The influence of time, facial side, and location on pain-pressure thresholds in chronic myogenous temporomandibular disorder

This study examined masseter and temporalis pain-pressure thresholds in 29 patients with chronic bilateral myogenous temporomandibular disorder and in 11 controls. Patients with evidence of temporomandibular joint pathosis were omitted. The influence of time, facial side, muscle site, and side of greatest spontaneous pain on pain-pressure thresholds was measured. No significant pain-pressure threshold differences were found between the more and less painful sides, as indicated by the patients, which lends support to theories of centrally mediated pain. Mean pain-pressure thresholds in patients differed over the four sessions, which is consistent with recent reports of fluctuating levels of pain in patients with temporomandibular disorders. Additional findings included significant pain-pressure threshold differences among muscle sites in patients and controls, and lower patient pain-pressure thresholds relative to controls. Within- and between-session reliability was adequate for patients (r = .85 and r = .75, respectively) and controls (r = .90 and r = .75, respectively).

Immunohistochemical and histological studies on internal derangement and organic disturbance of temporomandibular joint

The study examined the articular cartilages of 14 patients who suffered from temporomandibular joint disturbance syndrome (TMJDS) and 3 healthy fresh cadavers by light microscopy and immunofluorescence, and assayed 14 patients' synovial fluids and sera with indirect hemoagglutination. The results showed that there were antibodies to type II collagen in synovial fluids in 5 of 14 patients and there were some immune complexes in cartilage. So, the authors think that there are autoimmune reactions in the articular tissues in TMJDS because of the exposure of some sequestered antigens.

[Analysis of the image of external pterygoid muscle during close and wide open of the jaw by condylo-pterygo-maxillo-oblique projection in magnetic resonance]

External pterygoid muscle is an important muscle. It is easy to be hurt by acute and chronic trauma which may become one of the chief cause of TMJDS. It is difficult to be studied, because it locates deeply. It is covered by thick soft and hard tissues. That is why the questions about its anatomy and physiological functions have been debated. In this paper, the changes of images form of external pterygoid muscle during the jaw closing and wide opening were observed and analysed in 14 cases, 25 sides, of adult men and women. By CPMOP in MR. The results can by concluded that (1) the upper head of this muscle inserts fully or mainly to the condyle pterygoid fossa; (2) the direction of the muscle fibers is not entirely horizontal but with some inclined and (3) the two heads of this muscle are relaxed in the jaw closing and are contracted in the jaw wide opening synchronously.

Strategies for coping with pain and psychological distress associated with temporomandibular joint osteoarthrosis and internal derangement

OBJECTIVE

To analyse the relationship among a variety of emotional, cognitive, and behavioral coping strategies and pain/suffering and psychological distress in patients with temporomandibular joint (TMJ) pain.

DESIGN

Cross-sectional, correlational study.

SETTING

Department of Oral and Maxillofacial Surgery, University Hospital Groningen.

SUBJECTS

A consecutive sample of 53 patients with a mean age of 25 with TMJ osteoarthrosis and internal derangement or synovitis without internal derangement. There were seven men and 46 women. No patient was excluded.

MAIN OUTCOME MEASURES

Pain/suffering was assessed using the West Haven-Yale Multidimensional Pain Inventory and visual analogue scales. Psychological distress was assessed by the General Health Questionnaire and the Symptom Checklist. Coping with pain was assessed by the Coping with Specific Symptoms Questionnaire.

RESULTS

Psychological distress and pain severity were low, and there was little interference by pain with daily life. While none of the coping strategies were frequently used, these strategies did explain a significant proportion of the variance in pain and psychological distress measures (27-58% of the variance). Stepwise regression analysis showed that patients scoring high on expression of emotions and wishful thinking had significantly higher levels of pain/suffering and psychological distress.

CONCLUSIONS

Previous studies of other subgroups of patients with temporomandibular disorders (TMDs) report higher degrees of psychological distress. The need to distinguish between specific subgroups of patients with TMD is emphasized by the results of this study. Cognitive-behaviorial interventions to improve ways of coping is not very useful for the subgroup in this study.

The role of diagnostic arthroscopy in the management of temporomandibular joint dysfunction

Temporomandibular joint (TMJ) dysfunction may manifest itself clinically by a variety of presentations ranging from headache, pre-auricular pain or tenderness, otalgia, to mandibular hypomobility. Some symptoms may mimic forms of facial pain such as: temporal arteritis, migraine, cluster headache, trigeminal or glossopharyngeal neuralgias, myofascial pain dysfunction, or muscle contraction (tension) headache. This article will focus on a relatively new diagnostic tool that may be used to examine the TMJ for intracapsular pathology which may be responsible for the presenting patients' symptoms.

Computed tomography of the masticatory system in rheumatoid arthritis

The resolution of computed tomography (CT) allows evaluation of hard and soft tissues of the masticatory system. Eleven patients with RA were scanned by CT in direct sagittal and coronal projection because of temporomandibular joint problems. Our results indicate that in addition to bony changes there are changes in the masticatory muscles. These are detectable by CT and may be caused by the RA itself or related to impaired function.

Temporalis and masseter muscle activity in patients with anterior open bite and craniomandibular disorders

Activity in temporalis and masseter muscles, and traits of facial morphology and occlusal stability were studied in 22 patients (19 women, 3 men; 15-45 yr of age) with anterior open bite and symptoms and signs of craniomandibular disorders. Facial morphology was assessed by profile radiographs, occlusal stability by tooth contacts, and craniomandibular function by clinical and radiological examination. Electromyographic activity was recorded by surface electrodes after primary treatment with a reflex-releasing, stabilizing splint. Maximal voluntary contraction was reduced compared to reference values, particularly in subjects with muscular affection, but maximal activity increased significantly when biting on the splint. Maximal voluntary contraction was positively correlated to molar contact and negatively to anterior face height, mandibular inclination, vertical jaw relation and gonial angle. Relative loading of the muscles was markedly increased during resting posture. It was concluded that reduced occlusal stability and long-face morphology were associated with weak elevator muscle activity with disposition overload and tenderness. The results also indicated that increase of occlusal stability might lead to increased muscle strength and possibly reduce risk of physical strain.

[Ultrastructural changes in joint capsule in TMJ disturbance syndrome]

The joint capsule is one of component parts of joint. In order to clear the changes of the capsule in TMJ disturbance syndrome, we studied 3 normal capsules and 7 patient's capsules by light microscope and electron microscope. The results are: under LM, some fibrous materials are found on the surfaces of synovial membranes in TMJ disturbance syndrome. The synovial membranes in disease become thicker than usual. The connective tissue shows hyaline degeneration. Under EM, the surfaces of synovial membranes are covered by an irregular granulated or filamentous substance. Collagens are denatured or dissolved. Among fibrils amorphous moderate-electron dense materials are present. The authors think that these changes are associated with the autoimmune reaction in TMJ disturbance syndrome and increase the destruction of TMJ in this disease.

The clinical predictability of internal derangements of the temporomandibular joint

The value of clinical parameters as predictors of the arthrographic findings in patients with temporomandibular joint (TMJ) pain and dysfunction was examined in this study. We developed a series of simplified clinical prediction rules based on previous studies correlating clinical signs and symptoms with arthrographic diagnosis of the condition of the TMJ meniscus. One hundred eighty-six patients with signs and symptoms of TMJ dysfunction were clinically examined before TMJ arthrography. Arthrograms were performed on 246 joints (126 unilateral, 60 bilateral). The rules predicted 91 of the 246 joints to be normal when actually 59 were shown to be normal arthrographically. The rules slightly underpredicted those patients with positive arthrographic findings for internal derangements. Although there were some individual variations in the predictability of unilateral versus bilateral arthrograms (patients), there was very little overall difference, 58% and 60%, respectively. This study confirms previous suggestions that clinical findings alone are not consistently accurate in diagnosing the exact type of TMJ internal derangements depicted by arthrographic criteria.

Occlusal contacts in maximum intercuspation and craniomandibular dysfunction in 16- to 17-year-old adolescents

The relationship between number, distribution and intensity of occlusal tooth contacts and the craniomandibular functional status was investigated in 56 subjects aged 16-17 years. The photocclusion technique was used for the qualitative and quantitative evaluation of occlusal contacts, and a clinical examination was performed to assess the function of the stomatognathic system. According to a matched-pairs design two groups were formed, one consisting of individuals with signs of craniomandibular disorders, and the other consisting of functionally healthy adolescents. The pairs were matched according to morphological occlusal characteristics. The results of the present study emphasize the importance of occlusal contacts in relation to craniomandibular function. In particular the posterior occlusion appeared to be related to function, since statistically significant differences between the two groups were detected with regard to the number and load of contacts. Symmetry of intensity rather than symmetry of contact distribution per se seemed to be important in relation to craniomandibular function.

[Transmission electron microscopic and light microscopic study of condylar and joint disk in TMJ disturbance syndrome]

Temporomandibular joint disturbance syndrome (TMJDS) is a complex disease. Its etiological factors and pathologic nature are not clear still. After studying the condyles and discs of 3 normals and 14 TMJDS patients by transmission and scanning electron microscopy and light microscopy, we found: The pathologic changes of TMJDS are similar to those of osteoarthritis. These changes may be associated with the microtrauma in TMJ. There are some repair reactions after destruction of the articular cartilage. The destruction of fibrils is one of the main destruction in TMJDS. The changes of bilaminar zone may be one of the causes of treatment failure by conservative methods in some patients.

Psoriatic arthropathy of the temporomandibular joint

A case of psoriatic arthritis of both temporomandibular joints is described with a brief review of the literature and discussion on the management of this condition. To date, psoriatic arthritis has been successfully treated by conservative means. In the case reported, surgical replacement of the condyles became necessary to eliminate pain and restore function.

A prospective evaluation of the effectiveness of temporomandibular joint arthroscopy

This is a prospective study to evaluate therapeutic arthroscopy for internal derangement of the temporomandibular joint (TMJ). Fifty-nine patients with 76 abnormal joints were evaluated preoperatively for pain, noise, maximal incisal opening (MIO), and deviation on opening. Preoperative and postoperative magnetic resonance imaging (MRI) scans were obtained for 29 joints. Patients were treated by superior joint arthroscopy, lysis of adhesions, lavage, and steroid injection, along with preoperative and postoperative splint and physiotherapy. Pain, noise, and motion were evaluated at three time periods: 1) early (10 to 30 days); 2) intermediate (1 to 6 months); and 3) late (greater than 6 months). At early, intermediate, and late follow-up, increase in MIO was statistically significant (P less than .05). Noise did not return in the majority of patients. Disc position, evaluated by MRI, did not appear to change in 25 of 29 joints and did not correlate with clinical outcome. The results of this study indicate that TMJ arthroscopy is effective in reducing pain and increasing motion in patients with TMJ internal derangement.

Clinical and radiological findings in temporomandibular joints with disc perforation

Sixteen temporomandibular joints from 15 patients, reported to have disc perforation at arthrography, were studied. Pain from the TMJ region was reported by 11 patients. Clicking was found in 6 joints and crepitation in 6 joints. Nine patients displayed a deviation of the mandible at maximum mouth opening towards the affected side. The muscles of the affected side were tender on palpation more frequently than those on the contralateral side. The disc perforation was located in the posterior attachment in most joints. An anterior disc displacement was found in all joints except one, which exhibited a normal disc position. In 4 joints with an anterior disc displacement with reduction, the configuration of the discs varied, whereas in all 11 joints with an anterior disc displacement without reduction the disc was biconvex. In most joints, the condyle was located in a central position in the fossa in the intercuspal position and 13 joints were tomographically diagnosed as being osteoarthrotic. It is concluded that most joints with disc perforations are osteoarthrotic and the most severe clinical and radiological findings are associated with an anterior disc displacement without reduction.

Computerized axial tomography in the diagnosis of internal derangements of the temporomandibular joint

Fourteen patients with a history of pain, clicking and locking of the temporomandibular joint were assessed clinically and by using computerized axial tomography (CAT). The findings of the clinical and CAT scan assessment were correlated and compared with surgical observations. Computerized axial tomography scanning proved to be a highly accurate method of assessing meniscal position. With the advent of more sophisticated methods of CAT scanning, it provides an accurate, non-invasive method of assessing the temporomandibular joint and providing a basis for more effective treatment planning of problems related to internal derangements.

Morphologic differences between superior and inferior disc surfaces in chronic internal derangement of the temporomandibular joint

This study examines the morphologic differences between the superior and inferior disc surfaces in patients with chronic internal derangement of the temporomandibular joint. Forty-two discs were removed in 33 patients when morphologic or qualitative tissue changes made a reparative procedure impossible. Eighty-three percent of the joints operated in this series showed late opening (grade III) clicking or were considered clinically locked. Specific differences between superior and inferior disc surface anatomy were demonstrated in these cases of long-standing internal derangement.

The temporomandibular joint in rheumatoid arthritis--a comparative clinical and tomographic study pre- and post-prosthesis

Six partially or fully edentulous rheumatoid patients participated in the study. By comparing the clinical symptoms and tomograms of the temporomandibular joints (TMJS) pre-prosthesis with those post-prosthesis, this report assesses whether dental treatment could provide positive help for TMJS in patients with rheumatoid arthritis (RA). Among the clinical symptoms of TMJ dysfunction, pain from the TMJ region and limitations of movement were improved in all the patients post-prosthesis. Tomographic evidence of desirable remodelling of the condylar heads was observed in two cases.

Morphology of the condyles and mandibular fossa as seen by computed tomography

Computed tomography allows detailed three-dimensional examination of the hard and soft tissue of the temporomandibular joint. The morphology of the mandibular fossa and the condyles together with the horizontal and vertical condylar inclinations was determined in 25 patients with temporomandibular joint dysfunction and 29 controls by use of axial and coronal computed tomography projections. The shape of the condyle was evaluated according to its general appearance. The temporomandibular joint measurements obtained by computed tomography were in good agreement with morphologic studies performed on dry skulls and autopsy material.

Diagnosing disk dysfunction and tissue changes in the temporomandibular joint with magnetic resonance imaging

Magnetic resonance imaging (MRI) is a noninvasive technique that clearly documents disk positioning abnormalities and tissue structure changes not previously discovered except by surgical intervention and biopsy. The MRI also shows hyperplasias, disk folds, displaced disks, and disk thinning-important information to have before surgical intervention is begun. Overall, MRI provides a basis for complex dental treatment planning and prognostic evaluation.

Analysis of condylar path inclination and incisal guidance

A sample of 50 stomatognathic system dysfunction syndrome patients were analyzed in terms of the anterior discluding path in relation to the condylar path inclination, the condylar-incisal and incisal-APo angles, and the distance in millimeters between the latter and the interincisor angle employing cephalometric outlining. The present results reveal that the difference between the inclination of the incisal and condylar trajectories is smaller than that reported by other authors for normal occlusion samples. The lower incisor lies beyond the APo line in 25% of the sample, not conforming to the accepted standards. There was no significant difference between the present ratios and those reported by other authors for normal samples.

Synovial fluid glycosaminoglycan (acid mucopolysaccharide) analysis in assessment of temporomandibular joint dysfunction. A pilot study

Temporomandibular joint (TMJ) synovial fluid was aspirated from normal control subjects and patients undergoing surgery for TMJ dysfunction. The glycosaminoglycan (GAG) composition of this fluid was analysed and compared with the clinical diagnosis and histological appearance of the condylar tissues. Changes in GAG composition were observed where a histologically hyperplastic response was seen in joint tissues, but these findings did not necessarily correlate with the initial clinical diagnosis. It is suggested that the fluid composition reflects the current metabolic activities of the tissues and may provide a useful marker of such processes.

[The diagnostic importance of different imaging technics in temporomandibular joint dysfunction]

Various imaging techniques enable to explore the Temporo-mandibular joints (T.M.J.). The physicians prescribing them, must be perfectly aware of the informations they provide as well as their costs, for a judicious formulation of their indications. Conventional radiography is absolutely necessary and, most of the time, sufficient, since it simply permits to evaluate the bony structures. An orthopantomogram and modified Schüller views of each T.M.J., "open mouth" and "closed mouth" will be performed. Conventional tomograms are no longer indicated. They will be abandoned for Computed Tomograms. This examination permits, at a relatively low cost, to analyse a bony abnormality and explore the muscular soft tissues. It may also be possible to assess the meniscus, its position and displacement when the mouth is opened. In fact, if a meniscal or articular pathology is considered, which could result in surgical or endoscopic procedure, it is absolutely necessary to perform: -either an arthro-tomography, with contrast material, -or a magnetic resonance examination. The latter provides perfect anatomical and pathological informations of the joint and meniscus, in an atraumatic fashion for the patient. Its only contraindication is in the cost of the examination. It will be possible to look for a dislocation, a malformation or a structural alteration of the meniscus which could result in a perforation, a rupture of the posterior frenulum, adhesions or joint extravasation. A necrosis or early osteochondritis of the condyle will be ruled out.

Inclination of the temporomandibular joint eminence and anterior disc displacement

The articular eminence angle of 179 temporomandibular joints (TMJ) with anterior disc displacement (ADD) in 179 patients was measured and compared with 200 left and 200 right joints of 400 young adults without TMJ dysfunction. A steeper inclination of the posterior slope of the articular eminence, with a mean difference compared to the control group of 14.5 degrees, was seen in joints with ADD. In the group of 179 joints with ADD of the TMJ, no difference was seen in the mean articular eminence angle between joints with an ADD with reduction, and an ADD without reduction, between conservatively or surgically treated joints, or between joints with different presumed causes of ADD.