Effectiveness of conservative therapeutic modalities for temporomandibular disorders-related pain: a systematic review.

PURPOSE: The aim of this systematic review was to evaluate the effectiveness of conservative different therapeutic modalities for temporomandibular disorders (TMD) pain. MATERIALS AND METHODS: An electronic systematic search was conducted in the MEDLINE (PubMed) database to identify the randomized clinical trials (RCTs) published between 2001 and 2021. The following, simple or multiple conjunctions, search keywords were selected: TMD pain, TMD management or conservative treatment or treatment strategies and TMD pain, therapeutic modalities or interventions and TMD. Studies included must have patients older than 18 years, with painful TMD, which diagnosis was performed by Research Diagnostic Criteria for TMD or Diagnostic Criteria for TMD. Outcome variables were pain relief and post treatment pain intensity reduction. Data were analysed with non-parametric tests and the level of significance was set at p<.05. RESULTS: Out of 1599 articles obtained, 28 RCTs fulfilled all selection criteria and were included. The results of this study show that there was a significant decrease in short-term post-treatment TMD pain with the use of occlusal splint alone or in combination with other therapeutic modalities when compared with the control group. Statistically significant differences were also detected between laser and photobiomodulation group and the control, in short-term treatment TMD-related pain. CONCLUSIONS: The primary findings of the present systematic review showed that the occlusal splint alone or combined with other therapeutic intervention presented positive effect on short-term TMD pain reduction. Secondary outcome suggests that laser and photobiomodulation therapy had, also, a significant role in short term pain relief.

Prevalence of ß-lactam (bla TEM) and Metronidazole (nim) Resistance Genes in the Oral Cavity of Greek Subjects.

OBJECTIVES: The aim of this study is to investigate the prevalence of bla TEM and nim genes that encode resistance to ß-lactams and nitroimidazoles, respectively, in the oral cavity of systemically healthy Greek subjects. MATERIALS AND METHODOLOGY: After screening 720 potentially eligible subjects, 154 subjects were recruited for the study, including 50 periodontally healthy patients, 52 cases of gingivitis and 52 cases of chronic periodontitis. The clinical parameters were assessed with an automated probe. Various samples were collected from the tongue, first molars and pockets >6mm, and analysed by polymerase chain reaction-amplification of the bla TEM and nim genes, using primers and conditions previously described in the literature. RESULTS: There was a high rate of detection of bla TEM in plaque and tongue samples alike in all periodontal conditions (37% of plaque and 60% of tongue samples, and 71% of participants). The bla TEM gene was detected more frequently in the tongue samples of the periodontally healthy (56%) and chronic periodontitis (62%) groups compared to the plaque samples from the same groups (36% and 29%, respectively; z-test with Bonferroni corrections-tests, P<0.05). The nim gene was not detected in any of the 343 samples analysed. CONCLUSION: The oral cavity of Greek subjects often harbours bla TEM but not nim genes, and therefore the antimicrobial activity of ß-lactams might be compromised.

Prevalence of Staphylococcus aureus and methicillin resistant Staphylococcus aureus (MRSA) in the oral cavity.

OBJECTIVE: To assess the prevalence of Staphylococcus aureus and methicillin resistant Staphylococcus aureus (MRSA) in plaque and tongue samples from systemically healthy subjects with periodontal health, gingivitis or chronic periodontitis. METHODS: After screening 720 potentially eligible subjects, 154 systemically healthy participants were ultimately enrolled in the current study. Subgingival samples were taken from the first molars and the tongue and analyzed for the presence of S. aureus and MRSA by polymerase chain reaction (PCR), using primers and conditions previously described in the literature. In addition, samples were taken from deep periodontal pockets of chronic periodontitis patients. Statistical analysis was performed by applying non-parametric tests (Kruskal-Wallis for clinical parameters, and z-test with Bonferroni corrections for distributions of assessed parameters). All comparisons were set at the 0.05 significance level. RESULTS: S. aureus was detected in 18% of all participants and in 10% of the samples tested. No significant differences were found in its distribution among the three investigated groups (z-test for proportions with Bonferroni corrections, p>0.05). The mecA gene was not present in any of the S. aureus found. CONCLUSIONS: S. aureus can be found in the oral environment regardless of the periodontal conditions and therefore should be considered as a member of the transient flora not participating in periodontal pathology. Subgingival sites and tongue surfaces seem to be an unusual habitat of MRSA.

Prevalence and distribution of Aggregatibacter actinomycetemcomitans serotypes and the JP2 clone in a Greek population.

AIM: to investigate the distribution of Aggregatibacter actinomycetemcomitans serotypes and the prevalence of the JP2 clone in subgingival samples of Greek subjects. MATERIALS AND METHODS: two hundred and twenty eight subjects participated in the present study. Each contributed with one pooled subgingival sample from the mesiobuccal surface of the four first molars. Samples were analysed using polymerase chain reaction for five serotypes of A. actinomycetemcomitans and the JP2 clone, using primers and conditions described previously. Subjects were stratified according to periodontal status (untreated periodontitis, non-periodontitis and periodontitis patients receiving supportive treatment). Comparisons between and within groups were performed by applying non-parametric tests (Kruskall-Wallis, Pearson χ(2) , z-test with Bonferroni's corrections and Kramer's V-test) at p=0.05 level. RESULTS: a. actinomycetemcomitans was detected statistically more frequently in untreated patients (27.5%) compared with the other two groups (11.7% for non-periodontitis and 10% for periodontitis patients receiving supportive treatment). No statistical differences were observed concerning the distribution of serotypes among groups (z-test with Bonferroni's corrections p>0.05). Serotype c was more predominant within the periodontally diseased groups (Kramer's V-test p<0.05). The JP2 clone was not detected. CONCLUSIONS: a. actinomycetemcomitans serotype b was not statistically correlated with periodontal disease in the investigated sample and the utility of microbiological testing before antimicrobial administration is emphasized.

Clinical and microbiological effects of adjunctive, locally delivered chlorhexidine on patients with chronic periodontitis.

OBJECTIVE: The impact of a locally delivered chlorhexidine chip (Periochip) on clinical and microbiological parameters of chronic periodontitis requires further documentation. The aim of the present study was to investigate the effects of the chip as an adjunct to mechanical treatment of chronic periodontitis. METHODS: Fifty patients with chronic periodontitis were randomized into two groups. The test group (n = 25) received scaling and root planing and adjunctive Periochip in four pockets. The control group (n = 25) received scaling and root planing only. Clinical indices (probing depth, probing attachment level, bleeding on probing) were assessed at baseline, three and six months. Subgingival samples were analyzed at baseline, three weeks, three and six months after treatment for levels of eight bacterial species using "checkerboard" DNA-DNA hybridization. RESULTS: The targeted difference of probing depth of 2 mm between groups was not observed. Both treatments resulted in improvement of clinical indices and non-statistically significant differences were observed between the two groups at any time point, with the exception of bleeding on probing at three months (ANOVA, p < 0.05). No major differences were observed concerning levels of important periodontal pathogens (Mann-Whitney test, p < or = 0.05). CONCLUSIONS: In this small, six-month, phase 4 trial, no differences in mean probing depth reduction or "red-complex" periodontal pathogens were detected for patients with chronic periodontitis treated with adjunctive chlorhexidine chip (single administration) as compared to patients treated with scaling and root planing alone.

Clinical and microbiological effects of different antimicrobials on generalized aggressive periodontitis.

AIM: To evaluate and compare the effects of adjunctive metronidazole plus amoxicillin, doxycycline and metronidazole on clinical and microbiological parameters in patients with generalized aggressive periodontitis. MATERIAL AND METHODS: Forty-three patients participated in this randomized clinical trial divided into four groups. Six weeks after scaling and root planning (SRP), groups 1-3 received adjunctive metronidazole, plus amoxicillin, doxycycline and metronidazole respectively, and group 4 acted as controls. Clinical recordings concerning probing depth, probing attachment level and bleeding on probing were performed at baseline, 6 weeks after SRP and 6 months from baseline. Subgingival samples were analysed using the 'checkerboard' DNA-DNA hybridization for Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Tannerella forsythia and Treponema denticola. RESULTS: All treatments resulted in improvement of clinical parameters (ANOVA p > 0.05). Systemic administration of metronidazole plus amoxicillin or metronidazole resulted in statistically significant greater reduction of the proportion of sites > 6 mm than SRP (z-test, p < 0.05). These antimicrobials yielded a significant effect on levels of important periodontal pathogens for 6 months. CONCLUSION: Adjunctive metronidazole plus amoxicillin or metronidazole alone (when A.actinomycetemcomitans is not involved) is effective in deep pockets of aggressive periodontitis patients.