Temporomandibular Joint Clinic Research Articles

Low-intensity pulsed ultrasound in the treatment of masticatory myositis and temporomandibular joint synovitis: A clinical trial

BackgroundLow-intensity pulsed ultrasound (LIPUS) is a non-invasive physical stimulation application for the therapy of articular cartilage injury. This study aimed to explore the therapeutic effects of low-intensity pulsed ultrasound in treating masticatory myositis and synovitis in temporomandibular joint disorders and to establish an evaluation system to evaluate the clinical efficacy. MethodsTMD patients who met the inclusion criteria in the temporomandibular joint clinic of the affiliated Stomatological Hospital of Chongqing Medical University from April 3, 2021, to December 2021 were selected. Before the start and after 7 days of LIPUS treatment, the Fricton temporomandibular joint disorder index, Visual Analog Scale (VAS), and Pressure Difference of Precision Manometer (PD) were measured. A paired t-test was used to compare the values of the Fricton index, VAS, and PD before and after treatment in each group. One-way ANOVA analysis of variance was used to compare the differences between groups. ResultsAfter one week of LIPUS treatment, the PI, DI and CMI of the Fricton index in the masticatory myositis (PI: P < 0.001; CMI: P < 0.001; DI: P = 0.2641, ns) and the synovitis group (DI: P < 0.001; CMI: P < 0.001, PI: P = 0.9729, ns) significantly decreased. The VAS of the masticatory myositis group and the synovitis group were significantly reduced (P < 0.001). The PD between the affected and healthy sides of the masticatory myositis group and the synovitis group was significantly reduced (P < 0.001), and the reduction was more evident in the M group. ConclusionsLIPUS is effective in pain relief in patients with masticatory myositis and joint synovitis, meanwhile, masticatory myositis was more sensitive to LIPUS. A new comprehensive clinical efficacy evaluation system which includes PV, FI, and VAS was created to better 2 diagnose masticatory myositis and joint synovitis.

The True-Positive Rate of a Screening Questionnaire for Temporomandib-ular Disorders.

Background: Temporomandibular disorders (TMD) occur at an incidence of 5–12% in the general population. We aimed to investigate the rate of true-positives for a screening questionnaire for TMD (SQ-TMD) and differences in the characteristics between the true-positive and false-negative groups. Materials and Methods: Seventy-six individuals (16 men, 60 women; mean age, 41.1 ± 16.5 years) were selected from pa-tients with TMD who had visited the Temporomandibular Joint Clinic at Tokyo Medical and Dental University. The patients were assessed using a questionnaire that contained items on TMD screening (SQ-TMD); pain intensity (at rest, maximum mouth-opening, and chewing), as assessed using the visual analog scale (VAS); and TMD-related limitations of daily func-tion (LDF-TMD). A logistic regression analysis was performed to assess the factors potentially influencing the true-positive rate. Results: Of the 76 subjects, 62 (81.6%) were true-positive for the questionnaire based on the SQ-TMD scores. The mean VAS score for maximum mouth-opening and chewing and the mean LDF-TMD score were significantly greater in the true-positive group than those in the false-negative group. The results of the logistic regression analysis showed that only the VAS score for chewing was a statistically significant factor (P < 0.05). Conclusion: The true-positive rate of TMD using SQ-TMD was very high. The results indicate that SQ-TMD can be used to screen TMD in patients with moderate or severe pain and difficulty in living a healthy daily life.

Temporomandibular joint multidisciplinary team clinic

Patients with dysfunction of the temporomandibular joint (TMJ) commonly present to oral and maxillofacial departments and are increasingly being managed by a subspecialist group of surgeons. We review the outcomes of patients attending a specialist TMJ multidisciplinary team (MDT) clinic. All patients are simultaneously reviewed by a consultant oral and maxillofacial surgeon, consultant in oral medicine, specialist physiotherapist, and maxillofacial prosthetist, and they can also see a consultant liaison psychiatrist. They are referred from primary, secondary, and tertiary care when medical and surgical treatment in the routine TMJ clinic has failed, and are triaged by the attending maxillofacial surgeon. On discharge they are returned to the care of the referring practitioner. We review the outcomes of patients attending this clinic over a 2-year period and show improvements in pain scores and maximal incisal opening, as well as quality of life outcome measures. All units in the UK with an interest in the management of diseases of the TMJ should consider establishing this type of clinic and should use available resources and expertise to maximise outcomes.

Magnitude of Bite Force that is Interpreted as Clenching in Patients with Temporomandibular Disorders: A Pilot Study

Introduction: The magnitude of bite force that is interpreted as clenching (imagined clenching level: ICL) in patients with temporomandibular disorders (TMD) remains unknown. We aimed to investigate the relationship between ICL and symptoms of TMD to evaluate the suitability of the term clenching for interpreting bite force in these patients. Methods: A total 76 patients (16 men, 60 women; age, 41.1 ± 16.5 years) with temporomandibular disorders treated at the Temporomandibular Joint Clinic at Tokyo Medical and Dental University were selected. All patients completed a questionnaire that evaluated gender, age, pain intensity at rest and during maximum mouth opening and chewing, ICL, and TMD-related limitation of daily functions. Pain intensity and ICL were estimated using a visual analog scale for pain. TMD-related limitation of daily functions was evaluated using a 10-item questionnaire. Results: The mean (SD) visual analog scale score for ICL was 77.4 (± 18.7 mm) and was significantly correlated with the pain intensity during maximum mouth opening and chewing, and the TMD-related limitation of daily function score; however, only the latter was identified as significant in the multiple regression analysis (P<0.05). Conclusions: TMD patients imagined the clenching force at a magnitude of approximately 70% of the maximum bite force. Patients are considered unable to sustain clenching at this magnitude; therefore, clenching is not a preferred term when administering counseling and behavioral therapy to TMD patients.

Effect of water-soluble titanium microparticle-permeated tape on temporomandibular disorders-related pain: A preliminary study

Objective. Recent research has focused on the applicability of titanium particle-impregnated materials in healthcare and medical products. This preliminary study was undertaken to investigate the effect of water-soluble titanium microparticle-permeated (WSTi) tape on temporomandibular disorder (TMD)-related pain. Materials and methods. The study included 32 patients (41.5 ± 14.4 years, 26 women) who had visited the Temporomandibular Joint Clinic, Tokyo Medical and Dental University, for treatment of TMD-related pain. The subjects were instructed to apply the WSTi tape (AquaTitan tape) on the most painful area before going to sleep and remove the tape on awakening daily for 2 weeks. Seven outcome variables were statistically analyzed: maximum mouth-opening ranges with and without pain, spontaneous pain intensity, mouth-opening pain intensity, chewing pain intensity, TMD-related limitation of daily functions (LDF-TMD) and subjective evaluation of any change in TMD-related pain. Results. The mean maximum mouth-opening ranges with (p = 0.011) and without (p = 0.002) pain were significantly greater and mean pain intensities on mouth opening (p < 0.001) and chewing (p = 0.001) were significantly lower at the 2-week follow-up than at the baseline. The mean LDF-TMDQ scores were also significantly lower at the 2-week follow-up (p = 0.004). After 2 weeks of using the WSTi tape, 53.1% and 12.5% of the subjects reported a slight improvement and an improvement, respectively, in TMD-related pain. Conclusion. WSTi tape seems to have beneficial effects on TMD-related pain and LDF.

Case Series of an Intraoral Balancing Appliance Therapy on Subjective Symptom Severity and Cervical Spine Alignment

Objective. The objective of this study was to investigate the effect of a holistic intraoral appliance (OA) on cervical spine alignment and subjective symptom severity. Design. An observational study on case series with holistic OA therapy. Setting. An outpatient clinic for holistic temporomandibular joint (TMJ) therapy under the supervision of the Pain Center, CHA Biomedical center, CHA University. Subjects. Ambulatory patients presenting with diverse chief complaints in the holistic TMJ clinic. Main Measures. Any immediate change in the curvature of cervical spine and the degree of atlantoaxial rotation was investigated in the images of simple X-ray and computed tomography of cervical spine with or without OA. Changes of subjective symptom severity were also analyzed for the holistic OA therapy cases. Results. A total of 59 cases were reviewed. Alignment of upper cervical spine rotation showed an immediate improvement (P < 0.001). Changes of subjective symptom severity also showed significant improvement (P < 0.05). Conclusion. These cases revealed rudimentary clinical evidence that holistic OA therapy may be related to an alleviated symptom severity and an improved cervical spinal alignment. These results show that further researches may warrant for the holistic TMJ therapy.

Prevention and Treatment for the Rare Complications of Arthroscopic Surgery in the Temporomandibular Joint

To analyze the rare complications of arthroscopic surgeries in the temporomandibular joint (TMJ) and to investigate the preventive and treating methods. In this study, 2,034 consecutive patients (2,431 joints), diagnosed as TMJ internal derangement, were treated by arthroscopic surgeries when visiting the TMJ clinic at the Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, between May 2001 and September 2009. The clinical complications were analyzed to investigate cause, prevention, and control measures. Of all 2,034 cases, the complications were shown as follows: 5 joint hemorrhages of the lateral pterygoid muscle vascular, injuries of the lateral pterygoid muscle nerve in 5 joints, 3 joints with broken instruments, rejection reaction in 2 joints, and perforation of tympanic membrane in 2 joints. Arthroscopic surgery was a safe and effective method to treat TMJ internal derangement; its complications were limited and acceptable, but an experienced operator was required for this surgical technique.

Comparative study of sagittal and coronal MRI of histological disk and temporomandibular joint specimen for examining an identity of anterior disk dislocation and anterior capsular connective tissue

Anterior dislocation of the articular disk of the temporomandibular joint (TMJ) found by MRI tomography often presents a problem. It may persist in MRI despite improvement of articular symptoms and even be found in healthy persons free of any symptoms. Can this be explained by the similarity in structure of the anterior connective tissue of the disk and capsule and their pathological changes? Is a second coronal plane required for MRI investigation? The preauricular regions of 72 patients of the TMJ clinic were examined by oblique-sagittal and oblique-coronal MRI. A Siemens-Vision MRI was used. It was also possible to prepare 10 articular disks of the TMJ with anterior capsular tissue as well as 20 complete TMJs of adults from autopsy material. Sagittal, transversal, and horizontal serial sections were examined histologically. In 49 of the 72 cases examined, an anterior dislocation without reduction found in the sagittal MRI was not confirmed in the oblique-coronal MRI. In the sagittal MRI it was possible to differentiate three, in the coronal MRI six typical forms of magnetic resonance signals, which are represented in figures. They are compared with anatomical and histological connective tissue findings adjacent to the TMJ. The structural similarity of the disk and anterior capsular tissue of the TMJ is demonstrated. The close connection of the disk and connective tissue surrounding the TMJ makes differentiation of MRI findings difficult especially following regressive and adaptive reactions. In MRI, anterior capsular tissue is able to simulate dislocation of the disk. Pathological tissue reactions may alter the MRI signal and lead to the wrong diagnosis of dislocation of the disk. Diagnosis of an anterior disk dislocation cannot be established solely on the basis of oblique-sagittal MRI findings.

Craniocervical dysfunction levels in a patient sample from a temporomandibular joint clinic: Glenn T. Clark, Edward M. Green, M. Roberta Dornan, and Virginia F. FlackJ. Am. Dent. Assoc. 1987;115:251–256

Craniocervical dysfunction levels in a patient sample from a temporomandibular joint clinic: Glenn T. Clark, Edward M. Green, M. Roberta Dornan, and Virginia F. FlackJ. Am. Dent. Assoc. 1987;115:251–256

Craniocervical dysfunction levels in a patient sample from a temporomandibular joint clinic

Results gathered by examining 40 patients with temporomandibular disorders and 40 matched controls for craniocervical dysfunction showed that high scores were more frequent for patients with temporomandibular disorders. Results indicated that these patients should be screened routinely for craniocervical problems.

Factors influencing the outcome of treatment in patients referred to a temporomandibular joint clinic

A retrospective review was performed in 350 consecutive patients referred for functional disturbances of the masticatory system. Two and one-half years after the first visit, the records of all patients were examined for clinical findings, diagnosis, and observations related to treatment. Number of visits, length of the treatment period, and evaluation of signs and symptoms at last visit (factors which showed a wide variation) were analyzed for correlation with signs and symptoms at first visit and some background factors. A total of 50 variables were considered. The number of visits and length of treatment period were primarily correlated with variables that indicated the severity of signs and symptoms at the first visit. Multiple regression analysis showed that tenderness on muscle palpation at first visit was the most important of the independent variables. About one-fourth of the variance of number of visits and length of treatment could be explained ( R 2 = 0.28 and 0.27, respectively), while the corresponding value for the variance of the evaluation at last visit was 15% ( R 2 = 0.15). The results tend to emphasize the heterogeneity of patients with functional disturbances of the masticatory system and the difficulty of prognosticating the outcome of treatment in such patients, even when attempts are made to divide them into subgroups.

Long-term evaluation of non-surgical treatment of osteoarthrosis of the temporomandibular joint

For 25 patients with osteoarthrosis of the temporomandibular joint (TMJ), the course of the clinical symptoms consisting of limitation of mouth opening, pain, joint sound, mandibular deviation and facial deformity was studied throughout a long follow-up period. The diagnosis was based on clinical, radiographical and laboratory findings. It turned out that after a long period, only 1 patient still sufferred from the disease without any improvement. Clinical signs and symptoms exhibited a tendency of gradual improvement, and the number of patients who did not attend the TMJ clinic further increased gradually after the first year. With regard to pain, only slight occasional pain was observed by 4 patients, 15 patients became free from pain, and the remaining patients did not return to the TMJ clinic after a period of 18 months. Sounds produced by movements in the joint were observed in 22 patients at the first examination; at least 5 patients still had this symptom 18 months later, 10 patients only exhibited symptoms on rare occasions or were free from noises, and 7 patients no longer attended the TMJ clinic. 45.8% of the total number of patients recovered from the mandibular deviation, and 80% showed satisfactory mouth opening (more than 35 mm) at the last examination. Facial deformity was observed in at least 4 patients after a long follow-up period.

Therapy for mandibular dysfunction in adolescents and adults

T he myofascial pain-dysfunction syndrome is little understood, inconsistent, and a poorly defined clinical entity. The symptom complex may show acute, subacute, or chronic pain and soreness, stiffness, and spasm of associated muscles. The pain may be localized or widespread, and it appears to arise from trigger areas. These trigger areas are small, hypersensitive regions that, when stimulated, bombard the central nervous system and give rise to referred pain. The trigger areas are stimulated by pressure, heat or cold, or motion that stretches them. Trigger areas are located throughout the body. A particular area gives rise to a similar distribution of referred pain in most persons. Thus, a trigger area can be traced according to its known reference pattern of pain. Stiffness, soreness, and spasm of muscles probably represent a tissue response to the pain stimulus. Muscles contract in the presence of pain. When the pain is sustained, the muscle contraction also is sustained. This results in incoordination and restricted movements and dysfunction of the affected members1 Therapeutic exercises relieve painful spasm in the myofascial pain-dysfunction syndrome and associated disorders. Nevertheless, since Schwartz2 first advocated their use in 1959, exercises have generated little enthusiasm among dentists. The remoteness of exercises from other traditional dental treatments no doubt plays a part in their being almost universally ignored. Clinical trials using exercises were begun by Schwartz in 1950, and by 1956 the idea that pain and muscle spasm could best be treated through conservative and reversible methods led to the adoption of therapeutic exercises as a central treatment at the Temporomandibular Joint Clinic, Columbia University School of Dental and Oral Surgery. During the past 16 years of the Clinic’s operation, these exercises have been refined and simplified. For clinical purposes three qualities of muscle function should be differentiated : 1. Muscle contraction-the normal reaction of a muscle to stimuli, which is the source of muscle strength.

Personality and temporomandibular joint dysfunction

The Eyesenck Personality Inventory was employed in an investigation of seventy patients referred to a temporomandibular joint clinic. Their scores for neuroticism were significantly higher than those of a normal standardization sample. The relation of these results to current concepts of psychologic aspects of temporomandibular joint dysfunction is outlined. A possible use of the Inventory as a clinical screening test is suggested.

Role of a temporomandibular joint clinic in dental school curriculum

The role of the temporomandibular joint clinic in instruction in the temporomandibular joint syndrome to undergraduate dental students has been presented. The methodology of teaching was described. A plan for treatment of temporomandibular joint problems for dental students is a part of the teaching program.

Books Received

HomeRadiologyVol. 73, No. 5 PreviousNext Announcements and Book ReviewsBooks ReceivedPublished Online:Nov 1 1959https://doi.org/10.1148/73.5.792bMoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractBooks received are acknowledged under this heading, and such notice may be regarded as recognition of the courtesy of the sender. Reviews will be published in the interest of our readers and as space permits.The Mediastinum. By Ted F. Leigh, M.D., Professor of Radiology, Emory University School of Medicine, Director of the Department of Radiology, Emory University Hospital, Member of the Section of Radiology, Emory University Clinic, Atlanta, Ga., AND H. STEPHEN WEENS, M.D., Professor of Radiology and Chairman of the Department of Radiology, Emory University School of Medicine, Director of the Department of Radiology, Grady Memorial Hospital, Chief of the Section of Radiology, Emory University Clinic, Atlanta, Ga. A volume of 246 pages, with 290 figures. Published by Charles C Thomas, Springfield, Ill., 1959. Price $11.50.Disorders of the Temporomandibular Joint: Diagnosis, Management, Relation to Occlusion of Teeth. By Laszlo Schwartz, D.D.S., Clinical Professor of Dentistry, Columbia University; Director, Temporomandibular Joint Clinic, Columbia-Presbyterian Medical Center, and 18 contributors. Introduction by Charles Ragan, M.D., Professor of Clinical Medicine, Columbia University. Foreword by Harry Sicher, M.D., D.Sc, Professor of Anatomy, Loyola University School of Dentistry, Chicago. Illustrated by Robert J. Demarest. A volume of 472 pages, with 458 illustrations on 168 figures. Published by W. B. Saunders Co., Philadelphia, Penna., 1959. Price $15 00.Diagnostic Radioisotopes. By Charles A Owen, Jr., M.D., Ph.D. (Med.), Section of Clinical Pathology, Mayo Clinic, and Associate Professor of Clinical Pathology, Mayo Foundation Graduate School, University of Minnesota, Rochester, Minn. A volume of 426 pages, with 71 figures, 49 tables, and 1 nomogram. Published by Charles C Thomas, Springfield, Ill., 1959. Price $15.75.A Text-Book of X-Ray Diagnosis by British Authors. In Four Volumes. Volume IV: The Bones, Joints, and Soft Tissues. Edited by S. Cochrane Shanks, C.B.E., M.D., F.R.C.P., F.F.R., Director, X-Ray Diagnostic Department, University College Hospital, London, and Peter Kerley, C.V.O., C.B.E., F.R.C.P., F.F.R., D.M.R.E., Director, X-Ray Department, Westminster Hospital; Radiologist, National Heart Hospital, London. A volume of 714 pages, with 735 illustrations. Published by W. B. Saunders Co., Philadelphia, Penna., 3d ed., 1959. Price $21.00.Roentgens, Rads, and Riddles. A Symposium on Supervoltage Radiation Therapy Held at the Medical Division, Oak Ridge Institute of Nuclear Studies, July 15, 16, 17, and 18, 1956. Edited by Milton Friedman, M.D., Marshall Brucer, M.D., and Elizabeth Anderson, Oak Ridge Institute of Nuclear Studies, Oak Ridge, Tennessee, U. S. Atomic Energy Division. A volume of 496 pages, with figures and tables. For sale by the Superintendent of Documents, U. S. Government Printing Office, Washington 25, D. C, 1959. Price $3.50.Article HistoryPublished in print: Nov 1959 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 73, No. 5 Metrics Altmetric Score PDF download

Conclusions of the Temporomandibular Joint Clinic at Columbia

Conclusions of the Temporomandibular Joint Clinic at Columbia