Reciprocal effects of scleroderma and temporomandibular dysfunction between patient cohorts

OBJECTIVE

To estimate the prevalence of temporomandibular dysfunction in scleroderma patients according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and to correlate it with disease variables.

METHODS

Temporomandibular dysfunction was evaluated in 75 scleroderma patients and 74 healthy controls using DC/TMD. Gastrointestinal symptoms were evaluated through the University of California Los Angeles (UCLA) score in scleroderma patients.

RESULTS

There was no difference of prevalence in temporomandibular dysfunction [30 (40%) vs 30 (40.5%); p > 00.05] between scleroderma patients and healthy controls. Scleroderma patients had a significant reduction in all oral movements compared to healthy controls. Scleroderma patients with temporomandibular dysfunction had a statistically higher score in the UCLA distention/bloating item [1.75 (0.5-2.38) vs 0.75 (0.25-1.75); p < 0.05] than scleroderma patients without temporomandibular dysfunction.

DISCUSSION

Temporomandibular dysfunction prevalence between scleroderma patients and healthy controls is similar. In scleroderma patients, temporomandibular dysfunction reduces oral mobility and opening, which worsens distension/bloating.

Mechanisms Underlying Sex Differences in Temporomandibular Disorders and Their Comorbidity with Migraine

Sexual dimorphism in temporomandibular disorders (TMDs) and their comorbidity with migraine are important phenomena observed in clinics. TMDs are the most prevalent orofacial pain conditions with jaw joint and masseter muscle dysfunction. Migraine is the predominant headache commonly associated with TMDs. Women much more often suffer from this orofacial pain than men. However, currently, there is no gender-specific therapy for such pain conditions. Understanding the pathophysiological mechanisms behind sex differences in TMDs as well as their comorbidity with migraines is essential for developing novel approaches for gender-specific treatment of TMDs and related orofacial pain comorbidity. In this review, we summarize recent research progress regarding sex differences in TMDs, focusing on the underlying mechanisms including craniofacial anatomy, hormonal regulation, and roles of opioids, transient receptor potential channels, and endocannabinoid systems. We also discuss the mechanisms of comorbid TMDs and migraine. The information covered in this review will provide mechanistic insights into sex differences in TMDs and their comorbidity with migraine, which could aid in developing effective treatment strategies for the overlapping orofacial pain condition.

The Role of Malocclusion and Oral Parafunctions in Predicting Signs and Symptoms of Temporomandibular Disorders-A Cross-Sectional Study

BACKGROUND

The aim of this study was to examine to what extent malocclusion and parafunctional habits contribute to the development of signs and symptoms associated with temporomandibular disorders (TMD) in schoolchildren with mixed dentition in Croatia in a sample of 338 children, aged 9 to 15 years.

METHODS

TMD signs and symptoms assessed by the clinician were joint function and pain, masticatory muscles tenderness, range of mandibular motion, and joint sounds. To evaluate subjective symptoms and parafunctions, children and parents were asked about the presence of headaches, jaw locking, temporomandibular joint (TMJ) sounds, pain during mouth opening, or bruxism, as well as parafunctions like biting pencils or nails, chewing hard candies or ice, daily gum chewing, opening bottles with teeth, engaging in jaw play, thumb-sucking, and clenching/grinding teeth.

RESULTS

At least one symptom of a TMD was pronounced in 142 participants (42.0%). The most commonly reported parafunction was pencil or nail biting, present in 25.1% of participants. Class II malocclusion increased the likelihood by 2.6 times, pencil or nail biting by 2.34 times, and clenching/grinding teeth by 8.9 times that the subject would exhibit at least one TMD symptom.

CONCLUSIONS

Every child with mixed dentition should undergo a brief examination of the TMJ, especially in cases of Class II malocclusion, pencil or nail biting, and teeth clenching or grinding, as these have all been identified as significant risk factors that increase the likelihood of experiencing TMD symptoms. This highlights the need for proactive screening and assessment by healthcare providers to reduce the risk and prevalence of TMDs in affected children and ensure timely diagnosis and treatment.

Effects on temporomandibular disorder in the treatment of tension-type headache with acupuncture and therapeutic exercises. A secondary analysis from a randomized controlled trial

OBJECTIVES

To examine the effects of acupuncture and therapeutic exercise alone and in combination on temporomandibular joint symptoms in tension-type headache and to evaluate the potential interaction of existing temporomandibular dysfunction on the success of headache treatment.

DESIGN

Pre-planned secondary analysis of a randomized controlled, non-blinded trial.

SETTING

Outpatient clinic of a German university hospital.

SUBJECTS

Ninety-six Participants with frequent episodic or chronic tension-type headache were randomized to one of four treatment groups.

INTERVENTIONS

Six weeks of acupuncture or therapeutic exercise either as monotherapies or in combination, or usual care. Follow-up at 3 and 6 months.

MAIN MEASURES

Subjective temporomandibular dysfunction symptoms were measured using the Functional Questionnaire Masticatory Organ, and the influence of this sum score and objective initial dental examination on the efficacy of headache treatment interventions was analyzed.

RESULTS

Temporomandibular dysfunction score improved in all intervention groups at 3-month follow-up (usual care: 0.05 [SD 1.435]; acupuncture: -5 [SD 1.436]; therapeutic exercise: -4 [SD 1.798]; combination: -3 [SD 1.504]; P = 0.03). After 6 months, only acupuncture (-6 [SD 1.736]) showed a significant improvement compared to the usual care group (P < 0.01). Subjective temporomandibular dysfunction symptoms had no overall influence on headache treatment.

CONCLUSIONS

Only acupuncture had long-lasting positive effects on the symptoms of temporomandibular dysfunction. Significant dental findings seem to inhibit the efficacy of acupuncture for tension-type headache.

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.

Age and sex differences in comorbidities in adult temporomandibular disorders: A cross-sectional study using Korea National Health and Nutrition Examination Survey (KNHANES)

OBJECTIVES

To investigate the relationship between Temporomandibular disorder (TMD) and associated comorbidities in groups matched according to age and sex.

METHODS

Using data from the cross-sectional fifth Korea National Health and Nutrition Examination Survey (KNHANES). Of the 25,534 eligible KNHANES, 17,762 adults aged ≥19 years who responded to survey questionnaire on TMD and comorbidities. Subjects were classified into eight groups according to age and sex. Logistic regression analyses were performed to evaluate the association between TMD and comorbidities according to age and sex.

RESULTS

Of the enrolled participants, 2,107 (11.86%) complained of ≥1 TMD symptoms. In all groups, odds ratios (ORs) for prevalence of TMD were >1 in those with tinnitus. Rhinitis was closely associated with TMD in 6 groups. ORs for TMD with comorbidities according to age and sex were as follows: hypertension, men aged 50-64 years (OR 0.62; CI 0.41-0.94); ischemic heart disease, men aged 35-49 years (4.38; 1.54-12.47); osteoarthritis, women aged 50-64 years (1.38; 1.03-1.86); diabetes mellitus, men aged 35-49 years (0.21; 0.05-0.88); depression, men aged 50-64 years (1.68; 1.00-2.83), women aged 35-49 years (1.39; 1.05-1.85) and women aged 65-80 years (2.01; 1.46-2.77); migraine, men aged 50-64 years (1.60; 1.14-2.25), women aged d35-49 years (1.44; 1.14-1.81) and women aged 35-49 years (1.43; 1.07-1.90); cold hypersensitivity in the hands and feet, men aged 19-34 years (1.64; 1.05-2.58), men aged 35-49 years (1.68; 1.04-2.70), men aged 65-80 years (1.74; 1.09-2.75) and women aged 35-49 years (1.45; 1.15-1.84); olfaction disorder, men aged 50-64 years (2.49; 1.39-4.43); voice disorder, men aged 50-64 years (2.25; 1.28-3.96) and women aged 65-80 years (1.69; 1.09-2.63).

CONCLUSIONS

This study confirmed that the types and effects of comorbidities related to prevalence of TMD may differ according to the patient's age and sex and this result will increase the predictability of the onset of TMD.

Assessment of condylar anatomy and degenerative changes in temporomandibular joint disorders - A scoping review

Temporomandibular disorders (TMDs) are a group of conditions that cause pain and dysfunction in the temporomandibular joint (TMJ) and muscles that control mandibular movement. In most cases, the etiology is unclear and is considered multifactorial. Recent research suggests that some forms of TMD could be associated with specific TMJ morphological characteristics. This study aims to provide a review of the reported anatomical and degenerative morphological condylar characteristics of subjects with a clinical diagnosis of TMD as described with the use of CBCT imaging, as well as the detection of potential predisposing anatomical factors. This review was developed and reported in accordance with the PRISMA-ScR Checklist. A comprehensive search was performed in five databases. Reports were screened by two independent reviewers based on preselected inclusion and exclusion criteria. 45 studies were included in this review. The most frequently reported degenerative changes associated with TMD were condylar surface erosion, flattening, osteophytes, and sclerosis. Anatomical characteristics included a small condylar size and a posterior position of the condylar head in the TMJ. The anterosuperior area of the condylar head appears to be the most frequently affected. More studies are required to determine potential specific predisposing anatomical characteristics.

Clinical study of magnetic resonance imaging-based texture analysis and fasciculation of the lateral pterygoid muscle in young patients with temporomandibular disorder

OBJECTIVE

We aimed to evaluate the effectiveness of clinical examination combined with texture analysis of magnetic resonance imaging (MRI) and fasciculation patterns of the lateral pterygoid muscle (LPM) in distinguishing among the different anatomic causes of temporomandibular disorder.

METHODS

We divided the patients into four groups: healthy control (HC), disk without displacement (DWoD), disk displacement with reduction (DDWR), and disk displacement without reduction (DDWoR). Demographic information and clinical symptoms of patients in each group were recorded. LPM textures were compared among groups. LPM fasciculation was examined. P<0.05 indicated significant difference.

RESULTS

Several clinical symptoms and signs, but not age or sex, differed significantly among groups. Oblique sagittal planar MRI revealed significant differences in the parameters of Angular Second Moment, Contrast, Correlation, Inverse Difference Moment, and Entropy between the healthy controls and the 3 patient groups. MRI of the patients, both without and with disk displacement, demonstrated relative uniformity in gray distribution and correlation of gray values, with greater complexity but an unclear texture and no obvious regularity. The proportion of type B LPM fascicles was significantly higher in the DDWR and DDWoR groups CONCLUSION: Temporomandibular disorder, without and with disk displacement, is associated with clinical symptoms and texture analysis values that differ from healthy muscle. The types of LPM fascicles are related to the position of the articular disk.

Craniofacial disorders and headaches. A narrative review

OBJECTIVES

Craniofacial- and headache disorders are common co-morbid disorders. The aim of this review is to provide an overview of the research discussing craniofacial pain, especially temporomandibular disorders, and its relationship and impact on headaches, as well as suggestions for diagnostic assessment tools and physical therapeutic management strategies.

METHOD

A narrative structured review was performed. A search was conducted in MEDLINE using terms related to craniofacial pain and headaches. Additionally, papers regarding this topic were also extracted from the authors' personal libraries. Any study design (i.e., RCT, observational studies, systematic review, narrative review) that reported the concepts of interest was included, using Covidence. Results were narratively synthesized and described.

RESULTS

From an epidemiological perspective, craniofacial pain and headaches are strongly related and often co-existing. This may be due to the neuroanatomical connection with the trigeminal cervical complex, or due to shared predisposing factors such as age, gender, and psychosocial factors. Pain drawings, questionnaires, and physical tests can be used to determine the cause of pain, as well as other perpetuating factors in patients with headaches and craniofacial pain. The evidence supports different forms of exercise and a combination of hands-on and hands-off strategies aimed at both the craniofacial pain as well as the headache.

CONCLUSION

Headaches may be caused or aggravated by different disorders in the craniofacial region. Proper use of terminology and classification may help in understanding these complaints. Future research should look into the specific craniofacial areas and how headaches may arise from problems from those regions. (249 words).

Prevalence of Temporomandibular Disorders Based on a Shortened Symptom Questionnaire of the Diagnostic Criteria for Temporomandibular Disorders and Its Screening Reliability for Children and Adolescents Aged 7-14 Years

The prevalence and adequacy of diagnostic approaches for temporomandibular disorders (TMD) in children and adolescents are still matters of debate. This study aimed to determine the prevalence of TMD and oral habits in children and adolescents aged 7-14 years and evaluate the consistency between self-reported TMD symptoms and clinical findings using a shortened Axis I of Diagnostic Criteria for TMD (DC/TMD). Children (aged 7-10) and adolescents (aged 11-14) of both sexes were invited to participate in this study (n = 1468). Descriptive statistics for all observed variables and Mann-Whitney U-Tests for the clinical examination were performed. A total of 239 subjects participated in the study (response rate 16.3%). The self-reported prevalence of TMD was found to be 18.8%. The most frequently reported oral habit was nail biting (37.7%), followed by clenching (32.2%) and grinding (25.5%). Self-reported headache increased with age, while clenching and grinding decreased. Based on the answers to the DC/TMD Symptom Questionnaire, subgroups of asymptomatic and symptomatic participants (n = 59; 24.7%) were established and randomly selected for the clinical examination (f = 30). The shortened Symptom Questionnaire showed a sensitivity of 0.556 and a specificity of 0.719 for pain during the clinical examination. Although the Symptom Questionnaire exhibited high specificity (0.933), its sensitivity (0.286) for temporomandibular joint sounds was low. Disc displacement with reduction (10.2%) and myalgia (6.8%) were the most common diagnoses. In conclusion, the self-reported prevalence of TMD in children and adolescents in this study was comparable to that reported in the literature for adults. However, the accuracy of the shortened Symptom Questionnaire as a screening tool for TMD-related pain and jaw sounds in children and adolescents was found to be low.

Psychosocial factors associated with pain outcomes in patients with painful temporomandibular disorders and headaches

The objective of this study was to assess the association between psychosocial factors (in terms of anxiety, somatization, depression, and optimism) and pain (in terms of headache pain intensity and pain-related disability), in patients with a painful temporomandibular disorder (TMD) and one of the following headache types: migraine, tension-type headache (TTH), or headache attributed to TMD, corrected for the influence of bruxism. A retrospective study was conducted at an orofacial pain and dysfunction (OPD) clinic. Inclusion criteria were painful TMD, with migraine, TTH, and/or headache attributed to TMD. Linear regressions were performed to assess the influence of psychosocial variables on pain intensity and on pain-related disability, stratified per headache type. The regression models were corrected for bruxism and the presence of multiple headache types. A total of 323 patients (61% female; mean age 42.9, SD 14.4 years) were included. Headache pain intensity only had significant associations in TMD-pain patients with headache attributed to TMD, and anxiety showed the strongest relation (β = 0.353) with pain intensity. Pain-related disability was most strongly associated with depression in TMD-pain patients with TTH (β = 0.444), and with somatization in patients with headache attributed to TMD (β = 0.399). In conclusion, the influence of psychosocial factors on headache pain intensity and pain-related disability depends on the headache type presenting.

Physical Therapy in Tension-Type Headache: A Systematic Review of Randomized Controlled Trials

(1) Objective: The aim of this study is to synthesize the effects of physical therapy on pain, frequency, or duration management in the short, medium, and long term in adult patients diagnosed with Tension-type headache (TTH). (2) Background: Tension-type headache (TTH) is the most common headache with migraine and its pathophysiology and treatment has been discussed for years without reaching a consensus. (3) Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review was registered in PROSPERO (CRD42020175020). The systematic search for clinical trials was performed in the databases PubMed, CINAHL, Cochrane Central Register of Controlled Trials, PEDro, Scopus, SciELO and Dialnet. Articles were selected according to the inclusion and exclusion criteria, regarding the effectiveness of physical therapy interventions on adult patients with TTH published in the last 11 years with a score ≥ 6 in the PEDro Scale (Physiotherapy Evidence Database). (4) Results: In total, 120 articles were identified, of which 15 randomized controlled trials were finally included in order to determine the inclusion criteria. Changes in pain intensity, headache frequency or headache duration of individual studies were described (5) Conclusions: This systematic review shows that there is no standardized physical therapy protocol for the approach to tension headache, although all the techniques studied to date address in one way or another the cranio-cervical-mandibular region. The approach to the cranio-cervical-mandibular region reports significant effects in terms of decreasing the intensity of pain and frequency of headache episodes in the short and medium term. More long-term longitudinal studies are needed.

Oral splint therapy in patients with Menière's disease and temporomandibular disorder: a long-term, controlled study

PURPOSE

To assess the effect of oral splint therapy on audio-vestibular symptoms in patients with Menière's disease (MD) and temporomandibular disorder (TMD).

METHODS

Retrospective case-control study. Treatment group: 37 patients with MD and TMD who received gnatological treatment.

CONTROL GROUP

26 patients with MD and TMD who had never received gnatological treatment. The number of vertigo spells in 6 months (primary endpoint), pure-tone audiometry average (PTA), MD stage, functional level, Dizziness handicap Index (DHI), Tinnitus handicap Index (THI) and Aural Fullness Scale (AFS) were compared at baseline and after 24 months according to groups. Analysis of Covariance was used to determine the treatment effect.

RESULTS

Groups were comparable for demographic, clinical data, baseline PTAs and the number of vertigo spells. Analysis of covariance showed a significant effect of gnathological treatment on number of vertigo spells ([Formula: see text] = 0.258, p < 0.001), PTA ([Formula: see text] = 0.201, p < 0.001), MD stage ([Formula: see text] = 0.224, p < 0.001), functional level ([Formula: see text] = 0.424, p < 0.001), DHI ([Formula: see text] = 0.421, p < 0.001), THI ([Formula: see text] = 0.183, p < 0.001), but not for AFS ([Formula: see text] = 0.005, p = 0.582). The treatment group showed vertigo control of class A in 86.5% and class B in 13.5% of patients. In the control group, vertigo control was of class A in 19.2% of patients and class B in 11.5%, class C in 30.8%, class D in 11.5%, class E in 19.2% and class F in 7.7%. Classes of vertigo control differed significantly (X² test, p < 0.001).

CONCLUSIONS

Oral splint therapy could represent a viable treatment in patients with TMD and uncontrolled MD disease. The effects are maintained at least after 2 years.

The Role of Pain Inflexibility and Acceptance among Headache and Temporomandibular Disorders Patients

Temporomandibular disorders (TMD) and headache are complex. This study aims to assess the association between TMD, headache, and psychological dimensions such as psychological inflexibility and pain acceptance. The sample consisted of 120 participants following a non-probabilistic convenience sampling strategy through a direct invitation to the patients attending our facilities and their relatives (n = 61 diagnosed with headache, n = 34 diagnosed with TMD-headache, n = 25 control group). Diagnostic Criteria for Temporomandibular Disorders (DC-TMD), International Classification of Headache Disorders (ICHD-3 beta version), Chronic Pain Acceptance Questionnaire (CPAQ-8), and Psychological Inflexibility in Pain Scale (PIPS) were used as assessment tools. One-way ANOVA, multiple regression analysis (MRA), and the Johnson-Neyman approach were run by IBM SPSS, version 27 (IBM^® Company, Chicago, IL, USA). The significance level was 0.05. One third of our sample presented with headache with TMD. Females were predominant. Males with headache, no systemic disease, less pain severity but higher frequency, living longer with the disease and having sensitive changes, showed higher pain acceptance. When headache occurs with TMD, women with higher education, no headache family history, less pain, and no motor changes showed higher pain acceptance. Patients with both conditions are more liable to have chronic pain and pain inflexibility. Pain intensity and willingness explain 50% of the psychological inflexibility in the headache group. In our sample, individuals suffering from both conditions show greater pain inflexibility, implicating more vivid suffering experiences, leading to altered daily decisions and actions. However, further studies are needed to highlight this possible association.

Temporomandibular disorder and headache prevalence: A systematic review and meta-analysis

Background:

Temporomandibular disorders (TMD) and headaches are prevalent among the global population. Patients often suffer from both conditions, and they are likely to be associated in a bidirectional way. However, the nature of the association remains unclear. Understanding the epidemiological aspects of the relationship between these conditions could have important clinical implications.

Objective:

To evaluate the prevalence of headaches in TMD patients as well as the prevalence of TMD in patients who suffer from headaches.

Method:

A systematic literature search was conducted using electronic databases. Studies published in English and those that used an acknowledged diagnostic criteria for TMD and headaches were included. Study quality was assessed using the Newcastle-Ottawa scale and meta-analyses were performed to generate pooled prevalence estimates.

Result:

Thirty-one studies met the selection criteria for the review; 16 studies evaluated the prevalence of headache in TMD patients and 15 studies evaluated the prevalence of TMD in headache patients. The included studies were of moderate-to-high quality. Meta-analyses revealed moderate-to-large heterogeneities across included studies. Pooled prevalence estimates from meta-analyses indicated similar rates of headaches in TMD patients and of TMD in headache patients (61.58%, 95% CI 45.26–76.66 and 59.42%, 95% CI 51.93–66.60, respectively). Migraines were more commonly observed in TMD patients (40.25%, 95% CI 35.37–45.23) compared to tension-type headaches (18.89%, 95% CI 12.36–26.44). The prevalence of headaches was particularly high in painful-TMD (82.80%, 95% CI 75.41–89.10).

Conclusion:

Despite large variance in prevalence rates across included studies, this review suggests headache and TMD frequently co-occur, particularly in the case of migraines and muscle related TMD. This association has important clinical, pathophysiological and therapeutic implications.

Dry needling and upper cervical spinal manipulation in patients with temporomandibular disorder: A multi-center randomized clinical trial

OBJECTIVE

To compare the effects of dry needling and upper cervical spinal manipulation with interocclusal splint therapy, diclofenac, and temporomandibular joint (TMJ) mobilization in patients with temporomandibular disorder (TMD).

METHODS

One hundred-twenty patients with TMD were randomized to receive six treatment sessions of dry needling plus upper cervical spinal manipulation (n = 62) or interocclusal splint therapy, diclofenac, and joint mobilization to the TMJ (n = 58).

RESULTS

Patients receiving dry needling and upper cervical spinal manipulation experienced significantly greater reductions in jaw pain intensity over the last 7 days (VAS: F = 23.696; p < 0.001) and active pain-free mouth opening (F = 29.902; p < 0.001) than those receiving interocclusal splint therapy, diclofenac, and TMJ mobilization at the 3-month follow-up.

CONCLUSION

Dry needling and upper cervical spinal manipulation was more effective than interocclusal splint therapy, diclofenac, and TMJ mobilization in patients with TMD.

Patients' perceptions on temporomandibular disorder treatment with hydrostatic oral splints - a pilot study

Objective

To evaluate temporomandibular disorder (TMD) treatment with a prefabricated, hydrostatic oral splint (HOS) based on self-reported patient’s symptoms using a standardized questionnaire.

Methods

Two hundred fifty-eight questionnaires from patients diagnosed with TMD and subsequently treated with HOS were collected from two independent private practices. Based on patient’s comfort the questionnaire recorded TMD symptoms and symptom regression. Descriptive and comparative statistics was carried out using SPSS.

Results

A total of 221 questionnaires were analyzed. Patients reported TMD symptoms such as pain (93.2%), TMJ clicking (66.1%), headache (25.8%), cervical spine disorders (23.5%), restricted mouth opening (22.6%) and tinnitus (11.8%). For most symptoms, improvement was reported mostly after two weeks, except for tinnitus, where positive effects were usually reported after four weeks.

Conclusion

HOS seem to be effective for immediate treatment of pain and other TMD symptoms. Based on the available data, a treatment period of four weeks can be recommended.

Association between masticatory muscle activity and oral conditions in young female college students

The purpose of this study was to determine the characteristics of masticatory muscle activity and various oral condition factors, and to analyze their associations in order to improve the prevention and diagnosis of masticatory muscle-related diseases. This study included 30 Korean females (mean age of 20 years, age range of 19-21 years). Participants were instructed to complete a self-written questionnaire on factors that may affect their muscle activity. Surface electromyography was used to measure the activity of the masseter and temporalis muscles. We also observed the buccal mucosa ridge, tongue indentation, tooth cracks and fractures, and mandibular tori in the oral cavity. Spearman correlation analysis and the nonparametric Mann-Whitney U test were applied to the data. When subjects had temporomandibular disorder, the right temporalis muscle exhibited significantly lower activity (P<0.05). Those who had received orthodontic treatment within the previous 2 years showed significantly lower activity of the left masseter muscle (P<0.05). Those who had a left buccal mucosa ridge exhibited lower activity of the left masseter muscle and higher activity of the right temporalis muscle compared with those without such a ridge (P<0.05). Participants with no tongue indentation showed significantly higher activity in the left masseter muscle (P<0.05). These results indicate that there are relationships between masticatory muscle activity and various factors related to the oral condition.

Effects of therapeutic and aerobic exercise programs in temporomandibular disorder-associated headaches

Objective

To assess the effects of three 8-week exercise programs on the frequency, intensity, and impact of headaches in patients with headache attributed to temporomandibular disorder (TMD).

Methodology

Thirty-six patients diagnosed with headache attributed to TMD participated in the study and were divided into three groups of 12 patients: a therapeutic exercise program (G1, mean age: 26.3±5.6 years), a therapeutic and aerobic exercise program (G2, mean age: 26.0±4.6 years), and an aerobic exercise program (G3, 25.8±2.94 years). Headache frequency and intensity were evaluated using a headache diary, and the adverse headache impact was evaluated using the Headache Impact Test (HIT-6). The intensity was reported using the numerical pain rating scale. These parameters were evaluated twice at baseline (A01/A02), at the end of the 8-week intervention period (A1), and 8–12 weeks after the end of the intervention (A2).

Results

At A1, none of the G2 patients reported having headaches, in G1, only two patients reported headaches, and in G3, ten patients reported headache. The headache intensity scores (0.3 [95% CI: -0.401, 1.068]), (0.0 [95% CI: -0.734, 0.734]) and HIT-6 (50.7 [95% CI: 38.008, 63.459]), (49.5 [95% CI: 36.808, 62.259]), significantly decreased in G1 and G2 at A1. At A2 headache intensity scores (0.5 [95% CI: -0.256, 1.256]), (0.0 [95% CI: -0.756, 0.756]) and HIT-6 (55.1 [95% CI: 42.998, 67.268]), (51.7 [95% CI: 39.532, 63.802]) in G1 and G2 haven’t change significantly. The effects obtained immediately after the completion of the intervention programs were maintained until the final follow-up in all groups.

Conclusion

The programs conducted by G1 (therapeutic exercises) and G2 (therapeutic and aerobic exercise) had significant results at A1 and A2.

Characterization of chronic overlapping pain conditions in patients with chronic migraine: A CHOIR study

OBJECTIVE

Chronic overlapping pain conditions (COPCs) represent a co-aggregation of widespread pain disorders. We characterized differences in physical and psychosocial functioning in patients with chronic migraine (CM) and those with CM and COPCs.

BACKGROUND

Patients with CM and COPCs have been identified as a distinct subgroup of patients with CM, and these patients may be vulnerable to greater symptom severity and burden.

METHODS

Data were extracted from Collaborative Health Outcomes Information Registry (an open-source learning health-care system), completed at the patients' first visit at a large tertiary care pain management center and electronic medical records. In 1601 patients with CM, the number of non-cephalic areas of pain endorsed on a body map was used to examine the differences in pain, physical and psychosocial function, adverse life experience, and health-care utilization.

RESULTS

Patients endorsing more body map regions reported significantly worse symptoms and function across all domains. Scored on a t-score metric (mean = 50, SD = 10), endorsement of one additional body map region corresponded with a 0.69-point increase in pain interference (95% CI = 0.55, 0.82; p < 0.001; Cohen's f = 0.328), 1.15-point increase in fatigue (95% CI = 0.97, 1.32; p < 0.001; Cohen's f = 0.432), and 1.21-point decrease in physical function (95% CI = -1.39, -1.03; p < 0.001; Cohen's f = 0.560). Patients with more widespread pain reported approximately 5% more physician visits (95% CI = 0.03, 0.07; p < 0.001), and patients reporting adverse life events prior to age 17 endorsed 22% more body map regions (95% CI = 0.11, 0.32; p < 0.001).

CONCLUSIONS

Patients with CM and other overlapping pain conditions as noted on the body map report significantly worse pain-related physical function, psychosocial functioning, increased health-care utilization, and greater association with adverse life experiences, compared with those with localized CM. This study provides further evidence that patients with CM and co-occurring pain conditions are a distinct subgroup of CM and can be easily identified through patient-reported outcome measures.

Association between Temporomandibular Joint Disorder and Parkinson's Disease

This study performed two different analyses using a large set of population data from the Korean National Health Insurance Service Health Screening Cohort to evaluate the interactional association between temporomandibular disorder (TMD) and Parkinson’s disease (PD). Two nested case–control population-based studies were conducted on 514,866 participants. In Study I, 4455 participants with TMD were matched with 17,820 control participants, with a ratio of 1:4. In Study II, 6076 participants with PD were matched with 24,304 control participants, with a ratio of 1:4. Obesity, smoking, alcohol consumption, systolic, diastolic blood pressure, fasting blood glucose level, and total cholesterol were adjusted. The adjusted odds ratio (OR) for TMD was 1.43 (95% confidence interval (CI) = 1.02–2.00) in PD patients compared to non-PD patients in Study I (p < 0.001). The adjusted OR for PD was 1.56 (95% CI = 1.13–2.15) in TMD patients compared to non-TMD patients in Study II (p = 0.007). This study demonstrated that patients with TMD have a significantly higher risk of developing PD and, conversely, those with PD have a significantly higher risk of developing TMD.

Reduction of headache intensity and frequency with maxillary stabilization splint therapy in patients with temporomandibular disorders-headache comorbidity: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to analyze the effectiveness of maxillary stabilization splint (SS) therapy to reduce headache (HA) intensity and HA frequency in patients with temporomandibular disorders (TMD)-HA comorbidity. Randomized controlled trials (RCTs) using full-arch coverage, hard resin, and maxillary SS therapy were included. Electronic databases, including Cochrane Library, MEDLINE through PubMed, Web of Science, and EMBASE, were searched. The risk of bias was analyzed based on Cochrane's handbook. The search yielded 247 references up to January 28, 2020. Nine RCTs were included at a high risk of bias. The comparison groups included other splints, counseling, jaw exercises, medications, neurologic treatment, and occlusal equilibration. Four studies reported a statistically significant reduction in HA intensity, and five studies reported significant improvement in HA frequency from baseline at 2-12 months in patients with TMD-HA comorbidity treated with a full-arch hard maxillary SS. HA frequency in tension-type HA (TTH) comorbid with TMD diagnoses of myofascial pain (MFP) or capsulitis/synovitis improved significantly with SS than that with full-arch maxillary non-occluding splint (NOS) in two studies. Comparison groups receiving hard partial-arch maxillary splint nociceptive trigeminal inhibition (NTI) showed statistically significant improvements in HA intensity in patients with mixed TMD phenotypes of MFP and disc displacement comorbid with "general HA." Comparison groups receiving partial-arch maxillary resilient/soft splint (Relax) showed significant improvements in both HA intensity and frequency in patients with HA concomitant with MFP. The meta-analysis showed no statistically significant difference in the improvement of pain intensity at 2-3 months with comparison of the splints (partial-arch soft [Relax], hard [NTI], and full-arch NOS) or splint use compliance at 6-12 months with comparison of the splints (partial-arch Relax and full-arch NOS) versus the SS groups in patients with various TMD-HA comorbidities. In conclusion, although SS therapy showed a statistically significant decrease in HA intensity and HA frequency when reported, the evidence quality was low due to the high bias risk and small sample size. Therefore, further studies are required.

Temporomandibular-disorder-related pain as a predictor of severe headaches

OBJECTIVE

The current study aimed to investigate the association of temporomandibular disorders (TMD)-related pain with the presence of migraine or tension-type headaches (TTH) over a follow-up period of 11 years.

METHODS

Data sets from Finnish national health surveys, the Health 2000 Survey (baseline), and the Health 2011 Survey (follow-up) were utilized. Study participants are undergoing clinical TMD examination at baseline and answering questions related to the presence of migraine and TTH at follow-up were included in the study (n = 530). For analyses, the study sample was divided into two data sets: One with those excluded suffering from migraine at baseline (Data set I, n = 345), and the other excluding those having TTH at baseline (Data set II, n = 464).

RESULTS

Based on logistic regression modelling, no consistent association between TMD-related pain and the presence of migraine was observed, although jTMD associated with elevated estimates for migraine. However, participants with muscle-related TMD pain (mTMD) at baseline had markedly higher odds for having TTH at follow-up than participants without mTMD at baseline (OR 2.1, 95% CI 1.2-3.8). Joint-related TMD pain (jTMD) at baseline was inversely associated with the presence of TTH at follow-up (OR 0.4, 95% CI 0.1-1.3).

CONCLUSION

Contrasting patterns of the associations of TMD-related pain with different severe headaches point towards a more thorough and systematic research approach are needed to understand the mechanisms behind these associations.

Temporomandibular Disorders Slow Down the Regeneration Process of Masticatory Muscles: Transcriptomic Analysis

Background and Objectives: Musculoskeletal injuries represent a pathological condition due to limited joint motility and morphological and functional alterations of the muscles. Temporomandibular disorders (TMDs) are pathological conditions due to alterations in the musculoskeletal system. TMDs mainly cause temporomandibular joint and masticatory muscle dysfunctions following trauma, along with various pathologies and inflammatory processes. TMD affects approximately 15% of the population and causes malocclusion problems and common symptoms such as myofascial pain and migraine. The aim of this work was to provide a transcriptomic profile of masticatory muscles obtained from TMD migraine patients compared to control. Materials and Methods: We used Next Generation Sequencing (NGS) technology to evaluate transcriptomes in masseter and temporalis muscle samples. Results: The transcriptomic analysis showed a prevalent downregulation of the genes involved in the myogenesis process. Conclusions: In conclusion, our findings suggest that the muscle regeneration process in TMD migraine patients may be slowed, therefore therapeutic interventions are needed to restore temporomandibular joint function and promote healing processes.

Telemedicine for a Multidisciplinary Assessment of Orofacial Pain in a Patient Affected by Eagle’s Syndrome: A Clinical Case Report

Background:

Orofacial pain has a broad range of origins and a multidisciplinary approach occupies a relevant role.

Objective:

The aim of this study was to review the literature regarding the evolution of telemedicine and orofacial pain related to a case report of a patient affected by Eagle's syndrome.

Materials and Methods:

Two authors (RJM and SG) independently reviewed the literature up to March 2020. A case report was developed by including the interdisciplinary assessment and initial treatment of orofacial pain in a 38-year-old female patient affected by Eagle’s syndrome. The patient was interviewed by two different specialists (from Rome, Italy and Los Angeles, California) through an online meeting platform in order to evaluate her complex situation, demonstrating the possibilities that telemedicine offered during the COVID-19 pandemic.

Conclusion:

An interdisciplinary approach can be performed for future follow ups on patients as various advantages were found by the patient and by the clinicians themselves.

Is Irritable Bowel Syndrome Considered in Clinical Trials on Physical Therapy Applied to Patients with Temporo-Mandibular Disorders? A Scoping Review

The aim of the current scoping review was to identify if the presence of irritable bowel syndrome was included as eligibility criteria of participants included in clinical trials investigating the effects of physical therapy in individuals with temporomandibular pain disorders (TMDs). A systematic electronic literature search in the Web of Science database was conducted. Scientifically relevant, randomized clinical trials (those cited in other studies at least 5 times, or clinical trials published in high-impact journals, i.e., first and second quartiles (Q1-Q2) of any category of the Journal Citation Report (JCR)) evaluating the effects of any physical therapy intervention in patients with TMDs were included. The Physiotherapy Evidence Database (PEDro) scale was used to evaluate the methodological quality of the selected trials. Authors affiliated to a clinical or non-clinical institution, total number of citations, objective, sex/gender, age, and eligibility criteria in each article were extracted and analyzed independently by two authors. From a total of 98 identified articles, 12 and 19 clinical trials were included according to the journal citation criterion or JCR criterion, respectively. After removing duplicates, a total of 23 trials were included. The PEDro score ranged from 4 to 8 (mean: 6.26, SD: 1.48). Based on the eligibility criteria of the trials systematically reviewed, none considered the presence of comorbid irritable bowel syndrome in patients with TMDs. The comorbidity between TMDs and irritable bowel syndrome is not considered within the eligibility criteria of participants in highly cited clinical trials, or published in a high-impact journal, investigating the effects of physical therapy in TMDs.

Increased Risk of Migraine in Patients with Temporomandibular Disorder: A Longitudinal Follow-Up Study Using a National Health Screening Cohort

Background: The aim of this study was to investigate the association between temporomandibular disorder (TMD) and migraine through a longitudinal follow-up study using population data from a national health screening cohort. Methods: This cohort study used data from the Korean National Health Insurance Service-Health Screening Cohort from 2002 to 2015. Of the 514,866 participants, 3884 TMD patients were matched at a 1:4 ratio with 15,536 control participants. Crude models and models adjusted for obesity, smoking, alcohol consumption, systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol, and Charlson Comorbidity Index (CCI) scores were calculated. Chi-squared test, Kaplan–Meier analysis, and two-tailed log-rank test were used for statistical analysis. Stratified Cox proportional hazard models were used to assess hazard ratios (HR) and 95% confidence intervals (CIs) for migraine in both control groups. Results: The adjusted HR for migraine was 2.10 (95% CI: 1.81–2.44) in the TMD group compared to the control group, which was consistent in subgroup analyses according to age, sex, and Kaplan–Meier analysis. Conclusions: This study demonstrated that TMD patients have a higher risk of migraine. These results suggest that dentists can decrease the risk of migraine in TMD patients by managing TMD properly.

Clinical presentations on a facial pain clinic

Introduction The complex nature of facial pain conditions creates a diagnostic challenge which may necessitate specialist referral.Aim To identify the case mix presenting to a specialist tertiary care facial pain clinic.Methods A retrospective review of 112 patient records was undertaken. Trends in provisional diagnoses from referrers and the correlation to diagnoses made following specialist consultation were reviewed.Results The most common provisional diagnoses recorded in referral letters were painful temporomandibular disorders, trigeminal neuralgia and persistent idiopathic facial pain (PIFP). Over a quarter of referrals did not include a provisional diagnosis. Following assessment, only one case was not given a definitive diagnosis and no patients were diagnosed with PIFP. A causative factor was identified in all the initially queried PIFP cases, and painful post-traumatic trigeminal neuropathic pain was found in multiple patients.Conclusions Painful post-traumatic trigeminal neuropathic pain should be considered if pain onset coincides with dental treatment or other traumatic events. PIFP is a rare facial pain diagnosis and may be over-diagnosed by dental and medical practitioners. It is important to systematically exclude other causes before reaching this diagnosis. This will facilitate effective treatment, manage patient expectations and potentially reduce unnecessary referrals.

Prevalence of concurrent headache and temporomandibular disorders: a systematic review protocol

OBJECTIVE

The objective of this review is to determine the concurrent prevalence of temporomandibular disorders and headaches in patients.

INTRODUCTION

Temporomandibular disorders affect the temporomandibular joint and associated orofacial structures. It is the second-most common musculoskeletal disorder experienced by adults. Headache is one of the most pervasive neurological disorders and can be an extremely disabling condition. Temporomandibular disorders and headache are known to often occur simultaneously and have a bi-directional relationship due to their close anatomical association.

INCLUSION CRITERIA

The systematic review will include all studies with adult participants (>18 years) experiencing headaches (migraine, migraine with/without aura, tension-type, cervicogenic, and chronic headache) with symptoms of temporomandibular disorders occurring concurrently.

METHODS

An initial search of PubMed will be followed by CINAHL, the Cochrane Central Register of Controlled Trials in the Cochrane Library, EBSCO MasterFILE Premier, PEDro, ProQuest Health and Medical Complete, Science Direct, and Scopus. Titles and abstracts of studies will be reviewed, and full text articles will be selected if the inclusion criteria are met. Studies that meet the eligibility criteria will then be assessed by two independent reviewers. Full-text articles will be selected if the inclusion criteria are met. A standardized critical appraisal checklist for studies reporting prevalence data will be used to assess methodological quality and a standardized data extraction tool will be used. The results from the included studies will be analyzed using JBI SUMARI software.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO (CRD42019139689).

Using e-Health in the physical therapeutic care process for patients with temporomandibular disorders: a qualitative study on the perspective of physical therapists and patients

Background: Treatment of temporomandibular disorder (TMD) currently consists of a combination of noninvasive therapies and may be supported by e-Health. It is, however, unclear if physical therapists and patients are positive towards the use of e-Health.Purpose: To assess the needs, facilitators and barriers of the use of an e-Health application from the perspective of both orofacial physical therapists and patients with TMD.Methods: A descriptive qualitative study was performed. Eleven physical therapists and nine patients with TMD were interviewed using a topic guide. Thematic analysis was applied, and findings were ordered according to four themes: acceptance of e-Health, expected utility, usability and convenience.Results: Physical therapists identified the need for e-Health as a supporting application to send questionnaires, animated exercises and evaluation tools. Key facilitators for both physical therapists and patients for implementing e-Health included the increase in self-efficacy, support of data collection and personalization of the application. Key barriers are the increase of screen time, the loss of personal contact, not up-to-date information and poor design of the application.Conclusions: Physical therapists and patients with TMD are positive towards the use of e-Health, in a blended form with the usual rehabilitation care process for TMD complaints.Implications for rehabilitationThe rehabilitation process of temporomandibular complaints may be supported by the use of e-Health applications.Physical therapists and patients with temporomandibular disorders are positive towards the use of e-Health as an addition to the usual care.Especially during the treatment process, there is a need for clear animated videos and reminders for the patients.

Development of an instructional movie illustrating a standardized clinical examination on patients with TMD symptoms

Objectives: The aim of this project was to develop an instructional video that demonstrates a standardized clinical examination on patients with suspected temporomandibular disorders (TMD). After viewing the video, the learner should be knowledgeable about the examination steps and application of the examination techniques. Methods: The instructional video was created by two dentists who are experienced in assessing patients with suspected TMD. Additionally, both examiners were calibrated according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). The instructional video was divided into chapters. Various camera angles, key points, image enlargements, and replays were used to better depict essential aspects of the assessment. Background noise was reduced to a minimum. Results: The instructional video was modified and completed in two phases: the first by an experienced dentist and the second by a dentist specialized in TMD. The final video includes nine chapters and is 26.5 minutes in length (https://doi.org/10.5061/dryad.k8r7qc1). Conclusion: Divided into chapters, this German instructional video shows an optimally timed, standardized clinical assessment of patients with suspected TMD.

The differential impact of neuropathic, musculoskeletal and neurovascular orofacial pain on psychosocial function

BACKGROUND

While the psychosocial morbidity of orofacial pain (OFP) is widely recognized, the differential impact of musculoskeletal, neuropathic and neurovascular symptoms on pain and psychosocial function in individuals with and without coexisting OFP conditions is unclear.

MATERIALS AND METHODS

This was a comparative cross-sectional study of 350 consecutive patients attending an OFP clinic; 244 completed standardized self-report measures of pain experience, mood, and generic and oral health-related quality of life (HRQoL). The impact of musculoskeletal, neuropathic and neurovascular symptoms on measures was assessed using linear and logistic generalized linear models.

RESULTS

Two hundred patients were diagnosed with a neuropathic condition: 125 with musculoskeletal pain and 101 with (neurovascular) headache disorders. 23% of patients presented with multiple OFP conditions; this was more common in patients with neurovascular (62%) than neuropathic (21%) and/or musculoskeletal orofacial symptoms (28%). Patients with neurovascular symptoms experienced significantly higher levels of pain, evidenced less pain self-efficacy and had poorer overall health. Neuropathic OFP was significantly associated with greater psychological and social oral health disability. Multiple OFP symptoms were not linked to pain severity or psychosocial function, although health scores were worse for patients with neurovascular pain and neuropathic/musculoskeletal symptoms compared with patients with only neurovascular symptoms.

CONCLUSIONS

The profile and degree of psychosocial morbidity in patients with OFP is significantly related to the types of presenting orofacial symptoms. Patients with neurovascular pain present with higher pain levels and have poorer health while those with neuropathic pain have higher oral functional morbidity; both may require more complex multidisciplinary management.

A Pre-Existing Myogenic Temporomandibular Disorder Increases Trigeminal Calcitonin Gene-Related Peptide and Enhances Nitroglycerin-Induced Hypersensitivity in Mice

Migraine is commonly reported among patients with temporomandibular disorders (TMDs), especially myogenic TMD. The pathophysiologic mechanisms related to the comorbidity of the two conditions remain elusive. In the present study, we combined masseter muscle tendon ligation (MMTL)-produced myogenic TMD with systemic injection of nitroglycerin (NTG)-induced migraine-like hypersensitivity in mice. Facial mechanical allodynia, functional allodynia, and light-aversive behavior were evaluated. Sumatriptan, an FDA-approved medication for migraine, was used to validate migraine-like hypersensitivity. Additionally, we examined the protein level of calcitonin gene-related peptide (CGRP) in the spinal trigeminal nucleus caudalis using immunohistochemistry. We observed that mice with MMTL pretreatment have a prolonged NTG-induced migraine-like hypersensitivity, and MMTL also enabled a non-sensitizing dose of NTG to trigger migraine-like hypersensitivity. Systemic injection of sumatriptan inhibited the MMTL-enhanced migraine-like hypersensitivity. MMTL pretreatment significantly upregulated the protein level of CGRP in the spinal trigeminal nucleus caudalis after NTG injection. Our results indicate that a pre-existing myogenic TMD can upregulate NTG-induced trigeminal CGRP and enhance migraine-like hypersensitivity.

Standard Correction of Vision Worsens EMG Activity of Pericranial Muscles in Chronic TMD Subjects

Recent studies showed an evident correlation between the stomatognathic system and the visual system. These results suggest that subjects who are affected by both temporomandibular (TMD) disorders and refractive disorders present with altered control of pericranial musculature tone and higher open-eye electromyographic (EMG) values. The objective of this work was to evaluate the effects of standard vision correction on EMG in subjects suffering from TMD compared with application of the same vision treatments to non-TMD subjects. 40 subjects were enrolled in this study. The test group included 20 myopic subjects and also included patients with TMD. The control group included 20 healthy myopic subjects. All of the participants underwent a complete ocular examination and a sEMG analysis. The results showed that TMD subjects with vision disorders that are corrected with standard glasses present EMG values that are significantly higher than those presented by non-TMD subjects with vision disorders and standard glasses. Infact, in TMD subjects, eye correction did not have a positive effect on the stomatognathic or pericranial musculature.

What is the minimal important difference of pain intensity, mandibular function, and headache impact in patients with temporomandibular disorders? Clinical significance analysis of a randomized controlled trial

BACKGROUND

There are insufficient studies providing Minimal Clinically Important Difference (MCID) for outcomes related to temporomandibular disorders (TMD).

OBJECTIVES

(1) To provide the MCID of outcomes related to TMD using the Global Rating of Change Scale (GRCS) as an anchor. (2) To verify which outcomes can predict a moderate or large response to the treatment.

STUDY DESIGN

Secondary analysis of a randomized controlled trial in subjects with TMD.

METHODS

Sixty-one women with TMD were divided into intervention and control groups. Visual Analogue Scale (VAS), Headache Impact Test (HIT-6), pressure pain thresholds (PPTs) of masticatory muscles, Mandibular Function Impairment Questionnaire (MFIQ), and Craniocervical Flexion Test (CCFT) were collected at baseline and 5-weeks follow-up.

RESULTS

Participants were divided based on their response to the treatment, according to the GRCS. MCID values were provided for subjects that moderately or largely improved to the treatment. MCID was between 0 and 1.90 for orofacial pain, around 2 points for the MFIQ, between 3 and 6.26 points for the HIT-6, around 0.2 kg/cm2 for the PPTs on masticatory muscles, around 2.5 mm for MMO and between 60 and 68 points for CCFT. Orofacial pain and HIT-6 were the most discriminative variables at determining whether patients would largely/moderately improve or would not improve after treatment.

CONCLUSIONS

The values of MCID could be used as guidance for both clinical practice and research. Pain intensity and headache impact were the most predictive outcomes for improvement of the general health status of women with TMD.

Analysis of Masticatory Muscle Activity Based on Presence of Temporomandibular Joint Disorders

Background

This study was conducted to analyze the activity of masticatory muscles depending on the presence of temporomandibular joint disorders (TMD) when foods of various hardness are masticated.

Material/Methods

We enrolled 20 subjects (13 men and 7 women) who met our selection criteria, and they were divided into 3 groups (the Disorder Group, the Malalignment Group, and the Control Group) based on surveys and screening inspection. The average of reference voluntary contraction (RVC) was used to measure masticatory muscle activity. Using surface electromyography (SEMG) for each group during masticatory activity, the activities of the masseter muscle and temporalis muscle were measured based on the hardness of 3 different foods (soft, sticky, and hard).

Results

Characteristics of these 3 groups prior to the experiment were identical, and subsequent findings were as follows: First, when masticating sticky food, the Disorder Group and Malalignment Group showed significant differences from the Control Group in activities of the masseter muscle and temporalis muscle (p<0.05). Second, when masticating hard food, the Malalignment Group and Control Group showed significant differences from the Disorder Group in the masseter muscle and temporalis muscle activities (p<0.05). Based on these findings, the study showed that malalignment affects movement of the temporomandibular joint during mastication of sticky food, and the temporomandibular joint movement was affected by the presence of pain during mastication of hard food.

Conclusions

Our results provide basic data useful in the diagnosis of temporomandibular joint disorder, as well as guiding future studies on this topic.

Alterations in Surface Electromyography Are Associated with Subjective Masticatory Muscle Pain

Background

Tenderness of masseters and temporalis can be considered a relevant tool for diagnosis of myo-type craniofacial pain disorders, but a limit of pain score systems is that they are based on subjective pain perception. Surface electromyography (sEMG) is a noninvasive and reliable tool for recording muscle activity. Therefore, we investigated whether a correlation exists between tenderness on masseters and temporalis, assessed by subjective pain scale, and muscles activity, evaluated by sEMG, in patients with painful temporomandibular disorder (TMD) and concurrent tension-type headache (TTH).

Methods

A cross-sectional study on fifty adult volunteer patients with TMD and TTH, who underwent tenderness protocol according to Diagnostic Criteria for TMD (DC/TMD) guidelines, was conducted followed by sEMG recording of temporalis and masseters. Pearson's correlation was performed to investigate the correlation between muscular activity and subjective pain scores.

Results

An overall moderate correlation between muscle tenderness and sEMG values (y = 1 + 1.2 · x; r² = 0.62; p < 0.0001), particularly in the temporalis, was observed. Segregation of data occurred according to tenderness and sEMG values. At the highest pain score, the mean sEMG absolute value was higher at the temporalis than the masseters.

Conclusions

Our study provides evidence that subjective pain perception can be objectively quantified at a magnitude proportional to pain severity. At greater tenderness scores, higher sEMG activity at the level of temporalis could help discriminate clinically prevalent TTH versus prevalent TMD. sEMG confirms to be an accurate tool to reliably objectify the subjective perception of pain. When combined with clinical evaluation and patients' symptoms, sEMG increases diagnostic sensitivity in the field of myo-type craniofacial pain disorders. This trial is registered with NCT02789085.

Cross-cultural adaptation, reliability and validity of the Italian version of the craniofacial pain and disability inventory in patients with chronic temporomandibular joint disorders

Background

To develop an Italian version of the Craniofacial Pain Disability Inventory (CFPDI-I) and investigate its psychometric abilities in patients with temporomandibular disorders (TMD).

Methods

The CFPDI was translated following international standards. The psychometric analyses included reliability by internal consistency (Cronbach’s alpha) and test/retest stability (intraclass correlation coefficient, ICC); construct validity was investigated by matching (a priori hypotheses) the CFPDI-I with the Italian Neck Disability Index (NDI-I), a pain intensity numerical rating scale (NRS), the Italian Pain Catastrophising Scale (PCS-I), the Italian Tampa Scale of Kinesiophobia (TSK-I), and the Italian Migraine Disability Assessment Score Questionnaire (MIDAS) (Pearson’s correlation). Alpha was set at 0.05.

Results

Two hundred and twelve patients with chronic TMD completed the tool. The questionnaire was internally consistent (α = 0.95) and its stability was good (ICCs = 0.91). As hypothesised, validity figures showed CFPDI-I strongly correlated with the NDI-I (r = 0.66, p < 0.05) and moderately correlated with the NRS (r = 0.48, p < 0.05), PCS (r = 0.37, p < 0.05), TSKI (r = 0.35, p < 0.05) and MIDAS (r = 0.47, p < 0.05). Similar estimates were shown by CFPDI-I subscales.

Conclusions

The cross-culturally adapted version of the Craniofacial Pain and Disability Inventory (CFPDI-I) showed satisfactory psychometric properties that replicate those of the original version and, therefore, can be implemented in the clinical assessment of Italian people affected by TMD.

The best from East and West? Acupuncture and medical training therapy as monotherapies or in combination for adult patients with episodic and chronic tension-type headache: study protocol for a randomized controlled trial

BACKGROUND

This study aims to evaluate the feasibility and efficacy of a complex health intervention, based on the combination of conventional Western medicine and traditional Chinese medicine (TCM), in an outpatient department of a university hospital for patients with frequent episodic or chronic tension-type headaches.

METHODS/DESIGN

This is a prospective randomized controlled pilot study with four balanced treatment arms (usual care, acupuncture, training, and training plus acupuncture). Each arm will have 24 patients. After the initial screening examination and randomization, a 6-week treatment period follows, with treatment frequencies decreasing at 2-week intervals. After completion of the intervention, two follow-up evaluations will be performed 3 and 6 months after the start of treatment. At predefined times, the various outcomes (pain intensity, health-related quality of life, pain duration, autonomic regulation, and heart rate variability) as well as the participants' acceptance of the complex treatment will be evaluated with valid assessment instruments (Migraine Disability Assessment, PHQ-D, GAD-7, and SF-12) and a headache diary. The acupuncture treatment will be based on the rules of TCM, comprising a standardized combination of acupuncture points and additional points selected according to individual pain localization. The training therapy comprises a combination of strength training, endurance training, and training to improve flexibility and coordination. Besides descriptive analyses of the samples, their comparability will be assessed using an analysis of variance (ANOVA) or chi-squared tests. Analyses will be performed on an intention-to-treat basis. Potential interaction effects will be calculated using a repeated-measures ANOVA to test the primary and secondary hypotheses. In supplementary analyses, the proportion of treatment responders (those with a 50% reduction in the frequency of pain episodes) will be determined for each treatment arm.

DISCUSSION

This trial may provide evidence for the additive effects of acupuncture and medical training therapy as a combination treatment and may scientifically support the implementation of this complex health intervention.

TRIAL REGISTRATION

Registered on 11 Feburary 2019. German Clinical Trials Register, DRKS00016723.

Sex and Height Influence Neck Posture When Using Electronic Handheld Devices

With increased tablet ownership in the United States comes increased levels of neck flexion compared to desktop or laptop computer use, and these neck postures have been linked to increases in neck pain. Importantly, tablet viewing postures can be achieved in multiple ways and could be determined by the morphology of the individual and/or other extraneous factors. In this study, we aim to preliminarily evaluate how neck postures vary during tablet use among individuals and link this variation to other factors such as sex, height, weight, presence/absence of temporomandibular joint disorder (TMD), and morphology of the head and neck. We analyzed two-dimensional landmarks placed on lateral-view radiographs of 22 participants (10 female and 12 male) seated in neutral, upright, fully flexed, semi-reclined, and reclined postures. We utilize geometric morphometric techniques, which are advantageous for evaluating shape variation and have not been extensively applied to biomechanical analyses. We found skeletal morphology to be significantly related to sex and height in all but the neutral posture (P < 0.05), and weight was marginally significantly related to shape in the semi-reclined posture (P = 0.047). Morphologically, male participants exhibited more flexion at the articulatio atlantooccipitalis than females, and females showed greater mandibular protrusion than males, although this result is likely related to height. No relationship was found between posture and TMD. This research establishes a framework for future work that uses geometric morphometric analyses to evaluate how neck postures vary in relation to TMD. Clin. Anat. 32:1061-1071, 2019. © 2019 Wiley Periodicals, Inc.

Prevalence of Temporomandibular Disorder in Turkish University Students: a Questionnaire Study

Background/Aim: Temporomandibular dysfunction (TMD) might influence any individual with different signs and symptoms irrespective of gender or age. The aim of this study is to assess the prevalence of TMD in Oral and Dental Health Program students of İstanbul University-Cerrahpaşa.

Material and Methods: This study include a sample of 486 students with age ranging from18 to 24 years. The presence and severity of TMD was evaluated using the Fonseca’s Anamnestic Index (FAI) and its questionnaire. The data were analysed using SPSS Version 22. The chisquare test was used to compare the data from different groups and to determine whether the differences were statistically significant.

Results: The results showed that a total of 47,53% of students had some degree of TMD and females were generally more affected than males. These degrees were as follows: 33,95 % were classified as mild, 11,52 % moderate and 2,05 % severe signs and symptoms. The women exhibited some degree of TMD (51,8%) at a higher frequency than men (40,33%). No significant differences were observed between gender for a same TMD severity degree (p>0.05).

Conclusions: A high prevalence of mild TMD was found in this study population. In addition, tense personalities, headaches, and temporomandibular joint (TMJ) sounds were the most prevalent findings of TMD. The present study suggests that Fonseca’s Anamnestic Index (FAI) has been used in screening for TMD for prevention and management of TMD in a non-patient young population.

Preclinical Signs of a Temporomandibular Disorder in Female Patients With Episodic Cervicogenic Headache Versus Asymptomatic Controls: A Cross-Sectional Study

BACKGROUND

The International Classification of Headache Disorders, 3rd Edition, accepted "headache attributed to temporomandibular disorders" as a valid headache. The neurophysiologic interplay between cervical structures and the temporomandibular joint, however, might also suggest that a temporomandibular disorder could develop in patients with cervicogenic headache.

OBJECTIVE

To compare the presence of preclinical temporomandibular signs between female patients with episodic cervicogenic headache and a control group.

DESIGN

Case-controlled cross-sectional design.

SETTING

Institutional setting: Hasselt University.

PARTICIPANTS

Twenty-two women (mean age ± SD: 20.7 ± 2.5 years) with episodic cervicogenic headache, without temporomandibular signs and 22 matched (gender, age, level of education, occupation) asymptomatic controls (21 ± 2.3 years).

METHODS

(Un)assisted temporomandibular range of motion, pressure pain thresholds, painful palpations were examined and the level of perceived stress was measured.

MAIN OUTCOME MEASUREMENTS

Temporomandibular range of motion (mm), pressure pain thresholds (kPa/cm²), painful palpations (yes/no), and level of perceived stress (Perceived Stress Scale).

RESULTS

Maximal mouth-opening was significantly smaller in the headache group (P <.05; effect size [ES] -0.45). Palpation of the masseter resulted in significantly more positive pain responses in the headache group at the left (P = .009; ES ∞) and right (P = .002;ES 17.5) origin, left (P = .004; ES 14.54) and right (P = .03; ES 5.71) body and left (P < .001; ES 12) insertion. Significantly lower pressure pain thresholds on the left and right anterior (P = .03; ES -0.33 resp. P = .02; ES -0.35), central (P = .003; ES 1.02 resp. P = .02; ES 0.79) and right posterior (P = .03; ES 0.62) temporalis and right tibialis anterior (P = .03; ES -0.33) were measured in the headache group. The level of perceived stress was significantly higher (P = .02) in the headache group.

CONCLUSIONS

Patients with episodic cervicogenic headache present with signs of a preclinical temporomandibular disorder and sensitization. The smaller range of motion, lower pressure pain thresholds, and higher levels of stress accentuate the multidimensionality of the problem.

LEVEL OF EVIDENCE

IV.

Temporomandibular disorder and headache in university professors

[Purpose] Temporomandibular disorder is a condition with a multifactor etiology that involves the temporomandibular joint, bones, surrounding muscles and facial pain is the most common symptom. This study evaluated the possible association between headache and temporomandibular disorder in university professors. [Participants and Methods] Twenty-seven professors were recruited and answered the Axis II of the Research Diagnostic Criteria for Temporomandibular Disorders for the evaluation and diagnosis of temporomandibular disorder and filled out a “Headache Diary” proposed by the American Headache Society. [Results] The university professors showed headache and temporomandibular disorder, but no association was found between the two conditions. Comparing the gender, the males were most frequently affected, but females had more intensity of signs and symptoms. There is a lack of data on the population addressed in the present study. [Conclusion] Indeed, this was the first such study developed with university professors. It is of considerable importance to develop further studies to investigate the possible association between headache and temporomandibular disorder.

Widespread mechanical pain hypersensitivity in patients with chronic migraine and temporomandibular disorders: relationship and correlation between psychological and sensorimotor variables

OBJECTIVE

This study aimed to assess mechanical hyperalgesia in the trigeminal and extra-trigeminal regions in patients with chronic migraine (CM) and temporomandibular disorders (TMD) in comparison to asymptomatic subjects and to determine the association between sensorimotor variables and psychological and disability variables and evaluate the prediction of a sensorimotor variables though psychological and disability variables in patients with CM and TMD.

MATERIAL AND METHODS

A total of 52 subjects with concomitant CM and TMD and 30 asymptomatic subjects were included in the study. The pressure pain threshold (PPT), maximal mouth opening (MMO) and a series of self-reported factors were compared.

RESULTS

There were 52 CM and TMD (92.3% women and 7.7% men; age = 46.2 ± 9.5) and 30 asymptomatic subjects (80% women and 20% men; age = 47.4 ± 10). Differences were found between patients with CM and TMD and asymptomatic participants (p < .01) when comparing the PPTs in the trigeminal and extra-trigeminal regions. The PPT for the trigeminal region was predicted by depressive symptoms (variance of 18%) as well as disability and craniofacial pain (variance of 20%). The extra-trigeminal region PPT was predicted by depressive symptoms (variance of 10%), and pain-free MMO was predicted by disability and craniofacial pain (variance of 24%).

CONCLUSIONS

This study suggests that patients with CM and TMD present with generalized mechanical hyperalgesia. In addition, an association between sensorimotor, psychological and disability variables was observed.