The Internet Journal of Otorhinolaryngology TM
ISSN: 1528-8420
Temporomandibular Joint Dysfunction:
From Risk Factors To Prevention
Citation:
F. Salvinelli, M. Casale, L. D'Ascanio, V. Rinaldi, F. Paparo: Temporomandibular Joint Dysfunction: From Risk Factors To Prevention. The Internet Journal of Otorhinolaryngology. 2004. Volume 3 Number 1.
Abstract
Background: Temporomandibular joint dysfunction (TMJD) is widespread. About 60-70% of the general population is aware of symptoms. Aim of the study is to investigate the main risk factors involved in TMJD.
Methods: 68 consecutive patients admitted for surgical procedures were enrolled. Before surgical procedure, they were clinically evaluated for TMJD, according to accepted criteria. A logistic regression model step-wise was used to evaluate the correlation between single risk factors and TMJD.
Results: 47 out of 68 patient (69.12%) presented at least one sign or symptom of TMJD. Among all evaluated risk factors, only the presence of dental caries was significantly associated with TMJD (OR=6.13; p<0.05).
Conclusions: Dental caries, inappropriate caries obturations and/or caries mistreated by reconstructive materials may lead to occlusal disorder, one of the most common factors involved in the pathogenesis of TMJD.
Clinical Implications: Our data suggest a major role of the dentist in the prevention and treatment of TMJD.Introduction
Temporomandibular joint dysfunction (TMJD) is a collective term used to describe a number of related disorders involving the TMJ, masticatory muscles, and associated structures.
The three cardinal features of temporomandibular disorders are orofacial pain, joint noises, and restricted jaw function.
About 60-70% of the general population has at least one sign of TMJD, yet only one out of four individuals with these signs is actually aware of them, or reports any symptom. 1
The aetiology and the risk factors of the most common types of temporomandibular disorders are complex and are still largely unresolved. 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12
Materials And Methods
The purpose of this study was to investigate the main risk factors of TMJD in a study group population.
68 consecutive patients (41 F; 27 M; mean age: 51, range: 35-60), admitted for surgical procedures at the “Campus Bio-Medico University” of Rome between November and December 2002, were enrolled. Informed consent was obtained from all subjects who participated in the study. Before surgical procedure, all patients were evaluated for possible TMJD by history and clinical examination. The most important risk factors, according to the medical literature (2), were evaluated (Table 1).
Table 1: Risk factors of temporomandibular joint dysfunction
Results
47 out of 68 patients (6 9 .12%) presented at least one sign or symptom of TMJD (Table 2). The prevalence of risk factors among the study population is shown in Table 3.
Using a logistic regression model step-wise to evaluate the correlation between single risk factors and TMJD, only the presence of dental caries was significantly associated with TMJD (OR=6.13; p<0.05).
Table 2: TMJD signs and symptoms in the study population
Table 3: Frequency of TMJD risk factors among the study population
Discussion
Temporomandibular joint disorder embraces a number of clinical problems involving the masticatory musculature, temporomandibular joint and associated structures. 1 Therefore a multidisciplinary approach is necessary when treating patients affected by TMJD.
Dental caries, as much as inappropriate caries obturations and/or caries mistreated by reconstructive materials (metallic and composite) are possible causes of occlusal disorder, one of the most common factors involved in the pathogenesis of TMJD. 10
Our experience suggests a major role of the dentist in the prevention of TMJD. In particular, an appropriate management of caries helps preventing TMJD; the healing effect is probably attributed to stabilization of the occlusion, redistribution of occlusal forces, and reduction of joint loading. 9
Conclusions
Preventing TMJD is of a great importance, since the treatment of a well established TMJ impairment is frequently unsuccessful and its related symptoms, such as tinnitus and dizziness 13 , often affect patient's quality of life 14 and represent an additional cost to society. 15
Corresponding author
Manuele Casale, MD
Area of Otolaryngology
University Campus Bio-Medico - Rome
Via Longoni, 69/83 - 00155 Rome (Italy)
Tel.: 0039622541740 – Fax: 0039622541456
Email: m.casale@unicampus.itReferences
1. Dimitroulis G. Temporomandibular disorders: a clinical update. BMJ 1998;317(7152):190-4.
2. Locker D, Slade G. Prevalence of symptoms associated with temporomandibular disorders in a Canadian population. Community Dent Oral Epidemiol 1988;16(5):310-3.
3. Oikarinen KS, Raustia AM, Lahti J. Signs and symptoms of TMJ dysfunction in patients with mandibular condyle fractures. Cranio 1991;9(1):58-62.
4. De Kanter RJ, Truin GJ, Burgersdijk RC, Van 't Hof MA, Battistuzzi PG, Kalsbeek H et al. Prevalence in the Dutch adult population and a meta-analysis of signs and symptoms of temporomandibular disorder. J Dent Res 1993;72(11):1509-18.
5. McNamara JA Jr. Orthodontic treatment and temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83(1):107-17.
6. Marzooq AA, Yatabe M, Ai M.What types of occlusal factors play a role in temporomandibular disorders? A literature review. J Med Dent Sci 1999;46(3):111-6.
7. Henrikson T, Nilner M, Kurol J. Signs of temporomandibular disorders in girls receiving orthodontic treatment. Aprospective and longitudinal comparison with untreated Class II malocclusions and normal occlusion subjects. Eur J Orthod 2000;22(3):271-81.
8. Macfarlane TV, Gray RJM, Kincey J, Worthington HV. Factors associated with the temporomandibular disorder, pain dysfunction syndrome (PDS): Manchester case-control study. Oral Dis 2001;7(6):321-30.
9. Tallents RH, Macher DJ, Kyrkanides S, Katzberg RW, Moss ME. Prevalence of missing posterior teeth and intraarticular temporomandibular disorders. J Prosthet Dent 2002;87(1):45-50.
10. Celic R, Jerolimov V, Panduric J. A study of the influence of occlusal factors and parafunctional habits on the prevalence of signs and symptoms of TMD. Int J Prosthodont 2002;15(1):43-8.
11. Huang GJ, LeResche L, Critchlow CW, Martin MD, Drangsholt MT. Risk factors for diagnostic subgroups of painful temporomandibular disorders (TMD). J Dent Res 2002;81(4):284-8.
12. Kim MR, Graber TM, Viana MA. Orthodontics and temporomandibular disorder: a meta-analysis. Am J Orthod Dentofacial Orthop 2002;121(5):438-46.
13. Bush FM, Harkins SW, Harrington WG. Otalgia and aversive symptoms in temporomandibular disorders. Ann Otol Rhinol Laryngol. 1999;108(9):884-92.
14. Erlandsson SI, Hallberg LR. Prediction of quality of life in patients with tinnitus. Br J Audiol. 2000;34(1):11-20.
15. Hesse G, Rienhoff NK, Nelting M, Brehmer D. Drug costs in patients with chronic complex tinnitus HNO. 1999;47(7):658-60.
