Accurate Diagnosis and Treatment of Painful Temporomandibular Disorders: A Literature Review Supplemented by Own Clinical Experience

Assessing, categorizing and proposing the therapeutic effect of complete dentures on temporomandibular disorders analyzed by craniomandibular index: a prospective interventional study

BACKGROUND

Edentulism is a devastating condition that is often irreversible and considered a marker of a diseased state of oral health. The prevalence of edentulism globally is 22%, which is quite high. The long-term absence of complete dentures is thought to cause joint problems.

OBJECTIVES

To evaluate and categorize the effect of complete dentures on signs and symptoms of temporomandibular disorders (TMD) analyzed by the Craniomandibular Index (CMI) in completely edentulous patients.

METHODS

This interventional and prospective study was conducted. Preliminary screening of completely edentulous patients with the Anamnestic component of the Helkimos Index was done. 110 subjects with severe TMD, as per the preliminary screening, were included in the study. Secondary Screening for the Dysfunction and Palpation components of the CMI was done to obtain baseline measures. The complete denture was delivered. After three months, the CMI Score was re-evaluated. Descriptive and analytical statistics were done.

RESULTS

The mean CMI score before denture insertion was 1.50 ± 0.12, and after denture insertion, it was 0.45 ± 0.25. The test used for the analysis of the values was the student's paired t-test. A statistically significant difference in CMI at pre- and post-treatment with complete dentures (t = 57.90, p = 0.0001) was found.

CONCLUSION

The study results showed abate in the severity of the signs and symptoms of TMD among the complete denture wearers over 3 months. The result of current study established the remedial effect of complete dentures on TMD and also gave a new parameter to contemplate the line of treatment by categorizing the severity of TMD on the basis of the score obtained.

The Use of Front Plateau in the Treatment of Temporomandibular Disorders: A Case Series and Literature Review

Temporomandibular disorders (TMDs) are conditions with multifactorial etiology and complex treatment. Among the non-invasive therapeutic possibilities for these conditions is the Front Plateau, a partial anterior plate made from colourless self-curing acrylic resin. It is a simple procedure that can be carried out in a single clinical section promoting muscle relaxation to reduce symptoms associated with TMDs. This study aims to report a prospective, consecutive, single-centric case series to evaluate the Front Plateau's effectiveness in patients with temporomandibular disorders. A questionnaire adapted from the Research Diagnostic Criteria for TMDs was used and 4 patients were treated with the Front Plateau plaque. Patients were monitored after 5 and 9 months, respectively, after starting to use the Front Plateau. Of the 4 cases listed, 2 showed significant improvement in initial signs and symptoms. Front Plateau may be a favourable treatment option for patients with TMD, if the guidelines are followed. Clinical trials on this modality should seek to minimize possible biases and limitations associated with the design of this type of research.

Association Between Temporomandibular Disorders and Irritable Bowel Syndrome: A Scoping Review

Temporomandibular disorders (TMDs) encompass various clinical conditions associated with the temporomandibular joint (TMJ) and the masticatory muscles. TMD symptoms include pain in the orofacial region, restricted or altered mandibular movement, and sounds associated with the temporomandibular joint (TMJ). This condition adversely affects quality of life, social functioning, and daily activities, and may also contribute to widespread pain syndromes and comorbidities, including irritable bowel syndrome (IBS). IBS is a common chronic functional disorder of the lower gastrointestinal tract, characterized by recurrent abdominal pain associated with impaired bowel symptoms. Previous studies indicate an association between TMD and IBS. This scoping review examined the correlation between TMD and IBS concerning their pathology, frequency, and severity, and the potential similarities in how the nervous and endocrine systems influence them. PubMed, SCOPUS, Web of Science, and Google Scholar search engines were utilized to identify suitable studies for this article. Following the application of selection criteria, a total of 58 clinical papers met the eligibility requirements for inclusion in the systematic review. Research showed that both conditions significantly enhance the development of one another and have mutual comorbidities. Both ailments were proven to modify central nervous system processing, leading to high comorbidity in patients. Combining dental and gastroenterological treatments, including a simultaneous therapeutic approach, can significantly enhance patients' quality of life, but further research is needed for a holistic approach.

Assessing the causal role of the structural connectome in temporomandibular disorders: A Mendelian randomization study

OBJECTIVE

We examined the relationships between the structural connectome and temporomandibular disorders (TMDs).

METHODS

Bidirectional Mendelian randomization analyses were conducted using Genome-wide association studies data on the structural connectome and TMDs.

RESULTS

Positive associations with TMD risk were found for white matter structural connectivity from the left hemisphere limbic network to putamen, left hemisphere salience_ventral attention network to caudate, right hemisphere visual network to thalamus, and right hemisphere salience_ventral attention network to right hemisphere control network, while negative associations were observed for connectivity from the left hemisphere control and somatomotor networks to pallidum, left hemisphere somatomotor network to right hemisphere dorsal attention network, and right hemisphere somatomotor network to hippocampus (p< 0.05). In TMD patients, connectivity from the Left-hemisphere visual network to putamen was reduced, whereas connectivity from the Left-hemisphere limbic network to left-hemisphere control network was increased (p< 0.05).

CONCLUSION

Our findings provide insights into the TMD pathogenesis.

Effects of Hyaluronic Acid (HA) and Platelet-Rich Plasma (PRP) on Mandibular Mobility in Temporomandibular Joint Disorders: A Controlled Clinical Trial

Hyaluronic acid (HA) is a glycosaminoglycan composed of D-glucuronic acid and N-acetylglucosamine with an up-to-several-million-Daltons chain-length responsible for the lubricating properties of the temporomandibular joint (TMJ) synovial fluid. Arthritis results in the predominance of HA degradation over synthesis leading to temporomandibular disorders (TMDs). TMD injection treatments are divided into HA supplementation and platelet-rich plasma (PRP) inflammation suppression. We questioned whether either approach lubricated the TMJ better and answered it in a two-arm equal-allocation trial with a non-concurrent active treatment control (two groups of 39 patients each). HA statistically significantly improved (p < 0.01) and PRP did not statistically significantly change (0.06 ≤ p ≤ 0.53) articular mobility compared to baselines in 128 TMJs. Statistically significant inter-group discrepancies were observed for abduction (MD = -4.05 mm; SE = 1.08; p = 0.00; d = -0.85) and protrusion (MD = -0.97 mm; SE = 0.43; p = 0.03; d = -0.51) but not for rightward (MD = -0.21; SE = 0.43; p = 0.63; d = -0.11) and leftward (MD = -0.30; SE = 0.42; p = 0.47; d = -0.16) movements. HA supplementation proved superior to PRP autografting in ad hoc TMJ lubrication and hence is more appropriate in hypomobile TMD cases of symptomatic treatment.

Hyaluronic Acid/Platelet-Rich Plasma Mixture Improves Temporomandibular Joint Biomechanics: A Systematic Review

Hyaluronic acid (HA) is the main component of the temporomandibular joint (TMJ) synovial fluid. Arthritis in temporomandibular disorders (TMDs) disrupts HA metabolism, resulting in shorter polymeric chain predominance and increased friction. Intra-articular injections of HA supplement the larger molecules of this glycosaminoglycan, and the platelet-rich plasma (PRP) delivered in this way releases growth factors, suppressing inflammation. This PRISMA-compliant PROSPERO-registered (CRD42024564382) systematic review aimed to assess the validity of mixing HA with PRP in the injectable treatment of TMJ disorders. We searched the medical literature for eligible randomized clinical trials using BASE, Google Scholar, PubMed and Scopus engines on 9 May 2024, with no time frame limit. Selected reports were assessed for risk of bias using the Cochrane RoB2 tool. Numerical data were collected on articular pain and mandibular mobility. We provided mean differences from baseline and between study and control groups at each observation point. The efficacy of TMD treatment with HA/PRP versus HA or PRP alone was assessed meta-analytically. Of 171 identified records, we selected 6 studies. In the 6-month follow-up, the mean advantage of PRP supplementation with HA was 2.52 (SE = 2.44; d = 0.83) mm and the benefit of adding PRP to HA was 1.47 (SE = 2.68; d = 0.34) mm in mandibular abduction. The pain-improvement scores were -1.33 (SE = 1.02; d = -1.05) and -1.18 (SE = 0.92; d = 0.80), respectively. Presumably, the HA/PRP range of therapeutic efficiency includes cases non-respondent to HA or PRP alone.

Oral habits and temporomandibular joint disorders according to stress levels among military personnel in South Korea: A cross-sectional study

BACKGROUND

Military personnel suffer from stress-induced temporomandibular joint disorders (TMD). No previous studies have evaluated the oral habits and TMD in military personnel based on their stress levels.

OBJECTIVES

To examine the correlation between oral habits and TMD based on stress levels. In addition, we assessed the relationship between stress levels and TMD by military rank as well as the impact of oral habits on TMD.

METHOD

This cross-sectional survey included 89 military personnel who visited the Armed Forces Medical Center in Korea with discomfort in the temporomandibular joint (TMJ) discomfort. Oral habits, stress level, TMD and general characteristics of the subjects were investigated. A questionnaire was distributed to the subjects who agreed to the study, and they were asked to respond in a self-written form. Multiple linear regression analysis was performed to examine the factors that affect oral habits and TMJ symptoms.

RESULTS

Stress scores and oral habits were highest in the 'Private' rank. In contrast, temporomandibular joint symptoms were highest in the 'Corporal' rank. Additionally, the high-risk stress group exhibited higher scores in oral habits and TMD compared to the potential stress group. Furthermore, there was a positive correlation between an increase in high-risk stress scores and a rise in oral habits. And individuals with more oral habits are at an increased likelihood of experiencing TMD.

CONCLUSION

Our study findings suggest that military personnel with prevent TMD and improve oral habits by addressing stress levels.

Arthroscopic Assessment of Temporomandibular Joint Pathologies-Is It Possible for Non-Specialists in Arthroscopy? Analysis of Variability and Reliability of Dental Students' Ratings after a Comprehensive One-Semester Introduction

Background: Arthroscopy of the temporomandibular joint (TMJ) plays a long-established role in the diagnostics and therapy of patients suffering from arthrogenic temporomandibular disorders (TMDs), which do not respond adequately to conservative/non-invasive therapy. However, the interpretation of arthroscopic findings remains challenging. This study investigates the reliability and variability of assessing arthroscopic views of pathologies in patients with TMDs by non-specialists in arthroscopy and whether a standardized assessment tool may improve correctness. Methods: Following a comprehensive one-semester lecture, dental students in the clinical stage of education were asked to rate 25 arthroscopic views (freeze images and corresponding video clips) regarding the severity of synovitis, adhesions, and degenerative changes on a scale of 0-10 (T1). The results were compared to ratings stated by two European-board-qualified academic OMF surgeons. In a second round (T2), the students were asked to repeat the ratings using a 10-point rating scheme. Results: With regard to all three subcategories, congruency with the surgeons' results at T1 was at a low level (p < 0.05 in 19/75 cases) and even decreased at T2 after the implementation of the TMDs-SevS (p < 0.05 in 38/75 cases). For both T1 and T2, therefore, the inter-rater agreement was at a low level, showing only a slight agreement for all three subcategories (Fleiss' Kappa (κ) between 0.014 and 0.099). Conclusions: The judgement of the arthroscopic pathologies of the TMJ remains an area of temporomandibular surgery that requires wide experience and training in TMDs to achieve expertise in TMJ arthroscopic assessments, which cannot be transferred by theoretical instruction alone.

Knowledge and awareness about temporomandibular disorder among dentists in India: Questionnaire study and review

AIM

Temporomandibular disorders (TMD) comprise ailments involving the jaw joint (temporomandibular joint) and its associated anatomical structures. The complexity involved in TMD is primarily due to its broad spectrum of conditions, clinical signs and symptoms variability, and multifactorial etiology. Considering the above, the present study was performed to help understand the prevailing knowledge and awareness of TMD among Indian dentists in the context of the new specialty "orofacial pain".

SETTINGS AND DESIGN

Questinnaire study and review.

MATERIALS AND METHODS

The questionnaire was distributed using a web-based portal nationwide among Indian dentists. Dentists were invited to participate, clearly stating that the intent and purpose of the questionnaire was to record the existing knowledge and awareness concerning temporomandibular disorders among Indian dentists. The questionnaire was segregated into three sections: pathogenesis, diagnosis, and management of TMDs. The questions were recorded using a Likert three-point scale (1=agree; 2=disagree; 3=not aware). 310 dentists participated in the survey, among which 105 were general dentists (BDS [Bachelor of Dental Surgery] graduates), and 205 were dentists with specialist training (MDS [Masters of Dental Surgery] graduates).

STATISTICAL ANALYSIS USED

The results obtained from the study participants was used to calculate the percentage and frequency, following which tabulations were made based on graduate type and clinical experience. The values obtained from all three sections were recorded, and the responses were analysed using Pearson's Chi-Square test with statistical significance kept at P < 0.05.

RESULTS

Results of the study disclosed that only 58.1% of general dentists and 46.8% of specialists were confident in handling temporomandibular disorder patients. Splint therapy was the preferred treatment modality for general dentists, whereas dentists with specialist training preferred occlusal rehabilitation.

CONCLUSION

The results of the current survey indicate that Indian dentists lack sufficient training in dental schools on all three sections and face difficulty diagnosing and treating TMDs.

Dental practitioners' knowledge, management practices, and attitudes toward collaboration in the treatment of temporomandibular joint disorders: a mixed-methods study

BACKGROUND

Temporomandibular joint disorders (TMDs) are a variety of conditions that affect different parts of the temporomandibular joints (TMJ) and can cause orofacial pain and functional impairment. This study aims to investigate dental practitioners' knowledge and management of Temporomandibular Joint Disorders (TMDs), particularly their knowledge of the role physical therapy plays in TMD treatment.

METHODS

A mixed-methods approach was adopted to provide a comprehensive view of current knowledge, management practices, and attitudes toward collaboration among dental practitioners in treating TMD. Data were collected from a convenience sample of 335 dentists in Karachi using a detailed questionnaire to assess their knowledge of the role of physical therapy in the treatment of TMD. Twenty dentists were chosen for face-to-face, in-depth interviews to explore their experiences and challenges in managing TMDs based on their responses to the administered questionnaire.

RESULTS

The cumulative quantitative and qualitative findings of the study revealed a landscape marked by individualized approaches to referral practices and significant gaps in interdisciplinary collaboration. Most practitioners holding a bachelor's degree predominantly used medication (65.2%) and cause-specific treatment (65.3%) for TMD treatment. Thematic analysis of clinical efficacy and practitioner challenges in managing TMD revealed significant issues faced by dental professionals.

CONCLUSIONS

The study successfully validated a questionnaire to understand dental practitioners' knowledge regarding physical therapy in TMD treatment. The study identified significant gaps in knowledge and a lack of collaboration between dentists and physiotherapists. The limited referral practices highlighted in the study, along with insights from dentist interviews, emphasize the need for improved interdisciplinary approaches to managing TMDs within dental practice.

A Meta-Analysis of the Global Prevalence of Temporomandibular Disorders

Background: This meta-analysis aims to evaluate the proportion of people with TMDs in different studies, considering factors such as geographical region, patient age, and sample size. Methods: The search yielded 6984 articles on the incidence of TMDs. Finally, 74 studies with 172,239 subjects and 35,259 with TMDs were selected for final analysis. Analyses were performed using the R statistical language. Results: The incidence of TMDs in the world population was 34%. The age group 18-60 years is the most exposed to TMDs. From the data presented, we observed that for each continent, the female group was 9% to 56% larger than the male group. The highest female-to-male ratio (F:M) was reported in South America (1.56), whereas the lowest F:M ratio was reported in Europe (1.09), suggesting an almost equal distribution of males and females. Conclusions: This suggests that geographical location may play a role in the results of the studies. The prevalence of TMDs was significantly higher in South America (47%) compared to Asia (33%) and Europe (29%). Larger epidemiological studies of TMDs in African and Australian populations are recommended. In conclusion, both visual and statistical assessments suggest that the results of our meta-analysis are robust and unlikely to be significantly affected by publication bias. This suggests that geographical location may play a role in the prevalence of TMDs.

[Analysis of changes in the position of the temporomandibular joint articular disc during positioning splint therapy according to magnetic resonance imaging data]

THE AIM OF THE STUDY

Was to assess an impact of positioning occlusal splints made by various methods on the position of the articular disc of the temporomandibular joint according to MRI data.

MATERIALS AND METHODS

40 patients (8 men and 32 women) aged from 18 to 60 years with temporomandibular joint pain dysfunction syndrome were examined (ICD-10 code K07.60). Patients were treated with splint therapy using traditional splints made with combined method (20 patients) and subtractive occlusal splints made by CAD/CAM technology (20 patients). All patients had MRI of the temporomandibular joints before splint therapy and at the final stage of treatment to determine the position of the articular disc in the habitual occlusion and at maximum mouth opening.

RESULTS

After splint therapy, patients in both groups showed an improvement in the position of the articular disc in the usual occlusion: the rate of patients with bilateral dislocation of the articular disc decreased from 85% to 67.5%, and with unilateral articular disc dislocation decreased from 15% to 10%. With maximum mouth opening, complete reposition of the articular disc in both joints were recorded in 22.5%; the rate of patients with bilateral disorder of articular disc repositioning decreased from 85% to 67.5%, and with unilateral disorder of articular disc repositioning decreased from 15% to 10%.

CONCLUSIONS

Splint therapy had a pronounced positive clinical effect in patients with pain dysfunction syndrome in the temporomandibular joints. Splint therapy is more effective in correcting sagittal dislocation of the articular disc than transversal dislocation. The study showed comparable treatment results when using traditional and digital occlusal splints.

Test-retest reliability of the isometric contraction test (IC test) of the masticatory muscles in subjects with and without temporomandibular muscle disorders

OBJECTIVE

Recently, the DC/TMD has become an essential tool for the diagnosis of temporomandibular disorders (TMD). However, as they fail to include functional activities, new assessment proposals have emerged, such as the isometric contraction test (IC test) of the masticatory muscles, which uses muscle contractions to identify muscular TMD. This study aimed to determine the test-retest reliability of the IC test.

METHODS

A total of 64 participants (40 women and 24 men) completed the IC test administered by two different physical therapists on two non-consecutive days. Cohen's kappa (k), PABAK, and percent agreement (PA) between days were estimated.

RESULTS

The IC test showed good to excellent test-retest reliability values (k>0.77; PABAK>0.90), both globally and individually for the muscles evaluated, and PA>90%, therefore above the thresholds for clinical applicability. However, the global assessment of myofascial pain and the evaluation of the medial pterygoid muscle showed slightly lower reliability values.

CONCLUSION

The IC test is reliable for the assessment of subjects with muscular TMD, both in terms of the global assessment and the evaluation of each muscle, which supports its clinical applicability. Care should be taken when assessing myofascial pain globally and when evaluating the medial pterygoid in all types of pain.

Enhancing Pain Relief in Temporomandibular Joint Arthrocentesis: Platelet-Rich Plasma and Hyaluronic Acid Synergy

Temporomandibular joint (TMJ) disorders present complex challenges in pain management and functional restoration. This review delves into the innovative approach of using platelet-rich plasma (PRP) and hyaluronic acid (HA) combination therapy in TMJ arthrocentesis to address these issues. The potential benefits of this approach are highlighted through an exploration of mechanisms, clinical studies, safety considerations, and future directions. PRP's regenerative properties and HA's lubrication and anti-inflammatory effects offer a comprehensive solution to multifactorial TMJ pain and dysfunction. Clinical studies reveal significant pain reduction, improved mobility, and enhanced satisfaction in patients treated with PRP and HA. Although mild and transient adverse effects have been reported, the safety profile remains favorable. While the evidence is promising, more extensive randomized controlled trials are needed to establish sustained efficacy and safety. As research evolves, collaborative efforts among clinicians and researchers are crucial in realizing the potential of PRP and HA combination therapy, ultimately providing a novel pathway to alleviate TMJ-related pain and enhance patient well-being.

Temporomandibular Disorder Treated With Chiropractic Therapy

Temporomandibular disorders (TMDs) are common and affect the temporomandibular joint (TMJ) and surrounding musculoskeletal tissues. Although traditional rehabilitative treatments such as physiotherapy, occlusal splints, orthodontics, and electrotherapy effectively manage TMDs, chiropractic therapy is emerging as a promising non-invasive treatment option. We report a 39-year-old female patient with TMD who underwent chiropractic therapy, including spinal adjustments, soft tissue therapy, and exercise rehabilitation. After four weeks of treatment, the patient reported a complete resolution of symptoms and an improved quality of life score. Thereafter, the patient continued chiropractic treatment monthly for six months, during which she reported no symptoms and demonstrated improvements in her spinal range of motion, open-mouth anatomy, and cervical lordosis. This case study highlights the efficacy of applying an interdisciplinary approach to treating TMD and the potential of chiropractic therapy as a valuable treatment option for managing TMD.

[Duration of splint therapy in patients with temporomandibular joint disorders]

AIM

Studying the duration of treatment in patients with temporomandibular joint pain dysfunction syndrome, and the relationship of the duration of treatment with the age of the patient at the beginning of therapy.

MATERIALS AND METHODS

The study was carried out using information from medical records of dental patients, information from additional examinations of patients who were treated at the National Medical Research Centre for Dentistry and Maxillofacial Surgery of the Ministry of Health of Russia from 2016 to 2022. Statistical research methods: to evaluate the normality of the distribution, graphical methods were used, as well as the Shapiro-Wilk criterion.

RESULTS

The duration of splint therapy in patients with temporomandibular joint pain dysfunction syndrome varied from 4 to 27 months. The average duration of treatment of patients using occlusive splints was 10.5±5.3 months. Without abnormal observations, the average duration of splint therapy in patients with TMJ pain syndrome was 9.6±4.1 months. The obtained data allow stating the absence of a correlation between the age of patients and the duration of splint-therapy.

CONCLUSION

The majority of patients (68.4%) complete the splint therapy stage within 1 year, and a very small part (1.8%) are treated for more than 1.5 years. The duration of treatment of patients with temporomandibular joint pain dysfunction syndrome does not depend on age or gender.