Degenerative Changes In Temporomandibular Joint Research Articles

The relation between persistent foramen tympanicum and degenerative bone alterations in temporomandibular joint region.

The aim of this study was to evaluate, using cone-beam computed tomography (CBCT), the relationship of persistent foramen tympanicum (PFT) with degenerative changes in the temporomandibular joint (TMJ) and the presence of pneumatized glenoid fossae and articular eminences. Two experienced oral and maxillofacial radiologists evaluated 510 CBCT scans, from which 94 patients were divided into two groups: G1-patients with PFT and G2-control group. The location of the PFT, presence, or absence of degenerative TMJ changes and morphology were evaluated. Similarly, all images were evaluated for the presence of pneumatized articular eminence and glenoid fossa. The Chi-square test and Fisher's Exact test were used for the categorical variables. A multinomial logistic regression model was performed for subgroup analysis. To assess the estimation-chance occurrence of TMJ alterations the Odds Ratio analysis was used. Statistically significant results were found for erosion, planning, and subchondral cyst. Regarding TMJ morphology, significant results were found for: round, flat, and others. Moreover, it was possible to observe that patients who had the PFT were approximately 48 times more likely to manifest TMJ alterations and approximately 3 times more likely to manifest articular eminence pneumatization. Since individuals who have FTP have a greater chance of having TMJ and PEA changes, it is important for the dental radiologist to be aware of these signs in CBCT scans for a correct diagnosis. CAAE: 34328214.3.0000.0104 (11/30/2014).

Radiological Aspects of Temporo-Mandibular Joint Osteoarthritis

This article is about applications of computed tomography (CT) in diagnosis of inflammatory and degenerative disease of temporomandibular joint (TMJ). CT is highly informative method forvisualization of disease of temporomandibular joint. Finally, sections on other aspects of CT research related to the TMJ, clinical decision-making and concluding remarks are added. However, it should be emphasized that the diagnostic information obtained is limited to the morphology of the osseous joint components, cortical bone integrity and subcortical bonedestruction/production. Author of this research studied the frequency of radiological signs in different age group. In addition, there were studied frequency of isolated, combination types, and more and less localization sitesof radiological patterns of inflammatory and degenerative changes of temporo-mandibular joint

Age and Gender-related Morphometric Assessment and Degenerative Changes of Temporomandibular Joint in Symptomatic Subjects and Controls using Cone Beam Computed Tomography (CBCT): A Comparative Analysis.

The temporomandibular joint diseases have been associated with various predisposing factors. Joint spaces, articular eminence height and inclination, and the shapes of the condylar and glenoid fossa have all been shown to vary in temporomandibular joint diseases (TMD) patients. Advanced imaging techniques like cone beam computed tomography (CBCT) have been employed to estimate these parameters. The aim of the current study was to investigate the condylar morphology, condylar and glenoid fossa shapes, and assessment of joint spaces, such as anterior, posterior, superior, lateral, and medial spaces, through CBCT slices in coronal and sagittal planes and compare them between the control group and TMD group. A cross-sectional study was planned where 80 joints in 40 patients were assessed for the above parameters; group I consisted of healthy patients, and group II included those with temporomandibular joint diseases (TMDs). The articular eminence height and inclination were assessed on the midsagittal section. The condylar changes and shapes of the glenoid fossa and condyles, as well as the joint spaces, were assessed on the selected coronal and sagittal sections. The condylar fossa had a triangular shape in the TMJ group and an oval shape in the control group. The results were highly significant (P = 0.000**). A highly significant difference in morphological parameters, such as AJS, PJS, SJS, MJS, LJS, articular eminence height, and inclination, was found between the two groups (P = 0.000**). The association of morphological parameters, such as AJS, PJS, SJS, MJS, LJS, and articular eminence height and inclination were compared with condylar and glenoid fossa shapes, where the association of superior joint space and articular eminence inclination was observed. A highly significant difference was noted between the two groups with regard to all the parameters with P=0.00*. The articular eminence inclination, as well as the superior joint space, were found to be associated with the glenoid and condyle fossa shapes in the TMJ group. These observations would, therefore, help in the early diagnosis of temporomandibular joint diseases.

Relationship between bad oral habits, signs, and symptoms of temporomandibular joint disorders among Saudi population: A cross-sectional study.

According to the American Dental Association, temporomandibular disorders (TMD) refer to a group of disorders characterised by pain in the temporomandibular joint (TMJ), the periauricular area, or the muscles of mastication. TMJ noise/sounds, and any deviations or restriction during jaw movements. Many oral habits are common and usually do not harm the TMJ and associated structures. However, these habits may result in TMJ disorders, if the activity goes beyond someone's physiological tolerance. The causes of degenerative changes of TMJ are believed to be multifactorial and controversial too. This study aims to evaluate the prevalence of oral habits and its relationship with temporomandibular disorders in the Saudi population of Taif city. This questionnaire-based cross-sectional study was conducted from March 2021 to July 2021 at Taif city, Kingdom of Saudi Arabia (KSA). The Arabic version of a standardized questionnaire (recommended by the American Academy of Orofacial Pain) was used and distributed randomly among 441 citizens of Taif city. Our study showed that many respondents had different TMJ disorders, such as pain during eating, sound in jaw joint, pain around ear, temples, and cheek, headache and neck pain, change in bite, and pain during opening and closing of the mouth. On the other hand, many respondents answered that they had TMD, pain associated with nail biting/object biting, lip biting, clenching teeth, and chewing gum. In the present study, a relationship between harmful oral habits and the development of signs and symptoms of TMDs among adolescents who lived in Taif city, KSA was noted. In the present study, no clinical examinations were conducted and only consisted of closed-ended questions, all of which may have a lower the validity rate. An effort was made to overcome these limitations by using a well-designed standardized questionnaire by the American Academy of the Orofacial Pain. We conclude that further studies are required and using of clinical examination to measure the severity of the signs and symptoms for better understanding the association of oral habits with TMJ disorders.

Prevalence of Temporomandibular Joint Osteoarthritic Changes Using Cone-beam Computed Tomography in South Indian Population

Introduction: Osteoarthritis of temporomandibular joint (TMJ) is a chronic degenerative joint disease characterized by synovitis, cartilage destruction, and subchondral bone remodeling and it is an age-related disorder. Cone-beam computed tomography (CBCT) is used for diagnosis of degenerative changes in TMJ, at the same time ensuring lower radiation dose, a shorter exposure time, and a higher spatial resolution. Aim and Objectives: The aim of the study is to evaluate the prevalence of osteoarthritic changes of TMJ using CBCT. Materials and Methods: One hundred fifty CBCT images were collected from the department database and the condylar morphology and the degenerative changes were evaluated in the coronal and sagittal sections. The CBCT images which had changes were only included in the study. The left and right TMJ were evaluated separately. Results: In our study, the prevalence of osteoarthritic changes of TMJ was higher in females than males. TMJ on the right side was more affected than the left side. Among the study population, 40–49 years age group had extensive changes than other age groups, and severity increases in the older age group. The flattening was the most common change, followed by thinning, erosion, osteophyte, and sclerosis. Conclusion: The study revealed that there is significant gender- and age-related variation in the osteoarthritic changes of TMJ. This study showed that the occurrence of degenerative changes is much higher in females and the prevalence increases with advancement of age and was also seen in younger age groups. The occurrence of osteoarthritic changes was also much prevalent among the population.

The role of elastic bands (kinesiotapes) in complex therapy of patients with temporomandibular joint osteoarthrosis

Introduction. Temporomandibular joint (TMJ) arthrosis is a chronic disease, characterized by dystrophic and degenerative changes in TMJ with aseptic inflammatory process. The prevelence of TMJ arthrosis in patients with a history of other TMJ disorders varies between 32-39 % of cases. Complex treatment of TMJ arthrosis includes pharmacotherapy, physiotherapy, exercise therapy for TMJ and massage of the masticatory muscles, manual therapy, prosthodontics, but these treatment methods are not always lead to a desired result.The aim of the study is to improve the traditional treament method of patients suffering from TMJ arthrosis by using elastic tapes (kinesiotapes).Materials and methods. 68 patients were examined at the «Galaxy» Beauty Institute Clinic (St. Petersburg) and FSBEI HE SamSMU MOH Russia (Samara). Comparison group of patients was prescribed pharmacotherapy, exercise therapy for TMJ and massage of masticatory muscles, while for the main group of patients the same therapy was enhanced by elastic bands. The effectiveness of therapy was evaluated using a visual-analog pain scale (VAS), mouth opening width and electromyography of the masticatory muscles.Results. Noticeable positive effect in the main group of patients was observed on the 21th day of treatment. By this time patients noticed significant decrease in pain intensity from 8,77±0,8 to 5,19±0,5 (Z1-4=-5,88; p1-4=0,0015) points as well as increase in mouth opening width from 21-23 to 33-35 mm. Similar changes in the comparison group of patients were achieved only by the beginning of fifth week of treatment (Z1-6=-5,58; p1-6=0,0015). The range of mouth opening width increased from 21-23 to 27-29 mm. Amplitude of masticatory muscles biopotentials in maximum intercuspation in patients of the main group almost approached to the normal results by the beginning of the fourth week. In patients of the comparison group the amplitude of masticatory muscles biopotentials remained reduced even by the end of observations (42 day of the study).Conclusion. Thus, the combination of elastic bands applications with conventional treatment methods of TMJ arthrosis greatly increases the effectiveness of therapy and allows to relief pain and normalize bioelectric activity of masticatory muscles in a relatively short time. Due to the simplicity of elastic bands application it is possible to teach patients the technique of self-applying bands and recommend to use them as a prevention of relapse of TMJ arthrosis.

Degenerative Changes in the Temporomandibular Joint in Elderly Patients with Posterior Edentulous Maxilla and Mandibula According to Cone-Beam Computed Tomography Data.

Aim: This study aimed at assessing the degenerative changes in the Temporomandibular Joint (TMJ)in elderly patients with posterior edentulous maxilla and mandibula according to Cone-Beam Computed Tomography (CBCT) data. Materials and Methods: The study included 32 patients (64 temporomandibular joints) aged from 50 to 81 years (mean age 62 ± 7.9 years; 16 males and 16 females). TMJs were visualized on reconstructed parasagittal, paracoronal, and axial sections of the joint. The following changes in bone tissue were evaluated: condyle flattening, erosion, sclerosis, subchondral cysts, osteophytes. Joint space was evaluated as well. Results and Discussion: 100% of patients had at least one sign of degenerative changes in TMJ at least on one side. In 19 patients, degenerative symptoms were found only on one side. The most common sign was subchondral cysts. It was noted that the number of degenerative symptoms in male patients was statistically more than in the female group. On the right side, the anterior, superior, and posterior joint spaces had the following values: 2.35 mm, 2.95 mm, and 4.84 mm, respectively. On the left side, the anterior, superior, and posterior joint spaces had the following values: 2.14 mm, 2.3 mm, and 4.1 mm, respectively. Conclusion: Both edentulousness and aging affect the bone structure of TMJ in both genders.

Are Signs of Degenerative Joint Disease Associated With Chin Deviation?

Degenerative joint changes commonly affect the temporomandibular joint (TMJ) and can result in chin deviation. However, the extent of degenerative TMJ changes and chin deviation has not been well-characterized. The present study sought to correlate degenerative TMJ changes with condylar volume, grayscale measures, and chin deviation. The present cross-sectional study had enrolled women with skeletal Class III malocclusion. Cone-beam computed tomography scans were acquired preoperatively. For each condyle, degenerative TMJ signs were analyzed and the condylar volume and grayscale were measured. The predictor variable was the presence of degenerative TMJ signs, classified as categorical data: 0, if none; 1, only present in 1 joint; and 2, present in both joints. The primary outcome variable was a chin deviation of 3mm or more. Other associated variables were grouped by age, cephalometric data, and 3-dimensional condylar measurements. Descriptive bivariate statistics were computed, and univariate and multiple logistic regression analyses were conducted to identify any associations between degenerative TMJ disease and chin deviation. We included 85 patients, who were classified into 2 groups: less than 3mm of chin deviation (n=43) and 3mm or more of chin deviation (n=42). The presence of more than 10 degenerative TMJ signs was significantly associated with the presence of 3mm or more of chin deviation (P<.001). In multiple regression models, the presence of subcortical sclerosis in 1 joint and in both joints (adjusted odds ratio [OR], 3.698; 95% confidence interval [CI], 1.051 to 13.012; adjusted OR, 5.001; 95% CI, 1.461-17.119, respectively) correlated significantly with the presence of 3mm or more of chin deviation (P<.05). The volume difference between the 2 condyles was significantly greater in the group with more than 10 degenerative TMJ signs and 3mm or more of chin deviation than in the group with 10 or fewer degenerative TMJ signs and less than 3mm of chin deviation (P=.016 and P<.001, respectively). In women with skeletal Class III malocclusion, the presence of more than 10 degenerative TMJ signs increased the prevalence of 3mm or more of chin deviation. The presence of subcortical sclerosis in either 1 or both joints and volume differences between the 2 condyles were associated with greater chin deviation.

Effect of mesenchymal stem cells on the regeneration of structures associated with temporomandibular joint: narrative review

ABSTRACT BACKGROUND AND OBJECTIVES: Temporomandibular disorders are the problems involving the masticatory muscles and/or the temporomandibular joint and, among them, the bone and joint disc degenerative processes stand out. However, an effective treatment for these cases has not yet been identified in the literature. Thus, the primary objective of this study was to evaluate the reparative potential of mesenchymal stem cells on degenerative changes in structures associated with the temporomandibular joint in humans and animal models. CONTENTS: This narrative review included intervention trials in humans and animals that presented as an outcome variable the repair of joint discs and/or temporomandibular joint. The following databases were used: Pubmed, LILACS, Scielo and Google Scholar. Titles and abstracts were analyzed for the pre-selection of articles potentially eligible for inclusion in this review. The information collected from each article was included in a specific spreadsheet for this purpose containing the year of publication, article title, author’s name, study location, type of study, methodology, results, and conclusions. Two human studies and four animal studies were selected to compose the narrative review. In all studies presented, the presence of stem cells was able to improve the clinical, histological, and morphological parameters of the temporomandibular joint. CONCLUSION: The use of stem cells seems to be effective in treating degenerative changes in temporomandibular joint associated structures in both animal and human models. However, due to the small number of studies and their heterogeneity, the results presented should be evaluated sparingly.

Cone beam computed tomography study of osteoarthritic alterations in the osseous components of temporomandibular joints in asymptomatic patients according to skeletal pattern, gender, and age

The aim of this study was to evaluate the prevalence of osteoarthritic alterations in the osseous components of the temporomandibular joint (TMJ) in asymptomatic patients with different skeletal patterns, gender, and age groups with cone beam computed tomography (CBCT) images. CBCT images of 213 asymptomatic patients were assessed for the presence of any degenerative changes in the condyle and fossa/eminence complex. Each TMJ was evaluated separately and was classified as normal, indeterminate for osteoarthritis, or affected by osteoarthritis. Differences were tested by using the χ2 and Fisher's exact tests (P < .05). In total, 52.3% of the joints presented some visible alteration in the osseous components. Abnormalities were detected in 32.6% of the condyles and 31.5% of the articular fossae/eminences, and flattening was the most prevalent alteration in all classes. There was no statistically significant difference in the prevalence of alterations in either the condyle or the articular fossa/eminence among the skeletal groups for the entire sample or for the gender and age subsets. There are no differences in degenerative TMJ changes in patients with or without skeletal jaw discrepancies. No differences were found when gender and age were considered.

Temporomandibular joint osteoarthritis in human ancient skeletal remains from Late Holocene in southern Patagonia

AbstractLow prevalence of caries, high stages of dental attrition (DA), and moderate frequency of antemortem tooth loss (AMTL) were found in skeletal remains of hunter‐gatherers from southern Patagonia. However, osteoarthritis (OA) of temporomandibular joint (TMJ), possible related to oral health, has not been studied so far. The influence of hunter‐gatherer living conditions on the development of TMJ‐OA was scarcely evaluated, and analyses of degenerative changes of TMJ in nonindustrialized groups are needed. The aim of this study is to analyse the association between degenerative changes of TMJ, oral disease, and palaeodietary patterns in skeletal remains of hunter‐gatherers from southern Patagonia. Degenerative changes of TMJ were recorded in 25 adult skulls of both sexes. Eburnation of articular eminence and/or mandibular condyle was considered as pathognomonic of OA. In the absence of eburnation, OA was diagnosed when two or more of the following lesions were identified: (a) new bone formation on joint surface, (b) new bone formation of joint margins, (c) porosity on the joint surface, and (d) modification of joint contour. In the studied skeletons, it was found that OA prevalence is 28%, similar to those observed in other hunter‐gatherer populations elsewhere. TMJ‐OA is mostly related to AMTL and older age, but no relation was found with caries and DA, sex, region, dietary patterns, and chronology. However, consumption of terrestrial resources in the diet cannot be discarded as a related factor. Further studies are necessary to explore the morphological variability of the mandible and its possible relationship with different diets and dental pathologies in these populations.

Treatment of the Temporomandibular Joint in a Child with Juvenile Idiopathic Arthritis.

The oral and maxillofacial surgeon is instrumental in the management and care of pediatric patients with juvenile idiopathic arthritis (JIA) and should include JIA in the differential when evaluating pediatric patients with temporomandibular joint (TMJ) dysfunction. Medical management has largely decreased the need for surgical intervention, but these patients may require intraarticular steroid injections of the TMJ, close follow-up to monitor their facial growth, and management of the subsequent postinflammatory degenerative TMJ changes. This article reviews the oral and maxillofacial surgeon's role in the care of patients with JIA involvement in the TMJ.

Long-term management of temporomandibular joint degenerative changes and osteoarthritis: An attempt

Background: Osteoarthritis is the inflammation of body joints characterized by chronic degeneration of various hard and soft tissues around joint. Stress-bearing joints of body such as knee, hips, spine, fingers, and temporomandibular joint (TMJ) are commonly affected. Aims and Objectives: The aims were (1) to study whether constant masticatory mechanical overloading causes osteoarthritis and degenerative changes of TMJ in patients who underwent segmental mandibulectomy with primary repair (without microvascular free flap reconstruction) for malignancies of the mandible, floor of the mouth, and lower gingivobuccal sulcus; (2) to evaluate the effect of nutrition supplements such as glucosamine, chondroitin, and esterified fatty acids in reducing TMJ osteoarthritis and internal derangement; and (3) to assess whether joint flexibility and function improved after using the above medication. Materials and Methods: Patients with osteoarthritis and internal derangement of TMJ as well as patients who underwent segmental mandibulectomy followed by postoperative radiotherapy were randomly selected and included in the study. Age group of the patients ranged between 20 and 76 years. Results: One hundred and ninety-two patients of segmental mandibulectomy were screened and 79 patients were found to develop osteoarthritis in the longer contralateral mandibular segment (41.14%). This finding was statistically significant in our study (P

Degenerative temporomandibular joint changes associated with recent-onset disc displacement without reduction in adolescents and young adults

This study evaluated the occurrence of degenerative temporomandibular joint (TMJ) changes in adolescents and young adults with recent on-set disc displacement without reduction (DDw/oR) using high-resolution cone beam computed tomography (CBCT). The associations between types of osteoarthrosis (OA) changes and clinical factors including disease duration were also examined. CBCT and clinical data of 300 patients (84.70% females, mean age 20.93 ± 4.77 years) diagnosed with unilateral DDw/oR (≤12 months) based on RDC/TMD were acquired. CBCT images of both symptomatic and contralateral asymptomatic TMJs were independently evaluated and scored by two radiologists. Associations between OA changes and gender, age, mouth opening and duration of DDw/oR were analyzed statistically. Condylar OA changes were present in 59.30% of the joints with DDw/oR. Early-stage OA changes (loss of continuity of articular cortex and/or surface destruction) constituted most (45.67%) of the alterations. Prevalence of early-stage OA increased from 24% to about 60% one month after TMJ closed-lock occurred. Logistic regression analysis showed the risk of developing early-stage OA changes was 5.33 times higher one month after onset of DDw/oR. A high prevalence of degenerative TMJ changes was observed with recent on-set DDw/oR in adolescents and young adults. Early diagnosis and intervention of DDw/oR is therefore prudent.

Rheumatoid arthritis affecting temporomandibular joint

Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune inflammatory disorder that is characterized by joint inflammation, erosive properties and symmetric multiple joint involvement. Temporomandibular joint (TMJ) is very rare to be affected in the early phase of the disease, thus posing diagnostic challenges for the dentist. Conventional radiographs fail to show the early lesions due to its limitations. More recently cone-beam computed tomography (CBCT) has been found to diagnose the early degenerative changes of TMJ and hence aid in the diagnosis of the lesions more accurately. Our case highlights the involvement of TMJ in RA and the role of advanced imaging (CBCT) in diagnosing the bony changes in the early phase of the disease.

Effects of Enzymatic Degradation after Loading in Temporomandibular Joint

Synovial fluid of the joint decreases friction between the cartilage surfaces and reduces cartilage wear during articulation. Characteristic changes of synovial fluid have been shown in patients with osteoarthritis (OA) in the temporomandibular joint (TMJ). OA is generally considered to be induced by excessive mechanical stress. However, whether the changes in synovial fluid precede the mechanical overloading or vice versa remains unclear. In the present study, our purpose was to examine if the breakdown of joint lubrication affects the frictional properties of mandibular condylar cartilage and leads to subsequent degenerative changes in TMJ. We measured the frictional coefficient in porcine TMJ by a pendulum device after digestion with hyaluronidase (HAase) or trypsin. Gene expressions of interleukin-1β (IL-1β), cyclooxygenase-2 (COX-2), matrix metalloproteinases (MMPs), type II collagen, and histology were examined after prolonged cyclic loading by an active pendulum system. The results showed that the frictional coefficient increased significantly after HAase (35%) or trypsin (74%) treatment. Gene expression of IL-1β, COX-2, and MMPs-1, -3, and -9 increased significantly in enzyme-treated TMJs after cyclic loading. The increase in the trypsin-treated group was greater than that in the HAase-treated group. Type II collagen expression was reduced in both enzyme-treated groups. Histology revealed surface fibrillation and increased MMP-1 in the trypsin-treated group, as well as increased IL-1β in both enzyme-treated groups after cyclic loading. The findings demonstrated that the compromised lubrication in TMJ is associated with altered frictional properties and surface wear of condylar cartilage, accompanied by release of pro-inflammatory and matrix degradation mediators under mechanical loading.

Use of chondroitin sulphate and glucosamine sulphate in degenerative changes in TMJ: a systematic review

INTRODUCTION: Degenerative changes in Temporomandibular Joint (TMJ) have increased in prevalence and severity over the years. Within this context, it's necessary to obtain safe and effective therapies for control and management of the patient in cases of osteoarthritis and osteoarthrosis of the TMJ. Therapeutic options range from intra-articular infiltration protocols, occlusal splints, pharmacological therapies and physiotherapy and educational measures. The alternative treatment with structure-modifying agents, like as chondroitin and glucosamine sulphates, showed promising results, and especially safety. Thus, through a systematic literature review, this study aimed to analyze and discuss effectiveness and safety of chondroitin and glucosamine in degenerative changes of the TMJ. METHODS: Survey in research bases MEDLINE, Cochrane, EMBASE, Pubmed, Lilacs and BBO, between the years of 1966 and January 2009, with focus in randomized clinical trial (RCTs) and quasi-randomized clinical trials, systematic reviews and meta-analysis. RESULTS: After application of the inclusion criteria 2 articles were selected, both randomized controlled double-blind clinical trials, which evaluated the effectiveness of chondroitin and glucosamine in degenerative changes of the TMJ. CONCLUSIONS: There is the necessity of further RCT, with representative samples and long follow-up time, to obtainment more precise cause-effect relationships and to achieve an effective and objective protocol involving chondroitin and glucosamine in cases of degenerative changes of the TMJ.

The prevalence of TMJ osteoarthritis in asymptomatic patients with dentofacial deformities: a cone-beam CT study

Osteoarthritis of the temporomandibular joint (TMJ) can be described as non-inflammatory arthritic condition that results in degenerative changes of the joint structures. The aim of this study was to evaluate the skeletal morphology of the TMJ in patients with osteoarthritis with severe skeletal malocclusions (Class II and Class III) and patients with Class I occlusion as controls. Cone beam computed tomography images of 45 Class I, 28 Class II and 44 Class III joints of Caucasian patients were assessed for the presence of any degenerative changes in the condyle and fossa/eminence complex as described in the research diagnostic criteria for temporomandibular disorders (RDC/TMD). In all groups, the most commonly observed features were articular surface flattening and subcortical sclerosis. A combination of features that corresponds to a diagnosis of osteoarthritis was observed in 3% Class I, 43% Class II and 20% Class III patient joints. In conclusion, degenerative TMJ changes were more common in patients with skeletal jaw discrepancies, but wide inter-individual variations can be observed even in patients with clinically similar malocclusions.

Inflammatory markers in temporomandibular joint disorders

Temporomandibular joint disorders (TMD) have a chronic and progressive character. Multifactor ial etiology of the disorders and difficulties in detection of first signs and symptoms caused, in many cas es, symptomatic treatment approach. The essential is to establish the sensitive and specific diagnostic methods for early causal treatment possibilities. Clinical examination and imaging techniques do not always allow the full view of the ongoing disease. The concentration of inflammation indicators, such as C – reactive protein (CRP) is not a specific tool, which does not indicate any specific disease, but the synovial fluid markers, such as cytokines and proteinases, could allow detect the early bony deteriora tion in the temporomandibular joint (TMJ), which is not visible on radiographic imaging. Although, the small amount of collected fluid from the joint and specialist laboratory procedures are not regularly obtain in daily practice. Although, early detection of tissues damaged, would enable clinicians to intro duce proper treatment and prevent irreversible degenerative changes in TMJ.

Prevalence and clinical signs of degenerative temporomandibular joint changes validated by magnetic resonance imaging in a non-patient group

The aim of this study is to investigate associations between degenerative bony changes of the temporomandibular joint (TMJ) evaluated by magnetic resonance imaging (MRI) and signs and symptoms of temporomandibular disorders (TMD) in a non-patient group. A total of 307 subjects (140 males and 167 females) were selected from the cross-sectional epidemiological study "Study of Health in Pomerania" (SHIP) for this evaluation. A clinical functional examination of the masticatory muscles and the TMJs was performed as well as an MRI examination of the TMJs. Another 77 subjects (25%) exhibited degenerative changes of one or both TMJs in the MRI. Clinical analysis revealed pain on palpation of the masticatory muscles in 113 subjects. Some 39 subjects had pain during palpation of the TMJs. There were significant associations between the MRI confirmed diagnosis of osteoarthrosis and some clinical signs (joint noises, joint palpation pain, reduced mouth opening) and symptoms (reported pain in the jaw and masticatory muscles) of TMD as well as further MRI diagnoses (disc displacement with and without reduction, fibrosis of the posterior ligament). Although there were some associations, clinical examination alone is not sufficient for diagnosing degenerative joint diseases. MRI is a necessary diagnostic adjunct for estimating the prevalence of TMD subgroups in non-patient populations.