Static body postural misalignment in individuals with temporomandibular disorders: a systematic review

Diaphragm dysfunction is found in patients with chronic painful temporomandibular disorder: A case-control study

Aim

To determine whether patients with chronic painful temporomandibular disorder (TMD) had abnormal diaphragm function compared to healthy controls and to explore the correlation between diaphragm contractility, psychological status, and pain characteristics.

Methods

A single-blinded, case-control study was conducted involving 23 chronic painful TMD patients and 22 healthy volunteers. The examination and diagnosis were performed according to the Diagnostic Criteria for Temporomandibular Disorders, and questionnaires were used to evaluate pain, depression, anxiety, and physical symptoms status. B-mode ultrasound was used to measure diaphragm thickness and contractility. The sonographer responsible for measuring the diaphragm was blinded to group membership.

Results

1. Depression, anxiety, and physical symptoms scores were significantly higher in the patients than in the controls (p < 0.05). 2. The Interference Score of pain was significantly correlated with depression and physical symptoms (p < 0.01). 3. Bilateral diaphragm contractility was significantly smaller in the patients than in the controls (right: P = 0.003; left: P = 0.001). 3. There was no correlation between diaphragm contractility on the left and right sides in the patients (r = -0.112, P = 0.611), while there was a positive correlation in the control group (r = 0.638, P = 0.001). 4. No correlation was found between the degree of diaphragm contractility, psychological status, and pain scores.

Conclusions

1. Patients with chronic painful TMD have worse psychological status, including depression, anxiety, and physical symptoms. 2. Patients with chronic painful TMD have a smaller degree of bilateral diaphragm contractility and more significant left-right incongruity, which indicated that diaphragm dysfunction may be correlated with chronic painful temporomandibular disorder.

The role of scoliosis on temporomandibular joint disease: a cross-sectional study based on ultrasonography

AIM

To investigate the relationship between temporomandibular disorders (TMD) and the stomatognathic system and spine through a multidisciplinary approach, utilising ultrasound to assess the temporomandibular joint.

MATERIALS AND METHODS

Between October 2020 and January 2021, 50 patients aged 12-18 years with adolescent idiopathic scoliosis and 50 healthy individuals were enrolled. All participants underwent clinical examinations based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) protocol. Additionally, ultrasound evaluations were performed of the temporomandibular joint and masseter muscles. Subsequently, the data from both groups were compared and analysed.

RESULTS

The mean age of participants was 14.69 ± 2.73 years in the scoliosis group (SG) and 14.68 ± 1.81 years in the control group (CG). Among scoliosis patients, a moderate negative correlation was observed between the Cobb angle (indicative of curvature severity) and mouth opening (p=0.023; r=-0.320). Furthermore, the incidence of TMD was significantly higher in the scoliosis group compared to the control group (p<0.001). Additionally, it was found that a 1-unit increase in joint space elastography value led to a 4.81-fold higher likelihood of diagnosing disc displacement with reduction (p=0.009; 95% CI: 1.47-15.73).

CONCLUSION

This pioneering study, the first of its kind to explore the connection between scoliosis and ultrasound-based temporomandibular joint screening, suggests that scoliosis may be a predisposing factor for TMD. Moreover, the present findings underscore the importance of joint elastography as a valuable quantitative tool in TMD diagnosis.

Relationship of temporomandibular joint disorders with cervical posture and hyoid bone position

OBJECTIVE

To evaluate craniocervical posture and hyoid bone position in patients with and without temporomandibular joint disorder (TMD).

METHODS

A total of 113 people were included in the study, including 55 TMD patients and 58 healthy controls. Using lateral cephalograms, the craniofacial, craniocervical, and hyoid bone positions of the participants were evaluated in terms of 27 variables.

RESULTS

There was no significant difference in craniocervical angles between participants with or without TMD. While the Hy-B, Hy-NSL, Hy-NL measurements and FMA (°), AFH (mm) measurements of participants with TMD were lower than the control group, the hyoid angle was greater than the control group.

CONCLUSION

These study findings provide evidence that TMD is not related to craniocervical posture but to the position of the hyoid bone and craniofacial morphology.

Influence of the mandibular position on various postural anatomical segments

OBJECTIVE

To determine postural changes in relation to mandibular position in maximum intercuspation and at rest in adult patients of both sexes.

METHODS

: A descriptive observational clinical study was carried out in 76 patients. Using an analyzer and the Meersseman test, the necessary dermal points for postural analysis were located.

RESULTS

: The authors found significant differences in the posture adopted by the patient between maximum intercuspation and mandibular rest in the frontal, sagittal, and dorsal planes. Foot support in the right foot went from cavus to normal in 6% of the sample, and from flat to normal in 2.5% of the sample in the jaw rest position.

CONCLUSION

Postural changes were observed in various segments, with clinical and statistical significance at cervical level in the frontal plane, in the biscapular variable in the dorsal plane, and at the level of the lower limbs in the bipopliteal and bimalleolar variables.

An investigation of biomechanics, muscle performance, and disability level of craniocervical region of individuals with temporomandibular disorder

OBJECTIVE

To investigate biomechanics, muscle performance, and disability of the craniocervical region in temporomandibular disorder (TMD) patients and compare them with controls.

METHODS

Craniocervical posture was evaluated using lateral photography and radiography. Range of motion, muscle performance, disability, and TMD severity were assessed using an inclinometer, Functional Strength Testing of Cervical Spine, Neck Disability Index, and Fonseca Anamnestic Index, respectively.

RESULTS

Compared to the control group, the TMD group demonstrated higher cervical flexion angle (p=0.005) and neck disability (p<0.001) as well as lower cervical extension (p=0.040), right cervical rotation (p=0.005), left cervical rotation (p<0.001), and tragus-C7-horizontal (p=0.048) angles, and reduced muscle performances (p≤0.001). Most patients had higher than normal craniocervical angle (p<0.001). Muscle performance in each cervical motion (p<0.005) and disability (p<0.001) were associated with TMD severity in the TMD group.

CONCLUSION

Biomechanics, muscle performance, and disability of craniocervical region were altered in the TMD group.

Additional effects of therapeutic exercise and education on manual therapy for chronic temporomandibular disorders treatment: a randomized clinical trial

BACKGROUND

Previous studies have evaluated the implementation of behavioral approaches in individuals with chronic temporomandibular disorders (TMDs).

OBJECTIVE

To evaluate the benefits of a behavioral approach to craniofacial pain. Second, we assessed the benefits of kinesiophobia, catastrophizing, mouth opening without pain, and forward head posture.

METHODS

Individuals with chronic TMDs were treated for five weeks. The intervention group (n = 17) underwent pain neuroscience education, manual therapy, and therapeutic exercise, whereas the control group (n = 17) underwent manual therapy only. Outcomes were evaluated immediately, at seven and 19 weeks follow-up. The assessment tools used were the Craniofacial Pain Disability Inventory, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, Mandibular Range of Motion Scale, and Cervical Range of Motion Tool.

RESULTS

The interventions did not influence the differences in the improvements between the groups observed for craniofacial pain disability (inter-subject p 0.4). The intervention had a moderate influence on the improvement of kinesiophobia and catastrophizing (Inter-subject p 0.09 and 0.1 respectively) with a clinically significant effect size (Estimated mean (EM) -8.6 standard deviation (SD) ±3.48 p 0.019; and EM -7.6 SD ± 5.11 p 0.15 respectively).

CONCLUSION

The behavioral approach improved catastrophizing and kinesiophobia outcomes in individuals with chronic TMDs.

Efficacy of scapulothoracic exercises on proprioception and postural stability in cranio-cervico-mandibular malalignment: A randomized, double-blind, controlled trial

BACKGROUND

Cranio-cervico-mandibular (CCM) malalignment is associated with forward head posture (FHP) and temporomandibular joint (TMJ) disorders and affects masticatory muscles.

OBJECTIVE

This randomized, double-blind controlled trial aimed to compare the efficacy of scapula-thoracic (ST) exercises on temporomandibular and cervical joint position sense and postural stability in individuals with CCM malalignment.

METHODS

Fourty-nine participants with CCM malalignment were randomly assigned to the ST exercise group (STEG, n= 24) or the control group (CG, n= 25). STEG included progressive strengthening, proprioceptive, and stabilization exercises. All participants were assessed before treatment, at the end of the 8th week treatment period and at the 12th week post-treatment follow-up. Cranio-vertebral angle measurement, Fonseca's Questionnaire, Helkimo Clinical Dysfunction Index, TMJ position test, cervical joint position error test and postural stability assessment were used.

RESULTS

The TMJ and cervical joint position sense, total sway degree, area gap percentage, sway velocity and antero-posterior body sway results showed significant improvement in the STEG compared to the CG (p< 0.05), however medio-lateral body sway did not differ between groups (p> 0.05).

CONCLUSIONS

Postural stability, TMJ and cervical joint position sense appear to be affected in individuals with CCM malalignment. Our results showed that an exercise program including ST stabilization, proprioception and strengthening of the scapular muscles may be effective in the management of CCM malalignment and will allow clinicians to plan holistic treatment.

Sports performance adaptations through occlusal splint: Case reports of triathlon athletes

OBJECTIVE

Occlusal disturbances affect human posture and sports performance. This study aimed to monitor biomechanical adaptations to personalized occlusal splints.

METHODS

Splints were customized based on stabilometry, thermography, sEMG, and kinesiography, and administered to three triathlon athletes. They were evaluated during a 4-month period, using isokinetic indexes, running kinematics and anaerobic outputs.

RESULTS

Individuality emerged as a key factor driving type, quantity, quality, and time trajectories of adaptations. The use of instrumental and clinical tests allowed the detection of static balance and biting function improvements, but not necessarily parallel to sports performance improvements.

CONCLUSION

The authors argue that strength and kinematic imbalances are joint and task-specific and support the use of multi-stage monitoring of the biomechanical effect of mouthpieces. Kinematics of cycling and running may be widely assessed with ecological and inexpensive methods. Strength imbalances need to be continuously monitored due to the high informative value to injury prevention.

Temporomandibular joint disorders in seronegative spondyloarthritis: what a rheumatologist needs to know?

Temporomandibular joint (TMJ) can be affected in the context of spondyloarthritis (SpA) with detrimental impact on individuals' quality of life. Intra-articular inflammation, synovitis, enthesitis, disc displacement and cervical vertebrae malalignment are some of the pathophysiological phenomena involved. Temporomandibular joint disorders (TMD) incidence appears to be higher in patients with ankylosing spondylitis and psoriatic arthritis, especially when clinical evaluation includes not only imaging but relevant history, TMJ examination and diagnostic criteria for TMD. The Visual Analogue Scale (VAS) pain score and Health Assessment Questionnaire Disability Index (HAQ) quality of life score could be useful tools. Panoramic radiographs and ultrasound can be used for screening but in symptomatic patients magnetic resonance imaging (MRI) is preferable. Conservative management and early pharmacological treatment can prevent permanent joint impairment. For refractory cases, early referral to Legislation for Oral and Maxillofacial Surgery (OMFS) specialists is indicated. The aim of this narrative review is to address the involvement of TMJ in SpA and to encourage clinicians to incorporate TMJ assessment in their physical examination and basic screening.

[Effect of the forward head syndrome in the development of temporomandibular disorders]

Bad habits, such as poor posture during the use of technological devices, poor abdominal control and oral breathing pattern can lead to a forward head position, which has important implications for the entire future of the individual, especially at the stomatognathic system. There is a strong association between temporomandibular disorders and forward head syndrome. Where the muscular component is the main affected, with the appearance of more trigger points at the level of the sternocleidomastoid muscles, upper trapezius, rectus capitis posterior and upper oblique capitis. Degenerative changes in the temporomandibular joint have been observed, but evidence is still lacking to ensure that Forward Head Syndrome is the etiological factor.

Developing a predictive equation of muscular age to evaluate muscle health in Chinese community-dwelling older women

Muscle health plays an important role in most common age-related diseases and injuries. To date, a standardized quantitative method to assess muscle health has not yet been developed. Principal component analysis was employed to develop a predictive equation of muscular age based on muscle health variables including skeletal muscle mass of lower limb, grip strength and maximal gait speed. Then validity of muscular age was tested by comparing chronological age to muscular age of the elderly. A predictive equation of muscular age was developed. Muscular age = 0.690 × chronological age - 1.245 × skeletal muscle mass of lower limb + 0.453 × grip strength - 1.291 × maximal walking speed + 40.547. Cross-sectional validity test showed that the predictive equation of muscular age is a valid method to assess muscle health. It is applicable not only to the normal elderly but to the elderly with pre-sarcopenia or sarcopenia.

The association between forward head posture and masticatory muscle pressure pain thresholds in patients with temporomandibular joint dissorders: a cross-sectional observational study

OBJECTIVES

Forward head posture (FHP) is common in patients with temporomandibular joint disorders (TMDs); however, whether it contributes to TMD symptoms remains unclear. The aim of this study was to investigate the association between (1) FHP and masticatory muscle pressure pain thresholds (PPTs) and (2) neck muscle and masticatory muscle PPTs.

MATERIALS AND METHODS

A total of 145 patients diagnosed with TMD were recruited between December 2020 and April 2021. Data regarding FHP and neck and masticatory muscle PPTs were collected. FHP was characterized by the craniocervical angle (CVA) measured between the horizontal line through C7 and the line between the tragus of the ear and C7. Patients were divided into either the FHP group (CVA ≤ 51°) or the non-FHP group. Differences in the masseter and temporalis muscle PPTs between the two groups were analyzed using the Mann-Whitney U test. The correlation between the CVA, neck, and masticatory muscle PPTs in all patients was determined by Spearman's correlation analysis.

RESULTS

There were 70 patients in the FHP group and 75 patients in the non-FHP group. No significant difference in masseter and temporalis muscle PPTs was found between the two groups (p > 0.05). No correlation was found between FHP and masticatory muscle PPTs (p > 0.05). A significant association was found between the neck muscle and masticatory muscle PPTs (p < 0.05). The C5-C6 pillar and masticatory PPTs were either moderately (r = 0.435, masseter muscle) or strongly (r = 0.608, temporalis muscle) correlated, while the correlation between the trapezius and masticatory muscles was moderate (r = 0.378, masseter muscle and r = 0.461, temporalis muscle).

CONCLUSION

FHP was not directly associated with masticatory muscle PPTs. Masticatory muscle PPTs were strongly or moderately associated with neck muscle PPTs. Therefore, the presence of neck pain, not the degree of FHP, in patients with TMD is of significance.

CLINICAL RELEVANCE

In TMD treatment, we should pay attention to and actively relieve neck pain.

CMD und Kieferorthopädie

Die Craniomandibuläre Dysfunktion (CMD) ist mit einer Prävalenz von über 30% die häufigste chronische Schmerzerkrankung im Kiefer- Gesichtsbereich. Die Therapie erfordert einen interdisziplinären, individuell angepassten Behandlungsansatz. Diese Fallvorstellung soll einen Einblick über das Behandlungskonzept eines posterior-lateralen Zwangsbisses mit Oberkiefer- Okklusionsschiene und OK/UK Alignern (Invisalign) geben.

Conservative management of pediatric temporomandibular disc displacement presenting as juvenile idiopathic arthritis: a case report

There is limited research regarding management of temporomandibular disorders (TMD) in adolescents with imaging signs of juvenile idiopathic arthritis (JIA). An 11-year-old girl presented to a hospital-based chiropractor for evaluation of a 1.5-year history of unilateral temporomandibular joint (TMJ) pain and trismus. Previously, pediatric rheumatologists diagnosed JIA after contrast-enhanced magnetic resonance imaging revealed edema, effusion, and bilateral anterior disc displacement, and recommended methotrexate, corticosteroid injection, and arthrocentesis. The chiropractor questioned the JIA diagnosis, instead relating symptoms to a mechanical TMD/disc origin. Manual therapy, TMJ exercises, and acupuncture improved TMJ pain and opening. Invasive medical JIA interventions were avoided without long-term recurrence, further questioning the preceding JIA diagnosis. The success of this case suggests that stepped care, beginning with conservative treatment, has value for adolescents with TMD suspect for JIA. Integration of chiropractors and acupuncturists into healthcare institutions may facilitate this care model by affording nonpharmacologic interventions earlier in patient care.

Cause-Effect Relationships between Painful TMD and Postural and Functional Changes in the Musculoskeletal System: A Preliminary Report

Introduction. Temporomandibular disease (TMD) is a general term including a group of conditions that cause pain and dysfunction in the masticatory muscles, the temporomandibular joint (TMJ), and their related structures. The painful forms of these dysfunctions have become an increasing phenomenon among dental patients. A number of scientific publications indicated the relationship between the presence of postural dysfunctions and functional disorders of the masticatory system in humans. Nevertheless, dental procedures still very rarely include comprehensive diagnostics and procedures aimed at the normalization of the locomotor system related to TMD. Scientific literature usually refers to and describes the coexistence of postural disorders in patients with TMD in the context of anatomical connections, the so-called biokinematic chains, indicating specific types of postures that correlate with different positions of the mandible and/or teeth. Objective. The aim of the study was to investigate the effect of painless positioning of the mandibular head in the articular fossa on postural and functional changes in the musculoskeletal system. Materials and Methods. The study was conducted on a group of 30 randomly selected patients who reported to the Department of Propaedeutic, Physical Diagnostics and Dental Physiotherapy of the Pomeranian Medical University in Szczecin (Poland). Before the examination, the dentists and the physiotherapist were calibrated by an examiner who had previously been calibrated and had three years of experience in the management of patients with TMD. Training of the appropriate palpation strength was performed, and then the results were discussed. In the study group, painful disorders in the temporomandibular joint with an abnormal position of the mandibular head in the articular fossa and individual posture defects were found. The patients complained of pain in the area of the TMJ, episodes of locked joints, and difficulty biting. None of them was treated for these disorders, previously rehabilitated or participated in any body posture examination. The patients were examined by an interdisciplinary team who also performed a preliminary test. The inclusion criterion for the study group was the presence of TMD symptoms in the past. Myofascial pain was diagnosed on the basis of diagnostic criteria for temporomandibular disorders (RDC/TMD Ia and Ib). On the other hand, the displacement of the articular disc was diagnosed on the basis of the diagnostic criteria of temporomandibular disorders (RDC/TMD IIa)—displacement of the articular disc without reduction. At the same time, the body posture was assessed by inspection and using computer techniques while standing and during motion. The examinations were repeated after positioning the mandibular heads in the articular fossa and stabilizing the condylar process using a temporary silicone occlusal splint. Since there is no DC/TMD protocol in Polish to date, RDC/TMD was used in the study. Results. Initial pilot studies and the authors’ observations indicated that the positioning of the mandibular heads in the articular pits and stabilization of the condylar process by providing the oral cavity with a temporary, silicone occlusive splint significantly influenced the posture of the examined patients, both while standing and during locomotion. This correlation also applies to the corrective effect on the foot architecture during standing and patient gait. Conclusions. Diagnostic and therapeutic management in the course of TMD should be holistic. Nevertheless, the observed changes are often varied and largely dependent on individual posture defects, which is an important postulate for further research on a larger study group.

Association of cervical spine signs and symptoms with temporomandibular disorders in adults: a systematic review protocol

OBJECTIVE

The objective of this systematic review is to assess the evidence of association of cervical spine signs and symptoms with temporomandibular disorders (TMD). This will help to lend credence to mechanisms supporting the association in order to improve care strategies for this condition.

INTRODUCTION

The association of cervical spine impairments (in relation to neck posture, cervical spine mobility, muscle tenderness, muscle activity, and neck disability) with TMD has been widely discussed in the literature. Clarification of this relationship is important for health professionals to better assess and treat TMD.

INCLUSION CRITERIA

Eligible studies will include participants aged 18 years and over, with a diagnosis of TMD from the Research and Diagnostic Criteria for Temporomandibular Disorders or a revised version. Exclusion criteria will be participants with previous temporomandibular joint surgery, history of trauma or fracture in the temporomandibular joint or the craniomandibular system; serious comorbid conditions such as cancer, rheumatic disease, and neurological problems; primary cervical spine disorders such as disc herniation or spinal degenerative changes; or systemic disease such as ankylosing spondylitis.

METHODS

The search for articles will be conducted in the databases PubMed, PEDro, CINAHL, Web of Science, and Embase, without language or time restrictions. Two independent reviewers will review the title, abstract, and full texts of identified studies; select studies against the inclusion criteria; assess the methodological quality of eligible studies using critical appraisal tools; and perform data extraction. Relevant quantitative data will be pooled with statistical meta-analysis, when possible.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42019123698.

Occurrence and severity of neck disability in individuals with different types of temporomandibular disorder

BACKGROUND

Healthcare professionals need to know the degree of disability and severity of their patients to determine actions and therapy needed to minimize potential harm, improve their patient condition, and maximize clinical outcomes.

OBJECTIVES

To evaluate the occurrence and severity of neck disability in individuals with muscular, joint, and mixed temporomandibular disorder (TMD).

MATERIALS AND METHODS

Cross-sectional study with individuals divided into four groups: muscular TMD (n=20), joint TMD (n=20), mixed TMD (n=20) and control (n=20). For diagnosis and classification of TMD, it was used the Research Diagnostic Criteria (RDC) and to assess the severity of neck dysfunction the Neck Disability Index (NDI).

RESULTS

Moderate neck disability was frequent in all individuals with TMD; high scores of neck disability index were evidenced in the mixed and joint TMD groups; there was a moderate positive correlation between the severity of neck disability and TMD severity (r=0.7; CI=0.32-0.78; p<0.03).

CONCLUSION

The gravity of neck disability and the severity of TMD are directly proportional in the group of individuals with mixed TMD.

Association between constitution, axiography, analysis of dental casts, and postural control in women aged between 41 and 50 years

Objectives

The aim of this study was to investigate the relationship between anamnestic, axiographic and occlusal parameters and postural control in healthy women aged between 41 and 50 years.

Materials and methods

A total of 100 female participants aged between 41 and 50 (45.12 ± 2.96) years participated in the study. In addition to completing a general anamnesis questionnaire, lower jaw movements were measured axiographically, dental occlusion parameters were determined using a model analysis and postural parameters were recorded using a pressure measurement platform. The significance level was 5%.

Results

An increasing weight and a rising BMI lead to a weight shifted from the rearfoot (p ≤ 0.01/0.04) to the forefoot (p ≤ 0.01/0.02). A limited laterotrusion on the right resulted in a lower forefoot load and an increased rearfoot load (p ≤ 0.01). Laterotrusion to the left (extended above the standard) showed a lower frontal sway (p ≤ 0.02) and a reduced elliptical area, height and width (p ≤ 0.01, 0.02, 0.03). Thus, the extent of deviation correlated with reduced right forefoot loading (p ≤ 0.03) and the extent of deflection correlated with increased left foot loading (p ≤ 0.01). The higher the extent of angle class II malocclusion, the larger the ellipse area (p ≤ 0.04) and the ellipse height (p ≤ 0.02) resulted.

Conclusions

There is a connection between weight, BMI and laterotrusion, as well as between angle class II malocclusion and postural control in women aged between 41 and 50 years. Interdisciplinary functional examinations of mandibular movements treating possible limitations can be conducive for an improvement of postural control.

Clinical relevance

Angle class II malocclusion has a negative influence on postural control.

Bridging the gap between temporomandibular disorders, static balance impairment and cervicogenic dizziness: Posturographic and clinical outcomes

Several studies have investigated the possible influence of temporomandibular disorders (TMD) on body posture and whether cervical spine disorders, such as cervicogenic dizziness (CGD) could play an additional role in affecting static balance. The purpose of this study was to analyze static postural behavior by means of static posturography, in patients affected by either TMD or CGD alone or by both conditions, and to compare findings with a group of healthy subjects. Significant changes in posturographic parameters were found among the three groups of patients and when compared with controls. When the three study groups were compared to each other, subjects affected by a combination of TMD and CGD showed worse postural performances with respect to subjects affected by CGD or TMD alone. Correlations with self-perceived dizziness, anxiety, depression and jaw functionality, investigated by means of validated questionnaires, were found among all patient groups. These results provide new evidences for the presence of static balance alterations in patients suffering from TMD with and without associated cervical spine impairment, by using a reliable diagnostic technique. Further studies are needed in order to identify any causal relation between these two disorders.

Effect of Manual Therapy and Splint Therapy in People with Temporomandibular Disorders: A Preliminary Study

Background: Isolated manual therapy techniques (MT) have shown beneficial effects in patients with temporomandibular disorders (TMD) but the effect of the combination of such techniques, together with the well-stablished splint therapy (ST) remains to be elucidated. Objective: This study was conducted to ascertain whether a combined program of MT techniques, including intraoral treatment, plus traditional ST improves pain and clinical dysfunction in subjects with TMD. Methods: A preliminary trial was conducted. 16 participants were assigned to either the MT plus ST-Experimental Group (EG, n = 8) or the ST alone—Control Group (CG, n = 8). Forty-five minute sessions of combined MT techniques were performed, once a week for four weeks. Three evaluations were conducted: baseline, post-treatment, and one-month follow-up. Outcome measures were pain perception, pain pressure threshold (PPT), TMD dysfunction, and perception of change after treatment. Results: EG showed significant reduction on pain, higher PPT, significant improvement of dysfunction and significantly positive perception of change after treatment (p < 0.05 all). Additionally, such positive effects were maintained at follow-up with a high treatment effect (R² explaining 26.6–33.2% of all variables). Conclusion: MT plus ST showed reduction on perceived pain (3 points decrease), higher PPT (of at least 1.0 kg/cm²), improvement of disability caused by pain (4.4 points decrease), and positive perception of change (EG: 50% felt “much improvement”), compared to ST alone.

Temporomandibular disorders and cervicogenic dizziness: Relations between cervical range of motion and clinical parameters

OBJECTIVE

To analyze the cervical range of motion (CROM) and clinical parameters in patients affected by myogenous temporomandibular disorders (TMD), cervicogenic dizziness (CGD), both TMD and CGD (TMD/CGD), and a group of healthy subjects (HS).

METHODS

CROM degrees, Dizziness Handicap Inventory (DHI), Tampa Scale for Kinesiophobia (TSK-17), Hospital Anxiety and Depression Scale (HADS), and Jaw Functional Limitation Scale 20 (JFLS-20) scores were compared between 46 TMD patients, 49 CGD subjects, 43 TMD/CGD patients, and 98 HS.

RESULTS

TMD/CGD and CGD patients demonstrated significantly lower CROM degrees and higher DHI, TSK-17, and HADS values when compared to TMD patients. TMD/CGD and TMD patients demonstrated higher JFLS-20 values when compared to CGD and HS. Significant negative correlations were found in TMD/CGD and TMD patients between JFLS-20 and CROM in flexion and extension.

DISCUSSION

Present findings demonstrated a relation between spine movement impairment and TMD.

Temporomandibular disorders in ankylosing spondylitis: a cross-sectional, monocentric study

There are contradictory results in the relevant literature about the relationship between objective determinants of craniocervical posture and temporomandibular disorder (TMD), whereas no study has worked on ankylosing spondylitis (AS) and TMD relationship. We conducted this study to test the predictors of TMD in AS patients and its relationship with craniocervical posture. AS patients aged between 18 and 50 years consecutively admitted to our outpatient clinics were recruited. TMD was diagnosed by 'Diagnostic Criteria for Temporomandibular Disorders (DC/TMD)'. Spinal mobility was assessed by BASMI; disease activity by ASDAS-CRP and neck disability by Neck Disability Index. Craniocervical posture was assessed on lateral cervical X-ray by measuring the craniocervical angle, cervical curvature angle, suboccipital distance, atlas-axis distance, and anterior translation distance. A total of 98 (58.2% female) patients with a mean age of 37.4 ± 8.2 years were enrolled in this study. TMD was diagnosed in 58 (59.2%) patients. Spinal mobility and craniocervical posture measurements were similar among the two groups. Smoking, bruxism (in females), neck disability and AS disease activity (in males) were higher in TMD patients. Multivariate analysis revealed active smoking (aOR 6.9; 95% CI 1.8-25.6; p = 0.004), bruxism in females (aOR 17.9; 95% CI 2.0-159.2; p = 0.01), high ASDAS in males (aOR 11.8; 95% CI 1.2-122.5; p = 0.038) and neck disability (aOR 12.7; 95% CI 3.8-42.9; p < 0.001) as independent risk factors for TMD in AS patients. No relationship between the craniocervical posture measurements and TMD was found in AS patients. Active smoking, high disease activity in males, bruxism in females and neck disability were found as predictors of TMD in AS patients.

Adding Temporomandibular joint treatments to routine physiotherapy for patients with non-specific chronic neck pain: A randomized clinical study

INTRODUCTION

Neck Pain can be related to the disorders of other adjacent areas such as the Temporomandibular Joint (TMJ). This study aimed to investigate whether there is value in adding TMJ treatments to routine physiotherapy in patients with non-specific chronic neck pain compared with a control group.

METHODS

A randomized, single-blind, clinical study desined including two groups of patients. Group A (20 people) received routine physiotherapy for neck pain and group B (20 people) received TMJ manual therapy plus exercise therapy in addition to routine physiotherapy for neck pain. The Treatment program included six sessions for two days a week over a period of 21 days. Assessments were performed during the first session, in the last session and one month after treatment as a follow-up. Outcome measures included neck range of motion (ROM), neck disability index (NDI) and visual analogue scale (VAS). Before starting the study, the reliability of methods for measuring neck ROM was evaluated.

RESULTS

Participants were 21 women and 19 men. Initially, a pilot study was carried out on the 40 volunteers to assess the reliability of the measurement methods, and the results were acceptable. With both the control group and the intervention group, the indexes showed significant improvement (p < 0.001), although the intervention group showed more improvement (p < 0.001).

CONCLUSION

This result means adding treatments of TMJ to routine neck physiotherapy can magnify the effect of the intervention, a significant change still in evidence at follow up. Moreover, given the clinically important differences, our results for VAS and NDI were acceptable.

Severidade da disfunção temporomandibular e sua relação com a postura corporal

RESUMO O objetivo deste estudo foi identificar se existe correlação entre a severidade da disfunção temporomandibular (DTM) e postura corporal, bem como evidenciar as diferenças existentes na postura corporal nos diferentes graus de severidade. Foram avaliadas 71 mulheres de 18 a 35 anos quanto à severidade da DTM e à postura corporal, sendo divididas em grupo sem DTM e grupo com DTM. Foram utilizados o questionário Mandibular Function Impairment Questionnaire e o software Digital Image-Based Postural Assessment de avaliação postural por fotogrametria. Foi realizada análise estatística com ANOVA de um fator e teste de correlação Tau B de Kendall (α<0,05). Os grupos com e sem DTM apresentaram diferenças estatísticas, com tamanho de efeito grande (ŋ2>0,528), para: lordose cervical, pulsão e inclinação da pelve. Quanto à correlação da postura com a severidade da DTM, índices fracos, mas significativos, foram encontrados: ângulo da lordose cervical (τ=0,250), ângulo da cifose dorsal (τ=0,192), ângulo de inclinação pélvica (τ=−0,222) e medida de pulsão da pelve (τ=0,283). Esses resultados indicam que a lordose cervical e a pulsão da pelve se apresentam em aumento da lordose e da pulsão conforme o acréscimo da severidade da DTM, enquanto o ângulo de inclinação se apresenta em menor grau, tendendo à retroversão. Apesar das correlações fracas, os resultados evidenciam alguma relação da postura corporal com a DTM.

Unbalanced Occlusion Modifies the Pattern of Brain Activity During Execution of a Finger to Thumb Motor Task

In order to assess possible influences of occlusion on motor performance, we studied by functional magnetic resonance imaging (fMRI) the changes in the blood oxygenation level dependent (BOLD) signal induced at brain level by a finger to thumb motor task in a population of subjects characterized by an asymmetric activation of jaw muscles during clenching (malocclusion). In these subjects, appropriate occlusal correction by an oral orthotic (bite) reduced the masticatory asymmetry. The finger to thumb task was performed while the subject's dental arches were touching, in two conditions: (a) with the teeth in direct contact (Bite OFF) and (b) with the bite interposed between the arches (Bite ON). Both conditions required only a very slight activation of masticatory muscles. Maps of the BOLD signal recorded during the movement were contrasted with the resting condition (activation maps). Between conditions comparison of the activation maps (Bite OFF/Bite ON) showed that, in Bite OFF, the BOLD signal was significantly higher in the trigeminal sensorimotor region, the premotor cortex, the cerebellum, the inferior temporal and occipital cortex, the calcarine cortex, the precuneus on both sides, as well as in the right posterior cingulate cortex. These data are consistent with the hypothesis that malocclusion makes movement performance more difficult, leading to a stronger activation of (a) sensorimotor areas not dealing with the control of the involved body part, (b) regions planning the motor sequence, and (c) the cerebellum, which is essential in motor coordination. Moreover, the findings of a higher activation of temporo-occipital cortex and precuneus/cingulus, respectively, suggest that, during malocclusion, the movement occurs with an increased visual imagery activity, and requires a stronger attentive effort.

The inconclusiveness of research on functional pathologies of the temporomandibular system and body posture: Paths followed, paths ahead: A critical review

Objective: Literature on the functional pathologies of the temporomandibular system (FPTS) in its relationships with body posture is plagued with inconclusiveness. Despite being sometimes altogether disregarded, the issue is most relevant, due to its clinical implications. This paper aims for a deeper understanding of the origins of the inconclusiveness of research on such relationships by means of a critical analysis of the scientific literature on the subject, in order that clinicians may better treat patients with FPTS.Methods: Analysis of over 100 studies, published from 1918 through March 2018 in the PubMed database, using descriptors temporomandibular joint disorders and posture.Results: The analysis of the paths followed by researchers allowed for pinning down several methodological issues that may have led to the prevailing ambiguity on the matter.Conclusion: This review then proposes certain standardization of procedures in future studies, to be conducted by a proposed consortium of researchers.

[Assessment of postural control and balance in persons with temporomandibular disorders: A systematic review]

The stomatognathic system is the anatomo-functional unit of the cranio-cervico-facial region. Some dysfunctions affect its motor control. The aim of this study was to analyse the clinical usefulness of the various scales and instruments used in the assessment of postural control in people with temporomandibular disorders. A systematic review was carried out by 2independent reviewers in the PubMed, Medline, Ebsco, Science Direct and PEDro databases, selecting observational studies published between January 2006 and March 2017. The risk of bias and methodological quality was analysed following Cochrane indications and the Downs and Black quality scale. Ten studies were included, of which 9used computerised platforms, one added photogrammetry and one used electromyography. Seven studies were classified as moderate quality and 3as low quality. Posturography was the most widely used assessment instrument. Methodological differences did not allow determination of their clinical implications or the relationship between balance and the presence of temporomandibular disorders.

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.

Does occlusal splint affect posture? A randomized controlled trial

OBJECTIVE

The aim of this study was to evaluate the effect of an occlusal splint on body posture of intra-articular temporomandibular joint (TMJ) disorders patients.

METHODS

The study was performed on 45 women affected by TMJ disorders divided into an occlusal splint group and a control group. Rasterstereographic recordings were performed at baseline and after 1, 3, and 6 months, in order to analyze the following postural parameters: trunk inclination, cervical and lumbar arrows, kyphotic and lordotic angles, trunk imbalance, pelvic tilt and torsion.

RESULTS

Regarding the postural parameters in the intragroup analysis, no significant differences were detected. The analysis between the two groups revealed significant differences concerning the cervical arrow, the kyphotic and lordotic angles.

DISCUSSION

Even if some differences were found between the control and the occlusal splint group, the low range of statistical significance made these results not significant from a clinical point of view.

Relationship between foot posture and dental malocclusions in children aged 6 to 9 years: A cross-sectional study

The aim of this study was to determine the association, if any, between foot posture and dental malocclusions in the anteroposterior plane, in children.The study population consisted of 189 children (95 boys and 94 girls) aged 6 to 9 years. In every case, previous informed consent was requested and obtained from the parent/guardian and the study was approved by the Ethics Committee of the University of Málaga (CEUMA 26/2015H).This observational, descriptive, cross-sectional analysis is based on a study population (STROBE). Qualified personnel conducted a podiatric and dental examination of each child, recording the Clarke angle and the foot posture index (FPI) as an outcomes measure in the feet, and also dental malocclusions, according to Angle classification.A significant correlation was observed for the FPI scores (for right foot) as well as the Clarke angle (for right foot), in relation to dental malocclusions as determined by Angle classification (P < .001). Of all the supinated feet analyzed, 38.46% were Class II according to Angle classification, and none were Class III. Of the pronated feet, 48.57% were Class III, 42.85% were Class I, and 8.57% were Class II.The Clarke angle decreases with the progression from Class I to III, whereas the FPI increases with that from Class I to III. These findings suggest there is a relation between the Clarke angle and FPI, on the one hand, and dental malocclusion on the other.

Postural stability in subjects with temporomandibular disorders and healthy controls: A comparative assessment

PURPOSE OF THE STUDY

The influence of the stomatognathic apparatus on body posture is a continuously discussed topic with contrasting results. The aim of this study is to analyze differences in postural stability between subjects with and without myogenous TMD.

METHODS

25 subjects affected by myogenous TMD according with DC/TMD (6 males, 19 females; mean age 31.75±6.68years) and a healthy control group of 19 subjects (4 Males, 15 Females; mean age 27.26±3.85years) were enrolled in the study. Both groups underwent a posturo-stabilometric force platform exam under different mandibular and visual conditions. Sway area and sway velocity of the COP (Center Of foot Pressure) posturo-stabilometric parameters were evaluated and compared applying Mann-U-Whitney statistical test.

RESULTS

The sway area and sway velocity parameters resulted statistically significantly higher in the TMD group (sway area p<0.01; sway velocity p<0.05) in mandibular maximum intercuspation and rest positions with eyes open.

CONCLUSIONS

This study demonstrates a significant difference in body postural stability between subjects with myogenous TMD and healthy controls. In particular, sway area and sway velocity postural parameters are increased in these subjects.

Effects of central and unilateral posteroanterior mobilization on cervical lordosis, muscle stiffness and ROM in patient with ankylosing spondylitis: case study

[Purpose] The aim of this study was to determine the effects of central and unilateral posteroanterior (PA) mobilization on cervical lordosis, muscle stiffness and range of motion in a patient with ankylosing spondylitis (AS). [Subject and Methods] The subject of this case study was diagnosed with AS in 1997. At baseline, variance was measured without any intervention during the first 3 days (2016.6.13-2016.6.15). Cervical PA mobilization was applied to each segment from C2-C7 from the 4th to the 11th day for 8 days. Intervention was not performed from the 12th to the 15th days for 4 days. Variances were measured a final time without intervention on the 16th day (2016.6.28). [Results] Cervical lordosis was seen to have increased. Muscle stiffness was significantly decreased after intervention and the effect of treatment lasted for five days without any additional intervention. The cervical flexion and extension angles were increased. However these increases were not statistically significant. Both the lateral flexion and left rotation angle were significantly increased and the effects of treatment lasted for five days without any additional intervention. [Conclusion] These results suggest that central and unilateral PA mobilization is effective in increasing cervical lordosis and range of motion, and decreasing muscle stiffness in patients with AS.

Aspectos clínicos e psicossociais avaliados por critérios de diagnóstico para disfunção temporomandibular

RESUMO Objetivo: analisar a associação entre a classificação de diagnósticos clínicos (dor miofascial, desordem discal e articular) e a graduação de dor crônica, depressão e sintomas físicos não específicos em sujeitos com disfunção temporomandibular. Métodos: foram incluídos 32 pacientes, com média de idade de 28,71±4,66 anos. Como instrumento de avaliação, foi utilizado o Critério de Diagnóstico para Pesquisa das Desordens Temporomandibulares - Eixo I e II. Quanto ao grupo diagnóstico, 88,13% dos indivíduos apresentaram diagnóstico misto, sendo 43,75% dos grupos I e III (distúrbios musculares e articulares) e 34,38% dos grupos I, II e III (distúrbios musculares, articulares e deslocamento de disco). Resultados: de acordo com o eixo II, 96,88% dos participantes foram classificados com dor crônica grau I e II (baixa incapacidade e baixa intensidade; baixa incapacidade e alta intensidade). Graus moderado e grave de depressão foram observados em 84,38% dos participantes. Na avaliação de sintomas físicos não específicos incluindo e excluindo dor, respectivamente, 59,38% apresentaram sintomas severos e 71,88% apresentaram sintomas moderados e severos. Verificou-se relação significante dos diagnósticos clínicos de disfunção temporomandibular com o grau de sintomas físicos não específicos incluindo dor. Conclusão: alguns aspectos clínicos e psicossociais estão associados em pacientes com disfunção temporomandibular, observando uma multiplicidade de diagnósticos clínicos com a presença de uma relação significante entre os diagnósticos clínicos encontrados e a presença de sintomas físicos inespecíficos com dor. Queixa de maior gravidade de sintomas físicos foi encontrada em pacientes com diagnóstico clínico múltiplo.

Relationships between craniocervical posture and pain-related disability in patients with cervico-craniofacial pain

Objectives

This cross-sectional correlation study explored the relationships between craniocervical posture and pain-related disability in patients with chronic cervico-craniofacial pain (CCFP). Moreover, we investigated the test–retest intrarater reliability of two craniocervical posture measurements: head posture (HP) and the sternomental distance (SMD).

Methods

Fifty-three asymptomatic subjects and 60 CCFP patients were recruited. One rater measured HP and the SMD using a cervical range of motion device and a digital caliper, respectively. The Spanish versions of the neck disability index and the craniofacial pain and disability inventory were used to assess pain-related disability (neck disability and craniofacial disability, respectively).

Results

We found no statistically significant correlations between craniocervical posture and pain-related disability variables (HP and neck disability [r=0.105; P>0.05]; HP and craniofacial disability [r=0.132; P>0.05]; SMD and neck disability [r=0.126; P>0.05]; SMD and craniofacial disability [r=0.195; P>0.05]). A moderate positive correlation was observed between HP and SMD for both groups (asymptomatic subjects, r=0.447; CCFP patients, r=0.52). Neck disability was strongly positively correlated with craniofacial disability (r=0.79; P<0.001). The test–retest intrarater reliability of the HP measurement was high for asymptomatic subjects and CCFP patients (intraclass correlation coefficients =0.93 and 0.81, respectively) and for SMD (intra-class correlation coefficient range between 0.76 and 0.99); the test–retest intrarater reliability remained high when evaluated 9 days later. The HP standard error of measurement range was 0.54–0.75 cm, and the minimal detectable change was 1.27–1.74 cm. The SMD standard error of measurement was 2.75–6.24 mm, and the minimal detectable change was 6.42–14.55 mm. Independent t-tests showed statistically significant differences between the asymptomatic individuals and CCFP patients for measures of craniocervical posture, but these differences were very small (mean difference =1.44 cm for HP; 6.24 mm for SMD). The effect sizes reached by these values were estimated to be small for SMD (d=0.38) and medium for HP (d=0.76).

Conclusion

The results showed no statistically significant correlations between craniocervical posture and variables of pain-related disability, but a strong correlation between the two variables of disability was found. Our findings suggest that small differences between CCFP patients and asymptomatic subjects exist with respect to the two measurements used to assess craniocervical posture (HP and SMD), and these measures demonstrated high test–retest intrarater reliability for both CCFP patients and asymptomatic subjects.