Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children

Neck accessory respiratory muscles and mouth breathing suggest a direct relationship among asthma, Temporomandibular (TMD) and Cervical Spine (CSD) Disorders. This study was performed to eval-uate and correlate TMD, CSD in asthmatic and non-asthmatic. Thirty asthmatic children (7.1 ± 2.6 years old), 30 non-asthmatic predominantly mouth breathing children (Mouth Breathing Group -MBG) (8.80 ± 1.61 years) and 30 non-asthmatic predominantly nasal breathing children (Nasal breathing Group – NBG) (9.00 ± 1.64 years) participated in this study and they were submitted to clin-ical index to evaluate stomatognathic and cervical systems. Spearman correlation test and Chi-square were used. The level of significance was set at p<0.05. Significant frequency of palpatory tenderness of temporomandibular joint (TMJ), TMJ sounds, pain during cervical extension and rotation, palpatory tenderness of sternocleidomastoids and paravertabrae muscles and a severe reduction in cervical range of motion were observed in AG. Both AG and MBG groups demonstrated palpatory tenderness of posterior TMJ, medial and lateral pterygoid, and trapezius muscles when compared to NBG. Results showed a positive correlation between the severity of TMD and CSD signs in asthmatic children (r = 0.48). No child was considered normal to CSD and cervical mobility. The possible shortening of neck accessory muscles of respiration and mouth breathing could explain the relationship observed between TMD, CSD signs in asthmatic children and emphasize the importance of the assessment of temporo-mandibular and cervical spine regions in asthmatic children.

1. Aligne CA, Auinger P, Byrd R, Weitzman, M. Risk factors for pediatric asthma. Am J Respir Crit Care Med 162: 873-877, 2000.

2. Alamoudi N, Farsi N, Salako NO, Feteih. Temporomandibular disorders among school children. J Clin Pediatr Dent 22: 232-328, 1998.

3. American Society of Temporomandibular Joint Surgeons (ASTJS). Guidelines For Diagnosis and Management of Disorders Involving the Temporomandibular Joint and Related Musculoskeletal Structures. Cranio 21: 68-76, 2003.

4. Bakke M, Michler L. Temporalis and masseter muscle activity in asthmatic children with anterior open bite and craniomandibular disorders. Scandinavian J Dent Res 99: 119-128, 1991.

5. Bonjardim LR, Gavião MBD, Carmagnani FG, Pereira LJ, Castelo PM. Signs and symptoms of temporomandibular joint dysfunction in children with primary dentition. 28: 53-58, 2003.

6. Corren J. Allergic rhinitis and asthma: how important is the link?J Allergy Clin Immunol 99: S781-6, 1997.

7. De Wijer A, De Leeuw JRJ, Steenks, MH, Bosman F. Symptoms of the stomatognathic system in temporomandibular and cervical spine disorders. J Oral Rehab 21: 733-741, 1996.

8. Dworkin SF, LeResche L, DeRouen T, Von Korff M. Assessing clinical signs of temporomandibular disorders: reliability of clin-ical examiners. J Prosthet Dent 63: 574-9, 1990.

9. Egermark-Eriksson, I, Ingervall, B, Carlsson, GE. The depen-dence of mandibular dysfunction in children on functional and morphologic malocclusion. Am J Orthod 187-194, 1983.

10. Emerson, MFE, Cordeiro, NGB. Respiração Bucal em crianças com rinite alérgica: a ponta de um iceberg. SBAI 2: 51-64, 1993.

11. Fink M, Tschernitschek H, Stiesch-Scholz M. Asymptomatic cer-vical spine dysfunction (CSD) in asthmatic children with internal derangement of the temporomandibular joint. J Orofacial Pain 20: 192-197, 2002.

12. Gonzalez HE, Manns A. Forward head posture: Its structural and Functional Influence on the stomatognathic system, a conceptu-al study. Cranio 14: 71 – 80, 1996.

13. Helkimo, M. Studies on function and dysfunction of the mastica-tory system. II Index for anamnestic and clinical dysfunction and occlusal state. Swed Dent J 67: 101-121, 1974.

14. Hruska RJ. Influences of dysfunctional respiratory mechanics on orofacial pain. Dent Clin N Am 41: 211-27, 1997.

15. Kritsineli M, Shim YS. Malocclusion, body posture, temporo-mandibular disorder in children with primary and mixed denti-tion. J Clin Pediatr Dent 16: 86-93, 1992.

16. Lee WY, Okeson JP, Lindroth J. The relationship between for-ward head posture and temporomandibular disorders. J Orofacial Pain 9:161-167, 1995.

17. Lemle A, França AT, Lapa e Silva JR, Bethlem EP, Bethlem, N. Asma In: Bethlem, N. Pneumologia. 4th ed. São Paulo, Atheneu, p. 641-69, 2000.

18. Mannheimer JS, Rosenthal RM. Acute and Chronic Postural Abnormalities as Related to Craniofacial Pain and Temporomandibular Disorders. Dent Clin N Am 35: 185-208, 1991.

19. Miller AJ, Vargevick K, Chierici G. Sequential neuromuscular changes in rhesus monkeys during the initial adaptation to oral respiration. Am J Orthod 99-107, 1982.

20. Okeson, JP. Tratamento das desordens temporomandibulares e oclusão. 4ed. São Paulo, Artes Médicas; 2000.

21. Paesani D. Prevalence of temporomandibular joint internal derangement in asthmatic children with temporomandibular dis-orders. Am J Orthod Dentofac Orthop 101: 41-47, 1992.

22. Pedroni CR, Oliveira AS, Guaratini, MI. Prevalence study and symptoms of temporomandibular disorders in university stu-dents. J Oral Rehab 30: 283-9, 2003.

23. Ribeiro EC, Marchiori SC, Silva AMT. Electromyographic analy-sis of trapezius and sternocleidomastoideus muscles during nasal and oral inspiration in nasal and mouth breathing children. J Electromyography and Kinesiology 12: 305-16, 2002.

24. Ribeiro EC, Marchiori SC, Silva, AMT. Electromyographic mus-cle EMG activity in mouth and nasal breathing children. J Craniomandibular Practice 22: 145-150, 2004.

25. Sari S, Sonmez H. Investigation of relationship between oral parafunctions and temporomandibular joint dysfunction in Turkish children with mixed and permanent dentition. J Oral Rehab 20: 108-112, 2002.

26. Asher MI, Weiland SK. The international study of asthma and allergies in childhood (ISAAC). Clinical and Experimental Allergy 28: 52-66, 1998.

27. Solow B, Siersbaek-Nielsen S, Greve E. Airway adequacy, head posture and craniofacial morphology. Am J Orthod 86: 214-23, 1984.

28. Sonnesen L, Bakke M, Solow B. Temporomandibular disorders in relation to craniofacial dimensions, head posture and bite force in children selected for orthodontic treatment. Eur J Orthod 23: 179-92, 2001.

29. Stell IM, Polkey MI, Rees PJ, Green M, Moxham J. Inspiratory muscle strength in acute asthma. Chest 120: 757-764, 2001.

30. Stiesch-Scholz M, Fink M, Tschernitschek H. Co morbidity of internal derangement of the temporomandibular joint and silent dysfunction of the cervical spine. J Oral Rehab 30: 386-391, 2003.

31. Stokes N, Della-Mattia D. Discussing measurement methods, manisfestation and treatment of the mouthbreathing habit. Probe 30: 212-241, 1996.

32. Thilander B, Rubio G, Pena L, Mayorga C. Prevalence of tem-poromandibular dysfunction and its association with malocclu-sion in children and adolescents: an epidemiologic study related to specified stages of dental development. Angle Orthodontist 72: 146-154, 2002.

33. Vanderas AP, Papagiannoulis. L. Multifactorial analysis of the etiology of temporomandibular dysfunction in children. Internat J Pediatr Dent 12: 336-346, 2002.

34. Venetikidou A. Incidence of malocclusion in asthmatic children. J Clin Pediatr 17: 89 – 94, 1993.

35. Visscher CM, Lobbezoo F, De Boer W, Van Der Zang J, Noeije M. Prevalence of cervical spine pain in craniomandibular pain patients. Eur J Oral Sci 109: 76-80, 2001.

36. Wallace C, Klineberg IJ. Management of temporomandibular disorders. Part II: Clinical assessment of patients with craniocer-vical dysfunction. J Orofac Pain 8: 42-54, 1994.

37. Wenzel A, Henriksen JM, Melsen B. Nasal respiratory resistance and head posture: effect on intranasal corticosteroid (Budesonide) in children with asthma and perennial rhinitis. Am J Orthod 84: 83-92, 1983.

38. Widmalm SE, Christiansen RL, Gunn SM. Race and gender as TMD risk factors in children. J Craniomandibular Practice 13: 163- 166, 1995.