Epidemiology

Epidemiological studies have indicated that between 3 and 15 percent of the population will qualify for a TMD pain diagnosis.8,9 Few studies have tried to separate TMJ pain from myofascial TMD pain, but the latter appears to be less prevalent than the former.9 Most studies have, however, found that TMD pain is 1.5-2 times more prevalent in women, but it is critical to distinguish between the number of TMD cases presenting in the clinic and the number of TMD cases in the community, because treatment-seeking patterns and use of health services may bias a biological sex difference.10,11 The prevalence of TMD across the lifetime is still debated but there seems to be a peak around 20-45 years for women, although elderly people may also suffer from TMD pain.12,13 For some types of TMD problems such as osteoarthrosis, there seems to be an increase over the life span. There are few good studies on the incidence of TMD pain problems, but there is some evidence that the incidence is in the range of2-4 percent with the persistent types being around 0.1 percent.9 Some longitudinal studies have shown substantial variations in the time course of myofascial TMD14 with 31 percent being persistent over a five-year period, 33 percent being remittent, and 36 percent recurring. Asymptomatic clicks in the TMJ (disk displacement with reduction (DDwR)) are very common (10-35 percent),8,15 but have been shown to very rarely progress to disk displacement without reduction (DDwoR), in fact none of the 114 adolescents that were followed over a nine year period progressed from DDwR

to DDwoR. Interestingly, this study also indicated major fluctuations in the presence and absence of a DDwR so that only 2 percent of the examined population had a consistent click at all examination points during the nine year study period.15 This strongly indicates that asymptomatic DDwR should be managed by conservative techniques. Other studies have shown that patients with combined diagnosis of DDwR and arthralgia may have a higher risk to progress to a DDwoR.16,17

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