Journal of Oral & Facial Pain and Headache最新文献

This critical review explores the intricate interaction between orofacial pain and headache disorders and three prevalent sleep disorders: insomnia, obstructive sleep apnea (OSA) and periodic limb movements (PLMs) during sleep, while integrating the role of social determinants of health. Orofacial pain conditions, including temporomandibular disorders (TMD), headache, and burning mouth syndrome, frequently co-occur with sleep disturbances, creating a bidirectional cycle where poor sleep exacerbates pain and vice versa. The mechanisms underlying this relationship involve disrupted restorative sleep, neuroinflammation, heightened arousal and impaired descending pain modulation. Importantly, social factors such as socioeconomic status, healthcare access, education level, and social support influence the prevalence, severity, and management of these comorbidities, contributing to significant disparities in outcomes. We present recent advances in the phenotyping and endotyping of individuals with sleep-pain comorbidities, which aim to identify subgroups with shared characteristics to guide personalized interventions, emphasizing the need for interdisciplinary approaches that bridge dentistry, sleep medicine and public health to address the multifactorial nature of these conditions. Practical considerations for clinicians managing these patients are discussed, including screening tools, treatment modalities and the impact of social context. Future research directions prioritize the integration of measures of social factors into study designs, advancing personalized medicine and employing innovative technologies to better understand genotypes and phenotypes involved in pain perception and sleep characteristics, and manage the interplay between sleep and orofacial pain. The goal of addressing the interaction between sleep and pain is to improve health equity and optimize outcomes for individuals affected by these interrelated conditions.

Background: The article addresses the impact of total temporomandibular joint replacement (TMJR) on oral health-related quality of life (OHRQoL) in patients with advanced temporomandibular joint (TMJ) disorder. TMJ disorder encompasses a variety of conditions causing pain and dysfunction in the jaw, peripheral nerves, and TMJ. TMJR is considered a last resort in the surgical treatment of advanced joint disorders when conservative treatments fail.

Methods: The study followed 10 patients undergoing TMJR and assessed their oral health-related quality of life using the OHIP-14 (Oral Health Impact Profile-14) questionnaire at different postoperative time points.

Results: The results showed a significant improvement in physical pain, psychological discomfort, and physical disability after six months, with a restoration of oral health-related quality of life after twelve months.

Conclusions: The research concluded that TMJR treatment can significantly improve oral health-related quality of life in patients with advanced TMJ disorder. However, further studies are needed to analyze the long-term effectiveness of treatment and compare different surgical approaches.

Background: Masseter muscle hypertrophy is characterized by either symmetrical or asymmetrical enlargement of the muscle, often associated with bruxism and other parafunctional habits. Traditional methods for assessing muscle hypertrophy, such as palpation and visual inspection, can be subjective and heavily dependent on the clinician's experience. In contrast, devices like MyotonPRO offer a standardized, objective and reproducible approach, enhancing the precision and reliability of clinical diagnostics. The primary aim of our study was to evaluate the intra- and inter-rater reliability of the MyotonPRO device in assessing the viscoelastic properties of the masseter muscle. Additionally, we sought to investigate the potential correlation between subjective assessments of masseter hypertrophy and objective measurements obtained through myotonometry.

Methods: A clinical examination using muscle palpation was conducted to identify masseter hypertrophy, categorizing participants into Normal Muscle Volume (NMV) and Muscle Hypertrophy (MH) groups. The viscoelastic properties of their masseter muscles were then measured using MyotonPRO in both relaxed and maximal contraction states. Two experienced operators performed the myotonometry on the same day, with the first operator repeating the procedure 7 days later.

Results: Among the 58 participants, 51.7% were female, with a mean age of 28.6 years. The inter-rater reliability of masseter muscle measurements using MyotonPRO ranged from moderate to excellent, both at rest and during contraction, while intra-rater reliability ranged from moderate to good. The MH group showed higher levels of tension and stiffness, along with reduced relaxation time and creep during contraction, compared to the NMV group. The only statistically significant difference in relaxation between the groups was observed in muscle elasticity.

Conclusions: The MyotonPRO device effectively detects statistically significant differences (p < 0.05) between the MH and NMV groups for certain viscoelastic parameters. However, these differences were primarily significant during contraction, with elasticity being the only parameter showing a significant difference in the relaxed state.

Background: The relationship between chewing gum and the development of temporomandibular disorders (TMD) and other jaw anomalies presents a contentious topic within dental and orthodontic research communities. This systematic review aimed to synthesize the available evidence regarding the association of gum chewing with the incidence of TMD and jaw anomalies.

Methods: Adhering to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a comprehensive review across six electronic databases-PubMed, EMBASE, Cochrane Library, Web of Science, Scopus and PsycINFO. The studies were chosen based on predetermined inclusion and exclusion criteria, with quality and bias assessments performed on each included investigation. Data extraction and synthesis focused on the relationship between gum chewing habits and the occurrence of TMD symptoms.

Results: The review included 8 investigations, yielding mixed outcomes. Some studies within this review indicated no direct causative link between the act of gum chewing and the development of TMD-related symptoms, suggesting that symptoms were transient and subsided with the cessation of gum chewing. Conversely, other research suggested a dose-response relationship where increased frequency and duration of gum chewing were associated with escalated TMD symptoms, such as muscle discomfort and hypertrophy. Notably, several studies highlighted the resilience of jaw musculature to adapt to the stress of chewing in individuals without pre-existing TMD, which might be indicative of a protective adaptive response.

Conclusions: The association between gum chewing and TMD is complex and multifaceted. Evidence from this systematic review suggests a spectrum of effects, from negligible impact to a dose-dependent relationship between gum chewing and TMD symptomatology.

The prospero registration: CRD42024553227.

Background: Understanding the global prevalence and characteristics of a given health problem is essential for sizing its global and regional burden, estimating treatment needs, prioritizing healthcare services, and formulating targeted policies. This systematic review and meta-analysis aimed to estimate the global prevalence of temporomandibular disorders (TMDs) by gender, age, and continent, and the prevalence of specific categories such as myalgia, arthralgia, clicking/joint sounds, and limited mouth opening.

Methods: A comprehensive search was conducted across three databases-PubMed, Scopus and Web of Science and supplemented by manual search up to June 2024. TMD diagnoses were based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) or Diagnostic Criteria for Temporomandibular Disorders (DC/TMD).

Results: The database search yielded 15,628 records, from which 27 studies involving 20,971 subjects, including 6075 diagnosed with TMDs, were selected for final analysis. All meta-analyses utilized a random effects model. It is estimated that nearly a third of the global population (29.5%) suffers from TMDs. TMDs affected females at a significantly higher rate compared to males (36.7% versus 26.7%), representing a 1.75-fold greater likelihood among females. Prevalence among individuals under 18 years of age is 38.5%, compared to 34.1% in those 18 and older. TMDs are most prevalent in Europe (33.8%), followed by Asia (27.9%) and South America (27.3%); the lowest prevalence was in North America (19.4%). The most frequently reported signs and symptoms of TMDs are myalgia (37.2%), clicking/joint sounds (29.8%), and arthralgia (16.8%), with limited mouth opening/locking being the least prevalent (8.1%).

Conclusions: TMDs represent a significant and largely unrecognized health burden. Although conducting further primary studies is urgent for confirmation, this current research underscores that TMDs might constitute a silent epidemic that has not garnered the urgent attention it deserves from healthcare providers, the local community, and researchers.

The prospero registration: PROSPERO number is CRD42024583777.

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.