Clinical results of counselling therapy for temporomandibular disorder (TMD) were surveyed in 93 patients. Results were as follows:
1. At the end of treatment, the proportion of patients without symptoms was 22.7%, with improvement 39.8%, with no improvement 2.1%, with changes from the original state 3.2% and early drop out 32.3%. Counselling therapy was effective in 92.1% of cases, except for drop out patients.
2. Post treatment results were surveyed in 43 patients. 44.2% of patients were without symptoms. Most symptoms were mild and only of 4.7% patients required re-treatment. The incidence of limitation of mouth opening increased after treatment.
3. Two closed lock patients were judged as having no improvement. They dropped out after 2 or 11 months of treatment.
4. In conclusion, counselling therapy was effective especially muscle pain and TMJ. It is suggested that necessity of occlusal treatment for TMD should be reevaluated.

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A cross-sectional study of the prevalence of masticatory muscle disorders and temporomandibular joint disorders was carried out on 672 individuals (304 males and 368 females, age range 20-92 years) who were selected randomly in Okayama City, Japan. Many subjects who lacked supernormal temporomandibular functions as well as temporomandibular disorders, being assumed in adaptive state, were observed. The aim was to investigate signs, prevalences and risk factors of the adaptive population.
In the population the incidence of slight TMJ noise was the highest (83%) and most of the noises seemed likely to be the previous stages of disk displacement or degenerative joint disease. The frequency of the adaptive population was 24% in all subjects and no significant sex and age differences were found for the distribution of clinically relevant findings. The adaptive population was found to relate risk factors-life stresses, trauma, health condition, behavior and occlusion. Concerning occlusal factors, subjects who had abnormal static occlusal findings were found significantly more frequently in the adaptive population than in the asymptomatic population.
Moreover, subjects who had abnormal relationships between the upper and lower arches and who had balancing side and/or protrusive interferences were found significantly more frequently in the dysfunctional population than in the adaptive population. Histories of temporomandibular disorders (pain, noise and trismus) were found more frequently in the dysfunctional population than in the other populations, and histories of TMJ sounds were found more frequently in the adaptive population than in the asymptomatic population. These data suggest that there exist many subjects in an adaptive state of temporomandibular disorders in the Japanese adult population.

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This is a case report of posterior disk displacement of the left TMJ. The patient was a 22-year-old man who complained of a strange feeling at the left TMJ site, with uncomfortable movement of the mandible due to being unable to move the mandible to the left or to occlude well, especially the posterior teeth. Clinical examination revealed that the mandible was shifted to the right with a left class III molar occlusion. There was a bimaxillary protrusion.
On the stomatognathic-function analysis, TMJ symptoms were manifested in mandibular dysfunction of lateral excursion to the left side. The images of sagittal sections of TMJ performed by inferior joint cavity arthrotomography demonstrated that there was a posterior disk displacement of the left TMJ.
In order to correct the mandibular dysfunction, the patient was treated by manipulation of the mandible with a pivoting splint. This resulted in a movable lateral excursion of the mandible to the left. Then physical therapy and orthodontic treatment were performed to prevent a relapse of the mandibular dysfunction, and to correct bimaxillary protrusion as well as left molar relationship, respectively. Finally, the vertical dimension was increased by extrusion of the posterior teeth for expansion of the articular spaces. The patient's TMJ symptoms, as a result, completely disappeared.

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Splint therapy is a common method for treatment of CMD patients. However, the clinical assessment of the therapy was depended on the sensibility of the patient. The purpose of this study was to evaluate splint therapy for CMD patients using the pressure pain threshold (PPT).
The PPT measuring system consisted of a grip switch and a push-pressure sensor. The sensor pressed on the skin overlying the muscle concerned. As soon as the pressure sensation became painful, the patient relayed a signal via a switch-off. The pressure was then immediately released. The largest PPT at the time of a switch-off signal was recorded and stored in a laptop computer.
The daily change of PPT was observed in 10 normal subjects and four CMD patients with muscle palpation during splint therapy. Each PPT was measured at four sites of the masseter muscle and two sites of the temporal muscle on each side.
No difference of PPT between the sides was observed in normal subjects. However, PPT of the painful side was significantly lower than that of the other side before the splint therapy. This difference decreased over the period of splint therapy.
The measurement of pressure pain threshold could be an important tool for the judgement of the effect of splint therapy.

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Various surgical procedure have been reported for the treatment of recurrent dislocation of the temporomandibular joint (TMJ). However, we thought that a treatment involving the least possible surgical insult would be the most desirable procedure. Starting from this therapeutic principle and considering the pathologic features of this disease, we have developed an arthroscopic surgical procedure for this disease and evaluated its clinical utility. This paper describes the outline of our treatment for recurrent dislocation of the TMJ by arthroscopic disc suturing and fixation.
The upper joint cavity was the target of our procedure.
After arthroscopy, a fresh wound was formed by arthroscopic laser surgery starting from the area posterior to the disc to the posterior wall of the upper joint cavity and advancing to the mandibular fossa, articular tubercle and synovial membrane of the medial wall. The disc was then pulled backward to be fixed in place with arthroscopic suture needle using our procedure of arthroscopic disc suturing and fixation. This was concurrently supplemented with a manipulative procedure involving interior and exterior stitching of the lateral fibrous capsule for posteior traction and sew-up. Disc adhesion and fixation to the mandibular fossa and articular tubercle were done by pressure-welding of the mandibular head from beneath the disc by postoperative intermaxillar traction and fixation of the maxillary and mandibular dentitions. This manipulation succeeded in pulling and fixing the articular disc to the posterior wall and making the disc adhere to the mandibular fossa and articular tubercle, resulting in subsidence of the upper joint cavity and marked reduction of the mandibular head movement owing to the sew-up of the fibrous capsule. The procedural objective was to gain contracture of the soft tissue of TMJ through suturing and fixing of the articular disc and fibrous capsule and it could also be functionally categorized as a mobility-restricting procedure. As a new treatment for recurrent TMJ dislocation, it proved more useful than any other conventional treatment in fulfilling the primary objective with less surgical insult since it could be carried out without opening the joint. This procedure was conducted on 21 TMJs from 12 patients from November 1988 to January 1993. Although one patient suffered a recurrent TMJ dislocation requiring another operation, all patients including this one have since remained well and free from recurrence.

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Muscle and/or joint tenderness is defined as a patient's self-report of pain on palpation, but there is less interobserver agreement for pain-related measures. The pressure pain threshold (PPT) can confidently used to evaluate the tenderness at the muscle and/or joint with interexaminer reliability. However, there has not been a report of the cut-off values of PPT to define illness or normality.
We studied cut-off values of PPT (pressure rate 500g/cm²/sec) on five points between painful female TMD patients (N=45) and no pain female volunteers (N=19). Estimation for TMD-pain by traditional finger palpation was registered on a two-point scale, yes or no.
PPT at the paintul sites of TMD-pain patients was less than PPT at the mon-pain sites of non-pain subjects. Estimations for cut-off values at the mid portion of masseter muscle and the anterior portion of temporalis were acceptable (accuracy 0.73 and 0.72). However, other points showed unacceptable accuracy. These results suggest that PPT measurement at the belly of muscles might be reasonable.

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This Study was designed to investigate the effect of Eperizone hydrochloride in patients with temporomandibular joint arthrosis by means of electromyography and thermography. The subjects-consisted of 110 patients with temporomandibular joint arthrosis of types I to IV, classified according to the criteria of The Japanese Society for Temporomandibular Joint. Type V cases were excluded. Each of the patients were examined by (1) the protocol for patients with temporomandibular joint arthrosis, (2) thermography, and (3) electromyography by Occiuso Master^®. The following results were obtained;
(1) Clinical symptoms improved, especially in type I cases.
(2) The skin temperature of each insertion of the massete muscle was not always balanced.
(3) The silent period frequency increased.
The results indicated that Eperisone hydrochloride was effective as an antispasmodic agent in patients with temporomandibular joint arthrosis.

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To understand the relationship between the duration of pain and the expression for pain, an investigation was undertaken using Japanese McGill Pain Questionnaires (JMPQ) with 357 TMD patients.
The patients with joint or musclar pain for over six months, as a whole, had higher numbers of pain expressions than the patients who hed less than one month duration of pain, the expressions of affective qualities were significant.
In the patient group with joint pain, the longer the duration a patient had, the more expressions in sensory qualities he/she selected. Some pain expressions selected significantly by the patients with joint pain for over six months, had the quality of chronic pain. In the patient group with muscular pain, the longer duration period of pain a patient had, the more expressions in affective qualities he/she selected. This suggested that patients with musclar pain become anxious about pain as the duration of the pain extends.

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TMD (temporomandibular disorders) patients often have head and neck region symptoms as well as TMJ-sound, limited mouth opening and pain in the masticatory muscles and/or in the TMJ. These symptoms are called associated symptoms with TMD.
In this study, we investigated the relationship between the associated symptoms and neurosis. These symptoms surveyed included headache, stiffness in the neck and shoulders, vertigo or dizziness, tinnitus, stuffy sensation in the ear, deafness, dysgeusia, and numbness of the tongue. We used GHQ (General Health Questionnaire) to assess the patients' neurotic symptoms.
153 TMD patients (28 males, 125 females), 12-69 years old with a mean of 31.9 years, were investigated in our department. As a result, we found the GHQ scores correlated well with the number of associated symptoms. In short, the more the patients had associated symptoms, the more they had neurotic symptoms.

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