomandibular Disorders: Knowledge, Attitude and Practice among Dentists in Tehran, Iran.

Background and aims Temporomandibular disorders (TMD) account for the most common orofacial pains rising from musculoskeletal origin. The aim of this study was to investigate the level of knowledge, attitudes and practice of dental practitioners regarding TMD in Tehran, Iran. Materials and methods A questionnaire, containing 29 questions on etiology, signs and symptoms, diagnosis and treatment of TMD, was given to 200 randomly selected general dental practitioners and specialists as well as 11 TMD ex-perts. Results An overall response rate of 97% was achieved among participants (mean age: 39 ± 8.2 years old; mean years in practice: 11.5 ± 7.4). The mean score of knowledge of TMD was found to be 10.85± 2.54 (of a total of 23). TMD specialists were significantly more knowledgeable than general dental practitioners (p<0.05). With respect to attitude, there was a significant difference among various age groups, and by increasing age and years in practice, the attitude towards TMD had weakened. However, no significant difference was recorded between general dental practitioners’ attitude and that of TMD experts towards TMD. There was a positive correlation between subjects’ knowledge and attitude (P= 0.007, r=0.138). Conclusion According to the results, the level of knowledge and attitude of general dental practitioners of Tehran regarding TMD is not desirable. The majority are not willing to admit and treat TMD patients.

Prevalence of Temporomandibular Disorders in Patients With Gastroesophageal Reflux Disease: A Case-Controlled Study

The present study estimated the prevalence of temporomandibular disorders (TMDs) in patients with gastroesophageal reflux disease (GERD). A study group consisting of 60 adult patients (34 women and 26 men) diagnosed with GERD was matched by age and gender to a control group of 60 patients without any signs or symptoms of GERD. The diagnosis of TMD was established using the Research Diagnostic Criteria for Temporomandibular Disorders. Of the 60 patients in the study group, 22 (36.6%) had TMD compared with 11 (18.3%) in the control group (P = .025). Most patients with TMD in both groups were diagnosed with myofascial pain: 19 (31.7%) in the study group versus 9 (15%) in the control group (P = .031). The increased TMD prevalence in patients with GERD should be explored further to better characterize the association between TMD and GERD. The physicians treating the 2 disorders should consider the clinical implications of this association.

Stomatognathic adaptive motor syndrome is the correct diagnosis for temporomandibular disorders

Temporomandibular disorder is a generic and inadequate conception to be used as a diagnosis. It fails to express the etiology or the pathophysiology and it is mainly associated with the anatomical site. Moreover, the clinical condition presents a mandibular motor problem and not a joint problem. The hypothesis presents the new diagnosis stomatognathic motor adaptive syndrome, which comprehend a motor response and the adaptive processes it induces. Inadequate occlusal contacts cause the mandible to shift in order to reach an ideal intercuspal position. The condylar displacements are proportional to such movements. Temporomandibular joint (TMJ) receptors respond to the capsular mechanical stress and the information reaches the trigeminal sensory nuclei. The mandibular modified position seems to be relevant information and may interfere with catecholaminergic neurotransmission in basal ganglia. The main motor responses comprise increased jaw muscle tone, decreased velocity of movements and incoordination. The overload of muscle function will produce adaptive responses on many stomatognathic structures. The muscle adaptive responses are hypertonia, pain, fatigue and weakness. Temporomandibular joint presents tissue modification, disc alteration and cracking noise. Periodontium show increased periodontal membrane, bone height loss and gingival recession. Teeth manifest increased wear facets, abfraction and non-accidental fractures. The periodontal and teeth adaptive processes are usually identified as occlusal trauma. The altered stomatognathic functions will show loss of velocity during mastication and speech. Fatigue, weakness in jaw muscle and difficulties to chew hard food are related to hypertonia. Incoordination between stomatognathic muscles groups is found, causing involuntary tongue/cheek biting and lateral jaw movements on speech. Otologic complaints, as aural fullness and tinnitus, are related to the tensor tympani muscle, innervated by the trigeminal nerve.

Orofacial Myofunctional Disorder In Subjects with Temporomandibular Disorder

To determine the frequency and degree of orofacial myofunctional disorder (OMD) in a sample of patients with temporomandibular disorder (TMD), the dental records of 240 patients with a diagnosis of TMD were reviewed. Mean patient age and mean TMD duration, gender frequency, complaints, and signs and symptoms were calculated. The results showed that the sample studied was quite characteristic of a TMD group. The presence of the following signs/symptoms was significant: muscular pain, TMJ pain, joint noise, at least one otologic symptom, headache, and neck and shoulder pain. Most subjects presented some degree of OMD, with grade high prevailing over grade low. The importance of evaluating the stomatognathic structures and functions during the clinical examination of patients with TMD is emphasized.

Adapting the diagnostic definitions of the RDC/TMD to routine clinical practice: A feasibility study

The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) is a well-known diagnostic tool for clinical trials on TMD. Objectives This study aims to assess the reliability, validity and feasibility of a new method of physically diagnosing temporomandibular disorders (TMD), designed for routine clinical use. This version, known as Clinical Examination Protocol-TMD (CEP-TMD), was compared to the gold standard original RDC/TMD. Methods A total of 49 subjects (41 referred TMD patients and 8 symptom free subjects) were examined using both RDC/TMD and CEP-TMD versions. Three examiners, with varying levels of experience in diagnosing TMD, worked in pairs. Each member of a pair saw the same patient twice, once for the RDC/TMD and once for the CEP-TMD examination. The examination order was randomized. Each patient's examinations alternated between examiners to reduce the memory effect. Examinations could yield single, multiple or no diagnosis. Kappa statistics were calculated to estimate reliability. Results There was substantial overall agreement between the CEP-TMD and the RDC/TMD (kappa = 0.70). Intra-examination agreements were substantial in both RDC/TMD (kappa = 0.70) and CEP-TMD (kappa = 0.90). For examination and diagnosis, the CEP-TMD was almost 3 min faster than the RDC/TMD ( p < 0.05). Conclusions It was concluded that the CEP-TMD's diagnosis is comparable to the RDC/TMD thus providing a convenient and intuitive approach for dentists to physically diagnose TMD in clinical practice. The well-established RDC/TMD remains the gold standard for research diagnosis of TMD.

TMD in Consecutive Patients Referred for Orthognathic Surgery

To answer the question whether temporomandibular disorders (TMD) were more common in a group of individuals referred for orthognathic surgery than in a control group. The null hypothesis was that neither the frequency of signs and symptoms of TMD or diagnosed TMD would differ between the patient group and a control group. A sample of 121 consecutive patients referred for orthognathic surgery at the Department of Oral Maxillofacial Surgery, Malmö University Hospital, Sweden, was interviewed and examined regarding signs and symptoms of TMD and headaches. A control group was formed by 56 age- and gender-matched individuals attending the Department of Oral Diagnosis, Faculty of Odontology, Malmö University, Sweden, and Public Dental Health Clinic in Oxie, County of Skane, Sweden. TMD diagnoses were used according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The patient group showed more myofascial pain without limited opening, disc displacement with reduction, and arthralgia according to RDC/TMD than the control group. The patient group also had more symptoms and signs of TMD in general. The null hypothesis was rejected because patients who were to be treated with orthognathic surgery had more signs and symptoms of TMD and higher frequency of diagnosed TMD compared with the matched control group.

Kein erhöhtes Risiko für kraniomandibuläre Dysfunktionen und Bruxismus im Kindes- und Jugendalter während der kieferorthopädischen Therapie*

Whether orthodontic therapy is a risk factor for temporomandibular disorders (TMD) or parafunctional habits such as bruxism is a question that has long been discussed. The issue is highly relevant to public health due to the frequency of these functional disorders in the general population and the sheer number of orthodontic treatments. The aim of this cross-sectional study was to investigate the risk of TMD or bruxism in children and adolescents during orthodontic therapy. The study included 1,011 children and adolescents between the ages of 10 and 18 selected at random from the general public who had been examined for signs of TMD using the Helkimo index and Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Parafunctional activities (bruxism) were surveyed and documented in reference to wear effects on the front teeth using the method developed by Egermark-Eriksson. In addition, probands were asked about their current orthodontic treatments. Nearly 30% (N = 296) of the probands stated that they were undergoing orthodontic therapy. Roughly 1/10 proband presented with a clinical TMD according to the Helkimo index (9.6%; N = 97) or a TMD diagnosis according to the RDC/TMD (10.2%; N = 102). After controlling for the effects of age, gender and school-type using a multinomial logistical regression analysis there was no increased risk of anamnestic or clinical TMD symptoms or diagnoses during orthodontic treatment (odds ratios between 0.63 and 1.18; all p-values > 0.05). At the same time, both wear facets on the front teeth (tooth-related mean value with vs. without appliance: 0.12 vs. 0.16; t test: p = 0.038) and self-reported bruxing be havior (OR = 0.57; p = 0.018) were significantly reduced by orthodontic treatment. Our study revealed no increased risk of TMD in children and adolescents during orthodontic therapy, which seems to reduce parafunctional activities and thus the likelihood of noncarious dental damage.

Mandibular function, temporomandibular disorders, and headache in prematurely born children

Objective. To evaluate mandibular function, signs, and symptoms of temporomandibular disorders (TMDs) and headache in prematurely born 8- to 10-year-old children, and to compare the findings with matched full-term born controls. Material and Methods. Seventy-three preterm children were selected from the Medical Birth Register – one group comprising 36 extremely preterm children born before the 29th gestational week, the other group 37 very preterm children born during gestational weeks 29 to 32. The preterm children were compared with a control group of 41 full-term children matched for gender, age, nationality, and living area. The subjective symptoms of TMD and headache were registered using a questionnaire. Mandibular function, signs, and symptoms of TMD and headache were registered. TMD diagnoses were set per Research Diagnostic Criteria for temporomandibular disorders (RDC/TMD). Results. No significant differences between groups or gender were found for TMD diagnoses according to RDC/TMD or for headache. The preterm children had smaller mandibular movement capacity than the full-term control group, but when adjusting for weight, height, and head circumference mostly all group differences disappeared. Conclusions. Prematurely born children of 8 to 10 years of age did not differ from full-term born children when considering diagnoses according to RDC/TMD, signs, and symptoms of TMD or headache.