BACKGROUND:Surgical treatment of temporomandibular joint (TMJ) disc displacement (DD) has been established in different forms since over a century. Ther is a consensus to perform minimal invasive interventions as first-line surgical treatment since there are no evidence on best surgical practice yet.OBJECTIVE:The aim was to perform a complex systematic review (SR) on the topic-is there evidence for surgical treatment of TMJ DD?METHODS:The PICO was defined as DD patients (population), treated with different surgical interventions including arthrocentesis (intervention), compared with other or no treatment (control) regarding the outcome variables mandibular function, mouth opening capacity, TMJ pain, etcetera (outcome). For identification of prospective controlled trials and SRs, a search strategy was developed for application in three databases.RESULTS:The search yielded 4931 studies of which 56 fulfilled the stipulated PICO. Studies with low or moderate risk of bias were possible to include in meta-analyses. There were evidence suggesting arthrocentesis being more effective compared to conservative management (maximum interincisal opening (MIO): p < .0001, I2 = 22%; TMJ pain: p = .0003, I2 = 84%) and arthrocentesis being slightly more effective than arthrocentesis with an adjunctive hyaluronic acid injection (MIO: p = .04, I2 = 0%; TMJ pain: p = .28, I2 = 0%). Other treatment comparisons showed nonsignificant differences. The performed meta-analyses only included 2-4 studies each, which might indicate a low grade of evidence.CONCLUSION:Although arthrocentesis performed better than conservative management the findings should be interpreted cautiously, and non-invasive management considered as primary measure. Still, several knowledge gaps concerning surgical methods of choice remains.

Purpose To investigate the outcome of patients with long-term refractory temporomandibular disorders (TMD) three years after a Norwegian interdisciplinary evaluation program with attention to patient satisfaction, function, pain, and psychosocial variables. Patients and Methods The study population consisted of 60 long-term refractory TMD patients who were investigated by a Norwegian interdisciplinary team. A questionnaire that covered medical history, function, pain, lifestyle factors, TMD-status and follow-up from their general medical practitioner (GMP) was sent to the patients three years after the evaluation. Questionnaires that assessed function (Mandibular Functional Index Questionnaire [MFIQ] and Roland Morrison Scale [RMS]), pain intensity (General Pain Intensity questionnaire [GPI]) and psychosocial factors (Hospital Anxiety and Depression scale [HADS]); a 2-item version of the Coping Strategies Questionnaire [CSQ]) were included in the package. Results Thirty-nine out of 60 TMD patients completed the questionnaires. Improvements in TMD symptoms were reported in 10 patients (26%), were unchanged in 16 patients (41%) and worsened in 13 patients (33%). Only 8 patients (21%) were satisfied with the follow-up of the suggested treatments from their GMP. Significant improvements of symptoms were noted in MFIQ (jaw function), GPI (including pain intensity at maximum and suffering from pain), and CSQ (pain related catastrophizing), in all 39 TMD patients as one group. However, a subgroup analysis showed that the significant improvements were mostly within patients who reported improvement of TMD symptoms. A high pain intensity at baseline was a significant risk factor (OR = 5.79, 95% CI: 1.34, 24.96) for patients who reported worsening of TMD symptoms at follow-up. Conclusion High pain intensity at baseline was a significant risk factor for poorer recovery three years after an interdisciplinary evaluation. Our data support the notion that improved coping with TMD pain includes both decreased pain intensity, CSQ and MFIQ scores.

Temporomandibular joint (TMJ) disease classification and subsequent treatment selection are highly debated subjects within dentistry and medicine. Several suggestions for diagnostic classification and treatment algorithms have been proposed thus far without achieving a clear gold standard. A universally accepted diagnostic classification is essential for therapeutic decision-making as well as a prerequisite for prognostic evaluation and is necessary for achieving research results that are reproducible, comparable, relevant, and applicable in the clinical setting. Often, problems of the TMJ are viewed as mere symptoms or as a syndrome-like group of conditions, without clear demarcation, impeding individualized treatment planning. A Scandinavian group of experienced TMJ surgeons participated in an iterative, structured group discussion process in accordance with the Delphi method, aiming to produce recommendations for a standardized patient clinical evaluation in relation to TMJ dysfunction. Guided by this standardized evaluation, a disease-focused and simplified diagnostic classification scheme is herein suggested.

Temporomandibular disorders (TMDs) are characterized by moderate to severe pain in the masticatory muscles and/or the temporomandibular joint (TMJ). The present study is a part of a multidisciplinary project, initiated by the Norwegian Ministry of Health. The main purpose of this study is to compare a cohort of TMD patients to healthy individuals regarding experimental pain, the degree of disability caused by living with pain and psychometric variables, and to investigate which of these variables is the best predictor for TMD patients. We hypothesised that TMD patients have more disability when living with pain and lower pain thresholds than healthy controls, and those psychometric variables are stronger predictors than pain thresholds provoked by experimental pain. Sixty TMD patients were matched by sex and age to sixty healthy individuals without TMD symptoms or other musculoskeletal symptoms in the head and neck region. All subjects completed a questionnaire that included psychometric characteristics, that is, a one- and two-item version of the Pain Catastrophizing Scale, the Hospital Anxiety and Depression Scale (HADS), and the Roland Morris Scale (RMS), which measures disability when living with pain. They also underwent a clinical examination including the measurement of pain thresholds with electrical and pressure stimuli. The TMD patients had lower pain thresholds for experimental electrical and pressure stimuli compared with the controls ( P < 0.05 and <0.001, respectively). They also scored higher than healthy individuals with disability living with pain ( P < 0.001 ), anxiety ( P < 0.001 ), depression ( P < 0.001 ), and catastrophizing ( P < 0.001 ). The results for anxiety, depression, and catastrophizing have been published earlier, and the reused data in this study are compared with RMS and pain thresholds. The conditional logistic regression model identified catastrophizing (OR = 2.42, CI 1.22–4.79) as a significant predictor of TMD patients. The results support this hypothesis and indicate that TMD patients have lower pain thresholds and more disability when living with pain compared to healthy individuals, where the strongest prediction for TMD was catastrophizing. Awareness of psychometric disabilities in TMD patients is of importance when considering the choice of treatment.

Temporomandibular disorder (TMD) is characterized by pain and dysfunction in the temporomandibular join (TMJ) and the masticatory apparatus. Associations with autoimmune diseases, inflammatory conditions, and nutrition deficiencies have been reported in previous studies of TMD patients. To evaluate essential proteins, hormones, electrolytes, and vitamins in serum from TMD patients, a standard blood sample analysis was performed in 60 TMD patients and 60 healthy controls matched for age and gender, retrieving 19 different analyses. We found that TMD patients had significantly higher values of hemoglobin (p=0.036), cobalamin (p=0.023), albumin (p=0.005), parathyroid hormone (PTH) (p=0.038), and vitamin D (p=0.005), and significantly lower values of creatinine (p=0.006) and potassium (p=0.011), compared to controls. In the TMD group, most of the determinants had a wider range, and several subjects, compared to the control group, had values outside the normal reference area. However, most of the TMD patients and controls had values within normal biological range. Our findings could not associate any severe systemic disease, malnutrition, or systemic inflammation with the TMD. Results from our study suggest that serum analyses should neither be used as a biomarker of TMD nor a diagnostic tool for an individual subject with TMD.

Temporomandibular disorders (TMDs) are characterized by pain and dysfunction in the masticatory apparatus and the temporomandibular joint (TMJ). Previous trauma, stress symptoms, psychosocial impairment, and catastrophizing have been related to TMD. To assess if the hypothalamic-pituitary-adrenal (HPA) axis is upregulated in TMD patients, we performed a cross-sectional study with saliva from 44 TMD patients and 44 healthy sex- and age-matched controls for cortisol (F) and cortisone (E) with liquid chromatography-tandem mass spectrometry. Furthermore, we calculated the F/E ratio for the evaluation of 11 β -hydroxysteroid dehydrogenase activity. We also assessed anxiety/depression and pain catastrophizing scores from a questionnaire that participants completed prior to the examination. We found that F (P=0.01), E (P=0.04), the F/E ratio (P=0.002), and the sum of glucocorticoids (E + E) in saliva (P=0.02) were significantly higher in the TMD group. Anxiety/depression and catastrophizing scores were also significantly higher in the TMD group (P<0.0001). Our findings indicate that patients with TMDs may have an upregulated HPA axis with higher F secretion from the adrenal cortex. Anxiety/depression and pain catastrophizing scores were significantly higher in the TMD group, and psychological factors may contribute to chronic upregulation of the HPA axis.

Autologous grafting, despite some disadvantages, is still considered the gold standard for reconstruction of maxillofacial bone defects. The aim of this study was to evaluate bone regeneration using bone marrow-derived mesenchymal stromal cells (MSCs) in a clinical trial, a less invasive approach than autologous bone grafting. This comprehensive clinical trial included subjects with severe mandibular ridge resorption.

Objective. To describe and analyze recurrent pattern of KOTs according to time.Study Design. This retrospective chart study evaluated histologically confirmed nonsyndromic keratocystic odontogenic tumors (KOT) treated at our institutions between 1975 and 2012.Results. Mean age at time of diagnosis was 48 years, and male/female ratio was 1.8:1. The typical nonsyndromic KOT lesion was most often found in the posterior mandible, had radiographically smooth borders, and was associated with symptoms and clinical findings, perforated bone, with a thin capsule. Anterior jaw KOT were found more frequently in patients 50 years or older, and maxillary KOTs were more frequently infected. Treatment was enucleation (n = 70) or marsupialization with subsequent enucleation (n = 22). Observation time ranged from 0.5 months to 25 years (mean 53 months). Crude recurrence rate was 29%. Risk of recurrence increased until 7 years after treatment and then remained stable. Patients with impaired general health had a significantly increased risk of recurrence. Tumors in the posterior mandible that had bone perforation and a thin capsule and contained keratin showed increased recurrence rates. Although recurrence rates were similar for both treatment groups, the groups differed in size and tumor site; thus, the results of this study need to be confirmed in a prospective study.Conclusions. Time-dependent recurrence pattern of KOTs is described and analyzed. The following follow-up protocol is suggested for patients with impaired health or large lesions: clinical and radiographic examinations at 2, 4, and 7 years, followed by intervals of 3 to 4 years; for other patients: clinical and radiographic examination at 4, 6, and 8 years, followed by intervals of 3 to 4 years.

First authorship is shared between

Artroskopisk lysis og lavage er en minimalt invasiv behandlingsmetode som i økende grad er tatt i bruk mot smerter og gapevansker med årsak i kjeveleddet. Denne retrospektive studien omfatter 130 pasienter som ble behandlet med artroskopisk lysis og lavage i kjeveleddet ved Kjevekirurgisk avdeling, Haukeland universitetssykehus. Aldersspredningen var mellom 14 og 79 år, medianalder 40 år, og 83 % av pasientene var kvinner. De fleste pasientene hadde gjennomgått ulike former for konservativ behandling preoperativt. Artroskopiene ble gjennomført i narkose, og observasjonstiden varierte mellom 3 og 42 måneder, median observasjonstid var 6 måneder. Det ble funnet fibriller og adheranser over leddspalten hos 85 % av pasientene, hyperemi/inflammasjon hos 62 %. Hos pasienter med preoperativ gapeevne under 40 mm, ble gapeevnen bedret hos to av tre pasienter. Tre av fire pasienter angav betydelig bedring eller full smertelindring etter inngrepet.

Oversiktsartikkelen vil presentere illustrerte forslag til utføring av enkelte mjukvevsinngrep for allmenntannlegen. Forslag til indikasjonar og val for behandling er også gitt. Målet er å gjere tannlegen enda tryggare til ei behandling og prosedyre som ikkje er rutine.

This chapter will focus on the use of nitrous oxide–oxygen inhalational sedation with dental treatment or oral surgery procedures. Desirable properties for sedation systems in dentistry will be listed, the rationale and background for inhalational sedation related to dental treatment will be commented upon, with the emphasis being on several investigations that have shown superior effects of nitrous oxide–oxygen sedation compared to other methods.