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Stomatognathic Parafunctions and Their Etiology: Literature Review

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Stomatognathic Parafunctions and Their Etiology: Literature Review LITHUANIAN UNIVERSITY OF HEALTH SCIENCES MEDICAL ACADEMY FACULTY OF MEDICINE DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY Marijus Leketas Stomatognathic parafunctions and their etiology: Literature review. Master’s Thesis Supervisor: Prof. habil. dr. Ričardas Kubilius Kaunas, 2018 CONTENT SANTRAUKA ................................................................................................................................................................ 3 ABSTRACT ................................................................................................................................................................... 4 INTRODUCTION .......................................................................................................................................................... 5 MATERIALS AND METHODS ........................................................................................................................................ 5 RESULTS ...................................................................................................................................................................... 7 DISCUSSION .............................................................................................................................................................. 12 CONCLUSIONS .......................................................................................................................................................... 17 CONFLICT OF INTEREST ............................................................................................................................................. 17 REFERENCES ............................................................................................................................................................. 17 2 SANTRAUKA Marijus Leketas. “Stomatognatinės parafunkcijos ir jų priežastys. Sisteminė literatūros apžvalga”. Magistro baigiamasis darbas. Darbo vadovas – prof. habil. dr. Ričardas kubilius. Lietuvos sveikatos mokslų universitetas, Medicinos akademija, Medicinos fakultetas, Veido ir žandikaulių chirurgijos klinika. Kaunas, 2018; 22p. Tikslas ir uždaviniai: Kraniomandibulinių susirgimų atsiradime manoma, jog didžiausią reikšmę turi priežastys, kurių mechanizmas gan aiškus, tai traumos, onkologija, sąkandžio sutrikimai ir kt. Tokia nuomonė vyrauja tarp daugelio gydytojų. Tačiau patyrę šios srities specialistai pastebi, kad egzistuoja dar viena priežasčių grupė, kuri vadinama stomatognatinėmis parafunkcijomis. Gydytojas, kuris nėra įsigilinęs į kraniomandibulinių susirgimų galimas priežastis, dažnai net nežino kas tai yra stomatognatinė parafunkcija ir kokį vaidmenį ji atlieka patologijos atsiradime. Šio darbo tikslas atlikti sisteminę literatūros analizę apie stomatognatines parafunkcijas ir pateikti naują, aiškesnę definiciją bei klasifikaciją. Tyrimo metodika: Literatūros apžvalga buvo atlikta 2017 metų sausio mėnesį naudojant “Medline ir Embase” duomenų bazes. Rezultatai: Atlikus sisteminę literatūros analizę, rezultatai parodė, kad nėra vieningos stomatognatinės parafunkcijos definicijos ir aiškaus sutarimo ar stomatognatinės parafunkcijos yra kraniomandibulinių susrgimų priežastis. Išvados: Tradicinė stomatognatinės parafunkcijos definicija nėra pakankama, kad būtų galima paaiškinti visus procesus, kurie literatūroje apibrėžiami kaip parafunkcija. Be to, literatūroje nėra pateikiama jokia stomatognatinių parafunkcijų klasifikacija. Todėl mes siūlome labiau specifišką stomatognatinės parafinkcijos apibrėžima ir naują klasifikaciją, tikėdami, kad tai padės tyrėjams ir klinicistams gydant ir analizuojant parafunkcijas. 3 ABSTRACT Marijus Leketas. “Stomatognathic parafunctions and their etiology: Literature review”. Supervisor – prof. habil. dr. Ričardas Kubilius. Lithuanian University of Health Sciences, Medical Academy, Faculty of Medicine, Department of Oral and maxillofacial surgery. Kaunas, 2018; 22 p. Background and objective: Doctors usualy attribute craniomandibular disorders (CMD) reasons to obvious mechanisms such as traumas, oncology, malocclusion and etc. And only experienced doctors notice that there is one more group of reasons which is called stomatognathic parafunctions (SGP). However, SGP are not unanimously defined and understandable for common doctor. The main aim of this review was to overview what kind parafunctions are analyzed in literature and to suggest a new, broader definition and etiology-based classification of SGP. Material and methods: The literature review was conducted using the resources of Medline and Embase in January 2017. Results: The findings revealed that there is no unanimous definition of parafunctions and no consensus whether or not SGP influence temporomandibular joint pathology or other stomatognathic system structures. Conclusions: The traditional definition of SGP is not sufficient to explain whole range of processes wich are called in literature as parafunctions. Moreover, no classification of SGP exists in literature. Therefore, we suggest more specific definition and a new classification of SGP assuming that they will help researchers and clinicians in treatment and investigation of parafunctions. 4 INTRODUCTION There are many different habits in the society – some of them only temporarily influence certain body functions while others irreversibly damage body functions. Practitioners in oral health frequently face the patients with habits that are related with stomatognathic system (SGS). Such habits can lead to dysfunction not only in SGS but in other body systems as well, e.g. musculoskeletal system. The majority of such patients complain about the temporomandibular joint (TMJ) problems. Moreover, they are usually of younger age [1],[2] which is an alarming trend. TMJ pathology is considered as one of the main outcomes caused by stomathognathic parafunctions (SGP) [3]. The precise mechanism and the causes of certain part of TMJ damage are not known. Additionally, the stomatognathic parafunctions as such have no unified definition which reduces the opportunities to investigate the phenomenon in large scale. Therefore, we did a review of literature with the aim to overview which stomatognathic parafunctions are analyzed in literature and to propose a new, broader definition of such parafunctions, which is still lacking in field of dentistry. MATERIALS AND METHODS For this review the search in PubMed and Embase was conducted in January 2017. The search strategy included the publications from 1946 to 2017 and was based on two components in the search box: parafunction (defined in three alternative terms: keyword #1 „stomatognathic system parafunction“, keyword #2 „oral parafunction“, and keyword #3 „oral habit“) and pain type (5 alternative terms: keyword #4 „headache“, keyword #5 „TMD“, keyword #6 „muscle pain“, keyword #7 „myofacial pain“, keyword #8 „myofacial pain syndrome“), totalling to 15 search combinations per database. The primary set of eligible articles after removal of duplicates was 421. These articles were scrutinized using following exclusion criteria: review article, intervention study, editorial, or not related with purpose of review. Abstracts were included only if they were explicit about the object and findings of original studies. After reviewing and additional search of 421 articles, 46 met the eligibility criteria – this was a final set of current literature review. The detailed chart of literature search is presented in Figure 1. 5 Figure 1. Flowchart of literature review and its stages. Figure 1. Flowchart of literature review and its stages. MEDLINE EMBASE (1946 – 2017) (1946 – 2017) Stomatognathic Headache Stomatognathic Headache system (65540 hits) system (185573 hits) TMD parafunctions TMD n parafunctions o i (6372 hits) (81 hits) (12492 hits) t (100 hits) a c oral parafunction Muscle pain oral parafunction Muscle pain i f i (32984 hits) (605 hits) (276667 hits) t (99 hits) n e oral habits Myofascial pain oral habits Myofascial d I (13766 hits) (2520 hits) (55295 hits) pain myofascial pain (9529 hits) syndrome myofascial (13975 hits) pain syndrome (7271 hits) Combined with Combined with AND (264 hits) AND (280 hits) Records after duplicates removed (421 hits ) g n i n e e r c Records screened: 421 S y Articles assessed for Records excluded: 326 Reasons: t i l i eligibility: 95 review article, intervention study, b i g editorial, or not related with purpose i l E of review. d e d Studies included in u l qualitative synthesis: 46 c n I 6 Before the synthesis of studies, we searched for the best available classification of parafunctions according to their etiologies. However, we did not succeed in finding a classification of parafunctions and etiologies. Therefore, in our review all the analyzed articles were approached using following categorization of etiologies and manifestations of parafunctions: Non-specific etiology (Bruxism, Teeth clenching/grinding, Cheek/lip biting, Nail/pen biting, Thumb sucking, Gum chewing); Specific etiology: o Occupational (Playing a musical instrument, Singing, Scuba diving); o Psychogenic (Lip grimace, Nasal grimace); o Biomechanical (Position of the tongue in relation to the palate and the mouth floor, Head positions, Additional mandibular movements in time of mouth opening). The parafunctions were reviewed also regarding symptoms and dysfunctions attributed to stomatognathic system problems. They were categorized to for groups: Temporomandibular joint dysfunction; Headache; Facial muscles pain; Other. The findings
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