Heterogeneity of patients with craniomandibular disorders. A longitudinal study

The aim of this thesis was to investigate a consecutive series of patients with craniomandibular disorders (CMD), mainly functional disturbances of the masticatory system, in order to evaluate symptoms, the treatment outcome and the long-term prognosis in relation to different background factors. All 350 patients who came to a TMJ-clinic during a specific time period were included. 68% of the patients were women. The ages of the patients ranged between 12 and 80 years, with a mean of 39.9 years for the women and 38.3 for the men. At the first visit, the patients were given a self-administered questionnaire with 25 standardised questions. After 2 1/2 years, the records of the patients were examined for clinical findings, diagnoses and treatment. After about 4 years, a questionnaire, similar to the original one, was sent to a young and an old group of the patients to register present symptoms and need of treatment. Finally a clinical follow-up was performed in those who had reported that they wanted more treatment and, for comparison, in a group who had reported that they did not. The symptomatology was extremely varied in this group of 350 CMD patients. Headache, pain on mandibular movements and TMJ sounds were the most frequently reported symptoms. The significant correlation found between the severity of reported symptoms and the clinical dysfunction index (Di) was best explained by muscle tenderness on palpation. The dental status varied greatly among the patients and it was not significantly correlated to Di. The number of visits and length of the treatment period, factors that varied widely, were correlated to variables indicating severity of signs and symptoms at the first visit. Otherwise it was difficult to predict the treatment outcome, even when patients were divided into subgroups. Only one variable from the original questionnaire, duration of initial symptoms, and none from the first clinical examination, was significantly correlated to the treatment outcome at the 4-year follow-up. The mean number of days of sick-leave in the patients was correlated to Di, and it decreased after stomatognathic treatment. This series of studies has shown that patients with CMD are extremely heterogeneous in many respects, e.g. regarding symptoms, diagnosis and outcome of treatment.