Temporomandibular Joint Pain Patients Research Articles

Evaluation of the effect of different kinds of treatment modalities for temporomandibular joint pain and its relevance to chronic cervical pain: A randomized controlled trial.

The aim of this study was to evaluate the effect of different treatment modalities for temporomandibular joint (TMJ) pain and their relevance to chronic cervical pain after 12 months. This was a randomized controlled trial. Forty-eight participants with chronic cervical and TMJ pain were selected using research diagnostic criteria and randomized into four groups (n = 12), which included control, soft splints, transcutaneous electrical nerve stimulation (TENS), and low-level laser (LLL). The cervical and TMJ pain was recorded using visual analog scale (VAS) scores at baseline, 3 months, 6 months, and 12 months. Occlusal equilibration was done for all groups except for the control. The mean pain scores were statistically analyzed using one-way analysis of variance and posthoc test. The mean VAS scores in TMJ pain patients between the four groups at baseline and at final follow-up were 7.27 ± 1.29 in Group 1, 7.53 ± 0.70 in Group 2, 7.76 ± 0.80 in Group 3, and 7.61 ± 0.61 in Group 4. The mean difference between Groups 1 and 3, Groups 1 and 4, and Groups 2 and 3 was statistically significant (P < 0.00). Pearson correlation test yielded a mild and negative correlation between TMJ and cervical pain. TENS and LLL were found to be equally effective in reducing pain in the jaw joint region, followed by soft splints, and there was no correlation between TMJ and cervical pain.

Ecological Momentary Assessment of Awake Bruxism Frequency in Patients with Different Temporomandibular Disorders.

Self-reported awake bruxism (AB) has been associated with temporomandibular disorders (TMD). However, the daily amount of AB behavior has not been quantified in pain patients. Therefore, this study aimed to assess AB frequency in patients with myofascial pain and temporomandibular joint (TMJ) pain and compare it to a group of pain-free individuals. Eighty-four individuals belonging to either a TMD group (n = 54) or a healthy control group (n = 30) were selected. AB frequency was obtained by ecological momentary assessment with a dedicated smartphone application that sent sound alerts at random intervals during the day for one week. Upon receiving the alert, the volunteer reported the current muscular condition and/or the teeth position, i.e., relaxed jaw muscle, jaw bracing, teeth contact, teeth clenching, or teeth grinding. Data were evaluated by independent t-test (α = 0.05). During the seven days, AB frequency was 62.1% ± 26.8% for TMD patients and 36.2% ± 27.3% for pain-free subjects (p < 0.001). Mandible bracing was most common in the TMD group (p < 0.001), while teeth contact, clenching, and grinding did not differ between groups. Moreover, no differences were found in AB frequency between myofascial pain and TMJ pain patients. Therefore, TMD patients have higher AB frequency characterized by jaw bracing, irrespective of pain location.

Can ultrasonography be used to assess capsular distention in the painful temporomandibular joint?

BackgroundTo determine whether capsular distention in the painful temporomandibular joint (TMJ) can be assessed by ultrasonography, we compared the capsular width between painful TMJs and painless TMJ. The risk factors for TMJ pain were also investigated including capsular width and other clinical factors such as TMJ sounds that may affect the occurrence and persistence of TMJ pain.MethodsTMJ ultrasonography was performed on 87 temporomandibular disorder (TMD) patients, including 47 unilateral and 29 bilateral TMJ pain patients, and 11 patients without TMJ pain.ResultsThe capsular width was greater in the 105 painful joints than in the 69 painless joints. Considering individual anatomical variations, the differences between painful and painless joints in unilateral TMJ pain patients were also analyzed, revealing a greater width in painful joints. Capsular width was a risk factor for TMJ pain with an adjusted odds ratio of 1.496 (95% confidence interval 1.312–1.706; p < 0.001) and was significantly correlated with pain scores.ConclusionThis correlation may suggest that pain intensity is associated with widened capsular width because of joint effusion or synovitis. Further studies are required to refine and establish the protocols for standard examinations using ultrasound imaging.

A logistic analysis prediction model of TMJ condylar erosion in patients with TMJ arthralgia

BackgroundIn terms of diagnostic and therapeutic management, clinicians should adequately address the frequent aspects of temporomandibular joint (TMJ) osteoarthritis (OA) associated with disk displacement. Condylar erosion (CE) is considered an inflammatory subset of OA and is regarded as a sign of progressive OA changes potentially contributing to changes in dentofacial morphology or limited mandibular growth. The purpose of this study was to establish a risk prediction model of CE by a multivariate logistic regression analysis to predict the individual risk of CE in TMJ arthralgia. It was hypothesized that there was a closer association between CE and magnetic resonance imaging (MRI) indicators.MethodsThis retrospective paired-design study enrolled 124 consecutive TMJ pain patients and analyzed the clinical and TMJ-related MRI data in predicting CE. TMJ pain patients were categorized according to the research diagnostic criteria for temporomandibular disorders (RDC/TMD) Axis I protocol. Each patient underwent MRI examination of both TMJs, 1–7 days following clinical examination.ResultsIn the univariate analysis analyses, 9 influencing factors were related to CE, of which the following 4 as predictors determined the binary multivariate logistic regression model: missing posterior teeth (odds ratio [OR] = 1.42; P = 0.018), RDC/TMD of arthralgia coexistant with disk displacement without reduction with limited opening (DDwoR/wLO) (OR = 3.30, P = 0.007), MRI finding of disk displacement without reduction (OR = 10.96, P < 0.001), and MRI finding of bone marrow edema (OR = 11.97, P < 0.001). The model had statistical significance (chi-square = 148.239, Nagelkerke R square = 0.612, P < 0.001). Out of the TMJs, 83.9% were correctly predicted to be CE cases or Non-CE cases with a sensitivity of 81.4% and a specificity of 85.2%. The area under the receiver operating characteristic curve was 0.916.ConclusionThe established prediction model using the risk factors of TMJ arthralgia may be useful for predicting the risk of CE. The data suggest MRI indicators as dominant factors in the definition of CE. Further research is needed to improve the model, and confirm the validity and reliability of the model.

Botulinum Toxin Treatment of Temporomandibular Joint Pain in Patients with Bruxism

Bruxism is a parafunctional habit, usually performed in sleep, by rhythmic and involuntary teeth being squeezed or squeaked. The most common methods of treatment are the use of occlusal splints. The aim of this study was to compare the efficacy of occlusal splinting with botulinum toxin administration in the treatment of TMJ pain. For this purpose, 40 patients with bruxism were divided into two groups and one group was treated with occlusal splint and the other group received masseter muscle botulinum toxin injection. Then, the participants in both groups were evaluated in terms of pain, functional movement, and maximum bite force change at 2 weeks, 6 weeks, 3 months, and 6 months. Mann-Whitney U test was used to examine the differences between two independent groups. While Friedman test was used for differences between dependent groups, the Wilcoxon test was used for the differences between two repetitive measurements. Chi-square test was used to examine the relationship between categorical variables. Results: When pain was evaluated, both methods were effective in pain reduction, botulinum toxin injection was found to be less effective in reducing pain but no difference was found between the two methods. The maximum bite force decreased in the 2nd and 6th weeks and increased in the 3rd and 6th months in patients receiving botulinum toxin. In patients using occlusal splints, there was no change until the 3rd month and an increase was seen in the 6th month. In this study, it was observed that low dose BTX-A and occlusal splint use were effective in eliminating bruxism-related pain but not superior to each other. According to these results, low dose botulinum toxin can be considered as an alternative treatment in patients who cannot use occlusal splint for various reasons.

턱관절 통증 유무에 따른 개구 범위와 깨물근 두께의 비대칭 비교

Temporomandibular joint (TMJ) disorder leads to pain and limited opening range. TMJ disorder are caused by occlusal problem, bad habit, and muscular overactivity. The TMJ works bilaterally to create jaw motion; however, it moves asymmetrically during a production exercise. And most people move mandible toward their preferred side during a production exercise. In general, Masseter, main muscle used for chewing exercise, frequently results in TMJ disorder when biomechanical and physiological imbalance occurs. Therefore, the purpose of this study is to investigate the difference of TMJ movement range and the effect of masseter asymmetry on the TMJ pain in patients with and without TMJ pain. 30 subjects was recruited for this study, with 15 subjects with TMJ pain as the experimental group and 15 subjects with no TMJ pain as the control groups. Using Image J program, ranges of maximal mouth opening and mouth opening taken under only mandibular rotation were measured, and the thickness of masseter in the TMJ in resting condition was measured with the ultrasonography. The results of this study showed that there was a significant difference in the ratio of ranges of he maximum mouth opening and mouth opening taken under the mandibular rotation only(p<.05). However, no significant difference was found in the masseter’s thickness (p>.05). In this study, the results showed that the pain in the TMJ was not related to the asymmetry of the masseter’s thickness, and that the reduction of maximum opening and mandibular rotation were closely related to the pain. Therefore, training to use TMJ of both sides when chewing food may be helpful to prevent TMJ disorders. In addition, we recommend interventions to improve bad habits. Further studies qill bw continued in this field.

Clinical variables associated with the presence of articular pain in patients with temporomandibular joint clicking.

To study and estimate the impact of clinical, somatosensory, and psychosocial variables associated with the concomitant presence of temporomandibular joint (TMJ) pain in patients with TMJ clicking. Ninety-three individuals composed the sample: patients with painful TMJ clicking (n = 47) and patients with painless TMJ clicking (n = 46). Four categories of data were evaluated: clinical features (gender, maximal interincisal distance (MID), side of complaint, age); bruxism (sleep bruxism (SB), awake bruxism (AB)); somatosensory (mechanical pain threshold (MPT), wind-up ratio (WUR), pressure pain threshold (PPT), conditioned pain modulation (CPM)); and psychosocial (Pittsburgh Sleep Quality Index (PSQI), pain vigilance and awareness questionnaire (PVAQ), Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK/TMD), Oral Behaviors (OBs)). Female gender, AB, WUR, CPM, PSQI, PCS, and OBs significantly (p < 0.05) increased the chance of the concomitant presence of TMJ pain in patients with TMJ clicking. On the other hand, MID, MPT, and PPT significantly (p < 0.05) decreased this chance. The other variables had no association. It can be concluded that being a woman, having AB, hyperalgesia in WUR, less efficient CPM, poor sleep quality, pain catastrophizing, and harmful OBs significantly increased the chance of the concomitant presence of TMJ pain in patients with TMJ clicking. In the opposite, high figures of MID, MPT, and PPT decreased the chance. Most patients with TMJ clicking usually postpone seeking treatment until the clicking truly disturbs or there is a concomitant presence of TMJ pain. Understanding the variables associated with this concomitance can be important in clinical practice.

Prevalence, Course, and Associated Factors of Pain in the Temporomandibular Joint in Early Rheumatoid Arthritis: Results of a Longitudinal Cohort Study.

To assess the prevalence, 3-year course, and associated factors of temporomandibular joint (TMJ) pain in patients with newly diagnosed rheumatoid arthritis (RA). A total of 264 patients with newly diagnosed RA were included. Patients were assessed after 3 months, 6 months, 9 months, 1 year, 1.5 years, 2 years, and 3 years. TMJ pain was scored by manual palpation, and the prevalence of TMJ pain was calculated at baseline and at all seven follow-up intervals during 3 years. Factors assessed for a potential association with TMJ pain at baseline included: demographic factors (gender and age), disease-related factors (symptom duration, rheumatoid factor [RF], anti-cyclic citrullinated protein [anti-CCP], C-reactive protein [CRP], and Disease Activity Score 28 [DAS28]), and functional factors (Health Assessment Questionnaire [HAQ] and European Quality of Life 5 Dimensions Questionnaire [EQ5D]-anxiety/depression). A stepwise logistic regression model was used to determine factors associated with TMJ pain in patients with RA. The prevalence of TMJ pain in patients with RA was 10.6% at baseline, which decreased to 3.6% in the first year after inclusion and remained stable thereafter. Disease activity as determined by the DAS28 was significantly associated with TMJ pain (odds ratio [OR] = 1.51; 95% confidence interval [95% CI] = 1.12-2.05; P = .009) at baseline. A second logistic regression analysis was performed with the following variables of the DAS28: erythrocyte sedimentation rate (ESR), tender joint count, swollen joint count, and global health. Tender joint count (OR = 1.06; 95% CI = 1.01-1.12; P = .03) and global health (OR = 1.02; 95% CI = 1.00-1.03; P = .03) were significantly associated with TMJ pain at baseline. The remaining factors included in the analysis were not significantly associated with TMJ pain at baseline. The prevalence of TMJ pain in patients with newly diagnosed RA is approximately 10% and decreases during follow-up, especially in the first year. Disease activity is a risk factor for TMJ pain in patients with newly diagnosed RA.

Personality traits are potentially associated with the presence of chronic temporomandibular joint pain in patients without effusion as determined by T-2 weighted magnetic resonance

Objective: The study aimed at investigating personality traits in chronic temporomandibular joints (TMJ) pain patients with and without joint effusion.Methods: Two groups of chronic TMJ pain patients were recruited. The TMJ pain control group was composed of patients showing magnetic resonance imaging (MRI) signs of TMJ effusion, while the TMJ pain test group included patients with chronic TMJ pain seemingly not justified, due to the absence of MRI-detected disorders. A third set of pain free individuals was selected as a comparison group. All patients completed a personality assessment with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) instrument, and the between-group differences were assessed for significance by performing an analysis of variance test.Results: Patients of the TMJ pain test group had higher scores than subjects belonging to the TMJ pain and pain-free control groups in almost all of the MMPI-2 clinical scales. A significant difference was shown for the scales related to concerns about physical health (Scale 1-Hs; F = 7.74; p = .001) and physical symptoms (Scale 3-Hy; F = 8.43; p = .001).Conclusions: Chronic TMJ pain patients without MRI-detected TMJ effusion have a different personality profile than patients with TMJ effusion and pain-free individuals, regarding high levels of concerns about physical health and physical symptoms.Clinical implications: This study has important clinical implications for temporomandibular disorders practitioners, providing suggestions that symptoms in the TMJ area are not only related to a physical disorder. The possible existence of a psychologically modulated condition in patients who refer pain in the TMJ area without signs of effusion should be carefully taken into consideration.

Observational study of temporomandibular joint pain in osteoarthritis patients

Aim: The aim of this study was to evaluate the incidence of temporomandibular joint (TMJ) pain in osteoarthritis patients. Objectives: The three objectives of this study were as follows: 1. finding the occurrence of TMJ pain in osteoarthritic patients; 2. to evaluate the signs of TMJ disorders in osteoarthritic patients; and 3. to assess the involvement of TMJ in osteoarthritic patients. Materials and Methods: Twenty osteoarthritis patients who were under treatment for a minimum of 1 year were included in this study. All of them answered a questionnaire before undergoing examination. The questions pertained to the symptoms of the TMJ pain. Clinical examination of TMJ was done, which included evidence of sound, restricted mouth opening, and deviation. Results: Results indicated that about 40% of osteoarthritis patients had TMJ pain. Conclusion: This study shows the high incidence of TMJ pain in patients with osteoarthritis.

Psychopathology and Clinical Features in an Italian Sample of Patients with Myofascial and Temporomandibular Joint Pain: Preliminary Data

Aim of this study was to provide data on the relationships between psychopathological variables and temporomandibular disorders (TMD). Sixty-three TMD patients were investigated using clinical and anamnestical psychiatric informations and psychopathological measures. Three groups of TMD patients were recruited according to the Research Diagnostic Criteria for TMD guidelines: a group of patients presenting myofascial pain alone (RDC/TMD axis I group I), a group with temporomandibular joint (TMJ) pain alone (RDC/TMD axis I group IIIa, IIIb), and a group presenting both myofascial and TMJ pain. Two secondary groups were identified on the basis of the presence/absence of myofascial pain. The study design provided a psychiatric interview and psychometric assessment including the Symptom Check List-90-Revised (SCL-90-R), the Hamilton Depression Rating Scale (HDRS), and the Hamilton Anxiety Rating Scale (HARS). --Psychiatric evaluation: Myofascial pain patients had higher scores for personal psychiatric history and a history of more frequent psychotropic drug use. --HDRS and HARS: The sample presented scores indicating mild depressive symptoms and moderate anxiety symptoms. --SCL-90-R: The global sample showed acute levels of psychological distress as measured by the GSI score (Global Severity Index). Myofascial pain patients scored higher than TMJ pain patients in the GSI (p = .028), PAR (paranoia; p = .015), PSY (psychoticism; p = .032), and HOS (hostility; p = .034) subscales. TMD patients showed elevated levels of depression, somatization, and anxiety. These characteristics did not differ significantly between patients with myofascial or TMJ pain. Other specific psychopathological dimensions, detected with SCL-90-R, appeared to be closely associated to the myofascial component.

O.247 The influence of inflammatory mediators and markers on the temporomandibular joint pain in patients with rheumatoid arthritis

O.247 The influence of inflammatory mediators and markers on the temporomandibular joint pain in patients with rheumatoid arthritis

Interleukin‐1β influences the effect of infliximab on temporomandibular joint pain in rheumatoid arthritis

Objectives: The aim of this study was to investigate the influence of plasma and synovial fluid tumour necrosis factor alpha (TNFα), interleukin‐1beta (IL‐1β), IL‐6, soluble TNF receptor II (TNF‐sRII), IL‐1 receptor antagonist (IL‐1ra), soluble IL‐1 receptor II (IL‐1sRII) and IL‐10 on the effect of the TNFα antibody infliximab on temporomandibular joint (TMJ) pain in patients with active rheumatoid arthritis (RA).Methods: Fifteen patients with TMJ pain taking methotrexate were included in the study. The effect of intravenous infusions of infliximab was assessed after 14 or 22 weeks. TMJ resting and movement pain was assessed by a visual analogue scale (VAS) (0–100 mm) and samples of venous blood and TMJ synovial fluid were collected before and after treatment.Results: The effect of infliximab on TMJ pain was influenced by pretreatment plasma levels of IL‐1β, IL‐1ra, and IL‐10 as well as pretreatment levels of TMJ synovial fluid IL‐1sRII. High pretreatment levels of these cytokines and receptors as well as the presence of rheumatoid factor (RF) were associated with no or minor reduction in TMJ pain after treatment.Conclusions: Systemic treatment of RA with a combination of infliximab and methotrexate seems to be insufficient to alleviate TMJ pain in patients with RF or high pretreatment plasma levels of IL‐1β.

Serotonergic Mechanisms Influence the Response to Glucocorticoid Treatment in TMJ Arthritis

The aims of this study were to investigate the influence of serotonin (5-HT) on the effects of intra-articular injections of glucocorticoid on pain of the temporomandibular joint (TMJ) in patients with inflammatory disorders of the TMJ. The pretreatment synovial fluid 5-HT was negatively, and plasma 5-HT positively, correlated to change in TMJ pain after treatment. The pretreatment plasma 5-HT was positively correlated to change in pressure-pain threshold after treatment. In conclusion, this study shows that local and systemic serotonergic mechanisms partly determine the effect of intra-articular glucocorticoid treatment on TMJ pain in patients with chronic TMJ arthritis of systemic nature, while change in pressure-pain threshold over the TMJ is influenced by systemic serotonergic mechanisms.

A primary research on the concomitant symptoms of temporomandibular joint pain

To investigate the states of chronic symptoms of other parts of the body concomitant with temporomandibular joint (TMJ) pain. Fifty-one patients with TMJ pain and thirty-one control subjects without TMJ symptoms were chosen randomly. The TMJ symptoms and chronic symptoms of other regions were investigated at the base line. The TMJ pain patients were investigated again half year after treatment. Between-symptom correlations were analyzed using linear regression and Chi-squared analysis method (alpha = 0.05). The chronic symptoms related to the TMJ pain at the base line were headache, back pain, numbness of hand, neck and shoulder pain, insomnia, dizziness, reduced hearing ability, eye pain and fatigue (P < 0.05). The incidences of the symptoms of patients were higher than those of the control subjects (P < 0.01). Half year later, the headache, neck and shoulder pain and fatigue were the symptoms improved with the TMJ pain treatment (P < 0.05). The symptoms of adjacent regions of orofacial area such as neck and shoulder pain and headache are the main concomitant symptoms of the TMJ pain, and these symptoms may be improved by the treatment of TMJ.

Determining predictor variables for treatment outcomes of arthrocentesis and hydraulic distention of the temporomandibular joint.

Arthrocentesis and hydraulic distention of the temporomandibular joint (TMJ) has been described as an effective modality in the treatment of patients demonstrating clinical findings consistent with the diagnosis of disc displacement without reduction. The purpose of this study was to investigate whether the clinical variable of TMJ pain chronicity and the magnetic resonance (MR) imaging variable of osteoarthrosis (OA) may predict treatment outcomes of arthrocentesis and hydraulic distention of the TMJ. The study consisted of 29 TMJ pain patients, who were assigned a unilateral clinical temporomandibular disorder (TMD) of "TMJ pain associated with an internal derangement (ID) type III (disc displacement without reduction)," and a TMJ pain side-related MR imaging diagnosis of disc displacement without reduction. Bilateral sagittal and coronal MR images were obtained immediately preoperatively to establish the presence or absence of ID and OA. TMJ pain level of function and mandibular range of motion were assessed preoperatively and compared with the respective 2-month follow-up findings. Outcome criteria of success were 1). an absence of signs and symptoms characteristic of a diagnosis of ID type III and/or 2). a reduction in pain level of 85% or greater. A multiple logistic regression analysis was used to compute the odds ratio for TMJ pain chronicity (duration >6 months and <2 years) and OA for successful outcomes versus nonsuccessful outcomes. The pretreatment data revealed no significant relationship between the clinical disorder "TMJ pain associated with ID type III" and the MR imaging finding of OA (P =.103). At 2-month follow-up, clinical evaluation showed a significant reduction in TMJ pain during function (P =.000), a significant reduction in clinical diagnoses of TMDs (P =.000), and a significant increase in mandibular range of motion (P =.000). Significant increase in risk of a nonsuccessful outcome (pain reduction <85%) occurred with TMJ pain chronicity (odds ratio of 41.0) (P =.018). Significant increase in benefit of a successful outcome (absence of ID type III) occurred with TMJ OA (odds ratio 1:16.7, P =.06) (P =.044). Arthrocentesis in chronic TMJ pain patients was less successful than in nonchronic patients with regard to treatment outcome of pain reduction. Arthrocentesis in patients with TMJ OA was more beneficial with regard to the disappearance of ID type III than in non-OA patients. Predictive modeling may provide clinicians with the opportunity to identify "at-benefit" patients early and initiate specific treatments.

Are internal derangement and osteoarthrosis linked to changes in clinical outcome measures of arthrocentesis of the temporomandibular joint?

Purpose: Arthrocentesis and hydraulic distention of the temporomandibular joint (TMJ) have been described as an effective modality in the treatment of patients with clinical findings consistent with the diagnosis of disc displacement without reduction. The purpose of this study was to investigate whether the magnetic resonance (MR) imaging variables of internal derangement (ID) and osteoarthrosis (OA) and the presence of capsulitis/synovitis (C/S) may be linked to changes in TMJ signs and symptoms associated with the performance of arthrocentesis and hydraulic distention. Patients and Methods: The study consisted of 27 TMJ pain patients, who were assigned a clinical unilateral TMJ diagnosis of ID type III (disc displacement without reduction). Bilateral sagittal and coronal MR images were obtained immediately preoperatively and at a 2-month follow-up to establish the presence or absence of ID and OA. TMJ pain level of function and mandibular range of motion were assessed preoperatively and compared with the respective 2-month follow-up findings. Results: The pretreatment data revealed a significant relationship between the clinical finding of TMJ pain and the MR imaging findings of ID ( P < .001), ID type ( P < .001), and OA ( P < .05). At 2-month follow-up, clinical evaluation showed a significant reduction in TMJ pain during function ( P < .001), a significant reduction in the clinical diagnoses of ID type III ( P < .05), and a significant increase in mandibular range of motion ( P < .05). There was no change in the prevalence rates of associated MR imaging diagnoses of TMJ ID and/or OA. Conclusion: The study findings suggest that clinical pain is related to TMJ-related MR imaging findings of ID and OA. These diagnoses proved not to be linked to changes in therapeutic outcome measures of TMJ pain and mandibular range of motion.

Risk factors for temporomandibular joint pain in patients with disc displacement without reduction - a magnetic resonance imaging study.

The purpose of this study was to evaluate whether the magnetic resonance (MR) imaging variables of temporomandibular joint (TMJ) internal derangement, osteoarthrosis and/or effusion may predict the presence of pain in patients with a clinical disorder of an internal derangement type (ID)-III. The relationship between TMJ ID-III pain and TMJ internal derangement, osteoarthrosis and effusion was analysed in MR images of 84 TMJs in 42 patients with a clinical unilateral diagnosis of TMJ ID-III pain. Criteria for including a TMJ ID-III pain patient were report of orofacial pain referred to the TMJ, with the presence of unilateral TMJ pain during palpation, function and/or unassisted or assisted mandibular opening. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ internal derangement, osteoarthrosis and effusion. Using chi-square analysis for pair-wise comparison, the data showed a significant relationship between the MR imaging findings of TMJ ID-III pain and those of internal derangement (P=0.01) and effusion (P=0.00). Of the MR imaging variables considered simultaneously in the multiple logistic regression analysis, osteoarthrosis (P=0.82) and effusion (P=0.08) dropped out as non-significant in the diagnostic TMJ pain group when compared with the TMJ non-pain group. The odds ratio that a TMJ with an internal derangement type of disk displacement without reduction might belong to the pain group was strong (2.7:1) and highly significant (P=0.00). Significant increases in risk of TMJ pain occurred with 'disk displacement without reduction in combination with osteoarthrosis' (5.2:1) (P=0.00) and/or 'disk displacement without reduction in combination with osteoarthrosis and effusion' (6.6:1) (P=0.00). The results suggest that TMJ pain is related to internal derangement, osteoarthrosis and effusion. However, the data re-emphasize the aspect that these MR imaging variables may not be regarded as the unique and dominant factors in defining TMJ pain instances.

Magnetic resonance imaging findings of osteoarthrosis and effusion in patients with unilateral temporomandibular joint pain

The purpose of this study was to investigate the relationship between the presence of temporomandibular joint (TMJ) pain and the magnetic resonance (MR) imaging findings of osteoarthrosis (OA), and effusion. The study comprised 112 consecutive TMJ pain patients. Criteria for including a patient were report of unilateral pain near the TMJ, with the presence of unilateral TMJ pain during palpation, function, and/or unassisted or assisted mandibular opening. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ OA, and/or effusion. Comparison of the TMJ side-related data showed a significant relationship between the clinical finding of TMJ pain and the MR imaging diagnoses of TMJ OA (P=0.000), and TMJ effusion (P=0.000). Further, there was a significant relationship between the MR imaging diagnosis of TMJ OA and TMJ effusion (P=0.000). Use of the Kappa statistical test indicated poor diagnostic agreement between the presence of TMJ pain and the MR imaging diagnosis of TMJ OA (K=0.22), TMJ effusion (K=0.29), and TMJ ‘OA and effusion’ (K=0.30). The study's findings suggest that while clinical pain is correlated to TMJ-related MR imaging findings, clinical pain in and of itself, is not reliable for predicting the presence of TMJ OA and/or effusion. Validation of MR imaging diagnoses would involve the investigation of cross-sectional and longitudinal evidence to assess decisive differences in terms of prognosis and/or treatment outcome.

Clinical versus magnetic resonance imaging findings with internal derangement of the temporomandibular joint: An evaluation of anterior disc displacement without reduction

Purpose: The purpose of this study was to investigate whether the clinical finding of anterior disc displacement without reduction (ADWOR) and pain in the temporomandibular joint (TMJ) is correlated to the magnetic resonance imaging (MRI) findings of TMJ internal derangement (ID). Patients and methods: The TMJ group was composed of 55 TMJ pain patients who were assigned a clinical diagnosis of unilateral ADWOR. The control group consisted of 58 nonpainful TMJ patients. Sagittal and coronal MR images were obtained to establish the incidence and type of ID. Results: Using chi-square analysis, the results showed a significant relationship between the presence of pain and the MRI diagnosis of ID (P =.000) and its type (P =.000). Use of the kappa statistical test indicated poor diagnostic agreement between the presence of pain and the MRI diagnosis of ID (κ = 0.37) and disc displacement with reduction (κ = 0.20). The diagnostic agreement for disc displacement without reduction was 78.8%, with a corresponding κ-value of 0.58, indicating fair agreement between the clinical and the MRI diagnosis. Conclusion: The results suggest that TMJ pain associated with ADWOR is correlated with MRI diagnoses of ID and the ID type. These data confirm the use of the clinical diagnostic criteria for disc displacement without reduction as a reliable method of predicting similar MRI diagnoses. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:36-41, 2002