Functional, physical and psychosocial impact of degenerative temporomandibular joint disease

The Link Between Temporomandibular Disorders and Jaw Functional Limitations Among Chinese Adolescents

BACKGROUND

Currently, there is still controversy surrounding the relationship between temporomandibular disorders (TMDs) symptoms and jaw functional limitations. We investigated the distribution of TMDs in senior high school students, including both the number and types of symptoms, and assessed their association with jaw functional limitations. Furthermore, we explored sex differences in these associations.

METHODS

This study was conducted at a public high school in Hefei, Anhui Province, China, with data collected from September to October 2022. All subjects completed questionnaires assessing the anamnestic symptoms of TMDs and the Jaw Functional Limitation Scale (JFLS), and examinations were performed by trained dentists according to the Diagnostic Criteria for TMD. Data were analysed using the Kruskal-Wallis, Mann-Whitney U, and Chi-square tests.

RESULTS

The mean age of the participants (N = 2890) was 17.2 ± 0.14 years and 38.9% were females (61.1% were males). Limitations in self-assessed jaw function were associated with the presence of TMDs (P < .05). Participants with more symptoms reported significantly high levels of functional limitations (P < .05). Compared to male adolescents, female adolescents more commonly experienced TMDs pain and tended to have more symptoms (P < .05). However, no sex differences were observed in most associations between TMDs and jaw functional limitations.

CONCLUSION

TMDs-positive symptoms are common in adolescents. Female adolescents were more affected by TMDs symptoms than male adolescents. Individuals with more TMDs symptoms have greater jaw functional limitations.

The Association Between Temporomandibular-Related Quality of Life and Oral Behaviours: A Cross-Sectional Study in Patients With Temporomandibular Disorders

OBJECTIVES

Oral behaviours (OB) are some oral overuse behaviours which could be observed in patients with temporomandibular disorders (TMD). This study aims to investigate the association between TMD-related quality of life and OB to enhance understanding of these behaviours.

METHODS

A total of 319 participants diagnosed with TMD were included in this research. According to the diagnostic criteria for TMD, patients were divided into three subgroups: pain-related TMD (PT, n = 71), intra-articular TMD (IT, n = 91) and combined TMD (CT, n = 157). Participants completed the oral behaviour checklist (OBC), the oral health impact profile for TMD (OHIP-TMD), the generalised anxiety disorder 7-item (GAD-7) and the patient health questionnaire 9-item (PHQ-9), and demographic characteristics were collected from medical records.

RESULTS

TMD patients with high OBC scores (25-84 points) had higher scores in six of the seven OHIP-TMD domains (all p < 0.05). Logistic regression analysis indicated that OHIP-TMD scores (OR = 1.03), younger age (OR = 0.95), education (OR = 2.80-3.10), and PHQ-9 scores (OR = 1.14) were significantly positively correlated with OBC scores (p < 0.05). After adjusting for confounding factors, the psychological discomfort (OR = 1.09) and psychological disability (OR = 1.10) domains of the OHIP-TMD were identified as independent factors associated with higher OBC scores.

CONCLUSIONS

Patients with more frequent OB exhibited a lower quality of life across nearly all OHIP-TMD domains. Higher OHIP-TMD scores and specific psychological domains were independently associated with a higher frequency of OB. The causal relationship between quality of life and OB in TMD patients requires further investigation.

Cross Cultural Validation of Oral Health Index Profile for Temporomandibular Disorders in Spanish Speaking Population

OBJECTIVES

Structured patient-centred assessment is critical for improving care. OHIP-TMDs are a validated English-language outcome measure for temporomandibular disorders (TMD) which evaluates the biopsychosocial impact of TMD. Due to language and cultural changes, the original instrument's phrasing of its items may change when translated to Spanish. This study cross-culturally adapted and validated OHIP-TMDs for Spanish-speaking individuals with TMD.

METHODS

OHIP-TMDs was forward-backward translated into Spanish (OHIP-TMDs-Sp) and cross-culturally adapted to a Hispanic population with TMD (Diagnostic Criteria for TMD n = 154) according to international norms. All patients completed the OHIP-TMDs-Sp, the Graded Chronic Pain Scale (GCPS), and Jaw Functional Limitation Scale (JFLS-20). A subsample (n = 30) recompleted the OHIP-TMDs-Sp after a 3-week washout to measure test-retest reliability using an intra-class correlation coefficient (ICC 2.1). OHIP-TMDs-Sp, JFLS-20, and GCPS were analysed for convergent validity and internal consistency.

RESULTS

The sample with articular and muscular TMD diagnoses was 85.7% female with a mean age of 29.5. (SD 9.01). OHIP-TMDs-Sp had high internal reliability (Cronbach's Alpha = 0.95) and good test-retest reliability (ICC = 0.82; 95% CI = 0.57-0.93). In terms of convergent validity, the OHIP-TMDs-Sp demonstrated moderate to large positive correlations with the total JLFS-20 score (ρ = 0.72; p < 0.01), Mastication (ρ = 0.68; p < 0.01), Communication (ρ = 0.68; p < 0.001), as well to GCPS disability score (ρ = 0.59; p < 0.01), and characteristic pain intensity (ρ = 0.69; p < 0.01).

CONCLUSIONS

The total score of OHIP-TMDs-Sp is reliable for assessing quality-of-life in Spanish-speaking TMD patients.

Psoriatic Arthritis Involving TMJ: A Review on Pathogenesis and Consideration on Eventual Gender Differences

Psoriatic arthritis is defined as chronic inflammatory arthritis associated with psoriasis. The current data regarding gender differences in clinical manifestation and therapeutic outcomes of psoriatic arthritis are limited. Generally, men show a peripheral disease manifestation, while women have an axial distribution of the lesions. If we look at temporomandibular joint (TMJ) involvement, epidemiological data on the involvement of the TMJ are hard to find. Few studies on therapeutic management and the related impact on the quality of life are reported in the literature. Given the morpho-functional peculiarities of the TMJ and the different pain burdens between male and female genders, when manifestation of psoriatic arthritis occurs, clinicians should face it using a multidisciplinary approach for a correct diagnosis and successful treatment. This review aims to examine the diagnostic signs of psoriatic arthritis in the TMJ, the eventual variations of this disease in male and female patients, and the therapeutical strategies. The coordination of different specialties is fundamental to the remission of clinical symptoms and lesion regression.

A Patient with Moderate-to-Severe Temporomandibular Joint Degenerative Joint Disease and Unilateral Joint Pain Presents for Oral Medicine Consult

A patient presents with severe one-sided temporomandibular joint (TMJ) pain. Workup reveals a diagnosis of TMJ degenerative joint disease, articular disc disorder with reduction, and myofascial pain of the muscles of mastication. The patient's goals were to remain noninvasive in treatment. Conservative recommendations such as physical therapy, analgesics, and current occlusal appliance wear were recommended.

The relation of temporomandibular disorders with oral health-related quality of life in the Northern Finland Birth Cohort 1966

OBJECTIVE

This study aimed to evaluate the association between temporomandibular disorders (TMD) and oral health-related quality of life (OHRQoL) in an adult population.

METHODS

The data included 1,768 adults 46 years of age in the Northern Finland Birth Cohort 1966 (NFBC1966) study. The symptoms, signs and diagnoses of TMD were assessed using a modified protocol of the Diagnostic Criteria for TMD (DC/TMD) and validated questionnaires. OHRQoL was measured using the Oral Health Impact Profile (OHIP-14). Associations of TMD and OHRQoL were evaluated with χ2 -test and Fisher's exact test.

RESULTS

In females, pain-related TMD signs and diagnoses associated significantly with prevalence of OHIP total and all dimensions, whereas in joint-related TMD, psychological dimensions showed the strongest association. Males with pain- or joint-related TMD, the most impaired dimension was physical pain.

CONCLUSION

Pain-related TMD seems to associate more strongly with lower OHRQoL than joint-related TMD especially in females.

Differences in clinical and radiographic features between bilateral and unilateral adult degenerative temporomandibular joint disease: A retrospective cross-sectional study

OBJECTIVE

To study the correlations of clinical findings and the severity of osseous alterations between bilateral and unilateral degenerative joint disease (DJD) of the temporomandibular joint (TMJ).

MATERIALS AND METHODS

Forty-eight joints from 35 adult patients with DJD were retrospectively examined. The joints were divided into two groups: bilateral DJD (BDJD) (26 joints) and unilateral DJD (UDJD) (22 joints). We collected data on patient characteristics and symptoms, including pain on palpation, limited mouth opening, pain during mandibular movement, and joint noises. Cone beam Computed Tomography (CBCT) was used to assess bony changes, including maximum condylar bone change, severity of erosion, severity of osteophytes, glenoid fossa changes, and superior joint space measurements. Data were correlated between subgroups.

RESULTS

There was no significant difference between the two groups in terms of age or gender. However, pain on palpation was significantly more common in UDJD joints (81.8%) compared to BDJD joints (53.9%). Limitation of mouth opening was also significantly more common in BDJD cases (61.5%) compared to UDJD cases (22.7%). The number of joints with painless degeneration was more common in BDJD TMJs (38.4%) than in UDJD TMJs (9%). There was no significant difference between the two subgroups with regard to pain during mandibular movements or joint sounds and severity of bony changes.

CONCLUSIONS

This study provided important results outlining clinical the clinical profiles of DJD patients. While painful degeneration was more frequent in UDJD joints, painless degeneration was higher in BDJD joints. Limitation of mouth opening was more common in BDJD patients.

Accurate Diagnosis and Treatment of Painful Temporomandibular Disorders: A Literature Review Supplemented by Own Clinical Experience

Introduction

Temporomandibular disorders (TMD) is a multifactorial group of musculoskeletal disorders often with combined etiologies that demand different treatment plans. While pain is the most common reason why patients decide to seek help, TMD is not always painful. Pain is often described by patients as a headache, prompting patients to seek the help of neurologists, surgeons, and ultimately dentists. Due to the unique characteristics of this anatomical area, appropriate diagnostic tools are needed, as well as therapeutic regimens to alleviate and/or eliminate the pain experienced by patients. Aim of the Study. The aim of this study is to collect and organize information on the diagnosis and treatment of pain in TMD, through a review of the literature supplemented by our own clinical experience. Material and Methods. The study was conducted by searching scientific databases PubMed, Scopus, and Google Scholar for documents published from 2002-2022. The following keywords were used to build the full list of references: TMD, pain, temporomandibular joint (TMJ), TMJ disorders, occlusal splint, relaxing splints, physiotherapy TMD, pharmacology TMD, natural therapy TMD, diagnostic criteria for TMD, and DC/TMD. The literature review included 168 selected manuscripts, the content of which was important for pain diagnosis and clinical treatment of TMD.

Results

An accurate diagnosis of TMD is the foundation of appropriate treatment. The most commonly described treatments include physiotherapy, occlusal splints therapy, and pharmacological treatment tailored to the type of TMD.

Conclusions

Based on the literature review and their own experience, the authors concluded that there is no single ideal form of pain therapy for TMD. Treatment of TMD should be based on a thorough diagnostic process, including the DC/TMD examination protocol, psychological evaluation, and cone beam computer tomography (CBCT) imaging. Following the diagnostic process, once a diagnosis is established, a treatment plan can be constructed to address the patient's complaints.