Comparison of Early Effectiveness of Three Different Intervention Methods in Patients with Chronic Orofacial Pain: A Randomized, Controlled Clinical Trial

Analysis of the Use of Sample Size and Effect Size Calculations in a Temporomandibular Disorders Randomised Controlled Trial-Short Narrative Review

BACKGROUND/OBJECTIVES

Temporomandibular disorder (TMD) is the term used to describe a pathology (dysfunction and pain) in the masticatory muscles and temporomandibular joint (TMJ). There is an apparent upward trend in the publication of dental research and a need to continually improve the quality of research. Therefore, this study was conducted to analyse the use of sample size and effect size calculations in a TMD randomised controlled trial.

METHODS

The period was restricted to the full 5 years, i.e., papers published in 2019, 2020, 2021, 2022, and 2023. The filter article type-"Randomized Controlled Trial" was used. The studies were graded on a two-level scale: 0-1. In the case of 1, sample size (SS) and effect size (ES) were calculated.

RESULTS

In the entire study sample, SS was used in 58% of studies, while ES was used in 15% of studies.

CONCLUSIONS

Quality should improve as research increases. One factor that influences quality is the level of statistics. SS and ES calculations provide a basis for understanding the results obtained by the authors. Access to formulas, online calculators and software facilitates these analyses. High-quality trials provide a solid foundation for medical progress, fostering the development of personalized therapies that provide more precise and effective treatment and increase patients' chances of recovery. Improving the quality of TMD research, and medical research in general, helps to increase public confidence in medical advances and raises the standard of patient care.

Effect of physiotherapeutic procedures on the bioelectric activity of the masseter muscle and the range of motion of the temporomandibular joints in the female population with chronic pain: a randomized controlled trial

INTRODUCTION

Physical therapy (PT) methods applied in dentistry are increasingly discussed nowadays. Taking into account a rapidly growing number of temporomandibular disorders (TMDs) and orofacial pain patients, it is reasonable to determine which of the available physiotherapeutic (PT) methods are more effective than others, especially in terms of their possible analgesic and myorelaxant effects.

OBJECTIVE

To assess manual and physical factors influencing pain reduction or elimination and increased muscle tension in patients with TMD; yet the influence of the applied forms of PT on the range of motion (ROM) of temporomandibular joints (TMJ).

MATERIAL AND METHODS

A randomized, parallel-group, RCT, single-blind, equi-randomized (1:1) study was conducted in DC/TMD Group Ib patients (20-45 years of age). An experimental group (G1, n = 104) and a control group without TMD (G2, n = 104) were created according to CONSORT guidelines. Diagnostic measurements were performed in both groups (mass sEMG, temporomandibular joint range of motion-ROM, pain intensity - NRS). Group G1 was randomly divided (envelope method) into 4 therapeutic groups, in which therapy was carried out for 10 days: magnetostimulation (MS), magnetoledotherapy (MLE), magnetolaserotherapy (MLA), manual therapy (MT). Each time after the therapy, ROM and NRS measurements were performed, and after the 5th and 10th day sEMG.

RESULTS

Statistically significant differences were found in the sEMG values of the masseter muscles, TMJ ROM and the pain intensity in G1 and G2 (p < 0.00). The largest decrease in sEMG (% MVC) of the masseter muscle occurred in the subgroup in which the manual therapy (MT) procedures were applied, p < 0.000. There was no clinically significant difference in and between other subgroups. There was a distinct mandible ROM increase noted in the MT group, with minimal changes in the MLA and MLE groups and no changes in the MS group. There was a clear increase in the lateral mobility of both right and left TMJ in the MT group. There were no differences in the course of the study in the MS group, and slight increases in the MLA and MLE groups. In the case of pain measurements, the greatest decrease in pain intensity was observed in the MT subgroup.

CONCLUSIONS

According to our results manual therapy is an effective form of treatment in patients with pain, increased masticatory muscle tension and limitation in mandible ROM. Dental physiotherapy should become an integral part of multimodal TMD patients' treatment.

Is acupuncture an effective treatment for temporomandibular disorder?: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Acupuncture is used for treating various disorders, but its effects on temporomandibular disorder (TMD) remain unclear. This study aimed to assess the effectiveness and safety of acupuncture for TMD via a systematic review of randomized clinical trials.

METHODS

A total of 11 Korean and worldwide databases were searched to identify acupuncture studies in adults with TMD. A Cochrane risk of bias assessment was performed on all articles; a meta-analysis, which involved the categorization according to the type of control used (inactive control, active control, or add-on), was subsequently performed. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation methodology.

RESULTS

The qualitative analysis of randomized clinical trials with acupuncture as the intervention included 32 articles, 22 of which were included in the quantitative analysis (471 participants). Acupuncture significantly improved outcomes (effect rate, relative risk [RR]: 7.00, 95% confidence interval [CI]: 1.91, 25, 62; visual analog scale, standardized mean difference: 0.49, 95% CI: 0.24, 0.73) versus active controls (effect rate, RR: 1.19; 95% CI: 1.12, 1.27). In the analysis of add-ons, acupuncture significantly improved the effect rate and pain intensity (effect rate, RR: 1.36; 95% CI: 1.04, 1.77; visual analog scale, mean difference: -1.23; 95% CI -1.79, -0.67). However, the quality of evidence was determined to range from low to very low.

CONCLUSION

Acupuncture in TMD significantly improved outcomes versus active controls and when add-on treatments were applied. However, as the quality of evidence was determined to be low, well-designed clinical trials should be conducted in the future.

Evaluation of the efficacy of manual soft tissue therapy and therapeutic exercises in patients with pain and limited mobility TMJ: a randomized control trial (RCT)

The limited number of randomized controlled trials (RCTs) comparing the efficacy of soft tissue manual therapy and self-therapy interventions prompted the authors to focus on the analgesic and myorelaxant use of massage, post-isometric muscle relaxation (PIR) and therapeutic exercise in TMD patients.

OBJECTIVES

To evaluate the effectiveness of soft tissue therapy and therapeutic exercises in female patients with pain, increased masseter muscle tension and limited mandibular mobility.

MATERIAL AND METHODS

The study was conducted on a group of 82 women (G1) with the Ib disorder diagnosed in DC/TMD (Ib-myofascial pain with restricted mobility). The control group (G2) consisted of 104 women without diagnosed TMDs (normal reference values for TMJ ROM and masseter muscle sEMG bioelectric activity). Diagnostic procedures were performed in both groups (sEMG of the masseter muscles at baseline and during exercise, measurement of TMJ mobility, assessment of pain intensity-NRS scale). The G1 group was randomly divided into 3 therapeutic groups in which the therapy was carried out for 10 days: therapeutic exercises (TE), manual therapy - massage and therapeutic exercises (MTM_TE), manual therapy - PIR and therapeutic exercises (MTPIR_TE). Each time after therapy, the intensity of pain and TMJ mobility were assessed. Sealed, opaque envelopes were used for randomization. After 5 and 10 days of therapy, bilateral sEMG signals of the masseter muscles were acquired.

RESULTS

Massage, PIR and self-therapy led to a decrease in sEMG at rest as well as in exercise. After day 6 of therapy, the groups obtained a significant difference (p = 0.0001). Each of the proposed forms of therapy showed a minimal clinically significant difference (MID) in the sEMG parameter at the endpoint, with the most considerable difference in the MTM_TE group. The forms of MT used were effective in reducing the patients' pain intensity; however, a significant difference between therapies occurred after 4 treatments (p = 0.0001). Analyzing the MID between methods, it was observed that self-therapy had an analgesic effect only after 8 treatments, while PIR after 3 and massage after 1 treatment. After day 7, the mean pain score in the MTM_TE group was 0.889 and in the TMPIR_TE group was 3.44 on the NRS scale. In terms of MMO, a significant difference was obtained between monotherapy and each form of TM, i.e. massage (p = 0.0001) and PIR (p = 0.0001). Analyzing mandibular lateral movements, the authors got a significant difference in the proposed MT forms, of which massage treatments exceeded the effectiveness of PIR.

CONCLUSIONS

Soft tissue manual therapy and therapeutic exercise are simple and safe interventions that can potentially benefit patients with myogenic TMDs, with massage showing better analgesic effects than PIR.

Korean Medicine Clinical Practice Guideline Update for Temporomandibular Disorders: An Evidence-Based Approach

Many updated clinical research results have been published since the Korean Medicine Clinical Practice Guidelines (KMCPGs) for temporomandibular disorders (TMDs) were published in 2018. Therefore, it is necessary to update the existing clinical practice guidelines (CPGs). This study presents updated recommendations for TMD treatment based on current research data published up to February 2020. The draft version of the level of evidence and grade of recommendation was determined through an assessment of the risk of bias and a meta-analysis of selected literature based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). The final guidelines were derived using the Delphi method. Eighteen recommendations were derived for eight items of Korean medicine treatment for TMDs. Compared with previous Korean medicine CPGs for TMDs, the grades of seven recommendations, including acupuncture, pharmacopuncture, and Chuna manual therapy, were increased. The grades of the two recommendations have been changed. Six new recommendations were added to fully reflect clinical reality. Acupuncture, pharmacopuncture, and Chuna manual therapy are recommended for TMD patients in clinical practice. Concurrent conventional conservative therapy with Korean medicine or a combination of Korean medicines should be considered in clinical practice in patients with temporomandibular disorders.

Efficiency of occlusal splint therapy on orofacial muscle pain reduction: a systematic review

BACKGROUND

This systematic review aims to examine the existing original studies to determine the effectiveness of occlusal splints (OSs) in the management of orofacial myalgia and myofascial pain (MP) in comparison with no treatment or other interventions.

MATERIALS AND METHODS

Based on the inclusion and exclusion criteria of this systematic review, randomized controlled trials were qualified, in which the effectiveness of occlusal splint therapy in the management of muscle pain was examined in comparison with no treatment or other interventions. This systematic review was conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020. The authors searched three databases (PubMed, CINAHL (The Cumulative Index to Nursing and Allied Health Literature) and Scopus) for English publications published between January 1, 2010, and June 1, 2022. The last database search was carried out on June 4, 2022. Data were extracted from the included studies and assessed for risk of bias using the revised Cochrane risk-of-bias tool for randomized trials.

RESULTS

Thirteen studies were identified for inclusion in this review. In total, 589 patients were diagnosed with orofacial muscle pain who underwent education and various forms of therapy including different types of OSs, light emitting diode therapy, acupuncture, low-level laser therapy, device-supported sensorimotor training, Kinesio Taping, myofunctional therapy, and physical therapy. All studies included demonstrated a high risk of bias.

CONCLUSIONS

There is insufficient evidence regarding whether OS therapy in the treatment of orofacial myalgia and MP offers an advantage over other forms of interventions or no treatment. Further reliable clinical studies in this area are needed to improve the quality of research, which should be performed with larger groups of blinded respondents and controls.

CLINICAL RELEVANCE

Due to the large-scale nature of orofacial muscle pain, it is assumed that each dental clinician will meet patients with orofacial muscle pain repeatedly in daily practice; hence, the review of the effectiveness of OSs in the management of orofacial myalgia and MP is necessary.

The effect of systemic versus local transcutaneous laser therapy on tension-type cephalea and orofacial pain in post-COVID-19 patients: A pragmatic randomized clinical trial

INTRODUCTION

Orofacial pain and tensional cephalea were symptoms commonly reported in COVID-19 patients, even after recovery, and were considered chronic pain in these cases. The aim of this research is to evaluate the effect of the application of photobiomodulation with red and infrared lasers applied locally and systemically.

METHODS AND ANALYSIS

For this purpose, individuals who have been diagnosed with COVID-19 and have had a tension headache and/or orofacial pain for more than 3 months will be selected by convenience. The participants will be divided into two different groups: G1-photobiomodulation with red and infrared laser with local application on the pain points (808 nm and 660 nm, 100 mW, 6 J per point) and G2-photobiomodulation with red laser with transcutaneous application on the radial artery (660 nm, 100 mW, 30 minutes). All participants will be treated for a period of 4 weeks, with 8 application sessions. The effects will be measured by means of blood lactate level, Brief Pain Inventory, Visual Analog Scale (VAS), and Cephalea Impact Test. The data will be collected weekly before and after the treatment, and the following tests will be applied: Analysis of variance (ANOVA), Tukey paired t test, Kruskal-Wallis, or Wilcoxon, according to data distribution. α = 0.05 will be considered as the level of statistical significance.

ETHICS AND DISSEMINATION

This study was approved by the Research Projects Committee of the Nove de Julho University (approval number 4.673.963). Results will be disseminated through peer-reviewed journals and events for the scientific and clinical community, and the general public. It is registered in the ClinicalTrials.gov database with the number NCT05430776.

Does combined individualized orofacial manual therapy, pain neuroscience education, and brain training change orofacial pain, chronic face dysfunction, (facial) body perception and pain? An observational mixed methods case series study

BACKGROUND

Orofacial pain is a complex disabling condition. Multimodal physical therapy intervention may be helpful, yet studies of such approaches are not available and are the basis of this study.

OBJECTIVE

To identify whether combined orofacial manual therapy, pain neuroscience education, graded motor imagery, and face emotional expression training has an impact on orofacial pain and associated features.

DESIGN

Mixed-methods case series report.

METHODS

Eight subjects (five females) with predominant chronic unilateral face pain (mean duration 7.3 years) were given six individualized treatment sessions and a home program. The primary outcome was orofacial pain, while secondary outcomes were depression, quality of life, alexithymia, 2-point discrimination (TPD), laterality and emotional recognition, as well as qualitative analysis were evaluated post intervention.

RESULTS

Following the intervention orofacial pain intensity significantly reduced (p = 0.03) from 3.0 (0.53) to 2.2 (1.75) on the Graded Chronic Pain Status questionnaire. As well, secondary outcome measures depression, alexithymia, TPD, and quality of life also significantly improved. Changes were not significant in aspects of facial perception. Qualitative analysis of perception of therapy is discussed.

CONCLUSION

Multimodal therapy had a positive outcome in terms of improvement in unilateral persistent facial pain, depression score, facial body perception and quality of life, and pain in people with chronic unilateral facial pain. Based on the qualitative analysis of their perception of the therapy, multimodal therapy had beneficial effects through increased motivation and joy to exercise.

Effectiveness of Curcumin in Reducing Self-Rated Pain-Levels in the Orofacial Region: A Systematic Review of Randomized-Controlled Trials

The aim was to systematically review randomized controlled trials (RCTs) that assessed the effectiveness of curcumin in reducing self-rated pain levels in the orofacial region (OFR). The addressed focused question was “Is curcumin effective in reducing self-rated pain levels in the OFR?”. Indexed databases (PubMed (National Library of Medicine), Scopus, EMBASE, MEDLINE (OVID), and Web of Science) were searched up to and including February 2022 using different keywords. The inclusion criteria were (a) original studies (RCTs) in indexed databases; and (b) studies assessing the role of curcumin in the management of pain in the OFR. The risk of bias was assessed using the Cochrane risk of bias tool. The pattern of the present systematic review was customized to primarily summarize the pertinent information. Nineteen RCTs were included. Results from 79% of the studies reported that curcumin exhibits analgesic properties and is effective in reducing self-rated pain associated with the OFR. Three studies had a low risk of bias, while nine and seven studies had a moderate and high risk of bias, respectively. Curcumin can be used as an alternative to conventional therapies in alleviating pain in the OFR. However, due to the limitations and risk of bias in the aforementioned studies, more high-quality RCTs are needed.

Post-Operative Endodontic Pain Management: An Overview of Systematic Reviews on Post-Operatively Administered Oral Medications and Integrated Evidence-Based Clinical Recommendations

Endodontic treatment comprises the overall management of pre-, intra- and post-operative symptoms, including post-operative endodontic pain, considered as a complication susceptible of chronicization. Post-operative pain is very common and highly unpreventable and has a multi-factorial etiology and a potential pathogenic link to the acute inflammation of the periapical area, secondary to localized chemical, mechanical, host and/or microbial damage occurring during endodontic treatment. Considering the multitude of heterogeneous technical and pharmacological approaches proposed to control post-operative endodontic pain, the present study primarily comprised an overview of systematic reviews of systematic reviews of randomized clinical trials, summarizing findings on post-operatively administered oral medications for post-operative endodontic pain control, in order to note the most effective type and dosage of such drugs. Secondarily, a narrative review of the current evidence on technical solutions to be observed during endodontic treatment procedures, to control post-operative pain, was conducted to provide integrated evidence-based clinical recommendations for optimal post-operative endodontic pain management.

Nonpharmacological Interventions for Pain in Patients with Temporomandibular Joint Disorders: A Systematic Review

This systematic review aimed to compare the efficacy of nonpharmacological therapies for painful temporomandibular joint disorders. The protocol was registered on International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42020171364). The search was performed on the electronic databases PubMed, Google Scholar, Clinical Trials, and Web of Science. The eligibility criteria were randomized controlled trials in patients diagnosed with painful temporomandibular joint disorders comparing the pain relief between conventional treatment and nonpharmacological therapies such as acupuncture, physiotherapy, low-level laser, and massage. Fourteen articles were included in this review. At the overall bias of the studies included, 71.42% exhibited some concerns and 28.57% had high risk. The efficacy of nonpharmacological interventions was found to be moderate in the short term and variable in the long term for pain reduction in patients with temporomandibular joint disorders. The evidence pointed out that acupuncture, laser therapy, and physiotherapy are potentially useful interventions for pain relief in patients with temporomandibular joint disorders. However, there is a lack of consistency and short-term follow-up in the studies to determine the lasting of such effect.

Cranio-Mandibular Disorders after Whiplash Injury: A Mono-Institutional Clinical Study on 31 Patients

BACKGROUND

Whiplash is a consequence of traumatic injuries, mostly related to road accidents, with variable clinical manifestations, also known as Whiplash Associated Disorders, such as neck, head and temporo-cranio-mandibular pain.

METHODS

The current study aims to evaluate the onset and evolution of temporomandibular joint pain in people with whiplash in a study group treated with the use of Zimmer Collars (adjustable rigid cervical collars for neck immobilization), as compared to a control group. This prospective study included 31 patients followed by the Dental Prosthesis Department of the University of Bari "Aldo Moro": 20 patients with whiplash (age range: 20-39 years) treated with Zimmer collars and 11 patients with whiplash (age range: 20-33 years) who were not. Immediately after the whiplash occurred, a visual analogue scale (VAS) was used to describe the intensity of pain and to complete the chart of the European Academy of Craniomandibular Disorders. Five out of twenty patients, already treated with a Zimmer collar, wore an occlusal splint as well because of persistent pain reported at the 28-day and 60-day follow-up and were supported by pharmacological therapy with analgesics (paracetamol) and muscle relaxants (thiocolchicoside).

RESULTS

During the last follow-up (at six months), three out of five patients displayed a residual VAS score of 3, 4, and 5, respectively, while the remaining two displayed a VAS of 0. In the control group, four out of eleven patients needed to wear an occlusal splint but without muscle relaxants and analgesics pharmacological therapy; these four corresponded to the patients showing a residual painful symptomatology, with VAS reaching value of 2, and also were the oldest patients of the group. Data regarding VAS values and Zimmer collar use, both at the first visit and six months later, were statistically analyzed.

CONCLUSION

Our prospective study highlights how whiplash-associated acute disorders are often self-limiting over a period of few months, thus reducing the possibility of symptom chronicity; the latter seems to be strictly related to lesion severity, pre-existence of a craniomandibular dysfunction and patient age, but appears to be independent from Zimmer collar use, as statistically confirmed.

The Importance of Type D Personality in the Development of Temporomandibular Disorders (TMDs) and Depression in Students during the COVID-19 Pandemic

Background: a type D personality is a factor in a person’s susceptibility to general mental stress, especially during the COVID-19 pandemic. Although many studies were conducted on the relationships among stressful situations, an individual’s personality, depression, and the occurrence of various diseases, e.g., cardiovascular disease or cancer, there are no analogous data on people with temporomandibular disorders (TMDs). Aim: the assessment of TMDs and depression symptoms in students with type D personality. Material and Methods: the research was carried out with the participation of 240 physiotherapy students. The study group (G1) consisted of 120 participants with type D personalities, the control group (G2) consisted of the same number of participants, without “stress” personalities. All subjects were assessed for the occurrence of TMD symptoms, as well as for depression and anxiety symptoms, using the Beck Depression Inventory (BDI), based on the proprietary questionnaire. Results: in students with type D personality symptoms, TMDs occurred significantly more often and in greater number (p = 0.00) than in those without stress personalities. The exception was the symptom of increased muscle tension, which showed no statistical difference (p = 0.22). Among the 240 respondents, depression was found in 128 people (53.3%). In the group of students with type D personalities, depression was significantly more frequent than in the group without type D personalities (p = 0.00). In participants with depression, TMD symptoms were more common, i.e., headaches, neck, and shoulder girdle pain, TMJ acoustic symptoms, increased masticatory muscle tension, teeth clenching, and teeth grinding. There was no significant difference between the incidence of depression and TMJ pain and jaw locking. There was a significant interaction between the occurrence of headaches and acoustic symptoms and the occurrence of depression. For headache and depression interactions, the OR was >1; based on the results, we may assume that a headache depends more on the occurrence of depression rather than it being a symptom of a TMJ disorder in people with type D personalities. Conclusion: type D personality and depression may contribute to the development of TMD symptoms.

A Comparative Study of the Effectiveness of Pharmacopuncture Therapy for Chronic Neck Pain: A Pragmatic, Randomized, Controlled Trial

BACKGROUND

This two-arm, parallel, pragmatic, multicenter, clinical randomized, controlled trial with a 12-week follow-up period aimed to compare the effectiveness of pharmacopuncture therapy and physical therapy strategies for chronic neck pain.

METHODS

Eight sessions of pharmacopuncture therapy or physical therapy were administered within 2 weeks. The primary outcome was the visual analogue scale (VAS) score for neck pain. The secondary outcomes were the scores of the Northwick Park questionnaire (NPQ), VAS score for radiating arm pain, numeric rating scale (NRS) for neck and arm bothersomeness, neck disability index (NDI), patient global impression of change (PGIC), 12-item short form health survey (SF-12), and EuroQoL 5-dimension 5-level (EQ-5D-5L) instrument. The protocol was registered with Clinicaltrials.gov (NCT04035018) and CRIS (KCT0004243).

RESULTS

We randomly allocated 101 participants with chronic neck pain to the pharmacopuncture therapy (n = 50) or physical therapy group (n = 51). At the primary endpoint (week 5) the pharmacopuncture therapy group showed significantly superior effects regarding VAS score for neck pain and arm bothersomeness, NRS for neck pain, NDI, NPQ, and PGIC compared with the physical therapy group. These effects were sustained up to 12 weeks after follow-up.

CONCLUSION

Compared with physical therapy, pharmacopuncture therapy had superior effects on the pain and functional recovery of patients with chronic neck pain.

Electroacupuncture for Temporomandibular Disorders: A Systematic Review of Randomized Controlled Trials

Although electroacupuncture (EA) is an effective treatment for pain relief, there has been no systematic review of EA treatment for temporomandibular disorder TMD. This systematic review aimed to evaluate the efficacy and safety of EA in TMD management. We searched 14 databases until April 2021 for randomized controlled trials (RCTs) evaluating the effects of EA on TMDs. Eleven RCTs with 667 patients that used three acupuncture points (ST6, ST7, and LI4) were included. Two RCTs reported significant effects of EA plus microwave treatment compared with EA treatment alone on the total effectiveness rate (TER) for TMD. Further, two studies reported that compared with ultrashort wave alone, EA plus ultrashort wave had a significant effect on the TER for TMD and visual analog scale. All RCTs did not report adverse events. Our findings demonstrated the positive potential of EA in TMD management. However, there was weak evidence regarding EA use for TMD management given the poor quality and small sample sizes of the included studies. In the future, well-designed RCTs are required. It is necessary to investigate clinical trials and systematic reviews to compare the effectiveness and safety of EA and acupuncture for TMD.

COL5A1 RS12722 Is Associated with Temporomandibular Joint Anterior Disc Displacement without Reduction in Polish Caucasians

Numerous reports describe the association between the single-nucleotide polymorphism (SNP) rs12722 and rs13946 in the COL5A1 gene and injuries, such as Achilles tendon pathology, anterior cruciate ligament (ACL) injuries, and tennis elbow. Hence, there were no studies investigating COL5A1 and temporomandibular joint (TMJ) pathology. The aim of this study is to evaluate the relationship between COL5A1 rs12722 and rs13946 SNPs and TMJ articular disc displacement without reduction (ADDwoR). In this case-control study, the study group consisted of 124 Caucasian patients of both sexes. Each patient had a history of ADDwoR no more than 3 months prior. The control group comprised 126 patients with no signs of TMD according to DC/TMD. Genotyping of the selected SNPs was performed by real-time PCR using TaqMan probes. The significance of the differences in the distribution of genotypes was analyzed using Pearson’s chi-square test. Logistic regression modeling was performed to analyze the influence of the 164 investigated SNPs on ADDwoR. The COL5A1 marker rs12722 turned out to be statistically significant (p-value = 0.0119), implying that there is a difference in the frequencies of TMJ ADDwoR. The distribution of rs12722 SNPs in the study group TT(66), CC(27), CT(31) vs. control group TT(45), CC(26), CT(51) indicates that patients with CT had an almost 2.4 times higher likelihood of ADDwoR (OR = 2.41) than those with reference TT (OR = 1), while rs13946 genotypes were shown to be insignificant, with a p-value of 0.1713. The COL5A1 rs12722 polymorphism is a risk factor for ADDwoR in the Polish Caucasian population.

Efficacy of Manual Therapy and Transcutaneous Electrical Nerve Stimulation in Cervical Mobility and Endurance in Subacute and Chronic Neck Pain: A Randomized Clinical Trial

Neck pain is a frequent health problem. Manual therapy (MT) and transcutaneous electrical nerve stimulation (TENS) are recommended techniques for treatment of mechanical neck disorders (MND) in Spanish Public Primary Care Physiotherapy Services. The aim of this study was to compare the efficacy of MT versus TENS in active mobility and endurance in cervical subacute or chronic neck pain. Ninety patients with MND were randomly allocated to receive ten 30-min sessions of either MT or TENS, in a multi-centered study through 12 Primary Care Physiotherapy Units in the Madrid community. Active cervical range of motion (CD-ROM) and endurance (Palmer and Epler test) were evaluated pre- and post-intervention and at 6-month follow-up. A generalized linear model of repeated measures was constructed for the analysis of differences. Post-intervention MT yielded a significant improvement in active mobility and endurance in patients with subacute or chronic MND, and at 6-month follow-up the differences were only significant in endurance and in sagittal plane active mobility. In the TENS group, no significant improvement was detected. With regard to other variables, MT improved mobility and endurance more effectively than TENS at post-intervention and at 6-month follow-up in the sagittal plane. Only MT generated significant improvements in cervical mobility and endurance in the three movement planes.

TMD in Females with Menstrual Disorders

BACKGROUND

Temporomandibular disorders (TMD) are a common reason for patients to present at dental offices. The majority of people with TMD are women between the age of 20 and 40 years. The purpose of this study was to assess the types and prevalence of temporomandibular disorders in female patients of reproductive age with menstrual disorders.

MATERIALS AND METHODS

The study involved 65 females of reproductive age (18-40 years, an average of 28.00 ± 6.27 years). The women who qualified for the study were patients of the University Center for Maternal and Newborn's Health hospitalized because of infertility or menstrual cycle disorders. Women with confirmed estrogen metabolism disorders participated in a clinical study with the use of Diagnostic Criteria for Temporomandibular Disorders (DC/TMD).

RESULTS

In the studied female patients with menstrual disorders, temporomandibular disorders (92.3%) were frequent occurrences. The most common type was intra-articular joint disorders (68%). Other reported complaints included masticatory muscle pain (44.62%), and degenerative joint diseases (12.3%).

CONCLUSIONS

1. In women with menstrual disorders, TMD may exist. 2. In women with TMD symptoms, their medical history should be extended to include the diagnosis of female hormone disorders.

Influence of Cognitive Orientation and Attentional Focus on Pain Perception

Background. Recently, a growing interest has emerged in the role of attention and hypervigilance in the experience of pain. Shifting attention away from pain seems likely to reduce the perception of pain itself. Objectives. The present study has been designed to test the following overall hypotheses: (1) disposition to catastrophize, self-efficacy perceived in pain resistance (task self-efficacy), previous experiences concerning the tolerance of physical pain, and degree of impulsiveness are significant predictors of the decision to abandon a painful test such as the cold pressor test (CPT); (2) the manipulation of the attentive focus (internal or external) can influence the level of perceived pain. Methods. Effects of the manipulation of attentional focus (internal and external) on pain perception and response of trial abandonment were evaluated in a sample of university students (n = 246) subjected to the cold pressor test. Results. A significant effect (p < 0.05) was found through a test–retest comparison on the final level of perceived pain among subjects who had received instruction to externalize the focus of their attention (mixed factorial analysis of variance), but no significance was observed with respect to the decision to abandon the experiment. A general explanatory model of the abandonment behavior demonstrating overall good fit measurements was tested too. Conclusion. The abandonment of tests has been shown to be predicted mainly by catastrophic attitude. Attentive impulsiveness showed a further positive effect on catastrophic attitude. Perceived self-efficacy in the tolerance of pain limited learned helplessness, which in turn positively influenced catastrophizing.

Comparative Evaluation of Occlusion before and after Soft Tissue Mobilization in Patients with Temporomandibular Disorder-Myofascial Pain with Referral

The aim of the study was to evaluate occlusal parameters in patients with myofascial pain with referral before and after soft tissue mobilization. The study group consisted of 50 people (37 females and 13 males, average age 23.36 ± 2.14 years) diagnosed with myofascial pain with referral. All patients underwent triplicate soft tissue mobilization. Occlusal parameters were evaluated six times, before and after each treatment, using T-scan III. A decreasing tendency of the occlusion time was observed after the first, second, and third therapy. After the third treatment, the mean occlusion time in the entire study group was 0.119 s. The 1st soft tissue mobilization shortened both right and left disclusion times to 0.181 s and 0.185 s, respectively. After the third treatment, these parameters amounted to 0.159 s and 0.165 s, respectively. The Friedman test for the entire study group indicated that soft tissue mobilization altered the occlusion time and both disclusion times (p < 0.05). In conclusion, soft tissue mobilization affects biotensegrity of the masticatory system, thus modifying occlusal parameters. The occlusion time and both disclusion times cannot be considered as cofactors of the existing temporomandibular disorders-myofascial pain with referral.

Pressure Algometry Evaluation of Two Occlusal Splint Designs in Bruxism Management-Randomized, Controlled Clinical Trial

The aim of this pilot study was to evaluate the short-term effectiveness of two different occlusal devices and their impact on the pressure pain threshold (PPT) values among patients who reported to the Dental Prosthetics Outpatient Clinic of Pomeranian Medical University (Szczecin, Poland) and who were diagnosed with probable bruxism. Two groups were formed (A and B) to which patients were assigned randomly. Each group used a different occlusal splint for bruxism management. The occlusal appliance by Okeson, or the bimaxillary splint, was used overnight by each patient for 30 days of the study. The PPT was measured twice, at the first visit and after 30 days of using each occlusal device, with Wagner Paintest FPX 25 algometer. Bruxism was diagnosed based on data from the patient's medical history and from the physical examination. Nocturnal Bruxism Criteria according to the International Classification of Sleep Disorders (Third Edition) was used for the patient's evaluation. Results: similar pain factor (PF) reduction was observed in both the examined groups, regardless of the device used; canine guidance and no guidance were similarly effective in terms of increasing pain resilience.

Effect of botulinum toxin on quality of life of patients with chronic myofascial pain

Aim: This prospective controlled clinical study aimed to evaluate the effect of botulinum toxin Type A (BTX-A) on pain control and quality of life (QoL) in patients with chronic myofascial pain. Materials & methods: Patients with chronic myofascial pain were randomly divided into two groups (n = 20): counseling and self-care and Michigan-type occlusal splint (MOS) (CG-control group) or BTX-A injection (BTX-AG). The pain was evaluated with visual analogue scale and QoL with the oral health impact profile-14 (OHIP-14) questionnaire. Results: In both groups, the pain was reduced, and QoL improved after 30 days. The results of social disability and handicap were better for patients treated with counseling and self-care and MOS. Conclusion: Minimally invasive strategies and BTX-A application improved QoL and alleviated myofascial pain.

The Effects of Prednisone/Ketoprofen Administration in Association with Amoxicillin Clavulanate Following Periodontal Surgical Therapy in Patients with Severe Chronic Periodontitis

Background and Objectives: The aim of this study was to evaluate and compare the effects of two different anti-inflammatory drugs (ketoprofen and prednisone) combined with an antibiotic (amoxicillin + clavulanic acid) and periodontal surgery on dental and periodontal parameters in patients with severe chronic periodontitis. In addition, salivary stress expressed by cortisol levels was assessed. Materials and Methods: An interventional study was performed on 22 periodontal subjects and 19 clinical healthy controls. The patients were divided in four groups, depending on treatment planning, as follows: eight patients received prednisone and antibiotherapy, associated with surgical periodontal therapy; seven patients received ketoprofen and antibiotherapy, associated with surgical periodontal therapy (group II); seven patients received only prednisone. Periodontal healthy patients underwent routine scaling and polishing. Bleeding on probing (BOP), dental mobility and salivary cortisol (ng/mL) were assessed before and after treatment. The means and standard deviations for the salivary cortisol levels (SCLs), dental and periodontal parameters were calculated for all groups using each patient as a unit of analysis. Results: Data analyses showed that the two different anti-inflammatory drugs associated with or without surgical therapy were efficient on inflammation periodontal parameters (BOP, dental mobility). Prednisone treatment alone was associated with a significant decrease of SCLs between pretreatment and post-treatment. Conclusions: In the present study, the effects of either of the anti-inflammatory drugs on inflammation evolution and salivary stress were comparable in patients undergoing antibiotherapy and surgical periodontal therapy.

Orally Administered NSAIDs-General Characteristics and Usage in the Treatment of Temporomandibular Joint Osteoarthritis-A Narrative Review

Background: Temporomandibular joint osteoarthritis (TMJ OA) is a degenerative joint disease. The aim of this review was to present the general characteristics of orally administered nonsteroidal anti-inflammatory drugs (NSAIDs) and to present the efficacy of NSAIDs in the treatment of TMJ OA. Methods: PubMed database was analyzed with the keywords: "(temporomandibular joint) AND ((disorders) OR (osteoarthritis) AND (treatment)) AND (nonsteroidal anti-inflammatory drug)". After screening of 180 results, 6 studies have been included in this narrative review. Results and Conclusions: Nonsteroidal anti-inflammatory drugs are one of the most commonly used drugs for alleviation of pain localized in the orofacial area. The majority of articles predominantly examined and described diclofenac sodium in the treatment of pain in the course of TMJ OA. Because of the limited number of randomized studies evaluating the efficacy of NSAIDs in the treatment of TMJ OA, as well as high heterogeneity of published researches, it seems impossible to draw up unequivocal recommendations for the usage of NSAIDs in the treatment of TMJ OA. However, it is highly recommended to use the lowest effective dose of NSAIDs for the shortest possible time. Moreover, in patients with increased risk of gastrointestinal complications, supplementary gastroprotective agents should be prescribed.