Current diagnosis of temporomandibular pathologies

Orofacial Pain and Dentistry Management: Guidelines for a More Comprehensive Evidence-Based Approach

Orofacial pain represents one of the most common health problems that negatively affects the activities of daily living. However, the mechanisms underlying these conditions are still unclear, and their comprehensive management is often lacking. Moreover, even if pain is a common symptom in dentistry, differential diagnostic procedures are needed to exclude other pain origins. Misinterpretation of the pain origin, in fact, can lead to misdiagnosis and to subsequent mismanagement. Pain in the orofacial area is the most common reason for patients to visit the dentist, but this area is complex, and the pain could be associated with the hard and soft tissues of the head, face, oral cavity, or to a dysfunction of the nervous system. Considering that the origins of orofacial pain can be many and varied, a thorough assessment of the situation is necessary to enable the most appropriate diagnostic pathway to be followed to achieve optimal clinical and therapeutic management.

Reconstruction of the TMJ and condyle in inflammatory arthritis

Inflammatory arthritis presents a unique destructive process to the temporomandibular joint. This article provides information on the proper diagnosis, treatment planning, and surgical management aimed to provide patients with improvement in pain, function, stability and facial aesthetics. Additionally, it aims to provide a detailed insight on the joint reconstruction options including alloplastic joint replacement, autogenous joint replacement, orthognathic surgery and distraction osteogenesis.

OROFACIAL PAIN - DIAGNOSTIC AND THERAPEUTIC CHALLENGES

The concept of diagnostics and therapy of musculoskeletal and neuropathic diseases of the stomatognathic system, which are the subject of this paper, has been developing for decades. It can be said that in order to avoid misunderstanding, the orofacial pain as a clinical problem, in the narrower sense, involves non-odontogenic and non-malignant causes of orofacial region. In this study, the results of clinical diagnosis of the population of 557 consecutive patients with orofacial pain based on multidisciplinary diagnostics were evaluated. 15.6% of patients have given up on the participation in the study. It has been shown that the patients who dropped out of the study were significantly older (p=0.0411) than those who agreed to participate, but there was no difference in gender ratio (p=0.185) since the proportion of female patients prevailed. In an analysis of 84.4% of patients participating in the study, the elevated anxiety values were established (mean value on STAI 1 was 39.2 and STAI 2 was 41.1) and statistical significance was found in correlation between elevated anxiety and intensity of pain as shown on visual analogue scale on open mouth (p<0.0001). Compared to the age, the statistical significance was for STAI 1 (p=0.0097) but not for STAI 2 (p=0.5599). The most common form of therapy is Michigan stabilization splint: for disc displacement of temporomandibular joint (TMJ) in 38.9% of patients and in combination with physiotherapy in 18.7% of patients; for osteoarthritis of TMJ in 28.4% and in combination with physiotherapy in 26.4% of patients. The treatment with anticonvulsant drugs for trigeminal neuralgia predominates in 54.3% of patients, which is combined with acupuncture in 25.7% of patients and only acupuncture in 17.1% of patients. In this study, a multidisciplinary co-operation in initial diagnostics and differential was designed to develop subspecialist knowledge on orofacial pain.

Non-invasive joint decompression: An important factor in the regeneration of the bone marrow and disc recapture in temporomandibular arthropathies

BACKGROUND

This article aims to demonstrate the importance of the TMJ (Temporomandibular Joint) decompression in the treatment of degenerative processes and disc displacements, reporting two clinical cases treated with orthopedic and decompressive correction of TMJ.

MATERIAL AND METHODS

The studies reported in this article show patients with muscle and joint pain who were evaluated pre and post-treatment through MRI (Magnetic Resonance Irradiation) to follow-up bone marrow regeneration and TMJ disc placement. Transcutaneous electrical stimulation (TENS), measurement equipment and IO (Intraoral Orthotic) were used to evaluate and treat the patients. A critical review of literature has also been conducted to confront clinical outcomes.

RESULTS

Marrow bone regeneration and disc placement were observed in both patients.

CONCLUSIONS

The use of measurement equipment associated with TENS to find the correct rest position of the Jaw an the use of IO to decompress the TMJ was an effective way to promote bone marrow regeneration and disc placement, consequently improving function and quality of life.

Fracture of the articular disc in the temporomandibular joint: two case reports

Disc fracture of the temporomandibular joint (TMJ) is a little-known pathological condition owing to its extreme rarity. We report two cases of elderly patients who were diagnosed with disc fracture of the TMJ based on MRI, and we review related reports. On physical examination, an incomplete bite and mild joint pain were observed on the affected side in both patients. An MRI showed a complete fracture in the intermediate zone of the articular disc in the TMJ; the posterior fragment was displaced posteriorly, causing occlusal change in the closed position of the condyle and an incomplete bite. Conservative treatment including manual manipulation, physical therapy and oral appliance had no effect on the occlusal abnormality. Although the inciting cause of the disc fracture remained unclear, the degenerative changes in the joint may have been a factor by increasing the brittleness and reducing the elasticity of the disc.

Modern dental imaging: a review of the current technology and clinical applications in dental practice

A review of modern imaging techniques commonly used in dental practice and their clinical applications is presented. The current dental examinations consist of intraoral imaging with digital indirect and direct receptors, while extraoral imaging is divided into traditional tomographic/panoramic imaging and the more recently introduced cone beam computed tomography. Applications, limitations and current trends of these dental "in-office" radiographic techniques are discussed.