Modified dextrose prolotherapy for recurrent temporomandibular joint dislocation

Conservative interventions with simple procedures and predictable benefits are expected by patients with recurrent dislocation of the temporomandibular joint (TMJ). We have introduced a modified technique of prolotherapy that comprises injection of lignocaine and 50% dextrose at a single site in the posterior periarticular tissues. We studied the effects in 45 younger patients (age range 17–59 years) with non-neurogenic recurrent dislocation of the TMJ, and confirmed the therapeutic effect after more than a year's follow-up. There were appreciable improvements in the number of episodes of dislocation and clicking after the injection. The overall success rate, defined as the absence of any further dislocation or subluxation for more than 6 months, was 41/45 (91%). Of the 41 rehabilitated patients, 26 (63%) required a single injection, 11 (27%) had 2 treatments, and 4 (10%) needed a third injection. All patients tolerated the injections well. The modified dextrose prolotherapy is simple, safe, and cost-effective for the treatment of recurrent dislocation of the TMJ.     

颞下颌关节病的颈部伴随症状及其治疗的临床研究

目的：调查颞下颌关节病的颈背部伴随症状的临床发生情况及特性，探讨其治疗方法及疗效。方法：随机调查100例患者颈部伴随症状的发生情况。并和无关节病症状的对照组进行比较，对颞下颌关节病患者进行常规治疗，对有颈部症状的患者侧重进行修复，He垫和综合治疗并对治疗效果进行评价。结果：颞下颌关节病患者中伴随颈部症状的患者比例高于对照组，另外，前者的下颌偏斜比例及咬合异常比例均高于对照组，患者组中有明显咬合异常或下颌位不稳定的人，治疗开始一年后显效或有效率较高，而对有原发性椎病的人和可能伴有其它心理精神因素的人疗效较差。结论：颞下颌关节病和颈部状有一定的关联，下颌位置改变有可能引起部关节及肌系统的改变，进而影响颈部功能。     

Prevalence of temporomandibular joint disorder among North Saudi University students

The aim of the current investigation was to study the prevalence of temporomandibular disorder (TMD) among university students of North Saudi Arabia.

Methods:A specifically constructed questionnaire was distributed to 489 university students to investigate the prevalence of temporomandibular joint (TMJ) findings among them. The study sample consisted of 346 males and 143 females (age range was 18–25?years). The data were analyzed, and probability values were set at p?≤?0.05.

Results:A total of 49.7% of participants had at least one sign or symptom of TMD. Clicking was the most reported finding. Pain in or about the ears/cheeks was the second most common finding. In all, 24.3% of the participants reported one TMJ finding; meanwhile, 0.4% reported the presence of five concurrent TMJ signs and symptoms. Females reported more TMJ signs and symptoms than males (p?p?Discussion:University students in north Saudi Arabia reported high prevalence of TMD. Also, students from science and health colleges reported higher prevalence of TMD findings than humanitarian college students. Clicking and pain are the most prevalent findings of TMD among university students. The results of this investigation highlight the need for additional research to shed more light on the risk factors and findings related to TMD. This will facilitate drawing adequate guidelines for prevention and management of TMD.     

Prospective assessment of outcomes following disposable arthroscopy of the temporomandibular joint

Temporomandibular disorder (TMD) is a common cause of chronic facial pain that is often treated successfully without operation, but when no improvement is seen arthroscopy may be considered as a therapeutic and diagnostic tool. We prospectively assessed the outcome of 115 arthroscopic procedures to assess the effectiveness and reliability of a 1.2 mm disposable arthroscope (OnPoint™, Biomet Microfixation, Jacksonville, USA). All patients included had not improved after standard conservative management. Discharge from clinic was classed as a successful outcome. Measurements taken before, during, and after operation included mouth opening and lateral deviations (mm). Pain was assessed before and after operation using a 10 cm visual analogue scale. Mean improvement in pain scores was 69% and in mouth opening was 19%, and overall success was 76%. Compared with a previous study using a 1.9 mm scope there were fewer complications after arthroscopy with the small diameter scope.     

Outcomes of physical therapy in patients with temporomandibular disorder: a retrospective review

Temporomandibular disorder (TMD) encompasses a spectrum of disorders that are associated with pain in the temporomandibular joint (TMJ) and surrounding musculature. Current research shows that conservative physical therapy is beneficial in the management of the disorder. This study further explores if physical therapy is an effective approach to treating patients with TMJ disorders. Our objectives were to determine the effect of conservative physical therapy interventions on pain, maximal mouth opening, and TMJ disability index for patients with TMD. Medical records from 2013-2018 were retrospectively reviewed to identify patients and obtain demographic, baseline, and short-term outcomes of maximal mouth opening (MMO), pain, and temporomandibular disability index (TDI). A total of 100 patients were included. Significant changes were noted in MMO, pain rating, and TDI from initial evaluation to discharge from physical therapy. Sex, age, and weight did not affect the outcomes. There was also no correlation between the number of visits attended and change in MMO. Patients treated conservatively did show improvements in short term outcomes (MMO, pain rating, and TDI). These changes were statistically significant, indicating that conservative therapy may be a beneficial treatment option for patients with TMJ dysfunction. Future studies assessing the long-term outcomes of TMJ patients treated conservatively would determine if this treatment is beneficial in the long-term. In addition, researching the effectiveness of specific interventions for TMJ patients, and if certain TMJ disorders are more responsive to conservative care than others would be valuable in providing information on the effectiveness of conservative treatment in this patient population.     

Oral health and related quality of life status in patients from UK and Turkey: a comparative study in Behcet's disease

Background:  The aim of this study was to evaluate and compare oral health-related quality of life (oral QoL) in patients from UK and Turkey with Behcet's disease (BD).
Methods:  Thirty-one BD patients from UK (F/M: 18/13, mean age: 41.8 ± 11.5 years) and Turkey (F/M: 18/13, mean age: 41.5 ± 10.3) who were matched according to age and gender were included in the study. All patients had active oral ulcers. Oral QoL was assessed by Oral Health Impact Profile-14 (OHIP-14). Oral health was evaluated by dental and periodontal indices.
Results:  No significant difference was found in OHIP-14 scores between patients from UK (22.7 ± 14.4) and Turkey (20.4 ± 14.3) ( P  = 0.709). The OHIP-14 score correlated with the healing time of oral ulcers in UK ( r  = 0.4, P  = 0.04) and the number of oral ulcers in Turkey ( r  = 0.4, P  = 0.012). The number of oral ulcers per month was significantly higher in UK (3.3 ± 2.8) compared with that in Turkey (1.5 ± 2.5) ( P  = 0.014). However, the number of filled teeth and frequency of tooth brushing were significantly lower in patients from Turkey compared with those in UK ( P  = 0.000). Similarly, the duration since the last dental visit (5.1 ± 7.2 months) was significantly lower in UK compared with that in Turkey (28.6 ± 23.7 months) ( P  = 0.000).
Conclusions:  Oral QoL was similar in patients from UK and Turkey with active oral ulcers. However, the number of oral ulcers was observed to be higher in UK. As expected, a lower utilization rate of dental services might have led to a poorer oral health in patients from Turkey.     

Predictive factors in temporomandibular joint arthroscopy: a prospective cohort short-term outcome study

Improving the outcomes of surgical treatment of the temporomandibular joint (TMJ) is beneficial from a patient and health-economy perspective. Optimizing conditions for a successful result can be reached using validated, strict diagnostic criteria and by identifying patient-specific factors predicting the outcome. The aim of this study was to investigate possible predictive factors in TMJ arthroscopy. A prospective cohort study including 93 patients undergoing arthroscopy was conducted. The outcome was graded as successful (53%, n = 49), good (25%, n = 23), intermediate (20%, n = 19), or deteriorated (2%, n = 2) using a predefined set of objective and subjective outcome measures. The outcome was correlated with preoperative and perioperative variables and the diagnosis. Preoperative bilateral masticatory muscle tenderness on palpation was the only variable significantly correlated with a negative outcome in the adjusted regression analysis (odds ratio (OR) 2.56, P = 0.048). Low age (OR 1.03, P = 0.05) and bilateral joint surgery/operated side (OR 0.24, P = 0.05) were found to correlate with an unsuccessful outcome in the unadjusted analysis. Eighty-nine percent of the patients with osteoarthritis benefited from arthroscopy, while corresponding figures were 80% for disc displacement without reduction and 64% for chronic inflammatory arthritis. Preoperative bilateral masticatory tenderness might be a useful predictive factor suggesting the consideration of revised non-invasive therapy before surgery.     

邢台地区某煤矿工人口腔健康相关生活质量水平及影响因素分析

目的了解邢台地区某煤矿工人的口腔健康相关生活质量水平并探索相关影响因素。方法抽样调查邢台地区某煤矿1116名煤矿工人,采用口腔健康影响程度量表(OHIP-14中文版)进行生活质量调查,分析煤矿工人口腔健康相关生活质量的影响因素并根据性别、年龄等因素进行分组比较。结果回收有效问卷1054份,平均得分为14.93±3.12分,单因素分析中差异有统计学意义的是年龄、文化程度、余留牙数、龋齿数、失牙数、CPI值、楔状缺损。在多元逐步回归分析模型中,龋齿数、CPI值以及失牙数被纳入到最终模型中。男性总得分为14.91±3.11,女性总得分为15.25±3.28,两组差别无统计学差异(t=-0.787,P=0.431)。根据年龄分组显示≤34岁组得分为14.29±2.91,35~44岁组的得分为15.05±2.88,≥45岁组的得分为15.42±3.46,方差分析显示各组差异有统计学差异。结论煤矿工人口腔健康相关生活质量相对较低,生活质量与龋病、牙周病的患病情况有紧密的联系。     

The efficacy of acupuncture in the treatment of temporomandibular joint myofascial pain: a randomised controlled trial

OBJECTIVES: To compare the effect of real acupuncture and sham acupuncture in the treatment of temporomandibulat joint myofascial pain, in order to establish the true efficacy of acupuncture. METHODS: A double blind randomised controlled trial conducted in the TMD Clinic, at the School of Dentistry, The University of Manchester. Twenty-seven patients were assigned to one of two treatment groups. Group 1 received real acupuncture treatment whilst Group 2 received a sham acupuncture intervention. Both the assessor and the patient were blinded regarding the group allocation. Baseline assessment of the outcome variables was made prior to the first treatment session, and was repeated following the last treatment. RESULTS: The results demonstrated that real acupuncture had a greater influence on clinical outcome measure of TMJ MP than those of sham acupuncture, and the majority of these reached a level of statistical significance. CONCLUSION: Acupuncture had a positive influence on the signs and symptoms of TMJ MP. In addition, this study provides evidence that the Park Sham Device was a credible acupuncture control method for trials involving facial acupoints.     

Outcomes of office-based temporomandibular joint arthroscopy: a 5-year retrospective study

Temporomandibular joint (TMJ) arthroscopy is a minimally invasive surgical approach for intra-articular TMJ diseases. Office-based arthroscopy using the smallest TMJ scope allows for good visualization, as well as the ability to lavage the joint in an office setting. This study aimed to assess the efficacy of an office-based TMJ arthroscopic technique. A retrospective evaluation of 363 patients with a TMJ disorder was performed. These patients underwent office-based arthroscopy using the OnPoint 1.2 mm Scope System (Biomet Microfixation, Jacksonville, FL, USA) in Florida, USA, from July 2007. The following outcomes of the procedure were assessed: improvement in painless range of mandibular motion, pain on loading, and functional jaw pain; these were evaluated using a visual analog scale (VAS) over an average follow-up period of 263.81 ± 142.1 days. The statistical analysis was performed using IBM SPSS Statistics version 20. Statistically significant improvements in TMJ pain and function, and other variables (P = 0.001) were shown following TMJ arthroscopic lysis and lavage. Office-based arthroscopy using the OnPoint System was demonstrated to be a safe and efficient procedure for the treatment of patients with TMJ disorders as the first level of the algorithm of care.     

Assessment of quality of life and sociocultural aspects in patients with ameloblastoma after immediate mandibular reconstruction with a fibular free flap

Our aim was to evaluate the quality of life (QoL) in patients with ameloblastoma who had been treated by immediate mandibular reconstruction with a fibular free flap, and to analyse the association between QoL and their sociocultural and medical characteristics. We assessed the QoL outcomes of 33/45 patients using the University of Washington quality of life (UW-QoL) questionnaire and the 14-item Oral Health Impact Profile (OHIP-14). Thirty-three of the 45 questionnaires were returned (73%). In the UW-QoL the best-scoring domain was “shoulder”, whereas the lowest scores were for “chewing” and “activity”. In the OHIP-14 the lowest-scoring domain was “handicap”, followed by “social disability” and “psychological discomfort”. Mandibular reconstruction with a fibular free flap significantly influenced the patients’ QoL and oral function. Their sociocultural data showed that most patients had a fairly low level of education.     

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.     

Efficacy of Prolotherapy in Temporomandibular Joint Disorders: An Exploratory Study

IntroductionTemporomandibular joint (TMJ) disorders can be treated by both conservative and surgical approaches. Conservative interventions with predictable benefits can be considered as first-line treatment for such disorders. Dextrose prolotherapy is one of the most promising approaches in the management of TMDs, especially in refractory cases where other conservative management has failed.AimTo study the efficacy of prolotherapy and to establish it as an effective procedure in patients with TMJ disorders, to provide long-term solution to chronic TMJ pain and dysfunctions.Patients and MethodsWe conducted a study on 25 patients suffering from various TMJ disorders who were treated with prolotherapy, the solution consisting of 1 part of 50% dextrose (0.75 ml); 2 parts of lidocaine (1.5 ml); and 1 part of warm saline (0.75 ml). The standard programme is to repeat the injections three times, at 2-week interval, which totals four injection appointments over 6 weeks with 3-month follow-up.ResultsThere was appreciable reduction in tenderness in TMJ and masticatory muscles with significant improvement in mouth opening. The effect of the treatment in improving clicking and deviation of TMJ was found to be statistically significant (P < 0.05). There were no permanent complications.ConclusionOur study concluded that prolotherapy is an effective therapeutic modality that reduces TMJ pain, improves joint stability and range of motion in a majority of patients. It can be a first-line treatment option as it is safe, economical and an easy procedure associated with minimal morbidity.     

The use of bone scintigraphy in temporomandibular joint disorders

INTRODUCTION: The use of bone scintigraphy (bone scan) in the diagnosis of temporomandibular joint (TMJ) disease has been infrequent, as compared with traditional radiographic techniques. Bone scans have the potential to detect active bone remodeling whereas corresponding radiographs may be normal or document past structural change in the joint. Traditional radiographic findings and relevant clinical signs and symptoms correlated with bone scans may aid in the diagnosis of TMJ disease and possibly affect treatment and prognosis of individual cases. The use of bone scans as an additional tool in diagnosing TMJ disease was assessed in this series of patients. METHODS: Thirty consecutive subjects with TMJ tenderness were selected for bone scintigraphy using technetium diphosphonate 99 mTc and single photon emission computerized tomography. These subjects received bone scans as well as other selected imaging modalities for diagnostic purposes. RESULTS AND DISCUSSION: The findings on bone scan were evaluated and a change in preliminary clinical diagnosis or treatment was made in 60% of cases because of the findings on bone scintigraphy. Bone scintigraphy may be valuable to assess progress of TMJ inflammation or remodeling, and may affect diagnosis and treatment of patients with TMJ tenderness.     

颞下颌关节紊乱病的心理因素的研究

目的：探讨心理因素在颞下颌关节紊乱病(TMD)发病机制中的作用。方法：采用焦虑自评量表(SAS)、抑郁自评量表(SDS)和明尼苏达多项人格量表(MMPI)对颞下颌关节紊乱病患组和正常对照组各30例进行调查。结果：TMD患组与对照组相比，具有较高的焦虑和抑郁得分；MMPI测试结果显示，在MMPI十项临床量表中，患组在其中的疑病(HS)、抑郁(D)、癔病(HY)、精神病态(PD)、精神衰弱(PT)、精神分裂(SC)、社会内-外向(SI)七项中得分均高于对照组。另外，患组有26例临床量表中的一项或多项得分高于常模分数，说明TMD患的人格有偏离现象。结论：颞下颌关节紊乱病患的情绪障碍以及人格特征在其发病机制中具有重要作用。     

Absence of joint pain identifies high levels of sleep masticatory muscle activity in myofascial temporomandibular disorder

Although the development of reliable diagnostic criteria for temporomandibular disorders (TMDs) has operationalised identification of a subgroup with myofascial pain (mTMD), causal mechanisms remain elusive. This study examines masticatory muscle activity (MMA) in more homogenous research subgroups of mTMD. Data from an existing case‐control study of women were used to subcategorise mTMD cases based on joint pain with palpation to isolate muscle‐only pain (M‐pain) vs muscle and joint pain (MJ‐pain). Differences in laboratory indicators of MMA, specifically research diagnostic criteria for sleep bruxism (SB) and high background EMG activity, and other clinical and sociodemographic indicators were examined between groups. Compared to controls, the MJ‐pain subgroup did not show elevated background EMG or sleep bruxism. In contrast, the M‐pain subgroup showed significantly higher background EMG and a trend towards elevated prevalence of sleep bruxism. These results may explain why it has been difficult for studies of SB in mixed TMD and even mTMD samples to find a consistent positive association, since a positive association may be limited to mTMD without joint pain. The subcategorising of mTMD based on joint pain with palpation (ie M‐pain, MJ‐pain) appears to reveal subgroups with relatively high and low sleep masticatory muscle‐specific activity. Findings need replication in a larger study with updated mTMD diagnostic criteria, but may prove useful for understanding mechanism of pain maintenance in mTMD with and without joint pain.     

MRI assessment of temporomandibular disorders: an approach to diagnostic and therapeutic setting

Aims: The aim of this study was to evaluate the relationship between the clinical and the radiological data obtained by magnetic resonance imaging (MRI) in patients with temporomandibular disorder (TMD).

Methodology: The study group included 17 patients with symptoms of TMDs. The radiological assessments before and after therapy was evaluated by MRI; in the clinical analysis, signs and associated symptoms have been assessed.

Results: With MRI before therapy, we were able to distinguish the specific type of TMD that each patient had. At the end of the treatment, a general improvement of the clinical status was noticed; MRI, however, showed the permanence of several degrees of condyle–disc incoordination in some patients.

Conclusions: Certainly TMDs can be diagnosed without MRI; nevertheless, MRI gives us the possibility to obtain objective data of the patients concerned. Symptoms recorded during a clinical evaluation cannot be the only terms of diagnosis; MRI provides objective data in the diagnostic and post-therapy phases.     

Quality of life assessment in temporomandibular joint ankylosis patients after interpositional arthroplasty: a prospective study

Temporomandibular joint (TMJ) ankylosis significantly impacts both physical and psychosocial patient wellbeing. A complete evaluation of treatment outcomes necessitates knowing the extent to which a patient’s quality of life (QoL) is impacted. This study was performed to evaluate the impact of TMJ ankylosis on QoL in 25 TMJ ankylosis patients treated by interpositional arthroplasty. The patients completed OHIP-14 and UWQoL questionnaires once before and then at 3 months after the surgery. There was a significant improvement in mean cumulative scores for both questionnaires. With the exception of functional limitation, all OHIP domains showed significant improvement. Preoperatively, the worst scores were found in the psychological distress domain, followed by the social handicap, physical pain and physical disability domains. More than half of the subjects (56%) reported having suicidal thoughts. Amongst the individual UWQoL domains, appearance, chewing, anxiety (P < 0.01), recreation and mood (P < 0.05) showed improved scores. Appearance and chewing were the top ranked priority domains before and after surgery. No significant change was found in speech, taste, sleep, or breathing. Psychosocial factors were found to play a much bigger role than previously thought. The physical, psychological, and social factors were intricately related and dynamically interacted with each other. Surgical treatment produced a definitive QoL improvement in the patients.     

Cross-cultural validation of a short form of the Oral Health Impact Profile for temporomandibular disorders

OBJECTIVES: We set out to develop and validate an Italian version of the Oral Health Impact Profile Questionnaire (OHIP) that is appropriate for use in temporomandibular disorders (TMD). METHODS: At first, we had the questionnaire translated from English into Italian by three bilingual individuals whose mother tongue was Italian and thus had three different versions of the questionnaire. These were translated back into English by a native English speaker and the version closest to the original English OHIP was selected. The validation of a questionnaire generally involves the study of the psychometric properties of the instrument: its validity and reliability. Before studying these properties, we assessed the factorial structure of the questionnaire. RESULTS: The number of eigenvalues >1, computed by exploratory factor analysis, was seven. The percentage of cumulative variability explained by a model with six dimensions is 66, whereas that explained by a model with seven dimensions is 70. Therefore, considering that the increment of explained variability due to the seventh dimension is low (3.68%) and that the seventh eigenvalue is very close to 1, we considered a six-factor model capable of explaining the factorial structure of the data. Content analysis suggested eliminating the item 'Felt Self-conscious', as most of the subjects did not understand its meaning. Spearman correlation coefficients showed an association between the scores of all the different subscales and the variable for pain. All the coefficients were significantly different from 0 (P < 0.05). Cronbach's alpha value, always >0.70, showed quite a good reliability for each of the six subscales. CONCLUSIONS: These results reveal a reasonable degree of cross-cultural consistency between the two versions of the OHIP, and thus indicate that our Italian version is valid.