Background & Aims
Aligned with the standards of the American Academy of Orofacial Pain (AAOP) and the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), luxation and subluxation in the temporomandibular joint (TMJ) are identified as disorders linked to joint hypermobility (JH) of the TMJ, often marked by open locking episodes. JH has been recognized as a potential risk or predisposing factor for temporomandibular disorders (TMD), particularly disc displacement (DD) and frequently leads to complications like pain, fatigue, and notably kinesiophobia, which is commonly observed in clinical settings. However, the current lack of comprehensive data on the clinical characteristics of individuals with TMJ hypermobility underscores the need for further investigation. Therefore, this study aims to examine a group of patients displaying clinical and tomographic signs of TMJ hypermobility, focusing on comparing masticatory system dysfunction parameters in those with and without painful TMD.
Methods
This is a single-center observational study. TMJ hypermobility diagnosis was based on lateral condylar jump during maximal mouth opening (MMO), interincisal opening over 55 mm, and computed tomography confirmation. TMD presence was determined using DC/TMD, and pain, fatigue, stiffness, tension, sensitivity, and weakness were measured using the Visual Analog Scale (VAS). A fatigue test for masticatory muscles required participants to maintain 30% of their maximum bite force (MBF) until fatigue. Changes in MBF and endurance time were recorded. Kinesiophobia levels were assessed using the Tampa Scale for Kinesiophobia. The sample was categorized into two groups: 11 without painful TMD and 10 with, and parameters were compared. Statistical analyses included Shapiro-Wilk, t-test, Wilcoxon, and Mann-Whitney tests.
Results
The study encompassed 21 participants with TMJ hypermobility (28 years, 65 mm MMO). Fatigue was the most common symptom across the sample, with a VAS score of 2,09 mm. Analysis of masticatory muscle fatigue revealed no significant gender differences in terms of resistance duration and percentage change. Notably, men demonstrated higher pre and post-fatigue MBF values (p <0.001). The average kinesiophobia score across the sample was 21.8. In comparisons between groups, no significant differences were found in gender or DD. However, the occurrence of subluxation was notably higher in the painful TMD group (p<0.01). This group also exhibited elevated levels of pain (p<0.001), fatigue (p=0.003), stiffness (p=0.003), tension (p<0.001), sensitivity (p<0.001), and weakness (p=0.004). The fatigue test showed no significant differences in endurance time, percentage chance, pre and post-fatigue MBF. Statistically significant kinesiophobia values were observed in the painful TMD group (p<0.001).
Conclusions
The findings of this study indicate that TMJ hypermobility, in the absence of painful TMD, does not significantly affect the masticatory system. Fatigue was the most commonly reported symptom among all participants. However, there were no notable differences in the fatigue test results between the groups. Importantly, the presence of facial pain appears to be a key factor influencing various clinical parameters, including subluxation, kinesiophobia, pain, fatigue, stiffness, tension, sensitivity, and weakness, with these symptoms being more pronounced in the painful TMD group. The higher prevalence of subluxation and significantly greater levels of kinesiophobia in the painful TMD group underscore the impact of pain on TMJ hypermobility outcomes. Considering these observations and the current understanding that non-painful symptoms might precede the onset of TMD pain, it is advisable to place a greater emphasis on investigating non-painful musculoskeletal symptoms in future research.
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Presenting Author
Samilla Pontes Braga
Poster Authors
Samilla Braga
PhD student
Bauru School of Dentistry
Lead Author
Carolina Cunha
Sacred Heart University Center
Lead Author
Beatriz Amaral de Lima Netto Master's student
University of Sao Paulo
Lead Author
Leonardo Bonjardim
University of São Paulo
Lead Author
Maria Emilia Servin Berden
Bauru School of Dentistry, University of São Paulo
Lead Author
Tatiana da Fonte
University of São Paulo
Lead Author
Dyanne Medina Flores
Bauru School of Dentistry, Universidade de São Paulo
Lead Author
Paulo Conti
University of São Paulo
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Orofacial Pain