Craniomandibular Pain Research Articles

Osteoarthrosis as the cause of craniomandibular pain and dysfunction: a unifying concept.

It has been demonstrated that osteoarthrotic changes in the temporomandibular joint (TMJ) and in other synovial joints show a similar course, both clinically and (ultra)microscopically. Initially, cartilage changes and possibly also changes in the synovial membrane set up a vicious cycle of cartilage breakdown accompanied by attempts at repair. When the degradative process exceeds the response of repair, the osteoarthrotic disorder progresses into clinically detectable stages. Frequently, the gliding capacity of the articular disc is also impaired, giving rise to an internal derangement. In this article, a concept is presented in which it is suggested that in many cases of craniomandibular pain and dysfunction TMJ osteoarthrosis is the basic disorder.

The incidence and severity of premenstrual syndrome among female craniomandibular pain patients.

AbstractIn 1981, A.C. Fonder showed a marked correlation between craniomandibular pain dysfunction (CMP) and menstrual dysfunction among his female patients. Fonder's findings were flawed in that his sample was chosen retrospectively for inclusion in his article, and his subjects were not compared with a non-CMP group. This study compares patients of reproductive age presenting with CMP, one group using low-dose oral contraceptives and one group not, with a CMP-free group seen for routine examinations, fillings, or cleanings. All patients were examined between July and November 1985. Symptoms for all groups were collected using the Halbreich-Endicott Premenstrual Assessment Form and a checklist of known CMP symptoms. A strong association was demonstrated between premenstrual syndrome (PMS) complaints and craniomandibular pain dysfunction. A detailed comparison of the data was performed, and possible explanations for the relationship observed between PMS and CMP and implications for future research are off...

Orthodontic/orthopedic therapy for craniomandibular pain dysfunction. Part A. Anterior disk displacement, review of the literature.

AbstractThe most common symptoms of craniomandibular pain dysfunction (CMPD) include: headaches, myospasms, cephalic and cervical pain, limited range of motion, and joint sounds. More recently, the problem of internal derangement has been brought to light. Internal derangement manifests itself in the clinical symptom of reciprocal clicking (opening and closing clicks). Anterior disk dislocation or displacement and its treatment has remained controversial. Many clinicians believe anterior repositioning of the mandible is indicated, as long as the anterior repositioning is kept to a minimum. This article presents a review of the literature and its application to orthopedic/orthodontic treatment for anterior disk dislocation. The use of various radiographs to monitor and document the treatment changes is also presented. The concept of a therapeutic range extending from concentric to the Gelb position is presented as being the physiological range for the condyle.

Psychometric Profiles of Craniomandibular Pain Patients: Identifying Specific Subgroups

AbstractPrevious research using the Minnesota Multiphasic Personality Inventory has identified three distinct psychological subgroups among pain patients. Furthermore, there is evidence that these patient groups show a differential treatment response. This study assessed the psychological characteristics of 100 craniomandibular pain patients (78 females, 22 males) using the Symptom Checklist 90–Revised (SCL-90R). Using the statistical technique of cluster analysis, three discrete profiles emerged which represented normal, moderately distressed, and severely distressed psychological groups. Also, the three groups showed significant differences in many pain experience variables. Results are discussed in terms of the SCL-90R being useful for the early identification of patients in need of psychological treatment adjunctive to the physical medicine intervention.

Ernest syndrome as a consequence of stylomandibular ligament injury: A report of 68 patients

A clinical analysis of 68 patients diagnosed as suffering from Ernest's syndrome revealed: Injury to the stylomandibular ligament is a real and frequent disorder causing craniomandibular pain. Ages and sex differences, although variable, correspond to those reported elsewhere in the literature for craniomandibular pain. A diagnosis of Ernest's syndrome may be based on an adequate history, palpation of the insertion of the stylomandibular ligament, and a diagnostic local anesthetic block of the affected ligamentous insertion. Symptoms of Ernest's syndrome, in decreasing order of occurrence, are: TMJ and temporal pain, ear and mandibular pain, posterior tooth sensitivity, eye pain, and throat pain. In addition, shoulder pain may be involved. Of the patients in this study, 77.94% were treated successfully via nonsurgical management of their complaints. Resolution of this disorder is usually accomplished by a combination of a diagnostic injection of local anesthetic at the insertion of the ligament, localized injection of cortisone substitute, and placing the patient on a soft diet. Surgical management, if necessary, is best accomplished by a radiofrequency thermoneurolysis procedure in the involved ligamentous insertion.

Manipulative medicine in dentistry: a new potential for diagnosis and treatment.

Manipulative medicine can be extremely helpful in the treatment of craniomandibular disorders. With proper manipulation, the mandibular process of the temporal bone and other bones of the primary respiratory mechanism (PRM) can be moved to allow more physiological function.The PRM is made up of the bones of the skull, the reciprocal tension membrane, the cerebrospinal fluid, the central nervous system, and the movement of the sacrum between the ilia. If any of these components of the PRM are not able to move and function freely, there will often be compromises in remote and local structures and their attendant physiological processes. When the PRM is returned to normal, other problems, such as neck pain and craniomandibular dysfunction, can be treated more successfully. For this reason, it is important that an examination of the PRM be included in evaluations for craniomandibular pain and dysfunction.

Orthodontic/orthopedic treatment of craniomandibular pain dysfunction. Part 1: diagnosis with transcranial radiographs.

AbstractCraniomandibular dysfunction is a phenomenon with multiple causes. The most commonly cited of these factors are occlusal problems, stress, and condylar displacements. Craniomandibular dysfunction problems are more common than most practitioners have thought, and every orthodontic practice will come in contact with a significant number of these disorders.Since every orthodontic treatment is in reality a “full-mouth reconstruction” or orthopedic case when the craniomandibular relationship is taken into consideration, it is important that orthodontists recognize the extent of the craniomandibular dysfunction and correct it as best as possible with orthodontic/orthopedic treatment. Particular attention should be paid to the final placement of the condyles and the functional articulation (assuming that goals for skeletal and soft tissue harmony have been met). Transcranial radiographs should be made of each patient as treatment nears completion, and he or she should be carefully examined for posterior ...

The role of clinical psychology in the treatment of craniomandibular disorders.

With the birth of the behavioral medicine movement, clinical psychology has found itself involved with a wide range of physical disorders, many of which psychologists had never heard of prior to the 1970s. Included in these disorders are the “traditional” dental problems of bruxism and craniomandibular pain disorders.This article attempts to explain how both clinical psychology and medicine have become involved in the emerging behavioral medicine field, and it examines the implications of this involvement for various health care disciplines. We will outline and examine the value of clinical psychology's past involvement with dental disorders, as well as discussing the potential contributions of clinical psychology to dentistry. The article emphasizes the need for dentistry to guide psychology's work in this area and calls dentistry to become an active participant in the behavioral medicine movement.

The role of stress, occlusion, and condyle position in TMJ dysfunction-pain

Lateral transcranial TMJ radiographs are duplicable within +/- 0.2 mm and are cross-sectional views of the lateral third of the condyle and fossa. The innate asymmetry of humans, when the right and left sides of the fossa and condyle are compared, was clinically insignificant. Tomograms are not indicated because they lack appropriate resolution and detail to evaluate qualitative bone changes; and because they are not an in-office procedure, the condylar position in the fossa is completely unreliable. A correlation was reported between condylar position in the fossa and TMJ dysfunction in over 320 patients. This observation suggests that a new definition of centric relation is indicated, a definition that differentiates whether it is functional or dysfunctional. The criterion is the correlation between the occlusal findings and the condylar position in the fossa as recorded by the lateral TMJ radiographs (when the teeth are in maximum occlusion). Stress response was found to be greater in males than in females (in all vertebrates, including humans); therefore stress cannot be a direct cause of craniomandibular pain since more women have the disorder. It was concluded that stress is an indirect contributing factor that usually works through the medium of clenching. The role of the neuromuscular mechanism in craniomandibular pain was discussed. Proprioception reflex activity forms the basis for muscle length, mandibular positional sense, as well as masticatory function. Occlusal disharmonies increase noxious input to the neuromuscular system, as well as stress-induced clenching, causing increased muscle activity and spasm-pain. Condylar displacement also contributes to TMJ dysfunction-pain, depending on its direction. Anterior condylar displacement can initially affect the muscles by inducing overfunctional response in the proprioceptive system. Posterior condylar displacement usually results in an intrajoint response consisting of a disk derangement, reciprocal clicking, possible anterior disk dislocation, possible pathologic swallowing pattern, and noxious stimulation to the proprioceptive system. These factors contribute to subsequent trismus, muscle spasm and pain, and long-term pathologic remodeling of the joint. A detailed history is necessary to evaluate the role of stress. The physical occlusal findings are correlated with the condylar displacement observed in the TMJ radiographs to diagnose and plan corrective treatment.

The etiology, diagnosis, and treatment of TMJ dysfunction-pain syndrome. Part I: Etiology

Craniomandibular pain has five major causes: neurologic, vascular, the temperomandibular joint itself, muscular, and hysterical conversion. When the pain source is purely in the muscles it has been termed MPD (myofascial pain dysfunction) by Laskin. However, when the TMJ itself is also involved it is called TMJ dysfunction-pain syndrome.