Acute Temporomandibular Disorder Research Articles

Nerve blocks in the management of acute temporomandibular disorder emergencies—a narrative review

Nerve blocks in the management of acute temporomandibular disorder emergencies—a narrative review

Sleep analysis results of portable polysomnography in patients with acute and chronic temporomandibular disorder.

This study aimed to investigate portable polysomnography (PSG)-based 'sleep' and pre-diagnosis of obstructive sleep apnoea (OSA) in acute temporomandibular disorder (TMD) and patients with chronic TMD. Randomly selected 25 patients with acute TMD (mean age, 42.58 ± 18.77 years; 14 females) and 26 age-and sex-matched patients with chronic TMD (mean age, 49.24 ± 17.52 years, 19 females) were enrolled. The eight psychological subscales of SCL-90R had significantly higher values in the chronic TMD group than in the acute TMD group (all p < 0.05). There was no significant group difference in the respiratory event index examined using a portable PSG. OSA was observed in 57.7% in acute TMD, and 68.0% in chronic TMD, respectively. From the multiple regression analysis, palpation index was the strongest predictor of pre-diagnosis of OSA (OR = 17.550). Among the contributing factors for TMD, psychological stress (OR = 12.226), self-reported sleep problems (OR = 10.222), and above-average value of DEP (OR = 1.443) were followed. Patients with chronic TMD were psychologically more vulnerable than those with acute TMD, and the existence of subjectively perceived sleep problems or objective sleep indices examined by portable PSG could affect TMD symptom severity in different ways.

Subtypes of acute and chronic temporomandibular disorders: Their relation to psychological and sleep impairments.

To determine the differences in psychological states and sleep quality in patients with various temporomandibular disorder (TMD) subtypes, and to ascertain the relationships between TMD duration with psychological and sleep impairments. A total of 830 TMD patients were recruited categorized into pain-related (PT), intra-articular (IT), and combined (CT) TMD groups. Each group was further divided into acute and chronic subtypes. The Depression, Anxiety, and Stress Scales-21 (DASS-21), and Pittsburgh Sleep Quality Index (PSQI) were used to assess emotional states and sleep problems. Although chronic TMDs generally had higher levels of anxiety, depression, stress, and sleep impairments than acute TMDs, significant differences were only observed for the PT group. Ranking of the mean depression, anxiety, and stress scores was as follows: acute TMDs: CT>PT>IT; chronic TMDs: PT>CT>IT. For both acute and chronic TMDs, the ranking of mean PSQI global and component scores was PT≥CT≥IT. Logistic regression analyses indicated that stress (ORs=4.40) and depression (ORs=2.82) increased the risks of chronic pain-related TMDs (p<.05). Chronic pain-related TMDs are associated with high levels of psychological distress and poorer sleep, while chronic intra-articular TMDs are not. Stress and depression increased the probability of chronic pain-related TMDs.

Experience with mouthguards and prevalence of orofacial injuries among field hockey players in Catalonia.

Orofacial injuries are a serious problem in field hockey. The aim of this study was to determine the prevalence of orofacial injuries in field hockey players in Catalonia, the frequency of mouthguard use, the types of mouthguards used and the degree of interference with oral function. In this cross-sectional study, 325 field hockey players (28% women) from all age categories completed a questionnaire about orofacial injuries occurring during their sporting lives, including dental injuries, oral lacerations and episodes of acute temporomandibular disorder (TMD) pain. The questionnaire also asked about the experience of using a mouthguard, the type of mouthguard used and any adverse effects of use. The degree of interference with oral function was compared by type of mouthguard (mouth-formed, custom-made and pre-fabricated mouthguards) using the Kruskal-Wallis test. Half of the players (50.2%) reported at least one orofacial injury during their sporting lives. The mean number of oral lacerations, TMD pain episodes and dental injuries were 1.59, 0.24 and 0.18, respectively. In total, 310 players (95.7%) had tried a mouthguard, and of these 269 (86.8%) and 283 (91.3%) still used a mouthguard habitually during training and competition, respectively. Only 11 players (3.5%) had tried all three types of mouthguards, and 71 players (22.9%) had tried two types of mouthguard. By type, 217 players (70.0%) had tried mouth-formed (boil-and-bite) mouthguards, 156 (50.3%) had tried custom-made mouthguards and 30 (9.7%) had tried pre-fabricated mouthguards. Custom-made mouthguards were rated as more comfortable than the mouth-formed type (P<.05). The prevalence of orofacial injuries among field hockey players is relatively high. Most players habitually use a mouthguard during training and competition, typically preferring custom-made or a mouth-formed types. Custom-made mouthguards were considered the most comfortable.

The cost-effectiveness of TheraBite® as treatment for acute myogenic temporomandibular disorder

Objective: Temporomandibular disorder (TMD) is a very common and costly pain problem concerning the temporomandibular joint. A previous study has shown that for the treatment of acute myogenic TMD, TheraBite® (TB) offers a faster and greater effect than usual care consisting of physical therapy (PT). This study estimates the cost-effectiveness of TB compared to PT.Methods: Differences in costs and quality-adjusted life-years (QALYs) between TB and PT are analyzed using a decision model.Results: The point estimate for the incremental cost-effectiveness ratio is −28,068 EUR (−30,191 USD) per QALY (dominant) for TB versus PT. At the willingness-to-pay ratio of 20,000 EUR (21,513 USD) per QALY, TB has a 97% probability of being cost-effective compared to PT.Conclusion: TB is expected to be cost-effective compared to PT for the treatment of acute myogenic TMD, offering faster recovery of quality of life for patients, at a lower cost to society.

The Effects of an Early Intervention Program on Physical Symptoms in an Acute Temporomandibular Disorder Population: A Preliminary Study

The current preliminary study investigated the relative effectiveness of an early intervention program on self-reported pain, pain-related disability, emotional distress, and symptoms of temporomandibular joint and muscle disorder (TMJMD) as defined by the Research Diagnostic Criteria for TMD (RDC/TMD). These included symptoms of Axis I Group I muscle disorders, Group II disc displacements, and Group III bone deficiencies. Participants were 271 patients recruited from community dental clinics within a large major metropolitan area. Participants at a high risk for chronicity were randomly assigned to a high-risk self-care intervention or a high-risk biobehavioral intervention and were evaluated for their responsiveness immediately following treatment. As predicted, several symptoms of TMD were significantly reduced immediately following the intervention. Though these results are preliminary, it is implicated that the intervention may lead to symptom improvement.

The Prevalence of Comorbid Symptoms of Central Sensitization Syndrome Among Three Different Groups of Temporomandibular Disorder Patients

Symptoms of central sensitization syndrome (CSS) were evaluated among three different groups of temporomandibular disorder (TMD) patients. Additionally, TMD group differences in pain and pain-related disability were assessed, as well as emotional distress. Participants were 250 patients with symptoms of acute TMD, recruited from dental clinics within a major metropolitan area. Sequential regressions and multivariate analyses of covariance were conducted in order to make group comparisons. Those with a TMD Muscle Disorder (ie, myofacial TMD [m-TMD]) and those with more than one TMD diagnosis had the most symptoms of CSS and higher reports of pain and pain-related disability. Moreover, emotional distress accounted for a substantial amount of the variance for physical symptoms and mediated all TMD comparisons. Myofacial TMD is characterized by a high degree of comorbidity of symptoms of CSS and associated emotional distress.

Teporomandibular Eklem Hastalığı mı Yoksa Oromandibular Distoni mi? Multidisipliner Yaklaşım

Dear editor, a 21-year-old male patient was admitted to Diyarbakir Military Hospital with complaint of acute temporomandibular disorder (TMD) of unknown cause. The patient was counselled and prescribed classical TMD treatment, including non-steroidal inflammatory drugs and night plaque. Unfortunately, one month later, he was contacted and informed me that he had symptoms of muscle pain and dysphagia by chewing. He had vigorous complaint of involuntary clenching of the masticatory and facial muscles (Figure 1). Neurological consultation and electromyography (EMG) investigation confirmed that he had oromandibular dystonia (OMD).

Patients with Acute Painful TMD at High Risk for Developing a Chronic Condition Report Less Pain, Emotional Distress, and Health Care Use after a Psychological Intervention Using Cognitive-Behavioral Skills Training and Biofeedback

Article Title and Bibliographic Information Efficacy of an Early Intervention for Patients with Acute Temporomandibular Disorder-Related Pain: A One-Year Outcome Study Gatchel RJ, Stowell AW, et al. J Am Dent Assoc 2006;137(3):339-47 Level of Evidence 1b Purpose/Question To assess the ability of a 6-session intervention using cognitive-behavioral skills training and biofeedback to reduce pain, improve emotional functioning, reduce health care use, and prevent progression to chronic status in patients with acute temporomandibular disorder (TMD) pain. Source of Funding Government (National Institutes of Health) Type of Study/Design Randomized Controlled Trial

Hypothalamic–Pituitary–Adrenocortical Axis Dysregulation in Acute Temporomandibular Disorder and Low Back Pain: A Marker for Chronicity?1

Dysregulation of the hypothalamic–pituitary–adrenocortical (HPA) axis is believed to be a valid biological marker of stress. This study evaluating changes in patients with temporomandibular disorders (TMD) and low back pain (LBP) to determine whether dysregulation of this system represents a marker for chronicity. Salivary cortisol samples were collected from 78 patients (TMD = 41, LBP = 37) upon waking up and 20 minutes later daily for 2 weeks. High‐risk patients for chronic pain had different overall cortisol levels versus low‐risk patients. High‐risk patients exhibited greater variability in terms of cortisol secretion compared with low‐risk patients, F(1, 1,243) = 17.73, p &lt; .000. These results provide evidence of a neuroendocrine mechanism underlying a constellation of psychosocial risk factors for chronic pain.

Efficacy of an early intervention for patients with acute temporomandibular disorder–related pain: A one-year outcome study

The authors conducted a randomized clinical trial to evaluate the efficacy of a biopsychosocial intervention for patients who were at high risk (HR) of progressing from acute to chronic temporomandibular disorder (TMD)-related pain.The authors classified subjects' risk using a predictive algorithm and randomized them into an early-intervention (EI) or a nonintervention (NI) group. The EI included cognitive behavioral skills training and biofeedback. The authors assessed pain and psychosocial measures at intake and at a one-year follow-up. Subjects' self-reported pain levels were measured on an analog scale and as a response to palpation.At one year, EI-group subjects had significantly lower levels of self-reported pain and depression. At one year, more NI-group subjects than EI-group subjects had utilized health care for jaw-related pain. NI-group subjects were 12.5 times as likely to have a somatoform disorder, more than seven times as likely to have an anxiety disorder, and 2.7 times more likely to have an affective disorder at one year, compared with EI-group subjects.EI-group subjects had reduced pain levels, improved coping abilities and reduced emotional distress at one year.The TMD-related pain experience is complex and requires early identification with a biopsychosocial EI to achieve maximal, sustainable results.