No abstract

Differential diagnosis depends in cases with disk displacement on accurate identification of sound source. Mistakes may occur when clicking from one temporomandibular joint (TMJ) is heard on both sides of the head at auscultation and neither examiner nor patient, is sure about side. The hypothesis was that the head tissues affect spectral characteristics of TMJ sounds and that differences due to different positioning of sensors can be used in localization of source. The aim was to compare bilateral electronic recordings of unilateral TMJ sounds to obtain and compare attenuation, phase shift and time delay. Recordings were made from 12 subjects with unilateral clicking. Small electret condenser microphones, bandwidth 40-20 000 Hz, were placed at the openings of the auditory canals and the sounds were recorded at a sampling rate of 48 000 Hz. The head tissues acted as a filter causing a frequency dependent attenuation and phase shift. There was a time difference between the ipsi- and the contra lateral recordings, the latter always having a longer delay time (range 0.2-1.2 ms, group mean 0.68 ms, s.d. 0.292 ms). In conclusion, spectral analysis of bilateral electronic TMJ sound recordings is of diagnostic value when bilateral clicking is heard at auscultation and can help to avoid diagnosing a silent joint as clicking.

Referring to the temporomandibular joint (TMJ) of the human mandibular locomotor system, it has been asserted that displacement of the TMJ disc and inflammation of TMJ tissues are the results of acute and indirect trauma to the TMJ; on occasion this is allegedly experienced in motor vehicle accidents and commonly known as a TMJ whiplash injury. It is postulated that the TMJ whiplash injury is released in the occupant or occupants of a target vehicle when its rear end is impacted by the front end of a bullet vehicle. On the basis of detailed analyses of TMJ trauma/pain histories and TMJ magnetic resonance images, presented as circumstantial evidence in favour of the postulated TMJ whiplash injury, and detailed analyses of the mathematical biophysics of the mandibular locomotor system as well as direct experimental evidence, it is concluded that the postulated TMJ whiplash injury does not exist as a single and independent disease entity caused by motor vehicle accidents. If TMJ disc displacement and inflammation are present, they are expressions of an insidious and progressive pre-existing (pre-accident) disease entity that is comprised of TMJ synovitis/osteoarthritis (phase of inflammation with presence of immune system cells), TMJ internal derangement (phase of disc displacement and deformation with presence of proteinases), and TMJ osteoarthrosis (phase of degeneration with absence of immune system cells). For the asserted TMJ whiplash manoeuvre and ensuing injury to occur as postulated, the laws of physics and biology would have to be suspended.

No abstract

In 46 non-patients and 46 patients, the authors examined the presence (+) and the absence (-) of laterotrusive (LG) and mediotrusive (MG) tooth guidance, i.e. dynamic dental articulation events in contrast to static dental occlusion events. During a right and left laterotrusion/mediotrusion of the mandible, the number of compound, mutually exclusive and exhaustive tooth guidance events (possibilities) was six. In addition, the presence and the absence of temporomandibular joint (TMJ) sounds, provoked TMJ pains, and the associations between TMJ sounds and tooth guidance events were examined. In non-patients, LG+ and MG+ was relatively infrequent (30%) while LG+ and MG- was relatively frequent (70%). In patients, LG+ and MG+ was relatively frequent (58%) while LG+ and MG- was relatively infrequent (42%). LG- and MG+ was absent in non-patients and rare in patients (3%). Either unilateral or bilateral MG+ was relatively infrequent in non-patients (30%) and relatively frequent in patients (59%). Bilateral MG+ was relatively infrequent in non-patients (20%) and relatively frequent in patients (52%). Either unilateral or bilateral TMJ sounds were relatively infrequent in non-patients (39%) and relatively frequent in patients (74%). Either unilateral or bilateral provoked TMJ pains were absent in non-patients and relatively frequent in patients (72%). The authors found no evidence that TMJ sounds were associated with the ipsilateral absence of so-called balancing contacts (MG-) in non-patients and patients. Finally, no evidence supporting the use of a so-called positive predictive value, and "extension concept' of probability theory was found.