The Relationship between Temporomandibular Disorders(TMD) and Occlusion

측두하악장애와 교합요인의 관계

  • Kim, Seong-Taek (Department of Oral Diagnosis and Oral Medicine, College of Dentistry, Yonsei University) ;
  • Lee, You-Sik (Dr. Lee's Dental office)
  • 김성택 (연세대학교 치과대학 구강내과학교실) ;
  • 이유식 (이유식 치과의원)
  • Published : 2005.06.30


Temporomandibular disorders have been defined as a collective term embracing a number of clinical problems that involve the temporomandibular joint, the masticatory nuscles, and associated structures. There have been many different contributing factors of TMDs which were traumatic, occlusal, pathophysiological and psychosocial. Among there factors, the effect of occlusion on TMDs have been a controversy for a long time. The purpose of this study was to investigate the effect of occlusal factors and oral habits on TMDs. In this study, 140 subjects with signs and symptoms of TMDs and diagnosed of TMD in the Orofacial Pain clinic of Yonsei University Dental Hospital though March to July 2004 were selected for the TMDs group and 50 subjects without any signs and symptoms of TMDs as the control group. The subjects were evaluated clinically in TMDs' Occlusal and Prosthodontic Restoration examinations. TMDs' examination was composed of the TMJ pain, sound, locking, temporal or masseter muscle palpation, mandibular movement, oral habits and headache. Occlusal examination was made of overjet, overbite, lost teeth number, nonfunctional interference, midline shift, then pattern of lateral movement and attrition. prosthodontic restoration examination had the existence of restoration, placement, then number of crown or bridge and Satisfiable index which estimated the quality of occlusal state of prosthodontic restorations. Following results were obtained : 1. The prevalence of TMDs was higher in their 20s & 30s, female of the TMD patients group. 2. The clenching frequency in the TMDs group(40.71%) was higher than those in the control group(18.00%), and there was a significant statistical difference(p<0.05). 3. The frequency of Nonfunctional interference in the TMDs group(10.00%) was higher than those in then Control group(2.00%), and there was a significant statistical difference(p<0.05). The result of this study indicated TMDs prevalence was higher in their 20s, 30s, female group of TMDs patients similar to the previous studies. Clenching and nonfunctional interference were estimated as the contributing factors of TMDs.


Supported by : Dr. Lee's Dental office


  1. Ash M.M, and Ramfyord S.P. : OCCLUSION(4th ed). 1995 .pp 164-259, WB Saunders Co .Philadelphia
  2. McNeill C : History and evaluation of temporomandibular disorder concepts. In NIH technology assessment conference on management of TMDs, NIH, Bethesda, pp 15-19, 1996
  3. Egermark-Eriksson I, Ingervall B, Carlsson GE : The dependence of mandibular dysfunction in children functional and morphologic malocclusion. Am J Ortho Dentofacial Orthop, 83: 87-194: 1983
  4. Nesbitt BA, Moyers RE : Adult temporomandibular joint disorders symptomatology and its association with childhood occlusal relations. Ann Arbor. MI, 1985, pp. 183-185. University of Michigan Press
  5. Scholte AM, Steenks MH, Bosman F: Characteristics and treatment outcome of diagnostic subgroups of CMD patients: retrospective study. Community Dent Oral Epidermiol. 103:54-61 : 1993
  6. Seligman DA, Pullinger AG: A multiple stepwise logistic regression analysis of trauma history and 16 other history and dental cofactors in fenales with temporomandibular disorders. J Orofac Pain. 10:351-361 :1996
  7. Seligman DA, Pullinger AG: Analysis of occlusal variables, dental attrition, and age for distinguishing healthy controls from female patients with intracapsular temporomandibular disorders. J Prosthet Dent. 83(1):76-82:2000
  8. Williamson EH, Simmon MD :Mandibular asymmetry and its relation to pain dysfunction, Am J Orthod 76:612-617,1979
  9. Stringert HG, Worms FW :Variation in skelectal and dental patterns in patients with structural and functional alteration of the temporomandibular joint. Am J Orthod 89: 285-297, 1986
  10. De Boever,J.A. and Adriens,P.A. : Occlusal relationship in patients with pain-dysfunction symptoms in TMJ. J Oral Rehab, 10:1-10, 1983
  11. Kirveskari.P., Alanen.P., and Jamsa.T., : Association between craniomandibular disorders and occlusal interferences. J Prosth Dent, 62(1): 66-69, 1989
  12. Carlsson.G.E. and Droukas.B.C. : Dental occlusion and the health of the masticatory system. J Cranioman Prac, 2(2) : 141-147, 1984
  13. Thomston LJ : Anterior guidance : Group function/ canine guidance. A literature review : J Prosth Dent. 64: 479-482: 1990
  14. Friction JR, Kroening RJ, Hathaway KM. : TMJ and craniofacialpain : Diagnosis and Management. St.Louis, Ishiyaku EuroAmerica Inc, 1988
  15. 김기석 : 악관절 장애의 기여요인. 대한치과의사협회지, 29(5): 354-358: 1991
  16. Gerber A : temporomandibular joint and dental occlusion. Dtsch Zahnarztl, 26: 119, 1971
  17. Geening.A. : Occlusal interference and functional disturbances of masticatory system. J. Clinic Perio, 1:112, 1974
  18. Phillips, Hamilton : Report of the committee on scientific investigation of the A.A. Rest. D. J. pro. Dent, 53:844-848,1985
  19. Roth, R.H. : Temporomandibular pain dysfunction and Occlusal relationship. Angle Ortho, 43(2) : 136-152, 1973
  20. Solberg WK, Bibb CA, Nordstrom BB, Hansson TL : Malocclusion associated with temporomandibular joint changes in young adults at autopsy. Am J Ortho Dentofacial Orthop, 89: 326-330: 1986
  21. Helkimo.M. : Studies on function and dysfunction of the masticatory systems(IV) age and sex distribution of symptoms of dysfunction of the masticatory system in Lapps in the North of Finland. Acta Odontol Scand, 32: 255-257, 1974
  22. McNeill. C. : Management of Temporomandibular disorders : Concepts and controversies. J Prosth Dent, 77: 510-522: 1997
  23. 이유미,한경수: 측두하악장애에서 교합요인과 생활변화의 영향. 원광치의학 .5(1):237-250, 1995
  24. Griffiths R.H. : Report of the presidents confeerence on the examination, diagnosis and management of temporomandibular disorders. JADA, 106: 75: 1983
  25. Droukas B, Lindee C, Carlsson GE : Occlusion and Mandibular dysfunction : A clinical study of patients referred for functional disturbances of the masticatory system. J Prosthet Dent, 53: 402-406: 1985
  26. Ricketts. R. M. : Clinical implication of the TMJ. Am J Ortho, 52(6) : 416-439, 1966
  27. 한상훈,송영복,김인권 : 측두하악관절 장애 환자의 특성과 교합안정장치 치료후의 평가 p.321-346, 대한악기능교합학회지 Vol.12 ,No.2, 1996
  28. Okeson JP : American Academy of Orofacial Pain : Orofacial Pain ; Guidelines for Classification, assessment, diagnosis and management. 1st ed. 1996: pp .119-128. Quintessence, Chicago
  29. Rugh JD, Ohrbaha R : Occlusal parafunction in Mhlo N, Zarb G, Carlsson O, Rugh J(eds): A textbook of occlusion, Chicago, Quintessence Publ Co, 249-260, 1988
  30. Roberts CA, Tallents RH, Katzberg RW, SanchezWoodworth RE, Espeland MA, Handelman SL : Comparison of internal derangements of the TMJ with occlusal fmdings. Oral Surg Oral Med Oral Pathol, 63: 645-650: 1987
  31. Laskin, D.M. : Etiology of the pain dysfunction syndrome. J Am Dent Assoc, 79: 147-153, 1969
  32. Egerrnark-Eriksson, L and Thilander. B. : Craniomandibular disorders with special reference to orthodontic treatment : An evaluation from childhood to adulthood. Am J Ortho, 101: 28-34, 1992
  33. Sadowsky, C. : The risk of orthodontic treatment for produccing Temporomandibular disorder : A literature overview. Am J Ortho, 101(1): 79-83, 1992
  34. Riolo, M. L., Brandt, D. and Tenhave. T. R : Associstions between occlusal characteristics and sings and symptoms of TMJ dysfunction in children and young adults. Am J Ortho, 92(6): 467-477, 1987
  35. Posselt, U. : The TMJ syndrome and occlusion. J Prosth Dent, 25(4): 432-438, 1971
  36. Mohlin,B and Thilander.B. : The importance of relationship between malocclusion and mandibular dysfunction and some clinical application in adults. Europ J Ortho, 6:192-204, 1984
  37. Friel S. : Occlusion, Observation on its development from infancy to old age. Int J Orthod, 13: 323-335, 1977
  38. Anderson R.J., Myers G.E. : Nature of contacts in centric occlusion in 32 adults. J Dent Res, 50 : 7-13, 1971
  39. Hochman N., Ehrlich J., : Tooth contact location in intercuspal position. Quintessence Int. 18(3): 193-196, 1987
  40. Wanrnan A, Agerberg G : Etiology of Craniomandibular disorder : Evaluation of some occlusal and psychosocial factors in 19-year-olds. J Craniomandib Disord Facial Oral Pain, 5: 35-44: 1990