No Effects of Intra-Articular Injections of Sodium Hyaluronate, Corticosteroids, Platelet-Rich Plasma on Temporomandibular Joint Osteoarthritis: a Systematic Review and Network Meta-analysis of Randomized Controlled Trials

Background Intra-articular injections of corticosteroids (CCS), hyaluronic acid (HA), and platelet-rich plasma (PRP) have often been used for temporomandibular joint osteoarthritis (TMJ OA). However, there is no guideline for the choice of pharmacological injections. The aim of this network meta-analysis (NMA) is to compare the efficacy of different intra-articular injectable treatments on TMJ OA. Methods Studies were identified from PubMed, Embase and Cochrane Central with date up to December 2020. Randomized Controlled Trials (RCTs) included were the studies of patients with TMJ OA who had intra-articular treatment with CCS, HA, PRP, placebo and follow-up assessing TMJ function in target outcome variables. The primary outcome was temporomandibular joint pain (VAS). The secondary outcomes were maximal mouth opening (mm), and lateral movement to the affected side (mm). Results Nine RCTs involving 316 patients were included. For primary pain outcome, no significance was detected when CCS, HA and PRP were compared with placebo by both short- (3-6 months) and long-term (>12 months) follow-up. In addition, these injectables did not significantly outperform placebo by evaluating secondary functional outcomes (maximal mouth opening and lateral movement) with the same follow-up. Subgroup analyses showed that the effect of CCS on subgroups with more than 70% women was statistically less effective compared with placebo. Conclusion Evidence suggested that intra-articular pharmacological injections of CCS, HA, and PRP had no effect on improving TMJ pain and functional outcomes compared with placebo injection. Trial registration This study is registered with PROSPERO, number CRD42021270914.

Analysis of Earlier Temporomandibular Joint Disorders in JIA Patients: A Clinical Report

The aim of this study was to analyse the structural characteristics of the temporo-mandibular joint (TMJ) and the dysfunctional consequences induced by disease in subjects with juvenile idiopathic arthritis (JIA). The study was conducted in 25 patients with JIA (median age (IQR), 13.9 (10.9–15.3)) and 26 healthy controls (median age (IQR), 14.3 (11.6–17.2)) years. All enrolled patients were subjected to anamnestic evaluation, laboratory parameters, JIA subclass, and type of therapy for the disease. A clinical-gnathological evaluation, anamnestic and dysfunctional index (Ai and Di), and magnetic resonance imaging of TMJs were performed in all patients. The test group showed a significant reduction (p < 0.001) regarding the clinical findings such as maximal mouth opening, left and rightward laterotrusion and protrusion, and a significant difference in the reported symptoms (TMJ sounds, reduced mouth opening and pain), and Ai and Di (p < 0.001) compared to healthy patients. Correlation analysis showed a significant correlation between the median duration of disease and the maximum mouth opening and between visual analogue scale (VAS) score and maximum mouth opening, leftward laterotrusion, rightward laterotrusion, and protrusion. The results obtained in this study suggest that patients with JIA presented a cohort of symptoms in TMJs in comparison with healthy controls. Moreover, a careful TMJs evaluation and an early diagnosis of TMJs dysfunction and regular follow-ups are recommended in order to prevent and reduce functional and chewing problems in patients with JIA.

Mastication in Patients with Spinal Muscular Atrophy Types 2 and 3 is Characterized by Abnormal Efficiency, Reduced Endurance, and Fatigue

Mastication problems can have a negative impact on the intake of food and quality of life. This cross-sectional study characterizes mastication problems using clinical and instrumental assessments in patients with spinal muscular atrophy (SMA) types 2 and 3 with self-reported bulbar problems. We included 27 patients (aged 13–67 years), 18 with SMA type 2 and 9 patients with SMA type 3 (of whom three were still ambulant) and applied a questionnaire, clinical mastication tests (TOMASS and 6-min mastication test), and muscle ultrasound of the mastication muscles. Non-ambulant patients demonstrated inefficient mastication as reflected by median z scores for masticatory cycles (z = 1.8), number of swallows (z = 4.3) and time needed to finish the cracker (z = 3.4), and limited endurance of continuous mastication as demonstrated by the median z scores of the 6-min mastication test (z = − 1.5). Patients reported increased fatigue directly after the 6-min mastication test as well as 5 min after completing the test (p < 0.001; p = 0.003). Reduced maximal mouth opening was associated with mastication problems (p < 0.001). Muscle ultrasound of the mastication muscles showed an abnormal muscle structure in 90% of both ambulant and non-ambulant patients. This study aims to understand the nature and underlying mechanisms of mastication problems in patients with SMA types 2 and 3 with reported bulbar problems.

A novel neuromotor reprogramming treatment modality for temporomandibular disorders: a pilot retrospective observational study

Background The purpose of this investigation was to determine if neuromotor programming using the ALLYANE® process would significantly improve mouth-opening capacity in patients suffering from temporomandibular disorders (TMD). Methods A total of 21 adult patients (20 females and 1 male; mean age = 44 years) who underwent a rehabilitation session with neuromotor reprogramming were included. Maximal mouth opening (MMO) was measured before and just after neuromotor reprogramming session. Results The results showed a statistically significant (p < 0.001) mean gain of 4.95 mm (+ 13%) after neuromotor reprogramming. Furthermore, this preliminary study showed that the gain registered in patients with a lower-than-normal mouth opening and improvement of lateral movements were greater than the one obtained with the other patients. Conclusions Although these preliminary results need confirmation, the study suggests that the use of neuromotor reprogramming in patients suffering from TMD could present new possibilities for enhanced outcomes, in particular to relax the stomatognathic system with a noninvasive, reversible therapy without known side effects, providing open new perspectives in the area of joint diseases.

Effect of Cervical Extensor Strengthening on severity of Temporomandibular Joint Disorder among University students: A Randomized controlled trial

Background and Objectives: Awareness of temporomandibular joint disorder (TMD) is fairly concerning in management of physiotherapy as patients often seek for treatment from orthodontics when pain become their main concerns. In this case, cervical aspects are often overlooked in the treatment of temporomandibular joint disorder. This study aims to determine the effect of cervical extensor strengthening on severity of temporomandibular joint disorder. Methods: A randomized controlled trial study was carried out for 4 weeks to determine the effect of cervical extensor strengthening on severity of temporomandibular joint disorder among university students. A total of 40 participants were recruited via convenient sampling method. Subjects were randomly assigned into two groups: experimental group (E) and control group (C) through lottery randomization. Subjects in experimental group were instructed to perform 1 set of cervical extensor strengthening with 10 repetitions and goldfish exercises whereas subjects in control group were asked to perform goldfish exercises only. A pre-test and post-test severity of TMD, maximal mouth opening and maximal isometric cervical extensor strength were measured for both groups. Results: After 4 weeks of training, there was significant difference in pre-test and post-test severity of TMD and maximal mouth opening for both E and C group. On the other hand, there was significant difference of pre and post-test of maximal isometric cervical extensor strength in experimental group. There was no significant difference in post-test for severity of TMD (p=0.67), maximal mouth opening (p=0.21) and maximal isometric cervical extensor strength (p=0.40) between two groups. Conclusions: The study concluded that, 4 weeks of anti-gravity cervical extensor strengthening exercises protocol showed there was no significantly difference of the severity of TMD and maximal mouth opening between both control and experimental group. On the other hand, goldfish exercises showed significant improvement of maximal mouth opening and reduction in severity of TMD after 4 weeks of intervention period.

Efficacy of Submucosal Injection of Chymotrypsin, Oral Serratiopeptidase or Oral Dexamethasone in Reducing Postoperative Complications Following Impacted Lower Third Molar Surgery: A Prospective, Randomized, Double-Blind, Controlled Clinical Trial

Aim The study aimed to compare between chymotrypsin, oral serratiopeptidase, and oral dexamethasone following impacted mandibular third molars surgery in respect of postoperative complications.Materials and method: A randomized, double-blind clinical trial was conducted on 60 patients who were candidates for impacted mandibular third molars surgery and randomly allocated into the following 3 groups: submucosal chymotrypsin (5 mg), oral serratiopeptidase (10 mg), and oral dexamethasone (8 mg) (each group = 20). The outcome variables were postoperative pain (via visual analog scale), facial swelling (via tape method) and maximal mouth opening immediately after 2nd, 3rd, and 5th postoperative days.Results: A total of 60 patients underwent randomization and allocation concealment and were included in the current study. All of the subjects tolerated the medicines with no untoward side or adverse effects. There was no statistically significant difference between the three groups in respect of postoperative pain intensity, facial swelling and maximal mouth opening at the immediate first hour, 2nd, 3rd, and 5th postoperative days (P &lt; 0.05).Conclusion: The present randomized clinical trial concluded that preemptive sub-mucosal injection of chymotrypsin yields a comparable effectiveness in decreasing postoperative sequelae following impacted mandibular third molars surgery when compared to oral serratiopeptidase or dexamethasone. This is the first Randomized Clinical Trail that assessed efficacy and safety of sub-mucosal injection of chymotrypsin after impacted mandibular third molars surgery. This trial is registered at clinicaltrials.in.th, number (TCTR20200828006).

The use of stretching devices for treatment of trismus in head and neck cancer patients: a randomized controlled trial

Purpose To compare the effects of two stretching devices, the TheraBite® Jaw Motion Rehabilitation System™ and the Dynasplint Trismus System®, on maximal mouth opening in head and neck cancer patients. Methods Patients were randomly assigned to one of two exercise groups: the TheraBite® Jaw Motion Rehabilitation System™ group or the Dynasplint Trismus System® group. Patients performed stretching exercises for 3 months. During the three study visits, maximal mouth opening was measured and the patients completed questionnaires on mandibular function and quality of life. Results In our study population (n = 27), five patients did not start the exercise protocol, eight patients discontinued exercises, and two patients were lost to follow-up. No significant differences regarding the change in mouth opening between the two devices were found. Patients had an increase in MMO of 3.0 mm (IQR − 2.0; 4.0) using the TheraBite® Jaw Motion Rehabilitation System™ and 1.5 mm (IQR 1.0; 3.0) using the Dynasplint Trismus System®. Exercising with either stretching device was challenging for the patients due to the intensive exercise protocol, pain during the exercises, fitting problems with the stretching device, and overall deterioration of their medical condition. Conclusions The effects of the two stretching devices did not differ significantly in our study population. The factors described, influencing the progression of stretching exercises, need to be taken into account when prescribing a similar stretching regimen for trismus in head and neck cancer patients. Trial registration NTR - Dutch Trial Register number: 5589