Occlusal abnormalities, pericranial muscle and joint tenderness and tooth wear in a group of migraine patients

Case Report: Case report: Rapidly progressing tooth wear dominated by intrinsic and extrinsic erosion

Tooth wear is multi-factorial presenting as a combination of abrasion, attrition, and erosion. This case report represents a case of combined tooth wear in a 46-year-old Indo-Trinidadian male, with a predominant erosive component with both the clinical signs and features of intrinsic and extrinsic erosion. This patient case is unique since the wear predominated by dental erosion has occurred rapidly evidenced by the physical clinical appearance of a lack of compensation and the upper left premolars and molars relatively unaffected by the overall effects of tooth wear. This lack of compensation, where opposing teeth have not supra-erupted to maintain inter-arch stability, and the maintenance of occlusal vertical dimension on the left due to the non-worn posterior maxillary teeth, provides the benefit of simplifying subsequent restorative management. The medical and diet history corroborates the diagnoses of intrinsic and extrinsic erosion respectively. Complications noted with rapid tooth wear, such as dentine sensitivity and pulpal necrosis are known sequelae of tooth wear however the patient presented in this case report shows a concomitant high caries experience and poor oral hygiene. Cases such as the one presented here require not only comprehensive dental management, utilizing a restorative approach but also medical referral for confirmation of a diagnosis and management of gastroesophageal reflux disease. Inherent to the management of this patient should be a multidisciplinary medical and dental approach, with confirmation and management of the cause of the intrinsic erosion as well as restorative dental management, together with dietary counseling to mitigate the effect of intrinsic and extrinsic sources of acid on dental hard tissue. A key lesson learned from this case is the importance of history and targeted questioning when trying to determine the cause of tooth wear dominated by intrinsic and extrinsic erosion.

Adjunctive treatment of chronic migraine using an oral dental device: overview and results of a randomized placebo-controlled crossover study

Objective

To assess the nocioceptive input of habitual nocturnal jaw clenching that acts as a contributing factor in migraine pathogenesis.

Background

Habitual nocturnal jaw clenching has been implicated as a trigger, particularly in those whose headaches are present upon waking or shortly thereafter. Nocturnal EMG studies of patients diagnosed with migraine show nearly twice the temporalis clenching EMG levels and double the bite force as matched asymptomatic controls, leading to the speculation that parafunctional clenching activity may have some role in headache pathogenesis. The NTI (Nociceptive Trigeminal Inhibition) oral device is a dental splint designed to reduce nocturnal jaw clenching intensity and is FDA approved for the prevention of medically diagnosed migraine pain based on open label studies. There are no prior placebo-controlled trials to assess the migraine prevention efficacy of the NTI splint. This is the first placebo-controlled cross-over study to assess the efficacy of the NTI splint in patients with Chronic Migraine.

Method

A placebo controlled, single-blinded cross-over study was done with IRB oversight assessing the efficacy of the NTI splint compared to placebo using the change in the HIT-6 score as the outcome measure.

Results

68% of refractory chronic migraine sufferers using the NTI as measured by sequential HIT 6 scores had at least a one-category improvement (severe to substantial, or substantial to some, or some to none) compared to 12% when using a placebo device. 36% of subjects using the NTI device reported a two-category improvement in their HIT-6 score, compared to 0% when using placebo.

Conclusion

The improvement in HIT-6 scores produced by the NTI device, suggests that patients with Chronic Migraine may have intense nocturnal jaw clenching as a contributing factor to their headache related disability. An NTI device is one method of assessing whether jaw-clenching is a contributing factor to ongoing migraine.

Trial registration

Current Controlled Trials NCT04871581. 04/05/2021. Retrospectively registered.

Evaluation of the relationship between migraine disorder andoral comorbidities: multicenter randomized clinical trial

BACKGROUND/AIM

Although migraine is a common disorder, there is a lack of research investigating the possible relationship between migraine and oral health. The aim of the present study was to explore the relationship between temporomandibular disorders, bruxism, dental caries, periodontal status, and migraine disorder in a multicenter, parallel, case-controlled clinical study.

MATERIALS AND METHODS

A total of 2001 participants were divided into two groups: migraineurs (nm = 998) and nonmigraineurs (nh = 1003). International Headache Society's Second Edition of International Classification of Headache Disorders and modified Migraine Disability Assessment surveys were administered to evaluate the level of migraine; a pretreatment questionnaire and the World Health Organization oral health assessment form were used to determine the oral comorbidities and their possible effects on DMFT index, gingival plaque index, existence of temporomandibular disorders, bruxism, and consistency of daily oral hygiene habits.

RESULTS

The mean age was 39.6 ± 10.5 years. Female patients seemed to experience migraine attacks more than male patients (64%). The frequency of gastroesophageal reflux was higher in migraineurs in comparison with nonmigraineurs (47%) and tooth wear and abrasion also seemed more frequent (76%). DMFT and plaque index scores showed significant differences for both groups.

CONCLUSION

There is a strong relationship between migraine and oral health status. The existence of reflux in addition to migraine leads to higher dental problems.

Is There a Relation between Tension-Type Headache, Temporomandibular Disorders and Sleep?

Introduction. Tension-Type Headache (TTH) is the most prevalent headache often associated with impaired function and quality of life. Temporomandibular Disorders (TMD) and TTH frequently coexist; characterized by pericranial tenderness and impact on daily life. We aim to apply a standardized questionnaire for TMD to characterize and analyse an eventual relation between sleep and oral health in TTH in a controlled design. Material and Methods. 58 consecutive TTH patients and 58 healthy controls were included. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) questionnaire, Oral Health Impact profile (OHIP) and questionnaires for sleep were applied. Results. TTH-patients had significantly higher pain scores (P < 0.001), decreased quality of life (P < 0.001), and higher total sleep scores (P < 0.001) compared to controls. Conclusion. For the first time we have identified a clear relation between TTH and TMD symptoms, depression, anxiety, poor sleep, and impairments of oral function in carefully classified patients. These findings indicate a close, but incomplete, overlap between TTH and TMD. Their underlying pathophysiological mechanisms need further research.

Occlusal tooth wear in male F344/N rats with aging

With the aim of clarifying the aging properties of an animal model, the progress of occlusal tooth wear (OTW) of molars in male F344/N rats was monitored. Dried maxilla and mandible specimens from 61 male F344/N rats, aged 7 to >30 months, were used. The levels of OTW of all molars were monitored with aging. The cuspis dentis of molar teeth were worn out by 7 months (M) of age, and the occlusal surface became flat. As for each molar tooth (M(1-3), numbered in accordance with its position), OTW of M(1) was more severe in the lower than in the upper jaw, whereas M(3) was more severe in the upper than the lower jaw. OTW of M(2) in both the upper and the lower jaws progressed rapidly after 27M. OTW in male F344/N rats progressed faster than in females. However, when compensated for life span, both genders had similar profiles in OTW progress with aging. This study suggested that male rats were more convenient than females as a model for gerodontological research because of the earlier course of OTW progress.

Occlusal tooth wear in female F344/N rats with aging

OBJECTIVES

This study was conducted to ascertain whether laboratory rats are an adequate animal model for aging oral cavity research, especially on occlusal tooth wear (OTW), which progresses with aging and causes abnormal occlusions. Mastication has been reported to relate to cognition in the elderly. Thus, it is important to care for the oral cavity, especially in the frail elderly, for the maintenance of all-round quality of life. Adequate and appropriate animal models are essential for basic and clinical research on the oral cavity.

METHODS

Dried maxilla and mandible specimens from 98 young, aging or aged female F344/N rats were used.

RESULTS

The levels of OTW of all molars were monitored with aging. The molar tooth began to wear at 1-month old (M) and progressed rapidly till 12M. Subsequently, OTW progressed slowly till 30M, and then rapidly again after 35M.

CONCLUSIONS

This study showed that progress of OTW is well correlated with the entire life span of the rat, and suggested that the rat aged over 12M would be an adequate animal model for research on OTW in middle-aged and elderly people.

Familial occurrence of signs of temporomandibular disorders in headache children and their mothers

OBJECTIVE

Earlier studies have provided evidence of genetic inheritance of headache, especially migraine, but no familial occurrence has been found regarding temporomandibular disorders (TMD). In adults, headache and TMD have been found to be associated with each other, but studies on children are few. The aim of the present study was to test the hypothesis that there is no association between signs of TMD in 13-year-old headache children and their mothers.

MATERIAL AND METHODS

The study population was a nested case-control study of the population-based Finnish Family Competence Study originally consisting of over 1000 families. A structured questionnaire was sent to the families of 6-year-old children. A clinical examination was performed in 96 children with headache and 96 pairwise controls. At the age of 13 years, 75 of these same 96 children with headache and 79 of 96 headache-free controls participated in pediatric and stomatognathic examinations. Moreover, the mothers (n=154) filled in a structured headache questionnaire and participated in the stomatognathic examination.

RESULTS

No association between mother's and child's TMD signs was found. There was a significant association between signs of TMD and both migraine and tension-type headache in children. In mothers, the association was significant only between migraine and TMD signs.

CONCLUSIONS

Familial occurrence of signs of TMD cannot be found in headache children and their mothers.

Attrition, occlusion, (dys)function, and intervention: a systematic review

OBJECTIVES

Attrition and occlusal factors and masticatory function or dysfunction are thought to be related. This study aims to systematically review the literature on this topic with the emphasis to find evidence for occlusion-based treatment protocols for attrition.

MATERIALS AND METHODS

Literature was searched using PubMed (1980 to 2/2006) and the Cochrane Library of Clinical Trials with the keywords 'tooth' and 'wear'. Five steps were followed. Exclusion was based on the following: (1) reviews, case-reports, studies on non-human tooth material, and studies not published in English and (2) historical or forensic studies. Included were (3) in vivo studies. Next, studies on (4) occlusal factors, function or dysfunction [temporomandibular disorders (TMD), bruxism], or intervention, and (5) attrition were included. Two investigators independently assessed the abstracts; measure of agreement was calculated using Cohen's kappa; disagreement was resolved by discussion. Full-text articles were obtained and correlation between outcomes on occlusal factors, (dys)function, treatment, and attrition were retrieved. References in the papers included in the final analysis were cross-matched with the original list of references to add references that met the inclusion criteria.

RESULTS

The search procedure revealed 1289 references on tooth wear. The numbers of included studies after each step were (1) 345 (kappa=0.8), (2) 287 (kappa=0.87), (3) 174 (kappa=0.99), (4) 81 (kappa=0.71), and (5) 27 (kappa=0.68). Hand searches through the reference lists revealed six additional papers to be included. Analysis of the 33 included papers failed to find sound evidence for recommending a certain occlusion-based treatment protocol above another in the management of attrition.

CONCLUSION

Some studies reported correlations between attrition and anterior spatial relationships. No studies were found suggesting that absent posterior support necessarily leads to increased attrition, though one study found that fewer number of teeth resulted in higher tooth wear index (on the remaining teeth). Attrition seems to be co-existent with self-reported bruxism. Reports on attrition and TMD signs and symptoms provide little understanding of the relationship between the two.

Craniomandibular muscles, intraoral orthoses and migraine

Intraoral splints are effective in migraine prevention. In this review, changes in the quality of life of migraineurs treated with a palatal nonoccluding splint were measured. Using the Migraine Specific Quality of Life Instrument (Version 2.1), it was found that the palatal nonoccluding splint significantly improved the quality of life of migraineurs. The role of the craniomandibular muscles in the pathophysiology of migraine is also discussed.

Fitting acrylic occlusal splints and an experimental laminated appliance used in migraine prevention therapy

OBJECTIVE

To evaluate clinical procedures and chair time required to seat and adjust hard, heat-cured acrylic occlusal splints and an alternative laminated appliance developed to simplify construction of migraine prevention appliances.

DESIGN AND SETTING

Single-centre study in the Oral Medicine Clinic, The Royal Hospitals, Belfast, Northern Ireland.

METHOD

Questionnaires were distributed, January-May 2003, to operators fitting occlusal splints for 100 consecutive patients selected for migraine prevention therapy. Half the appliances were made in heat-polymerised acrylic with the remainder using a novel combination of ethylene vinyl acetate and light-curing urethane dimethacrylate. Information on operator experience, the nature of any fitting surface and occlusal adjustments together with an estimate of the time taken to make alterations was recorded.

KEY FINDINGS

The need for adjustment to seat appliances intraorally was significantly less for migraine prevention appliances made using an experimental laminating technique. Where modifications were necessary, there was no significant difference in the chair time required to fit either the heat-cured hard or experimental laminated migraine prevention appliance.

CONCLUSION

Provision of migraine prevention appliances may be more time efficient if the dental practitioner considers a laminated approach to construction.

A new retractor for surgical removal of mandibular torus

INTRODUCTION

A newly devised retractor for mandibular torus is presented. It has a half-spoon-shaped head and was applied to various cases of mandibular torus for its evaluation.

RESULTS

It was found that the elevated mucoperiosteum flap was safely protected lingually by using this retractor. Various mandibular tori were completely resected without damaging the surrounding tissues.

Migraine and tension-type headache reduction through pericranial muscular suppression: a preliminary report

Migraine and tension-type headaches have always plagued mankind. In spite of all the research dollars spent trying to determine the etiologies of these headaches, the neurology community still has not established a known cause of migraine and tension type headaches. This paper describes a study that was conducted for the U.S. Food and Drug Administration in which the efficacy of the Nociceptive Trigeminal Inhibition Tension Suppression System was evaluated and proved safe and efficacious in the reduction of medically diagnosed migraine and tension-type headache.

Headache and Bruxing Behavior Types in Craniomandibular Disorders (Cmds) Patients

Objective. Assess headache and bruxism in Craniomandibular Disorders (CMDs) and non CMDs patients. Method. Clinical examination, questionnaires, headache criteria, severity of bruxism. Results. The prevalence of headache was 68.3% in the CMDs group and 51.4% in the non-CMDs group (p<0.04).Tension type (TTH)=52.8% and combination headaches=25.2% predominated in CMDs. Migraine was more prevalent in Non-CMDs (21.1%) than in CMDs subjects (11.4%). Severe bruxism predominated in the headache/CMDs group=35% as compared to the non-headache/ CMDs group=21%, (p=0.08). We found a frequency of 29.3% extreme bruxism in the headache group and 7% in the non-headache group (p><0.0005). The frequencies of mild/moderate bruxism were about 28% in the TTH, 44.8% in the “other headaches” and 72% in the non-headache/CMDs groups. The frequencies of severe/extreme bruxism were 72.3% in the TTH, 55.2% in the “Other headaches”, and 28% in the non- headache/CMDs groups(p=0.0001). Conclusion. Headache, TTH and combination headache were common in the CMDs group. Severe and extreme bruxism were more prevalent in the headache /CMDs group than in the “other headaches” and in the non/headache CMDs groups. Severe and extreme bruxism were more frequent in the TTH/CMDs group.>

Masseter and temporalis muscle EMG levels and bite force in migraineurs

The purpose of this study was to compare absolute and proportional electromyography (EMG) levels in the masseter and temporalis muscles during performance of a variety of oral functions for migraineurs and age- and sex-matched controls. Both groups consisted of nine women and one man, with a mean age of 43 years (range, 29 to 51 years). Absolute resting EMG levels and those levels during swallowing and speech were not significantly different between the groups, but the levels of the group with migraine were significantly higher during maximum voluntary effort contractions on the anterior teeth and on the posterior teeth for both muscles. When expressed as a percentage of those levels obtained at maximal posterior contraction (ie, proportional levels), no difference in functional activity was demonstrated between groups. It was concluded that the two groups studied had similar levels of EMG activity in the masseter and temporalis muscles during the normal oral functions investigated, but that the group with migraine had higher levels of absolute EMG activity during anterior and posterior maximum voluntary contractions. Furthermore, the group with migraine demonstrated higher levels of anterior and posterior bite force, although not correlated with EMG levels.

Facial pain and temporomandibular disorders: an epidemiological study of the Northern Finland 1966 Birth Cohort

Recent clinical studies have shown an association between temporomandibular disorders (TMD) and facial pain. The aim of this epidemiological study was to investigate the prevalence of facial pain and TMD, their relation to each other, and also their relation to previous traumas, occlusal factors and pain in other areas of the body. The study is a part of the Well-Being and Health Research of the Northern Finland Birth Cohort 1966 using questionnaires where data on facial pain, TMD symptoms, occlusal divergencies, traumas in the face and other pain areas of the body were registered. Data were obtained from 5696 subjects born in the year 1966 in northern Finland. Twelve percent of the men and 18% of the women had suffered from facial pain during the last year. The most often reported symptom of TMD was clicking of the temporomandibular joints (TMJs) (21% in men, 28% in women), while prevalence of more severe symptoms was 13% or under. Facial pain was related to symptoms of TMD, as well as to traumas in the face or TMJs, distal occlusion and other pain areas (neck, shoulders, arms, lower back, jaws, tooth). The results suggest that facial pain is a usual symptom in adult population, and has an association with TMD, as well as with other musculoskeletal pain symptoms. Traumas to face and TMJs, certain occlusal factors and dental pathology may have a remarkable role in the etiology.

Role of temporomandibular disorders (TMD) in facial pain: occlusion, muscle and TMJ pain

Temporomandibular disorders (TMD) which comprise myogenic and arthralgic components have been reported to predispose subjects to headache and facial pain. The aim of this study was to evaluate the role of these components in patients with facial pain and to investigate the influence of treatment of TMD on pain of these patients. The subject group consisted of 25 patients suffering from facial pain. The clinical stomatognathic examination was performed before conservative treatment of TMD, and one-two weeks, three months and one year after treatment. The severity of TMD was assessed using the anamnestic (AI) and clinical dysfunction (DI) indices of Helkimo. The intensity of pain was evaluated on a numerical rating scale (NRS). According to clinical findings the patients were classified to following diagnostic subgroups: TMD myo (mainly myogenic), TMD arthro (mainly arthrogenous) and TMD comb (both myogenic and arthrogenous components involved). Fifteen patients were classified in the TMD myo group, nine in the TMD comb group and one in the TMD arthro group. The DI index decreased significantly one-two weeks after treatment and remained at this level at three month and one year follow-up examinations. At the first examination the TMD myo group had the highest level of NRS index, which decreased significantly during the time of follow-up, while no significant changes were found in other groups. Bruxism reported by the patient had a positive correlation with the amount of painful muscles on the right side at first examination. The results show that facial pain combined with TMD may be mostly of myogenic origin, and myogenic pain seems to have most favorable response to conservative treatment of TMD.

Report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The committee screened several hundred articles, citing 518 published papers. Some are present quality in research, others provide clinical interest, and some are identified as misleading. New techniques in pulp physiology and pathology are reported. Laser use and techniques in prevention, restorative dentistry, and materials use are reported. Epidemiology of selected diseases and the results of various formulations for treatment are cited. Diagnosis of craniomandibular dysfunction is well represented as well as references to literature reviews and other sophisticated scientific investigation. Research on adhesives is presented in respect to bonding agents for dentin and enamel. Several clinical studies are included, along with customary laboratory reports on several materials.