Importance of Standardized Palpation of the Human Temporomandibular Joint

Aim: Inflammatory idiopathic myopathies (IIMs) are inflammatory processes affecting skeletal musculature and extramuscular organs. Temporomandibular disorders (TMD) involve jaw muscles and temporomandibular joint. The aim of this observational study was to investigate the prevalence of the main TMD symptoms and signs as well as oral implications in IIM patients. Methods: The study group included 54 patients (42 women and 12 men), 22 of whom affected by dermatomyositis (DM), 29 by polymyositis (PM) and 3 by inclusion body myositis (IBM). A group of 54 patients not affected by this disease, served as CG. Oral and TMD signs and symptoms were evaluated by means of a questionnaire and through clinical examination. Results: About oral symptoms, the study group complained more frequently dysgeusia, with loss of taste or unpleasant taste (p<0.0001) and feeling of burning mouth (9.4% versus 0 controls). Xerostomia was more prevalent in the study group respect to the CG (p<0.0001). Dysphagia was reported by 48.1% of IIM patients while was absent in CG (p<0.0001). About oral signs, cheilitis (p<0.05) and oral ulcers (p<0.05) were significantly more frequent in CG. As regard to TMD symptoms, arthralgia and tinnitus didn't showed significant differences between the two groups, while neck/shoulders and masticatory muscle pain was significantly more referred in IIM patients than in the CG (p<0.05). About TMJ signs, sounds were overlapping in the two groups: click=11.1% in both IIM patients and CG (p>0.05), crepitation in 11.1% of IIM and 9.3% of controls (p>0.05). No significant difference was detected about deflection (9.3%, p>0.05), while deviation was wider in CG (p<0.05). Active opening and lateralities showed no significant differences, while endfeel was significantly increased in IIM group for a higher presence of muscular contracture. Bruxism was present only in CG. Conclusion:The data collected from this observational study seem to support the existence of a relationship between the prevalence of TMD symptoms and signs as well as oral features in patients with myositis. A remarkable reduction of salivary flow and dysphagia were more frequent and severe in IIM patients, as well as muscle contracture and myofacial pain evoked by palpation, this result being highly significant.

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“…An important part of the clinical examination of TMD is the assessment of deep pain sensitivity in muscles and joints using manual palpation 45 .…”

Section: Methodsmentioning

confidence: 99%

“…A pressure of 1.0 kgf was applied around the lateral pole of the condyle in the protruded position of the mandible for 5 seconds, while a 0.5-kg stimulus was applicated for 2 seconds at the lateral pole with the mandible in a relaxed position [45,[48][49][50].…”

Section: Muscle Painmentioning

confidence: 99%

Temporomandibular Disorders and Oral Features in Idiopathic Inflammatory Myopathies (IIMs) Patients: An Observational Study

Crincoli¹,

Cannavale²,

Cazzolla³

et al. 2021

Int. J. Med. Sci.

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“…Firstly, the clinical examination should be carried out in a repetitive way at every patient [18]. To realize the assumptions a way of examination was thoroughly described in the validated international protocol Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) [19].…”

Section: Temporomandibular Joint Examination Opportunitiesmentioning

confidence: 99%

Temporomandibular Joint Hypermobility Examination through Differentiation of Sounds

Loster¹,

Grochala²

2023

Temporomandibular Joint - Surgical Reconstruction and Managements

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The temporomandibular joint (TMJ), being an almost well-known anatomical structure but its diagnosis may become difficult due to sounds accompanying joint movement. One example is temporomandibular joint hypermobility (TMJH), which still requires comprehensive study. TMJH is a rare disorder; however, its prevalence at the level of around 4% is still significant. We propose a diagnostic method of TMJH based on the digital time-frequency analysis of sounds generated by TMJ. The volunteers were diagnosed using the RDC/TMD questionnaire and auscultated with the Littmann 3200 electronic stethoscopes on both sides of the head simultaneously. Recorded TMJ sounds were transferred to the computer via Bluetooth® for numerical analysis. The research reveals characteristic time-frequency features in acoustic signals which can be used to detect TMJH. This can help differentiate other disc displacements from joint hypermobility.

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“…4 A typical clinical sign of myofascial TMD is the tenderness or pain on palpation of muscle structures, with standardised areas that should be explored. 1,5,6 The most commonly accepted and worldwide used diagnostic protocol criteria for TMD in Spanish are The Diagnostic Criteria for Temporomandibular disorders (DC/TMD). 1 The aetiology of myofascial TMD is believed to be multifactorial.…”

Section: Backg Rou N Dmentioning

confidence: 99%

Pressure release technique versus placebo applied to cervical and masticatory muscles in patients with chronic painful myofascial temporomandibular disorder: A randomised clinical trial

Serrano‐Hernanz

Carrere

Ardizone‐García

et al. 2023

J of Oral Rehabilitation

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Background:The therapeutic approach to myofascial TMD should focus on pain relief and rehabilitation of function.Objective: This study investigated whether pressure release technique (PRT) is effective for reducing pain in people with chronic myofascial temporomandibular disorders (TMD). Methods: A single-blinded randomised parallel-group trial, with 3 months follow-up was conducted. A total of 72 patients were randomly allocated to receive PRT or sham PRT. Primary outcome was pain assessed with a visual analogue scale (VAS). Secondary outcomes included pressure pain thresholds (PPTs), range of opening of the mouth (ROM), Neck Disability Index (NDI), Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK-11), State-Trait Anxiety Index (STAI) and State-Trait Depression Index (ST-DEP). All parameters were assessed at baseline, at the end of the treatment and at 3 months follow-up. Statistical analysis was performed by ANOVA.Results: There were significant main effects of time, group and interaction between time and group (F ≥ 21.92; p < .001) on VAS pain. Post hoc tests showed a significant reduction in VAS pain scores in the PRT group (≥31.9%; p < .001). Effect sizes were moderate in the PRT group at all follow-up periods (≥1.25 Cohen's d). Also, there were significant effects of time in secondary outcomes (F ≥ 9.65; p < .001), and there were also interactions between time and group (F ≥ 3.82; p < .002) with better effects in the PRT group. Conclusions:The inclusion of PRT to conventional management with occlusal splints and self-care management appears to be effective to improve self-reported levels of pain in patients with chronic myofascial TMD pain. Retrospectively registered (Clini calTr ials.gov: NCT03619889).

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Importance of Standardized Palpation of the Human Temporomandibular Joint

Cited by 11 publications

References 0 publications

Temporomandibular Disorders and Oral Features in Idiopathic Inflammatory Myopathies (IIMs) Patients: An Observational Study

Temporomandibular Disorders and Oral Features in Idiopathic Inflammatory Myopathies (IIMs) Patients: An Observational Study

Temporomandibular Joint Hypermobility Examination through Differentiation of Sounds

Pressure release technique versus placebo applied to cervical and masticatory muscles in patients with chronic painful myofascial temporomandibular disorder: A randomised clinical trial

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