Do Temporomandibular Disorder Patients with Joint Pain Exhibit Forward Head Posture? A Cephalometric Study

Abstract

Purpose. To evaluate head and cervical posture in individuals with or without temporomandibular disorders (TMDs) and to assess the correlations between pain, severity of symptoms, and posture. Methods. A total of 384 patients (129 males and 255 females) was included. The Fonseca Anamnestic Index (FAI) was used to assess the severity and prevalence of TMD and the presence of temporomandibular joint (TMJ) pain. Patients were divided into three groups: the TMD-free group, TMD without TMJ pain group, and TMD with TMJ pain group. Subsequently, the patients with TMJ pain were further divided into mild TMD and moderate/severe TMD groups. Nine parameters were traced on cephalograms to characterize the head and cervical posture. Results. TMD patients with TMJ pain showed increased forward head posture (FHP) than patients without TMJ pain and TMD-free subjects. No significant difference was observed between the TMD patients without TMJ pain and TMD-free subjects. In the TMD patients with the TMJ pain group, the moderate/severe TMD patients demonstrated increased FHP compared to mild TMD patients. TMD patients with joint pain had greater CVT/RL (B = 3.099), OPT/RL (B = 2.117), and NSL/C2’ (B = 4.646) than the patients without joint pain after adjusting for confounding variables ( P < 0.05 ). Conclusion. TMD patients with TMJ pain showed increased FHP compared to other groups, and FHP became more significant as TMD severity increased in male patients, indicating the FHP might play an important role in the development of TMJ pain. In the clinical assessment of TMD, the patients’ abnormal head and cervical posture might be considered.

Frequency of temporomandibular disorders and their correlation with improper operating posture in Iranian dentists

“…Yao et al [23] showed signi cant correlation of forward head posture and TMDs. Also, Xiao et al [25] found that TMD patients had a more forward head posture than those without TMD. The results of the above-mentioned studies were all in agreement with the present ndings.…”

“…In a retrospective cohort, Kang [24] reported that in both males and females, neck disability can serve as an initiation point for TMDs. Xiao et al [25] indicated a signi cant correlation between forward head posture and severity of TMDs particularly in males while Inal [26] demonstrated that 78.9% of engineers with a sedentary work had mild to severe TMDs, and pain severity at rest and during activity and neck disability were signi cantly correlated in females. Difference between their results and the present ndings be due to different study populations.…”

Characterization of Headache in Patients with Temporomandibular Joint Disorders

“…Indeed, the cranio-mandibular-cervical complex has been considered as an anatomical and functional unit, with neuromuscular restoring forces stabilizing this unit against the force of gravity [81,82]. Epidemiological, clinical, and imaging studies have revealed a significant association between TMJD and neck pain [83][84][85][86]. It is postulated that this association might be due to the convergent nociceptive input from the TMJ and neck structures onto the subnucleuscaudalis in the brain stem [87].…”

Changes in the craniofacial morphology and hyoid bone position in the neutral and forward head posture in healthy people

“…Some studies explore the relationship between disease classi cation and cervical posture. For example, FHP in severe TMD patients was more signi cant compared to mild TMD patients [14]. Moreover, TMD with or without disk reduction signi cantly in uenced the craniocervical posture and hyoid bone position [11,15].…”