Journal of orofacial pain最新文献

Aims: To assess the effects of four- and six-point acupuncture on facial sensory detection thresholds to thermal and electrical stimuli.

Methods: Ten healthy volunteers underwent four-point acupuncture at ST6 and LI4 bilaterally for 15 minutes. A further 10 subjects underwent six-point acupuncture by adding needling at ST2 bilaterally. Sensory testing to thermal and electrical stimuli applied to mental and infraorbital nerve dermatomes was performed at baseline, 10 minutes, 1 hour, and 1 day after needling.

Results: In the mental and infraorbital nerve dermatomes, six-point acupuncture significantly increased warm threshold by a peak mean of 1.1°C to 1.4°C (repeated measures ANOVA P = .001) and this effect was significant at all time points relative to baseline (P < .05). No significant effects were observed by the four-point acupuncture on warm thresholds, and neither four- nor six-point acupuncture significantly altered electrical detection thresholds.

Conclusion: A dose effect, related to the number of points employed, may be present when employing acupuncture.

Aim: To assess whether changes in diagnoses and management of temporomandibular joint disorder (TMJD) patients are influenced by radiographic findings and if there is an association between specific radiologic alterations and management strategy changes.

Methods: A total of 204 patients with TMJ symptoms were examined using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Diagnoses and management were first decided without the aid of radiographs. Management categories were: pharmacology, physiotherapy, counseling and behavioral treatment, occlusal stabilization, surgery, additional examinations, and referrals, each with subcategories. Sagittal TMJ tomograms were assessed for the presence of flattening, erosion, osteophyte, and sclerosis in the TMJ components. Diagnoses and management were reevaluated after gaining access to the radiographs and radiographic classifications. Logistic regression analyses were performed with changes in management as the dependent variable and age and radiographic findings as the independent variables.

Results: Diagnosis was changed for 56 patients, mainly from arthralgia to osteoarthritis. Management was changed for 55 patients. Most changes occurred in pharmacology and physiotherapy followed by counseling and behavioral treatment, occlusal stabilization, referrals, additional examinations, and surgery. Changes were mostly within the categories, and the highest number of changes was seen in pharmacology, physiotherapy, and counseling and behavioral treatment. Radiographic degenerative findings increased the chance of change (any change) (odds ratio [OR] ⋝ 2.03) and the chance of change in pharmacology (OR ⋝ 2.56) and physiotherapy (OR = 2.48) separately. No other significant associations were found.

Conclusion: Radiographic degenerative findings increased the chance of changes in management strategy. However, 73% of the TMJD patients had no changes in management after radiographic examination. In cases with changes, these were mainly adjustments within management categories.

Aims: To evaluate the influence of an oral appliance on morning headache and orofacial pain in subjects without reported sleep-disordered breathing (SDB).

Methods: Twelve subjects aged 27.6 ± 2.1 (mean ± SE) years and suffering from frequent morning headache participated in this study. Each subject was individually fitted with a mandibular advancement appliance (MAA). The first two sleep laboratory polygraphic recording (SLPR) nights were for habituation (N1) and baseline (N2). Subjects then slept five nights without the MAA (period 1: P1), followed by eight nights with the MAA in neutral position (P2), ending with SLPR night 3 (N3). Subjects then slept five nights without the MAA (P3), followed by eight nights with the MAA in 50% advanced position (P4), ending with SLPR night 4 (N4). Finally, subjects slept 5 nights without the MAA (P5). Morning headache and orofacial pain intensity were assessed each morning with a 100-mm visual analog scale. Repeated measures ANOVAs and Friedman tests were used to evaluate treatment effects.

Results: Compared to the baseline period (P1), the use of an MAA in both neutral and advanced position was associated with a ⋝ 70% reduction in morning headache and ⋝ 42% reduction in orofacial pain intensity (P ⋜ .001). During the washout periods (P3 and P5), morning headache and orofacial pain intensity returned to close to baseline levels. Compared to N2, both MAA positions significantly reduced (P < .05) rhythmic masticatory muscle activity (RMMA).

Conclusion: Short-term use of an MAA is associated with a significant reduction in morning headache and orofacial pain intensity. Part of this reduction may be linked to the concomitant reduction in RMMA.

Aim: To assess the scientific evidence on the efficacy of low-level laser therapy (LLLT) in the treatment of temporomandibular disorders (TMD).

Methods: The databases of PubMed, Science Direct, Cochrane Clinical Trials Register, and PEDro were manually and electronically searched up to February 2010. Two independent reviewers screened, extracted, and assessed the quality of the publications. A meta-analysis- was performed to quantify the pooled effect of LLLT on pain and function in patients with chronic TMD.

Results: The literature search identified 323 papers without overlap between selected databases, but after the two-phase study selection, only six randomized clinical trials (RCT) were included in the systematic review. The primary outcome of interest was the change in pain from baseline to endpoint. The pooled effect of LLLT on pain, measured through a visual analog scale with a mean difference of 7.77 mm (95% confidence interval [CI]: -2.49 to 18.02), was not statistically significant from placebo. Change from baseline to endpoint of secondary outcomes was 4.04 mm (95% CI 3.06 to 5.02) for mandibular maximum vertical opening; 1.64 mm (95% CI 0.10 to 3.17) for right lateral excursion and 1.90 mm (95% CI: -4.08 to 7.88) for left lateral excursion.

Conclusion: Currently, there is no evidence to support the effectiveness of LLLT in the treatment of TMD.

Aims: To characterize the control of jaw-clenching forces by means of a simple force-matching exercise.

Methods: Seventeen healthy subjects, provided with visual feedback of the exerted force, carried out a unilateral force-matching exercise requiring developing and maintaining for 7 seconds a jaw-clenching force at 10%, 30%, 50%, and 70% of the maximum voluntary contraction. The task was repeated three times in each of two sessions. Motor performance was assessed, for both left and right sides, by different indices quantifying mean distance (MD), offset error (OE), and standard deviation (SD). Their dependence on force intensity, side, and time was assessed by ANOVA.

Results: All error indices increased with the intensity of contraction in absolute terms. After normalization with respect to force level, the average performance in the second session was characterized by MD of 8.1% ± 2.6, OE 4.8% ± 2.9, and SD 12.7% ± 6.7 (mean ± standard deviation). Assessment of performance exhibited good reliability for all indices (intraclass correlation coefficient ranging from 74% to 88%). The motor performance improved with repetition (P < .01), varied considerably between subjects, was not correlated with gender or age (P > .05) but was highly correlated between left and right side (P < .01).

Conclusion: The adopted approach is adequate to provide for an objective assessment of individual force control, although the presence of a learning phase must be taken into account.

Aims: To compare prevalences of self-reported temporomandibular joint and muscle disorders (TMJMD)-type pain, headaches, and neck and back pains in the 2000 to 2005 US National Health Interview Survey (NHIS) by gender and age for non-Hispanic Whites (Whites), Hispanics, and non-Hispanic Blacks (Blacks).

Methods: Data from the 2000 to 2005 NHIS included information on gender, age, race, ethnicity, and different common types of pain specifically: TMJMD-type pain, severe headaches/migraine, neck, and low back pains.

Results: A total of 189,992 people were included: 52% female and 48% male, 73% White, 12% Hispanic, 11% Black, and 4% "Other." The overall prevalence of TMJMD-type pain was 4.6%; severe headaches/migraine was 15.4%; neck, 14.9%; and low back, 28.0%. Survey logistic regression models estimating race-specific, age-adjusted curves revealed race by age pain differences. For TMJMD-type pain, White females presented the highest prevalence at younger ages, decreasing after age 40. Prevalences for Hispanic and Black females, although lower at younger ages, increased up to age 60 and remained higher than Whites. Males showed less racial/ethnic and age variation. Severe headaches/migraines presented an age pattern similar to TMJMD-type pain for White females and little overall variation for males, but without racial differences. Neck pain showed some similarities to TMJMD-type pain: higher in Whites at younger ages, lower at older ages, with Hispanics having the highest rates after their 60's. For low back pain, the rates peaked around the sixth decade for all racial/ethnic groups.

Conclusion: The patterns of TMJMD-type pain varied greatly within and across racial/ethnic groups by gender and across the adult lifespan. Similarities and differences for the other pains were noted.

Aims: To determine in a representative sample of the Australian adult population the relationship between age, gender, and two components of perceived stress (distress and control) and to investigate whether the relationship of perceived stress and temporomandibular disorder (TMD)-related orofacial pain symptoms was modified by gender or age.

Methods: Data were from the National Survey of Adult Oral Health conducted in Australia in 2004-2006 and were collected from 3,954 adults aged 18 to 91 years. TMD-related orofacial pain symptoms were evaluated using seven validated screening questions. Perceived stress was measured with the 14-item Perceived Stress Scale and was investigated to empirically test its two theoretical components (distress and sense of control), using principal components analysis.

Results: Prevalence of TMD-related orofacial pain symptoms was 10.1% in the Australian adult population. Prevalence was higher in females than in males, inversely related to age, and positively related to distress and current cigarette smoking. Principal component analysis confirmed the theoretical presence of two factors labeled here as distress and control. An inverse relationship of age and distress was more pronounced in females than in males (P value for interaction = .005). In the adjusted binary logistic regression model, age, smoking, and distress remained positively associated with symptoms. A sense of control was protective against TMD-related orofacial pain symptoms, but only for males (P value for interaction = .040).

Conclusion: The higher prevalence of TMD-related orofacial pain symptoms in females was better explained by their lower perception of control than from a greater perception of distress.

Myxomas of the maxillary sinus are uncommon benign tumors arising from the primitive mesenchyme. They may be related to dental malformations or missing teeth but may also occur without any abnormalities. They usually result in facial deformity manifested by slow, painless bony expansion. Although these tumors are well-circumscribed, they are more extensive than they appear due to their local aggressiveness and bone erosion. Therefore, it should be widely resected with maximal preservation of surrounding structures to prevent recurrence. This article reports a case of myxoma of the maxillary sinus and nighttime facial pain in a 33-year-old male who underwent curettage following debridement with a microdebrider via an intranasal endoscopic approach and surgery involving a modified Caldwell-Luc approach.

Aims: To use the ultrashort time-to-echo magnetic resonance imaging (UTE MRI) technique to quantify short T2* properties (obtained through gradient echo) of a disc from the human temporomandibular joint (TMJ) and to corroborate regional T2* values with biomechanical properties and histologic appearance of the discal tissues.

Methods: A cadaveric human TMJ was sliced sagittally and imaged by conventional and UTE MRI techniques. The slices were then subjected to either biomechanical indentation testing or histologic evaluation, and linear regression was used for comparison to T2* maps obtained from UTE MRI data. Feasibility of in vivo UTE MRI was assessed in two human volunteers.

Results: The UTE MRI technique of the specimens provided images of the TMJ disc with greater signal-to-noise ratio (~3 fold) and contrast against surrounding tissues than conventional techniques. Higher T2* values correlated with lower indentation stiffness (softer) and less collagen organization as indicated by polarized light microscopy. T2* values were also obtained from the volunteers.

Conclusion: UTE MRI facilitates quantitative characterization of TMJ discs, which may reflect structural and functional properties related to TMJ dysfunction.

This article reviews the existing literature of the common anatomic and physiologic aspects of cluster headache and sleep-related breathing disorders to point out evidence suggesting potential therapies beneficial for both maladies. A search of PubMed, as well as relevant textbooks, was conducted using the terms cluster, headache, sleep, apnea, pain, and chronobiology to find any previously published work that may connect the two disorders. Relevant references in the literature were also investigated. As a group, cluster headache patients tend to have a higher incidence of sleep-related breathing disorders as compared to the noncluster headache population. While commonalities in anatomy and physiology exist, robust evidence linking the two disorders is currently lacking. Many people are unaware that they suffer with a sleep-related breathing disorder. The high incidence of these two disorders occurring together should prompt the clinician who treats cluster headache patients to be acutely aware that a yet undiagnosed sleep disorder may also be present.