Management Of Temporomandibular Disorders Research Articles

Low-level Laser Therapy in the Management of Temporomandibular Disorders

Low-level Laser Therapy in the Management of Temporomandibular Disorders

The relationship between pregnancy and temporomandibular disorder (TMD) through diagnostic criteria for temporomandibular disorders (DC/TMD) axis II evaluation: a case-control cross-sectional study

IntroductionThis study focuses on temporomandibular disorders (TMDs), which affect the temporomandibular joint and related muscles and have multiple causes. Recent studies have examined the connection between menstrual cycles, estrogen levels, and TMDs, but results are inconsistent, highlighting the need for more research. The aim is to explore the prevalence of TMDs in pregnant women and consider how hormonal changes during pregnancy might influence these disorders.MethodsIn this cross-sectional case-control study, we compared 32 pregnant women with 35 non-pregnant women. We evaluated several TMD-related factors such as pain levels, chronic pain classification, scores on the Jaw Functional Limitation Scale-20 and Oral Behaviors Checklist, and psychological health. We used various statistical methods including descriptive statistics, chi-square tests, linear regression, and adjustments for multiple comparisons to analyze the data.ResultsPregnant women showed different pain perceptions, generally reporting less pain and lower severity. Nonetheless, these differences were not uniform across all TMD-related measures. Linear regression did not find a consistent link between pregnancy and TMD scores, except for chronic pain grade, which was not significant after adjusting for multiple comparisons. There was a significant relationship between depression and TMD severity, emphasizing the need to consider mental health in TMD evaluations.DiscussionThe findings suggest that pregnancy is neither a risk nor a protective factor for TMD. Differences in pain perception, functional status, and psychological health were observed in pregnant women but were not consistent for all TMD-related aspects. The role of estrogen in TMJ health and TMD risk is complex and requires further study. The research highlights the necessity of including mental health, especially depression, in TMD assessments. More comprehensive research with larger sample sizes is essential to better understand the connections between pregnancy, TMD, and hormones, aiming to improve TMD management in pregnant women and others.

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.

A comprehensive patient-specific prediction model for temporomandibular joint osteoarthritis progression

Temporomandibular joint osteoarthritis (TMJ OA) is a prevalent degenerative disease characterized by chronic pain and impaired jaw function. The complexity of TMJ OA has hindered the development of prognostic tools, posing a significant challenge in timely, patient-specific management. Addressing this gap, our research employs a comprehensive, multidimensional approach to advance TMJ OA prognostication. We conducted a prospective study with 106 subjects, 74 of whom were followed up after 2 to 3 y of conservative treatment. Central to our methodology is the development of an innovative, open-source predictive modeling framework, the Ensemble via Hierarchical Predictions through Nested cross-validation tool (EHPN). This framework synergistically integrates 18 feature selection, statistical, and machine learning methods to yield an accuracy of 0.87, with an area under the ROC curve of 0.72 and an F1 score of 0.82. Our study, beyond technical advancements, emphasizes the global impact of TMJ OA, recognizing its unique demographic occurrence. We highlight key factors influencing TMJ OA progression. Using SHAP analysis, we identified personalized prognostic predictors: lower values of headache, lower back pain, restless sleep, condyle high gray level-GL-run emphasis, articular fossa GL nonuniformity, and long-run low GL emphasis; and higher values of superior joint space, mouth opening, saliva Vascular-endothelium-growth-factor, Matrix-metalloproteinase-7, serum Epithelial-neutrophil-activating-peptide, and age indicate recovery likelihood. Our multidimensional and multimodal EHPN tool enhances clinicians' decision-making, offering a transformative translational infrastructure. The EHPN model stands as a significant contribution to precision medicine, offering a paradigm shift in the management of temporomandibular disorders and potentially influencing broader applications in personalized healthcare.

Telemedicine in the management of temporomandibular disorders: A literature review

Background: Temporomandibular disorders are clinical disorders involving the muscles of mastication, temporomandibular joints, and related structures. There are several treatments, such as self-help exercises, that can be done at home using remote care, often called telemedicine, after the patient has been directed to do so by a practitioner and evaluated during regular visits. Along with advancement of the times and technology, as well as with the prevention of COVID-19, telemedicine may currently be the main means of self-care for patients at home without losing the supervision of a doctor. Purpose: The purpose of this study is to determine the effect of using telemedicine in the management of temporomandibular disorders. Methods: A systematic literature review was undertaken using literature search methods in electronic databases: PubMed, ProQuest, and Google Scholar. The keywords were “(Telemedicine OR Teledentistry) AND (Temporomandibular disorder) AND (Effect).” The inclusion criteria for selection of the scientific articles were publication from 2012 to 2022, publication in English, and the full paper being available. Results: Seven articles have been included in this review. Based on the results of this systematic study, using telemedicine is considered able to assist the management of temporomandibular disorders by conducting consultation, follow-up, and treatment remotely via telephone, smartphone application, or internet-based or website-based applications. Conclusion: Telemedicine makes it easier for patients who do not have access to a health center to receive consultations and treatments from home, minimizing time and costs.

Cross‐cultural adaptation, validity, and reliability of the Turkish version of the Oral Behaviours Checklist

AbstractAimDetermining the occurrence of oral parafunctional behaviors is essential for the clinical management of temporomandibular disorders (TMDs). For this reason, the evaluation of parafunctional behaviors in patients with TMDs is highly important.MethodsThe purpose of the present study was to investigate the validity and reliability of the Turkish version of the Oral Behaviours Checklist (OBC‐T) in patients with TMDs. To determine the reliability of the questionnaire, it was applied in 142 patients with TMDs twice at a 2‐week interval. For concurrent validity of the OBC, Spearman correlation analysis was performed with Fonseca Anamnestic Index (FAI), Patient Health Questionnaire‐9 (PHQ‐9), Jaw Function Limitation Scale‐20 (JFLS‐20), and Tampa Scale for Kinesiophobia for TMDs (TSK‐TMDs).ResultsItems had good to excellent test–retest reliability. The OBC‐T score was correlated with FAI, JFLS‐20, PHQ‐9, and TSK‐TMDs scores.ConclusionThese results provided important evidence that the OBC‐T can be used to evaluate parafunctional behaviors in individuals with TMDs in Turkish‐speaking populations.

Current thinking in open temporomandibular joint surgery. Is this still indicated in the management of articular temporomandibular joint disorder?

Management of temporomandibular disorders (TMD) follows a stepwise approach of conservative management, minimally invasive surgery (arthrocentesis and arthroscopy), open surgery and alloplastic replacement. The majority of patients treated in primary care and managed initially in secondary care have myofascial pain and can be managed conservatively with rest, topical NSAIDs, muscle massage, and a bite orthosis. Those who fail to improve and have articular related pain with limitation of function should initially undergo arthroscopic investigation and arthrocentesis, which is effective at resolving symptoms in 80% of patients. Arthroscopy provides the best diagnostic aid should there be a failure to improve and should enable the surgeon to appropriately plan open surgery. Historically, surgical intervention was based on a ‘one size fits all’ philosophy with the surgeon carrying out a procedure which they are used to doing regardless of the pathology. Prior to arthroscopy this carried an ‘80% chance of getting 80% better’ regardless of approach. Prior arthroscopy reduced success rates to 50%-60% and a better success rate is needed. Basing surgical intervention on the pathology encountered is a sensible approach to joint management, with the surgeon performing surgery on the articular surfaces or disc as indicated. Having used this approach over the last 15 years the author has achieved success rates of 80% in the longer term and this philosophy, rationale, and technique will be discussed along with analysis of more recent publications in the field.

Pharmacological therapy in the management of temporomandibular disorders and orofacial pain: a systematic review and meta-analysis

BackgroundTemporomandibular disorders (TMD) are manifested by soreness in the jaw joint area and jaw muscles, clicks or creaks when opening or closing the mouth. All these symptoms can be disabling and occur during chewing and when the patient yawns or speaks. Several classes of drugs are used to treat symptoms. This review aims to assess which drug suits the different signs.MethodsPubmed, Web of Science and Lilacs were systematically searched until 01/02/2023. Clinical trials were selected that dealt with drugs used in temporomandibular dysfunctionResultsOut of 830 papers, eight studies were included. The Meta-Analysis with Continuous Outcomes with Pre-Calculated Effect Sizes resulted in the rejection that there is intergroup variability (p.0.74).ConclusionsTreatment of orofacial pain is still a significant challenge for dentistry. We can conclude that there is no drug of first choice in the treatment of temporomandibular pain. However, the clinician must distinguish the type of pain and the aetioloic cause of the pain so that the patient can be treated and managed pharmacologically.

Additional splint therapy has no superiority in myogenic temporomandibular disorders: A systematic review and meta-analysis of randomized controlled trials.

Purpose Temporomandibular disorders (TMDs) are frequent stomatological disorders. However, their treatment is controversial. Therefore, we compared the efficacy of combination therapy (splint therapy along with physiotherapy, manual therapy, and counseling) with physiotherapy, manual therapy, and counseling alone. The extent of mouth opening and pain perception were the outcomes.Study selection Systematic searches for English publications were performed using four major literature databases (Cochrane Library, EMBASE, PubMed, and Web of Science). We included randomized controlled trials. We calculated mean differences with 95% confidence interval (CI) for pain perception and maximum mouth opening (MMO) for the two groups. The Hartung-Knapp adjustment was used for cases comprising at least five studies.Results Six articles were included in the pain perception category, and four were reviewed for MMO at baseline. Four articles assessed pain perception, and two assessed MMO at 1 month. Five articles were analyzed upon comparing pain perception at baseline and 1-month follow-up. The mean difference was -2.54 [95% CI: -3.38; to -1.70] in the intervention group and -2.33 [95% CI: -4.06; to -0.61] in the control group. Two articles were analyzed upon comparing MMO at baseline and 1-month follow-up. The mean difference in the intervention group was 3.69 [95% CI: -0.34; 7.72], whereas that in the control group was 3.62 [95% CI: -3.43; 10.67].Conclusions Both therapies can be used in the management of myogenic TMD. Due to the marginal differences between the baseline and 1-month values, our results could not confirm the efficacy of combination therapy.

Females with painful temporomandibular disorders present higher intracortical facilitation relative to pain-free controls.

This study aimed to investigate cortical excitability differences in the primary motor cortex (M1) hand representation between individuals with temporomandibular disorders (TMD) and healthy controls. We assessed resting motor thresholds, motor-evoked potentials (MEPs), intracortical inhibition, and intracortical facilitation and explored potential associations with clinical and psychosocial characteristics in the TMD group. We recruited 36 female participants with TMD and 17 pain-free controls. Transcranial magnetic stimulation (TMS) was used to assess M1 cortical excitability. Correlations between clinical and psychosocial factors and cortical excitability measures were also evaluated. Patients with TMD showed significantly higher intracortical facilitation at 12ms (z = 1.98, p = 0.048) and 15ms (z = 2.65, p = 0.008) when compared to controls. Correlations revealed associations between intracortical facilitation and pain interference, sleep quality, depressive symptoms, and pain catastrophizing in the TMD group. Females with TMD exhibit heightened motor cortex intracortical facilitation in the hand representation, potentially indicating altered cortical excitability beyond the motor face area. This suggests a role for cortical excitability in TMD pathophysiology, influenced by psychosocial factors. Understanding cortical excitability in TMD may inform targeted interventions. Psychosocial variables may play a role in cortical excitability, emphasizing the multidimensional nature of TMD-related pain. Further research is needed to confirm and expand upon these findings, with potential implications for the management of TMD and related pain conditions.

Validity of a Mobile Application to Diagnose Temporomandibular Disorders.

This study aimed to assess the diagnostic accuracy of a mobile application by comparing its diagnoses to those of Orofacial Pain and Oral Medicine specialists and further imaging results (CBCT and MRI) in 500 patients with temporomandibular disorder (TMD). The research focused on three diagnostic categories: the initial specialist diagnoses, the final diagnoses after imaging, and the mobile app's diagnoses. The concordance rates, sensitivities, specificities, and positive predictive values of the diagnoses were examined, with further imaging serving as the gold standard. The mobile app demonstrated a high concordance rate compared to both the final (0.93) and the initial specialists' diagnoses (0.86). The sensitivities, specificities, and positive predictive values also indicated strong reliability, affirming the app's diagnostic validity. Although the concordance rate was slightly lower when comparing the app's diagnoses to the imaging results (CBCT and MRI), the specialists' diagnoses yielded similar results. The study suggests that user-friendly diagnostic mobile applications, based on the diagnostic criteria for TMD, could enhance the clinical management of TMD. Given the reliability of mobile applications for diagnostic purposes, their wider implementation could facilitate the provision of appropriate and timely treatments for patients with TMD.

Temporomandibular Disorders Treatments and Its Effects on Headaches

Objective: temporomandibular Disorders (TMD) are the most common causes of chronic orofacial pain and, along with primary headaches, are considered Chronic Overlapping Pain Conditions (COPCs). The aim of this study is to evaluate TMD treatment effects in individuals with comorbid headaches. Methods: a systematic review was conducted over a search in the database up to October 2020. Selected studies were randomized clinical trials with individuals diagnosed with TMD and comorbid headaches compared to a control group after treatments for TMD. All included studies were evaluated for their methodological quality through the Cochrane Collaboration tool for assessing the risk of bias. Results: seven studies fulfilled the inclusion criteria and were applied in the review, with a total of 432 participants. Four studies were included in a meta-analysis. There was no significative mean difference in the frequency of headache after TMD treatment, nor for a reduction in pain, after TMD intervention for less than 12 weeks. Although for an individual with a TMD intervention period higher than 12 weeks, there was a significant reduction in pain. Conclusion: there is moderate evidence that painful TMD therapies for 12 weeks or higher reduce headache intensity in individuals with painful TMD and headaches. Simultaneous management of TMD and headache must be prioritized for more effective results on both conditions.

Role of hydrostatic occlusal devices in the management of temporomandibular disorders (TMD) – An overview

Temporomandibular joint (TMJ), an integral component of stomatognathic system, is considered very unique because of the rotation and translation happening inside the same joint and is under the influence of various muscles and ligaments. Pain, clicking and functional impairment give a clue regarding the underlying temporomandibular disorder (TMD). TMD is a multifactorial and complex condition and is very difficult to diagnose and treat. Splints or occlusal devices are most often indicated for the management of TMDs. Rigid occlusal splints act by disengaging occlusion, restoring vertical dimension of occlusion, relaxing muscles and by unloading or repositioning TMJ. Hydrostatic self-adjusting splints help mandible to find its ideal position automatically. Unlike solid splints, hydrostatic splints like ‘Aqualizer’ eliminates the element of guesswork in treatment because of its inherent ability to relieve pressure on the TMJ.

Knowledge and Awareness of Temporomandibular Disorders (TMDs) among Post-graduate residents

INTRODUCTION: Malocclusion and TMD were believed to have a correlation when it is associated that the alteration of form might cause alteration in the stomatognathic system function. A multidisciplinary approach is particularly important for the successful treatment of chronic TMD cases. Management of TMD involves the work of dentists from various specialities. It is multifactorial in nature and requires proper examination and treatment planning. Thus, the primary purpose of this study is to find out the awareness of TMDs among postgraduate students. MATERIALS AND METHODOLOGY: The present study was retrospective in nature. A questionnaire involving TMDs was sent to all postgraduates involved in patient treatment through google forms. All participants were asked to anonymously answer the structured questionnaire containing multiple-choice and open-text questions in google forms. The questionnaire was specially developed for students and was organized into three sections. RESULTS: 204 participants responded and returned the completed questionnaires. Results showed that 98 % of the respondent’s occlusal disturbance causes TMD and TMJ problems are associated with malocclusion. The majority of the participants were aware of the aetiology and diagnosis but only 53% of them were aware of the treatment protocols. CONCLUSION: The causes and diagnosis domains of the questionnaire yielded a high degree of agreement while the treatment modalities were not known. Most of them were not aware of the treatment modalities reason being a lack of knowledge during the course of their undergraduate and postgraduate study.

Presentation and primary care management of temporomandibular disorders: A survey of primary care dentists in Santiago and Newcastle.

Primary care dentists are often the first point of call for people with temporomandibular disorders (TMD) but it is not known how many people present to their dentist with TMD or the forms of first-line management that are routinely offered. To report rates of presentation of TMD and management offered in primary care by general dental practitioners in two similarly urban areas, Santiago, Chile and North-East England. An online survey was developed and distributed to primary care dentists in both regions. Descriptive data were presented to quantify presentation rates and forms of management offered. Responses were received from 215 dentists practising in Chile and 46 in Newcastle. The majority reported seeing 1-2 patients weekly with TMD and less than one new presentation each week. Symptoms were most often treated conservatively and with self-management according to international guidelines. The form of self-management varied however and verbal instructions were often not backed up by written information. This research provides a useful starting point in understanding the presentation to, and initial treatment of TMD in primary care internationally. Limitations included the method of recruitment and potentially non-representative samples. Further research could build on this work by including more countries and using more structured sampling methods. The work will be useful in understanding and planning early care pathways for people experiencing TMD.

Use of occlusal splint in subjects with TMJ disorders by general dental practitioners in Indian scenario

Temporomandibular disorders (TMDs) constitute a global health concern, giving rise to both physical and financial burdens, as evidenced by symptoms and indications indicative of masticatory muscle imbalances. These symptoms encompass manifestations associated with disorders of the masticatory muscles. Scant literature exists regarding the utilization of occlusal splints by general dentists for addressing TMDs within the Indian context. Employing a cross-sectional questionnaire survey, the present study aimed to evaluate the application of occlusal splints in the treatment of temporomandibular issues by Indian dental practitioners. The inquiry involved the administration of a questionnaire designed to investigate the diagnosis, management, and treatment of TMDs by general dentists in India. Responses to the survey questions, provided by 314 general dental practitioners, were subjected to assessment and analysis through statistical methodologies. For practitioners with less than five years of experience, 77.63% (n=118) of participants reported no attendance at Certified Diabetes Educator (CDE) programs, whereas 14.47% (n=22) attended a single CDE session, and 7.89% (n=12) attended multiple CDE sessions related to TMDs. Among those practicing for five to ten years, 57.77% (n=52) did not participate in any TMD-related CDE programs, while 24.4% (n=22) attended one, and 17.7% (n=16) attended more than one. Among practitioners with over ten years of experience, 34.48% (n=20) did not attend any CDE, 24.13% (n=14) attended one, and 37.93% (n=22) attended multiple TMD-related CDE sessions. Diagnosis of TMDs was carried out by 64.33% (n=193) of participants using a combination of study models, imaging, patient history, and medical history. Among a total of 300 subjects, 64.6% (n=194) of participants responded affirmatively to the treatment of patients with TMDs. Hinge and mean value articulators were utilized in conjunction with soft materials for the fabrication of occlusal splints. The survey results suggest a paucity of knowledge among general dental practitioners regarding the application of occlusal splints in the treatment of TMDs.

An Update on Temporomandibular Disorders (TMDs) and Headache.

To provide an overview and highlight recent updates in temporomandibular disorders (TMDs) and their comorbidity with headache disorders regarding pathophysiology and management. In the last decade, there have been great advancements in the understanding of TMDs and their relationship with neurovascular pains such as headaches. Understanding of TMDs is necessary for the context of its comorbidity with primary headache disorders. The literature regarding management of these comorbidities is scarce but points to combination therapy including pharmacological and non-pharmacological approaches to optimize management. The use of CGRP receptor-targeted monoclonal antibodies or CGRP receptor antagonists should be explored for the management of chronic TMDs. It could also be used as a novel monotherapy or in combination with non-pharmacological approaches for TMDs' comorbidity with headache, particularly migraine. Research is needed to support evidence-based management protocols. A team involving neurology (headache medicine) and dentistry (orofacial pain) is critical for optimal management.

Temporomandibular Disorders among Dental Students in Pakistan: Assessment of Prevalence, Severity, and Associated Factors Based on Questionnaire.

To evaluate the prevalence, severity, and associated factors of temporomandibular disorder (TMD) among dental students. This cross-sectional study was performed on undergraduate dental students from four dental colleges in Punjab, Pakistan. Fonseca's questionnaire was used to measure the prevalence and severity of the TMD among the study participants. Bivariate and multiple logistic regression analyses were performed. Of 364 dental students, 323 returned the completed questionnaires and the response rate of the study was 88.7%. The study included 52.6% males and 47.4% females. The prevalence of TMD was 66.9% with mild TMD in 40.90%, moderate TMD in 14.6%, and severe TMD in 11.50% of the participants. Psychological stress (29.6%), malocclusion (20%), and hypersensitivity (19.5%) were common among participants. The mean TMD score of the sample was 31.54 ± 24.86 which was significantly higher among participants with no/school-educated mothers (P=0.021) and fathers (P=0.002). The participants with arthritis (72.81 ± 32.19) and malocclusion (59.46 ± 31.09) and those who received orthodontic treatment (53.21 ± 34.21) demonstrated higher TMD. After controlling for other study variables, the participants with arthritis were 4.71 times more likely to have moderate/severe TMD (P=0.042) than those without arthritis. Similarly, the participants with malocclusion had significantly higher odds (OR = 3.57, P=0.029) of having moderate/severe TMD than those without malocclusion. This sample of dental students demonstrated a high prevalence and severity of TMD. The participants with arthritis and malocclusion demonstrated higher TMD. The study findings underscore the importance of prevention, early diagnosis, and management of TMD among the dental students.

Telemedicine in the diagnosis and management of temporomandibular disorders: A systematic review conducted according to PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions.

Telemedicine (T-Med) has always been an important tool in the arsenal of clinicians worldwide. This technique has become increasingly popular in recent years, especially in light of the COVID-19 pandemic, which has made it difficult for some people to access traditional dental care. The current review aimed to analyse the usage of telemedicine in the diagnosis and management of temporomandibular disorders (TMDs) and its impact on general health. An extensive search of databases was conducted using keywords such as, "telemedicine," "teledentistry," "TMJ" and "temporomandibular disorders," resulting in a total of 482 papers to be available from which eligible studies were selected. The Risk of Bias in Observational Studies of Exposures (ROBINS-E) tool was used to evaluate methodological quality of included studies. Two studies were selected which fulfilled the eligibility criteria. All assessed studies indicated varying degrees of positive outcomes for patients who were intervened for TMDs using T-Med. T-Med shows promising results for the diagnosis and management of TMDs, especially since the advent of the COVID-19 pandemic and thereafter. Long-term clinical trials with larger samples are needed to further ascertain validity in this regard.

External validation of a clinical prediction tool for the use of manual therapy for patients with temporomandibular disorders: a protocol for a prospective observational study

IntroductionClinical guidelines recommend conservative treatment for the management of temporomandibular disorders (TMD), and manual therapy directed to temporomandibular structures is commonly applied to reduce pain and improve function. In a...