Occlusal Support and Temporomandibular Disorders Among Elderly Vietnamese

Prevalence and associations of temporomandibular disorders in older Brazilian adults

OBJECTIVE

The objective of the study was to estimate the prevalence of temporomandibular disorders (TMD) and describe associations in a representative sample of community-dwelling older Brazilian adults.

BACKGROUND

TMD cause recurrent or chronic pain and dysfunction with substantial impacts on quality of life, but little is known of their occurrence and associated factors among older adults.

MATERIALS AND METHODS

This was a cross-sectional study using data from the second wave of the Brazilian Longitudinal Study of Aging, a nationally representative sample of older Brazilian adults aged 50 or older. The presence of temporomandibular disorder symptoms was measured by the Fonseca Anamnestic Index. Independent variables included sociodemographic characteristics, general health conditions and self-reported oral health measures. The association between the independent variables and TMD symptoms was evaluated using logistic regression models.

RESULTS

Complete information for the variables of interest was available for 9391 individuals. The overall prevalence of TMD symptoms was 18.0% (95% CI 14.4-22.1). Relative to older adults aged 50-59 those in all age categories had lower odds of TMD symptoms. Individuals with depression, pain, sleep problems and self-reported poor general health had higher odds of reporting TMD symptoms. None of the oral health measures were related to TMD.

CONCLUSION

The prevalence of TMD symptoms among Brazilian older adults is associated with demographic and general health conditions, but not with dentition status.

Implant-Retained Prosthetic Rehabilitation of a Patient with Severe Oral Lichen Sclerosus

Background

Lichen sclerosus is a rare condition that occurs in the genital area or on the extraoral skin but can also manifest orally (oral lichen sclerosus (OLS)). The condition is associated with atrophy, scarring, and functional limitations of the tissues. In the present case, an extremely pronounced variant is described, and the oral rehabilitation of the patient is presented. Case Report. The edentulous patient showed a progressive course with severely restricted mouth opening and persistent pain. Conventional dental treatment was therefore impossible. To address this issue, two implants were placed in each jaw at the position of the lateral incisors. After osseointegration and exposure of the implants, provisional bridges made of polymethyl-methacrylate were fitted to test the new jaw relation. After a successful provisional phase, an FDP in the sense of an extreme short dental arch (ESDA) has been inserted.

Conclusion

The experimental treatment of the patient with only a total of four implants and the ESDA concept represented a satisfactory therapy for the patient. The patient regained her chewing ability, which significantly increased her oral health-related quality of life (OHRQoL). Still, it should be noted that this is a high-risk and experimental prosthetic treatment.

Remodeling dental anatomy vs sham therapy for chronic temporomandibular disorders. A placebo-controlled randomized clinical trial

BACKGROUND

Evidence regarding the etiology or effective treatments for chronic orofacial pain, the majority diagnosed as temporomandibular disorder (TMD), is limited.

PURPOSE

To investigate whether occlusal equilibration therapy (ET) and decreasing the (higher) angle of the lateral guidance on the nonworking-side leads to a reduction in chronic TMDs intensity.

METHODS

It was conducted a randomized, explanatory, single blind with blinded assessment, placebo-controlled trial with strong protection against bias involving patients with chronic TMDs. Participants were randomly assigned to receive equilibration therapy or sham therapy. ET in this study consisted of minimal invasive occlusal remodeling to obtain balanced occlusion with reduction of the steeper angle of lateral mandibular movement with respect to the Frankfort plane. The primary outcome was a change in the pain intensity score (on a 0-10 point scale, with 0 indicating no pain and 10 the worst possible pain) at month 6. Secondary outcomes include maximum unassisted mouth opening and psychological distress.

RESULTS

A total of 77 participants underwent randomization, 39 of whom received ET and 38 sham therapy. The trial was stopped early for efficacy, according to preestablished rules when 67 participants (n = 34, n = 33, respectively) had completed the analysis. At month 6, the mean unadjusted pain intensity score was 2.1 in the ET and 3.6 in the sham therapy group (adjusted mean difference, -1.54; 95% confidence interval [CI] -0.5 to -2.6; P = 0.004; ANCOVA model). The mean increase in maximum unassisted mouth opening (main secondary outcome) was significantly higher in the real therapy group (adjusted mean difference 3.1 mm, 95% CI 0.5-5.7, p = 0.02).

CONCLUSION

ET significantly reduced the intensity of facial pain associated with chronic TMDs and increased maximum unassisted mouth opening, as compared with sham therapy, over the course of 6 months. There were no serious adverse events. Funded by the Instituto de Salud Carlos III from the Ministry of Science and Innovation of the Government of Spain and European Regional Development Fund, Grant nº PI11/02507; "una manera de hacer Europa".

Temporomandibular Disorders and Dental Occlusion: What Do We Know so Far?

Throughout the recorded history in the literature of temporomandibular disorders (TMD) there have been a variety of opinions as to its primary cause. Those supporting an occlusal basis of TMD opined that occlusal dysfunction is either the primary cause for or a significant etiopathogenic factor in the causation of TMD. Most of the current literature, however, points to evidence in another direction and questions the causal role of occlusion and occlusal disharmony in TMD etiopathogenesis. Recognition of this evidence-based literature is paramount in eliminating and preventing the chances of overtreatment of patients with TMD.

Effect of the posterior stop on temporomandibular disorders: A systematic review

Background. Temporomandibular disorders have common signs and symptoms, including pain in the masticatory muscles, limitation or deviation in a mandibular range of motion, and other common patient complaints, such as headache and earache. The main focus of this study was to collect comprehensive and integrated data on the effect of the posterior stop on temporomandibular joint disorders, as well as prevention, treatment, and follow-up care for the patients. Methods. The authors conducted the search in PubMed, SCOPUS, Web of Science, Cochrane Library, CINHAL, Medline, ProQuest, Google Scholar, Magiran, IranDoc, SID, and Iranmedex databases for relevant articles. A list of selected study sources, related conferences, and grey literature were manually searched in addition to the databases mentioned above. A 21-year time limit was imposed (2000-2021). Results. Finally, 16 articles were selected to be reviewed in this systematic review. The designs of the included studies were heterogeneous, and due to the low number of studies covered, the authors could not carry out a meta-analysis. Conclusion. The causes of temporomandibular disorders are multifactorial and complex. Therefore, it is difficult to investigate the relationship between this disorder and predictors. The results of the present study indicate that to determine the effect of the posterior stop on temporomandibular joint disorders, more clinical trials and case-control studies should be conducted.

The impact of occlusal support on temporomandibular disorders: a literature review

Temporomandibular disorders are a multifactorial disease. Occlusal support and the number of teeth in dentition have significant effects on the masticatory system. The current study aims to review the role of occlusal support in association with findings of temporomandibular disorders. Data sources were PubMed, Web of Science and Google Scholar, with 1411 citations published over the period 1992–2019. The selection criteria stipulated that articles must have reported the association between the number of teeth, occlusal unit, occlusal support and temporomandibular disorders. A total of 15 full-text articles was finally accessed for eligibility in the current review. The studies on temporomandibular disorders were collected from various sources, including articles reporting temporomandibular disorder symptoms ( n=1), temporomandibular disorder signs ( n=5), temporomandibular joint osseous changes ( n=1), temporomandibular joint dysfunction using the Helkimo index ( n=2), and temporomandibular disorder classification ( n=6). Of these articles, significant associations were found between: the number of missing teeth and temporomandibular disorders ( n=5); the number of occlusal units and occlusal supports and temporomandibular disorders ( n=3); the position of the lost occlusal units and temporomandibular disorders ( n=1). Loss of the occlusal unit has more impact on temporomandibular disorders than the loss of posterior teeth. The total loss of unilateral occlusal support seems to be an aetiological factor for temporomandibular disorders, and maintenance of balanced posterior occlusal support has a role in the prevention and management of temporomandibular disorders.