Temporomandibular Rahatsızlıklarda Çiğneme Fonksiyonu ile Kinezyofobi, Çene, Baş-Boyun Propriyosepsiyonu Arasındaki İlişki

Abstract

The aim of this study was to investigate the relationship between chewing function and kinesiophobia, jaw and head-neck proprioception in Temporomandibular Disorders (TMD). The study included 34 individuals with a mean age of 29.23 ± 10.03 years who were diagnosed with TMD by dentistry. After the descriptive information of the participants was questioned, pain and disability status were evaluated by Visual Analog Scale (VAS), Graded Chronic Pain Scale (GCPS) and Craniofacial Pain and Disability Questionnaire (CF-PDI). Three different methods were used to assess masticatory function: Mandibular Dysfunction Questionnaire (MFIQ-T-N), Test of Chewing and Swallowing of Solids (TOMASS) and superficial Electromyography (sEMG) assessment while chewing different foods (biscuit, marshmellow, hard candy). During the sEMG evaluation, the activations of the masseter and temporalis anterior muscles as well as the duration of natural chewing were recorded. In addition, the TMR complaint side of individuals with TMR was defined as the affected side. Kinesiophobia was assessed with the Tampa Kinesiophobia Scale in Temporomandibular Disorders (TMD/TSK-T) and head posture, jaw and head-neck proprioception were assessed with Craniocervical Angle Measurement, AMEDA protocol using different diameter apparatus and Cervicocephalic Kinesthesia Test (CKT), respectively. The results of the jaw proprioception assessment were recorded as percentage of thicker and thinner perception, percentage of accuracy and amount of deviation. A moderate positive correlation was found between kinesiophobia and all parameters of the MFIQ-T-N assessment (p<0.05). There was a moderate negative correlation between the activities related to chewing score of the MFIQ-T-N and the percentage of thicker perception of jaw proprioception and a moderate positive correlation between the same score and the percentage of thinner perception of jaw proprioception (r=-0.41, p=0.015; r=0.35, p=0.041, respectively). A low negative correlation was found between the number of TOMASS swallows and the percentage of accuracy of jaw proprioception (r=-0.34, p=0.046). There was a low negative correlation between the percentage of unaffected side masseter muscle activation recorded by sEMG while chewing hard candy and the percentage of thicker jaw proprioception (r=-0.34, p=0.045). There was a low negative correlation between the duration of natural chewing recorded by sEMG during marshmellow chewing and the percentage of accuracy of jaw proprioception and a low positive correlation between the same duration and the percentage of thinner perception of the apparatus (r=-0.38, p=0.025; r=0.38, p=0.024, respectively). There was a moderate positive correlation between the natural chewing time recorded by sEMG during hard candy chewing and the amount of jaw proprioception deviation and the percentage of thinner perception of the apparatus, and a moderate negative correlation between the same time and the percentage of accuracy of jaw proprioception (r=0.44, p=0.009; r=0.55, p=0.001; r=-0.56, p=0.001, respectively). A low positive correlation was found between the MFIQ-T-N total score and the degree of functional impairment and the amount of left lateral flexion deviation (r=0.36, p=0.036; r=0.35, p=0.039, respectively). A low level negative correlation was found between the number of TOMASS bites and the amount of flexion deviation (r=-0.36, p=0.034). There was a low level negative correlation between the percentage of temporalis anterior muscle activation on the affected side recorded with sEMG while chewing biscuits and the amount of head-neck left rotation deviation (r=-0.34, p=0.046). There was a moderate negative correlation between the amount of head-neck flexion deviation and the duration of natural chewing recorded by sEMG during biscuit chewing and a low negative correlation between the duration of natural chewing recorded during marshmellow chewing (r=-0.42, p=0.012; r=-0.35, p=0.038, respectively). In conclusion, it was determined that chewing dysfunctions and difficulty in masticatory function increased as the level of kinesiophobia and deficiencies in jaw and head-neck proprioception increased in individuals with TMD. Kinesiophobia, jaw and head-neck proprioception should be evaluated and necessary treatment approaches should be included in individual rehabilitation programs to improve masticatory function in individuals with TMD.