Association between radiographic findings in the mandibular condyle and temporomandibular dysfunction in an elderly population

Diagnostic significance of magnetic resonance imaging in distinguishing temporomandibular disorders: a retrospective chart review

Background

This study was to evaluate the diagnostic significance of Magnetic Resonance Imaging (MRI) in distinguishing temporomandibular disorders (TMD).

Methods

A total of 684 patients with TMD were included in the study. Diagnosis for TMD was conducted according to the international criteria. Two professional radiologists were selected for professional training, and the Kappa values were compared for the diagnosis results to determine the consistency of the diagnosis. Then MRI images of these 684 patients were analyzed and the diagnosis results were obtained.

Results

MRI can be used for the diagnosis of TMD. There were significantly more females (518 cases) than males (166 cases) with TMD; Disc displacement with/without reduction is more common in the youth group, with the majority aged 20–30 years. The highest incidence of temporomandibular joint osteoarthrosis is in the 60-year-old age group, followed by the 70-year-old age group.

Conclusions

Bilateral temporomandibular joint MRI can clearly show their changes; there are significantly more female with TMD than male; osteoarthritis has a significant correlation with age.

Evaluation of the influence of mandibular condylar contour, height, and asymmetry in subjects with myalgia presenting with or without clicking among south coastal Karnataka population - A descriptive cross-sectional study

Aim:

The purpose was to evaluate the morphological variations of the condyle in patients presenting with myalgia associated with and without clicking of temporomandibular joint (TMJ) and its possible effect on the contour and height.

Setting and Design:

Cross sectional study.

Material and Methods:

A total of 60 patients comprising of 20 patients with myalgia, 20 patients with myalgia associated with clicking of TMJ, and a control group of 20 patients without any signs and symptoms of temporomandibular disorder were selected for purpose of the study. Using a digital panoramic radiograph, the contour of the condyle was evaluated for shape, condylar height (CH), and condylar asymmetry.

Statistical Analyses Used:

Chi-square test, One- way ANOVA.

Results:

Rounded contour of the condyle was the most prevalent shape of the condyle amongst the three groups. There was a significant decrease in mean right and left CH in subjects with myalgia (0.71 cm and 0.73 cm) and subjects with myalgia associated with clicking (0.65 cm and 0.62 cm) compared to control group subjects. There was also an increase in the mean asymmetry index in subjects with myalgia presenting with clicking (2.362 ± 1.4) and without clicking (1.388 ± 2.1) (P < 0.05).

Conclusion:

Within the limitations of the current study, round contour of the condyle is the most common variant. Subjects with myalgia showed a significant reduction in condyle height. Condyle contour, height, and asymmetry may not predispose the joint for clicking.

Age-related changes in the articular cartilage of the mandible of rats

This study investigated the effects of aging on the articular cartilage of the mandible. Wistar rats were divided in two groups (n = 10/per group): 3-months-old group (young group); and 13-months-old group (aged group). After euthanasia, the head of the mandible was collected and stained with hematoxylin and eosin (HE) to evaluate the thickness of the articular layer and cartilage. Sections stained with Picrosirius red and Safranin O were used to evaluate the collagen and proteoglycans deposition, respectively. First, aging has decreased the articular layer thickness. Second, the results suggest a decrease of chondrocytes followed by an increase of the matrix to maintain the mandible homeostasis. Finally, both collagen and proteoglycans increased with aging. Aging displayed important effects to the mandible of aged rats.

Clinical Outcome of Sodium Hyaluronate Injection into the Superior and Inferior Joint Space for Osteoarthritis of the Temporomandibular Joint Evaluated by Cone-Beam Computed Tomography: A Retrospective Study of 51 Patients and 56 Joints

BACKGROUND The aim of this study was to determine the clinical effects of sodium hyaluronate injection into the superior and inferior joint space for osteoarthritis of the temporomandibular joint (TMJ) and to evaluate the joint changes using cone-beam computed tomography (CBCT). MATERIAL AND METHODS A retrospective observational clinical study included 51 patients and 56 TMJs, with a diagnosis of osteoarthritis. All patients received sodium hyaluronate injections into the superior and inferior TMJ joint spaces (articular cavities). At baseline and post-treatment the condylar bony changes were evaluated by CBCT. To evaluate TMJ function, maximum mouth opening (MMO), and Helkimo's index was used, which included an anamnestic index (Ai) and a clinical dysfunction index (Di). Patients were divided into short-term (one year) follow-up groups. RESULTS In both patient follow-up groups, sodium hyaluronate injection of the superior and inferior TMJ space significantly improved MMO, the Ai, and the Di (P<0.05). There were no significant differences between the two groups in condylar bony changes of the TMJ seen by CBCT (sclerosis, erosion, hyperplasia, and flattening) (P>0.05). CBCT showed a good predictive ability on post-treatment symptom relief following sodium hyaluronate injection into the superior and inferior TMJ space in patients with osteoarthritis of the TMJ (P=0.024). CONCLUSIONS The findings of this clinical and CBCT imaging study showed that sodium hyaluronate injection into the superior and inferior TMJ space in patients with osteoarthritis improved clinical symptoms, but did not control the progression of osteoarthritic joint destruction.

Osseous changes in the temporomandibular joint in rheumatoid arthritis: A cone-beam computed tomography study

Purpose

To evaluate osseous changes of temporomandibular joint (TMJ) in patients with rheumatoid arthritis (RA) using cone-beam computed tomography (CBCT) and to correlate the imaging findings with the severity of TMJ dysfunction, clinical findings, and laboratory findings.

Materials and Methods

This study consisted of 28 subjects, including 14 RA patients and 14 controls, who were scheduled to undergo CBCT imaging for the diagnosis of a complaint not related to or affecting the TMJ. The Fonseca's questionnaire was used to assess the severity of TMJ dysfunction. Rheumatoid factor (RF) and the erythrocyte sedimentation rate (ESR) were assessed in the RA patients. CBCT was then performed in all subjects and osseous TMJ abnormalities were assessed.

Results

According to the Fonseca's questionnaire, 14.3% of the patients had no TMJ dysfunction, while 50%, 21.4%, and 14.3% had mild, moderate, and severe dysfunction, respectively. RF was positive in 64.3% of patients, and the ESR level was high in 100%. Imaging findings revealed a statistically significantly higher prevalence of erosion (85.7%), flattening (89.3%), osteophyte formation (32.1%), subchondral cyst (32.1%), sclerosis (64.3%), and condylar irregularities (28.6%) in the RA patients than in the controls. No correlations were found between CBCT findings and the clinical findings, the severity of TMJ dysfunction, disease duration, or laboratory results.

Conclusion

RA patients might show extensive osseous abnormalities with no/mild clinical signs or symptoms of TMJ dysfunction that necessitate TMJ imaging for these patients. CBCT is a valuable and efficient modality that can assess osseous TMJ changes in RA patients.

TMJ osteoarthritis: a new approach to diagnosis

Disorders of the temporomandibular joint (TMJ), including TMJ osteoarthritis (TMJ OA), are the topic of intensive clinical research; however, this is not the case in the archaeological literature, with the majority of work on the subject ceasing with the early 1990s. The methods employed in the diagnosis of TMJ OA within the archaeological work appear nonrepresentative of the disease and may have led to erroneous assumptions about the pattern and prevalence of OA. This current work presents a new method for evaluating OA specifically for the TMJ, considering both the biomechanics of the joint and the mechanisms of the disease. Totally, 496 specimens (including a group of modern documented specimens) were analyzed for the presence of TMJ OA using the following criteria: eburnation, osteophytes (marginal and new bone on joint surface), porosity, and alteration to joint contour. The results suggest that eburnation occurs rarely in the TMJ, so should not be used as an exclusive criterion. Rather a combination of at least two of the other criteria should be used, with osteophytes and porosity occurring the most frequently on both the mandibular condyle and articular eminence. Additionally, the prevalence of TMJ OA in the modern assemblage was similar to that observed in current clinical research, suggesting that the method employed here was able to produce a reasonable approximation of what is found in contemporary living populations.

Condylar Changes and Its Association with Age, TMD, and Dentition Status: A Cross-Sectional Study

The present study was undertaken to evaluate the prevalence of radiographic changes in the condylar morphology and its association with age, clinical signs and symptoms of temporomandibular dysfunction and dentition status and also to evaluate the intra examiner and inter examiner reliability in assessing condylar changes using panoramic radiographs. A total of 75 subjects were recruited for the study. They were divided into 3 age groups. 20–40 yrs (Group A), 41–60 yrs (Group B) and 61 yrs and above (Group C). In each age group 25 subjects were evaluated both clinically and radiographically. The prevalence of radiographic changes in condylar morphology and symptoms of temporomandibular dysfunction was 81.3% and 18.6%, respectively. Radiographic abnormalities in the mandibular condylar morphology increased with age. They were seen more frequently in patients with clinical signs and symptoms of temporomandibular dysfunction and in patients with loss of teeth. Intra examiner and inter examiner reliability was high indicating a good reliability in assessing the condylar changes using panoramic radiograph.

Prevalence of clinical and radiographic signs of osteoarthrosis of the temporomandibular joint in an older persons community

OBJECTIVES

The aim was to assess the prevalence of osteoarthrosis (OA) in the temporomandibular joint (TMJ) in a sample of older people by use of contrast agent-enhanced MRI.

METHODS

30 patients (73-75 years old) were drawn from a representative sample and were examined clinically. The shape of the condyle was assessed using gadolinium-enhanced MR images, which were evaluated by two independent raters. Statistical assessment was performed by using descriptive statistics, the chi(2) test and kappa statistics.

RESULTS

Agreement between raters was excellent with respect to the presence/absence of OA (kappa = 0.8). Only one subject reported pain in a TMJ. Fine and/or coarse crepitus was not heard in any subject. MRI showed that 70% displayed signs of OA in at least one TMJ. There were no gender-related differences in the prevalence of OA (P > 0.05).

CONCLUSION

Gadolinium-enhanced MRI showed that OA of the TMJ is common in older people (70%), although the prevalence of clinical signs of OA is very low.

Classifying degenerative joint disease by the RDC/TMD and by panoramic imaging: a retrospective analysis

The purposes of the study were to evaluate the utility of diagnosing degenerative joint disease (DJD) by the clinical finding of coarse crepitus alone, without supporting imaging studies, as defined by the RDC/TMD, and to evaluate the contribution of panoramic radiography as an aid in the diagnosis of DJD. A retrospective analysis of 372 consecutive patients with TMD was conducted. Their panoramic radiographs were evaluated for the extent of their contribution to the final diagnosis. Panoramic radiography was of no diagnostic value in 94.4% of the cases when the group was considered as a whole. When patients diagnosed with DJD were considered separately, panoramic radiography was completely sufficient for reaching the final diagnosis in 20.0% of the cases. In almost 90% of these patients, however, the clinical examination did not support the diagnosis of DJD (no coarse crepitus was found). This raises some doubts about the effectiveness of the clinical examination according to the RDC/TMD and about the utility of panoramic radiography in the definitive diagnosis of DJD, because both techniques have low accuracy (11.1% and 20%, respectively). The present study supports the current recommendations that panoramic radiography should not be ordered routinely to assess DJD, but still it is first choice when any dental problem is suspected. Further additional imaging (computerized tomography, magnetic resonance imaging) should be considered only if there is reason to expect that the findings might affect diagnosis and management. This study adds to recent criticisms of the clinical validity of the RDC/TMD, with regard to DJD.

Comparison of occlusal condition and prevalence of bone change in the condyle of patients with and without temporomandibular disorders

OBJECTIVE

The purpose of this study was to compare the differences in dental and occlusal conditions, and prevalence of bone change in the condyle, between a group of patients with temporomandibular disorders (TMD) and a group of dental patients without such complaints.

STUDY DESIGN

A group of 504 patients with temporomandibular disorders (TMD patients) and a group of 970 patients without such complaints (dental patients), all 25 years of age or older, were compared using the criteria of age, sex, dental and occlusal condition, and prevalence of bone change in the condyle based on panoramic radiographs and imaging request forms.

RESULTS

In both groups, the rate of complete dental arch was high for both jaws. According to Eichner's index, the rate for group A among the dental patients was 59.6%, whereas it was 84.7% in the TMD patients (P < .01). The prevalence of bone change in the condyle was 17.7% for the TMD patients and 11.6% for the dental patients (P < .01). Eichner's group C was somewhat high for the dental patients, and group A was high for the TMD patients. However, there were no significant differences in the occlusal conditions based on the prevalence of bone change. Deformity was the most common abnormality of bone change for both the dental and the TMD patients. In the TMD patients, the rate of osteophytes was the second most common abnormal finding. Osteophytes were the highest among the average age for all abnormal bone changes in the condyle. With the TMD patients, all the changes were more commonly found in Eichner's group A.

CONCLUSIONS

It was demonstrated that the symptoms of TMD correlated with age, sex, and dental and occlusal conditions. However, the prevalence of bone change in the condyle correlated poorly with age, sex, and dental and occlusal condition with and without TMD.

Panoramic findings in 34-year-old subjects with facial pain and pain-free controls

The aim of this study was to compare panoramic radiographic findings between subjects with reported facial pain and pain-free controls in a population-based sample of 34-year olds. The study was a part of a comprehensive medical survey including subjects born in the year 1966 in Northern Finland. A sub-sample of the cohort was formed based on the question concerning facial pain. A panoramic radiograph was taken of 48 subjects with facial pain and 47 pain-free controls. Pathological findings in the dentition, jaws, maxillary sinuses and temporomandibular joints (TMJs) were compared between the groups. The majority of the subjects in both groups did not have pathological findings. Compared with controls, the subjects with facial pain did not show significantly more pathological findings in the teeth, periodontium, maxillary sinuses, TMJs or in the other areas. Radiographic panoramic findings had no association with reported facial pain in the population-based sample of young adults, and have little impact on the diagnosis of facial pain.

Mice deficient in biglycan and fibromodulin as a model for temporomandibular joint osteoarthritis

The temporomandibular joint (TMJ) within the craniofacial complex is unique. In humans, the TMJ can become diseased resulting in severe and disabling pain. There are no cures for TMJ disease at this time. Animal models of TMJ disease are scarce, but some exist, and they are described in this paper. We present in greater detail one animal model that is deficient in two extracellular matrix (ECM) proteoglycans, biglycan (BGN) and fibromodulin (FMOD). Doubly deficient BGN/FMOD mice develop premature TMJ osteoarthritis (OA). In order to explore the mechanistic basis of TMJ-OA, tissues from the condyle of mutant mice were examined for their relative capacity to differentiate and undergo apoptosis. Our data show that there is a redistribution of the critical ECM protein, type II collagen, in mutant mice compared with controls. Mutant mice also have increased apoptosis of the chondrocytes embedded in the articular cartilage. We speculate that the overall imbalance in apoptosis may be the cellular basis for the abnormal production of structural ECM proteins. The abnormal production of the ECM could, in turn, lead to premature erosion and degradation of the articular surface resulting in TMJ-OA. These data underscore the importance of the ECM in controlling the structural integrity of the TMJ.

The comparison between pains, difficulties in function, and associating factors of patients in subtypes of temporomandibular disorders

The aim of this study was to compare the multidimensional properties among subtypes of painful temporomandibular disorders (TMD): myofascial pain (group I), disc displacement (group II), arthralgia (group IIIa) and osteoarthritis (group IIIb). A total of 511 patients answered a battery of questionnaires, which included questions relating to intensity and duration of pain, the Japanese version of the McGill Pain Questionnaire, limitation of daily functions, the Hospital Anxiety and Depression Scale, the Eysenck Personality Questionnaire short-form and 34 items of behavioural contributing factors. Group IIIb showed significantly the highest age in all subtypes. Those in group I had higher depression scores than those in group II (P = 0.005). Group IIIa had a lower women's ratio than in group II (P = 0.001) and the patients showed a shorter pain duration than those in groups I (P = 0.000) and II (P = 0.001). Group IIIa patients also showed lower visual analogue scale (VAS) ratings for pain descriptors 'heavy' (P = 0.002) and 'tiring' (P = 0.004) than those of group I, and 'dull' (P = 0.005), 'heavy' (P = 0.001) and 'tiring' (P = 0.005) than those of group II. Group IIIa showed lower ratios of contributing factors of 'an awareness of grinding/clenching during sleep' (P = 0.000) and 'an awareness of clenching sensation when waking up at night' (P = 0.002) than those of group I, and also showed a higher ratio of 'a liking for a hard food' (P = 0.000) and lower ratio of 'talking for a long time on the telephone' (P = 0.001) than those of group II. In conclusion, although several properties were different between subtypes, the majority of them were similar in the four subtypes of TMD.

The utility of panoramic radiography in temporomandibular joint assessment

OBJECTIVES

Panoramic radiography was used to determine (1) intrarater and inter-rater reliability in assessing temporomandibular joint (TMJ) condylar morphology; (2) alteration in condylar shape in patients with temporomandibular disorders (TMD) and controls when matched by age, gender, and state of dentition; and (3) prevalence of condylar abnormalities in individuals with and without TMD.

METHODS

One hundred panoramic radiographs were randomly selected from a hospital clinic (45 TMD and 55 non-TMD patients). The images were cropped to include only the temporomandibular apparatus and were independently evaluated by three examiners without knowledge of the patient's clinical status. Multiple statistical tests were performed to evaluate the accumulated data.

RESULTS

Intrarater reliability demonstrated substantial agreement, while inter-rater reliability was fair. There was no difference in condylar morphology between patient groups, but mild condylar change was prevalent in all age groups, regardless of TMD status.

CONCLUSIONS

Morphological condylar abnormalities are present on panoramic images in all adult age ranges, regardless of status of the dentition or presence of TMD. Condylar shape alone is not an indicator of TMD, and minor condylar discrepancies may have no significance in TMD.

Risk factors for diagnostic subgroups of painful temporomandibular disorders (TMD)

Temporomandibular Disorders (TMD) encompass several entities, which may have differing etiologies. To test this hypothesis, we investigated risk factors for three diagnostic subgroups of painful TMD. Ninety-seven subjects with myofascial pain only, 20 with arthralgia only, 157 with both myofascial pain and arthralgia, and 195 controls without TMD pain met criteria for study eligibility. Investigated risk factors included both physical and psychological variables. Adjusted odds ratios were calculated by multiple logistic regression analyses. Myofascial pain occurring alone was significantly associated with trauma (Odds Ratio [OR] = 2.0), clenching (OR = 4.8), third molar removal (OR = 3.2), somatization (OR = 3.7), and female gender (OR = 4.2). Myofascial pain with arthralgia was significantly associated with trauma (OR = 2.1), clenching (OR = 3.3), third molar removal (OR = 4.0), somatization (OR = 5.1), and female gender (OR = 4.7). No significant associations were found for the small-arthralgia-only group.

Need for occlusal therapy and prosthodontic treatment in the management of temporomandibular disorders. Part II: Tooth loss and prosthodontic treatment

The second part of this review, evaluating the literature on the relationship between dental occlusion and temporomandibular disorders (TMDs), focuses on the aetiological importance of tooth loss and the place of prosthodontic replacement in the treatment of TMD. Loss of teeth and lack of posterior occlusal support seem to have little influence on the development of TMD, which calls into question the use of prosthodontic restoration as prevention or treatment for TMD. In addition, there are practically no studies assessing the benefit of instrumental analysis in diagnosis or comparing the outcome of prosthodontic treatment with simple reversible methods in the management of TMD. There is a trend in the current literature to abandon any treatment, including positioning appliances and prosthodontic measures, to 'recapture the disk' in patients with disk displacements because of the favourable, long-term results achieved after using more simple methods. It is concluded that prosthetic therapy in TMD patients is not appropriate for initial TMD treatment and should only be carried out on prosthodontic indications after reversible treatment has alleviated pain and dysfunction.

The clinical significance of the horizontal condylar angle in patients with temporomandibular disorders

Ninety-one patients with unilateral temporomandibular disorders (TMD) were examined using submento-vertex projection radiography and lateral and frontal temporomandibular joint (TMJ) tomography. A comparison between clinical and radiographic findings was made to verify whether patients with TMJ osteoarthritis/osteoarthrosis (OA) tend to have high horizontal condylar angles and to determine the clinical significance of the horizontal condylar angle in the diagnosis of TMD. Our survey results did not confirm higher horizontal condylar angles in condyles with radiographic abnormal findings than in those with normal. However, significantly higher angles were observed in symptomatic TMJs with pain on movement/palpation than in those without (P < 0.05). A tendency toward higher angles was also observed in patients with other clinical findings such as TMJ sound on the symptomatic side and limitation of mouth opening, but there were no significant differences. Thus, the clinical significance of measuring the horizontal condylar angle was demonstrated. Careful diagnosis and treatment is therefore recommended with patients for whom the horizontal condylar angle is high.