- Email: [email protected]
Does temporomandibular disorder incidence increase in polycystic ovary syndrome patients?
21st ICOMS 2013 - Abstracts: Oral Papers T35.OR054
T35.OR052 Does temporomandibular disorder incidence increase in polycystic ovary syndrome patients? S.S.
Soydan 1,∗ ,
1369
K.
Deniz 2 ,
N. Basc´yl
Tutuncu 3 ,
S.
Uckan 1 ,
A. Dogruk
Unal 4
1 Baskent
University, Department of Oral and Maxillofacial Surgery, Ankara, Turkey 2 Baskent University, Istanbul Practice and Research Hospital, Department of Oral and Maxillofacial Surgery, Istanbul, Turkey 3 Baskent University, Department of Endocrinology and Metabolism, Ankara, Turkey 4 Baskent University, Istanbul Practice and Research Hospital, Department of Endocrinology and Metabolism, Istanbul, Turkey Background and objectives: Temporomandibular disorder (TMD) prevalence is higher in females than males (with ratio between 3:1 and 9:1). Polycystic ovary syndrome (PCOS) is a multisystem disease and characterized with hormonal irregularity. We hypothesized that expression of various matrix metalloproteinases in PCOS may lead matrix loss in temporomandibular joint (TMJ) fibrocartilage and cause TMD. Our study was performed to evaluate the incidence of TMD in patients with PCOS and compare with individuals who have not got any systemic disorder. Methods: One-hundred voluntary female patients who had menstrual cycles were included. Patients were divided into two groups; PCOS group consisted of 50 females (mean age: 27.4 ± 6.3) who had previously diagnosed PCOS and control group was consisted of 50 healthy females (mean age: 26.1 ± 5.4). Comprehensive clinical TMJ and muscle evaluation of patients were performed by the same clinician. The pain of TMJ was also evaluated by Visual Analogue Scale (VAS) and the results of two groups were statistically compared. Results: Internal joint disorder incidence was 86% (n: 43) in PCOS group and 24% (n: 12) in control group and the difference was statistically significant (p < 0.05). There was statistically significant difference between the VAS score of TMJ pain of two groups; as the VAS score was 2.9 in PCOS group, it was approximately 0 in control group. 72% (n: 36) of the patients had muscular tenderness and pain in PCOS group, while; the ratio was 28% (n: 14) control group and difference was statistically significant (p < 0.05). Maximal interincisal distance was 43.7 mm in PCOS group and 46.4 mm in control group and difference was not statistically significant (p > 0.05). Conclusion: Even a great number of heterogeneous conditions affect the TMJ, it can be concluded that TMD incidence is significantly higher in females who had PCOS when compared with healthy individuals. PCOS may be the one of the etiological factors for the female prominence of TMD. Key words: polycystic ovary syndrome; temporomandibular disorder; temporomandibular joint pain http://dx.doi.org/10.1016/j.ijom.2013.07.709 T35.OR053 Cost effectiveness of arthrocentesis as initial treatment for temporomandibular joint arthralgia: a randomized controlled trial L.M. Vos 1,∗ , A.D. Stant 2 , E.H. Quik 2 , J.J.R. Huddleston Slater 1 , B. Stegenga 1 1 Department
of Oral and Maxillofacial Surgery, University Medical Center Groningen, The Netherlands 2 Department of Epidemiology, University Medical Center Groningen, The Netherlands Objective: To determine the cost effectiveness of arthrocentesis as initial treatment compared to care as usual (CAU) for temporomandibular joint (TMJ) arthralgia. Materials and methods: 80 patients were randomly allocated to arthrocentesis as initial treatment (n = 40) or CAU (n = 40). Arthrocentesis was performed under local anaesthesia. The joint was rinsed with at least 300 ml isotonic saline chloride and no additional substances or drugs were applied. CAU consisted of a soft diet, physical therapy (which involved a home exercise program, joint mobilisation, and physical treatment modalities), and splint therapy using an intra-oral hard acrylic splint. Follow-up was after three, 12 and 26 weeks. Main outcome measures: Cost effectiveness, i.e. total costs from a societal point of view related to TMJ pain as measured on a visual analogue scale (VAS 0–100 mm) and cost utility, i.e. quality adjusted life years (QALY). Results: After 26 weeks, in both groups (arthrocentesis n = 36; CAU n = 36) TMJ pain had declined. Generalized estimating equation (GEE) models for the clinical effectiveness, based on intention to treat, showed significant differences between arthrocentesis as initial treatment and CAU (regression coefficient beta = −10.76 (95% confidence interval −17.75 to −3.77), p = 0.003). Estimated mean total (societal) costs during 26 weeks were D 589 ($795) in the arthrocentesis group and D 1680 ($2266) in the CAU group. With regard to cost effectiveness, arthrocentesis dominated CAU in about 98% of the bootstrap simulations. With regard to cost utility, arthrocentesis dominated CAU in approximately 95% of the bootstrap simulations. Conclusions: The results of this study suggest that arthrocentesis as initial treatment is cost effective in reducing TMJ pain compared to CAU. However, due to substantial missing data, current results with regard to cost effectiveness should be interpreted with caution. Trial registration: Trialregister.nl NTR1505. http://dx.doi.org/10.1016/j.ijom.2013.07.710
Noma, an orofacial gangrene with the challenge of trismus and ankylosis of the mandible: an overview B. Witsenburg ∗ , K.W. Marck Medisch Spectrum Twente, Enschede, The Netherlands Noma is a quickly spreading orofacial gangrene occurring in malnourished children weakened by disease. In the past common in Europe the disease is still present in (mainly) Africa. The World Health Organization estimates that 130,000 children die worldwide each year as a result of noma. The aetiology and pathogenesis of the affection is not well defined. A clear correlation exists between noma and the occurrence of extreme poverty, malnutrition, the presence of necrotizing gingivitis and concomitant debilitating diseases like measles and HIV. However the microbiological and infectious pathways that lead to noma have not been explored thoroughly yet. The onset is an intraoral ulcer that expands quickly to severe swelling in the face, often resulting in necrosis of parts of the face (lips, cheek, nose, maxilla) if not sepsis and death. The mortality rate of noma is estimated to be around 90%. Patients who survive noma often end up with facial disfigurement leading to social ostracism and problems with speech and eating. Surgical rehabilitation is directed to reconstruction of an acceptable face. Half of these patients have an impaired opening of the mouth due to fibrotic trismus or an ankylosis of the mandible. Release often gives disappointing results. http://dx.doi.org/10.1016/j.ijom.2013.07.711 T35.OR055 Modified temporomandibular joint disc anchor: the technique and note S.Y. Zhang ∗ , C. Yang, X. Zhang, M. Chen, L. Huo Department of Oral and Maxillofacial Surgery, Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute, China Purpose: To introduce an advanced anchor technique for internal derangement of temporomandibular joint. Methods: Consecutive 177 patients (232 TMJs) diagnosed as ID, through clinical examinations and MRI, were treated with a newly modified anchor technique from July 2011 to March 2012. The technique is commonly proposed for TMJ ID. The advanced approach was to put an anchoring nail in middle of the inclined surface, just below the posterior oblique surface of the condyle and use two 3-0 Nylon sutures fixing disc to the anchoring nail. Both preoperative and postoperative MRIs were taken to judge the disc position. For patients with malocclusion or irregular dentition, reposition biting plate and orthodontic treatment were also involved. Results: Among 232 joints of postoperative MRIs, 226 joints (172 cases) were excellent and 4 joints (4 cases) were good, only 2 joints (1 case) were poor which was needed a second open surgery. The total effectiveness was 99.14%. Conclusion: This advanced procedure has provided successful results in the treatment of TMJ ID. The design was more reasonable. But further clinical evaluation is necessary. http://dx.doi.org/10.1016/j.ijom.2013.07.712
T35.OR052 Does temporomandibular disorder incidence increase in polycystic ovary syndrome patients? S.S.
Soydan 1,∗ ,
1369
K.
Deniz 2 ,
N. Basc´yl
Tutuncu 3 ,
S.
Uckan 1 ,
A. Dogruk
Unal 4
1 Baskent
University, Department of Oral and Maxillofacial Surgery, Ankara, Turkey 2 Baskent University, Istanbul Practice and Research Hospital, Department of Oral and Maxillofacial Surgery, Istanbul, Turkey 3 Baskent University, Department of Endocrinology and Metabolism, Ankara, Turkey 4 Baskent University, Istanbul Practice and Research Hospital, Department of Endocrinology and Metabolism, Istanbul, Turkey Background and objectives: Temporomandibular disorder (TMD) prevalence is higher in females than males (with ratio between 3:1 and 9:1). Polycystic ovary syndrome (PCOS) is a multisystem disease and characterized with hormonal irregularity. We hypothesized that expression of various matrix metalloproteinases in PCOS may lead matrix loss in temporomandibular joint (TMJ) fibrocartilage and cause TMD. Our study was performed to evaluate the incidence of TMD in patients with PCOS and compare with individuals who have not got any systemic disorder. Methods: One-hundred voluntary female patients who had menstrual cycles were included. Patients were divided into two groups; PCOS group consisted of 50 females (mean age: 27.4 ± 6.3) who had previously diagnosed PCOS and control group was consisted of 50 healthy females (mean age: 26.1 ± 5.4). Comprehensive clinical TMJ and muscle evaluation of patients were performed by the same clinician. The pain of TMJ was also evaluated by Visual Analogue Scale (VAS) and the results of two groups were statistically compared. Results: Internal joint disorder incidence was 86% (n: 43) in PCOS group and 24% (n: 12) in control group and the difference was statistically significant (p < 0.05). There was statistically significant difference between the VAS score of TMJ pain of two groups; as the VAS score was 2.9 in PCOS group, it was approximately 0 in control group. 72% (n: 36) of the patients had muscular tenderness and pain in PCOS group, while; the ratio was 28% (n: 14) control group and difference was statistically significant (p < 0.05). Maximal interincisal distance was 43.7 mm in PCOS group and 46.4 mm in control group and difference was not statistically significant (p > 0.05). Conclusion: Even a great number of heterogeneous conditions affect the TMJ, it can be concluded that TMD incidence is significantly higher in females who had PCOS when compared with healthy individuals. PCOS may be the one of the etiological factors for the female prominence of TMD. Key words: polycystic ovary syndrome; temporomandibular disorder; temporomandibular joint pain http://dx.doi.org/10.1016/j.ijom.2013.07.709 T35.OR053 Cost effectiveness of arthrocentesis as initial treatment for temporomandibular joint arthralgia: a randomized controlled trial L.M. Vos 1,∗ , A.D. Stant 2 , E.H. Quik 2 , J.J.R. Huddleston Slater 1 , B. Stegenga 1 1 Department
of Oral and Maxillofacial Surgery, University Medical Center Groningen, The Netherlands 2 Department of Epidemiology, University Medical Center Groningen, The Netherlands Objective: To determine the cost effectiveness of arthrocentesis as initial treatment compared to care as usual (CAU) for temporomandibular joint (TMJ) arthralgia. Materials and methods: 80 patients were randomly allocated to arthrocentesis as initial treatment (n = 40) or CAU (n = 40). Arthrocentesis was performed under local anaesthesia. The joint was rinsed with at least 300 ml isotonic saline chloride and no additional substances or drugs were applied. CAU consisted of a soft diet, physical therapy (which involved a home exercise program, joint mobilisation, and physical treatment modalities), and splint therapy using an intra-oral hard acrylic splint. Follow-up was after three, 12 and 26 weeks. Main outcome measures: Cost effectiveness, i.e. total costs from a societal point of view related to TMJ pain as measured on a visual analogue scale (VAS 0–100 mm) and cost utility, i.e. quality adjusted life years (QALY). Results: After 26 weeks, in both groups (arthrocentesis n = 36; CAU n = 36) TMJ pain had declined. Generalized estimating equation (GEE) models for the clinical effectiveness, based on intention to treat, showed significant differences between arthrocentesis as initial treatment and CAU (regression coefficient beta = −10.76 (95% confidence interval −17.75 to −3.77), p = 0.003). Estimated mean total (societal) costs during 26 weeks were D 589 ($795) in the arthrocentesis group and D 1680 ($2266) in the CAU group. With regard to cost effectiveness, arthrocentesis dominated CAU in about 98% of the bootstrap simulations. With regard to cost utility, arthrocentesis dominated CAU in approximately 95% of the bootstrap simulations. Conclusions: The results of this study suggest that arthrocentesis as initial treatment is cost effective in reducing TMJ pain compared to CAU. However, due to substantial missing data, current results with regard to cost effectiveness should be interpreted with caution. Trial registration: Trialregister.nl NTR1505. http://dx.doi.org/10.1016/j.ijom.2013.07.710
Noma, an orofacial gangrene with the challenge of trismus and ankylosis of the mandible: an overview B. Witsenburg ∗ , K.W. Marck Medisch Spectrum Twente, Enschede, The Netherlands Noma is a quickly spreading orofacial gangrene occurring in malnourished children weakened by disease. In the past common in Europe the disease is still present in (mainly) Africa. The World Health Organization estimates that 130,000 children die worldwide each year as a result of noma. The aetiology and pathogenesis of the affection is not well defined. A clear correlation exists between noma and the occurrence of extreme poverty, malnutrition, the presence of necrotizing gingivitis and concomitant debilitating diseases like measles and HIV. However the microbiological and infectious pathways that lead to noma have not been explored thoroughly yet. The onset is an intraoral ulcer that expands quickly to severe swelling in the face, often resulting in necrosis of parts of the face (lips, cheek, nose, maxilla) if not sepsis and death. The mortality rate of noma is estimated to be around 90%. Patients who survive noma often end up with facial disfigurement leading to social ostracism and problems with speech and eating. Surgical rehabilitation is directed to reconstruction of an acceptable face. Half of these patients have an impaired opening of the mouth due to fibrotic trismus or an ankylosis of the mandible. Release often gives disappointing results. http://dx.doi.org/10.1016/j.ijom.2013.07.711 T35.OR055 Modified temporomandibular joint disc anchor: the technique and note S.Y. Zhang ∗ , C. Yang, X. Zhang, M. Chen, L. Huo Department of Oral and Maxillofacial Surgery, Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute, China Purpose: To introduce an advanced anchor technique for internal derangement of temporomandibular joint. Methods: Consecutive 177 patients (232 TMJs) diagnosed as ID, through clinical examinations and MRI, were treated with a newly modified anchor technique from July 2011 to March 2012. The technique is commonly proposed for TMJ ID. The advanced approach was to put an anchoring nail in middle of the inclined surface, just below the posterior oblique surface of the condyle and use two 3-0 Nylon sutures fixing disc to the anchoring nail. Both preoperative and postoperative MRIs were taken to judge the disc position. For patients with malocclusion or irregular dentition, reposition biting plate and orthodontic treatment were also involved. Results: Among 232 joints of postoperative MRIs, 226 joints (172 cases) were excellent and 4 joints (4 cases) were good, only 2 joints (1 case) were poor which was needed a second open surgery. The total effectiveness was 99.14%. Conclusion: This advanced procedure has provided successful results in the treatment of TMJ ID. The design was more reasonable. But further clinical evaluation is necessary. http://dx.doi.org/10.1016/j.ijom.2013.07.712