title: Four-year longitudinal course of TMD symptoms in an adult population and the estimation of risk factors in relation to symptoms.
abstract: OBJECTIVE
  To investigate the natural course of symptoms of temporomandibular disorders (TMD) in a non-patient population and to estimate the strength of the relationship between several hypothesized risk factors and precipitation and perpetuation of the symptoms.
  
  
  METHODS
  A total of 672 randomly selected citizens of Okayama City was requested to answer the same self-administered questionnaire that they had answered 4 years earlier. The mailed questionnaire failed to reach 58 subjects at the second survey, and 367 of the remaining subjects (59.8%) responded. The fluctuation of TMD symptoms was assessed by comparison of 6 pairs of answers for questions regarding temporomandibular joint (TMJ) pain, limitation of mouth opening, TMJ noise, headache, neck pain, and shoulder stiffness. Six factors (age under 40, female, clenching habit, history of extrinsic trauma, sleep disturbance, and family history of TMD) were tested for their relative risk in precipitating and perpetuating each TMD symptom by the use of its confidence interval to define significance.
  
  
  RESULTS
  The incidence of TMD symptoms ranged from 6.1% (TMJ pain) to 12.9% (TMJ noise). More than half of the subjects who had reported TMJ and neck pain at the initial survey no longer reported these symptoms at the second survey, whereas TMJ noise and shoulder stiffness remained in more than 70% of the subjects. Individuals under 40 years old had a 3.3:1 increased risk of precipitating TMJ noise (P < 0.01), individuals with a history of extrinsic trauma had a 2.85:1 increased risk of precipitating limited mouth opening (P < 0.01), and females had a 2.81:1 increased risk of perpetuating TMJ pain (P < 0.01).
  
  
  CONCLUSIONS
  The possible etiologic significance of these factors in TMD should be validated by future research.
authors.affiliation: Department of Fixed Prosthodontics, Okayama University Dental School, 2-5-1 Shikata, Okayama 700-8525, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Kamisaka
authors.forename: H
authors.initials: H
authors.lastname: Yatani
authors.forename: T
authors.initials: T
authors.lastname: Kuboki
authors.forename: Y
authors.initials: Y
authors.lastname: Matsuka
authors.forename: H
authors.initials: H
authors.lastname: Minakuchi
mesh_terms: D017677:Age Distribution; D006259:Craniocerebral Trauma / Q000150:complications; D018450:Disease Progression; D005157:Facial Pain / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000150:complications; D012075:Remission, Spontaneous; D012307:Risk Factors; D012494:Sampling Studies; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D013705:Temporomandibular Joint Disorders / Q000453:epidemiology* / Q000209:etiology