Prevalence of temporomandibular joint dysfunction in patients with ankylosing spondylitis and comparison of the findings with healthy controls

Ahısha, Büşra Şirin; Kesiktaş, Fatma Nur

doi:10.1590/1806-9282.20240807

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ORIGINAL ARTICLE • Rev. Assoc. Med. Bras. 70 (10) • 2024 • https://doi.org/10.1590/1806-9282.20240807 copy

Prevalence of temporomandibular joint dysfunction in patients with ankylosing spondylitis and comparison of the findings with healthy controls

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

This study aimed to assess the prevalence of temporomandibular dysfunction in ankylosing spondylitis patients and healthy controls, examining the relationship between temporomandibular dysfunction and disease activity in ankylosing spondylitis patients, as well as associations with psychosocial factors.

METHODS:

The study included 113 ankylosing spondylitis patients and 110 healthy individuals aged 18–75. Temporomandibular dysfunction presence was evaluated using Diagnostic Criteria for Temporomandibular Disorders Axis I. Disease activity was assessed with the Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Metrology Index, and Bath Ankylosing Spondylitis Functional Index.

RESULTS:

Among healthy individuals, 60.9% did not receive a temporomandibular dysfunction diagnosis, while 39.1% received at least one diagnosis. In contrast, 69.9% of the 113 ankylosing spondylitis patients received at least one temporomandibular dysfunction diagnosis, and only 30.1% were not included in any diagnosis group (p<0.001). Joint (p=0.001) and pain disorders (p=0.008) were significantly more common in the ankylosing spondylitis group than in the healthy controls. Significant associations emerged between Bath Ankylosing Spondylitis Disease Activity Index (p<0.001) and Bath Ankylosing Spondylitis Functional Index (p=0.005) scores and pain disorders.

CONCLUSION:

Temporomandibular dysfunction is more prevalent in ankylosing spondylitis patients than in healthy individuals, linked to increased joint issues and pain associated with disease activity.

ClinicalTrials.gov ID:

NCT05839925.

KEYWORDS:
Ankylosing spondylitis; Temporomandibular joint disorders; Temporomandibular disorders; TMJ; Spondylarthritis

	Healthy group Median (min–max)	Ankylosing spondylitis Median (min–max)	p-value
Pain-free opening^* *Median (min–max); Mann-Whitney U test. p<0.05 is considered significant. Statistically significant values are indicated in bold.	45 (28–65)	42 (22–55)	0.023
Maximum assisted opening^* *Median (min–max); Mann-Whitney U test. p<0.05 is considered significant. Statistically significant values are indicated in bold.	51 (32–73)	49 (33–69)	0.042
Maximum unassisted opening^* *Median (min–max); Mann-Whitney U test. p<0.05 is considered significant. Statistically significant values are indicated in bold.	50 (38–72)	47 (30–67)	0.003
Protrusion^* *Median (min–max); Mann-Whitney U test. p<0.05 is considered significant. Statistically significant values are indicated in bold.	6 (2–10)	6 (0–15)	0.621
Right lateral^* *Median (min–max); Mann-Whitney U test. p<0.05 is considered significant. Statistically significant values are indicated in bold.	9 (3–15)	8 (3–15)	0.598
Left lateral^* *Median (min–max); Mann-Whitney U test. p<0.05 is considered significant. Statistically significant values are indicated in bold.	7.5 (2–15)	7 (1–15)	0.091
Total lateral^* *Median (min–max); Mann-Whitney U test. p<0.05 is considered significant. Statistically significant values are indicated in bold.	17 (7–28)	16 (4–30)	0.184

	Control n, (%)	AS n, (%)	p-value
TMD^* *n (%), chi-square test. p<0.05 is considered significant. TMJ: temporomandibular joint, TMD: temporomandibular dysfunction, AS: ankylosing spondylitis. Statistically significant values are indicated in bold.
No	67 (60.9)	34 (30.1)	<0.001
Yes	43 (39.1)	79 (69.9)	<0.001
Right TMJ disorders^* *n (%), chi-square test. p<0.05 is considered significant. TMJ: temporomandibular joint, TMD: temporomandibular dysfunction, AS: ankylosing spondylitis. Statistically significant values are indicated in bold.
No	91 (82.7)	68 (60.2)	<0.001
Disc displacement with reduction	17 (15.5)	27 (23.9)
Disc displacement without reduction, without limited mouth opening	0 (0)	2 (1.8)
Degenerative joint disease	2 (1.8)	16 (14.2)
Left TMJ disorders^* *n (%), chi-square test. p<0.05 is considered significant. TMJ: temporomandibular joint, TMD: temporomandibular dysfunction, AS: ankylosing spondylitis. Statistically significant values are indicated in bold.
No	80 (72.7)	60 (53.1)	0.002
Disc displacement with reduction	24 (21.8)	34 (30.1)
Disc displacement with reduction, with intermittent locking	1 (0.9)	0 (0)
Disc displacement without reduction, without limited mouth opening	0 (0)	3 (2.7)
Degenerative joint disease	5 (4.5)	16 (14.2)
Myalgia^* *n (%), chi-square test. p<0.05 is considered significant. TMJ: temporomandibular joint, TMD: temporomandibular dysfunction, AS: ankylosing spondylitis. Statistically significant values are indicated in bold.
Yok	87 (79.1)	71 (62.8)	0.003
Local myalgia	22 (20)	31 (27.4)
Myofascial pain (spreading or referral)	1 (0.9)	11 (9.7)
TMJ pain^* *n (%), chi-square test. p<0.05 is considered significant. TMJ: temporomandibular joint, TMD: temporomandibular dysfunction, AS: ankylosing spondylitis. Statistically significant values are indicated in bold.
No	104 (94.5)	95 (84.1)	0.034
Right	1 (0.9)	1 (0.9)
Left	1 (0.9)	2 (1.8)
Bilateral	4 (3.6)	15 (13.3)
Headache attributed to TMD^* *n (%), chi-square test. p<0.05 is considered significant. TMJ: temporomandibular joint, TMD: temporomandibular dysfunction, AS: ankylosing spondylitis. Statistically significant values are indicated in bold.
No	105 (95.5)	102 (90.3)	0.133
Yes	5 (4.5)	11 (9.7)	0.133

	No pain disorders	Pain disorders	p-value
	Median (min–max)	Median (min–max)	p-value
BASDAI^* *Median (min–max), Mann-Whitney U test was used. p<0.05 is considered significant. Statistically significant values are indicated in bold.	4 (0–8)	6 (1–9)	<0.001
BASFI^* *Median (min–max), Mann-Whitney U test was used. p<0.05 is considered significant. Statistically significant values are indicated in bold.	3.5 (0–9)	5 (0–10)	0.005
BASMI^* *Median (min–max), Mann-Whitney U test was used. p<0.05 is considered significant. Statistically significant values are indicated in bold.	2 (1–7)	2 (0–8)	0.193
	No joint disorders	Joint disorders	p-value
	Median (min–max)	Median (min–max)	p-value
BASDAI^* *Median (min–max), Mann-Whitney U test was used. p<0.05 is considered significant. Statistically significant values are indicated in bold.	5 (0–9)	5 (1–9)	0.220
BASFI^* *Median (min–max), Mann-Whitney U test was used. p<0.05 is considered significant. Statistically significant values are indicated in bold.	4 (0–9)	4 (0–10)	0.979
BASMI^* *Median (min–max), Mann-Whitney U test was used. p<0.05 is considered significant. Statistically significant values are indicated in bold.	2 (1–7)	2 (0–8)	0.911

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[1] *Corresponding author: bsrn080@gmail.com