Correlation Between the State of the Temporomandibular Joint and Gynecological Status in Women of Reproductive Age

doi:10.21203/rs.3.rs-3749009/v1

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Correlation Between the State of the Temporomandibular Joint and Gynecological Status in Women of Reproductive Age

https://doi.org/10.21203/rs.3.rs-3749009/v1

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Introduction

The processes of synthesis and degradation of connective tissue are closely related to hormonal fluctuations occurring in the female body at various stages of development. Based on this, it can be assumed that the state of the cartilage and bone tissue of the components of the temporomandibular joint (TMJ) depends on the physiological state of the female body. The objective of this study is to establish correlations between the anamnestic data of gynecological health and the presence of pathologies of the temporomandibular joint in women of reproductive age.

Methods

For the study, 49 female patients of reproductive age with temporomandibular joint dysfunction (TMJD) were selected.

Among the gynecological health history data, we selected the following parameters: hysterectomy, breast cancer, oophorectomy, number of deliveries, number of abortions, number of miscarriages, presence of thyroid gland cyst, presence of ovarian cyst, use of hormonal contraceptives, elevated prolactin level in the blood, hypothyroidism, autoimmune thyroiditis in the anamnesis, mastopathy, rheumatoid arthritis, and uterine fibromatosis.

TMJ pathologies were differentiated by magnetic resonance imaging (MRI). The presence of correlation coefficients was checked using the Real Statistics 2019 extension for Microsoft Office Excel by calculating Kendall's tau (τ). Correlation ratios were considered statistically significant at p<0.05.

Results

Statistically significant correlations between pathologies of the temporomandibular joint and anamnestic data of gynecological status are observed only in relation to childbirth, abortions, ovarian cysts, uterine fibroids and pathologies of the thyroid gland, including hypothyroidism, and autoimmune thyroiditis.

Conclusions

The presence of the aforementioned pathologies in the anamnesis of a woman of reproductive age can serve as a basis for a detailed study of these processes and their impact on the condition of the temporomandibular joint.

temporomandibular joint

gynecological history

correlation

The regulation of bone metabolism in women throughout life is probably more complex than that in men, with obvious differences related to reproduction; therefore, hormonal influences may play a prominent role in the regulation of bone metabolism in women [1].

Puberty in women is accompanied by a series of events related to the menstrual cycle and hormones affecting the musculoskeletal system. Hormonal changes in the body of women can lead to laxity of the knee joint in most women [2, 3], increase the risk of developing an imbalance between the hamstring and quadriceps muscles [4, 5], and lead to changes in bone tissue, which depends on the menstrual cycle [6, 7].

The processes of synthesis and degradation of connective tissue are closely related to hormonal fluctuations occurring in the female body at various stages of development. Based on this, it can be assumed that the state of the cartilage and bone tissue of the temporomandibular joint (TMJ) depends on hormonal changes. Given the limited amount of information in the literature sources in this direction, it can be assumed that a low level of estrogen after menopause, for example, can potentiate the degeneration of the elements of the temporomandibular joint and the loss of density and mass of the alveolar bone [4].

Cartilage tissue of the TMJ undergoes age-related changes. At the age of 15–30, there is a decrease in the growth of the TMJ, progressive chondrogenesis of the surface and polymorphic zone, and the disappearance of the hypertrophic zone [8, 9]. As people age, growth stops, followed by a progressive decrease in the cellularity of the fibrocartilaginous condyle of the lower jaw and a gradual increase in degeneration, which reaches a plateau at the age of 50–60.

Age, hormonal factors, and excessive mechanical stress on TMJ components are the leading risk factors for the possible occurrence of TMJ osteoarthritis [10].

The purpose of this work is to establish correlations between the anamnestic data of gynecological health and the presence of TMJ pathologies in women of reproductive age.

Compliance with ethical standards and ethical approval.

This study complies with the Rules of Humane Treatment of Patients in accordance with the requirements of the World Medical Association Declaration of Tokyo. International recommendations of the Helsinki Declaration on Human Rights, the Convention on Human Rights and Biomedicine of the Council of Europe. The laws of Ukraine, the orders of the Ministry of Health of Ukraine and the requirements of the Code of Ethics of a doctor of Ukraine. The permission of the Committee on Ethical Issues and Biomedical Ethics of the ZVO "Poltava State Medical University" № 221 dated 22 November 2023 was obtained for conducting this study.

Participants

At the Department of Propaedeutics of Oral Surgery of the Poltava State Medical University, 169 female patients from reproductive to postmenopausal age were examined from September 2020 to August 2023. All patients were diagnosed with temporomandibular joint dysfunction (TMJ). For this study, a group of reproductive age (49 women, 15–51 years) was formed. All patients gave informed consent to participate in the study.

Patients were given a special questionnaire in written form. The questions were aimed at detailed clarification of gynecological and hormonal anamnesis.

Clarification of parameters of gynecological and hormonal pathology.

Among the data from the completed questionnaires, we identified the following parameters: hysterectomy, breast cancer, ovariectomy, number of births, number of abortions, number of miscarriages, thyroid gland cyst, ovarian cyst, use of hormonal contraceptives, elevated prolactin level in the blood, history of hypothyroidism, history of autoimmune thyroiditis, mastopathy, rheumatoid arthritis, and uterine fibromatosis.

Final diagnosis and confirmation of TMJ dysfunction.

All patients underwent magnetic resonance imaging (MRI) using the Siemens Magnetom Avanto device with a magnetic field strength of 1.5 T produced by Siemens AG, Germany.

To understand the cause-and-effect relationship of TMJ pathologies using MRI, all pathological signs were divided into two categories:

Only dysfunctional changes in the TMJ. Dislocations of the meniscus and its position relative to the articular head.

Dysfunctional changes in the TMJ combined with organic disorders. Dislocations of the meniscus and its position relative to the articular head. Damage to the bone elements of the joint: hypoplasia/flattening of the articular head and bone growth. Damage to the cartilage elements of the joint: degenerative changes of the meniscus.

Using the differentiation of pathological signs of the MRI of the TMJ, we identified four degrees of severity of TMJ pathology.

1 – dysfunctional: TMJ (anterior correctable/non correctable dislocation of articular discs) without organic TMJ damage.

2 – mild: TMJ with organic disorders in one of the joints. Bone and/or cartilaginous components of the joint are affected.

3 − medium: TMJ with organic disorders in both joints. Bone or cartilaginous components of the joints are affected: flattening of the joint heads, hypoplasia, or degenerative changes of the menisci.

4 – severe degree: TMJ with organic disorders of both joints. Bone and cartilaginous elements of the joints are affected, with the possible appearance of bone growth.

Among the TMJ pathologies, the following conditions were selected for statistical processing of the results: anterior maneuverable dislocation of both articular discs, the position of the right articular disc during dislocations, the position of the left articular disc during dislocations, reducible dislocation of one articular disc, anterior irreducible dislocation of one of the discs, irreducible dislocation of both discs, flattening of both articular heads, flattening of one of the articular heads, deforming arthrosis, bony growths of one joint, degenerative changes in the posterior articular ligaments, asymmetry of the articular heads, hypoplasia of the articular heads, degenerative disc changes, and degree of TMJ disorder severity.

Statistical methods.

The presence of correlation coefficients was checked using the Real Statistics 2019 extension for Microsoft Office Excel by calculating Kendall's tau (τ). Correlation ratios were considered statistically significant at p < 0.05.

Results. The presence of childbirth in the anamnesis has a directly proportional correlation with the presence of a reducible dislocation of one articular disc, an anterior irreducible dislocation of one of the discs, flattening of one of the joint heads with deforming arthrosis and with the degree of TMJ damage severity (Table 1). Additionally, the presence of childbirth in the anamnesis shows an inversely proportional correlation with the presence of anterior reducible dislocation of both articular discs.

Table 1

Statistically significant correlations between anamnestic data of gynecological health and the presence of TMJ pathologies in women of reproductive age.
Gynecological anamnesis data	TMJ pathology	τ	р
Childbirth in the anamnesis	anterior reducible dislocation of both articular discs	-0,421	0,0023
	reducible dislocation of one articular disc	0,345	0,0126
	irreducible anterior dislocation of one of the discs	0,345	0,0126
	flattening of one of the articular heads	0,276	0,0456
	deforming arthrosis	0,486	0,0004
	degree of severity of TMJ damage	0,298	0,021
History of abortions	anterior reducible dislocation of both articular discs	-0,329	0,0209
	irreducible dislocation of both discs	0,398	0,0052
	flattening of one of the articular heads	0,332	0,0196
	deforming arthrosis	0,414	0,0037
	asymmetry of the articular heads	-0,306	0,0319
Cysts of the thyroid gland	flattening of both articular heads	0,328	0,0236
Ovarian cysts	flattening of both articular heads	0,293	0,0423
History of hypothyroidism	flattening of both articular heads	0,328	0,0236
Autoimmune thyroiditis in the anamnesis	reducible dislocation of one articular disc	0,290	0,0446
	anterior irreducible dislocation of one of the discs	0,290	0,0446
	bone growths of one joint	0,290	0,0446
Fibromatosis of the uterus	flattening of one of the articular heads	0,326	0,0238
	deforming arthrosis	0,383	0,079
	degenerative disc changes	0,505	0,0005
	degree of severity of TMJ damage	0,306	0,0229

Abortions in the anamnesis have a directly proportional correlation with the presence of irreducible dislocation of both discs, flattening of one of the articular heads and deforming arthrosis (Table 1). Additionally, abortions in the anamnesis show an inversely proportional correlation with the presence of anterior movable dislocation of both articular discs and asymmetry of the articular heads.

Cysts of the ovaries or thyroid gland or hypothyroidism in the anamnesis of a woman of reproductive age show a directly proportional correlation with the presence of flattening of both articular heads (Table 1).

In the case of autoimmune thyroiditis, directly proportional correlations are noted with the presence of a reducible dislocation of one articular disc, an anterior irreducible dislocation of one of the discs, and the presence of bony growths of one joint (Table 1).

Uterine fibromatosis in the anamnesis has a directly proportional correlation with the flattening of one of the joint heads, the presence of deforming arthrosis, degenerative disc changes, and the degree of TMJ damage severity (Table 1).

Based on information from literary sources, it was found that women suffering from TMJ disorders consult a doctor more often, which was fully confirmed in our studies [11, 12]. Despite the psychogenic theory of TMDs, some studies indicate that young women are more resistant to stress factors [13]. This gives reason to believe that the differences in the course of this disease lie in sharp fluctuations in estrogen at certain stages of a woman's life.

Previous studies have indicated a connection between TMJ pathologies and hormonal disorders [14]. According to our observations, 140 patients had a confirmed diagnosis of TMD (according to the ICD10 classification), 76 had a certain pathology of the reproductive system, and 64 did not note any pathologies. Such a high incidence may indicate the connection of joint disorders with gynecological disorders [15].

During the physiological course of pregnancy, changes occur in a woman's body that go far beyond the limits of the female genital organs [15]. Childbirth is a natural result of pregnancy. Even under physiological conditions, childbirth affects the condition of the muscles and fascia of the abdomen and pelvic floor, leading to their thinning, especially under conditions of impaired fibroblast functions [16, 17]. Scientific literature provides data on structural changes in the extracellular matrix of the myometrium during pregnancy and childbirth in mammals and humans, which include remodeling of collagen and elastin [18, 19]. Given the important role of elastin in TMJ functioning, a possible reason for the correlation between childbirth and reducible/irreducible TMJ dislocations is elastin restructuring [20]. Currently, in the scientific literature, there are almost no data on changes in the structure of elastin in the TMJ during pregnancy and in the postpartum period. In experiments on animals, it was shown that the expression of matrix metalloproteinases (MMPs) changes during pregnancy and childbirth, among which MMP-12 is of particular importance for elastin metabolism [21]. Increased expression of MMP-12 is associated with the development of TMJ pathologies [22]. Therefore, a promising direction for further study of the pathogenesis behind the existence of a correlation between childbirth and reducible/irreducible TMJ dislocations is the study of changes in the activity of MMP-12 during pregnancy and in the postpartum period. Changes in MMP activities may also be responsible for the direct correlation between women's history of childbirth and the development of flattening and deforming arthrosis.

The establishment of possible pathogenetic relationships that could determine the presence of statistically significant correlations between abortions in anamnesis and TMJ pathologies is complicated by the limitations of our study. When analyzing the anamnestic data, we established only the presence/absence of abortions and their number, however, there are no important data on the methods of abortion, the periods of pregnancy at which this intervention was performed, and the presence of a previous pregnancy that ended in childbirth.

Thyroid gland cysts and hypothyroidism in a patient have a common link, since in both described conditions, the production of thyroid hormones decreases. Thyroid hormones can regulate the growth and differentiation of chondrocytes and osteocytes [23]. Deficiency of thyroid hormones under conditions of hypothyroidism and replacement of endocrinocytes by a thyroid gland cyst can explain the presence of direct correlations between the presence of these conditions in the anamnesis and the flattening of one of the joint heads. A similar imbalance of hormonal regulation of growth and differentiation of cellular components of bone and cartilage tissue may explain the presence of direct correlations between a history of an ovarian cyst and flattening of one of the articular heads [24].

The presence of direct correlations between autoimmune thyroiditis and the presence of repairable and nonrepairable dislocations of one of the joints may be associated with the activation of MMP expression [25].

Uterine fibromatosis is, on the one hand, the result of a hormonal imbalance involving muscle and connective tissue [26]. On the other hand, under the conditions of fibromatosis, the extracellular matrix and the conformation of its proteins are disturbed [26], which can explain the presence of direct correlations between uterine fibromatosis and flattening of one of the joint heads, the presence of deforming arthrosis and degenerative disc changes.

In conclusion, it should be noted that statistically significant correlations between organic TMJ pathologies and anamnestic data of gynecological status are observed only in relation to childbirth, abortions, ovarian cysts, uterine fibroids and thyroid gland pathologies - hypothyroidism, autoimmune thyroiditis. Only functional changes are weakly correlated with existing pathologies. This gives reason to believe that the health of the female body is directly dependent on the condition of the connective tissue.

We see prospects for further research in the study of pathogenetic cause-and-effect relationships between the studied anamnestic data of gynecological health and TMJ pathologies. Additionally, the determination of correlations between the anamnestic data of gynecological health and TMJ pathologies not covered in our study may be a promising direction of further research.

Trial registration. This study was conducted within the framework of the self-financed research project of Poltava State Medical University "Complex treatment of functional disorders and improvement of surgical intervention technologies for maxillofacial diseases" (state registration number 0120U105551).

Ethics approval and consent to participate. The study protocol was approved by the Committee on Ethical Issues and Biotic Ethics of the Poltava State Medical University, Ukraine № 221 dated 22 November 2023.

All patients provided written informed consent to participate in this study.

Data availability.

The datasets generated and/or analyzed during the current study are available from the corresponding author pon reasonable request.

Consent for publication. Not applicable.

Acknowledgments. None are declared.

Funding sources. None are declared.

Conflict of interest. None exists.

Availability of data and materials

The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.

Contributions

Vadym Novikov - research concept and design.

Mariia Korostashova - writing the article.

Lidiia Korovina - data analysis and interpretation.

Andrii Hohol - critical revision of the article.

Artur Pankevych - final approval of article.

Inna Kolisnyk - collection and assembly of data.

Corresponding author: Mariia Korostashova. E-mail: [email protected]

ORCID

Vadym Novikov 0000-0002-7131-8791

Mariia Korostashova 0000-0002-0520-557X

Lidiia Korovina 0000-0003-4989-997X

Andrii Hohol 0000-0001-7979-6870

Artur Pankevych 0000-0002-0805-333X

Inna Kolisnyk 0000-0003-3620-8527

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No competing interests reported.

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Correlation Between the State of the Temporomandibular Joint and Gynecological Status in Women of Reproductive Age

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Abstract

Introduction

Material and methods

Discussion

Conclusions

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References

Additional Declarations

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