Journal of Oral & Facial Pain and Headache最新文献

Background: This study aimed to evaluate the relationships between magnetic resonance imaging (MRI) findings (such as condylar degeneration, disc displacement, joint effusion and disc deformity) and clinical symptoms in patients with temporomandibular joint disorders (TMDs).

Methods: A total of 54 patients (108 temporomandibular joints (TMJs)) were included. Clinical evaluations assessed joint pain, joint sounds, mouth opening limitations, deviation/deflection and locking. MRI scans were analyzed for condylar degeneration, disc displacement (disc displacement with reduction (DDWR) or disc displacement without reduction (DDWOR)), joint effusion, and disc morphology. Statistical analyses included chi-square tests/Fisher's exact tests for categorical variables. A p value < 0.05 was considered to be statistically significant.

Results: DDWR and DDWOR were significantly associated with joint pain (p = 0.044) and sounds (p = 0.032). Joint effusion demonstrated no clear correlation with clinical symptoms. Condylar degeneration was frequently observed but had limited clinical impact, except for a reduction in joint sounds (p = 0.03). Moreover, disc deformity was significantly correlated with condylar degeneration and joint effusion (p < 0.001).

Conclusions: MRI findings provide valuable insights into the structural changes observed in TMDs. Although disc displacement is strongly linked to pain and joint sounds, condylar degeneration and effusion exhibit more complex relationships with clinical symptoms.

Background: The study aimed to retrospectively evaluate the clinical efficacy of a computer-aided design/computer-aided manufacturing (CAD/CAM)-fabricated occlusal splint combined with manual therapy in patients diagnosed with anterior disc displacement without reduction (ADDwoR) of the temporomandibular joint (TMJ).

Methods: The medical records of 65 adult patients with ADDwoR, treated between March 2022 and March 2023, were reviewed and allocated into three treatment groups based on the interventions they received, namely, occlusal splint therapy alone (n = 22), occlusal splint therapy combined with manual therapy (n = 22), or health education alone (n = 21). All participants received standardized health education. Clinical outcomes, including Maximum Mouth Opening (MMO), Visual Analog Scale (VAS) for pain, and the Mandibular Functional Impairment Questionnaire (MFIQ), were assessed at baseline and one and three months post-treatment by blinded evaluators. Statistical analyses were conducted using Python with Welch's analysis of variance (ANOVA) and repeated measures ANOVA, and significance was set at p < 0.05.

Results: The baseline demographic and clinical characteristics were similar among the three groups (all p > 0.05). At the three-month follow-up, no significant changes were observed in the health education group (p > 0.05). In contrast, both the occlusal splint group and the combined treatment group demonstrated significant improvements in MMO, VAS and MFIQ scores at both one and three months compared to baseline (all p < 0.05). Moreover, the combined treatment group showed significantly greater improvement in all measured outcomes than the splint-only group at each follow-up, with the most substantial differences observed at the three-month follow-up (all p < 0.05).

Conclusions: This short-term non-randomized retrospective study suggests that combining CAD/CAM-fabricated occlusal splint therapy with manual therapy yielded superior pain relief and functional improvement compared to splint therapy alone or health education in patients with ADDwoR.

The intricate interrelationship between obstructive sleep apnea (OSA) and orofacial pain represents a significant clinical challenge that necessitates comprehensive understanding and management. This review elucidates the bidirectional pathophysiological mechanisms underlying these comorbid conditions, wherein OSA demonstrates prevalence rates of 2-9% in adults, with marked gender dimorphism, while orofacial pain conditions affect 10-20% of individuals during their lifetime. The manuscript delineates how sleep-disordered breathing induces compensatory neuromuscular responses, manifesting as increased masticatory muscle activity and nocturnal bruxism, which subsequently precipitates or exacerbates temporomandibular dysfunction (TMD) and associated orofacial pain syndromes. Furthermore, chronic orofacial pain can reciprocally impact sleep architecture, potentially exacerbating sleep-disordered breathing through disrupted jaw mechanics and altered muscle tone. The neurological interface between these conditions involves central nervous system modulation of nociceptive input, contributing to heightened pain sensitivity. Management strategies necessitate a multidisciplinary approach, incorporating continuous positive airway pressure (CPAP) therapy, oral appliances, physical therapy and behavioral interventions, underscoring the importance of concurrent treatment modalities for optimal therapeutic outcomes.

Background: Burning mouth syndrome (BMS) is a chronic pain disorder affecting the oral mucosa, often accompanied by psychological comorbidities. Higher levels of mindfulness have been associated with reduced pain and fewer emotional symptoms in some chronic pain conditions, but its role in BMS remains inadequately explored.

Methods: 146 patients diagnosed with BMS, according to the International Classification of Orofacial Pain, 1st edition, were recruited from the Department of Oral Medicine at a stomatology hospital. Mindfulness, pain intensity and psychological symptoms were assessed using the Five Facet Mindfulness Questionnaire, visual analog scale, and self-report screening tools, respectively. Spearman's correlation and multiple regression analyses were conducted to evaluate the relationships between mindfulness and levels of pain, anxiety, and depression.

Results: Mindfulness showed significant negative correlations with pain (r = -0.204, p < 0.05), anxiety (r = -0.309, p < 0.01), and depression (r = -0.299, p < 0.01). After controlling for confounding variables, higher overall mindfulness remained significantly associated with lower pain intensity (β = -0.268, p < 0.05), although the associations with anxiety and depression were no longer statistically significant (p > 0.05). Among the mindfulness facets, higher scores on the "describing" facet were associated with reduced pain intensity (β = -0.231, p < 0.05). Additionally, higher scores on the "non-judging" (Odds Ratio (OR) = 0.871, p < 0.05) and "non-reactivity" (OR = 0.869, p < 0.05) facets were associated with fewer anxiety symptoms, while the "acting-with-awareness" facet was significantly associated with fewer depressive symptoms (OR = 0.869, p < 0.05).

Conclusions: The overall mindfulness level and the "describing" facet appear to be associated with pain severity, whereas the "non-judging" and "non-reactivity" facets are related to anxiety symptoms, and the "acting-with-awareness" facet is linked to depressive symptoms, suggesting that mindfulness-based interventions may offer a beneficial approach in the management of BMS.

Background: This study investigates the association between migraines and vasovagal syncope (VVS), focusing on shared autonomic dysfunction mechanisms in a Middle Eastern population.

Methods: Using a case-control design, 163 participants (57 with migraines and 106 controls) were assessed through validated tools, including the Migraine Disability Assessment (MIDAS) and Patient Health Questionnaire-4 (PHQ-4).

Results: Multivariable analyses results demonstrated a significant association between migraines and VVS, with migraine patients exhibiting nearly threefold higher odds of VVS. Gender differences were pronounced, with females displaying higher susceptibility. Additional drug use and comorbid conditions were also significant factors. Interestingly, the MIDAS score was not found to be significantly correlated with VVS, highlighting the intricacy of autonomic dysfunction.

Conclusions: These findings underline that screening for autonomic dysfunction must be conducted in migraine patients and that gender-specific approaches should be adopted in their clinical management. Further research is needed to study the causative pathways and to validate these findings in a large and varied population.

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.