Graduate Program in Dentistry, Federal University of Pelotas (UFPel), Pelotas, RS, Brazil.
National Dental Centre Singapore, National Dental Research Institute Singapore, Singapore, Singapore.
Clin Oral Investig. 2024 Feb 13;28(2):142. doi: 10.1007/s00784-024-05545-1.
This cross-sectional school-based study explored the influence of malocclusion on temporomandibular disorders (TMD) pain complaints, and whether this association would be mediated by sleep bruxism in a representative sample of 7- to 8-year-old children.
Path analysis estimated direct, indirect, and total effects of occlusal features on sleep bruxism and TMD pain in 7- to 8-year-old children. Occlusal features were assessed with Dental Aesthetic Index (DAI), orofacial pain complaints using the TMD pain screener, possible sleep bruxism based on self-reports, and probable sleep bruxism based on self-reports combined with clinical findings. Structural equation modeling analyzed data with confounding factors.
From 580 participants, possible sleep bruxism was observed in 136 children (31.5%), probable sleep bruxism in 30 children (6.7%), and TMD pain complaints in 78 children (13.8%). Malocclusion had no direct effect on either possible sleep bruxism [standardized coefficient (SC) 0.000; p = 0.992], or TMD pain complaints (SC - 0.01; p = 0.740). When probable sleep bruxism was set as the mediator of interest, malocclusion did not directly affect probable sleep bruxism (SC 0.01; p = 0.766), nor TMD pain complaints (SC - 0.02; p = 0.515). A direct effect of probable sleep bruxism on TMD pain complaints was observed with an SC of 0.60 (p < 0.001). However, in neither case, malocclusion indirectly affected TMD pain complaints via bruxism.
Malocclusion in 7- to 8-year-old children did not directly influence possible or probable sleep bruxism or TMD pain complaints. Instead, probable sleep bruxism was strongly associated with TMD pain complaints.
The impact of occlusal features on TMD pain complaints and bruxism has been a long-standing controversy in dentistry. However, the scientific literature linking this association may be inconsistent, mainly due to biased sample selection methods with inadequate consideration of confounders. Further research should try to identify additional risk factors for TMD pain in addition to probable sleep bruxism in children.
本横断面学校基础研究旨在探讨 7 至 8 岁儿童中错牙合畸形对颞下颌关节紊乱（TMD）疼痛的影响，以及这种关联是否会通过睡眠磨牙症来介导。
路径分析估计了 7 至 8 岁儿童的牙合特征对睡眠磨牙症和 TMD 疼痛的直接、间接和总影响。使用牙审美指数（DAI）评估牙合特征，使用 TMD 疼痛筛查器评估口面疼痛，基于自我报告评估可能的睡眠磨牙症，基于自我报告和临床发现评估可能的睡眠磨牙症。结构方程模型分析了混杂因素的数据。
在 580 名参与者中，136 名儿童（31.5%）观察到可能的睡眠磨牙症，30 名儿童（6.7%）观察到可能的睡眠磨牙症，78 名儿童（13.8%）观察到 TMD 疼痛。错牙合畸形对可能的睡眠磨牙症（标准化系数（SC）0.000；p=0.992）或 TMD 疼痛（SC-0.01；p=0.740）均无直接影响。当将可能的睡眠磨牙症作为感兴趣的中介时，错牙合畸形对可能的睡眠磨牙症（SC 0.01；p=0.766）或 TMD 疼痛（SC-0.02；p=0.515）没有直接影响。观察到可能的睡眠磨牙症对 TMD 疼痛的直接影响，SC 为 0.60（p<0.001）。然而，在这两种情况下，错牙合畸形都没有通过磨牙症间接影响 TMD 疼痛。
7 至 8 岁儿童的错牙合畸形不会直接影响可能的或可能的睡眠磨牙症或 TMD 疼痛。相反，可能的睡眠磨牙症与 TMD 疼痛有很强的关联。
牙合特征对 TMD 疼痛和磨牙症的影响一直是牙科领域的一个长期争议。然而，将这种关联联系起来的科学文献可能不一致，主要是由于样本选择方法存在偏差，对混杂因素的考虑不足。进一步的研究应该尝试除了可能的睡眠磨牙症之外，还应确定儿童 TMD 疼痛的其他风险因素。
