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ORIGINAL RESEARCH
Year : 2023 | Volume
: 14
| Issue : 1 | Page : 7-9
Clinical evaluation of the pain predictors among temporomandibular joint disorders patients with full dentition and free-end extensions: An Analytical Cross-Sectional Study
Ahmed Adel Othman1, Fawaz Aswad2
1 Oral Medicine Department, Uruk University, Baghdad, Iraq
2 Oral Medicine Department, University of Baghdad, Baghdad, Iraq
Correspondence Address:
Ahmed Adel Othman
University of Uruk/College of Dentistry, Baghdad
Iraq
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/denthyp.denthyp_170_22
Introduction: We aimed to evaluate the possible role of the age, occlusion type, type of dentition (full dentition or free-end extensions), and type of temporomandibular disorders (TMD) to predict the presence of pain. Methods: Subjects were selected from volunteer male TMD patients with one partially edentulous jaw from the Baghdad city in 2022. Pain was assessed via the Visual Analogue Scale (VAS). Angle’s and Kennedy’s classifications were employed to assess occlusion and partially edentulous jaw conditions. TMD was assessed using Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications. Relationship between pain as ordinal dependent variable and other predictor variables was assessed via ordinal logistic regression using SPSS 26. Results: 240 subjects were assessed for eligibility and 180 TMD patients (mean age 41.1 ± 0.46) were included in the study. The omnibus test showed that the model outperforms the null model (p < 0.001). Disc displacement with reduction (odds ratio: 0.09) and Kennedy’s Class I (odds ratio: 0.42) were statistically significant inverse predictors for pain (p < 0.05). Age (p = 0.66) and Angle’s occlusion type (p = 0.91) were not significant predictors for pain. Conclusion: Probability of pain decreased in disc displacement with reduction and Kennedy’s Class I.
Keywords: logistic regression, occlusion, orofacial pain, pain, temporomandibular disorders, temporomandibular joint
Temporomandibular joint (TMJ) is a bilateral synovial dynamic articulation act between the squamous region of the temporal bone of the skull above and condylar process of the mandible below; from these bones the name of TMJ is derived, the articular disc is located in the space between those two bones. This joint is unique in its shape, structural characteristics, and that it is a bilateral joint that functions as one piece.
Temporomandibular joint disorder (TMD) is a complex disease process caused by various factors, including muscle dysfunction or overactivity genetic, and traumatic injuries. Additionally, hormonal changes, as well as articular alterations, can contribute to the development of TMD. TMD affects 5% to 12% of the US population and costs American businesses an estimated $4 billion annually.[1] Several treatments are suggested in the literature for TMD including cognitive behavior therapy, physical therapy, occlusal devices, nonsteroidal anti-inflammatory drugs, benzodiazepines or antidepressants (for chronic cases), and injection of hyaluronic acid and platelet-rich plasma.[2],[3],[4],[5]
A review of 2419 articles stated that there is still much debate surrounding the interaction between occlusion and TMD.[6]
A recent meta-analysis reported the overall prevalence for TMD: 31.1% and disk displacements: 19.1% among adults and elderlies.[7] Pain is one of the main overwhelming symptoms for which patients with TMD seek treatment. Alkhubaizi Q and Khalaf ME reported the prevalence of TMD-associated pain was 26.8%.[8] Al-Khotani A et al. showed prevalence of pain among TMD patients was 15%.[9]
However, the aim of this study was to evaluate the possible role of the age, occlusion type, type of dentition (full dentition or free-end extensions), and type of TMD to predict the presence of pain.
Materials and methodsStudy protocol was approved by research ethics committee of the college of dentistry, University of Baghdad on December 27, 2021 (Ref. number 432).
Considering alpha error probability of 0.05, power of 0.90, effect size of 0.3, and difference of 4, a sample size of 174 was needed. Subjects were selected from volunteer male TMD patients with one partially edentulous jaw from the Baghdad city in 2022. All subjects signed informed consent. The inclusion criteria were: 1) Healthy subjects without history or signs and symptoms of any systemic disorders.[10],[11] 2) Subjects with pain in mastication muscles and/or pain with clicking with/or without limitation of mouth opening. 3) Subjects not taking any analgesic or anti-inflammatory medications. Exclusion criteria were: 1) Female patients (to avoid bias related to changes of the estrogen levels during menstrual cycle and its effect on pain).[12] 2) Patients with bridges, partial dentures, and mobile teeth. 3) Patients with neoplastic disease, parathyroid gland disease, endocrine disorders, rheumatoid arthritis, and developmental disorders of the TMJ, such as condylar aplasia, hypoplasia, or hyperplasia.
Pain was assessed via the Visual Analogue Scale (VAS). Angle’s and Kennedy’s classifications were employed to assess occlusion and partially edentulous jaw conditions.[11] TMD was assessed using Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications[13] and classified as: 1) Disc displacement (DD) with reduction. 2) DD with reduction with intermittent locking. 3) DD without reduction with limited opening. 4) DD without reduction without limited opening. 5) Myofascial pain dysfunction syndrome.
Relationship between pain as ordinal dependent variable and other predictor variables was assessed via ordinal logistic regression using SPSS 26 (IBM Corp., Armonk, NY). Sample size was determined using Gpower (http://www.gpower.hhu.de/).
ResultsTwo hundred and forty subjects were assessed for eligibility and 180 TMD patients were included in the study. All 180 participants (mean age 41.1 ± 0.46) completed the study and were included in the analysis. The omnibus test showed that the model outperforms the null model (p < 0.001). DD with reduction and Kennedy’s Class I were statistically significant inverse predictors for pain [TABLE 1].
TABLE 1 Results of Ordinal Logistic Regression Evaluating Pain Predictor Parameters Discussion Results of this study showed DD with reduction and Kennedy’s Class I were significant inverse predictors for pain. Age and Angle’s occlusion type were not significant predictors for pain.
PubMed search with the query "temporomandibular joint disorders" AND "pain" on Jan 25,2023 showed the number of articles is growing fast (y = 5.3659x − 10527, R2 = 0.8598, y: article number, x: year). Yet, to our knowledge assessment of pain predictors among TMD patients was rarely reported in the literatures.
Alkhubaizi Q and Khalaf ME reported that the TMD patients with pain were varied remarkably on the depression scale and Bodily pain scores in compression with control group.[8] Osiewicz M et al. showed a significant relationship between TMD ache and depression (odds ratio: 2.9) and nonsignificant relationship with gender, age, bruxism, somatization, and chronic pain-related impairment.[14] Choi YS et al. reported experience of injury in TMJ was found to be associated with pain in the joint region.[15] Jordani PC et al. reported obesity and sedentarism were not connected with the presence of pain in TMD adult patients.[16] Al-Khotani A et al. showed in children and adolescents, the TMD-related pain appears to have an association with emotional, behavioral and somatic functions, with higher frequencies of anguish, depression, somatic issues, aggressive behavior, and thought complications.[17]
However, readers must be noted to inherent limitations of cross-sectional study, such as the inability to make a causal inference and lack of follow-up. Study sample in this study is limited to a city. Large-scale, multicentral studies are needed to reach a more reliable conclusion.
As a suggestion for future researches, conduction of systematic review and meta-analysis to summarize results of studies regarding prevalence of pain among TMD patients is encouraged.
Financial support and sponsorship
Nil.
Conflict of Interest
The authors declare that there was no conflict of interest regarding this research.
References
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