Comparison of occlusal discomfort in patients with temporomandibular disorders between myofascial pain and disc displacement.

We compared occlusal discomfort in patients with temporomandibular disorders (TMD) between myofascial pain (MFP) and disc displacement (DD) using a database created from Sep, 2003 to Aug, 2005. We selected 71 patients with MFP and 170 patients with DD to construct a null model of structural equation modeling (SEM) in which anxiety influenced depressive mood, depressive mood aggravated occlusal discomfort and sleep complaints, and sleep complaints or an onset event caused by another person aggravated occlusal discomfort. We performed a simultaneous analysis of patients with MFP and DD. The estimated parameter of the path from depressive mood to occlusal discomfort was significant for patients with MFP, but not for patients with DD. The path from an onset event caused by another person, such as dental treatment to occlusal discomfort was significant in patients with MFP and those with DD. The Goodness of Fit Index (=0.909), The Adjusted Goodness of Fit Index (=0.867), and The Root Mean Square Error of Approximation (=0.039) indicated good acceptability. These results suggested that an increase in depressive mood may aggravate occlusal discomfort in patients with MFP, and an onset event caused by another person, such as dental treatment, also may aggravate occlusal discomfort in patients with MFP and those with DD.

Teeth contacting habit as a contributing factor to chronic pain in patients with temporomandibular disorders.

Many different factors are known to cause and perpetuate the symptoms of temporomandibular disorders (TMD). However, the roles of parafunctional factors have not been clearly elucidated. We found one of these habits in the clinical setting. This parafunctional habit involves daily light touching of the upper and lower teeth, when the mouth is closed. We named this habit Teeth Contacting Habit (TCH). [OBJECTIVES] To investigate the following hypotheses: 1) TCH is associated with perpetuation of chronic pain of TMD patients; 2) TCH is associated with other behavioral factors. [METHODS] Two hundred and twenty-nine TMD outpatients with chronic pain were analyzed with multivariate logistic regression models. [RESULTS] TCH was found in 52.4% of patients. Patients with TCH and pain lasting for more than four months were less likely to experience improvements in pain at the first visit (OR = 1.944, p = 0.043). Other factors associated with TCH were as follows: unilateral chewing (OR = 2.802) and involvement in a precision job (OR = 2.195). [CONCLUSION] TCH can prolong TMD pain and is associated with other behavioral factors.

Difficulty of food intake in patients with temporomandibular disorders.

PURPOSE: Although patients with temporomandibular disorders (TMD) often report impaired eating, the features of food intake difficulty have rarely been estimated. This study compared subjective difficulty in 4 categories of food intake situations among 3 subgroups of TMD patients. MATERIALS AND METHODS: A total of 511 TMD patients (402 women, 109 men, mean age 36.4 +/- 15.4, range 12 to 82) participated in this study. Subjects were divided into 3 TMD subgroups: myofascial pain (MFP), disc displacement with/without reduction (DD), and arthralgia or osteoarthritis (Arth). Patients' level of food intake difficulty was assessed using a visual analogue scale (VAS) for 4 categories of food intake situations: difficulty in putting food into mouth (PUT), difficulty in biting off foods (BIT), difficulty in grinding down foods (GRD), and overall difficulty in consuming a meal (OAL). RESULTS: Nearly all patients (98.6%) exhibited food intake difficulty in at least 1 category. In the category of PUT, the DD group exhibited significantly more difficulty than the MFP and Arth groups (P < .048), and the Arth group had a higher VAS score than the MFP group (P = .030). With regard to BIT and GRD, there was no significant difference among the TMD subgroups. In OAL, the DD group showed more difficulty than the MFP group (P = .046). CONCLUSION: TMD patients experienced impaired food intake ability. In particular, the DD group experienced more difficulty than the MFP group. Concerns about types of food and food intake behavior for each TMD subtype should be taken into account in the management of TMD patients.

[Postoperative evaluation of surgically treated cases with temporary silicone implant in temporomandibular joint].

We have carried out temporary silicone implants after diskectomies or arthroplasties in temporomandibular joint surgeries to avoid postoperative adhesion and to maintain articular space. We evaluated 19 joints in 15 patients who had received dacron-reinforced silicone implant after silicone sheet removal through follow-up for at least 6 months. The cases included temporomandibular joint disorder (10 joints in 9 patients), psoriatic arthritis (2 joints in 1 patient), ankylosis (4 joints in 3 patients) and synovial chondromatosis (2 joints in 2 patients). On the basis of the criteria of temporomandibular dysfunction for the results, they were classified as bad (4 patients). It is thought that factors other than the implant are related to the bad results in the postoperative evaluation. In this study, lymphadenopathy induced by exfoliated silicone debris could not be confirmed. The temporary silicone implant in the temporomandibular joint was thought to be useful.