Temporomandibular joint disorders among patients treated in the department of oral and maxillofacial surgery at Muhimbili national hospital

Abstract

Background

Temporomandibular joint disorders (TMJD) are the most common debilitating conditions of the stomatognathic system. Although they exist in the community they are not mentioned in the literature as an endemic health problem. Their prevalence does not seem to be clear enough for the health system in Tanzania to give them priority as other health problems.

Study setting: The study was done in the department of Oral and Maxillofacial Surgery at Muhimbili National Hospital (MNH).

Objective: To determine the occurrence of temporomandibular joint disorders (TMJD) among patients treated in the department of Oral and Maxillofacial Surgery at MNH.

Study Design: A descriptive prospective cross sectional hospital based study.

Study population: In and out patients with TMJ disorders attending treatment in the department of Oral Surgery.

Study duration: The study was conducted over a period of six months from September 2009 to February 2010.

Methods and materials: All out patients who attended at the Oral Surgery department and those admitted in wards 23 and 24 with TMJDs and had consented were included in the study. The patients were interviewed using a structured questionnaire. Physical examination was done and findings were recorded on a special clinical form. The study was conducted over a period of six months from September 2009 to February 2010.

Results:

Among 4661 patients who attended at the Oral Surgery department during the study period, 61 (1.3%) patients suffered from TMJDs. The age of patients ranged from 4 to 80 years, with a mean age of 35 +/-18.5 years and a male: female ratio of 1 :2.

TMJ-ankylosis was the most prevalent disorder comprising 36.1 % of the total TMJD patients. In this disorder the 11-20 years age group was the most (31. 8%) affected. It was noted that the prevalence declined with increase in age whereby 6 (27.3%) were in the 21-30 years age group. TMJ ankylosis showed a gender predilection whereby females were the most affected_accounting for 13 (59.1%) compared to 9 (40.9%) males with a female to male ratio of 2:1. Associated factors were trauma due to fall in 11 (50%) of the patients and infections to the joint in 8 (36.4%) patients. Major clinical features were limited opening of the mouth in 100% of the patients. About 14 (63.6%) of the patients presented with poor oral hygiene. Facial disfigurement was observed in 20 (90.9%) of the patients. X-ray revealed obliteration of the joint space in all the patients. Surgical treatment was provided to 18 (81.8%) and recurrence was found in 6 (33.3%) of the patients.

Myofascial pain dysfunction syndrome (MPDs) was the second most (32.8%) prevalent TMJD. Forty percent of the patients were in the 21-30 years age group and 5 (25%) patients in the 31-40 years age group. The prevalence of signs and symptoms was lower in age groups below 20 years and above 40 years. Masticatory muscle tenderness was the major clinical feature in all patients, while clicking sound on mouth opening and closing was present in 15 (75%) of the patients. Radiographs of the joints of all the patients were normal. Medications (NSAIDs and antidepressants) were provided to all patients however, 2 (10%) of patients who were partially

edentulous, missing posterior teeth were provided with prosthesis in addition to medications. Eighty percent of the patients improved while signs and symptoms persisted in 2 (10%) patients and the remaining 2 (10%) could not avail themselves for follow up.

TMJ dislocation was observed in 19 (31.1%) patients. Females were 11 (57.9%) while males were 8 (42.1 %) with male to female ratio of 1.4: 1. The most affected age groups were those in 21-30 years age group who comprised of 7 (36.8%) patients followed by the 31-40 years age group with 4 (21.1 %) patients. Yawning was the commonest associated factor in 10 (52.6%) of the patients. All patients had the condyles displaced anterior to the articular eminence. Chronic recurrent dislocation was observed in 12 (63.2%) of the patients, acute TMJ dislocation in 5 (26.3%) patients and chronic TMJ dislocation in 2 (10.5%) of the patients. The mean duration of the dislocation before seeking treatment ranged between 2 days to 9 months. Clinically all patients had open mouth while 13 (68.4%) had pain in the joint region and 7 (36.8%) had difficulty in speaking. Radiographic examination revealed displacement of the condyles anterior to the articular eminence in 100% patients. Closed reduction was done in 17 (89.5%) of the patients, open reduction was provided to 2 (10.5%) of the patients and there was no recurrence reported.

Conclusion:

The temporomandibular joint disorders that were seen in this study occurred at a rather low prevalence of about 1.3%. TMJ ankylosis, MPD and TMJ dislocation were the only TMJDs found. TMJ ankylosis which was the commonest TMJD was mainly a result of trauma and infection. The treatment rendered to these patients was surgery (condylectomy alone or condylectomy and coronoidectomy) with a very low recurrence rate. MPD was mainly associated