Diagnosis Of Temporomandibular Disorders Research Articles

Deep learning for temporomandibular joint arthropathies: Asystematic review and meta-analysis.

The accurate diagnosis of temporomandibular disorders continues to be a challenge, despite the existence of internationally agreed-upon diagnostic criteria. The purpose of this study is to review applications of deep learning models in the diagnosis of temporomandibular joint arthropathies. An electronic search was conducted on PubMed, Scopus, Embase, Google Scholar, IEEE, arXiv, and medRxiv up to June 2023. Studies that reported the efficacy (outcome) of prediction, object detection or classification of TMJ arthropathies by deep learning models (intervention) of human joint-based or arthrogenous TMDs (population) in comparison to reference standard (comparison) were included. To evaluate the risk of bias, included studies were critically analysed using the quality assessment of diagnostic accuracy studies (QUADAS-2). Diagnostic odds ratios (DOR) were calculated. Forrest plot and funnel plot were created using STATA 17 and MetaDiSc. Full text review was performed on 46 out of the 1056 identified studies and 21 studies met the eligibility criteria and were included in the systematic review. Four studies were graded as having a low risk of bias for all domains of QUADAS-2. The accuracy of all included studies ranged from 74% to 100%. Sensitivity ranged from 54% to 100%, specificity: 85%-100%, Dice coefficient: 85%-98%, and AUC: 77%-99%. The datasets were then pooled based on the sensitivity, specificity, and dataset size of seven studies that qualified for meta-analysis. The pooled sensitivity was 95% (85%-99%), specificity: 92% (86%-96%), and AUC: 97% (96%-98%). DORs were 232 (74-729). According to Deek's funnel plot and statistical evaluation (p =.49), publication bias was not present. Deep learning models can detect TMJ arthropathies high sensitivity and specificity. Clinicians, and especially those not specialized in orofacial pain, may benefit from this methodology for assessing TMD as it facilitates a rigorous and evidence-based framework, objective measurements, and advanced analysis techniques, ultimately enhancing diagnostic accuracy.

Impact of Orthodontic-Surgical Treatments on the Signs and Symptoms of Temporomandibular Disorders: A Systematic Review

Introduction: Some patients exhibit temporomandibular joint or muscular disorders of the masticatory system before, during, or after orthognathic surgery (OS). These are collectively referred to as temporomandibular disorders (TMDs). This systematic literature review aimed to determine the relationship between orthodontic-surgical treatment and TMDs. Methods: An electronic search of the PubMed database, supplemented by a manual search, was performed; the search included any studies published between 2021 (date of the last search in a systematic review of the literature on the subject) and June 2023 that evaluate the prevalence of TMDs during orthodontic-surgical treatment. The diagnosis of TMDs had to be established using the diagnostic algorithm “diagnostic criteria for temporomandibular disorders (DC/TMDs)”, and the diagnosis of disc displacement had to be confirmed using magnetic resonance imaging (MRI). The data were extracted and statistically analyzed. Results: Of the 100 results, seven eligible articles were included, representing a total of 529 cases undergoing orthodontic-surgical treatment. A reduction in joint noises (64.8%), arthralgia (57 to 77%), and myalgia (73 to 100%) was found after orthodontic-surgical treatment despite the fact that a minority of patients exhibited these signs and symptoms even though they were asymptomatic before treatment. The effects of OS on disc position were objectively unpredictable. After surgery, the presence of headaches decreased without significance and the risk of their occurrence was very low (1%). The studies converged toward a reduction in the amplitudes of mouth opening and lateral/protrusion movements. Finally, after the treatment, mandibular function was improved. Conclusion: Under the conditions of this study, OS seems to have a positive impact on the signs and symptoms of TMDs; however, it is not possible to predict the consequential effects on the position of the TMJ disc, whether it is initially in a normal position or displaced.

Is malocclusion a predictor of pain in patients suffering from TMD pain?

Temporomandibular disorders (TMD) affect the masticatory muscles, temporomandibular joints (TMJs) and associated structures. The relationship between occlusion and TMD is a contentious issue in the dental field. Although there is a strong argument against invasive and irreversible therapeutic TMD procedures, the TMD biopsychosocial model is still not accepted by some clinicians. Hence, this study aimed to verify whether malocclusions are related to TMD pain. The study included 49 adult patients with one or multiple TMD diagnoses and without any other diseases that could mimic TMD. A reliable investigator diagnosed the patients using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) protocol. The sample was divided into pain and non-pain TMD groups, and the predictor of malocclusion was categorized as the dependent variable. There were 33 patients in the TMD pain group and 16 patients in the non-pain TMD group. Analyses were conducted at a significance level of 0.05. The χ2 test (with Yates' correction for 2 × 2 matrix) was used to compare qualitative variables between the groups. Malocclusion was present in 13 patients in the pain group and 7 patients in the non-pain group. According to our study, there is no correlation between malocclusion and TMD pain.

Machine learning-based medical imaging diagnosis in patients with temporomandibular disorders: a diagnostic test accuracy systematic review and meta-analysis.

Temporomandibular disorders (TMDs) are the second most common musculoskeletal condition which are challenging tasks for most clinicians. Recent research used machine learning (ML) algorithms to diagnose TMDs intelligently. This study aimed to systematically evaluate the quality of these studies and assess the diagnostic accuracy of existing models. Twelve databases (Europe PMC, Embase, etc.) and two registers were searched for published and unpublished studies using ML algorithms on medical images. Two reviewers extracted the characteristics of studies and assessed the methodological quality using the QUADAS-2 tool independently. A total of 28 studies (29 reports) were included: one was at unclear risk of bias and the others were at high risk. Thus the certainty of evidence was quite low. These studies used many types of algorithms including 8 machine learning models (logistic regression, support vector machine, random forest, etc.) and 15 deep learning models (Resnet152, Yolo v5, Inception V3, etc.). The diagnostic accuracy of a few models was relatively satisfactory. The pooled sensitivity and specificity were 0.745 (0.660-0.814) and 0.770 (0.700-0.828) in random forest, 0.765 (0.686-0.829) and 0.766 (0.688-0.830) in XGBoost, and 0.781 (0.704-0.843) and 0.781 (0.704-0.843) in LightGBM. Most studies had high risks of bias in Patient Selection and Index Test. Some algorithms are relatively satisfactory and might be promising in intelligent diagnosis. Overall, more high-quality studies and more types of algorithms should be conducted in the future. We evaluated the diagnostic accuracy of the existing models and provided clinicians with much advice about the selection of algorithms. This study stated the promising orientation of future research, and we believe it will promote the intelligent diagnosis of TMDs.

Accuracy of temporomandibular disorders diagnosis evaluated through the diagnostic criteria for temporomandibular disorder (DC/TDM) Axis II compared to the Axis I evaluations: a systematic review and meta-analysis

BackgroundThe temporomandibular joint (TMJ) is a complex joint that facilitates mandibular movements during speech, chewing, and swallowing activities. The Axis I evaluation of the DC/TMD focuses on assessing physical diagnoses related to TMDs. It includes an assessment of pain and functional limitations, such as jaw opening range, joint sounds, and joint tenderness. The Axis II evaluation of the DC/TMD provides information on the patient’s psychological status and quality of life. This Systematic Review with Meta-Analysis aimed to evaluate the accuracy of Temporomandibular Disorders diagnosis considered through the Diagnostic Criteria for Temporomandibular Disorder (DC/TDM) axis II compared to the Axis I evaluations.MethodsA search was made in PubMed, Web of Science and Lilacs for articles published from the inception until 20 January 2023. We applied the Population, Exposure, Comparator, and Outcomes (PECO) model [1] to assess document eligibility. Only studies that evaluated patients by DC/TMD Axis I and Axis II were considered. Review Manager version 5.2.8 (Cochrane Collaboration) was used for the pooled analysis. We measured the odds ratio (OR) between the two groups (Axis I and Axis II).ResultsFifty-one articles were selected because of the search. Four papers were excluded before the screening: 2 pieces were not in English, and two were reviewed. The remaining 47 articles were selected for the title and abstract screening to evaluate whether they met the PECO criteria. Among these, four papers were established; the overall effect showed that there was no difference in TMD diagnosis between Axis I and Axis II (RR 1.17; 95% CI: 0.80– 1.71; Z:0.82; P = .41), suggesting that there is no difference between Axis I and Axis II.ConclusionIn conclusion, DC/TMD is an effective tool for the diagnosis of TMD. It improves the accuracy of TMD diagnosis, allows for the classification of subtypes, and assesses psychosocial factors that may impact the development or maintenance of TMD symptoms.

Oro-facial function and quality of life in children and adolescents with large horizontal maxillary overjet-A case-control study.

Large horizontal maxillary overjet (overjet) is associated with reduced bite force (BF) and number of contacts, which influence the chewing effectivity (CE). Oral health, oro-facial function (OF) and malocclusion have great impact on psychological well-being and quality of life (QoL). The aims of the study were to examine OF, temporomandibular disorders (TMD), BF, CE, QoL and well-being in children and adolescents with large overjet. The study was a case-control study including healthy children with large overjet in the study group compared to a control group of healthy children with neutral occlusion, all 9-14 years old. OF was examined by use of Nordic Orofacial Test-Screening (NOT-S), Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and registration of morphological and functional occlusion. QoL and well-being were examined using KIDSCREEN-10 and Strengths and Difficulties Questionnaire. The study and control groups included 37 and 32 participants, respectively. Significantly increased NOT-S score (p < .001) and reduced BF (p = .011), numbers of contacts (p < .001) and CE (p = .005) were found in the study group. BF, numbers of contacts and CE were negatively associated with erupting canines and premolars. No significant difference was found in age, gender, dental eruption, TMD diagnosis or QoL between the groups. Significantly increased emotional symptoms (p = .007), hyperactivity (p = .043) and total difficulties score (p = .009) were found in the study group. The study group showed higher NOT-S score and reduced BF, number of contacts and CE. No difference in QoL were found between the groups, although reduced well-being and increased emotional symptoms, hyperactivity and total difficulties were found in the study group.

Association Between Temporomandibular Joint Disorders and Metastatic Breast Cancer—A Mapping Review

Aim: The authors of the present study speculate that metastasis of breast cancer cells to the temporomandibular joint (TMJ) region mimics classical signs and symptoms of temporomandibular disorders (TMD). The aim of this mapping review was to investigate the association between metastatic breast cancer (MBC) and TMD. Materials and Methods: The focused question was, “Is there an association between MBC and TMD?” Indexed databases (PubMed/Medline, EMBASE, OVID, Scopus, Google Scholar, and Web of Science) were electronically searched up to and including March 2022. These databases were searched using different combinations of the following keywords: cancer, carcinoma, temporomandibular disorders, temporomandibular joint, disc displacement disorder, nociception, and tumor. Original clinical studies that meet the inclusion criteria were included. The risk of bias (RoB) was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for case reports. The structure of this current evidence-based review was tailored to primarily condense the relevant information. Results: Fifteen case reports were selected after screening the retrieved records from the electronic search. Fifteen out of 16 patients were women aged between 32 and 78 years. All patients were diagnosed with MBC, and most presented with adenocarcinoma. The symptoms identified in patients with TMD included: (a) preauricular pain; (b) preauricular swelling; (c) limited mouth opening; and (d) malocclusion. Fourteen of the included studies had a low RoB, while one had a moderate RoB. Conclusion: Based on the currently available evidence, a direct association between TMD and MBC or vice versa cannot be established. Routine visits to medical and oro-dental healthcare providers can contribute toward early diagnosis and management of TMD and MBC.

Use of Surface Electromyography to Evaluate Effects of Therapeutic Methods on Masticatory Muscle Activity in Patients with Temporomandibular Disorders: A Narrative Review

The presented narrative review aims to present the impact of therapeutic methods on the masticatory muscle activity measured using surface electromyography (sEMG) in patients with temporomandibular disorders (TMDs). Original interventional studies with baseline data for diagnosed TMD groups with full-text articles in English published in scientific journals in the last ten years were included in the evaluation process. The following narrative review considered only clinical, controlled, and randomized studies. Articles that included the following parameters were qualified for this review: adult participants, diagnosis of temporomandibular disorder, the presence of a musculoskeletal dysfunction, no other severe comorbidities, use of therapeutic interventions, and sEMG measurement before and after the intervention. Ten papers were accepted and analyzed for the final evaluation in the presented review. Several studies using surface electromyographic examination prove the effectiveness of various therapies to normalize the bioelectrical activity of the masticatory muscles, either reduction during rest or increase during a functional task in patients diagnosed with temporomandibular disorders. This narrative review shows the influence of manual and physical treatments on electromyographic masticatory muscle activity, including soft tissue mobilization, transcutaneous electrical nerve stimulation, low-level laser therapy, and moist heat therapy. Changes in masticatory muscle activity coincided with changes in TMD-associated pain and range of mandibular mobility.

Application of panoramic radiographs in the diagnosis of temporomandibular disorders.

To evaluate the feasibility of temporomandibular disorder (TMD) diagnosis with panoramic radiography, and provide standardized data for artificial intelligence-assisted diagnosis by measuring the differences in the condylar and mandibular ramus heights. A total of 500 panoramic radiographs (219 male and 281 female participants) of healthy individuals were examined. The panoramic machine compatible measurement software, SCANORA 5.2.6, was used to measure the bilateral condylar height and mandibular ramus height, and SPSS 27.0 was used to calculate the left- and right-side differences in condylar height and mandibular ramus height of healthy individuals. Magnetic resonance images of the temporomandibular joint region obtained from 46 outpatients in the Stomatology Department were selected along with their corresponding panoramic radiographs. The left- and right-sided differences were measured and compared with the magnetic resonance imaging results. The measurement data are expressed as mean ± standard deviation (mm). t Tests were used to analyze data from healthy male and healthy female groups. The findings revealed that while there was no significant difference (P > .05) in the height of the condyle between men and women, there was a significant difference (P < .05) in the height of the mandibular ramus. In healthy population, the difference in height between the left and right condyle was 1.09 ± 0.99 mm. The difference in height of mandibular ramus in men was 1.26 ± 0.85 mm and that in women was 1.19 ± 0.87 mm. For the diagnosis of TMD, the sensitivity of panoramic radiographs was 94.74% (36/38), specificity was 75.00% (6/8), and diagnostic accuracy was 91.30% (42/46). The height of the right and left lateral condyles was not identical in healthy individuals, resulting in a discernible height discrepancy. In addition, the height of the mandibular ramus varied. By considering the left-right lateral height differences identified in this study along with clinical examination, it is possible to employ this metric as a preliminary screening tool for patients with TMD. Further, the use of panoramic radiographs for initial TMD screening is both viable and significant.

WITHDRAWN: Detection of myofascial trigger points in the masseter muscle using ultrasonography in patients with myogenous temporomandibular disorder

We aimed to investigate the diagnostic efficacy of ultrasonography (US) using gray scale B-mode and ultrasound elastography (UE) in detecting myofascial trigger points (MTPs) in the masseter muscles of patients with myogenous temporomandibular disorder (TMD). A diagnostic cross-sectional study of patients with MTPs in the masseter muscles using US was conducted. The diagnostic results from the US examinations were compared with the clinical examination reference standard to determine the diagnostic efficacy of US. MTPs were detected as band-like hypoechoic localized areas with reduced vibration amplitude (stiffer) under US B-mode and UE imaging. In total, 116 sites from 29 patients (3 males, 26 females) with a mean age of 39.4 years were examined. US exhibited sensitivity of .946 (95% CI: .851-.989) and specificity of .900 (95% CI: .795-.962) in detecting MTPs when compared to the clinical examination. Diagnostic accuracy ranged from .902 to .950 when assuming 3 levels of myogenous TMD prevalence. US B-mode and UE imaging exhibited diagnostic accuracy comparable to the standard clinical examination carried out by a trained specialist. It can be a reliable technique in the detection and localization of MTPs for the diagnosis of myogenous TMD and localization of MTPs for therapeutic purposes.

Prevalence of temporomandibular disorders diagnosis in patients treated with Herbst appliance: a systematic review and meta-analysis

BackgroundThe Herbst appliance is an excellent therapy for treating class II malocclusions with increased overjet. Its mechanics involve propelling the mandibular bone using two pistons the patient cannot remove. The so-called bite-jumping keeps the mandible in a more anterior position for a variable period, usually at least 6 months. This appliance does not inhibit joint functions and movements, although there are scientific papers in the literature investigating whether this appliance can lead to temporomandibular disorders. This systematic review aims to evaluate whether Herbst’s device can cause temporomandibular diseases by assessing the presence of TMD in patients before and after treatment.MethodsA literature search up to 3 May 2023 was carried out on three online databases: PubMed, Scopus and Web of Science. Only studies that evaluated patients with Helkimo scores and Manual functional analysis were considered, as studies that assessed the difference in TMD before and after Herbst therapy. Review Manager version 5.2.8 (Cochrane Collaboration) was used for the pooled analysis. We measured the odds ratio (OR) between the two groups (pre and post-Herbst).ResultsThe included papers in this review were 60. Fifty-seven were excluded. In addition, a manual search was performed. After the search phase, four articles were considered in the study, one of which was found through a manual search. The overall effect showed that there was no difference in TMD prevalence between pre-Herbst and post-Herbst therapy (OR 0.74; 95% CI: 0.33–1.68).ConclusionHerbst appliance seems not to lead to an increase in the incidence of TMD in treated patients; on the contrary, it appears to decrease it. Further studies are needed to assess the possible influence of Herbst on TMDs.

Chronic temporomandibular disorder pain patients with a history of neuropathic pain treatment: a narrative research on their diagnosis and treatment history

The aims of this qualitative research were (1) to gain more insight in the diagnostic and treatment history of patients with chronic temporomandibular disorder (TMD) pain; (2) to get a deeper understanding of possible factors that are involved in the possible delay in setting a TMD-pain diagnosis and receiving appropriate treatment; and (3) to get a deeper understanding of the perspectives and experiences of chronic TMD-pain patients on the possible improvement of various aspects of their diagnostic and treatment journey.MethodsIn this narrative research, semi-structured interviews took place with patients who experienced chronic orofacial pain (OFP) for at least three years before getting diagnosed with, and treated for, TMD pain by an OFP specialist in an interprofessional setting.ResultsIn total, ten patients were interviewed in-depth. Patients experienced their chronic OFP in different ways, but all reported a significant impact of their pain on their quality of life. All patients visited numerous health care professionals before their TMD diagnosis was set. Among others, they underwent anti-neuropathic pain medication therapies and invasive surgeries, which did not significantly reduce their chronic OFP. The interprofessional TMD-pain treatment reduced the suffering of the chronic OFP substantially, also 6 months after the start of therapy, and improved the quality of life for all patients. In most of them, the OFP intensity was also decreased.ConclusionChronic TMD-pain patients with a history of neuropathic pain treatment may experience a long journey until receiving the appropriate diagnosis and treatment. This stresses the need to improve the implementation of chronic TMD-pain guidelines.

TMD diagnosis–What should general dentists and orthodontists know?

Diagnosis is the cornerstone of care for temporomandibular disorders (TMD) in order to provide crucial forward momentum in terms of patient engagement and education alongside provision of appropriate management. Despite its importance diagnostic confidence for TMD is reported as low in the primary care settings. This article will consider potential reasons for this and outline the importance of diagnosis for both individuals living with the condition and clinicians. We will suggest utilisation of a pragmatic, evidence based, broad group diagnosis using simplified examination procedures and diagnostic aids to support the TMD diagnostic process for clinicians.

Effectiveness of an 8-week neck exercise training on pain, jaw function, and oral health-related quality of life in women with chronic temporomandibular disorders: a randomized controlled trial

To test the effectiveness of an 8-week exercise program targeted to the neck muscles compared to manual therapy, and placebo treatments on orofacial pain intensity, jaw function, oral health-related quality of life (OHRQoL), and jaw range of motion (ROM) in women with Temporomandibular Disorders (TMD). In this randomized controlled trial, fifty-four women (between 18–45 years old) with a diagnosis of myofascial or mixed TMD according to the Research Diagnostic Criteria for TMD (RDC/TMD) were randomized into three groups: Neck motor control training (NTG), Manual Therapy Group (MTG), and Placebo Group (PG). All patients were evaluated with the Visual Analog Scale, Mandibular Function Impairment Questionnaire, Oral Health Impact Profile-14, and jaw Range of Motion (ROM) at baseline, immediately after treatment (after 8 weeks of treatment), one month, and three-month follow-up. For all outcomes, a mixed analysis of variance (ANOVA) with repeated measures was conducted with a Bonferroni post hoc test. NTG was significantly better than the PG group on pain and jaw function at the end of treatment, one- and three-month follow-up (Effect Size (ES) &gt;0.7). For OHRQoL, NTG was significantly better than MTG and PG at the end of treatment and at three-month follow-up (ES &gt;0.7). The results of this project are encouraging, and they could be used to guide clinical practice in this field. Exercises targeted to the neck (which require low therapeutic supervision) could be a simple and conservative way to improve pain and disability for women with TMD with neck involvement.

The role of scoliosis on temporomandibular joint disease: a cross-sectional study based on ultrasonography

To investigate the relationship between temporomandibular disorders (TMD) and the stomatognathic system and spine through a multidisciplinary approach, utilising ultrasound to assess the temporomandibular joint. Between October 2020 and January 2021, 50 patients aged 12-18 years with adolescent idiopathic scoliosis and 50 healthy individuals were enrolled. All participants underwent clinical examinations based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) protocol. Additionally, ultrasound evaluations were performed of the temporomandibular joint and masseter muscles. Subsequently, the data from both groups were compared and analysed. The mean age of participants was 14.69±2.73 years in the scoliosis group (SG) and 14.68±1.81 years in the control group (CG). Among scoliosis patients, a moderate negative correlation was observed between the Cobb angle (indicative of curvature severity) and mouth opening (p=0.023; r=-0.320). Furthermore, the incidence of TMD was significantly higher in the scoliosis group compared to the control group (p<0.001). Additionally, it was found that a 1-unit increase in joint space elastography value led to a 4.81-fold higher likelihood of diagnosing disc displacement with reduction (p=0.009; 95% CI: 1.47-15.73). This pioneering study, the first of its kind to explore the connection between scoliosis and ultrasound-based temporomandibular joint screening, suggests that scoliosis may be a predisposing factor for TMD. Moreover, the present findings underscore the importance of joint elastography as a valuable quantitative tool in TMD diagnosis.

The association between orthodontic treatment and temporomandibular disorders diagnosis and disease characteristics.

The association between orthodontic treatment and temporomandibular disorders (TMD) has been contentious in the literature. To analyse the associations between orthodontic treatment and TMD diagnosis and diseases characteristics. This case-control study included 291 individuals, 192 TMDs and 99 controls. All patients underwent assessment based on a questionnaire and a clinical examination according to Axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Differences in orthodontic treatment between TMDs and controls, as well as across different TMD diagnoses within the TMD group were analysed. Patients who underwent orthodontic treatment were compared to those who did not, regarding their trauma history, bruxism, aggressive teeth brushing, level of oral hygiene, pain scores, muscle tenderness scores and subjective sleep quality. Of the 291 participants, 119 (40.9%) underwent orthodontic treatment and 172 (59.1%) had no orthodontics experience. Orthodontic treatment included: mandibular orthodontic treatment (102 subjects) and maxillary orthodontic treatment (113 subjects) of those 47 used a headgear. Following multivariate analysis among TMDs, orthodontic treatment was associated with a good level of oral hygiene versus poor (Odds ratio [OR]: 5.17 [1.04-25.59]), lower number of tender muscles [OR = 0.84 (0.74-0.96)] and lower (better) Pittsburgh Sleep Quality Index (PSQI) scores (OR = 0.86 [0.76-0.97]). None of the studied parameters maintained a statistically significant association with orthodontic treatment in the multivariate analysis among the entire study population. Utilising a holistic approach, this study supports the main hypothesis that orthodontic treatment is not associated with TMD diagnosis and disease characteristics.

Temporomandibular disorders: the most common diagnostic approaches.

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

Temporomandibular treatments are significantly efficient in improving otologic symptoms

Symptoms of temporomandibular disorders (TMD) could be present as otologic symptoms like earache and dizziness in some patients. In most cases, these symptoms are not recognized because otolaryngologists fail to diagnose TMD as a source of the problem. This investigation was conducted to evaluate the effect of TMD treatments on the otologic symptoms which after taking history and clinical examinations seemed to be related to TMD. In the present study, the patients who were complaining of otalgia, ear fullness, tinnitus, hearing loss, and dizziness were evaluated by an ear fellow. Forty patients who had no known otologic or other primary causes to explain their symptoms, were referred to the orofacial pain clinic with the possible diagnosis of TMD. If the diagnosis was confirmed by an orofacial pain specialist, a combination of TMD treatments was administered to each case and the patients were followed up. The results showed that following implementation of treatment protocols for TMD, more than 50% of the patients reported complete or partial recovery in the second follow-up (p < 0.05). The most common otologic symptom of the referred cases was earache, and the most common associated complaint was neck pain. All the patients had one or more parafunctional habits. This study showed that TMD treatments were significantly efficient in improving otologic symptoms partially or completely and the authors concluded that for the patients with otolaryngologic unexplained symptoms, an overhaul examination is needed to assess TMD as a possible cause of the patient complaint. It is recommended that in cases with unexplained otologic symptoms, otolaryngologists care more about the neck trigger points (TP) and ask about the patient’s parafunctional habits. Otolaryngologists and dentists need to be aware of the risk of developing otologic symptoms caused by these habits or cervical TPs.

Rare diseases with temporomandibular joint manifestations: a systematic review

Background: Rare diseases (RDs) are serious often chronic progressive diseases that affect a smaller number of individuals. RDs can manifest in any region of the body and have systemic effects that are detrimental to individual health. Although RDs are individually rare, there are various debilitating disorders arising from RDs. One of the disorders that have been shown to have a negative impact on the health of RD patients is temporomandibular disorders (TMD). There is a dearth of data on the rare diseases and potential manifestations of TMD. The objective of this systematic review is to provide an overview of rare diseases and temporomandibular joint (TMJ) manifestations. Method: The criterion for analysis of a rare disease and temporomandibular manifestations was inclusion in the Orphanet Classification of Rare Diseases and/or the National Organization for Rare Disorders (NORD)/The Genetic and Rare Diseases (GARD) databases. Only rare diseases with TMJ manifestations were recorded. Results: A total of 54 RDs with TMJ manifestations and different TMD diagnoses were recorded. There were thirty-five studies derived from the Pubmed search, and the Orphanet input had 19 results. Overall, 13 different types of TMJ manifestations and TMD diagnoses were recorded in rare diseases. Conclusion: TMJ manifestations associated with rare diseases are not uncommon. Healthcare professionals can play an important role in diagnosing and managing the complexity of RDs with TMJ manifestations. A multidisciplinary approach to TMD patients with rare diseases is advisable.

Practitioner/Practice- and Patient-Based Factors Contributing to Dental Practitioner Treatment Recommendations for Patients with Pain-Related TMDs: Findings from the National Dental PBRN.

To document National Dental Practice-Based Research Network (PBRN) practitioner treatment recommendations for patients with painful temporomandibular disorders (TMDs) and to identify practitioner/practice- and patient-related factors contributing to treatment recommendations made at the initial clinical visit. This prospective single-sample cohort study formed groups based on treatment recommendations made by 185 dental practitioners who treated 1,901 patients with painful TMDs. At the baseline visit, which this article describes, practitioners provided patients with their diagnoses and a treatment plan and then completed a comprehensive questionnaire. Self-care, an intraoral appliance, medication, and practitioner-recommended jaw exercises were the most frequently recommended treatments. Practitioners recommended multiple treatments to most patients. TMD signs, symptoms, and diagnoses were primary considerations in treatment planning, but the practitioner's expectations for improvement were only significant for intraoral appliances and self-care. Female practitioners and those with expertise in TMDs more frequently recommended patient-directed and multidisciplinary treatments compared to their counterparts. Practitioners used a wide range of treatments for patients with few consistent patterns. The propensity to use TMD signs, symptoms, and diagnoses when making treatment recommendations suggests a tendency to conceptualize patients using the biomedical model. Infrequent referral to nondental providers suggests a lack of availability of these providers, a misunderstanding of the complexity of TMDs, and/or discomfort with assessment of psychosocial factors. Implications include the need for comprehensive training in the assessment and management of TMD patients during dental school and participation in TMD continuing education courses following evidence-based guidelines.