Recurrent headaches in relation to temporomandibular joint pain-dysfunction.

Two groups of 80 patients, one referred because of mandibular dysfunction and one seeking dental treatment, completed questionnaires concerning recurrent headaches. The function of the masticatory system of all patients was afterwards examined clinically. The investigation showed that clenching of teeth was correlated to the severity of headache. The frequency and severity of headache varied also with the severity of mandibular dysfunction. Of the variables included in the dysfunction index, only masticatory musculature painful to palpation was found to have a distinct relationship to headaches. This implies that functional treatment is indicated in patients with headaches and tendernes of the masticatory musculature. Functional examination of the masticatory system should therefore be included in investigations of recurrent headaches.     

Change in recurrent headache and mandibular dysfunction after treatment with new complete dentures

The changes in headache and mandibular dysfunction were studied in a group of forty-three complete denture wearers 6 months after treatment with new complete dentures. All patients completed a questionnaire and all were subjected to clinical examination of the function of the masticatory system. Eleven of the seventeen patients with recurrent headache reported less frequent headache 6 months after treatment and nine reported that the headache was less severe. There was also a statistically significant reduction of clinical signs of dysfunction of the masticatory system.     

Prevalence of recurrent headache and mandibular dysfunction in patients with unsatisfactory complete dentures

The prevalence of headache and mandibular dysfunction was studied in 43 patients with unsatisfactory complete dentures waiting for prosthodontic treatment at the Dental Clinic of the National Dental Service in Jokkmokk, Sweden. In addition to answering a questionnaire, all patients underwent a clinical-functional examination of the masticatory system. Seventeen patients (40%), 15 women and two men, reported recurrent headache. 63% of the men and 83% of the women showed marked clinical signs of mandibular dysfunction. A significant correlation between headache and mandibular dysfunction was found. The low representation of complete denture wearers in clinical series of patients referred for treatment of mandibular dysfunction may be due to a reduced propensity to seek help and a greater willingness to accept a certain degree of dysfunction compared with other people.     

Symptomatology of Patients Referred for Mandibular Dysfunction: Evaluation with the Aid of a Questionnaire

An accumulated list of patients, referred for treatment of mandibular dysfunction, received a self-administered questionnaire. The aim was to get a picture of the type of symptoms, their location, frequency, severity, and the subjective need for treatment. The answers would be the basis for administration and planning of the treatment.

A total of 331 persons (76%) answered the questionnaire; 31 percent of the respondents were men and 69 percent female, ages 11 to 84. Half of the sample was found in the 25 to 44 age group.

The two most common symptoms were TMJ sounds and headache, found in about 50 percent of the respondents. The most annoying symptoms were pain in the face and jaws and headache. Headache and fatigue in the jaws were significantly more often reported by the women than by the men.

Ninety percent of those who answered the questionnaire considered themselves in need of treatment. These patients had had their symptoms for several years, indicating that most mandibular pain dysfunction patients do not recover spontaneously, but need some kind of treatment.     

Dental Occlusion and the Health of the Masticatory System

The purpose of this article is to review recent dental literature dealing with the association between occlusal factors and functional disturbances of the masticatory system. There has been much controversy among various authors about the role of occlusion in mandibular dysfunction.

Studies on the number of teeth and the state of the dentition have shown no distinct patterns in patients with mandibular dysfunction. This can probably be explained by the existence of a wide range of individual adaptability to occlusal conditions. In most studies only weak correlations, if any, have been found between occlusal interferences and mandibular dysfunction. This article reviews clinical, electromyographic, experimental, and epidemiologic studies for such possible consequences.

The findings of our study lend support to the idea that the etiology of mandibular dysfunction is multifactorial. Occlusal factors generally seem to be of minor importance. It is thus probable that extensive occlusal rehabilitation is not necessary, at least in the initial phase, for treatment of mandibular dysfunction.     

Oral galvanism and mandibular dysfunction

Sixty-two patients were referred to the university dental clinics in G?teborg for examination and treatment of presumed oral galvanism. Thirty of the patients, with an average age of 47 years, were found to suffer from various degrees of mandibular dysfunction. In these 30 patients the most commonly reported symptom was headache, which was present in 67 per cent of the individuals, while mandibular dysfunction was the most common diagnosis. Nineteen patients improved or recovered completely after counselling and/or treatment. Occlusal splints, alone or in combination with other therapeutic methods, were given to 80 per cent of the patients. It is emphasised that patients with putative oral galvanism must be given proper care, including examination of the masticatory system and treatment of diagnosed functional disturbances.     

Craniomandibular status and function in patients with habitual snoring and obstructive sleep apnoea after nocturnal treatment with a mandibular advancement splint: a 2-year follow-up

The aim of the investigation was to evaluate the status and function of the temporomandibular joint (TMJ) and masticatory system in patients with habitual snoring and obstructive apnoea after 2 years nocturnal treatment with a mandibular advancement splint. Thirty-two patients participated in the study, ranging from 43.0 to 79.8 years of age (mean 54.4 years, SD 8.78) at the start of treatment. All patients had been referred from the ENT department for treatment with a mandibular advancement splint. The acrylic splint advanced the mandible 50-70 per cent of maximal protrusion, opened 5 mm vertically, and was used 6-8 hours per night and 5-7 nights per week. Overjet, overbite, and molar relationship were measured on dental casts. The patients were asked to answer a questionnaire concerning symptoms of craniomandibular dysfunction (CMD). They were also clinically examined in a standardized manner, including registration of range of mandibular movements, TMJ sounds, pain on movement, and palpatory tenderness of the TMJ and the masticatory muscles. None of the patients showed more than five symptoms of dysfunction either at the start of or after 2 years of treatment. A decrease in the frequency of headache was found for nine of those 18 patients that reported headache (P = 0.004). A minor, but significant decrease in overjet and overbite was found and the molar relationship was also changed. It was concluded that 2 years' treatment with a mandibular advancement splint had no adverse effects on the craniomandibular status and function, but the observed occlusal changes requires further evaluation.     

Occlusion and mandibular dysfunction: a clinical study of patients referred for functional disturbances of the masticatory system

Fifty patients were selected according to age (less than 40 years) and dentition (full complement of natural teeth) from a large group referred for treatment of functional disturbances of the masticatory system. They answered a questionnaire and were examined clinically for evaluation of the severity of their symptoms and signs according to the Helkimo dysfunction indexes. The occlusal conditions recorded included contacts in centric and eccentric mandibular positions, various defined occlusal patterns, occlusal interferences, and dental attrition. The occlusal conditions varied considerably but did not show significant correlations with signs and symptoms of mandibular dysfunction. These results suggest that the occlusal variables studied do not contribute to the severity of the signs and symptoms of dysfunction. While it is tempting to propose that our results suggest an argument for dysfunction, it must be admitted that the precise role of occlusion remains unclear.     

Effect of treatment of temporomandibular disorders (TMD) in patients with cervicogenic headache: a single-blind, randomized controlled study

The present study was comprised of 43 patients (16 men) with cervicogenic headaches for over three months, diagnosed according to the International Classification of Diagnostic Criteria of Headaches (ICDH-II). The patients were randomly assigned to receive either manual therapy for the cervical region (usual care group) or additional manual therapy techniques to the temporomandibular region to additionally influence temporomandibular disorders (TMD). All patients were assessed prior to treatment, after six sessions of treatment, and at a six-month follow-up. The outcome criteria were: intensity of headaches measured on a colored analog scale, the Neck Disability Index (Dutch version), the Conti Anamnestic Questionnaire, noise registration at the mandibular joint using a stethoscope, the Graded Chronic Pain Status (Dutch version), mandibular deviation, range of mouth opening, and pressure/pain threshold of the masticatory muscles. The results indicate in the studied sample of cervicogenic headache patients, 44.1% had TMD. The group that received additional temporomandibular manual therapy techniques showed significantly decreased headache intensities and increased neck function after the treatment period. These improvements persisted during the treatment-free period (follow-up) and were not observed in the usual care group. This trend was also reflected on the questionnaires and the clinical temporomandibular signs. Based on these observations, we strongly believe that treatment of the temporomandibular region has beneficial effects for patients with cervicogenic headaches, even in the long-term.     

Symptoms and signs of mandibular dysfunction in primary fibromyalgia syndrome (PSF) patients

Primary fibromyalgia syndrome (PFS) is a form of nonarticular rheumatism characterized by muscular pain and stiffness, commonly located in the neck-, shoulder-, back-, and pelvic regions. The most common finding in patients with mandibular dysfunction (MD) is pain or tenderness of the masticatory muscles, but tender and painful neck and shoulder muscles are also often found in relation to jaw muscle affection. Complaints presented by patients suffering from musculoskeletal conditions may overlap one another. Indeed, there may be some common causative factors for these complaints. To test the hypothesis that some complaints by PFS patients could be explained by mandibular dysfunction, we have investigated the subjective symptoms and the clinical state of the stomatognathic system in eight patients suffering from PFS. According to the Helkimo anamnestic dysfunction index, six patients were classified as having severe signs of MD. The Helkimo clinical dysfunction index revealed severe or moderate dysfunction in all patients. Recurrent headaches was reported by half of the patients. In conclusion, the present study shows that PFS patients also may suffer from mandibular dysfunction. Thus, an examination of the function of the stomatognathic system would be an important part in the investigation to elucidate possible etiological factors behind the reported complaints by PFS patients. PFS may also be of etiological importance for mandibular dysfunction.     

Signs and symptoms of mandibular dysfunction in patients with suspected oral galvanism

Fifty-four consecutive patients were examined by means of a self-administered questionnaire with questions related to general health and subjective symptoms. In addition, a clinical stomatognathic evaluation was carried out including palpation of the temporomandibular joints (TMJ) and the masticatory muscles and functional analysis of occlusion and mandibular mobility. High frequencies of general diseases were reported. The dominant subjective symptom was headache (62%), which often appeared daily. Symptoms such as pain from the teeth, pain in the face/jaws, and burning sensations in the tongue or oral cavity all appeared in more than half of the sample. The patients were frequently aware of parafunctions such as clenching of the teeth and tongue press. None of the investigated persons were completely free of clinical signs of dysfunction. The most frequent clinical finding was palpation tenderness in the masticatory muscles (96%), generally located in the masseter, temporal, and lateral pterygoid muscles. In more than half of the material TMJ findings were recorded, and more than one-third had TMJ pain. In 35% mandibular mobility was reduced. Occlusal interferences on retrusion and on the mediotrusion side were frequent findings. Impaired general state of health and multiple signs and symptoms of mandibular dysfunction were thus frequent findings in these polysymptomatic patients. Three-fourths of the patients needed treatment for mandibular dysfunction, indicating that great consideration must be made for the functional status of the masticatory system in clinical evaluation of so-called 'oral galvanists'.     

Use of an occlusal ramp for rehabilitation after a mandibulectomy and its effects on mastication

Statement of problemPatients with a mandibular defect can develop mandibular deviation, resulting in a loss of or reduction in occlusal contact and ultimately loss of function. The occlusal ramp is a prosthesis used to help restore the masticatory function of such patients and is used particularly in the maxillofacial rehabilitation of patients with masticatory dysfunction resulting from mandibular deviation. The occlusal ramp is usually attached to a mandibular denture or worn as an independent device placed on the palate corresponding to the mandible that produces the offset. However, evidence of the effects of its use is sparse.PurposeThe purpose of this clinical study was to investigate the effects of occlusal ramp use in functional rehabilitation.Materials and methodsThis study included 10 patients who had received mandibulectomies (5 men and 5 women; mean age 76.7 years, range 67 to 90 years) with deviation of the mandible. An occlusal ramp was fabricated for each participant as part of their maxillofacial prosthetic treatment. Masticatory performance was evaluated before and after the treatment by measuring glucose extraction while masticating a piece of gummy jelly. The Wilcoxon signed-rank test was used for statistical analysis (α=.05).ResultsThe median masticatory performance score, represented as glucose concentration (mg/dL), was 82.45 before treatment and 115.45 after treatment, with an overall improvement of 33.00. Scores differed significantly before and after treatment (P=.005). Masticatory performance for each participant improved in the range of 17.7 to 103.3, highlighting the role that the occlusal ramp played in mastication, although with differing effects in each participant.ConclusionsMasticatory performance in participants with mandibular deviation after a mandibulectomy was significantly improved with an occlusal ramp. This suggests the effectiveness of using occlusal ramps in maxillofacial prosthetic treatment for the recovery of masticatory function in patients with mandibular deviation.     

Effects of Sleep Duration on Classic Migraine and Depression Headache Pain: Case Reports

Headache etiology research has not supported the traditional headache classification system. This paper provides evidence that classic migraine headache and muscle contraction headaches that appear in the morning (depression headaches) may share a common etiology and respond to the same treatment—reducing sleep duration. Three clinical cases with long-standing headaches are presented, one a depression headache patient and two classic migraineurs. All case histories showed a strong relationship between extended sleep duration and headaches, and headaches completely remitted after patients consistently awakened one-half to one hour earlier than their normal rising time. Eight common migraineurs showed no such relationship and failed to respond to sleep manipulations.

We conclude that classic migraine and morning onset “muscle contraction” (or depression) headaches may result from serotonergic mechanisms which are triggered by excessive sleep. Common migraines, in contrast, may be related to oral habits and temporomandibular joint derangement.     

Evaluation of patient satisfaction after botulinum toxin A injection for the management of masticatory myofascial pain and dysfunction – A pilot study

ABSTRACT

Objective: To evaluate patient satisfaction with botulinum toxin type A injections for the management of masticatory myofascial pain and dysfunction.

Methods: The study group included 25 patients with myofascial pain and dysfunction. Maximum mouth opening (MMO), measured with a ruler, and pain, measured on a 10-cm visual analog scale (VAS), were assessed before treatment and six weeks after treatment. Satisfaction with the treatment, measured on a 10-cm VAS, was obtained six weeks post-treatment.

Results: The mean satisfaction score six weeks post-injection was 6.74/10, with a significant improvement in both MMO and pain. Satisfaction was positively correlated with a decrease in pain.

Discussion: Botulinum toxin type A injections were well tolerated for the treatment of masticatory myofascial pain and dysfunction in patients with temporomandibular disorder. Improvements were observed in both MMO and pain, with most patients satisfied with the management of pain.     

Anamnestic Index Severity and Signs and Symptoms of TMD

Abstract

The aim of this study was to determine the frequency and to characterize the symptoms and clinical signs of temporomandibular disorders (TMD) related to each severity category of Fonseca’s anamnestic index in a sample of Brazilian young adults (mean age 21.61±1.91 years, 87% females and 13% males), by the application of an anamnestic index proposed by Fonseca (1992) and by clinical examination considering mandibular range of motion and tenderness to palpation of stomatognathic system structures. A significant number of participants were classified with mild TMD (43.2%) and moderate TMD (34.8%). Pain frequency during mastication, temporomandibular joint (TMJ) pain, and TMJ sounds were shown to be good predictors of TMD severity. Neck pain, headache, difficulty during mouth opening and lateral deviation, and tenderness to palpation of masticatory sites and during protrusion accompanied the TMD severity but failed to demonstrate differences between moderate and severe groups, showing a poor ability to determine TMD severity progression. This study suggests that not only the frequency of signs and symptoms of TMD should be determined, but also symptom severity and its relationship to the presence of clinical signs in order to discriminate patients with real treatment needs in nonpatient samples.     

Sensory and motor integration during mandibular function

The subject of pain is intimately related to that of mandibular function. It is now clear that certain types of temporomandibular disorders, particularly myofascial pain dysfunction, result, in part, from rhythmic muscle activity produced by parafunctional oral habits such as diurnal or nocturnal bruxism. Furthermore, in addition to phasic hyperactivity, evidence also suggests that masticatory muscles of patients with MPD are tonically hyperactive. The pain associated with such hyperactive musculature prompts many patients to seek professional help. This article provides an updated historical review of one important aspect of mandibular function and gives insight into the general "state of the art."     

Influence on the masticatory system in treatment of obstructive sleep apnea and snoring with a mandibular protruding device: A 2-year follow-up

The aim was to identify the incidence and types of possible adverse events in the masticatory system after treatment with a mandibular protruding device (MPD) during a 2-year period in patients with obstructive sleep apnea (OSA) or snoring. The subjects comprised 65 middle-aged patients (44 OSA patients, 21 snorers). A clinical examination and a questionnaire concerning signs and symptoms from the masticatory system were performed before, after 6 months, and after 2 years of MPD use. The frequencies of registered signs from the masticatory system, such as muscle and joint tenderness, palpation, and pain during mandibular movement, decreased significantly between baseline and the 2-year follow-up. There were significant changes in the mandibular range of protrusion (+0.7 mm, P < .001), overjet (-0.5 mm, P < .001), and overbite (-0.6 mm, P < .001) compared with the initial examination. Nine patients developed a lateral open bite during treatment, and 2 of them experienced subjective symptoms related to the altered occlusion but still used the MPD every night. No patient reported pain on opening the mouth wide or during jaw movements. Two reported tiredness on jaw function. The reported frequency of headaches was also significantly reduced (P < .01). The high compliance rate in MPD use showed that the therapy is well tolerated, but there is a risk of minor alterations in the occlusion during MPD treatment.     

Treatment of temporomandibular joint dysfunction by intraoral vertical ramus osteotomy

The purpose of this study was to determine if the intraoral vertical ramus osteotomy is an effective treatment for anterior disk displacements with reduction and associated temporomandibular joint pain and dysfunction. Success with this procedure was predicated on producing a more functional articular disk-condyle relationship by anterior and inferior repositioning of the condyle. The prospective study was undertaken of nine (eight female and one male) patients (mean age of 25.8 years) with anterior disk displacement with reduction and associated temporomandibular joint pain and dysfunction (mean duration of pain of 6.8 years). History, clinical dysfunction, and pain indices were used to determine the frequency and severity of temporomandibular joint dysfunction. The incidence of ear pain, muscle fatigue, tinnitus, headaches, and clicking was also assessed. The severity of the pain experience in the masticatory muscles and temporomandibular joints was evaluated through the use of a pain index. The severity of the pain experience and temporomandibular joint dysfunction in all of the patients was significantly reduced or totally eliminated during the period of followup. Surgical treatment of anterior disk displacement with reduction by intraoral vertical ramus osteotomy resulted in improved temporomandibular joint function and resolution of symptoms.     

Mandibular dysfunction in adolescents. I. Prevalence of symptoms

The prevalence of symptoms of mandibular dysfunction was studied in 285 17-year-old adolescents living in the municipality of Skellefte?. They answered a questionnaire concerning general state of health and occurrence of headache, facial pain, or temporomandibular problems. A fifth of the subjects reported some symptoms involving the masticatory system. There was no statistically significant difference between sexes. Of the sample 13% had mild symptoms and 7% had severe symptoms of dysfunction. The most frequent symptoms were clicking sounds from the temporomandibular joint (13%) and a feeling of fatigue in the jaws (6%). Recurrent headache (once a week or more) was reported by 12% and appeared significantly more often among the girls (p less than 0.001). Three-quarters used both sides for chewing, and oral parafunctional habits were reported by 68%. Since mild and moderate symptoms of mandibular dysfunction and headache obviously make an early appearance, a routine dental examination should include screening of these symptoms to identify patients who should be observed more closely.     

A study of the occurrence of symptons of disease of the temporomandibular joint masticatory musculature and related structures

An examination of the temporomandibular joints, masticatory musculature and related structures was made on 1069 persons working in a ship-building yard in the south of Sweden. One-fifth of the persons reported that they had frequent headache and one-fourth of the persons reported TMJ-sounds. Clinical examination of the temporomandibular joints and masticatory musculature showed that clicking of the TMJ was the most common symptom (65%) followed by tenderness of the masticatory musculature to palpation (37%) and tenderness of the temporomandibular joint (10%). Thirty per cent of the persons examined reported two or more of these symptoms. Severe abrasion was noted in 12%. The results of the investigation suggested that the frequency of diseases related to function of the masticatory system is high. It was estimated that some 25–30% of the persons examined were in need of treatment.