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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Previous studies have shown that characteristics of posttraumatic temporomandibular disorders (pTMD) differ considerably from those of nontraumatic or idiopathic temporomandibular disorders (iTMD). Both the rate of recovery and the amount of treatment required appear to be different for both groups. In this blinded study, 14 patients with iTMD and 13 patients with pTMD were examined. Patients submitted to a variety of reaction-time tests and neuropsychologic assessments to test their ability to cope with simple and more complex tasks with and without a variety of cognitive interferences. Clinical examination was used to assess signs of TMD. Eleven of the subjects (six iTMD, five pTMD) consented to a second phase of the investigation, whereby the patients were studied with single-photon emission computerized tomography (SPECT) using 99mTc-hexamethylpropyleneamineoxime (HMPAO). For simple and complex reaction-time tests, the pTMD group was significantly slower than the iTMD group (P < .05 to P < .001). Other neuropsychologic assessment tools such as the Consonant Trigram Test and the California Verbal Learning Test indicated that pTMD patients were more affected by both proactive and retroactive interferences and were more likely to perseverate on a single thought. In clinical examination, pTMD patients demonstrated greater reaction to muscle palpation than did iTMD patients (P < .05). The SPECT results suggested that there were mild differences between the two populations, and further ther studies are required to confirm this finding. The results lend support to the concept that there are differences between pTMD and iTMD populations. It is suggested that although patients with pTMD may have some similarities to those with iTMD, the former population may benefit from being handled somewhat differently and should be assessed and treated using a more broad, multidisciplinary treatment paradigm. These results must be confirmed in studies of larger populations.
J Orofac Pain 1996
PMID:Neuropsychologic deficits and clinical features of posttraumatic temporomandibular disorders. 913 57

The clinician must maintain an awareness that at some time a patient may present in their busy dental practice with a chief concern of dental, sinus, or TMD-like pain that, in fact, is of cancer origin. The question remains if an earlier diagnosis can be established in cases similar to those illustrated. It is mandatory that a thorough medical and dental history be taken by all health care practitioners along with a systematic and comprehensive examination when addressing head and neck pain. This includes careful examination, including inspection and palpation, of the oral and extraoral structures and the cervical lymph nodes at regular intervals in all patients but especially in those who are at high risk. History of smoking and alcohol use is of particular concern. Early head and neck cancer is usually symptomatic. Persistence in applying this practice philosophy is imperative.
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PMID:Cancer in the differential diagnosis of orofacial pain. 914 89

The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) guidelines, originally developed in the United States, were translated and used to classify TMD patients on physical diagnosis (Axis I) and pain-related disability and psychologic status (Axis II) in a TMD specialty clinic in Sweden. The objectives of the study were to determine if such a translation process resulted in a clinically useful diagnostic research measure and to report initial findings when the RDC/TMD was used in cross-cultural comparisons. Findings gathered using the Swedish version of the RDC/TMD were compared with findings from a major US TMD specialty clinic that provided much of the clinical data used to formulate the original RDC/TMD. One hundred consecutive patients were enrolled in the study. Five patients with rheumatoid arthritis and 13 children or adolescents were excluded. The remaining 82 patients participating in the study comprised 64 women and 18 men. Group I (muscle) disorder was found in 76% of the patients; Group II (disc displacement) disorder was found in 32% and 39% of the patients in the right and left joints, respectively; Group III (arthralgia, arthritis, arthrosis) disorder was found in 25% and 32% of the patients in the right and left joints, respectively. Axis II assessment of psychologic status showed that 18% of patients yielded severe depression scores and 28% yielded high nonspecific physical symptom scores. Psychosocial dysfunction was observed in 13% of patients based on graded chronic pain scores. These initial results suggest that the RDC guidelines are valuable in helping to classify TMD patients and allowing multicenter and cross-cultural comparison of clinical findings.
J Orofac Pain 1996
PMID:Comparing TMD diagnoses and clinical findings at Swedish and US TMD centers using research diagnostic criteria for temporomandibular disorders. 916 Dec 29

Seventy-five patients suffering from myofascial pain, headaches and anterior disc displacement were assessed clinically and with a kinesiograph. Twenty-eight asymptomatic dental staff served as a control group. The prevalence of awareness of bruxism was significantly greater in our TMD patients than the controls. Bruxism patients recorded a higher prevalence of incisor dentine wear suggestive of a forward mandible posture. Class II, Division 1 malocclusions formed a significantly higher proportion of the TMD patient group than the controls. Kinesiographic recordings showed that the vertical and lateral components of movement from postural position to intercuspal were significantly greater in the patient group.
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PMID:Occlusal variables, bruxism and temporomandibular disorders: a clinical and kinesiographic assessment. 921 96

The effect on isometric strength of the shoulders and limbs while biting in habitual occlusion, on a bite-elevating appliance and on a placebo appliance was analyzed. Twenty female volunteer patients, presenting with temporomandibular pain dysfunction syndrome and obvious loss of vertical dimension, served as subjects. All were weaker to the manual application of the isometric Deltoid Press (IDP) when biting, as opposed to maintaining the mandible in an unsupported rest position. Two intraoral appliances were fabricated for each subject: a bite-elevating appliance (BEA) set by a functional criterion of peak strength to the IDP and a placebo appliance which did not interfere with occlusion but was "set" with a mock IDP procedure. Testing was carried out by the Neuromuscular Research Testing Laboratory of the Neurology Department of Tufts New England Medical Center. Testing was independent of the dentist who fabricated and set the appliances. A standard neuromuscular test with the Maximal Voluntary Isometric Contraction apparatus was used to assess strength of right and left shoulder, elbow and knee flexion and extension as is routinely performed with all neuromuscular disease patients. Twelve strength tests were carried out for each of three conditions: 1. Baseline-biting in habitual occlusion; 2. Elevated-biting on the BEA; and 3. Placebo-biting with the placebo appliance inserted. The order of conditions 2 and 3 was counterbalanced without knowledge of the subjects. Twelve repeated measures ANOVAs (each subject as their own control) were conducted for each of the 12 strength measures. All F-tests indicated a significant main effect for treatment differences (p < 0.0001). Mean strength biting on the BEA was consistantly greater (p < 0.001) than Baseline or Placebo strength. Baseline and Placebo condition were equivalent. These findings confirmed previous observations at this TMD Center: individuals with loss of vertical dimension of occlusion respond to a bite raising appliance by increased isometric-strength.
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PMID:Effect of increased maxillo-mandibular relationship on isometric strength in TMD patients with loss of vertical dimension of occlusion. 1200 32

For many years researchers and clinicians have been aware of the varying presenting signs and symptoms common in the TMD patient. The symptom-complex frequently includes preauricular pain; cephalgia (predominantly frontal, temporal, occipital, vertex, retro- and periorbital); cervicalgia (immobility/stiffness); otalgia (congestion, vertigo, tinnitus). The most prominent signs are those of joint sounds (popping, click and crepitus due to disc displacement with reduction and/or osseous breakdown); restricted mandibular excursion (disc displacement without reduction); and mandibular deviation/deflection (disc(s) displacement).
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PMID:Facial asymmetry: recognition of TMD. 961 Feb 80

The aim of this study was to compare sagittal condylar movement patterns (SCMP, Axiograph) and high-field (1.5 T) magnetic resonance imaging (MRI) findings of the temporomandibular disorders. One hundred forty-one patients with TMD signs and/or symptoms were selected for this study. SCMP was categorized into six patterns: normal, figure-eight (early/intermediate/late), limited, and other irregularities. The MRI findings of TMJ internal derangement were defined as one of five stages according to Wilkes criteria and then compared to the SCMP findings. Among normal SCMP, MRI revealed disc displacement in 27%. Sixty-three percent of figure-eight SCMP were regarded as stage I or II with reducible disc displacement. The sensitivity and specificity of SCMP for detecting TMJ internal derangement were 0.79 and 0.62, respectively. The point of deflection in figure-eight SCMP and the degree of disc displacement were not significantly related. However, a significant relationship was observed between the point of deflection in figure-eight SCMP and any type of disc deformation (chi-square = 9.80, P = .002). Thus, SCMP is not yet accurate enough for diagnosing a TMJ condition, especially in the case of chronic and/or adaptive internal derangement.
J Orofac Pain 1997
PMID:Diagnostic accuracy of sagittal condylar movement patterns for identifying internal derangement of the temporomandibular joint. 961 Mar 12

Recently developed Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) have been shown to be reliable for diagnosing and assessing TMD in U.S. and Swedish adult populations; however, few studies have focused on clinical examination methods and diagnostic criteria for use with children and adolescents. The present study used a sample of 50 Swedish children and adolescents, aged 12 to 18 years, to evaluate usefulness and reliability of existing and specially developed measures and methods for assessing and diagnosing TMD in youth. Subjects underwent repeated clinical exams by two calibrated examiners to assess signs and symptoms per the RDC/TMD, and they responded to a specially developed self-administered questionnaire that addressed location and frequency of TMD-related pain and symptoms, jaw function, effect of pain on daily activities, and use of pain medications. Interexaminer and intraexaminer reliability was assessed for clinical examination, questionnaire items, and diagnosis. Reliability values ranged from acceptable to excellent for the RDC/TMD clinical exam and questionnaire, and from good to excellent reliability for measuring virtually all modified clinical parameters of TMD assessed in these young patients.
J Orofac Pain 1998
PMID:Temporomandibular disorders in children and adolescents: reliability of a questionnaire, clinical examination, and diagnosis. 965 98

The purpose of this study was to determine if there was a difference between the temporomandibular condylar movement patterns of a symptomatic adult population and those of an asymptomatic adult population. Thirty-five volunteers who were not seeking treatment for TMD underwent two different assessments for TMD signs and symptoms: (1) a self-administered questionnaire and (2) a clinical examination. Based on the information obtained from the questionnaires, subjects were divided into "reported-symptomatic" and "reported-asymptomatic" groups. Based on the investigator's clinically evaluation of the same subjects, subjects were divided into "clinically symptomatic" and "clinically asymptomatic" groups. To compare condylar movement patterns, both groups of subjects then had their mandibular border condylar movements measured bilaterally using a sagittal recording device during maximum opening, maximum protrusion, and maximum left and right excursion movements. The patterns were separated into two broad groups, "symmetric" and "asymmetric." Symmetric gliding movements were defined as uninterrupted bilaterally mirror-like patterns of each condyle with a difference between left and right total length excursion not exceeding 2 mm during opening in the sagittal plane or horizontal plane. Our results show that 63% of the subjects who reported clinically asymptomatic for TMD demonstrated asymmetric condylar movements. However, 100% of the patients (n = 5) who reported clinically symptomatic for TMD exhibited asymmetric condylar movements. This finding suggests that, while a very high percentage of TMD subjects will have asymmetric condylar movements, condylar movements alone are not necessarily diagnostic of TMD, and the sagittal recording device may alert the clinician to abnormal movements.
J Orofac Pain 1997
PMID:Bilateral condylar movement patterns in adult subjects. 965 9

To test the hypothesis that the pain-producing effect of parafunctional clenching is mediated by oral contraceptive use and estrogen levels, eight premenopausal women participated in daily (five days/week) 20-minute-long EMG biofeedback training sessions (on the left and right temporalis and masseter muscles) structured as a two-phase cross-over study. Four subjects used oral contraceptives, and four did not. Subjects were instructed to maintain temporalis and masseter activity below 2 microV during decrease training and above 10 microV during increase training. All subjects began their participation at the start of menses. The initial week of training was followed by a week of rest and then a second week of training at mid-cycle. Preliminary screening examinations showed that none of the subjects had TMD. One subject was diagnosed with TMD pain during increase training, and no subjects were diagnosed with TMD during decrease training. Self-reported pain following training increased significantly during increase training. No effects on pain were observed for oral contraceptive status. We conclude that chronic, low-level parafunctional clenching may be a factor producing temporomandibular disorder pain and that oral contraceptive status does not play a role in the TMD pain produced by the experimental protocol.
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PMID:Effect of parafunctional clenching and estrogen on temporomandibular disorder pain. 970 61


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