TMJ dysfunction--principles of the clinical examination.

Determining if head pain is related to occlusal disharmony can be a challenge. A brief outline of the clinical examination of these patients was presented. Gross interceptive occlusal contacts should be corrected in all patients. The evaluation of signs and symptoms is the basis for determining whether to "adjust" the asymptomatic patient. Consideration should be given to the intensity of the occlusal disharmony, the level of anxiety, and the patient's adaptive response.     

Correlation of clinical, radiographic, and arthroscopic findings in internal derangements of the TMJ

Arthroscopic, clinical, and imaging observations were compared in 80 temporomandibular joints with suspected internal derangements. Rating scales were developed for assessment of the key arthroscopic findings of "roofing," vascularity, redundancy, articular surface condition, adhesions, and disc function. Clinical and imaging findings were correlated with the rated arthroscopic findings. The degree of roofing was found to have a significant relationship to disc quality and function. Arthroscopy completed the diagnostic picture in these cases and provided detailed information on the joints that was not elicited from clinical findings or imaging studies.     

The clinical assessment of TMJ sounds by means of auscultation, palpation or both

Anterior disc displacements are an important diagnostic subgroup (Group II) of TM disorders according to the Research Diagnostic Criteria (RDC; Dworkin & LeResche, 1992 ). Although the RDC yields clear-cut criteria for the diagnosis of a disc displacement, the interobserver reliability for the clinical recognition of joint sounds is highly variable. This high variance may be caused by the fact that the clinical assessment of joint sounds is difficult. In many previous studies, auscultation with a stethoscope was used. This technique is often claimed to be the most reliable one. However, it is unclear whether in these studies, auscultation was performed without simultaneous palpation of the contralateral joint. Therefore, the aim of the present study was to test the interobserver reliability of the clinical assessment of TMJ sounds by means of auscultation, palpation or both. A total of 220 undergraduate students (100 men; 120 women; mean age 21·9 ± 3·6 years) was examined independently by two calibrated dentists for the presence, probable presence or absence of sounds caused by anterior disc displacement, hypermobility, or another cause. The 79 students underwent auscultation only (i.e. without contralateral manual palpation); 87 students underwent bilateral palpation; the remainder (54 students) was subjected to both auscultation and palpation. The results show that the combination technique yields the highest reliability (Cohen's κ =0·53). For other techniques, κ -values of 0·46 (auscultation) and 0·48 (palpation) were found.
It was concluded that the combination of auscultation and palpation yields the highest interobserver reliability for the recognition of TMJ sounds, although the differences with other techniques were small . (Supported by the IOT)     

New TMJ clinical data and the implication on diagnosis and treatment

A review of the literature and the presentation of 220 patients with acute temporomandibular disorders and a control group are presented. Condylar position in the fossae is related to clinical symptoms. Ten important clinical factors were recorded and the data compared without reference to specific condylar position in the fossae and then in relation to condylar displacement groups. The significantly high incidence of posterior condylar displacement and joint pain in the patients described in this report indicates that elimination of the term joint in our definition of this disorder may be premature.     

TMJ fractures in children: clinical management and follow-up

The mandible is the facial structure that is the most affected by trauma and the most common fracture site is the condyle. New perspectives for this problem are due to the fact that often TMJ fractures in children are undiagnosed and consequently untreated. This becomes evident when growth disturbances show up a year or two later. These types of trauma must be focused not only as a cause of direct damage to osseous structures, but also of future disturbances of the dentofacial development. Three cases of particular significance for the requested therapeutic approach are reported.     

偏侧咀嚼患者颞下颌关节盘位置及临床症状的影响

目的：探讨偏侧咀嚼不良习惯对颞下颌关节盘位置及临床症状的影响。方法：随机选取2012年12月至2013年12月在清华大学玉泉医院口腔科就诊的伴有偏侧咀嚼不良习惯的患者60名为受试对象,其中男性30名,女性30名,年龄26-35岁,常规进行口腔及颞下颌关节的临床检查并拍摄双侧颞下颌关节开闭口位核磁共振。结果：全部60名患者的120个关节中,使用侧和废用侧可复性盘前移分别为13个和10个,P〉0.05,差异无统计学意义。使用侧和废用侧不可复性盘前移分别为11个和14个,P〉0.05,差异无统计学意义。使用侧和废用侧盘内移分别为4个和13个,P〈0.05,差异有统计学意义。使用侧和废用侧盘外移分别为12个和3个,P〈0.05,差异有统计学意义。使用侧和废用侧关节腔积液分别为15个和12个,P〉0.05,差异无统计学意义。使用侧和废用侧关节弹响分别为7个和9个,P〉0.05,差异无统计学意义。结论：偏侧咀嚼对关节盘内外移位有显著影响,对颞下颌关节盘前移位,积液和弹响无显著影响。     

Accuracy of clinical diagnosis for TMJ internal derangement and arthrosis.

This study investigated the accuracy of clinical examination in determining the status of the temporomandibular joint with respect to internal derangement and arthrosis. A series of 110 patients was given standard clinical examinations followed by bilateral imaging with arthrography and/or magnetic resonance imaging. There was agreement between the clinical diagnosis and the imaging finding in 95 joints (43%). In the other 125 joints (57%), the clinical diagnosis did not agree with imaging findings. There were false-positive clinical diagnoses in 39 joints and false-negative clinical diagnoses in 31 joints. In the other 55 joints the clinical diagnosis correctly indicated that the joint was abnormal but was incorrect about the stage of abnormality. On the basis of the overall diagnostic accuracy of 43%, it was concluded that a clinical examination is not reliable for determining the status of the joint in patients with signs and symptoms of temporomandibular joint internal derangement.     

Prediction of TMJ arthralgia according to clinical diagnosis and MRI findings

PURPOSE: The aim of this study was to investigate the ability of clinical and magnetic resonance imaging (MRI) diagnoses to predict pain in the temporomandibular joint (TMJ). MATERIALS AND METHODS: One hundred forty-nine patients were examined by 2 calibrated examiners in strict accordance with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). All patients who presented with a defined clinical RDC/TMD diagnosis were included and underwent bilateral coronal and sagittal MRI of the TMJ. Two raters blinded to the clinical diagnosis interpreted the MRI scans for TMJ pathology. The results were tested against the clinical diagnosis according to the RDC/TMD, including pain-related disability and psychosocial status, for associations to TMJ arthralgia using logistic regression analysis (GENMOD procedure, P < .05). RESULTS: MRI-depicted anatomic changes, such as joint effusions, disc displacement, and osteoarthrosis, were not significantly correlated with the presence of pain in the TMJ. However, a significant relationship between pain on palpation of the masseter muscle origin (P = .0050) and psychosocial factors (P = .0452) and pain in the TMJ was demonstrated. CONCLUSIONS: Pain in the TMJ caused by the anatomic proximity of the muscle masseter origin and the lateral TMJ pole and the possible existence of trigger points in the musculature may lead to a false-positive or a false-negative diagnosis of arthralgia. Additionally, clinicians must consider the psychosocial aspects of pain in ideal treatment planning.     

TMJ型矫正器治疗阻塞型睡眠呼吸暂停综合征的临床应用

选择6例OSAS患者接受TMJ型矫治器治疗,结合治疗前后X线头影测量和夜间多导睡眠图监测进行疗效评价.患者戴用后1个月进行各项指标检测,呼吸紊乱指数(AHI)显著减少(P<0.01),最低SaO_2显著增加(P<0.01).X线片示:上气道间隙显著增加(P< 0.01)、中气道间隙显著增加(P<0.05),下气道变化差异无显著性.研究证明 TMJ型矫治器治疗阻塞型呼吸睡眠暂停综合征是一种安全、方便、有效的方法.     

Dextrose prolotherapy for pain and dysfunction of the TMJ reducible disc displacement: A randomized,double-blind clinical study

To assess the efficacy of dextrose prolotherapy on the clinical signs and symptoms of patients having disc displacement with reduction (DDWR).This prospective, randomized, double-blind clinical study included thirty patients suffering from bilateral DDWR. The patients were randomly divided into two equal groups. After induction of local anesthesia, each joint was injected in two sites; one in the superior joint space and the other in the retrodiscal tissue, using 25% dextrose solution in group I and normal saline in group II. Pain intensity, maximal interincisal opening (MIO), and joint sounds (JS) were evaluated preoperatively, 1 week after each injection, and 3 months and 6 months after the last injection.Patients in group I showed significant improvement in pain and MIO, and higher satisfaction with treatment than patients in group II. Compared to saline injection, dextrose injection resulted in an improvement in JS but without significant difference within and between groups.Intra-articular injection of 25% dextrose is effective in the treatment of pain and dysfunction of TMJ DDWR as shown by significant improvement in pain and MIO and patient satisfaction. The technique is simple, easy to do, safe and should be adopted whenever appropriate.     

TMJ disc removal: comparison between pre-clinical studies and clinical findings

The debate continues surrounding the use of disc removal (discectomy) as the primary surgical treatment for patients suffering from severe temporomandibular joint disorders. Furthermore, the effectiveness of pre-clinical animal models for predicting the response of the joint to discectomy in humans remains uncertain. This review compares the results of animal models with the most recent clinical findings while also focusing on investigations that use imaging as an assessment tool. After a review of the literature from well-established animal studies to clinical findings, it was found that the results of animal models for discectomy corresponded to the clinical findings seen in patients. Overall, there is adaptive remodeling or degeneration of the TMJ following discectomy. Additionally, there is some reduction in pain but with various amounts of dysfunction remaining following disc removal. Noteworthy, in the most recent clinical studies, imaging was not used as an outcome to assess the success of discectomy at preventing further joint degeneration.