Temporomandibular Disorders Patients Research Articles

Construction of the chronic temporomandibular disorder patients: the association between neural and psychological pathways.

Chronic temporomandibular disorder (cTMD) as a term based on the diagnostic criteria for temporomandibular disorders (DC/TMD) classification refers, in this paper, to the condition listed that has a non-mechanical association without any obvious organic cause. Specifically, this is the condition that falls under the International Classification of Diseases 11th revision (ICD-11) classification of chronic primary and chronic secondary pains. This implies that there is increased responsiveness of nociceptive neurons in the central nervous system, a phenomenon known as central sensitisation. cTMD patients may have their beginning with genetic susceptibility to pain. Although no single gene is exclusively linked to cTMD, various genes associated with nervous and musculoskeletal systems are believed to play a role. Environmental triggers and epigenetic changes are also thought to contribute to cTMD development. The biopsychosocial model emphasises the need to comprehensively address biological, psychological and social factors in cTMD assessment and management. In this study, we leverage the cyclic causation framework within the biopsychosocial model to illuminate the intricate interplay between biological and psychosocial factors in the context of cTMD. The conceptualisation of cTMD involves the dynamic evolution of genetic predispositions, influenced by life events and other biological susceptibilities. These factors collectively contribute to the emergence of nociplastic changes, ultimately manifesting as the distinctive features observed in individuals afflicted with cTMD.

Climate temperature and seasonal influences on the prevalence of temporomandibular disorders in South Korea

This study aimed to explore seasonal variations in temporomandibular disorder (TMD) prevalence in South Korea, utilizing nationwide population-based big data. Data corresponding to the Korean Standard Classification of Diseases code of K07.6, which identifies TMD, were extracted from the Health Insurance Review and Assessment Service online platform for the period from 2010 to 2022. Additionally, we integrated these data with climate temperature records from the Korean Meteorological Administration. We subsequently conducted a statistical analysis of TMD patient data on a monthly and seasonal basis over the past 13 years to assess prevalence. Over the past 13 years, the number of TMD patients in Korea has steadily increased. The prevalence of TMD rose from 0.48% (224,708 out of a total population of 50,515,666) in 2010 to 0.94% (482,241 out of a total population of 51,439,038) in 2022, marking a 1.96-fold increase. Among children under 10 years of age, no significant differences were observed in TMD prevalence between boys and girls. However, a distinct female predominance emerged after the age of 10, with an average female-to-male ratio of 1.51:1. The peak prevalence of TMD occurred in individuals in their 20 s, followed by adolescents in their late 10 s. The majority of TMD patients were concentrated in Seoul and Gyeonggi province, with metropolitan areas accounting for 50% of the total patient count. Seasonally, TMD patient numbers showed no significant increase in winter compared with spring or summer. The temperature difference, defined as the absolute difference between the highest and lowest temperatures for each month, showed a positive correlation with TMD patient counts. A greater temperature difference was associated with higher patient counts. The strongest correlation between temperature differences and TMD patient numbers was observed in winter (r = 0.480, p < 0.01), followed by summer (r = 0.443, p < 0.01), and spring (r = 0.366, p < 0.05). Temperature differences demonstrated a significantly stronger correlation with the increase in the number of TMD patients than absolute climate temperatures. This aspect should be a key consideration when examining seasonal trends in TMD prevalence in South Korea.

Pain symptoms are associated with two-point discrimination threshold in patients with temporomandibular disorders.

This study aimed to explore the associations of orofacial two-point discrimination (2-PD) test result with pain symptoms and psychological factors in patients with Temporomandibular Disorders (TMDs). 193 patients with TMDs were included in this study. Patients' demographics, pain intensity, and psychological status were recorded. The 2-PDs in the bilateral temporal, zygomatic, mandibular, and temporomandibular joint (TMJ) regions of the patients were measured. Statistical analyses were conducted to observe the associations between variables. For Pain-related TMDs (PT) patients, Monthly Visual Analogue Scale (VAS-M) and Current Analogue Scale (VAS-C) were correlated with TMJ, zygomatic and temporal 2-PDs. Patients with PT tended to have higher TMJ 2-PDs[Right: β = 1.827mm, 95%CI(0.107, 3.548), P = 0.038], zygomatic 2-PDs[Right: β = 1.696mm, 95%CI(0.344, 3.048), P = 0.014], temporal 2-PDs[Left: β = 2.138mm, 95%CI(0.127, 4.149), P = 0.037; Right: β = 1.893mm, 95%CI(0.011, 3.775), P = 0.049]. Associations were also observed between VAS-C and TMJ 2-PDs[Left: β = 0.780, 95%CI(0.190, 1.370), P = 0.01; Right: β = 0.885, 95%CI(0.406, 1.364), P = 0.001], Zygomatic 2-PDs[Right: β = 0.555, 95%CI(0.172, 0.938), P = 0.005]; VAS-M and TMJ 2-PDs[Left: β = 0.812, 95%CI(0.313, 1.311), P = 0.002; Right: β = 0.567, 95%CI(0.152, 0.983), P = 0.008], zygomatic 2-PDs[Left: β = 0.405, 95%CI(0.075, 0.735), P = 0.016; Right: β = 0.545, 95%CI(0.221, 0.870), P = 0.001], and temporal 2-PDs [Left: β = 0.741, 95%CI(0.258, 1.224), P = 0.003; Right: β = 0.519, 95%CI(0.063, 0.975), P = 0.026]. TMJ, zygomatic, and temporal 2-PDs were significantly associated with PT and pain intensity. Age, gender and psychological factors were not associated with orofacial 2-PDs. PT patients exhibited weaker tactile acuity compared to Non-PT patients. Further discussion on the underlying mechanism is needed. Orofacial tactile acuity of TMDs patients was associated with their pain symptoms, which researchers should take account into when performing 2-PD tests for TMDs patients. The 2-PD test can be considered as a potential tool along with the current procedures for the differentiations of PT and Non-PT.

Prevalence of Signs and Symptoms of Temporomandibular Disorders in Patients with Different Rheumatic Diseases

Prevalence of Signs and Symptoms of Temporomandibular Disorders in Patients with Different Rheumatic Diseases

Sleep, Caffeine, BMI, and Pressure Pain Threshold in Temporomandibular Disorder Patients: An Observational Study.

Temporomandibular disorders (TMDs) represent a multifactorial condition involving a multitude of symptoms of the temporomandibular joint that emanates a series of distress. Understanding the relationship between these lifestyle factors and pain perception in TMD patients is essential for optimizing their management and care. This study delves into the intricate interplay between sleep, caffeine consumption, body mass index (BMI), and the potential effect on pressurepain threshold (PPT) values among individuals with TMDs. This is an observational study. Data were collected from a convenient sample of female patients at a single centerin Riyadh city, between the ages of 20 and 50 years. The variables collected were based on an operator-designed questionnaire, the symptom questionnaire, and the Diagnostic Criteria for Temporomandibular Joint Disorders (DC/TMD). A total of 139 participants were included in the study, appraising the occurrence of TMD and pain as per reports of caffeine intake and sleep duration. The observed outcomes indicate that the amount of sleep has a significant effect on the PPT values in TMD patients. This study highlights the substantial impact of sleep duration on lowering PPT values in individuals with TMDs. The findings highlight the importance of considering sleep duration and caffeine intake in the comprehensive management of TMD patients. There was no effect of BMI on this particular sample. This study shows a positive correlation between sleep and pain and TMD, caffeine, and pain. A deeper understanding of these relationships could pave the way for more effective pain management strategies and personalized treatment approaches tailored to the unique needs of TMD patients. BMI had no effect.

Effectiveness and safety of hominis placental pharmacopuncture for chronic temporomandibular disorder: A multi-center randomized controlled trial

BackgroundHominis placental (HPP) extract has been approved by the Ministry of Food and Drug Safety in Korea for treating chronic liver diseases and postmenopausal syndrome. However, its efficacy and safety for treating chronic temporomandibular disorder (TMD) remains unclear. We aimed to assess the effectiveness and safety of HPP for treating chronic TMD compared with physical therapy (PT). MethodsThis study is a 2-arm parallel, multi-center, randomized controlled trial. We enrolled 82 chronic TMD patients from 2 Korean medicine hospitals between December 2019 and January 2021. We included patients with chronic TMD and randomly assigned them to undergo HPP or PT. The primary outcome was the difference in the scores for temporomandibular joint (TMJ) pain at baseline and week 6. The secondary outcomes were the scores for TMJ pain and bothersomeness, TMJ range of motion, the Korean version of Beck's depression index-Ⅱ, jaw functional limitation scale (JFLS) score, patient global impression of change (PGIC) scores, EuroQoL 5-dimension 5-level score, and short form-12 health survey (SF-12) scores. ResultsCompared with PT, HPP showed significantly superior effects on TMJ pain and bothersomeness, protrusive movement pain, JFLS (verbal, emotional, and global), SF-12, and PGIC scores at week 6 (P < 0.05). Compared with the PT group, the HPP group showed a significantly higher recovery rate (≥50 % reduction in the scores for TMJ pain at the 24-week follow-up). ConclusionHPP was more effective than PT managing pain and improving function and quality of life. Our findings demonstrate the effectiveness and safety of HPP for TMD treatment. Trial registrationThis study has been registered at clinicalTrials.gov (NCT04087005), Clinical Research Information Service (CRIS) (KCT0004437), and Ministry of Food and Drug Safety (No. 31886).

Otologic Symptoms and Quality of Life in Individuals with Temporomandibular Disorders: A Cross-Sectional Study

Objective: Temporomandibular disorder (TMD) occurs as a result of alterations in the masticatory muscles and temporomandibular joint (TMJ). Otologic symptoms such as earache, hearing loss, and tinnitus may be observed in TMD patients and may impair quality of life (QOL). This paper aims to evaluate the frequency of otological symptoms, and their association with QOL in TMD patients.&#x0D; Methods: The archival records of patients who applied to the Maxillofacial Surgery Clinic of Ordu University with TMD complaints between December 2022 and August 2023 were reviewed retrospectively. Demographic data, otological symptoms such as tinnitus, hearing loss, and earache, and Visual Analog Scale (VAS) scores regarding QOL and masticatory efficacy were recorded.&#x0D; Results: One hundred-four patients (83 females, 21 males), with a mean age of 35.75 ± 15.09 years were included. No significant differences were observed among patients with/without earache, tinnitus, and hearing loss in terms of QOL and masticatory efficiency scores (p &gt; 0.05), except significant difference between patients with/without tinnitus in terms of QOL (p &lt; 0.01). No significant differences were observed between genders in QOL and masticatory efficiency scores (p &gt; 0.05).&#x0D; Conclusion: The frequency of otologic symptoms in TMD patients is high and tinnitus significantly impacts the QOL. For the optimum management of TMD patients with otological symptoms a multidisciplinary approach with dental clinicians and otolaryngologists should be performed.

The Gothenburg Trismus Questionnaire in China: Cross-cultural adaptation and measurement invariance.

The Gothenburg Trismus Questionnaire (GTQ) is a comprehensive scale for screening and assessing trismus in head and neck (H&N) cancer and temporomandibular joint disorders (TMD) patients. This study aimed to translate and cross-culturally adapt the GTQ in China, and to test its measurement invariance. This study comprised 278 H&N cancer, 245 TMD, and 507 control patients. Internal consistency and test-retest reliability were tested to assess the GTQ's reliability. The validity was evaluated through composite reliability (CR), average variance extracted (AVE), and correlation tests. Multi-group confirmatory factor analysis (CFA) was used to investigate the GTQ's measurement invariance across clinical status and gender. T tests were employed to compare score differences across clinical status and gender. The Chinese version of GTQ scale shows excellent internal consistency and test-retest reliability. The CR, AVE, and correlation values demonstrate the good validity of GTQ. The multi-group CFA supported configural invariance across clinical status but not metric invariance, while it supported strict invariance across gender. Additionally, t tests revealed that patients with H&N cancer and TMD scored higher than the control group, while males scored higher than females. The Chinese version of GTQ serves as an effective tool for screening and assessing trismus.

Evaluation of tinnitus in patients with Temporomandibular Disorders through Axis II of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and the Tinnitus Handicap Inventory (THI).

Tinnitus is a quite common and bothersome disorder that results in a perceived sound or noise, without an external origin, often causing notable psychological distress. Some interconnections between tinnitus, bodily pain perception, and psychological well-being were previously reported, thus the relationships between tinnitus and temporomandibular joint (TMJ)-related muscle issues, resulting in somatosensory tinnitus, must be deeply investigated. This study aims to assess the prevalence of tinnitus in patients with temporomandibular disorders (TMD) and to examine the impact of treatment approaches for TMD in patients with and without tinnitus. In this cross-sectional study, a total of 37 adults with TMD symptoms were treated with cognitive behavioural psychological therapy, including relaxation and self-inspection, self-care education, and physiotherapy. Diagnostic data were collected before and after treatment using the Axis II of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and the Tinnitus Handicap Inventory (THI) questionnaire. Statistical analysis included descriptive assessments and significance was set at p < .05. Individuals with tinnitus and TMD reported a significantly higher number of body pain areas, indicating a link between tinnitus and increased bodily pain perception. Tinnitus did not significantly impact TMJ-related functions. Significantly higher levels of psychological distress were observed in individuals with tinnitus, as evidenced by elevated scores in depression, generalised anxiety and somatic symptoms. Tinnitus is a complex condition with significant effects on health and well-being, requiring an interdisciplinary approach for effective evaluation and care. The study provides deep insights into the prevalence of tinnitus in TMD patients, underscoring the need for comprehensive treatment strategies addressing both TMD and tinnitus.

Exploring the effect of disc displacement on the risk and severity of condylar erosion in adult temporomandibular disorder patients: A CBCT and MRI study.

The objective of the study was to investigate the relationship between types of disc displacement (DD) diagnosed by magnetic resonance imaging (MRI), and the risk (presence or absence) and severity of condylar erosion (CE) graded using cone-beam computed tomography (CBCT) in adult Temporomandibular disorders (TMD) patients. A total of 353 TMD patients (283 females, 70 males) underwent MRI scans to categorise DD as normal (NA), anterior displacement with reduction (ADDR), or anterior displacement without reduction (ADDNR). CE severity was graded on a scale of 0-3 (absence, mild, moderate or severe) using CBCT. To establish the plausibility and cut-off points for CE diagnosis, the severity of CE was then further divided into three classifications: Grade 0 versus 1 + 2 + 3; Grades 0 + 1 versus 2 + 3; Grades 0 + 1 + 2 versus 3. Logistic regression analysis was performed, adjusting for age, gender and joint correlation. ADDNR significantly increased the risk of CE compared with NA (OR = 10.04, 95% CI: [6.41, 15.73]) and showed a significant increase in CE severity across all classifications (ORs = 10.04-18.95). The effects of ADDNR were significant in both genders (p < .001) and had a greater impact in females. ADDR was predominantly associated with mild CE. ADDNR significantly increased the risk and severity of CE independent of gender when compared to NA, whereas ADDR was mainly associated with mild CE. Slight cortical discontinuity may represent a subclinical diagnosis requiring further investigation.

Comparative study of clinical and MRI features of TMD patients with or without joint effusion: a retrospective study

BackgroundThe relationship between joint effusion and temporomandibular disorders (TMD) remains unclear. The purpose of this study was to investigate the correlation among joint effusion, clinical features and MRI imaging features of TMD.MethodsA total of 1532 temporomandibular joints (TMJs) from 766 patients (605 females and 161 males) with the mean age of 31.68 ± 13.71 years from January 2022 to June 2023 were included in the study. Clinical and MRI features were collected and analyzed. Chi-Square test, Spearman correlation coefficient and binary logistic regression analysis were performed.ResultsPatients with joint effusion were significantly older and had smaller value of MIO (p < 0.001). There were significant differences in the distribution of joint sounds (with or without), joint pain (with or without), disc morphology (biconcave, contracture, irregular and lengthened) and disc position between joint effusion group (JE) and non-joint effusion group (NA) (P < 0.05).The odds of having joint effusion were 1.726 higher in patients with joint sounds when compared to those without joint sounds. The odds of having joint effusion were 8.463 higher in patients with joint pain when compared to those without joint pain. The odds of having joint effusion were 2.277 higher in patients with contracture when compared to those with biconcave. The odds of having joint effusion were 1.740 higher in patients with anterior disc displacement with reduction (ADDWR) when compared to those with normal disc position. The prediction accuracy of this model is 74.9%, and the area under curve (AUC) is 79.5%, indicating that it can be used for the prediction and the judgment effect is average.ConclusionsThe results demonstrated that joint sounds, joint pain, contracture, and ADDWR are high risk factors for joint effusion, especially joint pain.Trial registrationThis study was retrospectively registered on 28/03/2022 and endorsed by the Ethics Committee of Affiliated Stomatology Hospital of Guangzhou Medical University (LCYJ2022014).

Biomechanical study of temporomandibular joints of patients with temporomandibular disorders under incisal clenching: A finite element analysis

Temporomandibular disorders (TMD) encompass a collection of pathologies. Within the multitude of etiological factors contributing to TMD, mechanical factors hold significant importance. The aim of this investigation was to assess the magnitude and distribution of stresses encountered by the temporomandibular joints (TMJs) during incisal clenching among TMD patients while also elucidating the mechanical pathogenesis underlying TMD. Ten asymptomatic subjects and ten TMD patients were recruited. The Control, Bilateral, and Unilateral groups were set. The contact stress, maximum principal stress, and minimum principal stresses of TMJ structures among the groups were compared. In addition, comparisons of the contact stress distribution among the groups were adopted. In the Control and Bilateral groups, the magnitudes of stresses (contact stress, maximum and minimum principal stresses) between the right and left sides showed no significant difference (P > 0.05). For unilateral TMD patients,the minimum principal stress on the condyle in the Uni-N group (the normal side) was significantly greater than thatin the Uni-T group (the TMD side)(P = 0.016, mean difference 9.99 MPa [95 %CI: 3.11 to 16.87]). Furthermore, stresses on the condyle and fossa of the patients were significantly greater than those of asymptomatic subjects (P < 0.05). The contact stress distributions were concentrated in the Control group while irregular in the TMD groups. In conclusion, asymmetrical contact stress distributions were observed in unilateral TMD, with excessive stresses on the healthy side. The protection of the healthy TMJ during treatment is recommended for patients with unilateral TMD.

Intra-articular pathologies detected by magnetic resonance imaging in patients with temporomandibular disorders undergone successful non-surgical treatments

ObjectiveThis study aimed to study on the MRI findings suggesting intra-articular pathologies in patients with temporomandibular disorders (TMD) undergone successful non-surgical treatments, and to discuss on their intra-articular pathological conditions with clinical symptoms. Patients and MethodsOne-hundred eleven TMJs of the consecutive 80 TMD patients were enrolled in this study. These TMJs were classified into the following 3 Groups, Group I: Bilateral 62 TMJs of the 31 patients with masticatory-muscle (MM) symptoms without functional pain, Group II: Affected-side TMJs of the 31 patients with unilateral functional MM pain, Group III: Affected-side TMJs of the 18 patients with unilateral functional TMJ pain. The detection rates of joint effusion (JE), osteoarthritis (OA), and disc displacement (DD) on the MR images were investigated. The correlations of JE, OA, DD, age, and gender were also analyzed. ResultsIn each Group, the detection rates of JE, OA, and DD were more than 70%, and no findings of them were sometimes observed. The detection ratio of moderate/marked JE in Group II was significantly higher among the 3 Groups. The significant correlation of JE, OA, and DD was found, and that of OA and age was also observed. ConclusionsOur results suggest that intra-articular pathologies often occur even in the painless TMJs, and functional TMJ pain sometimes appear even in the TMJs with early-stage OA, which cannot be detected by MRI. Furthermore, the TMJ synovitis occurred in patients with functional MM pain may be more severe than that in the painful TMJ.

Initial assessment of the psycho-emotional state of patients with temporomandibular disorders: A pilot study.

Temporomandibular disorders (TMD) are a group of conditions that affect the function of the masticatory muscles, temporomandibular joints and surrounding structures. The objective of the preliminary investigation was to develop an initial questionnaire for emotional assessment, pre-designed for TMD patients, and provide guidance for further management through referral to psychological and/or psychiatric counseling. Additionally, we aimed to compare the results of tests carried out in TMD patients with those of healthy subjects. The study involved 260 patients who reported for dental treatment. The TMD study group (Group 1, n = 130) consisted of patients diagnosed with TMD, and the control group (Group 2, n = 130) had TMD diagnostically excluded. The questionnaire included 30 questions about the emotional state of the patients in the past 4 weeks. The mean scores were 37.715 points for Group 1 (median (Me) = 35.5, standard deviation (SD) = 12.58 and 24.938 points for Group 2 (Me = 24, SD = 7.95) (p < 0.001). The research suggests that the developed questionnaire is useful for an initial assessment of the psycho-emotional state of TMD patients. Furthermore, the results emphasize a greater need for psychological counseling in TMD patients compared to their healthy counterparts.

Age distribution of East Asian TMD patients and age-related differences in DC/TMD axis I findings.

The pattern of age distribution in East Asian temporomandibular disorder (TMD) patients and age-related differences in DC/TMD diagnostic subtypes/categories were evaluated. TMD patients from two University-based centers in China and South Korea were enrolled. Axis I physical diagnoses were rendered according to DC/TMD. Patients were categorized into six age groups (15-24, 25-34, 35-44, 45-54, 55-64, and 65-84 years; Groups A-F respectively). Youths/young adults (Groups A-C) formed 74.1% of TMD patients. TMJ disc displacements (74.9%), arthralgia (49.2%), and degenerative joint disease [DJD] (36.8%) were the most common TMD subtypes. The majority had combined (54.0%) and chronic (58.5%) TMDs. Youths/young adults and middle-aged/old adults had substantially lower frequencies of merely pain-related (6.2-14.5%) and intra-articular (13.8-16.8%) TMDs correspondingly. "Being female" increased the prospects of pain-related/combined TMDs by 96%/49%, respectively. East Asian TMD patients comprised mostly of youths/young adults who had an alarmingly high prevalence of TMJ DJD.

Trismus in head and neck cancer: translation and validation of the Chinese version of the Gothenburg Trismus Questionnaire-2 (C-GTQ-2).

Trismus, marked by restricted mouth opening, significantly affects patients with temporomandibular disorder (TMD) and head and neck cancer (HNC). Despite its prevalence, specialized questionnaires for trismus assessment are scarce. This study aims to fill this gap by translating and validating the Gothenburg Trismus Questionnaire version 2 (GTQ-2) into Chinese (C-GTQ-2), enhancing the evaluation of trismus in HNC and TMD patients. The study involved 78 HNC patients, 75 TMD patients, and a control group of 150 individuals without trismus symptoms. Participants were asked to complete the C-GTQ-2 and other health-related quality of life (HRQL) instruments. A subset of 30 individuals retook the questionnaire within two weeks to assess test-retest reliability. The C-GTQ-2 demonstrated remarkable reliability, with Cronbach's alpha values exceeding 0.70 in three of the four domains, indicating high internal consistency. The instrument also showcased high intra-class correlations in the test-retest, affirming its reliability. Furthermore, it exhibited strong convergent validity, aligning well with other HRQL instruments, and effectively discriminated between patients with and without trismus, establishing its discriminant validity. The C-GTQ-2 emerges as a valid and reliable tool for assessing trismus in HNC and TMD patients, promising to significantly enhance both clinical and research approaches to managing trismus-related complications in the Chinese-speaking demographic. C-GTQ-2 proves effective for trismus assessment in head and neck cancer and temporomandibular disorder patients, offering enhanced clinical and research utility.

Investigation of masticatory muscle thickness and mechanosensitivity of cervical and masticatory muscles in myofascial temporomandibular disorder patients with bruxism: A cross-sectional study

ObjectiveBruxism is a common problem associated with temporomandibular disorders (TMD). The aim of this study was to compare a patient group with Myofascial TMD and bruxism and a healthy control group in terms of masseter and temporal muscle thickness (clenching and resting), mechanosensitivity of neck and jaw muscles, craniofacial pain, and disability and emotional stress status. MethodsThe study included 31 patients with myofascial TMD and bruxism (19 females, 12 males) with a mean age of 29.96 ± 8.12 years (range, 18–45 years), and a control group of 31 healthy subjects (19 females, 12 males) with a mean age of 27.58 ± 9.39 years years (range, 18–45 years). Masseter and temporal muscle thicknesses were evaluated with a mobile ultrasound device both at rest and when clenching the jaw. The mechanosensitivity values between the upper trapezius, obliquus capitis inferior, masseter and temporal muscles were measured with a digital algometer device. Craniofacial pain and disability level were evaluated with the Craniofacial Pain and Disability Index (CFPDI), and emotional stress levels with the Perceived Stress Scale-14 (PSS-14). ResultsNo difference was determined between the two groups in respect of the clenching and resting ratios of muscle thickness in any muscle (p > 0.05). The mechanosensitivity values in all muscles were lower in the myofascial TMD group than in the healthy group (p < 0.05). The CFPDI and PSS-14 scores were higher in the myofascial TMD group (p < 0.05). There was a moderate positive correlation between CFPDI, PSS-14 and Bruxism Frequency Score (p < 0.05). ConclusionThe difference in mechanosensitivity and CFPDI values between the myofascial TMD patients with bruxism and the healthy control group indicates that the problem in this patient group has effects in the craniocervical and cervical regions. In addition, the correlation between CFPDI, PSS-14 and Bruxism Frequency Score in myofascial TMD patients suggests that this problem may be affected by the interaction of different parameters.

Evaluation of masticatory muscles in temporomandibular joint disorder patients using quantitative MRI fat fraction analysis-Could it be a biomarker?

Temporomandibular joint disorders (TMDs) are closely related to the masticatory muscles, but objective and quantitative methods to evaluate muscle are lacking. IDEAL-IQ, a type of chemical shift-encoded magnetic resonance imaging (CSE-MRI), can quantify the fat fraction (FF). The purpose of this study was to develop an MR IDEAL-IQ-based method for quantitative muscle diagnosis in TMD patients. A total of 65 patients who underwent 3 T MRI scans, including CSE-MRI sequences, were retrospectively included. MRI diagnoses and clinical data were reviewed. There were 19 patients in the normal group and 46 patients in the TMD group with unilateral disc displacement. The TMD group was subdivided into those with and without clenching. The right and left FF values of the masseter, medial, and lateral pterygoid muscles were measured twice by two oral radiologists on CSE-MRI, and the average value was used. FF measurements using CSE-MRI showed excellent intra- and inter-observer agreement (ICC > 0.889 for both). There were no statistically significant differences between the right and left FF values in the masseter, medial pterygoid, and lateral pterygoid of the normal group (p > 0.05). A statistically significant difference was found in the TMD group without clenching, in which the masseter muscle had a statistically significantly lower FF value on the disc displacement side (3.94 ± 1.61) than on the normal side (4.52 ± 2.24) (p < 0.05). CSE-MRI, which can reproducibly quantify muscle FF values, is expected to be a biomarker for objective muscle evaluation in TMD patients. The masseter muscle is expected to be particularly useful compared to other masticatory muscles, but further research is needed.

Comorbid psychiatric conditions with temporomandibular disorders (TMD) in a tertiary referral clinic

Patients with chronic pain have a higher prevalence of mood disorders with depression and anxiety contributing to higher pain intensity, emotional allodynia, and neuro-anatomical changes. We sought to quantify the prevalence of psychiatric comorbidities (PCs) in a tertiary referral clinic for temporomandibular disorders (TMDs). Medical records of all patients attending clinics run by three tertiary temporomandibular joint (TMJ) surgeons for the period January to April 2022 inclusive were audited for the prevalence of concomitant psychiatric conditions. A total of 166 patients were identified with a female to male ratio of 5:1 and mean (SD) age of 45.1 (15.2) years. A total of 124 (89.9%) patients were tertiary referrals and 72 (43.4%) patients had concomitant psychiatric diagnoses, with 58 (34.9%) being on some form of psychotropic medication (PM) (patients on anticonvulsants for neuropathic pain were not included). A majority of 136 (81.9%) patients had some form of intervention (including Dysport® and minimally invasive surgery) which appeared more common in patients with co-existing psychiatric issues (p < 0.05). A higher proportion of mental health issues exist among TMD patients in a tertiary referral clinic than would be expected in the general population. We suggest a holistic approach to patients with multidisciplinary care taking into account this prevalence to ensure decision-making that contextualises the patient and not simply the pathology.

Can nano-fat injection in patients with tempromandibular disorder alters salivary matrix metalloproteinases 2 and 9?

Temporomandibular disorder (TMD) is a musculoskeletal condition that affects temporomandibular joint, causing pain and dysfunction in the jaw area, jeopardizing the ability to eat and even sleep comfortably. A key factor in the pathogenesis of TMD is the enhanced breakdown of extracellular matrix components, such as collagen and elastin. This breakdown is mediated by enzymes known as matrix metalloproteinases (MMPs), specifically MMP2 and MMP9. Elevated expression of MMP2 and/ or MMP9 may be involved in the pathophysiology of TMD. Methodology: Stimulated saliva samples were obtained from Thirty-two TMD patients. MMPs in collected samples were analyzed by ELISA. Results: Three months after nano-fat injection, Means of MMP2 and MMP9 were significantly decreased compared to that before procedure (139.59 versus 128.46 ng/ml, P= 0.003; and 545.37 versus 469.09 ng/ml, P= 0.001 respectively). Conclusion: this study provides evidence for a significant reduction in salivary MMP2 and MMP9 levels among TMD patients following nano-fat injection therapy. These findings suggest that nano-fat injections may have therapeutic potential for managing TMD by modulating ECM remodeling processes through their effects on these enzymes.