TMD: Epidemiology: Signs and Symptoms

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1 TMD: Epidemiology: Signs and Symptoms Mauno Könönen Prof., Dr. Odont. Dept. of Stomatognathic Physiology and Prosthetic Dentistry Institute of Dentistry University of Helsinki Finland

2 Temporomandibular disorders (TMD)

3 Temporomandibular Disorders Definition: Temporomandibular disorders is a collective term embracing a number of clinical problems that involve the masticatory musculature, the TMJ and associated structures, or both. AAOP 1996

4 Classification of Orofacial Pains Axis I Axis II Diagnosis Classification of Orofacial Pains

5

6 Differental Diagnosis of Orofacial Pain Intracranial Pain Disorders Primary Headache Disorders Neurogenic Pain Disorders Intraoral Pain Disorders Temporomandibular Disorders Associated Structures Mental Disorders

7 Diagnostic classification Temporomandibular Joint Articular Disorders Masticatory Muscle Disorders

8 Somatic Pain Neuropathic Pain Superficial Pain Deep Pain Episodic Pain Continuous Pain Symphathetically Maintained Pain Deafferentation Pain Neuritis Pain Paroxysmal Neuralgia Pain Visceral Pain Musculoskeletal Pain Mucogingival Pain Cutaneous Pain Traumatic Neuralgia Atypical Odontalgia Postherpetic Neuralgia Herpes Zoster Peripheral Pain Neurovascular Pain Vascular Pain Pulpal Pain Visceral Mucosal Pain Glandular, Ocular and Auricular Pain Periodontal Pain Soft Connective Tissue Pain Osseous and Periosteal Pain Temporomandibular Joint Pain Muscle Pain Classification of Orofacial Pains

9 Traumatic Neuralgia Atypical Odontalgia Postherpetic Neuralgia Herpes Zoster Peripheral Pain Neurovascular Pain Vascular Pain Pulpal Pain Visceral Mucosal Pain Glandular, Ocular and Auricular Pain Periodontal Pain Soft Connective Tissue Pain Osseous and Periosteal Pain Temporomandibular Joint Pain Muscle Pain Migraine with Aura Migraine without Aura Cluster Headache Paroxysmal Hemicrania Neurovascular Variants Arteritis Pain Carotidynia Ligamentous Pain Retrodiscal Pain Capsular Pain Arthritic Pain Co-contraction Delayed Onset Muscle Pain Myofascial Pain Muscle Spams Pain Muscle Inflammation Pain Classification of Orofacial Pains

10

11

12 Tautiluokitus ICD-10 suomalainen tautiluokitus Maailman terveysjärjestön (WHO) luokituksesta tautien ja muiden terveysongelmien sanalliset diagnoosit koodeiksi tilastot ja tutkimustyö

13 Tautiluokituskoodeja (TMD)

14 History of TMD Costen syndrome, James Costen 1934 symptoms in masticatory and ear area first study to seek association between masticatory and symptoms in the ear region stydy comprised 11 patients, no controls patients had decreased vertical dimension of occlusion treatment: increase vertical dimesion of occlusion anatomist Sicher showed that occlusion cannot cause impingement of n. auriculotemporalis

15 History of TMD 50 ies increased interest towards TMD muscle tenderness and pain caused by occlusion 60 ies: occlusion and stress 70 ies: more focus on pain in TM joint 80 ies: TMD is complex and multifactorial dentist s role in orofacial pain questioned

16 Temporomandibular Disorders Costen syndrome Temporomandibular joint (TMJ) disturbances TMJ dysfunction syndrome Functional TMJ disturbances Occluso-mandibular disturbances Myoarthropathy of TMJ Pain-dysfunction syndrome Myofascial pain-dysfunction TMJ-pain dysfunction syndrome Arthrosis deformans Oto-dental syndrome Autodestruction Craniomandibular disorders

17 Epidemiology of TMD about 33% at least one symptom from 40% to 70% at least one sign about 30% clicking TMD decreases in older age ratio men:women 1:3 to 1:9 seeking care only 3% to 7% in need of treatment natural history???????

18 Epidemiology

19 Helkimo s Clinical Dysfunction Index A. Mobility index (0, 1, 5) B. TMJ function (0, 1, 5) C. Muscle pain (0, 1, 5) D. TMJ pain (0, 1, 5) E. Pain on movement (0, 1, 5) Sum A+B+C+D+E = Dysfunction Score (0-25 points) Clinical Dysfunction Index Di, according to code: 0 points = clinically symptom free= Di points = mild dysfunction = Di I 5-9 points = moderate dysfunction = Di II points = severe dysfunction = Di III

20 Reported symptoms of mandibular dysfunction: median values and range of percentage frequencies in 18 studies Symptom median range TMJ sounds Tenderness, stiffness of jaws Pain: mandibular function Limitation of jaw movement Locking of TMJ 4 <1-7 Frequent headache Carlsson 1984

21 Clinical signs of mandibular dysfunction: median values and range of percentage frequencies in 18 studies Clinical finding median range TMJ sounds Palpation tenderness: masticatory muscles TMJ Pain:mandibular movement Limitation of jaw movement Carlsson 1984

22 Epidemiology

23 Epidemiology

24 Epidemiology of TMD

25 TMD: Seeking care

26 Epidemiology: seeking care 3400 patients enrollees men 33.8 yrs women 34.2 yrs 85.4 % women

27 Epidemiology: Why women? Women: all patient clinics Psychosocial factors - women seek care Recently - women more signs and symptoms Physiologic factors? Hormonal factors?

28 Sex differences in the use health care services NEJM 1997?

29 Sex differences in the use TMD health care services

30 Epidemiology (Kuttila 1998)

31 TMD Classification Muscle disorders Disc problems Joint diseases

32 Polyarthritides (ICM.9.CM 714.9) Rheumatoid arthritis Juvenile chronic arthritis Ankylosing spondylitis Psoriatic arthritis Reiter s disease Infectious arthritis Crystal induced disease Scleroderma Sjögren s syndrome Lupus erythematosus

33 CRANIOMANDIBULAR DISORDERS IN PSORIATIC ARTHRITIS A radiographic and clinical study Mauno Könönen Helsinki 1987

34 Psoriatic arthritis: Erosion in right TMJ

35 TMD Classification Muscle disorders Disc problems Joint diseases

36 Lateral view of TMJ Intercuspal position Opening of mouth

37 Coronal view of TMJ

38 Definition of TMJ clicking Temporomandibular joint clicking is defined as a distinct snapping or popping sound emanating from the TMJ during joint movement or with joint compression Okeson 1996

39 Sounds from TMJ Common causes for clicking disc dislocation deviation in form muscle co-ordination problem Common causes for crepitation arthrosis inflammatory joint diseases

40 Longitudinal variation in reported TMJ clicking sounds in young Finns (n=128) Könönen et al: THE LANCET 1996; 347:

41 Longitudinal variation in recorded TMJ clicking sounds in young Finns (n=128) Könönen et al: THE LANCET 1996; 347:

42 TMD Classification Muscle disorders Disc problems Joint diseases

43 Masticatory Muscle Disorders Myofascial pain chronic regional muscle pain complaint of pain tenderness to palpation with replication of chief complaint pain increased by mandibular function or parafunction Affected ROM possible presence of trigger points

44 Age (years) YES Orofacial pain NO (n=128)

45 Age (years) YES Muscle tenderness NO (n=128)

46 9-Year Follow-Up of TMD in Young Finnish Adults

47 Temporomandibular Disorders: To treat or not to treat?

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