Evaluation of the stomatognathic system in patients with rheumatoid arthritis according to the research diagnostic criteria for temporomandibular disorders.

The aim of this study was to investigate the clinical features of stomatognathic dysfunction in patients with rheumatoid arthritis (RA). The study sample consisted of 40 patients with RA (34 female, 6 male), mean age 44 years, recruited at the Rheumatology Division of the Department of Internal Medicine, University of Pisa, Italy. The inclusion criteria were diagnosis of RA according to the criteria of the American Rheumatism Association (ARA). In the study, 82.5% (n=33) of patients affected by RA satisfied at least the criteria of one diagnosis of temporomandibular disorders (TMD), according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The results are in agreement with the literature and the prevalence of such involvement ranges between 53% and 94% of patients. Several studies reported an involvement of the stomatognathic system in RA. In fact, RA can affect the temporomandibular joint as much as any other synovial joint. A more thorough analysis is required for a multidisciplinary approach to gnathological patients, including assessment by a rheumatologist. This issue and its epidemiologic relevance need further scientific research. Dentistry has a fundamental role in this process since patients who present with a systemic disease such as RA can be recognized and intercepted and referred to medical specialists, i.e., rheumatologists, to provide a diagnosis and therapy.

Evaluation of the effectiveness of biobehavioral therapy in the treatment of temporomandibular disorders: a literature review.

Temporomandibular disorders (TMDs) involve a heterogeneous group of clinical conditions affecting the stomatognathic system and its related structures. Because the etiology of these disorders is still unclear, a wide range of therapeutic solutions has been proposed in the literature, including occlusal appliances, physical therapies, drugs, and biobehavioral modalities. Biobehavioral therapy could have a beneficial effect in the treatment of TMDs because of the reportedly high prevalence of psychological dysfunction in TMD patients. The authors reviewed the biobehavioral modalities used to achieve pain relief in patients affected by such disorders, with the aim of synthesizing data on the effectiveness these therapeutic approaches. Literature data suggest that the inclusion of biobehavioral interventions in the management of TMDs may be reasonable, even if no conclusions can be drawn about their long-term effectiveness.

Clinical features of the stomatognathic involvement in fibromyalgia syndrome: a comparison with temporomandibular disorders patients.

Several studies have reported an involvement of the stomatognathic system in the course of fibromyalgia (FM) similar to that which characterizes temporomandibular disorders (TMD). The aim of this study was to investigate and compare the clinical features of stomatognathic dysfunction in patients with FM and TMD. Ninety-three FM patients underwent an assessment according to the RDC/TMD guidelines. Prevalence of the different RDC/TMD diagnoses and some clinical parameters of FM patients were compared with those of 181 patients affected by TMD. Seventy-four (79.6%) FM patients presented at least one RDC/TMD diagnosis and showed lower mean maximum voluntary and passive mouth opening values than TMD patients. Moreover, 34 FM patients presented with trigger and/or tender points. Results of the present study confirm the high rate of involvement of the stomatognathic system in the course of FM and support the need for a careful multidisciplinary approach to patients with TMD, including the rheumatologist.

Current concepts on the functional somatic syndromes and temporomandibular disorders.

BACKGROUND: The importance of psychosocial factors in the etiopathogenesis of temporomandibular disorders (TMD) has led to the hypothesis that these disorders may be part of a wider group of somatoform disorders, the functional somatic syndromes (FSS). Types of studies reviewed. The present paper is an overview summarizing the current concepts on the TMD-FSS relationship. A non-systematic search in the Medline database identified peer-reviewed papers on the epidemiological and clinical characteristics of the complex groups of disorders labelled functional somatic syndromes, focusing on the common features to temporomandibular disorders patients. RESULTS: Literature data suggest that FSS and TMD share many etiopathogenetic and epidemiological features, both groups of disorders having a multifactorial etiopathogenesis and needing a multidisciplinary approach to diagnosis and treatment. Psychosocial characteristics of patients seem to have many similarities and the prevalence of Axis I psychiatric disorders is elevated. The majority of studies focused on the relationship between TMD and fibromyalgia (FM), due to the high rate of orofacial involvement related to FM. Clinical implications. The presence of common features between TMD and FSS patient may suggest the need for changes in the diagnostic and therapeutic approach to TMD patients, with the introduction of treatment protocols which also address the psychosocial impairment accompanying TMD symptoms, in order to overcome the limits of traditional therapies.