Jaw Disability Research Articles

Comparison of Trigger Point Lidocaine Injection and Stabilization Splint Use in Myofascial Orofacial Pain Treatment

Objective: This study aims to compare the short-, medium-, and long-term efficacy of trigger point local anesthetic injection and stabilization splint use for myofascial orofacial pain. Materials and methods: Group 1 comprised 15 patients who received trigger point local anesthetic injections (LAI), while Group 2 comprised 15 patients who were treated with a stabilization splint (SS). Analysis of pain-free maximum mouth opening (MMO) measurements, jaw disability checklists (JDC), short-form McGill pain questionnaires (SF-MPQ), and Visual analog scales (VAS) were used for comparison between the groups. Results: The LAI group showed a significantly greater increase in pain-free MMO in all terms (p < 0.001) and had significantly lower values on the JDC in both the medium (p = 0.026) and the long term (p = 0.006). The SF-MPQ was significantly lower in the medium term (p = 0.001) in the LAI group; the VAS showed a significantly greater decrease in the short (p = 0.016) and medium terms (p < 0.001) in the LAI group. Conclusion: The results indicate that a treatment choice can be made between TN lidocaine injection and occlusal splint based on patient tolerance.

Does combining oro-facial manual therapy with bruxism neuroscience education affect pain and function in cases of awake bruxism? A pilot study.

Although awake bruxism is associated with temporomandibular disorder (TMD) as well as head and neck pain, the effects of physical therapy and bruxism education to address these factors have not been investigated. The aim of this study was to evaluate the effects of oro-facial manual therapy and bruxism neuroscience education (BNE) on awake bruxism over a 3-week period with an open-ended follow-up questionnaire after 3 months. Subjects (n = 28) were randomly allocated to one of two groups, an intervention group and a control group. Data regarding disability, function and pain were collected pre- and post-assessment, with all measures administered in a single-blind fashion. Participants in both groups received six treatment sessions during this period. In addition to manual therapy, participants were provided with information on the neurophysiological mechanisms of bruxism and contributing factors. Individual behavioural guidelines and daily exercises were determined in consultation with the therapist. An introduction to a bruxism specific app (Brux.App) was also provided, which all participants used as an adjunct to their treatment. The intervention group demonstrated notable improvement as indicated by their scores in the Neck Disability Index (NDI) (p = .008), Pain Disability Index (PDI) (p = .007) and Jaw Disability List (JDL) (p = .03). Furthermore, clinical assessments of the temporomandibular joint (TMJ) revealed a significant progress in terms of mouth opening (p = .03) and lateral jaw movement (laterotrusion) (p = .03). The mechanical pain threshold (PTT) of both the masseter (p = .02) and temporalis muscle (p = .05) also showed significant improvement. At 3-month follow-up, the questionnaire revealed that the majority of the intervention group (13/15, 87%) reported a benefit from the treatment. The reduction in pain and disability together with improvement in function and increased coping suggest a potential modification of awake bruxism through specialised musculoskeletal intervention and BNE tailored to the individual patient.

Mouth opening, jaw disability, neck disability, pressure pain thresholds, and myofascial trigger points in patients with disc displacement with reduction: A descriptive and comparative study

ABSTRACT Objective To assess jaw and neck function, pressure pain threshold (PPT), and the presence of trigger points (TrPs) in disc displacement with reduction (DDWR) subjects compared to healthy subjects. Methods One hundred DDWR subjects and 100 matched controls were studied. Clinical evaluations included demographic data, range of motion, jaw and neck disability, PPT, and muscle TrPs. Results DDWR subjects have limited pain-free opening limitation (p < 0.001), jaw and neck disability limitation (p < 0.001), and higher presence of active and latent TrPs limitation (p < 0.001) compared to healthy subjects. Conclusion DDWR subjects present a limited pain-free mouth opening, higher jaw and neck disability, lower PPT, and major presence of active and latent TrPs compared to healthy subjects. Cervical spine and TMJ evaluation and treatment should be considered in DDWR patients.

Quality of life, chronic pain, insomnia, and jaw malfunction in patients after alloplastic temporomandibular joint replacement: a questionnaire-based pilot study

Studies of patients undergoing alloplastic total temporomandibular joint replacement seldom report on quality of life (QoL) and sleep. The aim of this pilot study was to assess these factors in such a patient cohort using validated psychometric questionnaires. Data were collected via online surveys comprising the following six questionnaires: Short Form-12 Health Survey (SF-12), Patient Health Questionnaire-15, European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, Insomnia Severity Index, Graded Chronic Pain Scale, and Jaw Disability List. Pain intensity, limitation in nutrition, and treatment satisfaction were assessed using numerical rating scales. Mouth opening was measured at follow-up. The SF-12 Physical Composite Score was markedly lower than that of the age-matched general population, whereas the Mental Composite Score did not differ significantly. Participants indicated a low somatization level and low level of disability due to pain, but reduced QoL. Clinically relevant insomnia was reported by 36% of participants. In conclusion, the results of this pilot study indicate that QoL and sleep in patients with a total temporomandibular joint replacement differ from those in the general population, indicating the need for a comprehensive outcome assessment utilizing validated psychometric tools in accordance with the current biopsychosocial model of chronic disorders.

Craniocervical and Cervical Spine Features of Patients with Temporomandibular Disorders: A Systematic Review and Meta-Analysis of Observational Studies.

To assess neck disability with respect to jaw disability, craniocervical position, cervical alignment, and sensorimotor impairments in patients with temporomandibular disorders (TMD), a systematic review and meta-analysis of observational studies trials were conducted. The meta-analysis showed statistically significant differences in the association between neck disability and jaw disability (standardized mean difference (SMD), 0.72 (0.56–0.82)). However, results showed no significant differences for cervical alignment (SMD, 0.02 (−0.31–0.36)) or for the craniocervical position (SMD, −0.09 (−0.27–0.09)). There was moderate evidence for lower pressure pain thresholds (PPT) and for limited cervical range of motion (ROM). There was limited evidence for equal values for maximal strength between the patients with TMD and controls. There was also limited evidence for reduced cervical endurance and conflicting evidence for abnormal electromyographic (EMG) activity and motor control in TMD patients. Results showed a clinically relevant association between cervical and mandibular disability in patients with TMD. Regarding sensory-motor alterations, the most conclusive findings were observed in the reduction of PPT and cervical ROM, with moderate evidence of their presence in the patients with TMD. Lastly, the evidence on impaired motor control and cervical EMG activity in patients with TMD was conflicting.

The Course of Orofacial Pain and Jaw Disability After Whiplash Trauma: A 2-year Prospective Study.

Prospective cohort study. The aim of this study was to evaluate the course of orofacial pain and jaw disability in relation to neck pain, neck disability, and psychosocial factors at the acute stage and the chronic stage after whiplash trauma. Many individuals report chronic pain in the orofacial region after whiplash trauma. The possible association between whiplash trauma and orofacial pain is debated. Prospective studies are therefore needed to evaluate the development of orofacial pain after whiplash trauma. Within 1 month following a whiplash trauma, 176 cases were examined and compared to 116 controls with questionnaires concerning neck and jaw pain and related disability, nonspecific physical symptoms and depression. At the 2-year follow-up, 119 cases (68%) and 104 controls (90%) were re-examined. Compared to controls, cases reported more jaw and neck pain, both at baseline and follow-up. A majority (68%) of cases with pain in the jaw region in the acute stage also reported jaw pain at the follow-up. The intensity of jaw and neck pain was correlated both at baseline and follow-up. Both neck pain and jaw pain were correlated to nonspecific physical symptoms and to depression. Orofacial pain and jaw disability related to neck pain are often present already at the acute stage after whiplash trauma and persist into the chronic stage for most individuals. Assessment following whiplash trauma should therefore include both the neck and the orofacial regions. More studies are needed to further evaluate risk factors for development of orofacial pain after whiplash trauma. 3.

Effects on jaw function shortly after whiplash trauma.

Normal jaw function involves muscles and joints of both jaw and neck. A whiplash trauma may disturb the integrated jaw-neck sensory-motor function and thereby impair chewing ability; however, it is not known if such impairment is present shortly after a neck trauma or develops over time. The aim was to evaluate jaw function after a recent whiplash trauma. Eighty cases (47 women) were examined within 1month after a whiplash trauma and compared to 80 controls (47 women) without neck trauma. Participants completed the Jaw disability checklist (JDC) and Neck Disability Index (NDI) questionnaires and performed a 5-minute chewing test. Elicited fatigue and pain during chewing were noted, and group differences were evaluated with Fisher's exact test and Mann-Whitney U-test. Compared to controls, cases had higher JDC (P<.0001) and NDI scores (15% vs 2%, P<.0001), and reported more fatigue (53% vs 31%, P=.006) and pain (30% vs 10%, P=.003) during the chewing test. Cases also had a shorter onset time for fatigue and pain (both P=.001) Furthermore, cases reporting symptoms during chewing had higher JDC and NDI scores compared to cases not reporting symptoms (both P=.01). Symptoms mainly occurred in the trigeminal area for both groups, but also in spinal areas more often for cases than for controls. Taken together, the results indicate that jaw-neck sensory-motor function is impaired already within 1month after a whiplash trauma. The association between neck disability and jaw impairment underlines the close functional relationship between the regions, and stresses the importance of multidisciplinary assessment.

Influence of clinical and psychological variables upon the oral health-related quality of life in patients with temporomandibular disorders.

BackgroundTo analyze the association between the OHIP-14 and the different subtypes making up the clinical and psychological axis obtained using the RDC/TMD.Material and Methods407 patients treated at the TMD unit of the Andalusian Healthcare Service were administered the Spanish version of the Research Diagnostic Criteria for Temporomandibular Disorders questionnaire (RDC/TMD), together with the Oral Health Impact Profile questionnaire (OHIP-14). The degree of association between the patients’ score in the OHIP-14 and the clinical and biopsychosocial variables was analyzed through bivariate and multivariate analyses, specifically through linear regression.Results89.4% of the treated patients were women, while 10.6% were men, with an average age of 42.08 ± 14.9 years. The mean score and standard deviation for the OHIP-14 was 20.57 ± 10.73. A significant association (p<0.05) was observed with the following variables: Axis I, jaw disability checklist, depression, somatization, perceived pain duration, and pain interference with activities of daily living.ConclusionsThe analysis of the relation between self-perceived health in patients with TMD, as measured by the OHIP-14, showed a R2 of 0.3979, with a higher Beta value for the association between the OHIP and patients with both myofascial pain and arthopathy, jaw disability, depression, a higher pain duration and a higher pain interference with activities of daily living. Key words:Temporomandibular disorders, psychological factors, oral health impact profile, public healthcare, research diagnostic criteria for temporomandibular disorders (RDC/TMD).

Pain and Disability in the Jaw and Neck Region following Whiplash Trauma

The relationship between whiplash trauma and chronic orofacial pain is unclear, especially with regard to the time elapsed from trauma to development of orofacial pain. The aim was to analyze prevalence of jaw pain and disability, as well as the relationship between pain and disability in the jaw and neck regions in the early nonchronic stage after whiplash trauma. In this case-control study, 70 individuals (40 women, 30 men, mean age 35.5 y) who visited an emergency department with neck pain following a car accident were examined within 3 wk of trauma (group 1) and compared with 70 individuals (42 women, 28 men, mean age 33.8 y), who declined to attend a clinical examination but agreed to fill in questionnaires (group 2). The 2 case groups were compared with a matched control group of 70 individuals (42 women, 28 men, mean age 37.6 y) without a history of neck trauma. All participants completed questionnaires regarding jaw pain and dysfunction, rating pain intensity in jaw and neck regions on the Numerical Rating Scale, the Neck Disability Index, and Jaw Disability Checklist. Compared with controls, individuals with a recent whiplash trauma reported more jaw pain and dysfunction. Furthermore, there was a moderate positive correlation between jaw and neck pain ratings for group 1 (r = 0.61, P < 0.0001) and group 2 (r = 0.59, P < 0.0001). In the logistic regression analysis, cases showed higher odds ratios (range, 6.1 to 40.8) for jaw and neck pain and disability compared with controls. Taken together, the results show that individuals with a recent whiplash trauma report more jaw pain and disability compared with controls without a history of neck trauma. Furthermore, the correlation between jaw and neck pain intensity implies that intensity of neck pain in the acute stage after whiplash trauma might be a possible risk factor also for development of chronic orofacial pain.

Identification of psychological comorbidity in TMD-patients

Objectives: The aim of the current study was to access the prevalence of depression among patients with Temporomandibular Joint Disorder (TMD) compared to patients with no current TMD.Method: Patients (92) and controls (90) answered questionnaires on subjective pain, severity of chronic pain, jaw disability, emotional well-being and depression, and a clinical examination was performed.Results: Temporomandibular Joint Disorder patients reported higher disability of jaw function, compared to controls (p<0.001). The myoarthopathy subgroup (67.4%) had slightly more jaw disability than the myopathy subgroup (p>0.05). While 51% of TMD patients reported poor emotional well-being, only 7.8% of controls were affected (p<0.001). Clinical symptoms of depression were reported by 16% of TMD patients and not in the controls (p<0.001). Among TMD patients, a higher prevalence of depression was observed in the myopathy subgroup.Discussion: A regular screening for psychological problems, using standardized questionnaires, should be integrated in clinical examination of TMD patients.

Identification of psychological comorbidity in TMD-patients

Objectives: The aim of the current study was to access the prevalence of depression among patients with Temporomandibular Joint Disorder (TMD) compared to patients with no current TMD.Method: Patients (92) and controls (90) answered questionnaires on subjective pain, severity of chronic pain, jaw disability, emotional well-being and depression, and a clinical examination was performed.Results: Temporomandibular Joint Disorder patients reported higher disability of jaw function, compared to controls (p<0.001). The myoarthopathy subgroup (67.4%) had slightly more jaw disability than the myopathy subgroup (p>0.05). While 51% of TMD patients reported poor emotional well-being, only 7.8% of controls were affected (p<0.001). Clinical symptoms of depression were reported by 16% of TMD patients and not in the controls (p<0.001). Among TMD patients, a higher prevalence of depression was observed in the myopathy subgroup.Discussion: A regular screening for psychological problems, using standardized questionnaires, should be integrated in clinical examination of TMD patients.

Identifying potential predictors of pain–related disability in Turkish patients with chronic temporomandibular disorder pain

BackgroundThe aims of this study were to examine whether patients’ psychosocial profiles influence the location of pain, and to identify the clinical and psychosocial predictors of high levels of pain-related disability in temporomandibular disorders (TMD) patients with chronic pain at least 6 months in duration.MethodsThe Research Diagnostic Criteria of TMD (RDC/TMD) data for Axis I and II were obtained for 104 consecutive patients seeking treatment.Data were analyzed using descriptive statistics, t-test, Mann–Whitney U-test, chi-square test, One-way ANOVA, Kruskal-Wallis test, and binary multiple logistic regression tests. Patients were classified into two groups according to Graded Chronic Pain Scale scores: Grade III and IV were scored for patients with high levels of pain-related disability, whereas Grade I and II were scored for patients with low disability.ResultsMuscle and joint pain were found in 64.9% and 31.8% of the patients, respectively, and 27.3% of the patients suffered from both muscle and joint pain.Psychosocial disability was found in 26% of patients. There were no statistically significant differences among the diagnostic subgroups with regards to the demographic, behavioral, psychological, and psychosocial characteristics. Patients with high levels of pain-related disability had significantly higher depression, somatization, pain intensity and jaw disability scores than those with low levels of pain-related disability.Patients with high levels of pain-related disability were more likely to have higher pain intensity, to report higher somatization symptoms and functional impairment, and were less likely to have joint pain than those with low levels of pain related disability.ConclusionIn conclusion, the Turkish version RDC/TMD, based on a dual axis system, may be used to screen chronic TMD patients at high-risk for pain-related disability who need comprehensive care treatment program.

측두하악장애 연구진단기준(RDC/TMD)를 이용한 측두하악장애의 근육성 동통과 관절성 동통 환자군의 비교

본 연구의 목적은 근육성 동통 및 관절성 동통을 가진 측두하악장애 환자를 대상으로 측두하악장애 연구진단기준(RDC/TMD) axis II 지수 및 관련 요소들을 비교하여 동통과 관련된 장애와 사회심리학적 상태 그리고 치료에 미치는 영향을 알아보는데 있다. 서울대학교 치과병원 구강내과를 내원한 측두하악장애로 진단되어진 252명의 환자들을 대상으로, 측두하악장애 연구진단 기준을 이용하여 근육성 동통군, 관절성 동통군, 근육성 동통과 관절성 동통을 모두 보이는 혼합형 동통군으로 분류한 뒤, 측두하악장애 연구진단기준 설문지를 이용하여 통증의 강도, 동통과 관련된 장애 일수, 만성통증척도, 우울 지수, 신체화 지수, 하악기능과 관련된 기능제한 등을 조사하였으며, 동통의 기간, 치료 기간 및 치료 효과 등 임상적 요소들과의 관계를 분석하여 다음과 같은 결과를 얻었다. 1. 연구대상자의 17.5%가 근육성 동통군, 31.0%에서 관절성 동통군, 51.6%가 혼합형 동통군으로 분류되었다. 성별 분포는 여성이 남성보다 높았으나 세 그룹간의 연령 및 성별은 통계적으로 유의한 차이를 보이지 않았다. 2. 측두하악장애 각 통증군의 사회심리학적 상태는 통계적으로 유의한 차이를 보여주었다(p<0.01). 관절성 동통군에 비해 혼합형 동통군에서 통증의 강도, 동통과 관련된 장애 일수, 만성통증척도가 높게 나타났으며(p<0.01), 우울 지수 및 신체화 지수는 관절성 동통군에 비해 근육성 동통군과 혼합형 동통군에서 유의하게 높게 나타났다(p<0.01). 3. 하악기능과 관련된 기능제한은 각 군간 통계적으로 유의한 차이를 보이지 않았으나 최대 개구량은 근육성 동통군 환자보다 관절성 동통군 환자에서 작게 나타났다(p<0.05). 4. 관절성 동통군 환자들은 다른 동통군의 환자들에 비하여 적은 수에서 만성 동통의 경향을 보였으며 (p<0.01), 혼합형 동통군의 환자들은 다른 동통군의 환자들에 비하여 상대적으로 낮은 치료 효과를 나타내었다(p<0.01). 5. 측두하악장애 환자의 치료 효과는 신체화 지수와 높은 관련성을 나타내었다. (<TEX>${\beta}$</TEX>=-0.251, p<0.05) The purposes of this study were to compare psychological profiles, to investigate the differences in the clinical characteristics, and to compare treatment outcomes between myogenous pain and arthrogenous pain subgroups of temporomandibular disorder (TMD) based on Research Diagnostic Criteria for Temporomandibular disorders (RDC/TMD). Two hundred and fifty two patients diagnosed as TMD were divided into three groups based on the RDC/TMD axis I diagnostic guidelines; myogenous pain group, arthrogenous pain group, and mixed pain (both myogenous pain and arthrogenous pain) group. RDC/TMD history questionnaire was administered to each patient and depression, somatization, jaw disability, pain intensity, disability days, and graded chronic pain scale were analyzed. Bruxism, clenching, insomnia, headache, and unilateral chewing were assessed in a standardized TMD dysfunction questionnaire and the duration of onset, chronicity of pain, treatment period, the effectiveness of the treatment, and improvement of symptoms also analyzed. Myogenous pain group had higher depression (p=0.002), and somatization scales (p<0.001) than the arthrogenous pain group. Mixed pain group showed higher pain intensity (p=0.008), disability days (p<0.001), graded chronic pain scale (p=0.005), somatization (p<0.001), and depression scores (p=0.002) than the arthrogenous pain group. Jaw disability did not show any significant differences among the three groups (p=0.058). Arthrogenous pain group reported more limitation of mouth opening than myogenous pain group (p=0.007). Duration of onset showed that the arthrogenous pain group had lowest prevalence of chronicity among three groups (p=0.002). Mixed pain group patients showed lowest symptom improvements among three groups (p=0.007). Multiple linear regression analysis results showed that the treatment effectiveness was significantly associated with somatization score (<TEX>${\beta}$</TEX>=-0.251, p=0.03).

Masticatory muscle disorders diagnostic criteria: the American Academy of Orofacial Pain versus the research diagnostic criteria/temporomandibular disorders (RDC/TMD)

In this study, relevant cases were retrospectively reviewed to identify patients who were diagnosed as suffering from myofascial pain only according to the research diagnostic criteria/temporomandibular disorders (RDC/TMD) criteria, in order to examine whether or not they could fulfil the American Academy of Orofacial Pain (AAOP) diagnostic criteria for TMD-related masticatory muscle disorders. One hundred and twenty-seven patients, diagnosed according to the RDC/TMD criteria as having myofascial pain with or without limited jaw opening only, were allocated to two groups according to their answers to the RDC/TMD 'jaw disability checklist'. The two groups were compared for Axis I and II data taken from the RDC/TMD questionnaire. Thirty-eight of the patients (29·9%) did not associate their symptoms with jaw functions (e.g. chewing and yawning). This group was characterised by increased range of motion (ROM) and older average age. The AAOP diagnostic criteria for TMD require pain on function in all subtypes of TMD-related muscle disorders. An association between pain and jaw function is common and research is needed to determine whether this should be categorised differently to muscle pain unrelated to jaw function. There may well be different pathophysiological mechanisms and consequently different management strategies for these two pain conditions.

Signs and symptoms of temporomandibular disorders and their impact on psychosocial status in non‐patient university student's population

Temporomandibular disorders (TMD) exhibit a combination of signs and symptoms, mainly characterized by pain and dysfunction, which impairs the functional capacity of the mastication system. These symptoms may produce a negative impact on social activities, employment and leisure. The aim of this study was to early identify the signs and symptoms of TMD and their impact on daily life of non-patient university students. Data were collected from 183 students of the dentistry course. The Axis II of the Research Diagnostic Criteria for Temporomandibular Disorders was administered and analyzed using Spearman test at a significance level of 0.05. Among the 183 participants, 107 were women (58.47%) and 76 were men (41.53%). Age ranged from 18 to 47, with a mean age of 25.35 years. In relation to pain intensity and disability, 129 participants (70.88%) reported no pain in the previous 6 months. An analysis of depression revealed that 35 (19.67%) had moderate and 7 (3.83%) had severe depression. The assessment of nonspecific physical symptoms including pain revealed that nine (4.92%) exhibited moderate symptoms, and one (0.55%) exhibited severe symptoms. The nonspecific physical symptoms excluding items of pain analysis revealed that 44 (24.04%) exhibited moderate symptoms, and 91 (49.73%) exhibited severe. The functions reported as most adversely affected by jaw disability were yawning, eating hard foods, chewing, smiling and laughing. Regarding the habit, 64 (35%) confirmed having the nighttime and 59 daytime (32.3%) teeth grinding with a significant correlation with the four domains analyzed. A significant correlation was observed among all domains. This study analyzed a young population that exhibited para-functional habits and nonspecific physical symptoms excluding pain that need some intervention since they could progress to a symptomatic TMD in future.

The association between neck disability and jaw disability

The association between cervical spine disorders (CSD) and temporomandibular disorders (TMD) has been extensively investigated. However, no studies investigating the relationship between the level of jaw disability and neck disability have been published. Therefore, the objective of this study was to determine whether there was a relationship between neck disability measured using the neck disability index (NDI) and jaw disability measured through the jaw function scale (JFS). A sample of 154 subjects who attended the TMD/Orofacial Pain clinic and students and staff at the University of Alberta participated in this study. All subjects were asked to complete the NDI, the JFS, the jaw disability checklist (JDC), and the level of chronic disability of TMD (chronic pain grade disability questionnaire used in the RDC/TMD). Spearman rho test was used to analyse the relationship between neck disability and jaw disability. Multiple regression analysis was used to determine the association between the level of chronic disability of TMD and neck disability. A strong relationship between neck disability and jaw disability was found (r = 0.82). A subject with a high level of TMD disability (grade IV) increased by about 19 points on the NDI when compared with a person without TMD disability. These results have implications for clinical practice. If patients with TMD have neck disability in addition to jaw disability, treatment needs to focus on both areas because the improvement of one could have an influence on the other.

Reduced endurance of the cervical flexor muscles in patients with concurrent temporomandibular disorders and neck disability

Subjects with temporomandibular disorders (TMDs) have been found to have clinical signs and symptoms of cervical dysfunction. Although many studies have investigated the relationship between the cervical spine and TMD, no study has evaluated the endurance capacity of the cervical muscles in patients with TMD. Thus the objective of this study was to determine whether patients with TMD had a reduced endurance of the cervical flexor muscles at any level of muscular contraction when compared with healthy subjects. One hundred and forty-nine participants provided data for this study (49 subjects were healthy, 54 had myogenous TMD, and 46 had mixed TMD). There was a significant difference in holding time at 25% MVC between subjects with mixed TMD when compared to subjects with myogenous TMD and healthy subjects. This implies that subjects with mixed TMD had less endurance capacity at a lower level of contraction (25% MVC) than healthy subjects and subjects with myogenous TMD. No significant associations between neck disability, jaw disability, clinical variables and neck flexor endurance test were found.

Is Maximal Strength of the Cervical Flexor Muscles Reduced in Patients With Temporomandibular Disorders?

Armijo-Olivo SL, Fuentes JP, Major PW, Warren S, Thie NM, Magee DJ. Is maximal strength of the cervical flexor muscles reduced in patients with temporomandibular disorders? Objective To determine whether there was a difference in maximal cervical flexor muscle strength in subjects with temporomandibular disorders (mixed and myogenous) compared with healthy subjects. Design Cross-sectional study. Setting Orthopedics/sports laboratory at the University of Alberta. Participants Subjects (N=149) of whom 50 were healthy, 54 had myogenous temporomandibular disorders (TMD), and 45 had mixed TMD. Interventions Not applicable. Main Outcome Measures Maximal cervical flexor strength, pain. Results There was no statistically significant difference in maximal cervical flexor strength among groups ( P>.05). Subjects' body weight was significantly associated with strength. No significant association between jaw disability with maximal cervical flexor strength was found. A significant but weak association between neck disability and maximal cervical flexors strength was found. Conclusions These results indicated that strength evaluation is one of several assessment factors that need to be addressed when evaluating musculoskeletal painful conditions such as TMD and neck disorders, but strength evaluation cannot be considered as a direct measure of disability. Future studies should explore evaluation of strength in other muscular groups such as cervical extensors, rotators, and lateral flexors, and also under different conditions such as rapid movements, and in patients with more severe jaw disability.

Measuring Quality of Life in TMD: use of SF-36

Aim: Temporomandibular disorders (TMD) occur frequently in the population and measuring health-related quality of life may prove to be a very useful complementary measure. The aim of our study was to evaluate both the correlation and the agreement between SF-36 and the Axis II of Research Diagnostic Criteria for TMD in the assessment of health-related quality of life in TMD patients. Methods: This study was conducted on consecutives patients referred to our Department from 1 July 2007 to 31 January 2008. Each subject completed the Axis II and SF-36 questionnaires. Correlation of the SF-36 vs. the Axis II scales (graded chronic pain, depression, somatization with and without pain, jaw disability checklist) was calculated using non-parametric Spearmen coefficient. Results: The examined sample was composed by 146 subjects (30 males, 116 females; mean age 35,2 ±14,38 years). There isn’t significant gender difference in age (p=0.083). All the considered Axis II scales are significantly inversely related with all the SF-36 domains. Conclusion: Due to the good agreement with Axis II, SF-36 can be used for measuring Health Related Qualit of Life in TMD patients.

Arthroscopy Surgery for the Treatment of Chronic Closed Lock of the Temporomandibular Joint: A Clinical Study in 344 Arthroscopic Procedures

cant surgical changes, but remained stable at long-term follow-up. All 15 patients had statistically significant reduction in the incidence and severity of facial pain and headaches (61.5%), and TMJ pain (100%). There was significant improvement of jaw function (63.3%), dietary restrictions (57.9%) and disability (60%). There was significant reduction post surgery of average MIO (9.2%) and lateral excursions (right side 37.5% and left side 30.8%). Conclusions: Conservative condylectomy with recontouring of the residual condylar neck to function as a condyle and repositioning of the articular disc is a viable option for treatment of osteochondromas of the mandibular condyle. The use of this method of treatment permits effective removal of the tumor (no recurrence of the tumor was encountered in any of the cases) and eliminates the need for autogenous grafts or total joint prostheses for temporomandibular joint reconstruction. The significant long-term stability of TMJ and orthognathic surgery movements and significant reduction of TMJ dysfunction and pain symptoms demonstrate the benefits and predictability of managing these complex patients with this treatment protocol.