Changes in oral health-related quality of life after self-care treatment in patients with myofascial pain

OBJECTIVE

The aim of this study was to evaluate the changes in oral health-related quality of life (OHRQoL) of patients with myofascial pain treated by means of self-care measures.

METHODS

Fifteen patients with myofascial pain had OHRQoL evaluated by the Oral Health Impact Profile (OHIP-TMD) questionnaire and were instructed for self-care measures verbally and with a printed guide in the first consultation (T0), after 30 days (T1) and 60 days (T2). Paired t-test was performed to evaluate changes through time.

RESULTS

OHIP-TMD scores were 29.3 (SD 10.2) at T0, 18.9 (SD 11.2) at T1, and 15.9 (SD 10.7) at T2. There was a reduction of scores related to the OHIP-TMD domains of functional limitation, physical pain, psychological and social inability and incapacity (T1 and T2), and psychological discomfort (T2).

CONCLUSION

Self-care measures had positive effects on the myofascial pain treatment, reducing physical pain generated by TMD and improving patients' OHRQoL.

Primary headaches in scuba divers and the effect of temporomandibular dysfunction

OBJECTIVE

This study aimed to evaluate the frequency of episodic primary headaches (EPH) and temporomandibular dysfunction's (TMD) effect in experienced scuba divers.

METHODS

A form consisting of the Fonseca Anamnestic Index and a structured headache questionnaire was sent to individuals using social media platforms.

RESULTS

A total of 132 divers and 104 non-divers were included the study. In male divers, EPH and TMD were not different from the non-diver group (p = 0.1, p = 0.1), and TMD had an effect on increasing the possibility of migraine (OR = 2.5, p = 0.04). In female divers, the possibility of EPH and TMD were also lower (OR = 0.1, p < 0.001, OR = 0.2, p = 0.01).

CONCLUSION

Scuba diving does not pose a risk for EPH or TMD in either gender. TMD treatment in male divers is important for uncontrolled migraine attacks.

Novel Diagnostic and Therapeutic Approaches to Temporomandibular Dysfunction: A Narrative Review

Temporomandibular dysfunction (TMD) is a burgeoning area of study within the dental field. TMD is caused by abnormalities in the temporomandibular joint or muscles of mastication and can lead to pain, loss of function, and other complications. As this area of patient care receives increased focus, the ability to accurately diagnose TMD becomes paramount. The aim of this review is to summarize novel diagnostic and therapeutic techniques that have been proposed within the last approximately 3 years in order to inform readers of the cutting-edge advances in the field of TMD diagnosis and management, while also analyzing the clinical relevance of each study. A PubMed search was completed on 1 March 2023, using MeSH terms related to TMD diagnosis and treatment. The search yielded seven articles that pertained to the aim of this review article. The main findings from each study are summarized in this review article. These novel methods of diagnosing and treating TMD may improve our ability to assess and treat patients suffering from TMD.

Shear Wave Elastography in Bruxism-Not Yet Ready for Clinical Routine

Ultrasound shear wave elastography (SWE) is an emerging modality for the estimation of stiffness, but it has not been studied in relation to common disorders with altered stiffness, such as bruxism, which affects almost one-third of adults. Because this condition could lead to an increased stiffness of masticatory muscles, we investigated SWE in bruxism according to a proof-of-principle and feasibility study with 10 patients with known bruxism and an age- and gender-matched control group. SWE of the left and right masseter muscles was estimated under three conditions: relaxed jaw, 50% of the subjective maximal bite force, and maximal jaw opening. Rejecting the null hypothesis, SWE was significantly increased during relaxed jaw (bruxism 1.92 m/s ± 0.44; controls 1.66 m/s ± 0.24), whereas for maximal mouth opening, the result was vice versa increased with 2.89 m/s ± 0.93 for bruxism patients compared with 3.53 m/s ± 0.95 in the healthy control, which could be due to limited jaw movement in chronic bruxism patients (bruxism 4.46 m/s ± 1.17; controls 5.23 m/s ± 0.43). We show that SWE in bruxism is feasible and could be of potential use for diagnostics and monitoring, though we also highlight important limitations and necessary methodological considerations for future studies.

The Role of the Lateral Pterygoid Muscle in Articular Disc Displacement: A Cross-Sectional Magnetic Resonance Imaging Study

BACKGROUND

Determination of the role of the Lateral Pterygoid Muscle LPM in the articular disc displacement ADD is controversial referring to the variations in the pattern of insertion of the Superior Lateral Pterygoid Muscle SPLM.

INTRODUCTION

it was well understood that the superior head of the lateral pterygoid muscle has only a single insertion pattern among individuals in which the muscle is attached to the articular disc and capsule. However, recent findings in many studies have shown a noticeable variation in the insertion pattern of the upper LPM.

METHODS

MRI examinations were collected at King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. Scans of 61 patients (41 females, 20 males, mean age 33 years old) with symptoms of temporomandibular dysfunction were reviewed retrospectively. The direction of their articular disc displacement was evaluated through sagittal and coronal views in both open and closed mouth positions.

RESULTS

There was no statistical significance found between the LPM attachment types and TMJ disc position. The chi-square test also showed no significant difference between the type of LPM attachment and the condylar location. Forty-five percent of the articular discs were located between the articular eminence and the glenoid fossa. The majority of the disc displacement was in the anterior direction.

CONCLUSION

There was no statistically significant association between the type of LPM attachments and the direction of disc displacement.

Reciprocal effects of scleroderma and temporomandibular dysfunction between patient cohorts

OBJECTIVE

To estimate the prevalence of temporomandibular dysfunction in scleroderma patients according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and to correlate it with disease variables.

METHODS

Temporomandibular dysfunction was evaluated in 75 scleroderma patients and 74 healthy controls using DC/TMD. Gastrointestinal symptoms were evaluated through the University of California Los Angeles (UCLA) score in scleroderma patients.

RESULTS

There was no difference of prevalence in temporomandibular dysfunction [30 (40%) vs 30 (40.5%); p > 00.05] between scleroderma patients and healthy controls. Scleroderma patients had a significant reduction in all oral movements compared to healthy controls. Scleroderma patients with temporomandibular dysfunction had a statistically higher score in the UCLA distention/bloating item [1.75 (0.5-2.38) vs 0.75 (0.25-1.75); p < 0.05] than scleroderma patients without temporomandibular dysfunction.

DISCUSSION

Temporomandibular dysfunction prevalence between scleroderma patients and healthy controls is similar. In scleroderma patients, temporomandibular dysfunction reduces oral mobility and opening, which worsens distension/bloating.

Analysis of Earlier Temporomandibular Joint Disorders in JIA Patients: A Clinical Report

The aim of this study was to analyse the structural characteristics of the temporo-mandibular joint (TMJ) and the dysfunctional consequences induced by disease in subjects with juvenile idiopathic arthritis (JIA). The study was conducted in 25 patients with JIA (median age (IQR), 13.9 (10.9-15.3)) and 26 healthy controls (median age (IQR), 14.3 (11.6-17.2)) years. All enrolled patients were subjected to anamnestic evaluation, laboratory parameters, JIA subclass, and type of therapy for the disease. A clinical-gnathological evaluation, anamnestic and dysfunctional index (Ai and Di), and magnetic resonance imaging of TMJs were performed in all patients. The test group showed a significant reduction (p < 0.001) regarding the clinical findings such as maximal mouth opening, left and rightward laterotrusion and protrusion, and a significant difference in the reported symptoms (TMJ sounds, reduced mouth opening and pain), and Ai and Di (p < 0.001) compared to healthy patients. Correlation analysis showed a significant correlation between the median duration of disease and the maximum mouth opening and between visual analogue scale (VAS) score and maximum mouth opening, leftward laterotrusion, rightward laterotrusion, and protrusion. The results obtained in this study suggest that patients with JIA presented a cohort of symptoms in TMJs in comparison with healthy controls. Moreover, a careful TMJs evaluation and an early diagnosis of TMJs dysfunction and regular follow-ups are recommended in order to prevent and reduce functional and chewing problems in patients with JIA.

Evaluation of Dental Status in Relation to Excessive Horizontal and Vertical Overlap in North Indian Population

Introduction:

Tooth wear (attrition) is a multifactorial entity, the pathogenesis of which involves many factors but the role of malocclusion cannot be undermined. Overjet and overbite play an important role in defining occlusion, hence they should also play an important role in causing attrition.

Objectives:

This study aims to evaluate the relationship of dental health status between the vertical and horizontal overlap.

Materials and Methods:

This study was conducted on 600 patients selected randomly from rural population which were divided into three equal groups as per the predefined criteria, namely, horizontal overlap, vertical overlap, and control group. All patients were examined for the tooth attrition.

Results:

In Group 1 – 73 patients out of 200 showed one or more teeth attrition, in Group 2 – 38 patients out of 200 showed one or more teeth attrition, and in the control group, 22 patients out of 200 showed one or more teeth attrition.

Conclusion:

It was concluded that both vertical and horizontal abnormal relationships of teeth play an important role in the etiology of attrition, with abnormal horizontal overlap being the more detrimental as compared to the vertical one.

Diagnostic correlation between clinical protocols and magnetic resonance findings in temporomandibular disorders: A systematic review and meta-analysis

BACKGROUND

Our aim was to assess the diagnostic correlation between clinical protocols and magnetic resonance (MRI) findings in temporomandibular disorders (TMDs), including disc displacement with and without reduction (DDwR; DDwoR) and arthralgia.

METHODS

A systematic review performed in two phases according to the PRISMA checklist. Specific indexing terms were used for search of studies assessing TMDs through clinical diagnostic protocols with the aid of Research Diagnostic Criteria for TMDs or Diagnostic Criteria for TMDs. Quality assessment performed using QUADAS-2. Heterogeneity was assessed using I² . Publication bias was assessed using funnel plots. For meta-analysis, we used random effect model or fixed effect. The main outcomes were sensitivity and specificity of clinical protocols.

RESULTS

Fourteen studies included in the qualitative analysis and 11 studies in the meta-analysis. None of the studies fulfilled all criteria of QUADAS-2. High heterogeneity and high publication bias were found among the studies. Clinical protocols for assessing DDwR compared with MRI showed pooled sensitivity of 66% and specificity of 72%. For DDwoR, sensitivity was 61% and specificity 98%. For arthralgia, sensitivity was 43% and specificity 68% for the presence of effusion.

CONCLUSIONS

This review reveals the need for studies with improved quality. Clinical protocols show poor to moderate validity in diagnosis of DDwR and DDwoR compared with MRI. No correlation was found between a clinical diagnosis of arthralgia and MRI effusion. Clinical diagnostic protocols can be used as screening tools, reserving the use of MRI for a more accurate diagnosis in patients with symptoms or dysfunction.

Temporomandibular dysfunction among working Australian adults and association with workplace effort-reward imbalance

OBJECTIVES

To explore the prevalence of temporomandibular dysfunction (TMD) among working Australian adults and examine whether workplace effort-reward imbalance is associated with TMD.

METHOD

Data were from Australia's National Survey of Adult Oral Health (NSAOH) 2004-06, a cross-sectional stratified clustered sample of Australian adults. The NSAOH data included information from a Computer Assisted Telephone Interview, self-complete questionnaire and oral epidemiological examination. Data included demographics, socio-economic characteristics, caries experience, diagnostic criteria for TMD, the Perceived Stress Scale (PSS) and a modified version of the Effort-Reward Imbalance instrument (ERI) where ERI ratio is the weighted ratio of workplace effort/reward subscales. Subpopulation analysis for working adults was conducted including complex sample descriptive statistics, bivariate and multivariable logistic regression models.

RESULTS

NSAOH had 4014 participants with 2329 (65.1%, SE=1.3%) working adults included in the subpopulation analysis. Among working adults, TMD prevalence was 9.4% (SE=1.0%), which was slightly less than population prevalence (PR=9.9%, SE=0.8%), and was higher for females (PR=12.4%, SE=1.4%), people aged ⟨35 years (PR=11.2%, SE=2.2%) and uninsured (PR=11.8%, SE=1.7%). TMD prevalence was associated with the ERI ratio (OR=2.5, 95% CI: 1.3-4.5) and PSS scores (OR=1.1, 95% CI: 1.0-1.09) in bi-variate associations. In multivariable logistic regression, TMD was associated with being female (OR=2.1, 95% CI:1.3-3.6), university qualified (OR=0.43, 95%CI: 0.21-0.88) and with the ERI ratio (OR=2.63, 95% CI: 1.47-4.72).

CONCLUSION

Greater effort-reward imbalance in the workplace is a psychosocial risk factor for TMD. This finding might need to be considered by clinicians managing TMD patients with need for investigating the efficacy of workplace stress management interventions.

Self-exercise programmes and occlusal splints in the treatment of TMD-related myalgia-Evidence-based medicine?

BACKGROUND

The low-cost and reversible treatments concerning disorders of the masticatory muscles represent a vast array of regimens. Common treatments include information, stretching exercises, manual therapy, acrylic splints and cognitive behavioural therapy.

OBJECTIVE

The aim of this study was to evaluate the evidence behind the use of self-exercising programmes and occlusal splints in the treatment of myofascial pain.

METHODS

We conducted a thorough search of five databases, using four cardinal search terms in combination with twelve supporting terms. We also assessed the evidence quality, using GRADEpro software.

RESULTS

The search resulted in 4967 individual studies. 18 studies met the inclusion criteria and were re-evaluated.

CONCLUSION

The selected studies were in favour of a self-care or an occlusal splint treatment of myalgia. However, a GRADE assessment showed that 14 of the 18 selected studies had low or very low evidence quality. Studies also showed weaknesses with regard to nomenclature and reproducibility. Hence, it is our professional opinion that the evidence level for prescribing self-exercises and occlusal splints in the treatment of myalgia is low.

Bilateral bifid condyles: A rare etiology of temporomandibular joint disorders

Background: Bifid mandibular condyle (BMC) is a rare etiology of temporomandibular joint (TMJ) disorders characterized by a duplication of the head of the mandibular condyle.Case report: The authors report the case of a 20-year-old patient complaining of a painful and clicking TMJ and mandibular hypomobility, which had been progressing for several months. Radiological investigations (dental panoramic radiograph and X-ray CT scan) revealed right and left abnormalities of the TMJ due to bilateral BMC requiring surgical management.Conclusion: Despite a prevalence of 0.31% to 1.82% and the controversies surrounding its pathophysiology, maxillofacial surgeons should be aware of BMC to avoid misdiagnosis related to the clinical presentation (pain, clicking, hypomobility, or ankylosis) and provide adequate management.

Influence of craniocervical and craniomandibular dysfunction to nonrestorative sleep and sleep disorders

Objective: Nonrestorative sleep and sleep disorders are commonly reported in patients suffering from craniomandibular (CMD) and craniocervical dysfunctions (CCD). This study aimed to investigate polysomnographic characteristics and the reduction of pain before and after treatment in these patients.Methods: Seventy-four patients with sleep disorders and evident CMD and CCD were included. Manual therapy and an Aqualizer® were used in the therapeutic group. Polysomnographic measurements were conducted pre- and post-therapy.Results: The number of sleep stage alterations and the sleep stage index differed significantly between pre- and post-therapeutic measurements. Between both groups, these parameters were significantly different, as well (p = .001 and p = .012). The subjective perception of sleep quality improved in 81.6% post-therapy (p < .001).Discussion: Manual therapy and the application of an Aqualizer® may improve sleep quality in patients suffering from CMD and CCD. Pain may not be the main cause for the sleep disorders in CMD and CCD.

Temporomandibular disorders in children and adolescents

Temporomandibular disorders (TMDs) are conditions that affect the muscles of mastication, temporomandibular joints (TMJs), and associated structures. Historically these conditions were deemed to occur primarily in adults; however, many recent studies have reported a growing prevalence of signs and symptoms of TMDs in children and adolescents. The reported prevalence of these conditions in pediatric patients varies widely due to methodologic differences among studies; therefore, unified diagnostic criteria for children are needed. In this young population, TMDs can cause pain in the masticatory muscles and TMJs, restricted or asymmetric opening of the mouth, and TMJ noises. No single etiologic factor causes TMDs; rather, a combination of influences, including trauma, occlusion, systemic and genetic factors, and psychological factors, is usually to blame. A complete history and a thorough examination, which may include imaging, are needed to make a definitive diagnosis and achieve successful treatment of these conditions. A number of options exist for management of these conditions, but reversible options should prevail as the treatments of choice.

Postoperative temporomandibular dysfunction in patients with fractures of the zygomatic complex: a prospective follow-up study

The aim of this prospective follow-up study was to clarify the incidence and characteristics of dysfunction of the temporomandibular joint (TMJ) in patients treated surgically for fractures of the zygomatic complex. Patients were evaluated on presentation and six months after injury to assess the function of the masticatory system using the Helkimo index, which incorporates two complementary subindices: the subjective symptomatic (anamnestic) index (A_i) and the objective clinical dysfunction index (D_i). Forty-five patients (12 women and 33 men, mean (range) age 44 (21-83)years) completed the study. Six patients developed subjective symptoms of dysfunction of the TMJ during follow-up, in four of whom they were severe. Clinical findings were noted in 38 patients but without significant association with subjective symptoms. Dysfunction of the TMJ is common six months after surgical treatment of a fracture of the zygomatic complex, and patients with such fractures should be evaluated for temporomandibular dysfunction during follow-up and referred for treatment when necessary.

Oral and mandibular manifestations in the Ehlers-Danlos syndromes

The Ehlers-Danlos syndromes (EDS) are hereditary disorders that affect the connective tissue and collagen structures in the body. Several types of EDS have been identified. Oral and mandibular structures, which include oral soft tissue, dentition, facial and head pain, and the functioning of the temporomandibular joint (TMJ), are variably affected in the various types of EDS. These various manifestations of EDS have been noted for many years, but newer diagnostic techniques and studies are shedding additional light on the challenges faced by EDS patients in the area of oral and mandibular disorders. Further, the impact of temporomandibular disorder (TMD) on musculoskeletal dysfunction and vice versa, make this an important feature to recognize. Oral and mandibular hypermobility of the TMJ with associated consequences of EDS are noted. These features, diagnostic parameters and treatment procedures are presented. © 2017 Wiley Periodicals, Inc.

Executive summary of the Diagnostic Criteria for Temporomandibular Disorders for clinical and research applications

BACKGROUND

In this executive summary, the authors describe a protocol for assessing patients with temporomandibular disorder (TMD). It is based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for clinical and research applications.

METHODS

The DC/TMD was developed using published Axis I physical diagnoses for the most common TMDs. Axis I diagnostic criteria were derived from pertinent clinical TMD signs and symptoms. Axis II consists of psychosocial and behavioral questionnaires already in the public domain. A panel of experts vetted and modified the Axis I and Axis II diagnostic protocols. Recommended changes were assessed for diagnostic accuracy by using the Validation Project's data set, which formed the basis for the development of the DC/TMD.

RESULTS

Axis I diagnostic criteria for TMD pain-related disorders have acceptable validity and provide definitive diagnoses for pain involving the temporomandibular joint (TMJ) and masticatory muscles. Axis I diagnostic criteria for the most common TMJ intra-articular disorders are appropriate for screening purposes only. A definitive diagnosis for TMJ intra-articular disorders requires computed tomography or magnetic resonance imaging. Axis II questionnaires provide valid assessment of psychosocial and behavioral factors that can affect management of TMD.

CONCLUSIONS

The DC/TMD provides a questionnaire for the pain history in conjunction with validated clinical examination criteria for diagnosing the most common TMDs. In addition, it provides Axis II questionnaires for assessing psychosocial and behavioral factors that may contribute to the onset and perpetuation of the patient's TMD.

PRACTICAL IMPLICATIONS

The DC/TMD is appropriate for use in clinical and research settings to allow for a comprehensive assessment of patients with TMD.

The study of relationship between reported temporomandibular symptoms and clinical dysfunction index among university students in Shiraz

Background:

This study was designed to evaluate the correlation between subjective data obtained from a questionnaire and clinical examination among students in Shiraz university of medical sciences.

Materials and Methods:

In this cross-sectional prospective study, the samples consisted of 200 subjects, with equal distribution between males and females. Subjects’ ages ranged from 18 to 30 years (24.07±2.93). A functional evaluation was performed using the Helkimo clinical dysfunction (Di) and anamnestic (Ai) indices. Data were evaluated by the Chi-square test between gender and clinical dysfunction index (Di) and correlation coefficient between Di and Ai (the level of significance was set at P<0.05).

Results:

Among the total study population, 30% reported mild symptoms (Ai I) while 2% had severe (Ai II). In the clinical examination, 71% showed some degree of dysfunction. These degrees were as follows: 50% were classified as mild (Di I), 13% moderate (Di II) and 8% severe signs and symptoms (Di III).

With respect to gender, women (80%) were more affected than men (62%). A significant relationship was found between gender and the occurrence of temporomandibular disorder (TMD) (P<0.05). The correlation coefficient (r) between the reported symptoms (Ai) and recorded signs (Di) was 0.53. There were positive correlation coefficient between Di and Ai. They were statistically significant (P<0.001).

Conclusions:

A high prevalence of signs and symptoms of TMD among students in Shiraz University of Medical Sciences was seen, which was greater in women. Despite suffering from TMD, students were not aware of their disorders.

Effect of lengthy root canal therapy sessions on temporomandibular joint and masticatory muscles

Background and aims

Trauma is one of the major factors associated with temporomandibular joint disorders (TMD). These disorders result from macro-trauma or micro-trauma. Macro-trauma might be iatrogenic; for example, from intuba-tion procedures, third molar extraction procedures, and lengthy dental appointments. The aim of this study was to evaluate the effect of lengthy root canal therapy (more than 2 hours) on TMJ and its supporting structures.

Materials and methods

Eighty patients whose root canal therapy session lasted more than 2 hours were examined for the status of TMJ and masticatory muscles. After one week the second part of the examination was carried out for TMJ problems and pain and tenderness levels of masticatory muscles. Data was analyzed using Wilcoxon statistical test.

Results

Women showed more pain compared to men. There was a significant increase in pain in the external acoustic meatus examination one week after root canal therapy. Patients who were treated for their posterior teeth suffered more pain than those who were treated for the anteriors and premolars. Other aspects of the examination were not affected significantly by lengthy root canal therapy.

Conclusion

Lengthy dental treatments can harm TMJ and masticatory muscles and wide opening of the mouth during such appointments can worsen the situation. Therefore, it is wise to break the appointment into shorter intervals and let the patients rest during treatment to close their mouth to prevent iatrogenic damage to TMJ.

Patterns of salivary estradiol and progesterone across the menstrual cycle

The aim of this study was to characterize the normality of menstrual cycles on the basis of progesterone and estradiol levels in self-collected saliva samples. Twenty-two women, ages 19-40 years, self-collected whole unstimulated saliva specimens each morning for two consecutive menstrual cycles. On the basis of presence/timing of hormone peaks, two investigators classified 24 cycles as normal, 10 as likely normal, and 10 as clearly not normal with respect to expected profiles. Our results show that whole saliva samples collected at home on a daily basis provide a noninvasive, feasible method of determining menstrual cycle profiles.