Position paper of the American Academy of Craniomandibular Disorders. Craniomandibular (TMJ) disorders--the state of the art.
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Behavior Therapy↗
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[Clinical evaluation of protocol for the craniomandibular disorders. 2. Craniomandibular disorders according to new classification].
The purpose of this study is to clarify the actual state in the patients with extensive pathological states of craniomandibular disorders (CMDs). 100 patients, with their ages ranging from 11 to 77 years old, were selected for the study and they were divided into 5 groups according to classification of Japanese Society for Temporomandibular Joint. The following results were obtained: 1. By classification type, the ratio was 88, 16, 8 and 2% for Type III, Type I, Type IV and Type II. Type V was not found. 2. 22% of patients were male and 78% were female. The ratio of male and female was 1:4. 3. By age group, the ratio was 34, 23, 18, 12, 11, 1 and 1% for twenties, tens, thirties, fifties, forties, sixties and seventies. CMDs was found highly in younger ages (tens and twenties). 4. The ratio diagnosed Type III was 86.9, 97.0, 88.8 and 83.3% for tens, twenties, thirties and forties. Type III was found high ratio in all ages. 5. In all patients, right TMJ with disorder 37%, left TMJ with disorder 34%, bilateral TMJ with disorder 29%. There were no difference between right and left. 6. As can be seen from the above, young individuals with CMDs were clearly high ratio and many CMDs were diagnosed Type III through all the ages. Therefore, the results of our study suggest that young CMDs patients could be increasing gradually and complicating a pathological state.
Adolescent↗
Recognition of craniomandibular disorders.
Craniomandibular disorders often mimic diseases related to the ear, nose, and throat, so patients often seek the care of an otolaryngologist for these problems. After ruling out otolaryngologic disease, craniomandibular disorders should be considered in the differential diagnosis. If a clinical diagnosis is supported by history, symptoms, and clinical evidence, the patient should be referred in a timely manner to a dentist who is competent to manage the patient. In addition to dentists, other health care practitioners may be called on by the primary treating physician to aid in the diagnosis and treatment. These can include a neurologist, radiologist, ophthalmologist, physiatrists, physical therapist, and internist. With recent advances in imaging techniques (computed tomography and magnetic resonance imaging), precise bioelectronic measurement of mandibular movement and electromyography of masticatory function, and conservative orthotic and dental restorative treatments as well as surgical techniques including arthroscopic examination of the TMJ, craniomandibular disorders can be objectively and precisely diagnosed and treated (Figs. 10 through 16).
Craniomandibular Disorders↗
The prevalence of some joint disorders in craniomandibular disorder (CMD) and bruxers as compared to CMD nonbruxer patients and controls.
The objective of this study was to assess and compare the frequency of some joint disorders in 130 CMD + bruxing behavior patients, 66 CMD/nonbruxing behaviors patients referred for diagnosis and treatment to the Center for the Study of Craniomandibular Disorders and 130 control subjects seeking routine dental care. Both patients and controls were consecutive referrals to the clinic occurring over a five year period. The mean age of the CMD + bruxing behavior group was about 35.48 years (range 14-54, SD = 8.45), and 36.84 years (range 17-60, SD = 9.30) in the 66 CMD nonbruxing behavior group, and 34.34 years (range 14-62, SD = 9.92) in the control group of 130 subjects. Information gathered included a questionnaire, history of signs and symptoms, and a clinical examination. Different types of joint disorders, muscle signs and symptoms and bruxing behavior were assessed in the CMD groups and in the corresponding control group. The study concluded that capsulitis/synovitis, retrodiskal pain and disk-attachment pain predominated in CMD + bruxing behavior patients. The data reinforces the need to assess CMD + bruxing behavior patients to evaluate signs and symptoms of such disorders in order to obtain additional information about the true source of pain and the need for proper management.
Adolescent↗
[Clinical evaluation of protocol for the craniomandibular disorders. 3. Questionnaire for the craniomandibular disorders].
The purpose of this study is to clarify the effectiveness of questionnaire which is included in the protocol designed for screening the patients with extensive pathological states of craniomandibular disorders. 100 patients, with their ages ranging from 11 to 77 years old, were selected for the study and they were classified under various disorder classification which is based on the criteria of Japanese society for Temporomandibular Joint. Statistical analysis was performed to find the relationship between the different pathological states and the results of the questionnaire. The following results were obtained: 1. The ratio of appearance on TMJ pain was as follows: Type I (100%), Type II (0%), Type III (43.8-75.0%) and Type IV (75.0%). 2. The ratio of appearance on TMJ pain on chewing was as follows: Type I (50.0%), Type II (100%), Type III (20.0-100%) and type IV (37.5%). 3. The ratio of appearance on TMJ pain on maximum opening was as follows: Type I (100%), Type II (100%), Type III (50.0-100%) and Type IV (75.0%). 4. The ratio of appearance on TMJ noise was as follows: Type I (0%), Type II (0%), Type III (40.9-81.3%) and Type IV (50.0%). 5. The ratio of appearance on the fatigue by mastication was as follows: Type I (0%), Type II (50.0%), Type III (40.0-100%) and Type IV (75.0%). 6. The ratio of appearance on bruxism was as follows: Type I (0%), Type II (0%), Type III (10.4-40.0%) and Type IV (25.0%). 7. The ratio of appearance on the stiff of jaw on awakening was as follows: Type I (50.0%), Type II (0%), Type III (20.8-70.0%) and Type IV (37.5%). 8. The ratio of appearance on the unilateral chewing was as follows: Type I (50.0%), Type II (0%), Type III (20.0-50.0%) and Type IV (62.5%). 9. There were significances among those types about each items on the questionnaire, it can be suggested that the questionnaire for screening about craniomandibular disorders was effective.
Adolescent↗
[The role of stabilometry in assessing the correlations between craniomandibular disorders and equilibrium disorders].
We examined three groups: 29 patients suffering from balance disorders and craniomandibular disorders but from vestibular disease; 21 patients suffering from balance disorders, craniomandibular disorders and vestibular disease; 26 patients suffering from craniomandibular disorders but not from vestibular disease or balance disorders. All cases were examined by the odontologist and otoneurologist and tested by computerized stabilometry; they were reexamined after six months of therapy by an occlusal stabilization splint. The static analysis of the results show a significative reduction of the postural oscillations in all patients.
Adult↗
Asian Academy of Craniomandibular Disorders. Seventh Scientific Meeting & Japan Academy of Craniomandibular Disorders. Second Scientific Meeting, Sendai, Japan, November 23-24, 1997. Selected Abstracts.
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Animals↗
Curriculum guidelines for orofacial pain and temporomandibular disorders. European Academy of Craniomandibular Disorders.
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Clinical Competence↗
[Multidisciplinary diagnosis and treatment of craniomandibular disorders].
Treatment of craniomandibular disorders (CMD) requires a multidisciplinary approach. The CMD-team of the Academic Centre for Dentistry Amsterdam (ACTA) therefore consists not only of specialists in CMD and orofacial pain, but also of physiotherapists and a psychologist. Possible CMD-patients are referred to this team by the dentist-general practitioner, either directly or upon request of a family physician or a medical specialist; the many rules of such referrals are outlined in the article. The CMD-team regularly consults other disciplines for diagnosis and/or treatment of their patients. For instance, internal referrals are sometimes made to the departments of Oral radiology, Endontology, Periodontology, Orthodontics, or Oral and maxillofacial surgery. External referrals to, for example, a speech therapist or a medical specialist (e.g., a pain specialist) are arranged by the family physician upon request of the CMD-team.
Craniomandibular Disorders↗
[Occlusion in the etiology of craniomandibular disorders. Current directions].
Craniomandibular disorders are a pathology with a multifactorial genesis where the aetiological aspects it represented by emotional and occlusal factors. These provoke muscular hyperactivity so determining a change in all components of the stomatognathic apparatus. A critical analysis of the literature leads to an analysis of the importance of the occlusal factor in the aetiology of MCD. The conclusions reached are that the ideal occlusion is a theoretical concept. Physiological occlusion is the situation in which, independently of the number, lay-out and relationship between teeth there exists a subjective occlusal stability and a satisfactory masticatory, phonatory and aesthetic function.
Dental Occlusion↗
Self-reported symptoms of stress in Finnish patients with craniomandibular disorders.
This study compared the stress reports of Finnish craniomandibular disorder patients and nonpatients by using the Symptoms of Stress Inventory as a screening device. A comparison of Finnish and American craniomandibular disorder patients' stress reports was made in the same manner. The overall stress level of craniomandibular disorder patients was higher than that of nonpatients. The patients had elevated scores on somatic subscales, with muscle tension symptoms being the most characteristic. These results are in accordance with American results. However, statistically significant differences were not found for emotional symptoms.
Adult↗
The immediate effects of a stabilization splint on the muscular symmetry in the masseter and anterior temporal muscles of patients with a craniomandibular disorder.
In 36 myogenous craniomandibular disorder patients, the immediate effects of a stabilization splint on the symmetry in the activities of the masseter and anterior temporal muscles during submaximal clenching at five clenching levels were investigated electromyographically. After the adjustment of the splint necessary at the time of delivery, 20 splints remained free from occlusal interferences throughout the treatment period and thus needed no further adjustment. These splints caused an immediate improvement in masseter muscle symmetry at the time of delivery (p less than 0.01). However, 16 splints needed further adjustment for occlusal interferences at the first recall, 2 weeks after delivery of the splint. These splints resulted in a small but statistically significant worsening in masseter muscle symmetry at the 10% clenching level (p less than 0.01). No such response was found for temporal muscle activity. The immediate changes in masseter muscle activity suggest that muscular symmetry is an objective basis in the evaluation of the treatment provided.
Adult↗
[Clinical Evaluation of protocol for the craniomandibular disorders. 1. Protocol of our department].
Craniomandibular disorders are conditions encompassing various types of dysfunction of the stomatognathic system. To define the very nature of morbidity, both differential and pathological diagnosis are absolutely necessary. At present, each medical institution in this country has its own protocol for evaluating and treating craniomandibular disorders. This makes it difficult to exchange and compare data between institutions. In this paper, a protocol worked out by our department after a series of clinical tests and study is presented, and its merits and unresolved problems are discussed.
Clinical Protocols↗
A longitudinal study of craniomandibular disorders in Finnish adolescents.
Longitudinal variations of subjective symptoms and clinical signs of craniomandibular disorders, orofacial parafunctions, and occlusal conditions were examined in 131 Finnish adolescents. Patients were interviewed and clinically examined at the ages of 14, 15, and 18 years. Signs and symptoms of craniomandibular disorders were common, although usually mild. Reported and recorded temporomandibular clicking sounds were the most frequent findings and increased with age. They showed, however, no predictable pattern, and only a few patients consistently reported clicking sounds or had them recorded. Although the frequency of craniomandibular disorders according to Helkimo's clinical dysfunction index was high at each examination, there also was great intraindividual fluctuation longitudinally; impairment and improvement occurred almost equally often, showing no predictable pattern. Only 3% of those tested consistently had an index value of more than I. Thus, even longer follow-up studies are needed to understand natural longitudinal variations and evaluate the need and demand for treatment of craniomandibular disorder.
Adolescent↗
Electromyographic evidence of local muscle fatigue in a subgroup of patients with myogenous craniomandibular disorders.
Ten female patients with myogenous craniomandibular disorders who had complete dentitions and mainly unilateral muscle pain and tenderness to palpation, and 10 healthy female controls, participated in the study. The surface electromyographic signals of masseter and anterior temporal muscles were recorded during 30-s test contractions at 50% of the maximum voluntary clenching effort. A force transducer placed between the central incisors recorded the maximum voluntary bite force. The patients exerted a lower maximum voluntary bite force than the controls (p less than 0.05). In the patients the electromyographic signals of the painful muscles were weaker than those of the painless muscles (p less than 0.01). The signals of the control subjects were stronger than those of the painless muscles of the patients (p less than 0.01). The mean power frequency of the signals, recorded at the start of the 30-s contractions, showed no differences between the painful and painless muscles and between the muscles of the patients and of the controls. The rate of mean power frequency shift in the electromyographic signal, as a response to the 30-s test contraction, was normalized with respect to the amplitude of that signal to account for its amplitude dependency. The painful muscles showed a higher normalized rate of mean power frequency shift than the painless muscles and the muscles of the control subjects (p less than 0.01). These results confirm the presence of an impaired condition in the painful muscles of this group of patients with myogenous craniomandibular disorders.
Adolescent↗
Diagnostic subgroups of craniomandibular disorders. Part I: Self-report data and clinical findings.
An overview is given of the most commonly investigated signs and symptoms associated with craniomandibular disorders as detected in a population of patients with craniomandibular disorders and in four defined diagnostic subgroups. The information was collected with a questionnaire and during an extensive clinical examination. Comparison of self-report and clinical data indicated that these two methods reveal different aspects of the patient's complaints and should be interpreted in their own way. The results showed that no statistically significant differences could be found between the four diagnostic subgroups with respect to occlusal factors, trauma, and clinically assessed parafunctional habits. The groups differed considerably with respect to general characteristics, pain variables, signs of craniomandibular disorders, self-reported para-functional habits, psychosocial factors, and general health factors. However, despite the reduction in clinical characteristics of the four subgroups, there was little reduction in the diversity of factors associated with craniomandibular disorders. This implicates that almost all factors associated with craniomandibular disorders may influence the initiation and perpetuation of the different disorders in the individual patient, and therefore, remain of interest in future research.
Adolescent↗
Occlusion splint therapy in patients with craniomandibular disorders (CMD).
The etiology of craniomandibular disorders (CMD) is multi-factorial and the treatment should be selected with recognition of the different factors. The aim of the study was to investigate the influence of occlusion splint therapy (Michigan splint), physical exercises and transcutaneous nerve stimulation (TENS) on CMD symptomatology. At the Clinic of Maxillofacial Surgery in Belgrade, in the period from May, 2001-December, 2003, 168 patients were examined by the CMD working group. This group, comprised of different specialties (maxillofacial surgeon, prosthodontist, orthodontist, neurologist, psychiatrist and physiatrician), enabled multidisciplinary treatment of CMD patients according to the guidelines given by American Academy for Craniomandibular Dysfunctions. In all, a total of 30 patients with prevalent muscular tensions among other CMD symptoms were included in this study. The examination form according to Fricton and Shiffman for Craniomandibular Index (CMI) was used in order to evaluate the function of Craniomandibular system before and after therapy.A statistically significant difference (t = 8,735; P < 0,001) between the average values for CMI of patients before (0,2297 +/- 0,0827) and after therapy (0,1002 +/- 0,0479) was observed. Performed treatment resulted in complete response (pain relief and absence of CMD symptoms and signs) in over than 80% of patients and could be considered as a method of choice in reversible occlusal therapy.
Adult↗
Craniomandibular disorders and masticatory muscle function.
The heading craniomandibular disorders covers a wide range of abnormal and pathologic conditions accompanied by orofacial pain and impaired mandibular function, the masticatory muscles and the temporomandibular joints being the structures most frequently involved. Prevalences of severe craniomandibular disorders accompanied by headache and facial pain urgently in need of treatment are 1-2% in children, about 5% in adolescents, and 5-15% in adults, with higher values in women than in men. With respect to physiology and ergonomics, masticatory muscles are comparable to other human skeletal muscles, e.g. of shoulder, neck and lower back. Therefore these muscles share pathogenesis, symptoms and signs of muscular disorders caused by prolonged, low-level static contractions or intermittent isometric contractions at higher levels. Since the same elements of performance in the masticatory muscles are influenced by occlusal factors, they link the development of muscular fatigue, discomfort and pain to the dental occlusion. Furthermore, changes of the occlusal surfaces, e.g. due to dental treatment, may influence the performance of the masticatory muscles, and consequently interfere with local muscular function.
Adolescent↗