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Krunic J, Mladenovic I, Radovic I, Stojanovic N. Changes in pulp sensitivity across the menstrual cycle in healthy women and women with temporomandibular disorders. J Oral Rehabil 2020; 48:124-131. [PMID: 33064877 DOI: 10.1111/joor.13116] [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: 05/05/2020] [Revised: 09/25/2020] [Accepted: 10/06/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Menstrual cycle may contribute to experimental pain measures in healthy women and women with chronic pain. OBJECTIVES The present study aimed to investigate variation in pulp sensitivity across the menstrual cycle in healthy women and women with temporomandibular disorders (TMD) and to explore the effect of TMD pain and psychosocial variables on the pulp response. METHODS This longitudinal study involved 47 regularly menstruating women aged 20-45, 24 healthy and 23 with diagnosed painful TMD. The electric and cold stimuli were performed by electric pulp tester and refrigerant spray, respectively, on mandibular lateral incisors, in five menstrual phases (menstrual, follicular, periovulatory, luteal and premenstrual). Research Diagnostic Criteria for TMD were used to assess TMD, chronic pain, depression and somatisation. Regression analysis was performed to investigate the effect of the predictor variables on the pulp sensitivity. RESULTS Significant phase-related differences were observed for pain intensity to cold stimuli. Higher pain sensitivity was reported in menstrual in comparison with luteal phase (P = .019) among healthy women, and in menstrual in comparison with follicular (P = .033), periovulatory (P = .003) and luteal (P = .007) phases in TMD women. No significant differences were recorded for electric stimuli. Regression analysis identified depression as the determinant of cold and electric response in menstrual phase, regardless of age and presence of TMD. CONCLUSION Menstrual phase in healthy and TMD women with regular menstrual cycle is characterised with higher pulp sensitivity to cold stimuli. Depressive symptoms independently influence pulp response in this phase.
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Affiliation(s)
- Jelena Krunic
- Department of Dental Pathology, Faculty of Medicine, University of East Sarajevo, Foca, Bosnia and Herzegovina
| | - Irena Mladenovic
- Department of Prosthodontics, Faculty of Medicine, University of East Sarajevo, Foca, Bosnia and Herzegovina
| | - Ivana Radovic
- Clinic for Pediatric and Preventive Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikola Stojanovic
- Department of Dental Pathology, Faculty of Medicine, University of East Sarajevo, Foca, Bosnia and Herzegovina
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Leite WB, Oliveira ML, Ferreira IC, Anjos CF, Barbosa MA, Barbosa AC. Effects of 4-Week Diacutaneous Fibrolysis on Myalgia, Mouth Opening, and Level of Functional Severity in Women With Temporomandibular Disorders: A Randomized Controlled Trial. J Manipulative Physiol Ther 2020; 43:806-815. [PMID: 32893024 DOI: 10.1016/j.jmpt.2020.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/23/2019] [Accepted: 01/06/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the effects of 4-week protocol of diacutaneous fibrolysis (DF) compared with simulated DF (sham-DF) on myalgia and mouth opening. METHODS In a sham randomized controlled trial, 34 women with temporomandibular disorders and myofascial pain were randomly divided as intervention group (IG) and sham-DF group (SG). The IG received 4 weeks of real DF, and the SG received sham. Pain was assessed through the visual analog scale and pressure pain thresholds (PPTs) on the temporomandibular joint (TMJ), and over the temporal and masseter muscles. The Mandibular Function Impairment Questionnaire was used to classify the participants regarding to the severity of the functional limitation related to TMD. RESULTS Pain scores decreased for both groups, but the IG showed lower values at week 4, with between-group differences. Bilateral temporal PPT showed higher values at week 4, with between-group differences. The SG had lower PPTs but the IG had higher PPTs, both compared to baseline results. The time-by-group interaction and the frequency of participants above 40 mm of mouth opening showed a significant difference for the IG over time with higher results at the 4-week assessment compared to its own baseline. Both groups showed lower MFIQ scores from baseline to 4-week assessment. There was a lower frequency of a moderate level of severity for the IG. No differences were observed for TMJ or for the masseter muscles PPT. CONCLUSION Improvements were observed for visual analog scale scores and PPTs on temporal muscles. There was a group-by-time interaction in the IG, suggesting a possible potential use of DF for mouth opening.
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Affiliation(s)
- William B Leite
- Musculoskeletal Research Group - NIME, Department of Physical Therapy, Federal University of Juiz de Fora, Governador Valadare, Minas Gerais, Brazil
| | - Matheus L Oliveira
- Musculoskeletal Research Group - NIME, Department of Physical Therapy, Federal University of Juiz de Fora, Governador Valadare, Minas Gerais, Brazil; Master Degree Program in Rehabilitation and Physical Performance, Federal University of Juiz de Fora, Governador Valadare, Minas Gerais, Brazil
| | - Isabella C Ferreira
- Musculoskeletal Research Group - NIME, Department of Physical Therapy, Federal University of Juiz de Fora, Governador Valadare, Minas Gerais, Brazil
| | - Carolina F Anjos
- Musculoskeletal Research Group - NIME, Department of Physical Therapy, Federal University of Juiz de Fora, Governador Valadare, Minas Gerais, Brazil; Master Degree Program in Rehabilitation and Physical Performance, Federal University of Juiz de Fora, Governador Valadare, Minas Gerais, Brazil
| | - Michelle A Barbosa
- Musculoskeletal Research Group - NIME, Department of Physical Therapy, Federal University of Juiz de Fora, Governador Valadare, Minas Gerais, Brazil; Master Degree Program in Rehabilitation and Physical Performance, Federal University of Juiz de Fora, Governador Valadare, Minas Gerais, Brazil
| | - Alexandre C Barbosa
- Musculoskeletal Research Group - NIME, Department of Physical Therapy, Federal University of Juiz de Fora, Governador Valadare, Minas Gerais, Brazil; Master Degree Program in Rehabilitation and Physical Performance, Federal University of Juiz de Fora, Governador Valadare, Minas Gerais, Brazil; Master Degree Program in Applied Health Sciences, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil.
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Barbosa MA, Tahara AK, Ferreira IC, Intelangelo L, Barbosa AC. Effects of 8 weeks of masticatory muscles focused endurance exercises on women with oro‐facial pain and temporomandibular disorders: A placebo randomised controlled trial. J Oral Rehabil 2019; 46:885-894. [DOI: 10.1111/joor.12823] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Michelle Almeida Barbosa
- Musculoskeletal Research Group—NIME, Department of Physical Therapy Federal University of Juiz de Fora Governador Valadares Brazil
- Master Degree Program in Rehabilitation and Physical Performance Federal University of Juiz de Fora Juiz de Fora Brazil
| | - Ariany Klein Tahara
- Musculoskeletal Research Group—NIME, Department of Physical Therapy Federal University of Juiz de Fora Governador Valadares Brazil
- Master Degree Program in Rehabilitation and Physical Performance Federal University of Juiz de Fora Juiz de Fora Brazil
| | - Isabella Christina Ferreira
- Musculoskeletal Research Group—NIME, Department of Physical Therapy Federal University of Juiz de Fora Governador Valadares Brazil
| | | | - Alexandre Carvalho Barbosa
- Musculoskeletal Research Group—NIME, Department of Physical Therapy Federal University of Juiz de Fora Governador Valadares Brazil
- Master Degree Program in Rehabilitation and Physical Performance Federal University of Juiz de Fora Juiz de Fora Brazil
- Master Degree Program in Applied Health Sciences Federal University of Juiz de Fora Governador Valadares Brazil
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Is Repeated Arthrocentesis Beneficial in the Treatment of Temporomandibular Disorders: A Retrospective Study. J Oral Maxillofac Surg 2019; 77:1359-1364. [PMID: 30825439 DOI: 10.1016/j.joms.2019.01.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/20/2019] [Accepted: 01/24/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE Arthrocentesis is an effective, simple, and minimally invasive treatment in patients with temporomandibular joint (TMJ) closed lock (CL). The aim of this study was to compare the effectiveness of 1- versus 2-session arthrocentesis procedures in the management of TMJ CL. MATERIALS AND METHODS A retrospective cohort study was conducted using the files of patients with TMJ CL according to diagnostic criteria for temporomandibular disorders. Patients who underwent 1- or 2-session arthrocentesis were included in the study. The decision of whether to undergo 1- or 2-session arthrocentesis was made by the patients: Those who accepted a second arthrocentesis procedure were assigned to group 1 (repeated arthrocentesis group), and those who did not accept, to group 2 (arthrocentesis group). The primary predictor variable was treatment method. TMJ pain (scored on a visual analog scale) and maximum mouth opening (MMO) were selected as the outcome variables. To evaluate the clinical outcomes of 1- or 2-session arthrocentesis, MMO and pain score (on a visual analog scale) before treatment and at 1, 3, and 6 months' follow-up were analyzed. Descriptive, comparative, correlation, and multivariate analyses were conducted. RESULTS A total of 30 patients (25 female and 5 male patients) with TMJ disc displacement without reduction were enrolled in the study. Each group consisted of 15 patients. Statistically significant decreases in pain scores and increases in MMO values were observed in both treatment groups at 3 and 6 months (P < .05). At 6 months, MMO values were significantly higher and pain levels were significantly lower in patients who received 2 arthrocentesis procedures. CONCLUSIONS Repeated arthrocentesis is more successful at reducing pain and improving MMO than a single intervention in the treatment of TMJ CL.
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Trize DDM, Calabria MP, Franzolin SDOB, Cunha CO, Marta SN. Is quality of life affected by temporomandibular disorders? EINSTEIN-SAO PAULO 2018; 16:eAO4339. [PMID: 30517362 PMCID: PMC6276907 DOI: 10.31744/einstein_journal/2018ao4339] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/30/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To determine the impact of temporomandibular disorders in quality of life. METHODS A total of 102 volunteer patients (68 female) aged 19 to 86 years, who sought medical care in health clinics of the university and were evaluated in the period from September to December 2013. The subjects were examined according to the Research Diagnostic Criteria for Temporomandibular Disorders, using a mechanical algometer (Palpeter®) with standardized pressure of 0.5 and 1.0kg, and Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) questionnaire, to assess quality of life. The data were tabulated for statistical analysis and the variables were correlated with the clinical findings of the temporomandibular disorders and quality of life. RESULTS Fifty percent of patients were positive for temporomandibular disorders and 39.2% classified as myofascial pain group. The temporomandibular disorder group was significantly associated with uncomfortable bite (p=0.0000), temporomandibular joint clicking (p=0.0001) and tooth clenching (p=0.0001). The Mann Whitney test used to analyze the SF-36 revealed that the domains of pain (mean score of 47.80%; p<0.0001) and mental health (62.67%; p<0.05) were strongly associated with temporomandibular disorders. CONCLUSION The quality of life of individuals with temporomandibular disorders was negatively affected by the presence of pain and mental health disorders.
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De Souza Tesch R, Fernandes FS, Favilla EE, De Goffredo Filho GS, De Queiroz Faria Goes CP. Differences in non-specific physical symptom levels and pressure pain thresholds between patients with masticatory myofascial pain and arthralgia. Cranio 2018; 38:389-395. [DOI: 10.1080/08869634.2018.1531207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Welte-Jzyk C, Pfau DB, Hartmann A, Daubländer M. Somatosensory profiles of patients with chronic myogenic temporomandibular disorders in relation to their painDETECT score. BMC Oral Health 2018; 18:138. [PMID: 30092795 PMCID: PMC6085668 DOI: 10.1186/s12903-018-0601-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to characterize patients with chronic temporomandibular disorders (TMD) in terms of existing hyperalgesia against cold, heat and pressure. METHODS The extent of hyperalgesia for pressure and thermal sensation in TMD patients was determined by the use of the painDETECT questionnaire ("Is cold or heat in this area occasionally painful?" "Does slight pressure in this area, e.g., with a finger, trigger pain?") and experimental somatosensory testing against thermal and pressure stimuli (Quantitative Sensory Testing; QST). In addition, we explored psychological comorbidity among the chronic TMD patients (hospital anxiety and depression scale, HADS-D and coping strategies questionnaire, CSQ). RESULTS Nineteen patients with chronic TMD and 38 healthy subjects participated in the study. N = 12 patients had a painDETECT score ≤ 12, n = 3 patients had a painDETECT score of 13-18 and n = 4 patients had a painDETECT score ≥ 19. TMD patients with painDETECT scores ≥19 had moderately, strong or very strong enhancement of thermal and pressure pain perception, whereas patients with painDETECT scores 13-18 and ≤ 12 responded these questions with "never", "hardly noticed" or "slightly painful" (p < 0.05-0.01). With increasing painDETECT scores we found increased hyperalgesia for pressure (p < 0.01) and thermal stimuli (p < 0.05) in QST. The patients with a painDETECT score ≥ 19 showed increased signs of anxiety (p < 0.05), depression (p < 0.01), praying and hoping (p < 0.05). CONCLUSION The present study has shown that the PainDETECT questionnaire can be a helpful additional diagnostic tool. Together with QST, the PainDETECT questionnaire detected hyperalgesia for pressure and thermal sensation. Therefore the PainDETECT questionnaire is helpful to decide which TMD patients should undergo QST.
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Affiliation(s)
- C Welte-Jzyk
- Department of Oral and Maxillofacial Surgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Mainz, Germany.
| | - D B Pfau
- Mannheim Institute of Public Health (MIPH), Social and Preventive Medicine, University of Heidelberg, Heidelberg, Germany.,Department of Neurophysiology, Centre of Biomedicine and Medical Technology Mannheim (CBTM), University of Heidelberg, Heidelberg, Germany
| | - A Hartmann
- Private Practice Dr. Seiler and colleagues, Filderstadt, Germany
| | - M Daubländer
- Department of Oral and Maxillofacial Surgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Mainz, Germany
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Campi LB, Jordani PC, Tenan HL, Camparis CM, Gonçalves DAG. Painful temporomandibular disorders and central sensitization: implications for management-a pilot study. Int J Oral Maxillofac Surg 2016; 46:104-110. [PMID: 27553896 DOI: 10.1016/j.ijom.2016.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 05/12/2016] [Accepted: 07/25/2016] [Indexed: 10/21/2022]
Abstract
The objective was to investigate the presence of cutaneous allodynia and hyperalgesia in the trigeminal and extra-trigeminal areas, as a surrogate for central sensitization (CS), in women with a painful temporomandibular disorder (TMD) and without other painful conditions. Painful TMDs, depression, and non-specific physical symptoms (NSPS) were classified according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The amount of pain in the trigeminal and extra-trigeminal areas was determined using a visual analogue scale (0-100mm) after the application of a vibrotactile stimulus and assessment of the pressure pain threshold (PPT). Statistical tests (Fisher's, χ2, and Mann-Whitney) were performed, with a significance level of 5%. The sample comprised 45 women (mean age 37.5 years; 16 with a painful TMD) who were free of any headache, fibromyalgia, or other painful condition. Painful TMD was associated with higher pain sensitivity and lower PPT values in the trigeminal (P<0.01) and extra-trigeminal regions (P<0.01). The presence of depression contributed significantly to increased pain sensitivity. The presence of hyperalgesia and allodynia in both the trigeminal and extra-trigeminal regions among women with a painful TMD indicated the presence of CS. Changes involving the central nervous system should be considered during the evaluation and management of patients with a painful TMD.
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Affiliation(s)
- L B Campi
- Araraquara School of Dentistry, Universidade Estadual Paulista - UNESP, Araraquara, Sao Paulo, Brazil.
| | - P C Jordani
- Araraquara School of Dentistry, Universidade Estadual Paulista - UNESP, Araraquara, Sao Paulo, Brazil
| | - H L Tenan
- Araraquara School of Dentistry, Universidade Estadual Paulista - UNESP, Araraquara, Sao Paulo, Brazil
| | - C M Camparis
- Araraquara School of Dentistry, Universidade Estadual Paulista - UNESP, Araraquara, Sao Paulo, Brazil
| | - D A G Gonçalves
- Araraquara School of Dentistry, Universidade Estadual Paulista - UNESP, Araraquara, Sao Paulo, Brazil
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Frequency of daytime tooth clenching episodes in individuals affected by masticatory muscle pain and pain-free controls during standardized ability tasks. Clin Oral Investig 2016; 21:1139-1148. [DOI: 10.1007/s00784-016-1870-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/02/2016] [Indexed: 01/19/2023]
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