Short-term Effects of a First-Line Treatment Including Counseling and Self-Management Strategies on Chronic TMD Muscle Pain and Awake Bruxism in Women.

AIMS: To evaluate the short-term effects of a standardized first-line noninvasive approach (FL-A) including counseling and self-management strategies on pain, masticatory muscle tenderness, and awake bruxism in women with chronic temporomandibular disorder myalgia (mTMD) and to test whether patients' trait anxiety predicted their response to treatment. METHODS: FL-A was administered to 14 women with chronic mTMD (mean age ± SD = 33.8 ± 11.1 years; 8 with Graded Chronic Pain Scale [GCPS] grade I and 6 with grade II). Its effects on facial pain, masticatory muscle tenderness, and spontaneous awake bruxism episodes were evaluated using questionnaires, surface electromyography, and quantitative sensory testing. General linear models were used to test FL-A efficacy after 1 (T1) and 2 (T2) months. RESULTS: FL-A reduced pain (from baseline [T0] to T2, P = .010), the frequency of awake bruxism episodes (T0 to T1, P = .024), and their intensity by about 30% (T0 to T1, P < .001). Pressure pain thresholds at the masticatory muscle locations increased significantly from T0 to T2 (P < .001). Patients' trait anxiety decreased significantly from T0 to T2 (P = .030). Trait anxiety measured at baseline was not correlated with relative changes in pain (T0 to T2, P = .248). CONCLUSION: In the short term, FL-A reduces facial pain, masticatory muscle tenderness, and awake bruxism in women with chronic mTMD with low disability. A conservative management strategy should be prioritized for the initial management of these patients.

Temporomandibular disorders, neck disability, and oral parafunctions in tinnitus patients: A cross-sectional epidemiological study from Southern Italy.

OBJECTIVE: To assess the prevalence of temporomandibular disorders (TMD) in a sample of tinnitus patients and to determine the association between tinnitus, TMD, neck disability, and oral parafunctions. METHODS: Seventy-nine tinnitus patients were enrolled and underwent standardized clinical examination for TMD. The tinnitus severity was measured with the Tinnitus Handicap Inventory (THI). The oral parafunctions were self-reported with the Oral Behavior Checklist (OBC). The neck disability was recorded with the Neck Disability Index (NDI). RESULTS: More than half of the sample presented TMD, and the most frequent diagnosis was TMD pain. Higher THI was observed in TMD-pain individuals, compared to TMD-free (ß 18.4; 95%CI 6.7, 30.1; p = 0.002). The OBC showed a significant low-to-moderate positive correlation with the THI (rho= 0.368, p = 0.001), while the NDI did not. DISCUSSION: Standardized assessment of TMD and oral behaviors should be integrated into the routine diagnostic evaluations of tinnitus patients.

Jaw muscle activity patterns in women with chronic TMD myalgia during standardized clenching and chewing tasks.

Objective: To examine jaw muscle activity of women with chronic temporomandibular myalgia (mTMD). It was hypothesized that mTMD patients had a different masticatory muscle activity, increased work during isometric clenching, and a reduced chewing frequency as compared to TMD-free subjects.Methods: The electromyographic (EMG) activity of temporalis anterior (TA) and masseter (MM) of 27 women with mTMD and 18 TMD-free women was recorded during clenching tasks and while chewing. EMG indices comparing the activity of paired jaw muscles were computed.Results: Women with TMD myalgia had greater muscular work than controls (p = 0.025). The activity of TA and MM were similar between right and left sides in both groups. mTMD patients had a greater activity of MM than TA (p = 0.028). No between-groups differences were found in chewing rate.Conclusion: Women with mTMD showed an abnormal recruitment of the jaw-closing muscles during functional tasks, which may predispose to further tissue injury.

Salivary Cytokines and Airways Disease Severity in Patients with Cystic Fibrosis.

About 50% of patients with cystic fibrosis (CF) have sinonasal complications, which include inferior turbinate hypertrophy (NTH) and/or nasal polyposis (NP), and different degrees of lung disease, which represents the main cause of mortality. Monitoring of sinonasal disease requires complex instrumental procedures, while monitoring of lung inflammation requires invasive collection of bronchoalveolar lavage fluid. The aim of this study was to investigate the associations between salivary cytokines levels and CF-related airway diseases. Salivary biochemical parameters and cytokines, i.e., interleukin-6 (IL-6), IL-8, and tumor necrosis factor alpha (TNF-α), were analyzed in resting saliva from healthy subjects and patients with CF. Patients with CF showed significantly higher levels of salivary chloride, IL-6, IL-8, and TNF-α and lower calcium levels than healthy subjects. Among patients with CF, IL-6 and IL-8 were significantly higher in patients with NTH, while TNF-α was significantly lower in patients with NP. A decreasing trend of TNF-α in patients with severe lung disease was also observed. On the other hand, we did not find significant correlation between cytokine levels and Pseudomonas aeruginosa or Stenotrophomonas maltophilia colonization. These preliminary results suggest that salivary IL-6 and IL-8 levels increase during the acute phase of sinonasal disease (i.e., NTH), while the end stages of pulmonary disease and sinonasal disease (i.e., NP) show decreased TNF-α levels.

Prevalence of temporomandibular disorder pain, jaw noises and oral behaviours in an adult Italian population sample.

To evaluate the prevalence of temporomandibular disorder pain (TMD-pain), temporomandibular joint (TMJ) noises, oral behaviours in an Italian adult population sample, their possible association with gender, oral behaviours, self-reported facial trauma and orthodontic treatment. Subjects older than 18 years were recruited from general population in public spaces during their daily life. A specific questionnaire was developed to collect data on TMD-pain, TMJ noises, oral behaviours, orthodontic treatment and facial trauma. A total of 4299 subjects were included in the study. The most common symptom in the sample was TMJ clicking (30.7%), followed by TMD-pain (16.3%) and TMJ crepitus (10.3%). Oral behaviours were reported in 29% of the sample; 43.6% of the sample reported a previous or ongoing orthodontic treatment. TMD-pain and TMJ clicking were significantly associated to gender, oral behaviours and a positive history of previous facial trauma. Crepitus was significantly associated to oral behaviours, facial trauma and higher age. Ongoing orthodontic treatment was significantly associated to TMD-pain and TMJ sounds. In a general Italian adult population sample, TMD-pain is associated to female gender and is less prevalent than TMJ clicking. TMDs are associated to trauma and oral behaviours.

Genotype-phenotype correlation and functional studies in patients with cystic fibrosis bearing CFTR complex alleles.

BACKGROUND: The effect of complex alleles in cystic fibrosis (CF) is poorly defined for the lack of functional studies. OBJECTIVES: To describe the genotype-phenotype correlation and the results of either in vitro and ex vivo studies performed on nasal epithelial cells (NEC) in a cohort of patients with CF carrying cystic fibrosis transmembrane conductance regulator (CFTR) complex alleles. METHODS: We studied 70 homozygous, compound heterozygous or heterozygous for CFTR mutations: p.[Arg74Trp;Val201Met;Asp1270Asn], n=8; p.[Ile148Thr;Ile1023_Val1024del], n=5; p.[Arg117Leu;Leu997Phe], n=6; c.[1210-34TG[12];1210-12T[5];2930C>T], n=3; p.[Arg74Trp;Asp1270Asn], n=4; p.Asp1270Asn, n=2; p.Ile148Thr, n=6; p.Leu997Phe, n=36. In 39 patients, we analysed the CFTR gating activity on NEC in comparison with patients with CF (n=8) and carriers (n=4). Finally, we analysed in vitro the p.[Arg74Trp;Val201Met;Asp1270Asn] complex allele. RESULTS: The p.[Ile148Thr;Ile1023_Val1024del] caused severe CF in five compound heterozygous with a class I-II mutation. Their CFTR activity on NEC was comparable with patients with two class I-II mutations (mean 7.3% vs 6.9%). The p.[Arg74Trp;Asp1270Asn] and the p.Asp1270Asn have scarce functional effects, while p.[Arg74Trp;Val201Met;Asp1270Asn] caused mild CF in four of five subjects carrying a class I-II mutation in trans, or CFTR-related disorders (CFTR-RD) in three having in trans a class IV-V mutation. The p.[Arg74Trp;Val201Met;Asp1270Asn] causes significantly (p<0.001) higher CFTR activity compared with compound heterozygous for class I-II mutations. Furthermore, five of six compounds heterozygous with the p.[Arg117Leu;Leu997Phe] had mild CF, whereas the p.Leu997Phe, in trans with a class I-II CFTR mutation, caused CFTR-RD or a healthy status (CFTR activity: 21.3-36.9%). Finally, compounds heterozygous for the c.[1210-34TG[12];1210-12T[5];2930C>T] and a class I-II mutation had mild CF or CFTR-RD (gating activity: 18.5-19.0%). CONCLUSIONS: The effect of complex alleles partially depends on the mutation in trans. Although larger studies are necessary, the CFTR activity on NEC is a rapid contributory tool to classify patients with CFTR dysfunction.

Association between posterior crossbite, skeletal, and muscle asymmetry: a systematic review.

BACKGROUND: Of the various malocclusions, unilateral posterior crossbite has often been associated to skeletal and muscular asymmetrical growth and function. OBJECTIVE: To assess, by systematically reviewing the literature, the association between unilateral posterior crossbite (UPCB) and morphological and/or functional asymmetries (i.e. skeletal, masticatory muscle electromyographic (EMG) performance, bite force, muscle thickness, and chewing cycle asymmetries). MATERIALS AND METHODS: A literature survey covering the period from January 1965 to June 2015 was performed. Two reviewers extracted the data independently and assessed the quality of the studies. RESULTS: The search strategy resulted in 2184 citations, of which 45 met the inclusion criteria. The scientific and methodological quality of these studies was medium-low, irrespective of the association reported. In several studies, posterior crossbite is reported to be associated to asymmetries in mandibular skeletal growth, EMG activity, and the chewing cycle. Fewer data are available on bite force and masticatory muscle thickness. CONCLUSIONS: The relationship between unilateral posterior crossbite and skeletal asymmetry is still unresolved. To date, most of the studies available report a skeletal asymmetric growth. EMG activity of masticatory muscles is different between crossbite and non-crossbite sides. Subjects with UPCB show smaller bite force than non-crossbite subjects. There is no consistency of studies reporting masticatory muscle thickness asymmetry in UPCB subjects. UPCB is associated to an increase in the reverse chewing cycle. The literature available on the subject is of medium-low scientific and methodological quality, irrespective of the association reported. Further investigations with higher sample size, well-defined diagnostic criteria, rigorous scientific methodologies, and long-term control are needed.

Social impairment of individuals suffering from different types of chronic orofacial pain.

BACKGROUND: The daily life of patients suffering from orofacial pain is considerably impaired as compared to healthy subjects. The aim of this study was to investigate the influence of different categories of orofacial pain on the habitual life of adult individuals. METHODS: Seven hundred eighty-one individuals with orofacial pain were recruited from an initial sample of 1,058 patients. All the individuals were allocated to groups according to their diagnosis: myofascial pain (group A, 676 subjects, 525 females and 151 males; mean age ± SD = 35.2 ± 12.6), migraine (group B, 39 subjects, 29 females and 10 males; mean age ± SD 36.0 ± 10.7), and both myofascial pain and migraine (group C, 66 subjects, 56 females and 10 males, mean age ± SD = 35.6 ± 10.8). Characteristic pain intensity (CPI), disability days (DD), disability score (DS), and graded chronic pain intensity (GCPS) were calculated according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis II. Depression and somatization (nonspecific physical symptoms) scores were also calculated. RESULTS: A significant association between groups and GCPS categories was found (p < 0.0001). Post hoc tests showed a significant difference between groups A and B and between A and C, but not between B and C. In group A, the most frequent GCPS score was grade II. The most frequent GCPS score in groups B and C was grade III, indicating a moderate limiting impairment. This score was more frequent in group B (41%) than in the other groups (group A = 20.6%, group C = 34.8%). GCPS grade IV was more frequent in group C (19.7%) than in the other groups. Group C had significantly higher scores for nonspecific physical symptoms than group A (p < 0.05). CONCLUSIONS: Myofascial pain and migraine sensibly affect the common daily life of adult individuals. The comorbidity of both conditions determines a major impairment.

Effect of pH on in vitro biocompatibility of orthodontic miniscrew implants.

BACKGROUND: Although the clinical use of miniscrews has been investigated on a large scale, little is known about their biocompatibility. Since low pH can affect corrosion resistance, the aim of this study was to evaluate the cytotoxic effect of orthodontic miniscrews in different pH conditions. METHODS: Four orthodontic miniscrews of stainless steel and grade IV and grade V titanium were immersed in a pH 7 and pH 4 saline solution for 1, 7, 14, 21, 28, and 84 days. Human osteogenic sarcoma cells (U2OS), permanent human keratinocytes (HaCat), and primary human gingival fibroblasts (HGF) were exposed to eluates, and the mitochondrial dehydrogenase activity was measured after 24 h to assess the cytoxicity. The results were analyzed using the Mann-Whitney U test (P<0.05). RESULTS: When exposed to pH 7-conditioned eluates, the cell lines showed an even greater viability than untreated cells. On the contrary, the results revealed a statistically significant decrease in U2OS, HaCat, and HGF viability after exposure to eluates obtained at pH 4. Among the cell lines tested, HGF showed the most significant decrease of mitochondrial activity. Interestingly, grade V titanium miniscrews caused highest toxic effects when immersed at pH 4. CONCLUSIONS: The results suggested that at pH 7, all the miniscrews are biocompatible while the eluates obtained at pH 4 showed significant cytotoxicity response. Moreover, different cell lines can produce different responses to miniscrew eluates.

Association between posterior crossbite, masticatory muscle pain, and disc displacement: a systematic review.

BACKGROUND: Among different malocclusions, posterior crossbite is thought to have a strong impact on the correct functioning of the masticatory system. OBJECTIVE: To assess, by systematically reviewing the literature, the association between posterior crossbite and different temporomandibular disorder (TMD) diagnosis: disc displacement and masticatory muscle pain. MATERIALS AND METHODS: A literature survey covering the period from January 1965 to April 2012 was performed. Two reviewers extracted the data independently and assessed the quality of the studies. RESULTS: The search strategy resulted in 2919 citations, of which 43 met the inclusion criteria. The scientific and methodological quality of these studies was found to be medium-low, independently by association reported. In several studies, posterior crossbite is reported to be associated to the development of disc displacement, muscular pain, and tenderness, possibly linked to a skeletal and muscular adaptation of the stomatognathic system. However, the lack of consistency of the results reported deeply reduces the external validity of the studies, with a consequent impossibility to draw definite conclusions. CONCLUSIONS: It is not possible to establish an association between posterior crossbite, muscle pain, and disc displacement because the distribution of the studies supporting or not supporting the association is similar. The consequences of posterior crossbite on the development of TMDs deserve further investigations, with high sample size, well-defined diagnostic criteria, and rigorous scientific methodologies. Finally, long-term controlled studies are needed to identify posterior crossbite as a possible risk factor for TMDs.

The additional value of a home physical therapy regimen versus patient education only for the treatment of myofascial pain of the jaw muscles: short-term results of a randomized clinical trial.

AIMS: To compare the short-term efficacy of patient education only versus the combination of patient education and home exercises for the treatment of myofascial pain of the jaw muscles. MATERIALS AND METHODS: Seventy myogenous temporomandibular disorder patients were assigned to 2 treatment groups. One group received patient education supplemented by general information about self-care of the jaw musculature. The other group received both education and a home physical therapy program. Treatment contrast, calculated from the mean normalized relative changes in anamnestic and clinical scores, was used to determine treatment success. Clinical outcome measures included pressure pain threshold (PPT) of the masseter, anterior temporalis, and Achilles tendon; pain-free maximal jaw opening; and pain on chewing, spontaneous muscle pain, and headache as rated on visual analog scales. RESULTS: After 3 months the success rate was 57% for the group that received education only and 77% for the group that received both education and home physical therapy (P = .157). The patients were then redivided into 2 groups: successfully treated patients and unsuccessfully treated patients. In the unsuccessfully treated group, pain-free maximal jaw opening increased significantly more among those who had been in the education and physical therapy group than among those who had been in the education-only group (P = .019). The change in PPT was significantly greater in successfully treated patients than in unsuccessfully treated patients (.009 < P < .039), independent of the treatment modality, with higher PPTs among successful patients. There were no significant differences between the successfully and unsuccessfully treated groups or between treatment modalities for any other variable. CONCLUSION: Over a period of 3 months, the combination of education and a home physical therapy regimen, as used in this protocol, is slightly more clinically effective than education alone for the treatment of myofascial pain of the jaw muscles.

Mandibular condyle osteochondroma. Review of the literature and report of a misdiagnosed case.

Temporomandibular disorders can usually be diagnosed on the basis of a thorough history and a comprehensive examination of the patient. Additional diagnostic tests, such as imaging of the temporomandibular joint (TMJ) area, are mandatory and must be flawless in case of atypical findings. The aim of this report is to illustrate pitfalls in clinical reasoning and in imaging procedures in the diagnosis of temporomandibular pain and dysfunction. A case report of a patient with osteocartilaginous exostosis of the mandibular condyle, which was erroneously diagnosed and treated as an internal derangement of the TMJ for half a year, is presented.

Myofascial pain syndrome misdiagnosed as odontogenic pain: a case report.

The aim of this report is to illustrate the case of a patient whose myofascial pain syndrome was misdiagnosed as odontogenic pain, and who was treated using irreversible dental procedures. Even if dental pain commonly has an odontogenic etiology, it is also possible that pain arising from different orofacial sites such as jaw muscles, maxillary sinus, or nervous structures can be referred to the teeth. When the etiology of a dental pain condition cannot be clearly identified, it is necessary to consider all possible causes of dental pain, which may also be nonodontogenic. The need for comprehensive examination and careful diagnosis before irreversible dental treatment is emphasized.