Temporomandibular disorder symptoms and their association with quality of life of dental patients in Malaysia.

OBJECTIVE: To assess the prevalence of temporomandibular disorders (TMD) and their effects on quality of life (QoL) of dental patients. METHODS: A survey consisting of two validated questionnaires was distributed to dental patients registered at the University of Malaya Faculty of Dentistry. The Fonseca Anamnestic Index (FAI) evaluates the prevalence and severity of TMD, while the Oral Health Impact Profile - Temporomandibular Disorder (OHIP-TMD) appraises the effects of TMD on oral health-related QoL. RESULTS: Out of 342 patients (aged 16 to 50 years, 45% male and 55% female) enrolled in the survey, 50.9% had varying degrees of TMD. All 7 domains of OHIP-TMD showed a statistically significant correlation with TMD severity. CONCLUSION: TMD seems to be prevalent among Malaysian dental patients. Not only does TMD affect the QoL of an individual, but the more severe the degree of reported symptoms, the poorer their perceived oral health QoL.

Could painful temporomandibular disorders be nociplastic in nature? A critical review and new proposal.

Classification of temporomandibular disorders (TMD) and, indeed, all types of orofacial pains has significantly progressed in the last decade based on international consensus work and operationalized clustering of signs and symptoms. A challenging gap nevertheless continues to exist in terms of understanding the underlying pain mechanisms and link to management. Recently, a novel mechanistic descriptor 'nociplastic pain' was introduced, and diagnostic algorithms and characteristic features were proposed. This narrative and critical review aim to discuss to what extent could painful TMD conditions fit into this category. Moreover, a number of less common types of orofacial pain could possibly also reflect nociplastic pain mechanisms. A model to differentiate TMD pain mechanisms is proposed, and the implications for management are discussed. The purpose of this review is to stimulate original and novel research into mechanisms of orofacial pain and hopefully thereby improve management of the individual patient.

Temporomandibular Disorders, Bruxism and Headaches.

Temporomandibular disorders (TMDs) and headache disorders are highly prevalent in the population. TMDs can present headache symptoms as a secondary headache and, in addition, be comorbid with primary headache disorders. This overlap has significant clinical implications for which it is essential for the physician to be aware, and they should screen for the potential presence of TMDs in a headache patient. Bruxism is a parafunctional behavior also prevalent in the population which has a role in TMDs and may influence headache symptomatology, but it is still necessary to clarify this relationship.

Ultrasonographic examination of masticatory muscles in patients with TMJ arthralgia and headache attributed to temporomandibular disorders.

This study used ultrasonography to compare the thickness and cross-sectional area of the masticatory muscles in patients with temporomandibular joint arthralgia and investigated the differences according to sex and the co-occurrence of headache attributed to temporomandibular disorders (HATMD). The observational study comprised 100 consecutive patients with TMJ arthralgia (71 females and 29 males; mean age, 40.01 ± 17.67 years) divided into two groups: Group 1, including 86 patients with arthralgia alone (60 females; 41.15 ± 17.65 years); and Group 2, including 14 patients with concurrent arthralgia and HATMD (11 females; 33.00 ± 16.72 years). The diagnosis of TMJ arthralgia was based on the diagnostic criteria for temporomandibular disorders. The parameters of the masticatory muscles examined by ultrasonography were subjected to statistical analysis. The pain area (2.23 ± 1.75 vs. 5.79 ± 2.39, p-value = 0.002) and visual analog scale (VAS) score (3.41 ± 1.82 vs. 5.57 ± 12.14, p-value = 0.002) were significantly higher in Group 2 than in Group 1. Muscle thickness (12.58 ± 4.24 mm) and cross-sectional area (4.46 ± 2.57 cm2) were larger in the masseter muscle than in the other three masticatory muscles (p-value < 0.001). When examining sex-based differences, the thickness and area of the masseter and lower temporalis muscles were significantly larger in males (all p-value < 0.05). The area of the masseter muscle (4.67 ± 2.69 vs. 3.18 ± 0.92, p-value = 0.004) and lower temporalis muscle (3.76 ± 0.95 vs. 3.21 ± 1.02, p-value = 0.049) was significantly smaller in Group 2 than in Group 1. An increase in VAS was significantly negatively correlated with the thickness of the masseter (r = - 0.268) and lower temporalis (r = - 0.215), and the cross-sectional area of the masseter (r = - 0.329) and lower temporalis (r = - 0.293). The masseter and lower temporalis muscles were significantly thinner in females than in males, and their volumes were smaller in patients with TMJ arthralgia and HATMD than in those with TMJ arthralgia alone. HATMD and decreased masseter and lower temporalis muscle volume were associated with increased pain intensity.

Recurrence of exostosis as a result of medication-induced bruxism: case study.

Introduction: Alveolar oral exostosis is a common, benign condition routinely found in dentistry. Clinical problems associated with exostoses are the maintenance of oral hygiene as well as the fabrication of prosthodontic appliances. Over time, exostoses may contribute to irritation and periodontal disease. Case description: The patient in this case study had a recurrence of exostoses and was bothered by consistent and prominent pain. She reported being a bruxer; her bruxism was exacerbated due to attention-deficit hyperactivity disorder and antidepressant medications. Discussion: The etiology behind the recurrence of exostosis is discussed. The most evident etiology seems to be persistence of medication-induced bruxism, specifically awake bruxism. Conclusion: It is necessary to take a proper history to identify the cause of the recurrence of exostosis. Dental hygienists can contribute to a better understanding of and provide better treatment options for patients who have medication-induced bruxism.

Introduction: L'exostose buccale alvéolaire est une affection bénigne courante couramment observée en dentisterie. Les problèmes cliniques associés aux exostoses sont le maintien de l'hygiène buccale ainsi que la fabrication d'appareils prosthodontiques. Avec le temps, les exostoses peuvent causer de l'irritation et des maladies parodontales. Description de cas: Dans cette étude de cas, la patiente présente des exostoses récurrentes et est dérangée par une douleur constante et proéminente. Elle a déclaré souffrir de bruxisme exacerbé par la prise de médicaments antidépresseurs et contre le trouble déficitaire de l'attention avec hyperactivité. Discussion: L'étiologie derrière la récurrence de l'exostose est abordée. L'étiologie la plus évidente semble être la persistance du bruxisme induit par les médicaments, en particulier le bruxisme diurne. Conclusion: Il est nécessaire d'obtenir les antécédents médicaux appropriés pour identifier la cause de la récurrence de l'exostose. Les hygiénistes dentaires peuvent contribuer à une meilleure compréhension et offrir de meilleures options de traitement aux patients atteints de bruxisme induit par les médicaments.

Is painful temporomandibular disorder a real headache for many patients?

Temporomandibular disorders (TMDs) and primary headaches are common pain conditions and often co-exist. TMD classification includes the term 'headache secondary to TMD' but this term does not acknowledge the likelihood that primary headache pathophysiology underpins headache causing painful TMD signs and symptoms in many patients. The two disorders have a complex link and we do not fully understand their interrelationship. However, growing evidence shows a significant association between the two disorders. This article reviews the possible connection between temporomandibular disorders and primary headaches, specifically migraine, both anatomically and pathogenetically.

Investigation of masticatory muscle thickness and mechanosensitivity of cervical and masticatory muscles in myofascial temporomandibular disorder patients with bruxism: A cross-sectional study.

OBJECTIVE: Bruxism is a common problem associated with temporomandibular disorders (TMD). The aim of this study was to compare a patient group with Myofascial TMD and bruxism and a healthy control group in terms of masseter and temporal muscle thickness (clenching and resting), mechanosensitivity of neck and jaw muscles, craniofacial pain, and disability and emotional stress status. METHODS: The study included 31 patients with myofascial TMD and bruxism (19 females, 12 males) with a mean age of 29.96 ± 8.12 years (range, 18-45 years), and a control group of 31 healthy subjects (19 females, 12 males) with a mean age of 27.58 ± 9.39 years years (range, 18-45 years). Masseter and temporal muscle thicknesses were evaluated with a mobile ultrasound device both at rest and when clenching the jaw. The mechanosensitivity values between the upper trapezius, obliquus capitis inferior, masseter and temporal muscles were measured with a digital algometer device. Craniofacial pain and disability level were evaluated with the Craniofacial Pain and Disability Index (CFPDI), and emotional stress levels with the Perceived Stress Scale-14 (PSS-14). RESULTS: No difference was determined between the two groups in respect of the clenching and resting ratios of muscle thickness in any muscle (p > 0.05). The mechanosensitivity values in all muscles were lower in the myofascial TMD group than in the healthy group (p < 0.05). The CFPDI and PSS-14 scores were higher in the myofascial TMD group (p < 0.05). There was a moderate positive correlation between CFPDI, PSS-14 and Bruxism Frequency Score (p < 0.05). CONCLUSION: The difference in mechanosensitivity and CFPDI values between the myofascial TMD patients with bruxism and the healthy control group indicates that the problem in this patient group has effects in the craniocervical and cervical regions. In addition, the correlation between CFPDI, PSS-14 and Bruxism Frequency Score in myofascial TMD patients suggests that this problem may be affected by the interaction of different parameters.

Diagnostic Accuracy of a Temporomandibular Disorder Pain Screener in Patients Seeking Endodontic Treatment for Tooth Pain.

INTRODUCTION: This study assessed the accuracy of a TMD Pain Screener questionnaire in identifying patients with temporomandibular disorder (TMD) pain among those seeking endodontic treatment for tooth pain. It also investigated whether the screener accuracy could be improved by adding questions regarding putative predictors of TMD status. METHODS: One hundred patients seeking endodontic treatment for tooth pain were enrolled. Participants completed the 6-question TMD Pain Screener before treatment. A board-certified orofacial pain specialist/endodontic resident conducted endodontic and TMD examinations using validated Diagnostic Criteria for TMD (DC/TMD). The sensitivity (Se), specificity (Sp), and positive/negative predictive values (PPVs/NPVs) were calculated for the 6-question and 3-question versions of the TMD Pain Screener. Logistic regression and receiver operating characteristic curve (AUROC) analyses were performed to determine the screening accuracy. RESULTS: At the screening threshold of ≥3, TMD Pain Screener's sensitivity was 0.85, specificity 0.52, PPV 0.68, and NPV 0.75 for the 6-question version and 0.64, 0.65, 0.69, and 0.61, respectively, for the 3-question version. The AUROC was 0.71 (95% CL: 0.61, 0.82) and 0.60 (95% CL: 0.48, 0.71) for full and short versions, respectively. Adding a rating of current pain intensity of the chief complaint to the screener improved the AUROC to 0.81 (95% CL: 0.72, 0.89) and 0.77 (95% CL: 0.67, 0.86) for full and short versions, respectively, signifying useful overall accuracy. CONCLUSIONS: The 6-question TMD Pain Screener, combined with the patient's rating of current pain intensity of the chief complaint, could be recommended for use in endodontic patients with tooth pain for detecting painful TMD.

Influence of malocclusion on sleep bruxism and orofacial pain: data from a study in school children.

OBJECTIVES: This cross-sectional school-based study explored the influence of malocclusion on temporomandibular disorders (TMD) pain complaints, and whether this association would be mediated by sleep bruxism in a representative sample of 7- to 8-year-old children. METHODS: Path analysis estimated direct, indirect, and total effects of occlusal features on sleep bruxism and TMD pain in 7- to 8-year-old children. Occlusal features were assessed with Dental Aesthetic Index (DAI), orofacial pain complaints using the TMD pain screener, possible sleep bruxism based on self-reports, and probable sleep bruxism based on self-reports combined with clinical findings. Structural equation modeling analyzed data with confounding factors. RESULTS: From 580 participants, possible sleep bruxism was observed in 136 children (31.5%), probable sleep bruxism in 30 children (6.7%), and TMD pain complaints in 78 children (13.8%). Malocclusion had no direct effect on either possible sleep bruxism [standardized coefficient (SC) 0.000; p = 0.992], or TMD pain complaints (SC - 0.01; p = 0.740). When probable sleep bruxism was set as the mediator of interest, malocclusion did not directly affect probable sleep bruxism (SC 0.01; p = 0.766), nor TMD pain complaints (SC - 0.02; p = 0.515). A direct effect of probable sleep bruxism on TMD pain complaints was observed with an SC of 0.60 (p < 0.001). However, in neither case, malocclusion indirectly affected TMD pain complaints via bruxism. CONCLUSION: Malocclusion in 7- to 8-year-old children did not directly influence possible or probable sleep bruxism or TMD pain complaints. Instead, probable sleep bruxism was strongly associated with TMD pain complaints. CLINICAL SIGNIFICANCE: The impact of occlusal features on TMD pain complaints and bruxism has been a long-standing controversy in dentistry. However, the scientific literature linking this association may be inconsistent, mainly due to biased sample selection methods with inadequate consideration of confounders. Further research should try to identify additional risk factors for TMD pain in addition to probable sleep bruxism in children.

Trismus in head and neck cancer: translation and validation of the Chinese version of the Gothenburg Trismus Questionnaire-2 (C-GTQ-2).

OBJECTIVES: Trismus, marked by restricted mouth opening, significantly affects patients with temporomandibular disorder (TMD) and head and neck cancer (HNC). Despite its prevalence, specialized questionnaires for trismus assessment are scarce. This study aims to fill this gap by translating and validating the Gothenburg Trismus Questionnaire version 2 (GTQ-2) into Chinese (C-GTQ-2), enhancing the evaluation of trismus in HNC and TMD patients. MATERIALS AND METHODS: The study involved 78 HNC patients, 75 TMD patients, and a control group of 150 individuals without trismus symptoms. Participants were asked to complete the C-GTQ-2 and other health-related quality of life (HRQL) instruments. A subset of 30 individuals retook the questionnaire within two weeks to assess test-retest reliability. RESULTS: The C-GTQ-2 demonstrated remarkable reliability, with Cronbach's alpha values exceeding 0.70 in three of the four domains, indicating high internal consistency. The instrument also showcased high intra-class correlations in the test-retest, affirming its reliability. Furthermore, it exhibited strong convergent validity, aligning well with other HRQL instruments, and effectively discriminated between patients with and without trismus, establishing its discriminant validity. CONCLUSIONS: The C-GTQ-2 emerges as a valid and reliable tool for assessing trismus in HNC and TMD patients, promising to significantly enhance both clinical and research approaches to managing trismus-related complications in the Chinese-speaking demographic. CLINICAL RELEVANCE: C-GTQ-2 proves effective for trismus assessment in head and neck cancer and temporomandibular disorder patients, offering enhanced clinical and research utility.

Correlating estrogen replacement therapy and temporomandibular disorders: a comprehensive review following PRISMA principles and cochrane handbook for systematic reviews of interventions.

BACKGROUND: Estrogen replacement therapy (ERT) is a common hormonal treatment for postmenopausal women, aimed at alleviating menopausal symptoms and reducing the health risks associated with estrogen deficiency. However, the impact of ERT on temporomandibular disorders (TMDs) remains unclear. This systematic review aims to evaluate the relationship between ERT and TMDs, including TMD occurence, pain, and associated symptoms. METHODS: A comprehensive search of seven electronic databases was conducted using predefined search terms and Boolean operators. Inclusion criteria encompassed studies examining the association between ERT and TMDs. Two independent reviewers screened the identified articles, extracted data, and assessed the risk of bias using the RoB -2 tool. RESULTS: Search strategy identified a total of 3 articles which met the inclusion criteria. The included studies investigated the impact of ERT on TMD occurrence and its related symptoms. The analysis revealed no significant association between ERT and TMD occurrence. A significant dose relationship was noted in one of the studies while another mentioned the possible relationship of TMD with educational status. Risk of bias among the studies was low, and the overall quality of evidence was deemed to be high. CONCLUSION: This systematic review suggests that there is no conclusive evidence supporting an increased risk of TMDs among women receiving ERT. The findings indicate that ERT is unlikely to have a noticeable impact on TMDs. However, due to the limited number of studies available, further research is warranted to strengthen these conclusions and explore potential factors that may influence the relationship between ERT and TMDs.

Anesthetic management of patients with difficult intubation due to temporomandibular joint osteoarthritis: A case report.

INTRODUCTION: Temporomandibular joint osteoarthritis (TMJOA) affects 8% to 16% of the global population, yet TMJOA remains relatively underappreciated clinically. To anesthesiologists, who is concerned about patient safety, adequate preoperative evaluation and preparation, as well as individualized anesthetic management of patients, are necessary. Therefore, the anesthesiologist should be alert for difficult airways due to TMJOA, have a full and comprehensive understanding of the disease, and possess the appropriate expertise for difficult airway intubation. CASE PRESENTATION: A 52-year-old female patient was scheduled for laparoscopic operation of uterine adnexa under general anesthesia. The patient preoperative evaluation showed only 1 finger width of mouth opening, and the computed tomography scan showed bilateral temporomandibular arthritis, which was evident on the right side. Intraoperatively, the expected airway difficulties occurred, and the anesthesiologist opted to use lightwand intubation, which was ultimately successful in 1 pass without any complications. CONCLUSION: Intubation using a lightwand for patients with difficult intubation due to TMJOA is a very effective intubation modality.

Effects of physical activity levels on characteristic pain in temporomandibular dysfunctions: a cross-sectional study.

BACKGROUND: Physical activity is known to influence the symptoms of a variety of pain disorders including fibromyalgia and osteoarthritis although the underlying mechanism is not fully understood. In spite of the high prevalence of temporomandibular disorders (TMD), no previous study has objectively evaluated the relationship between TMD and general physical activity. This study aims to investigate the influence of physical activity on pain and disability from TMD, considering various confounders including sleep, systemic inflammation, psychosocial disturbances, and widespread pain. METHODS: This observational cross-sectional study is based on consecutive samples of 100 TMD patients (22 with high pain disability and 78 with low pain disability level). Physical activity levels were assessed with actigraph. Level of pain and disability were evaluated using the Graded Chronic Pain Scale. Hematologic examinations including inflammatory biomarkers were assessed and comorbidities were investigated with validated questionnaires. Differences were analyzed according to disability level. RESULTS: Patients with high disability level spent significantly more time doing both moderate (p = 0.033) and vigorous (p = 0.039) level physical activity. Light physical activity, on the other hand, was associated with low disability but the difference did not reach statistical significance. Time spent in light physical activity was significantly associated with high levels of pain and disability (p = 0.026, ß = -0.001) and time spent in vigorous physical activity had significant predictive power (cutoff value 2.5 min per week, AUC 0.643, p = 0.041). Scores of the Jaw Function Limitation Score-20 (p = 0.001), present McGill Pain Score (p = 0.010), and number of people potentially diagnosed with fibromyalgia (p = 0.033) were significantly higher in the high disability group. CONCLUSIONS: Moderate or vigorous physical activity is associated with worse TMD symptoms while light physical activity may be beneficial. Further research related to the amount and frequency of physical activity is necessary to establish clinical guidelines for TMD. TRIAL REGISTRATION: clinical trial registration of the Clinical Research Information Service of Republic of Korea (number KCT0007107).

Chronic temporomandibular disorder pain patients with a history of neuropathic pain treatment: a narrative research on their diagnosis and treatment history.

The aims of this qualitative research were (1) to gain more insight in the diagnostic and treatment history of patients with chronic temporomandibular disorder (TMD) pain; (2) to get a deeper understanding of possible factors that are involved in the possible delay in setting a TMD-pain diagnosis and receiving appropriate treatment; and (3) to get a deeper understanding of the perspectives and experiences of chronic TMD-pain patients on the possible improvement of various aspects of their diagnostic and treatment journey.MethodsIn this narrative research, semi-structured interviews took place with patients who experienced chronic orofacial pain (OFP) for at least three years before getting diagnosed with, and treated for, TMD pain by an OFP specialist in an interprofessional setting.ResultsIn total, ten patients were interviewed in-depth. Patients experienced their chronic OFP in different ways, but all reported a significant impact of their pain on their quality of life. All patients visited numerous health care professionals before their TMD diagnosis was set. Among others, they underwent anti-neuropathic pain medication therapies and invasive surgeries, which did not significantly reduce their chronic OFP. The interprofessional TMD-pain treatment reduced the suffering of the chronic OFP substantially, also 6 months after the start of therapy, and improved the quality of life for all patients. In most of them, the OFP intensity was also decreased.ConclusionChronic TMD-pain patients with a history of neuropathic pain treatment may experience a long journey until receiving the appropriate diagnosis and treatment. This stresses the need to improve the implementation of chronic TMD-pain guidelines.

Age and sex differences in comorbidities in adult temporomandibular disorders: A cross-sectional study using Korea National Health and Nutrition Examination Survey (KNHANES).

OBJECTIVES: To investigate the relationship between Temporomandibular disorder (TMD) and associated comorbidities in groups matched according to age and sex. METHODS: Using data from the cross-sectional fifth Korea National Health and Nutrition Examination Survey (KNHANES). Of the 25,534 eligible KNHANES, 17,762 adults aged ≥19 years who responded to survey questionnaire on TMD and comorbidities. Subjects were classified into eight groups according to age and sex. Logistic regression analyses were performed to evaluate the association between TMD and comorbidities according to age and sex. RESULTS: Of the enrolled participants, 2,107 (11.86%) complained of ≥1 TMD symptoms. In all groups, odds ratios (ORs) for prevalence of TMD were >1 in those with tinnitus. Rhinitis was closely associated with TMD in 6 groups. ORs for TMD with comorbidities according to age and sex were as follows: hypertension, men aged 50-64 years (OR 0.62; CI 0.41-0.94); ischemic heart disease, men aged 35-49 years (4.38; 1.54-12.47); osteoarthritis, women aged 50-64 years (1.38; 1.03-1.86); diabetes mellitus, men aged 35-49 years (0.21; 0.05-0.88); depression, men aged 50-64 years (1.68; 1.00-2.83), women aged 35-49 years (1.39; 1.05-1.85) and women aged 65-80 years (2.01; 1.46-2.77); migraine, men aged 50-64 years (1.60; 1.14-2.25), women aged d35-49 years (1.44; 1.14-1.81) and women aged 35-49 years (1.43; 1.07-1.90); cold hypersensitivity in the hands and feet, men aged 19-34 years (1.64; 1.05-2.58), men aged 35-49 years (1.68; 1.04-2.70), men aged 65-80 years (1.74; 1.09-2.75) and women aged 35-49 years (1.45; 1.15-1.84); olfaction disorder, men aged 50-64 years (2.49; 1.39-4.43); voice disorder, men aged 50-64 years (2.25; 1.28-3.96) and women aged 65-80 years (1.69; 1.09-2.63). CONCLUSIONS: This study confirmed that the types and effects of comorbidities related to prevalence of TMD may differ according to the patient's age and sex and this result will increase the predictability of the onset of TMD.

Temporomandibular joint herniation into the external auditory canal presenting as clicking tinnitus: A case report.

BACKGROUND: Herniation of the temporomandibular joint (TMJ) into the external auditory canal (EAC) due to a bony defect in the EAC is rare. Such bony defects can be secondary to inflammation, neoplasm, trauma. In rare instances, TMJ herniation can occur when the Huschke foramen is constantly exposed. TMJ herniation can induce clicking tinnitus, otalgia, conductive hearing loss, and otorrhea, but can also present with no symptoms. This study reports a case of TMJ herniation. CLINICAL PRESENTATION: A male patient presented with clicking tinnitus that had developed 3 years ago. Dome-shaped soft tissue was found on the anterior EAC wall, which protruded and depressed with mouth movement. The patient underwent surgical reconstruction of the bony defect with titanium mesh, and the symptoms resolved after surgery. CONCLUSION: This case highlights the importance of surgical reconstruction of a bony defect in the EAC using appropriate materials.

Clinical features of chronic primary pain in individuals presenting painful temporomandibular disorder and comorbidities.

BACKGROUND: The diagnosis of chronic primary pain (CPP), according to the recently released International Classification of Disease (ICD-11) criteria, refers to conditions with complex aetiologies. CPP is characterized by specific clinical features such as generalized sensory hypersensitivity and widespread pain, and is associated with functional disability and emotional distress. OBJECTIVE: This study investigated clinical features of CPP in individuals with painful temporomandibular disorders (TMD) and comorbidities (fibromyalgia, migraine and/or tension-type headache). METHODS: This cross-sectional study was conducted with a sample of 129 individuals. Painful TMD, fibromyalgia and primary headaches were evaluated based on well-established international criteria. Generalized sensory hypersensitivity was assessed using psychophysical tests. Symptoms of anxiety and depression were assessed by the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9. The Central Sensitization Inventory was applied to assess central sensitization-related symptoms and the Pittsburg Sleep Quality Index to evaluate the quality of sleep. The presence of widespread pain was assessed using a body map. The sample was stratified into three groups: control (n = 25), TMD-painful TMD only (n = 35) and TMD + Cm-painful TMD and comorbidities (n = 69). Statistical analysis was performed using one-way ANOVA, chi-squared test and ANCOVA, considering gender as a covariate (α = .05). RESULTS: Compared to controls, individuals presenting painful TMD and comorbidities showed lower pressure pain thresholds in all evaluated areas (p ≤ .012) and a higher number of painful areas in the body (p = .001). They presented more symptoms of anxiety (p = .040) and depression (p = .018), and a higher score in the Central Sensitization Inventory (p ≤ .006) than the other groups. CONCLUSION: Individuals with painful TMD and comorbidities presented more clinical features of CPP compared to those affected by TMD only.

Imaging features of temporomandibular joint synovial chondromatosis with associated osseous degenerative changes.

Synovial chondromatosis (SC) of the temporomandibular joint (TMJ) is a rare benign disease associated with the formation of multiple cartilaginous nodules in the synovial tissue of the TMJ. This can result in pain, swelling, clicking, limited mouth opening, and osseous degenerative joint changes. A retrospective cross-sectional study was performed to summarize the clinical features, radiographic findings, and surgical and histopathological findings of TMJ SC patients who underwent open surgery over a 24-year period. A radiographic scoring system was used to evaluate osseous changes and correlate condyle and joint fossa degeneration. The study included 38 patients and focused on 38 joints. All 38 of these joints showed degenerative changes in the condyle, while 37 showed osseous degenerative changes in the articular fossa. The degree of condylar degenerative changes was related to the duration of the chief complaints (r = 0.342, P = 0.036) and the histopathological stage of the TMJ SC (r = 0.440, P = 0.006), while the degree of joint fossa degenerative changes was associated with the radiographic extent of the SC (r = 0.504, P = 0.001), type of calcification (r = 0.365, P = 0.024), and the histopathological stage (r = 0.458, P = 0.004).

The association between orthodontic treatment and temporomandibular disorders diagnosis and disease characteristics.

BACKGROUND: The association between orthodontic treatment and temporomandibular disorders (TMD) has been contentious in the literature. OBJECTIVES: To analyse the associations between orthodontic treatment and TMD diagnosis and diseases characteristics. METHODS: This case-control study included 291 individuals, 192 TMDs and 99 controls. All patients underwent assessment based on a questionnaire and a clinical examination according to Axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Differences in orthodontic treatment between TMDs and controls, as well as across different TMD diagnoses within the TMD group were analysed. Patients who underwent orthodontic treatment were compared to those who did not, regarding their trauma history, bruxism, aggressive teeth brushing, level of oral hygiene, pain scores, muscle tenderness scores and subjective sleep quality. RESULTS: Of the 291 participants, 119 (40.9%) underwent orthodontic treatment and 172 (59.1%) had no orthodontics experience. Orthodontic treatment included: mandibular orthodontic treatment (102 subjects) and maxillary orthodontic treatment (113 subjects) of those 47 used a headgear. Following multivariate analysis among TMDs, orthodontic treatment was associated with a good level of oral hygiene versus poor (Odds ratio [OR]: 5.17 [1.04-25.59]), lower number of tender muscles [OR = 0.84 (0.74-0.96)] and lower (better) Pittsburgh Sleep Quality Index (PSQI) scores (OR = 0.86 [0.76-0.97]). None of the studied parameters maintained a statistically significant association with orthodontic treatment in the multivariate analysis among the entire study population. CONCLUSIONS: Utilising a holistic approach, this study supports the main hypothesis that orthodontic treatment is not associated with TMD diagnosis and disease characteristics.

Challenges in Managing Post-Radiation TMJ Pseudoankylosis.

This study demonstrates the outcomes of post-radiation temporomandibular joint (TMJ) pseudoankylosis management and its challenges. A rare maxillary squamous cell carcinoma was treated with subtotal maxillary resection. Subsequent radiation therapy, failure of free flap reconstruction, and 1 year of jaw hypomobility instigated TMJ pseudoankylosis with a maximal mouth opening (MMO) of less than 5 mm. Bilateral coronoidectomy was done simultaneously with maxillary reconstruction, followed up with buccal fibrosis release and extensive jaw exercises. At 16 months of follow-up, the patient's MMO was 20 mm. Although bilateral coronoidectomy released the attachment of the atrophic temporalis muscle, it did not correct the other causes of trismus, specifically the progressive fibrosis of masticatory muscles, loss of elasticity of the TMJ ligaments, and other soft tissue abnormalities. Radiotherapy-induced-trismus refractory to physical exercise may require further management to achieve satisfactory MMO.