Malocclusion traits and symptoms and signs of temporomandibular disorders in children with severe malocclusion

The present study reports the prevalence of the various traits of malocclusion, as well as the occurrence of associations between malocclusion, and symptoms and signs of temporomandibular disorders (TMD) in children selected for orthodontic treatment by the new Danish procedure for screening the child population for severe malocclusions entailing health risks. The sample comprised 104 children (56 F, 48 M) aged 7-13. Malocclusion traits were recorded at the time of selection, symptoms and signs of TMD were recorded at recall. The most prevalent malocclusion traits were distal molar occlusion (Angle Class II; 72 per cent), crowding (57 per cent), extreme maxillary overjet (37 per cent) and deep bite (31 per cent). Agenesis or peg-shaped lateral teeth were observed in 14 per cent of the children. The most prevalent symptom of TMD was weekly headache (27 per cent); the most prevalent signs of TMD were tenderness in the anterior temporal, occipital, trapezius, and superficial and profound masseter muscles (39-34 per cent). Seven per cent of the children were referred for TMD treatment. The Danish TMD screening procedure was positive in 26 per cent, while 20 per cent had severe symptoms (Aill), and 30 per cent had moderate signs (Dill) according to Helkimo (1974). Symptoms and signs of TMD were significantly associated with distal molar occlusion, extreme maxillary overjet, open bite, unilateral crossbite, midline displacement, and errors of tooth formation. The analysis suggests that there is a higher risk of children with severe malocclusions developing TMD. Errors of tooth formation in the form of agenesis or peg-shaped lateral teeth showed the largest number of associations with symptoms and signs of TMD; these associations have not previously been reported in the literature.     

A cross-sectional study of prevalence and etiology of signs and symptoms of temporomandibular disorders in high school and university students

The aim of this study was to evaluate the prevalence and need for treatment of temporomandibular disorders (TMD) in students living in Bauru, Brazil. The role of occlusal and emotional factors was also addressed. The presence and severity of TMD was determined by using a self-reported anamnestic questionnaire composed of 10 questions regarding common TMD symptoms. The symptoms were transposed into a severity classification according to the number and frequency of positive responses. Occlusal evaluation included an analysis of retruded contact position, intercuspal position, anterolateral guidance, and nonworking side contacts during mandibular movements. Palpation of the muscles and temporomandibular joints were performed to detect clinical signs of TMD. A chi square test was used to compare clinical and occlusal data with the presence and severity of TMD. A total of 0.65% of the subjects had severe TMD symptoms, 5.81% had moderate symptoms, and 34.84% had mild symptoms. Those with severe and moderate symptom levels were interpreted to be in need of treatment. Symptoms were found significantly more frequently in females than in males (P < .01). Self-reported emotional tension and parafunctional habits demonstrated strong associations with TMD (P < .01). Occlusion did not seem to influence the presence or severity of TMD. Based on these results, the efficacy of some traditional TMD treatments should be reconsidered, and reversible and conservative procedures should be the first choice for managing TMD patients.     

Symptoms of the cervical spine in temporomandibular and cervical spine disorders

This study was performed to assess the prevalence of signs and symptoms related to cervical spine disorders (CSD) in subgroups of patients with temporomandibular disorders (TMD) and to compare TMD patients and CSD patients with regard to the results of orthopaedic cervical spine tests. One hundred and eleven consecutive patients with TMD and 103 consecutive patients with signs and symptoms of CSD were examined. The results indicated that there is a considerable overlap in the signs and symptoms of patients with TMD and patients with CSD. Signs and symptoms on neck extension occurred more often in CSD patients than in subgroups of TMD patients. No significant differences in upper cervical extension, neck flexion, and shoulder girdle function were found between CSD patients and subgroups of patients with TMD. Patients with CSD reported neck pain during active and passive movements of the neck more often than the subgroups of patients with TMD. TMD patients and CSD patients did not differ with regard to pain on shoulder girdle function and palpation of the shoulder girdle. Logistic regression analyses showed that orthopaedic tests of the cervical spine are of minor importance in discriminating between patients with TMD and patients with CSD. It is concluded that TMD with a myogenous involvement in contrast to TMD with only an arthrogenous involvement should no longer be viewed as a local disorder of the stomatognathic system. The upper quarter, including the stomatognathic system, cervical spine, and shoulder girdle, should be evaluated in patients with more complex or persistent symptoms in the head and neck region.     

Long-term follow-up study on drop-out TMD patients with self-administered questionnaires

Although patient attrition might be a serious threat to the validity of treatment-outcome studies on temporomandibular disorders (TMD), studies on TMD patient attrition are scarce. Of the 1405 consecutive TMD patients examined in a recent 10-year period, 367 (26.1%) drop-out patients or patients identified with a control group were sampled. A mailed questionnaire failed to reach 41 patients, and 203 (62.3%) were returned. The questionnaire elicited information on reasons for dropping out, changes in symptoms, treatment received in other clinics after dropping out, present treatment needs, and current signs and symptoms. Dropouts were divided into two groups: (1) those who failed to show up for their first scheduled appointment after the clinical examination; (2) those who failed to complete treatment. A group of patients who were judged by the examiner not to need treatment were included as a control group. The main reasons for dropping out were environmental obstacles, perceived improvement of the disease, and dissatisfaction with services. Only 21.7% considered themselves to be in need of treatment, and only 10.3% had visited other clinics after dropping out. Only 8.9% complained of the continued aggravation of symptoms, whereas 57.6% reported improvement. In addition, pain, dysfunction, and daily activity limitation tended to improve with time, although temporomandibular joint noise tended to persist. These results suggest that TMD signs and symptoms tend to decrease in patients after dropping out, and that the natural fluctuation of TMD signs and symptoms should be taken into consideration when treating TMD.     

Persistent and secondary adenovirus-mediated hepatic gene expression using adenovirus vector containing CTLA4IgG

Some authors have hypothesized a relationship between rear-impact motor vehicle collisions and subsequent symptoms of neck pain and temporomandibular disorders, or TMD, despite no facial impact. This article examines the TMD aspect in terms of the physiological basis and cultural factors influencing the reporting of such symptoms.     

Comparing prospective and retrospective evaluations of temporomandibular disorders after orthognathic surgery

The authors conducted a study to document agreement between prospective examinations performed by trained clinical trial examiners and retrospective surgical chart reviews in identifying signs and symptoms of temporomandibular disorders, or TMD. Only a small fraction of the signs and symptoms identified by clinical trial examiners were documented in the surgical charts. Studies relying on retrospective chart reviews may seriously underestimate signs and symptoms of TMD.     

Parkinson''s disease, amyotrophic lateral sclerosis and spinal muscular atrophy are caused by an unstable (CAG)n trinucleotide repeat microsatellite

The influence of previous trauma in the management of patients with temporomandibular disorders (TMD) is controversial. The objectives of this study were to compare treatment regimens and outcomes in motor vehicle accident trauma-related versus nontrauma-related TMD patients. Files of 50 trauma and 50 matched nontrauma TMD patients were reviewed. Information concerning treatment received, progress of symptoms with treatment, and findings from the final examination were recorded. As a whole group, posttraumatic TMD patients tended to receive more types of treatment (P < .0001), have more medications prescribed (including analgesics, P < .001; nonsteroidal anti-inflammatory drugs, P = .001; muscle relaxants, P = .001; and tricyclic antidepressants, P < .001), have more oral medicine clinic visits (P = .07) over a longer period of time (P = .06), and have a poorer treatment outcome (P < .001) as compared to the nontrauma group. When the patients were separated into TMD diagnostic classification subsets, only some of these differences between trauma and nontrauma patients were seen, but the subset group sizes were small and only a few of the groups could be compared. There did not seem to be a significant effect from settling insurance claims prior to the last clinic visit. Trauma may be an important prognostic factor in the management of some TMD patients.     

Mandibular tori, migraine and temporomandibular disorders

In this study the presence of mandibular tori was related to conditions associated with parafunctional activity. Parafunction in the form of tooth clenching or grinding has been associated with temporomandibular disorders (TMD) and recently migraine. Patients attending a facial pain clinic in Belfast were assessed for the presence of tori and results compared to age and gender matched controls. The findings were that mandibular tori were present significantly more commonly in both migraineurs and TMD patients. The results support an association with parafunction in the aetiology of mandibular tori and suggest that tori are a useful marker of past or present parafunction in some patients.     

TMD warning sign: cephalometrics

The significance of predisposing factors to TMD is quite evident when considering the prevalence of orthodontic relapse and with the occurrence of TMD related symptoms observed in previously treated orthodontic patients. In using the Modified Sassouni Plus Cephalometric Analysis, the clinician now possesses an invaluable tool that is readily available without adding to the examination expense. The invaluable information gained from cephalometric evaluation should not, however, be used to replace other diagnostic TMJ radiographs. If a joint problem is suspected, one should follow the normal protocol for the examination of the temporomandibular joints.     

Signs and symptoms of temporomandibular disorders in 19-year-old individuals who have undergone orthodontic treatment

Fifty-five per cent of the 1554 19-year old subjects in Halmstad, Sweden, born in 1975, have received orthodontic treatment. Among these, 520 have been treated by specialists (specialist group) and 340 by general practitioners after consultation with specialists (consultation group). The aims were to study the prevalence of signs and symptoms of temporomandibular disorders (TMD) in these two groups on a long-term basis, to identify any possible difference between the groups, and to compare the results with those from a previously presented epidemiological study (control group). From the population of orthodontically treated subjects, a sample was randomly selected to represent the two groups, and 260 subjects agreed to attend for investigation, the participation rate being 77%. The investigation consisted of a questionnaire and clinical examination focusing on function and dysfunction of the masticatory system. Severe signs and symptoms of TMD were rare, the prevalence did not differ significantly between the two orthodontic groups, and the results were similar in the control group. The prevalence of several signs and symptoms was more common in females than in males. No significant correlation between TMD signs and symptoms and occlusal contact recordings was found. It was concluded that the vast majority of the 19-year old individuals who had undergone orthodontic treatment had well-functioning masticatory systems, and severe signs and symptoms of TMD were rare.     

Reoperation after the Fontan operation in single ventricle and tricuspid atresia]

This study evaluated the accuracy of the clinical diagnosis of patients with temporomandibular joint dysfunction symptoms compared to a group of asymptomatic volunteers. The clinical examination and history questionnaire used during the evaluation of TMD patients were less accurate evaluating asymptomatic subjects than when combined with computerized joint vibration analysis. "True normal" control subjects were rarely found when these diagnostic modalities were combined in the TMD examination process. Most of the asymptomatic subjects had subclinical signs of TMD. The small sample size is significant, especially since large numbers of subjects appear to be necessary to obtain even small numbers of "true normals."     

Reflections on the Michigan splint and other intraocclusal devices

It seems obvious in retrospect that the treatment of disorders by interocclusal devices followed two paths: stabilization splints and functional orthopedic appliances. The dividing line between them is not always clear. Both have some function related to the position of the mandible. They may not differ significantly in their control of occlusal stability (e.g., telescoping devices anchored to stabilization splints). The stabilization splint, as well as other conservative measures, will play an increasing role in accepted therapy for TMD. The use of anterior repositioning devices for TMD, including MPD syndrome, will decrease. Research may provide answers that allow them to be used more specifically and predictably. Perhaps there will be but little change in their use where there is an association of TMD and Class II malocclusion. There will be an increase in the use of interocclusal devices for the treatment of snoring and obstructive apnea. Some additional directions seem to have emerged in the late 1980s and early 1990s: In the absence of pain and significant debilitation, treatment for TMD, if any, is to be reversible. Prevention or aggravation of TMD should be practiced to the extent possible during dental procedures. One long-term, well-designed, prospective study indicated that the incidence and severity of TMD could be reduced by appropriate occlusal adjustment. There is a small, but nevertheless important minority of patients with TMD who progress to persistent pain and/or dysfunction. Initial management of the vast majority of patents with TMD should be use of noninvasive reversible therapies. Surgery is indicated in only a relatively small percentage of cases of TMD. Research on interocclusal devices should not terminate simply because they are in part dental devices (i.e., biomechanical forms of treatment). The diagnosis and treatment of TMD has been called a dilemma, especially for those patients with chronic pain for whom no treatment has been effective. However, it would be ill-advised to abandon what treatment is already known to be effective by allowing those few but psychosocially important patients with chronic pain to determine what should be done for the vast majority of patients with TMD: reversible forms of treatment, including physiotherapy, pharmacologicals, and the stabilization occlusal bite plane splint.     

Symptoms of the stomatognathic system in temporomandibular and cervical spine disorders

This study was performed to assess the prevalence of signs and symptoms of temporomandibular disorders (TMD) in patients with cervical spine disorders (CSD) and to compare patients with CSD and subgroups of patients with TMD with regard to the results of orthopaedic tests of the stomatognathic system. A group of 103 consecutive patients with signs and symptoms of CSD and a group of 111 consecutive patients with TMD were examined. All subgroups of TMD patients showed a significantly smaller range of motion than the CSD patients. Patients with TMD had limited mouth opening (< 40 mm) on active and passive mouth opening more often than CSD patients. TMD patients with myogenous problems reported oral habits more often than CSD patients, although no objective differences between CSD and TMD patients were found. Subgroups of TMD patients reported joint sounds, and pain on palpation and joint play tests of the temporomandibular joint (TMJ) more frequently than CSD patients. Joint sounds on active movements, pain on palpation of the TMJ, and pain on joint play tests correctly classified 82% of the patients with TMD and 72% of the patients with CSD. In spite of the biomechanical and anatomical relationship between the neck and the stomatognathic system, the results of the study show that CSD patients have signs and symptoms of TMD comparable with those of the adult Dutch population. It was concluded that the function of the masticatory system should be evaluated in patients with neck complaints in order to rule out a possible involvement of the masticatory system.     

Estrogen treatment caused acute attacks of porphyria

Two female patients with acute intermittent porphyria, who received oestrogen skin pads as supplementary treatment for postmenopausal discomfort, developed severe psychiatric disorders with persistent confusion, aggression and paranoid reactions. Some decades earlier they had reacted with symptoms of acute porphyria following oral contraceptive usage. There is well documented evidence of the advisability of restrictiveness in the use of oestrogens in conjunction with acute porphyria, particularly in cases of patients with a history of hormone-related symptoms of acute porphyria. The putative mechanisms by means of which oestrogens may exert effects on neurotransmitters and peptides are discussed in the article. The authors would be grateful to hear from colleagues abroad who have treated patients with similar symptoms following postmenopausal treatment with oestrogens.     

Evaluation of acupuncture and occlusal splint therapy in the treatment of temporomandibular joint disorders

One hundred patients showed signs and symptoms of temporomandibular joint disorder, were participated in a one year follow up study. The patients were randomly divided into four groups: Acuhealth treatment (group A), occlusal splint therapy (group B), Acuhealth and occlusal splint therapy (group C), and control (group D). Each group comprised 25 patients. The patients were examined before and 3, 6, and 12 months after treatment. At the three month evaluation, the patients who were not satisfied with the treatment outcome were offered additional treatment. The result showed that 87% of the patients treated by Acuhealth unit, 77.3% of the patients treated with occlusal splint therapy, and 91.3% of the patients received Acuhealth and occlusal splint therapy were improved subjectively and clinically after 3 months follow-up. The patients who responded well to treatment initially also responded well in the long run. The study showed that the Acuhealth unit proved to be an ideal early therapy for TMD, and complemented later with occlusal splint.     

Psychological factors in chronic pain: Evolution and revolution.

Research has demonstrated the importance of psychological factors in coping, quality of life, and disability in chronic pain. Furthermore, the contributions of psychology in the effectiveness of treatment of chronic pain patients have received empirical support. The authors describe a biopsychosocial model of chronic pain and provide an update on research implicating the importance of people's appraisals of their symptoms, their ability to self-manage pain and related problems, and their fears about pain and injury that motivate efforts to avoid exacerbation of symptoms and further injury or reinjury. They provide a selected review to illustrate treatment outcome research, methodological issues, practical, and clinical issues to identify promising directions. Although there remain obstacles, there are also opportunities for psychologists to contribute to improved understanding of pain and treatment of people who suffer from chronic pain. The authors conclude by noting that pain has received a tremendous amount of attention culminating in the passage of a law by the U.S. Congress designating the period 2001-2011 as the "The Decade of Pain Control and Research." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress-induced alterations of somatodendritic 5-HT1A autoreceptor sensitivity in the rat dorsal raphe nucleus--in vitro electrophysiological evidence

The role of trauma in the etiology of temporomandibular disorders (TMD) is controversial. The objectives of this study were to compare presenting signs, symptoms, and diagnoses in patients who had motor vehicle accident trauma-related TMD to patients who had nontrauma-related TMD. Files of 50 trauma and 50 matched nontrauma TMD patients were reviewed. Information concerning presenting pain, temporomandibular joint (TMJ) and related symptoms, examination findings, and diagnoses was recorded. Posttraumatic TMD patients reported higher facial (P = .006) and headache (P = .0001) pain ratings, neck symptom frequency (P < .01), ear-related symptoms (P = .02), sleep disturbance (P < .001), and occupational and avocational disability frequencies (P < .0001). They had greater masticatory muscle (P < .001), neck muscle (P < .001), and TMJ tenderness (P = .01) scores and myofascial pain (P = .006) and arthralgia/capsulitis (P = .008) diagnoses. The nontrauma group had more subjective (P = .02) and objective (P = .05) TMJ crepitus and higher self-reports of parafunctional jaw habits (P = .05). Trauma may be an important etiologic factor for some TMD patients.     

Early restenosis following percutaneous transluminal balloon angioplasty for the treatment of the superior vena caval syndrome due to pacemaker-induced stenosis

OBJECTIVES: To test the hypothesis that the outcome of temporomandibular disorders (TMD) is not influenced by condylar position, asymmetry, angle or structural bone changes. METHODS: Eighty consecutive patients (60 women, 20 men) with an age range of 6-81 years, referred to the Department of Stomatognathic Physiology, were included in the study. The patients were clinically and radiologically examined before and at least 1 year after treatment. RESULTS: The most common clinical diagnoses among the patients were TMD with a neuromuscular background in 35% and osteoarthritis in 21%. Seventy-two per cent of the patients were symptom-free or better, 24% unchanged and 1% worse 1 year or more after treatment. After treatment the bone structure of the TMJ was unchanged in 83% of the patients, in 12% erosions healed and in 5% erosions developed. Almost all patients had some degree of condylar displacement on tomography before treatment. In the majority the condylar position was unchanged after treatment. CONCLUSION: No single radiographic finding was found to be related to the treatment outcome and therefore plain radiography has a minor role in the management of TMD.     

The cracked tooth

Fractured molars and premolars are very common. Fractures usually result from cracks that develop and slowly extend until the tooth separates into buccal and lingual fragments. Sometimes, as these cracks expand, the patient exhibits symptoms of what is commonly referred to as "cracked tooth syndrome" (CTS). When CTS occurs, an opportunity exists to diagnose and treat these patients, to relieve their discomfort and prevent sequelae that would require more extensive treatment.     

Rapid treatment of acute psychosis

Twenty-four patients with acute functional psychoses were treated with intramuscular haloperidol in a three-hour period. There was almost complete remission of cardinal symptoms (thought disorder, hallucinations, and delusional activity) in this period for 11 patients. Acute dystonia, easily reversed, was the only significant side effect. The authors therefore suggest that outpatient management may be feasible and preferable in the treatment of some acute psychotic episodes.