Management Of Temporomandibular Joint Disorders Research Articles

Comparative efficacy of low-level laser therapy (LLLT) to TENS and therapeutic ultrasound in management of TMDs: a systematic review & meta-analysis

ABSTRACT Objective To assess the reduction in pain, muscle tenderness, joint clicking, and improvement in mouth opening (MO) after low-level laser therapy (LLLT) compared to transcutaneous electrical nerve stimulation (TENS) and therapeutic ultrasound (US) among temporomandibular joint disorder (TMD) patients. Methods A systematic search of online sources of electronic databases was undertaken. The quality of the study was assessed using the Cochrane risk of bias assessment tool for randomized controlled trials (RCTs). Results Twelve RCTs were included in the systematic review, and 9 were included in the meta-analysis. For reduction in pain between LLLT and TENS, LLLT was found to be better than TENS, at 95% CI. LLLT was also proven to be better in reducing pain than therapeutic US, at 81% CI. Conclusion This systematic review and meta-analysis compared the effectiveness of LLLT, TENS, and therapeutic US in TMD. LLLT provided relatively more effective pain relief and improvement in MO.

Effectiveness of cervical spine manual therapy in the management of temporomandibular joint disorders: A systematic review

Effectiveness of cervical spine manual therapy in the management of temporomandibular joint disorders: A systematic review

Nano Drug Delivery Platforms for Dental Application: Infection Control and TMJ Management-A Review.

The oral cavity is an intricate environment subjected to various chemical, physical, and thermal injuries. The effectiveness of the local and systemically administered drugs is limited mainly due to their toxicities and poor oral bioavailability that leads to the limited effectiveness of the drugs in the target tissues. To address these issues, nanoparticle drug delivery systems based on metals, liposomes, polymeric particles, and core shells have been developed in recent years. Nano drug delivery systems have applications in the treatment of patients suffering from temporomandibular joint disorders such as preventing degeneration of cartilage in patients suffering from rheumatoid arthritis and osteoarthritis and alleviating the pain along with it. The antibacterial dental applications of nano-drug delivery systems such as silver and copper-based nanoparticles include these agents used to arrest dental caries, multiple steps in root canal treatment, and patients suffering from periodontitis. Nanoparticles have been used in adjunct with antifungals to treat oral fungal infections such as candida albicans in denture wearers. Acyclovir being the most commonly used antiviral has been used in combination with nanoparticles against an array of viral infections such as the herpes simplex virus. Nanoparticles based combination agents offer more favorable drug release in a controlled manner along with efficient delivery at the site of action. This review presents an updated overview of the recently developed nanoparticles delivery systems for the management of temporomandibular joint disorders along with the treatment of different oral infections.

Recovery of Post-Traumatic Temporomandibular Joint after Mandibular Fracture Immobilization: A Literature Review

Considered as one of the most common traumatic injuries of the maxillofacial region, mandibular fractures remain among the complex causes of temporomandibular joint disorders (TMDs). Due to the complexity of the temporomandibular joint, the management of TMDs represents a challenge in real-life practice; although many treatment modalities have already been proposed, ranging from conservative options to open surgical procedures, a consensus is still lacking in many aspects. Furthermore, despite continuous improvement of the management of mandible fractures, the duration of immobilization and temporary disability is not reduced, and the incidence of complications remains high. The aim of the present study is to (i) review anatomophysiological components of temporomandibular joint; (ii) review concepts of temporomandibular joint fractures; and (iii) describe methods of the recovery of the temporomandibular joint after mandibular fracture immobilization.

Surgical Treatment Modalities in the Management of Temporomandibular Joint Disorders

Surgical Treatment Modalities in the Management of Temporomandibular Joint Disorders

English

BACKGROUND Temporomandibular joint disorders (TMD) are a group of disorders associated with temporomandibular joints, their associated muscles, and other related structures. TMD present with pain in the joints and related structures which can radiate to the neighbouring areas mimicking ear pains, headaches, neuropathic pain and odontogenic pain. Even though TMDs are more seen in both genders, the ratio of women reporting with TMD is higher (2:1) than men. Pain, the commonest symptom encountered, is usually chronic in duration and mild to severe in intensity. Various other signs and symptoms described are clicking or popping noise, deviation of the mandible, restricted mouth opening and jaw movements. Multiple factors have been reported as an aetiology, however, there is no definite established aetiology to cause TMD. Approaches to the management of TMDs require thorough history taking, clinical and radiological assessment and proper treatment planning. The signs, symptoms, and prevalence of the diseases are also necessary considerations in the treatment planning of TMDs. Traditional approaches in the management of TMDs involve systemic medications, physical therapies, and surgical interventions. The first line of systemic medications to be advised to relieve pain are analgesics. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, muscle relaxants, barbiturates like benzodiazepine have been frequently administered. In recent times, extraction of impacted or buccoverted third molar teeth has also proven to be effective in reducing the pain associated with TMDs. The purpose of this study is to provide new clinical practice guidelines to establish a multidisciplinary approach in the management of patients with TMDs and to improve the patient’s quality of life (QoL). KEY WORDS Pain, Temporomandibular Joint Disorder, TMD, Treatment Guidelines

Efficacy of Transcutaneous Electric Nerve Stimulation over Systemic Pharmacotherapy in the Management of Temporomandibular Joint Disorders – A Systematic Review and Meta-Analysis

Temporomandibular disorders (TMDs) encompass numerous clinical complications that involve the temporomandibular joint (TMJ), masticatory musculature, and its associated structures, or both. Abundant research in this field has been conducted; however, there is no conclusive evidence reported in the effective management of TMD using physical therapy such as Transcutaneous Electric Nerve Stimulation (TENS). The systematic review and meta-analysis aimed to compare and evaluate the efficacy of transcutaneous electric nerve stimulation over systemic pharmacotherapies in the management of symptomatic patients with temporomandibular joint disorders. The present review has been registered with PROSPERO – An international prospective register of systematic review (CRD42021233019). An electronic search was done in PubMed, Cochrane Library, Science Direct, Google Scholar, Latin American and Caribbean Health Sciences Literature (LILACS), ClinicalTrial.gov, and sci-hub.se. Manual electronic searches were also carried out and articles were handpicked. The assessments of articles were done using selection criteria. There are a vast number of studies done in this subject of interest and hence, only prospective clinical trials like Randomized clinical trials (RCTs) and controlled clinical trials (CCTs) were included in this review. A total of three studies were included in this review, which consisted of prospective RCTs and CCTs. Two studies have been reported for meta-analysis. The included studies show TENS is proven to be effective in the management of TMD. The currently available evidence was insufficient to conclude the effectiveness of transcutaneous electric nerve stimulation and systemic pharmacotherapies in temporomandibular joint disorders. Based on the results of the meta-analysis, we can conclude that there was a significant reduction in pain encountered due to TENS.

Conservative Treatment Modalities in The Management of Temporomandibular Joint Disorders

Conservative Treatment Modalities in The Management of Temporomandibular Joint Disorders

Effectiveness of Splint Therapy in the Management of Temporomandibular Joint Disorders

Effectiveness of Splint Therapy in the Management of Temporomandibular Joint Disorders

A SYSTEMATIC REVIEW OF CLINICAL OUTCOMES IN THE TREATMENT OF TEMPOROMANDIBULAR JOINT DYSFUNCTION USING ULTRASOUND GUIDED ARTHROCENTESIS AND CONVENTIONAL THERAPY

Objective: This systematic review aimed to compare outcomes between ultrasound (US)-guided arthrocentesis and conventional arthrocentesis for the management of temporomandibular joint disorders (TMDs). Methods: PubMed, MEDLINE, Cochrane Library, Google Scholar and th EBSCOhost databases were searched up to 30 September 2020 for randomized control trials (RCTs) comparing US-guided and conventional arthrocentesis. The review protocol followed the PRISMA guidelines and was registered in PROSPERO (CRD42020211942). The risk of bias of the studies was independently evaluated using Cochrane Risk of Bias tool. Results: Four RCTs were included. It did not demonstrate any statistically signicant difference in pain or maximal mouth opening (MMO) scores after 1 week and 1 month of follow-up between US-guided and conventional arthrocentesis. Studies also reported data on intra-operative needle relocations and operating time but with conicting results. Conclusion: This study indicates that the use of US during arthrocentesis may not improve postoperative pain and MMO in the short term. Further high-quality adequately powered RCTs are required to strengthen current evidence.

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.

Therapeutic Agents for the Treatment of Temporomandibular Joint Disorders: Progress and Perspective.

Temporomandibular joint disorders (TMD) are a common health condition caused by the structural or functional disorders of masticatory muscles and the temporomandibular joint (TMJ). Abnormal mandibular movement in TMD patients may cause pain, chronic inflammation, and other discomfort, which could be relieved by a variety of drugs through various delivery systems. In this study, we summarized commonly used therapeutic agents in the management of TMD as well as novel bioactive molecules in preclinical stage and clinical trials. The emerging therapy strategies such as novel intra-TMJ delivery systems and implants based on tissue engineering are also discussed. This comprehensive review will strengthen our understanding of pharmacological approaches for TMD therapy.

Awareness of the Role of Physiotherapy in Temporomandibular Disorders amongst DentistsAwareness of the Role of Physiotherapy in Temporomandibular Disorders amongst Dentists

Purpose: Temporomandibular joint disorder (TMD) is a complex disorder usually characterized by pain,crepitus and reduced movement which may be caused due to unbalanced activity, muscular spasm, oroveruse of the jaw muscles. Awareness among dentists in and around Mumbai and Navi-Mumbai about PT’srole for TMD treatment was found to be unknown. Therefore, the study aimed at finding out the awarenessof physiotherapy management of TMD amongst dentists.Method: This was a cross-sectional study including 100 dentists done over a period of 6 months. Thedata was collected from various private setups and hospitals in and around Mumbai and Navi-Mumbai. Aconsent form and a self-prepared validated questionnaire was used. The data was statistically analysed anddescriptive analysis was done with the help of pie charts and bar diagrams.Results: In our study 89% of the dentists considered physiotherapy as a treatment option for TMD. However,49% of the dentists refer people with TMD to physiotherapists. Fewer dentists were aware that physiotherapyhelps in improving strength and coordination of jaw muscles while greater number of dentists were awarethat physiotherapy also helps in pain relief, relaxation, minimization of stiffness and restoration of normalmobility and function.Conclusions: Although a large percentage of dentists that completed the survey were aware of the role of PTin treating people with TMD, the rate of referral was low. Therefore, there is a need to educate the dentistsabout the role of physiotherapy in treating people with TMD, to encourage them to refer people with TMDand thereby promote multidisciplinary rehabilitation of this complex disorder.

Evaluating the Efficacy of the Occlusal Splint on the Muscle Activity with the Transducer in Patients with Temporomandibular Joint Dysfunction Syndrome.

A prospective study was designed to evaluate the effectiveness of occlusal splint therapy for the management of temporomandibular joint disorder. This study recorded the activity of anterior temporalis and masseter muscles in patients with TMD using a transducer before and after conservative management with splint therapy. The results suggested that VAS mean dropped from 21.2 to 11% for temporalis and from 12.6 to 7% for masseter. The study concludes that the occlusal splints has a prominent action on muscles of mastication and can be effectively used in early stages of TMD.

Effect of low-level laser application in conjunction with splint therapy for management of temporomandibular joint disorders

This Randomized clinical trial was conducted to assess the value of using LLLT (Low level Laser Therapy) plus Splint therapy in comparison with using splint therapy alone for treatment of TMDs. Subject & methods. Twenty-six patients with TMDs were divided into 2 equal groups: Group I was the trial group where 5 LLLT sessions were done for all patients on a period of 5 weeks in conjunction with splint therapy, group II as a control group (splint therapy only). pain level, maximum mouth opening, lateral excursions, clicking sounds & disc position were all recorded and analyzed statistically. Results. There was a non-statistically significant difference after 6 Months concerning pain level, maximum mouth opening, lateral excursions & disc position However there were improvement regarding pain level initially for the trial group. Conclusion. LLLT proved to be helpful and encouraging effect in alleviating pain during acute phase of treatment of TMDs, however it has no significant effect on range of motion or disc position.

Management of temporomandibular joint disorders using acupuncture: A case report

Background: Temporomandibular joint disorder (TMD) is a term for disease of the TMJ and the muscles attached to it. The symptoms and signs of TMD are clicking, crepitation, headache, and pain in and around the TMJ. Management of TMD includes dental approaches (e.g., splints, bite plates, and jaw exercises) and surgical approaches. Acupuncture is a Chinese medicine that consists of insertion of small solid stainless-steel needles into many acupoints on the body to improve health and relieve pain in the surrounding areas. Case Report: A 34-year-old male patient reported with severe pain in the right and left TMJ region and difficulty in opening of his mouth for the past 6 months. Extra-oral examination revealed tenderness on both sides of the face, deviation of the mouth toward the right side, the mouth opening was two finger breadths, and mild early-opening click. Intra-oral examination revealed the presence of 28 teeth. Orthopantogram did not show any changes in the condyle and articular eminence. The patient was initially treated with palliative therapy and then treated with acupuncture. Conclusion: Acupuncture is an alternative mode of treatment for persons with muscular TMD.

Ultrasound-guided vs conventional arthrocentesis for management of temporomandibular joint disorders: A systematic review and meta-analysis

ABSTRACT Objective This systematic review and meta-analysis aimed to compare outcomes between ultrasound (US)-guided arthrocentesis and conventional arthrocentesis for the management of temporomandibular joint disorders (TMDs). Methods PubMed, Embase, Scopus, BioMed Central, CENTRAL, and Google scholar databases were searched up to April 1 2020 for randomized control trials (RCTs) comparing US-guided and conventional arthrocentesis. Results Four RCTs were included. Pooled analysis did not demonstrate any statistically significant difference in pain or maximal mouth opening (MMO) scores after 1 week and 1 month of follow-up between US-guided and conventional arthrocentesis. Studies also reported data on intra-operative needle relocations and operating time but with conflicting results. Conclusion This study indicates that the use of US during arthrocentesis may not improve postoperative pain and MMO in the short term. Data on intra-operative outcomes are scarce and conflicting for any definitive conclusions. Further high-quality adequately powered RCTs are required to strengthen current evidence.

Clinical Applications of Botulinum Toxin in Oral and Maxillofacial Surgery

Botulinum toxin is a toxin produced by Clostridium botulinum bacteria. This toxin has eight known serotypes, among which both A and B are currently used in medicine. Its mechanism of action acts on inhibiting acetylcholine release at neuromuscular junctions following its local injection. This toxin has wide applications in dentistry in general and in oral and maxillofacial (OMF) surgery in particular. It can be applied in the management of temporomandibular joint disorders, neuropathic facial pain, facial nerve palsy, hypertrophy, and hyperactivity of masticatory muscles as examples. At present, it can be used in cosmetic treatment in the facial region to control wrinkles and asymmetry. The therapeutic effects of these toxins are temporary and relatively safe if used in an appropriate manner. This review was aimed to identify the uses of botulinum toxin in surgical and non-surgical treatment of OMF problems, the types of treatment available, and benefits of those treatments.

The current referral patterns for temporomandibular joint disorders (TMD) in Greater Manchester.

Temporomandibular joint disorders (TMD) affect up to 50% of the population. Chronic TMD may have a significant impact on patients' quality of life and is associated with a significant cost burden to health services. The aim of this study was to investigate the incidence of TMD in Greater Manchester and to determine the most appropriate setting for its management. Data were retrospectively collected on the demographics, symptoms and management provided to patients referred for TMD. There were 789 referrals analysed; 616 to a Tertiary Centre and 173 to a District General Hospital (DGH). The most common reason for referral was pain (82%), followed by limitation in opening (55%) and clicks or sounds (44%). 27% of referrals were managed with a splint and 12% were provided with advice or a patient information leaflet prior to referral. The effect of chronic pain on patients' quality of life and the cost burden of its management compels us to review current practices in referral and management of TMD. Barriers to provision of treatment in primary care may include a lack of training, remuneration or confidence. These may be overcome with the development of self-care plans for patients and a care pathway for practitioners. Based on existing evidence, timely and conservative management of TMD should be encouraged in primary care, enabling better outcomes to be achieved for patients and the maintenance of the experience and skill level of specialist services in secondary care.

EFFICACY OF TMJ ARTHROCENTESIS IN TEMPOROMANDIBULAR JOINT DISORDERS

Objective: The purpose of this study was to determine the efficacy of the Arthrocentesis in Temporomandibular joints disorders in terms of pain reduction and trismus. Materials and Methods: A total of 30 patients was randomly selected from the department of oral and Maxillofacial Surgery, Bacha Khan Medical Complex, Gajju Khan Medical College, Swabi. Age more than 25 years, with Joint noise, mouth opening less than 35mm, Pain at TMJ, patients having conservative treatment failed were included. Patients having systemic involvement, with previous intervention, joint infection, previous and trauma were excluded. Joint lavage was done under local anesthesia, and Arthrocentesis was performed. Data were analyzed by SPSS 20.0. Wilcoxon signed ranks test was applied to compare pain and mouth opening between the preoperative and postoperative periods. P≤0.05 was considered significant. Results: Of total 30 sample n=11(36.7%) were males and n=19(63.3%) were females. The mean age was 36.03±7.604 years, with a range of 25-50 years. The overall mean pain score on the visual analog scale (VAS) decreased from the preoperative period (6.9±2.295) to after one week (2.267± 0.98) and at 3rd month (0.8±0.847) after Arthrocentesis. The overall mean mouth opening increased form preoperative period (31.03±8.206 mm) to after one week (42.1±5.346 mm) and in 3rd month (42.13±5.316 mm) after Arthrocentesis. The reduction in mean pain on VAS at 7th day and 3rd month were very highly statistically significant (P<0.001). The increase in mouth opening at 7th day and 3rd month were very highly statistically significant (P<0.001). There was no difference between males and females. In both genders, the decrease in pain and mouth opening was statistically significant (P<0.00). Conclusion: Arthrocentesis is a minimally invasive surgical procedure for the management of Temporomandibular joint disorders with an excellent improvement of mouth opening and reducing pain.