Temporomandibular Pain Dysfunction Research Articles

Pain and salivary biomarkers of stress in temperomandibular disorders were affected by maxillary splints.

Longitudinal intervention studies on treatment options in temporomandibular dysfunction (TMD) including self reports and salivary biomarkers of stress are rare and the exact therapeutic function of occlusal splints widely unknown. We examined the therapeutic effects of a Michigan splint with occlusal relevance in patients with TMD using a placebo-controlled, delayed-start design. Two intervention groups received a Michigan splint, while one of them had a placebo palatine splint for the first 3 weeks. We collected pain intensities (at rest and after five occlusal movements), salivary measures associated with stress (cortisol and alpha-amylase) and self-reported psychological distress (stress, anxiety, catastrophizing) at baseline and 3 and 7 weeks after onset of intervention. At baseline, we observed increased pain intensity and psychological distress in TMD patients compared to 11 matched healthy controls. Baseline anxiety was linked to movement pain intensity through stress. Over therapy reductions in pain intensity and morning cortisol were more pronounced in those patients starting immediately with the Michigan splint, while psychological distress decreased similarly in both groups. Our results suggest that perceived stress plays a role for the association between anxiety and TMD pain and underlines the need for an interdisciplinary perspective on the pathogenesis and therapy of TMD in a setting where psychotherapeutic knowledge is still scarce or rarely applied.

Pattern of Temporomandibular Pain Dysfunction Syndrome

Aim: The aim of this analysis was to understand the pattern of temporomandibular pain dysfunction syndrome among patients with TMPDS. Study Design: A descriptive cross-sectional study. Place and Duration: In the department of Oral and Maxillofacial Surgery, PIMS Hospital, Islamabad and Punjab Dental Hospital, Lahore for duration of Four months from 16th January 2021 to 15th May 2021. Methods: A total of 46 patients with a clinical demonstration of TMPDS were enrolled in the analysis. Data was collected on demographic characteristics, major ailments, etiology, history of stress and depression. Results: In this study, 18 (39.1%) of the 46 patients were male and 28 (68.9%) females. 17 to 70 years was the age range of patients with 24.3 ± 12.9 years mean age and 20 (43.5%) subjects in the 10-19 age group and then 9 (19.6%) patients in the 20-29 age group and 3 (6.5%) was observed in the 60-69 age group. Regarding the main complaint, pain was the most prevalent complain noticed in 34(73.9%) subjects. 7 (15.2%) patients reported click, limited mouth opening was observed in 5 patients (10.9%). Etiology was caused by facial trauma in 8 (17.4%) of 46 subjects and only 3 person (6.4%) reported Bruxism. Twelve patients (26.1%) have stress as the only etiology. Collectively stress was testified in 21 subjects (45.6%). The etiology could not be established in 14 (30.4%) patients. Nine stressed people used psychiatric medications for clinical depression (19.6%). Conclusions: In our analysis, TMPD was common in women with 25 years mean age. The most common underlying complaint was pain. Stress was the communal primary etiology. Also 23% have Clinical depression in stressed people. Keywords: Temporomandibular pain dysfunction syndrome, Stress, Pain.

A novel rat model of temporomandibular disorder with improved face and construct validities

AimsTemporomandibular disorders are a cluster of orofacial conditions that are characterized by pain in the temporomandibular joint (TMJ) and surrounding muscles/tissues. Animal models of painful temporomandibular dysfunction (TMD) are valuable tools to investigate the mechanisms responsible for symptomatic temporomandibular joint and associated structures disorders. We tested the hypothesis that a predisposing and a precipitating factor are required to produce painful TMD in rats, using the ratgnawmeter, a device that determines temporomandibular pain based on the time taken for the rat to chew through two obstacles. Materials and methodsIncreased time in the ratgnawmeter correlated with nociceptive behaviors produced by TMJ injection of formalin (2.5%), confirming chewing time as an index of painful TMD. Rats exposed only to predisposing factors, carrageenan-induced TMJ inflammation or sustained inhibition of the catechol-O-methyltransferase (COMT) enzyme by OR-486, showed no changes in chewing time. However, when combined with a precipitating event, i.e., exaggerated mouth opening produced by daily 1-h jaw extension for 7 consecutive days, robust function impairment was produced. Key findingsThese results validate the ratgnawmeter as an efficient method to evaluate functional TMD pain by evaluating chewing time, and this protocol as a model with face and construct validities to investigate symptomatic TMD mechanisms. SignificanceThis study suggests that a predisposition factor must be present in order for an insult to the temporomandibular system to produce painful dysfunction. The need for a combined contribution of these factors might explain why not all patients experiencing traumatic events, such as exaggerated mouth opening, develop TMDs.

Prevalence of Sign and Symptoms of Temporomandibular Joint Disorders in Pakistani Population at Sheikhupura, Lahore: A Gender comparison

Background: Temporomandibular disorders have been considered as a common orofacial pain condition. The term temporomandibular pain dysfunction (TMPD) is used synonymously with myofacial pain dysfunction disorder/syndrome, temporomandibular disorder, craniomandibular disorder and many other terms. Objective: To evaluate the prevalence of signs and symptoms of temporo-mandibular joint disorder (TMD). Study Design: Descriptive cross-sectional study Place and Duration of Study: Department of Oral and Maxillofacial Surgery, Faryal Dental College, Sheikhupura , Lahore, Pakistan from 1st February 2019 to 31st May 2021. Methodology: One hundred adolescents aged 15 to 60 years were enrolled. A detailed history about the chief complaint was taken and clinical examination was done. Temporomandibular joint examination performed included Auscultation for temporomandibular joint sounds like clicking and crepitus and palpation of both TMJs and associated muscles for evaluation of pain. Results: The most common signs of temporomandibular joint disorders were temporomandibular joint pain 78%, temporomandibular joint clicking 53% and trismus 29%. The most prevalent predisposing factors of temporomandibular joint disorders were parafunctional habits 40%, unknown factors 23% and history of road traffic accident/history of difficult extractions 9%. Male to female ratio showed female predominance (P = 0.001). Conclusion: Signs and symptoms of temporomandibular joint disorders were prevalent in Pakistani population with a clear female predominance. Key words: Temporomandibular disorders, Temporomandibular joint, Orofacial pain, Bruxism, Headache, Pain

Self-reported symptoms of temporomandibular pain and jaw dysfunction in adolescents are associated with exposure to violence.

Temporomandibular disorders (TMDs) are multifactorial, and high levels of stress seem to increase symptoms. The association with exposure to violence has not been explored in adolescent populations. To examine the association of self-reported symptoms of temporomandibular pain and jaw dysfunction with child physical abuse, intimate partner violence, forced sexual intercourse, and bullying victimisation. An epidemiological, cross-sectional, school-based study was conducted in Olinda, northeast Brazil. The sample comprised 2,431 adolescents aged 14-19years. TMD-related symptoms and exposure to violence were assessed with questions from the 3Q/TMD screener and queries on exposure to different forms of violence. Multilevel logistic regressions were conducted to evaluate how 3Q screen-positive responses are associated with self-reported exposure to violence. Self-reported TMD-related symptoms had a prevalence of 40.5%. Significantly more females than males screened positive to all 3Q/TMD questions (p<.001). Adolescents experiencing intimate partner violence (p=.012) and bullying (p<.001) had significantly higher odds of 3Q positive responses than those who reported no exposure to violence. Significant associations of TMD-related symptoms with forced sexual intercourse (p=.014) and with bullying (p=.007) were observed. Adolescents with self-reported symptoms of temporomandibular pain and jaw dysfunction were significantly more often exposed to some type of violence. The number of adolescents reporting TMD-related symptoms increased in a dose-response manner with the number of violence forms the individual had experienced.

Chronic pain and depression as factors associated with temporomandibular dysfunction in older adults with Parkinson's disease

ABSTRACT Purpose: to investigate whether chronic pain and depression are factors associated with temporomandibular dysfunction (TMD) in older adults with Parkinson's disease. Methods: a cross-sectional study using the Research Diagnostic Criteria for Temporomandibular Disorders questionnaire. The clinical variables studied were chronic pain, depression, nonspecific physical symptoms including and excluding items of pain, and dentures use. The associations between the dependent and independent variables were evaluated by the chi-square odds ratio, with a 95% confidence interval. Results: a total of 81 older adults met the eligibility criteria - 67% were males, 74% were married or had a partner, 43% reported earning 1 to 2 minimum wages, and 47% were in the moderate stage of Parkinson's disease. TMD was identified in 22% of the sample, 12% reporting chronic pain. The statistical analysis showed an association between TMD and chronic pain (p = 0.001, OR = inf, 95% CI = 12.13 - inf) and between TMD and moderate-to-severe depression (p = 0.014, OR = 4.8, 95% CI = 1.14 - 23.51). Conclusion: it was verified that chronic pain and moderate-to-severe depression were the factors associated with TMD in older adults presented with Parkinson's disease.

Use of non-invasive neuromodulation in the treatment of pain in temporomandibular dysfunction: preliminary study

ABSTRACT BACKGROUND AND OBJECTIVES: In temporomandibular disorder, the pain is a very present and striking symptom, with a tendency to chronicity, through mechanisms of maladaptive neuroplasticity. In the face of this, transcranial direct current stimulation appears as a possible strategy for the treatment of chronic pain in the temporomandibular disorder. This study aimed to evaluate the efficacy of anodal transcranial direct current stimulation in the pain symptoms and anxiety levels in individuals with chronic myofascial temporomandibular disorder. METHODS: The participants received three different types of intervention in a randomized order: anodic in the primary motor cortex, in the dorsolateral prefrontal cortex and sham stimulation. RESULTS: There were significant improvements in clinical pain in all stimulation protocols, with a relief of approximately 40% (p=0.001). There was no significant difference in the effect of the transcranial direct current stimulation between the different types of stimulation (p=0.14). There was a positive impact on anxiety symptoms, leading to a significant decrease in state anxiety levels (p=0.035) and trait (p=0.009). CONCLUSION: The use of the transcranial direct current stimulation improved the health status of patients with chronic myofascial temporomandibular disorder, promoting pain relief, decreased level of anxiety, and quality of life.

Effects of different photobiomodulation dosimetries on temporomandibular dysfunction: a randomized, double-blind, placebo-controlled clinical trial.

Changes involving temporomandibular joint, masticatory musculature, and associated structures characterize temporomandibular dysfunction (TMD). The analgesic and anti-inflammatory effect produced by photobiomodulation has contributed to pain relief and functional improvement. However, the parameters to be used have not yet been well established. The aim of this study is to compare the efficacy of three different photobiomodulation dosimetries in the treatment of patients with TMD. A randomized, double-blind, placebo-controlled clinical trial with 44 subjects divided into the groups 8J/cm2 (n = 11), 60J/cm2 (n = 11), 105J/cm2 (n = 11), and control (n = 11). Pain, symptom severity, and joint mobility were evaluated before and after a ten-session protocol of photobiomodulation with AlGaAs laser (830nm), at a power density of 30mW/cm2. The mouth opening increased in the 8-J/cm2 group from 10.49 ± 4.68 to 15.40 ± 6.43 degrees, and in the right protrusion from 9.80 ± 4.2 to 12.56 ± 5.40 degrees after the intervention protocol (p < 0.05). All groups significantly decreased pain (p < 0.05). 830-nm laser photobiomodulation was effective in reducing TMD pain and symptoms at all doses tested. Only the doses of 8J/cm2 were effective regarding maximal opening and protrusion of the mandible.

In quest of the longest-lasting and most annoying pain for patients and for dentists. Quantitative and qualitative characteristics of temporomandibular myofascial pain dysfunction syndrome – a questionnaire study

BackgroundDysfunctions in the face, due to the psychological importance of the structures in the face and head, have long been a subject of interest for researchers exploring issues concerning health-related quality of life. The surprising results of previous clinical trials for myofascial pain dysfunction syndrome of the temporomandibular joints encouraged the present authors to plan a study focused on obtaining systematic knowledge of the issue.Participants and procedureThe study included 26 patients of the Masticatory System Disorders Laboratory of the Dental Prosthetic Clinic at the Jagiellonian University Medical College diagnosed with the painful form of muscle-related functional masticatory organ disorders. The study was part of a larger research project. The data to be analysed for this article was obtained in the course of a single questionnaire survey conducted prior to the start of the treatment process.ResultsThe results showed the quantitative characteristics of pain experiences in the clinical group, observed in the context of the circadian dynamics, psychophysical factors, and the location of pain, as well as their quality characteristics. The analyses showed negative covariances of the quality of life perceived by patients and the length of periods without pain, pain intensifying factors, and emotional image of pain. The strongest pain experienced by the patients negatively correlated with the quality of life related to the sphere of physical pain and mental distress, whereas the weakest pain correlated with the quality of life related to the social sphere. The lower quality of life occurred together with the frontal, zygomatic, mental, parotideomasseteric, and occipital region.ConclusionsIt is necessary to further analyse the issue on a larger sample in order to explain and clarify the obtained results.

Mental disorders in patients with temporomandibular pain-dysfunction syndrome

IntroductionMaxillofacial surgeons and dentists often deal with the phenomenon of temporomandibular pain-dysfunction syndrome–painful condition of maxillofacial area without clear organic pathology. Psychiatric studies of this disorder are almost lacking. The aim of this study was to determine the prevalence of psychiatric disorders in patients with temporomandibular pain-dysfunction syndrome and to define the psychiatric diagnosis (ICD-10).MethodsStudy sample consists of 57 patients (44 women and 13 men) with temporomandibular pain-dysfunction syndrome aged older than 18 years, who gave inform consent. The study used clinical psychopathological, psychometric (HADS, HDRS, State-Trait Anxiety Inventory, Hypochondria Whitley Index, Visual Analog Scale for Pain).ResultsPsychiatric disorders were revealed in 48 patients (84.2%) with temporomandibular pain-dysfunction syndrome–39 women and 9 men aged 18-65 years (mean age 39.6 ± 15.4 years). Affective disorders was diagnosed in 56.3%, personality disorders in 20.8%, schizotypal personality disorder in 12.5% and schizophrenia in 10.4%. Among affective pathology mild and moderate depressive episodes prevailed (59.3%). The severity of pain (VAS) in patients with affective disorders was higher than in patients with other psychiatric conditions.ConclusionThis study shows high prevalence of psychiatric disorders in patients with temporomandibular pain-dysfunction syndrome and proves the feasibility of a psychiatrist participate in the complex treatment of these patients. The use of psychometric method allows to improve the timeliness of the detection of patients who require further clinical psychopathological examination in order to determine the need of pharmacotherapy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

MATHEMATICAL MODELING IN PREDICTION OF TMJ PAIN DYSFUNCTION SYNDROME

The study presents technology of the development of formalized forecasting model of the risk group for temporomandibular pain dysfunction syndrome on the basis of a systemic analysis of multivariate rapid screening questionnaire for prevalence rate of etiological and amnesic predisposing factors and manifestations of TMJ pain dysfunction syndrome. Formalized model allows us to identify an individual consulting and diagnostic itinerary of the subject, to diagnose the cause of abnormalities in the biomechanical system, to conduct timely correction, and to start the treatment. Aim - development of affordable formal risk prediction method for predicting the development of TMJ pain dysfunction syndrome. Materials and methods. The subjects of the study were 94 respondents, 34 men and 60 women aged from 18 to 57 years, chosen by accidental sampling. The following methods were used: sociological (rapid screening questionnaire), systemic multivariate analysis, regression analysis, mathematical modeling. The study was conducted with consistent integration of rapid screening questionnaire data of clinically healthy research subjects and those with signs of TMJ dysfunction, who did not complain and did not seek dental advice concerning the changes in the TMJ. Integration was carried out by multivariate systemic analysis of personal data and the assessment of changes in the dentition of all the subjects of the sampling. The two components were taken into account in the survey system corresponding to the two data blocks: "causes" and "effects". Information from the subjects of study was obtained by the principle of dichotomous presentation, during which the test subjects noticed the presence or absence of a specific sign (symptom) in the dentition. Results. Boundary values of the integral system status indicator (min Xbi = 0,04 + 0,01, max 0,11 + 0,04) were calculated, whereby the test subject can be attributed to the risk group for the causes and predisposing factors or the first manifestation of symptoms of TMJ pain dysfunction syndrome. Conclusion. The subjects of the research with the values of the integral index falling within the confidence interval boundary values of the modified system (from Xbi = 0,04 ± 0,01 to Xbi = 0,11 ± 0,04) require determination of an individual trajectory of system correction.

Temporomandibular pain and jaw dysfunction at different ages covering the lifespan--A population based study.

Temporomandibular pain and jaw dysfunction can have a negative effect on daily life, but these conditions are not well recognized in the health care systems. The general aim was to examine the cross-sectional prevalence of frequent temporomandibular pain and jaw dysfunction in men and women across the lifespan. The analysis was based on data from 137,718 individuals (mean age 35years, SD 22.7) who answered three questions (3Q/TMD) included in the digital health declaration in the Public Dental Health care in the county of Västerbotten, Sweden; Q1: 'Do you have pain in your temple, face, jaw or jaw joint once a week or more?'; Q2: 'Does it hurt once a week or more when you open your mouth or chew?'; and Q3: 'Does your jaw lock or become stuck once a week or more?' The prevalence of frequent temporomandibular pain (Q1) was 5.2% among women and 1.8% among men (p<0.0001). The prevalence of frequent pain on jaw movement (Q2) was 2.5% among women and 0.9% among men (p<0.0001). The prevalence of frequent locking of the jaw (Q3) was 2.7% among women and 1.2% among men (p<0.0001). The study shows that the cross-sectional prevalence of temporomandibular pain and jaw dysfunction varies during the lifespan. For men and women, respectively, symptoms increase during adolescence, peak in middle age and then gradually diminish. The prevalence of these symptoms is significantly higher among women except from the first and last decades of a 100-year lifespan.

EDGE Task Force on Head and Neck Cancer Outcomes: A Systematic Review of Outcome Measures for Temporomandibular-related Dysfunction

Background: Patients with head and neck cancer (HNC) often experience significant postoperative limitations in temporomandibular joint (TMJ) function, facial pain, reduced nutritional intake, speech impairments, and compromised activities of daily living due to side effects of cancer treatment. Physical therapists treating these individuals must use valid and reliable patientreported outcome measures to quantify change related to physical therapy intervention for the TMJ. Purpose: As part of the activities of the Oncology Section EDGE Task Force on Head and Neck Cancer Outcomes, we report evidence-based recommendations for patient-reported outcome measures for individuals with HNC-related temporomandibular dysfunction (TMD). Methods: A systematic literature review of TMD-related patient-reported outcome measures that are clinically feasible and relevant to the HNC patient population was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model. Recommendations are based on the quality of psychometric properties, clinical utility, and previous use in HNC-related research. Twenty-two outcome measures were selected for review; 4 received a rating of 3, “recommended” for use in the HNC population. Conclusions: A variety of outcome measures have been reported in the literature for individuals with HNC-related TMD. Four measures, the Graded Chronic Pain Scale, 8 and 20-item Jaw Functional Limitation Scale and TMD Pain Screener, are recommended for clinical use by the researchers on this task force although it is important to note psychometric properties specific to the HNC population are lacking. Systematic Review Registration Number: PROSPERO CRD42013004898

Upper cervical range of motion is impaired in patients with temporomandibular disorders

Aims:Clinicians increasingly suggest assessment and treatment of the cervical spine in patients with temporomandibular dysfunction (TMD); however, few studies have investigated upper cervical spine mobility in people who suffer from TMD. The purpose of this study was to investigate whether patients with TMD pain (with or without headache) present with upper cervical spine impairment when compared with asymptomatic subjects.Methodology:A single blind examiner evaluated cervical range of motion (ROM) measures including axial rotation during the flexion–rotation test (FRT) and sagittal plane ROM. Twenty asymptomatic subjects were compared with 37 subjects with pain attributed to TMD, confirmed by the Revised Research Diagnostic Criteria. Subjects with TMD were divided according to the presence of headache (26 without headache TMDNHA, 11 with headache TMDHA). One-way analysis of variance and planned orthogonal comparisons were used to determine differences in cervical mobility between groups. All subjects with TMD were positive on the FRT with restricted ROM, while none were in the control group.Results:The analysis of variance revealed significant differences between groups for the FRT F(2,54) = 57·96, P<0·001) and for sagittal ROM [F(2,54) = 5·69, P = 0·006]. Findings show that the TMDHA group had less axial rotation than group TMDNHA, and both TMD groups had less ROM than controls. For sagittal ROM, the only difference was between group TMDHA and controls.Conclusions:Subjects with TMD had signs of upper cervical spine movement impairment, greater in those with headache. Only subjects with TMD and headache had impairment of cervical spine sagittal plane mobility. This study provides evidence for the importance of examination of upper cervical mobility determined by the FRT in patients who suffer from TMD.

Correlation between TMD and cervical spine pain and mobility: is the whole body balance TMJ related?

Temporomandibular dysfunction (TMD) is considered to be associated with imbalance of the whole body. This study aimed to evaluate the influence of TMD therapy on cervical spine range of movement (ROM) and reduction of spinal pain. The study group consisted of 60 patients with TMD, cervical spine pain, and limited cervical spine range of movements. Subjects were interviewed by a questionnaire about symptoms of TMD and neck pain and had also masticatory motor system physically examined (according to RDC-TMD) and analysed by JMA ultrasound device. The cervical spine motion was analysed using an MCS device. Subjects were randomly admitted to two groups, treated and control. Patients from the treated group were treated with an occlusal splint. Patients from control group were ordered to self-control parafunctional habits. Subsequent examinations were planned in both groups 3 weeks and 3 months after treatment was introduced. The results of tests performed 3 months after the beginning of occlusal splint therapy showed a significant improvement in TMJ function (P > 0.05), cervical spine ROM, and a reduction of spinal pain. The conclusion is that there is a significant association between TMD treatment and reduction of cervical spine pain, as far as improvement of cervical spine mobility.

Association of temporomandibular dysfunction with the 102T-C polymorphism in the serotonin receptor gene in Brazilian patients

IntroductionSerotonin is a key neurotransmitter in the central nervous system. It has been suggested that serotoninergic dysfunction mediates the pathophysiology of temporomandibular dysfunction (TMD). Polymorphisms in the serotonin receptor gene (HTR2A) can alter its transcription, affecting the number of receptors in the serotoninergic system, altering nociceptive pain and hyperalgesia in TMD. The aim of this study is to investigate the association of the 102T-C polymorphism in the HTR2A gene in Brazilian patients with TMD.Material and methodsThis cross-sectional study examined 100 patients, of both genders, with TMD as index cases and 100 healthy volunteers as controls, also of both genders. DNA was extracted from peripheral blood leukocytes, and the site that encompassed the polymorphism in the HTR2A gene was amplified by polymerase chain reaction followed by restriction fragment length polymorphism (PCR-RFLP).ResultsOur results revealed that there were significantly more females among index cases compared with the control group (p < 0.05). The CC genotype of the 102T-C polymorphism was more frequent in patients with TMD vs. controls (OR: 2.25; 95% CI: 1.13–4.46; p < 0.05).ConclusionsThe present study supports the view that the 102T-C polymorphism in the HTR2A gene is associated with TMD in this studied Brazilian population.

Hot towel massage relieved a 7 years orofacial pain – a case report

Introduction: Diagnosis and management of orofacial pain of non-odontogenic origin has always been a challenge to dentists. Inaccurate diagnosis would result in delay of treatment and in cases of orofacial pain, affects patient’s quality of life. Temporomandibular pain dysfunction syndrome is the most common temporomandibular disorder that presents to dental clinics. Trigeminal neuralgia, also known as tic douloureux is a relatively rare condition that causes electric shock-like pain when the trigger zone is stimulated by triggering factor. Case report: A case of temporomandibular pain dysfunction syndrome in a 52 years old Indian lady that was managed as trigeminal neuralgia for 7 years is presented. Conclusion: The aim of this case report is to make dentists aware of the signs and symptoms of different orofacial pain, so that early and accurate diagnosis can be made and appropriate treatment instituted.

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.

Adaptação da CR10 à língua portuguesa para mensurar dor em disfunções têmporo-mandibulares

An adapted CR10 scale to Portuguese language was applied with Visual Analogue Scale in 121 patients with Temporomandibular Dysfunction (TMDs). We investigated the validatation of this CR10 scale for measuring spontaneous pain, pain during orofacial function and pain during palpation exam; and we established norms for this measure. The pain was reported as moderate mainly and the coefficients of correlation indicated that adapted CR10 is valid to measure pain in TMDs.

Outcome of therapy in the conservative management of temporomandibular pain dysfunction disorder

summary The present study considered predictors of the outcome of treatment for temporomandibular pain dysfunction disorder (TMPD). Thirty-seven patients were assessed with objective and self-report measures of physiological and psychosocial aspects of this disorder at initial assessment and at 6-month follow-up subsequent to conservative physical therapy. Patients were subdivided into slow and rapid responders to conservative physical therapy based on self-reported level of improvement. Measures employed included the Temporomandibular Pain Dysfunction Disorder Questionnaire and the Temporomandibular Pain Dysfunction Disorder Clinical Form. Eighty-one per cent of patients showed a 50% or greater improvement in pain severity at follow-up, with minimal differential changes across the two groups found in the physiological symptoms, while the rapid responding group showed greater improvement in terms of psychosocial factors. These findings indicated that psychosocial factors, particularly coping strategies and illness behaviour, cannot be ignored in the management of TMPD.