Incidence of bruxism in TMD population.

The objective of the study presented here was to examine the incidence of bruxism in patients suffering from temporomandibular disorders. Two cohorts of patients suffering from temporomandibular disorders were evaluated. One group, composed of 163 patients, was asked specifically about the occurrence of bruxism, while the other group, composed of 200 patients, was not specifically asked about bruxism (self-reporting). The incidence of bruxism was only 20.5% for the group that only self-reported bruxism, while the incidence was 65% when asked specifically about bruxism. It is critical to ask specifically about bruxism. Patients are more likely to report bruxism when asked specifically about it. It is important to incorporate this as part of a TMD evaluation.

Effect of cigarette smoking on pain intensity of TMD patients: a pilot study.

To evaluate the effect of cigarette smoking (CS) on pain intensity in a sample of temporomandibular disorder (TMD) patients, 352 clinical charts were reviewed. Subjects were first divided into two groups: smokers (YS) and nonsmokers (NS); then, YS were further divided into three subgroups: light smokers (LS), moderate smokers (MS), and heavy smokers (HS). Overall TMD pain intensity was higher in YS, compared to NS, and a correlation was found between pain intensity and the number of cigarettes smoked in a day by each subject. A significant difference was evident between NS and HS. The results were not evident in males; age was not correlated either with smoking or pain intensity, and the effect of CS on pain intensity was not correlated with any particular TMD diagnosis. CS seems to be a relevant factor affecting the intensity of TMD pain, thus, control of smoking habits should be considered when treating TMD patients.

Use of ultrasonography for the diagnosis of temporomandibular joint disorders: a review.

PURPOSE: To evaluate the reliability of ultrasonography in the diagnosis of temporomandibular joint (TMJ) disorders. METHODS: A review of the literature was performed, searching for all articles published between 1966 and 2006, and examining the ones which met the selection criteria. RESULTS: Ultrasonography sensitivity ranged from 13-100% for the evaluation of disc displacement (DD), from 70.6-83.9% for the evaluation of joint effusion (JE), and from 70-94% for the evaluation of condylar erosion (CE). Specificity ranged from 62-100% for the evaluation of DD, from 73.7-100% for the evaluation of JE, and from 20-100% for the evaluation of CE. Accuracy ranged from 51.5-100% for the evaluation of DD, from 72.2-95% for the evaluation of JE, and from 67-94% for the evaluation of CE.

The immediate effect of changing mandibular position on the EMG activity of the masseter, temporalis, sternocleidomastoid, and trapezius muscles.

This study investigated the immediate effect of changing mandibular position on the electromyographic (EMG) activity of the masseter (MS), temporalis (TM), sternocleidomastoid (SCM) and trapezius (TR) muscles. Thirty-three (33) asymptomatic subjects (16 males and 17 females), ages 23 to 52 were selected. Surface EMG recordings were obtained for all muscles bilaterally with the mandible in a relaxed open position (relaxed) and during maximal voluntary clenching (fullbite) for the following: a non-repositioning appliance (NONREPOS) and repositioning appliance (REPOS). REPOS significantly reduced EMG activity of all muscles bilaterally during fullbite. During relaxation, reduction in EMG activity was only found for TR bilaterally. NONREPOS decreased the EMG activity bilaterally for TM and TR and unilaterally (left) for MS and SCM during fullbite. During relaxation, NONREPOS decreased muscle activity bilaterally for TR and SCM. A unilateral reduction was found for TM (right). These findings suggest that immediate alterations in mandibular position affect the cranio-cervical system. Both mandibular positions tested lowered the EMG activity of masticatory and cervical muscles in the relaxed and fullbite positions. The trapezius muscle was the most responsive to alterations in mandibular position.

Use of Theraflex-TMJ topical cream for the treatment of temporomandibular joint and muscle pain.

This randomized, double-blind study was designed to evaluate the effectiveness of the topical cream Theraflex-TMJ (NaBob/Rx, San Mateo, CA) in patients with masseter muscle pain and temporomandibular joint (TMJ) pain. Fifty-two subjects (5 males and 47 females) were instructed to apply a cream over the afflicted masseter muscle(s) or over the jaw joint(s) twice daily for two weeks. Theraflex-TMJ cream was used by the experimental group, while a placebo cream was used by the control group. The means of pain ratings were calculated prior to the application of the cream (baseline), after ten days of tx (period 1), and 15 days of tx (period 2) days of treatment and five days after stopping the treatment (follow-up). There was a significant decrease in reported pain levels from baseline in the experimental group for period 1 (p < 0.01), period 2 (p < 0.001), and follow-up (p < 0.01). For the control group, no significant differences were found between the different time periods (p > 0.05). There was evidence of minor side effects such as skin irritation and/or burning on the site of the application in two subjects in the experimental as well as two subjects in the control groups. The data strongly suggest that Theraflex-TMJ topical cream is safe and effective for reducing pain in the masseter muscle and the temporomandibular joint.

Atypical odontalgia: a review of the literature.

OBJECTIVE: To review previous reports of cases of atypical odontalgia to examine its epidemiological and clinical characteristics and to explore the etiology and pathophysiology of the disease. BACKGROUND: Atypical odontalgia is one of many painful conditions that affect the oral cavity and is often overlooked in the differential diagnosis. METHODS: A search of the literature was performed for all cases of atypical odontalgia reported from 1966 to the present. RESULTS: The typical clinical presentation of atypical odontalgia that has been reported involves pain in a tooth in the absence of any sign of pathology; the pain may spread to areas of the face, neck, and shoulder. The existing literature suggests that this condition occurs in 3% to 6% of the patients who undergo endodontic treatment, with high female preponderance and a concentration of cases in the fourth decade of life. Deafferentation seems to be the most likely mechanism to initiate the pain, but psychological factors, alteration of neural mechanisms, and even an idiopathic mechanism have been implicated. Not all reported cases were preceded by trauma to the teeth or gums. The treatment of choice is a tricyclic antidepressant, alone or in combination with a phenothiazine. The outcome is usually fair, with many patients obtaining complete relief from pain. Especially in the absence of overt pathology, particular attention should be paid to avoiding any unnecessary and potentially dangerous dental intervention on the teeth. CONCLUSION: Atypical odontalgia is surprisingly common, of uncertain origin, and potentially treatable.