Prevalence of the Signs and Symptoms of Temporomandibular Disorders Among Spanish Adults and Seniors According to Five National Surveys Performed Between 1993 and 2015

Aims: To determine the prevalence of the signs and symptoms of temporomandibular disorders (TMD) and associated variables over the past two decades in samples of Spanish adults and seniors. Methods: Data from Spanish national oral health surveys from the last two decades (1993, 2000, 2005, 2010, and 2015) were analyzed from a total of 2,602 adults (35–44 years of age) and 2,529 seniors (65–74 years of age). All surveys were carried out using similar methods (according to World Health Organization standards) for determining prosthetic, dental, and periodontal statuses. For TMD (assessed only among the adults and seniors), inspection/palpation of the temporomandibular joint and masticatory muscles was used to evaluate three different domains: joint sounds; pain-related conditions (joints/muscles); and range of jaw motion. Risk factors were identified using bivariate analysis and were confirmed after a multivariate logistic regression analysis for predicting the presence of TMD pain/dysfunction. Results: Despite the clear improvement in oral health status observed over the entire study period (1993–2015), the prevalence of temporomandibular pain and dysfunction increased over time in both adults and seniors (the odds ratio [OR] 95% confidence interval [CI] for the entire study period increased, to 2.39 to 4.29). The odds of women and those living in rural areas developing TMD were higher than for men (OR = 1.85; 95% CI 1.52 to 2.25; P < .001) and for those living in urban areas (OR = 1.55; 95% CI 1.24 to 1.94; P < .001), respectively; however, the prevalence of joint sounds (with no pain or functional restrictions) appeared to be stable throughout the study period at around 14%. Conclusion: The prevalence of painful or dysfunctional TMD has significantly increased in the last 22 years in Spain. Besides the time factor, other major predictors of TMD were gender and place of residence.

epidemiology;functional limitation;pain;risk factors;secular changes;temporomandibular disorders

1.Okeson JP. Management of Temporomandibular Disorders and Occlusion, ed 7. St Louis: Mosby, 2013.

2.Wänman A. Longitudinal course of symptoms of cranioman-dibular disorders in men and women. A 10-year follow-up study of an epidemiologic sample. Acta Odontol Scand 1996;54:337–342.

3.Magnusson T, Egermarki I, Carlsson GE. A prospective in-vestigation over two decades on signs and symptoms of tem-poromandibular disorders and associated variables. A final summary. Acta Odontol Scand 2005;63:99–109.

4.Yekkalam N, Wänman A. Prevalence of signs and symptoms indicative of temporomandibular disorders and headaches in 35-, 50-, 65- and 75-year-olds living in Västerbotten, Sweden. Acta Odontol Scand 2014;72:458-465.

5.Köhler AA, Hugoson A, Magnusson T. Clinical signs indicative of temporomandibular disorders in adults: Time trends and as-sociated factors. Swed Dent J 2013;37:1–11.

6.Köhler AA, Hugoson A, Magnusson T. Prevalence of symp-toms indicative of temporomandibular disorders in adults: Cross-sectional epidemiological investigations covering two decades. Acta Odontol Scand 2012;70:213–223.

7.Salonen L, Helldén L, Carlsson GE. Prevalence of signs and symptoms of dysfunction in the masticatory system: An epide-miologic study in an adult Swedish population. J Craniomandib Disord 1990;4:241–250.

8.Osterberg T, Carlsson GE, Wedel A, Johansson U. A cross-sectional and longitudinal study of craniomandibular dysfunction in an elderly population. J Craniomandib Disord 1992;6:237–245.

9.Schmitter M, Rammelsberg P, Hassel A. The prevalence of signs and symptoms of temporomandibular disorders in very old subjects. J Oral Rehabil 2005;32:467–473.

10.Rutkiewicz T, Könönen M, Suominen-Taipale L, Nordblad A, Alanen P. Occurrence of clinical signs of temporomandibular disorders in adult Finns. J Orofac Pain 2006;20:208–217.

11.Montero J, Bravo M, López-Valverde A, Llodra JC. Clinical and sociodemographic predictors of oral pain and eating problems among adult and senior Spaniards in the nation-al survey performed in 2010. Med Oral Patol Oral Cir Bucal 2015;20:e393–e401.

12.World Health Organization. Oral Health Surveys: Basic Methods, ed 4. Geneva: World Health Organization, 1997.

13.World Health Organization. Oral Health Surveys: Basic Methods, ed 3. Geneva: World Health Organization, 1987.

14.Landis JR, Koch GG. The measurement of observer agree-ment for categorical data. Biometrics 1977;33:159–174.

15.Gesch D, Bernhardt O, Alte D, et al. Prevalence of signs and symptoms of temporomandibular disorders in an urban and ru-ral German population: Results of a population-based Study of Health in Pomerania. Quintessence Int 2004;35:143–150.

16.Tervonen T, Knuuttila M. Prevalence of signs and symptoms of mandibular dysfunction among adults aged 25, 35, 50 and 65 years in Ostrobothnia, Finland. J Oral Rehabil 1988; 15:455–463.

17.Matsuka Y, Yatani H, Kuboki T, Yamashita A. Temporomandibular disorders in the adult population of Okayama City, Japan. Cranio 1996;14:158–162.

18.Jensen R, Rasmussen BK, Pedersen B, Lous I, Olesen J. Prevalence of oromandibular dysfunction in a general popula-tion. J Orofac Pain 1993;7:175–182.

19.Carlsson GE, Ekbäck G, Johansson A, Ordell S, Unell L. Is there a trend of decreasing prevalence of TMD-related symp-toms with ageing among the elderly? Acta Odontol Scand 2014;72:714–720.

20.Sheiham A, Maizels JE, Cushing AM. The concept of need in dental care. Int Dent J 1982;32:265–270.

21.Al-Jundi MA, John MT, Setz JM, Szentpétery A, Kuss O. Meta-analysis of treatment need for temporomandibular disorders in adult nonpatients. J Orofac Pain 2008;22:97–107.

22.De Kanter RJ, Truin GJ, Burgersdijk RC, et al. Prevalence in the Dutch adult population and a meta-analysis of signs and symp-toms of temporomandibular disorder. J Dent Res 1993;72: 1509–1518.

23.Isong U, Gansky SA, Plesh O. Temporomandibular joint and muscle disorder-type pain in U.S. adults: The National Health Interview Survey. J Orofac Pain 2008;22:317–322.

24.Tuuliainen L, Sipilä K, Mäki P, Könönen M, Suominen AL. Association between clinical signs of temporomandibular disorders and psychological distress among an adult Finnish population. J Oral Facial Pain Headache 2015;29:370–377.

25.Dao TT, LeResche L. Gender differences in pain. J Orofac Pain 2000;14:169–184.

26.Komiyama O, Obara R, Iida T, et al. Age-related associations between psychological characteristics and pain intensity among Japanese patients with temporomandibular disorder. J Oral Sci 2014;56:221–225.

27.Unell L, Johansson A, Ekbäck G, Ordell S, Carlsson GE. Prevalence of troublesome symptoms related to temporo-mandibular disorders and awareness of bruxism in 65- and75- year-old subjects. Gerodontology 2012;29:e772–e779.

28.Manfredini D, Winocur E, Ahlberg J, Guarda-Nardini L, Lobbezoo F. Psychosocial impairment in temporomandibular disorders patients. RDC/TMD axis II findings from a multi-centre study. J Dent 2010;38:765–772.

29.Boscato N, Almeida RC, Koller CD, Presta AA, Goettems ML. Influence of anxiety on temporomandibular disorders—An ep-idemiological survey with elders and adults in Southern Brazil. J Oral Rehabil 2013;40:643–649.