Cranio-Mandibular Disorders after Whiplash Injury: A Mono-Institutional Clinical Study on 31 Patients

Background: Whiplash is a consequence of traumatic injuries, mostly related to road accidents, with variable clinical manifestations, also known as Whiplash Associated Disorders, such as neck, head and temporo-cranio-mandibular pain. Methods: The current study aims to evaluate the onset and evolution of temporomandibular joint pain in people with whiplash in a study group treated with the use of Zimmer Collars (adjustable rigid cervical collars for neck immobilization), as compared to a control group. This prospective study included 31 patients followed by the Dental Prosthesis Department of the University of Bari “Aldo Moro”: 20 patients with whiplash (age range: 20–39 years) treated with Zimmer collars and 11 patients with whiplash (age range: 20–33 years) who were not. Immediately after the whiplash occurred, a visual analogue scale (VAS) was used to describe the intensity of pain and to complete the chart of the European Academy of Craniomandibular Disorders. Five out of twenty patients, already treated with a Zimmer collar, wore an occlusal splint as well because of persistent pain reported at the 28-day and 60-day follow-up and were supported by pharmacological therapy with analgesics (paracetamol) and muscle relaxants (thiocolchicoside). Results: During the last follow-up (at six months), three out of five patients displayed a residual VAS score of 3, 4, and 5, respectively, while the remaining two displayed a VAS of 0. In the control group, four out of eleven patients needed to wear an occlusal splint but without muscle relaxants and analgesics pharmacological therapy; these four corresponded to the patients showing a residual painful symptomatology, with VAS reaching value of 2, and also were the oldest patients of the group. Data regarding VAS values and Zimmer collar use, both at the first visit and six months later, were statistically analyzed. Conclusion: Our prospective study highlights how whiplash-associated acute disorders are often self-limiting over a period of few months, thus reducing the possibility of symptom chronicity; the latter seems to be strictly related to lesion severity, pre-existence of a craniomandibular dysfunction and patient age, but appears to be independent from Zimmer collar use, as statistically confirmed.

Relationship between Oral Parafunctions and Signs and Symptoms of Craniomandibular Dysfunction in Children with Cleft Lip and Palate

The aim of this study was to evaluate the association of oral parafunctions with the presence of signs and symptoms of craniomandibular disorder in children with cleft lip and palate (CLP). A cross-sectional study was performed in which one hundred and eighty-eight children with CLP and absence of associated syndromes or malformations were investigated. During clinical examination, the presence of wear facets and dental occlusion were observed and palpation was performed in the temporomandibular joint region (TMJ) and orofacial musculature . The children and their guardians were interviewed regarding the presence of oral parafunctional habits (bruxism, the act of biting the lips and/or cheeks, nail biting, sucking of fingers and pacifiers) and signs and symptoms of craniomandibular dysfunction (headache, ear and/or neckache, tiredness or crack in the TMJ during mouth opening and chewing movements). The data were analyzed by means of absolute and relative frequency measurements, and bivariate analysis using Pearson’s chi-square test and likelihood ratio test were performed, considering the significance level of 5%. A higher prevalence of cleft lip and palate type (76.0%) and the presence of malocclusion (61.7%) was observed, highlighting the anterior crossbite (58.7%) and midline deviation (48.9%). There was a higher occurrence of teeth grinding (40.4%), onychophagy (28.7%) and biting lips and/or cheeks (28.7%). Onychophagia was associated with headache (p <0.05) and with pain or cracking during mouth opening (p <0.05). It was concluded that parafunctional oral habits may be associated with signs and symptoms of craniomandibular disorder in children with cleft lip and palate.Keywords: Craniomandibular Disorders. Nail Biting. Bruxism. Maxillofacial Abnormalities. Resumo O objetivo do estudo foi avaliar a associação de parafunções orais com sinais e sintomas da disfunção craniomandibular em crianças com fissuras labiopalatinas (FLP). Um estudo transversal foi realizado, no qual cento e oitenta e oito crianças com FLP e ausência de síndromes ou malformações associadas, foram investigadas. Durante exame clínico, a presença de facetas de desgaste e a oclusão dentária foram observadas e foi realizada a palpação na região da articulação temporomandibular (ATM) e musculatura orofacial. As crianças e seus responsáveis foram entrevistados com relação à presença de hábitos orais parafuncionais (bruxismo, ato de morder os lábios e/ou bochechas, onicofagia, sucção de dedos e de chupeta) e sinais e sintomas de disfunção craniomandibular (cefaléia, ouvido, dor, cansaço ou estalo na ATM durante movimentos de abertura bucal e de mastigação). Os dados foram analisados por meio de medidas de frequência absoluta e relativa e a análise bivariada foi realizada por meio dos testes do Qui-quadrado de Pearson (χ2) e a Razão de verossimilhança, considerando o nível de significância de 5%. Uma maior prevalência das fissuras envolvendo lábio e palato (76,0%) e presença de maloclusão (61,7%) foi observada, com destaque para mordida cruzada anterior (58,7%) e desvio de linha média (48,9%). Houve uma maior ocorrência do ato de ranger os dentes (40,4%), da onicofagia (28,7%) e do hábito de morder lábios e/ou bochechas (28,7%). A onicofagia foi associada à cefaléia (p<0,05) e à dor ou estalo durante abertura bucal (p<0,05). Conclui-se que hábitos orais parafuncionais podem estar associados a presença de sinais e sintomas da disfunção craniomandibular em crianças com FLP.Palavras-chave: Transtornos Craniomandibulares. Hábito de Roer Unhas. Bruxismo. Anormalidades Maxilofaciais.

What Role Does Synovitis Play in Craniomandibular Dysfunction (CMD)? A 3T-MRI Study

Purpose The purpose of the present study was to investigate the degree and clinical relevance of synovitis in craniomandibular dysfunction. Materials and Methods In total, 140 temporomandibular joints were examined using a 3 T MRI scanner. Quantitative analysis of synovial enhancement was performed and interrelated with arthrosis deformans, degenerative disc disease, joint effusion, bone marrow edema and restriction of motion. Results We found a statistically high and significant correlation between the degenerative changes as mentioned above and the intensity of synovial enhancement. Conclusion The study shows that typical MRI findings in CMD patients are often combined with signs of synovitis. Presumably joint inflammation has an effect on the clinical signs and symptoms and also the prognosis of CMD. These results should be taken into consideration when selecting treatment. Key Points: Citation Format

Factores etiológicos de la disfunción craneomandibular en una población de niños españoles

La Disfunción Craneomandibular (DCM) es una patología presente en niños. Este estudio ha analizado, en una muestra de 36 niños residentes en Madrid (España), la prevalencia de los factores etiológicos, así como su relación con la semiología de la DCM. Como método diagnóstico realizamos una exploración dentaria, muscular, de articulaciones témporomandibulares (ATMs), funcional y oclusal, que complementamos con un cuestionario específico. Los factores etiológicos más frecuentes fueron: la maloclusión (66,7%), el mordisqueo de uñas o bolígrafos y el uso de chupete más de 1 año (52,8% en ambos casos), seguidos de niños con personalidad nerviosa (41,7%). En el análisis estadístico hubo una relación significativa de: la lactancia artificial con el taponamiento de oídos (p=0,016) y con la ausencia de guía protrusiva (p=0,018); los traumatismos dentofaciales con las exóstosis (p=0,066); de la asimetría en la mesialización de los primeros molares definitivos con el dolor a la palpación de las ATMs (p=0, 059); de la mordida abierta anterior con el dolor a la palpación de los músculos masticatorios (p=0, 016); de la sobremordida con la ausencia de guía protrusiva (p=0,06); de la respiración bucal con el taponamiento de oídos (p=0,024); y de la presencia de enfermedad sistémica con el rechinamiento de dientes (p=0,057). Además, se halló una relación significativa de los niños con DCM severa (más de 6 síntomas/signos) y la respiración bucal (p=0,024) y la lactancia artificial (p=0,44). Abstract The craniomandibular dysfunction (CMD) is a pathology present in children. This study has analyzed in a sample of 36 children residing in Madrid (España), the prevalence of the etiological factors, as well as its relation with CMD semiology. As diagnostic method we performed dental and muscular examination, together with temporomandibular joints (TMJs) exploration, functional and occlusal examination, that we completed with our specific questionnaire. The most frequent etiological factors were: malocclusion (66,7%), nail and pen biting and pacifier sucking over 1 year old (52,8% in both cases), and kids with nervous personality (41,7%). In the statistic analysis, there was a significant relation between: bottle feeding and fullness in the ears (p=0,016) and also the lack of protrusive guide (p=0,018); dentofacial traumas and exostoses (p=0,066); the asymmetry in the mesialization of the first permanent molars and TMJ tenderness on palpation (p=0,059); anterior open bite and masticatory muscles tenderness on palpation (p=0,016); overbite and lack of protusive guide (p=0,06); mouth breathing and fullness in the ears (p=0,024); presence of sistemic desease and teeth grinding (p=0,057). In addition, a significant relation was found between children with severe CMD (more than 6 signs/symptoms) and mouth breathing (p=0,024) and bottle feeding (p=0,44). Key Words: Craniomandibular dysfunction, temporomandibular disorders, children.

Signs and symptoms of craniomandibular dysfunction in a population of Spanish children

The craniomandibular dysfunction (CMD) is a pathology that can appear at early ages. In a sample of 36 childrenresiding in Madrid (Spain), of both sexes, with ages between 7 and 13 years, the prevalence of signs and symptomsof CMD was analyzed. For that purpose, we did a dental and muscular examination, together with temporomandibularjoints, functional and occlusal examination, and completed with a specific questionnaire. The results revealedthat 100% showed some sign or sympthom of CMD. 77,8% of the pacients presented 3 or more CMD signs.The most prevalent were painful muscle palpation (94,4%), together with sliding anteriorly (91,7%), painful jointpalpation (69,4%), wear facets in permanent teeth (41,7%) and altered opening and closing trayectory (38,9%). Onthe other hand, only 38,9% showed any CMD symptom. The most prevalent symptoms were night teeth grinding(27,8%), followed by tooth sensitivity (19,4%) and fullness in the ears (16,7%). We conclude that in our sample,25% presented mild CMD (less that 3 signs or symptoms), 58,3% presented moderate CMD (from 3 to 6 signs orsymptoms) and 16,7% showed severe CMD (more than 6 symptoms). Nevertheless, it’s important to remark thatnone of these pacients came seeking treatment for his CMD and these symptoms were refered only when beingasked. Hence the importance of a comprehensive clinic history to precociously diagnose this pathology and havethe ability to prevent its progression.