Predictive Value of Combined Clinically Diagnosed Bruxism and Occlusal Features For TMJ Pain

Abstract

Several works showed a decreased role for occlusion in the etiology of temporomandibular disorders (TMD). Nonetheless, it may be hypothesized that occlusion acts as a modulator through which bruxism activities may cause damage to the stomatognathic structures. To test this hypothesis, a logistic regression model was created with the inclusion of clinically diagnosed bruxism and eight occlusal features as potential predictors for temporomandibular joint (TMJ) pain in a sample of 276 consecutive TMD patients. The final logit showed that the percentage of the total log likelihood for TMJ pain explained by the significant factors was small and amounted to 13.2%, with unacceptable levels of sensitivity (16.4%). The parameters overbite > or = 4 mm combined with clinically diagnosed bruxism [OR (odds ratio) 4.62], overjet > or = 5 mm (OR 2.83), and asymmetrical molar relationship combined with clinically diagnosed bruxism (OR 2.77) were those with the highest odds for disease, even though none of those values was significant with respect to confidence intervals. Thus, the hypothesis under evaluation has to be rejected. It is possible that future studies with a higher discriminatory power for the different bruxism activities might be indicated to get deeper into the analysis of the potential mechanisms through which occlusion may play a role, even if small, in the etiology of the different TMD.

Occlusal Grinding Pattern during Sleep Bruxism and Temporomandibular Disorder

“…Inklinasi permukaan lingual gigi kaninus yang curam menyebabkan pasien akan semakin nyaman dalam menggeretak sehingga tonjol gigi kaninus menjadi lebih datar atau disebut juga dengan faset. 18,19,[21][22][23] Selain itu pada saat bruxism, posisi rahang bawah juga cenderung miring pada pergerakan ke lateral, sehingga tonjol bukal gigi bawah selalu berkontak kuat dengan groove gigi rahang atas, sementara itu tonjol lingual gigi bawah tidak berkontak dengan tonjol lingual gigi atas. Hal ini yang menyebabkan faset lebih banyak terbentuk pada inklinasi tonjol bukal rahang atas.…”

“…Salah satu keuntungan dari BruxChecker adalah alat ini sangat tipis (tebalnya hanya 0.1mm), sehingga bisa dipastikan tidak menimbulkan gangguan terhadap oklusi atau pergerakan mandibula dan tidak menimbulkan aktivitas otot mastikasi berlebihan yang tidak diinginkan. 18,19,[21][22][23] BruxChecker memberikan visualisasi yang jelas adanya gangguan yang terjadi selama sleep bruxism berupa pola grinding oklusal secara individual. Pemeriksaan pola grinding oklusal selama bruxism sangat penting dan sebaiknya dilakukan pada penegakan diagnosis oklusi agar dapat disusun rencana perawatan yang tepat bagi setiap pasien.…”

“…subjek yang memiliki gejala TMD, hubungan rahang bawah relatif lebih ke posterior terhadap rahang atas dan arah gerakannya latero-retrusif. [21][22][23][24][25][26] Faset yang terbentuk pada gigi premolar dapat disebabkan adanya kontak prematur pada posisi relasi sentrik. Hal tersebut dikarenakan posisi dan lokasi gigi premolar di lengkung rahang terletak pada titik fulkrum.…”

Dental malocclusion is not related to temporomandibular joint clicking: a logistic regression analysis in a patient population

“…The following occlusal features were also accurately recorded for each patient, based on protocols adopted in previous studies 10,14,19 : (1) posterior crossbite recorded when the buccal cusps of any of the maxillary premolars and molars totally occluded lingually to the buccal cusps of the antagonist mandibular teeth; (2) overbite recorded as normal if the maxillary central incisors overlapped the crown of the mandibular central incisors for up to 3 mm, normal as ,4, and increased when $4 mm; (3) open bite recorded when no overlap was seen between the maxillary and mandibular incisors, including an edge-to-edge relationship; (4) overjet defined as the horizontal distance between the labial surface of the anterior upper maxillary and the anterior mandibular central incisor, parallel to the occlusal plane (overjet values ,5 mm were considered normal and values $5 mm were considered increased); (5) mediotrusive and (6) laterotrusive interferences within the first millimeters of the lateral excursions identified by 40-mm thick articulating paper (Baush Dental KG, Kö ln Germany); and (7) retruded contact position to maximum intercuspation (RCP-MI) slide length calculated in the three spatial axes after manual mandibular distraction. The RCP-MI slide values ,2 mm were considered normal and present when $2 mm.…”

“…7 In this regard, multiple variable models have shown that the various dental malocclusion features have much lower importance than believed in the past to explain, among the others, the presence of TMJ inflammatory-degenerative disorders, 8 myofascial pain of jaw muscles, 9 and pain in the TMJ. 10 Notwithstanding that there are still some claims that malocclusion traits may be associated with the onset of temporomandibular disorders, there are still some issues to be clarified. 11,12 In particular, it must be pointed out that the role of dental occlusion cannot be considered negligible because it may determine the patterns of load distribution on the temporomandibular joints, thus acting as a factor that could influence the overall resistance of the musculoskeletal system.…”