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Almeida MBD, Moreira M, Miranda-Oliveira P, Moreira J, Família C, Vaz JR, Moleirinho-Alves P, Oliveira R. Evolving Dynamics of Neck Muscle Activation Patterns in Dental Students: A Longitudinal Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:5689. [PMID: 39275600 PMCID: PMC11398279 DOI: 10.3390/s24175689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 08/29/2024] [Accepted: 08/30/2024] [Indexed: 09/16/2024]
Abstract
Cervical pain has been linked to increased motor unit activity, potentially associated with the initiation and progression of chronic neck pain. Therefore, this study aimed to compare the time-course changes in cervical superficial muscle activation patterns among dental students with and without neck pain throughout their initial semester of clinical training. We used an online Nordic Musculoskeletal Questionnaire for group allocation between neck pain (NP) (n = 21) and control group (CG) (n = 23). Surface electromyography (sEMG) of the sternocleidomastoid and upper bilateral trapezius was recorded before starting their clinical practice and after their first semester while performing a cranio-cervical flexion test (CCFT) in five increasing levels between 22 mmHg and 30 mmHg. After the first semester, both the CG (p < 0.001) and NP (p = 0.038) groups showed decreased sternocleidomastoid activation. The NP group exhibited a concomitant increase in upper trapezius coactivation (p < 0.001), whereas the muscle activation pattern in asymptomatic students remained unchanged (p = 0.980). During the first semester of clinical training, dental students exhibited decreased superficial flexor activity, but those with neck pain had increased co-contraction of the upper trapezius, likely to stabilize the painful segment. This altered activation pattern could be associated with further dysfunction and symptoms, potentially contributing to chronicity.
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Affiliation(s)
- Manuel Barbosa de Almeida
- Neuromuscular Research Lab, Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, Oeiras, 1499-002 Lisbon, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal
- Department of Physiotherapy, Egas Moniz School of Health & Science, Campus Universitario, Quinta da Granja, Caparica, 2829-511 Almada, Portugal
| | - Marion Moreira
- Department of Physiotherapy, Egas Moniz School of Health & Science, Campus Universitario, Quinta da Granja, Caparica, 2829-511 Almada, Portugal
| | - Paulo Miranda-Oliveira
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal
- Department of Physiotherapy, Egas Moniz School of Health & Science, Campus Universitario, Quinta da Granja, Caparica, 2829-511 Almada, Portugal
- ESTG-School of Technology and Management, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal
- Performance, Research and Planning Department, Portuguese Athletics Federation, 2799-538 Linda-A-Velha, Portugal
| | - José Moreira
- Nursing School São João de Deus, University of Évora, 7004-516 Évora, Portugal
- Comprehensive Health Research Centre, National School of Public Health, 1600-560 Lisbon, Portugal
| | - Carlos Família
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal
| | - João R Vaz
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal
| | - Paula Moleirinho-Alves
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal
- Department of Physiotherapy, Egas Moniz School of Health & Science, Campus Universitario, Quinta da Granja, Caparica, 2829-511 Almada, Portugal
| | - Raúl Oliveira
- Neuromuscular Research Lab, Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, Oeiras, 1499-002 Lisbon, Portugal
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Catunda IS, Lima Junior MOD, Costa Araujo FAD, Fontan Soares C, Ferreira JCA, Kosminsky M, Vasconcelos BCDE, Vasconcellos RJDH. Is Muscle Pain in Temporomandibular Disorder a Hyperactivity Problem? A Clinical, Thermographic, and Electromyographic Analysis. J Craniofac Surg 2024:00001665-990000000-01661. [PMID: 38829989 DOI: 10.1097/scs.0000000000010209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/09/2024] [Indexed: 06/05/2024] Open
Abstract
ABSTRACT This study aimed to report clinical data on muscle pain in temporomandibular disorders using thermography, algometry, and surface electromyography (EMG). This was done to support or rule out the hypothesis that painful muscles are always related to muscular hyperactivity. This cross-sectional, analytical study included 50 participants who underwent clinical examination and evaluation of anterior temporal muscles and bilateral masseters using thermography, algometry, and EMG. The muscles with greater pain symptoms had hyporadiation and a lower temperature compared with both contralateral muscles and muscles in the asymptomatic group. There was no muscle hyperactivity at rest on EMG analysis; however, there was a greater capacity for muscle recruitment of these symptomatic muscles after a joint decompression test with cotton rolls, suggesting hypoactivity of the affected muscles in the symptomatic patient group. Muscle pain may be related to hypoactivity of the musculature when there is neurological inhibition of the recruitment of muscle fibers, and treatment must consider these neurophysiological alterations. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | | | | | - Cauê Fontan Soares
- Department of Prosthesis and Maxillofacial Surgery, Faculty of Dentistry, Federal University of Pernambuco (UFPE), Recife, PE, Brazil
| | | | - Maurício Kosminsky
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Pernambuco (UPE)
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Kliangkaeo W, Tangpothitham S, Mitrirattanakul S, Wachiralarpphaithoon C. The effect of different pain characteristics on jaw functional limitations in patients with temporomandibular disorders. J Oral Rehabil 2024; 51:998-1004. [PMID: 38450596 DOI: 10.1111/joor.13674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/27/2023] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Patients with painful temporomandibular disorders (TMD) more often experience jaw functional limitations. The study of jaw functional limitations should be primarily focused on painful TMD. OBJECTIVES The impact of TMD pain characteristics (source, chronicity and intensity) on jaw functional limitations were evaluated using Jaw Functional Limitation Scale (JFLS). METHODS This cross-sectional study reviewed the dental records and self-report questionnaires of patients with painful TMD. The pain source, chronicity and intensity were evaluated to study the TMD pain characteristics. The jaw functional limitations were analysed using the Thai version of the JFLS. RESULTS A total of 176 patients with painful TMD were included in this study. The jaw functional limitations were affected only by pain intensity. Patients with TMD with severe pain intensity had significantly higher jaw functional limitations than those with mild-to-moderate pain intensity (p < .05). A significant association was observed between pain intensity and jaw functional limitations (p < .05). Mastication was highly restricted by pain intensity (odd ratio = 1.39, 95% confidence interval = 1.16-1.67). CONCLUSION The present study found a significant effect of TMD pain intensity on jaw functional limitations. Patients with severe TMD pain intensity were more likely to experience jaw functional limitations, particularly mastication limitation. Management focusing on reduction of pain intensity may improve jaw functions in patients with TMD.
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Affiliation(s)
- Watcharee Kliangkaeo
- Department of Masticatory Science, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Sakarin Tangpothitham
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, Prince of Songkla University, Songkhla, Thailand
| | - Somsak Mitrirattanakul
- Department of Masticatory Science, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Murray GM, Sessle BJ. Pain-sensorimotor interactions: New perspectives and a new model. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2024; 15:100150. [PMID: 38327725 PMCID: PMC10847382 DOI: 10.1016/j.ynpai.2024.100150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/25/2023] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Abstract
How pain and sensorimotor behavior interact has been the subject of research and debate for many decades. This article reviews theories bearing on pain-sensorimotor interactions and considers their strengths and limitations in the light of findings from experimental and clinical studies of pain-sensorimotor interactions in the spinal and craniofacial sensorimotor systems. A strength of recent theories is that they have incorporated concepts and features missing from earlier theories to account for the role of the sensory-discriminative, motivational-affective, and cognitive-evaluative dimensions of pain in pain-sensorimotor interactions. Findings acquired since the formulation of these recent theories indicate that additional features need to be considered to provide a more comprehensive conceptualization of pain-sensorimotor interactions. These features include biopsychosocial influences that range from biological factors such as genetics and epigenetics to psychological factors and social factors encompassing environmental and cultural influences. Also needing consideration is a mechanistic framework that includes other biological factors reflecting nociceptive processes and glioplastic and neuroplastic changes in sensorimotor and related brain and spinal cord circuits in acute or chronic pain conditions. The literature reviewed and the limitations of previous theories bearing on pain-sensorimotor interactions have led us to provide new perspectives on these interactions, and this has prompted our development of a new concept, the Theory of Pain-Sensorimotor Interactions (TOPSMI) that we suggest gives a more comprehensive framework to consider the interactions and their complexity. This theory states that pain is associated with plastic changes in the central nervous system (CNS) that lead to an activation pattern of motor units that contributes to the individual's adaptive sensorimotor behavior. This activation pattern takes account of the biological, psychological, and social influences on the musculoskeletal tissues involved in sensorimotor behavior and on the plastic changes and the experience of pain in that individual. The pattern is normally optimized in terms of biomechanical advantage and metabolic cost related to the features of the individual's musculoskeletal tissues and aims to minimize pain and any associated sensorimotor changes, and thereby maintain homeostasis. However, adverse biopsychosocial factors and their interactions may result in plastic CNS changes leading to less optimal, even maladaptive, sensorimotor changes producing motor unit activation patterns associated with the development of further pain. This more comprehensive theory points towards customized treatment strategies, in line with the management approaches to pain proposed in the biopsychosocial model of pain.
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Affiliation(s)
- Greg M. Murray
- Discipline of Restorative and Reconstructive Dentistry, Sydney School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Darcy Road, Westmead, NSW 2145, Australia
| | - Barry J. Sessle
- Faculty of Dentistry and Temerty Faculty of Medicine Department of Physiology, and Centre for the Study of Pain, University of Toronto, 124 Edward St, Toronto, ON M5G 1G6, Canada
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Chattrattrai T, Aarab G, Su N, Blanken TF, Mitrirattanakul S, Lobbezoo F. The association of self-reported awake bruxism and sleep bruxism with temporomandibular pain and dysfunction in adult patients with temporomandibular disorders. Clin Oral Investig 2023; 27:7501-7511. [PMID: 37864603 DOI: 10.1007/s00784-023-05338-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/11/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE To investigate the association of the severity of temporomandibular disorders (TMD) pain and dysfunction with the frequency of self-reported awake bruxism (AB), sleep bruxism (SB), and stress in an adult TMD-patient population. MATERIALS AND METHODS This cross-sectional study included 237 TMD patients based on the Diagnostic Criteria for TMD. Age, sex, frequency of self-reported AB and SB, and stress were included as independent variables. TMD pain and TMD dysfunction were included as dependent variables in regression analyses. Univariate and multivariable linear regression analyses were used to predict TMD pain and TMD dysfunction in two separate models. Finally, network analysis was performed to investigate the associations between all variables. RESULTS In the univariate analyses, TMD pain was significantly associated with self-reported AB-frequent (unstandardized coefficient (B) = 3.196, 95%CI 1.198-5.195, p = 0.002). TMD dysfunction was significantly associated with AB-frequent (B = 2.208, 95%CI 0.177-4.238, p = 0.033) and SB-sometimes (B = 1.698, 95%CI 0.001-3.394, p = 0.050). In the multivariable analyses, TMD pain was significantly associated with TMD dysfunction (B = 0.370, p < 0.001), stress (B=0.102, p < 0.001). TMD dysfunction was significantly associated with TMD pain (B = 0.410, p < 0.001) only. Network analysis showed that TMD pain is a bridge factor between AB, stress, and TMD dysfunction. CONCLUSIONS TMD pain is directly associated with AB, stress, and TMD dysfunction, while TMD dysfunction is only associated with TMD pain. CLINICAL RELEVANCE Reducing pain may improve pain-related dysfunction, and the management of AB and stress may improve TMD pain and dysfunction, and vice versa.
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Affiliation(s)
- Thiprawee Chattrattrai
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Masticatory Science, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Naichuan Su
- Department of Oral Public Health, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Tessa F Blanken
- Department of Psychological Methods, University of Amsterdam, Amsterdam, the Netherlands
| | - Somsak Mitrirattanakul
- Department of Masticatory Science, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Yıldız NT, Kocaman H, Yıldırım H. Predictors of the masticatory muscle activity during chewing in patients with myogenous temporomandibular disorder. Clin Oral Investig 2023; 27:6547-6558. [PMID: 37737891 DOI: 10.1007/s00784-023-05260-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVES The aim of the study was to identify predictors of the masticatory muscle activity during chewing (MMA) of the masseter and temporalis anterior (TA) muscles in patients with unilateral myogenous temporomandibular disorder (mTMD). MATERIALS AND METHODS This observational and cross-sectional study included 109 patients diagnosed with unilateral mTMD. Surface electromyography was used to separately evaluate the MMA of the masseter and TA on the affected and unaffected sides. Also, pain intensity (with a visual analog scale), pressure pain threshold (with an algometer), active pain-free maximum mouth opening and temporomandibular joint lateral movements (with a ruler), cervical range of motions (with a goniometer), and TMD severity (with a Fonseca Anamnestic Index) were assessed. Various statistical methods were used to predict the MMA of the masseter and TA, including standard, forward, and best subsets multiple regression models. RESULTS While there were significant correlations between the MMA of the masseter and TA and pain intensity, pressure pain threshold values, and TMD severity, they were not found with other variables. These parameters were also predictive factors for MMA of both muscles (p < 0.05). CONCLUSIONS According to the present study, pain intensity, muscle and joint tenderness, and the severity of the disorder are predictive factors for MMA of the masseter and TA muscles in patients with mTMD. It is recommended that these parameters be considered when establishing clinical evaluation and treatment programs focusing on MMA in patients with mTMD. CLINICAL RELEVANCE The pain intensity, masticatory muscles and TMJ tenderness, and disorder severity are predictors for MMA of the masseter and TA in patients with mTMD. Pain intensity has the most significant importance.
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Affiliation(s)
- Nazım Tolgahan Yıldız
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Karamanoğlu Mehmetbey University, Karaman, Turkey.
| | - Hikmet Kocaman
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Karamanoğlu Mehmetbey University, Karaman, Turkey
| | - Hasan Yıldırım
- Kamil Özdağ Faculty of Science, Department of Mathematics, Karamanoğlu Mehmetbey University, Karaman, Turkey
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Chen TC, Lin CS. Neuroimaging meta-analysis of brain mechanisms of the association between orofacial pain and mastication. J Oral Rehabil 2023; 50:1070-1081. [PMID: 37252887 DOI: 10.1111/joor.13526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Temporomandibular disorders (TMD) are characterized by pain and impaired masticatory functions. The Integrated Pain Adaptation Model (IPAM) predicts that alterations in motor activity may be associated with increased pain in some individuals. The IPAM highlights the diversity of patients' responses to orofacial pain and suggests that such diversity is related to the sensorimotor network of the brain. It remains unclear whether the pattern of brain activation reflects the diversity of patients' responses underlying the association between mastication and orofacial pain. OBJECTIVE This meta-analysis aims to compare the spatial pattern of brain activation, as the primary outcome of neuroimaging studies, between studies of mastication (i.e. Study 1: mastication of healthy adults) and studies of orofacial pain (i.e. Study 2: muscle pain in healthy adults and Study 3: noxious stimulation of the masticatory system in TMD patients). METHODS Neuroimaging meta-analyses were conducted for two groups of studies: (a) mastication of healthy adults (Study 1, 10 studies) and (b) orofacial pain (7 studies), including muscle pain in healthy adults (Study 2) and noxious stimulation of the masticatory system in TMD patients (Study 3). Consistent loci of brain activation were synthesized using Activation Likelihood Estimation (ALE) with an initial cluster-forming threshold (p < .05) and a threshold of cluster size (p < .05, familywise error-corrected). RESULTS The orofacial pain studies have shown consistent activation in pain-related regions, including the anterior cingulate cortex and the anterior insula (AIns). A conjunctional analysis of mastication and orofacial pain studies showed joint activation at the left AIns, the left primary motor cortex and the right primary somatosensory cortex. CONCLUSION The meta-analytical evidence suggests that the AIns, as a key region in pain, interoception and salience processing, contributes to the pain-mastication association. These findings reveal an additional neural mechanism of the diversity of patients' responses underlying the association between mastication and orofacial pain.
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Affiliation(s)
- Ta-Chung Chen
- Division of Prosthodontics, Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Shu Lin
- Department of Dentistry, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
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Garstka AA, Kozowska L, Kijak K, Brzózka M, Gronwald H, Skomro P, Lietz-Kijak D. Accurate Diagnosis and Treatment of Painful Temporomandibular Disorders: A Literature Review Supplemented by Own Clinical Experience. Pain Res Manag 2023; 2023:1002235. [PMID: 36760766 PMCID: PMC9904928 DOI: 10.1155/2023/1002235] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/04/2022] [Accepted: 01/21/2023] [Indexed: 02/04/2023]
Abstract
Introduction Temporomandibular disorders (TMD) is a multifactorial group of musculoskeletal disorders often with combined etiologies that demand different treatment plans. While pain is the most common reason why patients decide to seek help, TMD is not always painful. Pain is often described by patients as a headache, prompting patients to seek the help of neurologists, surgeons, and ultimately dentists. Due to the unique characteristics of this anatomical area, appropriate diagnostic tools are needed, as well as therapeutic regimens to alleviate and/or eliminate the pain experienced by patients. Aim of the Study. The aim of this study is to collect and organize information on the diagnosis and treatment of pain in TMD, through a review of the literature supplemented by our own clinical experience. Material and Methods. The study was conducted by searching scientific databases PubMed, Scopus, and Google Scholar for documents published from 2002-2022. The following keywords were used to build the full list of references: TMD, pain, temporomandibular joint (TMJ), TMJ disorders, occlusal splint, relaxing splints, physiotherapy TMD, pharmacology TMD, natural therapy TMD, diagnostic criteria for TMD, and DC/TMD. The literature review included 168 selected manuscripts, the content of which was important for pain diagnosis and clinical treatment of TMD. Results An accurate diagnosis of TMD is the foundation of appropriate treatment. The most commonly described treatments include physiotherapy, occlusal splints therapy, and pharmacological treatment tailored to the type of TMD. Conclusions Based on the literature review and their own experience, the authors concluded that there is no single ideal form of pain therapy for TMD. Treatment of TMD should be based on a thorough diagnostic process, including the DC/TMD examination protocol, psychological evaluation, and cone beam computer tomography (CBCT) imaging. Following the diagnostic process, once a diagnosis is established, a treatment plan can be constructed to address the patient's complaints.
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Affiliation(s)
- Adam Andrzej Garstka
- Department of Propaedeutic, Physical Diagnostics and Dental Physiotherapy, Faculty of Medicine and Dentistry, Pomeranian Medical University, Szczecin, Poland
| | - Lidia Kozowska
- Student Scientific Society, Pomeranian Medical University, Szczecin, Poland
| | - Konrad Kijak
- Student Scientific Society, Medical University of Silesia, Zabrze, Poland
| | - Monika Brzózka
- Department of Propaedeutic, Physical Diagnostics and Dental Physiotherapy, Faculty of Medicine and Dentistry, Pomeranian Medical University, Szczecin, Poland
| | - Helena Gronwald
- Department of Propaedeutic, Physical Diagnostics and Dental Physiotherapy, Faculty of Medicine and Dentistry, Pomeranian Medical University, Szczecin, Poland
| | - Piotr Skomro
- Department of Propaedeutic, Physical Diagnostics and Dental Physiotherapy, Faculty of Medicine and Dentistry, Pomeranian Medical University, Szczecin, Poland
| | - Danuta Lietz-Kijak
- Department of Propaedeutic, Physical Diagnostics and Dental Physiotherapy, Faculty of Medicine and Dentistry, Pomeranian Medical University, Szczecin, Poland
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Tavares LF, Gadotti IC, Ferreira LM, Maciel ACC, Carvalho BG, Barbosa GS, Almeida EO, Ribeiro KF. Pain, deep neck flexors performance, disability, and head posture in individuals with temporomandibular disorder with and without otological complaints. J Back Musculoskelet Rehabil 2022; 36:465-475. [PMID: 36404529 DOI: 10.3233/bmr-220079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Otological complaints (OC) are highly prevalent in subjects with temporomandibular disorders (TMD) and so is the risk of neck dysfunctions. OBJECTIVE To evaluate pain, deep neck flexor (DNF) performance, disability, and head and neck posture of individuals with TMD with and without OC. METHODS In this cross-sectional study, 57 individuals were divided into a group with TMD and OC (n= 31) and a group with TMD without OC (n= 26). Self-reported pain intensity, masticatory and neck muscles pressure pain thresholds, DNF performance, neck disability, and head and neck posture were evaluated. Data were compared between groups using the independent t test and Mann-Whitney test with Bonferroni correction for multiple comparisons. Effect sizes were evaluated using Cohen's index. RESULTS The TMD with OC group presented less muscle activation [26 (24-28) vs. 24 (24-26) mmHg; p< 0.05], less endurance [105 (46-140) vs. 44 (28-78) points; p< 0.05], and greater neck disability (8.15 ± 5.89 vs. 13.32 ± 6.36 points; p< 0.05). No significant difference was observed in self-reported pain, head and neck posture, or pressure pain thresholds. CONCLUSION Individuals with TMD with OC presented decreased DNF performance and increased neck disability compared to individuals with TMD without OC.
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Affiliation(s)
- Luiz Felipe Tavares
- Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brasil
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10
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Cleary J, Coombes BK, Hodges P, Tucker K. Motor Unit Recruitment is Altered When Acute Experimental Pain is Induced at a Site Distant to the Contracting Muscle. Neuroscience 2022; 496:141-151. [PMID: 35710065 DOI: 10.1016/j.neuroscience.2022.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/29/2022]
Abstract
Acute pain alters motor unit discharge properties in muscles that are painful or influence loading of painful structures. Less is known about the changes in discharge when pain is induced in distant tissues that are unable or have limited capacity to modify the load of the contracting muscle. We aimed to determine whether acute experimental pain alters quadriceps motor unit discharge when pain is induced in; (i) a muscle that is unlikely to be mechanically influenced by modified quadriceps activity (tibialis anterior: TA), or (ii) the antagonist muscle (biceps femoris: BF). Using a within-subject design, 16 adults performed force-matched isometric knee extension during pain-free control conditions, and trials after painful hypertonic saline injections into TA or BF. Surface and intramuscular electromyography recordings were made. Despite maintained force, discharge rate of quadriceps motor units was lower during Pain than Control conditions for TA and BF trials (both P < 0.001). Redistribution of motor unit activity was observed; some units were recruited in control or pain but not both. As modified quadriceps motor unit discharge has limited/no potential to modify load in the painful tissue to protect the painful part, the findings might support an alternative hypothesis that activity is redistributed to larger motor units.
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Affiliation(s)
- Jennifer Cleary
- The University of Queensland, School of Biomedical Sciences, Brisbane, Queensland, Australia
| | - Brooke K Coombes
- The University of Queensland, School of Biomedical Sciences, Brisbane, Queensland, Australia; Griffith University, School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Paul Hodges
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
| | - Kylie Tucker
- The University of Queensland, School of Biomedical Sciences, Brisbane, Queensland, Australia.
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Tavares LF, Gadotti IC, Carvalho BG, Fernandes APM, Padilha Silva J, Barbosa GAS, Almeida EO, Ribeiro KF. Are neck pain, disability, and deep neck flexor performance the same for the different types of temporomandibular disorders? Cranio 2022:1-9. [PMID: 35300577 DOI: 10.1080/08869634.2022.2052582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate neck pain, disability, and deep neck flexor (DNF) performance of individuals with temporomandibular disorders (TMD). METHODS Eighty individuals were divided into the following: arthrogenic TMD (n = 40), myogenic TMD (n = 12), and mixed TMD (n = 28). Neck pain intensity, neck disability, and DNF performance were evaluated. RESULTS Individuals with arthrogenic TMD reported lower intensity of neck pain when compared to mixed TMD (p = 0.01). Individuals with arthrogenic TMD had less neck disability than individuals with myogenic TMD (p = 0.037) and mixed TMD (p < 0.001). A moderate positive correlation was found between neck pain and neck disability (p < 0.001). No differences were found for DNF performance. CONCLUSION Neck pain and disability differs according to subtype of TMD, but performance of the deep neck flexors does not. Neck pain intensity and neck disability were correlated in patients with TMD.
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Affiliation(s)
- Luiz Felipe Tavares
- Department of Physical Therapy, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Inae Caroline Gadotti
- Department of Physical Therapy, Florida International University, Miami, FL, United States
| | | | | | - Jade Padilha Silva
- Department of Physical Therapy, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
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12
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Szyszka-Sommerfeld L, Sycińska-Dziarnowska M, Budzyńska A, Woźniak K. Accuracy of Surface Electromyography in the Diagnosis of Pain-Related Temporomandibular Disorders in Children with Awake Bruxism. J Clin Med 2022; 11:1323. [PMID: 35268414 PMCID: PMC8911396 DOI: 10.3390/jcm11051323] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/20/2022] [Accepted: 02/26/2022] [Indexed: 12/27/2022] Open
Abstract
The study assessed masticatory muscle electromyographic (EMG) activity in both children diagnosed with pain-related temporomandibular disorders (TMD-P) and awake bruxism (AB) and in children without TMD, as well as the diagnostic value of surface electromyography (sEMG) in diagnosing TMD-P in subjects with AB. After evaluation based on the Axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), 30 children diagnosed with myofascial pain were included in the myofascial pain group and 30 children without TMD diagnosis comprised the control group (mean age of 9.49 ± 1.34 years). The activity of the anterior temporal (TA) and masseter (MM) muscle was assessed bilaterally using a DAB-Bluetooth device (zebris Medical GmBH, Germany) at rest and during maximum voluntary clenching (MVC). The receiver operating characteristic (ROC) curve was used to determine the accuracy, sensitivity, and specificity of the normalized sEMG data. Statistically significant intergroup differences were observed in TA and MM muscle EMG activity at rest and during MVC. Moderate degree of sEMG accuracy in discriminating between TMD-P and non-TMD children was observed for TAmean, left MM, and MMmean EMG muscle activity at rest. sEMG can be a useful tool in assessing myofascial TMD pain in patients with AB.
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Affiliation(s)
- Liliana Szyszka-Sommerfeld
- Department of Orthodontics, Pomeranian Medical University in Szczecin, Al. Powst. Wlkp. 72, 70-111 Szczecin, Poland; (M.S.-D.); (A.B.); (K.W.)
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13
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Böthun A, Häggman-Henrikson B, Wiesinger B, Wänman A, Hellström F, Österlund C. Jaw-neck motor strategy during jaw-opening with resistance load. J Oral Rehabil 2021; 49:514-521. [PMID: 34878690 DOI: 10.1111/joor.13291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/23/2021] [Accepted: 12/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The jaw and neck motor systems have a close functional integration but the effect of resistance load to the mandible during jaw opening on the jaw-neck integration is not known. OBJECTIVES To evaluate the effect of resistance load compared to no load on integrated jaw and neck motor function in individuals free from pain and dysfunction in the jaw and neck regions. METHODS Jaw and head movements during continuous jaw opening were recorded with an optoelectronic system (MacReflex® ) in 26 pain-free individuals (14 women, 12 men, mean age 22 years). Jaw opening was performed with and without resistance load (1600 g) to the mandible. The relationship between jaw movement amplitude, head movement amplitude, head/jaw ratio (quotient of head and jaw movement amplitude) and resistance load were modelled using linear mixed-model analysis. A p-value <.05 was considered statistically significant. RESULTS The expected head/jaw ratio mean was increased by 0.05 (95% CI: 0.03, 0.08, p < .001) with resistance load as compared to no load. This corresponds to an increase in expected mean by 55.6%. With resistance load, expected mean head movement amplitude increased by 1.4 mm (95% CI: 0.2, 2.5, p = .018), and expected mean jaw movement amplitude decreased by 3.7 mm (95% CI: -7.0, -0.5, p = .025). CONCLUSION There is a compensation and adaptation of integrated jaw-neck motor function with an altered jaw-neck motor strategy during jaw opening with resistance load compared to no load. The head/jaw ratio demonstrates increased proportional involvement of the neck during increased load on the jaw system.
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Affiliation(s)
- Alicia Böthun
- Department of Odontology, Clinical Oral Physiology, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Birgitta Häggman-Henrikson
- Department of Odontology, Clinical Oral Physiology, Faculty of Medicine, Umeå University, Umeå, Sweden.,Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Birgitta Wiesinger
- Department of Odontology, Clinical Oral Physiology, Faculty of Medicine, Umeå University, Umeå, Sweden.,Department of Research and Development, Umeå University, Sundsvall, Sweden
| | - Anders Wänman
- Department of Odontology, Clinical Oral Physiology, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Fredrik Hellström
- Department of Occupational Health Science and Psychology, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| | - Catharina Österlund
- Department of Odontology, Clinical Oral Physiology, Faculty of Medicine, Umeå University, Umeå, Sweden
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14
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Beecroft EV, Penlington C, Allison JR, Palmer J, Durham J. Pharmacological interventions for painful persistent temporomandibular disorders (TMD). Hippokratia 2021. [DOI: 10.1002/14651858.cd014919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Chris Penlington
- School of Dental Sciences; Newcastle University; Newcastle upon Tyne UK
| | - James R Allison
- School of Dental Sciences; Newcastle University; Newcastle upon Tyne UK
| | - Julia Palmer
- School of Dental Sciences; Newcastle University; Newcastle upon Tyne UK
| | - Justin Durham
- School of Dental Sciences; Newcastle University; Newcastle upon Tyne UK
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15
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Effects of Therapeutic and Aerobic Exercise Programs on Pain, Neuromuscular Activation, and Bite Force in Patients with Temporomandibular Disorders. J Pers Med 2021; 11:jpm11111170. [PMID: 34834522 PMCID: PMC8623244 DOI: 10.3390/jpm11111170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 02/05/2023] Open
Abstract
Pain in masticatory muscles is one of the most frequent symptoms in patients with temporomandibular disorders (TMD) and can lead to changes in the patterns of neuromuscular activity of masticatory muscles and decrease in bite force. This study assesses the effects of three eight-week exercise programs on pain intensity, neuromuscular activation, and bite force of masticatory muscles in patients with TMD. Forty-five patients were divided into three groups: a therapeutic exercise program (G1), a therapeutic and aerobic exercise program (G2), and an aerobic exercise program (G3). The masticatory muscles’ pain was evaluated using the numeric pain rating scale (NPRS), surface electromyographic (sEMG) activity of the masseter was recorded during maximum voluntary contraction and at rest, and bite force was evaluated using a dynamometer. These parameters were evaluated twice at baseline (A01/A02), at the end of the eight-week intervention period (A1), and 8–12 weeks after the end of the intervention (A2). After intervention, G2 showed the best results, with a significantly decrease in masticatory muscles’ pain and increase in bite force. These results suggest that interventions to reduce pain in patients with TMD should be multimodal.
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16
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Muscle Activity Before and After Subacromial Injection. J Sport Rehabil 2021; 30:1144-1150. [PMID: 34470910 DOI: 10.1123/jsr.2020-0524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/20/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Shoulder muscle activation in patients with subacromial impingement is highly cited and variable in the literature. Differences between studies could be due to artifacts introduced by normalization practices in the presence of pain. Ultimately, this lack of knowledge pertaining to pathogenesis limits the clinical treatment and restoration of muscular function. DESIGN A total of 21 patients with stage 2 subacromial impingement and 21 matched controls were recruited for EMG testing of their affected shoulder during an arm elevation task. The patients were tested before and after receiving an injection to their subacromial bursa. METHODS The EMG from 7 shoulder muscles were measured before and after treatment during humeral motion in the scapular plane. RESULTS Our findings indicate an increase in anterior deltoid, middle deltoid, and upper trapezius activity following the injection; further, this trend extended to the controls. The control subjects had a greater activation of the latissimus dorsi at peak arm elevation when compared with the patient group postinjection. CONCLUSIONS Our results indicate that a reduction in subacromial pain is associated with changes in shoulder muscle recruitment, primarily of the deltoid. This change in deltoid activity may lend evidence to rotator cuff function in patients without rotator cuff tears.
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Cortical thickness, gyrification and sulcal depth in trigeminal neuralgia. Sci Rep 2021; 11:16322. [PMID: 34381144 PMCID: PMC8357824 DOI: 10.1038/s41598-021-95811-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/31/2021] [Indexed: 01/03/2023] Open
Abstract
Neuroimaging studies have documented brain structural alterations induced by chronic pain, particularly in gray matter volume. However, the effects of trigeminal neuralgia (TN), a severe paroxysmal pain disorder, on cortical morphology are not yet known. In this study, we recruited 30 TN patients and 30 age-, and gender-matched healthy controls (HCs). Using Computational Anatomy Toolbox (CAT12), we calculated and compared group differences in cortical thickness, gyrification, and sulcal depth with two-sample t tests (p < 0.05, multiple comparison corrected). Relationships between altered cortical characteristics and pain intensity were investigated with correlation analysis. Compared to HCs, TN patients exhibited significantly decreased cortical thickness in the left inferior frontal, and left medial orbitofrontal cortex; decreased gyrification in the left superior frontal cortex; and decreased sulcal depth in the bilateral superior frontal (extending to anterior cingulate) cortex. In addition, we found significantly negative correlations between the mean cortical thickness in left medial orbitofrontal cortex and pain intensity, and between the mean gyrification in left superior frontal cortex and pain intensity. Chronic pain may be associated with abnormal cortical thickness, gyrification and sulcal depth in trigeminal neuralgia. These morphological changes might contribute to understand the underlying neurobiological mechanism of trigeminal neuralgia.
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Shafira M, Maulina T, Lyana NP, Sjamsudin E, Hardianto A. The Correlation between Pain, Stress, and Oral Function in Oral and Maxillofacial Infection and Trauma Patients. Open Dent J 2021. [DOI: 10.2174/1874210602115010266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
The relationship between stress and acute pain has been documented in previous studies. Yet, very few studies have evaluated the relationship between stress and acute orofacial pain and its impact on jaw functional activities.
Objective:
The objective of the current study was to evaluate the correlation between acute orofacial pain, stress, and the limitation of the jaw and facial activities in oral and maxillofacial infection and oral and maxillofacial trauma patients.
Methods:
The current study recruited 50 (16 male, 34 female) patients from the Emergency Unit of the Ujung Berung Hospital, Bandung Indonesia. Twenty-five patients were those who had oral and maxillofacial trauma, and the rest were those who had an oral and maxillofacial infection. The patient’s stress level was evaluated by measuring their salivary alpha-amylase level, the pain level was measured by using the numeric rating scale (NRS), whilst the limitation of the jaw and facial activities was measured by using the Jaw and Facial Activities Limitation (JFAL) Questionnaire. All data were analysed using the Spearman correlation test.
Results:
Based on the analysis, it was revealed that there was no significant correlation (r = 0.176, p= 0.22) between stress and pain level. When associated with jaw and facial activities limitation, there was a significant positive correlation (r = 0.555, p < 0.01) found between pain level and jaw and facial activity limitation.
Conclusion:
The current study concluded that there was a significant positive correlation found between pain and jaw activity limitation on oral and maxillofacial infection and trauma patients.
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19
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Novel Functional Indices of Masticatory Muscle Activity. J Clin Med 2021; 10:jcm10071440. [PMID: 33916147 PMCID: PMC8036463 DOI: 10.3390/jcm10071440] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 12/13/2022] Open
Abstract
The aim of the present study was to analyze novel functional indices of masticatory muscle activity and compare them to existing and commonly used indices in patients with temporomandibular disorders (TMDs) and healthy adults. Based on the Research Diagnostic Criteria for Temporomandibular Disorders, 78 adult women qualified for the study. Subjects were divided into two groups: diagnosed TMDs (n = 36; mean age: 23.4 ± 2.6 years) and healthy adults (n = 42; mean age: 22.4 ± 2.3 years). Measurements of the bioelectric activity of the temporalis anterior (TA), superficial masseter (MM), and anterior bellies of the digastric muscle (DA) were carried out using the BioEMG III ™. Functional Clenching (FCI) and Functional Opening (FOI) indices were obtained as the ratio of the difference between the mean muscle root mean square (RMS) potentials during functional activity, including clenching (CL) and opening (MMO), and mean muscle resting (REST) potentials. Next, based on FCI and FOI indices, the Functional Clenching Activity Index (FCAI), Functional Clenching Symmetry Index (FCSI), and Functional Opening Symmetry Index (FOSI) were obtained. The statistical analysis showed significant differences in activity index left-sided (AcIL) and Activity index both-sided (AcItot) between TMDs and healthy women during rest measurements. The significant differences between both groups were noted in terms of all Functional Clenching Indices except Functional Clenching Index for MM right-sided (FCIMM-R). In all analyzed FCI indices, the control group showed higher values compared to the TMDs. Moreover, a significant difference between TMDs and controls was observed within Functional Clenching Activity Index left-sided (FCAIL) (14.56 vs. −0.45, p = 0.01). Both functional indices, and asymmetry (AsI) and activity (AcI) indices seem to be reliable in assessing symmetry and activity within masticatory muscles. Further studies should be performed to verify the effectiveness and suitability of the assessment of masticatory muscles using functional indices.
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20
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Electromyographic Patterns of Masticatory Muscles in Relation to Active Myofascial Trigger Points of the Upper Trapezius and Temporomandibular Disorders. Diagnostics (Basel) 2021; 11:diagnostics11040580. [PMID: 33805008 PMCID: PMC8063936 DOI: 10.3390/diagnostics11040580] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/08/2021] [Accepted: 03/20/2021] [Indexed: 01/04/2023] Open
Abstract
The presented study aimed to analyze and compare the electromyographic patterns of masticatory muscles in subjects with active myofascial trigger points (MTrPs) within upper trapezius, patients with temporomandibular disorders (TMDs) and healthy adults. Based on the diagnostic criteria of MTrPs according to Travell & Simons and the Research Diagnostic Criteria for Temporomandibular Disorders, 167 people were qualified for the study. Subjects were divided into 3 groups: with active MTrPs in the upper trapezius, with diagnosed temporomandibular disorders (TMDs) and healthy adults. Measurements of the bioelectric activity of the temporalis anterior (TA) and masseter muscle (MM) were carried out using the BioEMG III ™. Based on statistical analysis, significantly lower values of TA resting activity were observed among controls in comparison to MTrPs (1.49 μV vs. 2.81 μV, p = 0.00) and TMDs (1.49 μV vs. 2.97 μV, p = 0.01). The POC index values at rest differed significantly between MTrPs and TMDs (86.61% vs. 105%, p = 0.04). Controls presented different electromyographic patterns within AcI in comparison to both MTrPs (4.90 vs. −15.51, p = 0.00) and TMDs (4.90 vs. −16.49, p = 0.00). During clenching, the difference between MTrPs and TMDs was observed within MVC TA (91.82% vs. 116.98%, p = 0.02). TMDs showed differences within AcI in comparison to both MTrPs group (−42.52 vs. 20.42, p = 0.01) and controls (−42.52 vs. 3.07, p = 0.00). During maximum mouth opening, differences between MTrPs and TMDs were observed within the bioelectric activity of masseter muscle (16.45 μV vs. 10.73 μV, p = 0.01), AsI MM (0.67 vs. 11.12, p = 0.04) and AcI (13.04 vs. −3.89, p = 0.01). Both the presence of MTrPs in the upper trapezius and TMDs are related to changes in electromyographic patterns of masticatory muscles.
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21
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MRI characteristics of the asymptomatic temporomandibular joint in patients with unilateral temporomandibular joint disorder. Oral Radiol 2020; 37:469-475. [PMID: 32946019 DOI: 10.1007/s11282-020-00483-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the association between unilateral temporomandibular joint disorder (TMD) and the presence of imaging abnormalities in the contralateral, asymptomatic joint. METHODS MRI studies of 219 subjects with symptoms of unilateral TMD were examined for signs of disc displacement, osteoarthritis, disc deformation, and effusion in both temporomandibular joints (TMJ). The Chi-Square test and stepwise logistic regression analysis were performed. RESULTS Disc displacement, osteoarthritis, disc deformation, and effusion were more common on the symptomatic side. However, in the category of disc displacement with a reduction in open mouth position (DDWR), the difference was not significant between the symptomatic and the asymptomatic TMJs. Stepwise logistic regression showed that the presence of any imaging abnormality other than DDWR was related to osteoarthritis and disc deformity on the symptomatic side. On the other hand, the presence of any MRI abnormality (including DDWR) on the asymptomatic side was related only to the presence of osteoarthritis on the symptomatic side. CONCLUSIONS Unilateral symptomatic TMD is related to the presence of imaging abnormalities on the contralateral, asymptomatic side, suggesting that the development and progression of joint changes in symptomatic and contralateral asymptomatic TMJs are interrelated.
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22
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Ichinohe T, Akiike Y, Saito N, Koike M, Koshika K, Matsuura N. Effects of Stellate Ganglion Blockade on Muscle Blood Flow During Hypercapnia. Anesth Prog 2020; 67:135-139. [PMID: 32992330 DOI: 10.2344/anpr-67-01-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/27/2019] [Indexed: 11/11/2022] Open
Abstract
This study investigated the effects of a unilateral stellate ganglion block (SGB) on ipsilateral and contralateral masseter muscle blood flow during permissive hypercapnia. Eight male Japanese white rabbits were anesthetized with isoflurane. Observed variables included heart rate (HR), blood pressure (BP), left common carotid artery blood flow (LCBF), left and right masseter muscle tissue blood flow (LMBF and RMBF), and left femoral quadriceps muscle tissue blood flow (LQBF). Variable measurements were taken at a baseline end-tidal carbon dioxide tension (EtCO2) of 40 mm Hg and repeated at an elevated EtCO2 of 60 mm Hg prior to and after administration of a left SGB. HR decreased, while systolic BP was elevated during hypercapnia and after the SGB. LCBF increased during hypercapnia and after the SGB. LMBF and RMBF decreased to 75% and LQBF decreased to 60% of their respective baseline values during hypercapnia. After the SGB, LMBF was restored, reapproximating its baseline, but RMBF and LQBF further decreased to 55 and 45% of their respective baseline values. In conclusion, unilateral SGB restored the ipsilateral masseter muscle blood flow that had been reduced during hypercapnia. In contrast, the SGB exacerbated the hypercapnia-induced reduction in blood flows in the contralateral masseter muscle and the femoral quadriceps muscle.
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Affiliation(s)
- Tatsuya Ichinohe
- Professor and Chairman, Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan
| | - Yui Akiike
- Senior Assistant Professor, Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan
| | - Natsuki Saito
- Postgraduate Student, Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan
| | - Masato Koike
- Assistant Professor, Department of Dentistry and Oral Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kyotaro Koshika
- Senior Assistant Professor, Department of Anesthesiology, Ichikawa General Hospital, Tokyo Dental College, Tokyo, Japan
| | - Nobuyuki Matsuura
- Associate Professor, Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan
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Clemente MP, Mendes J, Moreira A, Ferreira AP, Amarante JM. Craniofacial morphology of wind and string instrument players: a cephalometric study. BMC Med Imaging 2020; 20:57. [PMID: 32456620 PMCID: PMC7249404 DOI: 10.1186/s12880-020-00455-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 05/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background Playing an instrument may promote a parafunctional behavior within the cranio-cervical-mandibular-complex with unknown repercussions. The aim of this study was to find any association between the dental inter-arch relationship and the practice of a wind or string instrument. Methods A sample of 77 musicians, divided in two groups of wind (n = 50) and string instrumentalists (n = 27), had a lateral cephalogram taken to compare six cephalometric parameters following the Rickett’s analysis (maxilla position, mandible position, facial type, skeletal class, upper incisor and lower incisor inclination). The Fisher test was performed to compare, with a 95% statistical confidence, if both groups have similar frequency distributions for each cephalometric parameter. Results No statistical differences were found for the maxilla position, mandible position, facial type, skeletal class and upper incisor inclination. Statistical differences were found for the lower incisor inclination (p = 0.011). Conclusions Playing a wind instrument showed to have little orthopaedic influence at the craniofacial morphology, on contrary it may influence the lower incisor inclination with its osseous base.
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Affiliation(s)
- Miguel Pais Clemente
- Department of Surgery, Faculty of Medicine, INEGI, Labiomep, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Joaquim Mendes
- Department of Mechanics, Faculty of Engineering, University of Porto, R. Dr. Roberto Frias, 4200-465, Porto, Portugal
| | - André Moreira
- Speacialization Student in Oral Rehabilitation, Faculty of Dental Medicine, University of Porto, 392, R. Dr. Manuel Pereira da Silva, Porto, Portugal.
| | - Afonso Pinhão Ferreira
- Department of Orthodontics, Faculty of Dental Medicine, University of Porto, 392, R. Dr. Manuel Pereira da Silva, Porto, Portugal
| | - José Manuel Amarante
- Department of Surgery, Faculty of Medicine, INEGI, Labiomep, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
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Zhang Y, Zhang J, Wang L, Wang K, Svensson P. Effect of transcutaneous electrical nerve stimulation on jaw movement-evoked pain in patients with TMJ disc displacement without reduction and healthy controls. Acta Odontol Scand 2020; 78:309-320. [PMID: 31876451 DOI: 10.1080/00016357.2019.1707868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Transcutaneous electrical nerve stimulation (TENS) may serve as non-invasive intervention for painful temporomandibular disorders (TMD) to improve jaw motor function, but its efficacy is still debated. This parallel study evaluated the effect of TENS on pain and movement patterns after repeated jaw movements in patients with painful temporomandibular joints (TMJ) and disc displacement without reduction (DDwoR), and compared with healthy controls.Material and Methods: 20 patients with TMJ pain and DDwoR and 20 age- and gender-matched healthy volunteers were randomly assigned to TENS/sham TENS (sTENS) intervention groups in a block design (10 in each group). Participants performed 20 repeated jaw movements (4 x 5 sessions), and reported pain intensity on a 0-10 Numerical Rating Scale (NRS) subsequently both before and after the intervention. Data were tested by repeated measures analysis of variance (ANOVA).Results: Significant increase of pain intensity and reduction of opening range were shown within repeated jaw movements in TMJ pain patients in contrast to healthy participants (p ≤ .001). Pain was significantly reduced during repeated open-close (p = .007), fast open-close (p = .016) and horizontal movements (p = .023), accompanied with increased opening range (p = .033) and open-close velocity (p = .019) with TENS intervention when compared with sTENS group (p > .05) in TMJ pain patients.Conclusions: This study indicated that movement-evoked pain was reduced either spontaneously or by sTENS in TMJ pain patients with DDwoR, and interestingly, that TENS could attenuate movement-evoked pain and improve jaw motor function during repeated jaw movements. The findings may have implications for TENS treatment in TMJ pain patients with DDwoR.
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Affiliation(s)
- Yuanxiu Zhang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China
- Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
- Orofacial Pain & TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Jinglu Zhang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China
- Orofacial Pain & TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Lin Wang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China
- Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
- Orofacial Pain & TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Kelun Wang
- Orofacial Pain & TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
- Center for Sensory-Motor Interaction (SMI), Aalborg University, Aalborg, Denmark
| | - Peter Svensson
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
- Faculty of Odontology, Malmö University, Malmö, Sweden
- Scandinavian Center for Orofacial Neurosciences, (SCON), Aarhus, Denmark
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25
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Cho GH, Lee Y. Analysis of Masticatory Muscle Activity Based on Presence of Temporomandibular Joint Disorders. Med Sci Monit 2020; 26:e921337. [PMID: 32153300 PMCID: PMC7083083 DOI: 10.12659/msm.921337] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Gi-Hoon Cho
- Department of Physical Therapy, College of Health Science and Social Welfare, Sahmyook University, Seoul, South Korea
| | - Yongwoo Lee
- Department of Physical Therapy, College of Health Science and Social Welfare, Sahmyook University, Seoul, South Korea
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Abstract
BACKGROUND Temporomandibular disorders (TMDs) are typically characterized by pain in the masticatory muscles and temporomandibular joints (TMJs) and by limitation of mandibular mobility. In June 2019, the German Society of Craniomandibular Function and Disorders presented a screening tool to identify individuals with TMDs. The assessment tool consists of patient history (three questions related to jaw pain, one question related to impaired mandibular mobility) and a clinical examination (palpation of masticatory muscles and TMJs; evaluation of maximum jaw opening; assessment of the presence of occlusal disturbances; documentation of TMJ noises). OBJECTIVES The present article focusses on two questions: (1) Which of the nine parts of the tool are appropriate, and which are not? (2) In general, can screening for TMDs be recommended? CONCLUSION While the anamnestic questions, as well as the assessment of maximum mandibular opening, reflect the clinically relevant symptoms and signs of TMD patients, the remaining four clinical measures do not. Furthermore, TMD screening for painful TMDs appears unnecessary because patients suffering from orofacial pain and/or restricted mandibular mobility are likely to consult a therapist by themselves. Therefore, the use of this screening tool may lead to overdiagnosis, possibly resulting in nonindicated diagnostic and therapeutic measures.
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Merkle SL, Sluka KA, Frey-Law LA. The interaction between pain and movement. J Hand Ther 2020; 33:60-66. [PMID: 30025839 PMCID: PMC6335190 DOI: 10.1016/j.jht.2018.05.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/14/2018] [Accepted: 05/05/2018] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Clinical commentary. INTRODUCTION/PURPOSE Pain and movement are universally relevant phenomena that influence human experiences in readily observable ways. Improved understanding of pain-movement relationships can guide medical and rehabilitative approaches to recovery and decrease risk of dysfunctional long-term consequences of otherwise normal neuromuscular responses. Therefore, the overall intent of this article is to elucidate the relationships between pain and movement as they relate to clinical decision making. CONCLUSIONS Motor output is highly adaptable, can be influenced by multiple mechanisms at various levels along the nervous system, and may vary between individuals despite similar diagnoses. Therefore, interventions need to be individualized and consider both the types of motor response observed (ie, whether the response is protective or maladaptive), and the patient's acute physical activity tolerance when prescribing exercise/movement.
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Affiliation(s)
- Shannon L Merkle
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA; Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, MA, USA.
| | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | - Laura A Frey-Law
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
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Valentino R, Cioffi I, Vollaro S, Cimino R, Baiano R, Michelotti A. Jaw muscle activity patterns in women with chronic TMD myalgia during standardized clenching and chewing tasks. Cranio 2019; 39:157-163. [DOI: 10.1080/08869634.2019.1589703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Roberta Valentino
- Department of Neuroscience, Reproductive Sciences and Oral Sciences, University of Naples “Federico II”, Naples, Italy
| | - Iacopo Cioffi
- Faculty of Dentistry, University of Toronto Centre for the study of Pain, Toronto, ON, Canada
| | - Stefano Vollaro
- Department of Neuroscience, Reproductive Sciences and Oral Sciences, University of Naples “Federico II”, Naples, Italy
| | - Roberta Cimino
- Department of Neuroscience, Reproductive Sciences and Oral Sciences, University of Naples “Federico II”, Naples, Italy
| | - Roberta Baiano
- Department of Neuroscience, Reproductive Sciences and Oral Sciences, University of Naples “Federico II”, Naples, Italy
| | - Ambrosina Michelotti
- Department of Neuroscience, Reproductive Sciences and Oral Sciences, University of Naples “Federico II”, Naples, Italy
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Szyszka-Sommerfeld L, Machoy M, Lipski M, Woźniak K. The Diagnostic Value of Electromyography in Identifying Patients With Pain-Related Temporomandibular Disorders. Front Neurol 2019; 10:180. [PMID: 30891001 PMCID: PMC6411686 DOI: 10.3389/fneur.2019.00180] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/12/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Orofacial pain disorders can be divided into several subgroups. One of them is temporomandibular disorders (TMD) with recognizable signs such as joint noises, limitations in the range of motion, or mandibular deviation during function and symptoms-pain in the muscles or joint. Surface electromyography (sEMG) is a diagnostic tool that ensures reliable and valid evaluation of muscle activity. sEMG detects electrical potentials and on this account may conceivably be employed in the TMD recognition. The aim of this study was to assess the sensitivity, specificity, and accuracy of electromyography in diagnosing subjects with temporomandibular disorders, including pain-free TMD and pain-related TMD. Methods: The sample comprised 88 patients with cleft lip and palate and mixed dentition. TMD has been recognized on the grounds of Axis I of the Research Diagnostic Criteria for TMD (RDC/TMD). To evaluate the electrical activity of the temporal and masseter muscles in the rest position and during maximum voluntary contraction, a DAB-Bluetooth Instrument (Zebris Medical GmbH, Germany) was used. The analysis of the receiver operating characteristic (ROC) curve gave information about accuracy, cut-off point value, sensitivity and specificity of the normalized sEMG data. Results: The highest diagnostic efficiency of sEMG in terms of identifying subjects with TMD and pain-related TMD was observed for the mean values of temporal and masseter muscle activity as well as the Asymmetry Index of the masseter muscles in a rest position. A moderate degree of EMG accuracy in differentiating between pain-related TMD and non-TMD children was observed for the mean values of masseter muscle activity and the Asymmetry Index of the masseter muscles at rest. Conclusion: An evaluation of electromyography exhibits its diagnostic usability in recognition of patients with pain-related TMD and it could be used as an adjunctive tool in the identification of this disorder. Clinical Trial Registration: This clinical research was registered in the ClinicalTrials.gov database under the number NCT03308266.
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Affiliation(s)
| | - Monika Machoy
- Department of Orthodontics, Pomeranian Medical University, Szczecin, Poland
| | - Mariusz Lipski
- Department of Preclinical Conservative Dentistry and Preclinical Endodontics, Pomeranian Medical University, Szczecin, Poland
| | - Krzysztof Woźniak
- Department of Orthodontics, Pomeranian Medical University, Szczecin, Poland
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Multivariate pattern classification of brain white matter connectivity predicts classic trigeminal neuralgia. Pain 2019; 159:2076-2087. [PMID: 29905649 DOI: 10.1097/j.pain.0000000000001312] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Trigeminal neuralgia (TN) is a severe form of chronic facial neuropathic pain. Increasing interest in the neuroimaging of pain has highlighted changes in the root entry zone in TN, but also group-level central nervous system gray and white matter (WM) abnormalities. Group differences in neuroimaging data are frequently evaluated with univariate statistics; however, this approach is limited because it is based on single, or clusters of, voxels. By contrast, multivariate pattern analyses consider all the model's neuroanatomical features to capture a specific distributed spatial pattern. This approach has potential use as a prediction tool at the individual level. We hypothesized that a multivariate pattern classification method can distinguish specific patterns of abnormal WM connectivity of classic TN from healthy controls (HCs). Diffusion-weighted scans in 23 right-sided TN and matched controls were processed to extract whole-brain interregional streamlines. We used a linear support vector machine algorithm to differentiate interregional normalized streamline count between TN and HC. This algorithm successfully differentiated between TN and HC with an accuracy of 88%. The structural pattern emphasized WM connectivity of regions that subserve sensory, affective, and cognitive dimensions of pain, including the insula, precuneus, inferior and superior parietal lobules, and inferior and medial orbital frontal gyri. Normalized streamline counts were associated with longer pain duration and WM metric abnormality between the connections. This study demonstrates that machine-learning algorithms can detect characteristic patterns of structural alterations in TN and highlights the role of structural brain imaging for identification of neuroanatomical features associated with neuropathic pain disorders.
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Kim SY, Oh JS. Scapula muscle exercises using the Neurac technique for a patient after radical dissection surgery: a case report. Physiother Theory Pract 2019; 36:1485-1492. [PMID: 30664395 DOI: 10.1080/09593985.2019.1566940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: After radical neck dissection, spinal accessory nerve damage can result in scapular muscle weakness, which causes shoulder pain, dysfunction, and a limited range of motion (ROM); scapular muscle strengthening exercises are used to reduce these symptoms. This report focuses on the importance of trapezius and serratus anterior strength exercises to reduce symptoms after radical neck dissection. Case Description: The patient was a 30-year-old female who had received radical neck dissection 3 years previously. She complained of shoulder pain, dysfunction, and limited ROM during shoulder elevation. Outcome: She was successfully treated by increasing trapezius and serratus anterior strength and improving pain, function, and range of motion by applying the Neurac technique for 12 weeks. Further controlled studies are required to identify the generalizability of these findings.
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Affiliation(s)
- Soo-Yong Kim
- Department of Physical Therapy, Pusan National University Yangsan Hospital , Yangsan, South Korea
| | - Jae-Seop Oh
- Department of Physical Therapy, College of Biomedical Science and Engineering, INJE University , Gimhae, South Korea
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32
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Bajramaj E, Häggman-Henrikson B, Dawson A, Gerdle B, Ghafouri B. The Effect of Microdialysis Catheter Insertion on Glutamate and Serotonin Levels in Masseter Muscle in Patients with Myofascial Temporomandibular Disorders and Healthy Controls. Diagnostics (Basel) 2019; 9:diagnostics9010014. [PMID: 30678220 PMCID: PMC6468744 DOI: 10.3390/diagnostics9010014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/09/2019] [Accepted: 01/19/2019] [Indexed: 11/16/2022] Open
Abstract
Myofascial temporomandibular disorders (TMD) are the most common cause of chronic pain in the orofacial region. Microdialysis has been used to study metabolic changes in the human masseter muscle. The insertion of the microdialysis probe causes acute tissue trauma that could affect the metabolic milieu and thereby influence the results when comparing healthy subjects to those with TMD. This study aimed to investigate the levels of serotonin and glutamate during the acute tissue trauma period in healthy subjects and in patients with TMD. Microdialysis was carried out in 15 patients with TMD and 15 controls, and samples were collected every 20 min during a period of 140 min. No significant alterations of serotonin or glutamate were observed over the 2 h period for the healthy subjects. For the TMD group, a significant decrease in serotonin was observed over time (p < 0.001), followed by a significant increase between 120 and 140 min (p < 0.001). For glutamate, a significant reduction was observed at 40 min compared to baseline. The results showed that there was a spontaneous increase of serotonin 2 h after the insertion of the catheter in patients with TMD. In conclusion, the results showed that there are differences in the masseter muscle levels of serotonin and glutamate during acute nociception in patients with myofascial TMD compared to healthy subjects.
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Affiliation(s)
- Ermira Bajramaj
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, 205 06 Malmö, Sweden.
| | - Birgitta Häggman-Henrikson
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, 205 06 Malmö, Sweden.
- Department of Odontology, Clinical Oral Physiology, Umeå University, 901 87 Umeå, Sweden.
| | - Andreas Dawson
- Centre for Oral Rehabilitation, Östergötland County Council, Linköping, 581 85 Norrköping, Sweden.
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, 581 85 Linköping, Sweden.
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, 581 85 Linköping, Sweden.
| | - Bijar Ghafouri
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, 581 85 Linköping, Sweden.
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Relation between Headache and Mastication Muscle Tone in Adolescents. Pain Res Manag 2018; 2018:7381973. [PMID: 30344802 PMCID: PMC6174730 DOI: 10.1155/2018/7381973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 08/29/2018] [Indexed: 11/18/2022]
Abstract
Headache is a common problem in the population, which decreases the quality of life and makes everyday functioning difficult. It often coexists with typical symptoms of temporomandibular disorders. The objective of the study was to clarify whether there is a relationship between the presence of headache in young volunteers and the mastication muscle tone. Material and Method. Volunteers aged 18 years who underwent general dental examination, clinical evaluation, and examination using the dual-axis diagnostic system Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) form in the Polish language version participated in the study. On the basis of the examination results, these individuals were divided into three groups according to RDC results. A group of healthy individuals (axis I value 0), a group of sick individuals (axis I diagnosis Ia, IIa, or IIIa), and a group of individuals suffering from depression (axis II values 1–3) were singled out. Then, volunteers were divided into two groups: group I reporting headache and group II without any pain. In each of these individuals, the contractile activity of the masseter muscles and anterior temporal muscles was recorded bilaterally as the surface electromyographic activity (sEMG) at rest, during swallowing, and maximum clenching. The activity index ranging between +100 (activity of the masseter muscles only) and −100 (activity of the anterior temporal muscles only) was used to indicate the predominance of activity of the study muscles. Results. The statistical analysis of data showed that there was a significant relationship between the presence of headache and a change in the mastication muscle tone, expressed as the predominant activity of the temporal muscles, only in the group of sick individuals during maximum clenching. Summary. The diversity of sEMG results implies that a change in the mastication muscle tone is not a direct consequence of headache, but it has to be modified by other factors.
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Tsai Y, Yuan R, Patel D, Chandrasekaran S, Weng H, Yang J, Lin C, Biswal BB. Altered structure and functional connection in patients with classical trigeminal neuralgia. Hum Brain Mapp 2018; 39:609-621. [PMID: 29105886 PMCID: PMC6866571 DOI: 10.1002/hbm.23696] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/10/2017] [Accepted: 06/13/2017] [Indexed: 12/26/2022] Open
Abstract
Classical trigeminal neuralgia (TN) is a specific type of neuropathic orofacial pain of which the plasticity of brain structure and connectivity have remained largely unknown. A total of 62 TN patients were included and referred to MRI scans. Voxel-based morphometry was used to analyze the change of gray matter volume. Resting-state functional imaging was used to analyze the connectivity between brain regions. The results showed gray matter volume reduction in components of the prefrontal cortex, precentral gyrus, cerebellar tonsil, thalamus, hypothalamus, and nucleus accumbens among right TN patient and in the inferior frontal gyrus, precentral gyrus, cerebellum, thalamus, ventral striatum, and putamen among left TN patients. The connections between the right superior frontal gyrus and right middle frontal gyrus were lower in right TN patients. The connection between the left precentral gyrus and the left superior frontal gyrus was lower while the connection between bilateral thalamus was higher in left TN patients. The changes of volume in bilateral thalamus of right TN patients and left ventral striatum of left TN patients, and the connectivity between bilateral thalamus of left TN patients were moderately correlated with pain duration. These findings suggest that brain regions such as the thalamus may not only be involved in processing of pain stimuli but also be important for the development of TN. The left hemisphere may be dominant in processing and modulation of TN pain signal. Chronification of TN induces volume changes in brain regions which are associated with emotional or cognitive modulation of pain. Hum Brain Mapp 39:609-621, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Yuan‐Hsiung Tsai
- Department of Diagnostic RadiologyChang Gung Memorial Hospital at Chiayi, Chang‐Gung University College of MedicineTaoyuanTaiwan
| | - Rui Yuan
- Department of Biomedical EngineeringNew Jersey Institute of Technology, University HeightsNewarkNew Jersey
| | - Dharni Patel
- Department of Biomedical EngineeringNew Jersey Institute of Technology, University HeightsNewarkNew Jersey
| | - Subhashini Chandrasekaran
- Department of Biomedical EngineeringNew Jersey Institute of Technology, University HeightsNewarkNew Jersey
| | - Hsu‐Huei Weng
- Department of Diagnostic RadiologyChang Gung Memorial Hospital at Chiayi, Chang‐Gung University College of MedicineTaoyuanTaiwan
| | - Jen‐Tsung Yang
- Department of NeurosurgeryChang Gung Memorial Hospital at Chiayi, Chang‐Gung University College of MedicineTaoyuanTaiwan
| | - Ching‐Po Lin
- Institute of Neuroscience, National Yang Ming UniversityTaipeiTaiwan
| | - Bharat B. Biswal
- Department of Biomedical EngineeringNew Jersey Institute of Technology, University HeightsNewarkNew Jersey
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Eken A, Gökçay D, Yılmaz C, Baskak B, Baltacı A, Kara M. Association of Fine Motor Loss and Allodynia in Fibromyalgia: An fNIRS Study. J Mot Behav 2017; 50:664-676. [DOI: 10.1080/00222895.2017.1400947] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Aykut Eken
- Biomedical Engineering Department, Düzce University, Düzce, Turkey
| | - Didem Gökçay
- Medical Informatics Department, Informatics Institute, Middle East Technical University, Ankara, Turkey
| | - Cemre Yılmaz
- Neuroscience Graduate Program, Bilkent University, Ankara, Turkey
| | - Bora Baskak
- Department of Psychiatry, Ankara University Faculty of Medicine, Ankara, Turkey
- Ankara University Brain Research Center, Ankara, Turkey
| | - Ayşegül Baltacı
- Department of Physical and Rehabilitation Medicine, Yenimahalle Research Hospital, Yıldırım Beyazıt University Ankara, Turkey
| | - Murat Kara
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Alizadeh Savareh B, Ghanjal A, Bashiri A, Motaqi M, Hatef B. The power features of Masseter muscle activity in tension-type and migraine without aura headache during open-close clench cycles. PeerJ 2017; 5:e3556. [PMID: 28775915 PMCID: PMC5530987 DOI: 10.7717/peerj.3556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 06/18/2017] [Indexed: 12/30/2022] Open
Abstract
Introduction Different types of headaches and TMJ click influence the masseter muscle activity. The aim of this study was to assess the trend of energy level of the electromyography (EMG) activity of the masseter muscle during open-close clench cycles in migraine without aura (MOA) and tension-type headache (TTH) with or without TMJ click. Methods Twenty-five women with MOA and twenty four women with TTH participated in the study. They matched with 25 healthy subjects, in terms of class of occlusion and prevalence of temporomandibular joint (TMJ) with click. The EMG of both masseter muscles were recorded during open-close clench cycles at a rate of 80 cycles per minute for 15 seconds. The mouth opening was restricted to two centimeters by mandibular motion frame. Signal processing steps have been done on the EMG as: noise removing, smoothing, feature extraction, and statistical analyzing. The six statistical parameters of energy computed were mean, Variance, Skewness, Kurtosis, and first and second half energy over all signal energy. Results A three-way ANOVA indicated that during all the cycles, the mean of energy was more and there was a delay in showing the peak of energy in the masseter of the left side with clicked TMJ in MOA group compared to the two other groups, while this pattern occurred inversely in the side with no-clicked TMJ (P < 0.009). The variation of energy was significantly less in MOA group compared to the two other groups in the no-clicked TMJ (P < 0.003). However, the proportion of the first or second part of signal energy to all energy showed that TTH group had less energy in the first part and more energy in the second part in comparison to the two other groups (P < 0.05). Conclusion The study showed different changes in the energy distribution of masseter muscle activity during cycles in MOA and TTH. MOA, in contrast to TTH, had lateralization effect on EMG and interacted with TMJ click.
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Affiliation(s)
- Behrouz Alizadeh Savareh
- Student Research Committee, School of Allied Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Ghanjal
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Azadeh Bashiri
- Health Information Management Department, School of Allied Medical sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Monireh Motaqi
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Boshra Hatef
- Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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37
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Butts R, Dunning J, Pavkovich R, Mettille J, Mourad F. Conservative management of temporomandibular dysfunction: A literature review with implications for clinical practice guidelines (Narrative review part 2). J Bodyw Mov Ther 2017; 21:541-548. [DOI: 10.1016/j.jbmt.2017.05.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 05/22/2017] [Accepted: 05/26/2017] [Indexed: 10/19/2022]
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38
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Butts R, Dunning J, Perreault T, Mettille J, Escaloni J. Pathoanatomical characteristics of temporomandibular dysfunction: Where do we stand? (Narrative review part 1). J Bodyw Mov Ther 2017; 21:534-540. [DOI: 10.1016/j.jbmt.2017.05.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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39
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da Cunha DV, Degan VV, Vedovello Filho M, Bellomo DP, Silva MR, Furtado DA, Andrade AO, Milagre ST, Pereira AA. Real-time three-dimensional jaw tracking in temporomandibular disorders. J Oral Rehabil 2017; 44:580-588. [PMID: 28498502 DOI: 10.1111/joor.12521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2017] [Indexed: 11/29/2022]
Abstract
When a dysfunction occurs in any component of the stomatognathic system, temporomandibular disorders (TMD) may originate. The aim of this study was to compare the deviations, displacement and the execution speed of mandibular movements among asymptomatic participants and those with TMD. Convenience sampling was used; forty participants diagnosed by clinical evaluation following the Research Diagnostic Criteria for Temporomandibular Disorders were divided into three groups: arthropathy (GART, 10 participants, 40% men), myopathy (GMYO, 10 participants, 30% men), and the control group (CG, 20 asymptomatic participants, 25% men). Participants were asked to perform the movements of free maximal mouth opening and closing, right and left lateral excursions, and protrusion with sliding teeth contacts. The mandibular trajectory was recorded using opto-electronic devices tracking reflective markers placed in front of the 'soft tissue pogonion point'. The movements were analysed on the following axis: x - medial-lateral, y - vertical, z - antero-posterior. Significative differences were found in CGxGART - unassisted maximal mouth opening and closing projection on y-axis (OCY), CGxGMYO - unassisted maximal mouth opening and closing projection on x-axis (OCX), and in the measures Opening lateral deviation on x-axis (OLDX), closing lateral deviation on x-axis (CLDX) and in the measures of speed for both. In regard to GARTxGMYO, a significative difference was found in Protrusion lateral deviation on x-axis (PLDX) 'Conover-Iman Test of Multiple Comparisons Using Rank Sums' using Bonferroni correction (P < 0·05). In conclusion, the total opening movements in individuals with TMD tended to have higher deviation than in those asymptomatic individuals and a reduction in the speed of movements.
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Affiliation(s)
- D V da Cunha
- Laboratory of Biomedical Engineering, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil.,Department of Orthodontics, Faculty of Dentistry, Hermínio Ometto University, Araras, Brazil
| | - V V Degan
- Department of Orthodontics, Faculty of Dentistry, Hermínio Ometto University, Araras, Brazil
| | - M Vedovello Filho
- Department of Orthodontics, Faculty of Dentistry, Hermínio Ometto University, Araras, Brazil
| | - D P Bellomo
- Laboratory of Biomedical Engineering, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - M R Silva
- Department of Occlusion, Fixed Prosthodontics and Dental Materials, Faculty of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - D A Furtado
- Faculty of Computer Science, Federal University of Uberlândia, Uberlândia, Brazil
| | - A O Andrade
- Laboratory of Biomedical Engineering, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - S T Milagre
- Laboratory of Biomedical Engineering, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - A A Pereira
- Laboratory of Biomedical Engineering, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
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Temporal summation and motor function modulation during repeated jaw movements in patients with temporomandibular disorder pain and healthy controls. Pain 2017; 158:1272-1279. [PMID: 28420009 DOI: 10.1097/j.pain.0000000000000911] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Temporal summation of nociceptive inputs may be an important pathophysiological mechanism in temporomandibular disorders (TMD) pain; however, it remains unknown how natural jaw function relates to underlying pain mechanisms. This study evaluated changes in pain and movement patterns during repeated jaw movements in patients with painful temporomandibular joints (TMJ) compared with healthy controls. Twenty patients with TMD with TMJ pain, and an anterior disk displacement without reduction and 20 age- and gender-matched healthy volunteers were included. Participants performed 20 trials (4 × 5 sessions) of standardized and repeated mandibular movements, and scored the movement-associated pain intensity on 0 to 10 numeric rating scale in addition to measurements of jaw movements. Patients with TMJ pain reported higher baseline pain compared to the control group for all types of jaw movements (P = 0.001) and significant increases in numeric rating scale pain scores by repetition of jaw movements (P < 0.001), which was not observed in the control group (P > 0.05). Jaw total opening distance (P = 0.030), maximum opening velocity (P = 0.043) and average closing velocity (P = 0.044) in the TMJ pain group were significantly reduced during the repeated movements. In the control group, however, total opening distance (P = 0.499), maximum opening velocity (P = 0.064), and average closing velocity (P = 0.261) remained unchanged, whereas average opening velocity (P = 0.040) and maximum closing velocity (P = 0.039) increased. The study demonstrates that repeated jaw movements constitute a sufficient and adequate stimulation for triggering temporal summation effects associated with significant inhibition of motor function in painful TMJs. These findings have practical implications for diagnosis of TMD pain and for more mechanism-driven management protocols in the future.
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Bavia PF, Vilanova LSR, Garcia RCMR. Craniofacial Morphology Affects Bite Force in Patients with Painful Temporomandibular Disorders. Braz Dent J 2017; 27:619-624. [PMID: 27982245 DOI: 10.1590/0103-6440201600708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 06/20/2016] [Indexed: 11/22/2022] Open
Abstract
Craniofacial morphology affects masticatory performance in healthy dentate subjects, but little is known about its effects in patients with painful temporomandibular disorders (TMDs). Forty-eight female patients (mean age of 28±5.8 years) with painful TMDs underwent lateral cephalometric radiography. Using Ricketts' cephalometric analysis and the Vert method, subjects were assigned to three groups according to their craniofacial morphology: brachyfacial (n=22), mesofacial (n=13), and dolichofacial (n=13). Research diagnostic criteria for TMD were used to confirm the TMD diagnosis for each patient. Pain intensity was reported by each patient based on a visual analog scale (VAS). Maximum bite force (MBF) was measured with pressure sensors placed on the first molar site. Masticatory performance (MP) was assessed by chewing a silicone-based artificial material and determining the resulting particle size by the sieve method. Chewing ability (CA) was evaluated for seven food types and analyzed by a VAS questionnaire. Data were analyzed by one-way ANOVA followed by a Tukey-Kramer test (p<0.05). MBF differed in each group, with brachyfacial patients having the highest MBF values. There was no difference in MP among the groups. The groups differed only in their ability to chew one of the seven evaluated food types. In summary, craniofacial morphology affects the MBF without impairing MP or CA in patients with painful TMDs.
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Affiliation(s)
- Paula Furlan Bavia
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, UNICAMP - Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | - Larissa Soares Reis Vilanova
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, UNICAMP - Universidade Estadual de Campinas, Piracicaba, SP, Brazil
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Pasinato F, Santos-Couto-Paz CC, Zeredo JLL, Macedo SB, Corrêa EC. Experimentally induced masseter-pain changes masseter but not sternocleidomastoid muscle-related activity during mastication. J Electromyogr Kinesiol 2016; 31:88-95. [DOI: 10.1016/j.jelekin.2016.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 07/30/2016] [Accepted: 09/26/2016] [Indexed: 11/24/2022] Open
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Mapelli A, Zanandréa Machado BC, Giglio LD, Sforza C, De Felício CM. Reorganization of muscle activity in patients with chronic temporomandibular disorders. Arch Oral Biol 2016; 72:164-171. [DOI: 10.1016/j.archoralbio.2016.08.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 06/02/2016] [Accepted: 08/19/2016] [Indexed: 01/04/2023]
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Henderson L, Akhter R, Youssef A, Reeves J, Peck C, Murray G, Svensson P. The effects of catastrophizing on central motor activity. Eur J Pain 2015; 20:639-51. [DOI: 10.1002/ejp.781] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2015] [Indexed: 11/11/2022]
Affiliation(s)
- L.A. Henderson
- Department of Anatomy and Histology; University of Sydney; Australia
| | - R. Akhter
- Jaw Function and Orofacial Pain Research Unit; Faculty of Dentistry; Westmead Hospital; University of Sydney; Australia
- School of Dentistry and Health Sciences; Charles Sturt University; Orange Australia
| | - A.M. Youssef
- Department of Anatomy and Histology; University of Sydney; Australia
| | - J.M. Reeves
- Department of Anatomy and Histology; University of Sydney; Australia
| | - C.C. Peck
- Jaw Function and Orofacial Pain Research Unit; Faculty of Dentistry; Westmead Hospital; University of Sydney; Australia
| | - G.M. Murray
- Jaw Function and Orofacial Pain Research Unit; Faculty of Dentistry; Westmead Hospital; University of Sydney; Australia
| | - P. Svensson
- Section of Clinical Oral Physiology; School of Dentistry; Aarhus University; Denmark
- MindLab; Centre for Functionally Integrative Neuroscience (CFIN); Aarhus University Hospital; Denmark
- Department of Oral Maxillofacial Surgery; Aarhus University Hospital; Denmark
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Pitta NC, Nitsch GS, Machado MB, de Oliveira AS. Activation time analysis and electromyographic fatigue in patients with temporomandibular disorders during clenching. J Electromyogr Kinesiol 2015; 25:653-7. [DOI: 10.1016/j.jelekin.2015.04.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 04/14/2015] [Accepted: 04/15/2015] [Indexed: 11/25/2022] Open
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Accuracy of the surface electromyography RMS processing for the diagnosis of myogenous temporomandibular disorder. J Electromyogr Kinesiol 2015; 25:596-602. [DOI: 10.1016/j.jelekin.2015.05.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 05/20/2015] [Accepted: 05/21/2015] [Indexed: 11/23/2022] Open
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Greene CS, Obrez A. Treating temporomandibular disorders with permanent mandibular repositioning: is it medically necessary? Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:489-98. [PMID: 25864818 DOI: 10.1016/j.oooo.2015.01.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/31/2014] [Accepted: 01/30/2015] [Indexed: 10/24/2022]
Abstract
In this paper, the authors review the rationale and history of mandibular repositioning procedures in relation to temporomandibular disorders (TMDs) as these procedures have evolved over time. A large body of clinical research evidence shows that most TMDs can and should be managed with conservative treatment protocols that do not include any mandibular repositioning procedures. Although this provides a strong clinical argument for avoiding such procedures, very few reports have discussed the biologic reasons for either accepting or rejecting them. This scientific information could provide a basis for determining whether mandibular repositioning procedures can be defended as being medically necessary. This position paper introduces the biologic concept of homeostasis as it applies to this topic. The continuing adaptability of teeth, muscles, and temporomandibular joints throughout life is described in terms of homeostasis, which leads to the conclusion that each person's current temporomandibular joint position is biologically "correct." Therefore, that position does not need to be changed as part of a TMD treatment protocol. This means that irreversible TMD treatment procedures, such as equilibration, orthodontics, full-mouth reconstruction, and orthognathic surgery, cannot be defended as being medically necessary.
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Affiliation(s)
- Charles S Greene
- Clinical Professor, Department of Orthodontics, UIC College of Dentistry, Chicago, Illinois, USA.
| | - Ales Obrez
- Associate Professor, Department of Restorative Dentistry, UIC College of Dentistry, Chicago, Illinois, USA
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Iwasaki LR, Liu H, Gonzalez YM, Marx DB, Nickel JC. Modeling of muscle forces in humans with and without temporomandibular joint disorders. Orthod Craniofac Res 2015; 18 Suppl 1:170-9. [PMID: 25865546 DOI: 10.1111/ocr.12075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Subjects with/without temporomandibular joint disorders (TMJD) were tested for differences in muscle forces. SETTING AND SAMPLE POPULATION School of Dental Medicine, University at Buffalo. Ninety-one subjects were classified in four groups based on the presence/absence (±) of chronic myofascial and/or TMJ pain (P) and bilateral disc displacement (DD). MATERIAL AND METHODS Validated numerical models employed an organizational objective and subjects' anatomy to calculate masticatory muscle forces during static biting. anova and Holm's step-down procedure post hoc tests assessed group differences. Theoretical geometries, representing the range of subjects' muscle orientations, were surveyed via numerical models to identify key combinations resulting in high muscle forces. Effect size (Cohen's d) and anova/post hoc tests assessed group differences in key muscle orientations. RESULTS +P-DD subjects had significantly higher muscle forces, especially for lateral pterygoid muscles, compared to the other groups (p<0.01) for bite forces that were directed posteromedially or posterolaterally on mandibular molars and posteriorly and slightly medially on mandibular incisors. Key muscle orientations for peak lateral pterygoid muscle forces were identified, and group comparisons showed mean orientation in +P-DD compared to other diagnostic groups was ≥5° more upright for masseter and ≥3° more posteriorly directed for temporalis muscles (all Cohen's d≥0.8). CONCLUSION Predicted lateral pterygoid muscle forces were significantly higher in +P-DD compared to other groups for specific biting conditions and were attributable, in part, to differences in masseter and temporalis muscle orientations.
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Affiliation(s)
- L R Iwasaki
- Departments of Orthodontics & Dentofacial Orthopedics and Oral & Craniofacial Sciences, University of Missouri-Kansas City, Kansas City, MO, USA
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Iwasaki LR, Gonzalez YM, Liu H, Marx DB, Gallo LM, Nickel JC. A pilot study of ambulatory masticatory muscle activities in temporomandibular joint disorders diagnostic groups. Orthod Craniofac Res 2015; 18 Suppl 1:146-55. [PMID: 25865543 PMCID: PMC4396707 DOI: 10.1111/ocr.12085] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine differences in masticatory muscle usage between temporomandibular joint disorders diagnostic groups. SETTING AND SAMPLE POPULATION Seventy-one informed and consented subjects (27 men; 44 women) participated at the University at Buffalo. MATERIAL AND METHODS Research diagnostic criteria and imaging data were used to categorize subjects according to the presence/absence +/- of TMJ disc placement (DD) and chronic pain (P) (+DD+P, n=18; +DD-P, n=14; -DD-P, n=39). Electromyographic (EMG)/bite-force calibrations determined subject-specific masseter and temporalis muscle activities per 20 N bite-force (T20N , μV). Over 3 days and nights, subjects collected EMG recordings. Duty factors (DFs, % of recording time) were determined based on threshold intervals (5-9, 10-24, 25-49, 50-79, ≥80% T20N ). anova and Tukey-Kramer post hoc tests identified 1) diagnostic group differences in T20N and 2) the effects of diagnostic group, gender, time and interval on muscle DFs. RESULTS Mean (±SE) temporalis T20N in +DD+P subjects was significantly higher (71.4±8.8 μV) than masseter T20N in these subjects (19.6±8.8 μV; p=0.001) and in -DD-P subjects (25.3±6.0 μV, p=0.0007). Masseter DFs at 5-9% T20N were significantly higher in +DD-P women (3.48%) than +DD-P men (0.85%) and women and men in both other diagnostic groups (all p<0.03), and in +DD+P women (2.00%) compared to -DD-P men (0.83%; p=0.029). Night-time DFs at 5-9% T20N in +DD-P women (1.97%) were significantly higher than in -DD-P men (0.47%) and women (0.24%; all p<0.01). CONCLUSIONS Between-group differences were found in masticatory muscle activities in both laboratory and natural environmental settings.
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Affiliation(s)
- L R Iwasaki
- Departments of Orthodontics & Dentofacial Orthopedics and Oral & Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA
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Rodrigues CA, Melchior MDO, Magri LV, Mestriner W, Mazzetto MO. Is the masticatory function changed in patients with temporomandibular disorder? Braz Dent J 2015; 26:181-5. [PMID: 25831111 DOI: 10.1590/0103-6440201300198] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 12/17/2014] [Indexed: 11/21/2022] Open
Abstract
Patients with temporomandibular disorders (TMD) often complain and have limitation in masticatory function, which can be affected by a complex interaction of factors. The aim of this study was analyze the masticatory function in patients with TMD using surface electromyography (EMG) and masticatory efficiency (ME). Twenty-seven patients with TMD and 25 considered control (n), aged between 18 and 60 years, paired by age and gender, were evaluated according to RDC/TMD. In both groups were performed: EMG with chewing gum, clinical evaluation of habitual chewing with stuffed cookie (CE) (number of chewing strokes and time) and analysis of ME with fuchsin beads. Nonparametric statistical analyses were used (Mann-Whitney) for comparisons between groups, with 5% significance level. For all variables, the TMD group showed higher values than the control, with statistical significance for ME (p<0.0001), number of chewing strokes (p=0.04), chewing time (p=0.009), right masseter EMG activity (p=0.05), left masseter (p=0.005), right anterior temporal (p=0.05) and left anterior temporal (p=0.001). The conclusion is that patients with TMD showed changed chewing pattern, but without impairment of masticatory function.
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Affiliation(s)
- Carolina Almeida Rodrigues
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, USP - University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Melissa de Oliveira Melchior
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, USP - University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Laís Valencise Magri
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, USP - University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Wilson Mestriner
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, USP - University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Marcelo Oliveira Mazzetto
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, USP - University of São Paulo, Ribeirão Preto, SP, Brazil
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