Arthrocentesis for temporomandibular joint pain dysfunction syndrome.

The management of refractory temporomandibular joint (TMJ) pain is both challenging and controversial. A number of simple, noninvasive approaches have been used in the management of this condition with variable success. In patients who fail to respond to conventional conservative measures, in a joint that is not deemed to be grossly mechanically deranged, we advocate the use of TMJ arthrocentesis. In our practice, this is followed by intra-articular morphine infusion in an attempt to give long-term pain relief. Arthrocentesis is a simple technique with minimal morbidity that can be tried instead of more invasive procedures. To date we have used arthrocentesis of the upper joint space, with intra-articular morphine injection in over 500 TMJs. Approximately 90% of patients have found the procedure beneficial, with pain often being reduced 1 year after the procedure. We recommend arthrocentesis as an effective, minimally invasive technique in patients with continuing pain in the TMJ that is unresponsive to conservative management. We additionally advocate the use of intra-articular morphine as a long acting analgesic in these patients. Although arthrocentesis is a well documented technique and there have been many studies published in relation to the use of intra-articular morphine in orthopedic surgery, further research is required, to delineate its use in the TMJ more fully.     

A method for preventive intervention regarding temporomandibular pain and dysfunction

Objective: Adolescent girls frequently suffer from temporomandibular disorder (TMD) symptoms and associated headache. A program aimed at informing about risk behavior for TMD symptoms, how to influence harmful habits and about general relaxation was tested.

Material and methods: Eighty girls at two high schools, 16 years of age, with or without symptoms, were invited to the health information on two occasions and 60 girls participated. Firstly, a questionnaire regarding symptoms and oral parafunctional habits was administrated. Structured information was given about the normal anatomy and function of muscles and joints, about the occlusion, oral habits and symptoms of orofacial pain/dysfunction and headache. General relaxation was instructed and trained. At a three-month follow-up, the same questionnaire regarding symptoms as at baseline was completed.

Result: The information provided was perceived as useful and instructive. At the follow-up, 77% reported that they used what they had learned. Headache once a week or more decreased from 49% at baseline to 35% and headache ‘never/rarely’ changed from 11% to 25% (p?=?.002). Reported joint sounds had decreased by the follow-up (p?=?.053), as had the use of chewing gum (p?=?.002). A majority of the girls suggested that the information should be scheduled during school hours.

Conclusion: Health information about the jaw system can influence risk factors for TMD symptoms and the frequency of symptoms among adolescent girls.     

Medical versus surgical management of temporomandibular joint pain and dysfunction

Most patients with temporomandibular joint pain and dysfunction have a history of stress and pains elsewhere in the body. These patients become symptom free in response to reassurance and a course of tricyclic antidepressant drug therapy when used as a muscle relaxant and central analgesic. Some however, will benefit from psychiatric help. A smaller proportion have secondary joint disturbances requiring surgery.     

Prevalence of temporomandibular dysfunction and pain in adult general practice patients

Objective. To analyse the prevalence of temporomandibular disorders and related pain (TMD-pain) among adult recall patients in general dental practice. Materials and methods. From November 2006 to September 2008, all adults attending a Swedish Public Dental Service (PDS) clinic for recall examination were asked two standardized questions about temporomandibular pain and dysfunction. Mouth-opening capacity was measured. The responses to the questions and mouth-opening capacity were combined to give a TMD-pain score, on a scale of 0–3. The patients' acceptance of their TMD condition was also noted. Results. The subjects comprised 2837 adults (53% females, 47% men). Of the total sample, 4.9% reported a TMD-pain score of 1–3. The gender difference was significant: women predominated (p < 0.003). Forty-three per cent of those with TMD-pain scores of 1–3 (36% men, 47% women) considered that the condition warranted treatment, especially those registering a pain score (significant difference between pain and dysfunction groups, p < 0.000). Conclusions. The TMD-pain score shows promise as a useful instrument for detecting and recording TMD-pain. The prevalence of TMD disclosed in the study is high enough to be considered a public health concern. Most of the subjects with lower scores on the TMD-pain scale accepted their condition as not severe enough to require treatment.     

Psychological factors in temporomandibular joint dysfunction pain. A review

Psychological factors are involved in TMJ dysfunction but much previous research has tried to identify single personality factors. Multiple factors, however, are involved. These can be divided into 2 main groups: external social factors and the innate psychiatric state of the patient. The concepts involved and their measurement by life events and illness behaviour questionnaires are discussed. The clinical importance of this to the oral surgeon is emphasised, in relation to the patient who fails to respond to conservative therapy and for whom TMJ surgery is planned. Some of these difficult patients may be less well socially integrated than the majority of TMJ patients.     

Parotid gland malignancy presenting as temporomandibular joint pain or dysfunction

Temporomandibular joint pain and dysfunction is a common complaint and a frequent cause of referral to oral and maxillofacial surgeons. The importance of considering malignant disease in the differential diagnosis is illustrated by the following cases of parotid gland neoplasia which were referred as temporomandibular joint dysfunction.     

Occlusion and temporomandibular dysfunction

The role of occlusion in the etiology of temporomandibular disorders is questionable. Therefore, preventive selective grinding is not advised. In the presence of signs and symptoms of overloading of structures of the masticatory system, grinding can be a therapy of choice. This procedure should be preceded by splint therapy in order to test the occlusal changes.     

Aspects of the periodontal condition of temporomandibular joint pain dysfunction patients

Aspects of the periodontal condition of 50 patients referred with temporomandibular joint pain dysfunction syndrome (TMJPDS) were compared with 50 patients of matched age, sex and social status and without previous history of periodontal disorders. Oral hygiene, gingival condition attrition and radiographic features were measured.There was no evidence that the periodontal conditions of TMJPDS patients differed from those of the control group.     

Causes and signs of temporomandibular joint pain and dysfunction: an electromyographical investigation

The spontaneous muscular activity of the masseter and two non-masticatory muscles, and their activity under conditions of noise and flickering light, were recorded in 30 patients with mandibular dysfunction, and in 25 control subjects. The mood of the subjects during the investigation, and the possible presence of emotional disturbances was evaluated by means of questionnaires. The enhanced muscular activity of the masseter muscle differentiated patients from the control group, although it does not constitute a pathognomic sign. Unilaterality of complaints, and dysfunctions of differing intensity were not reflected in differential EMG findings. One-fifth of the patients exhibited neck muscle activity occurring simultaneously with the masseter activity. The effect of the applied stimuli on the muscular activity was not homogeneous, leading to activation in some cases and inhibition in others. Symptoms of anxiety could be observed in seven TMJ patients. Anxious patients showed higher levels of muscular activity and emotional irritability during the experiment than non-anxious patients.     

Discriminant function analysis of clinical and psychological variables in temporomandibular joint pain dysfunction

Detailed clinical, psychological and illness behaviour information was obtained from 43 patients with temporomandibular joint pain dysfunction. A discriminant function analysis was performed on the multiple variables to test their effectiveness as predictors of a successful response to simple conservative therapy. The questionnaire and statistical methodology employed are described in detail. It was found that clinical, psychological, and illness behaviour factors when used alone were poor predictors (less than 60 per cent) of treatment outcome. However, grouping clinical and psychological factors resulted in over 80 per cent successful prediction.