Automatic prediction of obstructive sleep apnea in patients with temporomandibular disorder based on multidata and machine learning.

Obstructive sleep apnea (OSA) is closely associated with the development and chronicity of temporomandibular disorder (TMD). Given the intricate pathophysiology of both OSA and TMD, comprehensive diagnostic approaches are crucial. This study aimed to develop an automatic prediction model utilizing multimodal data to diagnose OSA among TMD patients. We collected a range of multimodal data, including clinical characteristics, portable polysomnography, X-ray, and MRI data, from 55 TMD patients who reported sleep problems. This data was then analyzed using advanced machine learning techniques. Three-dimensional VGG16 and logistic regression models were used to identify significant predictors. Approximately 53% (29 out of 55) of TMD patients had OSA. Performance accuracy was evaluated using logistic regression, multilayer perceptron, and area under the curve (AUC) scores. OSA prediction accuracy in TMD patients was 80.00-91.43%. When MRI data were added to the algorithm, the AUC score increased to 1.00, indicating excellent capability. Only the obstructive apnea index was statistically significant in predicting OSA in TMD patients, with a threshold of 4.25 events/h. The learned features of the convolutional neural network were visualized as a heatmap using a gradient-weighted class activation mapping algorithm, revealing that it focuses on differential anatomical parameters depending on the absence or presence of OSA. In OSA-positive cases, the nasopharynx, oropharynx, uvula, larynx, epiglottis, and brain region were recognized, whereas in OSA-negative cases, the tongue, nose, nasal turbinate, and hyoid bone were recognized. Prediction accuracy and heat map analyses support the plausibility and usefulness of this artificial intelligence-based OSA diagnosis and prediction model in TMD patients, providing a deeper understanding of regions distinguishing between OSA and non-OSA.

ETIOLOGY, DIAGNOSIS AND TREATMENT OF MUSCLE-ARTICULAR DYSFUNCTION OF THE TEMPOROMANDIBULAR JOINT IN ADOLESCENCE.

Etiologic and pathogenetic aspects cause the most contentious issue in the study of temporomandibular joint (TMJ) syndrome in childhood and adolescence. Some researchers have linked the emergence of this group of diseases with abnormal occlusion, others have more emphasis on the age characteristics of a growing organism, or rather on a number of morphological and psychomotor processes arising and ending at puberty and cause physiological abnormalities in the growing organism. The aim of the study was to improve the method of complex treatment of TMJ dysfunction in adolescence by exploring its development factors with early diagnosis methods. MATERIAL AND METHODS: We have examined by clinical and radiological methods 33 patients with TMJ syndrome disorder between the ages of 11 to 18 years, 20 of them (60.6%) girls and 13 (39.4%) boys. All examined patients complained of the presence of clicks in the joint when they open mouth widely, irregular movement of the lower jaw when opening the mouth, the periodic occurrence of unilateral pain in the joint and the ear, increasing when taking rigid and solid food, which allowed us to establish the diagnosis of the TMJ syndrome. A clinical study has focused on the survey of patients, and in some cases their parents, in order to study carefully the history of life and disease, and the patient's complaints. We have found out the factors predisposing to the disease: the presence of various bad habits, family history, trauma of the lower jaw and TMJ, errors in orthodontic treatment. RESULTS: The data obtained showed that 16 (48.5%) patients had a history revealed various factors that contribute to the TMJ syndrome. The presence of various bad habits was about 38%. In addition, 13 (39.4%) patients reported the presence of emotional stress. The presence of orthodontic pathology was determined in 26 (78.8%) patients, 7 (21.2%) patients had no dentofacial disorders was not determined. The most common symptom, occurring in 27 (81.8%) patients was clicking in the joint with one or two sides, as well as excessive excursion of articular heads, occurring in 17 (51.5%) patients. A distinctive feature of TMJ syndrome manifestations in children and adolescents is relatively rare, in contrast to adults, the appearance of symptoms: pain when opening the mouth wide detected only 7 (21.2%) patients; pain in the joints - 8 (24.2%) patients; pain in the masticatory muscles - 6 (18.2%) patients. CONCLUSIONS: Based on the above, the etiological factors of musculo-articular dysfunction of the TMJ in adolescence can be not only dental anomalies, but also the presence of bad habits, disproportions in the growth of the bone and muscular skeleton and hypokinetic states caused by psychophysiological responses to chronic stress. Accordingly, treatment of patients with this pathology should be comprehensive and include not only treatment of the dental system, but also be aimed at the uniform development of the musculoskeletal system in children and at eliminating bad habits and chronic stress factors.

High prevalence of orofacial pain in juvenile fibromyalgia as detected by a novel tool specifically devised for children and adolescents.

OBJECTIVES: To examine the prevalence of temporomandibular disorders (TMD) in patients with juvenile fibromyalgia syndrome (JFS) and identify TMD characteristics specifically associated to JFS. METHODS: Signs and symptoms of TMD were assessed using a novel clinical tool specifically devised for children that consists of: 1. a self-report multiple-choice questionnaire; 2. a protocol for the clinical examination of the orofacial region. Multivariate logistic regression model was used to identify TMD features associated with JFS. RESULTS: Thirty JFS patients (median age 15.5 years) and 45 healthy controls (median age 15.0 years) were included in this cross-sectional study. Orofacial pain was reported by 26 of 30 JFS patients (86.7%) and by 3 of 45 controls (6.7%; p<0.001). Pain on TMJ palpation was present in 18 of 30 JFS patients (60%) and in 5 of 45 controls (11.1%; p<0.001). Median values of maximum spontaneous mouth opening, voluntary active opening and assisted passive opening were significantly higher in JFS patients than in controls. On multiple regression analysis spontaneous orofacial pain (OR: 21.0; p=0.005), diffuse tenderness on palpation of the masticatory muscles (OR: 14.9; p=0.026) and TMJ hypermobility (OR 1.42; p=0.008) were independently associated with JFS. CONCLUSIONS: The high prevalence of TMD in JFS highlights the need for a broader interdisciplinary evaluation of JFS patients. TMJ hypermobility, in addition to orofacial and masticatory muscle pain, is an important clue for the diagnosis of TMD in adolescents with JFS. Elucidating the link between these disorders will advance individualised management and improve treatment efficacy.

Oral behaviors and anxiety are significant predictors of jaw function limitation in patients with anterior disc displacement without reduction.

OBJECTIVE: We aimed to describe jaw function characteristics in patients with anterior disc displacement without reduction (ADDWoR) using the jaw function limitation scale (JFLS), and to investigate the effects of biopsychosocial risk factors on limited jaw function. DESIGN: In this cross-sectional study of 636 patients with ADDWoR (females, 568; males, 68), we used the JFLS to assess jaw function. Behavioral, psychological, sociodemographic, and biomedical data were collected. Multivariate logistic regression analysis was used to determine risk factors affecting limited jaw function. A receiver operating characteristic curve was used to evaluate the predictive effect of these risk factors. RESULTS: ADDWoR-associated limitations included restricted jaw mobility and mastication, which exceeded median global functional limitations scale scores, especially mouth opening to bite an apple and chewing tough food. Females had greater limitations in jaw mobility, verbal and emotional communication, and overall. Multivariate logistic regression analysis findings indicated that oral behaviors, anxiety, sex, pain intensity, and maximal mouth opening (MMO) were predictive of limited jaw function (area under the curve, 72 %). CONCLUSION: Patients with ADDWoR reported mastication and jaw mobility restrictions, with females having more pronounced limitations, and specific risk factors identified as significant predictors of jaw function limitations. Along with pain relief and improvement in MMO, appropriate psychological counseling and oral behavioral correction facilitates recovery of jaw function in such patients.

Temporary Hydrostatic Splint Therapy and Its Effects on Occlusal Forces.

Background and objectives: This study analyzed and compared the distribution patterns of occlusal forces using T-Scan III before and after the hydrostatic temporary oral splint (Aqualizer Ultra) therapy in healthy subjects and subjects with temporomandibular disorders (TMDs). Materials and Methods: Fifty-one subjects were divided into groups based on anamnesis and responses to the Fonseca questionnaire. The first group, non-TMDs group (n = 19), and the second group, TMDs group (n = 32), had mild-to-severe TMDs, as identified by the Fonseca questionnaire. The non-TMDs group had an average age of 25.4 years (SD = 4.8, range 20-38) with 15 females (78.95%) and 4 males (21.05%). The TMDs group had an average age of 27.4 years (SD = 7.0, range 22-53) with 25 females (78.125%) and 7 males (21.875%). T-Scan III device was used for occlusal analysis before and after hydrostatic splint usage. Results: Significant differences were observed in the TMDs group for anterior and posterior right percentages of forces before and after hydrostatic splint usage. The analysis of force distribution per sector before and after hydrostatic splint therapy showed no significant differences in the non-TMDs group. Analysis of force distributions in the entire study population before and after hydrostatic splint therapy showed significant differences in the anterior and posterior right regions. Occlusal force increased by 32-56% in the front region and decreased in the posterior area after hydrostatic splint usage. Conclusions: Hydrostatic splint therapy is recommended as a part of full-mouth rehabilitation treatment for all patients regardless of the severity of TMDs.

Exploring the Link between Sleep Quality and Temporomandibular Disorders.

How to cite this article: Vlasa A. Exploring the Link between Sleep Quality and Temporomandibular Disorders. J Contemp Dent Pract 2024;25(4):293-294. Keywords: Sleep quality, Temporomandibular disorders, Temporomandibular joint.

Muscle oxygenation and pain in different types of temporomandibular disorders.

OBJECTIVES: Studies exploring variations in peripheral muscle oxygenation and pressure pain thresholds (PPT) of masticatory muscles in individuals with Temporomandibular Disorders (TMDs) are limited. The purpose of this study was to compare variations in peripheral oxygenation of the masseter muscle; PPT of the masseter and temporal muscles and correlate peripheral muscle oxygenation and PPT of the masseter muscle in individuals with different types of TMDs. MATERIALS AND METHODS: Cross-sectional study involving 116 participants classified into three groups: muscle group (MG, n = 32), joint group (JG, n = 30) and muscle-joint group (MJG, n = 54). Individuals aged 26.97 ± 6.93, 68.97% female, 31,03% males were included. All participants were evaluated using the Diagnostic Criteria for Temporomandibular Disorders, Near-infrared spectroscopy (NIRS) for peripheral muscle oxygenation and pressure algometer for PPT. RESULTS: There was no difference in masseter muscle oxygenation among groups. In the masseter muscle, a weakly positive correlation was observed between PPT and variation in tissue saturation index in the MG (rho = 0.365) and JG (rho = 0.317). In addition, the MJG expressed lower PPT (p = 0.004) than JG, demonstrating that MJG had more pain in this muscle. CONCLUSIONS: MJG have lower PPT in the masseter muscle. Although the PPT is dependent on the type of TMDs, the correlation between PPT and oxygenation is weak. All TMDs groups evaluated (MG, JG, MJG) showed hemodynamic similarities of the masseter muscle. CLINICAL RELEVANCE: Understanding pain thresholds and the hemodynamic behavior of the masticatory muscles contributes to a more assertive physiotherapeutic assessment in TMDs, serving as a basis for careful and individualized interventions.

Analysis of the Effect of Exams on Perceived Stress and Temporomandibular Joint Status in Physiotherapy Students: A Pilot Study.

Background and Objectives: Temporomandibular disorders or dysfunction (TMDs) encompass a range of complex conditions that impact the temporomandibular joint (TMJ), chewing muscles, teeth, and/or their supporting tissues. Stress is one of the most associated factors studied as a TMD predictor. The aim is to figure out the influence of stress on TMJ status and salivary cortisol in university students during and before exams. Materials and Methods: The study was non-experimental, employing a longitudinal, analytical, observational cohort design. The study population consisted of students enrolled in the physiotherapy degree program at the Alfonso X El Sabio University (Madrid, Spain). Data were collected during two distinct academic periods: the first period was characterized by low academic stress and no exams, and the second period coincided with the high academic stress of final course exams. The collected results included sociodemographic data, assessment of TMJ status (Fonseca Index), evaluation of muscle evaluation (masseter, upper trapezius, and sternocleidomastoid) using a MOXY Monitor (muscle oxygenation) and Neurotrac® (surface EMG, sEMG), assessment of perceived stress (PSS-14), and measurement of salivary cortisol (enzyme immunoassay with Elisa). The statistical analysis was conducted with a confidence level of 95% (p ≤ 0.05) and asymptotic or bilateral significance. Results: 70 students were analyzed during two different measurement periods. According to the Fonseca Index, initially, 37.14% of the analyzed students showed mild TMDs, 17.14% moderate TMDs, and 45.72% showed no TMDs. In general terms, stress increased with age and is related to female sex, maximum mouth opening decreased with age, oxygen saturation decreased with age and academic stress, and myoglobin concentration was related to age. Furthermore, muscle contraction decreased during higher academic stress and increased with age. For women, age was a risk factor for suffering from TMDs, and stress worsened the transition from having TMDs to having no TMDs in both sexes. Conclusions: Academic stress influences TMJ status and muscle outcomes such as oxygen saturation, myoglobin concentration, and muscle contraction, although more research is needed.

Study of axiography changes in patients with temporomandibular joint dysfunction.

OBJECTIVE: Aim: To determine the effectiveness of treatment of temporomandibular joints muscle and joint dysfunction with occlusive splints based on the analysis of axiography data. PATIENTS AND METHODS: Materials and Methods: 274 (two hundred and seventy-four) patients aged 18 to 44 years with a diagnosis of temporomandibular joints dysfunction before and after treatment. RESULTS: Results: All patients with signs of temporomandibular joints dysfunction before treatment had a violation of the movement trajectory of the lower jaw: deviation - 68.7%, diflexion - 31.3%. When opening and closing the mouth, asymmetric shifts of the lower jaw of more than 2 mm were observed. After treatment with occlusive splints, the correct trajectory of opening and closing the mouth was noted: the number of patients with a trajectory violation decreased by 89.1%, and the amount of displacement of the lower jaw during opening and closing the mouth in 92.4% of patients decreased on average to 0.9 mm. When analyzing the movements of the lower jaw in the sagittal plane, deviations of the trajectory of the lower jaw were found in 79% of clinical cases. After the treatment using occlusive splints, 93.4% of cases of mandibular movement trajectory violations in the transversal plane were eliminated, and 78.1% of patients had a reduction in displacement volume to 0.9 mm. When analyzing the movements of the lower jaw in the sagittal plane, deviations of the trajectory of the lower jaw were found in 79% of clinical cases. After the treatment using occlusive splints, 93.4% of cases of mandibular movement trajectory violations in the transversal plane were eliminated, and 78.1% of patients had a reduction in displacement volume to 0.9 mm. CONCLUSION: Conclusions: Movement trajectories of the lower jaw in the sagittal plane improved in 80.1% of patients, normalization of the position of the lower jaw in relation to the neuromuscular trajectory was achieved in 93.4% of clinical cases. According to the analysis of the parameters, this treatment should be considered effective.

Quality of life and level of physical activity of individuals with temporomandibular disorders with and without otological symptoms: Secondary analysis of a cross-sectional study.

BACKGROUND AND PURPOSE: Otological symptoms (OS) are highly prevalent in individuals with temporomandibular disorders (TMD). Individuals with TMD and OS have more neck disability and decreased deep neck muscles endurance when compared to individuals without OS. However, no studies have evaluated whether OS is associated with lower Quality of Life (QoL) and worse levels of physical activity. This study aimed to evaluate the QoL and level of physical activity of individuals with TMD with and without OS. METHODS: In this cross-sectional study, 62 individuals with TMD were allocated into 2 groups: TMD with OS (n = 36) or TMD without OS (n = 26). Self-reported complaints of dizziness, vertigo, tinnitus, earache, ear fullness, or hypoacusis were considered as OS. QoL was assessed with the WHOQOL-Bref and physical activity with the IPAQ-SF. Independent t-test and chi-squared test were used for analysis between-groups. Effect sizes were reported using Cohen's d. A Pearson correlation was used to compare the number of OS and QoL scores. A significance level of p < 0.05% and 95% confidence intervals were considered statistically significant. RESULTS: The total generic scores for QoL were not different between-groups (p = 0.076), but individuals with TMD with OS had lower satisfaction (p = 0.015; d: 0.63) and physical domain (p = 0.015; d: 0.64) scores with a moderate effect size. In TMD with OS, 69.4% of individuals were irregularly active and 50% for the TMD without OS, with no statistical significance (p > 0.05). The number of OSs was inversely and weakly associated with the QoL total score. CONCLUSION: Individuals with TMD and OS are associated with worsened QoL (physical domain and satisfaction) when compared to individuals with TMD without OS. The higher the number of OS, the worse the QoL score. Individuals with TMD with and without OS had similar levels of physical activity, but a high prevalence of irregularly active and sedentary individuals within TMD diagnosed population was found.

Comparative effects of post isometric relaxation technique and Bowen's therapy on pain, range of motion and function in patients with temporomandibular joint disorder.

BACKGROUND: The most common cause of mouth and facial pain is a temporomandibular joint disorder, which affects the patient's quality of life and interferes with their ability to perform daily tasks. OBJECTIVE: The purpose was to compare the effects of the Post-Isometric Relaxation Technique and Bowen's Therapy on pain, range of motion and functional activity in patients with temporomandibular joint disorders. METHODS: This study was a randomized clinical trial. A total of 24 participants were randomly allocated into two groups using the lottery method. Baseline treatment was the same (ultrasound and tapping) in both groups. Group 1 (12 participants) was treated with a post-isometric relaxation technique, and Group 2 (12 participants) with Bowen's therapy for two sessions per week (total duration of 4 weeks). Outcome measures were the Numeric Pain Rating Scale, Maximal mouth opening inter-incisal rural and jaw functional limitation scale-20. SPSS version 25 was used for statistical analysis. RESULTS: A significant improvement in pain, range of motions and functional activities in the post-isometric group showed significant results (p < 0.05) as compared to Bowen's group (independent t-test). However, within-group comparison (paired t-test), both groups showed significant results (p < 0.05). CONCLUSION: This study concluded that post-isometric relaxation was more effective in terms of pain, range of motions for mouth opening, lateral deviations and functional activity of temporomandibular joint disorder patients. However, both groups showed clinical results according to minimal clinical difference values. TRIAL REGISTRY NUMBER: The trial is registered under ClinicalTrials.govt with reference no. ID: NCT05392049 registered on 26/05/2022.

Comparison of Machine Learning Algorithms Fed with Mobility-Related and Baropodometric Measurements to Identify Temporomandibular Disorders.

Temporomandibular disorders (TMDs) refer to a group of conditions that affect the temporomandibular joint, causing pain and dysfunction in the jaw joint and related muscles. The diagnosis of TMDs typically involves clinical assessment through operator-based physical examination, a self-reported questionnaire and imaging studies. To objectivize the measurement of TMD, this study aims at investigating the feasibility of using machine-learning algorithms fed with data gathered from low-cost and portable instruments to identify the presence of TMD in adult subjects. Through this aim, the experimental protocol involved fifty participants, equally distributed between TMD and healthy subjects, acting as a control group. The diagnosis of TMD was performed by a skilled operator through the typical clinical scale. Participants underwent a baropodometric analysis by using a pressure matrix and the evaluation of the cervical mobility through inertial sensors. Nine machine-learning algorithms belonging to support vector machine, k-nearest neighbours and decision tree algorithms were compared. The k-nearest neighbours algorithm based on cosine distance was found to be the best performing, achieving performances of 0.94, 0.94 and 0.08 for the accuracy, F1-score and G-index, respectively. These findings open the possibility of using such methodology to support the diagnosis of TMDs in clinical environments.

Effect of occlusal contact on TMJ loading during occlusion: An in silico study.

Alterations in occlusal features may have significant consequences, ranging from dental aesthetics to health issues. Temporomandibular joint disorders (TMDs) are often associated with joint overload, and the correlation between occlusal features and TMDs has been thoroughly discussed. In current work, we introduced a novel stomatognathic model that aligns well with in vivo experimental measurements, specifically designed to decouple the impact of occlusal contact and periodontal ligament (PDL) negative feedback on temporomandibular joint (TMJ) loading. Utilizing an in-silico approach, the simulation analysis included six symmetric occlusal contact scenarios. Furthermore, a biomechanical lever model was employed to clarify the mechanical mechanism and investigate the multi-factorial effects of TMJ overload. These findings indicate that anterior shifts in the occlusal centre lead to increased TMJ loading, particularly in occlusal contact cases with anteroposterior changes. Considering the symmetrical distribution of occlusal contact, mediolateral alterations had a more modest effect on TMJ loading. Additionally, potential negative feedback activated by principal strain of periodontal could not only alleviate joint load but also diminish occlusal force. These investigations enhance our understanding of the intricate interactions between masticatory muscles, occlusal forces, and joint contact forces, thereby providing motivation for future comprehensive studies on TMJ biomechanical overload.

Does combining oro-facial manual therapy with bruxism neuroscience education affect pain and function in cases of awake bruxism? A pilot study.

BACKGROUND: Although awake bruxism is associated with temporomandibular disorder (TMD) as well as head and neck pain, the effects of physical therapy and bruxism education to address these factors have not been investigated. OBJECTIVE: The aim of this study was to evaluate the effects of oro-facial manual therapy and bruxism neuroscience education (BNE) on awake bruxism over a 3-week period with an open-ended follow-up questionnaire after 3 months. METHODS: Subjects (n = 28) were randomly allocated to one of two groups, an intervention group and a control group. Data regarding disability, function and pain were collected pre- and post-assessment, with all measures administered in a single-blind fashion. Participants in both groups received six treatment sessions during this period. In addition to manual therapy, participants were provided with information on the neurophysiological mechanisms of bruxism and contributing factors. Individual behavioural guidelines and daily exercises were determined in consultation with the therapist. An introduction to a bruxism specific app (Brux.App) was also provided, which all participants used as an adjunct to their treatment. RESULTS: The intervention group demonstrated notable improvement as indicated by their scores in the Neck Disability Index (NDI) (p = .008), Pain Disability Index (PDI) (p = .007) and Jaw Disability List (JDL) (p = .03). Furthermore, clinical assessments of the temporomandibular joint (TMJ) revealed a significant progress in terms of mouth opening (p = .03) and lateral jaw movement (laterotrusion) (p = .03). The mechanical pain threshold (PTT) of both the masseter (p = .02) and temporalis muscle (p = .05) also showed significant improvement. At 3-month follow-up, the questionnaire revealed that the majority of the intervention group (13/15, 87%) reported a benefit from the treatment. CONCLUSION: The reduction in pain and disability together with improvement in function and increased coping suggest a potential modification of awake bruxism through specialised musculoskeletal intervention and BNE tailored to the individual patient.

Modulatory Processes in Craniofacial Pain States.

Pain is a common symptom associated with many disorders affecting the craniofacial tissues that include the teeth and their supporting structures, the jaw, face and tongue muscles, and the temporomandibular joint. Most acute craniofacial pain states are easily recognized and readily treated, but chronic craniofacial pain states (e.g., temporomandibular disorders [TMD], trigeminal neuropathies, and some headaches) may be especially challenging to manage successfully. This chapter provides an overview of the processes that underlie craniofacial pain, with a focus on the pain-modulatory mechanisms operating in craniofacial tissues and in the central nervous system (CNS), including the role of endogenous chemical processes such as those involving opioids. The chapter outlines in particular findings from preclinical studies that have provided substantial information about the neural as well as nonneural (e.g., glial) processes involved in the initiation, transmission, and modulation of nociceptive signals in the trigeminal system, and also draws attention to their clinical correlates. The increased understanding gained from these preclinical studies of how nociceptive signals can be modulated will contribute to improvements in presently available therapeutic approaches to manage craniofacial pain as well as to the development of novel analgesic approaches.

Characteristics of painful temporomandibular disorders and their influence on jaw functional limitation and oral health-related quality of life.

BACKGROUND: There is limited knowledge about the impact of painful temporomandibular disorders (TMDs) and pain characteristics on jaw functional limitation and oral health-related quality of life (OHRQoL) in TMD patients. OBJECTIVES: The influence of painful TMDs and pain characteristics on jaw functional limitation and OHRQoL was investigated. Inter-relationships between limitation in jaw function and various OHRQoL domains, along with facial pain attributes predicting impaired jaw function and diminished OHRQoL were also examined. METHODS: TMD patients were recruited from a university-based hospital. A comprehensive questionnaire comprising demographic variables, the DC/TMD Symptom Questionnaire, Graded Chronic Pain Scale, Jaw Functional Limitation Scale-8 (JFLS-8) and Oral Health Impact Profile-TMD (OHIP-TMD) was administered. Participants underwent a protocolized physical examination, and TMD diagnoses were determined utilising the DC/TMD algorithms. Participants were subsequently stratified into intra-articular/pain-related/combined TMD groups, as well as no TMD pain, acute/chronic pain and low/high-intensity pain groups. Data were assessed using non-parametric and hierarchical linear regression analyses (α = .05). RESULTS: The final sample consisted of 280 participants (mean age 31.2 (SD 11.8) years; 79.3% women). Significant differences in pain characteristics, JFLS-8, and global OHIP scores were observed across the various TMD subtypes, pain chronicity and pain intensity categories. Pain intensity and pain-related interference exhibited moderate correlations with JFLS-8 and global OHIP scores (rs = 0.53-0.60). Moderate associations were also noted between JFLS-8 and global OHIP, as well as most OHIP domains (rs = 0.42-0.64). Both jaw functional limitation and OHRQoL were predicted by sex, pain intensity and pain-related interference. CONCLUSIONS: Sex, pain intensity and pain-related interference are key determinants for both impaired jaw function and diminished OHRQoL, with pain-related interference exerting a more pronounced effect.

Evaluation of functional interaction masseter and sternocleidomastoid muscles affected by TMJ dysfunction.

OBJECTIVE: Aim: To evaluate the functional connection and the bioelectrical state of the m.masseter and m. sternocleidomastoid using functional tests before and after treatment. PATIENTS AND METHODS: Materials and Methods: The sample consisted of 21 individuals with temporomandibular joint dysfunction. Examinations were carried out before and after treatment using repositioning splint therapy and in seated/standing positions. RESULTS: Results: M. masseter - p=0.072 before treatment and p=0.821 after treatment. Symmetry is also maintained after treatment. After treatment, a significant difference is noted at the level of significance p<0.001 for the right chewing muscle. In seated and standing positions before treatment did not reveal a statistically significant difference (p=0.07, p=0.143) and after (p=0.272, p=0.623).M. sternocleidomastoid- p<0.001 when comparing right and left sides. After treatment, there was no difference between the right and left sides (p=0.169). No statistical difference was found when assessing indicators separately for the right and left muscles in seated and standing positions (p=0.304, p=0.611, p=0.089, p=0.869). When comparing the bioelectric potentials of the right muscle before, after treatment, a statistically significant difference was found p=0.001. CONCLUSION: Conclusions: Biostatistical analysis of the indicators of bioelectrical activity of m. masseter and sternocleidomastoid indicates no changes in muscle microvolt indicators with changes in body position in patients. However, repositioning splint therapy is associated with reduced muscle tone in initially more spasmodic muscles. It is worth noting that the symmetry of interaction between muscles improves.

Influence of psychometric and sleep quality features on painful mechanical sensitivity and pain modulation in patients with temporomandibular disorders.

Investigating the collective impact of psychometric properties and sleep quality on pain sensitivity in temporomandibular disorder (TMD) patients could improve clinical management strategies. OBJECTIVE: Assessing whether combined psychometric properties and sleep quality impact painful mechanical sensitivity and pain modulation in TMD patients. MATERIALS AND METHODS: A cross-sectional study using secondary data analysis of 77 TMD patients and 101 controls. All participants completed questionnaires characterizing their psychometric profile (anxiety, depression, stress and catastrophizing) and sleep quality, alongside psychophysical tests for painful mechanical sensory (mechanical pain threshold (MPT), pressure pain threshold (PPT), and wind-up ratio (WUR)) and conditioned pain modulation (CPM). Participants were grouped into "High distress" or "Low distress" categories based on psychometric properties and sleep quality using hierarchical cluster and k-means analyses. Multiple linear regression evaluated the influence of TMD, age, and the distress cluster on MPT, WUR, PPT, and CPM in masseter and thenar muscles. Differences were statistically significant when p < 0.05. RESULTS: The presence of TMD was the strongest predictor of mechanical painful sensitivity in the trigeminal region (MPT[F(3,174) = 51.902;p < .001;R2 = .463]; TMD presence (ß = -.682) / PPT[F(3,174) = 15.573;p < .001;R2 = .198] TMD presence (ß = -.452), and extra-trigeminal (MPT[F(3,174) = 35.897;p < .001;R2 = .382] TMD (ß = -.647) / CPM [F(3,174) = 4.106;p < .05;R2 = .050] TMD presence (ß = .197). Furthermore, neither the high distress group nor the low distress group were able to significantly influence the variation of the values of any of the psychophysical variables evaluated (p > .05). CONCLUSIONS: There is not a significant influence of impairment clusters based on psychological variables and sleep quality on painful mechanical sensitivity and pain modulation, regardless of the presence of TMD. CLINICAL RELEVANCE: This outcome suggests that psychosocial factors and sleep quality may not play a decisive role in the sensory-discriminative aspect of pain, particularly concerning painful TMD.

Effects of athletic tape on orofacial pain and jaw movements after 24 hours of use: a randomized clinical trial. / Efeitos da bandagem elástica na dor orofacial e nos movimentos mandibulares após 24 horas de uso: ensaio clínico randomizado.

PURPOSE: To analyze the sensation of pain and the range of mandibular movements of adult individuals with temporomandibular disorder, before and after the application of the athletic tape. METHOD: This is a double-blind randomized clinical trial, in which 22 adults with temporomandibular disorder participated, randomly allocated into two groups, with group A comprising 10 women and one man (mean age 28.2±8.3 years) and group B comprising nine women and two men (mean age 26.2±3.9 years). Group A was submitted to the application of the athletic tape on the masseter with 40% stretch and the group B to the application of the athletic tape on the masseter without stretching. All participants underwent the application of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Pain threshold assessment was performed using an algometer to apply pressure to measurement points. The measurement of mandibular movements was performed using a caliper. The athletic tape was glued using the I technique, with a fixed point over the insertion and a movable point over the origin of the masseter muscle. Participants remained with the athletic tape for 24 hours and were re-evaluated. RESULTS: There was pain relief in the group A in the temporomandibular joint on the right and at the origin of the masseter on the left. The group B showed a reduction in pain in the left anterior temporal region. No differences were found in mandibular movements after intervention, as well as no difference was found in the comparison by groups. CONCLUSION: The use of the athletic tape over the masseter muscle, with stretching, for 24 hours produced relief from the sensation of pain, on the origin of the right masseter and in the right temporomandibular joint, and, without stretching, in the left anterior temporal muscle. There was no difference in the range of mandibular movements.

OBJETIVO: Analisar a sensação de dor e amplitude dos movimentos mandibulares de indivíduos adultos com disfunção temporomandibular, antes e após aplicação da bandagem elástica por 24 horas. MÉTODO: Trata-se de um ensaio clínico randomizado duplo-cego, do qual participaram 22 sujeitos adultos com disfunção temporomandibular, alocados aleatoriamente em dois grupos, sendo grupo A composto por 10 mulheres e um homem (média de idade de 28,2±8,3 anos) e grupo B por nove mulheres e dois homens (média de idade de 26,2±3,9 anos). Todos os participantes foram submetidos à aplicação do Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Foi realizada a avaliação do limiar da dor, com uso de um algômetro, para aplicação da pressão no masseter e temporal e medição dos movimentos mandibulares, com paquímetro. O grupo A foi submetido à aplicação da bandagem sobre o músculo masseter com estiramento de 40% e o grupo B sem estiramento. A colagem da bandagem foi realizada, com corte em "I", com ponto fixo sobre a inserção e ponto móvel sobre a origem do músculo masseter. Os participantes permaneceram com a bandagem por 24 horas e foram reavaliados. RESULTADOS: Houve alívio da dor no grupo A na articulação temporomandibular à direita e na origem do masseter à esquerda. O grupo B apresentou redução da dor em região de temporal anterior à esquerda. Não foram encontradas diferenças nos movimentos mandibulares após intervenção, bem como não houve diferença na comparação entre os grupos. CONCLUSÃO: O uso da bandagem sobre o masseter, por 24 horas, com estiramento, produziu alívio da dor na origem do masseter direito e na região da articulação temporomandibular direita e, sem estiramento, no temporal anterior esquerdo. Não houve diferença na amplitude de movimentos mandibulares.