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PubMed2007

Temporomandibular disorders: associated features.

Temporomandibular disorder (TMD) encompasses a number of clinical problems involving the masticatory muscles or the temporomandibular joints. These disorders are a major cause of nondental pain in the orofacial region, and are considered to be a subclassification of musculoskeletal disorders. Orofacial pain and TMD can be associated with pathologic conditions or disorders related to somatic and neurologic structures. When patients present to the dental office with a chief complaint of pain or headaches, it is vital for the practitioner to understand the cause of the complaint and to perform a thorough examination that will lead to the correct diagnosis and appropriate treatment. A complete understanding of the associated medical conditions with symptomology common to TMD and orofacial pain is necessary for a proper diagnosis.

Adaptation, Physiological↗
PubMed2006

Long-term reliable change of pain scores in individual myogenous TMD patients.

A within-patient change in pain score after treatment is statistically 'reliable' when it exceeds the smallest detectable difference (SDD). The aims of the present study were to: (i) determine SDDs for VAS-scores of pain intensity, for sufficiently long test-retest intervals to include most biological fluctuations, (ii) examine whether SDD is invariant to baseline score, and (iii) discuss the value of reliable change (RC) for detecting clinically important difference (CID) or as a possible indicator of successful treatment. SDDs were determined using duplicate data from 118 patients with myogenous Temporomandibular disorders: (1) VAS-scores of pain intensity from the masticatory system in a pre-treatment diary, and (2) VAS-scores of pain intensity from the hand (cold-pressor test). RC was determined in VAS-scores from a pre- and post-treatment questionnaire. The long-term SDD was 49mm. A regression analysis on duplicate VAS-scores showed that SDD was largely invariant to the baseline level. Because RC (change>SDD) exceeded CID, it might serve as an indicator of successful treatment. However, only 17% of the patients showed RC after treatment, mainly because the baseline was smaller than SDD in 67% of the patients thus making detection of any treatment effect impossible. For patients with possible detection (33%), the frequency of RC was 51%. If the detection threshold would be avoided by provoking pain in patients with a low baseline, a long-term RC in VAS-scores might occur in about half of all myogenous TMD patients and might then serve as an indicator of cases of treatment success.

Adult↗
PubMed2005

A long-term follow-up study of radiographically evident degenerative changes in the temporomandibular joint with different conditions of disk displacement.

The purpose of this retrospective study is to assess the relationship between an initial and persisting condition of disk displacement (DD) and the long-term course of radiographically evident degenerative changes of the temporomandibular joint (TMJ). Nineteen patients agreed to a radiographic follow-up examination of 29 joints and were included in this study. The joints were radiographically assessed at the first visit and at least 46 months after the first visit (mean 89.3 months). At the time of the follow-up, all subjects had a good clinical course after a favorable response to the treatments. There were significant relationships between the initial diagnosis of DD and the interval change in the morphology of the articular eminence. The articular eminence became flattened or deformed only in the joints with persistent DD without reduction. And there was a tendency that the condyle became smaller in the joints initially with permanent DD and in the joints which show a progression in the disk-condylar relationship. The results of this study suggested that, in the joints with persisting non-reducing disk displacement, flattening and deformation of the articular eminence and regression of the condylar size were likely to happen even after symptoms and signs of TMJ disorders were resolved or reduced.

Adolescent↗
PubMed2005

The relationship of bone marrow edema pattern in the mandibular condyle with joint pain in patients with temporomandibular joint disorders: longitudinal study with MR imaging.

The purpose of this study was to investigate the course of bone marrow edema pattern (decreased signal intensity on T1- or proton-density-weighted images and increased signal intensity on T2-weighted fat-suppressed images) in the mandibular condyle after improvement in clinical symptoms, and to clarify its relationship with temporomandibular joint (TMJ) pain. This study was based on 14 joints of 11 patients (all female, mean age 37.5 years) with TMJ disorders showing condylar bone marrow edema pattern on initial magnetic resonance (MR) images. All joints were re-evaluated clinically and using MR images after relief of joint pain following arthrocentesis combined with non-surgical treatment. The time interval between the initial and follow-up MR images ranged from 14 to 27 months (mean 17 months). Of the 14 joints, 4 joints (28.6%) showed a normal bone marrow signal, whereas 10 joints (71.4%) showed persistent bone marrow edema pattern on follow-up MR images (P = 0.125). Therefore, the reduction in TMJ pain did not correlate with resolution of bone marrow edema pattern in most joints. The results of this study suggest that the bone marrow edema pattern in the mandibular condyle does not always contribute to the occurrence of joint pain in patients with TMJ disorders.

Adolescent↗
PubMed2004

Stability of skeletal class III malocclusion after combined maxillary and mandibular procedures: rigid internal fixation versus wire osteosynthesis of the mandible.

PURPOSE: The aim of this study was to evaluate skeletal stability after double-jaw surgery for correction of skeletal Class III malocclusion to assess whether there were any differences between wire and rigid fixation of the mandible. PATIENTS AND METHODS: Thirty-seven Class III patients had Le Fort I osteotomy stabilized with plate and screws for maxillary advancement. Bilateral sagittal split osteotomy for mandibular setback was stabilized with wire osteosynthesis and maxillomandibular fixation for 6 weeks in 20 patients (group 1) and with rigid internal fixation in 17 patients (group 2). Lateral cephalograms were taken before surgery, immediately after surgery, 8 weeks after surgery, and 1 year after surgery. RESULTS: Before surgery, both groups were balanced with respect to linear and angular measurements of craniofacial morphology. One year after surgery, maxillary sagittal stability was excellent in both groups, and bilateral sagittal split osteotomy accounted for most of the total horizontal relapse observed. In group 1, significant correlations were found between maxillary advancement and relapse at the posterior maxilla and between mandibular setback and postoperative counterclockwise rotation of the ramus and mandibular relapse. In group 2, significant correlations were found between mandibular setback and intraoperative clockwise rotation of the ramus and between mandibular setback and postoperative counterclockwise rotation of the ramus and mandibular relapse. No significant differences in postoperative skeletal and dental stability between groups were observed except for maxillary posterior vertical position. CONCLUSIONS: Surgical correction of Class III malocclusion after combined maxillary and mandibular procedures appears to be a fairly stable procedure independent of the type of fixation used to stabilize the mandible.

Adolescent↗
PubMed2005

Characterization of patients with disc displacement without reduction unresponsive to nonsurgical treatment: a preliminary study.

PURPOSE: Arthrocentesis and arthroscopic lysis and lavage have been described as effective treatment modalities for temporomandibular joint (TMJ) disc displacement without reduction (DDw/oR). More commonly, nonsurgical intervention is offered as the desired first-line treatment; however, a certain group of DDw/oR patients receiving nonsurgical treatment may remain unresponsive, thereby prolonging suffering and treatment dissatisfaction. The purpose of this study is to characterize these nonresponders by evaluating the characteristic pretreatment findings peculiar to this group. PATIENTS AND METHODS: This retrospective study was based on the review of pretreatment clinical and magnetic resonance imaging (MRI) findings of 52 DDw/oR patients who were treated with stabilization appliance, jaw-stretching exercise, and nonsteroidal anti-inflammatory medication. On the last treatment visit, each patient was classified as either a responder (R) or nonresponder (NR) based on the satisfaction or dissatisfaction with the treatment received, respectively. Pretreatment data were then examined and analyzed by logistic regression to identify which clinical and MRI findings were specifically related to the NR group. RESULTS: Logistic regressions indicated that NR had significantly higher odds ratio for pretreatment pain-free mouth opening of less than 30 mm (odds ratio [OR] = 7.385), "stuck" disc (OR = 4.521), and unchanged disc shape during mouth opening (OR = 4.050). Multiple logistic regression analyses revealed that these factors combined gave the highest likelihood ratio of 15.90 ( P = .001), indicating a strong possibility that these factors are associated with the NR group. CONCLUSIONS: Nonresponders can be characterized by their pretreatment pain-free mouth opening (<30 mm) in combination with MRI confirmation of "stuck" disc and unchanged disc shapes during mouth opening.

Adult↗
PubMed2005

Prospective multicenter comparison of 4 temporomandibular joint operations.

PURPOSE: This study was designed to compare the outcomes of 4 operations used for the treatment of painful temporomandibular joints with an internal derangement. PATIENTS AND METHODS: A prospective, controlled study of arthroscopy, condylotomy, discectomy, and disc repositioning was conducted at 3 sites. All sites used the same inclusion and exclusion criteria. Trained, independent examiners assessed pain, diet, and range of motion before operation and 1 month and 1 year after operation. RESULTS: There were statistically significant reductions in the amount of pain ( P < .001) and daily time in pain ( P < .001) that were similar for all 4 operations 1 month and 1 year after the procedures. The degrees of change after each of the 4 procedures were not statistically different from each other (amount: P = .453 and time: P = .416). Ability to chew, as measured by diet visual analog scale, was substantially improved 1 year after operation ( P < .001). The degrees of change for diet at 1 year also were not different from each other ( P = .314). There were, however, statistically significant differences ( P < .05) in range of motion that varied with procedure. CONCLUSIONS: All 4 operations were followed by marked improvements in pain and diet. The amounts of improvement varied slightly by operation, but these differences were not statistically significant. There were small but statistically significant differences between procedures for range of motion. If these findings are confirmed, they have an important implication for procedure selection.

Adolescent↗
PubMed2005

Effects of Bartter's syndrome on dentition and dental treatment: a clinical report.

Bartter's syndrome is an autosomal recessive form of severe volume depletion due to renal salt wasting. This clinical report describes the prosthodontic treatment for a 24-year-old man who suffers from Bartter's syndrome. The treatment plan included endodontic treatment of the maxillary anterior incisors and placement of cast dowel-and-core restorations because of reduced crown height. The patient's remaining teeth were restored with metal-ceramic crowns.

Adult↗
PubMed2005

Comparing condylar positions achieved through bimanual manipulation to condylar positions achieved through masticatory muscle contraction against an anterior deprogrammer: a pilot study.

STATEMENT OF PROBLEM: The condylar position can vary depending on several factors. One factor is the influence of occluding teeth. If the influence from occluding teeth could be eliminated, it might be possible to evaluate the condylar position obtained from masticatory muscle contraction. PURPOSE: The purpose of this pilot study was to determine the placement of the condyles by contracted masticatory muscles without influence from occluding teeth. MATERIAL AND METHODS: For a group of 11 participants, 3 dentists were assigned, in turn, to fabricate a centric relation interocclusal record using bimanual manipulation on each member of the group. After obtaining the centric relation interocclusal records using bimanual manipulation, the records were stored in room temperature water. Subsequently, each of the 11 patients had an anterior deprogrammer fabricated and were given instructions to wear the anterior deprogrammer for 60 minutes. The anterior deprogrammer was designed with the contacting surface perpendicular to the arc of close of the mandibular incisors. In addition, the anterior deprogrammer was relined to eliminate any movement under force, and the occluding surface of the deprogrammer was free of any indentations. After wearing the deprogrammer, 4 interocclusal records (3 in a reclined position and 1 in an upright position to ensure the condylar position did not change in the upright position) were made by having the patient squeeze and close into a properly adapted, trimmed, and warmed interocclusal record. The condylar position in centric relation recorded in interocclusal records using bimanual manipulation was compared to the condylar position recorded by the contraction of the masticatory muscles against an anterior deprogrammer using a condylar position indicating device. The data were analyzed with a 2-independent-samples test of proportions, alpha=.05 (1-tail). RESULTS: The condylar positions obtained using bimanual manipulation repeated the condylar position within the 0.11-mm tolerance of the Centri-Check instrument in 33 out of 33 opportunities (100%). The condylar positions obtained by using the anterior deprogrammer technique repeated the condylar position within the 0.11-mm tolerance of the Centri-Check in 43/44 opportunities (97.7%). The sample size used in this pilot study was not large enough to detect a very small actual difference (5 percentage points or less) between the 2 methods, should such a difference exist. CONCLUSION: The results of this pilot study indicate that, without influence from occluding teeth, the contraction of the masticatory muscles places the condyles into the same position as centric relation.

Centric Relation↗
PubMed2004

Treatment of snoring and obstructive sleep apnea with mandibular repositioning appliances.

Snoring and obstructive sleep apnea form part of a spectrum of sleep disordered breathing affecting a significant proportion of the general population and particularly the middle aged. The consequences can be severe and even life threatening for both the individual directly affected and those more remotely involved. Adverse sequelae can manifest themselves acutely or in the longer term as a result of obstructive breathing induced hypersomnolence, neurocognitive deficits and cardiovascular abnormalities. The combination of anatomical and neuromuscular risk factors in the pathogenesis of OSA has resulted in a varied approach to its management. One such treatment option is mandibular repositioning appliances (MRA), which mechanically stabilize the airway. Whilst the efficacy of this simple intervention has been rigorously proven quite recently in a significant proportion of patients with varying disease severity, individual patient selection in its application remains uncertain. Short-term side-effects are common but usually transient, whilst in the long-term minor permanent adverse developments on the dentition and occlusion have been reported. Considering both the medicolegal implications of snoring and OSA and the increasing popularity of MRA, it is recommended that skilled multidisciplinary respiratory and dental personnel form the primary care team.

Critical Pathways↗
PubMed2005

Magnetic resonance images of the temporomandibular joints of patients with acquired open bite.

OBJECTIVES: Acquired anterior open bites were reported as the consequence of condylar collapse, which was associated with inflammatory TMJ disorders. However, we have seen such malocclusion patients whose condylar changes seemed to be related to TMJ degeneration associated with internal derangement. The aims of this study were to review the clinical history and to study the TMJ MRI of these patients. STUDY DESIGN: TMJ MRIs of patients, who had presented acquired anterior open bite at first visit, were retrieved from the image database for the analysis. Clinical histories focused on internal derangement were collected retrospectively. The soft tissue and hard tissue changes disclosed by MRI were also studied. RESULTS: All patients had experienced common signs/symptoms of TMJ internal derangement. All affected TMJs had anteriorly displaced disks and degenerative changes. Horizontally destructed condylar forms were seen significantly more frequently in these patients. CONCLUSION: TMJ degeneration associated with displaced disks might be a cause leading to the development of acquired anterior open bite.

Adolescent↗
PubMed2005

Radiographic follow-up of diseased temporomandibular joints.

OBJECTIVE: The objective of this study was to assess the long-term course of radiographically evident degenerative changes of the soft and hard tissues of the temporomandibular joint (TMJ) in patients with TMJ disorders. STUDY DESIGN: Twenty-one patients (33 joints) were included in the study. The results of radiographic assessments at the first visit and at least 46 months after the first visit (mean 96.0 months) were compared. RESULTS: All subjects had a good clinical course after a favorable response to treatment. Radiographic assessment showed that there was a statistically significant change in disk morphology during the intervening years, with the disks becoming more deformed (P < .05, McNemar test). On the other hand, there was no significant change in the condylar morphology or size. CONCLUSIONS: Most of the acute and destructive radiographically visible degenerative changes were arrested or slowed in the patients whose symptoms and signs were successfully resolved or reduced, while disk deformation significantly progressed.

Adolescent↗
PubMed2000

Quantitative changes in the mRNA for contractile proteins and metabolic enzymes in masseter muscle of bite-opened rats.

To study the effects of bite opening on the fibre phenotypes of rat masseter, the mRNAs of four predominant myosin heavy-chain isoforms (MHC I, IIa, IId/x and IIb) and two alkali light-chain isoforms (LC1f and 3f) as well as those of two metabolic enzymes, carbonic anhydrase III (CAIII, oxidative enzyme) and glucose-phosphate isomerase (GPI, glycolytic enzyme), were measured in relation to the total RNA of masseter muscle by competitive, reverse transcriptase-polymerase chain reaction in control and bite-opened rats. Bite opening (2.8 mm increase in the vertical dimension for 1 week) significantly (P<0.05) increased the amount of MHC IIa mRNA but decreased (P<0.001) the amount of MHC IIb mRNA without changing the amount of MHC IId/x mRNA. No MHC I mRNA was found in any masseter studied. A significant (P<0.01) increase in the mRNA of LC1f associated with a decrease (P<0.05) in that of LC3f was observed after the bite opening. The CAIII mRNA increased significantly (P<0.001), while the GPI mRNA decreased (P<0.05) in association with the bite opening. These results strongly suggest that in 1 week of bite opening changes the rat masseter muscle from a glycolytic, MHC IIb-LC3f-dominant fibre to an oxidative, MHC IIa-LC1f-dominant fibre.

Adaptation, Physiological↗
PubMed2000

Prevention of tongue biting with a removable oral device: a clinical report.

A method of preventing tongue biting with a removal device has been described in this clinical report. Restraint of the tongue may be necessary to promote healing by preventing repetitive tongue biting or as a preventive measure after a surgery or an injury. Any device that is used to restrain the tongue should be removable to avoid prolonged interference with oral hygiene, swallowing, mastication, and speech. A removable device is desirable for long-term use by comatose or semicomatose patients.

Aged↗
PubMed1995

A comparison of the effects of group function and canine guidance interocclusal device on masseter muscle electromyographic activity in normal subjects.

This study investigated the role of occlusal balance and canine guidance or group function guidance in masseter muscle function of normal subjects. Two types of interocclusal devices were constructed for each of the 10 subjects. Two ME 1020 EMG analyzers and bipolar Ag/AgCI electrodes were used to record the electromyographic activity of masseter muscles during clenching in centric occlusion, during left and right laterotrusive movements, and during clenching at the extremities of the jaw both with the natural dentition only and with adjusted and intentionally unadjusted interocclusal devices in place. This study demonstrated that there was no difference in masseter muscle electromyographic activity between the use of interocclusal devices designed for canine guidance or for group function guidance in normal subjects. It showed also that altering the occlusal balance significantly reduced muscle activity.

Adult↗