Temporomandibular joint involvement in rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis.

The aim of the present study was to estimate the prevalence of temporomandibular joint (TMJ) symptoms and clinical findings in Albanian patients with rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis. The authors examined 124 consecutive hospitalized patients (88 with rheumatoid arthritis, 22 with systemic lupus erythematosus and 14 with systemic sclerosis) and 124 age- and gender-matched healthy controls using a questionnaire and an oro-facial clinical examination for assessing the presence of TMJ sounds, pain in the TMJ area, tenderness of masticatory muscles and limited mouth opening. Significantly more patients (67%) reported TMJ symptoms than controls (19%). A significantly higher proportion of patients (65%) exhibited clinical signs of temporomandibular dysfunction compared with controls (26%). The most frequent findings in rheumatoid arthritis were temporomandibular sounds and pain. Pain was found in a significantly higher proportion in patients with systemic lupus erythematosus compared with controls. Difficulty and limitation in mouth opening were observed in the majority of systemic sclerosis patients, and in only a minority of rheumatoid arthritis patients. This study supports the notion that TMJ examination should be encouraged in the rheumatology setting and clinicians should be able to provide pain management and patient support.

Orientation of craniofacial planes and temporomandibular disorder in young adults with normal occlusion.

The aim of this study was to investigate the relationship between orientation of craniofacial planes relative to the true horizontal and temporomandibular disorder (TMD), in normal occlusion. Fourteen university dental students, with full natural dentition and bilateral Angle Class I occlusion, who exhibited signs and symptoms of TMD, were compared with 14 age- and sex-matched healthy controls. Frontal and lateral photographs were taken in natural head position with the subject standing up, clenching a Fox plane and having a facial arch positioned. Photographs were examined by a standardized image analysis. Inter-pupillary axis, Frankfurt, occlusal and Camper planes were evaluated. In frontal view, the Frankfurt plane was right rotated relative to the true horizontal both in TMD subjects (P < 0.01) and controls (P < 0.05), but rotation was larger in TMD subjects (mean difference between groups, 1.1 degrees, 95% confidence interval, 95% CI, 0.2-2.0 degrees ). No significant deviation from the horizontal or difference between groups was observed for the interpupillary axis and occlusal plane. In lateral view, the Frankfurt plane was upward-orientated relative to the true horizontal in TMD group (mean angular deviation 2.8 degrees, 95% CI, 1.0-4.6 degrees ). The occlusal and Camper planes were downward-orientated in both groups (P < 0.0001), but inclination of occlusal plane tended to be smaller in TMD subjects (mean difference between groups, -3.8 degrees, 95% CI, -7.6-0.1 degrees ). Angles between any craniofacial planes did not significantly differ between groups. The findings show that in young adults with normal occlusion, a weak association exists between the orientation of craniofacial planes in natural head position and signs and symptoms of TMD. Furthermore, they suggest that, within this population, TMD might be mainly associated with head posture rather than with craniofacial morphology.

The distribution of occlusal contacts in the intercuspal position and temporomandibular disorder.

The aim of this study was to describe the distribution of occlusal contacts in subjects with signs or symptoms of temporomandibular disorder (TMD), and to assess whether any difference exists with healthy subjects. Twenty-five university dental students with complete natural dentition who exhibited TMD (13 females and 12 males, age from 19 to 30 years) and 25 age- and sex-matched controls entered the study. Occlusal contacts were evaluated in the intercuspal position and wax registrations were made in all subjects. Occlusal contacts were classified according to location and intensity. No differences were found between TMD and control groups for the overall number and distribution of contacts or for any side and intensity of contact. An intra-subject analysis showed that TMD subjects had significantly greater bilateral asymmetry in the number of contacts than controls. Median absolute difference of the number of contacts on right and left sides was 3 (95% CI, 2-4) in TMD subjects and 2 (95% CI, 1-2) in controls. In TMD subjects with mono-lateral TMD there was a significant concordance (88.9%) between the side of disorder and the side of higher number of contacts. These findings, while confirming that a significant relationship exists between distribution of occlusal contacts and TMD, further suggest that in young adults it may be primarily expressed by asymmetries in occlusal contact patterns. Existence and aetiology of any association of TMD with occlusal contacts should be further investigated.

The relationship of bruxism with craniofacial pain and symptoms from the masticatory system in the adult population.

The association of bruxism with craniofacial pain and symptoms of dysfunction of the masticatory system was assessed in a sample of 483 adult subjects, aged 18-75 years and selected from the general population living in the municipality of Segrate, a metropolitan area in northern Italy. Subjects were interviewed by a questionnaire about oral conditions, occurrence of symptoms of masticatory disturbances, craniofacial and neck pain. The overall prevalence of bruxism was 31;4% (95% confidence interval (CI): 27;3-35;5%). At univariate analysis bruxism was significantly associated with craniofacial pain, difficulty in closing the mouth, difficulty in opening the mouth wide or in locking the mouth, temporomandibular joint sounds, pain on movement, a feeling of stiffness or fatigue of the jaws, and neck pain. After adjustment for reciprocal influences and confounding variables, logistic regression analysis disclosed a strong independent association of bruxism with difficulty in closing the mouth (adjusted odds ratio, (OR): 2;84, 95% CI: 1;68-4;48), and a weaker relationship with craniofacial pain (adjusted OR: 1;84, 95% CI: 1;16-2;93) and temporomandibular joint sounds (adjusted OR: 1;64, 95% CI: 1;00-2;69). The findings show that in the general adult population there is a complex connection among bruxism, craniofacial pain and symptoms of masticatory disturbances. Furthermore, they suggest that the most direct relationship of bruxism may be with difficulties in mouth movements, but also an independent association may exist with craniofacial pain and other symptoms of temporomandibular disorder.

The relationship between headache and symptoms of temporomandibular disorder in the general population.

OBJECTIVES: To describe the relationship between headache and symptoms of temporomandibular disorder (TMD) in a general population, and to assess whether there are specific symptoms associated with headache. METHODS: A personal interview survey conducted in 1995 on 483 adult subjects from the metropolitan community of Segrate, northern Italy. RESULTS: The overall prevalence of headache in the past year was 21.2%. The prevalence of temporomandibular symptoms was 54.3%. Headache occurred significantly more in females than males (26.5 vs 15.4%), and in subjects with, rather than without, symptoms of TMD (27.4 vs 15.2%). Among symptoms, temporomandibular pain, temporomandibular joint sounds, and pain on movements of the jaw were associated with headache using a univariate analysis. After adjustment for confounding variables, a multiple logistic regression confirmed a significant relationship of headache with temporomandibular pain (OR 1.83, 95% CI, 1.07-3.15). CONCLUSIONS: In the general adult population there is an association between headache and symptoms of TMD. A functional evaluation of the stomatognathic system should be therefore considered in subjects with unexplained headache, even if chronic conditions and mechanical symptoms of temporomandibular disorder are absent.

Connective tissue grafting employing the tunnel technique: a case report of complete root coverage in the anterior maxilla.

Techniques for surgical root coverage have been continuously revised over the past few decades. With increased knowledge on the etiopathogenesis of gingival recessions and on the repair/regeneration mechanisms of deep and superficial periodontal tissues, procedure simplification has been possible, and more predictable and stable results have been obtained. The maintenance of maximal blood supply has brought major changes in flap design. The coverage of contiguous recessions on the maxillary central incisors using a conservative technique for the incision of the recipient site is presented, along with the 11-month follow-up from surgery. A supraperiosteal tunnel was performed for the insertion and stabilization of a connective tissue autograft.

Association of neck pain with symptoms of temporomandibular dysfunction in the general adult population.

The association of neck pain with symptoms of temporomandibular dysfunction in the general adult population was evaluated in a sample of 483 subjects selected from the population living in the municipality of Segrate, northern Italy. Subjects were interviewed by a standard questionnaire about oral conditions, temporomandibular symptomatology and neck pain. Symptoms related to the Helkimo Anamnestic Index were the indicators of temporomandibular dysfunction, and the evaluation also included history of trauma of the masticatory system. Troublesome neck pain was experienced within the last year in 38.9% of the total series, and the prevalence of complaints was higher in women than in men (41.7 vs 34.4%). Prevalence increased with age (p < 0.005) and was significantly higher in subjects with than without temporomandibular symptomatology (47.4 vs 28.6%, p < 0.0001). At univariate analysis, facial and jaw pain (p < 0.001) and feeling of stiffness or fatigue of the jaws (p < 0.01) were significantly related to neck pain. Age- and sex-adjusted multiple logistic analysis showed that neck pain is associated with the temporomandibular symptomatology as a whole (p < 0.001), and in particular with facial and jaw pain (p < 0.01). These findings confirm that there is a significant association between neck pain and the temporomandibular symptomatology. Moreover, they suggest that the most relevant relationship is with facial and jaw pain, according to recent neurophysiologic studies on pain mechanism. Further clinical and longitudinal studies are desirable in order to give a better clarification of mutual specific roles of craniocervical and temporomandibular disorders in the aetiology of these pathologies.

Association between loss of occlusal support and symptoms of functional disturbances of the masticatory system.

The purpose of this study was to evaluate the association of loss of occlusal support with symptoms of functional disturbances of the masticatory system, in particular with the ones related to the temporomandibular dysfunction. A total of 483 adult subjects randomly selected from the population living in the municipality of Segrate, northern Italy, were studied. Subjects were interviewed by questionnaire about oral conditions and occurrence of symptoms of disturbances of the masticatory system. Also, denture was examined by dentists during the interview. Loss of occlusal support was observed in 60.2% of the subjects, symptoms of functional disturbances in 68.7% and temporomandibular dysfunction in 55.1%. At univariate analysis loss of occlusal support was mainly associated with a feeling of stiffness or fatigue of the jaws (P < 0.001), difficulty in closing the mouth (P < 0.005) and difficulty on mastication (P < 0.0001). Association with temporomandibular dysfunction as a whole was significant also (P < 0.001). Multiple age- and sex-adjusted logistic analysis disclosed a significant strong impact of loss of occlusal support on difficulty with mastication (odds ratio = 7.0, P < 0.0001). At that analysis, no significant relationship resulted with symptoms of temporomandibular dysfunction. These findings confirm that presence of an adequate occlusal support is a relevant factor in maintaining an efficient chewing, and also suggest that it may play any indirect role in preventing occurrence of symptoms of temporomandibular dysfunction.

Ear, nose, and throat symptoms in patients with TMD: the association of symptoms according to severity of arthropathy.

The association of the severity of temporomandibular arthropathy to ear, nose, and throat symptoms in patients with temporomandibular disorders has been poorly investigated in spite of its importance in clinical practice. The aim of this study was to see whether persons with more severe arthropathy have more ear, nose, and throat symptoms. Anamnestic and clinical evaluations were obtained at admission for 815 subjects with signs and symptoms of temporomandibular disorders of arthrogenic origin in physical tests. The severity of arthropathy was evaluated by a clinical index scoring joint sounds, tenderness to temporomandibular palpation, and pain severity in the temporomandibular joint region. Univariate analysis showed that the severity of arthropathy was significantly associated with ear, nose, and throat symptoms as a whole (P < .001) and specifically with deafness (P < .001) and dizziness (P < .05); however, tinnitus and earache were not statistically significantly associated. Multiple analysis showed deafness to be the only ear, nose, and throat variable independently associated with severity of arthropathy (P < .01). These findings lead to the conclusion that there is a considerable association between temporomandibular disorders of arthrogenic origin and ear, nose, and throat symptoms, especially deafness. They also suggest that further investigations should be done to compare the specific roles of craniocervical arthritis versus temporomandibular disorders in the etiology of ear, nose, and throat symptoms related to craniomandibular and craniocervical joint involvement.

[Arthromuscular interrelations in TMJ functional pathology]. / Interrelazioni artromuscolari nella patologia disfunzionale dell'ATM.

TMJ disorders includes: TMJ and masticatory muscles, pain, joint sounds, deviation and limitation of mandibular movements. A critical analysis of the literature dealing with the relationship between joint and muscle disorders in other joints (knee), leads to evaluate the reliability of the hypothesis of the existence of an arthro-myogenous relation in the aetiopathogenesis of craniomandibular disorders. As a preliminary conclusion we can say that the joint derangement seems the primary factor in the pathogenesis of TMJ disorders and cannot to differentiate muscle from joint involvement seems a difficult task.

Digital phonoarthrometry of temporomandibular joint sounds: a preliminary report.

A new technique is presented for recording and evaluating the dysfunctional TMJ sounds on an objective basis. The physical implications related to TMJ phonoarthrometry (PAM) are discussed and three cases are presented. The phonoarthrography and the digital phonoarthrometry presented in this paper can be a useful harmless diagnostic tool. Differential diagnosis of TMJ pathology is possible on the basis of an acoustical analysis and it is hoped that future investigation will confirm these observations.