TMD before and after correction of dentofacial deformities by orthodontic and orthognathic treatment.

The aims of the study were to investigate the alteration of temporomandibular disorders (TMD) after correction of dentofacial deformities by orthodontic treatment in conjunction with orthognathic surgery; and to compare the frequency of TMD in patients with dentofacial deformities with an age and gender matched control group. TMD were evaluated in 121 consecutive patients (treatment group), referred for orthognathic surgery, by a questionnaire and a clinical examination. 18 months after treatment, 81% of the patients completed a follow-up examination. The control group comprised 56 age and gender matched subjects, of whom 68% presented for follow-up examination. TMD were diagnosed according to research diagnostic criteria for TMD. At baseline examination, the treatment group had a higher frequency of myofascial pain (P=.035) and arthralgia (P=.040) than the control group. At follow-up, the frequencies of myofascial pain, arthralgia and disc displacement had decreased in the treatment group (P=.050, P=.004, P=.041, respectively). The frequency of TMD was comparable in the two groups at follow-up. Patients with dentofacial deformities, corrected by orthodontic treatment in conjunction with orthognathic surgery, seem to have a positive treatment outcome in respect of TMD pain.

Lavage treatment of painful jaw movements at disc displacement without reduction. A randomized controlled trial in a short-term perspective.

This study compared the short-term efficacy of two treatments (local anesthetics (A) and local anesthetics and lavage (AL)) in patients with permanently displaced discs and temporomandibular disorder (TMD) pain. 45 patients participated in the single-blind randomized controlled trial. All patients had received: a Research Diagnostic Criteria/TMD diagnosis of disc displacement without reduction; and magnetic resonance imaging confirmation of non-reducing disc displacement. Participants were randomized to treatment with A or AL and were assessed at baseline and at 1 and 3 month follow-ups. The primary outcome measure defining success was reduction in pain intensity of at least 30% during jaw movement. At the 3 month follow-up, the success rate was 76% for A and 55% for AL. Both groups reported similar pain relief with no significant difference between the groups. Similar trends were observed for outcome measures in the physical functioning, emotional functioning, and global improvement domains with no significant difference between the groups. Use of lavage to supplement extra-articular local anesthetic treatment of painful jaw movements at non-reducing discs does not appear to improve TMD pain and mouth opening capacity in the short term.

Long-term efficacy of resilient appliance therapy in TMD pain patients: a randomised, controlled trial.

The aim was to investigate long-term efficacy of a resilient appliance in patients with pain due to temporomandibular disorders (TMD). A randomised, controlled trial was performed in 80 recruited TMD pain patients. They were randomly allocated to one of two groups: treatment with a resilient appliance or treatment with a hard, palatal, non-occluding appliance. The primary treatment outcome was judged positive when patients' characteristic pain intensity decreased by at least 30%. Additional treatment outcomes were physical functioning, emotional functioning and headache. At the 12-month follow-up 50% of the patients in the treatment group and 42% in the control group had a 30% reduction of characteristic pain intensity, when calculated in an intent-to-treat analysis. Jaw function improved in both groups at the 6- and 12-month follow-up. Emotional functioning improved in both groups at the 6-month follow-up; an improvement concerning grade of depression was found in the control group at 12 months. Headache decreased in both groups at both follow-ups. There were no statistically significant differences found regarding primary and additional outcomes between groups at the 6- and 12-months follow-up. There was no statistically significant difference between the resilient appliance and the non-occluding control appliance in reducing TMD pain, physical functioning, emotional functioning and headache in a 12 months perspective.

Short-term treatment of a resilient appliance in TMD pain patients: a randomized controlled trial.

To investigate the short-term efficacy of a resilient appliance in patients with temporomandibular disorders (TMD) suffering from pain, a randomized, controlled trial was performed in 80 recruited TMD pain patients. They were randomly allocated to one of two groups: treatment with a resilient appliance or treatment with a hard, palatal, non-occluding appliance. The primary treatment outcome measure was judged positive when patients' TMD pain at worst, according to the Visual Analog Scale (VAS), decreased by at least 30%. One additional treatment outcome was reduction of characteristic pain intensity. Number needed to treat was measured on the basis of primary treatment outcome at 10 weeks. At baseline, patient characteristics and TMD pain did not differ between the groups. There were no significant differences between groups regarding a 30% reduction in VAS-reported TMD pain at worst at 10 weeks' follow-up; 61% in the treatment group and 46% in the control group. After 6 and 10 weeks of treatment, CPI decreased in both groups. Number needed to treat was 9.1 for both the resilient and the control appliance therapy during 10 weeks. There was no statistically significant difference between the resilient appliance and the non-occluding control appliance in reducing TMD pain from a short-term perspective.

Clinical diagnoses and MRI findings in patients with TMD pain.

The aim of this study was to compare the findings on magnetic resonance imaging (MRI) in temporomandibular disorders (TMD) pain patients with clinical diagnoses of myofascial pain or arthralgia/osteoarthritis in combination with myofascial pain according to the Research Diagnostic Criteria for TMD. The temporomandibular joints of 60 consecutive patients, 19 with myofascial pain and 41 patients with arthralgia/osteoarthritis in combination with myofascial pain were examined clinically and with MRI. Overall the most common MRI findings were different kinds of disc displacements and structural bone changes, which were found in both pain groups. However, disc displacements were found significantly (P=0.002) more often in the group arthralgia/osteoarthritis in combination with myofascial pain. One hundred and four joints were found to have no clinical diagnosis of disc displacements, but 64 of these joints had findings of disc displacements on MRI. Joint fluid was found in both pain groups. Patients having a combination of disc displacement and joint fluid were significantly (P=0.047) more common in the pain group arthralgia/osteoarthritis in combination with myofascial pain. In conclusion, the MRI findings of different kinds of disc displacement and structural bone changes were common in TMD patients. The clinical diagnoses for subdivision into myogenous only or combined arthrogenous and myogenous pain groups were not confirmed by MRI.

Treatment outcome of short- and long-term appliance therapy in patients with TMD of myogenous origin and tension-type headache.

The aim was to compare the short- and long-term effect of a stabilization appliance with a control appliance in myofascial pain patients suffering from episodic or chronic tension-type headache. Sixty patients (mean age 29 +/- 12 years) with temporomandibular disorders (TMD) of myogenous origin and headache were studied in this prospective controlled study. Seventy-seven per cent of the patients reported episodic and 23% chronic tension-type headache at the start of the study. The 60 patients were randomly assigned to a treatment group (stabilization appliance) or to a control group (control appliance). The patients were interviewed regarding symptoms of headache and myofascial pain and clinically examined for masticatory muscle tenderness. At the 10-week and the 6- and 12-month evaluations of appliance therapy, the treatment outcome of tension-type headache was studied. At the 10-week evaluation, 17 patients dropped-out from the control group by requesting another appliance and receiving a stabilization appliance. Another patient in the control group dropped out later during the trial. In an intent-to-treat analysis, significant differences in improvement of headache between treatment and control groups were found at the follow-ups. A 30% reduction of muscles tender to palpation correlated significantly to improvement of headache at all follow-ups. The stabilization appliance seems to have a positive effect on tension-type headache, both in a short- and in a long-term perspective in patients with TMD with pain of myogenous origin.

An evaluation of digital subtraction radiography for assessment of changes in position of the mandibular condyle.

OBJECTIVE: To compare conventional visual evaluation with digital subtraction for assessing changes in condylar position on TMJ radiographs. METHODS: Horizontally corrected oblique lateral transcranial radiographs of the TMJ were taken bilaterally with and without a stabilisation or a control appliance on the same occasion in 20 patients. All of the radiographs were assessed both conventionally and following digital subtraction by seven observers. Three observers assessed both sets of radiographs twice to calculate observer agreement. RESULTS: There were no statistically significant differences in observer performance or diagnostic outcome between the two techniques. Intra-observer agreement varied between 85 and 90% for the conventional visual evaluation and between 62 and 85% for digital subtraction. Although interobserver agreement was greater with the conventional evaluation the difference was not significant. CONCLUSION: Conventional visual evaluation is recommended for the assessment changes in condylar position from TMJ radiographs.

Occlusal appliance therapy in a short-term perspective in patients with temporomandibular disorders correlated to condyle position.

PURPOSE: The purposes of this study were to compare changes in the condyle-fossa relationship in patients with temporomandibular disorders of arthrogenous origin treated with either a stabilization or a control appliance in a double-blind controlled study, and to compare the changes in the condyle-fossa relationship with the short-term treatment effect in the two treatment groups. The radiographic appearance of the temporomandibular joint was also studied. MATERIALS AND METHODS: Fifty-eight patients with temporomandibular disorders of arthrogenous origin were assigned to two equally sized groups: a treatment group given a stabilization appliance; and a control group, given a control appliance. The study covered 10 weeks. The treatment outcome regarding changes in severity of temporomandibular joint pain on a verbal scale was compared to changes in the condyle-fossa relationship in horizontally corrected oblique lateral transcranial radiographs taken with and without the appliance. Condyle-fossa relationship and structural bone changes were observed before treatment in corrected lateral tomograms. RESULTS: The group treated with a stabilization appliance showed a changed condylar position significantly more often (P = 0.004) than the control group. Of the patients reporting a successful treatment outcome, significantly more (P = 0.006) showed a changed condyle position in the group treated with a stabilization appliance than in the group treated with a control appliance. CONCLUSION: In patients with temporomandibular disorders of arthrogenous origin, the short-term occlusal appliance therapy resulting in a changed condylar position gave relief of symptoms more often than if the condylar position was unchanged.

Masticatory efficiency and ability in relation to occlusion and mandibular dysfunction in girls.

PURPOSE: This study investigated the masticatory efficiency and ability in girls with normal occlusion and Class II malocclusion. Furthermore, it investigated the association between masticatory efficiency and ability on one hand and signs and symptoms of temporomandibular disorders (TMD) on the other hand. MATERIALS AND METHODS: A total of 183 girls, aged 11 to 15 years, were included in this study. Sixty subjects had normal occlusion and 123 subjects had Class II malocclusion. The examination included registration of signs and symptoms of TMD. Masticatory efficiency was evaluated with a masticatory efficiency test, while masticatory ability was self-assessed on a visual analog scale. RESULTS: Subjects with normal occlusion presented statistically significantly better masticatory efficiency and ability than subjects with Class II malocclusion. Thirty percent of the variation in masticatory efficiency was explained in a multiple regression analysis. Few occlusal contacts and a large overjet predicted a reduced masticatory efficiency. Subjects who reported frequent temporomandibular joint clicking and subjects who estimated their overall symptoms of TMD as moderate or severe also had reduced masticatory efficiency. CONCLUSION: The authors concluded that masticatory efficiency and ability were partly dependent on the occlusion and that symptoms of TMD influenced the masticatory efficiency and ability.

Occlusal appliance therapy in patients with temporomandibular disorders. A double-blind controlled study in a short-term perspective.

Stabilization appliances are commonly used in the treatment of temporomandibular disorders (TMD), although the treatment effects are not fully understood. This study evaluated the short-term efficacy of a stabilization appliance in patients with TMD of arthrogeneous origin, using a randomized, controlled, and double-blind design. Sixty patients were assigned to two equally sized groups: a treatment group given a stabilization appliance and a control group given a control appliance. Improvement of overall subjective symptoms was reported in both groups but significantly more often in the treatment group than in the control group (P = 0.006). Frequency of daily or constant pain showed a significant reduction in the treatment group (P = 0.02) compared with the control group. The results of this short-term evaluation showed that both the stabilization appliance and the control appliance had an effect on temporomandibular joint (TMJ) pain. It is improbable that the difference observed between the groups is due to chance alone.

Symptoms and signs of temporomandibular disorders in girls with normal occlusion and Class II malocclusion.

Mandibular function, headaches, and symptoms and signs of temporomandibular disorders (TMD) were studied in one group of girls with a well-defined normal occlusion (n = 60) and another group with class II malocclusion (n = 123). Frequent headaches and temporomandibular joint clicking, muscle tenderness to palpation, pain on mandibular movement, awareness of tooth clenching, and grinding were commoner in the class II malocclusion group. Awareness of tooth clenching had the largest influence on the odds for symptoms and signs of temporomandibular disorders (TMD) in a logistic regression analysis. Occlusal variables that increased the odds for symptoms and signs of TMD were large overjet, frontal open bite, few occlusal contacts, lateral sliding retruded-intercuspal contact position, crowding, and non-working side interferences. We concluded that normal occlusions have lower odds for symptoms and signs of TMD, whereas some occlusal characteristics, more frequently found in the class II malocclusion group, increased the odds for symptoms and signs of TMD.

Diclofenac sodium as an alternative treatment of temporomandibular joint pain.

In a double-blind study, diclofenac sodium (Voltaren), 50 mg two or three times a day, was compared with placebo in 32 patients with pain localized to the temporomandibular joint (TMJ). The patients were allocated into two equally large groups. A visual analog scale was used to estimate the pretreatment degree of pain. The treatment effect was assessed as the frequency of joint and muscle pain and by the patients' own evaluation of improvement. The change in the clinical condition was assessed by tenderness to palpation of the TMJ and masticatory muscles and by mandibular mobility. The frequency of TMJ pain showed a greater reduction in the diclofenac group than in the placebo group, and there was a significant reduction of daily TMJ pain in the diclofenac group. The diclofenac group also showed a significant decrease in tenderness to palpation of the masticatory muscles in comparison with the placebo group. The patients with short duration of pain showed the best response to diclofenac. There was no evidence in this study to prove that diclofenac should be used as a primary treatment of TMJ pain, but it could be used as a complement to other treatments of acute TMJ pain.

Short-term effect of occlusal adjustment on craniomandibular disorders including headaches.

The aim of this study was to assess the short-term effect of occlusal adjustment on craniomandibular disorders. Fifty patients were randomly selected and divided into a treatment (T) and a control (C) group. The initial clinical examination and the follow-up were made by one observer and the occlusal adjustment by another. There were no significant differences between groups with regard to frequency of headaches, facial pain, pain on mandibular function, or duration of headaches and facial pain. Fifty-two percent of the patients in the treatment group and 20% of the patients in the control group reported reduced subjective symptoms overall at follow-up examination. The improvement was statistically significant within the T group and significantly greater than in the C group. There was no significant change within or between groups with regard to frequency of headaches, facial pain, or pain on mandibular movements. There was an almost significant difference between groups after treatment with regard to changes in the number of tender muscles. The results of this study indicate that occlusal adjustment provides a general subjective improvement of craniomandibular disorders.