Computerized analysis of the distribution of occlusal contacts in individuals with Parkinson's disease and temporomandibular disorder

Temporomandibular Disorders and Dental Occlusion: What Do We Know so Far?

Throughout the recorded history in the literature of temporomandibular disorders (TMD) there have been a variety of opinions as to its primary cause. Those supporting an occlusal basis of TMD opined that occlusal dysfunction is either the primary cause for or a significant etiopathogenic factor in the causation of TMD. Most of the current literature, however, points to evidence in another direction and questions the causal role of occlusion and occlusal disharmony in TMD etiopathogenesis. Recognition of this evidence-based literature is paramount in eliminating and preventing the chances of overtreatment of patients with TMD.

Orofacial pain and dysfunction in patients with Parkinson's disease: A scoping review

BACKGROUND

Parkinson's disease (PD) is commonly known as a disorder that affects the smooth performance of body movements. In addition to the motor impairments, patients with PD often experience pain. Both motor impairments and pain can occur throughout the body, hence including the orofacial region. However, currently, there is a lack of knowledge on the orofacial manifestations. Since orofacial pain and dysfunction can, amongst others, reduce the quality of life of patients with PD, it is important to explore the prevalence of these symptoms in the PD population.

OBJECTIVE

To provide a broad overview of the relevant literature on orofacial pain and dysfunction in patients with PD. Furthermore, we aim to generate hypotheses for future research on this topic.

DATABASES AND DATA TREATMENT

A literature search (in PubMed, Embase.com, Web of Science [Core collection], and Cochrane Library) was performed on 20 January 2022, in collaboration with a medical librarian. In total, 7180 articles were found, of which 50 were finally included in this scoping review.

RESULTS

In the included studies, pain (e.g. orofacial pain (N = 2) and temporomandibular disorder pain (N = 2)), orofacial motor dysfunction (e.g. limited jaw movements (N = 10), reduced maximum muscle output (N = 3), chewing difficulties (N = 9), unspecified TMD (N = 3), sensory disturbances (N = 1)), and bruxism (N = 3) were observed more often in patients with PD than in healthy controls.

CONCLUSION

Patients with PD experience more pain in the orofacial area and more dysfunction of the masticatory system than their healthy peers.

SIGNIFICANCE

This scoping review can increase health care providers' awareness of the problems that can be encountered in the orofacial area of PD patients, especially pain syndromes also occur in the orofacial region and not only in the extremities. Besides, dysfunction of the orofacial area is elaborated in this scoping review, which helps to understand that this limits PD patients' quality of life. Further, the outcomes of this scoping review can assist in encouraging collaboration between medicine and dentistry. Finally, this scoping review suggests new research areas, based on the gaps identified in the current literature on this topic. Ultimately, this will improve individualized strategies for reducing orofacial pain and/or dysfunction in PD patients.

Chronic pain and depression as factors associated with temporomandibular dysfunction in older adults with Parkinson's disease

ABSTRACT Purpose: to investigate whether chronic pain and depression are factors associated with temporomandibular dysfunction (TMD) in older adults with Parkinson's disease. Methods: a cross-sectional study using the Research Diagnostic Criteria for Temporomandibular Disorders questionnaire. The clinical variables studied were chronic pain, depression, nonspecific physical symptoms including and excluding items of pain, and dentures use. The associations between the dependent and independent variables were evaluated by the chi-square odds ratio, with a 95% confidence interval. Results: a total of 81 older adults met the eligibility criteria - 67% were males, 74% were married or had a partner, 43% reported earning 1 to 2 minimum wages, and 47% were in the moderate stage of Parkinson's disease. TMD was identified in 22% of the sample, 12% reporting chronic pain. The statistical analysis showed an association between TMD and chronic pain (p = 0.001, OR = inf, 95% CI = 12.13 - inf) and between TMD and moderate-to-severe depression (p = 0.014, OR = 4.8, 95% CI = 1.14 - 23.51). Conclusion: it was verified that chronic pain and moderate-to-severe depression were the factors associated with TMD in older adults presented with Parkinson's disease.

Comparison between conventional and computerised methods in the assessment of an occlusal scheme

PURPOSE

In the definition of an occlusal scheme, clinicians should choose between conventional and computerised methods based on a careful appraise of the advantages and limitations. This study aims to assess the correlation between the two approaches in a clinical setting.

METHODS

Twenty-four patients were included to compare different methods of occlusal contacts assessment on the posterior surfaces of flat mandibular appliances. In supine position, they were asked to clench with maximum strength, in the maximum intercuspation position with a 24 μm articulating paper positioned between the teeth and the appliance surface. An extra-oral photograph of the marks was taken (total N = 2082). They were visually classified based on a pre-defined scale (ie, conventional assessment) and with ImageJ analysis software (ie, photographic software assessment). Additionally, a computerised occlusal analysis was performed (ie, computerised assessment). Correlation analysis of the data achieved with conventional, photographic and computerised assessments was performed.

RESULTS

Correlation between conventional and computerised assessments was weak (r = .265), whilst it was moderate between conventional and photographic assessments (r = .633), as well as between photographic and computerised assessments (r = .476).

CONCLUSIONS

This investigation showed a weak-to-moderate correlation between different methods (ie, conventional, photographic and computerised) to assess occlusal marks. None of the three can actually be considered the standard of reference, but based on their specific features, it can bet suggested that the conventional method may be enough for most clinical purposes, unless otherwise proven.

Effect of occlusal splint and therapeutic exercises on postural balance of patients with signs and symptoms of temporomandibular disorder

The aim of this study was to investigate the effects of the use of an occlusal splint on postural balance considering the occlusal splint as a device for treating temporomandibular joint disorder. A randomized, controlled, prospective clinical trial was conducted. The research group consisted of 49 patients (36 as test group and 13 as control group) between 18 and 75 years old, both genders, diagnosed as temporomandibular disorder by Research Diagnostic Criteria/Temporomandibular Disorders questionnaire and magnetic resonance imaging of the temporomandibular joints. Test group was treated with orientations for physiotherapeutic exercises and occlusal splint, whereas control group received orientation for physiotherapeutic exercises only. Postural equilibrium was evaluated by means of a force plate. After 12 weeks, the groups were re-evaluated. Patients from both groups presented a significant increase in antero-posterior speed with eyes closed, test group (P < 0.001) and control group (P = 0.046). Only patients of the test group presented a significant increase in antero-posterior speed with eyes opened (P = 0.023). We concluded that the use of occlusal splint affected the postural balance.

Prevalence of temporomandibular joint disorder in people with Parkinson’s disease in a public university hospital

ABSTRACT Objective: to evaluate the prevalence of temporomandibular joint disorder in people with Parkinson’s disease in a public university hospital, and relate it to sociodemographic factors, general health and oral health self-report, and phase and time of illness. Methods: the Research Diagnostic Criteria for Temporomandibular Disorders were used. The sample was classified according to the diagnosis of temporomandibular disorder and associated with the variables. The odds ratio of Chi-square was applied with a 95% confidence interval and a level of significance set at p<0.05. Results: 110 people presented with Parkinson's disease were assessed. The prevalence of temporomandibular disorder was 35%, being more frequent among males (58%), in elderly people (53%), in phase 2 of the disease (61%), click (37%) being the predominant clinical indication. Of the variables analyzed, only gender and self-perception of oral health showed to be associated with temporomandibular disorders. Conclusion: the presence of temporomandibular disorder has been observed in people with Parkinson's disease, and the fact of being male and reporting moderate oral health seen as associated factors.