IRIS CHANGES AT PATIENTS WITH TEMPORОMANDIBULAR JOINT DISEASES AND URINARY SYSTEM PATHOLOGY

Relevance. In recent years, many have been devoted to the problem of the temporomandibular joint (TMJ) diseases, in which the attention is paid to the widespread pathology of TMJ at young people, which develops against the background of genetically-determined weakness of connective tissue (CT), which is also present occurrence of various concomitant diseases of polygenic-multifactorial nature, including the organs of the urinary system (US). Objective. To investigate the manifestations of US pathology in young patients with TMJ diseases. Materials and methods. The study involved 32 patients (m-4, w-28) with diseases of the TMJ, whose average age was 31.6 ± 7.7 years, who were treated at the Dental Medical Center of the Bogomolets NMU. Manifestations of US pathology in patients of this group have been investigated. Examination of patients was performed according to the classical method of examination of patients with diseases of the TMJ. The orthopantomography with examination of the mandibular heads, open mouth X-ray by Parma, computed tomography or MRI scan, iridobiomicroscopy were obligatory. The presence of pathology of US was founding out from the anamnesis vitae, the patient was referred for consultation to a nephrologist. Ultrasound of the kidneys, urinary tract, urine tests were performed for all examined patients. The obtained laboratory data were referenced in the International System of Units and processed by variational statistics using MedStat and EZR v.1.35 (Saitama Medical Center, Jichi Medical University, Saitama, Japan, 2017), which is a graphical interface to RFSC (The R Foundation for Statistical Computing, Vienna, Austria). Results. The following manifestations of TMJ pathology were found in young patients with US diseases: chronic cystitis – 37.5% of cases, oxalate or urinary crystalluria – 37.5 %, nephroptosis – 9.4 %, urolithiasis – 6.3 %, chronic pyelonephritis – 6.3 %, double kidney – 3.1 %. Structural local or chromatic changes of the iris stroma in the projection region of the kidney (75 %) and bladder (43.6 %) in young patients with TMJ diseases showed a congenital weakness of the CT of these organs and a tendency to develop pathology of the US. Changes in urine tests were mainly in the form of oxalate crystalluria (34.4 %), increase specific gravity (15.6 %), proteinuria (9.4 %), which further confirmed the present pathology of the urinary system. Conclusions. The manifestations of developmental abnormalities and other kidney and bladder diseases found in young patients with TMJ disease suggest that there is a correlation between flow of pathological processes in the TMJ and US, which may be based on changes in the CT system. When planning the treatment of young patients with TMJ diseases and pathology of US, medicines that do not affect the urinary system and do not provoke exacerbation of the disease should be prescribed. In the presence of pathology of the kidneys and/or urinary tract, the ultrasound of this system should be prescribed in consultation with a nephrologist.

Temporomandibular disorders

Influence of headache frequency on clinical signs and symptoms of TMD in subjects with temple headache and TMD pain

Introduction. Temporomandibular joint (TMJ) dysfunction is the second most common musculoskeletal disease, affecting up to 33 % of people during their lifetime. The multicomponent etiopathogenesis of the disease actualizes the use of diagnostic criteria for the early symptoms of developing functional disorders. The algorithm for preclinical examination of the TMJ must be used already in the dentist′s office, which will allow to avoid the unpredictable results of dental rehabilitation and in time to attract other specialists to the complex therapy of the patient. The etiopathogenesis of TMJ dysfunction indicates the need for a closer study of the mutual infl uence of structural imbalances in the body and dentition, the determination of the primary disorder, which will help to develop a system for the prevention of TMJ dysfunctions, and may also affect the sequence, volume and nature of the treatment for this pathology.The goal of research — to identify the relationship of structural imbalances in the body and temporomandibular joint dysfunction.Materials and methods. From September to December 2019, a prospective study of 70 volunteers among university students was conducted at the Department of Orthopedic Dentistry of Omsk State Medical University. During the processing of clinical material, 6 people retired in accordance with exclusion criteria. All subjects underwent an assessment of the state of the dentofacial system, primarily the TMJ (using a short Hamburg test) and structural imbalances of the body (using the Notch Interfaces Inc. motion capture and reconstruction system). To assess the cervical-cranial relationship in the subjects who had 3–6 points according to the results of the Hamburg test, a head X-ray was make in lateral projection, and cephalometric analyzes were performed according to Rocabado and Sassuni. The presence and strength of the linear relationship between the phenomena was determined using the Pearson coefficient.Results. According to the results of the Hamburg test, a functional norm was revealed in only 12,5 % of the examined; TMJ dysfunction was revealed in the vast majority of volunteers (57,9 %). Structural imbalances of the body were detected in 82,8 % of cases. Patients with established by the results of the Hamburg test TMJ dysfunction were underwent cephalometric analysis. Structural changes in the TMJ were not found in the subjects according to the X-ray studies results. There was a high positive relationship between functional TMJ dysfunction and pelvic hyperfl exion (ρ=0,72, p<0,05), and an average positive relationship (ρ=0,55, p<0,05) between the head and neck forward tilting. A positive weak relationship was observed between the risk of TMJ dysfunction developing (2 points according to the Hamburg test) and pelvic hyperfl exion (ρ=0,31, p<0,05).Conclusion. The study showed a strong positive relationship between pelvic hyperfl exion and TMJ dysfunction signs; an average positive relationship between TMJ functional impairment and head and neck forward tilting. It was also found that in individuals with TMJ dysfunction signs there were no radiological signs of structural changes in the joint, which indicates the potential reversibility of the revealed disorders and the need for their timely detection and correction. This study is pilot and will be continued in a broader format.

Differential diagnosis of facial pain and guidelines for management

18F-NaF PET/CT for the evaluation of temporomandibular joint disorder

Orofacial pain or tenderness is a primary symptom associated with temporomandibular joint (TMJ) disorders (TMDs). To understand the pathological mechanisms underlying TMDs, several mouse models have been developed, including mechanical stimulus-induced TMD and genetic mouse models. However, a lack of feasible approaches for assessing TMD-related nociceptive behaviours in the orofacial region of mice has hindered the in-depth study of TMD-associated mechanisms. This study aimed to explore modifications of three existing methods to analyse nociceptive behaviours using two TMD mouse models: (1) mechanical allodynia was tested using von Frey filaments in the mouse TMJ region by placing mice in specially designed chambers; (2) bite force was measured using the Economical Load and Force (ELF) system; and (3) spontaneous feeding behaviour tests, including eating duration and frequency, were analysed using the Laboratory Animal Behaviour Observation Registration and Analysis System (LABORAS). We successfully assessed changes in nociceptive behaviours in two TMD mouse models, a unilateral anterior crossbite (UAC)-induced TMD mouse model and a β-catenin conditional activation mouse model. We found that the UAC model and β-catenin conditional activation mouse model were significantly associated with signs of increased mechanical allodynia, lower bite force, and decreased spontaneous feeding behaviour, indicating manifestations of TMD. These behavioural changes were consistent with the cartilage degradation phenotype observed in these mouse models. Our studies have shown reliable methods to analyse nociceptive behaviours in mice and may indicate that these methods are valid to assess signs of TMD in mice.

Background: Temporomandibular disorders have been considered as a common orofacial pain condition. The term temporomandibular pain dysfunction (TMPD) is used synonymously with myofacial pain dysfunction disorder/syndrome, temporomandibular disorder, craniomandibular disorder and many other terms. Objective: To evaluate the prevalence of signs and symptoms of temporo-mandibular joint disorder (TMD). Study Design: Descriptive cross-sectional study Place and Duration of Study: Department of Oral and Maxillofacial Surgery, Faryal Dental College, Sheikhupura , Lahore, Pakistan from 1st February 2019 to 31st May 2021. Methodology: One hundred adolescents aged 15 to 60 years were enrolled. A detailed history about the chief complaint was taken and clinical examination was done. Temporomandibular joint examination performed included Auscultation for temporomandibular joint sounds like clicking and crepitus and palpation of both TMJs and associated muscles for evaluation of pain. Results: The most common signs of temporomandibular joint disorders were temporomandibular joint pain 78%, temporomandibular joint clicking 53% and trismus 29%. The most prevalent predisposing factors of temporomandibular joint disorders were parafunctional habits 40%, unknown factors 23% and history of road traffic accident/history of difficult extractions 9%. Male to female ratio showed female predominance (P = 0.001). Conclusion: Signs and symptoms of temporomandibular joint disorders were prevalent in Pakistani population with a clear female predominance. Key words: Temporomandibular disorders, Temporomandibular joint, Orofacial pain, Bruxism, Headache, Pain

We read with great interest the randomized controlled trial by Poorna et al.1 on the efficacy of soft and hard splints for the symptomatic management of temporomandibular joint (TMJ) disorders, in which the severity of TMJ disorders, as measured by the modified Helkimo index, was compared between patients undergoing soft and hard splint treatments. The authors reported that soft and hard splints are equally effective during a follow-up period of 3 months, but hard splints exerted an earlier symptom-relieving effect in the first month.1 As splint therapy is an integral part and the foundation of a comprehensive TMJ treatment plan,1 several aspects are worth further research. In the study by Poorna et al., patients with certain baseline characteristics were excluded to ensure that the efficacy of splint therapies was not biased by external factors.1 Nonetheless, there were several confounders. For instance, given that female individuals are more likely to have TMJ disorders than male individuals,2 and that there are sex differences in pain perceptions,3 subgroup analysis based on stratification by sex may facilitate our understanding of populations in which splint therapies are more applicable. Moreover, although patients with a history of several rheumatic, psychiatric, or dental comorbidities were excluded, it was unclear whether the participants had osteoporosis or low bone mineral density of the maxilla and mandible, malocclusion, periodontitis,4-6 or a history of receiving orthognathic surgeries.7 Because the above-mentioned diseases or treatments may result in TMJ overloading thus leading to structural changes in TMJ,8 inclusion of these records may allow us to ascertain the safety and efficacy of splint therapies for TMJ disorders as a disease of multifactorial etiology. Likewise, future studies including patients with a history of TMJ-involving diseases such as osteoarthritis,9, 10 rheumatoid arthritis,11 or juvenile idiopathic arthritis7, 12 may allow for the generalization of splint therapies. On the other hand, further consideration of predictor variables of preferable clinical outcomes, including patient compliance to splint therapies or splint-wearing behaviors and outcomes other than the Helkimo index that can indicate observable symptoms of TMJ disorders,1 such as the visual analogue scale (VAS) and measures of quality of life, may augment our knowledge on the treatment outcomes of splint therapies more comprehensively. It was indicated in the article by Poorna et al. that panoramic radiographs were used to measure TMJ space produced following splint therapies.1 In the era of precision medicine, in addition to panoramic radiographs that provide two-dimensional information, the precise diagnosis and evaluation of TMJ disorders have largely benefited from advanced imaging modalities including cone-beam computed tomography and high-resolution magnetic resonance imaging, for which the morphological assessment of TMJ spaces, condylar volume in different planes, and glenoid fossa roof thickness has been realized.13 Furthermore, as kinematic parameters and trajectory-tracking technology have been widely applied to delineate TMJ functions and occlusion, studies incorporating these modalities can precisely determine morphological and functional changes before versus after splint treatments.14 In addition to anatomical changes, because it has been demonstrated that the severity and symptoms of TMJ disorders are associated with inflammatory biomarkers in the synovial fluid of TMJ,15 studies including synovial fluid analysis with respect to splint therapies or other treatments for TMJ disorders may expand our understanding of the management of TMJ disorders through a targeted approach. In conclusion, given the multifactorial etiology of TMJ disorders, more studies are needed to generalize the efficacy of splint therapies in patients with concurrent comorbidities. Moreover, as novel imaging modalities and diagnostic biomarkers for TMJ disorders have been proposed, future studies incorporating these technologies may strengthen our knowledge on the efficacy of treatments for TMJ disorders. None.

Background: Painful temporomandibular joint disorders (TMDs) are of musculoskeletal origin and are considered the most common cause of non-odontogenic pain in the orofacial region. The purpose of this study was to investigate the prevalence and awareness of temporomandibular joint (TMJ) disorders in Almadinah Almunawwarah community. Methods: An observational cross-sectional study with convenience sampling was conducted. A modified version of Fonseca's questionnaire was employed. The questionnaire asked about the participant's personal information, if they thought they had TMDs, and who to visit for therapy if necessary. These were followed by 10 items from Fonseca's questionnaire, each with a three-point scale. Results: The questionnaire was completed by 598 people. Females made up 57.1% of the participants. TMDs were present in 61% of the population, with varying degrees of severity. Males (44.3%) were less affected than females (55.7%). The difference, however, was not statistically significant (P = 0.354). Out of the 61% TMDs Positive patients, 74.1% had mild TMDs symptoms, while 20.8% and 5.1%, respectively, had moderate and severe TMDs symptoms (P = 0.05). The severity of the symptoms was unaffected by demographic data (P > 0.05). Only 40% seek care, with 64.6% selecting for a dentist and 24.6% preferring for an orthopaedic specialist (P= 0.008). Conclusions: Participants from Al-Madinah had a greater prevalence of mild TMDs. The majority of the participants had no idea who to go to for treatment. The findings of this study highlight the importance of educational activities to enhance public awareness. Fonseca's Anamnestic Index could also be considered as a useful instrument for early identification and measuring the severity of TMDs in the general population.

Background: Painful temporomandibular joint disorders (TMDs) are of musculoskeletal origin and are considered the most common cause of non-odontogenic pain in the orofacial region. The purpose of this study was to investigate the prevalence and awareness of temporomandibular joint (TMJ) disorders in Almadinah Almunawwarah community.Methods: An observational cross-sectional study with convenience sampling was conducted. A translated Arabic version of Fonseca's questionnaire was employed. The questionnaire asked about the participant's personal information, if they thought they had TMDs, and who to visit for therapy if necessary. These were followed by 10 items from Fonseca's questionnaire, each with a three-point scale.Results: The questionnaire was completed by 598 people. Females made up 57.1% of the participants. TMDs were present in 61% of the population, with varying degrees of severity. Males (44.3%) were less affected than females (55.7%). The difference, however, was not statistically significant (P = 0.354). Out of the 61% TMDs Positive patients, 74.1% had mild TMDs symptoms, while 20.8% and 5.1%, respectively, had moderate and severe TMDs symptoms (P = 0.05). The severity of the symptoms was unaffected by demographic data (P > 0.05). Only 40% seek care, with 64.6% selecting for a dentist and 24.6% preferring for an orthopaedic specialist (P= 0.008).Conclusions: Participants from Al-Madinah had a greater prevalence of mild TMDs. The majority of the participants had no idea who to go to for treatment. The findings of this study highlight the importance of educational activities to enhance public awareness. Fonseca's Anamnestic Index could also be considered as a useful instrument for early identification and measuring the severity of TMDs in the general population.

The purpose of this study was to investigate the relationship between temporomandibular joint (TMJ) dysfunction, bruxism and oral parafunctions in the permanent and mixed dentition of Turkish children. Examinations were performed on 59 children (26 girls and 33 boys) without TMJ dysfunction and 123 children (54 boys and 69 girls) with TMJ dysfunction in the mixed dentition. In the permanent dentition 89 children without TMJ dysfunction (45 girls and 44 boys) and 123 children with TMJ dysfunction (69 girls and 54 boys) were inducted into this study. The children with oral parafunctions (bruxism, nail biting and thumb/finger sucking) were determined through questionnaires. The Z-test was used for the analyses of the correlation between variables and differences between the groups. Generally a significant correlation was found between finger/thumb sucking and nail biting and TMJ dysfunction in the mixed dentition and bruxism was observed significantly to be associated with TMJ dysfunction in the permanent dentition (P < 0.05). The evaluation of the results showed that in the mixed dentition groups nail biting was significantly higher in the girls with TMJ dysfunction and finger or thumb sucking was significantly higher in the boys with TMJ dysfunction compared with those without TMJ dysfunction (P < 0.01). In the permanent dentition; bruxism and thumb/finger sucking were significantly higher in girls with TMJ dysfunction higher than those without TMJ dysfunction (P < 0.05). However, thumb/finger sucking was significantly higher in boys without TMJ dysfunction than with TMJ dysfunction (P < 0.05). The results of this study showed that the association of parafunctions and TMJ dysfunction is present in the mixed (thumb/finger sucking and nail biting) and the permanent dentitions (bruxism).

The incidence of temporomandibular joint dysfunction in women reaches 80% of the total number of patients. The symptoms of temporomandibular joint dysfunction are varied and were first described by otorhinolaryngologist J.B. Costen. In his honor, the entire symptom complex of this disease is named "Costen's syndrome" in specialized literature and in the International Classification of Diseases of the tenth revision. The symptom complex includes joint pain, sometimes radiating to the neck, back of the head, temple, ear, clicks in the joint during movements of the lower jaw, trismus, hearing loss, dull pain in the middle and outside the ear, pain and burning sensation of the tongue, dry mouth; dizziness, pain on the side of the affected joint and even facial pains like trigeminal neuralgia. It is clinically difficult to isolate all these symptoms in patients with dysfunction of the temporomandibular joint, because its pathogenic and etiological manifestation is characterized in most cases only by one or several symptoms.&#x0D; Temporomandibular joint dysfunction is polyetiological, has a varied clinical picture and is directly dependent on the hormonal state, and especially the gynecological status. Much attention is drawn to the study of estrogen, which, in addition to regulating the functioning of the reproductive system in a woman's body, also performs a number of other important functions, including helping the joint to remain healthy - preventing calcium leaching, stimulating collagen recovery and the work of osteoblasts.&#x0D; The aim of the study was to determine the frequency of temporomandibular joint dysfunction in women along with hormonal changes and to trace their correlation.&#x0D; Materials and methods. The study involved 169 students of the third year at the Department of Propedeutics of Surgical Dentistry of the Faculty of Dentistry of the Ukrainian Medical Stomatological Academy. The research methods were based on conducting an anonymous survey. The questions were written for both men and women and were characterized by general dental status. Questions on gynecological status were asked separately for women.&#x0D; Results and discussion. The study group consisted of 169 people, including 89 women and 80 men aged 18 to 28 years. 61% of men and 26% of women did not have complicated dental status, among those surveyed. At the same time, 35% of men (of their total number) and 28% of women (of their total number) had orthodontic pathology. The presence of individual symptoms of temporomandibular joint dysfunction in men was observed in 6% of the total number of patients, in women - 19% (4% of them had already consulted a dentist, but did not receive adequate treatment). It is worth noting that patients with suspected temporomandibular joint pathology complained only of clicks when opening their mouths or chewing.&#x0D; Among 89 women studied, 8% had temporomandibular joint dysfunction, but did not have pathologies of the reproductive system. In 20% of women who did not have temporomandibular joint dysfunction, pathology of the reproductive system was noted. 11% had temporomandibular joint dysfunction and pathology of the reproductive system. 26% of women were clinically healthy.&#x0D; Out of 10 women with temporomandibular joint dysfunction who had a pathology of the reproductive system, but never had problems with the dentition, 10% of the women in the group (1% of all women examined) suffered from menstrual irregularities and had human papillomavirus in their anamnesis. 20% had a suspicion of temporomandibular joint pathology along with problems in their gynecological status and a history of orthodontic treatment, 10% had menstrual irregularities (algodismenorrhea) and were treated by a gynecologist with hormonal contraceptives for up to 1.5 years. 30% of women had temporomandibular joint pathology with problems in their gynecological status and previous therapeutic treatment (presence of fillings in the oral cavity). Of these, 20% have menstrual irregularities, and 10% have cervical erosion. 40% of the total number of women had temporomandibular joint pathology with orthodontic treatment in the past and fillings in the oral cavity along with problems in their gynecological status, where all had menstrual irregularities. 10% of them had metaplasia, erosion of the cervix and uterine polyp, 10% - erosion of the cervix.&#x0D; It should be noted that out of 89 women, 14 (17.5%) did not have any complaints about the condition of the joint, but had fillings and orthodontic treatment in the past, as well as pathology of the reproductive system. 11 of them (14%) had menstrual irregularities. In 3 (4%) patients out of the total number of women, there was an increased level of androgens, progesterone, estradiol and a history of treatment by a gynecologist.&#x0D; Based on the results obtained, it is possible to confirm the forced frequency of women visiting the dentist. Among the total number of women with temporomandibular joint dysfunction and pathology of the reproductive system, there was only 1 patient out of 89 persons without any dental interventions in the past. This does not give us a reason to associate gynecological status with the etiology of temporomandibular joint dysfunction. But in view of the greater prevalence of temporomandibular joint dysfunction along with gynecological pathologies, it gives us a basis for active further research on this topic.

Subject. Questions of diagnostics and revealing of the reasons of temporo-mandibular joint (TMJ) disorders are very significant now. Realities of modern stomatology have a significant impact, namely, use of materials with high durability and rigidity, widely available of total restorations and orthodontic treatment, insufficiency of the high-grade diagnostics of maxillofacial pathology for revealing latent, compensated TMJ disorders before stomatologic intervention. All these factors leads to occurrence of patients with the expressed, developed semiology. The purpose. To consider interrelation of various occlusion derangements, lateral displacement of the mandible and internal TMJ disorders (or dislocations of the TMJ disc, intraarticulate elements). Methodology. The estimation of frequency of occurrence of TMJ disc dislocations according to literary sources is carried out, various etiological factors of internal TMJ disorders are considered, in particular, some types of pathological occlusion, which may have an essential impact on the violation of the ratio of intraarticulate elements. Two clinical cases of patients with TMJ disorders with similar semiology and presence of transversal malocclusion due to improper jaws growth and presence of the acquired pathology as result of stomatologic intervention as an example. Results of research. According to the domestic and foreign literature the role of occlusion factors in development of TMJ disorders is represents approximately 10―20 %, however there are researches by types of occlusal disorders which almost always lead to those or other TMJ disorders. Conclusion. It is revealed, that transversal malocclusion most often provokes TMJ dysfunction and internal joint disorders. In the future it is planned to reveal occlusal factors which able to provoke the development of TMJ disorders with high probability, mechanism of their influence and methods of revealing.

Relevance. Selective grinding is incorporated into the comprehensive treatment of periodontitis and TMJ (temporomandibular joint) dysfunction due to the presence of occlusal discrepancies, which can exacerbate or initiate these conditions. The evaluation of occlusal contacts, their distribution, and contact areas is crucial for diagnosing occlusal disturbances and selecting treatment approaches. Traditionally, occlusal contacts have been assessed using occlusograms obtained with articulating paper. However, the advent of digital technologies has made the interpretation of these parameters more challenging for practicing clinicians. This study aimed to evaluate occlusal contact parameters in patients with periodontitis and TMJ dysfunction (without pain symptoms) using traditional occlusiography with photographic documentation and articulating paper during clinical dental appointments.Material and methods. The study included 68 patients aged 18 to 44 years, of whom 41 were divided into four groups: 11 patients without signs of periodontitis or TMJ dysfunction, 11 with TMJ dysfunction but no periodontal pathology, 8 with both periodontitis and TMJ dysfunction, and 11 with periodontitis but no TMJ dysfunction. Occlusal contacts and their surface areas were assessed using occlusiography with photographic documentation.Results. The study revealed an increase in the number of occlusal contacts in cases of periodontitis and TMJ dysfunction. In patients with periodontitis and combined pathology (periodontitis and TMJ dysfunction), a significant rise in the frequency of pathological tooth wear was observed. The occlusal contact area varied significantly across all groups.Conclusion. An analysis of the literature and the obtained data identified consistent trends in changes in the number and area of occlusal contacts associated with these clinical conditions. The "occlusal contact area" parameter exhibited considerable variability and warrants further research to establish reference values. No conclusive data supporting selective grinding in patients with periodontitis and TMJ dysfunction were obtained.