Alterações morfológicas da articulação temporomandibular e sua relação com as dimensões das vias aéreas superiores, o risco de apneia obstrutiva do sono e o bruxismo em indivíduos com e sem disfunção temporomandibular

Abstract

Temporomandibular disorder (TMD), obstructive sleep apnea (OSA), and bruxism are prevalent conditions that may share pathophysiological mechanisms, although the etiopathogenic nature of their interrelationships remains controversial. This study aimed to investigate the association between degenerative and remodeling changes of the temporomandibular joint (TMJ), upper airway dimensions, OSA risk, and bruxism. A cross-sectional observational study was conducted with 60 participants, matched by sex and age (30 with TMD and 30 asymptomatic controls; mean age 44.9±17.1 years; 76.7% female in both groups). Degenerative and remodeling changes of the TMJ and upper airway dimensions were assessed by cone-beam computed tomography; OSA risk was investigated using the STOP-Bang and Berlin questionnaires, and bruxism was assessed using the Standardized Tool for the Assessment of Bruxism (STAB). Independent associations were investigated through multiple linear and logistic regression models, adjusted for age, sex, and other confounding factors, complemented by a sensitivity analysis using a TMJ Degenerative Index. Individuals with TMD showed a higher frequency of osteophytes in the right mandibular condyle (26.7% vs. 3.3%; p = 0.039) and bilateral sclerosis (46.7% vs. 10.0%; p ≤ 0.006), as well as a lower frequency of flattening of the left articular tubercle (13.3% vs. 43.3%; p = 0.027). No significant differences were found between groups regarding upper airway dimensions (p > 0.05) or OSA risk (p ≥ 0.180). Self-reported sleep bruxism was more frequent in the TMD group (median 5 vs. 4; p = 0.028), with no differences for awake bruxism. After multivariate adjustment, none of the degenerative or remodeling changes of the TMJ showed an independent association with upper airway dimensions, OSA risk, or bruxism, a finding confirmed by the sensitivity analysis. It is concluded that, although individuals with TMD present a higher frequency of certain TMJ changes and of sleep bruxism, these changes are not independently associated with upper airway dimensions, OSA risk, or bruxism. This study contributes to the literature by investigating, in an integrated and multivariate manner, the specific role of localized TMJ changes within this multifactorial context, suggesting that the interrelationships among TMD, bruxism, and sleep-related breathing disorders 12 predominantly involve functional and neuromuscular mechanisms, rather than being explained solely by articular structural changes.