Temporomandibular Joint Arthralgia Research Articles

Pain and persistent occlusal awareness: What should dentists do?

Pain and persistent occlusal awareness: What should dentists do?

Randomized Trial on the Effectiveness of Dexamethasone in TMJ Arthrocentesis

The aim of this study was to compare the effectiveness of dexamethasone administration following arthrocentesis of the temporomandibular joint (TMJ) with a placebo (saline). Twenty-eight participants with TMJ arthralgia were randomly assigned to two groups of a parallel double-blind RCT. In both groups, an arthrocentesis procedure was carried out. In one group, the procedure was followed by the administration of a single-dose intra-articular dexamethasone. In the other group, saline was administered as a control. Follow-up visits were scheduled after 1, 3, and 24 weeks. During each visit, TMJ pain (on a 100-mm VAS) and jaw stiffness (mouth opening in mm) were scored. In the statistical analysis, generalized estimating equation (GEE) models showed no differences between the two study groups, although pain and jaw stiffness were both reduced over 24 weeks. In conclusion, intra-articular dexamethasone following arthrocentesis did not improve the procedure’s effect in patients presenting with TMJ arthralgia (ClinicalTrials.gov number CT01275014).

Lateral cephalometric analysis of mandibular morphology: discrimination among subjects with and without temporomandibular joint disk displacement and osteoarthrosis

To assess whether in patients with temporomandibular joint (TMJ) arthralgia cephalometric variables of mandibular morphology may discriminate among the magnetic resonance (MR) imaging-based TMJ groups of 'bilateral presence of disk displacement without reduction (DDwoR) and osteoarthrosis (OA)' and 'bilateral absence of bilateral DDwoR and OA'. Bilateral MR imaging of the TMJ was performed in 45 consecutive TMJ arthralgia patients to identify individuals with the specific structural characteristics of bilateral TMJ DDwoR associated with OA. Linear and angular cephalometric measurements were taken from lateral cephalograms to apply selected criteria of mandibular morphology. A discriminant function analysis was used to investigate how cephalometric parameters discriminate among the TMJ groups of 'bilateral presence of DDwoR with OA' and 'bilateral absence of DDwoR and OA'. Ramus height (Ar-Go) and effective mandibular length (Ar-Pog) produced a significant discriminant function that predicted TMJ group membership (P < 0·001). This function correctly classified 80·2% of original and cross-validated grouped cases. This study supports the concept that cephalometric variables of mandibular morphology discriminate among subjects with and without bilateral TMJ DDwoR and OA.

Viscossuplementação como tratamento das alterações internas da articulação temporomandibular: relato de casos

JUSTIFICATIVA E OBJETIVOS: As formas de tratamento consideradas não invasivas para as alterações internas das articulações temporomandibulares (ATM) descritas na literatura são muitas, incluindo aconselhamento, farmacoterapia, fisioterapia e dispositivos interoclusais. No entanto, alguns pacientes tornam-se refratários aos tratamentos conservadores, sendo indicados procedimentos como artrocentese, artroscopia e cirurgias das ATM. A viscossuplementação é uma abordagem pouco invasiva, de baixo custo e com bons resultados em curto e médio prazo. O objetivo deste estudo foi discutir a técnica de viscossuplementação como tratamento das alterações internas da ATM, com relato de 2 casos clínicos com acompanhamento de 12 meses. RELATOS DOS CASOS: Duas pacientes com artralgia das ATM e refratárias à tratamento conservador foram submetidas a uma infiltração semanal de hialuronato de sódio por três semanas. Observou-se melhora da dor e da amplitude de abertura mandibular nas duas primeiras semanas, resultado que se manteve constante ao longo de um ano de acompanhamento. CONCLUSÃO: A viscossuplementação das ATM mostrou ser eficiente no controle da dor articular, melhorando também a função mandibular nos casos clínicos apresentados. Ensaios clínicos controlados com amostras significativas devem ser realizados para compreensão de sua real eficácia no tratamento das DTM.

Cephalometric variables discriminate among magnetic resonance imaging–based structural characteristic groups of the temporomandibular joint

The aim of this study was to assess retrospectively whether, in patients with temporomandibular joint (TMJ) arthralgia, commonly used cephalometric variables of dentofacial morphology can discriminate among magnetic resonanace imaging (MRI)-based TMJ structural characteristic groups of "uni- or bilateral disc displacement without reduction (DDwoR) associated with bilateral osteoarthrosis (OA)" and "uni- or bilateral disc displacement with reduction (DDwR) without OA." Bilateral MRI of the TMJ was performed in 56 consecutive TMJ arthralgia patients to identify individuals with specific structural characteristic of uni- or bilateral TMJ DDwoR, DDwR, and OA. Application of the criteria resulted in a study group of 31 patients with "uni- or bilateral DDwoR with bilateral OA" and 25 with "uni- or bilateral DDwR without OA." Linear and angular cephalometric measurements were taken from lateral cephalograms to apply selected criteria of dentofacial morphology. One-way analysis of variance was used to assess differences in cephalometric variables by MRI-based TMJ group. Then, discriminant function analysis predicted TMJ group membership. A-B plane to facial plane angle, palatal plane to occlual plane, and interincisal angle produced a significantly discriminant function that predicted TMJ group membership (P < .001). This function correctly classified 85.7% of original grouped cases. Cephalometric variables may discriminate among MRI-based TMJ structural characteristic groups. Additional diagnostic information related to MRI-based classification groups was generated.

Structural Characteristics of Bilateral Temporomandibular Joint Disc Displacement Without Reduction and Osteoarthrosis Are Important Determinants of Horizontal Mandibular and Vertical Ramus Deficiency: A Magnetic Resonance Imaging Study

To estimate in patients with temporomandibular joint (TMJ) arthralgia whether magnetic resonance (MR) imaging findings of bilateral TMJ disc displacement without reduction (DDwoR) and/or osteoarthrosis (OA) are determinants of horizontal mandibular and vertical ramus deficiencies. Bilateral MR imaging of the TMJ was performed in 68 consecutive patients with TMJ arthralgia to identify those with bilateral TMJ DDwoR and/or OA. Linear and angular cephalometric measurements were performed to apply selected criteria of horizontal mandibular (gonion-menton [Go-Me] <73 mm and articulare-pogonion [Ar-Pog] <105 mm) and vertical ramus (articulare-gonion [Ar-Go] <45 mm) deficiencies. Logistic regression analysis was used to estimate the association between selected MR imaging and cephalometric parameters. In the age- and gender-adjusted analysis, significant increases in the risk of horizontal mandibular (odds ratio, 7.5:1; P = .031) and vertical ramus (odds ratio, 9.5:1; P = .003) deficiencies occurred with bilateral DDwoR and OA. In patients with TMJ arthralgia, the MR imaging parameters of DDwoR and OA seem important determinants of horizontal mandibular and vertical ramus deficiencies.

Influence of headache frequency on clinical signs and symptoms of TMD in subjects with temple headache and TMD pain

The relationship of the frequency of temple headache to signs and symptoms of temporomandibular joint (TMJ) disorders (TMD) was investigated in a subset of a larger convenience sample of community TMD cases. The study sample included 86 painful TMD, nonheadache subjects; 309 painful TMD subjects with varied frequency of temple headaches; and 149 subjects without painful TMD or headache for descriptive comparison. Painful TMD included Research Diagnostic Criteria for Temporomandibular Disorders diagnoses of myofascial pain, TMJ arthralgia, and TMJ osteoarthritis. Mild to moderate-intensity temple headaches were classified by frequency using criteria based on the International Classification of Headache Disorder, 2nd edition, classification of tension-type headache. Outcomes included TMD signs and symptoms (pain duration, pain intensity, number of painful masticatory sites on palpation, mandibular range of motion), pressure pain thresholds, and temple headache resulting from masticatory provocation tests. Trend analyses across the painful TMD groups showed a substantial trend for aggravation of all of the TMD signs and symptoms associated with increased frequency of the temple headaches. In addition, increased headache frequency showed significant trends associated with reduced PPTs and reported temple headache with masticatory provocation tests. In conclusion, these findings suggest that these headaches may be TMD related, as well as suggesting a possible role for peripheral and central sensitization in TMD patients.Subjects with painful temporomandibular disorders (TMD) showed significant trends for increased signs and symptoms of TMD associated with increased frequency of concurrent temple headaches.

Are temporomandibular joint disk displacements without reduction and osteoarthrosis important determinants of mandibular backward positioning and clockwise rotation?

The aim of this study was to estimate whether, in patients with temporomandibular joint (TMJ) arthralgia, the magnetic resonanace imaging (MRI) findings of bilateral TMJ disk displacement without reduction (DDwoR) and/or osteoarthrosis (OA) are determinants of mandibular backward positioning and/or clockwise rotation. Bilateral MRI of the TMJ was performed in 50 consecutive TMJ arthralgia patients to identify individuals with bilateral TMJ DDwoR and/or OA. Linear and angular cephalometric measurements were taken to apply selected criteria of mandibular backward positioning (FH to Na-Pog <84°, Na-A-Pog >5°, and SNB <75°) and clockwise rotation (FH to OP >13°, MP to FH >35°, and S-Gn to FH >64°). Logistic regression analysis was used to estimate the association between selected MRI and cephalometric parameters. In the age- and gender-adjusted analyses, significant increases in risk of mandibular backward positioning and clockwise rotation occurred with bilateral DDwoR and OA (9.5:1; P = .040). In patients with TMJ arthralgia the MRI parameters of DDwoR and OA seem to be important determinants of mandibular backward positioning and clockwise rotation.

Likelihood ratio methodology to identify predictors of treatment outcome in temporomandibular joint arthralgia patients

The purpose of this prospective, cohort study of patients with temporomandibular joint (TMJ) pain was to develop rules to predict treatment outcome related to occlusal stabilization splints. The study comprised 119 patients with a unilateral Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis I diagnosis of arthralgia. Visual analog scale (VAS) pain level of function was assessed before stabilization splint therapy and compared with the respective 2-month and 6-month follow-up findings. Magnetic resonance (MR) images were obtained immediately before treatment to establish the presence or absence of disk displacement, osteoarthrosis, effusion, and bone marrow edema. Treatment outcome (success or failure) was categorized based on changes in the VAS pain level after 6 months. Sixty-five (55%) subjects were categorized as treatment success, 17 (14%) as treatment failures, and 37 (31%) as somewhat improved. After using univariate analyis to determine the association between potential clinical and MR imaging predictor variables and treatment outcome status, preliminary prediction rules were developed for prediction of success (positive LR, 10.8; 95% confidence interval [CI], 0.6-188.1) and failure (negative LR, 0.05; CI, 0.0-0.8). The most important variables were time since pain onset, basic VAS pain level, change in VAS level at 2-month follow-up, and clinical diagnoses of disk displacement with and without reduction. Outcome following use of occlusal stabilization splints may be predicted from variables collected from self-report and physical examination. Predictive modeling may provide clinicians with the opportunity to identify "at-risk" patients early and initiate alternative treatment approaches.

Temporomandibular joint involvement caused by Borrelia Burgdorferi

Lyme borreliosis is an endemic disease in Slovenia with an incidence of around 150 patients per 100,000 inhabitants. Although the large joints are most typically affected in Lyme borreliosis, there are also periods of disease activity with arthritis or arthralgias involving smaller joints, including the temporo-mandibular joint. During the years between 2000 and 2003, two patients with Lyme borreliosis affecting the temporo-mandibular joints were treated. The patients presented with fatigue and pain in diverse muscle groups accompanied by arthralgia, which was most pronounced in the temporomandibular joint area. None of the patients were febrile or had joint effusions. Both patients were examined by means of biochemical and serological examinations for Borrelia burgdorferi using ELISA assay and Western blot test (both for IgM and IgG), plain radiographs, MR and CT scans, and scinti-scan of the temporo-mandibular joints They both had positive serum markers for an acute B. burgdorferi infection and were treated with intravenous ceftriaxone. None of the patients had clinical or laboratory signs of chronic Lyme disease activity two and four years following therapy, respectively. Roentgenographic and nuclear magnetic resonance imaging of the temporo-mandibular joints had not shown any persistent sign of acute inflammation. There are only few reports of patients with manifest temporo-mandibular joint involvement of Lyme borreliosis in the literature. This report emphasizes the importance of differential diagnosis of acute temporo-mandibular joint arthralgia, of early diagnosis of Lyme borreliosis, and of the necessity for prompt antibiotic treatment.

Effects of intra-articular ketamine on pain and somatosensory function in temporomandibular joint arthralgia patients

Recent studies have hypothesized that peripheral glutamate receptors could be implicated in deep craniofacial pain conditions. In this study 18 temporomandibular joint (TMJ) arthralgia patients received intra-articular injections of the N-methyl- d-aspartate (NMDA) receptor antagonist, ketamine, or normal saline to study in a cross-over, double-blinded, placebo-controlled manner the effect on TMJ pain and somatosensory function. Spontaneous pain and pain on jaw function was scored by patients on 0–10 cm visual analogue scale (VAS) for up to 24 h. Quantitative sensory tests (QST): tactile, pin-prick, pressure pain threshold and pressure pain tolerance were used for assessment of somatosensory function at baseline and up to 15 min after injections. There were no significant effects of intra-articular ketamine over time on spontaneous VAS pain measures (ANOVA: P = 0.532), pain on jaw opening (ANOVA: P = 0.384), or any of the somatosensory measures (ANOVA: P > 0.188). The poor effect of ketamine could be due to involvement of non-NMDA receptors in the pain mechanism and/or ongoing pain and central sensitization independent of peripheral nociceptive input. In conclusion, there appears to be no rationale to use intra-articular ketamine injections in TMJ arthralgia patients, and peripheral NMDA receptors may play a minor role in the pathophysiology of this disorder.

Effectiveness of Low-Level Laser Therapy in Temporomandibular Joint Disorders: A Placebo-Controlled Study

Low-level laser therapy (LLLT) treatment for pain caused by temporomandibular joint disorders (TMD) was investigated in a controlled study comparing applied energy density, subgroups of TMD, and duration of disorders. Although LLLT is a physical therapy used in the treatment of musculoskeletal disorders, there is little evidence for its effectiveness in the treatment of TMD. The study group of 61 patients was treated with 10 J/cm(2) or 15 J/cm(2), and the control group of 19 patients was treated with 0.1 J/cm(2). LLLT was performed by a GaAlAs diode laser with output of 400 mW emitting radiation wavelength of 830 nm in 10 sessions. The probe with aperture 0.2 cm(2) was placed over the painful muscle spots in the patients with myofascial pain. In patients with TMD arthralgia the probe was placed behind, in front of, and above the mandibular condyle, and into the meatus acusticus externus. Changes in pain were evaluated by self-administered questionnaire. Application of 10 J/cm(2) or 15 J/cm(2) was significantly more effective in reducing pain compared to placebo, but there were no significant differences between the energy densities used in the study group and between patients with myofascial pain and temporomandibular joint arthralgia. Results were marked in those with chronic pain. The results suggest that LLLT (application of 10 J/cm(2) and 15 J/cm(2)) can be considered as a useful method for the treatment of TMD-related pain, especially long lasting pain.

In patients with temporomandibular disorders, do particular interventions influence oral health‐related quality of life? A qualitative systematic review of the literature

The use of patient-based outcomes to measure therapeutic effectiveness is increasing, because a growing number of clinical scientists are attempting to evaluate the impact of therapy on the recipient. There are indications that patients suffering from temporomandibular disorders (TMDs) may also show a reduced oral health-related quality of life (OHQoL). It was the purpose of this paper to answer the question as to whether therapeutic interventions in TMD patients have a positive effect on their OHQoL. A systematic electronic search (Ovid Medline 1966-2006; Science Citation Index 1945-2006) of the literature was carried out to identify pertinent articles of randomized and non-randomized clinical trials. Reports on retrospective and prospective studies that specifically focused on OHQoL changes in TMD patients as a consequence of therapeutic interventions were included. The reference lists of the identified articles were screened to find additional pertinent publications. The investigation yielded seven relevant contributions from Medline. A quantitative analysis of the seven identified articles was not possible. There was considerable heterogeneity among the investigations with regard to study design, patient characteristics, and provided therapy. Three of the identified articles reported about prospective controlled studies, of which one was an RCT. Four additional investigations were retrospective. According to the results of the only RCT, a 6-week course of the non-selective cyclooxygenase (COX) inhibitor naproxen may lead to slightly better OHQoL in patients with temporomandibular joint (TMJ) arthralgia than the selective COX-2 inhibitor celecoxib. The two other articles reporting of a controlled study showed that selective serotonine uptake inhibitors accompanied by psychological therapy improved OHQoL in individuals with TMJ arthralgia. In contrast, TMJ surgery did not improve OHQoL. It appears that all therapeutic interventions reported in the identified publications led to at least some improvement of OHQoL. The only exception were patients with multiple TMJ surgeries.

Arthralgia of the Temporomandibular Joint and Low-Level Laser Therapy

This case report describes the treatment of a patient with arthralgia of the temporomandibular joint (TMJ) caused by disc displacement. The goal of the treatment of TMJ arthralgia is to decrease pain by promotion of the musculoskeletal system's natural healing ability. This report describes the complex treatment of TMJ arthralgia. Low-level laser therapy (LLLT) was chosen for its antiinflammatory and analgesic effects. Laser therapy was carried out using the GaAlAs diode laser with an output power of 400 mW, emitting radiation with a wavelength of 830 nm, and having energy density of 15 J/cm2; the laser radiation was applied by contact mode on four targeted spots in 10 sessions. Physiotherapy was recommended to this patient to prevent the injury of intraarticular tissue caused by incorrect movement during opening of the mouth. Splint stabilization and prosthetic treatment were used to reduce overloading of the TMJ, resulting from unstable occlusion and to help repositioning of the dislocated disc. Five applications of LLLT led to decrease of pain in the area of the TMJ on the Visual Analog Scale, from 20 to 5 mm. The anti-inflammatory effect of the laser was confirmed by thermographic examination. Before treatment, the temperature differences between the areas of the normal TMJ and TMJ with arthralgia was higher than 0.5 degrees C. However, at the conclusion of LLLT, temperatures in the areas surrounding the TMJ were equalized. This study showed the effectiveness of complex non-invasive treatment in patients with arthralgia of the TMJ. The analgesic and anti-inflammatory effects of LLLT were confirmed by infrared thermography.

Can infrared thermography be a diagnostic tool for arthralgia of the temporomandibular joint?

This paper presents a review of the use of infrared thermography in diagnosis of temporomandibular joint (TMJ) arthralgia. The question examined was whether the infrared thermography could be reliably used as a tool to diagnose arthralgia by objectively assessing the site of origin and the degree of irritation. Controlled studies were performed by using advanced thermographic devices to show both diagnostic validity and reliability of infrared thermography as a screening test for selecting healthy subjects from patients with unilateral TMJ arthralgia. The study revealed that thermography fails to meet the criteria of high level of evidence. Further studies are required to confirm these results in order to specify analysis of facial thermal patterns and to better understand the relationship between TMJ arthralgia and regional temperature changes. Until then infrared thermography cannot be recommended for routine use as a diagnostic technique to identify TMJ disorders.

Efficacy of Pulsed Radio Frequency Energy Therapy in Temporomandibular Joint Pain and Dysfunction

This randomized double-blind study evaluated the effectiveness of pulsed radio frequency energy therapy (PRFE) in patients with temporomandibular joint arthralgia. Forty subjects (age range 22 to 55 yrs.) were assigned randomly into two equal groups: (1) Experimental group received PRFE using the Energex unit (Energex, Inc. Emerson, New Jersey) and (2) Control group received PRFE placebo treatment using a sham device. Both groups received six applications to the TMJ area over two weeks. Data were analyzed for the following times: baseline, first and second follow-up visits. Numerical Rating Scale scores for TMJ pain showed a significant reduction over time for the experimental group (mean = 6.13 to 3.05, p<0.001). There was also a significant effect for the controls (mean = 5.35 to 4.20, p=0.01). The effect for experimental subjects was a mean reduction of 3.07 versus 1.15 for controls. The significant reduction in controls was attributed to the placebo effect. The experimental group showed a significant increase in mouth opening (mean = 34.95 to 41.70 mm, p=0.002), right lateral movement (mean = 7.85 to 10.80 mm, p=0.001) and left lateral movement (mean = 7.65 to 10.85 mm, p<0.0001). No significant (p>0.1) change in the control group occurred for mouth opening (mean = 38.50 to 39.65 mm), right lateral movement (mean = 8.60 to 8.75 mm) and left lateral movement (mean = 8.50 to 8.80 mm). No side effects were reported during the treatment and the two week follow-up. These results suggest strongly that PRFE is a safe and effective treatment for TMJ arthralgia as well as for increasing mandibular range of motion.

Bilateral temporomandibular joint pseudogout

Pseudogout is an acute presentation of one type of crystal deposition disease in which calcium pyrophosphate dihydrate crystals are found in the joint spaces of synovial joints. In this case, a 56-year-old caucasian male presented with right sided preauricular swelling, temporomandibular joint arthralgia and restricted mouth opening; he developed identical symptoms on the left side two days later.

Cyclooxygenase-2 in synovial tissue and fluid of dysfunctional temporomandibular joints with internal derangement

Purpose: This study investigated cyclooxygenase-2 (COX-2) gene expression in temporomandibular joint (TMJ) synovial tissue and fluid from patients with internal derangement. Patients and Methods: Seventeen synovial tissue biopsy specimens and 16 synovial fluid samples were obtained from patients (1 male and 11 female) during arthroscopic TMJ surgery. The samples were frozen at −70°C and, by using Northern and reverse transcription polymerase chain reaction (RT-PCR) analysis, the levels of COX-2 RNA in relation to β-actin RNA message levels were determined. Results: COX-2 RNA message was detected in 16 of 17 synovial tissue samples (94%) and 12 of 16 synovial fluid samples (75%) by using β-actin RNA levels in the same sample (either tissue or fluid) as an internal control. Samples were not quantified because of the same sample mass. Conclusion: COX-2, an important inflammatory mediator, is present in the TMJ synovial tissue and fluid from patients with internal derangement. Therefore, COX-2 antagonists may be indicated in the treatment of TMJ arthralgia. © 2000 American Association of Oral and Maxillofacial Surgeons

The association of temporomandibular joint pain with abnormal bone marrow in the mandibular condyle

Sano et al have examined the association between pain and abnormal marrow of the mandibular condyle as assessed by signal intensity on proton density and T2-weighted magnetic resonance imaging (MRI) scans. The authors observed a significant association between MRI signal intensities and subjective rankings of pain. On the basis of this apparent association, the authors suggest that bone marrow involvement may be an important feature of temporomandibular joint (TMJ) disorders and a potential cause of TMJ arthralgia.

Electronic thermography for the assessment of mild and moderate temporomandibular joint dysfunction

Today facial heat emission patterns may be rapidly obtained and quantified with the use of advanced electronic thermography units that have the promise of being a nonionizing, noninvasive, low-cost diagnostic alternative for the evaluation of temporomandibular joint disorders. This study design measured the use of electronic thermography as a tool to select between asymptomatic (control) subjects and a patient group with mild to moderate temporomandibular joint disorders. Study populations consisted of 24 asymptomatic (control) subjects and 20 patients with (1) either locked or unlocked temporomandibular joints, (2) varying degrees of limitation of mouth opening, (3) mild to moderate muscle pain, and (4) mild to moderate temporomandibular joint arthralgia. The results indicated that the control group demonstrated a high level of thermal symmetry over the temporomandibular joint region. The patient group demonstrated a low level of thermal symmetry with a delta T value of 0.4 degrees C. The control group was selected from the patient group with 85% sensitivity (17 of 20), and 92% specificity (22 of 24), and 89% overall accuracy (39 of 44), when selecting among the 44 subjects used in this study. The conclusion therefore is that electronic thermography shows promise as a method of diagnosing mild to moderate temporomandibular joint disorders.