The concurrency of temporal tendinitis with TMD.

Temporomandibular disorder (TMD) is a type of orofacial pain that can originate from a number of craniofacial mandibular structures. These include the TM joints, the muscles of mastication, related nerves, tendons, ligaments, bones and teeth. Symptoms include impaired jaw function, TM joint noises and pain, limited opening, often with jaw deviations or deflections to the affected side. Temporal tendinitis is a disorder of the fibrous insertion of the temporalis muscle tendons on the coronoid process of the mandible that is characterized by both inflammation and degeneration. Sometimes, temporal tendinitis can be the primary disease entity, but the authors found that it frequently coexists with TMD. This retrospective study was undertaken to determine the prevalence of temporal tendinitis with TMD. The charts of 449 patients diagnosed with TMD were reviewed to determine the incidences of temporal tendinitis. The referred pain sites and their incidences were also determined.

Provocation testing to assist craniomandibular pain diagnosis.

Patients with TMD often present with complex pain symptoms, which can make it difficult to reach a diagnosis. Usually palpation of the masticatory muscles and TM joints, range of motion testing and imaging are used in the diagnostic process. Sometimes it is necessary to evaluate the jaw moving muscles from a functional prospective because they cannot be palpated due to inaccessibility or because they have other structures that are more superficial to them. In these instances, provocation testing can be a helpful adjunct in providing some insight into what is occurring in the area being tested and localizing a suspected source of pain. Anesthesia blocking can be used to confirm any positive findings. This article explores several provocation tests that can be used to evaluate conditions of the masticatory musculature, the TM joints and the stylomandibular ligament.

Masseter tenomyositis.

The masseter muscle is an integral part of the oral facial complex and one of the muscles of mastication. It functions with the other masticatory muscles in moving and posturing the mandible and in verbalizing, eating and swallowing. When a patient has temporomandibular dysfunction (TMD) or a myogenic disorder, the integrity of the masseter muscle can be compromised resulting in pain, malfunction, inflammation and/or swelling. A careful evaluation of the masseter muscles is necessary in facial pain patients since the pain can originate from a distant site and be referred to this area. One of the little known disorders involving the masseter and its tendinous origin is tenomyositis, in which an inflammation of the muscle and its tendon occurs. In this retrospective study, the charts of 114 consecutive patients (N = 114) were evaluated to determine the prevalence of this disorder and the reported etiology.

Management of nocturnal bruxism with an anterior stop point appliance.

Bruxism is an oral parafunctional activity. The more common symptoms are tooth grinding and tooth clenching; however, many other symptoms can be related to bruxism. Dentists treat the results of this condition which may include tooth wear, tooth mobility, tooth fracture, hypertrophy of masticatory muscles, head or neck ache, or poor sleep patterns. The etiology and pathophysiology of this disorder are still unclear. Anterior stop point appliances have been shown to be beneficial in the management of the signs and symptoms associated with bruxism, including nocturnal headaches in certain patient populations. The object of this study was to determine if anterior bite stop appliances with a small discluding element would be helpful in managing the subject's nocturnal bruxism symptoms.

Comorbidity of pterygoid hamular area pain and TMD.

Often craniofacial pain subjects report a number of conflicting and overlapping symptoms that can present a confusing clinical picture. Reaching a diagnosis on these individuals can prove to be a frustrating and difficult event for both the examiner and the patient. Thus, it is incumbent on clinicians treating patients with pain in the head, face and neck areas to be familiar with the less common pain disorders to assist in the differential review. This retrospective study examines the comorbidity of pterygoid hamulus pain with temporomandibular disorders (TMD). To acquire this information, the charts of 464 subjects with TMD in a private setting were examined to determine if pterygoid hamular pain was found at the evaluation. Ninety-two patients (N=92) had positive findings. Areas of referred pain that were elicited during the examination were charted. The pterygoid hamular area should be evaluated in individuals with TMD and especially those presenting with posterior palate and throat pain.

Acute malocclusion.

Acute malocclusion can result from disturbances in the maxillary/mandibular tooth relationship. These alterations in the occlusal position can result from high fillings, sinus problems, abscesses, periodontal disease, and moving or erupting teeth. Conditions seen less frequently include acute malocclusions secondary to an event (such as trauma) that make a stable dental relationship an unstable one. Patients can demonstrate any of a number of clinical conditions that interfere with their comfort and ability to function. This article provides information on some of the less familiar causes of acute malocclusion.

Clinical use of iontophoresis to treat facial pain.

Iontophoresis is a modality that assists with the entry of certain therapeutic medications into injured sites. Medications, such as anesthetics, vasoconstrictors, and some corticosteroids, when dissolved in water, separate into positive and negative ions. When an electric current is passed through an ionized solution, the ions of these agents carry the electric current from the positive to the negative electrode. The above medications have been shown to be beneficial in the treatment of TMD. These agents in liquid form are placed in meditrode pads that are attached to skin or mucosal surface over the sites that are to be treated. The treating (active) meditrodes and a larger ground (dispersive or return) meditrode are attached to an iontophoretic unit by wire leads to form a closed circuit. With iontophoresis, the treating medications can be placed in the target areas in high concentrations.

Simplified anesthesia blocking of the temporomandibular joint.

The general dentist's ability to perform an anesthesia block of the temporomandibular joint (TMJ) can be very beneficial, especially when trying to diagnose or treat patients with temporomandibular dysfunction who have joint and/or muscle pain. There are three common types of internal joint disorders--orthopedic, inflammatory, and degenerative--producing pain in the ligaments, TMJ capsule, or retrodiscal tissues. Secondary muscle splinting also may be involved. Subjects with these disorders can have pain, limited opening, or difficulty with extended opening. Dentists providing care for these individuals may need to schedule longer appointments and deal with mid-treatment facial or TMJ pain as well as more postoperative discomfort. An anesthesia block for the TMJ can reduce pain and protective muscle splinting, increase the mandibular range of motion, and assist in providing a more manageable treatment.

The prevalence of trigeminal neuritis with TMD.

Subjects with temporomandibular joint disorder (TMD) occasionally present with additional orofacial pain complaints. These can arise from dysfunction in teeth, bones, ligaments, tendons, nerves, and other structures. In this retrospective study, a group of 501 consecutive subjects with TMD complaints were evaluated for the presence of trigeminal neuritis. Very little information on the prevalence of this condition concomitant with TMDs exists in the literature. The existence of trigeminal neuritis was determined by the presence of pain when palpating trigeminal peripheral nerve branches exiting the supraorbital, infraorbital, and mental foramina in addition to the supratrochlear nerve. Each subject in this study had the involved nerves blocked with local anesthesia injections or lidocaine iontophoresis to assist in confirming the source of pain. Sixty subjects with TMD were found to have trigeminal neuritis. Early recognition of this disorder is important because treatment is usually more successful in the acute peripheral state.