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1.
Multiple Treatment Meta-Analysis of Intra-Articular Injection for Temporomandibular Osteoarthritis.
Liu, Y, Wu, JS, Tang, YL, Tang, YJ, Fei, W, Liang, XH
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2020;(3):373.e1-373.e18
Abstract
PURPOSE The purpose of the present study was to compare the efficacy of intra-articular injections of different agents for temporomandibular osteoarthritis (TMJOA) using a network meta-analysis. MATERIALS AND METHODS A comprehensive search strategy was performed in multiple English and Chinese language electronic databases. Randomized controlled trials comparing the effect of intra-articular injections of different agents to treat TMJOA were included in accordance with the inclusion and exclusion criteria. The bias of risk in each study was assessed, with data extraction performed independently by 2 reviewers. The primary outcomes included pain intensity and maximal mouth opening. RESULTS A total of 11 trials were included in the present study, and 10 different agents (ie, hyaluronic acid, dexamethasone, prednisolone, betamethasone, betamethasone plus hyaluronic acid, morphine, tramadol, platelet-derived growth factor [PDGF], placebo, arthrocentesis alone) administered using intra-articular injections were assessed. The evidence from the direct comparisons showed that arthrocentesis plus sodium hyaluronate resulted in significantly better pain relief outcomes compared with arthrocentesis alone. Also, the visual analog scale score was further reduced to 1.27 by PDGF injection after arthrocentesis (arthrocentesis plus PDGF) compared with arthrocentesis alone. Morphine and tramadol had a high probability of being the best treatment for pain control, with PDGF ranked third. When considering pain relief, arthrocentesis plus sodium hyaluronate resulted in a better outcome than arthrocentesis alone, and arthrocentesis plus PDGF was better than arthrocentesis plus placebo. PDGF injections had the greatest probability of being the best treatment for improving joint opening, followed by sodium hyaluronate. CONCLUSIONS Tramadol, morphine, and PDGF injections after arthrocentesis were effective in the treatment of TMJOA with excellent effects in reducing pain and improving joint opening. Hyaluronic acid injections were effective for improving the maximal mouth opening of patients with TMJOA in the short-term. The combination of a corticosteroid and hyaluronic acid injection reduced the symptoms of TMJOA more than corticosteroid injections alone, but not of hyaluronic acid alone.
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2.
Platelet-rich plasma for the therapeutic management of temporomandibular joint disorders: a systematic review.
Bousnaki, M, Bakopoulou, A, Koidis, P
International journal of oral and maxillofacial surgery. 2018;(2):188-198
Abstract
This systematic review aimed to investigate whether intra-articular injections of platelet-rich plasma (PRP) are beneficial for the treatment of degenerative temporomandibular disorders, such as temporomandibular joint osteoarthritis (TMJ-OA) and disc displacement with osteoarthritic lesions, when compared to other treatments, such as injections of hyaluronic acid (HA) or saline. An electronic search of the MEDLINE and Scopus databases was performed using combinations of the terms "temporomandibular" and "platelet rich plasma", to identify studies reported in English and published up until May 2017. A hand-search of relevant journals and the reference lists of selected articles was also performed. The initial screening identified 153 records, of which only six fulfilled the inclusion criteria and were included in this review. Of these studies, three compared PRP with HA, while three compared PRP with Ringer's lactate or saline. Four of the studies found PRP injections to be superior in terms of improvements in mandibular range of motion and pain intensity up to 12 months after treatment, while the remaining two studies found similar results for the different treatments. There is slight evidence for the potential benefits of intra-articular injections of PRP in patients with TMJ-OA. However, a standardized protocol for PRP preparation and application needs to be established.
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3.
Effectiveness of Intra-Articular Injections of Sodium Hyaluronate or Corticosteroids for Intracapsular Temporomandibular Disorders: A Systematic Review and Meta-Analysis.
Moldez, MA, Camones, VR, Ramos, GE, Padilla, M, Enciso, R
Journal of oral & facial pain and headache. 2018;(1):53–66
Abstract
AIMS: To assess the effectiveness of intra-articular injections of sodium hyaluronate (NaH) or corticosteroids (CS) for treatment of intracapsular temporomandibular disorders (TMD). METHODS Single- or double-blinded randomized controlled trials (RCTs) on the effectiveness of NaH or CS injections, compared to each other or to placebo, for the treatment of intracapsular TMD due to osteoarthritis and/or internal joint derangement were analyzed in this systematic review and meta-analysis. Electronic searches of MEDLINE through the PubMed, Web of Science, and Cochrane Library databases were conducted on March 17, 2015, and an updated search was conducted on June 7, 2017. Three reviewers independently extracted the data and assessed the risk of bias of included studies. RESULTS An initial search yielded 245 studies, and 5 additional studies were identified through cross referencing. A total of 22 studies were identified as relevant based on the abstracts, but only 7 RCTs met the inclusion criteria. Six of the included studies had unclear risk of bias, and one had high risk of bias. Four studies were eligible for meta-analysis. Pooled results showed no significant difference in short- or long-term pain improvement with NaH compared to CS. The number of responders to NaH was significantly more than placebo in one study, but not significantly higher than CS in another study. CONCLUSION Although there was no significant difference between the effectiveness of NaH and CS intra-articular injections, there was some evidence that NaH was better than placebo. Further research is needed to determine the minimum effective dose and long-term side effects of both injections.
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4.
Imaging Approach to Temporomandibular Joint Disorders.
Morales, H, Cornelius, R
Clinical neuroradiology. 2016;(1):5-22
Abstract
Internal derangement is the most common temporomandibular joint disorder. Degenerative osteoarthritis and trauma are next in frequency. Less common pathology includes rheumatoid arthritis, synovial chondromatosis, calcium pyrophosphate dehydrate deposition disease, pigmented villonodular synovitis, tumors, infection, and osteonecrosis. We provide a systematic approach to facilitate interpretation based on major anatomic structures: disc-attachments, joint space, condyle, and lateral pterygoid muscle. Relevant graphic anatomy and state of the art imaging are discussed in correlation with current clinical and therapeutic highlights of pathologic entities affecting the joint.
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5.
Surface EMG of the masticatory muscles (part 2): fatigue testing, mastication analysis and influence of different factors.
Hugger, S, Schindler, HJ, Kordass, B, Hugger, A
International journal of computerized dentistry. 2013;(1):37-58
Abstract
The second part of this review of the literature on the clinical significance of surface electromyography (EMG) of the masticatory muscles systematically examines the results of clinical studies in patients with temporomandibular disorders (TMD), preferably randomized controlled trials, investigating relevant aspects of EMG activity during prolonged chewing activity (fatigue effects), during the mastication process, and under the influence of different factors. Studies on the influence of factors such as gender, age, tooth status, orofacial morphology and (acute) pain, the significance of different occlusal relationships during static and dynamic occlusion, and the impact of changes in static occlusion on EMG activity of the masticatory muscles were included in the review.
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6.
Interventions for the management of temporomandibular joint osteoarthritis.
de Souza, RF, Lovato da Silva, CH, Nasser, M, Fedorowicz, Z, Al-Muharraqi, MA
The Cochrane database of systematic reviews. 2012;(4):CD007261
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Abstract
BACKGROUND Osteoarthritis (OA) is the most common form of arthritis of the temporomandibular joint (TMJ), and can often lead to severe pain in the orofacial region. Management options for TMJ OA include reassurance, occlusal appliances, physical therapy, medication in addition to several surgical modalities. OBJECTIVES To investigate the effects of different surgical and non-surgical therapeutic options for the management of TMJ OA in adult patients. SEARCH METHODS We searched the following databases: the Cochrane Oral Health Group Trials Register (to 26 September 2011); CENTRAL (The Cochrane Library 2011, Issue 3); MEDLINE via OVID (1950 to 26 September 2011); EMBASE via OVID (1980 to 26 September 2011); and PEDro (1929 to 26 September 2011). There were no language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing any form of non-surgical or surgical therapy for TMJ OA in adults over the age of 18 with clinical and/or radiological diagnosis of TMJ OA according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) guideline or compatible criteria.Primary outcomes considered were pain/tenderness/discomfort in the TMJs or jaw muscles, self assessed range of mandibular movement and TMJ sounds. Secondary outcomes included the measurement of quality of life or patient satisfaction evaluated with a validated questionnaire, morphological changes of the TMJs assessed by imaging, TMJ sounds assessed by auscultation and any adverse effects. DATA COLLECTION AND ANALYSIS Two review authors screened and extracted information and data from, and independently assessed the risk of bias in the included trials. MAIN RESULTS Although three RCTs were included in this review, pooling of data in a meta-analysis was not possible due to wide clinical diversity between the studies. The reports indicate a not dissimilar degree of effectiveness with intra-articular injections consisting of either sodium hyaluronate or corticosteroid preparations, and an equivalent pain reduction with diclofenac sodium as compared with occlusal splints. Glucosamine appeared to be just as effective as ibuprofen for the management of TMJ OA. AUTHORS' CONCLUSIONS In view of the paucity of high level evidence for the effectiveness of interventions for the management of TMJ OA, small parallel group RCTs which include participants with a clear diagnosis of TMJ OA should be encouraged and especially studies evaluating some of the possible surgical interventions.
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7.
Myths of orthodontic gnathology.
Rinchuse, DJ, Kandasamy, S
American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics. 2009;(3):322-30
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The human lateral pterygoid muscle.
Murray, GM, Bhutada, M, Peck, CC, Phanachet, I, Sae-Lee, D, Whittle, T
Archives of oral biology. 2007;(4):377-80
Abstract
One of the jaw muscles particularly implicated in temporomandibular disorders (TMD), a common form of non-dental chronic orofacial pain, is the human lateral pterygoid muscle. The precise role of this muscle in TMD is unclear as is the nature of the interaction between pain and motor function particularly involving this muscle. This research group has adopted a two-stage approach to studying the effects of pain on motor function. The first is to study normal orofacial motor function through recordings of jaw movement and electromyographic (EMG) activity from a number of jaw muscles (including recordings from the lateral pterygoid muscle; verification of electrode location achieved through computer tomography imaging) during a number of standardised jaw movements. These studies have defined the detailed functional properties of, in particular, the lateral pterygoid muscle, whose physiology and function is not well understood. In summary, the data are consistent with the hypothesis previously proposed that the lateral pterygoid should be regarded as a system of fibres that acts as one muscle, with varying amounts of evenly graded activity throughout its entire range, and with the distribution of activity within the muscle being determined by the biomechanical demands of the task. Our second approach has been to study the effects of experimental masseter muscle pain on the detailed functional properties (e.g., root-mean-square EMG activity) of the jaw muscles, especially the lateral pterygoid muscle. Preliminary data from these pain studies point towards significant effects of human experimental muscle pain on jaw muscle activity and jaw movement.
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9.
Pathogenesis of degenerative temporomandibular joint arthritides.
Milam, SB
Odontology. 2005;(1):7-15
Abstract
Over the past decade, remarkable progress has been made in the study of molecular mechanisms involved in degenerative temporomandibular joint arthritides. Based on recent findings, models of degenerative temporomandibular joint disease predict that mechanical loads trigger a cascade of molecular events leading to disease in susceptible individuals. These events involve the production or release of free radicals, cytokines, fatty acid catabolites, neuropeptides, and matrix-degrading enzymes. Under normal circumstances, these molecules may be involved in the remodeling of articular tissues in response to changing functional demands. However, if functional demands exceed the adaptive capacity of the temporomandibular joint or if the affected individual is susceptible to maladaptive responses, then a disease state will ensue. An individual's susceptibility to degenerative temporomandibular joint disease may be determined by several factors, including genetic backdrop, sex, age, and nutritional status. It is hoped that, by furthering our understanding of the molecular events that underlie degenerative temporomandibular joint diseases, improved diagnostics and effective therapies for these debilitating conditions will be developed.
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Nasopharyngeal carcinoma: the role of the dentist in assessment, early diagnosis and care before and after cancer therapy.
Mackie, AM, Epstein, JB, Wu, JS, Stevenson-Moore, P
Oral oncology. 2000;(5):397-403
Abstract
Nasopharyngeal carcinoma (NPC) may present first to the dental profession as facial pain, neck masses, difficulty in speech and swallowing, ear, nose and throat symptoms, or as symptoms of temporomandibular disorders (TMD). Recognition of the signs and symptoms are essential in order to lead to the correct diagnosis, and to avoid inappropriate intervention that may further delay diagnosis and initiation of treatment of the cancer. Differentiation between NPC and TMD may be facilitated by specific questioning of other symptoms that are not frequently associated with TMD such as neck masses, nasal obstruction, recent unilateral hearing deficit and epistaxis. The general dentist can become involved at three stages of a patient's experience with NPC: Stage 1, recognition of signs and symptoms; Stage 2, pre-treatment dental assessment; and Stage 3, post-treatment support. This paper is intended to: (1) alert the general dentist of the signs and symptoms associated with NPC, such that timely and appropriate treatment may ensue; (2) provide a basic outline for assessment, preparation, palliation and continuing care of a patient diagnosed with NPC; and (3) underline the significant role of the general dentist in achieving an optimal quality of life for these patients