TMJ Signs Research Articles

Development and Validation of a Magnetic Resonance Imaging-Based Machine Learning Model for TMJ Pathologies.

The purpose of this study was to propose a machine learning model and assess its ability to classify TMJ pathologies on magnetic resonance (MR) images. This retrospective cohort study included 214 TMJs from 107 patients with TMJ signs and symptoms. A radiomics platform was used to extract (Huiying Medical Technology Co., Ltd., China) imaging features of TMJ pathologies, condylar bone changes, and disc displacements. Thereafter, different machine learning (ML) algorithms and logistic regression were implemented on radiomic features for feature selection, classification, and prediction. The following radiomic features included first-order statistics, shape, texture, gray-level cooccurrence matrix (GLCM), gray-level run length matrix (GLRLM), and gray-level size zone matrix (GLSZM). Six classifiers, including logistic regression (LR), random forest (RF), decision tree (DT), k-nearest neighbors (KNN), XGBoost, and support vector machine (SVM) were used for model building which could predict the TMJ pathologies. The performance of models was evaluated by sensitivity, specificity, and ROC curve. KNN and RF classifiers were found to be the most optimal machine learning model for the prediction of TMJ pathologies. The AUC, sensitivity, and specificity for the training set were 0.89 and 1, while those for the testing set were 0.77 and 0.74, respectively, for condylar changes and disc displacement, respectively. For TMJ condylar bone changes Large-Area High-Gray-Level Emphasis, Gray-Level Nonuniformity, Long-Run Emphasis Long-Run High-Gray-Level Emphasis, Flatness, and Volume features, while for TMJ disc displacements Average Intensity, Sum Average, Spherical Disproportion, and Entropy features, were selected. This study has proposed a machine learning model by KNN and RF analysis on TMJ MR images, which can be used to classify condylar changes and TMJ disc displacements.

Temporomandibular Disorders and Oral Features in Idiopathic Inflammatory Myopathies (IIMs) Patients: An Observational Study.

Aim: Inflammatory idiopathic myopathies (IIMs) are inflammatory processes affecting skeletal musculature and extramuscular organs. Temporomandibular disorders (TMD) involve jaw muscles and temporomandibular joint. The aim of this observational study was to investigate the prevalence of the main TMD symptoms and signs as well as oral implications in IIM patients.Methods: The study group included 54 patients (42 women and 12 men), 22 of whom affected by dermatomyositis (DM), 29 by polymyositis (PM) and 3 by inclusion body myositis (IBM). A group of 54 patients not affected by this disease, served as CG. Oral and TMD signs and symptoms were evaluated by means of a questionnaire and through clinical examination.Results: About oral symptoms, the study group complained more frequently dysgeusia, with loss of taste or unpleasant taste (p<0.0001) and feeling of burning mouth (9.4% versus 0 controls). Xerostomia was more prevalent in the study group respect to the CG (p<0.0001). Dysphagia was reported by 48.1% of IIM patients while was absent in CG (p<0.0001). About oral signs, cheilitis (p<0.05) and oral ulcers (p<0.05) were significantly more frequent in CG. As regard to TMD symptoms, arthralgia and tinnitus didn't showed significant differences between the two groups, while neck/shoulders and masticatory muscle pain was significantly more referred in IIM patients than in the CG (p<0.05). About TMJ signs, sounds were overlapping in the two groups: click=11.1% in both IIM patients and CG (p>0.05), crepitation in 11.1% of IIM and 9.3% of controls (p>0.05). No significant difference was detected about deflection (9.3%, p>0.05), while deviation was wider in CG (p<0.05). Active opening and lateralities showed no significant differences, while endfeel was significantly increased in IIM group for a higher presence of muscular contracture. Bruxism was present only in CG.Conclusion: The data collected from this observational study seem to support the existence of a relationship between the prevalence of TMD symptoms and signs as well as oral features in patients with myositis. A remarkable reduction of salivary flow and dysphagia were more frequent and severe in IIM patients, as well as muscle contracture and myofacial pain evoked by palpation, this result being highly significant.

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.

Temporomandibular joint health status in war veterans with post-traumatic stress disorder.

Background and Aim:The objective of this study was to determine the prevalence of signs and symptoms of temporomandibular joint dysfunction (TMJD) in the Iran/Iraq war veterans suffering from post-traumatic stress disorder.Materials and Methods:A total of 120 subjects in the age range of 27 to 55 years were included; it included case group (30 war veterans with PTSD) and three control groups (30 patients with PTSD who had not participated in the War, 30 healthy war veterans, and 30 healthy subjects who had not participated in the War). All subjects underwent a clinical TMJ examination that involved the clinical assessment of the TMJ signs and symptoms.Results:The groups of veterans had high prevalence of TMJD signs and symptoms vs. other groups; history of Trauma to joint was significantly higher in subjects who had participated in the war compare with subjects who had not participated in the war (P = 0.0006). Furthermore, pain in palpation of masseter, temporal, pterygoideus, digastric, and sternocleidomastoid muscles in the groups of veterans was significantly greater than other groups (P < 0.0001). Clicking noise during mouth chewing was significantly different between groups (P = 0.01). And, there was significant difference in the frequencies of maximum opening of the mouth between groups (P = 0.001).Conclusion:The results of this study showed that subjects’ war veterans with PTSD have significantly poorer TMJ functional status than the control subjects.

연령에 따른 턱관절장애의 증상과 징후의 유병률

Previous studies of the relationship of TMJ signs and symptoms in elderly people have provided inconsistent findings. The objective of this study was to retrospectively analyze the prevalence of signs and symptoms of temporomandibular disorders(TMD). Additionally, young subjects were examined as a control group. Forty old patients (28 female, 12 male, mean age: 65.2±2.5 years) and forty young patients (30 female, 10 male, mean age: 23.3±2.6 years) clinically diagnosed with TMD were screened. Patient records were analyzed regarding: pain on chief complain, amount of range of mouth opening, TMJ noises(clicking sounds, crepitus), pain on palpation of the TMJ and masticatory muscles and neck and upper back muscles. Differences between the groups were assessed using t-test and the chi-squared test. (SPSS v.17) P value <0.05 was considered statistically significant. Geriatric subjects more often exhibited crepitus on mouth opening (25%), muscular palpation pain of masseter muscles (82.5%) and temporal muscles(60%). In contrast, young subjects more frequently exhibited joint sounds (62.5%), more amount of range of passive mouth opening (p=0.043). It was found that the younger subjects (82.5%) and the older subjects (87.5%) suffered from subjective sign (orofacial pain on chief complain). There were not statistically significant relationships between orofacial pain (VAS) and the groups. Differences between the groups with respect to joint sounds, muscular palpation pain and mandibular range of motion were significant. Although older subjects more frequently exhibited objective signs (crepitus on opening, pain on muscular palpation) of TMD, younger subjects more frequently objective signs (clicking sound on mouth opening, amount of mandibular range of motion).

Orthodontic treatment in adult with type I temporomandibular dysfunction : A case report

The relationship between occlusion and TMJ has been the subject of considerable controversy. It is widely believed that the TMJ signs and symptoms such as Joint pain, clicking, locking and headaches are secondary to abnormalities of occlusion, with actual derangement being uncommon. This case report is to put forward the hypothesis that, type I TMD is often due primarily to occlusal interferences for which orthodontic treatment is generally effective. This case report underlines the significance of fixed orthodontic appliance along with the anterior bite plane splint used in correction of type I TMD.

Temporomandibular joint dysfunction and orthognathic surgery: a retrospective study

BackgroundRelations between maxillo-mandibular deformities and TMJ disorders have been the object of different studies in medical literature and there are various opinions concerning the alteration of TMJ dysfunction after orthognathic surgery. The purpose of the present study was to evaluate TMJ disorders changes before and after orthognathic surgery, and to assess the risk of creating new TMJ symptoms on asymptomatic patients.MethodsA questionnaire was sent to 176 patients operated at the Maxillo-Facial Service of the Lille's 2 Universitary Hospital Center (Chairman Pr Joël Ferri) from 01.01.2006 to 01.01.2008. 57 patients (35 females and 22 males), age range from 16 to 65 years old, filled the questionnaire. The prevalence and the results on pain, sounds, clicking, joint locking, limited mouth opening, and tenseness were evaluated comparing different subgroups of patients.ResultsTMJ symptoms were significantly reduced after treatment for patients with pre-operative symptoms. The overall subjective treatment outcome was: improvement for 80.0% of patients, no change for 16.4% of patients, and an increase of symptoms for 3.6% of them. Thus, most patients were very satisfied with the results. However the appearance of new onset of TMJ symptoms is common. There was no statistical difference in the prevalence of preoperative TMJ symptoms and on postoperative results in class II compared to class III patients.ConclusionsThese observations demonstrate that: there is a high prevalence of TMJ disorders in dysgnathic patients; most of patients with preoperative TMJ signs and symptoms can improve TMJ dysfunction and pain levels can be reduced by orthognathic treatment; a percentage of dysgnathic patients who were preoperatively asymptomatic can develop TMJ disorders after surgery but this risk is low.

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.

顎変形症患者に対する顎矯正手術後アンケート調査

To assess whether patients were satisfied with the results of treatment, questionnaires were sent to 291 patients who had undergone orthognathic surgery for correction of jaw deformities and 133 questionnaires were returned with valid answers. The chief problem of 94 (71%) of these patients was appearance. Dysfunctions such as masticatory disturbance and speech difficulties were the primary reason for which 38 (29%) of the patients sought treatment. Seventy-five percent of the patients answered that they were satisfied with the results in regard to their chief problems. A favorable change in appearance was recognized by 125 patients, whereas five patients noticed no major changes and three patients were displeased with their postoperative faces. The patients'evaluations of their appearance seemed to be influenced by the responses of other peoPle to the surgical-results, and objective improvements did not always satisfy their expectations. Improvements in masticatory function and speech were recognized by 92 and 54 patients, respectively. Eighty patients had TMJ signs and symptoms such as click and/or pain before treatment, which disappeared in 53 (66%) of the symptomatic patients after the surgery. On the other hand, TMJ signs and symptoms appeared postoperatively in 7 (15%) of 47 patients without those before treatment. Psychologically, 42 patients noted favorable changes in personality after the surgery. Eight patients with mandibular set back noted the onset or worsening of snoring after the surgery.

Eccentric anterior wear facets in the diagnosis of temporomandibular disorders

The present study aimed at testing whether eccentric anterior bruxing facets are associated with clinical signs from the temporomandibular joints and with palpatory tenderness of the muscles of mastication. Wear facets in the canine and incisor areas were assessed by inspecting dental stone casts made at baseline and at the end of a 4-year clinical trial involving 129 adolescents and young adults. The subjects who showed distinct increase in wear were divided into three groups: (i) wear pattern indicating an anterior thrust of the working side mandible, (ii) wear pattern indicating a posterior thrust of the working side mandible and (iii) other wear patterns. The assessment of wear patterns was made without knowledge of clinical signs of temporomandibular disorders (TMD). The eventual change in muscular or joint signs of TMD from baseline to the final examination was then obtained from the records, and the association with wear pattern was calculated. There was no significant evidence of an association between eccentric anterior wear and signs of TMD. The direction of the mandibular thrust generated by bruxing was also unassociated with the presence of TMJ and muscular signs. In conclusion, the predictive value of eccentric anterior wear facets in young subjects is too low to be helpful in the diagnosis of TMD.

Temporomandibular disorders in the active phase of orthodontic treatment

Subjective symptoms and clinical signs of temporomandibular disorders (TMD) as well as presence of headache, bruxism and occlusal interferences were examined in 50 patients (mean age 12.9 years) before, during and immediately after orthodontic treatment. The prevalences of signs and symptoms of TMD were high before the treatment in comparison with subjects in an epidemiological study. Except for TMJ sounds, signs and symptoms of TMD as well as presence of headache decreased during the treatment. The major factor for decrease of the dysfunction index during the treatment compared with before the treatment, was tenderness to palpation of the masticatory muscles. Although there was a high prevalence of occlusal interferences during treatment, they seemed to have little importance for development of TMD. One explanation may be that the orthodontically moved teet are sensitive to contact resulting in a decrease of oral parafunctions. Such a decrease was also reported by the patients.

Orthodontic treatment needs in Westmead Hospital Dental Clinical School

One hundred and fifty-four adolescents, 76 female and 78 male consented to take part in this survey. The two authors examined and assessed them for dental aesthetics, malocclusion related features and TMJ related signs. The patients were also questioned about their opinion of dental aesthetics, their interest in having orthodontic treatment and their TMJ symptoms. Only 63 per cent of the adolescents who were considered suitable for orthodontic treatment expressed an interest in wanting treatment. Twenty-seven per cent of patients had signs and/or symptoms of TMJ disturbance. No association was found between individual malocclusion problems and TMJ signs and symptoms. The authors considered 56.5 per cent of the total group for orthodontic treatment, the majority for aesthetic reasons, and placed them into high, medium and low priority groups. Fixed appliance therapy for both arches was the recommended type of treatment for most patients.

A Study of the Change of the Prevalence of TMJ Dysfunction Syndrome and Signs Over Eight Years in Adolescents

A Study of the Change of the Prevalence of TMJ Dysfunction Syndrome and Signs Over Eight Years in Adolescents

Temporomandibular disorders. Part I: Functional status, dentomorphologic features, and sex differences in a nonpatient population

Angle classification of occlusion. In this study 68% of subjects were class I; 15% class II, division 1; 4% class II, division 2; and 13% class III. These figures generally Freshman dental and dental hygiene students, 120 men and 102 women (mean age 23.9 years), were assessed for the presence of masticatory pain or dysfunction by questionnaire, clinical examination, and evaluation of dental casts according to strict criteria. The purpose was to identify and analyze the level of signs and symptoms in a nonpatient population and describe occlusal variation. The prevalence of TMJ signs and symptoms was notable even though two thirds reported only mild or early symptoms, with only 3% reporting severe symptoms. This population was noted for the absence of locking, the low frequency of severe pain or severe TMJ dysfunction, and the low prevalence of restricted ranges of mandibular movement and TMJ crepitation. Women showed significantly more headache, TMJ clicking and tenderness, and muscle tenderness than men. Men were noted for the iabsence of. severe and widespread muscle tenderness and severe TMJ tenderness. TMJ clicking was not alwavs clinically confirmable in subjects with widespread muscle tenderness. This group was considered compatible with previous epidemiologic findings, and also matches the age range of most subjects seeking treatment for TMJ disorders. Therefore, the subjects in the study were considered a representative group of young adults and suitable for study of the possible associations between early signs of TMJ disorders and variables of morphologic malocclusion, which are discussed in Parts II and III of this article.

The prevalence of mandibular dysfunction. Part I: Sex and age distribution of related signs and symptoms

This study concludes the following: 1. Mandibular dysfunction is extensive. 2. Age and sex differences are apparent with various signs and symptoms. 3. Women and younger patients tend to respond positively more often than men and older patients to questions relating to subjective TMJ and muscle symptoms. 4. Objective TMJ and occlusal signs show little age or sex differentiation. 5. Positive responses to questions regarding bruxism were more common in men. 6. Age and sex differences in the prevalence of mandibular dysfunction may be influenced by the method of investigation (anamnestic versus clinical examination) and by the signs and symptoms selected to be representative of this disorder. When compared with the findings of earlier investigations, the conclusions suggest that social, cultural, psychologic, sex, and age differences contribute to the responses to questions pertaining to mandibular dysfunction. However, this may not be an accurate reflection of the prevalence of mandibular dysfunction since the objective signs do not show the age and sex differences that the subjective symptoms indicate. Therefore, additional studies are needed to correlate all data to establish a more reliable profile of both signs and symptoms of mandibular dysfunction.

Comparison of the efficacy of a questionnaire, oral history, and clinical examination in detecting signs and symptoms of occlusal and temporomandibular joint dysfunction

A comparison of three methods of obtaining information relating to some TMJ signs and symptoms has been made. The taking of an oral history by this examiner was shown to be the least reliable. The acquisition of data by this verbal process is a clinically sophisticated and difficult medical procedure and a major source of error is the bias or preconception that a clinician brings to his observations. Far more effective was a written, self-administered patient questionnaire, which proved quite reliable in detecting the presence of some occlusal habits. This study indicates that the initial use of a self-administered patient questionnaire, even in the hands of an inexperienced dentist, will ensure that certain essential data are obtained and recorded and will result in the discovery that a substantial number of patients have signs and symptoms of occlusal and TMJ dysfunction. The most objective method is of course the direct clinical examination. A combination of these three methods of obtaining information is recommended as an important part of routine occlusal and TMJ examinations.