Influence of botulinum toxin A in pain perception and condyle-fossa relationship after the management of temporomandibular dysfunction: a randomized controlled clinical trial.

OBJECTIVES: To investigate the pain perception (PP) and condyle-fossa relationship (CFR) after botulinum toxin A (BoNTA) injection in the masseter muscles of painful muscular temporomandibular dysfunction (TMD) patients. MATERIALS AND METHODS: Fourteen women (aged 29.7 ± 5.4 years) diagnosed with myogenic TMD were randomized in the BoNTA-treated group (TG) and control group (CG). TG masseter muscles (n = 7) were bilaterally injected with 30 U. The CG (n = 7) were injected with saline injections. Condyle-fossa relationship (CFR) spaces were measured in sagittal (SP) and frontal planes (FP) of images of cone-beam computed tomography (CBCT) done before (T0) and after 30 days' interventions (T1). Visual analogue scale (VAS) measured the patients' TMD pain perception (PP). Data were compared by generalized linear models considering the results over time (α = .05). RESULTS: There were no statistical differences in CFR in the SP or FP for TG and CG over time (p ˃ .05), except for frontal lateral space CFR (p < .05). In both groups, the condyle was positioned medially after interventions. Frontal lateral space increased in TG for both, left and right sides, over time (p < .05), as well as PP decreased over time (p < .05) for TG and CG. CONCLUSIONS: The results depicted that there was no significant association with BoNTA injection in TMD masseter muscles in PP and CFR, except considering the frontal lateral space of CFR. CLINICAL RELEVANCE: BoNTA injection in the masseter muscles may not promote clinically significant shifts in the condyle-fossa relationships of muscular TMD patients.

Functional literacy and the assessment process as a diagnostic instrument for temporomandibular disorders: observational study / Alfabetismo funcional e o processo de avaliação como instrumento diagnóstico das disfunções temporomandibulares: estudo observacional

ABSTRACT BACKGROUND AND OBJECTIVES: Health literacy is a topic that has been gaining traction in recent years, both on the policy and research agendas of many countries, however there is no evidence about temporomandibular disorders (TMD) and this topic. The objective was to evaluate the association between the level of functional literacy and the understanding of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) through self-report and to associate the time of TMD complaint with the levels of functional literacy. METHODS: This is an observational, cross-sectional study, comprising 56 patients from the Temporomandibular Disorders (TMD) clinic at São Leopoldo Mandic College. The DC/TMD questionnaire - axis I, a sociodemographic questionnaire, and tests of the Indicador de Alfabetismo Funcional (Functional Literacy Indicator - INAF) were applied. RESULTS: The outcomes showed that 85.7% of the sample were females and 14.3% males, mainly white (60.7%), with a schooling degree, predominantly from the 3rd grade of high school and professionally active. It was found that 22.5% of the sample were functionally illiterate and 77.5% were functionally literate, 30.6% of whom had elementary level schooling. There was a significant association between the schooling level and combined INAF (p=0.005), as well as between combined INAF and duration of complaint in intervals for jaw pain (p=0.037) when Chi-square tests were used. There is evidence to establish that the mean duration of headache complaints (in months) between literacy groups are different (p=0.001) when using the Student´s t-test. With these results, it is possible to suggest that lower levels of functional literacy are related to a poorly detailed perception of TMD complaints regarding the duration of the complaint and, mainly, to the association of headache with a complaint of TMD. CONCLUSION: Lower levels of functional literacy are related to a poorly detailed perception of TMD complaints regarding the duration of the complaint and, mainly, to the association of headache with a complaint of temporomandibular disorders.

RESUMO JUSTIFICATIVA E OBJETIVOS: O letramento em saúde é um tema que vem ganhando força nos últimos anos, tanto nas agendas políticas como de investigação de muitos países, no entanto não existem evidências sobre as disfunções temporomandibulares e este tema. O objetivo foi avaliar a associação entre o nível de alfabetismo funcional e a compreensão dos Critérios Diagnósticos para Disfunção Temporomandibular (DC/DTM) por meio do autorrelato e associar o tempo de queixa de DTM com os níveis de letramento funcional. MÉTODOS: Trata-se de um estudo observacional, transversal, realizado com 56 pacientes do ambulatório de Disfunções Temporomandibulares (DTM) da Faculdade São Leopoldo Mandic. Para isso foram aplicados o questionário DC/DTM - eixo I, questionário sociodemográfico e testes do Indicador de Alfabetismo Funcional (INAF). RESULTADOS: Mostraram que 85,7% da amostra era do sexo feminino e 14,3% do sexo masculino, predominantemente brancos (60,7%), com escolaridade superior, predominantemente do 3º ano do ensino médio e profissionalmente ativos (57,1%). Verificou-se que 22,5% da amostra eram analfabetos funcionais e 77,5% eram alfabetizados funcionalmente, sendo que 30,6% possuíam nível fundamental. Houve associação significativa entre escolaridade e INAF combinado (p=0,005), bem como entre INAF combinado e tempo de queixa nos intervalos de dor mandibular (p=0,037) quando foram utilizados testes Qui-quadrado. Há evidências que estabelecem que a duração média das queixas de cefaleia (em meses) entre os grupos de alfabetismo é diferente (p=0,001) quando utilizado o teste t de Student. Com base nesses resultados, é possível sugerir que níveis mais baixos de alfabetismo funcional estariam relacionados a uma percepção pouco detalhada das queixas de DTM quanto à duração da queixa e à associação de cefaleia com queixa de DTM. CONCLUSÃO: Níveis mais baixos de alfabetismo funcional foram relacionados à percepção pouco detalhada das queixas de DTM quanto à duração e, principalmente, à associação de cefaleia com queixa de disfunção temporomandibular.

Consecuencias de la artritis reumatoide en la articulación temporomandibular y su manejo odontológico / Consequences of rheumatoid arthritis in the temporomandibular joint and its dental management

Introducción: la artritis reumatoide es parte del grupo de las enfermedades autoinmunes con incidencia considerable sobre la población. Se caracteriza por la afección de las articulaciones del cuerpo que la padece; en mayor frecuencia se encuentra afectada la articulación temporomandibular por el complejo articular que ésta presenta; entre los signos y síntomas que comúnmente podemos encontrar en pacientes con este tipo de enfermedad son los chasquidos o ruidos articulares, dolor orofacial, pérdida o imposibilidad del movimiento de la mandíbula y cambios anatómicos localizados en el área de la articulación temporomandibular. Objetivo: describir las consecuencias que desencadena la artritis reumatoide sobre la articulación temporomandibular y cómo es para el odontólogo el manejo de estos pacientes en consulta, evaluar los tratamientos para cada caso sobre un correcto diagnóstico. Material y métodos: se realizó una revisión bibliográfica de artículos recientes sobre el tema, utilizando buscadores como SciELO, Elsevier y PubMed, siendo 30 las fuentes seleccionadas con idiomas en inglés y español. Resultados: esta enfermedad autoinmune se caracteriza por afectar múltiples articulaciones del cuerpo humano simétrica y bilateralmente incluyendo la articulación temporomandibular (ATM), lo cual conlleva al riesgo de desarrollar trastornos temporomandibulares (TTM). Es importante conocer los métodos para realizar un correcto diagnóstico oportuno de la ATM del paciente con artritis reumatoide (AR) con la finalidad de ofrecer un tratamiento conservador. Conclusión: los trastornos temporomandibulares desencadenantes de la artritis reumatoide son afecciones que se deben considerar para el buen manejo del paciente con este padecimiento, comprender y respaldar un diagnóstico clínico es de vital importancia para dar al paciente un tratamiento adecuado dependiendo el grado de complejidad en la que cada individuo se encuentra; conocer el manejo adecuado y encaminar al paciente a una mejor calidad de vida es clave en la consulta odontológica del día a día (AU)

Introduction: rheumatoid arthritis is part of the group of autoimmune diseases with considerable incidence in the population. It is characterized by the affection of the joints of the body that suffers from it; most frequently the temporomandibular joint is affected due to the articular complex that it presents; among the signs and symptoms that we can commonly find in patients with this type of disease are joint clicks or noises, orofacial pain, loss or impossibility of jaw movement and anatomical changes located in the temporomandibular joint area. Objective: to describe the consequences that rheumatoid arthritis triggers on the temporomandibular joint and how it is for the dentist to manage these patients in consultation, to evaluate the treatments for each case on a correct diagnosis. Material and methods: a bibliographic review of recent articles on the subject was carried out, using search engines such as SciELO, Elsevier and PubMed, with 30 sources selected in English and Spanish. Results: this autoimmune disease is characterized by affecting multiple joints of the human body symmetrical and bilaterally including the TMJ which leads to the risk of developing TMD. It is important to know the methods to make a correct diagnosis of the TMJ of the patient with RA in order to offer a conservative treatment. Conclusions: the temporomandibular disorders that trigger rheumatoid arthritis are conditions that should be considered for the proper management of the patient with this condition, understanding and supporting a clinical diagnosis is of vital importance to give the patient an adequate treatment depending on the degree of complexity in which each individual is; knowing the proper management and directing the patient to a better quality of life is key in the day-to-day dental practice (AU)

Novel Diagnostic and Therapeutic Approaches to Temporomandibular Dysfunction: A Narrative Review.

Temporomandibular dysfunction (TMD) is a burgeoning area of study within the dental field. TMD is caused by abnormalities in the temporomandibular joint or muscles of mastication and can lead to pain, loss of function, and other complications. As this area of patient care receives increased focus, the ability to accurately diagnose TMD becomes paramount. The aim of this review is to summarize novel diagnostic and therapeutic techniques that have been proposed within the last approximately 3 years in order to inform readers of the cutting-edge advances in the field of TMD diagnosis and management, while also analyzing the clinical relevance of each study. A PubMed search was completed on 1 March 2023, using MeSH terms related to TMD diagnosis and treatment. The search yielded seven articles that pertained to the aim of this review article. The main findings from each study are summarized in this review article. These novel methods of diagnosing and treating TMD may improve our ability to assess and treat patients suffering from TMD.

The efficacy of orofacial myofunctional therapy in oral dysphagia accompanying temporomandibular dysfunction.

OBJECTIVE: Patients with temporomandibular dysfunction (TMD) may develop oral-stage dysphagia (OD) in the chronic phase. METHODS: This study investigated the effect of orofacial myofunctional therapy (OMT) in individuals with TMD-related OD. Fifty-one patients aged 18-65 years with TMD-related OD were separated into three groups using a simple randomization method: the control group (n = 12) underwent patient education and a home-exercise program; additionally, to an exercise program the manual therapy (MT) group (n = 19) received MT; and the OMT group (n = 20) received the OMT program. MT and OMT were applied in two sessions per week for 10 weeks. The patients were re-evaluated after treatment and at 3 months. RESULTS: The OMT group showed the most improvement in jaw functionality, swallowing-related quality of life, pain, and dysphagia (p < .05). DISCUSSION: OMT was superior to MT and exercises alone in reducing dysphagia and improving the swallowing-related quality of life.

Shear Wave Elastography in Bruxism-Not Yet Ready for Clinical Routine.

Ultrasound shear wave elastography (SWE) is an emerging modality for the estimation of stiffness, but it has not been studied in relation to common disorders with altered stiffness, such as bruxism, which affects almost one-third of adults. Because this condition could lead to an increased stiffness of masticatory muscles, we investigated SWE in bruxism according to a proof-of-principle and feasibility study with 10 patients with known bruxism and an age- and gender-matched control group. SWE of the left and right masseter muscles was estimated under three conditions: relaxed jaw, 50% of the subjective maximal bite force, and maximal jaw opening. Rejecting the null hypothesis, SWE was significantly increased during relaxed jaw (bruxism 1.92 m/s ± 0.44; controls 1.66 m/s ± 0.24), whereas for maximal mouth opening, the result was vice versa increased with 2.89 m/s ± 0.93 for bruxism patients compared with 3.53 m/s ± 0.95 in the healthy control, which could be due to limited jaw movement in chronic bruxism patients (bruxism 4.46 m/s ± 1.17; controls 5.23 m/s ± 0.43). We show that SWE in bruxism is feasible and could be of potential use for diagnostics and monitoring, though we also highlight important limitations and necessary methodological considerations for future studies.

Manifestações clínicas da disfunção temporomandibular em indivíduos com dentição natural e usuários de prótese total dupla / Clinical manifestations of temporomandibular dysfunction in naturally dented and double total prosthesis users / Expresiones clínicas de disfunción temporomandibular en personas y usuarios dentiados naturales de prostesis doble total

Objetivo: Esta pesquisa teve como objetivo comparar as manifestações clínicas da disfunção temporomandibular (DTM) em indivíduos com dentição natural e usuários de prótese total dupla. Métodos: A amostra do estudo consistiu em 120 participantes, distribuídos em dois grupos de 60 indivíduos cada. O Grupo 1 era composto por pessoas com dentição natural, enquanto o Grupo 2 era composto por indivíduos que utilizavam próteses totais duplas. Para identificar os sinais e sintomas da DTM, foram realizados tanto o índice anamnésico quanto o exame físico específico. Resultados: Os indivíduos que utilizavam prótese total apresentaram um aumento de 2,63 vezes no risco de apresentar dor de ouvido e um aumento de 5,42 vezes de ter limitação do movimento lateral da mandíbula. Por outro lado, os indivíduos com dentição natural apresentaram maior sensibilidade à palpação dos músculos temporal anterior e temporal posterior, além de um risco de 0,27 vezes maior de ter sensibilidade articular. Conclusões: Concluiu-se que os principais sinais clínicos de DTM dos indivíduos dentados naturais foram a sensibilidade à palpação muscular e a sensibilidade à palpação articular e no grupo de desdentados a limitação de movimento lateral da mandíbula e o sintoma de dor de ouvido foram mais frequentes.

Objective: This research aimed to compare the clinical manifestations of temporomandibular dysfunction (TMD) in individuals with natural dentition and users of double total prosthesis. Methods: The study sample consisted of 120 participants, distributed in two groups of 60 individuals each. Group 1 was composed of people with natural dentition, while Group 2 was composed of individuals who used double total prostheses. To identify the signs and symptoms of TMD, both the anamnestic index and the specific physical examination were performed. Results: The individuals who used total prosthesis showed an increase of 2.63 times in the risk of presenting ear pain and an increase of 5.42 times of having limitation of the lateral movement of the jaw. On the other hand, individuals with natural dentition showed greater sensitivity to palpation of the anterior and posterior temporal muscles, in addition to a 0.27 times greater risk of joint tenderness. Conclusions: It was concluded that the main clinical signs of TMD of natural dentate individuals were the sensitivity to muscle palpation and the sensitivity to joint palpation and in the group of toothless individuals the limitation of lateral jaw movement and the ear pain symptom were more frequent.

Propósito: El objetivo de esta investigación fue comparar las manifestaciones clínicas de disfunción temporal (DTM) en individuos con dientes naturales y usuarios de prótesis doble total. Métodos: La muestra de estudio consistió en 120 participantes, distribuidos en dos grupos de 60 individuos cada uno. El grupo 1 estaba formado por personas con dientes naturales, mientras que el grupo 2 estaba formado por individuos con prótesis dobles totales. Para identificar los signos y síntomas de la DTM, se realizó tanto el índice anamésico como el examen físico específico. Resultados: los individuos que utilizaron la prótesis total mostraron un incremento de 2,63 veces en el riesgo de sufrir un dolor de oído y un aumento de 5,42 veces en la limitación del movimiento lateral de la mandíbula. Por otro lado, los individuos con dientes naturales mostraron mayor sensibilidad a la palpación de los músculos temporales anteriores y posteriores, además de un riesgo de 0,27 veces mayor de sensibilidad articular. Conclusiones: Se concluyó que los principales signos clínicos de MSD en sujetos con dientes naturales fueron sensibilidad a la palpación muscular y sensibilidad a la palpación articular y al grupo sin dientes, limitación del movimiento lateral de la mandíbula y síntoma de cefalea fueron más frecuentes.

Efectividad de Férulas de Descarga Oclusivas como Tratamiento para la Disfunción Temporomandibular. Revisión Sistemática

El objetivo de este estudio de revisión sistemática consistió en la búsqueda de hallazgos clínicos en estudios de calidad sobre la efectividad de la terapia con férulas de descarga oclusales. Esta investigación bibliográfica se realizó en PubMed, Embase, SciELO, Science Direct, Scopus, Google Scholar y en el Registro Central de Ensayos clínicos Cochrane; delimitando la búsqueda desde el 1 de enero de 2011 al 1 de junio de 2022. Se incluyeron un total de 21 artículos, todos relacionados con la disfunción de la articulación temporomandibular y la eficacia de las férulas de descarga oclusales como tratamiento. Las férulas de descarga oclusales reducen eficazmente los síntomas dolorosos en pacientes con trastornos temporomandibulares, tanto en patologías musculares como articulares, aunque con mayor eficacia en casos de disfunción muscular, ya que se han observado desplazamientos recurrentes de disco en patologías articulares.

The objective of this systematic review study was to search for clinical findings in quality studies on the effectiveness of occlusal splint therapy. This literature search was conducted in PubMed, Embase, SciELO, Science Direct, Scopus, Google Scholar, and the Cochrane Central Register of Clinical Trials; delimiting the search from January 1, 2011 to June 1, 2022. A total of 21 articles were included, all related to temporomandibular joint dysfunction and the efficacy of occlusal splints as a treatment. Occlusal splints effectively reduce painful symptoms in patients with temporomandibular disorders, both in muscular and joint pathologies, although more effectively in cases of muscular dysfunction, since recurrent disc displacements have been observed in joint pathologies.

Impact of surgically assisted rapid mandibular expansion on the temporomandibular joint - A retrospective study.

This study evaluates the impact of tooth-borne Surgically Assisted Rapid Mandibular Expansion (SARME) on the temporomandibular joint (TMJ) function and condylar morphology. Medical records of patients who received a SARME between 2014 and 2018 are retrospectively reviewed concerning functional problems. Morphological changes of the condyles are analyzed by means of surface registration of 3D reconstructed CBCT scans preoperatively and one-year postoperatively, and correlated to functional outcome. In 68 patients data are complete. The risk of TMJ dysfunction is slightly increased from 18 to 25% at a mean of 14 months after SARME. This is attributed to an increase in the number of minor problems (75-82%). The presence of complaints before SARME is the only identifiable risk factor for also having complaints after the intervention (p = 0.0019). In one patient with pre-existent TMJ dysfunction complaints deteriorated after SARME. After SARME no cases of extended condylar resorption are described. There is no correlation between morphological condylar changes and the prevalence of TMJ dysfunction (p = 0.7121 for appositional and p = 0.3038 for resorptive changes). However, appositional and resorptive changes at the condylar head appear to correlate with growth potential, based on age, gender and skeletal deformity (p < 0.0001 and p = 0.0154 respectively). Within the limitations of the study it seems that SARME does not have a negative impact on TMJ function or condylar integrity and, therefore, the choice for or against this approach can be made without considering consequences for TMJ a major issue for the decision.

Neuralgia and Atypical Facial, Ear, and Head Pain.

Though there have been considerable strides in the diagnosis and care of orofacial pain disorders, facial neuralgias, and myofascial pain dysfunction syndrome remain incredibly cumbersome for patients and difficult to manage for providers. Cranial neuralgias, myofascial pain syndromes, temporomandibular dysfunction (TMD), dental pain, tumors, neurovascular pain, and psychiatric diseases can all present with similar symptoms. As a result, a patient's quest for the treatment of their orofacial pain often begins on the wrong foot, with a misdiagnosis or unnecessary procedure, which makes it all the more frustrating for them. Understanding the natural history, clinical presentation, and management of facial neuralgias and myofascial pain dysfunction syndrome can help clinicians better recognize and treat these conditions. In this article, we review updated knowledge on the pathophysiology, incidence, clinical features, diagnostic criteria, and medical management of TN, GPN, GN, and MPDS.

Impact of sports on temporomandibular dysfunction: a comparison of competitive and recreational female athletes as well as female non-athletes.

OBJECTIVES: The present study was conducted to investigate the correlation between (competitive) sports and the occurrence of temporomandibular dysfunctions (TMD) by comparing the prevalences in competitive, recreational, and non-athletic women. MATERIALS AND METHODS: A total of 138 women between the ages of 18 and 45 were interviewed about symptoms of TMD by means of a questionnaire. Based on their athletic performance level, the participating women were classified as competitive athletes, recreational athletes, or non-athletes (each group n = 46). RESULTS: Symptoms of TMD were notably less frequent in competitive female athletes (52.2%) than in recreational female athletes (63.0%) and female non-athletes (60.9%). With increasing training load, the prevalence of TMD decreased in both the competitive and recreational female athlete groups. CONCLUSIONS: Athletic activity in general seems to have a positive effect on the occurrence of TMD. Competitive female athletes appear less likely to suffer from symptoms of TMD than recreational athletes and non-athletes. One possible explanation for this could be the better supervision by qualified trainers and physiotherapists in competitive sports. CLINICAL RELEVANCE: Patients should be motivated to engage in sports as a protective measure against symptoms of TMD. However, it is important to ensure that they are properly instructed by experienced personnel in order to avoid unphysiological strain and negative consequences.

Relationship between osteopathic manipulative treatment of the temporomandibular joint, molar shim and the orthostatic position: A randomized, controlled and double blinded study.

This randomized, controlled, double-blinded study related the effect of osteopathic manipulative treatment (OMT) of the temporomandibular joint (TMJ) and the orthostatic posture using the molar shim (MS) as a postural adjustment factor. Twenty individuals classified with temporomandibular disorder (TMD) were randomly assigned to a treated group (TG, n = 10) and placebo (PG, n = 10). The independent variables were: MS and OMT of the TMJ. The dependent variables were: DC-TMD data; local pressure pain using algometry; and orthostatic posture assessed by the distribution of plantar pressures (baropodometry), in the evaluation periods before and immediately after the interventions. Results: pain did not show a statistically significant difference after the interventions. However, when comparing the Effect Size (ES) between the groups in the post-intervention moment, a moderate relationship was observed for the left trapezius muscle (0.51) and right and left TMJ (0.41 and 0.54 respectively). When correlating the pain and percentage of anteroposterior postural dislocation variables, a significant moderate inverse correlation was observed in the post-intervention moment. The results of the MS pointed to a significant decrease (p ≤ 0.05) of the average peak pressure (Medium P) during the use of the MS (503.4 ± 44.1 kgf/cm2) and after performing the OMT (516.5 ± 49.6 kgf/cm2), both for the TG compared to the pre intervention moment (519.3 ± 42.9 kgf/cm2). There is a correlation between TMJ and orthostatic posture. OMT of the TMJ influences orthostatic posture. The MS can be added to the evaluative context of TMD.

Evaluation of the Effectiveness of Dry Needling in the Treatment of Myogenous Temporomandibular Joint Disorders.

Background and Objectives: The objective of our clinical trial was to determine the effectiveness of the deep dry needling technique (DDN) (neuromuscular deprogramming) as a first step in the treatment of temporomandibular disorders. Methods and Materials: The double-blind randomized clinical trial comprised 36 patients meeting the inclusion criteria who had signed the corresponding informed consent form. The participants were randomly distributed into two groups, the Experimental group (Group E) and the Control group (Group C). Group E received bilateral DDN on the masseter muscle, while Group C received a simulation of the technique (PN). All the participants were evaluated three times: pre-needling, 10 min post-needling, and through a follow-up evaluation after 15 days. These evaluations included, among other tests: pain evaluation using the Visual Analog Scale (VAS) and bilateral muscle palpation with a pressure algometer; evaluation of the opening pattern and range of the mouth, articular sounds and dental occlusion using T-scans; and electromyography, which was used to evaluate the muscle tone of the masseter muscles, in order to control changes in mandibular position. Results: Digital control of occlusion using Tec-Scan (digital occlusion analysis) showed a significant reduction both in the time of posterior disclusion and in the time needed to reach maximum force in an MI position after needling the muscle, which demonstrated that there were variations in the static position and the trajectory of the jaw. The symmetry of the arch while opening and closing the mouth was recovered in a centric relation, with an increase in the opening range of the mouth after the procedure. Conclusions: facial pain is significantly reduced and is accompanied by a notable reduction in muscle activity after needling its trigger points.

What conservative interventions improve bite function in those with temporomandibular disorders? A systematic review using self-reported and physical measures.

BACKGROUND: Bite is an important function of the human stomatognathic system. Despite this, it is commonly impaired in temporomandibular disorder (TMD) populations. The aim of this review is to evaluate the effectiveness of conservative interventions on self-reported and physical measures of bite function in individuals with TMD. METHODS: This review was performed in compliance with PRISMA guidelines. An electronic search was performed on databases including PubMed, CINAHL, Embase, and Cochrane Central. Inclusion criteria were journal articles evaluating the effect of any non-pharmacological conservative interventions on bite function in participants diagnosed with TMD. Risk of bias for individual studies was assessed using the Cochrane risk-of-bias v2 tool, and the NIH NHLBI pre-post tool. Data was synthesised based on outcome measures of bite function, and the quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Eleven studies were eligible for this review. Interventions included splinting, photobiomodulation, needling, exercise, manual therapy, and patient education, which were evaluated using mastication-related pain, self-reported chewing difficulty, and bite force/endurance outcome measures. Findings suggested manual therapy, needling, oral splinting, exercise, and PBM interventions may improve bite function in TMD, although confidence in cumulative evidence ranged from moderate to very low. There was no evidence that patient education improved bite function. CONCLUSION: Conservative interventions may be helpful to address bite-related impairments associated with TMD, although further research is needed to improve the quality of evidence and direct clinical guidelines.

The Role of the Lateral Pterygoid Muscle in Articular Disc Displacement: A Cross-sectional Magnetic Resonance Imaging Study.

OBJECTIVE: The objective of the study is to determine the role of Lateral Pterygoid Muscle LPM in the articular disc displacement ADD, which is considered controversial due to the variations in the pattern of insertion of the Superior Lateral Pterygoid Muscle SPLM. BACKGROUND: It is well understood that the superior head of the lateral pterygoid muscle has only a single insertion pattern among individuals, in which the muscle is attached to the articular disc and capsule. However, recent findings in many studies have shown a noticeable variation in the insertion pattern of the upper LPM. METHODS: MRI examinations were collected at King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. Scans of 61 patients (41 females, 20 males; mean age 33 years old) with symptoms of temporomandibular dysfunction were reviewed retrospectively. The direction of their articular disc displacement was evaluated through sagittal and coronal views in both open and closed mouth positions. RESULTS: There was no statistical significance found between the LPM attachment types and TMJ disc position. The chi-square test also showed no significant difference between the type of LPM attachment and the condylar location. Forty-five percent of the articular discs were located between the articular eminence and the glenoid fossa. The majority of the disc displacement was in the anterior direction. CONCLUSION: There was no statistically significant association found between the type of LPM attachments and the direction of disc displacement.

Relationship between temporomandibular dysfunctions, sleep disorders, and anxiety among dentistry students.

Introduction: This study aimed to evaluate the relationship between temporomandibular dysfunction (TMD), anxiety, and sleep disorder (DS) among dentistry students, relating the periods in which they are enrolled.Methods: The study consisted of 90 students: Group 1: 30 first-period students; Group 2: 30 fifth-period students; Group 3: 30 students from the ninth period. The participants responded to the RDC/TMD, Fletcher & Luckett questionnaires, and the Beck Anxiety Inventory to analyze symptoms of TMD, DS, and anxiety.Results: There was an association between TMD, DS, and the period studied. When related to moderate and severe anxiety, the group that had the highest incidence was Group 1 (first period students).Conclusion: The apprehension for what is new can influence the TMD and DS indices, while the greater concern for academic/professional performance can generate higher levels of anxiety.

Influência do autocuidado utilizando as práticas integrativas e complementares durante a pandemia da COVID-19 em crianças e adolescentes de 4 a 13 anos com bruxismo e disfunção temporomandibular / Influence of self-care using complementary and integrative therapies during the COVID-19 pandemic in children and adolescents aged 4 to 13 years with bruxism and temporomandibular disorders

O Bruxismo é um comportamento da musculatura mandibular, caracterizado pelo apertamento e/ou rangimento dental, tanto em estado de vigília quanto no sono, que pode acarretar na Disfunção Temporomandibular (DTM). Altamente prevalente em crianças e etiologia multifatorial, destacam-se os aspectos psicossociais, principalmente o estresse e ansiedade. A necessidade de distanciamento social durante a pandemia da COVID-19 trouxe consequências para as crianças e fez surgir novos formatos de ações na Odontologia. Esse estudo avaliou a influência do autocuidado nas manifestações do Bruxismo/DTM em crianças que estavam em tratamento, antes da pandemia, no Serviço de Atendimento de Bruxismo e DTM na Infância (SABDI) da FORP/USP, por meio de intervenções assistidas, implementadas remotamente, de Práticas Integrativas e Complementares (PICs). Previamente às intervenções (T0), os pais responderam o questionário (Q1) sobre a criança (no formato Google Forms, enviado por WhatsApp e e-mail). As práticas propostas foram explicadas em reuniões virtuais (Google Meet) e foram realizadas durante 21 dias, registradas em um "Diário de Controle". Um novo questionário (Q2) foi preenchido para análise comparativa após as intervenções (T1). Das 37 crianças que estavam em tratamento, a amostra final das 18 que concluíram todas as etapas propostas apresentou diferença quantitativa nos itens: "dor na boca/rosto quando mastiga"; "dor ou dificuldade de abrir e fechar a boca"; "acorda com dor no rosto ou dor de cabeça" e, "dor de cabeça durante o dia ou à noite", "range os dentes em vigília"; "frequência que range os dentes em vigília"; "range os dentes enquanto dorme" e, "frequência que range os dentes enquanto dorme", "sono agitado"; "pesadelo" e "insônia". Observou-se evidência de diferença estatística com valor P<0,05, no item "aperta os dentes em vigília" (p=0,0057). Conclui-se que as intervenções propostas influenciaram as manifestações do Bruxismo favorecendo o seu controle.

Bruxism is a behavior of the mandibular muscles, characterized by clenching and/or dental grinding, both in wakefulness and in sleep, which can lead to Temporomandibular Disorders (TMD). Highly prevalent in children and possessing a multifactorial etiology, psychosocial aspects stand out, especially stress and anxiety. The need for social distancing during the COVID-19 pandemic has had consequences for children and has given rise to new formats of actions in Dentistry. This study evaluated the influence of self-care on the manifestations of Bruxism/TMD in children who were undergoing treatment, before the pandemic, Care Center for children with Bruxism and TMD, whose acronyms in Portuguese is SABDI, located in Ribeirão Preto School of Dentistry (FORP-USP), through assisted interventions, implemented remotely, of Complementary and Integrative Therapies (CIT). Prior to the interventions (T0), the parents answered the questionnaire (Q1) about the child (in Google Forms, sent by WhatsApp and e-mail). The proposed practices were explained in virtual meetings (Google Meet) and performed for 21 days and recorded in a "Control Diary". A new questionnaire (Q2) was completed for comparative analysis after the interventions (T1). Of the 37 children who were undergoing treatment, the final sample of 18 who completed all the proposed steps showed a quantitative difference in the items: "pain in the mouth/face when chewing"; "pain or difficulty opening and closing the mouth"; "waking up with pain in the face or headache" and "headache during the day or night"; "grinding teeth while awake"; "frequency grinding teeth while awake"; "grinding teeth while sleeping"; "frequency grinding teeth while sleeping"; "restless sleep"; "nightmare"; and "insomnia". Evidence of statistical difference was observed with a P value <0.05, in the item "clenches teeth while awake" (p=0.0057). It is concluded that the proposed interventions influenced the manifestations of Bruxism, favoring its control.

Reciprocal effects of scleroderma and temporomandibular dysfunction between patient cohorts.

OBJECTIVE: To estimate the prevalence of temporomandibular dysfunction in scleroderma patients according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and to correlate it with disease variables. METHODS: Temporomandibular dysfunction was evaluated in 75 scleroderma patients and 74 healthy controls using DC/TMD. Gastrointestinal symptoms were evaluated through the University of California Los Angeles (UCLA) score in scleroderma patients. RESULTS: There was no difference of prevalence in temporomandibular dysfunction [30 (40%) vs 30 (40.5%); p > 00.05] between scleroderma patients and healthy controls. Scleroderma patients had a significant reduction in all oral movements compared to healthy controls. Scleroderma patients with temporomandibular dysfunction had a statistically higher score in the UCLA distention/bloating item [1.75 (0.5-2.38) vs 0.75 (0.25-1.75); p < 0.05] than scleroderma patients without temporomandibular dysfunction. DISCUSSION: Temporomandibular dysfunction prevalence between scleroderma patients and healthy controls is similar. In scleroderma patients, temporomandibular dysfunction reduces oral mobility and opening, which worsens distension/bloating.

A novel rat model of temporomandibular disorder with improved face and construct validities.

AIMS: Temporomandibular disorders are a cluster of orofacial conditions that are characterized by pain in the temporomandibular joint (TMJ) and surrounding muscles/tissues. Animal models of painful temporomandibular dysfunction (TMD) are valuable tools to investigate the mechanisms responsible for symptomatic temporomandibular joint and associated structures disorders. We tested the hypothesis that a predisposing and a precipitating factor are required to produce painful TMD in rats, using the ratgnawmeter, a device that determines temporomandibular pain based on the time taken for the rat to chew through two obstacles. MATERIALS AND METHODS: Increased time in the ratgnawmeter correlated with nociceptive behaviors produced by TMJ injection of formalin (2.5%), confirming chewing time as an index of painful TMD. Rats exposed only to predisposing factors, carrageenan-induced TMJ inflammation or sustained inhibition of the catechol-O-methyltransferase (COMT) enzyme by OR-486, showed no changes in chewing time. However, when combined with a precipitating event, i.e., exaggerated mouth opening produced by daily 1-h jaw extension for 7 consecutive days, robust function impairment was produced. KEY FINDINGS: These results validate the ratgnawmeter as an efficient method to evaluate functional TMD pain by evaluating chewing time, and this protocol as a model with face and construct validities to investigate symptomatic TMD mechanisms. SIGNIFICANCE: This study suggests that a predisposition factor must be present in order for an insult to the temporomandibular system to produce painful dysfunction. The need for a combined contribution of these factors might explain why not all patients experiencing traumatic events, such as exaggerated mouth opening, develop TMDs.

Analysis of Earlier Temporomandibular Joint Disorders in JIA Patients: A Clinical Report.

The aim of this study was to analyse the structural characteristics of the temporo-mandibular joint (TMJ) and the dysfunctional consequences induced by disease in subjects with juvenile idiopathic arthritis (JIA). The study was conducted in 25 patients with JIA (median age (IQR), 13.9 (10.9-15.3)) and 26 healthy controls (median age (IQR), 14.3 (11.6-17.2)) years. All enrolled patients were subjected to anamnestic evaluation, laboratory parameters, JIA subclass, and type of therapy for the disease. A clinical-gnathological evaluation, anamnestic and dysfunctional index (Ai and Di), and magnetic resonance imaging of TMJs were performed in all patients. The test group showed a significant reduction (p < 0.001) regarding the clinical findings such as maximal mouth opening, left and rightward laterotrusion and protrusion, and a significant difference in the reported symptoms (TMJ sounds, reduced mouth opening and pain), and Ai and Di (p < 0.001) compared to healthy patients. Correlation analysis showed a significant correlation between the median duration of disease and the maximum mouth opening and between visual analogue scale (VAS) score and maximum mouth opening, leftward laterotrusion, rightward laterotrusion, and protrusion. The results obtained in this study suggest that patients with JIA presented a cohort of symptoms in TMJs in comparison with healthy controls. Moreover, a careful TMJs evaluation and an early diagnosis of TMJs dysfunction and regular follow-ups are recommended in order to prevent and reduce functional and chewing problems in patients with JIA.