Sex hormones in association with general joint laxity and hypermobility in the temporomandibular joint in adolescents—results of the epidemiologic LIFE child study

Abstract

Objectives:The aim of this cross-sectional study was to investigate whether sex hormones (testosterone, oestradiol, sex-hormone-binding globulin = SHBG) are associated with general joint laxity (GJL) and hypermobility or derangements of the temporomandibular joint (TMJ) in adolescents. Methods:Within the LIFE Child study, 970 adolescents (10-18 years) were included.GJL was assessed using the Beighton test. Maximum mouth opening (MMO) and clinical clicking sounds as signs of disc displacement (DD) in the TMJ were assessed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD).Serum levels of sex hormones were assessed using standardised laboratory analyses.Results: Hypermobile joints were found in 54.9% (N = 532) of the sample; females were more affected than males (61.4% vs. 51.8%, P < 0.001). Using logistic regression analyses, the odds ratio (OR) for having >1 hypermobile joints increased to 1.15 (95% confidence interval [CI]: 1.04-1.27) in males and 1.09 (95% CI: 1.02-1.17) in females per 10 units of the SHBG serum level, compared to those without hypermobile joints-after controlling for the effect of age, adjusted BMI, pubertal development (Tanner scale), testosterone as well as oestradiol levels. Female subjects with >1 hypermobile joints showed a higher OR (1.89; 95% CI: 1.05-3.43) for having clinical clicking sounds in the TMJ and a 3.28 times higher OR (95% CI: 1.44-7.44) for MMO ≥ 55 mm. Conclusions:We observed age-and gender-independent associations of higher SHBG serum levels with GJL in adolescents. Moreover, hypermobile female adolescents show a more frequent hypermobility of the TMJ and clinical signs of DD. K E Y W O R D Sadolescents, general joint laxity, hypermobility, sex hormones, temporomandibular disorders

Relationship between Age-Dependent Body Constitution and Temporomandibular Joint Sounds in Adolescents

“…This part of the study was approved by the local Ethical Committee (354-10-13122010). For statistical purposes, all reproducible TMJ sounds during vertical and excursive jaw movements were summarized as clinical TMJ sounds [11]. Moreover, the TMJ sounds were separately analyzed, for clicking sounds on the one hand and for crepitus on the other.…”

“…A positive value is comparable to a relatively tall or heavy, and a negative value to a short or thin adolescent, respectively [17]. The Beighton classification was utilized to identify GJL, and it included the examination of nine joints [11,18]. For statistical analysis (SPSS 24, IBM, Armonk, NY, USA), a normal distribution was observed for SDS height values (Shapiro-Wilk test: p = 0.132), while age, SDS weight values, and the number of hypermobile joints were not normally distributed (Shapiro-Wilk tests: p ≤ 0.001).…”

“…The latter can be induced by a general joint laxity, which is very common in younger patients, and was observed as generalized hypermobility (≥4 joints) in 21.3% of the 10-to 18-year-olds. This mobility usually decreases during pubertal development, however less in girls than in boys, which can be explained by hormonal effects [11]. In most cases, TMJ sounds affect adolescents only minimally, but if painful, the TMJ should be treated, since an impaired oral health-related quality of life and limitations of the jaw movements can occur [12,13].…”

Topography and evidence of a separate “fascia plate” for the femoral nerve inside the iliopsoas – A dorsal approach

“…These changes could occur after a trauma or in diseases like diabetic neuropathy, or even after hormonal changes (Goodman, 1954). The correlation of sex hormones to laxity is also recently described (Graf et al, 2019). Such connective changes to the FN fascia plate may also be related (cause and effect) to insufficient blood flow, which, as Kobayashi's group stated for the FNST, correlates to femoral pain (Kobayashi et al, 2003).…”

Imaging of the temporomandibular joint - contemporary clinical and radiological implications

“…Hypermobility of the condyle is defined as the condyle motion of more than 120° anterior and superior to the eminence crest [42]. This condition occurs with the elongation of the posterior attachments, sphenomandibular and stylomandibular ligaments, in early cases of internal derangement of the TMJ or in Ehlers-Danlos syndrome [43]. If the condyle returns to the anatomical position with closed jaw, it is manifested as subluxation, but if it remains in the pathological place, it is considered dislocation (open lock).…”