Journal of Oral & Facial Pain and Headache, 01/1996

To study the interaction between human recombinant interleukin-1 alpha and the nervous system, substance P-, neurokinin A-, calcitonin gene-related peptide-, and neuropeptide Y-like immunoreactivity in the cerebrospinal fluid, plasma, and temporomandibular joint (TMJ) perfusates of rats during acute experimental monarthritis were examined. The right TMJs of the experimental rats were injected with 0.01 mL of human recombinant interleukin-1 alpha. The right TMJs of control rats were injected with 0.01 mL of saline. Cerebrospinal fluid, plasma, and perfusates from the right TMJs were obtained at 2, 6, and 24 hours following injection, and neuropeptide-like immunoreactivity was analyzed by specific radioimmunoassays. Values of neuropeptide-like immunoreactivity for the experimental rats were compared with those of the control rats. In the experimental group, substance P-, neurokinin A-, and calcitonin gene-related peptide-like immunoreactivities were increased in cerebrospinal fluid compared to those of the control group. In plasma, no changes in neuropeptide-like immunoreactivities rose significantly in the TMJ perfusates. Most pronounced changes in neuropeptide Y-like immunoreactivity occurred intra-articularly in the TMJ perfusates. The results indicate that the contribution of the nervous system to human recombinant interleukin-1 alpha-induced monarthritis is most pronounced in the affected joint.

Anterior disc position has been highly correlated with temporomandibular disorders (TMD). It was hypothesized that internal derangement of the temporomandibular joint may be a part of a joint phenotype that imparts an increased risk for joint disorders. If this hypothesis is true, an increased prevalence of joint disorders in indibiduals diagnosed with displaced discs should be expected. A total of 263 symptomatic TMD patients and 82 asymptomatic volunteers was examined. Asymptomatic volunteers with anteriorly displaced discs were twice as likely as asymptomatic volunteers without disc displacements to report pain/dysfunction in other joints. Symptomatic patients with and without displaced discs reported an increase in other joint problems three or four times greater than in asymptomatic subjects. Compared to symptomatic TMD patients without disc displacement, symptomatic TMD patients with anteriorly displaced discs were also twice as likely to report other family members as being affected by TMD. Familial aggregation of TMD and an increased prevalence of other joint problems in these individuals may represent more than a serendipitous occurrence.

This study assessed the relationship between temporomandibular disorders (TMD) and malocclusion in a group of 102 patients with horizontal mandibular deficiency who had elected mandibular advancement surgery. The prevalence of TMD as reflected by the overall Craniomandibular Index, Dysfunction index, and Muscle index scores was within the range of non TMD populations (mean Craniomandibular Index = 0.14; mean Dysfunction index = 0.12; mean Muscle index = 0.15). Forty-two percent of the patients exhibited essentially no signs of TMD, 7.8% had primarily muscle tenderness to palpation, 36.3% had joint sounds with or without temporomandibular joint tenderness, and 13.7% had combined muscle-joint signs. There were no convincing correlations among any of the cephalometric variables and Craniomandibular Index, Dysfunction index, and Muscle index scores. A subgroup of 30 of this patient population was evaluated both before and during orthodontic treatment just prior to surgery. No statistically significant changes were found in Craniomandibular Index, Dysfunction index, or Muscle index scores. Thus, a period of orthodontic treatment in these patients does not appear to increase the probability of TMD. e r o c s .

This study compares the frequency of signs and symptoms of craniomandibular disorders and dental conditions in patients diagnosed with Meniere's disease and in control subjects from a population sample. Thirty-one patients (12 men, 19 women) diagnosed with Meniere's disease were referred from three otolaryngologic clinics for clinical examination and possible treatment of craniomandibular disorders. Thirty-one control subjects were selected from the population in the same area of Sweden (Ystad). Both groups were subjected to a screening fo their symptoms with a self-administered questionnaire and to a routing stomatognathic examination. The function of the masticatory system was further calculated according to the index of Helkimo for both anamnestic dysfunction (Ai) and clinical dysfunction state (Di). Clinical symptoms of craniomandibular disorders such as pain in the face or jaw; pain on movement of the mandible; fatigue of the jaws; and pain located in the vertex area, the nexk/shoulder area, and the temples all occurred significantly more often in the patient group. Findings at the clinical examination included a statistically higher frequency of tenderness to palpation of the masticatory muscles, the temporomandibular joint, and the upper part of the trapezius muscle in the patient group compared to that of the control group. The findings indicate a much higher prevalence of signs and symptoms of craniomandibular disorders in patients diagnosed with Meniere's disease than in the general population.

The reliability of quantitative electromyography (EMG) of the masticatory muscles was investigated in 14 subjects without any signs or symptoms of temporomandibular disorders. Integrated EMG activity from the anterior temporalis and masseter muscles was recorded bilaterally by means of bipolar surface electrodes during chewing and biting activities. In the first experiment, the influence electrode relocation was investigated. No influence of electrode relocation on the recorded EMG signal could be detected. In a second experiment, three sessions of EMG recordings during five different chewing and biting activities were performed in the mroning (I); 1 hour later without intermediate removal of the electrodes (II); and in the afternoon, using new electrodes (III). The method errors for different time intervals (I-II and I-III errors) for each muscle and each function were calculated. Depending on the time interval between the EMG recordings, the muscles considered, and the function performed, the individual errors ranged from 5% to 63%. The method error increased significantly (P.05 to P.01) with the time interval between recordings. The error for the masseter (mean 27.2%) was higher than for the temporalis (mean 20.0%). The largest function error was found during maximal biting in intercuspal position (mean 23.1%). Based on the findings, quantitative electromyography of the masticatory muscles seems to have a limited value in diagnostics and in the evaluation of individual treatment results.

The aim of this study was to compare somatic complaints, anxiety, and pain related to temporomandibular disorders (TMD) in a group of TMD patients who had high scores for headache and muscle palpation compared with that of a group of TMD patients who had low or medium scores for headache and palpation before and 2 years after conservative TMD treatment, consisting of counseling, muscle exercises, and a stabilization splint. The high-score group consisted of 23 patients who had headaches several times a week or daily and had more than three muscles graded as severly tender to palpation. The low/medium-score group comprised 28 patients who had headaches hardly ever, once or twice a month, or several times amonth, and with muscles graded as slightly or medium tender to palpation. The patients answered three questionnaires (McGill Pain Questionnaire {Norwegian version}, a somatic complaints questionnaire, and the trait part of Spielberger Stait Trait Anxiety Inventory) before and 2 years after treatment. The findings showed differences between the two groups concerning pain description, general muscle complaints, and anxiety both before and after the treatment, with the high-score group showing the highest values. In general, the treatment outcome had improved in the low/medium-score group but remained unchanged in the high-score group.

Psychosocial factors have been frequently suggested as important risk factors that may delay recovery in patients temporomandibular disorders. In this study, 94 subjects with chronic temporomandibular disorders were studied using IMPATH:TMJ prior to their entering an interdisciplinary treatment program to determine which factors were most predictive of outcome. Treatment outcome was determined based on significant decreases in the Craniomandibular Index and the Symptom Severity Index from pretreatment to posttreatment. The IMPATH:TMJ items were regressed on treatment outcome for a random sample of half of the subjects (n=47) to isolate the psychosocial and demographic items for these subjects (criterion group), followed by a cross-validation of the items of the remaining 47 subjects (cross-validation group). Low self-esteem, feeling worried, low energy, and sleep activity were identified as useful predictors of treatment outcome for the criterion group. Each are correlates of depression. The discriminant analyis employing these four items accounted for 49% f the variance in treatment response, was statistically significant (P.0001), and correctly predicted treatment outcome for 41 of 47 subjects (87%) in the criterion group. The predictive utility of the identified items remained statistically significant when applied to the cross-validation group (P.01). The discriminant function employing the items correctly predicted treatment outcome for 37 of 47 subjects (79%) and explained 28% of the variance in treatment response. Findings of this study suggest that pretreatment psychosocial information is impoortant in predicitng treatment outcome for chronic temporomandibular disorders, and that symptoms of depression mediate treatment response for chronic pain patients.

Patients suffering from pain and dysfunction in the temporomandibular region sometimes ignore appointments after the initial examination. This form ofnoncompliance is well known and is often studied in patients suffering from recurrent headaches, arthritis, and lower back pain. Information on patients with temporomandibulr disorders (TMD) who fail to attend the next visits and do not comply with the proposed treatment is scarce. To 61 patients (aged 20 - 40 years) who did not attend the next visit after an initial examination and after discussing the treatment protocol, a questionnaire was mailed 6 monthes to 1 year after the first visit. The uestions related to reasons for not attending nd the possible treatment received. Some questions were also related to the present TMD stte. The clinical profiles of the nonattenders were compared to those of a group of 400 TMD patients who did finish the proposed treatment (positive control). The nonattenders had more pain and dysfunction at initial examination than did the treated patients. The treated patients reported a shorter duration of symptoms before seeking treatment than did the nonattenders, suggesting tht the latter group had a more chronic pain state. The main reason for no returning was that symptoms improved enough or disappeared completely and spontaneously without the proposed treatment. Sixteen patients did not return for further treatment for reasons linked to the dentist-patient relationship. Fifty-seven percent of the nonattenders reported to be symptom free or sufficiently improved. One year after the initial examination and without the proposed treatment, most still had some symptoms such as clicking (59%) and reduced opening (21%) but only 24% reported to be in need of treatment.

Although Lyme disease has spread rapidly and it is difficult to diagnose, a review of the dental literature does not reveal many references to this illness. Dental practitioners must be aware of the systemic effects of this often multiorgan disorder. Its clinical manifestations may include facial and dental pain, facial nerve palsy, headache, temporomandibular joint pain, and masticatory muscle pain. The effects precipitated when performing dental procedures on a patient with Lyme disease must also be considered. This study discusses the epidemiology and diagnosis of Lyme disease, its prevention, and factors to consider when making a differential diagnosis. Dental care of the patient with Lyme disease and currently available treatments are also considered. Three case reports are presented.