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Latest Research on TMJ
     
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Feb;105(2):e53-60.
Injection of sodium hyaluronate compared to a corticosteroid in the treatment of patients with temporomandibular joint osteoarthritis: a CT evaluation.
Møystad A, Mork-Knutsen BB, Bjørnland T.
Department of Maxillofacial Radiology, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway. amoystad@odont.uio.no

OBJECTIVE: Osseous changes in the temporomandibular joint (TMJ) were evaluated using computed tomography (CT) examinations before and after TMJ injections of sodium hyaluronate or a corticosteroid in patients with osteoarthritis (OA). STUDY DESIGN: Forty patients were randomly allocated into 2 groups for 2 intra-articular injections with either sodium hyaluronate or a corticosteroid. Bilateral TMJ examinations with high resolution CT were obtained in 36 patients before and 6 months after treatment. Treated and contralateral TMJs were evaluated for the presence of osteoarthritic osseous abnormalities by 2 reviewers independently. RESULTS: Progression, regression, and no changes of osseous abnormalities were demonstrated in 13, 9, and 14 TMJs, respectively, 6 months after treatment. There was no significant difference between the groups. CONCLUSIONS: Progression/regression and no changes of osteoarthritic abnormalities were observed on CT examinations in both the treated and the contralateral TMJs after treatment with intra-articular injection with sodium hyaluronate or corticosteroid.

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J Oral Rehabil. 2008 Feb;35(2):88-94.
Computerized axiography in TMD patients before and after therapy with 'function generating bites'.
Piancino MG, Roberi L, Frongia G, Reverdito M, Slavicek R, Bracco P.
Chair Department of Orthodontics and Gnathology-Masticatory Function, University of Turin, Turin, Italy.

The study evaluates the temporomandibular joint (TMJ) movements of patients with signs and symptoms of temporomandibular disorders (TMD) before and after therapy with the functional appliances of the 'function generating bite' (FGB) type. Thirty subjects suffering from TMD were selected and divided into two groups: group A (young patients: four males, nine females, mean age +/- standard deviation: 13.3 +/- 1.5 years); group B (adults: three males, 14 females, mean age +/- standard deviation: 23.2 +/- 4.4 years). A control group comprised 13 healthy subjects with perfect normal occlusion, TMD-free, was matched for age and sex with patient groups and was examined at T0 and after 12 months (T1). Computerized axiography was performed before and after therapy (average 13 months) with FGBs to evaluate any difference in condyle border movements. Results showed a statistically significant improvement after treatment, for groups A and B, in length, clicks, tracings with normal morphology, superimposition, deviations, regularity and return to starting position and speed (statistical analysis: chi-squared test) except for the symmetry of tracings which was significantly improved only for the young patient group. No statistically significant differences at time T0/T1 were found in the control group. In conclusion, the study shows that the TMJ tracings of TMD patients before and after therapy with 'FGB' significantly improve especially in young patients. FGB may be a useful appliance to improve TMJ function in young and adult TMD patients requiring orthodontic treatment.

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Proc (Bayl Univ Med Cent). 2008 Jan;21(1):18-24.
Outcomes of treatment with custom-made temporomandibular joint total joint prostheses and maxillomandibular counter-clockwise rotation.
Wolford LM, Pinto LP, Cárdenas LE, Molina OR.
Department of Oral and Maxillofacial Surgery, Baylor College of Dentistry, Texas A&M University System, and Baylor University Medical Center, Dallas, Texas (Wolford); and private practice, Fortaleza, Brazil (Pinto), Miami, Florida (Cárdenas), and Monterey, Mexico (Molina). Drs. Pinto and Cárdenas were fellows in oral and maxillofacial surgery at Baylor College of Dentistry, and Dr. Molina was a fellow in orthodontics, University of Texas Southwestern Medical School.

The first 25 consecutive patients with high occlusal plane angulation, dysfunction, and pain who were treated with temporomandibular joint (TMJ) total joint prostheses and simultaneous maxillomandibular counterclockwise rotation were evaluated before surgery (T1), immediately after surgery (T2), and at the longest follow-up (T3) for surgical movements and long-term stability. Subjective ratings were used for patients' facial pain/headache, TMJ pain, jaw function, diet, and disability, and objective functional changes were determined by measuring maximum incisal opening and lateral excursive movements. Results showed that the areas of greatest surgical change included an average decrease in the occlusal plane of 13.3 degrees with advancement at point B of 13.4 mm and at the genial tubercles of 16.3 mm. At longest follow-up, relapse was 0.7 degrees, 0.8 mm, and 1.2 mm, respectively, with no statistically significant changes. Significant subjective pain and dysfunction improvements were observed (P </= 0.001). Maximum incisal opening increased, but lateral excursion decreased. Those who had two or more previous TMJ surgeries showed greater levels of dysfunction at T1 and T3 than those who had one or no previous surgeries, but otherwise patients presented similar amounts of absolute changes. In conclusion, end-stage TMJ patients can achieve significant improvement in their pain, dysfunction, dentofacial deformity, and airway problems in one operation with TMJ reconstruction and mandibular advancement using TMJ custom-made total joint prostheses and simultaneous maxillary osteotomies for maxillomandibular counter-clockwise rotation.

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Rev Stomatol Chir Maxillofac. 2007 Dec 12 [Epub ahead of print]
[Efficiency of specific physiotherapy for temporomandibular joint dysfunction of muscular origin.]
[Article in French]
Katsoulis J, Richter M.
Département de chirurgie, service de chirurgie maxillofaciale et de chirurgie buccale, hôpitaux universitaires de Genève, 24, rue Micheli-du-Crest, 1211 Genève 14, Suisse.

INTRODUCTION: Little explanation is given to patients with temporomandibular disorders and muscles dysfunction on the mechanism and the expected results of conservative treatment. The purpose of this prospective study was to evaluate the efficacy of specific physical therapy prescribed after this explanation was given and also after using a flat occlusal splint adapted only if muscle pain remained after physical therapy. MATERIAL AND METHOD: Twenty-seven patients with temporomandibular joint dysfunction of muscular origin were evaluated after a mean of six sessions of specialized physical therapy with professionals. Patients were treated by oral and facial massages and were trained for self-reeducation. They were also trained for a specific exercise named the "propulsive/opening maneuver". Every patient was questioned on the subjective evolution of pain and the current maximal pain was evaluated with the Visual Analogical Scale (VAS). Clinical evaluation focused on tenderness of masticator muscles and also assessed the changes in the amplitude of mouth opening. RESULTS: Ninety-three percent of the patients treated by specific physical therapy had a significant reduction of their maximal pain feeling (p<0.05). The recovery of an optimal mouth opening without deviation was also improved as was the protrusion. For 33% of the patients a flat nighttime occlusal splint was necessary as a complementary treatment. Twenty-two percent of the patients decided to change their treatment for alternative therapies (osteopathy, acupuncture, etc.). Fifty percent of the patients were convinced of the efficacy of the prescribed treatment. DISCUSSION: Patients who undertake the specific physical therapy and who regularly practice self-physical therapy succeed in relaxing their masticator muscles and in decreasing the level of pain. Explanations given by the doctor concerning the etiology of pain, during temporomandibular joint dysfunction of muscular origin, and the purpose of specific physical therapy increase the capacity of self-relaxation. A flat occlusal splint is indicated for patients who grind their teeth and for those whose pain resists to physical therapy.

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Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Nov 29 [Epub ahead of print]
Is there a role for arthrocentesis in recapturing the displaced disc in patients with closed lock of the temporomandibular joint?
Sembronio S, Albiero AM, Toro C, Robiony M, Politi M.
Doctoral student.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of arthrocentesis in releasing acute and chronic closed lock of the temporomandibular joint, improving function, reducing pain and recapturing the displaced disc. STUDY DESIGN: We performed arthrocentesis and mandibular manipulation (MM) as an initial treatment in 33 patients (unilateral involvement) with a variable duration of closed lock and magnetic resonance imaging (MRI) evidence of anterior disc displacement without reduction (ADDWR). Duration of locking ranged from 1 week to 2 years. After the procedure, soft diet, physiotherapy, and an interocclusal appliance (IA) were prescribed. Postoperative MRI images were obtained at 1 month. A clinical examination with analysis of maximal mouth opening (MMO), a visual analog scale (VAS), and a self-administered questionnaire were used for evaluation of pain, jaw dysfunction, and activities of daily living (ADL). The follow-up period was 1 year. RESULTS: At 1-year
follow-up, MMO had increased significantly from a mean of 24.7 +/- 5.9 mm to 39.6 +/- 6.2 mm (P < .05). Functional improvement was associated with a significant reduction in VAS (from 6.2 +/- 2.3 to 2.8 +/- 3.4), pain (from 11.7 +/- 7.1 to 4 +/- 3.8), dysfunction (from 8.6 +/- 4.9 to 3.2 +/- 2.8), and ADL scores (from 13.9 +/- 12 to 4.4 +/- 5), with P < .05. The overall success rate was 72.7%; it was higher in acute patients (87.5%) than in chronic patients (68.0%). The disc was recaptured (the disc was interposed between the condyle and the eminence on closed and open MRI images) in 3 cases in which the duration of locking was less than 1 month (acute patients). CONCLUSIONS: The results indicate that arthrocentesis, in association with MM and IA, could be effective in improving function and reducing pain in patients with closed lock. Better results were obtained in terms of MMO, VAS, and questionnaire scores in acute closed lock cases than in chronic ones. Recapturing the anteriorly displaced disc is possible only in patients with acute closed lock.

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Prog Orthod. 2007;8(2):240-50.
Orthodontic treatment of TMJ disc displacement with pain: an 18 year follow-up.
Capurso U, Marini I.
Department of Orthodontics, School of Dentistry, University of Bologna, Italy. ucapurs@tin.it

OBJECTIVES: To assess the effects of mandibular repositioning-stabilization splints concluded by occlusal orthodontic therapy in patients affected with TMJ internal derangement (with and without disc reduction), all suffering from severe pain, with a follow-up of 18 years from treatment. SUBJECTS AND METHODS: A group of 68 patients, (58 women and 10 men, average age 22, range 14 to 55 years) was considered. The evaluated parameters were: a) mandibular dynamics, b) subjective symptoms (intensity of facial pain perceived through VAS), c) articular noises, d) condylar position via radiography. These were determined before treatment, immediately after completion and 5, 10 and 18 years after treatment. RESULTS: At the end of treatment there was a significant improvement of the manibular function (p < 0.001), a significant reduction of spontaneous pain (8 patients vs all patients, p < 0.001) and disappearance of joint noises in all cases. In the course of the 18-year period subsequent to the treatment only minor relapse of symptoms/signs was noted; spontaneous pain was present in 13 patients, with a pain intensity at TMJ level significantly lower than at baseline (p < 0.001). Clicking was present systematically in 3 patients and only occasionally in 19 patients (p < 0.001). A relapse of condylar dislocation was found only in 11 cases at the X-ray examination. CONCLUSIONS: It is suggested that a permanent occlusal orthodontic treatment be used in subjects suffering from disc displacement with pain, particularly if patients need that for malocclusion and if orthopaedic joint instability is present after a change in the mandibular positioning with a stabilization splint.

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J Craniofac Surg. 2007 Nov;18(6):1486-8.
Synovial chondromatosis of the temporomandibular joint.
Mandrioli S, Polito J, Denes SA, Clauser L.
Unit of Cranio-Maxillo-Facial Surgery, Centre for Craniofacial Deformities and Orbital Surgery, Ferrara, Italy.

Synovial chondromatosis is a cartilaginous metaplasia of the mesenchymal remnants of the synovial tissue of the joints. Its main characteristic is the formation of cartilaginous nodules in the synovium and inside the articular space (loose bodies). Synovial chondromatosis mainly affects big synovial joints such as the elbow and knee and is uncommon in the temporomandibular joint. The main symptoms are pain, limitation of jaw movement, crepitation, and inflammation. Diagnosis is made by panoramic radiograph, computed tomography scan, and mainly magnetic resonance imaging. Surgery is the therapeutic choice. The authors describe their experience in the treatment and in the follow up of a patient with unilateral synovial chondromatosis.

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Cranio. 2007 Oct;25(4):273-82.
Clinical indications for simultaneous TMJ and orthognathic surgery.
Wolford LM.
Department of Oral and Maxillofacial Surgery, Baylor College of Dentistry, Texas A&M University System, USA. LWolford@swbell.net

There are many temporomandibular joint (TMJ) conditions that can cause pain, TMJ and jaw dysfunction, and disability. The most common of these conditions include: (1) articular disk dislocation; (2) reactive arthritis; (3) adolescent internal condylar resorption; (4) condylar hyperplasia; (5) osteochondroma or osteoma; and (6) end-stage TMJ pathology. These conditions are often associated with dentofacial deformities, malocclusion, TMJ pain, headaches, myofascial pain, TMJ and jaw functional impairment, ear symptoms, etc. Patients with these conditions may benefit from corrective surgical intervention. Open joint surgery provides direct access to the TMJ allowing manipulation, repair, removal and/or reconstruction of the anatomical structures that cannot be accomplished by other treatment methods. TMJ surgery and orthognathic surgery can be predictably performed during one operation with high success rates. This paper discusses the most common TMJ pathologies and presents the surgical management considerations to correct the specific TMJ conditions and associated jaw deformities.

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Rev Med Suisse. 2007 Oct 3;3(127):2209-12, 2214.
[Surgical treatment for temporomandibular disorders]
[Article in French]
Scolozzi P, Jaques B, Broome M.
Division de chirurgie maxillo-faciale CHUV, 101 1 Lausanne. Paolo.Scolozzi@chuv.ch

Temporomandibular (TMJ) disorders are very common and account for pain and dysfunction in an important number of patients. Nevertheless, their treatment is far from reaching an international consensus and therefore is regularly replaced in argument and debated. While the literature emphasizes the role of conservative measures (physiotherapy and/or occlusal splint) as being the first line management, there is also a place for surgery. In the last two decades, minimally invasive procedures--such as arthroscopy and arthrocentesis with intra-articular lavage--have gained in popularity. These techniques have been proved to be extremely efficient for patients with disc displacement with or without reduction, as well as in patients with osteoarthritis or arthritis.

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Pain. 2007 Oct 6; [Epub ahead of print]
Effects of intra-articular ketamine on pain and somatosensory function in temporomandibular joint arthralgia patients.
Ayesh EE, Jensen TS, Svensson P.
Department of Clinical Oral Physiology, School of Dentistry, University of Aarhus, Vennelyst Boulevard 9, DK-8000 Aarhus, Denmark.

Recent studies have hypothesized that peripheral glutamate receptors could be implicated in deep craniofacial pain conditions. In this study 18 temporomandibular joint (TMJ) arthralgia patients received intra-articular injections of the N-methyl-d-aspartate (NMDA) receptor antagonist, ketamine, or normal saline to study in a cross-over, double-blinded, placebo-controlled manner the effect on TMJ pain and somatosensory function. Spontaneous pain and pain on jaw function was scored by patients on 0-10cm visual analogue scale (VAS) for up to 24h. Quantitative sensory tests (QST): tactile, pin-prick, pressure pain threshold and pressure pain tolerance were used for assessment of somatosensory function at baseline and up to 15min after injections. There were no significant effects of intra-articular ketamine over time on spontaneous VAS pain measures (ANOVA: P=0.532), pain on jaw opening (ANOVA: P=0.384), or any of the somatosensory measures (ANOVA: P>0.188). The poor effect of ketamine could be due to involvement of non-NMDA receptors in the pain mechanism and/or ongoing pain and central sensitization independent of peripheral nociceptive input. In conclusion, there appears to be no rationale to use intra-articular ketamine injections in TMJ arthralgia patients, and peripheral NMDA receptors may play a minor role in the pathophysiology of this disorder.

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J Oral Maxillofac Surg. 2007 Oct;65(10):1958-62.
Walker repair of the temporomandibular joint: a retrospective evaluation of 117 patients.
Griffitts TM, Collins CP, Collins PC, Beirne OR.
Collins Oral Surgery, Spokane, WA 99204, USA. trevor.griffitts@dental.temple.edu

PURPOSE: This study evaluated the outcome of a high condylar shave with meniscal repositioning (Walker repair) in patients with internal derangement of the temporomandibular joint (TMJ). Changes in incisal opening, pain level, chewing ability, and preoperative TMJ symptoms (tinnitus, vertigo, and crepitus) were evaluated. PATIENTS AND METHODS: A retrospective evaluation of 202 patients undergoing the Walker repair was completed using a questionnaire. A total of 117 patients responded to the questionnaire. Preoperative and postoperative examination findings, subjective questionnaire results, and panorex radiographs were analyzed. RESULTS: The Walker repair resulted in a statistically significant (P < .001) decrease in pain by an average of 5.6 points on a scale of 0 to 10. The procedure also improved incisal opening by an average of 5.8 mm (P < .001). Improvements of 69% in tinnitus, 72% in vertigo, and 66% in crepitus were documented. Patients evaluated their motion, diet, comfort, and overall improvement; each area was rated as good or excellent by more than 90% of patients. The overall success rate for the Walker repair was 86%. CONCLUSIONS: The Walker repair is an effective surgical treatment for internal derangement that significantly decreases pain level and increases incisal opening. No statistically significant difference in the success rate between unilateral and bilateral procedures was noted.

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Quintessence Int. 2007 Sep;38(8):e484-9.
Effect of intra-articular administration of buprenorphine after arthrocentesis of the temporomandibular joint: a pilot study.
Präger TM, Mischkowski RA, Zöller JE.
Charité-Universitätsmedizin Berlin, School of Dentistry, Institute of Orthodontics, Dentofacial Orthopedics and Pedodontics, Berlin, Germany. thomas.praeger@gmx.de

OBJECTIVE: The purpose of this double-blind study was to evaluate the effect of intra-articular opioid injections on postoperative pain and joint mobility after arthrocentesis of the temporomandibular joint (TMJ). METHOD AND MATERIALS: Forty patients suffering from persistent pain in combination with anterior disc displacement (22 with reduction, 18 without reduction) and unresponsive to nonsurgical therapy underwent arthrocentesis of the affected TMJ under local anesthesia. All patients were randomly assigned to 2 groups. In group 1 (20 patients), 1 mL of buprenorphine solution was injected into the joint space at the end of the intervention; in group 2 (20 patients), 1 mL of saline was used. For postoperative pain management, all patients received Paracetamol ad libitum. Preoperatively and at postoperative days 2, 4, 7, and 14, individual pain levels were determined on a visual analogue scale together with maximum mouth opening. RESULTS: At days 2 and 4 after the intervention, remarkable differences were detectable between the 2 groups, showing a rapid normalization of joint mobility and pain scores in group 1; in contrast, improvement in group 2 was delayed. CONCLUSION: Intra-articular injections of long lasting opioids seem to influence joint mobility and pain positively within the first week after arthrocentesis.

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Med Oral Patol Oral Cir Bucal. 2007 Aug 1;12(4):E292-8.
Review of temporomandibular joint pathology. Part I: classification, epidemiology and risk factors.
Poveda Roda R, Bagan JV, Díaz Fernández JM, Hernández Bazán S, Jiménez Soriano Y.
Service of Odontology, Valencia University General Hospital, Valencia. Spain. poveda_raf@gva.es

Pathology of the temporomandibular joint (TMJ) affects an important part of the population, though it is not viewed as a public health problem. Between 3-7% of the population seeks treatment for pain and dysfunction of the ATM or related structures. The literature reports great variability in the prevalence of the clinical symptoms (6-93%) and signs (0-93%), probably as a result of the different clinical criteria used. In imaging studies it is common to observe alterations that have no clinical expression of any kind. Radiographic changes corresponding to osteoarthrosis are observed in 14-44% of the population. Age is a risk factor, though with some particularities. In elderly patients there is an increased prevalence of clinical and radiological signs, though also a lesser prevalence of symptoms and of treatment demands than in younger adults. Approximately 7% of the population between 12 and 18 years of age is diagnosed with mandibular pain-dysfunction. Temporomandibular dysfunction (TMD) is more frequent in females. No clear relationship has been established between occlusal alterations and TMJ disease. Only disharmony between centric relation and maximum intercuspidation, and unilateral crossbite, have demonstrated a certain TMJ disease-predictive potential. Both local and systemic hyperlaxity has been postulated as a possible cause of TMD. Parafunctional habits and bruxism are considered risk factors of TMD with odds ratios (ORs) of up to 4.8. Psychophysiological theory holds stress as a determinant factor in myofascial pain. Genetic factors and orthodontic treatment have not been shown to cause TMD.

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Acta Odontol Scand. 2007 Aug 28;:1-5 [Epub ahead of print]
Outcomes of temporomandibular joint disorder therapy: observations over 13 years.
Behr M, Stebner K, Kolbeck C, Faltermeier A, Driemel O, Handel G.
Department of Prosthetic Dentistry, Regensburg University Medical Care Center, Germany.

Objective. To evaluate the outcome of temporomandibular joint (TMJ) disorder therapy with different kinds of splints. Methods. One-hundred-and-twenty-nine patients with TMJ disorders and meeting the primary selection criterion of reporting pain in the TMJ region were clinically evaluated. Magnetic resonance imaging of the TMJ was performed at baseline 1993-94. A protrusion splint was used whenever joint clicking could be eliminated by protrusion. In the other cases, a pivot or a Michigan splint was inserted. Re-evaluation of the patients after 12 months included a clinical examination. After 5 and 13 years, all patients were examined by means of a questionnaire. Results. Pain was significantly reduced in the case of more than two-thirds of the patients 1 year after the first consultation. After 5 and 13 years, the percentages of patients with reported pain had increased only slightly. However, the therapy did not reduce joint noises or mouth opening. The prevalence of joint noises was reduced to less than a quarter after 1 year, but during the next 13 years increased to the former level. Initially, one-third of the patients had mouth-opening reduction. This proportion dropped to one-third of these cases after 1 year, but increased to 40% after 13 years. Conclusions. Treatment using splints reduced pain in approximately two-thirds of the patients, but with no difference between the three types of splints used.

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Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Jun;103(6):e14-22. Epub 2007 Apr 6.
A one-year case series of arthrocentesis with hyaluronic acid injections for temporomandibular joint osteoarthritis.
Guarda-Nardini L, Stifano M, Brombin C, Salmaso L, Manfredini D.
Department of Maxillofacial Surgery, University of Padova, Padova, Italy.

OBJECTIVE: The present study presents a case series on the efficacy of arthrocentesis with hyaluronic acid injections for the treatment of temporomandibular joint osteoarthritis by providing patient evaluations at a one-year follow-up. STUDY DESIGN: Twenty-five patients with a diagnosis of osteoarthritis according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD axis I group IIIb) underwent a cycle of 5 arthrocenteses with injections (1 per week) of 1 mL hyaluronic acid. A number of clinical parameters (pain at rest and mastication, masticatory efficiency, maximum nonassisted and assisted mouth openings, functional limitation, subjective efficacy, and tolerability of the treatment) were assessed by the same blinded operator at the time of the diagnosis (baseline), at each appointment during the treatment, and at 1-week, 1-month, 3-month, 6-month, and 1-year follow-up appointments. RESULTS: Descriptive analysis showed improvements which were maintained over time for all the study parameters. Permutation tests evidenced the significance of changes which occurred in many clinical parameters within the first 2 injections. Differences with baseline levels remained significant at the end of the follow-up period, particularly for the masticatory efficiency and pain at mastication (minimum and maximum) parameters. CONCLUSIONS: Data from the present investigation support findings from studies on other joints, which show the efficacy of serial injections of hyaluronic acid after arthrocentesis to reduce symptoms of osteoarthritis and to maintain improvements over time.

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Dent Update. 2007 Apr;34(3):134-6, 138-9.
Diagnosis and management of non-dental orofacial pain.
Zakrzewska JM.
Clinical and Diagnostic Oral Sciences Dental Institute, Barts and the London Queen Mary's School of Medicine and Dentistry, Turner Street, London E1 2AD, UK.

Careful history-taking improves diagnosis of non-dental orofacial pain, a not uncommon group of conditions. Accurate diagnosis of conditions such as chronic idiopathic facial pain, temporomandibular disorders, burning mouth syndrome and trigeminal neuralgia is essential if inappropriate dental treatment is to be avoided. There are few investigations to help in the diagnostic process and many of these patients have other forms of chronic pain. All the conditions are best treated using a holistic approach. Drugs, such as tricyclic antidepressants and anticonvulsants, are often effective and surgery can be highly successfully in trigeminal neuralgia. Patient education is paramount. CLINICAL RELEVANCE: Although the majority of pain seen in general dental practice is dental in origin, chronic non-dental orofacial pain must be recognized as its management is entirely different.

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Stomatologija. 2007;9(1):3-9.
Current concepts on the functional somatic syndromes and temporomandibular disorders.
Fantoni F, Salvetti G, Manfredini D, Bosco M.
V.le XX Settembre 298, 54036 Marina di Carrara (MS), Italy. daniele.manfredini@tin.it.

BACKGROUND. The importance of psychosocial factors in the etiopathogenesis of temporomandibular disorders (TMD) has led to the hypothesis that these disorders may be part of a wider group of somatoform disorders, the functional somatic syndromes (FSS). Types of studies reviewed. The present paper is an overview summarizing the current concepts on the TMD-FSS relationship. A non-systematic search in the Medline database identified peer-reviewed papers on the epidemiological and clinical characteristics of the complex groups of disorders labelled functional somatic syndromes, focusing on the common features to temporomandibular disorders patients. RESULTS. Literature data suggest that FSS and TMD share many etiopathogenetic and epidemiological features, both groups of disorders having a multifactorial etiopathogenesis and needing a multidisciplinary approach to diagnosis and treatment. Psychosocial characteristics of patients seem to have many similarities and the prevalence of Axis I psychiatric disorders is elevated. The majority of studies focused on the relationship between TMD and fibromyalgia (FM), due to the high rate of orofacial involvement related to FM. Clinical implications. The presence of common features between TMD and FSS patient may suggest the need for changes in the diagnostic and therapeutic approach to TMD patients, with the introduction of treatment protocols which also address the psychosocial impairment accompanying TMD symptoms, in order to overcome the limits of traditional therapies.

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J Negat Results Biomed. 2007 Mar 23;6:4.
Psycho-education programme for temporomandibular disorders: a pilot study.
Jerjes W, Madland G, Feinmann C, El Maaytah M, Kumar M, Hopper C, Upile T, Newman S.
Unit of Oral & Maxillofacial Surgery, Division of Maxillofacial, Diagnostic, Medical and Surgical Sciences, Eastman Dental Institute & University College London, London, UK. waseem_wk1@yahoo.co.uk

BACKGROUND: Temporomandibular disorders (TMDs) are by far the most predominant condition affecting the temporomandibular joint (TMJ), however many patients have mild self-limiting symptoms and should not be referred for specialist care.The aim of this pilot study was to develop a simple, cost-effective management programme for TMDs using CD-ROM. 41 patients (age 18-70) participated in this study, patients were divided into three groups: the 1st group were involved in an attention placebo CD-ROM (contain anatomical information about the temporomandibular system), the 2nd group received information on CD-ROM designed to increase their control and self efficacy, while the 3rd group received the same programme of the 2nd group added to it an introduction to self-relaxing techniques followed by audio tape of progressive muscle relaxation exercises. Each of the groups was asked to complete a number of questionnaires on the day of initial consultation and six weeks afterwards. RESULTS: The two experimental groups (2nd & 3rd) were equally effective in reducing pain, disability and distress, and both were more effective than the attention placebo group (1st), however the experimental groups appeared to have improved at follow-up relative to the placebo-group in terms of disability, pain and depressed mood. CONCLUSION: This pilot study demonstrates the feasibility and acceptability of the design. A full, randomized, controlled trial is required to confirm the efficacy of the interventions developed here.

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J Oral Rehabil. 2007 Feb;34(2):97-104.
Reduction in parafunctional activity: a potential mechanism for the effectiveness of splint therapy.
Glaros AG, Owais Z, Lausten L.
Kansas City University of Medicine and Biosciences, Kansas City, MO, USA.

Interocclusal splints may be an effective modality in the management of temporomandibular disorders (TMD), but there is little evidence regarding the mechanism by which splints work. This study tested the hypothesis that pain reduction produced by splints is associated with reduction in parafunctional activity. In a two-group, single-blinded randomized clinical trial, patients diagnosed with myofascial pain received full coverage hard maxillary stabilization splints. Patients were instructed to maintain or avoid contact with the splint for the 6 weeks of active treatment. Patients who decreased the intensity of tooth contact were expected to show the greatest alleviation of pain, and those who maintained or increased contact were expected to report lesser reductions in pain. Experience-sampling methodology was used to collect data on pain and parafunctional behaviours at pre-treatment and during the final week of treatment. Patients were reminded approximately every 2 h by pagers to maintain/avoid contact with the splint. The amount of change in intensity of tooth contact accounted for a significant proportion of the variance in pain change scores. Patients who reduced tooth contact intensity the most reported greater relief from pain. Splints may produce therapeutic effects by reducing parafunctional activities associated with TMD pain.

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J Dent Res. 2007 Jan;86(1):58-63.
Randomized effectiveness study of four therapeutic strategies for TMJ closed lock.
Schiffman EL, Look JO, Hodges JS, Swift JQ, Decker KL, Hathaway KM, Templeton RB, Fricton JR.
University of Minnesota School of Dentistry, Department of Diagnostic and Biological Sciences, Minneapolis, MN 55455, USA. schif001@umn.edu

For individuals with temporomandibular joint (TMJ) disc displacement without reduction with limited mouth opening (closed lock), interventions vary from minimal treatment to surgery. In a single-blind trial, 106 individuals with TMJ closed lock were randomized among medical management, rehabilitation, arthroscopic surgery with post-operative rehabilitation, or arthroplasty with post-operative rehabilitation. Evaluations at baseline, 3, 6, 12, 18, 24, and 60 months used the Craniomandibular Index (CMI) and Symptom Severity Index (SSI) for jaw function and TMJ pain respectively. Using an intention-to-treat analysis, we observed no between-group difference at any follow-up for CMI (p > or = 0.33) or SSI (p > or = 0.08). Both outcomes showed within-group improvement (p < 0.0001) for all groups. The findings of this study suggest that primary treatment for individuals with TMJ closed lock should consist of medical management or rehabilitation. The use of this approach will avoid unnecessary surgical procedures.

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Dent Clin North Am. 2007 Jan;51(1):195-208, vii-viii.
Temporomandibular joint surgery for internal derangement.
Dolwick MF.
Division of Oral and Maxillofacial Surgery, University of Florida College of Dentistry, PO Box 100416, Gainesville, FL 32610-0416, USA. fdolwick@dental.ufl.edu

Surgery of the temporomandibular joint (TMJ) plays a small, but important, role in the management of patients who have temporomandibular disorders (TMDs). There is a spectrum of surgical procedures for the treatment of TMD that ranges from simple arthrocentesis and lavage to more complex open joint surgical procedures. It is important to recognize that surgical treatment rarely is performed alone; generally, it is supported by nonsurgical treatment before and after surgery. Each surgical procedure should have strict criteria for which cases are most appropriate. Recognizing that scientifically proven criteria are lacking, this article discusses the suggested criteria for each procedure, ranging from arthrocentesis to complex open joint surgery. The discussion includes indications, brief descriptions of techniques, outcomes, and complications for each procedure.

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Dent Clin North Am. 2007 Jan;51(1):61-83, vi.
Myogenous temporomandibular disorders: diagnostic and management considerations.
Fricton J.
Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, 6-320 Moos, Minneapolis, MN 55455, USA. frict001@umn.edu

Myogenous temporomandibular disorders (or masticatory myalgia) are characterized by pain and dysfunction that arise from pathologic and functional processes in the masticatory muscles. There are several distinct muscle disorder subtypes in the masticatory system, including myofascial pain, myositis, muscle spasm, and muscle contracture. The major characteristics of masticatory myalgia include pain, muscle tenderness, limited range of motion, and other symptoms (eg, fatigability, stiffness, subjective weakness). Comorbid conditions and complicating factors also are common and are discussed. Management follows with stretching, posture, and relaxation exercises, physical therapy, reduction of contributing factors, and as necessary, muscle injections.

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J Oral Rehabil. 2007 Jan;34(1):34-40.
Pivot appliances - is there a distractive effect on the temporomandibular joint?
Seedorf H, Scholz A, Kirsch I, Fenske C, Jude HD.
Department of Prosthetic Dentistry, University Hospital Hamburg-Eppendorf, Hamburg, Germany. seedorf@uke.uni-hamburg.de

The purpose of this study was to investigate the distractive effect of posterior occlusal pivots on the temporomandibular joint. The study comprised 23 healthy subjects. None of them had a third molar and none of them had a missing tooth or showed tooth mobility. All subjects clenched (i) on 1 mm tin foil positioned between the teeth 17/47 and 27/37; (ii) on a stiff bite registration material of 1 mm thickness that prevented protrusion because of its bold occlusal relief. During clenching on the tin foil and on the protrusion preventing bite registration material, respectively, the vertical and horizontal condylar position was measured using a 6 d.f. ultrasonic motion analyser. Clenching with maximal force on the tin foil lead to a noticeable anterior downward directed movement of the condyle. Clenching on the protrusion preventing pivot, however, caused a statistically significant upward condylar movement of about 0.3 mm. These results indicate that occlusal pivots have no distractive effect on the temporomandibular joint but can lead to unwanted joint compression, if they are designed in a way that is preventing protrusion.

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Rev Stomatol Chir Maxillofac. 2006 Dec;107(6):436-40.
[Surgical treatment of temporomandibular joint: a retrospective study of 94 cases]
[Article in French]
Poirier F, Blanchereau C, Francfort E, Agostini P, Petavy A, Khorshid M, Mahieddine R, Adi AR, Kolev T.
Service de Chirurgie Maxillo-faciale et Stomatologie, Hopital d'Argenteuil, France. fabrice.poirier@ch-argenteuil.fr

INTRODUCTION: The temporomandibular joint (TMJ) is a complex entity subjected to repeated stress with several symptoms. About one-third of people have at least one of those symptoms but only few (3 to 7%) need treatment. The aim of this retrospective study was to evaluate the results of temporomandibular joint surgery in 94 patients. PATIENTS AND METHODS: Several data were used for decision-making and the surgical technique was adapted to the etiology. The type of postoperative physiotherapy performed depended on the type of pathology. RESULTS: Most patients who underwent surgery between 1989 and 2004 were women (83%). The mean age was 30 years. We performed 179 surgical procedures and among them 151 Dautrey procedures. In 28 cases miniplates were used to avoid recurrences. In 57 cases postoperative physiotherapy was performed. The mean postoperative mouth opening increase was 4.7 mm (+ 23%). There was no infection or lost of plate. The mean of follow-up was about 14 months. DISCUSSION: With a long follow-up and an acceptable number of patients and operations, this retrospective study demonstrated the effectiveness of the Dautrey procedure in TMJ subluxations.

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Acta Odontol Scand. 2006 Nov;64(6):341-7.
Effect of therapeutic jaw exercise on temporomandibular disorders in individuals with chronic whiplash-associated disorders.
Klobas L, Axelsson S, Tegelberg A.
Department of Surgical Sciences, Oral and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden. luciano.klobas@surgsci.uu.se

OBJECTIVE: The aim of this study was to investigate the effect of a specific therapeutic jaw exercise on the temporomandibular disorders of patients with chronic whiplash-associated disorders. MATERIAL AND METHODS: Ninety-four consecutive patients with whiplash-related conditions were referred to and accepted for a treatment period at a center for functional evaluation and rehabilitation during 2001-2002. The patients followed a program of physical therapy, occupational therapy, and pain management. At the start of their stay, they were examined by a physician specialized in rehabilitation medicine and also by a dentist who performed a functional examination of the stomatognathic system. Of the 93 patients who accepted participation in the study, 55 were diagnosed with temporomandibular disorders and chronic whiplash-associated disorders in accordance with the inclusion criteria. They were randomized into a jaw exercise group (n = 25), who performed specific therapeutic jaw exercises, and a control group (n = 30). Both groups undertook the whiplash rehabilitation program at the center. RESULTS: There were no inter- or intra-group differences in symptoms and signs of temporomandibular disorders at baseline, nor at the 3-week and 6-month follow-ups, except for an increase of maximum active mouth-opening capacity in the control group. CONCLUSIONS: In conclusion, the therapeutic jaw exercises, in addition to the regular whiplash rehabilitation program, did not reduce symptoms and signs of temporomandibular disorders in patients with chronic whiplash-associated disorders.
 

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