Journal of Oral & Facial Pain and Headache, 01/1999

Aims: The aim of this study was to determine the prevalence of pain that is related to temporomandibular disorders (TMD), gender differences, and perceived treatment n eed in children and adolescents at a public dental clinic in Linkoping, Sweden. Methods: A total of 862 children and adolescents aged 12 to 18 years received a questionnaire and their jaw opening was measured. Those who reported pain once a week or more in t he masticatory system received a more comprehensive examination, including the Research Diagnostic Criteria for TMD and a neurologic examination (group 1). Group 2 reported pain less than once a week. Results: Seven percent of subjects (63/862) were diagnosed with TMD pain. Both genders exhibited similar distributions of TMD diagnoses, except that myofascial pain was significantly more common in girls than in boys. Prevalence of pain once a week or more was reported as: 21% in the head; 12% in the temples; and 3% in the face, temporomandibular joint, or jaws. The prevalnece of TMD-related pain was significantly higher in girls than in boys. Self-reported TMD symptoms were significantly more common (P 0.001) in group 1. No significant gender differences were found in group 1 for pain intensity, behavioral rating scale scores, medicine consumption, reported days of school absence, or perceived need for treatment. Conclusion: Overall, TMD-related pain was more common in girls than in boys. A mjaority of children and adolescents who experienced pain once a week or more perceived a need for treatment. Seven percent of the examined subjects were diagnosed with TMD pain.

Aims: The aim of this study was to investigate the prevalence of temporomandibular disorders (TMD) in patients with primary Sjogren syndrome (1 degree SS), analyze the impact of the disease on mandibular function, and assess psychosocial distress. Methods: Sixty-three subjects, 60 women and 3 men, participated in the study; 21 1 degree SS patients were compared with age-matched and gender-matched groups of TMD subjects and controls. Patients were examined according to the Research Diagnostic Criteria for Temporomandibular Disorders. Results: Results showed that the subjective, clinical, and radiographic signs of TMD are not more common in patients with 1 degree SS than in controls. The impact of the autoimmune disease on mandibular function, eg, speech and chewing ability, revealed limitations

Aims: Outcome evaluations of treatments incorporating electromyographic (EMG) biofeedback for temporomandibular disorders (TMD) have been conducted for more than 2 decades. The purpose of this study was to review the available literature to determine the efficacy of biofeedback-based treatments and to estimate treatment effect sizes. Methods: A literature search located 13 studies of EMG biofeedback treatment for TMD, including 6 controlled, 4 comparative treatment, and 3 uncontrolled trials. Three types of outcome were examined: patient pain reports, clinical exam findings, and ratings of global improvement. Results: Five of the 6 controlled trials found EMG biofeedback treatment to be superior to no treatment or psychologic placebo controls for at least 1 of the 3 types of outcome. Data from 12 studies contributed to a meta-analysis that compared pre- to posttreatment effect sizes for EMG biofeedback treatments to effect sizes for control conditions. Mean effect sizes for both reported pain and clinical exam outcomes were substantially larger for biofeedback treatments than for control conditions. In addition, 69% of patients who received EMG biofeedback treatments were rated as symptom-free or significantly improved, compared with 35% of patients treated with a variety of placebo interventions. Follow-up outcomes for EMG biofeedback treatments showed no deterioration from posttreatment levels. Conclusion: Alhtough limited in extent, the available data support the efficacy of EMG biofeedback treatments for TMD.

Aims: Stabilization appliances and mandibular anterior repositioning appliances have been used to treat patients with internal derangement of the temporomandibular joint (TMJ) based on the assumption that these appliances work by decompressing the TMJ. The purpose of this study was to indirectly test this assumption. Methods: Bilateral TMJ tomograms of 7 subjects with unilateral anterior disc displacement without reduction (ADDwor) were taken during comfortable closure and during maximum clenching in maximum intercuspation; tomograms were also taken with the 2 types of occlusal appliances in use. Outlines of the condyle and the temporal fossa were automatically determined by an edge-detection protocol, and the minimum joint space dimension of the joints with and without ADDwor was automatically measured for each experimental condition as the outcome variable. Results: Upon comfortable closure and maximum clenching, the minimum joint space dimensions of the ipsilateral and cont ralateral joints with the use of stabilization appliances and mandibular anterior repositioning appliances were not significantly different from those seen in maximum intercuspation. Conclusion: These findings do not indicate that these appliances induce an increase in joint space during closing and clenching in joints with ADDwor.

Aims: The aim of this study was to test the hypothesis that temporomandibular joint (TMJ) pain is influenced by circulating levels of neuropeptide Y, serotonin, and interleukin-1B in rheumatoid arthritis. Methods: Forty-three seropositive (RF+) or seronegative (RF-) rheumatoid arthritis patients and 24 healthy individuals were included in the study. Results: High serum concentrations of serotonin were associated with low TMJ pressure pain thresholds and pain during mandibular movement in the RF+ patients. The results of this study do not support a relationship between circulating neuropeptide Y or interleukin-1B and TMJ pain. The RF+ patients had higher C-reactive protein levels and erythrocyte sedimentation rates than the RF- patients. There were also higher plasma levels of interleukin-1B in the RF+ patients than in the healthy individuals. Plasma levels of neuropeptide Y in the RF- patients were higher than in the healthy individuals. Conclusion: This study indicates that the serum concentration of serotonin is associated with TMJ allodynia in seropositive rheumatoid arthritis.

Aims: This study was conducted to investigate the serum level of serotonin (S-5-HT) in patients with temporomandibular disorders (TMD) of muscular origin, ie, localized myalgia, and to compare it to that found in healthy individuals and patients with fibromyalgia. A second aim was to investigate the association between S-5-HT and pain parameters. Methods: Twenty patients with localized myalgia participated in the study. Twenty age- and gender-matched healthy individuals and twenty patients with fibromyalgia served as controls. The participants were examined clinically as to the condition of the temporomandibular region and S-5-HT. Results: The levels of S-5-HT did not differ significantly between the groups. However, in patients with localized myalgi a there was a negative correlation between S-5-HT and tenderness of the temporomandibualr muscles. Conclusion: The results of this study indicate that allodynia of orofacial muscles in patients with TMD is signficantly related to S-5-HT concentration.