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1.
Oral Glucosamine Hydrochloride Combined With Hyaluronate Sodium Intra-Articular Injection for Temporomandibular Joint Osteoarthritis: A Double-Blind Randomized Controlled Trial.
Yang, W, Liu, W, Miao, C, Sun, H, Li, L, Li, C
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2018;(10):2066-2073
Abstract
PURPOSE Temporomandibular joint (TMJ) disorders occur in many people and osteoarthritis (OA) is a severe form of this disease. Glucosamine has been used to treat OA of the large joints for many years and has been proved effective. A double-blinded randomized controlled trial was designed to investigate the effectiveness and safety of oral glucosamine hydrochloride pills combined with hyaluronate sodium intra-articular injection in TMJ OA. PATIENTS AND METHODS One hundred forty-four participants with TMJ OA were randomized to 4 hyaluronate sodium injections and oral glucosamine hydrochloride (1.44 g/day) for 3 months (group A) or 4 hyaluronate sodium injections and oral placebo for 3 months (group B). All participants were followed for 1 year. Eighteen participants were lost to follow-up. RESULTS The intention-to-treat analysis showed that group A had similar maximal interincisal mouth opening and pain intensity during TMJ function at months 1 and 6 (P > .05). However, during long-term follow-up, group A had significantly greater maximal interincisal mouth opening compared with group B at month 12 (41.5 vs 37.9 mm; P < .001). For pain intensity, group A showed obviously lower visual analog scale scores than group B at month 6 (20.6 vs 29.2 mm; P = .007) and month 12 (17.4 vs 28.6 mm; P = .001). Twenty-four participants had gastrointestinal tract side effects, fatigue, and rash. Of these, 23 had slight side effects that were not correlated with glucosamine. There was no significant difference between the 2 groups (P > .05). CONCLUSION The results of this study suggest that, compared with hyaluronate sodium injection alone, glucosamine hydrochloride pills added to hyaluronate sodium injection had no meaningful effect on TMJ OA in the short-term but did relieve the pain caused by TMJ OA and improved TMJ functions in the long-term.
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2.
Mandibular kinesiographic pattern of women with chronic TMD after management with educational and self-care therapies: A double-blind, randomized clinical trial.
Giro, G, Policastro, VB, Scavassin, PM, Leite, AR, Mendoza Marin, DO, Gonçalves, DA, Compagnoni, MA, Pero, AC
The Journal of prosthetic dentistry. 2016;(5):749-755
Abstract
STATEMENT OF PROBLEM Limited mandibular movements are one of the most important signs of temporomandibular disorders (TMDs) and may cause functional difficulties. PURPOSE The purpose of this double-blind, randomized clinical trial was to evaluate the effect of treatment with only educational or education associated with self-care therapies on the pattern of mandibular movements of women with chronic painful TMDs. MATERIAL AND METHODS Forty-two women were selected and randomly divided into 3 groups, control group (CG, n=13), education group (EG, n=16), and education and self-care group (ESG, n=13), according to the sequence of treatment they received. A kinesiograph device recorded mandibular movements during maximum mouth opening and mastication at baseline (T0) and at 30-day (T1) and 60-day (T2) follow-up. Kinesiographic data were statistically analyzed using 1-way ANOVA, followed by the Bonferroni test for multiple comparisons of means (α=.05). RESULTS The ESG group demonstrated an improvement in the maximum vertical opening (MVO= 5.1 ±3.4 mm; P=.012) and anteroposterior mandibular movement (MAM) during maximum opening (7.4 ±9.5; P=.019), significantly higher than that of the EG (MVO=1.8 ±3.5 mm; MAM=0.8 ±5.0 mm) and the CG (MVO=0.9 ±3.8 mm; MAM=0.8 ±4.4 mm) after 30 days of follow-up. Moreover, at T1, vertical mandibular movement during mastication was significantly higher in the ESG group (17.4 ±1.7 mm) than in the EG group (15.0 ±2.8, P=.027). No significant differences were found between the women who received treatment with educational and self-care therapies for 60 days and the women who received this treatment for 30 days. CONCLUSIONS In the short-term, education and self-care treatment positively influenced the mandibular movement pattern of women with chronic painful TMDs.
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3.
Effectiveness of manual therapy and home physical therapy in patients with temporomandibular disorders: A randomized controlled trial.
Tuncer, AB, Ergun, N, Tuncer, AH, Karahan, S
Journal of bodywork and movement therapies. 2013;(3):302-8
Abstract
The purpose of this study was to compare the short-term effectiveness of home physical therapy (HPT) alone with that of manual therapy (MT) in conjunction with home physical therapy (MT-HPT) performed for four weeks in patients with temporomandibular disorders (TMD). Forty subjects (nine males and 31 females; age, 18-72 years) with TMD were randomly divided into two groups: HPT (n = 20; five males and 15 females; mean age, 34.8 ± 12.4 years) and MT-HPT (n = 20; four males and 16 females; mean age, 37.0 ± 14.6 years). Pain intensity was evaluated at rest and with stress using a visual analogue scale (VAS). Pain-free maximum mouth opening (MMO) was also evaluated. Mean change score (MCS) in VAS and the smallest detectable difference (SDD) in pain-free MMO were measured over time. The results were analysed by MANOVA to evaluate the effects of treatment over time. At baseline, the groups did not differ from each other with respect to VAS scores and pain-free MMO (p > 0.05). Within each group, VAS with stress decreased (p < 0.001) and pain-free MMO increased (p < 0.001) over time. Between groups, both time*treatment effect and treatment effect were significant for VAS with stress (p < 0.001); however, only time*treatment effect was significant for pain-free MMO (p = 0.009). In the MT-HPT group, MCS for VAS with stress was 91.3% and SDD for pain-free MMO was 10 mm. Our results suggest that a four-week period of MT-HPT has a clinically significant effect on both pain and pain-free maximum mouth opening in patients with TMD.
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4.
Two-needle vs. single-needle technique for TMJ arthrocentesis plus hyaluronic acid injections: a comparative trial over a six-month follow up.
Guarda-Nardini, L, Ferronato, G, Manfredini, D
International journal of oral and maxillofacial surgery. 2012;(4):506-13
Abstract
The aim of the study was to compare the effectiveness of five weekly two-needle arthrocentesis plus hyaluronic injections vs. the same protocol performed with a single-needle technique in patients with inflammatory-degenerative disorders of the temporomandibular joint (TMJ). 80 patients with TMJ osteoarthritis were randomly assigned to the two-needle or single-needle protocol and followed up for 6 months after treatment. Several outcome parameters, such as maximum pain at rest and maximum pain on chewing, subjective chewing efficiency, limitation in jaw function, jaw range of motion in mm, were recorded at baseline and multiple follow up assessments. Both treatment groups recorded significant improvement with respect to baseline levels in almost all outcome variables. The rate of improvement was not significantly different between the treatment protocols in any of the outcome variables (p-values between 0.143 and 0.970). No between-group differences emerged for the perceived subjective efficacy (p=0.321) and the treatment tolerability (p=0.783). The present investigation did not support the existence of significant differences in the treatment effectiveness for inflammatory-degenerative TMJ disorders of a cycle of five weekly injections of arthrocentesis plus hyaluronic acid injections performed according to the classical two-needle or the single-needle technique.
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5.
Comparison of 2 hyaluronic acid drugs for the treatment of temporomandibular joint osteoarthritis.
Guarda-Nardini, L, Cadorin, C, Frizziero, A, Ferronato, G, Manfredini, D
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2012;(11):2522-30
Abstract
PURPOSE To compare the effectiveness of 2 treatment protocols providing 5 weekly temporomandibular joint (TMJ) arthrocenteses immediately followed by injections of 2 different molecular weight hyaluronic acid (HA) drugs to manage symptoms in patients with inflammatory-degenerative TMJ disease. MATERIALS AND METHODS Patients with a Research Diagnostic Criteria for Temporomandibular Disorders diagnosis of osteoarthritis were randomly assigned to 1 of 2 study groups receiving either low- or medium-molecular weight HA after arthrocentesis. The level of maximum pain at chewing was the primary outcome variable, and maximum pain at rest, subjective chewing efficiency, functional limitation, treatment tolerability, perceived treatment effectiveness, and jaw range-of-motion function in millimeters were the secondary outcomes. All variables were assessed and compared between groups at baseline, at the end of treatment, and 3 months later. RESULTS Forty subjects entered the study. At the end of the follow-up period, all the outcome variables improved in both groups of patients. A between-group comparison of changes over time showed that differences were not significant for any of the outcome variables, that is, pain at chewing (F = 0.056, P = .815), pain at rest (F = 0.383, P = .541), chewing efficiency (F = 0.050, P = .825), functional limitation (F = 0.268, P = .609), and mouth opening (F = 0.003, P = .954). In addition, no between-group differences were shown for perceived treatment effectiveness and treatment tolerability. CONCLUSIONS Similar positive effectiveness was shown for 2 treatment protocols for TMJ osteoarthritis (ie, 5-session single-needle arthrocentesis plus low- or medium-molecular weight HA).
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6.
Glutamate-induced temporomandibular joint pain in healthy individuals is partially mediated by peripheral NMDA receptors.
Alstergren, P, Ernberg, M, Nilsson, M, Hajati, AK, Sessle, BJ, Kopp, S
Journal of orofacial pain. 2010;(2):172-80
Abstract
AIM: To determine if glutamate injected into the healthy temporomandibular joint (TMJ) evokes pain through peripheral N-methyl-D-aspartate (NMDA) receptors and if such pain is influenced by sex or sex steroid hormones. METHODS Sixteen healthy men and 36 healthy women were included and subjected to two randomized and double-blind intra-articular injections of the TMJ. Experimental TMJ pain was induced by injection of glutamate (1.0 mol/L) and NMDA block was achieved by co-injection of the NMDA antagonist ketamine (10 mmol/L). The TMJ pain intensity in the joint before and during a 25-minute postinjection period was continuously recorded on an electronic visual analog scale (0 to 10). Estradiol, progesterone, and testosterone levels in serum were analyzed. RESULTS Glutamate-induced pain showed a median (25/75 percentile) duration of 8.3 (5.2/12.2) minutes. The peak pain intensity was 6.1 (4.2/8.2), the time to peak was 50 (30/95) seconds, and the area under the curve was 59 (29/115) arbitrary units. The women reported higher maximum pain intensity than the men and shorter time to peak. The sex hormone levels were not significantly related to the glutamate-induced TMJ pain. NMDA block significantly reduced the glutamate-induced TMJ pain, mainly in the women. There were no significant correlations between sex hormone levels and the effects of NMDA block for any pain variable. CONCLUSION Glutamate evokes immediate pain in the healthy human TMJ that is partly mediated by peripheral NMDA receptors in the TMJ.
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7.
Effects of intra-articular administration of sodium hyaluronate on plasminogen activator system in temporomandibular joints with osteoarthritis.
Tang, YL, Zhu, GQ, Hu, L, Zheng, M, Zhang, JY, Shi, ZD, Liang, XH
Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 2010;(4):541-7
Abstract
OBJECTIVE The aim of this study was to investigate the effect of intra-articular sodium hyaluronate (SH) injections on the main components of plasminogen activator (PA) system in the synovial fluid of temporomandibular joint (TMJ) osteoarthritis (OA). STUDY DESIGN Forty patients diagnosed with TMJ OA and 20 healthy control subjects were included in this study. Synovial fluid was collected in the OA group and the healthy group at baseline. The OA patients were randomly divided into 2 groups (20 patients for each group): One group received 5 injections of SH, and the other received 5 injections of physiologic saline solution in the upper joint space at weekly intervals. Synovial fluid was collected before and after treatment. Urokinase-type PA (uPA), soluble uPA receptor (suPAR) and PA inhibitor 1 (PAI-1) levels in synovial fluid were quantified by enzyme-linked immunosorbent assay. RESULTS The OA patients had significantly higher uPA activity and levels of uPA (median 80.01 ng/L), suPAR (median 7.54 ng/L), and PAI-1 (median 54.9 ng/mL) than the healthy control subjects (median 20.47 ng/L uPA, 2.34 ng/L suPAR, and 19.9 ng/mL PAI-1; (P < .05). The uPA activity and levels of uPA, suPAR, and PAI-1 were significantly decreased after SH injections in TMJs of OA patients (P < .05), and there was no difference after saline injection. Visual analog pain score reduction correlated with changes in uPA and uPAR levels as well as uPA activity. CONCLUSION The effects of SH on PA system provide new insight into a possible underlying mechanism by which SH alleviates pain of patients with TMJ OA.
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8.
Self-reported chewing side preference and its associations with occlusal, temporomandibular and prosthodontic factors: results from the population-based Study of Health in Pomerania (SHIP-0).
Diernberger, S, Bernhardt, O, Schwahn, C, Kordass, B
Journal of oral rehabilitation. 2008;(8):613-20
Abstract
This study investigated the prevalence of a preferred chewing side (PCS) and associations between a PCS and signs of temporomandibular disorders (TMD), antagonist contact and prosthetic restoration. A population representative sample of 4086 adults of the cross-sectional epidemiologic 'Study of Health in Pomerania' (SHIP-0) (age range 20-80 years, female 50.2%) was divided in two groups by the presence or absence of a PCS. PCS was evaluated by a questionnaire. Chi-squared tests and multiple logistic regression were used to determine the impact of the relation between a PCS and signs and symptoms of TMD as well as dental factors. The prevalence of a PCS was 45.4%. Women between 40 and 69 years reported more frequently a PCS. There was a preference for the right side (64%). The following independent variables were significantly associated with a PCS: subjective unilateral pain in the temporomandibular joint (TMJ), odds ratio (OR) 2.4; subjective unilateral joint clicking, OR 1.7; unilateral TMJ/muscle pain on palpation, OR 1.6/OR 1.3; loss of one supporting zone (Eichner-Classification), OR 1.9; loss of both supporting zones on one side, OR 2.2, one supporting zone left, OR 1.4; presence of a removable partial denture, OR 1.6; presence of an attachment restoration, OR 1.5. A PCS was found in almost half the study population and was associated with unilateral signs of TMD, most of all TMJ pain and asymmetrical loss of antagonist contact. Despite replacement of lost teeth not all restorations seemed to support bilateral mastication.
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9.
Low intensity laser therapy in temporomandibular disorder: a phase II double-blind study.
Carrasco, TG, Mazzetto, MO, Mazzetto, RG, Mestriner, W
Cranio : the journal of craniomandibular practice. 2008;(4):274-81
Abstract
The purpose of this study was to evaluate the analgesic effect of Low Intensity Laser Therapy (LILT) and its influence on masticatory efficiency in patients with temporomandibular dysfunction (TMD). This study was performed using a random, placebo-controlled, and double-blind research design. Fourteen patients were selected and divided into two groups (active and placebo). Infrared laser (780 nm, 70 mw, 60s, 105J/cm2) was applied precisely and continuously into five points of the temporomandibular joint (TMJ) area: lateral point (LP), superior point (SP), anterior point (AP), posterior point (PP), and posterior-inferior point (PIP) of the condylar position. This was performed twice per week, for a total of eight sessions. To ensure a double-blind study, two identical probes supplied by the manufacturer were used: one for the active laser and one for the inactive placebo laser. They were marked with different letters (A and B) by a clinician who did not perform the applications. A Visual Analogue Scale (VAS) and a colorimetric capsule method were employed. Data were obtained three times: before treatment (Ev1), shortly after the eighth session (Ev2), and 30 days after the first application (Ev3). Statistical tests revealed significant differences at one percent (1%) likelihood, which implies that superiority of the active group offered considerable TMJ pain improvement. Both groups presented similar masticatory behavior, and no statistical differences were found. With regard to the evaluation session, Ev2 presented the lowest symptoms and highest masticatory efficiency throughout therapy. Therefore, low intensity laser application is effective in reducing TMD symptoms, and has influence over masticatory efficiency [Ev2 (0.2423) and Ev3 (0.2043), observed in the interaction Evaluations x Probes for effective dosage].
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10.
Use of Theraflex-TMJ topical cream for the treatment of temporomandibular joint and muscle pain.
Lobo, SL, Mehta, N, Forgione, AG, Melis, M, Al-Badawi, E, Ceneviz, C, Zawawi, KH
Cranio : the journal of craniomandibular practice. 2004;(2):137-44
Abstract
This randomized, double-blind study was designed to evaluate the effectiveness of the topical cream Theraflex-TMJ (NaBob/Rx, San Mateo, CA) in patients with masseter muscle pain and temporomandibular joint (TMJ) pain. Fifty-two subjects (5 males and 47 females) were instructed to apply a cream over the afflicted masseter muscle(s) or over the jaw joint(s) twice daily for two weeks. Theraflex-TMJ cream was used by the experimental group, while a placebo cream was used by the control group. The means of pain ratings were calculated prior to the application of the cream (baseline), after ten days of tx (period 1), and 15 days of tx (period 2) days of treatment and five days after stopping the treatment (follow-up). There was a significant decrease in reported pain levels from baseline in the experimental group for period 1 (p < 0.01), period 2 (p < 0.001), and follow-up (p < 0.01). For the control group, no significant differences were found between the different time periods (p > 0.05). There was evidence of minor side effects such as skin irritation and/or burning on the site of the application in two subjects in the experimental as well as two subjects in the control groups. The data strongly suggest that Theraflex-TMJ topical cream is safe and effective for reducing pain in the masseter muscle and the temporomandibular joint.