Journal of Oral & Facial Pain and Headache最新文献

Background: The Hounsfield unit (HU) is a quantitative scale used to describe radiodensity in computed tomography (CT) scans. Since idiopathic condylar resorption (ICR) and temporomandibular joint osteoarthritis (TMJOA) involve destruction of bone and cartilage in the mandibular condyle, we hypothesized that HU values might be used to differentiate between the two conditions. This study aimed to evaluate the usefulness of HU values in the differential diagnosis of ICR and TMJOA.

Methods: Twelve TMJOA and 9 ICR patients, and 11 healthy subjects were recruited as the TMJOA, ICR, and control groups, respectively. CT scans were performed, and HU values were measured in the region of interest (ROI) with 5 mm thickness along the Z-axis from superior condylar surfaces. HU distributions were then analyzed for each ROI.

Results: Control and TMJOA patients were significantly older than those in the ICR group. Median HU values of the mandibular condyle did not differ significantly among the three groups. All groups showed a unimodal HU distribution peaking at 250-450 HU, while ICR condyles exhibited a tendency to have an additional peak at 1350-1500 HU. Compared to the control group, the HU distribution of the TMJOA and ICR condyles was significantly lower at 250-450 HU. After age adjustment, significant intergroup differences in the voxel ratio were noted at each HU level at 250-300, 300-350, 400-450, 1400-1450, and 1800-1850 HU. However, no significant differences in HU values were observed between the ICR and TMJOA groups.

Conclusions: HU values and distributions of the mandibular condyle may be used to differentiate between the control group and the ICR and TMJOA groups. Further studies with a sufficient sample size are needed to confirm whether HU values and distribution could become important indicators for distinguishing between the TMJOA and ICR condyles.

Headache is prevalent, disabling, and a frequent neurological referral in the healthcare system. Clinic-based procedures have evolved in recent years to play an important role in headache medicine, with growing evidence on the safety, tolerability and efficacy of peripheral nerve blocks (PNBs). Despite novel headache therapies, PNBs are still widely used in headache services to treat primary and secondary headache disorders, including cluster headache and other trigemino-autonomic cephalalgias, migraine, occipital neuralgia, and other less frequent headache disorders. We aim to provide an update of the current evidence and a practical approach for delivering the most common PNBs used in clinical practice. We aim to describe PNBs indications, contraindications, injection locations and techniques, drug constituents, and potential pitfalls.

Background: Temporomandibular disorders (TMD) are a group of musculoskeletal conditions that frequently affect the masticatory muscles and temporomandibular joints and often result in pain, dysfunction, and decreased quality of life. University students, particularly those in health-related fields, may be especially vulnerable to TMD owing to their elevated stress levels and the presence of oral parafunctional behaviors. Psychosocial factors such as anxiety and depression are recognized as important contributors to the onset and exacerbation of TMD symptoms.

Methods: This cross-sectional study included 182 undergraduate students enrolled in medical and dental programmes at a private university in Brazil. The participants completed an online self-report questionnaire that included the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Symptom Questionnaire, Oral Behavior Checklist (OBC), Generalized Anxiety Disorder Scale (GAD-7), and Patient Health Questionnaire (PHQ-9). Associations among TMD symptoms, oral behaviors, anxiety, and depression were analyzed using the chi-square and Fisher's exact tests (α = 0.05).

Results: A total of 78.6% of the participants reported TMD symptoms, with 38.5% experiencing both pain-related and joint-related symptoms. Oral behaviors were reported by 98.9% of the students, while symptoms of anxiety and depression were present in 74.7% and 65.4% of the sample, respectively. Significant associations were found between painful/joint TMD and higher levels of oral behaviors (p < 0.001), severe anxiety (p = 0.015), and moderately severe to severe depression (p = 0.016). Oral behaviors were more frequent in students in later semesters (p = 0.006) and were associated with anxiety (p < 0.001) and depression (p < 0.001). A strong correlation was observed between anxiety and depression (p < 0.001).

Conclusions: This study confirmed a high prevalence of temporomandibular disorder (TMD) symptoms among medical and dental students. Pain-related and joint-related TMD symptoms were significantly associated with high-frequency oral behaviors, as well as with moderate to severe levels of anxiety and depression.

Background: Trigeminal neuralgia (TN) is a debilitating neuropathic pain condition with profound quality of life impact. This study aims to compare the clinical outcomes of Gasserian ganglion conventional radiofrequency (CRF) and peripheral nerve pulsed radiofrequency (PRF) in patients with TN.

Methods: This retrospective cohort study included 74 patients with TN who underwent radiofrequency ablation (RFA) between January 2015 and June 2025 at a tertiary university pain clinic. Patients were divided into two groups: Group A (Gasserian CRF, n = 37) and Group B (Peripheral PRF, n = 37). Numerical Rating Scale (NRS) were recorded at baseline and at 1st, 3rd, and 6th months after treatment. Patient satisfaction was evaluated using a 5-point Likert scale for those with documented records.

Results: Both groups showed significant pain relief at the 1st month compared to baseline (p < 0.001 for both). But, Group A showed significantly greater pain relief at the 3rd (3.54 ± 2.21 vs. 5.51 ± 2.91; p = 0.0035) and 6th months (3.19 ± 1.97 vs. 6.08 ± 3.06; p = 0.0001) than Group B. Mean satisfaction scores were significantly higher in Group A (21.76 ± 5.30) compared to Group B (14.19 ± 8.78), with a statistically significant difference (p < 0.001). Likert scores correlated strongly with 6-month NRS values (Spearman's ρ = -0.91, p = 0.002). Linear regression also confirmed that lower pain scores at 6 months significantly predicted higher satisfaction (β = -2.75, R² = 0.18, p = 0.003).

Conclusions: Gasserian CRF appears more effective than peripheral PRF to ensure long-term pain relief in TN, and this may contribute to a trend toward higher patient satisfaction. Despite its invasiveness, CRF remains a valuable option for TN management. These findings support individualized procedural selection based on patient profiles and therapeutic goals.

Clinical trial registration: The study was retrospectively registered on ClinicalTrials.gov (Identifier: NCT07013500).

Background: Temporomandibular disorders (TMD) frequently occur with other pain conditions, and existing research has yielded mixed results regarding the presence or absence of endogenous pain modulation (EPM). This study aimed to investigate EPM in TMD patients with comorbid migraine and fibromyalgia (FM) in the non-trigeminal innervated area.

Methods: Conditioned pain modulation (CPM) and temporal summation (TS) were assessed in healthy controls (n = 30), TMD without comorbidity (n = 30), migraine (n = 30), TMD with migraine (n = 30), and TMD with migraine + FM (n = 19). Based on the TS and CPM responses, participants were categorized into pain modulation profiles (PMP, I-IV).

Results: In serial stimulation, patients with migraine, TMD + migraine, and TMDs + migraine + FM showed significantly reduced pain inhibition compared with controls (p = 0.003, p < 0.001, and p = 0.001, respectively), while TMD patients without comorbidity exhibited intact modulation. Increasing comorbidities were also linked to weaker CPM (single stimulation: R = -0.312, p < 0.001; serial stimulation: R = -0.344, p < 0.001). The PMP categorization demonstrated distinctions among the study population, although further subgroup analysis proved challenging.

Conclusions: TMD patients without comorbid pain exhibited intact EPM in non-painful areas. However, when these individuals experience comorbid pain conditions, their ability to modulate pain may be compromised due to the pain amplification and central sensitization associated with multiple comorbid pain conditions.

Background: This observational study investigates the potential link between temporomandibular disorders (TMD) and personality disorders. The Personality Inventory for Diagnostic and statistical manual of mental disorders (DSM)-5-Brief Form (PID-5-BF) was used to assess personality traits, while TMD diagnosis was established by combining dental and clinical history with specific screening questionnaires, including the TMD-Pain Screener.

Methods: The study sample was recruited based on inclusion criteria requiring the presence of TMD-related symptoms (pain, joint clicking or functional limitations of the temporomandibular joint), with no active systemic or psychiatric conditions. Collected data were analyzed using descriptive and inferential statistical methods to identify significant correlations between PID-5-BF scores and the severity of temporomandibular symptoms.

Results: Results highlight a relevant connection between specific personality domains and TMD symptom severity, suggesting that psychological factors may influence both the onset and persistence of the disorder. Statistically significant associations were found in the domains of antagonism (p = 0.039), negative affectivity (p = 0.024), and the mean total PID-5-BF score (p = 0.021), confirming the role of specific personality traits in modulating temporomandibular pain.

Conclusions: These findings underscore the importance of an integrated approach, combining dental and psychological expertise, to improve clinical management and develop more effective prevention and treatment strategies.

Background: Temporomandibular disorders (TMDs) are typical biopsychosocial conditions often accompanied by anxiety, somatization and even cyberchondria. Targeted online health information is increasingly prominent in digital era yet its psychological impact on TMDs remains underexplored. To examine the association between targeted online health information and TMDs severity, and to explore whether anxiety, cyberchondria and somatization mediate this relationship.

Methods: Participants were evaluated using questionnaires including the five TMDs symptoms (TMDs-5T) scale, 7-item Generalised Anxiety Disorder scale (GAD-7), short-form version of the cyberchondria severity scale (CSS-12) and somatic symptom scale-8 (SSS-8). Data on targeted online health information, search frequency and perceived impact were also collected. Analyses were conducted using SPSS and Mplus.

Results: A total of 588 valid responses were analyzed. Greater TMDs severity was significantly associated with targeted online health information delivery (β = 1.373, p < 0.001), anxiety (β = 1.714, p < 0.001) and cyberchondria (β = 1.641, p < 0.001). The chain mediation model revealed that both the total effect and direct effect (Targeted online health information → TMDs-5T) were significant (β = 2.261, p < 0.001; β = 1.003, p < 0.001). A significant indirect pathway was also identified, in which targeted online health information influenced TMD severity through somatization, anxiety, and cyberchondria (β = 0.210, p = 0.026).

Conclusions: Exposure to targeted online health information was associated with greater TMD symptom severity, mediated by psychological factors such as somatization, anxiety, and cyberchondria. These findings underscore the importance of algorithmic ethics, policy oversight, and user education to mitigate psychological risks in digital health environments.

Background: This study aimed to compare the clinical efficacy of C2-level and distal greater occipital nerve (GON) blockade in the management of cluster headache (CH), focusing on pain relief onset and overall treatment outcomes.

Methods: In this retrospective study, 48 patients diagnosed with CH were divided into two equal groups: one receiving bilateral C2 GON blocks and the other undergoing bilateral distal GON blocks. Both groups were treated with dexamethasone as the steroid and bupivacaine as the local anaesthetic. Pain relief and treatment duration were assessed, and adverse events were monitored.

Results: Both GON blockade techniques were effective in reducing CH symptoms. Patients treated with C2 GON blocks achieved complete pain relief by the third week, allowing for treatment cessation. In contrast, the distal GON block group required up to six injections for similar levels of relief. Rapid pain control was more pronounced in the C2 GON group, with no significant adverse effects observed in either group.

Conclusions: C2 GON blockade demonstrated greater efficacy for early pain relief in CH patients compared with distal GON blockade. These findings suggest that C2 GON blockade may be a more suitable option for both transitional and preventive therapy in CH. Further studies are recommended to confirm these results and to explore the long-term benefits of C2 GON blockade in CH management.

Background: This network meta-analysis (NMA) aims to evaluate the comparative efficacy of 13 intra-articular pharmacologic interventions in improving maximal mouth opening (MMO), pain relief, and functional recovery in patients with temporomandibular disorders (TMD) and restricted jaw mobility.

Methods: A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, and Web of Science to identify randomized controlled trials (RCTS) evaluating the effects of 13 intra-articular drug injections in patients with limited mouth opening TMD. The methodological quality of the included studies was assessed using the risk of bias (ROB) tool, and data were independently extracted by two researchers. Primary outcomes included maximum mouth opening (MMO) and pain intensity; secondary outcomes included joint lateral and protrusive movements.

Results: A total of 38 RCTs involving 1533 TMD patients were included. Thirteen different agents (including HA: hyaluronic acid, PRF: platelet-rich fibrin, PDGF: platelet-derived growth factor, PRP: platelet-rich plasma, MOR: morphine, LA: local anesthetic, MA: micro-fragment fat, TRA: tramadol, SAL: Saline, GC: glucocorticoid, GLU: glucose, NS: non-steroidal, and ARTH: arthrocentesis only) were evaluated. NMA results showed that PRF injection after arthrocentesis significantly improved the maximum temporomandibular joint opening (surface under the cumulative ranking curve (SUCRA): 99.1%) compared with arthrocentesis alone. MA injection following arthrocentesis was most effective for pain reduction (SUCRA: 84.7%), followed by PRF (SUCRA: 78.2%). PRF also led to significant improvements in lateral jaw movement (SUCRA: 95.5%) and protrusive movement (SUCRA: 63.5%) compared to arthrocentesis alone.

Conclusions: Based on the network ranking chart, PRF injection after arthrocentesis offers the greatest benefits for functional recovery in TMD patients. However, additional rigorous literature is required to validate this assertion.

Clinical trial registration: Registration number is INPLASY202450107.

Background: Temporomandibular disorders (TMD) are complex chronic conditions that significantly impair quality of life and impose a considerable social and economic burden. Although various treatment strategies have been developed, the prognostic factors influencing therapeutic outcomes remain poorly defined. This study aimed to identify relevant prognostic factors for treatment response using machine learning methods, with patient readiness for discharge serving as the primary outcome.

Methods: A total of 1050 medical records from patients diagnosed with TMD and treated at the Orofacial Pain and Dental Sleep Medicine clinic, between January 2018 and June 2023, were retrospectively analyzed with a follow-up period of one year. Twenty-six clinical and demographic variables were initially extracted and preprocessed using one-hot encoding. After the removal of highly correlated variables, the final dataset comprised 36 features derived from encoded categorical variables. Seven machine learning algorithms, namely Decision Tree, Random Forest, Logistic Regression, K-Nearest Neighbors (KNN), Support Vector Classifier (SVC), Gradient Boosting, and Extreme Gradient Boosting (XGBoost), were trained to predict discharge readiness. Model performance was evaluated using accuracy, precision, recall, F1 score, and the receiver operating characteristic-area under the curve (ROC-AUC). Feature importance was assessed using information gain and Shapley Additive exPlanations (SHAP) to interpret model predictions.

Results: The Random Forest model demonstrated superior performance in predicting readiness for discharge, with an accuracy of 0.7901, precision of 0.8611, recall of 0.8943, F1 score of 0.7901, and ROC-AUC of 0.6442. SHAP analysis identified onset duration, pain severity, anxiety level, presence of neck pain, and body mass index (BMI) as the most influential predictors.

Conclusions: The identified prognostic factors highlight the multidimensional nature of TMD and support their relevance in guiding patient-specific management strategies. The integration of machine learning approaches may enhance clinical decision-making and contribute to the development of more personalized and effective treatment pathways for TMD.