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Objectives: This study investigated the jaw functional status and severity of somatic/psychological symptoms in different Diagnostic Criteria for temporomandibular disorders (DC/TMD) diagnostic subtypes and established the correlates between jaw functional limitation, somatization, depression and anxiety. Methods: Data were accrued from consecutive 'first‐visit' patients seeking TMD treatment at a university‐based oral medicine/diagnosis clinic. Axis I physical TMD diagnoses were derived using the DC/TMD methodology and patients were categorized into pain‐related (PT), intra‐articular (IT) and combined (CT) TMD groups. Axis II measures were also administered and included the Jaw Functional Limitation Scale‐20 (JFLS‐20), Patient Health Questionnaire‐15 and 9 (PHQ‐15 and PHQ‐9) and General Anxiety Disorder Scale‐7 (GAD‐7). Chi‐square/Kruskal–Wallis tests and Spearman's correlation were employed for statistical evaluations (α =.05). Results: The final dataset consisted of 772 TMD patients (mean age of 37.7 ± 15.9 years; 70.2% females). The prevalence of PT, IT and CT was 11.9%, 15.7% and 72.4%, respectively. Significant differences in functional jaw limitations, somatization, depression (CT, PT > IT) and anxiety (CT > PT, IT) were observed. Moderate‐to‐severe somatization, depression and anxiety were detected in 12.6%–15.7% of patients. For all three TMD groups, JFLS global scale/subscale scores were weakly associated with somatization, depression and anxiety scores (rs < 0.4). Moderate‐to‐strong correlations were noted between somatization, depression and anxiety (rs = 0.50–0.74). Conclusions: Functional jaw limitations were associated with painful TMDs but appear to be unrelated to somatization and psychological distress. Somatization and depression/anxiety were moderately correlated, underscoring the importance of somatic symptom screening when managing TMD patients. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the generational-gender distinctions in Diagnostic Criteria for Temporomandibular disorders (DC/TMD) subtypes among East Asian patients. Methods: Consecutive "first-visit" TMD patients presenting at two university-based TMD/orofacial pain clinics in China and South Korea were enlisted. Demographic information along with symptom history was gathered and clinical examinations were performed according to the DC/TMD methodology. Axis I physical diagnoses were rendered with the DC/TMD algorithms and categorized into painful and non-painful TMDs. Patients were categorized into three birth cohorts, specifically Gen X, Y, and Z (born 1965–1980, 1981–1999, and 2000–2012 respectively) and the two genders. Data were evaluated using Chi-square/Kruskal-Wallis plus post-hoc tests and logistic regression analyses (α = 0.05). Results: Gen X, Y, and Z formed 17.2%, 62.1%, and 20.7% of the 1717 eligible patients examined (mean age 29.7 ± 10.6 years; 75.7% women). Significant differences in prevalences of arthralgia, myalgia, headache (Gen X ≥ Y > Z), and disc displacements (Gen Z > Y > X) were observed among the three generations. Gen Z had substantially fewer pain-related and more intra-articular conditions than the other generations. Women presented a significantly greater frequency of degenerative joint disease and number of intra-articular conditions than men. After controlling for generation-gender interactions, multivariate analyses showed that "being Gen X" and female increased the risk of painful TMDs (OR = 2.20) and reduced the odds of non-painful TMDs (OR = 0.46). Conclusions: Generational-gender diversities in DC/TMD subtypes exist and are important for guiding TMD care and future research endeavors. [ABSTRACT FROM AUTHOR]

Background: Sleep disturbance is a systemic symptom and at the same time a major modulating factor of temporomandibular disorders (TMD). Inflammation is known as a underlying mechanism involved in both poor sleep and increased pain. Objective: The relationship between long‐term clinical characteristics and hematologic biomarkers of hypothalamic–pituitary–adrenal axis activity and inflammation in TMD patients according to sleep duration was investigated to verify the possible role of sleep disturbance and systemic inflammation in TMD. Materials and methods: Inflammatory and stress mediator levels of venous blood samples were investigated in 63 female TMD patients along with comorbidity levels including stress, somatization, autonomic symptoms and sleep quality based on structured questionnaires. Differences in long‐term clinical characteristics and hematologic variables following conservative treatment were analysed according to total sleep time as normal, short and long sleep groups. Also, clinical and hematologic indices related to favourable treatment response were sought out. Results: Significantly less patients in the long sleep group reported pain on voluntary mandibular movement (p =.042) while depression (p =.043) and somatization levels (p =.002) were significantly higher in the short sleep group. Norepinephrine levels of the long sleep group were significantly lower than other groups. Decrease in pain intensity with treatment was smallest in the short sleep group. Erythrocyte sedimentation rate was associated with significant pain improvement at 3 months post‐treatment and interleukin‐1β, ‐4, and ‐8 levels could predict favourable treatment response. Conclusion: Short sleep is associated with more comorbidities and unfavourable long‐term treatment response in TMD which may be mediated by systemic inflammation. Effective management of sleep is necessary for successful TMD management. [ABSTRACT FROM AUTHOR]

Objectives: This study proposed a conceptual framework for reporting Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I conditions and investigated the prevalence of TMD subtypes/categories in patients from Confucian heritage cultures. Variances in gender, age, and TMD chronicity between Chinese (CN) and Korean (KR) patients were also explored. Materials and methods: Subjects were recruited from consecutive patients seeking care at two University-based centers in Beijing and Seoul. Eligible patients completed a demographic survey as well as the DC/TMD Symptom Questionnaire and were clinically examined according to the DC/TMD methodology. Axis I diagnoses were subsequently rendered with the DC/TMD algorithms and documented using the stratified reporting framework. Statistical evaluations were performed with chi-square, Mann–Whitney U tests, and logistic regression analysis (α = 0.05). Results: Data of 2008 TMD patients (mean age 34.8 ± 16.2 years) were appraised. Substantial differences in female-to-male ratio (CN > KR), age (KR > CN), and TMD duration (KR > CN) were observed. Ranked frequencies of the most common Axis I diagnoses were: CN – disc displacements (69.7%) > arthralgia (39.9%) > degenerative joint disease (36.7%); KR – disc displacements (81.0%) > myalgia (60.2%) > arthralgia (56.1%). Concerning TMD categories, notable differences in the prevalence of intra-articular (CN 55.1% > KR 15.4%) and combined (KR 71.8% > CN 33.4%) TMDs were discerned. Conclusions: Though culturally similar, the two countries require disparate TMD care planning/prioritization. While TMJ disorders in children/adolescents and young adults should be emphasized in China, the focus in Korea would be on TMD pain in young and middle-aged adults. Clinical relevance: Besides culture, other variables including socioeconomic, environmental, and psychosocial factors can influence the clinical presentation of TMDs. Chinese and Korean TMD patients exhibited significantly more intra-articular and combined TMDs respectively. [ABSTRACT FROM AUTHOR]

Objectives: Investigate the presence of widespread pain in a well‐defined TMD group and analyze its interrelationship with various comorbidities. Also, longitudinally seek the difference in treatment response according to the presence of widespread pain. Subjects and Methods: The observational study involved 45 female TMD patients in their 20s. Patients were grouped into localized and widespread pain groups based on the widespread pain index (WPI ≥ 4). Clinical characteristics and levels of comorbidities were analyzed through physical examination and validated questionnaires. Differences between the groups and the power of pre‐treatment WPI in predicting pre‐treatment comorbidities and post‐treatment pain level improvement were statistically analyzed. Results: Patients with widespread pain showed higher somatization and anxiety levels. SF‐36 scores were significantly lower and more patients complained of gastrointestinal symptoms. Conventional treatment significantly reduced pain intensity in both groups but less in the widespread pain group. WPI showed significant chances to predict patients showing improvement in pain levels with treatment with a cutoff value of 4. WPI was also effective in differentiating patients that showed a higher level of somatization. Conclusion: Widespread pain index could be effectively applied in differentiating those with a higher level of psychological distress and predicting TMD treatment response with further investigations into its reliability. [ABSTRACT FROM AUTHOR]

Background: While evidence is accumulating to propose a specific contribution of sleep disorders and low quality sleep in the pathogenesis of temporomandibular disorders (TMD), management of primary sleep disorders in the process of preventing and treating TMD still remains scientifically unsupported. Objective: To investigate the association of primary sleep disorders with TMD risk in South Korea. Patients and Methods: This study was based on the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) of South Korea with 468,882 participants. After excluding participants diagnosed in 2002, those with a diagnosis of a primary sleep disorder in 2003– 2005 were recruited. All participants diagnosed with TMD between January 1, 2006 and December 31, 2013 received follow-up. Cox proportional hazards regression was performed to determine the adjusted hazard ratios (aHR) and 95% confidence interval (CI) for TMD according to the presence or absence of a primary sleep disorder diagnosis. Results: After adjusting for all covariates, primary sleep disorder patients had a 44% higher risk for TMD compared with non-sleep disorder participants (aHR 1.44, 95% CI 1.02– 2.04). The incidence rate of TMD was nearly twice as high in participants with sleep disorders compared with those without (6.08 vs 3.27, per 104 person-years). In subgroup analysis, an association was observed with those over 60 years old or who frequently exercised physically. Conclusion: Primary sleep disorders could be an important independent risk factor for the initiation and maintenance of TMD. Patients with sleep disorders should be monitored for possible co-occurrence of TMD-related symptoms that could aggravate sleep disorders in turn. [ABSTRACT FROM AUTHOR]

Background: The current diagnostic criteria for temporomandibular disorders (TMD) do not require imaging for the diagnosis of degenerative joint disease (DJD) of the temporomandibular joint (TMJ) condyle, and there is a lack of data investigating the effectiveness of imaging modalities in predicting long‐term TMJ DJD prognosis. Objectives: To verify the association between initial bone scintigraphy results and long‐term DJD bone changes occurring in the TMJ condyle on cone beam computed tomography (CBCT). Methods: Initial bone scintigraphy, panoramic radiography and CBCT results were analysed in relation to long‐term (12 months) TMJ DJD bone change on CBCTs in 55 TMD patients (110 joints). Clinical and radiographic indices were statistically analysed among three groups (improved, no change, and worsened) based on long‐term TMJ DJD prognosis calculated by destructive change index (DCI). Results: Neither the uptake ratio nor visual assessment results from initial bone scintigraphy showed a significant difference according to long‐term condylar bone change groups. The cut‐off value of bone scintigraphy uptake ratio was 2.53 for long‐term worsening of TMJ DJD. Worsening of TMJ DJD was significantly associated with the diagnosis based on panoramic radiography (p =.011) and CBCT (p <.001). Initial DCI (β = −.291, p =.046) had a significant association with long‐term worsening of TMJ DJD. Conclusion: Initial bone scintigraphy results did not show sufficiently close associations with long‐term TMJ DJD prognosis. This should be considered in the selection process of imaging modalities for TMJ DJD patients. Future studies are needed to develop prognostic indices that comprise both clinical and imaging contents for improved predictive ability. [ABSTRACT FROM AUTHOR]

This article describes two cases of masseteric nerve neurectomy with radiofrequency done with the intention to treat temporomandibular disorders and related symptoms; the patients then visited our clinic complaining of side-effects after the procedure. A literature review was conducted to find scientific evidence relevant to masseteric nerve neurectomy with radiofrequency. A 21-year-old male patient visited with the chief complaint of swelling of both cheeks, dizziness, and generalized lethargy occurring after masseteric nerve neurectomy using radiofrequency. His mouth opening range was restricted. Magnetic resonance imaging indicated post-procedural inflammation with hemorrhage within both masseter muscles. A 28-year-old male patient visited with the chief complaint of occlusal discomfort and disocclusion after masseteric nerve neurectomy using radiofrequency. His occlusion was abnormal with only both second molars occluding. Overbite was −1 mm. Cone-beam computed tomography indicated degenerative joint disease of both condyles. In case 1, pharmacotherapy and physical therapy relieved overall symptoms. In case 2, although exacerbation of symptoms repeatedly occurred, long-term stabilization splint and physical therapy alleviated the temporomandibular disorders symptoms. However, the occlusion remained unstable. Scientific evidence of masseteric nerve neurectomy using radiofrequency for the treatment of temporomandibular disorders is still lacking. Therefore, conservative treatment should remain as the first line approach for temporomandibular disorders. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the association between general physical activity level and TMD pain in Koreans in a large‐scale national database established through a nationwide survey. Methods: Data from the Fourth Korean National Health and Nutrition Examination Survey (KNHANES IV), which was conducted from 2007 to 2009, were analysed. In total, 16 941 participants were included in this cross‐sectional study. Data on sociodemographic characteristics, TMD‐related variables, and general physical activity level were collected. Participants were divided into moderate‐ and low‐intensity exercise groups according to their physical activity levels. Multivariate logistic regression analyses were performed, adjusting for sociodemographic and other covariates. Results: The adjusted odds ratio (OR) (95% confidence interval; CI) for TMD pain was 1.373 (1.017‐1.854) for people doing moderate‐intensity exercises and 0.797 (0.629‐1.008) among people doing low‐intensity exercises. Those who did moderate‐intensity exercises had significantly more TMD pain. This was higher in the 30‐ to 39‐year age group (OR: 1.991, 95% CI: 1.137‐3.488), with significantly higher risk for TMD pain in those who did moderate‐intensity exercise, whereas low‐intensity exercise significantly decreased the risk for TMD pain in the same age group (OR: 0.625, 95% CI: 0.409‐0.958). Conclusions: Moderate‐intensity physical activity is associated with more TMD pain. Patients with TMD should avoid high‐intensity level exercises and continue low‐intensity exercises to prevent pain aggravation. [ABSTRACT FROM AUTHOR]

This study aimed to understand long-term changes of the osteoarthritic temporomandibular joint (TMJ) condyle using computed tomography (CT) and to verify its correlation with clinical characteristics of temporomandibular disorders. Eighty-nine patients (152 joints; 76 female, 13 male) who had taken follow-up CTs (mean follow-up period: 644.58 ± 325.71 days) at least once in addition to their initial evaluation were selected. Cross-sectional demographic and clinical data and longitudinal CT images were collected. Data were analyzed by analysis of variance and logistic regression. Overall destructive change index (number of TMJ condyle sections in which destructive change was observed) decreased from 1.56 to 0.66. Improvement was seen in 93 joints (61.2%) and 27 joints (17.8%) worsened. In the pain positive group, both initial and final destructive change index were significantly higher compared to the pain negative group (p = 0.04). Occlusal stabilization splint therapy and nonsteroidal anti-inflammatory drug administration showed a significant effect on improving the prognosis of TMJ osteoarthritis (p = 0.015 and 0.011). In conclusion, TMJ osteoarthritis showed long-term improvement in the majority of cases. TMJ osteoarthritis accompanied by pain showed unfavorable prognosis with additional bone destruction. Occlusal stabilization splint and nonsteroidal anti-inflammatory drug administration were beneficial on the prognosis of TMJ osteoarthritis. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Methods Results Conclusion The relationship of somatisation with facial pain duration/intensity, pain‐related interference/disability and psychological distress was investigated in East Asian temporomandibular disorder (TMD) patients. Correlations between somatisation, facial pain and psychological characteristics were also explored alongside the demographic/physical factors associated with moderate‐to‐severe depression and anxiety.Anonymised data were acquired from records of consecutive ‘first‐time’ patients seeking TMD care at a tertiary oral medicine clinic. Axis I physical TMD diagnoses were established utilising the diagnostic criteria for TMDs (DC/TMD) protocol and patients with TMD pain were stratified into those with pain‐related (PT) and combined (CT) conditions. Axis II measures administered encompassed the Patient Health Questionnaire‐15 (PHQ‐15), Graded Chronic Pain Scale (GCPS), Patient Health Questionnaire‐9 (PHQ‐9) and General Anxiety Disorder Scale‐7 (GAD‐7). Individuals with PT and CT were further categorised into those without (Pain − Som/Comb − Som) and with somatisation (Pain + Som/Comb + Som). Statistical evaluations were performed with nonparametric and logistic regression analyses (α = 0.05).The final sample comprised 473 patients (mean age 36.2 ± 14.8 years; 68.9% women), of which 52.0% had concomitant somatisation. Significant differences in pain duration (Comb + Som > Pain − Som), pain‐related interference/disability (Comb + Som > Comb − Som) and depression/anxiety (Pain + Som, Comb + Som > Pain − Som, Comb − Som) were discerned. Depression/anxiety was moderately correlated with somatisation (rs = 0.64/0.52) but not facial pain characteristics. Multivariate modelling revealed that somatisation was significantly associated with the prospects of moderate‐to‐severe depression (OR 1.35) and anxiety (OR 1.24).Somatisation exhibited a strong association with psychological distress when contrasted with facial pain in East Asian TMD patients. [ABSTRACT FROM AUTHOR]

Background: To investigate the differences in clinical characteristics and long-term treatment outcomes according to antinuclear antibody(ANA) and rheumatoid factor(RF) positivity and the correlation between pain-related and hematological indices in temporomandibular disorders(TMD) patients. Methods: Clinical examinations were done following the Research Diagnostic Criteria for TMD in 257 patients. Comprehensive screening along with psychological and hematological evaluations (ANA, RF, complete blood cell count, C-reactive protein[CRP] and erythrocyte sedimentation rate[ESR]) were conducted. Clinical characteristics and treatment outcomes were statistically compared between ANA/RF positive and negative groups. Results: Thirty-nine patients showed ANA/RF positivity. Male patients had smaller comfortable mouth opening(CMO)(p = 0.033) and maximum mouth opening(MMO)(p = 0.016) ranges with more painful neck muscles on palpation when RF/ANA positive. Pain duration, intensity, disability days and psychological distress levels were also higher in RF/ANA positive male patients. Significant correlation was shown in ESR with pain duration(p < 0.05) and numeric rating scale(NRS) before treatment(p < 0.05), CRP with NRS before treatment(p < 0.01), and red blood cell (RBC) with pain intensity(p < 0.05), NRS before treatment(p < 0.01), CMO(p < 0.01), pain on palpation of cervical muscles(p < 0.01), CMO(p < 0.05), and MMO(p < 0.05) 6 months after treatment. Conclusions: These results may point towards a nonspecific autoimmune disposition in a subgroup of TMD patients. RF and ANA could be considered as a screening test for the detection of autoimmune phenomena in TMD. [ABSTRACT FROM AUTHOR]

• Levels of IL-8 and IgG were significantly higher in the high disability group. • Certain cytokine and chemokine levels showed significant effects on jaw function and pain. • More severe TMD pain is associated with higher levels of systemic inflammation. Temporomandibular disorders (TMD) is a chronic pain disease affecting 4–60% of general population. Its suggested etiology includes mechanical overloading to related structures, psychosocial factors, and genetic vulnerability. However, its pathogenesis is yet to be fully understood, especially in cases with a higher level of pain and more associated comorbidities. Recently chronic systemic inflammation and possible autoimmunity has been indicated in several pain conditions as the underlying mechanism of chronicity but this aspect has not been rigorously investigated in TMD. This article focuses on analyzing the levels of cytokines, chemokines, autoantibodies and nonspecific inflammatory markers and comparing their levels according to pain severity and duration in 66 female TMD patients in their 20 s and investigating their association with clinical indices of TMD and comorbidities. The high pain disability group showed decreased range of jaw function and more pain on palpation of capsule areas compared to the low pain disability group. Comorbidities such as anxiety and sleep disturbance were also significantly more prevalent. The level of IL-8 and IgG were significantly higher in the high pain disability group. IL-2, -8, -13, IFN- γ, RANTES, PGE2, and thrombopoietin levels showed a significant effect on indices reflecting jaw function, generalized pain intensity, and health related quality of life. Such results imply that longer pain duration and higher pain intensity is associated with higher levels of systemic inflammation suggesting the possible role of immunologic disturbance as an underlying factor of chronic TMD pain and warranting further investigation for its consideration in diagnosis and treatment. [ABSTRACT FROM AUTHOR]