Are occlusal features associated with different temporomandibular disorder diagnoses in bruxers?

The present study was designed to test the hypothesis that dental occlusion may have a role in mediating the effects of bruxism in temporomandibular disorders (TMD) patients. It aimed to answer the clinical research question: in a population of TMD patients with clinically diagnosed clenching-type bruxism, are the different TMD diagnoses associated with different occlusal features?

A total of 294 TMD patients (73% females, mean age 38·3±9·2 years) who were positive for a clinical diagnosis of clenching-type bruxism underwent an assessment in accordance with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis I, as well as a recording of nine occlusal features. Statistical analyses were performed to test the null hypotheses that: (1) no differences existed between the patients with or without the various occlusal features as for the prevalence of the various single and combined RDC/TMD group diagnoses (single variable analysis), and (2) having any specific occlusal feature makes no difference in distinguishing within the RDC/TMD diagnoses (multiple variable analysis).

The distribution of the different combination of RDC/TMD axis I diagnoses was significantly different in patients with laterotrusive interferences with respect to those without such interferences (chi-square = 15·209; P = 0·033) as well as in patients with a slide from retruded contact position (RCP) to maximum intercuspation (MI) >2 mm with respect to those without such slide (chi-square = 4·029; P = 0·012) and in those with or without molar class asymmetry (chi-square = 17·438; P = 0·015). Multinomial regression analysis showed that the model including the various occlusal features account for 20·4% of the variance for RDC/TMD diagnoses (Nagelkerke R(2) = 0·204) and allowed the rejection of the null hypothesis that having such specific occlusal features makes no difference in distinguishing within the RDC/TMD diagnoses.

Within the limitations of this study, it can be suggested that in a population of patients with TMD and clinically-diagnosed clenching-type bruxism, the patterns of TMD diagnoses may be influenced, at least in part, by the presence of some features of dental occlusion, namely, slide RCP-MI, laterotrusive interferences, and molar asymmetry.