Risk factors for subchondral bone alterations in TMJ arthralgia: a retrospective multivariate CBCT study

Abstract

Abstract Background Temporomandibular joint (TMJ) osteoarthritis (OA) is a progressive degenerative joint disorder characterized by loss of cartilage and alterations in subchondral bone architecture. Prospective studies using multivariable analysis to identify risk factors for subchondral bone alterations (SBAs) are lacking. The aim of this study was to identify clinical baseline predictors mostly associated with the severity of TMJ condylar SBAs. Methods This retrospective paired-design study enrolled 233 consecutive TMJ pain patients. TMJ pain patients were classified according to the diagnostic criteria for temporomandibular disorders (DC/TMD) Axis I protocol. Following clinical examination, each patient underwent cone beam computed tomography (CBCT) evaluation of both TMJs. A composite condylar SBA grading score was created from the following items: erosion, resorption, cyst, sclerosis, osteophyte, and flattening; the maximum possible score was 4. Multivariate ordinal regression analysis identified baseline predictors of CBCT condylar SBA grades. Results The study group included 87.6% women, and the overall average age of the study population was 41.9 ± 18.1 years. The following factors were significantly associated with the severity of condylar SBAs: older age (> 45 years) (odds ratio [OR], 4.53; p < 0.001), having concomitant arthralgia (OR, 1.85; p = 0.035), and higher number of missing posterior teeth (> 4) (OR, 1.80; p = 0.039). Gender (p = 0.080) and time since pain onset (p < 0.05) had no significant association with condylar SBA grade. Conclusions Older patients with missing posterior teeth who have a concurrent arthralgia should be advised of their increased risk of developing SBAs. Delayed diagnosis and treatment can be avoided by focusing on these risk factors.