Stress Experience, Depression and Neck Disability in Patients with Temporomandibular Disorder-Myofascial Pain with Referral.

The etiology of temporomandibular disorders (TMDs) is firmly anchored in the biopsychosocial model in which a special role is attributed to the stress, depression, somatic symptoms, and anxiety. The aim of the study was to assess the level of stress, depression and neck disability in patients with temporomandibular disorder-myofascial pain with referral. The study group enrolled 50 people (37 women and 13 men) with complete natural dentition. All the patients underwent a clinical examination according to the Diagnostic Criteria for Temporomandibular Disorders and were diagnosed as individuals with myofascial pain with referral. The questionnaires were associated with stress, depression, and neck disability; Perceived Stress Scale (PSS-10), Beck Depression Inventory(BDI), and Neck Disability Index (NDI) were evaluated. Of the individuals evaluated, 78% showed elevated levels of stress, and the average value of the PSS-10 in the study group was 18 points (Me = 17). Furthermore, 30% of the subjects presented depressive symptoms, with the average value of BDI was 8.94 points (Me = 8), and 82% of the subjects showed neck disability. The multiple linear regression model revealed that BDI and NDI allowed explanations for the 53% differentiation of PSS-10. In conclusion, stress, depression, and neck disability coexist with temporomandibular disorder-myofascial pain with referral.

The Prevalence and Overlaps of Temporomandibular Disorders in Patients with Myofascial Pain with Referral-A Pilot Study.

The aim of the study was to evaluate the temporomandibular joint, the prevalence of single and multiple diagnosis and potential sided domination of temporomandibular dysfunction in patients with temporomandibular disorder-myofascial pain with referral. The study group enrolled 50 people-37 females and 13 males between 18 and 25 years old with an average age of 23.36 ± 2.14. The patients underwent joint vibration analysis. Sixty seven percent of all examined tem-poromandibular joints were classified as group I according to Mark Piper's classification. Class IIIA appeared in 17% of joints. Eight percent of temporomandibular joints were classified as class IVA. There were no statistically significant differences in the prevalence of temporomandibular disorder with respect to gender (p = 0.838639). The relatively high prevalence of multiple diagnoses proved the overlapping nature of muscle and intraarticular disorders. Twenty eight percent of the subjects suffered from a combination of myofascial pain with referral and bilateral temporoman-dibular dysfunction. In 62% of the patients a lack of intraarticular disorders was reported. The suggestion that there exists sided domination in the occurrence of temporomandibular disorders has not been confirmed. Due to the small sample size, such differences cannot be excluded. Fur-ther research is needed.

Comparative Evaluation of Occlusion before and after Soft Tissue Mobilization in Patients with Temporomandibular Disorder-Myofascial Pain with Referral.

The aim of the study was to evaluate occlusal parameters in patients with myofascial pain with referral before and after soft tissue mobilization. The study group consisted of 50 people (37 females and 13 males, average age 23.36 ± 2.14 years) diagnosed with myofascial pain with referral. All patients underwent triplicate soft tissue mobilization. Occlusal parameters were evaluated six times, before and after each treatment, using T-scan III. A decreasing tendency of the occlusion time was observed after the first, second, and third therapy. After the third treatment, the mean occlusion time in the entire study group was 0.119 s. The 1st soft tissue mobilization shortened both right and left disclusion times to 0.181 s and 0.185 s, respectively. After the third treatment, these parameters amounted to 0.159 s and 0.165 s, respectively. The Friedman test for the entire study group indicated that soft tissue mobilization altered the occlusion time and both disclusion times (p < 0.05). In conclusion, soft tissue mobilization affects biotensegrity of the masticatory system, thus modifying occlusal parameters. The occlusion time and both disclusion times cannot be considered as cofactors of the existing temporomandibular disorders-myofascial pain with referral.

The role of soft tissue mobilization in reducing orofacial and general complaints in a patient with Kimmerle anomaly and temporomandibular joint disorder: A case report.

Background: Kimmerle anomaly belongs to the anatomic varieties of the first cervical vertebra. The clinical pattern is dominated by vascular- and neurogenic-type headaches, dizziness, decreased postural muscle tension, and vegetative symptoms. Clinical Presentation: A 37-year-old woman who suffered from headache and pain in the left temporomandibular joint underwent clinical examination, electromyography of masticatory muscles, temporomandibular joint vibration analysis, cone beam computed tomography, and soft tissue mobilization. Radiologic examination revealed Kimmerle anomaly on the right side of the atlas. Clinical Relevance: Myofascial release decreased the tension within anatomic structures projected to the vertebral artery groove. Better movements of the cervical spine and fewer headaches were noted. Increased cervical and masseter muscle tension were considered the main cause of the ailments. The proprioceptive system of the cervical spine was accepted as a reason for persistent headaches. Soft tissue mobilization revealed positive healing effect in the patient with temporomandibular joint disorder and Kimmerle anomaly. Abbreviations: C1: First cervical vertebra; DC/TMD: Diagnostic Criteria for Temporomandibular Disorders (DC/TMD); BDI: Beck Depression Inventory; PSS: Perceived Stress Scale; NDI: Neck Disability Index; BioEMG: Surface electromyography; sEMG: Surface electromyography; ICC: Intraclass correlation coefficient; T-Scan® III: computer evaluation of dental occlusion; JVA: Joint Vibration Analysis; CBCT: Cone Beam Computed Tomography; TO: Occlusion time; the time from the first contact of the teeth to the maximum intercuspidation; reference value in patient with natural teeth <0.2 s; TDL: Disclusion time to the left; the time from the maximum intercuspidation to obtain complete lack of the teeth contact in lateral movement to the left; reference value in patient with natural teeth <0.4 s; TDR: Disclusion time to the right; the time from the maximum intercuspidation to obtain complete lack of the teeth contact in lateral movement to the right; reference value in patient with natural teeth <0.4 s; NHP: Natural head position; µSv: micro-Sievert; kV: kilovolt; mA: miliampere; cm: centimeter; µm: micrometer; s: second; Hz: Hertz; C1-C2: Segment of atlas and axis; AOD: Atlantooccipital dislocation; RV: Reference value; TrP: Trigger point; VAS: Visual Analog Scale; CN V: Cranial nerve V, trigeminal nerve; OC-C1: Occiput and first vertebra junction.

Evaluation of Soft Tissue Mobilization in Patients with Temporomandibular Disorder-Myofascial Pain with Referral.

The aim of the study was functional evaluation of soft tissue mobilization in patients with temporomandibular disorder-myofascial pain with referral. The study group consisted of 50 individuals-37 females and 13 males. The average age was 23.36 ± 2.14 years. All subjects were diagnosed with myofascial pain with referral (diagnostic criteria for temporomandibular disorders). Soft tissue mobilization was applied three times. Electromyography of selected masticatory muscles was performed six times-before and after the treatment. After each mobilization, a decreasing tendency of muscular activity was observed in the entire study group. The Friedman test indicated that mobilization altered the activity of the right temporal muscle (p = 0.00010), both masseters (p = 0.0000), right sternocleidomastoid (p = 0.00251), left sternocleidomastoid (p = 0.00033), and right and left digastric muscles (p = 0.00045 and p = 0.00000, respectively). With respect to symmetry a statistically significant difference was noted in the case of the sternocleidomastoid muscles (p = 0.00729). In conclusion, soft tissue mobilization seems to be effective in the relaxation of masticatory muscles in patients with temporomandibular disorders. Our findings proved that soft tissue mobilization does not improve the symmetry and synergy of the masticatory muscles limited by dental occlusion.

Evaluation of calcium and magnesium contents in tooth enamel without any pathological changes: in vitro preliminary study.

Enamel is the structure that covers the entire clinical crown of a tooth. It enables to chew and crush food, and gives a final shape to the crowns of teeth. To evaluate calcium and magnesium contents in tooth enamel and analyse relationships between the study minerals extracted human permanent teeth were cut at every 150 microns and subjected into acid biopsy. The amounts of calcium and magnesium were assessed in the laboratory using atomic absorption spectroscopy with an air/acetylene flame. The lowest calcium and magnesium contents were found on the enamel surface of the teeth. Statistically significant correlation between the calcium and magnesium concentrations was found at a depth between 150 and 900 µm. Calcium and magnesium contents increased with increasing enamel depth. Calcium and magnesium deposits appeared to be stable through all the enamel layers studied. It would be suggested that mineralization/demineralization affect only external layer of the enamel, whereas deeper layers are not affected by these processes.

The evaluation of zinc and copper content in tooth enamel without any pathological changes - an in vitro study.

OBJECTIVES: The objectives of the study were to evaluate the content of copper and zinc in individual layers of tooth enamel and to analyze the relationships between the study minerals in individual layers of tooth enamel. PATIENTS AND METHODS: Fifteen human permanent teeth were cut off every 150 µm alongside the labial surface. Acid biopsy of each layer was performed. The zinc content was determined using the air-acetylene flame method. The copper content was determined using the electrothermal technique with argon. RESULTS: The mean zinc concentrations increased significantly starting from the outer enamel surface, with the maximum concentration in the 150-300 µm layer. The mean copper concentrations increased substantially from the outer enamel surface to a depth of 150 µm, and then a slight downward trend of this mineral levels was seen, down to a depth of 450 µm. Strong positive correlation was found between the zinc and copper concentrations at depths of 150-300, 450-600 and 600-750 µm. CONCLUSION: The levels of zinc and copper in the outer enamel layers may have an effect on the increased content of unipolar minerals at deeper enamel layers. The content of the study elements determined may reflect the process of mineralization and maturation of enamel in the pre-eruption period.

Relationship between depression and masticatory muscles function in a group of adolescents.

OBJECTIVE: The aim of the study is to determine association between depressive symptoms and the electrical activity of muscles in maximum voluntary clench in a group of young adults. METHODS: A total of 186 volunteers (Females = 98, Males = 88), with a mean age of 19 years, were recruited to the study. All participants took a questionnaire survey stating the level of depression (Beck's scale), clinical examination, and instrumental diagnostics (EMG). RESULTS: Symptoms of mild or medium depression were found in 35 of the subjects (18.82%). Average electric potentials of the masticatory muscles in maximal voluntary clench were significantly higher among the subjects with depression symptoms in comparison with subjects without those symptoms (85.96 ± 10.25 vs 78.97 ± 15.32, p < . 0.05). DISCUSSION: An increase in the electrical potentials of masseter muscles in maximal voluntary clench was found in the group with depression symptoms. The study should be continued to confirm this finding.

Alveolar ridge atrophy related to facial morphology in edentulous patients.

OBJECTIVES: The morphology of the alveolar process determines the retention and stability of prosthetic restorations, thereby determining the result of the therapy. Considering that the edentulous jaws may be affected by the atrophy process, it was hypothesized that the morphology of the alveolar process of the maxilla may be dependent on the anterior facial height and anatomy of the mandible. SUBJECTS AND METHODS: Twenty-five healthy edentulous Caucasian individuals were randomly chosen. Each subject underwent a lateral cephalogram before and after prosthetic rehabilitation. During exposition, newly made prostheses were placed in the patient's mouth. Teeth remained in maximal intercuspidation. Morphological parameters were evaluated according to the Ricketts, McNamara, and Tallgren's method. RESULTS: An inversely proportional association was observed between patient age and the distal part of the maxilla. A statistically significant connection was noted between the vertical dimension of alveolar ridge and anterior total and lower facial height conditioned by prosthetic rehabilitation. CONCLUSION: The height of the lateral part of the alveolar ridge of the maxilla remains in connection with the anterior total and lower facial height obtained in the course of prosthetic rehabilitation. The vertical dimension of the alveolar ridge of the maxilla seems to be in close relationship with the morphology of the lower jaw.

Salivary protective factors in patients suffering from decompensated type 2 diabetes.

PURPOSE: Defining the level of protective factors in saliva of patients suffering from decompensated type 2 diabetes. MATERIAL AND METHODS: 50 Patients with diagnosis of decompensated type 2 diabetes, including 32 women and 18 men at the age of 57.9±9.2 years. The control group consisted of 50 people among whom there were 38 women and 12 men whose average age was estimated at 51.2±9.9 years. RESULTS: It was stated the increased concentration of total protein by 60% and decreased concentration of IgA by 70%, of lysozyme by 27% and of lactoferrin by 40% in resting saliva of patients with type 2 diabetes if compared to the control group. These outcomes were really statistically meaningful. The evaluation of dependences between the analyzed protective factors and the indicator of oral cavity condition proved the positive correlation between the concentration of total protein and the number of DMFT (i.e. the rate of caries intensity). The remaining coefficients of correlation being evaluated proved to be negative and statistically meaningless. CONCLUSION: The obtained outcomes prove a high influence of proteins included in saliva on the prevalence and development of caries at patients with decompensated type 2 diabetes.

Immunohistochemical evaluation of oestrogen receptors α and ß in epithelium of the vaginal mucous membrane in women after oestrogen therapy.

Oestrogens act on target cells through α and ß receptors (ERα and ERß). Expression of oestrogen receptors is associated with the age and menopausal condition of women. The aim of the study was an immunohistochemical evaluation of ERα and ERß receptors in epithelium of the vaginal mucous membrane of women subjected to different forms of hormonal therapy (HTM). Oestrogen receptors ERα and ERß were identified using immunohistochemical methods and evaluated in smears of vaginal mucous membranes collected from 60 patients subjected to HTM (including 20 patients after oral therapy, 20 patients after transdermal therapy, and 20 patients after vaginal therapy). The results showed a significant change in immunoreactivity of both studied receptors after three months of hormone therapy. The biggest differences in the changes of intensity of ERα and ERß reactions were observed in patients subjected to vaginal therapy. Immunostaining for α receptor showed differences between three types of hormone therapy. The highest increase in the overall intensity occurred after three months of topical therapy. Immunostaining for Erß also varied for different types of hormone therapy. The results indicate that hormone therapy administered vaginally is the most effective in the treatment of urogenital ailments during menopause. In addition, topical therapy eliminates adverse effects of systemic oestrogen.

The influence of occlusal morphology on occlusion time.

OBJECTIVES: The aim of the study was to assess how the morphology of the occlusal surfaces of premolars and molars influenced the occlusion time in a mixed gender group of young adults with full natural dentition. METHODS: Fifty healthy volunteers with Angle's Class I occlusion were included in the study. After clinical examination, the alginate impressions of both arches were taken, and plaster casts were prepared. To assess the morphology of lateral teeth, the digital models were measured. Occlusal analysis was performed with the T-Scan® III to assess occlusion time. RESULTS: A direct correlation was found between the cusp distance for the first upper premolar and occlusion time (r = -0.29, p<0.05) and the distance between distal buccal and distal lingual cusps of the first lower premolar and occlusion time (r = 0.33, p<0.05). The parameters that had their impact on occlusion time were the opening angle of lingual cusps for the lower molars and the furrow angle of aperture between cusps for first upper premolar. DISCUSSION: Occlusal surface morphologies of premolars may have direct impact on occlusion time. However, anterior guidance parameters and morphologies of molars could also influence the time teeth are in contact coming to maximal intercuspation.

Pathologies of the oral cavity in patients with non-controlled diabetes type 1 and type 2--analysis of periodontal status and periodontal treatment needs.

INTRODUCTION: Decompensated diabetes is a major risk factor in the development of periodontal diseases. This leads to disturbances of carbohydrates, protein, and fat and morphological changes in many organs. These changes also apply to the masticatory system, especially periodontal tissues. The aim of the study was to assess the periodontal status and periodontal treatment needs in patients with non-controlled diabetes type 1 and type 2 (HbA1c > 7%), and to compare the results with the data obtained in a group of generally healthy patients. MATERIAL AND METHODS: The study included 275 patients, 155 of them were patients with non-controlled diabetes during hospitalisation (study group), while 120 subjects constituted the control group of healthy people. The study excluded edentulous people. CPITN index (according to Ainamo et al.) was used to assess the periodontal state and periodontal treatment needs. RESULTS: The average level of glycated haemoglobin HbA1C among patients in the study group was 9.43% in women and slightly more at 9.57% in men. The periodontal status in healthy people was satisfactory, dominated by the maximum values of CPITN = 0, CPITN = 1, and CPITN = 2. The study group more frequently revealed the maximum values of CPITN = 3 and CPITN = 4. This shows the more advanced periodontal changes in this group. Due to the bad condition of the periodontium, the periodontal treatment needs proved to be far greater in the study group and related primarily to comprehensive specialist treatment (TN3). CONCLUSIONS: Decompensated diabetes may be an important cause of changes in periodontal tissues and may cause a significant loss of masticatory function in patients.

Assessment of masticatory muscle activity and occlusion time in patients with advanced tooth wear.

OBJECTIVE: Tooth wear is a basic physiological adjustment mechanism in the masticatory system. Unfortunately, it is not clear what the relationship is between the activity of the masticatory muscles and the tooth hard tissue loss (mainly enamel) in patients with advanced tooth wear. The aims of this study were (1) to compare the occlusion times and (2) to compare the EMG activity in maximal voluntary clench of the masseter and anterior temporalis muscles of patients with advanced tooth wear to the same activity of healthy volunteers. DESIGN: 50 (16F, 34M) patients and 30 (12F, 18M) age matched controls were clinically examined to assess the degree of wear (TWI). Each subject underwent electromyographic analysis (bilateral anterior temporalis, superficial masseter, anterior digastric and sternocleidomastoid muscles) and digital occlusal analysis. RESULTS: Mean values of the electrical potentials of the mandible elevating muscles during clench were higher in the study group compared to the controls. A negative correlation was found between the temporalis and masseter muscle activities during clench and the mean value of TWI (r=-0.383, p=0.009; r=-0.447, p=0.002). Occlusion time was longer in the study group compared to controls (p<0.05). CONCLUSIONS: Mandibular adductors demonstrated lower muscular activities during clenching in the tooth wear patients; however, the cause of this finding is not certain. Prolongation of occlusion time may exacerbate occlusal surfaces wear or excessive wear may prolong occlusion time.

Effect of the dental arches morphology on the masticatory muscles activities in normal occlusion young adults.

OBJECTIVES: The aim of this study was to assess the relationship between the morphology of dental arches and the activity of the masticatory muscles activities in healthy volunteers with full natural dentition. METHODS: Two-hundred youthful Class I volunteers (113 females, 87 males) were clinically investigated. Alginate impressions of dental arches were taken, and plaster casts were prepared and measured. EMG data from eight masticatory muscles was recorded to assess their activities in central occlusion, lateral and protrusive movements. RESULTS: Clinical measurements and plaster casts analyses confirmed normal values of parameters investigated. Most of the arch measurements were significantly larger in the males than in the females. Weak positive correlations were found between overbite and masseter activity in centric occlusion (the right Mm R = 0.151, P ≤ 0.05; the left Mm R = 0.191, P ≤ 0.05). Also, the range of protrusive movement positively correlated with masseter activities in central occlusion (the right Mm R = 0.194, P ≤ 0.05; the left R = 0.201, P ≤ 0.05). CONCLUSIONS: The null hypothesis that morphology of dental arches does not affect the masticatory muscles' activities was rejected. The findings of this investigation indicate that systemic, longitudinal analyses of morphology of occlusion and muscular response, even in normal subjects, are needed.

The relationship between facial morphology and the structure of the alveolar part of the mandible in edentulous complete denture wearers. A preliminary study.

OBJECTIVE: Although the effect of involutional processes that occurs in the maxilla and mandible of edentulous subjects is obvious, the problem of factors definitely determining the direction of changes still remains unsolved. This study was aimed at determining the relationship between facial morphology and the structure of the alveolar part and the body of the mandible in edentulous complete denture wearers. MATERIALS AND METHODS: Twenty-five healthy edentulous Caucasian patients in the 70.5 ± 9 years of age group were examined. All patients underwent tele-X-ray examination with the presence of currently used dentures in the oral cavity. To assess morphological parameters of the facial skeleton, cephalograms were analyzed according to Ricketts and Mc Namara method. To assess the mandible morphology, the films were measured using the method of Tallgren. RESULTS: The period of edentulism was found to be negatively correlated with the anterior segment of the body of the mandible within its symphysis. The parameter corresponding to the location of the first lower molar showed a directly proportional correlation with G'-Sn', G'-Me', Sn'-Me', N-Ans, N-Me, Ans-Me, Co-Gn and Co-Go. Positive correlations were found between the parameters describing contour of the alveolar part of the body of the mandible and mandibular symphysis and G'-Me', Sn'-Me', N-Me, Ans-Me describing the height of the occlusal vertical dimension. CONCLUSION: The study showed a directly proportional correlation between the vertical occlusal dimension of the lower face conditioned by prosthetic rehabilitation and the height of the alveolar part in the lateral regions of the mandible.

Evaluation of estrogen receptor-ß expression in the epithelium of the oral mucosa in menopausal women under hormone replacement therapy.

PURPOSE: We aimed to evaluate the ERß expression in the epithelium of the oral mucosa in menopausal women treated with oral, transdermal or local (vaginal) menopausal hormone therapy. MATERIAL/METHODS: In this study, we included 60 women treated with oral, transdermal or vaginal menopausal hormone therapy. The study material was obtained from swabs taken from the buccal mucosa before administering HRT, and after 6 weeks, 3 months, 6 months and 12 months of therapy. We assessed estrogen receptor-ß (ERß) expression levels in subsequent swabs by immunohistochemical analysis. RESULTS: The highest increase in the ERß expression was observed after 3 months of oral and transdermal hormone therapy. CONCLUSIONS: Oral and transdermal HRT may be an effective method of treatment of oral discomfort in menopausal women.

Enamel mineral content in patients with severe tooth wear.

PURPOSE: The amounts of calcium (Ca), magnesium (Mg), zinc (Zn), and copper (Cu) in enamel may be crucial for maintaining its integrity and to attenuate potential environmental effects on teeth. The aim of this study was to examine whether the mineral composition of enamel could influence tooth wear. MATERIALS AND METHODS: A total of 50 patients with severe tooth wear were compared with 20 healthy volunteers. Tooth wear was assessed using clinical examination according to the protocol of Smith and Knight. Subsequently, the maxillary central incisors of each subject were subjected to acid biopsies to assess the mineral composition in the enamel. Atomic absorption spectroscopy with an air/acetylene flame was used to analyze for Ca, Zn, and Mg. Graphite furnace atomic absorption spectroscopy was used to analyze for Cu. RESULTS: The concentrations of Ca and Mg in tooth enamel were comparable in the study and control groups. Zn enamel content was higher in patients with tooth wear, and Cu enamel content was lower in these patients compared with the control group. CONCLUSION: The differing Zn and Cu contents in tooth enamel might offer a reason for excessive tooth wear in these patients. However, the results require further, more detailed study.

Morphological and Functional Parameters in Patients with Tooth Wear before and after Treatment.

UNLABELLED: Advanced tooth wear often results in lost vertical dimension and impacts facial aesthetics. Complex restorative treatment can replace the lost tooth structure and improve functional occlusal and facial skeleton parameters. PURPOSE: The aim of the study is to assess changes in the morphological and functional occlusal parameters of the facial skeleton after prosthetic rehabilitation that increased lost occlusal vertical dimension. MATERIAL AND METHODOLOGY: 50 patients with advanced tooth wear were clinically examined, to assess the degree of wear. Each subject underwent cephalometric analysis, digital occlusal analysis, and electromyographic analysis, of the anterior temporalis, superficial masetter, anterior digastric, and the sternocleidomastoid muscles. Prosthodontic treatment was performed to restore the occlusal vertical dimension of each subject's occlusion, which was followed by repeating the pretreatment analyses. Pre and post treatment parameters were statistically compared. RESULTS: Pre-treatment cephalometric analysis showed that lost vertical dimension reduced anterior facial height and resulted in small angular skeletal parameters. Post treatment anterior facial height increased from the increased occlusal vertical dimension. The mean value of functional electrical activity during clenching post treatment, increased compared to pretreatment. CONCLUSION: Increasing the vertical dimension of occlusion improved facial aesthetics by positively affecting facial skeletal angles. The restored occlusal surface morphology changed the pre treatment flat broad occlusal contacts into more point contacts. The increased vertical dimension of occlusion after treatment also increased muscle activity levels over the pretreatment levels after three months period of adaptation.

Dental malocclusion is associated with reduced systemic bone mineral density in adolescents.

There is no published data about associations between the state of dentition and bone mass in adolescents. The objective of this study was to investigate whether the prevalence of caries and dental malocclusion is associated with bone mass during growth. In 123 healthy Caucasian subjects (72 males, 51 females) aged 14-18 yr, DMFT figures (decayed teeth, missing teeth, filled teeth) and presence of malocclusion, according to Angle classification, were determined. Participants completed a questionnaire regarding dental hygiene, physical activity level, and consumption of sweets. Anthropometry and pubertal stages were examined. Bone mineral density (BMD) was examined using dual energy X-ray absorptiometry (DXA) in the total body, head, and lumbar spine. No association was found between DMFT (mean+/-SD: 8.33+/-3.9) and BMD or Z-scores for BMD. Malocclusion was found in 49 subjects (39.8%) and was more prevalent in females than males. Malocclusion was associated with lower total BMD independently of body size (p=0.001; Z-scores: -0.21+/-0.27 vs +0.33+/-0.17; p=0.1) in males (but not females), producing odds ratio 1.6 (95% confidence interval: 1.09-2.34%; p=0.02). Head BMD was also lower in the males with malocclusion than in those without (p=0.004). Neither caries nor the tooth loss appear to be associated with BMD during growth. Boys with malocclusion are at higher risk of reduced BMD. This suggests that inadequate bone mass accrual in males coexists with impaired growth of the masticatory system in childhood and adolescence, however, the causal pathway is unknown. Factors that produce malocclusion may also affect bone mass or size but further prospective studies are needed to evaluate the relationship.