Journal of oral rehabilitation最新文献

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.

Background: Adherence to conservative treatments is essential for optimal outcomes in temporomandibular disorder (TMD) patients, yet validated tools for measuring adherence are lacking.

Purpose: This study aimed to develop and validate a bilingual (Arabic-English) questionnaire to comprehensively assess adherence among TMD patients.

Study design, setting, sample: A cross-sectional, observational, five-phase design was conducted at the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Mansoura University (Egypt). The study included a pilot sample of 60 TMD patients and a psychometric evaluation sample of 300 patients.

Exposure: The exposure was adherence behaviour, measured by a newly developed 50-item, 11-domain adherence questionnaire.

Main outcome variable(s): The primary outcomes were psychometric properties of the questionnaire, including content validity, internal consistency, test-retest reliability and construct validity.

Covariates: Patient language version (Arabic or English) was considered to examine potential influences on questionnaire performance.

Analyses: Content validity was assessed using Item-Content Validity Index (I-CVI) and Content Validity Ratio (CVR). Reliability was evaluated with Cronbach's α and intra-class correlation coefficient (ICC). Construct validity was examined with exploratory factor analysis (EFA).

Results: The final 50-item, 11-domain questionnaire demonstrated strong content validity. Internal consistency was acceptable for both Arabic (Cronbach's α = 0.70) and English (α = 0.68) versions. Test-retest reliability was good (ICC = 0.762-0.898; p < 0.001). EFA confirmed 11 domains, accounting for 61.5% of variance in Arabic and 64.73% in English.

Conclusions and relevance: The Badawy and Haggag Adherence Questionnaire for TMD demonstrated strong validity and reliability across Arabic and English versions. It provides a robust clinical and research tool for assessing adherence to conservative TMD management, enabling clinicians to identify non-adherence and design tailored interventions to improve outcomes.

Trial registration: ClinicalTrials.gov ID NCT07045441. The trial was first posted on 22 June 2025, and the most recent update was posted on 30 June 2025. Retrospectively registered.

Objective: The objective of this study was to investigate the prevalence and characteristics of self-perceived swallowing difficulties among community-dwelling older people in South Korea, as distinct from clinically diagnosed dysphagia.

Methods: A total of 489 community-dwelling, independent older adults (aged ≥ 65 years) were assessed using the Korean version of the Dysphagia Risk Assessment for the Community-dwelling Elderly (K-DRACE), a validated self-report questionnaire. We analysed the perceived frequency of difficulties across the three swallowing phases (oral, pharyngeal and oesophageal). Based on the cut-off score (4 points), the prevalence was calculated. Differences between the no perceived difficulties group and the perceived difficulties group according to participant characteristics were analysed using an independent sample t-test and one-way ANOVA.

Results: The prevalence of self-perceived swallowing difficulties among community-dwelling older people in South Korea was 40.7%. The total K-DRACE score increased with age; the oldest group (85+ years) showed the highest prevalence (57.0%) and mean score (4.91 ± 4.22). The highest mean score was observed in the oral phase. Significant differences were found according to gender, education level and residential area.

Conclusion: The high prevalence of perceived swallowing difficulties identified in this study, particularly among older adults not clinically diagnosed, underscores the critical need for community-based screening. Identifying this at-risk population through such screening is the essential first step to facilitate timely preventive interventions and ensure referral for further clinical evaluation.

Background: Recent research suggests a potential link between tooth loss and cognitive decline among the elderly population, but longitudinal evidence remains limited.

Aim: This meta-analysis aims to investigate the longitudinal relationship between dentition status (tooth loss/edentulism) and cognitive outcomes (dementia/MCI) in aging populations.

Method: A systematic search was conducted across PubMed, Scopus, and Web of Science up to February 2025. Twenty-one longitudinal studies (N = 35 744 989 participants) meeting inclusion criteria were analysed. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random- or fixed-effects models. Study quality was assessed via the Newcastle-Ottawa Scale.

Results: Longitudinal evidence supports a connection between tooth loss and cognitive decline. Specifically, tooth loss was associated with increased risks of dementia (OR = 1.26 [1.07, 1.49]) and MCI (OR = 1.40 [1.14, 1.71]). Edentulism showed higher risks (dementia: OR = 1.16 [1.09, 1.23]; MCI: OR = 1.90 [1.07, 3.35]). Subgroup analyses revealed greater risks in women and Western populations. Denture use mitigated dementia risk in individuals with tooth loss (OR = 1.03 [0.82, 1.28]).

Conclusion: Tooth loss may accelerate cognitive decline, with more severe loss correlating to greater deterioration. Dentures could help mitigate this effect by restoring chewing function. Given that tooth loss is a modifiable risk factor for cognitive impairment, preventive dental care and timely prosthodontic treatment may play a protective role in maintaining brain health among older adults.

Background: Oral hypofunction (OHF) is a multidimensional condition representing a subclinical decline in oral function. Cross-national comparisons using standardised criteria remain limited.

Objectives: This study aimed to compare the prevalence and characteristics of OHF among community-dwelling adults in Japan and Switzerland and to examine age-related patterns using standardised assessments.

Methods: A cross-sectional study was conducted in community settings in Japan (153 participants) and in a university dental clinic in Switzerland (117 participants). OHF assessments were performed between May 2023 and January 2024 in Japan and between December 2023 and January 2024 in Switzerland. Data were collected by trained and calibrated examiners from both countries following standardised protocols. OHF was diagnosed when three or more of the seven oral function domains, including oral hygiene, oral dryness, occlusal force, tongue-lip motor function, tongue pressure, masticatory function, and swallowing function, were impaired. Multiple logistic regression analyses were performed with OHF as the outcome after adjusting for country, age, and covariates. Interactions between country and age were also investigated.

Results: The prevalence of OHF was 30.7% in Japanese participants and 49.6% in Swiss participants (p = 0.002). The Swiss participants demonstrated significantly better oral hygiene (p < 0.001), while the Japanese participants showed better tongue pressure (p = 0.026), lip-tongue motor function (p < 0.001), maximum occlusal force (p = 0.002), and masticatory function (p < 0.001). In logistic regression, OHF was associated with Swiss nationality (odds ratio [OR]: 3.85, 95% confidence interval [CI]: 1.85-8.00, p < 0.001), age ≥ 70 years (OR: 5.73, 95% CI: 1.67-19.68, p = 0.006, compared to those in their 20s), lower hand grip strength (OR: 0.91, 95% CI: 0.87-0.96, p = 0.001), and fewer teeth (OR: 0.94, 95% CI: 0.89-0.98, p = 0.008). A significant interaction between country and age indicated differing age-related OHF progression between the Japanese and Swiss populations.

Conclusion: Both populations exhibited age-related declines in oral function; however, functional impairment was more prevalent and progressive in Switzerland. These findings support the cross-cultural applicability of the OHF criteria and underscore the need for population-specific preventive strategies.

Aim: To compare standardised surface electromyography (ssEMG) data and patient perception between two EMG standardisation methods for clenching (cotton rolls vs. wax pads) and swallowing (with vs. without an air-filled bulb). The third aim was to analyse ssEMG data during saliva swallowing to detect differences among masseter (MM), temporalis (TM) and submental (SM) activity.

Methods: Electromyographic data were obtained from 45 participants after clenching tests with wax pads and cotton rolls, and swallowing tests with and without an air bulb. Participants rated comfort, quickness, and stress of each modality on a 10-point Likert scale. TM, MM and SM activities were recorded using ssEMG indices. Clenching and swallowing data were compared using the Student's t-test. A one-way ANOVA was used to assess muscle roles during saliva swallowing. Perception scores were compared with the Student's t-test.

Results: Forty-five participants (37 women, mean age 22.75 ± 1.27 years) were included. No differences emerged between ssEMG indices during clenching and swallowing, except for the IMPACT index of MM (p < 0.001) and TM (p < 0.01), both lower with wax. No perception differences were found between wax and cotton roll clenching. Swallowing with an air bulb was rated as more comfortable (p < 0.001) and less stressful (p < 0.05). During swallowing, SM showed significantly higher activity and longer duration (p < 0.001) than TM and MM.

Conclusion: Both cotton rolls and wax pads are suitable for clenching standardisation, though wax may reduce TM and MM activity. For swallowing, the air-filled bulb does not affect ssEMG indices but is perceived as more comfortable and less stressful.

Background: Dental implants have become a widely accepted solution for replacing missing teeth. Despite their high success rates, postoperative discomfort such as pain, swelling and foreign body sensation is commonly experienced by patients. However, the prediction of such outcomes based on patient characteristics remains underexplored.

Objective: Develop and validate risk models for patient-reported postoperative symptoms after dental implant surgery.

Methods: A total of 506 patients who underwent dental implant surgery between January 2024 and December 2024 were included. Postoperative symptoms were assessed using Numerical Rating Scales (NRS) ranging from 0 to 10. Multivariable ordinal logistic regression models were developed to predict the severity of swelling, pain and foreign body sensation based on clinical and demographic factors.

Results: Among 506 patients, swelling occurred in 65.6% (47.0% mild; 18.6% moderate-severe), pain in 55.6% (51.4% mild; 4.2% moderate-severe) and foreign-body sensation in 63.1% (53.0% mild; 10.1% moderate-severe). Increased swelling was independently associated with female sex, hypertension, multiple surgical sites, membrane use and 4.8-mm diameter implants. Pain was associated with multiple sites and bone substitute use. Foreign-body sensation decreased with age and increased with multiple sites.

Conclusions: Postoperative discomfort is common after dental implant surgery, with significant variability in severity. Identifying key predictors of symptoms can help tailor preoperative counselling and postoperative interventions to improve patient outcomes and satisfaction.