Temporomandibular Disorders in 13‐ and 15‐Year‐Old Females: A Longitudinal Study

ABSTRACTThis comparative study by groups assesses the profiles of TMD (temporomandibular dysfunction) and bruxism patients and TMD-nonbruxing patients regarding chief complaint, previous medical and dental consultations, duration of the chief complaint, previous medication, and use of splints. The sample consisted of a group of 340 TMD patients, 275 of whom were bruxers and 65 who were nonbruxers. Both patients and controls were consecutive referrals over a period of five years. The group of TMD and Bruxer was classified according to the degree of severity. One hundred eight (108), 84, and 83 patients demonstrated mild, moderate, and severe bruxism respectively. Information gathered included a set of questionnaires, history of signs and symptoms, and a clinical examination. The most common chief complaints in TMD bruxers and nonbruxers were facial, temporomandibular joint, headache and/or cervical pain, and joint noises. It was observed that the need for medical and dental consultations increased with the severity of bruxism. It was also apparent in this study that the need for medication (analgesics, muscle relaxants, and antidepressants), increased with the severity of bruxism. Moderate and severe subgroups of bruxers used significantly more splints compared to mild bruxers and to TMD-nonbruxer patients. Both groups of TMD + bruxism and TMD—nonbruxism sought medical and dental consultations with dentists (clinicians and specialists) neurologists, and otolaryngologists more frequently compared to other medical professionals. Since the need for health services increased with the severity of bruxism, this study urges the need to include a protocol or questionnaire to assess the severity of bruxing behavior in TMD patients in order to use a customized method of treatment/management. This study also reinforces the point of view that different subgroups of TMD and bruxism do exist and suggests a differentiated therapeutic approach. They show previously confirmed findings that pain is the major complaint of TMD and bruxer patients.

Introduction. The temporomandibular joint (TMJ) is an anatomically and biomechanically complex structure, essential for critical functions such as chewing, breathing, verbal and non-verbal communication, and facial expressions. The term “temporomandibular joint disorders” encompasses a range of conditions characterized by pain with diverse, often polymorphic, manifestations. Purpose of this study is to analyze the trends and directions in publications on the diagnosis of painful temporomandibular joint disorders from 2017 to 2024 (up to March 31, 2024) across international and Ukrainian scientific resources. Materials and methods. We used the bibliosemantic method, the methods of the system approach and content analysis. We searched for scientific publications for the period from 2017 to 2024 as of 03/31/2024 in Google Academy and Medline (accessed via PubMed) using the following words and their combinations: “dysfunctional temporomandibular joint conditions” and “temporomandibular joint dysfunction”, “temporomandibular dysfunction and condylare position”, “temporomandibular dysfunction and classification”. Inclusion criteria were as follows: a) studies aimed at evaluating the anatomy of the temporomandibular joint; b) studies conducted with cone beam computed tomography images; c) research on humans; d) data of persons aged 18 to 60 years. Exclusion criteria were as follows: a) clinical cases; b) discussions; c) research with the participation of children and adolescents (under the age of 18). Results. For the period 2017-2024 (as of 31.03.2024), the main research topics on the painful form of temporomandibular joint dysfunction are the following: the prevalence of temporomandibular joint disorders (11 publications), the influence factors of the dysfunction development of the temporomandibular joint (42 publications), the improvement of existing and the search for new diagnostic criteria (17 publications); the anatomical and the morphological features of the temporomandibular join as the development predictors for the temporomandibular joint dysfunction (20 publications); search for new models for predicting the course and effectiveness of treatment for temporomandibular join dysfunction (4 publications). Conclusion. Researchers have primarily focused on examining factors influencing the clinical progression of temporomandibular joint dysfunction, accounting for 44.7% of all publications. Studies on anatomical and morphological features as predictors of temporomandibular joint dysfunction, along with new predictive models, remain contentious and highlight the need for further investigation.

To determine the incidence, prevalence, and progression of temporomandibular joint (TMJ) magnetic resonance (MR) imaging findings and symptoms during 15 years in adult asymptomatic and symptomatic volunteers (nonpatients). A regional committee for medical research ethics approved the study, and informed volunteer consent was obtained. Fifty-three volunteers were examined at study inception. For clinical assessment, a self-administered questionnaire was given, followed by an interview with each volunteer at study inception, at 1 year later, and at 15 years later. Bilateral TMJ MR imaging and clinical examination were performed at inception and at 15-year follow-up. The MR images were assessed for disk position, bone status, and joint fluid. All 53 volunteers participated at 1-year follow-up, and 50 of 53 volunteers participated at 15-year follow-up; of these 50 volunteers, 47 underwent MR imaging. The Fisher exact test was used to determine differences between groups, and the Wilcoxon signed-rank test was used to determine differences in prevalence of TMJ symptoms among the three examination times. At study inception, TMJ disk displacement was observed in 31% of asymptomatic volunteers (nine of 29) compared with 89% of symptomatic volunteers (16 of 18, P < .001). Inceptive TMJ status was maintained after 15 years in 91% (43 of 47). Unilateral progression was observed in four volunteers (9%); one was symptomatic and three were asymptomatic. Progression involved development of new disk displacement (n = 1), development of new bone changes (n = 2), and aggravation from reducing to nonreducing disk displacement (n = 1). Prevalence of TMJ symptoms did not change significantly between examination times (P = .77). TMJ clicking was the most common clinical symptom. Volunteers with mild symptoms had a prevalence of disk displacement of the same magnitude as that reported in patients, although most volunteers, symptomatic as well as asymptomatic, maintained their TMJ status during 15 years.

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

Background: Temporomandibular joint disorder is defined as a dysfunctional temporomandibular joint resulting from myoarthropathy of the masticatory system because of possible multifactorial nature of the disorder. Use of botulinum toxin A injections in treatment temporomandibular joint disorder that caused locally reduction of muscle activity by inhibiting acetylcholine release at the neuromuscular junction leading to decreases the muscle contractions, relief of myofacial pain and relieve the tenderness and restore functions of the temporo mandibular joint. The current study aim to evaluate the effect and duration of botulinum toxin type A (BTX-A) injections in the masseter, temporalis and lateral pterygoid muscles to treat Temporomandibular joint disorder symptoms in terms of pain intensity, maximum mouth opening, joint click and deviation on opening, with correlation of the patients age during three months following injection. Materials and Method: The human sample consists of 28 patients suffered from myofacial pain, trismus, and TMJ sounds related to temporo mandibular joint dysfunction, males and females, with age range of (16-42) years. The subjects recruited for the study were patients attending and whose get treatment with 100 U dose of botulinum toxin type A (BTX-A) was injected with 100 mL at sites per masseter, temporalis and lateral pterygoid muscles that carried out at the dental clinics. The subjects were divided into four groups: Group I : consisted of 7 males and females patients, with age 16-22. Group II : consisted of 7 males and females patients with age 23-29. Group III : consisted of 7 males and females patients with age 30-36. Group IV : consisted of 7 males and females patients with age 37-43, all of these patients had symptoms of myofacial pain with Temporo mandibular joint disorders of whole groups. The clinical evaluation: An intraoral examination was performed to assess the dental occlusion and teeth and periodontal damage caused by bruxism or parafunction. The existence of dentoskeletal dysmorphosis was also evaluated. The initial and follow-up reports after the BTX-A injection identified four main TMD symptoms: pain intensity, maximum mouth opening, joint click, and deviation on opening, and clinical evaluation of efficacy and tolerance was performed at 10 days, 1 month and 3 months after the injection. Patients were re-examined to assess the pain intensity, maximum mouth opening, joint click, and deviation on opening, the symptom release, and average duration of the BTX effect. Results: The mean age of patients was 29.4 ± 7.879 years (ranged from 16.2 to 42.0 years). A detailed sex and age distribution . Highest mean and ± SD (standard deviation) values of the pain intensity, maximum mouth opening, joint click and deviation on opening were recorded in Group IV (older age ), followed by Group III then Group II and Group I (younger age) in the initial (pre-treatment visit) and follow-up visits after the BTX-A injection. Inter study visits comparisons of each group regarding of the pain intensity, maximum mouth opening, joint click, and deviation on opening revealed, HS differences between the initial (pre-treatment visit) and follow-up visits after the BTX-A injection. Conclusions: Aging process leads to change physiology of neuromuscular junctions and distinct muscle mass and strength loss. The decline of the effectiveness and duration of BTX-A used as same dosage in the older group than the younger group, so that mean BTX-A dosages of the older group was little higher required than those used of the younger group in treatment of temporomandibular joint disorders and pain relief.

To analyze the relationship between symptoms and signs of temporomandibular disorders (TMD) and the patients' quality of life (QOL). A total of 492 TMD patients were included in this study. The clinical examination results were recorded using Fricton index of temporomandibular joint function. "Visual analog scale (VAS) evaluation of QOL disturbance" was designed to quantitate patients' QOL, to evaluate the degree that the patients QOL was affected. Chewing, daily life and emotion among all 8 items of QOL were frequently affected by TMD, and joint clicking had the least influence on QOL. Intermittent closed lock had more severe interference with QOL than joint clicking only. Severe and moderate pain or limited mouth opening affected the QOL more severely than mild pain or mild limited mouth opening. The simple linear relationship between Fricton index and patients' QOL was poor (r < 0.4). Pain is the most frequently seen symptom in TMD. TMD could affect patients' QOL, including both physical and social-psychological functions. The results suggest that the patients' QOL as well as TMD symptoms and signs should be considered in the management of TMD.

The aim was to evaluate and compare the therapeutic effect of sodium hyaluronate (SH) and corticosteroids (CS) on pain and temporomandibular dysfunction (TMD). Thirty patients with TMD [characterized by painful symptoms, affectations, and limitations of the mandibular movement and noises or clicks in the temporomandibular joint (TMJ)] were selected and divided into two equal groups nonrandomized. The clinical questionnaire was applied to each patient before performing the clinical procedures and included a visual analog scale with progressive values from 0 to 10 for the measurement of pain and clinical examination: maximum oral aperture (MOA), mandibular laterotrusive movement (MLM), and maximum protrusion (MP), before and after infiltration intra-articular with SH and CS up to 2 months. Both groups described benefits from treatment at the 1st and 2nd weeks, and at 1 and 2 months of follow-up, presenting a reduction in TMJ pain, and improvement in mandibular mobility with an increase of the MOA, lateralities, and protrusion. No statistically significant difference was found among these variables between the two drugs. However, SH showed a greater therapeutic effect in relation to a reduction in joint noises compared to CS. Intra-articular infiltration with SH and CS in TMD is effective for the relief of TMJ pain and also reduces joint noises and improves mandibular mobility. Both drugs can be used with similar optimal results in the treatment of TMD. This research allows to know what is the therapeutic impact of injectable CS on the TMJ.

Residents' journal review

Correlation of MRT imaging with real-time axiography of TMJ clicks

To study the association between dental malocclusions and temporomandibular joint dysfunction.To study the association between dental malocclusions and condylar position.To study the association between temporomandibular (TM) joint dysfunction and condylar position. The subjects were divided into four groups for dental malocclusions viz. class I malocclusion with or without TM dysfunction, class II division 1 malocclusion with or without TM dysfunction, class II division 2 malocclusion with or without TM dysfunction and class III malocclusion with or without TM dysfunction. Once the patient fulfilled the criteria, the presence or absence of signs of TM dysfunction were elicited from the patient. It shows the association between TM dysfunction signs and left and right condylar positions. It shows the association between TM dysfunction symptom and left and right condylar positions. It shows the association between dental malocclusions and TM dysfunction signs and symptom. It shows the association between dental malocclusions and left and right condylar positions. There was an association between TM dysfunction signs and left and right condylar positions. But, there was no association between TM dysfunction symptoms and left and right condylar positions. There was an association between dental malocclusions and TM dysfunction signs. But there was no association between dental malocclusions and TM dysfunction symptoms. There was an association between dental malocclusions and left condylar position, but there was no association between dental malocclusion and right condylar position. This study indicates that malocclusions and factors of condylar position should be seen as merely cofactors in the sense of one piece of the mosaic in the multifactorial problem of TM dysfunction. TM dysfunction factors that showed significant effects to various malocclusions through this study . This study shows clinical significance of association of various types of dental malocclusions to different conylar positions and TM dysfunction signs and symptoms. Before treating orthodontic patients, one should evaluate and treat the TM disorders for better prognosis.

Common functional pain syndromes

Background: Temporomandibular joint disorders refer to a group of heterogeneous pain and dysfunction conditions involving the masticatory system, reducing life quality of the sufferers. Arthrocentesis is simple and less invasive surgical procedure for the treatment of internal derangement than arthroscopy and better than other conservative procedures such as drugs, occlusal appliances and physiotherapy. The aim of the study was to evaluate the effect of arthrocentesis with injection of hyaluronic acid in the treatment of internal derangement of temporomandibular joint for the restoration of its function, reducing pain and preventing further deterioration of the temporomandibular joint dysfunction. Materials and methods: This study was performed in Al-Sheed Ghazi Al-Hariri Hospital, Department of Oral and Maxillofacial Surgery, from November 2012 to October 2013, included 60 patients, aged 18 to 45 years with symptoms of temporomandibular joint pain, clicking during function and limited mouth opening. Temporomandibular joint internal derangement was assessed with clinical examination and confirmed with computed tomography scan. Arthrocentesis was done with insertion of two 18 gauge needles in the upper joint compartment, lavaged with ringer’s lactate solution and at the end of the procedure 1ml of hyaluronic acid was injected. Intensity of temporomandibular joint pain was assessed using visual analog scale, maximum mouth opening was assessed with ruler scale and joint clicking was assessed clinically by stethoscope and manual palpation. All the parameters were measured before the procedure then 1 and 3 months later. Results: During 4 months follow-up, clinical examination and comparison of the results showed reduction in pain with success rate 95%, improvement in mouth opening with success rate 100% and clicking disappeared in 95% of patients. Conclusion: The technique of arthrocentesis using Sodium Hyaluronate injection, used in patients who presented with internal derangement, showed therapeutic benefits, simplicity, safety, patients acceptance of the technique and lack of significant side effects and complications.

Temporomandibular joint disorders (TMDs) are characterized by their multifactorial etiology and pathogenesis. A 3-year prospective study was conducted in a Portuguese TMDs department to study the prevalence of different TMDs signs and symptoms and their association with risk factors and comorbidities. Five hundred ninety-five patients were included using an online database: EUROTMJ. Most patients were female (80.50%), with a mean age of 38.20 ± 15.73 years. The main complaints were: (1) temporomandibular joint (TMJ) clicking (13.26%); (2) TMJ pain (12.49%); (3) masticatory muscle tension (12.15%). The main clinical findings were myalgia (74%), TMJ clicking (60-62%), and TMJ arthralgia (31-36%). Risk factors such as clenching (60%) and bruxism (30%) were positively associated with TMJ pain and myalgia. Orthodontic treatment (20%) and wisdom tooth removal (19%) were positively associated with TMJ clicking, while jaw trauma (6%), tracheal intubation (4%) and orthognathic surgery (1%) were positively associated with TMJ crepitus, limited mandibular range of motion, and TMJ pain, respectively. In total, 42.88% of TMDs patients had other associated chronic diseases, most of them were mental behavioral or neurodevelopmental disorders (33.76%), namely, anxiety (20%) and depression (13%). The authors also observed a positive association of mental disorders with the degree of TMJ pain and myalgia. The online database seems to be a relevant scientific instrument for healthcare providers who treat TMDs. The authors expect that the EUROTMJ database can serve as a milestone for other TMDs departments.

BACKGROUND: When playing the flute, flautists take an asymmetrical posture, involve their masseter muscles extraordinarily, and experience stress. All these factors can affect the temporomandibular joint.&#x0D; AIM: To identify pathognomonic signs of temporomandibular dysfunction in professional musicians playing the flute by analyzing clinical examination data in combination with joint vibration.&#x0D; MATERIAL AND METHODS: Thirty professional flautists and 30 asymptomatic control subjects were examined. A standard clinical examination, a questionnaire survey based on the OHIP-14 questionnaire with additional questions, and a simple Hamburg test were conducted. We also conducted joint vibration analysis in both flautists and control subjects using the BioJVA device from the BioPAK complex (BioResearch, USA).&#x0D; RESULTS: The survey showed that flautists experience clicks and pain in the temporomandibular joint and pain in the muscles of the head and neck significantly more often than the control group. According to the results of the Hamburg test, symptoms of temporomandibular joint dysfunction were detected much more often among the musicians than among the control subjects. These were clicks in the joint and pain during palpation of the masticatory and temporal muscles. Joint vibration analysis showed that the total integral in flautists tracks exceeded 20 PaHz, which was three times more often than that in the control group and indicates a pathology in the temporomandibular joint.&#x0D; CONCLUSIONS: Clinical examination and joint vibration analysis revealed that the symptoms of temporomandibular dysfunction are more common in flute players than in the control participants; however, no pathognomonic signs of dysfunction were found.

Prevalence and clinical signs of degenerative temporomandibular joint changes validated by magnetic resonance imaging in a non-patient group