Daniele Manfredini

Predictive value of clinical findings for temporomandibular joint effusion

OBJECTIVEnThe aim of this work was to evaluate the predictive value of clinical symptoms for magnetic resonance imaging (MRI) findings of temporomandibular joint (TMJ) effusion.nnnSTUDY DESIGNnSixty-one patients with TMJ pain were assessed by means of a standardized clinical examination and MRI. A calibrated investigator evaluated the presence of 8 clinical indicators (predictors) of TMJ effusion (outcome variable). A logistic regression analysis was performed to detect significant associations between clinical symptoms and MRI findings of TMJ effusion. The accuracy of the final logit to predict effusion was compared with that derived from univariate analysis.nnnRESULTSnA clinical examination based upon the assessment of pain in the TMJ with lateral palpation, with posterior palpation, during motion, and during maximum assisted opening, and the presence of click and crepitus sounds has an accuracy of 78.7% to predict TMJ effusion. Among the single clinical symptoms, the most reliable predictor of TMJ effusion is the presence of pain with lateral palpation (accuracy 76.2%; K =.525).nnnCONCLUSIONnThe use of a multiple regression approach demonstrated that an extensive clinical assessment which considers 6 main indicators consents to predict accurately the presence of MRI TMJ effusion. Based on these findings, MRI assessment should be reserved for patients in which the exact disc-condyle relationship needs to be evaluated.

Sexual hormone serum levels and temporomandibular disorders. A preliminary study

The aim of the present study was to investigate the role of sexual hormones in a young adult population affected by articular forms of temporomandibular disorders (TMD), measuring 17β-estradiol and progesterone serum levels. In the study, we included 40 patients (20 males and 20 females) with a Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis I group II diagnosis of disk displacement and/or group III diagnosis of arthralgia, osteoarthritis or osteoarhrosis, and 32 healthy controls. In female patients, blood samples were collected in follicular and luteal phases of the same menstrual cycle, while only one blood sample was drawn in male patients. Serum levels of estradiol and progesterone were determined using a radioimmunoassay and the comparison between the two groups was performed using a t test. Regarding estradiol, our results showed significantly higher serum levels in patients affected by TMD than in healthy controls, both in males (pu200a<u200a0.01) and in the luteal phase of the menstrual cycle in females (pu200a<u200a0.05), while no difference was found for progesterone serum levels. Considering the multifactorial etiology of TMD and the hypothesis that some joint tissues (e.g., bone, cartilage, collagen, proteins) could be a target for sexual hormones, these data suggest that high serum estrogen levels might be implicated in the physiopathology of TMD.

Mood Spectrum in Patients with Different Painful Temporomandibular Disorders

Abstract The purpose of this study was to investigate for difference in the prevalence of mood disorders between patients with different painful temporomandibular disorders (TMD). After a sample size necessary for the study was calculated, 60 patients with a painful TMD were selected and divided into the following groups: myofascial pain (n=20), temporomandibular joint (TMJ) pain (n=18), combined myofascial and TMJ pain (n=22). Two distinct comparison groups were selected: subjects with a non-painful TMD (n=25) and TMD-free subjects (n=29). All participants filled out a self-report validated instrument (MOODS-SR) to evaluate psychopathological symptoms related to mood disturbances. A one-way analysis of variance (ANOVA) with Bonferroni’s post hoc test for multiple comparisons was performed to investigate for significant differences among the groups. The three groups of patients with painful TMD scored significantly higher than comparison groups in all MOODS-SR domains investigating depression, but no difference was shown between subjects with myofascial pain and those with TMJ pain. No significant differences among the groups emerged for the presence of manic symptoms, indicating that depressive disorders associated with TMD are not an expression of a more complex manic depressive illness. The study concluded that the presence of depressive symptoms in TMD patients seems to be related to the presence of a painful condition and seems to be unrelated to the location of pain. Furthermore, depressive disturbances in painful TMD patients affect the whole spectrum of depressive psychopathology.