Degenerative joint disease. Part I: Diagnosis and management considerations

Treatment of Temporomandibular Joint Arthritis with Triamcinolone Acetonide and Hyaluronic Acid Injection: An Observational Study

Temporomandibular joint (TMJ) arthritis is a common cause of orofacial pain with distressing symptoms. The patients most commonly females are often anxious and worried due to the typical gritty sound produced during chewing moments. In other cases there is pain followed by decreased mouth opening. Currently the treatment is not standardised though the clinicians are treating these disorders either by oral medications; splintage or by injections. Though local injection of Triamcinolone acetonide and Hyaluronic acid is an innovative therapy yet it is elusive of much research. The main aim of the present study is to evaluate the efficacy of with Triamcinolone acetonide and Hyaluronic acid in treating temporomandibular joint arthritis. The present study is a prospective non randomized clinical trial of 100 patients in a tertiary referral centre. The patients diagnosed with temporomandibular joint arthritis were treated with local infiltration of 40 mg triamcinolone acetonide along with 20 mg of hyaluronic acid; one injection every week for 4 weeks. The pre-treatment and post-treatment data was compared using student paired t test and Mann-Whitney U test. Majority of the patients showed relief in symptoms like pain (87/96) and clicking sounds (81/88) and the difference was statistically significant (p < 0.05). Though other symptoms like restrictive mouth opening; discomfort on lateral and medial movement were also relieved in 9/15 patients and 21/23 patients respectively however the difference was not statistically significant. We highly recommend the use of Triamcinolone acetonide and hyaluronic acid injection in TMJ arthritis as it helps in relieving pain and clicking of sound in majority of the patients. The treatment is an out-patient department procedure with almost no side effects in most of the patients. The cost effectiveness of the treatment is another benefit.

An FDA-Approved Drug Screen for Compounds Influencing Craniofacial Skeletal Development and Craniosynostosis

Neural crest stem/progenitor cells (NCSCs) populate a variety of tissues, and their dysregulation is implicated in several human diseases including craniosynostosis and neuroblastoma. We hypothesised that small molecules that inhibit NCSC induction or differentiation may represent potential therapeutically relevant drugs in these disorders. We screened 640 FDA-approved compounds currently in clinical use for other conditions to identify those which disrupt development of NCSC-derived skeletal elements that form the zebrafish jaw. In the primary screen, we used heterozygous transgenic sox10:gfp zebrafish to directly visualise NCSC-derived jaw cartilage. We noted partial toxicity of this transgene in relation to jaw patterning, suggesting that our primary screen was sensitised for NCSC defects, and we confirmed 10 novel, 4 previously reported, and 2 functional analogue drug hits in wild-type embryos. Of these drugs, 9/14 and 7/14, respectively, are known to target pathways implicated in osteoarthritis pathogenesis or to cause reduced bone mineral density/increased fracture risk as side effects in patients treated for other conditions, suggesting that our screen enriched for pathways targeting skeletal tissue homeostasis. We selected one drug that inhibited NCSC induction and one drug that inhibits bone mineralisation for further detailed analyses which reflect our initial hypotheses. These drugs were leflunomide and cyclosporin A, respectively, and their functional analogues, teriflunomide and FK506 (tacrolimus). We identified their critical developmental windows of activity, showing that the severity of defects observed related to the timing, duration, and dose of treatment. While leflunomide has previously been shown to inhibit NCSC induction, we demonstrate additional later roles in cartilage remodelling. Both drugs altered expression of extracellular matrix metalloproteinases. As proof-of-concept, we also tested drug treatment of disease-relevant mammalian cells. While leflunomide treatment inhibited the viability of several human NCSC-derived neuroblastoma cell lines coincident with altered expression of genes involved in ribosome biogenesis and transcription, FK506 enhanced murine calvarial osteoblast differentiation and prevented fusion of the coronal suture in calvarial explants taken from Crouzon syndrome mice.

Occlusal stability

Occlusion is the foundation for clinical success in fixed, removable, and implant prosthodontic treatment. Understanding those principles is critical when restoring a patient's occlusion. Many philosophies, devices, and theories of occlusion have evolved based on anecdotal clinical observations and applied geometric perceptions. The literature has reported these classic and contemporary occlusal concepts. As evidence-based dentistry emerged, it championed scrutiny of previously held beliefs, resulting in the abandonment of many pragmatic, yet beneficial occlusal procedures. The impetus toward scientific discovery, whereby factual information might be universally applied in dental education and clinical practice, has renewed interest in occlusal studies.

Incidental findings in the maxillofacial area with 3-dimensional cone-beam imaging

INTRODUCTION

The purposes of this study were to evaluate the location, nature, and occurrence of incidental findings in maxillofacial structures on 3-dimensional cone-beam volumetric scans done for dental diagnostic purposes and to look for associations between these findings and symptoms in orthodontic patients.

METHODS

Images from 500 consecutive maxillofacial 3-dimensional scans were examined. The patient sample consisted of 252 orthodontic patients, 172 implant patients, 33 endodontic patients, 34 temporomandibular joint (TMJ) disorder patients, and 10 others.

RESULTS

The overall rate of incidental findings was 24.6% (123 patients of 500). The highest rate of incidental findings was in the airway area (18.2%), followed by TMJ findings (3.4%), endodontic findings (1.8%), and others (1.2%). In the orthodontic group, the incidences were airway findings, 21.4%; TMJ findings, 5.6%; and endodontic lesions, 2.3%. Only 22% of the airway findings, such as mucosal thickness, polyps, and retention cysts, were correlated with clinical signs and symptoms.

CONCLUSIONS

For clinical diagnosis, the data should be interpreted with a full history of clinical signs and symptoms, and with detailed communications with radiological colleagues and other specialists to comprehensively evaluate possible underlying diseases.

Condylar resorption following temporomandibular joint arthroscopy in a patient with essential thrombocythemia

Condylar resorption of the temporomandibular joint (TMJ) is a poorly understood phenomenon that is the subject of much controversy. The following case report depicts a unique case of condylar resorption (CR) in a 49-year-old female patient with essential thrombocythemia who underwent arthrocentesis of the TMJ. The exact cause of the CR is unclear but it is speculated that it was likely due to hemorrhagic and thrombotic complications during surgery secondary to an elevated platelet count.

The role of SPECT/CT with 99mTc-MDP image fusion to diagnose temporomandibular dysfunction

OBJECTIVE

The objective of this study was the evaluation of Single Photon Emission Computed Tomography with Technetium 99m Methylene Diphosphonate (SPECT with 99mTc-MDP) and computed tomography (CT), simultaneously acquired image in diagnosis of temporomandibular joint (TMJ) dysfunction.

STUDY DESIGN

A prospective study was conducted with 33 patients, 29 female and 4 male, all of then presenting signs and/or complaints suggestive of temporomandibular dysfunction. SPECT/CT with 99mTc-MDP was performed in all patients and imaging results compared with final diagnosis and clinical outcome.

RESULTS

The correlation of signs and symptoms with SPECT/CT imaging showed sensitivity 100%, specificity 90.91%, and accuracy 96.97%.

CONCLUSIONS

SPECT/CT with 99mTc-MDP coregistered imaging fusion is a suitable method of temporomandibular dysfunction diagnosis, due to the sensitivity, specificity, and accuracy observed.

Chiropractic care of a patient with temporomandibular disorder and atlas subluxation

OBJECTIVE

To describe the chiropractic care of a patient with cervical subluxation and complaints associated with temporomandibular disorder.

CLINICAL FEATURES

A 41-year-old woman had bilateral ear pain, tinnitus, vertigo, altered or decreased hearing acuity, and headaches. She had a history of ear infections, which had been treated with prescription antibiotics. Her complaints were attributed to a diagnosis of temporomandibular joint syndrome and had been treated unsuccessfully by a medical doctor and dentist.

INTERVENTION AND OUTCOME

High-velocity, low-amplitude adjustments (ie, Gonstead technique) were applied to findings of atlas subluxation. The patient's symptoms improved and eventually resolved after 9 visits.

CONCLUSION

The chiropractic care of a patient with temporomandibular disorder, headaches, and subluxation is described. Clinical issues relevant to the care of patients with this disorder are also discussed.

Condylar bony change and self-reported parafunctional habits in prospective orthognathic surgery patients with temporomandibular disorders

OBJECTIVE

The purpose of this study was to investigate the relationship between self-reported parafunctional habits and condylar bony change and disk displacement in orthognathic surgery patients with signs and symptoms of temporomandibular joint disorders.

STUDY DESIGN

This is a cross-sectional retrospective study of pretreatment helical computed tomography scans and questionnaires of 94 female orthognathic surgery patients.

RESULTS

Condylar bony change, unilaterally or bilaterally, was found in 56.4% of the subjects, or 43.6% of the joints. Disk displacement, unilaterally or bilaterally, was seen in 59.6% of the subjects, or 45.7% of the joints. Bruxism and clenching was significantly associated with condylar bony change and disk displacement. Subjects with 3 or more parafunctional habits showed a significantly higher rate of bilateral condylar bony change.

CONCLUSION

Our results suggest that bruxism and clenching might be related to deterioration of the temporomandibular joint and that the greater the number of parafunctional habits a subject has, the higher the risk of condylar bony change.