Reported symptoms and clinical findings in a group of subjects with longstanding bruxing behaviour

summary Signs and symptoms of craniomandibular dysfunction (CMD) and social medical history were reported in 29 subjects, aged 23–68 years, with longstanding (5 years or more) bruxing behaviour. The subjects were selected from answers to an advertisement in the local newspaper. The subjects presented many symptoms of a general character including somatic and psycho-social problems, sleep disorders (72%), and pain (86%). More than half of the subjects (55%) had symptoms every day. Frequent aches in the neck, back, throat or shoulders were reported by 69% and frequent headache by 48% of the subjects. The most common symptoms of CMD were pain in the face or jaws (48%), stiffness in the jaws in the morning (44%), temporo-mandibular joint (TMJ) sounds (34%) and fatigue in the jaws during chewing (38%) and the most common clinical signs were more than three muscles tender on palpation (76%), TMJ-sounds (55%) and tenderness of TMJ on lateral palpation (66%). There was a statistically significant correlation between frequent tooth clenching and headache, pain in the neck, back, throat or shoulders, sleep disorders and high scores of the clinical dysfunction index (Di). The frequent clenchers had higher score values than the 'non-clenchers' for pain in the face and the jaws; headache; pain in the neck, back, throat or shoulders and the clinical dysfunction index (Di). These findings indicate a causal relationship between frequent tooth clenching and signs and symptoms of CMD. including headache and pain in the neck, back, throat or shoulders and high pathogenicity for frequent clenching. However, the material in this study is small and some precaution must be taken prior to generalized conclusions. More studies are required, especially sleep laboratory investigations, which could perhaps give answers to some of the numerous questions in this unexplored field of odontology.     

General musculoskeletal complaints in a group of patients with craniomandibular disorders (CMD). A case control study

In a cross sectional study 30 patients with craniomandibular disorders (CMD) and 30 controls were screened for general musculoskeletal complaints. A questionnaire was used to mark the sites of the body that were painful and assessments of pain intensities in the neck, shoulders and the jaws were registered. "Pain tolerance" was clinically measured with cutaneous electrical stimulation over the masseter areas. The CMD patients had a significantly higher number of painful sites on the body than the controls. They showed significantly increased "relative risks" of having musculoskeletal pain especially in the upper neck, the shoulder and lower neck region, the shoulder joint and the thoracic back. Discomfort and pain rating values for the neck and shoulders were significantly higher for CMD patients than for controls. The measurements of "pain tolerance" did not differ between groups. However, an individual variation was found among the CMD patients. Those who had pain in many different parts of the body were the least tolerant of experimentally induced pain.     

Outcome of 6-week treatment with transcutaneous electric nerve stimulation compared with splint on symptomatic temporomandibular joint disk displacement without reduction

The aim of the present study was to compare the effect of transcutaneous electric nerve stimulation (TENS) with the flat occlusal splint in the treatment of temporomandibular joint (TMJ) disk displacement without reduction. Thirty-one patients were included and randomly selected to be treated 6 weeks with either TENS (90 Hz, 30 min, three times/day) or with a flat occlusal splint (24 h/day. Those selected for the TENS group had one electrode placed over the painful TMJ and another electrode over the anterior temporal muscle. The splint group used a conventional flat occlusal splint with cuspid guidance. Both treatment groups visited the clinic once a week. Symptoms and signs were registered before and after treatment. The intensity of pain was recorded with a visual analogue scale (VAS) and with an electronic pocket-sized recorder (Pain-Track) carried 1 week before and also the last week of treatment for continuous registration of pain. Measured with the VAS, half of the patients treated with splints became pain-free or their TMJ pain improved at least 50% both at rest and with jaw function compared with only 6% in the TENS-treated group. With regard to strictly chewing pain, the VAS-registered pain improved in two-thirds of the splint group, compared with 50% of the TENS group. With the Pain-Track device it was found that in most individuals pain was aggravated at mealtimes. The conclusion was that flat occlusal splints in several respects are better than TENS in the treatment of symptoms associated with TMJ disk displacement without reduction.     

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

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.     

颅颌功能紊乱的耳症及治疗研究

目的 研究颅颌功能紊乱（ＣＭＤ）者耳症的发生纺、临床特征及对肌位Ｈｅ板的治疗反应。方法 将２０８例ＣＭＤ者分为耳症组与非耳症组进行研究,临床症状以Ｈｅｌｋｉｍｏ指数计算。结果 ＣＭＤ者耳症发生率２６．４％,女性明显高于男性,其中耳鸣发生率１４．９％,耳痛发生率１０．６％,耳且盘突关系异常者显著多于非耳症组,临床症状表现为ＤｉⅡ者明显遍于非耳症组,耳症出现与颞颌关系结构紊乱密切相关而与髁突器质性改变     

Results obtained from patients referred for the investigation of complaints related to oral galvanism

One hundred consecutive patients, 74 women and 26 men, aged between 18 and 83 years (mean = 54.8 years), referred with complaints related to oral galvanism were investigated and treated and the treatment results were evaluated after 2-3 years. Forty of the patients reported facial pain, pain from the teeth, temporomandibular joints (TMJ) and masticatory muscles and TMJ clicking and locking and 26 reported headache. Smarting in the oral mucosa, smarting of the tongue and xerostomia were reported by 26, 21 and 24 patients, respectively, and 30 patients reported an unpleasant taste, a metallic taste or a battery taste. The same patient often reported several symptoms. The patients also reported various general symptoms, above all joint symptoms, pain in the back, neck and shoulders and general muscular pain but also tiredness, weakness, difficulty in concentrating, depression and insomnia. After clinical and radiological examination, salivary tests, determination of the maximum galvanic current at metallic contacts and screening for contact allergy to dental materials, various oral diagnoses could be established. Most of the patients exhibited functional disturbances of the masticatory system, periodontitis, smarting of the oral mucosa, xerostomia, pulpitis and pulpal necrosis and mucosal lesions. The medical illnesses the patients reported themselves to be suffering from or had been treated for included cardiovascular disorders, high and low blood pressure, asthma, rheumatic disorders, diabetes, pernicious anaemia, gastritis and peptic ulcer. Seventy-six patients took drugs regularly. In most cases there were several oral, dental and medical explanations for the symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)     

肌位板对颅颌功能紊乱症状的治疗作用研究

目的 :探讨肌位板对颅颌功能紊乱 CMD 症状与体征的治疗作用 .方法 :对 10 5例确诊为 CMD者 ,夜间戴用肌位板 3～ 6个月 ,咬合板使前牙平均加高 2 .6± 0 .8mm.结果 :颅颌功能恢复正常者 5 4例 ,占 5 1.4% ,颅颌功能好转 48例 ,占 45 .7% ,无效者 3例 ,占 2 .9% ,肌位板对疼痛的缓解率最高 ,2周内达 90 % ,弹响是最难消除的症状 .其中盘突关系正常者 ,可复性盘前移位者 ,不可复性盘前移位者临床症状消失率分别为 78.8%、42 .1%和 35 .3% .结论 :肌位板是治疗 CMD症状的较好方法 ,有效率达 90 %以上 ,半数 CMD者颅颌功能可完全恢复正常 ,研究同时发现随颞颌关节病变的加重 ,CMD的症状消失率降低 .     

颞下颌关节区疼痛患者全身伴随症状的初步研究

目的调查与颞下颌关节(TMJ)区疼痛伴随出现的全身症状的发生情况。方法选取TMJ区疼痛患者51例及TMJ区无疼痛的对照者31人,调查其TMJ症状及全身伴随症状。治疗半年后对TMJ区疼痛患者进行复查。应用一元线性回归和卡方检验对TMJ区疼痛与全身症状的相关性及伴随性进行统计学分析。结果与TMJ疼痛有相关性的症状包括头痛、背痛、手麻抖、肩颈痛、失眠、目眩、听力下降、眼痛和易疲劳(P<0.05)。患者组部分症状(头痛、肩颈痛、眼痛、耳鸣、目眩、眼下抽搐、易疲劳、手脚发凉、易烦躁、注意力不集中和消化不良)发生的比例显著高于对照组(P<0.01)。半年后与TMJ区疼痛伴随改善的症状有头痛、肩颈痛和易疲劳(P<0.05)。结论头部、肩颈等口腔颌面邻近器官的症状是TMJ区疼痛的主要伴随症状,与TMJ症状的改善有伴随关系。     

Condylar resorption during active orthodontic treatment and subsequent therapy: report of a special case dealing with iatrogenic TMD possibly related to orthodontic treatment

A 28-year-old female underwent orthodontic treatment for approximately 22 months. During the later stages of this treatment, the patient reported right shoulder and neck-muscle pain. In addition, temporomandibular joint disorder (TMD) with a 'clicking' sound during mastication commenced 5 months prior to treatment completion. Specific medication to deal with these symptoms was suggested by medical specialists, as were some stress-relief methods, although the pain still progressed, and subsequent clinical and radiographical examinations were undertaken by another orthodontist. Right mandibular condylar resorption was observed from both the panorex and temporomandibular joint (TMJ) radiographs. No clinical signs of rheumatic disease were observed, although bruxism was noted. Following the termination of the orthodontic treatment by the second practitioner, the patient was treated with splint therapy 1 month subsequent to which, the previous symptoms of pain in the shoulder and neck, and the clicking sound during mastication had subsided. During the 14-month period of splint therapy and follow-up, new bone growth in the right condyle was observed from radiographs.     

Follow-up Examination of the Temporomandibular Joint Disk After Splint Therapy by Magnetic Resonance Imaging—A Case Report

A 38-year-old female patient presented with temporomandibular joint (TMJ) pain, bilateral clicking and intermittent locking. The patient was treated with a splint in order to decrease the symptoms and to obtain a proper disk-condyle relationship. The effect of the splint therapy was investigated after one month and after one year and five months using magnetic resonance imaging (MRI) with splints in place. After treatment for one year and six months, the clicking sound of the right TMJ disappeared, and she became free from locking. With the aid of MRI, it was found that the disk of the right TMJ had changed from an anterior position with reduction to a superior position. In the left TMJ, the disk changed from an anterior position without reduction to an anterior position with reduction. MRI gave important information on the disk position and the efficacy of the splint therapy.     

Effect of occlusal splints on TMJ symptomatology.

The clinical response of TMJ symptomatology to full-coverage occlusal splints, when used as the only means of treatment, was evaluated. The symptomatology recorded during the last postoperative visit was compared to the initial visit. The response of the different symptoms to the use of the occlusal splint was analyzed statistically using a chi-square test. A statistically significant difference (p = .03) was only found when comparing those groups having only pain or dysfunction symptomatology. The response favored the remission of pain. However, every symptom was improved with the use of an occlusal splint. It was concluded that: 1. Both pain and dysfunction symptomatology will benefit from the occlusal splint therapy. 2. The pain response will be significantly better than the dysfunction response when the patient is treated with an occlusal splint. 3. Eighty percent of the patients suffering from a TMJ syndrome will improve or be cured when the only form of treatment is the use of a full-coverage occlusal splint.     

Association between CMD signs and symptoms, oral parafunctions, race and sex, in 4–6-year-old African-American and Caucasian children

summary The associations between oral parafunctions, signs and symptoms of craniomandibular disorders (CMD), race, and sex were analysed in recordings from 203 4-6-year-old African-American and Caucasian children. Significant correlations were found between bruxism, nail biting, thumb sucking and most of the CMD signs and symptoms. There were also significant associations between most of the signs and symptoms and race, while significant association with sex was found only regarding headache, TMJ sounds and chewing pain. Significant associations were found between most CMD signs and TMJ sounds supporting the view that joint sound recordings have diagnostic value. There were also significant associations between the pain variables recorded by questionnaire and those recorded by palpation, which indicates that reliable data can be obtained by interviewing children as young as five. The results of this study support the concept that oral parafunctions have a significant role in the aetiology of CMD. The results also show that race and sex need to be considered when analysing the possible aetiological role of oral parafunctions in CMD. Longitudinal studies, beginning with low age groups are needed to better determine the role of childhood oral parafunctions in CMD aetiology.     

Multidimensional evaluation of craniomandibular dysfunction. II: Pain assessment

To standardize clinical history taking, a comprehensive anamnestic questionnaire was developed (Screen). Screen includes questions about: (i) pain, (ii) other symptoms of craniomandibular dysfuntion (CMD), (iii) correlates of CMD, (iv) pychosocial factors, and (v) general health. The current study focuses on variables in Screen concerning pain reported somewhere in the head, neck and/or shoulders. This study was performed to assess whether subgroups of patients with signs and symptoms of CMD and a control group of dental patients with and without signs and symptoms of CMD can be characterized by differences in areas reported to be painful, in quantitative and qualitative characteristics of pain, and in factors exacerbating pain. Results indicate that several characteristics of pain as measured in Screen can be used to discriminate between: (i) subgroups of subjects with signs and/or symptoms of CMD and controls without signs or symptoms of CMD, (ii) subgroups of clinical cases and controls with signs or symptoms of CMD, and (iii) patients with CMD with mainly a myogenous component and patients with CMD with mainly an arthrogenous component. The results of logistic regression analysis indicate that four adverbs describing pain correctly classified 75% of patients with CMD-myo and patients with CMD-arthro. Differences between patients and controls are interpreted with regard to the correct classification of patients with CMD with a mainly myogenous component and patients with CMD with a mainly arthrogenous component and the subjective treatment need for CMD. Implications for further research are discussed.     

Outcomes of temporomandibular joint disorder therapy: observations over 13 years

Objective. To evaluate the outcome of temporomandibular joint (TMJ) disorder therapy with different kinds of splints. Methods. One-hundred-and-twenty-nine patients with TMJ disorders and meeting the primary selection criterion of reporting pain in the TMJ region were clinically evaluated. Magnetic resonance imaging of the TMJ was performed at baseline 1993–94. A protrusion splint was used whenever joint clicking could be eliminated by protrusion. In the other cases, a pivot or a Michigan splint was inserted. Re-evaluation of the patients after 12 months included a clinical examination. After 5 and 13 years, all patients were examined by means of a questionnaire. Results. Pain was significantly reduced in the case of more than two-thirds of the patients 1 year after the first consultation. After 5 and 13 years, the percentages of patients with reported pain had increased only slightly. However, the therapy did not reduce joint noises or mouth opening. The prevalence of joint noises was reduced to less than a quarter after 1 year, but during the next 13 years increased to the former level. Initially, one-third of the patients had mouth-opening reduction. This proportion dropped to one-third of these cases after 1 year, but increased to 40% after 13 years. Conclusions. Treatment using splints reduced pain in approximately two-thirds of the patients, but with no difference between the three types of splints used.     

Soft versus hard occlusal splint therapy in the management of temporomandibular disorders (TMDs)

Aim

To compare between soft and hard occlusal splint therapy for the management of myofacial pain dysfunction (MPD) or internal derangement (ID) of the temporomandibular joint (TMJ) with reciprocal clicking.

Patients and methods

This study included 50 patients (age range: 24–47 years) who had been diagnosed with MPD or ID of the TMJ in the form of reciprocal clicking. Patients were divided into two groups. They were treated for 4 months with either a vacuum-formed soft occlusal splint constructed from 2-mm-thick elastic rubber sheets (soft splint group) or a hard flat occlusal splint fabricated from transparent acrylic resin (hard splint group). Monthly follow-up visits were performed during the treatment period. Before treatment and 1, 2, 3 and 4 months after treatment, the dentist measured all parameters of TMJ function (pain visual analog scores, tenderness of masticatory muscles, clicking and tenderness of the TMJ, and range of mouth opening).

Results

All parameters of TMJ function showed significant improvement in both groups during the follow-up period, with a statistically significant difference between the two groups at the 4-month follow-up visit.

Conclusions

Both forms of occlusal splints (soft and hard) improved TMJ symptoms in patients with MPD or ID of the TMJ. However, the soft occlusal splints exhibited superior results after 4 months of use.     

Intra-articular and muscle symptoms and subjective relief during TMJ internal derangement treatment with maxillary anterior repositioning splint or SVED and MORA splints: A comparison with untreated control subjects

Discomfort associated with wearing an intraoral splint represents a problem in the management of temporomandibular joint (TMJ) internal derangement. This study evaluated whether the use of a mandibular splint during the day and a maxillary splint at night could be more comfortable and therefore as efficacious in internal derangement treatment as a maxillary splint (AR splint). Fifty (50) patients (average age 28.8; range 14-63) with confirmed internal derangement in at least one TMJ were divided into three groups: 20 patients treated with AR splint (Group I); 20 patients treated with a SVED (Sagittal Vertical Extrusion Device) and a MORA (Mandibular Anterior Repositioning Splint) (Group II); and 10 patients who underwent no treatment (Control Group). Joint noise, pain intensity and its character (as constant or chewing/biting pain), muscular pain, and subjective relief were evaluated monthly before treatment began (T0) and for six months thereafter. The following results were found: 1. Subjects in Group I and Group II displayed a significant decrease in joint pain (p<0.001), constant pain (p<0.001), chewing/biting pain (p<0.001), joint noise and muscle pain from the beginning through the sixth month follow-ups; 2. At T1 and T2, subjects in Group II reported significantly lower discomfort associated with the devices than subjects in Group I. The use of two splints seems to be as efficacious as the use of an AR maxillary splint; however an AR splint is considered more comfortable by patients, especially during the first months of therapy.     

Rigidity of commonly used dental trauma splints

Abstract – Background/Aims: The stability of immobilization devices varies from flexible to rigid, depending on the trauma. We evaluated the rigidity of various commonly used splints in vitro Material and Methods: An acrylic resin model was used. The central incisors simulated injured teeth, with increased vertical and horizontal mobility. The lateral incisors and canines stimulated uninjured teeth. Tooth mobility was measured with the Periotest^® device. Vertical and horizontal measurements were made before and after splinting, and the difference between values was defined as the splint effect. We evaluated 4 composite splints, 3 wire‐composite splints, a titanium trauma splint, a titanium ring splint, a bracket splint, and 2 Schuchardt splints Results: For all injured teeth and all splints, there was a significant splint effect for the vertical and horizontal dimensions (P < 0.05). For injured teeth, the composite splints produced the largest changes in vertical tooth mobility; wire‐composite splints 1 and 2, using orthodontic wires, produced the smallest vertical splint effects. For uninjured teeth, the Schuchardt 1 splint and the bracket splint produced the largest splint effects; wire‐composite splints 1 and 2 produced only a slight change in tooth mobility. Composite splints 2 and 3 produced the largest horizontal splint effects for injured teeth, and the 4 composite splints produced the largest horizontal splint effects for uninjured teeth. The most horizontally flexible splints were the titanium trauma splint and wire‐composite splints 1 and 2. Conclusions: According to the current guidelines and within the limits of an in vitro study, it can be stated that flexible or semirigid splints such as the titanium trauma splint and wire‐composite splints 1 and 2 are appropriate for splinting teeth with dislocation injuries and root fractures, whereas rigid splints such as wire‐composite splint 3 and the titanium ring splint can be used to treat alveolar process fractures.     

改良后牙咬合板治疗颞下颌关节盘不可复性前移位的效果评价

目的:探讨改良后牙咬合板治疗颞下颌关节盘不可复性前移位的临床效果.方法:随机选取2016年10月-2017年10月在广州医科大学附属口腔医院就诊的颞下颌关节盘不可复性前移位患者89例作为研究对象,其中,男18例,女71例,年龄16～59岁.患者分为2组,第1组47例,治疗方案为配戴改良后牙咬合板;第2组42例,治疗方案...     

The relationship between loading on the TMJ and occlusal splints]

The primary purpose of this study is to estimate loading conditions on the TMJ with five different occlusal splint.We developed a model that simulated dynamic relationship between dental occlusion,masticatory muscles and TMJ.It is demonstrated that loading on the condyle increases whatever kinds of splints are used.The anterior splint brings about larger loading on the condyle than any other splint.When the ratio force of the muscle on the non pivot is1,left-side pivot split makes loading on left condyle decrease and right increase.It was change on both condyles when posterior teeth are missing including loading, contact and unilateral mastication.     

三种牙合板结合肌松剂治疗可复性关节盘前移位

目的：对松驰型牙合板、稳定型牙合板及调位牙合板结合肌松剂Ｍｙｏｎａｌ治疗可复性关节盘前移位的疗效观察。方法：临床分组治疗，随访。结果：松驰型牙合板、稳定型牙合板及调位牙合板分别对９例，１２例和１８例可复性盘前移位病例的弹响消除或明显减弱效果达８８．９％，７５．０１％，１００．０％，结合Ｍｙｏｎａｌ治疗，３９例患者关节疼痛消除或减弱，开口度增大至正常。结论：松驰牙合板、稳定型牙合板及调位牙合板对可复性盘前移位有较好的治疗作用。