Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20200045
Brazilian Journal of Pain
Original Article

Relationship between symptoms and imagenological signs of degenerative temporomandibular joint disorders using the Research Diagnostic Criteria for Temporomandibular Disorders and cone-beam computed tomography

Relação entre sintomas e sinais imagenológicos das disfunções degenerativas da articulação temporomandibular com o Research Diagnostic Criteria for Temporomandibular Disorders e a tomografia computadorizada de feixe cônico

Bruno Moreira da-Silva; Rafael de Almeida Spinelli Pinto; Letícia Ladeira Bonato; Arnaud Alves Bezerra-Júnior; Eduardo Grossmann; Luciano Ambrósio Ferreira

http://dx.doi.org/10.5935/2595-0118.20200045 BrJP, vol.3, n3, p.222-227, 2020
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Abstract

BAKGROUND AND OBJECTIVES: Arthralgia is a common complaint among patients with temporomandibular osteodegeneration, however, for the accurate diagnosis of osteodegeneration, it is suggested the adoption of imaging tests associated with standardized clinical diagnosis protocols. The objective of this study was to evaluate patients with degenerative changes in the temporomandibular joint previously visualized by cone beam computed tomography, relating these changes with the clinical diagnoses and symptoms of temporomandibular disorders, in order to conclude which of the degenerative changes develop more painful symptomatology.

METHODS: A cross-sectional observational descriptive study. Thirty-eight patients who had previously done the cone beam computed tomography exam were evaluated. Subjects were grouped according to clinical diagnosis of temporomandibular joint changes using the Research Diagnostic Criteria for Temporomandibular Disorders questionnaire. The presence of pain was considered during lateral palpation; intra-articular palpation; excursive movements; and active mouth opening.

RESULTS: Among the purely clinical diagnoses, only 10.5% were conclusive, classifying patients as suffering from osteoarthritis/osteoarthrosis. Painful joint symptoms were found in all groups, with no statistically significant difference. Similarly, the presence of degenerative disorders, including flattening, osteophytes, sclerosis, and erosion were found in similar proportions in all diagnosis groups.

CONCLUSION: 89.5% of the degenerative changes were clinically underdiagnosed. There was a positive association between the presence of symptoms and the number of correct clinical diagnoses of osteoarthritis/osteoarthrosis obtained with the Research Diagnostic Criteria for Temporomandibular Disorders.

Keywords

Arthralgia, Cone-beam computed tomography, Osteoarthritis, Temporomandibular joint disorders

Resumo

JUSTIFICATIVA E OBJETIVOS: Entre os pacientes com osteodegeneração cortical temporomandibular, a artralgia é uma queixa comum, entretanto, para o diagnóstico preciso de osteodegeneração sugere-se a adoção de exames de imagem associados a protocolos de diagnóstico clínico padronizados. O objetivo deste estudo foi avaliar pacientes com alterações degenerativas da articulação temporomandibular previamente visualizados por tomografia computadorizada de feixe cônico, relacionando essas alterações com os diagnósticos e sintomas clínicos da disfunção temporomandibular, a fim de concluir quais das alterações degenerativas se associam ao sintoma álgico.

MÉTODOS: Trata-se de um estudo observacional descritivo transversal. Foram avaliados 38 pacientes que já haviam realizado realizado a tomografia computadorizada de feixe cônico. Os indivíduos foram agrupados de acordo com o diagnóstico clínico de alterações na articulação temporomandibular, utilizando o questionário Research Diagnostic Criteria for Temporomandibular Disorders. A presença de dor foi considerada durante: palpação lateral; palpação intra-articular; movimentos excursivos; e abertura ativa da boca.

RESULTADOS: Entre os diagnósticos puramente clínicos, apenas 10,5% foram conclusivos, classificando os pacientes como portadores de osteoartrite/osteoartrose. Sintomas articulares dolorosos foram encontrados em todos os grupos, sem diferença estatisticamente significante. Da mesma forma, a presença de distúrbios degenerativos, incluindo achatamento, osteófitos, esclerose e erosão, foi encontrada em proporções semelhantes em todos os grupos de diagnóstico.

CONCLUSÃO: 89,5% das alterações degenerativas foram clinicamente subdiagnosticadas. Houve associação positiva entre a presença de sintomas e o número de diagnósticos clínicos corretos de osteoartrite/osteoartrose obtidos com o Research Diagnostic Criteria for Temporomandibular Disorders.

Palavras-chave

Artralgia, Osteoartrite, Tomografia computadorizada de feixe cônico, Transtornos da articulação temporomandibular.

References

Yadav S, Palo L, Mahdian M, Upadhyay M, Tadinada A. Diagnostic accuracy of 2 cone-beam computed tomography protocols for detecting arthritic changes in temporomandibular joints. Am J Orthod Dentofacial Orthop. 2015;147(3):339-44.

de Souza RF, Lovato da Silva CH, Nasser M, Fedorowicz Z, Al-Muharraqi MA. Interventions for the management of temporomandibular joint osteoarthritis. Cochrane Database Syst Rev. 2012;18(4):CD007261.

Finnson KW, Chi Y, Bou-Gharios G, Leask A, Philip A. TGF-?signaling in cartilage homeostasis and osteoarthritis. Front Biosci. 2012;4:251-68.

Kalladka M, Quek S, Heir G, Eliav E, Mupparapu M, Viswanath A. Temporomandibular joint osteoarthritis: diagnosis and long-term conservative management: a topic review. J Indian Prosthodont Soc. 2014;14(1):6-15.

Man C, Zhu S, Zhang B, Hu J. Protection of articular cartilage from degeneration by injection of transforming growth factor-beta in temporomandibular joint osteoarthritis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(3):335-40.

Tanaka E, Detamore MS, Mercuri LG. Degenerative disorders of the temporomandibular joint: etiology, diagnosis, and treatment. J Dent Res. 2008;87(4):296-307.

Ok SM, Lee J, Kim YI, Lee JY, Kim KB, Jeong SH. Anterior condylar remodeling observed in stabilization splint therapy for temporomandibular joint osteoarthritis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;118(3):363-70.

Xiao JL, Meng JH, Gan YH, Zhou CY, Ma XC. Association of GDF5, SMAD3 and RUNX2 polymorphisms with temporomandibular joint osteoarthritis in female Han Chinese. J Oral Rehabil. 2015;42(7):529-36.

Vos LM, Kuijer R, Huddleston Slater JJ, Stegenga B. Alteration of cartilage degeneration and inflammation markers in temporomandibular joint osteoarthritis occurs proportionally. J Oral Maxillofac Surg. 2013;71(10):1659-64.

Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomand Disord. 1992;6(4):301-55.

Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP. 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 Group. J Oral Facial Pain Headache. 2014;28(1):6-27.

Lascala CA, Panella J, Marques MM. Analysis of the accuracy of linear measurement obtained by cone beam computed tomography (CBCT-NewTom). Dentomaxillofac Radiol. 2004;33(5):291-4.

Martinez-Blanco M, Bagán JV, Fons A, Poveda Roda R. Osteoarthrosis of the temporomandibular joint: A clinical and radiological study of 16 patients. Med Oral. 2004;9(2):110-5.

Milam SB. Pathophysiology and epidemiology of TMJ. J Musculoskelet Neuronal Interact. 2003;3(4):382-90.

Ahmad M, Hollender L, Anderson Q, Kartha K, Ohrbach R, Truelove EL. Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107(6):844-60.

Pereira Júnior FJ, Favilla EE, Dworkin S, Kimberly H. Critérios de diagnóstico para pesquisa das disfunções temporomandibulares (RDC/TMD): Tradução oficial para a língua portuguesa. J Bras Clin Odontol Integr. 2004;8(47):384-95.

Alexiou K, Stamatakis H, Tsiklakis K. Evaluation of the severity of temporomandibular joint osteoarthritic changes related to age using cone beam computed tomography. Dentomaxillofac Radiol. 2014;38(3):141-7.

Wiese M, Wenzel A, Hintze H, Petersson A, Knutsson K, Bakke M. Osseous changes and condyle position in TMJ tomograms: impact of RDC/TMD clinical diagnoses on agreement between expected and actual findings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106(1):52-63.

Grossmann E, Remedi MP, Ferreira LA, Carvalho AC. Magnetic resonance image evaluation of temporomandibular joint osteophytes: influence of clinical factors and artrogenics changes. J Craniofac Surg. 2016;27(2):334-8.

Wiese M, Svensson P, Bakke M, List T, Hintze H, Petersson A. Association between temporomandibular joint symptoms, signs, and clinical diagnosis using the RDC/TMD and radiographic findings in temporomandibular joint tomograms. J Orofac Pain. 2008;22(3):239-51.

Su N, Liu Y, Yang X, Luo Z, Shi Z. Correlation between bony changes measured with cone beam computed tomography and clinical dysfunction index in patients with temporomandibular joint osteoarthritis. J Craniomaxillofac Surg. 2014;42(7):1402-7.

Dagar SR, Turakiya V, Pakhan AJ, Jaggi N, Kalra A, Vaidya V. Modified stethoscope for auscultation of temporomandibular joint sounds. J Int Oral Health. 2014;6(2):40-4.

Hussain AM, Packota G, Major PW, Flores-Mir C. Role of different imaging modalities in assessment of temporomandibular joint erosions and osteophytes: a systematic review. Dentomaxillofac Radiol. 2008;37(1):63-71.

Ferreira LA, Grossmann E, Januzzi E, de Paula MVQ, Carvalho ACP. Diagnosis of temporomandibular joint disorders: indication of imaging exams. Braz J Otorhinolaryngol. 2016;82(3):341-52.

Hilgenberg-Sydney PB, Bonotto DV, Stechman-Neto J, Zwir LF, Pachêco-Pereira C, Canto GL. Diagnostic validity of CT to assess degenerative temporomandibular joint disease: a systematic review. Dentomaxillofacial Radiol. 2018;47(5):20170389.

Bakke M, Petersson A, Wiesel M, Svanholt P, Sonnesen L. Bony deviations revealed by cone beam computed tomography of the temporomandibular joint in subjects without ongoing pain. J Oral Facial Pain Headache. 2014;28(4):331-7.

Pantoja LLQ, de Toledo IP, Pupo YM, Porporatti AL, De Luca Canto G, Zwir LF. Prevalence of degenerative joint disease of the temporomandibular joint: a systematic review. Clin Oral Investig. 2019;23(5):2475-88.

Submitted date:
12/20/2019

Accepted date:
03/17/2020

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