Temporomandibular disorders and pregnancy

Abstracts

JUSTIFICATIVA E OBJETIVOS: As disfunções temporomandibulares (DTM) podem apresentar-se como dor à função e palpação muscular e/ou articular, diminuição da amplitude bucal, travamentos mandibulares, estalos articulares, entre outros, que quando presentes durante a gravidez podem gerar um importante impacto na qualidade de vida. O objetivo deste estudo foi analisar a literatura a respeito da prevalência de sinais e sintomas de DTM em gestantes. CONTEÚDO: Realizou-se busca eletrônica nas principais bases de dados internacionais disponíveis (Medline, Cochrane, EMBASE, Pubmed), referente ao período de janeiro de 2000 a agosto de 2012. Inicialmente foram encontrados 17 artigos, e após a aplicação dos critérios estabelecidos restaram três para inclusão e discussão neste estudo. CONCLUSÃO: Há menor, porém não significativa prevalência de sinais e sintomas de DTM em pacientes gestantes.

Dor facial; Gestantes; Prevalência; Transtornos da articulação temporomandibular

REVIEW ARTICLE

Temporomandibular disorders and pregnancy

^IMaster in Oral Rehabilitation and Specialist in Dental Prosthesis, Dentistry School of Bauru, University of São Paulo (SP). Curitiba, PR, Brazil

^IISpecialist in Temporomandibular Disorders and Orofacial Pain and Specialist in Dental Prosthesis, Federal University of Paraná (UFPR). Curitiba, PR, Brazil

^IIIMaster in Health Sciences, Catholic University of Paraná (PUC-PR) and Specialist in Temporomandibular Disorders and Orofacial Pain, and Specialist in Dental Prosthesis, Federal University of Paraná (UFUPR). Curitiba, PR, Brazil

^IVDoctor in Orthodontics, Dentistry School of Araçatuba, Paulista State University (UNESP) and Specialist in Temporomandibular Disorder and Orofacial Pain, Federal Council of Dentistry (CFO). Curitiba, PR, Brazil

^VDoctor in Sciences, School of Medicine, Federal University of São Paulo (UNIFESP), and Specialist in Temporomandibular Disorders and Orofacial Pain, Federal Council of Dentistry (CFO). Curitiba, PR, Brazil

Correspondence to

SUMMARY

BACKGROUND AND OBJECTIVES: Temporomandibular disorders (TMD) may present as pain at muscle and/or joint function and palpation, decreased mouth amplitude, jaw locking, clicking joints, among others, which when present during pregnancy may significantly impact quality of life. This study aimed at reviewing the literature on the prevalence of TMD signs and symptoms during pregnancy.

CONTENTS: Major available international databases (Medline, Cochrane, EMBASE, Pubmed) were queried from January 2000 to August 2012. Initially, 17 articles were found and after applying established criteria, only three were eligible for inclusion and discussion herein.

CONCLUSION: There is smaller however significant prevalence of TMD signs and symptoms during pregnancy.

Keywords: Facial pain, Pregnancy, Prevalence, Temporomandibular joint disorders.

INTRODUCTION

Temporomandibular disorders (TMD) are a subgroup of musculoskeletal disorders and are the primary source of facial pain, excluding dental pain¹. The literature suggests that it is 1.5 to 2 times more prevalent in females as compared to males and that 80% of patients treated for TMD are females^2-4. The severity of symptoms is also related to patients' age, with peaks at reproductive age, with the highest prevalence in females aged between 20 and 40 years^5,6, and low prevalence in children and older adults^6,7.

Most individuals looking for TMD treatment are females in reproductive age^5,6, however there is still no consensus in the literature about the reason for the higher prevalence among females⁶. Highest TMD prevalence at reproductive age, added to the pattern of starting after puberty, higher association to pre-menstrual period and lower prevalence in the post-menopausal period suggest that female hormones may play important role in TMD etiology or maintenance^6,8,9.

In addition, gestation brings about dramatic changes in sexual estrogen and progesterone hormones. Both are increased throughout pregnancy, with higher elevation rate starting in early second trimester and returning to their normal rates in up to one year after delivery¹⁰. During gestation there is also increase of relaxin hormone, responsible for increased mobility of body joints⁶. Generalized joint hypermobility may contribute to the development of TMD¹¹, such as luxation or subluxation of temporomandibular joints (TMJ), for example.

TMDs may present as pain at muscle and/or joint function and palpation, decreased mouth opening amplitude, jaw locking and clicking joints^1-3, among others, which when present during pregnancy may significantly impact quality of life^10,12. This study aimed at reviewing the literature on the prevalence of TMD signs and symptoms during pregnancy.

CONTENTS

Major available international databases (Medline, Cochrane, EMBASE and Pubmed) were queried from January 2000 to August 2012. Keywords used and crossed during query were "pregnant women", temporomandibular joint disorders", "facial pain", "prevalence", and "hormones", which were obtained from the DeCS/MeSH dictionary. Initial list of articles was submitted to evaluation according to inclusion and exclusion criteria. They are: articles written in English; following the evidence-based dentistry concept we have selected observational (transversal) and longitudinal (prospective) studies; articles published from January 2000 to August 2012; studies evaluating the prevalence of orofacial pain and/or TMD in pregnant adult women aged above 18 years; orofacial pain and/or TMD classification according to the criteria of the American Academy of Orofacial Pain or of RDC/TMD. Articles evaluating the prevalence of dental pain, headache or periodontal disease in pregnant women were excluded.

We have found 17 articles and after applying inclusion and exclusion criteria three were left to be included and discussed herein (Table 1)

In the context of Evidence-based Dentistry, observational studies are not the highest scientific evidence level, however they are the most adequate when the goal is to study the prevalence of a certain condition in a population. Longitudinal studies may evaluate both prevalence and incidence of a certain condition/disease in a population¹⁵. We have looked for observational and longitudinal studies evaluating the prevalence of orofacial pain and/or TMD in pregnant patients.

An important study¹⁰ evaluating the evolution of TMD signs and symptoms in women before, during and after pregnancy, has observed that TMD symptoms previously present have decreased during pregnancy and there has been increased mouth opening amplitude during the same period. Reported pain rates, which decreased throughout pregnancy, have returned to baseline values in one year after delivery. The same was true to estradiol and progesterone levels, which the authors believe is an indication of the role of such hormones in modulating pain during pregnancy.

In 2005, a group of authors¹³ has studied the possible association of systemic joint hypermobility and temporomandibular joint hypermobility in pregnant women as a way to establish a higher predisposition to the development of TMD. Although not finding an association between both conditions, there has been a prevalence of 46% TMJ hypermobility during mouth opening among pregnant women.

With similar objective, a study evaluating 70 pregnant women¹⁴ has not found higher prevalence of systemic joint hypermobility as compared to non-pregnant women. In addition, and similar to the already mentioned study¹³, it was not possible to establish association between systemic joint hypermobility and TMJ hypermobility.

If estradiol and progesterone levels influence orofacial pain experience, a decrease in pain reports may be expected during pregnancy. Although finding increased mouth opening amplitude during pregnancy, there has been no association with generalized joint hypermobility in pregnant patients.

Our study is a warning about the scarcity of studies evaluating TMD prevalence in pregnant women, being necessary studies with well-defined methodology to obtain reliable results.

CONCLUSION

Analyzed studies have shown lower, however not significant prevalence of TMD signs and symptoms among pregnant patients.

REFERENCES

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• 2. Conti PC, Ferreira PM, Pegoraro LF, et al. A cross-sectional study of prevalence and etiology of signs and symptoms of temporomandibular disorders in high school and university students. J Orofac Pain. 1996;10(3):254-62.
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• 8. Macfarlane TV, Blinkhorn AS, Davies RM, et al. Association between female hormonal factors and oro-facial pain: study in the community. Pain. 2002;97(1-2):5-10.
• 9. Nekora-Azak A, Evlioglu G, Ceyhan A, et al. Estrogen replacement therapy among postmenopausal women and its effects on signs and symptoms of temporomandibular disorders. Cranio. 2008;26(3):211-5.
• 10. LeResche L, Sherman JJ, Huggins K, et al. Musculoskeletal orofacial pain and other signs and symptoms of temporomandibular disorders during pregnancy: a prospective study. J Orofac Pain. 2005;19(3):193-201.
• 11. Kavuncu V, Sahin S, Kamanli A, et al. The role of systemic hypermobility and condylar hypermobility in temporomandibular joint dysfunction syndrome. Rheumatol Int. 2006;26(3):257-60.
• 12. de Oliveira BH, Nadanovsky P. The impact of oral pain on quality of life during pregnancy in low-income Brazilian women. J Orofac Pain. 2006;20(4):297-305.
• 13. Silveira EB, Rocabado M, Russo AK, et al. Incidence of systemic joint hypermobility and temporomandibular joint hypermobility in pregnancy. Cranio. 2005;23(2):138-43.
• 14. Solak Ö, Turhan-Haktanir N, Köken G, et al. Prevalence of temporomandibular disorders in pregnancy. Eur J Gen Med. 2009;6(4):223-8.
• 15. Reis FB, Ciconelli RM, Faloppa F. Pesquisa científica: a importância da metodologia. Rev Bras Ortop. 2002;37(3):51-5.

^*

Priscila Brenner Hilgenberg^I; Rafael Schlogel Cunali^II; Daniel Bonotto^III; Aguinaldo Coelho de Farias^IV; Paulo Afonso Cunali^V

Publication Dates

• Publication in this collection
  08 Jan 2013
• Date of issue
  Dec 2012

History

• Received
  01 June 2012
• Accepted
  04 Sept 2012