Orofacial pain

Cusp is an elevation or a mound on the crown portion of the tooth making up a divisional part of the occlusal surface. The occlusal surface of posterior teeth consists of varying number of cusps, which are specific to each tooth. Supernumerary or accessory cusps are the extra number of cusps that occur on the surface of the tooth. These cusps can occur on the posterior teeth, thereby increasing the number of cusps. They can also occur on the anterior teeth as cusp-like structures where cusps are usually not present (for example: talon cusp). Accessory cusps which occur as dental anomalies, such as dens evaginatus are mentioned in the dental literature. Apart from this, the dental anthropology literature also mentions of a number of accessory cusps considered as normal anatomical variants, such as protostylid, parastyle, and so on. Many of these anatomical variants occur as traits in certain racial populations. For the better understanding of the terminologies of these anatomical variants, it is essential to know the different nomenclatures and the various theories proposed to explain the origin of multicusp teeth. This article is therefore aimed at providing the reader an overview of the various dental cusp nomenclatures, theories proposed to explain the origin of multicusp teeth and the supernumerary cusps and cusp-like structures.

Either your web browser doesn't support Javascript or it is currently turned off. In the latter case, please turn on Javascript support in your web browser and reload this page. ... Short-term effects of dry needling of active myofascial trigger points in the masseter muscle in ...

Today more than hundred years have passed since Dr Edward angle placed his first archwire into a patient's mouth and orthodontics began. It was during that period many innovations did occur that have been explained in terms of art. As time passed scientifically based orthodontics evolved and we see from that time much new innovation in material science have sum uped with new treatment approach and modalities. However, when we turn around and see the developments and innovations in the material science, we stand with pride: but the urge to make treatment still more comfortable and less time consuming, have led us to the introduction of a plethora of new orthodontic materials and products that represent significant improvement over their predecessors. This article compiles all archwire from angle era till recent available newer archwire.

Dental caries is one of the most prevalent chronic diseases of humans worldwide. When different stages of the disease are taken into account, from the initial to the clinically manifesting lesion, very few individuals are truly unaffected. Quantitative light-induced fluorescence (QLF) is a prominent diagnostic technique in dentistry. The purpose of this article is to review the effectiveness of QLF system in early detection of carious lesions as well as its future clinical application in dentistry. The review article has been prepared doing a literature review from the world wide web and PubMed/medline.

To analyze the reliability, validity, and clinical utility of the depression, non-specific physical symptoms, and graded chronic pain scales comprising the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis II. Data resulting from independent longitudinal and cross-sectional epidemiological studies as well as randomized clinical trials conducted at the University of Washington and the University at Buffalo were submitted to descriptive, correlational, and inferential statistical analyses to evaluate selected psychometric properties of the RDC/TMD Axis II scales. Analyses of available data from both TMD clinical centers revealed good to excellent reliability, validity, and clinical utility for the Axis II measures of depression, somatization, and graded chronic pain. Specifically, data were presented comparing the RDC/TMD depression scale to the Beck Depression Inventory and the Center for Epidemiologic Studies Depression Scale; these data supported concurren...

There are different types of treatment for head and neck cancer, including: surgery, chemotherapy and radiotherapy. Their use alone or combined can lead to sequelae in the temporomandibular joint, resulting in limited mouth opening. However, there are few studies have been published that evaluated exercise therapy in oncology related trismus, and no standard of care exits. The objective of this study was to verify the influence of a 7-week structured orofacial myofunctional exercise program on increasing the mouth opening in head and neck cancer patients with trismus. The sample consisted of 17 patients aged between 45 and 77 years, 15 men and 2 women with mouth opening less than 40 mm. Postoperative radiotherapy was performed as an adjuvant treatment in all patients in the sample, with the median dose 65Gy. After 7 weeks, the initial mouth opening average went from 25.37 mm to 33.76 mm, demonstrating that these exercises contributed to the treatment of temporomandibular disorders and stomatognathic functions in this group of head and neck cancer patients.

Background: Dental caries remain the main oral disease with greatest socioeconomic impact that correlates with lifestyle specifically dietary patterns and oral hygiene practices. Being a cumulative process, the numbers of individuals affected increase with age. This study aimed at determining the occurrence of dental caries among adult patients attending a public regional hospital.

Craniofacial pain is a term that encompasses pain in the head, face, and related structures. Multiple etiologies and factors may be related to craniofacial pain; however, the association between the cervical spine and its related structures and craniofacial pain is still a topic of debate. The objective of this critical review was to present and analyze the evidence of the associations between the cervical spine, stomatognathic system, and craniofacial pain. A search of the databases Medline, PubMed, Embase, Web of Sciences, Cochrane Library, Cinahl, and HealthStar was conducted for all publications related to the topic in the English and Spanish languages. Relevant information was also derived from reference lists of the retrieved publications. The key words used in the search were cervical spine, cervical vertebrae, neck pain, neck injuries, neck muscles, craniofacial pain, orofacial pain, facial pain, temporomandibular joint pain, and temporomandibular joint disorders. The search...

SUMMARY Oro-facial pain research has during the last decades provided important novel insights into the basic underlying mechanisms, the need for standardised diagnostic procedures and classification systems, and multiple treatment options for successful rehabilitation of the patient in pain. Notwithstanding the significant progress in our knowledge spanning from molecules to chair, there may also be limitations in our ability to integrate and interpret the tremendous amount of new data and information, in particular in terms of the clinical implications and overriding conceptual models for oro-facial pain. The aim of the present narrative review is to briefly summarise some of the current thoughts on oro-facial pain mechanisms and recent attempts to identify biomarkers and risk factors leading to the proposal of a new risk assessment diagram for oro-facial pain (RADOP) and a provocative new concept based on stochastic variation between multiple risk factors. Finally, the implications for novel management strategies will briefly be discussed.

In this study, relevant cases were retrospectively
reviewed to identify patients who were
diagnosed as suffering from myofascial pain only
according to the research diagnostic criteria ⁄ temporomandibular
disorders (RDC ⁄TMD) criteria, in
order to examine whether or not they could fulfil
the American Academy of Orofacial Pain (AAOP)
diagnostic criteria for TMD-related masticatory
muscle disorders.

To investigate cerebral cortical changes by using functional magnetic resonance imaging (fMRI) after denture renewal and to test how these relate to prosthodontic treatment adaptability as measured by chewing efficiency and maximum bite force. Ten complete denture wearers (five women and five men, mean age ± standard deviation: 70.3 ± 9.1 years) participated in the study. Each had their complete dentures renewed and underwent an fMRI examination with three functional tasks (lip pursing; jaw tapping; jaw clenching) as well as a color-mixing test for chewing efficiency and unilateral maximum bite force measurements. Recordings were performed with the old dentures (T0) and with the new dentures on insertion (T1) and at 1 week (T2) and 3 months postinsertion (T3). At T1, denture stability and retention (S/T) were assessed by two independent operators. Wilcoxon signed rank tests and Spearman's rho correlation were carried out for data analysis. The right and the left precentral gyrus...

Objectives. The objective of this study was to determine the prevalence of temporomandibular disorders (TMD) and evaluate psychosocial domains in patients with fibromyalgia (FM) compared with patients with failed back syndrome (FBS). Study design. The study included 51 (32 FM and 19 FBS) adult patients who were administered orofacial pain and psychological questionnaires before a clinical examination. Presence of TMD was diagnosed according to the Research Diagnostic Criteria for TMD. Results. Fifty-three percent of the FM patients reported having face pain compared with 11% of the FBS patients. Of those FM patients who reported face pain, 71% fulfilled the criteria for a diagnosable TMD. FM patients had significantly higher subscale scores for somatization, obsessive-compulsive, medication used for sleep, and fatigue compared with FBS patients. Eighty-seven percent of the FM patients reported a stressful event and 42.3% had symptoms indicating posttraumatic stress disorder. Conclusion. The high prevalence of TMD and psychosocial dysfunction among FM patients suggests wide-reaching dysregulation of autonomic and hypothalamic-pituitary-adrenal axis functions.

Objectives. The objective of this study was to determine the prevalence of temporomandibular disorders (TMD) and evaluate psychosocial domains in patients with fibromyalgia (FM) compared with patients with failed back syndrome (FBS). Study design. The study included 51 (32 FM and 19 FBS) adult patients who were administered orofacial pain and psychological questionnaires before a clinical examination. Presence of TMD was diagnosed according to the Research Diagnostic Criteria for TMD. Results. Fifty-three percent of the FM patients reported having face pain compared with 11% of the FBS patients. Of those FM patients who reported face pain, 71% fulfilled the criteria for a diagnosable TMD. FM patients had significantly higher subscale scores for somatization, obsessive-compulsive, medication used for sleep, and fatigue compared with FBS patients. Eighty-seven percent of the FM patients reported a stressful event and 42.3% had symptoms indicating posttraumatic stress disorder. Conclusion. The high prevalence of TMD and psychosocial dysfunction among FM patients suggests wide-reaching dysregulation of autonomic and hypothalamic-pituitary-adrenal axis functions.

Aims: To assess the prevalence of temporomandibular joint (TMJ) bony changes in cone beam computed tomography (CBCT) images of adult subjects without ongoing orofacial pain or complaints from the TMJ. Methods: The study included 84 TMJs from 28 men and 14 women (mean age [± SD]: 51 ± 11 years) without orofacial pain or TMJ complaints who were participants in a study of patients with obstructive sleep apnea. They were examined before any treatment with the Research Diagnostic Criteria for Temporomandibular Disorders and with CBCT (NewTom VGi; 15 × 15 cm, exposure time 18 seconds, axial thickness 0.3 mm). Osseous TMJ deviations were assessed blindly and classified. Results: Degenerative changes were noted in the CBCT images of 33 (39.3%) of the TMJs, of which 21 were classified as osteoarthritic alterations and 12 as indeterminate changes of osteoarthritis. Two TMJs were clinically classified as osteoarthrosis and 6 as disc displacement with reduction. The CBCT images of the 2 TMJs with a clinical diagnosis of osteoarthrosis showed also bony changes, but the CBCT images also revealed osteoarthritic bony changes in the 18 TMJs without any clinical diagnosis. Conclusion: CBCT images of asymptomatic adult TMJs commonly show degenerative bony alterations. Accordingly, such radiographic findings should be used with care and only as a supplement to clinical assessment.

Tonsilloliths are rare calcified structures that usually result from chronic inflammation of the tonsils.
Concretions show differences in size, shape and colour. They are usually asymptomatic but can be associated
with halitosis, foreign body sensation, dysphagia and odynophagia, otalgia, and neck pain. A patient
was referred because panoramic radiography performed by a general dentist revealed radiopaque shadows
over the ascending rami of the mandible, located bilaterally: a solitary structure on the higher portion of
the right side and two small structures on the left side. Paroxysmal attacks of orofacial pain and symptoms
such as dysphagia and swallowing pain on the left side distributed within the tonsillar fossa and pharynx
and the angle of the lower jaw were present. The computed tomography images revealed bilateral tonsilloliths.
Clinically, there was no sign of inflammation, and the patient’s past history revealed an
approximately 2-year history of dysphagia, swallowing pain and left-sided neck pain. At the request of the
patient, no surgical intervention was carried out. Glossopharyngeal neuralgia is a rare entity, and the aim of
this report was to indicate the importance of tonsilloliths as a cause of orofacial pain.

Patients referred from an otorhinolaryngologist with a chief complaint of earache or other ear symptoms are common in a temporomandibular disorders (TMD) clinic. These patients often complain of other symptoms, such as headache, facial pain, and limited mouth opening, all of which can be present in a patient suffering from a nasopharyngeal carcinoma (NPC). The aim of this case report was to describe the signs and symptoms of NPC and discuss possible causes for the misdiagnosis of NPC as TMD. The characteristics of 8 NPC patients reported in the literature whose cancer was initially misdiagnosed as TMD and those of an NPC patient with TMD-like symptoms treated at the clinic of 1 of the authors are described, and the reasons for misdiagnosis are discussed. A revision of Trotter's syndrome for the differential diagnosis of TMD is proposed. There is a need for detailed exclusion criteria to be applied prior to the assignment of a clinical diagnosis based on the Research Diagnostic Criteria for TMD.

To prospectively evaluate the effectiveness of a treatment regimen comprising counseling and physical therapy in patients with myofascial pain of the masticatory system, and to explore whether the duration of the physical therapy offered (4 vs 6 weeks) would influence the treatment result. Twenty-six patients were randomly distributed over 2 groups. All patients received reassuring information, advice regarding relaxation of the jaws, avoiding parafunctions, and limited use of the jaws. In addition, a physical therapy program (heat application, massage, ultrasound and muscle stretching) was initiated 2 weeks after the start of the study (group I, receiving 4 weeks of physical therapy) or immediately from the start of the study (group II, receiving 6 weeks of physical therapy). The following parameters were taken at baseline, 2, 4, and 6 weeks: visual analog scale (VAS) scores of present pain; lowest and highest pain over the past period; percentage of pain relief; jaw function asses...

Aims: To test the hypothesis that the ovarian cycle influences the pressure-pain threshold of the masticatory muscles. Methods: Eighteen healthy women with a regular menstrual cycle (28 ± 2 days), ranging in age from 18 to 35 years, participated in tbe study. For each subject, pressure-pain thresholds (PPTs) of the masseter and temporalis muscles were assessed at 4 muscular sites by means of an electronic algometer. Measurements were taken at 4 separate sessions across the menstrual cycle corresponding to the following phases: menstrua!, foliicuiar, periovulatory, and luteal. Menstrual cycle phases were determined by a pelvic ultrasonographic screening. The study was carried out in a single-blind design, and the initial session was randomly determined for each individual. Data collected were analyzed by repeated-measures analysis of variance. Results: Tbe findings suggest tbat the PPTs of several masticatory muscles (2 of 4) are influenced by tbe ovarian cycle, but to a minor extent (T < 0.05), and tbe influence is of limited clinical relevance. Conclusion: ¡n healthy subjects, there is a link between mechanical sensitivity of the masticatory muscles and fluctuation of the ovarian hormones. The reiationsbip between PPTs of the masticatory muscles and the ovarian cycle sbould be also investigated in patients witb temporomandibular disorders and/or orofacial pain conditions. J OROFAC PAIN 2000a4:105-l n.

To test the hypothesis that jaw muscles and specific neck muscles, ie, levator scapulae, trapezius, sternocleidomastoideus, and sple nius capitis, co-contract at the different submaximum bite forces usually generated during jaw clenching and tooth grinding, and for different bite force directions. Methods: Bite-force transducers that measured all three spatial force components were incorporated in 11 healthy subjects. The test persons developed feedback-controlled submaximum bite forces in a variety of bite-force directions. The electromyographic (EMG) activity of the levator scapulae, splenius capitis, and trapezius muscles was recorded, at the level of the fifth cervical vertebra, by use of intramuscular wire electrodes. The activity of the sternocleidomastoideus and masseter muscles was recorded by surface electrodes. For normalization of the EMG data, maximum-effort tasks of the neck muscles were conducted in eight different loading directions by means of a special force-transducer system. Differences between neck-muscle activity during chewing, maximum biting in intercuspation, and the force-controlled motor tasks were compared with the baseline activity of the various muscles by one-way repeated-measures analysis of variance. Results: The results confirmed the hypothesis. Co-contractions of the neck muscles in the range of 3% to 10% of maximum voluntary contraction were observed. Significant (P < .05) activity differences were recorded as a result of the different force levels and force directions exerted by the jaw muscles. Long-lasting action potential trains of single motor units triggered by jaw clenching tasks were also detected. Conclusion: The findings support the assumption of a relationship between jaw clenching and the neck muscle activity investigated. The low level of co-contraction activity, however, requires further study to elucidate possible pathophysiological interactions at the level of single motor units.

To investigate the effectiveness of single and concomitant treatment of migraine and temporomandibular disorders (TMD) in women with the comorbidity. Eligible female patients met International Classification of Headache Disorders, second edition (ICHD-2) criteria for migraine with or without aura and the Research Diagnostic Criteria for myofascial TMD (Grade ll or lll). After a run-in period (30 days), women with both migraine and TMD were enrolled into a four-arm, double-blind, placebo-controlled, factorial study testing the separate and joint effects of a migraine treatment (propranolol 90 mg) and a TMD treatment (stabilization splint [SS]) in four groups of patients. The four treatment groups were propranolol and SS (n = 22); propranolol placebo and SS (n = 23); propranolol and non-occlusal splint (NOS) (n = 23); and propranolol placebo and NOS (n = 21). The primary endpoint for migraine was change in headache days from baseline to the third month, and the secondary endpoint was ...

Objectives: Epidemiological surveys indicate high comorbidity of masticatory-muscle and neck-muscle pain. It is hypothesized that close functional coupling between both muscle groups may be involved in the etiology of myofascial pain conditions. So far, however, interactions between pathophysiological loading of the masticatory system and the adjacent neck muscles, in particular caused by bruxism, lack the confirmation of neuromuscular coupling of both segments at submaximum bite forces. The objective of this study was to test the hypothesis that jaw and neck muscles co-contract during clenching of the masticatory system. Methods: Bite force transducers which measured all three spatial force components were incorporated in 11 healthy subjects. The test persons developed different feedback-controlled submaximum bite forces in a variety of bite-force directions. The corresponding electrical activity (EMG) of the levator scapulae, splenius capitis, and trapezius muscles was recorded by...

To test the hypothesis that the effects of an experimental occlusal interference differ between individuals reporting a high or low frequency of wake-time oral parafunctions. Methods: Study participants reporting very high (HFP group; n = 10) or very low (LFP group; n = 10) levels of oral parafunctions were selected by means of a questionnaire administered to 200 medical students. The selected participants wore an experimental occlusal interference in a single-blind longitudinal study, which comprised different occlusal conditions: interference free (IFC) and active occlusal interference (AIC). Assessments included clinical examination, measurements of nonfunctional tooth contacts, state and trait anxiety, and visual analog scale scores for occlusal discomfort, masticatory muscle pain, and headache. Data were analyzed by repeated measures twoway analysis of variance on ranked data, followed by calculation of within-and between-group differences using Friedman tests and Mann-Whitney tests, respectively. Results: During AIC, the frequency of nonfunctional tooth contacts significantly decreased in both groups (median [interquartile range, IQR]: in HFP from 55.3% [60.0%] to 31.1% [33.5%], P = .03; in LFP from 31.8% [32.4%] to 14.0% [22.8%], P < .01)

Laser is an acronym for light amplification by stimulated emission of radiation. The use of laser in dentistry dates way back to 1960s. Since then, its use has increased manyfold. The dental lasers cut tissue by a principle known as photothermal interaction or photothermal ablation. Lasers are effectively used in operculectomies, gingival depigmentation, gingivectomies, and many more procedures. Laser cannot only be used for surgical procedures but can also be used as an adjunct to scaling and root planing. The diode laser is used on the soft tissue side of the periodontal pocket to remove the inflamed soft tissue and reduce the pathogens. Lasers have been suggested as an adjunct and/or alternative to conventional techniques for various periodontal procedures and considered superior with respect to easy ablation, decontamination, and hemostasis along with less operative and postoperative pain.

To evaluate both cosmetic and functional effects of temporalis muscle atrophy, by means of clinical examination, magnetic resonance imaging (MRI), and electromyographic (EMG) activity in patients who underwent craniotomy in order to treat refractory mesial temporal lobe epilepsy (MTLE). A total of 18 controls and 18 patients who underwent surgery for MTLE were investigated. The temporalis muscle volume of the patients was assessed by a 3D reconstruction. The image analysis software (ITK-SNAP) was used for the 3D reconstruction. In addition, the amplitude of the EMG signal during a maximum voluntary clench was recorded from both temporalis muscles by surface electrodes. The presence of temporomandibular disorder (TMD) signs was assessed by clinical examination that was performed only after surgery. Data were analyzed statistically by means of the Mann-Whitney U test, paired t-test, Pearson χ² and linear regression. The volume of the temporalis muscle of the operated side was signific...

To assess Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis II variables in an initial psychosocial screening and as a part of biopsychosocial subtyping of Finnish referral patients with TMD pain for adjunct multidisciplinary assessment. Consecutive Finnish referral patients with TMD pain (n = 135) participated in this questionnaire-based survey. Psychosocial screening was based on Graded Chronic Pain Scale (GCPS) and culturally adjusted Symptom Checklist 90-revised (SCL-90R) depression scale scores and subtyping on GCPS pain-related interference in accordance with previous treatment tailoring studies. Biopsychosocial subtyping variables included symptoms of depression and somatization, general health, pain-related worry, sleep dysfunction, and coping ability. Subtype comparisons were analyzed with Bonferroni adjusted P values and multivariable logistic regression (SAS 9.3). Based on psychosocial screening, 44% of the patients were psychosocially uncompromi...

To identify associations between clinical symptoms of temporomandibular joint disorders and radiographic findings. Two hundred four adult patients (156 women, 48 men, mean age 40 years) with temporomandibular joint (TMJ) pain/sounds or changes in mandibular motion were examined according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Bilateral sagittal corrected TMJ tomograms in closed and open positions were assessed for the presence of flattening, erosion, osteophytes, and sclerosis in the joint components and the range of mandibular motion. Logistic regression analyses were performed with the radiographic findings as the dependent variables and the following clinical variables as independent variables: opening pattern, maximal jaw opening, TMJ sounds, number of painful muscle/TMJ sites, duration of pain, presence of arthritic disease, depression and somatization scores, graded chronic pain, and age and gender. Coarse crepitus on opening/closing (odds ratio [OR] &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 3.12), on lateral excursions (odds ratio &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 4.06), and on protrusion (OR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 5.30) was associated with increased risk of degenerative findings in tomograms. A clinical diagnosis of osteoarthritis increased the risk of radiographic findings (OR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 2.95) and so did increasing age (OR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 1.03 per year) and the female gender (OR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 2.36). Maximal assisted opening and maximal opening without pain (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 40 mm) was associated with a posterior condyle-to-articular tubercle position (OR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 2.60). No other significant associations were observed. Age, gender, and coarse crepitus, but no pain-related variables, were associated with increased risk of degenerative findings in TMJ tomograms. Maximal opening &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 40 mm was associated with a posterior condyle-to-articular tubercle relation on opening.

To evaluate the quality of methods used in randomized controlled trials (RCTs) of treatments for management of pain and dysfunction associated with temporomandibular muscle and joint disorders (TMJD) and to discuss the implications for future RCTs. A systematic review was made of RCTs that were implemented from 1966 through March 2006, to evaluate six types of treatments for TMJD: orthopedic appliances, occlusal therapy, physical medicine modalities, pharmacologic therapy, cognitive-behavioral and psychological therapy, and temporomandibular joint surgery. A quality assessment of 210 published RCTs assessing the internal and external validity of these RCTs was conducted using the Consolidated Standards of Reporting Trials (CONSORT) criteria adapted to the methods of the studies. Independent assessments by raters demonstrated consistency with a mean intraclass correlation coefficient of 0.63 (95% confidence interval). The mean percent of criteria met was 58%, with only 10% of the RCT...

T he clinical opinion that the lateral pterygoid muscle (LP) is dysfunctional in patients with temporomandibular disorders (TMD) is still widely accepted. 1,2 Popular theories of LP disturbance include muscle hyperactivity, muscle hypoactivity, poor coordination between the 2 heads of the muscle, and/or a disturbance to the normal role of the muscle in the control or stabilization of the temporomandibular joint (TMJ). 1-10 These and other claims are largely unsubstantiated, although many TMD patients report that the region of the LP is frequently very tender. 11,12 Irrespective of whether this report is a valid measure of LP tenderness, this clinical sign, together with preconceived notions of LP dysfunction in TMD patients, has formed part of the basis for unproven irreversible therapies-such as occlusal grinding and restorative treatments-as well as reversible treatments with occlusal splints or jaw exercises. The occlusal splint, for example, is thought to reduce muscle activity, improve muscle coordination, reduce TMJ loading, and/or aid in TMJ stabilization

To identify associations between clinical symptoms of temporomandibular joint disorders and radiographic findings. Two hundred four adult patients (156 women, 48 men, mean age 40 years) with temporomandibular joint (TMJ) pain/sounds or changes in mandibular motion were examined according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Bilateral sagittal corrected TMJ tomograms in closed and open positions were assessed for the presence of flattening, erosion, osteophytes, and sclerosis in the joint components and the range of mandibular motion. Logistic regression analyses were performed with the radiographic findings as the dependent variables and the following clinical variables as independent variables: opening pattern, maximal jaw opening, TMJ sounds, number of painful muscle/TMJ sites, duration of pain, presence of arthritic disease, depression and somatization scores, graded chronic pain, and age and gender. Coarse crepitus on opening/closing (od...