Treatment of Temporomandibular Disorders of Arthrogeneous Origin. Controlled double-blind studies of a non-steroidal anti-inflammatory drug and a stabilisation appliance.

The aim of this thesis was to prospectively evaluate the short-term effect of a non-steroidal anti-inflammatory drug (diclofenac sodium, Voltaren) and stabilisation appliance in controlled trials of patients with temporomandibular disorders (TMD) of arthrogeneous origin. The active treatments were compared to placebo in the study of diclofenac and to a control appliance in the other study. Thirty-two patients in the first study and 60 patients in the second study were randomly assigned into two equally large groups. In the second study two different techniques regarding assessment of changes in condylar position on radiographs with and without an occlusal appliance was evaluated. Changes in condyle-fossa relationship was compared in the two patient groups, and the changes in condyle-fossa relationship was compared with the treatment outcome between the two treatment groups. The influence of possible background variables on outcome of treatment with occlusal appliances were tested. The group treated with diclofenac did not seem to have recovered better from TMD than placebo. However, in the other study the group treated with a stabilisation appliance showed a better treatment outcome, with respect to both symptoms and signs, than the group treated with a control appliance. The group treated with a stabilisation appliance more often showed a changed condylar position in the transcranial radiographs of the TMJ than the group treated with a control appliance. It was also shown that the patients treated with a stabilisation appliance more often experienced relief of TMD symptoms when the stabilisation appliance had achieved a changed condyle-fossa relationship. Treatment with a stabilisation appliance was still a strong explanatory factor when testing possible background variables for a positive treatment outcome, but also male sex (positive) and severe or very severe TMJ pain (negative) influenced the treatment outcome. It was concluded that there was no evidence to suggest that diclofenac sodium (Voltaren) should be used as a primary treatment for TMJ pain in patients with TMD. However, the stabilisation appliance is recommended for the treatment of patients with TMD suffering from TMJ pain

Can Infrared Thermography be a Diagnostic Tool for Arthralgia of the Temporormandibular Joint?

This paper presents a review of the use of infrared thermography in diagnosis of temporomandibular joint (TMJ) arthralgia. The question examined was whether the infrared thermography could be reliably used as a tool to diagnose arthralgia by objectively assessing the site of origin and the degree of irritation. Controlled studies were performed by using advanced thermographic devices to show both diagnostic va-lidity and reliability of infrared thermography as a screening test for selecting healthy subjects from patients with unilateral TMJ arthralgia. The study revealed that thermography fails to meet the criteria of high level of evidence. Further studies are required to confirm these results in order to specify analysis of facial thermal patterns and to better un-derstand the relationship between TMJ arthralgia and regional tem-perature changes. Until then infrared thermography cannot be recom-mended for routine use as a diagnostic technique to identify TMJ dis-orders

Do psychological factors and general health influence the short-term efficacy of resilient appliance therapy in patients with temporomandibular disorder pain?

Objectives. To study how sense of coherence (SOC), grade of depression and non-specific physical symptoms and general health influence the efficacy of intraoral appliance therapy in patients with temporomandibular disorder (TMD) pain. A second objective was to study the association between SOC, grade of depression, grade of non-specific physical symptoms and general health. Material and methods. A total of 73 TMD pain patients participated; 36 were treated with a resilient appliance and 37 with a non-occluding control appliance in a randomized controlled trial for a period of 10 weeks. All patients had at least one pain diagnosis according to the research diagnostic criteria for TMD, including both the Symptom Checklist-90-Revised (Axis II) measuring grade of depression and non-specific physical symptoms, and general health (physical characteristics). Patients also filled in the 29-item SOC questionnaire. Results. A low grade of SOC was found in eight of the patients in the treatment group and in 17 of the control group at baseline, with a statistically significant difference between the groups. Logistic regression analyses revealed that, after correcting for the background variables, the resilient appliance did not differ from the non-occluding control appliance in terms of treatment outcome. No statistically significant differences were found when correlating mean SOC with grade of depression, grade of non-specific physical symptoms and general health. Conclusions. These findings indicate that none of the studied background variables (age, gender, SOC, depression, non-specific physical symptoms or general health) seemed to influence the short-term efficacy of intraoral appliances. No association was found between SOC and depression, non-specific physical symptoms or general health in TMD pain patients

Treatment outcome of short- and long-term appliance therapy in patients with TMD of myogenous origin and tension-type headache

The aim was to compare the short- and long-term effect of a stabilization appliance with a control appliance in myofascial pain patients suffering from episodic or chronic tension-type headache. Sixty patients (mean age 29 +/- 12 years) with temporomandibular disorders (TMD) of myogenous origin and headache were studied in this prospective controlled study. Seventy-seven per cent of the patients reported episodic and 23% chronic tension-type headache at the start of the study. The 60 patients were randomly assigned to a treatment group (stabilization appliance) or to a control group (control appliance). The patients were interviewed regarding symptoms of headache and myofascial pain and clinically examined for masticatory muscle tenderness. At the 10-week and the 6- and 12-month evaluations of appliance therapy, the treatment outcome of tension-type headache was studied. At the 10-week evaluation, 17 patients dropped-out from the control group by requesting another appliance and receiving a stabilization appliance. Another patient in the control group dropped out later during the trial. In an intent-to-treat analysis, significant differences in improvement of headache between treatment and control groups were found at the follow-ups. A 30% reduction of muscles tender to palpation correlated significantly to improvement of headache at all follow-ups. The stabilization appliance seems to have a positive effect on tension-type headache, both in a short- and in a long-term perspective in patients with TMD with pain of myogenous origin

Treatment Outcome of Appliance Therapy in Temporomandibular Disorder Patients with Myofascial Pain after 6 and 12 Months

Aim: To compare the long-term effect of treatment with a stabilization appliance (group T) and treatment with a control appliance (group C) in temporomandibular disorder (TMD) patents with myofascial pain. Methods: In this controlled trial, 60 patients (mean age 29 years) with myofascial pain were evaluated after 10 weeks of treatment with either a stabilization appliance or a control appliance. All 60 patients were then assigned to 1 of 3 groups according to demand for treatment. Seventeen patients from group C requested another appliance and were given a stabilization appliance, thus creating a mixed group (group M). Results: A significant difference was found between groups T and C. at the 6- and 12-months follow-ups, a significant reduction in myofascial pain, as measured on a visual analogue scale, was found in all three groups. A significant decrease in frequency and intensity of myofascial pain was found in group T at the follow-ups. A significant decrease in number of tender sites on the masticatory muscles was found in group T at the follow-ups. Conclusion: The results support the conclusion that the positive treatment outcome obtained by use of a stabilization appliance to alleviate the signs and symptoms in patients with myofascial pain persisted after 6 and 12 months. Most patients in groups T and M reported positive changes in overall subjective symptoms in this trial. We therefore recommend user of the stabilization appliance in the treatment of TMD patients with myofascial pain

Observations over eight years of TMD; after initially appliance therapy

Aim. Long-term follow-up studies of patients treated for temporomandibular disorders (TMD) pain are sparse in the literature. The aim of this study was to evaluate after 8 years the treatment outcome of patients with temporomandibular joint (TMJ) pain and/or myofascial pain. Materials and Methods. 120 patients were initially randomly assigned to two treatment modalities: an occlusal appliance or a control appliance. A questionnaire was sent to 118 eligible patients after 8 years. Ninety patients (76%) returned the questionnaire. Outcome measures were assessment of pain intensity, frequency of pain, physical and emotional functioning, overall improvement of pain and headache. Results. At follow-up the worst pain had decreased by 30% in 64 out of 90 patients. Also pain frequency decreased significantly. A better physical functioning was reported by a majority of all patients, 57/90. 50 out of 90 patients had a moderate to severe depression, while the value for non-specific physical symptoms was 61 patients out of 90. 68 patients (76%) reported overall improvement of their TMD pain. 61 patients felt that their headache had overall improved. As far as treatment modality, 57 patients had received another treatment in addition to the initial appliance, most often another occlusal appliance. Conclusion. Eight years after appliance therapy a majority of patients reported an improvement of their TMD pain and headache

A 6- and 12-month follow-up of appliance therapy in TMD patients : a follow-up of a controlled trial

PURPOSE: This study compared the long-term effects of treatment with a stabilization appliance and treatment with a control appliance in patients with temporomandibular disorders (TMD). MATERIALS AND METHODS: In a controlled trial, 60 TMD patients with tem-poromandibular joint (TMJ) pain were evaluated after 10 weeks of treatment with either a stabilization appliance or a control appliance. At the 10-week follow-up, the 60 patients were assigned to one of three groups according to their demand for treatment. Group T, the treatment group, comprised 30 patients treated with a stabilization appliance; group C, the control group, comprised nine patients treated with a control appliance; and group M, the mixed treatment group, comprised 21 patients treated with first a control appliance and then a stabilization appliance. Signs and symptoms were evaluated in all three groups at 6- and 12-month follow-ups. RESULTS: At the 6- and 12-month follow-ups, a significant reduction in TMJ pain as measured on a visual analogue scale was found in all three groups, and a significant decrease in signs and symptoms was found in groups T and M. CONCLUSION: After 6 and 12 months of use, the stabilization appli-ance was found to still be effective in the alleviation of signs and symptoms in patients with TMD. Many patients in group C changed to a stabilization appliance at the 1 0-week follow-up, which significantly reduced the number of patients in this group. Most patients reported positive change in overall subjective symptoms in this trial. The stabilization appliance can therefore be recommended for patients with TMD

TMD-pain among adults in the county of Scania, Sweden

Objectives: This study evaluates the prevalence of TMD-pain in adults in the county of Scania, in the south of Sweden. Methods: A questionnaire was in 2006 mailed to a randomized selected sample of 10 000 individuals in the county of Scania. If the individuals answered yes to one or both of following questions, the subject was classified as having TMD-pain (1) “ Do you have pain in your temples, face, jaw joint or jaws once a week or more?” and (2) “Do you have pain when you open your mouth wide or chew once a week or more?”. The questions have previously shown high validity and reliability for TMD-pain among adolescents. Results: 6123 individuals answered the questionnaire. 1210 individuals (20.4 %) reported TMD-pain. Mean age was 47 years, with a female-male ratio of 7:5. A higher prevalence of TMD-pain was found for the ages 20-59 with the highest figure for the ages between 20 and 29 years. TMD-pain was reported by 19–21 % of individuals born in Sweden or another Nordic country compared to 32 % of the individuals not born in the Nordic countries. Length of education was not related to TMD-pain. A higher prevalence of reported TMD-pain was found for individuals being unemployed, retired or were on sick leave compared to other occupations. Among individuals living with a partner, 19% reported TMD-pain compared to 23% among those living alone and 27% with another family situation. Conclusion: The study found a high prevalence (20.4 %) of TMD-pain among adults in the county of Scania. Highest prevalence (32%) was found among adults not born in a Nordic country

Achieved Competencies and Satisfaction in Temporomandibular Disorders and Orofacial Pain Education

AIMS: To assess dental students' achieved competencies and perceived satisfaction with their temporomandibular disorders (TMD) and orofacial pain education and to compare these with the results of their final examination in TMD and orofacial pain.METHODS: Dental students from two consecutive classes (2011/2012 and 2012/2013) at the Department of Orofacial Pain and Jaw Function at the dental school in Malmö, Sweden completed two self-evaluations, one at the beginning of semester seven and one at the end of semester eight. The questionnaire that they were given concerned achieved competencies and satisfaction with education in TMD and orofacial pain. Items focused on anatomy, physiology, and clinical training. Students estimated their competence and satisfaction on a numeric rating scale and described their idea of treating TMD and orofacial pain patients on a verbal rating scale. Outcome variables were tested with paired samples t test for differences over time and independent samples t test for between-class comparisons; both were adjusted for multiple testing with Bonferroni correction.RESULTS: Significant improvement in all items was observed for achieved competencies and satisfaction in both classes between semester seven and semester eight (P .05).CONCLUSION: This study has shown that expansion in undergraduate TMD and orofacial pain education at the dental school in Malmö has allowed all students to develop the same level of competence, independent of prior experience. The study also pointed out that continuous evaluation and enhancement of TMD and orofacial pain education in undergraduate dental education is beneficia