[Clinical efficiency of occlusive splints in the treatment of patients with temporomandibular joint dysfunction complicated by bruxism]. / Klinicheskaya effektivnost' okklyuzionnykh shin v lechenii patsientov s disfunktsiei visochno-nizhnechelyustnogo sustava, oslozhnennoi bruksizmom.

OBJECTIVE: Improving the effectiveness of treatment of patients with temporomandibular joint (TMJ) dysfunction complicated by bruxism. MATERIAL AND METHODS: 70 patients with signs of parafunction of the masticatory muscles were selected for the clinical study. The patients were divided into 2 groups of 35 people. Splints were made for patients from the groups using 2 different 3D printing methods. The treatment was monitored using clinical and instrumental studies, electromyography of the muscles themselves and computed tomography of the TMJ after 3, 6 and 12 months. RESULTS: The severity of hypertonicity of the masticatory muscles decreased by the end of 3 months of treatment with the help of repositioning occlusal splints. After 6 months of treatment, the mean BEA decreased in both study groups, but to a lesser extent than in the first 3 months. After wearing a splint after 12 months, the decrease in muscle tone was insignificant. CONCLUSION: The clinical use of positioning splints plays a crucial role in the stabilization of occlusion and is a mandatory stage of complex treatment of patients with pathology of the occlusal-musculoskeletal complex.

Repouso eletromiográfico dos músculos mastigatórios de pacientes com disfunção temporomandibular antes e após intervenção fonoaudiológica com e sem bandagem elástica / Electromyographic rest of the masticatory muscles of patients with temporomandibular disorders before and after speech therapy with and without elastic bandage / Resto electromiográfico de los músculos masticatorios de pacientes con trastornos temporomandibulares antes y después de logopedia con y sin venda elástica

Objetivo: A pesquisa tem por objetivo verificar os limiares de repouso eletromiográfico dos músculos masseter e temporal em pacientes com disfunção temporomandibular (DTM) antes e após intervenção fonoaudiológica com e sem a utilização de bandagem elástica terapêutica. Métodos: A coleta contou com 14 participantes do sexo feminino, com idade entre 18 e 40 anos, com diagnóstico de DTM muscular ou mista. As pacientes foram divididas entre dois grupos classificados em: pacientes com bandagem associada à terapia tradicional (CB) e grupo de terapia tradicional (SB). As pacientes inicialmente foram avaliadas pelo exame de eletromiografia de superfície nas situações de contração voluntária máxima e repouso, e após quatro semanas de intervenção, foi realizada nova avaliação com os mesmos instrumentos. A análise dos dados ocorreu de forma quantitativa e qualitativa. Resultados:No grupo SB o músculo masseter direito apresentou aumento dos valores de repouso com significância, foi observado que o mesmo ocorreu para todos os músculos deste grupo, influenciando no equilíbrio da musculatura ipsilateral e contralateral, no entanto sem evidência estatística. O grupo CB não demonstrou valores estatísticos significativos, porém qualitativamente os valores de repouso muscular diminuíram e equilibraram-se de forma contralateral. Conclusão: Não foram observadas mudanças estatisticamente significantes nos limiares eletromiográficos durante repouso dos músculos masseter e temporal em ambos os grupos. Qualitativamente houve aumento dos valores eletromiográficos após terapia manual tradicional em todos os músculos do grupo SB. Com relação ao grupo CB, houve diminuição dos valores do repouso eletromiográfico após terapia, embora sem evidências estatísticas. (AU)

Purpose: Objective: The research aims to verify the electromyographic rest thresholds of the masseter and temporal muscles in patients with temporomandibular disorders (TMD) before and after speech therapy intervention with and without the use of therapeutic elastic bandage. Methods: The collection included 14 female participants, aged between 18 and 40 years, who had a diagnosis of muscular or mixed TMD. The patients were divided into two groups: with traditional therapy (CB) bandage and traditional therapy (SB) only group. The patients underwent initial evaluation, as well as surface electromyography in situations of maximum voluntary contraction and rest and at the end of the four weeks of intervention, a new evaluation was performed with the same instruments. Data analysis occurred quantitatively and qualitatively. Results: In the SB group, the right masseter muscle showed a significant increase in resting values. It was observed that the same occurred for all muscles in this group, influencing the balance of the ipsilateral and contralateral muscles, although without statistical evidence. The CB group did not show statistically significant values, but qualitatively the muscle rest values decreased and balanced in a contralateral way. Conclusion: No statistically significant changes were observed in the resting electromyographic thresholds of the masseter and temporalis muscles in both groups. Qualitatively, there was an increase in electromyographic values after traditional manual therapy in all muscles in the SB group. Regarding the CB group, there was a decrease in electromyographic resting values after therapy, although without statistical evidence. (AU)

Objetivo: La investigación tiene como objetivo verificar los umbrales electromiográficos de reposo de los músculos masetero y temporal en pacientes con trastornos temporomandibulares (TMD) antes y después de la terapia del habla con y sin el uso de venda elástica terapéutica. Métodos: La colección incluyó a 14 participantes mujeres, con edades entre 18 y 40 años, diagnosticadas con TTM muscular o mixta. Los pacientes fueron divididos en dos grupos clasificados en: pacientes con vendaje asociado a terapia tradicional (CB) y grupo de terapia tradicional (SB). Los pacientes fueron inicialmente evaluados mediante electromiografía de superficie en situaciones de máxima contracción voluntaria y reposo, luego de cuatro semanas de intervención se realizó una nueva evaluación con los mismos instrumentos. El análisis de datos se llevó a cabo cuantitativa y cualitativamente. Resultados: En el grupo SB, el músculo masetero derecho presentó un aumento significativo en los valores de reposo, se observó que lo mismo ocurrió para todos los músculos de este grupo, influyendo en el equilibrio de los músculos ipsilaterales y contralaterales, sin embargo, sin evidencia estadística. El grupo CB no mostró valores estadísticamente significativos, pero cualitativamente los valores de descanso muscular disminuyeron y se equilibraron contralateralmente. Conclusión: No se observaron cambios estadísticamente significativos en los umbrales electromiográficos en reposo de los músculos masetero y temporal en ambos grupos. Cualitativamente, hubo un aumento de los valores electromiográficos después de la terapia manual tradicional en todos los músculos del grupo SB. En cuanto al grupo CB, hubo una disminución de los valores electromiográficos de reposo después de la terapia, aunque sin evidencia estadística. (AU)

Qualitative and quantitative assessment of headaches in people with temporomandibular joint disorders: A pilot study.

BACKGROUND: Headaches (HAs) and temporomandibular joint dysfunction (TMD) are common comorbidities, and the presence of one of them in a patient increases the incidence of the other. The relationship between these 2 conditions may involve common pathophysiological processes. Considering the topicality of the problem, it is justified to conduct research in this field. In this study, we assessed HA type and severity in people with TMD. OBJECTIVES: The aim of the study was to conduct qualitative and quantitative assessments of HAs in people with temporomandibular joint (TMJ) disorders. MATERIAL AND METHODS: The study group consisted of 51 subjects of both sexes with a TMD diagnosed using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) test. A self-report questionnaire was utilized to self-assess the presence of TMD symptoms, while the standardized Short-Form of the McGill Pain Questionnaire was used to qualitatively and quantitatively assess HAs. RESULTS: People with TMD were significantly more likely to report HA occurrences (p < 0.001). Pain intensity was statistically significantly higher among individuals with TMD compared to those without TMD symptoms (p < 0.001). Most often, the HA was associated with a pressing pain (r = 0.82) and least often, it was described as cutting (r = 0.30). Neck and shoulder girdle pain (p = 0.059; 82.9%) and clenching and/or grinding of teeth (p = 0.021; 92.7%) were significantly more common among patients who declared HAs than among those without HAs. The results obtained so far may indicate a significant relationship between HA and TMD. CONCLUSION: We have described the relationship between the occurrence of HAs and TMD. Headaches are more frequent and more severe in people with TMD.

Aplicação de ácido hialurônico e corticoide através de uma punção guiada por ultrassonografia no tratamento de disfunção da articulação temporomandibular: relato de caso / Hyaluronic and corticoid application through an ultrasound-guided puncture in the treatment of temporomandibular joint dysfunctions: case report / Aplicación de ácido hialurónico y corticoide a través de una punción guiada por ecografía en el tratamiento de la disfunción de la articulación temporomandibular: informe de un caso

Introdução: As Disfunções temporomandibulares (DTM) incluem desordens dos músculos da mastigação, das articulações temporomandibulares e da inervação local, frequentemente associadas a dor orofacial e que resultam em mioartropatias do Sistema Mastigatório. A tendência atual tende a começar com tratamento conservador e progredir a procedimentos mais invasivos na falha dos tratamentos iniciais. Relato de caso: O presente relato visa mostrar o resultado de uma técnica invasiva para o tratamento de uma DTM grave, com a aplicação do ácido hialurônico e de corticoide através de uma punção guiado por ultrassonografia. A paciente apresentava dor crônica e perda importante de peso devido a limitação da abertura da boca. A RM demonstrou disfunção das ATMs, com sinais de deslocamento parcial do disco direito anteromedialmente. Foi realizada a aplicação bilateral intra-articular de ácido hialurônico e de corticoide através de uma punção guiado por ultrassonografia. Considerações Finais: A associação destas classes na punção de ATMs ainda não está bem estabelecida havendo necessidade de estudos complementares para avaliar eficácia, como este relato de caso, que se mostrou favorável com grande melhora clínica da paciente... (AU)

Introduction: Temporomandibular dysfunctions (TMD) include disorders of the masticatory muscles, temporomandibular joints, and local innervation, often associated with orofacial pain and resulting in myoarthropathies of the masticatory system. The current trend tends to begin with conservative treatment and progress to more invasive procedures if the initial treatments fail. Case Report: The present report aims to show the result of an invasive technique for the treatment of a severe TMD, with the application of hyaluronic acid and corticoid through an ultrasound-guided puncture. The patient presented with chronic pain and significant weight loss due to limited mouth opening. MRI demonstrated TMJ dysfunction, with signs of partial anteromedial dislocation of the right disc. Bilateral intra-articular application of hyaluronic acid and corticoid was performed through an ultrasound guided puncture. Final considerations: The association of these classes in TMJ puncture is still not well established, and further studies are needed to evaluate efficacy, as in this case report, which proved favorable, with great clinical improvement for the patient... (AU)

Introducción: Los trastornos temporomandibulares (TTM) incluyen trastornos de los músculos masticatorios, de las articulaciones temporomandibulares y de la inervación local, a menudo asociados a dolor orofacial y que dan lugar a mioartropatías del sistema masticatorio. La tendencia actual es comenzar con un tratamiento conservador y progresar hacia procedimientos más invasivos al fracasar los tratamientos iniciales. Informe de un caso: El presente informe pretende mostrar el resultado de una técnica invasiva para el tratamiento de un TTM severo, con la aplicación de ácido hialurónico y corticoide a través de una punción guiada por ecografía. El paciente presentaba dolor crónico y una importante pérdida de peso debido a la limitación de la apertura bucal. La RMN demostró una disfunción de la ATM, con signos de dislocación parcial del disco derecho anteromedialmente. Se realizó la aplicación intraarticular bilateral de ácido hialurónico y corticoide mediante una punción guiada por ecografía. Consideraciones finales: La asociación de estas clases en la punción de la ATM aún no está bien establecida y se necesitan más estudios para evaluar la eficacia, como en el reporte de este caso, que resultó favorable con gran mejoría clínica del paciente... (AU)

Effects of a program consisting of strain/counterstrain technique, phonophoresis, heat therapy, and stretching in patients with temporomandibular joint dysfunction: A pilot study.

BACKGROUND: The present study was conceptualized as a pilot study to examine the effects of a 3-week program consisting of strain/counterstrain technique (SCST), phonophoresis, heat therapy, and stretching exercises on pain and functions in patients with temporomandibular dysfunction (TMD). METHODS: Seven participants (mean age 25.85 years) diagnosed with TMD having pain in the temporomandibular joint (TMJ) area with decreased jaw opening were recruited for the study. Treatment interventions consisting of SCST, phonophoresis (ultrasound gel mixed with diclofenac gel), heat therapy, and stretching (mouth-opening) exercises were performed 3 days a week for 3 weeks. SCST was performed on the masseter, medial, and lateral pterygoid muscles. No control group was present in the study. RESULTS: Paired samples t test revealed a significant difference in numerical pain rating scale (NPRS) (decreased by 50%, P < .001) and jaw functional limitation scale (JFLS) (reduced by 59.58%, P < .001) scores after 3 weeks of intervention. A large effect size (Cohen d = -3.00 for NPRS and -3.16 for JFLS) was observed for both variables. No correlation (R = 0) was found between the baseline values of NPRS and JFLS. CONCLUSION: A 3-week program consisting of SCST, phonophoresis, heat therapy, and stretching exercises was effective in reducing the pain and improving the functions related to TMJ in patients suffering from TMD. However, a randomized controlled trial is needed to reach a definite conclusion.

Intra-articular injections in the TMJ inferior joint space: A scoping review.

OBJECTIVE: To perform a scoping review to identify the available evidence regarding intra-articular injections in the inferior joint space (IJS) of the temporomandibular joint (TMJ). METHODS: An electronic search of the PubMed, Web of Science and Scopus databases was performed using the following terms: "Arthrocentesis", "injection", "joint injection", "technique", "Temporomandibular joint", "Temporomandibular joint disorder". Full-text articles were obtained from the records after applying the inclusion/exclusion criteria. Only articles with full-text access were included. RESULTS: Thirteen articles were included for analysis-one technical note, three cadavers studies, one animal study, two case reports, five randomised clinical trials and one retrospective study; studies were classified as 'patients-based studies' and 'non-patients-based studies'. Most 'patients-based studies' show moderate or high risk of bias. Techniques were categorised as 'anatomical technique' and 'image-guided technique'. Most 'patients-based studies' show favourable outcomes such as pain reduction, increase in maximum mouth opening, improvement in quality of life and improvement in TMJ dysfunction indexes for the treatment of arthrogenic TMDs. Comparisons between superior and IJS injections are scarce. On the other hand, 'non-patients-based' studies show that image-guided or ultrasound-checked injection techniques achieved a higher effectiveness for needle location than anatomical (or blind) techniques. CONCLUSION: The amount of available evidence is scarce, heterogeneous in design, and most 'patients-based studies' show moderate or high risk of bias, which demands the generation of new research to obtain definitive conclusions. The tendency observed suggests that intra-articular injections for the IJS of the TMJ are able to relieve TMJ pain, increase mouth opening and improve TMJ dysfunction, and image-guided injection techniques seem to be more effective than anatomical techniques to locate the needle in the IJS.

Prevalence of Temporomandibular Disorders in Orthognathic Surgery patients: A systematic review conducted according to PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions.

BACKGROUND: Orthognathic surgery is done to treat a variety of dentofacial abnormalities, but a wide gap still remains on how it can result in temporomandibular joint dysfunction (TMD). The primary goal of this review was to assess the effects of various orthognathic surgical techniques on the emergence or exacerbation of TMJ dysfunction. METHODS: A comprehensive search was conducted across several databases using Boolean operators and MeSH keywords related to temporomandibular joint disorders (TMDs) and orthognathic surgical interventions, with no limitation on the year of publication. Two independent reviewers screened the identified studies based on predetermined inclusion and exclusion criteria, followed by a risk of bias assessment using a standardised tool. RESULTS: Five articles were considered for inclusion in this review. A greater number of females opted for surgical options than their male cohorts. Three studies were of prospective design, 1 of retrospective and 1 of observational type. Mobility on lateral excursion, tenderness on palpation, arthralgia and popping sounds were the TMD characteristics that showed significant differences. Overall, orthognathic surgical intervention did not show an increase in TMD signs and symptoms as compared to nonsurgical counterparts. CONCLUSION: Though orthognathic surgery reported greater cases of some TMD symptoms and signs as compared to the nonsurgical cohorts in four studies, the conclusive evidence is debatable. Further studies are recommended with a longer follow-up period and greater sample size to determine the impact of orthognathic surgery on TMJ.

Carboxytherapy for the elimination of pain symptoms (or arthralgia) among the elderly persons with the pathology of the temporomandibular joint.

Temporomandibular arthralgia is difficult to treat, painful and often relapses. 48 patients (19 men and 29 women) aged 61-72 years, suffering from the syndrome of pain dysfunction of the temporomandibular joint, were under observation. In 1st (control) group of patients (18 people), NSAIDs indomethacin in tablet form of 25 mg 3 times a day were used for 9 days. In patients of the 2nd (main) group (30 people), the method of invasive carboxytherapy was used, consisting in subcutaneous injection of carbon dioxide with a volume of 3 ml of 5 procedures every other day. On the 3rd, 9th and 15th days of follow-up, invasive carboxytherapy was more effective than the use of a nonsteroidal anti-inflammatory agent by 8.9; 36,5 and 37%, respectively. The high efficiency of the method of invasive carboxytherapy for the elimination of pain symptoms in pain dysfunction was shown, which was 22,86% on day 3; 64,29% on day 9 and 68,16% on day 15 of observation. The method of invasive carboxytherapy can be used in the complex treatment of patients with pain dysfunction of the temporomandibular joint.

Orofacial myofunctional reeducation: what is the scientific background? / Rééducation myofonctionnelle orofaciale : quelles justifications scientifiques ?

Introduction: In 85% of orthodontic patients, lingual dyspraxias are present and may justify orofacial myofunctional rehabilitation because of their morphogenetic potential. The objective of this literature review is to search for scientific arguments corroborating or not the relationships between dysmorphias and the static, dynamic labio-lingual-jugal balance during functions and parafunctions. Material and Method: A review of the literature was carried out by keywords on PubMed. The search covered the period from 1913 to 2022. A complementary selection of articles or book chapters was made from the references of the included articles. Results: The morphogenetic role of the tongue is mainly involved at rest and during ventilation in all three dimensions. Oral ventilation is associated with many craniofacial dysmorphy. Concerning swallowing, phonation, non-nutritive sucking and temporomandibular joint dysfunctions, it is the combined association of several anomalies that is found in dysmorphia without a causal link being established. Thus, for some, the lingual posture would only constitute an adaptation to a dysmorphia. Discussion: Essentially based on expert opinion, the level of evidence is still insufficient. The authors are confronted with the difficulty of finding adequate, quantifiable and reproducible indicators. Conclusion: This subject, which probably remains neglected because it is interdisciplinary and the result of a historically European reflection, deserves to be further studied.

Introduction: Chez 85 % des patients orthodontiques, les dyspraxies linguales sont présentes, pouvant justifier une rééducation myofonctionnelle orofaciale en raison de leur supposé potentiel morphogénétique. L'objectif de cette revue de littérature était de rechercher les arguments scientifiques corroborant ou non les relations entre les dysmorphies et l'équilibre labio-linguo-jugal statique, dynamique lors des fonctions et des parafonctions. Matériel et méthode: Une revue de littérature a été réalisée par mots clés sur les bases de données PubMed (Medline) et EM Consulte. La recherche s'étend sur la période de 1913 à 2022, une sélection complémentaire d'articles ou de chapitres de livres a été effectuée à partir des références des articles inclus. Résultats: Le rôle morphogénétique de la langue intervient essentiellement au repos et lors de la ventilation dans les trois dimensions. Une ventilation buccale est associée à de nombreuses dysmorphies cranio-faciales. Concernant la déglutition, la phonation, la succion non nutritive et les dysfonctionnements des articulations temporo-mandibulaires, c'est la conjugaison de plusieurs anomalies qui est retrouvée dans les dysmorphies, sans que le lien de cause à effet ne soit établi. Ainsi, pour certains, la posture linguale ne constituerait qu'une adaptation à une dysmorphie. Discussion: Essentiellement basé sur des avis d'experts, le niveau de preuves demeure encore insuffisant. Les auteurs se heurtent à la difficulté à trouver des indicateurs adéquats quantifiables et reproductibles. Conclusion: Ce sujet, qui reste probablement délaissé car il est interdisciplinaire et le résultat d'une réflexion historiquement européenne, mérite d'être davantage étudié.

COMPARATIVE EVALUATION OF THE TEMPOROMANDIBULAR JOINT STRUCTURES AFFECTED BY TMJ DYSFUNCTION.

OBJECTIVE: The aim: To investigate the individual anatomical features of the temporomandibular joint structures affected by TMJ disorders and compare them with those of asymptomatic patients. PATIENTS AND METHODS: Materials and methods: The sample consisted of 41 patients. The study group included 29 patients. The retroposition of the right mandibular head was observed in 16 patients, the anterior position of the right mandibular head - in 13 patients, the retroposition of the left mandibular head - in 19 patients, and the anterior position of the left mandibular head - in 10 patients. The control group consisted of 12 patients with an anterior or central position of the right and left mandibular heads. RESULTS: Results: In the study group, a comparative analysis of the ABC angle on the right and left sides found no statistically significant difference in Student's criterion (p=0.176). In the control group, a comparative analysis of the ABC angle on the right and left sides found no statistically significant difference in Student's criterion (p=0.131). To identify a possible difference in the inclination of the articular tubercle in the study and control groups (anterior position of the mandibular head), calculations were carried out and when comparing two related samples using Wilkinson's T-criteria, the difference is not statistically significant p=0.119. The mean values obtained using Student's criterion did not reveal any statistically significant difference between both groups, р*=0,811. CONCLUSION: Conclusions: A comparative analysis of the ABC angle in patients with TMJ dysfunction and the control group did not reveal any statistically significant difference. At the same time, there was no statistically significant difference between patients with the anterior and posterior position of the mandibular head.

Evaluation of temporomandibular joint dysfunction in traumatic brain injury patients.

BACKGROUND: The aim of this study was to evaluate the frequency of temporomandibular joint dysfunction and related factors in patients with traumatic brain injury. METHODS: A total of 60 participants, 30 patients with traumatic brain injury and 30 healthy volunteers of similar age, have been included in this study, which was designed as a hospital-based cross sectional study. Fonseca questionnaire was used to evaluate and classify the temporomandibular joint dysfunction. Temporomandibular joint range of motion was evaluated with a digital calliper, and masticatory muscles pressure pain threshold was evaluated with an algometer. Labial commissure angle measurement was used to evaluate the severity of facial paralysis. Complications related to traumatic brain injury were recorded in patients with traumatic brain injury. RESULTS: According to Fonseca questionnaire score, 80% of traumatic brain injury patients and 16.7% of the control group had temporomandibular dysfunction (p < .001). In the intergroup comparison, a significant decrease was found in all temporomandibular range of motion and masticatory muscles pressure pain threshold parameters in favour of the traumatic brain injury group (p < .001). Labial commissure angle and Fonseca questionnaire scores were higher in the traumatic brain injury group (p < .001). The frequency of temporomandibular dysfunction was more common in traumatic brain injury patients with headache than in those without headache, as shown by the results of the Fonseca questionnaire (p = .044). CONCLUSION: Compared to healthy controls, patients with traumatic brain injury experienced issues with the temporomandibular joint more frequently. Additionally, TBI patients with headaches had a greater frequency of temporomandibular joint dysfunction. Therefore, it is advised to check for temporomandibular joint dysfunction in traumatic brain injury patients during follow-up. In addition, the presence of headache in traumatic brain injury patients may be a stimulant for temporomandibular joint dysfunction.

[Treatment approach to patients with distal malocclusion complicated by temporomandibular joint pain-dysfunction syndrome]. / Podkhody k lecheniyu patsientov s distal'noi okklyuziei zubnykh ryadov, oslozhnennoi sindromom bolevoi disfunktsii visochno-nizhnechelyustnogo sustava.

OBJECTIVE: Research is effective sequencing of measures for orthodontic treatment active period and unfavorable course of retention period predictors in patients with distal malocclusion, complicated by temporomandibular joint pain-dysfunction syndrome. MATERIAL AND METHODS: The retrospective study consists of 102 case reports of patients from 18 to 37 (average age is 26.75±3.25 years) with distal malocclusion (Angle Class II division 2 subdivision) associated with temporomandibular joint pain-dysfunction syndrome. RESULTS: Cases of successful treatment were 30.4% (n=31), semi-successful - 42.2% (n=43), semi-unsuccessful - 18.6% (n=19), unsuccessful - 8.8% (n=9). ANOVA analysis of orthodontic treatment stages reveals main risk factors for pain syndrome recurrence in retention period. The ineffective morphofunctional compensation and unsuccessful orthodontic treatment predictors are: incomplete pain syndrome elimination, persistent masticatory muscles dysfunction, distal malocclusion recurrence, condylar process distal position recurrence, deep overbite, upper incisors retroinclination for more than 15°, single posterior tooth interference. CONCLUSION: Thus, pain syndrome recurrence prevention in retention orthodontic treatment period includes pain and masticatory muscles dysfunction elimination in pre-treatment period, physiological dental occlusion and condylar process central position in active period.

Do Temporomandibular Disorder Patients with Joint Pain Exhibit Forward Head Posture? A Cephalometric Study.

Purpose: To evaluate head and cervical posture in individuals with or without temporomandibular disorders (TMDs) and to assess the correlations between pain, severity of symptoms, and posture. Methods: A total of 384 patients (129 males and 255 females) was included. The Fonseca Anamnestic Index (FAI) was used to assess the severity and prevalence of TMD and the presence of temporomandibular joint (TMJ) pain. Patients were divided into three groups: the TMD-free group, TMD without TMJ pain group, and TMD with TMJ pain group. Subsequently, the patients with TMJ pain were further divided into mild TMD and moderate/severe TMD groups. Nine parameters were traced on cephalograms to characterize the head and cervical posture. Results: TMD patients with TMJ pain showed increased forward head posture (FHP) than patients without TMJ pain and TMD-free subjects. No significant difference was observed between the TMD patients without TMJ pain and TMD-free subjects. In the TMD patients with the TMJ pain group, the moderate/severe TMD patients demonstrated increased FHP compared to mild TMD patients. TMD patients with joint pain had greater CVT/RL (B = 3.099), OPT/RL (B = 2.117), and NSL/C2' (B = 4.646) than the patients without joint pain after adjusting for confounding variables (P < 0.05). Conclusion: TMD patients with TMJ pain showed increased FHP compared to other groups, and FHP became more significant as TMD severity increased in male patients, indicating the FHP might play an important role in the development of TMJ pain. In the clinical assessment of TMD, the patients' abnormal head and cervical posture might be considered.

Psoriatic arthritis of the temporomandibular joint: A systematic review.

OBJECTIVES: Psoriasis is an inflammatory condition brought on by the immune system. This study aimed to perform a systematic review related to psoriatic arthritis (PsA) of the temporomandibular joint (TMJ). METHODS: The search strategy was developed by a radiologist expert with more than 20 years of experience. The search was performed without time restrictions in five electronic databases: PubMed, Web of Science, Embase, Scopus and Ovid. The search strategy was based on MeSH and Emtree terms. The methodological quality of the studies was rated using the quality assessment tools from the National Heart Lung and Blood Institute (NHLBI). RESULTS: Twenty-three publications were included, 10 being case reports. One hundred-fifty-one patients with TMJ PsA were reported. Psoriasis evolution ranged from 1.5 years to 24 years. Clinical symptoms of TMJ involvement included: TMJ pain and sounds, limited range of jaw movements, preauricular swelling, malocclusion, headache, tinnitus, neck stiffness and altered dietary function. TMJ was evaluated by magnetic resonance imaging (six studies), computed tomography (eight articles) and by ultrasonography findings (two articles). For TMJ treatment, topical and systemic medication was reported in 11 studies. Five studies included patients needing surgical procedures for TMJ ankylosis. CONCLUSIONS: A relationship between TMD and psoriasis has been revealed. TMJ PsA has been investigated and debated, although the radiographic findings or clinical symptoms of PsA are not noticeably different from other forms of TMJ arthritis. Conservative therapy can lead to significant improvement of TMJ function.

Relationship between myofascial pain and facial types: an observational study / Relação entre dor miofascial e tipos faciais: um estudo observacional

Temporomandibular disorder (TMD) is a term that covers a number of clinical problems involving the masticatory muscles, TMJ and all associated structures leading to signs and symptoms such as jaw pain, otalgia, headaches and limitation of function. In this context, TMD has been related to facial type and there are three distinct facial types (euryprosopic, mesoprosopic, and leptoprosopic). Objective: The aim of this study was to investigate the correlation between myofascial pain and facial types classified by the RDC/TMD Axis I. Material and Methods: this study was composed of 64 women aged between 12 and 49 years, using data obtained from two institutions. We used the anthropometric methodology, which meets the criteria of simplicity and reliability. We also applied the Brugsh Facial Index. The individuals were classified as euryprosopic (51.56%), mesoprosopic (12.50%) and leptoprosopic (35.94%), without statistical significance among the groups (p=0,3492). Results: there is no statistical difference between the age groups (p=0.2976) and no association between facial type and age range. Conclusion: this study found that there was a correlation between myofascial pain and facial types, with the predominance of euryprosopic faced women aged between 20 and 29 years when compared with other facial types and other age groups. (AU)

A Disfunção Temporomandibular é um termo que cobre uma série de problemas clínicos envolvendo os músculos mastigatórios, ATM e todas as estruturas associadas que levam a sinais e sintomas como dor na mandíbula, otalgia, dores de cabeça e limitação de função. Nesse contexto, a DTM tem sido relacionada ao tipo facial que são classificados em três tipos distintos (euryprosopo, mesoprosopo e leptoprosopo). Objetivo: O objetivo deste estudo foi investigar a correlação entre a dor miofascial e os tipos faciais classificados pelo RDC/TMD Eixo I. Material e Métodos: este estudo foi composto por 64 mulheres com idade entre 12 e 49 anos, utilizando dados obtidos em duas instituições. Utilizou-se a metodologia antropométrica, que atende aos critérios de simplicidade e de confiabilidade. Também foi utilizado o Índice Facial de Brugsh. Os indivíduos foram classificados em euriprosopo (51,56%), mesoprosopo (12,50%) e leptoprosopo (35, 94%), sem significância estatística entre os grupos (p = 0,3492). Resultados: não houve diferença estatística entre as faixas etárias (p = 0,2976) e nenhuma associação entre tipo facial e faixa etária. Conclusão: este estudo constatou que houve correlação entre dor miofascial e tipos faciais, com predomínio de mulheres euriprosopo com idade entre 20 a 29 anos quando comparadas com outros tipos faciais e outras faixas etárias.(AU)

Association of temporomandibular joint osteoarthrosis with dentoskeletal morphology in males: A cone-beam computed tomography and cephalometric analysis.

OBJECTIVE: The objective of the study was to assess the differences in dentoskeletal morphology in males with and without temporomandibular joint osteoarthrosis (TMJOA). METHODS: Three hundred seventy-one male participants seeking orthodontic treatment were enrolled in this cross-sectional study. Each participant's osseous status was evaluated using cone-beam computed tomography (CBCT) and classified into normal (N = 104), indeterminate for TMJOA (N = 110) and TMJOA (N = 157) groups. The dentoskeletal characteristics were evaluated using cephalograms. Stratified analysis was performed based on age and skeletal pattern. Descriptive statistics and one-way analysis of variance were performed to investigate dentoskeletal differences among groups. P < .05 was considered statistically significant. RESULTS: The differences in posterior cranial base length, FMA, MP-OP, anterior facial height, articular angle, ramus height and L1-MP were statistically significant. After stratification by age, the differences in FMA, maxillomandibular angle, posterior facial height, facial height ratio, gonial angle and mandibular body length were statistically significant in adults. No statistical difference except for articular angle was observed in adolescents. After stratification by skeletal pattern, statistical differences were mainly apparent in skeletal Class II adults. CONCLUSION: Males with TMJOA showed a posteriorly positioned and backward-rotated mandible, especially in skeletal Class II adults. Compared with women, the craniofacial morphology of men is less affected by TMJOA. The association between TMJOA and craniofacial morphology also varied across different age groups and skeletal patterns. Prospective studies are required to clarify the cause-effect relationship between TMJOA and craniofacial morphology in males.

Evaluation of Influence of Arthroscopy on the Range of Mandibular Movements Based on Medical Records.

The Temporomandibular Joint Dysfunction Syndrome (TJDS) is a group of pathologies that affect the temporomandibular joint, mastication muscles, and attached structures, 1 of the leading causes of orofacial pain. Arthroscopy is a technique used as a method of treatment for TJSD. This was a retrospective cohort study, and data were collected from the medical records of patients with TJDS. The diagnosis of TJDS was established based on computed tomography and nuclear magnetic resonance imaging tests, and clinical examination. All patients, who underwent arthroscopy, were operated on by the same surgeon in 2020. The variables analyzed in this study were: maximum mouth opening, laterality, and protrusion of patients undergoing arthroscopy at time intervals of 30, 90 days, and 6 months after surgery. Data from anamnesis of the medical records and findings on clinical examination were used to verify whether there was any correlation with good postoperative evolution. Afterward, these data were compared and submitted to statistical analysis (Wilcoxon (nonparametric and paired) and Mann-Whitney (nonparametric, unpaired) tests) to verify the degree of correlation between them. It could be concluded that in this sample, arthroscopy reduced the degree of pain in patients, increased mouth opening amplitude, and did not influence laterality and protrusion. The use of previous medication was correlated with a slight decrease in postoperative pain; patients who had undergone previous orthodontic treatment showed better results regarding maximum mouth opening without pain; patients who had previously felt pain on professional palpation had greater maximum mouth opening with and without pain after arthroscopy, and patients with noise at professional auscultation had greater maximum mouth opening without pain. Further studies should be conducted, with larger samples, associated with complementary exams (computed tomography and nuclear magnetic resonance) before and after arthroscopy.

Overview de revisões sistemáticas das modalidades de tratamentos em disfunções temporomandibulares musculares / Overview of systematic reviews of treatment modalities in temporomandibular muscle disorders

As disfunções temporomandibulares (DTM) são alterações capazes de comprometer substancialmente a qualidade funcional mastigatória, além de resultar em quadros clínicos dolorosos que podem ser constantes ou transitórios. No caso das disfunções temporomandibulares musculares (DTM-M), terapias que buscam melhorar a contração muscular sustentada são as mais indicadas. Várias abordagens terapêuticas são disponibilizadas, no entanto foram selecionados para análise farmacoterapia, fisioterapia, placas oclusais, laser de baixa potência, acupuntura, ozonioterapia, agulhamento seco, agulhamento com infiltração de: toxina botulínica ­ A, plasma rico em plaquetas e anestésico local, analisados e investigados por revisões sistemáticas e metanálises. Dessa forma, o presente estudo teve como objetivo unificar em uma revisão geral (overview) as sínteses das revisões sistemáticas já produzidas para buscar uma base de evidências ampla e de qualidade sobre os tratamentos para DTM-M. Para isso foi realizada uma busca sistemática nas bases de dados: MEDLINE-PubMed, EMBASE, BVS (LILACS e BBO), Web of Science, SCOPUS e Cochrane of Sistematic Reviews. Foram examinados 1623 artigos e após a análise dos títulos e resumos, foram selecionados 134 artigos para leitura na íntegra, resultando em 12 estudos para análise de qualidade pela ferramenta AMSTAR 2. Destes, dez revisões foram consideradas criticamente baixas e duas de qualidade baixa. De acordo com a síntese dos resultados, os tratamentos abordados apresentam certa efetividade, porém necessitam de estudos de qualidade metodológica mais consistente para que haja maior robustez de evidências (AU)

Temporomandibular disorders (TMD) are alterations to able of compromising masticatory functional quality, in addition to resulting in painful clinical conditions that may be constant or transient. In the case of muscle temporomandibular disorders (TMD-M), therapies that seek to improve sustained muscle contraction are the most indicated. Several therapeutic approaches are available, however, pharmacotherapy, physiotherapy, occlusal splints, low power laser, acupuncture, ozone therapy, dry needling, needling with infiltration of: botulinum toxin - A, platelet-rich plasma and local anesthetic, were selected for analysis. and investigated by systematic reviews and meta-analyses. Thus, the present study aimed to unify in a general review (overview) the syntheses of systematic reviews already produced to seek a broad and quality evidence base on treatments for M-TMD. For this, a systematic search was carried out in the databases: MEDLINE-PubMed, EMBASE, BVS (LILACS and BBO), Web of Science, SCOPUS and Cochrane of Systematic Reviews. 1623 articles were reviewed and after analyzing the titles and abstracts, 134 articles were selected for reading in full, generated in 12 studies for quality analysis by the AMSTAR 2 tool. Of these, ten reviews were considered critically low and two were considered low. According to the synthesis of the results, the observed treatments presented certain patterns, however observed from studies of more consistent methodological quality so that there is greater robustness of evidence (AU)

Professional delays in referral of patients with mouth cancer: six case histories.

Professional delay is an important delay in referral of patients with suspected mouth cancer. Missing the possibility of cancer might not only result in worse outcomes in respect to function and survival, but also have medicolegal implications. The aim of this article was to review a consecutive cohort of patients over a two-year period with mouth cancer diagnosis and identify those with professional delay and illustrate the main types of presentations using short case histories. The multi-disciplinary team records were used to identify case notes of a two-year (2019 and 2020) consecutive cohort of patients diagnosed with mouth cancer, including referrals from primary and secondary care. Professional delay was considered if red flag symptoms were not referred within two weeks or if there was initial misdiagnosis. In total, 246 patients with mouth cancer were discussed with the multi-disciplinary team: 35 had delay in referral or misdiagnosis of mouth cancer. Six common scenarios were identified: 1) sudden onset paraesthesia; 2) dental abscess; 3) temporomandibular joint dysfunction syndrome (TMJD) and abscess; 4) TMJD; 5) trauma/facial fracture; and 6) non-healing socket following dental extraction. To conclude, it can be difficult to accurately diagnose mouth cancer in primary dental and medical care and an index of suspicion is essential in order to minimise the possibility of professional delay.

[Development of a program for automatic collection and archiving of clinical data of patients with dysfunction of the temporomandibular joint]. / Razrabotka programmy avtomaticheskogo sbora i arkhivirovaniya klinicheskikh dannykh patsientov s disfunktsiei visochno-nizhnechelyustnogo sustava.

OBJECTIVE: Development of a program for the automatic collection and archiving of clinical patients with TMJ dysfunction. MATERIAL AND METHODS: Based on the clinical examination of 50 patients aged 18 to 30 years with temporomandibular joint dysfunction and the presence of an articular disc dislocation verified by magnetic resonance imaging, 80 signs were identified and terminologically formalized and were divided into 13 groups. RESULTS: This was the basis for the development of a detailed questionnaire for this contingent of patients, which the authors consider as the primary source of systematized data for processing in the program for automatic collection and archiving of clinical data. For graphical (animation) support for patient questioning, a library of "virtual patient" graphic files has been created, which includes static and dynamic animation explanations of the questions. CONCLUSION: An algorithm for optimizing the patient interrogation system based on the principle of excluding irrelevant units has been developed and implemented in the program.