Cranio-The Journal of Craniomandibular & Sleep Practice最新文献

Objective: Perform a clinimetric analysis of the visual analogue scale (VAS) and active pain-free mouth opening (PFMO) in patients with muscular temporomandibular disorder (mTMD).

Methods:  Reliability (intraclass correlation coefficient=ICC), construct validity, responsiveness (area under the curve=AUC), minimal detectable change (MDC), and minimal clinically important difference (MCID) values were calculated.

Results: The VAS-24hr (ICC=0.59), VAS-7day (ICC= 0.54), and PFMO (ICC=0.86) exhibited acceptable reliability. Both the VAS (AUC=0.96) and PFMO (AUC=0.87) exhibited a high level of responsiveness. The MCID was 15.5mm (VAS-24 and VAS-7day) and 3.5mm (PFMO) in the improved group; and 27.5mm (VAS-24), 21mm (VAS-7day), and 6.6mm (PFMO) in the much-improved group. The MDC was 9.6mm (VAS-24), 9.5mm (VAS-7day), and 6.1mm (PFMO). All outcomes demonstrated strong construct validity (Pearson's r; p<0.001) .

Conclusions: All three outcome measures demonstrated acceptable clinimetric properties in patients with mTMD at the 3-month follow-up. The MCID lies outside measurement error in all outcomes in the much-improved group.      .

Objective: The maxillary canines have long been considered critical for dental function and aesthetics, with traditional practice prioritizing their preservation and alignment. However, this view often stems from outdated teachings rather than evidence-based principles, since there is no scientific support for the concept of canine-protected occlusion. Therefore, this commentary paper provides justification for extraction of severely impacted maxillary canines with first premolar substitution.

Results: In cases of severely impacted maxillary canines, orthodontic alignment may be associated with higher morbidity, unpredictable outcomes, prolonged treatment times, and increased patient burden. As an alternative, extracting the impacted canines and substituting the first premolars offers a viable, efficient solution that can achieve functional and aesthetic outcomes with fewer complications.

Conclusion: This paper challenges traditional perspectives on the management of impacted canines, advocating for an evidence-based approach that prioritizes patient-centered care.

Objective: To investigate several postural parameters and upper cervical functions in patients with temporomandibular disorders (TMD).

Methods: Patients diagnosed with different subtypes of TMD and healthy individuals without complaints of TMD were evaluated for pain, functional limitation, and anxiety by validated instruments. For evaluating upper cervical functions and postural parameters, cervical joint range of motion, cervical performance test, tragus wall distance, hamstring flexibility measurement, and measurement of the sacrum angle were recorded.

Results: Pain and jaw functional limitation scores were statistically higher in all groups with TMD. Patients with internal derangement and myofascial pain were significantly linked to a severe limiting of functions, higher anxiety, and depression scores. Postural parameters and cervical functions were similar between groups.

Conclusion: Although postural parameters and cervical functions remained unaffected, parameters such as pain, anxiety, and functional limitation that may affect the quality of life were related to unfavorable values in the TMD groups.

Objective: This cross-sectional study evaluated associations between sleep disorders, pain, bruxism, and chronotypes in patients with trigeminal neuralgia (TN) or post-herpetic neuralgia (PHN) in orofacial area.

Methods: Ninety-four subjects (25 TN, 14 PHN, 55 controls) were evaluated for pain, sleep, chronotype, anxiety, depression, oral behaviors, and lifestyle by validated instruments. Bruxism was assessed by self-report. Between-group comparisons and associations using correlation and regression analysis were made.

Results: TN patients had more sleep disorders and depressive symptoms and poorer lifestyles. Morningness was more common in PHN. Pain and anxiety were correlated with lower sleep quality and oral risk behaviors, mainly in TN. Worse lifestyle in both groups was correlated to anxiety and depression, and morningness was correlated to better lifestyle in TN. No association was observed of sleep or awake bruxism with lifestyle, anxiety, or depression.

Conclusion: TN patients are more vulnerable to sleep disorders and psychosocial impacts of pain.

Objective: Dental professionals are highly vulnerable to work-related musculoskeletal disorders (WMSD). As females, who are more prone to WMSD, represent a growing proportion of the dental workforce, this study explored sex differences in WMSD-pain prevalence among dental students, and differentiated it between preclinical and clinical students.

Methods: A multi-center cross-sectional study was conducted among dental students at three U.S. dental schools. An anonymous survey assessed prevalence of WMSD pain over the last 12 months and 7 days using the Nordic Musculoskeletal questionnaire. Sex and academic stage differences were analyzed with independent t-tests and chi-square, adjusted for demographics and occupational habits (working hours, self-reported ergonomics, loupes, sport engagement) with ANCOVA.

Results: Among 175 students (26.6±3.6 years, 66.9% females), 93.7% and 57.7% reported WMSD-pain in the past 12 months and 7 days, respectively. Females scored higher than males in pain intensity (p=.025), WMSD-pain prevalence in the past 7 days (p=.006), and number of painful body sites in the past 12 months (p=.006) and 7 days (p<.001). Clinical students had higher WMSD-pain prevalence (p<.001) and number of painful body sites (p<.001) in the past 7 days than preclinical students. Differences remained significant only among females.

Conclusion: A high prevalence of WMSD-pain was evident in dental students, with significant sex and academic stage differences.

Objective: To analyse the relationship between bruxism and musculoskeletal parameters of the cervical and mandibular regions in children and adolescents.

Methods: A comparative cross-sectional study was performed with subjects from 6 to 16 years. Subjects were divided into bruxism (any type) and control groups. Descriptive data, jaw opening, upper cervical spine mobility, myofascial trigger points (MTPs) and muscular tension of the jaw and neck muscles, the activation pattern of neck flexors and activation of Deep Neck Flexors (DNF) were registered and compared between groups.

Results: 121 subjects participated in the study. Children and adolescents reporting bruxism showed a significant reduction in the contraction of DNF (p = .034) and the activation ratio (p = .035) compared to controls. Besides, MTPs of both masseters were significantly more frequent in subjects reporting bruxism (p = .001-0.002). No differences were found in other measurements.

Conclusion: Bruxism is related to a weaker contraction of DNF, a lower activation ratio, and a higher number of MTPs in masseters.

Objective: Evaluate the relationship between OSAS and floppy eyelid syndrome [FES], along with possible confounding factors such as gender, age, and BMI.

Methods: This was a multicenter, cross-sectional prospective study. Patients referred to the sleep clinic suspected of OSAS were included in the study. Polysomnography, ophthalmological examination, and standard sleep questionnaires were applied for all patients.

Results: A total of 617 patients, 68.4% of whom were men, with a mean age of 50.66 [±12.43] years were included. While FES was 70.2% in the group with OSAS for ≥5/h, OSAS was detected in 93.6% of the individuals with FES. In addition, a positive correlation was found between AHI and FES. Age and the male gender were independent risk factors for FES.

Conclusion: A direct relationship was found between FES and the severity of AHI and OSAS. However, there was no evidence that OSAS is an independent risk factor for FES.

Objective: To present a list of key points for good Temporomandibular Disorders (TMDs) clinical practice on behalf of the International Network for Orofacial Pain and Related Disorders Methodology (INfORM) group of the International Association for Dental, Oral and Craniofacial Research (IADR).

Methods: An open working group discussion was held at the IADR General Session in New Orleans (March 2024), where members of the INfORM group finalized the proposal of a list of 10 key points.

Results: The key points covered knowledge on the etiology, diagnosis, and treatment. They represent a summary of the current standard of care for management of TMD patients. They are in line with the current need to assist general dental practitioners advance their understanding and prevent inappropriate treatment.

Conclusions: The key points can be viewed as a guiding template for other national and international associations to prepare guidelines and recommendations on management of TMDs adapted to the different cultural, social, educational, and healthcare requirements.