A Clinical Study of Specific Signs and Symptoms of CMD in Bruxers Classified by the Degree of Severity

ABSTRACT

Two hundred and seventy-six CMD patients referred consecutively for diagnosis and treatment over a period of four years were assessed. Two hundred and eleven were classified as bruxers according to the use of a questionnaire and clinical examination. One hundred (47.39%) presented clinical characteristics of mild bruxers, 66 (31.27%) presented moderate bruxism and 45 (21.32%) demonstrated severe bruxism. Severe bruxers presented the lowest degree of jaw opening (39.21 mm) and highest prevalence of capsulitis (97.77%), retrodiskal pain (84.44%) and disk-attachment pain (48.88%). As compared to the mild and moderate groups, severe bruxers also demonstrated significantly higher prevalence of protective splinting and transient locking or recent history of intermittent locking, masticatory pain, reciprocal clicking and signs and symptoms of Myofascial Pain Dysfunction Syndrome (MPDS). Because higher prevalence of specific muscle and joint disorders were observed in bruxers and such prevalence was progressive from the mild to the moderate and severe group, it may be concluded that bruxing behavior is a significant factor in the etiology and progression of muscle and joint disorders. Based on the review of the literature, the analysis of our data in comparison to other studies allowed us to conclude that severe bruxers are more impaired by muscular and joint disorders as compared to mild and moderate bruxers.

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Notes on contributors

Omar Franklin Molina

Dr. Omar Franklin Molina received his D.D.S. degree in 1978 from the Stale University, Rio Grande do Sul, Brazil. He completed graduate studies at the State University of Santa Catarina, Brazil, receiving an M.S. degree in 1983. In 1983–1984 he specialized in orthodontics at the State University, Rio de Janeiro, Brazil and then attended advanced courses in occlusion and CMD in the United States. Dr. Molina has been a member of the American Equilibration Society since 1987 and has lectured on occlusion, facial pain and parafunctional habits in Brazil. He has published two books and is currently an instructor of advanced courses in CMD at The Brazilian Institute of Orthodontics, Rio de Janeiro. Dr. Molina is a member of The Center for Study of Craniomandibular Disorders at Porto Alegre, Brazil.

José dos Santos

Dr. José dos Santos, Jr. received his D.D.S. degree in 1959 from the University of São Paulo, Brazil. He was an adjunct professor at the University of São Paulo, Brazil from 1962 to 1979. He received his M.S. degree in 1969 from Rackham Institute of Graduate Studies, University of Michigan. He is a former (1980) associate professor in the Department of Occlusion and Orofacial Pain/Temporomandibular Joint Clinic, University of Michigan. Currently, Dr. dos Santos is a professor at the University of Texas Health Sciences Center, San Antonio. He is Director of Programs for Continuing Education Courses for Brazilian Dentists in the United States. He is a member of the American Equilibration Society, American Association of Dental Research and Association of University TMD and Orofacial Pain Programs. Dr. dos Santos has published several articles and books both nationally and internationally.

Stanley J. Nelson

Dr. Stanley J. Nelson is currently Associate Professor in the Division of Occlusion, Department of Restorative Dentistry. He received his D.D.S. in 1979 and his M.S. degree in restorative/occlusion in 1986 from the University of Michigan School of Dentistry where he also served as faculty in the school's Department of Occlusion. In addition to his 19 years teaching experience, Dr. Nelson has published numerous scientific articles and is currently serving as Councilor of the American Association of Dental School's Section on Dental Anatomy and Occlusion.

Thomas Nowlin

Dr. Thomas P. Nowlin is Professor and Head of the Division of Occlusion at the University of Texas Health Science Center. He received his dental training at The University of Texas Dental Branch at Houston in 1970 and his Master's in Education with emphasis in college and university curriculum and instruction in 1981. He has been active in curriculum design and planning, recently chairing the Curriculum Planning Committee for three years and has presented nationally on Curriculum Evaluation and Outcomes Assessment as a basis for planning.