Journal of oral rehabilitation最新文献

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.

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.