Oral health–related quality of life in women with temporomandibular joint disk anterior displacement before and after disk repositioning and anchoring surgery assessed with the Oral Health Impact Profile (OHIP-14)

A review of the use of patient reported outcome measures (PROMS) in temporomandibular joint (TMJ) surgery

Temporomandibular joint (TMJ) surgery accounts for a significant number of patient episodes in oral and maxillofacial surgery, and treatment effectiveness is commonly assessed using measures of pain and mouth opening. Patient-reported outcome measures (PROMs) enable assessment of the patient's perspective and perception of the diseases and treatment outcomes. The purpose of this review was to assess the use of PROMs in TMJ surgery. A review of 3 databases (PubMed, OVID, Trip) was carried out to assess the use of PROMs when reporting on TMJ surgical interventions. Studies were limited to the English language, involving humans and at least one surgical intervention of the TMJ. A total of 214 articles met the inclusion and exclusion criteria, of which only 28 used 18 PROMs among them. Half of these PROMs were single-question visual analogue scales or Likert scales on quality of life and disability. The Oral Health Impact Profile and the Helkimo Clinical Dysfunction Index were the second most used (n = 3). PROMs were used most in studies on internal derangement (n = 9) and in cohort study designs (n = 26), but this was not statistically significant. In the majority of research on TMJ surgery, no PROMs are used, and when one is, there is a tendency to use weaker single-question PROMs as opposed to multi-question PROMs to assess outcomes. With the increasing importance of PROMs for assessing patients' perception of treatment outcomes, further research is needed to establish valid and reproducible PROMs for TMJ surgery.

Gender differences in lateral pterygoid muscle in patients with anterior disk displacement

OBJECTIVE

To use quantitative MRI to assess gender differences in lateral pterygoid muscle (LPM) characteristics in patients with anterior disk displacement (ADD).

METHODS

Lateral pterygoid muscle of 51 patients diagnosed with temporomandibular joint disorders (TMD) who underwent T1-weighted Dixon and T1-mapping sequences were retrospectively analyzed. There were 34 female patients (10 with bilateral normal position disk [NP]; 24 with bilateral ADD) and 17 male patients (eight with bilateral NP; nine with bilateral ADD) among them. After controlling for age, differences in fat fraction, T1 value, volume and histogram features related to gender and disk status were tested with 2-way ANCOVA or Quade ANCOVA with Bonferroni correction.

RESULTS

Volume of LPM in NP was significantly smaller than that of ADD (p < 0.001). Fat fraction of LPM in females with NP was significantly higher than males with NP (p < 0.05). Females with ADD showed a significantly higher T1 value (p < 0.05), and higher intramuscular heterogeneity than males with ADD.

CONCLUSIONS

Lateral pterygoid muscle in female TMD patients presented more fatty infiltration in the NP stage and might present more fibrosis in the ADD stage compared with males. Together, this leads to more serious intramuscular heterogeneity during the pathogenesis of ADD in females.

Is the Temporomandibular Joints' Reciprocal Clicking Related to the Morphology and Position of the Mandible, as Well as to the Sagittal Position of Lower Incisors?-A Case-Control Study

The number of patients diagnosed with temporomandibular joint (TMJ) internal derangements, who are seeking orthodontic treatment, is increasing. The aim of the study was to assess the relationship between the presence of TMJ reciprocal clicking and the morphology and position of the mandible, and position of lower incisors, examined on the lateral cephalograms. Fifty patients diagnosed with reciprocal clicking in at least one of the TMJs and 55 patients with no symptoms of TMJ dysfunction were included in the study. Cephalometric analysis was used for the assessment of: skeletal class, sagittal and vertical position of the mandible, angle of the mandible, inclination of the mandibular ramus and the mandibular corpus, as well as for the assessment of the position of the mandibular incisors. The statistical significance level was set at p = 0.05. There were no statistically significant differences between the examined groups regarding the sagittal and vertical position of the mandible, as well as regarding the sagittal position of the mandibular incisors. Presence of TMJ reciprocal clicking is not associated with the position and the morphology of the mandible, as well as with the sagittal position of the mandibular incisors. Patients with early stages of TMJ internal derangements do not present any significant changes in Cephalometrics. Patients diagnosed with TMJ internal derangements before orthodontic treatment require an interdisciplinary approach to the treatment, including physiotherapy.

Patient-centered assessments: how can they be used in dental clinical trials?

Recently, there has been greater interest in adopting a more holistic approach to healthcare. However, this trend should not limit itself merely to the notion that a human being lies behind the mouth being treated. Rather, it should embrace the understanding that this human can actively participate in and contribute to the treatment process. Patient Report Outcome Measures (PROMs) and Patient Report Experience Measures (PREMs) provide means for measuring data from the patient's perspective, and enable health-related feelings and functions to be evaluated. Accordingly, this critical review aims to provide definitions, rationales and applications of patient-centered approaches in dental clinical research. Some patient-centered constructs are especially relevant to dental clinical trials, such as oral health-related quality of life, pain/discomfort, aesthetics and satisfaction concerning treatment and services. The selection and application of patient-reported measures can vary according to condition (generic, disease-specific or treatment-specific) and to the specific population evaluated (age and cognitive impairment). These measures can help weigh risks and benefits, as well as assess the cost effectiveness of treatments, thus influencing treatment recommendations and health policies. The incorporation of these measures into a professional's daily life not only represents an improvement in professional performance, but also addresses a humanitarian concern.