Osteoarthritis of the TMJ in teenaged females: report of cases

From the cases reported by Ogus and those presented here, it appears degenerative joint disease of the TMJ in young individuals is not a rare finding. The incidence of DJD of the temporomandibular joint has been reported to be 8% to 16%. In a review of 346 patients who were referred for jaw disorders, 23 patients were 19 years old or younger. Six patients (or 26%) had a diagnosis of osteoarthritis of the TMJ confirmed with charts, reviewed retrospectively, were considered as suggestive of degenerative joint disease. It has been reported that the symptoms of DJD continue for one to three years. The majority of patients have acute symptoms that usually last about nine months but gradually subside after nine months. It is important to rule out degenerative disease of the TMJ before beginning radical or irreversible dental procedures. Conservative management of these patients includes analgesics, antiarthritic drugs, muscle relaxants, antiinflammatory agents, the construction of hard or soft bite splints, exercise, warm moist heat applications, minor equilibration if indicated, and physical therapy. Injections of steroids into the joint are not recommended and anti-arthritic drugs should be used with caution because the safe usage of some of these drugs has not been demonstrated in children. Patients who still experience pain after one to three years, or patients who are refractory to conservative therapy, may be candidates for surgical treatment. Age should not be a deterrent to surgery or other treatment modality for treatment of severe degenerative joint disease that does not respond to conservative treatment and is intolerable to the patient.

Clinical, microscopical and biochemical investigation of synovial fluid from temporomandibular joints

The aim of this study was to investigate the relationship between pain and tenderness to palpation of the temporomandibular joint (TMJ), radiographic changes of the joint and signs of inflammation in the synovial fluid. Saline was injected into and aspirated from the TMJ of 29 patients with painful and tender TM joints and from five individuals with healthy joints. In another two patients synovial fluid could be aspirated without saline. The aspirated fluid was analyzed for inflammatory cells and for plasma proteins. A clinical examination of the stomatognathic system and a radiographic examination of the TMJ were performed before the aspiration. Besides tenderness to palpation of the TMJ, pain on mandibular movement and tenderness to palpation of the masticatory muscles were common. Erosion of the cortical outline of the joint surfaces was the most common radiographic finding. Inflammatory cells were present in the fluid of three patients but in none of the healthy individuals. Plasma proteins of inflammatory type could be detected in the fluid from seven of the patients. The results show that radiographic, cellular or biochemical signs of inflammation can frequently be found in the TMJ of patients with longstanding pain and tenderness of this joint.

Intra-articular meniscus dysfunction surgery. A preliminary report

Surgical management of painful intra-articular functional disorders of the temporomandibular joint has become a topic of much discussion. Data concerning the results of surgery are lacking not only because of the recent renewed interest in this surgery but also because of the small number of cases reported. The present study was undertaken to review the experience at the Medical College of Virginia/Virginia Commonwealth University Temporomandibular Joint and Facial Pain Center with surgical management of intra-articular meniscus dysfunction (IMD) as a specific entity. A review of IMD, criteria for establishment of the diagnosis, initial management, rationale for the surgery, type of surgery, and postoperative results in twenty-three cases will be discussed.

A study of the use of occlusion splints in the treatment of acute and chronic patients with craniomandibular disorders

Thirty-three patients were treated for a 4-week period with splint therapy. Fourteen muscle and joint regions were palpated before and after treatment, and observable pain scores were recorded. Maximal comfortable interincisal distance and maximal interincisal distance were recorded before and after treatment. The following results were observed. 1. Of the 33 patients, 28 showed improvement in observable pain scores. The mean decrease was 4.4 (p less than .01). 2. Of the 33 patients, 27 showed increase in maximal comfortable interincisal distance. The mean increase in interincisal distance was 5.3 mm (p less than .01). 3. Of the 33 patients, 21 showed an increase in maximal mandibular opening; however, the increase of 1.7 mm was not statistically significant. 4. When the patients were divided into two groups according to the duration of symptoms, there was no significant difference between the groups' symptoms or their responses to treatment.

Temporomandibular joint dysfunction in children presenting as otalgia

Thirty-one children between the ages of 6 and 16 years with otalgia but normal eardrums were investigated for temporomandibular joint dysfunction. Ear disease was excluded by microscopic examination, pure tone audiometry and impedance tympanometry. Dental disease was excluded by clinical and radiographic examination. Temporomandibular joint dysfunction was diagnosed by finding tenderness of the joint or masticatory muscles in at least two separate sites at one examination. Twenty-one patients were assessed as having joint dysfunction and in 18 of these the diagnosis was made when the child was seen in pain. Tympanometry on painful ears did not reveal any abnormality or trend in the values for compliance or middle ear pressure. Simple methods of treatment were effective in all cases. Temporomandibular joint dysfunction should be suspected in any child who complains of recurrent otalgia in the absence of dental and otological disease.