Effect of water-soluble titanium microparticle-permeated tape on temporomandibular disorders-related pain: a preliminary study.

OBJECTIVE: Recent research has focused on the applicability of titanium particle-impregnated materials in healthcare and medical products. This preliminary study was undertaken to investigate the effect of water-soluble titanium microparticle-permeated (WSTi) tape on temporomandibular disorder (TMD)-related pain. MATERIALS AND METHODS: The study included 32 patients (41.5 ± 14.4 years, 26 women) who had visited the Temporomandibular Joint Clinic, Tokyo Medical and Dental University, for treatment of TMD-related pain. The subjects were instructed to apply the WSTi tape (AquaTitan tape) on the most painful area before going to sleep and remove the tape on awakening daily for 2 weeks. Seven outcome variables were statistically analyzed: maximum mouth-opening ranges with and without pain, spontaneous pain intensity, mouth-opening pain intensity, chewing pain intensity, TMD-related limitation of daily functions (LDF-TMD) and subjective evaluation of any change in TMD-related pain. RESULTS: The mean maximum mouth-opening ranges with (p = 0.011) and without (p = 0.002) pain were significantly greater and mean pain intensities on mouth opening (p < 0.001) and chewing (p = 0.001) were significantly lower at the 2-week follow-up than at the baseline. The mean LDF-TMDQ scores were also significantly lower at the 2-week follow-up (p = 0.004). After 2 weeks of using the WSTi tape, 53.1% and 12.5% of the subjects reported a slight improvement and an improvement, respectively, in TMD-related pain. CONCLUSION: WSTi tape seems to have beneficial effects on TMD-related pain and LDF.

[Influence of contributing factors in temporomandibular disorders in female college students].

This study was performed to ascertain any relationship between temporomandibular disorders (TMD) and contributing factors such as tooth contacting habit (TCH) that influence the manifestation of TMD and TCH in graduate female college students. The subjects were 114 graduate female college students in Oral Health Care Sciences, Faculty of Dentistry, Tokyo Medical and Dental University. The subjects were assessed using a questionnaire and observation of tongue indentation and buccal mucosa ridging. Of these students, 89 (78.1%) answered the questionnaire. Statistical examinations were performed using t-tests and logistic regression analyses. A p value of less than 0.05 was considered to be a significant difference. The prevalence rate of TMD was 16 (19.3%) and the prevalence rate of TCH was 39 (47.0%). Logistic regression analyses indicated that unilateral chewing, presence of tongue indentation, and buccal mucosa ridging were significant contributors to the manifestation of TMD. In addition, these analyses indicated that sleep disorders and physical pain such as headaches and neck pain were significant contributors to the manifestation of TCH. This study suggested the following: unilateral chewing, presence of tongue indentation, and buccal mucosa ridging could correlate with the manifestation of TMD. In addition, sleep disorders, headaches, and neck pains could correlate with the manifestation of TCH.

Bone morphogenetic proteins are involved in the pathobiology of synovial chondromatosis.

Synovial chondromatosis is characterized by the formation of osteocartilaginous nodules (free bodies) under the surface of the synovial membrane in joints. Free bodies and synovium isolated from synovial chondromatosis patients expressed high levels of BMP-2 and BMP-4 mRNAs. BMP-2 stimulated the expression of Sox9, Col2a1, and Aggrecan mRNAs in free-body and synovial cells and that of Runx2, Col1a1, and Osteocalcin mRNAs in the synovial [corrected] cells only. BMP-2 increased the number of alcian blue-positive colonies in the free-body cell culture but not in the synovial cell culture. Noggin suppressed the expression of Sox9, Col2a1, Aggrecan, and Runx2 mRNAs in both the free-body and synovial cells. Further, it inhibited Osteocalcin expression in the synovial cells. These results suggest that BMPs are involved in the pathobiology of cartilaginous and osteogenic metaplasia observed in synovial chondromatosis.

Comparison of occlusal discomfort in patients with temporomandibular disorders between myofascial pain and disc displacement.

We compared occlusal discomfort in patients with temporomandibular disorders (TMD) between myofascial pain (MFP) and disc displacement (DD) using a database created from Sep, 2003 to Aug, 2005. We selected 71 patients with MFP and 170 patients with DD to construct a null model of structural equation modeling (SEM) in which anxiety influenced depressive mood, depressive mood aggravated occlusal discomfort and sleep complaints, and sleep complaints or an onset event caused by another person aggravated occlusal discomfort. We performed a simultaneous analysis of patients with MFP and DD. The estimated parameter of the path from depressive mood to occlusal discomfort was significant for patients with MFP, but not for patients with DD. The path from an onset event caused by another person, such as dental treatment to occlusal discomfort was significant in patients with MFP and those with DD. The Goodness of Fit Index (=0.909), The Adjusted Goodness of Fit Index (=0.867), and The Root Mean Square Error of Approximation (=0.039) indicated good acceptability. These results suggested that an increase in depressive mood may aggravate occlusal discomfort in patients with MFP, and an onset event caused by another person, such as dental treatment, also may aggravate occlusal discomfort in patients with MFP and those with DD.

[Improvement of outcomes by primary treatment for temporomandibular disorders].

The aim of this study was to survey the current state of the temporomandibular joint disorder treatment in our clinic and to confirm the therapeutic outcomes. The subjects in this study were recruited from among the patients with temporomandibular disorders who attended the Temporomandibular Disorder Special Clinic, Department of Oral Surgery, Hitachi Yokohama Hospital during one year period from February 2007 to January 2008. A total of 100 consecutive outpatients diagnosed with temporomandibular disorders were selected for the study. Pain intensity and the degree to which daily function was limited before and after treatment were evaluated using the Visual Analogue Scale (VAS). The Beck Depression Inventory-II (BDI-II) score was evaluated simultaneously, and the correlation with changes in symptom was evaluated. The median (25th, 75th percentiles) of pain intensity (VAS value) before treated was 45 (25.0, 65.0) and the degree of limitation of daily function (VAS value) was 15 (0.0, 50.0). The median (25th, 75th percentiles) of pain intensity at 4 weeks after was 10 (0.0, 30.0), and significantly lower than that before treatment (p = 0.000). The degree of limitation of daily function was 0 (0.0, 10.0), also significantly lower than that before treatment (p = 0.000). The BDI-II score decreased from 8 (2.0, 11.8) before treatment to 5 (2.0, 11.0, p = 0.024) and showed no significant correlation with the improvement in outcomes by primary treatment for temporomandibular disorders.

Teeth contacting habit as a contributing factor to chronic pain in patients with temporomandibular disorders.

Many different factors are known to cause and perpetuate the symptoms of temporomandibular disorders (TMD). However, the roles of parafunctional factors have not been clearly elucidated. We found one of these habits in the clinical setting. This parafunctional habit involves daily light touching of the upper and lower teeth, when the mouth is closed. We named this habit Teeth Contacting Habit (TCH). [OBJECTIVES] To investigate the following hypotheses: 1) TCH is associated with perpetuation of chronic pain of TMD patients; 2) TCH is associated with other behavioral factors. [METHODS] Two hundred and twenty-nine TMD outpatients with chronic pain were analyzed with multivariate logistic regression models. [RESULTS] TCH was found in 52.4% of patients. Patients with TCH and pain lasting for more than four months were less likely to experience improvements in pain at the first visit (OR = 1.944, p = 0.043). Other factors associated with TCH were as follows: unilateral chewing (OR = 2.802) and involvement in a precision job (OR = 2.195). [CONCLUSION] TCH can prolong TMD pain and is associated with other behavioral factors.

Synovial chondromatosis of the right side temporomandibular joint extending to the middle cranial fossa: A case report with 7-year postoperative follow up and expression of a biomarker of cell proliferative activity.

INTRODUCTION: Synovial chondromatosis of the temporomandibular joint (TMJ) with cranial extension is rare. Here, we report 7-year follow-up of a case with immunohistochemical examination of cell proliferative activity. PRESENTATION OF CASE: The patient was a 72-year-old man. Severe bone resorption of the glenoid fossa was apparent on CT images. Pathological findings by biopsy led to diagnosis of synovial chondromatosis of the right side TMJ. Extirpation of the tumor was performed via temporopreauricular incision under general anesthesia. PCNA expression was examined by immunohistochemical analysis. The lesion had penetrated into the middle cranial fossa, but the cranial dura mater was intact. Expression of PCNA was confirmed. DISCUSSION: The PCNA expression suggested that growth activity caused expansion of the lesion to the skull base. CONCLUSION: We were able to follow up this case for a long period without recurrence postoperatively.

Development of a new questionnaire to assess pain-related limitations of daily functions in Japanese patients with temporomandibular disorders.

BACKGROUND: Various measures/scales have been used to assess oral health-related quality of life in patients with temporomandibular disorders (TMDs). However, there have been few reports on the validity of questionnaires, and even fewer assessments of their use in Japanese sociocultural conditions. OBJECTIVES: The objectives of the study were: (i) to develop and refine the number of questions concerning pain-related limitations of daily function in the TMD questionnaire (LDF-TMDQ, 13 items) in Japanese patients with TMD, (ii) to assess factor validity, and (iii) to determine convergent and discriminant validity of the LDF-TMDQ with the observed items within a multidimensional questionnaire. METHODS: Four hundred and fifty-six (85.9%) outpatients with TMD were enrolled. The subjects were allocated into two roughly equal groups--E-group (233) for exploratory factor analysis and C-group (223) for confirmatory factor analysis [structural equation modeling (SEM)]. RESULTS: The exploratory factor analysis extracted 10 items and three factors. SEM showed the revised model to accurately describe the relationships between the measured items. As to convergent validity, the factor 'limitation in executing a certain task' and 'limitation of mouth opening' showed significant correlations with the observed items within the multi-dimensional questionnaire. However, the factor 'limitation of sleeping', show no correlation with any item. As to discriminant validity, all three factors had correlation coefficients below 0.4 with the psychological scale, the personality scale, and the visual analog scale for pain intensity. CONCLUSION: The LDF-TMDQ was reduced from 13 items to 10. The factor validity of the LDF-TMDQ, and the construct validity of 'limitation in executing a certain task' and 'limitation of mouth opening' were confirmed, while that of 'limitation of sleeping' remains to be determined.

Clinical evaluation of the temporomandibular joint following orthognathic surgery--multiple logistic regression analysis.

This study compares temporomandibular joint dysfunction (TMD) symptoms before and after bilateral sagittal split ramus osteotomy, and identifies predictive factors for the postoperative TMD symptoms by assessing the adjusted odds ratio using multiple logistic regression analysis. A consecutive series of 37 cases treated only with bilateral sagittal split ramus osteotomy were evaluated. New postoperative TMD symptoms appeared in 9 cases, preoperative TMD symptoms disappeared in 6 cases, and TMD symptoms were unchanged in 5 cases. The median period until the interincisal opening range attained 40 mm was 5 months (range, from 2 to 15 months). Age was a positive factor in patients with postoperative TMD symptoms, with an odds ratio of 1.43 (95 percent confidence interval, from 1.05 to 1.93). In addition, the maximum value of the bilateral setback distance of more than 9 mm was a positive factor of 6.95 (95 percent confidence interval, from 1.06 to 45.42). We concluded that surgical correction in skeletal malocclusion may affect temporomandibular joint dysfunction symptoms.

Relationship between oral sensory thresholds and depressive moods.

AIMS: The aims were to compare the sensory thresholds on the tip of the tongue with on the dorsum of the hand, and to investigate the relationship between the sensory threshold and depressive mood with volunteers whose psychological conditions were normal. METHODS: Fifty-five subjects (28 women, 27 men) took psychiatric structured diagnostic interview and Self-rating Depression Scale (SDS). In the next step, the quantitative sensory tests (light touch sensation and thermal sensory test) were carried out on the tongue and the hand. Then we investigated the relationship between depressive moods and sensory thresholds on the tongue and the hand using logistic regression model. RESULT: The sensory thresholds on the tip of the tongues were significantly different from those on the dorsum of the hands. Only on tongue tip, increment of SDS had relation to the thresholds of innoxious thermal stimulation (OR=0.152, 95% CI. 0.049-0.478) and noxious heat stimulation (OR=0.352, 95% CI. 0.169-0.734). CONCLUSION: This finding might support for the idea that depressive mood had closer association with the tongue of the orofacial areas than the dorsum of the hand.

[Sensory perceptive and discriminative abilities of patients with occlusal dysesthesia].

PURPOSE: It is not rare for dentists to come across patients who complain of several uncomfortable feelings of occlusion despite the absence of any observable occlusal anomaly or discrepancy. These kinds of symptoms are well defined by the term "occlusal dysesthesia" (OD). This study evaluated the occlusal perceptive and discriminative abilities in OD patients. METHODS: The sensory perceptive and discriminative abilities were tested in 8 OD patients and 31 healthy subjects as controls. All of these subjects went through three types of tests: 1) thickness discrimination test by using occlusal registration foils, 2) thickness discrimination test by using bite block, and 3) mouth opening reproducibility test. RESULTS: The median of the foil thickness discrimination ability of the control group was 14 microm and that of the patient group was 8 microm. In the bite block thickness discrimination test, both groups showed less than +/- 1mm thickness discrimination ability on average and were able to reproduce pre-indicated mouth opening with less than 10% error. There was no significant difference in these study results between the two groups. CONCLUSIONS: Sensory perceptive and discriminative abilities of OD patients were not significantly different from those of the healthy subjects in this study sample.

Expression of proteoglycan mRNA in human temporomandibular joint disks in temporomandibualr disorders.

The purpose of this study was to investigate the expression of PG mRNA in human temporomandibular joint (TMJ ) disks from patients with temporomandibular disorders (TMD). Total RNA was isolated from the TMJ disks. All patients had undergone diskectomy under general anethesia. RT-PCR was performed using primers for the proteoglycans, aggrecan and decorin. On electrophoresis of a lysate of human TMJ disks, decorin was recognized in each sample. In the calcified part of the disk which we recognized visually, aggrecan was also recognized. These results suggest that TMJ disks contain decorin, and are fibrous tissue. If the disk was subjected to excessive compression in addition to tension, cells similar to chondrocytes and expression of aggrecan was induced. Calcification would be initiated in the part of the disk experiencing the increased compression.

Synovial chondromatosis of the temporomandibular joint: long-term postoperative follow-up of the residual calcification.

Synovial chondromatosis of the temporomandibular joint is a rare disease, and extra-articular synovial condromatosis of the temporomandibular joint is even rarer. A review of the English literature from 1980 to 2000 has revealed 51 cases of synovial chondromatosis affecting the temporomandibular joint. We report a case of extra-articular synovial condromatosis, for which we carried out a long-term follow-up of the postoperative course using diagnostic images.

Clinical and magnetic resonance imaging study of unilateral sideways disc displacements of the temporomandibular joint.

The aim of our study was to find symptomatic diagnostic factors for sideways displacement of the temporomandibular joint disc, compared with anterior or rotational disc displacement. A consecutive series of 2310 temporomandibular joints were examined with MRI to define the clinical signs and symptoms particularly related to sideways disc displacement compared to anterior disc displacement with logistic regression model. Bone change of the mandibular condyle and age were negatively related factors in differentiating cases with lateral disc displacement from anterior disc displacement without reduction. Range of mouth opening (over 40 mm) was a significant predictor (odds ratio 4.5865 for lateral disc displacement). This study suggested the wide opening of the mouth to become the predictor for the lateral disc displacement among the cases suspected to have disc displacement without reduction.

Use of a new instrument for lateral release in arthroscopic surgery of the temporomandibular joint: a preliminary study.

We developed a new instrument, which we call a lateral releaser, to improve the safety of either a blind lateral release or lateral stretching within the TMJ We used it during arthroscopic surgery in patients with chronic painful hypomobility of the temporomandibular joint (TMJ). We operated on 24 TMJs in 17 patients (15 women and 2 men). At operation, the mean increase in the interincisal distance was 22 mm (range 10-32). No instruments were broken. No serious surgical complications were reported during or after operation. Many of the patients currently have an interincisal distance exceeding 38 mm.

Arthroscopic removal of nodules of synovial chondromatosis of the temporomandibular joint.

In this report we describe a new method for removing nodules of TMJ synovial chondromatosis using arthroscopic surgery instead of open surgery. We used two steps during arthroscopy. In the first, we lavaged the cavity with sterile saline. In the next step, the second cannula was replaced with ethmoid forceps. Under arthroscopic guidance through the first cannula, all loose bodies were removed using the forceps. Since the loose bodies are not fragmented during this procedure, the time needed for removal is shortened. Based on this experience, we suggest the use of ethmoid forceps should be considered as an alternative procedure when nodules are unable to pass through the cannula by lavage with sterile saline.

[Postoperative evaluation of surgically treated cases with temporary silicone implant in temporomandibular joint].

We have carried out temporary silicone implants after diskectomies or arthroplasties in temporomandibular joint surgeries to avoid postoperative adhesion and to maintain articular space. We evaluated 19 joints in 15 patients who had received dacron-reinforced silicone implant after silicone sheet removal through follow-up for at least 6 months. The cases included temporomandibular joint disorder (10 joints in 9 patients), psoriatic arthritis (2 joints in 1 patient), ankylosis (4 joints in 3 patients) and synovial chondromatosis (2 joints in 2 patients). On the basis of the criteria of temporomandibular dysfunction for the results, they were classified as bad (4 patients). It is thought that factors other than the implant are related to the bad results in the postoperative evaluation. In this study, lymphadenopathy induced by exfoliated silicone debris could not be confirmed. The temporary silicone implant in the temporomandibular joint was thought to be useful.

The True-Positive Rate of a Screening Questionnaire for Temporomandib-ular Disorders.

BACKGROUND: Temporomandibular disorders (TMD) occur at an incidence of 5-12% in the general population. We aimed to investigate the rate of true-positives for a screening questionnaire for TMD (SQ-TMD) and differences in the characteristics between the true-positive and false-negative groups. Materials and. METHODS: Seventy-six individuals (16 men, 60 women; mean age, 41.1 ± 16.5 years) were selected from pa-tients with TMD who had visited the Temporomandibular Joint Clinic at Tokyo Medical and Dental University. The patients were assessed using a questionnaire that contained items on TMD screening (SQ-TMD); pain intensity (at rest, maximum mouth-opening, and chewing), as assessed using the visual analog scale (VAS); and TMD-related limitations of daily func-tion (LDF-TMD). A logistic regression analysis was performed to assess the factors potentially influencing the true-positive rate. RESULTS: Of the 76 subjects, 62 (81.6%) were true-positive for the questionnaire based on the SQ-TMD scores. The mean VAS score for maximum mouth-opening and chewing and the mean LDF-TMD score were significantly greater in the true-positive group than those in the false-negative group. The results of the logistic regression analysis showed that only the VAS score for chewing was a statistically significant factor (P < 0.05). CONCLUSION: The true-positive rate of TMD using SQ-TMD was very high. The results indicate that SQ-TMD can be used to screen TMD in patients with moderate or severe pain and difficulty in living a healthy daily life.

Influence of psychosocial factors and habitual behavior in temporomandibular disorder-related symptoms in a working population in Japan.

BACKGROUND: The symptoms of temporomandibular disorders (TMD) are directly influenced by numerous factors, and it is thought that additional factors exert indirect influences. However, the relationships between TMD-related symptoms (TRS) and these contributing factors are largely unknown. Thus, the goal of the present study was to investigate influences on TRS in a working population by determining the prevalence of TRS, analyzing contributing factors, and determining their relative influences on TRS. MATERIALS AND METHODS: The study subjects were 2203 adults who worked for a single company. Subjects completed a questionnaire assessing TRS, psychosocial factors (stress, anxiety, depressed mood, and chronic fatigue), tooth-contacting habit, and sleep bruxism-related morning symptoms, using a 5-point numeric rating scale. Our analysis proceeded in 2 phases. First, all variables of the descriptor were divided into parts by using an exploratory factor analysis. Second, this factorial structure was verified by using a confirmatory factor analysis with structural equation modeling. RESULTS: Of 2203 employees, 362 reported experiencing TRS (16.4%). Structural equation modeling generated a final model with a goodness of fit index of 0.991, an adjusted goodness of fit index of 0.984, and a root mean square error of approximately 0.021. These indices indicate a strong structural model. The standardized path coefficients for "habitual behavioral factors and TRS," "psychosocial factors and habitual behavioral factors," "psychosocial factors and TRS," and "gender and habitual behavior factors" were 0.48, 0.38, 0.14, and 0.18, respectively. CONCLUSIONS: Habitual behavioral factors exert a stronger effect on TRS than do psychosocial factors.

A survey of influence of work environment on temporomandibular disorders-related symptoms in Japan.

INTRODUCTION: This study aimed at identifying the factors that influence the incidence of temporomandibular disorders (TMD)-related symptoms (TRS) in a Japanese working population. METHODS: Our study subjects comprised of 1,969 employees from the same Japanese company. The subjects were assessed using a questionnaire that covered both TRS and the work environment. TRS were measured from 4 items on the questionnaire. The work environment factors recorded were the daily mean duration of personal computer use, driving, precise work, commuting, time spent at home before going to bed, sleeping, attending business meetings, and performing physical labor. Statistical analysis was performed using t-tests, Chi-square tests, and logistic regression analyses. A result with P < 0.05 was considered statistically significant. RESULTS: The median total score on the 4 items used to assess TRS was 5 (25% = 4, 75% = 7). Two groups were defined such that the participants scoring ≤7 were assigned to the low-TRS group and those scoring ≥8, to the high-TRS group. The high-TRS group constituted 22.6% of the subjects. Logistic regression analyses indicated that female gender and extended periods of computer use were significant contributors to the manifestation of TRS. CONCLUSION: This questionnaire-based study showed that gender and computer use time was associated with the prevalence of TRS in this working population. Thus, evaluation of ergonomics is suggested for TMD patients.