Materiały źródłowe

• #1 Temporomandibular Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551612/

  Temporomandibular disorder (TMD) refers to a group of conditions involving the orofacial region divided into those affecting the masticatory muscles and those affecting the temporomandibular joint (TMJ). The typical features include pain in TMJ, restriction of mandibular movement, and TMJ sounds. […] The etiology of TMD is mildly understood, but it is believed to be multifactorial; the appropriate management of the condition requires recognizing the predisposing and contributing factors. […] Myofascial and intraarticular TMDs differ in their etiological factors. As the name implies, a myofascial disorder means that the muscles in this case, the ones involved in mastication – are affected, becoming tensioned, fatigued, and painful. Several factors are linked to muscular dysfunction, including stress, parafunctional habits like bruxism and abnormal posture, psychological conditions like depression and anxiety, and autoimmune diseases.

• #2 Temporomandibular Joint (TMJ) Syndrome: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/809598-overview

  The pathophysiology of TMJ syndrome is not entirely understood. The etiology is thought to be likely multifactorial, with contributing factors including the following: Abnormal dental occlusion, Bruxism, Joint capsule inflammation, Muscle spasm, Abnormalities in the intra-articular disk, Psychological stress, anxiety. […] Both local insults and systemic disorders may be involved. Local problems frequently arise from articular disc displacement and hereditary conditions affecting the structures of the joint itself, such as hypoplastic mandibular condyles. A study by Tallents et al found TMJ displacement in 84% of patients with symptomatic TMJ versus 33% of asymptomatic subjects. […] The TMJs can also be affected by conditions such as rheumatoid arthritis, juvenile idiopathic arthritis, osteoarthritis, and diseases of the articular disks. In addition, hypermobile TMJs, nocturnal jaw clenching, nocturnal bruxism, jaw clenching due to psychosocial stresses, and local trauma also play a significant role.

• #3 TMD Disorders can Progress to Chronic if Untreated

  https://www.orofacialtherapeutics.com/tmd-disorders/

  Here we present the importance of speed to treatment in the prevention of prolonged jaw dysfunction and pain. The pathogenesis of painful TMDs will be discussed, highlighting the presence of a narrow therapeutic window of time where conservative therapies have the potential to interrupt the progression of acute TMJ pain to chronic TMJ disorders. […] However, once a better understanding of the temporomandibular joints anatomy is gained, it is possible to break TMDs down into two general groups; those that affect the TMJ itself (intraarticular) and those that involve chronic pain in the masticatory tissues surrounding the joints (extraarticular). […] The pathogenesis of extraarticular TMDs is our primary focus because timely therapeutic intervention in acute injury scenarios may modify the conditions that predispose to chronic pain, making prevention strategies feasible.

• #4

  https://hegabacademy.com/articles.aspx?bid=51

  Here we present the importance of speed to treatment in the prevention of prolonged jaw dysfunction and pain. The pathogenesis of painful TMDs will be discussed, highlighting the presence of a narrow therapeutic window of time where conservative therapies have the potential to interrupt the progression of acute TMJ pain to chronic TMJ disorders. […] To some degree, the presence of such heterogenicity limits the ability to make broad generalizations about the pathogenesis of TMDs. However, it is possible to break TMDs down into two general groups; those that affect the TMJ itself (intraarticular) and those that involve chronic pain in the masticatory tissues surrounding the joints (extraarticular). […] The pathogenesis of extraarticular TMDs is our primary focus because timely therapeutic intervention in acute injury scenarios may modify the conditions that predispose to chronic pain, making prevention strategies feasible.

• #4

  https://hegabacademy.com/articles.aspx?bid=51

  The pathogenesis of chronic pain indicates that there are several potential targets that may interrupt the transition from acute to chronic pain. The key principle in preventing chronicity is speed to treatment. The primary preventive strategies include reducing peripheral sensitization, preventing chronic jaw muscle tension and the guarding reflex, and relieving the psychological states that accelerate central sensitization.

• #5 A comprehensive review on biomarkers associated with painful temporomandibular disorders | International Journal of Oral Science

  https://www.nature.com/articles/s41368-021-00129-1

  Pain of the orofacial region is the primary complaint for which patients seek treatment. Of all the orofacial pain conditions, one condition that possess a significant global health problem is temporomandibular disorder (TMD). […] TMD can occur due to complex interplay between peripheral and central sensitization, endogenous modulatory pathways, and cortical processing. […] In painful TMD conditions, the role of biomarkers is still elusive. We believe that the identification of biomarkers associated with painful TMD may stimulate researchers and clinician to understand the mechanism underlying the pathogenesis of TMD and help them in developing newer methods for the diagnosis and management of TMD. […] Painful TMD potentially occurs due to ongoing nociceptive input and interactions between peripheral and central sensitization, endogenous modulatory pathways, cortical processing and psychologic factors.

• #6 A comprehensive review on biomarkers associated with painful temporomandibular disorders | International Journal of Oral Science

  https://www.nature.com/articles/s41368-021-00129-1

  TMD has multifactorial etiologies and consists of various contributing factors including trauma, either physical or emotional, biological process such as aging, postural condition such as abnormal head and cervical position, systemic predisposition, sleep disorders and psychosocial alterations. […] Initially, it was observed that painful TMD are commonly caused by peripheral factors such as acute inflammation or trauma to the muscles, joint or adjacent structures. However, later it was noticed that not all patients have clearly identifiable peripheral etiological factors and lack of concordance was noticed between TMD and pain. […] Therefore, for diagnosis of painful TMD conditions, a special attention should be given to the history and clinical assessment. […] Due to this inherent complexity of painful TMD and poorly understood etiologies making diagnoses and subsequent treatments exceedingly difficult.

• #7 Muscle Relaxants For TMJ Issues – QuickSplint®

  https://quicksplint.com/resources/muscle-relaxants-for-tmj-issues/?srsltid=AfmBOoo_y-AQK38T8iPZhI8LXaBl8eba9GEiA3jHjpAWY84XjHZH2GuV

  Muscle relaxants for TMJ issues are appropriate in certain situations, but natural remedies should also be considered. […] Because the muscles surrounding the temporomandibular joint (TMJ) are often hyperactive in TMJ disorders, medical professionals have tried using muscle relaxants to relieve TMJ pain with varied success. Muscle relaxants decrease muscle spasticity by suppressing motor neuron firing in the central nervous system. […] Myofascial temporomandibular disorders (TMDs) are those that involve the jaw muscles, as opposed to the joint itself. With these disorders, the jaw tension and muscle hyperactivity are prominent. While the mechanisms of myofascial pain are only partially understood, its clear that jaw muscle hyperactivity plays a role. […] Muscle hyperactivity in TMJ disorders may be a dysfunctional adaptation of the guarding reflex seen in other acute muscle injuries. The hope is that by relaxing tense jaw muscles by any number of means, this aspect of TMJ pain can be relieved.

• #8 Current Concepts About Temporomandibular joint disorders: A Review Article

  https://www.jrmds.in/articles/current-concepts-about-temporomandibular-joint-disorders-a-review-article-59292.html

  Temporomandibular joint is formed by the mandibular condyle inserting into the mandibular fossa of temporal bone. Its considered as ginglymoarthroidal joint which mean that is capable of both hinge type and gliding movements. TMD affects up to 15% of adults, with a peak incidence at 20 to 40 years of age. However, it can be classified as intra-articular or extra- articular. Pain related conditions and intra-articular disorders are the most common TMD conditions, and internal derangement is the most common form. It affects the jaw joint and related structure causing internal derangement of joint space, bone alterations and degenerative pathologies. Many patients are tolerating the symptoms like debilitating pain which is over the time will affect their life quality, such a thing is due to improper understanding of the etiology or pathogenesis of disease or absence of actual diagnosis or therapeutic approaches. There is many factors for TMD such as (biological, emotional, social, environmental, cognitive) thats why TMD is consider multifactorial disease, Robert L.gauer et al. in 2015 suggested that there are factors associated with TMD such as fibromyalgia, sleep apnea, autoimmune disorders, and psychiatric illness. One of the etiological factors that lead to disk displacement with reduction (DDWR) are slightly referred to abnormal biomechanical forces directed to the mandibular condyle, which change the shape as well as function of the articular tissue. Bruxism, clenching, stress, and malocclusion are related to TMD, however, the etiological factors of this disorder are still ambiguous. The prevalence of TMD is still unclear. It is considered to have high prevalence among population, between 40% to 60%. TMD symptoms are more prevalent in women than men. Women tend to develop TMD during their premenopausal years. A study indicates that most of the cases are related to effect of the increasing psychological pressure on nowadays community. While myofascial pain has been reported by many studies that it is contributing to most TMD patients. The literature suggests evolving incidence and prevalence of TMD that can be attributed to many factors. Diagnosis is the key to successful treatment on account of TMD multifactorial nature.

• #9 Temporomandibular Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551612/

  Intraarticular disorders refer to inflammatory or mechanical factors that affect the joint itself, articular disc displacement being the most common. […] The derangement of the condyle disc complex arises due to a breakdown in the rotational function of the disc. This condition can result from the lengthening of ligaments (discal collateral and inferior retro-discal ligaments) or thinning of the posterior disc border. The contributing factors can be micro or macro trauma. […] Disc displacement can lead to partial or complete disarticulation of the disc from discal space in condyle-disc assembly. […] The disorder results from changes in the smooth sliding surfaces of the TMJ. The alteration causes friction stickiness and inhibits joint function. […] The physiological aging or minor degeneration of the condyle, disc, and fossa can cause deviations and dysfunction, significantly affecting mandibular movements.

• #10 Temporomandibular Disorders: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/1143410-overview

  The sudden reduction of the posterior band causes the characteristic pop or click. If the posterior band remains anteriorly displaced at all times during jaw opening, it is called anterior displacement without reduction; full jaw opening may not be possible, and the distance between the incisors is usually less than 25mm. The jaw will usually deviate to the side of pathology. Inability to attain a jaw opening of more than 10 mm is known as closed lock. In TMD of articular origin, the spasm of the mastication muscle is secondary in nature. […] The other causes of arthrogenous TMD are diseases such as degenerative joint disease, rheumatoid arthritis, ankylosis, dislocations, infections, and neoplasia, the pathophysiology of which are self-explanatory. One study found that, in patients with chronic inflammatory connective tissue disease, the pain on mandibular movement and tenderness on posterior palpation of temporomandibular joints was related to the level of tumor necrosis factor alpha in the synovial fluid.

• #11 Temporomandibular Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551612/

  An adherence represents a brief hold of the articular surfaces. Adhesion can happen between the condyle and disc or the disc and fossa. Adhesions result from a fibrous connective tissue or loss of lubrication between the structures. […] The joint disease of inflammatory origin characteristically presents with deep continuous pain commonly accentuated on functional movement. […] Pain originates in the joint, and features of inflammation or infection over the affected joint are usually seen, such as edema, erythema, or increased temperature. […] It is an inflammatory disorder that arises due to an increased joint overload. The increased forces soften the articular surfaces and resorb the subarticular surface.

• #12 Pathophysiology of Temporomandibular Joint Arthritis: Review

  https://www.journalomp.org/journal/view.html?doi=10.14476/jomp.2021.46.3.69

  Apoptosis of chondrocytes is prominent in the early stages of cartilage degeneration. […] Activation of various catabolic enzymes such as MMP, aggrecanases, disintegrin, and metalloproteinase with thrombospondin motifs is involved in the TMJ OA. […] In synovial tissues and synovial fluid with TMJ OA, inflammatory mediators such as IL-12, IL-1, IL-6, IL-17, IL-23, tumor necrosis factor-, and monocyte chemoattractant protein (MCP)-1 are observed. […] Chondrocytes contribute to the destruction of subchondral bone by regulating the receptor activator of NF-B ligand and the osteoprotegerin (OPG). […] 17b-estradiol induces the secretion of OPG and protects bones from systemic and local inflammatory factors. […] The TMJ OA is induced by dysregulation of the catabolic and anabolic activity of chondrocytes. […] The main cause of the dysregulation is mechanical overload, and other associated factors are age and estrogen.

• #12 Pathophysiology of Temporomandibular Joint Arthritis: Review

  https://www.journalomp.org/journal/view.html?doi=10.14476/jomp.2021.46.3.69

  TMJ OA, which is a multi-organ disease caused by various pathophysiological mechanisms, is developed mainly due to mechanical overload. […] Age, mechanical overload sensing of cartilage, chondrocyte apoptosis, catabolic enzymes, inflammatory factors, abnormal remodeling of subchondral bone, and estrogens may be involved in the pathogenesis of arthritis. […] TMJ OA is a multifactorial disease that is caused by various pathophysiological mechanisms. […] TMJ OA was believed to be a cartilage disease, but is now considered as a multi-factorial disease of cartilage, bone (bone marrow), joint disc, ligament, muscle, and nerve. […] Mechanical overload is the main causative factor in the destruction of the mandibular condylar cartilage as in other synovial cartilages. […] At the molecular level, several degeneration processes of articular cartilage due to the recognition of mechanical overload occur.

• #13 The Role of TNF-α in the Pathogenesis of Temporomandibular Disorders

  https://www.jstage.jst.go.jp/article/bpb/44/12/44_b21-00154/_html/-char/en

  Temporomandibular disorder (TMD) is an oral dentofacial disease that is related to multiple factors such as disordered dental occlusion, emotional stress, and immune responses. […] It is thought that TNF- participates in the pathogenesis of TMD by triggering immune responses, deteriorating bone and cartilage, and mediating pain in the temporomandibular joint (TMJ). […] TNF- is a commonly recognized contributor to pathogenesis of TMD, and there is evidence to support the role of IL-1 and IL-6 acting synergistically with TNF-. […] The production and concentration of TNF- are highly involved in pathogenesis of TMD, with multiple direct or indirect impacts on the joint tissues, muscles, and their associated structures. […] Mounting evidence has highlighted TNF- as a master regulator in the inflammatory process since it can promote the production of other inflammatory cytokines.

• #14 The Role of TNF-α in the Pathogenesis of Temporomandibular Disorders

  https://www.jstage.jst.go.jp/article/bpb/44/12/44_b21-00154/_html/-char/en

  TNF- itself is capable of inducing neutrophil migration, which means that TNF- can increase the recruitment of neutrophils into the rat joint in vivo, playing an important role in the inflammatory process. […] Moreover, TNF–induced inflammation is closely correlated with bone and cartilage degradation as a result of degradative enzymes released from joint tissues. […] The biological effects of TNF- are mediated by two cell-membrane receptors: tumor necrosis factor receptors (TNFR) 1 and 2. […] The central role of TNF- in the development of TMD is to trigger immune responses in TMD, inducing neutrophil migration, promoting the expression of degrading enzymes, and regulating other proinflammatory cytokines through multiple signaling pathways including NF-B, MAPK, ERK, and JNK/STAT pathways. […] Additionally, TNF- partially contributes to the pain in TMD by activating nociceptive trigeminal ganglion neurons. […] All these findings may highlight TNF- as a new therapeutic target for TMD treatment and therefore provide new insight for therapeutic intervention in TMD.

• #15 The neuro-pathophysiology of temporomandibular disorders-related pain: a systematic review of structural and functional MRI studies | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-020-01131-4

  Chronic pain surrounding the temporomandibular joints and masticatory muscles is often the primary chief complaint of patients with temporomandibular disorders (TMD) seeking treatment. Yet, the neuro-pathophysiological basis underlying it remains to be clarified. […] However, as with many chronic pain syndromes, the neurobiological mechanisms pertaining to pain in TMD remain to be clarified. […] Previous studies have thoroughly investigated changes in brain activity when experiencing clinical pain. […] MRI studies in TMD have provided evidence for structural and functional changes within the ascending trigemino-thalamo-cortical pathway involving the trigeminal nerve root, spinal tract subnucleus caudalis (SpVc), thalamus, and primary somatosensory cortex (S1). […] The classic trigemino-thalamo-cortical pathway is responsible for the sensation of oral and maxillofacial regions. Current evidence reveals brain structural and functional alteration in key nodes within this ascending trigemino-thalamo-cortical pathway in TMD. […] The reported discrepancy of diffusivity changes in the trigeminal nerve results from methodological differences between the two studies (with the same samples).

• #15 The neuro-pathophysiology of temporomandibular disorders-related pain: a systematic review of structural and functional MRI studies | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-020-01131-4

  The GMV decrease and MD increase in SpVc may reflect glia shrinkage/atrophy or neuronal loss and a reduction in dendritic density, while the elevated blood flow in SpVc could be a compensatory response of increased neural activity to structural reductions. […] The involvement of posterior insula in TMD-related chronic pain has also been noted. […] Neuroimaging studies in patients with TMD pain have reported structural and functional changes in the motor system, including M1, SMA, and striatum. […] The findings of increased GMV in the right putamen and right globus pallidus suggest a possible somatotopic reorganization or perhaps synaptic hypertrophy associated with sustained TMD pain. […] Splint therapy can impact the neural function of brain regions in TMD patients, accompanied by improved clinical symptoms, suggesting a central mechanism underlying the therapeutic effects of splint therapy.

• #16 Clinical Management of Direct Jaw Trauma | Jaw Pain Evaluation

  https://www.orofacialtherapeutics.com/blog/clinical-management-of-direct-jaw-trauma/

  Synovitis, hemorrhage, and collagen deformation are all present after direct jaw joint trauma of sufficient force. […] Because inflammatory mediators or blood in the joint space are implicated in joint ankylosis and fibrosis, early mobilization after an injury is recommended. […] Psychological factors are also important in TMD pathogenesis. […] The proposed sequence for central sensitization is as follows: Jaw trauma triggers a guarding reflex in the muscles of mastication. Constant tension of these muscles causes a decrease in tissue oxygenation and muscle fatigue, leading to the release of proinflammatory cytokines in the tissue. Inflammation and fatigue trigger peripheral sensitization by increasing the excitability of masticatory muscle trigeminal afferents. Tonic pain signals ultimately lead to central sensitization, the neurophysiologic hallmark of chronic pain syndromes.

• #16 Clinical Management of Direct Jaw Trauma | Jaw Pain Evaluation

  https://www.orofacialtherapeutics.com/blog/clinical-management-of-direct-jaw-trauma/

  Direct temporomandibular joint (TMJ) trauma is identified as a causal factor in many patients with temporomandibular disorders (TMDs) who then need clinical management. […] Approximately 20-25% of people with chronic TMDs have a history of direct TMJ trauma. […] TMJ trauma without fracture can still initiate pathological changes. Several preclinical and human studies have established that there are substantial changes in the joint space after direct trauma to the jaw, even in the absence of a mandible fracture. […] Direct trauma to the jaw causes predictable patterns of injury to the temporomandibular complex. Blunt force applied to the joint space can produce a variety of histological changes, including: Hemorrhage, Synovitis, Cartilage degeneration, Disc enlargement, Fibrous adhesions.

• #17 Neuroimaging and artificial intelligence for assessment of chronic painful temporomandibular disorders—a comprehensive review | International Journal of Oral Science

  https://www.nature.com/articles/s41368-023-00254-z

  According to the previous investigations, somatosensory, limbic system and associative brain structures are considered to be involved in the pain system. […] Accumulating evidence on painful TMD patients have revealed structural and functional changes in the pain related network including ascending trigeminal-thalamo-cortical pathway, lateral (sensory-discriminative areas) and medial systems (affective-cognitive and evaluative areas), antinociceptive pathway, salience network and default mode network (DMN) and motor system. […] However, the application of neuroimaging in identifying the patterns of altered brain function, structure and chemistry in individuals with chronic painful TMD is still in its development. […] Furthermore, there is a paucity of clinical research data on applications of neuroimaging methods in individuals with chronic painful TMD making it challenging in identifying diagnostic and prognostic brain markers in individuals with TMD.

• #17 Neuroimaging and artificial intelligence for assessment of chronic painful temporomandibular disorders—a comprehensive review | International Journal of Oral Science

  https://www.nature.com/articles/s41368-023-00254-z

  It is hypothesized dynamic interaction between peripheral and central nervous system contributes to the development of chronic painful TMD. […] Besides this other mechanism contributes to development and perpetuation of pain are abnormal autonomic functions, neuroendocrine system and triggers such as psychosocial stressors and emotional or physical trauma. […] TMD are difficult to diagnose and mange due to complexity of the disorder and limited understanding on underlying mechanisms. […] To investigate this, over the last decades researchers have been exploring how brain shapes in chronic painful TMD. […] Neuroimaging techniques, for instance functional and structural MRI methods have been widely used separately or combined to explore brain alterations in patients with chronic pain including TMD.

• #18 Temporomandibular Disorders: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/1143410-overview

  An important development may connect some of the psychosocial aspects of the disease to underlying neurobiology. This is the discovery that the likelihood of a patient being diagnosed with TMD is related to genetic variations in the gene coding for catecholamine-O-methyltransferase (COMT), a gene that relates in to some aspects of pain sensitivity.

• #19 Pathophysiology of TMD pain–basic mechanisms and their implications for pharmacotherapy – PubMed

  https://pubmed.ncbi.nlm.nih.gov/20337865/

  Finally, substantially more women suffer from TMD than men. Although there are arguably multiple reasons for sex-related differences in the prevalence of TMD, one candidate for the increased occurrence of this disorder in women has been suggested to be the female sex hormone oestrogen. […] Continued research into the pathophysiology of TMD-related pain and the effectiveness of analgesic treatments for this pain is required.

• #20 How To Cure TMJ Disorder Permanently – Harley Street Specialist Hospital

  https://hssh.health/blog/how-to-cure-tmj-disorder-permanently/

  TMJ disorder causes inflammation and pain in your jaw joint. Its twice as common in women than men, and mainly affects women aged 35-44. […] TMD covers a group of more than 30 conditions that affect the movement and function of your jaw joint. These conditions can cause a clicking jaw, pain and problems with movement in your jaw joint and muscles. […] This type of TMD includes joint pain, disc disorders and bone damage. A disc disorder is when the disc that cushions your jaw joint is in the wrong place, which can cause pain and swelling. […] Bone damage may be due to a degenerative joint disease, such as osteoarthritis or rheumatoid arthritis (RA). […] RA is an autoimmune disease, which means your immune system turns against your body and attacks healthy tissue in your joints. This can affect your jaw joint and cause pain, inflammation, and limited movement.

• #21 TMJ Basics – The TMJ Association

  https://tmj.org/living-with-tmj/basics/

  TMJ disorders, also commonly referred to as TMJ or TMD, are a complex, under-researched, and poorly understood set of conditions characterized by pain in the jaw joint and surrounding tissues frequently associated with limitation in jaw movements. […] Recent findings show that TMJ is a complex multi-systems condition involving the circulatory, digestive, endocrine, exocrine, immune, muscular, nervous, reproductive, respiratory, and the skeletal system. TMJ is no longer seen as a condition confined solely to the areas of the jaws and teeth. […] The observation that jaw problems are commonly found in women in the childbearing years has also led to research to determine the role of female sex hormones, particularly estrogen, in TMJ. […] Additionally, there are genetic, hormonal, and environmental factors that can increase the risk for TMJ. Studies have shown that genetic factors contribute to TMJ and are leading to the discovery of new ways of treating TMJ.

• #22 Temporomandibular joint dysfunction – Wikipedia

  https://en.wikipedia.org/wiki/Temporomandibular_joint_dysfunction

  TMD is considered by some to be one of the 4 major symptom complexes in chronic orofacial pain, along with burning mouth syndrome, atypical facial pain and atypical odontalgia. […] It has been suggested that TMD may develop following physical trauma, particularly whiplash injury, although the evidence for this is not conclusive. […] Emotional stress (anxiety, depression, anger) may increase pain by causing autonomic, visceral and skeletal activity and by reduced inhibition via the descending pathways of the limbic system. […] The interactions of these biological systems have been described as a vicious „anxiety-pain-tension” cycle which is thought to be frequently involved in TMD. […] The relationship of bruxism with TMD is debated. […] Trauma, both micro and macrotrauma, is sometimes identified as a possible cause of TMD; however, the evidence for this is not strong.

• #23 The use of pharmacologic agents in the management of temporomandibular joint disorder – Dammling – Frontiers of Oral and Maxillofacial Medicine

  https://fomm.amegroups.org/article/view/52991/html

  Muscle relaxants are commonly utilized in the management of TMD and are helpful in decreasing hyperactivity associated with excessive masticatory and cervical muscle contraction. […] Anticonvulsant medications are commonly used to manage neuropathic pain and therefore, play a potential role in the management of TMD. […] There is a correlation between chronic pain symptoms and depression which must be considered in order to provide appropriate and comprehensive patient care. […] Although less frequently used in the management of TMD, anxiolytics have been shown to decrease masticatory muscle hyperactivity and nocturnal bruxism. […] Topical use of NSAIDs through gels or ointments has been shown to be effective. […] Despite these improvements in muscle related symptoms, available studies lacked a definitive TMD diagnosis and were of a small sample size.

• #24 Etiologic Factors of Temporomandibular Disorders: A Systematic Review of Literature Containing Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) from 2018 to 2022

  https://www.mdpi.com/2227-9032/12/5/575

  The literature reports on the effect of raised blood pressure on the impairment of central pain regulatory systems and its potential contribution to painful TMD. […] It has been suggested that autoimmune and inflammatory disorders could potentially play a role in the development of TMD. […] According to the clinical study conducted by Selda Yenel et al., it was found that patients with inherited coagulation disorders, especially hemophilia, may have a higher likelihood of developing temporomandibular disorders (TMD) compared to healthy individuals. […] The persistent and progressive manifestation of symptoms deteriorates the quality of life and psychological well-being, which potentially impacts existing psychiatric ailments like depression, chronic stress, and anxiety. […] Considering the multifactorial etiology of TMD, their development is explained by the biopsychosocial model.

• #25 Clinical Management of Direct Jaw Trauma | Jaw Pain Evaluation

  https://www.orofacialtherapeutics.com/blog/clinical-management-of-direct-jaw-trauma/

  The therapeutic window for conservative measures to prevent TMD development is from the time of injury to 4 weeks after injury, according to both clinical data and models of TMD pathogenesis. The inference is that prompt treatment with a multimodal approach to therapy represents the best chance of preventing TMD development.

• #26 Temporomandibular Disorders of Iatrogenic Etiology | IntechOpen

  https://www.intechopen.com/chapters/81617

  Temporomandibular disorder (TMD) is a heterogeneous chronic systemic disease based on genetic, immunological, anatomical, morphological, and functional disorders of the articulatory norm. […] The transformation of the pathogenetic horizon of TMDs does characterize by the implementation of a scenario leading to the formation of three nosological forms of the disease: articular and nonarticular lesions of TMJ, and TMDs of iatrogenic etiology. […] Failure to identify biological, technological, and communication iatrogenic risks at the diagnostic stage is the main reason for triggering TMDs of iatrogenic etiology. […] The transformation of iatrogenic risks into iatrogenic pathogenetic factors leads to the formation of iatrogenic disease. […] Determining the features of the pathogenesis of TMDs of iatrogenic etiology is a demanded necessity to treat these disorders and for expert evaluation in the event of doctor-patient conflicts.

• #27 Temporomandibular Disorders of Iatrogenic Etiology | IntechOpen

  https://www.intechopen.com/chapters/81617

  Failure to identify iatrogenic etiological risks at the diagnostic stage leads to incorrect therapy planning for TMDs. […] Biological risks not identified at the diagnostic stage at the treatment planning stage become the cause of iatrogenic pathogenetic factors and iatrogenic disease. […] Therefore, the diagnostic stage tests the professional competencies of the clinic. […] Thus, undiagnosed iatrogenic risks cause the formation of iatrogenic pathogenic factors, the failure to identify which leads to an incorrectly formulated or preliminary clinical diagnosis, treatment plan, negative outcome of therapy, and iatrogenic TMDs. […] Timely diagnosis of iatrogenic risks is the main preventive measure that prevents the development of iatrogenic TMDs.

• #28 Neuropathic Pain in Temporomandibular Joint Disorders: Case-Control Analysis by MR Imaging | American Journal of Neuroradiology

  https://www.ajnr.org/content/30/7/1414

  BACKGROUND AND PURPOSE: Temporomandibular joint disorders (TMJ-D) may be associated with the onset of neuropathic pain. […] We suggest that a closer proximity between the TMJ disk and the mandibular nerve could be one of the causes of the onset of neuropathic pain in patients with TMJ-D and neuropathic pain. […] We suggest a possible relationship between neuropathic pain and a shorter distance between the disk and the mandibular nerve. […] The results of our study show that in vivo at the maximal open-mouth position, the distance between the disk and the mandibular nerve and/or its branches at the oval foramen level is significantly shorter in patients with TMJ-D and neuropathic pain than in patients with TMJ-D without neuropathic pain as in healthy volunteers. […] We suggest that in many patients with TMJ-D and neuropathic pain, the medially displaced disk during jaw-opening movement may directly damage the mandibular nerve or its branches at the oval foramen level by exerting intermittent compression, traction, or friction.

• #29 Neuropathic Pain in Temporomandibular Joint Disorders: Case-Control Analysis by MR Imaging | American Journal of Neuroradiology

  https://www.ajnr.org/content/30/7/1414

  With the patient in the open-mouth position, the distance between the disk and the mandibular nerve and/or its branches at the oval foramen level is shorter in patients with TMJ-D and neuropathic pain than in patients with TMJ-D without neuropathic pain as well as in healthy volunteers. […] It is possible that in many patients with TMJ-D and neuropathic pain, the disk may directly damage the mandibular nerve and/or its branches by exerting intermittent compression, traction, or friction during the jaw-opening movement.

• #30 Translational research of temporomandibular joint pathology: a preliminary biomarker and fMRI study | Journal of Translational Medicine | Full Text

  https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-019-02202-0

  The temporomandibular joint (TMJ) disorders (TMD) can cause neural-inflammation in the peripheral nervous system (PNS) at the site of injury, or compression, and may have systemic effects on the central nervous system (CNS). […] Neural-inflammation causes elevations in cytokine expression and microglia activation. […] When the site of injury, or compression is treated, or relieved, neural inflammation is reduced. […] Our findings highlight the importance of TMJ-CNS connections and use of fMRI as an investigative tool for understanding TMD and its related neurological pathologies. […] Pathologies affecting the TMJ are termed as temporomandibular joint disorders (TMD), a common condition involved in orofacial pain. […] Recent studies show that neurological disorders, such as Parkinsons Disease, Cervical Dystonia, Tourettes syndrome may have a root cause in TMJ related disorders.

• #31 Translational research of temporomandibular joint pathology: a preliminary biomarker and fMRI study | Journal of Translational Medicine | Full Text

  https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-019-02202-0

  Inflammation has been implicated in neuronal damage and cognitive impairment. […] Inflammation of TG results in activation of glial cells, such as microglia, astrocytes and satellite glial cells (SGCs) that are key players in the onset of neurological diseases. […] This results in an increased firing and activation as well as hyperexitability of nociceptive neurons and development of hyperalgesia and allodynia. […] Elevated levels of pro-inflammatory cytokines (IL-1, TNF- and IL-6) were found in the synovial fluid (SF) of TMD patients that needed to be confirmed and explored further. […] The primary function of Th-17-related cytokines is to modulate induction of many immune signaling molecules. […] The most notable role of IL-17 is its involvement in inducing and mediating pro-inflammatory responses that results in sustained (chronic) inflammation and bone resorption.

• #32 Translational research of temporomandibular joint pathology: a preliminary biomarker and fMRI study | Journal of Translational Medicine | Full Text

  https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-019-02202-0

  Our study also involved the emerging field of Osteoimmunology, which refers to the regulatory interaction between bone and immune cells and related pathways. […] The interplay begins when bone provides the microenvironment that is critical for the development of the hematopoietic stem cells from which all cells of the mammalian immune system derive, and they in turn produce various immunoregulatory cytokines that influence the fate of bone cells. […] This study identifies clinical and diagnostic markers of TMD and evaluates their association to the fMRI markers in TMD patients with comorbid neurological disorders before and after orthotic treatment. […] We hypothesize patients with TMD will have elevated levels of inflammatory (IL-1, TNF-, IL-6, IL-17A), pain (SP, CGRP), and enzymatic biomarker of tissue destruction (PAD-4) in their synovial and whole saliva fluids, which are associated to their clinical diagnostic markers.

• #33 The Portland TMJ Clinic – The Role of Body Posture

  https://portlandtmjclinic.com/tmj-disorders/the-role-of-body-posture

  The mandible (the lower jawbone) is an integral member of the head posture mechanism, and head posture affects body posture; because the position of the heavy head on the top of the spinal column reflexively determines how that column aligns beneath it to support the weight on top. […] To understand the role of the bite and the mandible in postural and TMJ disorders, it must be recognized that mandibular posture is under two different and sometimes competing influences – one from the tonus of the postural system and one from the neuromuscular reflexes designed to protect the teeth. […] Treating the symptomatic muscles usually just transfers the pain to a different set of muscles. […] The myofascial influence on mandibular posture in modern humans is often overridden by neuromuscular reflexes that were designed to protect the teeth.

• #34 The Portland TMJ Clinic – The Role of Body Posture

  https://portlandtmjclinic.com/tmj-disorders/the-role-of-body-posture

  As a result of that protective reflex, the postural location of the mandible in a horizontal plane is controlled by the location of its central bite position, and any displacement of the central biting position of the mandible also causes a displacement of mandibular posture. […] Backward mandibular posture resulting from a backwardly shifted bite, is almost always found in TMJ disorder patients on at least one side, usually the side of the most damaged TMJ. […] In most of these cases, the mandible has acquired a backwardly located position relative to the rest of the cranium, because its normal forward translation (advancement) has been blocked by a bite that locks it back posteriorly. […] The forward shifting of the head diminishes the normal cervical curve (lordosis) by bringing its top end forward over its base, as seen in the progression below, where the cervical lordosis flattens and eventually reverses.

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