Multifactorial analysis of the aetiology of craniomandibular dysfunction in children

Objectives. It is generally accepted that the aetiology of craniomandibular dysfunction (CMD) is multifactorial. Different types of malocclusion, oral parafunctions especially bruxism, trauma of the mandible or temporomandibular joint (TMJ) and emotional stress are known aetiologic factors. Research has been conducted into the relationship between each of these aetiologic factors and the signs and symptoms of CMD. However, such an approach does not control for the simultaneous effect of other factors responsible for the development of the dysfunction. The purpose of this study was to investigate the effect of each aetiologic factor on the signs and symptoms of CMD in children, controlling for the effect of all other known factors by means of a multifactorial analysis. Methods. A sample of 314 children, aged 6-8 years, was examined clinically for signs of CMD and morphologic and functional malocclusion. Symptoms of CMD and oral parafunctions were recorded by the same investigator in an interview. Emotional stress was measured through urinary catecholamines including epinephrine, norepinephrine and dopamine, detected in a 24-h urine sample, using high performance liquid chromatography. A questionnaire was distributed to the parents to collect information regarding socioeconomic factors and the history of dentofacial injuries. A logistic multiple regression was carried out to estimate the partial effect of each aetiologic factor. A 95% probability level was used. Results. Posterior crossbite with lateral shift significantly affected the probability of child developing deviation of the mandible on opening. Similarly, posterior crossbite and epinephrine had a significant impact on TMJ tenderness, overjet had an effect on clicking, clenching and biting of objects had an effect on muscle tenderness, and lip/cheek biting influenced dysfunctional opening. Of the symptoms reported, pain on wide opening was affected significantly by lip/cheek biting. Conclusion. On the basis of these results, it can be suggested that parafunctional and some structural and psychological factors may increase the probability of the child developing the signs and symptoms of CMD

Urinary catecholamine levels and dentofacial injuries in children

This study investigated the relationship between urinary catecholamine levels and dentofacial injuries in 221 children, boys and girls, aged 8 to 10 years. Dentofacial injuries were recorded by a questionnaire and a clinical examination. Three 24-h urine samples, taken with an interval of 1 year between each, were available for each subject. A representative urine sample from each examination was analyzed by the high-performance liquid chromatography technique to assay the catecholamine content. Socioeconomic factors were recorded by a questionnaire. Of the examined children 58 (24 boys and 34 girls) with complete 24-h urine samples showed neither historical nor clinical evidence of dentofacial injuries and constituted the control group. Two case groups, A and B, with historical and/or clinical evidence of dentofacial injuries were matched by age and gender. Differences in the quantitative and qualitative data were tested by the paired /-test and the %2 test, respectively, while a regression analysis was applied to measure the effects of norepinephrine on epinephrinc and dopamine. The 95% probability level was used. The results showed significant differences between control and case group A in the cpinephrine and norepincphrine levels of the second urine sample. Significant differences were also found between control and case group B at the first urine sample in epinephrine and dopamine and at the second in epinephrine. Injured boys had significantly higher values of all catecholamines except for epinephrine in the second urine sample than injured girls. The only significant difference found between boys and girls without dentofacial injuries was in norepinephrine in the second urine sample. The data suggested that children with dentofacial injuries are more frequently under emotional stress and consequently emotionally stressful children run a greater risk of sustaining such injuries. © Munksgaard, 1997

Urinary catecholamine levels in children with and without a history of dentofacial injuries

Abstract This study was conducted to investigate the existence of any differences in the urinary cathecholamine levels in children with and without a history of dentofacial injuries. Three hundred fourteen children, boys and girls, aged 6 to 8 years were included in this study. A questionnaire was distributed to the parents to collect information about the child's history of dentofacial injuries. A 24‐h urine sample was collected for each subject and a representative sample (25 ml) was analyzed by the HPLC technique to assay the catecholamine content. Of the examined children 68 (43 boys and 25 girls) had a history of dentofacial injury and constituted the experimental group. A control group of 68 children (43 boys and 25 girls) without a history of dentofacial injury w as matched by age and sex. The Student t‐test was used to identify any differences in urinary catecholamine levels between the two groups. The 95% probability was used. The results showed statistically significant differences in the mean values of epinephrine, while the differences in norepinephrine and dopamine were not significant. This study suggested that children with emotionally stressful states run a greater risk of having dentofacial injuries. Copyright © 1995, Wiley Blackwell. All rights reserve

Incidence of dentofacial injuries in children: A 2-year longitudinal study

In this prospective study the incidence of dentofacial injuries in 199 children aged 8 to 10 years was analyzed. Dentofacial injuries were recorded by a questionnaire and a clinical examination. After the first examination, each subject was re-examined at yearly intervals over a period of 2 years. Incidence rates were calculated in percentages and the chi-square was applied to test statistical differences. The 95% probability level was used. Results showed that the overall incidence of dentofacial injuries was 45.2%. The percentages for boys and girls were 28.6 and 16.6 respectively. The chi-square test showed significant gender differences, while differences by age were not significant. The highest incidence was recorded for dental injury followed by facial injury, historical evidence of injury and dental and facial injury

Longitudinal study on types of injury, complications and treatment in permanent traumatized teeth with single and multiple dental trauma episodes

The purpose of this study was to compare the type of injuries, complications and treatment in permanent traumatized teeth with single and multiple dental trauma episodes (MDTE). One hundred and fifty-five children, aged 6-14 years, sustaining one or more traumatic episodes to permanent teeth were included in this investigation. After the medical and dental history the patients were examined clinically and radiographically and the diagnosis of trauma, the treatment plan and the applied treatment were recorded. Also, information regarding the number of traumatic episodes, the number of injured permanent teeth and the vitality of the pulp was collected. In follow-ups, traumatized teeth were examined clinically and radiographically to evaluate the treatment applied and to detect any complication. The t-statistic was used to test differences in the mean number of teeth per patient with different types of injury, complications and treatment between permanent traumatized teeth with single and multiple trauma episodes. A 95% probability level was used. The results showed that MDTE significantly affected the mean number of teeth per patient with fractured restoration, root fracture, concussion, pulp canal obliteration, root replacement resorption, filling therapy, surgery and prosthetic treatment. It was concluded that MDTE increase the risk of having certain types of injury, complications and treatment. © 2007 Blackwell Munksgaard

Progression of proximal caries in children with different caries indices: a 4-year radiographic study.

AIM: This was to investigate survival rate, median survival time and differences in the progression of different stages of proximal caries in 196 children, aged 6 to 8 years old, with different caries index at baseline examination. METHODS: Based on DMFS/dmfs values, children were categorized as low, moderate and high caries index groups. Subjects with DMFS/dmfs smaller or equal to half of a child's age were classified as low caries index group, children with DMFS/dmfs greater to half and smaller than or equal to the child's age as moderate, while those with DMFS/dmfs greater than the child's age as high. Proximal caries and its progression were diagnosed from bitewing radiographs taken at 1-year intervals over a period of 4 years. The mesial surface of the first permanent molars, mesial and distal surfaces of the first and second primary molars and distal surfaces of the primary canines were examined. Sound surfaces, caries lesions in the external and internal half of the enamel and external, middle, internal third of the dentine as well as filled, extracted and exfoliated teeth were recorded. STATISTICS: A life table analysis was performed to estimate survival rate and median survival time of each state of proximal caries and differences between the groups in the progression of the proximal lesions were tested with the Wilcoxon pairwise comparison statistic. RESULTS: There were statistically significant differences in the caries rate of the sound proximal surfaces of the primary teeth between the low and high caries index groups. Also, statistically significant differences between these two groups were found in the progression of the external half of the enamel caries in the first permanent molars and in the primary teeth. CONCLUSIONS: A high caries index increases the risk of developing caries in the sound proximal surfaces of posterior primary teeth and causes faster progression of the external half of the enamel lesions in the first permanent molars and posterior primary teeth

Urinary Catecholamine Levels and Gingivitis in Children

THIS STUDY INVESTIGATED THE RELATIONSHIP between gingivitis and emotionally stressful states measured by the urinary catecholamines in children. Three-hundred and fourteen (314) children, boys and girls, aged 6 to 8 years were included in the study. Gingivitis was recorded by the gingival bleeding index and dental plaque by the plaque control record index. Proximal decayed surfaces, faulty restorations, and stainless steel crowns were diagnosed clinically and radiographically. Information concerning systemic and socioeconomic factors was collected by a questionnaire. A 24-hour urine sample was collected for each subject and analyzed by the HPLC technique to assay the catecholamine content. The multiple-regression analysis was carried out to test whether gingivitis was affected by the studied variables. The 95% probability was used. The results showed that epinephrine, norepinephrine, and dopamine did not have a significant association with gingival index. Dental plaque and proximal decayed surfaces significantly affected gingivitis. Of the socioeconomic factors, mother's education had a significant association with gingivitis when all factors were included in the analysis. The data suggest that emotionally stressful states may not increase the probability of developing gingivitis in children of this age

Urinary Catecholamine Levels in Children with and without Dental Caries

Urinary catecholamines have been used to measure emotionally stressful states which may affect the development of dental caries. This study investigates the hypothesis that children with and without dental caries do not differ significantly in the mean values of urinary catecholamines such as epinephrine, norepinephrine, and dopamine. As a test of this hypothesis, 314 children, males and females, aged from 6 to 8 years, were included in the study. Dental caries were recorded clinically and radiographically, and oral hygiene was evaluated by the recording of dental plaque. A 24-hour urine sample was collected for each subject, and a representative sample (25 mL) was analyzed by the HPLC technique to assay the catecholamine content. Socio-economic factors such as parental age, education, and profession were recorded by a questionnaire distributed to the parents. Of the examined children, 38 (14 males and 24 females) were free of dental caries and constituted the case group. Two control groups, A and B, of 38 children each (14 males and 24 females) with dental caries were matched by age and gender. Differences in the quantitative and qualitative data were tested by the paired t test and the X2-test, respectively, while a regression analysis was applied to measure the effects of norepinephrine and dopamine on epinephrine. The logistic multiple-regression analysis was used to test, in the entire population, the impact of catecholamines and other related factors on the probability of subjects' developing dental caries. The 95% probability was used. The results showed statistically significant differences in epinephrine values between the case group and control groups A and B. The data suggest, therefore, that children with emotionally stressful states have higher probability of developing dental caries. © 1995, SAGE Publications. All rights reserved