Temporomandibular dysfunction in adult patients with myotonic dystrophy (DM1)

Myotonic muscle dystrophy is a systemic disease with early engagement of the facial muscles. Our aim was to study dysfunction of the temporomandibular system in patients with 'classic' dystrophia myotonica (DM1) and compare it with TMD patients and healthy controls. The study included 27 referred patients with DM1, 18 women and nine men, aged 30-62 years, and two matched control groups: patients with temporomandibular disorders symptoms (TMD) and healthy controls, both groups were consecutive patients. The patients answered questions regarding facial pain, jaw function and dysfunction. A clinical examination of the temporomandibular system including the occlusion was performed, and the maximum bite force and finger forces were measured. Among the DM1 patients, 33% reported difficulty biting off, and 22% had difficulty chewing, avoiding foods like meat and raw vegetables, and 37% of the DM1 patients scored their pain and discomfort as moderate to fairly severe. Their main complaints were TMJ clicking and locking, difficulty opening wide and tiredness. They had more clinical signs of dysfunction compared with the controls (P < 0·001), but no statistically significant difference to the TMD patients. The maximum bite force in DM1 patients was impaired compared to both the TMD patients and the controls (P < 0·001). Significantly more occlusal interferences were found in DM1 patients and were associated with chewing difficulties (P < 0·001). In conclusion, patients suffering from DM1 had an increased prevalence of TMD symptoms, reported impaired chewing function and had a decreased maximum bite force.