10.59987/ads/2013.3-4.230-238
Aim. Aim of this study was to evaluate the prevalence of temporomandibular disorders (TMD) in a sample of consecutive subjects.
Materials and methods. TMDs were recorded in a sample of 580 subjects (279 M, 301 F; mean age: 13.4y). For each subject a case history was compiled to evaluate the social and demographic parameters. An extraoral exam was effected to point out the face proportions, and an intraoral exam was performed to analyze dental occlusion, mandibular deviation during opening, presence of cross-bites, overjet and overbite. A functional exam was carried out to evaluate mandibular movements and to find joint sounds and myofascial pain. The sample was divided into 6 groups according to the: gender, age (ages 6y-11y and 12y-16y), Angle Dental Class, cross-bite, midline deviation and chewing side. For this investigation latex gloves, a millimeter calipers (precision 0,01 mm) and a phonendoscope were used. The percentages of signs and symptoms were compared using the ?2-test with Yates correction to determine the differences among the groups for the rates of TMDs, reduced opening/lateral/protrusive movements, and myofascial pain.
Results. The prevalence of TMDs in the total sample was 13,9%. Among 6y-11y subjects the percentage of TMD was 7,3% while it was 16,1% among 12y-16y subjects (?2=1.634;; p=0.201). Females showed a percentage of 16,6% of TMDs while males one of 10,8% (?2=0.556;; p=0.456). According to angle malocclusion, the prevalence was 14% in subjects with Class I malocclusion, 15% in sample with Class II and 9% in patients with Class III (?2=0.540;; p=0.763). According to presence or absence of crossbite, prevalence of TMD signs and symptoms was 13,8% among subjects without crossbite and 14,3% among subjects with crossbite, with no significant difference between the two subgroups (?2= 0,047619;; p=0.050). In relation of midline deviation, prevalence of TMDs was 15% in subjects without deviation, 15,8% in functional deviation subjects and 4,7% in anatomic deviation ones (?2=1.555;; p=0.05). Prevalence of TMDs was 12,6% in subjects with bilateral chewing and 28% in unilateral chewing.
Conclusions. TMDs seem to be not associated to age, to gender, Angle Class, cross-bite and chewing side.
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                                                                                                                    Original article



                   Gnathological features in growing subjects




                                                                                                                                       li
                                                                                 na
                   Fabiana Ballanti, DDS, MS1                               of 16,6% of TMDs while males one of 10,8%
                   Salvatore Ranieri, DDS1                                  (?2=0.556;; p=0.456). According to angle malocclu-




                                                                               io
                   Alberto Baldini, DDS, PhD1                               sion, the prevalence was 14% in subjects with Class
                   Chiara Pavoni, DDS, MS1                                  I malocclusion, 15% in sample with Class II and 9%
                   Patrizio Bollero, DDS, MS2                               in patients with Class III (?2=0.540;; p=0.763). Ac-
                   Paola Cozza, MD, DDS, MS1                                cording to presence or absence of crossbite, preva-




                                                                            az
                                                                            lence of TMD signs and symptoms was 13,8%
                                                                            among subjects without crossbite and 14,3% among
                   1 Department of Orthodontics, “Tor Vergata” University   subjects with crossbite, with no significant differ-
                     of Rome, Italy                                         ence between the two subgroups (?2= 0,047619;;




                                                                         rn
                   2 Department of Dental and Oral Pathology, “Tor Ver-     p=0.050). In relation of midline deviation, prevalence
                     gata” University of Rome, Italy                        of TMDs was 15% in subjects without deviation,
                                                                            15,8% in functional deviation subjects and 4,7% in
                                                                            anatomic deviation ones (?2=1.555;; p=0.05). Preva-




                                                                      te
                   Corresponding author:                                    lence of TMDs was 12,6% in subjects with bilateral
                   Chiara Pavoni                                            chewing and 28% in unilateral chewing. Conclu-
                   Department of Orthodontics,                              sions. TMDs seem to be not associated to age, to
                   “Tor Vergata” University of Rome
                   viale Oxford, 81
                                                                   In       gender, Angle Class, cross-bite and chewing side.

                   00133 Rome, Italy                                        Key words: epidemiological study, temporo-
                   E-mail: chiarapavoni@libero.it                           mandibular disorders, dental malocclusions, skele-
                                                                            tal discrepancy.
                                                         ni

                   Summary
                                                                            Introduction
                   Aim. Aim of this study was to evaluate the preva-
                                          o

                   lence of temporomandibular disorders (TMD) in a          Temporomandibular disorders (TMD), a sub-classification
                   sample of consecutive subjects. Materials and            of musculoskeletal disorders, has been defined as a col-
                                      izi


                   methods. TMDs were recorded in a sample of 580           lective term embracing a number of clinical problems that
                   subjects (279 M, 301 F; mean age: 13.4y). For each       involve the masticatory musculature, the temporomandibu-
                   subject a case history was compiled to evaluate the      lar joints and associated structures or both of them (1).
                   social and demographic parameters. An extraoral          The aetiology and the pathophysiology of TMD are poorly
                         Ed




                   exam was effected to point out the face proportions,     understood. It is generally accepted that the aetiology is
                   and an intraoral exam was performed to analyze           multifactorial, involving a large number of direct and indi-
                   dental occlusion, mandibular deviation during open-      rect causal factors. Among such factors, occlusion is fre-
                   ing, presence of cross-bites, overjet and overbite. A    quently cited as one of the major aetiological factors
                   functional exam was carried out to evaluate              causing TMD (2). Other aetiological factors are: unstable
                   mandibular movements and to find joint sounds and        occlusion, stress and other psychologic factors, trauma,
               C




                   myofascial pain. The sample was divided into 6           individual predisposition, and structural conditions (3).
                   groups according to the: gender, age (ages 6y- 11y       In the past, TMD were considered like a typical degen-
    CI




                   and 12y-16y), Angle Dental Class, cross-bite, mid-       erative disease of the adult and so many epidemiologi-
                   line deviation and chewing side. For this investiga-     cal studies were performed in adult population. Fre-
                   tion latex gloves, a millimeter calipers (precision      quencies of TMD signs and symptoms were between
                   0,01 mm) and a phonendoscope were used. The per-         12% to 57% (4-13).
                   centages of signs and symptoms were compared             Since the end of the 1970s, several epidemiological
                   using the ?2-test with Yates correction to determine     studies of signs and symptoms of TMD in children and
©




                   the differences among the groups for the rates of        adolescents have been performed. In these studies, the
                   TMDs, reduced opening/lateral/protrusive move-           prevalence varies from 5,9% to 66% (14-28).
                   ments, and myofascial pain. Results. The preva-          There are several reasons for the diverging results in
                   lence of TMDs in the total sample was 13,9%.             previous epidemiological studies. Differences in the
                   Among 6y-11y subjects the percentage of TMD was          composition of the material, the examination methods
                   7,3% while it was 16,1% among 12y-16y subjects           and the definitions and criteria for the chosen variables
                   (?2=1.634;; p=0.201). Females showed a percentage        are some of the reasons.

                   230                                                                      Annali di Stomatologia 2013; IV (3-4): 230-238
2_Pavoni_Riv Annali 3-4 2013 13/02/14 10:23 Pagina 231




                   Gnathological features in growing subjects


                   The inevitable inter and intra-individual variations be-     the buccal groove of the mandibular first molar. In
                   tween examiners are other explanations. Another im-          Class I, the mesiobuccal cusp of the maxillary first
                   portant, yet frequently overlooked reason, is that ex-       molar is aligned with the buccal groove of the
                   amination methods designed for adults have been              mandibular first molar. In Class II, the molar relation-
                   used for children, without proper consideration of the       ship shows the buccal groove of the mandibular first




                                                                                                                                        li
                   difficulties and limitations that exist in the examination   molar distally positioned when in occlusion with the
                   of children (29).                                            mesiobuccal cusp of the maxillary first molar. In Class




                                                                                    na
                   The reasons for interest about these diseases in chil-       III, the molar relationship shows the buccal groove of
                   dren stems from the need for early identification the        the mandibular first molar mesially positioned to the
                   conditions responsible for the TMD symptoms because          mesiobuccal cusp of the maxillary first molar when the
                   they might lead to serious injury to stomatognathic.         teeth are in occlusion.




                                                                                  io
                   Therefore, the aim of this investigation was to evaluate     The sample were then divided into two groups based
                   the prevalence of TMD signs and symptoms in a sam-           on the existence of cross bite: 1) absence of cross-bite
                   ple of Caucasian young subjects.                             (unilateral or bilateral; anterior or posterior) (533 sub-




                                                                               az
                                                                                jects), 2) presence of crossbites (47 subjects).
                                                                                After these classifications, the TMD signs and symp-
                   Materials and methods                                        toms were evaluated using the Research Diagnostic
                                                                                Criteria for Temporomandibular Disorders.




                                                                            rn
                   In the period from October 2011 to November 2012, a re-
                   searcher has proposed to newly arrived 800 subjects to
                   participate in this investigation, but only 580 (279 males   Palpation of muscles and TMJ
                   and 301 females, mean age was 13.4 years) acceded to it.




                                                                         te
                   Inclusion criteria were:                                     It was necessary to find myofascial pain and arthralgia.
                   • Caucasian subjects (age range: 6-16 years)                 Palpation was accomplished mainly by fingertips of the
                   • Newly arrived patients                                     index and third fingers or the spade-like pad of the dis-
                   • No history of orthodontic treatments                       tal phalanx of the index finger only with standardized
                                                                      In
                   • No history of acute traumatic injury or motor vehicle      pressure, as follows: palpation will be done with 2 lbs of
                        accidents                                               pressure for extraoral muscles, 1 lb of pressure on the
                   • No cranio-facial syndromes, metabolic diseases,            joint and intraoral muscles. During palpation of one side
                        neurological disorders, neoplasia                       muscles, it was used the opposite hand to brace the
                   • No social or demographic differences.                      head to provide stability.
                                                             ni

                   The social and demographic information, TMD signs            Myofascial Pain: pain of muscle origin, including a com-
                   and symptoms, and occlusal features were recorded by         plaint of pain as well as pain associated with localized
                   a well–trained clinical researcher on the case history       areas of tenderness of palpation in muscles.
                                              o

                   based on the standardized Research Diagnostic Crite-         It was report pain or ache in the jaws, temples, face,
                   ria for Temporomandibular Disorders (30).                    preauricolar area or inside the ear at rest or during
                                          izi


                   Case history consists in a history questionnaire (Fig.1)     function and pain reported by the subject in response to
                   filled in by young subjects with the help of own parents     palpation of three or more of following of 20 muscles
                   and in a second part called examination form filled in by    sites: posterior temporalis, middle temporalis, anterior
                   a researcher with records coming from clinical evalua-       temporalis, origin of masseter, body of masseter, inser-
                           Ed




                   tion (Fig. 2).                                               tion of masseter, posterior mandibular region, sub-
                   The subjects were divided into 6 groups according to         mandibular region, lateral pterygoid area, and tendon of
                   gender, age, angle dental class, presence of cross-          temporalis.
                   bite; midline deviation; chewing side in Caucasian           Arthralgia: pain or tenderness in the joint capsule
                   population.                                                  and/or the synovial lining of the TMJ.
                   The sample was first classified into two groups accord-      1) Pain in one or both joint sites (lateral pole and /or
               C




                   ing to their age: 1) 6-11 years (185 subjects), 2) 12-16     posterior attachment) during palpation;
                   years (395 subjects) and according to their gender,          2) one or more of the following self-reports of pain:
    CI




                   which included 279 males and 301 females.                    pain in the region of the joint, pain in the joint during
                   The subjects were then divided according to Angle            maximum unassisted opening, pain in the joint during
                   Dental Class into four groups:                               lateral excursion;
                   Class I: Molar and canine bilateral Class I (311 sub-        3) for a diagnosis of sample artralgia, coarse crepitus
                   jects)                                                       must be absent.
                   Class II: Molar and canine bilateral Class II (192 sub-
©




                   jects)
                   Class III: molar and canine bilateral Class III (77 sub-     Auscultation of TMJ
                   jects)
                   Subdivision Class: different classes in the two sides (0     Using a stethoscope, it was possible to find TMJ
                   subjects).                                                   sounds. These sounds may occur as a single click, or
                   The classifications are based on the relationship of         may consist of multiple sounds or crepitus.
                   the mesiobuccal cusp of the maxillary first molar and        Clicking consists of a single joint sound of short dura-

                   Annali di Stomatologia 2013; IV (3-4): 230-238                                                                     231
2_Pavoni_Riv Annali 3-4 2013 13/02/14 10:23 Pagina 232




                   F. Ballanti et al.



                    NAME                                                         PLACE OF BIRTH
                    SURNAME                                                      GENDER
                    ADDRESS                                                      JOB




                                                                                                                                                 li
                    DATE OF BIRTH                                                RACE




                                                                                       na
                    Please read each question and respond accordingly. For each of the questions below, circle only one response.

                    1. Would you say your health in general?
                    Excellent
                    Very good




                                                                                     io
                    Good
                    Fair
                    Poor




                                                                                  az
                    2. Would you say your oral health in general?
                    Excellent
                    Very good




                                                                               rn
                    Good
                    Fair
                    Poor

                    3. Have you got?




                                                                            te
                    Genetic disease
                    Metabolic disease
                    Psychiatric disease
                    Anxiety
                    Rheumatoid arthritis
                                                                         In
                    Lupus
                    Systemica arthritic disease
                    Headache
                    Noises or ringing in your ears
                                                          ni

                    4. Have you ever had acute traumatic injury or motor vehicle accidents?
                    YES
                                            o

                    NO

                    5. Have you ever had othodontic treatment?
                                        izi


                    YES
                    NO

                    6. Have you had pain in the face, jaw temple, in front of ear or in the ear in the past mouth?
                          Ed




                    YES
                    NO
                    If yes, how many months ago did your facial pain begin for the first time?
                    months _________

                    7. Does your jaw click or pop when you open or close your mouth or when chewing?
               C




                    YES
                    NO
    CI




                    8. Have you ever had your jaw lock or catch so that it won’t open all the way?
                    YES
                    NO

                    9. Have you ever told, or do you notice, that you grind, your teeth or clench your jaw while sleeping at night?
                    YES
©




                    NO

                    10. Have you a favourite chewing side?
                    YES
                    NO
                    If yes, what?

                   Figure 1. History questionnaire.

                   232                                                                                Annali di Stomatologia 2013; IV (3-4): 230-238
2_Pavoni_Riv Annali 3-4 2013 13/02/14 10:23 Pagina 233




                   Gnathological features in growing subjects



                    Opening patterns
                    Straight
                    Right Lateral Deviation (Uncorrected)




                                                                                                                                  li
                    Right Corrected (S) Deviation




                                                                                    na
                    Left Lateral Deviation (Uncorrected)
                    Left Corrected (S) Deviation
                    Functional Deviation
                    Anatomic Deviation




                                                                                  io
                    Vertical range of motion                                                                                mm




                                                                               az
                    Unassisted opening without pain
                    Maximun unassisted opening
                    Maximun assisted opening




                                                                            rn
                    Vertical incisal overlap


                    Joint sounds
                    a) Opening                                                          Right              Left




                                                                         te
                                                                    None
                                                                    Click
                                                                      In
                                                                    Crepitus
                    b) Closing                                                          Right              Left
                                                                    None
                                                                    Click
                                                             ni
                                                                    Crepitus


                    Exursions                                                                                               mm
                                              o

                    Right lateral excursion
                    Left lateral excursion
                                          izi



                    Protrution


                    Joint sounds on excursions
                           Ed




                    Right Sounds
                                                                    None                Click              Crepitus
                    Excursion right
                    Excursion left
               C




                    Protrusion
    CI




                    Left sounds
                                                                    None                Click              Crepitus
                    Excursion right
                    Excursion left
©




                    Protrusion

                   Figure 2. Examination form.

                   tion. It is loud and may be referred to as a pop.           Mandibular excursive moviments
                   Crepitation is a multiple rough gravel-like sound de-
                   scribed as grating.                                         It was used a millimeter calipers (precision 0,01 mm)

                   Annali di Stomatologia 2013; IV (3-4): 230-238                                                                233
2_Pavoni_Riv Annali 3-4 2013 13/02/14 10:23 Pagina 234




                   F. Ballanti et al.



                    Extraoral muscle pain with palpation
                    0= No Pain 1= Mild Pain 2= Moderate Pain 3= Severe Pain
                                                                                                           Right                     Left
                    Temporalis (posterior) Back of temple                                                  0123                      0123




                                                                                                                                              li
                    Temporalis (middle) Middle of temple                                                   0123                      0123
                    Temporalis (anterior) front of temple                                                  0123                      0123




                                                                                    na
                    Masseter (origin) cheek/under cheejbone                                                0123                      0123
                    Masseter (body) cheek/side of face                                                     0123                      0123
                    Masseter (insertion) cheek/jawline                                                     0123                      0123
                    Posterior mandibular region (stylohyoid/posterior digastric region)                    0123                      0123




                                                                                  io
                    Submandibular region (medial pterigoyd/suprahyoid/anterior digastric region)           0123                      0123


                    Joint pain with palpation




                                                                               az
                                                                                                           Right                     Left
                    Lateral pole outside                                                                   0123                      0123
                    Posterior attachment                                                                   0123                      0123




                                                                            rn
                    Intraoral muscle pain with palpation
                                                                                                           Right                     Left
                    Lateral pterigoyd area (behind upper molars)                                           0123                      0123




                                                                         te
                    Tendon of temporalis                                                                   0123                      0123

                   Figure 2. (cont.) Examination form.
                                                                      In
                   for measuring mandibular excursive moviments: right            These calculations were performed for each of the six
                   lateral excursion, left lateral excursion, protrusive and      categories of the groups using Sigma Stat 3.5,
                   midline deviation.                                             Systat Software Inc, Point Richmond, California, USA.
                                                         ni
                   It was necessary for evalueting reduced opening, later-
                   al and protrusive movements.
                   A restrictive mandibular opening is considered to be of        Results
                   any distance < 40 mm.
                                            o

                   The lateral movements were noted when they were <8             In this study, the prevalence of signs and symptoms of
                   mm and the protrusive movements were also evaluated            TMD was 13,9%. TMD were represented by TMJ
                                        izi


                   in a similar manner.                                           sounds. It was not found others like muscle and/or TMJ
                   The sample was then divided into three groups accord-          pain or limitation of mandibular moviments.
                   ing to midline deviation that can be classified in:
                   1) absence of deviation when midline is aligned both in
                          Ed




                   closed mouth and in open mouth (446 subjects);                 Gender and age range
                   2) functional deviation when midline is deviated in
                   closed mouth but aligned in open mouth (64 subjects);          Prevalence of TMD signs and symptoms within the
                   3) anatomic deviation when midline is deviated both in         sample classified on the basis of gender was 16,6%
                   closed mouth and in open mouth (70 subjects).                  among females and 10,8% among males, with no sig-
                   Finally it was divided in two groups according to chew-        nificant difference with respect to gender distribution
               C




                   ing side: 1) unilateral chewing (47 subjects) and 2) bi-       (χ²=0.556; p=0.456).
                   lateral chewing (533 subjects).                                Prevalence of TMD signs and symptoms within the
    CI




                                                                                  sample classified on the basis of age was 7,3% among
                                                                                  subjects who were 6-11 years old and 16,1% among
                   Statistical analysis                                           those who were 12-16 years old, with no significant dif-
                                                                                  ference between the two subgroups (χ²=1.634;
                   The data regarding the prevalence of signs and symp-           p=0.201).
                   toms in the groups were analyzed considering the six
©




                   categories of groups before described.
                   For each category of groups, the prevalence (ex-               Angle Dental Class
                   pressed in percentage with respect to the number of
                   subjects included in each group) of each TMD sign              The prevalence of TMD signs and symptoms in sub-
                   or symptom and the percentages among the differ-               jects classified according to the Angle Dental Class
                   ent groups were compared using the Chi-square                  was 14% among subjects who had class I, 15% among
                   analysis.                                                      subjects who had Class II and 9% among subjects who

                   234                                                                             Annali di Stomatologia 2013; IV (3-4): 230-238
2_Pavoni_Riv Annali 3-4 2013 13/02/14 10:23 Pagina 235




                   Gnathological features in growing subjects


                                                                                                    Figure 3. CLINICAL EXAMINA-
                                                                                                    TION a) TMJ Palpation; b) Open-
                                                                                                    ing Patterns; c,d,e,f) TMJ Auscul-
                                                                                                    tation




                                                                                                                                   li
                                                                                      na
                                                                                    io
                                                                                 az
                     a                                              b




                                                                              rn
                                                                           te
                                                                        In
                                                             ni

                     c                                              d
                                              o
                                          izi
                           Ed
               C




                     e                                              f
    CI




                   had Class III. In this analysis, there were no observed   subjects without crossbite and 14,3% among subjects
                   significant differences in the prevalence of any of the   with crossbite, with no significant difference between
                   considered TMD signs and symptoms among the differ-       the two subgroups (χ²= 0,047619; p=0.050).
©




                   ent groups (χ²=0.540; p=0.763).

                                                                             Midline deviation
                   Crossbite
                                                                             According to midline deviation, prevalence of TMD was
                   According to presence or absence of crossbite, preva-     15% among subjects who had no midline deviation,
                   lence of TMD signs and symptoms was 13,8% among           15,8% among subjects who had a functional deviation

                   Annali di Stomatologia 2013; IV (3-4): 230-238                                                                 235
2_Pavoni_Riv Annali 3-4 2013 13/02/14 10:23 Pagina 236




                   F. Ballanti et al.


                   and 4,7% among subjects who had anatomic deviation            Other authors instead consider some Angle dental
                   (χ²= 1.555556; p=0.050).                                      classes like risk factors predisposing to TMD. Szentpte-
                                                                                 teri et al., in 1986; Selaimen in 2007 consider Class II
                                                                                 malocclusions as an important risk factor (13, 35).
                   Chewing                                                       Selaimen has analyzed a group of 72 subjects with TMD,




                                                                                                                                            li
                                                                                 myofascial pain, with or without restriction in the opening
                   According to chewing side, prevalence of TMD was              and artalgia comparing with a control group. His analysis




                                                                                     na
                   12,6% among subjects who had a bilanced chewing               showed that the absence of a canine in lateral excursions
                   and 28% among subjects who had unilateral chewing             (crude OR = 3.9, CI = 1.6 to 9.7) and the Class II maloc-
                   (χ²=2,18181; p=0.050).                                        clusion (crude OR = 8.0, confidence interval [CI] = 2.2 to
                                                                                 29.3) can be considered as potential risk factors (35).




                                                                                   io
                                                                                 Many authors consider class III malocclusion, especial-
                   Discussion                                                    ly those characterized by the presence of scissor-bite
                                                                                 and open bite, a condition of potential risk both in chil-




                                                                                az
                   TMD distribution according to gender and age                  dren and in adult because frequently associated with
                   In this epidemiological investigation we found no signifi-    occlusal interferences.
                   cant differences between the DTM and gender and age           Among occlusal variables, cross-bite, especially the
                   group. According to gender, our result is similar to          unilateral one, has a significant role in the development




                                                                             rn
                   those of some authors (18, 22, 26). Motegi et al. exam-       of the TMD.
                   ined 7337 Japanese subjects (3219 F and 4118 M)               In support of this thesis, there are in fact several au-
                   aged between 6 and 18 years and found an incidence            thors (9, 28, 34, 36). Myers et al. found that in children
                   of DTM, consisting mainly of joint sounds (97.2%),            with functional posterior cross-bite, the condyle can be




                                                                          te
                   12.2%. The incidence of DTM is 11% for males and              displaced upwardly from the side of the cross-bite and
                   13% for females without a statistically significant differ-   bottom side without cross-bite (36).
                   ence (18).                                                    Motegi has instead showed a higher correlation be-
                   If we consider pain symptoms, the situation changes.          tween TMD with crowding (24.9%) and excessive over-
                                                                       In
                   According Walhund K, 2003; Hirsch et al. 2006, Nilsson        jet (20.1%). Instead, the correlation with other occlusal
                   IM et al., 2007, females are more severely affected by        variables was lower: deep bite (6.8%), bite the head-to-
                   the pain symptoms than males and this can be ex-              head (6.3%), anterior cross-bite (5.4%) and posterior
                   plained by considering the different hormonal functions       cross-bite (3.8%) (18).
                   (23, 27, 31, 32). Walhund K analysed 864 adolescents          People with an excessive overjet, tend to protrude the
                                                          ni
                   and found a higher prevalence of pain symptoms in fe-         mandible (37). This tends to cause a double closure
                   males than in males (23). Hirsch has reached the same         (dual bite), which over time could affect the function of
                   conclusion, analysing a sample of 1011 subjects aged          the masticatory muscles, increase muscle tension and
                                            o

                   10-18 years (31). In our sample, the pain does not ap-        overload the TMJ (38). Occlusal crowd tends to cause
                   pear statistically significant (0 subjects) probably be-      occlusal interference and seems to be a critical factor in
                   cause of the young age of the subjects (mean age 13.4         the genesis of TMD.
                                        izi


                   years) due to a prepuberal growth stage.                      Other authors believe that to contribute to the onset of
                   In relation to age, our study showed no significant dif-      DTM, it is not malocclusion conceived as a static oc-
                   ferences between the DTM and age in contrast to other         clusal relationship but conceived by the functional point
                   studies in which the prevalence of DTM increases with
                          Ed




                                                                                 of view. Therefore, any alteration of the occlusal func-
                   increasing age (22, 26, 33, 34).                              tion as parafunction, habits, premature, interference,
                   Magnusson T, in a prospective study, followed 402 sub-        unilateral chewing, may result in TMD (39, 40).
                   jects 7, 11 and 15 years randomly selected for a period of    The cross-sectional study conducted by Casanova-
                   20 years. The author has observed that the prevalence of      Rosado on a sample of 506 Mexicans aged 14-25
                   DTM increases from childhood to adolescence (34).             years actually showed as significant risk factors gender
                   Studying 101 adolescents (aged 11-17) with a cross-
               C




                                                                                 (Female Odds Ratio (OR) = 1.7), bruxism (OR = 1.5)
                   sectional study, Le Resche has concluded that the             and unilateral chewing (OR = 1.5) (40).
                   prevalence of TMD is linked more to pubertal develop-
    CI




                   ment rather than to age (33).
                   Our hypothesys because, in relation to age, our study         Conclusions
                   showed no significant differences could be the mean
                   age of 12y-16y sample near to 13 years and so due to          The results in the current study, in a Caucasian sample
                   a preadolescent stage.                                        of 6-16 years old (580 subjects), indicate that there is
©




                                                                                 not any association among TMD signs and symptoms
                                                                                 and the analysed features.
                   TMD distribution according to occlusal factors
                   In our analysis significant differences between the DTM
                   and the different Angle dental classes were not found.        References
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                   238                                                                               Annali di Stomatologia 2013; IV (3-4): 230-238
