Disclosure orthodontic and TMD - new study.

DESIGN: Cooperative analysis of participants and controls. DATA SOURCE: Wiley Online Library, National Institute of Health, ResearchGate, ScienceDirect, Google Scholar. STUDY SELECTION: Human clinical trials age 18-30 years old, a case-control study included 291 individuals, 192 TMDs and 99 controls. All patients underwent assessment based on a questionnaire and a clinical examination according to Axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Patients who underwent orthodontic treatment were compared to those who did not, regarding their trauma history, bruxism, aggressive teeth brushing, level of oral hygiene, pain scores, muscle tenderness scores and subjective sleep quality. EXCLUSION CRITERIA: Medical and/or dental emergencies, subjects with a history of drug, alcohol or medication abuse, fibromyalgia, being pregnant or lactating, having a coexisting mental, psychiatric, or physical disability, cancerous or significant medical problems and the consumption of drugs and/or medications that affect the nervous system including narcotics, TCA (tricyclic antidepressants), anticonvulsant, muscle relaxants and medication overuse headache. DATA EXTRACTION SYNTHESIS: To identify differences between groups, categorical independent variables were analysed using the chi-square test or likelihood ratio, while numeric independent variables were analysed using independent t-tests and analysis of variance (ANOVA). A two-tailed level of statistical significance (α) was established at 0.05. Analysis of multicollinearity was performed following the univariate analyses to examine the collinearity among the independent variables and select independent variables with minimal correlation. Among the highly correlated variables, only one was selected for inclusion in the multivariate model, with the specific variable chosen based on contextual considerations. RESULTS: The research comprised a total of 291 individuals, consisting of two distinct groups: the TMD group (192 participants, 66%) and the control group (99 participants, 34%). Within the TMD group, further subcategorization was conducted, including MMP (masticatory muscle pain) with 44 individuals (15%); TMJD with 26 individuals (9%); and TMP (both MMP and TMJ) with 122 individuals (42%). CONCLUSIONS: Using a "holistic" and a "collinearity statistical approach and the utilization of a multivariate model" the conclusion is that TMD is not associated with orthodontics.

Is the traditional placement of stainless steel crowns in primary teeth more painful than the non-preparation Hall technique?

CLINICAL QUESTION: Is the anxiety level and pain experience in young children the same for the traditional method of stainless crowns placement that might require local anesthetic and excavation of decay compared to the Hall technique that requires no preparation and no anesthetic injections? DESIGN: A randomized controlled study of 2 groups (43 and 54) children 4-8 years old with proximal decay in primary first molars. Each child had one tooth restored with the Hall technique (HT) and the second tooth received a conventional stainless crown (CT) (with or without local anesthesia, as needed) and all crowns were cemented with a GIC resin type cement less than a month of each other. The order of the placement was reversed with the allocation randomly concealed. DATA ANALYSIS: A visual Wong-Baker Pain Scale with six cartoon faces was used to record pain levels. Data were analyzed using SPSS (version 25). After computing univariate descriptive statistics, differences among proportions were examined using cross-tabulations and χ2 tests (α = 0.05). Analysis of variance was conducted for parametric analysis, and the Wilcoxon signed-rank test was used for within-group, and the Mann-Whitney U-test was used for between-group, nonparametric analysis. RESULTS: The pain scores did not differ by treatment type. The majority of children (58.3%) reported low procedural pain for both treatments leaving 47.7% reporting moderate to high procedural pain. Using local anesthetic with CT did not change the results. CONCLUSION: The pain scores were similar for both procedures. HT has been recommended as less traumatic and but this might not be true for all children.

Local myalgia compared to myofascial pain with referral according to the DC/TMD: Axis I and II results.

BACKGROUND: The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) categorized TMD muscle disorders into 3 subgroups: local myalgia, myofascial pain with spreading and myofascial pain with referral. However, the rationale for such division into subgroups and the pathogenesis and prognosis of muscle-related TMD are still poorly understood. The aim of this study was to explore the differences between local myalgia and myofascial pain with referral by means of a biopsychosocial model based on the DC/TMD. METHODS: This retrospective study included all consecutive TMD patients who were diagnosed according to the DC/TMD in our institution between 2015 and 2018. The Axis I and II findings of patients diagnosed with local myalgia were compared to those of patients with myofascial pain with referral. A p value < 0.05 was considered statistically significant. RESULTS: A total of 255 patients (61 men and 194 women, mean age 37.8 ± 15.34 years) were enrolled into the study, 114 in the local myalgia group and 83 in the myofascial pain with referral group. The levels of depression and nonspecific physical symptoms, headache attributed to TMD (HAattrTMD), and characteristic pain intensity (CPI) were significantly higher in the latter group. The significant differences for depression and nonspecific physical symptoms persisted after excluding patients diagnosed with HAattrTMD, however, the levels of significance were lower (p = 0.006 compared to p = 0.033 for depression total score, and p = 0.001 compared to p = 0.046 for nonspecific physical symptoms total score). CPI levels, extent of disability, and pain duration were similar for both groups when excluding for HAattrTMD. CONCLUSION: The current study findings highlight the importance of differentiating between subgroups of myalgia according to the DC/TMD. The diagnosis of myofascial pain with referral may point to a significant Axis II component.

A fMRI evaluation of lamotrigine for the treatment of trigeminal neuropathic pain: pilot study.

Using functional magnetic resonance imaging (fMRI) methods, we evaluated the effects of lamotrigine vs placebo in a double-blind 1:1 randomized trial. Six patients with neuropathic pain were recruited for the study. All subjects had baseline pain >4/10 on a visual analog scale (VAS) and allodynia to brush as inclusion criteria for the study. Patients underwent two fMRI sessions, with half of the subjects receiving placebo first and half receiving drug first (based on the blinding protocol). Lamotrigine decreased their average pain intensity level from 5.6 to 3.5 on a VAS. All subjects had brush, cold, and heat applied to the affected and mirror-unaffected sides of their face. The results show: 1) in a small cohort, lamotrigine had a significant effect on heat VAS but not on the other stimuli; and 2) contrast analysis of fMRI results for heat stimuli applied to the affected face for lamotrigine vs placebo produced an overall decrease in blood oxygen dependent level signal, suggesting a potential inhibitory effect of the drug on predominantly cortical regions (frontal, parietal, and temporal).

A critical review of the use of botulinum toxin in orofacial pain disorders.

This article reviews the appropriate use, cautions, and contraindication for botulinum neurotoxin (BoNT) and reviews the peer-reviewed literature that describes its efficacy for treatment of various chronic orofacial pain disorders. The literature has long suggested that BoNT is of value for orofacial hyperactivity and more recently for some orofacial pain disorders; however, the results are not as promising for orofacial pain. The available data from randomized, double-blind, placebo-controlled trials (RBCTs) do not support the use of BoNT as a substantially better therapy than what is being used already. The one exception is that BoNT has reasonable RBCT data to support its use as a migraine prophylaxis therapy. The major caveat is that the use of BoNT in chronic orofacial pain is "off-label".

Oral appliance management of obstructive sleep apnea: a case report.

Obstructive sleep apnea (OSA) and snoring are common related conditions with major health and social implications. OSA is a progressive disease with symptoms of daytime sleepiness and chronic cardiovascular morbidity A mandibular advancement oral appliance is the only nonsurgical management modality available if continuous positive airway pressure (CPAP) cannot be tolerated. A patient who had been diagnosed with OSA was successfully treated but developed a posterior open bite and symptomatic temporomandibular joints (TMJ). An integrated approach to managing his OSA and TMJ conditions enabled him to have a comfortable and stable bite and to continue using his obstructive sleep apnea appliance. Management of OSA with an oral appliance should be handled by a dentist who is trained and experienced in the overall care of oral health, temporomandibular joints, dental occlusion, and associated structures. A team approach starting with the diagnosis of OSA by a physician and management by a dentist is described.