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Etiology, Diagnosis and Treatment of the Temporomandibular Joint and Masticatory Muscle Disorders in the Era of Emotional Challenges

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 March 2022) | Viewed by 25859

Special Issue Editors


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Guest Editor

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Guest Editor
Department of General Dentistry, Faculty of Medicine, Medical University of Łódź, 90419 Łódź, Poland
Interests: bruxism; masticatory muscles; personality; coping mechanisms; diagnostics; treatment
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Special Issue Information

Dear Colleagues,

Every day, new research evaluating the impact of mental health on the temporomandibular joint and masticatory muscles emerges. A thorough examination and diagnosis are crucial when both researching and discussing issues pertaining to temporomandibular disorders, bruxism, and orofacial pain. Treatment and management of these issues is complex, as it involves not only dentistry but also physiotherapy along with elements of psychology and psychotherapy.

Mental health is a global issue. It has been proven that poor mental health can have a negative impact on physical health, leading to an increased risk of developing medical conditions including temporomandibular disorders and bruxism. Similarly, poor physical health can lead to an increased risk of developing mental health problems. In times of emotional challenges, mental health issues and their influences on physical well-being are of even greater importance than usual.

The masticatory muscles and the temporomandibular joint, along with its surrounding structures, have been shown to be affected by various psychological and psychiatric conditions. Stress, anxiety, and personality aspects have been proven to be important factors in the occurrence of bruxism, temporomandibular disorders, and orofacial pain. Increased muscle activity and tension, loss of tooth structure, along with articular disc displacements are some of the consequences of emotional distress.

Polysomnography with audio and video recordings remains the “gold standard” in diagnosing sleep bruxism and muscle activity. However, an electromyographic (EMG) examination of muscle activity, sometimes combined with an electrocardiogram (ECG) has proved to be a promising strategy as well. Moreover, detailed examination of the temporomandibular joint and masticatory muscles by palpation of both the muscle origins and the heads can also be a viable option, along with a specific questionnaire. Treatment and management of these conditions involves splint therapy combined with physiotherapy, especially manual therapy. Furthermore, the use of relaxation techniques and biofeedback is recommended along with therapy or counselling for a more holistic approach.

This Special Issue of IJERPH will explore the relationship of mental health, including psychological factors, with the temporomandibular joint, its surrounding structures, and the masticatory muscles. Papers pertaining to the diagnosis and possible treatment options for temporomandibular disorders, masticatory muscle tension, fatigue, and pain in light of mental health conditions are encouraged.

Both reviews and research on the subject are welcome.

Dr. Monika Lukomska-Szymanska
Dr. Klara Saczuk
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

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Keywords

  • mental health
  • personality
  • bruxism
  • masticatory muscles
  • temporomandibular joint
  • orofacial pain

Published Papers (6 papers)

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Research

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17 pages, 1445 KiB  
Article
The Prevalence and Overlaps of Temporomandibular Disorders in Patients with Myofascial Pain with Referral—A Pilot Study
by Joanna Kuć, Krzysztof Dariusz Szarejko and Maria Gołębiewska
Int. J. Environ. Res. Public Health 2021, 18(18), 9842; https://doi.org/10.3390/ijerph18189842 - 18 Sep 2021
Cited by 10 | Viewed by 2427
Abstract
The aim of the study was to evaluate the temporomandibular joint, the prevalence of single and multiple diagnosis and potential sided domination of temporomandibular dysfunction in patients with temporomandibular disorder—myofascial pain with referral. The study group enrolled 50 people—37 females and 13 males [...] Read more.
The aim of the study was to evaluate the temporomandibular joint, the prevalence of single and multiple diagnosis and potential sided domination of temporomandibular dysfunction in patients with temporomandibular disorder—myofascial pain with referral. The study group enrolled 50 people—37 females and 13 males between 18 and 25 years old with an average age of 23.36 ± 2.14. The patients underwent joint vibration analysis. Sixty seven percent of all examined tem-poromandibular joints were classified as group I according to Mark Piper’s classification. Class IIIA appeared in 17% of joints. Eight percent of temporomandibular joints were classified as class IVA. There were no statistically significant differences in the prevalence of temporomandibular disorder with respect to gender (p = 0.838639). The relatively high prevalence of multiple diagnoses proved the overlapping nature of muscle and intraarticular disorders. Twenty eight percent of the subjects suffered from a combination of myofascial pain with referral and bilateral temporoman-dibular dysfunction. In 62% of the patients a lack of intraarticular disorders was reported. The suggestion that there exists sided domination in the occurrence of temporomandibular disorders has not been confirmed. Due to the small sample size, such differences cannot be excluded. Fur-ther research is needed. Full article
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9 pages, 596 KiB  
Article
Stiffness of the Masseter Muscle in Children—Establishing the Reference Values in the Pediatric Population Using Shear-Wave Elastography
by Cyprian Olchowy, Anna Olchowy, Aleksander Pawluś, Mieszko Więckiewicz and Luca Maria Sconfienza
Int. J. Environ. Res. Public Health 2021, 18(18), 9619; https://doi.org/10.3390/ijerph18189619 - 13 Sep 2021
Cited by 6 | Viewed by 2435
Abstract
In children, the quality and muscle function are altered in many pathologic conditions, including temporomandibular disorders. Although several methods have been used to evaluate muscle tonus, none became a golden standard. Moreover, the masseter muscle characteristics in children have not been investigated to [...] Read more.
In children, the quality and muscle function are altered in many pathologic conditions, including temporomandibular disorders. Although several methods have been used to evaluate muscle tonus, none became a golden standard. Moreover, the masseter muscle characteristics in children have not been investigated to date. This study aimed to measure the stiffness of the masseter muscle using shear-wave elastography in healthy children. We enrolled 30 healthy children (mean age 10.87 ± 3.38 years). The stiffness of masseter muscles was measured with shear wave elastography. Stiffness for the total sample was 6.37 ± 0.77 kPa. A comparison of the measurements did not show significant differences between the right and the left masseter muscles (left—6.47 ± 0.78 kPa; right—6.24 ± 0.76 kPa; p = 0.3546). A significant difference was seen between boys and girls (boys—5.94 ± 0.50 kPa; girls—6.63 ± 0.80; p = 0.0006). Shear-wave elastography is a promising diagnostic tool. It may help to detect changes in the stiffness of the masseter muscle and draw attention to pathological processes within the jaw muscles. Directions for further research shall include determining stiffness values in pathological conditions and the impact of biological and functional factors on the stiffness of the masseter muscle. Full article
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8 pages, 1269 KiB  
Article
Determination of Reference Values of the Masseter Muscle Stiffness in Healthy Adults Using Shear Wave Elastography
by Anna Olchowy, Mieszko Więckiewicz, Andrzej Malysa and Cyprian Olchowy
Int. J. Environ. Res. Public Health 2021, 18(17), 9371; https://doi.org/10.3390/ijerph18179371 - 5 Sep 2021
Cited by 8 | Viewed by 2338
Abstract
Shear wave elastography (SWE) is an objective and reliable method for the assessment of muscles and internal organs. Every organ exhibits its own stiffness characteristics and hence requires individual reference values. We aimed to determine the reference values of stiffness of the masseter [...] Read more.
Shear wave elastography (SWE) is an objective and reliable method for the assessment of muscles and internal organs. Every organ exhibits its own stiffness characteristics and hence requires individual reference values. We aimed to determine the reference values of stiffness of the masseter muscle in healthy adult individuals using SWE. We analyzed the data of 140 participants (74 men, 66 women) with a median age of 50 years. The overall mean elasticity was 10.67 ± 1.77 kPa. The average values were lower by 2.25 kPa (9.15%) in women compared to men (9.48 ± 1.47 kPa vs. 11.73 ± 1.27 kPa; p < 0.0001). The values of stiffness increased with age, with a correlation coefficient of about 0.35 and a p < 0.0001. Age was a significant influencing factor of masseter muscle stiffness. The left and right masseters had similar stiffness. We conclude that stiffness values are significantly lower in women than in men with a difference of 9%. Age significantly influences the stiffness of masseter muscle, and the values of stiffness increase significantly with age, particularly in men. However, further studies are required to determine the precise ranges of stiffness accounting for age and sex in healthy subjects and people with disorders and conditions of the masticatory system. Full article
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21 pages, 4397 KiB  
Article
Comparative Evaluation of Occlusion before and after Soft Tissue Mobilization in Patients with Temporomandibular Disorder—Myofascial Pain with Referral
by Joanna Kuć, Krzysztof Dariusz Szarejko and Maria Gołębiewska
Int. J. Environ. Res. Public Health 2021, 18(12), 6568; https://doi.org/10.3390/ijerph18126568 - 18 Jun 2021
Cited by 2 | Viewed by 2699
Abstract
The aim of the study was to evaluate occlusal parameters in patients with myofascial pain with referral before and after soft tissue mobilization. The study group consisted of 50 people (37 females and 13 males, average age 23.36 ± 2.14 years) diagnosed with [...] Read more.
The aim of the study was to evaluate occlusal parameters in patients with myofascial pain with referral before and after soft tissue mobilization. The study group consisted of 50 people (37 females and 13 males, average age 23.36 ± 2.14 years) diagnosed with myofascial pain with referral. All patients underwent triplicate soft tissue mobilization. Occlusal parameters were evaluated six times, before and after each treatment, using T-scan III. A decreasing tendency of the occlusion time was observed after the first, second, and third therapy. After the third treatment, the mean occlusion time in the entire study group was 0.119 s. The 1st soft tissue mobilization shortened both right and left disclusion times to 0.181 s and 0.185 s, respectively. After the third treatment, these parameters amounted to 0.159 s and 0.165 s, respectively. The Friedman test for the entire study group indicated that soft tissue mobilization altered the occlusion time and both disclusion times (p < 0.05). In conclusion, soft tissue mobilization affects biotensegrity of the masticatory system, thus modifying occlusal parameters. The occlusion time and both disclusion times cannot be considered as cofactors of the existing temporomandibular disorders—myofascial pain with referral. Full article
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21 pages, 6382 KiB  
Article
Evaluation of Soft Tissue Mobilization in Patients with Temporomandibular Disorder-Myofascial Pain with Referral
by Joanna Kuć, Krzysztof Dariusz Szarejko and Maria Gołębiewska
Int. J. Environ. Res. Public Health 2020, 17(24), 9576; https://doi.org/10.3390/ijerph17249576 - 21 Dec 2020
Cited by 9 | Viewed by 3828
Abstract
The aim of the study was functional evaluation of soft tissue mobilization in patients with temporomandibular disorder-myofascial pain with referral. The study group consisted of 50 individuals—37 females and 13 males. The average age was 23.36 ± 2.14 years. All subjects were diagnosed [...] Read more.
The aim of the study was functional evaluation of soft tissue mobilization in patients with temporomandibular disorder-myofascial pain with referral. The study group consisted of 50 individuals—37 females and 13 males. The average age was 23.36 ± 2.14 years. All subjects were diagnosed with myofascial pain with referral (diagnostic criteria for temporomandibular disorders). Soft tissue mobilization was applied three times. Electromyography of selected masticatory muscles was performed six times—before and after the treatment. After each mobilization, a decreasing tendency of muscular activity was observed in the entire study group. The Friedman test indicated that mobilization altered the activity of the right temporal muscle (p = 0.00010), both masseters (p = 0.0000), right sternocleidomastoid (p = 0.00251), left sternocleidomastoid (p = 0.00033), and right and left digastric muscles (p = 0.00045 and p = 0.00000, respectively). With respect to symmetry a statistically significant difference was noted in the case of the sternocleidomastoid muscles (p = 0.00729). In conclusion, soft tissue mobilization seems to be effective in the relaxation of masticatory muscles in patients with temporomandibular disorders. Our findings proved that soft tissue mobilization does not improve the symmetry and synergy of the masticatory muscles limited by dental occlusion. Full article
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Review

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16 pages, 410 KiB  
Review
Temporomandibular Myofascial Pain Syndrome—Aetiology and Biopsychosocial Modulation. A Narrative Review
by Paulina Golanska, Klara Saczuk, Monika Domarecka, Joanna Kuć and Monika Lukomska-Szymanska
Int. J. Environ. Res. Public Health 2021, 18(15), 7807; https://doi.org/10.3390/ijerph18157807 - 23 Jul 2021
Cited by 20 | Viewed by 10840
Abstract
This review elaborates on the aetiology, diagnosis, and treatment of temporomandibular (TMD) myofascial pain syndrome (MPS) regulated by psychosocial factors. MPS impairs functioning in society due to the accompanying pain. Directed and self-directed biopsychosocial profile modulation may be beneficial in the treatment of [...] Read more.
This review elaborates on the aetiology, diagnosis, and treatment of temporomandibular (TMD) myofascial pain syndrome (MPS) regulated by psychosocial factors. MPS impairs functioning in society due to the accompanying pain. Directed and self-directed biopsychosocial profile modulation may be beneficial in the treatment of MPS. Moreover, nutrition is also a considerable part of musculoskeletal system health. A fruit and vegetable diet contributes to a reduction in chronic pain intensity because of its anti-inflammatory influence. Cannabidiol (CBD) oils may also be used in the treatment as they reduce stress and anxiety. A promising alternative treatment may be craniosacral therapy which uses gentle fascia palpation techniques to decrease sympathetic arousal by regulating body rhythms and release fascial restrictions between the cranium and sacrum. MPS is affected by the combined action of the limbic, autonomic, endocrine, somatic, nociceptive, and immune systems. Therefore, the treatment of MPS should be deliberated holistically as it is a complex disorder. Full article
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