Temporomandibular Joint Pain is Negatively Correlated to TNF Alpha and Osteoprotegrin Content in Synovial Fluid in Patients with Juvenile Idiopathic Arthritis.

Objective: Temporomandibular joint (TMJ) involvement occurs in up to 80% of children with juvenile idiopathic arthritis (JIA). Little is known with regard to the complexity of the protein profile in synovial fluid (SF) from JIA arthritis during growth as compared to both JIA and rheumatoid arthritis (RA) of adults. Design: Synovial fluid was collected from 54 joints/30 patients with TMJ arthritis (JIA 35 joints/20 patients, JIA adults 9 joints/5 patients, RA 10 joints/5 patients). Three cytokines and seven bone markers were quantified using Luminex multiplex assays and compared to demographic and clinical data of function and pain. Results: Pain (spontaneous and upon palpation) and duration of pain were all negatively correlated with the TMJ SF content of tumor necrosis factor (TNF)-α. The level of Adrenocorticotropic hormone (ACTH) was negatively correlated to TMJ pain upon palpation and post-treatment pain and function. The concentration of ACTH was significantly lower in SF in JIA (1.4 ± 2.8 pg/ml) compared to adults with JIA (4.7 ± 12.2 pg/ml) and significantly higher compared to adults with RA (0.8 ± 1.5 pg/ml). Osteoprotegerin (OPG) was negatively correlated to spontaneous pain. Conclusions: Our results indicate that the local concentrations of TNF-α, ACTH and OPG in TMJ fluid may not contribute to TMJ pain and tissue destruction in JIA/RA patients. © 2014 Olsen-Bergem H, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Temporomandibular pain and quality of life assessment in adolescents in a Norwegian cohort

Abstract Objective The objective was to examine the prevalence of pain from the face and temporomandibular joint (TMJ) and oral function in adolescents and contribute to more focus on this patient group. Methods A total of 957 adolescents were included in this study, in age cohorts 18, 16, and 14, scheduled for a dental recall examination. Clinical data were collected as a part of the routine clinical examination. All participants also answered a survey. Results Almost half of the participants had experienced facial pain in the last 3 months, headache being the most prevalent site reported. A significantly higher prevalence was found for females for all pain sites, and facial pain was significantly higher among the oldest. A reduced maximal incisal opening was significantly associated with higher reported facial/jaw pain, with increased mouth opening pain and chewing pain. Fifty‐seven percent of the participants reported the use of nonprescription painkillers, highest among females, and in the oldest age cohort, mainly caused by nonfeverish headaches. General health was found to be negatively correlated to facial pain, headache, pain intensity, and duration, pain upon oral function, and oral movement, as well as the use of nonprescriptive drugs. Females in the older age group, experience less quality of life in general, as they felt more worried, anxious, lonely, and sad, compared to males. Conclusion Facial‐ and TMJ pain was higher in females, and higher with increasing age. Almost half of the participants had experienced facial pain in the last 3 months, headache being the most prevalent site reported. General health was found to be negatively correlated to facial pain

Self-exercise programmes and occlusal splints in the treatment of TMD-related myalgia – Evidence-based medicine?

Background The low‐cost and reversible treatments concerning disorders of the masticatory muscles represent a vast array of regimens. Common treatments include information, stretching exercises, manual therapy, acrylic splints and cognitive behavioural therapy. Objective The aim of this study was to evaluate the evidence behind the use of self‐exercising programmes and occlusal splints in the treatment of myofascial pain. Methods We conducted a thorough search of five databases, using four cardinal search terms in combination with twelve supporting terms. We also assessed the evidence quality, using GRADEpro software. Results The search resulted in 4967 individual studies. 18 studies met the inclusion criteria and were re‐evaluated. Conclusion The selected studies were in favour of a self‐care or an occlusal splint treatment of myalgia. However, a GRADE assessment showed that 14 of the 18 selected studies had low or very low evidence quality. Studies also showed weaknesses with regard to nomenclature and reproducibility. Hence, it is our professional opinion that the evidence level for prescribing self‐exercises and occlusal splints in the treatment of myalgia is low

Is it possible to contaminate the temporomandibular joint by arthrocentesis?

Introduction: Bacterial contamination of the temporomandibular joint (TMJ) by needle penetration of the skin has previously been discussed as a contributing factor in joint arthritis. The purpose of this study was to investigate the presence of bacterial deoxyribonucleic acid (DNA) in synovial fluid, and to detect any possible iatrogenic contamination during arthrocentesis of the TMJ in patients with juvenile idiopathic arthritis and rheumatoid arthritis. Method: Synovial fluid (SF) and skin swab samples (before and after disinfection) were collected from 54 TMJs in 30 patients with TMJ arthritis. Bacterial detection and classification was performed using 16S rRNA pyrosequencing. Results: Bacterial DNA was detected in 31 joints (57%) in 19 patients (63%). In six 12 joints (20%) in six patients specific bacterial species were detected in both skin samples and in the TMJ, indicating a possible contamination. 22 different bacterial species were detected in synovial fluid from these six patients. Conclusion: Bacterial DNA in TMJ SF with contamination was detected in 20% of the patients. Studies are needed to evaluate the consequences of potential contamination with bacterial DNA in SF with regard to arthrocentesis and treatment of TMJ arthritis