Meiqing Wang

Missing Posterior Teeth and Risk of Temporomandibular Disorders

There is disagreement about the association between missing posterior teeth and the presence of temporomandibular disorders (TMD). Here, the purpose was to investigate whether the number of missing posterior teeth, their distribution, age, and gender are associated with TMD. Seven hundred and forty-one individuals, aged 21–60 years, with missing posterior teeth, 386 with and 355 without TMD, were included. Four variables—gender, age, the number of missing posterior teeth, and the number of dental quadrants with missing posterior teeth—were analyzed with a logistic regression model. All four variables—gender (OR = 1.59, men = 1, women = 2), age (OR = 0.98), the number of missing posterior teeth (OR = 0.51), and the number of dental quadrants with missing posterior teeth (OR = 7.71)—were entered into the logistic model (P < 0.01). The results indicate that individuals who lose posterior teeth, with fewer missing posterior teeth but in more quadrants, have a higher prevalence of TMD, especially young women.

Asymmetric muscle function in patients with developmental mandibular asymmetry

The aim was to test the hypothesis that developmental mandibular asymmetry is associated with increased asymmetry in muscle activity. Patients with mandibular condylar and/or ramus hyperplasia having unilateral cross-bite were compared with healthy subjects with normal occlusion. Muscle activity was recorded with surface electrodes in the masseter, suprahyoid, sternocleidomastoid muscle (SCM) and upper trapezius areas during jaw opening-closing-clenching, head-neck flexion-extension, and elevation-lowering of shoulders. Root mean square (RMS) and mean power frequency (MPF) values were calculated and analysed using anova and t-tests with P < 0.05 chosen as significance level. The SCM and masseter muscles showed co-activation during jaw and head movements, significantly more asymmetric in the patients than in the healthy subjects. The RMS and MPF values were higher in the patients than in the controls in the SCM and suprahyoid areas on both sides during jaw opening-closing movement. The results indicate that the ability to perform symmetric jaw and neck muscle activities is disturbed in patients with developmental mandibular asymmetry. This is of clinical interest because asymmetric activity may be an etiologic factor in temporomandibular joint and cervical pain. The results support that co-activation occurs between jaw and neck muscles during voluntary jaw opening and indicate that postural antigravity reflex activity occurs in the masseter area during head extension. Further studies, where EMG recordings are made from the DMA patients at early stages are motivated to verify activity sources and test if the asymmetric activity is associated with muscle and joint pain in the jaw and cervical areas.

SEMG activity of jaw-closing muscles during biting with different unilateral occlusal supports

The aim of this study was to test the hypothesis that experimental and reversible changes of occlusion affect the levels of surface electromyographic (SEMG) activity in the anterior temporalis and masseter areas during unilateral maximal voluntary biting (MVB) in centric and eccentric position. Changes were achieved by letting 21 healthy subjects bite with and without a cotton roll between the teeth. The placement alternated between sides and between premolar and molar areas. The SEMG activity level was lower when biting in eccentric position without than with a cotton roll between teeth (P < 0.043). It was always lower with premolar than with molar support when biting with a cotton roll (P < 0.013). In the anterior temporalis areas, the SEMG activity was always lower on the balancing than on the working side (P < 0.001). Such a difference was also found in the masseter areas but only during molar-supported centric biting (P = 0.024). No differences were found when comparing the SEMG levels in masseter areas between centric and eccentric biting (P > 0.05). In the anterior temporalis area, the balancing side SEMG activity was lower in eccentric than in centric but only in molar-supported biting (P = 0.026). These results support that the masseter and anterior temporalis muscles have different roles in keeping the mandible in balance during unilateral supported MVB. Changes in occlusal stability achieved by biting with versus without a cotton roll were found to affect the SEMG activity levels.

Experimentally created nonbalanced occlusion effects on the thickness of the temporomandibular joint disc in rats.

OBJECTIVES To test the hypothesis that experimentally created physiologically nonbalanced occlusion will not affect the thickness of the temporomandibular joint (TMJ) discs in rats. MATERIAL AND METHODS Twenty-four 8-week-old Sprague-Dawley rats were equally divided into a control group that was left untreated and an experimental group where a nonbalanced occlusion was created. Elastic rubber bands, 1 mm in diameter, were inserted and 1 week later were replaced by plastic material between the first and the second molars of the left maxillary and the right mandibular dentitions to move the first molars about 0.8 mm mesially. This created and maintained a physiologically nonbalanced occlusion. The animals were euthanized 8 weeks later, and the TMJ disc thickness was measured on histologically prepared slices using an electronic meter. Two-way univariate analysis of variance was used to compare the groups (alpha level = .05). RESULTS The intermediate zone was thicker in the experimental group than in the control group (P = .003), but no differences were found between groups regarding the anterior and posterior bands. There were no significant sex-related effects on this observation. CONCLUSION The hypothesis is rejected. The results indicate that the intermediate zone of rat TMJ disc has the ability to adapt to the alteration of the space between condyle and fossa caused by occlusion changes. Further studies on larger groups that are followed for longer times are needed.

Changes of temporomandibular joint and semaphorin 4D/Plexin-B1 expression in a mouse model of incisor malocclusion.

AIMS To investigate the changes in condylar cartilage and subchondral bone of the temporomandibular joint (TMJ) in a mouse model of incisor malocclusion. METHODS By bonding a single (single group) or a pair (pair group) of metal tube(s) to the left incisor(s), a crossbite-like relationship was created between left-side incisors in mice. The morphological changes in the TMJ condyles were examined by hematoxylin and eosin and toluidine blue staining. Indices of osteoclastic activity, including tartrate-resistant acid phosphatase (TRAP) staining and macrophage colony stimulating factor (M-CSF) were investigated by histochemistry or real-time polymerase chain reaction (PCR). The osteoblastic activity was indexed by osteocalcin expression. Expressions of semaphorin 4D and its receptor, Plexin-B1, were detected by real-time PCR. Two-way analysis of variance was used to assess the differences between groups. RESULTS One week and 3 weeks after bonding the metal tube(s), cartilage degradation and subchondral bone loss were evident histologically. Both indices of osteoclastic activity (TRAP and M-CSF) were significantly increased in cartilage and subchondral bone after bonding the metal tube(s). Osteocalcin expression in cartilage was significantly increased at week 3, while its expression in subchondral bone was significantly increased at week 1 but decreased at week 3. The semaphorin 4D expression in cartilage and subchondral bone was significantly decreased at week 1 but significantly increased at week 3. For Plexin-B1 expression, a significant increase was detected in subchondral bone at week 3. CONCLUSION Bonding a single or a pair of metal tube(s) to left incisor(s) is capable of inducing remodeling in the TMJ, which involved cartilage degradation and alteration of osteoclastic and osteoblastic activity.

The effect of physiological nonbalanced occlusion on the thickness of the temporomandibular joint disc: A pilot autopsy study

STATEMENT OF PROBLEM The temporomandibular joint (TMJ) disc is often observed to be thicker in temporomandibular disorder (TMD) patients. This clinical observation requires verification. PURPOSE The purpose of this pilot study was to investigate whether the TMJ disc responds to dysfunctional occlusal changes by an increase in thickness. MATERIAL AND METHODS Twelve cadaver heads were divided into 2 groups, 1 with physiologically balanced occlusion (BO), 7 cadaver heads and 14 joints, and the other with physiologically nonbalanced occlusion (NO), 5 cadaver heads and 9 joints. The NO group had defining traits, such as reverse articulation or tightly locked occlusion. The latter is an occlusal relationship with drifted, tilted, and/or supraerupted teeth, often seen in patients who have lost posterior teeth. Histological sections from the lateral, center, and medial parts of the joints stained with haematoxylin and eosin were used for measuring the disc thickness. Student t tests and Bonferroni correction were used to compare groups (alpha=.05). RESULTS All 9 mean thickness values were higher in the NO than in the BO group. According to the t tests, the posterior band was thicker in the lateral (P=.007) and center (P=.015) sections, and the intermediate zone was thicker in the lateral section (P=.008) in the NO than in the BO group. These differences were not significant after Bonferroni corrections. CONCLUSIONS The results suggest that the TMJ disc has the ability to adapt to alteration of the space between condyle and fossa caused by occlusal changes. Further studies from larger groups should be undertaken.

Effects of periodontal afferent inputs on corticomotor excitability in humans

The aim of the present study was to determine in humans whether local anaesthesia (LA) or nociceptive stimulation of the periodontal ligaments affects the excitability of the face primary motor cortex (MI) related to the tongue and jaw muscles, as measured by transcranial magnetic stimulation (TMS). Twelve healthy volunteers (11 men, 1 woman, 25.3 +/- 4.2 years) participated in two 3-h sessions separated by 7 days. The LA carbocain or the nociceptive irritant capsaicin was randomly injected into the periodontal ligament of the lower right central incisor. In both sessions, TMS-motor evoked potential (MEP) stimulus-response curves and corticomotor maps were acquired for the tongue and masseter muscles before (baseline) and at 5, 30 and 60 min post-application of carbocain or capsaicin. Transcranial magnetic stimulation-MEP stimulus-response curves were also acquired at these time points for the first dorsal interosseous (FDI) as an internal control. Burning pain intensity and mechanical sensitivity ratings to a von Frey filament applied to the application site were recorded on an electronic visual analogue scale (VAS). All subjects reported a decreased mechanical sensitivity (anova: P = 0.004) in the LA session and a burning pain sensation (VAS peak pain: 6.4 +/- 1.0) in the capsaicin session. No significant changes in cortical excitability of the MI, as reflected by TMS-MEP stimulus-response curves or corticomotor maps for the tongue, masseter or FDI were found between baseline and post-injection for the LA (anovas: P > 0.22) or capsaicin (anovas: P > 0.16) sessions. These findings suggest that a transient loss or perturbation in periodontal afferent input to the brain from a single incisor is insufficient to cause changes in corticomotor excitability of the face MI, as measured by TMS in humans.

Evaluation of the use of and attitudes towards a face-bow in complete denture fabrication: a pilot questionnaire investigation in Chinese prosthodontists.

The aim of this study was to assess the use of and attitudes towards a face-bow among Chinese prosthodontists in complete denture fabrication. Thirty-six prosthodontists in two dental hospitals affiliated separately to two of the top four dental schools in China were included. A questionnaire was sent to them with 18 questions covering the following four aspects: (i) the education and experience background of the prosthodontists, (ii) their impression of the quality of the dentures, (iii) the use of and attitudes towards a face-bow in complete denture fabrication and (iv) their understanding of jaw relationship and occlusal adjustment in complete denture fabrication. Most (97%) experienced Chinese prosthodontists seldom used a face-bow in complete denture fabrication. Although they (92%) believed that more than 90% of their edentulous patients were satisfied with the complete dentures, 39% of them thought that not using a face-bow might lower the quality of complete dentures and 94% believed that there was a difference between the quality of dentures fabricated with an adjustable articulator and those made with a simple articulator. Among the 36 prosthodontists, 75% often and 8% occasionally did the occlusal adjustment when giving the newly made dentures to their patients. The great majority of prosthodontists in two of top four Chinese dental hospitals, who believed most of their patients satisfied with their complete dentures, seldom used a face-bow. Occlusal adjustment may be helpful to eliminate the possible errors caused by not using a face-bow.

Unilateral anterior crossbite induces aberrant mineral deposition in degenerative temporomandibular cartilage in rats.

OBJECTIVE To investigate whether mechanical stress induces mineral deposits that contribute to matrix degradation at the onset of osteoarthritis (OA) in temporomandibular joint (TMJ) cartilage. DESIGN Female Spraguee-Dawley rats were subjected to an unilateral anterior crossbite (UAC) procedure. Histology, electron microscopy, and energy dispersive spectrometer (EDS) were used to examine cartilage matrix structures and composition of mineral deposit in the affected TMJ cartilage. Protein and/or RNA expression of phenotypic markers and mineralization modulators and matrix degradation was analyzed by immunohistochemistry and/or real-time PCR. Synthetic basic calcium phosphate (BCP) and calcium pyrophosphate dehydrate (CPPD) crystals were used to stimulate ATDC5 cells for their impact on cell differentiation and gene expression. RESULTS Fragmented and disorganized collagen fibers, expanded fibrous spaces, and enhancement of matrix vesicle production and mineral deposition were observed in matrices surrounding hypertrophic chondrocytes in cartilage as early as 2-weeks post-UAC and exacerbated with time. The mineral deposits in TMJ cartilage at 12- and 20-weeks post-UAC had Ca/P ratios of 1.42 and 1.44, which are similar to the ratios for BCP. The expression of mineralization inhibitors, NPP1, ANK, CD73, and Matrix gla protein (MGP) was decreased from 2 to 8 weeks post-UAC, so were the chondrogenic markers, Col-2, Col-X and aggrecan. In contrast, the expression of tissue-nonspecific alkaline phosphatase (TNAP) and MMP13 was increased 4-weeks post-UAC. Treating ADTC5 cells with BCP crystals increased MMPs and ADAMTS5 expression, but reduced matrix production in a time-dependent manner. CONCLUSION UAC induces deposition of BCP-like minerals in osteoarthritic cartilage, which can stimulate matrix degradation by promoting the expression of cartilage-degrading enzymes to facilitate OA progression.

A Preliminary Anatomical Study On the Association of Condylar and Occlusal Asymmetry

Abstract The aim of this study was to test the hypothesis that condylar and occlusion asymmetry are not associated. For each of 22 skulls, the asymmetry of condyles was graded by one examiner and the asymmetry of occlusion by another examiner, both blinded to each other’s evaluation, as 0 = symmetrical, 1 = mild asymmetrical and 2 = severe asymmetrical. There were 18 condyles graded the same as to their occlusion, but in four, the grades differed by one degree. Nine were graded symmetrical, seven were mild, and six were graded severely asymmetrical condyles. The corresponding figures for occlusion were: 10 were graded symmetrical, seven were graded mildly asymmetrical, and five were graded severely asymmetrical occlusion. The relation between occlusion and condylar asymmetry was tested using Goodman-Kruskal’s gamma and was found to be 0.970 (p<0.001). The null hypothesis was not supported. The results indicate that asymmetry of occlusion and condyles are associated, which indicates the need for further studies on larger samples, and in vivo studies.