Prevalence of signs and symptoms of mandibular dysfunction among adults aged 25, 35, 50 and 65 years in Ostrobothnia, Finland

Influence of edentulism on the structure and function of temporomandibular joint

Background

With the acceleration of the aging process of the population, the number of edentulous patients continuously increased. Edentulism induces the loss of occlusal relationship and cause adverse effects on the stomatognathic system. Temporomandibular joint (TMJ), as a significant component of this system, may also be affected by edentulism in the process of supporting mandibular movement.

Purpose

Provide a comprehensive review of the structure and function of TMJ in the edentulous population, as well as the prevalence of temporomandibular joint disorder (TMD) in edentulous group.

Study selection

An electronic search was conducted on articles prior to December 2022 to filter all papers relevant to the structure and function of TMJ in edentulous population. The internet databases (PubMed, Cochrane Library, Embase) were searched using various combinations of keywords for "edentulism" or "edentulous" and "TMJ" or "TMD".

Results

Firstly, 522 articles were selected from the internet database, and finally, a total of 44 articles met the inclusion and exclusion criteria. The research content of these articles mainly focuses on the structure and function of TMJ in edentulous patients, as well as the clinical signs and symptoms of TMD.

Conclusions

Edentulous arch induces the loss of occlusal relationship, which may lead to degenerative changes of TMJ components consisting of changes in morphology and bone mass density of condyle, articular fossa, and articular eminence. In addition, the condyle could be shifted backward and upward, and displacement of the articular disc may occur after dentition loss. And the condyle and the articular disc may be guided back to the normal position after effective prosthodontic treatment. But the conclusions of the study on the function of TMJ and the prevalence of TMD in edentulous people are inconsistent. The condition of TMJ, especially the position of condyle-fossa and the symptoms and signs of TMD should not be ignored. If necessary, radiographic examinations should be performed.

Temporomandibular disorders in North Indian population visiting a tertiary care dental hospital

Background:

The terminology “temporomandibular disorders” (TMDs) encompasses a wide spectrum of conditions. Several hypothesized causes are occlusal disharmony, muscle hyperactivity, central pain mechanisms, psychological distress, and trauma. In day-to-day practice, TMDs had become more prevalent in Indian population due to changed dietary pattern and food habits, excessive stress of modern life, and other environmental causes. This study is an attempt to find the prevalence of TMDs in North Indian population.

Aims:

The present study is taken into account to determine the prevalence of TMDs on the basis of signs and symptoms based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD).

Materials and Methods:

The present cross-sectional study was conducted in the Department of Oral Medicine and Radiology. A total of 1009 patients aged between 6 and 80 years with a mean age of 42.04 ± 16.8 years seeking dental treatment from January 2016 to June 2017 were included in the study. All the patients were screened for TMD sign and symptoms. The demographic data and the signs and symptoms of TMDs were recorded in designed structured questionnaires which were based on the RDC/TMD criteria.

Results:

The study population consisted of 1009 patients aged between 6 and 80 years. In the present study population, based on RDC/TMD criteria, the incidence of clicking sound (42.5%) was highest in TMD joint followed by deviation of mandible on mouth opening (40.8%), internal derangement (36.8%), myofacial pain dysfunction syndrome (33.7%), osteoarthritis (29.5%), crepitus (25.8%), joint tenderness (5.8%), and pain on mouth opening (4.8%).

Conclusion:

Clicking sound was the most common sign of TMD disorders in Indian population.

Prevalence of clinical signs and pain symptoms of temporomandibular disorders and associated factors in adult Finns

Objective: To assess the prevalence of clinical signs and pain symptoms of temporomandibular disorders (TMD) and associated factors in the Finnish adult population, as well as the association between self-reported TMD pain symptoms and clinical signs.Material and methods: The sample consisted of 1577 Finnish adults who participated in the Health 2011 Survey (BRIF8901). Signs of TMD were assessed using clinical examination, and TMD pain symptoms were inquired using validated questions.Results: Of the study subjects, 35% showed at least one sign of TMD, 8% reported weekly facial pain and 6% weekly pain when biting or jaw opening. According to logistic regression, female gender, poor general health and low level of education increased the risk for most TMD signs and TMD pain symptoms. Muscle or TMJ pain on palpation associated significantly with self-reported weekly facial pain or pain when biting or jaw opening.Conclusion: Over a third of the population showed clinical signs of TMD and less than one-tenth reported TMD pain symptoms. An assessment of a patient's general health needs to be a part of TMD diagnosis and treatment. The Finnish versions of the validated questions are applicable for screening of TMD pain.

Factors associated with signs of temporomandibular pain: an 11-year-follow-up study on Finnish adults

Background: Pain in the temporomandibular region is a main complaint causing disability and distress among temporomandibular disorders sufferers.Objectives: The aim of the study was, over an 11-year follow-up on Finnish adult population, to investigate the prevalence of clinically assessed pain-related temporomandibular disorder (TMD) signs, i.e. temporomandibular joint (TMJ) and masticatory muscles (MM) pain on palpation, and their association with sociodemographic background and denture status.Methods: The data were based on the nationally representative Finnish Health 2000 and Health 2011 Surveys (BRIF8901). The sample comprised 1210 adults who underwent clinical oral examinations including TMD signs assessment. Statistical evaluations included chi-square tests and logistic regressions.Results: The prevalence of palpatory MM pain decreased from 9.5% at baseline to 4.6% in the follow-up. Cross-sectionally, presence of palpatory MM pain significantly associated with gender (p < .001, p = .002) and educational level (p < .001, p = .001) in both years, and with age (p = .006) and denture status (p = .022) at baseline. The prevalence of palpatory TMJ pain increased from 2.1% at baseline to 3.5% in the follow-up. Presence of palpatory TMJ pain significantly associated with gender in both years (p = .012, p = .032). Female gender, lower education and palpatory MM pain at baseline predicted palpatory MM pain in the follow-up.Conclusion: Palpatory MM pain is relatively prevalent in adults, yet with a favourable prognosis. Women and people with low education are more susceptible groups. Previous experience of palpatory MM pain increases the risk of exhibiting it later in life.

Prevalence of temporomandibular dysfunction and pain in adult general practice patients

OBJECTIVE

To analyse the prevalence of temporomandibular disorders and related pain (TMD-pain) among adult recall patients in general dental practice.

MATERIALS AND METHODS

From November 2006 to September 2008, all adults attending a Swedish Public Dental Service (PDS) clinic for recall examination were asked two standardized questions about temporomandibular pain and dysfunction. Mouth-opening capacity was measured. The responses to the questions and mouth-opening capacity were combined to give a TMD-pain score, on a scale of 0-3. The patients' acceptance of their TMD condition was also noted.

RESULTS

The subjects comprised 2837 adults (53% females, 47% men). Of the total sample, 4.9% reported a TMD-pain score of 1-3. The gender difference was significant: women predominated (p < 0.003). Forty-three per cent of those with TMD-pain scores of 1-3 (36% men, 47% women) considered that the condition warranted treatment, especially those registering a pain score (significant difference between pain and dysfunction groups, p < 0.000).

CONCLUSIONS

The TMD-pain score shows promise as a useful instrument for detecting and recording TMD-pain. The prevalence of TMD disclosed in the study is high enough to be considered a public health concern. Most of the subjects with lower scores on the TMD-pain scale accepted their condition as not severe enough to require treatment.

Signs and symptoms related to temporomandibular disorders—Follow-up of subjects with shortened and complete dental arches

OBJECTIVE

To assess prevalence of cardinal signs and symptoms related to temporomandibular disorders (TMD) in subjects with shortened dental arches and to clarify the individual course of these signs and symptoms.

METHODS

In this 9-year follow-up study, subjects with shortened dental arches (n=74) were compared with subjects with complete dental arches (n=72). Of three reported symptoms (pain, noises/clicking and restricted mobility of the lower jaw), and of two clinical signs (palpated clicking of the temporomandibular joint and restricted maximal mouth opening) estimates of mean scores were calculated by a mixed model. Suggested determinants for TMD (gender, time, bruxism, chewing side preference) were investigated by covariate analyses. Subjects with complete 9-year follow-up (shortened dental arches: n=42; complete dental arches: n=41) were described more detailed by frequency distributions, Pearson correlations of signs and symptoms, and fluctuation of the symptoms.

RESULTS

Covariate analyses using the mixed model revealed no significant differences between the shortened and the complete dental arch groups (p>0.05) with respect to symptoms and signs. Most prevailing effect was gender: females reported more frequently pain (p=0.05) and noises/clicking (p=0.03). Restricted mobility was significantly related with chewing side preference and bruxism habits (both: p=0.01). In both groups, subjects with complete 9-year follow-up had low prevalence of serious symptoms and signs and symptoms fluctuated without demonstrable correlation.

CONCLUSION

In this 9-year follow-up, subjects with shortened dental arches had similar prevalence, severity, and fluctuation of signs and symptoms related to TMD compared to subjects with complete dental arches.

A prospective investigation over two decades on signs and symptoms of temporomandibular disorders and associated variables. A final summary

The aim of this summary of a longitudinal investigation on temporomandibular disorders (TMD) was to present the prevalence figures of signs and symptoms of TMD and certain other examined variables, and the correlations between these variables, over a 20-year period. Originally, 402 randomly selected 7-, 11-, and 15-year-olds were examined clinically and by means of a questionnaire. The same examination procedure was repeated three times: after 4-5 years and after 10 and 20 years, respectively. Signs and symptoms of TMD were mainly mild, but common already in childhood. They increased up to young adulthood, after which they leveled out. Progression to severe pain and dysfunction was rare, and spontaneous recovery from more pronounced symptoms was also rare. Significant correlations between reported bruxism and TMD symptoms were found, and a baseline report of tooth-grinding was a predictor of TMD treatment during the 20 years covered by the investigation. Occlusal factors were only weakly associated with TMD signs and symptoms. However, a lateral forced bite between the retruded contact position (RCP) and the intercuspal contact position (ICP) and a unilateral crossbite deserve further consideration as possible local risk factors for development of TMD. In conclusion, a substantial fluctuation of TMD signs and symptoms was observed in this sample of Swedish subjects followed for 20 years from childhood to adult. The demand for TMD treatment was low at all examinations, while the estimated treatment need was larger. One-third of subjects who had some kind of orthodontic treatment did not run a higher risk of developing TMD later in life.

Prevalence of persistent pain after endodontic treatment and factors affecting its occurrence in cases with complete radiographic healing

AIMS

To (i) determine the prevalence of persistent dento-alveolar pain following nonsurgical and/or surgical endodontic treatment conducted in a teaching dental hospital and (ii) identify the risk factors associated with persistent pain after apparently successful root canal treatment.

STUDY DESIGN

A total of 175 patients/teeth were reviewed 12-59 months following treatment. The patients were examined clinically and radiographically and a detailed pain history obtained. Multiple logistic regression analysis was used to investigate the association between potential risk factors and persistent pain after successful endodontic treatment.

RESULTS

The prevalence of persistent pain after successful root canal treatment was 12% (21/175). Treatment success was determined by the absence of clinical and radiographic signs of dental disease. The factors that were significantly (P < 0.05) associated with persistent pain following endodontic treatment were: 'duration of preoperative pain' [odds ratio (OR) = 8.6], 'preoperative pain from the tooth' (OR = 7.8), 'preoperative tenderness to percussion' (OR = 7.8), 'previous chronic pain problems' (OR = 4.5), 'gender' (OR = 4.5) and 'history of painful treatment in the orofacial region' (OR = 3.8). 'Type of treatment received (surgical or nonsurgical treatment)' showed borderline significance at the 10% level.

CONCLUSIONS

The presence and duration of preoperative pain from the tooth site, lasting at least 3 months, a positive history of previous chronic pain experience or painful treatment in the orofacial region, and female gender were important risk factors associated with persistent pain after successful endodontic treatment.

Association between local mechanical factors and orofacial pain: survey in the community

OBJECTIVES

The aetiology of orofacial pain (OFP) is not well understood. We aimed to determine the relationship between OFP and local mechanical factors in an unselected general population sample.

METHODS

A cross-sectional population-based survey was conducted in the United Kingdom, involving 2504 participants (adjusted participation rate 74%). Postal questionnaire was used to collect information on OFP and local mechanical factors.

RESULTS

A significant association was found between OFP and a history of tooth grinding, facial trauma, the jaw getting stuck or locked, a clicking or grating sound in the jaw joint when opening or closing the mouth, difficulty in opening the mouth wide, and chewing of pens or biting finger nails. The jaw getting stuck or locked had the highest relative risk of 2.7 (95% CI: 2.3-3.2). A history of orthodontic treatment, having any type of dentures and using chewing gum were not associated with OFP. There was some evidence of heterogeneity between types of OFP and local mechanical factors.

CONCLUSIONS

Local factors play an important role in the aetiology of OFP.

Treatment received, treatment demand, and treatment need for temporomandibular disorders in 35-year-old subjects

An epidemiological sample of 114 subjects was followed longitudinally from the age of 15 to 35 years with regard to treatment received, treatment demand, and treatment need for temporomandibular disorders (TMD). Some kind of TMD treatment had been provided to 18% of the subjects during the 20-year follow-up period. Eighty-five percent of those who had received previous TMD treatment reported that the treatment had had a positive effect on their symptoms. The estimated present need for treatment was 11%, but, in line with several other investigations, the active demand for such treatment was much less (3%). From age 15 to 25 years, a small but gradual increase of clinical signs of dysfunction was found. From the age of 25 to 35 years, however, a significant reduction of such signs was noted. One explanation for this reduction of clinical signs and symptoms of TMD might be the stomatognathic treatment received. It was concluded that 18% of the subjects had received some TMD treatment during the 20-year follow-up period. Only 3% still had a demand for such treatment at age 35.

Systematic review of population-based epidemiological studies of oro-facial pain

OBJECTIVES

To conduct a systematic review of epidemiological literature in order to determine the prevalence and associated risk factors of oro-facial pain.

DATA

Population based observational studies (cohorts, cross-sectional and case-control studies) of oro-facial pain, published in the English language, prior to 1999 were included.

SOURCES

Electronic databases (Medline, Embase, Cinahl, BIDS and Health CD) were searched. Reference lists of relevant articles were examined, and the journals "Pain" and "Community Dentistry and Oral Epidemiology" were handsearched for the years 1994-1998.

RESULTS

The results of the search strategy were screened for relevance. A standardised checklist was used to assess the methodological quality of each study by two reviewers before an attempt was made to summarise the results. The median quality score was 70% of the maximum attainable score. Due to methodological issues, it was not possible to pool the data on the prevalence of oro-facial pain. Age, gender and psychological factors were found to be associated with OFP, however there was not enough information on other factors such as local mechanical and co-morbidities to draw any reliable conclusions. None of the factors fully fulfilled criteria for causality.

CONCLUSIONS

There is a need for good quality epidemiological studies of oro-facial pain in the general population. To enable comprehensive examination of the aetiology of oro-facial pain, it is necessary to address a broad range of factors including demography and life-style, local mechanical factors, medical history and psychological factors. Future studies should recruit adequately sized samples for precise determination of the prevalence and detection of important associated factors. Data on potential confounders and effect modifiers should also be collected and adjusted for in the statistical analysis.

Need for occlusal therapy and prosthodontic treatment in the management of temporomandibular disorders. Part II: Tooth loss and prosthodontic treatment

The second part of this review, evaluating the literature on the relationship between dental occlusion and temporomandibular disorders (TMDs), focuses on the aetiological importance of tooth loss and the place of prosthodontic replacement in the treatment of TMD. Loss of teeth and lack of posterior occlusal support seem to have little influence on the development of TMD, which calls into question the use of prosthodontic restoration as prevention or treatment for TMD. In addition, there are practically no studies assessing the benefit of instrumental analysis in diagnosis or comparing the outcome of prosthodontic treatment with simple reversible methods in the management of TMD. There is a trend in the current literature to abandon any treatment, including positioning appliances and prosthodontic measures, to 'recapture the disk' in patients with disk displacements because of the favourable, long-term results achieved after using more simple methods. It is concluded that prosthetic therapy in TMD patients is not appropriate for initial TMD treatment and should only be carried out on prosthodontic indications after reversible treatment has alleviated pain and dysfunction.

The effect of surgical treatment of the temporomandibular joint: a survey of 70 patients

Most patients with temporomandibular disorders (TMD) can be successfully treated by conservative methods, but approximately 10-20 percent have persistent symptoms. The aim of this study was to evaluate the signs and symptoms of TMD in patients treated with open surgery of the TMJ. Seventy-two patients (13 men, 59 women, mean age 37 years, range 14-68 years) were evaluated during an eight-year period. Altogether 45 right TMJs and 39 left TMJs were treated, including both TMJs during the same operation in eight of the cases. The patients were evaluated at follow-up in 1997. The degree of TMD at follow-up was assessed using the anamnestic and clinical dysfunction Helkimo indices. Most of the patients reported at the follow-up that they were subjectively satisfied with the surgical treatment. The main clinical findings in the post surgical patients at follow-up were TMJ sounds and deviation of the mandible during opening. The tenderness in the masticatory muscles and TMJs on palpation was reduced significantly and the ranges of mandibular movement were improved for all the patients. The mean anamnestic and clinical indices decreased with a statistical significance from the shortest follow-up group (Group I) to the longest on group (Group IV) (p = 0.000). The conclusion of this study was that after open surgical treatment of the TMJ, the patients have significantly better functioning of the masticatory system and reduced signs and symptoms of TMD in the long term.

The effect of hormone replacement therapy on salivary calcium concentrations in menopausal women

Hormone replacement therapy in menopausal women is known to affect the general calcium turnover of the body. No information is available about the effects of hormone therapy on salivary electrolytes and on calcium in particular. A group of 16 healthy peri- and postmenopausal women, all recommended to start hormone replacement therapy, were studied longitudinally for 5 months. Paraffin-stimulated whole saliva was collected at baseline, at 3 and at 5 months after the onset of therapy, and analysed for calcium, sodium and potassium concentrations. In response to hormone replacement therapy, calcium concentration decreased (p = 0.037), that of sodium increased (p = 0.019), while no change was observed in the potassium concentrations during the follow-up period.

Occlusal imbalance and temporomandibular disorders in the elderly

The prevalence of the anamnestic symptoms and clinical signs of temporomandibular disorders (TMD) in 76-, 81-, and 86-year-old subjects was studied, on the basis of Helkimo's anamnestic (Ai) and clinical (Di) dysfunction indexes. Occlusal status was recorded by means of the Eichner index: class A has a maximum of four supporting zones (minimum of one tooth contact between the antagonist jaws in the premolar and molar region on each side), class B has one to three supporting zones or tooth contact in the frontal area only, and class C has no supporting zones. The Eichner index was recorded with two kinds of variations: supporting zones with and without removable prostheses. In the population studied 8% were classified as Eichner class A, 22% as class B, and 70% as class C. Including occlusal supporting zones of the removable dentures, the percentages were 75% in Eichner class A, 21% in class B and 4% in class C. When the groups with and without removable prostheses were compared, no differences were found in the Ai or Di. In conclusion, among the elderly population the severity of TMD does not depend on the supporting zones of the dentition alone, and removable prostheses do not relieve the problem.

Epidemiology of temporomandibular disorders: implications for the investigation of etiologic factors

Epidemiology is the study of the distribution, determinants, and natural history of disease in populations. Epidemiology has several uses in addition to its traditional role of documenting the public health significance of a condition. Notably, epidemiologic methods and data can be used to identify and verify causes of disease. This article reviews the epidemiologic data on pain in the temporomandibular region, and on signs and symptoms associated with specific subtypes of temporomandibular disorders, with the aim of identifying possible etiologic factors for these conditions that deserve further study. Despite methodologic and population differences, several consistencies are apparent in the epidemiologic literature. Pain in the temporomandibular region appears to be relatively common, occurring in approximately 10% of the population over age 18; it is primarily a condition of young and middle-aged adults, rather than of children or the elderly, and is approximately twice as common in women as in men. This prevalence pattern suggests that etiologic investigations should be directed at biologic and psychosocial factors that are more common in women than in men, and diminish in older age groups. Most signs and symptoms associated with particular temporomandibular disorders (e.g., joint sounds, pain in the joint) also appear to be more prevalent in women than in men, although age patterns for these signs and symptoms are not as clear as for temporomandibular pain. The available data highlight the need for further research on etiologic factors associated with temporomandibular pain and with specific diagnostic subtypes of temporomandibular disorders.

The effect of stomatognathic treatment: a clinical follow-up study

Temporomandibular disorders (TMD) are common but complex problems in dentistry. Most patients can be treated using relatively simple methods, such as counselling, splint therapy, and occlusal adjustment. Patients who do not respond to conservative treatment may benefit from surgical treatment. Ninety-two patients (68 women, 24 men, mean age 36 years, range 14-74 years) were treated between 1988 and 1990 in the Department of Prosthetic Dentistry and Stomatognathic Physiology. Sixty-two patients of which 15 were surgically treated, attended for clinical follow-up in 1994. Success of treatment was evaluated using the anamnestic and clinical dysfunction indices of Helkimo. All patients reported that they had benefitted from their treatment. Symptoms of TMD were also noted to be clinically less than before. The results of the study reported show that the effects of stomatognathic treatment are beneficial in long-term, i.e. the patients were subjectively satisfied, and symptoms recorded clinically on follow-up were statistically significantly less than before.

Signs of temporomandibular dysfunction related to edentulousness and complete dentures: an anamnestic study

Symptoms of temporomandibular dysfunction (TMD) are prevalent among elderly individuals with complete dentures. In the agrarian areas of middle Finland it was, as recently as a few decades ago, almost a tradition to extract teeth during young adulthood. Women who today are in post-menopausal age are the last sizable age group in Finland where the problems of edentulousness can be investigated. The purposes of this study were twofold. First, postmenopausal women who are edentulous in the maxilla or totally edentulous were studied to determine if they differ from women with natural teeth in both jaws in terms of subjective TMD symptoms. Second, these subjective symptoms were examined to discover any correlation with duration of edentulousness, age of the dentures, or difficulties in wearing them. The results suggest that for postmenopausal women, clicking noises in the temporomandibular joint and tension in the neck are more common complaints among denture wearers than among those who still have natural teeth. Factors that make the wearing of complete dentures more difficult may also predispose the wearer to TMD symptoms. Duration of edentulousness is not, however, related to the prevalence of anamnestic TMD symptoms.

Pathogenesis of degenerative joint disease in the human temporomandibular joint

The wide range of disease prevalences reported in epidemiological studies of temporomandibular degenerative joint disease reflects the fact that diagnoses are frequently guided by the presence or absence of non-specific signs and symptoms. Treatment is aimed at alleviating the disease symptoms rather than being guided by an understanding of the underlying disease processes. Much of our current understanding of disease processes in the temporomandibular joint is based on the study of other articular joints. Although it is likely that the molecular basis of pathogenesis is similar to that of other joints, additional study of the temporomandibular joint is required due to its unique structure and function. This review summarizes the unique structural and molecular features of the temporomandibular joint and the epidemiology of degenerative temporomandibular joint disease. As is discussed in this review, recent research has provided a better understanding of the molecular basis of degenerative joint disease processes, including insights into: the regulation of cytokine expression and activation, arachidonic acid metabolism, neural contributions to inflammation, mechanisms of extracellular matrix degradation, modulation of cell adhesion in inflammatory states, and the roles of free radicals and heat shock proteins in degenerative joint disease. Finally, the multiple cellular and molecular mechanisms involved in disease initiation and progression, along with factors that may modify the adaptive capacity of the joint, are presented as the basis for the rational design of new and more effective therapy.

Prevalence of signs of temporomandibular disorders among elderly inhabitants of Helsinki, Finland

The prevalence of clinical signs of temporomandibular disorders in 76-, 81-, and 86-year-old subjects living in Helsinki, Finland, were studied, using Helkimo's clinical dysfunction index. In percentage distribution, clinically symptom-free subjects (Di 0) constituted 20% of all those examined, and by percentage the largest group of subjects without signs was that of the oldest men (47%). Women had a higher prevalence of signs of temporomandibular disorders, and only 15% were clinically symptom-free. Four per cent of all those examined had severe symptoms. The commonest signs were impaired range of movement of the mandible and impaired function of the temporomandibular joint.

Temporomandibular pain dysfunction disorder resulting from road traffic accidents--an Australian study

The relationship between temporomandibular pain dysfunction disorder (TMPD) and trauma to the head and neck is unclear. A retrospective analysis of the records from the Transport Accident Commission (TAC) of Victoria, Australia, in the year 1987, was done to identify those subjects who received treatment for TMPD resulting from a road traffic accident (RTA). Twenty-eight subjects with TMPD were identified from a total of 20 673 subjects who claimed health care services from the TAC for RTA-related disorders. In this study, TMPD for which subjects sought treatment was uncommonly associated with either direct or indirect trauma to the temporomandibular joints: 0.4% of subjects with mandibular fractures and 0.5% of subjects with whiplash injuries presented for treatment of an associated TMPD. Females were found to present for treatment of TMPD more commonly than males at a ratio of 5:2. It was also noted that 75% of subjects complained of symptoms of TMPD immediately after the accident and approximately 96% within 2 months of the accident. Subjects were not lost to follow-up because all claims for treatment were made to the TAC, regardless of the clinician involved. In this study, 25% of subjects attended more than one dentist for management. It was concluded that TMPD for which subjects sought treatment was an uncommon result of an RTA and was infrequently associated with a mandibular fracture or whiplash injury.

Prevalence of symptoms of craniomandibular disorders in a population of elderly inhabitants in Helsinki, Finland

The prevalence of symptoms of craniomandibular disorders (CMD) was studied by using a questionnaire in a random sample of 76-, 81-, and 86-year-old subjects living in Helsinki, Finland. Symptoms were reported with lower prevalence with increasing age. Of the total group of 364, 34% reported awareness of one or more symptoms of CMD, but only 2% found their symptoms extremely severe. Thirty per cent reported pains in the head and neck region, and 4% had headache daily.

Prevalence in the Dutch adult population and a meta-analysis of signs and symptoms of temporomandibular disorder

A nationwide survey of oral conditions, treatment needs, and attitudes toward dental health care in Dutch adults was carried out in 1986. One of the aims of the study was to assess the prevalence of signs and symptoms of temporomandibular disorder (TMD). A sample of 6577 persons (from 15 to 74 yr of age), stratified for gender, age, region, and socio-economic status, was contacted. Of this sample, 4496 persons participated in the behavioral part of the study, of whom 3526 were examined clinically. The TMD prevalence was based on (1) perceived signs and symptoms of TMD and (2) clinical examination of joint sounds, deviation, and pain on mandibular movements. A total of 21.5% of the Dutch adult population perceived some dysfunction, and 44.4% showed clinically assessed signs and symptoms of TMD. In nearly all age groups, the signs and symptoms of TMD appeared more in women than in men. Agreement between the results of the clinical examination and the anamnestic dysfunction index was significant (p < 0.0001); however, the Pearson's correlation coefficient was low (r = 0.29). The odds-value (risk-ratio) that subjects who perceived signs and symptoms of TMD would present with clinically assessed signs and symptoms of TMD was 2.3. The results of the survey were compared with results of a meta-analysis performed on 51 TMD prevalence studies. The analysis revealed (1) a perceived dysfunction rate of 30% and (2) a clinically assessed dysfunction of 44%, both based on compound samples of, respectively, over 15,000 (23 studies) and over 16,000 (22 studies) randomly selected subjects.

Prevalence of temporomandibular disorder symptoms in a major metropolitan area

An accurate description of the population prevalence of temporomandibular disorders (TMDs) would be of value to scientists, health-policy makers, and clinicians but, to date, various unreplicated epidemiologic methodologies have produced disparate prevalence figures. We report on a telephone survey that sought to describe the prevalence of six TMD-related symptoms among a random, non-clinic sample from the Kansas City metropolitan area. The prevalence figures for nocturnal bruxism, diurnal clenching, jaw soreness and joint sounds ranged from 10-19%. Some figures were higher than those from St. Louis, but generally the figures accord well with the results of other prevalence studies. Of the 534 people interviewed, 246 reported one or more of the six TMD-related symptoms. Symptoms were not more prevalent among women than men, but were higher among persons of age 45 and under. Pain was reported more commonly by persons with multiple symptoms. The level of concordance between data from Kansas City and St. Louis supports the validity of the telephone survey method for studying TMD prevalence in non-clinic samples.

Demand and need for treatment of craniomandibular dysfunction in the Dutch adult population

A nationwide survey of oral conditions, treatment needs, and attitudes toward dental health care in Dutch adults was carried out in 1986. One of the aims of the study was to investigate the perceived need and demand for treatment of craniomandibular dysfunction (CMD). A sample of 6577 persons (15-74 yrs of age), stratified for gender, age, region, and socio-economic status, was contacted. Of this sample, 4496 persons participated in the behavioral part of the study, of which 3526 were examined clinically. The CMD-treatment demand was based on (1) CMD complaints in the past, (2) CMD complaints at present, and (3) an anticipated increase of the present complaints. CMD was both anamnestically and clinically assessed, independently by different examiners. A total of 21.5% of the Dutch adult population reported dysfunction, but 85% of these perceived no need for treatment. With most of the remaining 15% either seeking or intending to seek treatment (or having had it before), a figure of 3.1% can be used to summarize the actual level of treatment need for CMD in the Dutch adult population.

Tenderness on palpation and occlusal abnormalities in temporomandibular dysfunction

Tenderness on palpation indicates objective painful symptoms. This study investigated the tenderness of the temporomandibular joint, muscles and their relation to occlusion in patients with temporomandibular dysfunction. Two hundred ten patients were examined; 96% had tenderness and 80% of cases of tenderness were diagnosed as occlusally related. The average number of tender areas was 5.4 per patient, despite the contribution of occlusion. Tenderness was observed most frequently in the lateral pterygoid muscle, followed by the insertion of temporal muscle. There was no correlation of temporomandibular joint tenderness to muscle tenderness, while tenderness of certain muscles to each other was correlated. Differences were related to the state of occlusion in the number of tender areas, to the ratio to tenderness of elevator muscles to horizontally acting muscles, and to the frequency of unilateral tenderness. The association of muscle tenderness and occlusion was suggested.

Awareness of dental disorders and discrepancy between "objective" and "subjective" dental treatment needs

A dental health survey including an interview, a questionnaire and a clinical examination was conducted among adults aged 25, 35, 50, and 65 yr in Ostrobothnia, Finland. A total of 1275 subjects, 80% of the sample, participated in the clinical examination. 40% of the subjects with at least one dentate sextant had noticed gingival bleeding, 16% gingival inflammation, 20% "gum disease", and 70% at least one decayed tooth. When objectively assessed, a total of 98% had a maximum CPITN code 1-4, 38% a maximum CPITN code 3-4 and 76% were deemed to be in need of fillings. Dentures were objectively non-acceptable in 64% of wearers and subjectively so in 42%. A need for replacing missing teeth was expressed by 14% of the total sample, whereas according to "objective" assessment, 23% had such a need. It is concluded that people tend to underestimate their dental treatment needs, the discrepancy being most distinct in the field of periodontology. Sufficient emphasis should thus be given to improving people's awareness and knowledge of their own dental disorders.