Journal of oral rehabilitation最新文献

Purpose: This study intends to assess the salivary glands of individuals with hypothyroidism and healthy controls using B-mode ultrasonography (US) parameters, shear wave elastography (SWE) values, and colour Doppler characteristics. Additionally, the study aims to compare salivary flow rates between the patient groups.

Methods: A total of 160 submandibular glands and 160 parotid glands from 80 patients (40 hypothyroidism individuals and 40 controls) were assessed using ultrasonography. Echogenicity, internal parenchymal structure, margin characteristics, dimensional measures, and colour Doppler and SWE assessments were conducted using a linear probe. Furthermore, the stimulated and unstimulated salivary flow rates of each subject were quantified in millilitres per minute (mL/min).

Results: A statistically significant difference was identified between the hypothyroidism and control groups regarding echogenicity, margin characteristics, parenchymal homogeneity, colour Doppler metrics, medio-lateral dimension, and mean values of SWE (kPa) and SWE (m/Sn) in the right submandibular gland; margin characteristics, parenchymal homogeneity, colour Doppler metrics, and mean values of SWE (kPa) and SWE (m/Sn) in the left submandibular gland; as well as echogenicity, margin characteristics, parenchymal homogeneity, and mean values of SWE (kPa) and SWE (m/Sn) in both the right and left parotid glands (p < 0.05). The patient group had significantly reduced stimulated and unstimulated salivary flow rates (p < 0.05).

Conclusion: Hypothyroidism has been shown to be associated with structural and functional changes in the salivary glands, including decreased salivary flow and increased gland stiffness. US and SWE are reliable imaging methods for evaluating the salivary glands in individuals with hypothyroidism.

Background: Esports practitioners are frequently exposed to prolonged screen time and sustained cognitive-motor demands, which may influence wake-time oral behaviours. Evidence on awake bruxism (AB) in this population remains scarce.

Objective: To assess the prevalence of awake bruxism (AB) and its associations with sociodemographic, behavioural, clinical and psychological factors, particularly anxiety and nomophobia, among esports practitioners.

Methods: In this cross-sectional study, 239 esports players completed a structured online questionnaire covering sociodemographic/lifestyle factors, gaming-related characteristics, clinical conditions, self-reported sleep quality, temporomandibular pain screening, anxiety (GAD-7) and nomophobia. Awake bruxism behaviours were assessed using the Oral Behaviours Checklist (OBC). Multivariable ordinal logistic regression (proportional odds model) was used to evaluate factors associated with AB frequency (never < sometimes < frequent). Additionally, separate ordinal models were fitted for each AB behaviour (grinding, clenching, light tooth contact and mandibular bracing) using the same frequency structure.

Results: Overall, 89.1% of participants reported AB-related behaviours, with light tooth contact being the most frequent. In the multivariable model, higher nomophobia scores were independently associated with higher AB frequency categories (OR = 1.031; 95% CI = 1.015-1.050; p < 0.001). In behaviour-specific models, nomophobia consistently emerged as a significant predictor across individual AB behaviours. Anxiety and nomophobia were strongly correlated (ρ = 0.650; p < 0.001).

Conclusion: Awake bruxism-related behaviours were highly prevalent among esports practitioners and nomophobia was consistently associated with higher AB frequency and specific AB manifestations. These findings highlight the relevance of psychobehavioral factors in the expression of AB in gamers.

Background: Pain is the primary symptom of Temporomandibular disorders (TMD) and the main reason patients seek treatment. Cognitive reappraisal has been shown to effectively alleviate pain, but evidence regarding its impact on TMD patients' pain remains insufficient. Furthermore, the mechanism by which cognitive reappraisal affects pain in TMD patients remains unclear.

Objectives: To investigate the influence of cognitive reappraisal, anxiety, and oral behaviours on pain among TMD patients and to verify the chain mediating role of anxiety and oral behaviours.

Methods: This study is a cross-sectional study conducted at West China Stomatological Hospital, Sichuan University, which enrolled 360 TMD patients. The Chinese version of the Emotion Regulation Questionnaire, the brief version of the Depression-Anxiety-Stress scale, the Oral Behaviour Checklist, and the Visual Analogue Scale were used. SPSS 27.0 software and PROCESS macro 3.0 were used to analyze data and verify all the hypotheses.

Results: A total of three mediation pathways between cognitive reappraisal and pain: (1) cognitive reappraisal → anxiety → pain (β = -0.11, 95% CI: -0.15 to -0.07); (2) cognitive reappraisal → oral behaviours → pain (β = -0.12, 95% CI: -0.19 to -0.07); (3) cognitive reappraisal → anxiety → oral behaviours → pain (β = -0.06, 95% CI: -0.09 to -0.04). Direct effect was estimated as β = -0.40 (95% CI: -0.46 to -0.34). Total effect was estimated as β = -0.70 (95% CI: -0.77 to -0.63).

Conclusions: Cognitive reappraisal reduces pain scores in TMD patients through multiple pathways, with anxiety and oral maladaptive behaviours acting as chain mediators. Cognitive reappraisal serves as one of the protective factors against pain in TMD patients.

Background: Temporomandibular disorders (TMD) and orofacial pain (OFP) are influenced by behavioural and psychosocial stressors. The Gaza Strip's prolonged conflict provides a critical context for estimating burden and correlates.

Objectives: To estimate the prevalence of self-reported TMD/OFP symptoms and identify independent risk factors among adults in Gaza during wartime.

Methods: Cross-sectional survey of 1000 adults (500 women, 500 men) equally allocated across five governorates. A structured questionnaire captured self-reported facial/TMJ/ear pain, jaw function, parafunctional behaviours (e.g., bruxism, oral habits) and psychological symptoms (tension, mood, sleep) was used. Analyses used descriptive statistics, chi-square tests and multivariable logistic regression adjusted for sex.

Results: TMD-related pain was reported by 33.1% (n = 331). Neck pain occurred in 41.0% and morning facial stiffness in 28.2%. In bivariate analyses, men more often reported jaw dysfunction (limited opening, chewing difficulty, joint sounds), while women more often reported psychological symptoms; sex was not an independent predictor. Independent predictors were morning facial stiffness (AOR 2.57-5.27 across frequency categories), limited mouth opening (AOR 3.03; 95% CI 1.75-5.28), joint noises (AOR 3.13; 95% CI 2.08-4.72), sleep bruxism (AOR 2.33; 95% CI 1.51-3.60) and daily somatic pain elsewhere (AOR 2.99; 95% CI 1.53-5.84). Gum chewing showed an inverse association (AOR 0.62-0.31). Tension, sadness, global sleep disturbance, daytime bruxism, smoking, alcohol use, orthodontic history and governorate were not independent predictors. The multivariable model showed good performance (AUC = 0.882; Nagelkerke's R² = 0.519).

Conclusions: During active war, self-reported TMD and OFP symptoms are prevalent among adults in Gaza and are strongly associated with parafunctional habits and psychological distress, both potentially intensified by war-related stress. These findings underscore the need for integrated dental and mental health interventions in conflict-affected populations.

Objective: To evaluate the clinical outcomes of modified crestal and lateral approaches in maxillary sinus lift.

Methods: Fifty patients with single missing posterior maxillary teeth and severe bone deficiency (residual bone height < 5 mm) requiring implant placement were selected from a tertiary hospital's dental department between January and December 2023. Patients were randomly assigned to the modified crestal sinus lift group (experimental group) or the lateral window sinus lift group (control group). Behavioural cognition was assessed using the Hospital Anxiety and Depression Scale (HADS), postoperative pain was quantified using the Visual Analog Scale (VAS). Bone gain was evaluated by Gained Bone Height (GBH), and implant success rate and complication incidence were recorded. The t-test was used for intergroup comparisons, and categorical data were analysed using the chi-square test. Statistical significance was set at p < 0.05.

Results: Significant differences were observed between the experimental and control groups in pre- and postoperative behavioural cognition, surgical time, and VAS pain scores (p < 0.05). No significant differences were found in bone gain, implant success rate, or complication incidence.

Conclusions: The bone augmentation outcomes of the two surgical techniques were essentially comparable. However, the modified crestal approach demonstrated advantages over the lateral window technique in terms of minimal trauma, improved patient behavioural cognition, and reduced postoperative pain. These findings suggest that optimising minimally invasive sinus lift techniques may enhance clinical applications, particularly with patient-centred considerations.

Background and objective: Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease that impairs motor function, including oral musculature, complicating oral hygiene and care. Despite its impact, oral health in ALS patients remains under-addressed. This personal scoping review explores oral health in ALS through the dual lens of Dr. Maurits K.A. van Selms-a dental researcher and ALS patient-highlighting care, research, and education priorities.

Methods: Semi-structured interviews were conducted via email with Dr. van Selms, using a topic guide adapted from a prior personal scoping review. The interview covered personal experiences and professional insights into oral health care, research, and education in ALS. Responses were analysed and synthesised into thematic agendas.

Results: Dr. van Selms emphasised the neglect of oral hygiene in ALS care. He advocated for patient-informed, tailored guidelines based on functional capacity, interdisciplinary collaboration, and improved accessibility to dental services. In research, he called for ethically sensitive, patient-centered studies that reduce the burden of oral care. Educationally, he stressed the need for inclusive training across disciplines and stakeholder levels, promoting self-advocacy and awareness. Instructional materials, such as videos, were recommended to support caregivers and patients.

Conclusion: This personal scoping review underscores the importance of integrating oral health into ALS management. Dr. van Selms' unique perspective reveals gaps in care delivery, research ethics, and education, advocating for interdisciplinary collaboration and proactive guideline development. His insights offer a roadmap for improving oral health outcomes and quality of life in ALS and similar neurodegenerative conditions.

Backgrounds: To assess cortical and trabecular bone modifications in the mandible of persons with and without bruxism by panoramic radiography-based fractal analysis and morphometric assessments.

Methods: This retrospective cross-sectional study examined panoramic radiographs of individuals diagnosed with bruxism and matched controls aged 18-50. Fractal dimension (FD) values were computed in three mandibular regions (condyle, molar, and angulus) utilising the box-counting method following image preprocessing. Morphometric measures, such as the antegonial index (AI) and antegonial notch depth (AND), were measured. The severity of bruxism was categorised using a four-tier (G0-G3) grading system predicated on the morphology of the mandibular angle. Statistical analyses were used to evaluate intergroup differences and geographical variations.

Results: The FD values in the condylar region were substantially lower in the bruxist group (1.29 ± 0.05) compared to the controls (1.31 ± 0.04; p = 0.015), indicating microstructural degradation. No substantial variations were observed in the molar and angulus areas. The AI in the bruxist group (2.19 ± 0.45 cm) was substantially lower than that of the control group (2.40 ± 0.41 cm; p = 0.002), whereas AND showed no significant difference. Subgroup analysis indicated that G3 bruxists exhibited the lowest condylar FD values, suggesting structural compromise in advanced cases.

Conclusions: Bruxism, especially in its more severe manifestations, may cause microarchitectural alterations in the mandibular trabecular bone, particularly in the condylar area. Fractal analysis and morphometric indices obtained from panoramic radiographs may function as supplementary, non-invasive methods for detecting bruxism-related bone changes in clinical settings.

Background: Awake bruxism (AB) is closely linked to psychological factors and commonly co-occurs with painful temporomandibular disorders (TMD).

Objective: To evaluate the role of anxiety comparing the frequency of AB behaviours, as well as levels of perceived stress, pain catastrophizing and depressive symptoms among patients with painful TMD, categorised by clinical anxiety levels.

Methods: A total of 72 patients diagnosed with painful TMD were enrolled and classified into two groups based on T-scores derived from the Generalised Anxiety Disorder 7-item scale [GAD-7]: elevated symptoms of anxiety group (T ≥ 61): 30 and normative anxiety (T ≤ 60): 42. T-score calculations were based on a previously studied pain-free control group. AB behaviours were recorded through Ecological Momentary Assessment (EMA), and participants completed the Perceived Stress Scale [PSS], the Pain Catastrophizing Scale [PCS] and the Patient Health Questionnaire-9 [PHQ-9], alongside lifestyle assessment. Between-group comparisons and correlation analyses were conducted to evaluate associations between anxiety and clinical, behavioural and psychosocial outcomes.

Results: Patients with elevated symptoms of anxiety exhibited higher total AB frequency (89%; 72.12%; p < 0.002), particularly increased tooth clenching (26.90%; 13.48%; p < 0.016). They also reported significantly higher clinical pain intensity (p < 0.005), as well as elevated perceived stress (p < 0.001), higher pain catastrophizing (p < 0.032), especially helplessness (p < 0.050) and rumination (p < 0.47) and more severe depressive symptoms (p < 0.002). No significant differences were seen between groups in physical activity, social engagement, alcohol drinking or smoking.

Conclusion: These findings underscore that TMD patients with elevated clinical symptoms of anxiety exhibit significantly higher frequencies of AB, specifically tooth clenching, psychological distress and pain intensity.

Background: Temporomandibular disorders (TMDs) and chronic orofacial pain are multifactorial conditions influenced by complex neurobiological and systemic mechanisms. Recent findings emphasise the gut-brain axis as a central modulator of pain, neuroinflammation, and immune signalling. Nevertheless, the role of the gut microbiota in TMD pathogenesis and oral rehabilitation remains insufficiently characterised.

Methods: A structured literature search was conducted in PubMed/MEDLINE, Scopus, and Web of Science up to December 2024 using combinations of keywords including "gut microbiota," "temporomandibular disorder," and "orofacial pain." Eligible publications included clinical studies, systematic and narrative reviews, meta-analyses, and theoretical works addressing microbiota-pain relationships.

Results: Recent Mendelian randomization studies reveal causal associations between specific bacterial genera and TMD risk. Experimental models demonstrate that gut dysbiosis exacerbates temporomandibular joint inflammation and neuroinflammatory responses, while restoring microbial balance through probiotics or faecal microbiota transplantation alleviates pain hypersensitivity. Mechanistic studies suggest that microbial metabolites such as short-chain fatty acids, GABA, and serotonin modulate trigeminal pain pathways via vagal and immune signalling.

Conclusion: Current evidence supports a bidirectional gut-brain-jaw communication system influencing both peripheral and central pain mechanisms. Incorporating microbiome-targeted approaches-such as dietary modulation, probiotics, and microbial therapy-may enhance TMD management and promote a more holistic, personalised model of oral rehabilitation.

Background: Oral frailty and physical frailty are linked to adverse health outcomes in older adults, but their relationship with sleep quality is not well understood. This study examined the association between oral frailty and sleep quality, and the combined effects of oral and physical frailty on sleep in community-dwelling older adults.

Methods: A cross-sectional study was conducted in Kaohsiung City, Taiwan (2018-2019), including 1180 adults aged ≥ 65 years selected by multistage stratified cluster sampling. Data were collected through questionnaires and dental exams. Sleep quality was measured by the Pittsburgh Sleep Quality Index. Oral frailty was assessed using indicators such as oral diadochokinesis, swallowing difficulty, masticatory performance, dry mouth, tongue coating, and number of natural teeth. Oral health-related quality of life (OHRQoL) was evaluated with the GOHAI. Logistic regression identified factors associated with poor sleep quality.

Results: Swallowing difficulty (AOR = 2.69) and dry mouth (AOR = 2.06) were significantly linked to poor sleep quality. A dose-response relationship was observed across stages of swallowing difficulty, with both suspected and confirmed cases reporting significantly poorer sleep quality compared to individuals without swallowing issues (p for trend < 0.001). Higher OHRQoL scores were linked to better sleep quality (AOR = 0.97). Additionally, the combined presence of oral frailty and physical frailty was significantly associated with poor sleep quality (AOR = 2.71).

Conclusion: Oral and physical frailty are significantly associated with sleep quality in older adults. Interventions targeting swallowing difficulty, dry mouth, and physical frailty may improve sleep quality in this population.