Relationship between craniomandibular dysfunction and pattern of speech sound production in a series of first-graders.

This report investigates associations between prevalence of functional disturbances of the masticatory system and speech disorders. The subjects were 157 children referred for speech therapy to the hospital and a control group all 130 first-graders at two elementary schools, mean age 7 years 6 months. During clinical examinations, signs and symptoms of TMJ dysfunction were recorded by the same dentist. Articulatory speech disorders were diagnosed by the same phoniatrician using the Remes Articulatory Test (Remes, 1975) for the Finnish language. The results showed that in the hospital referral group the mean value for maximal opening was smaller while laterotrusion movements and maximal protrusion of the mandible were larger than in the control group. The study group also more often had CM disorders and occlusal interferences than children of the first grade sample. In the present data, a higher frequency of subjective symptoms and several clinical signs of CMD were related to certain articulatory speech disorders. Risk of having too anteriorly-produced sounds, mainly 's'-sounds, decreased with advancing age in 6-8-year-old children. In conclusion, expression of both craniomandibular disorder and disorders in speech sound production seem to a considerable extent to reflect immaturity of fine motor control of the orofacial muscles in 6-8-year-old children.

Functional disturbances of the masticatory system in relation to articulatory disorders of speech in a group of 6-8-year-old children.

In the sample of 208 children, clinical signs and symptoms of craniomandibular disorder were mild, somewhat more common in boys than in girls, and clearly more common in children referred for speech therapy than in the control group. Of variables measured in millimetres, the differences indicate sexual dimorphism rather than differences between boys and girls in the occurrence of craniomandibular disorders. The differences may also reflect later maturing of neuromuscular control in boys rather than true differences between boys and girls in the prevalence of craniomandibular disorder. Logistical regression showed that children with articulatory speech disorders had more subjective symptoms and retrusive interferences, smaller maximal opening, and larger maximal laterotrusion and protrusion movements of the mandible than the controls. Thus different dysfunctions of the orofacial region tend to coexist in the same individuals. Subjective symptoms and clinical signs are mild in 6-8-yr-old children and may reflect immaturity of fine motor control.

Occlusal interferences related to dental panoramic radiographic changes in subjects treated with fixed prosthesis.

Because of contradictory reports between clinical and radiographic findings, occlusal analysis correlated to dental panoramic findings was completed in 147 patients treated with fixed prosthesis. Both occlusal interferences and radiographic changes in the TMJ area and/or in dentition were frequently discovered. Dysfunction and occlusal indices gave statistically significant correlations to radiographic changes (P less than 0.01 and P less than 0.05, respectively) in the TMJ area. Periodontal changes with vertical bone pocket formation and sclerotic lamina dura seem to be early radiographic findings and occlusal interferences were the only means to give a clear-cut correlation to the radiographic changes (P less than 0.001). However, if periodontal tissues with supporting bone structure fail to respond to occlusal trauma, changes in the TMJ area will probably appear. From the clinical changes the deviation on mouth opening, tenderness to palpation of TMJ, and slide from retrusion to intercuspidation (RP-IP) explained most of the radiological TMJ changes when tested by the discriminant analysis. The value of radiographic follow-up of subjects following prosthetic treatment is emphasized.

Functional disturbances of the masticatory system related to temporomandibular joint involvement by rheumatoid arthritis.

Several theories have been proposed concerning the aetiology of dysfunction of the temporomandibular joint (TMJ). To analyse the relationship of radiographic changes to clinical signs and symptoms of TMJ dysfunction, the present study was conducted in subjects highly predisposed to TMJ involvement, i.e. in patients with rheumatoid arthritis (RA). The aim of the study was to estimate the frequency of disturbances in the masticatory system of RA patients. In addition, the relationship between TMJ abnormalities and the signs and symptoms of dysfunction was investigated. The study consisted of sixty patients with RA and forty control subjects. Asymptomatic subjects were more frequent in the RA group than in the controls. Muscle pain during palpation was recorded in 53.3%, clicking in 53.3%, crepitation in 21.7%, reduced movement capacity of the TMJ in 41.7%, and restricted mouth opening in 31.7% of the RA patients examined. In the control group the most common symptoms and signs were clicking (57.5%), muscle pain during palpation (57.5%) and restricted opening (25.0%). Normal radiographic appearance of the TMJ in RA patients was found in 31.7%. Minor changes comprised 31.7%, moderate changes 21.6%, and severe changes or total loss of the condyle 15.0%. In the control group a normal joint was detected in 87.5%, while minor changes were encountered in 7.5%, and moderate or severe changes only in 5.0%. No relationship was found between Helkimo's anamnestic, clinical or occlusal indices and the severity of the disease graded according the criteria outlined by the American Rheumatism association (ARA). In the ARA group the frequency of signs and symptoms of dysfunction increased with the destructive changes in the TMJ area. In the controls, muscle pain during palpation and clicking sounds in the TMJ were most commonly connected with normal radiographic appearance of the TMJ. In the discriminant analysis the most discriminating factors were crepitation, tenderness to palpation of muscles and movement of TMJ.

Effects of occlusal adjustment on the periodontal condition and on the symptoms of masticatory dysfunction in patients treated with fixed prosthesis--a one-year follow-up study.

A total of fifty-nine patients treated with a fixed prosthesis 4 years previously were recalled for a clinical and radiological examination. The subjects studied consisted of two groups: in group A the teeth of the patients with TMJ symptoms were selectively ground, whereas no grinding was performed in group B. At the first examination, occlusal interferences were found in 43.0% of the crowns and in 29.0% of pontics in group A before occlusal adjustment. At the second examination 1 year later, the percentage of occlusal interferences was decreased in this group (33.0% of the crowns and 25.8% in the pontics). In group B no changes in occlusal interferences were found after the 1-year follow-up period. The results of the investigation suggested that the frequency of interferences related to occlusal adjustment is important and the effect of occlusal adjustment to periodontal condition and TMJ symptoms is beneficial.

Occlusal interferences analysed in patients treated with fixed prosthesis four years earlier.

This study consists of 147 subjects treated with fixed prostheses 4 years previously. Occlusal analyses were made, and the fillings, crowns, and pontics on the occlusal surfaces were recorded. Occlusal interferences were found in 42.6% of the fillings, in 34.9% of the crowns, in 27.0% of the pontics, and in 24.6% of the intact surfaces. The most common interference types were intercuspidation, retrusion and mediotrusion in the fillings, as well as intercuspidation, retrusion, and laterotrusion interferences in the crowns. In pontics interferences appeared mostly in intercuspidation and retrusion. When adjustment was made for preprosthetic occlusion, the number of interferences on all types of occlusal surfaces considerably decreased.

Influence of occlusal interferences on the periodontium in patients treated with fixed prosthesis.

Gingival bleeding, pocket depth, and tooth mobility were recorded, and occlusal analyses were made on 147 subjects treated with fixed prostheses placed 4 years earlier. The percent of gingival bleeding was greater in teeth with interferences than in those without interferences. A slight increase in pocket depth was found in connection with interferences. However, the difference was statistically significant only in the group with no preprosthetic treatment. No differences in tooth mobility were found between teeth with and those without interferences, possibly partly because of the splinting influence of the fixed partial dentures on the mobile teeth.