Maximum Voluntary Mouth Opening Research Articles

Synergistic effect of platelet rich plasma with hyaluronic acid injection following arthrocentesis to reduce pain and improve function in TMJ osteoarthritis

Increasing evidence supports the use of platelet-rich plasma (PRP) combined with hyaluronic acid (HA) for the treatment of knee osteoarthritis, which effectively promotes cartilage repair. This study aimed to determine whether injection of PRP+HA following arthrocentesis reduces pain and improves maximum incisal opening. This was a single-blind, prospective, randomized control study. The patients were selected based on the Hegab classification: Group I: patients treated with arthrocentesis followed by a single PRP injection; Group II (Control): patients treated with arthrocentesis followed by a single HA injection; and Group III: patients treated with arthrocentesis followed by a single PRP+HA combination injection. The primary predictor variable was the medication used for injection. The primary outcome variables were the maximum voluntary mouth opening and pain index scores. The secondary outcome variable was joint sounds. All outcome variables were assessed and compared among the three groups at baseline and at 1-, 3-, 6-, and 12-month intervals. Other variables, including patients’ age and sex, were evaluated in relation to the patient outcomes. Injecting PRP+HA showed statistically significant improvement in the primary and secondary treatment outcomes over PRP or HA injection throughout the study period (P<0.005). Injection of PRP+HA following arthrocentesis had significant long-term clinical efficacy regarding pain relief that considered the main concern of both the patient and clinician.

Comparison between two viscosupplementation protocols for temporomandibular joint osteoarthritis

ABSTRACT Objective This clinical trial aimed to compare the efficacy of two protocols using high molecular weight hyaluronic acid (HA) intra-articular injection in patients with temporomandibular joint (TMJ) osteoarthritis and evaluate involvement of subchondral bone changes and psychosocial factors as predictors of HA treatment. Methods Twenty-one individuals were divided into two groups: (A) received three intra-articular HA injections, and (B) received one injection. Outcomes observed were pain intensity, functional limitation, maximum voluntary mouth opening, maximum assisted mouth opening, and treatment tolerability. Follow-ups were performed weekly for 21 days, and two months after the treatment started. Results No statistically significant intergroup differences were observed in any of the evaluated outcomes. However, Group A showed significant improvement in all outcomes, whereas Group B showed significant improvement only in pain intensity and functional limitation. Conclusion This study demonstrated the effectiveness of both protocols in terms of pain intensity and functional limitation caused by osteoarthritis.

Classification of temporomandibular joint internal derangement based on magnetic resonance imaging and clinical findings of 435 patients contributing to a nonsurgical treatment protocol

This prospective clinical study aimed to establish a new classification system for TMJ internal derangement based on MRI in correlation with clinical findings contributing to a nonsurgical treatment protocol. A consecutive sample of 435 internal derangement patients was enrolled in the study. Clinical and MRI studies were used to establish the new classification system. A total of 747 joints were classified according to our staging system and received treatment according to the associated nonsurgical treatment protocol. The primary outcome variables were maximum voluntary mouth opening and visual analogue scale pain scores. The secondary outcome variable was joint sound. Statistical analysis of the differences between pretreatment and posttreatment measurements showed an increase in mouth opening throughout the study period (P < 0.001 at 12 m posttreatment). Statistical analysis of the VAS scores showed a statistically significant decrease in all study groups during all study periods, with P < 0.0001 at 12 months posttreatment. Statistical analysis of joint sounds showed significant improvement during all study periods. The new classification system is a simple, & reasonable including a detailed description of all the pathologic changes of the joint. The nonsurgical treatment protocol was Simple, effective and specific depending on the pathological changes in joint.

MRI-based determination of occlusal splint thickness for temporomandibular joint disk derangement: a randomized controlled clinical trial

This prospective study examined a method using magnetic resonance imaging (MRI) to assess the appropriate effective occlusal splint vertical thickness in the management of disk derangement. Patients were diagnosed as having internal disk displacement of the temporomandibular joint and were divided into 2 groups. Group I (disk displacement with reduction) was subdivided randomly into 2 subgroups: subgroup IA (control group) comprising patients treated with 3-mm-thick splints; and subgroup IB (study group) comprising patients treated with MRI-based splint thickness. Group II (disk displacement without reduction) was subdivided randomly into 2 subgroups: subgroup IIA (control group) comprising patients treated with 3-mm-thick splints; and subgroup IIB (study group) comprising patients treated with MRI-based splint thickness. The primary outcome variables were maximum voluntary mouth opening and visual analogue scale scores for pain. The secondary outcome variable was joint sound. The final sample was composed of 162 patients (Group I = 90 and Group II = 72). Statistical analysis showed significant improvement of the clinical outcomes in subgroups IB and IIB compared with that in subgroups IA and IIA. On the basis of MRI measurements and clinical outcome, the present study we recommend 4-mm and 6-mm vertical splint thickness for disk displacement with reduction and disk displacement without reduction, respectively, for 1 year.

Maximum mouth opening of ethnic Chinese in Taiwan

Background/purpose Maximum mouth opening (MMO) is a significant diagnostic reference for many clinical conditions. However, the number of relevant studies is limited, and the relationship between age and MMO has not yet been established. The purpose of this study was to measure and analyze the MMO of ethnic Chinese adults in Taiwan and to examine the possible relationship between age and MMO. Materials and methods A total of 1442 adult ethnic Chinese (Taiwanese) subjects aged 20–80 years (705 males, 737 females) were randomly selected. Subjects were divided into three age groups: 20–39 years (young), 40–59 years (middle), and ≥ 60 years (senior), and their maximum voluntary mouth opening was measured. Independent sample t test and one-way ANOVA followed by the post hoc Scheffe test were used to examine differences in MMO relative to sex and age groups. A simple linear regression model was used to estimate the relationship between MMO and age. Results The average MMO for sample subjects was 49.10 ± 6.30 mm, and the MMO of males (49.92 ± 6.55 mm) was significantly larger than that of females (48.32 ± 5.95 mm; P Conclusion Within the limits of this study, we concluded that both sex and age have significant influences on the MMO value of ethnic Chinese in Taiwan, and age is a significant predictor of MMO measurements.

Evaluation of the applicability of Temporomandibular Opening Index in Turkish Children With and Without Signs and Symptoms of Temporomandibular Joint Disorders

Limitation of mandibular movement is one of the cardinal signs of temporomandibular disorders. Temporomandibular Opening Index (TOI) is a new technique to determine the restricted mouth opening in temporomandibular joint dysfunction syndrome (TMD). The purpose of this study was to compare the TOI of Turkish children with and without TMD in primary, mixed, and permanent dentitions. In this study, a total of 270 children were evaluated. One hundred thirty-five (135) subjects had no signs or symptoms of TMD (Group 1), while the remaining 135 subjects did have signs and symptoms of TMD (Group 2). Forty-five (45) patients were selected for each dentition for two groups. “Maximum Voluntary Mouth Opening” (MVMO) values and TOI ranges were calculated. A Mann-Whitney U test and a Kruskal Wallis test were used to compare the data (p<0.05). TOI showed statistical differences between all dentitions with and without TMD (p<0.05). There were no significant differences between different dentitions or genders in Group 1 or Group 2 (p<0.05).

Following treatment of myogenous TMD patients with the temporomandibular opening index: an initial report.

Limitation of mandibular movement is one of the cardinal signs of temporomandibular disorders (TMD), usually assessed by measurement of maximum voluntary mouth opening. A new measure of assessing mandibular mobility, the temporomandibular opening index (TOI), is less dependent on variables such as age, gender and ramus length. It has also been found to be useful to categorize patients. This study examined changes in TOI as treatment progressed in a group of myogenous TMD patients. Seven patients with myogenous TMD were included in the study and the TOI determined at 0 and 2 weeks, 1 and 6 months after initiation of treatment. Treatment outcome was assessed on a 4 point scale, 0=none, 1=mild, 2=moderate, and 3=severe. Headache, neckache, pain (joints and muscles) and joint sounds were assessed. Nine patients with no signs or symptoms of TMD were included to obtain a normal TOI. The mean TOI of the patient group was 16.4% (s.d.=11.2%) initially and 3.95% (s.d.=1.0%) at 6 months, while mean treatment scores changed from 12.57 (s.d.=3.05) to 1.43 (s.d.=1.90). The mean TOI of the control group was 3.63 (s.d.=0.74). A paired t-test showed that the TOI decreased significantly with time (P=0.02) while there was a concomitant decrease in treatment score (P=0.0003) over the same period. The TOI may be a useful method of following treatment of this group of myogenous TMD patients.

Effect on prostaglandin E2 and leukotriene B4 levels by local administration of glucocorticoid in human masseter muscle myalgia

Our aim was to determine whether masseter muscle (M) and plasma (P) levels of prostaglandin E2 (PGE2) or leukotriene B4 (LTB4) are influenced by local glucocorticoid administration and whether such changes would be associated with corresponding changes in local pain or hyperalgesia. Eighteen patients with fibromyalgia and 15 with local masseter myalgia were examined immediately before and 2 weeks after intramuscular administration of glucocorticoid with regard to masseter muscle resting pain and tenderness to palpation, pressure pain threshold, maximum voluntary mouth opening (MVM), and pain on maximum voluntary mouth opening. The primary criteria for inclusion were presence of pain for a period of at least 3 months and tenderness to digital palpation in the masseter muscle region. At both visits microdialysis samples were obtained from the masseter muscle, and venous blood was collected for analysis of PGE2 and LTB4. Dialysate levels of M-PGE2 did not change significantly after glucocorticoid administration, but reduction of masseter resting pain and increase of MVM were associated with decrease of M-PGE2 in the patients with fibromyalgia. Dialysate levels of M-LTB4 increased in both groups. In the patients with local myalgia the plasma level of LTB4 also increased, and this increase was associated with a decrease of pain and masseter tenderness. In conclusion, this study shows that reduction of masseter level of PGE2 after intramuscular glucocorticoid administration is associated with a decrease of resting pain in patients with fibromyalgia. In addition, the masseter muscle level of LTB4 increases in patients with fibromyalgia and local myalgia.

Tumor necrosis factor-alpha in synovial fluid and plasma from patients with chronic connective tissue disease and its relation to temporomandibular joint pain

Purpose: The purpose of this study was to determine the level of tumor necrosis factor-alpha (TNF-α) in the temporomandibular joint (TMJ) synovial fluid (SF-TNF-α) and blood plasma (P-TNF-α) of patients with chronic inflammatory connective tissue disease and investigate its relation to TMJ pain, hyperalgesia, and allodynia.Patients and Methods: Twenty-four patients with a diagnosis of chronic inflammatory connective tissue disease and TMJ pain were included in the study. Visual analog scale, tenderness of the TMJ, and pain at mandibular movements were registered, and the pressure pain threshold and pressure pain tolerance levels were measured. TMJ synovial fluid samples and blood plasma were analyzed for TNF-α and the levels related to TMJ pain, hyperalgesia, and allodynia.Results: TNF-α was present in the TMJ synovial fluid of 8 of 24 patients at levels significantly exceeding those in plasma at the same visit. The presence of SF-TNF-α showed a significant positive correlation to TMJ pain at maximum voluntary mouth opening and tenderness to posterior palpation of the TMJ.Conclusion: Local production of TNF-a occurs in the TMJ synovium of patients with chronic inflammatory connective tissue disease. Pain on mandibular movement and tenderness on posterior palpation (allodynia) of the TMJ is related to the level of SF-TNF-α.

Pain and synovial fluid concentration of serotonin in arthritic temporomandibular joints

The aim of this study was to investigate the relation between serotonin in the synovial fluid (SF-5-HT) and pain of arthritic temporomandibular joints (TMJ). The study comprised 1 male and 10 female patients (22 TM joints) with bilateral TMJ pain or tenderness and a mean age of 42 years. The patients were studied regarding pain from the TMJ at rest and during mandibular movements as well as regarding pressure pain thresholds and tolerance levels over the TMJ. TMJ samples, obtained by saline washing of the joint, and blood serum samples were taken for measurement of the 5-HT content. There was a positive correlation between SF-5-HT and pain in the TMJ upon movement. Maximum voluntary mouth opening ability was negatively correlated to SF-5-HT. In conclusion, the results of this study indicate that 5-HT in the TMJ synovial fluid is related to pain perceived upon movement of the joint and to decreased mandibular mobility.

Symptoms and signs of temporomandibular disorders in patients with fibromyalgia and local myalgia of the temporomandibular system: A comparative study

Hedenberg-hiagnusson B, Ernberg M, Kopp S. Symptoms and signs of temporomandibular disorders in patients with fibromyalgia and local myalgia of the temporomandibular system. A comparative study.Symptoms and signs of temporomandibular disorders (TMD) in 46 patients were investigated and compared with those in 20 healthy individuals. Twenty-three patients had fibromyalgia (FM) and 23 had local myalgia &M). Facial pain was assessed with a visual analogue scale, and a clinical examination was performed, including maximum voluntary mouth opening, temporomandibular joint sounds, tenderness to digital palpation in the masticatory muscles, pressure pain threshold and tolerance level of the superficial masseter muscle, intramuscular temperature, and maximum voluntary bite force. There was a difference in the number of tender muscles between the groups. Pressure pain threshold and tolerance levels were lower in the FM than in the LM group, whereas both showed lower values than a control group (C). The intramuscular temperature and maximum voluntary mouth opening were lower in the patient groups than in the C group. TMD sounds showed a difference between all three groups. In conclusion, this study shows that FM patients frequently have TMD and indicates several differences between patients with FM and LM with regard to clinical variables.

両側性筋突起過形成症の１例

Here we report a case of bilateral coronoid process hyperplasia. A 37-year-old man was referred because of limited mouth opening. Panoramic tomography revealed bilaterally elongated coronoid processes protruding over the zygomatic arch. The coronoid processes were resected extraorally, and the maximum voluntary mouth opening was improved from 22mm to 40 mm.