Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
Visit old site
Home Print this page Email this page Small font size Default font size Increase font size
Users Online: 2003


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 6  |  Issue : 3  |  Page : 126-132

Prevalence of temporomandibular disorder in children and adolescents from public schools in Southern Portugal


1 School of Health Jean Piaget Algarve, Piaget Institute; National School of Public Health, NOVA University of Lisbon, Portugal
2 School of Health Jean Piaget Algarve, Piaget Institute, Portugal

Date of Web Publication11-Mar-2014

Correspondence Address:
Beatriz Minghelli
Instituto Piaget, Escola Superior de Saúde Jean Piaget/Algarve, Enxerim, 8300-025, Silves
Portugal
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1947-2714.128474

Rights and Permissions
  Abstract 

Background: The prevalence of temporomandibular disorder (TMD) in children and adolescents is in the range of 6-68% and can be triggered or aggravated by emotional stress. Aim: The study was to investigate the prevalence of TMD in Portuguese children and adolescents and its association with emotional stress. Materials and Methods: The sample comprised 3,260 students aged 5-19 years. The questionnaire was used to assess the presence of TMD, and was applied in a single moment. Results: TMD was observed in 821 (25.2%) students. The most common symptoms of TMD were: if considered tense or nervous (52%), have headaches (36.8%), and habit of clenching or grinding teeth (27.3%). The girls had a 1.36 higher probability of developing TMD than boys (95% CI: 1.14-1.63; p < 0.001); moreover, students from the older age group had a 2.31 higher probability of developing the disorder (95% CI: 1.85-2.89; p < 0.001). Students who considered themselves tense or nervous presented 8.74 higher probability (95% CI: 7.03-10.86; p < 0.001) of developing TMD. Conclusion: This study showed a high prevalence of TMD in children and adolescents in southern Portugal, and revealed a significant association between this dysfunction and the levels of emotional stress. Female students, older students, and those considered tense or nervous have a higher probability of developing TMD.

Keywords: Adolescent, children, emotional stress, prevalence, temporomandibular disorder


How to cite this article:
Minghelli B, Cardoso I, Porfírio M, Gonçalves R, Cascalheiro S, Barreto V, Soeiro A, Almeida L. Prevalence of temporomandibular disorder in children and adolescents from public schools in Southern Portugal. North Am J Med Sci 2014;6:126-32

How to cite this URL:
Minghelli B, Cardoso I, Porfírio M, Gonçalves R, Cascalheiro S, Barreto V, Soeiro A, Almeida L. Prevalence of temporomandibular disorder in children and adolescents from public schools in Southern Portugal. North Am J Med Sci [serial online] 2014 [cited 2019 Nov 16];6:126-32. Available from: http://www.najms.org/text.asp?2014/6/3/126/128474


  Introduction Top


Temporomandibular disorder (TMD) is a dysfunction that affects the tempomandibular joints (TMJ) and masticatory muscles of the stomatognathic system and associated structures. [1],[2],[3] The disease can affect individuals of any age group, with a higher prevalence among women in the age group of 20-45 years; [1],[2],[3] however, many studies have reported a high incidence of signs and symptoms of the disorder in children similar to those seen in adults. [4],[5],[6] Several studies indicate that approximately 60-70% of the population has at least one sign of TMD at some point in their life. [3],[7] In children and adolescents, the prevalence of TMD ranges between 6% and 68%. [1],[6],[8],[9]

The etiology of TMD is multifactorial and its signs and symptoms involve pain in the TMJ, pre-auricular region, cervical spine, head and face, muscle fatigue in the cervical and craniofacial region and the muscles of mastication, range limitation of jow motion and joint noises and headaches. [2],[10],[11],[12] The spasm of the muscles of mastication is the main cause of painful symptoms in TMD; this can be caused by distention, malocclusion, or the contraction muscle fatigue due to the presence of parafunctional habits, including bruxism and nail biting. [2],[3],[13] Several studies conducted in different populations have shown that these habits can be developed or aggravated by emotional stress. [2],[3],[13],[14],[15] Thus, psychosocial factors such as anxiety, stress, and depression play an important role in the pathogenesis of TMD. [16]

High levels of stress may lead to the development of constant dental clamping, affecting the circulation in local muscles and altering the ionic balance in cell membranes; this, in turn, leads to the accumulation of lactic and pyruvic acids, resulting in the stimulation of pain receptors. [16] There are various instruments for the assessment of TMD, including indices, questionnaires, protocols, rating scales, and diagnostic criteria. Of these, questionnaires have the advantage of low cost, ease of use, and fast for epidemiological survey; in addition, these can be easily applied to a large number of individuals. [17] National studies on the prevalence of TMD in children and adolescents are unavailable; therefore, studies are crucial to identify the prevalence of this disorder as it affects many individuals who are in the growth phase and are unaware of their diagnosis, which help prevent the appearance of craniofacial growth abnormalities, pain in the TMJ, or mandibular dysfunction in adulthood. [18]

Thus, the objectives of this study were to assess the prevalence of TMD in children and adolescents from public schools in southern Portugal and its association with emotional stress.


  Material and methods Top


The design of this study was epidemiological, observational, analytical, and cross-sectional. The study was approved by the Ethics Committee of the Regional Health Administration of the Algarve, the Regional Directorate of Education of the Algarve, the Directorate General for Innovation and Curriculum Development, the Ministry of Education and Science, and the Directors of the schools that participated in the project. Written informed consent was obtained from all subjects.

Population and sample:

The population involved students (of both sexes) enrolled in public schools from all counties of Algarve. The region of Algarve, South of Portugal, has 16 counties: Albufeira, Alcoutim, Aljezur, Castro Marim, Faro, Lagoa, Lagos, Loulé, Monchique Olhão Portimão São Brás, Silves, Tavira, Vila do Bispo, and Vila Real de Santo António.

Considering an estimate of the population dimension, among the number of students between the elementary school (1 st -4 th and 5 th -9 th ) and high school (10 th -12 th ) (52,480 students), the minimum sample size was taken as 2,527 students, taking into account an estimate of the annual prevalence of TMD of 20% reported in international studies [7],[19],[20],[21] and assuming an error margin of 2% with a confidence level of 99%.

A stratified random sample was used, where the target population was divided into subgroups considered homogeneous, and then a sample from each stratum was randomly selected. Therefore, within each county, schools were randomly selected (if there was more than one school in the county). The sample dimension in counties considered the number of students enrolled in each county. Taking into account non-adherence by students and/or parents, the questionnaires were distributed to all students in selected schools.

Inclusion criteria involved the students who had brought the parental or guardian consent and who wanted to participate.

Students were divided into three age groups: group 1 composed of students aged 5-9 years, group 2 included students aged 10-14 years, and group 3 had students aged above 15 years. This division considered the grade school level divided by schools, including the elementary school and high school.

Measures

The instrument of measurement consisted of a questionnaire that was applied only once during October 2012 to January 2013. The questionnaire consisted of two parts: Socio-demographic characterization of population and Fonseca Anamnestic Questionnaire.

Socio-demographic characterization of population questionnaire

The questions about socio-demographic characteristics of the population included the school name, age, grade school, and gender. We also included questions about prior knowledge of TMD diagnosis and whether the individual has made or makes any treatment for TMD. The choices of answers for these last questions were YES and NO.

Fonseca Anamnestic Questionnaire

The Fonseca Anamnestic Questionnaire is a modified version of the Index Anamnestic Helkimo and is one of the few instruments available in Portuguese and features that assess the severity of the TMD symptoms. The Helkimo index was one of the first to be referred to in the literature as having the reliability to identify signs and symptoms of TMD. [17],[21],[22]

The Fonseca Anamnestic Questionnaire obtained a 95% correlation with the clinical Helkimo index (r = 0.6169, p < 0.05), and 95% reliability in application and allows one to collect a large number of information in a short period of time, and is a low-cost application, easy for perception-based evaluation, and does not influence the appraiser in obtaining answers. [17],[21],[22]

This instrument consists of 10 questions, whose answer options are NO, SOMETIMES, and YES. The questionnaire included questions on the presence of TMJ pain, head and neck pain, pain while chewing, questions on parafunctional habits, limitation of joint movement, perception of malocclusion, and emotional stress. [17]

Each answer has a value; answer NO has 0 value, SOMETIMES has 5 values, and YES has 10 values. The sum of the values ​​obtained provides an index that classifies individuals in the absence of TMD (0-15 values), mild TMD (20-45 values), moderate TMD (50-65 values), and severe TMD (70-100 values​​). [17]

Statistical study

In the first approach, descriptive statistics were made to all variables in the study. After that, Chi-squared Test of Independence was applied in order to evaluate associations between the occurrence of TMD and gender, age group, and emotional stress.

In order to satisfy the requirements of applicability of Chi-squared Test for Independence, the variable TMD was grouped into absence and presence (included mild, moderate, and severe TMD).

The influence of the variables use in this study with the presence of TMD was assessed using binary logistic regressions. The models Enter e Forward LR and the Omnibus, Hosmer, Lemeshow, and Nagelkerke tests were used. The models' results were presented as Odds Ratios (OR) crude and adjusted and respective confidence intervals.

The statistical analysis was performed with the Statistical Package for Social Sciences (SPSS) version 19.0. Statistical significance was set at 0.05.


  Results Top


The sample consisted of 3,260 children and adolescents aged 5-19 years (11.83 ± 3.8 years), of which 1,504 (46.1%) were male and 1,756 (53.9%) were female.

From the 16 counties of the Algarve region, six did not participate because of logistics issues or refused to participate in the study. Of the students evaluated, 684 (21%) were from the counties of Portimão, 651 (20%) from Faro, 642 (19.7%) from Loulé, 427 (13.1%) from Silves, 244 (7.5%) from Vila Real Santo Anténio, 202 (6.2%) from São Brás do Alportel, 155 (4.8%) from Albufeira, 142 (4.4%) from Olhão, 75 (2.3%) from Vila do Bispo, and 38 (1.2%) from Alzejur.

Only 56 (1.7%) students reported that they had been diagnosed with TMD, and 26 (0.8%) were undergoing treatment.

[Table 1] shows the absolute and relative frequencies of answers to the Fonseca Anamnestic Questionnaire. The most common symptoms of TMD (summing the answers YES and SOMETIMES) were the following: if considered tense or nervous (52%), have headaches (36.8%), habit of clenching or grinding teeth (27.3%), and pain in the neck (17.7%).
Table 2: Associations between the presence of TMD with gender, age group, and emotional stress

Click here to view


A total of 2,439 (74.8%) students did not have TMD and 821 (25.2%) had TMD; moreover, 729 (22.4%) students presented with mild TMD, 83 (2.5%) had moderate, and 9 (0.3%) had severe TMD.

Of the 821 (100%) students with TMD, most were female (61.5%) and belonged to the age group of 15-19 years (43.4%), followed by the age group of 10-14 years (34.2%). With regard to emotional stress, 709 (86.3%) of the students with TMD considered themselves tense or nervous (considering the answers YES and SOMETIMES) [Table 2].{Table 2}

In the adjusted model, the values obtained in the Omnibus, Hosmer, Lemeshow, and Nagelkerke tests were respectively p = 0.000, p = 0.673, R 2 = 0.266 being considered mathematically valid models to perform the analysis (applied to the characteristics of the sub-sample absence and presence of TMD adjusted for the age group, gender, and tension).

[Table 3] shows the values ​​obtained with the binary logistic regression analysis for the presence of TMD. The data revealed that girls have 1.36 higher probability of developing TMD than boys (95% CI: 1.14-1.63; p < 0.001); moreover, students in the older age group have 2.31 higher probability (95% CI: 1.85-2.89; p < 0.001). With regard to emotional stress, the data revealed that students who considered themselves tense or nervous had 8.74 higher probability (95% CI: 7.03-10.86; p < 0.001) of developing TMD. The values ​​of the adjusted OR showed values ​​similar to the crude OR demonstrating independence between the variables analyzed.
Table 3: Results of binary logistic regression for the presence of TMD

Click here to view



  Discussion Top


The results of this study revealed a high prevalence of TMD in a stratified representative sample of adolescents in southern Portugal (25.2%), verifying that a minimum percentage of these had prior knowledge of TMD diagnosis (1.7%). These data are similar to those obtained in the studies of Bernal and Tsamtsouris [19] who found a prevalence of 21.2% in children aged 3-5 years; however, the age of the sample analyzed in this study differs. The study of Feteih [8] revealed a TMD prevalence of 21.3% in 385 adolescents in the age group of 12-16 years. Some studies [6],[23] have shown a higher prevalence rate than that in the present study, such as Gazit et al., [23] which evaluated 369 Israeli students in the age group of 10-18 years (56.4%).

Regarding severity, most students exhibited mild TMD (22.4%). The same was observed in a longitudinal study of Magnusson et al., [6] which evaluated 119 children at intervals of 4 years and found that, in most cases, the signs were mild; however, moderate TMD was noted in 11% of the 11-year-old children and 17% of the 15-year-old children. The most common symptoms of TMD observed in this study included emotional stress (52%), headache (36.8%), habit of clenching or grinding teeth (27.3%), pain in the neck (17.7%), fatigue/muscle pain while chewing (14.3%), and ear pain or in the region of TMJ (14.2%).

The responses from the Fonseca Anamnestic Questionnaire revealed that most of the subjects (86.3%) were tense or nervous at some point (information obtained from the student's perspective). The study by Martins et al. [16] revealed that 72.4% of the subjects who required treatment for TMD reported to be under emotional stress. The same was observed by Bertoli et al., [24] who found a significant difference in the signs and symptoms of TMD according to emotional status (higher in those with tense status compared to calm status).

Several studies have found that a child's emotional status may influence the risk of developing signals of TMD. [25],[26] High tension level can lead to the development of a constant dental clamping, which affects the local circulation in muscles, altering the cell membranes that perform ion exchange; this leads to an accumulation of lactic and pyruvic acids which results in the stimulation of pain receptors. [15]

The study by Muhtaro∂ullarý et al. [27] evaluated 40 children with primary dentition and 40 children with mixed dentition (age group 4-13 years) and found that the most frequent sign was headache (15% and 27.5%, respectively). Bonjardim et al. [28] evaluated 217 adolescents aged 12-18 years and found that the most prevalent symptoms were joint sounds (26.72%) and headache (21.65%); furthermore, the study by Feteih [8] revealed a prevalence of headache in 22% of the adolescents.

Bertoli et al. [24] evaluated the signs and symptoms of TMD in 50 children in the age group of 4-18 years who had headaches; they found a higher prevalence of signs and symptoms of TMD in patients having headaches compared to the control group. Franco et al. [20] evaluated 1,307 students in the age group of 12-14 years, and found that 45.5% of the students presented a headache, and this symptom was associated with the presence of TMD.

The headaches are very common among children and adolescents mainly in the premenstrual period, migraine, stress, tension-type headaches, and headache due to high blood pressure. [29] Thus, the presence of headache could also have causes other than the overhead of the muscles of the temporomandibular region. Liljeström et al. [30] observed the association of TMD and headache in a group of adolescents with primary headache and concluded that TMD should always be considered when headaches are associated with ear pain, difficulty in opening the mouth, and fatigue or stiffness of the jaw.

The possible relation between TMD and headache can be explained by the fact that headache is related to muscle activity; thus, activities involving the head and neck likely play an important role in the etiology of many headaches. [31]

Pain in the temporomandibular region appears to be relatively common with prevalence rates ranging from 0 to 18%, with an average of 3%; however, it is a condition usually seen in young and middle-aged adults, rather than in children or the elderly. [1] Pain in the ears may be present in individuals with TMD due to the proximity between that area and the TMJ and masticatory muscles because these structures have a common trigeminal nerve innervation, thus producing reflex pain. [31] Some studies show only 3% and 4% prevalence of pain in the TMJ in children in the age groups of 7-14 years and 15-18 years, respectively. [32],[33] A study by Muhtaro∂ullarý et al. [27] revealed 22.5% prevalence of pain in the TMJ in children aged 13 years and a study by Bonjardim et al. [28] showed 12.9% prevalence of pain in the face or jaw. The present study found a higher prevalence rate of pain, but was considered low compared to the other symptoms analyzed. It is believed that the low prevalence of pain in children may be due to a delayed action of risk factors, or the risk factors may be present but a certain duration of exposure to these risk factors is required for the pain to develop. Another explanation may be that in children, muscle tissue have a greater potential for cure and adjustment; hence, continuous pain does not develop. [1]

With regard to gender, girls showed a higher prevalence of TMD (61.5%), and these findings are in accordance with the results of other studies conducted in different populations. [8],[34],[35] Hirsch et al. [35] evaluated 1,011 German children and adolescents aged 10-17 years and found a higher probability of developing TMD in girls compared to boys (OR for girls versus boys: 1.42-1.53; p ≤ 0.05). The high prevalence of TMD in girls could be explained on the basis of physiological characteristics, particularly hormonal variations and structures in the connective tissue and muscle. The greater laxity of these tissues, related to estrogen levels, explains that these tissues have a lower capacity to support the functional pressure, thus leading to TMD. [3],[36] The study by Leresche et al. [37] found variations in clinical pain intensity in women with TMD during the menstrual cycle, where the highest values ​​of pain coincided with the period of higher concentrations of estrogen.

The highest prevalence of TMD was also observed in the older individuals, who were not analysed based on gender, this increase in prevalence with advancing age may be related to the hormonal impact. Future research is needed to find out the association of TMD with hormonal action.

The age of onset of TMD in children and adolescents is still unknown. [1] Data from this study revealed the highest prevalence of TMD in older students. The same was observed in the studies of Bertoli et al. [24] and Gazit et al. [23] Some studies reveal that the frequency of signs and symptoms of TMD increases during childhood and, in adolescence, reaches a level similar to that found in adults. [34],[37],[38]

The data from this study revealed a significant association between TMD and levels of anxiety or depression, which are in agreement with the results obtained in several studies. [10],[13],[39]

As previously reported, individuals subjected to some kind of stress can develop parafunctional habits and muscle tension, which leads to the development of TMD. [16] Thus, the parafunctional components, especially those that increase muscle tension and cause changes in the emotional status are good indicators of the jaw pain in patients with TMD, which indicates that anxiety or depression can be considered as etiological factors for TMD.

This study presented a limitation to the use of questionnaires as a method of collecting data in order to classify the individual as having TMD, requiring more detailed clinical examination of the signs and symptoms of TMD as well as imaging tests to confirm the diagnosis.

A limitation of the use of Fonseca Anamnestic Questionnaire is that it does not offer diagnostic classification of TMD. Thus, the data obtained with this index are restricted to the classification of the severity of signs and symptoms of TMD. Another limitation is the scoring system, since three affirmative answers are given to questions about headache, cervical pain, and perception of emotional tension, the individual will be classified as having mild TMD. However, these same symptoms can occur in isolation, with no association with TMD. Nevertheless, questionnaires are most widely used in prevalence studies since it is easier to get a large sample and apply these in children and adolescents, in terms of logistics. Hence, the simplicity of the Fonseca Anamnestic Questionnaire favors its use in epidemiological population studies. These limitations may be related to the high prevalence observed in this study.

The present study is a pioneering study, conducted on a sample of only one region of the country; however, it indicates that the prevalence of this condition may be higher. Disclosing the subject of the study with the population is of great importance for the participants as they become more aware of the signs and symptoms of TMD and are able to ask for help in solving it. Future studies are needed including a sample from other regions of the country in order to be aware of this disorder on the national level.


  Conclusion Top


The results of this study revealed a high prevalence of TMD in a sample of children and adolescents in southern Portugal, and described a relationship between this dysfunction with the levels of emotional stress. Female students, older students, and those considered tense or nervous are more likely to develop TMD.

 
  References Top

1.Leresche L. Epidemiology of temporomandibular disorders: Implications for the investigation of etiologic factors. Crit Rev Oral Biol Med 1997;8:291-305.  Back to cited text no. 1
    
2.Dimitroulis G. Temporomandibular disorders: A clinical update. BMJ 1998;317:190-4.  Back to cited text no. 2
    
3.Roda R, Bagán J, Fernández J, Bazán S, Soriano Y. Review of temporomandibular joint pathology. Part I: Classification, epidemiology and risk factors. Med Oral Patol Oral Cir Bucal 2007;7:E292-8.  Back to cited text no. 3
    
4.Gazit E, Liebermann M, Eini R, Hirsch N, Serfaty V, Fuchs C, et al. Prevalence of mandibular dysfunction in 10-18 year old Israel: School children. J Oral Rehabil 1984;11:307-17.  Back to cited text no. 4
    
5.Grosfeld O, Czarnecka B. Muscular articular disorders of the stomatognathic system in school children examined according to clinical criteria. J Oral Rehabil 1977;4:193-200.  Back to cited text no. 5
    
6.Magnusson T, Egermark-Eriksson I, Carlsson G. Four-year longitudinal study of mandibular dysfunction in children. Community Dent Oral Epidemiol 1985;13:117-20.  Back to cited text no. 6
    
7.Macfarlane T, Gray R, Kincey J, Worthington H. Factors associated with the temporomandibular disorder, pain dysfunction syndrome (PDS): Manchester case-control study. Oral Dis 2001;7:321-30.   Back to cited text no. 7
    
8.Feteih R. Signs and symptoms of temporomandibular disorders and oral parafunctions in urban Saudi arabian adolescents: A research report. Head Face Med 2006;2:25.  Back to cited text no. 8
    
9.Okeson J. Management of Temporomandibular Disorders and Occlusion. 6 th ed. St. Louis: Mosby Elsevier; 2008; 631.  Back to cited text no. 9
    
10.Callahan C. Stress, coping, and personality hardiness in patients with temporomandibular disorders. Rehabil Psychol 2000;45:38-48.  Back to cited text no. 10
    
11.American Society of Temporomandibular Joint Surgeons (ASTJS). Guidelines for diagnosis and management of disorders involving the temporomandibular joint and related musculoskeletal structures. Cranio 2003;21:68-76. (Accessed August 12, 2010, at http://astmjs.org/final%20guidelines-04-27-2005.pdf).  Back to cited text no. 11
    
12.AAOMS.org. Rosemont, Illinois: American Association of Oral and Maxillofacial Surgeons; c2008-2011 (Accessed September 24, 2010, at http://www.aaoms.org).  Back to cited text no. 12
    
13.Glaros A, Williams K, Lausten L. The role of parafunctions, emotions and stresse in predicting facial pain. J Am Dent Assoc 2005;136:451-8.  Back to cited text no. 13
    
14.Sherman J, Leresche L, Huggins K, Mancl L, Sage J, Dworkin S. The relationship of somatization and depression to experimental pain response in women with temporomandibular disorders. Psychosom Med 2004;66:852-60.  Back to cited text no. 14
    
15.Martins R, Garcia A, Garbin C, Sundefeld M. The relation between socio-economic class and demographic factors in the occurrence of temporomandibular joint dysfunction. Ciênc Saúde Coletiva 2008;13 Suppl 2:2089-96.  Back to cited text no. 15
    
16.Cestari K, Camparis C. Psychological Factors: its Importance in Temporomandibular Disorders Diagnosis. JBA 2002;2:54-60.  Back to cited text no. 16
    
17.Chaves T, Oliveira A, Grossi D. Main instruments for assessing temporomandibular disorders, part I: indices and questionnaires; a contribution to clinicians and researchers. Fisioter. Pesqui. 2008;15:92-100.  Back to cited text no. 17
    
18.Kritsineli M, Shim Y. Malocclusion, body posture, and temporomandibular disorders in children with primary and mixed dentition. Clin Pediatr Dent 1992;16:86-93.  Back to cited text no. 18
    
19.Bernal M, Tsamtsouris A. Signs and symptoms of temporomandibular joint dysfunction in 3 to 5 year old children. J Pedod 1986;10:127-40.  Back to cited text no. 19
    
20.Franco A, Fernandes G, Gonçalves D, Bonafé F, Camparis C. Headache associated with temporomandibular disorders among young Brazilian adolescents. Clin J Pain 2013. [In press]   Back to cited text no. 20
    
21.Wänman A, Agerberg G. Two-year longitudinal study of symptoms of mandibular dysfunction in adolescents. Acta Odontol Scand 1986;44:321-31.  Back to cited text no. 21
    
22.Nomura K, Vitti M, Oliveira A, Chaves T, Semprini M, Siéssere S, et al. Use of the Fonseca's Questionnaire to assess the prevalence and severity of temporomandibular disorders in Brazilian dental undergraduates. Braz Dent J 2007;18:163-7.  Back to cited text no. 22
    
23.Gazit E, Lieberman M, Eini R, Hirsch N, Serfaty V, Fuchs C, et al. Prevalence of mandibular dysfunction in 10-18 year old Israeli schoolchildren. J Oral Rehabil 1984;11:307-17.  Back to cited text no. 23
    
24.Bertoli F, Antoniuk S, Bruck I, Xavier G, Rodrigues D, Losso E. Evaluation of the signs and symptoms of temporomandibular disorders in children with headaches. Arq Neuropsiquiatr 2007;65:251-5.  Back to cited text no. 24
    
25.Vanderas A. Prevalence of craniomandibular dysfunction in white children with different emotional states: Part III. A comparative study. J Dent Child 1992;1:23-7.  Back to cited text no. 25
    
26.Alamondi N. Correlation between oral parafunction and temporomandibular disorders and emotional status among Saudi children. J Clin Pediatr Dent 2001;26:71-80.  Back to cited text no. 26
    
27.Muhtaroðullarý M, Demirel F, Saygýlý G. Temporomandibular disorders in Turkish children with mixed and primary dentition: Prevalence of signs and symptoms. Turk J Pediatr 2004;46:159-63.  Back to cited text no. 27
    
28.Bonjardim L, Gavião M, Pereira L, Castelo P, Garcia R. Signs and symptoms of temporomandibular disorders in adolescents. Braz Oral Res 2005;19:93-8.  Back to cited text no. 28
    
29.Strine T, Okoro C, McGuire L, Balluz L. The association among childhood headaches, emotional and behavioral difficulties, and health care use. Pediatrics 2006;115:1728-35.  Back to cited text no. 29
    
30.Liljestrom M, Le Bell Y, Anttila P, Aromaa M, Jamsa T, Metsahonkala L, et al. Headachechildren with temporomandibular disorders have several types of pain and other symptoms. Cephalalgia 2005;25:1054-60.  Back to cited text no. 30
    
31.Tomacheski D, Barboza V, Fernandes M, Fernandes F. Temporomandibular joint dysfunction: introductory study structuring dentistry recordings. Publ UEPG Ci Biol Saúde 2004;10:17-25.  Back to cited text no. 31
    
32.Nilner M, Lassing S. Prevalence of functional disturbances and diseases of the stomatognathic system in 7-14 year olds. Swed Dent J 1981;5:173-87.  Back to cited text no. 32
    
33.Nilner M. Prevalence of functional disturbances and diseases of the stomatognathic system in 15-18 year olds. Swed Dent J 1981;5:189-97.  Back to cited text no. 33
    
34.Wänman A, Agerberg G. Two-year longitudinal study of symptoms of mandibular dysfunction in adolescents. Acta Odontol Scand 1986;44:321-31.  Back to cited text no. 34
    
35.Hirsch C, Hoffmann J, Türp J. Are temporomandibular disorder symptoms and diagnoses associated with pubertal development in adolescents? An epidemiological study. J Orofac Orthop 2012;73:6-8.  Back to cited text no. 35
    
36.Ribeiro-da-Silva M, Line S, Santos M, Arthuri M, Hou W, Fillingim R, et al. Estrogen receptor-á polymorphisms and predisposition to TMJ disorder. J Pain 2009;10:527-33.  Back to cited text no. 36
    
37.Leresche L, Manci L, Sherman J, Gandara B, Dworkin S. Changes in temporomandibular pain and other symptoms across the menstrual cycle. Pain 2003;106:253-61.  Back to cited text no. 37
    
38.Morawa A, Loos P, Easton J. Temporomandibular joint dysfunction in children and adolescents: Incidence, diagnosis and treatment. Quintessence Int 1985;16:771-7.  Back to cited text no. 38
    
39.Bonjardim L, Lopes-Filho R, Amado G, Albuquerque R, Goncalves S. Association between symptoms of temporomandibular disorders and gender, morphological occlusion, and psychological factors in a group of university students. Indian J Dent Res 2009;20:190-4.  Back to cited text no. 39
[PUBMED]  Medknow Journal  



 
 
    Tables

  [Table 1], [Table 2], [Table 3]


This article has been cited by
1 How do we assess musicians’ musculoskeletal symptoms?: a review of outcomes and tools used
Jessica STANHOPE,Dino PISANIELLO,Rebecca TOOHER,Philip WEINSTEIN
Industrial Health. 2019; 57(4): 454
[Pubmed] | [DOI]
2 Prevalence and Extrinsic Risk Factors for Dental Erosion in Adolescents
Ana C Mafla,Ximena A Cerón-Bastidas,Maria E Munoz-Ceballos,Diana C Vallejo-Bravo,Maria C Fajardo-Santacruz
Journal of Clinical Pediatric Dentistry. 2017; 41(2): 102
[Pubmed] | [DOI]
3 Temporomandibular disorders and oral parafunction in children living with their parents and children living in institutional protective care: a comparative study
Ülkü Sermet Elbay,Husniye Demirturk Kocasarac,Mesut Elbay,Can Kaya,Ceren Ugurluel,Canan Baydemir
International Dental Journal. 2016;
[Pubmed] | [DOI]
4 Association between temporomandibular disorders and music performance anxiety in violinists
M. I. T. Amorim,A. I. L. Jorge
Occupational Medicine. 2016; 66(7): 558
[Pubmed] | [DOI]
5 Low Level Laser Therapy Versus Pharmacotherapy in Improving Myofascial Pain Disorder Syndrome
Hamid Reza Khalighi,Hamed Mortazavi,Seyed Masoud Mojahedi,Saranaz Azari-Marhabi,Faranak Moradi Abbasabadi
Journal of Lasers in Medical Sciences. 2016; 7(1): 45
[Pubmed] | [DOI]
6 The associations between psychosocial aspects and TMD-pain related aspects in children and adolescents
Amal Al-Khotani,Aron Naimi-Akbar,Mattias Gjelset,Emad Albadawi,Lanre Bello,Britt Hedenberg-Magnusson,Nikolaos Christidis
The Journal of Headache and Pain. 2016; 17(1)
[Pubmed] | [DOI]
7 The Prevalence of TMD in Polish Young Adults
Jolanta E. Loster,Magdalena A. Osiewicz,Magdalena Groch,Wojciech Ryniewicz,Aneta Wieczorek
Journal of Prosthodontics. 2015; : n/a
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Material and methods
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed1733    
    Printed42    
    Emailed0    
    PDF Downloaded440    
    Comments [Add]    
    Cited by others 7    

Recommend this journal