Journal of Oral & Facial Pain and Headache最新文献

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.

Background: To investigate in vitro how scrapie responsive gene 1 (SCRG1) contributes to the development of temporomandibular joint osteoarthritis (TMJOA).

Methods: Western blotting was used to identify protein expression. Proinflammatory cytokine levels were assessed by means of an enzyme-linked immunosorbent test. In order to find out whether chondrocytes expressed protein light chain 3B (LC3B), immunofluorescence was utilized.

Results: In the TMJOA in vitro model, hydrogen peroxide (H₂O₂) treatment increased the expression of SCRG1, stimulated chondrocyte catabolism and inflammatory response, and blocked autophagy. In chondrocytes, SCRG1 silencing reduces the inflammatory response, catabolism, and autophagy inhibition brought on by H₂O₂. Concurrently, H₂O₂ induction triggers the nuclear factor (NF)-κB pathway and nerve growth factor receptor (NGFR). When SCRG1 is downregulated, NGFR expression is inhibited and the NF-κB pathway is blocked.

Conclusions: By inhibiting NGFR and blocking the NF-κB pathway, knocking down SCRG1 can prevent H₂O₂-induced inflammatory response, metabolic breakdown and autophagy inhibition in chondrocytes.

Orofacial pain has become the most common debilitating disease resulting in high healthcare costs, and compromising the quality of life, speech, aesthetics and masticatory function of those affected. As its aetiology is multifactorial and as the treatment involves a multidisciplinary holistic approach, arriving at a confirmative diagnosis is challenging. Numerous studies have been published that support the bidirectional link between gut health and other organs like the cardiovascular system, respiratory system, neurological and hormonal. Recent studies indicate a potential link between gut microbiota dysbiosis and chronic orofacial and temporomandibular joint (TMJ) pain. In this review, we enumerate the link between the metabolites released by the gut bacteria and how they regulate the pain mechanism of various types of orofacial pain like chronic, neuropathic and inflammatory in the orofacial and TMJ regions. We also discuss the potential link between pain and gender predisposition. Further, we review the recent non-invasive therapeutic options which can be put forth to use for treating orofacial and TMJ pain.

Background: This study aimed to assess the influence of bruxism types and frequencies on pain localisation in individuals with temporomandibular disorders (TMD).

Methods: The study participants included 100 TMD patients. Participants consented to undergo clinical evaluations based on the Diagnostic Criteria for Temporomandibular Disorders Assessment Instruments Protocol (DC/TMD). Pain was determined by palpating the temporal and masseter muscles and the temporomandibular junction (TMJ). The oral behavior checklist (OBC) was used in DC/TMD to assess participants' risk for parafunctional movements and types of bruxism. The parafunctional risk assessment was performed with the assessment method reported by The International Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Consortium Network.

Results: Most participants are at high risk for parafunction. There was a statistically significant relationship between masseter, temporal and TMJ pain and parafunctional movements (p < 0.05). Masseter pain on palpation showed significant relationships with sleep bruxism and awake grinding frequency (p < 0.05). Temporal muscle pain on palpation showed significant relationships with the presence and frequency of awake clenching (p < 0.05). A significant correlation exists between TMJ pain on palpation and awake grinding and clenching and with awake clenching frequence (p < 0.05).

Conclusions: Based on their frequency and presence, different types of bruxism may be associated with different pain symptoms.

Background: Temporomandibular disorders associated myalgia (TMD-M) is one of the most common patient complaints in clinics. Because of the disease's multifactorial etiology and complexity,extensive understanding is required to determine an appropriate treatment protocol.

Methods: The current randomized comparison study included 80 patients who presented to the outpatient department with a TMD-M complaint. Patients were randomly assigned to one of two groups: continuous therapeutic ultrasound or pulsed therapeutic ultrasound, according to a standard protocol. The key outcome measures were pain intensity (visual analog scale (VAS), 0-10 cm) and muscle pressure pain threshold (PPT). Secondary outcome assessments included changes in maximal mouth opening, functional movements, and depression (Beck Depression Inventory (BDI)). A descriptive analysis was performed on the dataset to get data estimates for all variables.

Results: The means of the differences in the two group's values were compared. Intergroup comparisons for normally distributed data were performed using independent sample t-tests, and intragroup comparisons using repeated-measures Analysis of variance (ANOVA). For non-normally distributed data, such as pressure pain sensitivity (PPT), BDI, left laterotrusive movement (LLT), and protrusive movement (PM), intergroup comparisons were performed using the Mann-Whitney test, and intragroup comparisons using the Friedman test followed by the Wilcoxon signed-rank test. Although the intragroup changes in visual analogue scale (VAS) score, PPT, BDI, LLT and PM were highly significant in both groups (p < 0.001), there was no significant intergroup difference in pain reduction, PPT, BDI, LLT or PM (p > 0.05). There were no significant intergroup or intragroup differences in mouth opening or right lateral movement.

Conclusions: Both the pulse and continuous modes of therapeutic ultrasound (US) are equally effective in relieving pain. US therapy in both modes is a potent and independent therapeutic modality for the treatment of TMD-M.

Clinical trial registration: NCT05211245.

Diagnosis of jaw muscle and temporomandibular joint (TMJ) pain has been greatly standardized with the development and implementation of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). A significant part of the DC/TMD examination-pain on palpation and jaw movements-relies on psychophysical principles in the clinical procedures. Thus, it is essential that examiners are aware of the strengths and limitations of such techniques. Here we first review the background and psychophysical techniques used in the clinic and then discuss opportunities to apply both simple and more advanced modifications in research settings to further understand musculoskeletal pain mechanisms and signatures. The goal is to facilitate development of individualized treatment and precision medicine for which a good starting point seems to be careful pain phenotyping where psychophysical testing may play a substantial role.