Journal of Oral & Facial Pain and Headache最新文献

To evaluate the association between definitive sleep bruxism and primary headaches and to analyze other variables that may also be associated with definitive sleep bruxism. A descriptive study was carried out with a sample of adults with a medical indication for polysomnography in Florianópolis, Brazil. Data were collected in three phases: questionnaires, physical examinations and polysomnography. Pearson's chi-square test and unadjusted and adjusted binary regressions were carried out using the Statistical Package for the Social Sciences computer program. The significance level was 5%, and the confidence interval (CI) was 95%. The test power was calculated by the G*Power computer program. The sample consisted of 23 men and 19 women, with an average age of 45.6 ± 15 years. Approximately 76% of the participants had sleep bruxism, and 57% had primary headache. The odds ratio between definitive sleep bruxism and primary headaches was 0.86 (95% CI 0.20 to 3.64; p = 0.71), demonstrating no association between these variables. Among the other variables analyzed, only alcohol consumption was associated with bruxism, with an odds ratio of 5.96 (95% CI 1.26 to 28.28; p = 0.03). According to binary regression, no variable was a confounding factor for definitive sleep bruxism. The power of the test was 0.028. There was no association between definitive sleep bruxism and primary headaches. Alcohol consumption increases the patient's chance of having sleep bruxism by almost six times. Knowledge about the association of sleep bruxism with other variables can help dentists detect it and explain the condition to patients.

The aims of the study are to analyze the influence of pain and no pain expectations on the physiological (electromyography (EMG) and pupillometry) and cognitive (Numerical Rating Scale (NRS)) response to pain. Pain expectation and no pain expectation situations were induced by employing instructional videos. The induction of pain was performed by palpating the masseter with an algometer in a sample of 2 groups: 30 healthy participants (control group) and 30 patients (Temporomandibular disorders (TMD) group) with chronic myofascial pain with referral in the masseter muscle (Diagnostic Criteria for Temporomandibular Dissorders (DC/TMD)). Used a mixed design all participants were exposed to pain and no pain conditions in the same session, but the order of the presentation was counterbalanced across participants to control its possible influence. A significantly larger pupillary diameter was observed in the pain expectation relative to the no pain expectation condition in both groups. The TMD group presented larger EMG activity and larger scores in anxiety, somatization, catastrophizing and central sensitization than the control group. In the NRS, the TMD group also showed a significantly higher score than the control group. The TMD group presented similar NRS scores in the expectation condition compared to the no pain expectation condition, while the control group presented higher scores for pain expectation than for no pain expectation. Pain expectation modulated the pain cognitive pain assessment and pupil diameter in controls. The cognitive pain assessment was altered in the TMD group compared to the control group, particularly in the no pain expectation condition, this may be due to a negative reappraisal of pain due to past experiences, as pointed out by the observed level of catastrophizing. Pain expectations did not influence the EMG, significantly higher EMG activity was found in the TMD group compared to the control group regardless of expectation type.

Chronic intraoral neuropathic pain (NP), often developing post-dental procedures, poses significant management challenges. The prevalent use of systemic treatments, with their frequent substantial side effects, emphasizes the need for alternative therapeutic strategies. Our aim is to explore the efficacy and adherence with a topical drug regimen delivered through a neurosensory stent (NS) for treating chronic neuropathic pain (NP) within the oral cavity. A retrospective analysis in addition to a telephone structured questionnaire conducted on patients with chronic intraoral NP treated at the Orofacial Pain Clinic, Hadassah Medical Center, between 2017 and 2020. A standard combination of lidocaine 2%, pregabalin 5%, ibuprofen 5% and optionally amitriptyline 2% was administered using a custom-made NS. Out of 12 participants, 6 reported more than 50% pain relief, indicating high effectiveness. Notably, females showed a more favorable response than males. 75% of patients used the NS consistently. No significant difference in pain relief was observed between the standard formula and the one with supplementary amitriptyline. The results highlight the potential of NS as an alternative, or adjunct treatment that may reduce the dosage of systemic medications for chronic NP. Additionally, the NS device can be used as an "escape drug", or add-on, method if pain exacerbates under systemic therapy or if higher dose of systemic therapy causes serious side effects. Large scale prospective double-blind studies are required to substantiate the findings of this pilot study.

Trigeminal neuralgia (TN) usually affects the maxillary and mandibular branches of the fifth cranial nerve. Although the condition is primarily unilateral, few cases of bilateral manifestation have been reported. TN is uncommon; however, it significantly affects patients' quality of life because the neuropathic pain worsens over time. Paroxysmal pain is triggered by mechanical stimuli or environmental factors. Diagnosis is usually based on clinical findings, including pain triggered by palpation of distinct areas; nevertheless, imaging studies, such as magnetic resonance imaging, are always used to rule out a secondary cause. TN can be caused by several factors, such as trauma and neurovascular compression, or could be idiopathic, which complicates its treatment. Although several studies focused on TN have been reported, a treatment modality with 100% efficacy is lacking. The first-line treatment is pharmacological; however, surgery may be required if symptoms persist.

The aim is to assess the associations of jaw functional limitation and jaw overuse behavior with pain modified by function as a required diagnostic criterion for painful temporomandibular disorders. This cross-sectional study from the TMJ Impact Project utilized secondary data analyses of 249 participants who met the inclusion criteria of having facial pain in the prior 30 days and valid responses to the pain modified by function (Items 4A-D derived from the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Symptom Questionnaire). Independent t-tests (alpha = 0.05) were used to assess the associations between pain modified by function items with similarly assessed concepts from the Jaw Functional Limitation Scale (JFLS) and Oral Behavior Checklist (OBC). The magnitude of each association was converted to an effect size for interpretation. Pain modified by mastication (item A) and jaw mobility (item B) were significantly associated with the corresponding JFLS items (effect sizes <0.1-1.0) and exhibited a hierarchical pattern. Pain modified by jaw overuse behaviors (item C) was associated with the corresponding OBC items (effect sizes <0.1-0.8). Pain modified by other functions (item D) exhibited associations with the corresponding JFLS items (effect sizes 0.5-0.9). Pain modified by function is an integral part of musculoskeletal disorders and anchored to the interoceptive body experience. Results indicate that the DC/TMD pain modified by function questions used as diagnostic criteria have sufficient scope and the responses fit with data measuring related constructs pertaining to etiology (OBC) or consequences (JFLS).

Oral behaviors and psychological distress are known to be related to temporomandibular disorders (TMDs). However, the relationship between various oral behaviors and specific TMD subgroups in adult women experiencing psychological distress is still unclear. To investigate the relationship between various oral behaviors and different TMD subgroups with different psychological distress states. A total of 210 female TMD patients were divided into 3 subgroups according to their symptoms: pain-related (PT), intra-articular (IT) and combined pain-related and intra-articular (CT). Another 70 participants without TMDs were recruited as the non-TMD (NT) control group. We used reduced Chinese versions of the Oral Behavior Checklist (OBC-Ch 8), including awake (OBC-Ch 6) and sleep-related activities, the 9-item Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Disorder Scale (GAD-7) to assess oral behaviors and psychological distress. Differences in OBC scores among TMD subgroups were analyzed using Chi-square, Kruskal-Wallis H and post hoc tests, with significance set at p < 0.05. Oral behavior subscale scores significantly differed among TMD subgroups (p < 0.01). The OBC-Ch 8 scores of PT, IT and CT subjects were significantly higher than the NT group. PT and CT groups also had significantly higher GAD-7 and PHQ-9 scores. Sleep-related OBC scores of the PT, IT and CT groups were higher than those in the NT group, regardless of psychological states (p < 0.001). In psychologically distressed subjects, OBC-Ch 8 scores for PT and CT subgroups were significantly higher than those in the NT group. Oral behaviors are differentially associated with various TMD subgroups in female adults, and a correlation exists between individual psychological status and OBC scores.

Myofascial pain is one of the common symptoms in patients with temporomandibular joint disorders (TMD). Occlusal splint (OS) and masticatory muscle trigger point (TP) local injections are primary treatment options. We aimed to investigate the effects of these treatments using clinical and elastography measures. Patients who were diagnosed with myofascial pain according to Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) were included. There were 16 patients in each group. Group 1 was treated with occlusal splint, Group 2 was treated with occlusal splint and masseter muscle lidocaine injection, Group 3 was treated with masseter muscle lidocaine injection and Group 4 consisted of healthy volunteers. Degree of pain and maximum mouth opening (MMO) were recorded. Masseter muscle stiffness was evaluated by Shear wave elastography. Measurements were repeated at 1st and 3rd months of post-treatment. Pain decreased at all times in all the patients (p = 0.001). Pain in Group 2 and Group 3 approached 0 level at 3rd month. MMO increased from baseline to 1st month and from 1st month to 3rd month and masseter stiffness decreased from baseline to 1st month and to 3rd month (p = 0.001) in all groups. Occlusal splint and masseter muscle lidocaine injection were effective in reducing pain and increasing MMO in patients with myofascial pain. All treatments reduced masseter muscle stiffness. All the treatment modalities had clinically similar and successful outcomes.

Head pain (HP) and orofacial pain (OFP) are the most prevalent types of pain worldwide, encompassing cranial, oral and facial pain. The aim of this umbrella review was to answer the following questions: "What is the overall prevalence of HP/OFP and the different prevalences of HP/OFP conditions in adults and children?". We searched for studies investigating the prevalence of HP/OFP in four major databases and two databases from the grey literature, based on the following PECOS inclusion criteria: (P)opulation: Adults and children; (E)xposure: Orofacial or head pain conditions such as (1) dental, periodontal and gingival, (2) temporomandibular disorders (TMD), (3) neuropathic conditions, (4) headaches, and (5) idiopathic pain conditions; (C)omparison: None; (O)utcome: Prevalence; (S)tudies: Systematic reviews and/or meta-analyses. We identified 2275 studies and after selection through eligibility criteria, 24 systematic reviews were included. The prevalence of pain in adults for different subgroups ranged from 1.12% for Burning Mouth Syndrome to 80.80% for cancer therapy-related orofacial pain. In children, it ranged from 0.20% for temporomandibular joint osteoarthrosis to 83% for all types of headache. This umbrella review based on available evidence provides integrated data illustrating the highly variable prevalence of head pain and orofacial pain both in adults and children. Considering the high specificity of head pain/orofacial pain, specific public health programs should be developed to address such highly prevalent conditions.

This study investigated the effects of unilateral temporomandibular joint disorders (TMJDs), specifically disc displacement without reduction and osteoarthritis on one side of the temporomandibular joint (TMJ), on facial asymmetry in women, while the contralateral TMJ exhibits normal findings. Participants were retrospectively enrolled and divided into an affected group (n = 42 with unilateral TMJD) and a control group (n = 49 with bilateral healthy TMJs). The affected group was dagnosed with osteoarthritis on cone-bema computed tomograph and anterior disk displacement without reduction on magnetic resonance imaging. The control group showed normal findings bilaterally on both tests. Facial asymmetry was quantified using an asymmetry index derived from posteroanterior cephalograms, comparing both groups. The relationship between TMJD sub-findings and facial asymmetry was also investigated. Significant increases in the asymmetry indexes of the vertical distances from the antegonial notch and gonion to a horizontal reference plane were observed in the affected group (p < 0.05). Additionally, there was a noticeable upward canting of the maxillary, occlusal, and mandibular planes towards the affected side (p < 0.05). Horizontal asymmetry did not differ significantly between groups (p > 0.05). Parafunctional habits in the affected group were correlated with higher asymmetry indexes of the antegonial notch distance (p < 0.05). Women with unilateral TMJD exhibit significantly greater vertical facial asymmetry compared to those without TMJD. These findings may assist clinicians in diagnosing vertical asymmetry in patients with unilateral TMJD using cephalograms and in predicting facial asymmetry progression.

Temporomandibular disorders (TMD) usually affect the stomatognathic system and can be symptomatic. Patients often self-medicate to relieve symptoms, and this can increase the risk of complications such as adverse drug reactions, overdose, physical and psychological dependence, and delay of appropriate treatment. It is important for dentists to know the prevalence of self-medication to investigate this condition in their patients, thus the primary aim of this study was to estimate the prevalence of self-medication among university students with no TMD, non-painful TMD and painful TMD and the secondary aim was to assess association with independent factors. An online questionnaire was used to assess TMD symptoms (DC/TMD-Diagnostic Criteria for Temporomandibular Disorders: Clinical Protocol and Assessment Instruments) and self-medication practices (QAM/TMD-Questionnaire on the practice of self-medication associated with mandibular disorders). Qualitative data were analyzed using the Fisher's exact test and chi-square test, while the relationships between qualitative and quantitative data were examined using Spearman's rho correlation test. The level of statistical significance was set at p-value < 0.05. In total, 179 university students completed the questionnaire, of which 113 (63.1%) reported TMD symptoms. The majority (84.9%) practiced mild self-medication, and only 12.3% of patients with TMD symptoms practiced moderate or severe self-medication. Students with painful TMD are more likely to self-medicate than those that remain unaffected or exhibit non-painful TMD.