Journal of Oral & Facial Pain and Headache, 01/1993

This study used electronic thermography, an alternative diagnostic imaging modality, to assess the thermal image characteristics of the normal TMJ in 30 asymptomatic subjects. Assessments made included: thermal pattern recognition and symmetry, absolute temperature measurements and differences in absolute temperature measurements, and mean temperature measurements and differences in five anatomic zones. Results indicated the presence of a common thermal TMJ pattern in two thirds of patients, with variations from this pattern in the remaining patients. All TMJ thermal patterns demonstrated marked thermal symmetry, with delta T 0.2 degrees C in the region of the TMJ and related regions of the face. This consistent symmetry demonstrated in normal subjects suggests that substantial thermal asymmetry may prove to be a reliable indicator of TMJ disease.

This study explored the physiologic and psychologic distinctions between masticatory muscle pain patients and age and sex-matched normal controls. Subjects completed several standardized psychologic tests. They then underwent a laboratory stress profile evaluation to obtain physiologic measures (EMG, heart rate, systolic and diastolic blood pressure) under conditions of rest, mental stress, and relaxation. The pain patients reported greater anxiety, especially cognitive symptoms, and feelings of muscle tension than did the controls. Under stress, pain patients had higher heart rates and systolic blood pressure than the controls. Electromyogram activity in the masseter regions was not significantly different between the pain and control group. The results are discussed in terms of the likely mechanisms that might account for the observed differences between masticatory pain patients and normal subjects.

The aim of this study was to evaluate pain characteristics of patients with temporomandibular joint-related pain and propose a rationale for the assessment of pain and its impact on patients with temporomandibular disorders. Based on anamnestic information, the 88 patients in the sample were classified according to pain grade: (1) acute/subacute nonrecurrent or recurrent pain, n = 41 (46.6%); (2) persistently recurring pain in relatively high frequency, or nonsevere persistent pain, n = 32 (36.4%); (3) persistent and impairing pain, n = 8 (9.1%); (4) persistent and disabling pain, n = 7 (7.9%); and (5) persistent and handicapping pain, n = 0. Regarding TMJ pain provoked during the clinical examination, there was a significant difference among diagnostic subgroups, subgroups with different pain intensity levels, and pain grade subgroups, but no significant differences could be found based on the duration of the pain symptoms. Subgroups also did not significantly differ in scores on the Multi-dimensional Pain Inventory and the General Health Questionnaire. Based on the results of the study, the assessment of nonchronic TMJ pain may generally be limited to an accurate description of the pain complaint and thorough clinical assessment. Multidimensional assessment may be useful when the TMJ pain persists or is persistently recurring. Depending on individual circumstances, additional assessment procedures may prove to be useful. A general strategy for pain assessment in temporomandibular disorders is proposed.

This paper represents a general review of basic age-related changes that take place in the craniomandibular apparatus and the most frequently presenting conditions associated with craniomandibular disorders (CMD) in the elderly. The evaluation of geriatric patients with signs or symptoms of CMD must consider (1) normal age-related changes in the craniomandibular apparatus and their impact on both normal function and responses to stress; (2) the role of dentition status and dental prosthesis in CMD; and (3) the contribution of malignant disease, psoriasis, arthritic conditions, pseudogout, granulomatous vascular conditions, and metaplastic involvement of tissue to the pathosis of CMD. The clinician must also be aware of various effects of psychologic, sociologic, and biologic aspects of aging on the development of headache and atypical facial pain as components of CMD in the geriatric patient.

Of 353 patients screened, 86 answered positively to questions designed to identify bruxers. The bruxing patient profile revealed that 100% had working excursive interferences, 78% had balancing excursive interferences, and 95.4% had a premature contact into maximum intercuspation. Most of the bruxing patients had a chief complaint that related to pain, and 89.6% of the patients had a craniomandibular disorder. The patients were initially managed with an anterior deprogrammer and were later managed with other occlusal devices as signs and symptoms dictated. Definitive treatment was determined by the patient's maxillomandibular relationship.

A clinical follow-up of 45 previously symptomatic patients with arthrographically diagnosed TMJ disc positions was performed at least 1 year (average, 4 years 4 months) after treatment. The patients were divided into three groups according to disc position: (1) superior disc position, n = 5; (2) anterior disc displacement with reduction, n = 17; and (3) anterior disc displacement without reduction, n = 23. Ninety-two percent of the patient were treated conservatively. Seventy percent of the patients reported being symptom-free or improved. The frequency of joint clicking did not change considerably, but the amount of crepitating sounds increased markedly. No difference was found regarding treatment outcome between the anterior disc displacement groups with and without reduction.

The reproducibility of the condylar reference position was examined at the pont of unstrained hinging movement of the mandible in subjects with TMJ symptoms and in asymptomatic subjects. Three different operators performed the procedure to detect interoperator variability. Each operator made five registrations using computerized axiography in the electronic mandibular position indicator mode. Data were evaluated by an analysis of variance using three factors: (1) repetitions of the single operator, (2) data from symptomatic versus asymptomatic patients, and (3) values of different operators. The results showed that none of these factors had a significant influence on reproducibility of the condylar reference position. High reproducibility was obtained in both symptomatic and asymptomatic groups. Measured values remained within ± 0.1 mm in 58.6% and within ± 0.2 mm in 24.3% of the registrations.

An epidemiologic sample of 293 subjects in three age groups, now 17, 21, and 25 years of age, were followed longitudinally with respect to symptoms of craniomandibular dysfunction during a 10-year period. Reports of one or more such symptoms increased in all three age groups during the 10 years. At the follow-up, 1 in 3 individuals in all three groups had noticed such symptoms occasionally and 10% had them frequently. Reports of oral parafunctions such as bruxing and clenching also increased, while other parafunctions such as nail, lip, cheek, and tongue biting increased from the age of 7 to 11 but then decreased with age. Despite the high incidence of subjective symptoms of craniomandibular disorders, only a few subjects had had any kind of functional treatment performed during the 10-year period, and only 7 had an actual demand for treatment at present.

A craniocervical dysfunction index has been developed (based on the Helkimo Dysfunction Index) to comprehensively assess craniocervical dysfunction and to objectively monitor the management of patients who present with these clinical problems. The close functional interrelationship of temporomandibular joints, jaw muscles, and cervical joints and muscles is reviewed, and a mechanism is proposed to explain dysfunctional relationships between these structures. This is the first of three papers stemming from a clinical study that investigated craniomandibular disorders and assessed the effect of routine dental management on craniomandibular and craniocervical dysfunction.

The reproducibility of electromyographic parameters descriptive of deliberate unilateral chewing (activity, timing, curve symmetry) was investigated in normal asymptomatic volunteers. The best time for the initiation of muscle activity was also examined, with the future aim of staging TMJ internal derangements. The results suggest that activity is the most reliable variable, indicating that it may be helpful in describing muscle incoordination. When time was used in conjunction with another variable, overall reproducibility decreased.