Temporomandibular disorders, facial pain and headache following motor vehicle accidents.

Temporomandibular disorders are known to be a possible sequela of motor vehicle accidents, particularly when flexion-extension injury occurs. This paper recognizes the relationship between cervical injury and dysfunction, and temporomandibular dysfunction and headache. The literature related to motor vehicle accidents, whiplash injury, and temporomandibular dysfunction is reviewed, and the etiology, prognosis and management of the trauma associated with head and neck pain and dysfunction are presented.     

The relationship between bruxism and temporomandibular joint dysfunction as shown by computer analysis of nocturnal tooth contact patterns

Whilst there are many causes of temporomandibular joint dysfunction, one of the most frequently encountered is bruxism. The two conditions have many aetiological factors in common and there is a rational physiological reason why bruxism could cause temporomandibular joint dysfunction. In fact, experimental bruxism performed under laboratory conditions has been found to cause such joint dysfunction. This contention is supported by direct measurements of nocturnal tooth contact. Patients with temporomandibular joint dysfunction were found to differ from control subjects to a degree which was statistically significant.     

Symptoms of mandibular dysfunction in complete denture wearers

Recent epidemiological studies have shown that symptoms of mandibular dysfunction are very common, but prosthodontists have thought that complete denture wearers are spared such complications. However, in recent reported series of patients who have sought advice for mandibular dysfunction complete denture wearers have been included. According to epidemiological data individuals with few remaining natural teeth had more symptoms of dysfunction than those with most of their natural teeth, and complete denture wearers had more symptoms of mandibular dysfunction than subjects with natural teeth. Mandibular and temporomandibular joint dysfunction symptoms have a heterogeneous background, but occlusal instability is an important aetiological factor. In complete denture wearers with mandibular dysfunction, symptoms often disappear after improvement of the occlusion.     

Temporomandibular joint findings in pediatric populations and young adults: a critical review

The etiology, diagnosis and treatment of temporomandibular joint (TMJ) pain and dysfunction is a controversial subject. There are varying opinions regarding the contribution of occlusion (malocclusion) to the development of mandibular dysfunction and further, the contribution of occlusal alterations (orthodontic and restorative) to the development of pain and dysfunction. Epidemiologic investigations suggest there is a high incidence of subjective and objective symptoms in the pediatric population. Observations on incisal relationships, condyle position and joint sounds, and comparisons to controls seem to suggest that these factors are not the cause of pain or dysfunction. The purpose of this review is: (1) to bring the clinician's attention existing published information reporting the presence of symptoms in children, (2) to evaluate selected information in young adults, (3) to question anecdotal information on the etiology of TMJ problems. It is not in the purview of this paper to determine the overall etiology of TMJ dysfunction.     

The effects of electrogalvanic stimulation therapy on masticatory muscle dysfunction as determined by the pantronic reproducibility index

Patients with temporomandibular joint dysfunctional activity (TM dysfunction) present with a diverse spectrum of clinical signs and symptoms. The multifactorial aetiology of such disorders has been noted. Diagnostic and therapeutic problems arise due to the inadequacy of quantifying the dysfunction. TM dysfunction can affect the muscles of mastication which are responsible for mandibular movement. A pantographic reproducibility index (PRI) is available to quantitatively and qualitatively measure a subjects ability to reproduce mandibular border movements. Physical therapy modalities are used in the management of TM dysfunction. Electrogalvanic stimulation (EGS) is such an example. The effect of electrogalvanic stimulation on subjects with and without TM dysfunction was assessed by Pantronic PRI appraisal in 20 subjects. No statistically significant differences were noted. At the individual level, some changes were observed in susceptible subjects.     

Radiation-induced salivary dysfunction: clinical course and significance

Salivary gland dysfunction commonly occurs as a result of radiation therapy for cancers of the head and neck region. The effect of radiation on salivary glands is immediate and predictable. Histologic and sialochemical studies indicate both the acini and ducts are affected. The extent of salivary dysfunction is primarily determined by the radiation field and dose. Radiation-induced salivary dysfunction is permanent and leads to a host of clinical sequelae, both oral and systemic.     

Signs and Symptoms of Mandibular Dysfunction in Complete Denture Wearers Five Years after Receiving New Dentures

Studies have shown that signs and symptoms of mandibular dysfunction are a common finding in complete denture wearers. There is, however, a low representation of these patients in clinical series, probably due to their lower propensity to seek help and their greater willingness to accept a certain degree of dysfunction compared to other patients.

The author of this article examined a group of complete denture wearers five years after treatment with new complete dentures. These findings are compared with the situation before treatment and at a six-month follow-up. Clinical signs of dysfunction were a common finding on all three occasions. The favorable decrease of clinical signs that was noted at the six- month follow-up was generally followed by some relapse after five years.

The author stresses that a recall system, including correction of the dentures when needed, is important. This will not only preserve good comfort and extend the life of the dentures, but will also prevent or delay the development of signs and symptoms of mandibular dysfunction.     

A comparison of the signs of temporomandibular joint dysfunction and occlusal discrepancies in a symptom-free population of men and women

To date, there has been no conclusive explanation for the predominance of female patients with temporomandibular joint (TMJ) dysfunction. The purpose of this study was to survey a normal population without symptoms for the presence of certain putative signs of TMJ dysfunction in association with certain signs of occlusal discrepancy and to determine the presence of any gender variation. The subjects (217 men and 217 women) were examined for the presence of three putative signs of TMJ dysfunction: limited mandibular opening (under 37 mm), deviation on opening, and joint sounds. The subjects were also examined for the presence of four signs of occlusal discrepancy: an anterior slide from centric relation (CR) to centric occlusion (CO), lateral slide from CR to CO, nonworking occlusal contacts, and working disclusive contacts distal to the canines. CR is the mandibular position at which the condyles are in their most superior position on the posterior aspect of the articular tubercles. CO is the mandibular position at which the mandibular and maxillary teeth are in maximum intercuspation. There were no significant differences in the prevalence of the putative signs of TMJ dysfunction and occlusal discrepancy between men and women. It was concluded that factors other than the presence of these signs of TMJ dysfunction and occlusal discrepancy are responsible for the high predominance of female patients with TMJ dysfunction.     

An electronic, computerized pantographic reproducibility index for diagnosing temporomandibular joint dysfunction

One of the signs and symptoms of TMJ dysfunction is incoordinated mandibular movements. The PRI quantitates the incoordinated movements and gives a muscle dysfunction score and the relative severity of TMJ dysfunction. An electronic, computerized pantograph (Pantronic) has been developed that can be used in place of the mechanical pantograph. This study was undertaken to determine if the Pantronic can be programmed to produce PRI scores that are comparable to the M-pantograph PRI scores. Several programs were written for the computer until the Pantronic PRI was comparable to the M-pantograph PRI. The Pantronic PRI was within zero to 5 points of the M-pantograph PRI in all of the 25 patients studied. Because of this close comparison, studies used to validate the M-pantograph PRI also validate the Pantronic PRI. There was, however, a statistically significant difference (.05 level) between the two PRI scores. In spite of this difference the categories of TMJ dysfunction remained the same. The Pantronic PRI can be determined clinically in 20 to 30 minutes. It can be used to determine the presence and, more important, the absence of TMJ dysfunction; the success of occlusal splint therapy, occlusal adjustment, and restorative treatment; the changes in dysfunction over time; the success of other treatment modalities; and the level of dysfunction in TMJ dysfunction research.     

Prognostic stratification for the mandibular pain dysfunction syndrome

Abstract Combinations of the symptoms and signs of the mandibular pain dysfunction syndrome (MDS) provoked by movements of the mandible are complex and patients are treated as a homogeneous group. The process of prognostic stratification applied to an inception cohort of 169 MDS patients, separated groups of patients according to affected movements of the mandible associated with similar outcomes of treatments. From the data, two staging systems for the dysfunction were derived and evaluated. It is suggested that further analyses of more data would distinguish groups of patients with comparable prognoses enabling universal and valid comparisons of treatment of the dysfunction to be made.     

Asymmetry of masticatory muscle activity during intercuspal maximal clenching in healthy subjects and subjects with stomatognathic dysfunction syndrome

summary The present study investigated the asymmetry of masticatory muscle activity during maximal intercuspal clenching in healthy subjects and subjects with stomatognathic dysfunction syndrome. Stomatognathic dysfunction syndrome, unilateral mastication and the asymmetry of masticatory muscle activity appear to be related to each other. The asymmetry of masseter muscle activity was greater as stomatognathic dysfunction became increasingly severe. Because fatigue and pain are produced more quickly by unilateral clenching than bilateral clenching, clenching under conditions of left and right muscular imbalance can further aggravate stomatognathic dysfunction. It is suggested the asymmetry of masseter muscle activity during maximal clenching correlates with the onset of the stomagnathic dysfunction syndrome. Stomatognathic dysfunction syndrome is closely related to the asymmetry of masseter muscle activity and only slightly related to the asymmetry of temporal muscle activity. The asymmetry of anterior temporal muscle activity appears to have little clinical significance.     

Current concepts in the aetiology, diagnosis and treatment of TMJ and muscle dysfunction

The complexity of managing TMJ and muscle dysfunction is reflected in the variety of treatment modalities that are continually being advocated. The multidimensional nature of the problem is readily appreciated in a TMJ Oral-Facial Pain Clinic where most of the referred patients represent a broad spectrum of treatments that have failed. Where such a clinic has been present for several decades the introduction of new ideas, or the reintroduction of old forms of treatment, are readily seen as well as the quantity and quality of treatment successes and failures. A major shift in ideas concerning the natural history of TMJ/muscle dysfunction, and an explosion of treatment problems and failures related to mandibular repositioning appliances and surgery suggest the need to reconsider various approaches to the diagnosis and treatment of TMJ and muscle dysfunction. Guidelines for diagnosis and treatment of these disorders are discussed.     

A clinical study of joint sounds in subjects with restored occlusions

It has been implied that temporomandibular joint sounds must be treated to eliminate the sounds before restorative treatments are attempted. This study explored the possibility that joint sounds do not present a problem when other symptoms are absent. A group of 35 subjects with restored occlusions were studied for the presence of temporomandibular joint dysfunction symptoms using clinical examination, questionnaires, and the pantographic reproducibility index. Forty-six percent had some degree of temporomandibular joint dysfunction. Seventeen of 18 subjects (94%) with joint sounds were free of other symptoms. Therefore, the use of joint sounds as a symptom of temporomandibular joint dysfunction is questionable when not accompanied by other clinical symptoms. Subjects who had temporomandibular joint dysfunction symptoms were treated with occlusal splint therapy and occlusal adjustments. The period of time to eliminate the symptoms was 2 to 16 weeks with an average of 7 weeks. This study concludes that the presence of only joint sounds does not seem to be a hindrance to restorative treatments.     

A technique for evaluation of centric relation tooth contacts. Part II: Following use of an occlusal splint for treatment of temporomandibular joint dysfunction

The purpose of this study was to determine the effect of TMJ dysfunction on the recording of centric relation. Centric relation was recorded using an anterior occlusal stop and by bimanual manipulation. Changes in occlusal contacts were recorded before and after occlusal splint therapy in six subjects with TMJ dysfunction. The pantographic reproducibility index and clinical signs and symptoms were used to determine the presence or absence of dysfunction. Use of the anterior occlusal stop resulted in a more posterior, superior initial tooth contact position when compared with bimanual manipulation. Occlusal contact positions were less consistent in TMJ dysfunction subjects than in control subjects. Initial occlusal contacts changed toward centric relation as the dysfunction disappeared. Final occlusal contact was found on the side where clinical signs and symptoms occurred. The condyle on the affected side appeared to be repositioned posteriorly and superiorly in most instances. Occlusal splint therapy was more effective when the splint was adjusted weekly. This study indicates the need to eliminate TMJ dysfunction before recording centric relation or adjusting the occlusion. Occlusal interferences found with TMJ dysfunction are not the same as occlusal interferences found when TMJ dysfunction is absent. Abnormal features on pantographic tracings may aid in indicating the presence of occlusal interferences. Occlusal adjustment in the presence of TMJ dysfunction would result in erroneous occlusal reduction.     

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.     

Masticatory dysfunction in persons with Down's syndrome. Part 2: management

The functional and anatomical characteristics of Down's syndrome have direct repercussions on oral health; orofacial dysfunction results and feeding and swallowing are impaired. These problems have been described in an earlier article. Different techniques are proposed for the prevention of the development of orofacial dysfunction in Down's syndrome. In particular, early myofunctional therapy coupled with appliance wear has been shown to be successful over the long term when multidisciplinary management is possible. Functional or conventional orthodontic treatment may be successful for older children when performed concurrently with the use of appropriate behaviour management techniques. More recently, techniques for the compensation of masticatory dysfunction in adults have been proposed, although further research is necessary to confirm their efficacy. The aim of this second article was to review techniques for the prevention, treatment and compensation of orofacial dysfunction in persons with Down's syndrome from birth to adulthood.     

Speech evaluation of velopharyngeal dysfunction

This article reviews concepts basic to the evaluation of the speech of persons with velopharyngeal dysfunction. It defines velopharyngeal dysfunction as well as reviews normal and abnormal velopharyngeal function for speech. It defines the common speech characteristics of persons with velopharyngeal dysfunction, including hypernasality, hyponasality, nasal emission, compensatory articulations, and weak pressure consonants. Speech sounds commonly impacted by velopharyngeal dysfunction are discussed. This article identifies the components of a complete speech evaluation as well as identifies anatomic and physiologic measurements of palatal function used to corroborate perceptual speech judgments indicating palatal problems. It identifies special considerations in the evaluation of persons with suspected velopharyngeal dysfunction. It briefly discusses management of velopharyngeal dysfunction. Review questions follow the article.     

Electromyographic silent periods and jaw motion parameters: quantitative measures of temporomandibular joint dysfunction.

The purpose of this research was to compare, in the subjects, the duration of the EMG silent period with jaw motion error. The results indicate that both jaw motion error and silent period duration are large in patients with TMJ-muscle-pain dysfunction, both are small in normal subjects, and both are small in successfully treated patients. There is a statistically significant correlation (r=0.91; P less than 0.01) between the two diagnostic parameters of TMJ-muscle-pain dysfunction.     

The prevalence of mandibular dysfunction. Part I: Sex and age distribution of related signs and symptoms

This study concludes the following: 1. Mandibular dysfunction is extensive. 2. Age and sex differences are apparent with various signs and symptoms. 3. Women and younger patients tend to respond positively more often than men and older patients to questions relating to subjective TMJ and muscle symptoms. 4. Objective TMJ and occlusal signs show little age or sex differentiation. 5. Positive responses to questions regarding bruxism were more common in men. 6. Age and sex differences in the prevalence of mandibular dysfunction may be influenced by the method of investigation (anamnestic versus clinical examination) and by the signs and symptoms selected to be representative of this disorder. When compared with the findings of earlier investigations, the conclusions suggest that social, cultural, psychologic, sex, and age differences contribute to the responses to questions pertaining to mandibular dysfunction. However, this may not be an accurate reflection of the prevalence of mandibular dysfunction since the objective signs do not show the age and sex differences that the subjective symptoms indicate. Therefore, additional studies are needed to correlate all data to establish a more reliable profile of both signs and symptoms of mandibular dysfunction.     

Examining Temporomandibular Disorder Patients for Cranio-Cervical Dysfunction

This article presents a method for examining patients with TMJ disorders to determine whether cranio-cervical dysfunction is present. This procedure should be used on all patients who are being treated for craniomandibular problems, since untreated cranio-cervical dysfunction will cause difficulties in TMJ treatment. The material presented here includes a short questionnaire for the patient to answer and an explanation of how to examine the patient for six aspects of cranio-cervical function.