Assessing temporomandibular disorders: mouthpiece design considerations

Dino Buković; Igor Glavičić; Goran Dimitrić; Miroslav Smajić; Božana Radanović; Biljana Vitošević

doi:10.2298/VSP160405362B

Dino Buković University in Zagreb, Faculty of Dental Medicine, Department of Prosthodontics, Zagreb, Croatia
Igor Glavičić Diving Centre „Big blue diving“, Bol, Croatia
Goran Dimitrić University of Novi Sad, Faculty of Sport and Physical Education, Novi Sad, Serbia
Miroslav Smajić University of Novi Sad, Faculty of Sport and Physical Education, Novi Sad, Serbia
Božana Radanović University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Biljana Vitošević University of Priština/Kosovska Mitrovica, Faculty of Sport and Physical Education, Medical Department, Kosovska Mitrovica, Serbia

DOI: https://doi.org/10.2298/VSP160405362B

Keywords: diving;, equipment and supplies;, temporomandibular joint disorders.

Abstract

Background/Aim. Scuba diving is one of the sports with the fastest growing popularity. Nowadays doctors of dental medicine meet divers-patients in their offices more often. Treatment of these patients has some specific features that are related to difficulties in the temporomandibular joint, masticatory muscles and soft tissues of the oral cavity. A set of those complaints represent a condition called „diver's mouth syndrome“. Most scuba divers complain of temporomandibular joint and the masticatory muscles pain; inadequate mouthpieces can exacerbate temporomandibular dysfunction (TMD) even when its symptoms are not present in everyday life. The aim of this research was to find a decent substitute for a fully customised mouthpiece, that are not present at our market, to discover the qualities of a good mouthpiece and establish prevalence of TMD among divers. Methods. This study included 30 scuba divers. Scuba divers filled out the questionnaire before diving, then dived twice with each of the 3 different commercial mouthpieces provided for this research (Mares Universal, Seac sub, Mares LiquidSkin (Universal Mares, Seac sub, Mares LiquidSkin). After diving, they filled out the second part of the questionnaire and so they performed an assessment of the mouthpiece and gave insight into the prevalence of TMD symptoms caused by using the mouthpiece. Results. According to the average score of satisfaction (the least present symptoms such as pain, fatigue, and numbness of the masticatory muscles and the jaw joint), this research proved Mares LiquidSkin mouthpieces to be the best out of the 3 commercial mouthpieces. For its use, average satisfaction score among participants was 7.07 (out of 10) and none of the divers reported jaw and muscle stiffness during and after the dive with this mouthpiece. The smallest percentage of participants reported pain in the orofacial region and discomfort while swallowing when used it in comparison with other mouthpieces. The anatomy and material of the mouthpieces turned out to be an extremely important factor. Conclusion. Several factors contribute to a good mouthpiece design; the choice of material, its elasticity and softness, the thickness and length of the interdental bite platform and the width of the oral screen that is inserted into the vestibule. The preferred material should be soft silicone. The interdental bite platforms should support the posterior teeth and the oral screen should fit the jaws and not be too wide.

References

Hobson RS, Newton JP. Dental evaluation of scuba diving mouthpieces using a subject assessment index and radiological analysis of jaw position. Br J Sports Med 2001; 35(2): 84‒8.

Hobson RS. Temporomandibular dysfunction syndrome asso-ciated with scuba diving mouthpieces. Br J Sports Med 1991; 25(1): 49‒51.

Jagger RG, Jackson SJ, Jagger DC. In at the deep end - an insight into scuba diving and related dental problems for the GDP. Br Dent J 1997; 183(10): 380‒2.

de Leeuw R. Temporomandibular disorders. In: de Leeuw R, edi-tor. Orofacial pain guidelines for assesment, diagnosis and management. 4th ed. Hanover Park, IL: Quintessence Publishing Co, Inc; 2008. p. 158–76.

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: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†. J Oral Facial Pain Headache. J Oral Facial Pain Headache 2014; 28(1): 6‒27.

Manfredini D. Fundamentals of TMD management. In: Manfre-dini D, editor. Current concepts on temporomandibular dis-orders. Berlin: Quintessence Publishing; 2010. p. 305–18.

Öztürk Ö, Tek M, Seven H. Temporomandibular disorders in scuba divers-an increased risk during diving certification train-ing. J Craniofac Surg 2012; 23(6): 1825‒9.

Aldridge RD, Fenlon MR. Prevalence of temporomandibular dysfunction in a group of scuba divers. Br J Sports Med 2004; 38(1): 69‒72.

Hobson RS. Airway efficiency during the use of SCUBA diving mouthpieces. Br J Sports Med 1996; 30(2): 145‒7.

Scully C, Cawson RA. Travel, sports, leisure activities and health. In: Scully C, Cawson RA, editors. Medical problems in dentistry. 5th ed. Edinburgh: Elsevier Churchill Livingstone; 2005. p. 546–55.

Grant SM, Jonhson F. Diver's mouth syndrome: a report of two cases and construction of custom-made regulator mouthpiec-es. Dent Update 1998; 25(6): 254‒6.

Koob A, Ohlmann B, Gabbert O, Klingmann, Rammelsberg P, Schmitter M. Temporomandibular disorders in association with scuba diving. Clin J Sports Med 2005; 15(5): 359‒63.

Balestra C, Germonpré P, Marroni A, Snoeck T. Scuba diving can induce stress of the temporomandibular joint leading to head-ache. Br J Sports Med 2004; 38(1): 102‒4.

Lobezzo F, Van Wijk AJ, Klingler MC, Ruiz Vicente E, Van Dijk CJ, Eijkman MA. Predictors for the development of temporomandibular disorders in scuba divers. J Oral Rehabil 2014; 41(8): 573‒80.

Scholtanus JD. Gingiva damaged by ill-fitting scuba-diving mouthpiece. Ned Tijdschr Tandheelkd 2003; 110(10): 403‒5. (Dutch)

Zadik Y, Drucker S. Diving dentistry: a review of the dental implications of scuba diving. Aust Dent J 2011; 56(3): 265‒71.