Incidence Of Temporomandibular Disorders Research Articles

Isolate or combined use of platelet-rich plasma in the treatment of temporomandibular joint osteoarthritis: a concise systematic review

Introduction: In the context of temporomandibular disorders (TMD), temporomandibular joint osteoarthritis (TMJOA) is a common disease in the oral and maxillofacial regions, as well as being the most severe type. The incidence of TMD is high, affecting approximately 5%-12% of the population. There is evidence for the potential superiority of intra-articular platelet-rich plasma (PRP) injections in patients with TMJOA. Objective: This study aimed to carry out a systematic review to highlight the main clinical outcomes of the minimally invasive treatment of osteoarthritis of the temporomandibular joint through the injectable use of platelet-rich plasma. Methods: The research and development of the work were carried out from December 2022 to March 2023 in the Scopus, PubMed, Science Direct, and Scielo databases, using scientific articles from 2011 to 2022, following the PRISMA rules. The quality of the studies was based on the GRADE instrument and the risk of bias by the Cochrane instrument (Funnel Plot). Results and Conclusion: It was found 134 studies that underwent eligibility analysis. The final sample had 48 eligible studies and only 25 studies were described in the systematic review. Most studies showed homogeneity in their results, with X2 =91.2% >50%, with p<0.05. The symmetrical funnel plot did not suggest a risk of bias among studies with small sample sizes. Based on the objective of the present study, important clinical outcomes of the treatment of osteoarthritis of the temporomandibular joint were evidenced through the injectable use of platelet-rich plasma, alone or in combination with other types of treatment. However, it was observed that despite the extensive literature on the use of PRP in the treatment of joint disorders, its application in TMD is still largely unexplored.

Temporomandibular Disorders is associated with Genetic Factors: A Review

Background and objectives: Pain is the most leading cause of visits to physicians and dentists. It is also a common symptom of diseases that can significantly undermine the quality of life and physical activities. This study aimed to review the existing literature for the causes of Temporomandibular Disorders(TMD) from the genetic point of view.
 Methods: Four international scientific databases including Google Scholar, Biomed Central, PubMed, and ProQuest plus two Iranian databases including Magiran and SID. Then all articles published between1980 and 2019were searched using the following keywords: facial pain, genetic factors and temporomandibular disorders (TMDs). A total of 900 articles were found that 36 were review articles.
 Results: Our review shows that genetic factors have an impact on the incidence and pathology of TMDs These factors include TSPAN9 polymorphism and the COMT gene.
 Conclusion: There is growing evidence indicating that genetic factors play a key role in the pathology of temporomandibular disorders, however, the underlying mechanism of pain is still largely unknown.

Relationship between cervical angle and temporomandibular disorders in young and middle-aged population

ABSTRACT Objective To verify temporomandibular disorders (TMDs) and cervical angles in a young and middle-aged population. Methods Ninety participants were included, 45 of whom had TMDs. The participants were diagnosed according to the Research Diagnostic Criteria for TMDs. Lateral cervical radiographs were taken, and relevant cervical angles were measured. The general characteristics of the TMD group and control group were analyzed using chi-square analysis, and the relationship between cervical angles and TMDs was evaluated using the unpaired t-test. Results The decrease in C2–C7 Cobb and increase in the posterior occipitocervical angle (POCA) were associated with the incidence of TMDs (p < 0.0001). Conclusion This study revealed that the cervical angle was related to TMDs. People with a long-time habit of head bending posture had a decrease in C2–C7 Cobb and an increase in the POCA. This group of people was more likely to develop TMDs.

A Classification Tree to Identify Factors Affecting Temporomandibular Disorders

To examine the effects of stress, bruxism, malocclusion, and oral habits on the incidence of temporomandibular disorders (TMDs) using a classification tree method (CTM). We obtained data from a total of 1.338 patients: 669 who had TMDs and 669 who but haven’t TMDs. We recorded interview data on stress and oral habits, and during oral examination, noted malocclusions, bruxism, and any sign of poor oral habits. All data were subjected to CTM analyses. The TMD rate was highest in stressed patients (96.8%), and significantly lower in stress-free patients (25.3%) (P &amp;lt; 0.001). TMD was evident in all patients exhibiting both stress and bruxism (100.0%). In stressed patients lacking bruxism, the effects of malocclusion on TMD were significant (P &amp;lt; 0.001). CTM analyses showed that the most significant factor affecting TMD was stress, followed by bruxism and malocclusion. This is the first report to use CTM to define factors affecting TMD.

Correlation of patients’ demographics and clinical symptoms with temporomandibular disorders

ABSTRACT Objective To investigate the correlation between basic characteristics and clinical features of patients with temporomandibular disorders (TMD). Methods The R language statistical tool was used to analyze the clinical information of 500 TMD patients, i.e., age, sex, joint noises, mouth opening pattern, and pain symptoms, as well as the results of the mandibular push-back test. A pairwise correlation analysis of each clinical feature was carried out. Results The highest incidence of TMD was observed in the age group of 20 to 30 years (240/500). Around 2/3 of the patients showed pain symptoms. Abnormal mouth opening patterns, joint noises, and temporomandibular joint synovitis (TMJS) were observed in 48.4, 65.4, and 34% of patients, respectively. Conclusion Joint click and the corrected deviation of the mouth opening pattern are signs of early-stage TMD, whereas limited mouth opening and TMJS are indicators of progressive stage and complicated TMD.

Incidence of Temporomandibular Disorders in Patients in a University Hospital Setting

Disorders (TMD) is one of the most common pain disorders. TMD is defined as a heterogeneous group of psychological disorders, commonly characterized by pain, difficulty in chewing or both. It is one of the commonest problems affecting common people. This is also one of the most common disorder due to its varied vague signs and symptoms, which makes the common dentist to diagnose wrongly, which ultimately led to wrong treatment. The etiology of disorders is complex, the foremost normally cited factors are emotional tension, interference, genetics, teeth loss, postural deviation, dysfunction, internal and external changes in TMJ structure, either alone or both The disorders of TMJ, muscles and associated structure sometimes occur throughout childhood and adolescence, however with less intensity than in the adult population. Throughout adolescence, TMJ presents with mild or moderate signs and symptoms. So a study of this disorder is needed to create awareness among general dentist. This study aims to evaluate the incidence of disorders in patients reported to Saveetha Dental College. A total of 77 patients who underwent treatment for TMD were included in this study. The study was conducted at Saveetha Dental College. Data were collected from patients dental records. All the data were recorded and analyzed statistically using SPSS software. From the analysis, females were more prevalent than the male population. The most common treatment undergone by patients diagnosed with disorders is . Females are shown more prevalent than Male. A detailed examination should be done for better diagnosis and prognosis.

The Association between Temporomandibular Disorder and Sleep Apnea-A Nationwide Population-Based Cohort Study.

An increased incidence of temporomandibular disorders (TMD) among patients with sleep apnea (SA) has been reported. However, the association between TMD and SA has not been demonstrated in a large-scale study. This population-based cohort study with the Taiwan National Health Insurance (NHI) Research Database aimed to understand the association between SA and TMD. We identified adult patients with suspected SA (identified with diagnostic codes) and excluded those diagnosed with TMD prior to SA. Patients with SA diagnosis after polysomnography were also identified as probable SA patients. The index dates were the dates of their initial SA diagnosis. Ten control subjects were matched, by age and sex, to each SA patient, and were assigned the same index dates as the SA patients. In total, 10,408 suspected SA patients (including 4105 probable SA patients) matched to 104,080 control subjects (including 41,050 subjects matched to the probable SA patients) in this study. The TMD incidence rate was significantly higher in the SA patients than in the control subjects (2.8 vs. 1.0 per thousand-patient-year in probable SA patients vs. the corresponding control subjects, with an adjusted incidence rate ratio [95% confidence interval] = 2.5 [2.3–2.7], p < 0.0001). SA patients significantly showed a higher cumulative incidence of TMD than the corresponding control subjects (p < 0.0001). Multivariable Cox regression analysis revealed SA as an independent risk factor for the development of TMD (adjusted hazard ratio = 2.5 [1.7–3.7], p < 0.0001). In summary, this study confirmed an increased TMD incidence in the SA patients. While treating TMD patients, dentists should pay careful attention to the potential underlying SA.

Study on the correlation between the mandibular masticatory muscle movement and sleep tooth wear

To investigate the correlation between the clinical diagnostic criteria of sleep bruxism and the frequency of mandibular movements during sleep. Video polysomnography was used to record 20 healthy adults with at least one of the following clinical symptoms and signs: 1) report of frequent tooth grinding; 2) tooth wear and dentin exposure with at least three occlusal surfaces; 3) masticatory muscle symptoms in the morning; 4) masseter muscle hypertrophy. The rhythmic masticatory muscle activity (RMMA) and isolated tonic activity were scored to compare the correlations with clinical symptoms and signs. Finally, the incidence of temporomandibular disorders (TMD) was investigated in patients with isolated tonic and RMMA subjects. Among the 20 subjects, RMMA events were observed (5.8±3.1) times·h⁻¹ and isolated tonic episodes were observed (2.1±0.9) times·h⁻¹. The frequency of RMMA events was significantly greater in the patients with acoustic molars than in those without (P<0.05). Similarly, the frequency of RMMA events was significantly greater in the patients with tooth attrition than in those without (P<0.05). However, no difference was observed between the occurrence of RMMA and the symptoms of masticatory muscles or masseter hypertrophy in the morning. The incidence of TMD was significantly higher in the patients with RMMA than in the isolated tonic patients. The clinical symptoms and signs often used to diagnose sleep bruxism are different clinical and physiological mandibular movements during sleep. RMMA during sleep can reflect the occurrence of tooth attrition and the high risk of TMD.

Effect of Orthodontic Treatment With Straight-Wire Appliance on the Incidence of Temporomandibular Disorders—A 3-Year Cohort Study

Introduction: A change in occlusion during orthodontic treatment can affect muscles and joints surrounding the jaw, resulting in temporomandibular disorders (TMD). The aim of this study was to determine the effect of orthodontic treatment with straight-wire appliance on the incidence of TMD in young adults. Materials and Methods: A cohort study was carried out involving 177 adult patients (91 in the treatment group and 86 in the control group). Fonseca’s questionnaire was used for TMD evaluation for all patients at the time of obtaining orthodontic pretreatment records (T0). TMD assessment was repeated after an average of 3 years of initial assessment for both the treatment and control groups (T1). Results: The number of patients with TMD changed significantly ( P &lt; .001) from T0 to T1 in both groups. The prevalence of TMD increased from 36.3% to 41.8% in the treatment group and decreased from 46.5% to 38.4% in the control group after 3 years. The relative risk of developing TMD after orthodontic treatment was 1.16, whereas the odds of TMD resolution after orthodontic treatment was 0.73, both of which were statistically nonsignificant ( P &gt; .05). Conclusion: Orthodontic treatment with noncustomized straight-wire appliance has nonsignificant effects on the incidence of TMD in young adults.

An evaluation of referrals requesting third molar tooth removal: clinical diagnosis and treatment outcome.

Introduction To determine the reasons why patients are referred requesting removal of third molar teeth.Method Prospective evaluation of referrals requesting removal of third molar teeth only. Following review of symptoms, clinical, and if appropriate, radiographic findings, a diagnosis according to pre-defined criteria was made, and verified by a senior member of staff.Results 662 individual referrals were received requesting removal of 1,117 individual third molar teeth, of which 73% were for mandibular teeth. A total of 195 teeth (17.6%) were not removed as there was no disease process or insufficient symptoms. In 124 cases (11.1%) a diagnosis of temporomandibular disorders was made with no dental surgery being required. Other reasons for patients not proceeding to surgery were: no symptoms or sign of disease; symptoms were from an adjacent tooth; only single episode of pericoronitis; late incisor crowding; and cervical sensitivity.Conclusion While most patients referred did proceed to have removal of third molar teeth, a significant proportion had symptoms related to chronic orofacial pain that would not have been influenced by removal of third molar teeth. The overall incidence of temporomandibular disorders within the patient sample, either as a primary, secondary or tertiary diagnosis was 18.7%.

Temporomandibular disorders and Burnout syndrome in students of the eighth period of dentistry course

ABSTRACT Objective: To investigate the incidence of painful temporomandibular disorders (TMD) and Burnout Syndrome (BS) in Dentistry students, based on the subjective perception of signs and symptoms, and to verify if there is a coexistence relation between these conditions. Methods: 57 students (8th period of the dentistry course, 23 years mean age), 39 women and 18 men, responded to the Maslach Burnout Inventory Questionnaire – Students Survey (MBI-SS), ProTMDMulti and were evaluated for the presence of TMD diagnosis (DC/TMD). Results: The incidence of TMD was 22% and BS was 8.7%. Among the students with BS, 80% had a TMD diagnosis, as well as a greater subjective perception of TMD signs and symptoms and a longer duration of pain. They also showed higher scores of signs/symptoms perception for situations involving orofacial function. Conclusion: There seems to be a clinical coexistence between the BS and painful TMD in the studied sample, Dentistry students with BS and high scores on the MBI-SS are more likely to have painful TMD.

Relación entre síndrome de disfunción temporomandibular y síndrome de latigazo cervical tras un accidente de tráfico. Estudio de cohortes

IntroductionWhiplash is a frequent condition in rehabilitation centres, and according to the literature there is a great controversy about its relationship with temporomandibular disorders (TD). The objective of this study is to determine whether there is a higher incidence of TD in patients diagnosed with whiplash during the first 3 and 12 months after having suffered a vehicle accident, and to determine associated risk factors. Patients and methodProspective cohort study conducted between February 2013 to December 2015 with a cohort of 71 adults (36 men and 35 women) that had suffered a Quebec Task Force whiplash grade I or II, together with an unexposed cohort of 70 adults (46 men and 24 women). They were evaluated at 3 and 12 months using the Fonseca's Simplified Anamnestic Index (IASF) ResultsThe results obtained at 3 months showed that the proportion of TD in the exposed cohort was statistically higher than in the non-exposed cohort (53.0% versus 13.4%, P<.0001). At 12 months, the results showed that the proportion of SDT was statistically higher in the exposed cohort than in the non-exposed cohort (53.2% versus 21.7%, P<.0005). ConclusionsAfter a whiplash there is a greater probability of developing a TD. In addition, in the exposed cohort there is a greater deterioration over time in the IASF. The back pain and paraesthesias after a whiplash are symptoms to be taken into account, as they show a statistically significant probability of developing TD.

Incidence of Temporomandibular Disorders Among Dental Students

Incidence of Temporomandibular Disorders Among Dental Students

Do patients with malocclusion have a higher prevalence of temporomandibular disorders than controls both before and after orthognathic surgery? A systematic review and meta-analysis

PurposeThe aim of this study was to identify, through meta-analysis, whether patients who require orthognathic surgery have a higher prevalence of temporomandibular disorders (TMDs) than controls, both before treatment and after. Material and methodsA systematic review and meta-analysis were conducted based on PRISMA guidelines, to address the study purposes. A search of major databases through PubMed, EMBASE, and Cochrane CENTRAL was performed to locate all pertinent articles published from inception to June 2016. Inclusion criteria were controlled clinical studies, either prospective or retrospective, and case-control studies comparing preoperative and postoperative signs and symptoms of TMDs in patients who undergo orthognathic surgery to those of a healthy volunteer population with no dentofacial deformities. The predictor variables were patients with dentofacial deformities who underwent orthognathic surgery and patients with no dentofacial deformities and with good maxillomandibular relations and normal occlusion. The outcomes variables were the weighted, prevalence rate (proportion) in signs and symptoms of TMDs in patients with dentofacial deformities and risk ratio (RR) of signs and symptoms of TMDs before and after orthognathic surgery, compared to the control group. ResultsA total of 542 patients enrolled in 6 studies were included in this analysis. The overall pooled weighted rate or prevalence of TMDs for orthognathic surgery patients preoperatively was 32.5% (95% CI = 26.7%–38.9%). There was a significant difference between the 2 groups with respect to TMDs before surgery, but no significant difference in TMDs after surgery. The RR for patients who had dentofacial deformities before orthognathic surgery compared with a control group was 1.634 (95% CI = 1.216–2.194; P = 0.001). The RR for patients after orthognathic surgery compared with a control group was 1.262 (0.718; 95% CI = 0.805–1.979; P = 0.311). ConclusionThe results of this study show that patients who are going to have a correction of their malocclusion by orthodontics and orthognathic surgery have a significant incidence of TMDs when compared to a control population, but that after treatment, the incidence of TMDs does not differ from a control population. The reasons for these findings are not clear.

The effects of clinical wear on the incidence of temporomandibular disorders among patients with complete dentures

Abstract Objective This study evaluates the effect of clinical wear on the incidence of temporomandibular disorders in patients with complete dentures. Methods A randomized clinical trial was conducted on two groups; group 1 (30 patients) received complete upper and lower dentures with teeth made of heat-cured acrylic resin, and group 2 (29 patients) received complete upper and lower dentures with teeth fabricated of porcelain. The occurrence and clinical examination of temporomandibular disorders were evaluated using Helkimo anamnestic dysfunction index (Ai) and Helkimo clinical dysfunction index (Di), respectively. Clinical wear of denture teeth was estimated by the assessment of wear depth using the mean differences between tracing images of lingual cusps at each follow-up. The patients were followed up at 6, 12, 18 and 24 months for assessment of clinical wear and incidence of temporomandibular disorders. Results The acrylic resin group was subjected to significantly higher wear than the porcelain group at 12, 18 and 24 months of follow-up. The incidence of temporomandibular disorders was also significantly higher in the acrylic resin group than in the porcelain group at 18 and 24 months of follow-up. Conclusion There was higher incidence of temporomandibular disorders among patients who wore complete dentures with teeth made of acrylic resin than in patients who wore complete dentures with porcelain teeth.

Association of edentulousness and removable prosthesis rehabilitation with severity of signs and symptoms of temporomandibular disorders.

There are very few studies concerning the role of denture status in temporomandibular disorders (TMDs) and those show conflicting results. To evaluate the association of edentulousness and removable prosthesis rehabilitation with severity of TMD signs and symptoms. Data were collected from 2000 subjects reporting for dental treatment, above 30 years of age. The subjects were interviewed with a questionnaire and clinically examined for TMD on basis of Helkimo's index. The number of existing teeth, wearing of removable dentures, need for denture repair, and age of dentures was recorded. The association between the TMD findings and recorded variable outcomes was analyzed by means of Chi-square test. Completely edentulous individuals associated more with TMD related findings in incidence and intensity than partially/fully dentate subjects. Complete denture wearers were more associated with TMD symptoms, limited mandibular mobility, muscle tenderness, and pain on mandibular movement. Partial denture wearers were more associated with severely impaired temporomandibular joint function and joint pain. Signs and symptoms of TMD were more prevalent and severe in patients who needed to get their dentures repaired, those wearing dentures more than 5-year-old, and in patients who had not got their dentures repaired during the past 5 years. Edentulousness, complete/partial denture wearing and poor condition of the dentures associate with greater incidence and intensity of TMD associated signs and symptoms.

Prevalence of temporomandibular disorders among junior high school students who play wind instruments.

This study investigated whether playing wind instruments has adverse effects on musculoskeletal functions among junior high school students who play in music clubs. The study included 210 junior high school students (35 boys, 175 girls) belonging to 1 of 4 different school clubs that practiced playing wind instruments more than 6 days/week. The mean age of the participants was 14 years. The study was performed using a questionnaire survey and an electromyographic examination of jaw and cervical muscle activities during playing wind instruments. The prevalence of temporomandibular disorders (TMD) among the children playing woodwind (WW) or brass wind (BW) instruments was higher than in those playing non-wind (NW) instruments. Long duration of playing WW with a reed mouthpiece or BW with a small mouthpiece was suggested to affect the incidence of TMD, which was more marked in girls than in boys, irrespective of height or weight. Muscle activity in the masseter muscle during playing an instrument was significantly higher in the BW with a small mouthpiece group than in the NW group (p < 0.05). In cervical muscles, muscle activity of both the sternocleidomastoid and trapezius muscles was higher during playing BW than in the case of other instruments, and activity in the sternocleidomastoid muscle was significantly higher in the BW with a small mouthpiece group than in the case of other instrument groups (p < 0.05). Playing wind instruments may have adverse effects on musculoskeletal functions among junior high school students playing in music clubs as compared with playing NW instruments. The prevalence of TMD among the students playing wind instruments was higher than in those playing other instruments. Long duration of playing those instruments affects musculoskeletal function, and this effect is more marked in girls than in boys, irrespective of height or weight.

Influence of orthognathic surgery for symptoms of temporomandibular dysfunction

To evaluate the influence of orthognathic surgery on the clinical signs and symptoms of temporomandibular disorders (TMDs). In a cohort study, 54 patients undergoing orthognathic surgery were evaluated with regard to the signs and symptoms of TMDs through subjective and objective assessments. These evaluations were performed 1 week preoperatively (T1), 1 month postoperatively (T2), and 6 months postoperatively (T3). The evaluations included patient variables and surgery. Univariate analyzes were performed to verify the association of the variables (P < .05). The incidence of TMD 6 months after orthognathic surgery was significantly lower (P < .001). TMD intensity decreases significantly in the postoperative period. Females had a higher prevalence of TMD (P = .003) and muscular disorders preoperatively (P = .001). There was a decrease in clicks between T1 and T3 (P = .013). Mouth opening without pain worsened from T1 to T2 (P < .001) and improved from T1 to T3 (P = .015) and T2 to T3 (P < .001). The results were similar for mouth opening with pain (P < .001). In patients undergoing jaw fixation with bicortical screws, mouth opening without pain was significantly less in T3 patients than in patients undergoing fixation with plate and monocortical screws (P = .048). Orthognathic surgery reduces the clinical signs and symptoms of TMD.

Effect of chin-cup treatment on the temporomandibular joint: a systematic review.

To systematically search the literature and assess the available evidence for the influence of chin-cup therapy on the temporomandibular joint regarding morphological adaptations and appearance of temporomandibular disorders (TMD). Electronic database searches of published and unpublished literature were performed. The following electronic databases with no language and publication date restrictions were searched: MEDLINE (via Ovid and PubMed), EMBASE (via Ovid), the Cochrane Oral Health Group's Trials Register, and CENTRAL. Unpublished literature was searched on ClinicalTrials.gov, the National Research Register, and Pro-Quest Dissertation Abstracts and Thesis database. The reference lists of all eligible studies were checked for additional studies. Two review authors performed data extraction independently and in duplicate using data collection forms. Disagreements were resolved by discussion or the involvement of an arbiter. From the 209 articles identified, 55 papers were considered eligible for inclusion in the review. Following the full text reading stage, 12 studies qualified for the final review analysis. No randomized clinical trial was identified. Eight of the included studies were of prospective and four of retrospective design. All studies were assessed for their quality and graded eventually from low to medium level of evidence. Based on the reported evidence, chin-cup therapy affects the condylar growth pattern, even though two studies reported no significance changes in disc position and arthrosis configuration. Concerning the incidence of TMD, it can be concluded from the available evidence that chin-cup therapy constitutes no risk factor for TMD. Based on the available evidence, chin-cup therapy for Class III orthodontic anomaly seems to induce craniofacial adaptations. Nevertheless, there are insufficient or low-quality data in the orthodontic literature to allow the formulation of clear statements regarding the influence of chin-cup treatment on the temporomandibular joint.

The incidence and prevalence of temporomandibular disorders and posterior open bite in patients receiving mandibular advancement device therapy for obstructive sleep apnea

This study aims to evaluate the incidence and prevalence of temporomandibular disorders (TMD) in patients receiving a mandibular advancement device (MAD) to treat obstructive sleep apnea using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). In addition, it also aims to assess the development of posterior open bite (POB). Data from 167 patients were evaluated at baseline, from 159 patients after 118 days (visit II), from 129 patients after 208 days (visit III), and from 85 patients after 413 days (visit IV). The presence of TMD symptoms was evaluated through a questionnaire. TMD signs were assessed using the RDC/TMD. Clinical evaluation assessed for the presence of POB. The prevalence of TMD was 33/167 (19.8 %) at baseline. After an initial decrease to 14.5 % on visit II, the prevalence increased to 19.4 % on visit III and finally demonstrated a decrease to 8.2 % on visit IV. The incidence of TMD was 10.6 % on visit II. This decreased on further visits and only two (1.9 %) patients developed TMD from visit III to visit IV. POB was found to develop with an average incidence of 6.1 % per visit. The prevalence of POB was 5.8 % on visit II, 9.4 % on visit III, and 17.9 % on visit IV. The use of MADs may lead to the development of TMD in a small number of patients. Nevertheless, these signs are most likely transient. Patients with pre-existing signs and symptoms of TMD do not experience significant exacerbation of those signs and symptoms with MAD use. Furthermore, these may actually decrease over time. POB was found to develop in 17.9 % of patients; however, only 28.6 % of these patients were aware of any bite changes.