The impact of orthodontic-surgical treatment on female patients' temporomandibular symptoms, psychological distress, and quality of life

Abstract

Objective To analyze changes in patients' temporomandibular dysfunction (TMD) symptoms during orthodontic-surgical treatment and to investigate associations between symptoms, findings in temporomandibular joints (TMJs), satisfaction with occlusal function, psychological distress, and orthognathic quality of life (OQoL). Subjects and Methods Thirty-six consecutive female patients started orthodontic-surgical treatment, and 28 voluntary controls participated. Patients and controls filled in a semi-structured diary (regarding satisfaction and TMD symptoms) and the Orthognathic Quality of Life Questionnaire (OQLQ); patients also filled in the Symptom Checklist-90 (SCL-90). Patients' data were analyzed before treatment (T1), after preoperative orthodontics (T3), and one year after jaw surgery (T5). Controls' data were collected at respective time points (CT1, CT2, CT3). Magnetic Resonance Imaging (MRI) studies were performed on patients' and controls' TMJs at T1/CT1. Results Before surgery, patients reported more TMD symptoms than controls. The most frequent symptoms were head/neck pain, stiffness/fatigue of the jaws, and pain in jaw joints. The most common finding in TMJ-MRI was anterior disc displacement with or without reduction. One year after surgery, improvement was seen in patients' satisfaction and OQLQ scores. Patients' number of symptoms correlated negatively with satisfaction and positively with OQLQ scores. No significant correlations were found between the severity of TMJ-MRI findings and satisfaction, number of symptoms, OQLQ function, or sum score. Conclusions Although TMJ-MRI findings are common among orthodontic-surgical patients, they are not always reflected in subjective symptoms, nor in self-perceived treatment outcome. Individual characteristics, not detectable using objective measures, constitute an important aspect and should therefore reserve more emphasis.