Symptomatic Temporomandibular Disorders Research Articles

Evaluation of the Articular Disc Using the Magnetic Resonance Cartigram in Asymptomatic and Symptomatic Temporomandibular Disorders.

Objectives The study is aimed to perform magnetic resonance (MR) cartigram of the articular disc in patients with asymptomatic and symptomatic temporomandibular disorders (TMD). Materials and Methods Thirty-nine volunteers were divided into three groups: 16 symptomatic TMD, 16 asymptomatic TMD, and 7 controls. The articular disc was divided into three segments (anterior, middle, and posterior) and analyzed using morphological magnetic resonance imaging (MRI) and T2 mapping sequences. T2 relaxation values were measured and assessed by an experienced radiologist and two observers. The T2 values in the discs were compared between the control, asymptomatic, and symptomatic groups using the Kruskal-Wallis test. The right and left discs were compared using the Wilcoxon signed rank test. Inter-examiner reliability among different examiners was evaluated. Results The controls had the highest T2 values compared with the other groups. The comparison among the right and left sides of all the groups revealed statistically significant results in the anterior portion in the asymptomatic group and the middle portion in the symptomatic group ( p < 0.05). The inter-examiner reliability coefficients among the three examiners were consistently high, with values of 0.921, 0.920, and 0.930. Conclusion Our study found the T2 relaxation time span was shorter than that reported in previous studies, which could be attributed to the early stage of cartilage deterioration in the individuals with TMD inferring treatment at this phase may be eventually effective with a good prognosis.

Kinesio Taping as an alternative therapy for limited mandibular mobility with pain in female patients with temporomandibular disorders: A randomized controlled trial.

Kinesio Taping (KT) is a non-invasive therapy commonly used in physiotherapy (PT). However, the available data on its effectiveness in patients with symptomatic temporomandibular disorders (TMD) remains scarce and contradictory. The aim of the study was to evaluate the analgesic and myorelaxant effects of KT in TMD patients with limited mandibular mobility. A single-blind randomized controlled trial was conducted among female patients aged 20-45 years with Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) group Ib, using a parallel group design and equal randomization (1:1). All patients underwent surface electromyography (sEMG) of the masseter muscle (MAS), pain intensity was assessed using a Numeric Rating Scale (NRS), and temporomandibular joint mobility was measured before and after 6 and 12 days of treatment. The Perceived Stress Scale (PSS-10) questionnaire was administered on the first and last days of treatment. Statistical analysis was performed using analysis of variance (ANOVA). Mauchly's sphericity test determined changes over time and between groups for variables with a normal distribution. Bonferroni's correction was used for post hoc multiple comparisons. Variables with a non-normal distribution were analyzed using the nparLD package and multiple comparison post hoc test, while correlations were assessed using Spearman's coefficient. Each treatment had a significant effect on the bioelectrical sEMG parameters (p = 0.05). Kinesio Taping had a superior analgesic effect compared to the controls (p < 0.001). The combination of KT with therapeutic exercise (TE) proved to be a more effective therapy for improving the maximal mouth opening (MMO) and reducing perceived stress than monotherapy (p < 0.001). Minimally significant clinical differences were observed for sEMG, MMO and PSS-10 parameters after both therapies. Kinesio Taping combined with TE may be considered an effective complementary noninvasive treatment modality for TMD, either as a stand-alone or as part of the therapeutic process in patients experiencing pain and limited mandibular ROM. Additionally, the use of KT and TE was found to have a beneficial effect on perceived stress levels.

RETRACTION: Comparative effectiveness of low-level laser therapy and transcutaneous electrical nerve stimulation in symptomatic Temporomandibular Disorders: A Randomised Control Trial.

Batra, S. Srivastava, A., Shivakumar, G. C., Marrapodi, M. M., Herford, A. S., Cicciù, M., Minervini, G. (2023) Comparative effectiveness of low-level laser therapy and transcutaneous electrical nerve stimulation in symptomatic Temporomandibular Disorders: A Randomised Control Trial. Journal of Oral Rehabilitation, 50: 1185-1193. https://doi.org/10.1111/joor.13555 The above article, published online on 05 July 2023 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor in Chief, Peter Svensson, and John Wiley and Sons Ltd. The retraction has been agreed following concerns raised by a third party about the ethical approval for the study described. The publisher contacted the authors, who provided a letter of ethical approval from People's College of Dental Sciences & Research Center, People's University, which did not match the ethical approval reported in the article. The authors reported that the study was initiated at Banaras Hindu University, but were not able to provide evidence of ethical approval from this institution. In addition, the authors did not provide an explanation for why the clinical trial was registered with Clinical Trial Registry-India retrospectively, which violates the journal's author guidelines that require authors to provide an explanation for retrospective registration of clinical trials. Following the investigation by the publisher, the journal has concluded this article did not follow the journal's requirements regarding ethical approval of clinical trials and registration of clinical trials, and so the journal must issue a retraction. Shivakumar, G. C. has stated that Marrapodi, M. M., Herford, A. S., Cicciù, M., and Minervini, G. were not involved in the investigation, data curation, conceptualization, methodology, or formal analysis of the clinical study. The authors disagree with this retraction.

Comparative effectiveness of low-level laser therapy and transcutaneous electrical nerve stimulation in symptomatic Temporomandibular Disorders: A Randomised Control Trial.

Myofascial pain is one of the most common facial region pains, presenting itself with various signs and symptoms like tenderness of masticatory muscles and difficulty in mouth opening. Considering its multifactorial aetiology various treatment modalities are present. The aim of this study is to compare the effectiveness of transcutaneous electrical nerve stimulation (TENS)and low-level laser therapy (LLLT) for the patients of temporomandibular disorders (TMDS). The study was conducted with 20 patients diagnosed with TMDS. Group A received LLLT at 660 nm, 6 J/point, two sessions/week for 4 weeks and group B received TENS at 2-250 Hz, two sessions/week for 4 weeks. Pain Score decreased and mouth opening increased in both groups with time, however, the difference between the two groups was not statistically significant. Right and left lateral excursions showed improvement at different intervals in both groups. However, the LLLT group showed significant improvement. Clinical trial showed improvement in visual analogue scale (VAS), maximum mouth opening (MMO) and lateral excursion in the different time intervals in both the groups with LLLT showed more improvement with lateral excursions movements.

Knowledge, Attitude and Practice of The Dental Practitioners About Temporomandibular Disorder in the Union Territory of Jammu &amp; Kashmir and Ladakh Region of India – A Cross – Sectional Study

Introduction: Temporomandibular Disorder (TMD) is a disorder including temporomandibular joint (TMJ) and of the masticatory muscles and their associated structures. TMD accounts for the most common orofacial pains arising from musculoskeletal origin or non-dental origin with a prevalence of 5-12% in the population.&#x0D; Aim: The aim of the current study was to assess the knowledge, attitude and practice of the dental practitioners about temporomandibular disorder in the Union Territory of Jammu &amp; Kashmir and Ladakh region of India.&#x0D; Materials and Methods: A cross-sectional study was conducted wherein a self-structured questionnaire, which consisted of 31 close ended questions, was sent online via Google forms to the dental practitioners residing in the Union Territory of Jammu &amp; Kashmir and Ladakh region of India. A total of 500 subjects selected by Convenience sampling, were contacted for the study, out of which only 206 returned the completed questionnaire who were included in the study.&#x0D; Results: A statistical significance was noted between knowledge to practice (-0.22), knowledge to attitude (0.03) and between attitude and practice (-0.26), attitude to knowledge ( -0.03) and practice to knowledge (0.22), practice to attitude (0.26).&#x0D; Conclusion: The results obtained by analyzing data obtained in present study reflect that the knowledge of physiological anatomy along with the management of symptomatic TMD is insufficient.

T-Scan Guided Occlusal Equilibration as an Effective Treatment in the Management of Symptomatic Temporomandibular Disorders

Background: Temporomandibular disorders (TMDs) constitute clinical problems that involve the masticatory muscles, the temporomandibular joints, associated structures, or both. The etiology of TMDs is multifactorial. The association between occlusal interferences and TMD is controversial.. Objectives: This study is designed to evaluate the clinical outcome of T-Scan guided occlusal equilibration in patients suffering from TMD associated with occlusal discrepancies. Materials and Methods: A total of 15 patients clinically diagnosed with TMD based on the Diagnostic Criteria for Temporomandibular Disorders and with positive occlusal interferences were included in the study. The occlusal equilibration was achieved by performing T-Scan guided Immediate Complete Anterior Guidance Development. Results: The obtained data was subjected to statistical analysis using SPSS version 20.0 software. There was a statistically significant reduction in the occlusion time, i.e., from 0.77 ± 0.6 pre-treatment to 0.31 ± 0.2 post-treatment (P = 0.005), and also disclusion time, i.e., from 1.71 ± 1.09 pre-treatment to 0.11 ± 0.03 post-treatment (P = 0.000). There was a statistically significant reduction in the VAS score post-treatment (P = 0.000). Conclusion: T-Scan guided occlusal equilibration in TMD patients has resulted in significant improvement of symptoms. Hence, we emphasize the importance of the identification and correction of occlusal interferences in the management of symptomatic TMDs.

Intra-articular corticosteroids for treatment of temporomandibular joint internal disorders: protocol for systematic review and network meta-analysis

IntroductionInternal temporomandibular joint (TMJ) disorders are present in approximately 80% of patients with symptomatic temporomandibular disorders. Among the minimally invasive therapies, we find the intra-articular infiltration of substances, such as...

Can the Measurement of Jaw-Opening Forces Assist in the Diagnosis of Temporomandibular Disorders?

To investigate the effectiveness of a novel jaw-opening-force measuring device as a screening tool to aid in the diagnosis of temporomandibular disorders (TMD). Symptomatic TMD patients (n = 58) and control TMD-free participants (n = 56) were screened by an oral medicine specialist according to the Diagnostic Criteria for TMD (DC/TMD). TMD patients were divided into three subcategories based on TMD symptoms (myofascial pain, disc displacement, and both combined). Jaw-opening forces were measured in both groups with an adjustable head device connected to a 1,000-N-load cell. Seven attempts were recorded at 10-second intervals by a data-capturing system. The geometric mean force values were obtained after discarding the first and last attempts. TMD-free participants had greater jaw-opening forces than TMD patients both without and with adjustments for age, sex, height, and weight (both P < .001). The geometric mean ± standard deviation values for TMD patients were 18.5 ± 1.62 N and 47.7 ± 1.53 N for TMD-free participants. Differences in jaw-opening forces among the three TMD subcategories were not statistically significant; however, patients with disc displacement (23.7 ± 1.46 N) had greater jaw forces than patients with myofascial pain (17.0 ± 1.74 N) and both myofascial pain and disc displacement (17.0 ± 1.56 N). This study demonstrated that differences in jaw-opening forces could be used as a diagnostic tool for TMD. Future studies should explore the potential of this device to measure improvement in jaw-opening forces following TMD treatment.

Association of temporomandibular joint morphology in patients with and without temporomandibular joint dysfunction: A cone-beam computed tomography based study

The etiology of temporomandibular disorders (TMDs) is complex and associated with multiple predisposing and initiating factors. Articular eminence morphology and steep eminence inclination have been postulated as the etiological factors, but there has been no clear evidence of association of morphology of the temporomandibular joints (TMJ) complex as a probable predisposing factor in the pathogenesis of TMDs. This was a cross-sectional, case-control study, and cone-beam computed tomography scans, and the evaluation was performed for 60 joints in 30 patients with symptomatic TMDs and for 40 healthy joints of 20 age-matched patients. One-way ANOVA, post hoc, unpaired t-test, Chi-square, and intra-class correlation coefficient test were used to determine the correlation between the TMJ articular eminence inclination, height, condylar bone changes, condyle, and fossa shapes with symptomatic TMDs. The P < 0.05 were considered statistically significant. There was a statistically significant difference of articular eminence inclination and height with a steeper eminence inclination in the control group (P = 0.044*, and 0.035*). The condylar bone changes were found to be significantly more in the TMJ disorder group (P = 0.001*). There was no significant association of condyle and fossa shapes (P = 0.482 and 0.689) and of articular eminence inclination and height with condylar bone changes (P = 0.695, 0.498, 0.192, and 0.823) and condyle shapes (P = 0.389, 0.521, 0.260, and 0.387). The eminence inclination was not associated with fossa shapes (P = 0.471 and 0.086), but eminence height was associated with fossa shapes in the TMJ disorder group (P = 0.043* and 0.111). The results depicted that there was no significant association between TMJ complex anatomy and TMJ disorders in the present study population.

Assessment of Articular Disc Position before and after Gnathological Splint Therapy in Symptomatic Temporomandibular Disorder Patients Using Magnetic Resonance Imaging

Assessment of Articular Disc Position before and after Gnathological Splint Therapy in Symptomatic Temporomandibular Disorder Patients Using Magnetic Resonance Imaging

A mass lesion misdiagnosed as a malignant tumor in the masticator space: a case report

Temporomandibular disorder (TMD) is common, affecting up to 28 % of the population. Inflammatory conditions, developmental abnormalities, and neoplasms involving the masticator space can result in symptomatic TMD, which may present with signs such as pain and trismus. Because TMD treatments, including surgical management, differ according to the underlying cause, imaging plays an important role in identifying the precise category of TMD. Here, we report a case of an inflammatory lesion in the right cheek of a 47-year-old woman with symptoms of TMD from both clinical and radiographic perspectives. Computed tomography and magnetic resonance imaging in the present case showed atypical findings for TMD caused by an inflammatory lesion. This knowledge should be added to the list of possible imaging findings in cases exhibiting TMD.

Hormonal fluctuations intensify temporomandibular disorder pain without impairing masticatory function.

The influence of hormonal fluctuations on pain and mastication was evaluated in patients with painful temporomandibular disorder (TMD) symptoms. Fifty women were assigned to menstrual cycle and oral contraceptive groups (n = 25). Their TMD was diagnosed by Research Diagnostic Criteria for Temporomandibular Disorders. Pain levels, maximum oclusal force (MOF), and masticatory performance (MP) were measured in all menstrual cycle phases. A lower pain level was observed in the ovulatory phase when compared to menstrual and luteal phases (P = .02). No differences were found regarding MOF (P = .20) or MP (P = .94). Hormonal fluctuations intensify pain in women with symptomatic TMD without impairing mastication.

Signs and symptoms of temporomandibular disorders and their impact on psychosocial status in non‐patient university student's population

Temporomandibular disorders (TMD) exhibit a combination of signs and symptoms, mainly characterized by pain and dysfunction, which impairs the functional capacity of the mastication system. These symptoms may produce a negative impact on social activities, employment and leisure. The aim of this study was to early identify the signs and symptoms of TMD and their impact on daily life of non-patient university students. Data were collected from 183 students of the dentistry course. The Axis II of the Research Diagnostic Criteria for Temporomandibular Disorders was administered and analyzed using Spearman test at a significance level of 0.05. Among the 183 participants, 107 were women (58.47%) and 76 were men (41.53%). Age ranged from 18 to 47, with a mean age of 25.35 years. In relation to pain intensity and disability, 129 participants (70.88%) reported no pain in the previous 6 months. An analysis of depression revealed that 35 (19.67%) had moderate and 7 (3.83%) had severe depression. The assessment of nonspecific physical symptoms including pain revealed that nine (4.92%) exhibited moderate symptoms, and one (0.55%) exhibited severe symptoms. The nonspecific physical symptoms excluding items of pain analysis revealed that 44 (24.04%) exhibited moderate symptoms, and 91 (49.73%) exhibited severe. The functions reported as most adversely affected by jaw disability were yawning, eating hard foods, chewing, smiling and laughing. Regarding the habit, 64 (35%) confirmed having the nighttime and 59 daytime (32.3%) teeth grinding with a significant correlation with the four domains analyzed. A significant correlation was observed among all domains. This study analyzed a young population that exhibited para-functional habits and nonspecific physical symptoms excluding pain that need some intervention since they could progress to a symptomatic TMD in future.

Pigmented villonodular synovitis of the temporomandibular joint with intracranial extension: a case and literature review

Pigmented villonodular synovitis (PVNS) is a benign, yet locally aggressive proliferative lesion most commonly found in joints of the long bones; it rarely presents in the temporomandibular joint (TMJ). The authors report a case of PVNS involving the TMJ and review similar cases reported in the English literature. This is the first case of PVNS with long-term follow-up of 11 years to include imaging studies. A 36-year-old male with symptoms suggestive of a temporomandibular disorder (TMD) presented with a progressive preauricular/parotid swelling and restricted mandibular range of motion. Imaging suggested a lesion with an aggressive course due to tissue displacement and destruction proximal to the lesion. A multidisciplinary team performed complete excision of the lesion with immediate reconstruction. PVNS often presents with similar symptoms to a TMD, but must be distinguished from symptomatic TMD as it can be highly destructive. Owing to its aggressive nature and potential for recurrence, complete and early extirpation and long-term follow-up with advanced imaging is indicated.

Expression of matrix metalloproteinases and aggrecanase in the synovial fluids of patients with symptomatic temporomandibular disorders

To investigate whether matrix metalloproteinases (MMPs) and/or aggrecanase in synovial fluid can be used as biochemical markers in the diagnosis of internal derangement (ID) of the temporomandibular joint (TMJ). Forty-four samples of synovial fluid were obtained from 35 patients with ID and osteoarthritis (OA) and 15 normal samples from 10 asymptomatic volunteers. MMP-2, -9, and aggrecanase in the synovial fluid were examined by immunoblotting. The incidences of MMP-2, -9, and aggrecanase expression in the ID and OA group were significantly higher than those in the normal group (P < .05). Those with anterior disc displacement without reduction and severe OA showed significantly high expression of MMP-9 compared with other disease subgroups (P < .05). Conversely, comparatively high expression of MMP-2 and aggrecanase was shown in the early-stage OA group. However, there was no significant difference in expression of MMP-2 and aggrecanase among disease subgroups. These findings suggested that expression of aggrecanase could be a potential biochemical marker for articular cartilage degradation in ID of the TMJ.

Prevalence of missing posterior teeth and intraarticular temporomandibular disorders

Statement of Problem. The association between missing mandibular posterior teeth and the development of intraarticular temporomandibular disorders (TMDs) remains unclear. Purpose. The purpose of this study was to evaluate the prevalence of missing mandibular posterior teeth and intraarticular TMDs in a mixed population of asymptomatic subjects and symptomatic TMD patients. Material and Methods. Eighty-two asymptomatic volunteers and 263 symptomatic TMD patients were included in this study. Asymptomatic volunteers completed a subjective questionnaire and underwent clinical examination to document the absence of TMD signs and symptoms. All symptomatic subjects had localized jaw joint pain and pain on movement or when eating. The number of missing mandibular bicuspid and molar teeth (excluding third molars) in each subject was recorded, and magnetic resonance images were made to document the presence or absence of disk displacement in the temporomandibular joints. Subjects were divided into 4 groups: group 1 = asymptomatic, normal magnetic resonance imaging result; group 2 = asymptomatic, disk displacement; group 3 = symptomatic, normal magnetic resonance imaging result; and group 4 = symptomatic, disk displacement. Collected data were analyzed with chi-square tests (P<.05) with no adjustment for multiple comparisons. Results. A positive association between missing mandibular posterior teeth and the presence of disk displacement was found. Conclusion. The literature does not suggest that replacement of missing posterior teeth prevents the development of TMDs. However, missing mandibular posterior teeth may accelerate the development of degenerative joint disease. (J Prosthet Dent 2002;87:45-50.)

Magnetic resonance imaging of temporomandibular disorders: classification, prevalence and interpretation of disc displacement and deformation.

To analyse the prevalence of disc displacements and deformations from MRI of symptomatic temporomandibular disorders (TMD). The study was conducted retrospectively on 192 joints of 98 patients (67 females, 31 males, mean age 29 years), who had undergone bilateral MRI (except for four who had unilateral) in the sagittal (both open and closed mouth) and coronal (closed mouth only) planes. These displacements were subdivided into static (complete anterior and posterior, partial anterolateral and anteromedial, sideways lateral and medial, anterolateral and anteromedial rotational) and dynamic (with reduction, without reduction, with incomplete reduction; non-determinable). Disc deformations were subdivided into: enlargement of the posterior band, reversed biconcave shape, biplanar (flattened) and biconvex shape. Eighty per cent of patients had bilateral displacement, 15% unilateral and 5% a normally positioned disc. Complete anterior displacement was the commonest and sideways the rarest. Reduction was present in 58% of disc displacements, no reduction in 26%, incomplete reduction in 4%, while in the remaining 12%, it could not be determined. Rotational displacement was the most likely to feature reduction and sideways the least. Temporomandibular joints with no reduction were closely correlated with bone lesions. The most frequent deformation was biplanar and the rarest enlargement of the posterior band. There was a high prevalence of displacements and deformations. While they do not appear to be significant in inducing pain, they can predispose to the onset of osteoarthrosis.

Prevalence of dental occlusal variables and intraarticular temporomandibular disorders: Molar relationship, lateral guidance, and nonworking side contacts

Statement of problem. The association between dental occlusion and the development of intraarticular temporomandibular disorders remains unclear. Purpose. This study evaluated the prevalence of molar relationship, lateral guidance and nonworking side contacts and intraarticular temporomandibular disorders. Material and methods. Eighty-two asymptomatic volunteers and 263 symptomatic temporomandibular disorder (TMD) patients completed a subjective questionnaire that documented the absence of jaw pain, joint noise, locking, and a positive history for TMD. Participants also underwent clinical and dental examination for signs and symptoms commonly associated with TMD or internal derangements. Results. The most prevalent molar relationship was Class I. Symptomatic patients had a higher prevalence of Class II, Division 1 relationships on the left side compared with the asymptomatic volunteers with normal joints. There was a higher prevalence of canine guidance (52.04%; P <.005) on the right side in the symptomatic patients with disk displacement (DD). Volunteers with normal joints had a higher prevalence of 1 or more nonworking side contacts compared with symptomatic patients with normal joints ( P <.001) and symptomatic patients with DD ( P <.001). Conclusion. This study suggests there are no systematic dental occlusal differences that clearly separate symptomatic from asymptomatic patients. Results indicate that it is unclear as to the relationship of the 3 analyzed factors and of intraarticular TMDs. (J Prosthet Dent 1999;82:410-5.)

THE BIOMECHANICS- RELATION BETWEEN INCISOR AND CONDYLAR GUIDANCES IN DEEP BITE CASES

ABSTRACT The aim of this study was to investigate the biomechanical relationship between the condylar and anterior guidances of patients with symptomatic temporomandibular disorders before and after orthodontic treatment. For this purpose, a four-bar link system was described for use on lateral cephalometric radiographs taken before and after treatment. A computer program was developed utilizing the lengths of the bar links of this four-bar link system on the cephalometric films. The link measurements were entered into the computer program which subsequently calculated the rotations of the mandible and the condyle during the mandibular movement. Three subjects with class II malocclusion and deep bite were selected from patients with temporomandibular pain dysfunction for this investigation. All subjects were treated by intrusion and protrusion of incisors. The rotations of mandible and condyle of these three subjects decreased and temporomandibular joint pains of the subjects were greatly diminished by tr...

Elongated styloid process in a temporomandibular disorder sample: Prevalence and treatment outcome

An elongated styloid process is an anatomic anomaly present in 2% to 30% of adults; it is occasionally associated with pain. Its prevalence among patients with classic temporomandibular disorder pain symptoms is unknown. The effect of conservative treatment on patients who have symptoms of temporomandibular disorders and an elongated styloid process is also unknown. The objectives of this study were to determine the prevalence of the elongated styloid process in a sample of patients with temporomandibular disorders and to compare patients with and without the elongated styloid process on initial presenting signs and symptoms and treatment outcome. A total of 100 panoramic radiographs of patients with symptomatic temporomandibular disorders were examined to ascertain the presence or absence of an elongated styloid process. All patients participated in a conservative treatment program of biofeedback and stress management and a flat-plane intraoral appliance. Initial symptoms and treatment outcome of patients with and without an elongated styloid process were compared by use of multivariate analysis of variance on several oral-paraoral and psychosocial-behavioral methods. The prevalence of an elongated styloid process in this clinic sample of temporomandibular disorders was 27%. The patients with or without an elongated styloid process were not significantly different in pretreatment symptoms, and both groups exhibited substantial treatment gains. However, patients with an elongated styloid process showed significantly less improvement on unassisted mandibular opening without pain than did patients who did not have an elongated styloid process. This suggests that an elongated styloid process may place structural limitations on pain-free maximum mandibular opening. The results support conservative management of patients with symptoms of temporomandibular disorders when an elongated styloid process is present.