Temporomandibular Joint Signs Research Articles

Evaluation of psychosocial aspects in patients with juvenile idiopathic arthritis

The relationship between psychological factors and the overall health of patients with Juvenile Idiopathic Arthritis (JIA) is evident, yet the specific impact of the presence of Temporomandibular Joint (TMJ) signs or symptoms is not fully understood. This article seeks to elucidate the current knowledge of the relationship between TMJ signs and symptoms, psychosocial factors, and broader clinical manifestations in JIA patients. To investigate this relationship further, the present article will also present the results of a study including a total of 73 JIA patients, consisting of 56 females and 17 males (mean age 12.2 ± 2.8 years old; range 6–16). These patients were examined according to the diagnostic criteria for temporomandibular disorders (DC/TMD). Self-reported questionnaires were used to investigate the psychosocial aspects of stress, anxiety, depression, and catastrophizing. General quality of life and disease activity were assessed with the JAMAR questionnaire (Juvenile Arthritis Multidimensional Assessment Report). For inferential statistics, the Pearson r coefficient, linear regression models and T test for unpaired data were used. The level of significance was P<0.05. Increased general disease activity and significant impacts on quality of life were associated with increased psychological distress. The four psychosocial factors examined, including anxiety, stress, catastrophizing, and depression, all had a negative impact on the quality of life, symptomatology, and disease activity. Specifically, anxiety and catastrophizing influenced the relationship between the presence of symptoms and the reported quality of life where higher levels of anxiety and catastrophizing increased the impact of the symptoms on the quality of life. Finally, the presence of TMJ signs and/or symptoms did not exacerbate the psychosocial domains but affected the functional aspect of the patient.

Are Signs of Degenerative Joint Disease Associated With Chin Deviation?

Degenerative joint changes commonly affect the temporomandibular joint (TMJ) and can result in chin deviation. However, the extent of degenerative TMJ changes and chin deviation has not been well-characterized. The present study sought to correlate degenerative TMJ changes with condylar volume, grayscale measures, and chin deviation. The present cross-sectional study had enrolled women with skeletal Class III malocclusion. Cone-beam computed tomography scans were acquired preoperatively. For each condyle, degenerative TMJ signs were analyzed and the condylar volume and grayscale were measured. The predictor variable was the presence of degenerative TMJ signs, classified as categorical data: 0, if none; 1, only present in 1 joint; and 2, present in both joints. The primary outcome variable was a chin deviation of 3mm or more. Other associated variables were grouped by age, cephalometric data, and 3-dimensional condylar measurements. Descriptive bivariate statistics were computed, and univariate and multiple logistic regression analyses were conducted to identify any associations between degenerative TMJ disease and chin deviation. We included 85 patients, who were classified into 2 groups: less than 3mm of chin deviation (n=43) and 3mm or more of chin deviation (n=42). The presence of more than 10 degenerative TMJ signs was significantly associated with the presence of 3mm or more of chin deviation (P<.001). In multiple regression models, the presence of subcortical sclerosis in 1 joint and in both joints (adjusted odds ratio [OR], 3.698; 95% confidence interval [CI], 1.051 to 13.012; adjusted OR, 5.001; 95% CI, 1.461-17.119, respectively) correlated significantly with the presence of 3mm or more of chin deviation (P<.05). The volume difference between the 2 condyles was significantly greater in the group with more than 10 degenerative TMJ signs and 3mm or more of chin deviation than in the group with 10 or fewer degenerative TMJ signs and less than 3mm of chin deviation (P=.016 and P<.001, respectively). In women with skeletal Class III malocclusion, the presence of more than 10 degenerative TMJ signs increased the prevalence of 3mm or more of chin deviation. The presence of subcortical sclerosis in either 1 or both joints and volume differences between the 2 condyles were associated with greater chin deviation.

Sex hormones in association with general joint laxity and hypermobility in the temporomandibular joint in adolescents-results of the epidemiologic LIFE child study.

The aim of this cross-sectional study was to investigate whether sex hormones (testosterone, oestradiol, sex-hormone-binding globulin=SHBG) are associated with general joint laxity (GJL) and hypermobility or derangements of the temporomandibular joint (TMJ) in adolescents. Within the LIFE Child study, 970 adolescents (10-18years) were included. GJL was assessed using the Beighton test. Maximum mouth opening (MMO) and clinical clicking sounds as signs of disc displacement (DD) in the TMJ were assessed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Serum levels of sex hormones were assessed using standardised laboratory analyses. Hypermobile joints were found in 54.9% (N=532) of the sample; females were more affected than males (61.4% vs. 51.8%, P<0.001). Using logistic regression analyses, the odds ratio (OR) for having >1 hypermobile joints increased to 1.15 (95% confidence interval [CI]: 1.04-1.27) in males and 1.09 (95% CI: 1.02-1.17) in females per 10 units of the SHBG serum level, compared to those without hypermobile joints-after controlling for the effect of age, adjusted BMI, pubertal development (Tanner scale), testosterone as well as oestradiol levels. Female subjects with >1 hypermobile joints showed a higher OR (1.89; 95% CI: 1.05-3.43) for having clinical clicking sounds in the TMJ and a 3.28 times higher OR (95% CI: 1.44-7.44) for MMO≥55mm. We observed age- and gender-independent associations of higher SHBG serum levels with GJL in adolescents. Moreover, hypermobile female adolescents show a more frequent hypermobility of the TMJ and clinical signs of DD.

CBCT evaluation of condylar changes in children with unilateral posterior crossbites and a functional shift

Posterior crossbite is one of the most frequently occurring malocclusions in adolescents with a prevalence of 7% to 23%. The most common form of posterior crossbite is a unilateral posterior crossbite with a functional side shift. It has been suggested that functional posterior crossbites (FUPXB) may result in right-to-left-side differences in the condyle fossa relationship, resulting in temporomandibular joint (TMJ) problems. The objective of this study was to determine if pathological position of the condyles can cause condylar signs or symptoms like degenerative joint disease (DJD) or juvenile condylar resorption (JCR), or if the position of the condyle is just an altered position within the TMJ. Sixty patients with an average age of 9.6years were randomly selected from the office of one of the investigators (T.S.). The study group consisted of 29 patients with a FUPXB and the control group had 31 patients with no posterior crossbite. All patients had multislice CT scans of the TMJ taken as part of the orthodontic records. Transverse widths were measured at the skeletal base and the dentoalveolar base. Molar inclinations, condylar angulations, condylar anterior joint space, superior joint space, and posterior joint space were measured. Independent sample t-tests were used to compare different measurements between groups and paired sample t-tests were used to compare differences within the same patient. Reliability of measurements were determined using pairwise correlation. For dentoalveolar measurements of transverse width, the maxillomandibular difference for the study group was -8.2 mm and for the control group was -4.0 mm. No significant differences were found between the molar inclinations, condylar width, angulation, or any joint space measurements between the two groups. A total of 61.3% of the subjects in the control group and 72.4% in the study group had a radiographic sign of joint disease. The lack of condylar positional differences between the control and crossbite groups suggests that TMJ signs and symptoms in the study group may be related to remodeling in the TMJ instead.

Cranial structure and condylar asymmetry of patients with juvenile idiopathic arthritis: a risky growth pattern

The aim of the study was to evaluate the cephalometric differences and condylar asymmetry between patients with juvenile idiopathic arthritis (JIA) and normal control group. Sixty-two JIA patients with a latero-lateral cephalogram and orthopantomography, seeking for orthodontic therapy, and 62 normal matched subjects were comprised in the study. Cephalometric analysis was used for the evaluation of facial morphology while the method of Habets et al. (J Oral Rehabil 15(5): 465-471, 1988) was used to compare the condyles in orthopantomography. The significance of between-group differences was assessed using the Mann-Whitney test, as appropriate. The results showed a prevalence of the upper maxilla with hypomandibulia (class II), hyperdivergency with short vertical ramus posterior and posterior rotation of the mandible in JIA children (SNB, ANB, NSL/ML, Fh/ML, NL/ML, ArGo, ML P< 0.0001, ML/Oc P< 0.004, ArGo/GoGn P= 0.02, no difference for SNA). The condyles of the JIA group resulted highly asymmetric (P< 0.0001). The growth pattern of JIA patients resulted clearly different from normal subjects. This serious impairment of the cranial growth may be considered as an indicator of the need for early and continuous orthognatodonthic therapy during the entire period of development for all JIA patients, independently from temporomandibular joint signs or symptoms. To this end, it is important that rheumatologists and orthognathodontists set up a multidisciplinary treatment planned to control the side effects of a deranged growing pattern, to strictly avoid any orthodontic therapies that may worsen function and growth, and to promote treatments improving the physiology and biology of the cranial development.

Prevalence of temporomandibular joint disorder among North Saudi University students

Objective:The aim of the current investigation was to study the prevalence of temporomandibular disorder (TMD) among university students of North Saudi Arabia.Methods:A specifically constructed questionnaire was distributed to 489 university students to investigate the prevalence of temporomandibular joint (TMJ) findings among them. The study sample consisted of 346 males and 143 females (age range was 18–25 years). The data were analyzed, and probability values were set at p ≤ 0.05.Results:A total of 49.7% of participants had at least one sign or symptom of TMD. Clicking was the most reported finding. Pain in or about the ears/cheeks was the second most common finding. In all, 24.3% of the participants reported one TMJ finding; meanwhile, 0.4% reported the presence of five concurrent TMJ signs and symptoms. Females reported more TMJ signs and symptoms than males (p < 0.05). Science and health students reported more TMD findings than humanitarian college students (p < 0.05).Discussion:University students in north Saudi Arabia reported high prevalence of TMD. Also, students from science and health colleges reported higher prevalence of TMD findings than humanitarian college students. Clicking and pain are the most prevalent findings of TMD among university students. The results of this investigation highlight the need for additional research to shed more light on the risk factors and findings related to TMD. This will facilitate drawing adequate guidelines for prevention and management of TMD.

Three-Dimensional Computed Tomographic Assessment of Temporomandibular Joint Stability After Orthognathic Surgery

Ensuring that the condyle is appropriately positioned and that positional changes are minimal is considered crucial for the temporomandibular joint (TMJ) to function without symptoms after orthognathic surgery. The purposes of this study were to evaluate condylar changes after surgery and to examine the association between these changes and TMJ symptoms. A retrospective cohort study was conducted in patients with mandibular prognathism who underwent orthognathic surgery. Linear and angular changes in the positioning of the condyle were measured by superimposing 3-dimensional computed tomograms taken before surgery and 3months after surgery. Clinical symptoms of TMJ pain and sound were recorded at 3, 6, 9, and 12months after surgery. Possible associations between TMJ symptoms and clinical variables, such as postoperative condylar changes, were investigated using multiple logistic regression analysis. Linear condylar displacement after orthognathic surgery occurred predominantly in the anterior, medial, and inferior directions, with minimal changes (<1mm) observed. Most angular condylar changes were smaller than 4° and occurred in the inward direction in the axial plane and the posterior direction in the sagittal plane. The best predictor of postoperative TMJ signs and symptoms was the preoperative status of TMJ signs and symptoms. Neither linear nor angular condylar displacement showed a relevant influence on postoperative pain and sound. Within the ranges of linear (<1mm) and angular (<4°) condylar displacement noted in this study, displacement was not associated with postoperative TMJ pain and sound.

Prevalence of temporomandibular joint disorder among North Saudi University students

Objective:The aim of the current investigation was to study the prevalence of temporomandibular disorder (TMD) among university students of North Saudi Arabia.Methods:A specifically constructed questionnaire was distributed to 489 university students to investigate the prevalence of temporomandibular joint (TMJ) findings among them. The study sample consisted of 346 males and 143 females (age range was 18–25 years). The data were analyzed, and probability values were set at p ≤ 0.05.Results:A total of 49.7% of participants had at least one sign or symptom of TMD. Clicking was the most reported finding. Pain in or about the ears/cheeks was the second most common finding. In all, 24.3% of the participants reported one TMJ finding; meanwhile, 0.4% reported the presence of five concurrent TMJ signs and symptoms. Females reported more TMJ signs and symptoms than males (p < 0.05). Science and health students reported more TMD findings than humanitarian college students (p < 0.05).Discussion:University students in north Saudi Arabia reported high prevalence of TMD. Also, students from science and health colleges reported higher prevalence of TMD findings than humanitarian college students. Clicking and pain are the most prevalent findings of TMD among university students. The results of this investigation highlight the need for additional research to shed more light on the risk factors and findings related to TMD. This will facilitate drawing adequate guidelines for prevention and management of TMD.

Are temporomandibular joint signs and symptoms associated with magnetic resonance imaging findings in juvenile idiopathic arthritis patients? A longitudinal study.

The aims of this longitudinal study were to perform a comprehensive clinical evaluation of temporomandibular joint (TMJ) and to investigate the association between the clinical and magnetic resonance imaging (MRI) findings in the TMJs of patients with juvenile idiopathic arthritis (JIA). Seventy-five patients with JIA participated in this study. All patients underwent a rheumatological examination performed by a paediatric rheumatologist, a TMJ examination performed by a single dentist and an MRI with contrast of the TMJs. These examinations were scheduled on the same date. The patients were examined again 1 year later. Twenty-eight (37.3 %) patients reported symptoms at the first evaluation and 11 (14.7 %) patients at the second evaluation. In relation to signs, 35 (46.7 %) of the patients presented at least one sign at the first evaluation and 29 (38.7 %) at the second. Intense contrast enhancement of TMJ was significantly associated with disease activity (p < 0.001) at the first evaluation and a trend to significance was observed at the second (p = 0.056), with poly/systemic subtypes (p = 0.028 and p = 0.049, respectively), with restricted mouth opening capacity (p = 0.013 and p = 0.001, respectively), with the presence of erosions at both evaluations (p = 0.0001 and p < 0.0001, respectively) and with altered condylar shape at the second evaluation (p = 0.0005). TMJ involvement is highly prevalent in JIA patients, with asymptomatic children presenting severe structural alterations of the TMJ. The TMJ should always be evaluated in JIA patients, even in the absence of signs and symptoms.

Association of Temporomandibular Joint Signs & Symptoms with Dental Fluorosis & Skeletal Manifestations in Endemic Fluoride Areas of Dungarpur District, Rajasthan, India.

Endemic fluorosis resulting from high fluoride concentration in groundwater is a major public health problem. India is among the numerous nations, where fluoride sullied groundwater is creating wellbeing issues. Safe drinking water in rural areas of India is predominantly rely on groundwater sources, which are exceptionally contaminated with fluoride. To investigate the association of temporomandibular joint Signs & Symptoms with Dental Fluorosis & Skeletal Manifestations among people living in Dad, Bokersal & Deotalab villages of Dungarpur District, Rajasthan, India. The study group consisted of 750 subjects who were born & brought up in Dad, Bokersal & Deotalab villages of Dungarpur District, Rajasthan. Temporomandibular joint & Dental fluorosis was assessed by performing type III clinical examination according to WHO guidelines (1997). For the assessment of skeletal manifestations, participants were asked to perform three diagnostic tests: (1)Touching the toes without bending the knees; (2) Touching the chest with the chin; (3) Stretching the arms sideways & folding the arms to touch the back of the head. Chi Square test & Multiple Logistic Regression were applied for statistical analysis. Among the 750 (462 males & 288 females) who participated in the study, 53% had moderate grade of dental fluorosis. The most prominent symptom suggesting Temporomandibular Joint Disorder was the clicking sound affecting 21.4% population.(p>0.001). TMJ Signs & Symptoms were prominent in the age group of 45-54 years & males were highly affected than females. Clinical examination of TMJ in Dental Fluorosis & Skeletal Fluorosis subjects showed a significant association with Dental Fluorosis & Skeletal Fluorosis.

Evaluation of the superior semicircular canal morphology using cone beam computed tomography: a possible correlation for temporomandibular joint symptoms

This study aimed to assess the superior semicircular canal (SSCC) morphology and to determine whether superior semicircular canal dehiscence (SSCD) correlates with temporomandibular joint (TMJ) symptoms. Clinical data and cone beam computed tomography (CBCT) scans of 175 patients were retrospectively examined by 2 observers. Distribution and thickness measurements of the different types of bone cover of the SSCC were performed. Five radiologic SSCC patterns were identified from CBCT data: 147 cases (42%) were defined as normal (0.6-1.7 mm thickness); 62 cases (17.71%) had a papyraceous pattern (<0.5 mm); 77 cases (22%) showed a thick pattern (>1.8 mm); and 42 cases (12%) had a pneumatized pattern. Observer 1 and 2 diagnosed SSCD in 22 of 350 (6.28%) temporal bones individually and had no discordances between the 2 reviews. All patients with SSCD were identified as having TMJ signs and symptoms (P < .05). Maxillofacial radiologists should be informed about these structures, which can be helpful for the interpretation of CBCT scans.

Is early class III protraction facemask treatment effective? A multicentre, randomized, controlled trial: 3-year follow-up

To investigate the effectiveness of early class III protraction facemask treatment in children under 10 years of age at 3-year follow-up. Multicentre randomized controlled trial. Seventy-three patients were randomly allocated, stratified for gender, into early class III protraction facemask group (PFG) (n = 35) and a control/no treatment group (CG) (n = 38). Dentofacial changes were assessed from lateral cephalograms and occlusal changes using the peer assessment rating (PAR). Self-esteem was assessed using the Piers-Harris children's self-concept scale, and the psychosocial impact of malocclusion with oral aesthetic subjective impact score (OASIS) questionnaire. Temporomandibular joint (TMJ) signs and symptoms were also recorded. The time points for data collection were at registration (DC1), 15 months later (DC2) and 3 years post-registration (DC3). The following mean skeletal and occlusal changes occurred from the class III starting point to DC3 (3-year follow-up): SNA, PFG moved forwards +2·3° (CG forward +1·6°; P = 0·14); SNB, PFG moved forwards +0·8° (CG forward +1·5°, P = 0·26); ANB, PFG class III base improved +1·5° (CG stayed about the same at +0·1°; P = 0·001). This contributed to an overall difference in ANB between PFG and CG of +1·4° in favour of early protraction facemask treatment. The overjet was still improved by +3·6 mm in the PFG and changed a small amount +1·1 mm in the CG (P = 0·001). A 21% improvement in PAR was shown in the PFG and the CG worsened by 8·4% (P = 0·02). There was no increase in self-esteem (Piers-Harris score) for PFG compared with the CG (P = 0·56) and no statistically significant difference in the impact of malocclusion (OASIS) between groups in terms of the changes from DC1 to DC3 (P = 0·18). TMJ signs and symptoms were very low at DC1 and DC3. The favourable effect of early class III protraction facemask treatment undertaken in patients under 10 years of age, is maintained at 3-year follow-up in terms of ANB, overjet and % PAR improvement. The direct protraction treatment effect at SNA is still favourable although not statistically significantly better than the CG. Seventy per cent of patients in PFG had maintained a positive overjet which we have defined as ongoing treatment success. Early protraction facemask treatment does not seem to influence self-esteem or reduce the patient's personal impact of their malocclusion at 3-year follow-up.

Effects of surgical orthodontic treatment for dentofacial deformities on signs and symptoms of temporomandibular joint

ObjectivesThe purpose of this study was to determine the incidence of temporomandibular joint (TMJ) signs and symptoms in patients with dentofacial deformities and to assess longitudinally the changes in TMJ signs and symptoms after surgical orthodontic treatment. Materials and methodsThe subjects consisted of 170 patients with dentofacial deformities. A combination of Le Fort I osteotomy and bilateral sagittal split osteotomies was used in 112 patients, bilateral sagittal split osteotomies were performed in 58 patients. The joints were examined clinically and by computed tomography. ResultsTMJ signs and symptoms were recognized in 29.5% of the patients, and disk displacements and condylar bone changes were recognized in 22.1% and 13.4% of the joints, respectively. More patients with mandibular retrusion and asymmetry had TMJ signs and symptoms, disk displacements and condylar bone changes than those with mandibular prognathism. The incidence of TMJ signs and symptoms had significantly decreased to 12.1% at one year after orthognathic surgery, and there were no significant differences in the incidences of TMJ signs and symptoms among the types of dentofacial deformity. ConclusionSurgical orthodontic treatment has a beneficial effect on TMJ signs and symptoms in most patients with dentofacial deformities. However, there is a risk of TMJ symptoms and signs developing in preoperative asymptomatic patients after orthognathic surgery though the risk is low.

下顎枝矢状分割法が下顎頭の位置と顎関節症状に及ぼす影響について―３種類の術式の比較―

This study investigates the effects of sagittal split ramus osteotomy (SSRO) on condylar position and temporomandibular joint (TMJ) symptoms.The subjects were 51 patients (13 males and 38 females) in whom mandibular protrusions were corrected by SSRO; they were divided into three subtypes on the basis of the lateral bone cut location. The joints were examined clinically for pain, sound and maximum interincisal opening before surgery and at least six months after surgery. Submentovertex radiographs were taken before and immediately after surgery. The changes in condylar position were assessed by measuring the condylar angle, intercondylar axes angle and distance between the centers of the condyles.After SSRO, the condyles rotated inward (p < 0.01) on the axial plane, but the distances between their centers did not change significantly. TMJ signs and symptoms disappeared in four (31%) of the 12 symptomatic patients, worsened in one (8%) of the symptomatic patients and developed in three (8%) of the 39 asymptomatic patients six months after surgery. There were no significant differences in any of the parameters among the three subtypes of SSRO.

Is early class III protraction facemask treatment effective? A multicentre, randomized, controlled trial: 15‐month follow‐up

To investigate the effectiveness of early class III protraction facemask treatment in children under 10 years of age. Multicentre, randomized controlled trial. Eight UK hospital orthodontic units. Seventy-three patients were randomly allocated, stratified for gender, into an early class III protraction facemask group (PFG) (n = 35) and a control/no treatment group (CG) (n = 38). Dentofacial changes from lateral cephalograms and occlusal changes using the peer assessment rating (PAR). Self-esteem was assessed using the Piers-Harris children's self-concept scale, and the psychosocial impact of malocclusion with an oral aesthetic subjective impact scores (OASIS) questionnaire. Temporomandibular joint (TMJ) signs and symptoms were also recorded. The time points for data collection were at registration (DC1) and 15 months later (DC2). The following mean skeletal and occlusal changes occurred from the class III starting point: SNA, PFG moved forwards 1.4 degrees (CG forward 0.3 degrees; P = 0.018); SNB, PFG moved backwards -0.7 degrees (CG forward 0.8 degrees; P<0.001); ANB, PFG class III base improved +2.1 degrees (CG worsened by -0.5 degrees; P<0.001). This contributed to an overall difference in ANB between PFG and CG of 2.6 degrees in favour of early protraction facemask treatment. The overjet improved +4.4 mm in the PFG and marginally changed +0.3 mm in the CG (P<0.001). A 32.2% improvement in PAR was shown in the PFG and the CG worsened by 8.6%. There was no increased self-esteem (Piers-Harris score) for treated children compared with controls (P = 0.22). However, there was a reduced impact of malocclusion (OASIS score) for the PFG compared with the CG (P = 0.003), suggesting treatment resulted in slightly less concern about the tooth appearance. TMJ signs and symptoms were very low at DC1 and DC2 and none were reported during active facemask treatment. Early class III orthopaedic treatment, with protraction facemask, in patients under 10 years of age, is skeletally and dentally effective in the short term and does not result in TMJ dysfunction. Seventy per cent of patients had successful treatment, defined as achieving a positive overjet. However, early treatment does not seem to confer a clinically significant psychosocial benefit.

Risk factors associated with incidence and persistence of signs and symptoms of temporomandibular disorders

Objective. To analyze whether gender, self-reported bruxism, and variations in dental occlusion predicted incidence and persistence of temporomandibular disorder (TMD) during a 2-year period. Material and methods. The study population comprised 280 dental students at Umeå University in Sweden. The study design was that of a case-control study within a 2-year prospective cohort. The investigation comprised a questionnaire and a clinical examination at enrolment and at 12 and 24 months. Cases (incidence) and controls (no incidence) were identified among those without signs and symptoms of TMD at the start of the study. Cases with 2-year persistence of signs and symptoms of TMD were those with such signs and symptoms at all three examinations. Clinical registrations of baseline variables were used as independent variables. Odds ratio estimates and 95% confidence intervals of the relative risks of being a case or control in relation to baseline registrations were calculated using logistic regression analyses. Results. The analyses revealed that self-reported bruxism and crossbite, respectively increased the risk of the 2-year cumulative incidence and duration of temporomandibular joint (TMJ) signs or symptoms. Female gender was related to an increased risk of developing and maintaining myofascial pain. Signs of mandibular instability increased the risk of maintained TMD signs and symptoms during the observation period. Conclusion. This 2-year prospective observational study indicated that self-reported bruxism and variations in dental occlusion were linked to the incidence and persistence of TMJ signs and symptoms to a higher extent than to myofascial pain.

Juvenile idiopathic arthritis (JIA): a screening study to measure class II skeletal pattern, TMJ PDS and use of systemic corticosteroids

To screen patients with oligoarticular and polyarticular forms of Juvenile Idiopathic Arthritis (JIA) to determine (i) the severity of their class II skeletal pattern; (ii) temporomandibular joint signs and symptoms and (iii) use of systemic corticosteroids. Cross-sectional screening. Sixty-eight children with JIA aged between 9 and 16 years old who were screened at four regional treatment centres in the UK. Patients were screened clinically and radiographically for the presence of class II skeletal pattern and temporomandibular (TMJ) pain dysfunction syndrome. In addition, the JIA sub-type and history of disease activity and medication were recorded. Class II skeletal pattern, TMJ signs and symptoms, use of systemic corticosteroids. The mean ANB values were 4.2 degrees (SD = 2.9 degrees) in the oligoarticular group and 5.1 degrees (SD = 3.8 degrees) in the polyarticular group. Just under one-third of children had a moderate or severe class II skeletal pattern and a further quarter of children had a mild class II skeletal pattern. Clinical signs and symptoms of temporomandibular joint pain dysfunction syndrome were low (<20%), except for crepitus and click which affected between 24 and 40% of JIA children. Radiographically, 57% of oligoarticular and 77% of polyarticular cases exhibited condylar erosion. Use of systemic corticosteroids varied between centres, but overall, was prescribed more in polyarticular cases (P = 0.001). Just under one-third of oligoarticular and polyarticular JIA patients exhibited a moderate or severe class II skeletal pattern. It is, therefore, likely that any future clinical trial to investigate the effect of functional appliance treatment in JIA patients, will need multicentre co-operation to fulfil potential sample size requirements. Clinical signs and symptoms of temporomandibular joint pain dysfunction syndrome were low except for crepitus and click. However, radiographic evidence of condylar erosion was high particularly in the polyarticular group. Use of systemic corticosteroids was prescribed more in polyarticular cases and this is likely to reflect the severity of the disease.

Temporomandibular joint sounds and disc dislocations incidence after orotracheal intubation

Temporomandibular joint sounds and disc dislocations incidence after orotracheal intubation Estela T Rodrigues1, Iv&aacute;n C Suazo2, Antonio&nbsp;S Guimar&atilde;es31Centro de P&oacute;s Gradua&ccedil;&atilde;o em Odontologia S&atilde;o Leopoldo Mandic, Campinas, Brasil; 2Department of Morphology. Universidad de Talca, Talca, Chile; 3Centro de P&oacute;s Gradua&ccedil;&atilde;o em Odontologia S&atilde;o Leopoldo Mandic, Campinas, BrasilAbstract: The aim of this study was to analyze the temporomandibular joint (TMJ) disc displacement and articular sounds incidence after orotracheal intubation. A prospective cohort study was conducted in the Hospital Universit&aacute;rio do Oeste do Paran&aacute; (HUOP), in Cascavel, Brazil. 100 patients (aged 14&ndash;74 years, mean 44 years), 34 male and 66 female, in need of surgical procedure with orotracheal intubation were evaluated. The anterior disc displacement with reduction incidence and the nonclassifiable sounds incidence by the Research Diagnostic Criteria Axis I was evaluated in all patients after orotracheal intubation. The patients was evaluated one day before and until two days after the procedure. Eight percent present with anterior disc displacement with reduction and 10% presented nonclassifiable sounds after the orotracheal intubation. There was no correlation of any kind regarding gender related influence in the incidence of disc dislocations (P = 0.2591) and TMJ sounds (P = 0.487). Although anterior disc dislocations and TMJ sounds after anesthetic with orotracheal intubation presented a low incidence (8%&ndash;10%), it is recommended that the evaluation of TMJ signs and symptoms be done before the anesthetic procedure to take care with susceptible patients manipulation.Keywords: orotracheal intubation, TMJ sounds, TMJ dislocations, TMJ disorders, disc displacement, surgical procedure

Temporomandibular joint sounds and disc dislocations incidence after orotracheal intubation

The aim of this study was to analyze the temporomandibular joint (TMJ) disc displacement and articular sounds incidence after orotracheal intubation. A prospective cohort study was conducted in the Hospital Universitário do Oeste do Paraná (HUOP), in Cascavel, Brazil. 100 patients (aged 14-74 years, mean 44 years), 34 male and 66 female, in need of surgical procedure with orotracheal intubation were evaluated. The anterior disc displacement with reduction incidence and the nonclassifiable sounds incidence by the Research Diagnostic Criteria Axis I was evaluated in all patients after orotracheal intubation. The patients was evaluated one day before and until two days after the procedure. Eight percent present with anterior disc displacement with reduction and 10% presented nonclassifiable sounds after the orotracheal intubation. There was no correlation of any kind regarding gender related influence in the incidence of disc dislocations (P = 0.2591) and TMJ sounds (P = 0.487). Although anterior disc dislocations and TMJ sounds after anesthetic with orotracheal intubation presented a low incidence (8%-10%), it is recommended that the evaluation of TMJ signs and symptoms be done before the anesthetic procedure to take care with susceptible patients manipulation.

Postoperative stability of bimaxillary surgery in Class III patients with mandibular protrusion and mandibular deviation: a frontal cephalometric study

The aims of this study into bimaxillary surgery were to investigate and compare the postoperative stability of deviated side (lengthened side) and non-deviated side (shortened side), the effect of the type of surgery performed in the mandible, and the changes in signs and symptoms of temporomandibular joint (TMJ) disorders before and after surgery. The sample consisted of 31 Class III patients in whom imbalance between the maxilla and the mandible were corrected by Le Fort I osteotomy combined with bilateral intraoral vertical ramus osteotomy (BIVRO group, n = 9), bilateral sagittal split ramus osteotomy (BSSRO group, n = 10), or IVRO and SSRO (IVRO + SSRO group, n = 12). IVRO+SSRO and BIVRO are more effective in improving TMJ signs and symptoms. There was no significant post-surgical difference between deviated and non-deviated sides in any group. BIVRO and BSSRO showed excellent post-surgical stability on both sides; less was found in the IVRO + SSRO group. The IVRO + SSRO group showed greater transverse displacement in menton point than the BIVRO group. In conclusion, after bimaxillary surgery and in asymmetric patients there were no differences between deviated and non-deviated sides, BIVRO and BSSRO appear to be more stable than IVRO + SSRO.