The effect of supervised exercise on localized TMD pain and TMD pain associated with generalized pain

Objectives: To evaluate the effect of a supervised exercise program in patients with localized/regional temporomandibular disorder (TMD) pain and with TMD associated with generalized pain.

Material and methods: Consecutively referred patients with localized/regional TMD pain (n?=?56; 46 women and 10 men, mean age 44 years) and TMD associated with generalized pain (n?=?21; 21 women, mean age 41 years) participated. Patients underwent a 10-session structured supervised exercise program over 10–20 weeks that included relaxation, and coordination and resistance training of the jaw and neck/shoulders. The outcomes were jaw pain intensity on the Numerical Rating Scale, endurance time for jaw opening and protrusion against resistance and chewing, and effect of pain on daily activities.

Results: After the exercise program, a reduction in jaw pain was reported by the local (p?=?.001) and general (p?=?.011) pain groups. There were no significant differences in jaw pain intensity between the groups, before (p?=?.062) or after treatment (p?=?.121). Endurance time increased for both groups for jaw opening/protrusion (both p?<?.001) and chewing (both p?=?.002). The effect of jaw pain on daily activities decreased after exercise compared to baseline for both the local (p?<?.001) and general (p?=?.008) pain groups.

Conclusions: Supervised exercise can reduce TMD pain and increase capacity in patients with TMD. The results suggest that activation of the jaw motor system with exercise has a positive effect in patients with localized/regional TMD pain and TMD associated with generalized pain.     

Temporomandibular disorders and mandibular vertical asymmetry

Objective To analyze the association between mandibular vertical asymmetry and the presence of TMD in adult patients.

Methods This case-control study recruited patients from the orthodontic clinic at FEBUAP. Patients were classified on the basis of diagnostic criteria for temporomandibular disorders (DC/TMD). Panoramic radiographs were measured to determine mandibular vertical asymmetry indices according to criteria described by Kjellberg and Habets. Both methods (DC/TMD and index criteria) were standardized a priori.

Results A total of 56 patients were analyzed, of whom 25 (44.6%) met the inclusion criteria and were divided into two groups (TMD group, n = 15; non-TMD group, n = 10). The highest asymmetry index was observed in the condylar neck, followed by the total condylar asymmetry index, but without significant differences between groups (p > .05).

Conclusion There is no association (p > .05) between temporomandibular disorders and mandibular vertical asymmetry.     

Immunohistochemical analysis of IL-1 Receptor 1 in the discs of patients with temporomandibular joint dysfunction

Objective Temporomandibular joint dysfunction (TMD) may affect a patient’s quality of life, and one of the etiologies can be anterior disc displacement with reduction (ADDwR) and anterior disc displacement without reduction (ADDWoR). Interleukin 1 Receptor 1 (IL-1R1) is a membrane receptor that plays an important role on initiating immune and inflammatory response by binding the agonists ligands of IL-1 alpha and IL-1 beta. Therefore, the aim of this study was to evaluate, through immunohistochemical analysis, the association of IL-1R1 with TMD.

Methods Thirty-nine human disc samples were collected and composed three different groups: ADDwR (n = 19), ADDwoR (n = 12), and control group (n = 8). The samples were immunostained with IL-1R1 antibody and evaluated on both quantity and intensity of staining.

Results There was a statistically significant difference (p < 0.05) between the control and test groups for both quantity and intensity of staining.

Conclusion IL1-R1 was associated with ADDwR and ADDwoR in TMD discs of humans.     

The relationship between neck pain and cervical alignment in patients with temporomandibular disorders

ABSTRACT

Objective: To elucidate the impact of neck pain on cervical alignment in patients with TMDs.

Method: Patients diagnosed with TMDs between November 2013 and November 2015 were included. All subjects underwent lateral cervical X-ray evaluation and completed the RDC/TMD Axis II Biobehavioral Questionnaire for TMDs. Patients with neck pain also completed the Neck Pain & Disability Scale (NPDS). Cervical lordosis angle was measured according to C2-C7 Cobb’s method.

Results: The mean cervical lordosis angle of the whole group (n = 60) revealed hypolordosis (10.9 ± 12.7°). Cervical lordosis angle did not differ between patients with (n = 28) and without (n = 32) neck pain (12.2 ± 12.8° versus 9.8 ± 12.7°, respectively; p = 0.46). TMD-related variables were not correlated with cervical alignment but were moderately correlated with NPDS score, with the exception of TMD-associated disability.

Conclusion: Patients with TMDs have hypolordotic cervical malalignment (tendency toward kyphosis) regardless of neck pain.     

Temporomandibular clinical exploration in Italian adolescents

Objective: This study investigated the prevalence of the signs and symptoms of temporomandibular disorders (TMD) among Italian adolescents.

Methods: The data were recorded from 567 subjects (246 males and 321 females; age range 11–19 years), grouped according to age and molar class relationship.

Results: Forty-four point one percent of subjects showed at least one sign or symptom of TMD, which were significantly more frequent in the 16–19 year-old group (52.9%) in respect to the 11–15 year-old group (39.8%) (χ ² = 8.78; p = 0.003). Signs and/or symptoms were about 1.6 times more frequent in subjects with Class II/1 malocclusion (χ ² = 13.3, p = 0.0003), mostly for TMJ sounds (χ ² = 1.444; p = 0.036). Myalgia was more frequent in females than in males (χ ² = 3.882; p = 0.049).

Conclusion: TMD signs and/or symptoms among Italian adolescents seem diffused (44.1%). Therefore, all adolescents should be screened thorough medical history and clinical examination.     

A survey on the potential relationships between TMD,possible sleep bruxism,unilateral chewing,and occlusal factors in Turkish university students

Objective: To evaluate whether there is a relationship between possible sleep bruxism (PSB), temporomandibular disorders (TMD), unilateral chewing (UC), and occlusal factors in university students recruited from Cumhuriyet University in Turkey.

Methods: For this cross-sectional survey, 519 (223 males, mean age 21.57 ± 2.3 years, 296 females, mean age 21.02 ± 2 years) university students who admitted to the Department of Oral and Maxillofacial Radiology of the Faculty of Dentistry, Cumhuriyet University for dental care between 2012 and 2014 were selected randomly. Students were asked to complete a questionnaire form including questions about TMD, PSB and UC. Presence and direction of malocclusion were recorded during clinical examination. Chi-square test was used for statistical analysis.

Results: It was found that 96.6% of the students with PSB had TMD (p < 0.05). The prevalence of severe TMD was high among students with PSB. There was a significant association between UC, PSB and TMD (p < 0.05). No statistically significant association was found between occlusal factors and PSB and TMD (p > 0.05).

Conclusion: Sleep bruxism, which heavily depends on self-report, is significantly associated with TMD. Unilateral chewing seems to be a common factor for development of SB and TMD. However, further studies are needed to corroborate this finding. Additionally, this study supports the hypothesis that occlusal factors are not related to self-reported sleep bruxism.     

Immunohistochemical expression of TLR-4 in temporomandibular joint dysfunction

Objective Toll-like receptor 4 (TLR-4) is a transmembrane protein involved in the innate immune system and has been implicated in the pathogenesis of temporomandibular joint dysfunction (TMD). The purpose of this study was to histologically examine the level of expression of TLR-4 relative to severity of TMD.

Methods Thirty-one human TMJ disc samples were immunostained for TLR-4 and evaluated for intensity of stain. Among the samples, 8 were control samples, 16 were from patients with anterior disc displacement with reduction (ADDwR), and 7 were from patients with anterior disc displacement without reduction (ADDwoR).

Results There was no statistically significant difference in intensity of stain between groupings (p = 0.673).

Conclusions The results indicate a negative correlation between TMD and the expression of TLR-4.     

Evaluation of signs,symptoms, and occlusal factors among patients with temporomandibular disorders according to Helkimo index

Objective: This study sought to assess the clinical signs and subjective symptoms of TMD, including the occlusal condition.

Methods: Recruited individuals included 123 patients (58 men, 65 women) aged 15 to 65 years (mean 38.6 years) who had been referred to the TMD department. Helkimo dysfunction, occlusal, and anamnestic indices were used to assess signs of TMD, occlusal condition, and symptoms, respectively. Relationships of occlusal factors with signs and symptoms of TMD were evaluated by Spearman’s correlation test. Associations of TMD with sex and age distributions were assessed by Mann–Whitney and Spearman’s test, respectively.

Results: The prevalence of signs and symptoms was as high as 75%. Occlusal factors had significant associations with signs and symptoms of TMD.

Conclusion: Prevalence of TMD in the study population was high, without preference for age or sex. Occlusal factors may play a role in the etiology of TMD.     

Relationship of self-reported sleep bruxism and awake bruxism with chronotype profiles in Italian dental students

Objectives: A cross-sectional study was performed to assess the association between possible sleep bruxism (SB) and awake bruxism (AB) with sleep characteristics and chronotype (i.e. circadian cycle preference).

Methods: One-hundred-nineteen young adults filled out a self-reported questionnaire to assess SB and AB, a questionnaire about daily life aspects, as well as the Morningness-Eveningness Questionnaire (MEQ) to profile chronotype.

Results: The frequency of self-reported SB and AB was 25.2% and 37.0%, respectively. Both SB and AB were significantly more frequent in females than males. Most participants had an intermediate chronotype profile (n = 85; 71.4%). Neither SB (p = 0.556) nor AB (p = 0.334) were associated with chronotype. Nightmares were more prevalent among individuals with possible SB (38.3%). Difficulty concentrating in daily activities was more frequently reported among individuals with AB (51.9%).

Conclusion: There was no association between possible SB and AB or the chronotype profiles among Italian dental students.     

Risk factors related to aggressive condylar resorption after orthognathic surgery for females: retrospective study

Objective: The aim of the present study was to identify the risk factors for aggressive condylar resorption (ACR) after orthognathic surgery.

Methods: A total of 25 female patients with osteoarthritis (OA) scheduled for orthognathic surgery were divided into two groups: those who exhibited ACR (ACR (+), n = 8) and those who did not exhibit ACR (ACR (?), n = 17) after surgery. Clinical indices were used to determine the extent of mandibular advancement, the presence of temporomandibular disorder (TMD), and relevant medical treatment histories (including the use of oral contraceptive (OC) medication. TMJ dysfunction was clinically evaluated in terms of pain, the presence of sounds (clicks or crepitus), and disc displacement, joint effusion (JE), and synovial hyperplasia (SH); these were further investigated with the aid of magnetic resonance imaging (MRI). The cephalographic findings were compared with the normal profiles of Japanese subjects.

Results: The mean (with SD) extent of mandibular advancement was 11.4 mm (2.4) in ACR (+) and 4.1 mm (1.8) in ACR (?). The TMD medical history of ACR (+) was much more extensive than that of ACR (?); all patients in ACR (+) had a history of OC use. More patients in ACR (+) than in ACR (?) had TMJ dysfunction and disc displacement, JE, and SH on MRI. Preoperative cephalograms showed that ACR (+) patients exhibited counterclockwise rotation of the mandible and retrognathism that was attributable to a small sella–nasion–B (SNB) angle, a wide mandibular plane angle, and a negative inclination of the ramus.

Conclusions: The present findings suggest that the development of ACR after orthognathic surgery to treat mandibular retrognathism may be associated with coexisting TMJ pathologic abnormality.     

Prevalence of temporomandibular symptoms and parafunctional habits in a university dental clinic and association with gender,age, and missing teeth

Objective To assess the prevalence of symptoms of temporomandibular disorder (TMD) and parafunctional habits as well as to investigate their association with age, gender, and number of missing teeth.

Methods This retrospective study is based on 4204 randomly selected patients who were examined to determine their symptoms of TMD, such as clicking, difficulty chewing, difficulty opening/closing, as well self-reported joint pain and parafunctional habits.

Results Clenching/grinding was reported by 26.5% of the examined population, clicking by 14.8%, and difficulty chewing and closing by 3.6%. Significant associations between the number of missing teeth with clenching/grinding (p = 0.05) and difficulty chewing (p < 0.001) were detected. Age and gender showed significant effects on the examined parameters (p < 0.05).

Discussion Understanding the TMD subjective symptoms in relation to age, gender, and tooth loss would be of great value for treatment planning and could provide other perspectives to establish preventive measures.     

Relationship between the frequency of sleep bruxism and the prevalence of signs and symptoms of temporomandibular disorders in an adolescent population

PURPOSE: The relationship between sleep bruxism (SB) and temporomandibular disorders (TMD) is unclear. This study aimed to estimate SB prevalence in an adolescent population and to investigate the relationship between SB frequency and prevalence of TMD signs/symptoms. MATERIALS AND METHODS: First-year students at a high school in Okayama, Japan, were recruited in 2005, with 195 subjects responding. The SB detection device was a miniature disposable device (BiteStrip, SLP) that indicated the total SB events per night on a 4-grade score. The subjects were divided into severe and nonsevere SB groups with SB frequency cutoffs. The subjects were examined for temporomandibular joint (TMJ) noise during mouth opening/closing, tenderness of the masticatory/cervical muscles, and range of TMJ condylar movement. The presence/absence of headache and shoulder stiffness was also determined by the interview. The odds ratio (OR) and confidence interval (CI) were calculated to test the relationship between SB frequency, gender difference, and presence of the TMD signs/symptoms by multiple regression analysis. RESULTS: Severe SB (more than 125 events per night) was significantly related to the presence of TMJ clicking (OR: 3.74, CI: 1.22-11.49, P = .02), while gender (male) was not related to the presence of TMJ clicking. Severe SB was not related to headache, though gender (male) was significantly related to headache (OR: 2.52, Cl: 1.04-6.11, P= .04) in these subjects. CONCLUSION: These results suggest that the presence of TMJ clicking was closely related to severe SB in an adolescent population.     

Temporomandibular disorders and quality of life among 12-year-old schoolchildren

Objectives: The aim of this study was to investigate the association between symptoms of temporomandibular disorders (TMD), quality of life, and malocclusion.

Methods: A cross-sectional observational design study was utilized among 248 schoolchildren aged 12 years old. Symptoms of TMD were assessed using the Orofacial Pain and Temporomandibular Disorders Triage Questionnaire, and subjects were further evaluated as oral-health-related quality of life (CPQ_11-14), tooth clenching/grinding and malocclusion (Dental Aesthetic Index). Chi-square for independence, Odds Ratio and Mann–Whitney test were used (p = 0.05) statistically.

Results: Statistically, association was detected between TMD symptoms with pain and worse quality of life (p < 0.0138), and pain with quality of life and clenching/grinding (p = 0.0120 and 0.0007).

Discussion: The symptoms of TMD are associated with pain and teeth clenching, causing a negative impact on schoolchildren’s quality of life; thus, a study of the TMD impact on quality of life is justified.     

Frequency of temporomandibular disorder signs and symptoms among call center employees

Objective: The current study aimed to investigate the frequency of signs and symptoms of temporomandibular disorders (TMD) among call center employees.

Methods: Workers from four call centers (CC) were invited to participate in this study. The examination was based on the Research Diagnostic Criteria for Temporomandibular Disorder (RDC/TMD). The tenderness of the masticator muscles was assessed on both sides by bilateral palpation. The mobility of the mandible was measured with a plastic millimeter ruler on opening, lateral excursions, and protrusion.

Results: In total, 124 call center employees with a mean age of 28.61 ± 4.71 (between 22 and 47 years of age) were enrolled in this study. There was no statistically significant relation between the numbers of calls answered in a day and teeth clenching, teeth grinding, earache, tinnitus, or pain on yawning/chewing. Only protrusive movement pain and joint noise were significantly higher among employees who answered more than 140 calls/day (p < 0.01). An evaluation of the TMD signs and symptoms in relation to job stress level revealed that job stress level significantly affected the incidence of headaches among call center employees (p < 0.01).

Conclusion: The present study demonstrated no statistically significant relation between TMD signs and symptoms and call center employees except protrusive movement pain and joint noise. This relation was seen only in the employees who answered more than 140 calls per day. Headache, teeth clenching, and TMJ noise were the signs and symptoms encountered most often in this study. Multicentered studies in different geographic locations should be conducted to eliminate the limitation of this study.     

Management of pain in TMD patients: Bio-oxidative ozone therapy versus occlusal splints

Objective: To compare the effects of bio-oxidative ozone application with occlusal splints in temporomandibular disorder (TMD) patients with pain.

Methods: Forty participants were selected after the diagnosis of TMD and randomly divided into two groups: ozone group (OG, n = 20) and occlusal splint group (OCSG, n = 20). Ozone was applied to patients three times per week, for a total of six sessions. Patients in the OCSG were instructed to use occlusal splints every night over a period of four weeks.

Results: Mandibular movements showed significant differences for the time factor in OG and OCSG. Pressure pain thresholds of the temporal and masseter muscles at follow-up were significantly higher in the OCSG group. Both treatments statistically decreased the visual analog scale (VAS) scores. However, no statistically significant difference was observed between groups after the application of treatments.

Discussion: Occlusal splint treatment is still the gold treatment modality for objective pain relief in patients with TMD pain.     

Sex differences in pharyngeal airway morphology in adults with skeletal Class III malocclusion

Objectives: To compare the pharyngeal airway dimensions in adults with skeletal Class III malocclusion and well-balanced faces, to ascertain whether sex can influence such measurements and to correlate skeletal pattern with pharyngeal dimensions.

Methodology: Fifty adults were recruited and assigned to two groups: skeletal Class III (n = 25; 12 males and 13 females, mean age = 26.1 years), and skeletal Class I (n = 25; 11 males and 14 females, mean age = 26.0 years), with well-balanced faces. Pharyngeal measurements were made using cone beam computed tomography and analyzed with Dolphin Imaging software 11.5.

Results: Pharyngeal sagittal area, length, retroglossal area and width were statistically greater for males. Pharyngeal volume was greater for Class III patients (p = .0245), due to enlarged male dimensions. A significant but moderate correlation was observed between pharyngeal airway volume and ANB angle (r = ?.4917) and effective mandibular length (Co-Gn, r = .5181).

Conclusion: There is sexual differentiation in the pharyngeal airway morphology for Class III adults. As females present similar pharynx volume compared to a normal skeletal pattern, mandibular setback surgery should be carefully planned because of the risk of airway constriction.     

Comparison of three different options for immediate treatment of painful temporomandibular disorders: a randomized,controlled pilot trial

Objective: The purpose of this study was to compare the short-term effectiveness of three different types of immediate, non-pharmacological intervention for alleviation of the painful symptoms of temporomandibular disorders (TMD).

Material and methods: Thirty-six patients (mean age 41.6?±?16.7 years, 25 females) diagnosed with non-dysfunctional painful TMD received counselling and subsequently were randomly allocated to three treatment groups: patients in Group A received prefabricated oral splints with water-filled elastic pads (Aqualizer^®), those in Group B were provided with vacuum-formed co-polyester oral splints and those in Group C were given appointments to receive Michigan-type hard splints. Clinical examination was conducted, at baseline and after 2 weeks, by use of the RDC/TMD. Current pain intensity was determined by evaluation of graded chronic pain status (GCPS) on a numerical rating scale (NRS). Active maximum mouth opening without pain (AMMOP) was also measured. Paired sample t-tests and one-way analysis of variance with a significance level of p?≤?0.05 were conducted.

Results: After 2 weeks, overall mean current pain was reduced by 41.95% (p?p?p?=?0.56) and C (22.29%, p?=?0.26). After 2 weeks, current pain level for Group B was significantly lower than that for Group C (p?=?0.041). Overall, there was a statistically significant increase of AMMOP (p?=?0.01).

Conclusion: All therapeutic options were pain-reducing. The results from this study suggest that cost-effective and time-effective intervention of counselling combined with use of a vacuum-formed splint is a favourable option for initial, short-term treatment of painful TMD.