Prevalence of self-reported jaw pain in Germany: two cross-sectional surveys of the general German population

Sex hormones associated with temporomandibular pain on palpation in male adolescents-Results of the epidemiologic LIFE child study

OBJECTIVE

This study aimed to investigate whether the sex steroid precursor hormone dehydroepiandrosterone sulphate (DHEA-S), sex hormone-binding globulin (SHBG) and testosterone (TT) are associated with temporomandibular (TM) pain on palpation in male adolescents.

METHODS

Out of the LIFE Child study dataset containing 1022 children and adolescents aged 10-18 years (496 males, 48.5%), we used a subsample of 273 male adolescents (mean age: 13.8 ± 2.3 years) in advanced pubertal development (PD) to analyse the association between hormones and TM pain. The Tanner scale was applied to describe the stage of PD. Pain on palpation of the temporalis and masseter muscles and the TM joints (palpation pain) was assessed using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Serum levels of sex hormones (DHEA-S, SHBG and TT) were determined using standardised laboratory analyses. Free TT was estimated from the ratio between TT and SHBG (free androgen index[FAI]). We calculated the risk of perceived positive palpation pain for male participants as a function of hormone levels (DHEA-S, FAI) taking into account age and body mass index (BMI).

RESULTS

Among more developed (Tanner stage 4-5) male adolescents, 22.7% (n = 62) reported palpation pain in the TM region. In these participants, FAI levels were approximately half that of individuals without such pain (p < .01). DHEA-S levels were about 30% lower in the pain group (p < .01). In multivariable regression analyses, the odds ratio (OR) for pain on palpation decreased to 0.75 (95% confidence interval [CI]: 0.57-0.98) per 10 units of FAI level compared to those without pain, after controlling for the effects of age and adjusted BMI. We observed the same effect for this subgroup per unit of DHEA-S serum level (OR = 0.71; 95% CI: 0.53-0.94).

CONCLUSION

At subclinical lower levels of serum free TT and DHEA-S, male adolescents are more likely to report pain on standardised palpation of the masticatory muscles and/or TM joints. This finding supports the hypothesis that sex hormones may influence pain reporting.

Psychophysical assessment of pain in adults with moderate and severe haemophilia: A cross-sectional study

BACKGROUND

Joint pain is the hallmark of haemophilia; therefore it seems clinically rather a musculoskeletal than a bleeding disorder. Although joint pain in people with haemophilia (PwH) is a complex and multidimensional problem, pain assessment remains primarily focused on the structural evaluation of their joints. Whereas, only few data are available on the potential implication of psychophysical and psychological factors.

OBJECTIVE

This study aimed to perform a psychophysical pain assessment including quantitative sensory testing (QST) and an evaluation of psychological factors in a large sample of PwH, to get insight into the individuals' pain system.

METHODS

Ninety-nine adults (36.9 ± 13.5 years) with moderate/severe haemophilia A/B and 46 healthy controls filled in self-reported pain and psychological questionnaires and underwent a QST evaluation including static and dynamic tests. Static tests focused on the determination of thermal detection and pain thresholds and mechanical pressure pain thresholds. Dynamic tests evaluated pain facilitation and the efficacy of endogenous pain inhibition. Besides comparing PwH and healthy controls, between-subgroup differences were studied in PwH based on their pain distribution.

RESULTS

The study revealed increased thermal and mechanical pain sensitivity and the presence of unhelpful psychological factors such as anxiety/depression in PwH. Among the subgroups, especially PwH with widespread pain showed altered somatosensory functioning. Enhanced pain facilitation and impaired efficacy of endogenous pain inhibition in PwH could not be observed.

CONCLUSION

Altered somatosensory functioning and unhelpful psychological factors, appear to play an important role in the pathophysiology of pain in PwH, especially in PwH with widespread pain.

Effectiveness of and Patient’s Satisfaction with Dental Emergency Unit in Pitié Salpêtrière Hospital (Paris), Focusing on Pain and Anxiety

Background

The Dental Emergency Unit (DEU) of the Pitié Salpêtrière Hospital receives mainly painful emergencies. This study aimed at evaluating the suppression of pain and anxiety as well as the patient's satisfaction after a visit to the DEU. Patients and Methods. A prospective study was carried out in 2019 (NCT03819036) in adult patients. Data was collected on D0 on site and then on D1, D3, and D7 by phone, during daytime. The main objective and secondary objectives were, respectively, to assess the intensity of pain on D1; the intensity of pain on D3 and D7; the evolution of anxiety on D1, D3, and D7; and the patients' satisfaction. They were evaluated with a 0–10 numeric scale (NS) on D1, D3 and D7; mean scores were compared with nonparametric statistics (ANOVA, Dunn's test).

Results

814 patients were contacted and 581 patients included; 87 were lost to follow-up. 376 patients completed all the questionnaires. In the final sample (59% men, 40 ± 16 y.o.), 86% had health insurance. The mean pain scores were as follows: D0: 6.36 ± 0.12; D1: 3.49 ± 0.13; D3: 2.23 ± 0.13; D7: 1.07 ± 0.11—indicating a significant decrease of 45%, 65%, and 93% on D1, D3, and D7, respectively, compared to D0 (p < 0.0001) between D0 and D1, D3, D7. The mean NS anxiety scores were as follows: D0: 3.32 ± 0.15; D1: 3.69 ± 0.16; D3: 2.75 ± 0.16; D7: 1.98 ± 0.15. The decrease was significant between D0 and D7 (p < 0.0001). The perception of general heath improved between D1 and D7. The overall score of satisfaction was 8.64 ± 0.06.

Conclusion

DEU enabled a significant reduction in pain and anxiety with high overall satisfaction.

Association of psychological distress and widespread pain with sympatoms of temporomandibular disorders and self-reported bruxism in students

Objectives

The aim of this study was to evaluate the association of psychosocial distress and widespread pain with self‐reported symptoms of temporomandibular disorders (TMD) and bruxism, in two cross‐sectional surveys in 2012 and 2016, and whether there are temporal changes in the magnitude of associations.

Materials and methods

The data were gathered from Finnish university students in 2012 and 2016. TMD symptoms were assessed with three validated questions and bruxism with one frequently used question. Psychosocial distress was assessed with the General Health Questionnaire‐12 (GHQ‐12), and widespread pain with questions of pain in the extremities, the neck or upper back, and lower back. The associations of GHQ‐12, widespread pain and background variables with TMD symptoms and bruxism were analyzed with chi‐square tests, t‐test and binary logistic regression models stratified by gender, and adjusted for age‐group, self‐reported general health/wellbeing and presence of widespread pain.

Results

Higher GHQ‐12 score and presence of widespread pain were significantly associated with TMD symptoms in both genders at both time points. The association of higher GHQ‐12 score with sleep bruxism and awake bruxism were inconsistent. In the adjusted model higher GHQ‐12 score and widespread pain were significantly related to TMD pain symptoms in both genders at both time points, and to bruxism in 2012. Between the two time points a greater variability in these associations was seen in men than in women.

Conclusions

Psychological distress and widespread pain are significant determinants in perceived TMD pain and bruxism among students. No significant temporal alterations were observed.

["A picture is worth a thousand words…" : Diagnosis of orofacial pain using Dolografie®]

BACKGROUND

Since 2017, the diagnosis of patients with orofacial pain at the University Center for Dental Medicine Basel has been supplemented by using standardized image graphics (Dolografie® [Affolter/Rüfenacht, Bern, Switzerland]). For this purpose, patients select from a set of 34 cards those that visually best match their pain and then explain the reason for their choice.

OBJECTIVES

(1) How many cards are selected on average? (2) Do sex and age influence the choice of cards? (3) Are there preferences in the choice of cards? (4) Are there correlations between pain diagnostic categories (e.g., musculoskeletal versus neuropathic orofacial pain) and the cards selected? (4) Are there correlations between pain diagnostic categories (e.g., musculoskeletal versus neuropathic orofacial pain) and the selected cards?

METHODS

The available complete pain anamnestic data of 143 patients were evaluated.

RESULTS

(1) Patients selected an average of 3.5 cards to describe their pain. Up to six cards were sufficient for a detailed description of pain in almost all patients. With the 16 most frequently chosen cards, the majority of patients were able to adequately describe their pain. (2) Sex and age had no influence on the number of selected cards. (3) There were clear preferences: Card 02 was chosen most often (45 times), followed by cards 05 and 13 (27 times each). (4) A differentiating choice was made most clearly in neuropathic pain by a strong preference for card 28 and a disregard of card 18.

CONCLUSION

The use of standardized image cards as a "visual communication tool" has proven to be a time-efficient procedure in the context of history taking, which helps to obtain clinically relevant information not previously expressed by the patient.

[Screening for temporomandibular disorders : A sensible approach?]

BACKGROUND

Temporomandibular disorders (TMDs) are typically characterized by pain in the masticatory muscles and temporomandibular joints (TMJs) and by limitation of mandibular mobility. In June 2019, the German Society of Craniomandibular Function and Disorders presented a screening tool to identify individuals with TMDs. The assessment tool consists of patient history (three questions related to jaw pain, one question related to impaired mandibular mobility) and a clinical examination (palpation of masticatory muscles and TMJs; evaluation of maximum jaw opening; assessment of the presence of occlusal disturbances; documentation of TMJ noises).

OBJECTIVES

The present article focusses on two questions: (1) Which of the nine parts of the tool are appropriate, and which are not? (2) In general, can screening for TMDs be recommended?

CONCLUSION

While the anamnestic questions, as well as the assessment of maximum mandibular opening, reflect the clinically relevant symptoms and signs of TMD patients, the remaining four clinical measures do not. Furthermore, TMD screening for painful TMDs appears unnecessary because patients suffering from orofacial pain and/or restricted mandibular mobility are likely to consult a therapist by themselves. Therefore, the use of this screening tool may lead to overdiagnosis, possibly resulting in nonindicated diagnostic and therapeutic measures.

Prevalence of temporomandibular disorders in patients seeking orthodontic treatment: A systematic review

The objective of this systematic review was (a) to establish the prevalence of temporomandibular disorders (TMDs) in patients seeking orthodontic treatment and (b) to determine the association between the presence of TMD and sex, age and malocclusion. A systematic literature search was performed according to PRISMA guidelines from 1969 to 2019 using the PubMed and LIVIVO databases. Eight study articles met the inclusion and exclusion criteria. An additional three contributions were identified through manual searching of the reference lists of retrieved articles. The methodological quality of the 11 articles was assessed with the Joanna Briggs Institute Critical Appraisal Checklist for prevalence studies. TMD prevalence ranged from 21.1% to 73.3%. The frequency of painful TMD signs/symptoms varied from 3.4% to 65.7%, while non-painful signs/symptoms ranged from 3.1% to 40.8%. The percentage of males and females presenting with TMD varied from 10.6% to 68.1% and 21.2 to 72.4%, respectively. In all studies, TMD prevalence was higher among females. The majority of articles reported more TMD signs/symptoms in individuals older than 18 years as compared to younger ones (≤18 years). While in four studies no association between TMD and malocclusion was found, another three investigations indicated that TMD may be related to certain occlusal traits. The TMD prevalence in patients seeking orthodontic treatment was high, with many individuals presenting painful TMD signs/symptoms. Female and older patients appear to have a greater occurrence of TMD. Although no strong association between TMD and malocclusion was established, several occlusal traits were implicated.