Journal of Dentistry and

Oral Care
Research Article Open Access

Correlation between Temporomandibular Disorder, Fixed

Partial Denture and Restorative Treatment
Mohammad Alomair1, Waleed Alshaman1*, Mohammad Alshammary2, Magdy K Hamam3, Hamad N.
Albagiah3

1
Ministry of health, Dental sector, Tabuk, Saudi Arabia
2
Ministry of health, Dental sector, Hail, Saudi Arabia
3
College of Dentistry, King Saud University, Saudi Arabia

*
Corresponding author: Waleed Alshaman, Ministry of health, Dental sector, Tabuk, Saudi Arabia,
E-mail: alshaman@hotmail.com

Abstract Received date: March 14, 2016

Accepted date: August 10, 2016
The Temporo Mandibular Disorders (TMD) is complex multifactorial prob- Published date: August 15, 2016
lem. It is common cause of orofacial pain problems. The main approach for treatment is
supportive therapy. Therefore, the aim of this investigation is to study the effect of fixed
partial denture (FPD) and restorative treatment on TMD. A cross sectional survey was Citation: Alshaman, W., et al. Cor-
conducted in governmental and private hospitals in Riyadh city. A total of 300 patients relation between Temporomandibular
were enrolled in this survey. The results revealed significant correlation between FPD Disorder, Fixed Partial Denture and
and restorative treatment, and TMD. Restorative Treatment. (2016) J Dent
Oral Care 2(2): 29- 37.

Keywords: Temporomandibular disorders (TMD); Fixed partial denture (FPD);

Restorative treatment (RT) DOI:10.15436/2379-1705.16.807

Introduction

According to the Guidelines of the American Academy of Orofacial Pain Temporomandibular disorders (TMD) is defined
as, ‘a collective term embracing a number of clinical problems that involve the masticatory musculature, the temporomandibular
joints and associated structures, or both[1,2]. Temporomandibular disorders have been recognized as a common orofacial pain condi-
tion. The American Dental Association in 1983 has suggested that the term Temporo Mandibular Disorders (TMD) refers to a group
of disorders characterized by: pain in the Temporo Mandibular Joint (TMJ), the periauricular area, or the muscles of mastication;
TMJ noises (sounds) during mandibular function; and deviations or restriction in mandibular range of motion[3]. The etiology of
TMD has been considered to be one of the most controversial issues in clinical dentistry. A majority of dental practitioners believe
that occlusal disturbances can cause or are closely related to TMD, and many therefore also include occlusal adjustment as an initial
treatment for TMD, whereas most TMD experts hold opposing views[4-6]. Restorative procedures are divided into two types-. (1) Op-
erative and (2) fixed prosthodontic. Operative procedures are those in which the final restorations are fabricated intrao-rally (e.g., an
amalgam, a composite resin). Fixed prosthodontic procedures are those that involve extraoral fabrication with final adjustment and
cementation in the mouth (e.g., inlays, onlays, full crowns, fixed partial dentures[7]. The prevalence of TMD is still not well known
and more studies and comparisons are necessary to allow better understanding of the pathological aspects so as to address effective
preventive and therapeutic measures. Few studies reported the prevalence of TMD in Saudi Arabia in normal permanent dentition
and adults[8,9]. If your teeth don’t meet evenly, such as when you have a new filling or crown that is slightly “high”, this could cause
pain on biting or with extremes of temperature. In the long term you could develop mobile teeth, receding gums, fractures, abnor-
mal wear, tension headaches and even jaw joint problems such as stiffness, clicking and locking (British academy of restorative
dentistry). A review of the scientific literature reveals that five major factors associated with TMDs. These factors are the occlusal
condition, trauma, emotional stress, deep pain input, and parafunctional activities[10]. Three general classes of record are used for
transferring maxilla-mandibular relationships from the patient to the articulator including Interocclusal and hinge axis records. As
well as, the graphic records[11]. The reproducibility of occlusal marking technique is low. In studying the influence of force and jaw

Copyrights: © 2016 Alshaman, W. This is an Open access article distributed under the terms of Creative Com-
mons Attribution 4.0 International License.
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Correlation between TMD, FPD & RT

position on the number of tooth contacts, most restorative procedures cannot be performed without influencing to some degree the
existing occlusal condition. The potential effect of restorative procedures on the occlusion is obvious when a complete reconstruc-
tion of the dentition is being considered. However, one should be aware that even an occlusal amalgam can have a significant effect
on the occlusion when the restoration is undercarved or over carved[12-14].
The observation that many subjects have “occlusal abnormality” without TMD has clearly encouraged reviewers to con-
clude that occlusal factors have no significant etiological role[2,15]. Results of experimental interference studies are also seen as
strong evidence for the same conclusion[16]. The hypothesis, “dental occlusion plays a significant causal role in temporomandibular
disorders”, has been a central point of contention for many decades in the attempt to understand these disorders. Recently, certain
authors have asserted that the scientific literature does not support this hypothesis determining the cause(s) of TMDs is far from a
straightforward and simple process. There is general agreement that TMD is a broad, generic term that encompasses a wide variation
of conditions involving the masticatory musculoskeletal structures. There is also wide agreement that causation related to TMDs is
of multi factorial origin. The likelihood of identifying any single “cause” as having a predominant role is clearly remote. The aim of
this research is to show the relationship between the occlusal interference with fixed prosthesis, restorations, and tempromandibular
disorder.

Materials and Methods

Study Population
Request for ethical Approval for this study will be made by applying to College of Dentistry Research Center. The target
population this study is male patients attending one governmental and one private hospital in Riyadh The age range for these patients
will be limited to age (18 – 70 years old). The patient will identify in undergraduate clinics, intern and post graduate clinics. All of
the patient must have a FPD & restorations.

Questionnaire
The questionnaire to be used in this study will be in Arabic. The questionnaire it will determine if there is a correlation
between TMD, FPD & restorations. Firstly, the following information was collected: the demographic information such as patient’s
age, education, employment status, parity, and economic status then the past dental history data were collected including some med-
ical relevant as (did you have any medical problem, did have any complication with dental treatment, did you take any medications,
etc). The last part is the relation between TMD, FPD & restoration. We focused on the questions about the history of TMD and if
there are complications occurred after the prostho-opreative treatment. For example did you have any clicking or deviation or pain
in your joint? yes/no. as we mention all the patient must have crowns or FPD or restoration, then the next questions it will be (when
they do the treatment, how many crowns he have, any differentiations between the treatment, if its high, if they feel pain in muscle
and jaw after treatment etc).

Questionnaire Administration
The questionnaires were initially tested for clarity and accuracy on a sample of 100 male patients. After making necessary
changes in the tested questionnaire, the questionnaire were given to supervisor of the clinic in DUC and also to the private clinic. A
total of 300 male patients investigated in this study.

Data Analysis
All the collected data were statistically analyzed using SPSS version 21 software. The Chi square tests were used to deter-
mine the significant relations.

Results

Table 1 shows that the distribution of the study sample according to the variable Age that the vast majority (217) of the
study sample, representing a rate of (72.3%) of the total study sample age (from 20 to less than 25 years old), while it was found
that (29) of the study sample, representing a rate of (9.7%) of the total study sample age (from 25 to less than 30), also found that
(12) of the study sample, representing a rate of (4%) of the total study sample age (from 35 to less than 40 years old ), while equal
proportion of the study sample holders ages (less than 20 years old, from 30 to less than 35 years, from 50 years and above) and that
by (3%) of the total study sample, while it was found that (8) of the study sample, representing a rate of (2.7%) of the total study
sample age (from 40 to less than 45 years) and finally found that (7) of the study sample, representing a rate of (2.3%) of the total
study sample age (from 45 to less than 50 years).

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Correlation between TMD, FPD & RT

Table 1: Distribution of the study sample according to the variable Age.

Age Sample Size (n) Percentage
Less than 20 years 9 3.0%
From 20 to less than 25 217 72.3%
From 25 to less than 30 years 29 9.7%
From 30 to less than 35 9 3.0%
From 35 to less than 40 12 4.0%
From 40 to less than 45 8 2.7%
From 45 to less than 50 7 2.3%
From 50 and more 9 3.0%
Total 300 100%

Table 2 show that distribution of the study sample according to the variable work, it shows that the vast majority (240) of
the study sample, representing a rate of (80%) of the total sample individuals (students), while it was found that (17) of the study
sample representing a rate of (5.7%) of the total study sample employed in the police, while it was found that (15) of the study
sample, representing a rate of (5%) of the total study sample employed in government jobs, also found that (5) of the study sample
representing a rate of (1.7%) of the total study sample teachers , while it was found that (4) of the study sample representing (1.3%)
of the total study sample, “doctors”.

Table 2: Distribution of the study sample according to the variable work.

Job title Sample Size (n) Percentage
Criminal evidence 1 0.3%
National guard 1 0.3%
Police 17 5.7%
Traffic 1 0.3%
Provisional institute 1 0.3%
Imam University 1 0.3%
Businessman 3 1.0%
Driver 2 0.7%
Student 240 80.0%
Doctor 4 1.3%
Worker 1 0.3%
Military 1 0.3%
Private sector 2 0.7%
Retired 1 0.3%
Financial monitor 1 0.3%
Supervisor 1 0.3%
Commissioner 1 0.3%
Teacher 5 1.7%
Engineer 1 0.3%
Governmental employee 15 5.0%
Total 300 100%

From Table 3, it is indicated that (0.3%) of the total study sample complain of neurological disorders, while it was found
that (0.7%) of the total study sample complain of musculoskeletal disorders, arthritis, also found that (2.3%) of the total study sam-
ple complain of psychological pressure, and finally found that (3.3%) of the total study sample complain (stomach pain, headaches,
anemia, Orthodontic, disability, asthma, ligamentin the knee).

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Correlation between TMD, FPD & RT
Table 3: Distribution of the study sample according to medical problems.
Yes No
Do you suffer from the following diseases
Sample Size (n) Percentage Sample Size (n) Percentage
Neurological disorders 1 0.3% 299 99.7%
Musculoskeletal disorders – Arthritis 2 0.7% 298 99.3%
Psychological pressure 7 2.3% 293 97.7%
Medical problem not listed above (stomach pain,
headaches, anemia, Orthodontic, disability, 10 3.3% 290 96.7%
asthma, ligament in the knee).

Seen from Table 4 the distribution of the study sample according to the number of combinations or restorations that have
shown that (118) of the study sample, representing a rate of (39.3%) of the total members of the sample number of combinations
or restorations that have (more than 3), while found that (76) of the study sample, representing a rate of (25.3%) of the total study
sample number of combinations or restorations that have (one restoration), while it was found that (74) of the study sample, repre-
senting a rate of (24.7%) of the total study sample number of combinations or restorations that have (two restorations), and finally
found that (32) of the study sample, representing a rate of (10.7%) of the total study sample number of combinations or restorations
that they have (three restorations).
Table 4: Distribution of the study sample according to the number of restorations.
No. of FPD and Restorations Sample size (n) Percentage
1 76 25.3%
2 74 24.7%
3 32 10.7%
More than 3 118 39.3%
Total 300 100%

From Table 5, it is indicated that the (124) of the study sample, representing a rate of (41.3%) of the total members of the
duration where treatment combinations or restorations (over a year), while it was found that (73) of the study sample, representing
a rate of (24.3%) of the total study sample duration where treatment combinations or restorations (before 6 months), while it was
found that (52) of the study sample, representing a rate of (17.3%) of the total study sample wares or restorations (a month ago) and,
finally, it was found that (51) of the study sample, representing a rate of (17%) of the total study sample duration where treatment
combinations or restorations (a year ago).
Table 5: Time of dental treatment.
Time of completion of the treatment of FPD
Sample size (n) Percentage
or Restorations?
Before month 52 17.3%
Before 6 months 73 24.3%
Before a year 51 17.0%
More than this 124 41.3%
Total 300 100%

Through a review of Table 6 shows that the (194) of the study sample, representing a rate of (64.7%) of the total members
were subjected to treatment ( restorations), while it was found that (53) of the study sample, representing a rate of (17.7%) of the
total members of the sample The study underwent treatment (fixtures and restorations together), while it was found that (32) of the
study sample, representing a rate of (10.7%) of the total study sample were subjected to treatment (formulations), and finally found
that (11) of the study sample, representing a rate of (3.7%) of the total study sample were subjected to treatment (formulations, fill-
ers, implant) and finally found that (10) of the study sample, representing a rate of (3.3%) of the total study sample were subjected
to treatment (Implant).

Table 6: Type of dental treatment.

What is the type of treatment you have? Sample size (n) Percentage
FPD 32 10.7%
Restorations 194 64.7%
Implant 10 3.3%
All of them 11 3.7%
FPD and Restorations 53 17.7%
Total 300 100%

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Correlation between TMD, FPD & RT
Through a review of the Table 7 shows that the vast majority (179) of the study sample, representing a rate of (59.7%) do
not suspect any of the conditions listed above, while it was found that (46) of the study sample, representing a rate of (15.3%) of the
total members of the sample the study complained of (psychological stress), while it was found that (28) of the study sample, repre-
senting a rate of ( 9.3%) of the total study sample complain (arthritis ), while it was found that (21) of the study sample, representing
a rate of (7%) of the total study sample complain (musculoskeletal disorders), also found that (17) of the study sample, representing
a rate of (5.7%) of the total study sample complain (neurological disorders), and finally equal proportion of the study sample who
complain of (psychological pressure and neurological disorders, psychological pressure and muscle and nerve disorders).

Table 7: Patients suffer of other diseases.

Do you suffer of any of the following diseases? Sample size (n) Percentage
Neurological disorders 17 5.7%
Muscular disorders 21 7.0%
Arthritis 28 9.3%
Psychological pressure 46 15.3%
Psychological pressure and neurological disorders 1 .3%
Psychological pressure and muscle and nerve disorders 1 .3%
Psychological pressure and arthritis 7 2.3%
I am not suffering from any of the above diseases 179 59.7%
Total 300 100%

Can be seen from Table 8 that the (151) of the study sample, representing a rate of (50.3%) complain (dental caries), while
it was found that (29) of the study sample, representing a rate of (9.7%) of the total study sample complain (dental caries and teeth
fracture), while it was found that (20) of the study sample, representing a rate of (6.7%) of the total study sample complain (caries
in teeth and an imbalance in the match), while it was found that (12) of the study sample representing (4%) of the total study sample
complain (break-up teeth), also found that (11) of the study sample, representing a rate of (3.7%) of the total study sample complain
of (problems in the fixtures and a defect in the match), and found also that (9) of the study sample, representing a rate of (3%) of the
total study sample complain of (a defect in the match), while it was found that (5) of the study sample, representing a rate of (1.7%)
of the total study sample complain of decay in teeth and problems in formulations, and finally found that (4) of the study sample,
representing a rate of (1.3%) of the total study sample members complain of (problems in the formulations).

Table 8: Suffering from other teeth problem.

Do you suffer from any of the following problems in teeth Sample size (n) Percentage
Dental caries 151 50.3%
Teeth fracture 12 4.0%
Occlusion 9 3.0%
Problems in FPD 4 1.3%
Teeth caries and problems in FPD 5 1.7%
Dental caries and Teeth fracture 29 9.7%
Dental caries and Occlusion 20 6.7%
Problems in FPD and Occlusion 11 3.7%
Nothing at all 59 19.7%
Total 300 100%

Seen from Table 9 that the (117) of the study sample, representing a rate of (39%) of the total study sample complain of the
presence of caries in teeth, while it was found that (105) of the study sample, representing a rate of (35%) of the total members the
study sample does not complain of anything, while it was found that (28) of the study sample, representing a rate of (9.3%) of the
total study sample complain (break in fixtures or restorations).
Also, it was found that (19) of the study sample representing a rate of (6.3%) of the total study sample complain of (the
presence of caries in teeth and break in fixtures or restorations), while equal proportion of the study sample who suffer from (a rise in
installations) with the proportion of the study sample who suffer from (decrease of the level of congruence) with a rate of (3.7%) of
the total study sample for both of them, and found that (6) of the study sample, representing a rate of (2%) of the total study sample
complain of (the existence of decay and a rise in installations).
Finally, we found that (3) of the total study sample, representing a rate of (1%) of the total study sample members complain
of the existence of decay in the teeth and lower the level of capability.

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Correlation between TMD, FPD & RT
Table 9: Complaining from any problems in FPD or Restorations.
Do you complain from any of the following Sample size (n) Percentage
problems in FPD or Restorations
Dental caries 117 39.0%
FPD or Restorations Fracture 28 9.3%
High occlusion in FPD 11 3.7%
Low occlusion in FPD 11 3.7%
Dental caries and teeth fracture in FPD or 19 6.3%
Restoration
Dental caries and high occlusion in FPD 6 2.0%
Dental caries and low occlusion in FPD 3 1.0%
Nothing at all 105 35.0%
Total 300 ٪100

From Table 10 and Figure 1, it is indicated that (71.3%) of the total study sample did not feel any problem when under-
going treatment combinations, while it was found that (16.7%) of the study sample are problems when undergoing treatment for
restorations, and finally found that (12%) of the study sample are sometimes problems when undergoing treatment combinations.
Also (68.3%) of the total study sample does not match the teeth feel change upon completion of the treatment, while it was found
that (20.7%) of the study sample are changing the match dental Upon completion of the treatment.

Table 10: Diagnostic questions for TMD.

Freq. and Agreement degree

No. Diagnostic questions Mean SD Chi-Square p.value
percentage Sometimes No Yes
Did you feel any problem Freq. 36 214 50
1 when having FPD? 2.0467 0.53427 195.92 0.000
% 12% 71.3% 16.7%
Did you feel change in teeth Freq. 33 205 62
2 after treatment? 2.0967 0.55529 169.58 0.000
% 11% 81% 7.7%
Did you face difficulty in Freq. 34 243 23
3 opening mouth? 1.9633 0.43507 307.34 0.000
% 11.3% 81% 7.7%
Did you face difficulty in Freq. 48 231 21
4 moving the mandible from % 1.91 0.47185 261.06 0.000
16% 77% 7%
one side to another?
Do you feel pain in muscles Freq. 54 214 32
5 when chewing? 1.9267 0.53125 197.36 0.000
% 18% 71.3% 10.7%
Do you feel pain in ear and Freq. 34 232 34
6 neck regions? 2 0.47689 261.36 0.000
% 11.3% 77.3% 11.3%
Do you feel clicking in TMJ Freq. 51 190 59
7 when chewing? 2.0267 0.60595 121.82 0.000
% 17% 63.3% 19.7%
Do you grind teeth during Freq. 29 247 24
8 sleeping? 1.9833 0.42069 324.26 0.000
% 9.7% 82.3% 8%
Do you feel inclination of Freq. 22 249 29
9 jaw when opening it? 2.0233 0.41234 333.26 0.000
% 7.3% 83% 9.7%
Do you finddifficultieswhen Freq. 44 238 18
10 you openor closethe mouth 1.9133 0.44701 289.04 0.000
% 14.7% 79.3% 6%
Do you have problem with Freq. 18 240 42
11 matching? 2.08 0.44074 296.88 0.000
% 6% 80% 14%
Do you feel FPD or resto- Freq. 31 231 38
12 rations had affected the jaw? 2.0233 0.47982 257.66 0.000
% 10.3% 77% 12.7%
Did you visit dentist to ex- Freq. 17 225 58
13 plain your problem? 2.1367 0.48176 242.78 0.000
% 5.7% 75% 19.3%
Did you usedrestorations to Freq. 11 273 16
14 hinder teeth grinding? 2.0167 0.30004 449.06 0.000
% 3.7% 91% 5.3%

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Correlation between TMD, FPD & RT

Figure 1: Means of diagnostic questions.

While it was found that (11%) of the study sample feel sometimes changing the match teeth upon completion of treatment.
(81%) of the total study sample do not face difficulty in opening their mouth when installation or fillers, while it was found that
(11.3%) of the study sample face sometimes difficult to open their mouth when installation or fillers, while found to be (7.7%) of
the study sample are having difficulty in opening their mouth when installation or fillers. Also, (77%) of the total study sample do
not face difficulty in moving the jaw from side to side when the installation or fillers, while it was found that (16%) of the study
sample face sometimes difficult to open their mouth when installation or fillers, while found that (7%) of the study sample are having
difficulty in moving the jaw from side to side when the installation or fillers.
Also, (71.3 %) of the total study sample do not feel pain when chewing muscles, while it was found that (18%) of the study
sample sometimes feel pain in muscles when chewing, while it was found that (10.7%) of the study sample does not feel pain in
muscles when chewing. Also (77.3 %) of the total study sample did not feel pain in the ear or tenderness, while it was found that
(11.3%) of the study sample sometimes feel pain in the ear or tenderness, also found that (11.3%) of the sample the study experi-
enced pain in the ear or tenderness. Also, (63.3 %) of the total study sample did not feel jaw hinge when you open or when chewing,
while it was found that (19.7% ) of the study sample feel jaw hinge when you open or when chewing, while it was found that (17%)
of the study sample feel sometimes jaw hinge when you open or when chewing. Also, (82.3 %) of the total study sample does not
grind their teeth at bedtime, while it was found that (9.7%) of the study sample in a few cases, grind their teeth at bedtime, while it
was found that (8%) of the study sample grind their teeth at bedtime.
Moreover, (83%) of the total study sample did not feel Milan jaw when you open or close towards any destination, while it
was found that (9.7%) of the study sample feel Milan jaw when you open or close towards any destination, while it was found that
(7.3%) the study sample of individuals sometimes feel Milan jaw when you open or close towards any party and (79.3 %) of the
total study sample do not find difficulties when you open or close the mouth, while it was found that (14.7%) of the study sample
have sometimes difficulties when you open or close the mouth, while it was found that (7.3%) of the sample the study sometimes
feel Milan jaw when you open or close towards any party. And (80%) of the total study sample have a problem when the match in
hand without the other, while it was found that (14%) of the study sample have a problem when the match in hand without the other.
Furthermore, it was found that (6%) of the study sample find sometimes a problem when the match in hand without the
other and (77%) of the total study sample did not believe that the treatment of wares or restorations impact on the jaw, while it
was found that (12.7%) of the study sample believe that the treatment of wares or restorations, while it was found that (10.3%) of
individuals in the study sample sometimes think that the treatment of wares or restorations impact on the jaw and (75%) of the total
study sample have not visited the Dentist to explain to him the problem that suffer from it, while it was found that (19.3%) of the
study sample had visited the Dentist to explain to him the problem that they have, while it was found that (5.7%) of the study sample
who sometimes visit the dentist to explain to him the problem which they suffer. And (91%) of the total study sample did not use
the combination to prevent grinding the teeth during sleep, while it was found that (5.3%) of the study sample used the combination
to prevent grinding the teeth during sleep, while it was found that (3.7%) of the study sample in some often use the combination to
prevent teeth grinding during sleep.
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Correlation between TMD, FPD & RT
Seen from table 11 include the following: A positive relationship between the wave (TMD) and variable age as the value
of the relationship (0.153). The existence of an inverse relationship between (TMD) and both (number of combinations or resto-
rations, the time to complete treatment combinations or restorations, the type of treatment, you suffer from the following diseases,
you complain about any of the following problems in the teeth, do you complain about any of the following problems in the FPD or
restorations), reaching values of the relationship (-0.77, -0.130, -0.151, -0.97, -0.66, -0.121)

Table 11: Relationship between TMD and other variables.

Do you feel Do you suffer Do you suffer Treatment Time of com- No. of FPD or Age Relation
problem in FPD from the following from the following problem pleting FPD or restorations
or restorations problems diseases restorations
-0.121 -0.66 -0.97 -0.151** -0.130* -0.77 0.153** TMD

Discussion

Our research was focused to find a relationship of TMD with FPD and restorative treatment in Riyadh city. Data collection
was carried out by means of a self-applied questionnaire. The etiology of TMD has been considered to be one of the most controver-
sial issues in clinical dentistry. A majority of dental practitioners believe that occlusal disturbances can cause or are closely related
to TMD, and many therefore also include occlusal adjustment as an initial treatment for TMD, whereas most TMD experts hold
opposing views[4-6].
Few studies have been reported on the prevalence of TMD in Saudi Arabia in normal permanent dentition and adults[8,9].
Restorative procedures are divided into two types-(1) Operative and (2) fixed prosthodontic. Operative procedures are those in
which the final restorations are fabricated intrao-rally (e.g., an amalgam, a composite resin). Fixed prosthodontic procedures are
those that involve extraoral fabrication with final adjustment and cementation in the mouth (e.g., inlays, onlays, full crowns, fixed
partial dentures[7].
In our research result we found that there is direct relationship between TMD & age of patients representing rate of (0.153),
This value are in agreement with the previous study[17], this investigation revealed that radiographic appearance of TMJ varied wide-
ly, remodeling changes were commonly seen, and there was no direct linear relationship between age and radiographic changes in
condylar morphology. Also, we found there is reverse relation between TMD with Restorations and FPD numbers representing rate
of (-0.77) this agree with” Undergo corrective dental treatments. Corrective treatments including replacing missing teeth and using
crowns, bridges, or braces to balance the biting surfaces of your teeth or to correct a bite problem” (23). And there is reverse relation
between TMD with time of completing FPD &restorative treatment (-0.13) cause of a major of our sample doesn’t suffer from TMD
problem.
TMD relation with other diseases (-0.97) cause of 98% of our sample didn’t complain of medical problem. Because many
other conditions can cause similar symptoms to TMD – including toothache, sinus problems, arthritis, or gum disease – your dentist
will conduct a careful patient history and physical examination to determine the cause of your symptoms[18].

Conclusions

This research discusses and reviews correlation of TMD with FPD and restorative treatment, including role of FPD, restor-
ative treatment and many factors in TMD. Causes of TMD are not clear, but dentists believe that symptoms arise from problems with
the muscles of the jaw or with the parts of the joint itself. Carefully, observed patient history and physical examination to determine
the cause of TMD symptoms. It still need more and more research to clarify this problem, its causes in Saudi Arabia. Also, should
be community awareness of TMD problem and its symptoms and signs.

Acknowledgment
Thanks Prof. Magdy Hamam for his efforts and guidance in our research.

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Correlation between TMD, FPD & RT
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