Are Signs of Temporomandibular Disorders Stable and Predictable in Adolescents With Headache?

Mallampati score in patients with temporomandibular joint disorders: A pilot case-control study

OBJECTIVES

Temporomandibular joint disorder (TMD) is defined as any functional abnormalities in different parts of the face and neck. The Mallampati index is an indicator for determining the extent of airway blockage. No study has examined the relationship between TMD and Mallampati score. Most studies have investigated the relationship between temporomandibular joint problems and sleep problems. This pilot study aimed to assess the Mallampati index scores among TMD patients.

MATERIAL AND METHODS

Eighty-four people were divided into the case (based on RDC/TMD) and control groups. Demographic information, neck circumference, tongue size, Mallampati score, and other variables were asked of people. STOP-BANG and Pittsburgh Sleep Quality Index (PSQI) were also completed for each patient. Data were analyzed with Chi-square, Fisher's exact, and Mann-Whitney tests.

RESULTS

The Mallampati and PSQI questionnaire scores in the case group were significantly higher than those in the control group (p < 0.001). The results showed that larger tongue and neck circumference patients had a higher Mallampati score. Pearson correlation coefficient showed that the Mallampati score had a direct and significant relationship with body mass index and PSQI (p < 0.001).

CONCLUSIONS

The results of this study show that Mallampati scores were significantly higher among patients with TMD than among healthy individuals.

Temporomandibular disorders in children and adolescents: A review

BACKGROUND

Temporomandibular disorders (TMD) are generally observed in individuals between the ages of 20 and 40 years. TMD have also been described in children and adolescents but are still not widely detected and treated in routine practice. Through a literature review, this work aims to improve the diagnosis and management of TMD in children and adolescents by dentists.

METHODS

This literature review was performed by a computerized search of the database PubMed for published articles on TMD in children and adolescents. Articles evaluating the prevalence, etiologies and risk factors, diagnosis, signs, and symptoms as well as the comorbidities of TMD, published between 2001 and 2022, were included in this review.

RESULTS

A total of 51 articles were included. Most of studies reported a prevalence of over 20%, with a higher prevalence in females. The two most common diagnoses were myofascial pain and disk displacement with reduction. Headaches were often associated with the condition. The management of TMD in children and adolescents has been poorly studied.

CONCLUSION

TMD frequently affect children and adolescents. Therefore, for prevention purposes, an examination of the masticatory system should be included in the dental check-up. Early diagnosis is essential in order to limit effects on their growth, development, and quality of life. TMD management is not currently validated for children and adolescents. Noninvasive and reversible care should be preferred.

Reduction of headache intensity and frequency with maxillary stabilization splint therapy in patients with temporomandibular disorders-headache comorbidity: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to analyze the effectiveness of maxillary stabilization splint (SS) therapy to reduce headache (HA) intensity and HA frequency in patients with temporomandibular disorders (TMD)-HA comorbidity. Randomized controlled trials (RCTs) using full-arch coverage, hard resin, and maxillary SS therapy were included. Electronic databases, including Cochrane Library, MEDLINE through PubMed, Web of Science, and EMBASE, were searched. The risk of bias was analyzed based on Cochrane's handbook. The search yielded 247 references up to January 28, 2020. Nine RCTs were included at a high risk of bias. The comparison groups included other splints, counseling, jaw exercises, medications, neurologic treatment, and occlusal equilibration. Four studies reported a statistically significant reduction in HA intensity, and five studies reported significant improvement in HA frequency from baseline at 2-12 months in patients with TMD-HA comorbidity treated with a full-arch hard maxillary SS. HA frequency in tension-type HA (TTH) comorbid with TMD diagnoses of myofascial pain (MFP) or capsulitis/synovitis improved significantly with SS than that with full-arch maxillary non-occluding splint (NOS) in two studies. Comparison groups receiving hard partial-arch maxillary splint nociceptive trigeminal inhibition (NTI) showed statistically significant improvements in HA intensity in patients with mixed TMD phenotypes of MFP and disc displacement comorbid with “general HA.” Comparison groups receiving partial-arch maxillary resilient/soft splint (Relax) showed significant improvements in both HA intensity and frequency in patients with HA concomitant with MFP. The meta-analysis showed no statistically significant difference in the improvement of pain intensity at 2-3 months with comparison of the splints (partial-arch soft [Relax], hard [NTI], and full-arch NOS) or splint use compliance at 6-12 months with comparison of the splints (partial-arch Relax and full-arch NOS) versus the SS groups in patients with various TMD-HA comorbidities. In conclusion, although SS therapy showed a statistically significant decrease in HA intensity and HA frequency when reported, the evidence quality was low due to the high bias risk and small sample size. Therefore, further studies are required.

Self-reported symptoms of temporomandibular pain and jaw dysfunction in adolescents are associated with exposure to violence

BACKGROUND

Temporomandibular disorders (TMDs) are multifactorial, and high levels of stress seem to increase symptoms. The association with exposure to violence has not been explored in adolescent populations.

OBJECTIVE

To examine the association of self-reported symptoms of temporomandibular pain and jaw dysfunction with child physical abuse, intimate partner violence, forced sexual intercourse, and bullying victimisation.

METHODS

An epidemiological, cross-sectional, school-based study was conducted in Olinda, northeast Brazil. The sample comprised 2,431 adolescents aged 14-19 years. TMD-related symptoms and exposure to violence were assessed with questions from the 3Q/TMD screener and queries on exposure to different forms of violence. Multilevel logistic regressions were conducted to evaluate how 3Q screen-positive responses are associated with self-reported exposure to violence.

RESULTS

Self-reported TMD-related symptoms had a prevalence of 40.5%. Significantly more females than males screened positive to all 3Q/TMD questions (p < .001). Adolescents experiencing intimate partner violence (p = .012) and bullying (p < .001) had significantly higher odds of 3Q positive responses than those who reported no exposure to violence. Significant associations of TMD-related symptoms with forced sexual intercourse (p = .014) and with bullying (p = .007) were observed.

CONCLUSION

Adolescents with self-reported symptoms of temporomandibular pain and jaw dysfunction were significantly more often exposed to some type of violence. The number of adolescents reporting TMD-related symptoms increased in a dose-response manner with the number of violence forms the individual had experienced.

The relationship of temporomandibular disorders with Class II malocclusion as a risk factor

Objectives:

The temporomandibular joints (TMJs) play a fundamental role in mastication, deglutition, speech, and even respiration. Thus, temporomandibular disorders (TMDs) can affect the quality of life, especially if they become chronic. Considering the controversy regarding the etiology of the TMDs, this study aimed to assess the relationship of TMDs with dental malocclusion.

Materials and Methods:

Totally, 885 dentate patients between 18 years and 60 years with complete dental records and no condylar ankylosis, history of trauma, bruxism, clenching, or congenital TMJ anomalies participated in this study. Tenderness on palpation, clicking, crepitus, pain, deviation on mouth opening, open bite, deep bite, cross bite, and class of malocclusion (I, II or III) were recorded for all patients.

Results:

Of patients, 60.2% were males and 39.8% were females. Gender had no correlation with TMDs. Patients had a mean age of 34.8 years. Age had no correlation with TMDs. Of TMD symptoms, clicking had the highest frequency (23.3%) followed by deviation on mouth opening (10.6%), pain at the mouth opening (2.9%), tenderness on palpation (1.4%), trismus (1.2%), and crepitus (1.1%). Of patients, 76.7% were Class I, 13.8% were Class II, and 6.2% were Class III. Less than 2% of patients had deep bite, open bite, or cross bite.

Conclusion:

TMDs had a relatively high prevalence (35%) in our study population. Age, gender, and class of malocclusion had no correlation with TMDs; however, Class II malocclusion was slightly more prevalent among TMD patients, which needs to be taken into account by patients and orthodontists.

Prevalence and association of self-reported anxiety, pain, and oral parafunctional habits with temporomandibular disorders in Japanese children and adolescents: a cross-sectional survey

Background

Associations between temporomandibular disorder (TMD) and psychological variables, pain conditions, and daily activities have been reported more commonly in middle-aged individuals than in children. However, to determine factor-specific preventive programs for TMD, it is important to evaluate the associations between multiple factors and TMD symptoms during childhood. The aim of this study was to assess the relationship between TMD symptoms and other orofacial pain conditions, daily activities, and trait anxiety in a population-based cross-sectional survey of Japanese children and adolescents.

Methods

A total of 1,415 subjects (11–15 years old) self-reported their TMD symptoms, headache, neck pain, and toothache, and completed questionnaire scales that assessed 15 daily activities. Trait anxiety was assessed using the State Trait Anxiety Inventory for Children-Trait (STAIC-T) scale. Subjects were dichotomized into a TMD group or control group, based on whether they reported at least 1 TMD symptom: the TMD group (≥1 TMD symptom, n = 182) and the control group (no TMD symptoms, n = 1,233). Data were analyzed using the chi-square test and multivariate logistic regression analysis.

Results

The prevalence rates for headache and neck pain were significantly higher in the TMD group than in the control group (44.0% vs. 24.7% and 54.4% vs. 30.0%, respectively; both P < 0.001). The odds ratios for TMD symptoms in subjects with neck pain and frequent diurnal clenching were 2.08 (P < 0.001) and 3.69 (P = 0.011), respectively. Moreover, high STAIC-T scores were weakly associated with TMD symptoms.

Conclusions

In this young Japanese population, TMD symptoms were associated with other orofacial pain conditions, particularly neck pain, although they were only weakly associated with trait anxiety. Diurnal clenching was strongly associated with TMD symptoms. Health professionals should carefully consider these factors when developing appropriate management strategies for TMD in children and adolescents.

Are occlusal characteristics, headache, parafunctional habits and clicking sounds associated with the signs and symptoms of temporomandibular disorder in adolescents?

[Purpose] To assess the association between the oclusal characteristics, headache, parafunctional habits and clicking sounds and signs/symptoms of TMD in adolescents. [Subjects] Adolescents between 14 and 18 years of age. [Methods] The participants were evaluated using the Helkimo Index and a clinical examination to track clicking sounds, parafunctional habits and other signs/symptoms of temporomandibular disorder (TMD). Subjects were classified according to the presence or absence of headache, type of occlusion, facial pattern and type of bite. In statistical analyse we used the chi-square test and Fisher's exact test, with a level of significance of 5%. [Results] The sample was made up of 81 adolescents with a mean age of 15.64 years; 51.9% were male. The prevalence of signals/symptoms of TMD was 74.1%, predominantly affecting females. Signals/symptoms of TMD were significantly associated with clicking sounds, headache and nail biting. No associations were found between signals/symptoms of TMD and angle classification, type of bite and facial pattern. [Conclusion] Headache is one of the most closely associated symptoms of TMD. Clicking sounds were found in the majority of cases. Therefore, the sum of two or more factors may be necessary for the onset and perpetuation of TMD.

Temporomandibular Disorders and Related Factors in a Group of Iranian Adolescents: A Cross-sectional Survey

Background and aims

Temporomandibular disorders (TMDs) are the most common condition affecting the tem-poromandibular joint and associated structures. The aim of this study was the epidemiologic evaluation of TMDs and re-lated factors in a group of Iranian adolescents.

Materials and methods

This descriptive cross-sectional survey included a sample of800 high school students (400 girls and 400 boys) aged 14 to18 years, in Mashhad, Iran, selected using cluster sampling. Examiners completed question-naires and performed the clinical examinations. Data were analyzed with the Chi-square and Fisher exact tests.

Results

The prevalence of TMDs in the studied sample was 34.7%. The most common signs of TMDs were clicking, muscle tenderness and TMJ tenderness. The most prevalent predisposing factors of TMDs were clenching, premature con-tact in protrusive movement and bruxism. A clear predominance was seen in girls (40.5%) compared with boys (29%) (P = 0.001).

Conclusion

Signs and symptoms of TMDs were prevalent in Iranian adolescents with a clear female predominance.

Application of ICHD-II criteria for headaches in a TMJ and orofacial pain clinic

The aim of this study was to identify and diagnose headache in a temporomandibular joint and orofacial pain clinic population using the second edition of The International Classification of Headache Disorder criteria. In 502 temporomandibular disorder and orofacial pain patients, 246 patients (49%) were diagnosed with tension-type headache (TTH), followed by migraine without aura (14.5%), probable migraine (12.9%), migraine with aura (7%), probable TTH (4.8%) and cluster headache (0.2%). The prevalence of headaches was compared between male and female patients, and the prevalence of migraine was found to be higher in women than in men. In evaluating by age, the prevalence of migraine was highest in patients in their 20s and 30s and declined as age increased above 40. TTH showed the highest rate throughout all age groups, but it also decreased as age increased. In this study, the prevalence of migraine was lower than that reported in Dr Kim et al.'s study, and the prevalence of TTH much higher than that reported in the previous study. Of the headache patients, 81.1% presented with masseter muscle pain and 47.8% with temporal muscle pain. This finding suggests that pericranial muscle pain may be an inducing factor of primary headache.