- Email: [email protected]
Infrared thermography and TMJ arthralgia
Methods.—Forty-four middle-aged patients with OSA and 21 with snoring participated, undergoing a clinical examination and completing questionnaires covering signs and symptoms in the masticatory system. The questionnaires were administered before MPD use and 6 months and 2 years after beginning MPD use. Results.—Significant changes in the maximum range of protrusion and mouth opening were noted between baseline and the 6-month and 2-year follow-up evaluations, but the range of laterotrusion remained stable. A significant decrease in overjet and overbite occurred gradually from baseline until after 2 years of treatment. A lateral open bite developed in 9 of the 65 patients. Temporomandibular joint (TMJ) signs were present in 34% of the participants at baseline. After 2 years, pain during mandibular movements was significantly reduced and TMJ status was stable. Patients also reported a significant reduction in the frequency of headaches. Tiredness with jaw function was reported at baseline by 3 patients, after 6 months by 8 patients, and after 2 years by only 2 patients. None of the patients experienced TMJ locking several times weekly or every day or night when first examined, but 1 had TMJ locking after 6 months and another after 2 years. Only 2 patients reported having a permanent sense of an altered occlusion. Two of the patients who had a lateral open bite develop believed their occlusion was worse than at base-
line. Seven believed their occlusion had not experienced any negative effect. Discussion.—The adverse effects attending the use of an MPD for OSA or snoring were minor compared with the improved sleep and did not prevent patients from continuing to use the MPD. The signs and symptoms in the masticatory system had diminished, and the mean range of motion of the mandible increased slightly.
Clinical Significance.—Mandibular protruding devices are often effective in reducing snoring and sleep apnea, as well as improving range of motion and reducing headaches. Care must be taken, however, to monitor possible minor occlusal alterations.
Fransson AMC, Tegelberg Å, Johansson A, et al: Influence on the masticatory system in treatment of obstructive sleep apnea and snoring with a mandibular protruding device: A 2-year follow-up. Am J Orthod Dentofacial Orthop 126:687-693, 2004 Reprints available from A Fransson, Dept of Stomatognathic Physiology and Dept of Orthodontics, Postgraduate Dental Education Ctr, PO Box 1126, SE-701 11 Örebro, Sweden; e-mail: [email protected]
Temporomandibular Disorders Infrared thermography and TMJ arthralgia Background.—Among the diagnostic imaging methods used to assess joints are radiography, arthroscopy, computed tomography (CT), and magnetic resonance imaging (MRI). Clinical thermography uses instruments that can detect and record thermal patterns on the surface of the patient’s skin. Both visual and quantitative documentation is provided. Thermography can be divided into liquid crystal thermography (contact thermography) and infrared ther-
258 Dental Abstracts
mography (noncontact thermography). Infrared thermography gathers data regarding normal and abnormal function in the sensory and sympathetic nervous systems, dysfunction of the vascular system, myofascial trauma, and local inflammatory processes. The changes observed with infrared thermography reflect physiologic changes, not anatomic ones. Recent studies have evaluated the use of infrared thermography to distinguish asymptomatic subjects
from patients experiencing temporomandibular joint (TMJ) arthralgia. Methods.—Three controlled studies and 1 doubleblind controlled study assessed infrared thermography for use in TMJ arthralgia. The factor primarily used to distinguish between normal and abnormal conditions was the difference in temperature between the right and left sides of the face (∆T). The findings of these 4 studies were analyzed. Results.—One study found infrared thermography could not distinguish confidently between specific diagnoses such as osteoarthrosis and disk displacement. In a second study, a high degree of thermal symmetry was noted over the TMJ in the control group and a low level in patients with temporomandibular disorders (TMDs). With increasing TMJ pain, the mean TMJ ∆T values increased as well. The severity of the patient’s TMD discomfort correlated statistically with the mean TMJ ∆T values. In this case, infrared thermography was felt to offer promise as an aid to diagnosis. Similar findings were noted in 2 other studies. However, none of the studies met the criteria required to be considered a high level of evidence in diagnostic test research. Thus, infrared thermography cannot be supported currently as a diagnostic method for use in definitively distinguishing between patients with and without TMJ arthralgia.
Discussion.—The studies of thermography did not meet the criteria defining a high level of evidence. No clear relationship was found between TMJ pain, regional temperature, and inflammatory mediators. However, findings indicate that thermal patterns of the TMJ region reflect the influence of several factors, including the etiology, duration, and severity of signs and symptoms of TMD. Further studies are needed to confirm the results obtained and to better define the relationship between TMJ arthralgia and regional temperature changes.
Clinical Significance.—Suggested as an aid to demonstrate the physiologic changes in TMD, infrared thermography, while an interesting concept, has so far failed to meet the criteria necessary for a dependable diagnosis. More study is warranted.
Fikackova H, Ekberg E: Can infrared thermography be a diagnostic tool for arthralgia of the temporomandibular joint? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98:643-650, 2004 Reprints available from H Fikackova, 1st Medical Faculty of Charles Univ Prague, Inst of Biophysics and Informatics, Salmovská 1, Prague 2, Czech Republic; e-mail: [email protected]
Therapeutics Aggressive dental surgery for early childhood caries Background.—The populations at highest risk for early childhood caries (ECC) are impoverished babies and young preschool children, and there is no predilection for race, ethnicity, or culture. General anesthesia is usually needed when treatment is performed in these patients. The recommended treatment is generally restoration or
extraction of carious teeth and efforts to discontinue decay-promoting feeding behaviors. The results have not proved encouraging, with a high rate of relapse that entails further costly treatment and possibly significant morbidity. An aggressive dental surgery approach was used for the treatment of ECC, and its outcomes were reported.
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line. Seven believed their occlusion had not experienced any negative effect. Discussion.—The adverse effects attending the use of an MPD for OSA or snoring were minor compared with the improved sleep and did not prevent patients from continuing to use the MPD. The signs and symptoms in the masticatory system had diminished, and the mean range of motion of the mandible increased slightly.
Clinical Significance.—Mandibular protruding devices are often effective in reducing snoring and sleep apnea, as well as improving range of motion and reducing headaches. Care must be taken, however, to monitor possible minor occlusal alterations.
Fransson AMC, Tegelberg Å, Johansson A, et al: Influence on the masticatory system in treatment of obstructive sleep apnea and snoring with a mandibular protruding device: A 2-year follow-up. Am J Orthod Dentofacial Orthop 126:687-693, 2004 Reprints available from A Fransson, Dept of Stomatognathic Physiology and Dept of Orthodontics, Postgraduate Dental Education Ctr, PO Box 1126, SE-701 11 Örebro, Sweden; e-mail: [email protected]
Temporomandibular Disorders Infrared thermography and TMJ arthralgia Background.—Among the diagnostic imaging methods used to assess joints are radiography, arthroscopy, computed tomography (CT), and magnetic resonance imaging (MRI). Clinical thermography uses instruments that can detect and record thermal patterns on the surface of the patient’s skin. Both visual and quantitative documentation is provided. Thermography can be divided into liquid crystal thermography (contact thermography) and infrared ther-
258 Dental Abstracts
mography (noncontact thermography). Infrared thermography gathers data regarding normal and abnormal function in the sensory and sympathetic nervous systems, dysfunction of the vascular system, myofascial trauma, and local inflammatory processes. The changes observed with infrared thermography reflect physiologic changes, not anatomic ones. Recent studies have evaluated the use of infrared thermography to distinguish asymptomatic subjects
from patients experiencing temporomandibular joint (TMJ) arthralgia. Methods.—Three controlled studies and 1 doubleblind controlled study assessed infrared thermography for use in TMJ arthralgia. The factor primarily used to distinguish between normal and abnormal conditions was the difference in temperature between the right and left sides of the face (∆T). The findings of these 4 studies were analyzed. Results.—One study found infrared thermography could not distinguish confidently between specific diagnoses such as osteoarthrosis and disk displacement. In a second study, a high degree of thermal symmetry was noted over the TMJ in the control group and a low level in patients with temporomandibular disorders (TMDs). With increasing TMJ pain, the mean TMJ ∆T values increased as well. The severity of the patient’s TMD discomfort correlated statistically with the mean TMJ ∆T values. In this case, infrared thermography was felt to offer promise as an aid to diagnosis. Similar findings were noted in 2 other studies. However, none of the studies met the criteria required to be considered a high level of evidence in diagnostic test research. Thus, infrared thermography cannot be supported currently as a diagnostic method for use in definitively distinguishing between patients with and without TMJ arthralgia.
Discussion.—The studies of thermography did not meet the criteria defining a high level of evidence. No clear relationship was found between TMJ pain, regional temperature, and inflammatory mediators. However, findings indicate that thermal patterns of the TMJ region reflect the influence of several factors, including the etiology, duration, and severity of signs and symptoms of TMD. Further studies are needed to confirm the results obtained and to better define the relationship between TMJ arthralgia and regional temperature changes.
Clinical Significance.—Suggested as an aid to demonstrate the physiologic changes in TMD, infrared thermography, while an interesting concept, has so far failed to meet the criteria necessary for a dependable diagnosis. More study is warranted.
Fikackova H, Ekberg E: Can infrared thermography be a diagnostic tool for arthralgia of the temporomandibular joint? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98:643-650, 2004 Reprints available from H Fikackova, 1st Medical Faculty of Charles Univ Prague, Inst of Biophysics and Informatics, Salmovská 1, Prague 2, Czech Republic; e-mail: [email protected]
Therapeutics Aggressive dental surgery for early childhood caries Background.—The populations at highest risk for early childhood caries (ECC) are impoverished babies and young preschool children, and there is no predilection for race, ethnicity, or culture. General anesthesia is usually needed when treatment is performed in these patients. The recommended treatment is generally restoration or
extraction of carious teeth and efforts to discontinue decay-promoting feeding behaviors. The results have not proved encouraging, with a high rate of relapse that entails further costly treatment and possibly significant morbidity. An aggressive dental surgery approach was used for the treatment of ECC, and its outcomes were reported.
Volume 50 • Issue 4 • 2005 259