Epidemiology is the study of the distribution, determinants, and natural history of disease in populations. Epidemiology has several uses in addition to its traditional role of documenting the public health significance of a condition. Notably, epidemiologic methods and data can be used to identify and verify causes of disease. This article reviews the epidemiologic data on pain in the temporomandibular region, and on signs and symptoms associated with specific subtypes of temporomandibular disorders, with the aim of identifying possible etiologic factors for these conditions that deserve further study. Despite methodologic and population differences, several consistencies are apparent in the epidemiologic literature. Pain in the temporomandibular region appears to be relatively common, occurring in approximately 10% of the population over age 18; it is primarily a condition of young and middle-aged adults, rather than of children or the elderly, and is approximately twice as common in women as in men. This prevalence pattern suggests that etiologic investigations should be directed at biologic and psychosocial factors that are more common in women than in men, and diminish in older age groups. Most signs and symptoms associated with particular temporomandibular disorders (e.g., joint sounds, pain in the joint) also appear to be more prevalent in women than in men, although age patterns for these signs and symptoms are not as clear as for temporomandibular pain. The available data highlight the need for further research on etiologic factors associated with temporomandibular pain and with specific diagnostic subtypes of temporomandibular disorders.
References
1.
Abubaker AO, John F., Sotereanos GC, Patterson G., Jenosky J. (1992). Prevalence of female sex hormone use by female TMJ patients (abstract). J Dent Res71 (Spec Iss):259.
2.
Agerberg G., Bergenholtz A. (1989). Craniomandibular disorders in adult populations of West Bothnia, Sweden. Acta Odontol Scand47:129-140.
3.
Agerberg G., Carlsson GE (1972). Functional disorders of the masticatory system: I. Distribution of symptoms according to age and sex as judged from investigation by questionnaire. Acta Odontol Scand30:597-613.
4.
Agerberg G., Inkapööl I. (1990). Craniomandibular disorders in an urban Swedish population. J Craniornandib Disord Facial Oral Pain4:154-164.
5.
Alanen P., Kirveskari P. (1982). Stomatognathic dysfunction in a male Finnish working population. Proc Finn Dent Soc78:184-188.
6.
Bodnar RJ, Romero M., Kramer E. (1988). Organismic variables and pain inhibition: roles of gender and aging. Brain Res Bull21:947-953.
7.
Carlsson GE (1984). Epidemiological studies of signs and symptoms of temporomandibular joint-pain-dysfunction: a literature review. Aust Prosthodont Soc Bull14:7-12.
8.
Carlsson GE, LeResche L. (1995). Epidemiology of temporomandibular disorders. In: Temporomandibular disorders and related pain conditions. Sessle BJ, Bryant PS, Dionne RA, editors. Seattle: IASP Press, pp. 211-226.
9.
Dao TTT, Knight K., Tenenbaum HC, Lue F., Ton-That V. (1996). Influence of oral contraceptives on the fluctuations of myofascial pain over three consecutive menstrual cycles: A preliminary report (abstract). In: Abstracts, 8th World Congress on Pain. Seattle: IASP Press.
10.
Dean HT, Arnold FA Jr, Elvove E. (1942). Domestic water and dental caries. Publ Hlth Rep57:1155-1179.
11.
De Kanter R., Käyser AF, Battistuzzi P., Truin GJ, Van't Hof MA (1992). Demand and need for treatment of craniomandibular dysfunction in the Dutch adult population. J Dent Res71:1607-1612.
12.
De Kanter R., Truin GJ, Burgersdijk R., Van't Hof M., Battistuzzi P., Halsbeek H., et al. (1993). Prevalence in the Dutch adult population and a meta-analysis of signs and symptoms of temporomandibular disorder. J Dent Res72:1509-1518.
13.
Dworkin SF, LeResche L, editors (1992). Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord Facial Oral Pain6:301-355.
14.
Dworkin SF, LeResche L., DeRouen T. (1988). Reliability of clinical measurement in temporomandibular disorders. Clin Pain4:88-99.
15.
Dworkin SF, Huggins KH, LeResche L., Von Korff M., Howard J., Truelove E., et al. (1990). Epidemiology of signs and symptoms in temporomandibular disorders: clinical signs in cases and controls. ) J Am Dent Assoc120:273-281.
16.
Dworkin SF, Von Korff MR, LeResche L. (1992). Epidemiologic studies of chronic pain: a dynamicecologic perspective. Ann Behav Med14:3-11.
17.
Dworkin SF, Wilson L., Massoth DL (1994). Somatizing as a risk factor for chronic pain. In: Psychological vulnerability to chronic pain. Grzesiak RC, Ciccone DS, editors. New York: Springer Publishing Co., pp. 28-54.
18.
Eversole LR, Stone CE, Matheson D., Kaplan H. (1985). Psychometric profiles and facial pain. Oral Surg Oral Med Oral Pathol60:269-274.
19.
Fields H. (1987). Pain. New York: McGraw-Hill.
20.
Flor H., Birbaumer N., Schulte W., Roos R. ( 1991). Stress-related electromyographic responses in patients with chronic temporomandibular pain. Pain46:145-152.
21.
Goulet J.-P, Lavigne GJ, Lund JP ( 1995). Jaw pain prevalence among French-speaking Canadians and related symptoms of temporomandibular disorders. J Dent Res74:1738-1744.
22.
Goyer RA, Rogan WJ (1986). When is biologic change an indicator of disease? In: New and sensitive indicators of health impacts of environment agents. Underhill DW, Radford EP, editors. Pittsburgh: University of Pittsburgh, pp. 17-25.
23.
Greene CS, Marbach JJ (1982). Epidemiologic studies of mandibular dysfunction: a critical review. J Prosthet Dent48:184-190.
24.
Greene CS, Olson RE, Laskin DM (1982). Psychological factors in the etiology, progression, and treatment of MPD syndrome. J Am Dent Assoc105:443-448.
25.
Haskin CL, Milam SB, Cameron IL (1995). Pathogenesis of degenerative joint disease in the human temporomandibular joint. Crit Rev Oral Biol Med6:248-277.
26.
Helkimo M. (1974a). Studies on function and dysfunction of the masticatory system: IV. Age and sex distribution of symptoms of dysfunction of the masticatory system in Lapps in the north of Finland. Acta Odontol Scand32:255-267.
27.
Helkimo M. (1974b). Studies on function and dysfunction of the masticatory system: II. Index for anamnestic and clinical dysfunction and occlusal state. Swed Dent167:101-121.
28.
Helkimo M. (1979). Epidemiological surveys of dysfunction of the masticatory system. In: Temporomandibular joint: function and dysfunction. Zarb GA, Carlsson GE, editors. Copenhagen: Munksgaard, pp. 175-192.
29.
Helöe B., Helöe LA (1979). Frequency and distribution of myofascial pain-dysfunction syndrome in a population of 25-year-olds. Community Dent Oral Epidemiol7:357-360.
30.
Kapila S., Villadelgado M., Seunghyun K., Liu M., Peikoff E. (1996). Relaxin and (3-estradiol modulate the expression of matrix metalloproteinases in TM) disc cells (abstract). J Dent Res75(Spec Iss):122.
31.
Laskin D, Greenfield W, Gale E, Rugh J, Neff P, Alling C, et al, editors (1983). The President's conference on the examination, diagnosis and management of temporomandibular disorders. Chicago: American Dental Association.
32.
LeResche L., Dworkin SF, Sommers E., Truelove EL (1988). An epidemiologic evaluation of two diagnostic classification schemes for temporomandibular disorders. J Prosthet Dent65:131-138.
33.
LeResche L., Saunders K., Von Korff MR, Barlow W., Dworkin SF (1997). Use of exogenous hormones and temporomandibular disorder pain. Pain69:153-160.
34.
Lilienfeld AM, Lilienfeld DE (1980). Foundations of epidemiology. 2nd ed. New York: Oxford University Press.
35.
Lipton JA, Ship JA, Larach-Robinson D. (1993). Estimated prevalence and distribution of reported orofacial pain in the United States. J Am Dent Assoc124:115-121.
36.
Locker D., Slade G. (1988). Prevalence of symptoms associated with temporomandibular disorders in a Canadian population. Community Dent Oral Epidemiol16:310-313.
37.
Lundeen TF, Sturdevant JR, George )M. (1987). Stress as a factor in muscle and temporomandibular joint pain. J Oral Rehabil14:447-456.
38.
Magnusson T., Carlsson GE, Egermark-Eriksson I. (1991). An evaluation of the need and demand for treatment of craniomandibular disorders in a young Swedish population. J Craniomandib Disord Facial Oral Pain5:57-63.
39.
Marbach JJ, Lennon MC, Dohrenwend BP (1988). Candidate risk factors for temporomandibular pain and dysfunction syndrome: psychosocial, health behavior, physical illness and injury. Pain34:139-151.
40.
Marcus DA (1995). Interrelationships of neurochemicals, estrogen, and recurring headache. Pain62:129-139.
41.
Milam SB (1995). Articular disk displacements and degenerative temporomandibular joint disease. In: Temporomandibular disorders and related pain conditions. Sessle BJ, Bryant PS, Dionne RA, editors. Seattle: IASP Press, pp. 89-112.
42.
Mogil IS, Sternberg WF, Kest B., Marek P., Liebeskind JC (1993). Sex differences in the antagonism of swim stress-induced analgesia: effects of gonadectomy and estrogen replacement. Pain53:17-25.
43.
Mohlin B. (1983). Prevalence of mandibular dysfunction and relation between malocclusion and mandibular dysfunction in a group of women in Sweden. Eur J Orthodont4:115-123.
44.
Morris IN (1975). Uses of epidemiology. 3rd ed. Edinburgh: Churchill Livingstone.
45.
Nilner M. (1981). Prevalence of functional disturbances and diseases of the stomatognathic system in 15-18 year olds. Swed Dent J5:189-197.
46.
Nilner M., Lassing S-Å (1981). Prevalence of functional disturbances and diseases of the stomatognathic system in 7-14 year olds. Swed Dent J5:173-187.
47.
Norheim PW, Dahl BL ( 1978). Some self-reported symptoms of temporomandibular joint dysfunction in a population in northern Norway. J Oral Rehabil5:63-68.
48.
Nydell A., Helkimo M., Koch G. ( 1994). Craniomandibular disorders in children-a critical review of the literature. Swed Dent J18:191-205.
49.
Ogura T., Morinushi T., Ohno H., Sumi K., Hatada K. (1985). An epidemiological study of TMJ dysfunction syndrome in adolescents. J Pedodont10:22-35.
50.
Okeson JP (1995). Nonsurgical treatment of internal derangements. In: Medical management of temporomandibular disorders. Laskin DM, editor. Oral Maxillofac Surg Clin North Am7:63-71.
51.
Riegelman RK, Hirsh RP (1989). Studying a study and testing a test: how to read the medical literature. 2nd ed. Boston: Little, Brown and Company.
52.
Rossouw JE, Finnegan LP, Harlan WR, Pinn VW, Clifford C., McGowan JA (1995). The evolution of the Women's Health Initiative. J Am Med Wom Assoc50:50-55.
53.
Rothman K. (1986). Modern epidemiology. Boston: Little, Brown and Co.
54.
Rudy TE, Turk DC ( 1995). Integrating behavioral and dental treatments: utility of customizing protocols. In: Temporomandibular disorders and related pain conditions. Sessle BJ, Bryant PS, Dionne RA, editors. Seattle: IASP Press, pp. 351-362.
55.
Rudy TE, Turk DC, Zaki HS, Curtin HD (1989). An empirical taxonomic alternative to traditional classification of temporomandibular disorders. Pain36:311-320.
56.
Rudy T., Greco C., Turk D., Zaki H., Herlich A. (1996). Empirically-derived RDC axis I classification of TMD patients (abstract). I Dent Res75(Spec Iss):217.
57.
Rugh JD, Solberg WK (1976). Psychological implications in temporomandibular pain and dysfunction. Oral Sci Rev7:3-30.
58.
Rugh JD, Solberg WK (1985). Oral health status in the United States: temporomandibular disorders. J Dent Educ49:398-405.
59.
Salonen L., Helldén L., Carlsson GE (1990). Prevalence of signs and symptoms of dysfunction in the masticatory system. An epidemiological study in an adult Swedish population. I Craniomandib Disord Facial Oral Pain4:241-250.
60.
Schiffman EL, Fricton JR, Haley DP, Shapiro BL (1990). The prevalence and treatment needs of subjects with temporomandibular disorders. I Am Dent Assoc120:295-303.
61.
Schipper HM (1986). Neurology of sex steroids and oral contraceptives. Neurol Clin4:721-751.
62.
Seligman DA, Pullinger AG (1991a). The role of intercuspal occlusal relationships in temporomandibular disorders: a review. J Craniomandib Disord Facial Oral Pain5:96-106.
63.
Seligman DA, Pullinger AG (1991b). The role of functional occlusal relationships in temporomandibular disorders: a review. J Craniomandib Disord Facial Oral Pain5:265-279.
64.
Silberstein SD, Merriam GR (1991). Estrogens, progestins, and headache. Neurology41:786-793.
65.
Simon GE, Von Korff M. (1995). Recall of psychiatric history in cross-sectional surveys: implications for epidemiologic research. Epidemiol Rev17:221-227.
66.
Solberg WK, Woo MW, Houston JB (1979). Prevalence of mandibular dysfunction in young adults. J Am Dent Assoc98:25-34.
67.
Sternberg WF, Mogil JS, Kest B., Page GG, Leong Y., Yam V., et al. (1995). Neonatal testosterone exposure influences neurochemistry of non-opioid swim stress-induced analgesia in adult mice. Pain63:321-326.
68.
Szentpetery A., Huhn E., Fazekas A. (1986). Prevalence of mandibular dysfunction in an urban population in Hungary. Community Dent Oral Epidemiol14:177-180.
69.
Tervonen T., Knuuttila M. (1988). Prevalence of signs and symptoms of mandibular dysfunction among adults aged 25, 35, 50 and 65 years in Ostrobothnia, Finland. J Oral Rehabil15:455-463.
70.
Truelove EL, Sommers E., LeResche L., Dworkin SF, Von Korff M. (1992). Clinical diagnostic criteria for TMD: new classification permits multiple diagnoses. J Am Dent Assoc123:47-54.
71.
Turk DC, Rudy TE ( 1990). The robustness of an empirically derived taxonomy of chronic pain patients. Pain43:27-35.
72.
Von Korff M. (1995). Health services research and temporomandibular pain. In: Temporomandibular disorders and related pain conditions. Sessle BJ, Bryant PS, Dionne RA, editors. Seattle: IASP Press, pp. 227-236.
73.
Von Korff M., Dworkin SF, LeResche L., Kruger A. (1988). An epidemiologic comparison of pain complaints. Pain32:173-183.
74.
Von Korff M., Wagner EH, Dworkin SF, Saunders KW (1991). Chronic pain and use of ambulatory health care. Psychosomat Med53:61-79.
75.
Von Korff M., Ormel J., Keefe FJ, Dworkin SF (1992). Grading the severity of chronic pain. Pain50:133-149.
76.
Von Korff M., LeResche L., Dworkin SF (1993). First onset of common pain symptoms: a prospective study of depression as a risk factor. Pain55:251-258.
77.
Wanman A., Agerberg G. (1986). Mandibular dysfunction in adolescents. I. Prevalence of symptoms. Acta Odontol Scand44:47-54.
78.
Weissman MM, Olfson M. (1995). Depression in women: implications for health care. Science269:799-801.
79.
Westling L. (1992). Temporomandibular joint dysfunction and systemic joint laxity. Swed Dent J (Suppl 81).
80.
Wolfe F. (1994). Rheumatoid arthritis and osteoarthritis: pain facts. Am Pain Soc Bull4(2): 15.
