Clinical evaluation of amitriptyline for the control of chronic pain caused by temporomandibular joint disorders

Temporomandibular disorder (TMD) is characterized by a combination of symptoms affecting the temporomandibular joint and/or chewing muscles. The two most common clinical TMD symptoms are pain and dysfunction. Pain is usually caused by dysfunction, and emergency therapy has focused on controlling it. Recent investigations into TMD have led to the recommendation of antidepressants as a supporting treatment against constant neuralgic pain. The aim of this double-blind study was to verify the efficiency of antidepressants (amitriptyline) as a support in the treatment of chronic TMD pain. Twelve female volunteers presenting chronic TMD pain were divided into two groups and treated for 14 days: Group 1 with 25 mg/day of amitriptyline and Group 2 with a placebo. The intensity of pain and discomfort was evaluated daily, using a visual analog scale (VAS), over a period of seven days preceding the treatment (baseline), during the 14-day treatment, and for seven days after the treatment. The results revealed a significant reduction of pain and discomfort in Group 1 (75%) compared to Group 2 (28%) during the three weeks beginning at baseline (p < 0.01). Amitriptyline proved to be an efficient alternative treatment for chronic pain in TMD patients.     

Efficacy of dry needling in patients with myofascial temporomandibular disorders related to the masseter muscle

ABSTRACT

Objective

This randomized, single-center clinical trial aimed to compare the efficacy of superficial dry needling (SDN) and deep dry needling (DDN) in patients with myofascial temporomandibular disorder (MTMD) related to the masseter muscle.Methods: Forty patients showing MTMD with trigger points in the masseter muscle were randomly assigned to groups. Dry needling of the masseter muscle was performed once per week for three weeks. Pressure pain threshold (PPT) measurements, visual analog scale scores, and maximal jaw opening were assessed.Results: Both patient groups showed significant pain reduction, but the SDN group showed significantly better pain reduction. The PPT measurements obtained in the follow-up examinations at three and six weeks were significantly better than the values in SDN and DDN groups.Discussion: SDN showed better pain-reduction efficacy in patients with MTMD. Further research with a larger size sample and a longer follow-up period will help elucidate the benefits of SDN.     

Relationship between temporomandibular joint pain and magnetic resonance imaging findings in patients with temporomandibular joint disorders

The purpose of this study was to evaluate abnormal magnetic resonance imaging (MRI) findings related to temporomandibular joint (TMJ) pain. This study included 245 joints of 152 patients with temporomandibular disorders with anterior disc displacement; of these, 129 joints had joint pain whereas 116 joints had no joint pain. MRI was used to evaluate the reduction of anterior disc displacement, joint effusion, mandible condylar morphology, bone marrow oedema of the mandibular condyle, and signal intensity of the posterior disc attachment (PDA) on fat-suppressed T2-weighted images. The odds ratio (OR) for each MRI variable for the pain group versus the no pain group was computed using logistic regression analysis. Univariate logistic regression analysis showed significant correlations between TMJ pain and all MRI findings. Multivariate logistic regression analysis showed significant correlations with joint effusion (P = 0.03, OR 2.21), bone marrow oedema (P < 0.001, OR 11.75), and signal intensity of the PDA (P < 0.001, OR 6.21). These results suggest that bone marrow oedema, high signal intensity of the PDA on fat-suppressed T2-weighted images, and joint effusion, in descending order of influence, are factors related to TMJ pain.     

Skin surface temperature over the temporomandibular joint and masseter muscle in patients with craniomandibular disorder

Skin surface temperature was measured over the temporomandibular joint (TMJ) and over the origin of the superficial portion of the masseter muscle in 59 patients with craniomandibular disorder of different character. Forty patients suffered from disorder of muscular origin, 11 from non-specific arthritis and 8 from symptomatic osteoarthrosis. The degree of mandibular dysfunction was estimated by the clinical dysfunction score and index. The temperature was measured by a thermistor applied to the skin. The clinical dysfunction score of the patients varied between 1 and 25 units. Eleven patients had a clinical dysfunction index of I, 22 had II and 26 had III. The temperature over the TMJ varied between 31.3 degrees C and 36.7 degrees C, and over the masseter muscle between 31.1 degrees C and 35.5 degrees C. The patients with unilateral tenderness to palpation of the TMJ and who were diagnosed to have TMJ arthritis had a higher skin surface temperature over the symptomatic than non-symptomatic joint. It was concluded that tenderness to palpation of the TMJ in patients with TMJ arthritis is associated with raised skin surface temperature over the joint.     

Clinical evaluation of patients with temporomandibular joint implants

PURPOSE: An undetermined number of patients with temporomandibular joint (TMJ) symptoms have been treated with intra-articular disc implants composed of Teflon ethylene/propylene or Teflon polytetrafluoroethylene and aluminum oxide (Proplast-Teflon; Vitek, Houston, TX). These implants have shown the potential to fragment in situ resulting in nonbiodegradable particles that stimulate a giant cell reaction and lead to degeneration of local structures, pain, and limitation of mandibular opening. We examined the possible relationship between TMJ implants and persistent pain, responses to sensory stimuli, quality of life, and systemic immune dysfunction. PATIENTS AND METHODS: This case series (32 patients) were referred from university-based orofacial pain centers and private practices from across the United States. Laboratory and clinical assessments evaluated orofacial pain symptoms, neurologic function, clinical signs and symptoms of rheumatologic disease, physical function, systemic measures of immune function, and behavioral measures. RESULTS: We found that TMJ implant patients appeared to have altered sensitivity to sensory stimuli, a higher number of tender points with a diagnosis of fibromyalgia, increased self-report of chemical sensitivity, higher psychologic distress and significantly lower functional ability. Systemic illness or autoimmune disease was not evident in this series of TMJ implant patients. CONCLUSIONS: Significant problems were noted on clinical assessment of TMJ implant patients. This is a US government work. There are no restrictions on its use.     

Long-term evaluation of single-puncture temporomandibular joint arthrocentesis in patients with unilateral temporomandibular disorders

The purpose of this study was to evaluate the long-term effects of the single-puncture arthrocentesis (SPA) technique. Forty-two patients with unilateral temporomandibular joint disorders (TMDs) were treated by SPA. Thirty-eight of these patients completed 1–24 months of follow-up (short-term group) and 21 completed 11 months or longer of follow-up (long-term group). The two groups were evaluated statistically for pain (visual analogue scale), maximum mouth opening, lateral excursion, and protrusion. Both follow-up duration groups showed significant improvements when compared to baseline levels for almost all of the outcome variables (P < 0.05). Single puncture temporomandibular joint arthrocentesis is an effective treatment method over both the short and long term.     

Ultrasonographic features of the masseter muscle in female patients with temporomandibular disorder associated with myofascial pain

OBJECTIVE: The purpose of the present study was to examine ultrasonographic appearances in female patients with temporomandibular disorder (TMD) associated with myofascial pain in comparison with healthy volunteers. STUDY DESIGN: The thickness of the masseter muscle in 25 female patients with TMD was measured at rest and at maximum contraction using ultrasonography. The visibility and width of the internal echogenic bands of the masseter muscle were also assessed and the muscle appearance was classified as 1 of 3 types: type I, characterized by the clear visibility of the fine bands; type II, thickening and weakened echo-intensity of the bands; type III, disappearance or reduction in number of the bands. RESULTS: There were significant differences in the thickness at rest and the increase ratio by contraction between the patient and control groups. The distribution of muscle types showed a significant difference between the 2 groups. CONCLUSION: The ultrasonographic features of the masseter muscle in TMD patients with myofascial pain were clarified and they might be related to muscle edema.     

Ultrasonography as a tool for evaluating treatment of the masseter muscle in temporomandibular disorder patients with myofascial pain

Objectives This study clarified ultrasonography (US) changes after splint therapy and investigated the use of this modality for evaluating treatment of the masseter muscle in temporomandibular disorder (TMD) patients with myofascial pain. Methods Twenty-five female TMD patients with myofascial pain were examined with US before and after splint therapy. The thickness and internal appearance of the masseter muscle were evaluated. Results No differences in thickness were found before and after treatment in either “Improved” or “Not improved” patients. Twelve patients showed changes in the internal appearance. A significant difference was observed in the distributions of types of internal appearance before and after treatment. Three representative cases are presented. Conclusions US has potential for evaluating the masseter muscle in TMD patients with myofascial pain, especially muscles that appear edematous before treatment.     

The evaluation of temporomandibular joint disc position in TMJ disorders using MRI

The purpose of this study was to correlate disc position and the type of disc displacement, intra-capsular effusion and degenerative changes of the condyle as demonstrated in MRI studies. In this study, 126 temporomandibular joints (TMJs) of 63 patients with TMJ disorders were investigated using clinical examination and MRI. One hundred and twelve TMJs were found to have internal derangement as disc displacement. The angle between the posterior margin of the disc and the vertical line drawn through the centre of the condyle was measured on MRI for each TMJ. The positions of the discs were normal, 0 degrees-10 degrees, in 11.11%; slightly displaced, 11 degrees-30 degrees, in 37.30%; mildly displaced 31 degrees-50 degrees, in 15.08%; moderately displaced, 51 degrees-80 degrees, in 7.14% of the TMJs with anterior displacement with reduction (ADDR). The disc position was severely displaced anteriorly, as over 80 degrees, in all TMJs with anterior disc displacement without reduction (ADD), constituting 27.78% of all cases. We found that the smaller the degree of disc displacement the milder the internal derangement and that the intra-capsular effusion was more frequently associated with TMJ with ADDR. The degenerative condylar changes were more severe with an increased degree of anterior disc displacement.     

MRI characteristics of the asymptomatic temporomandibular joint in patients with unilateral temporomandibular joint disorder

Oral Radiology - To determine the association between unilateral temporomandibular joint disorder (TMD) and the presence of imaging abnormalities in the contralateral, asymptomatic joint. MRI...     

Clinical and arthrographic evaluation of the location of temporomandibular joint pain

Two hundred five patients were prospectively examined for temporomandibular joint pain. Arthrograms were performed on 222 joints (188 unilateral and 17 bilateral). Pain in the ear occurred more frequently in arthrographically normal patients and in nonreducing meniscus patients compared with reducing meniscus patients. The location of pain in front of the ear, in the temples, or in the neck or the degree of pain intensity did not correlate to specific meniscal abnormalities. No correlation between the distribution and the character of headaches was observed. Pain characterization alone does not clinically separate meniscal abnormalities.     

The relationship between clinical and MRI findings in patients with unilateral temporomandibular joint pain

BACKGROUND: With the advent of magnetic resonance imaging, or MRI, clinicians and researchers have sophisticated techniques by which to assess the anatomy of the temporomandibular joint, or TMJ. Imaging is indicated when the results will affect the patient's care beyond that which can be gained from a complete clinical assessment. One of the primary indications for treatment of patients with temporomandibular disorders, or TMDs, is jaw pain, including TMJ pain. Therefore, it is necessary to assess whether MRI-depicted TMJ findings are associated with TMJ pain. This study assessed the relationship between TMJ pain and clinical and MRI findings. METHODS: Subjects consisted of 85 patients with unilateral jaw pain in the area of the TMJ. The contralateral, nonpainful TMJ served as the matched control. All patients underwent a complete stomatognathic examination that included palpation of both TMJs. No care was given and no anti-inflammatory medications were prescribed until bilateral MRIs were obtained within one week. RESULTS: The authors found significant relationships between the side of reported jaw pain and the patient's report that palpation of the TMJ was painful and between the side of reported pain and the presence of MRI-detected effusions. The authors found no relationship between the side of reported pain and the presence of a disk displacement, or DD, or between the presence of effusions and DD on either side of the jaw. CONCLUSION: Although MRI-depicted effusions of the TMJ were associated with reports of TMJ pain, there was a high level of false-positive and false-negative findings. The results indicate that palpation of the TMJ is more accurate than MRI-depicted effusions in identifying the TMJ as the source of pain for patients with unilateral jaw pain. CLINICAL IMPLICATIONS: The results of this study suggest that palpation of the TMJ is superior to MRI in identifying the joint as the source of pain. Therefore, the most cost-effective and valid test to determine if the TMJ is a source of jaw pain is a complete clinical assessment.     

Normal variation in skin surface temperature over the temporomandibular joint and masseter muscle

Abstract – The range of the temperature at the skin surface overlying the temporomandibular joint (TMJ) and the origin of the superficial belly of the masseter muscle was investigated in 35 individuals with normal TM joints and 29 individuals with normal masseter muscles. The temperature was measured by a thermistor in contact with the skin. The temperature over the TMJ varied between 32.1°C and 35.5°C (average 34.3°C). The difference in temperature between right and left sides was to an average 0.3°C. The temperature over the masseter muscle ranged from 30.9°C to 35.7°C (average 33.2°C). The difference in temperature between right and left sides was an average 0.4°C. It was concluded that there is a fairly wide range of skin temperature over the normal TMJ and origin of the masseter muscle under the experimental conditions prevailing in this study but that the differences between right and left sides are fairly small. It therefore seems possible to use this thermometric method to assess inflammatory processes and/or changed metabolic activity in the TMJ and masticatory muscles.     

Electromyographic evaluation of masseter and anterior temporalis muscles in patients with temporomandibular disorders following interocclusal appliance treatment

The purpose of this study is to evaluate the interocclusal appliance efficiency in patients with temporomandibular disorder (TMD), by using computerized electromyographic (EMG) evaluation in the rest position of the mandible. Twenty-two patients (male and female) with TMD symptoms, between 18 and 53 years of age, were examined. EMG evaluations were performed before the treatment and during the 90th, 120th and 150th day of using the interocclusal appliance therapy. In the 90th and 120th day, inserting canine guidance and group function disclusion, respectively, changed interocclusal appliance. The results showed that group function disclusion caused shorter EMG activity in the mandible rest position for the anterior temporalis muscle.     

Clinical variables associated with the presence of articular pain in patients with temporomandibular joint clicking

Clinical Oral Investigations - To study and estimate the impact of clinical, somatosensory, and psychosocial variables associated with the concomitant presence of temporomandibular joint (TMJ) pain...