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Doc, my jaw is locked! But why do my ears hurt instead?


Welcome back to TGIF Dr Euan blogpost!


Have you suffered from ear pain and been surprised to find that your ears are normal? Do you experience pain and clicking in and around your ears? Do you sometimes yawn and get a sharp twang of pain?


Well then, you may have issues with your Temporo-Mandibular Joint or TMJ


In this blog post, we will look more deeply into the TMJ and how it works / can give you pain and other problems when things go wrong.


With the added stress and strain of our modern lives, TMJ problems are becoming more and more frequent.





What is TMD?


Temporomandibular disorders (TMD) is a term used to describe a group of dental or medical conditions affecting the temporomandibular joints (TMJ) in the jaw and the facial muscles that control jaw movement.


TMDs are a common cause of non-tooth-related facial pains and are more prevalent in women rather than men. TMDs can also display unexplained headaches, and pain in the jaw, or even the ears. As the symptoms of TMDs often overlap with other medical conditions, they are often under or misdiagnosed.

What is TMJ?


The temporomandibular joint (TMJ) is the joint that connects your lower jaw (mandible) to the skull’s bone. Situated on each side of the head and in front of the ears, it is a flexible joint that can move side to side, and up and down. These joints enable us to chew, talk and yawn. There are two joints, one on each side of the jaw.




The muscles attached to and surrounding the TMJ control its position and movement. A soft disc lying between the rounded end of the joint (condyle) and the joint socket (glenoid fossa) helps to keep jaw movements smooth, absorbing stress and shocks to the TMJ as we chew and perform other jaw functions.


The TMJ is richly innervated, mainly by the Trigeminal nerve (5th Cranial Nerve) but also by many other nerves.


The innervation to the temporomandibular joint (TMJ) is by branches from the mandibular division of the trigeminal nerve (CN V3), mostly through the auriculotemporal branch, along with branches from the masseteric and deep temporal nerves. The articular tissues and the dense part of the articular disc have no nerve supply.


Therefore, there is an overlap of sensory nerves with the ear and the ear canal. This explains why patients with TMD often experience ear pain. This is a form of referred otalgia.

What causes TMD?

The cause of TMD is not always clear and can vary between people, also at different stages of life. So symptoms may wax and wane. TMD is usually the result of a few factors:

  • Bruxism: The unconscious clenching or grinding of teeth during sleep or when awake.

  • Trauma: Injury to the face and/or jaws, prolonged or wide mouth opening, biting on hard food, etc.

  • Habits: Gum chewing, eating on one side, poor jaw posture, etc.

  • Bad bite and jaw relationships: Poorly aligned teeth, skeletal problems, etc.

  • Diseases: Systemic arthritis, certain neurological conditions, tumours, etc.

  • Emotional: Stress, anxiety, depression, etc.


Symptoms of TMD

TMD can significantly affect your quality of life if symptoms are left untreated

The indicators of TMD can include:

  • Headaches

  • Ear symptoms: Ear pain, blocked feeling, ringing sounds, partial hearing loss, dizziness

  • Jaw pain or tenderness: Painful jaw joints or chewing muscles located in temples and cheeks

  • Jaw joint sounds: Clicking, popping and grating sounds

  • Jaw function difficulty: Difficulty chewing, yawning, talking, and opening the mouth

  • Abnormal jaw opening: Restricted opening, irregular movement, jaw catching and locking

  • Bite and teeth problems: Change in fit of teeth, sore and cracked teeth

  • Neck and shoulder pain

How is TMD diagnosed and managed?

TMD is diagnosed through comprehensive medical history, physical examination and psychological screening (where applicable). Routine or special X-rays like MRI and CT scans are sometimes used to diagnose the condition.

TMD management depends on the type and duration of TMD you are suffering from and the extent of tissue damage. Generally, treatment is aimed at reducing pain, decreasing adverse loading of the jaw joints and muscles, restoring function and allowing you to return to normal activities. Treatment begins with conservative therapies that are not invasive and include:

  • Education and self-care practices

  • Behaviour modification of harmful habits

  • Psychotherapy, including stress management and relaxation techniques

  • Medications

  • Physical therapy

  • Dental splint therapy

Image of a dental splint


If TMD is chronic, long-standing or associated with major structural changes and/or significant psychological distress and disability, the following may be advised:


  • Jaw joint surgery

  • Bite (occlusal) therapy

  • Orthodontics

Self-care tips for TMD

Most of the reasons that cause your jaws and chewing muscles to hurt are not life-threatening. They can, however, be distressing and affect your quality of life.

The following self-care practices can help you manage TMD: Rest your jaw muscles and joints:

  • Avoid clenching and grinding your teeth. Relax your jaw by resting the tip of your tongue against the palate, keeping your teeth apart with face and jaws relaxed.

  • Avoid chewy or hard food.

  • Avoid chewing gum, biting your nails or other objects.

  • Avoid eating on the side that hurts.

Avoid opening your mouth too wide

  • Suppress your yawn to prevent your mouth from opening too wide.

  • Cut food into small pieces.

  • Avoid long dental appointments. Inform your dentist of your condition/s and take frequent breaks during appointments.


Apply hot or cold compresses, perform stretching exercises

  • Cold packs are used immediately following an injury (up to two days) while heat packs are used for long-term, lingering pain.

  • Apply a hot or cold pack directly to the painful area of your jaw for

  • five minutes.

  • Gently massage and stretch your mouth open and close five times without hurting yourself. Repeat five times.

Manage your stress

  • Stress decreases your body’s tolerance and “happy-pain-killing” hormones.

  • Most people react to stress by clenching or grinding their teeth. This is accompanied by tightening of the facial and neck muscles.

  • Choose a stress relief method that best suits you and stick to it.

  • Practice relaxation (e.g. deep breathing exercises) throughout the day.

Posture

  • Be aware of your posture throughout the day. Keep shoulders, back and head upright and maintain good back support.

  • Avoid slopping your shoulders.

  • Avoid crossing your legs for prolonged periods. Keep feet flat on the floor.

Sleep


  • Sleep on your back or side. Sleeping on the stomach puts pressure on your jaws.

  • Get adequate sleep.

  • Practice good sleep hygiene.

  • Massage your face and neck before bed.


Exercise


  • Choose low-impact exercise to avoid trauma to your joints, e.g. swimming, brisk walking, etc.

  • Avoid clenching your teeth during exercise.

  • Take the opportunity to exercise and stretch.

Nutrition


  • Avoid caffeine, alcohol and tobacco.

  • Drink plenty of water throughout the day.

  • Eat your meals regularly, especially if you are taking aspirin, Synflex or ibuprofen.


Use of your dental splint

Your dental splint is designed to protect, unload and/or stabilise your jaw muscles and joints. It should help you feel more comfortable and facilitate healing. To obtain maximum benefit, please note the following: When to use your splint

  • Your splint should be worn when you are asleep where bite forces are the greatest.

  • Daytime wear may be recommended if you experience severe stress or pain.

  • Avoid wearing your splint for 24 hours unless instructed to do so.

  • Do not wear your splint when you are eating.

Do not bite down on your splint

  • Your teeth should not touch the splint when you are awake.

  • Monitor your jaw position and try to break this habit.

Getting used to your splint

  • In the first few days of using your splint, you may salivate more or experience a temporary increase in jaw tension or noises. You may also subconsciously remove it in the middle of the night.

  • If your splint is causing your teeth to hurt, remove it and have it readjusted.

  • Increase the frequency of your splint wear until you reach the recommended wear schedule.

Relaxation of your jaw muscles


  • Your jaws may take a few minutes to adjust back to the way it was when you removed your splint after wearing it. This is usually caused by the relaxation of your jaw muscles and the settling in of your teeth after a night of clenching and/or grinding.

  • If you had an orthodontic treatment or have a severe bite problem, your new relaxed jaw position may be more comfortable than your original one.

  • This may be associated with bite changes and the need for bite therapy. Please inform us immediately should the latter occur.

When you are not wearing your splint


• Place your splint in a safe place and in a protective container.

• Avoid leaving it in a warm place. This prevents distortion.

• Store it in a moist environment if you are not wearing it for more than eight hours. Place it in a container of tap water, a zip-lock bag or a container with a few drops of water or a wet piece of facial cotton.

Cleaning your splint


• Clean the inside and outside of your splint with a toothbrush and some toothpaste daily.

• Soak your splint in a denture-cleaning solution once a week.

Splint review and modifications


• Your splint needs to be periodically reviewed and adjusted due to changes in your jaw position. It also allows your dentist to check the wear and tear of your splint.

• Remember to bring your splint with you to each appointment.

When to stop using your splint


• Your duration of wear will depend on your specific condition/s and symptoms.

• While some patients can stop wearing splints after a pain-free period, others have to wear them for years.

At Euan’s ENT Surgery & Clinic, we usually partner with a Dental or Oromaxillofacial specialist to manage your TMD. They will provide dental splints which are custom-made to fit your teeth and jaw.

If you require immediate attention, don't hesitate to get in touch with the clinic during office hours, Euan's ENT Surgery & Clinic to make an appointment or call our clinic number 6694 4282.


Well, I hope this post has given you an insight into the TMJ and TMD, and how it may affect you / your loved ones.


Have a restful weekend :-)


Here is a list of references in case you want to delve even deeper into the topic:


REFERENCES:


1. Von Korff M., Ormel J., Keefe F.J., Dworkin S.F. Grading the severity of chronic pain. Pain. 1992;50:133–149. doi: 10.1016/0304-3959(92)90154-4. [PubMed] [CrossRef] [Google Scholar]


2. Ismail F., Eisenburger M., Lange K., Schneller T., Schwabe L., Strempel J., Stiesch M. Identification of psychological comorbidity in TMD-patients. Cranio. 2016;34:182–187. doi: 10.1179/2151090315Y.0000000008. [PubMed] [CrossRef] [Google Scholar]


3. List T., Jensen R.H. Temporomandibular disorders: Old ideas and new concepts. Cephalalgia. 2017;37:692–704. doi: 10.1177/0333102416686302. [PubMed] [CrossRef] [Google Scholar]


4. Bitiniene D., Zamaliauskiene R., Kubilius R., Leketas M., Gailius T., Smirnovaite K. Quality of life in patients with temporomandibular disorders. A systematic review. Stomatologija. 2018;20:3–9. [PubMed] [Google Scholar]


5. Resende C., Rocha L., Paiva R.P., Cavalcanti C.D.S., Almeida E.O., Roncalli A.G., Barbosa G.A.S. Relationship between anxiety, quality of life, and sociodemographic characteristics and temporomandibular disorder. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. 2020;129:125–132. doi: 10.1016/j.oooo.2019.10.007. [PubMed] [CrossRef] [Google Scholar]


6. Dahlstrom L., Carlsson G.E. Temporomandibular disorders and oral health-related quality of life. A systematic review. Acta Odontol. Scand. 2010;68:80–85. doi: 10.3109/00016350903431118. [PubMed] [CrossRef] [Google Scholar]


7. Goncalves D.A., Camparis C.M., Speciali J.G., Franco A.L., Castanharo S.M., Bigal M.E. Temporomandibular disorders are differentially associated with headache diagnoses: A controlled study. Clin. J. Pain. 2011;27:611–615. doi: 10.1097/AJP.0b013e31820e12f5. [PubMed] [CrossRef] [Google Scholar]


8. Lim P.F., Smith S., Bhalang K., Slade G.D., Maixner W. Development of temporomandibular disorders is associated with greater bodily pain experience. Clin. J. Pain. 2010;26:116–120. doi: 10.1097/AJP.0b013e3181c507ef. [PMC free article] [PubMed] [CrossRef] [Google Scholar]


9. Facial Pain. [(accessed on 9 June 2019)]; Available online: http://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/FacialPain/


10. Lipton J.A., Ship J.A., Larach-Robinson D. Estimated prevalence and distribution of reported

orofacial pain in the United States. J. Am. Dental Assoc. 1993;124:115–121. doi: 10.14219/jada.archive.1993.0200. [PubMed] [CrossRef] [Google Scholar]


11. Locker D., Slade G. Prevalence of symptoms associated with temporomandibular disorders in a Canadian population. Community Dent. Oral Epidemiol. 1988;16:310–313. doi: 10.1111/j.1600-0528.1988.tb01783.x. [PubMed] [CrossRef] [Google Scholar]


12. Magnusson T., Egermark I., Carlsson G.E. A longitudinal epidemiologic study of signs and symptoms of temporomandibular disorders from 15 to 35 years of age. J. Orofac. Pain. 2000;14:310–319. [PubMed] [Google Scholar]


13. Ebrahimi M., Dashti H., Mehrabkhani M., Arghavani M., Daneshvar-Mozafari A. Temporomandibular Disorders and Related Factors in a Group of Iranian Adolescents: A Cross-sectional Survey. J. Dent. Res. Dent. Clin. Dent. Prospect. 2011;5:123–127. doi: 10.5681/joddd.2011.028. [PMC free article] [PubMed] [CrossRef] [Google Scholar]


14. Manfredini D., Piccotti F., Ferronato G., Guarda-Nardini L. Age peaks of different RDC/TMD diagnoses in a patient population. J. Dent. 2010;38:392–399. doi: 10.1016/j.jdent.2010.01.006. [PubMed] [CrossRef] [Google Scholar]


15. Klatkiewicz T., Gawriolek K., Pobudek Radzikowska M., Czajka-Jakubowska A. Ultrasonography in the Diagnosis of Temporomandibular Disorders: A Meta-Analysis. Med. Sci. Monit. 2018;24:812–817. doi: 10.12659/MSM.908810. [PMC free article] [PubMed] [CrossRef] [Google Scholar]


16. Sena M.F., Mesquita K.S., Santos F.R., Silva F.W., Serrano K.V. Prevalence of temporomandibular dysfunction in children and adolescents. Rev. Paul. Pediatr. 2013;31:538–545. doi: 10.1590/S0103-05822013000400018. [PMC free article] [PubMed] [CrossRef] [Google Scholar]


17. Valesan L.F., Da-Cas C.D., Reus J.C., Denardin A.C.S., Garanhani R.R., Bonotto D., Januzzi E., de Souza B.D.M. Prevalence of temporomandibular joint disorders: A systematic review and meta-analysis. Clin. Oral Investig. 2021 doi: 10.1007/s00784-020-03710-w. [PubMed] [CrossRef] [Google Scholar]


18. Rollman G.B., Gillespie J.M. The role of psychosocial factors in temporomandibular disorders. Curr. Rev. Pain. 2000;4:71–81. doi: 10.1007/s11916-000-0012-8. [PubMed] [CrossRef] [Google Scholar]


19. Auerbach S.M., Laskin D.M., Frantsve L.M., Orr T. Depression, pain, exposure to stressful life events, and long-term outcomes in temporomandibular disorder patients. J. Oral Maxillofac. Surg. 2001;59:628–633. doi: 10.1053/joms.2001.23371. [PubMed] [CrossRef] [Google Scholar]


20. Toh A.Q.J., Chan J.L.H., Leung Y.Y. Mandibular asymmetry as a possible etiopathologic factor in temporomandibular disorder: A prospective cohort of 134 patients. Clin. Oral Investig. 2021 doi: 10.1007/s00784-020-03756-w. [PubMed] [CrossRef] [Google Scholar]


21. Wilkes C.H. Internal Derangements of the Temporomandibular Joint: Pathological Variations. Arch. Otolaryngol. Head Neck Surg. 1989;115:469–477. doi: 10.1001/archotol.1989.01860280067019. [PubMed] [CrossRef] [Google Scholar]


22. Mercuri L.G. Osteoarthritis, osteoarthrosis, and idiopathic condylar resorption. Oral Maxillofac. Surg. Clin. N. Am. 2008;20:169–183. doi: 10.1016/j.coms.2007.12.007. [PubMed] [CrossRef] [Google Scholar]


23. Bertram S., Rudisch A., Innerhofer K., Pümpel E., Grubwieser G., Emshoff R. Diagnosing TMJ internal derangement and osteoarthritis with magnetic resonance imaging. J. Am. Dent. Assoc. 2001;132:753–761. doi: 10.14219/jada.archive.2001.0272. [PubMed] [CrossRef] [Google Scholar]


24. Turk D.C., Gatchel R.J. Psychological Approaches to Pain Management: A Practitioner’s Hand Book. The Gilford Press; New York, NY, USA: 2002. [Google Scholar]


25. Dworkin S.F., Massoth D.L. Temporomandibular disorders and chronic pain: Disease or illness? J. Prosthet. Dent. 1994;72:29–38. doi: 10.1016/0022-3913(94)90213-5. [PubMed] [CrossRef] [Google Scholar]


26. Suvinen T.I., Reade P.C. Temporomandibular disorders: A critical review of the nature of pain and its assessment. J. Orofac. Pain. 1995;9:317–339. [PubMed] [Google Scholar]


27. Yap A.U., Tan K.B., Chua E.K., Tan H.H. Depression and somatization in patients with temporomandibular disorders. J. Prosthet. Dent. 2002;88:479–484. doi: 10.1067/mpr.2002.129375. [PubMed] [CrossRef] [Google Scholar]


28. Saccomanno S., Bernabei M., Scoppa F., Pirino A., Mastrapasqua R., Visco M.A. Coronavirus Lockdown as a Major Life Stressor: Does It Affect TMD Symptoms? Int. J. Environ. Res. Public Health. 2020;17:8907. doi: 10.3390/ijerph17238907. [PMC free article] [PubMed] [CrossRef] [Google Scholar]


29. Medeiros R.A., Vieira D.L., Silva E., Rezende L., Santos R.W.D., Tabata L.F. Prevalence of symptoms of temporomandibular disorders, oral behaviors, anxiety, and depression in Dentistry students during the period of social isolation due to COVID-19. J. Appl. Oral Sci. 2020;28:e20200445. doi: 10.1590/1678-7757-2020-0445. [PMC free article] [PubMed] [CrossRef] [Google Scholar]


30. Fillingim R.B., Ohrbach R., Greenspan J.D., Knott C., Diatchenko L., Dubner R., Bair E., Baraian C., Mack N., Slade G.D., et al. Psychological factors associated with development of TMD: The OPPERA prospective cohort study. J. Pain Off. J. Am. Pain Soc. 2013;14:T75–T90. doi: 10.1016/j.jpain.2013.06.009. [PMC free article] [PubMed] [CrossRef] [Google Scholar]


31. Schiffman E., Ohrbach R., Truelove E., Look J., Anderson G., Goulet J.P., List T., Svensson P., Gonzalez Y., Lobbezoo F., et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: Recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Groupdagger. J. Oral Facial Pain Headache. 2014;28:6–27. doi: 10.11607/jop.1151. [PMC free article] [PubMed] [CrossRef] [Google Scholar]


32. Peck C.C., Goulet J.P., Lobbezoo F., Schiffman E.L., Alstergren P., Anderson G.C., de Leeuw R., Jensen R., Michelotti A., Ohrbach R., et al. Expanding the taxonomy of the diagnostic criteria for temporomandibular disorders. J. Oral Rehabil. 2014;41:2–23. doi: 10.1111/joor.12132. [PMC free article] [PubMed] [CrossRef] [Google Scholar]


33. Al-Saleh M.A., Alsufyani N.A., Saltaji H., Jaremko J.L., Major P.W. MRI and CBCT image registration of temporomandibular joint: A systematic review. J. Otolaryngol. Head Neck Surg. 2016;45:30. doi: 10.1186/s40463-016-0144-4. [PMC free article] [PubMed] [CrossRef] [Google Scholar]


34. Al-Saleh M.A., Jaremko J.L., Alsufyani N., Jibri Z., Lai H., Major P.W. Assessing the reliability of MRI-CBCT image registration to visualize temporomandibular joints. Dentomaxillofac. Radiol. 2015;44:20140244. doi: 10.1259/dmfr.20140244. [PMC free article] [PubMed] [CrossRef] [Google Scholar]


35. Ladeira D.B., da Cruz A.D., de Almeida S.M. Digital panoramic radiography for diagnosis of the temporomandibular joint: CBCT as the gold standard. Braz. Oral Res. 2015;29:S1806-83242015000100303. doi: 10.1590/1807-3107BOR-2015.vol29.0120. [PubMed] [CrossRef] [Google Scholar]


36. Larheim T.A., Abrahamsson A.K., Kristensen M., Arvidsson L.Z. Temporomandibular joint diagnostics using CBCT. Dentomaxillofac. Radiol. 2015;44:20140235. doi: 10.1259/dmfr.20140235. [PMC free article] [PubMed] [CrossRef] [Google Scholar]


37. Su N., van Wijk A.J., Visscher C.M., Lobbezoo F., van der Heijden G. Diagnostic value of ultrasonography for the detection of disc displacements in the temporomandibular joint: A systematic review and meta-analysis. Clin. Oral Investig. 2018;22:2599–2614. doi: 10.1007/s00784-018-2359-4. [PMC free article] [PubMed] [CrossRef] [Google Scholar]


38. Talmaceanu D., Lenghel L.M., Bolog N., Popa Stanila R., Buduru S., Leucuta D.C., Rotar H., Baciut M., Baciut G. High-resolution ultrasonography in assessing temporomandibular joint disc position. Med. Ultrason. 2018;1:64–70. doi: 10.11152/mu-1025. [PubMed] [CrossRef] [Google Scholar]


39. Choi B.H., Yoon S.H., Song S.I., Yoon J.K., Lee S.J., An Y.S. Comparison of Diagnostic Performance Between Visual and Quantitative Assessment of Bone Scintigraphy Results in Patients With Painful Temporomandibular Disorder. Medicine. 2016;95:e2485. doi: 10.1097/MD.0000000000002485. [PMC free article] [PubMed] [CrossRef] [Google Scholar]


40. Epstein J.B., Rea A., Chahal O. The use of bone scintigraphy in temporomandibular joint disorders. Oral Dis. 2002;8:47–53. doi: 10.1034/j.1601-0825.2002.10753.x. [PubMed] [CrossRef] [Google Scholar]


41. Kang J.H., An Y.S., Park S.H., Song S.I. Influences of age and sex on the validity of bone scintigraphy for the diagnosis of temporomandibular joint osteoarthritis. Int. J. Oral Maxillofac. Surg. 2018;47:1445–1452. doi: 10.1016/j.ijom.2018.05.011. [PubMed] [CrossRef] [Google Scholar]


42. Lee Y.H., Hong I.K., Chun Y.H. Prediction of painful temporomandibular joint osteoarthritis in juvenile patients using bone scintigraphy. Clin. Exp. Dent. Res. 2019;5:225–235. doi: 10.1002/cre2.175. [PMC free article] [PubMed] [CrossRef] [Google Scholar]


43. Park K.S., Song H.C., Cho S.G., Kang S.R., Kim J., Jun H.M., Song M., Jeong G.C., Park H.J., Kwon S.Y., et al. Open-Mouth Bone Scintigraphy Is Better than Closed-Mouth Bone Scintigraphy in the Diagnosis of Temporomandibular Osteoarthritis. Nucl. Med. Mol. Imaging. 2016;50:213–218. doi: 10.1007/s13139-016-0407-z. [PMC free article] [PubMed] [CrossRef] [Google Scholar]


44. Chan B.H., Leung Y.Y. SPECT bone scintigraphy for the assessment of condylar growth activity in mandibular asymmetry: Is it accurate? Int. J. Oral Maxillofac. Surg. 2018;47:470–479. doi: 10.1016/j.ijom.2017.09.008. [PubMed] [CrossRef] [Google Scholar]


45. Kumar A., Brennan M.T. Differential diagnosis of orofacial pain and temporomandibular disorder. Dent. Clin. N. Am. 2013;57:419–428. doi: 10.1016/j.cden.2013.04.003. [PubMed] [CrossRef] [Google Scholar]


46. Alpaslan G.H., Alpaslan C. Efficacy of temporomandibular joint arthrocentesis with and without injection of sodium hyaluronate in treatment of internal derangements. J. Oral Maxillofac. Surg. 2001;59:613–618. doi: 10.1053/joms.2001.23368. [PubMed] [CrossRef] [Google Scholar]


47. Nitzan D.W., Dolwick M.F., Heft M.W. Arthroscopic lavage and lysis of the temporomandibular joint: A change in perspective. J. Oral Maxillofac. Surg. 1990;48:798–801. doi: 10.1016/0278-2391(90)90335-Y. [PubMed] [CrossRef] [Google Scholar]


48. Zhang C., Wu J.Y., Deng D.L., He B.Y., Tao Y., Niu Y.M., Deng M.H. Efficacy of splint therapy for the management of temporomandibular disorders: A meta-analysis. Oncotarget. 2016;7:84043–84053. doi: 10.18632/oncotarget.13059. [PMC free article] [PubMed] [CrossRef] [Google Scholar]


49. Riley P., Glenny A.M., Worthington H.V., Jacobsen E., Robertson C., Durham J., Davies S., Petersen H., Boyers D. Oral splints for temporomandibular disorder or bruxism: A systematic review. Br. Dent. J. 2020;228:191–197. doi: 10.1038/s41415-020-1250-2. [PMC free article] [PubMed] [CrossRef] [Google Scholar]


50. Al-Moraissi E.A., Farea R., Qasem K.A., Al-Wadeai M.S., Al-Sabahi M.E., Al-Iryani G.M. Effectiveness of occlusal splint therapy in the management of temporomandibular disorders: Network meta-analysis of randomized controlled trials. Int. J. Oral Maxillofac. Surg. 2020;49:1042–1056. doi: 10.1016/j.ijom.2020.01.004. [PubMed] [CrossRef] [Google Scholar]


51. Alkhutari A.S., Alyahya A., Rodrigues Conti P.C., Christidis N., Al-Moraissi E.A. Is the therapeutic effect of occlusal stabilization appliances more than just placebo effect in the management of painful temporomandibular disorders? A network meta-analysis of randomized clinical trials. J. Prosthet. Dent. 2020 doi: 10.1016/j.prosdent.2020.08.015. [PubMed] [CrossRef] [Google Scholar]


52. Seifeldin S.A., Elhayes K.A. Soft versus hard occlusal splint therapy in the management of temporomandibular disorders (TMDs) Saudi Dent. J. 2015;27:208–214. doi: 10.1016/j.sdentj.2014.12.004. [PMC free article] [PubMed] [CrossRef] [Google Scholar]


53. Incorvati C., Romeo A., Fabrizi A., Defila L., Vanti C., Gatto M.R.A., Marchetti C., Pillastrini P. Effectiveness of physical therapy in addition to occlusal splint in myogenic temporomandibular disorders: Protocol of a randomised controlled trial. BMJ Open. 2020;10:e038438. doi: 10.1136/bmjopen-2020-038438. [PMC free article] [PubMed] [CrossRef] [Google Scholar]


54. van der Meer H.A., Calixtre L.B., Engelbert R.H.H., Visscher C.M., Nijhuis-van der Sanden M.W., Speksnijder C.M. Effects of physical therapy for temporomandibular disorders on headache pain intensity: A systematic review. Musculoskelet. Sci. Pract. 2020;50:102277. doi: 10.1016/j.msksp.2020.102277. [PubMed] [CrossRef] [Google Scholar]


55. Kutuk S.G., Ozkan Y., Kutuk M., Ozdas T. Comparison of the Efficacies of Dry Needling and Botox Methods in the Treatment of Myofascial Pain Syndrome Affecting the Temporomandibular Joint. J. Craniofacial Surg. 2019;30:1556–1559. doi: 10.1097/SCS.0000000000005473. [PubMed] [CrossRef] [Google Scholar]


56. Connelly S.T., Myung J., Gupta R., Tartaglia G.M., Gizdulich A., Yang J., Silva R. Clinical outcomes of Botox injections for chronic temporomandibular disorders: Do we understand how Botox works on muscle, pain, and the brain? Int. J. Oral Maxillofac. Surg. 2017;46:322–327. doi: 10.1016/j.ijom.2016.11.004. [PubMed] [CrossRef] [Google Scholar]


57. Kim Y.H., Bang J.I., Son H.J., Kim Y., Kim J.H., Bae H., Han S.J., Yoon H.J., Kim B.S. Protective effects of extracorporeal shockwave on rat chondrocytes and temporomandibular joint osteoarthritis; preclinical evaluation with in vivo(99m)Tc-HDP SPECT and ex vivo micro-CT. Osteoarthr. Cartil. 2019;27:1692–1701. doi: 10.1016/j.joca.2019.07.008. [PubMed] [CrossRef] [Google Scholar]


58. Schenk I., Vesper M., Nam V.C. Initial results using extracorporeal low energy shockwave therapy ESWT in muscle reflex-induced lock jaw. Mund Kiefer Gesichtschir. 2002;6:351–355. doi: 10.1007/s10006-002-0365-8. [PubMed] [CrossRef] [Google Scholar]


59. Dworkin S.F., Turner J.A., Mancl L., Wilson L., Massoth D., Huggins K.H., LeResche L., Truelove E. A randomized clinical trial of a tailored comprehensive care treatment program for temporomandibular disorders. J. Orofac. Pain. 2002;16:259–276. [PubMed] [Google Scholar]


60. Türp J.C., Jokstad A., Motschall E., Schindler H.J., Windecker-Gétaz I., Ettlin D.A. Is there a superiority of multimodal as opposed to simple therapy in patients with temporomandibular disorders? A qualitative systematic review of the literature. Clin. Oral Implant. Res. 2007;18(Suppl. 3):138–150. doi: 10.1111/j.1600-0501.2007.01480.x. [PubMed] [CrossRef] [Google Scholar]


61. Conti P.C., Correa A.S., Lauris J.R., Stuginski-Barbosa J. Management of painful temporomandibular joint clicking with different intraoral devices and counseling: A controlled study. J. Appl. Oral Sci. 2015;23:529–535. doi: 10.1590/1678-775720140438. [PMC free article] [PubMed] [CrossRef] [Google Scholar]


62. de Resende C., de Oliveira Medeiros F.G.L., de Figueiredo Rego C.R., Bispo A.S.L., Barbosa G.A.S., de Almeida E.O. Short-term effectiveness of conservative therapies in pain, quality of life, and sleep in patients with temporomandibular disorders: A randomized clinical trial. Cranio. 2019:1–9. doi: 10.1080/08869634.2019.1627068. [PubMed] [CrossRef] [Google Scholar]


63. de Barros Pascoal A.L., de Freitas R., da Silva L.F.G., Oliveira A., Dos Santos Calderon P. Effectiveness of Counseling on Chronic Pain Management in Patients with Temporomandibular Disorders. J. Oral Facial Pain Headache. 2020;34:77–82. doi: 10.11607/ofph.2163. [PubMed] [CrossRef] [Google Scholar]


64. Delgado-Delgado R., Iriarte-Álvarez N., Valera-Calero J.A., Centenera-Centenera M.B., Garnacho-Garnacho V.E., Gallego-Sendarrubias G.M. Association between temporomandibular disorders with clinical and sociodemographic features: An observational study. Int. J. Clin. Pract. 2021:e13961. doi: 10.1111/ijcp.13961. [PubMed] [CrossRef] [Google Scholar]


65. Al-Ani Z. Occlusion and Temporomandibular Disorders: A Long-Standing Controversy in Dentistry. Prim. Dent. J. 2020;9:43–48. doi: 10.1177/2050168420911029. [PubMed] [CrossRef] [Google Scholar]


66. Manfredini D., Lombardo L., Siciliani G. Temporomandibular disorders and dental occlusion. A systematic review of association studies: End of an era? J. Oral Rehabil. 2017;44:908–923. doi: 10.1111/joor.12531. [PubMed] [CrossRef] [Google Scholar]


67. Kakudate N., Yokoyama Y., Sumida F., Matsumoto Y., Gordan V.V., Gilbert G.H., Velly A.M., Schiffman E.L. Dentist Practice Patterns and Therapeutic Confidence in the Treatment of Pain Related to Temporomandibular Disorders in a Dental Practice-Based Research Network. J. Oral Facial Pain Headache. 2017;31:152–158. doi: 10.11607/ofph.1730. [PMC free article] [PubMed] [CrossRef] [Google Scholar]


68. Onishi M. Arthroscopy of the temporomandibular joint (author’s transl) Kokubyo Gakkai Zasshi. 1975;42:207–213. doi: 10.5357/koubyou.42.207. [PubMed] [CrossRef] [Google Scholar]


69. Murakami K., Ono T. Temporomandibular joint arthroscopy by inferolateral approach. Int. J. Oral Maxillofac. Surg. 1986;15:410–417. doi: 10.1016/S0300-9785(86)80029-1. [PubMed] [CrossRef] [Google Scholar]


70. Sanders B. Arthroscopic surgery of the temporomandibular joint: Treatment of internal derangement with persistent closed lock. Oral Surg. Oral Med. Oral Pathol. 1986;62:361–372. doi: 10.1016/0030-4220(86)90282-3. [PubMed] [CrossRef] [Google Scholar]


71. Sanders B., Buoncristiani R. Diagnostic and surgical arthroscopy of the temporomandibular joint: Clinical experience with 137 procedures over a 2-year period. J. Craniomandib. Disord.: Facial Oral Pain. 1987;1:202–213. [PubMed] [Google Scholar]


72. McCain J.P. Arthroscopy of the human temporomandibular joint. J. Oral Maxillofac. Surg. 1988;46:648–655. doi: 10.1016/0278-2391(88)90107-3. [PubMed] [CrossRef] [Google Scholar]


73. McCain J.P., Sanders B., Koslin M.G., Quinn J.H., Peters P.B., Indresano A.T. Temporomandibular joint arthroscopy: A 6-year multicenter retrospective study of 4,831 joints. J. Oral Maxillofac. Surg. 1992;50:926–930. doi: 10.1016/0278-2391(92)90047-4. [PubMed] [CrossRef] [Google Scholar]


74. Reston J.T., Turkelson C.M. Meta-analysis of surgical treatments for temporomandibular articular disorders. J. Oral Maxillofac. Surg. 2003;61:3–10. doi: 10.1053/joms.2003.50000. [PubMed] [CrossRef] [Google Scholar]


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