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Pavlou IA, Spandidos DA, Zoumpourlis V, Adamaki M. Nutrient insufficiencies and deficiencies involved in the pathogenesis of bruxism (Review). Exp Ther Med 2023; 26:563. [PMID: 37954114 PMCID: PMC10632959 DOI: 10.3892/etm.2023.12262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/02/2023] [Indexed: 11/14/2023] Open
Abstract
Stress has been well-documented to have a significant role in the etiopathogenesis of bruxism. Activation of the hypothalamic-pituitary-adrenal axis (HPA) and subsequent release of corticosteroids lead to increased muscle activity. Neurological studies have demonstrated that chronic stress exposure induces neurodegeneration of important neuronal structures and destabilization of the mesocortical dopaminergic pathway. These disruptions impair the abilities to counteract the overactivity of the HPA axis and disinhibit involuntary muscle activity, while at the same time, there is activation of the amygdala. Recent evidence shows that overactivation of the amygdala under stressful stimuli causes rhythmic jaw muscle activity by over activating the mesencephalic and motor trigeminal nuclei. The present review aimed to discuss the negative effects of certain vitamin and mineral deficiencies, such as vitamin D, magnesium, and omega-3 fatty acids, on the central nervous system. It provides evidence on how such insufficiencies may increase stress sensitivity and neuromuscular excitability and thereby reduce the ability to effectively respond to the overactivation of the sympathetic nervous system, and also how stress can in turn lead to these insufficiencies. Finally, the positive effects of individualized supplementation are discussed in the context of diminishing anxiety and oxidative stress, neuroprotection and in the reversal of neurodegeneration, and also in alleviating/reducing neuromuscular symptoms.
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Affiliation(s)
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Vassilis Zoumpourlis
- Biomedical Applications Unit, Institute of Chemical Biology, National Hellenic Research Foundation, 11635 Athens, Greece
| | - Maria Adamaki
- Biomedical Applications Unit, Institute of Chemical Biology, National Hellenic Research Foundation, 11635 Athens, Greece
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Sójka A, Stelcer B, Roy M, Mojs E, Pryliński M. Is there a relationship between psychological factors and TMD? Brain Behav 2019; 9:e01360. [PMID: 31339236 PMCID: PMC7649956 DOI: 10.1002/brb3.1360] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 04/15/2019] [Accepted: 04/24/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Medical students are in a very demanding environment and are affected by high degree of stress. High levels of anxiety can affect a student's academic performance and also increase the risk of other health-related problems. This study aims to evaluate, thanks to the intensity of stress manifestations (4DSQ) together with the sense of coherence (SOC), the prevalence of TMD and oral parafunctions in students enrolled in the University of Medical Sciences. Moreover, it aims to evaluate the relationship between the psychosocial manifestations of stress and sense of coherence in relation to gender. MATERIALS AND METHODS A total of 324 students of Poznań University of Medical Sciences participated in this study. Students were assessed using a three-part questionnaire: one was to assess symptoms of TMD, the second part was 4DSQ, and the third was a SOC Questionnaire. RESULTS About one-third of the students in this study presented symptoms of TMD and perceived more intensively symptoms of distress, anxiety, somatization, and depression. They presented a higher level of somatic symptoms and a lower level of Sense of Coherence than students without TMD symptoms. CONCLUSION There is a strong negative relationship between the sense of coherence and the level of perceived distress, anxiety, somatization, and depression. Female students attending Medical School showed a higher level of somatization of stress but with a higher capacity to overcome challenges as compared to men.
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Affiliation(s)
- Anna Sójka
- Department of ProsthodonticsPoznań University of Medical SciencesPoznanPoland
| | - Bogusław Stelcer
- Department of Clinical PsychologyPoznań University of Medical SciencesPoznanPoland
| | - Marco Roy
- Department of ProsthodonticsPoznań University of Medical SciencesPoznanPoland
| | - Ewa Mojs
- Department of Clinical PsychologyPoznań University of Medical SciencesPoznanPoland
| | - Mariusz Pryliński
- Department of ProsthodonticsPoznań University of Medical SciencesPoznanPoland
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Liu X, Zhou KX, Yin NN, Zhang CK, Shi MH, Zhang HY, Wang DM, Xu ZJ, Zhang JD, Li JL, Wang MQ. Malocclusion Generates Anxiety-Like Behavior Through a Putative Lateral Habenula-Mesencephalic Trigeminal Nucleus Pathway. Front Mol Neurosci 2019; 12:174. [PMID: 31427925 PMCID: PMC6689965 DOI: 10.3389/fnmol.2019.00174] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/01/2019] [Indexed: 01/06/2023] Open
Abstract
Malocclusion is an important risk factor for temporomandibular disorder (TMD), a series of disorders characterized by dysfunction in the orofacial region involving the temporomandibular joint (TMJ) and jaw muscles. We recently showed that experimental unilateral anterior crossbite (UAC) produced masseter hyperactivity through a circuit involving the periodontal proprioception, trigeminal mesencephalic nucleus (Vme), and trigeminal motor nucleus (Vmo). Anxiety is a common complication in patients with TMD. The lateral habenula (LHb) is involved in emotional modulation and has direct projections to the Vme. Therefore, the present research examined whether UAC facilitates excitatory input from the LHb to the Vme and, subsequently, anxiety-like behaviors in rats. The LHb activation was evaluated by the electrophysiological recording, assessment of vesicular glutamate transporter-2 (VGLUT2) mRNA expression, and measurement of anxiety-like behaviors. The effects of LHb activity on Vme were evaluated by electrophysiological recording from Vme neurons and local changes in VGLUT2 protein density. UAC produced anxiety in modeled rats and increased neuronal activity in the LHb. VGLUT2 mRNA expression was also increased in the LHb. Further, VGLUT2-positive boutons were observed in close apposite upon parvalbumin (PV)-labeled Vme neurons. VGLUT2 protein expression was also increased in the Vme. Significantly, injection of VGLUT2-targeted shRNA into the LHb reduced the expression of VGLUT2 protein in the Vme, attenuated UAC-associated anxiety-like behaviors, and attenuated electrophysiological changes in the Vme neurons. In conclusion, we show that UAC activates the LHb neurons as well as the periodontal proprioceptive pathway to provide excitatory input to the Vme and produce anxiety in rats. These findings provide a rationale for suppressing activity of the LHb to attenuate both the physical and psychological effects of TMD.
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Affiliation(s)
- Xin Liu
- State Key Laboratory of Military Stomatology, Department of Oral Anatomy and Physiology, National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi'an, China.,Department of Stomatology, The 960th Hospital of People's Liberation Army, Jinan, China
| | - Kai-Xiang Zhou
- Department of Anatomy, Histology and Embryology and K.K. Leung Brain Research Center, The Fourth Military Medical University, Xi'an, China
| | - Nan-Nan Yin
- Department of Stomatology, The 960th Hospital of People's Liberation Army, Jinan, China
| | - Chun-Kui Zhang
- Department of Anatomy, Histology and Embryology and K.K. Leung Brain Research Center, The Fourth Military Medical University, Xi'an, China
| | - Ming-Hong Shi
- State Key Laboratory of Military Stomatology, Department of Oral Anatomy and Physiology, National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Hong-Yun Zhang
- State Key Laboratory of Military Stomatology, Department of Oral Anatomy and Physiology, National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Dong-Mei Wang
- Department of Oral Medicine, School of Stomatology, Xinxiang Medical University, Xinxiang, China
| | - Zi-Jun Xu
- School of Clinical Medicine, University of South China, Hengyang, China
| | - Jing-Dong Zhang
- Department of Anesthesiology, University of Cincinnati Medical College of Medicine, Cincinnati, OH, United States
| | - Jin-Lian Li
- Department of Anatomy, Histology and Embryology and K.K. Leung Brain Research Center, The Fourth Military Medical University, Xi'an, China
| | - Mei-Qing Wang
- State Key Laboratory of Military Stomatology, Department of Oral Anatomy and Physiology, National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi'an, China
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van Bruggen HW, Wadman RI, Bronkhorst EM, Leeuw M, Creugers N, Kalaykova SI, van der Pol WL, Steenks MH. Mandibular dysfunction as a reflection of bulbar involvement in SMA type 2 and 3. Neurology 2016; 86:552-9. [DOI: 10.1212/wnl.0000000000002348] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 10/13/2015] [Indexed: 12/16/2022] Open
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van Bruggen HW, Van Den Engel-Hoek L, Steenks MH, Bronkhorst EM, Creugers NHJ, de Groot IJM, Kalaykova SI. Reduced mandibular range of motion in Duchenne Muscular Dystrophy: predictive factors. J Oral Rehabil 2015; 42:430-8. [PMID: 25600935 DOI: 10.1111/joor.12274] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2014] [Indexed: 11/26/2022]
Abstract
Patients with Duchenne muscular dystrophy (DMD) experience negative effects upon feeding and oral health. We aimed to determine whether the mandibular range of motion in DMD is impaired and to explore predictive factors for the active maximum mouth opening (aMMO). 23 patients with DMD (mean age 16.7 ± 7.7 years) and 23 controls were assessed using a questionnaire about mandibular function and impairments. All participants underwent a clinical examination of the masticatory system, including measurement of mandibular range of motion and variables related to mandibular movements. In all patients, quantitative ultrasound of the digastric muscle and the geniohyoid muscle and the motor function measure (MFM) scale were performed. The patients were divided into early and late ambulatory stage (AS), early non-ambulatory stage (ENAS) and late non-ambulatory stage (LNAS). All mandibular movements were reduced in the patient group (P < 0.001) compared to the controls. Reduction in the aMMO (<40 mm) was found in 26% of the total patient group. LNAS patients had significantly smaller mandibular movements compared to AS and ENAS (P < 0.05). Multiple linear regression analysis for aMMO revealed a positive correlation with the body height and disease progression, with MFM total score as the strongest independent risk factor (R(2) = 0.71). Mandibular movements in DMD are significantly reduced and become more hampered with loss of motor function, including the sitting position, arm function, and neck and head control. We suggest that measurement of the aMMO becomes a part of routine care of patients with DMD.
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Affiliation(s)
- H W van Bruggen
- Department of Oral Function and Prosthetic Dentistry, College of Dental Science, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; Department of Oral-Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center, Utrecht, The Netherlands
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6
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van Bruggen H, van de Engel-Hoek L, Steenks M, Bronkhorst E, Creugers N, de Groot I, Kalaykova S. Predictive factors for masticatory performance in Duchenne muscular dystrophy. Neuromuscul Disord 2014; 24:684-92. [DOI: 10.1016/j.nmd.2014.05.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/19/2014] [Accepted: 05/22/2014] [Indexed: 12/17/2022]
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Franco AL, Runho GHF, Siqueira JTTD, Camparis CM. Medical conditions and body pain in patients presenting orofacial pain. ARQUIVOS DE NEURO-PSIQUIATRIA 2012; 70:348-51. [PMID: 22618786 DOI: 10.1590/s0004-282x2012000500008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 01/10/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To verify the frequency of self-reported medical conditions and pain areas in orofacial pain patients, comparing them with patients from the routine dental care. METHODS Data were collected from archives of the Orofacial Pain Clinic (Group A, n=319) and of the routine dental care clinics (Group B, n=84) at Faculdade de Odontologia de Araraquara, São Paulo, in Brazil. All individuals answered a standardized clinical questionnaire and completed a body map indicating their pain areas. RESULTS The Mann-Whitney's test demonstrated that Group A presented a higher mean number of medical reports than Group B (p=0.004). In both groups, Pearson's correlation test showed that the highest frequencies of medical conditions were positively correlated to highest frequencies of painful areas (0.478, p=0.001 and 0.246, p=0.000, respectively). CONCLUSIONS Group A tended to report more medical conditions and there was a positive correlation between the number of medical conditions and the one of pain areas for both groups.
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Affiliation(s)
- Ana Lúcia Franco
- Department of Dental Materials and Prosthodontics, Dental School, Universidade Estadual Paulista, Araraquara, SP, Brazil.
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8
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van Bruggen HW, van den Engel-Hoek L, van der Pol WL, de Wijer A, de Groot IJM, Steenks MH. Impaired mandibular function in spinal muscular atrophy type II: need for early recognition. J Child Neurol 2011; 26:1392-6. [PMID: 21596705 DOI: 10.1177/0883073811407696] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of the study is to assess mandibular function in young patients with spinal muscular atrophy type II. A total of 12 children and young adults with spinal muscular atrophy type II and 12 healthy matched controls participated. The mandibular function impairment was moderate to severe in 50% of patients. A limited mouth opening (≤30 mm) was observed in 75% of the patients. In patients with a severe reduction of the mandibular range of motion the temporomandibular joint mainly rotated during mouth opening instead of the usual combination of rotation and sliding. The severity of the limited active mouth opening correlated with the severity of the disease (motor function measure scores). This study shows that mandibular dysfunction is common among young patients with spinal muscular atrophy type II. Early recognition of mandibular dysfunction may help to prevent complications such as aspiration as a result of chewing problems.
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Affiliation(s)
- H Willemijn van Bruggen
- Radboud University Nijmegen Medical Centre, Department of Oral Function, Nijmegen, The Netherlands.
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9
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Psychological correlates of medical comorbidities in patients with temporomandibular disorders. J Am Dent Assoc 2010; 141:22-31. [DOI: 10.14219/jada.archive.2010.0017] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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10
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Macfarlane TV, Kenealy P, Anne Kingdon H, Mohlin B, Pilley JR, Mwangi CW, Hunter L, Richmond S, Shaw WC. Orofacial pain in young adults and associated childhood and adulthood factors: results of the population study, Wales, United Kingdom. Community Dent Oral Epidemiol 2009; 37:438-50. [DOI: 10.1111/j.1600-0528.2009.00482.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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PEREIRA LJ, STEENKS MH, de WIJER A, SPEKSNIJDER CM, van der BILT A. Masticatory function in subacute TMD patients before and after treatment. J Oral Rehabil 2009; 36:391-402. [DOI: 10.1111/j.1365-2842.2008.01920.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Klasser GD, de Leeuw R. Medication use in a female orofacial pain population. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2007; 103:487-96. [PMID: 17145188 DOI: 10.1016/j.tripleo.2006.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Revised: 07/31/2006] [Accepted: 08/08/2006] [Indexed: 05/12/2023]
Abstract
OBJECTIVE This study compared, both quantitatively and qualitatively, the self-reported medication usage between an adult female orofacial pain population and a comparison group. STUDY DESIGN Eighty-seven subjects from both an orofacial pain center (OPC) and undergraduate dental clinic (UDC) completed a standardized medical history questionnaire. Both groups had a similar distribution with regard to age. The number of medications and medication categories were compared between the two groups. Statistical analysis used the Student t-test, Fisher's exact tests, Pearson's chi2 tests, and calculated odds ratios. RESULTS The number of pain and non-pain medications, and the number of medication categories endorsed by OPC subjects was significantly higher compared with the UDC group. CONCLUSION Adult female orofacial pain subjects report greater overall and higher rate of medication use, which was not limited to only the analgesic/narcotic categories, than the comparison group.
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Affiliation(s)
- Gary D Klasser
- Department of Oral Medicine and Diagnostic Services, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA.
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13
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Gameiro GH, da Silva Andrade A, Nouer DF, Ferraz de Arruda Veiga MC. How may stressful experiences contribute to the development of temporomandibular disorders? Clin Oral Investig 2006; 10:261-8. [PMID: 16924558 DOI: 10.1007/s00784-006-0064-1] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Accepted: 06/19/2006] [Indexed: 10/24/2022]
Abstract
Temporomandibular disorders (TMD) comprise the most common cause of chronic facial pain conditions, and they are often associated with somatic and psychological complaints including fatigue, sleep disturbances, anxiety, and depression. For many health professionals, the subjectivity of pain experience is frequently neglected even when the clinic does not find any plausible biologic explanation for the pain. This strictly biomedical vision of pain cannot be justified scientifically. The purpose of this study is to demonstrate, by original articles from the literature and recent studies conducted in our own laboratory, the biological processes by which psychological stress can be translated into the sensation of pain and contribute to the development of TMD. The role of the hypothalamic-pituitary-adrenal axis, the serotoninergic and opioid systems in the pathogenesis of facial pain is exposed, including possible future therapeutic approaches. It is hoped that knowledge from apparently disparate fields of dentistry, integrated into a multidisciplinary clinical approach to TMD, will improve diagnosis and treatment for this condition through a clinical practice supported by scientific knowledge.
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Affiliation(s)
- Gustavo Hauber Gameiro
- Department of Orthodontics, Piracicaba Dental School, University of Campinas-Unicamp, Av. Limeira 901 C.P. 52, CEP 13414-900, Piracicaba, São Paulo, Brazil.
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de Leeuw R, Klasser GD, Albuquerque RJC. Are female patients with orofacial pain medically compromised? J Am Dent Assoc 2005; 136:459-68. [PMID: 15884315 DOI: 10.14219/jada.archive.2005.0201] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Chronic pain has been linked to various medical conditions. The authors assessed whether certain medical conditions are more prevalent in female patients with orofacial pain than in age-matched controls. METHODS The study sample consisted of 87 female adult subjects from a university-based orofacial pain center (OPC) and 87 age-matched female subjects from a university-based undergraduate dental clinic (UDC). Subjects were evaluated between February 2003 and July 2003, and they completed a standardized, 78-question medical history questionnaire as part of routine clinical protocol. Using the subjects' medical histories, the authors compared 11 major medical categories and 77 individual conditions for both groups. For statistical analyses, the authors used nonparametric Kolmogorov-Smirnov Z tests and chi2 tests and calculated odds ratios (ORs). RESULTS The medical histories of subjects in the OPC group indicated a significantly greater number of medical conditions than did those of the subjects in the UDC group (Z = -4.411, P < .0001). Specifically, subjects in the OPC group reported having significantly more neurological (Z = -5.304, P < .0001), gastrointestinal (Z = -2.897, P = .004), pulmonary (Z = -2.298, P = .022), dermatologic (Z = -2.984, P = .003) and other conditions (Z = -2.885, P = .004) than did subjects in the UDC group. Subjects in the OPC group reported having 12 individual medical conditions significantly more often (P < .05, ORs ranged from 2.5 to 9.7) than did subjects in the UDC group. CONCLUSIONS Female patients with orofacial pain complaints appear to have more systemic problems than do female patients seeking routine dental care. CLINICAL IMPLICATIONS The presence of multiple medical conditions can influence orofacial pain management options and treatment outcomes. Patients with more medically complicated orofacial pain may require treatment on a multidisciplinary basis.
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Affiliation(s)
- Reny de Leeuw
- Orofacial Pain Center, University of Kentucky, College of Dentistry, Chandler Medical Center, Lexington 40536-0297, USA.
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van Grootel RJ, van der Glas HW, Buchner R, de Leeuw JRJ, Passchier J. Patterns of Pain Variation Related to Myogenous Temporomandibular Disorders. Clin J Pain 2005; 21:154-65. [PMID: 15722809 DOI: 10.1097/00002508-200503000-00007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Myogenous temporomandibular disorders are characterized by jaw muscle pain. The aims were: 1) to characterize this pain generally in terms of intensity, frequency, duration, and behavior across a period of 2 weeks; 2) to identify main intraday pain patterns and to examine whether subgroups of patients in this respect differed in clinical, demographic, pain and sleep variables, psychosocial factors, and use of medication; and 3) to investigate some possible interday trends of pain intensity at a group level. METHOD One hundred thirty-three patients with myogenous temporomandibular disorders completed a 2-week diary, rating pain intensity (100 mm Visual Analog Scale [VAS]), duration, behavior (verbal 6-point scale), and medication use on 4 times of the day. Furthermore, questionnaires were completed to score pain period before seeking treatment, spread of pain, and demographic, psychosocial, and sleep variables. RESULTS In the diary, pain intensity, frequency, daily pain duration, and the score of pain behavior were on average 29.1 mm, 69% of the scoring times, 5.5 hours, and 1.8 points (approaching "pain present, but I can ignore it at times"), respectively. Pain intensity was, on average, maximal late in the day (before dinner or bedtime) for the majority of patients (79%) and early in the day (before breakfast or lunchtime) for the minority (21%). The larger subgroup had a significantly higher daily pain intensity, more frequently a widespread pain and problems with falling asleep at bedtime, agreed more about the role of a physician as an external health locus of control, and had a more distancing coping style. Both subgroups were similar for other variables, most notably in the level of state anxiety and depressive mood, and in a sparse use (7.8% of all possible times) of over-the-counter medication. Daily mean VAS scores, averaged across patients, were approximately constant for the various diary days. Both the daily mean and maximal VAS score were not related to a specific day of the week. CONCLUSIONS Two main daily pain patterns occur in patients with myogenous temporomandibular disorders (79%: maximal pain late in the day; 21%: early in the day), which might be related to differences in processes that influence pain sensitivity and patterns of jaw muscle activation. The interday similarities in pain level suggest that a sustained influence of counseling after the intake or an influence of a common behavioral pattern with a cycle duration of a week are not involved.
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Affiliation(s)
- Robert J van Grootel
- Department of Oral-Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Uhac I, Kovac Z, Valentić-Peruzović M, Juretić M, Moro LJ, Grzić R. The influence of war stress on the prevalence of signs and symptoms of temporomandibular disorders. J Oral Rehabil 2003; 30:211-7. [PMID: 12535150 DOI: 10.1046/j.1365-2842.2003.01030.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this study was to determine the prevalence of signs and symptoms of temporomandibular disorders in patients with post-traumatic stress disorder (PTSD) occurring as a consequence of exposure to war stress. The examined group consisted of 100 male subjects, aged from 25 to 50 years, who had taken part in the War in Croatia, and in whom PTSD had previously been diagnosed. The control group comprised 100 subjects, without PTSD, of the same sex and age group, who had not taken part in the War. A functional evaluation of the stomatognathic system was performed using the Helkimo Anamnestic and Clinical Dysfunction Index. Eighty-two per cent of the group with PTSD had at least one symptom, and 98% at least one sign of dysfunction. Eight per cent reported mild symptoms and 74% severe symptoms. Twenty-eight per cent showed mild clinical signs, 22% had signs of moderate, and 48% of severe dysfunction. Twenty-four per cent of the control group of subjects had at least one symptom, and 52% at least one clinical sign of dysfunction. Twenty-two per cent reported mild and 2% severe symptoms. Mild clinical signs of dysfunction were found in 50% of subjects in the control group, moderate in 2% and none exhibited severe clinical signs. It is concluded that correlation exists between war stress and temporomandibular disorders.
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Affiliation(s)
- I Uhac
- Department of Prosthodontics, School of Dental Medicine, University of Rijeka, Rijeka, Croatia.
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Kuttila M, Le Bell Y, Savolainen-Niemi E, Kuttila S, Alanen P. Efficiency of occlusal appliance therapy in secondary otalgia and temporomandibular disorders. Acta Odontol Scand 2002; 60:248-54. [PMID: 12222651 DOI: 10.1080/000163502760148034] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In clinical practice, it is commonly assumed that occlusal splints have therapeutic value in the treatment of temporomandibular disorders CTMD), but the evidence based on randomized controlled trials is scarce. This study evaluated the short-term (10-week) efficacy of a stabilization splint in subjects with recurrent secondary otalgia and active TMD treatment need using a randomized, controlled, double-blind design. Thirty-six subjects were randomly allocated to the two treatment groups: the stabilization splint and the control splint group. After 10 weeks' treatment, the intensity of secondary otalgia, measured on a VAS scale (from 0 to 100 mm), decreased statistically significantly in the stabilization splint group (t 2.12; P 0.006), but not in the control group. Improvement in active TMD treatment need in subjects showing moderate or severe signs and symptoms of TMD was reported significantly more often in the stabilization splint group than in the control splint group (chi2 5.71; P.017). A statistically significant decrease in the Helkimo clinical dysfunction index was seen in the subjects with stabilization splint (Z-2.63; P.009), but not in the subjects with control splint. The results indicate that the use of a stabilization splint is beneficial with regard to secondary otalgia and active TMD treatment need.
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Sipilä K, Zitting P, Siira P, Laukkanen P, Järvelin MR, Oikarinen KS, Raustia AM. Temporomandibular disorders, occlusion, and neck pain in subjects with facial pain: a case-control study. Cranio 2002; 20:158-64. [PMID: 12150261 DOI: 10.1080/08869634.2002.11746206] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The etiology of facial pain is multifactorial. Based on the results of a questionnaire included in the study of the 1966 Northern Finland Birth Cohort, performed in 1997-98, we found an association of facial pain with subjective symptoms of temporomandibular disorders (TMD), neck pain and with occlusal factors reported by 5,696 subjects. The aim of the present study was to examine these associations clinically. In the year 2000, a new inquiry was sent to the following subjects living in Oulu: 1. all subjects who had reported facial pain in the former questionnaire (n=162) (case group); and 2. to a randomly selected group of nonpain controls (n=200), group matched for gender. Those who reported willingness to participate were invited to a clinical examination. Finally, the total number of subjects was 104, including 52 (10 men, 42 women) cases and 52 (10 men, 42 women) controls. Anamnestic data were collected, and clinical stomatognathic and musculoskeletal examinations were performed, both the clinicians and the subjects being unaware of the case-control status. Anamnestically, stress was the most often reported provoking factor for facial pain. Facial pain associated significantly with reported TMD symptoms and allergies. Based on clinical findings, most of the cases were classified in the myogenous subgroup of TMD. The risk for facial pain was six-fold in subjects with clinically assessed TMD, defined as moderate (DiII) or severe (DiIII) by Helkimo's clinical dysfunction index, almost six-fold in subjects with protrusion interferences and approximately three-fold in subjects with clinically assessed tenderness of distinct fibromyalgia (FM) points in the neck. According to the adjusted logistic regression analyses, TMD had the strongest influence on facial pain, followed by protrusion interferences, anamnestically reported allergies and "other headaches". The present study shows that as well as being connected with TMD, facial pain is associated with pain and muscle tenderness in the neck area.
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Affiliation(s)
- Kirsi Sipilä
- Dept. of Prosthetic Dentistry and Stomatognathic Physiology, Institute of Dentistry, University of Oulu, Finland.
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19
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Macfarlane TV, Kincey J, Worthington HV. Factors associated with the temporomandibular disorder, pain dysfunction syndrome (PDS): Manchester case-control study. Oral Dis 2001; 7:321-30. [PMID: 11834094 DOI: 10.1034/j.1601-0825.2001.00758.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To determine the individual and combined effects of potential risk factors in relation to the temporomandibular disorder, Pain Dysfunction Syndrome (PDS). DESIGN Case-control study. MATERIAL AND METHODS Cases were new referrals to the temporomandibular disorder clinic of the University Dental Hospital of Manchester, diagnosed with PDS. Controls were randomly selected from 24 dental practices. Using a postal questionnaire information was collected on socio-demographic, local mechanical, psychological factors, co-morbidities and illness behaviour. The adjusted participation rate was similar in cases and controls (64%), and 131 cases and 196 controls finally participated in the study. RESULTS Compared with the controls, the cases were more likely to report that their teeth felt as though they did not fit together properly [odds ratio (OR) 8, 95% Confidence Interval (CI) 6-13] and report history of facial trauma (OR 3, 95% CI 2-6). Both diurnal and nocturnal grinding were significantly associated with PDS, and individuals who reported grinding their teeth both during the day and at night had a risk of 6; 95% CI 3-13 for PDS compared with those who did not. A history of orthodontic treatment, having any dentures, having missing teeth, use of chewing gum or biting the fingernails did not show any relationship with PDS. People who took medication for the bowels had a higher risk of PDS (OR 2, 95% CI 1-4). Participants with frequent headaches had a threefold increase in risk of having PDS (OR 3, 95% CI 2-5) while having pain in parts of the body other than the head was associated with an OR of 3 (95% CI 2-5). An increased propensity to have PDS was seen in those individuals with higher levels of psychological distress (OR 3; 95% CI 1-4 in the highest category, test for trend P < 0.001) and sleep disturbance (OR 5; 95% CI 2-94 in the highest category, test for trend P < 0.001). Aspects of illness behaviour, such as disease conviction (OR 4; 95% CI 2-9 in the highest category) and perception of illness (0.3; 95% CI 0.2-0.5) were associated with PDS. The result for the denial scale became statistically significant after adjustment for age and gender (2; 95% CI 1-3). CONCLUSIONS The current case-control study provides complementary epidemiological information on oro-facial pain (OFP) and supports a multifactorial aetiology of PDS, with factors from many domains, including local mechanical factors, psychological and co-morbidities. People with PDS were characterized by frequent headaches, history of facial trauma, teeth grinding, sleep problems, pain elsewhere in the body and high levels of psychological distress. From the results of current study and available evidence it seems inappropriate to consider PDS in isolation and future research should adopt a multidisciplinary approach to OFP.
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Browne PA, Clark GT, Kuboki T, Adachi NY. Concurrent cervical and craniofacial pain. A review of empiric and basic science evidence. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1998; 86:633-40. [PMID: 9868716 DOI: 10.1016/s1079-2104(98)90195-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Because many patients present themselves for treatment with both craniofacial and craniocervical pain, 2 questions arise: (1) What are the sensory and motor consequences of dysfunction in either of these areas on the other? (2) Do craniofacial and craniocervical pain have a similar cause? These questions formed the impetus for this review article. The phenomenon of concurrent pain in craniofacial and cervical structures is considered, and clinical reports and opinions are presented regarding theories of cervical-to-craniofacial and craniofacial-to-cervical pain referral. Because pain referral between these 2 areas requires anatomic and functional connectivity between trigeminally and cervically innervated structures, basic neurophysiologic and neuroanatomic literature is reviewed. The published data clearly demonstrate neurophysiologic and structural convergence of cervical sensory and muscle afferent inputs onto trigeminal subnucleus caudalis nociceptive and non-nociceptive neurons. Moreover, changes in metabolic activity and blood flow in the brainstem and cervical dorsal horn of the spinal cord in both monkeys and cats have been demonstrated after electric stimulation of the V1-innervated superior sagittal sinus. In conclusion, the animal experimental data support the findings of human empiric and experimental studies, which suggest that strong connectivity exists between trigeminal and cervical motor and sensory responses.
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Affiliation(s)
- P A Browne
- Division of Physical Therapy, Chapman University, Los Angeles, Calif., USA
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21
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Kuttila M, Kuttila S, Niemi PM, Alanen P, Le Bell Y. Fluctuation of treatment need for temporomandibular disorders and age, gender, stress, and diagnostic subgroup. Acta Odontol Scand 1997; 55:350-5. [PMID: 9477027 DOI: 10.3109/00016359709059199] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Associations between fluctuation of treatment need for temporomandibular disorders (TMD) and age, gender, stress, and diagnostic subgrouping were analyzed in a 2-year follow-up of 391 subjects. All the studied factors were significantly associated with the treatment need for TMD at all examinations. The diagnostic subgroup (TMD arthro, TMD myo, TMD comb, or non-classified) at base line was significantly associated with the fluctuation of the treatment need for TMD also during the follow-up, but age, gender, and stress score were not. In the subgroup needing active treatment for TMD at least once during the follow-up (n = 65), the stress score did not show statistically significant covariation with the treatment need. The diagnostic subgrouping of these 65 subjects at the second and third examination at 12-month intervals did not show any association with the subgrouping at base line or with any studied variable. Detailed descriptive diagnostics may serve well in treatment planning but do not necessarily help us in understanding the nature of TMD.
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Affiliation(s)
- M Kuttila
- Institute of Dentistry, University of Turku, Finland
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22
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de Wijer A, de Leeuw JR, Steenks MH, Bosman F. Temporomandibular and cervical spine disorders. Self-reported signs and symptoms. Spine (Phila Pa 1976) 1996; 21:1638-46. [PMID: 8839465 DOI: 10.1097/00007632-199607150-00005] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
STUDY DESIGN The authors assessed the results of an anamnestic self-administered questionnaire given to 111 patients with temporomandibular disorders and 103 patients with cervical spine disorders. OBJECTIVES The present study was performed to investigate whether patients with cervical spine disorders and subgroups of patients with temporomandibular disorders differ regarding specific and accompanying signs and symptoms of temporomandibular disorders and cervical spine disorders. SUMMARY OF BACKGROUND DATA Patients with temporomandibular disorders frequently show signs and symptoms related to cervical spine disorders, and, vice versa, patients with cervical spine disorders may show signs and symptoms related to temporomandibular disorders. Many authors have pointed out the existence of neuroanatomical and biomechanical relationships. METHODS The questionnaire included questions about pain, symptoms of temporomandibular disorders, accompanying signs and symptoms, psychosocial factors, and general health. Before their clinical examination, all patients were requested by mail to complete the questionnaire. RESULTS Patients with cervical spine disorders reported fewer symptoms of temporomandibular disorders than the subgroups of patients with temporomandibular disorders, more general health symptoms than patients with temporomandibular disorders with an arthrogenous or myogenous component, and fewer ear symptoms than patients with temporomandibular disorders. There was no difference between the patient groups regarding other associated signs and symptoms and psychosocial factors as measured with the questionnaire. Logistic regression analyses showed that six variables (jaws, ears, eyes, temporomandibular joint sounds, complaints of the shoulders, and pain in joints other than the temporomandibular joint) correctly classified 91% of the patients as having temporomandibular disorders or cervical spine disorders. CONCLUSIONS The results of this study do not support the theoretical concept that cervical spine disorders may give rise to temporomandibular disorders. The authors' results indicate that the anamnestic questionnaire can be used as an aid to distinguish patients with cervical spine disorders from subgroups of patients with temporomandibular disorders.
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Affiliation(s)
- A de Wijer
- Department of Oral-Maxillofacial Surgery, Prosthodontics and Special Dental Care, Faculty of Medicine, Utrecht University, The Netherlands
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de Leeuw JR, Steenks MH, Ros WJ, Lobbezoo-Scholte AM, Bosman F, Winnubst JA. Assessment of treatment outcome in patients with craniomandibular dysfunction. J Oral Rehabil 1994; 21:655-66. [PMID: 7830201 DOI: 10.1111/j.1365-2842.1994.tb01181.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Psychosocial, socio-demographic and symptom characteristics have been shown to be associated with treatment outcome in patients with craniomandibular dysfunction (CMD). This study was performed to assess to what extent symptoms and correlates of CMD change as a consequence of conservative treatment for CMD. Treatment outcome in a group of CMD patients treated with a stabilization splint (experimental group) was compared with that of a group of patients with CMD who were not treated for CMD (control group). Patients in the experimental group had fewer symptoms of CMD at the end of treatment. However, several symptoms and correlates of CMD also improved in the control group (severity of pain, joint noises, ear symptoms). It was therefore questioned whether all improvements in symptoms and correlates of CMD in the experimental group could be attributed to the treatment received. Results suggest that the main improvement that might be ascribed to therapy was a decrease in 'jaw symptoms'. There was a noticeable decrease in depression and an increased use of 'planned actions and rational thinking' as a coping style in the experimental group whereas these variables did not change in the control group. Implications and suggestions for further research are discussed.
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Affiliation(s)
- J R de Leeuw
- Department of Oral-Maxillofacial Surgery, Faculty of Medicine, University of Utrecht, The Netherlands
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de Leeuw JR, Ros WJ, Steenks MH, Lobbezoo-Scholte AM, Bosman F, Winnubst JA. Craniomandibular dysfunction: patient characteristics related to treatment outcome. J Oral Rehabil 1994; 21:667-78. [PMID: 7830202 DOI: 10.1111/j.1365-2842.1994.tb01182.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In a previous study it was concluded that only a few changes in symptoms related to craniomandibular dysfunction (CMD) could be attributed to therapy. It was suggested that psychosocial and socio-demographic variables, as well as symptom characteristics, could be responsible for the unconvincing treatment outcome in patients treated with a splint. The present study was performed to investigate whether socio-demographic characteristics, symptom characteristics and various psychosocial variables are associated with treatment outcome in patients with CMD treated with a splint. Treatment outcome was determined by using self-reported follow-up data. Results showed that patients with a negative treatment outcome were older, reported more and more severe symptoms and correlates of CMD, reported fewer stressors and more frequently considered health to be determined by external factors than patients who were treated successfully. The two groups could not be differentiated with regard to anxiety and depression. Results are interpreted with regard to the prediction of treatment outcome.
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Affiliation(s)
- J R de Leeuw
- Department of Oral-Maxillofacial Surgery, Faculty of Medicine, University of Utrecht, The Netherlands
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25
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de Leeuw JR, Ros WJ, Steenks MH, Lobbezoo-Scholte AM, Bosman F, Winnubst JA. Multidimensional evaluation of craniomandibular dysfunction. II: Pain assessment. J Oral Rehabil 1994; 21:515-32. [PMID: 7996336 DOI: 10.1111/j.1365-2842.1994.tb01166.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To standardize clinical history taking, a comprehensive anamnestic questionnaire was developed (Screen). Screen includes questions about: (i) pain, (ii) other symptoms of craniomandibular dysfunction (CMD), (iii) correlates of CMD, (iv) psychosocial factors, and (v) general health. The current study focuses on variables in Screen concerning pain reported somewhere in the head, neck and/or shoulders. This study was performed to assess whether subgroups of patients with signs and symptoms of CMD and a control group of dental patients with and without signs and symptoms of CMD can be characterized by differences in areas reported to be painful, in quantitative and qualitative characteristics of pain, and in factors exacerbating pain. Results indicate that several characteristics of pain as measured in Screen can be used to discriminate between: (i) subgroups of subjects with signs and/or symptoms of CMD and controls without signs or symptoms of CMD, (ii) subgroups of clinical cases and controls with signs or symptoms of CMD, and (iii) patients with CMD with mainly a myogenous component and patients with CMD with mainly an arthrogenous component. The results of logistic regression analysis indicate that four adverbs describing pain correctly classified 75% of patients with CMD-myo and patients with CMD-arthro. Differences between patients and controls are interpreted with regard to the correct classification of patients with CMD with a mainly myogenous component and patients with CMD with a mainly arthrogenous component and the subjective treatment need for CMD. Implications for further research are discussed.
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Affiliation(s)
- J R de Leeuw
- Department of Oral-Maxillofacial Surgery, Prosthodontics and Special Dental Care, Faculty of Medicine, University of Utrecht, The Netherlands
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