Atypical odontalgia describes atypical facial pain in apparently normal teeth. Unfortunately, dentists usually consider this diagnosis only after the failure of invasive treatment. Atypical odontalgia patients are typified by women in their mid-40s who complain of persistent pain in one or more premolar or molar teeth. They associate pain with dental procedures or trauma to the region. While the cause of atypical odontalgia is uncertain, deafferentation pain appears to be a plausible mechanism. This article reviews relevant aspects of this perplexing pain problem. To help avert the untimely diagnosis of atypical odontalgia, identifying inclusion criteria are presented.
To investigate the nocturnal motor activity associated with teethgrinding, 12 patients and 12 controls were recorded during sleep with the masseter muscle electromyogram (EMG) and the static charge-sensitive bed movement sensor. The frequency of body movements per hour was 21.4 in the teethgrinders and 14.0 (P less than .05) in the control group. The movement time was 87.4 seconds per hour in the teethgrinders and 55.2 seconds per hour (P less than .01) in the controls. The differences were most obvious in the body movements with temporal association to EMG elevation during the first stage of sleep. The number of isolated EMG elevations showed great interindividual variation and did not differ between groups. The teethgrinders complained more frequently of delayed sleep onset and daytime tiredness. The data suggest that the motor disturbance of teethgrinding is not limited to masticatory muscles but is manifested also as increased general body movement activity.
Collagen failure has been shown to result in synovitis, joint adhesions, and internal joint derangement. This case report illustrates the similarities between patients with systemic lupus erythematosus and an internally deranged temporomandibular joint and patients with internal derangement with no lupus erythematosus. If abnormalities in intra-articular collagen tissue lead to adhesion formation and restrict normal mobility during translatory movements, joint mechanics would be compromised. Arthritic changes, vasculitis, and synovitis of systemic lupus erythematosus appear to be contributory factors in this pathophysiologic process. Diagnostic and therapeutic arthroscopic surgery was performed. Acute and chronic signs of synovitis were observed during surgery, and tissue samples were obtained for histologic interpretation.
This study examined whether pretreatment psychological characteristics of temporomandibular disorder (TMD) patients were related to the response to treatment in a TMD and facial pain clinic. The care provided to patients was either an evaluation only or an evaluation followed by a course of physical medicine/dental procedures (occlusal appliances, physical therapy, anti-inflammatory medications). Outcomes were assessed in terms of pain levels, jaw function difficulties, and satisfaction with care at 6 months posttreatment by phone and 16 months posttreatment by mail. There were no pretreatment differences between treated and evaluated patients except for higher pretreatment jaw function difficulty scores in the evaluated only patients. Factor analysis of pretreatment scores revealed distrust, pain, anxiety, and somatization. Somatization predicted follow-up pain levels at both follow-ups in the treated patients but only at the 16-month follow-up in the evaluated only patients. Pretreatment pain levels predicted posttreatment pain in both groups only at the 6-month follow-up. Posttreatment jaw function difficulties were related inconsistently to the pretreatment dimensions, while satisfaction was not predicted by pretreatment scores except for a possible connection between this outcome and distrust. It is concluded that an overconcern about bodily functioning appears to decrease the likelihood that patients obtain pain relief from physical medicine care.
To investigate the influence of nonworking-side interferences on mandibular masticatory movements and signs and symptoms of dysfunction of the masticatory system, an experimental balancing-side interference was introduced in 12 healthy subjects for 1 week. The individual response to the interference varied substantially. However, some of the movement variables were significantly changed immediately after insertion, but an adaptation of the neuromuscular system to the interference was evident at the end of the experimental period.
The interdependence of joint noises on age and gender was studied mixed-longitudinally in orthodontically treated subjects from 7 to 38 years of age. The prevalence of clicking signs and symptoms increased up to 25 years of age and leveled thereafter. Around age 19, a significant gender difference was present in clicking symptoms, with females reporting more clicks. The same pattern, although not significantly, was present for palpated clicks. Since male and female clicking prevalences are the same before and after adolescence, and since girls mature at an earlier age than boys, it is concluded that these noises reflect a maturity level rather than a multifactorial disorder. The prevalence of crepitation continued to increase slowly.
Histochemical enzyme reactions and physiological recordings of limb and jaw muscles have independently revealed three to five types of muscle fibers. Surprisingly, type II fibers are smaller than type I fibers in major human jaw muscles. This is the opposite of the situation in limb muscles. Human jaw muscles contain mixed fiber types. Type I fibers predominate in lateral pterygoid and type II fibers in digastric muscles. The masseters in carnivorans and rodents contain mainly type II fibers, whereas those of some herbivorans, including rabbits and bovids, contain mainly type I fibers. Attempts were made to describe the functional significance of some observations.
Only a few cases of condylar penetration into the middle cranial fossa have been documented in the literature. This study attempts to provide an anatomical explanation for this rare phenomenon. Mandibular (glenoid) fossa position in relation to important endocranial and exocranial structures located in close proximity to the TMJ, and relative condyle-fossa size, were evaluated on a dry skull sample. Additional osseous relationships were observed on cadaver material using dissection and x-ray. The anatomic relationships of the mandibular fossa and superior structures that appear to buttress it are described. It is concluded that the temporal squama that lies superior to the mandibular fossa provides a powerful buffer, which prevents condylar endocranial penetration in cases of an appropriate traumatologic mechanism.
Analysis of research on psychological aspects of temporomandibular disorders suggests that self-reports of symptoms do not constitute reliable instruments for the measurement of physiological processes. In TMJ clicking, the actual physiological signal can be measured and compared with self-reports of the sounds. In this article a model is presented to describe perception, interpretation, and reporting of TMJ sounds. Three questionnaires are presented that measure aspects of these psychological processes. Recommendations are made for future research.
Agreement between observers classifying TMJ sounds from data given in records of nonpatient adolescents was almost perfect in this interobserver study. Intraobserver and interobserver agreement in classifying all specific TMJ sounds at palpation and auscultation was acceptable to moderate (kappa value = 0.49 to 0.74). The agreement was considerably more reliable when classifying only one specific TMJ sound. Measurements of linear jaw opening showed small interobserver differences (coefficient of variation = 2.4 to 3.8). The significant difference found in calculating the angular mandibular opening may be the result of difficulties in maintaining maximum passive opening.
This laboratory study investigated the recording reliability and analysis of the K6 Diagnostic System, a computerized instrument that records mandibular movements in three planes. Two special devices were utilized for this purpose, one commercially available and the other designed and constructed by the authors. These devices could produce linear movements and simulate head and mandibular movements, respectively. The largest distortion of the simulated mandibular movements was found in the frontal plane tracings of simulated chewing patterns. For the linear movements in an x-axis, the error of the analyzed K6 system ranged from 9.4% to 30% and in a z-axis from 0% to 15%. A considerable degree of head movement was required to produce a significant error on the K6 measurements.
Twenty-three adult female patients were studied before and after injection of one temporomandibular joint to relieve pain. These patients had exhibited a persistent history of pain within their mandibular, neck, and somatic muscles, despite repeated treatment involving occlusal splints, physical therapy, and biofeedback. Patients were also screened for possible condylar degeneration using corrected tomograms. Initially, patients rated their pain on a linear scale from 0 to 10 and designated the site of the pain on a full-body-profile chart. The presence and location of the pain was determined by manual palpation using a rating scale of 0 to 10, and by the patients designating those regions perceived as painful by marking a full-body-profile chart. After this initial screening, subjects received an injection of 1% lidocaine (1:100,000) to the upper intracapsular space of one joint. The pain profile chart was completed by the patients 15 minutes after injection. Twenty of the 23 patients demonstrated a significant decrease in pain located in facial, head, and neck regions. These data suggest that injection of a local anesthetic to the temporomandibular joint will decrease pain for a short time in ipsilateral and contralateral regions of the head and neck.
In 32 consecutive patients with temporomandibular disorders radiographic changes were correlated with the patients' assessment of treatment outcome. The patients had been referred for tomographic examination because the clinical signs and anamnestic data were inadequate for definite clinical diagnosis. Initially all patients were treated conservatively with a flat occlusal splint. Surgery was advised in appropriate cases. The subjective effect of treatment was assessed using a questionnaire, and the material was divided into responder and nonresponder groups. Seventy-eight percent (25) of the patients experienced a positive subjective response to the treatment. No radiographic sign was found to be statistically correlated to the outcome of treatment.
Three cohorts of subjects in their 70s (born in 1901 to 1902, 1906 to 1907, and 1911 to 1912; n = 1,065) were investigated by means of questionnaires and clinical examination. The first cohort was followed to age 83 and the others to age 75. Symptoms of craniomandibular dysfunction were reported less frequently with increasing age. This was especially marked in men. Clinical signs of severe dysfunction were rare, and according to the Helkimo classification they tended to decrease with increasing age. The longitudinal results mainly confirmed the cross-sectional data. The results indicated that there is no increased risk of craniomandibular dysfunction with aging. On the contrary, awareness of such symptoms tended to decrease with aging.
