Identification of prostaglandin E2 and leukotriene B4 in the synovial fluid of painful, dysfunctional temporomandibular joints

Current concepts in the surgical management of temporomandibular joint disorders

A thorough understanding of the structure and function of diarthrodial joints is necessary for clinicians who treat individuals with temporomandibular disorders. Surgical procedures must be based on principles designed to restore and preserve joint physiology. The surgical management of patients with temporomandibular joint disorders not only requires adherence to surgical principles that make sense from a physiologic basis, but also an understanding of the disease process and continued nonsurgical management that is aimed at reducing or eliminating factors which perpetuate joint overloading.

Diagnosis of intracapsular pathology associated with temporomandibular joint disorders

The clinical diagnosis of a Temporomandibular Disorder (TMD) has traditionally been based on data gathered by means of a medical history and physical examination. The most common signs and symptoms associated with TMD are reduced jaw opening, pain and elevated tenderness in the muscles of mastication, pain and elevated temporomandibular joint (TMJ) tenderness, and TMJ noises upon movement. These signs and symptoms are routinely detectable by a skilled clinician upon examination. Unfortunately, the clinical problem described globally as a TMD has several different and overlapping patho-physiologic disease processes, and a traditional clinical examination does not provide highly tissue-specific pathologic information. Were it readily available, such information would be greatly useful, since logical and accurate treatment planning requires that each disease process be correctly identified. One important challenge for researchers interested in TMD will be the careful definition and subsequent validation of diagnostic methods which identify the relevant ongoing pathological disease process. On such research area, which has great promise, is the establishment of a valid diagnostic technique for intracapsular pathologies unique to TMD patients. This paper provides a critical review and discussion of the diagnostic validity of TMJ arthroscopy and other related methods of identifying intracapsular pathologies associated with TMD.

Reliability and validity of imaging diagnosis of temporomandibular joint disorder

The purpose of this article is to review reliability and validity of imaging diagnosis of temporomandibular joint disorders. Plain-film and tomography are basic imaging techniques for assessment of the temporomandibular joint. These can be used for evaluation of osseous disease and as a baseline for follow-up. In patients with symptoms from the joint, plain-film and tomography are rarely definitive, and evaluation of the soft tissues is frequently necessary. Arthrography, computed tomography, and magnetic resonance imaging have all been used for evaluation of the soft-tissue components of the joints. Accuracy studies of these techniques have demonstrated the highest diagnostic accuracy for magnetic resonance imaging. Arthrography is relatively insensitive for detection of medial and lateral displacements. Magnetic resonance imaging accurately depicts both hard and soft tissues, and this technique is emerging as the prime diagnostic imaging technique in patients presenting with clinical signs and symptoms of a disorder of the temporomandibular joint. The most frequent findings when patients with clinical symptoms of temporomandibular joint disorders are "imaged" are different forms of disc displacement and degenerative joint disease. Studies have demonstrated a high prevalence of different forms of disc displacement in patients, although these abnormalities are also seen in some asymptomatic volunteers. Future research should further refine imaging techniques to come closer to an understanding of the association between morphologic alterations and patient symptoms.

Toward an international consensus on temporomandibular joint surgery. Report of the Second International Consensus Meeting, April 1992, Buenos Aires, Argentina

This consensus statement reflects the current status of temporomandibular joint surgery in the international community of oral and maxillofacial surgeons in the early 1990s. It is not the end, and it is not the beginning; it is a step forward in the treatment of patients with temporomandibular disorders. It is hoped that this statement will encourage member organizations, and individual members to pursue the issues raised by the proposed criteria. Also there should be continuing debate on the findings presented and on future developments, as well as efforts to teach others the skills the specialty has acquired.

Temporomandibular joint synovial fluid analysis

A method for the estimation of the synovial fluid volume of the temporomandibular joint (TMJ) is described. Patients are administered 1.2 g of aspirin and the concentration of salicylate in plasma and in saline aspirates of the TMJ is measured by a sensitive high performance liquid chromatography assay. The ratio of the concentration of salicylate in the saline aspirate to that in the plasma allows the volume of the synovial fluid to be calculated. The method would also allow the determination of the concentration and the absolute amount of putative mediators of pathology in the upper joint.

Correlation between pain and synovitis in patients with internal derangement of the temporomandibular joint

A correlation between pain scores by questionnaire and synovitis index via arthroscopic inspection was made in 28 patients with internal derangement of the temporomandibular joint (TMJ) with closed lock. A statistically significant but weak correlation was found between the visual analog scale of pain and the index of distribution of synovitis. However, in the questionnaire, pain on chewing had a positive correlation with both the intensity and distribution of synovitis in the TMJ. This study indicates that synovitis is one cause of TMJ pain in patients with closed lock.

Tissue responses to degenerative changes in the temporomandibular joint: a review

The articular cartilage covering of the mandibular condyle and the articular eminence, as well as the tissue of the articular disc, may be affected by degenerative changes associated with osteoarthrosis. Degenerative changes of cartilage alter its physical properties and, as a result, affect its ability to withstand compressive and shearing stresses. Increased friction between the articular surfaces may impair joint movement and may elicit compensatory or pathologic responses of the cartilage and the adjacent tissues, such as capsule and ligaments, synovial membrane, subchondral bone, and associated musculature. In this review, these structural changes are described and related to common signs and symptoms of craniomandibular dysfunction, such as clicking, locking and instability, pain and tenderness, restricted ranges of mandibular motion, crepitation, deformity, muscle wasting, and changes of occlusion.

Report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

Subjects of the past decade in the dental literature are reflected in this year's Committee report. We note the decrease in the prevalence of caries, the influence of dental implants, the advancements in dental materials, and the continued efforts to control adhesive events in the oral cavity. This year we included comments from and about many significant review articles published this past year. The Committee continues to be concerned about the quality of some of the work reported and the quality of the reporting. We have attempted to select the distinguished work, that which provides new information to our profession. The subjects covered include pulp biology, caries prevention, periodontics, implants, craniomandibular function and dysfunction, occlusion, and dental materials.