Cervical Muscle Tenderness in Temporomandibular Disorders and Its Associations with Diagnosis, Disease-Related Outcomes, and Comorbid Pain Conditions

Galit Almoznino*, Avraham Zini, Hulio Zlutzky, Stav Bekker, Boaz Shay, Yaron Haviv, Yair Sharav, Rafael Benoliel, Avraham Zakuto

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Aims: To analyze cervical tenderness scores (CTS) in patients with various temporomandibular disorders (TMD) and in controls and to examine associations of CTS with demographic and clinical parameters. Methods: This case-control study included 192 TMD patients and 99 controls diagnosed based on a questionnaire and a clinical examination following the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) guidelines. CTS, adapted from the widely used total tenderness score, was the mean sum of the palpation scores from the suboccipital, sternocleidomastoid, and trapezius muscles. Depending on the variables, data were analyzed using Pearson chi-square, analysis of variance, t test, Bonferroni post hoc adjustment, and/or multivariate linear regression analyses. Results: CTS was higher in TMD patients compared to controls (P <. 001). Across TMD subgroups, CTS was notable only in those with a myogenous TMD diagnosis, but not in arthrogenous TMD (P =. 014). CTS was positively associated with: female sex (P =. 03), whiplash history, higher verbal pain scores, comorbid headaches, body pain, increased pain on mouth opening, and higher masticatory muscles tenderness scores (MTS) (P <. 001 for all). Sex (P <. 001), MTS (P <. 001), comorbid headache (P =. 042), and pain on opening (mild: P =. 031; moderate: P =. 022) retained significant associations with CTS in the multivariate analysis, and these main effects were influenced by interactions with whiplash history and comorbid body pain. Conclusion: CTS differentiated between TMD patients and controls and between TMD diagnoses. Specific patient and pain characteristics associated with poor outcome in terms of CTS included effects of interactions between myogenous TMD, female sex, whiplash history, comorbid body pain and headaches, and pain on opening. It can therefore be concluded that routine clinical examination of TMD patients should include assessment of the cervical region.

Original languageAmerican English
Pages (from-to)67-76
Number of pages10
JournalJournal of Oral and Facial Pain and Headache
Volume34
Issue number1
DOIs
StatePublished - 2020

Bibliographical note

Funding Information:
The authors received no external funding for this project. The authors declare no conflicts of interest. Each of the contributors provided substantive intellectual contributions to one or more of the activities related to this manuscript, as follows: G.A.: Corresponding author, principal investigator, made substantial contributions to the study's conception and design; acquisition, analysis, and interpretation of data; drafted the submitted article and provided final approval of the version to be published; A.Z.: Analysis and interpretation of data and approved the manuscript; Z.A.: Data collection of the TMD group and approved the manuscript; H.Z.: Data collection of the control group and approved the manuscript; S.B.: Interpretation of the results, revised and approved the manuscript; B.S.: Revised and approved the manuscript; Y.H.: Revised and approved the manuscript; Y.S.: Interpretation of the results, revised and approved the manuscript; R.B.: Made substantial contributions to the study's conception and design, interpretation of data, drafted, revised, and approved the manuscript.

Publisher Copyright:
© 2020. Quintessence Publishing Co Inc. All Rights Reserved.

Keywords

  • cervical muscle tenderness
  • masticatory muscle disorders
  • muscle tenderness score
  • temporomandibular disorders

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