Thermology and facial telethermography: Part II. Current and future clinical applications in dentistry

Thermography as a non-ionizing quantitative tool for diagnosing periapical inflammatory lesions

Background

Thermography is a contemporary imaging modality based on acquiring and analyzing thermal data using non-contact devices. The aim of the present study was to assess the validity of thermography, compared with that of the reference-standard, for the diagnosis of periapical inflammatory lesions and to evaluate the temperature ranges for acute pulpitis with apical periodontitis (AAP), acute periapical abscess (AA) and chronic periapical abscess (CA).

Methods

AAP, AA and CA were diagnosed based on clinical and radiographic criteria. Thermographic data were acquired using the FLIR E-5 Infrared Camera. Extraoral thermal images were taken from the front and right and left sides of patients whose mouths were closed, and one intraoral thermal image was taken from the palatal perspective. Agreement in the diagnoses based on the combination of clinical and radiographic assessments and the thermographic evaluation was calculated. The temperature ranges of the three diagnostic subgroups were also measured.

Results

A total of 80 patients were enrolled in this study. The mean intraoral thermal image temperature for AA was 37.26 ± 0.36, that for CA was 35.03 ± 0.63 and that for AAP was 36.07 ± 0.45. The differences between the mean intraoral thermal temperatures of the three diagnostic groups were statistically significant (P < 0.001). The result of the Kappa coefficient of agreement between the combination of clinical and radiographic assessments and the thermographic evaluation was significant (P < 0.001).

Conclusions

Thermography is an effective, quantitative and nonionizing approach that can be used for the diagnosis of periapical inflammatory lesions. The results of the present study indicated that the highest thermal image temperatures were recorded for AA. Thermography might be able to detect inflammatory reactions during the preclinical stage, leading to early diagnosis.

Diagnosis of Temporomandibular Disorders Using Thermovision Imaging

Temporomandibular joint dysfunction (TMD) is a chronic disease of various etiologies. Correct TMD diagnosis enables to apply effective treatment and significantly improves the quality of patients' lives. One of the diagnostic methods subjected to evaluation in recent years is thermography, which enables safe, noninvasive, and quick imaging of the temperature distribution of temporomandibular joint-associated tissues. This paper, based on Medline, Dentistry & Oral Sciences Source, Academic Search Ultimate, Medline Complete databases, presents basic information related to thermovision imaging and outlines the direction of research conducted in recent years which fight with difficulties in the interpretation of thermograms that require specialized, dedicated analysis and processing of the obtained images. The problem concerns also no standardized protocol for measuring masticatory muscle temperature.

Effect of the parasympathetic vasodilation on temperature regulation via trigeminal afferents in the orofacial area

The skin temperature (T_m) of the orofacial area influences orofacial functions and is related to the blood flow (BF). Marked increases in BF mediated by parasympathetic vasodilation may be important for orofacial T_m regulation. Therefore, we examined the relationship between parasympathetic reflex vasodilation and orofacial T_m in anesthetized rats. Electrical stimulation of the central cut end of the lingual nerve (LN) elicited significant increases in BF and T_m in the lower lip. These increases were significantly reduced by hexamethonium, but not atropine. VIP agonist increased both BF and T_m in the lower lip. The activation of the superior cervical sympathetic trunk (CST) decreased BF and T_m in the lower lip; however, these decreases were significantly inhibited by LN stimulation. Our results suggest that parasympathetic vasodilation plays an important role in the maintaining the hemodynamics and T_m in the orofacial area, and that VIP may be involved in this response.

Infrared thermography assessment of patients with temporomandibular disorders

OBJECTIVES

To assess patients with and without temporomandibular disorders (TMD) infrared thermography according to the differences in thermal radiance using quantitative sensitivity and specificity tests; and to evaluate the thermal asymmetry and the correlation of the thermal intensity with the intensity of pain upon palpation.

METHODS

This cross-sectional study performed a quantitative evaluation of clinical and thermographic examinations. The volunteers were evaluated for the presence of TMD using RDC/TMD (Diagnostic Research Criteria for Temporomandibular Disorders), and were divided into two groups: TMD group (n = 45); control group (n = 41), composed of volunteers without TMD, according to the Fonseca Anamnestic Index. The images were assessed for selected regions of interest for the masseter, anterior temporal and TMJ muscles. The mean values ​​of the areas of both groups were compared under the receiver operating characteristic curve. Spearman correlation analysis (non-parametric data) between pain level and mean temperature, by region, and the Pearson's χ² test was used to verify the association between the presence of temperature and pain asymmetry. The level of significance was set at p < 0.05.

RESULTS

Both Groups, with and without TMD, presented with absolute and non-dimensional mean temperature without statistical differences (p>0.05). When correlating temperature with intensity of pain upon palpation, a negative correlation was observed for the masseter muscle.

CONCLUSION

Infrared Thermography resulted in low area under the curve, making it difficult to differentiate TMD via thermographic analysis. The intensity of pain upon palpation in patients with TMD may be accompanied by a decrease in local temperature.

Cornea Thermography: Optimal Evaluation of the Outcome and the Resulting Reproducibility

Purpose

The aim of the study was to establish a standardized quantitative evaluation of corneal temperature (CT) that includes anchoring reference points in the topography and minimization of artifacts. We further investigated the distribution and the short- and long-term reproducibility of the CT values, as well as the influence of the core temperatures.

Methods

The CT values in both eyes of 40 healthy subjects were measured through thermography. These examinations took place over the course of four visits within 2 consecutive weeks. At each visit, the CTs were measured twice in both eyes with intervals of 15 minutes between measurements.

Results

CT values were not significantly different between the right and left eyes and their distribution was nearly normal. The CTs increased slightly when measured twice over the 15-minute intervals (short-term reproducibility) but remained stable over a period of 2 weeks (long-term reproducibility). In addition, the CT values depended on the core temperatures.

Conclusions

Ocular surface thermography is a fast and noninvasive examination. The methods of optimized and standardized evaluation of the CT values facilitate comparisons and follow-ups.

Translational Relevance

Thermography can be used clinically and scientifically only if both the measurement and its evaluation are efficient and standardized and if the outcomes are highly reproducible.

The employment of thermographic examinations in the diagnostics of diseases of the paranasal sinuses

OBJECTIVES

The article was aimed at assessing the diagnostic value of a thermographic examination of the pathology of the paranasal sinuses.

METHODS

39 patients met the inclusion criteria for the study. The cases of unilateral inflammations of the maxillary sinuses (odontogenic and non-odontogenic, acute and chronic) were chosen on the basis of a comprehensive panel of diagnostic tests including among other things: a radiological examination, endoscopy, the histopathological assessment of the state of the collected mucous membrane. The thermographic examination was carried out on the day preceding the surgery in the ward after finishing full clinical and radiological diagnostics. The measurements were conducted in accordance with the recommendations of the European Society of Thermology with the use of a FLIR E50 thermal imaging camera. The differences of the maximum temperatures (ΔT_max) between the affected side and the healthy side were characterized. The recorded thermal parameters were related to the totality of cases, the patients' age and gender, the category of clinical diagnoses in respect of aetiology, the presence of communication of the oral cavity with the maxillary sinus, changes in the radiological image and the degree of their intensity, a histopathological diagnosis, the presence of acute symptoms in the past as well as the time which elapsed between the occurrence of the first clinical symptoms of sinusitis noticed by the patients and the moment of surgical treatment implementation.

RESULTS

When the oroantral fistulas were present, a highly significant relationship between T_max of the affected and healthy sides was found (p = 0.0095). Odontogenic vs non-odontogenic aetiology seemed to have a significant influence on these temperature differences (p = 0.0133). ΔT_max links also with the state of the mucous membrane assessed during endoscopy (p = 0.038).

CONCLUSIONS

A thermographic examination can be only an auxiliary examination in the diagnostics of the diseases of the maxillary sinuses and may be helpful in the initial assessment of a chronic unilateral pathology.

Assessment of the Sensitivity, Specificity, and Accuracy of Thermography in Identifying Patients with TMD

Background

The purpose of the present study was to evaluate the sensitivity, specificity, and accuracy of thermography in identifying patients with temporomandibular dysfunction (TMD).

Material/Methods

The study sample consisted of 50 patients (27 women and 23 men) ages 19.2 to 24.5 years (mean age 22.43±1.04) with subjective symptoms of TMD (Ai II–III) and 50 patients (25 women and 25 men) ages 19.3 to 25.1 years (mean age 22.21±1.18) with no subjective symptoms of TMD (Ai I).

The anamnestic interviews were conducted according to the three-point anamnestic index of temporomandibular dysfunction (Ai). The thermography was performed using a ThermaCAM TMSC500 (FLIR Systems AB, Sweden) independent thermal vision system. Thermography was closely combined with a 10-min chewing test.

Results

The results of our study indicated that the absolute difference in temperature between the right and left side (ΔT) has the highest diagnostic value. The diagnostic effectiveness of this parameter increased after the chewing test. The cut-off points for values of temperature differences between the right and left side and identifying 95.5% of subjects with no functional disorders according to the temporomandibular dysfunction index Di (specificity 95.5%) were 0.26°C (AUC=0.7422, sensitivity 44.3%, accuracy 52.4%) before the chewing test and 0.52°C (AUC=0.7920, sensitivity 46.4%, accuracy 56.3%) after it.

Conclusions

The evaluation of thermography demonstrated its diagnostic usefulness in identifying patients with TMD with limited effectiveness. The chewing test helped in increasing the diagnostic efficiency of thermography in identifying patients with TMD.

Difference in ocular surface temperature by infrared thermography in phakic and pseudophakic patients

Purpose

To assess the change in ocular surface temperature between healthy phakic and pseudophakic patients.

Methods

We included patients with no history of ocular disease other than cataract. Patients were divided into three groups: clear lens, cataract, and pseudophakic. All patients had two ocular surface digital thermal scans. An average of five surface points was used as the mean ocular surface temperature. Results were analyzed with a one-way analysis of variance and a Tukey’s least significance difference test. The patients were further divided into phakic and pseudophakic groups. Correlation coefficients between several variables were done in order to assess dependencies.

Results

Fifty-six eyes (28 cataracts, 12 clear lenses, 16 pseudophakic) were enrolled. The mean ocular surface temperature in the cataract group was 34.14°C±1.51°C; clear lens: 34.43°C±2.27°C; and pseudophakic: 34.97°C±1.57°C. There were no statistical differences among the study groups (P=0.3). There was a nonsignificant negative correlation trend between age and surface temperature in the phakic group. The trend inverted in the pseudophakic group but without statistical significance.

Conclusion

Although cataract extraction and intraocular lens implantation seem to induce a mild increase in ocular surface temperature, the effect is not clear and not significant.

Women with more severe degrees of temporomandibular disorder exhibit an increase in temperature over the temporomandibular joint

Aim

The purpose of the present study was to correlate the degree of temporomandibular disorder (TMD) severity and skin temperatures over the temporomandibular joint (TMJ) and masseter and anterior temporalis muscles.

Materials and methods

This blind cross-sectional study involved 60 women aged 18–40 years. The volunteers were allocated to groups based on Fonseca anamnestic index (FAI) score: no TMD, mild TMD, moderate TMD, and severe TMD (n = 15 each). All volunteers underwent infrared thermography for the determination of skin temperatures over the TMJ, masseter and anterior temporalis muscles. The Shapiro–Wilk test was used to determine the normality of the data. The Kruskal–Wallis test, followed by Dunn’s test, was used for comparisons among groups according to TMD severity. Spearman’s correlation coefficients were calculated to determine the strength of associations among variables.

Results

Weak, positive, significant associations were found between FAI score and skin temperatures over the left TMJ (rs = 0.195, p = 0.009) and right TMJ (rs = 0.238, p = 0.001). Temperatures over the right and left TMJ were significantly higher in groups with more severe TMD (p < 0.05).

Conclusion

FAI score was associated with skin temperature over the TMJ, as determined by infrared thermography, in this sample. Women with more severe TMD demonstrated a bilateral increase in skin temperature.

Thermographic characterization of masticatory muscle regions in volunteers with and without myogenous temporomandibular disorder: preliminary results

OBJECTIVES

This study aims to conduct a non-invasive measurement of the cutaneous temperature of selected masticatory muscle regions of volunteers with and without myogenous temporomandibular disorder (TMD), using infrared thermography.

METHODS

23 females (10 myogenous TMD volunteers and 13 controls) were recruited and studied. The temperature at the surface of the facial area over the anterior temporalis and masseter muscles was assessed by medical thermography, using regional lateral views and clinical examination.

RESULTS

The temperature levels measured at the masseter and anterior temporalis muscle regions in myogenous TMD volunteers (32.85 ± 0.85 and 34.37 ± 0.64 ºC, respectively) were significantly lower (p < 0.05) than those measured in controls (33.49 ± 0.92 and 34.78 ± 0.44 ºC, respectively). Medical infrared imaging indicated a mean difference of 1.4 ºC between the masseter and anterior temporalis regions. Analysis of the comparison between the absolute and normalized mean temperatures was performed using the pairwise comparison of receiver operating characteristic curves, and no statistically significant difference was observed (p > 0.05). The sensitivity and specificity of the thermographic assessment for the masseter region was of 70% and 73%, respectively and for the anterior temporalis region was of 80% and 62%, respectively.

CONCLUSIONS

This method of evaluating masticatory muscle regions of this preliminary study seems to indicate that it can be used as an aid in complimentary diagnosing of TMDs.