Journal of Craniomandibular Function, 01/2011

Aim of the study: The aim of this study was to investigate personal experiences of pain and to determine the resulting restrictions and impairments in patients with chronic facial pain. This was performed by means of a special interview procedure. Materials and methods: The study was conducted within the framework of an eight-week project of the physiotherapy BA program at the Osnabrück University, Germany. A total of eight female patients were interviewed and the results were evaluated using the Mayring qualitative content analysis method. Results: The patients reported that their quality of life was severely restricted. Some of them also mentioned a problematic relationship with their physician, which was partly due to a disturbed communication between physician and patient. Apart from pain-related financial problems, also physical changes of the facial structure due to pain were reported. Discussion: All patients wished for a faster and more patient-oriented therapy. The patients and even some of their physicians were not sufficiently informed about physiotherapeutic treatment options for chronic facial pain.Physiotherapy should consolidate its value in the treatment of orofacial pain and further studies should be carried out to support its significance. Keywords: chronic pain, chronic facial pain, pain experiences, pain behavior, qualitative study

This study investigated a model of brain activity in an altered occlusion, which entailed an alteration of the TMJ position in eight healthy subjects with the help of functional magnetic resonance imaging (fMRI). The purpose of the study was to answer the question whether a specific spatial position of the mandibular condyles was related to an emotional and/ or neurological response. The occlusal changes/changes of TMJ position led to a marked increase in BOLD signals (blood oxygenation level dependency) in the anterior cingulate cortex (ACC), insula and amygdala in all subjects. These results indicate interdependence between occlusion, TMJ position, and the "emotion circuit" (limbic system) in the human brain. Keywords: brain activation emotion, functional magnetic resonance imaging, malocclusion

The aim of the present investigation was to compare the effectiveness of six treatment protocols providing TMJ arthrocentesis with or without additional drugs to manage symptoms in patients with inflammatory-degenerative TMJ disease over a three-months follow up period. Different combinations of single-needle and two-needle arthrocenteses, alone or with injection of corticosteroids or hyaluronic acid immediately following the joint lavage, were adopted in 72 patients. The protocol providing five weekly low-molecular weight hyaluronic acid injections, immediately following a classical two-needle arthrocentesis, was superior to all the other treatments to reduce pain-related symptoms in patients with inflammatorydegenerative TMJ disease. This was even if treatment effects were not significantly different with respect to those achieved with other protocols. Keywords: arthrocentesis, inflammatory-degenerative disease, hyaluronic acid, temporomandibular joint, temporomandibular disorders

A randomized empirical study investigated whether hypnosis audio CDs were a suitable and effective treatment for patients with craniomandibular dysfunction (CMD). The purpose of the study was to determine whether selfhypnosis at home using a CD with relaxation suggestions would relieve pain and improve the mobility of the mandible. Investigations were carried out over a four-week period. In addition, we investigated if any gender-related differences could be found. Patients and methods: After a clinical functional analysis according to Ahlers/Jakstat, 20 patients were randomly assigned to each of three study groups. The splint group was treated with an occlusal splint in the maxilla (Michigan Splint according to Ramfjord). It was compared with a CD group, in which the patients had listened to a relaxation CD (according to Schmierer). In the control group, patients were only informed about the causes for their disease and the treatment options for CMD, but received no further treatment. The change of the distance between the incisal edges when the patient opened his or her mouth actively to the maximum (active IED, as measured with the CMDmeter) was used as the criterion to assess functional impairment. The subjective perception of pain was assessed using a numeric analog scale (NAS score). The observation period was four weeks. Wilcoxon's and McNemar's test were used for statistical analysis, as were non-parametric (Mann-Whitney U and H test) and parametric methods (t-test, analysis of variance). Results: A comparison between the baseline examination and the last follow-up examination after four weeks showed a significant reduction of pain intensity and impairment by pain both in the splint group and in the CD group. No age- or gender-related differences could be found for the different parameters. In addition, a correlation analysis was used to determine whether the individual stress levels had an influence on the development of the variables pain, impairment by pain and active IED. Those patients with high scores on the stress indexes at baseline achieved more positive treatment results than patients with lower scores. Conclusion: The study results show that self-hypnosis using audio recordings is a positive enhancement to the initial treatment of CMD patients. Pain reduction seems to be independent of age or sex but dependent on the previously experienced stress levels. Keywords: CMD, distance between incisal edges, hypnosis, pain intensity, splint therapy