Journal of Oral & Facial Pain and Headache最新文献

Migraine is a primary headache disorder affecting about 14% of the global population. The knowledge about migraine pathophysiology is increasing constantly; however, there are still many unknowns and uncertainties. Intestinal microbiota builds the gut environment together with metabolites and the immune system. Its connections with disorders outside the digestive system have been described, mainly neuropsychiatric diseases, due to the existence of the microbiota-gut-brain axis. Therefore, it is suggested that migraine is also correlated with changes in the microbiome. The review aimed to summarize the available literature related to the topic. We performed an electronic article search through the Embase Database and PubMed Database, and included 14 articles after analysis under the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. Subsequently, a meta-analysis of randomized controlled clinical trials summarizing probiotics' effect on migraine prevention was conducted based on the same guidelines and resulted in including 2 adequate trials. Microbiome alterations have been observed in migraine patients with an influence on clinical presentation. Preclinical studies suggested a direct connection between migraine and microbiome changes. The meta-analysis has shown the influence of probiotics on migraine frequency (p = 0.003; Hedges' g = 1.22; standard error (SE) = 0.41), and no impact on migraine severity (p = 0.069; Hedges' g = 1.10; SE = 0.61) and attacks' duration (p = 0.149; Hedges' g = 0.18; SE = 0.15). However, the former was close to the statistical significance. The following work demonstrates a correlation between migraine and microbiome, which has a putative positive impact on migraine management. Moreover, probiotic supplementation can alleviate migraine symptoms. However, the main limitation is the limited number of studies, together with high heterogeneity and limited methodological consistency in the meta-analysis.

Background: Zygomaticomaxillary complex (ZMC) fractures significantly affect facial aesthetics and masticatory function, necessitating effective rehabilitation strategies. This systematic review and meta-analysis investigated the effects of fractures on masticatory muscle function and pain management.

Methods: Adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, conducted a comprehensive search across databases, including PubMed, MEDLINE, Embase, PsycINFO, Web of Knowledge, Scopus, CINAHL, LILACS, SciELO, Cochrane and Google Scholar, and selected studies that assessed masticatory function through metrics such as bite force, electromyography activity, and post-intervention pain levels in patients with ZMC fractures. Data were synthesized using a random-effects model.

Results: Fourteen studies were included, which highlighted diminished bite force and altered muscle activity patterns in patients with ZMC fractures. Significant improvements in muscle function and pain management were observed postoperatively, with interventions including surgical repair and physical therapy proving to be effective. The meta-analysis demonstrated a marked reduction in pain, substantiated by changes in visual analog scale scores from an average of 7.5 pre-operatively to 2.3 post-operatively.

Conclusions: ZMC fractures profoundly affect masticatory efficiency and cause notable pain, which can be substantially alleviated by targeted surgical and therapeutic interventions.

The prospero registration: This systematic review and meta-analysis followed the PRISMA guidelines and was registered in PROSPERO (CRD42024595963).

Background: Restrictive lingual frenula, commonly referred to as ankyloglossia, are well documented in pediatric literature, with established impacts on breastfeeding, swallowing, reflux, speech, maxillary development, breathing, and sleep in children. However, data on its effects in adolescents and adults remains limited. This study aimed to investigate the correlation between restrictive lingual frenula and the development of temporomandibular disorders (TMD) in an adult population.

Methods: A total of 129 patients (aged 18-80 years; 41 males and 88 females) were assessed for TMD signs and symptoms using the three Lövgren screening questions, supplemented by a clinical examination following the German Association for Craniomandibular Function and Diagnostics (DGFDT) screening protocol. The presence and severity of ankyloglossia were evaluated using the Tongue Range of Motion Ratio (TRMR 2019) and Kotlow's free tongue classification. Association between variables were analyzed using Chi-square tests.

Results: TMD was identified in 49.1% of the cohort, while ankyloglossia was observed in 46.7% based on the TRMR. No significant association was found between TMD and either anterior (39.6%) or posterior (34.9%) tongue restriction using the TRMR criteria. However, when categorized according to Kotlow's classification, mild to severe ankyloglossia (59.2%) showed a statistically significant association with TMD (p = 0.026). Age and sex were not significantly associated with the presence of ankyloglosson, while TMD occurrence was found to be correlated with sex.

Conclusions: A weak but significant correlation was observed between TMD and the degree of ankyloglossia, particularly when assessed using Kotlow's method. Further studies with larger sample sizes, stratified by age and sex, incorporating occlusal factors, and employing a standardized validated assessment tool adapted for adults, accounting for both anatomical and functional criteria are warranted to explore potential causal relationships.

Background: One of the main goals of treatment in temporomandibular disorder (TMD) patients is to improve mouth opening range of motion. However, it is not clear which factors influence its alteration. The aim of this study was to compare differences in mechanosensitivity, mouth opening and psychosocial factors, between people with and without TMD, to evaluate if changes observed in active mouth opening are mediated by an increase in tissues' mechanosensitivity, and to evaluate factors related to mandibular-related disability. Subjects with and without TMD were recruited.

Methods: Cross-sectional study conducted in Spain. The measured variables were the Craniofacial Pain and Disability Inventory (CF-PDI), pain intensity, pressure pain thresholds (PPT) at local points; active and passive mouth opening; the Short-Form 12 questionnaire (SF-12); the State-Trait Anxiety Inventory (STAI); and the Neck Disability Index (NDI). Multivariable regression and mediation models were constructed.

Results: A total of 179 subjects (85 with TMD) were included. Subjects with TMD had less mouth opening range of motion, and lower PPT. Tissues' mechanosensitivity did not mediate the reduction in active mouth opening in subjects with TMD (overall indirect effect, 0.98; 95% confidence interval, -0.87 to 3.12). Finally, no variable showed an association with CF-PDI.

Conclusions: Subjects with TMD seem to have decreased mouth opening, and greater mechanosensitivity of masticatory muscles, when compared with healthy controls. Tissues' mechanosensitivity does not seem to mediate the reduction of active mouth opening in subjects with TMD, and there seems to be no relationship between PPT measures, mental health outcomes, the NDI and mandibular-related disability.

Background: Burning mouth syndrome (BMS) is a chronic orofacial pain disorder. The etiology and pathophysiology of BMS remain unclear; multiple factors may interact in complex ways. There is a need for simpler and more cost-effective BMS evaluation criteria. This study aimed to evaluate the reliability and validity of the Short Form McGill Pain Questionnaire version 2 (SF-MPQ-2) in patients with BMS and develop a subscale based on factor analysis of the results to classify patients per their symptoms.

Methods: Several factors such as patient characteristics (age, sex, smoking habit, and medical history), the SF-MPQ-2 (original: eleven-point rating scale and modified: four-point rating scale), and the numerical rating scale (NRS) of BMS were examined and analyzed.

Results: In total, 38 patients were enrolled. Cronbach's alpha was 0.93 (0.88-0.96) and 0.83 (0.74-0.90) for the SF-MPQ-2 (original) and SF-MPQ-2 (Modified), respectively. Only the correlation between the NRS and the SF-MPQ-2 (Modified) reached statistical significance. These results showed that the SF-MPQ-2 (Modified) were more reliable than the SF-MPQ-2 (Original). Factor analysis led to classification into three new factors.

Conclusions: SF-MPQ-2 was useful for BMS. In current clinical practice, the modified questionnaire may yield similar or better results, and a more precise treatment strategy can be pursued by classifying responses according to the proposed subscales and examining treatment effects.

Background: Due to the many different underlying disorders causing orofacial pain, management of orofacial pain is a challenge. Many patients seek help from different healthcare providers during their patient journey. The primary aim of this study was to describe the physical and emotional patient journey of patients with orofacial pain. The secondary aim was to determine which personal factors may have contributed to number of healthcare providers visited and patient journey satisfaction.

Methods: For this, a concurrent triangulation mixed methods design was used. Patients 18 years or older with orofacial pain who visited the Orofacial Pain and Dysfunction (OPD) clinic of the Academic Centre of Dentistry Amsterdam were recruited. Participants filled out questionnaires regarding their patient journey, locus of control, readiness to change, catastrophizing, illness perception, and kinesiophobia. A linear regression analysis was performed to determine which factors were associated with the number of healthcare providers visited and the patient journey satisfaction. A subsample of participants was invited to an additional in-depth interview about their patient journey experiences.

Results: A total of 102 participants visited an average of 2.7 healthcare providers before their visit to the OPD clinic. There was an association between patient satisfaction and readiness to change as well as internal locus of control, and between the number of healthcare providers visited and readiness to change, as well as illness perception and chance-related locus of control. Themes related to a satisfactory patient journey included clear communication, feeling taken seriously, and thinking along with the patient. Non-helpful factors were long wait times, financial factors, perceived lack of knowledge of the healthcare providers, and feeling helpless.

Conclusions: The journey of patients with orofacial pain is complex, and the patient satisfaction could be improved by improving the efficiency and clear communication to patients.

Background: This study aimed to determine the frequency and associated factors of cervicogenic headache (CGH) in individuals with forward head posture (FHP). Additionally, craniovertebral angle (CVA)-related factors were examined in patients diagnosed with CGH.

Methods: This cross-sectional study included 117 patients aged 18-45 years who presented with neck pain and were identified with FHP. CGH diagnosis was based on the International Classification of Headache Disorders (ICHD-3) criteria. CVA was measured using posture analysis software, and assessments included the Neck Disability Index (NDI), Henry Ford Headache Disability Inventory (HDI-T), Headache Impact Scale (HIT-6), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and Visual Analog Scale (VAS) for pain. Statistical analyses included independent t-tests, chi-square tests and logistic regression models.

Results: The frequency of CGH in patients with FHP was 53.8%. Compared to the non-CGH group, those with CGH had significantly lower CVA (p = 0.030) and higher PSQI (p = 0.001) and BDI scores (p < 0.001). Logistic regression analysis identified low CVA (Odds Ratio (OR): 0.878, p = 0.014) and poor sleep quality (OR: 1.140, p = 0.025) as independent predictors of CGH. Additionally, Body Mass Index and VAS scores were negatively correlated with CVA (p < 0.05).

Conclusions: FHP may be associated with CGH, possibly through increased biomechanical load and neuromechanical sensitivity. Interventions such as corrective exercises, weight management, and improving sleep quality may be considered as supportive strategies in CGH management; however, causal relationships cannot be inferred from this study. Further studies are needed to explore the long-term effects of postural interventions on CGH.

Background: Temporomandibular disorders (TMD) encompass musculoskeletal and neuromuscular conditions affecting the temporomandibular joint (TMJ), masticatory muscles and other associated structures. While all dentists, regardless of their specialty, should possess a comprehensive understanding of TMD diagnosis and treatment, there is a limited number of studies assessing the knowledge and attitudes of pediatric dentists on this subject. The objective was to evaluate the knowledge and attitudes of pediatric dentists regarding the diagnosis and management of TMD in pediatric patients.

Methods: This observational, analytical, cross-sectional study included 266 pediatric dentists who completed a 41-item questionnaire. Of these, 35 items assessed knowledge, while six evaluated attitudes. Descriptive statistics were analysed, and the chi-square test was applied for comparisons, with statistical significance set at p < 0.05.

Results: The mean correct response rate across the four assessed domains was 49.5%. The lowest accuracy was observed in the pathophysiological domain (33%), followed by the psychophysiological domain (50%), the psychiatric disorders domain (64.1%) and the chronic pain domain (50.4%).

Conclusions: Pediatric dentists exhibited limited knowledge of TMD but expressed positive attitudes toward its diagnosis and treatment. Morever, they demonstrated a lack of awareness regarding their role in preventive education on this condition.

Background: It is unclear which oral behaviors are harmless and which might become harmful when performed excessively. This study aimed to determine which awake oral behaviors are associated with Temporomandibular Disorder (TMD)-related pain symptoms in a non-patient population.

Methods: Subjects' awake oral behaviors were assessed through: (i) Oral Behavior Checklist (OBC), a single-point self-report questionnaire that quantifies the frequency of awake functional and non-functional oral behaviors; and (ii) Ecological Momentary Assessment (EMA), a designated smartphone application which enabled real-time repeated data collection of oral behaviors throughout the day, for multiple days. 118 participants (62.7% female) completed both the OBC and EMA assessment modes. Subjects were allocated into two groups: (i) subjects with TMD-related pain symptoms (TMDPS, N = 34, 85.29% female); and (ii) subjects without TMD-related pain symptoms (noTMDPS, N = 84, 53.57% female).

Results: TMDPS subjects performed more awake oral behaviors compared to noTMDPS subjects. EMA behaviors that showed a significant predictive ability of masticatory muscle pain in binomial logistic regressions were entered into a multiple logistic regression model. Results show that teeth grinding increased the odds of subjects belonging to the TMDPS group by 22%. The final logistic regression demonstrated acceptable fit (Nagelkerke's R² = 0.232). In a multiple regression model evaluating the predictive ability of OBC behaviors, the final model showed a Nagelkerke's R² of 0.468. In addition to sex, three OBC behaviors came out as significant predictors in the final model: teeth grinding increased the odds of subjects belonging to the TMDPS group by 85%; holding or jutting the jaw increased the odds by 82%, and clenching increased the odds by 67%.

Conclusions: Reports of teeth clenching, holding or jutting jaw forward or to the side, and teeth grinding may be associated with the report of TMD-related pain symptoms in a non-patient student population.

A connection between orofacial, cranial and cervical regions has been documented through the trigeminocervical nucleus (TCN), but the predominant direction (orofacial/cranial-to-cervical or cervical-to-orofacial/cranio) of this connection still remains unclear. This scoping review was designed to determine the dominant direction of the connection between these two areas. Searches were conducted by combining these concepts: TCN, cervical and face/jaw/head region. Eighty-three studies were included. The most predominant direction was reported to be from the orofacial/cranial to the cervical region, with most of the studies conducted in mammals. The clinical implications of these findings for the spread and referral of pain between these regions are examined and discussed.