Correlation Between Orofacial Pain and Sensory and Autonomic Neuropathies.

Purpose: Orofacial Pain (OFP) affects 15% of the general population. OFP conditions can be myofascial, also known as temporomandibular disorders (TMDs) or neuropathic. The underlying pathophysiology in several chronic OFP conditions, is unknown. Small fiber neuropathy (SFN) is a disorder of thinly myelinated A-delta and non-myelinated C-fibers and can manifest as sensory and autonomic neuropathies. SFN has been demonstrated in some OFP conditions. Our study aims to assess the presence of OFP in patients with sensory and autonomic neuropathies and assess the correlation between OFP, skin biopsy and autonomic dysfunction. Patients and Methods: This is a retrospective study (2018-2020) of patients from the SFN registry, Massachusetts General Hospital, Boston, USA, for the presence of OFP. All patients were included. Primary outcome: Prevalence of OFP in patients with chronic neuropathies. Secondary outcomes: Correlation between OFP and skin biopsy, dysautonomia, headaches, chronic nociceptive pain, psychological conditions, and patient factors, such as mean age and BMI. Results: Charts of 450 patients with sensory and autonomic neuropathies were reviewed. 22.67% (n=102) had OFP. The mean (range) age at biopsy in patients with OFP was 48.36 (20-81) years, female: male ratio 3.25:1. More OFP patients had negative skin biopsy results (p value<0.05) than those with sensory neuropathies. Patients with OFP had significantly higher prevalence of psychological conditions (p value 0.000), and higher BMI >30 (p value 0.025). Dysautonomia was significantly higher in patients with TMDs when compared to the ones without TMDs (p value 0.030). There was no significant difference in mean age, gender predilection, presence of headaches, peripheral neuropathies, and nociceptive pain between patients with and without OFP. Conclusion: OFP and sensory neuropathies can be overlapping conditions. Patients presenting with concomitant TMD and dysautonomia can be further tested for SFN. This can further help us understand a correlation if any, between idiopathic TMD/OFP conditions and SFN and further our understanding of the pathophysiology of these conditions.

Synergies and complementarities between ecosystem accounting and the Red List of Ecosystems.

Safeguarding biodiversity and human well-being depends on sustaining ecosystems. Two global standards for quantifying ecosystem change, the International Union for Conservation of Nature Red List of Ecosystems (RLE) and the United Nations System of Environmental-Economic Accounting Ecosystem Accounting (EA), underpin headline indicators for the Kunming-Montreal Global Biodiversity Framework. We analyse similarities and differences between the standards to understand their complementary roles in environmental policy and decision-making. The standards share key concepts, definitions of ecosystems and spatial data needs, meaning that similar data can be used in both. Their complementarities stem from their differing purposes and thus how data are analysed and interpreted. Although both record changes in ecosystem extent and condition, the RLE analyses the magnitude of change in terms of risk of ecosystem collapse and biodiversity loss, whereas EA links ecosystem change with the ecosystem's contributions to people and the economy. We recommend that the RLE and EA should not be treated as unrelated nor undertaken in isolation. Developing them in concert can exploit their complementarities while ensuring consistency in foundational data, in particular ecosystem classifications, maps and condition variables. Finding pathways for co-investment in foundational data, and for knowledge-sharing between people and organizations who undertake RLE assessments and accounting, will improve both processes and outcomes for biodiversity, ecosystems and people.

Perspectives on the timing of ecosystem collapse in a changing climate.

Climate change is one of the most important drivers of ecosystem change, the global-scale impacts of which will intensify over the next 2 decades. Estimating the timing of unprecedented changes is not only challenging but is of great importance for the development of ecosystem conservation guidelines. Time of emergence (ToE) (point at which climate change can be differentiated from a previous climate), a widely applied concept in climatology studies, provides a robust but unexplored approach for assessing the risk of ecosystem collapse, as described by the C criterion of the International Union for Conservation of Nature's Red List of Ecosystems (RLE). We identified 3 main theoretical considerations of ToE for RLE assessment (degree of stability, multifactorial instead of one-dimensional analyses, and hallmarks of ecosystem collapse) and 4 sources of uncertainty when applying ToE methodology (intermodel spread, historical reference period, consensus among variables, and consideration of different scenarios), which aims to avoid misuse and errors while promoting a proper application of the framework by scientists and practitioners. The incorporation of ToE for the RLE assessments adds important information for conservation priority setting that allows prediction of changes within and beyond the time frames proposed by the RLE.

Perspectivas sobre el momento del colapso ecosistémico en un clima cambiante Resumen El cambio climático es uno de los principales causantes del cambio ecosistémico, cuyo impacto a escala global se intensificará en las próximas dos décadas. No sólo es un reto estimar el momento de los cambios sin precedentes, sino también es de gran importancia para el desarrollo de las directrices de conservación de los ecosistemas. El momento de aparición (MdA), el punto en el que el cambio climático puede diferenciarse de un clima previo; es un concepto de aplicación extensa en los estudios de climatología y proporciona una estrategia sólida pero poco explorada para evaluar el riesgo del colapso ecosistémico, como está descrito por el criterio C de la Lista Roja de Ecosistemas (LRE) de la Unión Internacional para la Conservación de la Naturaleza. Identificamos las tres consideraciones teóricas del MdA para la evaluación de la LRE (grado de estabilidad, análisis multifactoriales en vez de unidimensionales y distintivos del colapso ecosistémico) y cuatro fuentes de incertidumbre cuando se aplica la metodología MdA (difusión intermodelo, periodo de referencia histórica, consenso entre las variables y consideración de escenarios distintos), la cual busca evitar el mal uso y los errores mientras se promueve una aplicación adecuada del marco de los científicos y lo practicantes. La incorporación del MdA a las evaluaciones de la LRE añade información importante para el establecimiento de prioridades de conservación que permiten la predicción de cambios dentro y más allá del marco temporal propuesto por la LRE.

Roles of the Red List of Ecosystems in the Kunming-Montreal Global Biodiversity Framework.

The Kunming-Montreal Global Biodiversity Framework (GBF) of the UN Convention on Biological Diversity set the agenda for global aspirations and action to reverse biodiversity loss. The GBF includes an explicit goal for maintaining and restoring biodiversity, encompassing ecosystems, species and genetic diversity (goal A), targets for ecosystem protection and restoration and headline indicators to track progress and guide action1. One of the headline indicators is the Red List of Ecosystems2, the global standard for ecosystem risk assessment. The Red List of Ecosystems provides a systematic framework for collating, analysing and synthesizing data on ecosystems, including their distribution, integrity and risk of collapse3. Here, we examine how it can contribute to implementing the GBF, as well as monitoring progress. We find that the Red List of Ecosystems provides common theory and practical data, while fostering collaboration, cross-sector cooperation and knowledge sharing, with important roles in 16 of the 23 targets. In particular, ecosystem maps, descriptions and risk categories are key to spatial planning for halting loss, restoration and protection (targets 1, 2 and 3). The Red List of Ecosystems is therefore well-placed to aid Parties to the GBF as they assess, plan and act to achieve the targets and goals. We outline future work to further strengthen this potential and improve biodiversity outcomes, including expanding spatial coverage of Red List of Ecosystems assessments and partnerships between practitioners, policy-makers and scientists.

Beyond central-tendency: If we agree discrete vegetation communities do not exist, should we investigate other methods of clustering?

Clustering is indispensable in the quest for robust vegetation classification schemes that aim to partition, summarise and communicate patterns. However, clustering solutions are sensitive to methods and data and are therefore unstable, a feature that is usually attributed to noise. Viewed through a central-tendency lens, noise is defined as the degree of departure from type, which is problematic since vegetation types are abstractions of continua, and so noise can only be quantified relative to the particular solution at hand. Graph theory models the structure of vegetation data based on the interconnectivity of samples. Through a graph-theoretic lens, the causes of instability can be quantified in absolute terms via the degree of connectivity among objects. We simulated incremental increases in sampling intensity in a dataset over five iterations and assessed classification stability across successive solutions derived using algorithms implementing, respectively, models of central-tendency and interconnectivity. We used logistic regression to model the likelihood of a sample changing groups between iterations as a function of distance to the centroid and degree of interconnectivity. Our results show that the degree to which samples are interconnected is a more powerful predictor of instability than the degree to which they deviate from their nearest centroid. The removal of weakly interconnected samples resulted in more stable classifications, although solutions with many clusters were apparently inherently less stable than those with few clusters, and improvements in stability flowing from the removal of outliers declined as the number of clusters increased. Our results reinforce the fact that clusters abstracted from continuous data are inherently unstable and that the quest for stable, fine-scale classifications from large regional datasets is illusory. Nevertheless, our results show that using models better suited to the analysis of continuous data may yield more stable classifications of the available data.

Contributions of the IUCN Red List of Ecosystems to risk-based design and management of protected and conserved areas in Africa.

Protected and conserved areas (PCAs) are key ecosystem management tools for conserving biodiversity and sustaining ecosystem services and social cobenefits. As countries adopt a 30% target for protection of land and sea under the Global Biodiversity Framework of the United Nations Convention on Biological Diversity, a critical question emerging is, which 30%? A risk-based answer to this question is that the 30% that returns the greatest reductions in risks of species extinction and ecosystem collapse should be protected. The International Union for Conservation of Nature (IUCN) Red List protocols provide practical methods for assessing these risks. All species, including humans, depend on the integrity of ecosystems for their well-being and survival. Africa is strategically important for ecosystem management due to convergence of high ecosystem diversity, intense pressures, and high levels of human dependency on nature. We reviewed the outcomes (e.g., applications of ecosystem red-list assessments to protected-area design, conservation planning, and management) of a symposium at the inaugural African Protected Areas Congress convened to discuss roles of the IUCN Red List of Ecosystems in the design and management of PCAs. Recent progress was made in ecosystem assessment, with 920 ecosystem types assessed against the IUCN Red List criteria across 21 countries. Although these ecosystems spanned a diversity of environments across the continent, the greatest thematic gaps were for freshwater, marine, and subterranean realms, and large geographic gaps existed in North Africa and parts of West and East Africa. Assessment projects were implemented by a diverse community of government agencies, nongovernmental organizations, and researchers. The assessments have influenced policy and management by informing extensions to and management of formal protected area networks supporting decision-making for sustainable development, and informing ecosystem conservation and threat abatement within boundaries of PCAs and in surrounding landscapes and seascapes. We recommend further integration of risk assessments in environmental policy and enhanced investment in ecosystem red-list assessment to fill current gaps.

Contribuciones de la Lista Roja de Ecosistemas de la UICN al diseño y manejo basados en riesgos de las áreas conservadas y protegidas en África Resumen Las áreas protegidas y conservadas (APC) son herramientas clave del manejo de ecosistemas para conservar la biodiversidad y mantener los servicios ambientales y los cobeneficios sociales. Conforme los países adoptan un objetivo de 30% para la protección del suelo y el mar bajo el Marco Mundial de Biodiversidad de la Convención sobre la Diversidad Biológica de las Naciones Unidas, surge una pregunta crítica: ¿cuál 30%? Una respuesta basada en riesgos a esta pregunta es que se debe proteger el 30% que rinda la mayor reducción del riesgo de extinción de especies y del colapso del ecosistema. Los protocolos de la Lista Roja de la Unión Internacional para la Conservación de la Naturaleza (UICN) proporcionan métodos prácticos para evaluar estos riesgos. Todas las especies, incluidos los humanos, dependen de la integridad de los ecosistemas para su bienestar y supervivencia. África tiene una importancia estratégica para el manejo de ecosistemas debido a la convergencia de una gran diversidad de ecosistemas, presiones intensas y un nivel elevado de dependencia del humano hacia la naturaleza. Revisamos los resultados (p. ej.: aplicaciones de las valoraciones de las listas rojas de ecosistemas al diseño de áreas protegidas, planeación de la conservación y manejo) de un simposio en el primer Congreso de Áreas Protegidas Africanas convocado para discutir el papel de la Lista Roja de Ecosistemas de la UICN en el diseño y manejo de las APC. Existen avances recientes en la evaluación de los ecosistemas, con 920 tipos de ecosistemas evaluados bajo los criterios de la Lista Roja de la UICN en 21 países. Mientras estos ecosistemas comprenden una diversidad de ambientes en todo el continente, los principales vacíos temáticos los encontramos para los dominios subterráneos, de agua dulce y marina, además de que existe un gran vacío geográfico en el norte de África y en partes del este y oeste africano. Los proyectos de evaluación fueron implementados por una comunidad diversa de agencias gubernamentales, organizaciones no gubernamentales e investigadores. La influencia de las evaluaciones sobre las políticas y el manejo se da con la información que proveen a las extensiones y el manejo de las redes de áreas protegidas formales, el apoyo para la toma de decisiones de desarrollo sustentable y la guía para la conservación de ecosistemas y el abatimiento de amenazas dentro de los límites de las APC y en los paisajes terrestres y marinos adyacentes. Recomendamos una mayor integración de las evaluaciones de riesgo dentro de las políticas ambientales y más inversión para las evaluaciones de lista roja de los ecosistemas cubrir los vacíos existentes.

Are There Differences in Opioid Prescriptions to Urban and Rural Patients by Oral and Maxillofacial Surgeons in Massachusetts From 2011 to 2021?

PURPOSE: Oral-maxillofacial surgeons (OMSs) are frequent prescribers of opioid analgesics. It remains unclear if prescription patterns differ for urban versus rural patients, given potential differences in access to and delivery of care. This study aimed to characterize urban-rural differences in opioid analgesic prescriptions to patients in Massachusetts by OMSs from 2011 to 2021. METHODS: This retrospective cohort study used the Massachusetts Prescription Monitoring Program database to identify Schedule II and III opioid prescriptions by providers with specialty of oral and maxillofacial surgery from 2011 to 2021. The primary predictor variable was patient geography (urban/rural) and secondary predictor was year (2011-2021). The primary outcome variable was milligram morphine equivalent (MME) per prescription. Secondary outcome variables were days' supply per prescription and number of prescriptions received per patient. Descriptive and linear regression statistics were performed to analyze differences in prescriptions to urban and rural patients each year and throughout the study period. RESULTS: The study data, which includes OMS opioid prescriptions (n = 1,057,412) in Massachusetts from 2011 to 2021, ranged annually between 63,678 and 116,000 prescriptions to between 58,000 and 100,000 unique patients. The cohorts each year ranged between 48 and 56% female with mean ages between 37 and 44 years. There were no differences in the mean number of patients per provider in urban and rural populations in any year. The study sample had a large majority of urban patients (>98%). MME per prescription, days' supply per prescription, and prescriptions received per patient were all generally similar between urban and rural patients each year, with the largest MME per prescription difference in 2019 (87.3 for rural to 73.9 for urban patients, P < .01). From 2011 to 2021, all patients had a steady decrease in MME per prescription (ß = -6.64, 95% confidence interval: -6.81, -6.48; R2 = 0.39) and day's supply per prescription (ß = -0.1, 95% confidence interval: -0.1, -0.09; R2 = 0.37). CONCLUSION: In Massachusetts, there were similar opioid prescribing patterns by oral and maxillofacial surgeons to urban and rural patients from 2011 to 2021. There has also been a steady decrease in the duration and total dosage of opioid prescriptions to all patients. These results are consistent with multiple statewide policies over the last several years aimed at curbing opioid overprescribing.

Centers for Disease Control and Prevention Clinical Practice Guideline for Prescribing Opioids: United States, 2022: What dentists need to know.

BACKGROUND: The Centers for Disease Control and Prevention (CDC) published the Clinical Practice Guideline for Prescribing Opioids for Pain-United States, 2022 (CDCCPG) to replace the 2016 guideline. This guideline was designed to serve as a clinical tool to improve communication between clinicians and patients and empower them to make informed, person-centered decisions regarding pain management and the prescribing of opioids. It is intended for primary care and other clinicians, including dentists, who provide pain management for adults with acute, subacute, and chronic pain. TYPES OF STUDIES REVIEWED: This article summarizes the CDCCPG, with an emphasis on information of relevance to dentistry. RESULTS: For dentists, the most important recommendations for pain management are that nonsteroidal anti-inflammatory medications are first-line medications for acute dental pain, interdisciplinary care for chronic orofacial pain is indicated, and opioids should only be prescribed for acute dental pain for a maximum of 3 days after risk assessment. PRACTICAL IMPLICATIONS: The CDCCPG contains a great deal of relevant information that can help dentists and dental specialists make safe, effective, and evidence-based decisions in providing pain control for their patients.

Effects of interactions between anthropogenic stressors and recurring perturbations on ecosystem resilience and collapse.

Insights into declines in ecosystem resilience and their causes and effects can inform preemptive action to avoid ecosystem collapse and loss of biodiversity, ecosystem services, and human well-being. Empirical studies of ecosystem collapse are rare and hampered by ecosystem complexity, nonlinear and lagged responses, and interactions across scales. We investigated how an anthropogenic stressor could diminish ecosystem resilience to a recurring perturbation by altering a critical ecosystem driver. We studied groundwater-dependent, peat-accumulating, fire-prone wetlands known as upland swamps in southeastern Australia. We hypothesized that underground mining (stressor) reduces resilience of these wetlands to landscape fires (perturbation) by diminishing groundwater, a key ecosystem driver. We monitored soil moisture as an indicator of ecosystem resilience during and after underground mining. After landscape fire, we compared responses of multiple state variables representing ecosystem structure, composition, and function in swamps within the mining footprint with unmined reference swamps. Soil moisture declined without recovery in swamps with mine subsidence (i.e., undermined), but was maintained in reference swamps over 8 years (effect size 1.8). Relative to burned reference swamps, burned undermined swamps showed greater loss of peat via substrate combustion; reduced cover, height, and biomass of regenerating vegetation; reduced postfire plant species richness and abundance; altered plant species composition; increased mortality rates of woody plants; reduced postfire seedling recruitment; and extirpation of a hydrophilic animal. Undermined swamps therefore showed strong symptoms of postfire ecosystem collapse, whereas reference swamps regenerated vigorously. We found that an anthropogenic stressor diminished the resilience of an ecosystem to recurring perturbations, predisposing it to collapse. Avoidance of ecosystem collapse hinges on early diagnosis of mechanisms and preventative risk reduction. It may be possible to delay or ameliorate symptoms of collapse or to restore resilience, but the latter appears unlikely in our study system due to fundamental alteration of a critical ecosystem driver. Efectos de las interacciones entre los estresantes antropogénicos y las perturbaciones recurrentes sobre la resiliencia y el colapso de los ecosistemas.

La comprensión de la declinación en la resiliencia de los ecosistemas y sus causas y efectos puede orientar las acciones preventivas para evitar el colapso ecosistémico y la pérdida de biodiversidad, servicios ambientales y bienestar humano. Los estudios empíricos del colapso ecosistémico son escasos y se enfrentan a obstáculos como la complejidad del ecosistema, respuestas rezagadas y no lineales e interacciones entre las escalas. Investigamos cómo un estresante antropogénico podría reducir la resiliencia del ecosistema a una perturbación recurrente mediante la alteración de un causante importante. Estudiamos los humedales dependientes de aguas subterráneas que acumulan turbas y son propicios a incendios conocidos como pantanos de tierras altas en el sureste de Australia. Nuestra hipótesis fue que la minería subterránea (estresante) reduce la resiliencia de estos humedales a incendios (perturbación) al disminuir el agua subterránea, un causante clave para el ecosistema. Monitoreamos la humedad del suelo como un indicador de la resiliencia del ecosistema durante y después de la minería subterránea. Después de los incendios, comparamos la respuesta de múltiples variables de estado que representaban la estructura, composición y función del ecosistema en los pantanos dentro de la huella minera con los pantanos referenciales sin minería. La humedad del suelo declinó sin recuperación en los pantanos con hundimientos mineros (es decir, socavones) pero se mantuvo en los pantanos referenciales durante ocho años (tamaño del efecto: 1.8). En relación a los pantanos referenciales incendiados, los pantanos con socavones e incendios mostraron una mayor pérdida de turba mediante la combustión del sustrato; reducción en la cobertura, altura y regeneración de biomasa de la vegetación; reducción en la riqueza y abundancia de especies vegetales post incendio; alteraciones en la composición de especies vegetales; incremento en la mortalidad de las plantas leñosas; reducción en el reclutamiento post incendio de plántulas; y la extirpación de un animal hidrofílico. Por lo tanto, los pantanos con socavones mostraron síntomas fuertes de un colapso ecosistémico post incendio, mientras que los pantanos referenciales se regeneraron vigorosamente. Descubrimos que los estresantes antropogénicos redujeron la resiliencia de un ecosistema a perturbaciones recurrentes, lo que lo predispone al colapso. La eliminación de este colapso depende de un diagnóstico temprano de mecanismos y reducción del riesgo preventivo. Puede ser posible retardar o mitigar los síntomas del colapso o restaurar la resiliencia, aunque lo último parece ser improbable en nuestro sistema de estudio debido a la alteración fundamental de un causante importante del ecosistema.

A function-based typology for Earth's ecosystems.

As the United Nations develops a post-2020 global biodiversity framework for the Convention on Biological Diversity, attention is focusing on how new goals and targets for ecosystem conservation might serve its vision of 'living in harmony with nature'1,2. Advancing dual imperatives to conserve biodiversity and sustain ecosystem services requires reliable and resilient generalizations and predictions about ecosystem responses to environmental change and management3. Ecosystems vary in their biota4, service provision5 and relative exposure to risks6, yet there is no globally consistent classification of ecosystems that reflects functional responses to change and management. This hampers progress on developing conservation targets and sustainability goals. Here we present the International Union for Conservation of Nature (IUCN) Global Ecosystem Typology, a conceptually robust, scalable, spatially explicit approach for generalizations and predictions about functions, biota, risks and management remedies across the entire biosphere. The outcome of a major cross-disciplinary collaboration, this novel framework places all of Earth's ecosystems into a unifying theoretical context to guide the transformation of ecosystem policy and management from global to local scales. This new information infrastructure will support knowledge transfer for ecosystem-specific management and restoration, globally standardized ecosystem risk assessments, natural capital accounting and progress on the post-2020 global biodiversity framework.

Measuring plant biomass remotely using drones in arid landscapes.

Measurement of variation in plant biomass is essential for answering many ecological and evolutionary questions. Quantitative estimates require plant destruction for laboratory analyses, while field studies use allometric approaches based on simple measurement of plant dimensions.We estimated the biomass of individual shrub-sized plants, using a low-cost unmanned aerial system (drone), enabling rapid data collection and non-destructive sampling. We compared volume measurement (a surrogate for biomass) and sampling time, from the simple dimension measurements and drone, to accurate laboratory-derived biomass weights. We focused on three Australian plant species which are ecologically important to their terrestrial and floodplain ecosystems: porcupine grass Triodia scariosa, Queensland bluebush Chenopodium auricomum, and lignum Duma florulenta.Estimated volume from the drone was more accurate than simple dimension measurements for porcupine grass and Queensland bluebush, compared to estimates from laboratory analyses but, not for lignum. The latter had a sparse canopy, with thin branches, few vestigial leaves and a similar color to the ground. Data collection and analysis consistently required more time for the drone method than the simple dimension measurements, but this would improve with automation.The drone method promises considerable potential for some plant species, allowing data to be collected over large spatial scales and, in time series, increasing opportunities to answer complex ecological and evolutionary questions and monitor the state of ecosystems and plant populations.

Are There Identifiable Risk Factors Associated With Heterotopic Ossification of the Temporomandibular Joint?

PURPOSE: Heterotopic ossification (HO) is defined as bone where it does not belong and as the abnormal presence of calcifications within soft tissues or joints. The purpose of this study was to answer the following clinical question: Are there identifiable risk factors associated with HO in and around the temporomandibular joint (TMJ)? METHODS: We designed a retrospective review of patients seen at the Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, between January 1985 and December 2019 and diagnosed with HO involving the TMJ. Variables studied included demographic factors, medical history including hereditary conditions, and specific TMJ history including past interventions. The primary outcome variable was the diagnosis of HO based on radiographic findings using the classification system described by Turlington and Durr. Inclusion criterion was clinical or radiographic evidence of TMJ HO. RESULTS: A total of 67 patients met the inclusion criteria. There were 48 females and 19 males (2.5:1) with an average age of 44.1 ± 16.7 years (range, 5-76 years). Risk factors associated with TMJ HO included musculoskeletal disease, psychiatric illness, history of trauma or previous TMJ surgeries, and congenital conditions. Of these, a history of nonsurgical TMJ therapy (odds ratio [OR], 3.5; P < .00) was most closely associated with HO. This was followed by male sex (OR, 3.1; P = .001), other craniofacial or musculoskeletal surgeries (OR, 2.4; P = .004), TMJ surgeries (OR, 1.9; P = .012), and neurogenic injury (OR, 1.8; P = .018). The results also demonstrated that patients diagnosed with TMJ HO were medically complex, with 86.6% presenting with other systemic conditions. CONCLUSION: This study identifies several risk factors which differ from those reported in the orthopedic literature. The Turlington and Durr classification is only partially helpful in clinical decision-making and needs to include HO associated with TMJ alloplasts and autogenous bone grafts (eg, costochondral grafts).

The utility of telemedicine in orofacial pain: Guidelines for examination and a retrospective review at a hospital-based practice.

BACKGROUND: Following the onset of the COVID-19 pandemic, telemedicine has become rapidly implemented into both medical and dental practices. While guidelines for examination through telemedicine have been described in similar fields of oral medicine and neurology, the framework for a comprehensive telemedicine examination for a patient with symptoms of orofacial pain has not yet been described. OBJECTIVE: The objective of this study is to introduce the format of a telemedicine examination for a new patient with orofacial pain as well as describe the success and utility of a telemedicine consultation in a hospital-based orofacial pain practice. METHODS: A retrospective review was performed of all new telemedicine consults from April 2, 2020, to March 29, 2021. Medical records were reviewed for patient demographics as well as details of the initial telemedicine consult and in-office follow up. RESULTS: Two hundred seventy new patients were seen. The most common diagnoses were myofascial pain of the masticatory muscles (37%), an articular disc disorder of the TMJ (21%), and TMJ arthralgia (16%), followed by obstructive sleep apnea (9%) and neuropathic orofacial pain (6%). 146 patients returned to the clinic for an in-office follow up, 78.8% of which had an accurate telemedicine diagnosis. Difficulty discerning between masticatory myofascial pain and TMJ arthralgia was the most common reason for inaccuracy during the telemedicine diagnosis. CONCLUSIONS: Telemedicine consultation for patients with orofacial pain can help facilitate an accurate diagnosis and expedite treatment for patients who face challenges presenting for an in-office consultation.

Do rural oral and maxillofacial surgeons prescribe more postoperative opioids?

PURPOSE: This study assesses rural-urban differences in opioid prescription practices among oral and maxillofacial surgeons (OMSs) who treated Medicare beneficiaries in 2017. METHODS: This cross-sectional study examines the 2017 Medicare Provider Utilization and Payment Dataset. The primary predictor variable was provider Rural-Urban Commuting Area code (rural versus urban). The primary outcome variable was mean opioid claims per Medicare beneficiary. Additional outcomes include total opioid claims volume, average Medicare beneficiaries and opioid cost per provider, mean days' supply of opioids per opioid claim, and average percentage of Medicare Part D claims represented by opioid claims. Mann-Whitney U tests compared continuous variables. A least-squares regression identified correlates of opioid claims volume. RESULTS: Rural OMSs demonstrated a higher mean opioid claims per OMS and opioid cost per provider compared to urban surgeons. Urban OMSs prescribed a greater mean days' supply of opioids per opioid claim. A larger percentage of Medicare Part D claims were represented by opioid claims for rural OMSs compared to urban OMSs. There were no differences in mean opioid claims per Medicare beneficiary. Male provider gender, female Medicare beneficiary gender, total number of beneficiaries, and a higher hierarchical condition category score were correlated with increased opioid claims per Medicare beneficiary for urban providers only. CONCLUSION: Urban and rural OMSs prescribe a similar volume of opioids per Medicare beneficiary, with rural providers prescribing higher total volumes of opioids due to larger patient panels. This work indicates that rural and urban OMSs have similar opioid prescribing practices.

First Bite Syndrome - An Underrecognized and Underdiagnosed Pain Complication After Temporomandibular Joint Surgery.

PURPOSE: First bite syndrome (FBS) can develop after head and neck surgical procedures. The aim of this study is to identify patients diagnosed with FSB after temporomandibular joint (TMJ) surgery, including their pain characteristics and risk factors for FBS. METHODS: Using a retrospective study design, a cohort of 24 patients with confirmed diagnosis of FBS were identified from the oral and maxillofacial surgery and orofacial pain (OFP) practices at Massachusetts General Hospital and Research Patient Data Registry (RPDR) between 1975 and 2019. The inclusion criteria were facial pain that was triggered by taste stimulus only and followed by a refractory period until the next gustatory stimulus. RESULTS: Of the 24 patients identified, 19 had undergone TMJ surgery, 3 patients had idiopathic FBS, 1 had a parapharyngeal space tumor and 1 developed FBS after facial burns. In the surgical patients, the median duration of onset was 2.75 months post-surgery. Most patients reported pain in the parotid region. Pain was only triggered by a taste stimulus and subsided with subsequent bites of food. 2 patients underwent spontaneous resolution of their symptoms and 1 reported complete resolution with onabotulinum toxin A (BTX) injections. Anxiety and depression were the most common comorbid conditions. CONCLUSION: FBS is an underrecognized pain complication in TMJ surgery patients. A precise history and accurate description of the pain is necessary for correct diagnosis which is important for improved treatment outcomes.

Oromandibular dystonia and temporomandibular disorders.

BACKGROUND: The aim of this study was to characterize clinical features of patients with oromandibular dystonia (OMD) who had temporomandibular disorder (TMD) symptoms. METHODS: A retrospective chart review of patients seeking treatment at a tertiary-level orofacial pain clinic from January 2015 through December 2020 was undertaken. The inclusionary criteria consisted of a diagnosis of OMD (International Classification of Diseases, Revision 10 code G24.4), which had been confirmed by a neurologist. RESULTS: Eleven patients met the inclusion criteria. Focal dystonia and jaw deviation OMD were the most frequent diagnoses. A dental procedure was a triggering or aggravating factor in 36.4% of patients. All but 2 patients had a sensory trick, or tactile stimulus to a particular body part, and approximately one-half of the patients used an oral appliance as a sensory trick device. All but 1 patient had received a diagnosis of TMD, with myofascial pain of the masticatory muscles being the most prevalent diagnosis. Four patients had received a recommendation for orthodontic treatment. About one-half of the patients had undergone 1 or more invasive dental or maxillofacial surgical interventions to address their dystonia. Anxiety was the most common psychological comorbidity. CONCLUSIONS: Because patients with OMD commonly experience TMD symptoms, they can receive a misdiagnosis of TMD while the OMD is overlooked. PRACTICAL IMPLICATIONS: Owing to concomitant TMD symptoms, patients most often seek dental consultations and undergo treatments such as orthodontic interventions and temporomandibular joint surgeries. A dentist's competency in recognizing these patients can prevent unnecessary procedures and facilitate appropriate patient care.