Association between generalized joint hypermobility, temporomandibular joint hypertranslation and temporomandibular disorders: a scoping review

Samilla Pontes Braga; Carolina Ortigosa Cunha; Ambrosina Michelotti; Leonardo Rigoldi Bonjardim; Paulo César Rodrigues Conti

doi:10.1590/

Authors

Samilla Pontes Braga Universidade de São Paulo, Faculdade de Odontologia de Bauru. Departamento de Prótese. Grupo de Dor Orofacial de Bauru https://orcid.org/0000-0003-4582-7653
Carolina Ortigosa Cunha Universidade de São Paulo, Faculdade de Odontologia de Bauru. Departamento de Prótese. Grupo de Dor Orofacial de Bauru https://orcid.org/0000-0003-2748-6728
Ambrosina Michelotti University of Naples Federico II. Faculty of Dentistry. Postgraduate Program in Orthodontics and Master Program in TMD/Orofacial Pain https://orcid.org/0000-0002-2969-2069
Leonardo Rigoldi Bonjardim Universidade de São Paulo. Faculdade de Odontologia de Bauru. Departamento de Ciências Biológicas. Seção de Fisiologia da Cabeça e da Face. https://orcid.org/0000-0002-0080-7678
Paulo César Rodrigues Conti Universidade de São Paulo. Faculdade de Odontologia de Bauru. Departamento de Prótese, Grupo de Dor Orofacial de Bauru https://orcid.org/0000-0003-0413-4658

DOI:

https://doi.org/10.1590/

Keywords:

Temporomandibular joint disorders, Temporomandibular joint, Joint instability, Joint dislocations

Abstract

Generalized Joint Hypermobility (GJH) is one of the pathophysiological contributing factors for the development of temporomandibular disorders (TMD). There are, however, several counterpoints on the potential relation between TMD and joint hypermobility, especially when considering the temporomandibular joint (TMJ), event known as TMJ hypertranslation. Additionally, there is no consensus regarding the clinical and imaging diagnostic criteria for such condition. Hence, this scoping review addresses the association between GJH, TMJ hypertranslation and TMD, highlighting the lack of consensus concerning TMJ hypertranslation diagnosis. Eligibility criteria included book sections, clinical trials, meta-analyses, multicenter studies, observational studies, and reviews published in English between 1964 and 2024. Bibliographic search was conducted on the PubMed, SciELO, LILACS and Science Direct databases using the following Medical Subjective Headings (MeSH) terms: “temporomandibular joint disorders,” “temporomandibular joint,” “joint instability” and “joint dislocations.” “TMJ hypermobility” and “TMJ subluxation,” non-indexed terms, were applied as individual searches in the same databases. Manual search was performed in selected works by cross-referencing the included studies and book sections. Additional search was conducted in the grey literature. All searches were performed from January to June 2024. After selection, 54 texts were included. While some studies suggest that joint hypermobility (generalized or TMJ specific) may be a risk factor for TMD, especially of the intra-articular type, others rule out this association. No consensus on the potential association between joint hypermobility and TMD was achieved due to the diverse methodologies used to define TMJ hypertranslation diagnosis. More robust and controlled studies are needed to establish a diagnostic criteria and, consequently, understanding of its potential repercussions on masticatory structures, as well as management and prevention of the clinical manifestations.

Downloads

References

- Klasser GD, Reyes MR, editors. Orofacial pain: guidelines for assessment, diagnosis, and management. 7 th ed. Hanover Park: Quintessence Publishing; 2023.

- Newman Dorland W.A. Dorland's illustrated medical dictionary. 32 nd ed. Philadelphia: Elsevier Saunders; 2012.

- Tinkle BT. Symptomatic joint hypermobility. Best Pract Res Clin Rheumatol. 2020;34(3):101508. doi:10.1016/j.berh.2020.101508

» https://doi.org/doi:10.1016/j.berh.2020.101508

- Buckingham RB, Braun T, Harinstein DA, Oral K, Bauman D, Bartynski W, et al. Temporomandibular joint dysfunction syndrome: a close association with systemic joint laxity (the hypermobile joint syndrome). Oral Surg Oral Med Oral Pathol. 1991;72(3):449-53. doi:10.1016/0030-4220(91)90485-u

» https://doi.org/doi:10.1016/0030-4220(91)90485-u

- Kavuncu V, Sahin S, Kamanli A, Karan A, Aksoy C. The role of systemic hypermobility and condylar hypermobility in temporomandibular joint dysfunction syndrome. Rheumatol Int. 2006;26(3):257-60. doi:10.1007/s00296-005-0620-z

» https://doi.org/10.1007/s00296-005-0620-z

- Poluha RL, De La Torre Canales G, Costa YM, Grossmann E, Bonjardim LR, Conti PC. Temporomandibular joint disc displacement with reduction: a review of mechanisms and clinical presentation. J Appl Oral Sci. 2019;27:e20180433. doi:10.1590/1678-7757-2018-0433

» https://doi.org/10.1590/1678-7757-2018-0433

- Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med. 2018;169(7):467-73. doi:10.7326/M18-0850

» https://doi.org/10.7326/M18-0850

- Gupton M, Imonugo O, Black AC, Launico MV, Terreberry RR. Anatomy, bony pelvis and lower limb, knee [Internet]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024. [updated 2023 Nov 5; cited 2024 Mar 9]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK500017/

» https://www.ncbi.nlm.nih.gov/books/NBK500017/

- Tinkle B, Castori M, Berglund B, Cohen H, Grahame R, Kazkaz H, et al. Hypermobile Ehlers-Danlos syndrome (a.k.a. Ehlers-Danlos syndrome Type III and Ehlers-Danlos syndrome hypermobility type): clinical description and natural history. Am J Med Genet C Semin Med Genet. 2017;175(1):48-69. doi:10.1002/ajmg.c.31538

» https://doi.org/10.1002/ajmg.c.31538

- Ting TV, Hashkes PJ, Schikler K, Desai AM, Spalding S, Kashikar-Zuck S. The role of benign joint hypermobility in the pain experience in Juvenile Fibromyalgia: an observational study. Pediatr Rheumatol Online J. 2012;10(1):16. doi:10.1186/1546-0096-10-16

» https://doi.org/10.1186/1546-0096-10-16

- Chopra P, Tinkle B, Hamonet C, Brock I, Gompel A, Bulbena A. Pain management in the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet. 2017;175(1):212-9. doi:10.1002/ajmg.c.31554

» https://doi.org/10.1002/ajmg.c.31554

- Murray B, Yashar BM, Uhlmann WR, Clauw DJ, Petty EM. Ehlers-Danlos syndrome, hypermobility type: a characterization of the patients' lived experience. Am J Med Genet A. 2013;161(12):2981-2988. doi:10.1002/ajmg.a.36293.

» https://doi.org/10.1002/ajmg.a.36293

- Voermans NC, Knoop H. Both pain and fatigue are important possible determinants of disability in patients with the Ehlers-Danlos syndrome hypermobility type. Disabil Rehabil. 2011;33(8):706-7. doi:10.3109/09638288.2010.531373

» https://doi.org/10.3109/09638288.2010.531373

- Wolf JM, Cameron KL, Owens BD. Impact of joint laxity and hypermobility on the musculoskeletal system. J Am Acad Orthop Surg. 2011;19(8):463-71. doi:10.5435/00124635-201108000-00002

» https://doi.org/10.5435/00124635-201108000-00002

- Carter C, Wilkinson J. Persistent joint laxity and congenital dislocation of the hip. J Bone Joint Surg Br. 1964;46:40-5.

- Beighton P, Horan F. Orthopaedic aspects of the Ehlers-Danlos syndrome. J Bone Joint Surg Br. 1969;51(3):444-53.

- Westling L. Craniomandibular disorders and general joint mobility. Acta Odontol Scand. 1989;47(5):293-9. doi:10.3109/00016358909007715

» https://doi.org/doi:10.3109/00016358909007715

- Westling L, Mattiasson A. general joint hypermobility and temporomandibular joint derangement in adolescents. Ann Rheum Dis. 1992;51(1):87-90. doi: 10.1136/ard.51.1.87

» https://doi.org/10.1136/ard.51.1.87

- Ögren M, Fältmars C, Lund B, Holmlund A. Hypermobility and trauma as etiologic factors in patients with disc derangements of the temporomandibular joint. Int J Oral Maxillofac Surg. 2012;41(9):1046-50. doi:10.1016/j.ijom.2012.02.024

» https://doi.org/10.1016/j.ijom.2012.02.024

- Hirsch C, John Mt, Stang A. Association between generalized joint hypermobility and signs and diagnoses of temporomandibular disorders. Eur J Oral Sci. 2008;116(6):525-30. doi:10.1111/j.1600-0722.2008.00581.x

» https://doi.org/10.1111/j.1600-0722.2008.00581.x

- Pertes RA, Gross SG. Clinical management of temporomandibular disorders and orofacial pain. 1st ed. Chicago: Quintessence; 1995. p. 79-86.

- Westling L, Mattiasson A. Background factors in craniomandibular disorders: reported symptoms in adolescents with special reference to joint hypermobility and oral parafunctions. Eur J Oral Sci. 1991;99(4):286-91. doi:10.1111/j.1600-0722.1991.tb01022.x

» https://doi.org/10.1111/j.1600-0722.1991.tb01022.x

- Conti PC, Miranda JE, Araujo CR. Relationship between systemic joint laxity, TMJ hypertranslation, and intra-articular disorders. Cranio. 2000;18(3):192-7. doi:10.1080/0886963 4.2000.11746132

» https://doi.org/10.1080/0886963 4

- Chiodelli L, Pacheco AB, Missau TS, Silva AM, Corrêa EC. Influence of generalized joint hypermobility on temporomandibular joint and dental occlusion: a cross-sectional study. CODAS. 2016;28(5):551-7. doi:10.1590/2317-1782/20162014082

» https://doi.org/10.1590/2317-1782/20162014082

- Barrera-Mora JM, Espinar Escalona E, Abalos Labruzzi C, Llamas Carrera JM, Ballesteros EJ, Solano Reina E, et al. The relationship between malocclusion, benign joint hypermobility syndrome, condylar position and TMD symptoms. Cranio. 2012;30(2):121-30. doi:10.1179/crn.2012.018

» https://doi.org/10.1179/crn.2012.018

- Dijkstra PU, Kropmans TJ, Stegenga B. The association between generalized joint hypermobility and temporomandibular joint disorders: a systematic review. J Dent Res. 2002;81(3):158-63. doi:10.1177/0810158

» https://doi.org/10.1177/0810158

- Davoudi A, Haghighat A, Rybalov O, Shadmehr E, Hatami A. Investigating activity of masticatory muscles in patients with hypermobile temporomandibular joints by using EMG. J Clin Exp Dent. 2015;7(2):e310-5. doi:10.4317/jced.52125

» https://doi.org/10.4317/jced.52125

- De Wijer A, Lobbezoo-Scholte AM, Steenks MH, Bosman F. Reliability of clinical findings in temporomandibular disorders. J Orofac Pain. 1995;9(2):181-91.

- Okeson JP. Management of temporomandibular disorders and occlusion. 8 th ed. St. Louis: Elsevier; 2019. p. 154-6.

- Bell WE. Temporomandibular disorders: classification, diagnosis and management. In: Textbook of clinical dentistry. 3 rd ed. Chicago: Year Book Medical Publishers; 1990. p. 289-357.

- Kalaykova S, Naeije M, Huddleston Slater JJ, Lobbezoo F. Is condylar position a predictor for functional signs of TMJ hypermobility? J Oral Rehabil. 2006;33(5):349-55. doi:10.1111/j.1365-2842.2005.01572.x

» https://doi.org/10.1111/j.1365-2842.2005.01572.x

- August M, Troulis MJ, Kaban LB. Hypomobility and hypermobility disorders of the temporomandibular joint.. In: Waite PD, ed. Peterson's principles in oral and maxillofacial surgery. 2 nd ed. Hamilton: BC Decker; 2004. p. 1033-48.

- Tamimi D, Hatcher DC. Specialty imaging temporomandibular joint. In: Temporomandibular Joint Imaging. 1st ed. Philadelphia: Elsevier; 2016. p. 375.

- Boering G. Arthrosis defonnans van her koa/cgewricht [Thesis]. Groningen: University of Groningen; 1966.

- Dijkstra PU, de Bont LG, de Leeuw R, Stegenga B, Boering G. Temporomandibular joint osteoarthrosis and temporomandibular joint hypermobility. Cranio. 1993;11(4):268-75. doi:10.1080/08869634.1993.11677978

» https://doi.org/10.1080/08869634.1993.11677978

- Haghigaht A, Davoudi A, Rybalov O, Hatami A. Condylar distances in hypermobile temporomandibular joints of patients with excessive mouth openings by using computed tomography. J Clin Exp Dent. 2014;6(5):e509-13. doi:10.4317/jced.51562

» https://doi.org/10.4317/jced.51562

- Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for clinical and research applications: Recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†. J Oral Facial Pain Headache. 2014;28(1):6-27. doi:10.11607/jop.1151

» https://doi.org/10.11607/jop.1151

- Obwegeser HL, Farmand M, Al-Majali F, Engelke W. Findings of mandibular movement and position of the mandibular condyles during maximal mouth opening. J Oral Maxillofac Surg. 1987;63:515-25. doi: 10.1016/0030-4220(87)90219-2

» https://doi.org/10.1016/0030-4220(87)90219-2

- Salourni C, Palla S. Condylar rotation and anterior translation in healthy human temporomandibular joints. Schweiz Monatsschr Zahnmed. 1994;104(7):415-22.

- Lewis RP, Buschang PH, Throckmorton GS. Sex differences in mandibular movements during opening and closing. Am J Orthod Dentofacial Orthop. 2001;120(3):294-303. doi: 10.1067/mod.2001.115612

» https://doi.org/10.1067/mod.2001.115612

- Senna BR, Marques LS, França JP, Ramos-Jorge ML, Pereira LJ. Condyle-disk-fossa position and relationship to clinical signs and symptoms of temporomandibular disorders in women. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(3):e160-5. doi:10.1016/j.tripleo.2009.04.034

» https://doi.org/10.1016/j.tripleo.2009.04.034

- Tuijt M, Koolstra JH, Lobbezoo F, Naeije M. Biomechanical modeling of open locks of the human temporomandibular joint. Clin Biomech. 2012;27(8):749-53. doi:10.1016/j.clinbiomech.2012.04.007

» https://doi.org/10.1016/j.clinbiomech.2012.04.007

- Tuijt M, Parsa A, Koutris M, Berkhout E, Koolstra JH, Lobbezoo F. Human jaw joint hypermobility: Diagnosis and biomechanical modelling. J Oral Rehabil. 2018;45(10):783-9. doi:10.1111/joor.12689

» https://doi.org/10.1111/joor.12689

- Pullinger A. Establishing better biological models to understand occlusion. I: TM joint anatomic relationships. J Oral Rehabil. 2013;40(4):296-318. doi:10.1111/joor.12032

» https://doi.org/doi:10.1111/joor.12032

- Cohen A, Sela MC, Verkauf TA, Alterman M, Talisman S, Casap N. The influence of mandibular condyle morphology on TMJ anterior dislocations. Oral Surg Oral Med Oral Pathol Oral Radiol. 2021;132(4):393-7. doi:10.1016/j.oooo.2021.03.008

» https://doi.org/10.1016/j.oooo.2021.03.008

- Smith TO, Bacon H, Jerman E, Easton V, Armon K, Poland F, et al. Physiotherapy and occupational therapy interventions for people with benign joint hypermobility syndrome: a systematic review of clinical trials. Disabil Rehabil. 2014;36(10):797-803. doi:10.3109/09638288.2013.819388

» https://doi.org/10.3109/09638288.2013.819388

- Warby SA, Pizzari T, Ford JJ, Hahne AJ, Watson L. The effect of exercise-based management for multidirectional instability of the glenohumeral joint: a systematic review. J Shoulder Elbow Surg. 2014;23(1):128-42. doi:10.1016/j.jse.2013.08.006.

» https://doi.org/10.1016/j.jse.2013.08.006

- Bahu MJ, Trentacosta N, Vorys GC, Covey AS, Ahmad CS. Multidirectional instability: evaluation and treatment options. Clin Sports Med. 2008;27(4):671-89. doi:10.1016/j.csm.2008.07.002

» https://doi.org/10.1016/j.csm.2008.07.002

- Sharma N, Singh A, Pandey A, Verma V, Singh S. Temporomandibular joint dislocation. Natl J Maxillofac Surg. 2015;6(1):16. doi:10.4103/0975-5950.168212

» https://doi.org/10.4103/0975-5950.168212

- Abrahamsson H, Eriksson L, Abrahamsson P, Häggman-Henrikson B. Treatment of temporomandibular joint luxation: a systematic literature review. Clin Oral Investig. 2020;24(1):61-70. doi:10.1007/s00784-019-03126-1

» https://doi.org/10.1007/s00784-019-03126-1

- Shimada A, Ishigaki S, Matsuka Y, Komiyama O, Torisu T, Oono Y, et al. Effects of exercise therapy on painful temporomandibular disorders. J Oral Rehabil. 2019;46(5):475-81. doi:10.1111/joor.12770

» https://doi.org/10.1111/joor.12770

- Lindfors E, Arima T, Baad-Hansen L, Bakke M, De Laat A, Giannakopoulos NN, et al. Jaw exercises in the treatment of temporomandibular disorders: an international modified delphi study. J Oral Facial Pain Headache. 2019;39(4):389-98. doi:10.11607/ofph.2359

» https://doi.org/10.11607/ofph.2359

- Loudon JK, Santos MJ, Franks L, Liu W. The effectiveness of active exercise as an intervention for functional ankle instability a systematic review. Sports Med. 2008;38(7):553-63. doi: 10.2165/00007256-200838070-00003

» https://doi.org/10.2165/00007256-200838070-00003

- Baad-Hansen L, Thymi M, Lobbezoo F, Svensson P. To what extent is bruxism associated with musculoskeletal signs and symptoms? A systematic review. J Oral Rehabil. 2019;46(9):845-61. doi:10.1111/joor.12821

Association between generalized joint hypermobility, temporomandibular joint hypertranslation and temporomandibular disorders

a scoping review

Authors

DOI:

Keywords:

Abstract

Downloads

References

Downloads

Published

Versions

Issue

Section

License

How to Cite

Language

Information

Keywords