Temporomandibular disorders and functional somatic syndromes: Deliberations for the dentist.

Temporomandibular disorder (TMD) is an umbrella term for a collection of disorders affecting the temporomandibular joint (TMJ) and associated tissues. TMD is not a rare pathology for the dentist. The most common presenting symptom is pain, which causes the patient seek immediate treatment. Management is dictated by the cause. The most 'famed' causes include trauma, inflammation, aging, parafunctional habits, infections, neoplasms, and stress; and these are always considered in the differential diagnosis of TMJ pain. There are some less 'famed' causes of TMD, which are characterized by increased pain sensitivity due to psychosocial factors; these include myofascial pain syndrome and functional somatic syndromes (FSS) such as fibromyalgia and chronic fatigue syndrome. They present with chronic pain, fatigue, disability, and impairment in ability to perform daily activities. A non-systematic search in the English literature revealed numerous studies describing the occurrence of TMD in these conditions, along with few other oral manifestations. TMD has been even considered to be a part of the FSS by some. In these patients, TMD remains a recurring problem, and adequate management cannot be achieved by traditional treatment protocols. Awareness of these conditions, with correct diagnosis and modification of management protocols accordingly, may resolve this problem.

Evolución clínica del síndrome de disfunción dolorosa de la articulación temporomandibular con acupuntura / Clinical evolution of the pain dysfunction of the temporomandibular joint using acupuncture

Se realizó un estudio longitudinal y prospectivo con el objetivo de determinar la efectividad del tratamiento con acupuntura en el síndrome de disfunción dolorosa de la articulación temporomandibular, patología que aqueja a un por ciento elevado de la población y debido a su etiología multifactoria,l se hace difícil establecer un tratamiento. Esta investigación se desarrolló en el Hospital Universitario Abel Santamaría Cuadrado, durante el período de febrero a septiembre de 2006. La muestra estuvo constituida por 104 pacientes que asistieron a la consulta de cirugía maxilofacial, por presentar síntomas y signos propios del síndrome de disfunción dolorosa de la articulación temporomandibular. De manera aleatoria quedó la muestra dividida en dos grupos: un grupo control que se trató con el tratamiento convencional y uno de estudio, tratado con acupuntura. Los datos fueron recogidos en tablas y tabulados por el método estadístico de chi cuadrado. Se concluye que en la terapia con acupuntura no existieron reacciones adversas y a los cinco días de tratamiento solo un 29% presentó dolor a la masticación y un 27% a la palpación de la musculatura, mientras que por el tratamiento convencional un 40,4% y un 50% respectivamente tenían estas alteraciones. Con acupuntura el promedio de sesiones necesarias para la remisión de los síntomas fue de 9, quedó demostrada la efectividad de esta terapia en el tratamiento del dolor disfunción temporomandibular.

A longitudinal prospective study is carried out aimed at studying the effectivity of the treatment with acupuncture in presence of pain temporomandibular joint dysfunction, present in a high percentage of patients.Due to the multifactorial etiology is hard to establish the treatment.The present research was carried out in "Abel Santamaría Cuadrado"University Hospital during February _September 2006. The sample was comprised of 104 patients attending to the dental surgeon office showing symptoms and signs of pain dysfunction of the temporomandibular joint. The sample was separated into two groups: a control group being treated with the conventional treatment and one study group being treated with acupuncture. Data were shown in pictures and tabulated using the chi-square test.It is concluded that acupuncture showed non adverse reactions and presenting only 29% of patients pain at chewing and 27% showed pain at muscle palpation while with the conventional treatment a 40,4% and 50% presented both disturbances, respectively. Using acupuncture 9 sessions were necessary for attaining a remission of symptoms, being proved the effectivity of this therapy in the pain dysfuction of the temporomandibular joint treatment.

Treatment of Temporomandibular Joint Disturbance by Acupuncture, TDP Radiation and Tuina in 30 Cases / 针灸推拿医学（英文版）

Acupoints Xiaguan ( ST 7 ), Jiache ( ST 6 ),Hegu (LI 4 ) and Neiting (ST 44 ) were selected and electroacupuncture, TDP and Tuina were used to treat 60 cases of temporomandibular joint disturbance, all the patients were randomly divided into two groups to compare the therapeutic effect, the results showed the effective rate were 100% and 83% in groups of electroacupuncture, TDP and Tuina, and group of electroacupuncture and Tuina respectively.