Vitamin D and Temporomandibular Disorders: What Do We Know So Far?

BACKGROUND AND AIMS: Vitamin D is synthesized in the skin with the aid of ultraviolet-B radiation, playing a variety of roles in the body. Temporomandibular disorders (TMDs) are a group of pathological conditions involving the temporomandibular joints as well as the masticatory muscles and othersurrounding tissues. In the present narrative review, we investigated the potential role of vitamin D in the etiology of temporomandibular disorders in order todetermine whether the current knowledge supports 25-hidroxyvitamin D (25-OHD) supplementation in temporomandibular disorders associated with insufficient or deficient levels of vitamin D. METHODS: A literature research was performed in PubMed, Scopus, Science Direct, and Google Scholar databases, and a total of 10 articles were included for analysis. RESULTS: Among the observational studies published to date, investigating the role for vitamin D in the etiology of TMDs, six of them suggest that there is a connection between the two aspects. In this context, patients suffering from TMD, with deficient levels of vitamin D (<30 ng/mL), are most likely to benefit from supplementation, whereas individuals with vitamin D level >50ng/mL probably have little benefit from supplementation. CONCLUSION: Vitamin D might be a safe, simple, and potentially beneficial way to prevent TMDs or to reduce pain; however, more randomized and placebo-controlled trials are required before any firm conclusions can be drawn.

What should we tell patients with painful temporomandibular disorders about what to eat?

BACKGROUND AND OVERVIEW: Patients with painful temporomandibular disorders (TMD) commonly report problems eating, owing to limited mandibular opening and pain and discomfort with biting and chewing. Consequently, painful TMD may affect dietary intake and nutritional status. CONCLUSIONS: Treatment of painful TMD is multifaceted and involves pharmacologic, physical, and cognitive behavior and dietary therapies. Painful TMD may influence the quality of dietary intake and eating behaviors. There is a dearth of established guidelines and validated measures that clinicians can use to assess and manage diet and nutritional well-being in patients with this disorder. The authors present recommendations in an effort to guide clinicians on how to help patients with painful TMD improve the quality of their diets and avoid or minimize eating-related pain. PRACTICAL IMPLICATIONS: Providing comprehensive care for patients with painful TMD should include diet evaluation and recommendations for eating comfortably and supporting nutrition. An interprofessional approach may help improve treatment outcomes. Research is needed to develop evidence-based guidelines for diet and nutrition that clinicians can use in the care of patients with painful TMD.

Executive summary of the Diagnostic Criteria for Temporomandibular Disorders for clinical and research applications.

BACKGROUND: In this executive summary, the authors describe a protocol for assessing patients with temporomandibular disorder (TMD). It is based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for clinical and research applications. METHODS: The DC/TMD was developed using published Axis I physical diagnoses for the most common TMDs. Axis I diagnostic criteria were derived from pertinent clinical TMD signs and symptoms. Axis II consists of psychosocial and behavioral questionnaires already in the public domain. A panel of experts vetted and modified the Axis I and Axis II diagnostic protocols. Recommended changes were assessed for diagnostic accuracy by using the Validation Project's data set, which formed the basis for the development of the DC/TMD. RESULTS: Axis I diagnostic criteria for TMD pain-related disorders have acceptable validity and provide definitive diagnoses for pain involving the temporomandibular joint (TMJ) and masticatory muscles. Axis I diagnostic criteria for the most common TMJ intra-articular disorders are appropriate for screening purposes only. A definitive diagnosis for TMJ intra-articular disorders requires computed tomography or magnetic resonance imaging. Axis II questionnaires provide valid assessment of psychosocial and behavioral factors that can affect management of TMD. CONCLUSIONS: The DC/TMD provides a questionnaire for the pain history in conjunction with validated clinical examination criteria for diagnosing the most common TMDs. In addition, it provides Axis II questionnaires for assessing psychosocial and behavioral factors that may contribute to the onset and perpetuation of the patient's TMD. PRACTICAL IMPLICATIONS: The DC/TMD is appropriate for use in clinical and research settings to allow for a comprehensive assessment of patients with TMD.

Arthrocentesis as initial treatment for temporomandibular joint arthropathy: a randomized controlled trial.

OBJECTIVE: To determine the effectiveness of arthrocentesis compared to conservative treatment as initial treatment with regard to temporomandibular joint pain and mandibular movement. PATIENTS AND METHODS: In this randomized controlled trial, 80 patients with arthralgia of the TMJ (classified according to the Research Diagnostic Criteria for Temporomandibular Disorders) were randomly assigned to one of the two treatment groups. One group received arthrocentesis as initial treatment (n = 40), the other group received conventional treatment including soft diet, physical treatment and occlusal splint therapy (n = 40). Follow-up was after 3, 12 and 26 weeks post treatment. Prior to treatment, and at every follow-up assessment, pain intensity was measured (VAS 0-100 mm at rest, and VAS 0-100 mm during movement) and maximum mouth opening (MMO) (mm interincisor distance). Furthermore patients were asked to fill out several surveys concerning the impact of mandibular impairment on their daily life, and psychosocial aspects. RESULTS: After 26 weeks, the TMJ pain (mm VAS at rest, and mm VAS during movement) had declined comparably in both groups (arthrocentesis n = 36; conservative treatment n = 36) and MMO (mm interincisor distance) had slightly improved. GEE models showed significant differences between arthrocentesis as initial treatment and conservative treatment, indicating that the arthrocentesis group improved more rapidly with regard to TMJ pain (VAS at rest p = 0.008; regression coefficient ß = -8.90 (95% confidence interval -15.50, -2.31), VAS during movement p = 0.003; regression coefficient ß = -10.76 (95% confidence interval -17.75, -3.77)) and MMO (p = 0.045; regression coefficient ß = -2.70 (95% confidence interval -5.35, -0.06)) compared to conservative treatment. CONCLUSIONS: Arthrocentesis as initial treatment reduces pain and functional impairment more rapidly compared to conservative treatment. However, after 26 weeks, both treatment modalities achieved comparable outcomes. TRIAL REGISTRATION NUMBER: www.trialregister.nl: NTR1505.

Inclusion of cocoa as a dietary supplement represses expression of inflammatory proteins in spinal trigeminal nucleus in response to chronic trigeminal nerve stimulation.

SCOPE: Central sensitization is implicated in the pathology of temporomandibular joint disorder and other types of orofacial pain. We investigated the effects of dietary cocoa on expression of proteins involved in the development of central sensitization in the spinal trigeminal nucleus (STN) in response to inflammatory stimulation of trigeminal nerves. METHODS AND RESULTS: Male Sprague-Dawley rats were fed either a control diet or an isocaloric diet consisting of 10% cocoa powder 14 days prior to bilateral injection of complete Freund's adjuvant (CFA) into the temporomandibular joint to promote prolonged activation of trigeminal ganglion neurons and glia. While dietary cocoa stimulated basal expression of glutamate-aspartate transporter and mitogen-activated protein kinase phosphatase-1 when compared to animals on a normal diet, cocoa suppressed basal calcitonin gene-related peptide levels in the STN. CFA-stimulated levels of protein kinase A, P2X3 , P-p38, glial fibrillary-associated protein, and OX-42, whose elevated levels in the STN are implicated in central sensitization, were repressed to near control levels in animals on a cocoa-enriched diet. Similarly, dietary cocoa repressed CFA-stimulated inflammatory cytokine expression. CONCLUSION: Based on our findings, we speculate that cocoa-enriched diets could be beneficial as a natural therapeutic option for temporomandibular joint disorder and other chronic orofacial pain conditions.

Etiology, pathogenesis and treatment of habitual dislocations of the T.M. Joints [original work].

Definite treatment of any pathological condition, is based on the understanding of its correct pathogenesis and etiology. Without this basic understanding correct and lasting treatment is not possible. When there is no knowledge of exact pathogenesis and etiology, various theories and treatments are suggested by various workers. This is what exactly happened in the case of habitual dislocations of the T.M. Joints. This in term has happened because the dental surgeons and so called oral surgeons, never expanded their vision, beyond their restricted field of 20 deciduous teeth and 32 permanent teeth. Lack of understanding of basic physiological functions, of various tissues in the body and their effects on various systems as a whole was neglected. For this study four patients were selected from many, who could visit my clinic regularly and co-operate to follow all the instructions over a period of at least 5 years. The analysis of their symptoms and signs, had a different story to tell than what was described in the literature so far.