Symptoms Of Temporomandibular Joint Dysfunction Research Articles

Signs and symptoms of temporomandibular joint dysfunction in children with primary dentition

The presence of signs and symptoms of TMD in 99 children with primary dentition was evaluated through clinical exam and a questionnaire. The results showed that 34.34% presented signs and/or symptoms of TMD. Among the children with symptoms, 50% presented at least one sign or more, differing significantly from the ones without symptoms, and from those 21.6% presented sign (p = 0.0185). The most prevalent symptom was frequent headache (7.07%) followed by jaw pain (4.04%), earache (3.03%) and difficulty in swallowing (3.03%). The most prevalent sign was jaw deviation (18.18%) followed by occlusal interferences (7.07%), asymmetric condylar movement (5.05%) and TMJ sounds (3.03%). We concluded that signs and symptoms of TMD are present in early ages, even though in a small number of children.

Temporomandibular joint dysfunction in Marfan syndrome*1

Objective The aim of this study was to examine the prevalence of signs and symptoms of temporomandibular joint (TMJ) dysfunction in persons with Marfan syndrome. Study design A questionnaire was distributed to 350 patients with Marfan syndrome. Twenty-one patients were additionally subjected to a clinical examination and magnetic resonance imaging (MRI) of the TMJ. Results The prevalence of symptoms of TMJ dysfunction was 51.6% (n = 145), with 24.2 % (n = 68) indicating symptoms of subluxation, and 34.9% (n = 98) of the patients already undergoing medical treatment for their TMJ problems. Anterior disc displacement with and without reduction was observed in 17 of the examined patients (81.0%), with 4 of these patients additionally showing osteoarthrosis of the affected temporomandibular joints. Conclusion TMJ dysfunction appears to be an important aspect in Marfan syndrome.

Temporomandibular joint dysfunction in Marfan syndrome

Objective The aim of this study was to examine the prevalence of signs and symptoms of temporomandibular joint (TMJ) dysfunction in persons with Marfan syndrome. Study design A questionnaire was distributed to 350 patients with Marfan syndrome. Twenty-one patients were additionally subjected to a clinical examination and magnetic resonance imaging (MRI) of the TMJ. Results The prevalence of symptoms of TMJ dysfunction was 51.6% (n = 145), with 24.2 % (n = 68) indicating symptoms of subluxation, and 34.9% (n = 98) of the patients already undergoing medical treatment for their TMJ problems. Anterior disc displacement with and without reduction was observed in 17 of the examined patients (81.0%), with 4 of these patients additionally showing osteoarthrosis of the affected temporomandibular joints. Conclusion TMJ dysfunction appears to be an important aspect in Marfan syndrome.

Temporomandibular Joint Dysfunction: From Risk Factors To Prevention

Background: Temporomandibular joint dysfunction (TMJD) is widespread. About 60-70% of the general population is aware of symptoms. Aim of the study is to investigate the main risk factors involved in TMJD. Methods: 68 consecutive patients admitted for surgical procedures were enrolled. Before surgical procedure, they were clinically evaluated for TMJD, according to accepted criteria. A logistic regression model step-wise was used to evaluate the correlation between single risk factors and TMJD. Results: 47 out of 68 patient (69.12%) presented at least one sign or symptom of TMJD. Among all evaluated risk factors, only the presence of dental caries was significantly associated with TMJD (OR=6.13; p Manuele Casale, MD Area of Otolaryngology University Campus Bio-Medico Rome Via Longoni, 69/83 00155 Rome (Italy) Tel.: 0039622541740 – Fax: 0039622541456 Email: m.casale@unicampus.it

Pigmented Villonodular Synovitis of the Temporomandibular Joint: A Report of Two Cases

Pigmented villonodular synovitis is a benign but locally destructive disease that originates in the synovial membranes of the joints. It is a proliferative disorder of unknown etiology, and it is usually monarthric. Approximately 80% of cases involve the knee; the hip, ankle, foot, hand, elbow, and shoulder account for most other cases. Pigmented villonodular synovitis in the temporomandibular joint is rare. When it does occur, its features include preauricular swelling, trismus, and symptoms of temporomandibular joint dysfunction. It can be diagnosed by a combination of the history, clinical examination, characteristic radiologic findings, and fine-needle aspiration or biopsy results. Wide local excision, including the involved bone, and a total synovectomy are advocated because the lesion can recur if it is not adequately excised. We report two new cases of pigmented villonodular synovitis of the temporomandibular joint, and we review the literature on this subject.

Changes in temporomandibular joint dysfunction after orthognathic surgery

Purpose: We sought to evaluate the effects of orthognathic surgery on temporomandibular joint (TMJ) dysfunction in patients with known presurgical TMJ internal derangement who underwent double-jaw surgery for the treatment of dentofacial deformities. Patients and Methods: Treatment records of 25 patients with magnetic resonance imaging and clinical verification of preoperative TMJ articular disc displacement who underwent double-jaw surgery only were retrospectively evaluated, with an average follow-up of 2.2 years. Signs and symptoms of TMJ dysfunction, including pain, range of mandibular motion, and presence/absence of TMJ sounds, were subjectively (visual analog scales) and objectively evaluated at presurgery (T1), immediately postsurgery (T2), and at longest follow-up (T3). Surgical change (T2-T1) and long-term stability of results (T3-T2) were calculated using the superimposition of lateral cephalometric and tomographic tracings. Results: Presurgery, 16% of the patients had only TMJ pain, 64% had only TMJ sounds, and 20% had both TMJ pain and sounds. Postsurgery, 24% of the patients had only TMJ pain, 16% had only TMJ sounds, and 60% has both TMJ pain and sounds. Thus, presurgery 36% of the patients had TMJ pain, and postsurgery, 84% had pain. Average visual analog scale pain scores were significantly higher postsurgery and none of the patients with presurgery TMJ pain had relief of pain postsurgery. In addition, 6 patients (24%) developed condylar resorption postsurgically, resulting in the development of Class II open bite malocclusion. Conclusions: Patients with preexisting TMJ dysfunction undergoing orthognathic surgery, particularly mandibular advancement, are likely to have significant worsening of the TMJ dysfunction postsurgery. TMJ dysfunction must be closely evaluated, treated if necessary, and monitored in the orthognathic surgery patient. © 2003 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 61:655-660, 2003

Prevalence of temporomandibular dysfunction in Turkish children with mixed and permanent dentition

This study was carried out to determine the prevalence of temporomandibular joint (TMJ) dysfunction in mixed and permanent dentition and to evaluate the sex distribution in Turkish children. One hundred and eighty-two children with mixed dentition and 212 with permanent dentition were selected for the study, which used a questionnaire and clinical examination. Children with one or more signs (TMJ sounds, TMJ tenderness, muscle tenderness, restricted mouth opening) and/or symptoms (TMJ pain during mastication and mouth opening, restriction of the jaw opening and TMJ sounds) met the criterion of TMJ dysfunction. The total prevalence of signs and symptoms of TMJ dysfunction in the studied population was 68% (68% in girls and 68% in boys) in mixed dentition and 58% (61% in girls and 56% in boys) in permanent dentition. The Z-test and analysis of variance (ANOVA) were used for statistical analysis of the difference between the results. The total prevalence of signs and symptoms of TMJ dysfunction in mixed dentition was found to be higher than in permanent dentition (P < 0.05). No statistically significant difference was found in the total prevalence of TMJ dysfunction between girls and boys.

Orthodontic treatment for posterior crossbites.

'Posterior crossbite' occurs when the top back teeth bite inside the bottom back teeth. When it affects one side of the mouth the lower jaw may have to move to one side to allow the back teeth to meet together. It is unclear what causes posterior crossbites and they may develop or improve at any time from when the baby teeth come into the mouth to when the adult teeth come through. Several treatments have been recommended to correct this problem. Some treatments widen the upper teeth whilst others are directed at treating the cause of the posterior crossbite e.g. breathing problems or sucking habits. Most treatments have been used at each stage of dental development. The aim of this review was to evaluate orthodontic treatments used to expand the maxillary dentition and correct posterior crossbites. All randomised and controlled clinical trials identified from the Cochrane Controlled Trials Register according to the Oral Health Group Search Strategy and stored in the Cochrane Collaboration Oral Health Group Database of Clinical Trials, a MEDLINE search using the Mesh term Palatal Expansion Technique and relevant free text words, hand searching the British, European and American journals of orthodontics and Angle Orthodontist, and the bibliographies of papers and review articles which reported the outcome of orthodontic treatment to expand the maxillary dentition and/or correct a posterior crossbite that were published as abstracts or papers between 1970 and 1999. All randomised and controlled clinical trials published as full papers or abstracts which reported quantitative data on the outcomes crossbite correction, molar and/or canine expansion, signs and symptoms of temporomandibular joint dysfunction or respiratory disease. Data were extracted without blinding to the authors, treatments used or results obtained. The first named authors of randomised and controlled clinical trials were written to in an attempt to establish the method of randomisation / allocation and identify unpublished studies. Odds ratio, relative risk, relative risk reduction, absolute risk reduction, the number need to treat and corresponding 95% confidence intervals, were calculated for event data. The weighted mean difference and 95% confidence intervals were calculated for continuous data. Using the search strategy seven randomised and five controlled clinical trials were identified but following correspondence with the authors, three of the randomised and one of the controlled clinical trials were reclassified giving five randomised and seven controlled clinical trials for inclusion in the review. For the update an additional CCT was found giving five RCTs and eight CCTs for inclusion in this update. Trials comparing occlusal grinding in the primary dentition with/without an upper removable expansion appliance in the mixed dentition versus no treatment, banded versus bonded and two point versus four point rapid maxillary expansion, banded versus bonded slow maxillary expansion, transpalatal arch with/without buccal root torque, an upper removable expansion appliance versus quad-helix were identified. Occlusal grinding in the primary dentition with/without the addition of an upper removable expansion plate, in the mixed dentition for those children who did not respond to grinding, was shown to be effective in preventing a posterior crossbite in the primary dentition from being perpetuated to the mixed and permanent dentitions. No evidence of a difference in treatment effect (molar and canine expansion) between the test and control intervention was found in the trials which compared banded versus bonded and two point versus four point rapid maxillary expansion, banded versus bonded slow maxillary expansion, transpalatal arch with/without buccal root torque, or upper removable expansion appliance versus quad-helix. Insufficient data were provided in the paper comparing two point versus four point rapid maxillary expansion to allow a formal analysis. The evidence from the trials reported by Lindner (1989); Thilander (1984) suggests that removal of premature contacts of the baby teeth is effective in preventing a posterior crossbite from being perpetuated to the mixed dentition and adult teeth. When grinding alone is not effective, using an upper removable expansion plate to expand the top teeth will decrease the risk of a posterior crossbite from being perpetuated to the permanent dentition. The comparisons of treatments made in the trials reported by Asanza (1997); Sandikçioglu (1997); Mossaz-Joëlson (1989); Ingervall (1995); Schneidman (1990) were inconclusive so recommendations for clinical practice can not be made based on the results of these trials. (ABSTRACT TRUNCATED)

The relationship of the glenoid fossa to the functional occlusal plane

The geometric relationship of the functional occlusal plane to the center of the glenoid fossa, as seen in the sagittal view, is described for males and females from age 7 through 25 years. This relationship is fully described by the distance from the geometric center of the glenoid fossa perpendicular to the functional occlusal plane (L, in millimeters) and its angulation (θ, in degrees) relative to a constructed Frankfort horizontal (SN-7°). Regression formulas with 95% confidence levels are described for L and θ for both genders combined. The differences between genders were found to be statistically insignificant. No correlation was found between these dimensions relative to the presence of temporomandibular joint dysfunction symptoms. A statistically significant difference in both L and θ was found in males who exhibited a Class III relationship compared with males exhibiting a Class II relationship. (Am J Orthod Dentofacial Orthop 2000;118:658-61)

Occlusal grinding in the primary dentition effective in preventing a posterior crossbite

Objectives To identify and evaluate orthodontic treatments used to expand the maxillary dentition and correct posterior crossbites.Data sources Medline, Cochrane Library, handsearching of English language orthodontic journals (1970–1997).Selection criteria All published randomised clinical trials (RCTs) reporting quantitative outcomes data on the crossbite correction, molar and/or canine expansion, signs and symptoms of temporomandibular joint dysfunction or respiratory disease.Data collection and analysis Odds ratio, 95% confidence intervals (CI), relative risk, relative risk reduction, absolute risk reduction, and the number need to treat were calculated for event data. The weighted mean difference and 95% CI were calculated for continuous data.Results Five randomised and seven controlled clinical trials met the review criteria and were included. Trials comparing occlusal grinding in the primary dentition with/without an upper removable expansion appliance in the mixed dentition versus no treatment, banded versus bonded rapid maxillary expansion, banded versus bonded slow maxillary expansion, transpalatal arch with/without buccal root torque and an upper removable expansion appliance versus quad-helix were identified.Conclusions Occlusal grinding in the primary dentition with/without the addition of an upper removable expansion plate was effective in preventing a posterior crossbite in the primary dentition from being perpetuated to the mixed and permanent dentitions. No evidence was found for a difference in treatment effect (molar and canine expansion) in trials comparing banded versus bonded rapid maxillary expansion, banded versus bonded slow maxillary expansion, transpalatal arch with/without buccal root torque, or upper removable expansion appliance versus quad-helix.

Temporomandibular joint dysfunction in children: evaluation of treatment

Thirty-eight pediatric patients with temporomandibular joint (TMJ) dysfunction were diagnosed and treated. The etiology for the TMJ dysfunction was trauma in 30 (79%) patients, degenerative joint disease in two (5%) patients, growth disturbances in two (5%) patients and tumor in one (3%) patient. In three (8%) patients the etiology was unclear. The treatment modalities were: non-invasive therapy in 19 (50%) patients, occlusal therapy in 10 (26%) patients and surgical treatment in nine (24%) patients. The reported symptoms of temporomandibular joint dysfunction using the Helkino anamnestic index revealed that, at the initial examination, eight (21%) reported mild symptoms and 30 (79%) severe symptoms. One year later, 33 (87%) reported no symptoms, four (10%) mild symptoms and one (3%) severe symptoms. These differences were significant ( P<0.05–0.01). Maximum mouth opening 1 year after treatment as compared to the initial examination increased ( P<0.05) in all three treatment modalities. Deviation of the mandible on opening, 1 year after treatment as compared to the initial examination, decreased ( P<0.05) in all three treatment modalities. No differences were found between the modalities in both the maximum mouth opening or deviation of the mandible. TMJ dysfunction in children can be effectively treated by non-surgical treatment modalities. Surgery should be considered only when the non-surgical therapies were ineffective.

The prevalence of cardinal TMJ dysfunction symptoms and its relationship to occlusal factors in Japanese female adolescents

Cross-sectional data were obtained from 1182 Japanese high school girls of 12 and 15 years old. The data were analysed for the prevalence of specific occlusal features and the prevalence of cardinal Temporomandibular Joint Dysfunction (TMJD) symptoms in different occlusion groups. The associations between occlusal features and TMJD symptoms were analysed by the Z-analysis. The results were as follows: the prevalence of TMJD symptoms (total) was about 23% in both age groups examined. Noise had the highest prevalence of the specific TMJD symptoms in both age groups (16% and 11%). With age and for different occlusion groups, there was a significant increase in deviation on opening (P < 0.001) and a decrease in pain and noise (P < 0.05). No significant associations were found between the occurrence of TMJD symptoms (total) and occlusal features in all the examined occlusion groups. With respect to specific TMJD symptoms, however, the investigation of the different groups revealed a significant association (P < 0.05) of intra-arch occlusal (crowding) features with the occurrence of deviation on opening and with the occurrence of the combined TMJD symptoms which include deviation on opening. This indicates that crowding may be an important sign for predisposing TMJD. For the other single disorder symptoms (except pain), we did not find a significant relationship (P < 0.05) with aspects of occlusion, which may confirm a multifactorial TMJD problem wherein occlusal features can have a contribution to TMJD.

Temporomandibular Joint Findings Obtained by Brain MRI

Magnetic resonance imaging (MRI) is an excellent method for examining the temporomandibular joint (TMJ). Forty-five patients, 29 females and 16 males (mean age 44, range 17-77 years), who had been referred for MRI examination of the brain were asked about their TMJ problems by questionnaire. Subjectively, 29 of the 45 were symptom-free, 11 had mild symptoms, while five experienced severe ones. Symptoms of TMJ dysfunction were correlated with MRI findings that applied to the TMJ emerging in connection with a brain MRI. This study was performed in order to obtain valuable information about the structure of the TMJs. Seven of the 29 patients who anamnestically reported no symptoms of TMJ dysfunction had changes in the configuration and/or position of the disk. In this study, MRI findings concerning the TMJ did not clearly correlate with subjective symptoms of TMJ dysfunction.

Signs and symptoms of temporomandibular joint dysfunction in a Saudi Arabian population.

The signs and symptoms of temporomandibular joint dysfunction present in 219 Saudi Arabians attending a dental clinic for routine dental treatment are described. Joint sounds (36%) and muscle tenderness to palpation (34%) were common findings. Of the subjects examined, 31% reported suffering from frequent headaches. The study demonstrated a high incidence of signs and symptoms of temporomandibular joint dysfunction. Findings were similar to those of a previous study of an investigation in a bedouin community in Western Egypt (Abdel-Hakim, 1983).

Temporomandibular joint vibration analysis in a sample of non-patients.

In a sample of 20 non-patients, 60% of the subjects had an absence of subjective temporomandibular joint (TMJ) complaints (noises/sounds) that agreed with objective joint vibration analyses (electrovibratography). Among the remaining 40% of subjects, only 50% of the examined joints showed agreement between subjective and objective findings. Subjects appeared to be unable to reliably detect "weak" (early) symptoms of TMJ dysfunction but were able to reliably detect "strong" (late) symptoms of TMJ dysfunction and possibly disease. As measured through active protrusion and laterotrusion of the mandible, the guidance angles of the anterior teeth could not explain the absence and presence of TMJ vibrations.

The clinical predictability of internal derangements of the temporomandibular joint

The value of clinical parameters as predictors of the arthrographic findings in patients with temporomandibular joint (TMJ) pain and dysfunction was examined in this study. We developed a series of simplified clinical prediction rules based on previous studies correlating clinical signs and symptoms with arthrographic diagnosis of the condition of the TMJ meniscus. One hundred eighty-six patients with signs and symptoms of TMJ dysfunction were clinically examined before TMJ arthrography. Arthrograms were performed on 246 joints (126 unilateral, 60 bilateral). The rules predicted 91 of the 246 joints to be normal when actually 59 were shown to be normal arthrographically. The rules slightly underpredicted those patients with positive arthrographic findings for internal derangements. Although there were some individual variations in the predictability of unilateral versus bilateral arthrograms (patients), there was very little overall difference, 58% and 60%, respectively. This study confirms previous suggestions that clinical findings alone are not consistently accurate in diagnosing the exact type of TMJ internal derangements depicted by arthrographic criteria.

A clinical study of joint sounds in subjects with restored occlusions

It has been implied that temporomandibular joint sounds must be treated to eliminate the sounds before restorative treatments are attempted. This study explored the possibility that joint sounds do not present a problem when other symptoms are absent. A group of 35 subjects with restored occlusions were studied for the presence of temporomandibular joint dysfunction symptoms using clinical examination, questionnaires, and the pantographic reproducibility index. Forty-six percent had some degree of temporomandibular joint dysfunction. Seventeen of 18 subjects (94%) with joint sounds were free of other symptoms. Therefore, the use of joint sounds as a symptom of temporomandibular joint dysfunction is questionable when not accompanied by other clinical symptoms. Subjects who had temporomandibular joint dysfunction symptoms were treated with occlusal splint therapy and occlusal adjustments. The period of time to eliminate the symptoms was 2 to 16 weeks with an average of 7 weeks. This study concludes that the presence of only joint sounds does not seem to be a hindrance to restorative treatments.

Signs of Temporomandibular Joint Dysfunction in Spinal Cord Injured Patients Wearing Halo Braces: A Clinical Report

This clinical report was completed in response to the observations of physical therapists at the spinal cord injury (SCI) center of Jackson Memorial Hospital (Miami, Fla) and at other SCI centers that halo-braced spinal cord injured patients may develop symptoms of temporomandibular joint (TMJ) dysfunction. This report describes the assessment of TMJ mobility and the occurrence of symptoms of TMJ dysfunction in four halo-braced subjects with SCI. The results of these assessments indicate that patients with SCI may have some limitations in mandibular mobility early on and may complain of some symptoms associated with TMJ dysfunction. Reasons for the possibility of TMJ dysfunction occurring in this population and the importance of this occurrence to physical therapists are discussed. The author proposes that physical therapists treating halo-braced spinal cord injured patients should be aware of symptoms indicating TMJ dysfunction and that assessment may be indicated. Additionally, ideas for further clinical research are suggested.

Correlates of headache in a population-based cohort of elderly.

Data from a community-based study of 3811 persons aged 65 years and older were used to describe the characteristics of headache in the elderly. Subjects were asked whether they experienced headache in the past year, the frequency and severity of their headaches, and whether they experienced three symptoms of migraine: unilaterality, nausea or vomiting, an aura preceding the headache. Prevalence of headache in those aged more than 65 years declined with age in both men and women; women had a higher prevalence in each age group. The same was true for frequent, severe, and migrainous headache. We examined age- and sex-adjusted correlations of headache with several medical and social factors. Prevalence of any headache was strongly associated with joint pain, depression, bereavement, waking during the night, use of eyeglasses, symptoms of temporomandibular joint dysfunction, and self-assessment of health. Similar variables were associated with frequency, severity, and migrainous symptoms, and thus could not be distinguished among these various types.

The silent period in the masseter and the anterior temporalis muscles in adult patients with mild or moderate mandibular dysfunction symptoms.

The electromyographical silent period in the masseter and the anterior temporalis muscles during tooth tapping and jaw jerk were studied in patients with fairly mild temporomandibular joint dysfunction symptoms. The length of the silent periods in the patient group did not differ generally from that in a control group. During tooth tapping, however, patients with distinct muscular disorders had shorter silent period duration (7.7 ms) than patients with other symptoms or when compared with control subjects (10.5 and 11.3 ms, respectively). The duration returned to normal after correction of the muscular disorders. This finding suggests that the duration of the silent period is affected by the muscle condition. Patients with obvious muscular disorders of mild to moderate magnitude, thus, may show a shorter silent period duration during tooth tapping.