Temporomandibular Joint Sounds Research Articles

Efficacy of Intra-articular Platelet-rich Plasma versus Hydrocortisone with Local Anaesthetic Injection in Temporomandibular Joint Disorders - A Prospective Study

Abstract Introduction: Temporomandibular joint (TMJ) is subjected to many disorders commonly termed temporomandibular disorders (TMDs) which include TMJ hypermobility, ankylosis and internal derangement. In the past, many non-invasive conservative treatment modalities were tried out for their treatment which include joint unloading, the use of anti-inflammatory agents and physiotherapy. In recent times, injections of corticosteroids and platelet-rich plasma (PRP) into the TMJ have been proposed as alternative therapeutic methods. The main objective of the prospective study was to compare the efficacy of intra-articular injection of PRP and hydrocortisone with local anaesthetic agents in reducing the symptoms in patients with TMDs. Materials and Methods: This prospective study included 30 patients with TMDs, out of which 15 patients (Group I) received PRP injections and 15 patients (Group II) received hydrocortisone with local anaesthetics for arthrocentesis in their affected joints. The patients were assessed for pain, maximum interincisal mouth opening, TMJ sound and disc displacement. Results: The pain was markedly reduced in patients who received PRP injections (Group I) as compared to those who received hydrocortisone injection (Group II). An increase in mouth opening was similar in both the groups, and TMJ sounds were reduced in patients who received PRP. Magnetic resonance imaging also showed that PRP-treated patients showed better articular disc repair than patients treated with hydrocortisone. Discussion: PRP increases chondrocyte proliferation and production of matrix molecules and helps maintain the integrity of the chondral surface, thereby facilitating joint movement, whereas corticosteroids are more potent anti-inflammatory agents and they act by inhibiting prostaglandin synthesis which is the mediator of inflammation. Thus, the use of PRP has been proven to show better results in reducing the symptoms of TMDs and also helped in articular disc repair.

The Role of Malocclusion and Oral Parafunctions in Predicting Signs and Symptoms of Temporomandibular Disorders-A Cross-Sectional Study.

The aim of this study was to examine to what extent malocclusion and parafunctional habits contribute to the development of signs and symptoms associated with temporomandibular disorders (TMD) in schoolchildren with mixed dentition in Croatia in a sample of 338 children, aged 9 to 15 years. TMD signs and symptoms assessed by the clinician were joint function and pain, masticatory muscles tenderness, range of mandibular motion, and joint sounds. To evaluate subjective symptoms and parafunctions, children and parents were asked about the presence of headaches, jaw locking, temporomandibular joint (TMJ) sounds, pain during mouth opening, or bruxism, as well as parafunctions like biting pencils or nails, chewing hard candies or ice, daily gum chewing, opening bottles with teeth, engaging in jaw play, thumb-sucking, and clenching/grinding teeth. At least one symptom of a TMD was pronounced in 142 participants (42.0%). The most commonly reported parafunction was pencil or nail biting, present in 25.1% of participants. Class II malocclusion increased the likelihood by 2.6 times, pencil or nail biting by 2.34 times, and clenching/grinding teeth by 8.9 times that the subject would exhibit at least one TMD symptom. Every child with mixed dentition should undergo a brief examination of the TMJ, especially in cases of Class II malocclusion, pencil or nail biting, and teeth clenching or grinding, as these have all been identified as significant risk factors that increase the likelihood of experiencing TMD symptoms. This highlights the need for proactive screening and assessment by healthcare providers to reduce the risk and prevalence of TMDs in affected children and ensure timely diagnosis and treatment.

Impact of professional, recreational and nonsinging on temporomandibular disorders - a comparative study based on a self-assessment questionnaire

BackgroundThis study investigates the relationship between professional and recreational singing on temporomandibular disorders (TMDs) in women compared to a nonsinging control group.MethodsA total of 288 female subjects between the ages of 18 and 45 participated in the self-assessment questionnaire including demographic data, as well as questions on vocal practice and TMDs symptoms. Depending on the singing time per week, the (non)vocalists were assigned to the groups professional (n = 96), recreational (n = 96) and nonsingers (n = 96).ResultsThe TMDs prevalence in professional singers (42%) was higher than that in recreational singers (31%) and noticeably higher than that in nonsingers (25%). The Fisher-Freeman-Halton exact test showed that the differences between the groups were not noticeable (p = .053) but could be formulated as tendencies. The professionals suffered much more from restricted jaw movement (p = .004; OR = 2.718; 95% CI = 1.409–5.242), temporomandibular joint sounds (p < .009; OR = 2.267; 95% CI = 1.264–4.064) and temporomandibular pain (p = .010; OR = 2.333; 95% CI = 1.264–4.308) than nonsingers.ConclusionsSinging might have an enhancing effect on the appearance of TMDs. In particular, professional singers suffered more from self-reported TMDs than recreational singers and nonsingers. In addition to the high level of physical workload if participating in professional singing, the psychosocial impact should be investigated more in further studies. No new treatment strategies resulted from this study, as the etiological significance of singing is still unclear. Knowledge about risk factors for multifactorial TMDs can help practitioners and patients prevent and treat TMDs.

Effect of Orthognathic Surgery on Pre-existing Temporomandibular Disorders.

The management of patients with pre-existing temporomandibular disorders (TMDs) undergoing orthognathic surgery remains a subject of ongoing debate. This study aimed to profile these individuals and evaluate the correlation between orthognathic surgery and alterations in TMD indicators and symptoms. We conducted a retrospective cohort investigation involving patients with skeletal malocclusion and established TMDs. Variables of interest encompassed the performance of orthognathic surgery, documented TMDs (including temporomandibular joint (TMJ) sounds, TMJ pain, muscle discomfort, and jaw locking), and patients' self-assessments of TMJ and muscle pain using a visual analog scale (VAS). The primary outcome measures focused on changes in TMD indicators and symptoms. Among the study cohort, 73.4% exhibited skeletal class III malocclusion, while 26.6% presented with skeletal class II malocclusion. Notably, patients classified as skeletal class III were significantly younger than their skeletal class II counterparts (mean age: 23.06±5.37 vs. 26.71±7.33; P=0.034). The most prevalent pre-existing TMD complaint was TMJ sounds (65.5%), followed by TMJ pain (39.1%), muscle discomfort (23.4%), and jaw locking (12.5%). Skeletal class II patients were more likely to experience TMJ sounds compared to skeletal class III patients (88.2% vs. 57.4%; P=0.022). Statistically significant improvements were observed in the VAS assessments among class III patients following surgery. A majority of patients with pre-existing TMDs seeking orthognathic surgery exhibited skeletal class III malocclusion and were younger than those with skeletal class II malocclusion. Importantly, orthognathic surgery was associated with positive changes in TMD indicators and symptoms in these patients.

Prevalence and Clinical Characteristics of Temporomandibular Disorders in Adults: An Epidemiological Study in the Mediterranean Region of Turkiye

The prevalence and clinical characteristics of temporomandibular disorders (TMD) in the Mediterranean region of Türkiye have not yet been thoroughly investigated. Objective: This study aimed to determine the prevalence and severity of TMD in a sample of the population in this region and to characterize the clinical findings related to TMD. Methods: Four hundred and one participants were included in this study. “Presence of TMD” in the participants was evaluated using the Fonseca Anamnestic Index. Through clinical examination, the findings in the participants were classified as limited mouth opening, deviation, temporomandibular joint (TMJ) sounds, TMJ pain, and muscle pain. Results: The prevalence of TMD was found to be 66.8%, with “Mild TMD” being the most frequent diagnosis among the participants. Clinical findings related to TMD were detected in 48.6% of the participants, and TMJ sounds were the most common clinical finding. TMD was most commonly found in participants over the age of 52, and clinical findings related to TMD were most common in participants between the ages of 25 and 38. In addition, a relationship was found between “Presence of clinical findings” and the gender and age of the participants (p &lt; 0.001 for both comparisons). Conclusion: The results show that females may be more prone to TMD than males. During clinical examinations, it should be considered that “Presence of clinical findings” may be related to gender and age.

Simultaneous Audio Recording and Magnetic Resonance Imaging of the Temporomandibular Joint

Background: Temporomandibular joint disorder is a complex disease requiring multimodal treatment and often a delayed diagnosis. Purpose: The primary objective of this study is to evaluate the feasibility of simultaneously recording joint sounds while obtaining 3-tesla cine-magnetic resonance imaging (3T cine-MRI) of the temporomandibular joint (TMJ). A secondary objective pertains to optimization of a dynamic TMJ imaging protocol to maximize image quality and speed while maintaining synchronicity. Methods: Investigators enrolled four subjects (August 2018 to August 2019) eliciting audible joint sounds during continuous open-close jaw movements during clinical evaluation at the New York University College of Dentistry. A contact fiber-optic microphone (OptiRhythm 4130, Optoacoustics, Yehuda Israel) was utilized to record joint sounds elicited with functional movements during MR dynamic imaging at NYU Langone Health and all data was recorded appropriately. Results: Results of this feasibility study demonstrate the successful integration of audio and 3-Tesla MR imaging for the TMJ in all subjects. This protocol was shown to be well-tolerated by the subjects. A precise correlation of the movement of TMJ structures within cine-MRI images and with audible observations was achieved and assessed by an experienced oral and maxillofacial surgeon and an experienced radiologist. Conclusion: This protocol for simultaneous audio/cine-MRI is a viable tool for studying TMJ health and disease. In future studies, we anticipate this protocol will ultimately refine our understanding of TMJ sounds and their relation to anatomy, physiology, and pathology. In addition, we hope to establish a diagnostic aid to guide surgical and non-surgical decision-making more precisely.

Investigating the effect of obsessive-compulsive disorder on clinical symptoms of temporomandibular joint disorders.

Temporomandibular disorders (TMD) are a group of clinical conditions involving muscles of mastication, temporomandibular joint (TMJ), and related structures or both. TMD is characterized by facial pain in TMJ and muscles of mastication, limitation or deviation of jaw movement, and TMJ sounds during jaw movement and function. The highest risk of TMD prevalence is between 18 and 24 years, and a relationship is between chronic TMD and psychological disorders such as stress and depression. The knowledge of the function of this joint and those with TMD symptoms when visiting the dentist will help to provide an ideal treatment plan for the patient. Therefore, if the therapist is familiar with the various etiological factors of this disorder, he will provide better treatment, especially if the simultaneous effect of psychological factors such as stress and obsessive-compulsive disorder (OCD) along with occlusal factors such as posterior cross-bite, overjet, and overbite is measured, it can be a valuable guide for clinicians. In this study, 385 patients were examined by DASS42 and Maudsley's test and classified into normal, with stress, and stress plus OCD groups. TMJ was examined for each of them by the TMD-RDC test. The presence or absence of TMD was noted in their file. The prevalence of TMD was 20.7% in the normal group, 30.70% in the stress group, and 44.68% in the stress and OCD group. After analyzing the data by SPSS 24 and performing analysis of variance and Duncan tests, no significant difference was found between the probability of TMD in normal and stressed groups, but the stress and OCD group has a higher chance of TMD. Although the co-occurrence of stress and OCD is associated with the prevalence of TMD, it cannot be considered a cause of TMD.

The Effect of Photobiomodulation on Temporomandibular Pain and Functions in Patients With Temporomandibular Disorders: An Updated Systematic Review of the Current Randomized Controlled Trials.

Introduction: Temporomandibular disorders (TMDs) are the most prevalent non-dental origin orofacial pain conditions affecting the temporomandibular joints (TMJs) and/or orofacial muscles. Photobiomodulation therapy (PBMT) is a conservative way to improve function and reduce symptoms in TMD patients. This systematic review was conducted to update evidence about the effects of PBMT on pain intensity, TMJ movements, electromyography (EMG) activity, pressure pain threshold (PPT), and TMJ sound in patients with TMDs. Methods: A systematic literature search was conducted in Web of Science, PubMed/Medline, and Scopus databases using appropriate keywords and specific strategies from January 2000 to September 2022. Data extraction was done based on the inclusion/exclusion criteria. Results: A total of 40 studies were included. All included studies except one provided information on pain intensity; 27 studies showed a reduction in pain intensity in PBMT groups compared to control groups. Seven out of 15 studies, which reported maximum mouth opening (MMO), showed a greater MMO in PBMT groups than in placebo groups. In addition, the figures for passive maximum mouth opening (PMMO) and active maximum mouth opening (AMMO) in all the studies reporting PMMO and AMMO were higher in PBMT groups. In eight out of ten studies, lateral movement (LM) was greater in PBMT groups. Moreover, in three studies out of four, protrusive movement (PM) was reported to be greater in the PBMT group. Four out of nine studies showed a greater PPT in the PBMT group. Reduced TMJ sounds in the PBMT group were reported in two out of five studies. In addition, in most studies, no difference in EMG activity was detected between the two groups. Conclusion: This updated systematic review showed the promising effects of PBMT on the alleviation of pain and improvement in MMO. Using the infrared diode laser with a wavelength ranging between 780-980 nm, an energy density of<100 J/ cm2, and an output power of≤500 mW for at least six sessions of treatment seems to be a promising option for treating mentioned TMDs signs and symptoms based on the previously reported findings.

Prevalence of Temporomandibular Disorders Based on a Shortened Symptom Questionnaire of the Diagnostic Criteria for Temporomandibular Disorders and Its Screening Reliability for Children and Adolescents Aged 7-14 Years.

The prevalence and adequacy of diagnostic approaches for temporomandibular disorders (TMD) in children and adolescents are still matters of debate. This study aimed to determine the prevalence of TMD and oral habits in children and adolescents aged 7-14 years and evaluate the consistency between self-reported TMD symptoms and clinical findings using a shortened Axis I of Diagnostic Criteria for TMD (DC/TMD). Children (aged 7-10) and adolescents (aged 11-14) of both sexes were invited to participate in this study (n = 1468). Descriptive statistics for all observed variables and Mann-Whitney U-Tests for the clinical examination were performed. A total of 239 subjects participated in the study (response rate 16.3%). The self-reported prevalence of TMD was found to be 18.8%. The most frequently reported oral habit was nail biting (37.7%), followed by clenching (32.2%) and grinding (25.5%). Self-reported headache increased with age, while clenching and grinding decreased. Based on the answers to the DC/TMD Symptom Questionnaire, subgroups of asymptomatic and symptomatic participants (n = 59; 24.7%) were established and randomly selected for the clinical examination (f = 30). The shortened Symptom Questionnaire showed a sensitivity of 0.556 and a specificity of 0.719 for pain during the clinical examination. Although the Symptom Questionnaire exhibited high specificity (0.933), its sensitivity (0.286) for temporomandibular joint sounds was low. Disc displacement with reduction (10.2%) and myalgia (6.8%) were the most common diagnoses. In conclusion, the self-reported prevalence of TMD in children and adolescents in this study was comparable to that reported in the literature for adults. However, the accuracy of the shortened Symptom Questionnaire as a screening tool for TMD-related pain and jaw sounds in children and adolescents was found to be low.

Clinical research on the relationship between the curve of Wilson and temporomandibular joint disorders

ObjectiveThe aim of this study was to examine the relationship between the curve of Wilson (COW) and temporomandibular joint disorder (TMD). MethodsThe study cohort comprised patients aged 19–55 with malocclusion treated at our institution from January to July 2021. They were divided into a malocclusion with TMD group (TMD group) and a malocclusion without TMD group (non-TMB group) based on the diagnostic criteria of TMD. The study outcome was the differences in COW, measured via cone beam computed tomography (CBCT), and statistical analysis was performed using one-way analysis of variance and t-test. ResultsA total of 250 adult individuals were enrolled, including 162 females (age: 36.43 ± 11.00 years) and 88 males (age: 36.33 ± 9.88 years). Compared with the non-TMB group (n = 125), the TMD group (n = 125) had a significantly greater angle of COW (first molars: P = 0.002; second molars: P < 0.001), higher buccal inclination angle of molars in those with same side temporomandibular joint (TMJ) sounds than those with TMJ sounds (first molar: P = 0.000; second molar: P = 0.006) and greater the side with TMJ sounds (first molar: P < 0.001; second molar: P = 0.016). However, no difference was observed in the buccolingual axial inclination angle of molars between patients with and without TMJ sounds. ConclusionThe study reported the differences in malocclusion patients with and without TMB, which could be used as a reference by dentists to improve the treatment outcomes of these patients.

Longitudinal trends in temporomandibular joint disorder symptoms, the impact of malocclusion and orthodontic treatment: A 20-year prospective study.

Studies on the association between malocclusion and temporomandibular joint disorder (TMD) have reported conflicting results. To determine the impact of malocclusion and orthodontic treatment on symptoms of TMD. At 12 years, 195 subjects fulfilled a questionnaire regarding TMD symptoms and participated in an oral examination including preparation of dental casts. The study was repeated at ages 15 and 32. The occlusions were assessed by applying the Peer Assessment Rating (PAR) Index. Associations between the changes in PAR scores and TMD symptoms were analysed with the chi-square test. A multivariable logistic regression was used to calculate the odds ratios (OR) and 95% confidence intervals (CI) of TMD symptoms at 32 years predicted by sex, occlusal traits and orthodontic treatment history. One in three subjects (29%) was orthodontically treated. Sex was associated with more self-reported headaches by females at 32 years (OR 2.4, 95% CI 1.05-5.4; p = .038). At all time points, any crossbite was significantly associated with greater odds for self-reported temporomandibular joint (TMJ) sounds at 32 years (OR 3.5, 95% CI 1.1-11.6; p = .037). More specifically, association occurred with posterior crossbite (OR 3.3, 95% CI 1.1-9.9; p = .030). At 12 and 15 years, boys whose PAR score increased were more likely to develop TMD symptoms (p = .039). Orthodontic treatment had no impact on the number of symptoms. Presence of crossbite may increase the risk of self-reported TMJ sounds. Also, longitudinal changes in occlusion may have an association with TMD symptoms while orthodontic treatment is not associated with the number of symptoms.

AN INNOVATIVE DEVICE FOR TMJ VIBRATION ANALYSIS

Temporomandibular joint (TMJ) sounds are an important sign of temporomandibular disorder. Vibrations of different frequencies have been linked to certain types of disorders of the TMJ. Commercially available instrumentsemployed to record the vibrations of the TMJ are expensive and impractical to purchase in a clinical setup or for educational purposes. This article describes the development of a novel, innovative and inexpensive device using a pair of accelerometers, microphones and smartphones along with a developed software for the purpose of recording and analysing the recorded data from the TMJ.

RECENT DIAGNOSTIC AIDS FOR TEMPOROMANDIBULAR DISORDERS

The diagnosis of Temporomandibular disorders (TMD) includes the physical examination of the masticatory muscles and temporomandibular joint (TMJ) through muscle palpation, palpation and auscultation of TMJ sounds, and measurement of mandibular range of motion. Imaging is considered to be a useful adjunct in the diagnosis of TMD. The recent advancement in biometric gadgets has helped in more accurate and precise diagnosis. This article reviews the recent diagnostic aids used for temporomandibular disorders

Psoriatic arthritis of the temporomandibular joint: A systematic review.

Psoriasis is an inflammatory condition brought on by the immune system. This study aimed to perform a systematic review related to psoriatic arthritis (PsA) of the temporomandibular joint (TMJ). The search strategy was developed by a radiologist expert with more than 20 years of experience. The search was performed without time restrictions in five electronic databases: PubMed, Web of Science, Embase, Scopus and Ovid. The search strategy was based on MeSH and Emtree terms. The methodological quality of the studies was rated using the quality assessment tools from the National Heart Lung and Blood Institute (NHLBI). Twenty-three publications were included, 10 being case reports. One hundred-fifty-one patients with TMJ PsA were reported. Psoriasis evolution ranged from 1.5 years to 24 years. Clinical symptoms of TMJ involvement included: TMJ pain and sounds, limited range of jaw movements, preauricular swelling, malocclusion, headache, tinnitus, neck stiffness and altered dietary function. TMJ was evaluated by magnetic resonance imaging (six studies), computed tomography (eight articles) and by ultrasonography findings (two articles). For TMJ treatment, topical and systemic medication was reported in 11 studies. Five studies included patients needing surgical procedures for TMJ ankylosis. A relationship between TMD and psoriasis has been revealed. TMJ PsA has been investigated and debated, although the radiographic findings or clinical symptoms of PsA are not noticeably different from other forms of TMJ arthritis. Conservative therapy can lead to significant improvement of TMJ function.

Relationship between Posterior Permanent Dentition Pattern and Radiographic Changes of the Mandibular Condyle.

This study assessed the relationship between posterior permanent dentition and radiographic changes of the mandibular condyle. This descriptive, cross-sectional study was conducted on 300 panoramic radiographs of patients over 40 years of age (188 females and 112 males). Panoramic radiographs were evaluated for condylar changes such as flattening, subcortical sclerosis, subcortical cyst, erosion, osteophytes, and generalized sclerosis. Presence of muscle pain and temporomandibular joint (TMJ) pain and sounds, and history of TMJ trauma were also assessed. The occlusal scheme of posterior teeth was analyzed according to the Eichner's index. The frequency of condylar changes was calculated in the right and left sides, and their association with posterior permanent dentition was analyzed by the Chi-square test (alpha = 0.05). The frequency of flattening, muscle pain, TMJ sounds, and erosion was 11.7%, 9.7%, 5.7%, and 3.7% in the right side, respectively. The frequency of flattening, muscle pain, erosion, and subcortical cyst was 12%, 9.3%, 5%, and 5% in the left side, respectively. The frequency of bilateral muscle pain, flattening, TMJ sounds, and TMJ pain was 18%, 16.7%, 11.7%, and 9.3%, respectively. Cases with TMJ trauma, generalized sclerosis, and osteophytes were few. According to the Eichner's index, most patients with condylar changes had classes A and B, and a smaller percentage had class C. No significant difference was noted between healthy individuals and those with condylar changes regarding dentition patterns. No relationship existed between condylar changes and posterior permanent dentition pattern.

The Efficacy of Ozonized Water Versus Ringer Lactate Arthrocentesis for the Treatment of Temporomandibular Joint Internal Derangement.

Temporomandibular disorders are musculoskeletal conditions characterized by facial pain and impaired temporomandibular joint function, limited mouth opening, joint and muscular pain, and noises during mandibular movements are some of the most common symptoms. The most frequent cause of temporomandibular joint dysfunction is internal derangement (ID), which refers to an alteration in the normal pathways of motion of the joint that largely involves the function of the articular disc, therefore, these alterations have been also referred to as disc derangement. Arthrocentesis is a minimally invasive technique, less expensive than surgical treatment. Adhesions are released after arthrocentesis of the upper joint space under sufficient hydraulic pressure. Intra-articular ozone gas injection is used as conservative treatment modalities for ID of the temporomandibular as it possesses anti-inflammatory, analgesic effects, enhancement the host defense mechanism and accelerates the healing process of the damaged cells. The aim of this study was to compare the effectiveness of ozonized water against lactated ringer solution in the arthrocentesis of the temporomandibular joint. Sixty patients were used in this study, suffered from ID of the temporomandibular joint treated by arthrocentesis under hydraulic pressure and were allocated into 2 groups; the study group (A), which included 30 patients, managed by arthrocentesis utilizing ozonized water and the control group (B) with 30 patients also treated by the same procedure using ringer lactate solution. Visual analog scale pain scores, temporomandibular joint sounds, and maximal mouth opening were assessed preoperatively and at different intervals postoperatively. The age in this study ranged from 14 to 66 years. The mean age of group A was 29.93 years with an SD of ±11.79. For group B, the mean age was 27.56 years and the SD was ±10.80, the prominent percentage in both groups was < 30 years. Regarding sex, 45 patients were females, whereas the males were 15 with a ratio of 3:1. Group A registered the highest reduction in the visual analog scale at all postoperative intervals. With respect to the mouth opening, there was no significant difference in maximal mouth opening between the 2 groups after 1 week and 12 weeks in comparison with the preoperative measurements. The temporomandibular joint sounds improved in all patients in group A after 12 weeks, whereas in group B the sounds dropped to 33.3%. The data from the present study suggested more favorable treatment outcomes for ozonized water lavage and it is a promising new treatment modality for the relief of symptoms associated with the ID of the temporomandibular joint.

Changes in COVID-19 Perception and in TMD Prevalence after 1 Year of Pandemic in Italy.

The study aims to report the perception of dental practices and assess the individual's psychological stress level and related temporomandibular disorders (TMD) symptoms by evaluating the changes that occurred during the year following the first lockdown (May 2020). An online questionnaire was submitted to the Italian population between 20 March and 20 April 2021. It was sent via online platforms and included 14 questions. The data were analyzed using a chi-squared test and a comparison of the current data with the May 2020 survey data was performed using independent samples t-tests. The level of significance was set at p < 0.05. Forty-three percent of subjects (872) considered the dental practice to be a place with a high risk of infection. Temporomandibular pain and joint sounds were reported by 35.7% (724) of the population; of these more frequently were women (71.8%, 520/724, p < 0.001). About 31% of the participants had moderate/severe psychological distress and, among them, it was found that 46.4% (294/634) reported TMD pain (p < 0.001) and 34.9% (221/634) complained of temporomandibular joint sounds (p < 0.001). Most participants did not consider dental practices as a place with a higher risk of coronavirus disease 2019 transmission and, in contrast to the data from a previous study, people were less afraid to go to dental practices. After the first year of the pandemic, the level of stress and depression increased and the prevalence of TMD pain and joint sounds increased, in association with gender, age, and level of distress.

Assessment of Symptoms Associated with Temporomandibular Dysfunction and Bruxism among Elderly Population: An Epidemiological Survey

The aim of the study was to assess the symptoms associated with temporomandibular disorders (TMD) and bruxism among elderly population in Ranchi, India. A cross-sectional study was done on 600 elderly subjects; data regarding the signs and symptoms associated with temporomandibular disorder and bruxism were recorded using both structured questionnaire and clinical examination. Spearman correlation analysis was done to find the association between TMD and bruxism. Out of 600 subjects, 49% were males and 51% were females. The overall prevalence of TMD-related symptoms like temporomandibular joint (TMJ) pain, difficulty in jaw opening, TMJ sounds, and bruxism were 10.5, 11.2, 14, and 17% among elderly subjects. TMD symptoms and bruxism were relatively more commonly seen among females when compared to males. According to logistic regression (significantly correlated independent variables, i.e., TMD symptoms among analyzed variables), the dependent variable like bruxism had highest odds ratio, i.e., 8 for 60-70 years age-group and 15.1 for 70-80 year age-group. There was a lesser prevalence of symptoms related to TMD and bruxism among the study population, and bruxism had the highest odds ratio in TMD between the analyzed variables. Human aging contributes too many oral problems, while resolving these, the felt needs of the population are sometimes ignored which adds up to the growing list of issues. Studies have shown inconclusive evidence regarding the prevalence of symptoms related to TMD and bruxism as these are known to trouble elderly populations.

Temporomandibular Joint Acoustic Emissions in Children With Juvenile Idiopathic Arthritis Differ From Those in Healthy Children

Articulation of the temporomandibular joint (TMJ) generates sounds with specific characteristics known as joint acoustic emissions (AEs). The purpose of this project was to determine if AEs as described by the joint health score (JHS) in children with juvenile idiopathic arthritis (JIA) differ from AEs in healthy children. The investigators implemented a cross-sectional study with age- and sex-matched controls to compare AEs from 4 groups: (1) healthy subjects without TMJ sounds, (2) healthy subjectswith TMJ sounds, (3) subjects with JIA without TMJ sounds, and (4) subjects with TMJ sounds. Predictor variables were JIA status (ie JIA/healthy) and joint sounds (present/absent). The outcome variable was AEs. Subjects wore a specialized headset and performed specific jaw movements that generated AEs. AEs were recorded and analyzed using an aggregated decision tree classification model that calculates a JHS for each group. JHSs were compared using a receiver operating characteristic curve and classification accuracies. The study team used a 2-tailed unpaired t-test to determine if score distributions were different. Significance was P<.05. A total of 51 subjects (102 TMJs; 37 females) with an average age of 13.1years (range, 7 to 18) participated. Children with JIA and TMJ sounds had AEs with large repetitive clicks. Children with JIA without sounds had smaller repetitive clicks. Healthy children had grinding sounds with lower amplitude. The receiver operating characteristic curve had a classification accuracy of 71.6%. This accuracy compares against the gold standard clinical assessment for placing these patients into their groups (JIA vs healthy). JHSs of children with TMJ sounds and children with JIA and TMJ sounds were statistically significant (P<.0001). In our sample, the AE of TMJs in healthy children may be different than that in children with JIA. Assessment of an AE is a promising and noninvasive technique to determine involvement of TMJs in children with JIA.

New Methods for the Acoustic-Signal Segmentation of the Temporomandibular Joint.

(1) Background: The stethoscope is one of the main accessory tools in the diagnosis of temporomandibular joint disorders (TMD). However, the clinical auscultation of the masticatory system still lacks computer-aided support, which would decrease the time needed for each diagnosis. This can be achieved with digital signal processing and classification algorithms. The segmentation of acoustic signals is usually the first step in many sound processing methodologies. We postulate that it is possible to implement the automatic segmentation of the acoustic signals of the temporomandibular joint (TMJ), which can contribute to the development of advanced TMD classification algorithms. (2) Methods: In this paper, we compare two different methods for the segmentation of TMJ sounds which are used in diagnosis of the masticatory system. The first method is based solely on digital signal processing (DSP) and includes filtering and envelope calculation. The second method takes advantage of a deep learning approach established on a U-Net neural network, combined with long short-term memory (LSTM) architecture. (3) Results: Both developed methods were validated against our own TMJ sound database created from the signals recorded with an electronic stethoscope during a clinical diagnostic trail of TMJ. The Dice score of the DSP method was 0.86 and the sensitivity was 0.91; for the deep learning approach, Dice score was 0.85 and there was a sensitivity of 0.98. (4) Conclusions: The presented results indicate that with the use of signal processing and deep learning, it is possible to automatically segment the TMJ sounds into sections of diagnostic value. Such methods can provide representative data for the development of TMD classification algorithms.