Effects of physical activity levels on characteristic pain in temporomandibular dysfunctions: a cross-sectional study.

BACKGROUND: Physical activity is known to influence the symptoms of a variety of pain disorders including fibromyalgia and osteoarthritis although the underlying mechanism is not fully understood. In spite of the high prevalence of temporomandibular disorders (TMD), no previous study has objectively evaluated the relationship between TMD and general physical activity. This study aims to investigate the influence of physical activity on pain and disability from TMD, considering various confounders including sleep, systemic inflammation, psychosocial disturbances, and widespread pain. METHODS: This observational cross-sectional study is based on consecutive samples of 100 TMD patients (22 with high pain disability and 78 with low pain disability level). Physical activity levels were assessed with actigraph. Level of pain and disability were evaluated using the Graded Chronic Pain Scale. Hematologic examinations including inflammatory biomarkers were assessed and comorbidities were investigated with validated questionnaires. Differences were analyzed according to disability level. RESULTS: Patients with high disability level spent significantly more time doing both moderate (p = 0.033) and vigorous (p = 0.039) level physical activity. Light physical activity, on the other hand, was associated with low disability but the difference did not reach statistical significance. Time spent in light physical activity was significantly associated with high levels of pain and disability (p = 0.026, ß = -0.001) and time spent in vigorous physical activity had significant predictive power (cutoff value 2.5 min per week, AUC 0.643, p = 0.041). Scores of the Jaw Function Limitation Score-20 (p = 0.001), present McGill Pain Score (p = 0.010), and number of people potentially diagnosed with fibromyalgia (p = 0.033) were significantly higher in the high disability group. CONCLUSIONS: Moderate or vigorous physical activity is associated with worse TMD symptoms while light physical activity may be beneficial. Further research related to the amount and frequency of physical activity is necessary to establish clinical guidelines for TMD. TRIAL REGISTRATION: clinical trial registration of the Clinical Research Information Service of Republic of Korea (number KCT0007107).

Presence of widespread pain predicts comorbidities and treatment response in temporomandibular disorders patients.

OBJECTIVES: Investigate the presence of widespread pain in a well-defined TMD group and analyze its interrelationship with various comorbidities. Also, longitudinally seek the difference in treatment response according to the presence of widespread pain. SUBJECTS AND METHODS: The observational study involved 45 female TMD patients in their 20s. Patients were grouped into localized and widespread pain groups based on the widespread pain index (WPI ≥ 4). Clinical characteristics and levels of comorbidities were analyzed through physical examination and validated questionnaires. Differences between the groups and the power of pre-treatment WPI in predicting pre-treatment comorbidities and post-treatment pain level improvement were statistically analyzed. RESULTS: Patients with widespread pain showed higher somatization and anxiety levels. SF-36 scores were significantly lower and more patients complained of gastrointestinal symptoms. Conventional treatment significantly reduced pain intensity in both groups but less in the widespread pain group. WPI showed significant chances to predict patients showing improvement in pain levels with treatment with a cutoff value of 4. WPI was also effective in differentiating patients that showed a higher level of somatization. CONCLUSION: Widespread pain index could be effectively applied in differentiating those with a higher level of psychological distress and predicting TMD treatment response with further investigations into its reliability.

Is thyroid autoimmunity a predisposing factor for fibromyalgia? A systematic review and meta-analysis.

OBJECTIVES: Studies report that autoimmune thyroid disease and elevated levels of thyroid autoantibodies are associated with fibromyalgia and widespread chronic pain. The aim of this meta-analysis was to investigate the relationship between fibromyalgia and thyroid autoimmunity. Clinical symptoms and depression associated with fibromyalgia were also investigated in relation to the presence of thyroid autoantibodies. METHODS: A literature search was conducted on PubMed and Embase for studies published between January, 1980 and February, 2020 on thyroid autoimmunity in fibromyalgia patients. Two reviewers independently screened and assessed the quality of the articles. Meta-analysis was performed to analyse the difference in frequency of thyroid autoantibody positivity between fibromyalgia patients and healthy controls. Clinical symptoms and depression were also analysed according to the presence of thyroid autoantibodies. RESULTS: Data from 10 original studies were included in the systematic review, and 5 case-control studies that satisfied the selection criteria were subjected to meta-analysis. Thyroid autoantibody positivity was more common in fibromyalgia patients compared to healthy controls (thyroid peroxidase antibody: OR 3.41, 95% CI 1.97-5.90; thyroglobulin antibody: OR 2.23, 95% CI 1.23-4.01). The frequency of postmenopausal status was significantly higher in fibromyalgia patients with thyroid autoantibodies (OR 1.95, 95% CI 1.23-3.08). However, the severity of disease (pain and fatigue level, fibromyalgia impact questionnaire score, and disease duration) and prevalence of depression did not show a statistically significant difference according to thyroid autoantibody positivity. CONCLUSIONS: Thyroid autoimmunity should be considered in fibromyalgia patients. The percentage of women in menopause was higher in thyroid autoantibody positive fibromyalgia patients.

Various diagnostic possibilities for zygomatic arch pain: Seven case reports and review of literature.

BACKGROUND: Pain of the zygomatic arch region is common among patients with orofacial pain, especially in those with temporomandibular disorder-related pain of a myogenic origin. Since zygomatic arch pain may occur due to various causes other than muscle pain, appropriate diagnosis and treatment planning is essential to ensure its successful management. Unfortunately, zygomatic arch pain has not been handled as an independent clinical feature until now, and studies have mainly focused on pain resulting from trauma and surgical procedures. CASE SUMMARY: We describe 7 independent cases, all of which presented with the identical chief complaint of pain in the zygomatic arch region. However, the underlying causes were different for each, being myofascial pain, myositis, tooth crack, dental caries, sinusitis, neuropathic pain, and salivary gland tumor respectively. In this case report, the clinical features of each case are investigated and diseases to be considered in the diagnostic process are suggested, along with the diagnostic modalities (including computed tomography and magnetic resonance imaging) that can lead to the appropriate final diagnosis. CONCLUSION: Zygomatic arch pain is a common complaint encountered in the orofacial pain clinic but may lead to misdiagnosis. Clinicians must have in-depth knowledge of the possible differential diagnoses and evaluation tools.

Physical activity level and temporomandibular disorders in South Koreans.

OBJECTIVE: This study aimed to investigate the association between general physical activity level and TMD pain in Koreans in a large-scale national database established through a nationwide survey. METHODS: Data from the Fourth Korean National Health and Nutrition Examination Survey (KNHANES IV), which was conducted from 2007 to 2009, were analysed. In total, 16 941 participants were included in this cross-sectional study. Data on sociodemographic characteristics, TMD-related variables, and general physical activity level were collected. Participants were divided into moderate- and low-intensity exercise groups according to their physical activity levels. Multivariate logistic regression analyses were performed, adjusting for sociodemographic and other covariates. RESULTS: The adjusted odds ratio (OR) (95% confidence interval; CI) for TMD pain was 1.373 (1.017-1.854) for people doing moderate-intensity exercises and 0.797 (0.629-1.008) among people doing low-intensity exercises. Those who did moderate-intensity exercises had significantly more TMD pain. This was higher in the 30- to 39-year age group (OR: 1.991, 95% CI: 1.137-3.488), with significantly higher risk for TMD pain in those who did moderate-intensity exercise, whereas low-intensity exercise significantly decreased the risk for TMD pain in the same age group (OR: 0.625, 95% CI: 0.409-0.958). CONCLUSIONS: Moderate-intensity physical activity is associated with more TMD pain. Patients with TMD should avoid high-intensity level exercises and continue low-intensity exercises to prevent pain aggravation.

Upper cervical spine abnormalities as a radiographic index in the diagnosis and treatment of temporomandibular disorders.

OBJECTIVE: The aim of this study was to investigate the clinical characteristics and treatment outcomes of patients with temporomandibular disorders (TMD) according to the presence of upper cervical spine abnormalities and craniofacial morphology. STUDY DESIGN: Clinical examinations were conducted on 43 patients with TMD. Upper cervical spine characteristics (fusion, posterior arch deficiency [PAD], and craniofacial morphology) reflecting head-and-neck posture were evaluated on lateral cephalograms. Condylar bone changes in the temporomandibular joint were evaluated by using cone beam computed tomography. Clinical characteristics and treatment outcomes after 1 year of conservative therapy were statistically analyzed between groups, according to the presence of upper cervical spine abnormalities. RESULTS: Pain on neck muscle palpation was more frequent in patients with cervical fusion (P = .019) and with either fusion or PAD (P = .004) before treatment. Patients with PAD had smaller comfortable mouth opening ranges compared with those without the deficiency (P = .044) before treatment and smaller comfortable (P = .020) and maximum (P = .021) mouth opening ranges after treatment. Patients with PAD also had mouth opening limitation (P = .028) and pain on masticatory muscle palpation (P = .014) more frequently after treatment compared with patients without the deficiency. CONCLUSIONS: Associations exist between upper cervical spine characteristics and treatment outcomes in patients with TMD, suggesting such parameters as a possible radiographic index in TMD diagnosis and treatment.

Hemostatic effect and psychological impact of an oxidized regenerated cellulose patch after transrectal ultrasound-guided prostate biopsy: A prospective and retrospective study.

To investigate the usefulness of the oxidized regenerated cellulose patch (ORCP) for postbiopsy hemostasis, anxiety, and depression in patients undergoing transrectal ultrasound-guided prostate biopsy.This was a prospective-retrospective study of 300 patients who underwent systematic 12-core prostate biopsy from August 2016 through March 2018. The ORCP was inserted into the rectum immediately after prostate biopsy in the prospective group (n = 150), while the retrospective group (n = 150) underwent prostate biopsy alone. The frequency rate and duration of hematuria, rectal bleeding, and hematospermia were compared between the 2 groups. Anxiety and depression were assessed with the hospital anxiety and depression scale before and after prostate biopsy in the prospective group.The frequency rates of hematuria and hematospermia showed no significant differences between the prospective versus retrospective groups (64.7% vs 66.7%, P = .881; 18 vs 20%, P = .718; respectively). Frequency of rectal bleeding was significantly lower in the prospective group than in the retrospective group (26.7% vs 42.7%, P = .018). However, there were no significant differences in median duration of rectal bleeding, hematuria, or hematospermia between the 2 groups (2, 5, and 2 days vs 2, 7, and 1 day, P > .05, respectively, for the prospective vs retrospective group). Multivariate analysis found that ORCP insertion was a significant protective factor against postbiopsy rectal bleeding (P = .038, odds ratio 0.52). Only anxiety level in the prospective group before versus after prostate biopsy was significantly reduced (5 vs 4, P = .011).ORCP insertion after prostate biopsy is an effective and simple method for decreasing rectal bleeding. ORCP insertion may also alleviate anxiety in patients undergoing prostate biopsy.

Quality and readability of internet-based information on halitosis.

OBJECTIVE: To evaluate quality and readability of Internet-based information on halitosis. STUDY DESIGN: An Internet search through 3 engines (Google, Yahoo, and Bing) was done with the terms ("bad breath," "halitosis," "oral malodor," "foul breath," "mouth malodor," "breath malodor," "fetor ex ore," "fetor oris," "ozostomia," and "stomatodysodia"). The first 50 websites from each engine resulting from each search term were screened. Included websites were evaluated using Health on the Net (HON) criteria, Journal of American Medical Association (JAMA) benchmarks, DISCERN, Ensuring Quality Information for Patients (EQIP), Flesch Reading Ease (FRE) score, and Flesch-Kincaid Grade level. RESULTS: A total of 101 websites were included. HON, DISCERN, EQIP, and FRE score were 42.9%, 37.6%, 37.4%, and 51.9% of the maximum score, respectively. Fewer than 50% of sites displayed attribution, disclosure, and currency according to JAMA benchmarks. HON score, DISCERN score, and EQIP score had significant correlation with each other and were significantly higher in sites displaying the HON seal. CONCLUSION: The current quality and readability of informative websites on halitosis are generally low and poorly organized. Clinicians should be able to assess the Internet-based information on halitosis, as well as give accurate advice and guide patients concerning this issue.

Inhibition of malodorous gas formation by oral bacteria with cetylpyridinium and zinc chloride.

OBJECTIVE: The antimicrobial efficacy of zinc- (ZnCl2) and cetylpyridinium-chloride (CPC) and their inhibition capacity on volatile sulfur compound (VSC) production by oral bacterial strains were investigated. DESIGN: Minimum inhibitory concentrations (MIC) and growth curves were determined for ZnCl2, CPC, and CPC with ZnCl2 solutions against eight oral microorganisms (Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Treponema denticola, Tannerella forsythia, Staphylococcus aureus and Streptococcus mutans) known to be involved in the pathophysiology of both halitosis and periodontal disease. Gas chromatography was applied to measure VSCs (H2S, CH3SH, (CH3)2S) production levels of each strains following exposure to the solutions. RESULTS: ZnCl2 and CPC effectively inhibited growth of all eight strains. ZnCl2 was generally more effective than CPC in suppressing bacterial growth excluding A. actinomycetemcomitans, P. intermedia, and T. forsythia. Synergism between CPC and ZnCl2 was shown in A. actinomycetemcomitans. The MIC for CPC was significantly lower than ZnCl2. VSC production was detected in five bacterial strains (A. actinomycetemcomitans, F. nucleatum, P. gingivalis, T. denticola, and T. forsythia). Each bacterial strain showed unique VSCs production profiles. H2S was produced by F. nucleatum, P. gingivalis, and T. denticola, CH3SH by all five strains and (CH3)2S by A. actinomycetemcomitans, F. nucleatum, P. gingivalis, and T. denticola. Production of CH3SH, the most malodorous component among the three major VSCs from mouth air was evident in F. nucleatum and T. forsythia. CONCLUSION: Both ZnCl2 and CPC effectively inhibit bacterial growth causative of halitosis and periodontal disease, resulting in a direct decrease of bacterial VSCs production.

Neurofibromatosis Type 1 Accompanied by Craniofacial Pain: Literature Review and Descriptive Case.

Neurofibromatosis type 1 (NF-1) is a genetic disease with characteristic neurofibromas and bony dysplasia that manifest throughout the body, including the craniofacial region. NF-1 patients are known to frequently report chronic pain in areas below the head; however, the matter of pain in the craniofacial region in this patient group has not been handled intensively so far, and studies have mainly focused on headaches. This article comprehensively reviews the related literature and reports a case of an NF-1 patient whose chief complaint was headache and pain in the temporomandibular joint area. Craniofacial pain is probably not an exceptional problem in NF-1, but the current inadequacy of related data is worrisome, considering the impact of pain on NF-1 prognosis and patient quality of life. The presence of craniofacial pain in NF-1 patients should be actively sought out in the diagnostic process and appropriate guidelines for its diagnosis and treatment should be established.

Continuous and real-time bioaerosol monitoring by combined aerosol-to-hydrosol sampling and ATP bioluminescence assay.

We present a methodology for continuous and real-time bioaerosol monitoring wherein an aerosol-to-hydrosol sampler is integrated with a bioluminescence detector. Laboratory test was conducted by supplying an air flow with entrained test bacteria (Staphylococcus epidermidis) to the inlet of the sampler. High voltage was applied between the discharge electrode and the ground electrode of the sampler to generate air ions by corona discharge. The bacterial aerosols were charged by the air ions and sampled in a flowing liquid containing both a cell lysis buffer and adenosine triphosphate (ATP) bioluminescence reagents. While the liquid was delivered to the bioluminescence detector, sampled bacteria were dissolved by the cell lysis buffer and ATP was extracted. The ATP was reacted with the ATP bioluminescence reagents, causing light to be emitted. When the concentration of bacteria in the aerosols was varied, the ATP bioluminescence signal in relative light units (RLUs) closely tracked the concentration in particles per unit air volume (# cm-3), as measured by an aerosol particle sizer. The total response time required for aerosol sampling and ATP bioluminescence detection increased from 30 s to 2 min for decreasing liquid sampling flow rate from 800 to 200 µLPM, respectively. However, lower concentration of S. epidermidis aerosols was able to be detected with lower liquid sampling flow rate (1 RLU corresponded to 6.5 # cm-3 of S. epidermidis aerosols at 200 µLPM and 25.5 # cm-3 at 800 µLPM). After obtaining all data sets of concentration of S. epidermidis aerosols and concentration of S. epidermidis particles collected in the flowing liquid, it was found that with our bioluminescence detector, 1 RLU corresponded to 1.8 × 105 (±0.2 × 105) # mL-1 of S. epidermidis in liquid. After the lab-test with S. epidermidis, our bioaerosol monitoring device was located in the lobby of a building. Air sampling was conducted continuously for 90 min (air flow rate of 8 LPM, liquid flow rate of 200 µLPM) and the ATP bioluminescence signal of indoor bioaerosols was displayed with time. Air sampling was also carried out using the 6th stage of Andersen impactor in which a nutrient agar plate was used for the impaction plate. The sample was cultured at 37 °C for five days for colony counting. As a result, it was found that the variation of the bioluminescence signal closely followed the variation of indoor bioaerosol concentration in colony forming unit (CFU) and 1 RLU corresponded to 1.66 CFU m-3 of indoor bioaerosols. Our method can be used as a trigger in biological air contamination alarm systems.

Inflammatory Cytokines and Sleep Disturbance in Patients with Temporomandibular Disorders.

AIMS: To assess the degree and interrelationship of sleep disturbance and plasma cytokine levels in temporomandibular disorder (TMD) pain patients. METHODS: Forty female TMD patients and 20 age-, sex-, and body mass index (BMI)-matched healthy subjects were enrolled. TMD was diagnosed using the Research Diagnostic Criteria for TMD. The TMD patients were classified as having low or high disability according to Graded Chronic Pain Scale findings. The Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were used to measure sleep quality. Plasma concentrations of interleukin (IL)-1ß, IL-6, IL-10, tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP) were measured from blood samples collected between 9 am and noon. Statistical analyses included Kruskal-Wallis and one-way analysis of variance tests to compare results between different groups and multivariate general linear models to evaluate the effect of sleep status on cytokine levels. RESULTS: The high-disability group had the highest PSQI and ESS scores (P < .001). Plasma levels of IL-1ß, IL-6, IL-10, and TNF-α were significantly higher in the patient groups, with the high-disability group exhibiting the highest values (P ≤ .001). The plasma cytokine levels were significantly correlated with PSQI scores (P < .05). Plasma levels of IL-10 and TNF-α were significantly associated with the disability level after adjusting for both sleep indices (both P < .05). CONCLUSION: Patients with TMD, especially those with high disability, had elevated plasma cytokine levels and increased ESS and PSQI scores suggestive of sleep disturbance.

Antimicrobial effectiveness of cetylpyridinium chloride and zinc chloride-containing mouthrinses on bacteria of halitosis and peri-implant disease.

PURPOSE: To clarify the antimicrobial efficacy of zinc chloride (ZnCl2) and cetylpyridinium chloride (CPC) by testing their impact on the growth of seven bacterial strains known to be involved in the pathophysiology of both peri-implant disease and halitosis-Staphylococcus aureus, Streptococcus mutans, Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, Treponema denticola, and Tannerella forsythia. MATERIALS AND METHODS: A time-response growth curve was obtained. Commercial mouthrinses with CPC, ZnCl2, or both were added to the media in a final concentration of 0.25% CPC, 2.5% ZnCl2, and 2.5% ZnCl2 with 0.25% CPC. RESULTS: Both CPC and ZnCl2 effectively inhibited the growth of almost all bacterial strains tested except T denticola. ZnCl2 was generally more effective in suppressing bacterial growth than CPC. ZnCl2 with CPC showed the greatest inhibitory activities on almost all strains of bacterial growth except for P gingivalis and T denticola, followed by ZnCl2, then CPC, thus suggesting the possibility of a synergistic effect of the two agents. P gingivalis exhibited a different pattern because ZnCl2 showed the most significant inhibitory effect. CPC did not show growth inhibitory effects on T denticola, but ZnCl2 did. CONCLUSION: Zinc and CPC effectively inhibit bacterial growth that causes both halitosis and peri-implant disease. The effect is even more powerful when applied in combination.

Fast monitoring of indoor bioaerosol concentrations with ATP bioluminescence assay using an electrostatic rod-type sampler.

A culture-based colony counting method is the most widely used analytical technique for monitoring bioaerosols in both indoor and outdoor environments. However, this method requires several days for colony formation. In this study, our goal was fast monitoring (Sampling: 3 min, Detection: < 1 min) of indoor bioaerosol concentrations with ATP bioluminescence assay using a bioaerosol sampler. For this purpose, a novel hand-held electrostatic rod-type sampler (110 mm wide, 115 mm long, and 200 mm tall) was developed and used with a commercial luminometer, which employs the Adenosine triphosphate (ATP) bioluminescence method. The sampler consisted of a wire-rod type charger and a cylindrical collector, and was operated with an applied voltage of 4.5 kV and a sampling flow rate of 150.7 lpm. Its performance was tested using Staphylococcus epidermidis which was aerosolized with an atomizer. Bioaerosol concentrations were measured using ATP bioluminescence method with our sampler and compared with the culture-based method using Andersen cascade impactor under controlled laboratory conditions. Indoor bioaerosol concentrations were also measured using both methods in various indoor environments. A linear correlation was obtained between both methods in lab-tests and field-tests. Our proposed sampler with ATP bioluminescence method may be effective for fast monitoring of indoor bioaerosol concentrations.

Real-time monitoring of bioaerosols via cell-lysis by air ion and ATP bioluminescence detection.

In this study, we introduce a methodology for disrupting cell membranes with air ions coupled with ATP bioluminescence detection for real-time monitoring of bioaerosol concentrations. A carbon fiber ionizer was used to extract ATP from bacterial cells for generating ATP bioluminescence. Our methodology was tested using Staphylococcus epidermidis and Escherichia coli, which were aerosolized with an atomizer, and then indoor bioaerosols were also used for testing the methodology. Bioaerosol concentrations were estimated without culturing which requires several days for colony formation. Correlation equations were obtained for results acquired using our methodology (Relative Luminescent Unit (RLU)/m(3)) and a culture-based (Colony Forming Unit (CFU)/m(3)) method; CFU/m(3)=1.8 × measured RLU/m(3) for S. epidermidis and E. coli, and CFU/m(3)=1.1 × measured RLU/m(3) for indoor bioaerosols under the experimental conditions. Our methodology is an affordable solution for rapidly monitoring bioaerosols due to rapid detection time (cell-lysis time: 3 min; bioluminescence detection time: <1 min) and easy operation.

A comparison of neurosensory alteration and recovery pattern among different types of orthognathic surgeries using the current perception threshold.

OBJECTIVE: The objective of this study was to compare postsurgical neurosensory alteration and recovery patterns among different nerve fiber types and orthognathic surgeries by measuring current perception thresholds (CPT). STUDY DESIGN: CPTs of 186 patients who underwent various orthognathic surgeries (Le Fort I or II, bilateral sagittal split [BSSRO] or intraoral vertico-sagittal [IVSRO] ramus osteotomy with or without genioplasty) were measured at 2000, 250, and 5 Hz, assessing 3 different nerve fiber types before surgery and at 3, 6, and 12 months after surgery. RESULTS: CPTs were highest at 3 months postsurgery and gradually returned to presurgical levels until 12 months postsurgery in most cases. CPT at 2000 Hz showed the largest amount of increase. Le Fort I and IVSRO caused less neurosensory alteration compared with Le Fort II and BSSRO, respectively. CONCLUSION: Our data provide nerve recovery patterns following various orthognathic surgeries that may be applied to evaluating the patient's severity and recovery of nerve damage.

Long-term treatment of Langerhans cell histiocytosis of the mandibular condyle with indomethacin.

Langerhans cell histiocytosis (LCH) most commonly occurs as a localized solitary bone lesion and appears predominantly in pediatric patients. LCH is characterized by the proliferation and accumulation of Langerhans cells which may cause pain and adjacent soft-tissue swelling. This disease is of clinical importance to dental professionals because LCH commonly involves the oral and maxillofacial region and early symptoms can be manifested in the jaw and, when overlooked, may result in extensive destruction of the involved structures. Considering the fact that this is a relatively rare entity, close investigation of the cases that are encountered are warranted. Herein we report a case of LCH occurring in the left condyle of an 11-year-old boy that initially showed clinical symptoms mimicking an abscess of the temporomandibular joint. The clinical and radiographic features, differential diagnosis, treatment, and long-term follow-up of this patient with indomethacin are presented.