Temporomandibular Joint Disorder Patients Research Articles

Gender differences in lateral pterygoid muscle in patients with anterior disk displacement.

To use quantitative MRI to assess gender differences in lateral pterygoid muscle (LPM) characteristics in patients with anterior disk displacement (ADD). Lateral pterygoid muscle of 51 patients diagnosed with temporomandibular joint disorders (TMD) who underwent T1-weighted Dixon and T1-mapping sequences were retrospectively analyzed. There were 34 female patients (10 with bilateral normal position disk [NP]; 24 with bilateral ADD) and 17 male patients (eight with bilateral NP; nine with bilateral ADD) among them. After controlling for age, differences in fat fraction, T1 value, volume and histogram features related to gender and disk status were tested with 2-way ANCOVA or Quade ANCOVA with Bonferroni correction. Volume of LPM in NP was significantly smaller than that of ADD (p < 0.001). Fat fraction of LPM in females with NP was significantly higher than males with NP (p < 0.05). Females with ADD showed a significantly higher T1 value (p < 0.05), and higher intramuscular heterogeneity than males with ADD. Lateral pterygoid muscle in female TMD patients presented more fatty infiltration in the NP stage and might present more fibrosis in the ADD stage compared with males. Together, this leads to more serious intramuscular heterogeneity during the pathogenesis of ADD in females.

Comparison of symptoms, signs, gender, and magnetic resonance images of temporomandibular joint disorder patients

ABSTRACT Objective To compare patients’ complaints, clinician’s examination findings, and magnetic resonance imaging (MRI) findings by considering gender. Methods Temporomandibular joint (TMJ) pain, difficulty in mouth opening, masseter tenderness, deviation, clicking sound, bruxism, restriction, normal occlusion and normal mouth opening symptoms, and findings of temporomandibular disorder (TMD) patients who came to the author’s outpatient clinic were recorded. These recordings were compared with MRI. Results In the study, symptoms, signs, and MRIs of 276 TMD patients were analyzed, including gender. No difference was observed in terms of symptoms, signs, or MRI results for either gender. MRI findings were correlated with restriction and normal mouth opening in both groups (p < 0.05). Normal MRI findings were observed in 52.5% of the MRI results. Conclusion Except for normal mouth opening and limitation, MRI findings did not provide a significant result. Therefore, careful detection of symptoms and signs rather than MRI helps in diagnosis.

Temporomandibular Joint Space Dimensions among Saudi Patients with Temporomandibular Disorders: MRI-Based Retrospective Study.

Introduction The temporomandibular joint is a complex synovial joint in the body. It is the area in which the mandible articulates with the cranium. The temporomandibular joint space is located between the articular eminence and the glenoid fossa of the temporal bone at the base of the skull and the condylar process of the mandible. This interarticular space is divided into superior joint space (1.2 ml) and inferior joint space (0.9 ml) by the articular disc. The purpose of this study is to detect and evaluate the variations in the temporomandibular joint space among patients having temporomandibular joint disorders. Materials and Methods In this retrospective study, 60 magnetic resonance imaging scans were evaluated at King Faisal Specialist Hospital in Riyadh, Saudi Arabia, between the years 2006 and 2016. Measurements were done in sagittal view in three areas: anterior, central, and posterior areas. However, coronal view readings were recorded in two different areas: medial and lateral joint spaces. All measurements were recorded at the highest point of the condyle that is perpendicular to the opposing bone. The SPSS program was used for statistical analysis. Results The central joint space values were higher than the anterior and posterior joint spaces in both coronal and sagittal views. We also found that joint spaces among male patients were higher than female patients (right side P=0.015 and left side P=0.006). It is worth mentioning that the number of temporomandibular joint disorder female patients was more than the number of male temporomandibular joint disorder patients (52 females versus 24 males). Additionally, patients who were older than 55 years old had wider joint spaces than patients who were younger than 25 years old. Conclusion The central joint space value was the highest among the other joint spaces on both views of magnetic resonance imaging, and the values of joint spaces among males were larger than those of females on sagittal magnetic resonance imaging. Patients with elderly temporomandibular joint disorders showed larger joint spaces than young patients. This study spotlights the importance of magnetic resonance imaging evaluation in temporomandibular joint disorder patients for a better understanding of the clinical evolution of temporomandibular disorders.

Can TMJ morphological alterations impede TMJ agony?

Introduction: The relation between temporomandibular joint morphology and its incoordination is an arena which is not ventured in much even though many researches have been done but still it is a drop in the ocean of such a vast and complicated structure of the human TMJ anatomy. Objective: To evaluate morphological variations of temporomandibular joint in healthy and disorder patients using computed tomography. Study Design: A total of 20 temporomandibular joint disorder patients and 10 patients with normal TMJs and Class I occlusion were studied. The study was conducted at SUM Hospital and Oral Medicine and Radiology department, IDS Bhubaneswar with TMJ as chief complaint during a period from September 2016 to November 2016. Symptomatic group and asymptomatic group based on according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/ TMD) were selected. The present research on TMJ morphology has been designed to investigate parameters like shape of condyle, glenoid fossa and articular eminence in relation to various temporomandibular disorders (TMD).The patients were enrolled with symptoms or signs such as pain, restricted mouth opening, deviation, clicking. A series of morphological parameters with teeth in maximum intercusspation were studied in CT scan. &#x0D;

Increased Pain Sensitivity Is Associated with Reduced REM Sleep in Females with Temporomandibular Joint Disorder (TMD)

Previous evidence demonstrates that the incidence of chronic sleep disturbance is high in patients with temporomandibular joint disorder (TMD). However, there has been little examination of whether heightened daytime pain sensitivity in this population is associated with alter sleep architecture at night. We aimed to test the extent to which daytime pain sensitivity, measured using quantitative sensory testing (QST) is associated with objective markers of sleep physiology, including sleep architecture and power spectral density bands, in patients with TMD. Female participants (n=149) with insomnia and TMD were recruited as part of a randomized-controlled trial. Pre-randomization, we performed a quantitative sensory testing (QST) battery to measure General Pain Sensitivity, a Central Sensitization Index, and Masseter Pressure Pain Threshold, and performed polysomnography (PSG) that night to calculate sleep architecture parameters (N1%, N2%, SWS%, REM%) and derive relative power in the Delta (0.5-3.5 Hz), Theta (3.5-8.0 Hz), Alpha (8.0-15.0 Hz), and Beta (15-30.0 Hz) spectral bands during sleep. We fit linear regression models with sleep parameters as the outcome, and pain sensitivity as the predictor, controlling for age, depressive symptom severity, and race. Higher Central Sensitization (B = -2.863, P = <0.01) and General Pain Sensitivity Indices (B = -3.069, P = <0.01) were significantly associated with lower REM% both before after controlling for covariates, however masseter pressure pain threshold was not significantly associated with REM% (B = -0.0259, P = 0.0743). Pain sensitivity measures were not significantly associated with relative power in any of the spectral bands, or with any other sleep architectural stages. Heightened pain sensitivity, measured using QST is associated with objective features of sleep architecture in TMD patients, potentially due to heightened pain interfering with sleep. These findings may contribute to understanding of physiological mechanisms through which acute and chronic pain result in sleep disruption. Grant support from NIH Grant R01 DE019731. Previous evidence demonstrates that the incidence of chronic sleep disturbance is high in patients with temporomandibular joint disorder (TMD). However, there has been little examination of whether heightened daytime pain sensitivity in this population is associated with alter sleep architecture at night. We aimed to test the extent to which daytime pain sensitivity, measured using quantitative sensory testing (QST) is associated with objective markers of sleep physiology, including sleep architecture and power spectral density bands, in patients with TMD. Female participants (n=149) with insomnia and TMD were recruited as part of a randomized-controlled trial. Pre-randomization, we performed a quantitative sensory testing (QST) battery to measure General Pain Sensitivity, a Central Sensitization Index, and Masseter Pressure Pain Threshold, and performed polysomnography (PSG) that night to calculate sleep architecture parameters (N1%, N2%, SWS%, REM%) and derive relative power in the Delta (0.5-3.5 Hz), Theta (3.5-8.0 Hz), Alpha (8.0-15.0 Hz), and Beta (15-30.0 Hz) spectral bands during sleep. We fit linear regression models with sleep parameters as the outcome, and pain sensitivity as the predictor, controlling for age, depressive symptom severity, and race. Higher Central Sensitization (B = -2.863, P = <0.01) and General Pain Sensitivity Indices (B = -3.069, P = <0.01) were significantly associated with lower REM% both before after controlling for covariates, however masseter pressure pain threshold was not significantly associated with REM% (B = -0.0259, P = 0.0743). Pain sensitivity measures were not significantly associated with relative power in any of the spectral bands, or with any other sleep architectural stages. Heightened pain sensitivity, measured using QST is associated with objective features of sleep architecture in TMD patients, potentially due to heightened pain interfering with sleep. These findings may contribute to understanding of physiological mechanisms through which acute and chronic pain result in sleep disruption. Grant support from NIH Grant R01 DE019731.

Efficacy of Pulsed Short Wave Therapy in Symptomatic TMD Patients

Context: Temporomandibular joint (TMJ) is a ginglymoarthroidal joint of synovial variety. The joint's pathology includes those predominantly of musculoskeletal origin, which poses a complex problem in the clinical scenario. The management of temporomandibular joint disorders (TMD) remains a challenge due to the intricate anatomy of the joint and the multipart etiologies associated with it. Aims: This study aimed to compare the effectiveness of pulsed short wave therapy (PSWT) with pharmacotherapy in symptomatic TMD patients. Methods and Material: A total of 62 patients were included in this randomized control trial and were randomly allotted into two groups. Patients in Group I received PSWTand Group II received a combination of a muscle relaxant and a nonsteroidal anti-inflammatory drug (NSAID) for 5 consecutive days. Visual analog scale (VAS) scores were recorded during the follow-up. Statistical Analysis Used: The statistical analysis was performed using Stata/SE 17.0 statistical software. Results: There was a statistically significant difference in the groups for different periods. Kaplan–Meier function and extended survivor function tests showed better pain alleviation in the short wave therapy group. Conclusion: The current study shows that PSWT decreased pain without adverse effects. Therefore, it could be considered a safe and potentially effective adjuvant therapeutic modality for TMD.

Comparative efficacy of low-level laser therapy (LLLT) to TENS and therapeutic ultrasound in management of TMDs: a systematic review & meta-analysis

ABSTRACT Objective To assess the reduction in pain, muscle tenderness, joint clicking, and improvement in mouth opening (MO) after low-level laser therapy (LLLT) compared to transcutaneous electrical nerve stimulation (TENS) and therapeutic ultrasound (US) among temporomandibular joint disorder (TMD) patients. Methods A systematic search of online sources of electronic databases was undertaken. The quality of the study was assessed using the Cochrane risk of bias assessment tool for randomized controlled trials (RCTs). Results Twelve RCTs were included in the systematic review, and 9 were included in the meta-analysis. For reduction in pain between LLLT and TENS, LLLT was found to be better than TENS, at 95% CI. LLLT was also proven to be better in reducing pain than therapeutic US, at 81% CI. Conclusion This systematic review and meta-analysis compared the effectiveness of LLLT, TENS, and therapeutic US in TMD. LLLT provided relatively more effective pain relief and improvement in MO.

Temporomandibular Joint Disorders in Females with Adolescent Idiopathic Scoliosis: Long-Term Effects of Milwaukee Brace Treatment.

Patients with adolescent idiopathic scoliosis (AIS) more frequently suffer dysfunctions of dento-skeletal complex. To our knowledge, no study has ever evaluated the temporomandibular joint disorders (TMD) of AIS patients at least 23 years after the completion of Milwaukee brace treatment. We aimed to provide a complex assessment of TMD and AIS patients treated with a Milwaukee brace, in a minimum 23-year follow-up, using radiological, clinical, and socio-demographical data, and to adapt the TMD Disability Index Questionnaire (TMDQ) and Fonseca’s questionnaire (FQ) to Polish conditions. In total, 42 healthy females and 30 AIS patients with a minimum of 23 years after a completed Milwaukee brace treatment were asked to complete the Polish version of (TMDQ-PL) and (FQ-PL). AIS patients present higher TMD levels than healthy controls. Significant differences exist between TMDQ-PL and FQ-PL (both in total scores and particular sub-sections), and AIS patients. Clinical and radiological factors affected the TMDQ-PL and FQ-PL results. Adult patients with scoliosis treated conservatively present limitations in everyday activities connected with the temporomandibular joint (TMJ). The variety of curve-related factors in a long-term follow-up of wearing the Milwaukee brace influence TMJ.

Quantitative analysis of the mouth opening movement of temporomandibular joint disorder patients according to disc position using computer vision: a pilot study

Temporomandibular joint disorder (TMD), which is a broad category encompassing disc displacement, is a common condition with an increasing prevalence. This study aimed to develop an automated movement tracing algorithm for mouth opening and closing videos, and to quantitatively analyze the relationship between the results obtained using this developed system and disc position on magnetic resonance imaging (MRI). Mouth opening and closing videos were obtained with a digital camera from 91 subjects, who underwent MRI. Before video acquisition, an 8.0-mm-diameter circular sticker was attached to the center of the subject's upper and lower lips. The automated mouth opening tracing system based on computer vision was developed in two parts: (I) automated landmark detection of the upper and lower lips in acquired videos, and (II) graphical presentation of the tracing results for detected landmarks and an automatically calculated graph height (mouth opening length) and width (sideways values). The graph paths were divided into three types: straight, sideways-skewed, and limited-straight line graphs. All traced results were evaluated according to disc position groups determined using MRI. Graph height and width were compared between groups using analysis of variance (SPSS version 25.0; IBM Corp., Armonk, NY, USA). Subjects with a normal disc position predominantly (85.72%) showed straight line graphs. The other two types (sideways-skewed or limited-straight line graphs) were found in 85.0% and 89.47% in the anterior disc displacement with reduction group and in the anterior disc displacement without reduction group, respectively, reflecting a statistically significant correlation (χ2=38.113, P<0.001). A statistically significant difference in graph height was found between the normal group and the anterior disc displacement without reduction group, 44.90±9.61 and 35.78±10.24 mm, respectively (P<0.05). The developed mouth opening tracing system was reliable. It presented objective and quantitative information about different trajectories from those associated with a normal disc position in mouth opening and closing movements. This system will be helpful to clinicians when it is difficult to obtain information through MRI.

Assessment of the temporomandibular joint condition using two-dimensional ultrasound scanning and doppler ultrasonography methods in patients with chronic inflammatory periodontal diseases

Introduction. Currently, dentists are increasingly detecting changes in the temporomandibular joint in patients with chronic inflammatory periodontal disease.Aim of the study. To carry out a comprehensive dynamic assessment of the temporomandibular joint (TMJ) condition and the registration of regional blood flow using two-dimensional ultrasound scanning to improve the efficiency of diagnostics of inflammatory periodontal diseases.Materials and methods. The study included 2 groups of patients: group 1 (control) consisted of 20 volunteers aged 20–25; Group 2 consisted of 52 people aged 25–45 years with moderate chronic periodontitis. For TMJ ultrasound and Doppler ultrasound, a portable ultrasound scanner LogicScan 128 with an HL-10 linear ultrasound transducer with an operating frequency of 5 to 12 MHz was used.Results and discussion. During ultrasound examination of the temporomandibular joint and measuring the size of the joint space in patients with moderate chronic periodontitis in a state of relative physiological rest, the following values were obtained: in the anterior region – 2.3 ± 0.5 mm; in the upper section – 1.6 ± 0.6 mm; in the posterior section – 1.8 ± 0.3 mm. We also measured the area of the temporomandibular joint disc in various positions. According to ultrasound data, an increase in the size of the joint space from 12.2 to 16.1% and an increase in the area of the articular disc by 17.1 to 36.7% were found in patients with chronic periodontitis. When assessing the trajectory of the articular track, motion delay and joint wedging are determined. In addition, in the color Doppler mapping (CDM) mode, the speed and index indicators of Doppler ultrasonography of the external carotid and temporal arteries were calculated.Conclusions. Modern diagnostic methods of ultrasound and Doppler mapping, assessing the hemodynamics and functional state of the TMJ, allow early diagnosis of changes in order to prevent the development of TMJ disorders in patients with chronic inflammatory periodontal diseases.

Prevalence of Temporomandibular Joint Disorders in Patients with Ankylosing Spondylitis: A Cross-Sectional Study.

BackgroundThis study sought to investigate which temporomandibular disorders (TMD) can be expected in patients with ankylosing spondylitis (AS) and to determine the combined impact of these conditions on the psychological status, chronic pain, and functional disability.Material and MethodsA cross-sectional study composed of 30 patients between 18 and 65 years with ankylosing spondylitis was performed. The research protocol considered the evaluation of outcomes related to the ankylosing spondylitis (HLA-B27 antigen, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and Health Assessment Questionnaire – Spondylitis (HAQ-S)) and temporomandibular disorders (axis I and II of the Research Diagnostic Criteria for Temporomandibular Disorders – RDC/TMD). Descriptive analyses were applied to express the results.ResultsThe sample presented both AS and TMD, most of them (24) were diagnosed with conventional AS (HLA-B27 positive). The BASDAI was scored as 7.70 (2.30) (high activity of AS disease). Functional disability represented by high scores of BASFI [7.00 (2.63)] and HAQ-S [1.79 (0.62)] demonstrates the severe impact of the disease on the daily routine and quality of life. According to RDC/TMD diagnostic criteria, 17 (57%) share the three groups of TMD, and 9 (30%) share two groups of TMD (Group I and III). Over 73% of the volunteers scored high levels of chronic pain (Grade III and IV) associated with a high depression scale score. The sample scored the somatization scale (with and without pain) as severe.ConclusionPatients with ankylosing spondylitis presented a high prevalence of temporomandibular disorder, most of them having the degenerative forms of TMJ disease. AS and TMD cause moderate to severe chronic pain and a negative impact on psychological status and functional capacities.

Evaluation of Dentition Status and Temporomandibular Joint Disorders in Patients with Chronic Neck and/or Back Pain – A Cross-Sectional Study

Background: The stomatognathic system (SS) is a functional unit of the body formed by the orofacial structures, together with peripheral sensory and motor neuronal connections to perform different functions like mastication, speech, and deglutition. Stomatognathic system consists of skeletal components (maxilla and mandible), dental both maxillary and mandibular arches, soft tissue (salivary glands, their nervous and vascular supplies), and temporomandibular system, that is, temporomandibular joints (TMJ; which connects the mandible to the base of the skull), muscles of mastication and their ligaments and nerves (III, IV, V, XI) which regulates and co-ordinates all its structures. The stomatognathic system also plays an important role in postural control. In balance of imbalance stomatognathic system components such as occlusion may cause temporomandibular joint disorder (TMD), TMDs may affect neck and back muscles. Aims and Objectives: To evaluate the dentition status and TMDs in patients with chronic neck and/or back pain and to correlate dentition status and TMDs in both neck and back pain patients. Material and Methods: A cross-sectional study was carried out on 300 patients. Patients were selected according to inclusion and exclusion criteria. Findings were noted in specialized case history proforma. Results: Out of 300 patients, 116 (38.67%) were males and 184 (61.33) were females. The mean age of patients referred for the study was 38.09 years. The most common dental finding in both chronic neck and/or back pain patients was flat curve of Wilson's (90%) whereas the least finding found was Grade III tooth mobility (0.04 ± 0.31 teeth). In TMDs most common finding was deviation of jaw (79.3% in neck and 100% in back pain) whereas the least finding found was deflection of jaw (50% in neck and 48.2% in back pain). Statistical analysis: The result was found highly significant (p-value &lt;0.05). Conclusion: There was an association between disturbed dentition status, temporomandibular joint disorders, chronic neck and back pain.

English

BACKGROUND Temporomandibular joint(TMJ)is the third most common site of pain in the orofacial area, while the masseter muscle was the primary painful masticatory muscle. The temporal and frontal region were pain areas indicated by temporomandibular joint disorder (TMDs) patients. The purpose of this study was to compare two different treatment modalities, physical therapy and occlusal appliance to treat myofascial pain. METHODS This retrospective study comprises of all orofacial pain patients attending orofacial pain clinics of Dental University Hospital, King Saud University in Riyadh, Saudi Arabia. Patients were categorized into two groups, the first group: patients treated by the occlusal appliance (hard type). The second group: patients treated by physiotherapy home exercises, including posture position modification. Physical therapy included muscle stretching and isometric tension against resistance exercises and guided jaw movements. Methods of clinical examination was based on the research diagnostic criteria for temporomandibular disorders (RDC/TMD) criteria. The data of pain level was collected based on the visual analog scale (VAS). RESULTS 16.1 % of patients were male, and 83.9 % of the patients were female. With the mean age being 31.1 years old. 92.9 % were Saudi patients and 7.1 % were non-Saudi. 50 % of the patients were using an occlusal appliance, and 50 % went for physiotherapy. The independent t-test showed a highly significant difference between different management methods with a P – value of 0.038 and a mean difference of 0.32143. 80.5 % of the patients reported masseter muscle pain as one of their main complaints. CONCLUSIONS A significant difference was observed between physiotherapy and occlusal appliances with education in treating patients with myofascial pain. Patients using the occlusal appliances showed a high percentage of pain reduction (85.7 %) compared to physiotherapy treatment (57.1 %) in a short period of time. Henceforth, patient’s education plays a significant role in pain reduction. KEY WORDS Temporomandibular Joint Disorder, Occlusal Appliance, Myofascial Pain, Physiotherapy

Evaluation of the effectiveness of different puncture points for second cannula in double puncture arthrocentesis of temporomandibular joint

The study at checking if treatment outcomes in double puncture temporomandibular joint (TMJ) arthrocentesis (DPTMJA) changed when the puncture points of the second cannula punctate were changed.Using a retrospective cohort study design, the investigators enrolled a sample of temporomandibular joint disorder (TMD, internal derangement) patients receiving DPTMJA. The decision of whether to perform a modified or traditional arthrocentesis was made by the patients: Patients who accepted the close cannula relationship were evaluated as group 1 (modification group), and those who did not agree as group 2 (traditional group). The predictor variable was puncture points of the second cannula (close to vs. far from the first cannula; group 1 and 2, respectively). The main outcome variables included maximum mouth opening (MMO), and pain assessed using a Likert-type (0–10) visual analogue scale (VAS) before treatment and at 1st day and 3rd months intervals. Appropriate statistics were computed using P < .05 was considered significant.The study sample comprised 32 patients (93.8% females; 50% in each study arm) with an average age of 36.9 ± 15.3 years (range, 18–78). Although, patient age and gender, and baseline VAS in both groups were not significant different (P > .05), the baseline MMO in group 2 was significant higher than that in group 1 (P = .03). The within-group analyses demonstrated the significant improvement of both MMO and VAS at postoperative month 3 (P < .05). However, the between-group analyses rejected the significant differences between the 2 groups at day 1 and month 3 (P > .05).Within the limitations of the study the choice of one or the other technique should be left to the discretion of the surgeon.

The expression of Netrin-1 in the MIA-induced osteoarthritic temporomandibular joint in mice

Subchondral bone degeneration is the main pathological change during temporomandibular joint (TMJ) osteoarthritis (OA) development. Netrin-1, an axon-guiding factor, might play roles in OA development and pain. The purpose of this study was to investigate the expression of Netrin-1 in TMJ OA and its possible role in the progression of TMJ OA and pain. The synovial fluids of temporomandibular joint disorders (TMDs) patients were collected for Netrin-1 by enzyme linked immunosorbent assay (ELISA). TMJ OA model was built by MIA joint injection, and then the von Frey test, hematoxylin & eosin (H&E) staining, toluidine blue (TB) staining, immunohistochemical (IHC) staining and micro-CT were performed. After induction of osteoclast differentiation of raw264.7 cells, immunofluorescence (IF) was used to detect the Netrin-1 and its receptors on osteoclast membrane. The concentration of Netrin-1 increased in the synovial fluid of TMJ OA patients. After MIA injection to TMJ, the head withdrawal threshold (HWT) was significantly decreased. Microscopically, the structural disorder of subchondral bone was the most obvious at the 2nd week after MIA injection. In addition, Netrin-1 expression increased in the subchondral bone at the 2nd week after MIA injection. In vitro, the expressions of Netrin-1 and its receptor Unc5B were upregulated on the osteoclast membrane. Netrin-1 might be an important regulator during bone degeneration and pain in the process of TMJ OA.

Ultrasound is Effective to Treat Temporomandibular Joint Disorder.

BackgroundTemporomandibular joint disorder (TMD) affects millions of people. It is unclear if low intensity ultrasound (US) is effective to treat TMD.MethodsA total of 160 patients with TMD were enrolled in this study. The subjects were randomized into two groups to receive US therapy or no therapy. Patients in the US group were given US therapy once a day for 5 days per week for 2 consecutive weeks. Before and 4 weeks and 6 months after the treatments, the patients were assessed for pain using visual analog scale (VAS) and the maximum pain-free inter-incisal distance (IID). In addition, mandibular movement (MM), jaw noise (JN), disability index (DI) and craniomandibular index (CMI) were also assessed.ResultsCompared with the patients before the therapy, VAS, IID, MM, JN, DI and CMI in the US group were significantly improved 4 weeks and 6 months after therapy. However, 6 months after the therapy, US group had a recurrence rate of 2.63%.ConclusionUS therapy can significantly reduce the pain, and improve the functionality of the temporomandibular joint and mouth opening limit for TMD patients, and is therefore recommended for TMD patients.

Relationship of temporomandibular joint disorders with cervical posture and hyoid bone position

ABSTRACT Objective To evaluate craniocervical posture and hyoid bone position in patients with and without temporomandibular joint disorder (TMD). Methods A total of 113 people were included in the study, including 55 TMD patients and 58 healthy controls. Using lateral cephalograms, the craniofacial, craniocervical, and hyoid bone positions of the participants were evaluated in terms of 27 variables. Results There was no significant difference in craniocervical angles between participants with or without TMD. While the Hy-B, Hy-NSL, Hy-NL measurements and FMA (°), AFH (mm) measurements of participants with TMD were lower than the control group, the hyoid angle was greater than the control group. Conclusion These study findings provide evidence that TMD is not related to craniocervical posture but to the position of the hyoid bone and craniofacial morphology.

Analysis of three-dimensional imaging findings and clinical symptoms in patients with temporomandibular joint disorders.

The purpose of this study was to analyze cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) findings in temporomandibular joint disorder (TMD) patients and to comprehensively assess the relationships between these imaging findings and clinical symptoms. A total of 754 temporomandibular joints (TMJs) in 377 patients with clinical symptoms of TMD who underwent both CBCT and MRI examinations were retrospectively reviewed. Clinical symptoms included TMJ pain, TMJ sound, and limitation of mouth opening. Oral radiologists evaluated osseous changes of the condylar head on CBCT, as well as the disc configuration, internal derangement, and joint effusion on MRI. The frequency of CBCT and MRI findings and the mean and standard deviation of age were analyzed. Logistic regression analysis was used to identify associations between these imaging findings and clinical symptoms using SPSS version 25.0 for Windows (IBM Corp., Armonk, NY, USA). The model fit was evaluated using the Hosmer and Lemeshow test. TMD patients consisted of 294 females and 83 males, and the age group of 20-39 accounted for 47.2% of the patients. Normal findings regarding osseous changes of the condylar head on CBCT were found in 65.1% of the patients. On MRI, a change in disc configuration was found in 54.9% of the patients, internal derangement in 62.6%, and joint effusion in 46.0%. TMJ pain was significantly associated with sclerosis [odds ratio (OR): 3.81], disc displacement without reduction (DDWOR) (OR: 3.22), grade 2 joint effusion (OR: 2.33), and grade 3 joint effusion (OR: 5.54). TMJ sound was significantly associated with disc displacement with reduction (DDWR) (OR: 3.04), DDWOR (OR: 2.50), grade 2 joint effusion (OR: 2.37), and grade 3 joint effusion (OR: 3.23). Limitation of mouth opening was significantly associated with flattened disc configuration (OR: 2.08), folded disc configuration (OR: 2.30), and grade 3 joint effusion (OR: 2.85). CBCT findings had little to do with clinical symptoms. In contrast, MRI findings, including disc configuration, internal derangement, and joint effusion, were associated with clinical symptoms. These results suggest that MRI should be recommended over CBCT for the proper diagnosis of TMD patients.

Evaluating the role of stress and anxiety with clinical symptoms in TMD patients

Introduction: The etiology of TMD is complex and multifactorial, but it is thought that psychological factors contribute to the etiology and persistence of TMD. Therefore, the aim of this study was to investigate the role of anxiety and depression in the development of temporomandibular joint disorders in patients referred to Tehran University of Medical Sciences, School of Dentistry, International Campus.&#x0D; Materials and Methods: This cross-sectional study was performed on patients referred to Tehran University of Medical Sciences, School of Dentistry, International Campus who had temporomandibular joint disorder. Hence the number of 224 people easily selected at random. They were given 3 questionnaires to assess their anxiety and depression (9-PHQ, 4-PHQ7 and-GAD-7). After collecting data using SPSS software version 22 and considering the error level at 0.50% probability and one-way analysis of variance and frequency analysis were performed.&#x0D; Results: The rate of depression in patients with TMD was 8.83 according to the 9-PHQ questionnaire and 4.72 according to the 4-PHQ questionnaire, and the level of anxiety in patients with TMD according to the 7-GAD questionnaire was equal to 8.95 There was no significant relationship between patients’ gender and their level of anxiety (p&lt;0.50), but there was a significant relationship between patients’ age and their level of anxiety (p&gt;0.50).&#x0D; Conclusion: Age and gender are not significantly associated with temporomandibular joint disorders. Also, anxiety and depression are positively related and there is a significant value achieved with the incidence of TMD in the participants. A reduction in the level of anxiety and depression within people, can have a great impact on the treatment of TMDs in individuals.

Therapeutic Agents for the Treatment of Temporomandibular Joint Disorders: Progress and Perspective.

Temporomandibular joint disorders (TMD) are a common health condition caused by the structural or functional disorders of masticatory muscles and the temporomandibular joint (TMJ). Abnormal mandibular movement in TMD patients may cause pain, chronic inflammation, and other discomfort, which could be relieved by a variety of drugs through various delivery systems. In this study, we summarized commonly used therapeutic agents in the management of TMD as well as novel bioactive molecules in preclinical stage and clinical trials. The emerging therapy strategies such as novel intra-TMJ delivery systems and implants based on tissue engineering are also discussed. This comprehensive review will strengthen our understanding of pharmacological approaches for TMD therapy.