Socıo-demographıc and clınıcal characterıstıcs of patıents wıth temporomandıbular joınt dısorders: a cross-sectıonal study

Abstract

Aim: The etiology of temporomandibular disorder(TMD) is multifactorial and the role of the factors responsible for this etiology is still controversial. The aim of this study is to examine the socio-demographic and clinical characteristics of patients with TMD. Method: The study was carried out on 508 TMD patients who sought care at the oral and maxillofacial surgery clinic of a faculty of dentistry. The patients were evaluated in terms of socio-demographic characteristics, etiological risk factors, and clinical examination findings. Results: Eighty-three point five percent of the patients were female and the largest age group was 18-25 years old. TMD was more common among the unemployed, housewives, and students. 75.6% of the patients had bruxism and 14.2% had a parafunctional habit other than bruxism. The three most common diseases in the patients were psychiatric disorders, peptic ulcer, and thyroid diseases, respectively. Approximately one-quarter (24.4%) of the patients reported a musculoskeletal disease other than TMD and 11.8% reported a past temporomandibular joint trauma. The body mass index of 40.9% of the patients was above normal and 77.2% reported that they did not exercise or exercise regularly. Forty-five point seven percent of the patients had bilateral TMD complaints and 32.3% had 5 years or more. Headache was the most common additional symptom, with a rate of 70.1%, followed by tinnitus (46.5%) and neck pain (45.7%). In the clinical examination of the patients, 43.3% had severe pain on palpation, 71.7% click, 30.7% crepitation, and 59.8% deviation in the lower jaw. While the maximum mouth opening of 50.4% of the patients was 35 mm or less, 3.9% had a severely restricted (20mm or less) mouth opening. Conclusion: These cross-sectional study findings support that the etiology of TMD is complex and multifactorial. Long-term studies should be conducted to reveal the cause-effect relationship to explain the etiology of TMD.

Keywords

• Temporomandibular disorder
• socio-demographic features
• etiological risk factors
• clinical symptoms

Temporomandibular eklem bozukluğu olan hastaların sosyo-demografik ve klinik özellikleri: Kesitsel bir çalışma

Abstract

Amaç: Temporomandibular eklem (TME) bozukluklarının etiyolojisi çok faktörlüdür ve bu etiyolojiden sorumlu olan faktörlerin rolü hala tartışmalıdır. Bu çalışmanın amacı, temporomandibular bozukluğu (TMB) hastalarının sosyo-demografik ve klinik özelliklerini incelemektir. Yöntem: Çalışma, bir diş hekimliği fakültesinin ağız, diş ve çene cerrahisi kliniğinde tedavi arayan 508 TMB hasta üzerinde gerçekleştirildi. Hastalar sosyo-demografik özellikler, etiyolojik risk faktörleri ve klinik muayene bulguları açısından değerlendirildi. Bulgular: Çalışmaya katılan hastaların çoğu (%83.5) kadın idi ve en büyük yaş grubunu 18-25 yaşındakiler oluşturdu. İşsizler, ev hanımları ve öğrenciler arasında TMB daha yaygın idi. Hastaların yaklaşık dörtte üçünde (%75.6) bruksizm ve %14.2’sinde bruksizm dışında bir parafonksiyonel alışkanlık var idi. Hastalarda en sık görülen üç hastalık sırasıyla psikiyatrik bozukluklar, peptik ülser ve troid hastalıkları idi. Hastaların yaklaşık dörtte biri (%24.4) TMB dışında bir kas-iskelet sistemi hastalığı olduğunu ve %11.8’i geçmişte bir TME travması yaşadığını bildirdi. Hastaların %40.9’unun vücut kitle indeksi normalin üzerindeydi ve %77.2’si düzenli egzersiz ve spor yapmadıklarını bildirdi. Hastaların yarıya yakınında (%45.7) çift taraflı TMB şikayeti vardı ve %32.3’ünde şikayet süresi 5 yıl ve daha fazla idi. Hastalarda %70.1 oranı ile baş ağrısı en sık görülen ek semptomdu, bunu kulak çınlaması (%46.5) ve boyun ağrısı (%45.7) izledi. Hastaların klinik muayenesinde %43.3’ünde palpasyonda şiddetli ağrı, %71.7’sinde klik, %30.7’sinde krepitasyon ve %59.8’inde alt çenesinde deviasyon vardı. Hastaların %50.4’ünün maksimum ağız açıklığı 35mm ve altında iken, % 3,9’u ileri derecede kısıtlanmış ağız açıklığına (20mm ve daha az) sahip idi. Sonuç: Bu kesitsel çalışma bulguları TMB etyolojisinin karmaşık ve çok faktörlü olduğu tezini doğrulamaktadır. TMB etyolojisini açıklamaya yönelik neden-sonuç ilişkisini ortaya koyan uzun soluklu çalışmalar yapılmalıdır.

Keywords

• Temporomandibular bozukluk
• sosyodeografik özellikler
• etyolojik risk faktörleri
• klinik semptomlar

References

1. 1. Orofacial pain : guidelines for assessment, diagnosis, and management / | University of Toronto Libraries. https://search.library.utoronto.ca/details?9126690. Accessed January 22, 2021.
2. 2. Miettinen O, Lahti S, Sipilä K. Psychosocial aspects of temporomandibular disorders and oral health-related quality-of-life. Acta Odontol Scand. 2012;70(4):331-336. doi:10.3109/00016357.2011.654241
3. 3. Tjakkes GHE, Reinders JJ, Tenvergert EM, Stegenga B. TMD pain: The effect on health related quality of life and the influence of pain duration. Health Qual Life Outcomes. 2010;8. doi:10.1186/1477-7525-8-46
4. 4. Kim TY, Shin JS, Lee J, et al. Gender difference in associations between chronic temporomandibular disorders and general quality of life in Koreans: A cross-sectional study. PLoS One. 2015;10(12). doi:10.1371/journal.pone.0145002
5. 5. Chisnoiu AM, Picos AM, Popa S, et al. Factors involved in the etiology of temporomandibular disorders - a literature review. Clujul Med. 2015;88(4):473-478. doi:10.15386/cjmed-485
6. 6. Liu F, Steinkeler A. Epidemiology, diagnosis, and treatment of temporomandibular disorders. Dent Clin North Am. 2013;57(3):465-479. doi:10.1016/j.cden.2013.04.006
7. 7. Rai B, Kaur J. Association between stress, sleep quality and temporomandibular joint dysfunction: Simulated mars mission. Oman Med J. 2013;28(3):216-219. doi:10.5001/omj.2013.59
8. 8. Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: Recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†. J Oral Facial Pain Headache. 2014;28(1):6-27. doi:10.11607/jop.1151

9. 9. Dahlstrm L, Carlsson GE. Temporomandibular disorders and oral health-related quality of life. A systematic review. Acta Odontol Scand. 2010;68(2):80-85. doi:10.3109/00016350903431118
10. 10. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord. 1992;6(4):301-355.
11. 11. ASA Physical Status Classification System | American Society of Anesthesiologists (ASA). https://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system. Accessed December 31, 2019.
12. 12. Yap AUJ, Chua EK, Hoe JKE. Clinical TMD, pain-related disability and psychological status of TMD patients. J Oral Rehabil. 2002;29(4):374-380. doi:10.1046/j.1365-2842.2002.00822.x
13. 13. Zhang Q Bin, Yuan SS, Deng KT, et al. Correlation of patients’ demographics and clinical symptoms with temporomandibular disorders. Cranio - J Craniomandib Pract. 2020. doi:10.1080/08869634.2020.1866923
14. 14. Ferrando M, Andreu Y, José Galdón M, Durá E, Poveda R, Vincente Bagán J. Psychological variables and temporomandibular disorders: Distress, coping, and personality. Oral Surgery, Oral Med Oral Pathol Oral Radiol Endodontology. 2004;98(2):153-160. doi:10.1016/j.tripleo.2003.12.030
15. 15. Yasuoka T, Nakashima M, Okuda T, Tatematsu N. Effect of estrogen replacement on temporomandibular joint remodeling in ovariectomized rats. J Oral Maxillofac Surg. 2000;58(2):189-196. doi:10.1016/S0278-2391(00)90337-9
16. 16. Khastgir G, Studd J, Holland N, Alaghband-Zadeh J, Fox S, Chow J. Anabolic Effect of Estrogen Replacement on Bone in Postmenopausal Women with Osteoporosis: Histomorphometric Evidence in a Longitudinal Study1. J Clin Endocrinol Metab. 2001;86(1):289-295. doi:10.1210/jcem.86.1.7161
17. 17. Lobbezoo F, Ahlberg J, Raphael KG, et al. International consensus on the assessment of bruxism: Report of a work in progress. J Oral Rehabil. 2018;45(11):837-844. doi:10.1111/joor.12663
18. 18. Chew the Pain Away: Oral Habits to Cope With Pain and Stress and to Stimulate Cognition - PubMed. https://pubmed.ncbi.nlm.nih.gov/26090381/. Accessed July 10, 2020.
19. 19. Kataoka K, Ekuni D, Mizutani S, et al. Association between self-reported bruxism and malocclusion in university students: A cross-sectional study. J Epidemiol. 2015;25(6):423-430. doi:10.2188/jea.JE20140180
20. 20. Ekici Ö. Psychological Profile and Sleep Quality of Patients with Temporomandibular Joint Dysfunction with or without Bruxism. J Turkish Sleep Med. 2021;8(1):35-42. doi:10.4274/jtsm.galenos.2021.30592
21. 21. Talaat W, Ghoneim MM, Elsholkamy M. Single-needle arthrocentesis (Shepard cannula) vs. double-needle arthrocentesis for treating disc displacement without reduction. Cranio - J Craniomandib Pract. 2016;34(5):296-302. doi:10.1080/08869634.2015.1106810
22. 22. Manfredini D, Lobbezoo F. Relationship between bruxism and temporomandibular disorders: A systematic review of literature from 1998 to 2008. Oral Surgery, Oral Med Oral Pathol Oral Radiol Endodontology. 2010;109(6). doi:10.1016/j.tripleo.2010.02.013
23. 23. Michelotti A, Cioffi I, Festa P, Scala G, Farella M. Oral parafunctions as risk factors for diagnostic TMD subgroups. J Oral Rehabil. 2010;37(3):157-162. doi:10.1111/j.1365-2842.2009.02033.x
24. 24. Su N, Liu Y, Yang X, Shen J, Wang H. Association of malocclusion, self-reported bruxism and chewing-side preference with oral health-related quality of life in patients with temporomandibular joint osteoarthritis. Int Dent J. 2018;68(2):97-104. doi:10.1111/idj.12344
25. 25. Da Silva A, Costa EC, Gomes JB, et al. Chronic headache and comorbibities: A two-phase, population-based, cross-sectional study. Headache. 2010;50(8):1306-1312. doi:10.1111/j.1526-4610.2010.01620.x
26. 26. Talaat WM, Adel OI, Al Bayatti S. Prevalence of temporomandibular disorders discovered incidentally during routine dental examination using the Research Diagnostic Criteria for Temporomandibular Disorders. Oral Surg Oral Med Oral Pathol Oral Radiol. 2018;125(3):250-259. doi:10.1016/j.oooo.2017.11.012
27. 27. Cho H, Kim S, Park SE, Park JW. Physical activity level and temporomandibular disorders in South Koreans. Community Dent Oral Epidemiol. 2020;48(3):225-231. doi:10.1111/cdoe.12519
28. 28. McMillan AS, Wong MCM, Lee LTK, Yeung RWK. Depression and diffuse physical symptoms in southern Chinese with temporomandibular disorders. J Oral Rehabil. 2009;36(6):403-407. doi:10.1111/j.1365-2842.2009.01951.x
29. 29. Gameiro GH, da Silva Andrade A, Nouer DF, Ferraz de Arruda Veiga MC. How may stressful experiences contribute to the development of temporomandibular disorders? Clin Oral Investig. 2006;10(4):261-268. doi:10.1007/s00784-006-0064-1
30. 30. Monteiro DR, Zuim PRJ, Pesqueira AA, Ribeiro P do P, Garcia AR. Relationship between anxiety and chronic orofacial pain of temporomandibular disorder in a group of university students. J Prosthodont Res. 2011;55(3):154-158. doi:10.1016/j.jpor.2010.11.001
31. 31. Giannakopoulos NN, Keller L, Rammelsberg P, Kronmüller KT, Schmitter M. Anxiety and depression in patients with chronic temporomandibular pain and in controls. J Dent. 2010;38(5):369-376. doi:10.1016/j.jdent.2010.01.003
32. 32. Pizolato RA, de Freitas-Fernandes FS, Gavião MBD. Anxiety/depression and orofacial myofacial disorders as factors associated with TMD in children. Braz Oral Res. 2013;27(2):156-162. doi:10.1590/S1806-83242013000100021
33. 33. Mottaghi A, Razavi SM, Pozveh EZ, Jahangirmoghaddam M. Assessment of the relationship between stress and temporomandibular joint disorder in female students before university entrance exam (Konkour exam). Dent Res J (Isfahan). 2011;8(Suppl 1):S76-9. http://www.ncbi.nlm.nih.gov/pubmed/23372600. Accessed May 2, 2020.
34. 34. Calixtre LB, Da Grüninger BLS, Chaves TC, De Oliveira AB. Is there an association between anxiety/ depression and temporomandibular disorders in college students? J Appl Oral Sci. 2014;22(1):15-21. doi:10.1590/1678-775720130054
35. 35. Ekici Ö. Association of stress, anxiety, and depression levels with sleep quality in patients with temporomandibular disorders. Cranio - J Craniomandib Pract. 2020. doi:10.1080/08869634.2020.1861886
36. 36. Winocur E, Gavish A, Finkelshtein T, Halachmi M, Gazit E. Oral habits among adolescent girls and their association with symptoms of temporomandibular disorders. J Oral Rehabil. 2001;28(7):624-629. doi:10.1046/j.1365-2842.2001.00708.x
37. 37. Sleep Disorders and Their Association With Laboratory Pain Sensitivity in Temporomandibular Joint Disorder - PubMed. https://pubmed.ncbi.nlm.nih.gov/19544755/. Accessed May 2, 2020.
38. 38. Sleep and Depression as Risk Indicators for Temporomandibular Disorders in a Cross-Cultural Perspective: A Case-Control Study - PubMed. https://pubmed.ncbi.nlm.nih.gov/16602363/. Accessed May 2, 2020.
39. 39. Ahlberg J, Lobbezoo F, Ahlberg K, et al. Self-reported bruxism mirrors anxiety and stress in adults. Med Oral Patol Oral Cir Bucal. 2013;18(1). doi:10.4317/medoral.18232
40. 40. Liu X, Zhou H. Sleep duration, insomnia and behavioral problems among Chinese adolescents. Psychiatry Res. 2002;111(1):75-85. doi:10.1016/S0165-1781(02)00131-2
41. 41. Sleep-Wake Patterns and Sleep Disturbance among Hong Kong Chinese Adolescents. https://www.researchgate.net/publication/5578384_Sleep-Wake_Patterns_and_Sleep_Disturbance_among_Hong_Kong_Chinese_Adolescents. Accessed June 28, 2020.
42. 42. The transition of sleep-wake patterns in early adolescence. - Abstract - Europe PMC. https://europepmc.org/article/med/12841371. Accessed June 28, 2020.
43. 43. Laskin DM, Greene CS (Orthodontist), Hylander WL. Temporomandibular Disorders : An Evidence-Based Approach to Diagnosis and Treatment. Quintessence Pub; 2006.
44. 44. Ekici Ö. Relationship Between Chronic Pain and Sleep Quality in Patients with Temporomandibular Joint Dysfunction. J Turkish Sleep Med. 2021;8(1):67-72. doi:10.4274/jtsm.galenos.2021.16878
45. 45. List T, John MT, Dworkin SF, Svensson P. Recalibration improves inter-examiner reliability of TMD examination. Acta Odontol Scand. 2006;64(3):146-152. doi:10.1080/00016350500483137