Restricted Jaw Movement Research Articles

Low-Level Laser Therapy with Pharmacotherapy in the Management of Myofascial Pain Dysfunction Syndrome with or without Other Temporomandibular Disorders.

Myofascial pain dysfunction syndrome (MPDS) is one of the most important facial muscle disorders comprising signs and symptoms including pain during function, tenderness in the muscles of mastication and restricted jaw movement. The purpose of this study was to assess and compare the effectiveness of low-level laser therapy (LLLT) and combination therapy of LLLT and pharmacotherapy in the treatment of myofascial pain with or without other TMD (temporomandibular disorders). Forty patients with MPDS were randomly divided into two groups. Group 1 received LLLT (BiolaseTM; GA-Al-As; 940 nm) in 12 sessions. Group 2 received a combination of LLLT with the drug Aceclofenac 200 mg till the end of the 12th session. Following each session and after two months, the pain intensity, maximum mouth opening, clicking sound and jaw deviation were evaluated in both groups. Data were collected and analysed using the independent t test, Mann-Whitney U test and Friedman test (a = 0.05). Both group 1 and group 2 showed a significant reduction in pain and a significant increase in mouth opening, which was faster in group 2 compared to group 1. Both LLLT and a combination of LLLT and drug therapy are effective in the management of myofascial pain. LLLT + pharmacotherapy combination is more efficient at improving pain and mouth opening.

Progression of TMJ disorders in patients with rheumatoid arthritis

Relevance. The literature highlights the significant impact of rheumatoid arthritis (RA) on the onset of musculoskeletal dysfunction symptoms in the temporomandibular joint (TMJ). However, the risk factors that influence the clinical manifestations of TMJ disorders in RA patients remain insufficiently explored.Objective: To examine the impact of rheumatoid arthritis on the onset and progression of TMJ disorders.Materials and methods. At the Dental Clinic of the Central Research Institute of Stomatology and Maxillofacial Surgery, 180 patients from St. Petersburg State Clinical Rheumatology Hospital No. 25, diagnosed with rheumatoid arthritis, were examined. Standard clinical assessments and detailed medical history collection were performed.Results. Patients with long-standing RA (over 5 years) were more likely to experience TMJ disorder symptoms, with a relative risk of 1.342 (95% CI) [1.106; 1.628]. No statistically significant correlation was found between RA activity and TMJ disorders. The symptom pattern varied by timing: prior to RA, patients predominantly experienced TMJ clicking and crepitus (66%); during RA onset, pain and restricted jaw movement were more common (80% and 72%, respectively). After RA manifestation, pain became the dominant symptom, though its intensity diminished over time (to 60%).Conclusions. The duration of RA has a notable impact on both the frequency and nature of TMJ disorder symptoms. While RA treatment reduces symptom intensity over time, their frequency remains high.

Epidemiology of Bruxism and Temporomandibular Joint Disorders (TMD) in Iranian Adults: A Cross-Sectional Study

Objective: The prevalence of bruxism in the literature has been reported differently. The aim of this study was to assess the prevalence of bruxism in patients aged 25–40 who were referred to Kerman Dental School. Methods: This analytical descriptive cross-sectional study was performed on 320 patients referred to the Department of Oral Medicine of Kerman Dentistry Faculty in the age range of 25 to 40 years old. The prevalence of bruxism as well as TMJ disorders were evaluated. Data were collected in a questionnaire and entered into SPSS version 24. Analyzing was done by a chi-square test at a significant level of 0.05. Results: The prevalence of bruxism was 23.8%, with superiority in women. Although clenching was observed in 95.5% of the patients, 84.4% showed premature contacts on teeth, most of them related to the non-working side, and 82.9% presented premature contacts on restorations, especially on the non-working side. Regarding TMD symptoms, pain was the most common (83.4%), and clicking and crepitus were seen in 42% and 6% of the patients, respectively. Also, in 63.7% of the subjects with bruxism, jaw deviation was observed, and 18.7% showed restricted jaw movement. Conclusion: The prevalence of bruxism in the studied population is in the range of similar studies. Regarding TMD, troublesome symptoms such as pain, jaw deviation, and limited mouth opening were the only ones significantly related to bruxism.

Impact of professional, recreational and nonsinging on temporomandibular disorders - a comparative study based on a self-assessment questionnaire

BackgroundThis study investigates the relationship between professional and recreational singing on temporomandibular disorders (TMDs) in women compared to a nonsinging control group.MethodsA total of 288 female subjects between the ages of 18 and 45 participated in the self-assessment questionnaire including demographic data, as well as questions on vocal practice and TMDs symptoms. Depending on the singing time per week, the (non)vocalists were assigned to the groups professional (n = 96), recreational (n = 96) and nonsingers (n = 96).ResultsThe TMDs prevalence in professional singers (42%) was higher than that in recreational singers (31%) and noticeably higher than that in nonsingers (25%). The Fisher-Freeman-Halton exact test showed that the differences between the groups were not noticeable (p = .053) but could be formulated as tendencies. The professionals suffered much more from restricted jaw movement (p = .004; OR = 2.718; 95% CI = 1.409–5.242), temporomandibular joint sounds (p < .009; OR = 2.267; 95% CI = 1.264–4.064) and temporomandibular pain (p = .010; OR = 2.333; 95% CI = 1.264–4.308) than nonsingers.ConclusionsSinging might have an enhancing effect on the appearance of TMDs. In particular, professional singers suffered more from self-reported TMDs than recreational singers and nonsingers. In addition to the high level of physical workload if participating in professional singing, the psychosocial impact should be investigated more in further studies. No new treatment strategies resulted from this study, as the etiological significance of singing is still unclear. Knowledge about risk factors for multifactorial TMDs can help practitioners and patients prevent and treat TMDs.

Congenital mandibular coronoid process hyperplasia and associated diseases.

Coronoid process hyperplasia (CPH) is an oral and maxillofacial surgical disease that can result in restricted jaw movement due to an enlarged and elongated mandibular coronoid process. It is characterized by the painless progressive restriction of unilaterally or bilaterally mouth opening. Clinically, unexplained bilateral CPH is less common and therefore often overlooked or misdiagnosed, and coronoidectomy can be very effective on improving mouth opening. Currently, the exact etiology and mechanism of congenital CPH have not yet been fully understood, but it is generally believed to be genetically related. In this paper, the relationship of the congenital mandibular CPH with the related diseases was examined based on cases collected in our clinic and literature review for the clinical diagnosis and treatment of patients with restricted mouth opening associated with CPH.

Evaluation of the Levels of Pain, Discomfort, Functional Impairments and Satisfaction With the Periodontally Accelerated Osteogenic Orthodontics (PAOO) When Leveling and Aligning Crowded Teeth: A Prospective Cohort Study.

BackgroundOnly a few studies have reported levels of pain, discomfort, functional impairments, and patients' satisfaction after undergoing periodontally accelerated osteogenic orthodontics (PAOO). Therefore, the objectives were to evaluate postoperative pain, discomfort, functional impairments, and satisfaction following this surgical intervention.MethodsA prospective cohort study was undertaken at the Department of Orthodontics, University of Damascus Dental School, between August 2018 and November 2020. The sample consisted of 16 patients (4 males, 12 females, mean age: 21±3.05 years) with moderately crowded lower anterior teeth who underwent full-thickness vestibular flap elevation followed by cortical cuts using piezosurgery. Then a bovine xenograft was applied before reflecting the flap and suturing. Fixed orthodontic therapy was then initiated. Questionnaires were administered to assess the levels of pain, discomfort, and oral functional problems using a visual analog scale (VAS) at one day, seven days, 14 days, and 28 days after surgery. The level of satisfaction was also assessed at 28 days postoperatively. Friedman's test was employed, and Wilcoxon signed-rank tests were used for post-hoc tests with an adjusted alpha level.ResultsOn the first day following the PAOO, the mean values of perceived pain, discomfort, swelling, mastication difficulties, swallowing problems, limitation in jaw movements were 80.00, 80.63, 68.13, 78.13, 55.00, and 64.38, respectively. These mean values dropped significantly in the following assessment times (P<0.001). At 28 days following the PAOO, the mean satisfaction score was 84.94±22.46. All patients mentioned that they took painkillers after the surgical intervention.ConclusionsOn the first day following surgery, patients perceived high levels of pain and discomfort, moderate to severe levels of swelling and chewing difficulties, and suffered from restricted jaw movement. These levels decreased significantly in the following assessment times. Patients' satisfaction with the PAOO procedure was high.

Temporomandibular joint disorders

The temporomandibular joint (TMJ) is prone to a number of disease states involving any one of its anatomical components. The current favoured term for problems associated with the TMJ is ‘temporomandibular disorder’ (TMD). TMD is one of the most common orofacial pain conditions. Patients will present to GPs and general dental practitioners as well as directly to accident and emergency, typically for referral to Oral and maxillofacial surgery, due to either significant acute pain or chronic pain that can no longer be tolerated. Common features of TMD include pain in the face and preauricular area, restricted jaw movement, and noise from the TMJs during jaw movements. TMD can coincide with poor general health, psychological co-morbidities such as depression and often affects quality of life.

Radiation-induced temporo-mandibular joint disorder in post-radiotherapy nasopharyngeal carcinoma patients: assessment and treatment.

Nasopharyngeal carcinoma (NPC) is endemic in southern China, and its incidence in Hong Kong is relatively high. Radiotherapy is the mainstay treatment for NPC due to its relatively high radiosensitivity and deep‐seated anatomical position, which is not readily accessible by surgery. Although the technique of radiotherapy in NPC has been advancing and offers promising treatment outcome, complications around the irradiation areas are inevitable and the quality of life of the post‐radiotherapy patients is often compromised. Trismus, which is defined as the restricted mouth opening or jaw movement due to the disorder of temporo‐mandibular joint (TMJ), is one of the possible late complications for radiotherapy of NPC and is found in 5–17% of the post‐radiotherapy (post‐RT) patients. Trismus at early stage may only affect the speech, but in severe cases nutritional intake and oral hygiene condition may deteriorate seriously. This article reviewed the possible causes of radiation‐induced TMJ damage, the various assessments including imaging modalities and possible treatments. The conclusion is that the availability of simple, yet effective examinations for trismus is essential for delaying the progression and restoring TMJ functions. Although there is no absolutely effective treatment for trismus, many supportive, restorative and palliative management are possible under different clinical situations.

Masticatory muscle myositis in Rottweiler – Case report

The clinical presentation of masticatory muscle myositis (MMM) in dogs reflects focal inflammatory myopathy of the muscles of mastication, while limb muscles are spared. Signs range from acute swelling of the temporalis and masseter muscles, restricted jaw movement, jaw pain, and exophthalmus, to muscle atrophy. The diagnosis is confirmed by a muscle biopsy. Early diagnosis and therapy with immunosuppressive doses of corticosteroids usually yields a good prognosis. This paper reports a case of MMM in a Rottweiler.

Use of MRI for the Early Diagnosis of Masticatory Muscle Myositis

The medical records of two dogs that were diagnosed with masticatory muscle myositis (MMM) were reviewed. The reported clinical signs included intense pain when opening the mouth and restricted jaw movement. MRI detected widespread, symmetrical, and inhomogeneously hyperintense areas in the masticatory muscle. Electromyography (EMG) demonstrated severe and spontaneous pathologic activity in the temporal and masseter muscles. With early therapeutic treatment, remission of symptoms occurred within 2 mo, and no relapses were observed for the subsequent 2 yr. The gold standard for the diagnosis of MMM is the 2M antibody test, but the purpose of this study was to evaluate the use of MRI as an accurate and efficient diagnostic tool for the initiation of early therapy for the treatment of muscle myositis.

Safety and efficacy of US-guided CS injection into temporomandibular joints in children with active JIA

To assess the safety and efficacy of US-guided CS injection done by a paediatric rheumatologist into the TM joints (TMJs) in children with JIA. Children with JIA presenting to the rheumatology clinic were assessed for TMJ arthritis. Triamcinolone hexacetonide was injected in children with active arthritis assessed by MRI using US guidance under general anaesthesia by the same paediatric rheumatologist trained in the procedure. Efficacy and safety were assessed post-injection by patient-guided symptoms and physical examination. Thirty-eight children (34 girls) with JIA who had TMJ injection done between January 2009 and January 2011 were included in the analysis. Mean age was 12.25 (± 3.55) (range 5-18) years. The mean disease duration was 4.54 (± 2.73) (range 1.5-11.1) years. Symptoms pre-injection were pain in 17/38 (44.7%), jaw deviation in 14/38 (36.8%), restricted jaw movement in 13/38 (34.2%) and chewing dysfunction in 7/38 (18.4%). Five (12.5%) children had micrognathia. A total of 63 joints were injected. The injection was efficacious in 58/63 (92.06%) joints. All 17 (100%) children had resolution of pain, and chewing dysfunction improved in 5/7 (71.4%). Jaw deviation improved in 13/14 (92.8%). In the 5/63 (7.9%) injections that were not efficacious, two children with both TMJs injected (four joints) had persisting stiffness with chewing dysfunction and one had persistent jaw deviation. One child developed a scar at the site of injection. US-guided CS injection into the TMJ done by a paediatric rheumatologist trained in the procedure is safe with a high rate of success.

Contralateral Coronoid Hyperplasia in Patients Undergoing Hemimandibulectomy With Disarticulation: A Case Series

The purpose of this article is to evaluate whether hemimandibulectomy with disarticulation predisposes the patient to the development of contralateral coronoid hyperplasia, thereby justifying a coronoidectomy procedure for these patients to improve jaw function and mouth opening and decrease the length of postoperative physical therapy. Five patients who had hemimandibular resection with disarticulation for odontogenic cysts and benign tumors followed by hemimandibular graft reconstruction with either a cadaveric hemimandible or an iliac crest bone graft, or both, were retrospectively reviewed. The Levandoski panoramic radiograph analysis, which has been proven to be useful in evaluating facial asymmetry and hyperplasia of the coronoid process in adults, was used to analyze preoperative panoramic radiographs as well as those obtained at postoperative months 3 and 6. All patients performed postoperative range-of-motion exercises for treatment of limited mouth opening in a range between 12 to 24 mm lasting up to 3 or 4 months. Two patients had prolonged trismus with a maximum interincisal opening of about 30 mm. The mean preoperative Kr' (koronion')-Go' (gonion')/Cd' (condylion')-Go' ratio was 0.92. A minimal increase in the Kr'-Go'/Cd'-Go' ratio was noted at postoperative months 3 and 6, with mean values of 0.95 and 0.96, respectively. Only 3 patients showed minimal elongation of the coronoid process, with 1 having a notable increase from 0.91 to 1.04. Trismus, the clinical sign of restricted jaw movement, can result from pathology in a variety of structures around the oral cavity. Among the general population, the normal Kr'-Go'/Cd'-Go' ratio was found to be less than 1.07, which coincides with the preoperative mean Kr'-Go'/Cd'-Go' ratio of 0.92 in our series. Our study sample showed a minimal increase in the Kr'-Go'/Cd'-Go' ratio over the first 6 postoperative months, but the number of patients was not sufficient to conclude causality. The etiology of coronoid hyperplasia remains unclear, but the role of increased temporalis muscle activity cannot be excluded. We recommend the Levandoski analysis for patients who had hemimandibulectomy with disarticulation who complain of prolonged limited mouth opening. We also recommend considering coronoidectomy as a treatment option for those with persistent trismus and radiographic signs of coronoid hyperplasia.

The aetiology and pathogenesis of trismus

Review: The aetiology and pathogenesis of trismus The word trismus, from the Greek ‘trismos’, is defined as a prolonged, tetanic spasm of the jaw muscles by which the normal opening of the mouth is restricted (locked jaw). The designation was originally used only in tetanus, but as inability to open the mouth may be seen in a variety of conditions, the term is currently used in restricted jaw movement regardless of aetiology.1 As the literature on the subject mainly consists of case reports, the authors have reviewed the pathogenesis, aetiology and management of trismus

Interventions for the management of oral submucous fibrosis

Oral submucous fibrosis (OSF) is a chronic disease of the oral cavity which is more commonly found in patients in the Asian subcontinent and the Far East. It is characterised by the progressive build up of constricting bands of collagen in the cheeks and adjacent structures of the mouth which can severely restrict mouth opening and tongue movement and cause problems with speech and swallowing. To assess the effectiveness of interventions for the management of pain and restricted jaw opening or movement occurring as a result of oral submucous fibrosis. We searched the Cochrane Oral Health Group's Trials Register to July 2008; CENTRAL (The Cochrane Library 2008, Issue 2); MEDLINE (from 1950 to July 2008); EMBASE (from 1980 to July 2008) and IndMED on 18th November 2007. There were no language restrictions. Randomised controlled trials comparing surgical interventions, systemic or topical medicines or other interventions to manage the symptoms of oral submucous fibrosis. Two authors independently assessed trial quality and extracted trial data. Disagreements were resolved by consultation with a third author. Attempts were made to contact study authors where necessary for clarification and for additional information. Two trials, involving 87 participants, evaluated lycopene in conjunction with intralesional injections of a steroid, and pentoxifylline in combination with mouth stretching exercises and heat. Only two of the primary but none of the secondary outcomes of this review were considered in these trials and provided a limited amount of unreliable data. The data in one trial were based on inadequately defined evaluations of outcomes, and in the other trial are likely to be skewed due to a substantial number of withdrawals and therefore were not entered into the RevMan analyses. There were no reports of toxicity to the interventions but some side effects, which were mostly gastric irritation to pentoxifylline, were noted. The lack of reliable evidence for the effectiveness of any specific interventions for the management of oral submucous fibrosis is illustrated by the paucity, and poor methodological quality, of trials retrieved for this review.

Effects of Low-level Laser in the Treatment of Myofascial Pain Dysfunction Syndrome.

Background and aims Muscular pain in the facial region is the most common cause of facial pains. Myofascial pain dysfunction syndrome (MPDS) is one of the most important facial muscle disorders comprising of signs and symptoms including pain during function, tenderness in the muscles of mastication and restricted jaw movement. Due to the lack of an accepted therapeutic approach, the purpose of this paper was to find an effective treatment to decrease the pain of such patients. Considering the analgesic and anti-inflammatory action of laser therapy, the effects of low level laser (Ga-Al-As) in the treatment of MPDS patients referred to Tehran University of Medical Sciences Faculty of Dentistry, were investigated in the present study. Materials and methods This study was a quasi-experimental research. Twenty-two MPDS patients were selected from those referred to Department of Oral Medicine, Tehran University of Medical Sciences Faculty of Dentistry. Clinical examination was performed at six stages in the following order: prior to the treatment, at 2 and 4 weeks after treatment, and monthly thereafter for a 3-months follow-up. All patients underwent low-level laser therapy for 4 weeks (12 sessions). Variables such as pain severity, pain of cheek region, pain frequency, tenderness of masticatory muscles, click, and mouth opening were evaluated at each stage. Numerical variables were investigated using Analysis of Variance test for repeated measures whereas ranking variables were studied by non-parametric Kruskal-Wallis test. Results At the end of treatment period, pain severity, pain of cheek region, pain frequency, tenderness of masseter, temporalis, medial pterygoid, and lateral pterygoid muscles showed significant improvement as compared with the commencement of any treatment which continued during the 3-months post-treatment (p<0.05). Conclusion It was shown that low-level laser (Ga-Al-As) therapy had the efficacy to alleviate pain and decrease the tenderness of masticatory muscles among MPDS patients through a continuous and regular therapeutic program.

Physiotherapy in the treatment of temporomandibular joint disorders: a comparative study of four treatment methods

Temporomandibular joint pain dysfunction syndrome (TMJPDS) comprises of a constellation of signs and symptoms including joint tenderness and pain on function, restricted jaw movement, clicking, jaw locking and tenderness in the muscles of mastication. Headache may also be a feature. Physiotherapy is commonly employed in the treatment of this condition but there is little published material reporting the relative efficacy of the different types of treatment currently available. Further, no attempt seems to have been made to compare the costs of physiotherapy with other forms of treatment of this disorder such as occlusal splint therapy. This paper reports a comparative evaluation of four different physiotherapy treatments and placebo in the management of TMJPDS and comments on their cost benefit aspects compared with that of splint therapy. The four methods of physiotherapy tested were short-wave diathermy, megapulse, ultrasound and soft laser. There was no statistically significant difference in success rate between any of the four tested (range 70.4-77.7%) although each individually was significantly better than placebo treatment. The time of improvement appeared to vary between the four methods.

Coronoid process hyperplasia: CT studies.

Coronoid process hyperplasia is a disorder that causes restricted jaw movement due to enlargement of the coronoid process of the mandible, which impinges on the zygomatic arch with mouth opening. The cause is unclear. Computed tomographic (CT) findings in three patients with this disorder (two bilateral, one unilateral)--including a 3-year-old boy who may be the youngest patient with this disorder ever reported--include an enlarged coronoid process, with sclerosis and erosion of the zygomatic arch. CT is an effective and rapid method for establishing the diagnosis.

Restricted jaw movement caused by bilateral hyperplasia of the coronoid processes: Report of two cases

Restricted jaw movement caused by bilateral hyperplasia of the coronoid processes: Report of two cases

Ergonomics assessment of selected dust respirators: Their use in the tropics

The suitability and effectiveness of four different types of British made respirators were studied with respect to comfort, convenience and fit on wearers in Sri Lanka (a developing country). Objective and subjective assessments were made to evaluate the degree of discomfort and interferences to the use of senses. The study revealed that factors such as breathing resistance, work-rate and activity period affected the physiological responses. The weight of the respirator and the skin temperature had no direct relationship with the cardiovascular stress. Positive-pressure respirators that gave lower face temperatures than negative-pressure masks gave this type of respirator an additional advantage in hot environments. Respirators that restricted jaw movement affected the speech intelligibility of the wearer. Orinasal masks restricted vision more than the other types. The problem of fit was found negligible though head and face dimensions significantly differed between the British and the Sri Lankans. Subjective assessment correlated well with objective tests.

The aetiology and pathogenesis of trismus.

The word trismus, from the Greek 'trismos', is defined as a prolonged, tetanic spasm of the jaw muscles by which the normal opening of the mouth is restricted (locked jaw). The designation was originally used only in tetanus, but as inability to open the mouth may be seen in a variety of conditions, the term is currently used in restricted jaw movement regardless of aetiology. As the literature on the subject mainly consists of case reports, the authors have reviewed the pathogenesis, aetiology and management of trismus.