Masticatory sensory-motor changes after an experimental chewing test influenced by pain catastrophizing and neck-pain-related disability in patients with headache attributed to temporomandibular disorders

Hypoalgesic and Motor Effects of Neural Mobilisation versus Soft-Tissue Interventions in Experimental Craniofacial Hyperalgesia: A Single-Blinded Randomised Controlled Trial

Objective: The present trial aimed to compare the effects of the mobilisation of the nervous system (NS) to those of a soft-tissue intervention in subjects exposed to an experimentally induced hyperalgesia of the masticatory muscles. Methods: The study was a single-blinded randomised controlled trial. A total of 49 participants (mean ± SD age: 41 ± 11 years; 61% female) with latent myofascial trigger points (LMTrPs) in the craniofacial region were randomly assigned to one of three groups: neural mobilisation (NM), soft-tissues techniques and stretching (STT-S), and control group (CG). An initial assessment (baseline) was performed before the provocation chewing masticatory test. The pre-treatment measurements were registered 24 h later. Next, the randomised intervention was applied, and afterwards, post-treatment data were obtained. Outcome measures included pain-free maximum mouth opening (MMO), pressure pain thresholds (PPTs) in the trigeminal and cervical region, and trigeminal and cervical two-point discrimination (TPD). Results: ANOVA revealed significant differences for the time × group interaction for pain-free MMO and PPTs. The results showed an improvement in the MMO and the PPTs for NM and STT-S groups but not for the CG. There were no differences between the NM and STT-S groups. However, the effect sizes were large for the NM and medium for the STT-S. No differences were found for TDP between groups nor over time. Conclusions: The results show that with NM and STT-S techniques, we could influence motor and sensory variables in asymptomatic subjects with LMTrPs after a masticatory provocation test. Both techniques increased MMO and PPTs in the short term. These beneficial effects lead us to consider the importance of including these methods in clinical practice.

Mini-Anchors to Surgically Treat the Chronic Mandibular Dislocation

PURPOSE

Evaluate the feasibility of using mini-anchors for the treatment of chronic mandibular dislocation and to identify the variables that affect the success of this approach.

PATIENTS AND METHODS

A retrospective cohort study evaluated 9 patients with bilateral recurrent dislocation of the mandible (18 operated joints), treated by a mandibular translation control system using the mini-anchor technique. Data was collected using a Visual Analog Scale (VAS) for subjective parameters and measurements for objective parameters prior to surgery (T1) and at the longest available follow-up (T2) with a minimum of a 12 months interval. Patients subjectively rated their facial pain/headache, jaw function, disability, temporomandibular joint (TMJ) pain and diet. Objective functional changes were determined by measuring the interincisal opening and lateral excursions at T1 and T2.

RESULTS

Significant subjective improvements in pain and dysfunction (89 to 94%) were observed (P < .01) from T1 to T2 in all parameters. The comfortable and guarded interincisal opening without mandibular dislocation increased by 41%, the maximum interincisal opening reduced 12 mm, and lateral excursions improved by 43%.

CONCLUSIONS

Patients with recurrent mandibular dislocations with or without disc dislocation can be treated effectively by the mini-anchor translation control system.

Smartphone addiction and the relationship with head and neck pain and electromiographic activity of masticatory muscles

BACKGROUND

Excessive use of smartphones may be associated with behavioral and physical health changes and might cause musculoskeletal alterations in the head and neck region.

OBJECTIVE

To evaluate the prevalence of smartphone addiction in college students and its correlation with symptoms of head and neck pain and masticatory and trapezius muscle activity while resting, before and after smartphone use.

METHODS

Twenty university students participated in the study. They answered the Smartphone Addiction Scale and the Fonseca Anamnestic Index. Next, the participants were seated and prepared for electromyography through the placement of surface electrodes on the masseter, temporal, and trapezius muscles. Rest condition data were collected for 10 seconds before and after 30 minutes of smartphone use.

RESULTS

The results showed that 35% of the evaluated individuals were classified as smartphone addicted and 35% reported no head or neck pain in the previous 30 days. There was no association between smartphone use and head and neck pain. In the electromyography, there was an increase in RMS values after smartphone use in the right and left masseter muscles and the left trapezius.

CONCLUSION

College students presented a high prevalence of smartphone addiction and head and neck pain, but these were not statistically associated. There was a change in muscle activity only in the right trapezius muscles before and after 30 minutes of smartphone use. These findings are contrary to the current belief that the use of smartphones correlates with pain in the neck region and changes in the electrical muscle activity, leading to fatigue in the cervical muscles.

Occurrence and severity of neck disability in individuals with different types of temporomandibular disorder

BACKGROUND

Healthcare professionals need to know the degree of disability and severity of their patients to determine actions and therapy needed to minimize potential harm, improve their patient condition, and maximize clinical outcomes.

OBJECTIVES

To evaluate the occurrence and severity of neck disability in individuals with muscular, joint, and mixed temporomandibular disorder (TMD).

MATERIALS AND METHODS

Cross-sectional study with individuals divided into four groups: muscular TMD (n=20), joint TMD (n=20), mixed TMD (n=20) and control (n=20). For diagnosis and classification of TMD, it was used the Research Diagnostic Criteria (RDC) and to assess the severity of neck dysfunction the Neck Disability Index (NDI).

RESULTS

Moderate neck disability was frequent in all individuals with TMD; high scores of neck disability index were evidenced in the mixed and joint TMD groups; there was a moderate positive correlation between the severity of neck disability and TMD severity (r=0.7; CI=0.32-0.78; p<0.03).

CONCLUSION

The gravity of neck disability and the severity of TMD are directly proportional in the group of individuals with mixed TMD.

Toward Understanding Movement-evoked Pain (MEP) and its Measurement: A Scoping Review

OBJECTIVE

Individuals with chronic pain conditions often report movement as exacerbating pain. An increasing number of researchers and clinicians have recognized the importance of measuring and distinguishing between movement-evoked pain (MEP) and pain at rest as an outcome. This scoping review maps the literature and describes MEP measurement techniques.

MATERIALS AND METHODS

The scoping review utilized 6 databases to identify original studies that targeted pain or movement-related outcomes. Our search returned 7322 articles that were screened by title and abstract by 2 reviewers. The inclusion criteria focused on the measurement of MEP before, during, and after movement tasks in adults with chronic pain. Studies of children below 18 years of age or with nonhuman animals, case studies, qualitative studies, book chapters, cancer-related pain, non-English language, and abstracts with no full publish text were excluded from the study.

RESULTS

Results from 38 studies revealed great variation in the measurement of MEP, while almost all of the studies did not provide an explicit conceptual or operational definition for MEP. In addition, studies collectively illuminated differences in MEP compared with rest pain, movement provocation methods, and pain intensity as the primary outcome.

DISCUSSION

These results have clinically significant and research implications. To advance the study of MEP, we offer that consistent terminology, standardized measurement (appropriate for pain type/population), and clear methodological processes be provided in research publications. On the basis of the findings, we have put forth a preliminary definition of MEP that may benefit from the continued scholarly dialog.

Craniocervical and Cervical Spine Features of Patients with Temporomandibular Disorders: A Systematic Review and Meta-Analysis of Observational Studies

To assess neck disability with respect to jaw disability, craniocervical position, cervical alignment, and sensorimotor impairments in patients with temporomandibular disorders (TMD), a systematic review and meta-analysis of observational studies trials were conducted. The meta-analysis showed statistically significant differences in the association between neck disability and jaw disability (standardized mean difference (SMD), 0.72 (0.56-0.82)). However, results showed no significant differences for cervical alignment (SMD, 0.02 (-0.31-0.36)) or for the craniocervical position (SMD, -0.09 (-0.27-0.09)). There was moderate evidence for lower pressure pain thresholds (PPT) and for limited cervical range of motion (ROM). There was limited evidence for equal values for maximal strength between the patients with TMD and controls. There was also limited evidence for reduced cervical endurance and conflicting evidence for abnormal electromyographic (EMG) activity and motor control in TMD patients. Results showed a clinically relevant association between cervical and mandibular disability in patients with TMD. Regarding sensory-motor alterations, the most conclusive findings were observed in the reduction of PPT and cervical ROM, with moderate evidence of their presence in the patients with TMD. Lastly, the evidence on impaired motor control and cervical EMG activity in patients with TMD was conflicting.

Influence of smartphone use on the median frequency of mastigatory and trapezius muscles in women - a Pilot study

INTRODUCTION

The use of smartphones is growing every year, and their excessive use can cause adverse physical and mental effects.

AIM

This study aimed to evaluate the influence of smartphone use on the median frequency of the masticatory muscles and upper trapezius muscles in healthy women.

METHOD

Six healthy young women were evaluated. All the volunteers underwent a submaximal bite test to evaluate their masticatory muscles. In addition, the volunteers underwent a test for bilateral shoulder elevation to a submaximal load to evaluate their upper trapezius muscles. Both protocols were performed before and after a task using the smartphone for 30 min. Median frequency (MF) values were collected during the submaximal bite and submaximal shoulder elevation tests.

RESULTS

Data were analyzed using specific statistical tests. A statistically significant reduction in the MF for all the masticatory muscles was observed in the bilateral bite task when comparing pre and post smartphone use (p < 0.005). A significant reduction in the MF was also found for the right upper trapezius when comparing pre and post smartphone use in the shoulder elevation task (p = 0.001).

CONCLUSION

It appears that prolonged smartphone use may contribute to fatigue in the masticatory and upper trapezius muscles. Therefore, guidelines for smartphone users should include advice on the moderate use of this device.

Validation of a web-based version of the Craniofacial Pain and Disability Inventory

OBJECTIVE

To translate and cross-culturally adapt the Craniofacial Pain and Disability Inventory (CF-PDI) into Chinese and, to evaluate measurement properties of the web-based version of the CF-PDI.

METHODS

The Chinese version (CF-PDI/C) was first produced according the guidelines. Then, the web-based version of CF-PDI/C (eCF-PDI/C) was developed by our team and a third-party survey provider. The eCF-PDI/C was distributed to patients with painful temporomandibular disorders (TMD) with or without headache to evaluate its psychometric properties. The reliability of the eCF-PDI/C was detected by internal consistency and test-retest reliability. The validity of the measure was performed through construct validity and convergent validity.

RESULTS

A total of 206 patients were recruited. The Cronbach's α value and the intraclass correlation coefficients (ICC) value of the eCF-PDI/C was .912 and .82, respectively. Following exploratory factor analysis (EFA), three factors were extracted, accounting for 77.153% of the total variation. With regard to the convergent validity, the measure evidenced a good relationship with the global health question.

CONCLUSIONS

The eCF-PDI/C displays good reliability and validity through rigorous performance tests. This can be recommended for use among patients with painful TMD with or without headache.

Cross-cultural adaptation, reliability and validity of the Italian version of the craniofacial pain and disability inventory in patients with chronic temporomandibular joint disorders

Background

To develop an Italian version of the Craniofacial Pain Disability Inventory (CFPDI-I) and investigate its psychometric abilities in patients with temporomandibular disorders (TMD).

Methods

The CFPDI was translated following international standards. The psychometric analyses included reliability by internal consistency (Cronbach’s alpha) and test/retest stability (intraclass correlation coefficient, ICC); construct validity was investigated by matching (a priori hypotheses) the CFPDI-I with the Italian Neck Disability Index (NDI-I), a pain intensity numerical rating scale (NRS), the Italian Pain Catastrophising Scale (PCS-I), the Italian Tampa Scale of Kinesiophobia (TSK-I), and the Italian Migraine Disability Assessment Score Questionnaire (MIDAS) (Pearson’s correlation). Alpha was set at 0.05.

Results

Two hundred and twelve patients with chronic TMD completed the tool. The questionnaire was internally consistent (α = 0.95) and its stability was good (ICCs = 0.91). As hypothesised, validity figures showed CFPDI-I strongly correlated with the NDI-I (r = 0.66, p < 0.05) and moderately correlated with the NRS (r = 0.48, p < 0.05), PCS (r = 0.37, p < 0.05), TSKI (r = 0.35, p < 0.05) and MIDAS (r = 0.47, p < 0.05). Similar estimates were shown by CFPDI-I subscales.

Conclusions

The cross-culturally adapted version of the Craniofacial Pain and Disability Inventory (CFPDI-I) showed satisfactory psychometric properties that replicate those of the original version and, therefore, can be implemented in the clinical assessment of Italian people affected by TMD.

The prevalence of oral stage dysphagia in adults presenting with temporomandibular disorders: a systematic review and meta-analysis

OBJECTIVE

Temporomandibular disorders (TMDs) are the most commonly experienced non-dental orofacial pain disorders, with pain and dysfunction potentially resulting in oral stage dysphagia (OD). However, limited research has been conducted on this condition, with potential negative effects on clinical practice. Therefore, the aim of this study was to determine the prevalence of OD in adults presenting with TMDs, diagnosed as per the Research Diagnostic Criteria for Temporomandibular Disorders or the Diagnostic Criteria for Temporomandibular Disorders protocols.

MATERIAL AND METHODS

A systematic review of the literature was completed. Nine electronic databases were searched from inception to January 2017, with no date/language restriction applied. Grey literature, conference proceedings, and reference lists were also searched. Studies presenting original data regarding OD prevalence in adults presenting with TMDs were included if they investigated impaired swallowing, mastication, masticatory pain or fatigue, or weight loss. Study eligibility and quality were assessed by two independent reviewers. Methodological quality was assessed using the Down's and Black tool.

RESULTS AND CONCLUSIONS

This search yielded 20 eligible studies. Swallowing itself was impaired in only 9.3% of patients with TMDs. A range of additional OD signs and symptoms were also commonly reported (e.g. masticatory pain (87.4%) and fatigue (62%)). Study limitations included the small number of studies which were eligible for inclusion. As signs and symptoms of OD are frequently reported by patients with TMDs, psychometrically robust prospective research is warranted to determine current and optimal management of this condition.

Administration of low-level laser on muscles of mastication following the induction of initial fatigue: protocol for a randomized, controlled, clinical trial

BACKGROUND

Orofacial pain encompasses painful conditions, such as temporomandibular disorder (TMD). Multidisciplinary health teams seek to control such musculoskeletal disorders to improve the quality and functional capacity of the muscles of mastication. The aim of the proposed study is to evaluate the effect of low-level laser therapy as a form of treatment for the prevention of initial fatigue of the muscles of mastication (masseter and anterior temporal muscles) as well as the recovery of these muscles after induced exhaustion (caused by isometric contraction) in young adults.

METHODS

The participants will be 78 healthy male and female volunteers between 18 and 34 years of age. The volunteers will be randomly allocated to a laser group (n = 26), sham group (n = 26), and control group (n = 26). All participants will be submitted to a clinical evaluation to record mandibular movements, bite force, muscle sensitivity to palpation, and initial muscle fatigue. Initial fatigue will be induced by isometric contraction of the jaws. Maximum voluntary contraction will be performed to record the time until initial exhaustion of the masseter muscle (determined by electromyography). The groups will then be submitted to the interventions: active laser therapy (wavelength: 780 nm; fluence: 134 J/cm; power: 50 mW; irradiance: 1.675 W/cm; exposure time: 80 seconds per point) on 3 points of the masseter and 1 point on the anterior temporal muscles on each side; sham laser (placebo effect); or no intervention (control). Maximum voluntary contraction will be performed again after the interventions to record the time until initial exhaustion of the masseter muscle (determined by electromyography). Differences in individual time until exhaustion between the pre- and postintervention evaluations will be measured to determine the effect of low-level laser therapy.

DISCUSSION

Although studies have been made with the use of low-level laser therapy in TMDs and on the effect of photobiomodulation on fatigue, this the first study to test this therapy in the prevention of fatigue in this region. The clinical relevance lies in the fact that longer dental procedures could take place if the patients are less prone to fatigue.

Effect of Phototherapy on Masseter and Anterior Temporal Muscles Before Induction of Fatigue: A Randomized, Sham-Controlled, Blind Clinical Trial

OBJECTIVE

This is a randomized, sham-controlled, blind clinical trial that aimed to evaluate the effect of phototherapy on bite force, mandibular range of motion, sensitivity to palpation, and fatigue in the masseter and anterior temporal muscles of young patients when administered before the induction of fatigue.

MATERIALS AND METHODS

Fifty-two healthy volunteers aged 18-23 years were randomly allocated to a laser group and sham group. Both groups were submitted to a clinical evaluation to record mandibular range of motion, bite force, muscle sensitivity to palpation, and muscle fatigue. The laser group was then submitted to phototherapy (780 nm, 25 J/cm², 50 mW, 20 sec, and 1 J per point) on three points of the masseter and one point of the anterior temporal muscle on each side. The sham group was submitted to the same procedure, but with the device switched off. The volunteers were then instructed to chew two pieces of gum (one on each side) for 6 min, with the pace set by a metronome calibrated to 80 bpm, followed by the reevaluation of all variables. The results were submitted to t-test and Wilcoxon test. A significance level of 5% (p < 0.05) was considered in all analyses.

RESULTS

No statistically significant intergroup or intragroup differences were found for the variables analyzed.

CONCLUSIONS

With the proposed protocol, phototherapy administered before the induction of fatigue did not lead to any changes in bite force and mandibular range of motion, indicating that further studies are needed with different phototherapy dosimetric parameters.

Management of pain in patients with temporomandibular disorder (TMD): challenges and solutions

Thanks to advances in neuroscience, biopsychosocial models for diagnostics and treatment (including physical, psychological, and pharmacological therapies) currently have more clinical support and scientific growth. At present, a conservative treatment approach prevails over surgery, given it is less aggressive and usually results in satisfactory clinical outcomes in mild–moderate temporomandibular disorder (TMD). The aim of this review is to evaluate the recent evidence, identify challenges, and propose solutions from a clinical point of view for patients with craniofacial pain and TMD. The treatment we propose is structured in a multi-modal approach based on a biobehavioral approach that includes medical, physiotherapeutic, psychological, and dental treatments. We also propose a new biobehavioral model regarding pain perception and motor behavior for the diagnosis and treatment of patients with painful TMD.

Multimodal physiotherapy treatment based on a biobehavioral approach for patients with chronic cervico-craniofacial pain: a prospective case series

The purpose of this prospective case series was to observe and describe changes in patients with chronic cervico-craniofacial pain of muscular origin treated with multimodal physiotherapy based on a biobehavioral approach. Nine patients diagnosed with chronic myofascial temporomandibular disorder and neck pain were treated with 6 sessions over the course of 2 weeks including: (1) orthopedic manual physiotherapy (joint mobilizations, neurodynamic mobilization, and dynamic soft tissue mobilizations); (2) therapeutic exercises (motor control and muscular endurance exercises); and (3) patient education. The outcome measures of craniofacial (CF-PDI) and neck disability (NDI), kinesiophobia (TSK-11) and catastrophizing (PCS), and range of cervical and mandibular motion (ROM) and posture were collected at baseline, and at 2 and 14 weeks post-baseline. Compared to baseline, statistically significant (p < 0.01) and clinically meaningful improvements that surpassed the minimal detectable change were observed at 14 weeks in CF-PDI (mean change, 8.11 points; 95% confidence interval (CI): 2.55 to 13.69; d = 1.38), in NDI (mean change, 5 cm; 95% CI: 1.74-8.25; d = 0.98), and in the TSK-11 (mean change, 6.55 cm; 95% CI: 2.79-10.32; d = 1.44). Clinically meaningful improvements in self-reported disability, psychological factors, ROM, and craniocervical posture were observed following a multimodal physiotherapy treatment based on a biobehavioral approach.

Effects on jaw function shortly after whiplash trauma

Normal jaw function involves muscles and joints of both jaw and neck. A whiplash trauma may disturb the integrated jaw-neck sensory-motor function and thereby impair chewing ability; however, it is not known if such impairment is present shortly after a neck trauma or develops over time. The aim was to evaluate jaw function after a recent whiplash trauma. Eighty cases (47 women) were examined within 1 month after a whiplash trauma and compared to 80 controls (47 women) without neck trauma. Participants completed the Jaw disability checklist (JDC) and Neck Disability Index (NDI) questionnaires and performed a 5-minute chewing test. Elicited fatigue and pain during chewing were noted, and group differences were evaluated with Fisher's exact test and Mann-Whitney U-test. Compared to controls, cases had higher JDC (P < .0001) and NDI scores (15% vs 2%, P < .0001), and reported more fatigue (53% vs 31%, P = .006) and pain (30% vs 10%, P = .003) during the chewing test. Cases also had a shorter onset time for fatigue and pain (both P = .001) Furthermore, cases reporting symptoms during chewing had higher JDC and NDI scores compared to cases not reporting symptoms (both P = .01). Symptoms mainly occurred in the trigeminal area for both groups, but also in spinal areas more often for cases than for controls. Taken together, the results indicate that jaw-neck sensory-motor function is impaired already within 1 month after a whiplash trauma. The association between neck disability and jaw impairment underlines the close functional relationship between the regions, and stresses the importance of multidisciplinary assessment.

Influence of the mandibular position on the active cervical range of motion of healthy subjects analyzed using an accelerometer

OBJECTIVE

The aim of this study is to analyze the influence of the mandibular positions (habitual rest position, habitual maximum intercuspation, habitual maximum intercuspation with clenching, and mandibular position with cotton rolls) on the active cervical range of motion (ROM) (flexion-extension, lateroflexions, rotations) using an accelerometer in a sample of healthy subjects.

METHODS

A total of 21 (14 M, 7 F) healthy volunteers aged from 18 to 27 years (mean age 23.88 ± 2.34 years; mean weight 67.86 ± 11.38 kg; mean height 172.52 ± 9.00 cm) underwent a cervical range of movement examination using a 9-axis accelerometer. A one-way ANOVA analysis was performed in order to statistically evaluate the effective influence of the mandibular position on the recorded parameters.

RESULTS

The analysis showed no statistically significant differences (all p-values > 0.1) with variations smaller than three degrees among the different mandibular positions.

DISCUSSION

The mandibular position seems to have no influence on the active cervical ROM in healthy subjects. Further studies are needed to assess the usefulness of the accelerometer in the cervical analysis of temporomandibular disorder subjects.

Chronic Neck Pain and Cervico-Craniofacial Pain Patients Express Similar Levels of Neck Pain-Related Disability, Pain Catastrophizing, and Cervical Range of Motion

Background. Neck pain (NP) is strongly associated with cervico-craniofacial pain (CCFP). The primary aim of the present study was to compare the neck pain-related disability, pain catastrophizing, and cervical and mandibular ROM between patients with chronic mechanical NP and patients with CCFP, as well as asymptomatic subjects. Methods. A total of 64 participants formed three groups. All participants underwent a clinical examination evaluating the cervical range of motion and maximum mouth opening, neck disability index (NDI), and psychological factor of Pain Catastrophizing Scale (PCS). Results. There were no statistically significant differences between patients with NP and CCFP for NDI and PCS (P > 0.05). One- way ANOVA revealed significant differences for all ROM measurements. The post hoc analysis showed no statistically significant differences in cervical extension and rotation between the two patient groups (P > 0.05). The Pearson correlation analysis shows a moderate positive association between NDI and the PCS for the group of patients with NP and CCFP. Conclusion. The CCFP and NP patient groups have similar neck disability levels and limitation in cervical ROM in extension and rotation. Both groups had positively correlated the NDI with the PCS.

The efficiency of botulinum toxin type A for the treatment of masseter muscle pain in patients with temporomandibular joint dysfunction and tension-type headache

BACKGROUND

Temporomandibular joint dysfunction are often accompanied by symptoms of headache such as tension-type headache which is the most frequent spontaneous primary headache. Masseter muscle pain is commonly reported in this group. The purpose of the study was to assess the efficiency of intramuscular botulinum toxin type A injections for treating masseter muscle pain in patients with temporomandibular joint dysfunction and tension-type headache.

METHODS

This prospective outcome study consisted of 42 subjects of both genders aged 19-48 years diagnosed with masseter muscle pain related to temporomandibular joint dysfunction and tension-type headache. The subjects were treated by the intramuscular injection of 21 U (mice units) of botulinum toxin type A (Botox, Allergan) in the area of the greatest cross-section surface of both masseter bellies. Pain intensity was evaluated using visual analogue scale (VAS) and verbal numerical rating scale (VNRS) 1 week before the treatment and 24 weeks after the treatment. The obtained data were analyzed using the Wilcoxon matched pairs test (p ≤ 0,005).

RESULTS

The results of this study showed a decrease in the number of referred pain episodes including a decrease in pain in the temporal region bilaterally, a reduction of analgesic drugs intake as well as a decrease in reported values of VAS and VNRS after injections (p = 0,000).

CONCLUSIONS

The intramuscular botulinum toxin type A injections have been an efficient method of treatment for masseter muscle pain in patients with temporomandibular joint dysfunction and tension-type headache.