Temporomandibular disorders, bite force and osseous changes of the temporomandibular joints in patients with hypermobile Ehlers‐Danlos syndrome compared to a healthy control group

Abstract

Background: Ehlers-Danlos syndrome (EDS) is a hereditary disorder that affects the connective tissue and collagen structures in the body characterised by joint hypermobility, skin hyperextensibility and tissue fragility. Objective:The aim was to investigate temporomandibular disorders (TMD), bite force, teeth in occlusal contact and osseous changes of the temporomandibular joints (TMJs) in 26 patients with hypermobile EDS (hEDS), differentiated by a genetic test, compared to 39 healthy controls. Methods: Clinical examination according to Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), radiological examinations of the TMJs by cone-beam-computed tomographic (CBCT) scans, registration of bite force and teeth in occlusal contact was performed. Statistical analyses included Fisher's Exact Test, multiple logistic and linear regression models adjusted for age, gender and Body Mass Index (BMI).Results: Single symptoms and signs of TMD occurred significantly more often in hEDS (p = .002; p = .001; p = .003; p = <.0001; p = .012) and maximum mouth opening was significantly smaller in hEDS compared to controls (p = <.0001). The DC/TMD diagnosis myalgia, myofascial pain with referral, arthralgia, headache attributed to TMD, disc displacement disorders and degenerative joint disease occurred significantly more often in hEDS compared to controls (p = .000; p = .008; p = .003; p = .000; p = <.0001; p = .010, respectively). No significant differences were found in bite force and in teeth in occlusal contact between the groups (p > .05). On CBCT of the TMJs, subcortical sclerosis occurred significantly more often in hEDS compared to controls (p = .005). Conclusion:Symptoms and signs of TMD and osseous changes of the TMJs occurred significantly more often in hEDS. Bite force and teeth in occlusal contact were comparable to controls.

Temporomandibular disorders among Ehlers-Danlos syndromes: a narrative review

“…29 In a casecontrol study, individuals with hEDS had reduced pain-free mouth opening and a reduced maximum opening compared with controls. 7 In contrast, a single patient diagnosed with dermatosparaxis EDS exhibited limited horizontal movements and had an increased mouth opening of more than 50 mm; 36 compared with the mean maximum mouth opening of an adult male of 44.2 mm or an adult female of 40.29 mm without EDS in the Turkish population. 37…”

“…6 These findings align with comparable research, which presented a higher prevalence of orofacial pain based on DC/TMD in hEDS patients compared with controls. 7 In a large case-control study, 62% of patients diagnosed with hEDS/Hypermobile Spectrum Disorder (HSD) exhibited TMJ pain. 26 They also examined possible links between fibromyalgia and hEDS/HSD by comparing the symptoms reported among patients.…”

“…A case–control study presented a higher prevalence (myalgia: 5 versus 0; arthralgia: 5 versus 0; headache attributed to TMD: 13 versus 0) of TMD diagnoses based on DC/TMD among hEDS ( n = 26) compared with the control group. 7 A recent systematic review based on 12 included studies estimated the mean prevalence of TMD manifestations in EDS patients at approximately 65% (range, 26.6–100%), with hEDS being most commonly affected. 24 Our review highlights a major shortcoming of the current literature on TMD in EDS, namely the use of a variety of methods to assess TMD.…”

“…Based on the existing literature, TMD among EDS has been assessed by a few studies and without considering the heterogeneity of EDS. 4,7–9 However, the classification of EDS was changed considerably in 2017, and apart from hEDS, 10 other subtypes are considered as rare diseases. In the past, the different subtypes have often been studied collectively.…”

A pilot investigation of condylar position and asymmetry in patients with unilateral posterior scissors-bite malocclusion based on three-dimensional reconstructive imaging technique

“…It outgrows multi-directionally and has the capacity of adaptive remodeling. When the TMJ is subjected to abnormal bite force or long-term physical stress exceeds its own adaptive capacity, the condyle will undergo functional remodeling, leading to morphological changes and ultimately affecting the condylar size [ 8 ]. This adaptability is of great importance, since the condyle can be modified by persistent anomalous occlusal contact.…”