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Search Results for : Temporomandibular Joint Disorder
Merck Online Lab
Diagnosis Therapy Rehabilitation Imaging Clinical Laboratory
Effectiveness of acupuncture in the treatment of temporomandibular disorders of muscular origin: a systematic review of the last decade.
Author(s): La Touche, R; Angulo-D; íaz-Parreño, S; de-la-Hoz, JL; Fern; ández-Carnero, J; Ge, HY; Linares, MT; Mesa, J; S; ánchez-Gutiérrez, J
Journal: J Altern Complement Med 2010 Jun 2; Vol. 16, Issue 1; Page(s) 107-12
[Medline ID - 20038262]

OBJECTIVE: The purpose of this review is to evaluate the effectiveness of using acupuncture treatment for temporomandibular disorders (TMD) of muscular origin according to research published in the last decade. METHODS: The information was gathered using the MEDLINE, EMBASE, CINAHL, and CISCOM databases. The inclusion criteria for selecting the studies were the following: (1) only randomized controlled trials (RCTs) were selected; (2) studies had to be carried out on patients with TMD of muscular origin; (3) studies had to use acupuncture treatment; and (4) studies had to be published in scientific journals between 1997 and 2008. Two (2) independent reviewers analyzed the methodological quality of the studies using the Delphi list. A total of four RCTs were chosen once the methodological quality was judged as being acceptable. All of the studies included in the review compared the acupuncture treatment with a placebo treatment. All of them described results that were statistically significant in relation to short-term improvement of TMD signs and symptoms of a muscular origin, except one of the analyzed studies that found no significant difference between acupuncture and sham acupuncture. CONCLUSIONS: In the authors' opinion, research into the long-term effects of acupuncture in the treatment of TMD is needed. We also recommend larger samples sizes for future studies, so the results will be more reliable.

Biglycan and fibromodulin have essential roles in regulating chondrogenesis and extracellular matrix turnover in temporomandibular joint osteoarthritis.
Author(s): Embree, MC; Kilts, TM; Ono, M; Inkson, CA; Syed-Picard, F; Karsdal, MA; Oldberg, A; Bi, Y; Young, MF
Journal: Am J Pathol 2011 Feb 1; Vol. 176, Issue 2; Page(s) 812-26
[Medline ID - 20035055]

The temporomandibular joint is critical for jaw movements and allows for mastication, digestion of food, and speech. Temporomandibular joint osteoarthritis is a degenerative disease that is marked by permanent cartilage destruction and loss of extracellular matrix (ECM). To understand how the ECM regulates mandibular condylar chondrocyte (MCC) differentiation and function, we used a genetic mouse model of temporomandibular joint osteoarthritis that is deficient in two ECM proteins, biglycan and fibromodulin (Bgn(-/0)Fmod(-/-)). Given the unavailability of cell lines, we first isolated primary MCCs and found that they were phenotypically unique from hyaline articular chondrocytes isolated from the knee joint. Using Bgn(-/0) Fmod(-/-) MCCs, we discovered the early basis for temporomandibular joint osteoarthritis arises from abnormal and accelerated chondrogenesis. Transforming growth factor (TGF)-beta1 is a growth factor that is critical for chondrogenesis and binds to both biglycan and fibromodulin. Our studies revealed the sequestration of TGF-beta1 was decreased within the ECM of Bgn(-/0) Fmod(-/-) MCCs, leading to overactive TGF-beta1 signal transduction. Using an explant culture system, we found that overactive TGF-beta1 signals induced chondrogenesis and ECM turnover in this model. We demonstrated for the first time a comprehensive study revealing the importance of the ECM in maintaining the mandibular condylar cartilage integrity and identified biglycan and fibromodulin as novel key players in regulating chondrogenesis and ECM turnover during temoporomandibular joint osteoarthritis pathology.

The levels of vascular endothelial growth factor in the synovial fluid correlated with the severity of arthroscopically observed synovitis and clinical outcome after temporomandibular joint irrigation in patients with chronic closed lock.
Author(s): Kumagai, K; Hamada, Y; Holmlund, AB; Gotoh, A; Nakaoka, K; Arai, G; Yamane, S; Suzuki, R
Journal: Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010 May 4; Vol. 109, Issue 2; Page(s) 185-90
[Medline ID - 20034821]

OBJECTIVE: This study aimed to investigate the level of vascular endothelial growth factor (VEGF) in the temporomandibular joint (TMJ) synovial fluid (SF) and the severity of arthroscopically observed synovitis before and after visually guided TMJ irrigation (VGIR) in patients with chronic closed lock (CCL). In addition, the findings were correlated with the clinical outcome. STUDY DESIGN: Twenty-four patients with unilateral CCL, who underwent a second VGIR either as a repeated therapeutic TMJ irrigation or as a follow-up arthroscopy, were enrolled in the study. They were divided into either successful (s-group; n = 11) and unsuccessful (u-group; n = 13) groups. The VEGF level in the aspirated SF and the severity of synovitis were compared between the s- and u-groups. In each group, the same parameters were compared before and after VGIR. The correlation of the VEGF level with the severity of synovitis was also studied. RESULTS: At the first VGIR, the VEGF levels showed no significant differences when comparing s- and u-groups. At the second VGIR, the VEGF level was significantly higher in the u-group. The VEGF level significantly decreased after the first VGIR in the s-group but remained unchanged in the u-group. There was no significant correlation between the VEGF level and the severity of synovitis. CONCLUSIONS: The level of VEGF in TMJ SF seems to reflect the clinical status in patients with CCL. Moreover, VEGF may be an important target molecule in future chemotherapy of TMJ CCL.

Path generator control system and virtual compliance calculator for maxillofacial massage robots.
Author(s): Ishii, H; Koga, H; Obokawa, Y; Solis, J; Takanishi, A; Katsumata, A
Journal: Int J Comput Assist Radiol Surg 2010 Apr 2; Vol. 5, Issue 1; Page(s) 77-84
[Medline ID - 20033510]

PURPOSE: Oral disorders such as temporomandibular joint disorders (TMD) and dry mouth are common and often require treatment. Maxillofacial massage is used as a complementary and alternative therapy for these disorders. We developed an oral rehabilitation robot that massages the maxillofacial tissues for this purpose. In this paper, we propose a control system for oral rehabilitation robots. METHOD: The control system consists of a massage path generator, virtual compliance calculator, and inverse kinematics calculator. The massage path generator computes a target massage path based on a human head model obtained from a reference MRI image of an adult male. The head model includes the shape and elastic modulus of each component, all of which were obtained experimentally. Virtual compliance control is used to control manipulators with position servo actuators. The manipulators, which have a force sensor at their end-effectors, move actively in the direction of the external force applied to their sensors via virtual compliance control. We implemented this control in WAO-1, our first prototype oral rehabilitation robot. RESULTS: WAO-1 provided massage to three adult male subjects with and without virtual compliance control. One of the subjects was the adult male whose MRI image was used to synthesize the head model in the massage path generator. Without virtual compliance control, the actual massage force was greater than the target massage force, while that with virtual compliance control was less than the target massage force. Furthermore, with virtual compliance control, the massage paths conformed to the head shape of each patient. CONCLUSION: Implementation of virtual compliance control in the WAO-1 massage robot is feasible and useful for implementation of safe and potentially effective maxillofacial massage therapy.

Relationship of synovial tumor necrosis factor alpha and interleukin 6 to temporomandibular disorder.
Author(s): Lee, JK; Cho, YS; Song, SI
Journal: J Oral Maxillofac Surg 2010 May 5; Vol. 68, Issue 5; Page(s) 1064-8
[Medline ID - 20031289]

PURPOSE: The purpose of this study was to elucidate the relationship of tumor necrosis factor alpha (TNF-alpha) and interleukin 6 (IL-6) to temporomandibular disorder with clinical symptoms such as pain, joint sounds, and mouth opening limitation by analysis of the level of these molecules in the synovial fluid. PATIENTS AND METHODS: Twenty-four patients with chief complaints of pain, mouth opening limitation, and clicking sounds were selected as the experimental group and compared with 5 healthy subjects. After joint lavage with arthrocentesis, diluted synovial fluid was collected and enzyme-linked immunosorbent assay was done for analysis of TNF-alpha and IL-6 in 24 experimental patients and 5 healthy subjects. RESULTS: The synovial levels of TNF-alpha and IL-6 were elevated in the experimental group compared with the healthy control group, but no significant correlation was established. The synovial levels of TNF-alpha and IL-6 were elevated in the acute pain group compared with the chronic pain group, but no significant correlation was established. CONCLUSION: In ou r analysis of 2 proinflammatory cytokines, TNF-alpha and IL-6, in the synovial fluid of temporomandibular disorder patients with symptoms of pain, mouth opening limitation, and clicking, both were elevated without statistical significance.

Deglutition and temporomandibular disorders in children.
Author(s): Pizolato, RA; Silva De Freitas Fernandes, F; Beatriz Duarte Gavi; ão, M
Journal: Minerva Stomatol 2010 Jun 23; Vol. 58, Issue 11-12; Page(s) 567-76
[Medline ID - 20027127]

AIM: This study aimed to evaluate the characteristics of deglutition in children having or not temporomandibular disorders (TMD) or signs and/or symptoms of TMD. METHODS: The sample comprised 152 children aged from 8 to 12 years (78 males and 74 females, mean age 10.05+/-1.39 years). The clinical signs were evaluated using the axis I of the Research Diagnostic Criteria for TMD (RDC/TMD) and the symptoms, using a questionnaire. Patients were divided into the following groups: Group TMD (N.=40), signs and symptoms of TMD (Group S and S, N.=68), signs or symptoms of TMD (Group S or S, N.=33) and without signs and symptoms (Group N, N.=11). Characteristics of orofacial structures such as occlusion, tongue, lingual frenulum, lips and mentalis muscle were evaluated. Myofunctional evaluation during deglutition with solid (bread) and liquid (water) was also performed. RESULTS: A high prevalence of abnormal deglutition was found, with similar proportion in groups. Alterations in lips, mentalis muscle and tongue in swallowing was significantly smaller in Group N than in the other groups. The proportions of child ren with lower lip interposition and lateral tongue thrust, when swallowing liquid, were significantly higher than swallowing solids. There was a smaller proportion of children in Group N with lower lip interposition when swallowing liquids. CONCLUSIONS: TMD or presence of signs and/or symptoms of TMD was not associated with an abnormal deglutition. Nevertheless, orofacial myofunctional alterations could be considered influencing factors on TMD, due to the high prevalence of abnormal deglutition pattern. In addition, the abnormal deglutition could be attributed to the malocclusion, mixed dentition phase and orofacial myofunctional characteristics.

Role of psychosocial factors in the etiology of temporomandibular disorders: relevance of a biaxial diagnosis.
Author(s): Licini, F; Nojelli, A; Seg; ù, M; Collesano, V
Journal: Minerva Stomatol 2010 Jun 23; Vol. 58, Issue 11-12; Page(s) 557-66
[Medline ID - 20027126]

AIM: The prevalence of temporomandibular disorders (TMD) is higher among women than men, indicating a multifactorial role for gender-related differences in the etiology of TMD: physiological hormonal differences, inflammatory response to stress, and sociocultural differences in response to pain. The aim of this study was to draw a biobehavioral picture of the TMD patient based on Research Diagnostic Criteria for TMD (RDC/TM) Axis II diagnosis and analysis of gender-related differences. METHODS: Between January 2006 and January 2008, 362 subjects were consecutively enrolled from patients who presented at the Clinic for Temporomandibular Disorders, School of Dental Medicine, University of Pavia, because of orofacial pain, limitation or joint sounds on mandibular movement. Of the 362 subjects evaluated, 308 met the inclusion criteria. RESULTS: The average age of the study population was 41 years; the female: male ratio was 4:1. When stratified according to chronic pain intensity grade and gender, 26% of the women had grade I, 36.4% grade II, 17% grade III, and 9.7% grade IV; 34.4% of the men had grade I, 32.8% grade II, 6.5% grade III, and 3.3% grade IV. Depression was moderate in 35 women and in 6 men and severe in 138 women and in 24 men; somatization was moderate in 59 women and in 20 men and severe in 143 women and in 19 men. CONCLUSIONS: Gender-related differences may be considered risk factors for TMD; psychological characteristics, including somatization, depression, and anxiety related to gender, appear to have a significant impact on the prevalence of TMD.

Temporomandibular joint arthrocentesis and lavage.
Author(s): Currie, R
Journal: Evid Based Dent 2009 Dec 22; Vol. 10, Issue 4; Page(s) 110
[Medline ID - 19821335]

DATA SOURCES: The Cochrane Oral Health Group's Trials Register, Cochrane CENTRAL (Cochrane Library), Medline and Embase were used to identify likely studies. OpenSIGLE,(*) CBMdisc (the Chinese Biomedical Literature Database) and the Chinese Medical Library were also searched. All the Chinese professional journals in the oral health field were searched by hand and conference proceedings were consulted. There was no language restriction. STUDY SELECTION: Randomised controlled trials (RCT) and quasi-RCT that aimed to test the therapeutic effects of arthrocentesis and lavage on temporomandibular joint (TMJ) disorders were included.ATA EXTRACTION AND SYNTHESIS: Two review authors independently extracted data, and three review authors independently assessed the risk of bias of included trials. The first authors of the selected articles were contacted for additional information. Results: Two trials were included in the review, one of which was judged to have a high risk of bias and one to be unclear in its risk of bias. The two trials, which included 81 individuals who had TMJ disorders, compared arthrocentesis with arthroscopy. No statistically significant difference was found between the interventions in terms of pain. A statistically significant difference was found in favour of arthroscopy in maximum incisal opening (weighted mean difference of -5.28; 95% confidence interval, -7.10 to -3.46). Mild and transient adverse reactions, such as discomfort or pain at the injection site, were reported in both groups. No data about quality of life were reported. CONCLUSIONS: There is insufficient, consistent evidence to either support or refute the use of arthrocentesis and lavage for treating patients with TMJ disorders. Further high-quality RCT of arthrocentesis need to be conducted before firm conclusions can be drawn with regard to its effectiveness.

Temporomandibular joint dislocation during orotracheal extubation.
Author(s): Wang, LK; Lin, MC; Yeh, FC; Chen, YH
Journal: Acta Anaesthesiol Taiwan 2010 Mar 11; Vol. 47, Issue 4; Page(s) 200-3
[Medline ID - 20015821]

Temporomandibular joint (TMJ) dislocation can occur whenever the mouth is opened wide during upper airway manipulation, even without external force. In the perioperative period, the majority of TMJ dislocations occur during anesthetic induction. We report the occurrence and management of bilateral TMJ dislocation upon orotracheal extubation in a 35-year-old woman. At the end of an otherwise unremarkable ute rine myomectomy under general anesthesia, with the patient having regained consciousness in the operating room, we asked the patient to open her mouth so we could extubate her. Immediately after orotracheal extubation, however, the patient was found to be unable to close her mouth. The diagnosis of bilateral TMJ dislocation was made. The bilateral TMJ dislocation was reduced with the traditional transoral approach under morphine analgesia/sedation. The dislocation possibly occurred in consequence of her compliance with our request to open her mouth excessively before she was fully awake. As TMJ dislocation is a possible complication of upper airway manipulation, anesthesiologists should be prepared for its occurrence and to manage it competently.

Bilateral thermal hyperalgesia in trigeminal and extra-trigeminal regions in patients with myofascial temporomandibular disorders.
Author(s): Fern; ández-de-las-Peñas, C; Gal; án-del-Río, F; Ortega-Santiago, R; Jim; énez-García, R; Arendt-Nielsen, L; Svensson, P
Journal: Exp Brain Res 2010 Jun 24; Vol. 202, Issue 1; Page(s) 171-9
[Medline ID - 20013256]

Our aim was to assess thermal sensitivity in both trigeminal and extra-trigeminal regions in patients with myofascial temporomandibular disorder (TMD) but without comorbid conditions as compared to age-matched controls. Twenty women (age 24 +/- 3 years) diagnosed with myofascial TMD according to the research diagnostic criteria for TMD and 20 healthy women (age 24 +/- 4 years) were included. Warm and cold detection thresholds (WDT and CDT, respectively) and heat and cold pain thresholds (HPT and CPT, respectively) were bilaterally assessed over the masseter and frontalis muscles (trigeminal regions) and the wrist (extra-trigeminal region). The mean of three determinations at each site was calculated and used for analysis. The order of the test sites was randomized. A two-way ANOVA was used to test for differences between groups and sides (most painful/contra-lateral side; dominant/non-dominant). No significant differences between groups for WDT or CDT in trigeminal and extra-trigeminal regions (ANOVA, P > 0.389) were found. There were significant differences between groups, but not between sides, for HPT and CPT in both trigeminal and extra-trigeminal areas (ANOVA, P < 0.001). CPT (P < 0.001) over the trigeminal area was positively correlated with both pain intensity and duration of pain symptoms: the longer the history of pain or the greater the pain intensity, the higher the CPT (i.e., the greater cold hyperalgesia) over the trigeminal region. Our findings revealed bilateral thermal hyperalgesia (lower HPT and higher CPT) but normal WDT and CDT in trigeminal and extra-tri geminal regions in women with myofascial TMD as compared to healthy controls. Bilateral heat/cold hyperalgesia in trigeminal and extra-trigeminal areas may reflect a dysfunction of thermal channels in myofascial TMD patients as result of some combination of peripheral sensitization, facilitation of central nociceptive processing and/or decreased descending inhibition.
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