Network analysis of sleep bruxism in the EPISONO adult general population.

Sleep bruxism (SB) has been associated with biological and psychosocial factors. The assessment of SB includes self-report, clinical evaluation, and polysomnography. This study aimed to investigate the associations of self-reported SB with other sleep disorders and demographic, psychological, and lifestyle factors in the adult general population, and to investigate whether self-reported SB and polysomnographically (PSG) confirmed SB provide similar outcomes in terms of their associated factors. We recruited 915 adults from the general population in Sao Paulo, Brazil. All participants underwent a one-night PSG recording and answered questions about sex, age, BMI, insomnia, OSA risk, anxiety, depression, average caffeine consumption, smoking frequency, and alcohol consumption frequency. We investigated the link between SB and the other variables in univariate, multivariate, and network models, and we repeated each model once with self-reported SB and once with PSG-confirmed SB. Self-reported SB was only significantly associated with sex (p = 0.042), anxiety (p = 0.002), and depression (p = 0.03) in the univariate analysis, and was associated with insomnia in the univariate (p < 0.001) and multivariate (ß = 1.054, 95%CI 1.018-1.092, p = 0.003) analyses. Network analysis showed that self-reported SB had a direct positive edge to insomnia, while PSG-confirmed SB was not significantly associated with any of the other variables. Thus, sleep bruxism was positively associated with insomnia only when self-reported, while PSG-confirmed SB was not associated with any of the included factors.

The role of inflammatory markers in Temporomandibular Myalgia: A systematic review.

Approximately 10 % of the general population is affected by temporomandibular disorder (TMD) pain. Diagnosis of myogenous TMD pain (i.e., TM myalgia) may be challenging, while an adequate assessment of this pain is crucial to establish an adequate management strategy. We aim to analyze if there is a relation between inflammation and TM myalgia, and if we can identify and measure inflammatory markers in patients suffering from this condition. An electronic literature search was conducted from inception up to July 14 2022 through the databases PubMed, Cochrane Library, Web of Science, and Embase in collaboration with a medical information specialist. Studies on patients with masticatory muscle inflammation and/or pain were included. After a screening procedure, only nine full-text articles met the criteria for inclusion. In the included studies 9-131 patients showed TM myalgia, and presence of inflammation was reported with analysis of interleukines IL-1, IL-6, IL-10, tumor necrosis factor alpha, and prostaglandins from blood, saliva, and extracellular fluid of masseter muscle using microdialysis. Our results contributed to the identification of the relation between inflammation and TM myalgia and established that measurement of inflammatory cytokines may be a valid diagnostic tool, which is an essential step towards finding a better treatment.

Aging exaggerates pulpal pain sensation by increasing the expression levels of nociceptive neuropeptides and inflammatory cytokines.

BACKGROUND: Dental pain is a main clinical problem in the elderly population and its assessment and treatment make special challenges for health care services. However, the age-induced alteration in dental pain perception and the underlying molecular mechanism(s) has not yet been fully clarified. METHODS: Here, the effect of aging on nociceptive behaviors following inflammatory dental pulp pain was evaluated. Since prostaglandins, nociceptive neuropeptides, and inflammatory cytokines have critical roles in the development of aging as well as pain signaling, the expression levels of COX-2, CGRP, IL-1ß, IL-6, TNF-α and its converting enzyme TACE were assessed in the trigeminal ganglion of young and aged rats with dental pain. Dental pulp pain was induced by intradental application of capsaicin (100 µg). The immunofluorescence (COX-2 and CGRP) and western blot techniques were used. RESULTS: The data showed that aged animals have different pattern of pain. So that, the mean of nociceptive scores was significantly greater in aged rats at 10 and 15 min after capsaicin injection. In aged rats, dental pain was persisting over 7 h, while it was disappeared at 300 min in young rats. Molecular data showed that dental pain significantly increased the expression of COX-2, CGRP, IL-1ß, IL-6, TNF-α and TACE in the trigeminal ganglion of the young and aged rats. In addition, the amount of those parameters, except TACE, in capsaicin-treated aged animals were significantly (p < 0.05) greater than those in capsaicin-treated young rats. CONCLUSION: It seems that the induction of pro-inflammatory cytokines in an acute inflammatory pulpal pain model may contribute, at least in part to the increased nociceptive behaviors and pain perception in aged rats.

Location of mechanically-evoked referred sensations within the trigeminal region are not altered following a heterotopic painful stimulus.

To investigate whether the location, area and frequency of referred sensations occurring during palpation of the masseter muscle can be influenced by application of a conditioning painful stimulus to the temporalis muscle. Thirty healthy participants were included in this cross-over study, performed in two sessions with > 48 h in between. At each session, palpation of the masseter muscle was performed before and after 0.2 ml of glutamate (1 mol/L) or isotonic saline (control) were injected into the anterior portion of the temporalis muscle. Palpation of the masseter muscle was done using four different forces (0.5 kg, 1 kg, 2 kg and 4 kg). Participants rated the perceived intensity of the palpation and any referred sensations on a 0-50-100 numeric rating scale, the perceived pain intensity following the injections on an electronic visual analogue scale and drew any referred sensations they experienced. No difference in referred sensations location, area and frequency was shown r during palpation either before or after injections (P > 0.05). A moderate correlation was found between perceived sensation scores and referred sensations intensity for the temporalis muscle following glutamate injection (r = 0.407, P < 0.05). Moreover, significantly more participants reported referred sensations for glutamate injections into the temporalis muscle when compared to isotonic saline (P < 0.05). Finally, a significant decrease in the perceived intensity of palpation of the masseter muscle was seen after glutamate injection in the temporalis muscle (P < 0.05). In the current study, location, area and frequency of referred sensations following mechanical stimulation of the masseter muscle were not altered by the application of a painful stimulus to the temporalis muscle. In addition, there seems to be a positive relationship between painful stimuli and referred sensations frequency and intensity elicited from the temporalis muscle.

The association between myofascial orofacial pain with and without referral and widespread pain.

OBJECTIVES: Pain referral on palpation has been suggested to be a clinical sign of central sensitization potentially associated with widespread pain conditions. Our aim was to evaluate if myofascial pain with referral is a better predictor for widespread pain when compared to no pain or local myofascial pain. MATERIALS AND METHODS: Individuals at the Public Dental services in Västerbotten, Sweden, were randomly invited based on their answers to three screening questions for temporomandibular disorders (TMD). In total, 300 individuals (202 women, 20-69 yrs) were recruited, and examined according to the Diagnostic Criteria for TMD (DC/TMD) after completion of a body pain drawing. Widespread pain was considered present when seven or more pain sites were reported on the widespread pain index. A binary logistic regression model, adjusted for the effect of age and gender were used to evaluate the association between myofascial orofacial pain and widespread pain. RESULTS: Widespread pain was reported by 31.3% of the study sample. There was a 57.3% overlap with myofascial pain. Widespread pain was associated to myofascial orofacial pain with and myofascial orofacial pain (OR 4.83 95% CI 2.62-9.05 and OR 11.62 95% CI 5.18-27.88, respectively). CONCLUSION: These findings reinforce the existing knowledge on the overlap between painful TMD and other chronic pain conditions.

A network analysis of self-reported sleep bruxism in the Netherlands sleep registry: its associations with insomnia and several demographic, psychological, and life-style factors.

OBJECTIVES: To investigate the association between self-reported sleep bruxism and insomnia and their potential risk factors (eg, depression and anxiety), and to construct a network model with all these factors. METHODS: We recruited 2251 participants from the Netherlands Sleep Registry. All participants completed questionnaires on self-reported sleep bruxism, insomnia, depression, anxiety, smoking frequency, and alcohol and caffeine consumption. The associations between self-reported sleep bruxism and other variables were analyzed by univariate analysis, multivariate logistic regression, and network analysis. RESULTS: Although univariate analysis showed that there was a positive association between sleep bruxism and insomnia (P < 0.001), this association disappeared in the multivariate logistic regression model (P = 0.258). However, multivariate logistic regression did show an association between self-reported sleep bruxism and anxiety (OR = 1.087, 95% CI 1.041-1.134). The network model showed that there was no direct link between self-reported sleep bruxism and insomnia. However, there was an indirect link between self-reported sleep bruxism and insomnia via anxiety. CONCLUSIONS: Although self-reported sleep bruxism has no direct association with insomnia, anxiety is a bridging factor between these variables.

Maxillomandibular advancement versus multilevel surgery for treatment of obstructive sleep apnea: A systematic review and meta-analysis.

Multilevel surgery (MLS) and maxillomandibular advancement surgery (MMA) are two established options in surgical management of obstructive sleep apnea (OSA), which target different levels of airway obstruction. The objective of this review was to comparatively evaluate the clinical efficacy and safety of MMA and MLS in the treatment of OSA. MEDLINE and Embase databases were searched for studies on MMA and/or MLS in OSA patients. Twenty MMA studies and 39 MLS studies were identified. OSA patients who underwent MMA showed significant improvements in AHI, LSAT, ODI, and ESS by -46.2/h, 13.5%, -30.3/h, and -8.5, respectively. The pooled rates of surgical success and cure for MMA were 85.0% and 46.3%, respectively. Patients who underwent MLS showed significant improvements in AHI, LSAT, ODI, and ESS by -24.7/h, 8.7%, -19.1/h, and -5.8, respectively. The pooled surgical success and cure rates for MLS were 65.1% and 28.1%, respectively. The rates of major complication of MMA and MLS were 3.2% and 1.1%, respectively, and the rate of minor complication of MMA was higher than that of MLS. We conclude that both MMA and MLS are effective treatment options for OSA. Compared to MLS, MMA may be more effective in improving OSA. However, the complication rate of MMA is higher.

TMJ Pain and Crepitus Occur Early Whereas Dysfunction Develops Over Time in Rheumatoid Arthritis.

AIMS: To investigate inflammatory mediator levels in TMJ synovial fluid (SF) and blood and to investigate clinical TMJ symptoms in relation to general and TMJ symptom duration in patients with rheumatoid arthritis (RA). METHODS: Examination of 80 TMJs (68 patients; median age 55 years; 85% women) included the following variables: TMJ pain at rest, maximum mouth opening, and palpation; jaw movement capacity; number of painful movements; crepitus; and degree of anterior open bite. Levels of tumor necrosis factor (TNF), TNF soluble receptor II, interleukin 1ß, IL-1 receptor antagonist, IL-1 soluble receptor II, and serotonin in TMJ SF and blood; systemic disease activity; and duration of general and TMJ symptoms were assessed. General symptom duration ≤ 2 years was considered early RA. RESULTS: TMJ symptoms predominantly developed within 5 years following general symptom onset. Logistic regression analysis showed that number of involved joints, general pain, maximum mouth opening, anterior open bite, and TNF plasma levels combined explained 46% of the distinction between early and established RA. Furthermore, TMJ pain at rest and maximum mouth opening, contralateral laterotrusion, painful movements, crepitus, and SF TNF levels combined explained 35% of the distinction. In these analyses, higher general pain and maximum mouth opening, TMJ pain on maximum mouth opening, and crepitus were associated with early RA. CONCLUSION: This study indicates that TMJ pain and crepitus in RA usually occur within 2 years following general symptom onset. Pain-related dysfunction and structural changes develop with time. TNF in plasma and TMJ SF are associated with this development. This makes early (clinical) recognition of pain and inflammation important, enabling early treatment to minimize later irreversible damage.

The Effects of Noncontinuous Positive Airway Pressure Therapies on the Aerodynamic Characteristics of the Upper Airway of Obstructive Sleep Apnea Patients: A Systematic Review.

PURPOSE: The effects of noncontinuous positive airway pressure (non-CPAP) therapies on the airflow in the upper airway in obstructive sleep apnea (OSA) patients are not completely clear yet. Therefore, the primary aim of this systematic review was to determine the effects of various non-CPAP therapies on the aerodynamic characteristics of the upper airway in OSA patients. MATERIALS AND METHODS: A PICO (population or patient, intervention, comparison, outcome) search strategy, focusing on the effects of various non-CPAP therapies on the aerodynamic characteristics of the upper airway (ie, velocity, wall shear stress, wall static pressure, airway resistance, pressure drop, and pressure effort) of OSA patients, was conducted in the following databases: MEDLINE (PubMed), Embase (Excerpta Medica), and Web of Science. In this systematic review, the inclusion criteria were 1) adults diagnosed with OSA by polysomnography, 2) treatment outcome assessed by a second polysomnography, and 3) computational fluid dynamics (CFD) applied. RESULTS: Of 51 unique studies retrieved, 9 fulfilled the criteria for this systematic review. Seven studies were on maxillomandibular advancement (MMA) surgery, and 2 were on mandibular advancement device (MAD) therapy. The aerodynamic characteristics of the upper airway improved in OSA patients who underwent MMA surgery. However, the studies on MMA surgery included only responders to MMA surgery. In the responders to MAD therapy, the velocity, wall static pressure, and airway resistance of the upper airway decreased. In nonresponders to MAD therapy, the wall static pressure and airway resistance of the upper airway increased. CONCLUSIONS: This systematic review suggests that MMA surgery and MAD therapy may improve several aerodynamic characteristics of the upper airway in OSA patients by CFD analysis. However, because of limitations of the selected studies, there is not enough evidence yet to support CFD analysis as a routine tool to predict the treatment outcome in OSA patients.

Diagnostic accuracy of three screening questions (3Q/TMD) in relation to the DC/TMD in a specialized orofacial pain clinic.

OBJECTIVE: To determine the diagnostic accuracy of three screening questions (3Q/TMD) in relation to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), in a specialized clinic. MATERIAL AND METHODS: Consecutive patients, >18 years, referred with a possible TMD complaint to the Orofacial Pain and Dysfunction clinic, Academic Centre for Dentistry Amsterdam, the Netherlands, were included in the study. All patients (n = 449; mean age 44 years; 72% females), answered the 3Q/TMD and the DC/TMD questionnaire before a DC/TMD examination. The 3Q/TMD constitutes of two questions on weekly pain from the jaw, face and temple region (Q1), and on function (Q2), and one function-related question on weekly catching and/or locking of the jaw (Q3). Q1 and Q2 were evaluated in relation to a DC/TMD pain diagnosis and Q3 in relation to a subgroup of DC/TMD intra-articular diagnosis, referred to as the reference standard. RESULTS: In total, 44% of patients received a pain-related DC/TMD diagnosis and 33% an intra-articular reference DC/TMD diagnosis. Sensitivity for the two pain screening questions was high (0.83-0.94), whereas specificity was low (0.41-0.55). For the function-related question, sensitivity was low (0.48), whereas specificity was high (0.96). CONCLUSIONS: In a specialized pain clinic, the two pain questions (Q1, Q2) are positive in most patients with pain-related TMD. Therefore, in case of a positive response, further diagnostic procedures for TMD pain are warranted. For the functional screening question (Q3), a positive response is indicative for an intra-articular DC/TMD diagnosis, while in case of a negative outcome, an intra-articular TMD might still be present.

Cyclic Tensile Strain Reduces TNF-α Induced Expression of MMP-13 by Condylar Temporomandibular Joint Cells.

To investigate whether the disproportionate degradation of mandibular condyle cartilage in arthritic juvenile temporomandibular joint (TMJ) is related to distinctive responses of TMJ-derived cells to tumor necrosis factor-α (TNF-α), and whether mechanical loading affects this response. The effect of TNF-α (0.1-10 ng/ml) was tested on juvenile porcine TMJ cells isolated from the condyle, fossa, and disc, grown in 3D agarose gels. Expression of anabolic and catabolic factors was quantified by RT-qPCR and/or immunohistochemistry. Condylar cells were stimulated for 12 h with TNF-α (10 ng/ml), followed by 8 h of 6% cyclic tensile strain, and gene expression of MMPs was quantified. TNF-α (10 ng/ml) reduced the expression of the matrix proteins collagen types I and II after 6 h of incubation. Aggrecan gene expression was increased in the presence of 0.1 ng/ml TNF-α. The fossa and disc cells responded to TNF-α with an increased expression of the aggrecanase ADAMTS4. TNF-α enhanced MMP-13 gene and protein expression only by condylar cells. Mechanical loading reduced this effect. Cells isolated from the different cartilaginous structures reacted differently to TNF-α. Since the disc and fossa contain a very low level of proteoglycans in comparison to the condyle, the role played by ADAMTS4 in degradation of the fossa and disc might be limited. TNF-α induced MMP-13 expression by condylar cells might be involved in the degradation of the juvenile condyle. Since this expression was reduced by mechanical loading, functional loading with oral physiotherapy or orthodontic activators may help to reduce the catabolic effect of TNF-α. J. Cell. Physiol. 232: 1287-1294, 2017. © 2016 Wiley Periodicals, Inc.

Reliability of three-dimensional measurements of the upper airway on cone beam computed tomography images.

OBJECTIVES: The aim of this study was (1) to assess intra- and interobserver reliability of the localization of anatomic landmarks of the upper airway on cone beam computed tomography (CBCT) images; and (2) to assess intra- and interobserver reliability of the three-dimensional measurements of the upper airway based on these landmarks. STUDY DESIGN: Fifteen NewTom 5G (QR systems, Verona, Italy) CBCT data sets were randomly selected from the archives of the Department of Oral Radiology, Academic Centre for Dentistry (ACTA) at University of Amsterdam and VU University, Amsterdam, The Netherlands. Three observers localized six anatomic landmarks that are relevant for upper airway analysis twice, with a 10-day interval, using 3Diagnosys software (v5.3.1, 3diemme, Cantu, Italy). Subsequently, the observers performed upper airway volume measurement based on those landmarks twice as well, again with a 10-day interval, using Amira software (v4.1, Visage Imaging Inc., Carlsbad, CA). The upper airway measurements also included the minimum cross-sectional area (CSAmin), location of the CSAmin, and anteroposterior and lateral dimensions of the CSAmin. RESULTS: Both intraobserver reliability and interobserver reliability were excellent for the localization of the anatomic landmarks of the upper airway (intraclass correlation coefficients = 0.97-1.00) as well as for the three-dimensional upper airway measurements (intraclass correlation coefficients = 0.78-1.00). CONCLUSIONS: The methodology of landmark localization and upper airway measurements, as used in this study, showed an excellent reliability and can thus be recommended for upper airway analysis on CBCT images.

Long standing intra oral Acid burn.

Oral burn due to ingestion of corrosive substances can bring about debilitating consequences. It often brings mortality, and the survivors can have severe impairment of functions, especially in relation to the stomatognathic and gastrointestinal systems. This article presents a long-standing case (21 years) of an oral burn caused by a corrosive substance, its manifestation on growth and development of the face and its treatment. The patient was accidentally given acid orally when he was 4 months of age. He was treated at 21 years of age: the time he reported to us. This seems to be the first case report that describes the effects of long standing oral contracture secondary to burns on the growth and development of the maxillofacial structures and its treatment with a novel approach.

Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†.

AIMS: The original Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms have been demonstrated to be reliable. However, the Validation Project determined that the RDC/TMD Axis I validity was below the target sensitivity of ≥ 0.70 and specificity of ≥ 0.95. Consequently, these empirical results supported the development of revised RDC/TMD Axis I diagnostic algorithms that were subsequently demonstrated to be valid for the most common pain-related TMD and for one temporomandibular joint (TMJ) intra-articular disorder. The original RDC/TMD Axis II instruments were shown to be both reliable and valid. Working from these findings and revisions, two international consensus workshops were convened, from which recommendations were obtained for the finalization of new Axis I diagnostic algorithms and new Axis II instruments. METHODS: Through a series of workshops and symposia, a panel of clinical and basic science pain experts modified the revised RDC/TMD Axis I algorithms by using comprehensive searches of published TMD diagnostic literature followed by review and consensus via a formal structured process. The panel's recommendations for further revision of the Axis I diagnostic algorithms were assessed for validity by using the Validation Project's data set, and for reliability by using newly collected data from the ongoing TMJ Impact Project-the follow-up study to the Validation Project. New Axis II instruments were identified through a comprehensive search of the literature providing valid instruments that, relative to the RDC/TMD, are shorter in length, are available in the public domain, and currently are being used in medical settings. RESULTS: The newly recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for detecting any pain-related TMD as well as valid diagnostic criteria for differentiating the most common pain-related TMD (sensitivity ≥ 0.86, specificity ≥ 0.98) and for one intra-articular disorder (sensitivity of 0.80 and specificity of 0.97). Diagnostic criteria for other common intra-articular disorders lack adequate validity for clinical diagnoses but can be used for screening purposes. Inter-examiner reliability for the clinical assessment associated with the validated DC/TMD criteria for pain-related TMD is excellent (kappa ≥ 0.85). Finally, a comprehensive classification system that includes both the common and less common TMD is also presented. The Axis II protocol retains selected original RDC/TMD screening instruments augmented with new instruments to assess jaw function as well as behavioral and additional psychosocial factors. The Axis II protocol is divided into screening and comprehensive self report instrument sets. The screening instruments' 41 questions assess pain intensity, pain-related disability, psychological distress, jaw functional limitations, and parafunctional behaviors, and a pain drawing is used to assess locations of pain. The comprehensive instruments, composed of 81 questions, assess in further detail jaw functional limitations and psychological distress as well as additional constructs of anxiety and presence of comorbid pain conditions. CONCLUSION: The recommended evidence-based new DC/TMD protocol is appropriate for use in both clinical and research settings. More comprehensive instruments augment short and simple screening instruments for Axis I and Axis II. These validated instruments allow for identification of patients with a range of simple to complex TMD presentations.

Long-term results and complications after treatment of bilateral fractures of the mandibular condyle.

The purpose of this study was to investigate the long-term results of conservative treatment of bilateral condylar fractures and to study the influence of possible functional impairment on intensity of pain and associated disability. We studied 71 patients (mean (SD) age 33 (14) years) with conservatively treated bilateral condylar fractures. Traffic crashes (n=42, 59%) and falls (n=20, 28%) were the main cause of the fractures. Forty-one patients (58%) were re-examined after about 90 months (mean 86, range 3-193). Five of the 41 (12%) had developed malocclusion, but did not experience any pain in the temporomandibular joint according to the Research Diagnostic Criteria for Temporomandibular Disorders. There was a significant negative relation between the presence of pain and the duration of follow up (p=0.02). Increasing age was significantly related to reduction in the intensity of pain (p=0.03). Of the remaining 30 patients who were not followed up, 2 had had bilateral sagittal split osteotomy and 1 a Le Fort I osteotomy. One patient had had orthodontic correction for a malocclusion. Including the five malocclusion patients, at least 9 of the total of 71 (13%) developed a malocclusion after conservative treatment. Functional impairment had no influence on the intensity of pain or pain-related disability in the patients with malocclusion after conservatively treated bilateral condylar fractures. This report may therefore be of value in the debate about whether open or closed treatment is better for bilateral mandibular condylar fractures.