Temporomandibular joint disorders.

Am Fam Physician. 2007 Nov 15;76(10):1477-82

Authors: Buescher JJ

Temporomandibular joint disorders are common in adults; as many as one third of adults report having one or more symptoms, which include jaw or neck pain, headache, and clicking or grating within the joint. Most symptoms improve without treatment, but various noninvasive therapies may reduce pain for patients who have not experienced relief from self-care therapies. Physical therapy modalities (e.g., iontophoresis, phonophoresis), psychological therapies (e.g., cognitive behavior therapy), relaxation techniques, and complementary therapies (e.g., acupuncture, hypnosis) are all used for the treatment of temporomandibular joint disorders; however, no therapies have been shown to be uniformly superior for the treatment of pain or oral dysfunction. Noninvasive therapies should be attempted before pursuing invasive, permanent, or semi-permanent treatments that have the potential to cause irreparable harm. Dental occlusion therapy (e.g., oral splinting) is a common treatment for temporomandibular joint disorders, but a recent systematic review found insufficient evidence for or against its use. Some patients with intractable temporomandibular joint disorders develop chronic pain syndrome and may benefit from treatment, including antidepressants or cognitive behavior therapy.

PMID: 18052012 [PubMed - in process]

Methods of imaging in the diagnosis of temporomandibular joint disorders.

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2007 Jun;151(1):133-6

Authors: Tvrdy P

Background: Different methods of temporomandibular joint imaging are presented and discussed. Research reports published from 1979 to 2002 have been evaluated. Method and Results: The aim of this paper is to summarize the main findings from research. Basic X-ray examination is the most readily available method of imaging which usually does not have any contraindication. The use of computer tomography offers all advantages of tomographic scanning in different layers and projections, imaging soft tissues close to the joint and the possibility of "3D" reconstruction of bone structures. In case of joint dysfunctions and internal joint derangement, it is more preferable to use nuclear magnetic resonance for the depiction of the joint structures. To make a diagnosis more efficient, miniinvasive diagnostic methods are becoming necessary. Arthroscopy allows direct visual control of the joint space with the possibility of therapeutic help in cases when conservative treatment has failed. Ultrasonography, as a completely non-invasive procedure, is applied even in diagnosing functional temporomandibular defects. In these cases the diagnostic value of ultrasonography is almost comparable with this of nuclear magnetic resonance. Conclusions: So it is possible that, together with the improvement of the equipment, development of the diagnostic methods used during the treatment of temporomandibular joint defects could continue in this direction.

PMID: 17690757 [PubMed - in process]

Review of temporomandibular joint pathology. Part I: classification, epidemiology and risk factors.

Med Oral Patol Oral Cir Bucal. 2007 Aug;12(4):E292-8

Authors: Poveda Roda R, Bagan JV, Díaz Fernández JM, Hernández Bazán S, Jiménez Soriano Y

Pathology of the temporomandibular joint (TMJ) affects an important part of the population, though it is not viewed as a public health problem. Between 3-7% of the population seeks treatment for pain and dysfunction of the ATM or related structures. The literature reports great variability in the prevalence of the clinical symptoms (6-93%) and signs (0-93%), probably as a result of the different clinical criteria used. In imaging studies it is common to observe alterations that have no clinical expression of any kind. Radiographic changes corresponding to osteoarthrosis are observed in 14-44% of the population. Age is a risk factor, though with some particularities. In elderly patients there is an increased prevalence of clinical and radiological signs, though also a lesser prevalence of symptoms and of treatment demands than in younger adults. Approximately 7% of the population between 12 and 18 years of age is diagnosed with mandibular pain-dysfunction. Temporomandibular dysfunction (TMD) is more frequent in females. No clear relationship has been established between occlusal alterations and TMJ disease. Only disharmony between centric relation and maximum intercuspidation, and unilateral crossbite, have demonstrated a certain TMJ disease-predictive potential. Both local and systemic hyperlaxity has been postulated as a possible cause of TMD. Parafunctional habits and bruxism are considered risk factors of TMD with odds ratios (ORs) of up to 4.8. Psychophysiological theory holds stress as a determinant factor in myofascial pain. Genetic factors and orthodontic treatment have not been shown to cause TMD.

PMID: 17664915 [PubMed - indexed for MEDLINE]

Maximal bite force and its association with temporomandibular disorders.

Braz Dent J. 2007;18(1):65-8

Authors: Pereira-Cenci T, Pereira LJ, Cenci MS, Bonachela WC, Del Bel Cury AA

Individuals with temporomandibular disorders (TMD) are expected to have decreased maximum bite forces (MBF). This way, this study compared the MBF in subjects with TMD to a control group and also evaluated its association with age, gender, height and weight. Forty healthy adults with complete natural dentition divided into four groups according to gender and presence or absence of TMD signs/symptoms (based on the Research Diagnostic Criteria RDC) underwent a MBF test with a gnathodynamometer in molar and incisal areas. Statistical analysis was performed by ANOVA and Student-Newman-Keuls test (p=0.05), and the relationship between age, gender, weight, height and MBF was verified by Pearson's correlation test. There were no differences in MBF results between TMD and control groups (p>0.05). Female subjects exhibited lower MBF than male and MBF for the anterior area was lower than that for posterior area (p<0.05). Significant correlation was found between MBF and weight in TMD subjects (p<0.05), except for the anterior area in female subjects. There was a positive correlation between MBF and height in TMD male subjects (p<0.05). Within the limitations of this study, it is possible to conclude that bite force was not affected by TMD. Correlation between MBF and weight in TMD subjects and between MBF and height in TMD male subjects was observed.

PMID: 17639204 [PubMed - indexed for MEDLINE]

Temporomandibular disorders do not correlate with detectable alterations in body posture.

J Contemp Dent Pract. 2007;8(5):60-7

Authors: Perinetti G

AIM: This study aimed to determine if temporomandibular disorders (TMD) correlate with alterations in body posture detectable through posturography. METHODS AND MATERIALS: Thirty-five asymptomatic subjects and 35 TMD patients (34 males and 36 females; mean age, 27.7+/-8.6 years) constituted the matched control and TMD groups, respectively. Posturography was performed under four different experimental conditions: (a) eyes open with mandibular rest position (Eyes Open RP); (b) eyes open with dental occlusion (Eyes Open DO); (c) eyes closed with mandibular rest position (Eyes Closed RP); and (d) eyes closed with dental occlusion (Eyes Closed DO). The X, Y, and absolute centre of pressure displacements from the projection of a theoretical barycentre and the sway area, sway length, and sway velocity were recorded as static and dynamic posturographic parameters, respectively. RESULTS: Generally, no differences were found in any of these parameters between the groups and between the RP and DO within either Eyes Open/Closed conditions. The only differences were found under Eyes Closed as compared to Eyes Open, irrespective of the RP/DO conditions for dynamic and not for static posturographic parameters. CONCLUSION: This study failed to show detectable alterations in body posture in TMD patients.

PMID: 17618331 [PubMed - indexed for MEDLINE]

A clinical study of temporomandibular joint disorders -an analysis based on the Japanese subtype classification-.

Kobe J Med Sci. 2007;53(1-2):63-70

Authors: Shibuya Y, Takeuchi J, Ikehata N, Akashi M, Fujita T, Yokoo S, Umeda M, Komori T

In this study, cases of temporomandibular joint disorder (TMJD) were analyzed based on the subtype classification established by Japanese Society for the Temporomandibular Joint (JSTMJ) in 2001. The subject of our investigation consisted of cases who visited to the department of Oral and Maxillofacial Surgery of Kobe University Hospital in 2002 because of TMJD. Among them, any cases with no physical examination or strong psychogenic factors related to their symptoms were excluded. As a result, a total of 195 cases were investigated in this study. These cases consisted of 50 males and 145 females with a mean age of 38.1 years, and they were classified as type I (28 cases), type II (7 cases), type IIIa (91 cases), type IIIb (44 cases) and type IV (25 cases). The most frequently used therapy of the all diagnostic categories was a stabilization type of splint therapy (99 cases), and medication with muscle relaxants (52 cases) or analgesics (50 cases) ranked thereafter. All cases were followed until December 2004, and the results of the treatment were classified into 5 categories of 'improved', 'effective', 'no change', 'deteriorated' and 'discontinued'. No cases with a deterioration of symptoms were observed, while 109 cases (55.9%) were assessed as either 'improved' or 'effective'.

PMID: 17582206 [PubMed - indexed for MEDLINE]

[Expressions of calcitonin gene -related peptide in rats with occlusal reconstruction]

Shanghai Kou Qiang Yi Xue. 2006 Dec;15(6):649-52

Authors: Li XG, Yuan LL, Liu HJ, Wang YX

PURPOSE: To investigate the expressions of calcitonin gene-related peptide (CGRP) in rats with occlusal reconstruction. METHODS: 30 Wistar male rats were randomly divided into 3 experimental groups and 3 control groups, 5 rats in each group. The molar of the right maxilla and mandible of rats in the experimental groups were ground to the gingival level without occlusal contact. The occlusal contact was recovered by stopping grounding molar of the rats in two of the experimental groups. The section of the disc and articular capsule Was subject to immunohistological study to evaluate the expressions of CGRP by using SABC method. Light microscope and microscopic photo analytic software were employed to detect calcitonin gene-related peptide-like immunoreactive (CGRP-LI) nerve fibers in frozen section of TMJs in 30 rats. SPSS10.0 software package were used for statistical analysis. RESULTS: The areas of CGRP-LI nerve fibers in unilateral chew group were significantly larger than those in the control group (P < 0.01, P < 0.05). The increment in the non-chewing side was significantly higher than that in the chewing side (P < 0.05). There was no significant difference in the areas of CGRP-LI nerve fibers between the early occlusal reconstruction group and the control group (P > 0.05) and there was no significant difference between the non-chewing side and the chewing side (P > 0.05). There was significant difference in the areas of CGRP-LI nerve fibers between the later occlusal reconstruction group and the control group (P < 0.01), while no significant difference was found between the non-chewing side and the chewing side (P > 0.05). CONCLUSION: The expressions of CGRP can recover normal in early occlusal reconstruction but not in later occlusal reconstruction.CGRP might participate in the histopathogenesis of temporomandibular joint disorders. Supported by Research Fund from Science and Technology Bureau of Taian City (Grant No.2003-52).

PMID: 17533722 [PubMed - in process]

Analysis of helkimo and craniomandibular indexes for temporomandibular disorder diagnosis on rheumatoid arthritis patients.

Rev Bras Otorrinolaringol (Engl Ed). 2007 Jan-Feb;73(1):19-26

Authors: da Cunha SC, Nogueira RV, Duarte AP, Vasconcelos BC, Almeida Rde A

AIM: The aim of this study was to evaluate the use of two indexes (Helkimo and Craniomandibular) for the diagnosis of temporomandibular disorder (TMD) in patients with Rheumatoid Arthritis (RA). PATIENTS AND METHODS: The sample was composed of 80 patients divided into two groups: patients with RA and patients without RA. In both groups the two indexes were used. For TMD diagnosis, the following signs and symptoms were evaluated: TMJ pain, limited mouth opening and joint sounds. RESULTS: Results showed that of the RA patients, 87.1% were females and 12.9% were males. Among the patients without RA, 70% were females and 30% were males. The age of these RA patients ranged between 24 and 78 years. Among patients without RA, the age of the patients ranged between 22 and 72 years. It was observed that the prevalence of TMD was higher in the group with RA (98.6%-Helkimo and 87.1%-Craniomandibular) when compared to the group without the disorder (80%-Helkimo and 50%-Craniomandibular). CONCLUSION: In summary, one could conclude that both indexes are capable to diagnose temporomandibular disorders in RA patients, although the Helkimo index is less accurate.

PMID: 17505594 [PubMed - indexed for MEDLINE]

Prevalence study of signs and symptoms of temporomandibular disorders in a Turkish population.

J Contemp Dent Pract. 2007;8(4):35-42

Authors: Ozan F, Polat S, Kara I, K&#xFC;çük D, Polat HB

AIM: The aim of this study was to evaluate the prevalence of signs and symptoms of temporomandibular disorders (TMD) in a population of 792 Turkish adults ranging in age from 15- to 72-years-old. METHODS AND MATERIALS: Subjects were examined objectively and subjectively for signs and symptoms of TMD through the distribution of frequency of the data obtained from a questionnaire and a physical examination using a similar methodology of previous studies. RESULTS: This study determined the prevalence of signs and symptoms of TMDs in subjects from male and female subgroups in a Turkish adult population. Both signs and symptoms of TMDs were generally more prevalent in females than in males. CONCLUSION: The prevalence of signs and symptoms were generally greater than in previous studies of other populations.

PMID: 17486185 [PubMed - indexed for MEDLINE]

Treatment of severe bilateral temporomandibular joint ankylosis in adults: our protocol.

Minerva Stomatol. 2007 Apr;56(4):181-90

Authors: Turco M, Di Cosola M, Faccioni F, Cortelazzi R

AIM: In order to evaluate the reliability of interpositional gap arthroplasty with temporalis myofascial flap the authors retrospectively analysed the data of 5 patients suffering from bilateral temporomandibular ankylosis operated on with this technique. METHODS: The preoperative assessment included evaluation of pain during function, interference with eating and the maximal interincisal distance. All patients received bony ankylosis removal, interposition of a finger-shaped temporalis myofascial flap in the articular gap and coverage with temporoparietal fascial flap as a new capsule. In the postoperative period an aggressive physiotherapy was carried on for at least 6 months. RESULTS: All cases experimented release of pain (evaluated by a Visual Analogue Scale method), a return to a normal diet and a stable improvement in mouth opening during the follow-up period. CONCLUSIONS: This technique should be considered a reliable method to avoid relapse of ankylosis and to stabilize postoperative results.

PMID: 17452956 [PubMed - indexed for MEDLINE]

Tumor necrosis factor-alpha in temporomandibular joint synovial fluid predicts treatment effects on pain by intra-articular glucocorticoid treatment.

Mediators Inflamm. 2006;2006(6):59425

Authors: Fredriksson L, Alstergren P, Kopp S

The aim of this study was to investigate the influence of tumor necrosis factor-alpha (TNF-alpha) in temporomandibular joint (TMJ) synovial fluid and blood on the treatment effect on TMJ pain by intra-articular injection of glucocorticoid in patients with chronic inflammatory TMJ disorders. High pretreatment level of TNF-alpha in the synovial fluid was associated with a decrease of TNF-alpha and elimination of pain upon maximal mouth opening. Elimination of this TMJ pain was accordingly associated with decrease in synovial fluid level of TNF-alpha. There was also a significant decrease of C-reactive protein and TMJ resting pain after treatment. In conclusion, this study indicates that presence of TNF-alpha in the synovial fluid predicts a treatment effect of intra-articular injection of glucocorticoid on TMJ movement pain in patients with chronic TMJ inflammatory disorders.

PMID: 17392588 [PubMed - indexed for MEDLINE]

Psycho-education programme for temporomandibular disorders: a pilot study.

J Negat Results Biomed. 2007;6:4

Authors: Jerjes W, Madland G, Feinmann C, El Maaytah M, Kumar M, Hopper C, Upile T, Newman S

BACKGROUND: Temporomandibular disorders (TMDs) are by far the most predominant condition affecting the temporomandibular joint (TMJ), however many patients have mild self-limiting symptoms and should not be referred for specialist care.The aim of this pilot study was to develop a simple, cost-effective management programme for TMDs using CD-ROM. 41 patients (age 18-70) participated in this study, patients were divided into three groups: the 1st group were involved in an attention placebo CD-ROM (contain anatomical information about the temporomandibular system), the 2nd group received information on CD-ROM designed to increase their control and self efficacy, while the 3rd group received the same programme of the 2nd group added to it an introduction to self-relaxing techniques followed by audio tape of progressive muscle relaxation exercises. Each of the groups was asked to complete a number of questionnaires on the day of initial consultation and six weeks afterwards. RESULTS: The two experimental groups (2nd & 3rd) were equally effective in reducing pain, disability and distress, and both were more effective than the attention placebo group (1st), however the experimental groups appeared to have improved at follow-up relative to the placebo-group in terms of disability, pain and depressed mood. CONCLUSION: This pilot study demonstrates the feasibility and acceptability of the design. A full, randomized, controlled trial is required to confirm the efficacy of the interventions developed here.

PMID: 17381840 [PubMed - indexed for MEDLINE]

Tensor tympani muscle: strange chewing muscle.

Med Oral Patol Oral Cir Bucal. 2007 Mar;12(2):E96-100

Authors: Ram&#xED;rez LM, Ballesteros LE, Sandoval GP

This work seeks to alert medical and odontological staff to understanding and using interdisciplinary handling for detecting different pathologies common otic symptoms. It offers better tools for this shared symptomatology during therapy s conservative phase. Tensor tympani muscle physiology and function in the middle ear have been veiled, even when their dysfunction and anatomical relationships may explain a group of confused otic symptoms during conventional clinical evaluation. Middle ear muscles share a common embryological and functional origin with chewing and facial muscles. This article emphasizes that these muscles share a functional neurological and anatomical dimension with the stomatognathic system; these muscles increased tonicity ceases to be a phenomenon having no logical connections. It offers functionality and importance in understanding referred otic symptoms in common with other extra-otical symptom pathologies. Tinnitus, vertigo, otic fullness sensation, hyperacusia, hypoacusia and otalgia are not only primary hearing organ symptoms. They should be redefined and related to the neighboring pathologies which can produce them. There is a need to understand temporomandibular disorders and craniofacial referred symptomatology from neurophysiologic and muscle-skeletal angles contained in the stomatognathic system. Common symptomatology is frequently observed in otic symptoms and temporomandibular disorders during daily practice; this should be understood by each discipline from a broad, anatomical and clinical perspective.

PMID: 17322813 [PubMed - indexed for MEDLINE]

Facial nerve injury following surgery for the treatment of ankylosis of the temporomandibular joint.

Med Oral Patol Oral Cir Bucal. 2007 Mar;12(2):E160-5

Authors: Nogueira RV, Vasconcelos BC

OBJECTIVE: The purpose of the present paper was to carry out a longitudinal study of a series of cases in which injury of the facial nerve was observed following surgery for the treatment of temporomandibular ankylosis. STUDY DESIGN: The sample was composed of 13 patients, both male and female, in whom 18 surgical approaches were made. A postoperative assessment of the motor function of the facial nerve was made in accordance with the House-Brackmann grading system. All the patients were photographed and assessed at the following postoperative times: 24 hours, one week, one month and three months. RESULTS: The results showed that injury of the facial nerve occurred in 31% of the cases. An increase in the frequency of nerve injury was observed in the cases in which the interpositional arthroplasty technique was employed, as well as the fact that 75% of the patients had undergone at least one surgical intervention prior to the study. After three months all the patients displayed normal function of the facial nerve. CONCLUSION: The frequency of facial nerve injury is related to the degree of difficulty involved in the surgery determined by the type of ankylosis. The nerve lesions were shown to be of a temporary nature.

PMID: 17322807 [PubMed - indexed for MEDLINE]

Validation of the Portuguese version of the RDC/TMD Axis II questionnaire.

Braz Oral Res. 2006 Oct-Dec;20(4):312-7

Authors: de Lucena LB, Kosminsky M, da Costa LJ, de G&#xF3;es PS

The present paper aimed at evaluating the validity of the Portuguese version of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis II Questionnaire. The sample was comprised of 155 patients with signs and symptoms of Temporomandibular Disorders (TMD), evaluated at the Orofacial Pain Control Center, School of Dentistry, University of Pernambuco, Brazil, between July 2003 and February 2004. Data collection was performed with the following tools: the RDC/TMD Axis I (clinical evaluation and TMD classification), and Axis II (psychosocial evaluation), as well as specific questionnaires for evaluation of Oral Health Related Quality of Life, namely, Oral Impacts on Daily Performances and the Oral Health Impact Profile-14, considered to be gold standard criteria. Validity evaluation consisted of internal consistency evaluation by the Cronbach alfa reliability test, reliability and reproducibility estimated by the Kappa test and the Spearman's correlation, and concurring validation through Spearman's correlation. The Portuguese version of the RDC/TMD Axis II questionnaire was considered consistent (Cronbach alfa = 0.72), reproducible (Kappa values from 0.73 to 0.91, p < 0.01), and valid (p < 0.01). It was concluded that this version showed valid and reproducible results for the Brazilian population, thus paving the way for including Brazil in transcultural epidemiological studies on TMD.

PMID: 17242791 [PubMed - indexed for MEDLINE]

Temporomandibular joint arthrocententesis: evaluation of results and review of the literature.

Rev Bras Otorrinolaringol (Engl Ed). 2006 Sep-Oct;72(5):634-8

Authors: Cavalcanti do Egito Vasconcelos B, Bessa-Nogueira RV, Rocha NS

AIM: This study was designed to investigate the effects of arthrocentesis on the improvement of internal derangement symptoms and jaw function in a series of patients with anterior disc displacement and closed lockjaw. PATIENTS AND METHODS: The study was based on a review of patients records before and after treatment using clinical examinations and radiographs. Visual analog scales were used to measure pain before and after arthrocentesis. Six patients (12 temporomandibular joints) with closed lock symptoms (2 cases) and internal derangements (4 cases) were treated at the Oswaldo Cruz Hospital. The mean follow-up was 11.5 months. RESULTS: The mean maximum vertical opening before treatment was 31.83 mm and after arthrocentesis was 36.50 mm. The visual analog scale for pain before treatment was 7 points (mean) and after arthrocentesis the mean was 4.3. CONCLUSION: Arthrocentesis was shown to be effective in reducing pain and increasing jaw motion in this series of cases.

PMID: 17221055 [PubMed - indexed for MEDLINE]

Synovial chondromatosis of the temporomandibular joint.

Med Oral Patol Oral Cir Bucal. 2007 Jan;12(1):E26-9

Authors: Reyes Mac&#xED;as JF, Sánchez Prieto M

Synovial Chondromatosis (SC) is a disease whose etiology is unknown, can be defined as a benign synovial process characterized by the formation of metaplastic cartilaginous nodes inside connective tissue of articular surfaces, is considered an active metaplastic phenomenon better than a neoplastic process; it presents a greater preference to affect women who constitute almost 70% of reported cases, the age range is wide and oscillates between 18-75 years (average 44.6 years). Between the main clinical findings are: pain, crackle, volume augmentation and a limited buccal opening. SC is an unusual state and the reports in the English literature are no more than 75 cases, only 66 of those where histologically verified, most of those were affecting great joints like hip, knee and shoulder, but if SC is not frequent in this sites, is even more infrequent on temporomandibular joint. The aim of this paper is to report a clinical case and at the same time to realize a brief review of the literature.

PMID: 17195823 [PubMed - indexed for MEDLINE]

Functional outcomes of the retromaxillary-infratemporal fossa dissection for advanced head and neck/skull base lesions.

Skull Base Surg. 2000;10(3):109-17

Authors: Shibuya TY, Doerr TD, Mathog RH, Burgio DL, Meleca RJ, Yoo GH, Guthikonda M

The retromaxillary-infratemporal fossa (RM-ITF) dissection, using a preauricular incision, was initially popularized for the treatment of temporomandibular joint disorders, facial fractures, and orbital tumors. This approach has been expanded for the treatment of advanced head and neck and skull base tumors extending into the infratemporal fossa. We studied prospectively eight consecutive patients requiring a RM-ITF dissection. Pre- and postoperative functional outcomes measured were mastication, speech, swallowing, cranial nerve function, pain, and cosmesis. A significant reduction in pain was noted postoperatively in all patients studied. Limited changes were identified in mastication, speech, swallowing, vision, hearing, or cosmesis postoperatively. The RM-ITF dissection should be considered when resecting advanced head and neck/skull base lesions that extend into this region. We have found minimal morbidity associated with this dissection. This procedure may have a useful place in palliation of patients with incurable pain caused by tumor invasion into the infratemporal fossa.

PMID: 17171134 [PubMed - in process]

Bilateral TMJ disk displacement induces mandibular retrognathia.

J Dent Res. 2006 Dec;85(12):1118-23

Authors: Bryndahl F, Eriksson L, Legrell PE, Isberg A

Unilateral non-reducing TMJ disk displacement has been shown to retard mandibular growth on the ipsilateral side, with facial asymmetry a sequela. We hypothesized that bilateral affliction would impair mandibular growth bilaterally, generating mandibular retrognathia. Non-reducing TMJ disk displacement was surgically created in 10 growing New Zealand White rabbits. Ten additional rabbits served as a sham-operated control group. Facial growth was followed in serial cephalograms, with tantalum implants, during a period corresponding to childhood and adolescence in man. The results verified that bilateral non-reducing TMJ disk displacement retarded mandibular growth bilaterally, the extent corresponding to mandibular retrognathia in man. Maxillary growth was also retarded, but to a lesser degree. Growth impairment fluctuated over time, the most striking retardation occurring during periods of general growth acceleration. This should be taken into consideration when orthodontic treatment, aimed at stimulating mandibular growth, is initiated in adolescent individuals with non-reducing TMJ disk displacement.

PMID: 17122165 [PubMed - indexed for MEDLINE]

Facial pain of cardiac origin: a case report.

Sao Paulo Med J. 2006 May 4;124(3):163-4

Authors: Franco AC, Siqueira JT, Mansur AJ

CONTEXT: Cardiac pain may radiate to the face and lead patients to seek dental care. Dentists may contribute towards the diagnosing of ischemic heart disease and thus refer patients for cardiological evaluation. CASE REPORT: A 50-year-old female patient was referred to a dentist for evaluation of a suspected temporomandibular disorder after repeated visits to medical emergency departments due to excruciating facial and left temporal pain associated with exertion. The pain would start in the chest and radiate to the neck, face and left temporal region. The patient's chief complaint was the facial pain; hence, she sought dental care. The dental examination revealed an edentulous upper jaw and partially edentulous lower jaw with full upper prosthetic set of teeth and decreased vertical dimension. X-ray of facial bones did not reveal any bone abnormalities. A diagnosis of temporomandibular disorder was made. However, she was referred for cardiological evaluation, since her pain was starting in the chest and because she had a past medical history of surgical treatment for coronary artery disease. A diagnosis of angina pectoris was made, the therapeutic regimen was optimized and her angina was brought under control.

PMID: 17119696 [PubMed - indexed for MEDLINE]

Third-molar extraction as a risk factor for temporomandibular disorder.

J Am Dent Assoc. 2006 Nov;137(11):1547-54

Authors: Huang GJ, Rue TC

BACKGROUND: Although third-molar extraction is common in the U.S., there are few reports on the relationship between third-molar extraction and temporomandibular disorder (TMD). The aim of this study was to investigate this potential association. METHODS: The authors enrolled study subjects on their 15th birthdays and followed them continuously for a minimum of five years. The authors ascertained exposure (third-molar extraction) and outcome (TMD) via electronic dental insurance records. A survival analysis design estimated the relative risk of experiencing TMD after third-molar extraction. They considered sex, dental care utilization and other potentially confounding variables in the analyses. RESULTS: A total of 34,491 subjects met the inclusion criterion. Fifty percent of all subjects had third molars removed by the age of 20 years, and 391 subjects had claims indicating TMD. The adjusted relative risk of experiencing TMD after third-molar extraction was 1.6 (95 percent confidence interval, 1.3 to 2.0). Calculation of the population risk indicated that 23 percent of all TMD cases in this age group might be due to third-molar extraction. CONCLUSIONS: Third-molar extraction appears to be a risk factor for TMD. CLINICAL IMPLICATIONS: Dental providers should be aware of the risk of experiencing TMD related to third-molar extraction and take measures to minimize trauma to the joint during extraction.

PMID: 17082281 [PubMed - indexed for MEDLINE]

Nonsplint therapies.

J Am Dent Assoc. 2006 Nov;137(11):1498; author reply 1498, 1500

Authors: Kidder GM

PMID: 17082268 [PubMed - indexed for MEDLINE]

Cervical spine and temporomandibular joint arthritis in a child with Kawasaki disease.

Pediatrics. 2006 Nov;118(5):e1569-71

Authors: Jen M, Brucia LA, Pollock AN, Burnham JM

Severe neck pain, stiffness, and torticollis in a child with Kawasaki disease commonly represent aseptic meningitis or lymphadenitis. Here we present an unusual case of severe cervical spine and bilateral temporomandibular joint arthritis in a 5-year-old boy with a relapse of Kawasaki disease and coronary artery ectasia. The patient had a favorable response to a second course of intravenous immunoglobulin G and indomethacin therapy, with complete resolution of his symptoms.

PMID: 17060481 [PubMed - indexed for MEDLINE]

More about TMD and SEMG.

J Am Dent Assoc. 2006 Oct;137(10):1366; author reply 1366, 1368

Authors: Cooper BC

PMID: 17012709 [PubMed - indexed for MEDLINE]

Temporomandibular disorders.

J Am Dent Assoc. 2006 Oct;137(10):1362-3; author reply 1363-4, 1366

Authors: Jenkins D

PMID: 17012707 [PubMed - indexed for MEDLINE]

Commentary on "Arthrotomography of the temporomandibular joint".

AJR Am J Roentgenol. 2006 Oct;187(4):853-4

Authors: Helms CA

PMID: 16985124 [PubMed - indexed for MEDLINE]

Prevalence, intensity, and correlation of different TMJ symptoms in Lebanese and Italian subpopulations.

J Contemp Dent Pract. 2006 Sep 1;7(4):71-8

Authors: Abou-Atme YS, Zawawi KH, Melis M

AIM: The aim of this study was to compare self reported joint related temporomandibular disorder (TMD) symptoms in Lebanese and Italian dental and non-dental students and to detect any correlation between different symptoms. METHODS AND MATERIALS: A questionnaire was distributed in Sardinia (Italy) to dental and psychology students and in Lebanon to dental, physical therapy, and biology students to investigate the prevalence, intensity, and correlation of four temporomandibular joint (TMJ) symptoms. RESULTS: Prevalence of earache varied among the groups from 10.1% to 29.2%, ear stuffiness from 22.5% to 30.8%, TMJ pain from 13.2% to 21.2%, and TMJ sounds from 18.4% to 46.2%. DISCUSSION: Different prevalence and intensity of earache and TMJ sounds were found in the examined sub-populations diverse in cultural background and education. However, prevalence and intensity of ear stuffiness and TMJ pain were similar. Association between TMJ sounds and TMJ pain was detected in selected sub-populations, and correlation between one symptom on one side of the head with the same symptom on the contralateral side were noted suggesting most of these symptoms are bilateral. CONCLUSION: The results of the study might be useful to anticipate the possible occurrence of associated symptoms or the same symptom on both sides of the head. Correlations with cultural background and education are difficult to establish.

PMID: 16957793 [PubMed - indexed for MEDLINE]

Correlation of clinical and MRI findings of tempero-mandibular joint internal derangement.

Indian J Dent Res. 2006 Jan-Mar;17(1):22-6

Authors: Chowdary UV, Rajesh P, Neelakandan RS, Nandagopal CM

The most common clinical features of tempero-mandibular joint internal derangement are correlated with the MRI findings of shape of the disc in an attempt to find the etiology of tempero-mandibular joint internal derangement. In this study, the clinical parameters of pain, muscle tenderness, clicking with in the joint (like early, middle and late) are correlated with the MRI findings of disc shapes. (like biconcave, thick, lengthened, folded, adhesion). The study reveals any trauma that leads to muscle tenderness results in internal derangement of tempero-mandibular joint.

PMID: 16900891 [PubMed - indexed for MEDLINE]

Computed tomography of the TMJ in diagnosis of ankylosis: two case reports.

Med Oral Patol Oral Cir Bucal. 2006 Aug;11(5):E413-6

Authors: Casanova MS, Tuji FM, Ortega AI, Yoo HJ, Haiter-Neto F

Ankylosis of the temporomandibular joint is characterized by restriction or limitation of mandibular movement. It presents as a classic symptom a limited range of motion on opening. Radiographically, ankylosis presents features that facilitate the diagnosis. However, its visualization is not clear in most of the cases involving conventional radiographic techniques. With the evolution of radiographic techniques, computed tomography (CT) became an important examination in the diagnosis of the ankylosis of temporomandibular joint. Due to the increasing use of the CT and its importance in the diagnosis of this disease, the aim of this paper is to present and describe tomographic images of ankylosis of this joint by presenting two clinical cases, using several slices as axial, coronal, and three-dimensional reformatted images.

PMID: 16878058 [PubMed - indexed for MEDLINE]

The treatment of painful temporomandibular joint clicking with oral splints: a randomized clinical trial.

J Am Dent Assoc. 2006 Aug;137(8):1108-14

Authors: Conti PC, dos Santos CN, Kogawa EM, de Castro Ferreira Conti AC, de Araujo Cdos R

BACKGROUND: The authors compared the efficacy of bilateral balanced and canine guidance (occlusal) splints in the treatment of temporomandibular joint (TMJ) pain in subjects who experienced joint clicking with a nonoccluding splint in a double-blind, controlled randomized clinical trial. METHODS: The authors randomly assigned 57 people with signs of disk displacement and TMJ pain into three groups according to the type of splint: bilateral balanced, canine guidance and nonoccluding. The authors followed the groups for six months using analysis of a visual analog scale (VAS), palpation of the TMJ and masticatory muscles, mandibular movements and joint sounds. They used repeated analysis of variance and a chi(2) test to test the hypothesis. RESULTS: The type of guidance used did not influence the pain reduction, yet both occlusal splints were superior to the nonoccluding splint, on the basis of the VAS. Despite similar outcomes in relation to opening, left lateral and protrusive movements, TMJ and muscle pain on palpation, subjects who used the occlusal splints had improved clinical outcomes. The frequency of joint noises decreased over time, with no significant differences among groups. Subjects in the groups using the occlusal splints reported more comfort. CONCLUSION: The type of lateral guidance did not influence the subjects' improvement. All of the subjects had a general improvement on the VAS, though subjects in the occlusal splint groups had better results that did subjects in the nonoccluding splint group.

PMID: 16873326 [PubMed - indexed for MEDLINE]

The efficacy of traditional, low-cost and nonsplint therapies for temporomandibular disorder: a randomized controlled trial.

J Am Dent Assoc. 2006 Aug;137(8):1099-107; quiz 1169

Authors: Truelove E, Huggins KH, Mancl L, Dworkin SF

BACKGROUND: Treatment recommendations for patients with painful temporomandibular disorders (TMDs) range from conservative treatments such as physiotherapy to aggressive and irreversible treatments such as restorative reconstruction and joint surgery. METHODS: The authors randomized 200 subjects diagnosed with TMD into three groups: usual conservative, dentist-prescribed self-care treatment without any intraoral splint appliance (UT); UT plus a conventional flat-plane hard acrylic splint (HS); and UT plus a soft vinyl (a low-cost athletic mouth guard) splint (SS). Subjects completed questionnaires and clinical examinations at three, six and 12 months. RESULTS: The authors observed no significant differences among the groups in TMD-related pain levels or other common signs and symptoms of TMD at baseline (BL) or at any follow-up. The changes from BL were comparable for all three groups. The authors did not note any significant differences at any follow-up for compliance with study protocols or for occurrences of adverse effects from either splint type. For HS versus SS, there were significant differences in rates of splint use, but these differences were not accompanied by differences in either self-reported symptoms or in clinical findings. CONCLUSIONS: All patients improved over time, and traditional splint therapy offered no benefit over the SS splint therapy. Neither splint therapy provided a greater benefit than did self-care treatment without splint therapy. CLINICAL IMPLICATIONS: These findings suggest that clinicians who treat patients with TMD should consider prescribing low-cost nonsplint self-care therapy for most patients.

PMID: 16873325 [PubMed - indexed for MEDLINE]

The treatment of temporomandibular disorders with stabilizing splints in general dental practice: one-year follow-up.

J Am Dent Assoc. 2006 Aug;137(8):1089-98; quiz 1168-9

Authors: Wassell RW, Adams N, Kelly PJ

BACKGROUND: The authors evaluated temporomandibular disorder (TMD) outcomes in general dental practice one year after treatment with stabilizing splints (SS) or nonoccluding control splints (CS). METHODS: Seventy-two randomly allocated subjects completed initial treatment. The outcomes measures were a pain visual analog scale (VAS), muscle tenderness, temporomandibular joint (TMJ) tenderness, interincisal opening, TMJ clicks and headaches. After initial treatment, 81 percent of the subjects were found to have been treated satisfactorily. The dentists referred the remaining subjects to a dental hospital. At one year, the authors recalled 52 of the original subjects for evaluation. RESULTS: Improvements after initial treatment were maintained at one year for all outcomes, except for TMJ clicking, which returned to pretreatment levels. Eighty-one percent of the subjects rated their treatment as either good or excellent in reducing jaw pain. The authors found that subjects were aware of more of their TMJ clicks than dentists observed at the one-year clinical examination, but most subjects thought their clicking or the associated pain had been reduced. Fifty-five percent subjects had used their splints in the previous six months, but only 31 percent of these had done so daily. There were no significant differences between splint groups. CONCLUSION: At one year, a good response to TMD treatment in general practice had been maintained, but many subjects still had clicking TMJs. CLINICAL IMPLICATIONS: Trained dentists can manage TMD satisfactorily, with only a small proportion of patients needing specialist attention.

PMID: 16873324 [PubMed - indexed for MEDLINE]

Temporomandibular joint clicking noises caused by a multilocular bone cyst: a case report.

J Contemp Dent Pract. 2006 Jul 1;7(3):99-105

Authors: Oz&#xE7;elik TB, Ersoy AE

When diagnosing patients with temporomandibular disorder (TMD) symptoms, the possibility of unusual causes must be considered, including neoplastic disorders, as well as infections and inflammatory disease. Therefore, radiologic examination may prove to be invaluable in the differential diagnosis of TMDs. This article describes a patient whose temporomandibular joint (TMJ) noise was initially diagnosed by another dental clinic as a TMJ anterior disc displacement with reciprocal clicking. Occlusal splint therapy was used for nearly three to four months but did not improve the TMJ noise condition. When the patient was examined clinically and imaged with magnetic resonance imaging (MRI) and computed tomography (CT), a multilocular bone cyst (MBC) was suspected. The cyst could cause surface irregularities in the posterior part of the left eminence of the temporal bone, which could be the source of the clicking noise.

PMID: 16820813 [PubMed - indexed for MEDLINE]

Where is Dr. Dawson?

J Am Dent Assoc. 2006 Jul;137(7):952; author reply 952, 954

Authors: Romans AR

PMID: 16803819 [PubMed - indexed for MEDLINE]

The clinical usefulness of surface electromyography in the diagnosis and treatment of temporomandibular disorders.

J Am Dent Assoc. 2006 Jun;137(6):763-71

Authors: Klasser GD, Okeson JP

BACKGROUND: This article presents a comprehensive review of the recent literature regarding the scientific support for the use of surface electromyography (SEMG) in diagnosing and treating temporomandibular disorders (TMDs). TYPES OF STUDIES REVIEWED: The authors conducted a Medline search involving human studies using the key words "surface electromyography or electromyography" and "masticatory muscles or temporomandibular disorders or craniomandibular disorders." They also reviewed relevant articles regarding the clinical usefulness of SEMG based on reliability, validity, sensitivity and specificity, as well as additional references included in some of the articles. RESULTS: The clinical use of SEMG in the diagnosis and treatment of TMD is of limited value when one considers reliability, validity, sensitivity and specificity as measurement standards. SEMG does not appear to contribute any additional information beyond what can be obtained from the patient history, clinical examination and, if needed, appropriate imaging. CONCLUSIONS: Clinically, the determination of the presence or absence of TMD does not appear to be enhanced by the use of SEMG. However, the modality may be useful in a meticulously controlled research setting. CLINICAL IMPLICATIONS: SEMG has limited value in the detection or management of TMD and in some instances may lead to unnecessary dental therapy as a solution for those disorders.

PMID: 16803805 [PubMed - indexed for MEDLINE]

Psychosocial confusion.

J Am Dent Assoc. 2006 Jun;137(6):726; author reply 728

Authors: Friedman MH

PMID: 16803801 [PubMed - indexed for MEDLINE]

Increase in RANKL: OPG ratio in synovia of patients with temporomandibular joint disorder.

J Dent Res. 2006 Jul;85(7):627-32

Authors: Wakita T, Mogi M, Kurita K, Kuzushima M, Togari A

Although a recent study suggested the involvement of RANKL and osteoprotegerin (OPG) in the pathogenesis of bone-destructive disease, no study has focused on the RANKL:OPG ratio in the synovial fluid of patients with temporomandibular joint (TMJ) disorder. This communication reports on the concentrations of RANKL and OPG in synovial fluid from TMJ patients and healthy control individuals. In contrast to an unchanged concentration of RANKL, a strong decrease in the concentration of OPG was detected in the synovial fluid from patients with TMJ internal derangement. Treatment with the synovial fluid of osteoarthritis (OA) patients resulted in the high production of osteoclast-like cells from blood mononuclear cells in vitro, as well as in pit formation in dentin slices. The addition of anti-RANKL IgG or OPG attenuated OA-synovial fluid-induced osteoclast formation, suggesting that the increase in the RANKL:OPG ratio in the microenvironment of the joint has the potential to induce osteoclastogenesis in TMJ osteoarthritis.

PMID: 16798863 [PubMed - indexed for MEDLINE]

Ultrasonographic findings in normal temporomandibular joints.

Braz Oral Res. 2006 Jan-Mar;20(1):25-32

Authors: Elias FM, Birman EG, Matsuda CK, Oliveira IR, Jorge WA

The purpose of this study was to determine some ultrasonographic standards of temporomandibular joints with normally positioned discs. Nineteen patients from 18 to 45 years old (average age: 27.4 years; 16 females and 3 males), with history of orofacial pain, but without clinical or radiological signs of disc displacement, underwent ultrasonography (US) and magnetic resonance imaging (MRI) for the examination of their joints. In 30 joints, the distance between the most lateral point of the articular capsule and the most lateral point of the mandibular condyle (lateral capsule-condyle distance) was measured, as well as the distance between the most anterior point of the articular capsule and the most anterior point of the mandibular condyle (anterior capsule-condyle distance). In the closed-mouth position, the average values found for the lateral capsule-condyle distance were 1.4 mm and 1.6 mm, respectively in the longitudinal (coronal) and transverse (axial) scans. In the open-mouth position, the average distance was 1.2 mm, in both longitudinal (coronal) and transverse (axial) scans. The average values found for the anterior capsule-condyle distance were 2.3 mm in the closed-mouth position and 1.1 mm in the open-mouth position, both in transverse (axial) scans. Intra-examiner agreement, measured in terms of the intraclass correlation coefficient, varied from 0.83 to 0.93. We believe that this study can contribute to the validation of US as a diagnostic method for temporomandibular joint disorders, provided that the obtained measurements be used in future studies as normal reference values.

PMID: 16729171 [PubMed - indexed for MEDLINE]

Prevalence study of signs and symptoms of temporomandibular disorder in Brazilian college students.

Braz Oral Res. 2006 Jan-Mar;20(1):3-7

Authors: de Oliveira AS, Dias EM, Contato RG, Berzin F

The aim of this study was to evaluate the prevalence and severity of temporomandibular disorders (TMD) in Brazilian college students. A questionnaire was administered to 2,396 students. Seventy-three percent of women (mean age 21.94 +/- 5 years) and 27% of men (mean age 22.41 +/- 4.8 years) answered the questionnaire. The anamnestic index was used to classify the volunteers according to TMD severity degree. The results showed a higher percentage of men without TMD (43.74%) (p < 0.05, Chi-square test). The women exhibited some degree of severity (73.03%) at a higher frequency than men (56.26%). No significant differences were observed between sexes for a same TMD severity degree (p > 0.05). The results indicated TMD prevalence in Brazilian college students similar to that presented in other studies found in the literature reviewed. Longitudinal studies are recommended to follow the prevalence and health care needs in this population.

PMID: 16729167 [PubMed - indexed for MEDLINE]

MR imaging of temporomandibular joint dysfunction: a pictorial review.

Radiographics. 2006 May-Jun;26(3):765-81

Authors: Tomas X, Pomes J, Berenguer J, Quinto L, Nicolau C, Mercader JM, Castro V

Temporomandibular joint (TMJ) dysfunction is a common condition that is best evaluated with magnetic resonance (MR) imaging. The first step in MR imaging of the TMJ is to evaluate the articular disk, or meniscus, in terms of its morphologic features and its location relative to the condyle in both closed- and open-mouth positions. Disk location is of prime importance because the presence of a displaced disk is a critical sign of TMJ dysfunction. However, disk displacement is also frequently seen in asymptomatic volunteers, so that other findings may be required to help make the diagnosis. These findings include thickening of an attachment of the lateral pterygoid muscle, rupture of retrodiskal layers, and joint effusion and can serve as indirect early signs of TMJ dysfunction. It is important for the radiologist to detect early MR imaging signs of dysfunction, thereby avoiding the evolution of this condition to its final stage, an advanced and irreversible phase that is characterized by osteoarthritic changes such as condylar flattening or osteophytes. Further studies conducted with the latest MR imaging techniques will allow a better understanding of the sources of TMJ pain and of any discrepancy between imaging findings and patient symptoms.

PMID: 16702453 [PubMed - indexed for MEDLINE]

Facioskeletal changes in children with juvenile idiopathic arthritis.

Ann Rheum Dis. 2006 Jun;65(6):823-5

Authors: Twilt M, Schulten AJ, Nicolaas P, D&#xFC;lger A, van Suijlekom-Smit LW

OBJECTIVE: To investigate the facioskeletal morphology in patients with juvenile idiopathic arthritis (JIA) with and without temporomandibular joint (TMJ) involvement. METHODS: Eighty five patients were included. TMJ involvement was defined by orthopantomogram alterations. Lateral cephalograms were used to determine linear and angular measurements and occlusion. RESULTS: Patients regardless of their TMJ status had a 67% chance for retrognathia and a 52% chance for posterior rotation of the mandible and, respectively, 82% and 58% if TMJ involvement were present. Changes were not uniformly distributed among the different subtypes. CONCLUSION: Patients with JIA have an altered facial morphology, especially in the presence of TMJ involvement.

PMID: 16699052 [PubMed - indexed for MEDLINE]

Centric relation: A historical and contemporary orthodontic perspective.

J Am Dent Assoc. 2006 Apr;137(4):494-501

Authors: Rinchuse DJ, Kandasamy S

BACKGROUND: Centric relation (CR) has been a controversial subject in dentistry for more than a century. For at least the past four decades, issues involving CR have been of interest to orthodontists. The definition of CR has changed over the past half-century from a retruded, posterior and, for the most part, superior condyle position to an anterior-superior condyle position. TYPE OF STUDIES REVIEWED: The authors addressed the historical and contemporary orthodontic perspective of CR. The source material for this review came mainly from literature and searches the lead author accumulated over the last 30 years. As there is no evidence-based (EB) model level 3 (systemic) review on the topic of CR, the best evidence on this subject was gleaned only from a thorough examination and evaluation at EB model level 2 (experience plus best available sample studies). There was, however, enough high-quality EB model level 2 information on the topic of CR for the authors to draw conclusions on the basis of a scientific appraisal of relevant research. RESULTS: Although the reliability of CR records has been substantiated, the records' validity has little to no evidentiary support. In addition, population-based sample studies and consensus statements from national conferences support the view that the positions of the temporomandibular joint (TMJ) condyles in relation to the glenoid fossa or CR position are not diagnostic of temporomandiblar disorders. There appears to be little to no benefit of using gnathologic records and articulator-mounted dental casts to discern discrepancies in maximum intercuspation of the teeth coincident with TMJ condyles in an anterior-superior CR position in orthodontic patients. CLINICAL IMPLICATIONS: The benefit of using gnathologic CR records and articulators in orthodontics has not been substantiated by scientific evidence.

PMID: 16637479 [PubMed - indexed for MEDLINE]

The use of acupuncture in the treatment of temporomandibular dysfunction--an audit.

Acupunct Med. 2006 Mar;24(1):16-22

Authors: Rosted P, Bundgaard M, Pedersen AM

OBJECTIVE: Temporomandibular dysfunction often represents a major therapeutic problem in a dental practice. Evidence from clinical studies suggests that acupuncture may be useful in the treatment of temporomandibular dysfunction. However, most studies have been performed in university settings. The aims of this study were to determine if the results of acupuncture treatment of temporomandibular dysfunction in general dental practice are comparable to the results obtained in previous studies in university clinics, and whether the treatment approach differs from that used in previous studies. METHODS: The case reports submitted by 15 dentists applying for the diploma of the British Dental Acupuncture Society were combined into one audit. All dentists were informed before submitting the forms that the data might be used for scientific purposes. The criteria for Pain Syndrome Dysfunction were used as inclusion criteria. A visual analogue scale (VAS) was used to assess the pain intensity before and after acupuncture treatment. The acupuncture points and technique used were recorded for each treatment. RESULTS: A total number of 70 case reports were received. Ten patients were excluded, as they did not fulfil the criteria. The remaining 60 patients (50 female) fulfilled an average of 3.2 of the Pain Syndrome Dysfunction criteria, out of a possible five. Their mean age was 40.6 years (range 14-68). The average duration of temporomandibular dysfunction was 32 months (range 1-180). The patients received a mean of 3.4 treatments, each treatment lasting on average 12 minutes. The dentists used only manual stimulation, and mainly acupuncture points over the temporomandibular joint and in the masticatory muscles, points on the neck, and additional relaxing points. The mean pain scores were 7.35 (SD 1.52) before treatment and 2.67 (SD 0.58) after treatment (P < 0.001). A beneficial effect was observed in 85% with an average reduction in the pain intensity of 75%. CONCLUSION: This audit shows that the results of using acupuncture in the treatment of temporomandibular dysfunction in a general dental practice are comparable to those obtained in clinical studies in university settings. Also the therapeutic approach of using acupuncture is similar. Thus, acupuncture is a simple, relatively safe and potentially efficacious and useful technique in the management of temporomandibular dysfunction in a general dental practice.

PMID: 16618045 [PubMed - indexed for MEDLINE]

Intraarticular induction of interleukin-1beta expression in the adult mouse, with resultant temporomandibular joint pathologic changes, dysfunction, and pain.

Arthritis Rheum. 2006 Apr;54(4):1184-97

Authors: Lai YC, Shaftel SS, Miller JN, Tallents RH, Chang Y, Pinkert CA, Olschowka JA, Dickerson IM, Puzas JE, O'Banion MK, Kyrkanides S

OBJECTIVE: To examine the effects of intraarticular induction of interleukin-1beta (IL-1beta) expression in adult mice. METHODS: We used somatic mosaic analysis in a novel transgenic mouse with an inducible IL-1beta transcription unit. Transgene activation was induced by Cre recombinase in the temporomandibular joints (TMJs) of adult transgenic mice (conditional knockin model). The effects of intraarticular IL-1beta induction were subsequently evaluated at the cellular, histopathologic, and behavioral levels. RESULTS: We developed transgenic mice capable of germline transmission of a dormant transcription unit consisting of the mature form of human IL-1beta as well as the reporter gene beta-galactosidase driven by the rat procollagen 1A1 promoter. Transgene activation by a feline immunodeficiency virus Cre vector resulted in histopathologic changes, including articular surface fibrillations, cartilage remodeling, and chondrocyte cloning. We also demonstrated up-regulation of genes implicated in arthritis (cyclooxygenase 2, IL-6, matrix metalloproteinase 9). There was a lack of inflammatory cells in these joints. Behavioral changes, including increased orofacial grooming and decreased resistance to mouth opening, were used as measures of nociception and joint dysfunction, respectively. The significant increase in expression of the pain-related neurotransmitter calcitonin gene-related peptide (CGRP) in the sensory ganglia as well as the auxiliary protein CGRP receptor component protein of the calcitonin-like receptor in the brainstem further substantiated the induction of pain. CONCLUSION: Induction of IL-1beta expression in the TMJs of adult mice led to pathologic development, dysfunction, and related pain in the joints. The somatic mosaic model presented herein may prove useful in the preclinical evaluation of existing and new treatments for the management of joint pathologic changes and pain, such as in osteoarthritis.

PMID: 16572453 [PubMed - indexed for MEDLINE]

Efficacy of an early intervention for patients with acute temporomandibular disorder-related pain: a one-year outcome study.

J Am Dent Assoc. 2006 Mar;137(3):339-47

Authors: Gatchel RJ, Stowell AW, Wildenstein L, Riggs R, Ellis E

BACKGROUND: The authors conducted a randomized clinical trial to evaluate the efficacy of a biopsychosocial intervention for patients who were at high risk (HR) of progressing from acute to chronic temporomandibular disorder (TMD)-related pain. METHODS: The authors classified subjects' risk using a predictive algorithm and randomized them into an early-intervention (EI) or a nonintervention (NI) group. The EI included cognitive behavioral skills training and biofeedback. The authors assessed pain and psychosocial measures at intake and at a one-year follow-up. Subjects' self-reported pain levels were measured on an analog scale and as a response to palpation. RESULTS: At one year, EI-group subjects had significantly lower levels of self-reported pain and depression. At one year, more NI-group subjects than EI-group subjects had utilized health care for jaw-related pain. NI-group subjects were 12.5 times as likely to have a somatoform disorder, more than seven times as likely to have an anxiety disorder, and 2.7 times more likely to have an affective disorder at one year, compared with EI-group subjects. CONCLUSIONS: EI-group subjects had reduced pain levels, improved coping abilities and reduced emotional distress at one year. CLINICAL IMPLICATIONS: The TMD-related pain experience is complex and requires early identification with a biopsychosocial EI to achieve maximal, sustainable results.

PMID: 16570467 [PubMed - indexed for MEDLINE]

Report of ankylosis of the temporomandibular joint: treatment with a temporalis muscle flap and augmentation genioplasty.

J Contemp Dent Pract. 2006 Feb 15;7(1):125-33

Authors: Martins WD

A case of true bilateral ankylosis of the temporomandibular joint (TMJ) is presented. A 19-year-old male patient had a life-threatening ear infection at the age of ten resulting in a progressive restriction of his mouth opening. He presented with almost complete lack of mobility of the mandible. Surgical treatment was a resection of the ankylotic mass, interpositional temporalis composite muscle flaps, and early mobilization and aggressive physiotherapy. The functional results of the interpositional arthroplasty were excellent. After a two-year follow up, an augmentation genioplasty was performed in order to improve facial aesthetics.

PMID: 16491155 [PubMed - indexed for MEDLINE]

Treatment of temporomandibular joint ankylosis by gap arthroplasty.

Med Oral Patol Oral Cir Bucal. 2006 Jan;11(1):E66-9

Authors: Vasconcelos BC, Bessa-Nogueira RV, Cypriano RV

PURPOSE: The purpose of this paper is to show that gap arthroplasty improve mouth opening when treating TMJ ankylosis. PATIENTS AND METHODS: Eight patients with TMJ ankylosis were treated by gap arthroplasty. The patients were evaluated by at least twenty-four months (minimum 24 and maximum 48 months). RESULTS: Of the eight patients (eleven joints), five (62.5%) had unilateral involvement and three patients (37.5%) had bilateral involvement. The mean age was 20 years -/+ 9 (range 3 to 30 years). The mean maximal incisal opening (MIO) in the preoperative period was 9.25 -/+ 6.41 mm and in the postoperative period it was 29.88 -/+ 4.16 mm. The complication of temporary facial nerve paresis was encountered in two patients (25%). No recurrence was observed in our series. CONCLUSIONS: Trauma was the major cause of tempomandibular joint ankylosis in our sample. Gap arthroplasty showed good results when treating TMJ ankylosis.

PMID: 16388298 [PubMed - indexed for MEDLINE]

Gastroesophageal reflux diagnosed by occlusal splint tintion.

Med Oral Patol Oral Cir Bucal. 2006 Jan;11(1):E26-8

Authors: Cebri&#xE1;n-Carretero JL, López-Arcas-Calleja JM

The gastroesophageal reflux (GER) disease is a very frequent digestive disorder, mainly characterised by the reflux of the gastric acidic content to the esophage in abnormal quantities. There are different situations that favour this situation but almost in all of them rely an incompetence of the esophagic sphincter. The clinical consequences are many, including oral manifestations. Among all of them the most frequent is the esophagitis followed by symptoms at the pharynx or larynx and finally, the oral cavity. At this level fundamentally we will find enamel and oral mucosa erosions. We report the case of a patient who was indirectly diagnosed of her esophague disease by the observation of the alterations in the occlusal splint induced by the gastric reflux. We review the literature concerning the above topic and its possible association with the miofascial syndrome.

PMID: 16388289 [PubMed - indexed for MEDLINE]

Severe retrognathia as a risk factor for recent onset painful TMJ disorders among adult females.

J Orthod. 2005 Dec;32(4):249-56; discussion 247

Authors: Miller JR, Mancl L, Critchlow C

OBJECTIVE: To evaluate the importance of severe retrognathia as a risk factor for the development of recent onset painful TMJ disorders among adult females. DESIGN: Case-control study. SETTING: This study was conducted in a large health maintenance organization between 1998 and 1999 [Kaiser Permanente Northwest (KPNW), Portland, OR, USA]. PARTICIPANTS: Adult females with recent onset painful TMJ disorders (n=29) and normal controls (n=104). METHODS: Cases were recruited from the TMD clinic at Kaiser Permanente Northwest (KPNW). Controls were recruited from a dental clinic at KPNW. Case status was determined using a questionnaire; mandibular sagittal position was determined by measuring a research angle on facial photographs. The mean research angle for cases was compared to the mean for controls. Multivariable exact conditional logistic regression analysis was used to examine the demographic characteristics of cases and controls, and to determine the strength of association between recent onset painful TMJ disorders and severe retrognathia. The population attributable risk percentage (PAR%) and the attributable risk percentage (AR%) were calculated to further evaluate severe retrognathia as a risk factor. RESULTS: The mean research angle among cases (67.7 degrees; 95% CI=66.0-69.4) was smaller than among controls (71.6 degrees; 95% CI=70.7-72.5, P<0.001). The odds ratio for the association between case status and the presence or absence of severe retrognathia was elevated (OR=6.3; 95% CI=1.1-47.5, P=0.039). The PAR% and AR%, associated with severe retrognathia, were 13.3 and 84.1%, respectively. CONCLUSIONS: Severe retrognathia is strongly associated with recent onset painful TMJ disorders (OR=6.3). Only a small proportion of these disorders are attributable to severe retrognathia among the total population of adult females (PAR%=13.3%). However, a large proportion of these TMJ disorders are potentially attributable to severe retrognathia among adult females with severe retrognathia (AR%=84.1%).

PMID: 16333046 [PubMed - indexed for MEDLINE]

Temporomandibular joint disorder and other medically unexplained symptoms in rheumatoid arthritis, osteoarthritis, and fibromyalgia.

J Rheumatol. 2005 Dec;32(12):2288-90

Authors: Smythe HA

PMID: 16331751 [PubMed - indexed for MEDLINE]