Hybrid treatment of varied orthodontic appliances for a patient with skeletal class II and temporomandibular joint disorders:A case report and review of literature

BACKGROUND The relation between orthodontic treatment and temporomandibular disorders(TMDs)is under debate;the management of TMD during orthodontic treatment has always been a challenge.If TMD symptoms occur during orthodontic treatment,an immediate pause of orthodontic adjustments is recommended;the treatment can resume when the symptoms are managed and stabilized.CASE SUMMARY This case report presents a patient(26-year-old,female)with angle class I,skeletal class II and TMDs.The treatment was a hybrid of clear aligners,fixed appliances and temporary anchorage devices(TADs).After 3 mo resting and treatment on her TMD,the patient’s TMD symptom alleviated,but her anterior occlusion displayed deep overbite.Therefore,the fixed appliances with TAD were used to correct the anterior deep-bite and level maxillary and mandibular deep curves.After the levelling,the patient showed dual bite with centric relation and maximum intercuspation discrepancy on her occlusion.After careful examination of temporomandibular joints(TMJ)position,the stable bite splint and Invisible Mandibular Advancement appliance were used to reconstruct her occlusion.Eventually,the improved facial appearance and relatively stable occlusion were achieved.The 1-year follow-up records showed there was no obvious change in TMJ morphology,and her occlusion was stable.CONCLUSION TMD screening and monitoring is of great clinical importance in the TMD susceptible patients.Hybrid treatment with clear aligners and fixed appliances and TADs is an effective treatment modality for the complex cases.

An Overview of Anterior Repositioning Splint Therapy for Disc Displacement-related Temporomandibular Disorders

Anterior repositioning splint(ARS)therapy is considered one of the most effective therapies for treating disc displacement-related temporomandibular disorders(TMDs),which account for a large proportion of TMD cases.Owing to the wide application of this therapy,the exact mechanism of remission has increasingly drawn attention.Given that practitioners have different views on ARS therapy,its indications are broadened,and operating methods diverged.This review attempts to provide an overview of ARS therapy and helps practitioners establish indications and suitable operating methods.Representative views in the past 10 years were summarised,and conclusions were drawn as follows:The mechanism of ARS therapy is mainly attributed to internal derangement correction,improvement of stress distribution and recently reported joint remodeling.It has an evident effect in the short term,and the most prevalent operating methods are protruding the mandible to the edge-to-edge position and wearing the ARS for 24 hours daily for 3-6 months.However,long-term stability is not optimal,and thus indications should be selected carefully.Notably,most of the clinical studies in this field are case analyses with low-quality evidence.Well-designed RCTs are required to further validate relevant theories.

High risk of temporomandibular disorder in irritable bowel syndrome: Is there a correlation with greater illness severity?

AIMTo investigate the prevalence and the risk of temporomandibular disorders (TMDs) in patients with irritable bowel syndrome (IBS) (including each subtype: constipation, diarrhoea, and mixed) compared to the general population.METHODSBetween January 2014 and December 2015 we enrolled consecutively adult patients diagnosed with IBS at the outpatient clinic of the University of Salerno and healthy controls (HC) without IBS. At enrollment, we analyzed all patients for the presence of TMDs according to the Research Diagnostic Criteria for TMD.RESULTSWe enrolled 91 IBS patients (23 IBS-D, 30 IBS-C and 38 IBS-M) and 57 HC in the study. We found a higher risk of having TMD (OR = 3.41, 95%CI: 1.66-7.01) compared to the HC. The risk of having TMD was independent of IBS-subtype. Multiple regression analysis showed that facial pain was positively related to abdominal pain and higher level of depression.CONCLUSIONIBS patients had a more than three times greater risk of TMD compared to HC. The risk of having TMD was similar in different IBS subtypes. IBS patients that also fulfilled criteria for TMD seem to share along with chronic facial and abdominal pain a significant co-occurrence with psychiatric disorders and female preponderance.

Relationship between uncertainty in illness,mood state and coping style in patients with temporomandibular disorders

Objective:To investigate the relationship between uncertainty in illness,mood state and coping style in patients with temporomandibular disorders(TMD)in the hospital,in order to identify nursing measures.Methods:Chinese versions of the Mishel Uncertainty In Illness Scale(MUIS),Brief Profile Of Mood States(BPOMS)and Medical Coping Modes Questionnaire(MCMQ)were used to assess uncertainty in illness,mood state and coping style,respectively,in 126 patients with TMD.Results:The total score of uncertainty in illness of the patients was 91.33±16.38,which was at middle level.The total score of mood state was 37.93±17.0.The order of coping style rated from high to low was confrontation(18.81±3.65),avoidance(15.44±4.26)and acceptance(10.41±5.04).Acceptance was positively correlated with uncertainty in illness(r=0.463,p<0.001),and mood state(r=0.187,p<0.05).Avoidance and confrontation were negatively correlated with uncertainty in illness and mood state(r=0.286,p<0.01),(r=0.175,p<0.05),(r=0.171,p<0.05),(r=0.221,p<0.01).Conclusions:Both uncertainty in illness and mood state were related to coping style.These data suggest that nurses should be trained to offer appropriate guidance to help decrease patients'uncertainty in illness and relieve their negative emotions.

Orthodontic retreatment of an adult woman with mandibular backward positioning and temporomandibular joint disorder:A case report

BACKGROUND The role of occlusal factors on the occurrence of temporomandibular joint disorders(TMDs)is still unclear and it is tricky for orthodontists to treat malocclusions in patients with TMDs.We report the case of the second orthodontic treatment of an adult female with Class II division 2 malocclusion associated with TMD.With the removal of anterior occlusal interference,TMD symptoms were alleviated and cone beam computed tomography(CBCT)images showed the bilateral condyles shifted forward.CASE SUMMARY This case report presented an orthodontic retreatment of an adult female with TMD and mandibular backward positioning based on CBCT examination and Joint Space Index(JSI)analysis.The left and right JSI values of-38.5 and-52.6 indicated that the position of bilateral condyles had posterior displacement.Ten years prior to this evaluation,she underwent orthodontic treatment resulting in the extraction of two upper premolars and one lower central incisor.The joint symptoms,including pain and sounds,were alleviated along with verified mandibular forward repositioning by extraction of another lower central incisor.CONCLUSION Mandibular backward positioning could be associated with TMD.JSI analysis based on CBCT is a convenient way to examine condylar positions quantitatively.

Effectiveness of Mesotherapy on Temporomandibular Joint Disorders

TMJDs （Temporomandibular joint disorders） are a common pathology but best treatment remains unclear. The goal of this study was to evaluate the effectiveness of mesotherapy on TMJD. We conducted a case review of all TMJD patients treated since 2006 with mesotherapy procedures only and using a cocktail of drugs composing of lidocaine, piroxicam and pentoxifylline. Patients were treated every 15 days until symptomatic relief was achieved and thereafter every two months. Main outcome was complete symptomatic relief, and associated factors were analysed. 27 patients were included. Complete pain relief was achieved in 26. The necessary number of procedures to get pain relief ranged from 1 to 6 （median of 1） and the total number of treatments from 1 to 40 （median of 11）. 19 patients had other painful complains mainly related with anxiety disorders. A weak correlation （r = 0.357; p = 0.05） between anxiety disorders and the required months of treatments was found. Mesotherapy is a valuable option on pain relief in a temporomandibular pain syndrome with none of the systemic effects of oral medication. Anxiety may have a role on the aetiology and therapeutic success highlights the holistic approach of these patients. Future comparative studies are necessary.

Temporomandibular Disorder in University Students of the Parque das Rosas Campus, Universidade Estácio de SáThat Practice Sports

The stomatognathic system (SS) is a functional unit of the body that depends on the balance of several tissues. It consists of various structures, including the temporomandibular joint. Temporomandibular disorder (TMD) can occur due to alterations in the SS. The Fonseca Anamnestic Index (FAI) is a scale used to evaluate and to characterize the TMD Type: no DTM, mild, moderate and severe. The aim is to evaluate the prevalence of signs and symptoms related to TMD in university students of the Parque das Rosas Campus, Universidade Estácio de Sá that practice sports. This investigation was approved (CAAE number 325678413.9.0000.5284). Two hundred eighth students (110 male and 98 female, aged 19 - 35 years) accepted to be in this investigation. All the participants answered a General Questionnaire (GQ) and the FAI. The GQ had questions about the age, sex and the presence of TMD. The FAI was used. A statistical difference (p > 0.05) was not found about the presence of TMD. Among the female, an elevated number of the students with signal or symptoms related to the temporomandibular with statistic significance (p < 0.05) was observed. In the population without TMD, the prevalence of this disorder is higher between male than female. Considering the FAI, among the female students, there is a prevalence of the Mild Type. Considering the evaluation of the type of TMD among the male and female students no difference was found between male and female to the types mild and moderate, however, the prevalence of the severe Type is higher in female than in male with statistical significance. In conclusion, TMD is a relevant clinical condition with an important prevalence among the university students. Moreover, the type of the TMD could be considered due to prevalence of the Type Severe among the women.

Screening Survey of Pain Intensity in Patients with Temporomandibular Disorders

Objective: Pain tends to be the chief complaint in patients suffering temporomandibular disorders (TMD). Previous studies on pain and psychosocial factors have reported on the relationship between presence of pain and mental disorders. To date, however, few studies have addressed the relationship between intensity of pain and psychosocial factors. In this study, we investigated the relationship between intensity of pain and age, gender, palpation scores (PPS), tendencies toward depression, anxiety, and somatization, and oral parafunctional habits. Methods: This screening survey encompassed 104 patients (70 women and 34 men;mean age of 46.1 ± 19.3) who visited our clinic. We gathered the following data: age;gender;PPS included in Axis I diagnosis;and characteristic pain intensity (CPI), depression, anxiety, somatization, and oral parafunctional habits (assessed by the Oral Behavior Checklist) included in Axis II diagnosis. Based on the results of CPI, we divided patients into two groups: those experiencing low pain intensity (LP group) and those experiencing high pain intensity (HP group). The statistically significant level was set to below 5%. IBM SPSS Statistics V25 was used to perform all statistical analyses. Results: We observed no gender differences between LP and HP groups. The HP group included significantly more patients with higher scores for depression, anxiety, somatization, and oral parafunctional habits than the LP group. While no gender differences were observed in CPI, depression, anxiety, somatization, and oral parafunctional habits were significantly more common in women than in men. We observed no differences in age or PPS between the LP and HP groups. However, scores for depression, anxiety, somatization, and oral parafunctional habits were significantly higher in the HP group than in the LP group. We performed multiple regression analysis using the CPI score as the dependent variable and scores for depression, anxiety, somatization, and oral parafunctional habits as independent variables in both the LP and the HP groups. We identified no significant predictors for the LP group, but extracted depression as a significant predictor in the HP group. On evaluating the correlation of PPS with depression, anxiety, somatization, and oral parafunctional habits in both the LP and the HP groups, we found no correlation between the PPS and the seven-item generalized anxiety disorder (GAD-7) scale in the LP group but identified a significant correlation between the PPS and GAD-7 scores in the HP group. Moreover, the correlation coefficient between the patient health questionnaire (PHQ)-9 and GAD-7 scores was higher in the HP group than in the LP group. Conclusion: In those reporting more intense pain, we found a stronger correlation among psychological factors in patients diagnosed with TMD. Greater tendency toward depression was directly associated with pain intensity. The results point to the need to consider differences in psychosocial factors associated with pain intensity when treating TMD.

Management of disorder of temporomandibular joint syndrome using elastic resin occlusal pad: a clinical observation

Objective To investigate the possibility of occlusal pad in treating disorder of temporomandibular joint syndrome.Methods We treated 25 patients with disorder of temporomandibular joint syndrome using occlusal pad made of elastic resin,and evaluated the effects.Results Total effective rate was 96%.Clicking and pain dissappeared in all patients.Conclusion Occlusal pad made of elastic resin could be used for treating disorder of temporomandibular joint syndrome in clinic.

Research progress of Kinesiophbia in patients with temporomandibular disorders

This article reviews the source and concept of Kinesiophbia,the assessment tools,the adverse effects on temporomandibular disorders,the influencing factors and intervention methods,and provides a reference for clinical practitioners to choose appropriate intervention regimes.Nursing staff provide information support for effective health education,thereby reducing the level of patients with Kinesiophbia,promoting the recovery of mandibular function and improving their quality of life.

Current Status and Risk Factors of Kinesiophobia in Patients with Temporomandibular Disorders in Tianjin,China:a Cross-Sectional Study

Objective:To investigate the current status of kinesiophobia in patients with temporomandibular disorders(TMD)and analyze its risk factors.Methods:The Tampa Scale for kinesiophobia for patients with Temporomandibular Disorders(TSK-TMD),Numerical Rating Scale(NRS),Hospital Anxiety and Depression Scale(HADS),General Self-Efficacy Scale(GSES),Simplified Coping Style Questionnaire(SCSQ),and Social Support Rating Scale(SSRS)were adopted to measure patient's kinesiophobia,pain intensity,anxiety,depression,self-efficacy,coping styles and social support.Multiple linear regression was used to analyze the risk factors of kinesiophobia in patients with TMD.Results:A total of 307 participants were included in the present study.The average score of patients with kinesiophobia was(34.37±6.96)points.Multiple linear regression analysis showed that pain duration,worst pain intensity,mouth opening limitation,joint noise,joint trauma,self-efficacy,depression,negative coping style,support utilization and education level are independent risk factors for kinesiophobia.Conclusion:Patients with TMD have higher levels of kinesiophobia and poor recognition of the disease.Longer pain duration,pain intensity,mouth opening limitation,joint noise,joint trauma,lower self-efficacy,depression,negative coping style,lower support utilization and lower educational level can be used to predict the degree of kinesiophobia.

Effect of Articular Cavity Injection Combined with Bite Splint Treatment on Anterior Disc Displacement Without Reduction

Objective:To observe the clinical effect of articular cavity injection combined with bite splint therapy for the treatment of anterior disc displacement without reduction(ADDWoR).Methods:The research subjects for this study were 30 patients with ADDWoR treated in the temporomandibular joint specialist outpatient clinic from November 2018 to November 2019,with a disease duration of 1 to 6 months.The treatment group was treated with an articular cavity injection of sodium hyaluronate+bite splint.The control group was treated with a simple articular cavity injection of sodium hyaluronate.The two groups were followed up once every 2 weeks to evaluate the treatment effect and observe the clinical efficacy of the two groups.Statistical analysis was carried out using SPSS 24.0.t-test and general linear regression analysis were carried out to compare the data of both groups,andχ^(2)-test and binary logistic regression analysis were performed for pain index comparison.Results:There was no significant difference in terms of the efficacy of the treatment received by both groups.The mouth opening and joint pain of patients in both groups were significantly improved after treatment(P<0.001).Conclusion:Articular cavity injection of sodium hyaluronate and occlusal splint therapy are both effective and safe methods for treating ADDWoR.

A study of the temporomandibular joint during bruxism

A finite element model of the temporomandibular joint （TMJ） and the human mandible was fabricated to study the effect of abnormal loading, such as awake and asleep bruxism, on the articular disc. A quasilinear viscoelastic model was used to simulate the behaviour of the disc. The viscoelastic nature of this tissue is shown to be an important factor when sustained （awake bruxism） or cyclic loading （sleep bruxism） is simulated. From the comparison of the two types of bruxism, it was seen that sustained clenching is the most detrimental activity for the TMJ disc, producing an overload that could lead to severe damage of this tissue.

Mutual Effect between Neuropeptides and Inflammatory Cytokines in Neurogenic SMSCs of Human Temporomandibular Joint

In temporomandibular disorders（TMD）, pain takes place when neuropeptides stimulate synovial tissue to produce several cytokines such as interleukin（IL）-1β, IL-6 and tumor necrosis factor（TNF）-α, which activate neurons and glia of synovial membrane at the bilaminar regions of temporomandibular joint（TMJ）. It has been reported that, after neurogenic differentiation, the synovial mesenchymal stem cells（SMSCs）, deriving from TMJ, possess the same cytological features as the neuronal cells. This study examined the ability of substance P（SP） and calcitonin gene-related peptide（CGRP） to stimulate SMSCs and neurogenic SMSCs secreting inflammatory cytokines during TMD, evaluated the mutual effects of inflammatory cytokines and neuropeptides and tested the analgesic effect of hyaluronic acid（HA）. The levels of IL-1β, IL-6 and TNF-α in SMSCs and neurogenic SMSCs in the presence of neuropeptides were measured by ELISA. SP and CGRP produced by SMSCs and neurogenic SMSCs were determined by RT-PCR and Western blotting. The results showed that the expression of SP and CGRP was significantly enhanced in the neurogenic SMSCs in response to IL-1β, IL-6 and TNF-α, and the effect was remarkably inhibited by HA. IL-1β, IL-6 and TNF-α, in return, could be enhanced in the neurogenic SMSCs upon stimulation by SP and CGRP. Neuropeptides and inflammatory cytokines might work mutually on the TMD pain. The HA-mediated analgesic effect may be implicated in the inhibition of SP and CGRP expression in neurogenic SMSCs.

Expression of Dickkopf-related Protein 1 in Patients with Temporomandibular Osteoarthritis after Treatment with Hyaluronic Acid

We previously reported that the increased expression of Dickkopf-related protein 1(DKK1)is positively related to vascular endothelial growth factor in the synovial fluid from patients with temporomandibular joint disorders(TMDs).DKK1 is involved in angiogenic activities in the TMD synovium in vitro,but the expression of DKK1 after treatment of TMD-osteoarthritis(TMD-OA)with hyaluronic acid(HA)remains unknown.In this study,we assessed the expression of DKK1 in the synovial fluid of TMD-OA patients before and after treatment with HA via enzyme-linked immunosorbent assay.We also investigated the role of DKK1 in TMD-OA via immunohistochemical staining.The relationship between the expression of DKK1 and the clinicopathological characteristics was determined by Pearson analysis.The results showed that the expression of DKK1 was significantly decreased after treatment with HA.Correlation analyses indicated that the expression of DKK1 in the TMD-OA samples was closely correlated with mouth opening and pain.These findings suggest that DKK1 could play an important role in the pathogenesis and treatment of TMD.Reduction of the pain by HA treatment may be correlated with the decreased expression of DKK1.

Effect of Disc Position for Acute Closed Lock of the Temporomandibular Joint

In this manuscript, the authors have studied the Disc Displacement (DD) status of patients with acute Closed Lock (CL) to determine differences between DD with Reduction (DDwR) and DD without Reduction (DDwoR). Among the acute CL patients who visited our hospital within 2 weeks of the onset of CL, we studied 10 patients whose CL was released (DDwR) and 13 patients whose CL was not released (DDwoR). The DDwoR group was significantly older than the DDwR group. Although the mouth opening distance was significantly greater in the DDwoR group than in the DDwR group, the two groups were identical in the duration of CL. Sagittal MRI images showed no significant differences between the two groups in disc length and disc thickness (anterior band, intermediate zone, and posterior band). Multisection sagittal and coronal images identified lateral DD in 7 of the 10 patients in the DDwR group, although no specific direction of the DD was observed in the DDwoR group. Furthermore, deformation of the medial disc was common in the DDwoR group but uncommon in the DDwR group.

Acupuncture combined with medicated cupping for temporomandibular disorders

Objective To observe the application of acupuncture at distal points combined with medicated cupping on the affected parts in the treatment of temporomandibular disorders（TMD） and to evaluate its effectiveness. Methods A total of 120 patients with TMD were randomly divided into two groups according to the random number table and random number remainder method. Sixty-two patients in acupuncture combined with cupping group（group A） were treated with acupuncture at Hég（合谷 LI 4） and Tàichōng（太冲 LR 3） combined with medicated cupping on the affected parts with Sānqī（三七 Radix et Rhizoma Notoginseng） and Báizh（白芷 Radix Angelicae Dahuricae）. Fifty-eight patients in cupping group（group B） were just treated with medicated cupping. Patients were treated for 30 min each time, once daily, and 10 times were considered as one course of treatment. After one course of treatment, the therapeutic effect was evaluated. Before and after treatment, craniomandihular index（CMI）, dysfunction index（DI）, palpation index（Pl） and changes in pain degree（VAS score） were compared. Results Before and after treatment, CMI in group A were 0.27±0.02 and 0.04±0.01, respectively, and in group B were 0.29±0.02 and 0.06±0.01, respectively; PI in group A were 0.19±0.01 and 0.05±0.03, respectively, and in group B were 0.18±0.02 and 0.11±0.02, respectively; DI in group A were 0.33±0.04 and 0.06±0.02, respectively, and in group B were 0.34±0.05 and 0.11±0.04, respectively; VAS in group A were 5.39±0.24 and 2.13±0.47, respectively, and in group B were 5.70±0.31 and 3.97±0.26, respectively. After treatment, CMI, DI, PI and VAS in both groups significantly decreased when compared with those before treatment（all P0.01）, and the indices in group A were significantly lower than that in group B after treatment（all P0.05）, indicating that the difference was significant. Conclusion The therapeutic effect of acupuncture at distal points combined with cupping at adjacent points in treatment of TMD is superior to that of single medicated cupping therapy.

Twenty cases of temporomandibular disorders with warming-needle moxibustion on ginger at Xiàguān(下关ST 7)

Objective: To observe the clinical efficacy of treatment for temporomandibular disorders with warmingneedle moxibustion on ginger at Xiàguan(下关ST 7).Methods: Twenty patients with temporomandibular disorders were given acupuncture at ST 7 of the affected side, and then the self-prepared round cake-shaped ginger with moxa was set on the needle closing to skin surface, Ignited moxa, burn out as one cone, three cones were given for once. The treatment was performed once a day, 7 times was 1 course, and the curative effect was evaluated after 1 course of treatment.Results: Among 20 patients, 12 were cured, improvement was observed in 7 patients, and 1 case had no response to treatment. The effective rate was up to 95.0%;improvement was observed in 14 patients after treatment for 3 times. According to follow-up visit 1 month after treatment, 1 patient relapsed due to excessive mouth opening, but the symptom was mild and relieved after rubbing.Conclusion: The clinical efficacy of treatment for temporomandibular disorders with warming-needle moxibustion on ginger at ST 7 was ideal.

Clinical observation of tuina plus heat-sensitive moxibustion for temporomandibular disorders

Objective： To observe the clinical efficacy of tuina plus heat-sensitive moxibustion in treating temporomandibular disorders （TMD）. Methods： Fifty patients with TMD were randomized into a treatment group and a control group, 25 cases in each group. The treatment group was intervened by tuina plus heat-sensitive moxibustion, while the control group was by medication. The Fricton-Shiffman craniomandibular index （CMI） was observed before and after intervention, and the clinical efficacies of the two groups were also evaluated. Results： There was no significant difference in comparing the CMI score between the two groups before intervention （P^0.05）. After a treatment course, there were significant improvements in evaluating the CMI score in both groups （P^0.01）, and the improvement was more significant in the treatment group than that in the control group （P〈0.01）. The total effective rate of the treatment group was significantly higher than that of the control group （P〈0.01）. Conclusion： Tuina plus heat-sensitive moxibustion is effective in treating TMD, and it＇s safe, without adverse reactions, thus worth promoting in clinic.

Warm Needling Combined with Iontophoresis of Chinese Medicine for Temporomandibular Joint Disorder

Objective: To observe the clinical efficacy of warm needling combined with iontophoresis of Chinese medicine for temporomandibular joint disorder(TMD). Methods: A total of 100 TMD cases were randomly allocated into a treatment group and a control group, 50 in each group. Cases in the treatment group were treated with warm needling combined with iontophoresis of Chinese medicine, whereas cases in the control group were treated with Western medication. The therapeutic efficacies in two groups were assessed after three courses of treatment. Results: The recovery rate and total effective rate were 54.0% and 98.0% respectively in the treatment group, versus 30.0% and 82.0% in the control group, showing significant differences(both P<0.05). The recovery rates in the treatment group were higher than those in the control group respectively after 1, 2 and 3 courses of treatment, indicating that warm needling combined iontophoresis of Chinese medicine could substantially shorten the course of treatment. Conclusion: Warm needling combined with iontophoresis of Chinese medicine is remarkably effective for TMD and deserves further clinical application.