Journal of Oral & Facial Pain and Headache最新文献

Background: The evolution of concepts that have featured the last decade in the field of bruxism led to the necessity of providing clinicians and researchers with adequate tools for the assessment of bruxism, such as the Standardized Tool for the Assessment of Bruxism (STAB) and the BruxScreen. The former is a multidimensional evaluation tool for the evaluation of bruxism status, while the latter is an instrument that could potentially find its applicability in large-scale epidemiological research projects for screening purposes. However, both tools lack the evaluation of orofacial symptoms at awakening, which can be predictive of temporomandibular disorders (TMDs) pain intensity and prognosis. The aim of this paper is to discuss the development of a novel tool, the OroFacial Awakening Symptoms Questionnaire (OFASQ). This questionnaire could be integrated into the STAB to investigate the presence of orofacial symptoms upon awakening and enhance knowledge of the relationship between sleep-time bruxism activities and potential clinical consequences. The OFASQ consists of a preliminary screening question about the presence or absence of a series of orofacial symptoms upon awakening and five items that evaluate the amount of pain and impairment they cause.

Methods: For pilot testing, the OFASQ was administered to a diverse group of 85 subjects, including dental practitioners of various specialties, postgraduate and undergraduate dentistry students and patients.

Results: Following the face validity and pilot testing phase, it emerged that OFASQ could represent a valid tool for quantifying the intensity and severity of orofacial symptoms upon awakening in everyday clinical practice.

Conclusions: The OFASQ tool is considered ready for more in-depth clinical testing. The authors do not exclude the possibility of minor editing to the tool following further, more in-depth tests.

Background: Trigeminal neuralgia (TN) is a severe neuropathic pain condition in the orofacial region, with carbamazepine recommended as the first-line treatment. Nonetheless, its application is constrained by unfavorable drug responses and side effects. The objective of this research was to assess the effectiveness and safety of lacosamide, a third-generation anticonvulsant, in individuals with TN, and to juxtapose the findings with observational records from recently diagnosed TN patients who underwent carbamazepine monotherapy within the corresponding timeframe.

Methods: An 8-week flexible dose titration of lacosamide was performed on newly diagnosed 12 TN patients who were divided into two groups: 200 mg/day (n = 5), and 400 mg/day (n = 7). Outcome measures included average pain score, Brief Pain Inventory-facial scores, and side effects. Patients were followed-up at 2, 4 and 8 weeks after baseline.

Results: The percentage change of pain score at 4-week visit was compared between both lacosamide groups and patients receiving carbamazepine (n = 6) for four weeks during concurrent period. Both lacosamide groups experienced a decrease in pain score at 2-week follow-up, and differences in average pain score reduction were not observed between the two groups across all visits (p > 0.05). The mean Brief Pain Inventory-facial score in the lacosamide 200 mg/day group was higher than that in the 400 mg/day group at the 2-week follow-up (p = 0.03). Interestingly, the 4-week follow-up revealed that there were no significant variances in pain intensity between the lacosamide and the contemporaneous carbamazepine cohorts (p > 0.05). Frequently noted adverse events were mild somnolence (n = 9), slight vertigo (n = 5), and emotional lability (n = 2) without instances of severe adverse drug responses.

Conclusions: Lacosamide demonstrates potential as a therapeutic option for patients suffering from trigeminal neuralgia.

Clinical trial registration: TCTR20210811002.

Background: This study evaluated the effectiveness and safety of ultrasound-guided pulsed radiofrequency (PRF) at the C2 dorsal root ganglion (DRG), specifically at the C1-2 level, for patients with cervicogenic headaches.

Methods: The study involved 29 patients with unilateral symptoms from January to July 2023. Headache intensity was measured using the numerical rating scale (NRS), with scores recorded before and after the procedure at specified intervals extending up to 24 weeks. Additionally, the neck disability index (NDI) scores were assessed at baseline, 4, 12 and 24 weeks.

Results: The findings demonstrated significantly reduced headache NRS scores at all post-treatment checkpoints, with notable pain relief rates of 13.79% and 72.41% at 4 weeks, and 17.24% and 68.97% at 12 and 24 weeks, respectively. NDI scores also showed significant reductions at all evaluated post-treatment time points. Importantly, no significant adverse events were observed in any of the individuals.

Conclusions: Our ultrasound-guided approach could be a safe and effective alternative for managing cervicogenic headaches.

Background: Vitamin D has roles in neurological, hormonal and immunological processes, affecting various pain disorders and related comorbidities. The aim of this study was to investigate relationship between vitamin D levels and clinical features in postmenopausal females with burning mouth syndrome (BMS).

Methods: This retrospective, cross-sectional study reviewed clinical and laboratory data from 144 postmenopausal females with BMS. Laboratory tests measured 25-(OH) hydroxyvitamin D, hematic components and inflammatory markers. Participants were categorized by serum levels of 25-(OH) hydroxyvitamin D, as deficient (<20 ng/mL), inadequate (20-30 ng/mL), and adequate (>30 ng/mL). Pain intensity and oral health-related quality of life were assessed using visual analog scale (VAS), McGuill Pain Questionnaire (MPQ) and Oral Health Impact Profile-49 (OHIP-49).

Results: Pain intensity and oral health-related quality of life were associated with serum vitamin D levels. Hemoglobin, folic acid and high-sensitivity C-reactive protein (hs-CRP) concentrations varied among groups. Serum 25-(OH) hydroxyvitamin D levels showed negative correlation with VAS, MPQ sensory, MPQ affective, MPQ evaluative and OHIP-49 scores, indicating lower pain intensity and suffering with higher vitamin D levels. Additionally, iron levels were negatively related to VAS score, while folic acid levels were negatively associated with OHIP-49 score. Serum 25-(OH) hydroxyvitamin D levels were negatively correlated with hs-CRP levels.

Conclusions: These findings suggest significant interactions between 25-(OH) hydroxyvitamin D levels and pain intensity and suffering and oral health-related quality of life, indicating its therapeutic potential for postmenopausal BMS patients.

Background: Type 2 diabetes has been shown to reduce the risk of migraine, whereas insulin resistance (IR) is often elevated in migraineurs. The triglyceride glucose index (TyG) serves as a reliable surrogate marker of IR, which has been hypothesized to be associated with migraine pathophysiology. This study aimed to examine the relationship between TyG index scores and incidence as well as the severity of migraines through both cohort and cross-sectional analyses.

Methods: Using data from the China Health and Retirement Longitudinal Study (CHARLS), we evaluated migraine incidence between 2015 and 2020. TyG index values were calculated using the following formula: ln[fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. The impact of TyG index scores on the incidence of migraines was assessed using a multivariate-adjusted Cox regression model. The cross-sectional study included 161 patients with migraines in Xiamen, China. The relationship between TyG index scores and different migraine characteristics was examined using multivariable and ordered logistic regression models with further subgroup analysis by migraine course.

Results: Among the cohort participants, 1001 new migraine cases were identified during follow-up, with no significant relationship found between TyG index scores and migraine incidence (hazard ratio = 1.024 (0.916, 1.145), p = 0.677 > 0.05). The cross-sectional study showed that migraine-related disability was significantly lower among patients in the second, third and fourth quartiles of TyG index scores compared to the first quartile (odds ratio = 0.402 (0.163, 0.973), 0.322 (0.128, 0.789) and 0.301 (0.119, 0.736), respectively; p_trend = 0.009). A similar trend was observed in patients with migraine history of less than ten years.

Conclusions: Integrating the results of both cohort and cross-sectional studies, this study suggests that IR may play a protective role in the early stages of migraine. Further research into the relevant underlying mechanisms could aid in identifying new therapeutic targets for migraine management.

Background: Post-traumatic trigeminal neuropathic pain represents neuropathic pain in the distribution of the trigeminal nerve caused by trauma to the trigeminal nerve. Dental traumatic interventions, such as root-canal therapy and extractions, are reported to precede, in some cases, the onset of the disease. The current study aims to investigate how much dentists are trained to recognize, treat or properly address patients suffering from Post-traumatic trigeminal neuropathic pain.

Methods: Data were collected from a large sample of Italian dentists in 2021. The setting of this study relates to an epidemiological survey conducted on the web. Google Forms, a product of Google Inc., was used as the operating system. An online questionnaire was sent to each participant, and the degree of knowledge of the disease along with the direct experience of having encountered it was investigated through specific multiple-choice questions.

Results: 634 dentists participated in the survey. 29% of participants declared to be unaware of the existence of Post-traumatic trigeminal neuropathic pain. 70% of dentists reported to have had patients suspicious of such pain in their clinical activity, following endodontic treatment (60%), tooth extraction (43%), spontaneously (37%) or other dental therapies (21%). When encountered, only in one out of three cases were patients sent to a pain specialist, and in most cases dentists performed irreversible therapies the site of the pain.

Conclusions: This study evidences a major public health problem, such as the incapability of clinicians to perform a correct diagnosis and management of Post-traumatic trigeminal neuropathic pain. Such a lack of knowledge costs the patients mistaken and irreversible surgical therapies in many cases, and resulting delays in receiving proper diagnosis and management that could affect the success of the treatment. Furthermore, the unawareness had high socioeconomic costs for both the healthcare system and the patients due to the disability.

Clinical trial registration: NP/2021/5460, Institutional Review Boards of the University of Cagliari, Italy.

Background: Fractures of the mandible are among the most common injuries to the bones of the facial skeleton and are associated with a relatively high incidence of complications, particularly purulent-inflammatory conditions, especially when treatment is delayed. These complications and surgical interventions can damage the masticatory muscles, disrupt their physiological balance, impair mandibular movement and contribute to pain syndrome development. This study aimed to investigate the dynamics of pain severity, the restoration of stomatognathic apparatus function following purulent-inflammatory complications of mandibular fractures and their impact on patients' quality of life.

Methods: We assessed the data of 15 patients with mandibular fractures without fragment displacement but complicated by purulent-inflammatory processes. Surgical intervention was combined with intermaxillary immobilization for four weeks, followed by myogymnastic exercises during rehabilitation. Mandibular movement amplitude was measured in three planes and surveys were conducted. Pain syndrome was assessed using the Visual Analog Scale and McGill Pain Questionnaire, and their psycho-emotional status was evaluated using the Spielberger-Hanin Anxiety Scale and Beck Depression Inventory. Quality of life was measured using the Medical Outcomes Study-Short Form questionnaire (SF-36). Assessments were performed on the fourth postoperative day, immediately after splint removal,and at one, six and twelve months post-operation. Mandibular mobility was also measured seven and fourteen days post-splint removal.

Results: The results were then compared with a group of healthy volunteers. Over one year of observation, we found that all functional and psychometric parameters of the patients remained significantly lower than those of the healthy volunteer group, and these deficits predisposed patients to muscle dysfunction and negatively impacted their quality of life.

Conclusions: Therefore, continued research is essential to develop effective treatment and rehabilitation strategies for this patient population.

Background: This study employed resting-state functional magnetic resonance imaging (rs-fMRI) to examine alterations in the brain's spontaneous activity during rest in patients with trigeminal neuralgia (TN) affecting different sides of the face.

Methods: We included 30 cases each of right-sided TN (R_TN), left-sided TN (L_TN), and healthy controls (HC). We analyzed changes in amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) values between L_TN and R_TN groups in comparison to HC. We also explored relationships between disease duration, visual analog scale scores, and ALFF/ReHo values in significant brain regions.

Results: Relative to HC, L_TN exhibited increased ALFF values in the left superior temporal gyrus and reduced values in the bilateral middle frontal gyrus. Elevated ReHo values were observed in the left cerebellar Crus2 region, while decreased values were identified in the bilateral middle frontal gyrus and left dorsolateral superior frontal gyrus. In R_TN, ALFF values increased in the left precentral gyrus and decreased in the right middle frontal gyrus; ReHo values remained unchanged. Correlation analysis indicated positive associations between disease duration and ALFF value of left superior temporal gyrus, as well as ReHo value of left cerebellar Crus2 region in L_TN.

Conclusions: This research indicated that both left and right TN patients exhibited changes in spontaneous brain activity during rest. These alterations predominantly occurred contralateral to the pain. These identified brain regions are implicated in pain perception, regulation, and emotional processing, suggesting their relevance to the modulation and adaptive changes of the human brain in response to trigeminal neuralgia.

Headaches are considered as major health problems being common in childhood and adolescence and are debilitating, thus, they lead to poor quality and low performance in all walks of life. Among all types of headaches, episodic migraine and tension-type headache are commonly encountered in the aforementioned phases of life and are likely to have devastating impacts as they become chronic. Stress factors related to school, peers and family, mental problems and traumatic experience may play an essential role in the occurrence of headaches affecting the lives of children and adolescents deleteriously. In this regard, there is unanimity on the most effective treatment of both paediatric and adult headaches through a biopsychosocial approach in which specialists from different fields contribute to the process in a collective manner. There is strong evidence that psychological interventions, which are among the basic elements of holistic treatment, provide relief to patients, especially when applied in combination with pharmacological treatment options in the early period. In general, the research has indicated that such treatments significantly improve the quality of life of children and adolescents suffering from different types of headaches by reducing the frequency, duration and intensity of pain, as well as alleviating the psychological symptoms accompanying the pain. In line with the thorough literature overview, this study aims to shed light on the main goals, domains and scope of application of psychological interventions that are widely applied or considered auspicious in the multidisciplinary treatment of paediatric headache in general terms.

Background: Arthroscopic surgery of the temporomandibular joint (TMJ) requires inserting an arthroscope and a working cannula into the joint cavity. Working cannula introduction and positioning require high levels of expertise.

Methods: A randomized controlled trial was performed on patients with closed lock of the TMJ who underwent arthroscopic lysis and lavage. A total of 15 subjects participated in this study, with 6 in the study group using the Locator-Positioner guide device (LOPO) and 9 in the control group using triangulation. The main outcomes included: (1) Number of attempts necessary for successful cannula insertion. (2) The time between arthroscope insertion and the appearance of the working cannula on the monitor, and (3) Overall surgery duration.

Results: A successful cannula insertion took an average of 2.1 attempts in the study group compared with 3 attempts in the control group (p = 0.045). Study group arthroscope insertion to monitor appearance of cannula took 2.3 minutes, whereas control group took 4 minutes (p = 0.039). A total of 14 minutes was spent on surgery in the study group compared to 16.5 minutes in the control group (p = 0.009).

Conclusions: LOPO device improved both the insertion of the working cannula into the TMJ and its positioning relative to the arthroscope throughout surgery. It reduced insertion attempts and shortened the surgery duration.

Clinical trial registration: the study was registered at clinicaltrials.gov, identifier: NCT06520917.