Changes in TMD signs and in mandibular movements from 10 to 15 years of age in relation to articulatory speech disorders

This study is part of a longitudinal study on the associations between different orofacial dysfunctions. The aim was to determine changes in signs of temporomandibular disorders (TMD) and in mandibular movement capacity in subjects with articulatory speech disorders and in controls by re-examining a sample of 187 previously studied children from 10 to 15 years of age. Articulatory speech disorders were diagnosed by a phoniatrician. Mandibular movement capacity, signs of TMD, occlusal contacts/interference and slide between retruded and intercuspal positions were recorded by a dentist. The followup results showed that mandibular mobility mainly increased up to the age of 15, but there was a decrease in protrusion capacity in almost half of the cases. This fluctuation probably reflects the normal changes in growth pattern. Signs of TMDs proved to be inconsistent in nature, especially among the controls. With age, girls in the control group, more so than boys, were prone to new signs of TMD, but no gender difference was found in the group of subjects with misarticulations of speech. The findings indicate that in adolescence different orofacial dysfunctions are related.     

Diagnostic accuracy of three screening questions (3Q/TMD) in relation to the DC/TMD in a specialized orofacial pain clinic

Objective: To determine the diagnostic accuracy of three screening questions (3Q/TMD) in relation to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), in a specialized clinic.

Material and methods: Consecutive patients,?>18 years, referred with a possible TMD complaint to the Orofacial Pain and Dysfunction clinic, Academic Centre for Dentistry Amsterdam, the Netherlands, were included in the study. All patients (n?=?449; mean age 44 years; 72% females), answered the 3Q/TMD and the DC/TMD questionnaire before a DC/TMD examination. The 3Q/TMD constitutes of two questions on weekly pain from the jaw, face and temple region (Q1), and on function (Q2), and one function-related question on weekly catching and/or locking of the jaw (Q3). Q1 and Q2 were evaluated in relation to a DC/TMD pain diagnosis and Q3 in relation to a subgroup of DC/TMD intra-articular diagnosis, referred to as the reference standard.

Results: In total, 44% of patients received a pain-related DC/TMD diagnosis and 33% an intra-articular reference DC/TMD diagnosis. Sensitivity for the two pain screening questions was high (0.83–0.94), whereas specificity was low (0.41–0.55). For the function-related question, sensitivity was low (0.48), whereas specificity was high (0.96).

Conclusions: In a specialized pain clinic, the two pain questions (Q1, Q2) are positive in most patients with pain-related TMD. Therefore, in case of a positive response, further diagnostic procedures for TMD pain are warranted. For the functional screening question (Q3), a positive response is indicative for an intra-articular DC/TMD diagnosis, while in case of a negative outcome, an intra-articular TMD might still be present.     

急慢性颞下颌关节紊乱病患者临床疼痛特征对比研究

目的:探讨急、慢性颞下颌关节紊乱病(TMD)患者的临床疼痛特征。方法:纳入TMD患者68例(急性30例,慢性38例),使用视觉模拟量表评价患者的疼痛强度,短式McGill疼痛调查表评价患者的疼痛感觉和感受。结果:①静止和功能状态下急、慢性组组内男女患者之间疼痛强度的差异无统计学意义(P>0.05);②静止状态下急、慢性组患者疼痛强度的差异无统计学意义(P>0.05);③功能状态下女性患者急性组疼痛强度高于慢性组(P<0.05);④急性组患者常用胀痛、触痛、刺痛、持续固定痛来描述疼痛,慢性组患者常用的词汇是胀痛、痉挛牵扯痛、绞痛、持续固定痛;⑤急性组患者有15人(占50.00%)在情感项主要选择害怕和软弱无力,慢性组患者有29人(占76.32%)在情感项主要选择厌烦和软弱无力。结论:急、慢性TMD患者疼痛强度多为轻度和中度;急、慢性TMD患者对疼痛的感觉和感受有所不同。     

Jaw clenching effects in relation to two extreme occlusal features: patterns of diagnoses in a TMD patient population

Objective:

The aim of this investigation was to compare the pattern of temporomandibular disorder (TMD) diagnoses in clenching patients with different occlusal features, the null hypothesis being that no between-group differences exist.

Materials and methods:

Two groups of subjects receiving a jaw clenching diagnosis and having large overjet or anterior open bite (Group A; N?=?45, 75·5% females, mean age: 38·1±15·9 years) or normal occlusion (Group B; N?=?69, 71% females, mean age: 34·6±13·8 years) were recruited among a TMD patient population and were given Research Diagnostic Criteria for TMD (RDC/TMD) axis I diagnoses, namely, group I muscle disorders, group II disc displacements, and group III arthralgia/osteoarthritis/osteoarthrosis.

Major findings:

The distribution of RDC/TMD single and combined group diagnoses was significantly different between the two groups (P<0·05), with Group A subjects showing a higher prevalence of multiple diagnoses (60% versus 43·3%), as well as a higher prevalence of combined RDC/TMD axis I group II and III diagnoses (37·8% versus 20·2%). All TMD signs and symptoms were more frequent in the patients with large overjet or anterior open bite with respect to the patients with normal occlusion.

Conclusion:

In a TMD patient population, jaw clenching may have different consequences in subjects with large overjet or anterior open bite with respect to subjects featuring normal occlusion.     

下颌第三磨牙近中阻生患者垂直向咬合状况与TMD的关系探讨

目的 探讨下颌第三磨牙近中阻生患者垂直向咬合情况与颞下颌关节紊乱病( temporomandibular joint disorders,TMD)的关系. 方法 选取37例下颌第三磨牙近中阻生患者纳入观察组,另选20例非下颌第三磨牙近中阻生的口腔疾病患者纳入对照组,评估其垂直向、颊舌向、近远中向咬合状况,运用AutoCAD软件进行下颌牙列Spee曲线测量. 结果 观察组 TMD患病率(51. 4%)显著高于对照组(15. 0%),差异具有统计学意义(χ2 =7. 24,P=0. 007);观察组垂直向咬合异常率(40. 5%)高于对照组(10. 0%),差异有统计学意义(χ2 =5. 79, P=0. 056),观察组和对照组颊舌向、近远中向咬合异常率差异无统计学意义(P>0. 05);观察组和对照组Spee曲线平均深度分别为(2. 41 ± 0. 26) mm、(2. 05 ± 0. 18) mm,观察组Spee曲线深度较对照组有增加,差异具有统计学意义(t=4. 51,P=0. 009). 结论 下颌第三磨牙近中阻生患者TMD发生率高于非近中阻生患者;下颌第三磨牙近中阻生引发垂直向咬合异常.     

Psychosocial impairment in temporomandibular disorders patients. RDC/TMD axis II findings from a multicentre study

Objectives

The relationship between the rate of chronic pain-related disability and depression and somatization levels as well as the influence of pain duration on Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis II findings were assessed in a three centre investigation.

Methods

The study sample (N = 1149; F:M 4.1:1, m.a. 38.6 years) consisted of patients seeking for TMD treatment and undergoing RDC/TMD axis II psychosocial assessment to be rated in chronic pain-related disability (Graded Chronic Pain Scale, GCPS), depression (Symptoms Checklist-90[SCL-90] scale for depression, DEP) and somatization levels (SCL-90 scale for non-specific physical symptoms, SOM). The null hypotheses to be tested were that (1) no correlation existed between GCPS categories and DEP and SOM scores, and (2) no differences emerged between patients with pain from more or less than 6 months as for the prevalence of the different degrees of pain-related impairment, depression, and somatization.

Results

In the overall sample, the prevalence of high pain-related disability (GCPS grades III or IV), severe depression and somatization was 16.9%, 21.4%, and 28.5%, respectively. A correlation was shown between GCPS and both DEP and SOM categories (Spearman's correlation test, p < 0.001). A significant association between pain lasting from more than 6 months and high GCPS scores was shown (χ², p < 0.001), while no association was found between DEP and SOM scores and pain duration in the overall sample (χ², p = 0.742 and p = 0.364, respectively).

Conclusions

Pain-related disability was found to be strongly related with depression and somatization levels as well as associated with pain duration. Depression and somatization scores were not associated with pain duration.     

DC/TMD推荐心理量表在颞下颌关节紊乱病诊疗中的应用

目的: 采用新版DC/TMD推荐的心理量表,评估颞下颌关节紊乱病（temporomandibular disorders, TMD）患者焦虑、抑郁及躯体症状等心理状况,探讨新版量表作为TMD心理轴诊断依据的临床意义。方法: 选择100例TMD初诊患者作为实验组,100例无TMD症状的普通门诊患者作为对照组。收集2组患者的一般信息,包括年龄、性别、受教育程度、个人收入等。采用广泛性焦虑症量表（GAD-7）、抑郁症状量表（PHQ-9）和健康问卷量表15（PHQ-15）对患者心理因素进行评估。采用SPSS 20.0软件包对数据进行统计学分析。结果: <30岁组和30~50岁组TMD发病率显著高于50岁以上年龄组（P<0.05）。实验组高学历者比例显著高于对照组（P<0.05）,而收入水平不是罹患TMD的危险因素（P=0.642）。实验组焦虑发生率与平均得分显著高于对照组（P<0.05）,而两组间抑郁和躯体症状得分无统计学差异（P>0.05）。疼痛性TMD患者的焦虑和抑郁程度显著高于关节疾病患者（P<0.05）,而两组间躯体症状无显著差异（P>0.05）。结论: 性别（女）、年龄（<50岁）和高学历（本科及以上）是罹患TMD的高危因素,而与收入水平无关。TMD患者的焦虑发生率和评分均高于普通口腔门诊患者,但抑郁和躯体症状与普通患者的发生率无显著差异。     

Prevalence of TMD symptoms in Turkish migrants and re-settlers from the former Soviet Union in comparison to a German group

Objectives: The objective of this study was to investigate the prevalence of temporomandibular disorder (TMD) symptoms among Turks and re-settlers with German origin from Russia and to compare those findings with a German group from the same area.

Method: Sixty-nine Turkish migrants, 50 re-settlers, and 96 Germans were clinically examined according to a short version of the Research Diagnostic Criteria (RDC/TMD) protocol. The subjects participated in a feasibility study of the German National Cohort and were recruited from the study center Heidelberg/Mannheim of the cluster Baden-Württemberg/Saarland.

Results: Significant differences emerged between the three ethnic groups for unassisted opening without pain, maximum unassisted opening, and overbite, with highest values for the German group. No significant differences were found for muscle pain on palpation or muscle and joint pain during opening.

Discussion: As the authors identified significant differences between the different ethnic groups for metric measurements, it might be beneficial to include questions concerning the ethnicity to the German version of the RDC/TMD for further research, to make the results more comparable.     

Thirty-year follow-up of a TMD case treated based on the neuromuscular concept

Aim:

Occlusal therapy is employed to alleviate the symptoms of a temporomandibular disorder (TMD) at times. However, the long-term effect of occlusal therapy in the masticatory system is not well understood. This case study aims to present a 30-year follow-up of a TMD case.

Methodology:

The patient developed TMD with intermittent closed lock of the left temporomandibular joint (TMJ). Chief complaints included trismus, pain, and noise of the left TMJ during function. The patient’s occlusal disharmony was assessed with use of electronic instruments and corrected based on the neuromuscular concept. A minimum-invasive and reversible approach using adhesive occlusal restorations was used.

Results:

The jaw movement and masticatory muscle activity assessed at the 7- and 23-year follow-ups revealed that the established occlusion was well adapted, and re-established the patient’s functional occlusion system. The patient has been free from TMD symptoms with the corrected occlusion for 30 years.

Conclusions:

Occlusal reconstruction based on the neuromuscular concept can be stably integrated into the patient’s functional occlusion system.     

TMD in class III patients referred for orthognathic surgery: Psychological and dentition-related aspects

ObjectiveTo investigate temporomandibular disorders (TMD), psychosocial, and occlusal variables in class III orthognathic surgery patients with respect to the control subjects, and to compare psychosocial and occlusal features in class III patients with different Research Diagnostic Criteria for TMD (RDC/TMD) diagnoses.Materials and methodsThe study enrolled 44 class III patients referred for orthognathic surgery and 44 individuals without a malocclusion. TMD, depression and somatization were assessed by RDC/TMD. Occlusal analysis included Helkimo's Occlusal Index items, overjet and overbite.ResultsIn the controls, patients with class III deformities had higher prevalence of myogenic TMD, increased grade of chronic pain, and more occlusal deviations. Within the study group, TMD patients reported higher depression score (P < 0.01), myofascial pain was related to higher depression and somatization grades (P < 0.01, P < 0.05 respectively), and disc displacement showed relation with RCP-ICP slide interferences (P < 0.05).ConclusionWith respect to subjects without a malocclusion, TMD in class III dentofacial deformities is similar in prevalence, but differs in clinical appearance. Occlusal, but not psychosocial features deviate from those in the controls. While psychosocial variables accompanied TMD and myofascial pain, increased RCP-ICP slide was related to disc displacement in class III patients.     

超声法取根管内折断的镍钛和不锈钢根管锉的效果比较

目的比较根管内折断的镍钛和不锈钢根管锉在超声取出率和根管壁切削量上的差异。方法选取离体人下颌切牙64颗,随机分为镍钛锉组和不锈钢锉组,每组32颗牙,分别将机用ProTaper镍钛根管锉和不锈钢K锉折断于根管内,超声法取折断根管锉,计算取出率,并使用图像分析软件分析术前、术后数字x线片的根管面积变化。结果不锈钢锉取出率大于镍钛锉,根管壁切削量也大于镍钛锉,但差异无统计学意义（P〉0．05）。折断根管锉断端暴露长度小于1．5mm时81％镍钛锉可取出,不锈钢锉约为47％,差别有统计学意义（P〈0．05）。结论超声法可有效取出根管内镍钛和不锈钢根管锉。取不锈钢锉需暴露的断端长度大于镍钛锉;2种根管锉采用超声法取出时根管壁切削量无显著差异。     

A high prevalence of TMD is related to somatic awareness and pain intensity among healthy dental students

Objective: Dental students have been identified as a group with high risks of developing both temporomandibular disorders (TMD) and psychosocial conditions. Our primary aim was to evaluate the cross-sectional prevalence of TMD diagnoses, as defined in the Diagnostic Criteria (DC)/TMD, among dental students. The secondary aim was to evaluate the prevalence and association of behavioural and psychosocial factors in relation to DC/TMD diagnoses.

Materials and methods: The study was conducted among undergraduate dental students during the second semester of their third year at the Department of Odontology, Medical Faculty, Umeå University, Sweden. Three consecutive cohorts were recruited during August in 2013, 2014, 2015. In total, 54 students were included and examined according the DC/TMD procedure.

Results and conclusions: The prevalence of any DC/TMD diagnosis was 30%. The most prevalent TMD diagnosis was myalgia. Individuals with a TMD-pain diagnosis (i.e. myalgia or arthralgia) reported significantly higher pain intensity levels according to the Graded Chronic Pain Scale (GCPS) as compared to individuals without TMD-pain (Fisher’s exact test p?p?p?=?.005) as compared to individuals without TMD. The psychosocial factors evaluated did not differ between individual with or without a TMD diagnosis. The majority of the dental students reported symptoms that are already identified as risk factors for developing TMD and pain conditions. However, longitudinal data are needed to evaluate how this evolves over time.     

The effect of a mandibular advancement appliance on cervical lordosis in patients with TMD and cervical pain

Aims:

A preliminary study to compare cervical lordosis by means of cervical cephalometric analysis, before and after six months of continuous mandibular advancement appliance (MAA) use, and to show how physical therapy posture re-education would improve the cervical lordosis angle.

Methodology:

Twenty-two female patients with temporomandibular disorders (TMD) and cervical pain with lordosis <20° were included. Patients had to have a muscle pain history for at least six months, and with an intensity ≥6, measured by means of a visual analog scale (a horizontal 0–10 numeric rating scale with 0 labeled as ‘no pain’ and 10 as ‘worst imaginable pain’). Patients had to present the angle formed by the posterior tangents to C2 and C7 of equal or less than 20°. Cephalometric and clinical diagnostics were performed initially (baseline) and at the end of the study period (six months). During the third month with MAA treatment, a physical therapist evaluated the postural deficit and performed a program of postural re-education. Angular and linear dimension data presented a normal distribution (P>0·05; Shapiro Wilk Test), so the paired comparison of the cephalometric measurements was made by t-test for dependent samples.

Results:

Angle 1 (OPT/7CVT); angle 3 (CVT/EVT) and angle 4 (2CL/7CL) showed a significant increase in the cervical lordosis. Angle 2 (MGP/OP), angle 5 (HOR/CVT) and the distances C0–C2 and Pt–VER, presented no significant changes.

Conclusions:

The increase in cervical lordosis implies that six months of continuous MAA use, together with a program of postural re-education, promotes the homeostasis of the craniocervical system.     

鼠颞颌关节中弹力纤维的电镜观察

为了进一步观察鼠颞颌关节各部位的有胶原纤维和弹力纤维，作者应用计算机图象分析系统和电镜来研究鼠颞颌关节中三种弹力纤维的分布与形态。结果表明：在关节各部位中的弹力纤维以微原纤维和前弹力纤维为主。关节盘表面的微原纤维排列方向与胶原纤维几乎成直角。在关节盘表层下方和关节其它部位的弹力纤维排列上未见方向性。弹力纤维在关节盘和关节囊中形成一个广泛的纤维网。     

An index for the evaluation of 3D masticatory cycles stability

ObjectivesTo introduce an index (Masticatory Stability Index, MSI) to analyze the stability of chewing cycles in standardized conditions and test it in a group of patients with subclinical mild temporomandibular disorder (TMD).Design23 subjects with mild subacute TMD and 21 healthy subjects were involved; they all responded to a questionnaire about signs and symptoms of TMD (ProTMDmulti) and underwent a myofunctional orofacial evaluation with scores, using the protocol of orofacial myofunctional evaluation with scores (OMES). Their mandibular kinematics was assessed with a 3D motion capture system during deliberate unilateral gum chewing. The MSI was computed synthesizing the information contained in nine kinematics parameters into a single global figure. Patients’ and controls’ MSI were compared considering the preferred and non-preferred chewing side using a 2-way ANOVA (factors: group, side).ResultsTogether with a lower total score of myofunctional orofacial status, the TMD group showed a reduced stability based on MSI (p < 0.05).ConclusionsThe MSI is an efficient method to measure the stability of the masticatory cycles. These preliminary results encourage validating the index on a larger sample. The variability in the motor behavior of chewing can impair the objectivity of its evaluations in several types of patients, including those with TMD. The MSI could be useful to complement clinical assessments, providing data for planning the rehabilitation of masticatory function in these patients.