Clinical Diagnosis Of Temporomandibular Disorder Research Articles

Association between clinical diagnosis of temporomandibular disorders using research diagnostic criteria and morphological changes of the condyle and abnormal joint spaces using CBCT

Association between clinical diagnosis of temporomandibular disorders using research diagnostic criteria and morphological changes of the condyle and abnormal joint spaces using CBCT

Data on ultrasound therapy as an adjuvant pain control method among Indian TMDS patients.

It is of interest to evaluate the efficacy of ultrasound therapy as an adjuvant pain control modality in dysfunctions of the temporomandibular joint. The study comprised 20 patients with TMJ issues who had received a clinical diagnosis of temporomandibular disorders (TMDS). These patients underwent independent VAS evaluations for the intensity of pain, opening and closing of the mouth, and soreness of the muscles of mastication, including the masseter muscle, medial pterygoid muscle, lateral pterygoid muscle, and temporalis muscle, as well as additional auxiliary muscles. The chosen patients received ultrasonic treatment. The mean value of mouth opening before therapy was 39.51cm, with SD values of 7.61 cm. The mean value of mouth opening after therapy was 42.91 cm with SD values of 6.08.The findings were statistically significant, with a p-valueof0.021. The mean value of VAS in the TMJ area before therapy was 8.41 with SD values of 2.11.There was a reduction in the mean values of VAS after therapy, which was 3.11 with SD values of 1.12. The findings were significant statistically, with a p-value equal to 0.001. Thus, ultrasonographic therapy for temporomandibular joint pain demonstrated a considerable improvement in pain reduction and mouth opening. It is possible to view this therapy as the adjuvant methodology to control pain in disorders of TMJ.

Matrix Metalloproteinase-2 Gene Polymorphisms Decrease Chances of Muscle TMD Development in Brazilian Population

Introduction: Muscular Temporomandibular disorders or masticatory disorders are characterized by orofacial pain and functional limitations associated with oral dysfunctions, emotional changes and/or genetic factors. Matrix Metalloproteinases (MMPs) are proteolytic enzymes that constitute the extracellular matrix and play an important role in the skeletal muscle adaptation. Objectives: To evaluate the association between polymorphisms in the Matrix Metaloprotease-2 (MMP2) gene and the presence of muscular disorders. Methods: RDC/TMD questionnaire was applied for clinical diagnosis of Temporomandibular Disorders (TMD) in the study sample and three diagnosis groups were formed: control group (n=154), muscular TMD (n=122) and joint TMD (n=49). Genomic DNA was obtained from saliva samples and six single nucleotide polymorphisms in the MMP2 gene were selected. Results: A tendency of association between the presence of the CT genotype (rs243865) and the absence of muscular TMD was observed when compared to the control group (p=0.05). There was a significant prevalence of the polymorphic CT+TT (rs243865) genotypes in the control group (p=0.04) compared to the muscular TMD group (p=0.05). Confirming these results, TCCACC MMP2 haplotype showed higher association (p=0.01) with protection against muscular TMD. Conclusion: Polymorphism in the MMP2 gene (rs243865) is related to protection against muscular TMD.

Correlation between patient complaint, temporomandibular disorder diagnosis and mandible head morphology

The aim of this study was to evaluate the correlation between patient complaints, clinical diagnosis of temporomandibular disorder (TMD) based on the diagnostic criteria for TMD, and morphology of the mandibular condyle obtained by cone-beam computed tomography (CB-CT). Data were collected from 40 patients. The anatomy of the mandibular condyle was assessed using CB-CT, the diagnosis of TMD according to diagnostic criteria for TMD, and patients' complaints was registered at the appointment. Data were explored and all statistical references were completed in bicaudal tests, with 95% confidence level (α=0.05). The Chi-squared test was used with Bonferroni correction (z-tests). Main complaints found were grouped as muscular, articular, muscular and articular, or headache and articular symptoms. Clinical diagnosis of TMD involved myalgia, local myalgia, myofascial pain, myofascial pain with reference, myofascial pain with arthralgia, arthralgia, or disc displacement with reduction. At least one joint showed condylar flattening, erosion, sclerosis, or osteophytes. No correlation was observed between main complaints, clinical diagnosis, and morphology of the mandibular condyle in all comparisons. The findings suggest that due to the absence of clinical and morphological correlation, CB-CTs should be requested only in specific cases, when doubt remain after careful TMD diagnosis, to avoid their over-indication.

Optimizing the clinical diagnosis of temporomandibular disorder

Standard TMJ is the key to the morphology of the face as it enables the occlusive function and spatially situates the chin. The diagnosis of the temporomandibular joint disorders is made intricate not only by the multifactorial etiology of these pathologies but also by the difficulty to comprehend the pain felt by the patient. Through a review of the literature and our respective practices (over 30 years) and teachings, this article surveys the main principles of temporomandibular joint disorder. As numerous writers have focused on the problems created by TMJ pathologies, it's only natural that various therapeutic approaches be suggested. What primarily matters is that they lead to a stabilization of the occlusion. As far as diagnosis is concerned, only a precise and rigorous protocol - followed by everyone - can produce a therapeutic result that would be acceptable for each patient. The orthodontist can and must be the coordinator of the cross-disciplinary team. He steps in over 72 % of temporomandibular joint disorder cases and proposes the most conservative, cheapest, and the best cost/benefit ratio for the patient.

General health & psychological distress in children with temporomandibular disorder.

Temporomandibular disorders (TMD) are an heterogeneous group of disorders affecting temporomandibular joints (TMJ), masticatory muscles, or both. The aim of this study is to evaluate the relationship between general health and psychological distress variables and the clinical diagnosis of TMD in children between 8 - 13 years old. Moreover, it will be underlined the different perception of psychological distress existing between patients and their parents. Patients were divided in two groups: the "case group", which includes patients with TMD, and the "control group", which included patients asymptomatic for TMD. The "case group" is composed by 29 patients, while the "control group" is composed by 22 patients. The patients were asked to fill in a questionnaire called Child Health Questionnaire (CHQ), to evaluate general health and psychological condition and, eventually, the presence of symptoms of stress, anxiety and/or depression. The CHQ is 87 - item questionnaire developed in USA specifically for children. As widely reported during the present work, the link between TMD and psychological distress is existing and quite strong, because of lack of number of patients many aspects worth of attentions have not been analyzed as they deserved. That's way the conclusion must lead to the proposal of going on with the present study following, possibly, some aspects of research as an increase of the number of patients involved in the study; Individuate possible elements, internal and external, that could strongly influence differences between patient's results and parent's results, etc.

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.

CBCT analysis of bony changes associated with temporomandibular disorders

Objectives: The aim of the present study was to compare cone-beam computerized tomography (CBCT) findings and joint space measurement in temporomandibular disorder (TMD) and non-TMD joints, and to correlate these findings with the clinical diagnosis.Methods: The study was conducted on patients diagnosed with temporomandibular joint (TMJ) osteoarthritis or closed lock according to the Research Diagnostic Criteria for TMDs (Group IIb, IIc, and III). CBCT and clinical records of non-TMD patients who sought treatment for purposes other than TMD were used retrospectively as a control. The following radiographic criteria were assessed: flattening, osteophyte, Ely’s cyst, condylar surface irregularities, and joints’ space measurements.Results: Osteoarthritic joints had significantly more condylar irregularities (P50.0), osteophytes (P50.0), and condylar flattening (P50.003) than non-TMD joints. Osteoarthritic joints had significantlymore superior surface irregularities (P50.0) and osteophytes (P50.006) than closed lock joints.Non-TMDjoints had significantlymore joint space (5.64+1.88) compared with osteoarthritic joints (4.57+1.97), (P50.025). The correlation among TMD, osteophytes, and flattening of the condylar surface was statistically significant (r50.331, Pv0.000).Discussion: Cone-beam computerized tomography findings are significantly associated with the clinical diagnosis of TMD. Osteophytes and flattening of the condylar surface are common features of TMD.

Aspectos clínicos e psicossociais avaliados por critérios de diagnóstico para disfunção temporomandibular

RESUMO Objetivo: analisar a associação entre a classificação de diagnósticos clínicos (dor miofascial, desordem discal e articular) e a graduação de dor crônica, depressão e sintomas físicos não específicos em sujeitos com disfunção temporomandibular. Métodos: foram incluídos 32 pacientes, com média de idade de 28,71±4,66 anos. Como instrumento de avaliação, foi utilizado o Critério de Diagnóstico para Pesquisa das Desordens Temporomandibulares - Eixo I e II. Quanto ao grupo diagnóstico, 88,13% dos indivíduos apresentaram diagnóstico misto, sendo 43,75% dos grupos I e III (distúrbios musculares e articulares) e 34,38% dos grupos I, II e III (distúrbios musculares, articulares e deslocamento de disco). Resultados: de acordo com o eixo II, 96,88% dos participantes foram classificados com dor crônica grau I e II (baixa incapacidade e baixa intensidade; baixa incapacidade e alta intensidade). Graus moderado e grave de depressão foram observados em 84,38% dos participantes. Na avaliação de sintomas físicos não específicos incluindo e excluindo dor, respectivamente, 59,38% apresentaram sintomas severos e 71,88% apresentaram sintomas moderados e severos. Verificou-se relação significante dos diagnósticos clínicos de disfunção temporomandibular com o grau de sintomas físicos não específicos incluindo dor. Conclusão: alguns aspectos clínicos e psicossociais estão associados em pacientes com disfunção temporomandibular, observando uma multiplicidade de diagnósticos clínicos com a presença de uma relação significante entre os diagnósticos clínicos encontrados e a presença de sintomas físicos inespecíficos com dor. Queixa de maior gravidade de sintomas físicos foi encontrada em pacientes com diagnóstico clínico múltiplo.

CBCT analysis of bony changes associated with temporomandibular disorders

Objectives: The aim of the present study was to compare cone-beam computerized tomography (CBCT) findings and joint space measurement in temporomandibular disorder (TMD) and non-TMD joints, and to correlate these findings with the clinical diagnosis.Methods: The study was conducted on patients diagnosed with temporomandibular joint (TMJ) osteoarthritis or closed lock according to the Research Diagnostic Criteria for TMDs (Group IIb, IIc, and III). CBCT and clinical records of non-TMD patients who sought treatment for purposes other than TMD were used retrospectively as a control. The following radiographic criteria were assessed: flattening, osteophyte, Ely’s cyst, condylar surface irregularities, and joints’ space measurements.Results: Osteoarthritic joints had significantly more condylar irregularities (P50.0), osteophytes (P50.0), and condylar flattening (P50.003) than non-TMD joints. Osteoarthritic joints had significantlymore superior surface irregularities (P50.0) and osteophytes (P50.006) than closed lock joints.Non-TMDjoints had significantlymore joint space (5.64+1.88) compared with osteoarthritic joints (4.57+1.97), (P50.025). The correlation among TMD, osteophytes, and flattening of the condylar surface was statistically significant (r50.331, Pv0.000).Discussion: Cone-beam computerized tomography findings are significantly associated with the clinical diagnosis of TMD. Osteophytes and flattening of the condylar surface are common features of TMD.

Orthodontics is temporomandibular disorder-neutral.

To assess if subjects with a clinical diagnosis of temporomandibular disorders (TMDs) have a similar prevalence of orthodontic history as a population of TMD-free individuals and to assess if those subjects who have a history of ideal orthodontics have fewer symptoms than those with a history of nonideal orthodontics. Two groups of age- and sex-matched individuals belonging to either a study ("TMD") or a control group were recruited. Subjects who underwent orthodontic treatment were classified as having a history of ideal or nonideal orthodontics based on the current presence of normal values in five reference occlusal features. The correlation with a history of orthodontic treatment was not clinically significant for any of the TMD diagnoses (ie, muscle pain, joint pain, disc displacement, arthrosis), with Phi (Φ) coefficient values within the -0.120 to 0.058 range. Within the subset of patients with a history of orthodontics, the correlation of ideal or nonideal orthodontic treatment with TMD diagnoses was, in general, not clinically relevant or was weakly relevant. Findings confirmed the substantial absence of clinically significant effects of orthodontics as far as TMD is concerned. The very low correlation values of a negative or positive history of ideal or nonideal orthodontics with the different TMD diagnoses suggest that orthodontic treatment could not have a true role for TMD.

Tens versus ultrasonic massage therapy in temporomandibular disorders - a study

The aim of this study is to compare the effectiveness of transcutaneous electrical nerve stimulation (TENS) and ultrasonic massager in the management of TMJ Pain disorders. A total of 20 subjects with clinical diagnosis of temporomandibular disorders were randomly allocated in two study groups GROUP A received TENS therapy and GROUP B received ULTRASOUND MASSAGER therapy. All patients were examined before and after the treatment using a visual analogue scale(VAS). A significant pain reduction was observed in both TENS and Ultrasound massage therapy groups. Decrease in pain and muscle tenderness was significantly more in Ultrasonic therapy group than TENS group, so Ultrasonic therapy appears to be valuable physiotherapy method for pain reduction in TMD disorders.

Temporomandibular disorder in patients with juvenile idiopathic arthritis: clinical evaluation and correlation with the findings of cone beam computed tomography

The objective of this study was to assess the presence of temporomandibular disorder (TMD) in patients with juvenile idiopathic arthritis (JIA), and correlate with tomographic findings and clinical aspects. Fifteen patients with JIA were evaluated by means of RDC/TMD, and submitted to a cone beam computerized tomography (CBCT) examination, then correlated with the clinical diagnosis of TMD with tomographic findings, gender, age at the time of evaluation, time elapsed since the onset of symptoms, and time of treatment of JIA. In the 30 temporomandibular joints evaluated, 25 (83.3%) were clinically diagnosed with TMD. Although tomographic alterations have frequently been found (83.3%), only 5 (16.7%) were clinically diagnosed with osteoarthritis/arthrosis. There was a difference in the degree of TMD when evaluated, the time elapsed since the onset of symptoms, and the time of treatment of JIA. Diagnosis based on physical examination and complementary evaluation is necessary to provide early therapeutic procedures so that possible functional and/or anatomical problems do not develop.

Temporomandibular disorders after orthognathic surgery in patients with mandibular prognathism with depression as a risk factor

Objective. To examine the prevalence of temporomandibular disorders (TMD) after orthodontic-surgical treatment in patients with mandibular prognathism and analyze psychosocial variables related to TMD. Materials and methods. The case-control study comprised 40 patients with mandibular prognathism who underwent combined orthodontic-surgical treatment (orthognathic surgery group). Forty-two patients with untreated mandibular prognathism served as a control group. Research diagnostic criteria for temporomandibular disorders was used in order to assess the clinical diagnosis of TMD (Axis I) and to estimate depression, somatization and patient's disability related to chronic pain (Axis II). Results. The overall prevalence of TMD was not significantly different between the groups. Myofascial pain was significantly higher, while arthralgia, arthritis and arthrosis was significantly lower in the orthognathic group compared with the controls (90.5% vs 50.0%, 0.0% vs 27.8%, respectively) (p < 0.05). Females in orthognathic surgery group showed higher prevalence of TMD (p < 0.05) and myofascial pain (p < 0.01) and increased level of chronic pain (p < 0.05) in comparison with post-operative males. No significant difference in chronic pain, somatization and depression scores was found between investigated groups. With respect to presence of TMD within the groups depression was higher in untreated subjects with dysfunction (p < 0.05). Conclusion. Prevalence of TMD immediately after completion of orthodontic-surgical treatment for mandibular prognathism is similar to frequency of dysfunction in untreated subjects, is significantly higher in females and is most commonly myogenic. Furthermore, females show an increased level of chronic pain post-operatively. Somatization and depression levels do not differ between patients with corrected prognathism and untreated prognathic patients.

Magnetic resonance imaging findings of internal derangement in temporomandibular joints without a clinical diagnosis of temporomandibular disorder.

The purpose of this study was to assess the prevalences of magnetic resonance (MR) imaging findings of internal derangement (ID) in temporomandibular joints (TMJs) without a specific clinical diagnosis of temporomandibular disorder (TMD), and to investigate whether in this TMJ group the variable of pain may be linked to MR imaging findings of ID. The study comprised 109 patients, who were assigned a clinical uni- or bilateral TMJ-related diagnosis of 'absence of TMD'. Bilateral sagittal and coronal MR images were obtained subsequently to establish the prevalence of TMJ ID. An MR imaging diagnosis of ID was found in 99 (55.9%) of the 177 TMJs investigated. About 30.3% of the closed mouth-related TMJ positions characterized by disc displacement presented with anterior disc displacement, while 27.3% had anterolateral and 25.3% anteromedial disc displacement. Analysis of the data revealed the presence of TMJ pain to be associated with significantly more MR imaging diagnoses of disc displacement without reduction than disc displacement with reduction (P < 0.05), while there was no significant difference in the prevalences of ID and those of absence of ID (P > 0.05). Using chi-square analysis, no significant relationship was found between the presence of TMJ pain and the MR imaging diagnosis of TMJ ID (P=0.93). Use of the kappa statistical test indicated poor diagnostic agreement between the presence of TMJ pain and the MR imaging diagnosis of ID (kappa=0.01). The results suggest TMJs with a clinical diagnosis of 'absence of TMD' to be associated with a high rate of IDs, while in these instances the clinical variable of TMJ pain may have no effect on prevalences of MR imaging diagnoses TMJ ID. The data confirm the aspect of clinical diagnostic criteria as an unreliable instrument in predicting MR imaging diagnoses of TMJ ID.

The clinical diagnosis oftemporomandibular disorders in the orthodontic patient

Because many of the diseases and disorders that affect the temporomandibular joint (TMJ) and associated masticatory muscles occur in the age group of patients generally seen by the orthodontist, their recognition is of great importance in planning and performing orthodontic therapy. This article discusses the diagnosis and clinical significance of the various conditions that may be encountered.

顎関節症の診断法について

顎関節症の診断法について