Presence Of Temporomandibular Joint Pain Research Articles

Temporal Summation and Aftersensations of Second Pain in Women with Myofascial Temporomandibular Disorder Differ by Presence of Temporomandibular Joint Pain.

PurposeMechanisms underlying myofascial temporomandibular disorder (mTMD) are poorly understood. One theory is dysfunction in the central mediation of pain, specifically in enhanced facilitatory pain modulation. Because mechanisms leading to central sensitization may differ for joint and muscle pain, this study of mTMD addressed phenotypic heterogeneity by temporomandibular (TM) joint pain in the examination of quantitative sensory testing (QST).Patients and MethodsThe stimulus dependent increase in second pain (temporal summation (TS)) and associated aftersensations (AS) were examined across groups of women with mTMD with TM joint pain and without, and a demographically matched control group.ResultsTS was slightly more evident in mTMD without joint pain vs with (p = 0.035), but AS were most robustly persistent in the group with joint pain vs without (p < 0.002).ConclusionWhile both subgroups demonstrated evidence of central sensitization relative to controls on one of two measures, differences in QST results, if replicated, may point to possible differences in the mechanisms that yield central sensitization. Alternatively, it may represent methodological artifacts that need to be addressed. Therefore, greater consideration should be given to symptom-based phenotypes in studies examining TS and AS.

"Pressure pain threshold over masticatory muscles and temporomandibular joint in patients with juvenile idiopathic arthritis".

Juvenile idiopathic arthritis (JIA) is an autoimmune, chronic, inflammatory joint disease, affecting children and adolescents. Patients with JIA may have pain and fatigue in muscles. There are not studies evaluating the pressure pain thresholds (PPTs) of both masticatory muscles and temporomandibular joint (TMJ) in patients with JIA. This study aimed to investigate PPTs of masticatory muscles and TMJ in subjects with JIA. Fifty-one JIA patients and fifty-two healthy subjects were recruited. JIA group was assessed for with a standardised clinical examination for temporomandibular disorders. In all subjects, the PPT was evaluated in the following sites: anterior temporalis (AT) and masseter (MM) muscles, TMJ and thenar (TH) eminence. Comparisons between groups were assessed with unpaired t test and ANOVA (P<.05). Pressure pain thresholds were significantly lower among JIA patients compared with controls (P<.001) for all analysed sites. The presence of TMJ pain at palpation was significantly associated with a lower PPT at TMJ (P=.031). Patients with JIA have generally lowered pain threshold to mechanical stimulus, which suggests an effect of JIA on nocicepton-modulating processes.

Global Doctor Opinion Versus a Patient Questionnaire for the Outcome Assessment of Treated Temporomandibular Disorder Patients

Accurately assessing treatment outcomes has become increasingly important for maintaining hospital privileges. When these assessments are based on the judgment of the treating doctor, there is often an inherent positive bias. As a result, there has been increased interest in using patient-based assessments. The purpose of this study was to compare doctor's and patient's assessments of the outcomes of treatment in a series of patients with various temporomandibular disorders (TMDs). Fifty-two consecutive TMD patients were initially given a questionnaire designed to evaluate their pain, problems eating and sleeping, the occurrence of headache and earache, the presence of temporomandibular joint pain and/or jaw stiffness in the morning, and interference with daily activity. The patients then filled out the same questionnaire at each post-treatment visit, and the findings were compared with the baseline information. At each visit, the treating doctor also recorded a global evaluation of the patient's progress as excellent, good, fair, or poor. Comparison of the doctor's global evaluation with the patient's evaluation based on the questionnaire showed a discrepancy in 44% of the cases. When there was a discrepancy, the doctor scored the improvement better than the patient 54.5% of the time and worse than the patient 45.5% of the time. The results of this study confirm the unreliability of using a global opinion by the treating doctor for outcome assessment in patients with various TMDs.

Magnetic resonance imaging findings of osteoarthrosis and effusion in patients with unilateral temporomandibular joint pain

The purpose of this study was to investigate the relationship between the presence of temporomandibular joint (TMJ) pain and the magnetic resonance (MR) imaging findings of osteoarthrosis (OA), and effusion. The study comprised 112 consecutive TMJ pain patients. Criteria for including a patient were report of unilateral pain near the TMJ, with the presence of unilateral TMJ pain during palpation, function, and/or unassisted or assisted mandibular opening. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ OA, and/or effusion. Comparison of the TMJ side-related data showed a significant relationship between the clinical finding of TMJ pain and the MR imaging diagnoses of TMJ OA (P=0.000), and TMJ effusion (P=0.000). Further, there was a significant relationship between the MR imaging diagnosis of TMJ OA and TMJ effusion (P=0.000). Use of the Kappa statistical test indicated poor diagnostic agreement between the presence of TMJ pain and the MR imaging diagnosis of TMJ OA (K=0.22), TMJ effusion (K=0.29), and TMJ ‘OA and effusion’ (K=0.30). The study's findings suggest that while clinical pain is correlated to TMJ-related MR imaging findings, clinical pain in and of itself, is not reliable for predicting the presence of TMJ OA and/or effusion. Validation of MR imaging diagnoses would involve the investigation of cross-sectional and longitudinal evidence to assess decisive differences in terms of prognosis and/or treatment outcome.

骨格型下顎前突症の顎矯正手術前後の下顎頭に関する研究

Ninety mandibular prognathism patients were radiographically assessed for condylar position and clinically evaluated for temporomandibular joint (TMJ) function before and after orthognathic surgery. Forty-five of them underwent bilateral intraoral vertical ramus osteotomies (IVRO) with passive condylar seating and no interosseous fixation. Another 45 patients underwent bilateral sagittal split ramus osteotmies (SSRO) with anterosuperiorly directed condylar seating and titanium miniplate internal fixation. Changes in condylar position following surgical-orthodontic treatment were quantified using lateral oblique transcranial radiographs of the TMJ. Condylar position in the surgical group was compared to that derived from 20 controls with normal occlusion and asymptomatic TMJs.The following results were obtained:1. In the surgical group before treatment, condylar postion was more broadly distributed among various positions than in the control group. There was correlation between posterior condylar position and the presence of TMJ pain or noise.2. In the IVRO patients, the condyle exhibited significant anteroinferior displacement just after surgery. During the postoperative follow-up period, significant superoposterior movement of the condyles occurred.3. In the SSRO patients, the condyle showed significant anterior displacement just after surgery. During the postoperative follow-up period, a slight tendency for posterior condylar movement was observed.4. In the surgical group at the final postoperative follow-up, condylar position was similar to that in the control group. In addition, the incidence of the TMJ signs and symptoms was greatly reduced after orthognathic surgery.The results in this study suggest that surgical correction of mandibular prognathism can improve TMJ function by repositioning the condyle to a more stable and functional position.