QUESTIONING CHIROPRACTICS

Differential diagnosis of facial pain and guidelines for management

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.

Subject. Questions of diagnostics and revealing of the reasons of temporo-mandibular joint (TMJ) disorders are very significant now. Realities of modern stomatology have a significant impact, namely, use of materials with high durability and rigidity, widely available of total restorations and orthodontic treatment, insufficiency of the high-grade diagnostics of maxillofacial pathology for revealing latent, compensated TMJ disorders before stomatologic intervention. All these factors leads to occurrence of patients with the expressed, developed semiology. The purpose. To consider interrelation of various occlusion derangements, lateral displacement of the mandible and internal TMJ disorders (or dislocations of the TMJ disc, intraarticulate elements). Methodology. The estimation of frequency of occurrence of TMJ disc dislocations according to literary sources is carried out, various etiological factors of internal TMJ disorders are considered, in particular, some types of pathological occlusion, which may have an essential impact on the violation of the ratio of intraarticulate elements. Two clinical cases of patients with TMJ disorders with similar semiology and presence of transversal malocclusion due to improper jaws growth and presence of the acquired pathology as result of stomatologic intervention as an example. Results of research. According to the domestic and foreign literature the role of occlusion factors in development of TMJ disorders is represents approximately 10―20 %, however there are researches by types of occlusal disorders which almost always lead to those or other TMJ disorders. Conclusion. It is revealed, that transversal malocclusion most often provokes TMJ dysfunction and internal joint disorders. In the future it is planned to reveal occlusal factors which able to provoke the development of TMJ disorders with high probability, mechanism of their influence and methods of revealing.

Introduction. Temporomandibular joint (TMJ) dysfunction is the second most common musculoskeletal disease, affecting up to 33 % of people during their lifetime. The multicomponent etiopathogenesis of the disease actualizes the use of diagnostic criteria for the early symptoms of developing functional disorders. The algorithm for preclinical examination of the TMJ must be used already in the dentist′s office, which will allow to avoid the unpredictable results of dental rehabilitation and in time to attract other specialists to the complex therapy of the patient. The etiopathogenesis of TMJ dysfunction indicates the need for a closer study of the mutual infl uence of structural imbalances in the body and dentition, the determination of the primary disorder, which will help to develop a system for the prevention of TMJ dysfunctions, and may also affect the sequence, volume and nature of the treatment for this pathology.The goal of research — to identify the relationship of structural imbalances in the body and temporomandibular joint dysfunction.Materials and methods. From September to December 2019, a prospective study of 70 volunteers among university students was conducted at the Department of Orthopedic Dentistry of Omsk State Medical University. During the processing of clinical material, 6 people retired in accordance with exclusion criteria. All subjects underwent an assessment of the state of the dentofacial system, primarily the TMJ (using a short Hamburg test) and structural imbalances of the body (using the Notch Interfaces Inc. motion capture and reconstruction system). To assess the cervical-cranial relationship in the subjects who had 3–6 points according to the results of the Hamburg test, a head X-ray was make in lateral projection, and cephalometric analyzes were performed according to Rocabado and Sassuni. The presence and strength of the linear relationship between the phenomena was determined using the Pearson coefficient.Results. According to the results of the Hamburg test, a functional norm was revealed in only 12,5 % of the examined; TMJ dysfunction was revealed in the vast majority of volunteers (57,9 %). Structural imbalances of the body were detected in 82,8 % of cases. Patients with established by the results of the Hamburg test TMJ dysfunction were underwent cephalometric analysis. Structural changes in the TMJ were not found in the subjects according to the X-ray studies results. There was a high positive relationship between functional TMJ dysfunction and pelvic hyperfl exion (ρ=0,72, p<0,05), and an average positive relationship (ρ=0,55, p<0,05) between the head and neck forward tilting. A positive weak relationship was observed between the risk of TMJ dysfunction developing (2 points according to the Hamburg test) and pelvic hyperfl exion (ρ=0,31, p<0,05).Conclusion. The study showed a strong positive relationship between pelvic hyperfl exion and TMJ dysfunction signs; an average positive relationship between TMJ functional impairment and head and neck forward tilting. It was also found that in individuals with TMJ dysfunction signs there were no radiological signs of structural changes in the joint, which indicates the potential reversibility of the revealed disorders and the need for their timely detection and correction. This study is pilot and will be continued in a broader format.

This study assessed 24 adult patients, suffering from severe chronic unilateral pain diagnosed as temporomandibular joint (TMJ) disorder (TMD). The full dentate patients had normal occlusion and had never received an occlusal therapy, i.e., were with natural dental evolution/maturation. The following functional and dynamic factors were assessed: (1) chewing function; (2) TMJ remodeling or the condylar path (CP); and (3) lateral jaw motion or lateral guidance (LG). CPs were assessed using conventional axiography, and LG was assessed by K7 jaw tracking. Seventeen (71%) of the 24 (100%) patients consistently showed a habitual chewing side. The mean (standard deviation [SD]) of the CP angles was 47.90 (9.24) degrees. The mean (SD) of the LG angles was 42.95 (11.78) degrees. Data collection emerged from the conception of a new TMD paradigm where the affected side could be the habitual chewing side, the side with flatter lateral jaw motion or the side with an increased CP angle. These data may lead to improved diagnosis, therapy plans and evolution in TMD patients.

Background: Painful temporomandibular joint disorders (TMDs) are of musculoskeletal origin and are considered the most common cause of non-odontogenic pain in the orofacial region. The purpose of this study was to investigate the prevalence and awareness of temporomandibular joint (TMJ) disorders in Almadinah Almunawwarah community. Methods: A prospective observational cross-sectional study with convenience sampling was conducted. The patients were selected from the dental college and the hospital at Taibah University in Al-Madinah, Saudi Arabia. A translated Arabic version of Fonseca's questionnaire was employed. The questionnaire asked about the participant's personal information, if they thought they had TMDs, and who to visit for therapy if necessary. These were followed by 10 items from Fonseca's questionnaire, each with a three-point scale. Results: The questionnaire was completed by 518 people. Females made up 57.1% of the participants. TMDs were present in 61% of the population, with varying degrees of severity. Males (44.3%) were less affected than females (55.7%). The difference, however, was not statistically significant (P = 0.354). Out of the 61% TMDs Positive patients, 74.1% had mild TMDs symptoms, while 20.8% and 5.1%, respectively, had moderate and severe TMDs symptoms (P = 0.05). The severity of the symptoms was unaffected by demographic data (P > 0.05). Only 40% seek care, with 64.6% selecting for a dentist or orofacial pain specialists for their management and 24.6% preferring for an orthopaedic specialist (P= 0.008). Conclusions: Participants from Al-Madinah had a greater prevalence of mild TMDs. The majority of the participants had no idea who to go to for treatment. The findings of this study highlight the importance of educational activities to enhance public awareness

Is There a Role for Oxidative Stress in Temporomandibular Joint Disorders?

Temporomandibular joint (TMJ) disorders (TMD) are usually diagnosed based on the patient's clinical findings and the results of image investigations; however, understanding of the inflammatory process in TMJ is difficult. In addition, many of the TMJ disease types share common principal symptoms. Therefore, TMJ diseases in the early stage can be misdiagnosed with TMD. It is hypothesized that cytopathologic examination of the joint lavage fluids is useful in interpreting the TMD-associated inflammatory process from a cellular aspect. The aim of this study was to assess the TMJ lavage fluid cytopathologically in TMD patients. Thirty-nine patients, clinically diagnosed as TMD, were included in the present study. Clinical symptoms of the patients were recorded. Forty-four samples of TMJ lavage fluid were collected and paraffin-embedded cell sections were made by cell block tissue array method. Cytologic conditions in upper articular cavity of TMJ were cytopathologically diagnosed and were compared with the clinical symptoms of each patient. Cell components were detected in 22 of the 44 analyzed joint lavage fluids. There was a correlation between cytopathologic findings and clinical symptoms. Variety of cytopathology and inflammatory conditions in patients with similar clinical symptoms were also found. The results suggested that cytopathologic examination of the joint lavage fluids from TMD patients is helpful for gaining an understanding of the inner local conditions of TMJ at the cellular level.

Background: The controversy surrounding the role of occlusion in temporomandibular joint (TMJ) dysfunction led to this study. Temporomandibular joint (TMJ) dysfunction has been the subject of considerable study for decades, yet despite voluminous literature, the multifactorial aetiology of temporomandibular dysfunction, is even today a cryptic issue.The cause of the signs and symptoms of TMJ dysfunction is not clearly understood and various opinions on their aetiology have been offered. The aim of study was to evaluate the effects of the occlusal interference with fixed prosthesis on the position of the terminal hinge axis and to stady the role of the occlusal interference with fixed prosthesis in the etiology of Temporomandibular joint dysfunction by using cadiax compact 2. Material and methods this study was carried out on 32 patients who came to the teaching hospital in the college of dentistry at university of al Mustansiria suffering from missing teeth and need for substitution by fixed partial denture. Everyone of the selected sample was examined in three visits with a new computerized axiography technology for recording the transverse hinge axis and Bennett movement by cadiax compact 2 and an evaluation for TMD was done by Helkimo index which was used to collect the TMJ dysfunction data, The 1st record in the 1st visit at the starting date before dental preparation, the 2nd record immediately after cementation of fixed prosthesis and the 3rd recorded 1 month after the 2nd record. Result: The results of this study showed that no effect of occlusion adjustment on TMD by using fixed partial denture even if patients have change in position of hinge axis and Bennett angle .the comparison between the angle changes in the same side of treatment shows no significant changes (p value >0.05) and that is shown also by Helkimo index because there was no score for all the patients. Conclusion Occlusion interferance does not play a major role in the aetiology of TMD; the impact of occlusion is not zero, however, and should be determined in each individual case.

Arthroscopic laser surgery for temporomandibular joint disorders

Purpose To evaluate the diagnostic accuracy of the quantitative parameter standardized uptake value (SUV) at single photon emission computed tomography (SPECT)/computed tomography (CT) for the evaluation of temporomandibular joint (TMJ) disorder (TMD). Materials and Methods This study was approved by the institutional review board, and the need for informed consent was waived. Forty-four TMJs in 22 patients with TMD (five men and 17 women; mean age ± standard deviation, 30.0 years ± 12.1) were evaluated. The patients underwent planar bone scintigraphy and SPECT/CT 3-4 hours after injection of technetium 99m hydroxymethylene diphosphonate. The planar scintigraphy parameter of relative ratio (RR) and SPECT/CT parameters mean SUV (SUVmean) and maximum SUV (SUVmax) were compared for the visual assessment of TMD on planar scintigraphy images and for the presence of TMJ arthralgia. Group comparisons, receiver operating characteristic analysis, and Pearson correlation analysis were conducted. Results SUVmax gradually increased from normal (2.82 ± 0.73) to mild or moderately abnormal (3.56 ± 0.76, P < .05) and then to severely abnormal (4.86 ± 1.25, P < .05). However, RR and SUVmean did not vary significantly according to visual grade (P > .05). On the other hand, SUVmax was significantly greater in arthralgic TMJs (4.15 ± 1.11) than in nonarthralgic TMJs (2.97 ± 0.75, P < .001), as was SUVmean (1.63 ± 0.42 vs 1.30 ± 0.31, respectively; P = .005). However, there was no significant difference in RR (3.61 ± 0.57 vs 3.76 ± 0.68, P = .45). In receiver operating characteristic curve analyses for arthralgic TMJ, SUVmax had the greatest area under the curve (area of 0.815). Conclusion SUVmax derived from bone SPECT/CT may be useful for the evaluation of TMD. (©) RSNA, 2016 Online supplemental material is available for this article.

Temporomandibular disorder can affect the quality of sleep. Objective: To analyze the association betweentemporomandibular disorder and quality of sleep among nurses in a type C private hospital using the ID-TMDand PSQI Indonesian version questionnaire. Methods: This cross-sectional study assessed the data of 92 nursesin Hasanah Graha Afiah Hospital, Depok City, West Java, Indonesia. Three questionnaires were administeredto each hospital nurse. The ID-TMD questionnaire was used to evaluate temporomandibular disorder; the PSQIIndonesian version was used to evaluate quality of sleep. Results: The results showed significant differencesbetween temporomandibular disorder and quality of sleep among nurses in a type C private hospital (p = 0.02). Conclusion: There was a relationship found in this study between temporomandibular joint disorder and qualityof sleep in a type C private hospital.

The negative impact of psychological factors on temporomandibular disorders (TMD) has attracted widespread attention. However, the association between marriage as an essential psychological influence and TMD has never been reported. The authors sought to examine the correlation between marriage and TMD. We performed a case-control research with 105 adult patients who met the inclusion criteria during the study period and 114 matched controls who were matched to the patients from our hospital. An investigation was conducted using weighted multivariable and logistic regression analyses to examine the autonomous correlation between marriage history and TMD. Additionally, subgroup analysis and interaction testing were conducted. Conditional logistic regression analysis revealed that, in the fully adjusted model, marriage history was associated with a significantly lower risk of temporomandibular disorders (TMD) (OR = 0.14, 95% CI: 0.03–0.65, P = .0126). Gender significantly modified this association (P for interaction = .0017), with married men showing an extremely low prevalence of TMD (OR = 0.00, 95% CI: 0.00–0.07, P = .0001). After marriage, the risk of TMD decreased, reaching its lowest level among individuals with 1 child. However, as the number of children increased, the incidence of TMD gradually rose and could eventually exceed the premarriage level. Subgroup analyses and curve-fitting methods supported this nonlinear relationship between the number of children and TMD risk. Marriage appears to protect against temporomandibular joint disorders, with the lowest risk observed in individuals with 1 child. However, the incidence of TMD increases as the number of children rises. Further studies are needed to explore the factors contributing to the increased risk of TMD following childbearing.

The ideal lavage volume for removing bradykinin, interleukin-6, and protein from the temporomandibular joint by arthrocentesis

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.