Journal of orofacial pain最新文献

Aims: To combine empirical evidence and expert opinion in a formal consensus method in order to develop a quality-assessment tool for experimental bruxism studies in systematic reviews.

Methods: Tool development comprised five steps: (1) preliminary decisions, (2) item generation, (3) face-validity assessment, (4) reliability and discriminitive validity assessment, and (5) instrument refinement. The kappa value and phi-coefficient were calculated to assess inter-observer reliability and discriminative ability, respectively.

Results: Following preliminary decisions and a literature review, a list of 52 items to be considered for inclusion in the tool was compiled. Eleven experts were invited to join a Delphi panel and 10 accepted. Four Delphi rounds reduced the preliminary tool-Quality-Assessment Tool for Experimental Bruxism Studies (Qu-ATEBS)- to 8 items: study aim, study sample, control condition or group, study design, experimental bruxism task, statistics, interpretation of results, and conflict of interest statement. Consensus among the Delphi panelists yielded good face validity. Inter-observer reliability was acceptable (k = 0.77). Discriminative validity was excellent (phi coefficient 1.0; P < .01). During refinement, 1 item (no. 8) was removed.

Conclusion: Qu-ATEBS, the seven-item evidence-based quality assessment tool developed here for use in systematic reviews of experimental bruxism studies, exhibits face validity, excellent discriminative validity, and acceptable inter-observer reliability. Development of quality assessment tools for many other topics in the orofacial pain literature is needed and may follow the described procedure.

Aims: To test whether temporomandibular disorders (TMD) case-control differences in conditioned pain modulation (CPM) exist, using a mechanically evoked temporal summation (TS) model.

Methods: A series of 10 repetitive, mildly noxious, mechanical stimuli were applied to the fingers of 30 women with TMD, who had a primary diagnosis of masticatory myofascial pain, and 30 age-matched healthy women. The subjects rated the pain intensity caused by the 1st, 5th, and 10th stimuli in the series. To evaluate CPM, the same series of mechanical stimulations were applied with concomitant exposure of the other hand to a painfully cold water bath. Statistical inferences were based on t tests, chi-square tests, or analysis of variance (ANOVA), as appropriate.

Results: Pain ratings increased significantly with stimulus repetition (P < .01) and CPM significantly reduced TS of pain (P < .01). Of particular note, both groups showed very similar degrees of CPM, with no significant group difference.

Conclusion: Painful TMD is not necessarily associated with a compromised ability to engage the endogenous analgesic system in an experimental setting.

Aims: To investigate thermal thresholds of selected orofacial sites, determine if there is a relationship between thermal thresholds at each site, and analyze the influence of two different baseline temperatures on thermal thresholds at the tongue tip.

Methods: Thirty healthy men (mean age, 26 years) participated. Cold detection (CDT), warm detection (WDT), cold pain (CPT), and heat pain (HPT) thresholds were measured bilaterally at five orofacial sites (mentum, lower lip, cheek, forehead, and tongue tip). Relations between thermal thresholds at each test site were assessed. Thermal sensitivity of the tongue tip was compared at two different baseline temperatures (32°C and 36°C). One-way ANOVA, Turkey post-hoc test, paired t test and Pearson's correlation were used for statistical analyses.

Results: There was a significant difference for CDT, WDT, and HPT between test sites (ANOVA, P < .001) but no significant difference for CPT (P = .634). Subjects sensitive to cooling were sensitive to warming at the mentum (r = 0.379), tongue tip (r = 0.610), and cheek (r = 0.431) but not at the other test sites. There was a strong negative correlation between CPT and HPT at all test sites. There was no significant difference for CDT and WDT at the baseline temperature of 36°C (paired t test, P = .660), but there was a significant difference at the baseline temperature of 32°C (P < .001). There were no significant differences between CPTs at the two different baseline temperatures (P = .773), while a significant difference existed between HPTs (P = .034).

Conclusion: Thermal thresholds varied between the orofacial test sites, and baseline temperature affected thermal sensitivity of the tongue. Subjects who were relatively sensitive to cold tended to be more sensitive to heat.

Aims: To assess the influence of myofascial temporomandibular disorder (TMD) pain on the pressure pain threshold (PPT) of masticatory muscles in women during a migraine attack.

Methods: The sample comprised 34 women, 18 to 60 years of age, with a diagnosis of episodic migraine previously confirmed by a neurologist. All subjects were evaluated using the Research Diagnostic Criteria for TMD (RDC/TMD) to determine the presence of myofascial pain. They were divided into two groups: group 1 (n = 18) included women with migraine; group 2 (n = 16) included women with migraine and myofascial TMD pain. Participants were evaluated by measuring PPT values of the masseter and anterior temporalis muscles and Achilles tendon with a pressure algometer at two moments: pain free and during a migraine attack. A three-way analysis of variance with a 5% significance level was used for statistical purposes.

Results: Significantly lower PPT values were found during the migraine attack, especially for women with concomitant myofascial pain, regardless of the side of the reported pain.

Conclusion: Migraine attack is associated with a significant reduction in PPT values of masticatory muscles, which appears to be influenced by the presence of myofascial TMD pain.

Aims: To determine whether an intervention reduces oromotor activity and masticatory muscle pain in myofascial temporomandibular disorder (M/TMD) patients with high levels of masticatory muscle activity associated with sleep bruxism.

Methods: Fourteen women with M/TMD and prior polysomnographic evidence consistent with sleep bruxism participated in a 10-week single-group pre-test/ post-test mechanistic clinical trial. A 2-week period of baseline monitoring of individually biocalibrated electromyographic (EMG) events associated with sleep bruxism was followed by 6 weeks of EMG-event-contingent treatment via an innocuous electrical pulse to the skin overlying the temporalis muscle. Treatment was discontinued during 2-week follow-up monitoring. Each night before sleep, subjects recorded their average daily pain.

Results: Mixed-model analysis of variance showed a reliable reduction of EMG events during contingent stimulation treatment periods, but frequency of EMG events returned to baseline levels during follow-up (linear term, P = .002; quadratic term, P = .001). In contrast, nightly pain reports failed to show any systematic changes during treatment (linear and quadratic trends, both P > .10).

Conclusion: Spontaneous pain severity and nighttime oromotor activity vary independently over nights, even in M/TMD patients selected for relatively high levels of both characteristics.

Aims: To evaluate the impact of smoking on pain severity, psychosocial impairment, depression, anxiety, and sleep disturbances in a large sample of patients with temporomandibular disorders (TMD).

Methods: A retrospective database review was performed on data from 3,251 patients with TMD, diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Pain severity ratings and psychometric data regarding impairment, sleep disturbance, depression, and anxiety were obtained. Differences between smokers and nonsmokers were evaluated by means of chi-square tests and independent samples t tests. Logistic regression models were used to study the impact of smoking, pain severity, and psychometric variables.

Results: Of the total population, 42.5% comprised RDC/TMD group I (muscle pain), 25.3% comprised RDC/TMD group III (joint pain), and 32.2% comprised a mixed RDC/TMD group consisting of patients with both a group I and a group III diagnosis. Of the entire population, 26.9% admitted they were smokers. Even after controlling for relevant covariates, smokers reported significantly higher pain severity, impairment, anxiety, depression, and sleep disturbances than nonsmokers.

Conclusion: Smokers with TMD reported higher pain severity than nonsmokers with TMD. These patients are at higher risk for factors that may adversely affect treatment outcomes. J OROFAC PAIN 2013;27:32-41.

Aims: To test the hypothesis that jaw muscles and specific neck muscles, ie, levator scapulae, trapezius, sternocleidomastoideus, and splenius capitis, co-contract at the different submaximum bite forces usually generated during jaw clenching and tooth grinding, and for different bite force directions.

Methods: Bite-force transducers that measured all three spatial force components were incorporated in 11 healthy subjects. The test persons developed feedback-controlled submaximum bite forces in a variety of bite-force directions. The electromyographic (EMG) activity of the levator scapulae, splenius capitis, and trapezius muscles was recorded, at the level of the fifth cervical vertebra, by use of intramuscular wire electrodes. The activity of the sternocleidomastoideus and masseter muscles was recorded by surface electrodes. For normalization of the EMG data, maximum-effort tasks of the neck muscles were conducted in eight different loading directions by means of a special force-transducer system. Differences between neck-muscle activity during chewing, maximum biting in intercuspation, and the force-controlled motor tasks were compared with the baseline activity of the various muscles by one-way repeated-measures analysis of variance.

Results: The results confirmed the hypothesis. Co-contractions of the neck muscles in the range of 3% to 10% of maximum voluntary contraction were observed. Significant (P < .05) activity differences were recorded as a result of the different force levels and force directions exerted by the jaw muscles. Long-lasting action potential trains of single motor units triggered by jaw clenching tasks were also detected.

Conclusion: The findings support the assumption of a relationship between jaw clenching and the neck muscle activity investigated. The low level of co-contraction activity, however, requires further study to elucidate possible pathophysiological interactions at the level of single motor units.

Aims: To identify potential predictors of self-reported sleep bruxism (SB) within children's family and school environments.

Methods: A total of 65 primary school children (55.4% males, mean age 9.3 ± 1.9 years) were administered a 10-item questionnaire investigating the prevalence of self-reported SB as well as nine family and school-related potential bruxism predictors. Regression analyses were performed to assess the correlation between the potential predictors and SB.

Results: A positive answer to the self-reported SB item was endorsed by 18.8% of subjects, with no sex differences. Multiple variable regression analysis identified a final model showing that having divorced parents and not falling asleep easily were the only two weak predictors of self-reported SB. The percentage of explained variance for SB by the final multiple regression model was 13.3% (Nagelkerke's R² = 0.133). While having a high specificity and a good negative predictive value, the model showed unacceptable sensitivity and positive predictive values. The resulting accuracy to predict the presence of self-reported SB was 73.8%.

Conclusion: The present investigation suggested that, among family and school-related matters, having divorced parents and not falling asleep easily were two predictors, even if weak, of a child's self-report of SB.

Aims: To identify potential predictors of self-reported sleep bruxism (SB) within children's family and school environments.

Methods: A Aims: To assess possible differences between care seekers and non-care seekers with temporomandibular disorder (TMD) pain complaints, by using semi-structured interviews.

Methods: Semi-structured interviews were held with 16 subjects who had TMD- pain complaints: 8 care seekers and 8 non-care seekers, matched for age, sex, pain intensity, and fear of movement. Subjects were selected from a previously held survey study, with their consent. The interviews were audiotaped, transcribed verbatim, and analyzed according to qualitative content analysis.

Results: From the analysis, seven themes differentiating care seekers from non-care seekers were identified: catastrophizing, pain management, assertiveness, critical attitude towards health care, confidence in medical care, recognition, and adequate referral.

Conclusion: Aspects upon which care seekers differed from non-care seekers were mainly person-related characteristics. Next to these characteristics, it appeared that inadequate referrals may play a role in care seeking. The use of semi-structured interviews may further improve insights into processes that determine care seeking among people with TMD pain complaints.