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

Bruxism is a parafunction observed both in young and adult populations. The mean prevalence is about 20% and is decreasing with age. Women appear to clench more frequently than men. Often, bruxism is understood as both clenching with occasional tooth contact or grinding. A correct and validated definition has only recently been suggested. Many symptoms are assigned to this process, although few symptoms scientifically can be used as specific diagnostic criteria. The symptoms most often associated with bruxism like muscle-stiffness and -pain, limitation of mouth opening. TMJ-internal derangements, toothwear, are also found in TMD-patients. Because the bruxism-process is not only a problem for the patient, who suffers from pain, dysfunction and possible toothwear, it concerns also the dentist. It is essential that those who treat the bruxist-patient, have an understanding of the etiology, diagnosis and management of bruxism, of the many described oral parafunctional behaviors (oromotor behavior). This literature-review could not find a causal etiological mechanism between the occurrence of TMD-symptoms and the bruxism although a relationship between those two conditions has been described.
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PMID:[The role of bruxism in the appearance of temporomandibular joint disorders]. 970

Over the last years, aetiological concepts have changed drastically. The role of occlusal factors in the aetiology has been overestimated in the past. The role of occlusal therapy should be aimed at restoring function. In the initial phase of treatment an occlusal splint, counseling, physiotherapy and occasionally NSAID's, leads to relieve pain and reduction of dysfunction in most patients. A repositioning splint in cases of anterior disc dislocation is not longer recommended. Selective grinding can be done in "occlusally sensitive" patients with pain or dysfunction of muscular origin. The adjustment should have a limited character, and is not indicated as preventive measure. Occlusal prosthetic reconstruction is in most patients not indicated for reasons linked to TMD because the aetiologic relationships between TMD and loss of molars has not been established. In cases of rheumatoid arthritis, osteo-arthrosis and spondylitis ankylosans, occlusal changes can occur due to the degeneration of the joint components. After the initial phase of treatment replacing the lost molars by prostheses in these particular patients, results in unloading of the joints and in decreasing recurrence of symptoms.
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PMID:[Dental aspects of the treatment of temporomandibular joint disorders]. 970 3

It seems obvious in retrospect that the treatment of disorders by interocclusal devices followed two paths: stabilization splints and functional orthopedic appliances. The dividing line between them is not always clear. Both have some function related to the position of the mandible. They may not differ significantly in their control of occlusal stability (e.g., telescoping devices anchored to stabilization splints). The stabilization splint, as well as other conservative measures, will play an increasing role in accepted therapy for TMD. The use of anterior repositioning devices for TMD, including MPD syndrome, will decrease. Research may provide answers that allow them to be used more specifically and predictably. Perhaps there will be but little change in their use where there is an association of TMD and Class II malocclusion. There will be an increase in the use of interocclusal devices for the treatment of snoring and obstructive apnea. Some additional directions seem to have emerged in the late 1980s and early 1990s: In the absence of pain and significant debilitation, treatment for TMD, if any, is to be reversible. Prevention or aggravation of TMD should be practiced to the extent possible during dental procedures. One long-term, well-designed, prospective study indicated that the incidence and severity of TMD could be reduced by appropriate occlusal adjustment. There is a small, but nevertheless important minority of patients with TMD who progress to persistent pain and/or dysfunction. Initial management of the vast majority of patents with TMD should be use of noninvasive reversible therapies. Surgery is indicated in only a relatively small percentage of cases of TMD. Research on interocclusal devices should not terminate simply because they are in part dental devices (i.e., biomechanical forms of treatment). The diagnosis and treatment of TMD has been called a dilemma, especially for those patients with chronic pain for whom no treatment has been effective. However, it would be ill-advised to abandon what treatment is already known to be effective by allowing those few but psychosocially important patients with chronic pain to determine what should be done for the vast majority of patients with TMD: reversible forms of treatment, including physiotherapy, pharmacologicals, and the stabilization occlusal bite plane splint.
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PMID:Reflections on the Michigan splint and other intraocclusal devices. 986 32

The purpose of this study was to investigate the effectiveness of repositioning splint therapy as a conservative treatment modality for TMD patients. The treatment sequence of 160 randomly sampled TMD patients was monitored in order to assess different aspects of the patients' response to splint therapy. Included among these aspects were the pretreatment symptoms; the treatment duration required for initial and final alleviation of symptoms; the number of patients requiring surgery; and the particular appliance and its wear pattern utilized to maintain the treatment results. The treatment success was based on the remission of symptoms including but not limited to pain to palpation, headaches, earaches, jaw locking, and joint noises. Eighty-nine and four tenths percent (89.4%) of the patients experienced a complete remission of symptoms and did not require any surgical intervention. The average time for initial improvement was 22.3 days, while the average time for complete remission of symptoms was 4.3 months. The results of the study indicate that repositioning splint therapy is an effective treatment modality for the conservative treatment of temporomandibular disorders.
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PMID:The treatment of temporomandibular disorders through repositioning splint therapy: a follow-up study. 1002 48

Clinical/occlusal scores and jaw-muscle EMGs were recorded in 24 TMD symptomatic (group S) and 20 normal (group N) subjects to evaluate the significance of EMG parameters and their clinical associations. Results indicated: (1) integrated EMG activity (IEMG) was larger at the rest position (RP) in anterior temporalis (Ta) but smaller at maximal voluntary clenching (MVC) in masseter (Ma) and Ta, and the ratios of IEMG at 70%MVC to the corresponding bite force (70%BF) were greater in group S; (2) mean power frequency (MPF) were almost the same in both groups but its shift was more rapid in group S; (3) silent period duration (SPD) was longer in group S; (4) asymmetry indices for SPD and silent period latency (SPL) were larger in group S; (5) muscle pain was associated negatively with IEMG at MVC and 70%BF but positively with IEMGs at RP and 70%MVC, and impaired jaw movements were associated negatively with the above EMG values; (6) muscle pain was positively associated with SPD in Ma, while joint pain and sound showed positive and negative associations with SPD, respectively; (7) associations between occlusion and EMG parameters were found more in group N. These findings verify: (1) jaw elevators in TMD may have hyper-tonic activities and a weak functional efficiency; (2) jaw muscles in TMD may become easily fatigued following a functional effort, and less relaxed following a muscle twitch; (3) the severity of pain could not be reflected in EMG activities, but impaired jaw movement may increase tonic activity and decrease functional effort; (4) TMD symptoms may alter the functional adaptation of jaw-muscle activities and occlusion.
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PMID:Electromyographic examination of jaw muscles in relation to symptoms and occlusion of patients with temporomandibular joint disorders. 1008 Mar 23

This study tests whether facial pain or associated symptoms and disorders aggregates in first degree relatives of those with myofascial temporomandibular disorders (M/TMD). We randomly selected one first degree relative of 106 probands with a lifetime history of M/TMD and one first degree relative of 118 acquaintance control probands with no history of M/TMD. Relatives were directly interviewed about the lifetime occurrence of a broad range of painful and non-painful health conditions and symptoms. Analyses revealed that rates of facial pain, symptoms of TMDs, and a range of other musculoskeletal conditions were not significantly different in first degree relatives of M/TMD probands and first degree relatives of controls. In addition, proband descriptors of facial pain severity or disability did not significantly predict the likelihood of having a first degree relative with one or more TMD-related symptoms. These results indicate that M/TMD is not a familial disorder.
Pain 1999 Mar
PMID:Myofascial TMD does not run in families. 1020 13

There are inconsistent data on the age/sex prevalence pattern of back pain and on chest pain. However, it is possible that for chest pain, the rates are higher in younger women and older men. Neck pain, joint pain, and fibromyalgia all appear to increase with age in both genders, whereas abdominal pain and tension-type headaches decrease with age, and migraine headache and TMD appear to peak in the reproductive years. A concluding example illustrates how epidemiologic data can be used to enhance our understanding of the causes of pain. A higher prevalence in women and a peak prevalence during the reproductive years as seen in TMD suggest that either biologic or psychosocial factors unique to women in this period of life could increase the risk of developing or maintaining this pain. As female reproductive hormones can play a role in migraine, at least for some women, it would be interesting to examine whether hormones play a role in TMD. The situation that occurs when menopause is followed by hormone replacement therapy (HRT) provides a natural experiment similar to a laboratory experiment in which female animals are deprived of the natural sources of hormones and then hormones are replaced exogenously. In women, of course, the decision to receive HRT may be associated with a number of psychosocial variables that might also influence pain. Recognizing these limitations, data from records of a large health maintenance organization were examined to ascertain whether use of estrogen or progestin (or both) in postmenopausal women might be associated with the occurrence of TMD pain and, thus, whether the hormone hypothesis might be worthy of further investigation. More women with TMD than controls used estrogen replacement therapy, and slightly more patients than controls used progestin. The use of estrogen significantly increased the odds of having TMD. Progestin use showed a weaker association, which did not hold up after other factors were controlled. However, the risk of TMD appears to increase with increasing doses of estrogen. A review of the epidemiologic literature indicates that there are definite age and sex differences in the prevalence of many chronic pain conditions. There is little basic information about the source of these differences, such as different onset rates, different probabilities of recurrence, or different durations of pain, or combinations of these in women and men. Nevertheless, a systematic examination of the existing epidemiologic data may be an important step in helping pain researchers to generate hypotheses in the search for a better understanding of chronic pain in both sexes.
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PMID:Chronic pain conditions in women. 1032 86

Chronic Pain extracts a "penalty" on society now estimated to be well in excess of $100 million per year. The "penalty" that Chronic Pain extracts from its victims is incalculable. Chronic Pain is a major component of Temporomandibular Disorders. The current neurological theory of the mechanism of chronic TMD pain is explored along with the current modes of treatment. Pharmacological management of Chronic Pain in a clinical setting is outlined. Dentists are involved in pain management on a daily basis. Dentists treat pain both prophylacticly and in response to specific patient symptoms. Most dental treatment involves some type of pain management. We, dentists, have become very adept at managing acute pain. We have much greater difficulty managing chronic pain. The word "pain" derives from the Greek word for penalty, and appeared to them to be a "penalty" inflicted by the gods. In 1984, Bonica estimated that one-third of all Americans suffered from some kind of chronic pain at a "penalty" to society of $65 Billion annually in medical expenses and lost wages and productivity. This figure is certainly much greater now. Chronic pain can be a very complex problem that can require a multidisciplinary approach to treatment. Chronic pain in the dental setting is most frequetly caused by prolonged Temporomandibular Disorders.
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PMID:Clinical management of chronic TMD pain. 1061 32

Facial arthromyalgia (temporomandibular joint pain dysfunction syndrome, TMD) is a chronic pain condition of unknown origin. This paper examines the extent to which the condition is associated with symptoms of anxiety and depression. It also identifies factors which may be predictive of raised levels of these two moods and of the presence of clinical anxiety and clinical depression. Self-report measures of pain beliefs, coping strategies, pain intensity, disability and mood were administered to a sample of 80 facial arthromyalgia patients of differing chronicity. The results showed anxious mood to be associated with several factors including beliefs that pain is itself worsened by negative mood, passive coping in terms of catastrophising about pain, and speech problems. Depressed mood was associated with catastrophising and disability in the form of disturbance in taste and digestion. These factors may be considered as potential targets for therapy, rather than the orthodox objective of pain relief.
Pain 2000 Feb
PMID:Factors associated with anxiety and depression in facial arthromyalgia. 1066 27

Fifty-eight patients (mean age 18.4 years) who had received splint therapy for internal derangement of the temporomandibular joint (TMJ) were examined retrospectively to investigate the efficacy of occlusal reconstruction by orthodontic treatment. The subjects were divided into three groups: 18 patients (mean age 18.6 years) who underwent orthodontic treatment combined with the use of splints (ST group); 27 patients (mean age 18.2 years) who underwent orthodontic treatment without the use of splints (NST group); and 13 patients (mean age 17.9 years) who received only splint therapy for temporomandibular joint disorders (TMD; control group). TMJ sound, pain on movement and restriction of mandibular movement were examined at the initial examination (T1), at the end of the splint therapy for TMD or beginning of orthodontic treatment (T2), at the end of orthodontic treatment (T3), and at recall or 1 year after orthodontic treatment (T4). The following results were found. (1) The percentage of patients with no joint sound at T2 was 20-30 per cent. The percentage of such patients in both the ST and NST groups increased to over 50 per cent at T3, but slightly decreased to 39-50 per cent at T4. There were no significant inter-group differences at any time point. (2) The number of patients who had no pain on movement at T2 was 60-80 per cent. The percentage of such patients in both the ST and NST groups increased to over 90 per cent at T3, but then slightly decreased to 80 per cent at T4. There were no significant inter-group differences at any time point. (3) None of the patients showed restriction of movement of the TMJ at T2 or T4. One patient in the ST group was found to have restriction at T3. There were no significant inter-group differences at any time point. (4) The most frequent type of malocclusion in both ST and NST groups was anterior open bite. These results suggest that TMD symptoms that have been eliminated by splint therapy are not likely to recur due to subsequent orthodontic treatment, but it cannot be concluded that orthodontic treatment itself had a positive effect on TMD symptoms. The results also indicate that there is a relationship between anterior open bite and TMD.
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PMID:Long-term follow-up of clinical symptoms in TMD patients who underwent occlusal reconstruction by orthodontic treatment. 1072 Dec 46


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