Can temporomandibular disorder symptoms and headaches be prevented in 13- to 15-year-old girls by information provided in a school setting?

OBJECTIVE: Temporomandibular disorders (TMD) may develop, especially among girls, during the adolescence period. The aim of this study was to study if information and advice in a school setting could prevent development of TMD symptoms and headaches during the early teenage period. METHODS: Thirteen-year-old girls, at 19 upper elementary schools were invited to participate in a study with structured information about the jaw system, TMD symptoms and risk factors, as well as advice how to manage risk factor and TMD. Six hundred and fifty-one girls enrolled, of which 507 girls were followed for 2-2.5 years. Half received information on three occasions (cases), and the other half served as controls. Included in the analysis of incidence of TMD symptoms were those without frequently occurring TMD symptoms (not including headaches) at baseline (n = 396) and included in the analysis of incidence of headaches were those without frequent headaches at baseline (n = 297). RESULT: The 2-year incidence of TMD symptoms was significantly lower in the information cohort (19%) compared to the controls (28%) (p = .03). The 2-year incidence of headaches was lower among those who were allocated to information (30%) compared to controls (40%), but the difference was not statistically significant (p = .099). Cases who had headaches at baseline reported a significantly lower prevalence at follow-up compared to controls (p = .03). CONCLUSION: Standardized information in school settings can prevent development of TMD symptoms and headaches among young girls.

Pain relief following a single-dose intra-articular injection of methylprednisolone in the temporomandibular joint arthralgia-A multicentre randomised controlled trial.

BACKGROUND: Temporomandibular joint (TMJ) arthralgia is a painful condition assumed to be associated with local inflammation. OBJECTIVE: The objective of the present study was to determine the efficacy for reducing pain of a single-dose intra-articular (IA) injection of methylprednisolone to the TMJ. The hypothesis was that methylprednisolone would effectively reduce TMJ pain. METHODS: This randomised, double-blind, parallel-group, multicentre, controlled study included visits for enrolment, treatment and 4-week follow-up. The study included patients 18 years and older who had been diagnosed with unilateral TMJ arthralgia. All participants were randomly assigned to receive 1 mL IA injections of methylprednisolone or saline. The primary outcome was change in recorded pain intensity on a visual analogue scale (VAS) at maximum jaw opening, analysed in the per protocol population. RESULTS: In total, 54 patients were randomly assigned to single-dose IA injections with methylprednisolone (n = 27) or saline (n = 27). Between baseline and the 4-week follow-up, VAS-rated pain intensity at maximum jaw opening decreased from a mean of 61.0 (95% confidence interval [CI]: 50.1; 70.7) to 33.9 (95% CI: 21.6; 46.2) in the methylprednisolone group and from 59.6 (95% CI: 50.7; 65.9) to 33.9 (95% CI: 23.8; 43.9) in the saline group. The between-group difference was not significant (P = 0.812). Treatment-related adverse events were doubled in the methylprednisolone group. CONCLUSION: Methylprednisolone provided no additional benefit for reducing pain, but caused more harm compared with saline following a single-dose IA injection in patients with TMJ arthralgia.

Short clinical examination for temporomandibular symptoms in general practice.

OBJECTIVE: The aims of the study are to assess the reliability of the short clinical examination, and to compare the information gained with a well-known and validated examination, the diagnostic criteria for temporomandibular disorders (DC/TMD). MATERIALS AND METHODS: The study comprises 52 consecutive, newly referred patients at their first visit and examination to an Orofacial Pain and TMD Clinic, 15 years and older, mean age 44 years. The patients first answered three screening questions for reported symptoms. The clinical examination was performed using both the short examination and the DC/TMD and the result was compared. Another group of 40 newly referred patients, with similar inclusion criteria, was examined twice according to the short clinical examination by two examiners, and the inter-examiner variation was studied. The protocol of the short clinical examination is described. RESULT: The overall agreement between the two methods was fairly good to excellent, as was the degree of agreement between repeated examinations and two examiners using the short clinical examination method. The sensitivity and specificity of the short examination for diagnoses were acceptable to high (with DC/TMD as the golden standard). CONCLUSIONS: The short clinical examination has acceptable reliability and, together with three screening questions, provides enough information about the jaw function to decide whether there is a dysfunction.

Oral parafunctions, piercing and signs and symptoms of temporomandibular disorders in high school students.

OBJECTIVE: The use of chewing-gum and piercing has become common among adolescents and might result in increased oral muscle activity and overloading. Aim To investigate the frequency of oral piercing and parafunctions in relation to symptoms of temporomandibular disorders (TMD) among adolescents. MATERIALS AND METHODS: One hundred and twenty-four third level high school students, living either in a city or in a small town, enrolled in either science or media programmes, were included. The students completed a questionnaire regarding different parafunctions and symptoms of TMD. A clinical examination of the temporomandibular system and estimation of the tooth wear was performed in 116 students. RESULTS: Chewing-gum was used by 86% of the students (25% with a daily use) and 14% had an oral piercing. The science students used more chewing gum than the media students (p = 0.008), while the media students had more piercings (p < 0.001). Symptoms once a week or more were reported with 39% for headache, 18% for clicking, 7% for facial pain and 6% for difficulty to open wide. Girls reported more headaches (p = 0.007) and more severe symptoms (p = 0.003), had more medical consultations and used more analgesics (both p < 0.05) and had more clinical signs (p = 0.01) than boys. Girls had more oral piercings and used more chewing gum than boys (both p < 0.05). The media students had more sick leave (p < 0.01) than the science students. Chewing-gum use was associated with headache (p < 0.01), with difficulty to open wide (p < 0.05) and with tenderness of the temporomandibular joints and muscles (both p < 0.05). Oral piercing was associated with headache and muscle tenderness (both p < 0.05) and daily nail biting with headache (p < 0.05) and tooth wear (p = 0.004). CONCLUSIONS: There is an association between use of chewing gum, nail biting, oral piercing, and symptoms of TMD.

Aural symptoms in patients referred for temporomandibular pain/dysfunction.

With the aim of studying frequency of aural symptoms and associations with symptoms of TMD new patients referred to the Orofacial Pain Clinic, Odontologen, Göteborg, were asked, at their first appointment and before meeting a specialist, to report any symptoms regarding pain or fullness/swelling of the ear, impaired hearing, sensitivity to sound, and irritation/itching of the ear. They also answered a standardized questionnaire regarding temporomandibular pain and/or dysfunction, and classified their degree of TMD symptoms on a five-point verbal scale and a visual analogue scale. 108 consecutive patients were included in the study, they completed the questionnaires and were examined and diagnosed by different specialists at the clinic. Any ear symptoms were reported by 68% of the patients, fullness of ear by 44% and impaired hearing by 37%. 38% of the patients had previously consulted a physician, and most of them had had pharmacological treatment due to their ear symptoms. Females reported more pain in the ear (P = 0.034) and more sensitivityto sound (P = 0.046) than men. No significant association was found between age and aural symptoms. The degree of TMD- symptoms, as reported by the five grade scale, showed significant association with aural symptoms (P < 0.001), as did the clinical dysfunction index of Helkimo (P = 0.005). The diagnoses of myalgia, arthralgia, arthritis and headache showed significant association with aural symptoms, while no association with crepitus (osteoartrosis) and disc displacement. Itching in the ear was frequently reported (24%) and was associated with myalgia (P = 0.003) and tension headache (P = 0.018). A medical examination by an ear-nose-throat specialist of 19 patients reporting a sensation of fullness of ear, did not reveal any objectifiable ear disease. To conclude, aural symptoms are common in patients with temporomandibular pain and/or dysfunction, are associated with TMD-symptoms and should be regarded as possible symptoms of TMD. A cooperation between physicians and dentists can give these patients a good treatment.

Temporomandibular disorder as risk factor for radiation-induced trismus in patients with head and neck cancer.

OBJECTIVES: The aim of this study was to investigate if patients with temporomandibular disorders (TMD) prior to head and neck cancer (HNC) treatment are at higher risk of developing trismus after oncological treatment. MATERIALS AND METHODS: Eighty-three study patients underwent detailed dental examination prior oncological treatment and 6 months after radiotherapy completion, including evaluation of temporomandibular jaw function, palpation of the jaw muscles, and measurement of mouth opening capacity. TMD criteria were based on both clinical examination findings and patient-reported symptoms. TMD at baseline was used in regression analysis in order to predict restricted mouth opening. RESULTS: At the 6 months follow-up more than a third of the patients (35%) were examined with reduced mouth opening of >20% compared to baseline. A majority of the patients had bilateral tenderness of both the temporal and the masseter muscle. At the 6 months follow-up, 42% of the study patients reported mouth opening problems. About one-third of the patients suffered from fatigue and stiffness of the jaw as well as pain when mowing the jaw. Two questions from the validated symptom-specific Gothenburg Trismus Questionnaire were found to be related to a statistically significant increased risk of restricted mouth opening after radiotherapy; "During the last week, have you felt: Pain on moving the jaw?" (OR [95% CI] 5.9 (1.2-29.4) [p = 0.030]) and "During the last week, have you felt pain and tenderness in the muscles of mastication?" (OR [95% CI] 5.90 [1.19-29.40] [p = 0.030]). CONCLUSIONS: TMD is common amongst HNC patients. Patients who suffer from pain in the jaw muscles and pain when moving the jaw before start of treatment are at higher risk of radiation-induced trismus after 6 months. Clinicians should strive for optimizing the patients pain treatment and oral health before, during, and after radiotherapy.

Ear symptoms in patients with orofacial pain and dysfunction - An explorative study on different TMD symptoms, occlusion and habits.

OBJECTIVES: Ear symptoms coincident with TMD symptoms have been noticed for a long time. The aim was to investigate the relationship between reported ear symptoms in TMD patients and different TMD symptoms, dental occlusion, oral parafunction and habits. MATERIAL AND METHODS: Consecutive patients, ≥18 years of age and referred to a specialist clinic for orofacial pain and dysfunction during a three-month period, were considered for the study. Patients with poor general or psychiatric health were excluded. One hundred thirty-two patients were included and studied with regard to reported ear symptoms in relation to clinical dysfunction, occlusion, habits and subjective rating of their symptoms. A clinical examination was performed according to RDC/TMD and extended with occlusal factors, parafunctions and habits. RESULTS: Ear symptoms were reported by 72% of the TMD patients, with ear fullness in 49% as the most frequent symptom. The patients with ear symptoms were significantly older and proportionally more often females. Ear symptoms were significantly correlated to the subjective index, to myalgia (p = 0.003), decreased opening capacity (p = 0.01), TMJ pain (p = 0.02), parafunctions (p = 0.007), and some occlusal factor (p = 0.018-0.003). Muscle pain on palpation was significantly associated with ear fullness, and changed hearing and sensitivity to sound, on the same side (p < 0.005). CONCLUSIONS: Ear symptoms are frequently reported by TMD patients. Concomitant ear symptoms are associated with oral parafunction and muscle pain on palpation on the same side as the ear symptoms.

Temporomandibular disorder in head and neck cancer patients undergoing radiotherapy: Clinical findings and patient-reported symptoms.

BACKGROUND: The aim of this study was to investigate how common temporomandibular disorder (TMD) symptoms are among head and neck cancer (HNC) patients before and after oncological treatment. METHODS: Eighty-nine patients with HNC receiving radiotherapy were enrolled in the study. Patients were examined before radiotherapy and at 6 and 12 months after radiotherapy to evaluate the function and tenderness of the temporomandibular jaw and the muscles of mastication as well as the patient-reported symptoms. RESULTS: At 6 months after radiotherapy, there was a large increase in the number of patients reporting problems with opening their mouth, fatigue, stiffness, and pain of the jaw. Sixty-eight percent of the patients had symptoms of TMD before oncological treatment and 94% and 81% had symptoms at the 6- and 12-month follow-up, respectively. CONCLUSION: The signs and symptoms of TMD escalate after radiotherapy, with symptoms peaking at 6 months after radiotherapy. Most commonly, patients suffer from restricted mouth opening, stiffness, fatigue, and pain of the jaw.

Anterior Bite Opening in Adulthood.

OBJECTIVES: To study anterior bite opening of unknown cause presenting in adulthood regarding prevalence, symptoms of Temporomandibular Dysfunction (TMD) and possible causes of the bite opening. METHODS: Patients referred to two Orofacial Pain and TMD clinics with the complaint of recent anterior bite opening, presenting in adulthood and of unknown cause, were considered for the study. Patients with systemic rheumatic or neuromuscular diseases, degenerative joint disease, previous fractures of the jaws or orthodontic treatment, were excluded. The clinical examination was according to DC/TMD and extended for the occlusion. Reported symptoms, clinical signs, the occlusion and diagnoses found are presented. According to the information gained from the patient's history, previous occlusion and appearance, and present signs of parafunction, a possible association with the bite opening was suggested. RESULTS: Anterior bite opening was found in 1.6% of the referred patients. Symptoms of tiredness and/or orofacial pain were reported by 62%, headache by 41%, TMJ clicking by 24% and sensitive/tender teeth by 41%. Parafunction or bruxism was reported by 2/3 of the patients. A previous period in life of TMD symptoms, before the bite opening, was reported by 66%. Myalgia and headache associated with TMD were frequently diagnosed. The use of a partial dental splint, tongue pressure and pregnancy were possible causes found for the bite opening. CONCLUSION: Anterior bite opening can occur in adulthood without organic or systemic disease of the TMJ or masticatory muscles, and was frequently associated with muscle TMD symptoms.