Characteristics and Treatment of Temporomandibular Disorder in Children and Adolescents: An Analytic Review

  • Park, Hyung-Seok (Department of Oral Medicine, Institute of Translational Dental Sciences, Pusan National University) ;
  • Ahn, Yong-Woo (Department of Oral Medicine, Institute of Translational Dental Sciences, Pusan National University) ;
  • Jeong, Sung-Hee (Department of Oral Medicine, Institute of Translational Dental Sciences, Pusan National University) ;
  • Jeon, Hye-Mi (Dental Clinic Center, Pusan National University Hospital) ;
  • Ok, Soo-Min (Department of Oral Medicine, Institute of Translational Dental Sciences, Pusan National University)
  • Received : 2017.09.20
  • Accepted : 2017.12.20
  • Published : 2017.12.30


Purpose: The purpose of this study is to investigate the prevalence of temporomandibular disorders (TMDs) in children and adolescents, their characteristic contributing factors, the characteristic features of symptoms and symptoms, and the response to treatment. Methods: We studied the researches, that were the results of the searches for words such as temporomandibular disorder, TMD, children, adolescents, and juvenile through PubMed and DBpia. Results: According to a study conducted in Busan, the ratio of adolescents increased from 18.3% to 21% in 2008 compared to 2000, and the proportion of boys increased from 38.58% to 45.38%. One of the characteristic contributing factors for adolescents is the macrotrauma such as jaw trauma, vehicle accidents, sports, physical abuse, forceful intubation, and third molar extraction. The second is a microtrauma from parafunctional habit such as bruxism, clenching, hyperextension, wind instrument, and fingernail biting that can cause joint overload, cartilage breakdown, synovial fluid alterations, and other changes within the joint. The diagnosis of TMDs in juvenile adolescents is not significantly different from that of adults. Medical history, clinical examination and radiological examinations are required. Conclusions: In the temporomandibular joint history and assessment, all comprehensive dental history examination is required, including head and neck pain, mandibular dysfunction, previous orofacial trauma, history of present illness with an account of current symptoms. For the treatment and management of temporomandibular arthritis in juvenile adolescents, understanding the characteristics of TMDs in juvenile adolescents and thoroughly analyzing appropriate diagnosis and possible contributing factors through comprehensive history taking & examination, conservative treatment, including fast and active cautions education, will be essential.


Supported by : Pusan National University Dental Hospital


  1. de Leeuw R, Klasser GD; American Academy of Orofacial Pain. Orofacial pain: guidelines for assessment, diagnosis, and management. 5th ed. Chicago, IL: Quintessence Publishing; 2013. pp. 127-186.
  2. Willems NM, Langenbach GE, Everts V, Zentner A. The microstructural and biomechanical development of the condylar bone: a review. Eur J Orthod 2014;36:479-485.
  3. Gredes T, Mack H, Spassov A, et al. Changes in condylar cartilage after anterior mandibular displacement in juvenile pigs. Arch Oral Biol 2012;57:594-598.
  4. Leung FY, Rabie AB, Hagg U. Neovascularization and bone formation in the condyle during stepwise mandibular advancement. Eur J Orthod 2004;26:137-141.
  5. Rabie AB, Xiong H, Hagg U. Forward mandibular positioning enhances condylar adaptation in adult rats. Eur J Orthod 2004;26:353-358.
  6. Xiong H, Rabie AB, Hagg U. Neovascularization and mandibular condylar bone remodeling in adult rats under mechanical strain. Front Biosci 2005;10:74-82.
  7. Bouvier M. Effects of age on the ability of the rat temporomandibular joint to respond to changing functional demands. J Dent Res 1988;67:1206-1212.
  8. Zeng G, Kuang B, Xun WX, Ren GT, Wei KW. Response of mandibular condyles of juvenile and adult rats to abnormal occlusion and subsequent exemption. Arch Oral Biol 2017;80:136-143.
  9. Thilander B, Rubio G, Pena L, de Mayorga C. Prevalence of temporomandibular dysfunction and its association with malocclusion in children and adolescents: an epidemiologic study related to specified stages of dental development. Angle Orthod 2002;72:146-154.
  10. Graue AM, Jokstad A, Assmus J, Skeie MS. Prevalence among adolescents in Bergen, Western Norway, of temporomandibular disorders according to the DC/TMD criteria and examination protocol. Acta Odontol Scand 2016;74:449-455.
  11. Nilsson IM, List T, Drangsholt M. Headache and co-morbid pains associated with TMD pain in adolescents. J Dent Res 2013;92:802-807.
  12. LeResche L, Mancl LA, Drangsholt MT, Huang G, Von Korff M. Predictors of onset of facial pain and temporomandibular disorders in early adolescence. Pain 2007;129:269-278.
  13. Ok SM, Kim CY, Jeong SH, Ahn YW, Ko MY. Comparative analysis: the patterns of temporomandibular disorder among adolescents. J Oral Med Pain 2012;37:47-59.
  14. Greco CM, Rudy TE, Turk DC, Herlich A, Zaki HH. Traumatic onset of temporomandibular disorders: positive effects of a standardized conservative treatment program. Clin J Pain 1997;13:337-347.
  15. Fischer DJ, Mueller BA, Critchlow CW, LeResche L. The association of temporomandibular disorder pain with history of head and neck injury in adolescents. J Orofac Pain 2006;20:191-198.
  16. Imahara SD, Hopper RA, Wang J, Rivara FP, Klein MB. Patterns and outcomes of pediatric facial fractures in the United States: a survey of the National Trauma Data Bank. J Am Coll Surg 2008;207:710-716.
  17. Akhter R, Hassan NM, Ohkubo R, Tsukazaki T, Aida J, Morita M. The relationship between jaw injury, third molar removal, and orthodontic treatment and TMD symptoms in university students in Japan. J Orofac Pain 2008;22:50-56.
  18. Leuin SC, Frydendall E, Gao D, Chan KH. Temporomandibular joint dysfunction after mandibular fracture in children: a 10-year review. Arch Otolaryngol Head Neck Surg 2011;137:10-14.
  19. Guven O. A clinical study on temporomandibular joint ankylosis in children. J Craniofac Surg 2008;19:1263-1269.
  20. Mejersjo C, Ovesson D, Mossberg B. Oral parafunctions, piercing and signs and symptoms of temporomandibular disorders in high school students. Acta Odontol Scand 2016;74:279-284.
  21. Lee S, Kang H, Shin G. Head flexion angle while using a smartphone. Ergonomics 2015;58:220-226.
  22. Carlsson GE, Egermark I, Magnusson T. Predictors of signs and symptoms of temporomandibular disorders: a 20-year followup study from childhood to adulthood. Acta Odontol Scand 2002;60:180-185.
  23. De Boever JA, Carlsson GE, Klineberg IJ. Need for occlusal therapy and prosthodontic treatment in the management of temporomandibular disorders. Part I. Occlusal interferences and occlusal adjustment. J Oral Rehabil 2000;27:367-379.
  24. Taskaya-Yilmaz N, Ogutcen-Toller M, Sarac YS. Relationship between the TMJ disc and condyle position on MRI and occlusal contacts on lateral excursions in TMD patients. J Oral Rehabil 2004;31:754-758.
  25. Henrikson T, Nilner M. Temporomandibular disorders, occlusion and orthodontic treatment. J Orthod 2003;30:129-137; discussion 127.
  26. Egermark I, Carlsson GE, Magnusson T. A prospective long-term study of signs and symptoms of temporomandibular disorders in patients who received orthodontic treatment in childhood. Angle Orthod 2005;75:645-650.
  27. Henrikson T, Nilner M, Kurol J. Symptoms and signs of temporomandibular disorders before, during and after orthodontic treatment. Swed Dent J 1999;23:193-207.
  28. Henrikson T, Nilner M, Kurol J. Signs of temporomandibular disorders in girls receiving orthodontic treatment. A prospective and longitudinal comparison with untreated Class II malocclusions and normal occlusion subjects. Eur J Orthod 2000;22:271-281.
  29. Kim MR, Graber TM, Viana MA. Orthodontics and temporomandibular disorder: a meta-analysis. Am J Orthod Dentofacial Orthop 2002;121:438-446.
  30. Phillips JT. What skeletal and dental characteristics do TMD patients have in common? Funct Orthod 2007;24:24-26, 28, 30.
  31. Pahkala R, Qvarnstrom M. Can temporomandibular dysfunction signs be predicted by early morphological or functional variables? Eur J Orthod 2004;26:367-373.
  32. List T, Wahlund K, Larsson B. Psychosocial functioning and dental factors in adolescents with temporomandibular disorders: a case-control study. J Orofac Pain 2001;15:218-227.
  33. de Leeuw R, Klasser GD; American Academy of Orofacial Pain. Orofacial pain: guidelines for assessment, diagnosis, and management. 5th ed. Chicago, IL: Quintessence Publishing; 2013. pp. 392-426.
  34. Karibe H, Goddard G, Aoyagi K, et al. Comparison of subjective symptoms of temporomandibular disorders in young patients by age and gender. Cranio 2012;30:114-1120.
  35. Kim BS, He JY, Ok SM, et al. Cyber leisure activities and physical activities in adolescents with temporomandibular disorder. J Oral Med Pain 2013;38:187-201.
  36. Al-Khotani A, Naimi-Akbar A, Gjelset M, et al. The associations between psychosocial aspects and TMD-pain related aspects in children and adolescents. J Headache Pain 2016;17:30.
  37. Milam SB, Zardeneta G, Schmitz JP. Oxidative stress and degenerative temporomandibular joint disease: a proposed hypothesis. J Oral Maxillofac Surg 1998;56:214-223.
  38. Howard JA. Temporomandibular joint disorders in children. Dent Clin North Am 2013;57:99-127.
  39. Clinical Affairs Committee - Temporomandibular Joint Problems in Children Subcommittee, American Academy of Pediatric Dentistry. Guideline on acquired temporomandibular disorders in infants, children, and adolescents. Pediatr Dent 2015;37:78-84.
  40. Brooks SL, Brand JW, Gibbs SJ, et al. Imaging of the temporomandibular joint: a position paper of the American Academy of Oral and Maxillofacial Radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83:609-618.
  41. de Senna BR, dos Santos Silva VK, Franca JP, Marques LS, Pereira LJ. Imaging diagnosis of the temporomandibular joint: Critical review of indications and new perspectives. Oral Radiol 2009;25:86-98.
  42. Hunter A, Kalathingal S. Diagnostic imaging for temporomandibular disorders and orofacial pain. Dent Clin North Am 2013;57:405-418.
  43. Zhao YP, Zhang ZY, Wu YT, Zhang WL, Ma XC. Investigation of the clinical and radiographic features of osteoarthrosis of the temporomandibular joints in adolescents and young adults. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:e27-e34.
  44. Bodner L, Miller VJ. Temporomandibular joint dysfunction in children: evaluation of treatment. Int J Pediatr Otorhinolaryngol 1998;44:133-137.
  45. Ok SM, Kim KH, Heo JY, Ahn YW, Jeong SH. Self-checking type, repetitive, education efficacy for temporomandibular disorder patients. J Oral Med Pain 2015;40:72-78.
  46. Koh H, Robinson PG. Occlusal adjustment for treating and preventing temporomandibular joint disorders. Cochrane Database Syst Rev 2003;(1):CD003812.
  47. Luther F, Layton S, McDonald F. Orthodontics for treating temporomandibular joint (TMJ) disorders. Cochrane Database Syst Rev 2010;(7):CD006541.
  48. Rey D, Oberti G, Baccetti T. Evaluation of temporomandibular disorders in Class III patients treated with mandibular cervical headgear and fixed appliances. Am J Orthod Dentofacial Orthop 2008;133:379-381.
  49. Dym H, Israel H. Diagnosis and treatment of temporomandibular disorders. Dent Clin North Am 2012;56:149-161.
  50. Kim JH, Ok SM, He JY, et al. The clinical and radiographic features of patients with temporomandibular joint osteoarthritis. J Oral Med Pain 2014;39:2-9.