Ülle Voog-Oras

Long-term evaluation of arthroscopic surgery with lysis and lavage of temporomandibular joint disorders

AIM To estimate and analyse the long-term outcome of arthroscopy for the treatment of the temporomandibular joint (TMJ) internal derangements. PATIENTS AND METHODS Twenty-nine patients (35 joints) who underwent TMJ arthroscopy under general anaesthesia due to osteoarthritis between years 2000 and 2007 (Wilkes stages IV and V) were included in this study. The age range at the time of surgery was from 18 to 69 years. The scores for preoperative maximal interincisal opening (MIO), and visual analogue scale (VAS) score for pain before arthroscopy, 6 months and 5 years after arthroscopy were compared. RESULTS Fibrous adherences were found in all cases, fibrillations in 76% of cases. The most frequent radiographic sign was erosion (69%). There was a significant increase in the MIO postoperatively after 6 months (r(s)=0.56; n=29, p>0.01) that held during the longer-term follow-up (5 years) period (r(s)=0.58; p<0.001). VAS after 6 months was positively correlated to VAS after 5 years (r(s)=0.38; p=0.040). There were no significant differences between the results of follow-up when comparing the shorter (6 months) and longer (5 years) results. CONCLUSION Arthroscopic lysis and lavage for the treatment of TMJ disorders offers favourable long-term stable results with regard to increasing MIO and reduced pain and dysfunction.

Contemporary management of TMJ involvement in JIA patients and its orofacial consequences.

Juvenile idiopathic arthritis is the most common chronic rheumatic condition during childhood. Temporomandibular joint arthritis is frequently asymptomatic. When it takes place during childhood, it may affect condylar growth; therefore, these children are at risk of unfavorable long-term outcomes from the associated joint damage. The etiology is not completely understood, but it is considered as multifactorial with both genetic and environmental factors involved.The standardized examination and imaging protocols serve important purpose to diagnose temporomandibular joint (TMJ) arthritis not only to establish an early interventional strategy but also to assess craniofacial growth and the progression of signs and symptoms in those patients. Although the treatment of juvenile idiopathic arthritis (JIA) has changed dramatically over the last decades due to new therapeutic options, TMJ arthritis still can develop during the course of the disease. In clinical experience, TMJs appear to respond less well to the standard of care used to treat other joints. More individualized approach to the patient’s treatment serves as the main goal of personalized medicine. It could be achieved by adopting new methods of medical imaging such as conebeam computer tomography as well as developing reliable biomarkers which may assist with predicting disease type, course, or severity and predicting response to medication.This article provides an overview of current information on orofacial complications in JIA and its management. Based on information provided in this review, more precise diagnosis, proper tools for recognizing people at risk, and more efficient treatment approaches could be implemented. This may lead to more personalized treatment management strategies of TMJ complications of JIA patients.

Symptoms and signs of temporomandibular disorders among elderly Vietnamese

Background: To assess the prevalence of the symptoms and signs of temporomandibular disorders (TMDs) and determine the prevalence of TMDs among elderly Vietnamese aged 65–74 years old. Methods: A cross-sectional study was conducted among 258 participants aged 65–74 years old (128 females and 130 males) using two strategies for TMD diagnosis: a clinical examination of the temporomandibular joint and its associated structures using the Diagnostic Criteria for Temporomandibular Disorders Axis I; and a set of 14 questions regarding TMD symptoms to obtain anamnestic data. Results: The prevalence of TMD symptoms was: headache 49.6%; temporomandibular joint noise 28.0%; orofacial pain 25.2%; jaw locking 3.1%; 62.5% of participants had at least one TMD symptom. Headaches were more prevalent in females than males (p=0.009) and rural than urban residents (p<0.001). The most frequent signs were temporomandibular joint crepitus (50.4%), clicking (48.1%) and mouth-opening deviation (37.6%). Temporomandibular joint crepitus and mouth-opening deviation were more frequent among rural than urban (p=0.024 and p<0.001, respectively). TMD was found in 56.6% of the total sample. Of the TMD sufferers, 37.6% were diagnosed with disc displacement, 34.9% with degenerative joint disease, 3.5% with myalgia and 1.2% with arthralgia. Conclusions: More than half of elderly Vietnamese have at least one TMD symptom. TMD sounds were the most common clinical sign of TMD. There were no differences between the genders or place of residence and TMD diagnosis. Disc displacement and degenerative joint disease were most prevalent among elderly Vietnamese.

Occlusal Support and Temporomandibular Disorders Among Elderly Vietnamese

PURPOSE The aim of this study was to analyze the associations between missing teeth, occlusal support, and temporomandibular disorders (TMD) among elderly Vietnamese. MATERIALS AND METHODS The study consisted of 145 TMD and 112 non-TMD (control group) participants aged 65 to 74 years. TMD was evaluated using Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I. An occlusal unit (OU) was defined as the cusp of a tooth coupled with the fossa of its antagonist tooth. A premolar pair was counted as one OU and a molar pair as two OUs. Dentition was divided into four occlusal support zones (OSZs) based on occluding pairs of posterior teeth by using Eichner classification: Class A had 4 OSZs, Class B had 1 to 3 OSZs or only anterior teeth, and Class C had no OSZ. RESULTS The TMD group lost significantly more posterior teeth (mean ± SD 5.1 ± 4.7) than the control group (4.0 ± 3.9, P = .033). The mean ± SD OUs of the TMD and control groups were 5.1 ± 4.6 and 6.0 ± 4.3, respectively, which was nonsignificant (NS). The distribution of Class A (40.7%), Class B (40.0%), and Class C (19.3%) among the TMD group was not significantly different from the control group (50.0%, 38.4%, and 11.6%, respectively, NS). The odds of having TMD were positively associated with total unilateral loss of OUs (OR = 3.4, 95% CI = 1.2-9.4, P = .020) and total bilateral loss of OUs (OR = 2.7, 95% CI = 1.2-6.6, P = .027). CONCLUSION Total loss of OSZs on one or both sides of the mouth were found to be predictors of TMD among elderly Vietnamese.

TOOTH LOSS AND RISK FACTORS AMONG ELDERLY VIETNAMESE

Introduction: Oral health care systems for older people tend to be reducing tooth loss and saving functional dentition. Elderly Vietnamese had to live under challenging conditions and were not entitled to any dental care for over 30 years due to the Vietnam War. The aim of the current study was to investigate tooth loss and related risk factors among elderly Vietnamese aged 65-74. Methodology: The sample study was 258 elderly Vietnamese aged 65–74 years old. Each absent tooth was registered as a tooth loss. Risk factors were evaluated based on the Oral Health Questionnaire for adults (WHO, 2013). Results: The mean tooth loss for the sample was 7.6 (±7.0). 27.1% of participants had lost 1–3 teeth, 23.6% 4–6 teeth, 27.1% 7–16 teeth and 13.6% >16 teeth; 8.5% had full dentition. Within each category of predictors, a statistically higher number of lost teeth was found for: the 70-74 age group (Mean±SD, 8.8±7.9); rural residents (8.8±7.6); time in education ≤5 years (10.2±7.7); frequency of teeth cleaning ≤1 time/day (8.7±7.3); last visit to dentist >1 year ago (8.2±7.5); tobacco smoking (9.4±7.6); no alcohol drinking (8.3±7.2). The odds of having >6 lost teeth was significantly more frequent among elders with less time in education (OR=2.2, p<0.01) and tobacco smoking (OR=2.8, p<0.01). Conclusion: There are high prevalence and number of tooth loss among elderly Vietnamese. Smoking behaviour and time in education were significantly related to maintaining teeth of the elderly community population.

Importance of Bone Markers and Radiological Status on Clinical Signs of Temporomandibular Joint Disorders

This chapter describes the diagnostics of temporomandibular joint disorders (TMDs) with the main focus on the radiographic changes and the role of different bone markers as procollagen type I N-terminal propeptide (P1NP), C-telopeptide crosslaps of type I col‐ lagen (CTX-1) as well as vitamin D (25(OH)D) in the pathogenesis of TMDs. From our population-based study, 47% subjects had TMJ problems where pain is commonly ac‐ companied by stiffness, sounds and functional limitations, resulting in a decreased quali‐ ty of life, and thus exert a significant negative impact on activities of daily living (ADL). Assessment of individual pain level is important in the evaluation of TMD. Radiographic examination is commonly used for assessment of TMJ problems. Orthopantomograph (OPTG) is the most routine method for assessment of bone structural changes as erosions, flattening and osteophytes of the condyle and temporal part of TMJ. It is found that sub‐ jects with increased levels of P1NP, CTX-1 have less TMJ pain/discomfort. Increased lev‐ els of CTX-1 would probably cause an immediate increase of P1NP which is known as a sensitive marker of bone formation. TMJ radiographic changes seem to be related to the low level of 25(OH)D level. Hence, the aim of this chapter is to critically review the evidence of possible association between TMJ pain and bone radiographic changes with main focus on the role of differ‐ ent bone markers and vitamin D.