COMPARISON OF DENTAL STATUS AND ORAL FUNCTION BETWEEN THE ELDERLY WITH AND WITHOUT
TEMPOROMANDIBULAR DISORDERS
122
findings of Jeon et al. [19] suggested a positive
correlation between chronic periodontitis and TMD-
related muscle pain, while Fabri et al. [24] found that
there were clinical comorbidities between periodontal
disease and craniofacial pains. All these studies support
our findings indicating that periodontitis accumulated
over time might be a risk factor for TMD.
TMD are a group of disorders that disrupt function
or cause parafunction of the masticatory system.
Surprisingly, the number of oral parafunctional
activities was equal across two groups; participants
in both groups had a range of 4–5 parafunctional
behaviours. Our study is in accordance with Leketas et
al.’s study [25] indicating that the behaviours of “Lean
with your hand on the jaw”, “Chew food on one side
only”, and “Sleep in a position that puts pressure on the
jaw” were the most common in the TMD group. Meulen
et al. [26] showed that these parafunctional behaviours
often had higher scores than other parafunctional
items when evaluating the validity items of OBC-21
in the Dutch population. This could suggest that the
frequency of parafunctional behaviours affected TMD.
The current study found that 2 out of 21 items of OBC
were significantly associated with TMD among the
elderly. The TMD group had higher frequency of “Hold,
tighten, or tense muscles without clenching”, but a
lower frequency of “Eating between meals (i.e., food
that requires chewing)” than the non-TMD group. These
findings could be explained by muscular activity. The
increase in the frequency of tensing muscles heightened
the risk of TMD between 2.9 – 10.8 times [25]. Based on
an electromyography study, Ohrbach et al. found [27]
a high score of masseter muscular activity in subjects
with tense muscles. A high activity of masseter muscle
in combination with the neuromuscular change in
older age would cause muscular disorders, a subgroup
of TMD. This also explained why the TMD elderly group
had a lower frequency of eating between meals in our
study because of muscular impairment.
The current study reported difficulty chewing tough
and hard food in most participants, but none indicating
that TMD was related to functional limitations of
mastication; such findings contrast with findings of
Brandini et al. [28]. In older adults, the rate of loss was
often higher in the posterior than the anterior teeth;
therefore, the impaired masticatory performance was
prevalent in both groups in our study. There were no
differences between the two groups concerning other
functional limitations related to mandibular mobility
and verbal/emotional expression. However, limited
mouth opening could occur with increasing age. Ikebe
et al. found that 7.9% of elderly Japanese exhibited
this limitation [29]. Similarly, our study demonstrated
that approximately 23% of examinees self-reported
a reduced mouth opening capacity to perform
daily activities. The age-related degeneration of the
temporomandibular joints and muscle weakness could
contribute to such limitation in older people.
Although the prevalence of functional limitations was
high in the TMD group, there were no correlations
between the functional limitations of masticatory
system and TMD when compared to the non-TMD
group. This suggests that multiple factors could
affect the function of the masticatory system in the
elderly, including chronic orofacial pain, psychological
disorders, and age-related reduction of the motor
function of masticatory muscles [29–31]. The important
finding of the current study was that determining the
JFLS-20 score of older adults might enable us to predict
TMD, as the prevalence of TMD is correlated with an
increasing JFLS-20 score in the general population [13].
The limitation of the study was that we only studied
the oral function and parafunctional behaviours based
on self-rated questionnaires. There is a need for more
clinical research on this aspect.
5. Conclusion
Temporomandibular disorders were associated with
missing teeth and periodontal diseases. There was no
association between TMD and mandibular functional
limitations among the elderly. The elderly suffering
from TMD tended to have increased frequency of
holding, tightening, or tensing muscles.
Conflicts of interest
The authors declare that they have no conflict of
interest.
Author contributions
MSN searched literature, performed clinical studies,
data acquisition and statistical analysis, and wrote draft
of manuscript. ÜVO, TJ, and MS designed protocol,
interpreted data, and edited the manuscript. All
authors read and approved the final manuscript.
Acknowledgements
This study was supported by the Estonian Science
Foundation grant ESF 9255, the Estonian Research
Council IUT 20-46, and the Internationalization
Programme DoRa of the European Social Fund, which is
carried out by the Foundation Archimedes. The authors
would like to thank the volunteer participants from the
Hoa Vang, Hai Chau, Thanh Khe, and Cam Le districts
of Danang City in Vietnam for their cooperation and
agreement to provide data on their oral health and
temporomandibular joint status.
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