Temporomandibular Disorders, Bruxism and Headaches

Temporomandibular disorders (TMDs) and headache disorders are highly prevalent in the population. TMDs can present headache symptoms as a secondary headache and, in addition, be comorbid with primary headache disorders. This overlap has significant clinical implications for which it is essential for the physician to be aware, and they should screen for the potential presence of TMDs in a headache patient. Bruxism is a parafunctional behavior also prevalent in the population which has a role in TMDs and may influence headache symptomatology, but it is still necessary to clarify this relationship.

A systematic review of temporomandibular disorder diagnostic methods

Objective: To compile the screening tools used to study temporomandibular disorders (TMD), classify and analyze their potential application in the field of physiotherapy.Methods: All gathered data included randomized clinical trials on humans over 18 years of age pulled from three databases up to November 2019.Results: Nineteen articles were retained, in which the subjects included 1095 women and 385 men. The 32 valuation systems reported were classified as follows: direct, requiring observation and/or palpation in situ by a clinician, which can be subdivided into protocols and instrumental systems; and indirect, requiring neither observation nor palpation by a clinician, which can be subdivided into questionnaires and scales.Conclusion: In order to evaluate TMD, the best choice is to combine direct and indirect assessment methodologies. The valuation of pressure pain threshold with an algometer and Fonseca's Anamnestic Index in combination with Anamnestic Questionnaire CMD, respectively, seems to provide the best results.

Comparison of force profiles from two musculoskeletal palpation methods: A methodological study

BACKGROUND

The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) protocol recommends a 5 s and 1 kg force dynamic palpation around the lateral condylar pole of the temporomandibular joint. However, the accuracy and precision of the generated force are not known.

OBJECTIVE

To assess and compare the force profiles generated from dynamic palpation manually and using a palpometer, based on the forces and time recommendations suggested by the DC/TMD protocol.

METHODS

Nineteen healthy adults applied forces of 0.5 kg, 1.0 kg and 2.0 kg on a calibrated force sensor in a circular motion within target times of 2 s and 5 s. Participants used their right index finger for manual palpation and a calibrated palpometer for device-assisted palpation. Ten repetitions of each target force at both target times were applied. Time taken to complete each application was recorded. Repeated measures analysis of variance was used for analysis of accuracy measured as the relative difference between targeted force and actual force values and precision measured as the coefficient of variation (CV) within the 10 repeated measurements.

RESULTS

Accuracy was significantly lower (better) and precision higher (lower CV) with the palpometer than with manual palpation (p < .001). There were significant differences in accuracy and precision between the different forces but not palpation times. Most participants could not achieve the target times and tended to be faster, irrespective of the palpation method (p > .063).

CONCLUSION

A palpometer is a more accurate and precise palpation method for dynamic force assessment compared to manual palpation; however, it remains difficult to standardize the palpation duration.

Diagnostic and screening inventories for temporomandibular disorders: A systematic review

Objective: To evaluate reliable and validated temporomandibular disorder (TMD) diagnostic instruments for use as diagnostic tools in epidemiological surveys.Methods: Two independent reviewers performed searches in the Medline/PubMed, Cochrane Library, and Web of Science databases to identify validation studies of diagnostic and screening instruments for TMD published up to March 2021.Results: Sixteen studies were included for the systematic review. Different TMD instruments were evaluated, such as FAI, RDC/TMD, DC/TMD, Helkimo Index, and AAOP Questionnaire. The instruments differed according to the number of items. Some questionnaires appear to be effective for the initial screening of TMD patients and can be incorporated in clinical practice and epidemiological studies since they are easy and fast to apply.Conclusion: To provide an accurate TMD diagnosis, it is important to use instruments that involve a clinical examination. Authors suggest the development of a new validated diagnostic tool for use in epidemiological surveys.

Accuracy of the Fonseca Anamnestic Index for identifying pain-related and/or intra-articular Temporomandibular Disorders

Objectives: This study established the diagnostic accuracy of the Fonseca Anamnestic Index (FAI) in relation to the Diagnostic Criteria for TMD (DC/TMD) standard.Methods: A total of 866 TMD patients and 57 TMD-free controls were instructed to answer the FAI and DC/TMD Symptom Questionnaire (SQ). Participants were subsequently categorized into no (NT), pain-related (PT), and/or intra-articular (IT) TMDs using the DC/TMD protocolized examination/algorithms. Receiver operating characteristics (ROC) curves, best cut-off points, and accuracy measures were determined.Results:The FAI demonstrated high accuracy for detecting all TMDs, PT, and IT (AUC = 0.96-0.98). The best cut-off points were 22.50 for all TMDs/IT and 27.50 for PT. Sensitivity of the FAI was high (94.23-98.21%), but specificity was moderate (87.72%) for all diagnostic categories.Discussion:The diagnostic accuracy of the FAI for identifying pain-related and intra-articular TMDs was high. FAI scores ≥25 points should be used to screen for TMDs.

Could painful temporomandibular disorders be nociplastic in nature? A critical review and new proposal

Classification of temporomandibular disorders (TMD) and, indeed, all types of orofacial pains has significantly progressed in the last decade based on international consensus work and operationalized clustering of signs and symptoms. A challenging gap nevertheless continues to exist in terms of understanding the underlying pain mechanisms and link to management. Recently, a novel mechanistic descriptor 'nociplastic pain' was introduced, and diagnostic algorithms and characteristic features were proposed. This narrative and critical review aim to discuss to what extent could painful TMD conditions fit into this category. Moreover, a number of less common types of orofacial pain could possibly also reflect nociplastic pain mechanisms. A model to differentiate TMD pain mechanisms is proposed, and the implications for management are discussed. The purpose of this review is to stimulate original and novel research into mechanisms of orofacial pain and hopefully thereby improve management of the individual patient.

Is temporomandibular joint involvement more frequent in patients with epilepsy? A clinical study

STATEMENT OF PROBLEM

Epileptic seizures may affect the stomatognathic system via transmission of an increased load to the dentition and the temporomandibular joint (TMJ), resulting in temporomandibular joint dysfunction (TMD).

PURPOSE

The purpose of this clinical study was to assess whether TMD was more prevalent in patients with epilepsy than in those without epilepsy.

MATERIAL AND METHODS

A total of 107 participants diagnosed with epilepsy and 100 healthy controls were enrolled in the study. Those with epilepsy were divided according to their dental manageability into 3 subgroups: mild group, moderate group, and severe group. Following general, dental, and TMJ-related history, the range of maximal mouth opening (MMO), laterotrusion, possible deviation and deflection, and presence of crepitation and clicking was recorded, as suggested by the diagnostic criteria for temporomandibular diseases (DC/TMD). Pressure pain threshold (PPT) was also measured by using a pressure algometer on 3 points bilaterally.

RESULTS

Incidence of TMJ complaints was not significantly different between the control (30%) and the group diagnosed with epilepsy (33%); however, the number of complaints experienced was significantly higher in the epilepsy group (C: 3%, E: 16% had 3 or more complaints; P<.001). Joint clicking was significantly more prevalent in the entire epilepsy group (P=.012) and in the mild group (P=.004) than in controls. Crepitation and joint pain were not significantly more common in the epilepsy group. Maximal mouth opening, laterotrusion, and the ratio of restricted mouth opening did not differ significantly in the epilepsy group. Deflection occurred significantly more often in the epilepsy subgroups (mild and moderate groups; P<.001), and the extent of deflection was also significantly higher in all the epilepsy subgroups (P<.001) than in controls. Regarding the pressure pain threshold, significant difference was observed in the severe group at the left masseter muscle points M1 (P=.046) and M2 (P=.028) compared with controls.

CONCLUSIONS

All parameters typical of TMD could be found frequently in patients with epilepsy. Because of the seizures and the consequent joint overload, the TMJ involvement was more common or more serious in those diagnosed with epilepsy. Outcomes of this study support the assumption that epilepsy is a risk factor for the development of TMD.

Performance of key physical tests for temporomandibular disorder via telehealth: Establishing validity and reliability

BACKGROUND

During the COVID-19 pandemic, many individuals sought healthcare virtually. Physiotherapy is integral in managing temporomandibular disorders (TMDs); therefore, establishing how key physical tests can be appropriately adapted to telehealth is paramount.

OBJECTIVES

To establish the validity and reliability of telehealth (specifically videoconferencing) assessments against in-person assessments on a battery of TMD physical tests.

METHOD

A repeated-measures study design was undertaken. Thirty-six adult participants (19 healthy and 17 TMD) underwent concurrent temporomandibular joint (TMJ) physiological movement measurements via videoconferencing and in-person as per standard clinical practice. Inclusion criteria included the presence of central incisors and no significant comorbidities precluding a safe telehealth examination. Participants with TMD completed seven additional pain provocation physical tests.

RESULTS

Agreement between telehealth and in-person physiological movement measures was excellent (ICC >0.90, 95% CI: 0.53 to >0.99). Inter- and intra-rater reliability for telehealth measures indicated excellent reliability (ICC >0.97, 95% CI: 0.91 to >0.99). Exact agreement between telehealth and in-person for provocation tests ranged between 58.8% and 94.1%. Fourteen of the twenty-six individual measures produced substantial to near perfect agreement (PABAK = 0.65-0.88), seven produced moderate agreement (PABAK = 0.53), while five produced poor to fair agreement (PABAK = 0.18-0.29).

CONCLUSION

There is high level of agreement between telehealth and in-person measurements of TMJ physiological movement and pain provocation tests.

Mallampati score in patients with temporomandibular joint disorders: A pilot case-control study

OBJECTIVES

Temporomandibular joint disorder (TMD) is defined as any functional abnormalities in different parts of the face and neck. The Mallampati index is an indicator for determining the extent of airway blockage. No study has examined the relationship between TMD and Mallampati score. Most studies have investigated the relationship between temporomandibular joint problems and sleep problems. This pilot study aimed to assess the Mallampati index scores among TMD patients.

MATERIAL AND METHODS

Eighty-four people were divided into the case (based on RDC/TMD) and control groups. Demographic information, neck circumference, tongue size, Mallampati score, and other variables were asked of people. STOP-BANG and Pittsburgh Sleep Quality Index (PSQI) were also completed for each patient. Data were analyzed with Chi-square, Fisher's exact, and Mann-Whitney tests.

RESULTS

The Mallampati and PSQI questionnaire scores in the case group were significantly higher than those in the control group (p < 0.001). The results showed that larger tongue and neck circumference patients had a higher Mallampati score. Pearson correlation coefficient showed that the Mallampati score had a direct and significant relationship with body mass index and PSQI (p < 0.001).

CONCLUSIONS

The results of this study show that Mallampati scores were significantly higher among patients with TMD than among healthy individuals.

The Adaptive, Pain Sensitive, and Global Symptoms Clusters: Evidence from a Patient-Based Study

OBJECTIVES

The largest epidemiologic study conducted about painful temporomandibular disorders (pTMDs) to date identified 3 clusters of individuals with similar symptoms-adaptive, pain sensitive, and global symptoms-which hold promise as a means of personalizing pain care. Our goal was to compare the clinical and psychological characteristics that are consistent with a pTMD clinical examination among patients who are seeking care and assigned to the different clusters.

METHODS

This cross-sectional study used data from the medical records of patients attending Duke Innovative Pain Therapies between August 2017 and April 2021 who received a pTMD diagnosis (i.e., myalgia) and consented to have their data used for research. Data included orofacial and pain-related measures, dental features, and psychological measures. We used the Rapid OPPERA Algorithm to assign clusters to patients and multinomial regression to determine the likelihood (odds ratios [OR] and 95% confidence intervals [CI]) of being assigned to the pain sensitive or global symptoms cluster attributed to each measure.

RESULTS

In total, 131 patients were included in this study and assigned a cluster: adaptive (n = 54, 41.2%), pain sensitive (n = 49, 37.4%), and global symptoms (n = 28, 21.4%). The PS cluster displayed greater numbers of temporomandibular joint sites (OR, 1.29; 95% CI, 1.01 to 1.65) and masticatory (1.48; 1.19 to 1.83) and cervical (1.23; 1.09 to 1.39) muscles with pain evoked by palpation. The GS cluster displayed greater scores of pain catastrophizing (1.04; 1.01 to 1.06) and perceived stress (1.23; 1.03 to 1.46) and was more likely to report persistent pain (16.23; 1.92 to 137.1) of higher impact (1.43; 1.14 to 1.80).

CONCLUSION

Our findings support that care-seeking patients with pTMDs who are assigned to the GS cluster display a poorer psychological profile, even though those assigned to the PS cluster display more measures consistent with orofacial pain. Findings also establish the PS cluster as a group that does not display psychological comorbidities despite being hypersensitive.

KNOWLEDGE TRANSFER STATEMENT

This study informs clinicians that patients seeking care for painful temporomandibular disorders, in specific cases of myalgia, can be classified into 1 of 3 groups that display unique profiles of symptoms. Most importantly, it emphasizes the importance of examining patients with painful temporomandibular disorders in a holistic manner that includes assessing symptoms of psychological distress. Patients with greater psychological distress will likely benefit from multidisciplinary treatment strategies that may include psychological treatments.

Psychometric properties of the Fonseca Anamnestic Index (FAI) for temporomandibular disorders: Turkish version, responsiveness, reliability, and validity study

PURPOSE

Many assessment tools have been proposed for use in clinical practice and research on individuals with temporomandibular disorders (TMD). It aimed to translate the Fonseca Anamnestic Index into Turkish (FAI/T) and examine the responsiveness, reliability and validity of the FAI/T in this study.

MATERIALS AND METHODS

Two hundred forty-nine individuals (207 female/42 male) with TMD were included in this study according to the RDC/TMD (muscle disorders, disc displacement, arthralgia and mixed disorders (muscle disorders and disc displacement)). Reliability was evaluated with test-retest reliability, internal consistency, and reproducibility. Validity was assessed with structural validity, construct validity, content validity, and face validity. In addition, responsiveness and floor and ceiling effects were also examined.

RESULTS

The ICC value (0.906) and Cronbach's α (0.951) of the (FAI/T) were excellent. Following Explarotary Factor Analysis, two factors were extracted, accounting for 51.859% of the total variation. Structural validity, construct validity, content validity, and face validity analyses proved the validity of the FAI/T. The responsiveness analysis showed that the Turkish FAI and its subscales were able to detect change over time.

CONCLUSIONS

The FAI/T has shown excellent reliability and good validity. The FAI/T can assess the symptoms of Turkish-speaking persons with TMD.Clinical Trials registration number: NCT04274985.

Temporomandibular disorders among Ehlers-Danlos syndromes: a narrative review

This narrative review aims to demonstrate and summarize the complex relationship between Ehlers-Danlos syndromes (EDS) and temporomandibular disorders (TMD) by reviewing the results of observational studies and case reports. EDS are a set of hereditary connective tissue disorders, where generalized joint hypermobility (GJH), especially in the hypermobile subtype (hEDS), is a key symptom. Mutations have been identified in genes that impact the production or assembly of collagen for all subtypes except hEDS. While the correlation between GJH and TMD has been analysed in various studies, fewer studies have examined TMD in patients with EDS, with most showing an increased prevalence of TMD. In case-control studies, an elevated prevalence of myalgia, arthralgia and disc-related disorders was found in individuals with EDS. Various therapeutic interventions have been reported within the literature in the form of case reports and observational studies, but there are no long-term clinical trials with results on the efficacy of different therapeutic approaches to date. This review demonstrates the high prevalence of different TMDs in different subtypes of EDS, but also shows that little is known about the success of treatment thus far. Further clinical research is necessary to provide adequate guidance on targeted treatment.

Impact of professional, recreational and nonsinging on temporomandibular disorders - a comparative study based on a self-assessment questionnaire

BACKGROUND

This study investigates the relationship between professional and recreational singing on temporomandibular disorders (TMDs) in women compared to a nonsinging control group.

METHODS

A total of 288 female subjects between the ages of 18 and 45 participated in the self-assessment questionnaire including demographic data, as well as questions on vocal practice and TMDs symptoms. Depending on the singing time per week, the (non)vocalists were assigned to the groups professional (n = 96), recreational (n = 96) and nonsingers (n = 96).

RESULTS

The TMDs prevalence in professional singers (42%) was higher than that in recreational singers (31%) and noticeably higher than that in nonsingers (25%). The Fisher-Freeman-Halton exact test showed that the differences between the groups were not noticeable (p = .053) but could be formulated as tendencies. The professionals suffered much more from restricted jaw movement (p = .004; OR = 2.718; 95% CI = 1.409-5.242), temporomandibular joint sounds (p < .009; OR = 2.267; 95% CI = 1.264-4.064) and temporomandibular pain (p = .010; OR = 2.333; 95% CI = 1.264-4.308) than nonsingers.

CONCLUSIONS

Singing might have an enhancing effect on the appearance of TMDs. In particular, professional singers suffered more from self-reported TMDs than recreational singers and nonsingers. In addition to the high level of physical workload if participating in professional singing, the psychosocial impact should be investigated more in further studies. No new treatment strategies resulted from this study, as the etiological significance of singing is still unclear. Knowledge about risk factors for multifactorial TMDs can help practitioners and patients prevent and treat TMDs.

The relationship between pregnancy and temporomandibular disorder (TMD) through diagnostic criteria for temporomandibular disorders (DC/TMD) axis II evaluation: a case-control cross-sectional study

INTRODUCTION

This study focuses on temporomandibular disorders (TMDs), which affect the temporomandibular joint and related muscles and have multiple causes. Recent studies have examined the connection between menstrual cycles, estrogen levels, and TMDs, but results are inconsistent, highlighting the need for more research. The aim is to explore the prevalence of TMDs in pregnant women and consider how hormonal changes during pregnancy might influence these disorders.

METHODS

In this cross-sectional case-control study, we compared 32 pregnant women with 35 non-pregnant women. We evaluated several TMD-related factors such as pain levels, chronic pain classification, scores on the Jaw Functional Limitation Scale-20 and Oral Behaviors Checklist, and psychological health. We used various statistical methods including descriptive statistics, chi-square tests, linear regression, and adjustments for multiple comparisons to analyze the data.

RESULTS

Pregnant women showed different pain perceptions, generally reporting less pain and lower severity. Nonetheless, these differences were not uniform across all TMD-related measures. Linear regression did not find a consistent link between pregnancy and TMD scores, except for chronic pain grade, which was not significant after adjusting for multiple comparisons. There was a significant relationship between depression and TMD severity, emphasizing the need to consider mental health in TMD evaluations.

DISCUSSION

The findings suggest that pregnancy is neither a risk nor a protective factor for TMD. Differences in pain perception, functional status, and psychological health were observed in pregnant women but were not consistent for all TMD-related aspects. The role of estrogen in TMJ health and TMD risk is complex and requires further study. The research highlights the necessity of including mental health, especially depression, in TMD assessments. More comprehensive research with larger sample sizes is essential to better understand the connections between pregnancy, TMD, and hormones, aiming to improve TMD management in pregnant women and others.

Temporomandibular disorder in individuals with spinal cord injuries

OBJECTIVE

This study evaluated Temporomandibular Disorder (TMD) in individuals with Spinal Cord Injuries (SCI) compared to individuals without physical disabilities.

DESIGN

Cross-sectional.

SETTING

International Fair of Technologies in Rehabilitation and Accessibility (REATECH) and School of Dentistry at the University of São Paulo (USP), Brazil.

PARTICIPANTS

In total, 19 patients with SCI and 19 patients without SCI (36.9 ± 11.4 years old) were examined by a calibrated examiner.

METHODS

using the following parameters: cervical spine mobility, palpation of muscle groups of the head and neck, functional manipulation of the lateral and medial pterygoids, and joint palpation (Diagnostic Criteria). The pattern and amplitude of mandibular movements were determined during screening using the Helkimo index.

STATISTICAL ANALYSES

Student's t-test, chi-square, Fisher's exact and Shapiro-Wilk test were used.

RESULTS

The groups did not differ in the presence of noise, pain, temporomandibular joint palpation, locking, dislocation, jaw pain, muscle sensitivity, or in pain, mobility of the cervical spine and functional manipulation. With respect to the jaw mobility index, the groups differed in range of movement (P = 0.020) and maximum right lateral movement (P = 0.007), with the worst values in the SCI group. The groups also differed in relation to lateral flexion in cervical mobility, in which the group without SCI presented better results (P = 0.046).

CONCLUSION

The Spinal Cord Injuries group showed higher levels of TMD in terms of range of movement, lateral flexion, and maximum right lateral movement, than the individuals without physical disabilities, demonstrating a clinical significance between cervical and mandibular disability in this group.

Temporomandibular disorders and bruxism - up-to-date assessment and screening tools the general dentist should be aware of

The recently proposed shortened screening tools for temporomandibular disorders (TMD) and bruxism should enable a better assessment of these conditions by the general dentist.

Prevalence of temporomandibular disorders in clear aligner patients using orthodontic intermaxillary elastics assessed with diagnostic criteria for temporomandibular disorders (DC/TMD) axis II evaluation: A cross-sectional study

BACKGROUND

The objective of this investigation is to assess the relationship between the utilisation of orthodontic intermaxillary elastics and temporomandibular disorder (TMD) symptoms in clear aligner patients and to examine the correlation between the elastic usage time with the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD)-Axis II Evaluation Forms.

METHODS

This study was carried out on a total of 40 clear aligner patients using intermaxillary elastics in the experimental group and 30 clear aligner patients who did not use any intermaxillary elastics in the control group. The data were evaluated using the Mann-Whitney U, chi-square, Fisher's exact chi-square, and Fisher Freeman Halton exact chi-square tests.

RESULTS

The characteristic pain intensity, mastication, mobility, communication, global and PHQ-9 scores of the experimental group were significantly higher than those of the control group (p < .05). The characteristic pain intensity score, interference score and chronic pain grade score of patients using Class III elastics were statistically significantly higher than those of patients using Class II elastics (p < .05). Patients who used elastics for less than 6 months had statistically significantly higher PHQ-9 scores than those who used elastics for more than 6 months (p < .05).

CONCLUSIONS

Orthodontic treatment may affect occlusion, bite force and jaw movement, which may cause or worsen TMD symptoms, and the DC/TMD questionnaires can determine if orthodontic patients acquire TMD by assessing their psychosocial state and pain-related problems.

Validity and Reliability of the Turkish Version of Mandibular Function Impairment Questionnaire

OBJECTIVE

To assess the validity and reliability of the Turkish version of the Mandibular Function Impairment Questionnaire (MFIQ-TR).

METHODS

Included in this study were 248 patients diagnosed with temporomandibular disorder (TMD) according to Diagnostic Criteria for TMD Axis I protocol. Construct-related validity was evaluated through internal and external construct validity; convergent and divergent validities were evaluated by the average variance extracted (AVE), composite reliability (CR), and bivariate correlations between factors. Reliability was assessed by internal consistency and test-retest reliability.

RESULTS

All items of the MFIQ-TR had content validity and factor loadings above 0.5. The model statistics indicated a good fit. The convergent validity was very good (AVE > 0.5 and CR > 0.7), and the discriminant validity was satisfied. Internal consistency and test-retest reliability of the MFIQ-TR were excellent.

CONCLUSION

The MFIQ-TR is a valid and reliable instrument for evaluating the impairment of mandibular function in Turkish patients with TMD.

Equine poor performance: the logical, progressive, diagnostic approach to determining the role of the temporomandibular joint

Poor performance is an ambiguous term used frequently by people in the horse industry. It means different things to different people, depending on the breed, discipline, or problem being discussed. There are myriad reasons that a horse may fail to achieve the expectations put upon it or, having achieved those goals, begin to falter. Equine temporomandibular joint (TMJ) disease is beginning to be reported as 1 such cause of poor performance. Despite this, in certain disciplines, it has become the trendy diagnosis, and a logical approach to the diagnostic workup is often lacking. Many of the clinical signs attributed to TMJ abnormalities can be readily explained by other more common problems. This ambiguity is compounded by a lack of extensive scientific evidence linking TMJ-related disease to behavioral or performance changes. Despite this fact, the equine TMJ has been reported to be a cause of poor performance, and while rare, it should be included in a differential diagnosis list, albeit one of exclusion. The purpose of this article is to describe a logical, stepwise approach to excluding common causes of poor performance before investigating the potential role of the TMJ in cases of poor performance.

Is painful temporomandibular disorder a real headache for many patients?

Temporomandibular disorders (TMDs) and primary headaches are common pain conditions and often co-exist. TMD classification includes the term 'headache secondary to TMD' but this term does not acknowledge the likelihood that primary headache pathophysiology underpins headache causing painful TMD signs and symptoms in many patients. The two disorders have a complex link and we do not fully understand their interrelationship. However, growing evidence shows a significant association between the two disorders. This article reviews the possible connection between temporomandibular disorders and primary headaches, specifically migraine, both anatomically and pathogenetically.

Temporomandibular joint disorders in skeletal class II patients referred to orthognathic surgery: A cross-sectional study

OBJECTIVES

The aim of this study was to assess the prevalence of Temporomandibular Disorders (TMD) in subjects with skeletal class II dentofacial deformity referred for orthognathic surgery, as well as to elucidate its association with sociodemographic and psychosocial features.

METHODS

This was a cross-sectional study using the Research Diagnostic Criteria for Temporomandibular Disorders. The sample comprised class II skeletal patients referred to an Oral and Maxillofacial Surgery center in the Brazilian Northeast.

RESULTS

Seventy-three subjects were enrolled and completed the data collection, which consisted of a physical examination according to Axis I of the Research Diagnostic Criteria for Temporomandibular Disorders and facial analysis. Women represented 82.2% of the sample. Among the assessed subjects, 68.5% were already undergoing orthodontic treatment, and the mean overjet of patients was 6.97 mm. The prevalence of TMD in this sample was 46.6%, with muscular disorders being the most common. Patients with an anteroposterior discrepancy greater than 7 mm showed a higher occurrence of TMD (p = 0.017).

CONCLUSION

This study demonstrated a high prevalence of TMD in skeletal class II patients referred for orthognathic surgery, especially in those with a pronounced overjet, being Group I (muscular disorders) and Group III (degenerative disorders) the most prevalent.

Pregnancy related factors and temporomandibular disorders evaluated through the diagnostic criteria for temporomandibular disorders (DC/TMD) axis II: a cross sectional study

INTRODUCTION

Temporomandibular disorder (TMD) is a multifaceted condition impacting the chewing system, with its frequency varying across different age groups and showing a higher incidence in women. The involvement of estrogen in TMD has been examined due to the presence of estrogen receptors in the TMJ area. However, the exact effect of estrogen on TMD is complex. During pregnancy, marked by significant hormonal fluctuations, the impact on TMD has been hypothesized but remains unclear due to inconsistent results from various studies.

METHODS

In this cross-sectional study, we enrolled 32 pregnant women consecutively. We gathered information on demographics, TMD evaluations (using the Graded Chronic Pain Scale, Jaw Functional Limitation Scale-20, and Oral Behaviors Checklist), and mental health assessments (including Patient Health Questionnaire-9, Patient Health Questionnaire-15, and Generalized Anxiety Disorder-7). We employed descriptive statistics to summarize continuous and categorical data and used t-tests and chi-square tests for comparisons. We also conducted multivariate linear regression, adjusted for demographic factors, to investigate correlations.

RESULTS

The study group mainly consisted of women aged 30-35 (40.6%) and 25-30 (18.8%). Most participants had completed high school (50%) and were married (71.9%). A notable association was found between younger women (under 30) and higher levels of somatic symptoms (p = 0.008) and generalized anxiety (p = 0.015). Women in their second trimester showed lower severity of somatic symptoms (p = 0.04). A significant link was also observed between depression severity and somatic symptom severity (p = 0.01). However, we found no significant correlations with other TMD-related health aspects.

DISCUSSION

Our study identified significant associations between psychosomatic and psychological symptoms with variables like age and pregnancy trimester in pregnant women. However, it notably failed to establish a clear relationship between pregnancy-related factors and the severity of temporomandibular disorders (TMD). More comprehensive studies with larger participant pools are necessary to further validate and expand these findings.

Assessment of neuromuscular fatigue through frequency analysis of the electromyographic signal of control participants and those with temporomandibular dysfunction treated with resilient or hard occlusal devices

STATEMENT OF PROBLEM

Muscle hyperactivity that leads to neuromuscular fatigue can be evaluated by electromyography. Whether treatment with occlusal devices can restore neuromuscular balance to patients with temporomandibular disorders (TMDs) is unclear.

PURPOSE

The purpose of this clinical study was to evaluate neuromuscular fatigue by analyzing the frequency of the electromyographic signal of the masseter and anterior temporalis muscles on both sides in healthy participants and those with TMD treated with a resilient or hard occlusal device.

MATERIAL AND METHODS

One hundred asymptomatic participants and 30 with TMD were divided into 2 groups: treated with a hard device or treated with a resilient device. All underwent electromyographic examination before and after treatment with the occlusal devices.

RESULTS

In both groups, the results showed statistically significant differences (P<.01) when the fatigue rate before and after treatment with an occlusal device was compared.

CONCLUSIONS

Treatment with both types of occlusal device was efficient in reducing the rate of neuromuscular fatigue in patients with TMDs.

Clinical features of chronic primary pain in individuals presenting painful temporomandibular disorder and comorbidities

BACKGROUND

The diagnosis of chronic primary pain (CPP), according to the recently released International Classification of Disease (ICD-11) criteria, refers to conditions with complex aetiologies. CPP is characterized by specific clinical features such as generalized sensory hypersensitivity and widespread pain, and is associated with functional disability and emotional distress.

OBJECTIVE

This study investigated clinical features of CPP in individuals with painful temporomandibular disorders (TMD) and comorbidities (fibromyalgia, migraine and/or tension-type headache).

METHODS

This cross-sectional study was conducted with a sample of 129 individuals. Painful TMD, fibromyalgia and primary headaches were evaluated based on well-established international criteria. Generalized sensory hypersensitivity was assessed using psychophysical tests. Symptoms of anxiety and depression were assessed by the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9. The Central Sensitization Inventory was applied to assess central sensitization-related symptoms and the Pittsburg Sleep Quality Index to evaluate the quality of sleep. The presence of widespread pain was assessed using a body map. The sample was stratified into three groups: control (n = 25), TMD-painful TMD only (n = 35) and TMD + Cm-painful TMD and comorbidities (n = 69). Statistical analysis was performed using one-way ANOVA, chi-squared test and ANCOVA, considering gender as a covariate (α = .05).

RESULTS

Compared to controls, individuals presenting painful TMD and comorbidities showed lower pressure pain thresholds in all evaluated areas (p ≤ .012) and a higher number of painful areas in the body (p = .001). They presented more symptoms of anxiety (p = .040) and depression (p = .018), and a higher score in the Central Sensitization Inventory (p ≤ .006) than the other groups.

CONCLUSION

Individuals with painful TMD and comorbidities presented more clinical features of CPP compared to those affected by TMD only.

Predictors of patients' satisfaction after temporomandibular disorder treatment in a referral clinic

BACKGROUND

Evaluating patients' satisfaction after received care for temporomandibular disorders (TMD) pain provides oral health care professionals with knowledge and tools to improve their clinical procedures. However, knowledge on patient characteristics that determine satisfaction with the received care for TMD pain is lacking.

OBJECTIVE

To identify potential baseline predictors for patients' satisfaction regarding the management of TMD pain upon treatment completion in a referral clinic.

METHODS

Eligible patients, viz., individuals of ≥16 years of age, with a TMD-pain diagnosis according the diagnostic criteria for TMD (DC/TMD), and who were treated in a referral clinic, were included. As part of their standard care, a set of diagnostic questionnaires was filled in (e.g. TMD-pain screener, graded chronic pain scale (GCPS), etc.). After completion of the received care, patients filled in a custom-made questionnaire based on patient reported experience measures (PREMs) to quantify their satisfaction with their treatment results and received care. To identify potential predictors associated with patients' satisfaction, univariate and multivariate linear regression analyses were used.

RESULTS

Twenty-seven patients (mean 39.6, SD 15.0) were included in this study. Overall, the patients were satisfied with the treatment results and the received care. Depressive feelings were negatively associated with satisfaction of treatment results (p = .01) and positively associated with satisfaction of received care (p = .01), while pain intensity was negatively associated with satisfaction of the received care.

CONCLUSION

Depressive feelings are a significant negative predictor of patients' satisfaction with the treatment result for TMD pain, while average pain intensity is a significant negative predictor of patients' satisfaction with the received care.

Presentation and primary care management of temporomandibular disorders: A survey of primary care dentists in Santiago and Newcastle

BACKGROUND

Primary care dentists are often the first point of call for people with temporomandibular disorders (TMD) but it is not known how many people present to their dentist with TMD or the forms of first-line management that are routinely offered.

OBJECTIVES

To report rates of presentation of TMD and management offered in primary care by general dental practitioners in two similarly urban areas, Santiago, Chile and North-East England.

METHODS

An online survey was developed and distributed to primary care dentists in both regions. Descriptive data were presented to quantify presentation rates and forms of management offered.

RESULTS

Responses were received from 215 dentists practising in Chile and 46 in Newcastle. The majority reported seeing 1-2 patients weekly with TMD and less than one new presentation each week. Symptoms were most often treated conservatively and with self-management according to international guidelines. The form of self-management varied however and verbal instructions were often not backed up by written information.

CONCLUSIONS

This research provides a useful starting point in understanding the presentation to, and initial treatment of TMD in primary care internationally. Limitations included the method of recruitment and potentially non-representative samples. Further research could build on this work by including more countries and using more structured sampling methods. The work will be useful in understanding and planning early care pathways for people experiencing TMD.

Pharmacological therapy in the management of temporomandibular disorders and orofacial pain: a systematic review and meta-analysis

BACKGROUND

Temporomandibular disorders (TMD) are manifested by soreness in the jaw joint area and jaw muscles, clicks or creaks when opening or closing the mouth. All these symptoms can be disabling and occur during chewing and when the patient yawns or speaks. Several classes of drugs are used to treat symptoms. This review aims to assess which drug suits the different signs.

METHODS

Pubmed, Web of Science and Lilacs were systematically searched until 01/02/2023. Clinical trials were selected that dealt with drugs used in temporomandibular dysfunction RESULTS: Out of 830 papers, eight studies were included. The Meta-Analysis with Continuous Outcomes with Pre-Calculated Effect Sizes resulted in the rejection that there is intergroup variability (p.0.74).

CONCLUSIONS

Treatment of orofacial pain is still a significant challenge for dentistry. We can conclude that there is no drug of first choice in the treatment of temporomandibular pain. However, the clinician must distinguish the type of pain and the aetioloic cause of the pain so that the patient can be treated and managed pharmacologically.

Chronic temporomandibular disorder pain patients with a history of neuropathic pain treatment: a narrative research on their diagnosis and treatment history

The aims of this qualitative research were (1) to gain more insight in the diagnostic and treatment history of patients with chronic temporomandibular disorder (TMD) pain; (2) to get a deeper understanding of possible factors that are involved in the possible delay in setting a TMD-pain diagnosis and receiving appropriate treatment; and (3) to get a deeper understanding of the perspectives and experiences of chronic TMD-pain patients on the possible improvement of various aspects of their diagnostic and treatment journey.MethodsIn this narrative research, semi-structured interviews took place with patients who experienced chronic orofacial pain (OFP) for at least three years before getting diagnosed with, and treated for, TMD pain by an OFP specialist in an interprofessional setting.ResultsIn total, ten patients were interviewed in-depth. Patients experienced their chronic OFP in different ways, but all reported a significant impact of their pain on their quality of life. All patients visited numerous health care professionals before their TMD diagnosis was set. Among others, they underwent anti-neuropathic pain medication therapies and invasive surgeries, which did not significantly reduce their chronic OFP. The interprofessional TMD-pain treatment reduced the suffering of the chronic OFP substantially, also 6 months after the start of therapy, and improved the quality of life for all patients. In most of them, the OFP intensity was also decreased.ConclusionChronic TMD-pain patients with a history of neuropathic pain treatment may experience a long journey until receiving the appropriate diagnosis and treatment. This stresses the need to improve the implementation of chronic TMD-pain guidelines.

Thermographic findings related to facial pain - a survey of 40 subjects

OBJECTIVE

The purpose of this study was to assess how thermography findings relate painful symptoms and signs of temporomandibular disorders (TMD).

METHODS

Thermography, combined with chewing of paraffin wax, was performed on 40 subjects. The results were analyzed according to gender and pain-related TMD symptoms and clinical signs.

RESULTS

The overall temperatures after chewing were higher in TMD patients than in controls. For females, the most significant findings were the thermal increase between the relaxed state and subjects' state after chewing in temporal and temporomandibular joint (TMJ) regions. For males, all calculated parameters demonstrated a poor ability to discriminate TMD from controls.

CONCLUSION

Thermography could be a potential tool in diagnostics of female TMD patients. The results suggest that the thermal information assessed in specific facial areas could help to discriminate TMD patients from non-TMD patients and could be used to quantify the pain associated with TMD.

Diagnostic Criteria for Temporomandibular Disorders (DC/TMD): Polish assessment instruments

The article presents the Polish version of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), the process of document translation and cultural adaptation.

Awake bruxism in temporomandibular disorders patients referred to tertiary care: A retrospective study on its assessment and TMD management

BACKGROUND

Bruxism is defined as a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. Bruxism can occur during sleep (sleep bruxism, SB) or during wakefulness (awake bruxism, AB). To date, the effect of AB on the purported negative consequences of bruxism has remained unclear.

OBJECTIVES

The assessment of AB, its relation to temporomandibular disorders (TMD) treatment modalities, and their possible outcomes were investigated among TMD patients resistant to treatment in primary care and referred to a tertiary care clinic.

METHODS

The records of 115 patients were studied. Patients were referred to the Head and Neck Centre, Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, for TMD treatment between 2017 and 2020. The data derived from the eligible patients' records included the following: background data (age and sex), referral data (reason and previous treatment), medical background (somatic and psychiatric), clinical and possible radiological diagnoses at a tertiary care clinic, treatment modalities for masticatory muscle myalgia, bruxism assessment, its possible treatment modalities and their outcomes, and overall management outcome. We analysed the outcomes of single treatment modalities and combined groups of modalities. For the demographic data, the Chi-squared test and Fischer's Exact test were used to determine the associations between the categorical variables. A Sankey-diagram was used to describe the flow of treatment.

RESULTS

Temporomandibular joint-pain-dysfunction syndrome (K07.60) was the most frequent single reason to refer a patient to tertiary care (17.4%). At referral, men had myalgia (M79.1) significantly more often (p = .034) than women. Similarly, men had depression (p = .002) more often and other psychiatric diagnoses (p = .034). At tertiary care, the presence of AB was assessed in 53.9%, and self-reported AB was recorded in 48.7%. In patients with possible AB, those who were prescribed neuropathic pain medication showed significantly less improvement in symptoms (p = .021) than those who underwent splint therapy (p = .009). Overall, half of the patients showed overall improvement in their TMD symptoms from the treatment combinations.

CONCLUSION

Despite several treatment modalities, only half of the patients showed improvement in their symptoms in the present study. A standardised assessment method encompassing all factors contributing to bruxism behaviours and their consequences is suggested.

Diagnostic Accuracy of a Temporomandibular Disorder Pain Screener in Patients Seeking Endodontic Treatment for Tooth Pain

INTRODUCTION

This study assessed the accuracy of a TMD Pain Screener questionnaire in identifying patients with temporomandibular disorder (TMD) pain among those seeking endodontic treatment for tooth pain. It also investigated whether the screener accuracy could be improved by adding questions regarding putative predictors of TMD status.

METHODS

One hundred patients seeking endodontic treatment for tooth pain were enrolled. Participants completed the 6-question TMD Pain Screener before treatment. A board-certified orofacial pain specialist/endodontic resident conducted endodontic and TMD examinations using validated Diagnostic Criteria for TMD (DC/TMD). The sensitivity (Se), specificity (Sp), and positive/negative predictive values (PPVs/NPVs) were calculated for the 6-question and 3-question versions of the TMD Pain Screener. Logistic regression and receiver operating characteristic curve (AUROC) analyses were performed to determine the screening accuracy.

RESULTS

At the screening threshold of ≥3, TMD Pain Screener's sensitivity was 0.85, specificity 0.52, PPV 0.68, and NPV 0.75 for the 6-question version and 0.64, 0.65, 0.69, and 0.61, respectively, for the 3-question version. The AUROC was 0.71 (95% CL: 0.61, 0.82) and 0.60 (95% CL: 0.48, 0.71) for full and short versions, respectively. Adding a rating of current pain intensity of the chief complaint to the screener improved the AUROC to 0.81 (95% CL: 0.72, 0.89) and 0.77 (95% CL: 0.67, 0.86) for full and short versions, respectively, signifying useful overall accuracy.

CONCLUSIONS

The 6-question TMD Pain Screener, combined with the patient's rating of current pain intensity of the chief complaint, could be recommended for use in endodontic patients with tooth pain for detecting painful TMD.

Recording the maxillomandibular relationship with the Aqualizer system prior to occlusal splint therapy for treating temporomandibular disorders: a randomized controlled trial

Temporomandibular disorders (TMD) present a public health issue and are one of the most common musculoskeletal conditions causing chronic pain. This study compares the outcomes of occlusal splint therapy in patients with TMD following two different maxillomandibular relationship (MMR) registration techniques. 40 TMD patients were randomly allocated to MMR registration with the Aqualizer system (AQU) or with chin point guidance (CPG) prior to fabricating occlusal splints. TMD symptoms, subjective pain intensity, and quality of life (QoL) were recorded at baseline and after 3 and 6 months. The treatment led to an overall reduction of TMD symptoms in both groups (Conover test, p < 0.00001). TMJ sounds, TMJ pain with palpation and muscle pain with palpation subsided regardless of the type of MMR registration method used (Cohen's d > 0.8). AQU-based occlusal splints led to a better improvement of TMJ pain with maximum opening compared to CPG-based occlusal splints (Cohen's d = 0.9; CPG d = 0.13). In both groups, occlusal splint treatment had little to no effect on correcting lateral mandible deviation or improving restricted jaw opening. After 6 months occlusal splints in both groups had a large effect on improving subjective pain intensity (Cohen's d > 0.8), however, patients reported a higher QoL in the AQU group compared to the CPG group (Mann-Whitney-U-test, p < 0.05). The results of this study support the premise that occlusal splints are effective in relieving pain-related TMD symptoms. The Aqualizer can be considered for determining MMR in cases, where guided registration techniques are not possible.Trial registration: DRKS00031998.

Ganglion cyst of temporomandibular joint - A systematic review

Ganglion cyst of the temporomandibular joint (TMJ) is an uncommon pathology with uncertain etiology. There is no consensus on their management. The current systematic review aimed to discuss the clinical and histopathological features of ganglion cysts of TMJ, to aid in appropriate treatment. A literature search was done and a total of 20 cases were retrieved from published databases such as PubMed, SCOPUS, and Google Scholar. The cyst presented with swelling in all the cases followed by pain (50 %) and trismus (35 %) as other common symptoms. Though CT and MRI proved helpful in determining the location of the cyst, a histopathological examination was essential in concluding its final diagnosis. It is a pseudocyst lined by dense fibro-connective tissue with myxoid tissue degeneration. Histologically, it is essential to distinguish them from the clinically and radiographically similar true cyst of TMJ, synovial cyst. The lining of ganglion cyst is devoid of epithelium and synovial cells. Surgical excision was found to be the treatment of choice with minimal recurrence (10 %) being reported.

Persistent foramen of Huschke: Clinical manifestations and complications, systematic review

BACKGROUND

Foramen of Huschke is a bone defect with wide clinical symptoms which ca can be responsible for severe complications. Clinical history and imaging are unspecific, it is therefore essential to recognize and treat the pathology related to the persistence of this foramen, to avoid destruction of the TMJ, chronic pain or OBJECTIVE: The aim of this review was to summarise the clinical manifestations and complications of persistent foramen of Huschke in adult patients, through a review of the cases reported in the literature.

METHODS & MATERIALS

A literature search of the PubMed, Cochrane Library, ScienceDirect and Embase databases was conducted for all articles published up to November 2022 to identify studies and case reports concerning clinical manifestations and complications of persistent foramen of Huschke in adult patients, with the key words "foramen of Huschke" or "foramen tympanicum".

RESULTS

74 papers where firstly identify, and 21 were selected. This correspond to 46 patients with the additional case from our department. Symptoms mostly reported consisted of otitis (63%, 29/46), otorrhea (28.26%, 13/46), and masticatory tinnitus (19.57%, 9/46). Diagnosis was priority made by CT-scan (95.65%, 44/46). Surgery was the most performed treatment (28.26%, 13/46). In our case, the use of FLUOBEAM® NIR camera was help-full for TMJ surgery.

CONCLUSION

Persistent foramen of Huschke should be suspected in the presence of otitis, otorrhea and masticatory tinnitus. Knowledge of this anatomical variation could help to treat certain pathology like TMJ disorders or TMJ septic arthritis.

Digitalized diagnosis and treatment of pigmented villonodular synovitis of temporomandibular joint: a case report

Pigmented villonodular synovitis (PVNS) is a rare locally aggressive benign tumor in the temporomandibular joint (TMJ). This paper presents a patient with TMJ-PVNS involving masseteric space, temporal bone, zygomatic process, and mandibular ramus. Digital technique was used to determine the boundary of the lesion and reconstruct the normal glenoid fossa. The temporalis myofascial flap was transplanted between titanium mesh and condyle to reconstruct the disk after the complete resection of the tumor. The patient's facial profile is symmetrical, with a mouth ope-ning of 43 mm. No local recurrence and complications, such as cerebrospinal fluid fistula and encephaloceles, were detected during 30-month follow-up period.

Efficacy of the transcutaneous electrostimulation in treatment dysfunctions of the TMJ associated with occlusion distortions

BACKGROUND

The study evaluation of the effectiveness the method of electrostimulation in treatment TMJ associated with occlusion disorders with the use of a patches by the company "Aganyan''.

METHODS

The study included 54 patients with temporomandibular dysfunction syndrome who had previously undergone endodontic dental treatment. In patients temporomandibular disorders (TMD) determined on the basis of Diagnostic criteria for temporomandibular disorders(DC/TMD).All patients had occlusion disorders due to errors after dental filling restoration. To diagnose the TMJ, a CT scan was used. The complex therapy also included therapy and with the use of a patches by the company "Aganyan''. The wearable patch includes a flexible substrate, a binder an adhesive layer, with an electrode foil attached to it. Patients applied one patch behind each TMJ. The patches were applied for eight hours every third day for three months. All the patients were given full-fledged endodontic treatment and restoration of the crown part, taking into account anatomical features.

RESULTS

The dynamics of the complex treatment of patients diagnosed with TMJ dysfunction syndrome showed that after treatment, the clinical symptoms gradually decreased and disappeared at the end of treatment. CT scan a year after treatment showed a normal ratio of TMJ elements. Сomplex treatment was effective in 87% of patients, after 3-5 months gradually decreased pain, noise in the joints, restriction of opening and closing of the mouth disappeared. Patients recovered their chewing functions, psycho-emotional state.

CONCLUSION

The results of the studies revealed a positive effects for the complex treatment dysfunctions syndrome TMJ the using the patches by the company "Aganyan" through electrical stimulation with low intensity.

The Physical Symptom Scale-8: Psychometric Characteristics of a Short-Form Version of the PHQ-15 and its Use in TMD-Related Assessment and Research

AIMS

To describe the development of the Physical Symptom Scale-8 (PSS-8) and to examine its psychometric properties and use in temporomandibular disorder (TMD)-related assessment and research.

METHODS

An online survey comprising demographic variables, the DC/TMD pain screener (TPS), Short-Form Fonseca Anamnestic Index (SFAI), PSS-8, PHQ-15, and Depression, Anxiety, and Stress Scale-21 (DASS-21) was administered to young adults attending a technical college. The PSS-8 adopted the Somatic Symptom Scale-8 (SSS-8) items but maintained the 3-point response scale and 4-week time frame of the PHQ-15. Internal consistency and reliability of the PSS-8 were determined by its Cronbach α value. Known-groups and concurrent/convergent validity were examined using Mann-Whitney U test and Spearman correlation (α = .05), respectively.

RESULTS

Responses from 400 participants (mean age 18.8 ± 1.5 years; 52.3% women) were evaluated. Pain-related (WPT) and all (WAT) TMDs were present in 8.5% and 17.3% of the sample, respectively. The PSS-8 exhibited good internal consistency (α = 0.82) and sound known-groups validity, with the WPT/WAT groups having significantly higher PSS-8 scores than those without TMDs. Good concurrent and convergent validity were also observed, with moderate to strong correlations with the PHQ-15 (rs = 0.97) and DASS-21 scores (rs = 0.48 to 0.60). Correlations with the TPS and SFAI scores were weaker (rs = 0.28 to 0.34).

CONCLUSION

The PSS-8 presented good psychometric properties and performed similarly to the PHQ-15. It holds promise as the "de facto" shortened version of the PHQ-15 for TMDs and related work.

Practitioner/Practice- and Patient-Based Factors Contributing to Dental Practitioner Treatment Recommendations for Patients with Pain-Related TMDs: Findings from the National Dental PBRN

AIMS

To document National Dental Practice-Based Research Network (PBRN) practitioner treatment recommendations for patients with painful temporomandibular disorders (TMDs) and to identify practitioner/practice- and patient-related factors contributing to treatment recommendations made at the initial clinical visit.

METHODS

This prospective single-sample cohort study formed groups based on treatment recommendations made by 185 dental practitioners who treated 1,901 patients with painful TMDs. At the baseline visit, which this article describes, practitioners provided patients with their diagnoses and a treatment plan and then completed a comprehensive questionnaire.

RESULTS

Self-care, an intraoral appliance, medication, and practitioner-recommended jaw exercises were the most frequently recommended treatments. Practitioners recommended multiple treatments to most patients. TMD signs, symptoms, and diagnoses were primary considerations in treatment planning, but the practitioner's expectations for improvement were only significant for intraoral appliances and self-care. Female practitioners and those with expertise in TMDs more frequently recommended patient-directed and multidisciplinary treatments compared to their counterparts.

CONCLUSIONS

Practitioners used a wide range of treatments for patients with few consistent patterns. The propensity to use TMD signs, symptoms, and diagnoses when making treatment recommendations suggests a tendency to conceptualize patients using the biomedical model. Infrequent referral to nondental providers suggests a lack of availability of these providers, a misunderstanding of the complexity of TMDs, and/or discomfort with assessment of psychosocial factors. Implications include the need for comprehensive training in the assessment and management of TMD patients during dental school and participation in TMD continuing education courses following evidence-based guidelines.

Somatosensory tinnitus and temporomandibular disorders: A common association

BACKGROUND

Although the association between tinnitus and temporo-mandibular disorders (TMD) has been frequently reported, their rate of association in the literature shows a great variability.

OBJECTIVE

We aimed to investigate the prevalence of TMD in patients with somatosensory tinnitus and, vice versa, the occurrence of somatosensory tinnitus in patients with TMD.

METHODS

The study included patients with somatosensory tinnitus (audiological group) and patients with TMD (stomatological group), evaluated at the audiologic and stomatologic clinics of the Policlinic Hospital of Milan, Italy. Common causes of tinnitus, such as hearing and neurological disorders, were excluded. A cervicogenic somatic tinnitus was also ruled out. Different TMD symptoms, including joint noise and joint pain, were considered. The collected data were analysed using descriptive statistical methods, and the Pearson's Chi-squared test was performed to study the prevalence of the different symptoms by clinical groups.

RESULTS

Audiological group included 47 patients with somatosensory tinnitus. Overall, TMD was diagnosed in 46 patients (97.8%), including TMJ noise in 37 (78.7%), clenching in 41 (87.2%) and pain in 7 (14.8%) patients. Stomatological group included 50 patients with TMD, including joint noise in 32 (64.0%), clenching in 28 (56.0%) and TMJ pain in 42 (84.0%) patients. A somatosensory tinnitus was diagnosed in 12 (24.0%) patients.

CONCLUSION

Our study showed a high prevalence of TMD in patients with tinnitus, as well as a not uncommon occurrence of tinnitus in patients presenting with TMD. The distribution of TMD symptoms, such as joint noise, and joint pain was different between the two groups.

Diagnosis of TMJ degenerative diseases by panoramic radiography: is it possible? A systematic review and meta-analysis

OBJECTIVE

The objective of this work was to determine the diagnostic accuracy of panoramic radiography in detecting degenerative diseases of the temporomandibular joint.

METHOD

The protocol was registered at the PROSPERO website. To consider the eligibility of studies to be included/excluded from this review, the acronym "PIRDS" was used and appropriate word combinations and truncations were adapted in the following electronic databases: PubMed/Medline, EMBASE, Latin American and Caribbean Literature on Health Sciences, Web of Science, Scopus, and Cochrane Library.

RESULTS

A total of 2572 references, after the removal of duplicates, were retrieved from the eight electronic databases. After reading the titles and abstracts, a total of 26 articles were selected for full reading, of which ten were excluded, resulting in 16 articles included for qualitative synthesis. All in vivo studies were classified as having a low risk of bias. Regarding in vitro studies none of the included studies scored below 80% in the overall evaluation.

CONCLUSIONS

Both in vitro and in vivo studies consistently report a low accuracy in detecting degenerative diseases of the temporomandibular joint using panoramic radiography.

CLINICAL RELEVANCE

Cone-beam computed tomography offers a superior image quality without overlapping structures and a higher accuracy compared to panoramic radiography. However, panoramic radiography can still serve as an initial examination when combined with a clinical assessment. CBCT should be reserved for cases where there are evident clinical and/or radiographic alterations that recommend its use. This approach ensures a judicious and cost-effective use of CBCT resources.

Diagnostic criteria for temporomandibular disorders-INfORM recommendations: Comprehensive and short-form adaptations for adolescents

BACKGROUND

The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for use in adults is in use worldwide. Until now, no version of this instrument for use in adolescents has been proposed.

OBJECTIVE

To present comprehensive and short-form adaptations of the adult version of DC/TMD that are appropriate for use with adolescents in clinical and research settings.

METHODS

International experts in TMDs and experts in pain psychology participated in a Delphi process to identify ways of adapting the DC/TMD protocol for physical and psychosocial assessment of adolescents.

RESULTS

The proposed adaptation defines adolescence as ages 10-19 years. Changes in the physical diagnosis (Axis I) include (i) adapting the language of the Demographics and the Symptom Questionnaires to be developmentally appropriate for adolescents, (ii) adding two general health questionnaires, one for the adolescent patient and one for their caregivers and (iii) replacing the TMD Pain Screener with the 3Q/TMD questionnaire. Changes in the psychosocial assessment (Axis II) include (i) adapting the language of the Graded Chronic Pain Scale to be developmentally appropriate for adolescents, (ii) adding anxiety and depression assessment that have been validated for adolescents and (iii) adding three constructs (stress, catastrophizing and sleep disorders) to assess psychosocial functioning in adolescents.

CONCLUSION

The recommended DC/TMD, including Axis I and Axis II for adolescents, is appropriate to use in clinical and research settings. This adapted first version for adolescents includes changes in Axis I and Axis II requiring reliability and validity testing in international settings. Official translations of the comprehensive and short-form to different languages according to INfORM requirements will enable a worldwide dissemination and implementation.

Telemedicine in the diagnosis and management of temporomandibular disorders: A systematic review conducted according to PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions

BACKGROUND

Telemedicine (T-Med) has always been an important tool in the arsenal of clinicians worldwide. This technique has become increasingly popular in recent years, especially in light of the COVID-19 pandemic, which has made it difficult for some people to access traditional dental care. The current review aimed to analyse the usage of telemedicine in the diagnosis and management of temporomandibular disorders (TMDs) and its impact on general health.

METHODS

An extensive search of databases was conducted using keywords such as, "telemedicine," "teledentistry," "TMJ" and "temporomandibular disorders," resulting in a total of 482 papers to be available from which eligible studies were selected. The Risk of Bias in Observational Studies of Exposures (ROBINS-E) tool was used to evaluate methodological quality of included studies.

RESULTS

Two studies were selected which fulfilled the eligibility criteria. All assessed studies indicated varying degrees of positive outcomes for patients who were intervened for TMDs using T-Med.

CONCLUSION

T-Med shows promising results for the diagnosis and management of TMDs, especially since the advent of the COVID-19 pandemic and thereafter. Long-term clinical trials with larger samples are needed to further ascertain validity in this regard.

Centric relation-A biological perspective of a technical concept

BACKGROUND

Few terms and concepts have been so extensively debated in dentistry as the words 'centric relation' (CR). Debates involve its biological, diagnostic and therapeutic usefulness.

METHODS

A review of the literature on the current concepts on CR as a diagnostic or therapeutic aid in dentistry was provided. Clinical trials assessing the superiority of one CR recording method over the others to identify patients with temporomandibular disorders (diagnostic use) or to manage patients with prosthodontic or orthodontic needs (therapeutic use) were tentatively included.

RESULTS

Due to the absence of literature addressing either of the above targets, a comprehensive overview was provided. The diagnostic use of CR as a reference position to identify the correct position of the temporomandibular joint condyle within the glenoid fossa is not supported and lacks anatomical support. From a therapeutic standpoint, the use of CR can be pragmatically useful in prosthodontics as a maxillo-mandibular reference position when occlusal re-organization is warranted and/or when the position of maximum intercuspation is no longer available.

CONCLUSIONS

The derived occlusal goals from a diagnostic misuse of CR are generally the result of circular reasoning, that is a technique is based on the recording of a certain condylar position that is believed to be 'ideal' and the treatment is considered successful when such position is shown by the specific instrument that was manufactured for that purpose. The term 'Centric Relation' might be replaced with the term 'Maxillo-Mandibular Utility Position'.

Insomnia is associated with symptoms of central sensitization in patients with painful temporomandibular disorders

BACKGROUND

Central sensitization (CS) and temporomandibular disorder (TMD) are both associated with insomnia. Therefore, the authors aimed to investigate whether insomnia was associated with more symptoms of CS in patients with TMD.

METHODS

In 82 volunteers with TMD, insomnia was clinically assessed, allowing sample stratification according to its presence. The Central Sensitization Inventory questionnaire was self-applied to assess the clinical symptoms of CS.

RESULTS

Participants with insomnia had significantly higher mean (SD) scores of CS according to the Central Sensitization Inventory than participants without insomnia (43.10 [12.57] vs 26.59 [13.66]; P = < .001).

CONCLUSIONS

Insomnia was associated with higher scores of CS symptoms in patients with TMD.

PRACTICAL IMPLICATIONS

Insomnia influences TMD as well as its relationship with CS, and, therefore, it is critical to the clinical management of TMD.

Do dental implant therapies arouse signs and symptoms of temporomandibular disorders? A scoping review

OBJECTIVE

To delineate and discuss the literature about TMD in the context of dental implantology.

METHODS

The PRISMA-ScR and Joanna Briggs guidelines for scoping reviews were used as methodological parameters. In vivo studies published in the English language showing interplay between dental implant therapy and TMD were included. A systematic screen strategy was applied in two platforms to obtain a broad range of relevant literature published in English.

RESULTS

The literature review indicated that prolonged surgical procedure may be a risk for TMD. Conversely, implant-supported prostheses were found to contribute to the mitigation of some TMD aspects. Empirical principles for the best practice in implant dentistry concerning the TMD were discussed in the present study.

CONCLUSION

The included clinical studies suggest that factors associated with the implant placement, such as long duration of surgical procedures, may represent risk factors for TMD. They also indicate long-term benefits of implant-supported restorations.