Clinical evaluation of amitriptyline for the control of chronic pain caused by temporomandibular joint disorders

Temporomandibular disorder (TMD) is characterized by a combination of symptoms affecting the temporomandibular joint and/or chewing muscles. The two most common clinical TMD symptoms are pain and dysfunction. Pain is usually caused by dysfunction, and emergency therapy has focused on controlling it. Recent investigations into TMD have led to the recommendation of antidepressants as a supporting treatment against constant neuralgic pain. The aim of this double-blind study was to verify the efficiency of antidepressants (amitriptyline) as a support in the treatment of chronic TMD pain. Twelve female volunteers presenting chronic TMD pain were divided into two groups and treated for 14 days: Group 1 with 25 mg/day of amitriptyline and Group 2 with a placebo. The intensity of pain and discomfort was evaluated daily, using a visual analog scale (VAS), over a period of seven days preceding the treatment (baseline), during the 14-day treatment, and for seven days after the treatment. The results revealed a significant reduction of pain and discomfort in Group 1 (75%) compared to Group 2 (28%) during the three weeks beginning at baseline (p< 0.01). Amitriptyline proved to be an efficient alternative treatment for chronic pain in TMD patients. Copyright © 2003 by CHROMA, Inc.

Evaluation of temporomandibular joint noise in partially edentulous patients.

In order to evaluate the presence of TMD (temporomandibular disorder), dissatisfaction related to the use of removable partial dentures (RPD) and the effect of the treatment on temporomandibular joint noises, 13 female patients with Kennedy class I and II mandibular arch were selected. Another 13 young, asymptomatic, dentate patients, also female, were used as reference. After four years, 38.4% were found to have a moderate or severe degree of TMD. Over the four years, the degree of TMD increased in 46.15% of the patients, was not affected in 20.07%, while in 15.38% it decreased or the patients remained free from signs and symptoms. About 30% of the patients at the second year and 46% after the fourth year, had complaints regarding retention and stability. It was concluded that there is no relationship between TMD and the condition of partially edentulous Kennedy class I and II, but patient dissatisfaction increased after the second year and temporomandibular joint noise was reduced significantly with the replacement of the teeth.

Relationship between anxiety and chronic orofacial pain of temporomandibular disorder in a group of university students

Purpose: This study evaluated the relationship between anxiety levels and severity degrees of chronic orofacial pain of temporomandibular disorder in brazilian university students. Methods: 150 volunteers (117 men and 33 women), with age ranging from 17 to 30 years, were subjects to this study. Spielberger's trait-state anxiety inventory was used to evaluate trait and state anxiety of the students, while examination for chronic orofacial pain was performed in accordance with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Association between anxiety levels and severity degrees of chronic orofacial pain was tested using the Chi-square test. The significance level was set at p<.05. Results: The results showed that 32.7% (n = 49) of the subjects exhibited TMD, and the intensity of chronic orofacial pain was classified as degree 1 in 85.7% (n = 42) and as degree 2 in 14.3% (n = 7) of them. Based on the results of the Spielberger's trait-state anxiety inventory, the majority of the students had moderate anxiety (48.6% and 48.1%, respectively). The correlation between trait-anxiety levels and chronic orofacial pain degrees was significant and positive (p<.05). However, no significant correlation was found to state-anxiety levels and chronic orofacial pain degrees (p>.05). Conclusion: It was concluded that chronic orofacial pain of TMD could be present in university students and anxiety may be related. © 2010 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved.

Temporomandibular disorders, sleep bruxism, and primary headaches are mutually associated.

To investigate the association among temporomandibular disorders (TMD), sleep bruxism, and primary headaches, assessing the risk of occurrence of primary headaches in patients with or without painful TMD and sleep bruxism. The sample consisted of 301 individuals (253 women and 48 men) with ages varying from 18 to 76 years old (average age of 37.5 years). The Research Diagnostic Criteria for Temporomandibular Disorders were used to classify TMD. Sleep bruxism was diagnosed by clinical criteria proposed by the American Academy of Sleep Medicine, and primary headaches were diagnosed according to the International Classification of Headache Disorders-II. Data were analyzed by chi-square and odds ratio tests with a 95% confidence interval, and the significance level adopted was .05. An association was found among painful TMD, migraine, and tension-type headache (P < .01). The magnitude of association was higher for chronic migraine (odds ratio = 95.9; 95% confidence intervals = 12.51-734.64), followed by episodic migraine (7.0; 3.45-14.22) and episodic tension-type headache (3.7; 1.59-8.75). With regard to sleep bruxism, the association was significant only for chronic migraine (3.8; 1.83-7.84). When the sample was stratified by the presence of sleep bruxism and painful TMD, only the presence of sleep bruxism did not increase the risk for any type of headache. The presence of painful TMD without sleep bruxism significantly increased the risk in particular for chronic migraine (30.1; 3.58-252.81), followed by episodic migraine (3.7; 1.46-9.16). The association between painful TMD and sleep bruxism significantly increased the risk for chronic migraine (87.1; 10.79-702.18), followed by episodic migraine (6.7; 2.79-15.98) and episodic tension-type headache (3.8; 1.38-10.69). The association of sleep bruxism and painful TMD greatly increased the risk for episodic migraine, episodic tension-type headache, and especially for chronic migraine.

Estudo da prevalência de cefaléias primárias e da sua associação com a dor orofacial em pacientes com disfunção temporomandibular crônica

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Painful temporomandibular disorders, self reported tinnitus, and depression are highly associated

Objetivo Investigar a associação entre disfunção temporomandibular (DTM) dolorosa, auto-relato de zumbido e níveis de depressão. Método A amostra foi composta por 224 indivíduos com idades de 18 a 76 anos. O Research Diagnostic Criteria for Temporomandibular Disorders , eixo I, foi usado para classificar a DTM e o eixo II para obtenção do auto-relato de zumbido e dos níveis de depressão. Para a análise dos dados, foi aplicado o teste odds ratio (OR) com intervalo de confiança (IC) de 95%. Resultado Somente a presença de DTM dolorosa estava significativamente associada aos níveis de depressão moderado/severo (OR=9,3, 95%; IC: 3,44-25,11). A presença concomitante de DTM dolorosa e auto-relato de zumbido aumentaram a magnitude da associação com os níveis de depressão moderado/severo (OR=16,3; 95% IC: 6,58-40,51). Conclusão Disfunção temporomandibular dolorosa, altos níveis de depressão e auto-relato de zumbido estão fortemente associados. Entretanto, o desenho do estudo não permite estabelecer uma relação causal entre essas três entidades.

Treatment of Comorbid Migraine and Temporomandibular Disorders: A Factorial, Double-Blind, Randomized, Placebo-Controlled Study

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Avaliação Postural em Sujeitos com Disfunção Temporomandibular Submetidos a Tratamento de Terapia Manual

Individuals with temporomandibular disorders (TMD) often have signs and symptoms such as intra-articular pain, muscle spasm, neck pain radiating from others who interfere with this balance. Over time can lead to postural changes and correction of the cervical spine, anterior head and shoulder asymmetry. The aim was to verify the effects of manual therapy on posture in subjects with TMD. Materials and methods: 30 volunteers (mean: 21.43± SD:1.43) of both sexes who had TMD classified according to axis I of the Research Diagnostic Criteria participated in this study. These were photographed in the anterior frontal and sagittal planes for analysis of the following angles (acromion clavicular joint, sternoclavicular joint, orbicular external, corners of the mouthand and protruding head). After, the volunteers were divided into groups ATM (manual therapy in the treatment of temporomandibular joint), Cervical (manual therapy in the treatment of cervical joint) and Control. The Kolmogokov-Smirnov test, followed by ANOVA, considering a significance level of 5% was used. Results: Groups ATM, Cervical and Control were considered homogeneous with respect to the values of the angles measured. These also showed no significant difference between the 1st, 5th and 10th sessions, so the manual therapy techniques applied to the TMJ and Cervical groups were not sufficient to change postural alignment. Conclusion: The postural alignment, the TMD patients evaluated in this study did not change after attending the sessions proposals with manual therapy techniques in the cervical and TMJ.

Prevalência de alterações locais e sistêmicas em indivíduos com disfunção temporomandibular

Temporomandibular disorder describes a variety of conditions including joint and muscle in the stomatognathic system, characterized by pain, TMJ sounds, functions irregular jaw and represent the leading cause of nondental pain in the orofacial region. The objective of this research was to evaluate the prevalence of ophthalmological, otological and cognitive-behavioral changes, parafunctional habits in individuals with temporomandibular disorders (TMD). A total of 117 medical records of female and male individuals, aged 18 to 60 years, from the Occlusion, Temporomandibular Dysfunction and Orofacial Pain of the Ribeirão Preto School of Dentistry – USP, between 2010 and 2011. The anamnesis index proposed by Helkimo was used to classify the individuals according to TMD severity degree and to divide them into two groups: AiI (mild to moderate) with 69 individuals and AiII (severe) with 48 individuals. The groups were then subdivided with respect to gender (72.64% female and 27.36% male) and age. There was predominance in the 18-40 year age group (60.68%) when compared to the 41-60 year age group (39.32%). Data were collected through an interview with questions about the presence of parafunctional habits, otological, ophthalmological and behavioral changes. Data were subjected to the statistical analysis using the Kruskal-Wallis test. The prevalence of each change was also evaluated. The results showed statistically significant for all groups according to gender, age and degree of severity. Individuals with temporomandibular disorders exhibited high prevalence of systemic and local dysfunctions.

Association between painful temporomandibular disorders, sleep bruxism and tinnitus

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Temporomandibular disorders among Brazilian adolescents: reliability and validity of a screening questionnaire

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Low Level Laser Therapy as an Adjunctive Technique In the Management of Temporomandibular Disorders

The purpose of this study was to assess the effect of low level laser therapy on subjects with intra-articular temporomandibular disorders (IA-TMD), and to quantify and compare severity of signs and symptoms before, during, and after the laser applications. The sample consisted of 45 subjects randomly divided into three groups (G) of 15 subjects each: G-I: 15 individuals with IA-TMD submitted to an energy dose of 52.5 J/cm(2); G-II: dose of 105.0 J/cm(2); and G-III: placebo group (0 J/cm(2)). In all groups, the applications were performed on condylar points on the masseter and anterior temporalis muscles. Two weekly sessions were held for five weeks, totaling 10 applications. The assessed variables were: mandibular movements and painful symptoms evoked by muscle palpation. These variables were measured before starting the study, then immediately after the first, fifth, and tenth laser application, and finally, 32 days after completing the applications. The results showed that there were statistically significant differences for G-I and G-II at the level of 1% between the doses, as well as between assessments. Therefore, it was concluded that the use of low level laser increased the mean mandibular range of motion and reduced painful symptoms in the groups that received effective treatment, which did not occur in the placebo group.

Electromyographic indices, orofacial myofunctional status and temporomandibular disorders severity: A correlation study

This study examined whether there is an association between surface electromyography (EMG) of masticatory muscles, orofacial myofunction status and temporomandibular disorder (TMD) severity scores. Forty-two women with TMD (mean 30 years, SD 8) and 18 healthy women (mean 26 years, SD 6) were examined. According to the Research Diagnostic Criteria for TMD (RDC/TMD), all patients had myogenous disorders plus disk displacements with reduction. Surface EMG of masseter and temporal muscles was performed during maximum teeth clenching either on cotton rolls or in intercuspal position. Standardized EMG indices were obtained. Validated protocols were used to determine the perception severity of TMD and to assess orofacial myofunctional status. TMD patients showed more asymmetry between right and left muscle pairs, and more unbalanced contractile activities of contralateral masseter and temporal muscles (p < 0.05, t-test), worse orofacial myofunction status and higher TMD severity scores (p < 0.05, Mann-Whitney test) than healthy subjects. Spearman coefficient revealed significant correlations between EMG indices, orofacial myofunctional status and TMD severity (p < 0.05). In conclusion, these methods will provide useful information for TMD diagnosis and future therapeutic planning. (C) 2011 Elsevier Ltd. All rights reserved.

Validity of the 'protocol of oro-facial myofunctional evaluation with scores' for young and adult subjects

The aims of this study were to analyse the validity, sensitivity and specificity of the protocol of oro-facial myofunctional evaluation with scores (OMES) for oro-facial myofunctional disorder (OMD) diagnosis in young and adult subjects. Eighty subjects were examined. The OMES was validated against the Nordic Orofacial Test-Screening (NOT-S) protocol (criterion validity) (Spearman correlation test). The construct validity was tested by analysis of the ability of the OMES (i) to differentiate healthy subjects (n = 22) from temporomandibular disorder (TMD) patients (n = 22), which frequently have OMD (MannWhitney test) and (ii) to measure the changes that occurred in a subgroup with TMD between the period before and after oro-facial myofunctional therapy (T group, n = 15) (Wilcoxon test). Two speech therapists trained with the OMES participated as examiners (E). There was a statistically significant correlation between the OMES and NOT-S protocols, which was negative because the two scales are inverse (r = -0.86, P < 0.01). There was a significant difference between the healthy and TMD subjects regarding the oro-facial myofunctional status (OMES total score, P = 0.003). After therapy, the T group showed improvement in the oro-facial myofunctional status (OMES total score, P = 0.001). Inter- and intra-examiner agreement was moderate, and the reliability coefficients ranged from good to excellent. The OMES protocol presented mean sensitivity and specificity = 0.80, positive predictive value = 0.76 and negative predictive value = 0.84. Conclusion: The OMES protocol is valid and reliable for clinical evaluation of young and adult subjects, among them patients with TMD.

Effect of low-level laser therapy on pain levels in patients with temporomandibular disorders: a systematic review

Temporomandibular disorders (TMD) are characterized by the presence of temporomandibular joint (TMJ) and/or masticatory muscle pain and dysfunction. Low-level laser is presented as an adjuvant therapeutic modality for the treatment of TMD, especially when the presence of inflammatory pain is suspected. Objective: To systematically review studies that investigated the effect of low level laser therapy (LLLT) on the pain levels in individuals with TMD. Material and Methods: The databases Scopus, embase, ebsco and PubMed were reviewed from January/2003 to October/2010 with the following keywords: laser therapy, low-level laser therapy, temporomandibular joint disorders, temporomandibular joint dysfunction syndrome, temporomandibular joint, temporomandibular, facial pain and arthralgia, with the inclusion criteria for intervention studies in humans. exclusion criteria adopted were intervention studies in animals, studies that were not written in english, Spanish or Portuguese, theses, monographs, and abstracts presented in scientific events. Results: After a careful review, 14 studies fit the criteria for inclusion, of which, 12 used a placebo group. As for the protocol for laser application, the energy density used ranged from 0.9 to 105 J/cm², while the power density ranged from 9.8 to 500 mW. The number of sessions varied from 1 to 20 and the frequency of applications ranged from daily for 10 days to 1 time per week for 4 weeks. A reduction in pain levels was reported in 13 studies, with 9 of these occurring only in the experimental group, and 4 studies reporting pain relief for both the experimental group and for the placebo. Conclusion: Most papers showed that LLLT seemed to be effective in reducing pain from TMD. However, the heterogeneity of the standardization regarding the parameters of laser calls for caution in interpretation of these results. Thus, it is necessary to conduct further research in order to obtain a consensus regarding the best application protocol for pain relief in patients with TMD.