Gender difference in prevalence of signs and symptoms of temporomandibular joint disorders: a retrospective study on 243 consecutive patients

Oral behaviors and anxiety are significant predictors of jaw function limitation in patients with anterior disc displacement without reduction

OBJECTIVE

We aimed to describe jaw function characteristics in patients with anterior disc displacement without reduction (ADDWoR) using the jaw function limitation scale (JFLS), and to investigate the effects of biopsychosocial risk factors on limited jaw function.

DESIGN

In this cross-sectional study of 636 patients with ADDWoR (females, 568; males, 68), we used the JFLS to assess jaw function. Behavioral, psychological, sociodemographic, and biomedical data were collected. Multivariate logistic regression analysis was used to determine risk factors affecting limited jaw function. A receiver operating characteristic curve was used to evaluate the predictive effect of these risk factors.

RESULTS

ADDWoR-associated limitations included restricted jaw mobility and mastication, which exceeded median global functional limitations scale scores, especially mouth opening to bite an apple and chewing tough food. Females had greater limitations in jaw mobility, verbal and emotional communication, and overall. Multivariate logistic regression analysis findings indicated that oral behaviors, anxiety, sex, pain intensity, and maximal mouth opening (MMO) were predictive of limited jaw function (area under the curve, 72 %).

CONCLUSION

Patients with ADDWoR reported mastication and jaw mobility restrictions, with females having more pronounced limitations, and specific risk factors identified as significant predictors of jaw function limitations. Along with pain relief and improvement in MMO, appropriate psychological counseling and oral behavioral correction facilitates recovery of jaw function in such patients.

Tobacco smoking and its impact on pain intensity of temporomandibular disorders: A systematic review and metanalysis

BACKGROUND

Temporomandibular disorders (TMDs) encompass a spectrum of orofacial conditions characterised by pain and dysfunction in the temporomandibular joint and surrounding structures. Tobacco smoking has been posited as a potential factor influencing the prevalence and intensity of TMD. However, the nature and extent of this relationship remain unclear due to variations in study outcomes. This systematic review aimed to consolidate existing research findings to elucidate the association between tobacco smoking and TMD pain intensity.

METHODS

A comprehensive search of electronic databases was conducted to identify relevant studies published up to June 2023. Studies investigating the relationship between tobacco smoking and TMD pain were included. Data extraction was conducted by two reviewers. Quality assessment was performed using the New Castle-Ottawa scale. Review Manager 5.4 was used to quantitatively analyse the results.

RESULTS

The review included four studies employing similar TMD assessment techniques. All studies reported elevated TMD pain intensity among tobacco users, with non-smokers exhibiting lower pain intensity. The quality of the included studies was good. Meta-analytic results showed that TMD pain intensity was higher in the smokers group compared to the non-smokers group, with a weighted mean difference (WMD) of 0.65 (BPM) (95% CI: [0.10, 1.19], p = .02).

CONCLUSION

This systematic review provides a comprehensive synthesis of the existing literature on tobacco smoking and TMD symptoms. The findings underscore the multifaceted nature of the relationship between smoking and TMD pain, highlighting its clinical relevance and the need for tailored interventions. Further research is warranted to elucidate underlying mechanisms and potential moderating factors, contributing to a more nuanced understanding of this complex association.

Association between Clinical Manifestations in Temporomandibular Joint Disorders and Corresponding Radiographic Findings

Background: Temporomandibular disorders are common conditions characterized by discomfort within the temporomandibular joints, acoustic changes, and restricted mandibular movement. Accurate diagnosis and subsequent treatment rely heavily on clinical examination, but it is often necessary to add radiological examinations to the diagnostics. Magnetic Resonance Imaging (MRI) is the gold standard for visualizing the disc, while cone-beam computed tomography (CBCT) is primarily used for evaluating condylar morphology. Ultrasound (US) serves as a real-time imaging modality for soft tissues. The objective of the present study was to explore the association between clinical manifestations observed in patients with temporomandibular joint disorders and corresponding radiographic findings. Methods: A total of 63 adult patients (51 female and 12 male) with temporomandibular joint disorders were included in this cross-sectional study. Each patient underwent a clinical examination, followed by appropriate radiological examinations (MRI, CBCT, or US). The level of statistical significance was set at an alpha of 0.05. The Shapiro-Wilk test assessed the normality of numerical variables. The Wilcoxon rank sum test compared two independent groups with non-normally distributed data. Relationships between categorical variables were evaluated using the Pearson chi-square test or Fisher's exact test. The Kendall tau (τ) method analyzed the correlation between two binary variables. Results: The analysis included 63 patients with TMD, predominantly females (80.95%). Ages ranged from 18 to 74 years with a median of 39 years. In the CBCT study, we observed rarefied changes in the left bone structures in patients with bruxism (p = 0.010). MRI and ultrasound imaging revealed changes in patients with limited jaw opening: erosions in the right mandibular head on ultrasound (p = 0.008) and abnormal right bone structures on MRI (p = 0.009). In CBCT, asymmetry in the left joint space was correlated with a high incidence of right side muscle tension (p = 0.004). Additionally, both CBCT and ultrasound showed a correlation between muscle tension and erosion (p = 0.040 in ultrasound, p = 0.020 in CBCT). Acoustic changes, when compared with radiological imaging, were evident in all three studies, like temporomandibular joint pain or palpation. Conclusions: Our study compared three radiographic imaging methods with clinical examinations to assess their correlation with clinical symptoms. Each imaging technique provided unique insights depending on the specific symptoms presented. The observed correlations varied, highlighting the unique contributions of each modality to the diagnostic process. This underscores the importance of employing multiple diagnostic approaches for a thorough assessment of the temporomandibular joint. However, a limitation of our study is the small sample size and the uneven distribution of participants among the groups. Additionally, not all patients underwent every imaging modality.

Mechanisms Underlying Sex Differences in Temporomandibular Disorders and Their Comorbidity with Migraine

Sexual dimorphism in temporomandibular disorders (TMDs) and their comorbidity with migraine are important phenomena observed in clinics. TMDs are the most prevalent orofacial pain conditions with jaw joint and masseter muscle dysfunction. Migraine is the predominant headache commonly associated with TMDs. Women much more often suffer from this orofacial pain than men. However, currently, there is no gender-specific therapy for such pain conditions. Understanding the pathophysiological mechanisms behind sex differences in TMDs as well as their comorbidity with migraines is essential for developing novel approaches for gender-specific treatment of TMDs and related orofacial pain comorbidity. In this review, we summarize recent research progress regarding sex differences in TMDs, focusing on the underlying mechanisms including craniofacial anatomy, hormonal regulation, and roles of opioids, transient receptor potential channels, and endocannabinoid systems. We also discuss the mechanisms of comorbid TMDs and migraine. The information covered in this review will provide mechanistic insights into sex differences in TMDs and their comorbidity with migraine, which could aid in developing effective treatment strategies for the overlapping orofacial pain condition.

Hormone replacement therapy did not alleviate temporomandibular joint inflammatory pain in ovariectomized rats

This study had the aim of examining the relationships between variations in estrogen levels resulting from ovariectomy, and estrogen hormone replacement therapy (HRT) in rats subjected to an orofacial inflammatory pain model. Eighty adult female Wistar rats were initially divided into 2 groups: Sham or ovariectomy (OVX-D1). Seven days later (D7), the rats were subjected to an unilateral infiltration of Freund's Complete Adjuvant (CFA) or saline solution into the right temporomandibular joint (TMJ). Then, rats received 17β-estradiol (28 µg/kg/day) or placebo for 21 days (D10-D31). Nociception was evaluated by the von Frey (VF) and the Hot Plate (HP) tests, and depressive-like behavior by the Forced Swimming (FS) test. On D32 all rats were euthanized and serum, hippocampus and brainstem were collected. The CFA groups presented a mechanical hyperalgesia until day 21 (p ≤ 0.05). No differences were observed among groups in the HP (p = 0.735), and in the immobility and swimming time of the FS (p = 0.800; p = 0.998, respectively). In the brainstem, there was a significant difference in the TNF-ɑ levels (p = 0.043), and a marginal significant difference in BDNF levels (p = 0.054), without differences among groups in the hippocampal BDNF and TNF-ɑ levels (p = 0.232; p = 0.081, respectively). In conclusion, the hormone replacement therapy did not alleviate orofacial pain in ovariectomized rats. However, there is a decrease in brainstem TNF-ɑ levels in the animals submitted to both models, which was partially reverted by HRT.

Is low dose of botulinum toxin effective in controlling chronic pain in sleep bruxism, awake bruxism, and temporomandibular disorder?

OBJECTIVE

To evaluate the effects of low doses of botulinum toxin type A (BoNT-A) to control pain in patients with sleep bruxism (SB), awake bruxism (AB), and temporomandibular disorder (TMD) during 180 days.

METHODS

Overall sample of thirty-five patients with chronic pain related to TMD, SB, and AB received a single dose of 20 U of BoNT-A in masseter and temporalis muscles. The pain was assessed with a visual analog scale (VAS) before and after 15, 30, 60, 90, and 180 days of the application.

RESULTS

The three clinical conditions experienced decrease in pain after 15 days of treatment (p < 0.0001); the maximum pain relief persisted for up to 90 days after BoNT-A application in patients with SB and AB and 15 days for patients with TMD.

CONCLUSION

A low dose of BoNT-A may be effective for controlling chronic pain related to SB and AB, but TMD pain reduction was short-lived.

Exploring the effect of disc displacement on the risk and severity of condylar erosion in adult temporomandibular disorder patients: A CBCT and MRI study

OBJECTIVE

The objective of the study was to investigate the relationship between types of disc displacement (DD) diagnosed by magnetic resonance imaging (MRI), and the risk (presence or absence) and severity of condylar erosion (CE) graded using cone-beam computed tomography (CBCT) in adult Temporomandibular disorders (TMD) patients.

METHODS

A total of 353 TMD patients (283 females, 70 males) underwent MRI scans to categorise DD as normal (NA), anterior displacement with reduction (ADDR), or anterior displacement without reduction (ADDNR). CE severity was graded on a scale of 0-3 (absence, mild, moderate or severe) using CBCT. To establish the plausibility and cut-off points for CE diagnosis, the severity of CE was then further divided into three classifications: Grade 0 versus 1 + 2 + 3; Grades 0 + 1 versus 2 + 3; Grades 0 + 1 + 2 versus 3. Logistic regression analysis was performed, adjusting for age, gender and joint correlation.

RESULTS

ADDNR significantly increased the risk of CE compared with NA (OR = 10.04, 95% CI: [6.41, 15.73]) and showed a significant increase in CE severity across all classifications (ORs = 10.04-18.95). The effects of ADDNR were significant in both genders (p < .001) and had a greater impact in females. ADDR was predominantly associated with mild CE.

CONCLUSIONS

ADDNR significantly increased the risk and severity of CE independent of gender when compared to NA, whereas ADDR was mainly associated with mild CE. Slight cortical discontinuity may represent a subclinical diagnosis requiring further investigation.

The epidemiological profile of temporomandibular joint disorders in the Tunisian population: A cross-sectional study

Objective

This study aimed to explore the prevalence, signs, and symptoms of different types of TMD (Temporomandibular joint disorders) disorders in Tunisian patients.

Methods

A retrospective cross-sectional study was conducted using the clinical records of patients from the Department of Functional Exploration, Pain, and Orofacial Dysfunction of the Dental Clinic of Monastir.

Results

TMD is associated with a female predominance, with a peak prevalence among those aged between 20 and 40 years. Pain and a limited range of motion were significantly more prevalent in women (p = 0.019 and p = 0.012, respectively). Clicking sounds were the most frequent joint noises (38.2 %). Crepitus was more prevalent among older adults (33 %). Of the different types of TMD, disk displacement with reduction was the most prevalent (n = 216, 39 %). Sleep bruxism was more prevalent than awake bruxism (20.7 % VS 9.5 %). Due to the heterogeneous TMD signs and symptoms, patients tend to seek medical attention from various specialties (e.g. neurology and otolaryngology).

Conclusion

The prevalence of different types of TMD, and the different signs and symptoms varied depending on sociodemographic characteristics, such as sex, age and lifestyle. Diagnosis is challenging and TMD may be confused with other orofacial pain conditions.

Ultrasonographic examination of masticatory muscles in patients with TMJ arthralgia and headache attributed to temporomandibular disorders

This study used ultrasonography to compare the thickness and cross-sectional area of the masticatory muscles in patients with temporomandibular joint arthralgia and investigated the differences according to sex and the co-occurrence of headache attributed to temporomandibular disorders (HATMD). The observational study comprised 100 consecutive patients with TMJ arthralgia (71 females and 29 males; mean age, 40.01 ± 17.67 years) divided into two groups: Group 1, including 86 patients with arthralgia alone (60 females; 41.15 ± 17.65 years); and Group 2, including 14 patients with concurrent arthralgia and HATMD (11 females; 33.00 ± 16.72 years). The diagnosis of TMJ arthralgia was based on the diagnostic criteria for temporomandibular disorders. The parameters of the masticatory muscles examined by ultrasonography were subjected to statistical analysis. The pain area (2.23 ± 1.75 vs. 5.79 ± 2.39, p-value = 0.002) and visual analog scale (VAS) score (3.41 ± 1.82 vs. 5.57 ± 12.14, p-value = 0.002) were significantly higher in Group 2 than in Group 1. Muscle thickness (12.58 ± 4.24 mm) and cross-sectional area (4.46 ± 2.57 cm2) were larger in the masseter muscle than in the other three masticatory muscles (p-value < 0.001). When examining sex-based differences, the thickness and area of the masseter and lower temporalis muscles were significantly larger in males (all p-value < 0.05). The area of the masseter muscle (4.67 ± 2.69 vs. 3.18 ± 0.92, p-value = 0.004) and lower temporalis muscle (3.76 ± 0.95 vs. 3.21 ± 1.02, p-value = 0.049) was significantly smaller in Group 2 than in Group 1. An increase in VAS was significantly negatively correlated with the thickness of the masseter (r =  - 0.268) and lower temporalis (r =  - 0.215), and the cross-sectional area of the masseter (r =  - 0.329) and lower temporalis (r =  - 0.293). The masseter and lower temporalis muscles were significantly thinner in females than in males, and their volumes were smaller in patients with TMJ arthralgia and HATMD than in those with TMJ arthralgia alone. HATMD and decreased masseter and lower temporalis muscle volume were associated with increased pain intensity.

Degenerative Temporomandibular Disorders: An Assessment of Bone Trabecular Structure Using Fractal Analysis in Digital Panoramic Radiographs

Introduction Fractal analysis has proved to be a salient tool to quantitatively assess the qualitative changes in the bone trabeculae of patients with hyperparathyroidism, osteoporosis, and various temporomandibular disorders, including osteoarthritis (OA) and rheumatoid arthritis of temporomandibular joint (TMJ), in several previous studies. The purpose of this study was to use fractal analysis to assess alterations in the trabecular pattern of the mandibular condyle in patients with degenerative temporomandibular disorders. Materials and methods This study comprised 98 subjects with 49 subjects in the study group and 49 subjects in the control group, aged 18-50 years. Age and sex in the control group were matched to those in the case group. The subjects were assessed clinically with the Diagnostic Criteria for Temporomandibular Disorders. Digital panoramic X-ray equipment with set parameters of 70 kvp, 8 mA, and 16-second exposure duration was used to take panoramic radiographs. Fractal analysis was done and the calculated fractal dimension value was obtained using ImageJ version 1.48 software (National Institutes of Health, Bethesda, MD). The same observer used Muir and Goss's method to rate the total degenerative changes in the condylar surfaces, which were substantiated by the calculated fractal dimension value. The data were statistically analyzed. Results The results revealed a significant difference (p-value = 0.041) between the mean fractal value in the case group's (1.35) and the control group's (1.38) left sides whereas the differences in the mean fractal values between the case and control groups on the right side was not significant (p-value = 0.49). Conclusion It is recommended to use the fractal dimension value and the total degenerative severity score together to quantify degenerative changes in the TMJ OA rather than exclusively relying on fractal value.

The relationship between the oblique sagittal temporomandibular joint disc position and the volume surface area of the condyle in young TMD adults

The present study aims to compare the volume surface area of the condyle, the horizontal condylar axial angle and the disc-condyle angle between temporomandibular disorder (TMD) and asymptomatic volunteers, explore and analyze the relationship between the temporomandibular joint (TMJ) disc position in oblique sagittal plane and the volume surface area of the condyle in young adults with TMD symptoms. 84 young adult volunteers were received TMJ examination by Magnetic Resonance Imaging (MRI) and Cone Beam Computed Tomography (CBCT). TMD and asymptomatic volunteers were 42 each. MRI was used to assess the position of TMJ disc in the oblique sagittal plane with the condyle apex method. CBCT data were used for three-dimensional (3D) reconstruction of condyle and the measurements of the horizontal condylar axial angle and the volume surface area of the condyle. The condylar volume surface area of the TMD group was smaller than that of the asymptomatic group (p < 0.05), the disc condyle angle was larger than that of the asymptomatic group (p < 0.05), and no significant difference was found in the horizontal condylar axial angle (p > 0.05). In terms of correlation, the volume surface area of the condyle were negatively correlated with the position of the articular disc in TMD patients (p < 0.05). This significant negative correlation suggests that the possibility of disc displacement can be considered when poor condylar morphology is found.

Comparison of Pre- and Posttreatment Airway Volume in Patients with Temporomandibular Joint Disorders Treated with Ultra-Low Frequency Transcutaneous Electrical Nerve Stimulation Using Cone Beam Computed Tomography

Introduction  Temporomandibular joint disorders (TMD) present with a multitude of symptoms that can range from headaches to shoulder pain. Patients frequently present with pain in the ear, dizziness, and vertigo. It is noted that some patients who report TMDs also have a history of sleep disturbances, which is noted in cone beam computed tomography (CBCT) as a reduction in the oropharyngeal airway volume. Objective  To evaluate the airway volume in pre- and posttreatment of TMD with the use of neuromuscular orthotics made with ultra-low frequency transcutaneous electrical nerve stimulation (ULF-TENS). Methods  A total of 15 patients were evaluated for TMDs using the related criteria. Those included were treated with ULF-TENS with evaluation of the airway volume both pre- and posttreatment using CBCT and the Dolphin 3D volume analysis software. Results  While the symptoms were shown to be significantly reduced in patients who were treated with this particular modality, the airway volume varied in those who reported a reduction after a period of 3 months and those that reported after a period of 6 months. Conclusion  Posttreatment evaluation of the airway should be done after a period of 6 months for a more objective evaluation. A multidisciplinary evaluation of the patient is required in such cases.

Association of stress, anxiety, and depression levels with sleep quality in patients with temporomandibular disorders

OBJECTIVE

To examine the psychological symptoms of TMD and their effects on sleep quality in patients with temporomandibular disorders.

METHODS

The study was carried out with 425 consecutive TMD patients who sought care at the oral and maxillofacial surgery clinic of a faculty of dentistry. Perceived Stress Scale-14, Beck Anxiety Scale, and Beck Depression Scale were used to evaluate the psychological state. Sleep quality was evaluated with the Pittsburgh Sleep Quality Index.

RESULTS

The mean sleep score of all participants was 6.52. As the level of anxiety and depression increased, the scores of both total sleep quality and sleep quality components increased significantly p < 0.01. On the other hand, those with poor sleep quality had significantly higher stress, anxiety, and depression levels than those with good sleep quality p < 0.01.

CONCLUSION

Negative emotional situations such as stress, anxiety, and depression seriously impair sleep quality in TMD patients.

Individual Dimensions of Pain Catastrophizing Do Not Mediate the Effect of Sociodemographic and Psychological Factors on Chronic Orofacial Pain Severity, Interference, and Jaw Limitation: A Structural Equation Modeling Approach

Pain catastrophization (PC), involving rumination, magnification, and helplessness, can be viewed as a coping strategy associated with chronic pain. PC is considered a driving force in mediating pain-related outcomes, but it is still unclear whether PC mediates the relationship between psychological and sociodemographic factors with chronic pain when considered in a single model. Using baseline data from a parent study, this study examined the effect of positive and negative psychological and sociodemographic factors on pain severity, interference, and jaw limitation mediated by the PC dimensions in a sample of 397 temporomandibular disorder (TMD) participants using structural equation modeling (SEM). SEM revealed that pain severity regressed on age, sex, education, and income; interference regressed on positive and negative psychological factors, education, and income; and jaw limitation regressed on age. The PC dimensions did not individually mediate these relationships. Although they jointly mediated the relationships between negative psychological factors and pain severity and between age and pain interference, the effect size was small, suggesting that PC is not a critical factor in mediating TMD pain outcomes. Reducing negative cognitions, not just PC, may be of greatest benefit to the most vulnerable TMD populations. PERSPECTIVE: This study examines sociodemographic and psychological factors that affect orofacial pain, finding that the pain catastrophizing dimensions do not mediate these relationships. Understanding which factors most strongly affect pain outcomes will help identify targets for intervention to produce the greatest benefit for the most vulnerable persons suffering from pain.

Malocclusion complexity as an associated factor for temporomandibular disorders. A case-control study

OBJECTIVE

To evaluate the association between temporomandibular disorders (TMD) and malocclusion complexity using the Index of Complexity Outcome and Need (ICON) levels.

METHODS

A prospective, cross-sectional, case and control study was done. Cases and controls were matched in a one-to-one relationship (179 subjects each). The Research Diagnostic Criteria was used to evaluate the presence of TMD, and the ICON was used to quantify malocclusion complexity. A binary logistic regression (p < 0.05) was used to identify associations between variables.

RESULTS

TMD presence was associated with gender and malocclusion complexity (p < 0.05). The largest proportion of controls were in the lowest three levels of ICON complexity, while most cases were in the three highest levels (p < 0.001). Higher malocclusion complexity indicated a greater TMD risk.

CONCLUSION

The results indicate that TMD is associated with malocclusion complexity. As malocclusion complexity increases, so do the odds of presenting with TMD.

The Effect of Photobiomodulation on Temporomandibular Pain and Functions in Patients With Temporomandibular Disorders: An Updated Systematic Review of the Current Randomized Controlled Trials

Introduction: Temporomandibular disorders (TMDs) are the most prevalent non-dental origin orofacial pain conditions affecting the temporomandibular joints (TMJs) and/or orofacial muscles. Photobiomodulation therapy (PBMT) is a conservative way to improve function and reduce symptoms in TMD patients. This systematic review was conducted to update evidence about the effects of PBMT on pain intensity, TMJ movements, electromyography (EMG) activity, pressure pain threshold (PPT), and TMJ sound in patients with TMDs. Methods: A systematic literature search was conducted in Web of Science, PubMed/Medline, and Scopus databases using appropriate keywords and specific strategies from January 2000 to September 2022. Data extraction was done based on the inclusion/exclusion criteria. Results: A total of 40 studies were included. All included studies except one provided information on pain intensity; 27 studies showed a reduction in pain intensity in PBMT groups compared to control groups. Seven out of 15 studies, which reported maximum mouth opening (MMO), showed a greater MMO in PBMT groups than in placebo groups. In addition, the figures for passive maximum mouth opening (PMMO) and active maximum mouth opening (AMMO) in all the studies reporting PMMO and AMMO were higher in PBMT groups. In eight out of ten studies, lateral movement (LM) was greater in PBMT groups. Moreover, in three studies out of four, protrusive movement (PM) was reported to be greater in the PBMT group. Four out of nine studies showed a greater PPT in the PBMT group. Reduced TMJ sounds in the PBMT group were reported in two out of five studies. In addition, in most studies, no difference in EMG activity was detected between the two groups. Conclusion: This updated systematic review showed the promising effects of PBMT on the alleviation of pain and improvement in MMO. Using the infrared diode laser with a wavelength ranging between 780-980 nm, an energy density of<100 J/ cm2, and an output power of≤500 mW for at least six sessions of treatment seems to be a promising option for treating mentioned TMDs signs and symptoms based on the previously reported findings.

Temporomandibular Disorders among Dental Students in Pakistan: Assessment of Prevalence, Severity, and Associated Factors Based on Questionnaire

Objective

To evaluate the prevalence, severity, and associated factors of temporomandibular disorder (TMD) among dental students.

Methods

This cross-sectional study was performed on undergraduate dental students from four dental colleges in Punjab, Pakistan. Fonseca's questionnaire was used to measure the prevalence and severity of the TMD among the study participants. Bivariate and multiple logistic regression analyses were performed.

Results

Of 364 dental students, 323 returned the completed questionnaires and the response rate of the study was 88.7%. The study included 52.6% males and 47.4% females. The prevalence of TMD was 66.9% with mild TMD in 40.90%, moderate TMD in 14.6%, and severe TMD in 11.50% of the participants. Psychological stress (29.6%), malocclusion (20%), and hypersensitivity (19.5%) were common among participants. The mean TMD score of the sample was 31.54 ± 24.86 which was significantly higher among participants with no/school-educated mothers (P=0.021) and fathers (P=0.002). The participants with arthritis (72.81 ± 32.19) and malocclusion (59.46 ± 31.09) and those who received orthodontic treatment (53.21 ± 34.21) demonstrated higher TMD. After controlling for other study variables, the participants with arthritis were 4.71 times more likely to have moderate/severe TMD (P=0.042) than those without arthritis. Similarly, the participants with malocclusion had significantly higher odds (OR = 3.57, P=0.029) of having moderate/severe TMD than those without malocclusion.

Conclusion

This sample of dental students demonstrated a high prevalence and severity of TMD. The participants with arthritis and malocclusion demonstrated higher TMD. The study findings underscore the importance of prevention, early diagnosis, and management of TMD among the dental students.

Neural Correlates of Tooth Clenching in Patients with Bruxism and Temporomandibular Disorder-Related Pain

AIMS

To measure brain activity in patients with bruxism and temporomandibular disorder (TMD)-related pain in comparison to controls using functional magnetic resonance imaging (fMRI) and to investigate whether modulations in jaw clenching led to different pain reports and/or changes in neural activity in motor and pain processing areas within and between both groups.

METHODS

A total of 40 participants (21 patients with bruxism and TMD-related pain and 19 healthy controls) performed a tooth-clenching task while lying inside a 3T MRI scanner. Participants were instructed to mildly or strongly clench their teeth for brief periods of 12 seconds and to subsequently rate their clenching intensity and pain experience after each clenching period.

RESULTS

Patients reported significantly more pain during strong clenching compared to mild clenching. Further results showed significant differences between patients and controls in activity in areas of brain networks commonly associated with pain processing, which were also correlated with reported pain intensity. There was no evidence for differences in activity in motor-related areas between groups, which contrasts with findings of previous research.

CONCLUSIONS

Brain activity in patients with bruxism and TMD-related pain is correlated more with pain processing than with motoric differences.

Effectiveness of Physical Therapy Interventions for Temporomandibular Disorders Associated with Tinnitus: A Systematic Review

Temporomandibular disorders (TMDs) refers to different clinical conditions affecting the temporomandibular joints, masticatory muscles, and adjacent structures. Although TMDs signs and symptoms (e.g., pain and limited mouth opening) are common, otological symptoms, such as tinnitus, might also be present. This study aims to summarize the evidence of the effectiveness of physical therapy interventions in individuals with TMDs associated with tinnitus. Randomized controlled trials investigating the effectiveness of physical therapy in individuals of both genders aged 18 or older with TMDs associated with tinnitus were included. The electronic search was performed in the following databases: MEDLINE, EMBASE, CINAHL, PEDro and CENTRAL. A total of four studies were included. All studies showed that physical therapy reduced the intensity of tinnitus, and two trials showed a decrease in the pain intensity caused by TMDs, an increase in the pressure pain thresholds in the masticatory muscles and an improvement of mandibular function. Two studies presented a low risk of bias. Despite a low certainty of the evidence, this review showed that physical therapy reduces the intensity or severity of tinnitus associated with TMDs. Results may support future research on the topic and evidence-based practice by recommending the best physical therapy approach for patients, clinicians, researchers, and health system managers.

Surface electromyography evaluation of selected manual and physical therapy interventions in women with temporomandibular joint pain and limited mobility. Randomized controlled trial (RCT)

Non-invasive approach is gaining an increasing recognition in the TMD patients management. It is therefore reasonable to conduct RCTs evaluating the effectiveness of both physical and manual physiotherapy interventions. The aim of this study was to evaluate the short-term efficacy of selected physiotherapeutic interventions and their effect on the bioelectrical function of the masseter muscle in patients with pain and limited TMJ mobility. The study was conducted on a group of 186 women (T) with the Ib disorder diagnosed in DC/TMD. The control group consisted of 104 women without diagnosed TMDs. Diagnostic procedures were performed in both groups. The G1 group was randomly divided into 7 therapeutic groups in which the therapy was carried out for 10 days: magnetostimulation (T1), magnetoledotherapy (T2), magnetolaserotherapy (T3), manual therapy- positional release and therapeutic exercises (T4), manual therapy - massage and therapeutic exercises (T5), manual therapy - PIR and therapeutic exercises (T6), self therapy - therapeutic exercises (T7). In the T4 and T5 groups, the treatments led to complete resolution of pain after the 10th day of therapy and to the largest minimal clinically significant difference in the MMO and LM parameter. GEE model for PC1 values using treatment method and time point showed that T4, T5 and T6 treatments had the strongest effect on the parameters studied. Therefore, it may be concluded that SEMG testing is a helpful indicator to assess the therapeutic effectiveness of physiotherapeutic interventions.

BACKGROUND

Non-invasive approach is gaining an increasing recognition in the TMD patients management. It is therefore reasonable to conduct RCTs evaluating the effectiveness of both physical and manual physiotherapy interventions in a qualitative and quantitative manner. However, there were numerous controversies reported regarding the use of surface electromyography (SEMG) in Orofacial Pain patients. Therefore, we wanted to assess the effectiveness of physiotherapy interventions in TMD patients using SEMG.

PURPOSE

Evaluation of the short-term efficacy of selected physiotherapeutic interventions and their effect on the bioelectrical function of the masseter muscle in patients with pain and limited TMJ mobility.

MATERIAL AND METHODS

The study was conducted on a group of 186 women (T) with the Ib disorder diagnosed in DC/TMD (Ib - myofascial pain with restricted mobility). The control group consisted of 104 women without diagnosed TMDs (normal reference values for TMJ ROM and masseter muscle SEMG bioelectric activity). Diagnostic procedures were performed in both groups (SEMG of the masseter muscles at baseline and during exercise, measurement of TMJ mobility, assessment of pain intensity - NRS scale). The G1 group was randomly divided into 7 therapeutic groups in which the therapy was carried out for 10 days: magnetostimulation (T1), magnetoledotherapy (T2), magnetolaserotherapy (T3), manual therapy- positional release and therapeutic exercises (T4), manual therapy - massage and therapeutic exercises (T5), manual therapy - PIR and therapeutic exercises (T6), self-therapy - therapeutic exercises (T7). Each time after therapy, the intensity of pain and TMJ mobility were assessed. Sealed, opaque envelopes were used for randomization. After 5 and 10 days of therapy, bilateral SEMG signals of the masseter muscles were acquired. PC1 factor analysis was performed. A score of 99% in the PC1 parameter, demonstrates the clinical relevance of electromyography (MVC).

RESULTS

Synergism of physical factors will lead to a higher MID on the NRS scale. Evaluating the MID of the therapeutic interventions used showed a better therapeutic effect of manual interventions over physical and self-therapy. In the T4 and T5 groups, the treatments led to complete resolution of pain after the 10th day of therapy and to the largest minimal clinically significant difference in the MMO and LM parameter. GEE model for PC1 values using treatment method and time point showed that T4, T5 and T6 treatments had the strongest effect on the parameters studied.

CONCLUSIONS

1. Exercise SEMG testing is a helpful indicator to assess the therapeutic effectiveness of physiotherapy interventions. 2. Manual therapy treatments are superior to physical treatments in their relaxation and analgesic efficacy and should therefore be prescribed as a first line non-invasive intervention for TMD pain patients.

Examination for the Factors Involving to Joint Effusion in Patients with Temporomandibular Disorders Using Magnetic Resonance Imaging

BACKGROUND

This study investigated the factors involving joint effusion in patients with temporomandibular disorders.

METHODS

The magnetic resonance images of 131 temporomandibular joints (TMJs) of patients with temporomandibular disorders were evaluated. Gender, age, disease classification, duration of manifestation, muscle pain, TMJ pain, jaw opening disturbance, disc displacement with and without reduction, deformation of the articular disc, deformation of bone, and joint effusion were investigated. Differences in the appearance of symptoms and observations were evaluated using cross-tabulation. The differences in the amounts of synovial fluid in joint effusion vs. duration of manifestation were analyzed using the Kruskal-Wallis test. Multiple logistic regression analysis was performed to analyze the factors contributing to joint effusion.

RESULTS

Manifestation duration was significantly longer when joint effusion was not recognized (p < 0.05). Arthralgia and deformation of the articular disc were related to a high risk of joint effusion (p < 0.05).

CONCLUSIONS

The results of this study suggest that joint effusion recognized in magnetic resonance imaging was easily observed when the manifestation duration was short, and arthralgia and deformation of the articular disc were related to a higher risk of joint effusion.

Sensory Neuron-TRPV4 Modulates Temporomandibular Disorder Pain Via CGRP in Mice

Temporomandibular disorder (TMD) pain that involves inflammation and injury in the temporomandibular joint (TMJ) and/or masticatory muscle is the most common form of orofacial pain. We recently found that transient receptor potential vanilloid-4 (TRPV4) in trigeminal ganglion (TG) neurons is upregulated after TMJ inflammation, and TRPV4 coexpresses with calcitonin gene-related peptide (CGRP) in TMJ-innervating TG neurons. Here, we extended these findings to determine the specific contribution of TRPV4 in TG neurons to TMD pain, and examine whether sensory neuron-TRPV4 modulates TMD pain via CGRP. In mouse models of TMJ inflammation or masseter muscle injury, sensory neuron-Trpv4 conditional knockout (cKO) mice displayed reduced pain. Coexpression of TRPV4 and CGRP in TMJ- or masseter muscle-innervating TG neurons was increased after TMJ inflammation and masseter muscle injury, respectively. Activation of TRPV4-expressing TG neurons triggered secretion of CGRP, which was associated with increased levels of CGRP in peri-TMJ tissues, masseter muscle, spinal trigeminal nucleus, and plasma in both models. Local injection of CGRP into the TMJ or masseter muscle evoked acute pain in naïve mice, while blockade of CGRP receptor attenuated pain in mouse models of TMD. These results suggest that TRPV4 in TG neurons contributes to TMD pain by potentiating CGRP secretion. PERSPECTIVE: This study demonstrates that activation of TRPV4 in TG sensory neurons drives pain by potentiating the release of pain mediator CGRP in mouse models of TMJ inflammation and masseter muscle injury. Targeting TRPV4 and CGRP may be of clinical potential in alleviating TMD pain.

[Dental condiction of patients with temporomandibular dysfunction]

OBJECTIVE

To evaluate the dental condition and the vertical dimension in patients with TMD, and the age and origin of the DTM.

METHODS

Was performed a descriptive study, observational, cross-sectional, with a sample of thirty patients with TMD, diagnosed by Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). This sample was determined based on estimates the service thus a sample of convenience. The association between gender, age, vertical dimension and dental condition with TMD were verified using the chi-square statistical test with 95% confidence intervals.

RESULTS

It found that 26 patients were female and 4 males. Fifteen subjects presented aged below 36.5 years. How much the origin of the DTM, 19 subjects had articular disorder, and 11 muscle disorder. Has been determined that there was no statistically significant association between the independent variables with the DTM.

CONCLUSION

The etiological factors analyzed in isolation do not seem to influence in a unique way in the development of TMD, but may act together with other factors, because the cause is multifactorial.

Assessment of the severity of temporomandibular disorders in females: Validity and reliability of the Fonseca anamnestic index

OBJECTIVE

To evaluate the validity and reliability of the Fonseca anamnestic index (FAI) over time in Turkish females.

METHODS

Four hundred-fourteen patients who visited the otorhinolaryngology clinic were initially included in the study between January 1, 2018 and January 1, 2019. The Turkish version of the FAI is a self-report instrument that was completed by all of the patients after a brief explanation from the clinician. Cronbach's alpha was calculated using data from the first questionnaire.

RESULTS

The results of the first assessment showed 243 patients had no TMD (58.7%), 40 had mild TMD (9.7%), 87 had moderate TMD (21%), and 44 had severe TMD (10.6%). At the second assessment, the respective values were 243 (58.7%), 37 (8.9%), 98 (23.7%), and 36 (8.7%). The internal consistency of the first test was high.

CONCLUSION

The FAI can be used to collect a large amount of data easily, at minimal cost.

Clinical Evaluation of Intra-Articular Injection of Chondroitin Sulfate and Sodium Hyaluronate in the Management of Degenerative Osteoarthritis of Temporomandibular Joint

AIM: This study aims to evaluate the effectiveness of intra-articular injection of chondroitin sulfate and sodium hyaluronate in cases of temporomandibular joint (TMJ) degenerative osteoarthritis. MATERIAL AND METHODS: Thirty patients ASA I of both sexes, who were selected from outpatient clinic of Oral Surgery Department, Faculty of Dentistry – Suez Canal University, complaining of painful TMJ, presence of unilateral or bilateral TMJ pain, impairment of jaw movements, and joint sounds. Clinical examination was performed to all patients and pre-operative measurements of visual analog scale (VAS) for morning pain, pain with movement and spontaneous pain, maximum mouth opening, and presence or absence of clicking. Patients were randomly divided into two groups; (a) Study group consisted of 15 patients, they had intra-articular injection of chondroitin sulfate and sodium hyaluronate once weekly for 3 weeks and (b) control group consisted of 15 patients, they had intra-articular injection of sodium hyaluronate once weekly for 3 weeks. Post-operative measurements of VAS for previous pain types, maximum mouth opening, and clicking were obtained at 1 month, 3 months, and 6 months post-injection. RESULTS: There was a statistically significant reduction of all types of pain in the study group compared to the control group at all time intervals (p ≤ 0.05), for maximum mouth opening, there was a significant improvement in mouth opening in the study group for all time intervals (p ≤ 0.05), but for the clicking, there was not statistically significant difference between the study and control groups after 1 month, 3 months, and 6 months. The difference between groups was barely statistically significant (p = 0.05). CONCLUSION: Intra-articular injection of a combination of chondroitin sulfate and sodium hyaluronate is an effective tool in reducing pain, clicking, limited mouth opening, and other symptoms associated with degenerative TMJ diseases.

The Efficacy of Ozonized Water Versus Ringer Lactate Arthrocentesis for the Treatment of Temporomandibular Joint Internal Derangement

BACKGROUND

Temporomandibular disorders are musculoskeletal conditions characterized by facial pain and impaired temporomandibular joint function, limited mouth opening, joint and muscular pain, and noises during mandibular movements are some of the most common symptoms. The most frequent cause of temporomandibular joint dysfunction is internal derangement (ID), which refers to an alteration in the normal pathways of motion of the joint that largely involves the function of the articular disc, therefore, these alterations have been also referred to as disc derangement. Arthrocentesis is a minimally invasive technique, less expensive than surgical treatment. Adhesions are released after arthrocentesis of the upper joint space under sufficient hydraulic pressure. Intra-articular ozone gas injection is used as conservative treatment modalities for ID of the temporomandibular as it possesses anti-inflammatory, analgesic effects, enhancement the host defense mechanism and accelerates the healing process of the damaged cells.

AIM

The aim of this study was to compare the effectiveness of ozonized water against lactated ringer solution in the arthrocentesis of the temporomandibular joint.

PATIENTS AND METHODS

Sixty patients were used in this study, suffered from ID of the temporomandibular joint treated by arthrocentesis under hydraulic pressure and were allocated into 2 groups; the study group (A), which included 30 patients, managed by arthrocentesis utilizing ozonized water and the control group (B) with 30 patients also treated by the same procedure using ringer lactate solution. Visual analog scale pain scores, temporomandibular joint sounds, and maximal mouth opening were assessed preoperatively and at different intervals postoperatively.

RESULTS

The age in this study ranged from 14 to 66 years. The mean age of group A was 29.93 years with an SD of ±11.79. For group B, the mean age was 27.56 years and the SD was ±10.80, the prominent percentage in both groups was <30 years. Regarding sex, 45 patients were females, whereas the males were 15 with a ratio of 3:1. Group A registered the highest reduction in the visual analog scale at all postoperative intervals. With respect to the mouth opening, there was no significant difference in maximal mouth opening between the 2 groups after 1 week and 12 weeks in comparison with the preoperative measurements. The temporomandibular joint sounds improved in all patients in group A after 12 weeks, whereas in group B the sounds dropped to 33.3%.

CONCLUSION

The data from the present study suggested more favorable treatment outcomes for ozonized water lavage and it is a promising new treatment modality for the relief of symptoms associated with the ID of the temporomandibular joint.

Relationship Analogy between Sleep Bruxism and Temporomandibular Disorders in Children: A Narrative Review

Sleep bruxism (SB) is a condition characterized by repetitive clenching or grinding teeth and/or by bracing or thrusting of the mandible during sleep. Although SB is not considered a disorder in children, SB can be a potential physical and psychological hazard or consequence, and this study examines whether SB is a risk factor for TMD as it is in adults. A narrative review on the topic of inferring the relationship between sleep bruxism and TMD in children was performed based on a search in the PubMed and Google Scholar databases for articles published between 1999 and 2022. A total of 76 articles were included in this review. SB is very common in children, may be related to psychological distress or sleep breathing disorder, with a prevalence of up to 49%, and mainly occurs in the non-rapid eye movement stage in the sleep structure. SB may be one cause of TMD. The prevalence of TMD in children is 16–33%. Compared to the female-dominant TMD prevalence in adults, the sex-differences in TMD prevalence in children are less pronounced. However, TMD-related pain is more prevalent in girls than in boys. Given the complex etiology of each of SB and TMD in children, it can be inferred that the explanation of the relationship between the two conditions is very challenging. Ultimately, their relationship should be understood in the individual biopsychosocial model in the process of special physical growth and mental development of children. Moreover, appropriate clinical guidelines for a definitive diagnosis of SB and TMD in children and more research with a high scientific evidence level, which is comprehensive, considering physical, psychological, genetic, and social cultural factors, are required.

Evaluation of the effect of T-Scan™ as an adjunct to stabilization splint in the treatment of temporomandibular joint disorders

OBJECTIVE

To assess the effectiveness of the stabilization splint (SS) combined with the T-Scan™ III system in the treatment of temporomandibular joint disorder (TMD) with myofascial pain.

METHODS

Forty-eight enrolled patients were randomly assigned to the SS group or T-Scan™-guided SS group. Mandibular Function Impairment Questionnaire (MFIQ), Maximum Comfortable Opening (MCO), Visual Analog Scale (VAS), and Patient Health Questionnaire-9 (PHQ-9) were used as the outcome variables.

RESULTS

The occlusal contacts of patients in the SS plus T-Scan™ group showed lower Occlusal Time (OT), Disocclusion Time (DT), and Asymmetry Index of Occlusal Force (AOF) after occlusal adjustment under the guidance of the T-Scan™. Importantly, the TMD symptoms were alleviated more obviously in SS plus T-Scan™ group, with better scores for MCO and MFIQ.

CONCLUSION

T-Scan™-guided occlusal adjustment of SS can obtain better OT, DT, and AOF, which furthers improvement of the therapeutic effects on TMD with myofascial pain.

The TMD-7 as a Brief Measure for Assessing Temporomandibular Disorder

OBJECTIVES

 The aim of this cross-sectional prospective study was to determine the internal consistency of the TMD-7, and compare prevalence of TMD symptoms in an adult population.

MATERIALS AND METHODS

 Upon presenting to the orthodontic screening appointment, a total of 440 subjects (316 females and 124 males) were asked to complete the TMD-7 questionnaire. A total of 108 of the participants were later excluded from the study either due to the duplicate or missing responses. The final sample consisted of data from 332 participants (232 females and 100 males), aged between 18 and 64 (mean age: 42.9 ± 9.0) years.

STATISTICAL ANALYSIS

 Cronbach's α statistics were calculated to assess internal consistency. Comparisons between genders, among age categories, and between subjects with versus without prior orthodontic treatment were performed using Wilcoxon ranks sum and Kruskal-Wallis tests. Comparisons for differences in the individual TMD-7 item ratings were performed using Mantel-Haenszel chi-square tests for ordered categorical responses.

RESULTS

 The calculated Cronbach's α for TMD-7 scale was 0.77. No statistically significant differences were found in the TMD-7 scale score or the individual TMD-7 item ratings between age categories (p = 0.993). Females had significantly higher TMD-7 scale score and higher ratings for headache, pain in jaw, pain in neck, pain in forehead, difficulty opening mouth, and difficulty while eating (p < 0.05). No statistically significant differences were found in the TMD-7 scale score or the individual TMD-7 item ratings between subjects with versus without previous orthodontic treatment (p = 0.075).

CONCLUSION

 The TMD-7 tool has good internal consistency and can be used reliably for assessment of TMD symptoms in adults. The use of this tool revealed no significant differences between age groups or between subjects with or without previous orthodontic treatment. However, a significant female gender predisposition for TMD symptoms in the adulthood was determined.

Effects of sarcopenia and sarcopenic obesity on joint pain and degenerative osteoarthritis in postmenopausal women

This study aimed to identify the prevalence of sarcopenia, obesity, and sarcopenic obesity and examine their association with radiographic knee osteoarthritis (OA) and knee pain in Korean postmenopausal women. This cross-sectional study utilized the data from Korean National Health and Nutrition Examination Surveys 2009–2011. The participants were categorized into 4 groups based on body composition: either sarcopenic (appendicular skeletal muscle < 23%) or not, either obese (body mass index ≥ 25.0 kg/m²) or not. The prevalence of radiographic knee OA and knee pain was calculated. The effect of hormone replacement therapy (HRT) was also evaluated. The prevalence of radiographic knee OA, knee pain, and both were all highest in the sarcopenic obese group and lowest in the control group (61.49% vs. 41.54%, 39.11% vs. 27.55%, 32.04% vs. 17.82%, all p < 0.001). Without sarcopenia, obese women showed significantly higher ratio of radiographic knee OA only (57.64% vs. 41.54%, p < 0.001). With sarcopenia, the coexistence of obesity presented higher ratio of radiographic knee OA, knee pain, and both compared to sarcopenia without obesity (61.49% vs. 41.82%, 39.11% vs. 27.61%, 32.04% vs. 17.60%, all p < 0.001). The use of HRT for more than 1 year was not associated with radiographic knee OA, knee pain, or both (p = 0.147, 0.689 and 0.649, respectively). Obesity with sarcopenia had greater effect on knee OA compared to obesity without sarcopenia. Moreover, HRT use for more than 1 year was not associated with the prevalence of knee OA. Therefore, more efforts should focus on reducing body fat and increasing muscle in postmenopausal women with knee OA.

Oral medicine services: a two-centre study of 99,603 patients between 2015 and 2020

Objective

This study aimed to investigate the patterns of patients managed at the oral medicine service centres at the Faculty of Dentistry, University of Otago, New Zealand and Weifang People’s Hospital, Weifang, China.

Materials and methods

Patients’ clinical records were collected from 2015 to 2020. Patient data from electronic and paper records were examined. The data included in this study for each patient were age, sex, ethnicity, source of referral, clinical investigation, diagnosis, and management.

Results

There were 99,603 patients included in the analysis. Most of the patients (56.5%–71.0%) were women aged 50 to 70 years. Referrals were typically from internal sources (20.0%–52.7%), medical practitioners (27.5%–29.6%), and dental practitioners (18.3%–28.3%). The main clinical investigations included blood tests (22.1%–25.4%), diagnostic imaging (12.2%–28.3%), and biopsy (9.4%–12.8%). Oral and maxillofacial pathology accounted for 73.9% to 83.3% of all diagnoses. The main treatment was self-care (15.2%–36.6%), and the most prescribed medication was a corticosteroid (26.4%–30.2%).

Conclusions

Most patients in oral medicine clinics were 50 to 70-year-old women. Blood tests, imaging, and biopsy were the main clinical investigations. Most of the diagnoses were oromucosal diseases. The main treatments were self-care and corticosteroid prescriptions.

"Testosterone decreases temporomandibular joint nociception"- A systematic review of studies on animal models

OBJECTIVE

The aim of the present systematic review was to assess the effect of testosterone on temporomandibular joint (TMJ) nociception.

DESIGN

A systematic review of pertinent indexed literature was performed. The focused question addressed was "Is there a connection between testosterone and TMJ nociception?" Original studies were included. In-vitro and ex-vivo studies, case-reports/series, letters to the Editor and commentaries were not sought. Indexed databases were searched without time and language restrictions up to and including September 2021 using different free text key words: testosterone OR "male sex hormones" OR "gonadal hormones" AND "temporomandibular joint" OR "temporomandibular dysfunction" AND nociception AND males. The literature search was performed in accordance with the preferred reporting outcomes of systematic reviews and meta-analysis guidelines. The risk of bias (RoB) was assessed using the SYstematic Review Centre for Laboratory animal Experimentation (SYRCLE) tool.

RESULTS

Out of the 406 studies identified, seven studies on animal-models were included. All studies were performed in rats with age and weight ranging between 21 and 90 days and 200-300 g, respectively. Testosterone was administered in concentrations ranging between 1 and 10 mg/Kg. Results from all studies showed that testosterone administration in gonadectomized male rats reduces induced TMJ nociception. The RoB was high in 3 and unclear in 4 studies.

CONCLUSION

Testosterone offers protection against TMJ nociception in male rats; however, from a clinical perspective, potential contribution of testosterone therapy towards the management of TMD remains indeterminate.

Prevalence of signs and symptoms of temporomandibular disorder in the metropolitan region of Rio De Janeiro: A population-based cross-sectional study

OBJECTIVE

Temporomandibular disorder (TMD) is a group of heterogeneous pathological conditions that affect the temporomandibular joint (TMJ), mastication muscles, and some associated structures. The aim of this study was to measure the prevalence of signs and symptoms of dysfunction, including knowledge of TMD in a stratum of the population.

METHODS

A population extract from Rio de Janeiro subdivided by conglomerates was interviewed through an online form.

RESULTS

The results showed that only 19% of the participants had no symptoms related to TMD.

CONCLUSION

The results showed that the symptom prevalence is directly related to knowledge and practices about the disorder and that its presence may be under-reported.

Efficacy of the use of chondroitin sulphate and glucosamine for the treatment of temporomandibular joint dysfunction: A systematic review and meta-analysis

OBJECTIVE

To evaluate the efficacy of chondroitin sulfate (CS) and glucosamine (GS), the most relevant drugs of "Symptomatic Slow Acting Drug for Osteoarthritis" (SYSADOA), in the functional and symptomatic improvement of temporomandibular dysfunction. Although, controversy exists regarding their benefit.

METHODS

An electronic search was conducted to retrieve randomized controlled clinical trials (RCTs). The risk of bias assessment was evaluated using the Cochrane Collaboration's tool. Data were meta-analyzed with a random effect model whenever possible.

RESULTS

Three RCTs were included. Qualitative results showed a decrease in pain, joint noise, and inflammatory biomarkers in synovial fluid and an improvement in maximum mouth opening without significant adverse effects. Meta-analysis showed a significant increase in maximum mouth opening with the use of CS-GS (p = 0.19). No statistically significant differences were found in pain reduction compared to tramadol.

CONCLUSION

CS-GS is effective and safe in the symptomatic and functional improvement of patients with TMD.

Temporomandibular joints disorders (TMDs) prevalence and their relation to anxiety in dental students

Background: Temporomandibular joint disorders (TMDs) are very common disorders affecting the population and causing pain. Researchers have reported a high prevalence of TMDs among university students due to increased distress. The aims of this study were to determine the frequency of TMDs in Umm al-Qura University (UQU) dental students using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), and to examine the relationship between anxiety, bruxism, and TMDs among those students. Methods: The DC/TMD pain screener questionnaire was completed by dental students. Students who reported TMD pain or had at least one positive TMD symptom were invited to the dental clinic for a full TMJ evaluation. History of bruxism was documented and an ultra-brief tool for detecting anxiety and depression (Patient Health Questionnaire-4 PHQ) was completed by all students. Results: A total of 240 students responded to the TMD pain screener in which 119 reported at least one TMJ symptom. Only 93 dental students presented to clinical examination in which 64.5% (n=60) of them had temporomandibular joint disorders. Disc displacement with reduction and local myalgia (38.7% & 32.25%, respectively) were the most frequent diagnosis. A total of 29% (n=27) of students had more than one diagnosis. Overall, 41 participants (44.09%) reported a positive response to the anxiety scale and (n=38) 40% of participants reported parafunctional habits. Both the history of bruxism and anxiety were significantly related to TMDs (P=0.0002) and also significantly higher in women of higher academic years (P≤0.01). Conclusions: This study found a high prevalence of TMDs among UQU dental students. Disc displacement with reduction was the most prevalent disorder. Bruxism and anxiety were associated with painful TMDs.

Imaging of the Temporomandibular Joint

Temporomandibular disorder (TMD) is a common musculoskeletal condition that causes pain and disability for patients and imposes a high financial burden on the healthcare system. The most common cause of TMD is internal derangement, mainly secondary to articular disc displacement. Multiple other pathologies such as inflammatory arthritis, infection, and neoplasm can mimic internal derangement. MRI is the modality of choice for evaluation of the TMJ. Radiologists need to be familiar with the normal anatomy and function of the TMJ and MR imaging of the internal derangement and other less common pathologies of the TMJ.

Masticatory Muscle Thickness and Activity Correlates to Eyeball Length, Intraocular Pressure, Retinal and Choroidal Thickness in Healthy Women versus Women with Myopia

This study aims to examine the correlations between masticatory and neck muscle thickness and activity versus eyeball length, retinal thickness, choroidal thickness, and intraocular pressure in healthy women versus women with myopia. The study group consisted of 21 women aged 24 years and a control group of 19 women (mean age 23 years). For bioelectrical activity analysis within the temporalis anterior, the superficial part of the masseter muscle, the middle part of the sternocleidomastoid muscle, and the anterior belly of the digastric muscle, an eight-channel BioEMG III electromyograph were used. An M-Turbo ultrasound machine was used to analyze masticatory and neck muscle thickness. The eyeball length was examined by IOL Master 500; choroidal and retinal thickness by Optovue Angiovue; and intraocular pressure by Tono-Pen XL. Refractive errors are related to differences in muscle thickness and electromyographic activity. Bioelectrical activity within the temporalis anterior seems to be associated with ocular length, retinal thickness, and choroidal thickness in women with myopia.

Comparison of factors affecting patients with a myofascial temporomandibular disorder with and without sleep bruxism

Aims and Background

The aim of the present study was to evaluate the relationship between jaw function, neck disability, sleep quality, fatigue, and headache in patients with myofascial temporomandibular disorder (TMD) with sleep Bruxism (SB) and without it (non-SB).

Subjects and Methods

This case-control study was conducted with a total of 200 myofascial TMD patients, comprising 91 identified as SB and 109 as non-SB. The Jaw Function Limitations Scale (JFLS), Neck Disability Index (NDI), Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), and Headache Impact Test-6 (HIT-6) scales and indexes were used.

Results

In the group with SB compared to the non-SB group, JFLS, NDI, PUKI, and FSS scores were statistically significantly higher (P < 0.001). No statistically significant difference was found between the groups in terms of visual analog scale (VAS) (P = 0.127) and HIT-6 scores (P = 0.365). The probability of having JFLS in patients with SB compared to those without was folded 3.551 times (P = 0.002), and the probability of having NDI increased 3.473 times (P = 0.002). In addition, SB was observed to trigger poor sleep quality (P < 0.001). There was no statistically significant determinant of bruxism on FSS (P = 0.196), and on HIT-6 (P = 0.488).

Conclusion

It can be concluded that SB causes limitation of the jaw's functional activities, neck problems, and decreased sleep quality in myofascial TMD. These findings emphasize the importance of considering SB when evaluating and treating patients with myofascial TMD problems.

MRI-based observation of the size and morphology of temporomandibular joint articular disc and condyle in young asymptomatic adults

OBJECTIVE

To investigate the size and morphology of the temporomandibular joint (TMJ) articular disc and condyle in young asymptomatic adults by using magnetic resonance imaging (MRI) and to provide a reference for clinical diagnosis and scientific study of temporomandibular disorders (TMD).

METHODS

Overall, 93 undergraduate volunteers without TMD were enrolled from the freshmen pool at the Qingdao University. All participants underwent MRI of the oblique sagittal and oblique coronal TMJ planes. The articular disc and condyle were subsequently measured, and their morphology was evaluated. The obtained data were then grouped and analyzed statistically. Finally, intragroup correlation coefficient (ICC) was used to evaluate the interobserver measurement reliability.

RESULTS

We totally received 186 TMJ imaging samples. Based on our analysis, disc's anterior band in young asymptomatic adult females were thicker than males of the same age (p = 0.024). Moreover, the media-lateral dimensions of the condylar head of adult females were shorter than males of equal age (P＜0.001). The bilateral articular disc morphology was the same in 72.4% of subjects while the condylar morphology was the same in 63.4% of participants. Finally, using measurement reliability assessment, we demonstrated that our conclusions are reliable (ICC ≥0.7).

CONCLUSION

The thickness of the anterior band of the disc and the media-lateral dimensions of the condylar head were gender-related. Additionally, the morphology of the bilateral articular disc and condyle was different among the subset of young asymptomatic adults.

Inclination of the osseous components of the temporomandibular joint related with disc displacement: Magnetic resonance and cone beam computed tomography imaging-based study

OBJECTIVE

To assess the association between three-dimensional inclination of the osseous structures of temporomandibular joints (TMJ) and the risk of disc displacement (DD).

METHODS

The 120 TMJs of 60 patients were evaluated. According to magnetic resonance images, disc position was classified as normal, anterior DD with reduction (ADDWR) and without reduction (ADDWoR) and as normal, medial DD (MDD), and lateral DD (LDD) on the sagittal and coronal views, respectively. Condyle and eminence inclinations were measured using cone beam computed tomography.

RESULTS

Smaller horizontal condylar inclination was associated with ADDWoR (p < 0.05). Larger coronal condylar inclination was associated with ADDWR (p < 0.05) and LDD (p < 0.05). There was no association between sagittal eminence inclination and DD (p < 0.05).

CONCLUSION

Medial condylar rotation in the axial view may be associated with ADDWoR. The condyle head horizontally inclined in the coronal view may be associated with ADDWR and LDD.

Patients' perceptions on temporomandibular disorder treatment with hydrostatic oral splints - a pilot study

Objective

To evaluate temporomandibular disorder (TMD) treatment with a prefabricated, hydrostatic oral splint (HOS) based on self-reported patient’s symptoms using a standardized questionnaire.

Methods

Two hundred fifty-eight questionnaires from patients diagnosed with TMD and subsequently treated with HOS were collected from two independent private practices. Based on patient’s comfort the questionnaire recorded TMD symptoms and symptom regression. Descriptive and comparative statistics was carried out using SPSS.

Results

A total of 221 questionnaires were analyzed. Patients reported TMD symptoms such as pain (93.2%), TMJ clicking (66.1%), headache (25.8%), cervical spine disorders (23.5%), restricted mouth opening (22.6%) and tinnitus (11.8%). For most symptoms, improvement was reported mostly after two weeks, except for tinnitus, where positive effects were usually reported after four weeks.

Conclusion

HOS seem to be effective for immediate treatment of pain and other TMD symptoms. Based on the available data, a treatment period of four weeks can be recommended.

The Impact of Wearing a Face Mask during the COVID-19 Pandemic on Temporomandibular Joint: A Radiological and Questionnaire Assessment

Aim  Several health problems have been reported to be triggered or facilitated by prolonged mask usage during the coronavirus disease 2019 (COVID-19) pandemic. While wearing a face mask, people tend to push their jaws forward and downward in a repetitive manner to hold their masks in the right position; these jaw motions may induce temporomandibular joint disorder (TMD). In this study, we aimed to investigate these repetitive jaw movements while wearing face masks and their effects on TMD. Patients and Methods  Patients who applied with TMD signs between June 2020 and May 2021 were evaluated prospectively. A survey using a questionnaire was conducted to define patients with TMD that caused only by mask-related repetitive jaw movements. Demographic data (age and gender), mean duration of daily mask usage, mask type, and magnetic resonance imaging results were recorded. Results  Prolonged daily mask usage (≥8 hours/day) was significantly higher in patients with mask-related habits (group a) with a rate of 40.4% ( p ≈ 0.001). Also, in this group, the disc displacement with reduction rate (54.6%) was higher compared with other groups ( p ≈ 0.010). On the contrary, patients with no underlying risk factor (group c) showed an unexpected high osteoarthritis rate ( p ≈ 0.029). Conclusions  In this study, we demonstrate that correcting the position of a face mask by repetitive jaw movements can increase the occurrence of TMD. Informing individuals wearing face masks about the risk of TMD and the importance of choosing the appropriate mask size according to the face shape are important issues to be addressed in the near future.

Investigation of Snoring and Obstructive Sleep Apnea Using Portable Polysomnography in Patients with Temporomandibular Disorder

Objective

To investigate snoring and obstructive sleep apnea (OSA) in patients with temporomandibular disorder (TMD) using portable polysomnography and identify sex-based differences in clinical features and sleep-related results.

Methods

Seventy consecutive patients (44 female; mean age, 46.6918.18 years) with myofascial pain-associated TMD, diagnosed based on the criteria for TMD Axis I, were enrolled. Sleep quality and quantity were measured using portable polysomnography. Clinical characteristics were investigated using well-structured standardized reports on clinical signs and symptoms, questionnaires, and clinical examination by TMD specialists.

Results

Among 70 TMD patients, 50.0% had OSA and 15.7% had snoring, with no sex-based differences. The mean Mallampati scores for OSA prediction (2.69±1.12 vs. 1.70±0.82, p<0.001), mean body mass index (BMI) (24.94±1.78 vs. 22.02±2.24, p<0.001), and ratio of overweight patients (57.7 vs. 11.4%) with BMI ≥25 were significantly higher in males than in females (all p<0.001). Conversely, the mixed sleep apnea index was significantly higher in females than in males (0.81±0.80 vs. 0.44±0.54, p=0.022). Female sex was associated with the absence of snoring (OR=0.146, p=0.022). Based on the area under curve (AUC) value for snoring prediction, Mallampati score was the strongest predictor (AUC>0.932, p<0.001), followed by BMI, overweight, and obstructive sleep apnea index (AUC>0.8, all p<0.001).

Conclusions

Our results support the necessity of investigating sex-based differences when examining sleep problems, including snoring and OSA, in TMD patients. Mallampati scoring could be a useful tool for physical examination prior to polysomnography. Sleep and biopsychosocial factors are important for the diagnosis and treatment of TMD.

The Relationship between Depression and Anxiety with Temporomandibular Disorder Symptoms in Dental Students

Objectives:It can be said that approximately 60-70% of the general population would probably experience at least one symptom of temporomandibular disorder (TMD) in their lives, but only about 5% of these people seek treatment. On the other hand, depression and anxiety are now recognized as a serious public health problem among adults. Anxiety disorder is a chronic, high-risk disease that may lead to dysfunction and reduce quality of life. The aim of this study was to assess the association between depression and anxiety with TMD in dentistry students of Zanjan Dental School in 2020-2021. Methods:The population of this study consisted of students with TMD, and the control population was selected from students of the same faculty. To collect the data, volunteers first answered questions about the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Then the Depression, Anxiety and Stress Scale (DASS-21) questionnaire was completed by students in both groups. The collected data were then entered into stata software version 14. Results:According to the results of univariate analysis of logistic regression, gender, tuition, residential status, stress, anxiety and depression have a significant effect on TMD (P <0.2). After examining the gisimultaneous effect of variables and eliminating possible confounding variables with multiple logistic regression models, stress was identified as the most effective factor in TMD (significance level in this model is less than 0.05). Conclusion:Based on findings, while there was a significant relationship between stress, depression and anxiety with symptoms of TMD, stress alone was identified as the most effective factor in developing TMD.

Impact of estrogen therapy on temporomandibular joints of rats: Histological and hormone analytical study

Objectives

This research aims to evaluate the effects of estrogen deficiency and replacement on the TMJ structures of rats. The considerable similarities in the anatomical features of rats and humans make rats a suitable model for human scientific studies.

Methods

A clinical trial was conducted on 18 female Sprague-Dawley rats grouped into three categories. The GI group included 6 female rats labelled as the control group, the GII group consisted of 6 females that received ovariectomies, and the GIII group had 6 ovariectomised females that were injected with estrogen replacement therapy in a science laboratory at King Abdulaziz University. ANOVA and Tukey HSD post hoc tests were used to determine any significant differences between the levels of estrogen among the three groups.

Results

The results indicate that some TMJ structures, including the articular disc and condylar cartilaginous layer, were degraded after estrogen deficiency. However, there was a slight improvement in the cartilaginous layer thickness and proliferation of chondroid cells after estrogen replacement therapy. Estrogen level was reduced in the ovariectomized rats, and while estrogen injections increased blood hormone levels, the levels did not reach those of the control group.

Conclusion

Estrogen deficiency degraded some TMJ structures, and there is only a slight recovery after estrogen replacement therapy.

COL5A1 RS12722 Is Associated with Temporomandibular Joint Anterior Disc Displacement without Reduction in Polish Caucasians

Numerous reports describe the association between the single-nucleotide polymorphism (SNP) rs12722 and rs13946 in the COL5A1 gene and injuries, such as Achilles tendon pathology, anterior cruciate ligament (ACL) injuries, and tennis elbow. Hence, there were no studies investigating COL5A1 and temporomandibular joint (TMJ) pathology. The aim of this study is to evaluate the relationship between COL5A1 rs12722 and rs13946 SNPs and TMJ articular disc displacement without reduction (ADDwoR). In this case-control study, the study group consisted of 124 Caucasian patients of both sexes. Each patient had a history of ADDwoR no more than 3 months prior. The control group comprised 126 patients with no signs of TMD according to DC/TMD. Genotyping of the selected SNPs was performed by real-time PCR using TaqMan probes. The significance of the differences in the distribution of genotypes was analyzed using Pearson’s chi-square test. Logistic regression modeling was performed to analyze the influence of the 164 investigated SNPs on ADDwoR. The COL5A1 marker rs12722 turned out to be statistically significant (p-value = 0.0119), implying that there is a difference in the frequencies of TMJ ADDwoR. The distribution of rs12722 SNPs in the study group TT(66), CC(27), CT(31) vs. control group TT(45), CC(26), CT(51) indicates that patients with CT had an almost 2.4 times higher likelihood of ADDwoR (OR = 2.41) than those with reference TT (OR = 1), while rs13946 genotypes were shown to be insignificant, with a p-value of 0.1713. The COL5A1 rs12722 polymorphism is a risk factor for ADDwoR in the Polish Caucasian population.

Prevalence of Temporomandibular Disorder among Schoolchildren in Jordan

Purpose

The purpose of this study was to evaluate the prevalence of temporomandibular disorders (TMDs) in schoolchildren.

Materials and methods

In this study a questionnaire taken as part of RDC/TMD of the samples on TMD symptoms. The samples were school students, who were of the age range 15–17 years old (n = 396), 200 are males and 196 are females. All from eight randomly selected schools. They were asked to answer the questionnaire in their classrooms.

Results

The prevalence of periauricular pain was 29.0%. More males were affected by TMD than females and most of the affected students were of ages 16 and 17 years old. Severe depression occurs in 69.6% of the affected students with periauricular pain. Periauricular pain resulted in low disability low-intensity pain (grade I) in 64.9%.

Conclusion

Based on the results obtained it can be concluded that: (1) Data obtained from the questionnaire identified a nearly lower percentage of TMD in schoolchildren than most of the studies published in the literature; (2) Comparing with females, males with TMD had a higher disability, depression, and non-specific symptoms with and without pain.

Clinical significance

Temporomandibular disorder in adolescents is relatively high, in addition, the accompanying pain and depression that is high to worsen the condition.

How to cite this article

Jomhawi JM, Elsamarneh AM, Hassan AM. Prevalence of Temporomandibular Disorder among Schoolchildren in Jordan. Int J Clin Pediatr Dent 2021;14(2):304–310.