Journal of Oral & Facial Pain and Headache最新文献

Background: To evaluate the association of oral parafunctions with clinical DC/TMD (Diagnostic Criteria for Temporomandibular Disorders) Axis I diagnoses, Axis II biopsychosocial assessment and pain widespreadness in TMD pain patients in tertiary care.

Methods: 197 TMD pain patients were clinically examined and responded to DC/TMD OBC (Oral Behaviour Checklist) and Axis II comprehensive instruments. Patients were divided into Pain Drawing (PD) profile subgroups: PD-1 = head/face pain; PD-2 = head and neck/shoulder regional pain; PD-3 = widespread pain. Using the Graded Chronic Pain Scale 2.0 assessing pain-related intensity/interference, the patients were classified into TMD subtypes 1-3. Associations of frequent sleep bruxism (4-7 times per week) and daytime clenching (most/all of the time) with explanatory variables were evaluated with Independent Samples Kruskal-Wallis and chi-square tests and pairwise comparisons were made with Mann-Whitney U-test with Bonferroni correction.

Results: Frequent sleep bruxism was reported by 46.2% and daytime clenching by 67.5% of the participants. Sleep bruxism and daytime clenching associated significantly with muscle-related TMD diagnoses. Sleep bruxism and daytime clenching were significantly associated with anxiety (GAD-7, General Anxiety Disorder-7) subgroups, the highest prevalence being in the most severe subgroups. Frequent sleep bruxism was reported more by participants in TMD subtype 2 as well as those in PD-2 and PD-3 profile subgroups, with significant differences between PD-1 vs. PD-2 and between PD-1 vs. PD-3.

Conclusions: Oral parafunctions are associated with muscle-related TMD diagnoses, anxiety symptoms and wider body pain, which should be considered in the assessment, treatment planning and personalized care of TMD pain patients.

Background: This study aims to report a case of synovial chondromatosis (SC) of the left temporomandibular joint (TMJ) and provide an update of a previous review published in 2010 by summarizing the last 15 years of literature on the topic.

Methods: On 07 July 2024, two of the authors independently performed a systematic search in the most relevant medical databases to identify all the English-language papers reporting cases of TMJ SC. After selecting the articles, the authors discussed their potential inclusion in the systematic review, and in case of disagreement, a third author was consulted.

Results: From the assessment of all four databases, 466 citations were retrieved. After the removal of the duplicates, 136 articles remained for evaluation. In the end, a total of 108 articles were selected for inclusion, reporting a total of 1046 cases of SC of the TMJ. The most frequently reported signs and symptoms were pain, reduced interincisal mouth opening, swelling, crepitus, and clicking.

Conclusions: Despite the different surgical treatment options that were adopted, the recurrence rate remains low. From the present review, no evidence arises for a specific risk factor for TMJ SC. THE PROSPERO REGISTRATION: register number CRD42024568102.

Background: To conduct a bibliometric analysis mapping the intellectual landscape and emerging trends in Magnetic resonance imaging (MRI) research of temporomandibular disorders (TMD), identifying knowledge gaps and future directions.

Methods: A total of 1017 articles were retrieved from the Web of Science Core Collection (WOSCC) database from 1995 to 2024 using the search formula: TS (Topic Search) = ("Temporomandibular Disorders" OR "Temporomandibular Joint Disease" OR TMD) AND TS = ("Magnetic Resonance Imaging" OR MRI). Author/country collaboration network, co-citation analysis, keyword clustering, and burst detection were conducted via CiteSpace 6.4.R1 (Parameters: Time slice: 1 year; g-index k = 25; Log-Likelihood Ratio clustering).

Results: Annual publications exhibited triphasic growth, peaking at 75 articles in 2022. The United States (160 articles, centrality = 0.22) dominated global collaborations, while Shanghai Jiao Tong University emerged as the most productive institution (30 articles). Key clusters revealed 15 clusters (Q = 0.4235, S = 0.7521), with core clusters including "juvenile idiopathic arthritis" and "deep learning". Burst strength identified four major research frontier directions: analysis of pathological characteristics of diseases (morphology with a burst strength of 4.49; anterior disc displacement with a burst strength of 3.69); innovation in imaging examination methods (ultrasonography with a burst strength of 3.61; cone-beam computed tomography with a burst strength of 3.51); development of intelligent diagnostic technologies (diagnostic criteria with a burst strength of 12.09; deep learning with a burst strength of 5.81); and support for clinical management applications (management with a burst strength of 4.62).

Conclusions: This study delineates an evolving research paradigm integrating Artificial Intelligence (AI)-driven diagnostics with multimodal imaging.

Nausea, vomiting, photophobia, and phonophobia are common concomitant symptoms in patients with migraine and provide valuable information for headache specialists during consultations. Clinical observations have identified various olfactory abnormalities in patients with migraine, such as osmophobia, olfactory hallucinations, hyperosmia and hyposmia, which are often overlooked by neurologists. These olfactory abnormalities may interact with the trigeminal vascular system, parasympathetic nervous system, and cortical spreading depression. This review aimed to examine the mechanisms underlying olfactory abnormalities in patients with migraine and the clinical correlations between these abnormalities and migraine. Additionally, olfactory training is highlighted as a promising non-pharmacological treatment for migraine.

Background: There is a limited amount of published research on the dimensionality and reliability of the Epworth Sleepiness Scale (ESS) questionnaire for adult patients referred for oral appliance therapy. This information is crucial for dentists, who often lack objective measures of sleep-disordered breathing (SDB) during titration process of an oral appliance. This study investigated the dimensionality and reliability of ESS scores in adult dental patients with SDB undergoing oral appliance treatment.

Methods: In 103 dental patients with SDB referred by a physician (mean age: 52.3 ± 13.0 years; 35% female), the dimensionality of the ESS was investigated using exploratory (EFA) and confirmatory factor analyses (CFA) to determine how many scores are needed to characterize the construct. ESS questionnaires were administered twice before treatment. Internal consistency and test-retest reliability were assessed.

Results: Horn's parallel analysis suggested a one-factor model. Extracting one factor and standardizing loadings led to strong loadings for all items, ranging from 0.53 to 0.82. The fit indices indicated a good model fit (Comparative Fit Index = 0.999, Root Mean Square Error of Approximation = 0.020, and Standardized Root Mean Square Residual = 0.064). Cronbach's alpha with 95% confidence interval (CI) was 0.85 (0.82-0.88), indicating strong internal consistency. The intraclass correlation coefficient type 2,1 (95% CI) was 0.86 (0.79-0.90), and the weighted kappa ranged from 0.50 to 0.81.

Conclusions: In this patient population, the ESS reliably characterizes excessive daytime sleepiness with a single score and appears suitable for individual assessment in dental patients undergoing oral appliance treatment for SDB.

Background: This prospective clinical study investigates whether functionally compensated but clinically inapparent temporomandibular disorder (TMD) findings can be detected in individuals without pre-existing medical conditions.

Methods: A total of 200 participants (10-50 years) without a medical history were examined using screening methods: Craniomandibular Disorders (CMD)-Short Finding, CMD-Screening, Preventive Manual Structural Analysis (PMSA), and Preventive Structural Stress Screening (PSSS). The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I served as the reference standard. Five diagnoses were analyzed based on prevalence, sensitivity, specificity, predictive values, 95% confidence intervals, and p-values (McNemar, Cochran Q).

Results: TMD findings were detectable. PMSA and PSSS always produced identical results (p = 1.000), differing significantly from CMD-Short Finding for arthralgia and disc displacement (p < 0.001), and from CMD-Screening for myogenic pain (p < 0.001). No significant differences were found between PMSA/PSSS and CMD-Screening for arthralgia (p = 0.528) or CMD-Short Finding for myogenic pain (p = 0.490). Not all tests achieved a 70% sensitivity and a 95% specificity. The most important results are summarized here: arthralgia (0.0%-15.0%) by PMSA/PSSS (sensitivity 96.00% [79.65-99.90], specificity 96.57% [92.69-98.73], p = 0.125); myogenic pain (34.5%-49.5%) by CMD-Screening (excluding digastric muscle: sensitivity 84.15% [74.42-91.28], specificity 100.00% [96.92-100.00], p < 0.001) and by PMSA/PSSS (including digastric muscle: sensitivity 98.02% [93.03-99.76], specificity 100.00% [96.34-100.00], p = 0.500); disc displacement (14.5%-20.5%) by CMD-Short Finding (sensitivity 100.00% [85.18-100.00], specificity 96.61% [92.77-98.75], p = 0.031); degenerative joint disease and disc displacement without reduction with limited opening showed very low prevalence (0.0%-1.0%), which results in limiting reliability.

Conclusions: TMD findings were detectable in asymptomatic individuals. PMSA and PSSS were the most suitable screening tools. The results support the need for regular screening, and further studies.

Clinical trial registration: DRKS00035175, https://drks.de/search/en/trial/DRKS00035175, retrospectively registered.

Temporomandibular disorders (TMD) are a prevalent source of chronic pain and disability, yet current therapies often provide limited relief with notable side effects. Photobiomodulation (PBM) has emerged as a promising non-pharmacologic approach to modulate inflammation and pain. This study investigated the effects of a dual-wavelength PBM protocol (laser + light-emitting diode (LED)) on the lipopolysaccharide (LPS)-stimulated monocyte response from individuals with painful TMD. Monocytes were isolated from 16 individuals with TMD enrolled in a randomized, placebo-controlled clinical trial (NCT05916235). Cells were plated into 96-well plates and divided into Control, LPS, and LPS + PBM treatment groups. Monocytes received four alternating-day treatments with two PBM probes: a laser probe (810/660 nm, 180 J/cm²) and an LED probe (660/850 nm). Cytokine and chemokine levels in culture supernatants were measured via multiplexed immunoassays. To verify cell viability after PBM treatment, the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) was used. Statistical analysis was conducted using one-way analysis of variance (ANOVA) with Bonferroni correction, and p < 0.05 was considered significant. PBM significantly reduced levels of pro-inflammatory mediators interleukin-1 beta (IL-1β) (p = 0.005), C-X-C motif chemokine ligand 9 (CXCL9) (p = 0.0042), interferon gamma-induced protein 10 (IP-10) (p = 0.001), and tumor necrosis factor-alpha (TNF-α) (p = 0.0003), while increasing expression of regulatory mediators interleukin-10 (IL-10) (p = 0.0009), interleukin-1 receptor antagonist (IL-1RA) (p = 0.004), and CC motif chemokine ligand 17 (CCL17) (p = 0.003).These findings suggest that the dual-wavelength PBM protocol was able to shift the monocyte immune response from a more pro-inflammatory (M1) phenotype to a more anti-inflammatory, tissue-repair (M2) cytokine profile. These results provide additional evidence for PBM as a benign and non-invasive technique to control and potentially modify TMD-related inflammation. ClinicalTrials.gov ID: NCT05916235.

Background: Current pharmacological treatments for acute orofacial pain present limitations, risks, and side effects. Thus, the search for safer alternatives is justified. The essential oil of Alpinia zerumbet (EOAz) has been used in the treatment of several medical conditions, including pain and inflammation, but scientific validation is scarce. The aim of this study was to investigate the antinociceptive and anti-inflammatory effects of EOAz in models of acute orofacial pain in rats and in inflammatory parameters in vitro.

Methods: Adult male Wistar rats were subjected to intraoral incision surgery, a model of postoperative pain. The effect of the facial topical application (1 to 3 times a day for 3 days) of EOAz or a formulation based on EOAz (Fb-EOAz) was assessed on heat and mechanical hyperalgesia. The same rats were tested in the open field test (OFT) to assess the influence of the treatments on rats' locomotion. Moreover, the effects of the treatments were evaluated on facial heat hyperalgesia induced by lipopolysaccharide (LPS), a model of myofascial pain, and in vitro, in the release of nitric oxide (NO) and interleukin-6 in macrophages stimulated by LPS.

Results: EOAz and Fb-EOAz reduced postoperative heat hyperalgesia, but only Fb-EOAz reduced postoperative mechanical hyperalgesia and heat hyperalgesia induced by LPS. Fb-EOAz reduced NO and interleukin-6 release by macrophages stimulated by LPS. None of the treatments affected the rat's locomotion.

Conclusions: These data provide preclinical evidence of antinociceptive and anti-inflammatory effects of Fb-EOAz. This approach may represent an alternative or adjuvant therapy in the control of inflammatory and myofascial orofacial pain.

The orofacial sensorimotor system encompasses a variety of orofacial tissues as well as several pathways and circuits in the central nervous system (CNS) that participate in orofacial sensorimotor behaviors such as chewing, facial expression, speech, and swallowing. Acute or chronic pain can severely affect these behaviors, but the relationships between sensorimotor behaviors and pain, and the factors influencing the interactions and underlying mechanisms have remained unclear. Several theories proposed to account for the interactions and mechanisms have not provided a comprehensive picture of pain-sensorimotor interactions, nor fully acknowledged the diversity of biopsychosocial factors that may affect pain-related sensorimotor behaviors and the musculoskeletal tissues involved in the behaviors, and that may also contribute to the inter-individual and sex differences in pain-sensorimotor interactions. Such considerations prompted, last year, a review that has provided new perspectives of pain-sensorimotor interactions, and identified the wide range of biological, psychological, and sociocultural factors that may influence the interactions and underlying mechanisms. It also resulted in a novel theory being proposed, the Theory of Pain-Sensorimotor Interactions (TOPSMI), which has provided a more comprehensive mechanistic framework to consider the interactions between sensorimotor behaviors and pain, and their complexity. Since the new perspectives leading to TOPSMI were derived mainly from findings in the spinal sensorimotor system, the present article aims to determine the particular applicability of TOPSMI to orofacial pain-sensorimotor interactions. It reviews orofacial pain-related sensorimotor behaviors and the nociceptive pathways, CNS circuits and their plasticity, and musculoskeletal tissues involved in these behaviors, as well as the influences of psychosocial, genetic, epigenetic, and environmental factors bearing specifically on orofacial pain-sensorimotor interactions. The article concludes that the basic tenets of TOPSMI are applicable to orofacial pain-sensorimotor interactions and that this has implications for the clinical management of orofacial pain and future research in this field.

Background: Temporomandibular joint osteoarthritis (TMJOA) is a pathological condition marked by subchondral bone remodeling. Osteoarthritis can lead to TMJ pain, nevertheless, the relationship between nociceptive mechanisms and subchondral bone in TMJOA still unclear.

Methods: In the present investigation, a rat TMJOA model was established via intra-articular administration of monosodium iodoacetate (MIA). Following the induction of MIA-triggered TMJOA, tissue samples were collected from the TMJ condyle, trigeminal system components including ganglion (TG) and nucleus caudalis (TNC), and hippocampal formation. Micro-computed tomography (Micro-CT) was employed to evaluate subchondral bone degeneration in the TMJ, while tartrate-resistant acid phosphatase (TRAP) staining was conducted to measure the activity of osteoclasts in the subchondral bone. Furthermore, immunofluorescence (IF) staining was performed to detect the expression of calcitonin gene related peptide (CGRP) in the TMJ subchondral bone. Afterwards, immunohistochemistry (IHC) was used to detect the expression of CGRP in the TG, TNC and hippocampus tissues. The experimental results were expressed as mean ± Standard Error of the Mean (SEM) values and two-way Analysis of Variance (ANOVA) with Student-Newman-Keuls post hoc testing was employed for statistical comparisons, adopting a significance threshold of p < 0.05.

Results: Compared with the control group, Micro-CT results revealed progressive condylar degeneration over time. Consistently, MIA-induced TMJOA rats demonstrated a pronounced accumulation of TRAP-positive osteoclasts in the subchondral bone. The expression of CGRP in the TMJ subchondral bone, TG, TNC and hippocampus tissues was also obviously increased in MIA-induced TMJOA rats.

Conclusions: MIA-induced rat TMJOA pain could be attributed to the augmented exprssion of CGRP in the TMJ subchondral bone, TG, TNC and hippocampus tissues. An elevated level of CGRP stimulated nociception which was implicated in the development of peripheral and central sensitization in TMJOA pain.