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At least 19 recordsLinked to original sources
PubMed1992

Temporomandibular joint disorder.

Temporomandibular joint disorder is a common clinical entity with diverse etiologies and symptoms. The hallmarks on physical examination are reduced or dysfunctional mandibular range of motion, malocclusion, and joint or preauricular tenderness. The diagnosis is made when a history of craniofacial symptoms or headache is linked with temporomandibular joint dysfunction. Temporomandibular joint disorders usually respond to medical treatment with anti-inflammatory medications, soft diet and occlusal therapy, without the need for surgical intervention. These disorders must be considered in the differential diagnosis of chronic headache, facial pain and compromised mandibular movement.

Humans↗
PubMed1998

The possible role of nitric oxide in the physiopathology of pain associated with temporomandibular joint disorders.

Temporomandibular joint disorders (TMD) pose a significant challenge to the practice of oral and maxillofacial surgery. When painful, TMD are generally associated with hyperthermia of the overlying skin. It is hypothesized that this skin hyperthermia, caused by regional vasodilation, is induced by nitric oxide (NO) produced in the extravascular space of the joint. Extravascular NO can be produced by osteoblasts, chondrocytes and macrophages, or by stimulated neurons. It is suggested that this kind of pain is associated with NO-enhanced sensitivity of the peripheral nociceptors. Verification and clinical implications of the proposed mechanism are discussed.

Chondrocytes↗
PubMed1993

Arthroscopic temporomandibular joint surgery. A new approach to temporomandibular joint disorders.

Temporomandibular joint arthroscopy provides a minimally invasive surgical means of gaining access to the TMJ. It offers valuable diagnostic information and options in the treatment of TMJ dysfunction. Recovery and healing are more rapid, thereby reducing patient discomfort and rehabilitation time. It is estimated that there is an 85% to 90% success rate of this procedure. Patients with TMJ problems resulting from an emotional component can be helped, but their pain may persist because of related muscle tension.

Arthroscopy↗
PubMed2003

Hyaluronate for temporomandibular joint disorders.

BACKGROUND: Temporomandibular joint disorders (TMD) refer to a group of heterogeneous pain and dysfunction conditions involving the masticatory system, reducing life quality of the sufferers. Intra-articular injection of hyaluronate for TMD has been used for nearly two decades but the clinical effectiveness of the agent has not been summarized in the form of a systematic review. OBJECTIVES: To assess the effectiveness of intra-articular injection of hyaluronate both alone and in combination with other remedies on temporomandibular joint disorders. SEARCH STRATEGY: Intensive electronic and handsearches were carried out. The Oral Health Group's Trials Register (September 2001), The Cochrane Library CENTRAL database (Issue 3, 2001), MEDLINE (1966- May 2001), PubMed ( up to March 2002), EMBASE (1974 - August 2001), SIGLE (1980 - December 2001), CBMdisc (1983 - July 2001, in Chinese) and Chinese Medical Library were searched. All the Chinese professional journals in the oral health field were handsearched and conference proceedings consulted. There was no language restriction. SELECTION CRITERIA: Randomized or quasi-randomized controlled trials (RCTs), with single or double blind, design testing the effectiveness of hyaluronate for patients with temporomandibular joint disorders. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data, and three reviewers independently assessed the quality of included studies. The first authors of the selected articles were contacted for additional information. MAIN RESULTS: Seven studies were included in the review. Three studies, including 109 patients with temporomandibular disorders, compared hyaluronate with placebo. Long term effects (three months or longer) are in favour of hyaluronate for the improvement of clinical signs/overall improvement of TMD (RR=1.71, 95%CI: 1.05, 2.77) from two of the studies (n=71). However, this conclusion was not stable enough at sensitivity analysis. Three studies provided data from 124 patients for the comparison of hyaluronate with glucocorticoids (one study also included a placebo group). Hyaluronate had the same short term and long term effects on the improvement of symptoms, clinical signs or overall conditions of the disorders as glucocorticoids. When comparing the effect of arthroscopy or arthrocentesis with and without hyaluronate, results were inconsistent. Hyaluronate had a potential in improving arthroscopic evaluation scores. Mild and transient adverse reactions such as discomfort or pain at the injection site were reported in the hyaluronate groups. No quality of life data were reported REVIEWER'S CONCLUSIONS: There is insufficient, consistent evidence to either support or refute the use of hyaluronate for treating patients with TMD. Further high quality RCTs of hyaluronate need to be conducted before firm conclusions with regard to its effectiveness can be drawn.

Glucocorticoids↗
PubMed2003

Clinical evaluation of amitriptyline for the control of chronic pain caused by temporomandibular joint disorders.

Temporomandibular disorder (TMD) is characterized by a combination of symptoms affecting the temporomandibular joint and/or chewing muscles. The two most common clinical TMD symptoms are pain and dysfunction. Pain is usually caused by dysfunction, and emergency therapy has focused on controlling it. Recent investigations into TMD have led to the recommendation of antidepressants as a supporting treatment against constant neuralgic pain. The aim of this double-blind study was to verify the efficiency of antidepressants (amitriptyline) as a support in the treatment of chronic TMD pain. Twelve female volunteers presenting chronic TMD pain were divided into two groups and treated for 14 days: Group 1 with 25 mg/day of amitriptyline and Group 2 with a placebo. The intensity of pain and discomfort was evaluated daily, using a visual analog scale (VAS), over a period of seven days preceding the treatment (baseline), during the 14-day treatment, and for seven days after the treatment. The results revealed a significant reduction of pain and discomfort in Group 1 (75%) compared to Group 2 (28%) during the three weeks beginning at baseline (p < 0.01). Amitriptyline proved to be an efficient alternative treatment for chronic pain in TMD patients.

Amitriptyline↗
PubMed1992

A comparison of clinical examination, history, and magnetic resonance imaging for identifying orthodontic patients with temporomandibular joint disorders.

The temporomandibular joint (TMJ) status of 51 juvenile orthodontic patients was assessed with magnetic resonance imaging (MRI), clinical examination, and questionnaire data. The results of this study demonstrated that the prevalence of anterior displacement of the meniscus was 11.8% (6 of 51) as assessed by MRI. Clicking or pain in the TMJ area was found in 9.8% (5 of 51) of the subjects by clinical exam, and 19.8% (10 of 51) of the subjects had a history of pain or clicking of the TMJ. Three subjects had a positive MRI and a negative history and clinical examination. However, all subjects with positive MRI findings had a history of other risk factors known to be associated with TMJ internal derangement (TMJ-ID). Therefore practitioners should use a history form and a clinical examination technique that includes a broad range of signs and symptoms of temporomandibular disorders (TMD) to identify patients who may have abnormal condyle disk relationships and be at risk for TMD. Clicking and pain in the TMJ helped identify only one half of the patients with abnormal condyle-disk relationships in this study population. Future cephalometric studies will monitor the effects of abnormal condyle disk relationships on facial growth during orthodontic treatment.

Adolescent↗
PubMed1997

[Functional state of the masticatory system in healthy individuals (control group) and in patients with temporomandibular joint disorders].

The functional status of the masticatory system was investigated in a sample of 68 self-defined controls without any treatment need and 82 craniomandibular disorder patients. Among the parameters investigated were measures of mandibular mobility, the presence of joint noises and palpation tenderness of 17 muscle and 3 TMJ sites. These data allowed for calculation of Fricton's Craniomandibular Index (CMI) and Helkimo's Clinical Dysfunction Index (Di). Several socalled signs of dysfunction were found in the normal control group: 38% of the joints had some kind of noise and several muscle sites were tender to palpation (splenius capitis muscle 50%, anterior masseter and temporal muscle 45%, insertion of the trapezius muscle 40%). In addition, according to Helkimo's Di. 90% of the controls would be classified as having mild to moderate dysfunction. The high prevalence of positive signs in the control sample calls for a less rigid definition of what is called a normal craniomandibular status and refutes the a priori establishment of a narrow set of criteria for normality. Some parameters showed a highly statistically significant difference among the control and patient group (p < .001): active range of motion, deviation upon opening, pain on mandibular movement, number of tender palpation points and the CMI and Di.

Adult↗
PubMed1984

Predictors of treatment outcome in patients with myofascial pain-dysfunction syndrome and organic temporomandibular joint disorders.

A total of 46 variables were initially examined for their usefulness as predictors of treatment outcome in patients with facial pain diagnosed as either MPDS or an organic disorder, such as disease of the TMJ (for example, degenerative joint disease or inflammatory arthritis) or typical facial neuralgia. The information about each variable was collected from the patients prior to beginning of treatment. Data included sociocultural background, social group attitudes, sociomedical orientation, level of psychologic distress, symptoms and treatment history, behavioral and attitudinal responses to pain, and clinical findings. Two discriminant analyses were performed to determine the most important variables for predicting whether a patient would respond successfully (with either elimination of or significant decrease in pain) or unsuccessfully (no change or increase in pain) to conservative reversible treatment. The first analysis was used to reduce the original group of 46 variables to 18 variables, which were labelled "potential" predictors. In the first analysis it was noted that clinical factors, such as oral status and physical examination findings, were irrelevant for predicting treatment outcome. Of the 16 clinical variables initially included for analysis, only the presence of clenching was included as a potential predictor. Patients' psychologic status, as measured by their level of psychologic distress, was also not relevant. The greatest number of potential predictors was related to patients' sociocultural background, sociomedical orientation, symptom and treatment history, and behavior in response to and attitudes toward pain. These factors, then, appear to be more useful than clinical and physical data as indicators of the potential response of facial pain patients with either MPDS or organic TMJ deficits to treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude to Health↗
PubMed1997

[Temporomandibular joint disorders and surgery of the temporomandibular joint].

Surgery of the TMJ is a useful tool in Temporo Mandibular Disorders (TMD). After have been identified what is part of TMD and what isn't, this article lay stress upon the fact that surgery of the TMJ is the appropriate treatment only when the nonsurgically therapy had failed. Indications, danger and complications are discussed. Procedures of arthrotomy and arthroscopy are explained. Various surgical procedures and staging of TMD are discussed.

Arthroscopy↗
PubMedDate not supplied

Emotional factors in temporomandibular joint disorders.

The chronic pain of many temporomandibular disorders is associated with multiple changes in emotional function and activities of daily living. Temporomandibular disorders (TMD) are similar to other chronic pain disorders in their impact on patients. Depression is probably the most common emotional state associated with chronic pain, although anxiety disorders also can be associated with TMD. The probability of emotional problems appears to be greatest in those individuals diagnosed with myofascial pain and least in those with disk displacement. Dental practitioners are encouraged to seek professional liaisons with mental health professionals who can assist them in managing chronic pain patients.

Activities of Daily Living↗
PubMed1997

[Etiologic factors in temporomandibular joint disorders and pain].

Parallel to the construction of better classifications and the identification of subgroups of temporomandibular disorders, an important development has taken place in research concerning its etiology. The etiological factors implied in muscle problems refer to more generalised disorders as myofascial pain syndrome and fibromyalgia. The role of occlusal and articular factors has been brought down to realistic proportions, indicating a minor contribution. Similarly, doubt has arisen concerning the existence of a vicious cycle of pain/spasm/pain. With regard to internal derangements, emphasis has been put on the high prevalence in an otherwise normal population and the fluctuating character of the symptom. Also here, developments point towards constitutional and systemic factors, more than local influences. Trauma, however, seems to play an increasing role. The development of osteoarthrosis has been studied more in depth revealing local processes of inflammation, neurogenic inflammation and the existence of specific markers which might be important in the future. The relationship between disc derangement and the development of osteoarthrosis remains unclear.

Facial Pain↗
PubMed2000

Functional magnetic resonance imaging of temporomandibular joint disorders.

Fifty-eight temporomandibular joints (TMJs) from 40 patients with TMJ-related symptoms were examined by means of magnetic resonance scans with modified gradient echo sequences and a special double coil. This technique yielded a good spatial resolution of the intra-articular soft tissues, especially the articular disc and the bone structure of the TMJ. In combination with an incremental jaw opener, the disc-condyle complex was analysed in various closed and open mouth positions, depending on the clinical examination. Open mouth movement with differentiation of disc-condyle rotational and translation movement was demonstrated. Disturbances of TMJ motion showed interrupted condylar translation combined with mandibular deviation during open mouth movement (n = 8/58). Early phases of internal derangement of the TMJ with partial anterior disc displacement with (n = 12/58) or without (n = 2/58) reduction, total anterior disc displacement without reduction (n = 10/58), disc deformation (n = 10/58), disc adhesion (n = 2/58), condylar hypermobility (n = 6/58), condylar displacement (n = 8/58), and late phases of internal derangement of the TMJ with osteoarthrosis (n = 14/58) were clearly identified. Bilateral TMJ disorder was found in 72.5 per cent of the patients. By using motion-adapted, semi-dynamic magnetic resonance imaging (MRI), it is possible to improve the understanding of the complexity of TMJ movements.

Adult↗
PubMed2003

Subchondral bone resorption in temporomandibular joint disorders.

Several tissues are involved in temporomandibular joint (TMJ) health, including synovial fluid, the TMJ disc, articular cartilage, and subchondral bone. This article focuses upon bone resorption in temporomandibular joint disorders (TMD) and has the following objectives: (1) to provide a brief review of the current understanding of bone formation and bone resorption (bone remodeling); (2) to present selected case studies which illustrate the spectrum of bone resorption patterns in TMD patients of various ages; (3) to review previous reports in the literature describing loss of subchondral bone in TMD, and (4) to discuss the interaction between osteoporosis and TMD and the potential role for antiresorbing agents in TMD therapy.

Bone Resorption↗
PubMed1999

[Relation between temporomandibular joint disorder and subjective symptoms of fatigue].

An investigation was performed for the purpose of guaging the relation between temporomandibular joint disorder on the one hand and occupational category and subjective symptoms of fatigue on the other. Subjects were 2,414 workers (1,598 male, 816 female) in small and medium size enterprises at 67 workplaces in Hiroshima Prefecture. A comparison of cases with and without temporomandibular joint disorder showed that there were more complaints of fatigue among those with the disorder. Given these indications that temporomandibular joint disorder was related to occupation, it is possible that temporomandibular joint disease may be a work-related disease.

Adult↗
PubMedDate not supplied

Magnetic resonance evidence of joint fluid with temporomandibular joint disorders.

OBJECTIVES: The relationship between temporomandibular joint (TMJ) effusion and TMJ disorders is controversial. The frequency of TMJ effusion has varied as shown in previous studies. Furthermore, though some authors have suggested a correlation between TMJ effusion and pain, others question the relationship. In order to clarify the relationship, it is necessary to quantify the degree of effusion and thoroughly investigate its relationship to other factors. The purpose of this study was to analyze the amount of TMJ fluid present in joints with TMJ disorders and to see how TMJ effusion is related to TMJ status and pain. METHODS: We studied 577 joints in 293 patients referred to us for magnetic resonance imaging. The joints were divided into painful and nonpainful categories and also classified according to Westesson's criteria for the status of the TMJ. The grading system of Larheim et al was used for categorizing the amount of fluid. Statistical methods were used for analyzing the relationship between TMJ fluid and TMJ status and pain. RESULTS: TMJs with disk displacement without reduction showed the largest amount of fluid while TMJs with normal superior disk position showed the least fluid (Kruskal-Wallis test, P<0.001; Scheffe test, P<0.001). There was a significant difference in the amount of the fluid between painful and nonpainful joints in the group of disk displacement without reduction (Wilcoxon rank sum test, P<0.001). No significant differences were found between other groups. CONCLUSIONS: Joint effusion is likely to appear in painful TMJs with disk displacement without reduction. Joint effusion may be an abnormal entity just suited to joints with disk displacement without reduction.

Adult↗
PubMed2004

[Whiplash lesions and temporomandibular joint disorders].

Attributing dysfunction of the temporomandibular joint (TMJ) to whiplash injury is a difficult problem to solve. TMJ disorders do not seem to be secondary to direct articular trauma but rather caused by a postural disorder of the cervical spine. Occlusal disorders and stress further complicate the picture. Four clinical cases illustrate a new hypothetical approach.

Adult↗