Temporomandibular joint disorder and gross motor function in children with cerebral palsy

AIM: To determine the prevalence of the clinical signs and symptoms of temporomandibular joint (TMJ) disorder (TMD) in children with cerebral palsy (CP) and to examine their associations with severity of gross motor impairment, CP subtype, and caregiver-reported bruxism. METHOD: This cross-sectional study included 517 children with CP (mean age = 10 years 10 months [SD 3 years 7 months]; 57.2% male) classified according to Gross Motor Function Classification System (GMFCS) levels I to IV. TMJ function was evaluated using standardized clinical criteria, including maximum mouth opening, lateral jaw movement, joint sounds, palpation tenderness, pain intensity, and caregiver-reported bruxism. RESULTS: The overall prevalence of TMD was 38.7% (95% confidence interval [CI] = 34.5-42.9), while caregiver-reported bruxism was observed in 32.6% (95% CI = 28.6-36.9) of participants. TMD increased progressively with severity of gross motor impairment, from 24.3% at GMFCS level I to 62.5% at GMFCS level IV (p < 0.001). Children with spastic CP showed a higher prevalence (44.3%) compared with those with the ataxic (26.1%), dyskinetic (36.6%), and mixed subtypes (33.3%) (p = 0.012). In a multivariable analysis, higher GMFCS level (odds ratio [OR] = 1.82, 95% CI = 1.45-2.29), spastic subtype (OR = 1.67, 95% CI = 1.12-2.50), and caregiver-reported bruxism (OR = 2.21, 95% CI = 1.55-3.15) emerged as independent factors associated with TMD. INTERPRETATION: TMD is common in children with CP and is associated with greater severity of gross motor impairment, spastic subtype, and caregiver-reported bruxism. Systematic TMJ assessment should be incorporated into routine paediatric neurorehabilitation to support orofacial function and participation.