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Lemos GA, da Silva PLP, Moretti EC, Pereira AC. Custo-Efetividade de Diferentes Tratamentos Minimamente Invasivos Para Disfunção Temporomandibular de Origem Articular sob a Perspectiva do Sistema Público de Saúde Brasileiro. Value Health Reg Issues 2024; 44:101014. [PMID: 39368195 DOI: 10.1016/j.vhri.2024.101014] [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: 05/03/2024] [Accepted: 05/27/2024] [Indexed: 10/07/2024]
Abstract
OBJECTIVE This study aimed to evaluate the cost-effectiveness (CE) of minimally invasive interventions for pain associated with articular temporomandibular dysfunction from the Brazilian Public Health System (SUS) perspective. METHODS This is a CE study with a 1-year time horizon. Effectiveness data were extracted from a network meta-analysis, and 2 treatments with moderate levels of evidence certainty were evaluated: arthrocentesis (ARTRO) plus intra-articular corticosteroid (CO) injection and ARTRO plus intra-articular injection of sodium hyaluronate (SH). For CE analysis, the costs of 2 types of SH (low and high molecular weight) and 4 COs (betamethasone [B], dexamethasone acetate [D], methylprednisolone sodium succinate [M], or triamcinolone hexacetonide [T]) were considered. Modeling was conducted using TreeAge Pro Healthcare software, with the construction of a decision tree representing a hypothetical cohort of adults with articular temporomandibular dysfunction. Deterministic and probabilistic sensitivity analyses were performed. In addition, an acceptability curve was developed. RESULTS The total costs per joint for ARTRO plus low- and high-molecular-weight SH and ARTRO plus COs B, D, M, and T were, respectively, R$583.32, R$763.85, R$164.39, R$133.93, R$138.57, and R$159.86. ARTRO plus dexamethasone acetate was considered cost-effective, with lower cost and higher net monetary benefit than other technologies. In all sensitivity analysis scenarios, it remained cost-effective. It also showed greater acceptability. CONCLUSION ARTRO plus dexamethasone acetate was considered the cost-effective technology, exhibiting higher net monetary benefit and higher acceptability from the SUS perspective.
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Affiliation(s)
- George A Lemos
- Instituto de Ciências Biológicas e da Saúde, Universidade Federal de Alagoas, Maceió, Alagoas, Brasil.
| | - Pâmela L P da Silva
- Programa de Pós-graduação em Odontologia, Universidade Federal da Paraíba, João Pessoa, Paraiba, Brasil
| | - Eduarda C Moretti
- Instituto de Ciências Biológicas e da Saúde, Universidade Federal de Alagoas, Maceió, Alagoas, Brasil
| | - Antônio C Pereira
- Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas, Piracicaba, São Paulo, Brasil
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Zhu Y, Xu J, Zhang J, Wan Y, He Y, Lei J, Zhang Y, Yang C, Yang Y. Exercise therapy in postoperative patients with temporomandibular joint internal derangement: A systematic review. J Oral Rehabil 2024; 51:2158-2168. [PMID: 38873746 DOI: 10.1111/joor.13780] [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: 01/29/2024] [Revised: 05/16/2024] [Accepted: 05/31/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE Postoperative patients with temporomandibular joint internal derangement (ID) often have problems such as limited mouth opening and pain. Exercise therapy can be advantageous for improving the recovery of patients following surgery. However, there is continuing discussion on the precise aspects of the exercise program, including the optimal timing, length, intensity, and use of assistive equipment. Hence, this study aimed to incorporate pre-existing exercise treatment regimens and investigate their impact. METHODS Publications that detailed the clinical treatment of patients with temporomandibular joint ID who received postoperative exercise therapy interventions were included. Nine databases were searched until October 1st, 2023. The JBI critical appraisal tools were used to assess the methodological quality of the included studies. RESULTS Five studies were finally included for subsequent analysis; two were randomised controlled studies, and three were quasi-experimental. Exercises suitable for such patients encompass vertical, transverse, and horizontal stretching, among which vertical stretch can be divided into active and passive movements. The start time ranged from the first to the fifth week after surgery, with a duration of 1-6 months. Although the data in the studies could not be integrated and further analysed, preliminary results showed that maximum mouth opening and pain in patients improved significantly. The therapeutic effect of combining three exercise methods was best and was related to patient compliance. CONCLUSION Exercise therapy positively affects postoperative rehabilitation in patients with temporomandibular joint ID. It is proposed that targeted, comprehensive studies be conducted to provide a basis for designing more sophisticated exercise therapy regimens and further confirm its curative effect.
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Affiliation(s)
- Yongkang Zhu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology and National Center of Stomatology, Beijing, People's Republic of China
| | - Jiaqi Xu
- Nursing Department, Peking University Third Hospital, Beijing, People's Republic of China
| | - Jing Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology and National Center of Stomatology, Beijing, People's Republic of China
| | - Yifan Wan
- Franklin and Marshall College, Lancaster, Pennsylvania, USA
| | - Yang He
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology and National Center of Stomatology, Beijing, People's Republic of China
| | - Jie Lei
- Center for TMD & Orofacial Pain, Department of Oral & Maxillofacial Radiology, Peking University School and Hospital of Stomatology & National Center of Stomatology, Beijing, People's Republic of China
| | - Yi Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology and National Center of Stomatology, Beijing, People's Republic of China
| | - Chengfengyi Yang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology and National Center of Stomatology, Beijing, People's Republic of China
| | - Yue Yang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology and National Center of Stomatology, Beijing, People's Republic of China
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Ferreira DMAO, Soares FFC, Raimundini AA, Bonjardim LR, Costa YM, Conti PCR. Prediction of duloxetine efficacy in addition to self-management in painful temporomandibular disorders: A randomised, placebo-controlled clinical trial. J Oral Rehabil 2024; 51:476-486. [PMID: 37994185 DOI: 10.1111/joor.13628] [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: 07/23/2023] [Revised: 10/19/2023] [Accepted: 11/06/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Conditioned pain modulation (CPM) is a potential predictor of treatment response that has not been studied in temporomandibular disorders (TMD). OBJECTIVES We conducted a randomised, double-blind, placebo-controlled trial (RCT) of duloxetine in addition to self-management (SM) strategies to investigate its efficacy to reduce pain intensity in painful TMD patients. Moreover, we investigated whether baseline CPM would predict the duloxetine efficacy to reduce TMD pain intensity. METHODS Eighty participants were randomised to duloxetine 60 mg or placebo for 12 weeks. The primary outcomes were the change in the pain intensity from baseline to week-12 and CPM-sequential paradigm at baseline. Safety, physical and emotional functioning outcomes were also evaluated. RESULTS Of 80 participants randomised, 78 were included in intention-to-treat analysis. Pain intensity decreased for SM-duloxetine and SM-placebo but did not differ between groups (p = .82). A more efficient CPM was associated with a greater pain intensity reduction regardless of the treatment group (p = .035). Physical and emotional functioning did not differ between groups, but adverse events (p = .014), sleep impairment (p = .003) and catastrophizing symptoms (p = .001) were more prevalent in SM-duloxetine group. CONCLUSION This study failed to provide evidence of a beneficial effect of adding duloxetine to SM strategies for treatment of painful TMD. Nonetheless, this RCT has shown the feasibility of applying pain modulation assessment to predict short-term treatment response in painful TMD patients, which confirms previous finds that CPM evaluation may serve a step forward in individualising pain treatment.
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Affiliation(s)
| | | | - Amanda Ayla Raimundini
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | | | - Yuri Martins Costa
- Department of Biosciences, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Paulo César Rodrigues Conti
- Department of Prosthodontics and Periodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
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Sagl B, Schmid-Schwap M, Piehslinger E, Yao H, Rausch-Fan X, Stavness I. The effect of bolus properties on muscle activation patterns and TMJ loading during unilateral chewing. J Mech Behav Biomed Mater 2024; 151:106401. [PMID: 38237207 DOI: 10.1016/j.jmbbm.2024.106401] [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: 09/28/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/03/2024]
Abstract
Mastication is a vital human function and uses an intricate coordination of muscle activation to break down food. Collection of detailed muscle activation patterns is complex and commonly only masseter and anterior temporalis muscle activation are recorded. Chewing is the orofacial task with the highest muscle forces, potentially leading to high temporomandibular joint (TMJ) loading. Increased TMJ loading is often associated with the onset and progression of temporomandibular disorders (TMD). Hence, studying TMJ mechanical stress during mastication is a central task. Current TMD self-management guidelines suggest eating small and soft pieces of food, but patient safety concerns inhibit in vivo investigations of TMJ biomechanics and currently no in silico model of muscle recruitment and TMJ biomechanics during chewing exists. For this purpose, we have developed a state-of-the-art in silico model, combining rigid body bones, finite element TMJ discs and line actuator muscles. To solve the problems regarding muscle activation measurement, we used a forward dynamics tracking approach, optimizing muscle activations driven by mandibular motion. We include a total of 256 different combinations of food bolus size, stiffness and position in our study and report kinematics, muscle activation patterns and TMJ disc von Mises stress. Computed mandibular kinematics agree well with previous measurements. The computed muscle activation pattern stayed stable over all simulations, with changes to the magnitude relative to stiffness and size of the bolus. Our biomedical simulation results agree with the clinical guidelines regarding bolus modifications as smaller and softer food boluses lead to less TMJ loading. The computed mechanical stress results help to strengthen the confidence in TMD self-management recommendations of eating soft and small pieces of food to reduce TMJ pain.
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Affiliation(s)
- Benedikt Sagl
- Center for Clinical Research, University Clinic of Dentistry, Medical University of Vienna, 1090, Vienna, Austria.
| | - Martina Schmid-Schwap
- Division of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090, Vienna, Austria
| | - Eva Piehslinger
- Division of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090, Vienna, Austria
| | - Hai Yao
- Department of Bioengineering, Clemson University, 29634, Clemson, SC, United States; Department of Oral Health Sciences, Medical University of South Carolina, 29425, Charleston, SC, United States
| | - Xiaohui Rausch-Fan
- Center for Clinical Research, University Clinic of Dentistry, Medical University of Vienna, 1090, Vienna, Austria
| | - Ian Stavness
- Department of Computer Science, University of Saskatchewan, SK S7N 5C9 Saskatoon, Saskatchewan, Canada
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Penlington C, Palmer J, Martinez-Telchi D, Durham J, Valentine TL, Casals MJ, Oyarzo JF. Presentation and primary care management of temporomandibular disorders: A survey of primary care dentists in Santiago and Newcastle. J Oral Rehabil 2024; 51:241-246. [PMID: 37675953 DOI: 10.1111/joor.13587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 04/05/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Primary care dentists are often the first point of call for people with temporomandibular disorders (TMD) but it is not known how many people present to their dentist with TMD or the forms of first-line management that are routinely offered. OBJECTIVES To report rates of presentation of TMD and management offered in primary care by general dental practitioners in two similarly urban areas, Santiago, Chile and North-East England. METHODS An online survey was developed and distributed to primary care dentists in both regions. Descriptive data were presented to quantify presentation rates and forms of management offered. RESULTS Responses were received from 215 dentists practising in Chile and 46 in Newcastle. The majority reported seeing 1-2 patients weekly with TMD and less than one new presentation each week. Symptoms were most often treated conservatively and with self-management according to international guidelines. The form of self-management varied however and verbal instructions were often not backed up by written information. CONCLUSIONS This research provides a useful starting point in understanding the presentation to, and initial treatment of TMD in primary care internationally. Limitations included the method of recruitment and potentially non-representative samples. Further research could build on this work by including more countries and using more structured sampling methods. The work will be useful in understanding and planning early care pathways for people experiencing TMD.
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Affiliation(s)
- Chris Penlington
- Faculty of Medical Sciences, Newcastle University School of Dental Sciences, Framlington Place, Newcastle, UK
| | - Julia Palmer
- Faculty of Medical Sciences, Newcastle University School of Dental Sciences, Framlington Place, Newcastle, UK
| | - Daniela Martinez-Telchi
- Temporomandibular Disorders and Orofacial Pain Program, Faculty of Dentistry, Andrés Bello University, Santiago, Chile
| | - Justin Durham
- Faculty of Medical Sciences, Newcastle University School of Dental Sciences, Framlington Place, Newcastle, UK
| | - Tobar Lahosa Valentine
- Temporomandibular Disorders and Orofacial Pain Program, Faculty of Dentistry, Andrés Bello University, Santiago, Chile
| | - Maria Jose Casals
- Temporomandibular Disorders and Orofacial Pain Program, Faculty of Dentistry, Andrés Bello University, Santiago, Chile
| | - Juan Fernando Oyarzo
- Temporomandibular Disorders and Orofacial Pain Program, Faculty of Dentistry, Andrés Bello University, Santiago, Chile
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Seyhan M, Atalay ES. Is core stability training effective in temporomandibular disorder? A randomized controlled trial. Clin Oral Investig 2023; 27:7237-7246. [PMID: 37924356 DOI: 10.1007/s00784-023-05274-x] [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: 08/20/2022] [Accepted: 09/23/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVES This study investigated the effect of core stability training on pain, function, quality of life, and posture in individuals with temporomandibular disorder. MATERIALS AND METHODS Participants were divided into the following: the core stability group and the control group. For pain assessment, the Graded Chronic Pain Scale 2.0; for function, the 20-item Jaw Functional Limitation Scale (JFLS-20); for oral health-related quality of life, Oral Health Impact Profile-14 (OHIP-14); and for posture assessment, the New York Scale were used. Rocabado exercises were applied to the control group. Additionally, spinal stabilization exercises were applied for the core stability group for 6 weeks. RESULTS Both types of exercise contribute positively to the quality of life associated with oral health. Rocabado exercise provided a significant change in Chronic Pain Intensity and Disability Score. CONCLUSION Rocabado exercise and core stability training, implemented with Rocabado, provide significant changes in pain values. When evaluated in terms of function, no significant difference was found in both exercise programs. CLINICAL RELEVANCE Core stability training with Rocabado provides significant changes. CLINICAL TRIAL REGISTRATION NUMBER NCT04755621.
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Affiliation(s)
- Merve Seyhan
- Department of Physical Therapy and Rehabilitation, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Emre Serdar Atalay
- Faculty of Physiotherapy and Rehabilitation, University of Health Sciences Turkey, Emrah Mah, Ankara, Turkey.
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Greenbaum T, Emodi-Perlman A. Headache and orofacial pain: A traffic-light prognosis-based management approach for the musculoskeletal practice. Front Neurol 2023; 14:1146427. [PMID: 36895899 PMCID: PMC9990418 DOI: 10.3389/fneur.2023.1146427] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/26/2023] [Indexed: 02/22/2023] Open
Abstract
Introduction Headache (HA) is one of the most prevalent disabling conditions worldwide and is classified as either primary or secondary. Orofacial pain (OFP) is a frequent pain perceived in the face and/or the oral cavity and is generally distinct from a headache, according to anatomical definitions. Based on the up-to-date classification of the International Headache Society, out of more than 300 specific types of HA only two are directly attributed to the musculoskeletal system: The cervicogenic HA and HA attributed to temporomandibular disorders. Because patients with HA and/or OFP frequently seek help in the musculoskeletal practice, a clear and tailored prognosis-based classification system is required to achieve better clinical outcomes. Purpose The aim of perspective article is to suggest a practical traffic-light prognosis-based classification system to improve the management of patients with HA and/or OFP in the musculoskeletal practice. This classification system is based on the best available scientific knowledge based on the unique set-up and clinical reasoning process of musculoskeletal practitioners. Implications Implementation of this traffic-light classification system will improve clinical outcomes by helping practitioners invest their time in treating patients with significant involvement of the musculoskeletal system in their clinical presentation and avoid treating patients that are not likely to respond to a musculoskeletal based intervention. Furthermore, this framework incorporates medical screening for dangerous medical conditions, and profiling the psychosocial aspects of each patient; thus follows the biopsychosocial rehabilitation paradigm.
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Affiliation(s)
- Tzvika Greenbaum
- Department of Physical Therapy, Faculty of Health Sciences, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Alona Emodi-Perlman
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ferrillo M, Ammendolia A, Paduano S, Calafiore D, Marotta N, Migliario M, Fortunato L, Giudice A, Michelotti A, de Sire A. Efficacy of rehabilitation on reducing pain in muscle-related temporomandibular disorders: A systematic review and meta-analysis of randomized controlled trials. J Back Musculoskelet Rehabil 2022; 35:921-936. [PMID: 35213347 DOI: 10.3233/bmr-210236] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients with temporomandibular disorders (TMD) mostly suffer from muscle-related pain. Several conservative interventions have been suggested as treatments for TMD in the last years. OBJECTIVE The aim of this systematic review with meta-analysis was to assess the efficacy of rehabilitative approaches in reducing pain in patients with muscle-related TMD. METHODS PubMed, Scopus, and Web of Science were systematically searched from inception until April 28th, 2021 to identify randomized controlled trials (RCTs) presenting: patients with painful muscle-related TMD; rehabilitative approaches as interventions; placebo or sham treatment as comparisons; pain intensity, using visual analogue scale as outcome. A meta-analysis was performed to evaluate the overall effect on painful muscle-related TMD patients. PROSPERO registration number of this systematic review is CRD42021251904. RESULTS Out of 1997 papers suitable for title/abstract screening, 189 articles were assessed for eligibility. Sixteen RCTs were included and most of them (n= 6, 37.5%) investigated the effects of the laser therapy. The meta-analysis revealed that rehabilitative interventions had a significant overall effect size (ES) of 1.44 (p< 0.0001) in decreasing pain in patients with muscle-related disorders. CONCLUSION Findings of this systematic review with meta-analysis suggested that rehabilitative approaches might be effective in reducing pain in muscle-related TMD patients. However, the low number of RCTs evaluating conservative approaches might impair the synthesis of evidence regarding the different techniques, calling for caution in the interpretation of these results.
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Affiliation(s)
- Martina Ferrillo
- Department of Health Sciences, School of Dentistry, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, Physical Medicine and Rehabilitation Unit, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Sergio Paduano
- Department of Health Sciences, School of Dentistry, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Dario Calafiore
- Department of Neurosciences, Physical Medicine and Rehabilitation Unit, ASST Carlo Poma, Mantova, Italy
| | - Nicola Marotta
- Department of Medical and Surgical Sciences, Physical Medicine and Rehabilitation Unit, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Mario Migliario
- Department of Translational Medicine, Dentistry Unit, University of Eastern Piedmont, Novara, Italy
| | - Leonzio Fortunato
- Department of Health Sciences, School of Dentistry, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Amerigo Giudice
- Department of Health Sciences, School of Dentistry, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Ambra Michelotti
- Department of Neurosciences, School of Orthodontics, Reproductive Sciences and Oral Sciences, University of Naples 'Federico II', Naples, Italy
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, Physical Medicine and Rehabilitation Unit, University of Catanzaro "Magna Graecia", Catanzaro, Italy
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Penlington C, Bowes C, Taylor G, Otemade AA, Waterhouse P, Durham J, Ohrbach R. Psychological therapies for temporomandibular disorders (TMDs). Cochrane Database Syst Rev 2022; 8:CD013515. [PMID: 35951347 PMCID: PMC9370076 DOI: 10.1002/14651858.cd013515.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Temporomandibular disorders (TMDs) are a group of musculoskeletal disorders affecting the jaw. They are frequently associated with pain that can be difficult to manage and may become persistent (chronic). Psychological therapies aim to support people with TMDs to manage their pain, leading to reduced pain, disability and distress. OBJECTIVES To assess the effects of psychological therapies in people (aged 12 years and over) with painful TMD lasting 3 months or longer. SEARCH METHODS Cochrane Oral Health's Information Specialist searched six bibliographic databases up to 21 October 2021 and used additional search methods to identify published, unpublished and ongoing studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) of any psychological therapy (e.g. cognitive behaviour therapy (CBT), behaviour therapy (BT), acceptance and commitment therapy (ACT), mindfulness) for the management of painful TMD. We compared these against control or alternative treatment (e.g. oral appliance, medication, physiotherapy). DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We reported outcome data immediately after treatment and at the longest available follow-up. We used the Cochrane RoB 1 tool to assess the risk of bias in included studies. Two review authors independently assessed each included study for any risk of bias in sequence generation, allocation concealment, blinding of outcome assessors, incomplete outcome data, selective reporting of outcomes, and other issues. We judged the certainty of the evidence for each key comparison and outcome as high, moderate, low or very low according to GRADE criteria. MAIN RESULTS We identified 22 RCTs (2001 participants), carried out between 1967 and 2021. We were able to include 12 of these studies in meta-analyses. The risk of bias was high across studies, and we judged the certainty of the evidence to be low to very low overall; further research may change the findings. Our key outcomes of interest were: pain intensity, disability caused by pain, adverse events and psychological distress. Treatments varied in length, with the shortest being 4 weeks. The follow-up time ranged from 3 months to 12 months. Most studies evaluated CBT. At treatment completion, there was no evidence of a benefit of CBT on pain intensity when measured against alternative treatment (standardised mean difference (SMD) 0.03, confidence interval (CI) -0.21 to 0.28; P = 0.79; 5 studies, 509 participants) or control (SMD -0.09, CI -0.30 to 0.12; P = 0.41; 6 studies, 577 participants). At follow-up, there was evidence of a small benefit of CBT for reducing pain intensity compared to alternative treatment (SMD -0.29, 95% CI -0.50 to -0.08; 5 studies, 475 participants) and control (SMD -0.30, CI -0.51 to -0.09; 6 studies, 639 participants). At treatment completion, there was no evidence of a difference in disability outcomes (interference in activities caused by pain) between CBT and alternative treatment (SMD 0.15, CI -0.40 to 0.10; P = 0.25; 3 studies, 245 participants), or between CBT and control/usual care (SMD 0.02, CI -0.21 to 0.24; P = 0.88; 3 studies, 315 participants). Nor was there evidence of a difference at follow-up (CBT versus alternative treatment: SMD -0.15, CI -0.42 to 0.12; 3 studies, 245 participants; CBT versus control: SMD 0.01 CI - 0.61 to 0.64; 2 studies, 240 participants). There were very few data on adverse events. From the data available, adverse effects associated with psychological treatment tended to be minor and to occur less often than in alternative treatment groups. There were, however, insufficient data available to draw firm conclusions. CBT showed a small benefit in terms of reducing psychological distress at treatment completion compared to alternative treatment (SMD -0.32, 95% CI -0.50 to -0.15; 6 studies, 553 participants), which was maintained at follow-up (SMD -0.32, 95% CI -0.51 to -0.13; 6 studies, 516 participants). For CBT versus control, only one study reported results for distress and did not find evidence of a difference between groups at treatment completion (mean difference (MD) 2.36, 95% CI -1.17 to 5.89; 101 participants) or follow-up (MD -1.02, 95% CI -4.02 to 1.98; 101 participants). We assessed the certainty of the evidence to be low or very low for all comparisons and outcomes. The data were insufficient to draw any reliable conclusions about psychological therapies other than CBT. AUTHORS' CONCLUSIONS We found mixed evidence for the effects of psychological therapies on painful temporomandibular disorders (TMDs). There is low-certainty evidence that CBT may reduce pain intensity more than alternative treatments or control when measured at longest follow-up, but not at treatment completion. There is low-certainty evidence that CBT may be better than alternative treatments, but not control, for reducing psychological distress at treatment completion and follow-up. There is low-certainty evidence that CBT may not be better than other treatments or control for pain disability outcomes. There is insufficient evidence to draw conclusions about alternative psychological therapeutic approaches, and there are insufficient data to be clear about adverse effects that may be associated with psychological therapies for painful TMD. Overall, we found insufficient evidence on which to base a reliable judgement about the efficacy of psychological therapies for painful TMD. Further research is needed to determine whether or not psychological therapies are effective, the most effective type of therapy and delivery method, and how it can best be targeted. In particular, high-quality RCTs conducted in primary care and community settings are required, which evaluate a range of psychological approaches against alternative treatments or usual care, involve both adults and adolescents, and collect measures of pain intensity, pain disability and psychological distress until at least 12 months post-treatment.
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Affiliation(s)
- Chris Penlington
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Charlotte Bowes
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Greig Taylor
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Paula Waterhouse
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Justin Durham
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York, USA
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Uçar İ, Kararti C, Dadali Y, Özüdoğru A, Okçu M. Masseter Muscle Thickness And Elasticity in Bruxism After Exercise Treatment: A Comparison Trial. J Manipulative Physiol Ther 2022; 45:282-289. [DOI: 10.1016/j.jmpt.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 04/04/2022] [Accepted: 07/14/2022] [Indexed: 10/14/2022]
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Durham J, Greene C, Ohrbach R. A commentary on Temporomandibular disorders: priorities for research and care - bridging from the US to the UK. Br Dent J 2022; 233:232-233. [PMID: 35962105 PMCID: PMC9372950 DOI: 10.1038/s41415-022-4501-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/28/2021] [Indexed: 12/05/2022]
Abstract
In January 2019, the United States National Academy of Medicine initiated a comprehensive study of the status of current knowledge and clinical practices associated with temporomandibular disorders (TMDs). The National Academy of Sciences, which includes the National Academy of Medicine, was chartered by the US Government in the late 1800s as a non-profit institution working outside of government in order to provide unbiased, objective opinions on matters including healthcare. In this brief paper, we will discuss the open access 2020 report Temporomandibular disorders: priorities for research and care, available online. While the main focus of this report was the situation of TMDs in the US, the evidence base, authorship, expertise and literature scope was international and the findings therefore are at least in part generalisable to and important for the UK. The authors of this commentary were directly involved in the National Academy process, with RO a panel member, JD a consultant and CG one of 15 reviewers of the draft report. There was a wide variety of clinical and research fields involved in gathering the evidence and constructing the report. In addition, there was extensive involvement from affected patients with TMDs and their families, which is critical because their perspective is typically omitted in textbooks and professional consensus meetings. The report on TMDs from the US National Academy of Medicine is a seminal book describing the problems that individuals with TMDs confront for diagnosis and treatment. The situation in the UK, according to UK colleagues, is similar with regards to challenges. The UK has implemented a number of initiatives to provide better diagnosis and treatment; identifying these excellent efforts in relation to the disease challenges is valuable.
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Affiliation(s)
- Justin Durham
- Head and Professor/Honorary Consultant Oral Surgeon, School of Dental Sciences, Newcastle University, UK
| | - Charles Greene
- Clinical Professor Emeritus, Department of Orthodontics, UIC College of Dentistry, Chicago, Illinois, USA
| | - Richard Ohrbach
- Professor, Oral Diagnostic Sciences, University at Buffalo School of Dental Medicine, Buffalo, New York, USA.
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12
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Zwiri AMA, Ahmad WMAW, Asif JA, Phaik KS, Husein A, Kassim NK, Ab-Ghani Z. A Randomized Controlled Trial Evaluating the Levels of the Biomarkers hs-CRP, IL-6, and IL-8 in Patients with Temporomandibular Disorder Treated with LLLT, Traditional Conservative Treatment, and a Combination of Both. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158987. [PMID: 35897358 PMCID: PMC9332699 DOI: 10.3390/ijerph19158987] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/08/2022] [Accepted: 07/15/2022] [Indexed: 02/06/2023]
Abstract
Temporomandibular disorders (TMDs) are a type of idiopathic orofacial pain. Inflammation, particularly elevated circulating levels of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and interleukin-8 (IL-8), has been linked to pain symptoms. The purpose of this study was to compare hs-CRP, IL-6, and IL-8 biomarkers and pain intensity with different treatment strategies (LLLT, standard conservative treatment, and combination) for TMD patients. Methods: A total of 32 participants were randomly included in the study and divided into three groups (Group I, Group II, and Group III) referred from the Dental Clinic, School of Dental Science, HUSM. Patients received LLLT (Groups II and III) in five sessions for the duration of 10 days. Patients in Groups I and III received standard conservative TMD treatment (diet and stress counseling, jaw exercises, physical therapy, which was a hot towel application) by the principal investigator. All blood samples for biomarkers were performed before starting treatments and directly after finishing the treatment protocols, where all results were recorded. Results: The result showed a significant difference in the mean IL-8 (p = 0.001) between the three intervention groups (LLLT, standard treatment, and combined treatment). IL-6 showed an increase in the mean of IL-6 levels from baseline to post-treatment with a better mean in the LLLT treatment group without any significant differences. Additionally, there were no significant mean differences found between the groups and in the group for the hs-CRP biomarker. Conclusions: A statistically non-significant difference was found in hs-CRP and IL-6 before and after LLLT, conservative, and combined treatment strategies of TMD. A statistically significant difference was observed in the mean levels of IL-8 between the LLLT intervention group and the combined treatment group. Although there was no statistically significant correlation between pain intensity and biomarkers, a statistically significant difference was found in pain intensity before and after LLLT, conservative, and combined treatment strategies. TMJ degeneration could be exacerbated by elevated IL-8 levels. Thus, this can be an important biomarker to mark or identify the painful condition of TMJ.
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Affiliation(s)
- Abdalwhab MA Zwiri
- School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (W.M.A.W.A.); (J.A.A.); (A.H.); (N.K.K.)
- Correspondence: (A.M.Z.); (Z.A.-G.)
| | - Wan Muhamad Amir W. Ahmad
- School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (W.M.A.W.A.); (J.A.A.); (A.H.); (N.K.K.)
| | - Jawaad Ahmed Asif
- School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (W.M.A.W.A.); (J.A.A.); (A.H.); (N.K.K.)
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Khoo Suan Phaik
- Department of Oral Diagnostic and Surgical Sciences, School of Dentistry, International Medical University, Bukit Jalil 57000, Kuala Lumpur, Malaysia;
| | - Adam Husein
- School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (W.M.A.W.A.); (J.A.A.); (A.H.); (N.K.K.)
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Nur Karyatee Kassim
- School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (W.M.A.W.A.); (J.A.A.); (A.H.); (N.K.K.)
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Zuryati Ab-Ghani
- School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (W.M.A.W.A.); (J.A.A.); (A.H.); (N.K.K.)
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence: (A.M.Z.); (Z.A.-G.)
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13
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Sagl B, Schmid-Schwap M, Piehslinger E, Rausch-Fan X, Stavness I. An in silico investigation of the effect of bolus properties on TMJ loading during mastication. J Mech Behav Biomed Mater 2021; 124:104836. [PMID: 34544017 DOI: 10.1016/j.jmbbm.2021.104836] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 09/12/2021] [Indexed: 11/16/2022]
Abstract
Mastication is the motor task with the highest muscle activations of the jaw region, potentially leading to high temporomandibular joint (TMJ) loading. Since increased loading of the TMJ is associated with temporomandibular disorders (TMD), TMJ mechanics during chewing has potential clinical relevance in TMD treatment. TMD self-management guidelines suggest eating soft and small pieces of food to reduce TMJ pain. Since TMJ loading cannot be measured in vivo, due to patient safety restrictions, computer modeling is an important tool for investigations of the potential connection between TMJ loading and TMD. The objective of this study is to investigate the effect of food bolus variables on mechanical TMJ loading to help inform better self-management guidelines for TMD. A combined rigid-body-finite-element model of the jaw region was used to investigate the effect of bolus size, stiffness, and position. Mandibular motion and TMJ disc von Mises stress were reported. Computed mandibular motion generally agrees well with previous literature. Disc stress was higher during the closing phase of the chewing cycle and for the non-working side disc. Smaller and softer food boluses overall lead to less TMJ loading. The results reinforce current guidelines regarding bolus modifications and provide new potential guidelines for bolus positioning that could be verified through a future clinical trial. The paper presents a first in silico investigation of dynamic chewing with detailed TMJ stress for different bolus properties. The results help to strengthen the confidence in TMD self-management recommendations, potentially reducing pain levels of patients.
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Affiliation(s)
- Benedikt Sagl
- Center of Clinical Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria.
| | - Martina Schmid-Schwap
- Department of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Eva Piehslinger
- Department of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Xiaohui Rausch-Fan
- Center of Clinical Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Ian Stavness
- Department of Computer Science, University of Saskatchewan, SK S7N 5C9 Saskatoon, Saskatchewan, Canada
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Şen S, Orhan G, Sertel S, Schmitter M, Schindler HJ, Lux CJ, Giannakopoulos NN. Comparison of acupuncture on specific and non-specific points for the treatment of painful temporomandibular disorders: A randomised controlled trial. J Oral Rehabil 2020; 47:783-795. [PMID: 32077514 DOI: 10.1111/joor.12952] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/31/2020] [Accepted: 02/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this single-centre, two-arm, parallel-group, double-blinded, randomised controlled trial was to investigate the disputed specific effectiveness of acupuncture by comparing acupuncture on specific and non-specific points among patients with non-chronic, painful TMDs. METHODS Following predefined eligibility criteria, 49 consecutive patients of both sexes were recruited to the study. All subjects were diagnosed with a non-chronic (Graded Chronic Pain Scale grade <3) painful TMD, as assessed using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Patients were randomly assigned to group A (acupuncture on specific points) or group B (acupuncture on non-specific points) after the initial examination (T0). Both acupuncture treatment sessions were conducted by a trained dentist once a week for four weeks. The examination was repeated five weeks (T5) after T0 by one calibrated examiner who was unaware of the study groups. Characteristic pain intensity (CPI) was evaluated as the main outcome criterion and compared between times and treatment groups by means of non-parametric tests (significance level set at P = .05). Secondary outcomes comprised the maximum corrected active mouth-opening without pain (MAO); patients' expectations regarding acupuncture treatment and pain development; depressivity; and oral health-related quality of life (OHRQoL). RESULTS A total of 41 patients (38 female) successfully completed the study (mean age: 40.17 ± 16.61). The two groups did not differ significantly at any time in terms of age and CPI. However, CPI was significantly (P < .05) lower at T5 than at T0 for both groups (29.66 and 30.35% lower in group A and group B, respectively). An increase in MAO was observed at T5 for both groups but was significant for group B only (P = .016). All patients had positive expectations of acupuncture therapy, and the two groups did not differ significantly at T5 with regard to the extent to which their expectations had been fulfilled by the treatment (P = .717). Comparison of T0 and T5 showed a statistically significant reduction of depressivity for group A (P = .0205), but no significant change for group B (P = .329). At T5, OHRQoL had improved significantly for both groups (group A, P = .018; group B, P < .001) compared with at T0. CONCLUSIONS Acupuncture on both specific and non-specific points reduces the non-dysfunctional pain of TMD patients. The effect of acupuncture on painful TMD cannot be attributed to the specific point selection.
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Affiliation(s)
- Sinan Şen
- Department of Orthodontics and Dentofacial Orthopaedics, University of Heidelberg, Heidelberg, Germany
| | - Gül Orhan
- Department of Orthodontics and Dentofacial Orthopaedics, University of Heidelberg, Heidelberg, Germany
| | - Serkan Sertel
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Heidelberg, Heidelberg, Germany.,ENT practice Prof. Sertel, Ludwigshafen am Rhein, Germany
| | - Marc Schmitter
- Department of Prosthodontics, University of Würzburg, Würzburg, Germany
| | - Hans J Schindler
- Department of Prosthodontics, University of Würzburg, Würzburg, Germany
| | - Christopher J Lux
- Department of Orthodontics and Dentofacial Orthopaedics, University of Heidelberg, Heidelberg, Germany
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15
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Dean D. The first medications in my TMD toolbox. Cranio 2020; 38:1-4. [DOI: 10.1080/08869634.2020.1691707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- David Dean
- Seattle Cancer Care Alliance, Fred Hutch-Seattle Children’s UW Medicine, Seattle, WA, USA
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16
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L'homme S, Piron A, Garcion C, Bianco A, Dieudonné P, Liesens S. Osteovox self-management concept study. Part 1: Focus on the population. Cranio 2019; 39:518-532. [PMID: 31566119 DOI: 10.1080/08869634.2019.1669319] [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: 10/25/2022]
Abstract
Objective: To analyze the prevalence of parafunctional behaviors in patients suffering from painful temporomandibular disorders (TMD) during the selection process of the study.Methods: This multidisciplinary study was based on seven selection criteria, of which the two main ones were parafunctions and symptomatology. The main clinical outcomes were (1) the type of TMD, (2) psychological symptoms, and (3) otological symptoms. From 409 consecutive examinations for TMD, 107 subjects met all criteria.Results: During the selection process, among the 409 subjects, 81.9% were diagnosed with parafunctions. After the selection process, among the 107 parafunctional subjects, pain (71%) was more disabling than functional limitations (29%). Most patients (74%) exceeded the thresholds of psychometric scales. Otological symptoms were observed in 52% of the subjects.Discussion: The study highlighted the importance of parafunctions and psychological factors in patients with painful TMD. Treatment should include all factors identified in this study (see Part 2).
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Affiliation(s)
| | - Alain Piron
- TMD, Private practice, Beyne-Heusay, Belgium
| | | | | | | | - Sébastien Liesens
- TMD, Multidisciplinary Medical Center Saivedent, Saive, Belgium.,TMD, Private practice, Beyne-Heusay, Belgium
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17
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L'homme S, Piron A, Pirard B, Thiry X, Sbarbaro M, Garcion C. Osteovox self-management concept study. Part 2: focus on the therapy. Cranio 2019; 40:23-32. [PMID: 31573875 DOI: 10.1080/08869634.2019.1672406] [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: 10/25/2022]
Abstract
Objective: To evaluate the effect of a self-management program on a population with both painful temporomandibular disorder (TMD) and parafunctional behaviors. Methods: One hundred-seven participants enrolled in a program called Osteovox Self-Management Concept (OSMC). The primary outcome measure was the overall relief (OR) based on four pain and three functional limitation parameters. The secondary outcome measures concerned parafunctional behaviors, compliance with treatment, and several psychological and otological symptoms. Results: The mean OR was 47% (standard deviation (SD): 28%) after 1 month, 72% (SD: 26%) after 3 months, and 77% (SD: 23%) after 6 months. Significant OR (i.e., 60%-100%) was observed in 80.11% of the patients. OR was strongly correlated with compliance. The OSMC efficiently reduced parafunctional behaviors and otological symptoms. Discussion: This study demonstrated that OSMC is an effective, simple, short, and inexpensive therapy. This type of treatment follows the international recommendations of using reversible treatment for TMD.
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Affiliation(s)
| | - Alain Piron
- TMD, Private Practice , Beyne-Heusay , Belgium
| | | | - Xavier Thiry
- TMD, Multidisciplinary Medical Center , Saive , Belgium
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18
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Takeuchi‐Sato T, Ono Y, Funato M, Sato H, Suganuma T, Baba K. Efficacy of an email‐based recording and reminding system for limiting daytime non‐functional tooth contact in patients with temporomandibular disorders: A randomized controlled trial. J Oral Rehabil 2019; 47:158-163. [DOI: 10.1111/joor.12875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/23/2019] [Accepted: 08/10/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Tamiyo Takeuchi‐Sato
- Division of Temporomandibular Disorders and Orofacial Pain, Department of Special Needs Dentistry Showa University School of Dentistry Ohta‐ku Japan
| | - Yasuhiro Ono
- Department of Prosthodontics Showa University School of Dentistry Ohta‐ku Japan
| | - Masahiko Funato
- Research Institute for Sport and Exercise Sciences Showa University Yokohama Japan
| | - Hitoshi Sato
- Department of Oral and Maxillofacial Surgery Showa University School of Dentistry Ohta‐ku Japan
| | - Takeshi Suganuma
- Division of Temporomandibular Disorders and Orofacial Pain, Department of Special Needs Dentistry Showa University School of Dentistry Ohta‐ku Japan
| | - Kazuyoshi Baba
- Department of Prosthodontics Showa University School of Dentistry Ohta‐ku Japan
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19
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Garrigós-Pedrón M, Elizagaray-García I, Domínguez-Gordillo AA, Del-Castillo-Pardo-de-Vera JL, Gil-Martínez A. Temporomandibular disorders: improving outcomes using a multidisciplinary approach. J Multidiscip Healthc 2019; 12:733-747. [PMID: 31564890 PMCID: PMC6732565 DOI: 10.2147/jmdh.s178507] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/16/2019] [Indexed: 12/19/2022] Open
Abstract
Patients with temporomandibular disorders (TMD) can become very complex. This article aims to highlight the importance of the multimodal and multidisciplinary approach in this type of patients to improve clinical outcomes. At present we have innumerable techniques and tools to approach this type of patients from a biopsychosocial model where active and adaptive type treatments are fundamental. There are various health professions that have competence in the treatment of TMD, however, although in the most complex cases should be treated simultaneously, still too many patients receive unique treatments and only from one point of view. This review exposes the treatments available from a clinical-scientific perspective and also emphasizes the importance of working in specialized units with those professionals who have competencies on the different conditions that may occur.
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Affiliation(s)
- Miriam Garrigós-Pedrón
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimeinto (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España.,CranioSPain Research Group, Instituto de Neurociencias y Ciencias del Movimeinto (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España
| | - Ignacio Elizagaray-García
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimeinto (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España.,CranioSPain Research Group, Instituto de Neurociencias y Ciencias del Movimeinto (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España
| | | | - José Luis Del-Castillo-Pardo-de-Vera
- CranioSPain Research Group, Instituto de Neurociencias y Ciencias del Movimeinto (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España.,Departamento de Cirugía Oral y Maxilofacilal, Hospital Universitario La Paz, Madrid, España
| | - Alfonso Gil-Martínez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimeinto (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España.,CranioSPain Research Group, Instituto de Neurociencias y Ciencias del Movimeinto (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España.,Departamento de Cirugía Oral y Maxilofacilal, Hospital Universitario La Paz, Madrid, España.,Departamento de Fisioterapia, Hospital Universitario La Paz, IdiPAZ, Madrid, España
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20
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Exposto FG, Arima T, Svensson P. Sleep Disorders and Chronic Orofacial Pain. CURRENT SLEEP MEDICINE REPORTS 2019. [DOI: 10.1007/s40675-019-00152-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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21
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Albano MG, d'Ivernois JF, de Andrade V, Levy G. Patient education in dental medicine: A review of the literature. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2019; 23:110-118. [PMID: 30556294 DOI: 10.1111/eje.12409] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 12/12/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION In dental medicine, chronic diseases and chronic conditions (such as chronic periodontitis, temporomandibular disorders, chronic orofacial pain) justify patient education to self-care. This strategy of secondary or tertiary prevention, even if officially recognised, is still less known compared to health education, a form of primary prevention. The aim of the study was to make the point of recent studies devoted to patient education. Thus, the purpose of the study was to give an updated picture of patient education in odontology, describing, through an analysis of the international literature from 2006 to 2016, its characteristics and development. METHODS The main databases selected were: PubMed, EMBASE, CINAHL, Web of Sciences, DOSS, 302 articles published between 2006 and 2016 on patient education among which four RCTs and a case study were analysed because of their rigorous scientific quality. RESULTS Patient education concerns chronic diseases and conditions also in the field of orthodontics. This limited number of studies, showed that patient education in odontology can bring real bio-clinic, cognitive, psychological and economic benefits to patients. Overall, it allows patients to better understand their illness and treatment and, thus, to improve their health behaviours and self-care techniques, which would reduce the treatment costs. Educational interventions in odontology should constitute a component of patient education in several chronic systemic diseases such as diabetes. It would be necessary to train future practitioners in this field and to develop a scientific research on this practice.
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Affiliation(s)
- Maria G Albano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Jean François d'Ivernois
- Health Education Laboratory EA3412, University Paris 13, Sorbonne Paris Cité, Bobigny Cedex, France
| | - Vincent de Andrade
- Health Education Laboratory EA3412, University Paris 13, Sorbonne Paris Cité, Bobigny Cedex, France
| | - Gérard Levy
- Health Education Laboratory EA3412, University Paris 13, Sorbonne Paris Cité, Bobigny Cedex, France
- Faculté de chirurgie dentaire, Paris Descartes University, Sorbonne Paris Cité, Montrouge, France
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Abstract
Temporomandibular disorder (TMD), a type of musculoskeletal pain, is a main cause of pain in the orofacial region. It involves the masticatory muscles, temporomandibular joints (TMJs), and associated structures. The most common signs and symptoms are pain, limited range of motion, and TMJ sounds. TMD is a highly prevalent condition with a multifactorial etiology. Management aims to reduce pain and to improve function using a combination of therapeutic options. Noninvasive techniques are the first option and should be indicated considering the needs of each individual, the clinical features, and the mechanisms involved.
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Affiliation(s)
- Giovana Fernandes
- Department of Dental Materials and Prosthodontics, Araraquara School of Dentistry, Univ Estadual Paulitsa, Humaitá, 1680 - Centro, Araraquara, São Paulo 14801-903, Brazil.
| | - Daniela A G Gonçalves
- Department of Dental Materials and Prosthodontics, Araraquara School of Dentistry, Univ Estadual Paulitsa, Humaitá, 1680 - Centro, Araraquara, São Paulo 14801-903, Brazil
| | - Paulo Conti
- Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Al Otavio P. Brisola 9-75, Bauru, São Paulo 17012-901, Brazil
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Abstract
Background Temporomandibular disorders (TMD) is an umbrella term for pain and dysfunction involving the masticatory muscles and the temporomandibular joints (TMJs). TMD is the most common orofacial pain condition. Its prominent features include regional pain in the face and preauricular area, limitations in jaw movement, and noise from the TMJs during jaw movements. TMD affects up to 15% of adults and 7% of adolescents. Chronic pain is the overwhelming reason that patients with TMD seek treatment. TMD can associate with impaired general health, depression, and other psychological disabilities, and may affect the quality of life of the patient. Assessment Evaluations indicate that the recently published Diagnostic Criteria for TMD (DC/TMD) are reliable and valid. These criteria cover the most common types of TMD, which include pain-related disorders (e.g., myalgia, headache attributable to TMD, and arthralgia) as well as disorders associated with the TMJ (primarily disc displacements and degenerative disease). As peripheral mechanisms most likely play a role in the onset of TMD, a detailed muscle examination is recommended. The persistence of pain involves more central factors, such as sensitization of the supraspinal neurons and second-order neurons at the level of the spinal dorsal horn/trigeminal nucleus, imbalanced antinociceptive activity, and strong genetic predisposition, which also is included in DC/TMD. Conclusion The etiology is complex and still not clearly understood, but several biological and psychosocial risk factors for TMD have been identified. Several studies indicate that patients with TMD improve with a combination of noninvasive therapies, including behavior therapy, pharmacotherapy, physical therapy, and occlusal appliances. More stringently designed studies, however, are needed to assess treatment efficacy and how to tailor treatment to the individual patient.
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Affiliation(s)
- Thomas List
- 1 Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.,2 Scandinavian Center for Orofacial Neurosciences (SCON), Malmö, Sweden.,3 Department of Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Rigmor Højland Jensen
- 4 Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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24
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Durham J, Al-Baghdadi M, Baad-Hansen L, Breckons M, Goulet JP, Lobbezoo F, List T, Michelotti A, Nixdorf DR, Peck CC, Raphael K, Schiffman E, Steele JG, Story W, Ohrbach R. Self-management programmes in temporomandibular disorders: results from an international Delphi process. J Oral Rehabil 2016; 43:929-936. [DOI: 10.1111/joor.12448] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2016] [Indexed: 11/27/2022]
Affiliation(s)
- J. Durham
- Centre for Oral Health Research & Institute of Health and Society; Newcastle-upon-Tyne Hospitals’ NHS Foundation Trust; Newcastle University; Newcastle-upon-Tyne UK
| | - M. Al-Baghdadi
- Oral Surgery Unit; Al-Noor Specialized Dental Care Centre; Iraqi Ministry of Health; Baghdad Iraq
| | - L. Baad-Hansen
- Section of Orofacial Pain and Jaw Function; Institute of Odontology and Oral Health; Aarhus University; Aarhus Denmark
| | - M. Breckons
- Institute of Health & Society; Newcastle University; Newcastle-upon-Tyne UK
| | - J. P. Goulet
- Faculty of Dental Medicine; Université Laval; Quebec QC Canada
| | - F. Lobbezoo
- Department of Oral Health Sciences; Academic Centre for Dentistry Amsterdam (ACTA); MOVE Research Institute Amsterdam; University of Amsterdam and VU University Amsterdam; Amsterdam The Netherlands
| | - T. List
- Department of Orofacial Pain and Jaw Function; Scandinavian Center for Orofacial Neurosciences (SCON); Faculty of Odontology; Malmö University; Malmö Sweden
| | - A. Michelotti
- Section of Orthodontics; Department of Neuroscience, Reproductive and Oral Sciences; University of Naples Federico II; Naples Italy
| | - D. R. Nixdorf
- Division of TMD and Orofacial Pain; School of Dentistry; University of Minnesota; Minneapolis MN USA
| | - C. C. Peck
- Faculty of Dentistry; The University of Sydney; Sydney NSW Australia
| | - K. Raphael
- New York University College of Dentistry; New York NY USA
| | - E. Schiffman
- Division of TMD and Orofacial Pain; School of Dentistry; University of Minnesota; Minneapolis MN USA
| | - J. G. Steele
- Centre for Oral Health Research & Institute of Health and Society; Newcastle-upon-Tyne Hospitals’ NHS Foundation Trust; Newcastle University; Newcastle-upon-Tyne UK
| | - W. Story
- Centre for Oral Health Research; Newcastle University; Newcastle-upon-Tyne UK
| | - R. Ohrbach
- Department of Oral Diagnostic Sciences; School of Dental Medicine; University at Buffalo; Buffalo NY USA
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