Summary
PURPOSE: The purpose of this study was to observe the prevalence of the different diagnostic groups of TMD disorders (articular, muscular, and associated disorders) and the prevalence of the different TMD risk factors from a population of patients seeking specialized care in the TMD clinic at a public dental school. MATERIALS AND METHODS: Data were collected from the retrospective analysis of archival records of 500 consecutive new patients who attended the TMD clinic at the Dental School of Lyon, France, over a 4-year period. The diagnostic criteria were based on those defined by the American Academy of Orofacial Pain: articular disorders (TMJ pain, disc displacement with or without reduction, osteoarthritis and osteoarthrosis), masticatory and cervical muscle disorders, and associated symptoms (migraine/tension-type headache, tinnitus, dizziness). The diagnosis was mainly made based on clinical history and clinical examination of the patient performed by the same trained examiner. In addition, an oral questionnaire was submitted to each patient in order to list all potential risk factors for TMD which were classified into five groups: traumatic, oral parafunctions, psychologic, occlusal, and systemic. RESULTS: The selected population was composed of 300 patients including 232 females (77.3%) and 68 males (22.7%) corresponding to a female-to-male ratio of 3.4:1. Disc displacement with reduction (66.7% of the patients) and muscular tenderness/masseter hypertrophy (62.3%) were the two most prevalent TMD symptoms followed by masticatory myofacial pain (38%) and TMJ pain (29.6%). Associated disorders represented almost 9% of the symptoms, headache being the most prevalent one (14.3% of the patients). Oral parafunctions represented the most important risk factor group (n = 489, 36.9%) followed by traumatic factors (n = 354, 26.7%) and psychologic factors (n = 257, 19.4%). The weakest percentage was obtained for the occlusal factors (n = 57, 4.3%). When all risk factors are considered individually, the two most prevalent factors identified on this population were tooth clenching (77% of the patients) and self-reported stress (59.3%) followed by antecedents of extraction of wisdom teeth (34.3%), endotracheal intubation (30.7%), biting habits (29.3%), gum chewing (28%), and previous orthodontic treatment (28%). CONCLUSION: The results of this study emphasized the high prevalence of disc displacement with reduction and muscular tenderness to palpation among the TMD diagnostic groups and the high prevalence of tooth clenching and psychologic factors (stress) among the risk factors. It may be hypothesized that stress affects TMD symptoms by increasing clenching habits thus predisposing to disc displacement. This is supported by the results of a recent study which showed that daytime tooth clenching/grinding is a significant risk factor for myofacial pain and disc displacement (Michelotti et al., 2010). The prevention of tooth clenching appears to be an essential component of the treatment of temporomandibular disorders.
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References
Anastassaki A, Magnusson T. Patients referred to a specialist clinic because of suspected temporomandibular disorders: a survey of 3194 patients in respect of diagnoses, treatments and treatment outcome. Acta Odontol Scand 2004;62:183–92
Armijo Olivo SA, Magee DJ, Parfitt M, Major PW, Thie NMR. The association between the cervical spine, the stomatognathic system and craniofacial pain: a critical review. J Orofac Pain 2006;20:271–87
Byun ES, Ahn SJ, Kim TW. Relationship between internal derangement of the temporomandibular joint and dentofacial morphology in women with anterior open bite. Am J Orthod Dentofac Orthop 2005;128:87–95
Cairns BE. The influence of gender and sex steroids on craniofacial nociception. Headache 2007;47:319–24
Chen CY, Palla S, Erni S, Sieber M, Gallo LM. Nonfunctional tooth contact in healthy controls and patients with myogenous facial pain. J Orofac Pain 2007;21:185–93
Cortese SG, Biondi AM. Relationship between dysfunctions and parafunctional oral habits and temporomandibular disorders in children and teenagers. Arch Argent Pediatr 2009;107:134–8
Craft RM. Modulation of pain by estrogens. Pain 2007;132:S3–12
De Leeuw R, Bertoli E, Schmidt JE, Carlson CR. Prevalence of traumatic stressors in patients with temporomandibular disorders. J Oral Maxillofac Surg 2005;63:42–50
Deodato F, Trusendi R, Giorgetti R, Scale MU. Predisposition for temporomandibular joint disorders: loose ligaments. J Craniomand Pract 2006;24:179–83
Egermark I, Carlsson GE, Magnusson T. A prospective long-term study of signs and symptoms of temporomandibular disorders in patients who received orthodontic treatment in childhood. Angle Orthod 2005;75:645–50
Farella M, Michelotti A, Iodice G, Milani S, Martina R. Unilateral posterior crossbite is not associated with TMJ clicking in young adolescents. J Dent Res 2007;86:137–41
Filho J, Manzi FR, de Freitas DQ, Boscolo FN, de Almeida SM. Evaluation of temporomandibular joint in stress-free patients. Dentomaxillofac Radiol 2007;36:336–40
Flake NM, Bonebreak DB, Gold MS. Estrogen and inflammation increase the excitability of rat temporomandibular joint afferent neurons. J Neurophysiol 2005;93:1585–97
Franco AL, Goncalves DAG, Castanharo SM, Speciali JG, Bigal ME, Camparis CM. Migraine is the most prevalent primary headache in individuals with temporomandibular disorders. J Orofac Pain 2010;24:287–92
Galdon MJ, Dura E, Andreu Y, Ferrando M, Poveda R, Bagan JV. Multidimensional approach to the differences between muscular and articular temporomandibular patients: coping, distress and pain characteristics. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:40–6
Gameiro GH, Da Silva Andrade A, Nouer DF, Ferraz de Arruda Veiga MC. How may stressful experience contribute to the development of temporomandibular disorders? Clin Oral Invest 2006;10:261–8
Gavish A, Halachmi M, Winocur E, Gazit E. Oral habits and their association with signs and symptoms of temporomandibular disorders in adolescent girls. J Oral Rehabil 2000;27:22–32
Gebeile-Chauty S, Robin O, Messaoudi Y, Aknin JJ. Le traitement orthodontique peut-il générer des algies et/ou dysfonctionnements articulaires ou musculaires (ADAM)? Une revue de littérature. Orthod Fr 2010;81:1–9
Glaros AG, Williams K, Lausten L, Friesen LR. Tooth contact in patients with temporomandibular disorders. J Craniomand Pract 2005;23:188–93
Glaros AG, Williams K, Lausten L. The role of parafunctions, emotions and stress in predicting facial pain. J Am Dent Assoc 2005; 136:451–8
Glaros AG, Waghela R. Psychophysiological definitions of clenching. J Craniomand Pract 2006;24:252–7
Goncalves DAG, Dal Fabbro AL, Campos JADB, Bigal ME, Speciali JG. Symptoms of temporomandibular disorders in the population: an epidemiological study. J Orofac Pain 2010;24:270–8
Greene CS. The etiology of temporomandibular disorders: implications for treatment. J Orofac Pain 2001;15:93–105
Helenius LM, Hallikainen D, Helenius I, Meurman JH, Kononen M, Leirisalo-Repo M, Lindqvist C. Clinical and radiographic findings of the temporomandibular joint in patients with various rheumatic diseases. A case-control study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:455–63
Henrikson T, Nilner M. Temporomandibular disorders, occlusion and orthodontic treatment. J Orthod 2003;30:129–37
How CK. Orthodontic treatment has little to do with temporomandibular disorders. Evid Based Dent 2004;5:75
Huang GJ, Drangsholt MT, Rue TC, Cruikshank DC, Hobson KA. Age and third molar extraction as risk factors for temporomandibular disorder. J Dent Res 2008;87:283–7
Juhl GI, Norholt SE, Svensson P. Incidence of symptoms and signs of TMD following third molar surgery: a controlled, prospective study. J Oral Rehabil 2009;36:199–209
Kavuncu V, Sahin S, Kamanli A, Karan A, Aksoy C. The role of systemic hypermobility and condylar hypermobility in temporomandibular joint dysfunction syndrome. Rheumatol Int 2006; 26:257–60
Klasser GD, Balasubramaniam R, Epstein J. Topical review – connective tissue diseases: orofacial manifestations including pain. J Orofac Pain 2007;21:171–84
Klobas L, Tegelberg A, Axelsson S. Symptoms and signs of temporomandibular disorders in individuals with chronic whiplash – associated disorders. Swed Dent J 2004;28:29–36
Kobs G, Bernhardt O, Kocher T, Meyer G. Oral parafunctions and positive examination findings. Stomatologija 2005;7:81–3
Koh KJ, List T, Petersson A, Rohlin M. Relationship between clinical and magnetic resonance imaging diagnoses and findings in degenerative and inflammatory temporomandibular joint diseases: a systematic literature review. J Orofac Pain 2009;23:123–39
Kraus S. Temporomandibular disorders, head and orofacial pain: cervical spine considerations. Dent Clin N Am 2007;51:161–93
Landi N, Lombardi I, Manfredini D, Casarosa E, Biondi K, Gabbantini M, Bosco M. Sexual hormone serum levels and temporomandibular disorders. A preliminary study. Gynecol Endocrinol 2005;20:99–103
Le Resche L, Mancl LA, Sherman JJ, Gandara B, Dworkin SF. Changes in temporomandibular pain and other symptoms across the menstrual cycle. Pain 2003;106:253–61
Le Resche L, Sherman JJ, Huggins K, Saunders K, Mancl LA, Lentz G, Dworkin SF. Musculoskeletal orofacial pain and other signs and symptoms of temporomandibular disorders during pregnancy: a prospective study. J Orofac Pain 2005;19:193–201
Macfarlane TV, Kenealy P, Kingdon HA, Mohlin BO, Pilley JR, Richmond S, Shaw WC. Twenty-year cohort study of health gain from orthodontic treatment: temporomandibular disorders. Am J Orthod Dentofacial Orthop 2009;135:692
Machado LPS, Nery CG, Leles CR, Nery MBM, Okeson JP. The prevalence of clinical diagnostic groups in patients with temporomandibular disorders. J Craniomand Pract 2009;27:194–9
Mc Neil C (ed.). Temporomandibular disorders. Guidelines for classification, assessment and management. Chicago: Quintessence; 1993
Manfredini D. Etiopathogenesis of disk displacement of the temporomandibular joint: a review of the mechanisms. Int J Dent Res 2009;20:212–21
Manfredini D, Lobbezoo F. Role of psychosocial factors in the etiology of bruxism. J Orofac Pain 2009;23:153–66
Manfredini D, Cantini E, Romagnoli M, Bosco M. Prevalence of bruxism in patients with different research diagnostic criteria for temporomandibular disorders (RDC/TMD) diagnoses. J Craniomand Pract 2003;21:279–85
Manfredini D, Bucci MB, Montagna F, Guarda-Nardini L. Temporomandibular disorders assessment: medicolegal considerations in the evidence-based era. J Oral Rehabil 2010;37, doi: 10.1111:j.1365-2842.2010.02131.x
Martin MD, Wilson KJ, Ross BK, Souter K. Intubation risk factors for temporomandibular joint/facial pain. Anesth Prog 2007;54:109–14
Michelotti A, Cioffi I, Festa P, Scala G, Farella M. Oral parafunctions as risk factors for diagnostic TMD subgroups. J Oral Rehabil 2010; 37:157–62
Mohlin B, Axelsson S, Paulin G, Pietilä T, Bondemark L, Brattström V, Hansen K, Holm AK. TMD in relation to malocclusion and orthodontic treatment. Angle Orthod 2007;77:542–8
Nilner M, Ekberg E, Doepel M, Andersson J, Selovuo K, Le Bell Y. Short-term effectiveness of a prefabricated occlusal appliance in patients with myofascial pain. J Orofac Pain 2008;22:209–18
Oakley M, Vieira AR. The many faces of the genetics contribution to temporomandibular joint disorder. Orthod Craniofac Res 2008; 11:125–35
Oral K, Bal Kucuk B, Ebeoblu B, Dincer S. Etiology of temporomandibular disorder pain. Agri 2009;21:89–94
Osterberg T, Carlsson GE. Relationship between symptoms of temporomandibular disorders and dental status, general health and psychosomatic factors in two cohorts of 70 year old subjects. Gerodontology 2007;24:129–35
Pallegama RW, Ranasinghe AW, Weerasinghe VP, Sitheeque M. Anxiety and personality traits in patients with muscle related temporomandibular disorders. J Oral Rehabil 2005;32:701–5
Pergamalian A, Rudy TE, Zaki HS, Greco CM. The association between wear facets, bruxism and severity of facial pain in patients with temporomandibular disorders. J Prosthet Dent 2003;90: 194–200
Polso HL, Näpänkangas R, Raustia AM. Treatment outcome in patients with TMD – a survey of 123 patients referred to specialist care. J Craniomand Pract 2010;28:156–65
Poveda-Roda R, Bagan JV, Diaz-Fernandez JM, Hernandez-Bazan S, Jimenez-Soriano Y. Review of temporomandibular joint pathology. Part I: Classification, epidemiology and risk factors. Med Oral Patol Oral Cir Buc 2007;12:E292–8
Pullinger AG, Seligman DA, Gornbein JA. A multiple logistic regression analysis of the risk and relative odds of temporomandibular disorders as a function of common occlusal features. J Dent Res 1993;72:968–79
Rinchuse DJ, Rinchuse DJ, Handasamy S. Evidence-based versus experience-based views on occlusion and TMD. Am J Orthod Dentofacial Orthop 2005;127:249–54
Robin O. Temporomandibular disorders in children and adolescents. Rev Francoph Odontol Pediatr 2010;5:121–8
Saez-Yuguero RM, Linares-Tovar E, Calvo-Guirado JL, Bermejo-Fenoll A, Rodriguez-Lozano FJ. Joint hypermobility and disk displacement confirmed by magnetic resonance imaging: a study of women with temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:e54–7
Sale H, Isberg A. Delayed temporomandibular joint pain and dysfunction induced by whiplash trauma: a controlled prospective study. J Am Dent Assoc 2007;138:1084–91
Sato F, Kino K, Sugisaki M, Haketa T, Amemori Y, Isikawa T, Shibuya T, Amagasa T, Shibuya T, Tanabe H, Yoda T, Sakamoto I, Omura K, Miyaoka H. Teeth contacting habit as a contributing factor to chronic pain in patients with temporomandibular disorders. J Med Dent Sci 2006;53:103–9
Sato S, Slavicek R. The masticatory organ and stress management. J Stomat Occ Med 2008;1:51–7
Schmitter M, Rammelsberg P, Hassel A. The prevalence of signs and symptoms of temporomandibular disorders in very old subjects. J Oral Rehabil 2005;32:467–73
Scrivani SJ, Keith DA, Kaban LB. Temporomandibular disorders. N Engl J Med 2008;359:2693–705
Sipila K, Veijola J, Jokelainen J, Järvelin MR, Oikarinen KS, Raustica AM, Joukamaa M. Association between symptoms of temporomandibular disorders and depression: an epidemiological study of the Northern Finland 1966 birth cohort. J Craniomand Practice 2001; 19:183–7
Stiesch-Scholz M, Fink M, Tschernitschek H. Comorbidity of internal derangement of the temporomandibular joint and silent dysfunction of the cervical spine. J Oral Rehabil 2003;30:386–91
Svensson P, Jadidi F, Arima T, Baad-Hansen L, Sessle BJ. Relationships between craniofacial pain and bruxism. J Oral Rehabil 2008; 35:524–47
Threlfall AG, Kanaa MD, Davies SJ, Tickle M. Possible link between extraction of wisdom teeth and temporomandibular disc displacement with reduction: matched case control study. J Oral Maxillofac Surg 2005;43:13–6
Toure G, Duboucher C, Vacher C. Anatomical modifications of the temporomandibular joint during ageing. Surg Radiol Anat 2005; 27:51–5
Van Selms MKA, Lobbezoo F, Wicks DJ, Hamburger HL. Craniomandibular pain, oral parafunctions and psychological stress in a longitudinal case study. J Oral Rehabil 2004;31:738–45
Visscher CM, Lobbezoo F, De Boer W, Van Der Zaag J, Naeije M. Prevalence of cervical spinal pain in craniomandibular pain patients. Eur J Oral Sci 2001;109:76–80
Visscher CM, Lobbezoo F, Naeije M. Comparison of algometry and palpation in the recognition of temporomandibular disorder pain complaints. J Orofac Pain 2004;18:214–9
Visscher CM, Naeije M, De Laat A, Michelotti A, Nilner M, Craane B, Ekberg EC, Farella M, Lobbezoo F. Diagnostic accuracy of temporomandibular disorders pain tests: a multicenter study. J Orofac Pain 2009;23:108–14
Wang MQ, Xue F, He JJ, Chen JH, Chen CS, Raustia A. Missing posterior teeth and risk of temporomandibular disorders. J Dent Res 2009;88:942–5
Yap AUJ, Tan KBC, Chua EK, Tan HH. Depression and somatization in patients with temporomandibular disorders. J Prosthet Dent 2002;88:479–84
Yun PY, Kim YK. The role of facial trauma as a possible etiologic factor in temporomandibular joint disorder. J Oral Maxillofac Surg 2005;63:1576–83
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Robin, O., Chiomento, A. Prevalence of risk factors for temporomandibular disorders: a retrospective survey from 300 consecutive patients seeking care for TMD in a French dental school. J. Stomat. Occ. Med. 3, 179–186 (2010). https://doi.org/10.1007/s12548-011-0066-8
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DOI: https://doi.org/10.1007/s12548-011-0066-8