Ultrasonography of the temporomandibular joint: comparison of findings in patients with rheumatic diseases and temporomandibular disorders. A preliminary report.

OBJECTIVE: The objective of the study was to compare findings from ultrasonography (US) of the temporomandibular joint (TMJ) in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and temporomandibular disorders (TMD). STUDY DESIGN: US assessment of the temporomandibular joints was bilaterally performed in 68 patients (22 with RA, 11 with PsA, and 35 with TMD). All the TMJs were assessed for the presence of disc displacement, effusion, and changes of the condylar profile, and the prevalence of such abnormalities was compared across the 3 groups of patients. To confirm generalizability of results, US findings were also compared with those of magnetic resonance (MR), taken as the standard of reference. RESULTS: Prevalence of disc displacement and changes in condylar profile were similar between patients with rheumatic diseases and temporomandibular disorders, while effusion was significantly more present in TMJs of TMD patients. Sensitivity of US to detect TMJ abnormalities was acceptable, while specificity was low for condylar alterations. CONCLUSIONS: Temporomandibular joint involvement in patients with rheumatic diseases seems to be similar to that described in subjects with temporomandibular disorders. Ultrasonography confirmed to be an accurate technique to detect disc displacement and effusion within the temporomandibular joint, but not to detect condylar abnormalities.     

Conservative management of pediatric temporomandibular disc displacement presenting as juvenile idiopathic arthritis: a case report

There is limited research regarding management of temporomandibular disorders (TMD) in adolescents with imaging signs of juvenile idiopathic arthritis (JIA). An 11-year-old girl presented to a hospital-based chiropractor for evaluation of a 1.5-year history of unilateral temporomandibular joint (TMJ) pain and trismus. Previously, pediatric rheumatologists diagnosed JIA after contrast-enhanced magnetic resonance imaging revealed edema, effusion, and bilateral anterior disc displacement, and recommended methotrexate, corticosteroid injection, and arthrocentesis. The chiropractor questioned the JIA diagnosis, instead relating symptoms to a mechanical TMD/disc origin. Manual therapy, TMJ exercises, and acupuncture improved TMJ pain and opening. Invasive medical JIA interventions were avoided without long-term recurrence, further questioning the preceding JIA diagnosis. The success of this case suggests that stepped care, beginning with conservative treatment, has value for adolescents with TMD suspect for JIA. Integration of chiropractors and acupuncturists into healthcare institutions may facilitate this care model by affording nonpharmacologic interventions earlier in patient care.     

Oral habits and their association with signs and symptoms of temporomandibular disorders in adolescents: a gender comparison.

OBJECTIVES: The prevalence of oral parafunctions and signs and symptoms of temporomandibular disorders (TMD) in female and male adolescents were compared and their relationship to one another evaluated. STUDY DESIGN: The study consisted of 314 adolescents (136 males and 178 females). Each participant filled out a questionnaire regarding their oral habits and symptoms of TMD. A clinical examination was carried out regarding signs of TMD. RESULTS: Generally, the prevalence of most oral habits was higher among adolescent females than males. Most examined signs and symptoms of TMD showed a statistically significant higher prevalence among females. Gender and nearly all oral habits were a risk factor for TMD. CONCLUSIONS: Adolescent females had a higher prevalence of TMD signs and symptoms and carried out oral habits more intensively. Parafunctional activity may be another contributing factor in the discrepancies found in the prevalence of signs and symptoms between the sexes. Parafunctional habits and gender may be risk factors of TMD.     

Statistical correlation between pharyngitis and temporomandibular joint disease.

OBJECTIVE: The objective of this study was to evaluate the upper respiratory infection (URI) as an aggravating factor in the established temporomandibular joint (TMJ) disease. PATIENTS AND METHODS: Four hundred seventeen patients suffering from temporomandibular disorder (TMD) were selected and investigated by means of questionnaires and clinical examinations. After excluding the patients with only muscle disorders, 283 patients were included for the association study between TMJ disease and infectious conditions. The screened infectious conditions were otitis media, maxillary sinusitis/rhinitis, and pharyngitis/tonsillitis. The chi-square test was used to determine the association between variables and stepwise logistical regression was then used. RESULTS: The prevalence of maxillary sinusitis/rhinitis in TMD patients was 7.0%. The patients who had mouth-opening limitation were 9.93 times more likely to have maxillary sinusitis/rhinitis than those without ( P = .0004). The prevalence of tonsillitis/pharyngitis in TMD patients was 9.1%. The patients who had mouth-opening limitation were 3.50 times more likely to have tonsillitis/pharyngitis than those without it ( P = .0028). The patients who had TMJ capsulitis were 3.91 times more likely to have tonsillitis/pharyngitis than those without it ( P = .0028). CONCLUSION: The conclusion is made that pharyngitis/sinusitis is significantly associated with some clinical symptoms of TMD. The infection of closely related anatomical structures with TMJ may have an influence on TMJ symptoms. Thus, pharyngitis/sinusitis in the established TMD patients can be a significant warning sign for TMJ symptoms to appear shortly thereafter.     

Comparison of occlusal condition and prevalence of bone change in the condyle of patients with and without temporomandibular disorders.

OBJECTIVE: The purpose of this study was to compare the differences in dental and occlusal conditions, and prevalence of bone change in the condyle, between a group of patients with temporomandibular disorders (TMD) and a group of dental patients without such complaints. STUDY DESIGN: A group of 504 patients with temporomandibular disorders (TMD patients) and a group of 970 patients without such complaints (dental patients), all 25 years of age or older, were compared using the criteria of age, sex, dental and occlusal condition, and prevalence of bone change in the condyle based on panoramic radiographs and imaging request forms. RESULTS: In both groups, the rate of complete dental arch was high for both jaws. According to Eichner's index, the rate for group A among the dental patients was 59.6%, whereas it was 84.7% in the TMD patients (P < .01). The prevalence of bone change in the condyle was 17.7% for the TMD patients and 11.6% for the dental patients (P < .01). Eichner's group C was somewhat high for the dental patients, and group A was high for the TMD patients. However, there were no significant differences in the occlusal conditions based on the prevalence of bone change. Deformity was the most common abnormality of bone change for both the dental and the TMD patients. In the TMD patients, the rate of osteophytes was the second most common abnormal finding. Osteophytes were the highest among the average age for all abnormal bone changes in the condyle. With the TMD patients, all the changes were more commonly found in Eichner's group A. CONCLUSIONS: It was demonstrated that the symptoms of TMD correlated with age, sex, and dental and occlusal conditions. However, the prevalence of bone change in the condyle correlated poorly with age, sex, and dental and occlusal condition with and without TMD.     

Signs of bruxism and temporomandibular disorders among psychiatric patients.

OBJECTIVES: To investigate the prevalence of bruxism and signs of temporomandibular disorders (TMDs) among psychiatric patients compared with a healthy population and to assess the effect of psychiatric medications on the parameters studied. STUDY DESIGN: Subjects included 77 psychiatric patients under treatment at 2 psychiatric hospitals in Israel and 50 healthy individuals (control). One experienced calibrated examiner performed the clinical examination (presence of bruxism and signs of TMD). RESULTS: Abnormal attrition was evident in 46.8% of the psychiatric patients compared with 20% in the controls (P < .005). Significant differences between groups were apparent for mean muscle sensitivity to palpation, joint sensitivity to palpation, and range of mouth opening. There were no differences between groups in the prevalence of joint clicks and no association between time of receiving treatment with dopamine antagonists (or any other psychotropic drugs) and TMD signs and symptoms. CONCLUSION: The higher prevalence of bruxism and signs of TMD in psychiatric patients is a major clinical comorbidity. Whether it is a manifestation of the abnormal central nervous system of psychiatric patients or neuroleptic-induced phenomenon deserves further attention. The exact factors that affect the pain experience in these patients should be evaluated as well.     

Intubation risk factors for temporomandibular joint/facial pain

Endotracheal intubation has been proposed as a risk factor for temporomandibular joint dysfunction (TMD) in a limited number of published case reports and systematic studies. Symptoms may result from forces applied with the laryngoscope, or manually in an attempt to complete the intubation, and may be related to the duration in which temporomandibular joint (TMJ) structures are stressed. The objective of this study was to examine risk factors for TMD complaints associated with endotracheal intubation. One hundred twenty-two patients who underwent endotracheal intubation for surgery at the University of Washington Medical Center participated. Exclusions included surgery of the head or neck, cognitive deficit, or emergency surgery. Subjects were assessed presurgically, and at 7 and 14 days postoperatively. Gender, interincisal distance, and age were found to be significantly associated with TMD symptoms lasting as long as 14 days following intubation. For both TMD pain and TMD nonpain symptoms, the most reliable predictor of a complaint following intubation was a history of TMD complaints within a year preoperatively. Any association between endotracheal intubation and the development of short-term TMD symptoms is likely to be found in patients with prior report of such conditions, and we therefore recommend a review of TMD complaint history when planning general anesthesia.     

Trigeminal Electrophysiology: a 2 × 2 matrix model for differential diagnosis between temporomandibular disorders and orofacial pain

Background  

Pain due to temporomandibular disorders (TMDs) often has the same clinical symptoms and signs as other types of orofacial pain (OP). The possible presence of serious neurological and/or systemic organic pathologies makes differential diagnosis difficult, especially in early disease stages. In the present study, we performed a qualitative and quantitative electrophysiological evaluation of the neuromuscular responses of the trigeminal nervous system. Using the jaw jerk reflex (JJ) and the motor evoked potentials of the trigeminal roots (_bR-MEPs) tests, we investigated the functional and organic responses of healthy subjects (control group) and patients with TMD symptoms (TMD group).     

Disc and condyle translation in patients with temporomandibular disorder.

OBJECTIVE: The purpose of this study was to elucidate causal relationship between disc and condyle range of movement and clinical signs and symptoms in patients with temporomandibular disorders (TMD), using magnetic resonance imaging (MRI). STUDY DESIGN: The subjects comprised of a study group of 191 patients with TMD and a control group of 43 asymptomatic patients. The clinical assessment consisted of range of maximum mouth opening (MMO) and preauricular pain during mandibular function. After clinical and radiographic findings assessment, disc and condyle condition were examined by MRI and the range of movement was accordingly classified. RESULTS: Disc displacement was observed in 156/191 (81.7%) of the study group and 9/43 (20.9%) of the control group. When disc and condyle mobility was presented around the eminence, wider MMO range was maintained, P < .05. Presence of osteoarthrosis (OA) was not correlated with preauricular pain, because OA variables were mild in the study group. CONCLUSION: Maintenance of disc/condyle translation is an important factor in TMJ function, irrespective of disc displacement or arthritis.     

Prevalence of temporomandibular disorders in fibromyalgia and failed back syndrome patients: a blinded prospective comparison study.

OBJECTIVES: The objective of this study was to determine the prevalence of temporomandibular disorders (TMD) and evaluate psychosocial domains in patients with fibromyalgia (FM) compared with patients with failed back syndrome (FBS). STUDY DESIGN: The study included 51 (32 FM and 19 FBS) adult patients who were administered orofacial pain and psychological questionnaires before a clinical examination. Presence of TMD was diagnosed according to the Research Diagnostic Criteria for TMD. RESULTS: Fifty-three percent of the FM patients reported having face pain compared with 11% of the FBS patients. Of those FM patients who reported face pain, 71% fulfilled the criteria for a diagnosable TMD. FM patients had significantly higher subscale scores for somatization, obsessive-compulsive, medication used for sleep, and fatigue compared with FBS patients. Eighty-seven percent of the FM patients reported a stressful event and 42.3% had symptoms indicating posttraumatic stress disorder. CONCLUSION: The high prevalence of TMD and psychosocial dysfunction among FM patients suggests wide-reaching dysregulation of autonomic and hypothalamic-pituitary-adrenal axis functions.     

Radiographic and clinical features of temporomandibular dysfunction in patients following indirect trauma: a retrospective study.

OBJECTIVES: Patients developing temporomandibular dysfunction (TMD) following a motor vehicle accident (MVA) have been reported to respond poorly to standard TMD treatment compared with TMD patients who have not sustained an MVA. The purpose of this study was to determine clinical and radiographic differences between post-MVA and nontrauma TMD patients and to determine whether radiographic findings in post-MVA patients undergoing litigation show more severe anatomical changes than post-MVA patients not undergoing litigation. STUDY DESIGN: One hundred thirty-six files with magnetic resonance imaging (MRI) and/or bone scan studies of TMD patients were randomly drawn (54 post-MVA and 82 nontrauma TMD). RESULTS: Patients with post-MVA TMD demonstrated significantly more orofacial pain complaints but significantly less disk displacements on MRI (47.5% post-MVA vs. 69.2% control; P = .03). Litigating post-MVA patients had significantly more nonreducing disks than the nonlitigating group (37.7% litigating vs. 7.7% nonlitigating; P = .05). CONCLUSION: Based on these findings, it is suggested that treatment limited to the temporomandibular joints (TMJs) in post-traumatic TMD patients may fail without consideration that pain may originate in structures other than the TMJs. Within the post-MVA group, the more severe anatomical changes were found in the litigating patients, suggesting that some of their symptoms are associated with anatomical changes.     

垫治疗青少年颞下颌关节紊乱病临床疗效的观察

目的:观察利用垫治疗青少年颞下颌关节紊乱病临床症状改善情况。方法:采用热凝塑料垫或全牙弓软塑胶牙垫治疗65例青少年颞下颌关节紊乱患者,观察治疗前后张口度、颔面部疼痛和关节弹响的变化情况。结果:治疗组65例患者中关节弹响51例,张口受限14例,疼痛伴关节弹响24例,疼痛伴张口受限12例,治疗后疼痛及张口受限均得到缓解,缓解率为100%,弹响消失38例,27例弹响减轻。结论:垫对青少年颞下颌关节紊乱病患者的临床症状有显著改善作用。     

The Impact of Wearing a Face Mask during the COVID-19 Pandemic on Temporomandibular Joint: A Radiological and Questionnaire Assessment

Aim  Several health problems have been reported to be triggered or facilitated by prolonged mask usage during the coronavirus disease 2019 (COVID-19) pandemic. While wearing a face mask, people tend to push their jaws forward and downward in a repetitive manner to hold their masks in the right position; these jaw motions may induce temporomandibular joint disorder (TMD). In this study, we aimed to investigate these repetitive jaw movements while wearing face masks and their effects on TMD. Patients and Methods  Patients who applied with TMD signs between June 2020 and May 2021 were evaluated prospectively. A survey using a questionnaire was conducted to define patients with TMD that caused only by mask-related repetitive jaw movements. Demographic data (age and gender), mean duration of daily mask usage, mask type, and magnetic resonance imaging results were recorded. Results  Prolonged daily mask usage (≥8 hours/day) was significantly higher in patients with mask-related habits (group a) with a rate of 40.4% ( p ≈ 0.001). Also, in this group, the disc displacement with reduction rate (54.6%) was higher compared with other groups ( p ≈ 0.010). On the contrary, patients with no underlying risk factor (group c) showed an unexpected high osteoarthritis rate ( p ≈ 0.029). Conclusions  In this study, we demonstrate that correcting the position of a face mask by repetitive jaw movements can increase the occurrence of TMD. Informing individuals wearing face masks about the risk of TMD and the importance of choosing the appropriate mask size according to the face shape are important issues to be addressed in the near future.     

Evaluation of low-level laser therapy in patients with acute and chronic temporomandibular disorders

The purpose of this study was to address the following question: among patients with acute or chronic temporomandibular disorders (TMD), does low-level laser therapy (LLLT) reduce pain intensity and improve maximal mouth opening? The sample comprised myogenic TMD patients (according Research Diagnostic Criteria for TMD). Inclusion criteria were: male/female, no age limit, orofacial pain, tender points, limited jaw movements and chewing difficulties. Patients with other TMD subtypes or associated musculoskeletal/rheumatologic disease, missing incisors teeth, LLLT contra-indication, and previous TMD treatment were excluded. According to disease duration, patients were allocated into two groups, acute (<6 months) and chronic TMD (≥6 months). For each patient, 12 LLLT sessions were performed (gallium–aluminum–arsenide; λ?=?830 nm, P?=?40 mW, CW, ED?=?8 J/cm²). Pain intensity was recorded using a 10-cm visual analog scale and maximal mouth opening using a digital ruler (both recorded before/after LLLT). The investigators were previously calibrated and blinded to the groups (double-blind study) and level of significance was 5% (p?<?0.05). Fifty-eight patients met all criteria, 32 (acute TMD), and 26 (chronic TMD). Both groups had a significant pain intensity reduction and maximal mouth opening improvement after LLLT (Wilcoxon test, p?<?0.001). Between the groups, acute TMD patient had a more significant pain intensity reduction (Mann–Whitney test, p?=?0.002) and a more significant maximal mouth opening improvement (Mann–Whitney test, p?=?0.011). Low-level laser therapy can be considered as an alternative physical modality or supplementary approach for management of acute and chronic myogenic temporomandibular disorder; however, patients with acute disease are likely to have a better outcome.     

Orofacial evaluation of individuals with temporomandibular disorder after LED therapy associated or not of occlusal splint: a randomized double-blind controlled clinical study

Lasers in Medical Science - This study compared the effects of LED therapy associated with occlusal splint (OS) on the signs and symptoms of temporomandibular disorder (TMD). In this randomized,...     

The role of SPECT/CT with 99mTc-MDP image fusion to diagnose temporomandibular dysfunction.

OBJECTIVE: The objective of this study was the evaluation of Single Photon Emission Computed Tomography with Technetium 99m Methylene Diphosphonate (SPECT with 99mTc-MDP) and computed tomography (CT), simultaneously acquired image in diagnosis of temporomandibular joint (TMJ) dysfunction. STUDY DESIGN: A prospective study was conducted with 33 patients, 29 female and 4 male, all of then presenting signs and/or complaints suggestive of temporomandibular dysfunction. SPECT/CT with 99mTc-MDP was performed in all patients and imaging results compared with final diagnosis and clinical outcome. RESULTS: The correlation of signs and symptoms with SPECT/CT imaging showed sensitivity 100%, specificity 90.91%, and accuracy 96.97%. CONCLUSIONS: SPECT/CT with 99mTc-MDP coregistered imaging fusion is a suitable method of temporomandibular dysfunction diagnosis, due to the sensitivity, specificity, and accuracy observed.     

正畸治疗中对颞下颌关节紊乱病的防治策略研究

颞下颌关节紊乱病（TMD）病因复杂,涉及身体解剖、社会心理、环境遗传等因素。研究表 明,若TMD发生在正畸治疗前或治疗期间,则可能增加治疗的难度和风险。因此,防治TMD对提升正畸 治疗效果具有重要意义。本文旨在通过TMD的诊断、正畸治疗前TMD筛查及正畸治疗中可能诱发TMD的 因素进行综述。     

Masticatory muscle tendon-aponeurosis hyperplasia diagnosed as temporomandibular joint disorder: A case report and review of literature

IntroductionMasticatory muscle tendon-aponeurosis hyperplasia (MMTAH) is a new clinical entity that presents mainly with trismus due to hyperplasia of the masseter aponeurosis and temporalis muscle tendon. However, the etiological factors of this disease are unknown; it is often mistreated as temporomandibular joint disorder (TMD).Presentation of caseWe report a 32-year-old female patient complaining of bilateral pain in her jaw and difficulty opening her mouth. She was first diagnosed as TMD and treated with a splint; however, her symptoms did not improve. Clinical examination revealed a square mandible, tenderness in the left and right temporalis muscles and masseter muscles, and tenderness along the anterior border of the masseter muscle. Her maximum mouth-opening was 30 mm. Short TI inversion recovery magnetic resonance imaging showed areas of low intensity at the anterior border of the masseter muscle and around the coronoid process where the temporalis muscle tendon attaches. Consequently, the diagnosis made based on the clinical and radiographic findings was MMTAH. Bilateral coronoidectomy was performed, followed by a rehabilitation program for six months. The maximum opening was maintained at 48 mm two years after the operation.DiscussionMMTAH was treated as type 1 TMD until it was recognized as a new disease at the conference for the Japanese Society for Oral and Maxillofacial Surgeons. Since then, many clinicians have become aware of this particular condition, and different treatment modalities have been proposed.ConclusionClinicians should consider MMTAH as a differential diagnosis when the patient’s chief complaint is gradually decreasing mouth-opening.     

Prevalence of post-traumatic stress disorder symptoms in orofacial pain patients.

OBJECTIVE: There is a high comorbidity between symptoms of post-traumatic stress disorder (PTSD) and chronic pain incidence. The objective of this investigation was to determine the prevalence of PTSD symptoms in chronic orofacial pain patients. STUDY DESIGN: The study included 1478 adult patients (mean age 36.4 +/- 12.7 years) with primary diagnoses of masticatory/cervical muscle pain or temporomandibular joint pain. Patients completed a battery of psychometric questionnaires including a screening for PTSD symptoms. The sample was divided into a PTSD-positive group (n=218, 15%) a PTSD-negative group (n=551, 37%), and a no-stressor group (n=709, 48%) according to stressor incidence and symptom severity. RESULTS: The current prevalence of PTSD symptomatology was considerably higher than that reported in surveys from the general population. Patients in the PTSD-positive symptom group reported significantly higher psychological distress, sleep dysfunction, and pain severity compared to patients in the other groups. Psychological distress as measured by the SCL-90-R reached clinically significant levels only in those patients with PTSD symptomatology. CONCLUSIONS: The results of this study performed at a tertiary care center suggest that TMD patients without PTSD symptomatology show low levels of psychological distress, if any. Clinically significant levels of psychological distress are likely indicators for PTSD. PTSD screening should be included as part of a routine psychometric test battery in TMD patients.