[Dental occlusion and subjective temporomandibular joint symptoms in men and women. Results of the Study of Health in Pomerania (SHIP)].
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Abstract:
Aim of the study was to determine whether associations exist in men as well as in women between occlusal factors like malocclusions or factors of functional occlusion and subjective temporomandibular joint (TMJ) symptoms, based on the population-based Study of Health in Pomerania (SHIP-0). A representative sample of 4310 men and women (response rate 68.8%) aged 20 to 81 years was examined for subjective temporomandibular joint symptoms, malocclusions (incl. normal occlusion), factors of functional occlusion and for sociodemographic parameters. Men and women were analyzed separately with multiple logistic regression analyses, adjusted for age. The results were compared to other population-based studies from an own systematic review on this subject. In men and women, none of the 48 occlusal factors under survey (malocclusions or functional occlusion) was significantly more frequently associated with the dependent variable "subjective temporomandibular joint symptoms". In contrast, the parafunction "frequent clenching" was associated more frequently and clinically relevant with TMJ symptoms in both sexes (for men, odds ratio = 4.2, prevalence 4.9%; for women OR = 2.9, prevalence 5.6%). Malocclusions and functional occlusion factors only explained a smaller part of the differences between the male and female population with and without subjective TMJ symptoms. Compared to other population-based studies only few and inconsistent associations between occlusal factors and subjective temporomandibular symptoms were ascertainable in both sexes.Keywords:
Dental occlusion
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The accuracy and reliability of the TMJ Scale were originally determined in cross-validation studies on large, research-based patient samples. It had been assumed that the demographic characteristics and test responses of these research-based samples would be representative of the clinical population in which the TMJ Scale would ultimately find use. The present study on more than 10,000 patients that were evaluated for temporomandibular disorders in clinical practice demonstrates that the test scores, demographic variables, and the patterns of symptom severity that characterize the original TMJ Scale research sample accurately represent the general temporomandibular disorder patient population in which the TMJ Scale is now being used. The results suggest a high degree of confidence in the clinical efficacy of this assessment tool. The overall symptom severity of temporomandibular disorders was found to be normally distributed in the patient population. Women with temporomandibular disorders report a higher level of severity of all physical and psychological symptoms than men. This may explain the high female-to-male ratio in patients seeking treatment. However, a higher percentage of male temporomandibular disorder patients has clinically significant psychological and stress-related problems than do women. The severity and prevalence of symptoms associated with joint dysfunction and range of motion limitation are lower in older age groups, and the overall symptom severity of temporomandibular disorders is not higher in older age groups. However, the severity and prevalence of symptoms associated with joint dysfunction are greater in groups in which temporomandibular disorders have existed for longer durations, although pain levels do not follow this trend. There is also an association between time duration of the temporomandibular disorder and the severity of psychological problems and chronicity. Patients with chronic problems are symptomatically more impaired than those with acute problems.
Research Diagnostic Criteria
TMJ disorders
Temporomandibular disorder
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Dental occlusion
Signs and symptoms
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The objective of this study was to determine whether associations exist between occlusal factors and signs of temporomandibular disorders (TMD) in adults using the population-based Study of Health in Pomerania (SHIP), Germany. A representative sample of 4310 men and women aged 20 to 81 years (response 68.8%) was investigated for TMD signs, malocclusions, functional occlusion factors, and sociodemographic parameters. Multiple logistic regression analysis, adjusted for sex, age, and socioeconomic status, was used. The results were compared with other population-based studies identified by a systematic review. Few malocclusions and no factors of functional occlusion except socioeconomic parameters were associated with TMD signs, and these associations were mostly weak. Only bilateral open bite up to three mm appeared to be clinically relevant and was associated with TMD signs (odds ratio [OR] = 4.0). This malocclusion, however, was of rare occurrence, with a prevalence of 0.3% (n = 9), and this finding was not confirmed by other representative studies. Occlusal factors examined in this study explained only a small part of the differences between normal subjects and those with TMD signs. This and other population-based studies indicate that malocclusions and factors of functional occlusion surveyed should be seen as merely cofactors in the sense of one piece of the mosaic in the multifactorial problem of temporomandibular dysfunction. Single occlusal factors that showed significant effects throughout several studies could not be detected. In view of the large number of occlusal variables already investigated, other variables including nonocclusal ones probably also play a role and should be looked at more intensely.
Dental occlusion
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Purpose: This study aimed to investigate the characteristics of the symptoms of temporomandibular disorders (TMD) in Korean children and adolescents using representative samples and questionnaires. Methods: A survey involving the interview of 10-, 12-, and 15-year-old children and adolescents regarding the symptoms of TMD was conducted as a part of the 2010 National Oral Health Surveys. The study population included 18,112 subjects (male, 9,734; female, 8,378). The interview involved three questions related to the symptoms of TMD. The prevalence of symptoms of TMD, correlation of the symptoms with sex and age, and the difference in the number of symptoms according to sex and age were analyzed. Results: Among the symptoms of TMD in children and adolescents, the prevalence of temporomandibular joint (TMJ) sounds during mouth opening was 13.0%, while those of TMJ pain and limitation were 3.1% and 4.3%, respectively. While the prevalence of TMJ sounds during mouth opening did not show any statistically significant difference between the sexes, the rates of prevalence of TMJ pain and limitation of mouth opening in were higher in the female subjects than the male (p<0.05). It was also observed that the older the subjects, the higher the prevalence of TMJ sounds, TMJ pain, and limitation of mouth opening (p<0.05). The number of symptoms of TMD was found to be increased among female subjects as well as the older ones (p<0.05). Conclusions: There are variations in the prevalence of symptoms of TMD among Korean children and adolescents according to sex and age, which is consistent with the results of previous studies. It is necessary to conduct a national cohort study to evaluate the risk factors for TMD in children and adolescents.
Signs and symptoms
Temporomandibular disorder
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The aim of this study was to evaluate the prevalence and need for treatment of temporomandibular disorders (TMD) in students living in Bauru, Brazil. The role of occlusal and emotional factors was also addressed. The presence and severity of TMD was determined by using a self-reported anamnestic questionnaire composed of 10 questions regarding common TMD symptoms. The symptoms were transposed into a severity classification according to the number and frequency of positive responses. Occlusal evaluation included an analysis of retruded contact position, intercuspal position, anterolateral guidance, and nonworking side contacts during mandibular movements. Palpation of the muscles and temporomandibular joints were performed to detect clinical signs of TMD. A chi square test was used to compare clinical and occlusal data with the presence and severity of TMD. A total of 0.65% of the subjects had severe TMD symptoms, 5.81% had moderate symptoms, and 34.84% had mild symptoms. Those with severe and moderate symptom levels were interpreted to be in need of treatment. Symptoms were found significantly more frequently in females than in males (P < .01). Self-reported emotional tension and parafunctional habits demonstrated strong associations with TMD (P < .01). Occlusion did not seem to influence the presence or severity of TMD. Based on these results, the efficacy of some traditional TMD treatments should be reconsidered, and reversible and conservative procedures should be the first choice for managing TMD patients.
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Cross-sectional study
Signs and symptoms
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Dental occlusion
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Abstract Few epidemiologic studies of TM disorders have used random samples drawn from the general population. The aim of this study was to estimate the prevalence and distribution of symptoms commonly associated with such disorders among a sample of adults in Toronto, Canada. A random digit dialing technique was used to identify 1002 individuals aged 18 and over. A symptom questionnaire was completed by 67.7%. Overall, 48.8% responded positively to one or more of the nine questions concerning symptoms. Joint sounds, tiredness or stiffness of jaw muscles, and an uncomfortable bite were the symptoms most frequently reported. Functional pain or pain while at rest was reported by 12.9%. Sex and age differences were small although statistically significant, with women and the younger age groups more likely than men or the older age groups to report one or more symptoms. Significant associations were observed between the reporting of symptoms and potential risk factors such as parafunctional behaviours and reports of frequent stress. The proportion in need of treatment varied from 3.5% to 9.7% according to the case definition used.
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summary Longitudinal data were obtained for 4 years from 361 Japanese high school girls between the ages of 12 and 16. The data were analysed for the occurrence of pain and its associations with the occurrence of other cardinal TMJ dysfunction symptoms and occlusal states. It was determined that even if pain or noise or jaw‐deviation symptoms appeared, those symptoms did not necessarily last thereafter. The symptoms were not persistent but rather appeared and disappeared repetitively. Those who exhibited noise during at least one of the surveys of the 4‐year survey period showed a significantly higher prevalence of pain than those who did not exhibit noise at all (P < 0.05). Those who exhibited noise by the age of 13 showed a significantly higher prevalence of pain than those who exhibited noise after age 14 (P < 0.1). The temporal occurrence of pain depended upon the appearance of noise and the age at which noise first appeared. On the other hand, the occurrence of pain symptoms was not necessarily related to specific types of malocclusions, which suggests the significance of multifactorial contributions in understanding the aetiology of pain rather than the occlusal factor.
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Longitudinal Study
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An analysis of exclusively representative population-based studies on adults has shown that only few and inconsistent associations could be detected between malocclusions and clinical signs of temporomandibular disorders (TMD)--and none for functional occlusion factors (occlusal interferences, non-working side contacts, etc). The aim of this study was to analyze associations between morphologic occlusion as well as factors of functional occlusion and subjectively perceived symptoms of TMD--again on the basis of the population-based Study of Health in Pomerania (SHIP), providing a sample of 4310 subjects (out of 7008 subjects yielding a response rate of 68.8%) aged 20 to 81 years, and other international representative studies from the systematic review. Besides occlusal factors also parafunctions and socioeconomic status (SES) were taken into account (including age and sex). Multiple logistic regression analysis was used--adjusted for SES. In this study, none of the occlusal factors were significantly associated with the indication of more frequent subjective TMD symptoms. However, the parafunction "frequent clenching" was connected with subjective TMD symptoms (odds ratio = 3.4). Compared with other population-based studies few and (across studies) inconsistent associations between malocclusions and subjective TMD symptoms could be ascertained. No significant associations of factors of functional occlusion with TMD symptoms were identifiable.
Dental occlusion
Association (psychology)
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The aim of this study was to find possible predictors of signs and symptoms of temporomandibular disorders (TMD) in a long-term perspective. Baseline questionnaire and clinical examinations focusing on function and dysfunction of the masticatory system were performed in a sample of 402 subjects 7, 11, and 15 years old. After 20 years, 320 subjects (80% of the original sample) completed a similar questionnaire as at baseline. From the oldest age group, now aged 35 years, 100 subjects (74% of the original sample) also attended a clinical examination. Three variables from the 20-year follow-up were chosen as dependent variables in logistic regression analyses, with independent variables selected from the baseline examinations. Three variables at baseline were significant predictors for reported TMJ clicking at the 20-year follow-up, tooth wear index being the strongest (odds ratio = 4.3). Reported TMJ clicking at the start was the only significant predictor for TMD symptoms without clicking 20 years later (odds ratio = 2.3). The third logistic regression model, using the Helkimo Clinical Dysfunction Score as dependent variable, resulted in four significant predictors from the baseline examinations (bruxism, oral parafunctions, TMJ clicking, and deep bite). The results indicated that some signs and symptoms might predict TMD signs and symptoms in a long-term perspective. However, it cannot be concluded from this study whether these symptoms recorded in childhood--oral parafunction, tooth wear, TMJ clicking, and deep bite--can be used for predicting manifest TMD in adult age.
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Abstract Objectives The aim of the study was to assess the prevalence of symptoms indicative of temporomandibular disorders (TMD) in an adult population in Troms County in Northern Norway, as well as the associations between TMD and socio‐demographic factors, dental status, self‐reported general, and oral health as well as oral health related quality of life (OHQoL). Methods Data were collected from a structured questionnaire and a clinical examination of a random sample of almost 2000 adults, 20–79‐year‐old, in Troms County in Northern Norway. Results Women had a higher prevalence of all self‐reported and clinical signs of pain and dysfunction in the temporomandibular complex compared to men. For both genders, sounds from the temporomandibular joint (TMJ) upon clinical examination was the most common symptom, followed by pain to palpation of jaw muscles. Headache was the most common of the self‐reported symptoms and sounds from the TMJ the second most common. Young women had a higher prevalence of self‐reported headache and jaw‐ and face pain compared to middle‐aged and elderly women. TMD‐related symptoms of pain were significantly associated with poor self‐reported general health and correlated with OHQoL as assessed by the oral health impact profile 14 questionnaire. Conclusion Being women and having moderate to poor self‐reported general health were associated with clinical signs and self‐reported symptoms of pain in the jaw, face and head region. Self‐reported symptoms of TMD correlated more strongly with OHQoL than clinical signs.
Palpation
Cross-sectional study
Oral examination
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