Temporomandibular Joint Dysfunction: From Risk Factors To Prevention

F. Salvinelli Area of Otolaryngology, Interdisciplinary Center for Biomedical Research (CIR), University Campus Bio-Medico Rome Italy

M. Casale Area of Otolaryngology, Interdisciplinary Center for Biomedical Research (CIR), University Campus Bio-Medico Rome Italy

L. D'Ascanio Area of Otolaryngology, Interdisciplinary Center for Biomedical Research (CIR), University Campus Bio-Medico Rome Italy

V. Rinaldi Area of Otolaryngology, Interdisciplinary Center for Biomedical Research (CIR), University Campus Bio-Medico Rome Italy

F. Paparo Area of Otolaryngology, Interdisciplinary Center for Biomedical Research (CIR), University Campus Bio-Medico Rome Italy

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

Keywords: temporo-mandibular joint, caries, jaw pain

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 (69.12%) 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 dizziness13, often affect patient's quality of life14 and represent an additional cost to society.15

Correspondence to

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.it

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Journal

The Internet Journal of Otorhinolaryngology ISSN: 1528-8420