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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 27  |  Issue : 1  |  Page : 55-58

Observational study of temporomandibular joint pain in osteoarthritis patients


1 Department of Oral Medicine and Radiology, Vivekanandha Dental College for Women, Tiruchengode, Tamil Nadu, India
2 Department of Oral Medicine and Radiology, Vinayaka Mission's Sankarachariar Dental College, Salem, Tamil Nadu, India
3 Department of Periodontics, Sree Sai Dental College and Research Institute, Srikakulam, Andhra Pradesh, India
4 Department of Prosthodontics, Sree Sai Dental College and Research Institute, Srikakulam, Andhra Pradesh, India
5 Department of Biochemistry, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India

Date of Submission29-Sep-2014
Date of Acceptance01-Aug-2015
Date of Web Publication09-Oct-2015

Correspondence Address:
Sahul Hameed Abdul Samad
126/7 1st Floor, Chennai Salai, Panruti - 607 106, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-1363.167081

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   Abstract 

Aim: The aim of this study was to evaluate the incidence of temporomandibular joint (TMJ) pain in osteoarthritis patients. Objectives: The three objectives of this study were as follows: 1. finding the occurrence of TMJ pain in osteoarthritic patients; 2. to evaluate the signs of TMJ disorders in osteoarthritic patients; and 3. to assess the involvement of TMJ in osteoarthritic patients. Materials and Methods: Twenty osteoarthritis patients who were under treatment for a minimum of 1 year were included in this study. All of them answered a questionnaire before undergoing examination. The questions pertained to the symptoms of the TMJ pain. Clinical examination of TMJ was done, which included evidence of sound, restricted mouth opening, and deviation. Results: Results indicated that about 40% of osteoarthritis patients had TMJ pain. Conclusion: This study shows the high incidence of TMJ pain in patients with osteoarthritis.

Keywords: Osteoarthritis, pain, temporomandibular joint


How to cite this article:
Abdul Samad SH, Narayanan M, Vannan T, Killamsetty S, Konchada J, Deshpande K. Observational study of temporomandibular joint pain in osteoarthritis patients. J Indian Acad Oral Med Radiol 2015;27:55-8

How to cite this URL:
Abdul Samad SH, Narayanan M, Vannan T, Killamsetty S, Konchada J, Deshpande K. Observational study of temporomandibular joint pain in osteoarthritis patients. J Indian Acad Oral Med Radiol [serial online] 2015 [cited 2019 Dec 15];27:55-8. Available from: http://www.jiaomr.in/text.asp?2015/27/1/55/167081


   Introduction Top


Arthritis is the inflammation of the articular surfaces of the joints. Several types of arthritis can affect the temporomandibular joint (TMJ), such as osteoarthritis (OA), osteoarthrosis, and polyarthritis. Of these, OA is one of the most common arthritis affecting the TMJ. Osteoarthritis is the progressive degeneration of the joint with bony changes, destruction of the disc, and muscle pain which begins in loaded articular cartilage that thins, clefts (fibrillation), and then fragments. It is classified as generalized and localized. [1] Generalized osteoarthritis (GOA) is primarily a non-inflammatory disease with involvement of three or more joints or groups of joints. It most commonly involves the interphalangeal, first metatarsophalangeal, and first carpometacarpal joints, knees, cervical and lumbar spine, metacarpophalangeal joints, hips, and wrists. In localized OA, mainly knees, hips, and hands are involved. Osteoarthritis is an aging process of the cartilage, related to wear and tear, and therefore occurs predominantly in weight-bearing joints. [2] Osteoarthritis is the most common joint disease which is primarily a disorder of the articular cartilage and subchondral bone with secondary inflammation of the synovial membrane. [3] It is a localized joint disease without systemic manifestations. The first sign of OA is reduction of the joint space. Following this, the condyle and eminence begin to flatten and the bone underlying the articular surface begins to become sclerotic. Osteoarthritic bony changes include flattening, sclerosis, formation of osteophytes, erosion of mandibular fossa, and reduced joint space. [2] But little is known about the prevalence of OA in the TMJ. [4] Hence, this study was undertaken as an observational study of TMJ pain in OA patients.


   Materials and Methods Top


The study included 20 patients of OA who were under treatment including medication, physiotherapy, and occupational therapy for a period of minimum 1 year. Patients who were under any modality of treatment of OA for less than a year were excluded. All of them answered a questionnaire before a thorough clinical examination was conducted. The questions were on the history of pain including location, type, quality, degree of pain, and trauma history. The clinical examination of TMJ included pain, evidence of sound, irregular joint or deviating jaws, and restricted mouth opening. The clinical examination was performed based on the following parameters:

  • Lateral and posterior joint tenderness on palpation.
  • Ipsilateral muscle tenderness on palpation.
  • TMJ clicking (reciprocal or other).
  • TMJ crepitation.
  • Reduced opening (<40 mm; including vertical overbite) measured using vernier caliper.
  • Reduced protrusion (<7 mm).



   Results Top


Descriptive analysis was used for statistical analysis. [Table 1] shows the minimum and maximum range, mean and standard deviation of age, duration, and visual analog scale (VAS) score. The mean age of the study subjects was 63.90 years. The mean duration of treatment of the patients for OA was 2.90 years. The VAS score was 1.90. [Table 2] shows the occurrence of TMJ pain among the study participants. Out of 10 male and 10 female patients participating in this study, 3 male and 5 female patients had TMJ pain. The P value was not statistically significant. [Table 3] shows the location of TMJ pain among the study participants, whether it was unilateral or bilateral. Out of 10 male and 10 female patients who participated in this study, 2 male and 3 female patients had unilateral TMJ pain and 1 male patient and 2 female patients had bilateral TMJ pain. The P value was not statistically significant. In [Table 4] is shown the occurrence of lock jaw among the study participants. Out of 10 male and 10 female patients who participated in this study, 2 male patients and 1 female patient had lock jaw. The P value was not statistically significant. [Table 5] shows the occurrence of deviation among the study participants. Out of 10 male and 10 female patients who participated in this study, 4 male and 7 female patients had deviation. The P value was not statistically significant. In [Table 6] is given the occurrence of deflection among the study participants. Out of 10 male and 10 female patients who participated in this study, 1 male patient had deflection and no female patients had deflection. The P value was not statistically significant. [Table 7] shows the occurrence of click sound among the study participants. Out of 10 male and 10 female patients who participated in this study, 1 male patient and 8 female patients had click sound. The P value was statistically highly significant. [Table 8] shows the occurrence of deviation among the study participants. Out of 10 male patients who participated in this study, 6 male patients had TMJ disorder in which 2 patients had unilateral and 4 patients had bilateral TMJ disorder. Out of 10 female patients who participated in this study, all the 10 female patients had TMJ disorder in which 7 patients had unilateral and 3 patients had bilateral TMJ disorder. The P value was 0.031, which was statistically significant. In [Table 9] is shown the occurrence of crepitus sound among the study participants. Out of 20 patients who participated in this study, 9 patients had crepitus sound. The P value was 0.003, which was statistically highly significant. [Table 10] shows the correlation of symptoms and signs of TMJ disorder in OA patients. Out of 20 patients who participated in this study, 12 patients had symptoms of TMJ disorder and 3 patients had signs of TMJ disorder. The P value was <0.01, which was statistically highly significant. Results of this study showed that 40% of OA patients had pain in TMJ [Figure 1].
Table 1: Average age, duration of pain, and VAS score of the patients of the study

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Table 2: Occurrence of TMJ pain

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Table 3: Location of TMJ pain (unilateral/bilateral)

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Table 4: Occurrence of lock jaw

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Table 5: Occurrence of signs of TMJ disorder — deviation

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Table 6: Occurrence of signs of TMJ disorder — deflection

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Table 7: Occurrence of TMJ click in osteoarthritic patients

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Table 8: Occurrence of signs of TMJ disorder in male and female patients

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Table 9: Occurrence of signs of TMJ disorder — crepitus

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Table 10: Correlation of symptoms and signs of TMJ disorder in osteoarthritic patients

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Figure 1: Signs and symptoms in OA patients

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   Discussion Top


Temporomandibular joint is a synovial joint often involved in OA. The articular pathology leads to malocclusion characterized by a mandibular backward rotation, distal molar occlusion with increased over jet, and anterior open bite. Temporomandibular joint is the most frequently used joints in human body since birth. Any disorder in TMJ limits the chewing ability of the individual, which subsequently influences the quality of life. [5] In our study, the mean age of patients was 63.90 years, which shows that older age group patients are more frequently affected with TMJ OA compared to younger individuals, [6] since degenerative arthritis is an age-related disease. [6] Also, in our study, females were affected more with TMJ pain; epidemiologic studies also suggest that OA is female predilection disease.

Although OA is an essential problem, there is a lack of information about the prevalence of OA of TMJ in older people diagnosed based on both standard clinical examination and imaging. There is no report describing the prevalence of OA based on clinical diagnosis. In our study, out of 20 patients, 8 patients presented with symptoms like pain (unilateral/bilateral), since the pathological structural changes due to OA and inflammation with a related increase in cytokines lead to peripheral sensitization manifesting as pain normally. [7] Also, in our study, 17 patients out of 20 had signs like deviation, deflection, click, and crepitus because any macrotrauma or microtrauma causes the anteromedial movement of the disc which leads to thinning of the posterior border of the disc and elongation of the disc. Furthermore, it causes functional displacement of disc, which is manifested as click, and functional dislocation of the disc manifesting as deviation and deflection.

The results of prevalence studies based on clinical examination might be biased. Furthermore, the reliability of the diagnosis of OA of TMJ based on clinical examination remains uncertain. Gynther et al. were the first to describe about the radiographic changes in the TMJ of patients with GOA and rheumatoid arthritis. Radiographic examination is of great value in detecting changes in the osseous and soft tissue components. [8] However, objective diagnosis (such as imaging modalities) provide more reproducible results and facilitate conducting more accurate comparative studies. [5] Clinical examination with predictive values for degenerative joint diseases is insufficient. Moreover, the clinical assessment of TMJ pain and impairment seems to be even more complicated than in other joints because of the close relationship with other functional structures. Thus, results of prevalence studies based on clinical examination might be biased, since radiographic diagnosis is always confirmatory but the clinical examination additionally favors the diagnosis. Also, the sample size of the present study is limited. So, increased sample size would give better idea about the prevalence of OA in TMJ. The clinical assessment of TMJ pain and impairment seems to be even more complicated than in other joints because of the closer relationship with other functional structures.


   Conclusion Top


In our study, 40% of the OA patients had TMJ disorder. Though many OA patients had pain in TMJ, not all are attributed to TMJ OA. Results of this study may be biased, since the reliability of the diagnosis of OA of the TMJ based only on clinical examination remains uncertain. Thus, radiographic study along with clinical diagnosis would give a better idea about the prevalence of the TMJ pain in OA patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Okeson JP. Diagnosis of temporomandibular disorder. In: Okeson JP, editor. Management of Temporomandibular Disorders and Occlusion. 4 th ed. Orlando, Florida, USA: Mosby Inc.; 1997. p. 343-6.  Back to cited text no. 1
    
2.
Huskisson EC, Dieppe PA, Tucker AK, Cannell LB. Another look at osteoarthritis. Ann Rheum Dis 1979;38:423-8.  Back to cited text no. 2
[PUBMED]    
3.
Blasberg B, Greenberg MS. Temporomandibular disorders. In: Burket's Oral Medicine. 11 th ed. Hamilton: Greenberg, Glick & Ship BC Decker Inc, 2008. p. 249-50.  Back to cited text no. 3
    
4.
Gynther GW, Holmlund AB, Reinholt FP, Lindblad S. Temporomandibular joint involvement in generalized osteoarthritis and rheumatoid arthritis: A clinical, arthroscopic, histologic, and immunohistochemistry study. Int J Oral Maxillofac Surg 1997;26:10-6.  Back to cited text no. 4
    
5.
Schmitter M, Essig M, Seneadza V, Balke Z, Schröder J, Rammelsberg P. Prevalence of clinical and radiographic signs of osteoarthrosis of the temporomandibular joint in an older persons community. Dentomaxillofac Radiol 2010;39:231-4.  Back to cited text no. 5
    
6.
Alexiou K, Stamatakis H, Tsiklakis K. Evaluation of the severity of the temporomandibular joint osteoarthritic changes related to age using cone beam computed tomography. Dentomaxillofac Radiol 2009;38:141-7.  Back to cited text no. 6
    
7.
Wheeless CR. The adult hip. In: Textbook of Orthopaedics. 3 rd ed. Maryland: Data Trace Publishing Company; 2006. p. 529-34.  Back to cited text no. 7
    
8.
Gynther GW, Tronje G, Holmlund AB. Radiographic changes in the temporomandibular joint in patients with generalised osteoarthritis and rheumatoid arthritis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;81:613-8.  Back to cited text no. 8
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]



 

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