Temporomandibular disorders: the habitual chewing side syndrome

Urbano Santana-Mora, José López-Cedrún, María J Mora, Xosé L Otero, Urbano Santana-Penín, Urbano Santana-Mora, José López-Cedrún, María J Mora, Xosé L Otero, Urbano Santana-Penín

Abstract

Background: Temporomandibular disorders are the most common cause of chronic orofacial pain, but, except where they occur subsequent to trauma, their cause remains unknown. This cross-sectional study assessed chewing function (habitual chewing side) and the differences of the chewing side and condylar path and lateral anterior guidance angles in participants with chronic unilateral temporomandibular disorder. This is the preliminary report of a randomized trial that aimed to test the effect of a new occlusal adjustment therapy.

Methods: The masticatory function of 21 randomly selected completely dentate participants with chronic temporomandibular disorders (all but one with unilateral symptoms) was assessed by observing them eat almonds, inspecting the lateral horizontal movement of the jaw, with kinesiography, and by means of interview. The condylar path in the sagittal plane and the lateral anterior guidance angles with respect to the Frankfort horizontal plane in the frontal plane were measured on both sides in each individual.

Results: Sixteen of 20 participants with unilateral symptoms chewed on the affected side; the concordance (Fisher's exact test, P = .003) and the concordance-symmetry level (Kappa coefficient κ = 0.689; 95% confidence interval [CI], 0.38 to 0.99; P = .002) were significant. The mean condylar path angle was steeper (53.47(10.88) degrees versus 46.16(7.25) degrees; P = .001), and the mean lateral anterior guidance angle was flatter (41.63(13.35) degrees versus 48.32(9.53) degrees P = .036) on the symptomatic side.

Discussion: The results of this study support the use of a new term based on etiology, "habitual chewing side syndrome", instead of the nonspecific symptom-based "temporomandibular joint disorders"; this denomination is characterized in adults by a steeper condylar path, flatter lateral anterior guidance, and habitual chewing on the symptomatic side.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Axiography procedure: condylar path tracings.
Figure 1. Axiography procedure: condylar path tracings.
A, the kinematic face-bow attached with silicone putty to mandibular teeth through an occlusal rim; lateral condylar path drawn on the surface of the recording card. B, parasagittal plane of lateral condylar path tracings and their angle with respect to the tragus-infraorbital Frankfort plane.
Figure 2. Gnathography procedure.
Figure 2. Gnathography procedure.
A, The face-bow placed on the patient’s head and the magnet attached to the buccal surface of the mandibular incisors. B, lateral anterior dental guidance tracings and the right angle with respect to the bimeatus-horizontal plane.
Figure 3. Craniomandibular relationships of a patient…
Figure 3. Craniomandibular relationships of a patient with left-side symptoms.
A, Maximal intercuspal position. B, Right lateral jaw motion. C, Left lateral jaw motion. Left lateral jaw motion is more horizontal than right lateral jaw motion (α>α’ and/or β>β’).

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