Intracapsular TMJ Disorders: Diagnostic and Management Considerations

Temporomandibular disorders represents a large group of musculoskeletal conditions of the masticatory system. The two most common TM disorders are masticatory muscle pain doisorders and inracapsular pain disorders. This presentation will discuss the differential diagnosis and management of intracapsular pain disorders. Functional anatomy of the temporoandibular joint will be reviewed first. This will be followed by a description of the various alterations that can occur in the TMJ and their associated symptoms. Included in this review will be the proper indications and uses of occlusal appliances as determined by the research data collected over the last 20 years. Successful management of intracapsular pain disorders can only bean once the clinician appreciates the various types of conditions that can occur in the TMJ as well as the natural course of these conditions

Quality Difference in Craniofacial Pain of Cardiac vs. Dental Origin

Craniofacial pain, whether odontogenic or caused by cardiac ischemia, is commonly referred to the same locations, posing a diagnostic challenge. We hypothesized that the validity of pain characteristics would be high in assessment of differential diagnosis. Pain quality, intensity, and gender characteristics were assessed for referred craniofacial pain from dental (n = 359) vs. cardiac (n = 115) origin. The pain descriptors “pressure” and “burning” were statistically associated with pain from cardiac origin, while “throbbing” and “aching” indicated an odontogenic cause. No gender differences were found. These data should now be added to those craniofacial pain characteristics already known to point to acute cardiac disease rather than dental pathology, i.e., pain provocation/aggravation by physical activity, pain relief at rest, and bilateralism. To initiate prompt and appropriate treatment, dental and medical clinicians as well as the public should be alert to those clinical characteristics of craniofacial pain of cardiac origin

Anti-prion activity generated by a novel vaccine formulation

Chronic wasting disease (CWD) is a transmissible spongiform encephalopathy (TSE) of domestic and wild cervids in North America. To address possible prevention regimens for CWD, we have used a mouse model system and the Rocky Mountain Laboratory (RML) mouse-adapted scrapie prion strain to screen efficacy of potential vaccine candidates. Three peptides derived from the primary amino acid sequence of the prion protein were conjugated to blue carrier protein (BCP) and formulated in an adjuvant containing M. avium subsp. avium. CL57/BL6 mice were vaccinated and boosted with 50 µg of the carrier protein–peptide conjugate formulation; all vaccines produced a humoral immune response as measured by ELISA. Disease challenge with the RML scrapie prion strain revealed anti-prion activity was generated by the vaccine formulations as measured by a delay in clinical disease onset and prolonged survivorship

Ambulatory Electromyogram Activity in the Upper Trapezius Region: Patients With Muscle Pain vs. Pain-free Control Subjects

Study Design: This study compared the ambulatory electromyogram activity of persons reporting pain in the shoulder and cervical regions with an equal group of persons not reporting such pain. Ambulatory electromyogram data were obtained over 3-day periods. In addition, all participants completed several standard psychological questionnaires. Objectives: The results were analyzed with inferential statistics to determine whether subjects reporting significant pain in the shoulder and cervical regions had greater ambulatory electromyogram activity than an equal number of subjects not reporting pain. Summary of Background Data: Considerable controversy exists regarding the role of muscle activity in the etiology and maintenance of muscle pain disorders. Given the availability of ambulatory recording devices that can provide a detailed record of muscle activity over an extended period of time, the present research was conducted to determine whether persons reporting shoulder and cervical pain could be differentiated from a group of normal subjects. Methods: All subjects (N = 20) completed a battery of tests with standardized psychometric instruments and then were fitted with ambulatory electromyogram monitors to record electromyographic activity of the upper trapezius region of the dominant side; the time, duration, and amplitude of electromyogram activity greater than 2 μV was recorded. The monitors were worn during normal working hours (mean, 6.2 hours per day) over 3 consecutive days. In addition to wearing the monitors, all subjects completed hourly self-ratings of perceived muscle tension during the recording periods. Results: As expected, subjects with muscle pain reported significantly more pain (mean, 4.9) than did the normal control subjects (mean, 0.9), t(15) = 3.29, P \u3c 0.01. However, patients with muscle pain did not have greater average electromyogram activity (mean, 6.4 μV) over the 3-day period as compared to the normal controls (mean, 7.1 μV), t(18) = -0.25, P \u3c 0.80. Self-monitoring of perceived muscle tension also did not reveal differences between pain subjects and the normal control subjects (P \u3c 0.75). Conclusions: Ambulatory measurements of electromyogram activity did not differentiate persons reporting upper trapezius or cervical pain from those that did not report such pain. Persons reporting pain are also not distinguishable from normal control subjects on a variety of self-report measures. These results raise questions regarding the role of ambulatory electromyogram recordings in the evaluation and treatment of muscle pain disorders

Postural loads during walking after an imbalance of occlusion created with unilateral cotton rolls

<p>Abstract</p> <p>Background</p> <p>It was showed that stomatognathic functions correlate with alterations in locomotion, that are detectable through the analysis of loading during walking. For example, subjects with symptoms of Temporomandibular disorders (TMDs) showed a significant higher load pressure on the two feet, respect to health subjects, when cotton rolls were inserted. This previous study appeared to suggest that the alteration of postural loads associated to a particular alteration of stomatognathic condition (in this case, the cotton rolls inserted between the two dental arches) is detectable only in TMD's subjects, while it resulted not detectable in health subjects, because in that study, health subjects did not show any significant alteration of postural loads related to the different stomatognathic tested conditions. In other words, in that previous study, in the group of health subjects, no significant difference in postural loads was observed among the different test conditions; while TMD subjects showed a significant higher load pressure on the two feet when cotton rolls were inserted, respect to all the other tested conditions. Thus, the aim of this study was to better investigate these correlations in health subjects without TMD's symptoms, testing other different intra-oral conditions, and to verifywhether an experimentally induced imbalance of occlusion, obtained putting an unilateral cotton roll, could cause an alteration of postural loading on feet during walking.</p> <p>Findings</p> <p>In a sample of thirty Caucasian adult females (mean age 28.5 ± 4.5), asymptomatic for TMDs, when a cotton roll was positioned on the left or the right sides of dental arches, so causing a lateral shift of the mandible, the percentage of loading and the loading surface of the ipsi-lateral foot, left or right, were found to be significantly lower than in habitual occlusion (p < 0.05). Males were not included because of their different postural attitude respect to females. Further studies in a sample of males will be presented.</p> <p>Conclusions</p> <p>This study showed that in health subjects without TMD's symptoms, an experimentally induced imbalance of the occlusion, obtained through an unilateral cotton roll, is associated to detectable alterations in the distribution of loading on feet surface, during walking.</p

Differential diagnosis of temporomandibular disorders and other orofacial pain disorders

The focus of this article is on the differential diagnosis of pain disorders that typically fall outside the realm of dental diseases. There are a great variety of such conditionstoo many to review here. Therefore, this article discusses the differential diagnosis of a few of the more common orofacial pain conditions the dentist may face in a practice. These conditions are divided into two sections: temporomandibular disorders (TMD) and other common orofacial pain disorders. The first section reviews common TMD that are the responsibility of the dentist to identify and manage. The second section reviews some common orofacial pain disorders that the dentist needs to recognize but for which the dentist may not be the primary care provider. TMD TMD is a collective term that includes a number of clinical complaints involving the muscles of mastication, the temporomandibular joint (TMJ), or associated orofacial structures. 1 TMD are a major cause of nondental pain in the orofacial region and are considered a subclassification of musculoskeletal disorders. In many TMD patients the most common complaint originates from the muscles of mastication rather than from the TMJ. Therefore, the terms TMJ dysfunction or TMJ disorder are inappropriate for many complaints arising from the masticatory structures. It i