Temporomandibular disorders and the need for stomatognathic treatment in orthodontically treated and untreated girls.
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The aim of this investigation was to study symptoms of temporomandibular disorders (TMD) and headaches longitudinally in girls with Class II malocclusions receiving orthodontic treatment in comparison with subjects with untreated Class II malocclusions and girls with normal occlusion, and to evaluate the need and demand for stomatognathic treatment. The frequency and location of subjective symptoms of TMD and headaches were registered by means of an interview and a questionnaire in three groups of age-matched adolescent girls. Sixty-five Class II subjects received orthodontic fixed straight-wire appliance treatment (Orthodontic group), 58 with Class I malocclusion were orthodontically untreated (Class II group) and 60 had a normal occlusion (Normal group). Individual fluctuations of reported symptoms of TMD were found in all three groups over the 2-year period of the study. Subjects with untreated Class II malocclusions rated their overall symptoms of TMD as more severe than the Orthodontic and the Normal groups. In the Orthodontic group, the prevalence of symptoms of TMD decreased over the 2 years. The overall prevalence of symptoms of TMD was, however, lower in the Normal group than in the other two groups. The need for stomatognathic treatment in the whole sample was estimated to be 13 per cent, while the actual demand was 3 per cent. The large fluctuation of symptoms of TMD over time leads us to suggest a conservative treatment approach when stomatognathic treatment in children and adolescents is considered. The results show that orthodontic treatment did not increase the risk of TMD. (+info)
Temporomandibular dysfunction in patients treated with orthodontics in combination with orthognathic surgery.
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Fifty-two patients with malocclusions underwent orthodontic treatment in combination with orthognathic surgery involving a Le Fort I and/or sagittal split osteotomy. Approximately 5 years after surgery, the patients were examined for signs and symptoms of temporomandibular disorders (TMD). The frequencies were found to be low in comparison with epidemiological studies in this field. The aesthetic outcome and chewing ability were improved in most patients (about 80 per cent). Some of the patients had reported recurrent and daily headaches before treatment. At examination, only two patients had reported having a headache once or twice a week, while all the others suffered from headaches less often or had no headache at all. Eighty-three per cent of the patients reported that they would be prepared to undergo the orthodontic/surgical treatment again with their present knowledge of the procedure. This study shows that orthodontic/surgical treatment of malocclusions not only has a beneficial effect on the aesthetic appearance and chewing ability, but also results in an improvement in signs and symptoms of TMD, including headaches. (+info)
A case of anterior open bite developing during adolescence.
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Imaging studies have reported on the relationship between temporomandibular joint (TMJ) degeneration and facial deformity. These studies have suggested that mandibular growth is affected by TMJ degeneration, resulting in altered skeletal structure as mandibular retrusion. However, there are very few longitudinal case reports on TMJ osteoarthrosis (OA). Progressive open bite occurred in an adolescent patient with TMJ OA. Cephalometric analysis showed a downward and backward rotated mandible, and a labial inclination of the upper incisor. Magnetic resonance imaging showed internal derangement without reduction and erosion in the right and the left condyles. Although the cause of open bite is unclear in this case, tongue thrusting, and internal derangements in the temporomandibular joint were suspected as causes of the open bite. (+info)
Variability in sleep bruxism activity over time.
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Sleep bruxism (SB) is an oral activity associated with jaw movements and tooth grinding. Sleep bruxism is believed to be highly variable over time, with subjects showing no activity on some nights and intense activity on others. Assessment of SB variability in individual patients is necessary for clinical trials designed to estimate the efficacy of SB management strategies. The present study analysed SB night-to-night variability over time in nine moderate to severe SB patients. Excluding the first night for habituation, a total of 37 nights were analysed, with a range of 2-8 nights per subject. The interval between the first and the last recording was between 2 months and 7.5 years. The outcomes were the number of SB episodes per hour, number of SB bursts per hour and number of SB episodes with grinding noise. The within subject variability of the three SB oromotor outcomes was evaluated using standard deviation (SD) and coefficient of variation. To verify the diagnosis of subjects over time, the values of the oromotor outcomes were compared with a standard research diagnostic cut-off: (1) Number of SB episodes per hour >4, (2) Number of SB bursts per hour >25, (3) Number of SB episodes with noise per night >1 (Lavigne et al. 1996). The mean coefficient of variation for the nine subjects was 25.3% for SB episodes per hour, 30.4% for SB bursts per hour and 53.5% for episodes with noise. Linear regression showed that the number of SB episodes per hour of stages 1 and 2 explains a large proportion of the variability. The SB diagnosis remained constant over time for every subject: 35 nights over 37 respected criteria 1 and 2, while grinding was present every night. These results indicate that while the SB diagnostic remains relatively constant over time in moderate to severe sleep bruxers, individual variability could be important in some SB patients. (+info)
Emotional stress and brux-like activity of the masseter muscle in rats.
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The aim of this study was to further clarify the relationship between emotional stress and bruxism. In experiment 1, 60 male 9-week-old Wistar rats were divided into four groups: the emotionally stressed (ES), the emotionally non-stressed (NS), the electrically foot-shocked (FSd), and the non-foot-shocked (NSd). ES rats were confined in a communication box for one hour a day to observe the emotional responses of neighbouring FSd rats. On days 0, 1, 4, 8, and 12, the electromyographic activity of the ES and NS rats' left masseter muscles was recorded for one hour, three hours after confinement in the communication box. Brux-like activity appeared in the masseter muscle of the ES group on days 1, 4, 8, and 12, but not in the NS group. In experiment 2, 36 male Wistar rats, 9 weeks old, were divided into three groups: emotionally stressed rats treated with an anti-anxiety drug (DES), emotionally stressed rats treated with saline as a vehicle (VES), and 24 FSd rats. Stress and EMG procedures were the same as those in experiment 1. Brux-like episodes decreased in DES rats from day 1 and significant differences were found on days 4 (P < 0.01), 8 (P < 0.05), and 12 (P < 0.05), when compared with the VES group. These findings suggest that emotional stress induces brux-like activity in the masseter muscle of rats, which was reduced with anti-anxiety drugs. (+info)
The cracked tooth syndrome.
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The purpose of this article is to review the clinical features, diagnosis and management of the cracked tooth syndrome (CTS). The condition refers to an incomplete fracture of a vital posterior tooth that occasionally extends into the pulp. A lack of awareness of the condition coupled with its varied clinical features can make diagnosis of CTS difficult. Common symptoms include an uncomfortable sensation or pain from a tooth that occurs while chewing hard foods and which ceases when the pressure is withdrawn. The patient is often unable to identify the offending tooth or quadrant involved, and may report a history of numerous dental procedures with unsatisfactory results. Successful diagnosis and management requires an awareness of the existence of CTS and the appropriate diagnostic tests. Management options depend on the nature of the symptoms and extent of the lesion. These options include routine monitoring, occlusal adjustments, placement of a cast restoration and endodontic treatment. A decision flowchart indicating the treatment options available to the dental practitioner is presented. (+info)
Oral habits of temporomandibular disorder patients with malocclusion.
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The purpose of this study was to clarify the relationship between oral habits and symptoms of temporomandibular joint disorder in patients who had sought orthodontic treatment by analyzing their present and past history. The subjects were 57 female patients (average age: 23 years and 6 months old) who had visited the "Temporomandibular Disorder Section" in our orthodontic department. Their chief complaints were the symptom of TMJ and the abnormalities of occlusion such as maxillary protrusion, open bite, crowding, mandibular protrusion, cross bite, deep bite, edge-to-edge bite, and spacing. Their present conditions and past histories were examined and evaluated. The most typical primary symptom was joint sound (23 patients, 40.0%). The second was joint sound and pain (15 patients, 26.3%). Of the symptoms present at the time of examination, the most prevalent were joint sound and pain (20 patients, 35.1%). The 48 patients (82.8%) had significant oral habits. Unilateral chewing was seen in 35 patients (72.9%), bruxism in 27 (56.3%), abnormality of posture in 14 (29.2%), habitual crunching in 10 (20.8%) and resting the check on the hand in 4 (8.3%), respectively. When comparing the primary symptoms to those at the time of examination, the patients with unilateral chewing and bruxism tended to have more complicated symptoms. In conclusion, the TMD symptoms of the patients with notable oral habits did not change or become worse during a period of about 5 years. (+info)
Signs and symptoms of temporomandibular disorders in adolescents.
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The aim of this study was to verify the prevalence of signs and symptoms of temporomandibular disorders (TMD) in adolescents and its relationship to gender. The sample comprised 217 subjects, aged 12 to 18. The subjective symptoms and clinical signs of TMD were evaluated, using, respectively, a self-report questionnaire and the Craniomandibular Index, which has 2 subscales; the Dysfunction Index and the Palpation Index. The results of muscle tenderness showed great variability (0.9-32.25%). In relation to the temporomandibular joint, tenderness of the superior, dorsal and lateral condyle regions occurred in 10.6%, 10.6% and 7.83%, respectively, of the sample. Joint sound during opening was present in 19.8% of the sample and during closing in 14.7%. The most prevalent symptoms were joint sounds (26.72%) and headache (21.65%). There was no statistical difference between genders (p > 0.05), except for the tenderness of the lateral pterygoid muscles, which presented more prevalence in girls. In conclusion, clinical signs and symptoms of TMD can occur in adolescents; however, gender influence was not perceived. (+info)