The effects of practice and visual feedback on mandibular border movements

Twenty healthy subjects were studied on the effects of training on mandibular border movements. Maximum left (LL) and right (RL) lateral excursions, maximum protrusive movement (PT), maximum mouth opening (MO), the difference between left and right excursions (R-L), midline deflection (DF) during opening and closing and midline deviation of the jaw (MOD) at maximum opening position of mandibular border tracing with or without practicing and visual feedback were compared among various sessions. No significant difference has been found on the amount of border extension under the influence of training. However, 70 to 85% of the subjects had some improvement after verbal instruction practicing, while only 50 to 65% of the same subjects showed improvement through visual feedback. It is suggested that doing research related to the jaw border movement on healthy subjects does not have to train them to obtain comparable data. On the other hand, since repeated border tracing in healthy subjects did not worsen the results, practicing or visual feedback training might ascertain a repeatable border tracing.     

Incidence of temporomandibular disorders at tooth loss in the supporting zones

Although the literature reports that occlusal disorders can be associated with temporomandibular disorders (TMD), their direct scientific correlation is still mainly unproved. The aim of this study was to establish the incidence of symptoms and signs of TMD and tissue-specific diagnoses in a population of subjects with tooth loss in the supporting zones. The study was conducted on 196 partially edentulous subjects (Eichner's class II and III) at the average age of 51.2. Manual functional analysis was used as a diagnostic procedure. Chi-square test for independent samples was used for establishing the significance of the differences between the variables. In the total sample, 16.3% of the subjects had symptoms and signs of temporomandibular disorders (TMD), while in 46.9% of the subjects a tissue-specific diagnosis of TMD was found. The most frequent tissue-specific diagnoses were osteoarthrosis and total or partial anterolateral disc displacement. A statistically significant difference between Eichner's class II and III was found for the tissue-specific diagnoses of myofascitis of the lateral pterygoid muscle, partial anterolateral disc displacement and capsulitis. The results of this study suggest that the incidence and intensity of TMD are higher in subjects with greater tooth loss in the supporting zones, regardless of their sex.     

Influence of depression and somatization on acute and chronic orofacial pain in patients with single or multiple TMD diagnoses

To examine whether psychological variables such as depression and non-specific physical symptoms (somatization) influence pain entity among acute and chronic TMD patients with one or more TMD diagnoses (muscle disorders, MD; disc displacements, DD; and arthralgia, arthritis, arthrosis, AAA). One hundred and fifty-four patients (37 male and 117 female; mean age, 39.0 +/- 14.5 years) with Research Diagnostic Criteria for Temporomandibular Disorders (RDC/ TMD) protocol were selected. Differences in mean depression and somatization scores between acute and chronic TMD patients, as well as TMD patients with one or multiple TMD diagnoses were compared by using the parametric T-test for independent samples. The majority of patients were acute TMD patients (81.8%), while the remaining 28 patients (18.2%) were chronic TMD patients. 62% of patients had only one TMD diagnosis (MD or DD or AAA), 31% of patients had two diagnoses (MD+DD, MD+AAA, DD+AAA) and, finally, 7% of patients had three diagnoses (MD+DD+AAA) according to the RDC/TMD protocol. According to the SCL-90 psychometric evaluation, 19.5% of patients presented a severe depression score (> 1.105), 27.3% of participants presented a severe somatization score with pain items included (> 1.000). The results of the t-test for independent samples showed statistically significant differences between acute and chronic TMD patients (p < 0.001), as well as between patients who were assigned one diagnosis (p = 0.019) and patients who had two or more diagnoses (p < 0.001); for mean levels of depression and somatization scores. Chronic TMD patients and patients with multiple TMD diagnoses had higher rates of depression and somatization in this study. These results could be used in a tailored strategy of TMD treatment.     

Mandibular kinematics and masticatory muscles EMG in patients with short lasting TMD of mild-moderate severity

Mandibular kinematic and standardized surface electromyography (sEMG) characteristics of masticatory muscles of subjects with short lasting TMD of mild-moderate severity were examined.Volunteers were submitted to clinical examination and questionnaire of severity. Ten subjects with TMD (age 27.3 years, SD 7.8) and 10 control subjects without TMD, matched by age, were selected.Mandibular movements were recorded during free maximum mouth opening and closing (O–C) and unilateral, left and right, gum chewing. sEMG of the masseter and temporal muscles was performed during maximum teeth clenching either on cotton rolls or in intercuspal position, and during gum chewing. sEMG indices were obtained. Subjects with TMD, relative to control subjects, had lower relative mandibular rotation at the end of mouth opening, larger mean number of intersection between interincisal O–C paths during mastication and smaller asymmetry between working and balancing side, with participation beyond the expected of the contralateral muscles (P < 0.05, t-test). Overall, TMD subjects showed similarities with the control subjects in several kinematic parameters and the EMG indices of the static test, although some changes in the mastication were observed.     

Influence of occlusal stabilization splint on the asymmetric activity of masticatory muscles in patients with temporomandibular dysfunction

The aim of present study was to evaluate the symmetry of masticatory muscles' activity at various clenching levels in the intercuspal position in patients with functional disorders and in healthy subjects. The purpose was also to determine the effect of full-arch maxillary stabilization splint on the asymmetry of masticatory muscle activity in patients with temporomandibular dysfunction. In this study 6 TMD patients and 12 healthy subjects were investigated. Surface EMG recordings were obtained from left and right anterior temporal, left and right masseter and from the sub-mandibular group in the region of the anterior belly of the digastric muscle on the left and right side during clenching with the maximum 100% voluntary contraction (MVC) as well as during clenching at 50% and 25% of the maximum activity in the position of maximal intercuspation of teeth. In order to quantify asymmetrical masticatory muscle activity, the asymmetry index (AI) was calculated for each subject and for each muscle from the average anterior temporal, masseter and digastric potentials recorded during each test (100% MVC, 50% MVC and 25% MVC). In the group of patients EMG recordings were repeated during and after the splint therapy. The asymmetries of masticatory muscle activity was present in both groups, but in the group of TMD patients the asymmetry indices for anterior temporal muscle at 100% MVC (p = 0.049) and 50% MVC (p = 0.031) were significantly higher. Results have shown that the use of splint suppressed the asymmetry of all muscles, as during the splint therapy the asymmetry indices were lowered. After the therapy, the level of temporal muscle symmetry during submaximal clenching in the intercuspal position increased significantly (p = 0.046). This investigation points out that electromyography may be a valuable method of documenting that asymmetric activity of masticatory muscles improves after occlusal splint therapy in patients with TMD.     

Superficial,suprahyoid, and infrahyoid neck musculature in naked mole-rats (Heterocephalus glaber): Relative size and potential contributions to independent movement of the lower incisors

Naked mole-rats (Heterocephalus glaber) are fossorial, eusocial rodents that exhibit the unusual capability of moving their lower incisors independently in lateral and rostroventral directions. The evolution of this trait would presumably also involve concurrent alterations in neck musculature to support and control movements of the lower incisors. In order to assess morphological adaptations that might facilitate these movements, we performed detailed dissections of the neck musculature of adult naked mole-rats. In addition to characterizing attachment sites of superficial, suprahyoid, and infrahyoid musculature, we also quantified muscle mass and mandibular features thought to be associated with gape (condyle height, condyle length, and jaw length). Based on muscle attachment sites, the platysma myoides may contribute to lateral movement of the lower incisor and hemi-mandible in naked mole-rats. The large digastric muscle is likely to be a main contributor to rostroventral movement of each lower incisor. The geniohyoid and mylohyoid muscles also likely contribute to rostroventral movements of the lower incisors, and the mylohyoid may also produce lateral spreading of the hemi-mandibles. The transverse mandibular (intermandibularis) muscle likely serves to reposition the lower incisors back to a midline orientation following a movement.     

Computation of trunk equilibrium and stability in free flexion-extension movements at different velocities

Velocity of movement has been suggested as a risk factor for low-back disorders. The effect of changes in velocity during unconstrained flexion-extension movements on muscle activations, spinal loads, base reaction forces and system stability was computed. In vivo measurements of kinematics and ground reaction forces were initially carried out on young asymptomatic subjects. The collected kinematics of three subjects representing maximum, mean and minimum lumbar rotations were subsequently used in the kinematics-driven model to compute results during the entire movements at three different velocities. Estimated spinal loads and muscle forces were significantly larger in fastest pace as compared to slower ones indicating the effect of inertial forces. Spinal stability was improved in larger trunk flexion angles and fastest movement. Partial or full flexion relaxation of global extensor muscles occurred only in slower movements. Some local lumbar muscles, especially in subjects with larger lumbar flexion and at slower paces, also demonstrated flexion relaxation. Results confirmed the crucial role of movement velocity on spinal biomechanics. Predictions also demonstrated the important role on response of the magnitude of peak lumbar rotation and its temporal variation.     

Proteomic signature of Temporomandibular Joint Disorders (TMD): Toward diagnostically predictive biomarkers

The temporomandibular joint (TMJ) articulates the mandible with the maxilla. Temporomandibular joint disorders (TMD) are dysfunctions of this joint, which range from acute to chronic inflammation, trauma and dislocations, developmental anomalies and neoplasia. TMD manifest as signs and symptoms that involve the surrounding muscles, ligaments, bones, synovial capsule, connective tissue, teeth and innervations proximal and distal to this joint. TMD induce proximal and distal, chronic and acute, dull or intense pain and discomfort, muscle spasm, clicking/popping sounds upon opening and closing of the mouth, and chewing or speaking difficulties. The trigeminal cranial nerve V, and its branches provide the primary sensory innervation to the TMJ. Our clinical work suggests that the auriculotemporal (AT) nerve, a branch of the mandibular nerve, the largest of the three divisions of the trigeminal nerve, plays a critical role in TMD sequelae. The AT nerve provides the somatosensory fibers that supply the joint, the middle ear, and the temporal region. By projecting fibers toward the otic ganglion, the AT nerve establishes an important bridge to the sympathetic system. As it courses posteriorly to the condylar head of the TMJ, compression, injury or irritation of the AT nerve can lead to significant neurologic and neuro-muscular disorders, including Tourette's syndrome,Torticolli, gait or balance disorders and Parkinson's disease. Here, we propose that a proteomic signature of TMD can be obtained by assessing certain biomarkers in local (e.g., synovial fluid at the joint) and distal body fluids (e.g., saliva, cerebrospinal fluid), which can aid TMD diagnosis and prognosis.     

Anatomy of emotion: a 3D study of facial mimicry

Alterations in facial motion severely impair the quality of life and social interaction of patients, and an objective grading of facial function is necessary. A method for the non-invasive detection of 3D facial movements was developed. Sequences of six standardized facial movements (maximum smile; free smile; surprise with closed mouth; surprise with open mouth; right side eye closure; left side eye closure) were recorded in 20 healthy young adults (10 men, 10 women) using an optoelectronic motion analyzer. For each subject, 21 cutaneous landmarks were identified by 2-mm reflective markers, and their 3D movements during each facial animation were computed. Three repetitions of each expression were recorded (within-session error), and four separate sessions were used (between-session error). To assess the within-session error, the technical error of the measurement (random error, TEM) was computed separately for each sex, movement and landmark. To assess the between-session repeatability, the standard deviation among the mean displacements of each landmark (four independent sessions) was computed for each movement. TEM for the single landmarks ranged between 0.3 and 9.42 mm (intrasession error). The sex- and movement-related differences were statistically significant (two-way analysis of variance, p=0.003 for sex comparison, p=0.009 for the six movements, p<0.001 for the sex x movement interaction). Among four different (independent) sessions, the left eye closure had the worst repeatability, the right eye closure had the best one; the differences among various movements were statistically significant (one-way analysis of variance, p=0.041). In conclusion, the current protocol demonstrated a sufficient repeatability for a future clinical application. Great care should be taken to assure a consistent marker positioning in all the subjects.     

Electromyographic indices, orofacial myofunctional status and temporomandibular disorders severity: A correlation study

This study examined whether there is an association between surface electromyography (EMG) of masticatory muscles, orofacial myofunction status and temporomandibular disorder (TMD) severity scores. Forty-two women with TMD (mean 30 years, SD 8) and 18 healthy women (mean 26 years, SD 6) were examined. According to the Research Diagnostic Criteria for TMD (RDC/TMD), all patients had myogenous disorders plus disk displacements with reduction. Surface EMG of masseter and temporal muscles was performed during maximum teeth clenching either on cotton rolls or in intercuspal position. Standardized EMG indices were obtained. Validated protocols were used to determine the perception severity of TMD and to assess orofacial myofunctional status. TMD patients showed more asymmetry between right and left muscle pairs, and more unbalanced contractile activities of contralateral masseter and temporal muscles (p<0.05, t-test), worse orofacial myofunction status and higher TMD severity scores (p<0.05, Mann-Whitney test) than healthy subjects. Spearman coefficient revealed significant correlations between EMG indices, orofacial myofunctional status and TMD severity (p<0.05). In conclusion, these methods will provide useful information for TMD diagnosis and future therapeutic planning.     

Numerical simulation (FEM) of the human mandible: validation of the function of the masticatory muscles]

The article describes part of a research project aiming to develop a new modular software tool for the individual dynamic numerical simulation of the human mandible using the finite element method (FEM). Its planned use in the clinical setting makes it very important to validate the results of the simulations. Here, the function of the masticatory muscles is to be tested. On the basis of biomechanical data from the literature, standard movements, such as closing the mouth, forward movement, lateral movement or backward movement, were dynamically simulated. Apart from muscle activity, the movements of the mandible are defined by the temporomandibular joint. At present, translating the condylar dynamics to the simulation still poses problems. For this reason, therefore, simulations of the two extreme cases "fixed" and "force-free" condyles are compared. While in the case of fixed condyles, some of the movements could be reproduced either not at all or only weakly, in the case of force-free condyles, all standard movements were reproduced qualitatively, albeit without the guiding effect of the joint capsule or the articular disc.     

Sensory Attenuation Assessed by Sensory Evoked Potentials in Functional Movement Disorders

Background

Functional (psychogenic) movement disorders (FMD) have features associated with voluntary movement (e.g. distractibility) but patients report movements to be out of their control. One explanation for this phenomenon is that sense of agency for movement is impaired. The phenomenon of reduction in the intensity of sensory experience when movement is self-generated and a reduction in sensory evoked potentials (SEPs) amplitude at the onset of self-paced movement (sensory attenuation) have been linked to sense of agency for movement.

Methods

We compared amplitude of SEPs from median nerve stimulation at rest and at the onset of a self-paced movement of the thumb in 17 patients with FMD and 17 healthy controls.

Results

Patients showed lack of attenuation of SEPs at the onset of movement compared to reduction in amplitude of SEPs in controls. FMD patients had significantly different ratios of movement onset to rest SEPs than did healthy controls at each electrode: 0.79 in healthy controls and 1.35 in patients at F3 (t = -4.22, p<0.001), 0.78 in healthy controls and 1.12 at patients C3 (t = -3.15, p = 0.004) and 0.77 in healthy controls and 1.05 at patients P3 (t = -2.88, p = 0.007).

Conclusions

Patients with FMD have reduced sensory attenuation as measured by SEPs at onset of self-paced movement. This finding can be plausibly linked to impairment of sense of agency for movement in these patients.     

Relationship between symptoms of temporomandibular disorders and dental status, general health and psychosomatic factors in two cohorts of 70-year-old subjects

Objective: To study the prevalence of symptoms of temporomandibular disorders (TMD) in two cohorts of 70‐year‐old subjects examined 8 years apart and analyse the relationship between such symptoms and dental status, general health and various background factors. Materials and methods: Two cohorts of 70‐year‐old subjects, born in 1922 (n = 422) and 1930 (n = 491) respectively, were examined with an interval of 8 years. A TMD symptom index (0–5) was established on answers to five questions related to TMD symptoms. Results: There were no statistically significant differences between the two cohorts for prevalence of TMD symptoms and TMD index, neither for headache, neck ache, bruxism and chewing ability. TMJ sounds was the most prevalent symptom, 14%, whereas other TMD symptoms had low prevalence. The distribution of the TMD symptom index showed that 81% reported no symptoms, 15% one symptom, 3% two symptoms and 1% three to five symptoms. Single TMD symptoms and the TMD index exhibited significant associations (p < 0.001) with bruxism, headache, neck pain and several general health and psychosomatic factors, but with dental status only in women. Logistic regression showed that bruxism, neck pain, mouth dryness and a number of psychosomatic factors were associated with the TMD index. Conclusions: Besides TMJ sounds (14%), other TMD symptoms were rarely reported by the 70‐year‐old subjects. The TMD index was significantly associated with bruxism and several general health and psychosomatic complaints but with dental status only in women.     

Inter- and intra-rater reliability of 3D kinematics during maximum mouth opening of asymptomatic subjects

Previous studies evaluated 3D human jaw movements using kinematic analysis systems during mouth opening, but information on the reliability of such measurements is still scarce. The purpose of this study was to analyze within- and between-session reliabilities, inter-rater reliability, standard error of measurement (SEM), minimum detectable change (MDC) and consistency of agreement across raters and sessions of 3D kinematic variables during maximum mouth opening (MMO). Thirty-six asymptomatic subjects from both genders were evaluated on two different days, five to seven days apart. Subjects performed three MMO movements while kinematic data were collected. Intraclass correlation coefficient (ICC), SEM and MDC were calculated for all variables, and Bland-Altman plots were constructed. Jaw radius and width were the most reproducible variables (ICC > 0.81) and demonstrated minor error. Incisor displacement during MMO and angular movements in the sagittal plane presented good reliability (ICC from 0.61 to 0.8) and small errors and, consequently, could be used in future studies with the same methodology and population. The variables with smaller amplitudes (condylar translations during mouth opening and closing and mandibular movements on the frontal and transversal planes) were less reliable (ICC < 0.61) and presented larger SEM and MDC. Although ICC, SEM and MDC showed less between-session reproducibility than within-session and inter-rater, the limits of agreement were larger in inter-rater comparisons. In future studies care must be taken with variables collected on different days and with mandibular movements in the frontal and transversal planes.     

Proteomic signature of Temporomandibular Joint Disorders (TMD): Toward diagnostically predictive biomarkers

The temporomandibular joint (TMJ) articulates the mandible with the maxilla. Temporomandibular joint disorders (TMD) are dysfunctions of this joint, which range from acute to chronic inflammation, trauma and dislocations, developmental anomalies and neoplasia. TMD manifest as signs and symptoms that involve the surrounding muscles, ligaments, bones, synovial capsule, connective tissue, teeth and innervations proximal and distal to this joint. TMD induce proximal and distal, chronic and acute, dull or intense pain and discomfort, muscle spasm, clicking/popping sounds upon opening and closing of the mouth, and chewing or speaking difficulties. The trigeminal cranial nerve V, and its branches provide the primary sensory innervation to the TMJ. Our clinical work suggests that the auriculotemporal (AT) nerve, a branch of the mandibular nerve, the largest of the three divisions of the trigeminal nerve, plays a critical role in TMD sequelae. The AT nerve provides the somatosensory fibers that supply the joint, the middle ear, and the temporal region. By projecting fibers toward the otic ganglion, the AT nerve establishes an important bridge to the sympathetic system. As it courses posteriorly to the condylar head of the TMJ, compression, injury or irritation of the AT nerve can lead to significant neurologic and neuro-muscular disorders, including Tourette''s syndrome,Torticolli, gait or balance disorders and Parkinson’s disease. Here, we propose that a proteomic signature of TMD can be obtained by assessing certain biomarkers in local (e.g., synovial fluid at the joint) and distal body fluids (e.g., saliva, cerebrospinal fluid), which can aid TMD diagnosis and prognosis.     

Mutual influences of upper and lower extrimities during cyclic movements

The possibility of muscle activation of passive arm during its cyclic movements, imposed by active movements of contralateral arm or by experimenter was studied, as well as the influence of lower extremities cyclic movements onto arm muscles activity. In addition to that the activity of legs muscles was estimated in dependence on motor task condition for arms. Ten healthy supine subjects carried out opposite movements of arms with and without stepping-like movements of both legs. The experiment included three conditions for arm movements: 1) the active movements of both arms; 2) the active movements of one arm, when other entirely passive arm participated in the movement by force; 3) passive arm movement caused by experimenter. In the condition 2) additional load on active arm was applied (30 N and 60 N). In all three conditions the experiment was carried out with arms movements only or together with legs movements. The capability of passive moving arm muscles activation depended on increasing afferent inflow from muscles of contralateral arm was demonstrated. Emerging electrical activity was modulated in the arms movements cycle and depended on the degree of active arm loading. During combined active movements of arms and legs the reduction of activity in the flexor muscles of shoulder and forearm was observed. Concomitant arms movements increased the magnitude ofelectromiographic bursts during passive stepping-like movements in the most of recorded muscles, and the same increasing was only observed in biceps femoris and tibialis anterior muscles during active legs movement. The increasing of loading of one arm caused essential augmentation of EMG-activity in the majority of recording legs muscles. The data obtained are the additional proof of existence of functionally significant neuronal interaction both between arms and between upper and lower extremities, which is evidently depend on the intraspinal neuronal connections.     

Eustachian tube cartilage and medial movement of lateral pharyngeal wall on phonation

Several authors have demonstrated the importance of medial movement of the lateral pharyngeal wall in velopharyngeal closure upon phonation. However, it remains controversial what muscle is responsible for lateral pharyngeal wall movement and where is the main site of this movement. The purpose of this study was to address the above two unanswered questions. In 22 subjects (12 normal volunteers, 10 patients with cleft palate), lateral pharyngeal wall movement upon phonation was evaluated by using rapid magnetic resonance imaging (MRI). Before rapid MRI, their lateral pharyngeal wall movements were classified into three groups: the poor, moderate, and good, according to the findings of nasopharyngoscopy. Inward displacement of the eustachian tube cartilages upon phonation, which was quantified as distance ratio in the transverse plane of MR images, was compared with nasopharyngoscopic findings. In addition, the level of lateral pharyngeal wall movement was observed in the plane 5 mm lateral to the mid-sagittal plane of MR images. Inward displacement of the eustachian tube cartilage in the transverse plane of MR images was coincident with medial movement of lateral pharyngeal wall observed by nasopharyngoscopy in all 22 subjects. By using one-way analysis of variance, a statistically significant correlation was found between nasopharyngoscopic classification and distance ratio. The sagittal plane of MR images revealed that the main site of movement occurred at the level of the hard palate and above. It is concluded that medial movement of the lateral pharyngeal wall consists of inward displacement of the eustachian tube cartilage, which is caused by contraction of the levator veli palatini muscle, and that the primary site of this movement is at the level of the hard palate and above, where the eustachian tube, but not the superior constrictor muscle, exists.     

Electromyography and mechanics of mastication in the albino rat.

The masticatory apparatus in the albino rat was studied by means of electromyography and subsequent estimation of muscular forces. The activity patterns of the trigeminal and suprahyoid musculature and the mandibular movements were recorded simultaneously during feeding. The relative forces of the individual muscles in the different stages of chewing cycles and biting were estimated on the basis of their physiological cross sections and their activity levels, as measured from integrated electromyograms. Workinglines and moment arms of these muscles were determined for different jaw positions. In the anteriorly directed masticatory grinding stroke the resultants of the muscle forces at each side are identical; they direct anteriorly, dorsally and slightly lingually and pass along the lateral side of the second molar. Almost the entire muscular resultant force is transmitted to the molars while the temporo-mandibular joint remains unloaded. A small transverse force, produced by the tense symphyseal cruciate ligaments balances the couple of muscle resultant and molar reaction force in the transverse plane. After each grinding stroke the mandible is repositioned for the next stroke by the overlapping actions of three muscle groups: the pterygoids and suprahyoids produce depression and forward shift, the suprahyoids and temporal backward shift and elevation of the mandible while the subsequent co-operation of the temporal and masseter causes final closure of the mouth and starting of the forward grinding movement. All muscles act in a bilaterally symmetrical fashion. The pterygoids contract more strongly, the masseter more weakly during biting than during chewing. The wide gape shifts the resultant of the muscle forces more vertically and moreposteriorly. The joint then becomes strongly loaded because the reaction forces are applied far anteriorly on the incisors. The charateristic angle between the almost horizontal biting force and the surface of the food pellet indicates that the lower incisors produce a chisel-like action. Tooth structure reflects chewing and biting forces. The transverse molar lamellae lie about parallel to the chewing forces whereas perpendicular loading of the occlusal surfaces is achieved by their inclination in the transverse plane. The incisors are loaded approximately parallel to their longitudinal axis, placement that avoids bending forces during biting. It is suggested that a predominantly protrusive musculature favors the effective force transmission to the lower incisors, required for gnawing. By grinding food across transversely oriented molar ridges the protrusive components of the muscles would be utilized best. From the relative weights of the masticatory muscles in their topographical relations with joints, molars and incisors it may be concluded that the masticatory apparatus is a construction adapted to optimal transmission of force from muscles to teeth.     

Bridging the gap between temporomandibular disorders,static balance impairment and cervicogenic dizziness: Posturographic and clinical outcomes

Several studies have investigated the possible influence of temporomandibular disorders (TMD) on body posture and whether cervical spine disorders, such as cervicogenic dizziness (CGD) could play an additional role in affecting static balance. The purpose of this study was to analyze static postural behavior by means of static posturography, in patients affected by either TMD or CGD alone or by both conditions, and to compare findings with a group of healthy subjects. Significant changes in posturographic parameters were found among the three groups of patients and when compared with controls. When the three study groups were compared to each other, subjects affected by a combination of TMD and CGD showed worse postural performances with respect to subjects affected by CGD or TMD alone. Correlations with self-perceived dizziness, anxiety, depression and jaw functionality, investigated by means of validated questionnaires, were found among all patient groups. These results provide new evidences for the presence of static balance alterations in patients suffering from TMD with and without associated cervical spine impairment, by using a reliable diagnostic technique. Further studies are needed in order to identify any causal relation between these two disorders.