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Patel K, Eley KA, Cascarini L, Watt-Smith S, Larkin M, Lloyd T, Maddocks C, McLaren E, Stovell R, McMillan R. Temporomandibular disorders-review of evidence-based management and a proposed multidisciplinary care pathway. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:54-69. [PMID: 36990844 DOI: 10.1016/j.oooo.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 01/28/2023] [Accepted: 02/05/2023] [Indexed: 02/14/2023]
Abstract
Temporomandibular disorders (TMDs) are a prevalent but complex group of conditions that cause orofacial pain. Temporomandibular disorders are recognized as one of the most common chronic pain conditions, alongside back pain and headache disorders. Given the competing theories surrounding what causes TMDs and limited high-equality evidence on optimally treating TMDs, clinicians often encounter challenges in developing an effective management plan for patients. Furthermore, patients will often seek advice from multiple health care providers from varying specialties, seeking curative management, often resulting in inappropriate treatments and no improvement in pain symptoms. Throughout this review, we explore the existing evidence base surrounding the pathophysiology, diagnosis, and management of TMDs. An existing United Kingdom-based multidisciplinary care pathway for the management of TMDs is described herein, highlighting the benefits of a multidisciplinary approach to patient care for TMDs.
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Affiliation(s)
- Krupali Patel
- Department of Facial Pain, Royal National ENT & Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, UK; University College London Eastman Dental Institute, London, UK
| | - Karen A Eley
- Department of Radiology, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | - Maeve Larkin
- Department of Facial Pain, Royal National ENT & Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tim Lloyd
- Department of Facial Pain, Royal National ENT & Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, UK
| | - Clare Maddocks
- Department of Facial Pain, Royal National ENT & Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, UK
| | - Elenor McLaren
- Department of Facial Pain, Royal National ENT & Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rachel Stovell
- Department of Facial Pain, Royal National ENT & Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, UK
| | - Roddy McMillan
- Department of Facial Pain, Royal National ENT & Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, UK; University College London Eastman Dental Institute, London, UK.
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Management of temporomandibular disorders: a rapid review of systematic reviews and guidelines. Int J Oral Maxillofac Surg 2022; 51:1211-1225. [PMID: 35339331 DOI: 10.1016/j.ijom.2021.11.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/10/2021] [Accepted: 11/16/2021] [Indexed: 01/08/2023]
Abstract
Temporomandibular disorders (TMD) impact a significant proportion of the population. Given the range of management strategies, contemporary care should be evidence-informed for different TMD types. A knowledge-to-action rapid review of systematic reviews published in the past 5 years and guidelines published in the past 10 years concerning the management of TMD was conducted. The Cochrane, Embase, MEDLINE, PEDro, and PubMed databases were searched. A qualitative data analysis was undertaken, with quality assessment completed using the AMSTAR 2 checklist. In total, 62 systematic reviews and nine guidelines considering a range of treatment modalities were included. In concordance with current guidelines, moderate evidence supports a multi-modal conservative approach towards initial management. Contrary to existing guidelines, occlusal splint therapy is not recommended due to a lack of supporting evidence. The evidence surrounding oral and topical pharmacotherapeutics for chronic TMD is low, whilst the evidence supporting injected pharmacotherapeutics is low to moderate. In concordance with current guidelines, moderate quality evidence supports the use of arthrocentesis or arthroscopy for arthrogenous TMD insufficiently managed by conservative measures, and open joint surgery for severe arthrogenous disease. Based on this, a management pathway showing escalation of treatment from conservative to invasive is proposed.
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Schneider SA, Gateno J, Coppelson KB, English JD, Xia JJ. Validity of Medical Insurance Guidelines for Orthognathic Surgery. J Oral Maxillofac Surg 2021; 79:672-684. [PMID: 33338420 PMCID: PMC7925386 DOI: 10.1016/j.joms.2020.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/26/2020] [Accepted: 11/12/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study was to assess the validity of the medical insurance guidelines for orthognathic surgery used by the major American medical insurance companies. MATERIALS AND METHODS This study assessed the validity of the medical insurance guidelines for orthognathic surgery used by Aetna, Anthem Blue Cross Blue Shield (BCBS), Cigna, Humana, and UnitedHealthcare (UHC). To evaluate the validity, we calculated the approval and denial rates of the 5 guidelines when we used them to assess the medical necessity for a control group of carefully selected patients. Patients were included in the control group if they met the criteria of a "prudent provider," crafted for this study. All rejected cases were analyzed to determine the root cause of the denials. The validity of the guidelines was also ascertained by determining their completeness and correctness. RESULTS The current study proves that no insurance guideline is in agreement with the criteria of a "prudent provider." When applied to carefully chosen patients, the requirements of BCBS, Aetna, Humana, and Cigna produce modest rejection rates of 6 to 12%. UHC is an outlier. Its guideline rejects 86% of patients, a rate about 7 times higher than its peers. Insurance guidelines disqualified patients for 3 different reasons: 1) no significant jaw deformity, 2) no demonstrable health impairment, and 3) the etiology of the condition is not a covered benefit. Additional evaluations demonstrate that the private insurance guidelines are incomplete, and at times, incorrect. CONCLUSIONS This study shows that the medical insurance guidelines for orthognathic surgery used by the major American medical insurance plans need revision. The most consequential flaw was considering etiology in judging medical necessity. Fortunately, only one company adopted this policy. Moreover, all guidelines have omissions and errors in the way jaw deformity is determined and how health impairment is determined.
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Affiliation(s)
- Sydney A Schneider
- Resident and Graduate Student, Department of Orthodontics, University of Texas Houston Health Science Center School of Dentistry, Houston, TX
| | - Jaime Gateno
- Chairman, Oral and Maxillofacial Surgery Department, Houston Methodist Hospital, Professor of Oral and Maxillofacial Surgery, Houston Methodist Academic Institute, Houston, TX; and Professor of Clinical Surgery (Oral and Maxillofacial Surgery), Weill-Cornell Medical College, New York, NY
| | - Kevin B Coppelson
- Former Advanced Oral and Maxillofacial Surgery Fellow, Houston Methodist Hospital, Houston, TX
| | - Jeryl D English
- Professor and Chairman, Department of Orthodontics, University of Texas Houston Health Science Center School of Dentistry, Houston, TX
| | - James J Xia
- Director of Surgical Planning Laboratory, Oral and Maxillofacial Surgery Department, Houston Methodist Hospital, Houston, TX; Professor of Oral and Maxillofacial Surgery, Houston Methodist Academic Institute, Houston, TX; and Professor of Surgery (Oral and Maxillofacial Surgery), Weill-Cornell Medical College, New York, NY.
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Malik S, Singh S, George RT, Kakkar M, Vaid NR. Optimal Use of a Panoramic Radiograph as a Screening Tool for Condylar Resorption in Patients Undergoing Active Orthodontic Treatment: A Case Series. J Clin Imaging Sci 2020; 10:65. [PMID: 33194307 PMCID: PMC7656026 DOI: 10.25259/jcis_143_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/27/2020] [Indexed: 11/04/2022] Open
Abstract
Condylar resorption of temporomandibular joint findings in the panoramic radiographs is an indication of bone resorption suggesting possible degenerative joint disease that warrants early screen and subsequent referral to a dedicated specialist. This case series reports three patients that underwent the active orthodontic treatment for the duration of approximately 24-36 months. The patients were asymptomatic at the initial examination. The clinical examination was negative for clicking; the range of motion on opening, lateral excursion, and protrusion was normal. Neither of these patients had a history of rheumatic disease or bruxism. During the later stages of orthodontic treatment, two of the three patients reported mild pain and clicking during mastication, which was also confirmed chairside on clinical evaluation. Patients were referred to the orofacial pain specialist, were they were prescribed specific medication for the symptoms, along with cognitive behavioral therapy, and were further evaluated for splint therapy. Panoramic radiographs taken before the start of the treatment, during the treatment and at the completion of the orthodontic treatments indicate the progression in the resorption of mandibular condyle in all three patients suggesting possible degeneration that warrants further investigation and therapy.
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Affiliation(s)
- Shaima Malik
- Department of Orthodontics and Dentofacial Orthopedics, University of Rochester, New York, United States
| | - Shilpa Singh
- Department of Orofacial Pain/TMD and Community Dentistry, University of Rochester, New York, United States
| | - Robby T. George
- Department of Orofacial Pain/TMD and Community Dentistry, University of Rochester, New York, United States
| | - Mayank Kakkar
- Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, New York, United States
| | - Nikhilesh R. Vaid
- Department of Department of Orthodontics, European University College, Dubai, United Arab Emirates
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López-Frías FJ, Gil-Flores J, Bonilla-Represa V, Ábalos-Labruzzi C, Herrera-Martinez M. Knowledge and management of temporomandibular joint disorders by general dentists in Spain. J Clin Exp Dent 2019; 11:e680-e685. [PMID: 31598195 PMCID: PMC6776402 DOI: 10.4317/jced.55634] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 07/11/2019] [Indexed: 11/05/2022] Open
Abstract
Background Given the importance of temporomandibular disorders (TMD), we tried to assess general dentists' knowledge regarding etiology, diagnosis, and treatment in order to understand their attitude. Material and Methods A sample of 130 general dentists answered a 16-item questionnaire on three areas - etiology, diagnosis, and management of common temporomandibular disorders - as well as a question on the need for continuous education regarding TMD management in common clinical practice in Spain. Given that the descriptive statistics achieved reflect significantly different values among means in each area, a variance analysis for repeated measurements was applied in order to contrast differences among etiology, diagnosis, and management knowledge levels. Results The contrast test was based on Wilks' Lambda, which assumed a value of 0.120 (F = 467.28; p<.001), demonstrating statistically significant differences among knowledge levels in the three dimensions. The effect size for these differences, measured by partial eta squared, was very high (η2p = 0.88). Such parameters were also analyzed to search for potential differences according to professional experience, with differences being exposed as non-significant at the 0.05 level: etiology (T = 1.60; p = 0.113), diagnosis (T = - 0.17; p = 0.868), and treatment (T = 1.10; p = 0.273). Conclusions Our study found that, even though clinicians are generally skilled regarding the knowledge of the etiologic that explain the diagnosis of TMD, they have room for improvement in terms of TMD management compared to the other two areas studied. General dentists could benefit from specific educational programs enhancing TMD management skills. Key words:Temporomandibular disorders (TMD), knowledge and management. Clinical competence, postgraduate, continuing professional development. Surveys, education,orofacial pain.
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Affiliation(s)
- Francisco-Javier López-Frías
- Associate Professor, Department of Stomatology, School of Dentistry, University of Seville, C / Avicena s / n, 41009-Seville, Spain
| | - Javier Gil-Flores
- Professor, Department of Education Science Research Methods, University of Seville, C / Pirotecnia s / n, 41013-Seville, Spain
| | - Victoria Bonilla-Represa
- Associate Professor, Department of Stomatology, School of Dentistry, University of Seville, C / Avicena s / n, 41009-Seville, Spain
| | - Camilo Ábalos-Labruzzi
- PhD Contractual Professor, Department of Stomatology, School of Dentistry, University of Seville, C / Avicena s / n, 41009-Seville, Spain
| | - Manuela Herrera-Martinez
- PhD Assistant Professor, Department of Stomatology, School of Dentistry, University of Seville, C / Avicena s / n, 41009-Seville, Spain
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Acri TM, Shin K, Seol D, Laird NZ, Song I, Geary SM, Chakka JL, Martin JA, Salem AK. Tissue Engineering for the Temporomandibular Joint. Adv Healthc Mater 2019; 8:e1801236. [PMID: 30556348 DOI: 10.1002/adhm.201801236] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/17/2018] [Indexed: 12/24/2022]
Abstract
Tissue engineering potentially offers new treatments for disorders of the temporomandibular joint which frequently afflict patients. Damage or disease in this area adversely affects masticatory function and speaking, reducing patients' quality of life. Effective treatment options for patients suffering from severe temporomandibular joint disorders are in high demand because surgical options are restricted to removal of damaged tissue or complete replacement of the joint with prosthetics. Tissue engineering approaches for the temporomandibular joint are a promising alternative to the limited clinical treatment options. However, tissue engineering is still a developing field and only in its formative years for the temporomandibular joint. This review outlines the anatomical and physiological characteristics of the temporomandibular joint, clinical management of temporomandibular joint disorder, and current perspectives in the tissue engineering approach for the temporomandibular joint disorder. The tissue engineering perspectives have been categorized according to the primary structures of the temporomandibular joint: the disc, the mandibular condyle, and the glenoid fossa. In each section, contemporary approaches in cellularization, growth factor selection, and scaffold fabrication strategies are reviewed in detail along with their achievements and challenges.
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Affiliation(s)
- Timothy M. Acri
- Department of Pharmaceutical Sciences and Experimental Therapeutics; College of Pharmacy; University of Iowa; Iowa City, Iowa 52242 USA
| | - Kyungsup Shin
- Department of Orthodontics; College of Dentistry and Dental Clinics; University of Iowa; Iowa City, Iowa 52242 USA
| | - Dongrim Seol
- Department of Orthopedics and Rehabilitation; Carver College of Medicine; University of Iowa; Iowa City, Iowa 52242 USA
| | - Noah Z. Laird
- Department of Pharmaceutical Sciences and Experimental Therapeutics; College of Pharmacy; University of Iowa; Iowa City, Iowa 52242 USA
| | - Ino Song
- Department of Orthopedics and Rehabilitation; Carver College of Medicine; University of Iowa; Iowa City, Iowa 52242 USA
| | - Sean M. Geary
- Department of Pharmaceutical Sciences and Experimental Therapeutics; College of Pharmacy; University of Iowa; Iowa City, Iowa 52242 USA
| | - Jaidev L. Chakka
- Department of Pharmaceutical Sciences and Experimental Therapeutics; College of Pharmacy; University of Iowa; Iowa City, Iowa 52242 USA
| | - James A. Martin
- Department of Orthopedics and Rehabilitation; Carver College of Medicine; University of Iowa; Iowa City, Iowa 52242 USA
| | - Aliasger K. Salem
- Department of Pharmaceutical Sciences and Experimental Therapeutics; College of Pharmacy; University of Iowa; Iowa City, Iowa 52242 USA
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Meade MJ, Weston A, Dreyer CW. Valid consent and orthodontic treatment. AUSTRALASIAN ORTHODONTIC JOURNAL 2019. [DOI: 10.21307/aoj-2020-031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract
Valid patient consent is a legal and ethical principle that is fundamental to healthcare provision. Oral health practitioners (OHPs) must understand the principles that need to be addressed to ensure that the consent given by a patient is valid. Failure to obtain consent may result in a negligence claim or a complaint of professional misconduct against the OHP. Orthodontic treatment is mostly elective but is not without risk to the patient. Obtaining and maintaining valid consent for orthodontic treatment presents additional challenges in comparison with other dental procedures as the treatment lasts over a longer time and is most commonly performed in adolescents. In addition, prospective patients need to be informed regarding ‘lifelong’ management in the retention phase to minimise the risk of relapse. The present paper outlines the principles of valid consent with particular regard to orthodontic treatment in the adolescent patient. OHPs must ensure that they are satisfied that the competent patient has the capacity to voluntarily consent. Clinicians must also recognise that valid consent is not a one-off ‘tick the box’ procedural exercise but an ongoing process of effective information sharing in light of changing laws and an ever-changing scientific evidence base within a patient-centred model of healthcare.
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Affiliation(s)
- Maurice J. Meade
- * Orthodontic Unit , School of Dentistry , The University of Adelaide , Adelaide South Australia , Australia
| | | | - Craig W. Dreyer
- * Orthodontic Unit , School of Dentistry , The University of Adelaide , Adelaide South Australia , Australia
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Manfredini D. Occlusal Equilibration for the Management of Temporomandibular Disorders. Oral Maxillofac Surg Clin North Am 2018; 30:257-264. [DOI: 10.1016/j.coms.2018.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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Difference in Response to a Motor Imagery Task: A Comparison between Individuals with and without Painful Temporomandibular Disorders. Pain Res Manag 2018; 2018:6810412. [PMID: 30154945 PMCID: PMC6091325 DOI: 10.1155/2018/6810412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/19/2018] [Accepted: 07/04/2018] [Indexed: 01/06/2023]
Abstract
The aim of the study was to investigate the difference in response to a motor imagery task between individuals with and without painful temporomandibular disorders (TMDs). The participants were 24 adults with and without TMD (TMD and control group, resp.). A set of photographic images of the profile view of a person's head and neck and a hand and a foot were presented in a random order. The set consisted of six different orientations with rotations of each image at 0, 60, 120, 180, 240, and 300 degrees and included left and right representations. The participants were required to view the image and make a decision as to whether it was a left or a right side presented, that is, mental rotation (MR) task. Data were collected on 48 tasks (including left and right) at each orientation for each body part. Reaction times (RTs) for correct answers and accuracy in making the left or right judgements were recorded. The RT was slower in the TMD group than in the control group. The RT for the profile image was slower than those for the hand and foot images. For images that were 180 degrees, the RT was slower and the accuracy was lower than those for five of the other image orientations. The judgements made about the 180-degree rotated image were more inaccurate compared to images of all other orientations among all types of stimuli.
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Gil-Martínez A, Paris-Alemany A, López-de-Uralde-Villanueva I, La Touche R. Management of pain in patients with temporomandibular disorder (TMD): challenges and solutions. J Pain Res 2018; 11:571-587. [PMID: 29588615 PMCID: PMC5859913 DOI: 10.2147/jpr.s127950] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Thanks to advances in neuroscience, biopsychosocial models for diagnostics and treatment (including physical, psychological, and pharmacological therapies) currently have more clinical support and scientific growth. At present, a conservative treatment approach prevails over surgery, given it is less aggressive and usually results in satisfactory clinical outcomes in mild–moderate temporomandibular disorder (TMD). The aim of this review is to evaluate the recent evidence, identify challenges, and propose solutions from a clinical point of view for patients with craniofacial pain and TMD. The treatment we propose is structured in a multi-modal approach based on a biobehavioral approach that includes medical, physiotherapeutic, psychological, and dental treatments. We also propose a new biobehavioral model regarding pain perception and motor behavior for the diagnosis and treatment of patients with painful TMD.
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Affiliation(s)
- Alfonso Gil-Martínez
- Department of Physiotherapy.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid.,Hospital La Paz Institute for Health Research, IdiPAZ
| | - Alba Paris-Alemany
- Department of Physiotherapy.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid.,Hospital La Paz Institute for Health Research, IdiPAZ.,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain
| | - Ibai López-de-Uralde-Villanueva
- Department of Physiotherapy.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid.,Hospital La Paz Institute for Health Research, IdiPAZ
| | - Roy La Touche
- Department of Physiotherapy.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid.,Hospital La Paz Institute for Health Research, IdiPAZ.,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain
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11
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Abstract
The diagnosis and management of orofacial pain may be challenging due to complex histories, pathophysiology and associated psychosocial co-morbidities such as depression and anxiety. Neuropathic facial pain conditions such as burning mouth syndrome (BMS), persistent idiopathic facial pain (PIFP), atypical odontalgia (AO) and trigeminal neuralgia (TN) require early recognition by primary care clinicians and referral to secondary care. Acute pain-related temporomandibular disorder (TMD) may be managed in the primary care setting, with identification of those at risk of developing chronic TMD receiving an early referral to secondary care. Adopting a biopsychosocial approach, consisting of physical therapies, pharmacotherapy and psychological support can lead to effective management and may limit the negative impact of facial pain upon quality of life and daily functioning.
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12
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Do patients with malocclusion have a higher prevalence of temporomandibular disorders than controls both before and after orthognathic surgery? A systematic review and meta-analysis. J Craniomaxillofac Surg 2017; 45:1716-1723. [PMID: 28843406 DOI: 10.1016/j.jcms.2017.07.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 06/27/2017] [Accepted: 07/24/2017] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The aim of this study was to identify, through meta-analysis, whether patients who require orthognathic surgery have a higher prevalence of temporomandibular disorders (TMDs) than controls, both before treatment and after. MATERIAL AND METHODS A systematic review and meta-analysis were conducted based on PRISMA guidelines, to address the study purposes. A search of major databases through PubMed, EMBASE, and Cochrane CENTRAL was performed to locate all pertinent articles published from inception to June 2016. Inclusion criteria were controlled clinical studies, either prospective or retrospective, and case-control studies comparing preoperative and postoperative signs and symptoms of TMDs in patients who undergo orthognathic surgery to those of a healthy volunteer population with no dentofacial deformities. The predictor variables were patients with dentofacial deformities who underwent orthognathic surgery and patients with no dentofacial deformities and with good maxillomandibular relations and normal occlusion. The outcomes variables were the weighted, prevalence rate (proportion) in signs and symptoms of TMDs in patients with dentofacial deformities and risk ratio (RR) of signs and symptoms of TMDs before and after orthognathic surgery, compared to the control group. RESULTS A total of 542 patients enrolled in 6 studies were included in this analysis. The overall pooled weighted rate or prevalence of TMDs for orthognathic surgery patients preoperatively was 32.5% (95% CI = 26.7%-38.9%). There was a significant difference between the 2 groups with respect to TMDs before surgery, but no significant difference in TMDs after surgery. The RR for patients who had dentofacial deformities before orthognathic surgery compared with a control group was 1.634 (95% CI = 1.216-2.194; P = 0.001). The RR for patients after orthognathic surgery compared with a control group was 1.262 (0.718; 95% CI = 0.805-1.979; P = 0.311). CONCLUSION The results of this study show that patients who are going to have a correction of their malocclusion by orthodontics and orthognathic surgery have a significant incidence of TMDs when compared to a control population, but that after treatment, the incidence of TMDs does not differ from a control population. The reasons for these findings are not clear.
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13
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Patel AA, Lerner MZ, Blitzer A. IncobotulinumtoxinA Injection for Temporomandibular Joint Disorder. Ann Otol Rhinol Laryngol 2017; 126:328-333. [PMID: 28290229 DOI: 10.1177/0003489417693013] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Temporomandibular disorder (TMD) involves dysfunction of the temporomandibular joint and associated muscles of mastication causing pain with chewing, limitation of jaw movement, and pain. While the exact pathophysiology of TMD is not completely understood, it is thought that hyperfunction of the muscles of mastication places stress on the temporomandibular joint, leading to degeneration of the joint and associated symptoms. We hypothesize that chemodenervation of the muscles of mastication with IncobotulinumtoxinA (Xeomin) will decrease the stress on the temporomandibular joint and improve pain associated with temporomandibular joint and muscle disorder (TMJD). METHODS Twenty patients were randomized to IncobotulinumtoxinA (170 units) or saline injection of the masticatory muscles. Patient-reported pain scale (0-10) was recorded at 4-week intervals following injection for 16 weeks. Patients who received saline injection initially were assessed for reduction in pain at the first 4-week interval and if still had significant pain were rolled over into the IncobotulinumtoxinA arm. RESULTS Preinjection pain scores were similar between patients. While there was a statistically significant reduction in pain score in the placebo group one month, there was an overall larger drop in average pain scores in those patients injected with IncobotulinumtoxinA initially. All patients initially injected with placebo crossed over into the IncobotulinumtoxinA group. Similar results were seen when examining the composite masticatory muscle tenderness scores. There was no significant change in usage of pain medication. CONCLUSIONS We demonstrate utility of IncobotulinumtoxinA in treating patients with TMD with pain despite pain medication usage and other conventional treatments.
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Affiliation(s)
- Amit A Patel
- 1 New York Center for Voice and Swallowing Disorders, New York, New York, USA
| | - Michael Z Lerner
- 1 New York Center for Voice and Swallowing Disorders, New York, New York, USA
| | - Andrew Blitzer
- 1 New York Center for Voice and Swallowing Disorders, New York, New York, USA
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14
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Aslanidou K, Kau CH, Vlachos C, Saleh TA. The fabrication of a customized occlusal splint based on the merging of dynamic jaw tracking records, cone beam computed tomography, and CAD-CAM digital impression. J Orthod Sci 2017; 6:104-109. [PMID: 28717635 PMCID: PMC5508405 DOI: 10.4103/jos.jos_61_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The aim of this case report was to present the procedure of fabricating a customized occlusal splint, through a revolutionary software that combines cone beam computed tomography (CBCT) with jaw motion tracking (JMT) data and superimposes a digital impression. MATERIALS AND METHODS The case report was conducted on a 46-year-old female patient diagnosed with the temporomandibular disorder. A CBCT scan and an optical impression were obtained. The range of the patient's mandibular movements was captured with a JMT device. The data were combined in the SICAT software (SICAT, Sirona, Bonn, Germany). RESULTS The software enabled the visualization of patient-specific mandibular movements and provided a real dynamic anatomical evaluation of the condylar position in the glenoid fossa. After the assessment of the range of movements during opening, protrusion, and lateral movements all the data were sent to SICAT and a customized occlusal splint was manufactured. CONCLUSIONS The SICAT software provides a three-dimensional real-dynamic simulation of mandibular movements relative to the patient-specific anatomy of the jaw; thus, it opens new possibilities and potentials for the management of temporomandibular disorders.
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Affiliation(s)
- Katerina Aslanidou
- Department of Orthodontics, School of Dentistry, University of Alabama, Dental School, Suite 305, 1919 7th Ave South, Birmingham, AL 35233
| | - Chung How Kau
- Department of Orthodontics, School of Dentistry, University of Alabama, Dental School, Suite 305, 1919 7th Ave South, Birmingham, AL 35233
| | - Christos Vlachos
- Department of Orthodontics, School of Dentistry, University of Alabama, Dental School, Suite 305, 1919 7th Ave South, Birmingham, AL 35233
| | - Tayem Abou Saleh
- Department of Orthodontics, School of Dentistry, University of Alabama, Dental School, Suite 305, 1919 7th Ave South, Birmingham, AL 35233
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15
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Christensen L, Luther F. Adults seeking orthodontic treatment: expectations, periodontal and TMD issues. Br Dent J 2016; 218:111-7. [PMID: 25686427 DOI: 10.1038/sj.bdj.2015.46] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 01/06/2023]
Abstract
The growth in adult orthodontics presents new challenges to both the general dental practitioner and the orthodontist. Although many of the main objectives of orthodontic treatment are similar for adults, young adults and children, adult patients frequently bring significant challenges in several areas not often seen in the younger patient group. In areas such as planning realistic treatment outcomes, it is paramount that the patient's expectations are identified, respected and managed where appropriate. The adult patient's dental health often dictates deviation from the ideal treatment plan and periodontal problems are a common example. Based on current evidence, this paper presents an overview of some of the difficulties in the management of these issues, as well as highlighting developments with regard to pain conditions and their relevance to orthodontic treatment and its effects on temporomandibular joint disorders (TMD) management.
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Affiliation(s)
- L Christensen
- Specialist in Orthodontics, 69-71 Banbury Road, Oxford, OX2 6PE
| | - F Luther
- Consultant and Honorary Senior Clinical Lecturer in Orthodontics, Charles Clifford Dental Hospital (Sheffield Teaching Hospitals NHS Foundation Trust), 76 Wellesley Road, Sheffield, S10 2SZ
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16
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Hughes D, Song B. Dental and Nondental Stem Cell Based Regeneration of the Craniofacial Region: A Tissue Based Approach. Stem Cells Int 2016; 2016:8307195. [PMID: 27143979 PMCID: PMC4842076 DOI: 10.1155/2016/8307195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/16/2016] [Indexed: 12/22/2022] Open
Abstract
Craniofacial reconstruction may be a necessary treatment for those who have been affected by trauma, disease, or pathological developmental conditions. The use of stem cell therapy and tissue engineering shows massive potential as a future treatment modality. Currently in the literature, there is a wide variety of published experimental studies utilising the different stem cell types available and the plethora of available scaffold materials. This review investigates different stem cell sources and their unique characteristics to suggest an ideal cell source for regeneration of individual craniofacial tissues. At present, understanding and clinical applications of stem cell therapy remain in their infancy with numerous challenges to overcome. In spite of this, the field displays immense capacity and will no doubt be utilised in future clinical treatments of craniofacial regeneration.
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Affiliation(s)
- Declan Hughes
- School of Dentistry, Cardiff University, Heath Park, Cardiff CF14 4XY, UK
| | - Bing Song
- School of Dentistry, Cardiff University, Heath Park, Cardiff CF14 4XY, UK
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Abstract
TMDs are a group of conditions affecting the joint and or the muscles of mastication.TMDs consist of three main groups of conditions: myofascial pain; disc disorders; TMJ arthritides.The gold standard diagnostic criteria for research involving TMDs are the Research Diagnostic Criteria for TMDs (RDC/TMD). A pragmatic clinically applicable alternative is the Clinical examination protocol for TMDs (CEP-TMD).Signs and symptoms can include: pain in masticatory musculature and or the joint; noises associated with joint movements; locking; headache; otalgia.TMDs' aetiology is multifactorial and biopsychosocial in nature.Reversible conservative management as defined by the American Association of Dental Research is the initial management of choice for all subgroups of TMDs.
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Affiliation(s)
- J Durham
- NIHR Academic Clinical Lecturer in Oral Surgery
| | - R W Wassell
- Senior Lecturer/Hon Consultant in Restorative Dentistry School of Dental Sciences, Newcastle University. United Kingdom
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18
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Manfredini D, Stellini E, Gracco A, Lombardo L, Nardini LG, Siciliani G. Orthodontics is temporomandibular disorder-neutral. Angle Orthod 2015; 86:649-54. [PMID: 26512757 DOI: 10.2319/051015-318.1] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To assess if subjects with a clinical diagnosis of temporomandibular disorders (TMDs) have a similar prevalence of orthodontic history as a population of TMD-free individuals and to assess if those subjects who have a history of ideal orthodontics have fewer symptoms than those with a history of nonideal orthodontics. MATERIALS AND METHODS Two groups of age- and sex-matched individuals belonging to either a study ("TMD") or a control group were recruited. Subjects who underwent orthodontic treatment were classified as having a history of ideal or nonideal orthodontics based on the current presence of normal values in five reference occlusal features. RESULTS The correlation with a history of orthodontic treatment was not clinically significant for any of the TMD diagnoses (ie, muscle pain, joint pain, disc displacement, arthrosis), with Phi (Φ) coefficient values within the -0.120 to 0.058 range. Within the subset of patients with a history of orthodontics, the correlation of ideal or nonideal orthodontic treatment with TMD diagnoses was, in general, not clinically relevant or was weakly relevant. CONCLUSIONS Findings confirmed the substantial absence of clinically significant effects of orthodontics as far as TMD is concerned. The very low correlation values of a negative or positive history of ideal or nonideal orthodontics with the different TMD diagnoses suggest that orthodontic treatment could not have a true role for TMD.
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Affiliation(s)
- Daniele Manfredini
- a Associate Professor, Temporomandibular Disorders Clinic, Section of Maxillofacial Surgery, Department of Neuroscience, University of Padova, Padova, Italy
| | - Edoardo Stellini
- b Professor and Head, Department of Neuroscience, School of Dentistry, University of Padova, Padova, Italy
| | - Antonio Gracco
- c Researcher, School of Dentistry, Department of Neuroscience, University of Padova, Padova, Italy
| | - Luca Lombardo
- d Researcher, Postgraduate School of Orthodontics, University of Ferrara, Ferrara, Italy
| | - Luca Guarda Nardini
- e Head, Temporomandibular Disorders Clinic, Section of Maxillofacial Surgery, Department of Neuroscience, University of Padova, Padova, Italy
| | - Giuseppe Siciliani
- f Professor and Head, Postgraduate School of Orthodontics, University of Ferrara, Ferrara, Italy
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Motro PFK, Motro M, Oral K. Orthodontics and Temporomandibular Disorders. Are They Related? Turk J Orthod 2015. [DOI: 10.13076/tjo-d-14-00030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Fleming PS, Springate SD, Chate RAC. Myths and realities in orthodontics. Br Dent J 2015; 218:105-10. [DOI: 10.1038/sj.bdj.2015.41] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2014] [Indexed: 11/09/2022]
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21
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Affiliation(s)
- Sorin T. Teich
- Clinical Operations; Department of Comprehensive Care; Case Western Reserve University School of Dental Medicine
| | - Lisa A. Lang
- Department of Comprehensive Care; Case Western Reserve University School of Dental Medicine
| | - Catherine A. Demko
- Department of Community Dentistry; Case Western Reserve University School of Dental Medicine
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Affiliation(s)
- J. L. Carmalt
- Department of Large Animal Clinical SciencesWestern College of Veterinary Medicine Saskatchewan Canada
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Masci C, Ciarrocchi I, Spadaro A, Necozione S, Marci MC, Monaco A. Does orthodontic treatment provide a real functional improvement? a case control study. BMC Oral Health 2013; 13:57. [PMID: 24152806 PMCID: PMC3827987 DOI: 10.1186/1472-6831-13-57] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 10/17/2013] [Indexed: 11/23/2022] Open
Abstract
Background Electromyographic analysis of the masticatory muscles provides useful data on the behavior of these muscles during stomatognathic system functioning and allows a functional assessment of orthodontic treatments. This study was undertaken to verify if achieving an Angle Class I bite through orthodontic treatment can lead to neuromuscular balance. Methods This study enrolled 30 patients (20 females, 10 males, mean age: 15.78 years) with an Angle Class II, division 1 malocclusion that was orthodontically treated. A group of 30 subjects (19 females, 11 males; mean age: 16.15 years), randomly selected among subjects with an Angle Class II, division 1 malocclusion that had not been orthodontically treated served as the Control group. Both groups were subjected to electromyography to study their neuromuscular characteristics. The Shapiro-Wilk's test revealed a non normal distribution, therefore we used a Friedman two way ANOVA by ranks test to compare differences of surface electromyography values between treated and untreated subjects at closed and open eyes condition. Results A statistically significant interaction between orthodontic treatment and open eyes conditions was detected for anterior temporal muscles. A significant imbalance of the anterior temporal muscles, which is indicative of an asymmetric electromyographic pattern, was also found. Conclusions The present data indicate that achieving a correct occlusal target does not necessarily correspond to a neuromuscular balance.
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Affiliation(s)
- Chiara Masci
- Department of Life, Health and Environmental Sciences, V, le Vetoio 1, L'Aquila 67100, Italy.
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Craniomandibular disorders and mandibular reference position in orthodontic treatment. Int J Dent 2013; 2013:890942. [PMID: 24101929 PMCID: PMC3786527 DOI: 10.1155/2013/890942] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 07/11/2013] [Accepted: 07/30/2013] [Indexed: 01/15/2023] Open
Abstract
The aim of this paper is to bring into focus the literature on the choice of the mandibular reference position in orthodontic treatment; of a particular reference to this paper is intercuspal position, centric relation position, or therapeutic position. To give a comprehensive account of the literature review on craniomandibular disorders (CMD), we have relied on books and articles using both Google Scholar and PubMed. Selection criteria included a combination of Mesh and type of article. Article classification was made by two authors, using the following structure outline: prevalence of craniomandibular disorders, its etiology and pathophysiology, occlusion and craniomandibular disorders, orthodontic treatment and CMD, and the mandibular reference position in orthodontics. An important conclusion that emerged from the present literature review is that CMD do not seem to be directly related to orthodontic treatment, and their appearance cannot be predicted or prevented by any means. Therefore, orthodontists must adopt a mandibular reference suitable to their patients and which best respects the balance existing in the stomatognathic system.
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Garner S, Docherty M, Somner J, Sharma T, Choudhury M, Clarke M, Littlejohns P. Reducing ineffective practice: Challenges in identifying low-value health care using Cochrane systematic reviews. J Health Serv Res Policy 2013; 18:6-12. [DOI: 10.1258/jhsrp.2012.012044] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives: Despite international agreement that stopping low value practices will increase efficiency, identifying them is difficult and controversial. Opponents of centralized lists of low value practices stress that the actual problem is inappropriate low value use, and better targeting and implementation of treatment thresholds is needed. Our objective was to use Cochrane Reviews to identify low value practices to support local disinvestment decisions. Methods: New or updated reviews were included if the authors concluded that the uncertain effectiveness of an intervention meant it should only be used in research, or that it was ineffective or harmful and should not be used. The reviews go through a production and quality assurance process, and are published as ‘Cochrane Quality and Productivity topics’ through the NHS Evidence website ( http://www.library.nhs.uk/qipp/ ). Results: Over a six-month period, 65 Cochrane reviews were processed by the National Institute for Health and Clinical Excellence (NICE). Of these, 28 identified potentially low value practices in the UK context. This was primarily due to a lack of randomized evidence of effectiveness, rather than robust evidence of a lack of effectiveness, or evidence of harm. Conclusions: Identifying low-value health care practices for local disinvestment (total or partial) is both practically and politically challenging, yet it is necessary to manage health budgets. This project identified that Cochrane Reviews can potentially identify low value health care practices. However, each review has to be reinterpreted for the UK context and additional analysis has to be undertaken to facilitate local implementation. Recommendations to improve the usability of systematic reviews are made.
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Affiliation(s)
- Sarah Garner
- National Institute for Health and Clinical Excellence, London
| | - Mary Docherty
- Institute of Psychiatry, King's College London, London
| | - John Somner
- The Vision & Eye Research Unit, Anglia Ruskin University, Cambridge
| | - Tarang Sharma
- National Institute for Health and Clinical Excellence, London
| | - Moni Choudhury
- National Institute for Health and Clinical Excellence, London
| | - Mike Clarke
- Queen's University Belfast, County Antrim, UK
| | - Peter Littlejohns
- Division of Health and Social Research, King's College London, London, UK
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Lotze M, Lucas C, Domin M, Kordass B. The cerebral representation of temporomandibular joint occlusion and its alternation by occlusal splints. Hum Brain Mapp 2011; 33:2984-93. [PMID: 22102437 DOI: 10.1002/hbm.21466] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 07/18/2011] [Accepted: 08/16/2011] [Indexed: 11/05/2022] Open
Abstract
Occlusal splints are a common and effective therapy for temporomandibular joint disorder. Latest hypotheses on the impact of occlusal splints suggest an altered cerebral control on the occlusion movements after using a splint. However, the impact of using a splint during chewing on its cerebral representation is quite unknown. We used functional magnetic resonance imaging (fMRI) to investigate brain activities during occlusal function in centric occlusion on natural teeth or on occlusal splints in fifteen healthy subjects. Comparisons between conditions revealed an increased activation for the bilateral occlusion without a splint in bilateral primary and secondary sensorimotor areas, the putamen, inferior parietal and prefrontal cortex (left dorsal and bilateral orbital) and anterior insular. In contrast, using a splint increased activation in the bilateral prefrontal lobe (bilateral BA 10), bilateral temporo-parietal (BA 39), occipital and cerebellar hemispheres. An additionally applied individually based evaluation of representation sites in regions of interest demonstrated that the somatotopic representation for both conditions in the pre- and postcentral gyri did not significantly differ. Furthermore, this analysis confirmed the decreasing effect of the splint on bilateral primary and secondary motor and somatosensory cortical activation. In contrast to the decreasing effect on sensorimotor areas, an increased level of activity in the fronto-parieto-occipital and cerebellar network might be associated with the therapeutic effect of occlusal splints.
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Affiliation(s)
- Martin Lotze
- Functional Imaging Unit, Center of Diagnostic Radiology and Neuroradiology, University of Greifswald, Germany.
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Benoliel R, Svensson P, Heir GM, Sirois D, Zakrzewska J, Oke-Nwosu J, Torres SR, Greenberg MS, Klasser GD, Katz J, Eliav E. Persistent orofacial muscle pain. Oral Dis 2011; 17 Suppl 1:23-41. [PMID: 21382137 DOI: 10.1111/j.1601-0825.2011.01790.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The pathophysiology of persistent orofacial myalgia has been the centre of much controversy. In this article we suggest a novel descriptive term; 'persistent orofacial muscle pain' (POMP) and review current evidence that supports the hypothesis that the induction of POMP involves the interplay between a peripheral nociceptive source in muscle, a faulty central nervous system component and decreased coping ability. In this context it is widely accepted that a complex interaction of variable intrinsic and extrinsic factors act to induce POMP and dysfunction.
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Affiliation(s)
- R Benoliel
- Department of Oral Medicine, The Faculty of Dentistry, Hebrew University-Hadassah, Jerusalem, Israel.
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