Application of auriculotemporal nerve block and dextrose prolotherapy in exercise therapy of TMJ closed lock in adolescents and young adults.

BACKGROUND: Temporomandibular joint (TMJ) 'closed lock' is a clinical condition causing TMJ pain and limited mouth opening (painful locking). Recent studies suggest an increasing prevalence of degenerative joint disease associated with the onset of TMJ closed lock in adolescents and young adults. Early interventions are recommended, but the curative effect of standard therapies remains controversial. In this retrospective study, an alternative method of non-surgical treatment of TMJ closed lock is presented, and its long-term efficacy has been observed. METHODS: Forty adolescents and young adults, aged 16 to 30 years old, with distinct combination of symptoms of TMJ closed lock, were enrolled. Patients received anesthetic blockages of the auriculotemporal nerve, then performed mandibular condylar movement exercise for 10 min, and subsequently received hypertonic dextrose prolotherapy in retro-discal area of TMJ. Clinical assessments at baseline and at follow-up (2 weeks, 2 months, 6 months, and 5 years) included intensity and frequency of TMJ pain, mandibular range of motion, TMJ sounds, and impairment of chewing. RESULTS: Cone beam CT images of the TMJs revealed joint space changes in all patients and degenerative bone changes in 20% (8/40) of the patients. The patients were diagnosed as having disc displacement without reduction with limited opening. Successful reduction of displaced disc had been achieved in the treatment. And pain at rest and pain on mastication had substantially decreased in all patients and mandibular function and mouth opening had significantly improved since 2 weeks' follow-up. The overall success rate kept at a high level of 97.5% (39/40) at 6 months and 5 years' follow-up. CONCLUSIONS: The technique combining mandibular condylar movement exercise with auriculotemporal nerve block and dextrose prolotherapy is straightforward to perform, inexpensive and satisfactory to young patients with TMJ closed lock.

Improved sedation for dental extraction by using video eyewear in conjunction with nitrous oxide: a randomized, controlled, cross-over clinical trial.

OBJECTIVE: The purpose of this study was to investigate the effect of a portable video eyewear entertainment system used in conjunction with nitrous oxide/oxygen sedation during the removal of impacted lower third molars. STUDY DESIGN: Thirty-eight patients had their bilateral third molars removed under local anesthesia and nitrous oxide/oxygen inhalation sedation in 2 visits. On one side, video eyewear was used (group NE). On the other side, the tooth was removed without the use of video eyewear (group N). Vital signs were monitored. Overall behavior and the outcome of treatment were assessed. RESULTS: All 38 patients completed the study. The mean scores on behavior rating in group NE were significantly higher than those in group N (P < .05). The majority of patients (92.1%) preferred nitrous oxide with video eyewear. CONCLUSIONS: The use of video eyewear appeared to augment the effectiveness of nitrous oxide sedation in dental extraction patients.

The effect of chemical sympathectomy and stress on bone remodeling in adult rats.

OBJECTIVES: Bone remodeling has recently been revealed to be under sympathetic nerve control. The role of the sympathetic nerve system is not clearly understood. The present study aim to explore the effect of chemical sympathectomy and stress on bone remodeling in adult rats. METHODS: 24 twelve-month-old Wistar rats were divided into three group (sympathectomy, stress and control). The sympathectomy and stress group rats were administered 6-hydroxydopamine (150 mg/kg each day) and saline (1 ml/kg each day) intraperitoneal respectively for one week and exposed to stress procedure for another three weeks. The stress procedure was mild, unpredictable footshock, administered for one hour once daily. Analysis of serum chemistry, microcomputed tomography, dual energy X-ray absorptiometry, biomechanical testing and bone histomorphometry were employed. RESULTS: The stress group rats showed increased bone resorption in contrast to the sympathectomy and control group rats. The serum level of calcium and phosphorus cations and norepinephrine were enhanced, the cancellous bone volume and bone mineral density were reduced, bone mechanical property such as strength, ductility and toughness were weakened, the osteoclast counts and osteoclast surfaces were increased and the bone formatin rate were decreased significantly in the stress group rats in contrast to the other two groups rats. There was no significant difference of bone remodeling between the sympathectomy group and control group rats. CONCLUSION: Our study showed stress-increased sympathetic nerve system activity enhanced bone resorption while chemical sympathectomy inhibited bone resorption under stress. We postulate sympathetic neurotransmitter and neuropepitide may play a role in regulating bone remodeling.