Subjective sleep complaints were associated with painful temporomandibular disorders in adolescents: The Epidor-Adolescere study.

BACKGROUND: Sleep disturbances in adolescents has received a lot of attention in the literature and it is recognised as a serious health concern. The association between pain and sleep disturbances in adolescents has been extensively studied. However, to the best of our knowledge, there is a lack of studies investigating the association between various subjective sleep variables and painful TMD in adolescents. OBJECTIVES: to investigate the association between painful TMD and subjective sleep variables in adolescents' non-clinical sample. We conducted a cross-sectional study. TMD was classified according to the RDC/TMD criteria. The Revised Face Scale evaluated TMD pain intensity, and pressure pain thresholds (PPTs) were assessed in trigeminal and extra-trigeminal areas. The subjective sleep variables were assessed according to the Sleep Disturbance Scale for Children and Sleep Behaviour Questionnaire. RESULTS: The final sample consisted of 690 adolescents (12.7 ± 0.76 years), with 16.2% of them presenting painful TMD. Adolescents who frequently reported waking up more than twice per night and feeling tired when awake were more likely to present painful TMD symptoms [OR = 1.7 (95% CI: 1.04-2.90); p = .034 and OR = 1.6 (95% CI: 1.01-2.48); p = .046, respectively]. The intensity of TMD pain was negatively associated with sleep quality (p = .015). Also, PPT values in the trigeminal and extra-trigeminal areas were negatively associated with total sleep time (p = .048 and p = .042, respectively). CONCLUSIONS: The present results point out the importance of considering sleep complaints associated with painful TMD in adolescents.

Association between primary headaches and temporomandibular disorders: A systematic review and meta-analysis.

BACKGROUND: The primary objective of this systematic review was to answer the following question systematically: Is there any association between primary headaches (PHs) and temporomandibular disorders (TMDs) in adults? TYPES OF STUDIES REVIEWED: The protocol was registered with the International Prospective Register of Systematic Reviews. The authors performed the search in 6 main databases and 3 gray literature sources. The included articles had to have adult samples. PHs must have been diagnosed using the International Classification of Headache Disorders, and TMDs must have been diagnosed using Research Diagnostic Criteria for Temporomandibular Disorders, Diagnostic Criteria for Temporomandibular Disorders, or International Classification of Orofacial Pain. Risk of bias was evaluated using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument tools. The meta-analysis was performed using Review Manager software, Version 5.4. Certainty of evidence was screened according to Grading of Recommendations Assessment, Development and Evaluation. RESULTS: Nine of 2,574 articles reviewed met the inclusion criteria for qualitative analysis and, of these, 7 met the inclusion criteria for quantitative analysis. Odds ratios (ORs) for painful TMD and tension-type headache (OR, 1.94 [95% CI, 0.56 to 6.76] to OR, 7.61 [95% CI, 1.84 to 31.48]), migraines (OR, 4.14 [95% CI, 1.38 to 12.43] to OR, 5.44 [95% CI, 3.61 to 8.21]), and chronic headaches (OR, 40.40 [95% CI, 8.67 to 188.15] to OR, 95.93 [95% CI, 12.53 to 734.27]) were calculated. Articular TMDs without pain were evaluated in 2 articles, and both did not show positive association with tension-type headache nor migraine. Three studies were classified as moderate risk of bias and 6 as low risk of bias. The certainty of evidence varied between very low and low. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Recognizing the positive association between painful TMD and PHs can help dentists and physicians treat the pain and avoid it, or recommend the patient to a specialist.

Widespread Pain and Central Sensitization in Adolescents with Signs of Painful Temporomandibular Disorders.

AIMS: To investigate the associations between signs of painful temporomandibular disorders (TMD) and number of tender points (TPs) and fibromyalgia in adolescents, as well as the relationship between TPs and pressure-pain threshold (PPT) in individuals presenting with local, regional, or widespread pain as a way to investigate the presence of central sensitization (CS). METHODS: The sample consisted of 690 Brazilian adolescents with and without signs of painful TMD, aged 12 to 14 years old. Painful TMD was classified according to the Research Diagnostic Criteria for TMD (RDC/TMD) Axis I. The criteria established by Yunus were applied to assess juvenile fibromyalgia and TPs. Mann-Whitney and chi-square tests were applied to test the associations between signs of painful TMD and demographic variables. Regression models were used to estimate the association between signs of painful TMD and number of TPs and to determine which additional predictive variables were associated with TPs. Regression analyses were performed to test the associations between PPT values and number of TPs. Fisher test was used to estimate the association between signs of painful TMD and FM. RESULTS: Significant associations between signs of painful TMD and the number of TPs (P < .001), as well as between TPs and the PPT values for local, regional, and widespread pain (P < .001), were found. No association between signs of painful TMD and fibromyalgia was found (P = .158). CONCLUSION: Individuals with signs of painful TMD presented with more TPs compared to pain-free adolescents. Moreover, the higher the number of TPs, the lower the PPT. This finding suggests that adolescents with signs of painful TMD are at increased risk of presenting with CS.

Systemic diseases and other painful conditions in patients with temporomandibular disorders and migraine.

Temporomandibular disorders (TMD) are a highly prevalent, painful musculoskeletal condition affecting the masticatory system, and are frequently associated with migraines (M) and other diseases. This study aimed to investigate the association between painful TMD and M with other painful conditions and systemic diseases, such as cervicalgia, body pain (BP), ear-nose-throat disorders, musculoskeletal disorders, diabetes, cardiopulmonary diseases and gastritis/peptic ulcer. METHODS: This was a cross-sectional study conducted in a sample of 352 individuals. Participants were stratified into three groups according to the presence of painful TMD and M: controls [individuals free of TMD and any headache (HA)]; TMD only (presence of painful TMD, but free of any HA); and TMD+M (presence of painful TMD and M). TMD was classified according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) - Axis I. Nonspecific physical symptoms (NSPS) were assessed by RDC/TMD - Axis II. The International Classification of Headache Disorders - II criteria, second edition, were applied to identify and classify primary HA. Other painful conditions and systemic diseases were assessed by volunteers' self-report. The prevalence of all assessed conditions was higher in the TMD+M group. Multiple regression models showed that cervicalgia was associated with the TMD only group (p<0.05), whereas gender (p<0.05), cervicalgia (p<0.05), BP (p<0.05) and NSPS (p<0.05) were significantly associated with the TMD+M group. Our results suggest that individuals with a comorbidity (TMD associated with M) have a more severe condition than those presenting only painful TMD.

Parafunctional habits are associated cumulatively to painful temporomandibular disorders in adolescents.

This cross-sectional study was designed to evaluate the effect of sleep bruxism, awake bruxism and parafunctional habits, both separately and cumulatively, on the likelihood of adolescents to present painful TMD. The study was conducted on a sample of 1,094 adolescents (aged 12-14). The presence of painful TMD was assessed using the Research Diagnostic Criteria for Temporomandibular Disorders, Axis I. Data on sleep bruxism, awake bruxism and parafunctional habits (nail/pen/pencil/lip/cheek biting, resting one's head on one's hand, and gum chewing) were researched by self-report. After adjusting for potential demographic confounders using logistic regression, each of the predictor variables (sleep bruxism, awake bruxism and parafunctional habits) was significantly associated with painful TMD. In addition, the odds for painful TMD were higher in the concomitant presence of two (OR=4.6, [95%CI=2.06, 10.37]) or three predictor (OR=13.7, [95%CI=5.72, 32.96]) variables. These findings indicate that the presence of concomitant muscle activities during sleep and awake bruxism and parafunctional habits increases the likelihood almost linearly of adolescents to present painful TMD.

Parafunctional habits are associated cumulatively to painful temporomandibular disorders in adolescents

Abstract This cross-sectional study was designed to evaluate the effect of sleep bruxism, awake bruxism and parafunctional habits, both separately and cumulatively, on the likelihood of adolescents to present painful TMD. The study was conducted on a sample of 1,094 adolescents (aged 12-14). The presence of painful TMD was assessed using the Research Diagnostic Criteria for Temporomandibular Disorders, Axis I. Data on sleep bruxism, awake bruxism and parafunctional habits (nail/pen/pencil/lip/cheek biting, resting one's head on one's hand, and gum chewing) were researched by self-report. After adjusting for potential demographic confounders using logistic regression, each of the predictor variables (sleep bruxism, awake bruxism and parafunctional habits) was significantly associated with painful TMD. In addition, the odds for painful TMD were higher in the concomitant presence of two (OR=4.6, [95%CI=2.06, 10.37]) or three predictor (OR=13.7, [95%CI=5.72, 32.96]) variables. These findings indicate that the presence of concomitant muscle activities during sleep and awake bruxism and parafunctional habits increases the likelihood almost linearly of adolescents to present painful TMD.

Auriculotemporal neuralgia.

In this article, the anatomic and physiologic characteristics and clinical syndromes involving the auriculotemporal nerve (ATN) are reviewed. The ATN is a terminal branch of the mandibular nerve (third division of the trigeminal nerve). The syndrome of ATN neuralgia (ATNa), which is characterized by attacks of paroxysmal, moderate to severe pain on the preauricular area, often spreading to the ipsilateral temple, is discussed in this article. The classification of ATNa under the Second Edition of the International Classification of Headache Disorders, as well as our personal experience in diagnosing and treating this syndrome, also are reviewed.