Symptoms and signs of temporomandibular disorders and oral parafunctions among Saudi children

This study aimed to record the prevalence of signs and symptoms of temporomandibular disorders (TMD) and oral parafunctions among Saudi children. A questionnaire and a clinical examination of signs and symptoms of TMD were performed on 1940 stratified randomly selected schoolchildren. The sample was divided into three groups, 505 with primary, 737 with mixed and 734 with permanent dentition. The prevalence of TMD signs was found to be 20.7% and the most common sign of TMD was joint sounds (11.8%). The second most common sign was restricted mouth opening (5.3%). Muscle and temporomandibular joint (TMJ) pain as well as deviation upon jaw opening appeared infrequently. TMJ sounds were significantly increasing with age (P < 0.05). TMD symptoms as reported by the parents were evident in 24.2% of the returned questionnaires (1113). The most common symptoms were headache (13.6%) and pain on chewing (11.1%). The incidence of headache was found to be significantly increasing from primary to permanent dentition (P < 0.01). No sex difference in the prevalence of any symptom was reported. Nail biting was the most common oral parafunction (27.7%) while bruxism was the least common (8.4%). All parafunctions except bruxism were significantly related to age. Cheek biting and thumb sucking were reported more in females than in males. The importance of a screening examination for symptoms and signs of TMD should not be overlooked in the clinical assessment of the pediatric patient.     

Association of caries and treatment experiences with subjective symptoms of temporomandibular disorders in female adolescents

A 2-year cohort study of subjective symptoms of temporomandibular disorders (TMD) was performed. A total of 229 female adolescents, all 15 years of age, completed questionnaires and underwent dental examinations at baseline, 1- and 2-year follow-up surveys. The questionnaire included questions on typical TMD symptoms; i.e. temporomandibular joint (TMJ) noise, tiredness in jaws, pain on jaw movements, and difficulty in mouth opening. The relative risk was computed to determine the relationships of the baseline number of filled teeth (FT) and decayed, missing and filled teeth (DMFT) increment with the incidence of TMD. The percentage of subjects with one or more subjective symptoms at 17 years of age was 30.6%, significantly higher than the percentages at 15 (17.0%) and 16 (19.7%) years of age (P < 0.01). The symptom-emerging rate of TMJ noise during the 2-year period was 13.5%, which was the highest among the rates of possible subjective symptoms. Individuals with a 2-year increment in DMFT of > or =2 had a 2.14-times increased risk of experiencing mild symptoms, and individuals with baseline FT of > or =3 had 2.41-times increased risk of experiencing mild or severe subjective symptoms. The results of this study showed that TMD symptoms occurred in a relatively high percentage of female adolescents during the 2-year period and suggested that DMFT is one factor affecting the incidence of TMD.     

Association of dietary habits with symptoms of temporomandibular disorders in Bangladeshi adolescents

The prevalences of signs and symptoms of temporomandibular disorder (TMD) in Bangladeshi adolescents and their associations with intake of various hard food items were investigated. A group of 1200 randomly selected high school students aged 12-17 years from three communities (rural, semi-urban and urban) completed a questionnaire on dietary habits and presence of TMD symptoms and were examined clinically. In bivariate analysis, no significant relationship was observed between TMD symptoms and eating of hard foods. However, in logistic regression analysis, clicking showed a significant correlation with consumption of hard vegetable and fruits more than three times per week (P < 0.05). A statistically significant correlation was also observed between consumption of all hard food items (at least one item in each of the four categories of hard food) more than 12 times per week and pain in the temporomandibular joint (TMJ) (P < 0.05). A positive association was found between pain in the TMJ and older age (15-17 years) (P < 0.001). The prevalence of pain in the TMJ was significantly higher in males (P < 0.01). Prevalences of clicking and pain in the TMJ were significantly higher in subjects living in a rural area than in subjects living in an urban area (P < 0.01 and P < 0.01, respectively). Subjects having one or more decayed, missing and filled teeth (DMFT) showed significantly higher prevalences of clicking (P < 0.01) and restricted mouth opening (P < 0.01). The results suggest that prevalence of TMD symptoms are related to prolonged consumption of hard food items.     

Multivariate analysis of risk factors in relation to TMD symptoms

The epidemiological studies on risk factors for temporomandibular disorders (TMD) are still extremely lacking. Therefore, their aetiological significance has scarcely been documented. The aim of this study was to quantitatively investigate the relationship between hypothesized risk factors and the precipitation and perpetuation of TMD symptoms. The same 672 adults who participated in a previous study ( Matsuka et al., 1996 ) were selected for this study. All subjects had already answered a self‐administered questionnaire and the same questionnaire was sent to them 4 years after the first survey. The questionnaire failed to reach 58 subjects at the second survey. Of the remaining 614 subjects, 367 (166 males and 201 females with a mean age of 53·1 ± 14·2 years) returned the questionnaire, for a return rate of 59·8%. Information about three TMD symptoms [temporomandibular joint (TMJ) pain, limitation of mouth opening, TMJ noise] was obtained from the questionnaire, and fluctuation of these symptoms was assessed by comparing three pairs of answers between the first and second surveys. Information about 18 hypothesized risk factors for TMD (age, sex, trauma, bruxism, malocclusion, oral habit, etc.) were also obtained from the questionnaire at the first survey. To evaluate how strongly each risk factor was associated with precipitation and perpetuation of TMD symptoms, odds ratio of each risk factors for precipitating or perpetuating TMD symptoms was calculated by means of logistic regression analysis. Statistically significant risk factors for precipitating TMD symptoms were lip biting for TMJ pain (3·65) and trauma for limitation of mouth opening (3·20), and statistically significant risk factors for perpetuating TMD symptoms were female for TMJ pain (4·50) and TMJ noise (3·85) (odds ratio in parenthesis). The possible aetiological significance of these factors in TMD should be validated by future research.     

Signs of temporomandibular disorders in tinnitus patients and in a population-based group of volunteers: results of the Study of Health in Pomerania

The literature has documented a controversial discussion on the possible relationship of otogenous symptoms and craniomandibular dysfunction since the 1920s. Therefore, an investigation was conducted which consisted of two parts: a case study with population-based controls and a cross-sectional study. The aim of the first study was to screen a group of patients suffering from acute or chronic tinnitus for temporomandibular disorders (TMD) in comparison with a population-based group of volunteers without tinnitus. To this end, 30 patients (13 females and 17 males, age 18-71 years) suffering from acute hearing loss associated with tinnitus, isolated acute tinnitus, and chronically transient tinnitus were examined for symptoms of craniomandibular dysfunction. The results were compared with those of clinical functional analysis from 1907 subjects selected representatively and according to age distribution from the epidemiological 'Study of Health in Pomerania' (SHIP); the occurrence of tinnitus was ruled out in these control subjects. Statistical analysis was performed with Chi-square and Mann-Whitney U-tests. Sixty per cent of the tinnitus patients and 36.5% of the control subjects exhibited more than two symptoms of TMD (P = 0.004). Tinnitus patients had significantly more muscle palpation pain (P < 0.001), temporomandibular joint (TMJ) palpation pain (P < 0.001), and pain upon mouth opening (P < 0.001) than the general population group. No statistical differences were found in TMJ sounds, limitation of mandibular movement, or hypermobility of the TMJ. Furthermore, 4228 subjects of the population group examined in the epidemiological study were screened for co-factors of tinnitus with the help of a multivariate logistic regression model which was adjusted for gender, age, and a variety of anamnestic and examined data. Increased odds ratios (OR) were found for tenderness of the masticatory muscles (OR = 1.6 for one to three painful muscles and OR = 2.53 for four or more painful muscles), TMJ tenderness to dorsal cranial compression (OR = 2.99), listlessness (OR = 2.0) and frequent headache (OR = 1.84) A relationship between tinnitus and TMD was established in both examinations. Tinnitus patients seem to suffer especially from myofascial and TMJ pain. A screening for TMD should be included in the diagnostic survey for tinnitus patients.     

Correlation between oral parafunction and temporomandibular disorders and emotional status among saudi children.

Studies on association between temporomandibular disorders and oral parafunction in preschool children are few. The aim of the present study is to investigate the relationship between the subjective and objective signs and symptoms of temporomandibular disorders (TMD), oral parafunction and emotional status in preschool children. The study is based on a clinical examination and questionnaire. Five hundred and two Saudi children aged 3 to 7 years were examined for different signs and symptoms of TMD. In addition, the parents of the children were given a questionnaire to investigate the existence of oral parafunction and evaluate the emotional status of children. The results of the study showed significant association between attrition and temporomandibular joint (TMJ) pain, muscle tenderness and restricted opening, (P Values were 0.008, 0.019, 0.037 respectively). Significant association was found between habit of grinding and pain, while eating or opening the mouth (P<0.012). Significant association was found between emotional status and multiple signs and symptoms of TMJ tenderness, TMJ pain and muscle tenderness (P<0.042). Significant association was found between emotional status and pain, while eating or opening of the mouth (P<0.048). Close to positive association was found between oral parafunction and jaw lock. The association between TMD and oral parafunction as well as emotional status should direct the attention of the dentist to the importance of considering the emotional status, oral parafunction and TMD when examining and formulating treatment plan for the child patient.     

Temporomandibular disorders in 19-year-old Korean men.

PURPOSE: The purpose of this study was to determine the prevalence and the nature of the relationships between 3 temporomandibular joint disease (TMD) symptoms and symptoms of associated structures. MATERIALS AND METHODS: This study was designed to rule out the effect from the uneven composition of the samples on TMD symptoms. The samples were collected from subjects who were of the same age, gender, district, and race. Nineteen-year old men (n = 27,978) were selected and investigated by means of questionnaires and clinical examinations. The prevalence of each symptom was studied and tried to determine the effects of the TMD-associated signs on the TMD signs. The indices allocated to reflect the TMD signs and symptoms and the others were dichotomized for bivariate analysis. The predictor variables were headache, neck pain, referred pain, stress, past trauma history in the TMJ, past TMJ dislocation, bruxism, and clenching. The outcome variables were mouth opening limitation, TMJ pain on rest, and TMJ pain during function. RESULTS: The incidence of masticatory muscle stiffness was 17.8%; TMJ sounds, 14.3%; headache, 7.2%; neck pain, 13.5%; bruxism, 8.4%; and clenching, 9.9%. Stress occurred in 12.8%, past trauma history in 11%, and previous joint dislocation in 2.5%. The experience of dislocation in the TMJ was found to be the most important risk factor in terms of mouth opening limitation (odds ratio, 4.08, P <.0001), joint pain during function (odds ratio, 5.50, P <.0001), and joint pain in the rest state (odds ratio, 4.63, P <.0001). Referred pain and the experience of trauma in TMJ were the secondary risk factors in terms of joint pain and referred pain and the stress in terms of mouth opening limitation. Considering referred pain can be induced by TMD, stress may be more related to mouth opening limitation (odds ratio, 2.18, P <.0001), and the experience of trauma in TMJ may be more related to pain in the rest state (odds ratio, 2.56, P <.0001) and during function (odds ratio, 2.47, P <.0001). CONCLUSIONS: The prevalence of TMD signs and symptoms as determined by this examination was in accord with the findings in women or mixed samples of other workers. Prior experience of a dislocated disc was found to be the most risky factor in TMD. Stress was related to limitations of mouth opening, and the experience of trauma in the TMJ was found to be related to pain in the joint region. Bruxism may not be a direct risk factor in TMD, and the clenching habit found to be more harmful than bruxism.     

Risk factors associated with symptoms of temporomandibular disorders in a population of 50- and 60-year-old subjects

summary The aims of this study were first to investigate, by means of a mail questionnaire, variables from three domains: (i) socio‐economic attributes; (ii) general and oral health; and (iii) dental attitudes and behaviours in a large sample of 50‐ and 60‐year‐old subjects, and second to compare subjects with or without reported temporomandibular joint (TMJ) pain with respect to these variables. In 2002, a questionnaire was mailed to all 50‐ and 60‐year‐old subjects in two Swedish counties, Örebro and Östergötland (n = 17 138; n₅₀ = 8878; n₆₀ = 8260). Individuals not responding within 2 weeks were given a reminder. If still not answering, a new questionnaire was sent. The final response rate was 72·8% (n = 12 468). The reported responses to questions regarding ‘pain in the TMJ region’ and ‘difficulty to open the mouth wide’ were dichotomized into two groups: (i) no temporomandibular disorders (TMD) symptoms; and (ii) some, rather great or severe TMD symptoms. Striking differences in demographic, occupational, general and oral health conditions were found between the groups with and without TMD symptoms. The strongest risk indicator for both pain and dysfunction was reported bruxism. Women, younger subjects (50 years old) and blue‐collar workers were significantly more prevalent in the TMD symptom groups. Variables related to impaired general and oral health were more common in the groups with reported TMD problems, whereas satisfaction with received dental care and with teeth was lower. Individuals with reported TMD symptoms differed significantly from those without TMD symptoms in socio‐economic attributes, general and oral health symptoms, dental conditions and satisfaction with their teeth.     

Some self-reported symptoms of temporomandibular joint dysfunction in a population in Northern Norway

The distribution of a number of self-reported symptoms of temporomandibular joint (TMJ) dysfunction, parafunctions and treatment behaviour was studied by means of a questionnaire answered by 94% of a population group of 358 persons aged 20-69 years in Northern Norway. Nine subjects reported pain from the temporomandibular joint (TMJ) when opening their mouth and/or when chewing, while twenty-one subjects had clicking sounds in the TMJ. Seventeen persons had been grinding their teeth during the previous week. Only seven individuals had ever sought medical or dental advice because of TMJ disorder. Tooth grinding and symptoms of TMJ dysfunction were most common in young people, in people with twenty teeth of more and/or in people from high social classes, whereas differences according to sex and income were small. The low frequency of subjective symptoms of TMJ dysfunction and parafunctions in this population was related to demographical, social, dental and methodological influences.     

Generalized joint laxity and its relation with oral habits and temporomandibular disorders in adolescent girls

A group of 248 girls, aged 15-16 years, were randomly selected and examined both clinically and by questionnaire with regard to the signs and symptoms of temporomandibular disorders (TMD), generalized joint laxity (GJL), range of mandibular opening, temporomandibular joint (TMJ) hypermobility and presence of oral parafunctions. The prevalence of GJL was 43% and that of TMJ hypermobility (TMJH) was 27.3%. A significant, albeit weak, correlation was found between the two. In the presence of joint click, both active and passive opening were significantly larger. When either muscle or joint sensitivity to palpation was present, the difference between the active and passive range of mouth opening increased significantly. The presence of reported clicks was negatively associated with GJL. This association was not valid in the presence of parafunction. Some of the signs and symptoms of TMD affected the range of mouth opening. In the presence of joint clicks, the mean active and passive mandibular opening were significantly larger. In the presence of joint and muscle sensitivity to palpation, the difference between passive and active mouth opening was larger. This was possibly because of the effect of pain on the full active range of opening, which was invalid in the registration of the passive mandibular opening. GJL, when present, did not seem to jeopardize the health of the stomatognathic system as expressed in the signs and symptoms of TMD. There was a negative association between GJL and the presence of reported joint clicks and catch. When a parafunction was present in addition to GJL, this association was invalid but not reversed, as has been previously reported.     

Chewing ability as a parameter for evaluating the disability of patients with temporomandibular disorders

Restoration of chewing ability is an important aspect of the treatment for temporomandibular disorders (TMDs). However, too little attention has been paid to it. We have used a questionnaire to evaluate and score the chewing ability of TMD patients. The questionnaire includes 19 kinds of food and a chewing task. The patient was asked if she/he experiences difficulty in enjoying eating. The aim of this study was to evaluate correlations between score of chewing ability (SCA) and other symptoms/signs of TMD. Four hundred and seventy-three consecutive TMD patients were evaluated for SCA and other symptoms/signs including temporomandibular joint (TMJ) pain, TMJ and muscle tenderness, TMJ noise (clicking and crepitus), and maximum mouth opening. The relationship between SCA and other symptoms/signs were analysed by multiple regression analysis. Score of chewing ability correlated significantly with TMJ pain and mouth opening capacity but not with TMJ noise and muscle tenderness. Age was a background factor but sex was not. The result of this study suggests that SCA correlated with dysfunction of the TMD patients. This method could be used to evaluate the ability of chewing in assessment of TMD.     

低年级大学生颞下颌关节紊乱病咬合异常因素的logistic回归分析

目的探讨低年级大学生咬合异常因素对颞下颌关节紊乱病(temporomandibular disorders,TMD)发病的影响,以期为TMD的防治提供病因学基础。方法对遵义医科大学珠海校区低年级学生754名(男性354名,女性400名)进行颞下颌关节检查、牙列与咬合关系检查、问卷调查,采用多因素非条件logistic回归分析与哑变量单因素非条件logistic回归分析咬合功能异常、错畸形以及口腔副功能运动等咬合异常因素与颞下颌关节紊乱病的关系。结果颞下颌关节紊乱病的患病率为31.7%,多因素非条件logistic回归分析结果显示夜磨牙(OR=2.070)、日间紧咬牙(OR=2.553)、无意识空嚼(OR=2.642)和前牙覆关系(OR=1.228),与TMD的发病均有影响(P<0.05)。对不同程度前牙深覆设置哑变量采用单因素非条件logistic回归分析显示深覆程度越重,TMD的发病风险越高[轻度(OR=1.558)、中度(OR=2.189)、重度(OR=3.236),P<0.05]。结论前牙覆关系、夜磨牙、日间紧咬牙、无意识空嚼均是低年级大学生TMD发病的危险因素,前牙深覆程度越重,TMD发病风险越高。     

Association between temporomandibular joint symptoms, signs, and clinical diagnosis using the RDC/TMD and radiographic findings in temporomandibular joint tomograms

AIM: To identify associations between clinical symptoms of temporomandibular joint disorders and radiographic findings. METHODS: Two hundred four adult patients (156 women, 48 men, mean age 40 years) with temporomandibular joint (TMJ) pain/sounds or changes in mandibular motion were examined according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Bilateral sagittal corrected TMJ tomograms in closed and open positions were assessed for the presence of flattening, erosion, osteophytes, and sclerosis in the joint components and the range of mandibular motion. Logistic regression analyses were performed with the radiographic findings as the dependent variables and the following clinical variables as independent variables: opening pattern, maximal jaw opening, TMJ sounds, number of painful muscle/TMJ sites, duration of pain, presence of arthritic disease, depression and somatization scores, graded chronic pain, and age and gender. RESULTS: Coarse crepitus on opening/closing (odds ratio [OR] > or = 3.12), on lateral excursions (odds ratio > or = 4.06), and on protrusion (OR > or = 5.30) was associated with increased risk of degenerative findings in tomograms. A clinical diagnosis of osteoarthritis increased the risk of radiographic findings (OR > or = 2.95) and so did increasing age (OR > or = 1.03 per year) and the female gender (OR > or = 2.36). Maximal assisted opening and maximal opening without pain (< 40 mm) was associated with a posterior condyle-to-articular tubercle position (OR > or = 2.60). No other significant associations were observed. CONCLUSION: Age, gender, and coarse crepitus, but no pain-related variables, were associated with increased risk of degenerative findings in TMJ tomograms. Maximal opening < 40 mm was associated with a posterior condyle-to-articular tubercle relation on opening.     

Relationship between the frequency of sleep bruxism and the prevalence of signs and symptoms of temporomandibular disorders in an adolescent population

PURPOSE: The relationship between sleep bruxism (SB) and temporomandibular disorders (TMD) is unclear. This study aimed to estimate SB prevalence in an adolescent population and to investigate the relationship between SB frequency and prevalence of TMD signs/symptoms. MATERIALS AND METHODS: First-year students at a high school in Okayama, Japan, were recruited in 2005, with 195 subjects responding. The SB detection device was a miniature disposable device (BiteStrip, SLP) that indicated the total SB events per night on a 4-grade score. The subjects were divided into severe and nonsevere SB groups with SB frequency cutoffs. The subjects were examined for temporomandibular joint (TMJ) noise during mouth opening/closing, tenderness of the masticatory/cervical muscles, and range of TMJ condylar movement. The presence/absence of headache and shoulder stiffness was also determined by the interview. The odds ratio (OR) and confidence interval (CI) were calculated to test the relationship between SB frequency, gender difference, and presence of the TMD signs/symptoms by multiple regression analysis. RESULTS: Severe SB (more than 125 events per night) was significantly related to the presence of TMJ clicking (OR: 3.74, CI: 1.22-11.49, P = .02), while gender (male) was not related to the presence of TMJ clicking. Severe SB was not related to headache, though gender (male) was significantly related to headache (OR: 2.52, Cl: 1.04-6.11, P= .04) in these subjects. CONCLUSION: These results suggest that the presence of TMJ clicking was closely related to severe SB in an adolescent population.     

颞下颌关节紊乱病患者与健康人群颌面部机械疼痛敏感性的比较

目的 利用定量触诊仪对受试者双侧咬肌区及关节区进行触诊,比较和分析疼痛性颞下颌关节紊乱病（TMD）患者与健康人群口颌面部机械疼痛敏感性的差异。 方法 选取患有单侧咬肌区或关节区疼痛的TMD患者各40例作为试验患者组,40例健康人作为对照组。利用定量触诊仪在受试者双侧咬肌区或关节区进行触诊,通过口述疼痛模拟评分法（NRS）获得受试者不同检测位点的机械疼痛感觉,绘制机械疼痛敏感性地图,并计算熵值和重心坐标。利用两因素方差分析法分析性别和检查侧（患者组：健患侧;对照组：左右侧）对各组熵值和重心坐标的影响;利用三因素方差分析法分析性别、检查侧和检测位点对各组NRS评分的影响。 结果 TMD患者咬肌区及关节区健患侧熵值均有统计学差异（咬肌：P＜0.001,关节：P=0.006）,且患侧NRS指数显著高于健侧（咬肌：P＜0.001,关节：P＜0.001）;但对照组咬肌区及关节区双侧熵值及NRS指数无明显统计学差异（P≥0.071）。 结论 机械疼痛敏感性地图技术在提供标准化触诊的基础上可以作为区分疼痛性TMD患者及正常人的有效辅助工具,并为该技术应用于TMD患者治疗效果评估的可行性提供了依据。     

JOINT DISORDER: NONREDUCING DISC DISPLACEMENT WITH MOUTH OPENING LIMITATION – REPORT OF A CASE

The internal derangement of the temporomandibular joint (TMJ) represents 8% of all cases of temporomandibular disorders (TMD) posing difficulties to establish an accurate diagnosis and treatment because of its low prevalence. This article presents the case of an 18-year-old Caucasian female patient who came to our Orofacial Pain and TMD Outpatient Service with complaints of intense pain on the right TMJ and limitation of mouth opening (maximum interincisal opening of 29 mm) with deviation to right, which she had been experiencing for the past 3 years. After a detailed clinical interview, a diagnosis hypothesis of nonreducing disc displacement with mouth opening limitation was established. The proposed treatment consisted of intra-joint infiltration with anesthetic in the right TMJ followed by jaw manipulation to recapture the articular disc, which was impeding the complete translation movement of the affected TMJ. After jaw manipulation, a new evaluation was done and showed the re-establishment of jaw dynamics with mouth opening and closing without deviation to the right side, clicking, opening limitation or pain. The patient was followed up at 6 months intervals. Two years after treatment, the patient was reevaluated and her mandibular range of motion without aid increased to 54 mm with no clicking, deviation to right, trismus or pain on the TMJ, indicating success of the treatment approach without recurrence of the pathology.     

Temporomandibular dysfunction post-craniotomy: Evaluation between pre- and post-operative status

ObjectiveTo identify risk factors associated with post-operative temporomandibular joint dysfunction after craniotomy.MethodsThe study sample included 24 patients, mean age of 37.3 ± 10 years; eligible for surgery for refractory epilepsy, evaluated according to RDC/TMD before and after surgery. The primary predictor was the time after the surgery. The primary outcome variable was maximal mouth opening. Other outcome variables were: disc displacement, bruxism, TMJ sound, TMJ pain, and pain associated to mandibular movements. Data analyses were performed using bivariate and multiple regression methods.ResultsThe maximal mouth opening was significantly reduced after surgery in all patients (p = 0.03). In the multiple regression model, time of evaluation and pre-operative bruxism were significantly (p < .05) associated with an increased risk for TMD post-surgery.ConclusionA significant correlation between surgery follow-up time and maximal opening mouth was found. Pre-operative bruxism was associated with increased risk for temporomandibular joint dysfunction after craniotomy.     

Signs and symptoms of temporomandibular disorders in Nigerian adult patients with and without occlusal tooth wear

OBJECTIVES: The purpose of this study was to investigate the prevalence of signs and symptoms of temporomandibular disorders in Nigerian patients with and without occlusal tooth wear, and to relate the signs and symptoms with the severity of occlusal tooth wear. METHODS: One hundred and fifty patients with occlusal tooth wear, and 100 control subjects participated in this study (mean age 40.8 +/- 12.2 years, range 18-65 years). Exclusion criteria included patients and subjects with more than one missing opposing pair of premolars or molars, restorations covering the entire incisal edge, canine cusps and occlusal surfaces of premolars and molars. The severity of occlusal wear was assessed using the tooth wear index (TWI) designed by Smith and Knight (1984). Chi-square test was used to compare the differences in signs and symptoms of TMD. P < 0.05 was defined as significant. RESULTS: Although more females reported pain than males the difference was not statistically significant (p = 0.05). Except for impaired range of movement, tooth wear patients and controls differ significantly with respect to the variables; pain report, pain on palpation, TMJ sound and deviation on opening (p < 0.001). Patients with mean occlusal TWI score of > or =3 differ significantly from those with TWI score < or =2 with respect to pain on palpation and TMJ sound (p < 0.001). CONCLUSIONS: Posterior occlusal wear (mean TWI scores of 3 or 4) was significantly associated with pain on palpation and TMJ sound. Hence there may be a clinically relevant risk of TMD among Nigerian patients with occlusal tooth wear.     

Symptoms of the stomatognathic system in temporomandibular and cervical spine disorders

This study was performed to assess the prevalance of signs and symptoms of temporomandibular disorders (TMD) in patients with cervical spine disorders (CSD) and to compare patients with CSD and subgroups of patients with TMD with regard to the results of orthopaedic tests of the stomatognathic system. A group of 103 consecutive patients with signs and symptoms of CSD and a group of 111 consecutive patients with TMD were examined. All subgroups of TMD patients showed a significantly smaller range of motion than the CSD patients. Patients with TMD had limited mouth opening (<40 mm) on active and passive mouth opening more often than CSD patients. TMD patients with myogenous problems reported oral habits more often than CSD patients, although no objective differences between CSD and TMD patients were found. Subgroups of TMD patients reported joint sounds, and pain on palpation and joint play tests of the temporomandibular joint (TMJ) more frequently than CSD patients. Joint sounds on active movements, pain on palpation of the TMJ, and pain on joint play tests correctly classified 82% of the patients with TMD and 72% of the patients with CSD. In spite of the biomechanical and anatomical relationship between the neck and the stomatognathic system, the results of the study show that CSD patients have signs and symptoms of TMD comparable with those of the adult Dutch population. It was concluded that the function of the masticatory system should be evaluated in patients with neck complaints in order to rule out a possible involvement of the masticatory system.     

Effect of turban use on temporomandibular joint problems

The aim of this study was to evaluate the effects of daily turban wear on temporomandibular joint (TMJ) problems. This cross-sectional study was carried out on 249 female patients. Of these, 119 patients were using turban daily, while 130 patients did not use. Patients were asked questions to ascertain the signs of TMJ problems. Thereafter, the TMJ region was examined clinically. Cross-tabulations and Chi-square statistics were computed in accordance with Bonferroni correction for multiple comparisons. To investigate the association between continuous turban wear and temporomandibular disorder symptoms, logistic regression analysis was performed. Limited mouth opening, deviation, pain on TMJ palpation and mouth opening were not affected with turban usage. However, turban users more frequently demonstrated pain during palpation of the masticatory muscles than non-users (P = 0.001). Duration of the turban usage did not affect clinical examination findings except pain on masticatory muscles during palpation (P = 0.001). Complaint of pain on masticatory muscles are more frequently seen among the turban users.