Temporomandibular Joint Pain Dysfunction Research Articles

Clinical experience of the carboxytherapy method in the treatment of patients with temporomandibular joint pain dysfunction syndrome (К07.60)

Objective. Improving the effectiveness of treatment of patients with TMJ PDS myogenic origin. Material and methods. According to the purpose of the study, a group of 10 patients (8 women and 2 men aged 14 to 60 years) was formed with the coincidence of a triad of signs: pain during movements of the lower jaw, a feeling of heaviness and tension in the chewing and facial muscles, restriction of mouth opening. A set of diagnostic measures has been implemented in the following scope: clinical and radiological examination methods, TMJ MRI, ultrasound and surface EMG of the chewing muscles, digital axiography. In the treatment of patients in the study group, the method of invasive carboxytherapy was used, based on dosed injections of CO2 in the projection of trigger points of the masticatory muscles. The research examines the therapeutic value of using of CO2 in the protocol of functional rehabilitation of patients with TMJ diseases of myogenic origin. Results. The analysis of the effectiveness of treatment of patients in the study group was carried out to assess the dynamics of key parameters: the severity of the pain syndrome according to VAS, the magnitude of the IMPACT index values and the magnitude of mouth opening. The severity of pain in patients in the study group, according to average values, decreased by 86% from the initial values, an increase in the amplitude of mouth opening by 28.5%, a decrease in the IMPACT index values by 42.5% from the initial values of hypertonicity of the masticatory muscles, an increase in blood flow speed of superficial temporal artery at 52.5%. Conclusion. The results of the clinical application of the carboxytherapy method in the treatment of patients with TMJ PDS allow us to recommend this method for implementation in the rehabilitation protocols of patients with TMJ PDS of myogenic origin, trismus and hypertonus of the masticatory muscles. Carboxytherapy as a method of etiopathogenetic rehabilitation contributes to the early relief of pain syndrome, normalization of the bioelectric activity of the chewing muscles and restoration the physiological kinematics of the lower jaw’s movements.

Analysis of changes in the position of the temporomandibular joint articular disc during positioning splint therapy according to magnetic resonance imaging data

Was to assess an impact of positioning occlusal splints made by various methods on the position of the articular disc of the temporomandibular joint according to MRI data. 40 patients (8 men and 32 women) aged from 18 to 60 years with temporomandibular joint pain dysfunction syndrome were examined (ICD-10 code K07.60). Patients were treated with splint therapy using traditional splints made with combined method (20 patients) and subtractive occlusal splints made by CAD/CAM technology (20 patients). All patients had MRI of the temporomandibular joints before splint therapy and at the final stage of treatment to determine the position of the articular disc in the habitual occlusion and at maximum mouth opening. After splint therapy, patients in both groups showed an improvement in the position of the articular disc in the usual occlusion: the rate of patients with bilateral dislocation of the articular disc decreased from 85% to 67.5%, and with unilateral articular disc dislocation decreased from 15% to 10%. With maximum mouth opening, complete reposition of the articular disc in both joints were recorded in 22.5%; the rate of patients with bilateral disorder of articular disc repositioning decreased from 85% to 67.5%, and with unilateral disorder of articular disc repositioning decreased from 15% to 10%. Splint therapy had a pronounced positive clinical effect in patients with pain dysfunction syndrome in the temporomandibular joints. Splint therapy is more effective in correcting sagittal dislocation of the articular disc than transversal dislocation. The study showed comparable treatment results when using traditional and digital occlusal splints.

ORTHODONTIC PATHOLOGY IN THE SYNDROME OF PAIN DYSFUNCTION OF THE TEMPOROMANDIBULAR JOINT IN CHILDREN AND ADOLESCENTS

The number of patients with temporomandibular joint pain dysfunction syndrome (TMJ) is increasing every year, and the number of children and adolescents is also growing. One of the causes of the disease is considered to be dental pathology, in particular dental anomalies.
 A survey of 622 students of gymnasiums and lyceums was carried out, which were divided into 2 age groups according to the main periods of the formation of the dental system and the scheme of age periodization of human ontogenesis.
 An increase in the prevalence of TMJ SBD in adolescence was found (weak reliable relationship, r=0.10, p0.05).
 In two age groups, correlation analysis revealed a weak reliable relationship between HR and TMJ SBD (r=0,21 in children and r=0,16 in adolescents) (p0,01); as well as a weak significant association of distal bite (r=0,13, p0.01), and excessively deep vertical bite with TMJ SBD (r=0,15, p0,01) in adolescence.
 Key words: syndrome of pain dysfunction of the temporomandibular joint, dentomandibular anomalies, cervical vertebral dystrophy syndrome

Treatment approach to patients with distal malocclusion complicated by temporomandibular joint pain-dysfunction syndrome

Research is effective sequencing of measures for orthodontic treatment active period and unfavorable course of retention period predictors in patients with distal malocclusion, complicated by temporomandibular joint pain-dysfunction syndrome. The retrospective study consists of 102 case reports of patients from 18 to 37 (average age is 26.75±3.25 years) with distal malocclusion (Angle Class II division 2 subdivision) associated with temporomandibular joint pain-dysfunction syndrome. Cases of successful treatment were 30.4% (n=31), semi-successful - 42.2% (n=43), semi-unsuccessful - 18.6% (n=19), unsuccessful - 8.8% (n=9). ANOVA analysis of orthodontic treatment stages reveals main risk factors for pain syndrome recurrence in retention period. The ineffective morphofunctional compensation and unsuccessful orthodontic treatment predictors are: incomplete pain syndrome elimination, persistent masticatory muscles dysfunction, distal malocclusion recurrence, condylar process distal position recurrence, deep overbite, upper incisors retroinclination for more than 15°, single posterior tooth interference. Thus, pain syndrome recurrence prevention in retention orthodontic treatment period includes pain and masticatory muscles dysfunction elimination in pre-treatment period, physiological dental occlusion and condylar process central position in active period.

Роль функциональной терапии при болевой дисфункции височно-нижнечелюстного сустава: патофизиологические и клинические аспекты

Nowadays, each second patient seeking dental care suffers from some pathology of the temporomandibular joint. Most often patients are diagnosed with temporomandibular joint pain dysfunction syndrome, which is poorly treatable and often relapses. Objective: to evaluate changes in the clinical course of TMJ pain dysfunction syndrome when using myogymnastics in the complex rehabilitation of patients suffering from this pathology. Materials and methods. We performed dynamic observation of 62 young patients who suffered from painful dysfunction of the temporomandibular joint, revealed during the preparation of patients for dental prosthetics. Group 1 included 31 people who were treated with the conventional complex treatment to relieve painful dysfunction. Group 2 included 31 people, for the treatment of which the same standard complex of therapeutic and prophylactic measures with the additional application of masticatory muscles myogymnastics was applied. To objectivize the efficiency of using myogymnastics we used the method of severity degree evaluation as well as semi-quantitative method of efficiency evaluation of the treatment of the pathology in question. Results. It was found out that application of masticatory muscles myogymnastics in the complex treatment of painful dysfunction of the temporomandibular joint allows increasing the efficiency of dental rehabilitation of such patients by 6,9% and decreasing the number of patients with recurrence of the disease by 16,1% in the period up to 2 years. Conclusion. As a pathogenetic functional method of treatment of painful temporomandibular joint dysfunction, application of masticatory muscle myogymnastics to patients allowed to develop mutually consistent reflexes of the masticatory muscles, causing movements of the mouth opening (lowering the lower jaw) without its deviation and advancement. It is advisable to include the technique of masticatory muscle myogymnastics for painful TMJ dysfunction in the clinical guidelines.

Differential diagnosis of Costen's syndrome and cerebellopontine angle tumours

Relevance. Our study aimed to determine the main differential diagnosis criteria for temporomandibular joint (TMJ) pain dysfunction syndrome (temporomandibular disorders, Costen's syndrome) and cerebellopontine angle tumours.Materials and methods. We examined 22 people (19 women and three men), aged 21 to 74 years (mean age 37.2 ± 5.1 years), who presented to the prosthodontic clinic with facial pain.Results. The study proposed the following differential diagnostic criteria for TMJ pain dysfunction syndrome and brain tumors: different nature of pain, unilateral ear noise; distal displacement of the mandibular head diagnosed by cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI), as well as articular disc displacement (detected by MRI) in temporomandibular disorders. Unilateral facial burning pain indicated meningioma of the cerebellopontine angle, which head MRI confirmed.Conclusion. The proposed table for evaluating clinical and paraclinical study methods for patients with facial pain helps to differentiate the cause of pain properly and proceed with the optimal treatment method.

Minimally invasive intraarticular platelet rich plasma injection for refractory temporomandibular joint dysfunction syndrome in comparison to arthrocentesis.

Context:Internal derangements of temporomandibular joint (TMJ) with associated symptoms which do not respond to conservative therapies are refractory cases of temporomandibular joint dysfunction syndrome (TMD). Minimally invasive techniques like arthrocentesis and platelet rich plasma (PRP) injections are usually employed to improve TMJ symptoms and function in these cases.Aims:To compare PRP with arthrocentesis for evaluating the effectiveness of PRP in relieving symptoms of refractory TMJ pain dysfunction syndrome.Setting and Design:A clinical study was carried out on 52 patients of refractory Temporomandibular joint dysfunction syndrome. The patients were divided in two groups that is Group A - test group and Group B -control Group.Methods and Material:Group A consisted of 26 patients who underwent intraarticular PRP injection in TMJ and Arthrocentesis of TMJ was done in 26 patients of Group B. TMJ pain, Maximium Interincisal opening and TMJ clicking were assessed among the group as well as between the groups over a period of 6 months.Statistical Analysis Used:Repeated Measure ANOVA was used to compare the parameters within the groups and T test was used for group comparison at 0.05 level of significance.Result:There was statistically significant difference in pain intensity improvement 1 ± 0.75 versus 3.17 ± 2.13, maximum interincisal opening 39.86 ± 2.86 versus 37.59 ± 4.03 and clicking 6 versus 16 between the PRP group and arthrocentesis group at P < 0.05.Conclusions:Intraarticular PRP injection for the management of refractory TMD is more effective than arthrocentesis in reducing symptoms and functional improvement.

Clinical assessment of the effectiveness of botulinum toxin A in the treatment of temporomandibular joint pain dysfunction syndrome

Assessment of the effectiveness of botulinum toxin A in the treatment of temporomandibular joint pain dysfunction syndrome. In accordance with the diagnostic and treatment guidelines for TMJPDS, 20 patients with TMJPDS with pronounced pain on palpation of the chewing muscles, discoordination of the chewing muscles according to the EMG, and degenerative changes in the temporomandibular joint according to the MRI were examined. The patients had no contraindications to the use of botulinum toxin. Exclusion criteria: 1) age under 21 years, 2) somatic pathology, 3) refusal of the steps of the proposed diagnostic and treatment algorithm. Methods used: clinical, psychometric (visual analogue scale (VAS) - for pain assessment), X-ray, electromyographic and statistical methods. An objective reduction in the tone of the chewing muscles was observed after treatment In both groups. However, 30 days after the injection of BtA the IMPACT indicator in the first group was reduced by 403.5 µV or more (38.5%, p<0.05), while in the second group it decreased by 201.5 µV or more (25%, p<0.05). A correlation was identified between the VAS index (mean 7 points, severe pain level) and IMPACT (p<0.05). The onset of a significant pain reduction was observed one week after BtA injection, the most pronounced effect was achieved after 2 weeks and lasted for about 3 months. The use of BtA as part of the temporomandibular joint pain dysfunction syndrome treatment algorithm contributes to the creation of a «therapeutic window» for comprehensive rehabilitation of patients in this group. It increases the efficacy of the conducted treatment and contributes to a significant prolongation of the TMJPDS remission.

Possibilities and organizational problems of diagnostics and treatment of patients with the syndrome of temporomandibular joint pain dysfunction

The relevance of research in the field of organization and provision of medical care to patients with the temporomandibular joint pain dysfunction syndrome (TMJ PDS) is determined by the prevalence of this disease not only among the pathologies of the maxillofacial region, but also among the pathologies of other organs and systems in general. Patients with the pathology of this joint are treated by doctors of various specialties. Therefore, there is often inconsistency not only in diagnostic algorithms, comprehensive examination and organization of medical care, but also in the terminological aspects of the TMJ PDS. The purpose of this review is to systematize the existing methods of diagnostics and treatment of TMJ PDS and to formulate possible options of osteopathic correction inclusion in the complex treatment of patients with this pathology. The review of literature sources on the problem of diagnosis and organization of treatment of TMJ PDS and masticatory muscle dysfunctions showed, on the one hand, a scientifically grounded spectrum of diagnostic and therapeutic capabilities of modern medicine, a trend in the development of highly informative digital technologies for diagnostic purposes, the development of various diagnostic and treatment protocols, a desire for an integrated approach involving specialists of different profiles. On the other hand, there is disunity between doctors of different specialties and the absence of a single algorithm for the diagnosis and treatment of TMJ PDS. Due to the variety of etiopathogenetic mechanisms of this disease development, further in-depth study of this issue is promising.

"Differential diagnosis of patients with temporomandibular joint pain dysfunction syndromes"

The article presents the results of a study of a specially developed map proposed by the authors in 84 patients with TMJ DM aged from 20 to 60 years, and 36 patients without TMJ dysfunction were selected as a control. According to the results of the study, the authors found that the main number of patients accounted for 59.6% after 40 years and among women - 61.9% of cases; also found in patients 46.42% occlusive-articulatory syndrome, 33.33% neuromuscular syndrome and 20.23% dislocation of the intra-articular disc; that the relationship between the amplitude of the vertical movement of the lower jaw, changes in the bioelectric potential of the masticatory muscle and the occurrence of these pathologies

Evaluation of the effectiveness and satisfaction of patients in the treatment of pain dysfunction of the temporomandibular joint, taking into account the peculiarities of the personality and compliance

The work is devoted to the actual problem of dentistry — the treatment of pain dysfunction of the temporomandibular joint (TMJ), the occurrence of which among the adult population is increasing in Russia and abroad. The purpose of the study was to assess the effectiveness and satisfaction of patients with the treatment of pain dysfunction of the TMJ, taking into account the characteristics of the typological orientation of higher nervous activity and compliance. Using semi-quantitative methods, methods of assessing personal response to the disease, known as "Psychosensory-anatomical-functional maladaptation syndrome" (SPSAF), patient satisfaction and compliance, the effectiveness of treatment of TMJ pain dysfunction in 57 men aged 25 to 42 years, with taking into account their temperament. In group 1 (sanguine persons) included 19 people; in 2 (choleric) — 15 people; 3 (phlegmatic) — 11 people; in 4 (melancholic) — 12 people. It was established that before treatment, patients with pain dysfunction of the TMJ had a state of disadaptation. After the patients underwent a complex of dental treatment and preventive measures recommended by dentists, there was a positive trend in the personal response to the disease and, in conclusion of the dynamic observation of the patients, they were adapted to the conditions of existence. A positive change in the internal picture of the disease affected the patient satisfaction with treatment. Patients of groups 1 and 3 were generally satisfied with the results of treatment, which corresponded to the data obtained in evaluating the effectiveness of the treatment and preventive measures taken (40.91% and 64.1%, respectively). Patients of groups 2 and 4 of the study, despite the high clinical efficacy of treating TMJ pain dysfunction (32.18% and 19.7%, respectively), were less satisfied with the results of treatment due to the typological features of their higher nervous activity that play not the last role in ensuring compliance. The most committed to the implementation of medical recommendations were patients of 3 groups who performed them regularly and in full. Patients of groups 1, 2 and 4 carried out the recommendations of the dentist partially, from 25% to 50%. Despite the knowledge of medical recommendations, the possibility of negative consequences for non-compliance, most patients did not have adequate commitment to perform medical prescriptions, did not voluntarily fully follow the prescribed treatment regimen and behavior. Taking into account the findings, it was suggested to pay more attention to the somatopsychic approach in diagnosing and treating various diseases, including organs and tissues of the masticatory apparatus, taking into account the personal response to the disease, typological orientation of higher nervous activity and other factors that take into account the individual characteristics of the patient.

ОЦЕНКА ФИЗИОЛОГИЧЕСКИХ ПАРАМЕТРОВ ТРИГЕМИНАЛЬНОЙ И КОХЛЕОВЕСТИБУЛЯРНОЙ СИСТЕМ ПРИ БОЛЕВОЙ ДИСФУНКЦИИ ВИСОЧНО-НИЖНЕЧЕЛЮСТНОГО СУСТАВА

One of the most common causes of chronic pain in the facial region, including in the trigeminal nerve link, which is not associated with dental diseases, is pain dysfunction of the temporomandibular joint. At the same time, there is evidence in the literature that there are relationships between pain dysfunction of the temporomandibular joint, abnormal occlusion, cervical-muscular tonic phenomena, postural disorders, dysfunction of the Autonomous nervous system and cochleovestibular manifestations. At the same time, neurophysiological indicators of functional disorders in the maxillofacial region and intersystem interactions in pain dysfunction of the temporomandibular joint are insufficiently studied.Goal. The aim of the work is to evaluate the neurophysiological features of trigeminal afferentation in terms of trigeminal somatosensory evoked potentials (TSWP) and the auditory conducting system of the brain in terms of acoustic stem evoked potentials (ASVP) in distal occlusion of the dentition with pain dysfunction of the temporomandibular joint (TMJ) in comparison with physiological occlusion in students 18-21 years old. Material and methods. The main study included 41 students with distal occlusion (21 girls and 20 boys), (grade II Engl, symmetrically right and left in 14 people, and grade II Engl on the left and grade I on the right in 12 people, grade I on the left and grade II on the right in 15 people). All respondents with distal occlusion and who were practically healthy signed an informed consent to participate in the study. We used complex orthodontic methods of examination, subjective degree of severity and intensity of pain in the TMJ, assessment of the Autonomous nervous system (samples and tests), and neurophysiological methods for assessing TSVP and ASVP. Results. Significant differences in ASEP parameters were found in the group of respondents with distal occlusion in the form of a decrease in the latency period of peak I, III, and V compared to physiological occlusion, that correlated with the subjective assessment (in points) of cochleovestibular disorders. According to the TSVP study, a decrease in the duration of latent periods was found, which indicates an increased excitability of non-specific brain stem structures at the medullo-ponto-mesencephalic level compared to the control group. Conclusions. The results obtained are supposed to be used for differential diagnostics, including such dental diseases as TMJ pain dysfunction, occlusion abnormalities accompanied by pain syndrome. Additional functional diagnostics of multi-modal VP of the brain (acoustic evoked potentials, trigeminal evoked potentials) can be performed in conjunction with indicators of autonomic nervous system dysfunction, with parameters of severity of clinical symptoms of cochleovestibular disorders, musculoskeletal dysfunction the maxillofacial area, with indicators of pain, which will determine the tactics and effectiveness of subsequent treatment.

Biochemical Parameters of Temporemandibular Joint Pain Dysfunction Syndrome

The complex approach to the treatment of patients with rheumatic diseases (RD) has been elaborated at the department. Considering the above, this paper focuses on studying the biochemical parameters of blood serum characterizing the body's response to pain and stress. This is achieved by examining the content of histamine and hormones (adrenaline, cortisol, TSH, total alkaline phosphatase) (Total ALP) in patients with pain dysfunction syndrome of the TMJ, taking into account changes in the blood biochemical composition (K, Na, Ca, Mg, Cl, protein, glucose, Vitamin D, and adenosine triphosphate acid). Objective: To evaluate the efficiency of Biochemical Parameters of Temporemandibular Joint Pain Dysfunction Syndrome. Patients and Methods: The study of biochemical parameters of blood serum was held in patients with temporomandibular joint pain dysfunction syndrome. Biochemical studies were conducted in 61 patients with TMJ pain dysfunction syndrome at the age of 20 to 40 years (1st, main group) and in 10 healthy people of similar age who do not show any complaints characteristics of the studied pathology (2nd, control). Results and Discussion: There is a significant increase in the level of sodium and total protein, which has not been statistically confirmed. For vitamin D (total 40.98IU/ml) and alkaline phosphatase activity, there was a significant decrease in vitamin D in temporom and ibular disorder patients when compared to the controls (P=0.001). Also, there was a significant negative correlation between serum vitamin D activity with total alkaline phosphatase activity in temporomandibular disorder patients (P=0.001). In addition, there was a significant increase in serum total alkaline phosphatase as bone marker in temporomandibular disorder patients which provides a more reliable and complete profile of inflammatory contributors to temporomandibular disorder. A tendency to decreasing in the content of calcium, total protein, and glucose in the blood serum were found. Thus, this indicates the activation of stress systems and the enhancement of protein catabolism. A significant increase in the content of ATP, histamine, adrenaline, and cortisol confirms the important role of psycho-emotional disorders in the pathogenesis of temporomandibular joint pain dysfunction syndrome.

Electromyography characteristics of the motor unit action potential of the lateral pterygoid muscle and bioelectrical activity of masticatory muscles during splint therapy for pain temporomandibular joint dysfunction

The aim of the study was to investigate the motor unit action potential (MUAP) of the lateral pterygoid muscle and bioelectrical activity of masticatory muscles in temporomandibular joint (TMJ) dysfunction patients undergoing splint therapy. The study included patients aged 18-30 with TMJ pain dysfunction (clinical group). Control group enrolled 25 healthy volunteers. Electromyography was monitored before and after 1, 3, 6 and 12 months from the beginning of therapy with occlusal splints. Increased functional activity of all masticatory muscles was registered in the resting phase in patients with TMJ dysfunction. Duration and amplitude of the MUAP of the lateral pterygoid muscle in the functional activity phase were less on the TMJ healthy side. Amplitude of a bioelectrical activity of masseter and temporal muscles at maximal voluntary contraction was less on the TMJ pain side. High correlation were observed between indicators of the lateral pterygoid muscle on the TMJ healthy side and masseter muscle on the TMJ pain side. After 6 months of the splint-therapy stabilization of amplitude of masseter muscle was noticed; at the same time the lateral pterygoid muscle began it's reparation. After 12 months the start of the treatment the duration and amplitude of the MUAP of the lateral pterygoid muscle symmetry was received and measured up control level.

Myofascial pain syndrome in the dysfunction of the temporomandibular joint

Selection of the clinical characteristics of pain syndrome in the orofacial region in temporomandibular joint pain dysfunction syndrome (TMJ PDS). One hundred and two patients with TMJ PDS were examined using the Verbal Descriptive Pain Rating Scale of the orofacial area. The Clinical Index of TMJ dysfunction (CID) by Helkimo M. was used for objectification of the level of musculo-tonic disorders in the area of the chewing muscles. The psychopathological status of patients with TMJ PDS was assessed with HRDS and SCL-90-R. A significant proportion of patients with TMJ PDS, in addition to algic symptoms, have hypertonus of the facial muscles, the nature and severity of which require not only a special diagnostic assessment, but also follow-up treatment. The analysis of data allowed us to identify three clinical groups of patients: with isolated (muscular-tonic), neurological symptoms; with mixed (combination of muscular-tonic and somatoform manifestations) neurological and psychopathological symptoms and with somatoform symptoms. Patients with TMJ PDS are clinically heterogeneous and require clinical differentiation, distinguishing the common group of patients with muscular dysfunction accompanied by pain and emotional response to it (anxiety and minor depressive symptoms) and the group of patients with a somatoform disorder (and manifestations as general anxiety).

The Relationship of Tempromandibular joint disorders with Bony Exostosis in the Oral Cavity

The temporomandibular joint (TMJ) may be affected by inflammatory, traumatic, infectious, congenital, and developmental, as seen in other joints. However, the most common affliction of the TMJ and masticatory apparatus is a group of functional disorders with associated pain that occurs predominantly in women and was previously known as the TMJ pain dysfunction syndrome. Since 1978, there have been substantial changes in the study of etiologic factors, pathophysiology, diagnosis, and management of what are now called temporomandibular disorders (TMD).(1)The general perception that all symptoms in the head, face, and jaw region without an identifiable cause constitute a "TMJ" problem is clearly unfounded.Although some oral lesions, such as torus palatinus and torus mandibularis are normal variants, but require prompt diagnosis and sometime treatment to reduce the potential for serious complication and enhance prosthodontic treatment. The purpose of this study is to inspect the relation of TMJ dysfunction syndrome to the presence of oral exostosis, and find the prevalence of torus palatinus (TP) and torus mandibularis (TM)The sample consisted of 932 teachers, 301 males and 631 females were examined for the presence of TMD, TP and / or TM. Analysis was carried out according to age, gender, TMJ dysfunction and the presence of TP and TM.Results indicated that 123(16.1%) had at least one symptoms of TMD, where as 49 (5.3%) had TP; and 67 (7.2) had TM. The male: female prevalence ratios of TP and TM were 1: 3.42 and 1: 1.81 respectively. The results revealed that significant relationship between TMD and tori, and increase in percentage of mandibular tori with the presence of TMJ dysfunctional syndrome more than maxillary tori were found.TP and TM were more frequent in females and there is significant relation between the TP and TM with presence of TMJ dysfunction syndrome ( P&lt; 0.05 ) especially TM , the presence of TM might be useful to look for sign of dysfunction.

PHYSIOTHERAPY IN THE COMPLEX TREATMENT OF THE TEMPOROMANDIBULAR JOINT PAIN DYSFUNCTION SYNDROME IN PERSONS PROFESSIONALLY ENGAGED IN VOCAL

Application in complex treatment of the temporomandibular joint pain dysfunction syndrome in vocalists infrared irradiation and ultrasonic treatment eliminates the pain and increased tone of the masticatory muscles in a short time, which increases the amplitude of movements of the mandible and the functional capabilities of the temporomandibular joint with increased professional workload. The proposed course of physiotherapy procedures allows for successful rehabilitation in a complex of therapeutic measures and to improve the effectiveness of treatment of the temporomandibular joint pain dysfunction syndrome, which is especially important for the quality of life of people involved in the vocals.

Common functional pain syndromes

### Key points When a patient presents with pain of no obvious organic origin, they are often labelled as having ‘functional’ pain. The exact diagnosis is derived from the organ system displaying the predominant symptoms e.g. musculoskeletal pain in fibromyalgia (FM) or visceral pain in irritable bowel syndrome (IBS). The worldwide prevalence of all functional pain syndromes (FPS) is 15–20%. World Health Organization (WHO) surveys reveal that ∼10% of primary care patients develop a chronic pain condition within 12 months of initial registration. Of these, at least 50% continue to have symptoms beyond 1 yr. FPS cause enormous economic burden on society with concurrent ramifications for the individual's family in particular and society in general. FM alone has been estimated to cost around £4000 per patient per year. There has been a paradigm shift in the understanding of FPS. The old model of multiple discrete chronic pain conditions is being replaced by a more overarching, although no less complex, state of central sensitivity syndrome (CSS). Evidence is being accrued that FPS represent the phenotypic output of a complex interplay between genetic susceptibility, gene–environment interactions, and environmental triggers. Four common FPS will be reviewed in this article: FM, IBS, temporomandibular dysfunction (TMD), and chronic cardiac chest pain (CCCP). The pathophysiology and management of each will be examined and the case presented for a shared underlying mechanism called CSS. Once this new mechanism is adopted more widely, it will allow for future novel management options to be …

Patient with chronic orofacial pain in a private dental office: Diagnostic dilemmas

Patients with chronic orofacial pain (COP), which means pain lasting almost always more than six months and serving no obvious purpose, very often present a quite diagnostic dilemmas. In some instances, this may especially create problem in a private dental office as various variants and manifestations of COP should be treated differently. COP may have several clinical manifestations; however, it is usually classified in three basic categories: (1) neural pain, caused by functional or structural irregularities within neural components; (2) somatic pain, caused by disturbances within the muscular/skeletal system; and (3) atypical pain, mainly caused by emotional stress and consequent changes of psychological response. Diagnosis and treatment of any kind of COP should be undertaken only after thorough and meticulous diagnostic procedures, preferably done multidisciplinary in institutions particularly orientated to the treatment of COP syndromes. Choice of treatment method should be directed to control the basic cause of chronic pain, which is ascertained by detailed clinical assessment, and fully adjusted to the particular needs of each patient. That is why the treatment of most frequent chronic orofacial syndromes - paroxysmal trigeminal neuralgia, temporomandibular joint pain dysfunction syndrome, and atypical pains - after diagnosis of chronic pain made in a private dental office, should be often, and preferably, done in institutions particularly orientated to the treatment of COP syndromes.

Indicators of the functional state of the autonomic nervous system in different age group patients with temporomandibular joint pain dysfunction syndrome

Aim. To study the functional state of the autonomic nervous system and of the adaptative capabilities of the organism in patients of different age groups with temporomandibular joint pain dysfunction syndrome. Methods. The study included 234 patients with temporomandibular joint pain dysfunction syndrome (22 men and 212 women) aged 12 to 35 years, without anomalies of the dentition, who were divided into three age groups. Three control groups consisted of 30 healthy subjects (3 men and 27 women, 10 men in each age group) with intact dentition, and orthognathic bite. A clinical dental examination, and a multi-dimensional verbal-color pain test were conducted. In order to assess the functional status of the autonomic nervous system and the adaptive capacity of the organism used were the schemes of examination for detecting signs of autonomic disorders, a physicians questionnaire «Study Design for detecting signs of autonomic disorders», an autonomic test - «Questionnaire for detecting signs of autonomic changes for the patient» and a questionnaire, adapted for children and adolescents, cardiointervalography. Results. In all 234 patients with temporomandibular joint pain dysfunction syndrome revealed were the signs of autonomic dysfunction, possessing vagotonic features in 93.9% of the cases. An unbalanced condition of the autonomic nervous system in association with the temporomandibular joint pain dysfunction syndrome was registered significantly (p 0.05) more frequently in patients of the mature age group. According to cardiointervalography, in the patients revealed was a primarily vagotonic or hypersympaticotinic type of response, a significant predominance (p 0.05) of the functional stress adaptation mechanisms, mismatch of the processes that control heart rhythm until the breakdown of the adaptation mechanism. Conclusion. The revealed instability of the autonomic regulation and the features of autonomic responses in patients of different age groups with the temporomandibular joint pain dysfunction syndrome are necessary to consider when developing and selecting methods of pathogenetic therapy.