A nationwide survey of oral conditions, treatment needs, and attitudes toward dental health care in Dutch adults was carried out in 1986. One of the aims of the study was to assess the prevalence of signs and symptoms of temporomandibular disorder (TMD). A sample of 6577 persons (from 15 to 74 yr of age), stratified for gender, age, region, and socio-economic status, was contacted. Of this sample, 4496 persons participated in the behavioral part of the study, of whom 3526 were examined clinically. The TMD prevalence was based on (1) perceived signs and symptoms of TMD and (2) clinical examination of joint sounds, deviation, and pain on mandibular movements. A total of 21.5% of the Dutch adult population perceived some dysfunction, and 44.4% showed clinically assessed signs and symptoms of TMD. In nearly all age groups, the signs and symptoms of TMD appeared more in women than in men. Agreement between the results of the clinical examination and the anamnestic dysfunction index was significant (p < 0.0001); however, the Pearson's correlation coefficient was low (r = 0.29). The odds-value (risk-ratio) that subjects who perceived signs and symptoms of TMD would present with clinically assessed signs and symptoms of TMD was 2.3. The results of the survey were compared with results of a meta-analysis performed on 51 TMD prevalence studies. The analysis revealed (1) a perceived dysfunction rate of 30% and (2) a clinically assessed dysfunction of 44%, both based on compound samples of, respectively, over 15,000 (23 studies) and over 16,000 (22 studies) randomly selected subjects.

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A nationwide survey of oral conditions, treatment needs, and attitudes toward dental health care in Dutch adults was carried out in 1986. One of the aims of the study was to investigate the perceived need and demand for treatment of craniomandibular dysfunction (CMD). A sample of 6577 persons (15-74 yrs of age), stratified for gender, age, region, and socio-economic status, was contacted. Of this sample, 4496 persons participated in the behavioral part of the study, of which 3526 were examined clinically. The CMD-treatment demand was based on (1) CMD complaints in the past, (2) CMD complaints at present, and (3) an anticipated increase of the present complaints. CMD was both anamnestically and clinically assessed, independently by different examiners. A total of 21.5% of the Dutch adult population reported dysfunction, but 85% of these perceived no need for treatment. With most of the remaining 15% either seeking or intending to seek treatment (or having had it before), a figure of 3.1% can be used to summarize the actual level of treatment need for CMD in the Dutch adult population.

By analogy with the journal's title Pain Research and Management, this review describes TMD Research and Management. More specific are the (1) research aspects of “occlusion,” still one of the most controversial topics in TMD, and (2) as much as possible evidence-based management aspects of “TMD” for the dental practitioner. Research. The disorders temporomandibular dysfunction and the synonymous craniomandibular dysfunction are still being discussed intensely in the literature. Traditionally, attention is mostly devoted to occlusion and its relationship with these disorders. The conclusions reached are often contradictory. Considering the definitions of temporomandibular and craniomandibular dysfunctions/disorders and “occlusion,” a possible explanation for this controversy can be found in the subsequent methodological problems of the studies. Based on a Medline search of these terms over the past 40 years related to contemporary terms such as “Evidence Based Dentistry” and “Pyramid of Evidence,” these methodological aspects are examined, resulting in recommendations for future research and TMD-occlusal therapy. Management. To assist the dental practitioner in his/her daily routine to meet the modern standards of best practice, 7 guidelines are formulated that are explained and accompanied with clinical examples for an evidence-based treatment of patients with this disorder in general dental practices.

Previous clinical observations have revealed that resin-bonded bridges for posterior tooth replacements are less retentive than anterior resin-bonded bridges. Improved bonding procedures and preparation designs, however, may have a positive effect on the functional durability of these restorations. The present study reports the final analysis of a randomized controlled clinical trial in which different designs of posterior resin-bonded bridges were evaluated for a period of at least 5 years. The operational hypothesis was that the bonding system and the preparation design used in posterior resin-bonded bridges have an influence on the survival and clinical functioning of these restorations. Survival in this study was defined at two levels: (1) 'complete' survival (survival without any debonding), and (2) 'functional' survival (survival including loss of retention on one occasion and successful rebonding of the original RBB without further debonding). With regard to 'complete' survival, no significant differences were found between the bonding systems used for adherence of the restorations to abutment teeth (etching/Clearfil F2, sandblasting/Panavia EX, and silica-coating/Microfill Pontic C). The variable 'preparation form' (conventional preparation form vs. modified preparation form) for complete survival was statistically in favor of the modified preparation form (62% vs. 46%), but did not influence the functional survival. With regard to 'functional' survival, the combination of silica coating and Microfill Pontic C was more retentive than the other bonding systems (90% survival vs. 72% and 75%, p < 0.01). Factor location was found to be highly significant for both survival levels [Cox's PH model, p = 0.0002 (Cox, 1972)]: The five-year 'complete' survival rates were 65% for maxillary restorations and 40% for mandibular restorations, while the five-year 'functional' survival rates were 89% and 68%, respectively. It is concluded that preparation of grooves in abutment teeth for posterior resin-bonded bridges is beneficial to their chance of survival. Resin-bonded bridges placed in the maxilla have a better prognosis than those made in the mandible. The bonding systems used in this study appear to have no influence on the chance of failure. In rebonded posterior resin-bonded bridges, the bonding system silica-coating/Microfill Pontic C was more retentive than the other systems tested.