Etiology and Epidemiology

  • Daniele ManfrediniEmail author
  • Luca Guarda-Nardini
Part of the SpringerBriefs in Statistics book series (BRIEFSSTATIST)


In the present chapter, which is dedicated to provide examples of the different strategies to investigate for the role of etiological/risk factors and to report data for epidemiological purposes, the main focus is put on two aspects that represent the fil rouge of the various investigations here described. The first issue is related with the epidemiology of the temporomandibular disorders (TMDs), the description of which must forcedly take into account for the psychosocial features of the disease, as suggested by the biopsychosocial model of orofacial pain. The need to describe and report as many details as possible on the so-called axis II impairment is well-exampled in the large-sample study commented in the section on how to report epidemiology data. The second issue, which is strictly related to the other, is related with the shift from past beliefs of an importance of dental occlusion in the etiology and bruxism to the current concepts providing that a triangle of factors, namely, bruxism, pain, and psychosocial factors, may explain most part of the pathogenesis of TMD. Three example investigations are provided on the topic of the etiology of bruxism and TMD, all authored by two of this book’s editors. The materials and methods as well as the results sections will be edited with respect to the original publication, especially by providing specific comments on the different clinical and statistical strategies underlying the study rationale. Taken together, the information contained in this chapter succeeds to reach the twofold aim of providing suggestions for clinical purposes (i.e., presentation of the current concepts on TMD epidemiology and etiology) as well as for statistical uses (i.e., discussion of the various models that need to be adopted for some different research situations and/or to test different hypotheses).


Masseter Muscle Myofascial Pain Sleep Bruxism Disc Displacement Orofacial Pain 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Anderson GC, Gonzalez YM, Ohrbach R, Truelove EL, Sommers E, Look JO, Schiffman EL. The research diagnostic criteria for temporomandibular disorders. VI. Future directions. J Orofac Pain. 2010; 24:79–88.Google Scholar
  2. Cox DR, Snell EJ. Analysis of binary data. 2nd ed. London: Chapman and Hall; 1989. p. 209.zbMATHGoogle Scholar
  3. Dworkin S, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria examinations and specifications, critique. J Craniomandib Disord Fac Oral Pain. 1992; 6:301–55.Google Scholar
  4. Gallo LM, Guerra PO, Palla S. Automatic on-line one-channel recognition of masseter activity. J Dent Res. 1998; 77:1539–46.CrossRefGoogle Scholar
  5. Hill BA. The environment and disease: association or causation? Proc Royal Soc Med. 1965; 58:295–300.Google Scholar
  6. Lavigne GJ, Khoury S, Abe S, Yamaguchi T, Raphael K. Bruxism physiology and pathology: an overview for clinicians. J Oral Rehabil. 2008; 35:476–94.CrossRefGoogle Scholar
  7. List T, Dworkin SF. Comparing TMD diagnoses and clinical findings at Swedish and US TMD centers using research diagnostic criteria for temporomandibular disorders. J Orofac Pain. 1996;10:240–53.Google Scholar
  8. Lobbezoo F, Naeije M. Bruxism is mainly regulated centrally, not peripherally. J Oral Rehabil. 2001; 28:1085–91.CrossRefGoogle Scholar
  9. Lobbezoo F, Visscher CM, Naeije M. Some remarks on the RDC/TMD validation project: report of an IADR/Toronto-2008 workshop discussion. J Oral Rehabil. 2010; 37:779–83.CrossRefGoogle Scholar
  10. Lobbezoo F, Rompré PH, Soucy JP, Iafrancesco C, Turkewicz J, Montplaisir JY, Lavigne GJ. Lack of associations between occlusal and cephalometric measures, side imbalance in striatal D2 receptor binding, and sleep-related oromotor activities. J Orofac Pain. 2001; 15:64–73.Google Scholar
  11. Lobbezoo F, Ahlberg J, Manfredini D, Winocur E. Are bruxism and the bite causally related? J Oral Rehabil. 2012; 39:489–501.CrossRefGoogle Scholar
  12. Manfredini D, Guarda-Nardini L. Agreement between research diagnostic criteria for temporomandibular disorders and magnetic resonance diagnoses of temporomandibular disc displacement in a patients population. Int J Oral Maxillofac Surg. 2008; 37:612–6.CrossRefGoogle Scholar
  13. Manfredini D, Lobbezoo F. Bruxism and temporomandibular disorders. In: Manfredini D, Editor. Current concepts on temporomandibular disorders. Berlin: Quintessence Publishing; 2010a. p. 135–52.Google Scholar
  14. Manfredini D, Lobbezoo F. Relationship between bruxism and temporomandibular disorders: a systematic review of literature from 1998 to 2008. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010b; 109:e26–e50.CrossRefGoogle Scholar
  15. Manfredini D, Landi N, Tognini F, Montagnani G, Bosco M. Occlusal features are not a reliable predictor of bruxism. Minerva Stomatol 2004;53:231–9.Google Scholar
  16. Manfredini D, Piccotti F, Ferronato G, Guarda-Nardini L. Age peaks of different RDC/TMD diagnoses in a patient population. J Dent. 2010; 38:392–9.CrossRefGoogle Scholar
  17. Manfredini D, Ahlberg J, Winocur E, Guarda-Nardini L, Lobbezoo F. Correlation of RDC/TMD axis I diagnoses and axis II pain-related disability. A multicenter study. Clin Oral Investig. 2011a; 15:749–56.CrossRefGoogle Scholar
  18. Manfredini D, Fabbri A, Peretta R, Guarda-Nardini L, Lobbezoo F. Influence of psychological symptoms on home-recorded sleep-time masticatory muscle activity in healthy subjects. J Oral Rehabil. 2011b; 38:902–11.CrossRefGoogle Scholar
  19. Manfredini D, Guarda-Nardini L, Winocur E, Piccotti F, Ahlberg J, Lobbezoo F. Research diagnostic criteria for temporomandibular disorders: a systematic review of axis I epidemiologic findings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011c; 112:453–62.CrossRefGoogle Scholar
  20. Manfredini D, Arveda N, Guarda-Nardini L, Segù M, Collesano V. Distribution of diagnoses in a TMD patient population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2012a; 114:e35–e41.CrossRefGoogle Scholar
  21. Manfredini D, Visscher C, Guarda-Nardini L, Lobbezoo F. Occlusal factors are not related with self-reported bruxism. J Orofac Pain. 2012b; 26:163–7.Google Scholar
  22. Manfredini D, Winocur E, Guarda-Nardini L, Lobbezoo F. Self-reported bruxism and temporomandibular disorders. Findings from two specialised centers. J Oral Rehabil. 2012c; 39:319–25.CrossRefGoogle Scholar
  23. Palla S. Biopsychosocial pain model crippled? J Orofac Pain. 2011; 25:289–90.Google Scholar
  24. Rollmann GB, Gillespie JM. The role of psychosocial factors in temporomandibular disorders. Curr Rev Pain. 2000; 4:71–81.CrossRefGoogle Scholar
  25. Schiffman EL, Ohrbach R, Truelove EL, Tai F, Anderson GC, Pan W, et al. The research diagnostic criteria for temporomandibular disorders. V: methods used to establish and validate revised axis I diagnostic algorithms. J Orofac Pain. 2010; 24:63–78.Google Scholar
  26. Steenks MH, de Wijer A. Validity of the research diagnostic criteria for temporomandibular disorders axis I in clinical and research settings. J Orofac Pain. 2009; 23:9–16.Google Scholar
  27. Sugimoto K, Yoshimi H, Sasaguri K, Sato S. Occlusion factors influencing the magnitude of sleep bruxism activity. Cranio. 2011; 29:127–37.Google Scholar
  28. Suvinen TI, Reade PC, Kemppainen P, Kononen M, Dworkin SF. Review of aetiological concepts of temporomandibular pain disorders: a biopsychosocial model for integration of physical disorder factors with psychological and psychosocial illness impact factors. Eur J Pain. 2005; 9:613–33.CrossRefGoogle Scholar
  29. Svensson P, Jadidi F, Arima T, Baad-Hansen L, Sessle BJ. Relationships between craniofacial pain and bruxism. J Oral Rehabil. 2008; 35:524–47.CrossRefGoogle Scholar
  30. Truelove E, Pan W, Look JO, Mancl LA, Ohrbach RK, Velly AM, Huggins KH, Lenton P, Schiffman EL. The research diagnostic criteria for temporomandibular disorders. III: validity of axis I diagnoses. J Orofac Pain. 2010; 24:35–47.Google Scholar
  31. Van Selms MK, Lobbezoo F, Visscher CM, Naeije M. Myofascial temporomandibular disorder pain, parafunctions and psychological stress. J Oral Rehabil. 2008; 35:45–52.CrossRefGoogle Scholar
  32. Winocur E, Steinkeller-Dekel M, Reiter S, Eli I. A retrospective analysis of temporomandibular findings among Israeli-born patients based on the RDC/TMD. J Oral Rehabil. 2009; 36:11–7.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2014 2014

Authors and Affiliations

  1. 1.University of PadovaPadovaItaly

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