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Pain Management and Rehabilitation for Central Sensitization in Temporomandibular Disorders: A Comprehensive Review. Int J Mol Sci 2022; 23:ijms232012164. [PMID: 36293017 PMCID: PMC9602546 DOI: 10.3390/ijms232012164] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/07/2022] [Accepted: 10/09/2022] [Indexed: 11/24/2022] Open
Abstract
Temporomandibular disorders (TMD) are a group of musculoskeletal diseases affecting masticatory muscles and temporomandibular joints (TMJ). In this context, the chronic TMD could be considered as a condition with chronic primary orofacial pain, presenting as myofascial TMD pain or TMJ arthralgia. In this context, myogenous TMD may present overlapping features with other disorders, such as fibromyalgia and primary headaches, characterized by chronic primary pain related to dysfunction of the central nervous system (CNS), probably through the central sensitization. This phenomenon could be defined as an amplified response of the CNS to sensory stimuli and peripheral nociceptive, characterized by hyperexcitability in the dorsal horn neurons in the spinal cord, which ascend through the spinothalamic tract. The main objectives of the management of TMD patients are: decreasing pain, increasing TMJ function, and reducing the reflex masticatory muscle spasm/pain. The first-line treatments are physical therapy, pharmacological drugs, occlusal splints, laser therapy, extracorporeal shockwave therapy, transcutaneous electrical nerve stimulation, and oxygen–ozone therapy. Although all these therapeutic approaches were shown to have a positive impact on the central sensitization of TMD pain, there is still no agreement on this topic in the scientific literature. Thus, in this comprehensive review, we aimed at evaluating the evidence on pain management and rehabilitation for the central sensitization in TMD patients.
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Wadhokar OC, Patil DS. Current Trends in the Management of Temporomandibular Joint Dysfunction: A Review. Cureus 2022; 14:e29314. [PMID: 36277551 PMCID: PMC9579904 DOI: 10.7759/cureus.29314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/15/2022] [Indexed: 11/09/2022] Open
Abstract
The temporomandibular joint (TMJ) is a synovial bi-condylar joint with 3 degrees of freedom. One-third of the adult population reportedly suffers from temporomandibular joint dysfunction (TMD). Females are more commonly affected than males. Almost 50% of TMD patients do not require any intervention, and the symptoms are self-limiting within one year after the onset; however, 75-80% of adults suffering from TMD require medical intervention and it takes up to three years for the complete remission of the symptoms. The clinical features of TMD are clenching, clicking, and locking of the jaw, and occlusion due to faulty posture. Based on the diagnostic criteria for temporomandibular disorder (DC/TMD) criteria proposed in the year 2014, the classification of TMD is done based on axis I and axis II diagnoses. This review aims to provide an overview of TMD and examine available treatment strategies for TMD. Various conservative treatment methods have been proven to be effective, including self-care strategies, dental treatment strategies, pharmacological treatment, physical therapy modalities, manual mobilization, electrotherapy and dry needling, relaxation techniques, intra-articular injections, cognitive behavioral therapy, and surgical corrections.
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Aboalnaga AA, Amer NM, Alhammadi MS, Fayed MMS. Positional and dimensional TMJ characteristics in different temporomandibular disorders: A cross-sectional comparative study. Cranio 2022:1-9. [PMID: 35061575 DOI: 10.1080/08869634.2022.2028115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate the morphological and positional temporomandibular joint (TMJ) characteristics of different temporomandibular disorders (TMDs). METHODS One hundred forty-three TMD patients were divided into three groups: Group 1: Myalgia (M), Group 2: Disc displacement with reduction (DDWR), and Group 3: Disc displacement without reduction (DDWOR). Three-dimensional positional and dimensional parameters of the TMJ, including mandibular fossa, condyle, and TMJ spaces were evaluated using cone beam computed tomography (CBCT). The significance level was p < 0.05. RESULTS Mandibular condyles were significantly positioned in more vertical, posterior, and medial directions, with the reduced condylar width in the DD groups (p < 0.001). Anterior joint space was significantly higher in the DDWR group than the myalgia group; the superior joint spaces were more reduced in DD groups than the myalgia group. CONCLUSION Patients diagnosed with disc displacement showed significantly different condylar positions and joint spaces compared to the myalgia group in a skeletally comparable sample.
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Affiliation(s)
- Amira A Aboalnaga
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Nehal M Amer
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Maged S Alhammadi
- Orthodontics and Dentofacial Orthopedics, Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Mona M Salah Fayed
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Cairo University, Cairo, Egypt
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Zagalaz-Anula N, Sánchez-Torrelo CM, Acebal-Blanco F, Alonso-Royo R, Ibáñez-Vera AJ, Obrero-Gaitán E, Rodríguez-Almagro D, Lomas-Vega R. The Short Form of the Fonseca Anamnestic Index for the Screening of Temporomandibular Disorders: Validity and Reliability in a Spanish-Speaking Population. J Clin Med 2021; 10:jcm10245858. [PMID: 34945153 PMCID: PMC8709097 DOI: 10.3390/jcm10245858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 11/24/2022] Open
Abstract
The Short Form of the Fonseca Anamnestic Index (SFAI) is a simple and quick questionnaire used for screening temporomandibular disorders (TMDs). The present study aimed to validate the Spanish version of the SFAI in patients with TMDs. The study sample comprised 112 subjects (50 TMDs and 52 controls). Test–retest reliability, factorial validity, internal consistency, concurrent validity, and the SFAI’s ability to discriminate between TMDs subjects and healthy controls were analyzed using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD protocol) as the reference. Factor analysis showed a single factor that explained 63% of the total variance. Cronbach’s alpha was 0.849. The reliability of the items measured with the Kappa index showed values from 0.767 to 0.888. Test–retest reliability was substantial (intraclass correlation coefficient = 0.837). The total SFAI score showed a significant correlation with orofacial pain, vertigo, and neck disability measurements. For a cut-off point of >10 points, the SFAI showed a sensitivity of 78% and specificity of 78.85% at differentiating between TMDs patients and healthy subjects, with an area under the curve (AUC) of 0.852. The Spanish version of the SFAI is a valid and reliable instrument for diagnosing people with TMDs and shows generally good psychometric properties.
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Affiliation(s)
- Noelia Zagalaz-Anula
- Department of Health Sciences, Campus Las Lagunillas, University of Jaén, 23071 Jaén, Spain; (N.Z.-A.); (E.O.-G.); (R.L.-V.)
| | | | | | - Roger Alonso-Royo
- FisioMedic Clinic, 41701 Dos Hermanas, Spain; (C.M.S.-T.); (R.A.-R.)
| | - Alfonso Javier Ibáñez-Vera
- Department of Health Sciences, Campus Las Lagunillas, University of Jaén, 23071 Jaén, Spain; (N.Z.-A.); (E.O.-G.); (R.L.-V.)
- Correspondence:
| | - Esteban Obrero-Gaitán
- Department of Health Sciences, Campus Las Lagunillas, University of Jaén, 23071 Jaén, Spain; (N.Z.-A.); (E.O.-G.); (R.L.-V.)
| | | | - Rafael Lomas-Vega
- Department of Health Sciences, Campus Las Lagunillas, University of Jaén, 23071 Jaén, Spain; (N.Z.-A.); (E.O.-G.); (R.L.-V.)
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Losert-Bruggner B, Hülse M, Hülse R. Muskuloskeletale Erkrankungen und die kraniomandibuläre Dysfunktion – eine mögliche Ursache für nichterholsamen Schlaf. MANUELLE MEDIZIN 2021. [DOI: 10.1007/s00337-021-00794-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Zusammenfassung
Methode
Kiefer- und Kopfgelenke bilden eine kybernetische Einheit. Ziel dieser Studie ist es, mögliche Zusammenhänge zwischen schlechtem Schlaf und der kraniozervikalen (CCD) bzw. kraniomandibulären Dysfunktion (CMD) zu ermitteln.
Ergebnisse
Von den 606 untersuchten CMD-CCD-Patienten mit schlechtem Schlaf waren 65,4 % der Patienten weiblich, 34,6 % männlich; 90,3 % erfüllten zusätzlich die diagnostischen Kriterien des Fibromyalgiesyndroms der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften. Durch die synchrone Therapie der CMD bzw. CCD und der funktionellen Wirbelsäulenstörungen konnten bei 85 % der bislang therapieresistenten CMD-CCD-Patienten mit schlechtem Schlaf eine gute Besserung der Beschwerden im Körper und bei 81,5 % eine gute Schlafbesserung erzielt werden.
Diskussion
Die CMD/CCD kann als Folge chronischer Schmerzen auftreten. Umgekehrt kann eine CMD/CCD auch eine muskuloskeletale Störung hervorrufen oder unterhalten. Chronische Schmerzen können den Schlaf stören. Bei der Diagnose und Behandlung von Schlafstörungen muss auch auf eine CMD/CCD hin untersucht und diese ggf. mitbehandelt werden.
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Anandkumar S, Manivasagam M. Physical therapist guided active intervention of chronic temporomandibular disorder presenting as ear pain: A case report. Physiother Theory Pract 2021; 38:3146-3158. [PMID: 34152897 DOI: 10.1080/09593985.2021.1938307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This case report describes the successful physical therapy management of a 40-year-old female who presented with left ear pain referred from the temporomandibular joint. Diagnosis was primarily based on clinical examination findings and ruling out of red flags. Guidance was given on active self-care approaches consisting of pain neuroscience education designed with individualized pain curriculum, exercise therapy, manual therapy, and breathing exercises for a period of sixweeks. Clinically meaningful improvements were obtained in the outcome measures of Numeric Pain Rating Scale (NPRS), Patient-Specific Functional Scale (PSFS), and Global Rating of Change (GROC) scale and progress in Pain-Self Efficacy Questionnaire (PSEQ) and Tampa Scale for Kinesiophobia (TSK) scores. Positive changes were achieved with functional activities (chewing, eating, yawing, brushing teeth and physical intimacy), and the patient was pain-free on discharge, which was maintained at a six-month follow-up.
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Affiliation(s)
- Sudarshan Anandkumar
- Synergy Rehab Clayton Heights Physiotherapy and Sports Injury Clinic, Surrey, British Columbia, Canada
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7
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The association between specific temporomandibular disorders and cervicogenic headache. Musculoskelet Sci Pract 2021; 52:102321. [PMID: 33482538 DOI: 10.1016/j.msksp.2021.102321] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 12/19/2020] [Accepted: 01/08/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Upper neck signs, symptoms and hypomobility have been shown to present with a higher prevalence in patients with temporomandibular disorders (TMDs). However, there is currently no evidence of an association between specific TMDs and cervicogenic headache (CGH). Therefore, the aim of this study was to evaluate the odds ratio and the relative risk of CGH in patients with specific TMDs. METHOD 116 participants, including 74 patients with TMD (pain-related/intraarticular/mixed TMD) and 42 healthy controls took part in this study. The TMD diagnosis was made by senior faculty members of the Dental School according to the Diagnostic Criteria for TMD, while the cervical diagnosis was made by a qualified senior physical therapist. The analysis comprised the evaluation of the odds ratio of CGH among patients with TMD and the relative risk (RR) for CGH during 14-24 months of follow-up. RESULTS Significantly higher odds ratios of cervicogenic headache were found among pain-related and mixed TMD (12.17 and 10.76, respectively) versus healthy controls. During the 14-24 months of follow-up, there was no significant difference of relative risk for CGH among patients with TMD versus healthy controls. SUMMARY AND CONCLUSIONS The results support a clear clinical association between painful TMD (pain-related and mixed TMD) and cervicogenic headache.
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Figueroba SR, Moreira JC, Amorim KS, Cunha LDLL, Morais TML, Ferreira LEN, Groppo FC. Effect of glucosamine sulphate on the temporomandibular joint of ovariectomised rats. Br J Oral Maxillofac Surg 2020; 59:202-208. [PMID: 33384177 DOI: 10.1016/j.bjoms.2020.08.078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 08/10/2020] [Indexed: 12/26/2022]
Abstract
Glycosamine is an amino-monosaccharide present in connective and cartilage tissues that contribute to the maintenance, resistance, flexibility, and elasticity of these tissues. This study aimed to determine the in vivo effects of glucosamine sulphate (GS) on the temporomandibular joint (TMJ) of ovariectomised rats (OVX).Thirty-two rats were distributed into four groups as follows: G1, sham-OVX+saline solution; G2, sham-OVX+glucosamine sulphate (80mg/kg) - oral administration; G3, OVX+saline solution; G4, OVX+glucosamine sulphate (80mg/kg) - oral administration. Animals were treated for seven days. The TMJ was removed and stained with toluidine blue. The thickness of the cartilage layers and cytokines IL-1β, IL-6, and TNF-α levels were determined by histomorphometry and immunoassay, respectively. The administration of GS to OVX females did not change the thickness of condylar cartilage when compared with the other groups (p>0.05). There was an increase in the total cartilage thickness in sham-OVX females. IL-1β and TNF-α levels were significantly lower in sham-OVX females than in OVX females, indicating that ovariectomy acts as potent cytokine inducer. IL-6 levels were significantly higher in sham-OVX females. GS did not affect cytokine production in OVX females (p>0.05). In conclusion, the administration of GS did not affect cytokine levels, but did induce an increase in the total thickness of the TMJ condylar cartilage in sham-OVX rats.
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Affiliation(s)
- S R Figueroba
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas - UNICAMP - Piracicaba, São Paulo, Brazil.
| | - J C Moreira
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas - UNICAMP - Piracicaba, São Paulo, Brazil.
| | - K S Amorim
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas - UNICAMP - Piracicaba, São Paulo, Brazil.
| | - L D L L Cunha
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas - UNICAMP - Piracicaba, São Paulo, Brazil.
| | - T M L Morais
- Oral Patology, Departament of Oral Diagnosis, Piracicaba Dental School, University of Campinas - UNICAMP - Piracicaba, São Paulo, Brazil.
| | - L E N Ferreira
- Laboratory of Inflammation and Immunology, Guarulhos University - Guarulhos, São Paulo, Brazil.
| | - F C Groppo
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas - UNICAMP - Piracicaba, São Paulo, Brazil.
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9
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Greenbaum T, Dvir Z, Emodi-Perelmam A, Reiter S, Rubin P, Winocur E. Relationship between specific temporomandibular disorders and impaired upper neck performance. Eur J Oral Sci 2020; 128:292-298. [PMID: 32627243 DOI: 10.1111/eos.12718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2020] [Indexed: 11/26/2022]
Abstract
Upper neck impairments are more prevalent in patients with temporomandibular disorders (TMDs) but the differences between specific types of TMDs are unclear. This study evaluated the distribution of such impairments among different forms of TMD. In total, 116 participants (86 women and 30 men, age range 21-75 yr) were investigated. Forty-two individuals had no TMDs and were assigned to the control group. The remaining 74 patients were assigned to one of three groups based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) findings: pain-related (n = 37); intra-articular (n = 17); or mixed (combined pain-related and intra-articular) (n = 20). Analyses of impairments included between-group comparisons of key parameters of upper neck performance (active/passive mobility and muscular capabilities) and pain (subjective neck disability and pain sensitivity). Patients in the pain-related and mixed TMD groups were found to have decreased upper neck mobility in the cervical flexion-rotation test compared with patients in intra-articular and control groups, as well as poorer capabilities of the deep neck flexor muscles in the cranio-cervical flexion test compared to the control group. It was concluded that patients with pain-related TMD diagnoses are more likely to experience significant upper-neck hypomobility and poor muscular capabilities than patients with intra-articular diagnoses of TMD.
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Affiliation(s)
- Tzvika Greenbaum
- The Department of Physical Therapy, Tel Aviv University, Tel Aviv, Israel
| | - Zeevi Dvir
- The Department of Physical Therapy, Tel Aviv University, Tel Aviv, Israel
| | - Alona Emodi-Perelmam
- The School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shoshana Reiter
- The School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pessia Rubin
- The School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ephraim Winocur
- The School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Yap AU, Natu VP. Inter‐relationships between pain‐related temporomandibular disorders, somatic and psychological symptoms in Asian youths. J Oral Rehabil 2020; 47:1077-1083. [DOI: 10.1111/joor.13033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/25/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Adrian Ujin Yap
- Department of Dentistry Ng Teng Fong General HospitalNational University Health System Singapore Singapore
- Faculty of Dentistry National University of Singapore Singapore Singapore
- Duke‐NUS Medical School Singapore Singapore
- National Dental Research Institute SingaporeNational Dental Centre Singapore Singapore
- School of Health ScienceNanyang Polytechnic Singapore Singapore
| | - Vaishali Prakash Natu
- Faculty of Dentistry National University of Singapore Singapore Singapore
- School of Health ScienceNanyang Polytechnic Singapore Singapore
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11
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Thorp JN, Willson J. Thoracic spine manipulation did not improve maximal mouth opening in participants with temporomandibular dysfunction. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 25:e1824. [PMID: 31729114 DOI: 10.1002/pri.1824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/24/2019] [Accepted: 11/01/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Temporomandibular joint disorders (TMD) have a prevalence of more than 5% in the general population. A positive correlation exists between temporomandibular joint mobility and cervical spine mobility. Similarly, a relationship exists between thoracic and cervical spine mobility. However, it is unknown if interventions to improve the mobility of the thoracic spine positively impact temporomandibular joint motion and pain. This study tested the hypothesis that a single thoracic thrust joint manipulation (TJM) would improve maximum mouth opening (MMO) compared with participants without TMD as well as decrease TMD symptoms. METHODS Forty-eight people with TMD (30.9 years old ±11.3) and 55 people without TMD (28.5 years old ±9.2) participated. Both groups received a seated upper thoracic TJM and were measured for MMO before and immediately following the TJM. The duration of TMD symptoms and pre-thrust current pain, using the 11-point Verbal Pain Rating Scale (VPRS), was recorded in the TMD group. Participants in the TMD group were contacted 2-3 days after TJM to report current VPRS and improvement utilizing the Global Rating of Change (GROC) scale. RESULTS No difference in MMO treatment response over time was observed between groups (p = .56). The MMO in the TMD group improved from 40 to 41.3 mm, and the non-TMD similarly improved from 44.5 to 45.4 mm. The VPRS decreased from 2.4 (±1.8) to 1.3 (±1.5) following thoracic TJM (p < .001), and the average GROC score was 1.8 (±2.25), which was statistically different than zero (no change; p < .001). The duration of TMD symptoms prior to TJM was not associated with GROC scores (r = .018, p = .90) or VPRS change scores (r = -.07, p = .64). CONCLUSION The observed treatment effects did not exceed previously reported standards for clinical relevance (5 mm and 2 points, respectively).
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Affiliation(s)
- Jacob N Thorp
- Department of Physical Therapy, East Carolina University, Greenville, NC, USA.,Department of Physical Therapy, Charleston Southern University, Charleston, SC, USA
| | - John Willson
- Department of Physical Therapy, East Carolina University, Greenville, NC, USA
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12
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Dimitroulis G. Management of temporomandibular joint disorders: A surgeon's perspective. Aust Dent J 2019; 63 Suppl 1:S79-S90. [PMID: 29574810 DOI: 10.1111/adj.12593] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Disorders of the Temporomandibular joint (TMJ) may clinically present with jaw pain and restricted mouth opening that may limit a patient's access to comprehensive dental care. The aim of this article is to provide a general overview of the current treatment strategies available in the management of disorders of the TMJ. Both conservative and surgical treatment options will be discussed as there is no one treatment for temporomandibular disorders (TMD) which encompasses a wide range of diagnoses. A multidisciplinary team approach to management is essential in the fundamental care of all TMD patients so that treatment can be specifically tailored to individual patient needs.
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Affiliation(s)
- G Dimitroulis
- Maxillofacial Surgery Unit, Department of Surgery, St.Vincent's Hospital, The University of Melbourne, Melbourne, Vic., Australia
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13
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Ferreira MP, Waisberg CB, Conti PCR, Bevilaqua‐Grossi D. Mobility of the upper cervical spine and muscle performance of the deep flexors in women with temporomandibular disorders. J Oral Rehabil 2019; 46:1177-1184. [DOI: 10.1111/joor.12858] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/18/2019] [Accepted: 06/28/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Michele P. Ferreira
- Department of Healthy Science, Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | - César B. Waisberg
- Department of Prosthodontics, Bauru School of Dentistry University of São Paulo Bauru Brazil
| | - Paulo César R. Conti
- Department of Prosthodontics, Bauru School of Dentistry University of São Paulo Bauru Brazil
| | - Débora Bevilaqua‐Grossi
- Department of Healthy Science, Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
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14
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Balik A, Peker K, Ozdemir-Karatas M. Comparisons of measures that evaluate oral and general health quality of life in patients with temporomandibular disorder and chronic pain. Cranio 2019; 39:310-320. [DOI: 10.1080/08869634.2019.1622869] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Ali Balik
- Department of Prosthodontics, Faculty of Dentistry, Istanbul University, Capa, Istanbul, Turkey
| | - Kadriye Peker
- Department of Dental Public Health, Faculty of Dentistry, Istanbul University, Capa, Istanbul, Turkey
| | - Meltem Ozdemir-Karatas
- Department of Prosthodontics, Faculty of Dentistry, Istanbul University, Capa, Istanbul, Turkey
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15
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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: 112] [Impact Index Per Article: 18.7] [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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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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Ribeiro-Dasilva MC, Fillingim RB, Wallet SM. Estrogen-Induced Monocytic Response Correlates with TMD Pain: A Case Control Study. J Dent Res 2016; 96:285-291. [PMID: 27856968 DOI: 10.1177/0022034516678599] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Temporomandibular disorders (TMD) are a set of conditions characterized by pain and dysfunction in the temporomandibular joint and muscles of mastication. These pain conditions are associated with considerable morbidity, societal costs, and reduced quality of life. The prevalence varies between 4% and 10%, with females at higher risk, and a higher prevalence occurs during reproductive years. The increased prevalence of TMD in females and low prevalence in childhood reinforce that sex hormones, like estrogen, play an important, complex role in the pathophysiology of these disorders. The goal of this study was to determine whether women with TMD exhibit a monocytic hyperinflammatory response compared with control women, and to examine associations of monocytic inflammatory responses with clinical pain. Eighteen women, aged 18 to 35 y, were seen during their follicular menstrual phase. A blood sample was collected, a clinical questionnaire about pain history was administered, and a Research Diagnostic Criteria (RDC) exam was performed. Extracted monocytes were stimulated with the toll-like receptor (TLR)-4 ligand, lipopolysaccharide (LPS), in the presence and absence of estrogen, and the levels of IL6 expression evaluated. Women with TMD showed a systemic hyperinflammatory phenotype, manifested by an increased monocytic release of cytokines after an inflammatory insult, and this was further increased by estrogen. In addition, monocytes from participants who self-reported more pain on the VAS scale produced higher levels of IL6 compared with those from participants who self-reported lower pain sensitivity. These data suggest that an estrogen-induced hyperinflammatory phenotype in women with TMD may at least in part contribute to heightened clinical pain, perhaps via central sensitization.
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Affiliation(s)
- M C Ribeiro-Dasilva
- 1 Department of Restorative Dental Science, University of Florida, Gainesville, FL, USA.,2 Department of Community Density and Behavioral Sciences, University of Florida, Gainesville, FL, USA
| | - R B Fillingim
- 2 Department of Community Density and Behavioral Sciences, University of Florida, Gainesville, FL, USA
| | - S M Wallet
- 3 Department of Oral Biology, University of Florida, Gainesville, FL, USA
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