Recognizing Otolaryngologic Symptoms in Patients with Temporomandibular Disorders

Temporomandibular disorders (TMD) afflict millions of men, women and children. Although the management of these disorders has traditionally been the pervue of dentistry, the most common symptoms are otolaryngologic. The involvement of an otolaryngologist was important and necessary in the role of primary diagnostician and as a secondary diagnostician to rule out primary otolaryngologic disease in many of the 2,760 patients evaluated over the past 13 years. In 996 patients referred to the Center for Myofacial Pain/TMJ Therapy from the Otolaryngology Clinic of the New York Eye and Ear Infirmary, 85% complained of ear symptoms, including otalgia (64%), dizziness (42%), and muffling (30%). Sixty percent complained of throat symptoms, while headaches were reported by 81%. In 1,764 private patients evaluated for TMD, 53% were seen and/or referred by an otolaryngologist. The dentist and otolaryngologist must act as a team in recognizing and diagnosing TMD. As many of the symptoms of TMD fall within the pervue of the otolaryngologist, he or she must be cognizant of the clinical presentation of TMD. Likewise, dental practitioners must utilize the services of their medical colleagues to rule out primary otolaryngologic disorders in all patients with suspected TMD.     

On the Perception of Jaw Position and Bite Force by Subjects with Craniomandibular Disorders

This study investigated the sense of jaw position and the sense of bite force in subjects with symptoms of temporomandibular joint (TMJ) disorders. The results were compared with those of control experiments on symptom-free subjects. It was shown that: 1. Some subjects with signs of TMJ disorders showed deviant matching behavior when matching the magnitude of jaw separations to an imagined standard but not when matching to the remembered size of a standard gauge of 4.75 mm. These subjects also showed considerable fluctuation in their match. Moreover, values of imprecision of jaw position matches were greater in subjects with TMJ symptoms than in symptom-free subjects.

2. Some subjects with TMJ symptoms showed deviant matching behavior when matching to a 2-N and a 10-N but not to a 50-N standard. These subjects were also variable in their match.

3. Bruxism and nail biting correlated with these findings. Certain clinical implications are discussed.

     

Cortical Dysfunction in Patients with Temporomandibular Disorders

Temporomandibular disorders are a group of chronic and painful conditions in the masticatory musculature and temporomandibular joint. The pathological mechanisms underlying temporomandibular disorders remain to be clarified; however, it is known that disturbances in neurophysiological, cognitive, behavioral and neuromuscular functions are involved in the development and persistence of such disorders. In addition, it has been suggested that neuropathological changes in the central nervous system are involved in the development of temporomandibular disorders. This review describes changes in the cortical machinery in patients with temporomandibular disorders by comparing neuromagnetic signals between healthy subjects and patients elicited by observing jaw opening movements made by another person.     

Correlation of Occlusal Factors and Condyle Position Asymmetry with Signs and Symptoms of Temporomandibular Disorders in Young Adults

The role of the occlusion in the etiology and prevalence of temporomandibular disorders (TMD) has not been conclusively demonstrated. Occlusal factors and condyle position asymmetry as deduced from computed tomography (CT) axial scans were correlated with signs and symptoms of TMD in 49 young adults (mean age 24 years, range 15–33 years) with complete or almost complete dentition. A statistically significant correlation was noted between these signs and symptoms and occlusal variables describing asymmetry (the amount and lateral deviation of the slide from the retruded contact position (RCP) to the intercuspal position (IP), deviation of protrusion and asymmetry in bilateral cuspid occlusion). It seems that occlusal discrepancy can be a predisposing factor to TMD, especially when it is asymmetrically expressed.     

Health Care Utilization by Patients with Temporomandibular Joint Disorders

The claims data base of a large New England managed care organization was used to compare the health care utilization patterns of patients with TMJ disorders to non-TMJ subjects. Inpatient, outpatient and psychiatric claims data were examined over a wide range of diagnostic categories. Age and sex adjusted results showed that, overall, patients with TMJ disorders were greater utilizers of health care services and had higher associated costs than non-TMJ subjects. For some of the major diagnostic categories, such as nervous, respiratory, circulatory, and digestive, the inpatient and outpatient claims differences in utilization and costs were as large as 3 to 1. For only one diagnostic category, pregnancy and childbirth, were utilization and costs greater for non-TMJ subjects than TMJ patients. The psychiatric claims for TMJ patients exhibited differences that were at least twice as large as those for the non-TMJ subjects.     

Dentition Status and Temporomandibular Joint Disorders in Patients with Rheumatoid Arthritis

We compared dentition status and temporomandibular joint (TMJ) disorders in 142 women with rheumatoid arthritis (RA, ages, 40 to 69 years) and 143 women of similar age without RA. The RA group had significantly fewer remaining teeth than the non-RA group. Number of decayed, missing, and filled (DMF) teeth, number of edentulous subjects, and number of subjects with complete and removable partial dentures were significantly higher in the RA group. Among RA subjects, 1.4% had unprovoked TMJ pain, 4.9% had pain on mouth opening, and 14.8% noted difficulty with opening. In the RA group, TMJ tenderness was elicited in 9.2%, clicking in 12.7%, and crepitus in 35.9%, representing a significant excess occurrence of crepitus. The prevalence of TMJ disorders was 67.6% in the RA group and 32.9% in the non-RA group; degenerative joint disorders were particularly frequent. TMJ disorders correlated with Steinbrocker stage and the duration of RA.     

Temporomandibular Disorders and Occlusion: An Appliance to Treat Occlusion Generated Symptoms of TMD in Patients Presenting with Deficient Anterior Guidance

Temporomandibular disorders (TMD) are of multifactorial origin. If it is determined that the patient's occlusal scheme is a contributing factor to their TMD symptoms, it is accepted that reversible, noninvasive procedures be instituted at the outset of treatment. Splint therapy conforms to this guideline, offering temporary, reversible alteration of the occlusal scheme in order to provide this relief. In a mutually protected occlusion, the posterior teeth accept the occlusal force of closure, while the anterior teeth separate the dentition during excursive movements. The purpose of the disclusion splint described in this article is to eliminate muscle hypertonicity, along with its ensuing problems. This is accomplished by establishing a mutually protected occlusion via the guide planes created by the acrylic portions of the splint, but not compromising the patient's “freeway” space.     

On the Three-Dimensional Physiological Position of the Temporomandibular Joint

Despite intensive research regarding the position of the temporomandibular joint, only few evidence-based facts are known about a three-dimensional physiological condyle-fossa relationship. The aim of this systematic literature review was therefore to summarize the existing literature regarding the condyle position and to draw conclusions about a standardized three-dimensional condyle position.An extended search profile based on the search strategy of the Cochrane Oral Health Group and applied to twelve medical databases was used to identify existing studies. Articles which were not electronically accessible (mainly those published before 1960) were identified from reference lists and bibliographies. These publications were assessed independently by two clinicians with reference to points based on specified criteria. The interexaminer agreement was assessed on the basis of the kappa coefficient.1903 articles published in the period 1899-2001 and relating to condyle position were identified. These studies showed a pronounced variability in their methodological approaches, with only 49 of them meeting the inclusion criteria. The interexaminer agreement yielded a kappa-value of 0.92. Although numerous studies used three-dimensional data, no physiological three-dimensional condyle position was determined. The most frequent analytic method was two-dimensional projection of the temporomandibular joint onto a subjectively selected sagittal plane. This evaluation method revealed a noticeable shift over time in condyle position from posterior to anterior, suggesting a clear-cut publication bias. Publications with the highest evidence level favored no specific position (p > 0.05).Simplification of the three-dimensional structure of the temporomandibular joint to a two-dimensional projection is questionable for therapeutic positioning of the condyle in relation to the fossa.     

颞下颌关节紊乱病症状、体征与心理焦虑状态的相关性分析

目的:分析颞下颌关节紊乱病(temporomandibular disorders,TMD)患者症状、体征及相关因素与心理焦虑状态的相互关系.方法:检查250名患有颞下颌关节紊乱病患者的相关症状及体征.采用一般情况调查问卷及心理焦虑状况量表(SAS)调查患者一般情况及心理焦虑状况.分析TMD患者的症状、体征及相关因素与患者心理焦虑状况的相互关系.结果:TMD患者焦虑分值(44.19±11.01)高于我国焦虑常模的标准分(29.78±10.07)(P＜0.01),不同症状TMD患者心理焦虑状况具有差异(P＜0.01).疼痛及开口受限患者心理焦虑程度高于单纯关节弹响患者,不同程度TMD症状患者心理焦虑状况具有差异(P＜0.01).结论:TMD患者的心理焦虑状况与TMD的临床症状、体征关系密切.     

Profiling of Patients with Temporomandibular Disorders: Experience of One Tertiary Care Center

ObjectivesThe aim of this study was to assess typical and most prevalent characteristics of patients suffering from temporomandibular disorders (TMD) by a retrospective assessment of their medical records.Material and MethodsDemographic data and data on the characteristics of TMD were collected from the existing medical documentation of 304 TMD patients (250 females and 54 males) who had been referred to the Department of Dentistry, Clinical Hospital Center Zagreb from October 2016 to October 2020 due to temporomandibular pain. For the purpose of analysis, three age groups were formed: i) “children and adolescents” (up to 19 years of age); ii) “middle age” (from 20 to 50 years of age); iii) “older age” (>50 year- olds). A two-step cluster analysis was performed with the aim of classifying TMD patients into homogenous groups.ResultsThe mean age of patients whose data were included in the study was 33.8 ± 16.66, with a significantly higher age in the group of women (p<0.001). Most of the patients had chronic pain (67.4%), with the ratio in favor of chronic patients being significantly higher in women than in men (p=0.001). Data on parafunctional behavior were confirmed in 14.5% of patients. Data on the onset of symptoms during/just after orthodontic treatment were present in 14.5% of patients. Data on spontaneous pain, assessed with a visual analogue scale, were recorded in 87 patients, with a mean of 6.14 ± 1.79 and with the highest pain in the “older age” group. Physical therapy was the most common therapeutic modality (56.3%) followed by an occlusal splint (40.5%). The analysis revealed 5 different clusters in the TMD patient data set.ConclusionsOur results are largely in line with current epidemiological knowledge on TMD. Women predominated in all age groups and most of the patients experienced chronic pain. Classifying patients into homogeneous groups using the clustering method could provide better identification of subgroups of conditions that mainly occur together in these patients, thus providing the basis for more specific management.     

Malocclusions and Clinical Signs or Subjective Symptoms of Temporomandibular Disorders (TMD) in Adults

AIM AND METHOD: The objective was to determine with reference to a representative sample of 4310 men and women aged 20 to 81 (response rate 68.8%) drawn from the population-based Study of Health in Pomerania (SHIP-0) whether associations exist between malocclusions and temporomandibular dysfunctions in adults. Besides clinically investigated signs, subjectively perceived symptoms of temporomandibular disorders (TMD) were studied in each individual together with malocclusions (plus normal occlusion), functional occlusion factors, and sociodemographic parameters. A multivariate logistic regression analysis was used, adjusted for age and discriminated for gender. The results were compared with those of other population-based studies identified by a systematic review undertaken by the present authors. RESULTS: Some malocclusions were associated with signs or symptoms of TMD but tended to occur only rarely: unilateral open bite, negative overjet, and unilateral scissors-bite in men, and edge-to-edge bite in women. However, malocclusions (and functional occlusion factors) accounted for only a small part of the differences between the control population and the study population with signs or symptoms of TMD. In terms of the multifactorial problem of temporomandibular disorders they should be seen as cofactors. The results, together with those of other population-based studies, revealed no specific, i.e. recurring malocclusions (or other occlusal factors) presenting as risk markers.     

颞下颌关节紊乱患者心理因素与唾液中SIgA含量的关系

目的观察人格、应激、情绪与应对方式等心理因素在颞下颌关节紊乱病(TMD)中的作用及其与口腔局部免疫功能的关系。方法采用明尼苏达多相人格调查表(MMPI)、生活事件调查表、特质应对问卷、自我评定焦虑量表(SAS)、抑郁自评表(SDS)对确诊TMD患者31例和匹配对照组30例进行个别心理测试,以放射免疫法对两组被试唾液中的SIgA含量进行测定。结果TMD患者MMPI诸指标得分均高于对照组,差异有显著性(P<0.05,P<0.01),其中有10例患者的临床量表得分高于全国常模正常值;病人组的负性生活事件和负性工作得分均高于正常对照组,差异有显著性(P<0.05,P<0.01);病人组正性应对的得分低于正常对照组,而负性应对的得分高于正常对照组,差异有显著性(P≤0.05,P<0.01);病人组的焦虑、抑郁得分均高于正常对照组,差异有显著性(P<0.01);病人组唾液中SIgA含量低于正常对照组,差异有显著性(P<0.01);抑郁得分与SIgA含量呈轻度负相关(r=-0.320,P<0.05)。结论TMD患者具有明显的人格偏离、不良生活事件、不良情绪和负性应对方式,这些所导致的更强、更持久的应激以及口腔局部免疫功能的低下,是疾病的重要原因之一。     

Pain Assessment in Temporomandibular Disorders

Pain characteristics, symptoms, medication use, demographic and psychological variables were assessed in 85 patients diagnosed with temporomandibular (TM) disorders. Results showed that 46 myofascial pain dysfunction (MPD) patients responded differently from 39 temporomandibular joint (TMJ) patients for numerous measures of pain-related variables. MPD patients perceived more generalized facial pain of longer duration and were able to identify more specific symptoms associated with their pain. The only symptom variable rated higher by TMJ patients was the presence of bothersome joint noise. When asked to rate their pain at its worse, the unpleasantness of pain was significantly higher in MPD patients than reported by TMJ patients. MPD patients might be considered more psychologically distressed than TMJ patients, as shown by their higher ratings for anxiety and inability to endure the pain. Although both types of pain patients took the same categories of medications, MPD patients consumed a larger total number. Such findings suggest that the prognosis of the dysfunction for MPD patients would be less favorable than for TMJ patients.