Oral jaw behaviors in TMD and bruxism: a comparison study by severity of bruxism.

The purpose of this study was to document the prevalence of oral jaw behaviors concomitant to bruxism in TMD+bruxing behavior patients and in nonbruxer controls. Clinical examination, questionnaires, and specific criteria to allocate patients to mild, moderate, and severe groups of TMD and bruxers were used. The sample consisted of 274 TMD+bruxing behavior patients and 52 control non-bruxing behavior groups evaluated at the Center for the Study of TMD. The mean age of the TMD+bruxing behavior group was about 33.11 years old (range 16.66, SD = 11.52) as compared to 34.90 years old (range 17-67, SD = 14.26) in the control group. Oral jaw behaviors were assessed in the mild, moderate, and severe TMD+bruxing groups, and in the corresponding control group. It was found that the prevalence of oral jaw behaviors was higher in the TMD+bruxing behavior group as compared to the control. Hence, concomitant oral jaw behaviors predominated in bruxers and increased with its severity. The data reinforce the need to assess TMD patients in terms of the presence of bruxism, its severity, and concomitant oral jaw habits. Such approach will enable the clinician to have better understanding about the role of these behaviors in TMD. Epidemiological data was also provided regarding jutting the jaw forward (a rarely-described oral jaw habit) in a relatively large sample of TMD+bruxing patients, suggesting a more clinical intervention in children and adolescents. This study is the first to document the prevalence of specific oral jaw habits in a relatively large sample of TMD+bruxing behavior classified by degree of severity. Results suggest that TMD+bruxing patients may present many other additional oral jaw habits which may concur to increase masticatory muscle activity thus leading to TMD signs and symptoms. Factors responsible for the increased frequency of oral jaw habits with the severity of bruxism behavior remain unknown and therefore further studies are needed.

Profile of TMD and Bruxer compared to TMD and nonbruxer patients regarding chief complaint, previous consultations, modes of therapy, and chronicity.

This comparative study by groups assesses the profiles of TMD (temporomandibular dysfunction) and bruxism patients and TMD-nonbruxing patients regarding chief complaint, previous medical and dental consultations, duration of the chief complaint, previous medication, and use of splints. The sample consisted of a group of 340 TMD patients, 275 of whom were bruxers and 65 who were nonbruxers. Both patients and controls were consecutive referrals over a period of five years. The group of TMD and Bruxer was classified according to the degree of severity. One hundred eight (108), 84, and 83 patients demonstrated mild, moderate, and severe bruxism respectively. Information gathered included a set of questionnaires, history of signs and symptoms, and a clinical examination. The most common chief complaints in TMD bruxers and nonbruxers were facial, temporomandibular joint, headache and/or cervical pain, and joint noises. It was observed that the need for medical and dental consultations increased with the severity of bruxism. It was also apparent in this study that the need for medication (analgesics, muscle relaxants, and antidepressants), increased with the severity of bruxism. Moderate and severe subgroups of bruxers used significantly more splints compared to mild bruxers and to TMD-nonbruxer patients. Both groups of TMD + bruxism and TMD - nonbruxism sought medical and dental consultations with dentists (clinicians and specialists) neurologists, and otolaryngologists more frequently compared to other medical professionals. Since the need for health services increased with the severity of bruxism, this study urges the need to include a protocol or questionnaire to assess the severity of bruxing behavior in TMD patients in order to use a customized method of treatment/management. This study also reinforces the point of view that different subgroups of TMD and bruxism do exist and suggests a differentiated therapeutic approach. They show previously confirmed findings that pain is the major complaint of TMD and bruxer patients.

The prevalence of some joint disorders in craniomandibular disorder (CMD) and bruxers as compared to CMD nonbruxer patients and controls.

The objective of this study was to assess and compare the frequency of some joint disorders in 130 CMD + bruxing behavior patients, 66 CMD/nonbruxing behaviors patients referred for diagnosis and treatment to the Center for the Study of Craniomandibular Disorders and 130 control subjects seeking routine dental care. Both patients and controls were consecutive referrals to the clinic occurring over a five year period. The mean age of the CMD + bruxing behavior group was about 35.48 years (range 14-54, SD = 8.45), and 36.84 years (range 17-60, SD = 9.30) in the 66 CMD nonbruxing behavior group, and 34.34 years (range 14-62, SD = 9.92) in the control group of 130 subjects. Information gathered included a questionnaire, history of signs and symptoms, and a clinical examination. Different types of joint disorders, muscle signs and symptoms and bruxing behavior were assessed in the CMD groups and in the corresponding control group. The study concluded that capsulitis/synovitis, retrodiskal pain and disk-attachment pain predominated in CMD + bruxing behavior patients. The data reinforces the need to assess CMD + bruxing behavior patients to evaluate signs and symptoms of such disorders in order to obtain additional information about the true source of pain and the need for proper management.

A clinical study of specific signs and symptoms of CMD in bruxers classified by the degree of severity.

Two hundred and seventy-six CMD patients referred consecutively for diagnosis and treatment over a period of four years were assessed. Two hundred and eleven were classified as bruxers according to the use of a questionnaire and clinical examination. One hundred (47.39%) presented clinical characteristics of mild bruxers, 66 (31.27%) presented moderate bruxism and 45 (21.32%) demonstrated severe bruxism. Severe bruxers presented the lowest degree of jaw opening (39.21 mm) and highest prevalence of capsulitis (97.77%), retrodiskal pain (84.44%) and disk-attachment pain (48.88%). As compared to the mild and moderate groups, severe bruxers also demonstrated significantly higher prevalence of protective splinting and transient locking or recent history of intermittent locking, masticatory pain, reciprocal clicking and signs and symptoms of Myofascial Pain Dysfunction Syndrome (MPDS). Because higher prevalence of specific muscle and joint disorders were observed in bruxers and such prevalence was progressive from the mild to the moderate and severe group, it may be concluded that bruxing behavior is a significant factor in the etiology and progression of muscle and joint disorders. Based on the review of the literature, the analysis of our data in comparison to other studies allowed us to conclude that severe bruxers are more impaired by muscular and joint disorders as compared to mild and moderate bruxers.

Prevalence of modalities of headaches and bruxism among patients with craniomandibular disorder.

This study compared the presence of headache and bruxing behavior among 133 craniomandibular disorder patients (CMD) referred to the The Center For the Study Of Craniomandibular Disorders and to the presence of headache and bruxing behavior occurring in 133 controls seeking routine dental care. Both patients and controls were consecutive referrals to the clinic occurring over a three year period. The mean age of the CMD group was 38 years (range 28-42), and the mean age of the controls was 37 years (range 25-44). The information gathered included questionnaire and clinical examination. Different types of headaches, signs and symptoms of CMD, and bruxing behavior were assessed both in the CMD group and in the corresponding control group. Results of this study showed that bruxing behavior and headache pain were significantly more prevalent in the CMD group (57%, 76%) than in the corresponding control group (37%, 49%). Of the three types of headache observed, tension and combination headaches were more prevalent in the CMD group (n = 48 = 36% and n = 37 = 28%). Migraine headache was more prevalent in the CMD group (n = 16 = 12%) than in the control group (n = 3 = 2%). It was concluded that headache and bruxing behavior predominated in CMD patients. This data reinforces the need to assess headache pain and signs and symptoms of bruxing behavior in CMD patients, particularly in those suffering chronic facial pain and headache.