Supervisors: dotsent Ülle Voog-Oras (TÜ stomatoloogia kliinik), emeriitprofessor Edvitar Leibur (TÜ stomatoloogia kliinik)
ja dotsent Riina Kallikorm (TÜ sisekliinik).
Opponent: professor Anders Holmlund, PhD (Karolinska Instituut, Rootsi)
This thesis is the first population-based study describing temporomandibular joint (TMJ) pain/discomfort impact on activities of daily living (ADL) in relation to the TMJ radiographic changes and bone markers (P1NP, CTX-1) and vitamin D (25(OH)D). A long-term results of arthroscopic surgery of the TMJ disorders are analysed. It is found that 28% of the adult population have signs of TMJ. In our population based study 47% subjects had TMJ problems where pain is commonly accompanied by stiffness, sounds and functional limitations with result in a decreased quality of life, and thus exert a significant negative impact on ADL. Assessment of individual ADL is important in the evaluation of TMJ disorders. Orthopantomograph (OPTG) is commonly used for assessment of bone changes in the TMJ. The OPTGs were evaluated for presence of radiographic signs of bone structural changes as erosions, flattening and osteophytes of the condyle and temporal bone. We found that pain/discomfort is related to the biochemical markers of bone turnover and 25(OH)D level. Several functions of daily activities such as eating, swallowing, exercising and social life are the most disturbed. TMJ radiographic changes and teeth loss seems to be related to the low level of BMD and 25(OH)D level. Fibrillations and fibrous adhesions are the most usual pathological signs of arthroscopic findings in TMJ. Arthroscopic releasing of these restrictive bands improves the joint mobility and contributes to reducing pain level. The results of arthroscopy offered favourable long-term stable results with regard to improved mouth opening and reducing pain and dysfunction.