Pain severity, negative affect, and microstressers as predictors of life interference in TMD patients

Coronavirus Lockdown as a Major Life Stressor: Does It Affect TMD Symptoms?

Temporomandibular disorders are multi-factorial conditions that are caused by both physical and psychological factors. It has been well established that stress triggers or worsens TMDs. This paper looks to present early research, still unfolding, on the relationship between COVID-19 as a major life stressor and TMDs. The main aims of this study were to: investigate the presence of symptoms related to TMDs and the time of onset and the worsening of painful symptoms in relation to the changes in social life imposed by the coronavirus pandemic; and to evaluate the perception of COVID-19 as a major stressful event in subjects who report worsening of painful TMD symptoms. One hundred and eighty-two subjects answered questionnaires-Axis II of the RDC/TMD, the PSS, and specific items about coronavirus as a stressful event-during the lockdown period for COVID-19 in Italy to evaluate the presence of reported symptoms of TMD and the level of depression, somatization, and stress perceived. The results showed that 40.7% of subjects complained about TMD symptoms in the past month. Regarding the time of onset, 60.8% of them reported that facial pain started in the last three months, while 51.4% of these subjects reported that their symptoms worsened in the last month and were related to the aggravation of pain due to the coronavirus lockdown as a major life event and to the stress experienced. The results of this study seem to support the hypothesis that stress during the pandemic lockdown influenced the onset of temporomandibular joint disorders and facial pain, albeit with individual responses.

Clinical study of splint therapeutic efficacy for the relief of temporomandibular joint discomfort

PURPOSE

This study aimed to evaluate the relationship between displacement of the mandibular condyle/disc due to occlusal splint insertion with splint therapy and changes in discomfort of the temporomandibular joint (TMJ), and to clarify the relationships between the outcomes over time of temporomandibular discomfort and TMJ magnetic resonance imaging (MRI) findings at the initiation of splint therapy.

MATERIALS AND METHODS

A total of 75 patients admitted to hospital with discomfort around the TMJ were evaluated. A visual analogue scale for TMJ discomfort was administered during visits for approximately 3 months following the initiation of splint therapy. At the start of splint therapy, magnetic resonance imaging (MRI) was performed with and without splint insertion, and condyle and disc movements were evaluated. Disc balance, disc position and function, disc configuration, joint effusion, osteoarthritis, and bone marrow were evaluated. Linear regression and multiple regression analyses were used to clarify relationships between changes in discomfort and the factors evaluated.

RESULTS

There was no significant correlation between TMJ discomfort and condyle/disc movement with splint insertion. TMJ discomfort was significantly relieved by splint therapy regardless of temporomandibular MRI findings. Unilateral anterior disc displacement and marked or extensive joint effusion fluid were significantly improved with splint therapy.

CONCLUSION

Discomfort tended to remit with splint therapy regardless of temporomandibular MRI findings. Improvement of TMJ discomfort appears more likely to occur in patients with unilateral anterior disc displacement and with an apparent organic disorder, such as a joint effusion.

Correlation between temporomandibular disorder and quality of sleep in women

Abstract Introduction: Temporomandibular Disorder (TMD) is caused by multiple factors and exhibits various symptoms. Its most common symptom is pain, a factor that can influence the quality of an individual's sleep. Objective: The aim of the present study was to assess the correlation between TMD and sleep. Methods: A cross-sectional study was conducted with 60 women, aged between 18 and 40 years, who had been diagnosed with TMD based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Fonseca's anamnestic index (FAI) was used to classify the severity of the dysfunction. To complete the assessment, each volunteer was assessed using the visual analogue scale (VAS) for pain. They also responded to two questions related to their quality of sleep and the average hours of sleep per night. Results: The more severe the TMD, the fewer hours of sleep per night (r = -0.5663). In total, 63.33% of the volunteers reported not sleeping well. Concerning pain, the greater the VAS score, the less hours of sleep (r = -0.516) and the more severe the TMD. Conclusion: It was found that the severityof TMD was correlated with pain symptoms and the number of hours of sleep per night.

Translation and cross-cultural adaptation of the manchester orofacial pain disability scale

Objectives

The purpose of the present study was to translate and perform a cross-cultural adaptation of Manchester Orofacial Pain Disability Scale to the Portuguese language.

Material and Methods

A synthesis of two independent translations done by bilingual translators whose mother tongue was the Portuguese language began the process of translation. From the synthesis of the translated version and totally blind to the original version, two different non-native English language teachers without dental knowledge translated the questionnaire back to English. The pre-final version was done by an Expert committee: the researchers, two other non-native English language teachers and one native English language speaker. The new questionnaire was then piloted among 8 patients from the target setting that were interviewed to probe it on their perceived meaning of each question. The Manchester Orofacial Pain Disability Scale (MOPDS) thus translated was called Brasil-MOPDS and was validated in 50 patients with Orofacial pain from TMJ and Occlusion clinic ambulatory of São Paulo University School of Dentistry. The Brasil-MOPDS was administered twice by an interviewer (15 - 20 day interval) and once by a second independent interviewer. The Brazilian version of the short form oral health impact profile (OHIP-14) questionnaire and the visual analogue pain scale (VAS) were applied on the same day.

Results

Internal consistency (Cronbach's α = 0.9), inter-observer (ICC = 0.92) and intra-observer (ICC = 0.98) correlations presented high scores. Validity of Brasil-MOPDS compared to OHIP-14 (r = 0.85) and VAS (r = 0.75) shown high correlations.

Conclusions

Brasil-MOPDS was successfully translated and adapted to be applied to Brazilian patients, with satisfactory internal and external reliability.

The electromyographic activity of masseter and anterior temporalis during orofacial symptoms induced by experimental occlusal highspot

The aim of the present study was to investigate the short-term impact of an occlusal highspot on the occurrence of orofacial symptoms by collecting self-evaluation and using electromyography (EMG) evaluation. A rigid unilateral intercuspal occlusal highspot (A cast onlay of 0.5 mm) was placed on the right lower first molar of six adult volunteers (three males, three females), and remained for 6 days. Continuously all the induced orofacial symptoms were collected and the subjects scored the orofacial pain on a 10-cm visual analogue scale (VAS) during the placement of onlay. The surface EMG was recorded before the placement of onlay, during (on the 3rd and 6th day) and after the onlay was removed. Then the contractile symmetry of bilateral masseter (MAL, MAR) and anterior temporalis (TAL, TAR) was measured by using an asymmetry index. On the 3rd day of the placement of the occlusal highspot, all subjects complained of headache in right temporal region (mean VAS +/- s.d.=3.7+/-0.5); the activity of TAR at rest position of mandible increased significantly (P=0.027). In addition, on the 3rd and 6th day with the highspot the EMG activity of the tested muscles during maximal voluntary contraction (MVC) was significantly reduced; the asymmetry index of bilateral anterior temporalis during MVC was increased significantly (P(3rd)=0.028; P(6th)=0.046). A unilateral occlusal highspot may make the ipsilateral anterior temporalis become tenser at rest position. Furthermore, the activity of bilateral anterior temporalis becomes more unsymmetrical during MVC although there are inter-individual differences between subjects. The changes in muscular activity may have some relationship with the occurrence of tension-type headache in temporal region.

In patients with temporomandibular disorders, do particular interventions influence oral health-related quality of life? A qualitative systematic review of the literature

OBJECTIVES

The use of patient-based outcomes to measure therapeutic effectiveness is increasing, because a growing number of clinical scientists are attempting to evaluate the impact of therapy on the recipient. There are indications that patients suffering from temporomandibular disorders (TMDs) may also show a reduced oral health-related quality of life (OHQoL). It was the purpose of this paper to answer the question as to whether therapeutic interventions in TMD patients have a positive effect on their OHQoL.

MATERIAL AND METHODS

A systematic electronic search (Ovid Medline 1966-2006; Science Citation Index 1945-2006) of the literature was carried out to identify pertinent articles of randomized and non-randomized clinical trials. Reports on retrospective and prospective studies that specifically focused on OHQoL changes in TMD patients as a consequence of therapeutic interventions were included. The reference lists of the identified articles were screened to find additional pertinent publications.

RESULTS

The investigation yielded seven relevant contributions from Medline. A quantitative analysis of the seven identified articles was not possible. There was considerable heterogeneity among the investigations with regard to study design, patient characteristics, and provided therapy. Three of the identified articles reported about prospective controlled studies, of which one was an RCT. Four additional investigations were retrospective. According to the results of the only RCT, a 6-week course of the non-selective cyclooxygenase (COX) inhibitor naproxen may lead to slightly better OHQoL in patients with temporomandibular joint (TMJ) arthralgia than the selective COX-2 inhibitor celecoxib. The two other articles reporting of a controlled study showed that selective serotonine uptake inhibitors accompanied by psychological therapy improved OHQoL in individuals with TMJ arthralgia. In contrast, TMJ surgery did not improve OHQoL.

CONCLUSION

It appears that all therapeutic interventions reported in the identified publications led to at least some improvement of OHQoL. The only exception were patients with multiple TMJ surgeries.

Development of a new questionnaire to assess pain-related limitations of daily functions in Japanese patients with temporomandibular disorders

BACKGROUND

Various measures/scales have been used to assess oral health-related quality of life in patients with temporomandibular disorders (TMDs). However, there have been few reports on the validity of questionnaires, and even fewer assessments of their use in Japanese sociocultural conditions.

OBJECTIVES

The objectives of the study were: (i) to develop and refine the number of questions concerning pain-related limitations of daily function in the TMD questionnaire (LDF-TMDQ, 13 items) in Japanese patients with TMD, (ii) to assess factor validity, and (iii) to determine convergent and discriminant validity of the LDF-TMDQ with the observed items within a multidimensional questionnaire.

METHODS

Four hundred and fifty-six (85.9%) outpatients with TMD were enrolled. The subjects were allocated into two roughly equal groups--E-group (233) for exploratory factor analysis and C-group (223) for confirmatory factor analysis [structural equation modeling (SEM)].

RESULTS

The exploratory factor analysis extracted 10 items and three factors. SEM showed the revised model to accurately describe the relationships between the measured items. As to convergent validity, the factor 'limitation in executing a certain task' and 'limitation of mouth opening' showed significant correlations with the observed items within the multi-dimensional questionnaire. However, the factor 'limitation of sleeping', show no correlation with any item. As to discriminant validity, all three factors had correlation coefficients below 0.4 with the psychological scale, the personality scale, and the visual analog scale for pain intensity.

CONCLUSION

The LDF-TMDQ was reduced from 13 items to 10. The factor validity of the LDF-TMDQ, and the construct validity of 'limitation in executing a certain task' and 'limitation of mouth opening' were confirmed, while that of 'limitation of sleeping' remains to be determined.

Orofacial pain and occlusion: Is there a link? An overview of current concepts and the clinical implications

This paper addresses the current concepts in orofacial pain and occlusion and queries their possible relationship to each other. English-language peer-reviewed articles were identified using Medline (1990-2003), as well as a hand search. The key words occlusion, orofacial pain , and temporomandibular disorders (TMD) were used. Additional references from citations within the articles were obtained, and current textbooks were used as well. The textbooks provided contemporary concept overviews and further additional references.

Sex differences in negative emotional responses to chronic pain

We proposed a sequential model of pain processing with pain intensity as stage 1, pain unpleasantness as stage 2, pain-related emotions (depression, anxiety, frustration, anger, fear) as stage 3, and overt behavioral expression of pain as stage 4. We tested hypotheses about relationships between sex and the first 3 stages of pain processing by conducting simultaneous regression analysis using LISREL-8 with data collected from 967 women and 680 men with chronic pain. We found the following results: (1) women reported higher pain-related frustration and fear; (2) frustration related most highly to pain intensity among women, as compared with anxiety and depression among men; (3) depression and frustration related most highly to usual and highest pain unpleasantness among women, as compared with frustration among men; and (4) contrary to expectations, pain-related emotions were more strongly related to pain for men. Consistent with the sequential model of pain processing, emotional response to pain was more closely related to pain unpleasantness than to pain intensity across sex. Anxiety and frustration were the emotions most highly related to pain. The current results highlight sex differences in the experience of chronic pain and the importance of assessing a range of emotions in patients with pain.

Impacto da dor na vida de portadores de disfunção temporomandibular

Foi realizado um estudo do impacto da dor na vida de indivíduos portadores de disfunção da articulação temporomandibular (DTM). Foram estudados 22 pacientes (20 mulheres e dois homens, com idade média de 28 anos) portadores de DTM que procuraram atendimento fisioterapêutico especializado, submetidos a uma versão brasileira do Questionário McGill de Dor (Br-MPQ), que inclui questões específicas sobre a qualidade de vida, como: 1) prejuízo social; 2) atividades da vida diária; 3) percepção do outro; 4) tolerância à dor; 5) sensação de estar doente; 6) sensação de utilidade; 7) satisfação com a vida. Os resultados mostraram que a dor da DTM prejudicou as atividades do trabalho (59,09%), da escola (59,09%), o sono (68,18%) e o apetite/alimentação (63,64%). Os autores concluíram que a dor da DTM tem um impacto negativo na qualidade de vida do paciente e que o questionário empregado, embora não específico, permitiu avalia-lo adequadamente.

Cognitive impairment in patients with chronic pain: the significance of stress

This review article examines the role of emotional distress and other aspects of suffering in the cognitive impairment that often is apparent in patients with chronic pain. Research suggests that pain-related negative emotions and stress potentially impact cognitive functioning independent of the effects of pain intensity. The anterior cingulate cortex is likely an integral component of the neural system that mediates the impact of pain-related distress on cognitive functions, such as the allocation of attentional resources. A maladaptive physiologic stress response is another plausible cause of cognitive impairment in patients with chronic pain, but a direct role for dysregulation of the hypothalamic-pituitary-adrenocortical axis has not been systematically investigated.

The impact of pain and symptoms of depression in scleroderma

Systemic sclerosis (scleroderma) is a rare connective tissue disease that can affect multiple organ systems. Case reports and small treatment studies suggest that pain is significant in scleroderma, but few data speak of the frequency or impact of pain. This study sought to determine the frequency and impact of pain, symptoms of depression, and social network characteristics on physical functioning and social adjustment in patients with scleroderma. One hundred and forty-two scleroderma patients completed measures of pain, depressive symptoms, social network characteristics, physical functioning, and social adjustment. Sixty-three percent reported at least mild pain and 50% reported at least mild levels of depressive symptomatology. Hierarchical regression analyses revealed that pain, depressive symptoms, and employment status (disabled/unemployed vs. not) were significant, independent predictors of physical functioning, together accounting for 37% of the total variance. Pain was the single strongest predictor of physical function, accounting for 20% of the variance. Depressive symptoms, physical functioning, diversity of social network, and employment status were significant independent predictors of social adjustment, together accounting for 63% of the variance. Depressive symptoms were the single strongest predictor of social adjustment, accounting for 26% of the variance. The effects of pain and physical function on social adjustment became non-significant when depressive symptoms were entered into the model, suggesting that symptoms of depression mediate the effect of pain and physical function on social adjustment. These findings indicate that pain is common in scleroderma and that pain and depressive symptoms are significant determinants of physical functioning and social adjustment, two important components of health-related quality of life. Increased attention to effective management of pain and symptoms of depression in scleroderma will likely lead to improved functioning and quality of life.

Oro-facial pain in the community: prevalence and associated impact

STUDY OBJECTIVE

To determine the prevalence of oro-facial pain (OFP) in the population and within-population subgroups and to describe the associated disability.

DESIGN

Cross-sectional population study.

SETTING

General medical practice in South East Cheshire, United Kingdom.

PARTICIPANTS

A random sample of 4000 adults aged 18-65 years of whom 2504 responded (adjusted participation rate 74%).

MAIN RESULTS

The overall prevalence of OFP was 26% (95% Confidence Interval (CI) 24%, 28%). The prevalence of symptoms was higher in women (30%) than in men (21%) and in both sexes the highest (30%) prevalence was found in the 18-25 year age group and the lowest (22%) in the 56-65 age group. Of all the participants, 12% had pain in or around the eyes, 10% reported pain in and around the temples, 6% pain in front of the ears and 6% pain in the jaw joints. Only 46% of the participants with OFP had sought professional advice from a dentist or general medical practitioner and 17% had to take time off work or were unable to carry out normal activities because of pain.

CONCLUSIONS

OFP is a common symptom experienced by a quarter of the adult population, of whom only 46% seek treatment. The prevalence is higher in women and younger age groups.

Validity of MMPI-2 profiles in chronic back pain patients: differences in path models of coping and somatization

OBJECTIVE

To show clinical utility and empirical validity of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) chronic pain patient subgroups by identification of differential multivariate relationships across groups.

METHOD

This study used structural equation modeling to test cognitive coping strategies and somatization as mediator variables in path models with pain severity and depression used as exogenous (independent) variables and patient's activity level as the final endogenous (dependent) variable, across MMPI-2 profiles.

RESULTS

Hierarchical cluster analysis, performed on a sample of 569 chronic low back patients, resulted in four cluster profiles identifiable as those found in previous work with the MMPI-2 (within normal limits, V-type, neurotic triad, and depressed-pathological). Somatization mediated the relationship between depression and activity level for the neurotic triad group but not the other three groups. A positive linear relationship was found between somatization and depression for the within normal limits, neurotic triad, and depressed-pathological groups, whereas their linear association was negative for the V-type group. Cognitive coping strategies mediated the relationship between depression and activity level for the within normal limits group. In addition, cognitive coping was predictive of activity level for the within normal limits, V-type, and neurotic triad groups but not for the depressed-pathological group.

CONCLUSION

Consistent with previous cluster analytic studies, this study replicated four MMPI-2 cluster profile groups in chronic pain patients. These results have also shown that several multivariate relationships between variables are different across MMPI-2 groups, providing evidence for the validity for these MMPI-2 subgroups.

Morphological characteristics of primary sensory and post-synaptic sympathetic neurones supplying the temporomandibular joint in the cat

The cells of origin of peripheral nerves that supply the temporomandibular joint were investigated by examining the centripetal transport of wheat germ agglutinin-horseradish peroxidase (WGA-HRP). Following WGA-HRP injection into the temporomandibular joint capsule of the cat, a large number of labelled neurones were observed in the trigeminal and superior cervical ganglia ipsilateral to the injection site, while no labelled neurones were detected in the cervical dorsal-root ganglia. Only one labelled neurone was seen in the stellate ganglion. Labelled neurones were primarily located in the posterolateral and dorsal regions of the trigeminal ganglion, but their distribution in the superior cervical ganglion was not localized to specific regions. The labelled neurones in the trigeminal ganglion were significantly larger than those in the superior cervical ganglion but the sizes of smaller neurones overlapped, suggesting that trigeminal ganglion neurones send both myelinated and unmyelinated fibres to the temporomandibular joint. The innervation of the temporomandibular joint by somatosensory and sympathetic fibres suggests that sympathetic nerves could be responsible for allodynia or neuropathic pain caused by temporomandibular disorders.