Prevalence of whiplash trauma in TMD patients: a systematic review

Whiplash trauma did not predict jaw pain after 2 years: an explorative study

OBJECTIVES

To explore predictive factors for the development and maintenance of jaw pain over a 2-year period.

METHODS

One hundred nineteen cases (73 women) and 104 controls (59 women), mean age 34.9 years (SD 13.9), attended baseline and 2-year follow-up examinations. The whiplash cases visited the emergency department at Umeå University Hospital, Sweden, with neck pain within 72 h following a car accident, and baseline questionnaires were answered within a month after trauma. Controls were recruited via advertising. Inclusion criteria were age 18-70 years, living in Umeå municipality and Swedish speaking. The exclusion criterion was neck fracture for cases and a previous neck trauma for controls. Validated questionnaires recommended in the standardized Research Diagnostic Criteria for temporomandibular disorders were used. Jaw pain was assessed by two validated screening questions answered with "yes" or "no." A logistic regression analysis was used to predict the outcome variable jaw pain (yes/no) after 2 years.

RESULTS

Whiplash trauma did not increase the odds of development of jaw pain over a 2-year period (OR 1.97, 95% CI 0.53-7.38). However, non-specific physical symptoms (OR 8.56, 95% CI 1.08-67.67) and female gender (OR 4.89, 95% CI 1.09-22.02) did increase the odds for jaw pain after 2 years.

CONCLUSION

The development and maintenance of jaw pain after whiplash trauma are primarily not related to the trauma itself, but more associated with physical symptoms.

CLINICAL RELEVANCE

The development of jaw pain in connection with a whiplash trauma needs to be seen in a biopsychosocial perspective, and early assessment is recommended.

Whiplash-associated temporomandibular disorders: a review article

Data from the literature on temporomandibular disorder (TMD) amplification or exacerbation in whiplash injuries is quite discordant. Substantial controversy exists regarding the incidence, prevalence, proposed mechanism of injury, clinical characteristics, and prognosis of TMDs due to whiplash.This article describes this controversy and presents findings from contemporary literature.

Alterations in kinematics of temporomandibular joint associated with chronic neck pain

BACKGROUND

Temporomandibular disorder (TMD) is an umbrella term for pain and dysfunction of the temporomandibular joint (TMJ) and its associated structures. Patients with TMD show changes in TMJ kinematics and masticatory muscle activation. TMD is commonly comorbid with non-specific chronic neck pain (NCNP), which may be one of the risk factors for TMD.

OBJECTIVES

This study aimed to investigate whether patients with NCNP have altered TMJ kinematics and masticatory muscle activity.

METHODS

This was a cross-sectional exploratory study including 19 healthy participants and 20 patients with NCNP but without TMD symptoms. TMJ kinematics was measured during mouth opening and closing, jaw protrusion and jaw lateral deviation. Surface electromyography was used to record the muscle activity of the anterior temporalis, masseter, sternocleidomastoid and upper trapezius while clenching. Furthermore, cervical posture, cervical range of motion (ROM) and pressure-pain threshold of the neck and masticatory muscles were measured.

RESULTS

Compared with the healthy group, the NCNP group showed significantly reduced upper cervical rotation ROM (p = .041) and increased condylar path length (p = .02), condylar translation (opening p = .034, closing p = .011) and mechanical pain sensitivity of the upper trapezius (p = .018). Increased condylar translation was significantly correlated with reduced upper cervical mobility and poor cervical posture (r = -0.322 to -0.397; p = .012-.046).

CONCLUSION

Increased condylar translation and path length in patients with NCNP may indicate poor control of TMJ articular movement, which may result from neck pain or may be a compensation for limited neck mobility. Evaluation of excessive TMJ translation may be considered in patients with NCNP.

High Pain Intensity is a Risk Factor of Non-Resolving TMD: A Three-Year Follow-Up of a Patient Group in a Norwegian Interdisciplinary Evaluation Program

Purpose

To investigate the outcome of patients with long-term refractory temporomandibular disorders (TMD) three years after a Norwegian interdisciplinary evaluation program with attention to patient satisfaction, function, pain, and psychosocial variables.

Patients and Methods

The study population consisted of 60 long-term refractory TMD patients who were investigated by a Norwegian interdisciplinary team. A questionnaire that covered medical history, function, pain, lifestyle factors, TMD-status and follow-up from their general medical practitioner (GMP) was sent to the patients three years after the evaluation. Questionnaires that assessed function (Mandibular Functional Index Questionnaire [MFIQ] and Roland Morrison Scale [RMS]), pain intensity (General Pain Intensity questionnaire [GPI]) and psychosocial factors (Hospital Anxiety and Depression scale [HADS]); a 2-item version of the Coping Strategies Questionnaire [CSQ]) were included in the package.

Results

Thirty-nine out of 60 TMD patients completed the questionnaires. Improvements in TMD symptoms were reported in 10 patients (26%), were unchanged in 16 patients (41%) and worsened in 13 patients (33%). Only 8 patients (21%) were satisfied with the follow-up of the suggested treatments from their GMP. Significant improvements of symptoms were noted in MFIQ (jaw function), GPI (including pain intensity at maximum and suffering from pain), and CSQ (pain related catastrophizing), in all 39 TMD patients as one group. However, a subgroup analysis showed that the significant improvements were mostly within patients who reported improvement of TMD symptoms. A high pain intensity at baseline was a significant risk factor (OR = 5.79, 95% CI: 1.34, 24.96) for patients who reported worsening of TMD symptoms at follow-up.

Conclusion

High pain intensity at baseline was a significant risk factor for poorer recovery three years after an interdisciplinary evaluation. Our data support the notion that improved coping with TMD pain includes both decreased pain intensity, CSQ and MFIQ scores.

Whiplash injuries associated with experienced pain and disability can be visualized with [11C]-D-deprenyl positron emission tomography and computed tomography

ABSTRACT

Knowledge of etiological mechanisms underlying whiplash-associated disorders is incomplete. Localisation and quantification of peripheral musculoskeletal injury and inflammation in whiplash-associated disorders would facilitate diagnosis, strengthen patients' subjective pain reports, and aid clinical decisions, all of which could lead to improved treatment. In this longitudinal observational study, we evaluated combined [11C]-D-deprenyl positron emission tomography and computed tomography after acute whiplash injury and at 6-month follow-up. Sixteen adult patients (mean age 33 years) with whiplash injury grade II were recruited at the emergency department. [11C]-D-deprenyl positron emission tomography and computed tomography, subjective pain levels, self-rated neck disability, and active cervical range of motion were recorded within 7 days after injury and again at 6-month follow-up. Imaging results showed possible tissue injuries after acute whiplash with an altered [11C]-D-deprenyl uptake in the cervical bone structures and facet joints, associated with subjective pain locale and levels, as well as self-rated disability. At follow-up, some patients had recovered and some showed persistent symptoms and reductions in [11C]-D-deprenyl uptake correlated to reductions in pain levels. These findings help identify affected peripheral structures in whiplash injury and strengthen the idea that positron emission tomography and computed tomography detectable organic lesions in peripheral tissue are relevant for the development of persistent pain and disability in whiplash injury.

The prevalence of comorbid chronic pain conditions among patients with temporomandibular disorders: A systematic review

BACKGROUND

This systematic review was designed to evaluate the presence of comorbid conditions among patients with temporomandibular disorders (TMDs).

TYPES OF STUDIES REVIEWED

The authors reviewed studies that reported the prevalence or incidence of chronic pain conditions or psychiatric disorders (anxiety, mood, personality disorders) among patients with any type of TMD. The authors calculated sample size-weighted prevalence estimates when data were reported in 2 or more studies for the same comorbid condition.

RESULTS

A total of 9 prevalence studies and no incidence studies were eligible for review; 8 of the studies examined chronic pain comorbidities. Weighted estimates showed high prevalence of pain comorbidities across studies, including current chronic back pain (66%), myofascial syndrome (50%), chronic stomach pain (50%), chronic migraine headache (40%), irritable bowel syndrome (19%), and fibromyalgia (14%). A single study examined psychiatric disorders and found that current depression was the most prevalent disorder identified (17.5%).

CONCLUSIONS AND PRACTICAL IMPLICATIONS

There is a high prevalence of comorbid chronic pain conditions among patients with TMDs, with more than 50% of patients reporting chronic back pain, myofascial syndrome, and chronic stomach pain. Psychiatric disorders among patients with different types of TMDs were studied less commonly in this pain population. Knowledge of the distribution of these and other comorbid disease conditions among patients with different types of TMDs can help dentists and other health care providers to identify personalized treatment strategies, including the coordination of care across medical specialties.

Temporomandibular joint trauma and disability assessment - A longitudinal exploratory study

BACKGROUND

Orofacial trauma can encompass, isolated or not, several anatomical regions, namely facial, dental and temporomandibular joint (TMJ), one of the most complex joints in the human body. Evidence-based knowledge in the field of TMJ trauma and in temporomandibular joint disorders (TMD) diagnosis and treatment, provides the necessary data for medico-legal assessment.

OBJECTIVE

The aim of this study is to bring up epidemiological data referring to TMJ injuries and sequelae, in order to present a medico-legal approach of TMJ disability.

METHODS

An observational longitudinal exploratory study was performed in the database of the National Institute of Legal Medicine and Forensic Sciences, Portugal, between 2000 and 2017, regarding inclusion and exclusion criteria.Statistical significance was set as P‹0.05, Fisher's exact test, Binomial test and Goodman and Kruskal's test were used.

RESULTS

Post-traumatic orofacial reports (n = 2622) included 234 TMJ-injury and 149 TMJ-sequelae.Epidemiological data was presented regarding age,gender, professional status and etiology. There was a statistically significant association between TMJ injury and TMJ sequela, despite a weak relation (ƛ = 0.170). No statistically significant association was identified between TMJ-injury/TMJ-sequelae and the professional status, etiology.

CONCLUSION

The TMJ sequela group is smaller than the TMJ-injury, reflecting that 2/3 of the injuries have been cured without a monetary compensation value and without Health costs. The association between TMJ injury and TMJ sequelae reinforces the necessity of preventive measures in TMJ trauma, namely in physical violence context and in medico-legal impairment.

MRI-Based Assessment of Masticatory Muscle Changes in TMD Patients after Whiplash Injury

Objective: to investigate the change in volume and signal in the masticatory muscles and temporomandibular joint (TMJ) of patients with temporomandibular disorder (TMD) after whiplash injury, based on magnetic resonance imaging (MRI), and to correlate them with other clinical parameters. Methods: ninety patients (64 women, 26 men; mean age: 39.36 ± 15.40 years), including 45 patients with symptoms of TMD after whiplash injury (wTMD), and 45 age- and sex-matched controls with TMD due to idiopathic causes (iTMD) were included. TMD was diagnosed using the study diagnostic criteria for TMD Axis I, and MRI findings of the TMJ and masticatory muscles were investigated. To evaluate the severity of TMD pain and muscle tenderness, we used a visual analog scale (VAS), palpation index (PI), and neck PI. Results: TMD indexes, including VAS, PI, and neck PI were significantly higher in the wTMD group. In the wTMD group, muscle tenderness was highest in the masseter muscle (71.1%), and muscle tenderness in the temporalis (60.0%), lateral pterygoid muscle (LPM) (22.2%), and medial pterygoid muscle (15.6%) was significantly more frequent than that in the iTMD group (all p < 0.05). The most noticeable structural changes in the masticatory muscles occurred in the LPM with whiplash injury. Volume (57.8% vs. 17.8%) and signal changes (42.2% vs. 15.6%) of LPM were significantly more frequent in the wTMD group than in the iTMD group. The presence of signal changes in the LPM was positively correlated with the increased VAS scores only in the wTMD group (r = 0.346, p = 0.020). The prevalence of anterior disc displacement without reduction (ADDWoR) (53.3% vs. 28.9%) and disc deformity (57.8% vs. 40.0%) were significantly higher in the wTMD group (p < 0.05). The presence of headache, sleep problems, and psychological distress was significantly higher in the wTMD group than in the iTMD group. Conclusion: abnormal MRI findings and their correlations with clinical characteristics of the wTMD group were different from those of the iTMD group. The underlying pathophysiology may differ depending on the cause of TMD, raising the need for a treatment strategy accordingly.

Efficacy of arthrocentesis and lavage for treatment of post-traumatic arthritis in temporomandibular joints

Objectives

Joint injuries frequently lead to progressive joint degeneration that causes articular disc derangement, joint inflammation, and osteoarthritis. Such arthropathies that arise after trauma are defined as post-traumatic arthritis (PTA). Although PTA is well recognized in knee and elbow joints, PTA in the temporomandibular joint (TMJ) has not been clearly defined. Interestingly, patients experiencing head and neck trauma without direct jaw fracture have displayed TMJ disease symptoms; however, definitive diagnosis and treatment options are not available. This study will analyze clinical aspects of PTA in TMJ and their treatment outcomes after joint arthrocentesis and lavage.

Materials and Methods

Twenty patients with history of trauma to the head and neck especially without jaw fracture were retrospectively studied. Those patients developed TMJ disease symptoms and were diagnosed by computed tomography or magnetic resonance imaging. To decrease TMJ discomfort, arthrocentesis and lavage with or without conservative therapy were applied, and efficacy was evaluated by amount of mouth opening and pain scale. Statistical differences between pre- and post-treatment values were evaluated by Wilcoxon signed-rank test.

Results

Patient age varied widely between 20 and 80 years, and causes of trauma were diverse. Duration of disease onset was measured as 508 posttrauma days, and 85% of the patients sought clinic visit within 2 years after trauma. In addition, 85% of the patients showed TMJ disc derangement without reduction, and osteoarthritis was accompanied at the traumatized side or at both sides in 40% of the patients. After arthrocentesis or lavage, maximal mouth opening was significantly increased (28-44 mm on average, P<0.001) and pain scale was dramatically decreased (7.8-3.5 of 10, P<0.001); however, concomitant conservative therapy showed no difference in treatment outcome.

Conclusion

The results of this study clarify the disease identity of PTA in TMJ and suggest early diagnosis and treatment options to manage PTA in TMJ.

Retrospective analysis of trauma incidence in patients with temporomandibular disorders

BACKGROUND/AIM

The relationships between direct trauma, whiplash injuries, and temporomandibular disorders (TMD) have not been well established. The aim of this study was to evaluate the percentage of direct and/or whiplash trauma in patients with TMDs.

MATERIAL AND METHODS

The clinical records of 237 patients with temporomandibular disorders who had sought treatment at the Orofacial Pain Clinic were reviewed. Clinical data for age and gender of the patients, history of trauma, temporomandibular joint (TMJ) sounds, and TMD diagnosis were extracted from the medical records of all included patients. The presence of TMJ sounds and TMD diagnosis had been determined based on the Research Diagnostic Criteria for TMDs.

RESULTS

The mean age of patients with osteoarthritis was significantly higher than that of patients with disk displacement with reduction (P = .001, P ˂ .05). There was no statistically significant gender-based difference in diagnosis, clicking, crepitus, and trauma frequency (P > .05). A history of direct and whiplash trauma was observed in 18.6% and 14.8% of patients, respectively. Statistical analysis for the relationship between clicking and crepitus, and trauma showed no significant correlation (P > .05).

CONCLUSION

Direct and/or whiplash trauma in patients with temporomandibular disorders were not associated with the diagnostic records and temporomandibular joint sounds.

The Course of Orofacial Pain and Jaw Disability After Whiplash Trauma: A 2-year Prospective Study

STUDY DESIGN

Prospective cohort study.

OBJECTIVE

The aim of this study was to evaluate the course of orofacial pain and jaw disability in relation to neck pain, neck disability, and psychosocial factors at the acute stage and the chronic stage after whiplash trauma.

SUMMARY OF BACKGROUND DATA

Many individuals report chronic pain in the orofacial region after whiplash trauma. The possible association between whiplash trauma and orofacial pain is debated. Prospective studies are therefore needed to evaluate the development of orofacial pain after whiplash trauma.

METHODS

Within 1 month following a whiplash trauma, 176 cases were examined and compared to 116 controls with questionnaires concerning neck and jaw pain and related disability, nonspecific physical symptoms and depression. At the 2-year follow-up, 119 cases (68%) and 104 controls (90%) were re-examined.

RESULTS

Compared to controls, cases reported more jaw and neck pain, both at baseline and follow-up. A majority (68%) of cases with pain in the jaw region in the acute stage also reported jaw pain at the follow-up. The intensity of jaw and neck pain was correlated both at baseline and follow-up. Both neck pain and jaw pain were correlated to nonspecific physical symptoms and to depression.

CONCLUSION

Orofacial pain and jaw disability related to neck pain are often present already at the acute stage after whiplash trauma and persist into the chronic stage for most individuals. Assessment following whiplash trauma should therefore include both the neck and the orofacial regions. More studies are needed to further evaluate risk factors for development of orofacial pain after whiplash trauma.

LEVEL OF EVIDENCE

3.

Exercise, headache, and factors associated with headache in chronic whiplash: Analysis of a randomized clinical trial

BACKGROUND

Almost 40% of individuals with chronic whiplash-associated disorders (WAD) report headache after 5 years, making it one of the most common persistent symptoms besides neck pain, but randomized treatment studies are lacking. This study aimed to evaluate the effect of 3 different exercise approaches on headache in chronic WAD grades 2 and 3, and to identify potential factors associated with such headache, and whether they differ depending on 3 different aspects of such headache (current headache, maximum headache, or headache bothersomeness).

METHODS

This was an analysis of a randomized clinical trial of people with chronic WAD and headache (n = 188), who were randomized to either 12 weeks of neck-specific exercise without (NSE) or with a behavioral approach (NSEB) or physical activity prescription (PPA). Data were collected at baseline and at 3, 6, and 12 months. Physical and psychosocial factors were tested for association with headache. Multivariate regression models and linear mixed models were used.

RESULTS

The NSE/NSEB groups reported reduced headache both over time and compared to PPA. Up to 51% (NSE) and 61% (NSEB) reported at least 50% reduction in their headache at 12 months. The PPA group was not improved over time. Neck pain and dizziness were associated with headache regardless of aspect of headache. The only associated psychosocial factor was anxiety, which was associated with headache bothersomeness. Other factors were mainly physical, and up to 51% of the variance was explained.

CONCLUSION

Headache in chronic WAD, may be reduced with neck-specific exercise with or without a behavioral approach. Chronic headache was associated with neck pain and dizziness regardless of aspect tested. Other factors associated with headache in chronic WAD were mainly physical rather than psychosocial.

TRIAL REGISTRATION NUMBER

Clinical Trials.gov, no: NCT015285.

Acute and chronic pain in orofacial trauma patients

Trauma or injury to the dentition and supporting tissues is associated with pain and discomfort, as expected, that may present immediately, shortly afterwards, or within a few days. Pain is an essential response to injury because it allows the organism to develop avoidance behavior to potential threats and helps the organism to avoid usage of the injured organ during the healing process. Not only does external trauma induce pain, but also essential invasive dental procedures such as extractions, dental implant insertions, root canal treatments, and oral surgeries are accompanied by similar post-surgical (post-traumatic) pain. The pain intensity after trauma varies and does not always correlate with the extent of injury. Trauma to the orofacial region or the teeth may also indirectly affect and induce pain in other orofacial structures such as the masticatory muscles, the temporomandibular joint, and even the cervical spine. In most cases, the pain will resolve as soon as healing of the affected tissue occurs or after dental and routine palliative treatment. In a limited number of cases, the pain persists beyond healing and evolves into a chronic pain state. Chronic pain in the orofacial region presents diagnostic and management challenges. Misdiagnosis or delayed diagnosis of the oral chronic pain condition may lead to unnecessary dental treatment. This article will discuss diagnosis and treatment for acute and chronic pain as well as potential mechanisms involved in the undesirable transition from acute to chronic pain.

Sex-related differences in symptoms of temporomandibular disorders and structural changes in the lateral pterygoid muscle after whiplash injury

Whiplash injury is an initiating or aggravating factor of temporomandibular disorder (TMD). Although there are sex-related differences in the mechanism of pain perception and pain control, there is a lack of research on differences in TMD after whiplash injury. We aimed to evaluate sex-related differences in the clinical symptoms and magnetic resonance imaging (MRI) findings of patients with TMD attributed to whiplash injury. This retrospective, cross-sectional study included 100 patients (50 women; 50 men; mean age, 37.60 years) who visited our oro-facial pain clinic with symptoms of TMD after whiplash injury. All patients underwent detailed evaluations for history of trauma, and their clinical and MRI findings were comprehensively assessed. Women with TMD after whiplash injury perceived more pain and presented more tenderness upon palpation than did men with TMD. In addition, women showed higher volume (58% vs 26%) and signal changes (54% vs 20%) in the lateral pterygoid muscle (LPM) and more anterior disc displacement without reduction (ADDWoR) (40% vs 20%) than did men. The presence of ADDWoR (odds ratio, 10.58; P = 0.007) and condylar degeneration (odds ratio, 9.30; P = 0.015) predicted LPM volume; stressful conditions (beta = 1.34; P = 0.011) correlated with increased visual analogue scale scores, and sleep problem was associated with an increased palpation index (PI) (beta = 0.42; P < 0.001) and neck PI (beta = 0.49; P < 0.001) scores only in women. Our results showed sex-specific differences in pain intensity, distribution of clinical and abnormal MRI findings, and their relationships, and these differences should be considered when treating patients with TMD.

Patients' experiences of therapeutic jaw exercises in the treatment of masticatory myofascial pain-A postal questionnaire study

BACKGROUND

The most common non-dental pain in the orofacial region is pain associated with temporomandibular disorders (TMD), and jaw exercises are a common treatment in these cases. Since masticatory myofascial pain has components of an affective and cognitive nature, knowledge about the patients' experiences of the condition and treatment is important.

OBJECTIVE

The aim was to study the patients' experiences of jaw exercises in the treatment of masticatory myofascial pain.

METHODS

A questionnaire, containing 24 statements that should be answered according to a five-item verbal Likert scale, was sent to 150 consecutive patients with masticatory myofascial pain according to the Research Diagnostic Criteria for TMD after they had been treated with jaw exercises for 3-12 months.

RESULTS

The response rate was 73% (n = 109), and 79% of the responders were women. 71% of the patients reported that it was easier to remember the jaw exercises if they put them in conjunction with an already established routine. Before examination, 49% of the patients suspected serious disease behind their symptoms, but these concerns were greatly relieved by the information provided. As a result, 78% reported that information about the underlying cause of their symptoms made them more involved in the treatment. Finally, 72% of the respondents reported that the jaw exercises were effective in reducing their symptoms.

CONCLUSIONS

Information about the cause of the symptoms and the treatment is important to reassure and make the patient involved in the treatment. Most patients report that jaw exercises are an effective treatment and they appreciated to have tools to tackle the problems themselves if the symptoms should return.

Central Sensitization Is Modulated Following Trigger Point Anesthetization in Patients with Chronic Pain from Whiplash Trauma. A Double-Blind, Placebo-Controlled, Crossover Study

Objective

Central sensitization (CS) with low peripheral pain thresholds (PPTs) is a common finding among patients with chronic pain after whiplash (CPWI). While it has been proposed that myofascial myofascial trigger points (MTrPs) may act as modulators of central sensitization, previously reported findings are conflicting and inconclusive. The present study was designed to investigate immediate responsiveness of CS to alterations in nociceptive input.

Design

Controlled, double-blind, cross-over.

Subjects

Thirty-one patients with chronic pain (trapezius myalgia) and CS after whiplash.

Methods

Participants were referred by randomization to group A for injection of a single peripheral pain generator (MTrP or other discrete tender point) with local anesthetic or to group B for sham injection and cross-over. Documentation of PPT (Algometer), maximum jaw opening (caliper), and grip strength (Vigorimeter), as well as subjective overall pain (visual analog scale [VAS]), was made before and after each intervention.

Results

Statistical analysis of data (Student's t test, analysis of variance) confirmed that peripheral pain thresholds were significantly higher and maximum jaw opening significantly greater after anesthetizing a focal pain generator in the trapezius, but not after a sham injection. In contrast with the objective variables, subjective generalized pain improved (VAS) after not only an injection of local anesthetic, but also, and to a similar extent, after a sham injection.

Conclusions

CS, as expressed by lowered PPT, is a rapidly adjusting physiological response to nociceptive stimuli in some patients with chronic pain after whiplash. PPT are likely modulated by myofascial tender points in selected patients with CS. With reference to the present findings, surgical ablation of MTrPs is discussed as a potential treatment modality for CS.

Impact of Temporomandibular Disorders and Sleep Bruxism on Oral Health-Related Quality of Life of Individuals With Complete Cleft Lip and Palate

The temporomandibular disorders (TMDs) and sleep bruxism (SB) affect the quality of life (QoL) of the individuals in general. However, the literature lacks studies on individuals with cleft lip and palate (CLP). Thus, this study aimed to evaluate the impact of TMD and SB on the oral health-related quality of life (OHRQoL) of individuals with CLP. Thirty-six individuals, both genders, aged between 30 and 50 years, at routine treatment in the Dental Prosthesis Sector of Hospital for Rehabilitation of Craniofacial Anomalies-University of São Paulo were selected and divided into the following groups: G1-unilateral complete CLP (n = 22) and G2-bilateral complete CLP (n = 14). Three questionnaires were applied: Oral Health Impact Profile (OHIP-14), SB self-report and Research Diagnosis Criteria for TMD. Fisher test, Mann-Whitney test, and t test were applied to verify values between TMD, SB, gender, and OHIP-14 (P < 0.05). The mean OHIP-14 score was of 5.80, and females had higher (8.58) OHRQoL than males (3.31). There was association with gender and OHRQoL (t test, P = 0.006), TMD with OHRQoL (Mann-Whitney test, P = 0.036), and TMD and SB (Fisher test, P = 0.006). Temporomandibular disorder was diagnosed in 30% of the individuals. Of these, 16.66% did not present SB, while 13.88% presented it. The association TMD versus SB showed statistically significant differences and 83.33% of the individuals reporting SB also had TMD. Based on this study, the authors can conclude that: TMD impacts OHRQoL in CLP patients, females are more affected in their OHRQoL than males, SB was strongly associated with TMD.

Association of risk factors with temporomandibular disorders in the Northern Finland Birth Cohort 1966

OBJECTIVE

To investigate the association between risk factors and pain-related symptoms and clinical signs of temporomandibular disorders (TMD) in Northern Finland Birth Cohort (NFBC) 1966.

MATERIAL AND METHODS

A total of 1962 subjects (1050 women, 912 men) attended the follow-up study. The questionnaires included the subjects' background information concerning living conditions and general health, socioeconomic factors, and dental health. The clinical examination was performed using the modified protocol of Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) presented at the International Association for Dental Research (IADR) Conference in 2010. Cross-tabulation, a chi-square test and Fisher's exact test were used to analyze differences between groups.

RESULTS

Female gender showed statistically significant association with symptoms and signs of TMD, while marital status, living conditions, and socioeconomic group showed no association. A strong association was found between self-reported health condition as well as general health problems [i.e. depression, migraine, fibromyalgia (FM), gastrointestinal diseases] and TMD pain-related symptoms and pain on palpation in the masticatory muscles and TMJs.

CONCLUSION

In conclusion, general health problems and female gender had a strong association with pain-related symptoms and clinical signs of TMD. These findings are important to take into account when diagnosing and treating TMD patients. Conversely to earlier presented results, no statistically significant association was shown here between marital status, living conditions or socioeconomic group and pain-related symptoms and clinical signs of TMD.

Scoping review of systematic review abstracts about temporomandibular disorders: Comparison of search years 2004 and 2017

INTRODUCTION

The purposes of this study were to determine how many systematic reviews and meta-analyses relating to temporomandibular disorders (TMDs) had been published as of 2017 compared with those published as of 2004 and then to summarize the findings, based on an analysis of the abstracts from those studies.

METHODS

A PubMed search was initiated on May 1, 2017. There were 2 separate searches. The first search was for the topic, "temporomandibular disorders." The second search was for "temporomandibular disorders and published in the Cochrane database." The number and the topic category of reviews for 2017 were compared with those published as of 2004.

RESULTS

There were 120 relevant TMD systematic reviews found in search year 2017: 110 from the PubMed and 10 from the Cochrane searches. By comparison, there were only 8 TMD systematic reviews published in 2004. The abstracts for all 120 reviews indicated increased roles of genetics and psychosocial factors in the etiology of TMD. The future of TMD diagnoses appears to be toward various psychosocial and cellular tests, along with brain neuroimaging. The reviews on the topic of "treatment" supported conservative, noninvasive, reversible therapies, with a trend toward more targeted individual strategies.

CONCLUSIONS

There were only 8 TMD systematic reviews published in 2004 compared with 110 in 2017. Overall, the trend has been in the direction of better diagnostic procedures, more scientific concepts of etiology, and more conservative treatments for TMD.

Magnetic Resonance Imaging-Based Prediction of the Relationship between Whiplash Injury and Temporomandibular Disorders

Purpose

Whiplash injury can cause internal derangement of the temporomandibular joint (TMJ) and lead to temporomandibular disorders (TMDs). Our aim was to evaluate whether the initial clinical findings in TMD patients with whiplash injury are correlated with their magnetic resonance imaging (MRI) characteristics.

Materials and methods

This case–control study involved 219 patients (135 women, 84 men; mean age: 37.84 years) who visited our orofacial pain clinic with TMD; TMD was diagnosed using the diagnostic criteria for TMD Axis I. Patients were categorized into three groups based on the presence and type of macrotrauma: in the “wTMD” group, patients had suffered whiplash injury; patients in the “pTMD” group had post-traumatic TMD; the “iTMD” group comprised patients who had presented with TMD symptoms and had sustained no macrotrauma. We investigated the presence of disk displacement, effusion, disk deformity, and condylar degeneration, and changes in the lateral pterygoid muscle (LPM). To evaluate the severity of TMD pain and objectively analyze symptoms, we used a visual analog scale (VAS), palpation index (PI), neck PI, dysfunction index, and craniomandibular index (CMI).

Results

The VAS scores, and the severity indexes of the TMD including PI, neck PI, and CMI were highest in the wTMD patients. Atrophy of the LPM was most commonly seen in the wTMD group, as was disk deformity. In wTMD patients only, VAS score was significantly correlated with stress; it was correlated with headache in wTMD and iTMD patients. The clinical symptoms of TMD were not correlated with MRI findings in the wTMD group. However, alterations in the LPM were strongly correlated with disk displacement.

Conclusion

If clinicians recognize alterations in the LPM and disk displacement in the TMJ, they will better understand the clinical symptoms and pathophysiology of TMD with whiplash injury. Whiplash injury may lead to TMD via different mechanisms from other macrotraumas.

Efficacy of Low-Level Laser Therapy in Subjective Tinnitus Patients with Temporomandibular Disorders

OBJECTIVE AND BACKGROUND

Tinnitus is an apparent sound, perceived in the ear with no stimulus. It has been described as a sound originating from the brain. It affects 17% of the general population. Etiological factors for tinnitus include temporomandibular joint disorders (TMJ, TMD) and Costen's syndrome. The aim of treatment is to eliminate the tinnitus or at least decrease its apparent volume.

MATERIALS AND METHODS

In total, 46 patients referred to our department with bilateral subjective tinnitus with TMDs were selected for this study. Low-level laser therapy (LLLT) with an neodymium-doped yttrium aluminum garnet (Nd:YAG) (1064 nm) laser, LLLT with a diode laser (810 nm), and placebo treatment were applied to the patients. There were 15 patients each in the Nd:YAG and placebo groups and 16 patients in the 810 nm diode laser group. LLLT was applied for 10 days, once per day. A visual analog scale (VAS) was used, with values between 0 and 10. VAS scores were recorded before treatment, on the last day of treatment, and 1 month after treatment. The VAS scores were the same on the last day of treatment and 1 month after treatment. The VAS scores before treatment and at 1 month after treatment were compared in a statistical analysis.

RESULTS

There were statistically significant differences in the Nd:YAG laser (p = 0.001) and 810 nm diode laser groups (p = 0.005), but no difference in the placebo group (p = 0.065).

CONCLUSIONS

Both the Nd:YAG and 810 nm diode lasers were effective for the treatment of subjective tinnitus related to TMDs.

Vertical Craniofacial Morphology and its Relation to Temporomandibular Disorders

Objectives

This study investigated the association between craniofacial morphology and temporomandibular disorders in adults. The influence of different craniofacial morphologies on painful temporomandibular disorders was also evaluated.

Material and Methods

A total of 200 subjects were selected, including 100 with temporomandibular disorders (TMD) and 100 without TMD (control), diagnosed by research diagnostic criteria for temporomandibular disorders. All subjects were submitted to lateral cephalometric radiographs, and classified as brachyfacial, mesofacial, or dolichofacial by Ricketts’ analysis. Data were analysed by Tukey-Kramer and Chi-square tests.

Results

No association between craniofacial morphology and TMD was found (P = 0.6622). However, brachyfacial morphology influences the presence of painful TMD (P = 0.0077).

Conclusions

Craniofacial morphology is not related to temporomandibular disorders in general.

Pain and Disability in the Jaw and Neck Region following Whiplash Trauma

The relationship between whiplash trauma and chronic orofacial pain is unclear, especially with regard to the time elapsed from trauma to development of orofacial pain. The aim was to analyze prevalence of jaw pain and disability, as well as the relationship between pain and disability in the jaw and neck regions in the early nonchronic stage after whiplash trauma. In this case-control study, 70 individuals (40 women, 30 men, mean age 35.5 y) who visited an emergency department with neck pain following a car accident were examined within 3 wk of trauma (group 1) and compared with 70 individuals (42 women, 28 men, mean age 33.8 y), who declined to attend a clinical examination but agreed to fill in questionnaires (group 2). The 2 case groups were compared with a matched control group of 70 individuals (42 women, 28 men, mean age 37.6 y) without a history of neck trauma. All participants completed questionnaires regarding jaw pain and dysfunction, rating pain intensity in jaw and neck regions on the Numerical Rating Scale, the Neck Disability Index, and Jaw Disability Checklist. Compared with controls, individuals with a recent whiplash trauma reported more jaw pain and dysfunction. Furthermore, there was a moderate positive correlation between jaw and neck pain ratings for group 1 (r = 0.61, P < 0.0001) and group 2 (r = 0.59, P < 0.0001). In the logistic regression analysis, cases showed higher odds ratios (range, 6.1 to 40.8) for jaw and neck pain and disability compared with controls. Taken together, the results show that individuals with a recent whiplash trauma report more jaw pain and disability compared with controls without a history of neck trauma. Furthermore, the correlation between jaw and neck pain intensity implies that intensity of neck pain in the acute stage after whiplash trauma might be a possible risk factor also for development of chronic orofacial pain.

Association of temporomandibular disorder with occupational visual display terminal use

Increased visual display terminal (VDT) use has raised the prevalence of VDT-related adverse conditions, such as dry eye disease, and musculoskeletal and psychopathological symptoms, in office workers, including temporomandibular disorder (TMD). Many factors contributing to TMD have been identified, such as parafunctional habit (bruxism and teeth clenching), trauma, mental disorders, lifestyle, poor health, and nutrition, as well as hormonal factors (i.e., estrogen). It is likely that various contributing factors overlap in TMD development in individuals who routinely use a VDT for work. However, the relationship between TMD and VDT use has not been fully elucidated. In this mini-review, findings of recent studies of TMD in relation to occupational VDT use in Japan are discussed, as well as characteristic features and prevention strategies.

Treatment of chronic canalithiasis can be beneficial for patients with vertigo/dizziness and chronic musculoskeletal pain, including whiplash related pain

Background and aim Chronic musculoskeletal pain, e.g. whiplash associated disorders (WAD), fibromyalgia and myalgia, causes significant burden on both the individual and on society as a whole. In a previous study, the authors concluded that there is a likely connection between chronic benign paroxysmal positional vertigo (BPPV)/canalithiasis and headache, neck pain, generalized pain, fatigue, cognitive dysfunctions as well as tinnitus. The balance dysfunction in BPPV/canalithiasis is dynamic and not static. This leads to a perpetual postural mismatch. The vicious cycle of a disturbed equilibrium control system may be the driving force behind the vicious cycle of pain. The aim of this study is to investigate if otolith-repositioning manoeuvres in patients with chronic BPPV/canalithiasis can be beneficial. Methods During a period of about two years a prospective observational study on patients with chronic musculoskeletal pain referred for physiotherapy was performed. Those with a Dizziness Handicap Inventory (DHI) inquiry score above 20 underwent further investigations to diagnose chronic BPPV/canalithiasis. Diagnostic criteria: (A) The diagnosis of BPPV/canalithiasis was confirmed with the following: (1) specific history of vertigo or dizziness provoked by acceleration/deceleration, AND (2) nystagmus and symptoms during at least one of the test positions; (B) the disorder had persisted for at least one year. Specific otolith repositioning manoeuvre for each semi-circular canal (SCC) was performed. Symptom questionnaire ("yes" or "no" answers during a personal interview) and a follow-up questionnaire were used. Results The responders of the follow-up questionnaire constituted the study group. Thirty-nine patients responded (i.e. 87%) (31 females, 8 males) with a median age of 44 years (17-65). The median duration of the disease was5 years. Seventy-nine percent had ahistory ofhead or neck trauma. The DHI median score was 48 points (score >60 indicates a risk of fall). The video-oculography confirmed BPPV/canalithiasis in more than one semi-circular canal in all patients. In the present study the frequency of affected anterior semi-circular canal (SSC) was at a minimum of 26% and could be as high as 65%. Ninety-five percent suffered from headache, 92% from neck pain, 54% had generalized pain, and 56% had temporo-mandibular joint region pain. Fatigue (97%), aggravation by physical exertion (87%), decreased ability to concentrate (85%) aswellas visual disturbances (85%) were the most frequently reported symptoms, and 49% suffered from tinnitus. The median number of otolith repositioning manoeuvres done was six (2-29). Median time span between finishing otolith repositioning manoeuvres and answering the questionnaire was 7 months. Effects of treatment and conclusion The present study has shown that repositioning of otoliths in the SCCs in nearly all patients with chronic BPPV/canalithiasis ameliorated pain and other symptoms. The correlation between vertigo/dizziness and the majority of symptoms was significant. Therefore, there is strong evidence to suggest that there is a connection between chronic BPPV/canalithiasis and chronic pain as well as the above-mentioned symptoms. Implications Patients with unexplained pain conditions should be evaluated withthe Dizziness Handicap Inventory-questionnaire, which can identify treatable balance disorders.

Chronic whiplash pain

Although most patients recover from acute whiplash injuries, those with chronic whiplash syndrome develop signs of central nervous system (CNS) amplification of pain and have a poor prognosis. In this context, specific pain generators from acute whiplash have been identified through clinical, biomechanical, and animal studies. This article gives a clinical perspective on current understanding of these pain generators, including the phenomenon of CNS sensitization.

The association between temporomandibular disorders and joint hypermobility syndrome: a nationwide population-based study

OBJECTIVES

This study aims to investigate the risk factors of temporomandibular disorders (TMDs), including disc or non-disc-related disorders, and joint hypermobility syndrome (JHS) retrospectively and to analyze the factors by estimating the magnitude of the association between the two conditions using a nationwide population-based dataset.

MATERIALS AND METHODS

A total of 975,788 eligible patients' de-identified data were obtained from a representative database composed of one million of Taiwan's population since 2004 to 2008. All associated factors, such as gender, age, facial trauma, and psychosis, which correlated with TMDs and JHS were examined. Multiple logistic regression modeling adjusted for confounding variables to determine the odds ratio of variables that made an important contribution to TMDs and JHS.

RESULTS

For all TMDs patients, only 1.47% patients had disc-related disorders. For all JHS patients, only 3.85% patients are diagnosed with concomitant TMDs. Statistically significant association was observed between joint hypermobility and TMDs. Furthermore, the prevalence of JHS patients shows significant difference within TMD subgroups, in which 9.52% of JHS patients have disc disorders and 90.48% of JHS patients do not. All associated factors, such as gender, age, JHS, facial trauma, and psychosis, had a significant impact on the TMDs. Interestingly, patients with TMJ articular disc disorders are 6.7 times more likely to be diagnosed with JHS compared to patients without disc-related disorders.

CONCLUSIONS

Our results confirm that there is a significant positive association between TMDs and JHS, highlighting that patients with disc-related TMDs are more likely to experience JHS than patients with TMDs without disc disorders.

CLINICAL RELEVANCE

Individuals with TMD associated with JHS should be carefully evaluated by inter-disciplinary specialists as these factors may eventually have impact on the prognosis of TMDs and JHS.