Prevalence of temporomandibular disorders in a population of complete denture wearers

doi: 10.1111/j.1741‐2358.2011.00574.x
Prevalence of temporomandibular disorders in a population of complete denture wearers Background: Complete tooth loss among the elderly is still frequent in developing countries and the incidence of temporomandibular disorders (TMD) is a common finding in complete denture wearers. Objectives: The aim of this study was to evaluate the prevalence of temporomandibular disorders (TMD) in a population of complete denture wearers. Materials and Methods: The data were collected by four examiners for the diagnosis of use and need for complete dentures followed by the World Health Organization standards and interviews for TMD signs and symptoms evaluation. Exploratory variables included demographic, socio‐economic status and TMD prevalence. Results: The prevalence of TMD among denture wearers was 55.12%. Chi‐squared test showed no statistical difference between subjects with or without TMD for gender, geographical location and skin colour (p < 0.05). The number of subjects with TMD increased as the period of complete denture wear increased, although no statistical difference between groups were found (p < 0.05). Conclusions: There is a need of educational programmes aiming at the importance of health care and periodical change of a complete denture, and strategies with a preventive approach to quality general dental care.     

Nocturnal masseter electromyographic activity of complete denture wearers

doi: 10.1111/j.1741‐2358.2011.00528.x Nocturnal masseter electromyographic activity of complete denture wearers Objective: Collection of normative data on activity patterns of the masseter during sleep in elderly denture wearers by portable electromyography (EMG) recorders. Background: Complete denture wearers might suffer from orofacial pain caused by myoarthropathies of the masticatory system. Indeed, denture instability may precipitate parafunctional habits and consequently muscle soreness and/or temporomandibular pain. Materials and methods: We collected normative masseter EMG data during sleep in 15 complete denture wearers (five women, 10 men, 56–88 years) by portable recorders in their natural environment. Activity periods (AP) were signal portions including subthreshold intervals ≤5 s. Signal amplitude was expressed in per cent of maximum voluntary contraction (%MVC). For this reason, maximum bite force was assessed. Twenty age‐matched dentate controls were also recorded for the maximum bite force. Results: We found 157.2 ± 86.5 AP per night, i.e. 24.0 ± 12.2 AP/h. Mean amplitude was 15.1 ± 4.3%MVC. AP lasted 6.8 ± 4.1 s, and their time integral was 126.3 ± 112.5%MVC?s. Maximum bite force was 116.8 ± 69.6 N in the edentulous, significantly lower than in controls (344.8 ± 150.4 N). Conclusions: Healthy complete denture wearers showed intermittent periods of nocturnal masseter activity of very low intensity and short duration.     

Electromyographic evaluation of masseter and anterior temporalis muscles in rest position of edentulous patients with temporomandibular disorders, before and after using complete dentures with sliding plates

Objectives: This study was performed with the purpose of investigating electromyographic (EMG) activity of the anterior temporalis and masseter muscles in edentulous individuals with temporomandibular disorder (TMD), before and after using sliding plates on complete dentures in the mandibular rest position. Background: Edentulous patients may present TMD, which is characterised by pain in temporomandibular joints, masticatory and neck muscles, uncoordinated and limited mandible movements, joint sounds and an altered occlusal relationship. It is imperative to offer treatment in order to re‐establish stomatognathic system structures before submitting the individual to any definitive restorative treatment. Materials and methods: The patients were edentulous for at least 10 years. EMG recordings were made before the insertion of the dentures (0 months) and also after using the sliding plates at the fourth month, 9th month and 12th month, using computerised electromyography K6‐I/ EMG Light Channel Surface. EMG evaluations of the muscles were performed under the following clinical conditions: rest position with dentures (R1), rest position without dentures (R2), rest position with dentures post‐activity (chewing) (R3), rest position without dentures post‐activity (chewing) (R4). Results: All patients obtained remission of muscular fatigue and reduced pain in stomatognathic system structures. Temporalis muscle showed significant increase in EMG activity compared with initial values (p < 0.01). Masseter muscles showed significantly lower mean values (p < 0.01) compared with initial values. Conclusion: The sliding plates allowed the process of neuromuscular deprogramming, contributing to muscular balance of the masticatory system, and are therefore indicated to be used before the fabrication of definitive complete dentures in patients with TMD.     

A Review of the Prevalence of Temporomandibular Dysfunction

The prevalence of five representative signs and symptoms of temporomandibular pain and dysfunction were evaluated with respect to the age of several different populations. For each of the five signs and symptoms (mouth opening, joint noises, presence of degenerative joint disease, subjectively reported symptoms, and pain on function) no increase was found in the older age group over the middle-age group. In one category (joint sounds), the prevalence decreased in the older age group when compared to the middle-age group. When asked by questionnaire if there was pain on function, the oldest age groups had the lowest proportion of positive responses. As a result of this information it is suggested that the prevalence of temporomandibular disorders diminishes in the elderly population, although not as much as the very few numbers of elderly actually seeking treatment for this disease would suggest.     

Oral function in dentate elderly with reduced dentitions

This study covers the characteristics of reduced dentitions in a population of elderly people. The sample consisted of 329 independently living individuals between 55 and 75 years of age. They all had one or more natural teeth and were all interviewed and investigated clinically. The findings showed that 13% of the subjects had a natural dentition with at least the first molars: 4–7 natural occlusal units (defined as ‘pairs of opposing teeth that support the occlusion’) occurred in 37% of the subjects; 1–4 natural occlusal units in 41% and 0 units in 9% (only anterior contacts). A removable partial denture was worn by 39% of the subjects: most of them were acrylic based dentures (61%). The percentages of restored teeth per subject were high. The need for further restorations, however, was low. Periodontal problems were uncommon: 25% of the subjects had one pocket above 5 mm: 8% had severe problems. Poor oral hygiene was present in a quarter of the cases. Most of the subjects (70%) had no pain or noises in the temporomandibular joint. Only 10% of subjects had more than one sign of craniomandibular dysfunction. Most of the subjects (85%) visit their dentist regularly and 65% had their last tooth extraction more then three years ago. A majority mentioned that they have never had problems with their dentition in the past: 50% had had no real toothache for the last five years. However problems with food-packing were often mentioned. It can be concluded that, although the dentitions of the elderly in this population are often reduced, their dentitions are in general in good condition and few give TMJ problems.     

Study of temporomandibular joint disorder in older patients by magnetic resonance imaging

doi: 10.1111/j.1741‐2358.2011.00552.x Study of temporomandibular joint disorder in older patients by magnetic resonance imaging (MRI) Objectives: To compare characteristics in older patients in a sample of the general population of those with temporomandibular joint disorder (TMJD). Materials and methods: A prospective study was carried out between 2001 and 2008 in patients with TMJD. The whole sample consisted of 141 patients divided in two groups: 31 patients aged over 60 (median age 67.9, ranging from 60 to 82) and the remaining 110 patients (median age 36.3, ranging from 12 to 59) who were seeking treatment. Clinical diagnostics was confirmed by MRI. Pain intensity was rated on a visual analogue scale (VAS 0‐10). Results: There was no statistical difference between average pain in older patients (6.2) and patients aged up to 59 (5.7) evaluated by VAS. There was a statistically significant difference (p = 0.002) in pain duration: older patients reported shorter duration of experienced pain (7.8 months) than patients aged up to 59 (12.2 months). Conclusion: In this study, it was found that 22% were older patients with TMJD. A higher level of anxiety was shown in both patients’ groups, regardless of shorter pain experience in the older patients.     

Use of a mandibular advancement device in patients with congestive heart failure and sleep apnoea

Objective: To evaluate the practical use of the mandibular advancement device (MAD) for treatment of sleep apnoea (SA) in patients with congestive heart failure (CHF) over 1 year. Subjects: Twenty‐five patients aged 66 ± 8 years (mean ± SD) met the inclusion criteria and were included in the study. Design: In a prospective, clinical trial, the apnoea‐hypopnoea index (AHI), a measure of SA, was determined with a portable device. Failure to enter treatment and compliance, adverse events and signs and symptoms of temporomandibular disorders (TMD) were examined before intervention and 4–6 weeks, 6 months, and 1 year after intervention. Results: Six patients had removable dentures of whom four had complete dentures. Before treatment, eight patients reported minor symptoms of TMD. The AHI fell from 19.3 ± 12.1 to 11.8 ± 9.5 (p = 0.004) with use of the device. In most patients, use of the MAD had no severe effects on the signs and symptoms of TMD. Adverse events such as pain in the temporomandibular joints, soreness in the teeth, and tiredness in the jaws were reported by 10 patients. Dental complications were observed in two patients. Sixty‐four per cent of the patients were still using the MAD at the 1‐year follow‐up. Conclusions: Both the general and oral health of CHF patients were important in treatment with a MAD. The MAD therapy had no severe effect on the masticatory system and edentulous patients could be treated.     

Validation of communication between elderly denture wearers and dentists: a questionnaire on satisfaction with complete dentures using semi-structured interviews

Objectives: To validate a semi‐structured interview (SSI) for communication between complete denture wearers and dentists. Design: A SSI using a questionnaire with eight questions on satisfaction with complete dentures (CD): covering function, aesthetics and comfort. The first seven questions used a five‐point Likert scale and the last was dichotomous. Two dentists, carefully trained in the use of the structured questionnaire, administered the SSI. Setting: A Greek Department of Prosthetic Dentistry. Subjects: A consecutive sample of 78 CD wearers took part in the study. All subjects presented with complaints from their dentures. Intervention: All participants and their dentures underwent clinical examination. Results: The method showed good reliability, verified by the Cronbach alpha (0.86). Both dentists used the questionnaire produced very similar results. (Wilcoxon test 61–99%). Further, the association of the answers with respect to the five‐point Likert scale was very high; all gamma coefficients were statistically significant except for pain and discomfort from the upper CD (CDU). Conclusions: This method of communication between patients and dentists is reliable and can be used to give good repeatability for qualitatively assessing satisfaction with CD. It can be valuable for clinical use and for extending the study of denture quality to establish outcome measures based on the subjective criteria of satisfaction.     

Nutritional status, dietary intake and oral quality of life in elderly complete denture wearers

doi: 10.1111/j.1741‐2358.2011.00545.x Nutritional status, dietary intake and oral quality of life in elderly complete denture wearers Background and objective: The prevalence of malnutrition increases with age because of many factors. Edentulousness leads to the avoidance of many types of foods. The aim of this study was to determine whether elderly complete denture wearers have a higher risk of malnutrition than dentate controls. Material and methods: A Mini‐Nutritional Assessment (MNA) and a 3‐day dietary record were compiled for a group of fully dentates (21 women and 29 men; mean age 70.1 ± 6.1) and for a group of complete denture wearers (31 women and 16 men; mean age 70.1 ± 8.1). Socio‐demographic data and scores on the General Oral Health Assessment Index (GOHAI) questionnaire were collected. Results: Inter‐group comparison of MNA scores showed that more subjects in the edentulous group (21.3%) risked malnutrition than in the dentate group (0%). The variability of the MNA could be explained for 22% by dental status, 7% by loneliness and 4% by the GOHAI score (regression analysis). Both groups had insufficient energy intakes and deficits in vitamins and micronutrients; moreover, edentulous subjects had lower intakes than dentate subjects. Conclusion: The use of conventional dentures increases the risk of malnutrition in the elderly.     

TMD and GOHAI indices of Brazilian institutionalised and community-dwelling elderly

Rationale and objectives: Considering the controversy in the literature regarding several aspects of temporomandibular dysfunction (TMD) in elderly populations and the absence of reliable data on elderly Brazilians in this field, this study consisted of an evaluation of TMD prevalence and the self‐perception of oral health among institutionalised and community‐dwelling elderly in São José dos Campos, Brazil. Methods: Two hundred and fifteen community‐dwelling and 185 institutionalised elderly people were evaluated by the Helkimo anamnestic (Ai) and clinical dysfunction (Di) indices and answered a questionnaire using the Geriatric Oral Health Assessment Index (GOHAI). Results: The major prevalence of TMD symptoms was for the Ai0 (symptom‐free) group (69.5%), while the major prevalence of clinical signs was for the DiI (mild) group (56%). Women presented a higher AiII classification than men (χ² test, p = 0.049). Community‐dwelling elderly presented a significantly lower Ai0 classification than the institutionalised ones (Two ratios equality test, p < 0.001). There was no relationship between the institutionalised status and the clinical dysfunction index for Di0 and DiIII classification (Two ratios equality test, p = 0.194 and 0.535 respectively). The institutionalised elderly presented greater (One‐way anova = 0.005) self‐perception of oral health (33.45) than did the community‐dwelling group (32.66). There were only weak Pearson’s correlations among the anamnestic (?33.0%) or clinical (?14.7%) findings by the TMD and GOHAI indices. Symptom‐free (Ai0) institutionalised elderly presented better scores in all GOHAI dimensions and elderly representing an absence of clinical TMD signs (Di0) presented higher GOHAI physical dimension scores in both groups. Conclusions: The prevalence of TMD symptoms among this sample of elderly individuals was relatively low, self‐perception of oral health was reasonable and a weak, inverse correlation was found between TMD signs and symptoms and elderly self‐perception of oral health measured by the GOHAI index.     

Elderly complete denture wearers: a social approach to tooth loss

doi: 10.1111/j.1741‐2358.2011.00550.x Elderly complete denture wearers: a social approach to tooth loss Objectives: To correlate emotional reactions to tooth loss with denture satisfaction attributes in elderly complete denture wearers. Background: Total tooth loss is a serious life event, and poor oral health has an impact on daily life. Edentulism treated by rehabilitation with dentures can have a positive effect on patients’ self‐image and social behaviour. Methods: A group of 80 edentulous subjects undergoing routine prosthetic care in a Greek Department of Prosthetic Dentistry were interviewed using two structured questionnaires. The first questionnaire explored reactions to tooth loss, whereas the second measured their subjective experience of complete dentures. The responses to both questionnaires were compared using the statistical package spss v.17. Results: The results showed significant correlation between aspects of tooth loss experience and complete denture satisfaction. Despite the fact that a substantial proportion of patients were satisfied with their complete dentures, some patients experienced increased social and psychological problems related to their edentulousness and the wearing of complete dentures. The aesthetic and functional aspects of complete dentures affected both patients’ social behaviour and self‐confidence. Conclusions: Total tooth loss was not only reflected in patient’s social behaviour and self‐image, but it had a complex and multifaceted impact on satisfaction from complete dentures.     

Tooth loss, the wearing of dentures and associated factors in Sri Lankan older individuals

Objective: To determine tooth loss, wearing of dentures and associated factors in older individuals from Sri Lanka. Design: A cross‐sectional survey where the data were collected by means of an oral examination and an interviewer administered questionnaire. Setting: Negambo within the Gampaha district of Sri Lanka. Subjects: A total of 630 subjects who were aged 60 years and above. Results: Only 11 subjects had all 32 teeth and 17% were edentulous. Age, gender and level of income were significantly associated with the number of missing teeth. Of those with missing teeth, 22% wore dentures. Only 16% of the non‐denture wearers perceived a need for dentures. Among the non‐denture wearers who perceived a need for dentures, a majority had cited ‘cost’ as the main barrier for obtaining dentures. Logistic regression analysis revealed that age, gender, levels of income and education and missing teeth were significant predictors of wearing of dentures. Conclusions: Knowledge of factors that influence tooth loss and wearing of dentures may have implications for oral health care planners in the provision and delivery of oral health services to the older individuals.     

The orodental status of a group of elderly in-patients: a preliminary assessment

Objective: To provide a preliminary assessment of the orodental status and dental treatment requirements of a group of elderly in-patients. Design: Cross-sectional. Setting: Acute Care of the Elderly and Stroke Rehabilitation units at teaching hospitals in Merseyside. Subject: 150 patients aged 58 to 94 years, in which a history could be validated at interview. Intervention: Questionnaire administered by dentist and clinical examination. Main outcome measures: Registration with a dentist, prosthetic status and difficulties with dentures, denture hygiene and identification marking, dental treatment needs and evidence of mucosal pathology. Results: Only 27% of patients claimed registration with a dentist. Three quarters of the patients were edentulous and 66 patients wore full dentures; 18 had no prostheses. Difficulties were experienced by one quarter of patients with upper dentures, compared with a half of lower denture wearers. Of the dentures available for inspection, 61 % had removable soft debris, 66% were left out at night and 75% were cleaned by the patient, whilst on the ward. No dentures had evidence of identification marking. Of the 39 partially dentate patients, 75% required interventive dental treatment. Denture stomatitis was diagnosed in 29% of patients and 19 had evidence of benign mucosal pathology. Conclusions: The orodental status of this group of elderly in-patients was poor, with a high proportion being edentulous. Few were registered with a dentist and denture hygiene was inadequate. Lack of identification marking is a matter of concern. Closer liaison between hospital staff responsible for elderly in-patients is required, to improve the orodental health and quality of life of this medically compromised group of patients.     

Implant overdentures for edentulous elders: study of patient preference

Background: Studies show that elders wearing implant overdentures have improved nutrition and quality of life. However, upfront costs of this therapy are high, and the income of elderly edentulous populations is low. Objectives: This study was designed (i) to measure the preferences of edentulous patients for mandibular two‐implant overdentures using Willingness‐To‐Pay (WTP) and Willingness‐To‐Accept (WTA), (ii) to assess the effect of long‐term financing on WTP and (iii) to assess the desired role of health care plans in financing dental prostheses. Methods: Edentulous elders (68–79 years; n = 36) wearing maxillary dentures and either a mandibular conventional denture (CD, n = 13) or a two‐implant overdenture with ball attachments (IOD, n = 23) participated in this study. All had received their prostheses 2 years previously, as part of a randomised clinical trial. A three‐part questionnaire was completed during a 20‐min interview with a trained researcher. Results: Forty‐six per cent (6/13) of the CD wearers and 70% (16/23) of the IOD wearers were willing to pay three times more than the current cost of conventional dentures for implant prostheses. These percentages were increased to 77% (CD) and 96% (IOD) if participants could pay for implant overdentures in monthly instalments. Eighty‐six per cent (31/36) of all participants in both groups (21/23 IOD; 10/13 CD) thought that the government should cover at least some of the cost of implant overdentures. Conclusions: This study shows that, the majority of elderly edentate individuals who have not experienced mandibular two‐implant overdenture therapy are willing to pay the cost, particularly when payment can be made in monthly instalments.     

Knowledge of prosthodontic treatment among denture-wearers and non-denture-wearers attending a dental institute in India: a survey report

Objective: Knowledge of subjects regarding prosthodontic treatment may play a role in their acceptance of the prostheses. The purpose of this survey was to assess the knowledge of prosthodontic treatment among the denture‐wearers and non‐denture‐wearers reporting to the Institute of Dental Sciences, Belgaum. Methods: A self‐designed closed‐ended questionnaire containing 14 questions was designed. Four‐hundred and nineteen subjects aged between 25 and 65 years were surveyed over a period of 2 months. Collected data were statistically analysed using chi‐squared test at a significance level of p < 0.05. Results: From the 419 subjects surveyed, 140 subjects (33.4%) were dentate and 279 subjects (66.6%) were edentulous either in the maxillary, mandibular or both arches. Among the 279 edentulous subjects, 143 (51.3%) did not use any kind of prosthesis. There was a statistically significant difference in knowledge regarding the replacement of teeth by artificial means, the number of visits required for the provision of a complete denture, problems with dentures among subjects using and not using them (p < 0.001) whereas no significant difference was found among the subjects regarding aesthetics with dentures and socializing with friends. Conclusion: Attempts should be made to raise the level of knowledge of both denture‐wearers and non‐denture‐wearers reporting to the Institute for any dental treatment.     

Oral mucosal lesions and temporomandibular joint impairment of elderly people in the South East Local Government Area of Ibadan

Objective: To determine the prevalence of oral mucosal lesions, temporomandibular joint (TMJ) impairment and oral health‐related habits in the elderly people in South East Local Government Area (SELGA) in Ibadan. Background data: SELGA is one of the largest local government areas in Oyo State, Nigeria and has a population of 225 800. Design: A cross‐sectional survey. Methodology: A randomly selected sample of 690 elderly people from 23 wards in SELGA were examined by two trained and calibrated examiners using mirror, probe and natural light. Results: One hundred and fifty‐five (22.46%) of the elderly examined had one or more oral pathology lesions, representing infection‐related swelling, non‐infection‐related swelling, pre‐malignant lesions, denture stomatitis, non‐denture based ulcers, angular cheilitis, geographic tongue, scrotal tongue, lichen planus, hyper‐pigmentation and TMJ impairment. Fifty‐five (35.5%) of these pathologies were infection‐related swellings. Six (3.9%) of the pathologies were denture‐related stomatitis, 14(9.03%) were pre‐malignant lesions, 14(9.03%) were non‐infection‐related swelling, while 27 (17.4%) were TMJ impairment. The rest of the lesions constituted the remaining 25.1%. Only 15.9% of the participants had tobacco‐related habits, 10.7% drank alcohol, whilst 41.6% chewed kola nuts. Conclusion: Oral pathoses prevalence (22.46%) was similar to findings in developed countries (29.9%) but with a reversal of causal factors, infection‐related swellings were more common, whereas pre‐malignant lesions were less common. The infections were mostly complications from periodontal disease, which culminated in abscess formation. Tobacco‐related habits were not highly prevalent among the elderly people in SELGA. However, oral pathoses resulting from nutritional deficiencies were the third most frequent lesions observed.     

Influence of psychological factors on the acceptance of complete dentures

Objectives: To assess the influence of psychological factors on the acceptance of complete dentures in a population wearing dentures judged to be clinically satisfactory. Design: Subjects were asked to complete personality profiles and also to rate their dentures using a denture satisfaction questionnaire. Setting: The survey was conducted in the prosthetics clinic of a teaching hospital. Subjects: Patients were selected from those who had new complete dentures constructed in the department within the previous two years. Intervention and main outcome measures : The personality inventory was a self‐administered questionnaire comprising 240 items covering the five domains of personality. Denture satisfaction was scored on a nine item scale with four Likert type responses to each. Results: A group of 16% consistently complained about their dentures. Statistical analysis showed that personality factors especially Neuroticism had a significant relationship with denture satisfaction. Conclusion: Psychological factors significantly influence denture satisfaction and profiles may provide useful in predicting potential difficult denture wearers.     

The Biomechanical Effects of Sagittal Split Ramus Osteotomy on Temporomandibular Joint

Abstract

The aim of this study was to evaluate the stress distributions and deformations of the temporomandibular joint (TMJ) during different periods before and after sagittal split ramus osteotomy (SSRO). A three-dimensional finite element model of the mandible and TMJ was established, based on the preoperative CT of a patient with mandibular prognathism. Numerical SSRO was performed and the models of three postoperative periods were established. Contact elements were used to simulate the interaction between the articular discs and the articular cartilages. Nonlinear cable elements were used to simulate the disc attachments and the ligaments. Muscle forces and boundary conditions corresponding to the central occlusion were applied on all the models. The results showed that the stress distributions of the patient’s TMJs were not the same as those of asymptomatic subjects. The stress distributions and deformations of the disc, condylar and temporal cartilage were changed at different periods after SSRO. The biomechanical parameters of TMJ were improved after SSRO. And the postoperative results showed that appropriate functional training could help to avoid TMJ diseases. Therefore SSRO could improve the stress distributions of the TMJ and relieve the symptoms of temporomandibular disorder (TMD).