Diagnosis Of Temporomandibular Dysfunction Research Articles

PAINe: An Artificial Intelligence–based Virtual Assistant to Aid in the Differentiation of Pain of Odontogenic versus Temporomandibular Origin

IntroductionPain associated with temporomandibular dysfunction (TMD) is often confused with odontogenic pain, which is a challenge in endodontic diagnosis. Validated screening questionnaires can aid in the identification and differentiation of the source of pain. Therefore, this study aimed to develop a virtual assistant based on artificial intelligence using natural language processing techniques to automate the initial screening of patients with tooth pain. MethodsThe PAINe chatbot was developed in Python (Python Software Foundation, Beaverton, OR) language using the PyCharm (JetBrains, Prague, Czech Republic) environment and the openai library to integrate the ChatGPT 4 API (OpenAI, San Francisco, CA) and the Streamlit library (Snowflake Inc, San Francisco, CA) for interface construction. The validated TMD Pain Screener questionnaire and 1 question regarding the current pain intensity were integrated into the chatbot to perform the differential diagnosis of TMD in patients with tooth pain. The accuracy of the responses was evaluated in 50 random scenarios to compare the chatbot with the validated questionnaire. The kappa coefficient was calculated to assess the agreement level between the chatbot responses and the validated questionnaire. ResultsThe chatbot achieved an accuracy rate of 86% and a substantial level of agreement (κ = 0.70). Most responses were clear and provided adequate information about the diagnosis. ConclusionsThe implementation of a virtual assistant using natural language processing based on large language models for initial differential diagnosis screening of patients with tooth pain demonstrated substantial agreement between validated questionnaires and the chatbot. This approach emerges as a practical and efficient option for screening these patients.

Applicability of Infrared Thermography in Dentistry: Mini Review

Infrared thermography is a precise, non-invasive and safe method for measuring superficial temperature, with increasing application in different areas of dentistry, such as endodontics, implantology, restorative dentistry, periodontics, prosthodontics, surgery and principally, for the diagnosis of temporomandibular dysfunction. The aim of this study is to briefly present how thermographic imaging has been used in dentistry. The use of thermography is still restricted in dentistry, but it has great potential for use in daily practice.

Novel Diagnostic and Therapeutic Approaches to Temporomandibular Dysfunction: A Narrative Review.

Temporomandibular dysfunction (TMD) is a burgeoning area of study within the dental field. TMD is caused by abnormalities in the temporomandibular joint or muscles of mastication and can lead to pain, loss of function, and other complications. As this area of patient care receives increased focus, the ability to accurately diagnose TMD becomes paramount. The aim of this review is to summarize novel diagnostic and therapeutic techniques that have been proposed within the last approximately 3 years in order to inform readers of the cutting-edge advances in the field of TMD diagnosis and management, while also analyzing the clinical relevance of each study. A PubMed search was completed on 1 March 2023, using MeSH terms related to TMD diagnosis and treatment. The search yielded seven articles that pertained to the aim of this review article. The main findings from each study are summarized in this review article. These novel methods of diagnosing and treating TMD may improve our ability to assess and treat patients suffering from TMD.

The Efficacy of Prolotherapy in Temporomandibular Dysfunction: A Prospective Study

Prolotherapy (proliferation injection therapy) also known as regenerative injection therapy was introduced by Hackett to treat chronic musculoskeletal pain. Prolotherapy reinitiates the inflammatory process and thereby augments the natural healing process of the body. It is especially useful in refractory cases where conservative management has failed. The objective of this study is to determine the effectiveness of dextrose prolotherapy in the management of temporomandibular joint disorders. A prospective clinical study was conducted on patients visiting the Department of Oral and Maxillofacial Surgery, with a diagnosis of temporomandibular dysfunction. Twenty-one patients (32 joints) with chief complaints of TMJ pain, limited mouth opening, and clicking sounds in the TMJ were evaluated and treated on an outpatient basis. All TMJs were examined clinically and radiographically. Based on patient’s history and clinical and radiographical examination, a diagnosis of TMJ disorder was made. All patients were given 4 sessions of 12.5 % dextrose prolotherapy in TMJ and associated structures at interval of 2 weeks. After prolotherapy there was increase in mouth opening and statistically significant decrease in intensity of pain which was found at the end of 3 months, however there was no significant difference in clicking of TM joint. In our study, we have concluded that 12.5 % dextrose prolotherapy has a faster effect on pain relief and mouth opening but not on clicking. Our results are encouraging and have been promising, showing a significant improvement in TMJ symptoms after 4 sessions of dextrose prolotherapy.

Temporomandibular dysfunction diagnosis by means of computerized axiography.

Background and aimsThe objective of this study was to evaluate the accuracy of the CADIAX Compact 2 axiograph in confirming the presumptive clinical diagnosis of temporomandibular dysfunction, established according to the muscular-articular clinical examination.MethodsA retrospective analytical study was carried out on 50 patients, aged between 21 and 62 years, 31 women and 19 men. A clinical diagnosis was established after masticatory muscles, temporomandibular joints and mandibular border limit movements were assessed. During the same day a computerized axiography (Cadiax Compact 2, Gamma, Vienna, Austria) was performed in order to confirm the diagnosis.ResultsThe study had a sensitivity of 100%, which means that the CADIAX device detected all clinically positive patients. On the other hand, the specificity of the study was 74%, representing the percentage of patients negatively diagnosed by CADIAX device out of the total number of patients clinically diagnosed as negative. The 88% accuracy shows the proportion in which the CADIAX device provides a diagnosis equal to the clinical one.ConclusionsOf all the methods for investigating temporomandibular joint dysfunction, axiography is less invasive, does not irradiate the patient, it is relatively easy to use and it offers functional information about the TMJ function.

Conservative therapies to treat pain and anxiety associated with temporomandibular disorders: a randomized clinical trial

Temporomandibular dysfunction (TMD) is a condition that affects the stomatognathic system. To determine the effect of treatment with an occlusal splint (OS), manual therapy (MT), counselling (CS) and the combination of an occlusal splint and counselling (OSCS) on pain and anxiety in patients with TMD. A randomised clinical trial was conducted with 89 patients diagnosed with TMD through RDC/TMD (Research Diagnostic Criteria for Temporomandibular Disorders) and divided into four groups of treatment: OSCS (n=25); OS (n=24); MT (n=21); and CS (n=19). Participants were assessed before and after 1month of therapy for pain, anxiety and TMD diagnosis. Pain was measured by a visual analogue scale. To assess anxiety, Hospital Anxiety and Depression Scale (HADS), Beck Anxiety Inventory (BAI) and the State-Trait Anxiety Inventory (STAI-S and T) were used. The data were analysed using SPSS (Statistical Package for Social Science) 22.0. The four groups obtained a significant reduction (P<0.001) in the pain after 1month of treatment. Treatment in all groups promoted a significant reduction in anxiety symptoms 1 month after completion, HADS (P<0.001), BAI (P<0.001), STAI-T (P=0.006). Thus, no group was superior to the other in reducing the studied variables. The therapies used were effective in reducing pain and anxiety in patients diagnosed with TMD. However, no treatment was superior to the other in reducing the studied variables.

Oscillatory joint mobilization as a physiotherapeutic treatment of temporomandibular dysfunction: a case report

Introduction: The temporomandibular joint (TMJ) acts during chew, swallowing, yawning, conversation and in activities involving jaw movements. Temporomandibular Dysfunction (TMD) is a set of disorders involving the masticatory muscles in the TMJ and associated structures. Joint mobilization aims to relief pain and restoring the function of the compromised body segment, increasing its degree of mobility. Objective: We aimed to evaluate the influence of oscillatory joint mobilization on TMD. Method: A descriptive case study with a patient who presented a clinical diagnosis of TMD in the Clinical School of Physiotherapy of the Leão Sampaio School, Juazeiro do Norte, CE, Brazil, from September 3 to October 6 of 2014, twice a week, lasting 40 minutes, a total of 10 visits. Results: The patient presented a gain in the range of motion of the mouth opening (from 17 mm to 46 mm), pain relief (from grade 6 to grade 0 on the Visual Analogue Scale) and improvement in muscle function. Conclusion: Oscillatory joint mobilization in TMD may be effective in increasing mandibular range of motion and opening of the mouth, as well as in reducing TMJ pain and masticatory musculature.

Effect of the dry needling vs manual myofascial therapy at the trigger points in temporomandibular dysfunction

Introduction: The etiology of Temporomandibular Dysfunction (TMD) is multidimensional, considering biomechanical, neuromuscular and biopsychosocial [1]. TMDs are defined in subgroups as problems involving temporomandibular joint (TMJ), masticatory system muscles, and musculoskeletal structures associated with the head and neck [2]. The most relevant signs of TMD are the presence of joint sounds (clicking and crepitation), reduced mouth opening, and disrupted jaw movements. However, pain is the primary problem of this pathology, and it is typically the reason these patients request medical care [3]. The muscular etiology TMD includes the myofascial pain syndrome, which is characterized by the presence of trigger points (TP). The intervention of physical therapy in TP involves myofascial manual therapy and dry needling [4]. The purpose of this study was to investigate the effect of physiotherapy technique for the treatment of muscular TMD by applying manual myofascial therapy and dry needling. Material and Methods: This was a quasi-experimental study that enclosed a group of 15 individuals with a diagnosis of TMD, selected as sample through the questionnaire of Diagnostic Criteria for Research in Temporomandibular Dysfunction (RDC/TMD) and the Fonseca questionnaire, in which they have at least level II of severity. The subjects were randomized into two groups: group one (G1) was submitted to myofascial manual therapy and group two (G2) was submitted to dry needling. Subjects had the pressure pain threshold (PPT) and pain intensity (VAS) evaluated, through algometry and EVA scale respectively, at beginning (M0) and one hour (M1) after being submitted to interventions. This study follows all the principles of the Declaration of Helsinki. Results: The results indicate that both therapies increase the PPT and decrease the VAS, with statistic significantly differences (p < 0.05) between M0 and M1 within both groups. When comparing techniques, no significant differences were observed. Discussion and conclusions: Myofascial manual therapy and dry needling focused in masseter and temporal promoted an increased in the PPT values and a decrease in the VAS value after a single session on patient’s symptoms with TMDs. However, further studies with larger samples should be carried out in order to analyze which technique presents superior results.

Temporomandibular dysfunction, myofascial, craniomandibular and cervical pain: effect on masticatory activity during rest and mandibular isometry

ABSTRACT BACKGROUND AND OBJECTIVES: Craniomandibular and cervical symptoms interfere with mandibular stability. Determining whether these disorders influence muscle activation when chewing, it is possible to improve interventions for this population. The objective of this study was to verify the effect of the temporomandibular joint dysfunction, craniomandibular and cervical pain on the electromyographic activity of the masticatory muscles during rest and mandibular isometry. METHODS: Fifty-five women aged between 18 and 30 years were divided into two groups: with temporomandibular dysfunction (n=28) and without temporomandibular dysfunction (n=27). The diagnosis of temporomandibular dysfunction was established using the Research Diagnostic Criteria for Temporomandibular Disorder (RDC/TMD). The RDC was also used to determine the presence of craniomandibular pain. Cervical pain was defined by physical examination. The electromyographic activity of masseter and temporalis muscles was evaluated in the rest position and mandibular isometry. The amplitude of muscle activation was represented by the root mean square values (RMS%) and normalized by maximum voluntary contraction. The Mann-Whitney U test was used to detect differences between the groups with and without temporomandibular dysfunction; with and without myofascial craniomandibular pain; and with and without cervical myofascial pain. RESULTS: It was observed greater amplitude in the activation of masseter and right temporalis muscles in the rest position in individuals with myofascial craniomandibular pain compared to asymptomatic (p<0.05). There was no difference among individuals with and without cervical myofascial pain, and with and without temporomandibular dysfunction. CONCLUSION: The presence of myofascial craniomandibular pain did not affect the masticatory activity, with greater muscle activation in mandibular rest.

Association between Temporomandibular Dysfunction and Depression in People Living with HIV/AIDS

Background: The origin of temporomandibular dysfunction (TMD) is complex and associates with several factors, including emotional states, such as depression, currently considered one of the main etiological factors of TMD. Objective: to measure the prevalence of temporomandibular dysfunction and its association with the degree of depression in people living with HIV/AIDS. Method: cross-sectional, descriptive, exploratory, quantitative study, developed through the application of Fonseca’s instrument for evaluation of TMD and the Beck Depression Inventory (BDI) in people living with HIV/AIDS from the Expert Assistance Service (EAS). For data analysis, one used Fisher's exact test with statistical significance level p<0.05. Results: The study enrolled 32 subjects, of whom the majority had brown color (65.63%), incomplete elementary school (43.75%), was single (56.25%), with income lower than or equal to the minimum wage ( 87.5%), had mild TMD diagnosis (53.13%), associated with mild degree of depression (40.63%). Conclusions: there was a prevalence of Depression and Temporomandibular Dysfunction in the majority of the sample, and a significant association between those two diseases. It is necessary nursing interventions in health education and early detection of the signs and symptoms of those diseases in that population.

Effects of exercise training and photobiomodulation therapy (EXTRAPHOTO) on pain in women with fibromyalgia and temporomandibular disorder: study protocol for a randomized controlled trial.

BackgroundFibromyalgia (FM) is a syndrome most prevalent in women, in whom it is characterized mainly by chronic pain. An important issue is that many patients with FM are reported to have temporomandibular dysfunction (TMD), and the coexistence of these pathologies generates a clinical outcome of high complexity. The literature is unclear regarding an effective therapy for reducing pain in patients with both comorbidities. Exercise training and phototherapy (low-level laser therapy with light-emitting diode) are two of the approaches used to treat pain. Thus, the aim of this study is to assess the potential role of exercise training plus phototherapy in reducing chronic pain in women with FM and TMD. A further aim is to determine whether the interventions can improve quality of life and modulate endogenous serotonin.Methods/DesignA randomized controlled clinical trial will be conducted. It will involve 60 women ≥ 35 years of age with a diagnosis of FM and TMD. After recruitment, patients will be randomly allocated to one of four groups: a control group (no intervention), a group that will receive a phototherapy intervention (PHO), a group that will be prescribed muscle-stretching, aerobic, and facial exercises (EXT), or a group that will receive phototherapy plus exercise interventions (PHO + EXT). The trial will last 10 weeks, and the following outcomes will be evaluated on two separate occasions (baseline and within 24 h after the last day of the protocol). Pain intensity will be analyzed using a visual analogue scale and the McGill Pain Questionnaire, and pain thresholds will be punctuated using a digital algometer. FM symptoms will be assessed using the Fibromyalgia Impact Questionnaire, and quality of life will be determined with the 36-item Short Form Health Survey. Serotonin levels will be evaluated in salivary samples using a competitive enzyme-linked immunosorbent assay.DiscussionThis is the first randomized controlled trial in which the role of phototherapy, exercise training, and a combination of these interventions will be evaluated for chronic pain in patients with FM and TMD. The results will offer valuable clinical evidence for objective assessment of the potential benefits and risks of procedures.Trial registrationClinicalTrials.gov Identifier: NCT02279225. Registered 27 October 2014.

Associação entre funções estomatognáticas, oclusão dentária e sinais de disfunção temporomandibular em mulheres assintomáticas

OBJETIVO: verificar a associação entre funções estomatognáticas de mastigação e deglutição, oclusão dentária e sinais de disfunção temporomandibular em mulheres assintomáticas. MÉTODOS: as funções estomatognáticas foram avaliadas pelo exame miofuncional orofacial; o exame da oclusão dentária compreendeu: classificação de Angle; medidas de sobrepasse horizontal e vertical; presença de mordida aberta e cruzada; e a avaliação da articulação temporomandibular foi realizada pelo instrumento Critérios de Diagnóstico para Pesquisa de Desordens Temporomandibulares. RESULTADOS: foram avaliadas 43 mulheres com idade média de 23,7 anos. O exame miofuncional orofacial demonstrou alterações no padrão de mastigação (30,2%) e contrações atípicas na mastigação (18,6%) e deglutição (58,1%). Quanto à oclusão dentária, houve predomínio de classe I de Angle (74,4%), porém nenhuma voluntária apresentou uma oclusão ideal. A avaliação da articulação temporomandibular apresentou amplitude de movimento dentro da normalidade, presença de desvio na abertura da boca (60,5%) e diagnóstico de disfunção temporomandibular (16,3%). Houve associação significante entre presença de ruídos articulares e diagnóstico de disfunção temporomandibular e contrações atípicas na deglutição; padrão de abertura e contrações atípicas na mastigação; e não houve associação entre a Classe Oclusal de Angle, padrão de mastigação e disfunção temporomandibular. CONCLUSÃO: voluntárias assintomáticas apresentaram alterações das funções estomatognáticas, como contrações atípicas durante a deglutição e mastigação, as quais foram associadas com a presença de ruídos articulares e padrão de abertura da boca. Tais achados podem ser atribuídos a desequilíbrios e incoordenação dos músculos envolvidos nessas funções. Nenhuma voluntária apresentou oclusão ideal e não foram encontradas associações com esta condição.

Radiographic measurement of the cervical spine in patients with temporomandibular dysfunction

Aim To compare the craniocervical angles and distances between temporomandibular dysfunction (TMD) and free TMD subjects. Casuistic and methods The sample consisted of young adults, of both genders, with age ranging between 18 and 30 years. TMD diagnosis was based on the clinical criteria of the Research Diagnostic Criteria for TMD (RDC/TMD), associated with self-reported symptoms of TMD. For radiological analysis we measured three angles and two distances of craniocervical region. Results Of the 56 subjects, only 23 completed all stages of research, which were divided into two groups: (1) free TMD group – composed of 11 individuals; (2) TMD group – constituted of 12 subjects. The most common clinical diagnosis of TMD was arthralgia (75.0%) followed by myofascial pain without limited mouth opening (58.4%). Among the self-reported symptoms of TMD, the most frequents were facial (83.4%) and neck (66.6%) pain. Of radiological measurement, only plane atlas angle (APA) ( p = 0.026) and anterior translation distance (Tz C 2–C 7) ( p = 0.045) showed statistical difference between groups TMD (APA = 16.7 ± 1.63; Tz C 2–C 7 = 28.7 ± 2.58) and free TMD (APA = 21.64 ± 1.24; Tz C 2–C 7 = 19.82 ± 3.29). Conclusion It could be verified that the symptomatic TMD patients presented a flexion of the first cervical vertebra associated with an anteriorization of the cervical spine (hyperlordosis).

The role of SPECT/CT with 99mTc-MDP image fusion to diagnose temporomandibular dysfunction

The objective of this study was the evaluation of Single Photon Emission Computed Tomography with Technetium 99m Methylene Diphosphonate (SPECT with 99mTc-MDP) and computed tomography (CT), simultaneously acquired image in diagnosis of temporomandibular joint (TMJ) dysfunction. A prospective study was conducted with 33 patients, 29 female and 4 male, all of then presenting signs and/or complaints suggestive of temporomandibular dysfunction. SPECT/CT with 99mTc-MDP was performed in all patients and imaging results compared with final diagnosis and clinical outcome. The correlation of signs and symptoms with SPECT/CT imaging showed sensitivity 100%, specificity 90.91%, and accuracy 96.97%. SPECT/CT with 99mTc-MDP coregistered imaging fusion is a suitable method of temporomandibular dysfunction diagnosis, due to the sensitivity, specificity, and accuracy observed.