Signs of temporomandibular disorders in tinnitus patients and in a population-based group of volunteers: results of the Study of Health in Pomerania

The literature has documented a controversial discussion on the possible relationship of otogenous symptoms and craniomandibular dysfunction since the 1920s. Therefore, an investigation was conducted which consisted of two parts: a case study with population-based controls and a cross-sectional study. The aim of the first study was to screen a group of patients suffering from acute or chronic tinnitus for temporomandibular disorders (TMD) in comparison with a population-based group of volunteers without tinnitus. To this end, 30 patients (13 females and 17 males, age 18-71 years) suffering from acute hearing loss associated with tinnitus, isolated acute tinnitus, and chronically transient tinnitus were examined for symptoms of craniomandibular dysfunction. The results were compared with those of clinical functional analysis from 1907 subjects selected representatively and according to age distribution from the epidemiological 'Study of Health in Pomerania' (SHIP); the occurrence of tinnitus was ruled out in these control subjects. Statistical analysis was performed with Chi-square and Mann-Whitney U-tests. Sixty per cent of the tinnitus patients and 36.5% of the control subjects exhibited more than two symptoms of TMD (P = 0.004). Tinnitus patients had significantly more muscle palpation pain (P < 0.001), temporomandibular joint (TMJ) palpation pain (P < 0.001), and pain upon mouth opening (P < 0.001) than the general population group. No statistical differences were found in TMJ sounds, limitation of mandibular movement, or hypermobility of the TMJ. Furthermore, 4228 subjects of the population group examined in the epidemiological study were screened for co-factors of tinnitus with the help of a multivariate logistic regression model which was adjusted for gender, age, and a variety of anamnestic and examined data. Increased odds ratios (OR) were found for tenderness of the masticatory muscles (OR = 1.6 for one to three painful muscles and OR = 2.53 for four or more painful muscles), TMJ tenderness to dorsal cranial compression (OR = 2.99), listlessness (OR = 2.0) and frequent headache (OR = 1.84) A relationship between tinnitus and TMD was established in both examinations. Tinnitus patients seem to suffer especially from myofascial and TMJ pain. A screening for TMD should be included in the diagnostic survey for tinnitus patients.     

Risk factors associated with symptoms of temporomandibular disorders in a population of 50- and 60-year-old subjects

summary The aims of this study were first to investigate, by means of a mail questionnaire, variables from three domains: (i) socio‐economic attributes; (ii) general and oral health; and (iii) dental attitudes and behaviours in a large sample of 50‐ and 60‐year‐old subjects, and second to compare subjects with or without reported temporomandibular joint (TMJ) pain with respect to these variables. In 2002, a questionnaire was mailed to all 50‐ and 60‐year‐old subjects in two Swedish counties, Örebro and Östergötland (n = 17 138; n₅₀ = 8878; n₆₀ = 8260). Individuals not responding within 2 weeks were given a reminder. If still not answering, a new questionnaire was sent. The final response rate was 72·8% (n = 12 468). The reported responses to questions regarding ‘pain in the TMJ region’ and ‘difficulty to open the mouth wide’ were dichotomized into two groups: (i) no temporomandibular disorders (TMD) symptoms; and (ii) some, rather great or severe TMD symptoms. Striking differences in demographic, occupational, general and oral health conditions were found between the groups with and without TMD symptoms. The strongest risk indicator for both pain and dysfunction was reported bruxism. Women, younger subjects (50 years old) and blue‐collar workers were significantly more prevalent in the TMD symptom groups. Variables related to impaired general and oral health were more common in the groups with reported TMD problems, whereas satisfaction with received dental care and with teeth was lower. Individuals with reported TMD symptoms differed significantly from those without TMD symptoms in socio‐economic attributes, general and oral health symptoms, dental conditions and satisfaction with their teeth.     

Intra-articular oxidative state correlated with the pathogenesis of disorders of the temporomandibular joint

We investigated the redox state of albumin in the synovial fluid from patients with temporomandibular joint (TMJ) disorders (TMD) to evaluate the relation between the cause of the TMD and the number of types of oxygen in synovial fluid. The albumin was fractionated into three components, human mercaptalbumin (HMA, reduced form) and two types human non-mercaptalbumin (HNA, oxidized form), by high-performance liquid chromatography (HPLC). The 63 patients were divided into three groups radiologically, and the ratios of the redox state of the synovial fluid in each group were compared. The fraction of HNA was significantly higher in patients with advanced disease than in patients with early disease. This indicates that the TMJ is affected by intra-articlular oxidative stress, and the severity of TMD correlates closely with the number of oxidative factors. Oxidative stress was thought to be responsible for the genesis of TMD.     

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     

颞下颌关节紊乱病的“梯度序列治疗”

颞下颌关节紊乱病是口腔科临床常见的疾病,好发于青年群体,女性多见,发病率在30%左右;其临床表现多为下颌运动异常、疼痛、弹响与杂音,部分患者伴有耳鸣、头痛等症状。颞下颌关节紊乱病的治疗目前主张采用"梯度序列治疗"模式,每个"层级"均有其严格的适应证。一般首选保守治疗或无创治疗,适用于功能障碍性或轻度器质性病变患者;次选微创治疗,适用于保守治疗无效患者或轻度器质性病变患者;最后才考虑选择开放手术治疗,适用于前两种治疗无效并伴有严重器质性病变的患者。"梯度序列治疗"方案的制定应该是个性化的,由医生主导,患者配合的情况下完成的。本文对颞下颌关节紊乱病的"梯度序列治疗"进行阐述。     

Mood spectrum in patients with different painful temporomandibular disorders

The purpose of this study was to investigate for difference in the prevalence of mood disorders between patients with different painful temporomandibular disorders (TMD). After a sample size necessary for the study was calculated, 60 patients with a painful TMD were selected and divided into the following groups: myofascial pain (n=20), temporomandibular joint (TMJ) pain (n=18), combined myofascial and TMJ pain (n=22). Two distinct comparison groups were selected: subjects with a nonpainful TMD (n=25) and TMD-free subjects (n=29). All participants filled out a self-report validated instrument (MOODS-SR) to evaluate psychopathological symptoms related to mood disturbances. A one-way analysis of variance (ANOVA) with Bonferroni's post hoc test for multiple comparisons was performed to investigate for significant differences among the groups. The three groups of patients with painful TMD scored significantly higher than comparison groups in all MOODS-SR domains investigating depression, but no difference was shown between subjects with myofascial pain and those with TMJ pain. No significant differences among the groups emerged for the presence of manic symptoms, indicating that depressive disorders associated with TMD are not an expression of a more complex manic depressive illness. The study concluded that the presence of depressive symptoms in TMD patients seems to be related to the presence of a painful condition and seems to be unrelated to the location of pain. Furthermore, depressive disturbances in painful TMD patients affect the whole spectrum of depressive psychopathology.     

Signs and symptoms of temporomandibular disorders and the incidence of tinnitus

In a cross-sectional analysis of data from the Study of Health in Pomerania (SHIP 0), temporomandibular disorders (TMD) were the strongest predictors for tinnitus beside headache. The aim of this study was to investigate whether signs and symptoms of TMD can be identified as risk factors for developing tinnitus. The SHIP 1 is a population-based 5-year longitudinal study intended to systematically describe the prevalence of and risk factors for diseases common in the population of Pomerania in northern Germany. A total of 3300 subjects (76% response) were reevaluated after 5 years for tinnitus and signs and symptoms of TMD using the same questionnaires and examination tools as baseline. To estimate the relative risk (RR) appropriately, a modified Poisson regression was used. After exclusion of prevalent cases with diagnosed tinnitus, 3134 subjects were analysed. Among the 191 exposed subjects with palpation pain in the temporomandibular joint (TMJ), 24 subjects (12·6%) received diagnosed tinnitus after 5 years, whereas among the 2643 unexposed subjects 142 subjects (5·8%) received tinnitus yielding a risk difference of 7·7% (95% confidence interval [CI]: 3·0%-12·5%) and a risk ratio of 2·60 (95% CI: 1·7-3·9). The risk ratio was 2·4 (95% CI: 1·6-3·7) after adjustment for gender, age, school education and frequent headache. Pain on palpation of the TMJ, however, did not worsen the prognosis for tinnitus in prevalent tinnitus cases (RR = 0·8, P = 0·288). Signs of TMD are a risk factor for the development of tinnitus.     

The comparison of outcomes of surgically treated bilateral temporomandibular joint disorder in different groups: A retrospective study

Objectives: The main purpose of this study was to determine the prognosis and outcomes of the patients with bilateral temporomandibular disorder which underwent bilateral temporomandibular joint surgery in a consecutive number of patients in a retrospective study. Study Design: Sixty five patients with 130 bilateral TMJ were included the study with the selection from consecutive 256 TMJ patients who were treated with open surgery who do not respond to conservative treatment. 65 patients were divided in to 3 main groups according to the clinical diagnosis of bilateral TMJ site. In the first group comprised 29 patients with 48 TMJ, the clinical diagnosis was bilaterally presence of anterior disc displacement with reduction (ADDR). In the second group comprised 19 patients with 26 TMJ, bilateral presence of TMD consisted of anterior disc displacement without reduction (ADDNR) on both site. In the third group comprised 27 patients with 46 TMJ, bilaterally presence of TMD consist of ADDR on one site and ADDNR on another site. The patients in three different groups were operated either high condylectomy alone or high condylectomy with additional surgical procedures. Results: In the evaluation of pain relief, clicking, crepitation, headache, marked improvement was determined in all groups, but it was statistically insignificant in the comparison of 3 groups. Slight increase in maximal mouth opening was determined in the mean values of the 3 groups and also in the comparison of 3 groups it was not statistically significant. Conclusions: These similar succesfull outcomes of bilateral TMD with the respect of TMJ surgical procedures were obtained in 3 main groups although different diagnosis on the patients’ groups waspresent. Key words:Temporomandibular joint, prognosis, retrospective studies.     

The craniocervical connection: a retrospective analysis of 300 whiplash patients with cervical and temporomandibular disorders

Because the concept of whiplash as a causative factor for temporomandibular disorders (TMD) is highly controversial, we decided to do a retrospective analysis of patients treated in our office who had sustained whiplash injuries and were treated for cervical and temporomandibular disorders. The records of 300 patients with TMD preceded by a motor vehicle accident were examined retrospectively. The most common presenting symptoms, in order, were: jaw pain, neck pain, post-traumatic headache, jaw fatigue, and severe temporomandibular joint (TMJ) clicking. The most common TMD diagnoses were: masseter trigger points, closing jaw muscle hyperactivity, TMJ synovitis, opening jaw muscle hyperactivity, and advanced TMJ disk derangement. Based primarily on the physical examination, we concluded that the TMJ and surrounding musculature should be examined similarly to other joints, with no preconceived notion that TMD pathology after whiplash is unlikely.     

The influence of stabilisation appliance therapy and other factors on the treatment outcome in patients with temporomandibular disorders of arthrogeneous origin.

The aim of this study was to investigate if the difference in treatment outcome between patients provided with a stabilisation appliance and a control appliance was due to the treatment and/or other factors in patients with temporomandibular disorders (TMD) of arthrogeneous origin. Sixty patients were assigned to two equally sized groups: a treatment group, treated with a stabilisation appliance, and a control group given a control appliance. Thirteen possible background variables for the treatment outcome were correlated to changes in severity of temporomandibular joint (TMJ) pain on a verbal scale in the two patient groups. The logistic regression analyses revealed that, after correcting for the background variables, stabilisation appliance treatment was a strong explanatory factor for a positive treatment outcome, with a significance of P = 0.0013 compared to patients belonging to the control group. Background variables of significant importance for the treatment outcome were male sex (positive) (P = 0.0268), and severe or very severe TMJ pain (negative) (P = 0.0034). These findings indicate that not only the treatment with a stabilisation appliance but also sex and the intensity of the TMJ pain before treatment might influence the treatment outcome in patients with TMD of arthrogeneous origin.     

Generalized joint hypermobility and temporomandibular disorders: inherited connective tissue disease as a model with maximum expression

AIMS: To study the relationship between generalized joint hypermobility (GJH) and temporomandibular disorders (TMD) by assessing prevalence and patient characteristics of TMD in a population of patients with maximum expression of GJH as a symptom of inherited connective tissue disease. In addition, diagnostic reliability of a series of clinical signs indicative of temporomandibular joint (TMJ) hypermobility was tested. METHODS: The study sample consisted of 42 subjects with GJH, 24 with Marfan syndrome and 18 with Ehlers-Danlos syndrome. A subgroup of 27 individuals was selected by age (> or = 18 yrs) and was compared to 40 controls with TMD and normal peripheral joint mobility. TMD diagnoses were assigned to each subject according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). RESULTS: In the GJH sample (n = 42), 71.4% of the subjects were symptomatic for TMD. Of those, 13.3% had sought treatment. A myofascial pain diagnosis was made in 69%, disc dislocation with reduction was diagnosed in 85.7%, and TMJ arthralgia in 61.9%. Multiple TMD diagnoses were assigned in 69% of the subjects; of these, 57% had 3 or more subgroup diagnoses. Joint noises (P < .01) and recurrent TMJ dislocations (P < .01) were a frequent finding in adult GJH subjects (n = 27) compared to controls, with symptomatic GJH subjects presenting more and more prolonged dislocation events than asymptomatic subjects (P < .001). TMJ hypermobility signs were expressed significantly more often in GJH compared to controls with TMD and normal joint mobility. CONCLUSION: This study indicates a positive relationship between GJH and TMD.     

正颌外科患者术前的颞下颌关节功能评价

目的　了解正颌患者颞下颌关节 (TMJ)的功能状况 ,探讨牙颌面畸形与颞下颌关节之间的关系。方法正颌外科发育性牙颌面畸形 12 3例患者 ,平均年龄 2 3.8岁 ,男性 45例 ,女性 78例。颞下颌关节功能的检查方法采取问诊与检查相结合 ,颞下颌关节功能记分采取 Helkim o指数记分方法。结果　 (1)牙颌面畸形患者颞下颌关节紊乱病 (TMD)各种症状发生率明显高于对照组人群。(2 )男性患者弹响症状发生率高于女性 ,而女性患者关节触诊疼发生率高。(3) 16～ 2 5岁患者张口受限发生率较高 ,但大多数为轻度张口受限。(4 )不对称畸形 (下颌前突偏斜 )者弹响症状发生率较高 ,而且相应偏斜侧最大侧向移动度小。而下颌后缩组开口度明显小于其他各组 ,提示其关节功能受损较严重。结论　牙颌面畸形患者的颞下颌关节功能不同于正常人 ,部分下颌偏斜与后缩患者关节功能受损     

Palpation and pressure pain threshold: reliability and validity in patients with temporomandibular disorders

This study assessed the interexaminer reliability and validity of palpation (PA) and pressure pain threshold (PPT) of the temporomandibular joint (TMJ) and the masseter and temporalis muscles in patients with temporomandibular disorders (TMD) and asymptomatic controls. Eighty (80) subjects were distributed into two groups: Group 1 consisted of 40 TMD patients with muscular and joint pain selected by RDC/TMD Axis I; and Group 2 (control) with 40 asymptomatic individuals. Training and calibration of examiners was undertaken prior to testing. Mean reliability values were 0.64 and 0.78 (PPT), and 0.59 and 0.75 (PA), for patients and controls, respectively. Results showed statistically significant differences (p<0.001), for PA and PPT among TMD patients compared with the control. The results also showed acceptable specificity values (above 0.90), although sensitivity had low values. The tests had low diagnostic validity to discriminate between patients and controls, with low positive predictive values (PPV).     

Chewing Pattern Analysis in TMD Patients with and without Internal Derangement: Part I

In order to investigate the chewing movement of temporomandibular disorders (TMD) patients with and without internal derangement of the temporomandibular joint (TMJ), analysis of the envelope of motion during chewing was performed in 103 TMD patients with unilateral internal derangement (ID group), 94 TMD patients without internal derangement (NID group) and 10 normal subjects (normal group). The analysis of numeric parameters revealed that the ID group demonstrated a significantly restricted range of motion compared to the NID or normal groups, and the NID group demonstrated significant irregularity of chewing compared to the ID or normal groups. The analysis of chewing also demonstrated that the chewing pattern for the ID group demonstrated more frequent deviation of the turning point to the nonchewing side in the frontal plane and a narrow anteroposterior pattern in the sagittal plane compared to the other groups. No characteristic chewing patterns were identified for the NID group.     

Prevalence of different temporomandibular joint sounds,with emphasis on disc-displacement,in patients with temporomandibular disorders and controls

Temporomandibular joint (TMJ) sounds are very common among patients with temporomandibular disorders (TMD), but also in non-patient populations. A variety of different causes to TMJ-sounds have been suggested e.g. arthrotic changes in the TMJs, anatomical variations, muscular incoordination and disc displacement. In the present investigation, the prevalence and type of different joint sounds were registered in 125 consecutive patients with suspected TMD and in 125 matched controls. Some kind of joint sound was recorded in 56% of the TMD patients and in 36% of the controls. The awareness of joint sounds was higher among TMD patients as compared to controls (88% and 60% respectively). The most common sound recorded in both groups was reciprocal clickings indicative of a disc displacement, while not one single case fulfilling the criteria for clicking due to a muscular incoordination was found. In the TMD group women with disc displacement reported sleeping on the stomach significantly more often than women without disc displacement did. An increased general joint laxity was found in 39% of the TMD patients with disc displacement, while this was found in only 9% of the patients with disc displacement in the control group. To conclude, disc displacement is probably the most common cause to TMJ sounds, while the existence of TMJ sounds due to a muscular incoordination can be questioned. Furthermore, sleeping on the stomach might be associated with disc displacement, while general joint laxity is probably not a causative factor, but a seeking care factor in patients with disc displacement.     

颞下颌关节紊乱病患者与健康人群颌面部机械疼痛敏感性的比较

目的 利用定量触诊仪对受试者双侧咬肌区及关节区进行触诊,比较和分析疼痛性颞下颌关节紊乱病（TMD）患者与健康人群口颌面部机械疼痛敏感性的差异。 方法 选取患有单侧咬肌区或关节区疼痛的TMD患者各40例作为试验患者组,40例健康人作为对照组。利用定量触诊仪在受试者双侧咬肌区或关节区进行触诊,通过口述疼痛模拟评分法（NRS）获得受试者不同检测位点的机械疼痛感觉,绘制机械疼痛敏感性地图,并计算熵值和重心坐标。利用两因素方差分析法分析性别和检查侧（患者组：健患侧;对照组：左右侧）对各组熵值和重心坐标的影响;利用三因素方差分析法分析性别、检查侧和检测位点对各组NRS评分的影响。 结果 TMD患者咬肌区及关节区健患侧熵值均有统计学差异（咬肌：P＜0.001,关节：P=0.006）,且患侧NRS指数显著高于健侧（咬肌：P＜0.001,关节：P＜0.001）;但对照组咬肌区及关节区双侧熵值及NRS指数无明显统计学差异（P≥0.071）。 结论 机械疼痛敏感性地图技术在提供标准化触诊的基础上可以作为区分疼痛性TMD患者及正常人的有效辅助工具,并为该技术应用于TMD患者治疗效果评估的可行性提供了依据。     

Symptoms of the stomatognathic system in temporomandibular and cervical spine disorders

This study was performed to assess the prevalance of signs and symptoms of temporomandibular disorders (TMD) in patients with cervical spine disorders (CSD) and to compare patients with CSD and subgroups of patients with TMD with regard to the results of orthopaedic tests of the stomatognathic system. A group of 103 consecutive patients with signs and symptoms of CSD and a group of 111 consecutive patients with TMD were examined. All subgroups of TMD patients showed a significantly smaller range of motion than the CSD patients. Patients with TMD had limited mouth opening (<40 mm) on active and passive mouth opening more often than CSD patients. TMD patients with myogenous problems reported oral habits more often than CSD patients, although no objective differences between CSD and TMD patients were found. Subgroups of TMD patients reported joint sounds, and pain on palpation and joint play tests of the temporomandibular joint (TMJ) more frequently than CSD patients. Joint sounds on active movements, pain on palpation of the TMJ, and pain on joint play tests correctly classified 82% of the patients with TMD and 72% of the patients with CSD. In spite of the biomechanical and anatomical relationship between the neck and the stomatognathic system, the results of the study show that CSD patients have signs and symptoms of TMD comparable with those of the adult Dutch population. It was concluded that the function of the masticatory system should be evaluated in patients with neck complaints in order to rule out a possible involvement of the masticatory system.     

下颌骨矢状劈开后退术对颞下颌关节的影响

目的:评价下颌骨矢状劈开后退术对颞下颌关节(TMJ)的影响.方法:研究我院50 例术前有颞下颌关节病(TMD),且行下颌骨矢状劈开后退术的患者,从关节压痛、弹响、张口度、张口型等方面量化评估术前、术后颞下颌关节症状变化情况.结果:从关节压痛、弹响、张口度、张口型等各方面评估均显示术后颞下颌关节症状评分均显著低于术前(P<0.05).结论:对于术前有颞下颌关节病的患者,行下颌骨矢状劈开后退术可以有效改善颞下颌关节症状.     

Temporomandibular disorders and headache

Headache is a common symptom, but when severe, it may be extremely disabling. It is assumed that patients who present to dentists with headache often are diagnosed with a temporomandibular disorder (TMD), although many may have migraine. TMD as a collective term may include several clinical entities, including myogenous and arthrogenous components. Because headache and TMD are so common they may be integrated or separate entities. Nevertheless, the temporomandibular joint (TMJ) and associated orofacial structures should be considered as triggering or perpetuating factors for migraine. This article discusses the relationship between the TMJ, muscles, or other orofacial structures and headache.     

Mouse genetic models for temporomandibular joint development and disorders

The temporomandibular joint (TMJ) is a synovial joint essential for hinge and sliding movements of the mammalian jaw. Temporomandibular joint disorders (TMD) are dysregulations of the muscles or the TMJ in structure, function, and physiology, and result in pain, limited mandibular mobility, and TMJ noise and clicking. Although approximately 40–70% adults in the USA have at least one sign of TMD, the etiology of TMD remains largely unknown. Here, we highlight recent advances in our understanding of TMD in mouse models.