Perceived malocclusion and other teeth-associated signs and symptoms in temporomandibular disorders

This article reports the results of a clinical study that evaluated adjunctive teeth-associated signs and symptoms before and after nonsurgical temporomandibular disorder therapy. Eighty-nine patients were referred to a private prosthodontic practice in the Washington, DC metropolitan area. Of the 89 patients, 75 were selected for the clinical study after completing the interview, history, and clinical examination. The major signs and symptoms were recorded, along with adjunctive teeth-associated signs and symptoms. The treatment included an anterior programming device, a centric relation occlusal device, and, when indicated, a selective occlusal equilibration. The results were recorded after five treatment visits. Of 75 patients, 67 made good-to-excellent improvement in the signs and symptoms of their major temporomandibular disorder. Patients with adjunctive teeth-associated signs and symptoms demonstrated a marked reduction in these signs and symptoms as assessed by their mental perception and verbal feedback. The symptoms of perceived awareness of malocclusion were not resolved with centric relation occlusal device therapy in 22 of the 24 patients with this symptom. However, excellent improvement was noted in this symptom when occlusal device therapy was followed by a selective occlusal equilibration. Thirty-eight patients in this study had difficulty in making lateral gliding articulation movements with the occlusal device out of the mouth. This problem was resolved in 36 patients after removal of eccentric occlusal interferences. It is suggested that adjunctive teeth-associated signs and symptoms be initially recorded and addressed in patients, especially if extensive or invasive dental therapy is planned. Although this clinical study in a private practice was carefully performed, it does not meet the criteria of evidence-based research, because a control group was not included.