Epidemiology, Diagnosis, and Treatment of Temporomandibular Disorders

Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19103, USA. Electronic address: .
Dental clinics of North America 07/2013; 57(3):465-79. DOI: 10.1016/j.cden.2013.04.006
Source: PubMed


Temporomandibular disorder (TMD) is a multifactorial disease process caused by muscle hyperfunction or parafunction, traumatic injuries, hormonal influences, and articular changes. Symptoms of TMD include decreased mandibular range of motion, muscle and joint pain, joint crepitus, and functional limitation or deviation of jaw opening. Only after failure of noninvasive options should more invasive and nonreversible treatments be initiated. Treatment can be divided into noninvasive, minimally invasive, and invasive options. Temporomandibular joint replacement is reserved for severely damaged joints with end-stage disease that has failed all other more conservative treatment modalities.

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Available from: Frederick Liu, Mar 01, 2014
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    • "The current gold standard for the diagnosis of TMD is still a combination of anamnesis and clinical examination (Dworkin and LeResche, 1992; Chaves et al., 2008b,a) and, when appropriate, radiographic evaluation (Schiffman et al., 2010; 2014). Its etiology is multifactorial and probably due to muscular hyperfunction, parafunctional habits, traumatic injury, hormonal influence or internal joint derangement (Tartaglia et al., 2011; Suvinen and Kemppainen, 2007; Liu and Steinkeler, 2013). As the stomatognathic system of TMD patients is dysfunctional, the muscular activity of such individuals may present differences in comparison to healthy individuals (Tartaglia et al., 2011). "
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    ABSTRACT: The use of surface electromyography (SEMG) is controversial in the diagnosis and subsequent treatment of temporomandibular disorders (TMD), although there is some evidence that the pattern of the masticatory muscles in TMD patients differs from controls. The aim of this study was to compare relative time of mandibular elevator muscle activation at different levels of activity and median frequency (MF) during sustained clenching. Twenty-two women, aged between 18 and 48years, volunteered to participate in the study. The TMD group had 14 participants diagnosed as group Ia muscle disorders (RDC/TMD). The control group had eight healthy individuals. SEMG records were obtained from masseter and temporal muscles during 10s of sustained clenching. Normalized SEMG amplitudes were classified as minimal, moderate and maximal and time of activation in each level of activity was calculated and compared using two-way ANOVA (groups versus time). A slope of the linear regression line that fits MF values over time was calculated as a fatigue index for elevator muscles. Only the temporal muscles of the TMD group showed longer activation time at moderate and minimal activity levels compared to controls. Fatigue indexes were greater for the TMD group compared to controls. Results showed motor control strategies during sustained clenching that differentiate controls from TMD patients. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Apr 2015 · Journal of Electromyography and Kinesiology
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    • "The values are similar to the results obtained on the basis of the conduced computer simulation. This kind of numeric considerations seems to be also important from the point of view of function disorders in diagnostics of the mastication organ movement system especially the temporomandibular joint dysfunctions [36] [37] [38] [39]. It is known that patients suffering from bruxism [40] are able to generate occlusion forces often exceeding the value of 1 kN. "
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    ABSTRACT: Unlabelled: PURPOSE OF THE PAPER: This paper is an attempt to mathematically describe the mastication organ muscle functioning, taking into consideration the impact of the central nervous system. Material: To conduct model tests, three types of craniums were prepared: short, normal, and long. The necessary numeric data, required to prepare the final calculation models of different craniofacial types, were used to identify muscle and occlusion forces generated by muscles in the area of incisors and molars. The mandible in model tests was treated as a nondeformable stiff form. Methods: The formal basis for the formulated research problem was reached using the laws and principles of mechanics and control theory. The proposed method treats muscles as "black boxes," whose properties automatically adapt to the nature of the occlusion load. The identified values of occlusion forces referred to measurements made in clinical conditions. Results: The conducted verification demonstrated a very good consistency of model and clinical tests' results. The proposed method is an alternative approach to the so far applied methods of muscle force identification. Identification of muscle forces without taking into account the impact of the nervous system does not fully reflect the conditions of mastication organ muscle functioning.
    Full-text · Article · Mar 2015 · BioMed Research International
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    • "This suggests a need for interdisciplinary treatment due to the complex character of complaints. Temporomandibular joint pain is a special problem as the mandible motion upon chewing and talking constitutes a stimulus for a significant increase in the pain being experienced [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [24] [29] [31] [32] [33] [34]. "
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    ABSTRACT: Objective: The objective of this study was to evaluate the regression of temporomandibular pain as a result of intra-articular injections of platelet-rich plasma (PRP) to patients with temporomandibular joint dysfunction previously subjected to prosthetic treatment. Materials and methods: The baseline study material consisted of 10 patients, both males and females, aged 28 to 53 years, previously treated due to painful temporomandibular joint dysfunction using occlusal splints. All patients were carried out to a specialist functional assessment of the dysfunction using the Polish version of the RDC/TMD questionnaire axis I and II. Intra-articular injections were preceded by a preparation of PRP. The injection sites were determined by the method used during arthroscopic surgical procedures. Following aspiration, 0.5 mL of plasma was injected into each temporomandibular joint. Results: The comparison of the intensity of pain during all examinations suggests a beneficial effect of the procedure being performed as the mean VAS score was 6.5 at examination I, 2.8 at examination II, and 0.6 at examination III. Conclusion: Application of the intra-articular injections of platelet-rich plasma into the temporomandibular joints has a positive impact on the reduction of the intensity of pain experienced by patients treated for temporomandibular joint dysfunction.
    Full-text · Article · Aug 2014 · BioMed Research International
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