Myogenous Temporomandibular Disorders Research Articles

Impact of applying different levels of threshold-based artifact correction on the processing of heart rate variability data in individuals with temporomandibular disorder.

Although heart rate variability (HRV) is a valid method to evaluate the behavior of the autonomic nervous system in individuals with temporomandibular disorder (TMD), the measurement can easily be biased by factors involving the analysis methodology, such as the removal of artifacts. Therefore, the objective of this investigation is to evaluate the impact of using different levels of threshold-based artifact correction to process HRV data in individuals with TMD. This cross-sectional observational study. Adults aged 18 to 55 years old with a diagnosis of myogenic TMD, score ≥ 50 on the Fonseca Anamnestic Index (FAI) and pain ≥ 3 on the Numerical Pain Scale (NPS) participated. The HRV was registered in the supine position (short-term) using a Polar S810i. Kubios software was used for HRV analysis using all filters. One-way ANOVA with Tukey-Kramer post-hoc was used to test the differences in HRV using the different Kubios Software artifact correction filters. The effect size was calculated based on the Cohen d. The very strong filter was statistically different (p < 0.05) compared to the no filter in all overview and time domain variables. In the frequency domain, the variables VLF, LF, HF and Total Power showed statistical differences (p < 0.05) when using the very strong filter. The same occurred with the variables SD1, SD2 and DFA α2 of the non-linear analysis (p < 0.05). The most restrictive filter of the Kubios software (very strong) significantly impacts the quantification of HRV parameters in individuals with TMD.

Evaluation of the single and combined therapeutic effects of individually manufactured earplug therapy in patients with myogenous temporomandibular disorders: A randomized controlled clinical trial

ObjectiveTo evaluate the effect of individually manufactured earplug therapy on pain intensity (PI), symptom severity (SS), and maximum mouth opening (MMO), in patients with myogenous temporomandibular disorders (TMD).MethodsOne-hundred-twenty patients were randomly allocated to six groups: Groups EP (earplug), OS (occlusal splint), EX (exercise), EPO (earplug with occlusal splint), EPE (earplug with exercise), and C (control). Outcomes were PI (assessed with a visual analog scale (VAS)), SS (assessed with the modified Symptom Severity Index Questionnaire (mSSI)), and MMO (evaluated with a digital caliper). Measurements were performed at T0 (before the therapy), T1 (1-month follow-up), and T2 (3-month follow-up). Data were analyzed using one-way analysis of variance (ANOVA), Tukey’s HSD, and chi-square tests (alpha = 0.05).ResultsAt T1 and T2, the greatest VAS and mSSI reduction was detected for the groups EPE (VAS = 5.3 ± 1.05, 3.3 ± 0.7; mSSI = 38.2 ± 2.27, 43.6 ± 3.94) and EPO (VAS = 5.2 ± 0.91, 3.2 ± 0.78; mSSI = 36.3 ± 3.97, 42.2 ± 3.19), respectively (p < 0.05). At T1, occlusal splint groups (groups OS (34.8 ± 2.97 mm) and EPO (33.8 ± 3.49 mm)) gave the highest MMO values, while T2 values did not constitute a significant difference with T1 (p > 0.05).ConclusionsThe short-term use of combined earplug therapy resulted in a decrease in both PI and SS. Improvement in MMO in participants using occlusal splints was observed in the 1st month and was maintained through the 3rd month.Clinical RelevanceEarplug therapy can be applied as a complementary therapy to occlusal splint and exercise treatments to decrease PI and SS in patients with myogenous TMD. To achieve functional recovery such as MMO, its combined use with splints should be taken into consideration by clinicians.

The Relationships Between Psychosocial Factors and Short-Term Treatment Outcomes of Massage Therapy in Patients with Myogenic Temporomandibular Disorders: A Single-Arm Preliminary Study.

Massage therapy is included as part of a comprehensive treatment plan for patients with temporomandibular disorders (TMDs). However, it displayed varying degrees of success. Preexisting psychosocial impairments may be one of the possible factors affecting the treatment response. This preliminary study aimed to investigate the relationships between psychological factors and treatment outcomes of massage therapy in myogenous TMD patients. Twenty-two myogenous TMD patients were enrolled in this single-arm preliminary study. Baseline psychosocial assessment was done using self-report measures associated with chronic pain severity, depression, anxiety, and non-specific physical symptoms. Massage therapy including the intraoral and extraoral massage of the face and neck muscles was performed twice a week for 4 weeks. Pain intensity and quality of life related to oral health were evaluated as treatment outcomes before and immediately after eight sessions of massage therapy. Regression analyses showed a significant effect of depression on changes in the quality of life after massage (β = 0.35, p-value = 0.026). In addition, results showed a significant effect of chronic pain severity on changes in the pain intensity following massage (β = 1.50, p-value = 0.027). Our findings suggested that psychosocial characteristics of myogenous TMD patients should be considered as important factors that may adversely affect pain intensity reduction and quality-of-life improvement after short-term massage therapy.

Physical therapy in addition to occlusal splint in myogenic temporomandibular disorders: A randomised controlled trial.

Myogenic temporomandibular disorders (M-TMD) commonly involve occlusal splint (OS) therapy and musculoskeletal physiotherapy (MPT). To compare the effects of combining OS with MPT and education (EG) against OS and education (CG), in chronic M-TMD patients. In this double-blind randomised controlled trial, 62 participants were assigned to either EG or CG. The primary outcomes, pain levels at rest (VAS rest), maximum oral opening (VAS open) and during chewing (VAS chew), were measured by Visual Analogue Scale (VAS) in cm. The secondary outcome was the range of motion (ROM) for maximum oral opening. Both interventions lasted 3 months, with outcomes assessed at baseline (T0), post-treatment (T1) and 3 months post-treatment (T2). Intention-to-treat analysis revealed significant improvements favouring EG (VAS rest = -1.50 cm [CI95%: -2.67, -0.32], p = .04; VAS open = -2.00 cm [CI95%: -3.23, -0.75], p < .01; VAS chew = -1.71 cm [CI95%: -2.90, -0.52], p = .01; ROM = 4.61 [CI95%: 0.93, 8.30], p = .04). Additionally, VAS measures were influenced by follow-up times (VAS rest = -0.73 cm [CI95%: -1.30, -0.17], p = 0.03; VAS open = -0.97 cm [CI95%: -1.57, -0.37], p < .01; VAS chew = -1.15 cm [CI95%: -1.73, -0.58], p < .01). At T1, EG demonstrated higher number of responders compared to CG for VAS open (χ2(1) = 4.39, p = .04) and VAS chew (χ2(1) = 11.58, p < .01). Adding MPT to education and OS yields better outcomes in terms of pain reduction and ROM improvement, in chronic M-TMD. NCT03726060.

Botulinum Toxin-A for the Treatment of Myogenous Temporomandibular Disorders: An Umbrella Review of Systematic Reviews.

Temporomandibular disorders (TMDs) encompass several conditions that cause pain and impair function of the masticatory muscles (M-TMDs) and temporomandibular joints. There is a large interest among clinicians and researchers in the use of botulinum toxin-A (BoNT-A) as a treatment for M-TMD. However, due to the lack of consistent evidence regarding the efficacy as well as adverse events of BoNT-A, clinical decision making is challenging. Therefore, this umbrella review aimed to systematically assess systematic reviews (SRs) evaluating BoNT-A treatment effects on pain intensity, mandibular movements, and adverse events in patients with M-TMDs. An electronic search was undertaken in the databases MEDLINE, EMBASE, CINAHL, Cochrane Central Registry of Controlled Trials (CENTRAL), Web of Science, Epistemonikos, ClinicalTrials.gov, and ICTRP to identify SRs investigating BoNT-A effects on M-TMDs, published from the inception of each database until 6 December 2023. The quality of evidence was rated according to the critical appraisalchecklist developed by the umbrella review methodology working group. Only high-quality SRs were included. In total, 18 SRs were included. BoNT-A was shown to be more effective than placebo to reduce pain intensity, but not compared to standard treatments. Additionally, BoNT-A was not superior to placebo or standard treatments regarding improvement of mandibular movements. BoNT-A was considered to have a higher risk for adverse events on muscle and bony tissue compared with other treatments. The synthesis in this umbrella review provides the highest level of evidence present. Taken together, there are indications of effectiveness of BoNT-A for treatment of M-TMDs, supported by moderate evidence. However, considering the risk of causing serious adverse events, treatment with BoNT-A is recommended to be the last treatment alternative.

The effectiveness of cervical rehabilitation interventions for pain in adults with myogenic temporomandibular disorders: A systematic review and meta-analysis.

Little evidence exists for the most effective conservative treatment approach for adults with myogenic temporomandibular disorders (MTMD). We aim to assess the effectiveness of cervical rehabilitation interventions on pain intensity and sensitivity in adults with MTMD compared to comparison intervention such as placebo, sham treatment, education or no intervention. For this systematic review and meta-analysis, we searched PubMed, EMBASE, Medline, PEDro databases, forward and backward citations and grey literature studies through PROSPERO, clinical trials and data registries without language or date restrictions between inception and 1 December 2021. We selected randomised controlled trials (RCTs) based on adult populations with MTMD who had a cervical rehabilitation intervention which was defined as any conservative intervention targeting the anatomical structures of the cervical spine. The primary outcome measures for pain were self-reported pain intensity and pain sensitivity through the pressure pain threshold (PPT) of the masseter and temporalis muscles. Secondary outcome measures of maximal mouth opening (on MMO) were included. Included studies were assessed for bias with the Cochrane risk of bias tool for randomised trials. Evidence from RCTs was synthesised to determine treatment effect size as differences between standardised mean difference (SMD) for changes in pain intensity, PPT and MMO comparing adults with MTMD who were treated with cervical rehabilitation interventions compared to a control group. This study is registered on Prospero, number CRD 42021289299. Our general search yielded 2647 studies where seven RCTs met eligibility criteria with low to some concerns in their risk of bias. Pain intensity (five studies, n = 223, SMD -0.98, 95% CI -1.67 to -0.28, I2 = 79%), PPT of the masseter muscle (six studies, n = 395, SMD 0.64, 95% CI 0.43 to 0.86, I2 = 90%) and the temporalis muscles (five studies, n = 295, SMD 0.76, 95% CI 0.07 to 1.45, I2 = 84%) showed large treatment effect estimates favouring cervical rehabilitation interventions compared to no treatment, sham cervical treatment, patient education or non-cervical neuromuscular techniques. Compared to control interventions, one type of cervical rehabilitation intervention, cervical manual therapy alone or in combination with a neck exercise program was associated with statistically significant, large treatment effect estimates on pain intensity (four studies, n = 203, SMD -1.52, 95% CI -2.50 to -0.55). This review found that in the short-term, cervical rehabilitation interventions especially upper cervical MT alone or in combination with a neck exercise program are effective in improving multiple pain outcomes in adults with MTMD. However, further research is needed to measure the long-term effects of this type of intervention.

Efficacy of Aerobic Exercise on Widespread Pain Sensitization in Patients with Temporomandibular Disorders: A Preliminary Randomized Controlled Study

Myogenic temporomandibular disorders (TMDs) are commonly associated with pain sensitization (PS), manifesting decreased local and distal pressure pain thresholds (PPTs). Aerobic exercise (AE) has shown hypoalgesic effects on PS. This study aimed to analyze the effects of AE in addition to physical therapy (PT) on widespread PS in myogenic TMDs. A randomized controlled trial was carried out, involving 20 subjects allocated to PT (n = 10) or PT + AE (n = 10). Both groups performed six sessions over four weeks, consisting of education, manual therapy, and therapeutic exercise. The PT + AE group also performed high-intensity intervallic AE on a stationary bike. Primary outcome: PPT in the Achilles tendon assessed with an algometer. Secondary outcome: Central Sensitization Inventory (CSI). Outcomes were recorded at baseline (T0), post-intervention (T1), and after 12 weeks (T2). Significant between-groups differences were found favoring PT + AE at T1 and T2 for the left Achilles PPT (T1 p &lt; 0.01; d = 1.3; T2 p &lt; 0.001; d = 2.5) and CSI (T1 p &lt; 0.001; d = 2.3; T2 p &lt; 0.01; d = 1.7), and at T2 for the right Achilles PPT (p &lt; 0.001; d = 0.9). Thus, adding AE to PT improved widespread PS more than only PT in myogenic TMD.

WITHDRAWN: Detection of myofascial trigger points in the masseter muscle using ultrasonography in patients with myogenous temporomandibular disorder

We aimed to investigate the diagnostic efficacy of ultrasonography (US) using gray scale B-mode and ultrasound elastography (UE) in detecting myofascial trigger points (MTPs) in the masseter muscles of patients with myogenous temporomandibular disorder (TMD). A diagnostic cross-sectional study of patients with MTPs in the masseter muscles using US was conducted. The diagnostic results from the US examinations were compared with the clinical examination reference standard to determine the diagnostic efficacy of US. MTPs were detected as band-like hypoechoic localized areas with reduced vibration amplitude (stiffer) under US B-mode and UE imaging. In total, 116 sites from 29 patients (3 males, 26 females) with a mean age of 39.4 years were examined. US exhibited sensitivity of .946 (95% CI: .851-.989) and specificity of .900 (95% CI: .795-.962) in detecting MTPs when compared to the clinical examination. Diagnostic accuracy ranged from .902 to .950 when assuming 3 levels of myogenous TMD prevalence. US B-mode and UE imaging exhibited diagnostic accuracy comparable to the standard clinical examination carried out by a trained specialist. It can be a reliable technique in the detection and localization of MTPs for the diagnosis of myogenous TMD and localization of MTPs for therapeutic purposes.

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.

Effectiveness of Photobiomodulation Alone and 0.5% Nanocurcumin Gel with Photobiomodulation in Treating Myogenous Temporomandibular Disorders: Protocol for a Randomised Clinical Trial

Introduction: Temporomandibular Disorders (TMD) encompass a variety of clinical dysfunctions affecting the Temporomandibular Joint (TMJ), masticatory muscles, and nearby tissues. Pain typically originates from the muscles associated with the functional movements of these structures. Low-level Laser Therapy (LLLT) has been used in TMD patients to control inflammation and disrupt the stress-pain-stress cycle. Curcuma longa is a significant plant in Asia used for medicinal purposes. Curcumin (diferuloylmethane) is a hydrophobic bioactive compound commonly found in the rhizome of C. longa. Considerable attention has been given in recent years to its various pharmacological actions. The available research has shown significant potential in inflammation control, with nanorange preparations of curcumin (Nanocurcumin) enhancing the pharmacological actions and benefits of curcumin, which were not markedly achievable before. Need for the study: The TMDs are among the most common types of disorders associated with orofacial pain. Conditions originating from stress related to the joint often impact the associated muscles, initiating the stress-pain-stress cycle. As TMDs do not have a definitive treatment plan, further research is needed regarding the treatment associated with TMDs. Aim: To assess the effectiveness of photobiomodulation alone and 0.5% nanocurcumin gel with photobiomodulation in treating myogenous TMDs. Methodology: In the present randomised clinical trial, 44 patients with myogenous TMDs will be included. The patients will be divided into two groups: Group A will receive laser applications at the trigger zones, and Group B will receive the application of 0.5% nanocurcumin gel along with laser at the trigger zones. Patients will be assessed for jaw opening, Beck’s Anxiety Inventory, and Visual Analogue Score after four weeks.

Sensory innervation of masseter, temporal and lateral pterygoid muscles in common marmosets

Myogenous temporomandibular disorders is associated with an increased responsiveness of nerves innervating the masseter (MM), temporal (TM), and lateral pterygoid muscles (LPM). This study aimed to examine sensory nerve types innervating MM, TM and LPM of adult non-human primate—common marmosets. Sensory nerves were localized in specific regions of these muscles. Pgp9.5, marker for all nerves, and NFH, a marker for A-fibers, showed that masticatory muscles were primarily innervated with A-fibers. The proportion of C- to A-fibers was highest in LPM, and lowest in MM. All C-fibers (pgp9.5+/NFH-) observed in masticatory muscles were peptidergic (CGRP+) and lacked mrgprD and CHRNA3, a silent nociceptive marker. TrpV1 was register in 17% of LPM nerves. All fibers in masticatory muscles were labeled with GFAP+, a myelin sheath marker. There were substantially more peptidergic A-fibers (CGRP+/NFH+) in TM and LPM compared to MM. MM, TM and LPM NFH+ fibers contained different percentages of trkC+ and parvalbumin+, but not trkB+ fibers. Tyrosine hydroxylase antibodies, which did not label TG, highlighted sympathetic fibers around blood vessels of the masticatory muscles. Overall, masticatory muscle types of marmosets have similarities and differences in innervation patterns.

Associations of tissue damage induced inflammatory plasticity in masseter muscle with the resolution of chronic myalgia

Gene plasticity during myogenous temporomandibular disorder (TMDM) development is largely unknown. TMDM could be modeled by intramuscular inflammation or tissue damage. To model inflammation induced TMDM we injected complete Freund’s adjuvant (CFA) into masseter muscle (MM). To model tissue damage induced TMDM we injected extracellular matrix degrading collagenase type 2 (Col). CFA and Col produced distinct myalgia development trajectories. We performed bulk RNA-seq of MM to generate gene plasticity time course. CFA initiated TMDM (1d post-injection) was mainly linked to chemo-tacticity of monocytes and neutrophils. At CFA-induced hypersensitivity post-resolution (5d post-injection), tissue repair processes were pronounced, while inflammation was absent. Col (0.2U) produced acute hypersensitivity linked to tissue repair without inflammatory processes. Col (10U) generated prolonged hypersensitivity with inflammatory processes dominating initiation phase (1d). Pre-resolution phase (6d) was accompanied with acceleration of expressions for tissue repair and pro-inflammatory genes. Flow cytometry showed that immune processes in MM was associated with accumulations of macrophages, natural killer, dendritic and T-cells, further confirming our RNA-seq findings. Altogether, CFA and Col treatments induced different immune processes in MM. Importantly, TMDM resolution was preceded with muscle cell and extracellular matrix repairs, an elevation in immune system gene expressions and distinct immune cell accumulations in MM.

Persistent myogenic temporomandibular disorders: Are navigation-guided botulinum toxin-A injections into the lateral pterygoid muscles effective?

BackgroundBotulinum toxin has proven effective in treating persistent myogenous temporomandibular disorders (M-TMDs) unresponsive to conservative therapies. While the usual injection sites are the masseter and temporalis muscles, the deeper lateral pterygoid muscle (LPM) is often overlooked due to its difficulty of access and the risk of local complications. This study aims to evaluate the effectiveness of botulinum toxin-A injections (BTX-A) in the LPM with MR-guided navigation of patients with persistent M-TMDs. MethodsThis retrospective study enrolled 34 patients suffering from M-TMDs despite conservative therapies with a total of 51 injection sessions. All of them were treated by BTX-A injections in the LPM using MR-guided navigation, masseter and temporalis with clinical guidance. The effectiveness of the treatment was evaluated with measures of maximum pain-intensity scores of breakthrough and background pain, maximal interincisal mouth opening (MIO), and the presence of joint sounds. The assessment was conducted before injections, and subsequently, at 1 and 3 months postoperatively. Adverse events and perception of improvement with the treatment were also reported for each injection sessions. ResultsBTX-A injections in the LPM significantly improved pain scores intensity with a reduction of 65 % and 49 % respectively at the 1- and 3-month follow-ups, with peak effectiveness at 1 month. This study showed also a statistically significant improvement in mean MIO at 3 months post-injection and a decrease in joint sounds with persistence in 9,7 % of cases at 3-month follow-up compared to 41,2 % at baseline. No significant adverse events were observed. Patients treated with BTX-A injections in the LPM had a subjective complete improvement in their perception of treatment efficacy in 63 % of cases at the end of the follow-up period. ConclusionsThis study reports clinical experience on the use of MR-guided navigation to perform accurate, reliable, and safe BTX-A injections in the LPM. Although our results appear to be encouraging regarding symptom improvement of patients suffering from persistent M-TMDs, this approach may not be feasible as a primary standard procedure for managing M-TMDs. Further research is necessary to explore potential reproducible, safe, and cost-effective alternatives to enhance the accessibility of the LPM in clinical practice.

Effect of Botulinum Toxin on Masticatory Muscle Pain in Patients with Temporomandibular Disorders: A Randomized, Double-Blind, Placebo-Controlled Pilot Study.

This study aimed to evaluate the efficacy of botulinum toxin type A (BoNT/A) in patients with temporomandibular disorders (TMDs) associated with masticatory muscle pain (MMP) and headaches. This randomized, double-blind, placebo-controlled pilot study is the first clinical trial to evaluate both disorders simultaneously. Twenty-one patients with myogenous TMD were randomly assigned to two groups. The experimental and control groups received injections of either BoNT/A or saline into the sites showing tenderness after palpation of a total of 16 muscle areas, including each masseter, a temporalis, splenius capitis, sternocleidomastoid, and trapezius muscle. During each visit, the clinical effects, based on the intensity of orofacial pain (OVAS), headache (HVAS), number of tender points (TPs), maximum mouth opening (MMO), and headache frequency (HF), were evaluated at four time points, namely, pre-injection and 4, 8, and 12 weeks after the injection, in both groups. Friedman and Mann-Whitney tests were used for the analyses. In the experimental group, the reductions in OVAS, TP, HVAS, and HF showed significant differences over time, excluding MMO, whereas there was no significant difference in any of the variables in the control group. In addition, the decline in TPs was significantly different between the experimental and control groups at all time points, especially after 4 and 12 weeks, compared to that during pre-injection. In conclusion, treatment with BoNT/A was relatively effective for masticatory muscle pain caused by TMDs and headache compared to the saline placebo.

A female-specific role for trigeminal dynorphin in orofacial pain comorbidity.

Migraine is commonly reported in patients with temporomandibular disorders (TMDs), but little is known about the mechanisms underlying the comorbid condition. Here, we prepared a mouse model to investigate this comorbidity, in which masseter muscle tendon ligation (MMTL) was performed to induce a myogenic TMD, and the pre-existing TMD enabled a subthreshold dose of nitroglycerin (NTG) to produce migraine-like pain in mice. RNA sequencing followed by real-time quantitative polymerase chain reaction confirmation showed that MMTL plus NTG treatment increased prodynorphin ( Pdyn ) mRNA expression in the spinal trigeminal nucleus caudalis (Sp5C) of female mice but not in male mice. Chemogenetic inhibition of Pdyn -expressing neurons or microinjection of antidynorphin antiserum in the Sp5C alleviated MMTL-induced masseter hypersensitivity and diminished the MMTL-enabled migraine-like pain in female mice but not in male mice. Moreover, chemogenetic activation of Pdyn -expressing neurons or microinjection of dynorphin A (1-17) peptide in the Sp5C enabled a subthreshold dose of NTG to induce migraine-like pain in female mice but not in male mice. Taken together, our results suggest that trigeminal dynorphin has a female-specific role in the modulation of comorbid TMDs and migraine.

A retrospective study on the use of Botulinum toxin as part of first line of management in the treatment of myogenous TMD

Statement of the problem Temporomandibular disorder (TMD) represents a common group of disorders related to the impairment of the temporomandibular joints and the associated neuro-muscular system, which commonly present with features such as pain in the orofacial region, headache, joint sounds, and disturbances in jaw movements. Recently, botulinum toxin type-A (BTX-A) has increasingly been used as an adjuvant treatment for TMD. Purpose of the study This retrospective study aims to evaluate the effectiveness of BTX-A for the management of myogenous TMD and its potential to be included as a first line of treatment. Materials and methods A retrospective search was carried out through the Oral and Maxillofacial Department’s logbook from January 1, 2016, to December 31, 2020. Patients who received BTX-A for the management of myogenous TMD were identified and their hospital electronic records were accessed. Results From January 1, 2016, to December 31, 2020, 60 patients were diagnosed with myogenous TMD and treated conservatively together with intramuscular injections of BTX-A. Forty-five patients (75%) reported improvement in pain levels, of whom 10 (17%) reported complete resolution of pain. Fifteen patients (25%) reported no improvement in pain levels, of whom four (7%) reported transient improvement in pain levels lasting four weeks. A mean improvement of 50% was reported in terms of self-perceived pain levels. No adverse effects from BTX-A treatment were reported. Conclusion Although BTX-A shows great potential to be included as a first line of treatment for myogenous TMD, more high-quality research with larger sample sizes, minimal bias, and longer follow-up periods is needed.

Maximum bilateral bite strength and RMS EMG for the diagnosis of myogenic TMD

Aim: The study aimed to evaluate the accuracy of the maximum bilateral molar bite force and the Root Mean Square (RMS) Electromyography (EMG) index of the masticatory muscles in the maximum bilateral molar bite (MMBMax) of women with myogenic Temporomandibular Disorder (TMD) and asymptomatic. Methods: This is a cross-sectional study, composed of 86 women allocated to the TMD Group (n=43) and Control Group (n=43) diagnosis through the Diagnostic Criteria for Temporomandibular Disorders. The maximum bilateral molar bite force was evaluated using a bite dynamometer and the RMS EMG index of the masticatory muscles (anterior temporalis, masseter) during 5 seconds of the MMBMax task. Student t-test was used for data comparison between accuracy of the bite force and RMS EMG of masticatory muscles during the MMBMax. Results: The maximum bilateral molar bite force showed high accuracy (AUC=0.99) for the diagnosis of women with myogenic TMD and asymptomatic women, and the RMS EMG index evaluated during the MMBMax showed a moderate level of accuracy for all masticatory muscles (AUC=0.70 to 0.75). Conclusion: The bilateral bite dynamometer with a surface EMG during bilateral bite can be used to diagnose TMD in young women.

Assessing change in functional outcomes and quality of life in myogenic temporomandibular disorders undergoing botulinum toxin injection: A before and after comparison

PurposeThis prospective study aimed to evaluate the changes in functional outcomes and quality of life after the injection of botulinum toxin (BTX) into the masticatory muscles for the management of myogenic temporomandibular disorders (TMDs). Materials and MethodsThis study was conducted with 45 individuals who presented with clinically myogenic TMDs according to the Diagnostic Criteria for Temporomandibular Disorders. All patients received BTX injections in the temporalis and masseter muscles. The Oral Health Impact Profile–Temporomandibular Dysfunction (OHIP–TMD) questionnaire was used to evaluate the effects of treatment on quality of life. The OHIP–TMD, visual analogue scale (VAS), and maximum mouth opening (MMO) scores before and 3 months after BTX injection were evaluated. ResultsThe preoperative and postoperative assessments revealed a statistically significant reduction (p ≤ 0.001) in the average overall OHIP–TMD scores. A significant increase in the MMO scores and a significant decrease in the VAS scores were observed (p < 0.001). ConclusionsThe injection of BTX into the masticatory muscles is beneficial for improving the clinical and quality of life parameters in the management of myogenic TMD.

Patient experience and satisfaction with different temporomandibular joint treatments: A retrospective study

This retrospective study aimed to evaluate patient satisfaction with different temporomandibular joint (TMJ) treatments. Patients were included in the study according to the following inclusion criteria: 1) arthrogenous and/or myogenous temporomandibular disorders (TMD); 2) Dimitroulis classification category between 1-4; 3) conservative treatment without any improvement at least for 3 months; 4) indication for one of the following TMD treatments: injection of botulinum toxin; arthrocentesis; arthroscopy, and open surgery without alloplastic material; and 5) age ≥16 years. An independent satisfaction questionnaire with 11 queries was applied via phone call to all patients, which included 6 questions using a 10-point Likert scale and 5 yes-or-no questions. The principal outcome was the overall satisfaction with the clinical result of the treatment, and the secondary outcomes were specific satisfaction with the following: 1) pain reduction; 2) range of mouth opening; 3) chewing ability; 4) postoperative recovery; 5) the fulfillment of expectations; 6) treatment choice; 7) treatment recommendation to a friend; and 8) the need for another intervention. Anxiety and depression were also included as variables. Data were analyzed using descriptive statistics, non-parametric Kruskal-Wallis and Spearman rank correlation coefficient tests. A total of 120 patients (mean age 41.20 ± 17.78 years) were enrolled, comprising 109 women (90%) and 11 men (10%). The overall clinical satisfaction of all patients was 8.24 ± 2.23 (mean ± SD), and 97 patients (80.8%) stated that they would repeat the treatment. Patients submitted to TMJ arthrocentesis and arthroscopy had higher overall clinical satisfaction (9.09 ± 0.971 and 9.03 ± 1.13, p = 0.021) followed by open surgery (8.38 ± 1.84). The authors observed three statistically significant correlations: 1) overall clinical satisfaction and patient expectations (r = 0.803; p < 0.0001); 2) overall clinical satisfaction and post-treatment pain (r = −0.299; p = 0.003); and (3) the presence of depression and the need for further TMJ treatment (r = 0.186; p = 0.043). Within the limitations of the study it seems that patient expectations should be addressed ad initium, and the presence of a diagnosis of depression with concomitant TMD must alert the clinical team and patient for the possible need of additional treatment.

Myogenous Temporomandibular Disorders: Diagnostic Concepts and Prospective Pilot Study on Extracorporeal Shockwave Therapy

The aims of this article are to discuss the current, and potential future directions, in the diagnosis of myogenous temporomandibular disorders (M-TMD), as well as to report a pilot study to investigate the feasibility and clinical outcomes of extracorporeal shockwave therapy (ESWT) in the treatment of M-TMD. Forty-one adult patients presented with M-TMD were recruited into the study and randomized into two groups: Group 1 received ESWT treatment, whereas Group 2 received placebo treatment. The variables investigated were pain, measured by a numerical rating scale (NRS) and mouth opening. Twenty-six patients (Group 1: n = 14, mean age = 45.3 (16.7) years; Group 2: n = 12, mean age = 46.8 (19.7) years) completed 1-year follow up and were included into the final analysis. In both groups, reduction in pain and increase in MO (unassisted maximum, assisted maximum, and pain-free) were seen at post-treatment 1 year. There were more reduction in pain and increase in all MO in Group 1 than Group 2, but statistical significance was not detected. No major complications were encountered in this study. Although significant differences were not seen between groups, this prospective pilot study provided preliminary evidence that ESWT is safe and potentially beneficial in the treatment of M-TMD.