Journal of Craniomandibular Function, 03/2012

Grindcare^® (Medotech, Copenhagen, Denmark) is a biofeedback device that combines electromyographic (EMG) measurements and electrical responses after recorded muscle contractions. The device is advertised for its reduction of sleep bruxism and related symptoms. The aim of this study was to measure EMG activity in patients with myofascial pain and to test if the device reduces EMG activity and symptoms of myofascial pain. Forty-eight patients with complaints of myofascial pain were invited for the study and divided randomly into two groups. The treatment group received instructions, EMG measurement and treatment with electrical stimulation. The control group received instructions and EMG measurement only. EMG measurements were recorded for 4 weeks. Pain assessment was performed at baseline, after 1 week, 3 weeks and 5 weeks after beginning of measurements using an numerical analog scale (NAS) for pain intensity, pain frequency, degree of limitation and restriction of daily life. Furthermore, clinical functional examination was performed. An analysis of variance (ANOVA) and a Wilcoxon Test were applied for statistical analyses. After 3 weeks of application of the active device, the number of EMG events/h dropped from 96.72 (± 57.81) to 33.57 (± 23.98). The controls exhibited 75.80 (± 59.00) EMG events/h at baseline and after 4 weeks, the measurement was 70.25 (± 50.40) EMG events/h (P = 0.02). Clinical data recording the pain intensity, the extent of daily life restrictions as well as the number of painful muscles on palpation, which did not differ significantly between groups at any examination (P > 0.05). In the treatment group, however, significant differences between baseline examination and examination after 5 weeks were observed for pain intensity (P = 0.001), daily life restrictions (P = 0.001) and number of painful muscles on palpation (P 0.001). Within the limitations of this observational study, it was demonstrated that in patients with myofascial pain, EMG events/h of the temporalis muscle were significantly reduced after 3 weeks of therapy with electrical stimulation of this muscle. Keywords: biofeedback, myofascial pain, sleep bruxism, temporomandibular disorders

In this study, a total of 21 patients who had presented for treatment on account of temporomandibular symptoms were examined over a period lasting from 2003 until 2008 at the University Clinic of the RWTH Aachen University, Germany. Manual structural analysis (MSA) and axiography were conducted by a treatment provider experienced in functional diagnostics to record the temporomandibular situation of all patients. In addition to this, magnetic resonance imaging (MRI) of the temporomandibular joints (TMJs) was performed on each study participant. The objective of the study was to evaluate the diagnostic value of MSA and axiography in comparison to MRI. For pathological MSA and axiographical findings, defined point values were assigned to each TMJ; these were combined to form an overall point value, the temporomandibular dysfunction (TMD) index. This TMD index comprises a clinical, symptomatic evaluation with the aid of manual structural analysis (MSA), as well as a joint function-related evaluation by means of axiography. In this study, a complete concurrence was observed between TMJs with pathological clinical findings and a high TMD index, whereby only patients with dysfunctional clinical symptoms were included in the evaluation. The question as to whether this index also enables a definition of different treatment areas must be investigated in controlled clinical studies. Keywords: temporomandibular dysfunction (TMD), temporomandibular joint, TMD index, axiography, manual structural analysis

Some patients afflicted by temporomandibular joint (TMJ) pain today seek advice in online discussion forums. The present study sought to analyze the content of these online forums. Having entered the search terms "kiefergelenkschmerzen forum" ("TMJ pain forum") in Google, the first 20 relevant online discussion forums that came up were included. Pain was the central term in the 27 opening posts. Often, functional impairment of the jaw was reported as well. Most posters asked questions as to how to deal with complaints, and about diagnostics and therapy. The most frequently suspected reason for the complaints was bruxism. Approximately 40% of the posters criticized previous therapies, and three out of four patients exhibited feelings of insecurity, irritation, and disappointment. A total of 96 people wrote 189 replies to the 27 initial posts. In almost all cases, the advice was to consult a professional. More than half of the threads mentioned oral appliances, followed by physiotherapy and other physical treatment, as well as analgesics. Some of the statements made were incorrect; even some of the recommendations made by dentists were at odds with current published information. Keywords: arthralgia, evidence-based dentistry, online forum, pain, suffering textual analysis, TMDs, temporomandibular joint

Complete anterior disc displacement without reduction constitutes a morphological and functional alteration of the temporomandibular joint. In this paper, a conservative treatment approach without an attempt at reduction is described. The primary treatment objective is the acute relief of the bilaminar zone structures and the long-term reconstructive stabilization of the therapeutically altered mandibular position. Keywords: complete anterior disc displacement without reduction, decompression splint, therapeutic mandibular position, adhesively cemented composite resin restorative structure, occlusal plate, definitive reconstruction