To evaluate the importance of severe retrognathia as a risk factor for the development of recent onset painful TMJ disorders among adult females.
Design
Case-control study.
Setting
This study was conducted in a large health maintenance organization between 1998 and 1999 [Kaiser Permanente Northwest (KPNW), Portland, OR, USA].
Participants
Adult females with recent onset painful TMJ disorders (n=29) and normal controls (n=104).
Methods
Cases were recruited from the TMD clinic at Kaiser Permanente Northwest (KPNW). Controls were recruited from a dental clinic at KPNW. Case status was determined using a questionnaire; mandibular sagittal position was determined by measuring a research angle on facial photographs. The mean research angle for cases was compared to the mean for controls. Multivariable exact conditional logistic regression analysis was used to examine the demographic characteristics of cases and controls, and to determine the strength of association between recent onset painful TMJ disorders and severe retrognathia. The population attributable risk percentage (PAR%) and the attributable risk percentage (AR%) were calculated to further evaluate severe retrognathia as a risk factor.
Results
The mean research angle among cases (67.7°; 95% CI=66.0–69.4) was smaller than among controls (71.6°; 95% CI=70.7–72.5, P<0.001). The odds ratio for the association between case status and the presence or absence of severe retrognathia was elevated (OR=6.3; 95% CI=1.1–47.5, P=0.039). The PAR% and AR%, associated with severe retrognathia, were 13.3 and 84.1%, respectively.
Conclusions
Severe retrognathia is strongly associated with recent onset painful TMJ disorders (OR=6.3). Only a small proportion of these disorders are attributable to severe retrognathia among the total population of adult females (PAR%=13.3%). However, a large proportion of these TMJ disorders are potentially attributable to severe retrognathia among adult females with severe retrognathia (AR%=84.1%).
NesbittB, MoyersR, Ten HaveT.Adult temporomandibular joint disorder symptomatology and its association with childhood occlusal relations: a preliminary report. In: CarlsonD (Ed.). Developmental Aspects of Temporomandibular Joint Disorders, Monograph No. 16, Craniofacial Growth Series. Ann Arbor: University of Michigan, 1985: 183–9.
2.
DibbetsJ, van der WeeleL, BoeringG.Craniofacial morphology and temporomandibular joint dysfunction in children. In: CarlsonD (Ed.). Developmental Aspects of Temporomandibular Joint Disorders, Monograph No. 16, Craniofacial Growth Series. Ann Arbor: University of Michigan, 1985: 151–82.
3.
BrandtDTemporomandibular disorders and their association with morphologic malocclusion in children. In: CarlsonD (Ed.). Developmental Aspects of Temporomandibular Joint Disorders, Monograph No. 16, Craniofacial Growth Series. Ann Arbor: University of Michigan, 1985: 279–98.
4.
StringertH, WormsFVariations in skeletal and dental patterns in patients with structural and functional alterations of the temporomandibular joint: a preliminary report. Am J Orthod Dentofac Orthop1986; 89: 285–97.
5.
SchellhasK, PolleiS, WilkesCPediatric internal derangements of the temporomandibular joint: effect on facial development. Am J Orthod Dentofac Orthop1993; 104: 51–9.
6.
BrandJ, NielsonK, TallentsR, NandaR, CurrierF, OwenWLateral cephalometric analysis of skeletal patterns in patients with and without internal derangement of the tempormandibular joint. Am J Orthod Dentofac Orthop1995; 107: 121–8.
7.
DibbetsJMH, van der WeeleLT. Signs and symptoms of temporomandibular disorder (TMD) and craniofacial form. Am J Orthod Dentofac Orthop1996; 110: 73–8.
BosioJA, BurchJG, TallentsRH, WadeDB, BeckFMLateral cephalometric analysis of asymptomatic volunteers and symptomatic patients with and without bilateral joint disk displacement. Am J Orthod Dentofac Orthop1998; 114: 248–55.
10.
MillerJR, BurgessJA, CritchlowCWAssociation between mandibular retrognathia and TMJ disorders in adult females. J Publ Hlth Dent2004; 64: 157–63.
11.
GidarakouIK, TallentsRH, KyrkanidesS, SteinS, MossMEComparison of skeletal and dental morphology in asymptomatic volunteers and symptomatic patients with bilateral disk displacement without reduction. Angle Orthod2004; 74: 684–90.
12.
RughJ, SolbergWOral health status in the United States: temporomandibular disorders. J Dent Educ1985; 49: 398–405.
13.
HowardJATemporomandibular joint disorders, facial pain and dental problems in performing artists. In: SataloffR, BrandfonbrenerA, LedermanR (Eds). Textbook of Performing Arts Medicine. New York: Raven Press, 1991: 111–69.
14.
McNeillCTemporomandibular Disorders Guidelines for Classification, Assessment, and Management. Chicago: Quintessence Publishing Co., Inc., 1993.
15.
HelkimoMStudies 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 Scand1974; 32: 255–67.
16.
RioloM, BrandtD, TenHaveTAssociations between occlusal characteristics and signs and symptoms of TMJ dysfunction in children and young adults. Am J Orthod Dentofac Orthop1987; 92: 467–77.
17.
DworkinSF, HugginsKH, LeRescheL, Epidemiology of signs and symptoms in temporomandibular disorders: clinical signs in cases and controls. J Am Dent Assoc1990; 120: 273–81.
18.
SeligmanD, PullingerAA multiple stepwise logistic regression analysis of trauma history and 16 other history and dental cofactors in females with temporomandibular disorders. J Orofac Pain1996; 10: 351–61.
19.
IsbergA, HagglundM, PaesaniDThe effect of age and gender on the onset of symptomatic temporomandibular joint disk displacement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod1998; 85: 252–7.
20.
McLainJ, ProffitWOral health status in the United States: prevalence of malocclusion. J Dent Educ1985; 49: 386–96.
21.
BrunelleJA, BhatM, LiptonJAPrevalence and distribution of selected occlusal characteristics in the US population, 1988–1991. J Dent Res1996; 75(Special): 706–13.
22.
ProffitWR, FieldsHW, MorayLJPrevalence of mal-occlusion and orthodontic treatment need in the United States: estimates from the NHANES III survey. Int J Adult Orthod Orthognath Surg1998; 13(2): 97–106.
23.
MoyersRThe development of occlusion and temporomandibular joint disorders. In: CarlsonD (Ed.). Developmental Aspects of Temporomandibular Joint Disorders, Monograph No. 16, Craniofacial Growth Series. Ann Arbor: University of Michigan, 1985: 53–70.
24.
PullingerA, SeligmanD, GornbeinJA multiple logistic regression analysis of the risk and relative odds of temporomandibular disorders as a function of common occlusal features. J Dent Res1993; 72: 968–79.
25.
McNamaraJA, SeligmanDA, OkesonJPOcclusion, orthodontic treatment, and temporomandibular disorders: a review. J Orofac Pain1995; 9: 73–89.
26.
TrueloveE, SommersE, LeRescheL, Von KorffM.Clincial diagnostic criteria for TMD: new classification permits multiple diagnoses. J Am Dent Assoc1992; 123: 47–54.
27.
HennekensC, BuringJ.Epidemiology in Medicine. Boston: Little, Brown and Co., 1987.
28.
HenriksonT, NilnerM, KurolJSigns of temporomandibular disorders in girls receiving orthodontic treatment. A prospective and longitudinal comparison with untreated Class II malocclusions and normal occlusion subjects. Eur J Orthod2000; 22: 271–81.
29.
FrictonJR, KroeningRJ, HathawayKM. TMJ and Craniofacial Pain: diagnosis and management. St Louis: Ishiyaku EuroAmeria, Inc., 1988.
30.
DahlstromL, KeelingSD, FrictonJR, HilsenbeckSG, ClarkGM, RughJDEvaluation of a training program intended to calibrate examiners of temporomandibular disorders. Acta Odontol Scand1994; 52: 250–4.
31.
WestessonP, ErikssonL, KuritaKReliability of a negative clinical temporomandibular joint examination: prevalence of disk displacement in asymptomatic temporomandibular joints. Oral Surg Oral Med Oral Pathol Oral Radiol Endod1989; 68: 551–4.
32.
RibeiroRF, TallentsRH, KatzbergRW, The prevalence of disk displacement in symptomatic and asymptomatic volunteers aged 6 to 25 years. J Orofac Pain1997; 11: 37–46.
33.
FarkasL, BrysonW, KlotzJIs photogrammetry of the face reliable?Plast Reconstr Surg1980; 66: 346–55.
34.
LauwerynsI, Van CauwenbergheN, CarelsC.Interobserver and intraobserver agreement of clinical orthodontic judgements based on intraoral and extraoral photographs. Angle Orthod1994; 64: 23–30.
35.
FerrarioV, SforzaC, MianaA, TartagliaGCraniofacial morphometry by photographic evaluations. Am J Orthod Dentofac Orthop1993; 103: 327–37.
36.
MichielsG, SatherAValidity and reliability of facial profile evaluation in vertical and horizontal dimension from lateral cephalograms and lateral photographs. Int J Adult Orthod Orthognath Surg1994; 9: 43–54.
37.
BisharaSE, JorgensenGJ, JakobsenJRChanges in facial dimensions assessed from lateral and frontal photographs. Part I—Methodology. Am J Orthod Dentofac Orthop1995; 108: 389–93.
38.
StraussRA, WeisBD, LindauerSJ, RebellatoJ, IssacsonRJVariability of facial photographs for use in treatment planning for orthodontics and orthognathic surgery. Int J Adult Orthod Orthognath Surg1997; 12: 197–203.
39.
RioloM, MoyersR, McNamaraJ, HunterW.Angular Measurements. An Atlas of Craniofacial Growth: Cephalometric Standards from the University School Growth Study, the University of Michigan, Monograph No. 2, Craniofacial Growth Series. Ann Arbor: University of Michigan, 1974: 23–100.
