Can the Measurement of Jaw-Opening Forces Assist in the Diagnosis of Temporomandibular Disorders?

Aims: To investigate the effectiveness of a novel jaw-opening–force measuring device as a screening tool to aid in the diagnosis of temporomandibular disorders (TMD). Methods: Symptomatic TMD patients (n = 58) and control TMD-free participants (n = 56) were screened by an oral medicine specialist according to the Diagnostic Criteria for TMD (DC/TMD). TMD patients were divided into three subcategories based on TMD symptoms (myofascial pain, disc displacement, and both combined). Jaw-opening forces were measured in both groups with an adjustable head device connected to a 1,000-N–load cell. Seven attempts were recorded at 10-second intervals by a data-capturing system. The geometric mean force values were obtained after discarding the first and last attempts. Results: TMD-free participants had greater jaw-opening forces than TMD patients both without and with adjustments for age, sex, height, and weight (both P < .001). The geometric mean ± standard deviation values for TMD patients were 18.5 ± 1.62 N and 47.7 ± 1.53 N for TMD-free participants. Differences in jaw-opening forces among the three TMD subcategories were not statistically significant; however, patients with disc displacement (23.7 ± 1.46 N) had greater jaw forces than patients with myofascial pain (17.0 ± 1.74 N) and both myofascial pain and disc displacement (17.0 ± 1.56 N). Conclusion: This study demonstrated that differences in jaw-opening forces could be used as a diagnostic tool for TMD. Future studies should explore the potential of this device to measure improvement in jaw-opening forces following TMD treatment.

diagnostic tool; jaw-opening forces; myofascial pain; temporomandibular disorders; temporomandibular joint

1. Tjakkes GH, Reinders JJ, Tenvergert EM, Stegenga B. TMD pain: The effect on health related quality of life and the influence of pain duration. Health Qual Life Outcomes 2010;8:46.

2. Bitiniene D, Zamaliauskiene R, Kubilius R, Leketas M, Gailius T, Smirnovaite K. Quality of life in patients with temporo-mandibular disorders. A systematic review. Stomatologija 2018;20:3–9.

3. Fan WY, Tiang N, Broadbent JM, Thomson WM. Occurrence, associations, and impacts of nocturnal parafunction, daytime parafunction, and temporomandibular symptoms in 38-year-old individuals. J Oral Facial Pain Headache 2019;33:254–259.

4. Mense S. The pathogenesis of muscle pain. Curr Pain Headache Rep 2003;7:419–425.

5. Maixner W, Diatchenko L, Dubner R, et al. Orofacial pain prospective evaluation and risk assessment study—The OPPERA study. J Pain 2011;12(11 suppl):T4–T11.e1–e2.

6. Smith SB, Maixner DW, Greenspan JD, et al. Potential genetic risk factors for chronic TMD: Genetic associations from the OPPERA case control study. J Pain 2011;12(11 suppl):T92–T101.

7. Slade GD, Ohrbach R, Greenspan JD, et al. Painful temporo-mandibular disorder: Decade of discovery from OPPERA studies. J Dent Res 2016;95:1084–1092.

8. Harper DE, Schrepf A, Clauw DJ. Pain mechanisms and centralized pain in temporomandibular disorders. J Dent Res 2016;95:1102–1108.

9. McNeill C. Management of temporomandibular disorders: Concepts and controversies. J Prosthet Dent 1997;77: 510–522.

10. Okeson JP. Management of Temporomandibular Disorders and Occlusion, ed 7. St Louis: Mosby, 2014.

11. Polonowita AD, Thomson WM, Thorburn DN. Clinical efficacy of a simplified approach to managing chronic temporomandibular disorders: Evidence from a 1-year case series. Oral Surg Oral Med Oral Pathol Oral Radiol 2019;128:227–234.

12. Koolstra JH, van Eijden TM. Biomechanical analysis of jaw-closing movements. J Dent Res 1995;74:1564–1570.

13. Pruim GJ, de Jongh HJ, Ten Bosch JJ. Forces acting on the mandible during bilateral static bite at different bite force levels.J Biomech 1980;13:755–763.

14. Waltimo A, Könönen M. A novel bite force recorder and maximal isometric bite force values for healthy young adults. Scand J Dent Res 1993;101:171–175.

15. de Abreu RA, Pereira MD, Furtado F, Prado GP, Mestriner W, Jr, Ferreira LM. Masticatory efficiency and bite force in individuals with normal occlusion. Arch Oral Biol. 2014;59:1065–1074.

16. Sharkey P, Boyle DK, Orchardson R, McGowan DA. Jaw opening forces in human subjects. Br Dent J 1984;156:89–92.

17. Bolt KJ, Orchardson R. Relationship between mouth-opening force and facial skeletal dimensions in human females. Arch Oral Biol 1986;31:789–793.

18. Hara K, Tohara H, Wada S, Iida T, Ueda K, Ansai T. Jaw-opening force test to screen for dysphagia: preliminary results. Arch Phys Med Rehabil 2014;95:867–874.

19. Brunton PA, Loch C, Waddell JN, Bodansky HJ, Hall R, Gray A. Estimation of jaw-opening forces in adults. Orthod Craniofac Res 2018;21:57–62.

20. Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for clinical and research applications: Recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache 2014;28:6–27.

21. Gray RJ, Davies SJ, Quayle AA. A clinical approach to tem-poromandibular disorders. 1. Classification and functional anatomy. Br Dent J 1994;176:429–435.

22. Gray R, Al-Ani Z. Temporomandibular Disorders: A Problem-Based Approach. Chichester: John Wiley & Sons, 2011.

23. Greene CS. The etiology of temporomandibular disorders: Implications for treatment. J Orofac Pain 2001;15:93–105.

24. Slade GD, Fillingim RB, Sanders AE, et al. Summary of findings from the OPPERA prospective cohort study of incidence of first-onset temporomandibular disorder: Implications and future directions. J Pain 2013;14(12 suppl):T116–T124.

25. Bagis B, Ayaz EA, Turgut S, Durkan R, Özcan M. Gender difference in prevalence of signs and symptoms of temporo-mandibular joint disorders: A retrospective study on 243 consecutive patients. Int J Med Sci 2012;9:539–544.

26. Manfredini D, Chiappe G, Bosco M. Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnoses in an Italian patient population. J Oral Rehabil 2006;33:551–558.

27. Bayat M, Abbasi AJ, Noorbala AA, Mohebbi SZ, Moharrami M, Yekaninejad MS. Oral health–related quality of life in patients with temporomandibular disorders: A case-control study considering psychological aspects. Int J Dent Hyg 2018;16:165–170.

28. John MT, Reissmann DR, Schierz O, Wassell RW. Oral health-related quality of life in patients with temporomandibular disorders. J Orofac Pain 2007;21:46–54.

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

30. Kohno S, Matsuyama T, Medina RU, Arai Y. Functional-rhythmical coupling of head and mandibular movements. J Oral Rehabil 2001;28:161–167.

31. Muto T, Kanazawa M. Positional change of the hyoid bone at maximal mouth opening. Oral Surg Oral Med Oral Pathol 1994;77:451–455.