A case-control investigation of the psychological and physiological stress markers with salivary cortisol levels in patients with temporomandibular joint disorders: A short clinical study

Aims

This study aimed to determine the association of stress and salivary cortisol levels in the adult Indian population with and without temporomandibular disorder (TMD) and to validate it with bite force.

Settings and Design

The present study had an observational, case-control study design.

Materials and Methods

This study sample comprised two groups of 25 cases and 25 controls between 18 and 45 years of age. Diagnostic criteria-TMD questionnaire Axis I was used to assess TMD classification, the TMD Disability Index and modified Perceived Stress Scale (PSS) questionnaires were filled, and salivary cortisol levels were measured using electrochemiluminescence immunoassay (ECLIA). Bite force analysis was performed using a portable load indicator.

Statistical Analysis Used

To characterize and analyze the study variables, means, standard deviations, Mann-Whitney U-test, and logistic regression were employed (STATA 14.2 [Texas, USA]). Shapiro-Wilk test was used to test the normality of the data. P < 0.05 was considered statistically significant (95% power).

Results

Female gender was proportionately higher in both the groups (P = 0.508), TMD Disability Index was significantly higher for cases (P < 0.001), TMD cases perceived higher stress levels (P = 0.011), there was no statistically significant difference in salivary cortisol level between cases and controls (P = 0.648), and the median bite force was lower for cases (P = 0.0007).

Conclusions

This study concluded that the chance of developing TMD increased with age. An increase in the TMD Disability Index score and modified PSS scores; and a decrease in the bite force increased the likelihood of TMD. Modified PSS score was negatively correlated with salivary cortisol concentrations, indicating a two-way response to TMD symptoms.

Cross-cultural adaptation, reliability, and validity of the Turkish version of the Craniofacial Pain and Disability Inventory (CF-PDI/T) for individuals with temporomandibular disorders

PURPOSE

To translate the Craniofacial Pain and Disability Inventory into Turkish (CF-PDI/T) and to examine its reliability and validity.

MATERIALS AND METHODS

Cultural adaptation of CF-PDI/T was conducted according to international standards. The psychometric analyses included reliability by internal consistency (Cronbach's alpha) and test/retest reliability (intraclass correlation coefficient, ICC); structural validity was evaluated with exploratory factor analysis (EFA), confirmatory factor analysis (CFA); and construct validity was investigated by matching (a priori hypotheses) the CF-PDI/T with the Numeric Rating Scale (NRS), Headache Impact Test-6 (HIT-6), Tampa Scale for Kinesiophobia for Temporomandibular Disorders-12 (TSK-TMD-12), Pain Catastrophizing Scale (PCS), Neck Disability Index (NDI), Fonseca Anamnestic Index (FAI), and Jaw Functional Limitation Scale-20 (JFLS-20). Correlations ranging from low to high were expected.

RESULTS

CF-PDI/T showed excellent test-retest reliability (ICC = 0.971), excellent internal consistency (Cronbach's α = 0.985), and low to high correlation with NRS, HIT-6, TSK-TMD, PCS, NDI, FAI, and JFLS-20. Following EFA, three factors ("pain and psychosocial limitation", "jaw functional status", and "frequency comorbidities and disability") were extracted, accounting for 55.028% of the total variation.

CONCLUSIONS

The CF-PDI/T is a reliable and valid instrument to assess the symptoms and disability in the Turkish population with temporomandibular disorders. Clinical trial registration number: NCT03837587.Implications for rehabilitationThe Spanish version of the Craniofacial Pain and Disability Inventory is a highly reliable and good valid outcome measure to evaluate disability and treatment outcomes for individuals with temporomandibular disorders (TMDs).We suggest the Turkish version of the Craniofacial Pain and Disability Inventory (CF-PDI/T) be used in the Turkish population to indicate small changes in the severity of disorder of individuals with TMDs until a normal quality of life is achieved.The CF-PDI/T can be used with high reliability and validity by experienced and inexperienced dentists and physiotherapists.

Establishment of quantitative indicators for an efficient treatment on masticatory muscle pain

BACKGROUND

Although several studies have investigated effective treatments for masticatory muscle pain (MMP), no unified conclusion has been drawn regarding the effectiveness of these treatments.

OBJECTIVES

This study aimed to define quantitative indicators for predicting the outcome of MMP treatment.

MATERIALS AND METHODS

In total, patients aged 20-70 years were recruited and divided into the MMP (n = 24) and control (n = 36) groups, based on the presence of MMP according to the Diagnostic Criteria for Temporomandibular Disorders. At pretreatment, the MMP group was assessed using quantitative indicators such as subjective pain levels, pain duration, graded chronic pain scale (GCPS), and perceived stress scale (PSS). Salivary alpha-amylase (sAA) and interleukin-6 (IL-6) levels were analyzed. The masticatory muscle palpation score and the range of mouth opening were measured. At posttreatment, subjective pain levels, mouth opening, and treatment/medication duration were examined. The PSS and sAA levels were assessed in the control group.

RESULTS

sAA levels in the MMP group were significantly higher than those in the control group (p < .05). The masseter muscle palpation score (MPS) showed a positive correlation with IL-6 levels (ρ = 0.503, p < .05) and a negative correlation with nonsteroidal anti-inflammatory drug (NSAID) treatment period (ρ = -0.462, p < .05). The temporalis muscle palpation score (TPS) was positively correlated with pain duration and GCPS grade (ρ = 0.483, p < .05, and ρ = 0.445, p < .05, respectively).

CONCLUSIONS

Treatment with NSAIDs was effective in the MMP group with high MPS and IL-6 levels, but not in the MMP group with high TPS, pain duration, and GCPS grade.

[Quality Evaluation of Temporomandibular Joint Images from 3 High-resolution Dynamic Sequences]

Objective To compare the image quality of three high-resolution dynamic MRI methods for evaluating the motion of temporomandibular joint disc and condyle. Methods Twenty-five patients with suspected temporomandibular joint disorders were examined by single-shot fast spin-echo (SSFSE),fast imaging employing steady-state acquisition (FIESTA),and spoiled gradient echo (SPGR) on the oblique sagittal position.Two radiologists performed subjective and objective evaluation on the images with double-blind method.The subjective evaluation included the signal intensity of mandibular condyle,articular disc,soft tissue around articular disc,and lateral pterygoid muscle,the contrast between articular disc and condyle,the contrast between articular disc and surrounding soft tissue,condylar motion,and disc movement.The objective evaluation indexes included image signal intensity,signal-to-noise ratio (SNR),and contrast-to-noise ratio (CNR).The subjective and objective indexes of the image quality were compared between the three sequences. Results The SSFSE sequence had lower signal intensity of articular disc and higher signal intensity of condyle and surrounding soft tissue than FIESTA and SPGR sequences (all P<0.001).The SPGR sequence showed higher signal intensity of lateral pterygoid muscle than the SSFSE and FIESTA sequences (P=0.017,P<0.001).Among the three sequences,SSFSE sequence showed the clearest articular disc structure (χ2=41.952,P<0.001),the strongest contrast between articular disc and condyle (χ2=35.379,P<0.001),the strongest contrast between articular disc and surrounding soft tissue (χ2=27.324,P<0.001),and the clearest movement of articular disc (χ2=44.655,P<0.001).SSFSE and FIESTA sequences showed higher proportion of disc displacement and reduction than SPGR sequence (all P<0.001).The CNR (χ2=21.400,P<0.001),SNR (χ2=34.880,P<0.001),and condyle signal intensity (F=337.151,P<0.001) demonstrated differences among SSFSE,FIESTA,and SPGR sequences.The CNR of SSFSE sequence was higher than that of FIESTA sequence (P<0.001),while it had no significant difference between SSFSE and SPGR sequences (P=0.472).In addition,the SSFSE sequence had higher SNR and signal intensity than FIESTA and SPGR sequences (all P<0.001). Conclusion The best image quality can be observed from SSFSE sequence where both the structure and movement of temporomandibular joint are well displayed.Therefore,SSFSE is preferred for the examination of temporomandibular joint movement.

TMJ Disorders in Athletes

ABSTRACT

Temporomandibular joint dysfunction is common in both the general population and athletes with a much higher incidence in women than in men. We review current research on temporomandibular joint disorders, discuss relevant risk factors, manifestations of temporomandibular disorders in athletes, and treatment options. Certain sports, particularly contact sports, pose an increased risk for problems with the temporomandibular joint. The stress of athletic performance also may be a contributing factor. Mouthguards should be encouraged for prevention of injury and physical therapy is the most effective treatment.

A Meta-Synthesis of the Experience of Chronic Temporomandibular Disorder Patients Within Health Care Services

Aims: To systematically review the qualitative evidence related to experiences of patients with temporomandibular disorders (TMD) and to explore their journeys within health care services. Methods: A systematic search of the following databases was conducted: MEDLINE, Embase, PsycINFO, Web of Science, CINAHL Complete, and the Cochrane database. Thematic synthesis was used to analyze and synthesize the data from qualitative studies that explored the journeys of TMD patients within health care services. The Critical Appraisal Skills Programme (CASP) tool was used to critically appraise the quality of the included studies. Results: The search strategies yielded 4,563 articles across all databases, and 18 articles were eventually included. Six themes were derived: care-seeking attitudes; expectations and health care experience; the patient-clinician interaction; diagnosis as a stepping stone for improvement; management; and social support. Conclusion: The journey within health care services may play a valuable role in the ability to cope with chronic TMDs. Receiving a diagnosis, being listened to, and being believed are among the most important elements making for a positive clinical experience.

Prevalence of painful temporomandibular disorders, awake bruxism and sleep bruxism among patients with severe post-traumatic stress disorder

BACKGROUND

Post-traumatic stress disorder (PTSD) is associated with painful temporomandibular disorder (TMD) and may be part of the aetiology of awake bruxism (AB) and sleep bruxism (SB). Investigating the associations between PTSD symptoms on the one hand, and painful TMD, AB and SB on the other, can help tailoring treatment to the needs of this patient group.

OBJECTIVES

The aim of this study was to investigate the associations between PTSD symptoms and painful TMD, AB and SB among patients with PTSD, focusing on prevalence, symptom severity and the influence of trauma history on the presence of painful TMD, AB and SB.

METHODS

Individuals (N = 673) attending a specialised PTSD clinic were assessed (pre-treatment) for painful TMD (TMD pain screener), AB and SB (Oral Behaviours Checklist), PTSD symptoms (Clinician-Administered PTSD Scale) and type of traumatic events (Life Events Checklist).

RESULTS

Painful TMD, AB and SB were more prevalent among patients with PTSD (28.4%, 48.3% and 40.1%, respectively) than in the general population (8.0%, 31.0% and 15.3%, respectively; all p's < .001). PTSD symptom severity was found to be significantly, but poorly, associated with the severity of painful TMD (rs  = .126, p = .001), AB (rs  = .155, p < .001) and SB (rs  = .084, p = .029). Patients who had been exposed to sexual assault were more likely to report AB than patients who had not. Similarly, exposure to physical violence was associated with increased odds for SB.

CONCLUSION

Patients with severe PTSD are more likely to experience painful TMD, AB or SB, whereas type of traumatic event can be of influence. These findings can contribute to selecting appropriate treatment modalities when treating patients with painful TMD, AB and SB.

Potential Role of Obstructive Sleep Apnea on Pain Sensitization and Jaw Function in Temporomandibular Disorder Patients

BACKGROUND

The relationships between obstructive sleep apnea (OSA) and diverse types of pain disorders have been reported. However, the interaction between OSA and pain-related temporomandibular disorder (TMD) remains obscure.

METHODS

A total of 60 adults (male/female, 48/12; mean age, 41.7 ± 13.2 years) with pain-related TMD were enrolled. All participants underwent overnight full-channel polysomnography and had assessment of size and position of the tongue, tonsillar size, height, and weight. Diagnostic Criteria/TMD criteria was applied to diagnose TMD. Myofascial trigger points (TrPs) were bilaterally evaluated in the two masticatory and four cervical muscles including the temporalis, masseter, trapezius, sternocleidomastoid, occipitalis, and splenius capitis muscles. Participants were divided into three groups in accordance with their levels of OSA.

RESULTS

The significantly higher number of active TrPs were detected in participants with severe OSA. The number of active TrPs in the masticatory muscles significantly interacted with diverse types of apneic and arousal indices.

CONCLUSION

The myofascial pain modulating mechanisms and jaw function could have interactions with nocturnal hypoxia and sleep fragmentation in chronic pain-related TMD patients.

[Temporomandibular joint disorders: current concepts for conservative management]

The temporomandibular joint is subject to repeated stress. The overloading of the compensation system leads to dysfunction, which manifests itself in the form of muscular and articular damage. Pain, joint noises and limitation of mouth opening are the most frequent reasons for a temporomandibular dysfunction (TMD) consultation. The diagnosis is mainly clinical. The therapeutic concepts are still controversial. The aim of this article is to offer a management strategy based on evidence through the analysis of literature reviews.

THE INFLUENCE OF THE ORTHODONTIC TREATMENT ON THE DEVELOPMENT OF THE TEMPOROMANDIBULAR JOINT DISORDER - LITERATURE REVIEW

TMJ is highly prevalent stomatognathic disease affecting all age groups. Frequently, malocclusion can be the reason of the development of TMJ disorders. However, in addition to this, in the course of orthodontic treatment there may be some complaints about the pain and discomfort in temporomandibular joint, which is caused by orthodontic appliances that aimed to change the condition of malocclusion and mandibles. TMJ disorders are characterized with more complexity in case disorders are chronic or persistent. Orthodontic treatment has a potential role for the possible recovery as a consequence of correction of malocclusion. Pre-orthodontic preparation frequently is a necessary stage of orthodontic treatment. Orthodontists and general dentists must be aware of the multifactorial etiology of TMD and should accept recommendations about controlling the process before or after any dental or orthodontic interventions. The aim of this literature review is to show the effect of the orthodontic treatment in the development of temporomandibular joint disorders. The research may be an important factor for orthodontic patients for better assessment in order to avoid the post treatment complications. In the electronic database of PubMed, Google Scholar, Web of Science and Scopus using the key words the studies held before 2022 were searched and analyzed in addition to the data from the books related to temporomandibular joint and complications of orthodontic treatment. Orthodontic treatment in combined treatment of TMJ disorders has a potential role for the possible recovery. For the successful recovery it is essential clinicists to be informed about TMJ clinical signs and symptoms, have appropriate knowledge about all possible treatment means and detailed assessment of TMJ myofunctional condition before and after the orthodontic treatment. As a result of the correct control of the treatment process amongst the patients with the signs of TMJ dysfunction, the structure of temporomandibular joint is adapted to a new functional positioned that improves clinical condition in the surroundings. On the basis of this research and experience, it must be emphasized one more time that TMJ diagnosis must be a crucial criterion at a pre-orthodontic preparation stage in order to assess the treatment quality and avoid the post treatment complications.

[Patient-specific joint prothesis for ankylotic temporomandibular joints]

A 49-year-old woman who suffered from severe obstructive sleep apnea (OSA) was referred to the department of Oral-, Maxillofacial Surgery department due to progressive limitation of the mouth opening and chronic pain in both temporomandibular joints. Based on clinical and radiological examinations, the patient was diagnosed with recurrent ankylosis of the temporomandibular joints. The patient was treated with 2 patient-specific implants of the temporomandibular joint combined with a Le Fort I osteotomy, and a genioplasty including a genioglossus advancement. This treatment may have advantages for the patient such as a lower recurrence rate of ankylosis, improved maximal mouth opening, pain reduction and improved aesthetic results.

Case-report of an Abrikossoff tumor of the temporomandibular joint Rapport de cas d'une tumeur d'Abrikossoff de l'articulation temporo-mandibulaire

Granular cell tumors are rare tumors with multiple localizations. The most common localizations are in the cervicofacial region in 45-65% of cases. The characterization of this tumor depends on its clinical and histopathological findings. A few cases have been reported describing more unusual localizations, such as in the juxta-axilla or in the gastrointestinal tract. In this article, we describe an original localization: the region of the temporomandibular joint. This case-report describes a clinical case that was managed in the Department of Maxillofacial and Oral Surgery of the Saint-Joseph Hospital. The tumoral lesions usually described for this anatomical location are usually bony or synovial lesions. Here, the clinical examination didn't correspond to any of those descriptions and the MRI also confirmed that this tumor characteristics weren't compatible with this kind of lesion.

Risk factors for the development of temporomandibular disorders related to the work environment - a literature review and own experience

This article characterizes the etiology of temporomandibular disorder with particular emphasis on emotional factors that have a major impact on the development of these dysfunctions and the most common their symptoms. They mainly affect people in the third and fourth decade of life and women predominate among this group of patients. The article analyzes the current literature (Pub Med Database, Scopus and EMBASE) in relation to the conditions in the work environment, which often constitute important causes of emotional tensions, constant state of mental tension and susceptibility to the effects of stressors, which have an impact on the state of functioning of the musculoskeletal system of the masticatory system. Despite the high frequency of temporomandibular disorders, unfortunately only a few studies describe the influence of harmful factors related to the work environment, and own experience (information from the patient's interview) and data from the literature indicate a significant share of these factors in the development of temporomandibular disorder. The relationships and anatomical connections affecting the influence of stressors on the functioning of masticatory muscles and temporomandibular joints are also discussed. In conclusion, it should be stated that the work environment and the emotional tensions generated in it constitute a serious sociological problem and increase the risk of developing and intensify the symptoms of TMD.

Septic arthritis of the temporomandibular joint in adults: Systematic review

BACKGROUND

Septic arthritis of the temporomandibular joint (SATMJ) is acute or chronic bacterial or fungal infection involving temporomandibular joint (TMJ) space. It is a disease with high mortality in whole body joints, and about three-fourths of survivors have residual malfunctioning of the affected joint.

OBJECTIVE

The aim of this review was to search systematically, evaluate and then summarize scientific literature about etiology, signs and symptoms, diagnosis, treatment and prognosis of the SATMJ in adults.

METHODS

After registration at PROSPERO this systematic review was conducted and reported according to the PRISMA checklist. The following databases were systematically searched: MEDLINE, EBSCO, The Cochrane Central Register of Controlled Trials (Central), SCIndex, Scopus, Google Scholar and Registry of clinical studies with human participants.

RESULTS

In total 37 studies with 91 patients were included in the review. Dominant signs and symptoms of SATMJ were pain and trismus, while fever was infrequent. The most frequent isolates from the TMJ were Staphylococcus aureus and Streptococci; however, less than 20% of patients had data about susceptibility of the isolates to antibiotics. Combination of third generation cephalosporin and metronidazole was the most frequently prescribed empirically, and antibiotics especially active against S. aureus (glycopeptides and anti-staphylococcal beta-lactams) were under-prescribed. Administration of antibiotics was prolonged (median over 30 days), although two weeks are sufficient treatment for SATMJ if right choice of antibiotics was made. There was high rate of repeated surgical interventions (53.5%), which were linked to higher risk of long-term functional defects.

CONCLUSIONS

The SATMJ is serious infection that requires early empiric administration of antibiotics with good coverage of Gram-positive bacteria, and subsequent correction of antibiotic therapy according to susceptibility of isolates. Appropriate antibiotic therapy decreases risk of long-term functional disorders.

Temporomandibular disorder: A guide for general dental practitioners

The presentation of patients with symptoms associated with temporomandibular disorders (TMDs) is a common finding in general dental practice. The management of patients with TMDs is often complicated by its multifactorial aetiology. This paper aims to provide a guide for dental practitioners to the clinical examination, diagnosis, and recognition of red flags in relation to TMDs and inform the busy practitioner when to refer patients presenting with TMDs for specialist/secondary care management.

Therapy outcome measures in temporomandibular disorder: a scoping review

OBJECTIVES

Therapy outcome measures (TOMs) in temporomandibular disorders (TMDs) have not been systematically evaluated. We systematically explored the main TOM assessment methods for TMD TOMs used in previous studies.

DESIGN

Scoping review.

DATA SOURCES

According to Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Review reporting guidelines, we systematically searched five key databases (MEDLINE/PubMed, Web of Science, Embase, Epistemonikos and ClinicalTrials) and thoroughly scanned relevant grey literature using Medical Subject Headings, Emtree and index terms.

ELIGIBILITY CRITERIA

We considered primary research papers published from January 2010 to December 2020 that included patients with TMD aged ≥18 years, diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders.

DATA EXTRACTION AND SYNTHESIS

Four reviewers extracted general information and information on study design and setting, target, interventions, and outcome type.

RESULTS

One hundred and seventy-two of the 3726 screened articles (3704 by search engines and 22 manually) were included. The TOMs analysed included pain (n=161 articles), maximal mouth opening (MMO) (91), jaw function (32), jaw movement (26), joint sound (16), quality of life (QOL) (15), depression/anxiety (14), oral QOL (10) or others (30). Evaluation periods were <4 weeks (111), <8 weeks (62), <12 weeks (59), >12 weeks (75) or 'not mentioned' (12). Pain outcomes (229) included general pain (115), tenderness (45), pain during functioning (44), resting pain (16) and others (8). Pain outcome evaluation methods included Visual Analogue Scale (VAS; 121), Numerical Rating Scale (21) and other methods (21). Pain outcome indicators were binary (10) or continuous (158); only five studies reported the least significant difference in treatment efficacy. MMO evaluation using painless methods (19) and jaw function evaluation using methods assessing mandibular movement range (23) were the most frequent.

CONCLUSIONS

TMD TOMs are diverse; the major outcomes were pain, MMO, jaw function and jaw movement. Most pain outcomes are evaluated by VAS Score changes.

Can malocclusion provide clinicians with information for differential diagnosis of temporomandibular joint diseases?: A review

The aim of this literature review was to summarize the clinical characteristics and symptoms of temporomandibular joint diseases, and to discuss the associations between temporomandibular joint diseases and categorization of malocclusion. Electronic literature searches were performed using the PubMed database. The authors established a differential diagnostic method for temporomandibular joint diseases related to malocclusion. A literature search using PubMed yielded 213 texts, of which based on exclusion criteria, 28 were included in this study. Malocclusions were categorized into 5 types. The authors suggested a diagnostic tree of temporomandibular joint diseases based on the types of malocclusion and 4 variables in clinical characteristics and symptoms. Clinicians treating malocclusions must attempt to clarify the cause of the occlusal condition. If caused by temporomandibular joint disease, it is important to make a proper differential diagnosis at first, and not to overlook the causative disease. Further clinical knowledge of associations between temporomandibular joint diseases and malocclusions should be accumulated, and the diagnostic tree should be improved based on new information.

Diagnosis of temporomandibular disorders using artificial intelligence technologies: A systematic review and meta-analysis

Background

Artificial intelligence (AI) algorithms have been applied to diagnose temporomandibular disorders (TMDs). However, studies have used different patient selection criteria, disease subtypes, input data, and outcome measures. Resultantly, the performance of the AI models varies.

Objective

This study aimed to systematically summarize the current literature on the application of AI technologies for diagnosis of different TMD subtypes, evaluate the quality of these studies, and assess the diagnostic accuracy of existing AI models.

Materials and methods

The study protocol was carried out based on the preferred reporting items for systematic review and meta-analysis protocols (PRISMA). The PubMed, Embase, and Web of Science databases were searched to find relevant articles from database inception to June 2022. Studies that used AI algorithms to diagnose at least one subtype of TMD and those that assessed the performance of AI algorithms were included. We excluded studies on orofacial pain that were not directly related to the TMD, such as studies on atypical facial pain and neuropathic pain, editorials, book chapters, and excerpts without detailed empirical data. The risk of bias was assessed using the QUADAS-2 tool. We used Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) to provide certainty of evidence.

Results

A total of 17 articles for automated diagnosis of masticatory muscle disorders, TMJ osteoarthrosis, internal derangement, and disc perforation were included; they were retrospective studies, case-control studies, cohort studies, and a pilot study. Seven studies were subjected to a meta-analysis for diagnostic accuracy. According to the GRADE, the certainty of evidence was very low. The performance of the AI models had accuracy and specificity ranging from 84% to 99.9% and 73% to 100%, respectively. The pooled accuracy was 0.91 (95% CI 0.76–0.99), I² = 97% (95% CI 0.96–0.98), p < 0.001.

Conclusions

Various AI algorithms developed for diagnosing TMDs may provide additional clinical expertise to increase diagnostic accuracy. However, it should be noted that a high risk of bias was present in the included studies. Also, certainty of evidence was very low. Future research of higher quality is strongly recommended.

Psychologic Impact of Chronic Orofacial Pain: A Critical Review

AIMS

To explore the prevalence of clinically significant anxiety and depression in adult patients with chronic orofacial pain (COFP) conditions.

METHODS

A systematic online search of the Medline (PubMed) and Ovid databases was performed for articles published from 2006 to 2019. Observational studies- including cross-sectional, case-control, and case series-and longitudinal prospective studies were included. A total of 118 articles were selected for inclusion, and the prevalence rates of clinically significant anxiety and depression were summarized.

RESULTS

Most studies focused on temporomandibular disorder (TMD) pain and less often on neuropathic COFP conditions. Prevalence rates varied widely across studies according to OFP condition and assessment measure; most questionnaire-based assessments yielded rates of clinically significant depression and anxiety in, respectively, 40% to 60% and 40% to 65% of individuals with TMD and in 20% to 50% and 25% to 55% of patients with neuropathic, mixed, or idiopathic/atypical COFP conditions. Rates of anxiety and depression were lower in studies using diagnostic instruments and in TMD studies with nonpatient samples. Most controlled studies showed a higher prevalence of anxiety and depression in individuals with COFP than in those without. Higher COFP pain levels and the presence of comorbid conditions such as migraines or widespread pain increased the likelihood of anxiety and/or depressive symptoms in individuals.

CONCLUSION

Clinically significant anxiety and depression were commonly observed in patients with COFP, were present at higher rates than in pain-free participants in controlled studies, and were closely linked to pain severity. More research is needed to evaluate the psychologic impact of multiple COFP conditions in an individual and the prevalence of precondition psychologic morbidity.

Relationship between attention deficit hyperactivity disorder and temporomandibular disorders in adults: a questionnaire-based report

OBJECTIVE

The symptoms of the attention deficit hyperactivity disorder (ADHD) persist in the adult years of life in most cases. They appear in adults with accompanying psychosocial problems. Temporomandibular disorder (TMD) refers to signs and symptoms associated with pain of non-dental origin in the oro-facial region, functional and structural disruptions of the masticatory system, especially the temporomandibular joints (TMJs) and masticatory muscles. The aim of the study was to show the relationship between the presence of ADHD symptoms in adulthood, in relation to the intensity of pain experienced in the face and problems connected to the TMD symptomatology, as well as sleep disorders.

PATIENTS AND METHODS

The study group consisted of 252 individuals aged 18-55 years of both sexes, generally healthy. Each participant was asked to fill in several questionnaires, namely: ASRS (the World Health Organization ADHD Adult Self-Report Scale), DIVA (18 questions, 9 for concentration and attention disorders with an option in adulthood and childhood, 9 for hyperactivity and impulsivity with an option in adulthood and childhood), Athens Insomnia Scale, Stanford Sleepiness Scale (SSS), DC/TMD classification (Diagnostic Criteria for Temporomandibular Disorders - biaxial diagnostic criteria based on the biopsychosocial model).

RESULTS

Results show that when ADHD symptoms observed in childhood persist, personality disorders, social relations disorders and affective disorders are found more often in adults than motor hyperactivity.

CONCLUSIONS

There is a positive association between ADHD and the occurrence of symptoms of TMD in adults. This study confirmed this picture, extending it to include pain and sleep disorders.

sEMG and Vibration System Monitoring for Differential Diagnosis in Temporomandibular Joint Disorders

The stomatognathic system represents an important element of human physiology, constituting a part of the digestive, respiratory, and sensory systems. One of the signs of temporomandibular joint disorders (TMD) can be the formation of vibroacoustic and electromyographic (sEMG) phenomena. The aim of the study was to evaluate the effectiveness of temporomandibular joint rehabilitation in patients suffering from locking of the temporomandibular joint (TMJ) articular disc by analysis of vibrations, sEMG registration of masseter muscles, and hypertension of masticatory muscles. In this paper, a new system for the diagnosis of TMD during rehabilitation is proposed, based on the use of vibration and sEMG signals. The operation of the system was illustrated in a case study, a 27-year-old woman with articular dysfunction of the TMJ. The first results of TMD diagnostics using the k-nearest neighbors method are also presented on a group of fifteen people (ten women and five men). Vibroacoustic registration of temporomandibular joints, sEMG registration of masseter muscles, and functional manual analysis of the TMJ were simultaneously assessed before employing splint therapy with stomatognathic physiotherapy. Analysis of vibrations with the monitoring of sEMG in dysfunctions of the TMJ can lead to improve differential diagnosis and can be an objective way of monitoring the rehabilitation process of TMD.

Remote physical examination for temporomandibular disorders

ABSTRACT

There is a need to further develop telemedicine approaches because of the immediate and perhaps long-term consequences of the coronavirus disease 2019. Thus, a remote protocol for assessment of patients with temporomandibular disorders (TMD) was developed, and the agreement of this protocol was compared with the guidelines of the Diagnostic Criteria for TMD (DC/TMD). A total of 16 individuals were first assessed by a reference standard examination (RSE) and 3 other examinations applied in a random order by 3 examiners: standard physical examination (standard examination), physical examination keeping 2-m distance (physical distanced examination), and examination conducted with the aid of video communication technology (video communication examination). The primary outcomes were the diagnoses of myalgia of the masseter and temporalis muscles and arthralgia. The diagnoses of intra-articular joint disorders were considered secondary outcomes because of a less impact on psychosocial functioning and quality of life when compared with the pain-related diagnoses. The Fleiss kappa coefficient and its 95% confidence interval were computed to determine the level of agreement in diagnoses between each examination protocol and the RSE. There was substantial to almost perfect agreement between the RSE and all the examination protocols for the diagnoses of myalgia (0.86-1.00) and arthralgia (0.74-0.87) (P < 0.001). On the other hand, there was an overall poor agreement (0.30-0.58) between the RSE and all the protocols for the diagnosis of disk displacement with reduction. Remote assessment of patients with pain-related TMD is feasible and presents a high degree of accuracy.

The Level of Self-Perceived Knowledge Regarding Temporo-mandibular Disorders among the Saudi Arabian Dental Professionals Working in Dental Institutes or Universities vs. Clinics or Hospitals

Temporo-mandibular disorders (TMDs) are considered as one of the most common type of oro-facial pain. The basic knowledge regarding examining, diagnosing and treating the TMDs is part of the dental curriculum designed by the Saudi Dental Council. But till date it is not reported how the dentists working in dental institutes/universities and clinics/hospital of Saud Arabia make an attempt to diagnose and treat TMDs cases. Therefore, the main aim of the study was to evaluate the level of self-perceived TMD knowledge among the dentists working in Saudi Arabia and to compare the between those working in dental institutes/universities (Group I) and clinics/hospital (Group II). On prior ethical approval from Riyadh Elm University, the participants graduated from various universities of Saudi Arabia with more than two years of experience were randomly selected. They were asked to fill a previously validated questionnaire to evaluate them regarding their knowledge regarding TMDs diagnosis and therapy. It was observed only 9.09% of participants working in dental institutes/universities considered their knowledge as very good whereas it was higher (36.36%) among the participants working in clinics/hospitals. Of all respondents working in dental institutes/universities 7.23% attempted to diagnose and treat TMDs, slightly higher number of respondents (9.09%) working in hospitals/clinics attempt to treat patients with TMDs. A strong relationship was observed for both groups between the knowledge for TMDs and attempt to diagnose/ treat TMD patients (p≤0.05). The level of knowledge for TMDs is better among the dentists working in dental clinics or hospitals than those in dental institutes or universities. But in general it is still insufficient in both groups of dentists. Therefore, it should be considered to raise the level of knowledge regarding TMD among the dentists of Saudi Arabia, particularly to make them able for referring to the right specialist for diagnosis, treatment or interdisciplinary management.

Fear of Movement and Catastrophizing in Participants with Temporomandibular Disorders

AIMS

To assess differences in catastrophizing and kinesiophobia in relation to areas of pain and somatic symptoms among participants with temporomandibular disorders (TMDs) and controls.

METHODS

In total, 401 participants (333 women, 68 men, mean age: 45.8 years) in the TMJ Impact Project were examined in accordance with the Diagnostic Criteria for TMD, including clinical examination (Axis I) and psychosocial assessment (Axis II) augmented with imaging of the temporomandibular joint (TMJ). Of these, 218 participants had a painful TMD pain diagnosis, 63 had a nonpainful TMD diagnosis, and 111 had no TMD. Nine participants had missing data. Participants completed the Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, Areas of Pain figure, and the Patient Health Questionnaire-15 for assessing somatic symptoms.

RESULTS

Compared to controls, participants with TMD pain showed higher levels of catastrophizing (P = .017), kinesiophobia (P < .001), areas of pain (P < .001), and somatic symptoms (P < .001). Participants with nonpainful TMD showed a higher level of kinesiophobia (P < .001) than controls. There was a positive correlation between catastrophizing and kinesiophobia for participants with TMD pain (r = 0.33, P < .001) and nonpainful TMD (r = 0.42, P < .001).

DISCUSSION

The results suggest more fear of movement, as well as an association between catastrophizing and fear of movement, in participants with TMD pain and in participants with nonpainful TMD compared to controls. Assessment and management of fear of movement as well as catastrophizing may be useful as part of individualized treatment strategies for patients with TMD.

The effect of functional mandibular advancement for adolescent patients with skeletal class II malocclusion on the TMJ: a systematic review and meta-analysis

OBJECTIVES

This study aimed to assess whether functional mandibular advancement (FMA) will cause temporomandibular joint disorders (TMD) or have side effects on temporomandibular joint (TMJ) in adolescent patients.

METHODS

All searched databases, including PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trails and Scopus were searched. Gray literature and unpublished literature was also searched. Randomized controlled trails (RCT) and non-randomized studies of the effects of interventions (NRSI) directly observe the condition of adolescent patients' TMJ after finishing treatment will be considered to include in our study. According to Cochrane Handbook, Cochrane Collaboration risk of bias tool was used to assess the quality of included RCTs, and Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool was used to assess the quality of included NRSIs.

RESULT

Finally 18 researches were evaluated as eligible to include in this study. 5 of the studies were RCTs, 8 were NRSIs and 5 were systematic reviews. The data of RCTs and NRSIs were statistically pooled in meta-analysis. The number of samples under investigated among primary studies was 579 individuals,there were 80 patients who developed temporomandibular symptoms during or after treatment. But all the subjective symptoms disappeared during follow-up time. The statistical outcomes proved that patients received FMA didn't show more tendency to develop temporomandibular symptoms [I2 = 27%, OR = 0.54, 95%CI (0.33,0.87), p = 0.01].

CONCLUSION

(1) TMJ symptoms may occur during the functional oral appliance wearing, but the symptoms will release or disappear after treatment or during the follow-up period. (2) Less convincing evidence indicates that slightly previous TMD and condyle-glenoid fossa relationship will be improved after treatment. (3) There is TMJ disc anterior displacement observed during treatment, but most of them will return to the normal position later. (4) Moderate evidence support that FMA will not have side effects on TMJ of adolescent patients.