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Table of Contents
ORIGINAL ARTICLE
Year : 2017  |  Volume : 7  |  Issue : 3  |  Page : 87-90

Cheek Bite Keratosis among Temporomandibular Disorder Patients


Department of Medical Education, College of Medicine and Director of Quality Assurance, Deanship of Quality Management, King Saud Bin Abdulaziz University for Health Sciences; Department of Dental Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia

Date of Web Publication29-Dec-2017

Correspondence Address:
Abdullah Mohammed Alzahem
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, PO Box 22490 (MC 1243), Riyadh 11426
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jid.jid_33_17

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   Abstract 


Introduction: Cheek biting commonly reported by patients with temporomandibular disorders (TMDs). This cheek biting may cause cheek bite keratosis. This research aims to study the prevalence of cheek bite keratosis among TMD patients. Materials and Methods: A cross-sectional survey was conducted on 373 TMD patients seen in the temporomandibular joint (TMJ) clinic by one TMJ specialist since 2013. Convenient sampling technique was followed where all screened patients having TMDs were included in the study. Results: TMD patients who have cheek-bite keratosis are 226 patients (60.6%). Female TMD patients are the majority (75.60%) and 78.8% of TMD patients with cheek bite keratosis were female. The highest number of TMD patients (4.6%) was at the age of 20 years old. Conclusion: Cheek bite keratosis is an important sign for TMD screening for the general dentist in the first dental visit. Dentist who finds cheek bite keratosis during intraoral examination advised to ask more screening questions and do more clinical examination for TMDs.

Keywords: Cheek bite keratosis, cheek biting, temporomandibular disorders, temporomandibular joints


How to cite this article:
Alzahem AM. Cheek Bite Keratosis among Temporomandibular Disorder Patients. J Interdiscip Dentistry 2017;7:87-90

How to cite this URL:
Alzahem AM. Cheek Bite Keratosis among Temporomandibular Disorder Patients. J Interdiscip Dentistry [serial online] 2017 [cited 2018 Jan 21];7:87-90. Available from: http://www.jidonline.com/text.asp?2017/7/3/87/221892




   Clinical Relevance to Interdisciplinary Dentistry Top


  • Temporomandibular disorder patients need to be managed by multidisciplinary team
  • Cheek bite keratosis as a sign should act as alert for different dental disciplines
  • Diagnosing temporomandibular disorders as early as possible is important for all dental disciplines.



   Introduction Top


Temporomandibular disorders (TMDs) are a group of conditions and cause pain and dysfunction of the jaw joints and the muscles of mastication. TMDs affect women more than men, and mostly, the symptoms are self-limited with little or no treatment. However, some people develop significant long-term symptoms and need treatment.[1] TMDs are related to mixed etiologic factors.[2] One of these etiological factors reported in the literature was the oral parafunctions as cheek biting.[3] Cheek biting influenced dysfunctional opening and pain on opening.[4] Other oral habits did not affect TMD symptoms in a period of about 5 years by getting worse or change.[5] Cheek biting was the most common parafunctional habit among patients with TMDs and did affect 41% of them.[6] TMD patients with limited mouth opening entrapped buccal mucosa between teeth during the chewing cycle, which in turn can lead to further injury of the mucosa.[7] Cheek biting existed in 3.05% of normal adults and 0.97% of normal children and youth.[8]

Removable prosthesis introduced in the literature to prevent the injury of cheek biting but requires enough compliance by a patient.[9] An adolescent with a history of hydrocephalus and developmental delay successfully treated with a modified standard maxillary orthodontic retainer to prevent cheek biting injury.[10] Cheek biting is a chronic, usually unhurt, self-inflicted injury[11] and may cause cheek bite keratosis.[12] The largest study of 23,785 patients, attending a Mexican dental school clinic, found that cheek biting lesions were ranked fifth or 21.7 cases per 1000 patients.[13] Biting of the buccal mucosa was very frequent injury and could cause facial emphysema but rarely.[14]

Cheek bite as a sign has not been discussed in the literature to the best of my knowledge, but what has been mentioned was the cheek biting as a symptom. There is a need to investigate the significance of the cheek bite as a sign for screening TMDs by investigating the prevalence of cheek bite keratosis among TMD patients.

This research aimed to study the prevalence of cheek bite keratosis among TMD patients. The study objectives were to calculate the presence percentage of cheek bite keratosis among TMD patients and to correlate the presence percentage of cheek bite keratosis to age and gender of patients. Moreover, the study determined the percentage of female and male TMD patients.


   Materials and Methods Top


Ethics

Ethical clearance was granted by the Institutional Review Board and no additional patient consent was required. Every patient has medical record with consent for routine examination in dental clinics.

Study design

A cross-sectional survey was conducted on 373 patients diagnosed with TMDs to determine the prevalence of cheek bite keratosis among TMD patients. Convenient sampling technique was used, where all diagnosed patients with TMDs were included since 2013.

Referred patients with TMD symptoms and signs were screened by one temporomandibular joint (TMJ) specialist in TMJ clinic then given appointment for comprehensive TMJ examination. During the comprehensive TMJ examination, TMJ evaluation form was filled for each patient. Observation recording form was developed and used as data collection form, containing the following fields: medical record number, patient age, patient gender, and cheek bite keratosis availability as a sign.

Statistics

Data were categorized in groups according to age and gender. Data were categorized according to age into four groups; the first group was patients with age below 22 years old, the second group was patients with age 22–29 years old, the third group was patients with age 30–42 years old, and the fourth group was patients with age above 42 years old.

The prevalence of cheek-bite keratosis among TMDs patients was calculated. A Chi-square statistic was used to compare age and gender in TMD patients and their association with cheek-bite keratosis. Logistic regression models were used to assess the impact of variables that were significantly associated (P < 0.05) with both TMDs and cheek-bite keratosis. All calculations were carried out with the IBM SPSS Statistics for Windows, Version 21.0 (Armonk, NY: IBM Corp).


   Results Top


All 373 TMD patients with age 7–76 years old (mean = 32) were distributed according to their age [Table 1]. Seventeen TMD patients (4.6%) at the age of 20 years old were the highest number among all ages [Figure 1]. Three hundred and seventy-three TMD patients were seen in the past 5 years, where 109 (29.22%) TMD patients seen in 2013, 76 (20.38%) TMD patients seen in 2014, 95 (25.47%) TMD patients seen in 2015, 78 (20.91%) TMD patients seen in 2016, and 15 (4.02%) TMD patients seen this year 2017.
Table 1: Age of patients, frequency, and cheek bite keratosis

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Figure 1: Age of temporomandibular disorders patients' distribution

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Our sample had 282 female TMD patients (75.60%) and 91 male TMD patients (24.40%). The sample has been divided into four age groups, and each group has 91–93 TMD patients [Table 2]. The third age group (30–42 years old) has the highest prevalence for cheek bite keratosis (65.59%), and the first age group (below 22 years old) has the lowest prevalence of cheek bite keratosis (54.35%).
Table 2: Cheek bite keratosis among age groups

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Two hundred and twenty-six patients (60.59%) have cheek bite keratosis, and 147 TMD patients (39.41%) do not have cheek bite keratosis [Table 3]. The female TMD patients who have cheek bit keratosis are 178 patients (63.12%), and the male TMD patients who have cheek bite keratosis are 48 patients (52.75%) [Table 3]. The number of female TMD patients showed that cheek bite keratosis is more than the number of male TMD patients.
Table 3: Gender of patients who are having cheek bite keratosis

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   Discussion Top


The objective of this study was to investigate the prevalence of cheek bite keratosis among TMD patients. The cheek bite keratosis as a sign existed in 60.59% of TMD patients according to this study. This makes cheek bite keratosis as an important sign for screening TMDs by non-TMJ specialist, to refer the patient with cheek bite keratosis to a specialized dentist in TMDs for further evaluation.

TMD is more prominent in female patients than male patients and affects people at the age of 20 years old the most. No significant correlation between the prevalence of cheek bite keratosis and the age of TMD patients found, but there is a significant correlation between the age of the TMD patients and the cheek bite keratosis. The third age group (30–42 years old) showed the cheek bite keratosis more than others, and the female TMD patients showed the cheek bite keratosis more than male TMD patients. This makes middle age female TMD patients more prone to the cheek bite keratosis, which might be linked to physiological and psychological status.


   Conclusion Top


The cheek bite keratosis is an important sign for TMD patients during examination in the first dental visit. Dentist who finds cheek bite keratosis during intraoral examination should ask more screening questions for TMDs including history of frequent headache, earache, neck pain, difficult mouth opening, pain upon opening and closing, joint sound, ear sound, and history of clenching or grinding teeth. In addition, the dentist may do further clinical examination as palpation of the TMJs and masticatory and cervical muscles, inspect mouth opening direction, measure range of mouth opening, inspect teeth for significant occlusal wear, and auscultate TMJs for click or crepitation sound.

This study is the first to the best of our knowledge discussing the prevalence of cheek bite keratosis among TMD patients and has limitations for the applicability on other samples. Further research recommended to investigate the significance of cheek bite keratosis as screening sign for TMDs with other TMJ patients around the world.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Jain R, Ashish Y, Saurabh R, Shrikant P. Management of temporomandibular disorder: A review. J Adv Med Dent Sci Res 2016;4:126-31.  Back to cited text no. 1
    
2.
Mundt T, Mack F, Schwahn C, Bernhardt O, Kocher T, Biffar R, et al. Association between sociodemographic, behavioral, and medical conditions and signs of temporomandibular disorders across gender: Results of the study of health in Pomerania (SHIP-0). Int J Prosthodont 2008;21:141-8.  Back to cited text no. 2
    
3.
Farsi N, Alamoudi N, Feteih R, El-Kateb M. Association between temporo mandibular disorders and oral parafunctions in Saudi children. Odontostomatol Trop 2004;27:9-14.  Back to cited text no. 3
    
4.
Vanderas AP, Papagiannoulis L. Multifactorial analysis of the aetiology of craniomandibular dysfunction in children. Int J Paediatr Dent 2002;12:336-46.  Back to cited text no. 4
    
5.
Fujita Y, Motegi E, Nomura M, Kawamura S, Yamaguchi D, Yamaguchi H, et al. Oral habits of temporomandibular disorder patients with malocclusion. Bull Tokyo Dent Coll 2003;44:201-7.  Back to cited text no. 5
    
6.
Feteih RM. Signs and symptoms of temporomandibular disorders and oral parafunctions in Urban Saudi Arabian adolescents: A research report. Head Face Med 2006;2:25.  Back to cited text no. 6
    
7.
Nanda A, Koli D, Sharma S, Gill S, Verma M. Checking the cheek bite injury: Fabrication of an interim cheek guard appliance. Spec Care Dentist 2014;34:208-11.  Back to cited text no. 7
    
8.
Shulman JD. Prevalence of oral mucosal lesions in children and youths in the USA. Int J Paediatr Dent 2005;15:89-97.  Back to cited text no. 8
    
9.
Romero M, Vicente A, Bravo LA. Prevention of habitual cheek biting: A case report. Spec Care Dentist 2005;25:214-6.  Back to cited text no. 9
    
10.
Silva DR, da Fonseca MA. Self-injurious behavior as a challenge for the dental practice: A case report. Pediatr Dent 2003;25:62-6.  Back to cited text no. 10
    
11.
Flaitz CM, Felefli S. Complications of an unrecognized cheek biting habit following a dental visit. Pediatr Dent 2000;22:511-2.  Back to cited text no. 11
    
12.
Tapia JL, Aguirre A. Oral Frictional Hyperkeratosis. Medscape 2016.  Back to cited text no. 12
    
13.
Castellanos JL, Díaz-Guzmán L. Lesions of the oral mucosa: An epidemiological study of 23785 mexican patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:79-85.  Back to cited text no. 13
    
14.
Yamada H, Kawaguchi K, Tamura K, Sonoyama T, Iida N, Seto K, et al. Facial emphysema caused by cheek bite. Int J Oral Maxillofac Surg 2006;35:188-9.  Back to cited text no. 14
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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