Journal of Oral & Facial Pain and Headache最新文献

Background: This study aimed to assess the impact of different types of orofacial pain on sleep quality and to examine the influence of age and gender on sleep-related parameters.

Methods: In this cross-sectional study, 400 patients with orofacial pain presenting to the Faculty of Dentistry, Fırat University, were included. Participants were divided into eight pain categories: pulpal, periodontal, impacted tooth-related, dental implant-related, temporomandibular disorder-related, mucosal/cutaneous, neuropathic, and oncologic. Pain intensity was measured using the Numeric Rating Scale, and sleep quality was assessed via the Pittsburgh Sleep Quality Index (PSQI). Non-parametric tests and correlation analyses were used for statistical evaluation.

Results: The mean age was 33.62 ± 13.06 years, and 66.8% were female. The mean global PSQI score was 5.56 ± 2.84. Neuropathic and mucosal/cutaneous pain groups demonstrated significantly higher PSQI scores, especially in sleep latency and disturbances (p < 0.05). Females had significantly higher scores in sleep latency, disturbances, and daytime dysfunction than males (p < 0.05). Age was weakly but significantly correlated with several PSQI components.

Conclusions: Neuropathic and mucosal/cutaneous pain types were associated with the most detrimental effects on sleep quality. Gender and age were also found to influence specific sleep parameters.

Approximately one-third of adults in the United States are estimated to suffer from temporomandibular disorders (TMD). Despite the widespread prevalence, effective diagnosis and management of TMD remains inadequate, contributing to patient frustration and a sense of stigmatization by healthcare providers. To address this gap, significant attention is being directed toward improving educational initiatives at all levels regarding TMD. This perspective aims to explore the historical development, current standards, and emerging trends in TMD-related education in the U.S. and Canada. From its early misconceptions as a disorder primarily caused by occlusal discrepancies, TMD education has evolved towards a biopsychosocial model that acknowledges the multifactorial nature of these disorders. Significant gaps persist in predoctoral dental curricula, hindering the development of effective clinical skills among students, despite advancements in diagnostic criteria, including the Research Diagnostic Criteria for TMD (RDC/TMD) and the more comprehensive Diagnostic Criteria for TMD (DC/TMD) and International Classification of Orofacial Pain (ICOP). Current standards for TMD education highlight the necessity for dentists to achieve competence in managing these disorders, yet the lack of standardization across schools remains a barrier. Integrating multidisciplinary and interprofessional education strategies into the curriculum offers a path forward, as these approaches foster collaborative practice and enhance patient management. Additionally, incorporating artificial intelligence (AI) and other innovative educational technologies holds the potential to revolutionize TMD education, enabling personalized learning and improved clinical decision-making. Addressing these educational gaps and embracing a standardized approach to TMD-related predoctoral education will equip future dental professionals with the knowledge and skills necessary to improve patient outcomes in TMD.

Background: Temporomandibular disorders (TMD) are prevalent orofacial pain conditions; however, the interrelationships among clinical, psychological, and behavioral factors remain insufficiently explored, particularly within the Thai population. This single-center retrospective study aimed to examine the associations among clinical characteristics, pain, bruxism, and psychological factors in patients with TMD.

Methods: The medical records of 222 adult patients diagnosed with TMD at the Orofacial Pain Clinic between January and December 2024 were reviewed. The primary outcomes were the associations of pain severity and symptom duration with psychological factors, and the secondary outcomes were the relationships of sleep and awake bruxism with psychological factors and related variables. Statistical analyses included nonparametric tests, chi-square tests, and logistic regression.

Results: Among the 222 patients (75.7% female; mean age 35.83 ± 17.08 years), 56.8% presented with chronic symptoms, 36.0% reported sleep bruxism, and 37.8% reported awake bruxism. Higher pain severity was significantly associated with depression (p = 0.004), anxiety (p = 0.001), and stress (p = 0.045). Chronic symptoms (>3 months) were associated with depression, anxiety, and stress (p < 0.001). Awake bruxism demonstrated significant associations with all three psychological factors (p < 0.001), whereas sleep bruxism did not show such associations. In multivariable analyses, patients with acute symptoms (≤3 months) had lower odds of sleep bruxism compared with those with chronic symptoms (odds ratio (OR) = 0.37, p = 0.003), and higher stress levels were associated with awake bruxism (OR = 1.15, p < 0.001).

Conclusions: The findings highlight the burden of psychological factors among TMD patients, particularly those with higher pain intensity, chronic symptoms, and awake bruxism. Awake bruxism may serve as a clinical indicator of psychological factors, underscoring the importance of psychological screening and biopsychosocially oriented management. Nonetheless, the results should be interpreted with caution given the retrospective design and the single-center setting.

Background: Temporomandibular Disorders (TMD) are musculoskeletal and neuromuscular conditions involving the temporomandibular joint (TMJ), masticatory muscles, and related structures. Stress can trigger dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, leading to increased cortisol secretion. Salivary cortisol assessment provides a non-invasive method to investigate this relationship.

Methods: A total of 98 participants were recruited-49 patients diagnosed with TMD and 49 healthy controls-at the Faculty of Medicine of the University of Coimbra. Participants were evaluated according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Saliva samples were collected between 9:00 and 11:00 AM, processed with Enzyme-Linked Immunosorbent Assay (ELISA), and analyzed statistically using Shapiro-Wilk and Mann-Whitney tests, with a 95% confidence level.

Results: Salivary cortisol levels were significantly higher in TMD patients (mean = 17.55 nmol/L) compared with controls (mean = 11.09 nmol/L; p = 0.0032). No significant correlations were found between age and cortisol levels.

Conclusions: Patients with TMD present higher salivary cortisol levels, suggesting dysregulation of the HPA axis associated with stress. These findings support the integration of psychosocial factors into the management of TMD.

Clinical trial registration: ClinicalTrials.gov identifier NCT06874868.

Hyperpolarization-activated cyclic nucleotide-gated (HCN) channels have recently emerged as promising targets for the treatment of neuropathic pain. This study investigated the potential involvement of HCN2 channels in the development of trigeminal neuropathic pain following peripheral nerve injury. Infraorbital nerve chronic constriction injury (ION-CCI) model was adopted to rats, and head withdrawal thresholds (HWT) to mechanical stimulation were assessed pre- and postoperatively, as well as after pharmacological intervention. In the trigeminal ganglion (TG), intracellular cyclic adenosine monophosphate (cAMP) and cytoplasmic protein kinase A (PKA) levels were quantified by Enzyme-Linked Immunosorbent Assay (ELISA), while Hcn2 mRNA expression was evaluated by quantitative Polymerase Chain Reaction (qPCR). Immunohistochemical analysis was performed to assess phosphorylated cAMP response element-binding protein (pCREB) expression in the TG and HCN2 expression in infraorbital nerve (ION) axons. In the TG, cAMP and pCREB levels were elevated, whereas cytoplasmic PKA and Hcn2 mRNA levels were reduced. Axonal HCN2 expression was increased in CCI rats. On day 14, HWT was significantly reduced following CCI but was ameliorated by local administration of the HCN channel blocker ivabradine at the site of axonal injury. Collectively, these findings suggest that CCI-induced alterations in cAMP-PKA-pCREB signaling promote HCN2 accumulation in injured axons, thereby contributing to the development of orofacial neuropathic pain following peripheral nerve injury.

Background: Temporomandibular disorders (TMD), particularly pain-related TMD (TMDp), are closely associated with social and psychological factors. However, the neuromechanisms of pain of TMDp are still currently unclear. This study aimed to investigate the altered topological properties of the brain network in the TMDp patients using resting-state functional magnetic resonance imaging (rs-fMRI), and to explore the association between these parameters and emotional and clinical variables of TMDp.

Methods: A total of 41 TMDp patients and 33 age- and gender-matched healthy controls (NCs) were recruited, and rs-fMRI data were obtained from a 3.0T MR scanner. The topological properties of brain functional networks were calculated based on the rs-fMRI data and were compared between two groups to investigate the altered topological characteristics in TMDp. The correlation analysis was also performed between the abnormal topological characteristics and the clinical variables in TMDp patients.

Results: TMDp patients presented significantly decreased clustering coefficient (Cp) and decreased local efficiency (Eloc) when sparsity threshold was 0.05 and 0.06 compared with NCs (p < 0.05), and the Eloc values when sparsity threshold was 0.06 were positively correlated with depressive (r = 0.319, p = 0.042) and anxious (r = 0.348, p = 0.026) variables in TMDp patients.

Conclusions: The current study demonstrated the abnormal topological changes of the brain network were observed in TMDp, which could be helpful in understanding the neuromechanisms of pain of TMDp. The topological properties of the brain network based on rs-fMRI could be considered as a new simple tool to monitor the dysfunction network of the brain in TMDp.

Background: This study evaluated the clinical efficacy of prolotherapy using hypertonic dextrose and polydeoxyribonucleotide (PDRN) in patients with temporomandibular joint disorders (TMDs) who did not respond to conventional treatments.

Methods: A retrospective chart review of 66 patients diagnosed with TMD was conducted. Patients underwent prolotherapy between March and December 2024 and were classified into soft-tissue-related and bone-related TMD groups. Treatment involved injections of hypertonic dextrose or PDRN targeting anatomical structures within the temporomandibular joint (TMJ). Pain and function were assessed using the visual analog scale (VAS) and maximum mouth opening (MMO). Additional parameters, including joint sounds and jaw displacement (S deviation or L deflection), were analyzed. Outcomes were measured at baseline, after each prolotherapy session, and during the final follow-up. Statistical analyses included paired t-tests, McNemar's tests, Analysis of Variance (ANOVA), and regression modeling.

Results: Prolotherapy was administered an average of 2.3 times per patient. The baseline VAS score decreased from 4.34 ± 2.12 to 1.00 ± 1.58 (p < 0.001), and MMO improved from 31.0 ± 8.7 mm to 40.8 ± 4.55 mm (p < 0.001). Joint sounds, jaw displacement, and deflection also showed significant reductions. Comparative analysis of prolotherapy agents revealed no statistically significant differences between the PDRN and dextrose groups, although both demonstrated significant improvements in MMO and VAS scores. Among patients with baseline joint sounds, 23 individuals experienced complete resolution of sounds, along with significant reductions in jaw displacement (69.6% to 13.0%, p < 0.001) and deflection (52.2% to 8.7%, p < 0.001).

Conclusions: Prolotherapy is an effective intervention for improving pain and jaw function in TMD patients. Both hypertonic dextrose and PDRN demonstrated significant clinical improvements on TMD prolotherapy.

Burning Mouth Syndrome (BMS) is a complex chronic neuropathic orofacial pain disorder characterized by a persistent burning or dysesthetic sensation in the oral cavity without an identifiable organic cause. The management of BMS has evolved beyond symptom relief to focus on achieving full functional recovery (FFR), which encompasses restoring patients to their usual activities without restrictions, addressing both physical and psychological dimensions. Key pharmacological treatments such as clonazepam and capsaicin are explored in detail, alongside the potential of newer agents like various classes of antidepressants (including tricyclic antidepressants, selective serotonin reuptake inhibitors, and serotonin and noradrenaline reuptake inhibitors, vortioxetine) and antiepileptics showing promise in addressing the multifactorial nature of BMS. Non-pharmacological interventions, such as cognitive-behavioral therapy (CBT), low-level laser therapy (LLLT), and transcranial magnetic stimulation (TMS), are highlighted for their potential to complement pharmacological treatments. These interventions aim to modify pain perception, reduce psychological burdens, and enhance overall quality of life. Lifestyle modifications, including dietary changes, stress management techniques, improved sleep hygiene, and regular physical activity, are essential components of a holistic treatment plan that addresses modifiable risk factors affecting brain health. The integration of telemedicine and digital health resources is proposed to enhance patient management and accessibility to multidisciplinary care. This review provides a comprehensive update on all available therapeutic approaches for BMS, encompassing pharmacological treatments, non-pharmacotherapeutic interventions, and lifestyle optimization strategies, offering a holistic perspective on managing this condition.

Temporomandibular disorders (TMD) are common orofacial pain conditions with multifactorial etiologies. Somatization refers to the manifestation of psychological distress as physical symptoms in the absence of clear medical causes. A growing body of clinical research has recently shown a strong association between TMD and somatization. A substantial proportion of TMD patients exhibit moderate to high levels of somatic symptoms, leading to greater pain intensity, longer disease duration, and heightened psychological distress. The TMD-somatization relationship has been underpinned by complex pathophysiological interactions and the underlying mechanisms involved, including central sensitization (CS), potential biomarkers, nociplastic pain, neurobiological changes, and so on. Clinically, recognizing somatization in TMD patients is essential, as it can adversely affect treatment outcomes and necessitate a biopsychosocial management approach. In this narrative review, we summarize the clinical evidence of the TMD-somatization association, discuss the underlying mechanisms, explore management implications, and identify directions for future research.

Background: The study evaluated how often pharmacological therapies were started, modified, or discontinued after a consultation in a sample of orofacial pain patients and identified potential factors associated with treatment choices in the pharmacological management of orofacial pain.

Methods: For this study, patient files (N = 208) originating from the daily routine of the Orofacial Pain Unit, University of Zurich (January 2017-December 2022) were analysed. Demographics, lifestyle, pain characteristics, diagnosis, and pharmacological therapy pre- and post- consultation with an orofacial pain specialist were recorded. Changes in pharmacotherapy, pain perception, and therapeutic success were assessed. Descriptive statistics, paired McNemar and chi-square tests were conducted.

Results: A total of 208 patients were included in the study (64.4% females, mean age 45.9 years). The mean pain intensity was 6.93 for maximum pain and 4.62 for average pain. The most common pain locations were the face (64.3%), followed by the head (33.3%). At the initial consultation, 51.4% of patients were already using pharmacological therapy. The most common pre-diagnosis medications were non-steroidal anti-inflammatory drugs (NSAIDs) (44.9%), antidepressants with pain-modulating properties (9.3%), and magnesium (7.5%). After consultation, myofascial orofacial pain was the most common diagnosis (50.5%). The prescription of medications increased significantly to 74.5% (p < 0.001). Topical NSAIDs (64.0%) and magnesium supplements (40.0%) were the most prescribed. A significant relationship between therapy changes and diagnosis was observed, particularly for myofascial pain (p = 0.024) and temporomandibular joint disorders (p < 0.001). Therapy outcomes were positive for 67.0% of the observed patients.

Conclusions: Age, psychological distress, and pain location significantly influenced pharmacological management of orofacial pain. Pharmacological therapy differed between before and after consultation at the Orofacial Pain Unit. Accurate diagnosis and a multidisciplinary approach to treatment can significantly improve therapy success.