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Temporomandibular disorders: incidence, course, and risk factors
Umeå University, Faculty of Medicine, Odontology, Clinical Oral Physiology.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Käkfunktionsstörning : förlopp och riskfaktorer (Swedish)
Abstract [en]

Temporomandibular disorders (TMD) embrace pain and dysfunction in the temporomandibular joint (TMJ) and jaw muscles. TMD is a prevalent condition in the population and constitutes a significant health problem. Knowledge of factors influencing the onset and course of TMD is important in preventive care and development of treatment strategies as well as in clinical decision making. The aim of this thesis was to gain knowledge of whether variations in dental occlusion, bruxism, spinal pain and gender predicted the development and course of TMD.

The study population comprised 371 undergraduate dental students. A questionnaire was used to obtain case histories. Clinical examination included the function of the TMJ, jaw muscles, maximal jaw mobility, the morphological occlusion, and contact patterns in centric and eccentric positions. The examinations were performed at start, and after 12 and 24 months. In total, 280 subjects were examined at all three occasions.

The incidence of TMJ pain and dysfunction was high among both males and females. The course composed onset, recovery and maintenance resulting in a fluctuating pattern. Females were more likely to have persistent TMJ pain and dysfunction than males. The incidence and persistence of jaw muscle signs and symptoms was high and significantly more common in females. A similar fluctuating pattern as for TMJ pain and dysfunction was found. Crossbite predicted onset and persistence of TMJ pain and dysfunction; mandibular instability in centric positions predicted persistent TMJ pain and dysfunction, as well as persistent jaw muscle signs or symptoms. Reported bruxism increased the risk for TMJ pain and dysfunction but did not significantly affect the course of jaw muscle signs and symptoms. Spinal pain at baseline predicted the onset of jaw pain, headaches, and TMD pain. Signs of TMD at baseline predicted the onset of non-pain symptoms of TMD, jaw pain, headaches, and spinal pain.

In conclusion, the results in this thesis show high incidence rates for TMD, headaches, and spinal pain among dental students. Crossbite, mandibular instability, reported bruxism, as well as female gender were identified as contributing risk factors. Spinal pain and TMD mutually predicted each other, indicating common pathophysiological mechanisms and individual vulnerability. The findings support a multidisciplinary approach, and it is recommended that the status and function of the jaw system be considered in patients with spinal pain.

Place, publisher, year, edition, pages
Umeå, 2009. , 68 p.
Series
Umeå University odontological dissertations, ISSN 0345-7532 ; 108
Keyword [en]
bruxism, dental occlusion, gender, headaches, longitudinal, myofascial pain, orofacial pain, prospective cohort, risk factors, spinal pain, temporomandibular joint
National Category
Dentistry
Identifiers
URN: urn:nbn:se:umu:diva-25689ISBN: 978-91-7264-832-6 (print)OAI: oai:DiVA.org:umu-25689DiVA: diva2:233160
Distributor:
Klinisk oral fysiologi, 901 87, Umeå
Public defence
2009-09-25, Sal B, By 1D, 9tr, Tandläkarhögskolan, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2009-09-07 Created: 2009-08-28 Last updated: 2009-12-15Bibliographically approved
List of papers
1. Incidence and prevalence of temporomandibular joint pain and dysfunction: a one-year prospective study of university students
Open this publication in new window or tab >>Incidence and prevalence of temporomandibular joint pain and dysfunction: a one-year prospective study of university students
2007 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 65, no 2, 119-127 p.Article in journal (Refereed) Published
Abstract [en]

Objective. The aims of this study were to investigate the incidence and recovery of temporomandibular joint (TMJ) pain and dysfunction during a 1-year period, and to examine factors associated with TMJ signs and symptoms.

Material and Methods. The study population comprised 371 dental students examined at the start of education, out of which 308 were re-examined after 1 year. Case histories were collected with the aid of a questionnaire.

The cinical examination involved TMJ mobility, TMJ pain, TMJ sounds, morhological and functional dental occlusion.

Results. The 1-year incidence of TMJ signs and/or symptoms was 12%, with no statistically significant difference between men and women. Reported TMJ sounds (10%) and clinically registered TMJ pain (8%) reached the highest incidence rates. Approximately a quarter of those who had TMJ signs and/or symptoms at baseline had recovered at follow-up. Subjects with a non-symptomatic TMJ were significantly more often found among men and among those with bilateral contacts in centric relation, a normal transverse inter-maxillary relationship, and a stabile manadibular position in centric occlusion.

Conclusion. The 1-year incidence of TMJ pain and/or dysfunction was high among 1st-year univerisity students. The persistence of signs and symptoms during the observation period was related to gender, while incidence and disappearance of symptoms were not. Dental occlusion was not rejected as a possible concurrent factor in relation to TMJ pain and/or dysfunction among university students.

Keyword
Dental occlusion, longitudinal study, mandibular instability, pain, temporomandibular disorders
Identifiers
urn:nbn:se:umu:diva-12972 (URN)10.1080/00016350601083554 (DOI)17453430 (PubMedID)
Available from: 2008-01-18 Created: 2008-01-18 Last updated: 2017-12-14Bibliographically approved
2. Incidence and prevalence of myofascial pain in the jaw-face region: a one-year prospective study on dental students
Open this publication in new window or tab >>Incidence and prevalence of myofascial pain in the jaw-face region: a one-year prospective study on dental students
2008 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 66, no 2, 113-121 p.Article in journal (Refereed) Published
Abstract [en]

Objective. The aims of this study were to examine the 1-year period prevalence, incidence, and course of myofascial pain in the jaw-face region, and to analyze whether female gender, dental occlusion, and oral parafunctions have any influence on these signs and symptoms. Material aad methods. The study population comprised 308 dental students examined at the start of their dentistry course and re-examined after 1 year. Case histories were collected using a questionnaire. The clinical examination included palpation sites of muscles, a submaximal clenching test, measurements of maximal mandibular mobility, and classification of morphological and functional dental occlusion. Results. The 1-year period prevalence of frequent myofascial symptoms was 19%. The incidence of myofascial pain, according to the Research Diagnostic Criteria for TemporoMandibular Disorders (RDC/TMD), was 4%. The female students presented an almost 4-fold incidence rate of myofascial symptoms compared to the male students. Non-symptomatic subjects were found among those without awareness of bruxism and with simultanious bilateral contact in the retruded contact position (RCP), and among those with a stable intercuspal position (ICP). Variations in morphological occlusion did not show any relation to myofascial symptoms, nor did contact patterns in eccentric positions. Conclusions. Female dental students were more prone to developing frequent myofascial pain and to perceiving local muscle soreness than were male students during a 1-year period. Both self-reported bruxism and registered mandibular instability in ICP showed association with the 1-year period prevalence of myofascial signs and symptoms in the jaw-face region.

Keyword
Dental occlusion, longitudinal study, masticatory, risk factors, temporomandibular disorders
Identifiers
urn:nbn:se:umu:diva-10987 (URN)10.1080/00016350802010372 (DOI)
Available from: 2008-11-10 Created: 2008-11-10 Last updated: 2017-12-14Bibliographically approved
3. Reciprocal influence on the incidence of symptoms in trigeminally and spinally innervated areas
Open this publication in new window or tab >>Reciprocal influence on the incidence of symptoms in trigeminally and spinally innervated areas
2010 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 14, no 4, 366-371 p.Article in journal (Refereed) Published
Abstract [en]

Temporomandibular disorders (TMD), headaches, and spinal pain show co-morbidity and may therefore influence each other. The hypothesis tested is that the presence of any of these conditions will increase the risk of onset of new symptoms within a 2-year period. The study population comprised 280 dental students, who were examined three times at 12-month intervals. The incidence was calculated for a 2-year period, based on subjects without the defined symptom at baseline. Each participant was classified into five different case-control groups, representing incidence cases or no incidence (controls) of: (1) nonpain TMD symptoms; (2) jaw pain; (3) headaches; (4) spinal pain; and (5) TMD pain. Presence of headaches and of spinal pain and signs and symptoms of TMD at baseline were used as independent variables in logistic regression analyses, controlling for age and sex. Incidence cases with TMD pain reported spinal pain at baseline significantly more often than the controls, and were mostly women. Incidence cases with headaches and incidence cases with jaw pain significantly more often had signs of TMD and reported spinal pain at baseline, compared to controls. Incidence cases with nonpain TMD symptoms or spinal pain significantly more often presented with signs of TMD at baseline. Our findings show that pain and dysfunction in trigeminally innervated areas and pain in spinally innervated areas mutually predict the onset of new symptoms in dental students, indicating common pathophysiological mechanisms and individual vulnerability. This may be of importance in risk assessment and treatment planning of individuals with musculoskeletal pain.

Place, publisher, year, edition, pages
John Wiley & Sons, 2010
Keyword
Incidence, Temporomandibular disorders, Headaches, Spinal pain, Reciprocal influence, Prospective cohort
National Category
Dentistry
Research subject
Odontology
Identifiers
urn:nbn:se:umu:diva-25688 (URN)10.1016/j.ejpain.2009.06.004 (DOI)000277881000006 ()
Available from: 2009-09-07 Created: 2009-08-28 Last updated: 2017-12-13Bibliographically approved
4. Risk factors associated with incidence and persistence of temporomandibular disorders
Open this publication in new window or tab >>Risk factors associated with incidence and persistence of temporomandibular disorders
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Aims: The aim of this study was to analyze whether gender, reported bruxism, and variations in dental occlusion predicted incidence and persistence of temporomandibular disorders (TMD) during a 2 year period.

Methods: The study population comprised 280 dental students at Umeå University, Sweden. The study design was that of a case-control study within a 2-year prospective cohort. The investigation comprised a questionnaire and a clinical examination at enrolment, and at 12 and 24 months. Cases (incidence) and controls (no incidence) were identified among those without signs and symptoms of TMD at start. Cases with persistent TMD were those with such signs and symptoms at all three examinations. Clinical registrations of baseline variables were used as independent variables. Odds ratio estimates and 95% confidence intervals of the relative risks of being a case or control in relation to baseline registrations were calculated using logistic regression analyses.

Results: The analyses revealed that reported bruxism and crossbite, respectively, increased the risk of incidence and duration of temporomandibular joint (TMJ) signs or symptoms. Female gender was related to an increased risk to develop and maintain myofascial pain. Signs of mandibular instability increased the risk of long-standing signs and/or symptoms of TMD.

Conclusion: This 2-year prospective observational study indicated that reported bruxism and variations in dental occlusion were linked to incidence and persistence of TMJ signs and symptoms to a higher extent than to myofascial pain.

Research subject
Odontology
Identifiers
urn:nbn:se:umu:diva-25687 (URN)
Available from: 2009-09-07 Created: 2009-08-28 Last updated: 2009-12-15Bibliographically approved

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