Temporomandibular Disorder Cases Research Articles

Evaluating the Impact of Various Treatment Modalities on the Chewing Efficiency of Anterior Disc Displacements of Temporomandibular Joint Disorder Cases: A Comparative Study

Abstract Aim: Internal disc displacement of the temporomandibular joint (TMJ) is identified by an anomaly between the condylar-disc assembly, which, in many cases, may lead to discomfort and malfunction of the chewing function. The study’s objective was to assess the effects of four distinct treatment approaches on temporomandibular disorder cases with anterior disc displacements focusing on their chewing efficiency. Materials and Methods: One hundred participants suffering from reducible TMJ disc displacement were selected for enrollment in the study. Subjects were divided equally into four groups: group I patients were treated with behavioral therapy; group II patients were treated with low-level laser therapy (LLLT); group III patients were treated with anterior repositioning splints; and group IV patients were treated with flat plane splints. Chewing efficiency was assessed utilizing the fractional sieving method and a synthetic food substitute was created using silicon impression material. The statistical analysis encompassed comparisons of chewing efficiency between groups and between baseline and posttreatment within each group, employing analysis of variance (ANOVA) and paired t tests, respectively. Results: Using the paired t test, a significant difference in chewing efficiency values as expressed by the median particle size was observed between the baseline and 6-month values in all groups (P < 0.05), except for group I where no significant change was noted over the 6 months (P > 0.05). The one-way ANOVA test revealed a statistically significant difference among groups following therapies (P ˂ 0.05). The post hoc Tukey test was employed for pairwise comparisons and revealed statistically significant variances in the main values of chewing efficiency among all groups at a 95% confidence level (P ˂ 0.05). Conclusion: The study’s results suggest that occlusal splints and LLLT are more effective in improving chewing efficiency than behavioral interventions.

Temporomandibular disorders: the most common diagnostic approaches.

Temporomandibular disorders (TMDs) are a heterogeneous group of conditions involving the temporomandibular joint complex, and surrounding musculature and osseous components. They are a multifactorial disease that can be determined by organic, genetic aspects, oral parafunctional habits, and psychological stress. They have an annual incidence of more than 5% of the population and about 6% to 12% of the population is affected by symptoms. The diagnostic criteria (DC), introduced by Dworkin, is considered the standard system to diagnose this disease in a specific way. Imaging can support the diagnosis of TMD when history and physical examination findings are equivocal. The aim of the study was to evaluate instrumental examinations and therapies, clinicians prefer to use in different cases of TMDs. An anonymized survey, available in two languages (Italian and English), was given to 450 patients, 398 (120 males, 274 females and 4 who did not answer) of different private dental practices were considered, using Google Form (Google LLC, Mountain View, CA, USA) and used an electronic platform, from September 2021 to February 2022. There was no reminder sent to patients to let them feel free to answer. We performed binary regression for oral bite prescription considering common symptoms and found that the most representative is jaw block (P=0.007, exponential value [EXP]=0.509), followed by TMJ noises (P=0.01, EXP=0.503) and feeling stressed (P=0.04, EXP=1.125) while headache and tinnitus resulted not significant. The study highlighted that magnetic resonance imaging (MRI) is the most instrumental examination adopted by the clinicians and the oral splint(bite) is the therapy most widespread nowadays, even if TMDs are a multifactorial disease that is not, probably, only linked to an alteration of dental occlusion.

Whole-genome methylation profiling reveals regions associated with painful temporomandibular disorders and active recovery processes.

Temporomandibular disorders (TMDs), collectively representing one of the most common chronic pain conditions, have a substantial genetic component, but genetic variation alone has not fully explained the heritability of TMD risk. Reasoning that the unexplained heritability may be because of DNA methylation, an epigenetic phenomenon, we measured genome-wide DNA methylation using the Illumina MethylationEPIC platform with blood samples from participants in the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) study. Associations with chronic TMD used methylation data from 496 chronic painful TMD cases and 452 TMD-free controls. Changes in methylation between enrollment and a 6-month follow-up visit were determined for a separate sample of 62 people with recent-onset painful TMD. More than 750,000 individual CpG sites were examined for association with chronic painful TMD. Six differentially methylated regions were significantly ( P < 5 × 10 -8 ) associated with chronic painful TMD, including loci near genes involved in the regulation of inflammatory and neuronal response. A majority of loci were similarly differentially methylated in acute TMD consistent with observed transience or persistence of symptoms at follow-up. Functional characterization of the identified regions found relationships between methylation at these loci and nearby genetic variation contributing to chronic painful TMD and with gene expression of proximal genes. These findings reveal epigenetic contributions to chronic painful TMD through methylation of the genes FMOD , PM20D1 , ZNF718 , ZFP57 , and RNF39 , following the development of acute painful TMD. Epigenetic regulation of these genes likely contributes to the trajectory of transcriptional events in affected tissues leading to resolution or chronicity of pain.

Knowledge and Awareness of Temporomandibular Disorders (TMDs) among Post-graduate residents

INTRODUCTION: Malocclusion and TMD were believed to have a correlation when it is associated that the alteration of form might cause alteration in the stomatognathic system function. A multidisciplinary approach is particularly important for the successful treatment of chronic TMD cases. Management of TMD involves the work of dentists from various specialities. It is multifactorial in nature and requires proper examination and treatment planning. Thus, the primary purpose of this study is to find out the awareness of TMDs among postgraduate students. MATERIALS AND METHODOLOGY: The present study was retrospective in nature. A questionnaire involving TMDs was sent to all postgraduates involved in patient treatment through google forms. All participants were asked to anonymously answer the structured questionnaire containing multiple-choice and open-text questions in google forms. The questionnaire was specially developed for students and was organized into three sections. RESULTS: 204 participants responded and returned the completed questionnaires. Results showed that 98 % of the respondent’s occlusal disturbance causes TMD and TMJ problems are associated with malocclusion. The majority of the participants were aware of the aetiology and diagnosis but only 53% of them were aware of the treatment protocols. CONCLUSION: The causes and diagnosis domains of the questionnaire yielded a high degree of agreement while the treatment modalities were not known. Most of them were not aware of the treatment modalities reason being a lack of knowledge during the course of their undergraduate and postgraduate study.

A case-control investigation of the psychological and physiological stress markers with salivary cortisol levels in patients with temporomandibular joint disorders: A short clinical study.

This study aimed to determine the association of stress and salivary cortisol levels in the adult Indian population with and without temporomandibular disorder (TMD) and to validate it with bite force. The present study had an observational, case-control study design. This study sample comprised two groups of 25 cases and 25 controls between 18 and 45 years of age. Diagnostic criteria-TMD questionnaire Axis I was used to assess TMD classification, the TMD Disability Index and modified Perceived Stress Scale (PSS) questionnaires were filled, and salivary cortisol levels were measured using electrochemiluminescence immunoassay (ECLIA). Bite force analysis was performed using a portable load indicator. To characterize and analyze the study variables, means, standard deviations, Mann-Whitney U-test, and logistic regression were employed (STATA 14.2 [Texas, USA]). Shapiro-Wilk test was used to test the normality of the data. P < 0.05 was considered statistically significant (95% power). Female gender was proportionately higher in both the groups (P = 0.508), TMD Disability Index was significantly higher for cases (P < 0.001), TMD cases perceived higher stress levels (P = 0.011), there was no statistically significant difference in salivary cortisol level between cases and controls (P = 0.648), and the median bite force was lower for cases (P = 0.0007). This study concluded that the chance of developing TMD increased with age. An increase in the TMD Disability Index score and modified PSS scores; and a decrease in the bite force increased the likelihood of TMD. Modified PSS score was negatively correlated with salivary cortisol concentrations, indicating a two-way response to TMD symptoms.

Functional orthopedic device type Sn20 – a therapeutic resource in the control of chronic temporomandibular dysfunction – case report

The literature indicates that patients with a history of Temporomandibular Disorder (TMD), who experience sudden occlusal changes, may worsen their parafunctional habits and develop TMD again. In this sense, the aim of this study is to present a clinical case of recurrent chronic TMD after oral rehabilitation (increase of vertical dimension in all teeth) using Simões Network 20 (SN20) functional orthopedic appliance as one of the resources therapies. The patient was female, 62 years old, and complained of disabling pain, anxiety symptoms, hypervigilant and history of TMD. The patient reported failure of other treatment modalities, including use of the smooth stabilizer device. The diagnosis was chronic TMD – primary osteoarthritis of the temporomandibular joint and related myofascial pain and orofacial migraine. Treatment included physical measurements, instructions, peripheral and central medication, AOF type SN20 (night use). After three months of therapy, the patient showed significant improvement with complete pain reduction. The use of the AOF SN20 together with conservative measures represents a valuable therapeutic modality for patients with chronic TMD.

Strength of scapular elevation in women with TMD and asymptomatic women

Temporomandibular disorder (TMD) is recognized for its high prevalence, presenting characteristic signs and symptoms. Cervical spine pain is present in 70% of diagnosed TMD cases. Aim: To verify if women with TMD present changes in isometric muscle strength in the scapula elevation. Methods: This is an observational, cross-sectional study. Thirty-five women, aged 22.89±2.04 years, were divided into the TMD group (TMDG), diagnosed with TMD according to the DC/TMD, and control group (CG), with asymptomatic individuals. The volunteers accessed a online link by the smartphone in order to answer questions on personal data, the Fonseca Anamnestic Index (FAI), Neck Disability Index (NDI), and Masticatory preference. In all participants, evaluation of the force of the scapula elevation muscles was performed, using a load cell model MM-100 (Kratos® SP, Brazil). Data were analyzed descriptively using the maximum, mean, and standard deviation and a two-way ANCOVA test was applied for all variables. A significance level of 5% was considered. Results: There were no statistically significant differences between the TMDG and CG for the maximal and mean muscle strength of scapular elevation. There were statistically significant differences in FAI (p &lt;0.001*) between the CG and the TMDG. Conclusion: Based on the results, it was not possible to confirm the hypothesis that women diagnosed with TMD present lower isometric strength during scapular elevation (right/left).

Ratio of Omega-6/Omega-3 Polyunsaturated Fatty Acids Associated With Somatic and Depressive Symptoms in People With Painful Temporomandibular Disorder and Irritable Bowel Syndrome

Somatic symptom disturbance is among the strongest predictors of painful temporomandibular disorder (TMD). Related psychological constructs, such as anxiety and depression, respond therapeutically to omega-3 polyunsaturated fatty acids (PUFAs) in clinical trials. This cross-sectional study investigated associations between the omega-6/omega-3 PUFA ratio and somatic symptom disturbance and depressive symptoms in a community-based sample of 501 adults and determined whether these associations differed between adults with and without TMD or irritable bowel syndrome (IBS). Liquid chromatography tandem mass spectrometry quantified PUFAs in circulating erythrocytes. Somatic symptoms and depression were quantified using Symptom Checklist-90-Revised subscales. Presence or absence of TMD and IBS, respectively, were determined by clinical examination and Rome III screening questions. The standardized beta coefficient for the omega-6/omega-3 long-chain PUFA ratio was 0.26 (95% confidence limits (CL): 0.08, 0.43) in a multivariable linear regression model in which somatic symptom disturbance was the dependent variable. When modelling depressive symptoms as the dependent variable, the standardized beta coefficient was 0.17 (95% CL:0.01, 0.34). Both associations were stronger among TMD cases and IBS cases than among non-cases. Future randomized control trials that lower the omega-6/omega-3 PUFA ratio could consider somatic or depressive symptoms as a therapeutic target for TMD or IBS pain. PerspectiveIn people with TMD or IBS, a high n-6/n-3 PUFA ratio was positively associated with somatic symptom disturbance and depressive symptoms. Both measures of psychological distress were elevated in people with painful TMD and IBS. Future randomized clinical trials will determine whether lowering the n-6/n-3 ratio is therapeutic for pain.

Temporomandibular disorders cases with high-impact pain are more likely to experience short-term pain fluctuations

Temporomandibular disorders (TMD) patients can present clinically significant jaw pain fluctuations which can be debilitating and lead to poor global health. The Graded Chronic Pain Scale evaluates pain-related disability and its dichotomous grading (high/low impact pain) can determine patient care pathways and in general high-impact pain patients have worse treatment outcomes. Individuals with low-impact TMD pain are thought to have better psychosocial functioning, more favorable disease course, and better ability to control pain, while individuals with high-impact pain can present with higher levels of physical and psychological symptoms. Thereby, there is reason to believe that individuals with low- and high-impact TMD pain could experience different pain trajectories over time. Our primary objective was to determine if short-term jaw pain fluctuations serve as a clinical marker for the impact status of TMD pain. To this end, we estimated the association between high/low impact pain status and jaw pain fluctuations over three visits (≤ 21-day-period) in 30 TMD cases. Secondarily, we measured the association between jaw pain intensity and pressure pain thresholds (PPT) over the face and hand, the latter measurements compared to matched pain-free controls (n = 17). Jaw pain fluctuations were more frequent among high-impact pain cases (n = 15) than low-impact pain cases (n = 15) (OR 5.5; 95% CI 1.2, 26.4; p value = 0.033). Jaw pain ratings were not associated with PPT ratings (p value > 0.220), suggesting different mechanisms for clinical versus experimental pain. Results from this proof-of-concept study suggest that targeted treatments to reduce short-term pain fluctuations in high-impact TMD pain is a potential strategy to achieve improved patient perception of clinical pain management outcomes.

Predictability and Accuracy of the Short-Form Fonseca Anamnestic Index in Relation to the Modified Helkimo Index for the Diagnosis of Temporomandibular Disorders: A Cross-Sectional Study.

ABSTRACTAim:The aim of this study was to evaluate the predictability and accuracy of the Short-Form Fonseca Anamnestic Index (SFAI) in relation to the modified Helkimo Index for the diagnosis of temporomandibular disorders (TMDs).Materials and Methods:A cross-sectional, prospective, and analytical predictive study was conducted in 240 students of a public institute of higher technological education in Ica, Peru during the months of February to May 2018. The SFAI of 10 closed questions and the Helkimo Index modified by Maglione (gold standard) were used as instruments to diagnose TMDs. For the analysis of concordance between both instruments, Cohen’s Kappa Index was applied. To evaluate the association according to gender and age group, Pearson’s chi-square test was used. For validity of the SFAI in relation to accuracy, sensitivity and specificity were calculated, and they were verified by receiver operating characteristics (ROC) to determine the best cutoff points (area under the curve [AUC]) considering a P value < 0.05. Regarding the predictability of the SFAI, the positive and negative predictive value was calculated by applying Bayes’ theorem.Results:The SFAI was highly significantly associated with the modified Helkimo Index according to gender (P < 0.001), age group (P < 0.001), and overall (P < 0.001) moderate overall agreement (k = 0.416; 95% confidence interval [CI] = 0.287–0.545); better concordance was obtained in individuals older than 20 years (k = 0.490, CI = 0.302–0.679) and women (k = 0.565, CI = 0.371–0.759). The ROC curve analysis of the SFAI showed good accuracy (0.852, CI = 0.800–0.905) and was highly significant (P < 0.001), with an optimal cutoff point of 17.5 and good sensitivity (80.10%) and specificity (74.36%). In addition, a very good positive predictive value (PPV) (94.15%) and a fair negative predictive value (NPV) (42.02%) were obtained.Conclusions:Although there was moderate concordance between the SFAI and the modified Helkimo Index for the diagnosis of TMDs, the SFAI obtained good accuracy in the overall analysis of sensitivity and specificity. In addition, it demonstrated a high predictive efficacy for detecting positive TMD cases, whereas its ability to rule out positive cases was fair.

Management of Resistant Myofascial Pain in temporomandibular joint disorders with Photobiomodulation

Abstract Background: The existence of temporomandibular joint pain and/or dysfunction in masticatory muscles is characterized in temporomandibular disorders (TMDs). Non-surgical treatment is the first step in the treatment of TMDs. Photobiomodulation therapy (PBMT) is, due to its impact on biological processes, especially inflammation, considered as an adjuvant treatment modality in TMD cases. Aim: To evaluate the effectiveness of PBMT in treatment of resistant myofascial pain in patients with TMDs . Material and Methods: A total of 60 patients aged from 17 to 49 years, with temporomandibular joint (TMJ) myofascial pain or TMJ arthralgia were involved in this study, patients examined clinically and orthopantomographic radiographs were taken for all the patients to rule out any gross anatomical deformity in relation to the TMJ. All patients treated by PBMT or low level laser therapy (LLLT). Pain intensity, maximum active and passive mouth opening, lateral jaw motions were assessed before and immediately after finishing treatment and after 3 months follow up. Results: Statistically significant results were achieved in all study parameters Conclusion: this study shows that PBMT effectively relieves pain and improves TMJ functional outcomes in patients with TMDs. Keywords: Photobiomodulation, Low-level laser therapy, Temporomandibular joint, Temporomandibular disorder

Etiology and management of disorders of temporomandibular joint: A literarure review

Temporomandibular disorders usually represented as a group of painful as well as altered conditions involving the muscles of mastication and the muscles around the temporomandibular joint. Usually the patient are un aware of the condition. Temporomandibular joint disorders affects twenty five percent of the population. Temporomandibular disorders represent with musculoskeletal degenerative conditions of the joint which results in functional as well as morphological deformities of the temporomandibular joint. As temporomandibular disorders cases are complex with unique nature with respect to each case, so the diagnosis and treatment modality is quite different for each type of case.

An Overview of Anterior Repositioning Splint Therapy for Disc Displacement-related Temporomandibular Disorders.

Anterior repositioning splint (ARS) therapy is considered one of the most effective therapies for treating disc displacement-related temporomandibular disorders (TMDs), which account for a large proportion of TMD cases. Owing to the wide application of this therapy, the exact mechanism of remission has increasingly drawn attention. Given that practitioners have different views on ARS therapy, its indications are broadened, and operating methods diverged. This review attempts to provide an overview of ARS therapy and helps practitioners establish indications and suitable operating methods. Representative views in the past 10 years were summarised, and conclusions were drawn as follows: The mechanism of ARS therapy is mainly attributed to internal derangement correction, improvement of stress distribution and recently reported joint remodeling. It has an evident effect in the short term, and the most prevalent operating methods are protruding the mandible to the edge-to-edge position and wearing the ARS for 24 hours daily for 3-6 months. However, long-term stability is not optimal, and thus indications should be selected carefully. Notably, most of the clinical studies in this field are case analyses with low-quality evidence. Well-designed RCTs are required to further validate relevant theories.

COL12A1 Single Nucleotide Polymorphisms rs240736 and rs970547 Are Not Associated with Temporomandibular Joint Disc Displacement without Reduction.

Temporomandibular disorders (TMDs) may affect up to 25% of the population, with almost 70% of these TMD cases developing malpositioning of the disc over time in what is known as internal derangement (ID). Despite significant efforts, the molecular mechanism underlying disease progression is not yet very well known. In this study, the role of COL12A1 rs970547 and rs240736 polymorphisms as potential genetic factors regulating ID was investigated. The study included 124 Caucasian patients of both sexes after disc displacement without reduction (DDwoR) in either one or two temporomandibular joints (TMJs), either of which meet the criteria for this condition. All patients underwent clinical examination and 3D digital imaging. The COL12A1 rs970547 and rs240736 polymorphisms were evaluated. There were no statistically significant differences in the chi-square test between the study group and healthy controls. The examined COL12A1 rs240736 and rs970547 polymorphisms do not contribute to DDwoR in Polish Caucasians.

Awareness and Knowledge of General Dental Practitioners in Central India Towards Management of Patients with Temporomandibular Disorder: A Questionnaire-based Survey

Introduction: Temporomandibular Disorders (TMDs) accounts for common Orofacial Pain (OFP) arising from musculoskeletal origins, affecting almost 80% of the overall population. The multifactorial nature of the disease makes it difficult to diagnose and treat and is challenging to a considerable number of General Dental Practitioners (GDPs). They’re increasingly approached by patients for advice on TMD, but little is understood about how this disorder is addressed with in primary health care. Aim: To assess the awareness and knowledge regarding management of TMDs among GDPs in Central India. Materials and Methods: The cross-sectional study was conducted at Central India, Nagpur, Maharashtra, India from 20th June 2020 to 12th December 2020, including 200 general dental practitioners, who were registered under the Dental Council of India. A questionnaire consisting of 17 questions with reference to TMDs was designed and the questionnaire was circulated through a web designed program. The responses were collected, and data were analysed descriptively using Statistical Package for the Social Sciences (SPSS) statistics for windows version 24.0. Results: The mean age of the participants in the study was 24.80±1.63 years. Predominantly, participants were 164 females (82%). Among all the participants, about 181 (90.50%) of GDP’s were practicing Dentistry. The study findings suggest that the overall general practicing dentists encounter TMD cases and 162 (81%) of GDP’s treat patient at their clinic. A 76% of GDPs acknowledged the causative factor for TMD to be multifactorial and physical examination (88.50%) as the diagnostic tool. Most of the general practitioners around 126 (63%) preferred referring the patient to the specialist, maxillofacial surgeon. Among the practitioners who were confident in treating TMD, occlusal splint was the treatment of choice for 198 (96%) of the GDPs. Conclusion: Many GDPs lack standard protocol knowledge, felt insecure in TMD diagnosis, therapy decisions and treatment. There is a requirement for better quality evidence on which TMD diagnosis and treatment, including the event of a valid, reproducible patient-centered outcome measure to enable dental practitioners to feel confident in managing TMD. It is essential to train GDPs to identify individuals with TMDs through professional courses and training. It would be highly beneficial to educate the undergraduates regarding the diagnosis of TMDs in their curriculum.

Relato de caso de desordem temporomandibular articular refratária: a importância da abordagem multidisciplinar

A disfunção temporomandibular (DTM) acontece quando há envolvimento da articulação temporomandibular (ATM), com músculos da mastigação e estruturas associadas. Essas desordens podem gerar desde limitação dos movimentos mandibulares, à dificuldade na mastigação, fala e deglutição. A viscossuplementação da ATM com ácido hialurônico (AH) é um método minimamente invasivo e uma alternativa terapêutica em casos de dor e limitação mandibular. O objetivo do trabalho é relatar a evolução de um caso clínico de DTM articular refratária ao tratamento conservador, o qual a queixa da paciente era dor bilateral na ATM durante função mandibular, zumbido e crepitação com dificuldade de abertura bucal. Foi realizado acompanhamento multidisciplinar, juntamente com terapia de viscossuplementação com ácido hialurônico (VAH) e terapia de motricidade oral baseado em fortalecimento mandibular. Foram realizadas avaliações após 7 dias, 30 dias e 60 dias, demonstrando melhora satisfatória em 2 meses. Em conclusão, a viscossuplementação associada à terapia baseada em exercícios podem ser consideradas medidas terapêuticas eficientes para o restabelecimento funcional da ATM e diminuição da dor. O tratamento multidisciplinar em casos refratários de DTM são de suma importância para o controle dos sinais e sintomas a longo prazo.

Application of arthrography with cone-beam CT imaging in the diagnosis of temporomandibular disorders

Objective: To evaluate the meaning of arthrography with cone-beam CT（CBCT） imaging in the diagnosis of temporomandibular disorders(TMD). Methods: Four hundred and forty-eight cases of temporomandibular upper joint cavity arthrography with CBCT imaging were retrospectively analyzed. The distribution of disc displacement with reduction or without reduction, disc perforation, enlargement or tearing of joint capsule were analyzed. The characteristics of arthrography with CBCT imaging were also described. Results: There were 384 female and 64 male among the 448 cases of TMD with CBCT arthrographic images. The median age was 31.5 years， range from 14 to 81 years old. As about the age distribution, there were 63 cases in the group of ≤20 years old, 150 cases in the group of >20 and ≤30 years old, 86 cases in the group of >30 and ≤40 years old, 59 cases in the group of >40 and ≤50 years old, 58 cases in the group of>50 and ≤60 years old, and 32 cases in the group of >60 years old. There were 356 cases with disc displacement, in which there were 328 cases of disc displacement without reduction, and 28 cases of disc displacement with reduction. There were 152 cases with disc perforation, and 12 cases with articular capsule tearing or laxation. Conclusions: Arthrography with CBCT imaging was a meaningful approach to diagnose the TMD with structure disorders.

Role of inflammatory and pain genes polymorphisms in temporomandibular disorder and pressure pain sensitivity

ObjectiveThe aim of this study was to assess the correlation of inflammatory and pain genes polymorphisms with the presence of temporomandibular disorder (TMD) patients and with pressure pain sensitivity. DesignData was collected from 268 consecutive subjects at Bauru School of Dentistry. Subjects aged younger than 20 years, with dental and neuropathic pain, sinusitis, cognitive and neurologic disorder were excluded. Included subjects were evaluated using the Research Diagnostic Criteria for Temporomandibular disorders and divided into two groups: TMD cases and healthy controls. Groups were submitted to pressure pain threshold (PPT) test for the temporomandibular joint, anterior temporalis and masseter muscles and genotyped for Val158Met, IL6−174, IL-1β-3954 and TNFA-308. Student’s t-test and Pearson chi-square test were used to comparisons between groups. A linear multiple regression was used to evaluate the influence of genetics variables on the PPT and a bivariate analysis was used to assesses the influence of genetics variables on pain sensitivity below the PPT cut off of the structures in TMD group. ResultsTMD group showed significantly lower PPT values for all structures when compared with control group (p < 0.001). SNP IL6−174 predicted higher pain sensitivity in the temporomandibular joint (p < 0.005) and in anterior temporalis muscle (p < 0.044) and SNP Val158Met in the masseter muscle (p < 0.038); when TMD group was divided according to PPT cut-off values the SNP Val158Met influenced increase pain sensibility in the masseter muscle. ConclusionTNFA-308 was associated with TMD and SNP IL6−174 and SNP Val158Met influenced pain sensitivity of patients with TMD.

Cambios en la dinámica mandibular y en la cadena sinérgica muscular mandibular luego de aplicación de punción seca y TENS en paciente con TTM

Antecedentes: El tratamiento del trastorno temporomandibular (TTM) con la técnica de punción seca no se ha investigado a fondo. Este informe evaluó su eficacia a través del equipo BIOPAK™ (Electromiografía de Superficie (BioEMGTM) y Trazador mandibular (JT-3DTM)). Presentación clínica: Paciente de 57 años con TTM grave que fue tratada previamente con un dispositivo interoclusal (DIO) de relajación, sin éxito. Se trató con la técnica de aguja seca (PS) en la parte anterior de los músculos pterigoideos lateral y medial, temporal anterior y masetero. Durante la punción, se aplicó una estimulación nerviosa eléctrica transcutánea (T.E.N.S.), produciendo estimulación eléctrica neuromuscular (NMES). Relevancia Clínica: Es importante desarrollar nuevas técnicas para casos complicados de TTM; por lo tanto, la técnica de PS más NMES podría ser una buena alternativa para restaurar la sinergia muscular normal de los músculos de la masticación. Conclusión: Se logra una importante estabilidad biomecánica mandibular y un alivio subjetivo de los síntomas del TTM inmediatamente post PS y seis días posteriores a esta. El uso de BIOPAK™ (BioEMGTMm y JT-3DTM), es una buena alternativa de evaluación en TTM, proporcionando mediciones fiables.

Photobiomodulation in Temporomandibular Disorders.

Objective: This systematic review aimed to comprehensively review all available documents regarding photobiomodulation therapy (PBMT) application in temporomandibular disorder (TMD) patients and to suggest an evidence-based protocol for therapeutic PBM administration for these patients. Background data: The existence of temporomandibular joint and/or pain and dysfunction in masticatory muscles is characterized in TMDs. PBMT is, due to its impact on biological processes, especially inflammation, considered as an adjuvant treatment modality in TMD cases. Materials and methods: All original articles related to PBMT for TMDs in EMBASE, MEDLINE (NCBI PubMed and PMC), Cochrane library, Scopus, Web of Science, and Google Scholar were reviewed until December 2018. Results: The energy density ranging from 0.75 to 112.5 J/cm2 with 0.9-500 mW power was found to be a window protocol for light application. The best results for pain relief and mandibular movement enhancement were reported after application of GaAlAs diode laser, 800-900 nm, 100-500 mW, and <10 J/cm2, twice a week for 30 days on trigger points. The session of light applications varied from 1 to 20. Conclusions: Although most articles showed that PBMT is effective in reducing pain and contributed to functional enhancement in TMD patients, the heterogenic parameters that have been reported in various studies made the standardization of PBMT complicated. However, such evidence-based consensus can be beneficial for both future research and for clinical applications.