Journal of Oral Rehabililation, 1992, Volume 19, pages 435-440
Sex differences in signs and symptoms from masticatory and other muscles in 19-year-old individuals B, S, KROGSTAD, B, L, DAHL, T, EGKERSBERG and B . 0 G A A R D * Dei>arliiieiil of I'roslhelic Deiuislry atul Stojiatogiuithic Fliysiologv and *Departincnl of Orthodontics, Dental Facultv, Vniversitv of Oslo, Norway
Summary Pain and tenderness of masticatory iiuiscles are often related lo muscle tenderness elsewhere in the body. It has been shown tliat women are more prone to musculoskelelal disorders than men. We sought to determine whether sex diffetences of muscular symptoms were established by the age of 19. The subjects comprised 51 boys and girls who received a questionnaire regarding the function of their masticatory system, ltequency of headache, and neck, shoulder and low back pain. Their masticatory system was examined, and neck and shonlders were palpated. For all variables in the questionnaire girls reported symptoms more often than tlie boys. Of the subjects 50% had tender chewing muscles upon palpation. Again the girls had the most. There was good correlation between reports of pain in one area as compared to others. The number of clinically tender neck and shoulder muscles correlated with the number of tender masticatory muscles. It was concluded that girls presented more muscular symptoms than boys. Introduction Investigations have demonstrated that pain and tenderness of the chewing muscles, as two of many signs and symptotns of cratiiomandibular disorders, are closely related to tender muscles in other parts of the body, as well as impaired respiratory function and a protruded head postute (Krogstad, 1980; Hel0e, Heibeig & Ktogstad, 1980; Eggen, 1954; Janda, 1986), Therefore, craniomandibular disorders should probably not be looked upon as a disotder with local signs and symptoms only, but rather as a local expression of more generalized musculo-skeletal disorders. It has been shown that women are more prone to such disorders than men (0gar, 1977). The reason has been claimed to be multi-factorial, one of them being the fact that many women have a job or profession to attend to in addition to being a mother and a housewife (Tra;en, Hoist & Krogstad, 1988). Nearly all elinical materials have demonstrated that the majority of patients seeking tieattnent for craniomandibular disorders have been women between 30 and 40 years of age (Garlsson, Kopp & Wedel, 1982; Dahl et al... 1988a), The aims of this study were to investigate whether sex differences regarding muscle tenderness were established already at the age of 19, and to which degree muscle pain in one part of the body correlates with pain in other parts? Coriespoiulence: Ms Berit Schie Krogstad, Departmeiil ol I'losllietic Deiuislry ami SloiiialogiuUhic Physiology, P,O,box 1109, Bliiuicni, 0317 Oslo 3, Norway,
435
436
B.S. Krogstad et al.
Material and methods At Raufoss, a small industrial village some 130 km north of Oslo, all 19-year-olds received an invitation to participate in this study as part of their annual dental cheekup. Of the total number invited, 98 individuals (80%) aecepted the invitation and were examined, that is 51 boys and 47 girls. The examination comprised a questionnaire about the funetional state of the masticatory system — that is sounds (elieking) from the temporomandibular joints, and a feeling of stiffness or fatigue in the chewing muscles upon awakening in the morning. The questionnaire also eontained questions about frequency of headache, and pain in the neck and shoulders as well as in the low back region. In addition, all were subjected to common, elinical methods of functional examination of the masticatory system (Carlsson & Helkimo, 1972), These comprised the recording of palpably tender muscles of mastication, neck and shoulders as well as clicking from the temporomandibular joints. The palpations were performed by a physieal therapist specially trained in working with people displaying signs and symptoms of craniomandibular disorders. The muscles were palpated, applying firm pressure to the bulk of the muscle tissue with the examinee lying baek in the dental chair and with the operator positioned behind the subject. In this way palpation was most conveniently carried out exerting equal pressure on both sides, and any expressions indieating pain or discomfort made by the patient could easily be observed. Pain or tenderness was not graded. Either the muscle was painful/tender or it was not. The total number of sites palpated was 12 on either side (Table 1), The number of tender palpation sites was used as a variable. As all variables were on an ordinal scale, a correlation matrix between all variables was computed. Sex differences concerning the number of tender muscles were tested with student's /-test. Differences between other variables were tested using the chi-square test. For ease of presentation all frequency tables are piesented in a collapsed, dichotomized version. Result Answers to the questionnaire are presented in Table 2, For all variables girls reported symptoms more often than the boys, but only the values for low baek pain were statistically different at the 5% level. The clinical findings and the distribution of tender jaw, neck and shoulder muscles in respect to sex is presented in Table 3. The only thing to be pointed out is the fact that 50% of all subjects had no tender chewing muscles upon palpation. Analyses revealed correlation between reports on pain in one part of the body and in other parts as demonstrated in Table 4, For instance, the Table 1. Number and position ol palpation sites in niuseles examined Musele Temporal Masseter Lateral plerygoid Digaslrie Stemoeleido-mastoid Suboccipital Trapezius Neek
Number of palpation sites
•
3 2 1 2 1' 1 , 1 1
Sex differences from masticatory and other miLscles
437
Table 2. Pereentage of boys and girls with regard to some symptoms reported in c|iiestioiinaire
Headaehe TMJ - elieking Tiredness in jaw Pain in neek and shoulder Low baek pain
Boys
Girls
18 21 8
23 35 11
19
34
29
49
/'
Sex differences in signs and symptoms from masticatory and other muscles in 19-year-old individuals B, S, KROGSTAD, B, L, DAHL, T, EGKERSBERG and B . 0 G A A R D * Dei>arliiieiil of I'roslhelic Deiuislry atul Stojiatogiuithic Fliysiologv and *Departincnl of Orthodontics, Dental Facultv, Vniversitv of Oslo, Norway
Summary Pain and tenderness of masticatory iiuiscles are often related lo muscle tenderness elsewhere in the body. It has been shown tliat women are more prone to musculoskelelal disorders than men. We sought to determine whether sex diffetences of muscular symptoms were established by the age of 19. The subjects comprised 51 boys and girls who received a questionnaire regarding the function of their masticatory system, ltequency of headache, and neck, shoulder and low back pain. Their masticatory system was examined, and neck and shonlders were palpated. For all variables in the questionnaire girls reported symptoms more often than tlie boys. Of the subjects 50% had tender chewing muscles upon palpation. Again the girls had the most. There was good correlation between reports of pain in one area as compared to others. The number of clinically tender neck and shoulder muscles correlated with the number of tender masticatory muscles. It was concluded that girls presented more muscular symptoms than boys. Introduction Investigations have demonstrated that pain and tenderness of the chewing muscles, as two of many signs and symptotns of cratiiomandibular disorders, are closely related to tender muscles in other parts of the body, as well as impaired respiratory function and a protruded head postute (Krogstad, 1980; Hel0e, Heibeig & Ktogstad, 1980; Eggen, 1954; Janda, 1986), Therefore, craniomandibular disorders should probably not be looked upon as a disotder with local signs and symptoms only, but rather as a local expression of more generalized musculo-skeletal disorders. It has been shown that women are more prone to such disorders than men (0gar, 1977). The reason has been claimed to be multi-factorial, one of them being the fact that many women have a job or profession to attend to in addition to being a mother and a housewife (Tra;en, Hoist & Krogstad, 1988). Nearly all elinical materials have demonstrated that the majority of patients seeking tieattnent for craniomandibular disorders have been women between 30 and 40 years of age (Garlsson, Kopp & Wedel, 1982; Dahl et al... 1988a), The aims of this study were to investigate whether sex differences regarding muscle tenderness were established already at the age of 19, and to which degree muscle pain in one part of the body correlates with pain in other parts? Coriespoiulence: Ms Berit Schie Krogstad, Departmeiil ol I'losllietic Deiuislry ami SloiiialogiuUhic Physiology, P,O,box 1109, Bliiuicni, 0317 Oslo 3, Norway,
435
436
B.S. Krogstad et al.
Material and methods At Raufoss, a small industrial village some 130 km north of Oslo, all 19-year-olds received an invitation to participate in this study as part of their annual dental cheekup. Of the total number invited, 98 individuals (80%) aecepted the invitation and were examined, that is 51 boys and 47 girls. The examination comprised a questionnaire about the funetional state of the masticatory system — that is sounds (elieking) from the temporomandibular joints, and a feeling of stiffness or fatigue in the chewing muscles upon awakening in the morning. The questionnaire also eontained questions about frequency of headache, and pain in the neck and shoulders as well as in the low back region. In addition, all were subjected to common, elinical methods of functional examination of the masticatory system (Carlsson & Helkimo, 1972), These comprised the recording of palpably tender muscles of mastication, neck and shoulders as well as clicking from the temporomandibular joints. The palpations were performed by a physieal therapist specially trained in working with people displaying signs and symptoms of craniomandibular disorders. The muscles were palpated, applying firm pressure to the bulk of the muscle tissue with the examinee lying baek in the dental chair and with the operator positioned behind the subject. In this way palpation was most conveniently carried out exerting equal pressure on both sides, and any expressions indieating pain or discomfort made by the patient could easily be observed. Pain or tenderness was not graded. Either the muscle was painful/tender or it was not. The total number of sites palpated was 12 on either side (Table 1), The number of tender palpation sites was used as a variable. As all variables were on an ordinal scale, a correlation matrix between all variables was computed. Sex differences concerning the number of tender muscles were tested with student's /-test. Differences between other variables were tested using the chi-square test. For ease of presentation all frequency tables are piesented in a collapsed, dichotomized version. Result Answers to the questionnaire are presented in Table 2, For all variables girls reported symptoms more often than the boys, but only the values for low baek pain were statistically different at the 5% level. The clinical findings and the distribution of tender jaw, neck and shoulder muscles in respect to sex is presented in Table 3. The only thing to be pointed out is the fact that 50% of all subjects had no tender chewing muscles upon palpation. Analyses revealed correlation between reports on pain in one part of the body and in other parts as demonstrated in Table 4, For instance, the Table 1. Number and position ol palpation sites in niuseles examined Musele Temporal Masseter Lateral plerygoid Digaslrie Stemoeleido-mastoid Suboccipital Trapezius Neek
Number of palpation sites
•
3 2 1 2 1' 1 , 1 1
Sex differences from masticatory and other miLscles
437
Table 2. Pereentage of boys and girls with regard to some symptoms reported in c|iiestioiinaire
Headaehe TMJ - elieking Tiredness in jaw Pain in neek and shoulder Low baek pain
Boys
Girls
18 21 8
23 35 11
19
34
29
49
/'
