Development of Core Outcome Sets for Clinical Trials in Temporomandibular Disorders

Background Temporomandibular Disorder (TMD) is a generic term applied to describe musculoskeletal disorders that affect the temporomandibular joint (TMJ), the masticatory muscles and the related structures. TMD comprises two groups of disorders, namely intra-articular TMD and masticatory muscle disorders. There is still difficulty in establishing the effectiveness of different therapeutic modalities for TMD with robust evidence, despite the large volume of publications in the area. The lack of outcomes standardization may represent a limiting factor in the search for scientific evidence. Objective This study aims to develop a core outcome sets (COS) for clinical trials in intra-articular TMD and masticatory muscle disorders. Methods The protocol for determining the COS-TMD will consist of three phases: 1. Synthesis of TMD Management Intervention Outcomes. The identification of outcomes will be carried out through a systematic review, which will include randomized clinical trials that evaluated the effectiveness of interventions used in TMD management. 2. Through a two-round international Delphi survey, the list of outcomes will be scored by three panels of stakeholders. 3. A representative sample of key stakeholders will be invited to participate in a face-to-face meeting where they can discuss the results of the Delphi survey and determine the final core set. Conclusions The implementation of this protocol will determine the COS-TMD, which will be made available for use in all TMD clinical studies. The use of COS when planning and reporting TMD clinical trials will reduce the risk of publication bias and enable proper comparison of results found by different studies.

Relationship of Malocclusions with Disorders of the Temporomandibular Joint in Children of CALI—Colombia

Objective The aim of this study was to determine the relationship of malocclusion with the presence and severity of temporomandibular disorders (TMDs) in children. Materials and Methods A clinical examination was performed in 87 patients (from 4 to 14 years of age) who attended the dentistry clinics of Universidad del Valle. Results The 77 patients studied had malocclusions; 55 patients had TMD and 67.3% were female. The most frequent symptom of TMD was articular unilateral noise with 33.8%, followed by pain in at least one masticatory muscle with 26%. TMJ pain was observed in 24.7% of the patients. There was a statistically significant relationship between the presence and severity of TMD with type of dentition and transverse malocclusion, respectively. Conclusion The presence of TMD in children with malocclusion presented in a high frequency. TMD depends on the type of dentition and its severity is dependent on transverse malocclusion.

Brow and Masticatory Muscle Activity Senses Subjective Hedonic Experiences during Food Consumption

Sensing subjective hedonic or emotional experiences during eating using physiological activity is practically and theoretically important. A recent psychophysiological study has reported that facial electromyography (EMG) measured from the corrugator supercilii muscles was negatively associated with hedonic ratings, including liking, wanting, and valence, during the consumption of solid foods. However, the study protocol prevented participants from natural mastication (crushing of food between the teeth) during physiological data acquisition, which could hide associations between hedonic experiences and masticatory muscle activity during natural eating. We investigated this issue by assessing participants’ subjective ratings (liking, wanting, valence, and arousal) and recording physiological measures, including EMG of the corrugator supercilii, zygomatic major, masseter, and suprahyoid muscles while they consumed gel-type solid foods (water-based gellan gum jellies) of diverse flavors. Ratings of liking, wanting, and valence were negatively correlated with corrugator supercilii EMG and positively correlated with masseter and suprahyoid EMG. These findings imply that subjective hedonic experiences during food consumption can be sensed using EMG signals from the brow and masticatory muscles.

Diagnosis of hypertonicity of the masticatory muscles at a dental appointment

Summary. The purpose of the study. Hypertonus of the masticatory muscles is a fairly common pathology that leads to the development of parafunctional masticatory activity. At the same time, the nature of the course of the pathology becomes long-lasting, leading to irreversible consequences. Patients often do not pay attention to minor pain in the area of the masticatory muscles, so hypertonus of the masticatory muscles is diagnosed randomly. In view of the variety of clinical symptoms from headaches to the phenomena of oral stomalgia, the diagnosis of hypertension is extremely difficult. Also, there is currently no single algorithm for the management of such patients.Materials and methods. In the presented scientific study, a survey of 189 patients who applied to a dental clinic for the treatment of dental caries and its complications, a professional examination was conducted. All patients were examined according to the method of diagnosis of muscle hypertonus developed by us. The methodology includes a thorough collection of anamnesis, questionnaires (PSM-25, VAS, MAS, author's methods), the use of objective research methods, including: OPTG, CT, ultrasound, the author's method of determining the degree of mouth opening.Results. Muscle hypertonus of varying severity was diagnosed in 80% of cases, high stress level on the PSM-25 scale in 71% (135), the presence of morning pain in the area of the masticatory muscles in 55%(104). An assessment of muscle tone on the MAS scale confirmed a significant increase in masticatory muscle hypertonicity in 34% of cases. These additional methods of investigation confirmed the presence of hypertonicity of the masticatory muscles in patients with an objective clinical picture. In the study of this area, the main role is played by the clinician, only if all the diagnostically valuable information is available, it is possible to formulate an optimal treatment plan and avoid aggravation of the patient's condition due to incorrect diagnosis and treatment.Conclusions. The application of the developed diagnostic method contributes to the random detection of parafunctional activity of the masticatory muscles at a dental appointment, as well as to the final diagnosis of masticatory muscle hypertonus.