Temporomandibular Joint Arthralgia Research Articles

Role of Low-Level Laser Therapy in the Management of Temporomandibular Joint Arthralgia.

To study the efficacy of low-level laser therapy in the management of temporomandibular joint arthralgia. Design Interventional study (pre-post study), Setting Meenakshi Medical College And Hospital, Research Institute. Subjects 50 patients with temporomandibular joint arthralgia were evaluated for pain, mouth opening and clicking sound while mouth opening before and after treatment. Method Patients are subjected to undergo low-level laser therapy with Infrared and red rays with a therapeutic dosage ranging from 8J/cm2 to 15J/cm2 up to 3-5 sessions for a month each session lasts for 15-20min. The patients are to be followed up regularly after 1, 3, 6 and 8months in the study.The study measured the range of mouth opening in patients before and after undergoing low-level laser therapy. Before treatment, the range of mouth opening was from 2.78 to 3.97cm, with a mean value of 2.78cm and a standard deviation of 0.22. After treatment, the range of mouth opening was from 2.78 to 3.97cm, with a mean value of 3.97cm and a standard deviation of 0.24. The study also measured the VAS score for pain, with a mean and standard deviation of 7.9 ± 0.73 before treatment and 0.88 ± 0.718 after treatment. There was a significant difference between the pretreatment and post-treatment VAS scores, with a P-value of 0.05. Low-level laser therapy is an effective non invasive treatment modality for temporomandibular joint arthralgia. The patients who underwent this procedure had symptomatic relief and no remissions were observed.

Ultrasonographic examination of masticatory muscles in patients with TMJ arthralgia and headache attributed to temporomandibular disorders.

This study used ultrasonography to compare the thickness and cross-sectional area of the masticatory muscles in patients with temporomandibular joint arthralgia and investigated the differences according to sex and the co-occurrence of headache attributed to temporomandibular disorders (HATMD). The observational study comprised 100 consecutive patients with TMJ arthralgia (71 females and 29 males; mean age, 40.01 ± 17.67years) divided into two groups: Group 1, including 86 patients with arthralgia alone (60 females; 41.15 ± 17.65years); and Group 2, including 14 patients with concurrent arthralgia and HATMD (11 females; 33.00 ± 16.72years). The diagnosis of TMJ arthralgia was based on the diagnostic criteria for temporomandibular disorders. The parameters of the masticatory muscles examined by ultrasonography were subjected to statistical analysis. The pain area (2.23 ± 1.75 vs. 5.79 ± 2.39, p-value = 0.002) and visual analog scale (VAS) score (3.41 ± 1.82 vs. 5.57 ± 12.14, p-value = 0.002) were significantly higher in Group 2 than in Group 1. Muscle thickness (12.58 ± 4.24mm) and cross-sectional area (4.46 ± 2.57 cm2) were larger in the masseter muscle than in the other three masticatory muscles (p-value < 0.001). When examining sex-based differences, the thickness and area of the masseter and lower temporalis muscles were significantly larger in males (all p-value < 0.05). The area of the masseter muscle (4.67 ± 2.69 vs. 3.18 ± 0.92, p-value = 0.004) and lower temporalis muscle (3.76 ± 0.95 vs. 3.21 ± 1.02, p-value = 0.049) was significantly smaller in Group 2 than in Group 1. An increase in VAS was significantly negatively correlated with the thickness of the masseter (r = - 0.268) and lower temporalis (r = - 0.215), and the cross-sectional area of the masseter (r = - 0.329) and lower temporalis (r = - 0.293). The masseter and lower temporalis muscles were significantly thinner in females than in males, and their volumes were smaller in patients with TMJ arthralgia and HATMD than in those with TMJ arthralgia alone. HATMD and decreased masseter and lower temporalis muscle volume were associated with increased pain intensity.

Comparative analysis of temporomandibular joint morphology in degenerative joint disease: A cone-beam CT study in patients with and without arthralgia

ObjectivesThis cross-sectional study aimed to compare, by using Cone-Beam Computed Tomography (CBCT), temporomandibular joint (TMJ) morphology among patients with degenerative joint disease (DJD) with or without arthralgia, as well as a control group. Methods: Thirty-one patients and their respective CBCT TMJ exams were assessed. These individuals were selected from an Orofacial Pain Service and classified into three groups based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD): group 1 (10 patients with TMJ DJD and arthralgia), group 2 (11 patients with TMJ DJD without pain), and group 3 (the control group, consisting of 10 healthy individuals without any signs or symptoms of TMD). A second examiner, who was calibrated and blinded for the patient's diagnosis, evaluated the CBCT images. Results: Group 1 showed a statistically significant association with the variables of erosion (p = 0.003) and osteophyte (p = 0.04) on the condyle surface, as well as concentric condyle position with reduced joint space (p = 0.01). The Kappa concordance index between the clinical diagnosis of DC/TMD and CBCT images was k = 0.134 (p ≤ 0.001). Conclusion: The presence of erosion, osteophyte, and concentric condyle position with reduced joint space was statistically associated with DJD and ongoing TMJ joint pain.

Binary Logistic Regression Analysis on the Association of Occlusion with the Temporomandibular Joint Arthralgia in the Partial Denture Wearers-A Retrospective Study.

To analyze the potential association between the occlusion features and the incidence of temporomandibular joint (TMJ) arthralgia in patients with partial dentures. A total of 101 partial denture wearers were collected, 45 with unilateral TMJ arthralgia diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Binary logistic regression analysis was adopted. The TMJ asymptomatic group (n = 45) was quantified as 0, while the TMJ arthralgia group (n = 56) was quantified as 1. In total, 13 occlusion variables were analyzed: gender, age, number of prosthetic teeth, number of dentition quadrants with a prosthetic tooth, anterior or posterior prosthesis location in maxillary or mandibular dentition, occluded prosthesis pair, anterior overjet, and overbite relation. Simple and multiple binary logistic models were adopted, accordingly, for the risk impact of them on TMJ arthralgia. Overbite (OR = 2.238) and maxillary anterior prosthesis (OR = 0.305) were entered into the simple binary logistic model; while overbite (OR = 2.774) plus maxillary anterior prosthesis (OR = 0.347), overbite (OR = 3.425) plus unilateral maxillary posterior prosthesis (OR = 4.672), and overbite (OR = 3.476) plus overjet (OR = 0.436) and mandibular anterior prosthesis (OR = 0.177) were entered into the multivariate logistic regression model (all, P < .05). Partial denture wearers with a deep overbite, especially those with a unilateral maxillary posterior prosthesis, had a higher prevalence of unilateral TMJ arthralgia.

Temporomandibular Disorders and Serological Tests in Patients with Rheumatoid Arthritis

Background: Rheumatoid Arthritis (RA) is a systemic and chronic autoimmune disease with inflammation at the synovial joints. The purposes of this study were to evaluate the correlation between serological variables and temporomandibular disorders (TMDs) in patients diagnosed with RA, evaluated through diagnostic criteria for temporomandibular disorders (DC/TMD), and to check the influence of comorbidities on the different TMD signs and symptoms, or any serological variables. Methods: This observational cohort research study included seventeen patients affected by RA. The comorbidities and some variables from the initial serological analyses were collected from the clinical rheumatological charts. Then, the presence of any of the following TMD signs/symptoms, temporal myalgia, temporomandibular joint arthralgia, click or crepitus, was evaluated through the symptom questionnaire of the DC/TMD during clinical evaluation following the DC/TMD examination form. Results: Rheumatoid factor (RF), anticitrullinated protein antibodies (ACPA), and anti-nuclear antibody (ANA) positivity were present in 82.4%, 52.9%, and 41.2% of patients, respectively. Indicators of tissue inflammation were evaluated with median values of 21 mm/h for erythrocyte sedimentation rate (ESR) and 0.50 mg/dL for C-reactive protein (CRP). The RA patients presented comorbidities such as hypertension in 70.6% and diabetes in 23.5%. Negative ACPA had a significant association with myalgia (p = 0.03), and positive ANA was significantly associated with crepitus (p = 0.05). Conclusion: ANA and ACPA evaluation can be considered predictive serological tests associated with specific TMDs. Conversely, no influence of any comorbidities was found between different TMD signs and symptoms, or any serological variables.

Importance of Relative Comparison of Capsular Widths on the Affected and Non-Affected Sides of Temporomandibular Joint Arthralgia Patients: An Ultrasonography Study

Importance of Relative Comparison of Capsular Widths on the Affected and Non-Affected Sides of Temporomandibular Joint Arthralgia Patients: An Ultrasonography Study

Bilateral arthroscopy of the temporomandibular joint: clinical outcomes and the role of a second intervention-a prospective study.

Evaluate the efficacy of bilateral temporomandibular joint (TMJ) arthroscopy in patients with different categories of severity based on Dimitroulis classification (categories 2-4) and the role of a second TMJ intervention in primary failure. A 3-year prospective study was designed, including patients submitted to bilateral TMJ arthroscopy. The primary outcome was TMJ pain (VAS, 0-10) and the secondary outcomes were the maximum mouth opening (MMO) and masticatory myalgia degree (0-3). In cases of symptomatic relapse, a second TMJ intervention was performed (TMJ arthrocentesis or TMJ open surgery). Eighty patients (93.4% women) were enrolled, with a mean age of 32.40 ± 11.41years. With an average follow-up of 523.7 days (34-1606), a statistically significant improvement in TMJ pain, MMO, and myalgia degree was observed (P < 0.0001). The overall successful outcome of one-single bilateral arthroscopy was ~ 69%. Twenty-two patients relapsed: (1) arthralgia (n = 15, 68.18%); (2) arthralgia + myalgia (n = 4, 18.18%); (3) dislocated disc without reduction (DDwoR) (n = 2, 9.09%); (4) DDwoR + osteoarthrosis (OA) (n = 1, 4.55%). Arthralgia was re-managed with TMJ arthrocentesis with local anesthesia (n = 19, 86.36%). New DDwoR with or without OA was re-treated with TMJ open surgery (n = 3, 13.64%). After the second intervention, the success rate increased to 85%. Bilateral TMJ arthroscopy presented overall benefit in all parameters evaluated. This study highlights the importance of TMJ arthroscopy as the first line of treatment for moderate-severe temporomandibular disorders cases contributing to the reduction of TMJ open surgeries. In cases of arthroscopy unsuccess, TMJ arthrocentesis under local anesthesia was an effective and safe intervention for patients with recurrent TMJ arthralgia.

Reconstructed magnetic resonance image-based effusion volume assessment for temporomandibular joint arthralgia.

Joint effusion is often noticed in magnetic resonance image (MRI) and its diagnostic value for arthralgia of the temporomandibular joint (TMJ) remains obscure. To develop a method for quantitatively evaluating the joint effusion revealed in MRI and its diagnostic value for arthralgia of the TMJ. Two-hundreds and twenty-eight TMJs, 101 with arthralgia (Group P) and 105 without (Group NP) from 103 patients, and 22 TMJs (Group CON) from 11 asymptomatic volunteers were examined by using MRI. The effusion volume was measured after constructing a three-dimensional structure of the joint effusion revealed in MRI by using the ITK-SNAP software. The diagnostic capabilities of the effusion volume on arthralgia were evaluated with receiver operating characteristic (ROC) curve analysis. Totally 146 joints showed MRI signs of joint effusion, including nine joints from Group CON. However, the medium volume was greater in Group P (66.65 mm3 ), but was much similar in Group CON (18.33 mm3 ) to Group NP (27.12 mm3 ). The effusion volume larger than 38.20 mm3 was validated to discriminate Group P from Group NP. The AUC value was 0.801 (95% CI 0.728 to 0.874), with a sensitivity of 75% and specificity of 78.9%. The median volume of the joint effusion was larger in those with than without bone marrow oedema, osteoarthritis, Type-III disc configurations, disc displacement and higher signal intensity of the retrodiscal tissue (all, p < .05). The present method for evaluate joint effusion volume well discriminated painful TMJs from non-pain ones.

Prevalence of Clinical Signs and Symptoms of Temporomandibular Joint Disorders Registered in the EUROTMJ Database: A Prospective Study in a Portuguese Center.

Temporomandibular joint disorders (TMDs) are characterized by their multifactorial etiology and pathogenesis. A 3-year prospective study was conducted in a Portuguese TMDs department to study the prevalence of different TMDs signs and symptoms and their association with risk factors and comorbidities. Five hundred ninety-five patients were included using an online database: EUROTMJ. Most patients were female (80.50%), with a mean age of 38.20 ± 15.73 years. The main complaints were: (1) temporomandibular joint (TMJ) clicking (13.26%); (2) TMJ pain (12.49%); (3) masticatory muscle tension (12.15%). The main clinical findings were myalgia (74%), TMJ clicking (60-62%), and TMJ arthralgia (31-36%). Risk factors such as clenching (60%) and bruxism (30%) were positively associated with TMJ pain and myalgia. Orthodontic treatment (20%) and wisdom tooth removal (19%) were positively associated with TMJ clicking, while jaw trauma (6%), tracheal intubation (4%) and orthognathic surgery (1%) were positively associated with TMJ crepitus, limited mandibular range of motion, and TMJ pain, respectively. In total, 42.88% of TMDs patients had other associated chronic diseases, most of them were mental behavioral or neurodevelopmental disorders (33.76%), namely, anxiety (20%) and depression (13%). The authors also observed a positive association of mental disorders with the degree of TMJ pain and myalgia. The online database seems to be a relevant scientific instrument for healthcare providers who treat TMDs. The authors expect that the EUROTMJ database can serve as a milestone for other TMDs departments.

Relationship between Mandibular Condyle Position and Pain in Patients with Disc Displacement with Reduction: A Retrospective Study

Objective: This study aimed to compare the condyle position of the temporomandibular joint (TMJ) in patients with disc displacement with reduction (DDWR) between with and without arthralgia using cone-beam computed tomography (CBCT). Methods: A total of 39 adult patients were examined retrospectively and were divided into three groups: 14 patients (21 joints) with TMJ DDWR and arthralgia, 14 patients (14 joints) with TMJ DDWR without arthralgia, and 11 asymptomatic patients (22 joints). Joint space measurements and condyle position were assessed using sagittal and coronal CBCT images. The radiographic data were correlated between the subgroups. One-Way ANOVA test was used for the analysis of normally distributed data, Kruskal Walis H test was used for non-normally distributed data in comparisons between three or more groups. The relationship between categorical data was examined with Chi-Square analysis. A descriptive statistical method (Mean, Median, Standard Deviation, Minimum-Maximum) was used while evaluating the study data. The confidence interval was set at 0.05 Results: There was no significant difference in age and gender between subgroups. The mean posterior and lateral joint space distance was found significantly higher in the painful DDWR group than in the painless DDWR group, and the incidence of anterior condylar position was significantly higher in the painful DDWR group than in the control group and painless DDWR group respectively. However, there was no significant difference in mediolateral condyle position variables among subgroups. Conclusion: Anterior condyle position may be correlated with pain in disc displacement disorders.

What are the Effects of Internal Fixation on Trigeminal Neurosensory Function and the Temporomandibular Joints Following Intraoral Vertical Ramus Osteotomy?

Intraoral vertical ramus osteotomy (IVRO) has, traditionally, been accomplished without internal fixation, necessitating a period of maxillomandibular fixation (MMF). With advances in instrumentation, internal fixation of IVRO is feasible, obviating the need for MMF. The purpose is to investigate the effects of transoral internal fixation on the prevalence of third division trigeminal nerve (CNV3) injury, temporomandibular joint (TMJ) arthralgia, and surgical site bleeding following IVRO. A retrospective study was conducted on patients who underwent IVRO at Vanderbilt University Medical Center between January 2017 and December 2020. The primary predictor variable was fixation status-internal fixation versus MMF. The primary outcome variable was postoperative CNV3 neurosensory disturbance. The secondary outcome variables were TMJ arthralgia and surgical site bleeding. Statistical analysis included Fisher's exact test and McNemar's Chi-squared test. Seventy two subjects (59 IVROs without internal fixation and 65 IVROs with internal fixation) were studied. The frequency of CNV3 neurosensory deficit was 0% in the IVRO without internal fixation group and 3.1% in the IVRO with internal fixation group (P=.49). Within group analysis showed a decreased frequency of postoperative TMJ arthralgia compared to preoperative records in both groups (IVRO without internal fixation group, P=.04 and IVRO with internal fixation group, P=.004). The frequency of active surgical site bleeding controlled with local measures was 1.7% in the IVRO without internal fixation group and 3.1% in the IVRO with internal fixation group (P=1). Internal fixation of IVRO is associated with low incidence of neurosensory deficit, TMJ arthralgia, and active surgical site bleeding.

Arthrocentesis versus non-surgical intervention as initial treatment for temporomandibular joint arthralgia: a randomized controlled trial with long-term follow-up

Arthrocentesis for arthralgia of the temporomandibular joint (TMJ) is often only indicated when conservative, non-surgical interventions have failed. However, performing arthrocentesis as initial therapy may facilitate earlier and better recuperation of the joint. The aim of this study was to assess the efficacy of this therapy with a long-term follow-up. Eighty-four patients were randomly allocated to receive either arthrocentesis as initial treatment (n = 41) or non-surgical intervention (n = 43). Pain (100-mm visual analogue scale, VAS) and mandibular function impairment questionnaire scores (MFIQ, 0–100) were recorded at 3, 12, and 26 weeks, and ≥ 5 years (median 6.2, interquartile range 5.6–7.4 years). Univariable analyses were performed and linear mixed-effect models were constructed. Patients in the arthrocentesis group experienced significantly lower TMJ arthralgia compared to those treated non-surgically (pain during movement: −10.23 mm (95% confidence interval −17.86; −2.60); pain at rest: − 8.39 mm (95% confidence interval −13.70; −3.08)), while mandibular function remained similar in the two groups (MFIQ −2.41 (95% confidence interval −8.61; 3.78)). Of the final sample, 10 patients (10/39, 26%) in the non-surgical intervention group and two patients (2/34, 6%) in the arthrocentesis group received additional treatment during follow-up. Thus, initial treatment with arthrocentesis reduced TMJ arthralgia more efficaciously than non-surgical intervention in the long term, while maintaining similar mandibular function.

Physiotherapy and occlusal splint treatment in myalgia, cervi-cogenic headache, and arthralgia: a case report

Abstract: The purpose of this study was to describe a rare case of myalgia, cervicogenic headache, and arthralgia in which interaction of physiotherapy, relaxation techniques, cognitive and behavioral counseling, psychosocial support, and occlusal splint treatment resulted in a positive outcome. A 27-year-old woman presented to our clinic with myalgia of the right side of the face, right temporomandibular joint arthralgia, right and left temple pain, jaw elevator muscle pain, and head and neck muscle soreness. The right and left joints' magnetic resonance imaging revealed anterior disc displacement without reduction. The treatment strategy aimed for a non-invasive treatment approach to relieve pain and restore functions. An occlusal appliance with an anterior bite plane was selected, along with counseling, psychosocial support, physiotherapy, posture self-control, massage of the head and neck muscles, mouth opening exercises, and self-massage. A temporomandibular specialist oversaw the splint treatment's progress, a maxillofacial surgeon managed the clinical signs and symptoms of the muscles and joints, and a physiotherapist provided the physiotherapy. Muscle stability in the head and neck has been related to temporomandibular disorders and may have repercussions on craniofacial structure and function. Keywords: physiotherapy; massage; relaxation techniques; oral splint; temporomandibular dis-order

Rhinogenic Contact Point Headache – a Review

Headache is a universal symptom in the course of everyone's life. There are myriads of causes for headache ranging from simple migraine, tension headache, refractory errors in the eye, temporomandibular joint arthralgia, and myofascial spasm to severe form of headache by brain tumors. The anatomical variations in the nasal cavity result in mucosal contact between the opposing surface and cause rhinogenic contact point headache (RCPH). RCPH is a new type of headache in medical literature. The pathogenesis of the RCPH is still the subject of controversy. Nose has diverse anatomical variations. Deviated nasal septum or spur, middle turbinate concha bullosa, and enlarged bulla ethmoidalis are the common anatomical variation in the nasal cavity which can cause RCPH. Diagnostic nasal endoscopy and computed tomography scan are helpful to confirm the mucosal contact points inside the nasal cavity. The precise excision of the contact points with the help of endoscopic approach in patients of RCPH is very effective. Clinicians should not ignore the anatomical variation of the nasal cavity during management of the headache. There is not much literature for RCPH indicating that this clinical entity is neglected. This review article presents an overview of the current aspect of RCPH.

Comparison of sleep quality deterioration by subgroup of painful temporomandibular disorder based on diagnostic criteria for temporomandibular disorders

Chronic pain conditions, including temporomandibular disorders, are closely related to poor sleep quality. This study investigated whether sleep deterioration in patients with painful temporomandibular disorder differed depending on the origin of pain, and also analyzed which clinical disease characteristics and whether psychological distress affected sleep quality. A total of 337 consecutive patients (215 women; mean age, 33.01 ± 13.01 years) with painful temporomandibular disorder (myalgia [n=120], temporomandibular joint arthralgia [n=62], mixed joint–muscle temporomandibular disorder pain [n=155]), who were assessed and classified based on the diagnostic criteria for temporomandibular disorder (DC/TMD), were enrolled. They completed a battery of standardized reports on clinical sign and symptoms, and answered questions on sleep quality, excessive daytime sleepiness, and patients’ psychological status. The mean global Pittsburgh Sleep Quality Index scores were significantly higher in the mixed temporomandibular disorder pain group (6.97 ± 3.38) and myalgia group (6.40 ± 3.22) than in the arthralgia group (5.16 ± 2.94) (p=0.001). Poor sleepers were significantly more prevalent in the mixed temporomandibular disorder pain group (76.8%) and myalgia group (71.7%) than in the arthralgia group (54.8%) (p=0.006). The presence of psychological distress in the myalgia group (β=1.236, p=0.022), global severity index of the Symptom Checklist-90-Revised in the arthralgia group (β=1.668, p=0.008), and presence of headache (β=1.631, p=0.002) and self-reported sleep problems (β=2.849, p<0.001) in the mixed temporomandibular disorder pain group were associated with an increase in the Pittsburgh Sleep Quality Index score. Ultimately, as the source of pain in painful temporomandibular disorder can affect and determine sleep quality and contributing factors, and as the complex interplay between sleep and pain can vary, a comprehensive treatment approach is necessary because good sleep is required by patients.

Management of Resistant Myofascial Pain in temporomandibular joint disorders with Photobiomodulation

Abstract Background: The existence of temporomandibular joint pain and/or dysfunction in masticatory muscles is characterized in temporomandibular disorders (TMDs). Non-surgical treatment is the first step in the treatment of TMDs. Photobiomodulation therapy (PBMT) is, due to its impact on biological processes, especially inflammation, considered as an adjuvant treatment modality in TMD cases. Aim: To evaluate the effectiveness of PBMT in treatment of resistant myofascial pain in patients with TMDs . Material and Methods: A total of 60 patients aged from 17 to 49 years, with temporomandibular joint (TMJ) myofascial pain or TMJ arthralgia were involved in this study, patients examined clinically and orthopantomographic radiographs were taken for all the patients to rule out any gross anatomical deformity in relation to the TMJ. All patients treated by PBMT or low level laser therapy (LLLT). Pain intensity, maximum active and passive mouth opening, lateral jaw motions were assessed before and immediately after finishing treatment and after 3 months follow up. Results: Statistically significant results were achieved in all study parameters Conclusion: this study shows that PBMT effectively relieves pain and improves TMJ functional outcomes in patients with TMDs. Keywords: Photobiomodulation, Low-level laser therapy, Temporomandibular joint, Temporomandibular disorder

A Systematic Review on the Association Between Clinical Symptoms and CBCT Findings in Symptomatic TMJ Degenerative Joint Disease

To evaluate the association between clinical signs/symptoms and bone changes on CBCT images in patients with degenerative joint disease (DJD) of the temporomandibular joint (TMJ). An electronic literature search of the MEDLINE, PubMed, EMBASE, Scopus, and Web of Science databases, as well as Google Scholar for gray literature, was conducted to identify relevant articles on February 26, 2021. Risk of bias was evaluated using the Joanna Briggs Institute critical appraisal tools. The GRADEpro (Recommendation, Assessment, Development, and Evaluation) system instrument was applied to assess the level of evidence across studies. Nine papers assessing clinical signs/symptoms and CBCT findings were included. TMJ pain (arthralgia) and TMJ noises carried the strongest associations with various CBCT findings, each of which were supported by four studies with significant associations. Only one study found significant associations between masticatory myalgia (muscle pain) and CBCT findings. Range of motion carried no significant associations with CBCT findings in the included studies. Based on the GRADEpro system, the certainty of evidence is low for said associations. The results suggest that TMD patients with TMJ arthralgia and joint noises may benefit from CBCT imaging. There would be less benefit in TMD patients exhibiting primarily myalgia or limited range of motion, and therefore these patients should not be prescribed routine CBCT radiographs unless indicated by other clinical findings. The heterogeneity of reporting in the included studies suggests that embracing universal clinical (DC/TMD) and radiographic diagnostic criteria for TMJ-DJD would benefit both research and clinical outcomes.

Acute arthritis of the right temporomandibular joint due to Lyme disease: a case report and literature review

BackgroundLyme disease is the most frequent tick-borne infectious disease in Europe. It often presents with a wide variety of symptoms. For this reason, affection of the temporomandibular joint (TMJ) caused by Lyme disease (LD) can be misdiagnosed as a common temporomandibular disorder (TMD).Case presentationThe purpose of this case report of a 25-year-old woman presenting to the Departments of Orthodontics and Oral and Maxillofacial Surgery with extensive symptoms of temporomandibular disorder is to illustrate the delayed diagnosis of Lyme disease which was only made after extensive therapy of the temporomandibular joint. The specialist literature only reports a few cases of patients suffering from Lyme disease with TMJ manifestations.ConclusionThis case report and the relevant literature review aim to emphasize the importance of accurate request of medical history and differential diagnosis of acute TMJ arthritis and arthralgia. Early interdisciplinary diagnosis of Lyme disease and early antibiotic therapy are essential to avoid misdiagnosis and unnecessary, sometimes invasive, therapies.

A logistic analysis prediction model of TMJ condylar erosion in patients with TMJ arthralgia

BackgroundIn terms of diagnostic and therapeutic management, clinicians should adequately address the frequent aspects of temporomandibular joint (TMJ) osteoarthritis (OA) associated with disk displacement. Condylar erosion (CE) is considered an inflammatory subset of OA and is regarded as a sign of progressive OA changes potentially contributing to changes in dentofacial morphology or limited mandibular growth. The purpose of this study was to establish a risk prediction model of CE by a multivariate logistic regression analysis to predict the individual risk of CE in TMJ arthralgia. It was hypothesized that there was a closer association between CE and magnetic resonance imaging (MRI) indicators.MethodsThis retrospective paired-design study enrolled 124 consecutive TMJ pain patients and analyzed the clinical and TMJ-related MRI data in predicting CE. TMJ pain patients were categorized according to the research diagnostic criteria for temporomandibular disorders (RDC/TMD) Axis I protocol. Each patient underwent MRI examination of both TMJs, 1–7 days following clinical examination.ResultsIn the univariate analysis analyses, 9 influencing factors were related to CE, of which the following 4 as predictors determined the binary multivariate logistic regression model: missing posterior teeth (odds ratio [OR] = 1.42; P = 0.018), RDC/TMD of arthralgia coexistant with disk displacement without reduction with limited opening (DDwoR/wLO) (OR = 3.30, P = 0.007), MRI finding of disk displacement without reduction (OR = 10.96, P < 0.001), and MRI finding of bone marrow edema (OR = 11.97, P < 0.001). The model had statistical significance (chi-square = 148.239, Nagelkerke R square = 0.612, P < 0.001). Out of the TMJs, 83.9% were correctly predicted to be CE cases or Non-CE cases with a sensitivity of 81.4% and a specificity of 85.2%. The area under the receiver operating characteristic curve was 0.916.ConclusionThe established prediction model using the risk factors of TMJ arthralgia may be useful for predicting the risk of CE. The data suggest MRI indicators as dominant factors in the definition of CE. Further research is needed to improve the model, and confirm the validity and reliability of the model.

Effect of photobiomodulation therapy on painful temporomandibular disorders

To evaluate the effect of photobiomodulation therapy (PBMT) on painful temporomandibular disorders (TMD) patients in a randomized, double-blinded, placebo-controlled manner. Participants were divided into a masseter myalgia group (n = 88) and a temporomandibular joint (TMJ) arthralgia group (n = 87) according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Both groups randomly received PBMT or placebo treatment once a day for 7 consecutive days, one session. The PBMT was applied with a gallium-aluminum-arsenide (GaAlAs) laser (wavelength = 810 nm) at pre-determined points in the masseter muscle (6 J/cm2, 3 regions, 60 s) or TMJ region (6 J/cm2, 5 points, 30 s) according to their most painful site. Pain intensity was rated on a 0–10 numerical rating scale (NRS) and pressure pain thresholds (PPT) and mechanical sensitivity mapping were recorded before and after the treatment on day 1 and day 7. Jaw function was assessed by pain free jaw opening, maximum unassisted jaw opening, maximum assisted jaw opening, maximum protrusion and right and left excursion. Data were analyzed with a mixed model analysis of variance (ANOVA). Pain intensity in arthralgia patients decreased over time (P < 0.001) for both types of interventions, however, PBMT caused greater reduction in pain scores than placebo (P = 0.014). For myalgia patients, pain intensity decreased over time (P < 0.001) but without difference between interventions (P = 0.074). PPTs increased in both myalgia (P < 0.001) and TMJ arthralgia patients over time (P < 0.001) but without difference between interventions (P ≥ 0.614). Overall, PBMT was associated with marginally better improvements in range of motion compared to placebo in both myalgia and arthralgia patients. Pain intensity, sensory function and jaw movements improve after both PBMT and placebo treatments in myalgia and arthralgia patients indicating a substantial non-specific effect of PBMT.