Symptoms Of Temporomandibular Joint Disorders Research Articles

MRI characteristics of the asymptomatic temporomandibular joint in patients with unilateral temporomandibular joint disorder.

To determine the association between unilateral temporomandibular joint disorder (TMD) and the presence of imaging abnormalities in the contralateral, asymptomatic joint. MRI studies of 219 subjects with symptoms of unilateral TMD were examined for signs of disc displacement, osteoarthritis, disc deformation, and effusion in both temporomandibular joints (TMJ). The Chi-Square test and stepwise logistic regression analysis were performed. Disc displacement, osteoarthritis, disc deformation, and effusion were more common on the symptomatic side. However, in the category of disc displacement with a reduction in open mouth position (DDWR), the difference was not significant between the symptomatic and the asymptomatic TMJs. Stepwise logistic regression showed that the presence of any imaging abnormality other than DDWR was related to osteoarthritis and disc deformity on the symptomatic side. On the other hand, the presence of any MRI abnormality (including DDWR) on the asymptomatic side was related only to the presence of osteoarthritis on the symptomatic side. Unilateral symptomatic TMD is related to the presence of imaging abnormalities on the contralateral, asymptomatic side, suggesting that the development and progression of joint changes in symptomatic and contralateral asymptomatic TMJs are interrelated.

Changes in the temporomandibular joint clicking and pain disorders after orthognathic surgery: Comparison of orthodontics-first approach and surgery-first approach.

The purposes of this study were to investigate the influence of the orthodontics-first approach (OFA) and surgery-first approach (SFA) on changes in the signs and symptoms of temporomandibular joint disorders (TMDs) and to compare pre- and postoperative orthodontic treatment duration and total treatment duration between the two approaches. This retrospective study recruited 182 adult patients with malocclusions treated with OFA and SFA and recorded variables such as age, gender, skeletal classification, and signs and symptoms of TMD (clicking and pain disorders) before the start of the surgical-orthodontic treatment and after surgery. Changes in the signs and symptoms of TMD and treatment duration were evaluated within each approach and compared between two approaches. A binary logistic regression was performed to assess the influence of the variables on the postoperative signs and symptoms of TMD. There were no significant postoperative changes in temporomandibular joint (TMJ) pain for OFA and SFA, whereas a significant reduction was found in TMJ clicking after surgery for both approaches. According to binary logistic regression, the type of surgical-orthodontic treatment (OFA or SFA) was not a significant risk factor for postoperative TMJ clicking and pain, and the risk of postoperative TMJ clicking and pain was significant only when TMJ clicking (OR = 10.774, p < 0.001) and pain (OR = 26.876, p = 0.008) existed before the start of the entire treatment, respectively. With regard to the treatment duration, SFA (21.1 ± 10.3 months) exhibited significantly shorter total treatment duration than OFA (34.4 ± 11.9 months) (p < 0.001). The results of this study suggest that surgical-orthodontic treatment using SFA can be a feasible option of treatment for dentofacial deformities based on the equivalent effect on TMD and shorter overall treatment period compared to conventional surgical-orthodontic treatment using OFA.

Are temporomandibular disorders associated with facial asymmetry? A systematic review and meta-analysis.

To assess scientific evidence of the association between temporomandibular joint (TMJ) disorders and facial asymmetry (FA). A systematic review was performed in accordance with the PRISMA checklist. A search strategy was developed in electronic databases including MEDLINE, Scopus, Web of Science, Virtual Health Library and Cochrane Library until January 2020. Eligibility criteria included observational studies that investigated the occurrence of FA among patients with and without signs and symptoms of TMJ disorders. Risk of bias of individual studies was analysed after study selection and data collection processes according to Fowkes and Fulton guidelines. Four meta-analyses (MA) were performed to evaluate the association between TMJ disorders andlinear/angular menton deviation, subgrouping the studies intounilateral and bilateral cases. The evidence was certainty-tested using the GRADE approach. The search retrieved 2371 studies, 31 of which were eligible for full-text reading. Seven cross-sectional clinical studies met the eligibility criteria and were included in the qualitative synthesis, comprising a total of 621 subjects (345 with TMJ disease and 276 in control group), four of which were classified as being methodologically sound. Five studies were eligible for quantitative synthesis. Linear and angular menton deviation was greater in individuals with unilateral TMJ disorders than controls (MD=2.41 [0.33, 4.50] P=.02; I2 =86% and MD=2.68 [0.99, 4.38] P=.002; I2 =0%, respectively). Despite the low certainty in evidence, the present study indicated that unilateral TMJ disorders are associated with FA. However, longitudinal studies with greater certainty of evidence should be conducted to achieve a stronger estimate of this association.

Temporomandibular dysfunction in patients with a history of stroke.

Background: The temporomandibular joint (TMJ) is certainly one of the most complex joints in the human body. The American Academy of Orofacial Pain defines temporomandibular joint disorder (TMD) as a set of disorders involving the masticatory muscles, the TMJ, and associated structures. It is pointed as the main cause of non-dental pain in the orofacial region, including head, face and related structures. The most common TMD symptoms involve joint, chewing and face pain. There may also be crackling when opening and closing the mouth, earache, tinnitus, dizziness, dislocations, limitation of movement and painful tenderness to palpation. Stroke causes sequelae in subjects that include motor disorders, speech or language disorders, and swallowing disorders. Approximately 50% of patients with hemiparesis after stroke are known to have facial control deficiency, weakened orofacial and mandibular functions. Objective: To evaluate patients with a history of stroke, seeking a possible relationship with TMD, the pain associated with this change, and the limitations of range of motion related to the presence of hemibody spasticity in patients post stroke. Methods: The sample consisted of 19 patients of both genders, aged 55 to 70 years, who had suffered stroke. It was used the RDC/TMD for TMD diagnosis, Pressure Pain Threshold test, Ashworth scale, and Sanny Fleximeter for cervical ROM evaluation, being the statistical analysis performed by the software Bioestat version 5.3. Results: TMD was diagnosed in 81.8% of the sample, and of these, 45.4% had a diagnosis of disc displacement with reduction. Conclusion: There was an increase in the muscle tone and the pressure pain threshold, and a decrease in cervical spine ROM, related to the affected side and diagnosed with this disorder, observing that the muscle alterations caused by stroke may be predisposing factors to patients, to the development of muscle TMD or even joint TMD.

Short-Term Effects of Intra-Articular Hyaluronic Acid Administration in Patients with Temporomandibular Joint Disorders.

The study described in this paper was conducted to assess the short-term outcomes of intra-articular administration of hyaluronic acid in patients with symptoms of temporomandibular joint disorders. A group of 40 patients suffering from temporomandibular joint disorders underwent a series of hyaluronic acid intra-articular injections. Questionnaires and clinical examinations were conducted to assess stress exposure of the subjects and to evaluate short-term treatment outcomes, i.e., reducing joint and muscle pain and increasing the mobility of the mandible. A weak positive correlation between stress exposure and pain was observed. As a result of treatment, 61% of subjects revealed a total reduction of muscle pain, while joint pain completely resolved in 88% of patients. Mandibular mobility increased by 11%, 31%, 9%, and 11% regarding opening, protrusive, and lateral right and left movements, respectively. The study confirms the short-term effectiveness of intra-articular administration of hyaluronic acid on reducing joint and muscle pain in patients with articular disc displacement. The treatment positively affected the mobility of the mandible in all directions. The verification of late treatment effects of hyaluronic acid viscosupplementation requires the continuation of the research.

Comparison of the Usefulness of CBCT and MRI in TMD Patients According to Clinical Symptoms and Age

Recently, the number of patients who visit the hospital with symptoms of temporomandibular joint disorders (TMD) has been gradually increasing, and the need for special imaging such as cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) is increasing for accurate diagnosis and treatment. The purpose of this study was to help the image guideline by comparing the usefulness of CBCT and MRI according to the clinical symptoms of TMD patients and further examining whether the usefulness varies with age. A total of 473 temporomandibular joints (TMJs) with clinical symptoms of TMD who underwent both CBCT and MRI examinations were retrospectively reviewed. Clinical symptoms included pain, sound and limited mouth opening. The CBCT findings included sclerosis, flattening, erosion and osteophyte, while the MRI findings were defined as disc deformity, disc derangement or joint effusion. Joints were divided according to the presence of CBCT and MRI findings as follows: type I (neither CBCT nor MRI findings), type II (only CBCT findings), type III (only MRI findings) and type IV (both CBCT and MRI findings). We assessed the usefulness of the two imaging modalities by comparing the frequency of those four groups according to clinical symptoms and age. In TMD patients with the clinical symptoms, MRI and CBCT are complementary, but if it is difficult to choose the first of these two modalities, MRI is more recommended, and the younger the patient, the more the MRI is recommended.

Prevalence of temporomandibular disorders among Palestinian medical students

Temporomandibular joint disorder (TMD) is a collective term that involves alterations in the temporomandibular joint, muscles of mastication and the occlusion. The TMD disorder is a common health problem which affects about 33% of the population within their lifetime. The aim of this study was to evaluate the prevalence of TMDs among university students in Palestine. The role of various risk factors in the etiology of TMD symptoms was also addressed. This is a cross sectional study based on a self-administered questionnaire. The study sample consisted of 416 dental and medical field students from all cities of Palestine studying at Arab American University of Palestine (with an age range of 18 – 27 years). In this study, 63.5% (n = 264) of the investigated students had at least one TMD symptom; clenching was the most prevalent TMD (35.6%) followed by joint noise (33.4%) while locked jaw was the least prevalent (10.6%) symptom. In the conclusion high prevalence of TMD among Palestinian medical students was reported, females reported more pain on TMJ area than males, age group (23 to 25) years reported more frequency of clenching than the other age groups, and strong correlation was found between stress, headache and TMD.

Outcomes of temporomandibular joint disorders treatment after a survey in the population of Uttarakhand, Part I: An epidemiological study

AimTo observe the prevalence of signs and symptoms of Temporomandibular joint disorders in patients visiting outpatient department, AIIMS Rishikesh. Method and materialThe survey was conducted in a total of 960 patients, who visited outpatient Department (OPD), dept of Dentistry, AIIMS Rishikesh and were asked to fill a questionnaire based on Fonseca questionnaire for TMD in accordance to the inclusion and exclusion criteria. ResultsOut of 960 patients, 449 had no TMD, 322 patients had mild TMD, 123 moderate and severe TMD was seen in 54 patients. Also, male dominance for TMD was seen in all the groups. There was no age predilection; however most of the patients with severe TMD fell between 16 and 60 years of age. ConclusionTMD is a common problem occurring in all age groups, there was a male dominance seen in the epidemiological study.

Correlation between temporomandibular joint dysfunction and Eichner classification

Introduction: The Dental Prosthetics Department's most common patients are elderly who have lost their teeth. Dental deficiencies not only impair the functions of the stomatognathic system but can also be the cause of temporomandibular disorders (TMD). Deficiencies in the lateral sections lead to a decrease in the occlusion height in patients, which negatively affects the aesthetics of the face by shortening the lower floor and overloading the remaining teeth, eventually leading to their pathological wear. Loss of occlusion height changes the spatial arrangement of the lower jaw to the upper jaw, which can lead to changes in the temporomandibular joint. The loss of a tooth or group of teeth is an indication for proper prosthetic treatment. The dentist should be able to take into account, evaluate and, if necessary, cure TMD, but this is not a common skill among dentists. Such treatment requires an appropriate comprehensive approach. There are currently no standards for such treatment. We presented one of the methods as part of our study.Purpose of work:The aim of the study was to check the correlation between the occurrence of temporomandibular disorders and missing teeth and used prosthetic restorations. Material and methods:Medical history records of 58 patients under the care of the Department of Dental Prosthetics at Medical University of Lublin were analyzed. Factors such as age and gender, occlusion height, distribution of missing teeth according to the Eichner classification and symptoms of temporomandibular joint disorders, i.e. crackling, pain, limited and excessive abduction of the jaw were checked. Before starting prosthetic treatment, every patient underwent comprehensive conservative, surgical and periodontics treatment in accordance with existing needs. Results:The study group consisted of 38 women and 20 men. The average age of all patients was 69.6 years; - average for men - 70.45 years, women 68.16 years. The oldest patient was an 88-year-old man, and the youngest was a 43-year-old woman. 31% of patients were toothless. 25.9% of patients had pain within the stomatognathic system, of which 86.7% were women and 13.3% men. Relaxation splint was made in 24.1% of patients.Summary:The study showed that the ailments associated with the stomatognathic system are correlated with a reduction in occlusion height. Larger dental deficits are more common in older people. Pain symptoms are the most common cause of making relaxation splints. Women more often than men complain of pain. The correct treatment scheme for patients with missing teeth and long-term loss of support zones is staggered treatment - two-stage. The first stage of treatment is to restore the correct occlusion height by using the occlusal splint. Then, after the adaptation period, there is a transition to the second stage of treatment - the use of proper prosthetic restoration maintaining the correct height of occlusion

Impact Age in Treatment Myofacial Pain with Temporomandibular Joint Disorders by Botox Injection

Background: Temporomandibular joint disorder is defined as a dysfunctional temporomandibular joint resulting from myoarthropathy of the masticatory system because of possible multifactorial nature of the disorder. Use of botulinum toxin A injections in treatment temporomandibular joint disorder that caused locally reduction of muscle activity by inhibiting acetylcholine release at the neuromuscular junction leading to decreases the muscle contractions, relief of myofacial pain and relieve the tenderness and restore functions of the temporo mandibular joint. The current study aim to evaluate the effect and duration of botulinum toxin type A (BTX-A) injections in the masseter, temporalis and lateral pterygoid muscles to treat Temporomandibular joint disorder symptoms in terms of pain intensity, maximum mouth opening, joint click and deviation on opening, with correlation of the patients age during three months following injection. Materials and Method: The human sample consists of 28 patients suffered from myofacial pain, trismus, and TMJ sounds related to temporo mandibular joint dysfunction, males and females, with age range of (16-42) years. The subjects recruited for the study were patients attending and whose get treatment with 100 U dose of botulinum toxin type A (BTX-A) was injected with 100 mL at sites per masseter, temporalis and lateral pterygoid muscles that carried out at the dental clinics. The subjects were divided into four groups: Group I : consisted of 7 males and females patients, with age 16-22. Group II : consisted of 7 males and females patients with age 23-29. Group III : consisted of 7 males and females patients with age 30-36. Group IV : consisted of 7 males and females patients with age 37-43, all of these patients had symptoms of myofacial pain with Temporo mandibular joint disorders of whole groups. The clinical evaluation: An intraoral examination was performed to assess the dental occlusion and teeth and periodontal damage caused by bruxism or parafunction. The existence of dentoskeletal dysmorphosis was also evaluated. The initial and follow-up reports after the BTX-A injection identified four main TMD symptoms: pain intensity, maximum mouth opening, joint click, and deviation on opening, and clinical evaluation of efficacy and tolerance was performed at 10 days, 1 month and 3 months after the injection. Patients were re-examined to assess the pain intensity, maximum mouth opening, joint click, and deviation on opening, the symptom release, and average duration of the BTX effect. Results: The mean age of patients was 29.4 ± 7.879 years (ranged from 16.2 to 42.0 years). A detailed sex and age distribution . Highest mean and ± SD (standard deviation) values of the pain intensity, maximum mouth opening, joint click and deviation on opening were recorded in Group IV (older age ), followed by Group III then Group II and Group I (younger age) in the initial (pre-treatment visit) and follow-up visits after the BTX-A injection. Inter study visits comparisons of each group regarding of the pain intensity, maximum mouth opening, joint click, and deviation on opening revealed, HS differences between the initial (pre-treatment visit) and follow-up visits after the BTX-A injection. Conclusions: Aging process leads to change physiology of neuromuscular junctions and distinct muscle mass and strength loss. The decline of the effectiveness and duration of BTX-A used as same dosage in the older group than the younger group, so that mean BTX-A dosages of the older group was little higher required than those used of the younger group in treatment of temporomandibular joint disorders and pain relief.

Thoracic spine manipulation did not improve maximal mouth opening in participants with temporomandibular dysfunction.

Temporomandibular joint disorders (TMD) have a prevalence of more than 5% in the general population. A positive correlation exists between temporomandibular joint mobility and cervical spine mobility. Similarly, a relationship exists between thoracic and cervical spine mobility. However, it is unknown if interventions to improve the mobility of the thoracic spine positively impact temporomandibular joint motion and pain. This study tested the hypothesis that a single thoracic thrust joint manipulation (TJM) would improve maximum mouth opening (MMO) compared with participants without TMD as well as decrease TMD symptoms. Forty-eight people with TMD (30.9 years old ±11.3) and 55 people without TMD (28.5 years old ±9.2) participated. Both groups received a seated upper thoracic TJM and were measured for MMO before and immediately following the TJM. The duration of TMD symptoms and pre-thrust current pain, using the 11-point Verbal Pain Rating Scale (VPRS), was recorded in the TMD group. Participants in the TMD group were contacted 2-3 days after TJM to report current VPRS and improvement utilizing the Global Rating of Change (GROC) scale. No difference in MMO treatment response over time was observed between groups (p = .56). The MMO in the TMD group improved from 40 to 41.3 mm, and the non-TMD similarly improved from 44.5 to 45.4 mm. The VPRS decreased from 2.4 (±1.8) to 1.3 (±1.5) following thoracic TJM (p < .001), and the average GROC score was 1.8 (±2.25), which was statistically different than zero (no change; p < .001). The duration of TMD symptoms prior to TJM was not associated with GROC scores (r = .018, p = .90) or VPRS change scores (r = -.07, p = .64). The observed treatment effects did not exceed previously reported standards for clinical relevance (5 mm and 2 points, respectively).

The 'lifespan' of mandibular repositioning appliances.

Introduction Mandibular replacement appliances (MRAs) can be used in the treatment of snoring, mild to moderate obstructive sleep apnoea and as a second-line treatment where continuous positive airway pressure (CPAP) fails. There is currently a paucity of evidence as to how long these appliances last.Aims Assess the replacement rate for MRAs using this as a proxy for lifespan; estimate the period prevalence of temporomandibular joint disorder (TMJD) and bruxism in the study population.Methods Prospective observational study as part of service evaluation. Data from consecutive patients seeking a replacement MRA were collected over a three-month period, yielding a sample of 60. The mean time between the provision of appliances was calculated in months. Reasons for replacement were sought, collated and categorised. Patients were asked to report any TMJD symptoms and bruxing.Results The mean replacement rate was 36.7 months. The main reasons for replacement were: device condition; fit and reduced effectiveness; and other minor reasons reported. Period prevalence of TMJD was 6.7%; bruxism was reported in 5% of patients.Conclusions A 'lifespan' of ust over three years for thermoplastic MRAs is estimated. The main reasons for replacement were: condition, poor fit and reduced effectiveness. MRAs do not appear to increase the frequency of TMJD and bruxism.

Symptoms of temporomandibular joint disorders in university students – a correlational study

Introduction: The term temporomandibular dysfunction (TMD) has been associated with a set of musculoskeletal manifestations located at the temporomandibular joint (TMJ). These manifestations can be translated as symptoms of pain of the masticatory muscles at the TMJ or associated structures, restriction of movement, muscle tension, and articular sounds. All of these signs and symptoms may occur isolated or in combination [1]. About 60 to 70% of the World population will demonstrate at least one sign or symptom of TMD during their life span. However, only 5% will actually seek treatment for their condition. To that extent, some authors have investigated the prevalence of TMD in the Brazilian University population, using the Fonseca Questionnaire (FQ) [2]. This research tool can help to define the level of severity of TMD and obtained a significant level of correlation with the Helkimo Index (r = 0.6169, p < 0.05), which can be used to assess TMD in a specified population [2]. As such, the purposes of this study were to analyze the prevalence of TMD symptoms in University students and to verify if a correlation existed between the descriptive variables. Materials and methods: An informed consent form and the questionnaires (sample characterization and FQ) were distributed during classes to all participants (n = 200), irrespectively of their course year. The initial analysis of the Fonseca Questionnaire answers provided the categorization into two groups (with TMD and without TMD). This categorization enabled the posterior analysis of correlational data between the answers of the FQ and their status in relation to TMD. This study followed all the principles of the Declaration of Helsinki. Results: We were able to obtain answers from 156 students (78% response rate), with an average age of 22 years. The majority were females (65%). A total of 65 students (42%) were classified as suffering from TMD. Of those with TMD, 53(34%) were classified as mild, 11(7%) as moderate, and 1(0.6%) as severe conditions. We found correlations between gender and frequent headaches (p = 0.004) and being nervous (p = 0.004). We also found that TMJ pain correlated with difficulties opening their mouth (p = 0.000), mandibular movement (p = 0.000), and TMJ sounds (p = 0.000). Correlations were also found between age and teeth loss (p = 0.02). Discussion and conclusions: A significant prevalence of TMD symptoms was identified in University students with different levels of severity. The most common level of severity was classified as “mild”. These results are in agreement with other studies [3]. We also found some correlations concerning pain to movement disorders and sounds surrounding the TMJ which may predispose subjects to develop TMD. Further studies, using other tools, are advised to research these issues.

Cone Beam CT Evaluation of the Bony Changes in the Temporomandibular Joint and the Association with the Clinical Symptoms of Temporomandibular Joint Disorders

Introduction: Temporomandibular joint (TMJ) disorders are among the most prevalent abnormalities of the jaw, which affect the masticatory system, including the muscles, TMJ, and tendons. Clinical examination alone cannot determine the cause of temporomandibular disorder (TMD). In most cases, the cause of TMD and a proper treatment plan are determined based on imaging modalities. The present study aimed to investigate the bone changes in the patients with TMD symptoms using cone beam computed tomography (CBCT). Methods: This retrospective, cross-sectional study was conducted through recording data on the pain caused by TMJ (upon touching, using the TMJ, and maximum mouth opening), clicking, and crepitus using a checklist of clinical symptoms. CBCT images were examined for the associated bone changes, including sclerosis, flattening, erosion, and osteophyte. Data analysis was performed in SPSS version 21 using Chi-square and logistic regression analysis. Results: In total, 160 joint images were examined, including 132 cases of flattening (82.5%), 45 cases of sclerosis (28.12%), 41 cases of osteophytes (25.62%), and 66 cases of erosion (41.25%). A significant association was observed between pain and flattening, and sclerosis and osteophytes. Moreover, a significant correlation was observed between flattening and clicking (P<0.05). Conclusion: According to the results, flattening was the most common bone change in the patients with TMD. In addition, sclerosis had the most significant association with pain, while sclerosis, osteophytes, and erosion were significantly correlated with joint crepitation.

Temporomandibular Disorder among Women Who Experienced Posttraumatic Stress Disorder after a Miscarriage.

Objectives:This study intended to understand the risk of developing temporomandibular disorder among Saudi women who experienced a miscarriage.Materials and Methods:Two hundred and eight Saudi women from several hospitals’ gynecologic clinics in two areas in Saudi Arabia were screened to fill out the Impact of Events Scale-Revised (self-reporting questionnaire) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic criteria for posttraumatic stress disorder and a structured temporomandibular joint disorder (TMD) Questionnaire (Research Diagnostic Criteria for Temporomandibular Disorders). A single examiner did the clinical examination for temporomandibular joint (TMJ). One-hundred and fifty-eight of the participants were divided into two groups. Group A (85 participants) included females who had had a previous miscarriage, whereas Group B (73 participants) included females who had not had a miscarriage. IBM SPSS version 22.0 was used to conduct a nonparametric Chi-square test to find the significance of any observed differences.Results:Almost 40% of the participants had symptoms that qualified for possible TMD. Around 73% of the miscarried Saudi women in Group A showed symptoms of TMD. Furthermore, approximately 38% of the participants in Group B developed significant symptoms of TMD. The Chi-square test (Chi-test = 22.03 with P = 0.0001) shows highly significant association between treatment groups (control and study) and temporomandibular joint disorder group and non temporomandibular joint disorder group.Conclusion:Women who suffer from spontaneous single or recurrent miscarriages are advised to seek a dental specialist for diagnosis and prevention devices such as a night guard.

Prevalence of the Signs and Symptoms of Temporomandibular Joint Disorders among Dental Students in Navi Mumbai

Prevalence of the Signs and Symptoms of Temporomandibular Joint Disorders among Dental Students in Navi Mumbai

Association of temporomandibular joint disorder symptoms with anxiety and depression

Association of temporomandibular joint disorder symptoms with anxiety and depression

Is There a Relationship Between Otological Symptoms and Temporomandibular Joint Disorders A Retrospective Study

Introduction: Otological symptoms are often associated with temporomandibular joint disorders (TMD). The exact correlation between these two phenomena is being controversially discussed in the literature for many years. This retrospective study aims to investigate the possible association of otological symptoms with specific TMD findings, as well as stress and chronic pain. Method: We analyzed the anonymized medical records of 56 patients. This included the assessment of the clinical functional status and Manual Structural Analysis (MSA) in accordance to the German Society for Functional Diagnostics and Therapy (DGFDT) and the Graded Chronic Pain Status (GCPS). Results: From all 56 patients with TMD 32 had otological symptoms. The most common TMD symptoms in patients with aural complains were pain by palpation of the m. masseter (81,82- 83,33%) and m. digastrics venter posterior (81,82% – 100%). Articular sounds were a prevalent finding especially in tinnitus patients (63,64%). An insufficient posterior static occlusion was present in 27,27% – 50% of the cases. Approximately half of the patients with aural complaints mentioned, that they feel stressed. Most of the patients suffered from a functional chronic pain (56,25%). A dysfunctional chronic pain was prevalent in 18,75% of the cases. Conclusion: The results indicate, that TMD patients with aural complaints have most often pain in the areas of m. digasticus venter posterior and m. masseter, so there might be an association of ear symptoms with a pathology of these muscles. However, no causal relationship could be proven. Arthropathology, malocclusion, psychological condition and stress levels are other factors, that seem to have influence. The etiology is multifactorial and remains unclear.

TMD symptoms and vertical mandibular symmetry in young adult orthodontic patients in North Sumatra, Indonesia: a cross-sectional study.

Background: Temporomandibular joint disorder (TMD) includes symptoms of pain and dysfunction in the muscles of mastication and the temporomandibular joint. Differences in vertical condylar height, observed in the assessment of mandibular asymmetry, is a structural alteration that represents a risk factor for TMD. The study aimed to evaluate the association between TMD symptoms and vertical mandibular symmetry in young adult orthodontic patients in North Sumatra, Indonesia. Methods: The cross-sectional study included 18-25-year-old (mean ± SD, 21.9 ± 2.0 years) old orthodontic patients admitted to the Dental Hospital of Universitas Sumatera Utara, Medan, between June 2016 and March 2017. Vertical mandibular asymmetry was assessed from all 106 subjects using Kjellberg's technique from pre-treatment panoramic radiographs. The TMD symptoms were assessed by structural interviews using modified questionnaires based on Temporomandibular Disorder Diagnostic Index and Fonseca's Anamnestic Index. Results: Of the 106 subjects, 26 (24.5% of the total) with vertical mandibular symmetry and 39 (36.8%) with vertical mandibular asymmetry were positive for TMD symptoms. By contrast, 17 patients (16.0% of the total) with vertical condylar symmetry and 24 patients (22.6%) with vertical mandibular asymmetry were regarded negative for TMD symptoms. There was no significant difference (p=0.520) in TMD symptoms based on vertical mandibular symmetry. Conclusion: The results from this studied Sumatran population indicate that there are common TMD symptoms in young adult orthodontic patients, but there is no significant association between vertical mandibular asymmetry and TMD symptoms. Further study on the development of TMD, mandibular asymmetry and treatment planning for growing patients is suggested, using longitudinal and transitional approaches.

TMD symptoms and vertical mandibular symmetry in young adult orthodontic patients in North Sumatra, Indonesia: a cross-sectional study

Background: Temporomandibular joint disorder (TMD) includes symptoms of pain and dysfunction in the muscles of mastication and the temporomandibular joint. Differences in vertical condylar height, observed in the assessment of mandibular asymmetry, is a structural alteration that represents a risk factor for TMD. The study aimed to evaluate the association between TMD symptoms and vertical mandibular symmetry in young adult orthodontic patients in North Sumatra, Indonesia. Methods: The cross-sectional study included 18-25-year-old (mean ± SD, 21.9 ± 2.0 years) old orthodontic patients admitted to the Dental Hospital of Universitas Sumatera Utara, Medan, between June 2016 and March 2017. Vertical mandibular asymmetry was assessed from all 106 subjects using Kjellberg’s technique from pre-treatment panoramic radiographs. The TMD symptoms were assessed by structural interviews using modified questionnaires based on Temporomandibular Disorder Diagnostic Index and Fonseca’s Anamnestic Index. Results: Of the 106 subjects, 26 (24.5% of the total) with vertical mandibular symmetry and 39 (36.8%) with vertical mandibular asymmetry were positive for TMD symptoms. By contrast, 17 patients (16.0% of the total) with vertical condylar symmetry and 24 patients (22.6%) with vertical mandibular asymmetry were regarded negative for TMD symptoms. There was no significant difference (p=0.520) in TMD symptoms based on vertical mandibular symmetry. Conclusion: The results from this studied Sumatran population indicate that there are common TMD symptoms in young adult orthodontic patients, but there is no significant association between vertical mandibular asymmetry and TMD symptoms. Further study on the development of TMD, mandibular asymmetry and treatment planning for growing patients is suggested, using longitudinal and transitional approaches.