Orthodontic treatment and temporomandibular joint sounds--a longitudinal study

Temporomandibular joint sounds are often recognized as a clinical sign of temporomandibular disorders. The purpose of this study was to examine changes in the occurrence and resolution of these sounds in patients before and after orthodontic treatment with full fixed appliances. From a pool of 324 patients who came to a university postgraduate orthodontic clinic specifically for treatment of a malocclusion, 160 were examined before and after orthodontic treatment. When joint sounds were either reported or detected clinically, the patients underwent an audiovisual examination to more precisely and objectively record the occurrence and timing of the sound during mandibular opening and closing. No statistically significant difference could be found in the change in occurrence of joint sounds among patients treated with extraction and nonextraction treatment strategies. Overall, fewer patients had joint sounds at the end of the active stage of orthodontic treatment than before treatment. Also, fewer patients demonstrated reciprocal clicking after treatment than before treatment. Therefore it appeared that orthodontic treatment did not pose an increased risk for developing temporomandibular joint sounds irrespective of whether extraction or nonextraction treatment strategies were used. A progression of signs or symptoms to more serious problems was not apparent over the time period studied.     

Comprehensive treatment of temporomandibular joint disorders

Aims:

Changing lifestyles, decreasing physical activity, which is increasing the number of degenerative joint diseases of various etiology, and certain dental procedures are increasing the number of patients complaining of pain in their temporomandibular joints. The aim of the study was to assess the benefits of comprehensive physiotherapy sessions in order to decrease the number of temporomandibular joint problems, thereby improving the patient’s quality of life.

Methodology:

An examination by a dentist determined each patient’s treatment plan, which consisted of a medical exam, physical therapy and education. Each form of treatment was applied 10 times at intervals of 7–14 days. The main goal of the therapeutic physical education was to redress the muscle imbalance in the mandibular joint. This was achieved by restoring balance between the masticatory muscles, along with releasing the spastic shrouds found in the masticatory muscles. The aim of education was to teach the patient exercises focused on the temporomandibular joint and masticatory muscles. The intensity of the exercises and their composition were individually adjusted and adapted to their current state. Physical therapy consisted of the application of pulsed magnetic therapy, laser therapy, and non-invasive positive thermotherapy.

Results:

The above procedure was conducted on a therapeutic group of 24 patients (3 men and 20 women). In the course of therapy, there were no complications, and all patients adhered to the prescribed regime. None reported any side effects. The mean treatment duration was 123±66 days. The outcome of the therapy was evaluated as described in the methodology, the degree of pain affecting the joint, and the opening ability of the mouth. In both parameters, there was a significant decline in patient pain.

Conclusions:

In a study devoted to tactics of rehabilitation treatment for temporomandibular joint disorders, the need for comprehensive long-term therapy, involving education, and learning proper chewing habits was made apparent for recovery and pain reduction. A priority in physical therapy, and combinations of pulsed magnetic therapy and hyperthermia-positive peloids, are also beneficial.     

颞下颌关节紊乱病的“梯度序列治疗”

颞下颌关节紊乱病是口腔科临床常见的疾病,好发于青年群体,女性多见,发病率在30%左右;其临床表现多为下颌运动异常、疼痛、弹响与杂音,部分患者伴有耳鸣、头痛等症状。颞下颌关节紊乱病的治疗目前主张采用"梯度序列治疗"模式,每个"层级"均有其严格的适应证。一般首选保守治疗或无创治疗,适用于功能障碍性或轻度器质性病变患者;次选微创治疗,适用于保守治疗无效患者或轻度器质性病变患者;最后才考虑选择开放手术治疗,适用于前两种治疗无效并伴有严重器质性病变的患者。"梯度序列治疗"方案的制定应该是个性化的,由医生主导,患者配合的情况下完成的。本文对颞下颌关节紊乱病的"梯度序列治疗"进行阐述。     

Endoscopic treatment of disorders in the temporomandibular joint

Arthroscopy was used in the treatment of 21 patients with disorders of the temporomandibular joint. Good results were attained: pain relief and cure in more than half of the patients. The method is recommended for wide clinical practice.     

Efficiency of arthrocentesis treatment for different temporomandibular joint disorders

This study was performed to determine whether arthrocentesis therapy has different outcomes in three groups of patients with different temporomandibular disorders (TMDs). A clinical trial was conducted including 45 patients with 45 unilaterally affected joints divided into three groups (n = 15): osteoarthritis (OA), disc displacement with reduction (DDWR), and disc displacement without reduction (DDWoR). All patients underwent the same arthrocentesis treatment protocol. The outcome variables, including visual analogue scale evaluations and measurements of mandibular motion (in millimetres), were recorded at baseline and at 1 and 6 months postoperative. Inter-group assessments showed significant short-term differences in joint sounds (P = 0.016) and significant long-term differences in masticatory efficiency (P = 0.046) and protrusive movement (P = 0.048). The estimation of mean changes between baseline and long-term follow-up revealed significant differences in joint sounds (P < 0.001), disruption in daily activities (P = 0.002), maximum mouth opening (P = 0.008), and protrusive movement (P = 0.002) between the groups. Arthrocentesis therapy may be useful to improve clinical symptoms and range of mandibular movement in patients with all three types of TMD. However, the benefit of arthrocentesis may be greater for patients with DDWoR than for those in the other groups.     

Activator矫治对颞下颌关节的影响及其与颞下颌关节紊乱病的关系

Activator矫治器是较早用于临床的功能矫治器,由Andresen于1908年设计,对安氏Ⅱ类1分类错(牙合)畸形患者有良好的治疗效果,通过前移下颌刺激下颌骨的生长且抑制上颌矢状向生长,从而调节上下颌骨矢状向的关系.目前,关于Activator矫治器的矫治原理还存在较多的分歧,其中之一就有Activator是否能刺...     

Non-surgical treatment of sports-related temporomandibular joint disorders in basketball players

Abstract –  In this study, 18 basketball players (11 female, seven male; age range 14–32 years) with temporomandibular joint (TMJ) problems who had a history of sport injuries related to head or jaw region were evaluated and the results of the treatment were presented. A standardized functional examination of the masticatory system was performed including measurement of maximal jaw movements, recording of joint sounds, pain on movement of the jaw as well as tenderness to palpation of the both TMJ or masticatory muscles. Patients were also evaluated periodontally. Diagnosis was made according the criteria, described by Okeson, and appropriate treatment was applied using different kind of splints. At the end of treatment only one patient continued with right TMJ reduction with slight pain. Except for that patient, none of the patients had pain after treatment. The maximum opening of the jaws and the maximal jaw movements were statistically increased after treatment. Patients with TMJ problems also showed periodontal problems, most likely due to inadequate oral hygiene because of the limited jaw movements and pain. Periodontal parameters including probing depth (PD), Plaque index (PI), and Sulcus Bleeding Index (SBI) improved after treatment. Sports-related TMJ injuries may result in complex problems such as pain, TMJ sounds, limitation in maximal jaw movements and maximum opening of the mouth, difficulty in chewing. With the appropriate diagnosis this could be treated non-surgically in 6–8 months. This study also showed that the TMJ disorders may cause periodontal problems, which may affect all teeth and also the general health of the athlete.     

Nomenclature and classification of temporomandibular joint disorders

Currently, there are basically two approaches to classification, one based on structural and one on positional changes occurring within the joint. Despite the increase in knowledge of pathologic changes occurring within the temporomandibular joint (TMJ), the disc still seems to be a central issue in nomenclature and classifications of TMJ disorders. Basic pathologies of the TMJ involve inflammation and degeneration in arthritic disorders (irrespective of the presence or position of the disc) and structural aberrations in growth disorders. Some internal derangements may occur independent of underlying pathology, e.g. because of a traumatic event. In this position paper, a classification of TMJ disorders is proposed based on basic structural changes occurring in the joint.     

Emotional factors in temporomandibular joint disorders

The chronic pain of many temporomandibular disorders is associated with multiple changes in emotional function and activities of daily living. Temporomandibular disorders (TMD) are similar to other chronic pain disorders in their impact on patients. Depression is probably the most common emotional state associated with chronic pain, although anxiety disorders also can be associated with TMD. The probability of emotional problems appears to be greatest in those individuals diagnosed with myofascial pain and least in those with disk displacement. Dental practitioners are encouraged to seek professional liaisons with mental health professionals who can assist them in managing chronic pain patients.     

Facial asymmetry in temporomandibular joint disorders

In order to investigate skeletal deviation in patients with internal derangement of the TMJ, facial asymmetry was examined by the frontal cephalogram and compared with a control group of asymptomatic subjects. It was demonstrated that mandibular lateral displacement in the patients was significantly greater than that in the controls. The degree of displacement was significantly related to the cant of the frontal occlusal plane and the frontal mandibular plane, indicating the reduced vertical dimension of the posterior occlusal level and the ramus height on the mandibular displaced side. It is concluded that facial asymmetry due to mandibular lateral displacement is a relatively common problem in patients with internal derangement of TMJ. The cant of the frontal occlusal plane seems to be an important occlusal characteristic related to temporomandibular joint dysfunction.