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In order to discover the prevalence of signs and symptoms of temporomandibular disorders (TMD) in Japan, and the difference in the prevalence among various sex and age groups in the Japanese population, 672 individuals (304 males and 368 females, age range 20-92 years) were selected randomly in Okayama City, Japan, and were investigated by means of questionnaires and clinical examinations. The reported frequency of symptoms was: TMJ sounds 24%, facial-TMJ-jaw pain 11%, headache 27%, teeth clenching 30%, and grinding 34%. The percent frequency of the following signs was: impaired mouth opening 5%, clicking 46%, reciprocal clicking 20%, crepitus 19%, TMJ tenderness 6%, and masticatory muscle tenderness 21%. The subjects with TMJ clicking were more frequently females than males. TMD signs and symptoms were found to be common in all age groups, but they were fewer in the older than in the younger age group. The younger-aged subjects with clicking appeared with significant frequency, whereas crepitus was populated with significant frequency by the oldest age group.
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PMID:Temporomandibular disorders in the adult population of Okayama City, Japan. 894 71

This study examines the development of signs and symptoms of craniomandibular disorders (CMD), and some effects of orthodontic treatment from the age of 12-19 years of age. The data is drawn from a special sample of adolescents recruited at 11 years of age by random stratified sampling to contain a high prevalence of malocclusions of particular orthodontic interest. The sample does not reflect malocclusion in a normal population. The prevalence of frequent headache and TMJ disorders shows a major increase from 12 to 15 years of age. From 15 to 19 years of age, there is some increase in the prevalence of TMJ disorders in girls, but altogether the prevalence of signs and symptoms of CMD is much more stable. When the data from subjects who received orthodontic treatment were compared with data from subjects who had not received orthodontic treatment, only small differences were found.
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PMID:A survey of craniomandibular disorders in 500 19-year-olds. 907 Oct 46

The dental profession is not static, but dynamic. New research findings, along with medical and technological advances, necessitate constant re-examination of treatment philosophies and techniques. What were acceptable treatment techniques in the past may not necessarily be the most effective and best techniques for our patients today. Currently, many practitioners feel that the only treatment for the correction of a skeletal Class III abnormality is via orthognathic surgery in older patients. In some cases it may be the only treatment option. But in most cases today, there are more conservative, non-surgical treatment alternatives in correcting Class III problems in younger aged children. In treating facial-skeletal problems, it must be emphasized that the human face is a biological masterpiece of form and function. Its importance has been documented in arts and sciences since the beginning of modern civilization. It is important enough so that individuals who are blessed with attractive features are afforded greater opportunities in our society. Attractive faces are associated with intelligence, honesty and good work ethics. With the advent of orthognathic surgery, functional appliance, functional regulator, and myofunctional therapy, the dental profession has the capability of leveling out the playing field for many individuals in our society. It does so by being able to correct problems closely associated with the human psyche--the human face. The ability to change facial features brings tremendous prestige to our profession. Along with this prestige comes greater responsibility. Our ability to change facial features entails greater understanding of facial balance and harmony. Ricketts states that the face must conform to stringent proportions known as the "divine proportion" in order for it to be esthetically pleasing. Also, our ability to move facial-skeletal structures entails greater understanding of the biomechanics of the human face. Without this knowledge practitioners can cause iatrogenic problems, such as temporomandibular disorders. Conversely, correcting facial-skeletal abnormalities have been found to alleviate many medical problems, such as chronic headaches, neck-back-shoulder pain, respiratory disorders, auditory disorders, etc. As more and more information is gathered, it is becoming clear that the physical, emotional and psychological health of a human being is intimately related to craniomandibular anatomy. In fact, the jaw and dental structures (with the exception of the tooth enamel) is formed from the neural crest cells along with the endocrine system, while the central nervous system is formed from the neural tube. The entire nervous system, the endocrine system and the dental system are formed from common tissue origin. This can explain why many facial-skeletal corrections are often accompanied by alleviation of many medical and physiological problems. These are exciting times for our profession. However, if we wish to address the needs of our patients well into the next century, we must continue to seek greater and greater knowledge in the area of the craniomandibular anatomy relative to the rest of the human body. It has much to do with facial esthetics, physiologic and psychologic harmony, and TMJ health. This knowledge will enable our profession to have the power to change human lives in a very positive way. As doctors, there can be no greater personal and professional satisfaction than to realize that, through our professional intervention, we are able to offer our patients the possibility of achieving greater happiness and quality of life.
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PMID:Non-surgical alternative in the treatment of skeletal Class III problems. 952 Jul 15

One hundred and ninety-three patients with varying occlusal discrepancies were diagnosed as having TM disorders with orofacial pain. They were divided into five groups with similar clinical symptomatology. There were 84 patients with clicking, 45 with headaches, 13 with neckaches, 39 with tenderness in the TMJ bilaterally and masticatory muscles and 12 with uncomfortable occlusal relationships. All were given an anterior deprogrammer to wear for a period of one week in order to relax the masticatory muscles and allow the jaw to return to a physiologic position. The follow-up occlusal device therapy varied according to clinical symptoms. The group with clicking wore anterior repositioning orthopedic devices to recapture the displaced articular disc, followed by a gradual return to a centric relation position. The other groups wore centric relation appliances providing even posterior cusp tip contacts and anterior guidance. All patients wore the appliances for varying periods, up to one year, with monthly adjustments. The clinical symptoms significantly decreased, and all but 4 patients who had to be treated surgically, had the malocclusion corrected at the same treatment position of the centric relation appliances that were worn for one year. The results suggest that short-term occlusal device therapy is effective as an interim method towards the correction of occlusal discrepancies, but should be followed by a final treatment that will maintain the jaw in an asymptomatic and physiologic position. Four-year re-evaluations revealed no reoccurrence of chronic symptoms after finalization treatment.
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PMID:The effect of non-surgical management of TM disorders. 959 57

A prospective follow-up study was performed to examine the influence of contemporary orthognathic treatment on signs and symptoms of TMJ dysfunction. Sixty consecutive patients were examined once preoperatively and twice postoperatively, and Helkimo's Anamnestic and Dysfunction Indices (Ai and Di) were determined. The prevalence of headache was also assessed. The average follow-up was 4 years from the initial examination. A group of 20 patients with a similar type and grade of dentofacial deformity, who did not wish to have surgery or other occlusal therapy, served as a control group. The majority (73.3%) of the patients had signs and symptoms of TMJ dysfunction (TMD) in the initial phase. At final examination the prevalence of TMD had been reduced to 60% (P=0.013). There was a dramatic improvement in headache: initially 38 (63%) patients reported that they suffered from headache, but at the final visit only 15 (25%) did so. It is concluded that functional status can be significantly improved and pain levels reduced with orthognathic treatment. The risk for new TMD is extremely low. No association, however, could be shown between TMD and the specific type or magnitude of dentofacial deformity.
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PMID:Effects of orthognathic surgery on temporomandibular joint dysfunction. A controlled prospective 4-year follow-up study. 1097 79

Fibromyalgia is a chronic syndrome characterized by widespread pain, unrefreshed sleep, disturbed mood, and fatigue. Until such time as we have a clearer understanding of the trigger and/or pathophysiologic mechanisms producing these symptoms, pharmacologic treatment should be aimed at individual symptoms. Such treatment should ideally be offered as part of a multidisciplinary treatment program using both pharmacologic and nonpharmacologic treatment modalities. Critical components of any successful fibromyalgia treatment program include addressing physical fitness, work and other functional activities, and mental health, in addition to symptom-specific therapies. The main symptoms that should be addressed include pain, sleep disturbances including restless leg syndrome, mood disturbances, and fatigue. Pharmacologic therapy should also be considered for syndromes commonly associated with fibromyalgia including irritable bowel syndrome, interstitial cystitis, migraine headaches, temporomandibular joint dysfunction, dysequilibrium including neurally mediated hypotension, sicca syndrome, and growth hormone deficiency. This article provides general guidelines in initiating a successful pharmacologic treatment program for fibromyalgia.
Curr Pain Headache Rep 2001 Aug
PMID:Pharmacologic treatment of fibromyalgia. 1140 39

Headaches that have an explosive onset with exercise, including sexual activity, generally are benign in origin. A subarachnoid hemorrhage, a mass lesion in the brain, or an anomaly of the posterior fossa must be considered, however. The mechanisms that produce sexually induced or cough headaches of abrupt onset are unknown. It is known, however, that a rapid increase in intrathoracic pressure suddenly reduces right atrial pressure and presumably decreases venous sinus drainage from the brain. This situation results in a transient increase in intracranial pressure. Jaw pain that occurs with chewing often is considered to be TMJ dysfunction when arthritic in quality and if subluxations of the jaw can be shown on the physical examination. Giant cell arteritis and common or external carotid artery occlusive disease should be considered when the pain is ischemic in quality. An anginal equivalent is another possibility. Headaches that worsen with vigorous exercise are commonly migrainous. When their onset is apoplectic with exertion (particularly exertion against a closed glottis), the most likely diagnoses are increased intracranial pressure, a posterior fossa abnormality, or benign exertional headaches. Most cardiac induced headaches, but not all, are of a more gradual onset. If there are significant risk factors for coronary artery disease, an exercise stress test is appropriate. A therapeutic trial of nitroglycerin may help to establish a diagnosis if it improves the headache. Using antimigraine drugs as a diagnostic test is inappropriate because triptans and ergots are contraindicated in the presence of coronary artery disease, and a positive response is not diagnostic of migraine.
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PMID:A spectrum of exertional headaches. 1148 Feb 60

To describe three patients with recurrent severe paroxysmal headache precipitated by yawning. Pain elicited by yawning is a well-recognized clinical phenomenon in patients with cranial neuralgia, temporomandibular joint dysfunction syndrome and Eagle syndrome. Clinical history, neurological and oral examinations, brain magnetic resonance imaging (MRI), cranial nerve electrophysiological testing and skull X-rays are reported. In all the patients pain was induced by yawning; in the third patient pain was also triggered by eructation. None had history of migraine. Facial gestures and forceful opening of the mouth did not reproduce the pain. The first patient had retroauricular pain, simvastatin-induced myopathy and subclinical axonal peripheral neuropathy; the second patient had a post-viral benign sensory neuropathy; and the third had retroauricular and facial pain and no underlying neurological illness. Cranial nerve testing and MRI of the brain were normal except for a coincidentally found pituitary adenoma on the first patient. Headache or cranial pain with yawning may occur in patients with no apparent cause (primary yawning headache). It is a chronic, benign condition that requires no specific treatment but needs to be distinguished from secondary yawning headache, of greater clinical relevance.
Cephalalgia 2001 Jul
PMID:Primary yawning headache. 1153 3

So now it may be seen what is meant by the term "The MAS Difference". The American orthodontic specialty has for the most part been slow, or even in isolated pockets, willfully resistant to expansion of orthodontic technique up out of the "Procrustean bed" of fixed appliance limitations to the panorama of attacking the teeth-bone-muscle triangle of malocclusion with separate techniques and appliance systems designed specifically for each. What makes this anathema to those of a broader view is that it is only with those expanded, combined fixed AND functional techniques, that one has any chance at all of rendering anything close to significantly successful treatment of major TMJ-pain-headache-dysfunction chronic pain problems. And that is serious stuff. So, if you want to do "ortho" you had better know "TMJ". And, if you want to do "TMJ", at least TMJ to any meaningful degree, you had better know "ortho", and that means the discipline of functional orthodontics (or "maxillofacial orthopedics" if you will). The "why" of it is easily understandable once one truly understands the orthopedic (condylar displacement), myofunctional (Class II neuromuscular sling), and neurological (chronic repetitive compression nerve damage) aspects of the common functionally induced TMJ problem. The "how" of it all is another matter. That is why knowledge of a broad variety of various specific orthodontic techniques is required for the clinician because there are a vast variety of malocclusive situations with their own unique demands. But in the broadest sense, since a major portion of the orthodontic patient population suffers from somewhat of a skeletal Class II relationship, or "Class II effect" with respect to the joint, somewhere in the proposed treatment plan for these patients the clinician will have to consider some form of mandibular advancement series, whatever that series may be. But it is that MAS difference that sets that clinician and his or her specific treatment plan apart from the older, more restricted ways. It is a difference we must pay attention to, for Nature surely will.
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PMID:The MAS (mandibular advancement series) difference. 1188 74

The aim of this study was to evaluate the prevalence of temporomandibular disorders (TMD) in individuals before and after orthodontic treatment. The sample comprised 200 individuals divided into four groups according to the type of malocclusion (class I or II) and the orthodontic treatment accomplished. An anamnestic questionnaire, comprising questions regarding the most frequent symptoms of TMD, was used to classify the sample according to the TMD presence and severity. A clinical examination, including TMJ and muscle palpation, mandibular range of motion, and joint noise analysis was performed. Based on the anamnestic questionnaire, 34% of the sample was considered as having mild TMD, whereas 3.5% had moderate TMD. A higher TMD prevalence was found in females. Joint noises (15.5%) followed by headache (13%) constituted the most frequent reported symptoms. The presence and severity of TMD have not shown any relationship with either the type of orthodontic mechanics or extraction protocols. On the other hand, a positive association was found between TMD and parafunctional habits and reported emotional tension. Orthodontic treatment is not associated with the presence of signs and symptoms of TMD.
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PMID:Relationship between signs and symptoms of temporomandibular disorders and orthodontic treatment: a cross-sectional study. 1294 May 62


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