Temporomandibular Joint Clicking Research Articles

A 31-year-old woman with jaw deviation and pain: Part II

J Evid Base Dent Pract 2002;2:254-7

Observations of newborn babies with temporomandibular joint clicking: three cases

Observations of newborn babies with temporomandibular joint clicking: three cases

The relation of mandibular laterotrusion with ipsilateral TMJ clicking.

The purpose of this study was to investigate the association of temporomandibular joint (TMJ) clicking with the types of canine guidance, the tracing patterns of mandibular laterotrusion and, especially, with the movements of the working side condyle. In a young subject group, the movements of left and right mandibular laterotrusion were measured at the incisal and the lateral pole point of the working side condyle. All samples were divided into one of two groups according to the mesial (M) or distal (D) canine guidance. They were also divided into protrusive laterotrusion (PL) or retrusive laterotrusion (RL) groups according to the tracing patterns. The incidence of clicking was 23.8% in all 84 TMJs. There was no significant difference between the M and the D groups. However, clicking occurrence was significantly higher in the RL than in the PL group (P<0.05). The condyles in clicking joints moved more posterior in ipsilateral laterotrusion than the condyles in non-clicking joints. The condyles in RL also moved more posterior than those in PL. It is suggested that the posterior movement of the working side condyle in RL has a strong relationship with the internal derangement of the TMJ. However, it is not related to the type of canine guidance.

Therapeutic manipulation of the temporomandibular joint

We present a prospective study of manipulation of the temporomandibular joint (TMJ) under a general anaesthetic undertaken to find out the success rate in an effort to reduce the number of patients referred for invasive surgery.Results : Of the 55 patients invited to participate in this study, 15 improved, 15 did not, 6 showed partial improvement, and 19 were not treated. The median pre-treatment opening was 20mm (range 13–27). Among those who improved after manipulation, the median opening after treatment was 38mm (range 35–56). Some of those who improved experienced a return of TMJ clicking but not of joint or muscle tenderness. Conclusion: Manipulation under general anaesthesia helps some patients with disc displacement without reduction.

Avaliação das disfunções craniomandibulares em pacientes parcialmente edentados unilaterais: um estudo longitudinal sobre o efeito da utilização de Prótese Parcial Removível (PPR)

O objetivo deste estudo foi comparar a severidade dos sinais e sintomas das desordens craniomandibulares em 29 pacientes edentados parciais unilaterais, submetidos a tratamento protético corretivo, acompanhados e avaliados longitudinalmente, por meio de investigação clínica, dois anos após a instalação da prótese parcial removível. Em cada um dos casos, a comparação das diferenças clínicas, antes e após os procedimentos de reconstrução protética, baseou-se na mensuração e registro das variáveis por meio da utilização de uma metodologia de testes de escores. As observações clínicas objetivas e subjetivas consistiram no exame da sensibilidade dolorosa muscular e da ATM, na auscultação dos ruídos articulares e no registro dos movimentos mandibulares (MM). Vinte e nove outros pacientes, totalmente dentados, atuaram como grupo controle. Após análise estatística não-paramétrica, conclui-se que os pacientes apresentavam uma prevalência significativamente maior na severidade das desordens craniomandibulares antes do tratamento protético e que o tratamento corretivo por meio da instalação de prótese parcial removível (PPR) bem indicada e planejada, atuou positivamente na diminuição da severidade destes distúrbios nesses pacientes.

白血病細胞浸潤と顎内障が併存し開口障害を呈した急性リンパ性白血病の１例

A 18-year-old woman was referred to the Department of Oral and Maxillofacial Surgery, Handa City Hospital because of arthralgia of the right temporomandibular joint (TMJ). The patient had a history of right TMJ clicking and limited mouth opening (30 mm). MRI disclosed anterior disc displacement without reduction of the right TMJ. Medication and pumping manipulation had little effect, followed by a gradual reduction in mouth opening. Three months later, she had a mild fever, nasal obstruction, and peripheral paresthesia. CT and MRI demonstrated tumor invasion into the nasopharynx, maxillary sinus, infratemporal fossa, and pterygoid muscles. Examination of a biopsy specimen taken from the upper pharynx revealed a hematogenic tumor. The patient was admitted to the hematology division of Fujita Health University. The diagnosis of acute lymphocytic leukemia was established by examination of the bone marrow aspirate. Induction chemotherapy was initiated according to the JAL SG ALL-93 protocol. The TMJ symptoms resolved with subsequent courses of chemotherapy. On CT and MRI, the tumor disappeared, but mouth opening was limited to 30 mm. Splint therapy and manipulation on every visit were carried out. Two months later, her maximum mouth opening increased to 42 mm. Her clinical course has been favorable without any evidence of recurrence after bone marrow transplantation.

Effects of stabilization appliances on nocturnal parafunctional activities in patients with and without signs of temporomandibular disorders.

This study was designed to investigate the short-term effects of stabilization appliances on parafunctional oral motor behaviour (bruxing and clenching) during sleep in patients with and without signs of temporomandibular disorders (TMD). Results revealed that stabilization appliances do not stop nocturnal parafunctional activities in both groups of patients. Active wear facets on the guide ramps of appliances were created by bilateral mandibular excursions. The extension of these facets indicate that the mandible moves laterally far beyond the edge-to-edge contact relationship of the canines during eccentric bruxism. Results also indicate that, with the exception of temporomandibular joint (TMJ) clicks, stabilization appliance therapy is effective in eliminating the signs of TMD evaluated.

Variability of disk position in asymptomatic volunteers and patients with internal derangements of the TMJ

This study determined the variability of temporomandibular joint (TMJ) disk position in medial, central, and lateral aspects of the joint using magnetic resonance imaging (MRI). Subjects had clinical evidence of reciprocal TMJ clicking (N = 123) or restricted mandibular motion (N = 52). Eighty-nine asymptomatic volunteers provided a control group. Disk position was quantified on MRI by measuring the angle formed by a line through the middle of the condyle and perpendicular to the Frankfort plane and a line through the same midpoint of the condyle and tangential to the posterior-most aspect of the disk. The disk position in asymptomatic TMJs varied considerably with a tendency toward farther anterior placement in more lateral images. In 47 TMJs from a total of 52 TMJs (90%), restricted mobility was associated with anterior disk displacement (ADD) without reduction. The disk position demonstrated a mean displacement of 77 degrees without significant differences at the medial and lateral aspects of the condyle. One hundred TMJs from a total of 123 TMJs (81%) with reciprocal clicking demonstrated ADD with reduction. Tomograms revealed larger lateral displacements or rotational displacements in these joints, whereas medial images frequently showed similar ranges of disk positions as compared with asymptomatic TMJs. The results suggest that disk positions of up to +15 degrees on medial tomograms and +30 degrees on lateral tomograms should be regarded as normal variations. Furthermore, multisection analysis of all parasagittal images improved the separation between disk displacement and asymptomatic TMJs.

Orthodontic residents' indications for use of the lateral TMJ tomogram and the posteroanterior cephalogram

The purpose of this study was to determine the selection criteria used by orthodontic residents for ordering a corrected lateral tomogram (LT) of the temporomandibular joint (TMJ) and a posteroanterior cephalogram (PAC) for the diagnosis of patients needing orthodontic care. The impact of the radiographs on their treatment plans was also assessed. We conducted a study of the 144 new patients assigned to eight orthodontic residents during a two-year period. The residents responded through questionnaires describing their rationale for ordering the radiographs. A LT was ordered for twenty-eight (19 percent) of the patients. The most common reasons cited for requesting the LTs were TMJ clicking (67 percent) and pain (33 percent). The residents also perceived a need to order the LT for medico-legal protection in 85 percent of these cases. The LT tended not to have an impact on treatment planning. A PAC was ordered thirty-eight times (26 percent). The most common reasons cited by residents for ordering a PAC included clinical findings of facial asymmetry (41 percent) and maxillary airway anatomy (24 percent). Medico-legal protection was a perceived need in only 12 percent of the cases. While the PAC had no impact on treatment planning for 56 percent of the cases, they did define the transverse problems as dental or skeletal for 38 percent of the cases. Six patient traits were statistically associated with PAC requests: difficulty chewing, abnormal TMJ, TMJ clicking, facial asymmetry. crossbite, and midline discrepancy. The teaching of appropriate selection criteria for ordering these radiographs needs to be emphasized early in a resident's training.

Symptoms and Signs of Temporomandibular Disorders in Girls with Normal Occlusion and Class II Malocclusion

Henrikson T, Ekberg EC, Niler M. Symptoms and signs of temporomandibular disorders in girls with normal occlusion and class II malocclusion.Mandibular function, headaches, and symptoms and signs of temporomandibular disorders (TMD) were studied in one group of girls with a well-defined normal occlusion (n=60) and another group with class II malocclusion (n=123). Frequent headaches and temporomandibular joint clicking, muscle tenderness to palpation, pain on mandibular movement, awareness of tooth clenching, and grinding were commoner in the class Il malocclusion group. Awareness of tooth clenching had the largest influence on the odds for symptoms and signs of temporomandibular disorders VMD) in a logistic regression analysis. Occlusal variables that increased the odds for symptoms and signs of TMD were large overjet, frontal open bite, few occlusal contacts, lateral sliding retruded-intercuspal contact position, crowding, and non-working side interferences. We concluded that normal occlusions have lower odds for symptoms and signs of TMD, whereas some occlusal characterstics, more frequently found in the class II malocclusion group, increased the odds for symptoms and signs of TMD.

Does clicking in adolescence lead to painful temporomandibular joint locking?

Summary Background It has been assumed that clicking of the temporomandibular joint (TMJ) may predispose to closed locking. Although jaw clicking is a common complaint, locking of the TMJ is rare. Methods To assess whether clicking is a reliable predictor of locking, we examined longitudinally over 9 years the variation of reported and recorded TMJ clicking in 128 young Finnish adults. Subjects were interviewed and examined at the ages of 14, 15, 18, and 23 years. Findings Reported and recorded TMJ clicking both increased significantly with age, varying from 11% to 31% and from 11% to 34%, respectively. However, clicking showed no predictable pattern, and only a few subjects consistently reported clicking (2%) or had it recorded (2%). None developed locking. Interpretation Because none of the young adults developed locking of the TMJ, we suggest treatment for clicking should be conservative.

顎関節症を伴う顎変形症患者に対する不顎枝垂直骨切り術（ＩＶＲＯ）の経験

The purpose of this study was to evaluate the clinical efficacy and changes of magnetic resonance (MR) imaging of temporomandibular joint (TMJ) by intraoral vertical ramus osteotomoy (IVRO). The subjects were ten patients with mandibular prognathism associated with TMJ clicking and dysfunction.Ten patients were treated with IVRO and followed-up for 226 days on average. Signs and symptoms and MR imaging of TMJ were evaluated in pre- and postoperative phases. Prior to IVRO, all patients had been treated nonsurgically for their TMJ dysfunction, and most of the patients relieved pain, but not joint clicking. Preoperative orthodontic treatment was performed for about 13 months.Surgical correction of mandibular prognathism by IVRO was successfully done without any episode of relapse, and clicking sound disappeared in all patients after surgery. There was neither associated pain nor dysfunction in all TMJs. In the MR imagings, postoperative improvement of preoperative abnormal disc configuration was found in four of eight TMJs, nine joints disclosed appropriate condylar sag, and normal disc-condyle coordination was restored in seven of ten joints. Interestingly, despite of no obvious imaging changes in the remaining subjects, clinical improvement was confirmed.These results suggested that IVRO may be a suitable surgery for a jaw deformity patient with concomitant TMJ clicking and dysfucntion.

The wave forms of temporomandibular joint sound clicking and crepitation.

The aim of the present study was to determine the sound wave forms which correspond to auscultatory findings of temporomandibular joint (TMJ) clicking and crepitation. Such knowledge is important when selecting parts of digital recordings for spectral analysis. Electronic digital recordings were made with a sampling rate of 44,100 Hz from 60 subjects, including 51 patients referred for suspected rheumatological disease and nine healthy subjects. Accelerometers with the bandwidth 20-3600 Hz were used for all subjects and complementary recordings were made from a subgroup of nine subjects using a measurement microphone with the bandwidth 20-20,000 Hz. The clicking sounds could be classified into different types according to differences in temporal period duration (T) as measured on the analogue display. One type of clicking, found in 51% of the patients, had a T of 2-20 ms. Another type, found in 70% of the subjects, had a T of less than 1 ms, often as low 0.2 ms. This type of clicking was not seen at all in the analogue display if the sampling rate was below 3,000 Hz. The character of the two types of clicking differed: the short duration sounds had a very high pitch, while the pitch of the longer duration sound was lower. Crepitation was found in 63% of the subjects and was observed to be composed of a series of short duration sounds, occurring with brief (less than 10 ms) intervals. It is concluded that the accelerometer (or microphone) bandwidth should cover the entire audible range (20-20,000 Hz), and that sampling rates must be much higher than 3000 Hz, and preferably greater than 10,000 Hz, before the true significance of electronically recorded joint sounds/vibrations can be determined.

Pilot study of the heterogeneous patterns of masticatory muscle coordination in nonpatient population

This pilot study characterized coordination patterns of the muscles of mastication during voluntary chewing in a nonclinical population. Dental students (n = 177) who did not exhibit symptoms of temporomandibular disorder were screened by a comprehensive muscle and temporomandibular joint palpation examination. A group of 44 students was identified on the basis of the presence of four or more tender points indicated during palpation. This group was further subgrouped by the absence (group A-1) and presence (group A-2) of temporomandibular joint clicking. Five volunteers from groups A-1 and A-2 and five volunteers without any palpation tenderness and joint clicking (control group) were examined by simultaneous recordings of electromyography of bilateral masseter and posterior one third of the temporalis muscles and by mandibular kinesiography. The electromyographic coordination pattern for the control group demonstrated predominantly working masseter muscle activity. This "predominant working masseter" pattern was not observed in groups A-1 or A-2. Additional analyses of the recordings indicated that a hypoactive tendency of the working side masseter muscle particularly outlasting the tooth contact was present in group A-1, whereas significant hyperactivity of the posterior one third of the temporalis was present in group A-2. The data suggested that an asymptomatic nonpatient population may be functionally diverse.

Evaluation of TMJ Surgery in Cases not Responding to Conservative Treatment

The aim of the study was to evaluate the treatment outcome after temporomandibular joint (TMJ) surgery, which was performed in 33 patients (27 women and six men) between 1970 and 1986. Before surgery, the patients received different types of conservative treatment for an average time of 29 months. The most common diagnosis was anterior disk displacement (ADD) with or without reduction (n = 10), followed by unspecified arthralgia (n = 8), osteoarthrosis (n = 7) and ankylosis (n = 4). Standardized clinical records served as the basis for comparison of symptomatology at comparable time points. Furthermore, 31 of the 33 patients were subjected to a clinical follow-up, including anamnestic, clinical, radiological and cast analysis, 2-17 years after operation. Pain, sleeping problems and consumption of analgesics were significantly reduced after surgery. The anamnestic, as well as the clinical dysfunction indices, according to Helkimo, were also significantly reduced. TMJ clicking was reduced, but crepitations increased in number. The best improvements were seen in patients with ADD without reduction and in patients with ankylosis.

The Effect of Occlusal Splint Therapy on Different Curve Parameters of Axiographic TMJ Tracings

Computerized axiography was used as an objective instrumental method of evaluating the response of patients with temporomandibular joint (TMJ) symptomatology to occlusal splint therapy. Diagnosis was performed in a standardized manner by systematically analyzing TMJ path tracings obtained by computerized axiography. Thirty-six patients were axiographed before and after therapy with full-arch occlusal stabilizing appliances, followed by assessing the effect of therapy on various path curve parameters. The data obtained for the patient group treated with splints was compared to that of six patients also axiographed, but left untreated for a period of six weeks before a second TMJ tracing was obtained. The results show that splints have a certain effect on reciprocal TMJ clicking (response rate 67%). Retral stability and path characteristics are also substantially improved (response rates 44% and 40%). Less influence was noted on hypomobile joint paths (response rate 29%), the quality of movements (response rate 28%) and Bennett angle values (response rate 23%). Patients with disk displacements without reduction were not treated with splints, they underwent surgery. Their results will be reported later. By contrast, TMJ tracings in the control group remained essentially unchanged.

A Retrospective Study on the Clinical Results of Temporomandibular Joint Surgery

A retrospective study on the results of temporomandibular joint (TMJ) surgery was performed in 74 patients with total menisectomy, 90 patients with partial menisectomy with disk repair, and 66 patients with arthroscopic lysis of adhesion and lavage of the joint space. TMJ pain during jaw movement, TMJ noise and maximum jaw opening was evaluated one year after surgery. TMJ pain and TMJ noise were significantly reduced by all three procedures. However, TMJ clicking was more significantly observed in patients with arthroscopy. Maximum jaw opening was significantly increased by all three procedures. However, maximum opening of patients with total menisectomy was significantly smaller than in the other two procedures.

Electromyograph of the Inferior Head of the Lateral Pterygoid Muscle during Temporomandibular Joint Clicking

Electromyograph of the Inferior Head of the Lateral Pterygoid Muscle during Temporomandibular Joint Clicking

Isokinetic exercise management of temporomandibular joint clicking in young adults

Temporomandibular joint clicking is frequently a sign of craniomandibular disorders, and the etiologic predisposing, initiating, and perpetuating factors must be considered in its management. The present study assesses the usefulness of isokinetic exercises in the treatment of temporomandibular joint clicking. At the end of a 6-month test period, 18 of 22 subjects (approximately 82%) with clicks no longer had clicking, but four subjects (approximately 18%) with bilateral reciprocal clicking did not lose their clicks. A number of proposals have been suggested in the past as an explanation of the cause of temporomandibular joint clicking, but the present study has shown that clicking in young adults is predominantly neuromuscular in origin and may be a reversible condition that can be treated successfully with a conservative exercise regimen.

Incidence of temporomandibular joint symptoms following whiplash injury.

Recently there has been considerable litigation involving the development of temporomandibular joint (TMJ) pain and dysfunction following cervical musculoskeletal injury (whiplash). The purpose of this investigation was to interview, examine, and follow up patients with a diagnosis of whiplash injury to determine the incidence of associated temporomandibular disorders. Patients were divided into two categories: those with and those without radiologic evidence of cervical skeletal injury. In the 63 patients with radiographic evidence of cervical skeletal injury (group 1), none had clicking at the time of initial examination. In the 92 patients without positive radiographs (group 2), only one had clicking. At 1 month follow-up by telephone, 2 of 51 available patients in group 1 had developed clicking, but no new TMJ symptoms were reported by the 78 patients in group 2 contacted by phone. Seventy percent of the initial follow-up group (44 patients) with radiographic evidence of injury were contacted by telephone at 1 year and none reported new symptoms of TMJ pain or clicking. Sixty-five percent of the initial follow-up group without radiographic evidence of injury (60 patients) were interviewed and also reported no new TMJ symptoms. These data indicate that the incidence of TMJ pain and clicking following whiplash injury is extremely low, and that patients who do not have clicking on resolution of their initial pain/dysfunction subsequently do not develop this problem.