Abstract
Objectives
The purpose of this study was to evaluate the MR characteristics of temporomandibular joint (TMJ) disc displacement in elderly patients.
Methods
Of the MR images of 1660 TMJs in 847 patients with disc displacement who underwent MRI for suspected temporomandibular disorders, 301 TMJs in 154 patients aged over 50 years were studied as an elderly group. These MR images of the elderly group were compared with those of a control group (1359 TMJs in 693 patients aged under 51 years) concerning disc displacement with or without reduction, joint effusion and osteoarthrosis.
Results
The incidence of disc displacement with osteoarthrosis was significantly different between the elderly (41.9%) and the control (19.8%) groups (p = 0.000). Logistic multivariate regression analysis demonstrated that the osteoarthrosis was a significant variable (odds ratio = 2.94, p = 0.000).
Conclusions
This study suggests that MR characteristics of TMJ disc displacement in elderly patients includes osteoarthrosis.
Keywords: elderly patients, magnetic resonance, temporomandibular joint
Introduction
Temporomandibular disorders (TMD) represent a major cause of non-dental pain in the orofacial region and are considered to be a subclass of musculoskeletal disorders.1
Epidemiological research has demonstrated a high prevalence of signs and symptoms of TMD in virtually all examined populations and age groups.2 The prevalence of TMD has been extensively examined for various populations, for example in children,3 birth cohorts,4 different cultural regions5 and environments.6 However, the results for older subjects have been inconsistent:7-11 some studies have reported that the frequency of symptoms of TMD was similar for various age groups;7 others have found that it was lower among older subjects.8
MRI is frequently used in the region of the temporomandibular joint (TMJ), particularly to examine disc position and configuration, posterior disc attachment and mandibular marrow status, and to assess the presence of joint effusion.12-17 However, few studies have been concerned with the evaluation of MR characteristics of TMJ disc displacement in elderly patients. The purpose of this study was to evaluate the MR characteristics of TMJ disc displacement in elderly patients.
Materials and methods
Of the MR images of 1660 TMJs in 847 patients (179 males, 668 females; age 6–80 years, mean age 29.9 years) with disc displacement who underwent MRI for suspected TMD in the Nihon University School of Dentistry Hospital, Japan, from January 2001 to December 2004, 301 TMJs in 154 patients aged over 50 years (24 males, 130 females; age 51–80 years, mean age 59.9 years) were studied as an elderly group. As a control group, 1359 TMJs in 693 patients aged under 51 years (155 males, 538 females; age 6–50 years, mean age 23.2 years) were studied. All participants read and signed an informed consent form. Figure 1 shows distribution of TMJ disc displacement according to age.
Figure 1.
Distribution of temporomandibular joint disc displacement according to age
MRI was performed with a 0.5 Tesla superconductive MR unit (Toshiba Flexart; Tokyo, Japan) with a surface coil for the TMJ. Imaging included proton density-weighted sagittal imaging at the closed mouth position (repetition time (TR)/echo time (TE) 2000 ms/20 ms), the maximum mouth opening position (TR/TE 1500 ms/20 ms) and T2 weighted sagittal imaging at the closed mouth position (TR/TE 2000 ms/100 ms). T2 weighted imaging was performed with a double echo in proton density-weighted imaging. Other parameters were as follows: field of view (FOV) 12.0 × 12.0 cm, matrix size 192 × 256, and 1 acquisition. The MRI of the elderly group were compared with those of the control group concerning disc displacement with or without reduction, joint effusion and osteoarthrosis. A grading system proposed by Larheim et al16 was used for categorizing the amount of fluid on T2 weighted images. All images were independently evaluated by two oral radiologists and any differences were resolved by forced consensus.
Statistical analyses for the comparison of MRI finding of TMD, such as disc displacement with or without reduction, joint effusion and osteoarthrosis, between the elderly group and the control group were performed using the χ2 test with Fisher's exact test. The odds ratios for the elderly group vs the control group were analysed using logistic multivariate regression analysis in relation to MRI findings, such as disc displacement with or without reduction, joint effusion and osteoarthrosis. These analyses were performed with the statistical package SPSS version 14.0 (SPSS Japan Inc., Tokyo, Japan). p < 0.05 was considered to indicate statistical significance.
Results
Table 1 shows MR characteristics of TMJ disc displacement in elderly patients. The incidence of disc displacement without reduction was significantly different between the elderly group (44.9%) and the control group (35.5%) (p = 0.003). The incidence of disc displacement with joint effusion was not significantly different between the elderly group (37.9%) and the control group (39.7%) (p = 0.602). The incidence of disc displacement with osteoarthrosis was significantly different between the elderly group (41.9%) and the control group (19.8%) (p = 0.000). Table 2 shows logistic multivariate regression analysis of MR characteristics of TMJ disc displacement in elderly patients. The analysis demonstrated that the osteoarthrosis was a significant variable (odds ratio = 2.94, p = 0.000). Figure 2 shows MRI of TMJ disc displacement in an elderly patient.
Table 1. MR characteristics of temporomandibular joint disc displacement in elderly patients.
| Reductiona |
Joint effusionb |
Osteoarthrosisc |
Total (%) | ||||
| With (%) | Without (%) | With (%) | Without (%) | With (%) | Without (%) | ||
| Elderly | 166(55.1) | 135(44.9) | 114(37.9) | 187(62.1) | 126(41.9) | 175(58.1) | 301(100) |
| Control | 877(64.5) | 482(35.5) | 539(39.7) | 820(60.3) | 269(19.8) | 1090(80.2) | 1359(100) |
| Total | 1043(62.8) | 617(37.2) | 653(39.3) | 1007(60.7) | 395(23.8) | 1265(76.2) | 1660(100) |
ap = 0.003.
bp = 0.602.
cp = 0.000.
Table 2. Logistic multivariate regression analysis of MR characteristics of temporomandibular joint disc displacement in elderly patients.
| MR findings | Odds ratio | 95% CI | p-value |
| Reduction | 0.97 | 0.72–1.32 | 0.862 |
| Joint effusion | 1.21 | 0.92–1.59 | 0.182 |
| Osteoarthrosis | 2.94 | 2.19–3.96 | 0.000 |
CI, confidence interval.
Figure 2.
MRI of the left temporomandibular joint in a 58-year-old female with temporomandibular disorders. (a) Proton density image. The disc is dislocated anteriorly in the closed-mouth position. (b) Proton density image, open-mouth position. The condyle with osseous changes pushes the disc anteriorly but does not recapture. (c) T2 weighted image, closed-mouth position, shows joint effusion in the superior joint space
Discussion
MRI is the modality of choice for the assessment of internal derangement of the TMJ in patients with TMD.13 TMJ internal derangement describes an abnormal positional relationship between the articular disc, the mandibular condyle and the articular eminence. The disorder has been associated with characteristic clinical findings such a pain, joint sounds and irregular or deviating jaw function.18-20 Harms et al12 showed that disc displacement and arthrosis were the most common findings on MRI of the TMJ in patients with signs and symptoms of a TMD. Westesson and Brooks14 indicated that TMJ effusions primarily occurred in joints with disc displacement. In this study, MR images of the elderly group with TMD were compared with those of the control group concerning disc displacement with or without reduction, joint effusion and osteoarthrosis.
The prevalence of TMD for older subjects has been inconsistent.7-11 Osterberg et al8 showed that symptoms of craniomandibular dysfunction were reported less frequently with increasing age and the results indicated that there was no increased risk of craniomandibular dysfunction with aging. Ow et al9 reported that the most common single symptom of craniomandibular disorder among elderly people was occasional to frequent clicking sounds from the TMJs. TMJ clicking, one of the most frequent findings, has been discussed as a potentially severe symptom that may develop into TMJ locking, disc displacement or osteoarthrosis.4 Schmitter et al10 indicated that older subjects more frequently exhibited objective signs (joint sounds) of TMD and they rarely suffered from pain. This study showed that the incidence of TMJ disc displacement in elderly patients (154 patients) is less than in the control group (693 patients).
Westesson21 showed that osseous changes involving the condyle and temporal bone often occurred as a sequel to disc displacement and structural hard-tissue changes frequently occurred in TMJs displaying anterior disc displacement without reduction but seldom in joints showing displacement with reduction. In this study, the incidence of disc displacement without reduction was significantly different between the elderly group (44.9%) and the control group (35.5%) (p = 0.003). The incidence of disc displacement with osteoarthrosis in the present study was significantly different between the elderly group (41.9%) and the control group (19.8%) (p = 0.000). We therefore consider that disc displacement without reduction is related to osteoarthrosis.
TMJ effusion, which typically appears as a bright signal on T2 weighted MRI, has been recognized as a possible sign related to pain in patients with TMJ disorders. Westesson and Brooks14 indicated that joint effusions were seen more often in joints with more advanced stages of disc displacement (displacement without reduction) than in normal joints or in joints with earlier stages of disc displacement (displacement with reduction). Joint effusion probably represents an inflammatory response to the dysfunction of the displaced disc. Furthermore, Westesson and Brooks14 also showed that the prevalence of joint effusion was lower in joints with arthrosis than in those with disc displacement. These results suggested that most effusions were seen before arthrosis developed. In the present study, the incidence of disc displacement with joint effusion was not significantly different between the elderly group (37.9%) and the control group (39.7%).
Osteoarthrosis has been considered an age-related degenerative change of the articular cartilage and the subchondral bone in synovial joints, including the TMJs. Widmalm et al22 showed that TMJ arthrosis was more frequent in older than in younger people. Ishibashi et al23 indicated that the articular surface of the mandibular condyle morphologically showed severe degenerative changes with advancing age. However, Wiberg and Wanman24 indicated that osteoarthrosis of the TMJs was found in 66% of 131 patients ranging in age from 12 years to 30 years and a high prevalence of TMJ osteoarthrosis in young patients was found. In this study, logistic multivariate regression analysis between the elderly and the control group demonstrated that disc displacement with osteoarthrosis was a significant variable (odds ratio = 2.94, p = 0.000). These results suggest that MR characteristics of TMJ disc displacement in elderly patients include osteoarthrosis. We therefore consider that osteoarthrosis is a degenerative condition associated with advancing age. Furthermore, the follow-up in the younger patients is important for future studies.
Acknowledgments
This study was supported in part by a Nihon University individual research grant (No. 06-098) for 2006.
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