The effectiveness of different types of acupuncture to reduce symptoms and disability for patients with orofacial pain. A systematic review and meta-analysis

PURPOSE

To determine the effectiveness of different types of acupuncture in reducing pain, improving maximum mouth opening and jaw functions in adults with orofacial pain.

METHODS

Six databases were searched until 15 June 2023. The Cochrane risk of bias tool and GRADE were employed to evaluate bias and overall evidence certainty.

RESULTS

Among 52 studies, 86.5% (n = 45) exhibited high risk of bias. Common acupoints, including Hegu LI 4, Jiache ST 6, and Xiaguan ST 7, were used primarily for patients with temporomandibular disorder [TMDs]. Meta-analyses indicated that acupuncture significantly reduced pain intensity in individuals with myogenous TMD (MD = 26.02 mm, I2=89%, p = 0.05), reduced tenderness in the medial pterygoid muscle (standardised mean differences [SMD] = 1.72, I2 = 0%, p < 0.00001) and jaw dysfunction (SMD = 1.62, I2 = 88%, p = 0.010) in mixed TMD when compared to sham/no treatment. However, the overall certainty of the evidence was very low for all outcomes as evaluated by GRADE.

CONCLUSION

The overall results in this review should be interpreted with caution as there was a high risk of bias across the majority of randomized controlled trial (RCTs), and the overall certainty of the evidence was very low. Therefore, future studies with high-quality RCTs are warranted evaluating the use of acupuncture in patients with orofacial pain.

Evaluation of oral health-related quality of life in patients with temporomandibular disorders

OBJECTIVE

To evaluate oral health-related quality of life (OHRQoL) in patients with temporomandibular disorders (TMDs).

METHODS

Subjects included 56 patients diagnosed with TMD. Control subjects consisted of 30 individuals without temporomandibular joint symptoms. OHRQoL was evaluated using the Japanese version of the Oral Health Impact Profile (OHIP-J54) before and 4 months after treatment.

RESULTS

Total score and all subscale scores of the OHIP-J54 in patients before treatment were significantly higher than those of the control subjects and were significantly improved after treatment, except for social disability. Gender and NRS pain scores had statistically significant effects on OHRQoL, which was low in females and patients with severe pain.

CONCLUSION

OHIP-J54 appeared to be useful for understanding psychological and social problems as a screening tool and for assessing the extent of changes in the well-being of patients with TMD.

Oral health-related quality of life in patients with osteoarthritis of the temporomandibular joint-Results of a systematic review

OBJECTIVES

The aim of this systematic review was to assess the oral health-related quality of life (OHRQoL) of patients with osteoarthritis (OA) of the temporomandibular joint (TMJ).

METHODS

This systematic literature search applied the search terms "oral health-related quality of life AND osteoarthritis of jaw OR arthritis of temporomandibular joint AND oral health-related quality of life" in PubMed, Medline, Web of Science and Scopus. Eligibility criteria were publication until 31 August 2021, examination of children or adults with OA of TMJ, reporting of any OHRQoL measurement and a full text in English language. Two different, independent and experienced reviewers performed this systematic literature search. The analysis of respective data was qualitative. For quality appraisal, the available checklist from the Agency for Healthcare Research and Quality (AHRQ) was applied.

RESULTS

Out of 102 findings, eight studies were included in qualitative analysis. Seven clinical investigations were performed in adults aged between 34 and 43 years. The other included study was performed on children. The quality of two studies was moderate, and six studies were evaluated as of high quality. Most studies applied the 14-item short form of the oral health impact profile (OHIP 14) for assessment of OHRQoL. OHIP 14 ranged between 9.24 and 38.86 points in means of sum score. Comparison with healthy individuals revealed worse OHRQoL of OA patients in two studies. Associations between OHRQoL with either oral health, general quality of life or disease-related parameters were rarely reported and heterogeneous. Five of the included studies reported subscales of OHIP 14, showing an impairment in all subscales.

CONCLUSIONS

There are hints that patients with OA of the TMJ show a reduced OHRQoL. More studies are needed, especially regarding oral health, disease-related parameters and pain intensity and its potential influence on OHRQoL.

Does anxiety have an impact on temporomandibular disorders? A study in a Turkish sample by using specific questionnaires

OBJECTIVE

The aim of the study is to verify the impact of anxiety on temporomandibular disorders (TMD) by using specific questionnaires in a Turkish sample.

METHODS

This survey was conducted on 292 patients with a mean age of 38.59 ± 10.38 using Helkimo index, Oral Health Impact Profile (OHIP-14), and State Trait Anxiety Inventory (STAI). Spearman Correlation and Fisher Freeman Halton analyses were used for the statistical analysis.

RESULTS

There was no statistically significant difference between the Helkimo anamnestic dysfunction (HAD) levels in terms of OHIP-14 total scores or STAI state scores. There was, however, a statistically positive correlation between STAI state and OHIP-14 total values at 18.4%, a positive correlation between the STAI trait and OHIP-14 total values at 29.8%.

CONCLUSION

No significant correlation was observed between OHIP-14 total scores, STAI state scores, and HAD levels. Therefore, this study did not find a significant relationship between TMDs and anxiety.

Effects of photobiomodulation associated with orofacial myofactional therapy on temporomandibular joint dysfunction

PURPOSE

To investigate the influence of photobiomodulation associated with orofacial myofunctional therapy (OMT) in patients with temporomandibular muscle disorders (TMD).

METHODS

Randomized, blinded trial clinical study with a sample of eleven women with muscle TMD divided into two groups. The experimental group (EG) consisted of five women submitted to orofacial myofunctional therapy associated with photobiomodulation, and the control group (CG) consisted of six women submitted to orofacial myofunctional therapy associated with inactive photobiomodulation (placebo). The intervention was performed in the following twelve sessions: one evaluation, ten speech therapy sessions associated with photobiomodulation, and one reevaluation. For outcomes, investigation on pain perception using the visual analogue scale (VAS), investigation of palpation sensitivity with the research diagnostic criteria for temporomandibular disorders (RDC/TMD), and quality of life (QOL) verification through oral health impact profile - short form (OHIP-14) were considered.

RESULTS

The EG increased measurements of mandibular movements of opening and protrusion and improved in the evaluation of QOL.

CONCLUSION

Orofacial myofunctional therapy, when associated with photobiomodulation, contributed to increase the range of mandibular movements, with important improvements in the perception of quality of life and with significant improvement in the painful conditions of volunteers with TMD.

Temporomandibular disorders in prospective orthodontic patients

OBJECTIVES

To determine the prevalence and severity of temporomandibular disorders (TMDs) in prospective orthodontic patients. The association between TMDs and malocclusion severity as well as the impact of TMDs on oral health-related quality of life (OHRQoL) were also examined.

MATERIALS AND METHODS

A total of 350 consecutive patients seeking orthodontic treatment were invited to participate in the study. The presence of TMDs was established with the Fonseca Anamnestic Index (FAI), while malocclusion severity and OHRQoL were evaluated using the Peer Assessment Rating (PAR) index and Oral Health Impact Profile-14 (OHIP-14), respectively. Data were analyzed using chi-square, Kruskal-Wallis, and Mann-Whitney U tests and Spearman's correlation (P < .05).

RESULTS

Of the 350 patients, 164 consented to participation. Data from 26 participants were excluded because of incomplete entries, and that from 138 subjects (mean age 21.02 ± 5.45 years) were examined. TMD-related symptoms were present in two-thirds of the subjects, with 20.3% experiencing moderate/severe TMDs. While no significant difference in PAR scores were observed between the group with no TMDs and those with TMDs, subjects with TMDs had significantly higher OHIP-14 summary/domain scores than those without TMDs. Although a moderately strong correlation was observed between the FAI and summary OHIP-14 scores (rs = 0.57), no association was observed between FAI and PAR index scores.

CONCLUSIONS

The prevalence of TMD-related symptoms in prospective orthodontic patients was high, emphasizing the importance of screening the masticatory system before initiating orthodontic therapy. Although the presence of TMDs was not associated with malocclusion severity, it had a significant negative impact on OHRQoL.

Gender-specific associations of malocclusion traits with oral health-related quality of life in a Finnish adult population

AIM

The aim of this cross-sectional study was to investigate gender-specific associations of different malocclusion traits with oral health-related quality of life (OHRQoL) among Finnish adults.

MATERIAL AND METHODS

The study material comprised 1885 subjects from the Northern Finland Birth Cohort 1966. A clinical oral examination including registration of occlusion was carried out in connection with a 46-year follow-up examination. The 14-item Oral Health Impact Profile (OHIP-14) was used to measure OHRQoL. Subgroups with increased/decreased overjet, deep bite, open bite, lateral crossbite, and scissor bite were selected for further analysis. Subjects with normal occlusion were selected to form the normal occlusion group. Differences between subgroups and the normal occlusion group were evaluated for both genders separately. Education, number of teeth, caries, and orthodontic treatment history were chosen as confounding variables. Multivariate Poisson regression analyses were conducted to assess the effect of independent variables on OHRQoL.

RESULTS

After adjustments, decreased overjet, open bite, and scissor bite were associated with higher OHIP severity in women (P < 0.01). In men, deep bite was associated with higher OHIP severity (P = 0.007). Different malocclusion traits had associations with some OHIP dimension either in men or women. Orthodontic treatment history had a positive effect on OHRQoL in both genders.

CONCLUSION

The associations of malocclusion traits with OHRQoL differed between genders, with women reporting more impacts. Deviations from normal occlusion were generally found to have a negative impact on OHRQoL, but most of the adults with malocclusion seem to adapt to their condition.

Evaluation of signs, symptoms, and occlusal factors among patients with temporomandibular disorders according to Helkimo index

Objective: This study sought to assess the clinical signs and subjective symptoms of TMD, including the occlusal condition. Methods: Recruited individuals included 123 patients (58 men, 65 women) aged 15 to 65 years (mean 38.6 years) who had been referred to the TMD department. Helkimo dysfunction, occlusal, and anamnestic indices were used to assess signs of TMD, occlusal condition, and symptoms, respectively. Relationships of occlusal factors with signs and symptoms of TMD were evaluated by Spearman's correlation test. Associations of TMD with sex and age distributions were assessed by Mann-Whitney and Spearman's test, respectively. Results: The prevalence of signs and symptoms was as high as 75%. Occlusal factors had significant associations with signs and symptoms of TMD. Conclusion: Prevalence of TMD in the study population was high, without preference for age or sex. Occlusal factors may play a role in the etiology of TMD.

Self-reported temporomandibular disorder symptoms and severity of malocclusion in prospective orthognathic-surgical patients

OBJECTIVE

The objective of this study is to analyze the association between self-reported symptoms of temporomandibular joint disorder (TMD) and the severity of malocclusion in prospective orthognathic-surgical patients.

MATERIAL AND METHODS

The subjects consisted of 50 consecutive patients (13 males and 37 females) referred to two university clinics for assessment of orthodontic-surgical treatment need. Data considering self-reported TMD symptoms were gathered using a semi-structured diary. At the first appointment, all patients rated the importance of treatment (on a scale of 1-10) and assessed self-perceived dental appearance using a VAS scale. The scale was anchored with photographs 1 and 10 from the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). Study models were assessed by an experienced orthodontic specialist using the Peer Assessment Rating (PAR) index and the Index of Complexity, Outcome and Need (ICON). Association between the PAR and ICON scores and the number of reported symptoms was analyzed statistically.

RESULTS

Seventy-one percent of patients reported experiencing TMD symptoms. The most prevalent symptoms were pain in the head and/or neck region and fatigue in the TMJ region. The number of symptoms was highest in the morning. Ninety percent of males and 86% of females rated the importance of treatment as high; males experiencing TMD symptoms tended to rate surgery as more important compared with males with no symptoms (p = 0.056).

CONCLUSIONS

In this sample, the results cannot unambiguously confirm an association between self-reported symptoms of TMD and objectively defined severity of malocclusion.

Correlação entre sinais e sintomas da Disfunção Temporomandibular (DTM) e severidade da má oclusão

Introdução O papel da oclusão como fator etiológico das disfunções temporomandibulares (DTMs) tem sido um assunto polêmico e ainda controverso. Objetivo Avaliar a correlação entre sinais e sintomas da disfunção temporomandibular e a severidade da má oclusão. Método Foram avaliados 135 estudantes de Odontologia da UFPB. A presença de DTM foi estimada através do Índice Anamnésico de Fonseca (DMF) e de questões objetivas sobre seus sintomas. Os estudantes também foram submetidos a um protocolo resumido de avaliação clínica de DTM. A avaliação dos fatores oclusais foi realizada através do Índice de Prioridade de Tratamento (IPT) aplicado a modelos de gesso dos arcos dentários superior e inferior. As diferenças entre as médias do IPT relacionadas aos sinais e sintomas de DTM foram determinadas por meio dos testes t e One-way ANOVA. As correlações entre os fatores oclusais e a DTM foram determinadas a partir de correlação de Pearson. Resultado A severidade da má oclusão, segundo o IPT, não influenciou no surgimento de DTM e de sinais clínicos musculares ou articulares, e na necessidade de tratamento. A má oclusão de classe II, trespasse vertical acentuado e dentes girados foram estatisticamente correlacionados à necessidade de tratamento e aos sinais clínicos de DTM. Conclusão Em modelos multifatoriais, como na fisiopatologia da DTM, a oclusão pode desempenhar um papel de cofator na predisposição ou perpetuar as diferentes formas de DTM, não devendo ser considerada fator principal.

Do changes in oral health-related quality-of-life, facial pain and temporomandibular disorders correlate after treatment of severe malocclusion?

INTRODUCTION

The aim was to evaluate the relationships of changes in facial pain, temporomandibular disorders (TMDs) and oral health-related quality-of-life (OHRQoL) in adults who underwent orthodontic or orthodontic/surgical treatment.

METHODS

Sixty-four patients (46 women, 18 men, range 18-64 years) with severe malocclusion and functional problems were treated in Oulu University Hospital. Of these, 44 underwent orthodontic-surgical and 20 orthodontic treatment. Data were collected with questionnaires and clinical stomatognathic examinations before and on average 3 years after treatment. The OHRQoL was measured with OHIP-14 (The Oral Health Impact Profile), the intensity of facial pain with the Visual Analogue Scale (VAS) and the severity of TMD with the Helkimo's anamnestic (Ai) and clinical (Di) dysfunction indices.

RESULTS

A significant improvement was found in facial pain, signs and symptoms of TMD and OHRQoL after the treatment (p < 0.05). The decrease in VAS was associated with improvement in OHIP-14 severity (r = 0.296, p = 0.019). The correlations between changes in OHIP-14 severity and Ai and Di were not statistically significant.

CONCLUSION

Treatment of severe malocclusion seemed to improve OHRQoL via decreased facial pain. Decreased facial pain was associated especially with improved OHRQoL dimensions of physical pain, physical disability and social disability.

Risk factors for temporomandibular disorder: binary logistic regression analysis

Objectives: To analyze the influence of socioeconomic and demographic factors (gender, economic class, age and marital status) on the occurrence of temporomandibular disorder. Study Design: One hundred individuals from urban areas in the city of Recife (Brazil) registered at Family Health Units was examined using Axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) which addresses myofascial pain and joint problems (disc displacement, arthralgia, osteoarthritis and oesteoarthrosis). The Brazilian Economic Classification Criteria (CCEB) was used for the collection of socioeconomic and demographic data. Then, it was categorized as Class A (high social class), Classes B/C (middle class) and Classes D/E (very poor social class). The results were analyzed using Pearson’s chi-square test for proportions, Fisher’s exact test, nonparametric Mann-Whitney test and Binary logistic regression analysis. Results: None of the participants belonged to Class A, 72% belonged to Classes B/C and 28% belonged to Classes D/E. The multivariate analysis revealed that participants from Classes D/E had a 4.35-fold greater chance of exhibiting myofascial pain and 11.3-fold greater chance of exhibiting joint problems. Conclusions: Poverty is a important condition to exhibit myofascial pain and joint problems.

Key words:Temporomandibular joint disorders, risk factors, prevalence.

Application of an oral health-related quality of life questionnaire in primary care patients with orofacial pain and temporomandibular disorders

Objectives: To examine whether patients who report orofacial pain (OP) and temporomandibular disorders (TMD) have a poorer perception of their oral health-related quality of life and, if so, to what extent, and to analyze the association between oral health perception, sociodemographic variables and reported pain duration. Study Design: 407 patients treated at the OP and TMD units in the Healthcare District of Cordoba, Spain, diagnosed following the standard criteria accepted by the scientific community – the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) – were administered the Spanish version of the Oral Health Impact Profile questionnaire (OHIP-14). Bivariate and logistic regression analyses were performed to determine the degree of association between the patients’ OHIP-14 score and pain duration, pain intensity, and various sociodemographic variables. Results: The observed distribution was 89.4% women and 10.6% men. The mean OHIP-14 score was 20.57 ± 10.73 (mean ± standard deviation). A significant association (p<0.05) was found for gender, age, marital status, chronic pain grade, self-perceived oral health status and pain duration. Conclusions: The analysis of self-perceived oral health status in patients with OP and TMD, as measured by the OHIP-14, showed that oral health is perceived more negatively by women. Moreover, a one-point increase in the Chronic Pain Grade indicator increases the OHIP-14 indicator by 4.6 points, while chronic pain, defined as pain suffered by patients for one year or more, increases the OHIP-14 indicator by 3.2 points.

Key words:Orofacial pain, temporomandibular disorders, Oral Health Impact Profile, sociodemographic variables, primary care, Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD).

Dental esthetics and quality of life in adults with severe malocclusion before and after treatment

OBJECTIVE

To investigate the association between satisfaction with dental esthetics and quality of life, and esthetics satisfaction in relation to esthetic evaluations of three panel groups.

MATERIALS AND METHODS

Fifty-two patients (36 women, 16 men; age 18-61 years) with severe malocclusion were treated in Oulu University Hospital. Of these, 38 and 14 patients underwent orthodontic/surgical treatment and orthodontic treatment, respectively. A questionnaire and dental photographs were collected before and after treatment. The 14-item Oral Health Impact Profile (OHIP-14) was used to measure oral health-related quality of life. Satisfaction with dental esthetics was evaluated using the Visual Analogue Scale. Dental photographs were presented to three panel groups: 30 laypersons, 30 dental students, and 10 orthodontists, who rated the photographs using the Aesthetic Component of the Index of Orthodontic Treatment Need.

RESULTS

Oral health-related quality of life (OHIP-14 severity score) and esthetic satisfaction (according to the Visual Analogue Scale) improved after the treatment (P < .001). The most unsatisfied patients reported oral effects more often both before and after treatment. Changes in oral health-related quality of life components of severity, psychological discomfort, and psychological disability correlated positively with the changes in esthetic satisfaction. Orthodontists graded the situation before treatment as worse and the outcome as better than the laypersons; the level of grading by dental students fell between these two groups.

CONCLUSION

Improvement in esthetic satisfaction due to the treatment of severe malocclusion improves oral health-related quality of life, particularly by decreasing psychological discomfort and psychological disability.