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Published in final edited form as:

J Am Geriatr Soc. 2018 July ; 66(6): 1213–1217. doi:10.1111/jgs.15354.

Temporomandibular Joint Disorders in the Elderly and Aging

Population
Sumit Yadav1, Yun Yang2, Eliane H. Dutra3, Jennifer L. Robinson4, Sunil Wadhwa5
1SumitYadav BDS, MDS, PhD, Associate Professor, Division of Orthodontics, University of
Connecticut Health Center
2Yun Yang, Department of Orthodontics, School of Stomatology, Capital Medical University,
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Beijing 100050, China

3Eliane
H Dutra DDS, PhD, Assistant Professor, Division of Orthodontics, University of
Connecticut Health Center
4JenniferL Robinson PhD, Postdoctoral Associate, Division of Orthodontics, Columbia University
College of Dental Medicine
5SunilWadhwa DDS, PhD, Associate Professor and Chair, Division of Orthodontics, Columbia
University College of Dental Medicine

Abstract
Objective—To review the literature and summarize the evidence of Temporomandibualar Joint
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Disorders (TMD) in elderly and older individuals. The goal of this review is to focus on clinical
manifestations of TMD in the elderly by highlighting the increased incidence of
Temporomandibular Joint (TMJ) degeneration in the elderly, the sexual dimorphism and the role
of sex hormones in this process. The review concludes with potential treatment options of TMD in
elderly.

Design—Two review authors performed the literature search, study inclusion and data extraction.
Pubmed, Embase and Google scholar were searched for literature until August 2017(Figure 1). We
adopted a combination of Medical Subject Headings with related free text word for the search in
pubmed and optimized the search in other search engines. Traditionally, it was believed that
temporomandibular joint disorders (TMD) predominantly afflicted women of childbearing ages.
However, recent very large sample size studies in Europe and in the United States have shown that
the prevalence for TMD peaks between past child bearing ages (45–64 years of age) and then only
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gradually decreases with age. However, not much is known of the disease in the elderly.

Conclusion—In the elderly, the majority of patients have TMJ degeneration and it afflicts
women more than men. In the majority of elderly patients, the symptoms of TMD are mild and
self-limiting and usualy can be treated by patient self management.

Corresponding Author: Sumit Yadav BDS, MDS, PhD, Associate Professor, Division of Orthodontics, University of Connecticut
Health Center, 263 Farmington Avenue, Farmington, CT 06030, syadav@uchc.edu.
Authors Contribution: All the authors contributed equally for this review article.
Conflict of Interest: The authors of this manuscript have no conflict of interest.
Sponsor’s Role: Their was no role in the review article design and interpretation of the published literature
 Yadav et al. Page 2

Keywords
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Temporomandibular joint disorders; cartilage degeneration and temporomandibular joint

Introduction
Temporomandibular joint disorders (TMD) are a broad group of clinical problems involving
the masticatory musculature, the temporomandibular joint (TMJ), surrounding bony and soft
tissue components, and/or any combinations of these anatomical structures 1. Symptoms of
TMD include decreased mandibular range of motion, pain in the muscles of mastication,
joint pain, associated joint noise during function, and a functional limitation or deviation of
jaw opening 1.

TMD is a fairly common disease and is currently estimated to afflict approximately 5–12%
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of the United States population 2. Traditionally, all diseases that make up TMD were thought
to be sexual dimorphic and predominantly afflict women 3–5. However, in a recent large
prospective clinical trial that investigated the natural history of acute and chronic TMD
diseases ( Orofacial Pain: Prospective Evaluation and Risk Assessment.the Oppera study), it
was shown that only the chronic form of TMD disease predominantly afflicted women and
that the acute form of TMD had an equal prevalence between the sexes 6. It has been further
speculated that the increased prevalence of TMD found in women in a number of cross-
sectional studies 7 is due to its increased duration of TMD symptoms in women so that at
any given moment of time more women than men would have TMJ symptoms 8.

In regards to age, TMD prevalence has been shown to follow a inverted U curve 3. Recent
studies have shown that the peak prevalence occurs in 45–64 year-olds 9,10, whereas older
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studies showed that the prevalence peaked in women of child bearing ages (20–40 year-olds)
5 Nevertheless, the prevalence of TMD in adults over 65 years of age is still relatively high

at 3–5% of the US population, 9,11,12. Despite the relatively high prevalence of TMD in the
elderly population, there are no current review articles that focus on this specific age group.

Therefore, the goal of this review is to focus on clinical manifestations of TMD in the
elderly by highlighting the increased incidence of TMJ degeneration in the elderly, the
sexual dimorphism, and the role of sex hormones in this process. Following this discussion,
theories to explain why the elderly do not seek treatment are presented. The review
concludes with potential treatment options of TMD in the elderly.

TMJ Degeneration Increases with Age

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TMD encompasses a number of acute and chronic diseases. One established method to
classify the disease that is most widely used in the published literature is by dividing the
diseases into three groups: Group 1) muscle disorders, Group 2) disc disorders, and Group
3) joint disorders 13. A more recent TMD classification has been proposed 2; however, there
are only a few TMD epidemiological studies published that have used the new classification
of TMD. Similar to other joints, studies have found that the TMJ degenerates with age
141516. In a series of papers, Guarda-Nardini et al. have shown an increasing prevalence of

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TMJ degeneration with advancing age 15,17, suggesting that in people over the age of 65, the
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majority of patients with TMD have the degenerative joint disorder form of the disease.
Human autopsy materials have also shown increased TMJ degeneration up to 60–70 years of
age 18,19. In addition, radiographic evidence has shown approximately 45–70% of people
over the age of 65 with evidence of TMJ degeneration 20–22. However, in the majority of
TMJ degeneration patients, the clinical symptoms are minimal 22. Further, in patients with
clinical symptoms from TMJ degeneration, the process is usually self-limiting. After 5–8
years of intial diagnosis, the clinical symptoms resolve 23–25. Still, there are approximately
15% of TMJ degeneration patients who experience progression of the disease process 25.

The etiology of TMJ degeneration is not fully known. Shi et al. studied the association
between bone loss and osteoarthritis (OA) in the condylar bone of the TMJ complex. They
found that low condylar bone quality was significantly correlated with TMJ-OA
development and that condylar bone mineral density and bone volume fraction can be used
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together as a potential diagnostic tool for TMJ-OA 26. Another theory for the etiology of
TMJ degeneration is that the remodeling capacity of TMJ fibrocartilage decreases with age
27. Therefore, it is possible as one ages that the functional demands of the TMJ may exceed

the repair and remodeling capacity of the joint resulting in degeneration 28

Role of Female Sex Hormones in Mediating TMJ degeneration

The vast majority of studies have shown that women over the age of 50, are more likely, than
age-matched men to suffer from TMJ degeneration 29, 1614. Since TMJ degeneration is a
chronic form of TMD, this is consistent with a recent longitudinal study that found that the
prevalence of chronic TMD is greater in women than in men even though the prevalence of
acute TMD is similar between the sexes 8. The reason for prevalence of chronic TMD in
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women over 50 years old could be associated with menopause, suggesting that the incidence
of chronic TMD/TMJ degeneration is correlated with a reduction of endogenous female
hormones levels.

There are four studies that have looked at the effects of hormone replacement therapy (HRT)
collectively on all TMD diseases. In the first study, they found a significant increase in TMD
prevalence in post-menopausal women on HRT compared to women who were not 4.
However, at the time when the study was done, a high portion of the post-menopausal
women on HRT had undergone hysterectomy 30 that can cause an increase in TMD
prevalence because of intubation 31, potentially biasing the results. In contrast, three recent
studies found no difference in the prevalence of TMD in post-menopausal women on HRT
compared to those who were not undergoing treatment 10,32,33; albeit the sample sizes were
small for these particular studies. Taken together, the aforementioned studies suggest that
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HRT may have no significant effect on the prevalence of TMD overall. However, to date,
there is currently no human clinical data that investigates the effect of HRT specifically on
TMJ degeneration.

The published literature is inconclusive on the effects of estrogen in mediating TMJ

degeneration. Studies have shown that certain Estrogen Receptor alpha (ERα)
polymorphisms are more prevalent in patients with TMJ degeneration 34 and specifically in

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patients with moderate to severe pain compared to patients with mild pain 35. Furthermore,
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these clinical studies have been validated in animal models to understand the mechanism
behind it. Two studies that looked at the effects of ovariectomy on TMJ degeneration. One
was done in young growing rats 36 while the other was performed on adult rats 37. In both
studies, they found that 8–12 weeks after ovariectomy, there was histological evidence of
TMJ degeneration 36,37. These specific studies suggest estrogen protects the TMJ from
degeneration. However, studies have also looked at the role of estrogen in mediating
collagenase activity and promotion of degradation in the TMJ disc. In the disc, estrogen has
been shown to increase both protease and protease inhibitor expression 38–40. However, the
TMJ disc and mandibular condylar fibrocartilage that interfaces with the subchondral bone
differ in their collagen type 1 and type 2 content. Thus, the effects of estrogen may be
different in these tissues 41. Finally, there is a study that looked at the effects of altered
estrogen levels in mediating TMJ degeneration in young growing rats in a chemical model of
osteoarthritis 42. In this study, they found that supraphysiological doses of estrogen
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potentiated TMJ degeneration. However, the studies were performed in young growing rats,
and it is established that estrogen inhibits TMJ growth in the young 36. Therefore, the effects
of estrogen in potentiating TMJ degeneration in the young may be overridden with
inhibiting TMJ growth as opposed to modifying the progression of degeneration. Additional
studies investigating the role of estrogen concentration on the mandibular condylar
fibrocartilage and TMJ disc as a function of age in older samples will provide more accurate
evidence to decode the sexual dimorphism of TMJ degeneration.

We are currently examing the role of estrogen through estrogen receptor alpha and estrogen
receptor beta signaling in mediating TMJ homeostasis. We have found that estrogen causes
the upregulation of critical extracellular matrix macromolecule collagen type 2 in the
mandibular condylar fibrocartilage 43. Therefore, decreased estrogen levels in menopausal
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women may result in decreased mechanical stiffness and integrity of the mandibular
condylar fibrocartilage increasing the likelihood of TMJ degeneration.

Other common TMD diseases in the elderly

It is unclear whether the incidence of TMD muscle disorders decrease or remain the same
with advancing age 10,44–46. In contrast, the majority of studies have found that TMJ disc
disoders decrease with advancing age 4715,17. In addition, if disc displacement is found in
the elderly it is usually associated with TMJ degeneration 48.

Elderly are Unlikely to Seek Treatment for TMJ degeneration

It is interesting that most studies have shown that self-reported TMJ pain decreases with
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advancing age 499, whereas the radiographic signs of TMJ degeneration increase with
advancing age 20–22. The exact reason behind this discrepancy is unknown. However, there
are many possible explanations. One explanation is the subjectivity of the interpretation of
pain. The majority of people with TMJ pain describe it as mild and only 5% of patients
describe it as severe 44,50,51. However, as the average life expectancy increases, the number
of diseases with more severe symptoms that affect other areas of the body may take

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precedence. This results in elderly patients less aware of TMJ pain and/or degeneration and
unlikely to seek treatment 52.
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Another explanation is that the main causes of TMDs involve both pathophysiological and
psychosocial factors. Several psychosocial factors can not only predispose a person to TMD
pain, but also prolong it 53,54. Since most mental disorders decline in people over the age of
60 55,56, this may cause a dampening of TMJ pain in the elderly. Another explanation is that
the majority of studies have shown that the natural progression of TMDare self-limiting
23,24,57. In a recent study, people diagnosed with TMJ degeneration were followed with

magnetic resonance imaging and computed tomography after 8 years. It was found that
about 80% of the people diagnosed with TMJ degeneration remained stable or showed
improvement 25. Therfore, in genereal the prevalence of TMJ degeneration is not cumulative
or progressing.
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Treatment Considerations
Since it is difficult to differentiate the self-limiting from the progressive TMD patients,
conservative treatments strategies are recommended. Conservative treatments consist of
patient education, jaw exercises, massage, thermal therapy, dietary advice and nutrition,
parafunctional behaviour identification, monitoring and avoidance 58. The use of NSAIDs
and muscle relaxants have also been shown to be effective in the relief of TMJ pain 59. If
these initial methods do not provide relief in TMJ degeneration patients, arthocentesis of the
TMJ should be advocated as the next step of treatment 60,61. Total replacement of TMJ is the
end stage management of TMD 62. Long term studies have confirmed the safety and efficacy
of the new generation of alloplastic TMJ implants 63. The use of alloplastic TMJ implants
for the treatment of TMD has increased over the last last decade in the United States and
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expected to increase by 58% in the next 10–15 years 64.

Summary
TMD encompasses many disorders that affect multiple tissues of the TMJ complex and
cause both functional disturbances and orofacial pain. While much focus has been placed on
TMD in young and adult populations, the diagnostics and treatment of symptoms for the
elderly has not been largely investigated. In the elderly, the majority of patients have TMJ
degeneration and it afflicts women more than men. In the majority of elderly patients, the
symptoms of TMD are mild and self-limiting and usualy can be treated by patient self
management. In the few patients that are refractory from conservative treatment,
arthocentesis and TMJ replacement are both available. A major challenge in the field that
must be addressed to avoid the risk of morbidity from TMJ replacement surgery is the
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development of new pharmaceutical therapies (such as estrogen replacement) for patients in

which conservative treatment fails.

References
1. Wadhwa S, Kapila S. TMJ disorders: future innovations in diagnostics and therapeutics. J Dent
Educ. 2008; 72:930–947. [PubMed: 18676802]

J Am Geriatr Soc. Author manuscript; available in PMC 2019 August 19.

 Yadav et al. Page 6

2. 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:
Author Manuscript

recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special
Interest Groupdagger. J Oral Facial Pain Headache. 2014; 28:6–27. [PubMed: 24482784]
3. LeResche L. Epidemiology of temporomandibular disorders: implications for the investigation of
etiologic factors. Crit Rev Oral Biol Med. 1997; 8:291–305. [PubMed: 9260045]
4. LeResche L, Saunders K, Von Korff MR, Barlow W, Dworkin SF. Use of exogenous hormones and
risk of temporomandibular disorder pain. Pain. 1997; 69:153–160. [PubMed: 9060026]
5. Warren MP, Fried JL. Temporomandibular disorders and hormones in women. Cells Tissues Organs.
2001; 169:187–192. [PubMed: 11455113]
6. Slade GD, Bair E, Greenspan JD, Dubner R, Fillingim RB, Diatchenko L, et al. Signs and symptoms
of first-onset TMD and sociodemographic predictors of its development: the OPPERA prospective
cohort study. J Pain. 2013; 14:T20–32. e21–23. [PubMed: 24275221]
7. Manfredini D, Guarda-Nardini L, Winocur E, Piccotti F, Ahlberg J, Lobbezoo F. Research
diagnostic criteria for temporomandibular disorders: a systematic review of axis I epidemiologic
findings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011; 112:453–462. [PubMed:
Author Manuscript

21835653]
8. Slade GD, Ohrbach R, Greenspan JD, Fillingim RB, Bair E, Sanders AE, et al. Painful
Temporomandibular Disorder: Decade of Discovery from OPPERA Studies. J Dent Res. 2016;
95:1084–1092. [PubMed: 27339423]
9. Maixner W, Fillingim RB, Williams DA, Smith SB, Slade GD. Overlapping chronic pain conditions:
implications for diagnosis and classification. J Pain. 2016; 17:T93–T107. [PubMed: 27586833]
10. Lora VR, de Canales GL, Goncalves LM, Meloto CB, Barbosa CM. Prevalence of
temporomandibular disorders in postmenopausal women and relationship with pain and HRT. Braz
Oral Res. 2016; 30:e100. [PubMed: 27556676]
11. Horst OV, Cunha-Cruz J, Zhou L, Manning W, Mancl L, DeRouen TA. Prevalence of pain in the
orofacial regions in patients visiting general dentists in the Northwest Practice-based REsearch
Collaborative in Evidence-based DENTistry research network. J Am Dent Assoc. 2015; 146:721–
728. e723. [PubMed: 26409981]
12. Slade GD, Bair E, By K, Mulkey F, Baraian C, Rothwell R, et al. Study methods, recruitment,
sociodemographic findings, and demographic representativeness in the OPPERA study. J Pain.
Author Manuscript

12:T12–26.
13. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review,
criteria, examinations and specifications, critique. J Craniomandib Disord. 1992; 6:301–355.
[PubMed: 1298767]
14. Agerberg G, Bergenholtz A. Craniomandibular disorders in adult populations of West Bothnia,
Sweden. Acta Odontol Scand. 1989; 47:129–140. [PubMed: 2756818]
15. Manfredini D, Piccotti F, Ferronato G, Guarda-Nardini L. Age peaks of different RDC/TMD
diagnoses in a patient population. J Dent. 2010; 38:392–399. [PubMed: 20100537]
16. Alexiou K, Stamatakis H, Tsiklakis K. Evaluation of the severity of temporomandibular joint
osteoarthritic changes related to age using cone beam computed tomography. Dentomaxillofac
Radiol. 2009; 38:141–147. [PubMed: 19225084]
17. Guarda-Nardini L, Piccotti F, Mogno G, Favero L, Manfredini D. Age-related differences in
temporomandibular disorder diagnoses. Cranio. 2012; 30:103–109. [PubMed: 22606853]
18. Ishibashi H, Takenoshita Y, Ishibashi K, Oka M. Age-related changes in the human mandibular
Author Manuscript

condyle: a morphologic, radiologic, and histologic study. J Oral Maxillofac Surg. 1995; 53:1016–
1023. [PubMed: 7643271]
19. Luder HU. Factors affecting degeneration in human temporomandibular joints as assessed
histologically. Eur J Oral Sci. 2002; 110:106–113. [PubMed: 12013552]
20. Back K, Ahlqwist M, Hakeberg M, Dahlstrom L. Occurrence of signs of osteoarthritis/arthrosis in
the temporomandibular joint on panoramic radiographs in Swedish women. Community Dent Oral
Epidemiol. 2017
21. Massilla Mani F, Sivasubramanian SS. A study of temporomandibular joint osteoarthritis using
computed tomographic imaging. Biomed J. 2016; 39:201–206. [PubMed: 27621122]

J Am Geriatr Soc. Author manuscript; available in PMC 2019 August 19.

 Yadav et al. Page 7

22. Schmitter M, Essig M, Seneadza V, Balke Z, Schroder J, Rammelsberg P. Prevalence of clinical

and radiographic signs of osteoarthrosis of the temporomandibular joint in an older persons
Author Manuscript

community. Dentomaxillofac Radiol. 2010; 39:231–234. [PubMed: 20395464]

23. de Leeuw R, Boering G, Stegenga B, de Bont LG. Clinical signs of TMJ osteoarthrosis and internal
derangement 30 years after nonsurgical treatment. J Orofac Pain. 1994; 8:18–24. [PubMed:
8032326]
24. de Leeuw R, Boering G, van der Kuijl B, Stegenga B. Hard and soft tissue imaging of the
temporomandibular joint 30 years after diagnosis of osteoarthrosis and internal derangement. J
Oral Maxillofac Surg. 1996; 54:1270–1280. [PubMed: 8941176]
25. Schiffman EL, Ahmad M, Hollender L, Kartha K, Ohrbach R, Truelove EL, et al. Longitudinal
Stability of Common TMJ Structural Disorders. J Dent Res. 2017; 96:270–276. [PubMed:
27856966]
26. Shi J, Lee S, Pan HC, Mohammad A, Lin A, Guo W, et al. Association of Condylar Bone Quality
with TMJ Osteoarthritis. J Dent Res. 2017
27. Bouvier M. Effects of age on the ability of the rat temporomandibular joint to respond to changing
functional demands. J Dent Res. 1988; 67:1206–1212. [PubMed: 3166002]
Author Manuscript

28. Milam SB. Pathogenesis of degenerative temporomandibular joint arthritides. Odontology. 2005;
93:7–15. [PubMed: 16170470]
29. Kim K, Wojczynska A, Lee JY. The incidence of osteoarthritic change on computed tomography of
Korean temporomandibular disorder patients diagnosed by RDC/TMD; a retrospective study. Acta
Odontol Scand. 2016; 74:337–342. [PubMed: 26881919]
30. Brett KM, Madans JH. Use of postmenopausal hormone replacement therapy: estimates from a
nationally representative cohort study. American journal of epidemiology. 1997; 145:536–545.
[PubMed: 9063344]
31. Martin MD, Wilson KJ, Ross BK, Souter K. Intubation risk factors for temporomandibular joint/
facial pain. Anesthesia progress. 2007; 54:109–114. [PubMed: 17900209]
32. Nekora-Azak A, Evlioglu G, Ceyhan A, Keskin H, Berkman S, Issever H. Estrogen replacement
therapy among postmenopausal women and its effects on signs and symptoms of
temporomandibular disorders. Cranio. 2008; 26:211–215. [PubMed: 18686498]
33. Hatch JP, Rugh JD, Sakai S, Saunders MJ. Is use of exogenous estrogen associated with
Author Manuscript

temporomandibular signs and symptoms? J Am Dent Assoc. 2001; 132:319–326. [PubMed:

11258088]
34. Stemig M, Myers SL, Kaimal S, Islam MS. Estrogen receptor-alpha polymorphism in patients with
and without degenerative disease of the temporomandibular joint. Cranio. 2015; 33:129–133.
[PubMed: 25178548]
35. Kang SC, Lee DG, Choi JH, Kim ST, Kim YK, Ahn HJ. Association between estrogen receptor
polymorphism and pain susceptibility in female temporomandibular joint osteoarthritis patients.
Int J Oral Maxillofac Surg. 2007; 36:391–394. [PubMed: 17391927]
36. Okuda T, Yasuoka T, Nakashima M, Oka N. The effect of ovariectomy on the temporomandibular
joints of growing rats. J Oral Maxillofac Surg. 1996; 54:1201–1210. [PubMed: 8859239]
37. Cheng P, Ma X, Li S. Histologic study of the temporomandibular joints after ovariectomy in rats.
Zhonghua Kou Qiang Yi Xue Za Zhi. 2000; 35:458–461. [PubMed: 11780535]
38. Hashem G, Zhang Q, Hayami T, Chen J, Wang W, Kapila S. Relaxin and beta-estradiol modulate
targeted matrix degradation in specific synovial joint fibrocartilages: progesterone prevents matrix
loss. Arthritis Res Ther. 2006; 8:R98. [PubMed: 16784544]
Author Manuscript

39. Naqvi T, Duong TT, Hashem G, Shiga M, Zhang Q, Kapila S. Relaxin’s induction of
metalloproteinases is associated with the loss of collagen and glycosaminoglycans in synovial joint
fibrocartilaginous explants. Arthritis Res Ther. 2005; 7:R1–11. [PubMed: 15642129]
40. Kapila S, Xie Y. Targeted induction of collagenase and stromelysin by relaxin in unprimed and
beta-estradiol-primed diarthrodial joint fibrocartilaginous cells but not in synoviocytes. Lab Invest.
1998; 78:925–938. [PubMed: 9714180]
41. Tabeian H, Bakker AD, de Vries TJ, Zandieh-Doulabi B, Lobbezoo F, Everts V. Juvenile porcine
temporomandibular joint: Three different cartilaginous structures? Arch Oral Biol. 2016; 72:211–
218. [PubMed: 27612163]

J Am Geriatr Soc. Author manuscript; available in PMC 2019 August 19.

 Yadav et al. Page 8

42. Wang XD, Kou XX, Meng Z, Bi RY, Liu Y, Zhang JN, et al. Estrogen aggravates iodoacetate-
induced temporomandibular joint osteoarthritis. J Dent Res. 2013; 92:918–924. [PubMed:
Author Manuscript

23934157]
43. Chen J, Kamiya Y, Polur I, Xu M, Choi T, Kalajzic Z, et al. Estrogen via estrogen receptor beta
partially inhibits mandibular condylar cartilage growth. Osteoarthritis Cartilage. 2014
44. Camacho JG, Oltramari-Navarro PV, de Navarro RL, Conti AC, Conti MR, Marchiori LL, et al.
Signs and symptoms of temporomandibular disorders in the elderly. Codas. 2014; 26:76–80.
[PubMed: 24714862]
45. Almagro Cespedes I, Castro Sanchez AM, Mataran Penarocha GA, Quesada Rubio JM, Guisado
Barrilao R, Moreno Lorenzo C. Temporomandibular joint dysfunction, disability and oral health in
a community-dwelling elderly population. Nutr Hosp. 2011; 26:1045–1051. [PubMed: 22072351]
46. Greene CS. Temporomandibular disorders in the geriatric population. J Prosthet Dent. 1994;
72:507–509. [PubMed: 7844753]
47. Dulcic N, Panduric J, Kraljevic S, Badel T, Celic R. Frequency of internal derangement of the
temporomandibular joint in elderly individuals. Eur J Med Res. 2003; 8:465–471. [PubMed:
14594653]
Author Manuscript

48. Ogura I, Kaneda T, Mori S, Sakayanagi M, Kato M. Magnetic resonance characteristics of

temporomandibular joint disc displacement in elderly patients. Dentomaxillofac Radiol. 2012;
41:122–125. [PubMed: 22116131]
49. Lovgren A, Haggman-Henrikson B, Visscher CM, Lobbezoo F, Marklund S, Wanman A.
Temporomandibular pain and jaw dysfunction at different ages covering the lifespan--A population
based study. European journal of pain (London, England). 2016; 20:532–540.
50. Chantaracherd P, John MT, Hodges JS, Schiffman EL. Temporomandibular joint disorders’ impact
on pain, function, and disability. J Dent Res. 2015; 94:79S–86S. [PubMed: 25572112]
51. Progiante PS, Pattussi MP, Lawrence HP, Goya S, Grossi PK, Grossi ML. Prevalence of
Temporomandibular Disorders in an Adult Brazilian Community Population Using the Research
Diagnostic Criteria (Axes I and II) for Temporomandibular Disorders (The Maringa Study). Int J
Prosthodont. 2015; 28:600–609. [PubMed: 26523719]
52. Abrahamsson AK, Kristensen M, Arvidsson LZ, Kvien TK, Larheim TA, Haugen IK. Frequency of
temporomandibular osteoarthritis and related symptoms in a hand osteoarthritis cohort.
Osteoarthritis Cartilage. 2017
Author Manuscript

53. Bair E, Gaynor S, Slade GD, Ohrbach R, Fillingim RB, Greenspan JD, et al. Identification of
clusters of individuals relevant to temporomandibular disorders and other chronic pain conditions:
the OPPERA study. Pain. 2016; 157:1266–1278. [PubMed: 26928952]
54. Fillingim RB, Ohrbach R, Greenspan JD, Knott C, Diatchenko L, Dubner R, et al. Psychological
factors associated with development of TMD: the OPPERA prospective cohort study. J Pain. 2013;
14:T75–90. [PubMed: 24275225]
55. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and
age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication.
Arch Gen Psychiatry. 2005; 62:593–602. [PubMed: 15939837]
56. Komiyama O, Obara R, Iida T, Nishimura H, Okubo M, Uchida T, et al. Age-related associations
between psychological characteristics and pain intensity among Japanese patients with
temporomandibular disorder. J Oral Sci. 2014; 56:221–225. [PubMed: 25231149]
57. de Leeuw R, Boering G, Stegenga B, de Bont LG. Symptoms of temporomandibular joint
osteoarthrosis and internal derangement 30 years after non-surgical treatment. Cranio. 1995;
Author Manuscript

13:81–88. [PubMed: 8697504]

58. Durham J, Al-Baghdadi M, Baad-Hansen L, Breckons M, Goulet JP, Lobbezoo F, et al. Self-
management programmes in temporomandibular disorders: results from an international Delphi
process. J Oral Rehabil. 2016; 43:929–936. [PubMed: 27727477]
59. Haggman-Henrikson B, Alstergren P, Davidson T, Hogestatt E, Ostlund P, Tranaeus S, et al.
Pharmacological treatment of orofacial pain - Health Technology Assessment including a
systematic review with network meta-analysis. J Oral Rehabil. 2017

J Am Geriatr Soc. Author manuscript; available in PMC 2019 August 19.

 Yadav et al. Page 9

60. Ahmed N, Sidebottom A, O’Connor M, Kerr HL. Prospective outcome assessment of the
therapeutic benefits of arthroscopy and arthrocentesis of the temporomandibular joint. Br J Oral
Author Manuscript

Maxillofac Surg. 2012; 50:745–748. [PubMed: 22381517]

61. Rajapakse S, Ahmed N, Sidebottom AJ. Current thinking about the management of dysfunction of
the temporomandibular joint: a review. Br J Oral Maxillofac Surg. 2017; 55:351–356. [PubMed:
28341275]
62. Sidebottom AJ. surgeons UTr, British Association of O, Maxillofacial S. Guidelines for the
replacement of temporomandibular joints in the United Kingdom. Br J Oral Maxillofac Surg.
2008; 46:146–147. [PubMed: 17223231]
63. Johnson NR, Roberts MJ, Doi SA, Batstone MD. Total temporomandibular joint replacement
prostheses: a systematic review and bias-adjusted meta-analysis. Int J Oral Maxillofac Surg. 2017;
46:86–92. [PubMed: 27644588]
64. Onoriobe U, Miloro M, Sukotjo C, Mercuri LG, Lotesto A, Eke R. How Many Temporomandibular
Joint Total Joint Alloplastic Implants Will Be Placed in the United States in 2030? J Oral
Maxillofac Surg. 2016; 74:1531–1538. [PubMed: 27186874]
Author Manuscript
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Figure 1.
Flow Diagram of the Study Selection
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