Abstract
Background and Objective:
Whether orthodontic therapy is a risk factor for temporomandibular disorders (TMD) or parafunctional habits such as bruxism is a question that has long been discussed. The issue is highly relevant to public health due to the frequency of these functional disorders in the general population and the sheer number of orthodontic treatments. The aim of this cross-sectional study was to investigate the risk of TMD or bruxism in children and adolescents during orthodontic therapy.
Probands and Methods:
The study included 1,011 children and adolescents between the ages of 10 and 18 selected at random from the general public who had been examined for signs of TMD using the Helkimo index and Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Parafunctional activities (bruxism) were surveyed and documented in reference to wear effects on the front teeth using the method developed by Egermark-Eriksson. In addition, probands were asked about their current orthodontic treatments.
Results:
Nearly 30% (N = 296) of the probands stated that they were undergoing orthodontic therapy. Roughly 1/10 proband presented with a clinical TMD according to the Helkimo index (9.6%; N = 97) or a TMD diagnosis according to the RDC/TMD (10.2%; N = 102). After controlling for the effects of age, gender and school-type using a multinomial logistical regression analysis there was no increased risk of anamnestic or clinical TMD symptoms or diagnoses during orthodontic treatment (odds ratios between 0.63 and 1.18; all p-values > 0.05). At the same time, both wear facets on the front teeth (tooth-related mean value with vs. without appliance: 0.12 vs. 0.16; t test: p = 0.038) and self-reported bruxing be havior (OR = 0.57; p = 0.018) were significantly reduced by orthodontic treatment.
Conclusion:
Our study revealed no increased risk of TMD in children and adolescents during orthodontic therapy, which seems to reduce parafunctional activities and thus the likelihood of noncarious dental damage.
Zusammenfassung
Hintergrund und Ziel:
Die Frage, ob die kieferorthopädische Therapie einen Risikofaktor für kraniomandibuläre Dysfunktionen (CMD) oder Parafunktionen wie Bruxismus darstellt, wird schon seit langem diskutiert. Die Fragestellung besitzt wegen der Häufigkeit dieser Funktionsstörungen in der Bevölkerung sowie der Vielzahl an kieferorthopädischen Behandlungen eine hohe Public-Health-Relevanz. Ziel der Querschnittsstudie war, das Risiko für CMD bzw. Bruxismus bei Kindern und Jugendlichen während der kieferorthopädischen Therapie zu untersuchen.
Probanden und Methodik:
Es wurden 1011 zufällig ausgewählte Kinder und Jugendliche im Alter von 10 bis 18 Jahren aus der Allgemeinbevölkerung auf das Vorkommen von CMD nach dem Helkimo-Index sowie den Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) untersucht. Parafunktionelle Aktivitäten (Bruxismus) wurden erfragt bzw. anhand von Schliff-Facetten an den Frontzähnen nach der Methode von Egermark-Eriksson erfasst. Zusätzlich wurden die Probanden nach gegenwärtigen kieferorthopädischen Behandlungen befragt.
Ergebnisse:
Knapp 30% (N = 296) der Probanden gaben an, sich derzeit in kieferorthopädischer Therapie zu befinden. Etwa jeder zehnte Proband wies eine klinische CMD nach dem Helkimo-Index (9,6%; N = 97) bzw. eine CMD-Diagnose nach den RDC/TMD auf (10,2%; N = 102). Nach Kontrolle der Effekte von Alter, Geschlecht und Schulform mittels multinomialer logistischer Regressionsanalyse ergab sich weder für anamnestische noch klinische CMD-Symptome bzw. -Diagnosen ein erhöhtes Risiko während der kieferorthopädischen Behandlung (Odds-Ratios zwischen 0,63 und 1,18; alle p-Werte > 0,05). Gleichzeitig waren sowohl Schliff-Facetten an den Frontzähnen (zahnbezogener Mittelwert mit vs. ohne Apparatur: 0,12 vs. 0,16; t-Test: p = 0,038) als auch subjektiv angegebene Bruxismusaktivitäten (OR = 0,57; p = 0,018) durch die kieferorthopädische Behandlung signifikant verringert.
Schlussfolgerung:
Die Studie ergab kein erhöhtes Risiko für CMD bei Kindern und Jugendlichen während der kieferorthopädischen Therapie. Gleichzeitig reduziert diese offenbar parafunktionelle Aktivitäten und damit die Gefahr von nichtkariösen Zahnschäden.
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* This paper received the Research Award “DGKFO 100” of the German Orthodontic Society in the category “Temporomandibular Dysfunction”, 2008.
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Hirsch, C. No Increased Risk of Temporomandibular Disorders and Bruxism in Children and Adolescents during Orthodontic Therapy*. J Orofac Orthop 70, 39–50 (2009). https://doi.org/10.1007/s00056-009-0820-3
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DOI: https://doi.org/10.1007/s00056-009-0820-3