J Orofac Pain
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Temporomandibular disorders is a common form of chronic pain affecting the head, face, and jaw. The distinguishing symptoms of this disorder include pain and impairment of the masticatory function, and frequent display of symptoms, ranging from aches in the head, neck, ears, and eyes, to atypical toothaches, throat symptoms, and occlusal changes. ⋯ This article is a review of the literature on the psychophysiologic factors contributing to temporomandibular disorders and its limitations. Recommendations for future research are also given.
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Case Reports
Fibrous ankylosis of the temporomandibular joint: report of a case with atypical presentation.
A case of chronic unilateral mandibular dislocation with development of fibrous ankylosis is presented. This was an unusual presentation of intracapsular tissue ankylosis to the eminentia, as well as retrocondylar cicatrix combined with contralateral mandibular osseous compensations and remodeling with resulting ramus impingements upon relocation of the condyle. Various diagnostic and therapeutic considerations are reviewed and discussed.
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This study examined masseter and temporalis pain-pressure thresholds in 29 patients with chronic bilateral myogenous temporomandibular disorder and in 11 controls. Patients with evidence of temporomandibular joint pathosis were omitted. The influence of time, facial side, muscle site, and side of greatest spontaneous pain on pain-pressure thresholds was measured. ⋯ Mean pain-pressure thresholds in patients differed over the four sessions, which is consistent with recent reports of fluctuating levels of pain in patients with temporomandibular disorders. Additional findings included significant pain-pressure threshold differences among muscle sites in patients and controls, and lower patient pain-pressure thresholds relative to controls. Within- and between-session reliability was adequate for patients (r = .85 and r = .75, respectively) and controls (r = .90 and r = .75, respectively).
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To assess the knowledge and beliefs of practicing dentists regarding temporomandibular disorders and chronic pain, a random sample of dentists in the Kansas City metropolitan area was surveyed. A survey instrument examining knowledge and beliefs in four domains (psychophysiological, psychiatric disorders, chronic pain, and pathophysiology) was used. The responses of the practicing dentists were compared to the responses of panels of experts. ⋯ The findings partially replicate an earlier, similar survey of dentists in the Seattle, Washington, area. The findings suggest that the role of psychiatric disorders and psychophysiologic factors in the etiology of temporomandibular disorders is widely acknowledged by practicing dentists. However, there is considerable discrepancy between practicing dentists and temporomandibular disorder experts on the pathophysiology of temporomandibular disorders and how best to diagnose and treat these chronic conditions.
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Pain and tenderness at trigger points and referral sites may be modified in subjects with myofascial pain in the head and neck region by injecting local anesthetic into active trigger points, but the effect of injection on jaw muscle pain-pressure thresholds has not been measured. The mechanism by which trigger-point injection affects muscle tenderness is also unclear and may be related to the "hyper-stimulation analgesia" induced by stimulation of an acupuncture point. A pressure algometer was used before and after an active trigger point injection in the masseter to measure the pain-pressure threshold in the masseter and temporal muscles of 10 subjects with jaw muscle pain of myogenous origin. ⋯ In the control group, the pain-pressure threshold increased significantly at all recording sites in the masseter after acupuncture-point injection. Although local anesthetic injection acts peripherally at the painful site and centrally where pain is sustained, pain-pressure thresholds were not dramatically increased in myofascial pain subjects, in contrast to controls. This suggests that in subjects with myofascial pain, there was continued excitability in peripheral tissues and/or central neural areas which may have contributed to the persistence of jaw muscle tenderness.