Journal of oral rehabilitation最新文献

Background: The severity of xerostomia often does not correlate with objective salivary flow rates. Moreover, the influence of concomitant oral burning pain and/or dysesthesia on xerostomia is not well understood.

Objective: To investigate the influence of oral burning pain and/or dysesthesia on the severity of xerostomia.

Methods: This retrospective study analysed 396 patients with a chief complaint of dry mouth. Patients were divided into those with xerostomia alone (n = 146) and those with concomitant oral burning pain and/or dysesthesia (n = 250). Data were collected through comprehensive questionnaires, salivary flow rate measurements, Candida culture test and psychological evaluations. Multiple linear regression analyses were used to identify factors related to the severity of xerostomia.

Results: No significant differences were observed in the self-reported severity of xerostomia-related symptoms or behaviours between the two groups. In patients with xerostomia alone, symptom severity was primarily associated with objective factors, particularly lower stimulated whole salivary flow rate and a higher degree of Candida colonisation. In contrast, in patients with xerostomia and concomitant oral burning pain and/or dysesthesia, the severity of xerostomia was most significantly associated with the intensities of taste disturbances and oral pain, and the presence of psychological distress, with salivary flow rates showing a much weaker correlation.

Conclusion: The severity of xerostomia in patients with xerostomia alone is closely linked to salivary gland function, whereas in patients with xerostomia and concomitant oral burning pain and/or dysesthesia, it is more strongly influenced by the severity of these symptoms and psychological distress.

Background: The brief Diagnostic Criteria for Temporomandibular Disorders (bDC/TMD) was developed to simplify the original DC/TMD for wider clinical use. While its diagnostic accuracy for most painful TMDs is acceptable, the sensitivity for headache attributed to TMD (HaTMD) was reported to be poor.

Objectives: To improve the diagnostic sensitivity of HaTMD within the bDC/TMD framework by reintroducing selected examination items from the original DC/TMD protocol.

Methods: This retrospective multicentre study used data from Finland and Israel. The cohort included 114 individuals previously diagnosed with HaTMD according to the DC/TMD and with myalgia and/or arthralgia diagnoses in both DC/TMD and bDC/TMD. Four examination items excluded from the bDC/TMD-E1b (headache location in temple), E4c (familiar headache on assisted opening), E5a/b (lateral movements) and E5c (protrusive movements)-were reintroduced individually. Four calibrated examiners reassessed each modified dataset. Inter-examiner reliability (Cohen's kappa) and diagnostic sensitivity were calculated using DC/TMD as the gold standard.

Results: Inter-examiner reliability for HaTMD diagnosis was almost perfect (κ = 0.81-1.00) across all items. Sensitivity improved markedly from the previously reported 0.16-0.38 to 0.82 (E1b)-0.90 (E5c). Item E1b (temple headache confirmation) was present in 95% of Finnish and 86% of Israeli cases, identifying it as the most representative finding.

Conclusion: Reintroducing item E1b into the bDC/TMD examination substantially increases the diagnostic sensitivity for HaTMD while maintaining brevity. Refinement of the painful TMD diagnostic decision tree and prospective validation of the modified bDC/TMD are recommended to ensure reliability and clinical applicability.

Objectives: To compare occlusal tactile acuity (OTA), the ability to detect and discriminate occlusal contacts, between patients with chronic painful temporomandibular disorders (TMDp) and healthy controls and to examine the influence of pain and oral behaviours on foil perception.

Methods: Forty TMDp patients (34 female, 6 male) and 40 healthy controls (20 female, 20 male) completed OTA testing with foils 8-56 μm thickness and a sham stimulus (48 trials). Participants bit in maximal intercuspal position and gave yes/no responses regarding foil perception. Oral behaviours were assessed using the Oral Behaviour Checklist (OBC). Repeated-measures ANOVA evaluated group and thickness effects, and signal detection theory separated perceptual sensitivity from response bias.

Results: TMDp patients showed higher recognition accuracy across thin foil thicknesses, with the most robust group difference observed at 32 μm after correction for multiple comparisons. They also exhibited higher perceptual sensitivity and a more liberal response criterion. Regression analyses identified TMDp status and female sex as positive predictors of perceptual sensitivity, whereas OBC-total and OBC-night were negative predictors. Models with decision bias as the outcome showed that TMDp predicted a more liberal criterion, while all OBC subscales predicted a more conservative criterion.

Conclusion: TMDp participants detected thinner foils more accurately but tended to overreport contact presence. In contrast, frequent oral behaviours were associated with reduced perceptual sensitivity and more conservative response tendencies.

Background: Stress is recognised as a contributing risk factor for temporomandibular disorders (TMDs), and salivary stress biomarker levels may be altered in such patients.

Objectives: This systematic review aimed to assess the current evidence to determine the association between salivary stress biomarkers and temporomandibular disorders (TMDs).

Methods: PubMed, Cochrane, Google Scholar and Scopus were searched. Case-control and cross-sectional studies exploring the association of salivary stress biomarkers in adult subjects with TMDs were included. A random effects model was used for quantitative data analysis. Risk-of-bias was assessed using the Newcastle-Ottawa Scale (NOS).

Results: Out of 5319 studies, 16 studies met the eligibility criteria. All included studies were case-control studies; they included 549 TMD cases and 494 controls. Overall, TMD cases showed higher levels of morning unstimulated salivary cortisol compared to controls (SMD: 1.38, 95% CI: 0.40-2.36), whereas the level of evening cortisol between both groups was non-significant (SMD: 0.47, 95% CI: -0.00 to 0.95). Also, the qualitative results showed that the salivary oxidative-stress biomarker was increased in the TMD group compared to controls.

Conclusion: The level of morning salivary cortisol seems to be increased in patients with TMDs compared to controls. This may indicate an association of salivary stress biomarkers and TMDs, although the level of evidence is very low. Therefore, further standardised studies are required to support these findings.

Background: Rhythmic masticatory muscle activity (RMMA) is a biomarker of sleep-related bruxism (SRB). Sleep quality and sympathetic nervous system activity are associated with SRB onset. We focused on fluctuations in blood glucose levels during sleep, which are considered to affect these factors.

Objectives: This study aimed to clarify the effects of stabilising blood glucose levels through dietary instructions on SRB improvement.

Methods: Nineteen healthy adults diagnosed with SRB were included in this study. The first 7 days were the non-intervention period, and the second 7 days were the dietary instruction period (prohibiting sugary beverages, alcohol consumption and high-carbohydrate snacks). A portable continuous glucose monitoring device, polysomnography, electromyography and pulse oximetry were used to measure and compare the interstitial fluid glucose concentration (which is highly correlated with blood glucose levels), electroencephalogram frequency analysis, RMMA frequency per hour (RMMA Index) and heart rate variability.

Results: After instruction, blood glucose fluctuations during sleep [standard deviation of glucose concentration in interstitial fluid (11.0 ± 5.5 to 5.7 ± 3.3 mg/dL, p < 0.01)] decreased significantly and RMMA Index (9.9 ± 3.7 to 7.0 ± 2.8 episodes/h, p < 0.001) also decreased significantly. Analysis of heart rate variability showed a decrease in sympathetic nervous activity, but there were no significant changes in sleep quality indicators based on electroencephalogram analysis.

Conclusion: Stabilisation of blood glucose levels during sleep may improve SRB, particularly by suppressing sympathetic nervous system activity.

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.