M.Tech. / Purpose: Many diseases are very complex and this is especially true with temporomandibular disorders (TMDs). The lack of consensus on the aetiology, signs and symptoms and treatments available makes it extremely difficult for health care practitioners to treat TMDs. A clear definition of the condition itself has not been agreed on between many disciplines involved in the diagnoses and treatment of TMDs. Two competing definitions stand out in current literature. The physical medicine and dental professions define TMDs as various musculoskeletal disorders of the masticatory system. Some authors also stated that most patients with TMDs suffer primarily from a muscular disorder caused by masticatory myofascial trigger points (TrPs). The chiropractic profession defines TMDs as a group of somatic disorders that occur around the structurally integrated craniomandibular system but primarily affects the temporomandibular joint (TMJ) system. The term TMDs recognises that this craniomandibular pathology is a result of dysfunction in any structural area of the head or neck, not only the TMJ. This purpose of this study was to compare an adjustment treatment approach versus a soft tissue approach for the treatment of TMDs. Method: This study consisted of two groups; both the experimental and control groups consisted of 15 participants with TMDs. The participants were between the ages of 18 and 40 years. Potential participants were examined and accepted based on the inclusion and exclusion criteria. The experimental group received adjustments delivered to the TMJ and upper cervical spine, the control group received therapeutic ultrasound (U/S) to the xiv muscles of mastication. Objective and subjective findings were based on the treatments. Procedure: Each participant agreed to 6 treatment sessions and a seventh follow up session over a 4 week period. The participant completed a TMDs Disability Questionnaire. Algometer readings were taken over the masseter and temporalis TrPs bilaterally. Calliper readings measured the range of motion (ROM) of the TMJ, i.e. mandibular depression, protrusion and right and left deviation. The experimental group received adjustments to restricted segments of the TMJ and upper cervical spine as determined by motion palpation. The control group received therapeutic U/S to the masseter and temporalis muscles bilaterally. The same treatment procedures were administered over the study; subjective and objective readings were only taken again at visit 4 and 7. Results: In terms of subjective measurements based on the TMDs Disability Questionnaire scores, a statistically significant difference in the disability, severity and frequency of symptoms within the experimental and control groups individually, as well as the usual symptom intensity level within the control group was revealed. No statistically significant difference in terms of disability, frequency, severity and usual symptom intensity between the two treatment groups over time was revealed. In terms of objective measurements based on algometer readings, a statistically significant difference in the left masseter muscle and right temporalis muscle sensitivity within the experimental group individually was revealed. A statistically significant difference in the left masseter muscle and left temporalis muscle sensitivity within the control group individually was revealed. No statistically significant difference in muscle sensitivity between the groups over time was revealed. However, the control group showed a larger overall clinical significant difference in the masseter and temporalis muscle sensitivity bilaterally.

This thesis discusses the illness experience of people living with chronic pain resulting from Temporomandibular disorders (TMD). The literature discusses various aspects of the experience of chronic pain, but there is little research reported specifically on the experience of living with TMD. Using analysis of sufferers' narratives, I discuss common explanatory models and coping strategies. I then present aspects of the bodily experience of TMD as seen in people with comorbid illnesses. The personal or mental aspects of TMD are explored, particularly in terms of fear, anxiety, and hope for the future. Lastly, the broader impacts of TMD are explored through sufferers' relationships with friends and family, and sufferers' ability to function in social contexts. It is concluded that TMD impacts many areas of sufferers' lives, and that the lived experience extends beyond diagnosis and treatment seeking to include the day to day management of TMD pain.

No description available.

No description available.

Temporomandibular disorders (TMD) consist of a group of pathologies affecting the masticatory muscles, the temporomandibular joint and related structures. The association between the cervical spine and TMD has been studied from different perspectives; however, the study of cervical muscles and their significance in the development and perpetuation of TMD has not been elucidated. Thus, this project was designed to investigate the association between cervical musculoskeletal impairments and TMD. A sample of subjects who attended the TMD/Orofacial Pain clinic, and students and staff at the University of Alberta participated in this study. All subjects underwent a series of physical tests and electromyographic assessment (i.e. head and neck posture, maximal cervical muscle strength, cervical flexor and extensor muscles endurance, and cervical flexor muscle performance) to determine cervical musculoskeletal impairments. All subjects were asked to complete the Neck disability Index and the Jaw Function Scale, and the Chronic Pain Grade Disability Questionnaire. A strong relationship between neck disability and jaw disability was found (r=0.82). Craniocervical posture (measured using the eye-tragus-horizontal angle) was statistically different between patients with myogenous TMD and healthy subjects. However, the difference was too small (3.3) to be considered clinically relevant. Maximal cervical flexor muscle strength was not statistically or clinically different between patients with TMD and healthy subjects. No statistically significant differences were found in electromyographic activity of the sternocleidomastoid or the anterior scalene muscles in patients with TMD when compared to healthy subjects while executing the craniocervical flexion test (p=0.07). However, clinically important effect sizes (0.42-0.82) were found. Subjects with TMD presented with reduced cervical flexor as well as extensor muscle endurance while performing the flexor and extensor muscle endurance tests when compared to healthy individuals. Furthermore, patients with mixed TMD presented with steeper negative slopes (although modest) at several times during the neck extensor muscle endurance test than healthy subjects. The results of this research provided an important clinical contribution to the area of physical therapy and TMD. It identified impairments in the cervical spine in patients with TMD that could help guide clinicians in the assessment and prescription of more effective interventions for individuals with TMD. / Rehabilitation Science

Aims: Many patients with temporomandibular disorders (TMD) seem to go undetected within primary dental health care. Previous studies have concluded that further efforts are needed to safeguard the clinical decision process in dentistry for patients with probable TMD. Primarily we evaluated if the implemented intervention in 2015 that was based on the 3Q/TMD increased the clinical decision-making for TMD patients compared to clinics that did not receive the intervention; secondarily we evaluated if other factors could be identified that predict performed or recommended TMD treatment; thirdly we evaluated treatment frequencies between 3Q-positives and 3Q-negatives at the intervention clinics. Methods: This case-control study was carried out within the Public dental health service in Västerbotten county, Sweden. An intervention based on a decision-tree with three screening questions for TMD (3Q/TMD) was implemented at four PDH clinics,intervention clinics. A total of 400 individuals were selected – 200 of 3Q-positives and 200 of 3Q-negatives. Clinics that were not included in the intervention programme was used as reference. The 3Q/TMD answers were analysed in relation to any TMD related decision that was collected from the digital dental records. Results: The intervention did not increase the frequencies of traceable clinical decisions among 3Q-positive patients at the interventions clinics when compared to the reference clinics. Conclusions: Despite the tailored intervention aimed at optimal use of the 3Q/TMD, the indicated under-treatment of patients with TMD remains. Future studies are still needed to gain a deeper understanding of the clinical decision-making process for TMD patients in general practice dentistry. / <p>Arbetet kommer att publiceras i en vetenskaplig tidsskrift - endast abstract publiceras på DiVA.</p>

>Magister Scientiae - MSc / Aim: To compare osseous changes in the mandibular condyles in patients presenting to the Oral Health Center, Tygerburg Campus, with and without clicking of the temporomandibular joint. Background: Clicking of the temporomandibular joint (TMJ) is not a normal occurrence in its form or function. A chronic click may lead to the development of osteoarthritis. A clinical finding of clicking of the joint can reflect osseous changes of the bony structures and form part of the early signs of degenerative joint diseases. These osseous changes can be detected on Cone Beam Computed Tomography (CBCT) images. The purpose of this study is to confirm the presence osseous changes of the joint and institute the early management of these patients. Failure to intervene in the early stages could result in disease progression to possible osteoarthritis. CBCT imaging will be used to assess osseous changes in the temporomandibular joints with reference to erosions, flattening, lipping, sclerosis and osteophyte formation. Materials and methods: 25 patient records were selected for a control group and 25 patients that attended the Oral Health center were screened for asymptomatic clicking of the temporomandibular joints. Osseous changes of the 100 condyles were examined by the author and a senior member of the department. Changes were recorded when consensus was reached on the presence of any changes. Cone Beam Computed Tomography was used to assess the joints in both groups. Results: Age and gender showed no statistical significance between the 2 groups. The proportion of ‘yes’ for the variables showed that sclerosis (right) was statistically significant when comparing case versus control groups (P = 0.002). A chi-squared test applied to the data resulted in observed chi-square = 15.68, df = 1, p-value = 7.501e-05, (<0.0001) confirming that the discrimination is statistically significant. Conclusion: Osseous changes were found in both the control and case group. The case group exhibited equal or greater prevalence of osseous changes. Patients with asymptomatic click of the temporomandibular joints demonstrate osseous changes.

O objetivo deste estudo foi avaliar a atividade elétrica dos músculos da mímica de pacientes com dor muscular mastigatória utilizando eletromiografia de superfície. Foram avaliadas 15 mulheres com dor muscular mastigatória (idade média de 33.4, variando de 22-44), grupo de estudo (GMM) e 21 mulheres (idade média de 28.5, variando de 21-45), do grupo controle (GC) Foram realizadas avaliação clínica fonoaudiológica e eletromiográfica (eletromiógrafo ADS 1200, da Lynx Tecnologia Eletrônica Ltda, eletrodos de disco de prata, descartáveis, gel condutor, auto-adesivos com 10mm de diâmetro por HAL Ind. e Com. LTDA) dos músculos: orbicular dos lábios, bucinador, supra-hióideos e masseter em repouso e nos movimentos: protrusão dos lábios, apertamento dos lábios, inflar bochechas, sorriso fechado e sorriso aberto. Houve diferença significativa entre os grupos: os valores da eletromiografia de repouso foram inferiores para o músculo masseter direito (p=0.012) e esquerdo (p=0.019); nos movimentos, os valores eletromiográficos foram superiores no grupo controle durante os movimentos: protrusão dos lábios bucinador esquerdo (p=0.005); suprahióideo esquerdo (p=0.011); apertamento dos lábios bucinador esquerdo (p=0.005); bucinador direito (p=0.007); supra-hióideo esquerdo (p=0.046); supra-hióideo direito (p=0.039); orbicular superior (p=0.042); inflar as bochechas masseter esquerdo (p=0.021); bucinador esquerdo (p=0.007); bucinador direito (p=0.002); orbicular superior (p=0.039); sorriso fechado masseter esquerdo (p=0.004); masseter direito (p=0.019); bucinador esquerdo (p=0.013); supra-hióideo esquerdo (p=0.046) e no sorriso aberto masseter esquerdo (p=0.030). Desta forma, o músculo de maior atividade eletromiográfica foi o orbicular da boca. No repouso, os valores foram inferiores para o masseter e superiores para os demais músculos e nos movimentos, os valores foram superiores em todos os músculos para o grupo de estudo / The objective this study is assess the electric activity of mimic muscles in patients with masticatory muscle pain using surface electromyography (EMG). Was evaluated 15 women with masticatory muscle pain (mean age 33.4, ranging between 22 44 years old), study group (GMM) and 21 women (mean age 28.5, ranging between 21 45 years old), control group (CG). Clinical phonoaudiological and electromyographic assessments were performed (electromyograph ADS 1200 of Lynx Tecnologia Eletrônica Ltda, 10mm disposable pregelled self-adhesive silver disk electrodes of HAL Ind. e Com. LTDA) in the muscles: orbicularis oris, buccinator, suprahyoid and masseter, both at rest and in movement: lip protrusion, lip contraction, cheek inflation, close smile and open smile. There was significant difference between the groups: the values of the electromyography at rest were lower for the right and left masseter muscle (p=0.012 and p=0.019, respectively); in movement, the eletromyographic values were higher in the group control during movement: lip protrusion right buccinator (p=0.005); left suprahyoid (p=0.011); lip contraction left buccinator (p=0.005); right buccinator (p=0.007); left suprahyoid (p=0.046); right suprahyoid (p=0.039); orbicularis oris (p=0.042); cheek inflation left masseter (p=0.021); left buccinator (p=0.007); right buccinator (p=0.002); orbicularis oris (p=0.039); closed smile left masseter (p=0.004); right masseter (p=0.019); left buccinator (p=0.013); left suprahyoid (p=0.046); open smile left masseter (p=0.030). Thus, the orbicularis oris muscle presented the highest EMG activity. At rest, the values were lower for the masseter and higher for the other muscles and, in movement, the values were higher for all the muscles in the study group

A disfunção temporomandibular (DTM) engloba as alterações relacionadas com as articulações temporomandibulares (ATMs), a musculatura mastigatória e demais estruturas do sistema estomatognático apresentando-se na forma de dores nos músculos da mastigação, ATMs, músculos cervicais, reduções e desvios nos movimentos da mandíbula, sons articulares e padrões de oclusão inadequados. É de relevante importância estudar a musculatura mastigatória por causa da grande influência que a mesma tem no sistema estomatognático. O objetivo deste estudo foi analisar a espessura do músculo masseter e temporal, bilateralmente, por meio da ultrassonografia em indivíduos portadores de DTM muscular, com a finalidade de definir o padrão de espessura muscular nesta disfunção. Os resultados deste estudo permitiram a avaliação do sistema estomatognático do ponto de vista funcional em indivíduos portadores de DTM muscular e poderão nortear o cirurgião dentista na elaboração de diagnósticos, prognósticos e planos de tratamento, com ganho de qualidade de vida para seus pacientes. Portanto conclui-se que na condição de repouso como no apertamento em máxima intercuspidação habitual houve uma diminuição da espessura do músculo masseter esquerdo, temporal direito e esquerdo para o grupo com DTM muscular. E com relação ao gênero houve uma diminuição da espessura muscular, tanto para o músculo masseter quanto para o músculo temporal, nas mulheres. / The temporomandibular disorders (TMD) includes changes related to the temporomandibular joints (TMJ), masticatory muscles and other structures of the stomatognathic system presents itself as pain in the masticatory muscles, joints, cervical muscles, cuts and deviations in the movements of jaw joint sounds and patterns of inadequate occlusion. It is of major importance to study the masticatory muscles because of the great influence which it has in the stomatognathic system. The objective of this study was to analyze the thickness of the masseter and temporal bilaterally by ultrasonography in patients with TMD muscle, in order to set the standard for this thick muscle dysfunction. The results of this study will allow assessment of the stomatognathic system\'s functional point of view in individuals with TMD muscle and can guide the dentist in making diagnoses, prognoses and treatment plans, with gains in quality of life for their patients. Therefore it is concluded that at rest as in clenching in maximum intercuspation was a thinning of the left masseter, temporalis left and right for the group with muscular TMD. And with respect to gender there was a decrease in muscle thickness for both the masseter and temporalis muscle for in women.

A disfunção temporomandibular (DTM) é uma doença complexa e multifatorial. Diversas modalidades terapêuticas prometem aliviar os sintomas, melhorar a função e reduzir o impacto da doença na qualidade de vida do paciente. O objetivo desse estudo foi investigar o efeito da fotobiomodulação (PBM) e da terapia manual (MT) isoladas ou combinadas no controle da dor, no restabelecimento dos movimentos mandibulares, nos aspectos psicossociais e dos níveis de ansiedade nos pacientes com DTM mista. Cinqüenta e um pacientes com DTM foram alocados randomicamente em três grupos: grupo PBM (808 nm, 100mW, 13,3J / cm2, 4J por ponto), grupo MT (sessões de 21 minutos, nos músculos mastigatórios e ATM) e grupo de Terapia Combinada (CT). Todos os tratamentos foram realizados três vezes por semana durante quatro semanas consecutivas. As avaliações foram realizadas no início, durante o tratamento (dias 7, 14, 21 e 28) e no follow up(dia 60 e dia 90). A escala analógica visual (VAS), o Research Diagnostic Criteria (RDC / TMD) e o inventário de ansiedade Beck (BAI) foram utilizados em diferentes momentos do estudo. Todos os grupos demonstraram redução da dor ao longo do tratamento e follow up(<0,001). Todos os tratamentos promoveram melhora em alguns movimentos mandibulares durante o período de tratamento e follow up. A avaliação dos aspectos psicossociais da DTM, comparando o início e o follow up, não revelou modificação na intensidade da dor crônica (D1) em nenhum dos grupos de tratamento. No entanto, a avaliação de D2 (depressão) mostrou redução nos grupos PBM e CT. Todos os tratamentos promoveram redução dos sintomas físicos com e sem dor (D3a e D3b). Além disso, todos promoveram melhora funcional mandibular. A MT promoveu a melhora em 5 funções, PBM em 2 e CT em 1. A análise de BAI revelou que todos os tratamentos reduziram a ansiedade. Os resultados indicam que PBM, MT e CT são capazes de promover alívio da dor, melhorar a função mandibular e reduzir os efeitos dos aspectos psicossociais em pacientes com DTM. / Temporomandibular disorders (TMD) is a complex and multifactorial disease. Therapeutic modalities expected to relief symptoms, improve function and reduce the impact of the disease in patient’s quality of life. The aim of the present study was to investigate the effect of photobiomodulation (PBM) and manual therapy (MT) isolated or combined in the treatment of TMD. Fifty-one TMD patients were randomly allocated to three groups: PBM (808 nm, 100mW, 13.3J /cm2, 4 J per point), MT group (21 minutes sessions of MT of the masticatory muscles and TMJ)and Combined Therapy group (CT). All treatments were done three times a week for four consecutive weeks. Evaluations were performed at baseline, during the treatment (Days 7, 14, 21, and 28) and follow up (Day 60 and Day 90).Visual analogue scale(VAS),Research Diagnostic Criteria(RDC / TMD),Beck anxiety inventory (BAI)were used in different moments of evaluation time. All groups demonstrated reductions in pain throughout treatment and maintained low pain value in follow up period (<0.001). All treatments promoted improvement in some jaw movements during the treatment and follow up period.The assessment of psychosocial aspects of TMD comparing baseline and follow up in all treatment groups revealed that treatment do not promote modification in intensity of chronic pain (D1). However, D2 (depression) evaluation showed reduction in PBM and CT groups. All treatments promoted reduction in physical symptoms with and without pain (D3a and D3b). Also, all the treatments results in enhancement of jaw disabilities. MT promotes improvement in 5 functions, PBM in 2 and CT in 1.BAI analysis revealed that all treatments lead to a reduction in anxiety. The present findings indicate that PBM, MT and CT are able to promote pain relief, improve mandibularfunction and reduce the psychosocial negative aspects in TMD patients.