Bioelectrical Activity of Masticatory Muscles and Postural Stability Across TMD Subtypes.

Differential diagnosis of facial pain and guidelines for management

The term temporomandibular disorders is used as a collective term for a group of musculoskeletal disorders that involve pain dysfunction in the masticatory muscles, temporomandibular joints, and related structures. Patients with temporomandibular disorders usually present to clinics with pain, limitation, and noise in jaw movement. While clinical examination is considered the most important process in the diagnosis of temporomandibular disorders, imaging methods selected according to the cases, are also considered important aids in diagnosis. The use of artificial intelligence in the diagnosis of temporomandibular disorders is also becoming increasingly common. Current studies on this subject recommend the use of deep learning models to facilitate diagnosis and increase diagnostic accuracy. The etiology of temporomandibular disorders is quite complex and multifactorial. Due to this complex etiology, current studies support conservative multidisciplinary treatment methods including behavioral therapy, physical therapy, and pharmacotherapy. The role of osteotomy in the treatment of temporomandibular joint disorders is also very important. It is also stated that temporomandibular joint dysfunctions decrease after osteotomies such as sagittal splint osteotomy, which corrects occlusion disorders. The purpose of this chapter is to provide an overview of the latest developments in the etiology, pathophysiology, diagnosis, and treatment of temporomandibular disorders.

Diagnostic accuracy of the short-form Fonseca Anamnestic Index in relation to the Diagnostic Criteria for Temporomandibular Disorders

Temporomandibular disorders (TMD) comprise a group of conditions affecting the masticatory muscles, the temporomandibular joints and associated structures, often manifesting as orofacial pain and functional limitations of the mandible. Central sensitization (CS) is gaining increasing attention in research focused on pain syndromes and somatization, playing a significant role in the pain experience. This study investigates the prevalence of CS and somatization among TMD patients, analyzing their relationships with TMD diagnoses and the intensity of chronic masticatory muscle pain (MMP). A prospective observational study was conducted with 214 adult participants diagnosed with TMD, based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). The Central Sensitization Inventory (CSI) and the Somatic Symptom Scale-8 (SSS-8) were utilized to assess CS and the burden of somatic symptoms, respectively. Furthermore, the patients were assessed for MMP, and the average pain in these muscles was calculated. Statistical analysis investigated correlations between CSI and SSS-8 scores, specific TMD diagnoses and MMP intensity. Most participants did not surpass the subclinical level for CS as assessed by the CSI. Women reported higher SSS-8 scores than men, suggesting sex differences in somatic symptom reporting. No significant relationship was found between specific TMD diagnoses and levels of CS or the SSS-8. However, a significant correlation was observed between SSS-8 scores and the intensity of chronic MMP, underscoring the impact of the intensity of chronic MMP on the perception of somatic symptoms among TMD patients. Additionally, the group with subclinical levels of CS presented significantly lower SSS-8 scores than other groups. This study highlights a lower-than-expected prevalence of CS among TMD patients. Higher levels of somatization were related to higher levels of CS and greater MMP. The findings suggest that TMD management should not only address specific pain sources but also consider the broader psychosocial aspects of the disorders, especially in chronic types.

Whether orthodontic therapy is a risk factor for temporomandibular disorders (TMD) or parafunctional habits such as bruxism is a question that has long been discussed. The issue is highly relevant to public health due to the frequency of these functional disorders in the general population and the sheer number of orthodontic treatments. The aim of this cross-sectional study was to investigate the risk of TMD or bruxism in children and adolescents during orthodontic therapy. The study included 1,011 children and adolescents between the ages of 10 and 18 selected at random from the general public who had been examined for signs of TMD using the Helkimo index and Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Parafunctional activities (bruxism) were surveyed and documented in reference to wear effects on the front teeth using the method developed by Egermark-Eriksson. In addition, probands were asked about their current orthodontic treatments. Nearly 30% (N = 296) of the probands stated that they were undergoing orthodontic therapy. Roughly 1/10 proband presented with a clinical TMD according to the Helkimo index (9.6%; N = 97) or a TMD diagnosis according to the RDC/TMD (10.2%; N = 102). After controlling for the effects of age, gender and school-type using a multinomial logistical regression analysis there was no increased risk of anamnestic or clinical TMD symptoms or diagnoses during orthodontic treatment (odds ratios between 0.63 and 1.18; all p-values > 0.05). At the same time, both wear facets on the front teeth (tooth-related mean value with vs. without appliance: 0.12 vs. 0.16; t test: p = 0.038) and self-reported bruxing be havior (OR = 0.57; p = 0.018) were significantly reduced by orthodontic treatment. Our study revealed no increased risk of TMD in children and adolescents during orthodontic therapy, which seems to reduce parafunctional activities and thus the likelihood of noncarious dental damage.

This study examined the occurrence of specific oral activities across different temporomandibular disorder (TMD) subtypes and explored the associations of oral behaviours with psychological distress, sleep propensity and jaw function. Additionally, it identified the sociodemographic and biopsychosocial determinants of high jaw overuse behavior (JOB) in TMD patients. Participants from a dental hospital completed a comprehensive survey covering sociodemographics, the Symptom Questionnaire and relevant psychosocial/behavioural measures of the Diagnostic Criteria for TMDs (DC/TMD), as well as the Epworth Sleepiness Scale. TMD diagnoses were established utilising the DC/TMD methodology and corresponding diagnostic algorithms. Participants were subsequently categorised into intra-articular (IT), pain-related (PT) and combined (CT) TMD groups, as well as normal (NO), low (LO) and high (HO) JOB groups. Data were assessed with Chi-square/non-parametric tests and logistic regression analyses (α = 0.05). The study sample included 798 participants (mean age 29.8 [SD 10.7] years; 79.6% female). Of these, 36.1%, 21.9% and 42.0% were diagnosed with IT, PT and CT, while 19.2%, 30.3% and 50.5% had NO, LO and HO, respectively. For all TMD subtypes, 'sleeping in a position that puts pressure on the jaws' was most prevalent (71.4%-74.9%). Significant differences in depression, anxiety, sleep propensity (HO > LO > NO) and jaw functional limitation (HO > LO, NO) were observed among JOB categories. The correlations between JOB and depression, anxiety, sleep propensity and jaw functional limitation, although significant, were weak (rs = 0.16-0.34). High JOB was associated with age, advanced education, sleep propensity and jaw functional limitation in TMD patients.

The Journal of Orthopaedic & Sports Physical Therapy is pleased to publish selected abstracts of the Congresso Internacional de Reabilitação Neuromusculoesquelética e Esportiva, which took place in Vitória, Brazil, May 18 to 21, 2011. This collection of abstracts provides a brief summary of the research presented at that meeting. These abstracts do not permit a full evaluation of the scientific rigor with which the work was conducted, but they provide an idea of the type of clinical questions being researched by individuals participating in that meeting. J Orthop Sports Phys Ther 2011;41(10):A1–A4. doi:10.2519/jospt.2011.0301

The aim of this cross-sectional study was to assess the impact of temporomandibular disorder (TMD) on oral health-related quality of life (OHRQoL) of adolescents. The OHRQoL of adolescents undergoing dental treatment at a University clinic in 2019 was measured using the Brazilian version of the Oral Heath Impact Profile – 14 (OHIP-14). The diagnosis of TMD was performed using Research Diagnostic Criteria for Temporomandibular disorders (RDC/TMD). The patients were examined for other oral conditions and the parents/guardians answered questions addressing socioeconomic/demographic characteristics and the general health of the adolescents. Statistical analysis involves simple and multiple logistic regression models. Ninety male and female adolescents between 13 and 18 years of age participated in the study. The prevalence of negative impact on OHRQoL was 34%. In the unadjusted analysis, negative impact on OHRQoL was associated with a poorer self- perception of general and oral health of the adolescent, nonspecific symptoms including pain, and generalized anxiety disorder, caries, reports of dental pain, muscle disorders and disc displacement, and chronic pain related to TMD. In the adjusted model, negative impact on OHRQoL was associated with all diagnoses related to TMD on the RDC/TMD, except signs of depression. Adolescents with at least one diagnosis related to TMD were 4.13-fold more likely (95% CI:1.08-15.80) to have negative impact on OHRQoL than adolescents without a diagnosis of TMD. The different diagnostic categories of TMD had a negative impact on the OHRQoL of the adolescents analyzed in the present study.

We evaluated the effects of upper cervical manipulation on the surface electromyographic activity (sEMG) of masticatory muscles and range of motion of the opening movement of the mouth in women with temporomandibular disorders (TMD). We evaluated 10 women with myogenic a TMD diagnosis, according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and divided randomly into an experimental group (EG) n=5, which received upper cervical manipulation, and a placebo group (PG) n=5, which received maneuvers without therapeutic effects. Five interventions were performed in both groups, once a week, with performance of pre-intervention assessments, post-immediate assessments (after 1st intervention) and post-delayed assessments (48 hours after the 5th intervention). The sEMG activity was processed using the root mean square and normalized by the peak value (RMS EMGn). We used for comparison the Student's t-test and ANOVA two-way repeated measures, adopting as significance the amount of 5%, and the Cohen d for treatment effect size. We found a significant interaction of group vs time (p<0.05) in the RMS EMGn of the left and right temporal muscles at rest, as well as for all masticatory muscles during maximal isometric contraction during jaw-elevation and jaw-depression. Treatment effect size, high to moderate, was observed in the EG, especially in the post-delayed assessment. We also observed a significant increase (p<0.05) and a high treatment effect during mouth opening in the EG. The upper cervical manipulation demonstrated a balance of the RMS EMGn of the masticatory muscles and increase the opening range of motion of the mouth in women with myogenic TMD.

Temporomandibular Disorder (TMD) has been considered as one of the commonest disorder in Pakistan. In this disorder, the patient complains of pain in Temporomandibular joint and associated anatomical muscles. This research study has been performed to evaluate the frequency of Anxiety and Depression in patients with Chronic Temporomandibular Disorder (CTMD). Objectives: The objective of this research study is to evaluate the frequency of Anxiety and Depression among patients with Chronic Temporomandibular joint Disorder. Study Design: A Cross-sectional Descriptive research study. Setting: This research study was conducted in the Department of Oral and Maxillofacial Surgery at Dr. Ishrat-ul-Ebad Khan Institute of Oral and Health sciences, Dow University of Health Sciences and Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan. Period: This research study was conducted for a respective period of 1 year from 1st March 2018 to 1st March 2019. Materials and Methods: A total of 213 patients having persisting Temporomandibular joint pain for more than 6 months were included in this study. The diagnosis of Temporomandibular Disorder (TMD) was established if the patient demonstrated pain/discomfort in the Temporomandibular Joint (TMJ) and muscles of mastication and masticatory dysfunction for a period, exceeding 6 months. After demographic questions, Hospital Anxiety and Depression Scale (HADS) was administered to each patient and the intensity and severity of Anxiety and Depression were recorded and documented by the Operator. Results: The percentage of Anxiety and Depression among patients with Chronic Temporomandibular Disorder (TMD) was 31.46% (67/213) and 36.15% (77/213). Conclusion: In our respective study, the Frequency of psychological disorders like Anxiety and Depression were significantly high. Our results showed that an adequate and profound diagnosis and treatment planning is very necessary for all patients suffering from Chronic Temporomandibular Disorder (CTMD) so that both physical and psychological factors of patients with Chronic Temporomandibular Disorder (CTMD) should be taken into primary foremost consideration prior to the decision pertaining to its management respectively.

BackgroundDespite its major existential, societal, and health impacts, research concerning the COVID-19 pandemic and Temporomandibular disorders (TMDs) is still limited. This study examined the effect of the pandemic on TMD subtypes and elucidated the influence of the pandemic, sex, and age on the prospect of pain-related (PT) and/or intra-articular (IT) TMDs in East Asian patients.MethodsData were accrued from consecutive new patients attending two university-based TMD/orofacial pain clinics in China and South Korea, 12 months before (BC; Mar 2019-Feb 2020) and during (DC; Mar 2020-Feb 2021) the COVID-19 pandemic. TMD diagnoses were derived from pertinent symptoms, signs, and radiographic findings according to the Diagnostic Criteria for TMDs (DC/TMD) methodology. Patients were subsequently categorized into those with PT, IT, and combined TMDs (CT) and also stratified by attendance period, sex, and age groups (adolescents/young adults [AY] and middle-aged/older adults [MO]) for statistical analyses using Chi-square/Mann-Whitney U tests and logistic regression analyses (α = 0.05).ResultsThe BC and DC groups comprised 367 (75.2% females; 82.8% AY) and 471 (74.3% females; 78.3% AY) patients correspondingly. No significant differences in sex and age group distributions were observed. The DC group had significantly more PT/IT conditions with higher prevalence of myalgia, headache, and degenerative joint disease than the BC group. Univariate analyses showed that PT/CT was associated with sex and age, whereas IT was related to the pandemic and age. However, multivariate analyses indicated that the odds of PT were affected by sex (OR = 2.52) and age (OR = 1.04) while the odds of IT (OR = 0.95) and CT (OR = 1.02) were influenced by age only.ConclusionsThe COVID-19 pandemic, as an impact event, did not influence the prospect of PT and/or IT. Sex and age appeared to play more crucial roles in the development of PT and IT/CT respectively.

Objective: to evaluate the prevalence of temporomandibular joint disorder in people with Parkinson’s disease in a public university hospital, and relate it to sociodemographic factors, general health and oral health self-report, and phase and time of illness. Methods: the Research Diagnostic Criteria for Temporomandibular Disorders were used. The sample was classified according to the diagnosis of temporomandibular disorder and associated with the variables. The odds ratio of Chi-square was applied with a 95% confidence interval and a level of significance set at p&lt;0.05. Results: 110 people presented with Parkinson's disease were assessed. The prevalence of temporomandibular disorder was 35%, being more frequent among males (58%), in elderly people (53%), in phase 2 of the disease (61%), click (37%) being the predominant clinical indication. Of the variables analyzed, only gender and self-perception of oral health showed to be associated with temporomandibular disorders. Conclusion: the presence of temporomandibular disorder has been observed in people with Parkinson's disease, and the fact of being male and reporting moderate oral health seen as associated factors.

Background: Temporomandibular disorders (TMD) are common musculoskeletal conditions affecting the temporomandibular joints, masticatory muscles, and associated structures. Their etiology is complex and multifactorial, involving anatomical, behavioral, and psychosocial contributors. Parafunctional habits such as clenching, grinding, and abnormal jaw positioning have been proposed as contributing factors, yet their individual and cumulative contributions remain unclear. This exploratory cross-sectional study aimed to evaluate the prevalence and severity of parafunctional habits and their association with TMD in medical students-a group exposed to elevated stress levels. Subjects were examined in Krakow, Poland, using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) protocol. Methods: Participants completed a 21-item Oral Behavior Checklist (OBC) assessing the frequency of oral behaviors on a 0-4 scale. A self-reported total parafunction load was calculated by summing individual item scores (range: 0-84). Logistic regression was used to evaluate associations between individual and total parafunction severity scores and TMD presence. Results: The study included 66 individuals aged 19-30. TMD was diagnosed in 55 participants (83.3%). The most commonly reported habits were resting the chin on the hand (90.9%) and sleeping in a jaw-compressing position (86.4%). Notably, jaw tension (OR = 14.5; p = 0.002) and daytime clenching (OR = 4.7; p = 0.027) showed significant associations with TMD in the tested population. Each additional point in the total parafunction score increased TMD odds by 13.6% (p = 0.004). Conclusions: These findings suggest that parafunctional behaviors-especially those involving chronic muscle tension or abnormal mandibular positioning-may meaningfully contribute to the risk of TMD in high-stress student populations. Moreover, the cumulative burden of multiple low-intensity habits was also significantly associated with increased TMD risk. Early screening for these behaviors may support prevention strategies, particularly among young adults exposed to elevated levels of stress.

BackgroundChildren and adolescents with juvenile idiopathic arthritis (JIA) may suffer pain from temporomandibular disorder (TMD). Still, routines for the assessment of temporomandibular joint (TMJ) pain in health and dental care are lacking. The aims of this study were to examine the prevalence of TMD in children and adolescents with JIA compared to their healthy peers and to investigate potential associations between JIA and TMD.MethodsThis comparative cross-sectional study is part of a longitudinal multicentre study performed during 2015–2020, including 228 children and adolescents aged 4–16 years with a diagnosis of JIA according to the ILAR criteria. This particular substudy draws on a subset of data from the first study visit, including assessments of TMD as part of a broader oral health examination. Children and adolescents with JIA were matched with healthy controls according to gender, age, and centre site. Five calibrated examiners performed the clinical oral examinations according to a standardised protocol, including shortened versions of the diagnostic criteria for TMD (DC/TMD) and the TMJaw Recommendations for Clinical TMJ Assessment in Patients Diagnosed with JIA. Symptoms were recorded and followed by a clinical examination assessing the masticatory muscles and TMJs.ResultsIn our cohort of 221 participants with JIA and 221 healthy controls, 88 (39.8%) participants with JIA and 25 (11.3%) healthy controls presented with TMD based on symptoms and clinical signs. Painful TMD during the last 30 days was reported in 59 (26.7%) participants with JIA vs. 10 (5.0%) of the healthy controls (p < 0.001). Vertical unassisted jaw movement was lower in participants with JIA than in controls, with means of 46.2 mm vs. 49.0 mm, respectively (p < 0.001). Among participants with JIA, a higher proportion of those using synthetic disease-modifying antirheumatic-drugs and biologic disease-modifying antirheumatic-drugs presented with painful masticatory muscles and TMJs at palpation.ConclusionSymptoms and clinical signs of TMD were seen in approximately half of the JIA patients compared to about one fourth of their healthy peers. Painful palpation to masticatory muscles and decreased vertical unassisted jaw movement were more frequent in participants with JIA than among healthy controls and should be part of both medical and dental routine examinations in patients with JIA.

Objectives:This study intended to understand the risk of developing temporomandibular disorder among Saudi women who experienced a miscarriage.Materials and Methods:Two hundred and eight Saudi women from several hospitals’ gynecologic clinics in two areas in Saudi Arabia were screened to fill out the Impact of Events Scale-Revised (self-reporting questionnaire) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic criteria for posttraumatic stress disorder and a structured temporomandibular joint disorder (TMD) Questionnaire (Research Diagnostic Criteria for Temporomandibular Disorders). A single examiner did the clinical examination for temporomandibular joint (TMJ). One-hundred and fifty-eight of the participants were divided into two groups. Group A (85 participants) included females who had had a previous miscarriage, whereas Group B (73 participants) included females who had not had a miscarriage. IBM SPSS version 22.0 was used to conduct a nonparametric Chi-square test to find the significance of any observed differences.Results:Almost 40% of the participants had symptoms that qualified for possible TMD. Around 73% of the miscarried Saudi women in Group A showed symptoms of TMD. Furthermore, approximately 38% of the participants in Group B developed significant symptoms of TMD. The Chi-square test (Chi-test = 22.03 with P = 0.0001) shows highly significant association between treatment groups (control and study) and temporomandibular joint disorder group and non temporomandibular joint disorder group.Conclusion:Women who suffer from spontaneous single or recurrent miscarriages are advised to seek a dental specialist for diagnosis and prevention devices such as a night guard.