Analyzing the relationship between primary complaint, diagnosis, and treatment in patients with temporomandibular joint disorders

Yıl 2025, Cilt: 14 Sayı: 1, 1 - 8, 27.01.2025

Merve Çakır , Gül Merve Yalçın Ülker

https://doi.org/10.54617/adoklinikbilimler.1507819

Öz

Aim: This study aimed to assess patients’ with temporomandibular joint disorder (TMD) the complaints and diagnoses of patients diagnosed according to Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) criteria and evaluate the effectiveness of the treatments.
Material and Methods: The clinical examinations of the patients with complaints of TMD were performed according to the internationally accepted Turkish version of the DC/TMD guideline. Patients’ complaints, symptoms, VAS scores and diagnosis were recorded. Patients were classified into three groups: Group A, Patients with pain-related TMD; Group B, Patients with intra-articular TMD; and Group A-B, Patients with both pain-related TMDs and intra-articular TMD. Patients received various treatments according to their examination and diagnosis. In the follow-up sessions after treatment, patients’ remaining complaints and VAS scores were recorded. Descriptive statistics were performed to analyze relationship of the primary complaint, diagnose and the treatment effectiveness.
Results: The study included 127 patients (105 women and 22 men, mean age 34.5±11.2). 55 patients were in Group A, 14 patients in Group B, and 56 patients in Group A-B. 2 patients were classified as 'undefined'. A statistically significant result (p = 0.001) was found when comparing complaints with diagnostic groups. Pain complaints were more frequent in group A, while complaints of TMJ sounds were less common in group A compared to other groups. In the relationship between treatment and diagnostic group, a statistically significant difference was found (p<0.001); pharmacotherapy was applied more frequently in groups A and A-B than in group B. It was determined that occlusal splint treatment differed between groups A and B. There was no significant difference between the median values of the difference in VAS scores according to the number of treatments applied. A decrease in VAS scores was observed as a result of the treatments applied.
Conclusion: For the most appropriate treatment of TMD, the complaints of the patients must first be clearly understood.

Anahtar Kelimeler

DC/TMD, primary complaint, TMD

Temporomandibular eklem bozukluğu olan hastalarda birincil şikayet, tanı ve tedavi arasındaki ilişkinin incelenmesi

Öz

Amaç: Bu çalışmanın amacı; temporomandibular eklem düzensizliği (TMD) olan hastaların şikayetlerini ve Temporomandibular Düzensizliklerin Tanısal Kriterleri (TMD/TK) klavuzuna göre tanı alan hastaların tanılarını değerlendirmek ve tedavilerin etkinliğini değerlendirmektir.
Gereç ve Yöntemler: TMD şikayeti olan hastaların klinik muayeneleri TMD/TK kılavuzunun uluslararası kabul görmüş Türkçe versiyonuna göre yapılmıştır. Hastaların şikayetleri, semptomları, VAS skorları ve tanıları kaydedilmiş ve hastalar üç gruba ayrılmıştır: Grup A, Ağrıya bağlı TMD hastaları; Grup B, Eklem içi TMD'li hastalar ve Grup A-B, Hem ağrıyla ilişkili TMD'leri hem de eklem içi TMD'si olan hastalar. Hastalara muayene ve tanılarına göre çeşitli tedaviler uygulanmıştır. Tedavi sonrası takip seanslarında hastaların kalan şikayetleri ve VAS skorları kaydedilmiş, birincil şikayet, tanı ve tedavi etkinliği arasındaki ilişkiyi analiz etmek için tanımlayıcı istatistiksel değerlendirmeler yapılmıştır.
Bulgular: Çalışmaya 127 hasta (105 kadın ve 22 erkek, ortalama yaş 34.5±11.2) dahil edilmiştir. Grup A'da 55 hasta, Grup B'de 14 hasta ve Grup A-B'de 56 hasta bulunurken, 2 hasta 'tanımsız' olarak sınıflandırılmıştır. Şikayetlerin tanı grupları ile karşılaştırılmasında istatistiksel olarak anlamlı bir sonuç (p=0.001) bulunmuştur. Grup A'da ağrı şikayeti daha sık görülürken, temporomandibular eklemde ses şikayeti grup A'da diğer gruplara göre daha az görülmüştür. Tedavi ve tanı grubu arasındaki ilişkide istatistiksel olarak anlamlı fark bulunmuştur (p<0.001); farmakoterapi A ve A-B gruplarında B grubuna göre daha sık uygulanmışken, okluzal splint tedavisinin A ve B grupları arasında farklılık gösterdiği belirlenmiştir. Tedavi sayısına göre VAS skorları arasındaki farkın medyan değerleri arasında anlamlı fark bulunmazken, uygulanan tedaviler sonucunda VAS skorlarında azalma gözlenmiştir.
Sonuç: TMD'nin en uygun tedavisi için öncelikle hastaların şikayetlerinin net olarak anlaşılması gerekmektedir.

Anahtar Kelimeler

primer şikayet, TMD, TMD/TK

Kaynakça

• Referans1. Sousa BM, López-Valverde N, López-Valverde A, Caramelo F, Fraile JF, Payo JH, et al. Different Treatments in Patients with Temporomandibular Joint Disorders: A Comparative Randomized Study. Medicina 2020;56:113.
• Referans2. Valesan LF, Da-Cas CD, Réus JC, Denardin ACS, Garanhani RR, Bonotto D, et al. Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis. Clin Oral Investig 2021;25:441-53.
• Referans3. Warren MP, Fried JL. Temporomandibular disorders and hormones in women. Cells Tissues Organs 2001;169:187-92.
• Referans4. Tatli U, Benlidayi ME, Ekren O, Salimov F. Comparison of the effectiveness of three different treatment methods for temporomandibular joint disc displacement without reduction. Int J Oral Maxillofac Surg 2017;46:603-9.
• Referans5. Melo RA, de Resende C, Rego CRF, Bispo ASL, Barbosa GAS, de Almeida EO. Conservative therapies to treat pain and anxiety associated with temporomandibular disorders: a randomized clinical trial. Int Dent J 2020;70:245-53.
• Referans6. Okeson JP. Management of temporomandibular disorders. 8th. edition Louis, Missouri: Elsevier Mosby; 2020.
• Referans7. Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, 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 Groupdagger. J Oral Facial Pain Headache 2014;28:6-27.
• Referans8. Turp JC, Kowalski CJ, Stohler CS. Temporomandibular disorders--pain outside the head and face is rarely acknowledged in the chief complaint. J Prosthet Dent 1997;78:592-5.
• Referans9. Dimitroulis G, Dolwick MF, Gremillion HA. Temporomandibular disorders. 1. Clinical evaluation. Aust Dent J 1995;40:301-5.
• Referans10. Rodrigues ALP, Cardoso HJ, Angelo DF. Patient experience and satisfaction with different temporomandibular joint treatments: A retrospective study. J Craniomaxillofac Surg 2023;51:44-51.
• Referans11. Kulkarni S, Thambar S, Arora H. Evaluating the effectiveness of nonsteroidal anti-inflammatory drug(s) for relief of pain associated with temporomandibular joint disorders: A systematic review. Clin Exp Dent Res 2020;6:134-46.
• Referans12. Yekkalam N, Wanman A. Factors associated with clinical decision-making in relation to treatment need for temporomandibular disorders. Acta Odontol Scand 2016;74:134-41.
• Referans13. Ohrbach R ePS, Polat NT, Çetinoğlu A. Diagnostic Criteria for Temporomandibular Disorders:Assessment Instruments. Version 15May2016 Temporomandibuler Düzensizlikler için TanıKriterleri: Değerlendirme Araçları: Turkish Version. Vol 2022. www.rdctmdinternational.org2016.
• Referans14. Pimenta e Silva Machado L, de Macedo Nery MB, de Gois Nery C, Leles CR. Profiling the clinical presentation of diagnostic characteristics of a sample of symptomatic TMD patients. BMC Oral Health 2012;12:26.
• Referans15. Greene CS, Marbach JJ. Epidemiologic studies of mandibular dysfunction: a critical review. J Prosthet Dent 1982;48:184-90. 16. Carlsson GE. Epidemiological studies of signs and symptoms of temporomandibular joint-pain-dysfunction. A literature review. Aust Prosthodont Soc Bull 1984;14:7-12.
• Referans17. Bagis B, Ayaz EA, Turgut S, Durkan R, Ozcan M. Gender difference in prevalence of signs and symptoms of temporomandibular joint disorders: a retrospective study on 243 consecutive patients. Int J Med Sci 2012;9:539-44.
• Referans18. Progiante PS, Pattussi MP, Lawrence HP, Goya S, Grossi PK, Grossi ML. Prevalence of Temporomandibular Disorders in an Adult Brazilian Community Population Using the Research Diagnostic Criteria (Axes I and II) for Temporomandibular Disorders (The Maringa Study). Int J Prosthodont 2015;28:600-09.
• Referans19. Zhang Q, Yuan S, Deng K, Li X, Liang Y, Wu A, et al. Correlation of patients’ demographics and clinical symptoms with temporomandibular disorders. Cranio 2023;41:432-9.
• Referans20. Bonjardim LR, Gaviao MB, Pereira LJ, Castelo PM, Garcia RC. Signs and symptoms of temporomandibular disorders in adolescents. Braz Oral Res 2005;19:93-8.
• Referans21. Rauhala K, Oikarinen KS, Jarvelin MR, Raustia AM. Facial pain and temporomandibular disorders: an epidemiological study of the Northern Finland 1966 Birth Cohort. Cranio 2000;18:40-6.
• Referans22. Bonacci CE, Syrop SB, Gold N, Israel H. Temporomandibular/ facial pain. An epidemiological report. N Y State Dent J 1992;58:30-3.
• Referans23. Vainionpaa R, Kinnunen T, Pesonen P, Laitala ML, Anttonen V, Sipila K. Prevalence of temporomandibular disorders (TMD) among Finnish prisoners: cross-sectional clinical study. Acta Odontol Scand 2019;77:264-8.
• Referans24. Alrashdan MS, Nuseir A, Al-Omiri MK. Prevalence and correlations of temporomandibular disorders in Northern Jordan using diagnostic criteria axis I. J Investig Clin Dent 2019;10:e12390.
• Referans25. Wieckiewicz M, Grychowska N, Nahajowski M, Hnitecka S, Kempiak K, Charemska K, et al. Prevalence and Overlaps of Headaches and Pain-Related Temporomandibular Disorders Among the Polish Urban Population. J Oral Facial Pain Headache 2020;34:31-9.
• Referans26. van Grootel RJ, Buchner R, Wismeijer D, van der Glas HW. Towards an optimal therapy strategy for myogenous TMD, physiotherapy compared with occlusal splint therapy in an RCT with therapy-and-patient-specific treatment durations. BMC Musculoskelet Disord 2017;18:76.
• Referans27. Incorvati C, Romeo A, Fabrizi A, Defila L, Vanti C, Gatto MRA, et al. Effectiveness of physical therapy in addition to occlusal splint in myogenic temporomandibular disorders: protocol of a randomised controlled trial. BMJ Open 2020;10:e038438.
• Referans28. Fricton J. Current evidence providing clarity in management of temporomandibular disorders: summary of a systematic review of randomized clinical trials for intra-oral appliances and occlusal therapies. J Evid Based Dent Pract 2006;6:48-52.
• Referans29. Machon V, Hirjak D, Lukas J. Therapy of the osteoarthritis of the temporomandibular joint. J Craniomaxillofac Surg 2011;39:127-30.
• Referans30. Nitzan DW. Arthrocentesis--incentives for using this minimally invasive approach for temporomandibular disorders. Oral Maxillofac Surg Clin North Am 2006;18:311-28.