The difficult relationship between occlusal interferences and temporomandibular disorder - insights from animal and human experimental studies

The impact of malocclusion on the prevalence of pain-related temporomandibular disorders in children and adolescents: a systematic review

Background

The connection between occlusion and temporomandibular disorders (TMD) remains a topic of discussion, and current research does not provide a definitive answer. Pain-related TMD are the most common types of TMD. They include myalgia, arthralgia, and headaches attributed to TMD. This systematic review aims to synthesize the current scientific evidence regarding impact of malocclusion on the prevalence of pain-related TMD in individuals under 18 years.

Methods

The study was based on a searching of the PubMed, Scopus, Embase, and Web of Science databases. Selection was limited to studies that explored the link between malocclusion and pain-related TMD in young individuals. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the selected research. The certainty of evidence was assessed using the Grading Recommendations Assessment, Development and Evaluation (GRADE) approach. A visual representation of the screening and inclusion processes was created using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram. The information from the research was then summarized in a descriptive format.

Results

Out of 868 potentially relevant articles initially identified, 13 studies were selected based on the inclusion criteria. The majority of these studies were determined to be of moderate quality, according to the NOS assessment. The certainty of evidence was assessed as low, according to the GRADE approach. Most of the studies showed that malocclusion may be associated with TMD-pain signs/symptoms in children and adolescents. The most frequent relationship was found between the prevalence of pain-related TMD and posterior crossbite, Class II malocclusion, Class III malocclusion, and anterior open bite.

Conclusion

Certain types of malocclusion may have an impact on the prevalence of some TMD-pain signs and symptoms in young individuals. However, given the limited reliability of existing research and the inconsistencies observed across studies, additional well-structured, long-term investigations are necessary.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42024570950.

Relationship between Mediotrusive Occlusal Contacts and Temporomandibular Disorders in Young Adults without Psychosocial Disorders: A Case-Control Study

Aim

Temporomandibular disorders (TMDs) are multifactorial pathologies often associated with pain, muscle dysfunction, and joint alterations. Mediotrusive (MT) occlusal contacts have been implicated in TMDs due to their potential to alter mandibular biomechanics and masticatory patterns. However, the strength of this association, especially in individuals without psychosocial disorders, remains unclear. The aim was to investigate the relationship between MT occlusal contacts and acute TMDs symptomatology in young adults without psychosocial disorders.

Materials and Methods

This case-control study included 116 university students aged 18-30 years, divided into cases (n = 58) with TMDs and controls (n = 58) without TMDs. The Diagnostic Criteria for TMDs were used for diagnosis. MT occlusal contacts were evaluated using 12 µm Arti-Fol tape. Guided lateral mandibular movements were performed to assess their role in TMD symptomatology. Statistical analyses, including Chi-square tests and multivariable logistic regression, were conducted to assess the association between MT contacts and TMDs, adjusting for confounders such as age, gender, angle classification, and retruded contact position to maximum intercuspation (RCP-MI) discrepancies ≥2 mm. Statistical significance was set at P < 0.05.

Results

MT occlusal contacts were significantly associated with TMDs (P = 0.003). The adjusted odds ratio (OR) for individuals with MT occlusal contacts was 3.70 (95% confidence interval (CI): 1.58-8.66). This association was strongest at short lateral movement trajectories, particularly at 0.5 mm (P = 0.013, OR=2.63) and 1 mm (P = 0.002, OR=4.56). Class II malocclusion and RCP-MI discrepancies ≥2 mm were also significantly associated with TMDs in adjusted models.

Conclusion

MT occlusal contacts are associated with acute TMDs symptomatology in young adults without psychosocial disorders, particularly during short lateral mandibular movements. However, their predictive value is low, and adaptive mechanisms likely mitigate their long-term effects. This study does not support routine occlusal therapy for managing these contacts in TMD patients. Future longitudinal research should explore chronicity, digital methods for occlusal recording, and the interplay between MT contacts and other etiological factors.

Influence on the temporomandibular joint induced by mandibular malpositioning caused by vertical dimension elevation and occlusal loss in adult rats: An imaging, histological and immunohistochemical study

BACKGROUND

Mandibular malpositioning may result in an abnormal concentration of stresses within the temporomandibular joint (TMJ) in adult rats, which may further lead to a series of pathological changes, such as articular cartilage wear, subchondral bone sclerosis and osteophyte formation. However, the pathological and adaptive changes in condylar cartilage caused by different stress distributions are still controversial.

OBJECTIVE

The aim of this study was to observe the effect of sagittal changes in mandibular position on condylar cartilage by changing the occlusal vertical dimension (OVD) in adult rats.

METHODS

Fifteen-week-old female rats were divided into three groups: control (CON), increased OVD (iOVD) and loss of occlusion (LO) groups. An occlusal plate and tooth extraction were used to establish the animal model. TMJ samples of the experimental and CON groups were observed and investigated by bone morphological, histomorphological and immunohistochemical staining analyses at 3 days, 1 week, 2 weeks, 4 weeks and 8 weeks. Weight curves were plotted.

RESULTS

Micro-computed tomography showed that, compared with the CON group, cartilage destruction followed by repair occurred in both experimental groups, which was similar to the trend observed in haematoxylin-eosin staining. All experimental results for the iOVD group showed an approximately similar time trend. Compared with the iOVD group, the toluidine blue and immunohistochemical staining results in the LO group showed no obvious change trend over time.

CONCLUSION

Compared with occlusal loss, an increase in OVD caused faster and more severe damage to condylar cartilage, and subchondral bone repair occurred later.

Clinical and electromyographic signals analysis about the effect of space-adjustment splint on overerupted maxillary molars

BACKGROUND

Overerupted maxillary molars is common in adults, which can lead to insufficient intermaxillary vertical space ,great difficulty in prosthetic reconstruction ,and cause occlusal interference in movements.To reconstruct occlusal function, it is necessary to prepare enough space for prostheses. The aim of the present study was to evaluate the effect of space-adjustment occlusal splint on overerupted maxillary molars by clinical and electromyographic signals analysis.

METHODS

Eighteen patients with overerupted maxillary molars were selected to wear space-adjustment occlusal splint suppressing overerupted maxillary molars for three months. Satisfaction was assessed by 5-point Likert; intermaxillary vertical space and the teeth transportation distance were measured in models; clinical periodontal status were evaluated by periodontal probing depth (PPT) and bleeding index (BI); electromyographic recordings of the masseter and anterior temporal muscles were monitored by Cranio-Mandibular K7 Evaluation System.

RESULTS

All the patients were satisfied with the treatment effect (Likert scale ≧ 4). The intermaxillary space in edentulous areas after treatment showed statistically significant increasing when compared with those before treatment. PPT and BI showed no significant difference. No statistically significant differences were found in electromyographic activity of anterior temporal muscles, while a reduction of muscle activity in masseter in the contralateral side were detected in post-treatment evaluations compared with pre-treatment at mandibular rest position.

CONCLUSIONS

Space-adjustment occlusal splint is an efficient treatment option on overerupted maxillary molars by intruding the maxillary molar to obtain adequate intermaxillary space for prostheses.

Relationship between natural or iatrogenic malocclusions and temporomandibular disorders: A case control study

OBJECTIVE

To investigate the link between malocclusions and temporomandibular disorders (TMD) with a focus on iatrogenic malocclusion. Other etiologies of TMD (oral parafunctions) were also assessed.

METHODS

The prevalence of malocclusions was correlated in two groups: patients with TMD (case group) and patients without TMD (control group). Malocclusions involving dental care were specified. Parafunctions in the case group were assessed.

RESULTS

A statistically significant association between TMD and overbite >4 mm, interferences in laterotrusion, and absence of Angle Class I was shown. A potential deleterious effect of iatrogenic malocclusions was highlighted.

CONCLUSION

The multifactorial etiology of TMD was confirmed because an association between TMD and three malocclusions was found, and all case patients had parafunction(s). Current recommendations advising first a reversible treatment, TMD care should start with a behavioral re-education to remove parafunctions. However, it is essential to avoid creating iatrogenic malocclusion during dental care.

Effect of artificial eccentric occlusal interferences on masticatory performance: A randomised double-blind clinical trial

BACKGROUND

Occlusal interferences lead to changes in mandibular kinematics to compensate and improve function. However, the effects of different types of eccentric disturbance on the comminution capacity are not known.

OBJECTIVE

To determine the immediate effect of eccentric occlusal interferences on masticatory performance.

METHODS

This crossover clinical trial included 12 healthy dentate subjects aged 25.2 ± 3.3 years who were randomly submitted to seven types of occlusal interference: unilateral and bilateral laterotrusive and mediotrusive, protrusive, dummy and control (no interference). The interference forms were planned in a semi-adjustable articulator, fabricated with composite resin and adhered to the mandibular first molars such that subjects' maximum intercuspation was maintained. Masticatory performance and the chewing rate during 20 cycles were evaluated during subjects' comminution of silicone test food under one interference condition per test day; the multiple sieve method was applied to the comminuted particles. The interference was removed upon test completion, and a 1-week washout period was applied between tests.

RESULTS

Comminuted median particle sizes were larger under unilateral (4.94 ± 0.41 mm) and bilateral (4.81 ± 0.49 mm) laterotrusive, bilateral mediotrusive (4.65 ± 0.50 mm) and protrusive (4.83 ± 0.54 mm) interferences (p < .05) than under the control (4.01 ± 0.52 mm) and dummy (4.18 ± 0.58 mm) conditions (p < .05). Only unilateral and bilateral laterotrusive interferences narrowed the comminuted particle size dispersion (p < .05). The chewing rate did not differ among conditions (p = .1944).

CONCLUSION

Artificial eccentric interferences had an immediate adverse effect on masticatory performance by resulting in larger comminuted particles.

CLINICAL TRIAL REGISTRATION

Brazilian Registry of Clinical Trials (RBR-8g5zfg8).

Relationship Between Occlusal Factors and Temporomandibular Disorders: A Systematic Literature Review

Temporomandibular disorders (TMD) originate from various components within the temporomandibular joint (TMJ), causing an impact on the masticatory muscles, the joint itself, and associated structures. They are a widely prevalent issue across the world. According to epidemiological research, up to 50% of adults in the population have TMD-related symptoms. The objective of this work was to analyze the existing scientific literature regarding the association between malocclusion classes, bruxism, and tooth loss in relation to the etiology of TMD. This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 analysis protocol. For the development of the question focus, the population, intervention, control, and outcomes (PICO) study design protocol was used. The question in focus according to the PICO format was: "Do malocclusion, tooth loss, and bruxism contribute to temporomandibular disorders?". The review was performed with articles from PubMed, Web of Science, and Google Scholar databases according to the specified inclusion and exclusion criteria. The included articles were not older than five years. The risk of bias was assessed in the included studies by using the Cochrane Risk-of-bias 2 (RoB-2) tool. Out of a total of 32 results received, 21 articles were chosen according to the established criteria after conducting a review and analysis of their full texts. The article search sequence was presented in the PRISMA 2020 flow diagram, and the outcomes of the chosen articles were presented. The literature results revealed a relationship between occlusion and the development of TMD. The influence of occlusal factors on the TMJ was explained by an examination of joint anatomy and symptoms related to TMD. This study revealed variations in TMJ factors across different malocclusion classes. Additionally, it was observed that the occurrence and attributes of TMD are influenced by the number of tooth loss quadrants and the frequency of missing teeth. Furthermore, a correlation was found between bruxism and the symptoms of TMD, including myofascial pain, disc displacement, arthralgia, and muscle disorders. This literature review provides comprehensive information on the relationship between malocclusion classes, bruxism, tooth loss, and TMDs. This prompts healthcare professionals to prioritize patients' occlusal assessment and TMJ condition.

Temporomandibular disorders in children and adolescents: A review

BACKGROUND

Temporomandibular disorders (TMD) are generally observed in individuals between the ages of 20 and 40 years. TMD have also been described in children and adolescents but are still not widely detected and treated in routine practice. Through a literature review, this work aims to improve the diagnosis and management of TMD in children and adolescents by dentists.

METHODS

This literature review was performed by a computerized search of the database PubMed for published articles on TMD in children and adolescents. Articles evaluating the prevalence, etiologies and risk factors, diagnosis, signs, and symptoms as well as the comorbidities of TMD, published between 2001 and 2022, were included in this review.

RESULTS

A total of 51 articles were included. Most of studies reported a prevalence of over 20%, with a higher prevalence in females. The two most common diagnoses were myofascial pain and disk displacement with reduction. Headaches were often associated with the condition. The management of TMD in children and adolescents has been poorly studied.

CONCLUSION

TMD frequently affect children and adolescents. Therefore, for prevention purposes, an examination of the masticatory system should be included in the dental check-up. Early diagnosis is essential in order to limit effects on their growth, development, and quality of life. TMD management is not currently validated for children and adolescents. Noninvasive and reversible care should be preferred.

Pain Management and Rehabilitation for Central Sensitization in Temporomandibular Disorders: A Comprehensive Review

Temporomandibular disorders (TMD) are a group of musculoskeletal diseases affecting masticatory muscles and temporomandibular joints (TMJ). In this context, the chronic TMD could be considered as a condition with chronic primary orofacial pain, presenting as myofascial TMD pain or TMJ arthralgia. In this context, myogenous TMD may present overlapping features with other disorders, such as fibromyalgia and primary headaches, characterized by chronic primary pain related to dysfunction of the central nervous system (CNS), probably through the central sensitization. This phenomenon could be defined as an amplified response of the CNS to sensory stimuli and peripheral nociceptive, characterized by hyperexcitability in the dorsal horn neurons in the spinal cord, which ascend through the spinothalamic tract. The main objectives of the management of TMD patients are: decreasing pain, increasing TMJ function, and reducing the reflex masticatory muscle spasm/pain. The first-line treatments are physical therapy, pharmacological drugs, occlusal splints, laser therapy, extracorporeal shockwave therapy, transcutaneous electrical nerve stimulation, and oxygen-ozone therapy. Although all these therapeutic approaches were shown to have a positive impact on the central sensitization of TMD pain, there is still no agreement on this topic in the scientific literature. Thus, in this comprehensive review, we aimed at evaluating the evidence on pain management and rehabilitation for the central sensitization in TMD patients.

Celecoxib in the treatment of orofacial pain and discomfort in rats subjected to a dental occlusal interference model

Purpose:

To evaluate the effect of a selective cyclooxygenase 2 (COX-2) inhibitor on trigeminal ganglion changes and orofacial discomfort/nociception in rats submitted to an experimental model of dental occlusal interference (DOI).

Methods:

Female Wistar rats (180-200 g) were divided into five groups: a sham group (without DOI) (n=15); and four experimental groups with DOI treated daily with 0.1 mL/kg saline (DOI+SAL), 8, 16, or 32 mg/kg celecoxib (DOI+cel -8, -16, -32) (n=30/group). The animals were euthanized after one, three, and seven days. The bilateral trigeminal ganglia were analyzed histomorphometrically (neuron cell body area) and immunohistochemically (COX-2, nuclear factor-kappa B [NFkB], and peroxisome proliferator-activated receptor-y [PPARy]). A bilateral nociception assay of the masseter muscle was performed. The number of bites/scratches, weight, and grimace scale scores were determined daily. One-way/two-way analysis of variance (ANOVA)/Bonferroni post hoc tests were used (P < .05, GraphPad Prism 5.0).

Results:

DOI+SAL showed a reduction in neuron cell body area bilaterally, whereas DOI+cel-32 exhibited a significative increase in neuron cell body area compared with DOI+SAL group (P < 0.05). The ipsilateral (P=0.007 and P=0.039) and contralateral (P < 0.001 and P=0.005) overexpression of COX-2 and NFkB and downregulation of PPARy (P=0.016 and P < 0.001) occurred in DOI+SAL, but DOI+cel-32 reverted this alteration. DOI+SAL showed increase in isplateral (P < 0.001) and contralateral (P < 0.001) nociception, an increased number of bites (P=0.010), scratches (P < 0.001), and grimace scores (P=0.032). In the group of DOI+cel-32, these parameters were reduced.

Conclusions:

Celecoxib attenuated DOI-induced transitory nociception/orofacial discomfort resulting from trigeminal COX-2 overexpression.

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.

Occlusal Trauma Induces Neuroimmune Crosstalk for a Pain State

Temporomandibular joint (TMJ) disorder caused by occlusal trauma is one of the most controversial topics in dentistry. Experimental traumatic occlusion (ETO) induced by metal crowns cemented to mandibular first molars in rats causes a long-lasting nociceptive response. This study aimed to elucidate whether ETO generates an increase in inflammatory mediators in the TMJ. In addition, the impact of ETO on trigeminal ganglia, neurotransmitter release, and satellite glial cell (SGC) activation was investigated. ELISA revealed enhanced inflammatory mediators, including TNF-α, IL-1β, IL-6, CX3CL1, and ADAM-17 by Western blotting, in periarticular TMJ tissue after 28 d of ETO. In the trigeminal ganglia, ETO groups increased the release of the neurotransmitters substance P and glutamate. Overexpression of the AMPA receptor and upregulation of NMDA were observed in the 0.4- and 0.7-mm ETO groups, respectively, highlighting enhanced neuronal excitation. Increased IL-1β and COX-2 mRNA levels in the 0.7-mm ETO group confirmed trigeminal ganglia SGC activation. Immunofluorescence and electrophoresis of SGC revealed increased pERK expression in the 0.7-mm ETO group. ERK phosphorylation was shown to be nociceptive specific, with its upregulation occurring in cases of chronic inflammatory pain. Increased PKA mRNA levels were observed in the 0.4-mm ETO group, while CREB mRNA levels were upregulated for both ETO groups. Electrophoresis showed overexpression of sodium channel Nav 1.7 in the 0.7-mm ETO group, while immunofluorescence revealed that Nav 1.7 is expressed in sensory trigeminal ganglia cells. The results of this study suggest that occlusal trauma induces neuroimmune crosstalk, with synthesis of proinflammatory/pronociceptive mediators, which increases neuronal activity in trigeminal ganglia via the activation of an inflammatory response cascade to develop a persistent neuroinflammatory state that leads to central sensitization.

Does the Stomatognathic System Adapt to Changes in Occlusion? Best Evidence Consensus Statement

PURPOSE

The purpose of this Best Evidence Consensus Statement was to evaluate the existing literature on the stomatognathic system's ability to adapt to occlusal changes.

MATERIALS AND METHODS

The search term stomatognathic system was not useful as it resulted in over 400,000 results nor was the search term temporomandibular joint adaptation with 738 results due to the large number of references not related to the topic. The terms stomatognathic system adaptation to occlusal changes (186 results), teeth flexion (139 results), muscle adaptation to dental occlusion (278 results), and occlusal changes and neuroplasticity (11 results) provided the best selection of articles related to the topic. Limiting the above searches to systematic reviews and randomized controlled clinical trials resulted in multiple publications that were related to the question.9-13 Other literature reviews, data-based publications, and expert opinion resources have been included due to their relationship to the question.

RESULTS

From the extensive list of search results, 242 articles were determined to be potentially related to the focus question and were evaluated with 56 being included in this paper. It was determined that the stomatognathic system adapts to occlusal changes through the temporomandibular joint, muscles, teeth and bone. The dynamically modified periosteum on the articulator surfaces of the condyle and fossa has a unique load-bearing morphology with 3 subarticular layers of fibrocartilage that absorb and dissipate both peak (impact) and sustained loads. Adaptability of the TMJs and muscles can be documented through studies where artificially produced occlusal interferences were placed in patients and those study participants with normal temporomandibular joints (TMJs) adapted fairly well whereas those with a previous history of temporomandibular disorders (TMD) did not adapt as well.

CONCLUSIONS

Available evidence indicates patients generally adapt to the occlusal change inherent in orthodontic treatment, mandibular advancement surgery, and the use of mandibular advancement devices. The head and neck muscles also adapt to occlusal changes in patients without a history of TMD. The dentition adapts to changes through the bone and periodontal ligaments as well as the ability of teeth to undergo slight flexion under masticatory loading. This article is protected by copyright. All rights reserved.

Peripheral and central substance P expression in rat CFA-induced TMJ synovitis pain

Synovitis contributes to temporomandibular joint (TMJ) pain, nevertheless, the detailed nociceptive mechanism remains unclear. In this study, a rat model of TMJ synovitis was induced by intra-articular injection with complete Freund’s adjuvant (CFA). After CFA-induced synovitis, pain behaviors were observed. Then, TMJ, trigeminal ganglion, and trigeminal nucleus caudalis (TNC) tissues were collected, and immunohistochemistry was used to detect the expression of substance P (SP) and protein gene product 9.5 (PGP9.5) in the synovium tissue. Furthermore, the gene expression level of SP and PGP9.5 in synovium was detected by reverse transcription-polymerase chain reaction (RT-PCR). Afterwards, the expression of SP in the trigeminal ganglion and TNC and c-fos in the TNC was detected by immunohistochemistry. Compared with the control group, the expression of SP and PGP9.5 nerve fibers density and gene levels of them in the synovium tissue were significantly increased in CFA-induced TMJ synovitis rats. Similarly, SP expression in the trigeminal ganglion and TNC, and c-fos expression in the TNC were also obviously increased in CFA-induced TMJ synovitis rats. Collectively, CFA-induced rat TMJ synovitis resulted in obvious pain. This nociceptive reaction could be attributed to the augmented quantity of SP and PGP9.5 positive-stained nerve fibers distributed in the inflammatory synovium as well as enhanced SP expression in the trigeminal ganglion and TNC tissue. c-fos expression in the rat TNC illustrates CFA-induced TMJ synovitis can evoke the acute pain.

Tratamento para disfunções temporomandibulares: uma revisão sistemática

RESUMO Introdução: A disfunção temporomandibular (DTM) é complexa e multifatorial. São encontrados, na literatura, estudos que comparam diferentes métodos de tratamento. Objetivo: Investigar estudos sobre o tratamento das disfunções temporomandibulares (DTMs) nas diversas áreas da saúde, avaliando a eficácia das técnicas empregadas, principalmente no que se refere ao uso da terapia miofuncional orofacial. Estratégia de pesquisa: Os artigos compilados neste estudo foram selecionados por meio da base de dados PubMed, utilizando os descritores “temporomandibular disorders and oral motor therapy”, “orofacial myofunctional therapy and temporomandibular disorders” e “temporomandibular disorders and myofunctional rehabilitation”. O levantamento realizado limitou-se aos artigos publicado nos idiomas Inglês e Português, entre janeiro de 2006 e dezembro de 2016. Critérios de seleção: Foram incluídos artigos sobre os tratamentos das DTMs associados aos exercícios musculares e/ou terapias manuais. Publicações sem acesso completo, repetidas por sobreposição das palavras-chave, revisões de literatura, cartas ao editor e não relacionadas diretamente ao tema foram excluídas. Resultados: Dos 102 estudos selecionados, 22 atenderam aos critérios estabelecidos. Em geral, a maioria dos tratamentos descritos apresentou efeitos benéficos para pacientes com DTMs. Foi observada grande variabilidade da metodologia adotada para a aplicação e verificação dos efeitos dos tratamentos e somente poucos estudos fizeram uso de grupo controle. Conclusão: Apesar do crescimento no número de pesquisas sobre DTMs, ainda não é possível estabelecer qual a melhor técnica de tratamento. Após análise dos artigos selecionados, observou-se que as técnicas combinadas de terapia (ex.: exercício associado ao uso de equipamento para redução da dor) produzem melhores resultados, com maior redução da dor e melhora da mobilidade mandibular.

Relationship between anxiety and temporomandibular disorders in dental students

OBJECTIVE

To evaluate the prevalence of temporomandibular disorder (TMD) in dental students and its correlation with anxiety.

METHODS

After probability sampling, 105 students were selected. The diagnosis of TMD was carried out using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) - Axis I; the anxiety level was obtained by the State-Trait Anxiety Inventory (STAI). Data from TMD and anxiety were calculated through frequency and Chi-square test to assess the association between TMD and anxiety, considering a significance level of 5%.

RESULTS

TMD was present in 36.2% of the students; disc displacement (42.1%), and arthralgia (42.1%) were the most prevalent subtypes. The majority of students presented both traits (57.1%) and state (65.7%) anxiety in mild levels, followed by moderate levels. No statistical association between TMD and anxiety was found (p > 0.05).

CONCLUSION

Joint TMD was the most prevalent subtype of TMD in dental students and was not associated with anxiety levels.

Assessment of electromyographic activity in patients with temporomandibular disorders and natural mediotrusive occlusal contact during chewing and tooth grinding

OBJECTIVES

The aim of this study was to investigate whether the presence of a natural mediotrusive contact influences electromyographic (EMG) pattern activity in patients with temporomandibular disorders (TMDs).

METHOD

Bilateral surface EMG activity of the anterior temporalis (AT), masseter (MM), and sternocleidomastoid (SCM) muscles was recorded in 43 subjects during unilateral chewing and tooth grinding. Thirteen patients had TMD and a natural mediotrusive contact (Group 1), 15 had TMD without a natural mediotrusive contact (Group 2), and 15 were healthy subjects without mediotrusive contacts (Group 3). All subjects were examined according to the Research Diagnostic Criteria for TMD (RDC/TMD). All EMG values were standardized as the percentage of EMG activity recorded during maximum isometric contraction on cotton rolls.

RESULTS

EMG activity from all muscles measured showed no significant differences between groups during chewing and grinding. Overall, in all groups, the EMG activity during chewing was higher in the working side than the non-working side in AT and MM muscles. During grinding, these differences were only found in masseter muscles (mainly in eccentric grinding). SCM EMG activity did not show significant differences during chewing and grinding tasks. Symmetry, muscular balance, and absence of lateral jaw displacement were common findings in all groups.

DISCUSSION

EMG results suggest that the contribution of a natural mediotrusive occlusal contact to EMG patterns in TMD patients is minor. Therefore, the elimination of this occlusal feature for therapeutic purposes could be not indicated.

Association of occlusal interference-induced masseter muscle hyperalgesia and P2X3 receptors in the trigeminal subnucleus caudalis and midbrain periaqueductal gray

P2X3 receptor plays a role in nociception transmission of orofacial pain in temporomandibular disorder patients. A previous study found that P2X3 receptors in masseter muscle afferent neurons and the trigeminal ganglia were involved in masseter muscle pain induced by inflammation caused by chemical agents or eccentric muscle contraction. In this study, we attempted to investigate changes in P2X3 receptors in the trigeminal subnucleus caudalis (Vc) and midbrain periaqueductal gray (PAG) in relation to the hyperalgesia of masseter muscles induced by occlusal interference. Experimental occlusal interference by crown application was established in 30 rats and another 30 rats were treated as sham controls. On days 1, 3, 7, 14, and 28 after crown application, the mechanical pain threshold was examined by von-Frey filaments. The expression of the P2X3 receptor in Vc and PAG was investigated by immunohistochemistry and quantitative PCR. We found that mechanical pain threshold of bilateral masseter muscles decreased significantly after occlusal interference, which remained for the entire experimental period. The mRNA expression of the P2X3 receptor increased significantly and the number of P2X3R-positive neurons increased markedly in Vc and PAG accordingly. These results indicate that the upregulated expression of P2X3 receptors in Vc and PAG may contribute toward the development of orofacial pain induced by occlusal interference and P2X3 receptors in the PAG may play a key role in the supraspinal antiociception effect.

Effect of p38 Mitogen Activated Protein Kinase Inhibitor on Temporomandibular Joint Synovitis Induced by Occlusal Alteration

PURPOSE

To investigate the alteration in rat temporomandibular joint (TMJ) synovial membrane induced by increased occlusal vertical dimension (iOVD) and to determine whether the p38 mitogen activated protein kinase (MAPK) signaling cascade is involved.

MATERIALS AND METHODS

Thirty-six rats were randomly divided into 3 groups: control + normal saline (NS; controls), iOVD + NS, and iOVD + SB203580 (a potent p38 MAPK inhibitor). Morphologic changes of synovial tissues were observed and scored. Activation levels of p38 MAPK and activating transcription factor-2 (ATF2) were detected by immunohistochemistry. Expression levels of interleukin-1β (IL-1β) and matrix metalloproteinase-3 (MMP-3) were measured by quantitative real-time polymerase chain reaction and immunohistochemistry.

RESULTS

Obvious synovitis was found in the iOVD group. P38 and ATF2 were activated, and mRNA and protein expression levels of IL-1β and MMP-3 were upregulated after iOVD. However, decreased synovial tissue inflammation and lower mRNA and protein levels of IL-1β and MMP-3 were observed in the iOVD + SB203580 group.

CONCLUSION

iOVD can induce temporomandibular joint synovitis, and the p38 MAPK signaling cascade might participate in and aggravate the process of articular inflammation.

Role of TRPV1 and ASIC3 channels in experimental occlusal interference-induced hyperalgesia in rat masseter muscle

BACKGROUND

Masticatory muscle pain may occur following immediate occlusal alteration by dental treatment. The underlying mechanisms are poorly understood. Transient receptor potential vanilloid-1 (TRPV1) and acid-sensing ion channel-3 (ASIC3) mediate muscle hyperalgesia under various pathologic conditions. We have developed a rat model of experimental occlusal interference (EOI) that consistently induces mechanical hyperalgesia in jaw muscles. Whether TRPV1 and ASIC3 mediate this EOI-induced hyperalgesia is unknown.

METHODS

Rat model of EOI-induced masseter hyperalgesia was established. Real-time polymerase chain reaction, Western blot and retrograde labelling combined with immunofluorescence were performed to evaluate the modulation of TRPV1 and ASIC3 expression in trigeminal ganglia (TGs) and masseter afferents of rats after EOI. The effects of intramuscular administration of TRPV1 and ASIC3 antagonists on the EOI-induced hyperalgesia in masseter muscle were examined.

RESULTS

After EOI, gene expressions and protein levels of TRPV1 and ASIC3 in bilateral TGs were up-regulated. The percentage of ASIC3- (but not TRPV1-) positive neurons in masseter afferents increased after EOI. More small-sized and small to medium-sized masseter afferents expressed TRPV1 and ASIC3 separately following EOI. These changes peaked at day 7 and then returned to original status within 10 days after EOI. Intramuscular administration of the TRPV1 antagonist AMG-9810 partially reversed this mechanical hyperalgesia in masseter muscle. No improvement was exhibited after administration of the ASIC3 antagonist APETx2. Co-injection of AMG-9810 and APETx2 enhanced the effect of AMG-9810 administration alone.

CONCLUSIONS

Peripheral TRPV1 and ASIC3 contribute to the development of the EOI-induced mechanical hyperalgesia in masseter muscle.

Effect of natural mediotrusive contact on electromyographic activity of jaw and cervical muscles during chewing

OBJECTIVE

This study evaluated the effect of a natural mediotrusive contact on the electromyographic (EMG) activity of the anterior temporalis and sternocleidomastoid muscles during chewing in healthy subjects.

MATERIALS AND METHODS

The study sample included two groups of 15 subjects each (Group 1: with natural mediotrusive contact; Group 2: without natural mediotrusive contact). Bilateral surface EMG activity was recorded on anterior temporalis and sternocleidomastoid muscles during unilateral chewing of a half cookie and unilateral chewing of a piece of apple. Anterior temporalis and sternocleidomastoid muscle activity was normalized against activity recorded during maximal voluntary clenching in intercuspal position and maximal intentional isometric head-neck rotation to each side, respectively. The partial and total asymmetry indexes were also calculated. Data were analyzed using Mann-Whitney, Wilcoxon and unpaired t-test.

RESULTS

EMG activity of anterior temporalis and sternocleidomastoid muscles showed no significant difference between the groups. EMG activity of anterior temporalis was similar between working and non-working sides during chewing in both groups. EMG activity of sternocleidomastoid muscle was higher in the working side than in the non-working side in Group 2 subjects. Asymmetry indexes were not significantly different between groups.

CONCLUSIONS

The similar EMG pattern and asymmetry indexes observed suggest the predominance of central nervous control over peripheral inputs on anterior temporalis and sternocleidomastoid motor neuron pools.

Norepinephrine Regulates Condylar Bone Loss via Comorbid Factors

Degenerative changes of condylar subchondral bone occur frequently in temporomandibular disorders. Although psychologic stresses and occlusal abnormalities have been implicated in temporomandibular disorder, it is not known if these risks represent synergistic comorbid factors that are involved in condylar subchondral bone degradation that is regulated by the sympathetic nervous system. In the present study, chronic immobilization stress (CIS), chemical sympathectomy, and unilateral anterior crossbite (UAC) were sequentially applied in a murine model. Norepinephrine contents in the subjects' serum and condylar subchondral bone were detected by ELISA; bone and cartilage remodeling parameters and related gene expression in the subchondral bone were examined. Subchondral bone loss and increased subchondral bone norepinephrine level were observed in the CIS and UAC groups. These groups exhibited decreased bone mineral density, volume fraction, and bone formation rate; decreased expressions of osterix, collagen I, and osteocalcin; but increased trabecular separation, osteoclast number and surface, and RANKL expression. Combined CIS + UAC produced more severe subchondral bone loss, higher bone norepinephrine level, and decreased chondrocyte density and cartilage thickness when compared to CIS or UAC alone. Sympathectomy simultaneously prevented subchondral bone loss and decreased bone norepinephrine level in all experimental subgroups when compared to the vehicle-treated counterparts. Norepinephrine also decreased mRNA expression of osterix, collagen I, and osteocalcin by mesenchymal stem cells at 7 and 14 d of stimulation and increased the expression of RANKL and RANKL/OPG ratio by mesenchymal stem cells at 2 h. In conclusion, CIS and UAC synergistically promote condylar subchondral bone loss and cartilage degradation; such processes are partially regulated by norepinephrine within subchondral bone.

Histamine and substance P in synovial fluid of patients with temporomandibular disorders

Although psychosocial factors and malocclusion are regarded as potential causes of temporomandibular disorders (TMD), the underlying pathogenesis is poorly understood. Recent studies suggest that substance P (SP), which has been associated with both psychosocial factors and malocclusion, and histamine, whose release can be induced by SP, may be implicated in the pathogenetic process. This study was designed to measure the concentration of histamine and SP in synovial fluid (SF) of both 38 patients with TMD and 11 healthy controls, and analyse the correlation between histamine and SP. Patients with TMD were divided into three subgroups: displaced disc with reduction (DDR), displaced disc without reduction (DDNR) and osteoarthritis (OA), with 10, 13, 15 subjects in every subgroup, respectively. After collecting SF samples, histamine and SP levels were measured by enzyme-linked immunosorbent assay analysis (ELISA) and calibrated by bicinchoninic acid (BCA)-quantified protein level in the samples. The results suggest that OA group presented a significantly higher level of both histamine and SP than DDNR, DDR and healthy control groups. Histamine or SP in DDR and DDNR groups tend to be higher than control group, but no significance was found. Painful TMJs show higher histamine and SP than painless TMJs. Correlation analysis reveals a significant correlation between histamine and SP concentrations. Collectively, this study showed the changes of histamine and SP in the SF from different stages of TMD and found a significant correlation between the two substances, suggesting their potential implication in the pathogenesis of TMD.

The influence of altered occlusion on pro-inflammatory cytokine levels in the TMJ synovial tissues of rats

OBJECTIVE

The aim of this study was to evaluate whether altered occlusion affects both the condylar cartilage thickness and the cytokine levels of the TMJs of rats.

DESIGN

Thirty adult-male rats (n=30) were randomly assigned to three experimental conditions: a control group that underwent sham operations with unaltered occlusion; an FPDM group that underwent functional posterior displacement of the mandible that was induced by an incisor guiding appliance; and an iOVD group in which the increased occlusal vertical dimension was induced in the molars. The rats were subjected to the FPDM or iOVD model for 14 days and then killed. Both the right and left TMJs were removed and randomly assigned to examination with staining or immunoassay techniques. Toluidine blue staining was used to measure the thicknesses of the four layers of the articular cartilage (i.e., the fibrous, proliferating, mature, and hypertrophic layers). ELISA assays were used to assess the concentrations of the pro-inflammatory cytokines IL-1α, IL-1β, IL-6, and tumour necrosis factor (TNF-α). The measurements of the articular cartilage layers and cytokine concentrations were analyzed with ANOVA and Tukey's tests and Kruskal-Wallis and Dunn tests, respectively (α=5%).

RESULTS

The thickness of articular cartilage in the FPDM group (0.3±0.03mm) was significantly greater than those of the control (0.2±0.01mm) and iOVD (0.25±0.03mm) groups. No significant difference was observed between the control and iOVD groups. The four articular cartilage layers were thicker in the FPDM group than in the control and iOVD groups, and the latter two groups did not differ one from each other. Both the FPDM and iOVD groups exhibited higher cytokine levels than did the control (p<0.05) group. Compared to the FPDM group, the iOVD group exhibited significantly higher levels of IL-1β and TNF-α.

CONCLUSION

Both models induced inflammation in the TMJ and caused significant structural changes in the TMJ and surrounding tissues.