Aims:The genetic aspect of degenerative joint disease (DJD) of the temporomandibular joint is poorly understood. The prevalence of the estrogen receptor alpha (ER-alpha) gene polymorphism in patients with and without DJD using xbal and pvull restriction fragment length polymorphisms (RFLPs) was studied.Methodology:DNA samples from 42 DJD+ and 36 DJD− subjects were amplified. A 346-base pair long ER-alpha gene fragment containing the two sites of polymorphism in intron 1 was analyzed for xbal and pvull RFLP. Statistical analysis was carried out using Fisher's exact test and two-group t-test.Results:Five different ER-alpha genotypes were found in both groups. These were PXPX, pxpx, pxPX, PxPX, and pxPx.Discussion:There was a higher number of pxpx and pxPX genotypes in the DJD+ samples compared to the DJD− group, which suggests the presence of polymorphism possibly modulates the ER-alpha activity in bone and contributes to the degenerative process in the joint.
Oral lichen planus is a complex and poorly understood clinical condition which cannot be cured. A definitive diagnosis and careful, conscientious follow-up are imperative. Symptoms and complications are common and challenging but may be managed with a variety of therapies including orally administered and systemic medications as well as lifestyle alterations and reduction of precipitating factors.
To provide a national systematic program to collect removed TMJ implants and biological tissues, make them available to researchers, and study them in conjunction with long-term clinical follow-up, with the ultimate goal of stimulating research toward understanding the safety and outcomes of TMJ implants.Two synchronized divisions: The Registry, recruiting clinicians and/or surgeons and patients, and collecting comprehensive clinical patient data over time; the Repository, procuring and archiving high quality, well characterized biological specimens and retrieved implants for dissemination.Clinicians, surgeons, patients, researchers, pilot studies.October 2002-present: Recruited 34 TMJ surgeons, 34 TMJ clinicians; registered 723 surgical/non-surgical TMJD patients and control subjects; collected 542 specimens, blood, saliva; initiated 19 projects using TIRR resources; produced 60 publications and presentations nationally and internationally; sent ten grants into review, with more being developed.Continuing collection of long-term data for the development of new and improved implant designs and materials and investigation into understanding pathological mechanisms of TMJD.
Orofacial clefts are frequently associated with other congenital malformations. Studies vary in incidence and types of anomalies. Objective: To evaluate associated malformations in orofacial cleft patients at a major research hospital. Study Design: Medical records of 1127 patients, in the Cleft Palate / Craniofacial Clinic, Boys Town National Research Hospital, from January 1980 through February 2000 were reviewed. Patients were divided into two categories: 1) cleft palate only (CP), and 2) cleft lip, with or without cleft palate (CL±P). Further categorization included location and type, if any, of other congenital malformations.Results: 47.2% of patients had CP and 52.8% had CL±P. 32.2% of all cleft patients had associated congenital malformations. The orofacial region was the most common site, followed by cardiovascular, central nervous, and skeletal systems. Congenital malformations were more common in CP (38.7%), than CL±P(26.4%). Of malformations diagnosed, 63.1% were chromosomal/syndromic anomalies while 36.9% were non-chromosomal/syndromic. Conclusions: Recognition of the spectrum of congenital malformations,associated with orofacial clefting, is essential for further diagnostic testing and in some cases genetic counseling.
The objective of this study was to determine the diagnostic accuracy of panoramic radiography and magnetic resonance imaging (MRI) for detection of signs of temporomandibular joint (TMJ) degenerative joint disease (DJD). Panoramic radiography and bilateral MRI and computed tomography (CT) of the TMJs were performed for 705 subjects. Three calibrated board-certified radiologists who were blinded to the clinical findings interpreted all images. The diagnoses of DJD established using the panoramic radiographs and MRIs were compared to the reference standard diagnoses derived from the CTs. DJD was defined as the presence of at least 1 of the following 4 signs: a subcortical cyst, surface erosion, osteophyte formation, or generalized sclerosis. The target values for sensitivity and specificity were 70% or greater and 95% or greater, respectively. Compared to the reference standard CTs, the panoramic radiographs had the following sensitivity and specificity values: subcortical cysts, 14% and 100%, respectively; erosion, 20% and 100%, respectively; osteophytes, 12% and 100%, respectively; and sclerosis, 33% and 100%, respectively. The MRIs achieved the following sensitivity and specificity values: subcortical cysts, 32% and 100% respectively; erosion, 35% and 99% respectively; osteophytes, 71% and 98%, respectively; and sclerosis, 50% and 100%, respectively. The radiologists' interexaminer reliability was slight (κ = 0.16) when using panoramic radiographs, moderate (κ = 0.47) when using MRIs, and substantial when using CTs (κ = 0.71) for diagnosis of signs of DJD. Panoramic radiographs and MRIs had below-target sensitivity but above-target specificity in detecting all CT-depicted signs of DJD with the exception of osteophytes, for which MRIs demonstrated adequate diagnostic accuracy. Use of CT for diagnosis of TMJ DJD is recommended to avoid the false-negative findings that can occur if panoramic radiographs and MRIs are used.
Chronic pain conditions constitute the primary reason for seeking healthcare, the development of related disability and addiction, and the highest driver of healthcare costs. Chronic temporomandibular, jaw and orofacial pain after acute jaw sprain/strain can be prevented if prompt and appropriate treatment in an emergency or urgent care clinic is provided using a jaw sprain/strain clinical protocol immediately after onset to begin the healing and recovery process. If pain does persist beyond a few weeks, a delayed-recovery protocol can be helpful. The rationale and strategies for both are discussed.
