This study investigated the prevalence of a preferred chewing side (PCS) and associations between a PCS and signs of temporomandibular disorders (TMD), antagonist contact and prosthetic restoration. A population representative sample of 4086 adults of the cross-sectional epidemiologic 'Study of Health in Pomerania' (SHIP-0) (age range 20-80 years, female 50.2%) was divided in two groups by the presence or absence of a PCS. PCS was evaluated by a questionnaire. Chi-squared tests and multiple logistic regression were used to determine the impact of the relation between a PCS and signs and symptoms of TMD as well as dental factors. The prevalence of a PCS was 45.4%. Women between 40 and 69 years reported more frequently a PCS. There was a preference for the right side (64%). The following independent variables were significantly associated with a PCS: subjective unilateral pain in the temporomandibular joint (TMJ), odds ratio (OR) 2.4; subjective unilateral joint clicking, OR 1.7; unilateral TMJ/muscle pain on palpation, OR 1.6/OR 1.3; loss of one supporting zone (Eichner-Classification), OR 1.9; loss of both supporting zones on one side, OR 2.2, one supporting zone left, OR 1.4; presence of a removable partial denture, OR 1.6; presence of an attachment restoration, OR 1.5. A PCS was found in almost half the study population and was associated with unilateral signs of TMD, most of all TMJ pain and asymmetrical loss of antagonist contact. Despite replacement of lost teeth not all restorations seemed to support bilateral mastication.

It seems therefore that in this population, the major oral health concern is related to caries and the small number of teeth retained among the dentate subjects.

Our findings highlight the impact of the anterior insula for the internal monitoring and the anticipation of temporomandibular joint (TMJ) pain. In addition, an increase of symmetry of condylar movements after therapy has been associated with a decrease of activation magnitude in primary motor and cerebellar regions.

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