Knowledge and awareness of physical therapy role in evaluating and treating temporomandibular disorders among physical therapists in Saudi Arabia

Background

Practitioners, including physical therapists, are not proficiently trained to evaluate and treat individuals with temporomandibular disorders. The purpose of this study is to evaluate the knowledge and awareness of examining and treating temporomandibular disorders among physical therapists in Saudi Arabia.

Methods

An online questionnaire was distributed to physical therapists on different social media platforms. The survey covered demographics characteristics and knowledge of examining and treating temporomandibular disorders. Descriptive statistics were used for data analysis.

Results

A total of 143 participants with a mean of age of 30 (± 6.6) years participated in this study. The majority of participants (n = 109; 76.2%) did not take educational courses on temporomandibular disorders; more than half (n = 84; 58.7%) had never evaluated or treated individuals with temporomandibular disorders. Most physical therapists were aware that they could treat individuals with temporomandibular disorders (n = 121, 84.6%). The most common evaluation methods were temporomandibular joint palpation, jaw movement during opening and closing, and palpation of the masticatory muscles (n = 56, 95%); (n = 49, 83%); (n = 48, 81%), respectively. The common methods used for treatment were therapeutic exercise strengthening, manual therapy, and patient education (n = 49; 83%; n = 46; 78%; n = 33; 56%), respectively. Thirty-one participants (53%) referred patients to other practitioners.

Conclusion

This preliminary study indicates there is a fair level of knowledge, low confidence, low education, and low clinical experience for physical therapists in the evaluation and treatment of temporomandibular disorders in Saudi Arabia. More attention is needed on physical therapy education programs and post-graduate education courses on temporomandibular disorders.

White Matter Diffusion Properties in Chronic Temporomandibular Disorders: An Exploratory Analysis

Objective

To determine differences in diffusion metrics in key white matter (WM) tracts between women with chronic temporomandibular disorders (TMDs) and age- and sex-matched healthy controls.

Design

Cross sectional study compared diffusion metrics between groups and explored their associations with clinical variables in subjects with TMDs.

Methods

In a total of 33 subjects with TMDs and 33 healthy controls, we performed tractography to obtain diffusion metrics (fractional anisotropy [FA], mean diffusivity [MD], radial diffusivity [RD], and axial diffusivity [AD]) from the cingulum near the cingulate gyrus (CGC), the cingulum near the hippocampus (CGH), the fornix, the anterior limb of the internal capsule (ALIC), the posterior limb of the internal capsule (PLIC), and the uncinate fasciculus (UF). We compared diffusion metrics across groups and explored the relationships between diffusion metrics and clinical measures (pain chronicity and intensity, central sensitization, somatization, depression, orofacial behavior severity, jaw function limitations, disability, and interference due to pain) in subjects with TMDs.

Results

We observed differences in diffusion metrics between groups, primarily in the right side of the brain, with the right CGC having lower FA and the right UF having lower FA and higher MD and RD in subjects with TMDs compared to healthy controls. No clinical measures were consistently associated with diffusion metrics in subjects with TMDs.

Conclusion

The UF showed potential microstructural damage in subjects with TMDs, but further studies are needed to confirm any associations between diffusion changes and clinical measures.

Reliability of the Joint Position Sense Error Test for Women With Neck Pain and Asymptomatic Men and Women

OBJECTIVE

The purpose of this study was to evaluate the intra-rater between-days reliability of the joint position sense error (JPSE) test in asymptomatic men and women, as well as in women with neck pain.

METHODS

Fourteen asymptomatic men and 27 women (14 asymptomatic and 13 with neck pain) participated. The JPSE test was performed during right and left cervical rotation (10 trials for each side) in 2 sessions, with at least 7 days between them. The head repositioning error during the JPSE test (in degrees) was measured and used to calculate the intra-rater between-days reliability of the test, evaluated through the intraclass correlation coefficient and Bland-Altman analyses. Independent t tests were calculated to compare the head repositioning errors of asymptomatic women and men. The minimal detectable change was also calculated.

RESULTS

The neck pain group showed higher intraclass correlation coefficient values (0.866 and 0.773, good reliability) compared to the asymptomatic men (0.478 and 0.403, poor reliability) and to the asymptomatic women (-0.161 and 0.504, poor and moderate reliability, respectively) for both right and left cervical rotation, respectively. Considering Bland-Altman analyses, the neck pain group showed better agreement between the measurements for right cervical rotation than the asymptomatic groups.

CONCLUSION

The results indicate that the methodology used to perform the JPSE test in this study may be a reliable way to assess the proprioception of women with neck pain in clinical settings.

Orthodontic Treatment and Craniocervical Posture in Patients with Temporomandibular Disorders: An Observational Study

Orthodontic treatment acts through the application of forces and/or by stimulating and redirecting the functional forces within the craniofacial complex. Considering the interrelationship between craniomandibular and craniocervical systems, this intervention may alter craniocervical posture. Thus, our aim is to (a) compare craniocervical posture, hyoid bone position, and craniofacial morphology before, after, and also in the contention phase at least one year after the orthodontic treatment, in patients with temporomandibular disorders and (b) to verify whether the presence of condylar displacement, the skeletal class, or the facial biotype interferes with the abovementioned outcomes. To do so an observational, analytical, longitudinal, and retrospective design study was carried out. A non-probabilistic convenience sampling method was applied. The sample consisted of clinical records of patients diagnosed with temporomandibular disorders in order to compare pre-orthodontic treatment with post-orthodontic treatment (n = 42) and contention phase data (n = 26). A cephalometric analysis of several variables was performed. The p-value was set as 0.05. When the pre- and post-orthodontic treatment data were analyzed, there were statistically significant changes in variables concerning craniocervical posture (CV angle, C0-C1, and AA-PNS) and also concerning hyoid bone position (C3-Rgn). When pre- and post-orthodontic treatment and contention phase data were analyzed the variables concerning craniocervical posture (C0-C1, CVT/Ver, NSL/OPT, NSL/CVT, NSL/Ver; OPT/CVT, OPT/Ver) and facial biotype had statistically significant changes. This allowed us to conclude that in the sample studied, there were significant differences regarding hyoid bone position (pre- versus post-orthodontic treatment) and craniocervical posture (pre- versus post-orthodontic versus contention), with the craniocervical posture being prone to return to basal values. The presence of condylar displacement was found to significantly increase the H-H1 distance in the three moments of evaluation. Facial biotype was found to significantly increase the NSL/Ver angle on hypodivergent compared to hyperdivergent in the contention phase.

Coordinated features in jaw and neck muscle activities induced by chewing of soft and hard gum in healthy subjects

Backgrounds

Jaw and neck muscles may be activated by chewing load using a hard food. However, it remains unclear how effects the gum hardness to the coordinated features in jaw and neck muscle activities during chewing performance.

Objectives

This study was conducted to quantitatively elucidate the effects of the hardness of the gum on coordinated features in jaw and neck muscle activities using intermuscular EMG–EMG transfer function and EMG–EMG coherence function analyses in 18 healthy subjects.

Methods

Jaw and neck muscle activities were aggregated into the first peak frequency of the power spectrum, and power, gain, phase, and coherence parameters between jaw and neck muscle activities were examined in the first peak frequencies during soft and hard gum chewing.

Results

The first peak frequency was not significantly different between soft and hard gum chewing. In contrast, power values of the jaw and neck muscles were significantly increased by chewing of hard gum as compared with soft gum, whereas gain, phase, and coherence were not significantly changed by gum hardness.

Conclusions

The chewing rhythm, the quantitative and temporal coordination, and the functional coordination in jaw and neck muscle activities were not changed during soft and hard gum chewing, as well as increased jaw and neck muscles activities. It is therefore concluded that the chewing rhythmicity and jaw and neck muscles coordination accompanied with the increased jaw and neck muscle activities are maintained under the condition of the chewing load using gum hardness in the healthy individuals.

Neck associated factors related to migraine in adolescents with painful temporomandibular disorders

OBJECTIVE

Migraine is a comorbidity of painful temporomandibular disorders (TMDs). Both migraine and painful TMD have associations with neck pain and head posture. The aim of this study was to clarify the role of neck pain and head posture on the association between migraine and painful TMD in adolescents.

MATERIALS AND METHOD

In total 314 adolescents were included: 235 adolescents with only painful TMD (pTMD) and 79 adolescents with painful TMD and migraine (TMDMIG). Adolescents were diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders and International Classification of Headache Disorders, 3rd edition. Head postures were identified using lateral cephalograms. Myofascial trigger points (TrPs) were evaluated in the temporalis, masseter, trapezius, sternocleidomastoid, sub-occipitalis, and splenius capitis muscles.

RESULTS

Multivariate logistic regression analysis confirmed the associations among the orofacial pain duration, number of active TrPs in the trapezius muscles, intensity of neck pain, and distance between the occiput and atlas and migraine in adolescents with TMD. The relationships among intensity of neck pain, number of TrPs in the cervical muscles, and head posture were more prominent in the TMDMIG than those in the pTMD.

CONCLUSION

Neck associated factors seemed to have relevance with migraine in adolescents with painful TMD.

Cervical musculoskeletal disorders in patients with temporomandibular dysfunction: A systematic review and meta-analysis

OBJECTIVE

To verify which are the neck musculoskeletal disorders presented by individuals with temporomandibular disorders (TMD).

METHODS

It is a systematic review and meta-analysis that were included cohort, case-control and cross-section studies that analyzed the presence of cervical musculoskeletal disorders in individuals with TMD, with age between 18 and 55 years. The searches were carried out in the databases: Medline/PubMed, Cinahl, Web of Science, Cochrane, Lilacs and Scopus; and there was no linguistic or temporal restriction. The evidence quality was evaluated by GRADE system and methodological quality by Newcastle-Ottawa Quality Assessment Scale (NOS) and the risk of publication bias assessed by the funnel plot graph. The data was quantitatively analyzed by the meta-analysis using the mean differences (MD) as an effect measure.

RESULTS

There were included 21 manuscripts in the synthesis, of theses 16 were evaluated by meta-analysis with methodological quality ranging from poor to excellent by NOS scale. Individuals with TMD present lower endurance of extensor neck muscle compared to TMD-free (MD = -194.66s [95%CI: 212.44;-176.88]), with moderate to excellent quality. As, upper neck hymobility on the right (MD = -8.59° (95%CI: -10.43°;-6.75°) and left (MD = -7.99° (95%CI: -9.63°;-6.35°), and in all global neck movements. Also, individuals with TMD presented worse self-reported neck disability (MD = 7.91 (95%CI: 7.39; 8.43)) compared to free-TMD.

CONCLUSION

There is moderate and strong evidence that patients with TMD present lower endurance of extensor neck muscle, global and upper neck hypomobility, worse self-reported neck disability, however, their cranio-cervical posture is similar to individuals without TMD, based on a moderate to excellent methodological quality.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42018103918.

Craniocervical and Cervical Spine Features of Patients with Temporomandibular Disorders: A Systematic Review and Meta-Analysis of Observational Studies

To assess neck disability with respect to jaw disability, craniocervical position, cervical alignment, and sensorimotor impairments in patients with temporomandibular disorders (TMD), a systematic review and meta-analysis of observational studies trials were conducted. The meta-analysis showed statistically significant differences in the association between neck disability and jaw disability (standardized mean difference (SMD), 0.72 (0.56–0.82)). However, results showed no significant differences for cervical alignment (SMD, 0.02 (−0.31–0.36)) or for the craniocervical position (SMD, −0.09 (−0.27–0.09)). There was moderate evidence for lower pressure pain thresholds (PPT) and for limited cervical range of motion (ROM). There was limited evidence for equal values for maximal strength between the patients with TMD and controls. There was also limited evidence for reduced cervical endurance and conflicting evidence for abnormal electromyographic (EMG) activity and motor control in TMD patients. Results showed a clinically relevant association between cervical and mandibular disability in patients with TMD. Regarding sensory-motor alterations, the most conclusive findings were observed in the reduction of PPT and cervical ROM, with moderate evidence of their presence in the patients with TMD. Lastly, the evidence on impaired motor control and cervical EMG activity in patients with TMD was conflicting.

The Usefulness of the Pressure Algometer in the Diagnosis and Treatment of Orofacial Pain Patients: A Systematic Review

Objectives

The pressure pain threshold (PPT) may be an efficient approach to screen and evaluate orofacial pain. However, the results of previous PPT studies have varied greatly. The aim of this paper was to determine whether the PPT is an efficient approach for screening and evaluating orofacial pain.

Methods

The search yielded 123 articles. After removal of duplicates and screening of abstracts, 32 articles were selected for further evaluation. The Cochrane Collaboration tool for assessing the risk of bias was used for the evaluation of the studies.

Results

The studies covered a total of 4403 adult patients, aged 16-62, and 30 children. The studies investigated the reliability and validity of the PPT (measured by a pressure algometer) in TMD patients. The PPT was investigated in relation to headache, menstrual cycle, oral contraception, occlusal interference, and occlusal appliances. Generally, the risk of bias was low to unclear. Some structural limitations were inherent in the studies, such as small samples and short duration of the testing involved. Also, the analyzed studies lacked consistency in study design and patient management. Pressure increase values differed from 20 kPa/s to 50 kPa/s and from 0.5 kg/cm²/s to 2 kg/cm²/s. Descriptions of the PPT examination points also varied, from very precise and repeatable to a simple listing of anatomical points. The number of measurements varied from 1 to 5 at each visit. The intervals ranged from 5 seconds to 15 minutes. However, some studies confirmed that the pressure algometer is an effective tool for determining the source of orofacial pain.

Conclusions

Based on the analyzed articles, the authors argue that the PPT is not an efficient approach for screening and evaluating orofacial pain. What is more, it should not be used as the only diagnostics tool for patients with orofacial pain. Importantly, however, additional factors should be considered in the future for the evaluation of the PPT, including body symmetry and posture, hormone levels and the menstrual phase in women, and the use of medications and its influence on the PPT. Further clinical trials should also be performed on the PPT, examining head and neck pain patients, with more precise study design and larger samples.

Electromyography of the masticatory muscles during chewing in different head and neck postures - A pilot study

Objectives

The objectives of this pilot study were to analyze the electromyography (EMG) activity of masseter and anterior temporalis muscles during chewing in 2 different posture conditions: natural head posture (NHP) and maximum yet comfortable forward head posture (FHP) in healthy individuals; and to compare EMG activity between subjects based on their NHP during chewing.

Methods

Fifteen subjects participated. Sagittal head posture in sitting position was clinically assessed using a plumb line. Participants were classified as having FHP or upright head posture (UP). Surface EMG was used to evaluate superficial masseter and anterior temporalis bilaterally during chewing in NHP and FHP. Three trials with five chewing cycles were recorded. EMG data were normalized using a maximum voluntary contraction. An independent t-test was used to calculate differences between sides. If no differences were found, both sides were analyzed together. To analyze differences between the 2 conditions, a paired t-test was used. Independent t-test was used to calculate difference between subjects with UP and FHP.

Results

A significant increase in muscle activity was found for masseter muscle in the FHP condition. No differences were found in muscle activity in natural head position by posture classification. A trend of increased activity was observed for masseter and temporalis muscles during chewing in FHP.

Conclusion

Head and neck posture was found to influence masticatory muscle activity during the function of chewing. The results of this study may help clinicians to better understand the association between head and neck posture alterations with masticatory muscles related disorders.

Cross-cultural adaptation, reliability and validity of the Italian version of the craniofacial pain and disability inventory in patients with chronic temporomandibular joint disorders

Background

To develop an Italian version of the Craniofacial Pain Disability Inventory (CFPDI-I) and investigate its psychometric abilities in patients with temporomandibular disorders (TMD).

Methods

The CFPDI was translated following international standards. The psychometric analyses included reliability by internal consistency (Cronbach’s alpha) and test/retest stability (intraclass correlation coefficient, ICC); construct validity was investigated by matching (a priori hypotheses) the CFPDI-I with the Italian Neck Disability Index (NDI-I), a pain intensity numerical rating scale (NRS), the Italian Pain Catastrophising Scale (PCS-I), the Italian Tampa Scale of Kinesiophobia (TSK-I), and the Italian Migraine Disability Assessment Score Questionnaire (MIDAS) (Pearson’s correlation). Alpha was set at 0.05.

Results

Two hundred and twelve patients with chronic TMD completed the tool. The questionnaire was internally consistent (α = 0.95) and its stability was good (ICCs = 0.91). As hypothesised, validity figures showed CFPDI-I strongly correlated with the NDI-I (r = 0.66, p < 0.05) and moderately correlated with the NRS (r = 0.48, p < 0.05), PCS (r = 0.37, p < 0.05), TSKI (r = 0.35, p < 0.05) and MIDAS (r = 0.47, p < 0.05). Similar estimates were shown by CFPDI-I subscales.

Conclusions

The cross-culturally adapted version of the Craniofacial Pain and Disability Inventory (CFPDI-I) showed satisfactory psychometric properties that replicate those of the original version and, therefore, can be implemented in the clinical assessment of Italian people affected by TMD.

Preclinical Signs of a Temporomandibular Disorder in Female Patients With Episodic Cervicogenic Headache Versus Asymptomatic Controls: A Cross-Sectional Study

BACKGROUND

The International Classification of Headache Disorders, 3rd Edition, accepted "headache attributed to temporomandibular disorders" as a valid headache. The neurophysiologic interplay between cervical structures and the temporomandibular joint, however, might also suggest that a temporomandibular disorder could develop in patients with cervicogenic headache.

OBJECTIVE

To compare the presence of preclinical temporomandibular signs between female patients with episodic cervicogenic headache and a control group.

DESIGN

Case-controlled cross-sectional design.

SETTING

Institutional setting: Hasselt University.

PARTICIPANTS

Twenty-two women (mean age ± SD: 20.7 ± 2.5 years) with episodic cervicogenic headache, without temporomandibular signs and 22 matched (gender, age, level of education, occupation) asymptomatic controls (21 ± 2.3 years).

METHODS

(Un)assisted temporomandibular range of motion, pressure pain thresholds, painful palpations were examined and the level of perceived stress was measured.

MAIN OUTCOME MEASUREMENTS

Temporomandibular range of motion (mm), pressure pain thresholds (kPa/cm²), painful palpations (yes/no), and level of perceived stress (Perceived Stress Scale).

RESULTS

Maximal mouth-opening was significantly smaller in the headache group (P <.05; effect size [ES] -0.45). Palpation of the masseter resulted in significantly more positive pain responses in the headache group at the left (P = .009; ES ∞) and right (P = .002;ES 17.5) origin, left (P = .004; ES 14.54) and right (P = .03; ES 5.71) body and left (P < .001; ES 12) insertion. Significantly lower pressure pain thresholds on the left and right anterior (P = .03; ES -0.33 resp. P = .02; ES -0.35), central (P = .003; ES 1.02 resp. P = .02; ES 0.79) and right posterior (P = .03; ES 0.62) temporalis and right tibialis anterior (P = .03; ES -0.33) were measured in the headache group. The level of perceived stress was significantly higher (P = .02) in the headache group.

CONCLUSIONS

Patients with episodic cervicogenic headache present with signs of a preclinical temporomandibular disorder and sensitization. The smaller range of motion, lower pressure pain thresholds, and higher levels of stress accentuate the multidimensionality of the problem.

LEVEL OF EVIDENCE

IV.

Physical therapists' self-perceived adequacy of entry-level education and their current confidence levels with respect to temporomandibular disorders: A pilot study

OBJECTIVE

Physical therapy (PT) has been shown to be one of the most effective conservative treatments for temporomandibular disorders (TMD). The objectives of this pilot study are to determine the self-perceived knowledge, adequacy of entry-level education, and the current confidence levels of PTs in Florida regarding TMD treatment.

METHODS

An online questionnaire was used. The overall experience, education, and confidence regarding TMD treatment and its implications were discussed.

RESULTS

A total of 247 PTs participated. Nearly 70% of the PTs responded that they did not believe they received adequate education in TMD, and 50% are not confident to treat these patients. Seventy-seven percent were interested in knowing more about PT for TMD.

DISCUSSION

This pilot study shows the lack of confidence of PTs in Florida to treat TMD patients. More adequate training on TMD in the entry-level professional education is needed.

Dentists' Awareness of Physical Therapy in the Treatment of Temporomandibular Disorders: A Preliminary Study

Background

Physical therapy (PT) has been shown to be one of the most effective conservative treatments for temporomandibular disorders (TMD). Not all dentists are aware of the importance of the collaboration with physical therapists in the treatment of TMD pain.

Objectives

To determine the awareness of dentists in Florida about the importance of PT for TMD pain and to create awareness related to collaborations.

Methods

An online questionnaire was used. A contact list of dentists was obtained from the Florida Dental Association. The overall awareness and information on patient referral were presented per dentist specialty.

Results

A total of 256 dentists completed the survey. Prior to the survey, 41% of the dentists reported not aware that PTs can treat TMD patients. Oral surgeons and orthodontists were more aware about PT compared to other specialties. After the survey, 81% of the dentists were more likely to refer their TMD patients to PT, and 80% were interested to know more about the benefits of collaborations.

Conclusion

This study shows the lack of dentists' awareness in Florida about the benefits of PT for TMD treatment. This study increased the awareness of the surveyed dentists in Florida about the benefit from a multidisciplinary approach.

Pain threshold and temporomandibular function in systemic sclerosis: comparison with psoriatic arthritis

The aim of the study was to evaluate whether a reduced pain threshold is associated with increased temporomandibular dysfunction in systemic sclerosis (SSc) compared to psoriatic arthritis (PsA) and healthy controls. Ninety subjects participated in the study (30 SSc, 30 PsA, and 30 healthy controls). The Helkimo index was used to evaluate temporomandibular dysfunction. Digital palpation was performed at the temporomandibular joint (TMJ) surface and at the superficial masseter muscle (SMM) and pain intensity was recorded on a visual analog scale (VAS), while pain pressure threshold (PPT) was measured at the same sites through a pressure algometer. PPT scores were lower in SSc patients compared to PsA patients and controls. In addition, the average Helkimo index score, measuring the degree of TMJ dysfunction, was higher in SSc compared to PsA and controls. A significant inverse correlation was observed between every PPT score, and both Helkimo index and VAS palpation in SSc and PsA. Both the range of motion and all the other pain-related subdomains of the Helkimo index score (pain on movement, pain palpation TMJ and pain palpation muscle) were significantly worse in SSc compared to PsA, while no significant differences were observed in the TMJ function subdomain. In SSc patients, the skin score was directly associated with the range of motion subdomain of the Helkimo index. Our results confirm that TMJ function is impaired in SSc; further longitudinal studies are needed to assess the role of pain threshold in the assessment of limitations in TMJ function and to identify an objective marker of therapeutic response.

Chronic Temporomandibular Disorders: disability, pain intensity and fear of movement

Background

The objective was to compare and correlate disability, pain intensity, the impact of headache on daily life and the fear of movement between subgroups of patients with chronic temporomandibular disorder (TMD).

Methods

A cross-sectional study was conducted in patients diagnosed with chronic painful TMD. Patients were divided into: 1) joint pain (JP); 2) muscle pain (MP); and 3) mixed pain. The following measures were included: Craniomandibular pain and disability (Craniofacial pain and disability inventory), neck disability (Neck Dsiability Index), pain intensity (Visual Analogue Scale), impact of headache (Headache Impact Test 6) and kinesiophobia (Tampa Scale of Kinesiophobia-11).

Results

A total of 154 patients were recruited. The mixed pain group showed significant differences compared with the JP group or MP group in neck disability (p < 0.001, d = 1.99; and p < 0.001, d = 1.17), craniomandibular pain and disability (p < 0.001, d = 1.34; and p < 0.001, d = 0.9, respectively), and impact of headache (p < 0.001, d = 1.91; and p < 0.001, d = 0.91, respectively). In addition, significant differences were observed between JP group and MP group for impact of headache (p < 0.001, d = 1.08). Neck disability was a significant covariate (37 % of variance) of craniomandibular pain and disability for the MP group (β = 0.62; p < 0.001). In the mixed chronic pain group, neck disability (β = 0.40; p < 0.001) and kinesiophobia (β = 0.30; p = 0.03) were significant covariate (33 % of variance) of craniomandibular pain and disability.

Conclusion

Mixed chronic pain patients show greater craniomandibular and neck disability than patients diagnosed with chronic JP or MP. Neck disability predicted the variance of craniofacial pain and disability for patients with MP. Neck disability and kinesiophobia predicted the variance of craniofacial pain and disability for those with chronic mixed pain.

Interrelationship between temporomandibular joint osteoarthritis (OA) and cervical spine pain: Effects of intra-articular injection with hyaluronic acid

OBJECTIVE

The aim of this study was to evaluate cervical spine pain and function after five sessions of viscosupplementation with hyaluronic acid (HA) in patients with temporomandibular joint (TMJ) osteoarthritis.

METHODS

Forty-nine patients, (79% females, aged between 43-81 years), affected by TMJ osteoarthritis and concurrent cervical spine pain and limited function were recruited. All patients underwent a cycle of five weekly arthrocenteses and viscosupplementation with 1 ml of medium molecular weight HA according to the single-needle arthrocentesis technique. Outcome variables were TMJ pain (VAS), cervical active ranges of motion, cervical disability (NPDS), and presence of painful palpation sites. Assessments were carried out at baseline and at one, three and six months after the end of treatment protocol.

RESULTS

A significant reduction over time was shown both in TMJ pain levels and in NPDS values with respect to baseline (p < 0.001). Most parameters of active cervical range of motion showed an improvement with time. Benefits remained stable throughout six months after the viscosupplementation protocol.

CONCLUSIONS

A protocol of TMJ intra articular arthrocentesis and viscosupplementation improved cervical function and reduced disability in patients with concurrent cervical spine pain. These findings add to the complex amount of literature on the relationship between temporomandibular disorders and cervical spine disorders.

Cervical-scapular muscles strength and severity of temporomandibular disorder in women with mechanical neck pain

Abstract Introduction: Changes in cervical muscle function have been observed in patients with neck pain (NP) and TMD. However, the relationship between TMD severity and neck muscle strength in the presence/absence of NP is unknown. Objective: To determine the prevalence of TMD in women with and without mechanical NP and assess the cervical-scapular muscle strength and its association with TMD severity. Methods: Fifteen volunteers without neck pain (CG) and 14 women with mechanical neck pain (NPG) took part and were selected by the Neck Disability Index. The diagnosis and severity of TMD were determined by the Research Diagnostic Criteria for TMD and Temporomandibular Index (TI), respectively. The strength of the upper trapezius muscle, and cervical flexor and extensor muscles was measured by digital hand dynamometer. Results: 64.5% of women with NP and 33.3% without NP were diagnosed with TMD (p = 0.095). The NPG showed lower strength of the cervical flexor (p = 0.044) and extensor (p=0.006) muscles, and higher TI (p = 0.038) than in the CG. It was also verified moderate negative correlation between TI and the strength of dominant (p = 0.046, r = -0.547) and non-dominant (p = 0.007, r = -0.695) upper trapezius, and cervical flexors (p = 0.023, r = -0.606) in the NPG. Conclusion: There was no difference in the prevalence of TMD in women with and without NP. However, women with NP have lower cervical muscle strength - compared to those without NP - which was associated with greater severity of TMD. Thus, in women with NP associated with TMD, it is advisable to assess and address the severity of this dysfunction and identify the cervical-scapular muscles compromise.