Journal of Oral & Facial Pain and Headache最新文献

Background: This study aims to elucidate the causal relationships between 1400 blood metabolites and pain related to temporomandibular disorders (TMD) using Mendelian Randomization (MR) analysis.

Methods: Utilizing data from genome-wide association studies (GWAS), our analysis was conducted with R software using the "TwoSampleMR" package. The primary method applied was Inverse Variance Weighted (IVW) analysis, which was supplemented with MR-Egger, Weighted Median, Simple Mode and Weighted Mode methods to examine the causal impact of blood metabolites on TMD-associated pain. We also assessed heterogeneity and the presence of horizontal pleiotropy using MR-Egger regression, MR-PRESSO (MR Pleiotropy Residual Sum and Outlier) global tests, and MR-Egger intercept tests.

Results: Three metabolites-Acetylcarnitine, Propionylcarnitine (c3) and X-24241-were significantly associated with TMD-related pain. Specifically, Acetylcarnitine had an odds ratio (OR) of 1.409 (95% CI (confidence intervals): 1.016-1.954, p = 0.04), Propionylcarnitine (c3) had an OR of 1.194 (95% CI: 1.036-1.377, p = 0.014), and X-24241 had an OR of 1.408 (95% CI: 1.108-1.790, p = 0.005).

Conclusions: This study establishes a causal link between increased levels of these three metabolites and TMD-related pain. Our findings provide new insights into the pathogenesis of TMD and potential therapeutic targets.

Background: Migraine is a chronic neurological disorder affecting over one billion individuals globally. It is a leading cause of disability, significantly impacting daily functioning, social relationships and work-related productivity. This study aims to explore the impact of migraine-related disability in everyday life in terms of missed days and productivity loss, as well as to identify work-related difficulties associated with migraine and the potential factors that exacerbate these difficulties.

Methods: This cross-sectional study was conducted from October 2023 to June 2024, involving 604 adult patients with migraine in Greece, selected through a convenience sampling method. Data collected included socio-demographic and clinical information, obtained using two validated self-reported questionnaires: the Migraine Disability Assessment (MIDAS) and the HEADWORK questionnaire. Statistical analysis was performed using IBM SPSS (Version 20.0), and descriptive statistics, chi-square tests, t-tests and Spearman's correlation were employed to evaluate the relationship between disability and work-related challenges.

Results: The MIDAS score revealed a high level of disability, with 52.2% of participants classified in the Severe Disability grade. HEADWORK scores highlighted moderate-to-severe work-related difficulties, particularly concerning stress management and environmental factors such as noise and brightness. Females, patients experiencing migraine with aura, and individuals with chronic migraine exhibited higher MIDAS and HEADWORK scores.

Conclusions: This study reveals the substantial impact of migraine on professional productivity and social relationships, emphasizing challenges in work-related performance and daily activities. The findings underscore the need for workplace accommodations and targeted interventions to improve the quality of life of individuals with migraine.

Background: To examine whether the combination of ultrasound (US)-guided superior cervical ganglion (SCG) block with standard triptans has a superior relief of headache as compared to triptans alone for acute migraine.

Methods: The retrospective-prospective cohort study enrolled patients presenting with acute migraine. The records of 243 cases receiving standard triptans and an adjunctive US-guided SCG were reviewed, while 230 cases were prospectively enrolled to receive triptan alone for control after age and sex matching in a 1:1.2 ratio. The primary endpoint was sustained headache relief and complete freedom from pain within post-procedural 24 hours. Secondary outcomes included headache relief and freedom from pain at 2 hours, monthly migraine days (MMDs), migraine disability assessment (MIDAS) scores, migraine-specific quality of life questionnaire (MSQ) scores, need for rescue analgesics use and adverse events.

Results: Sustained headache relief was observed in 69.5% of cases in the SCG cohort, yielding a superior outcome increased by 21.7% (95% confidence interval (CI): 13.1%, 30.4%) (p < 0.001). Overall, SCG block plus triptans had a better effect on headache relief and freedom from pain at post-procedural 2 hours, and sustained freedom from headache within 24 hours compared to triptans alone. At 1-month visit, SCG cohort also showed a greater improvement in MMDs (p < 0.01), MIDAS scores (p = 0.040) and MSQ scores (p = 0.036). No major adverse events were observed.

Conclusions: There was a superior therapeutic effectiveness of US-guided SCG block in conjunction with standard triptans for better headache relief up to post-procedural 1 month in acute migraine. It had an adjunctive beneficial effect in functional ability, life quality and possible facilitation of avoiding more adverse events.

This article reviews the various treatment options for anterior temporomandibular joint disc displacement, including disc reduction. These options include functional splints, anchorage, arthroscopy, combined orthodontic and disc repositioning, and combined orthognathic and disc repositioning. This article summarizes and analyses the indications, advantages, disadvantages, clinical efficacy, and available supportive trials of each treatment option. The objective of this study is to guide clinicians in the fields of temporomandibular joint orthognathic and orthodontics in their multidisciplinary diagnosis and combined treatment planning. Additionally, the article serves as a comprehensive reference for the selection of treatment options for clinicians. Conservative treatments can provide symptomatic relief, but it is difficult to reposition the disc. Arthroscopy or anchorage techniques can effectively reposition disc displacement, laying the foundation for subsequent treatment. The use of conservative treatments after surgery, combined with orthodontic and orthognathic treatment, can facilitate the promotion of effects and the prevention of recurrence. However, further research is needed to investigate long-term outcome, such as the impact of early intervention in adolescents on facial shape development.

Background: This study aims to evaluate the diagnostic accuracy of chronic facial pain conditions through telephone consultations.

Methods: Retrospective cross-sectional service evaluation of diagnosis during remote against face-to-face consultations were compared, based on international classification of orofacial pain. Clinical data from consecutive new patients were assessed from March-May 2020 at University College London Hospitals (UCLH)-Eastman Dental Hospital, UK, reviewed independently by two specialists. Exclusion criteria included non-English speakers, patients unable to engage in consultation, unrelated pain diagnoses at assessment and inadequate documentation. Accuracy test of sensitivity, specificity and predictive values were employed.

Results: A total of 93 patients were included, and 6 orofacial pain diagnoses met. Nearly 25% had at least one imaging test, however none demonstrated underlying cause or change of diagnosis. Overall diagnostic accuracy was 97.85% with 100% sensitivity and specificity with perfect inter-rater agreement (kappa = 1). Only persistent idiopathic facial pain and post-traumatic neuropathic pain had reduced accuracy (98.9%) and positive predictive value (75% and 50% respectively), being 100% for all other conditions.

Conclusions: This study showed high diagnostic accuracy for diagnosing facial pain remotely, corroborating previous reports. Further investigations and physical examinations have not changed the diagnosis or management plan. This study evidenced that remote structured consultations represent a safe strategy for accurate facial pain diagnosis that may improve clinical efficiency.

Background: Low-level laser therapy (LLLT) is a non-invasive, innovative approach for alleviating pain and improving function in temporomandibular joint (TMJ) disorders. This study aimed to compare the effect of three different doses of photobiomodulation (PBM) (2.5, 5 or 10 J/cm²) on the reduction of nociceptive events of rats' TMJ with persistent inflammation and inflammatory profile modulation.

Methods: Male Wistar rats (n = 240) were submitted to a model of temporomandibular inflammation induced by induced by Complete Freund's Adjuvant (CFA) and treated with PBM on days 1, 3, 5, 7 and 10 post-CFA or saline (SAL) injection. Assessments included orofacial mechanical sensitivity through von Frey test, quantification of Evans blue plasma extravasation, myeloperoxidase activity analysis (MPO) and neutrophil/leukocyte infiltration in synovial fluid and TMJ tissues.

Results: Regarding the analgesic effect of LLLT, an inverted U-shaped curve was observed, as despite the effectiveness of all three tested doses, the 5 J/cm² dose completely prevented the reduction in the mechanical allodynia threshold induced by temporomandibular inflammation. Regarding the evaluation of inflammatory parameters, all three doses studied effectively reduced plasma extravasation, neutrophils and MPO, with more pronounced effects observed at the 5 and 10 J/cm² doses. Interestingly, the lowest dose evaluated, 2.5 J/cm², partially prevented mechanical allodynia, plasma extravasation, MPO activity and neutrophil count, both in the acute application and with repeated treatment for up to 10 days. Total leukocyte levels, however, were reduced with LLLT at the 5 and 10 J/cm² doses.

Conclusions: This study highlights the dose-dependent efficacy of LLLT, with an intermediate dose (5 J/cm²) producing the most pronounced analgesic effects and the 5 and 10 J/cm² doses demonstrating significant therapeutic benefits in reducing acute and persistent TMJ inflammation. Importantly, even the lowest dose effectively modulated key components of the innate immune response, indicating its potential to reduce early inflammatory processes.

Background: Although the relationship between temporomandibular disorders and posture has been addressed in many studies, a complete consensus has not yet been reached. This study aimed to evaluate global posture, cervical, thoracic and lumbar mobility, and the biomechanical characteristics of muscles in individuals with disc displacement with reduction.

Methods: A total of 70 participants were included in the study, consisting of 37 healthy individuals in the control group and 33 individuals in the study group. The participants included in the study were assessed for temporomandibular joint range of motion, pressure pain threshold in regions related to the temporomandibular disorders (lateral capsule, masticatory muscles and upper trapezius), global posture and thoracic and lumbar spine mobility, cervical posture and mobility, and the biomechanical characteristics (elasticity, stiffness and tone) of the paravertebral muscles, masticatory muscles and upper trapezius. The assessment was conducted using a digital caliper, an analog algometer, a spinal mouse, a universal and modified universal goniometer, and MyotonPRO, respectively.

Results: Cervical and temporomandibular joint range of motion were similar in both groups. The study group showed lower pressure pain threshold overall, except in the left upper trapezius and right anterior temporalis. The biomechanical characteristics (elasticity, stiffness and tone) of the masseter muscle and paravertebral muscles were also comparable, except for reduced elasticity in the left semispinalis muscle. Global posture and mobility (cervical, thoracic and lumbar) were alike in both groups.

Conclusions: This study showed that young adults with disc displacement with reduction largely have similar global posture, mobility (cervical, thoracic and lumbar) and muscle biomechanical characteristics (elasticity, stiffness and tone) compared to healthy individuals. However, their pressure pain threshold, especially at the joint capsule and most measurement points, was lower, except for a few areas.

Background: Temporomandibular disorder (TMD) is a prevalent condition associated with pain and dysfunction of the temporomandibular joint (TMJ) and surrounding structures. Sleep disturbances are common in TMD patients, yet the bidirectional causal relationship between specific sleep behaviors and TMD remains unclear. This study aimed to investigate this relationship using a two-sample Mendelian randomization (MR) approach.

Methods: A bidirectional two-sample MR analysis was conducted using genome-wide association study (GWAS) summary statistics for seven sleep behaviors and TMD/TMD related pain (TMD-pain). Single nucleotide polymorphisms (SNPs) were used as instrumental variables. The analysis included data from the UK Biobank and FinnGen Consortium, focusing on individuals of European ancestry. Statistical methods included inverse variance weighting (IVW), MR-Egger regression and sensitivity analyses to ensure robust findings.

Results: The analysis identified that genetically predicted "morning person" status reduced the risk of TMD (β: -0.173, p = 0.014), while longer sleep duration decreased the risk of TMD-pain (β: -0.382, p = 0.015). In reverse MR analysis, TMD-pain increased the risk of insomnia, obstructive sleep apnea (OSA) and sleep disorders (p < 0.05). No significant associations were found between other sleep behaviors and TMD or TMD-pain.

Conclusions: This study demonstrates a bidirectional relationship between sleep behaviors and TMD. Being a morning person and having longer sleep duration protect against TMD and TMD-pain, respectively, while TMD-pain increases the risk of certain sleep disorders. These findings highlight the importance of addressing sleep issues in TMD management.

Background: This study investigated how cumulative lifetime stress, as measured by the Stress and Adversity Inventory (STRAIN) scale, relates to salivary cortisol levels in temporomandibular disorders (TMD) patients compared to controls. Furthermore, to determine which specific lifetime stress domains are the strongest predictors of TMD.

Methods: The study was conducted with 110 participants (55 TMDs patients, 55 controls). Lifetime stress was assessed using the STRAIN questionnaire, and salivary cortisol levels were measured at two time points (7 AM and 10 AM) using Enzyme-Linked Immunosorbent Assay (ELISA). Statistical analyses included t-tests, Analysis of variance (ANOVA) and multiple regression to identify significant stress predictors for TMD.

Results: The TMDs patients had significantly higher stress scores (11.10 ± 3.26) compared to the controls (1.43 ± 0.99) (p = 0.001). Myalgia showed highest stress levels (11.69 ± 3.72), while patients with myofascial pain had the lowest (8.80 ± 1.14) (p = 0.043). Cortisol levels were highest in the of disc displacement without reduction with limited mouth opening (DDWoR with LO) group (82.49 ± 124.34) and lowest in myalgia patients (4.69 ± 3.90) (p = 0.001). Significant stress predictors for TMDs included relationship stress (p = 0.04), humiliation (p = 0.02), marital/partner stress (p < 0.001) and death-related stress (p = 0.01).

Conclusions: TMDs patients experience significantly higher lifetime stress and cortisol levels than controls. Myalgia patients showed a complex psychological and physiological stress link, whereas the DDWoR with LO subgroup exhibited a distinct physiological stress response. Specific life stressors, particularly relationship- and partner-related stress, are key predictors of TMDs. These findings reinforce the importance of a biopsychosocial approach in understanding and managing TMDs. Future research should focus on longitudinal and interventional studies to further elucidate causal mechanisms and effective therapeutic strategies.

Background: Considering that temporomandibular disorder (TMD) can negatively affect individuals' general health and quality of life by limiting orofacial functions, it is important to evaluate jaw-related functional limitations in TMD. This study aimed to investigate the psychometric properties of the Turkish version of the 8-item Jaw Functional Limitation Scale (JFLS-8-TR) in Turkish-speaking TMD patients.

Methods: A total of 162 patients with TMD and 114 individuals without TMD participated in the study. Face and content validity were assessed. To confirm the construct validity of the JFLS-8-TR, structural (with confirmatory factor analysis (CFA)), convergent (with pain severity and maximum mouth opening (MMO), Oral Health Impact Profile (OHIP-14), Fonseca Anamnestic Index (FAI) and the Turkish version of the 20-item JFLS (JFLS-20-TR)) and known-group validity were analyzed. Cronbach's alpha and intraclass correlation coefficient (ICC) were calculated to examine internal consistency and test-retest reliability.

Results: Both content and face validity were met. The acceptable model fit indices based on CFA confirmed the structural validity of the JFLS-8-TR. Robust associations between the JFLS-8-TR score and pain intensity (r = 0.92), MMO (r = -0.87) and scores on the FAI (r = 0.89), OHIP-14 (r = 0.86) and JFLS-20-TR (r = 0.96) supported the convergent validity (p < 0.05). The JFLS-8-TR was able to discriminate between individuals with and without TMD, indicating that it has known-group validity (p < 0.05). The internal consistency (Cronbach's alpha = 0.91) and test-retest reliability (ICC = 0.93) of the JFLS-8-TR were excellent.

Conclusions: The JFLS-8-TR is a valid, reliable and useful instrument for a more practical assessment of functional limitations in the masticatory system in Turkish-speaking TMD patients.