Chronic Temporomandibular Disorders Research Articles

Orofacial pain - an update on diagnosis and management.

The diagnosis and management of orofacial pain may be challenging due to complex histories, pathophysiology and associated psychosocial co-morbidities such as depression and anxiety. Neuropathic facial pain conditions such as burning mouth syndrome (BMS), persistent idiopathic facial pain (PIFP), atypical odontalgia (AO) and trigeminal neuralgia (TN) require early recognition by primary care clinicians and referral to secondary care. Acute pain-related temporomandibular disorder (TMD) may be managed in the primary care setting, with identification of those at risk of developing chronic TMD receiving an early referral to secondary care. Adopting a biopsychosocial approach, consisting of physical therapies, pharmacotherapy and psychological support can lead to effective management and may limit the negative impact of facial pain upon quality of life and daily functioning.

Cross-cultural adaptation, reliability and construct validity of the Tampa scale for kinesiophobia for temporomandibular disorders (TSK/TMD-Br) into Brazilian Portuguese.

Fear of movement (kinesiophobia) seems to play an important role in the development of chronic pain. However, for temporomandibular disorders (TMD), there is a scarcity of studies about this topic. The Tampa Scale for Kinesiophobia for TMD (TSK/TMD) is the most widely used instrument to measure fear of movement and it is not available in Brazilian Portuguese. The purpose of this study was to culturally adapt the TSK/TMD to Brazilian Portuguese and to assess its psychometric properties regarding internal consistency, reliability, and construct and structural validity. A total of 100 female patients with chronic TMD participated in the validation process of the TSK/TMD-Br. The intraclass correlation coefficient (ICC) was used for statistical analysis of reliability (test-retest), Cronbach's alpha for internal consistency, Spearman's rank correlation for construct validity and confirmatory factor analysis (CFA) for structural validity. CFA endorsed the pre-specified model with two domains and 12-items (Activity Avoidance - AA/Somatic Focus - SF) and all items obtained a loading factor greater than 0·4. Acceptable levels of reliability were found (ICC > 0·75) for all questions and domains of the TSK/TMD-Br. For internal consistency, Cronbach's α of 0·78 for both domains were found. Moderate correlations (0·40 < r < 0.60) were observed for 84% of the analyses conducted between TSK/TMD-Br scores versus catastrophising, depression and jaw functional limitation. TSK/TMD-Br 12 items and two-factor demonstrated sound psychometric properties (transcultural validity, reliability, internal consistency and structural validity). In such a way, the instrument can be used in clinical settings and for research purposes.

Haplotypes of the RANK and OPG genes are associated with chronic arthralgia in individuals with and without temporomandibular disorders

The aim of this study was to evaluate the association between genetic polymorphisms and the comorbid presence of chronic systemic arthralgia in patients with articular temporomandibular disorders (TMD). Subjects were evaluated for the presence of TMD and asked about the presence of chronic joint pain. Four groups were included in the study: articular TMD and systemic arthralgia (n=85), no articular TMD and systemic arthralgia (n=82), articular TMD and no systemic arthralgia (n=21), no articular TMD and no systemic arthralgia (control, n=72). A total of 14 single nucleotide polymorphisms in the OPG, RANK, and RANKL genes were investigated. In the statistical analysis, a P-value of <0.05 was considered significant. For the OPG gene, an association was observed between the group with chronic arthralgia and joint TMD and the control group (P=0.04). There was also a tendency towards an association of the haplotype CGCCAA with an increased risk of developing chronic joint pain, even in the absence of TMD (P=0.06). For the RANK gene, the AGTGC haplotype was associated with the lowest risk of presenting chronic joint pain in individuals without TMD (P=0.03). This study supports the hypothesis that changes in the OPG and RANK genes influence the presence of chronic joint pain in individuals with and without TMD.

Influence of culture on pain comorbidity in women with and without temporomandibular disorder-pain.

Evidence on cultural differences in prevalence and impact of common chronic pain conditions, comparing individuals with temporomandibular disorders (TMD) versus individuals without TMD, is limited. The aim was to assess cross-cultural comorbid pain conditions in women with chronic TMD pain. Consecutive women patients (n = 122) with the index condition of chronic TMD pain diagnosed per the research diagnostic criteria for TMD and TMD-free controls (n = 121) matched for age were recruited in Saudi Arabia, Italy and Sweden. Self-report questionnaires assessed back, chest, stomach and head pain for prevalence, pain intensity and interference with daily activities. Logistic regression was used for binary variables, and ancova was used for parametric data analysis, adjusting for age and education. Back pain was the only comorbid condition with a different prevalence across cultures; Swedes reported a lower prevalence compared to Saudis (P < 0·01). Saudis reported higher prevalence of work reduced >50% due to back pain compared to Italians or Swedes (P < 0·01). Headache was the most common comorbid condition in all three cultures. The total number of comorbid conditions did not differ cross-culturally but were reported more by TMD-pain cases than TMD-free controls (P < 0·01). For both back and head pain, higher average pain intensities (P < 0·01) and interference with daily activities (P < 0·01) were reported by TMD-pain cases, compared to TMD-free controls. Among TMD-pain cases, Italians reported the highest pain-related disability (P < 0·01). Culture influences the associated comorbidity of common pain conditions. The cultural influence on pain expression is reflected in different patterns of physical representation.

Effectiveness of vitamin b complex in reducing chronic temporomandibular joint disorder pain — double blind randomised clinical trial

Background: Chronic temporomandibular joint disorder (TMD) pain management has always been challenging and usually requires long-term analgesics. Commonly used analgesics have a potential for adverse effects in long-term usage, thus there is a need to look for a safer alternative analgesic option. Objectives: To evaluate efficacy of vitamin B complex (VBC) [B1, B6, B12] in reducing chronic TMD pain. Methods: 26 patients with chronic TMD pain secondary to arthralgia, osteoarthritis and disc displacement were included. The patients were allocated randomly into two groups and received either VBC tablet (B1: 242.5 mg, B6: 250 mg, B12: 1 mg) or placebo once per day for six weeks. Clinical measurements were recorded at week 0 and week 2, week 4, and week 6 to evaluate the efficacy of the treatment. Pain intensity was measured by visual analogue score (VAS) and mandibular range of movement was measured by maximal comfortable mandibular opening and lateral excursion. Adverse effects and compliance rate towards treatment were also assessed. Findings: In this 6-week clinical trial, both groups showed significant VAS pain reduction (VBC 2.49 ± 1.71; placebo 1.41 ± 1.53; P < 0.05). The amount of VAS pain reduction in the VBC group was significantly higher than in the Placebo group at week 2 (1.19 ± 1.28 versus 0.23 ± 0.90) and week 4 (2.32 ± 1.42 versus 1.25 ± 0.75; P < 0.05). No statistically significant difference was noted in mouth opening improvement. Both VBC and placebo medications were well tolerated with minimal adverse effects. Conclusion: In this study a dose of VBC (B1: 242.5 mg, B6: 250 mg, B12: 1 mg) was significantly better than placebo in reducing chronic TMD pain at week two and week four.

Primary temporomandibular disorders and comorbid conditions

INTRODUCTION: The aim of this study is to evaluate the distribution of the most common comorbid conditions associated with chronic temporomandibular disorders, and the Pharmacological agents which play an integral role in the overall management of temporomandibular joint disorders . MATERIAL AND METHODS: A total of 23 articles are included in this comprehensive review of the relevant studies on common comorbid conditions related to temporomandibular disorders. This review provides summarized clinical and online platform based analyses focused on five most common comorbid conditions and its relevant pharmacological therapy. RESULTS AND CONCLUSION : The majority of the studies show that comorbid conditions may include fibromyalgia, systemic myofascial pain and chronic fatigue syndrome, chronic headaches, migraine, heart arrhythmias, endometriosis, interstitial cystitis, irritable bowel syndrome, low back pain, sleep disorders - insomnia, autoimmune diseases, sleep apnea, noises and irritation in the ear, vulvodynia and mental disorders. The top comorbid conditions reported from people with TMJ syndrome, regardless of status are: anxiety, depression, insomnia, fatigue and pain.

Association Between Chronic Tension-Type Headache Coexistent with Chronic Temporomandibular Disorder Pain and Limitations in Physical and Emotional Functioning: A Case-Control Study.

To assess the association between chronic tension-type headache coexistent with chronic temporomandibular disorder (TMD) pain and severe limitations in physical and emotional functioning. Sample size estimation was used to determine that this case-control study should include 126 subjects. Subjects suffering from chronic TMD who were aged between 18 and 68 were recruited in routine clinical practice. Of the 126 included subjects, 63 had TMD pain associated with chronic tension-type headache (cases) and 63 had TMD pain without a history of tension-type headache (controls). Clinical diagnosis of TMD was made according to the Research Diagnostic Criteria for TMD (RDC/TMD) Axis I criteria, and clinical diagnosis of headache was made according to the International Classification of Headache (ICHD-II). RDC/TMD Axis II criteria were applied to record the scores from the Graded Chronic Pain Scale (GCPS) and the Symptoms Checklist-90-Revised Depression (SCL-DEP) and Somatization (SCL-SOM) scales. A logistic regression analysis was used to assess the relationship between TMD pain with chronic tension-type headache and high levels of depression and somatization severity as scored on the SCLDEP and SCL-SOM scales, respectively, and high pain-related disability (GCPS grade III or IV). Data were adjusted to take into account age, gender, time since TMD pain onset, chronic TMD pain intensity, and characteristic pain intensity. The presence of chronic tension-type headache was significantly associated with severe SCL-DEP (odds ratio [OR] = 7.2; P < .001), severe SCLSOM (OR = 13.8; P < .001), and high pain-related disability (OR = 9.7; P < .001). This study provides evidence of associations between the clinical diagnosis of chronic tension-type headache coexistent with chronic TMD pain and key aspects of physical and emotional functioning reflected in severe depression, severe somatization, and high pain-related disability.

Clinical outcomes of Botox injections for chronic temporomandibular disorders: do we understand how Botox works on muscle, pain, and the brain?

The main objective of this retrospective review was to analyze the clinical outcomes following the use of botulinum toxin (onabotulinumtoxinA, Botox) injections to relieve the symptoms of chronic temporomandibular disorders (TMD). Seventy-one patients with a diagnosis of TMD (according to the RDC/TMD international consortium) associated with or without bruxism and refractory to conventional treatment (e.g. oral appliances, physiotherapy, etc.) received Botox injections into the temporalis and masseter muscles. Subjective responses to Botox were categorized as ‘beneficial’ or ‘not beneficial’, as patient-reported outcomes based on the subjective reduction in pain and/or improvement in function. Fifty-five of the 71 subjects (77%) reported beneficial effects with Botox. Subjects with a concomitant bruxism diagnosis reported significant improvement over subjects without bruxism (87% vs. 67%; P=0.042). Subjects with stress-related psychiatric comorbidities and bruxism had a significantly higher benefit than those with stress-related psychiatric comorbidities alone (P=0.027). Patients reported less improvement if the time between the initial Botox injection and follow-up was less than an average of 5 weeks, compared to an average follow-up of 5–10 weeks (P=0.009). The subgroup TMD diagnosis and time interval post-injection are important predictors of patient-reported beneficial outcomes.

Chronic Temporomandibular Disorders: disability, pain intensity and fear of movement.

BackgroundThe objective was to compare and correlate disability, pain intensity, the impact of headache on daily life and the fear of movement between subgroups of patients with chronic temporomandibular disorder (TMD).MethodsA cross-sectional study was conducted in patients diagnosed with chronic painful TMD. Patients were divided into: 1) joint pain (JP); 2) muscle pain (MP); and 3) mixed pain. The following measures were included: Craniomandibular pain and disability (Craniofacial pain and disability inventory), neck disability (Neck Dsiability Index), pain intensity (Visual Analogue Scale), impact of headache (Headache Impact Test 6) and kinesiophobia (Tampa Scale of Kinesiophobia-11).ResultsA total of 154 patients were recruited. The mixed pain group showed significant differences compared with the JP group or MP group in neck disability (p < 0.001, d = 1.99; and p < 0.001, d = 1.17), craniomandibular pain and disability (p < 0.001, d = 1.34; and p < 0.001, d = 0.9, respectively), and impact of headache (p < 0.001, d = 1.91; and p < 0.001, d = 0.91, respectively). In addition, significant differences were observed between JP group and MP group for impact of headache (p < 0.001, d = 1.08). Neck disability was a significant covariate (37 % of variance) of craniomandibular pain and disability for the MP group (β = 0.62; p < 0.001). In the mixed chronic pain group, neck disability (β = 0.40; p < 0.001) and kinesiophobia (β = 0.30; p = 0.03) were significant covariate (33 % of variance) of craniomandibular pain and disability.ConclusionMixed chronic pain patients show greater craniomandibular and neck disability than patients diagnosed with chronic JP or MP. Neck disability predicted the variance of craniofacial pain and disability for patients with MP. Neck disability and kinesiophobia predicted the variance of craniofacial pain and disability for those with chronic mixed pain.

Prevalence of Suicidal Ideation, Depression, and Anxiety in Chronic Temporomandibular Disorder Patients.

To investigate the prevalence of suicidal ideation (SI), depression, and anxiety in patients with a chronic temporomandibular disorder (TMD). The sample consisted of 1,241 consecutive patients diagnosed with muscle or joint pain, consistent with the Research Diagnostic Criteria for TMD (RDC/TMD), and assigned to one of three groups: Muscle pain (MM) group, joint pain (TMJ) group, and Mixed group. Variables of interest were specific demographics and psychometrics derived from the Symptom Checklist 90-Revised (SCL-90-R): three SI-related items, depression, anxiety, and Global Symptom Index score. Group comparisons were performed with χ² tests and t tests; the level of significance was set at α = .05. The mean (± standard deviation) age for the whole sample was 35.76 ± 12.6 years; 88.3% were women. The overall prevalence of SI items from the SCL-90-R was 8.4% for "thoughts of ending your life," 28.5% for "feeling hopeless about the future," and 20.5% for "having thoughts of death and dying." The overall prevalence of depression was 30.4% and overall prevalence of anxiety was 28.9%. Patients in the MM group reported the highest prevalence of SI. Patients in the MM group were significantly more likely to be depressed and anxious compared to patients in the TMJ (P < .0001) and Mixed groups (P < .0001). Elevated levels of SI, depression, and anxiety were reported in a chronic TMD population, especially in those with chronic muscle pain, compared to the general population. These findings emphasize the need for screening for suicidality and other comorbidities in TMD patients suffering from chronic pain.

Genetic Polymorphisms of Catechol-O-Methyltransferase: Association with Temporomandibular Disorders and Postoperative Pain.

To evaluate the association between catechol-O-methyltransferase (COMT) gene polymorphisms and temporomandibular disorders (TMD), TMD pain, psychosocial impairment related to TMD, and postoperative pain. A total of 90 patients with a diagnosis of painful TMD and 92 matched controls were investigated for the presence of TMD, TMD pain, and psychosocial variables by the Research Diagnostic Criteria for TMD. In a prospective cohort study of 40 subjects who underwent extraction of at least one fully impacted mandibular third molar, subjects had 6 months post-surgery follow-up of postoperative pain. DNA extracted from peripheral blood was genotyped for three COMT polymorphisms (rs4680, rs6269, and rs165774) by real-time TaqMan method. The association between COMT polymorphisms and clinical variables was determined by calculating odds ratios (OR) and their 95% confidence intervals (CI). Homozygous AA genotype and heterozygous variant A allele carriers (genotype AG/AA) for rs165774 polymorphism were associated with increased risk of TMD compared to wild type (wt) GG genotype (OR = 9.448, P = .006; OR = 2.088, P = .017, respectively). In addition, AA genotype was associated with increased risk of arthralgia (OR = 4.448, P = .011), myofascial pain (OR = 3.543, P = .035), and chronic TMD pain (OR = 6.173, P = .006), compared to wt genotype. AA genotype for rs6269 polymorphism was related to less postoperative chronic TMD pain (P = .025) and lower postoperative acute pain at the extraction site (P = .030). No associations with depression and somatization were observed. AA genotype of rs165774 could be a significant risk factor for the development of TMD and TMD pain, while AA genotype of rs6269 presents less postoperative chronic TMD pain and acute pain at a dental extraction site.

Reorganization of muscle activity in patients with chronic temporomandibular disorders

ObjectiveTo investigate whether reorganization of muscle activity occurs in patients with chronic temporomandibular disorders (TMD) and, if so, how it is affected by symptomatology severity. MethodsSurface electromyography (sEMG) of masticatory muscles was made in 30 chronic TMD patients, diagnosed with disc displacement with reduction (DDR) and pain. Two 15-patient subgroups, with moderate (TMDmo) and severe (TMDse) signs and symptoms, were compared with a control group of 15 healthy subjects matched by age. The experimental tasks were: a 5s inter-arch maximum voluntary clench (MVC); right and left 15s unilateral gum chewing tests. Standardized sEMG indices characterizing masseter and temporalis muscles activity were calculated, and a comprehensive functional index (FI) was introduced to quantitatively summarize subjects’ overall performance. Mastication was also clinically evaluated. ResultsDuring MVC, TMDse patients had a significantly larger asymmetry of temporalis muscles contraction. Both TMD groups showed reduced coordination between masseter and temporalis muscles’ maximal contraction, and their muscular activity distribution shifted significantly from masseter to temporalis muscles. During chewing, TMDse patients recruited the balancing side muscles proportionally more than controls, specifically the masseter muscle. When comparing right and left side chewing, the muscles’ recruitment pattern resulted less symmetric in TMD patients, especially in TMDse. Overall, the functional index of both TMDmo and TMDse patients was significantly lower than that obtained by controls. ConclusionsChronic TMD patients, specifically those with severe symptomatology, showed a reorganized activity, mainly resulting in worse functional performances.

Mandibular kinesiographic pattern of women with chronic TMD after management with educational and self-care therapies: A double-blind, randomized clinical trial

Statement of problemLimited mandibular movements are one of the most important signs of temporomandibular disorders (TMDs) and may cause functional difficulties. PurposeThe purpose of this double-blind, randomized clinical trial was to evaluate the effect of treatment with only educational or education associated with self-care therapies on the pattern of mandibular movements of women with chronic painful TMDs. Material and methodsForty-two women were selected and randomly divided into 3 groups, control group (CG, n=13), education group (EG, n=16), and education and self-care group (ESG, n=13), according to the sequence of treatment they received. A kinesiograph device recorded mandibular movements during maximum mouth opening and mastication at baseline (T0) and at 30-day (T1) and 60-day (T2) follow-up. Kinesiographic data were statistically analyzed using 1-way ANOVA, followed by the Bonferroni test for multiple comparisons of means (α=.05). ResultsThe ESG group demonstrated an improvement in the maximum vertical opening (MVO= 5.1 ±3.4 mm; P=.012) and anteroposterior mandibular movement (MAM) during maximum opening (7.4 ±9.5; P=.019), significantly higher than that of the EG (MVO=1.8 ±3.5 mm; MAM=0.8 ±5.0 mm) and the CG (MVO=0.9 ±3.8 mm; MAM=0.8 ±4.4 mm) after 30 days of follow-up. Moreover, at T1, vertical mandibular movement during mastication was significantly higher in the ESG group (17.4 ±1.7 mm) than in the EG group (15.0 ±2.8, P=.027). No significant differences were found between the women who received treatment with educational and self-care therapies for 60 days and the women who received this treatment for 30 days. ConclusionsIn the short-term, education and self-care treatment positively influenced the mandibular movement pattern of women with chronic painful TMDs.

Effects of oral motor exercises and laser therapy on chronic temporomandibular disorders: a randomized study with follow-up.

This study investigated the efficacy of combining low-level laser therapy (LLLT) with oral motor exercises (OM-exercises) for rehabilitation of patients with chronic temporomandibular disorders (TMDs). Eighty-two patients with chronic TMD and 20 healthy subjects (control group) participated in the study. Patients were randomly assigned to treatment groups: GI (LLLT + OM exercises), GII (orofacial myofunctional therapy-OMT-which contains pain relief strategies and OM-exercises), and GIII (LLLT placebo + OM-exercises) and GIV (LLLT). LLLT (AsGaAl; 780-nm wavelength; average power of 60mW, 40s, and 60 ± 1.0J/cm²) was used to promote analgesia, while OM-exercises were used to reestablish the orofacial functions. Evaluations at baseline (T1), after treatment immediate (T2), and at follow-up (T3) were muscle and joint tenderness to palpation, TMD severity, and orofacial myofunctional status. There was a significant improvement in outcome measures in all treated groups with stability at follow-up (Friedman test, P < 0.05), but GIV did not show difference in orofacial functions after LLLT (P > 0.05). Intergroup comparisons showed that all treated groups had no difference in tenderness to palpation of temporal muscle compared to GC at follow-up (Kruskal-Wallis test, P < 0.01). Moreover, GI, GII, and GIII showed no difference from GC in orofacial functional condition (T2 and T3) while they differed significantly from GIV (P < 0.01). In conclusion, LLLT combined with OM-exercises was more effective in promoting TMD rehabilitation than LLLT alone was. Similar treatment results were verified with the OMT protocol.

Association of pain intensity, pain-related disability, and depression with hypothalamus–pituitary–adrenal axis function in female patients with chronic temporomandibular disorders

Patients with temporomandibular disorders (TMD) commonly experience myofascial and joint pain, pain-related disability, and other pain conditions including depression. The present study was carried out to explore the function of the hypothalamus–pituitary–adrenal (HPA) axis in relation to variables of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis II and comorbid depression in female patients with TMD. Cortisol and dehydroepiandrosterone (DHEA) levels were determined in saliva samples that had been collected at various periods after waking (0, 30, and 60min) and at nighttime (2100–2200h) from 52 female patients with chronic TMD pain and age- and gender-matched controls (n=54, 20–40 years old). There were no significant differences in the levels and diurnal patterns of cortisol and DHEA secretion between groups of patients with TMD and controls. In patients, the cortisol awakening response (CAR) or diurnal cortisol rhythm were not associated with any variables of the RDC/TMD Axis II or the Beck Depression Inventory (BDI)-II total scores. However, the ratio of overall cortisol secretion within the first hour after waking (CARauc) to overall DHEA secretion during the post-waking period (Daucawk), defined as CARauc/Daucawk, was significantly associated with pain-related RDC/TMD variables (pain intensity and pain-related disability) and BDI-II total scores. Pain intensity and pain-related disability scores were also significantly associated with BDI-II total scores. These results indicated that an increase in molar cortisol/DHEA ratio due to the dissociation between cortisol and DHEA secretion was associated with pain intensity, pain-related disability, and depression in female patients with TMD.

Regional effects of orthopedic manual physical therapy in the successful management of chronic jaw pain

Objective and importance: Temporomandibular disorders (TMD) encompass a variety of dysfunction of the maxillofacial region. A strong relationship between TMD and cervical spine pain exists, and widespread hyperalgesia is common in TMD. This case describes the management and reduction in regional hyperalgesia in a patient with chronic TMD.Clinical presentation: A 23-year-old female with a 10-year history of tinnitus and bilateral (B) jaw pain, and 5-year history of intermittent neck pain, presented with pain, which could reach 10/10 on the numeric pain rating scale, locking, tightness and restricted eating habits. Cervical motion testing did not reproduce her jaw pain. Her mouth opening (MO) and B temporomandibular joint (TMJ) accessory glides were limited and painful. Accessory glides at the upper cervical facet joints reproduced her jaw pain. Pressure pain thresholds (PPT) at her B masseters and thenar eminences at the hand were diminished, indicating hyperalgesia.Intervention: Treatment included passive mobilizations at her TMJs and cervical spine. Home exercises included self-mobilization of her TMJs and neck. In six sessions, her MO improved from 30 to 45 mm and average pain improved from 4/10 to 0/10. The jaw pain and function questionnaire improved from 16/52 to 5/52. PPTs at her right/left masseter and thenar eminence improved from 140/106 and 221/230 kPa to 381/389 and 562/519 kPa, respectively.Conclusion: This case described the treatment and reduction of upper extremity hyperalgesia of a patient with chronic jaw and neck pain. Manual therapy may be a valuable intervention in the treatment of chronic TMD with distal hyperalgesia.

Psychosocial and Somatosensory Factors in Women with Chronic Migraine and Painful Temporomandibular Disorders.

Introduction. Psychosocial and somatosensory factors are involved in the pathophysiology of chronic migraine (CM) and chronic temporomandibular disorders (TMD). Objective. To compare and assess the relationship between pain catastrophizing and kinesiophobia in patients with CM or chronic TMD. Method. Cross-sectional study of 20 women with CM, 19 with chronic TMD, and 20 healthy volunteers. Pain catastrophizing and kinesiophobia were assessed. The level of education, pain intensity, and magnitude of temporal summation of stimuli in the masseter (STM) and tibialis (STT) muscles were also evaluated. Results. There were significant differences between the CM and chronic TMD groups, compared with the group of asymptomatic subjects, for all variables (p < .05) except kinesiophobia when comparing patients with CM and healthy women. Moderate correlations between kinesiophobia and catastrophizing (r = 0.46; p < .01) were obtained, and the strongest association was between kinesiophobia and magnification (r = 0.52; p < .01). The strongest associations among physical variables were found between the STM on both sides (r = 0.93; p < .01) and between the left and right STT (r = 0.76; p < .01). Conclusion. No differences were observed in pain catastrophizing and kinesiophobia between women with CM and with chronic TMD. Women with CM or chronic TMD showed higher levels of pain catastrophizing than asymptomatic subjects.

Ear acupuncture associated to home self-care in the treatment of chronic temporomandibular disorders in women. Case reports

JUSTIFICATIVA E OBJETIVOS: O objetivo desse estudo foi descrever, em uma serie de casos, o efeito da acupuntura auricular associada ou nao as tecnicas de educacao e autocuidados caseiros, no tratamento das disfuncoes temporomandibulares cronicas em mulheres. RELATO DOS CASOS: Nove pacientes com disfuncao temporomandibular cronica dolorosa, com idade entre 22 e 45 anos (media de 32,11 anos) foram avaliadas por meio da ficha clinica de disfuncoes temporomandibulares e dor orofacial da Disciplina de Oclusao II da Universidade de Araraquara, pelo Research Diagnostic Criteria for Temporomandibular Disorders e por um diario de dor com escalas analogicas visuais, entregues semanalmente na referencia (primeira semana) e apos cada sessao de tratamento (acupuntura auricular e/ou aconselhamento). Durante as tres semanas de tratamento, as pacientes receberam instrucoes para controle das disfuncoes temporomandibulares, sendo que seis pacientes receberam, alem dos autocuidados, acupuntura auricular nos pontos recomendados para o tratamento das disfuncoes temporomandibulares e sintomas associados (protocolo: Shen-men, sistema neurovegetativo, rim, disfuncoes temporomandibulares e triade da ansiedade). A acupuntura auricular associada a educacao e autocuidados caseiros apresentou os melhores resultados na remissao/diminuicao dos sintomas apos 3 semanas de tratamento quando comparada ao grupo que recebeu apenas as instrucoes de autocuidados. CONCLUSAO: A acupuntura auricular associada a educacao e as tecnicas de autocuidados caseiros demonstrou melhores resultados no controle da dor dos pacientes com disfuncao temporomandibular.

Gender Difference in Associations between Chronic Temporomandibular Disorders and General Quality of Life in Koreans: A Cross-Sectional Study.

BackgroundChronic temporomandibular disorder (TMD) is known to have strong correlations with psychological factors and to display gender disparity. However, while chronic TMD is known to affect quality of life, large-scale studies investigating the influence on quality of life by gender are scarce.MethodsThis cross-sectional study assessed the data of 17,198 participants aged ≥19 years who completed chronic TMD and EuroQol-5 Dimension sections in the 4th Korean National Health and Nutrition Examination Survey (2007–2009). We adjusted for covariates (health behavior, sociodemographic factors) in regression analysis for complex sampling design to calculate regression coefficients and 95% CIs for gender difference in the association between chronic TMD and quality of life. We also evaluated which covariates of somatic health, mental health, health behavior, and sociodemographic factors weakened the relationship between TMD and EQ-5D.ResultsPrevalence of chronic TMD was 1.6% (men 1.3%, women 1.8%), and chronic TMD persisted to negatively impact quality of life even after adjusting for confounding variables. Low sociodemographic factors and health behavior had a negative effect on quality of life. Somatic health and mental health were most affected by chronic TMD. As for quality of life, women were affected to a greater extent than men by TMD. Women were more affected by osteoarthritis and general mental health (stress, depressive symptoms, and thoughts of suicide), and men by employment.ConclusionsThese results imply that chronic diseases and psychological factors are important in chronic TMD, and that there may be physiological and pathological gender differences in TMD.

GaAlAs phototherapy for tension and compression related temporomandibular disorders

Introduction: The aim of this study is to evaluate the distribution of the most common etiological factors responsible for the development of chronic temporomandibular disorders, and to test the pain - relief effectiveness of combined gallium-aluminum-arsenide laser (GaAlAs; 785 nm) and superluminiscent diods (SLD; 633 nm) phototherapy (MedX 1100 device) for most common tension and compression pain-related diagnostic subgroups of chronic temporomandibular disorders. Material and methods: This study includes 62 patients - 7 men and 55 women, aged between 21-74 years with clinical signs and symptoms of chronic temporomandibular joint and myofascial pain. Using DC/TMD instruments the most common causative factors were identified, and part of the TMDs assessed were classified to tension and compression related diagnostic subgroups. Trigger point oriented combination of laser (MedX 1100 console with three GaAlAs laser diodes, 785 nm, 3x33 mW, 100 s, 8 J/cm 2 per spot) and SLD red light sessions (633 nm, 200 mW, 300 s, 8 J/cm 2 per spot) was applied for temporomandibular joints and affected muscles. Results and conclusion: Using descriptive analysis and paired samples Student`s t-test, the most statistically manifested pain reduction is found for Arthralgia attributed to Tension-related TMDs (Subluxations, Dislocations, Sprain and strain of joints, ligaments and TMJ - related structures, Flexion-extension injuries; p=0,000001), followed by Myalgia for the same disorders (p=0,000014), followed by Arthralgia attributed to Compression-related TMDs (bruxism, psychosomatic parafunctions, occlusal microtrauma, dentofacial anomalies and malocclusions, p=0,000037), and Myalgia attributed to the same TMDs (p=0,000808). This study shows that combined phototherapy provides statistically significant reduction of pain symptoms for the most common temporomandibular disorders, and that Arthralgia and Myalgia attributed to tension-related disorders are better influenced by combined phototherapy than compression-related ones.