One year into the COVID-19 pandemic - temporomandibular disorders and bruxism: What we have learned and what we can do to improve our manner of treatment.

The coronavirus disease 2019 (COVID-19) pandemic has drastically changed the routine way of life and challenged the ways in which health and dental services are provided. During the 1st lockdown, practiced in most of the countries, routine dental procedures were suspended. Even after the lockdown was eased, visiting crowded dental clinics was still considered health-threatening, especially among populations at high risk of developing a severe reaction to COVID-19. Regretfully, in most cases, temporomandibular disorders (TMD) and bruxism were not included under the definition of emergency, leaving many patients without the possibility of consulting their dentists. A literature search, performed about 10 months after the declaration of the pandemic, found only a few studies dealing with TMD and bruxism during COVID-19. Most of the studies indicate adverse effects on subjects' psycho-emotional status (stress, anxiety, depression), which in turn lead to the intensification of subjects' TMD and bruxism symptoms, and increased orofacial pain. Unlike other oral pathologies, which require manual interventions, chronic orofacial pain can be addressed, at least at its initial stage, through teledentistry and/or consultation. Remote first aid for patients suffering from orofacial pain includes various kinds of treatment, such as the self-massage of tense and painful areas, stretching, thermotherapy, drug therapy, relaxation techniques, meditation, and mindfulness, all of which can be administered through the phone and/or the Internet. Relevant legal and ethical issues should be considered while using remote modes for the triage, diagnosis and treatment of chronic orofacial pain patients.

Effect of computerized delivery intraligamental injection in primary molars on their corresponding permanent tooth buds.

OBJECTIVE: To evaluate the prevalence of developmental disturbances in permanent teeth in which buds were exposed to intraligamental injection (ILI) delivered by a computer controlled local anaesthetic delivery (C-CLAD). METHODS: The study population consisted of 78 children (age 4.1-12.8 years) who received ILI-C-CLAD to 166 primary molars. A structured form was designed to include information regarding age at treatment, gender, type of treated tooth, tooth location, type of dental treatment, and type of developmental disturbance(s) present in the associated permanent tooth. Teeth, which received regular anaesthesia or were not anaesthetized by local anaesthesia, served as controls. RESULTS: Five children had developmental defects. In C-CLAD-ILI exposed teeth, one child had two hypomaturation defects. The corresponding primary teeth were extracted. No defects were found on the control side. In two children, hypoplastic defects were found only in the control teeth (one in each child). One suffered from a dentoalveolar abscess in the corresponding primary tooth. Diffuse hypomaturation defects were found in two children on both the C-CLAD-ILI exposed and control sides. CONCLUSION: In the primary dentition, C-CLAD-ILI does not increase the danger of developmental disturbances to the underlying permanent dental bud.

Effectiveness of various modes of computerized delivery of local anesthesia in primary maxillary molars.

PURPOSE: The purpose of this study was to compare the effectiveness of infiltration and intrasulcular injection, delivered by a computerized delivery system (CDS), to primary maxillary molars. METHODS: The study population consisted of 178 children (2-14 years old) who received local infiltration (buccal and palatal) or intrasulcular injection to primary maxillary molars with the use of a CDS. Behavior was managed using: (1) behavioral management techniques; (2) N2O inhalation; or (3) sedation. Measured dependent variables included the: (1) child's subjective perception of well-being before and immediately after anesthesia (scale = 0-100); (2) child's pain behavior during anesthesia, as measured by Children's Hospital of Eastern Ontario pain scale (CHEOPS; range = 4-13); and (3) effectiveness of anesthesia during dental treatment. RESULTS: Low stress levels were shown for most children before and immediately after anesthesia (range = 12-23). The CHEOPS rating for pain-distractive behavior associated with palatal and buccal infiltration and intrasulcular anesthesia by CDS was similar (6.0 +/- 1.9, 5.8 +/- 1.7, and 5.9 +/- 1.6, respectively). Children treated under sedation, compared to behavioral management techniques, showed higher CHEOPS scores (P = .004). The effectiveness of anesthesia using a CDS (infiltration and intrasulcular) had a downward trend, but was not significantly different for restoration (91%), pulpotomy and preformed crowns (79%), or extraction (74%; mean = 86%). There was no significant difference between infiltration and intrasulcular effectiveness or for age, gender, or tooth location (primary maxillary first vs second molars). CONCLUSIONS: CDS caused low levels of stress and pain reaction after palatal infiltration equal to that for buccal infiltration. All procedures achieved anesthesia effectiveness (86%), with no differences between primary maxillary first and second molars.

Effectiveness of computerized delivery of intrasulcular anesthetic in primary molars.

BACKGROUND: Pain measures associated with computerized delivery of intrasulcular anesthestic have not been reported. The authors evaluated a computerized delivery system for intrasulcular (CDS-IS) anesthesia in primary molars. METHODS; The study population consisted of children aged 2 to 13 years who received CDS-IS injections, 159 in mandibular molars and 48 in maxillary molars. Children were treated by one of three modes of behavioral management: behavior modification (BM) only, inhalation of nitrous oxide (N2O) in addition to BM or intrarectal sedation. Variables evaluated included the subjective perception of the child's well-being before and after administration of the anesthetic, the child's pain behavior during anesthetic administration, effectiveness of the anesthetic during dental treatment, incidence of reported postoperative dental pain (PDP) and analgesic use after the CDS-IS injections. RESULTS: The effectiveness of CDS-IS anesthesia in mandibular molars was 97 percent, 92 percent, 63 percent and 71 percent for restorations, preformed stainless steel crowns, extractions and pulpal therapies, respectively (mean effectiveness, 89 percent). The effectiveness of CDS-IS anesthesia in maxillary molars was 96 percent, 50 percent, 92 percent and 78 percent, respectively (mean effectiveness, 90 percent). CDS-IS was less effective in children aged 2 to 4 years who received sedation than it was in older children. The authors found no differences between children's subjective self-reports of well-being before and after anesthetic administration, between the sexes and/or between modes of behavioral management (that is, BM or N2O). Most children exhibited low pain-related behavior during anesthetic administration, with no differences between boys and girls. The overall incidence of PDP was 31.4 percent; 64.9 percent of these patients received pain-relieving medications as a result, with no correlation to age, tooth treated, effectiveness of anesthesia or type of treatment. CONCLUSIONS: CDS-IS is effective for anesthetizing primary molars, mainly for amalgam, resin-based composite and stainless steel crown restorations.

Hypnorelaxation as treatment for myofascial pain disorder: a comparative study.

BACKGROUND: Hypnorelaxation has a potentially beneficial effect in the treatment of masticatory myofascial pain disorders (MPD). However, there are no data regarding the efficacy of hypnorelaxation in the treatment of MPD compared with other accepted modes of treatment (such as occlusal appliance) or with the mere effect of time. OBJECTIVE AND SUBJECTS: The purpose of the present study was to evaluate the effectiveness of hypnorelaxation in the treatment of MPD compared with the use of occlusal appliance and/or to minimal treatment. The study population consisted of 40 female patients with myofascial pain who were allocated to 1 of 3 possible treatment groups: (1) hypnorelaxation (n = 15), (2) occlusal appliance (n = 15), and (3) minimal treatment group (n = 10). RESULTS: Both active treatment modes (hypnorelaxation and occlusal appliance) were more effective than minimal treatment regarding alleviating muscular sensitivity to palpation. However, only hypnorelaxation (but not occlusal appliance) was significantly more effective than minimal treatment with regard to the patient's subjective report of pain on the Visual Analog Scale. CONCLUSION: Hypnorelaxation is an effective mode of treatment in MPD, especially with regard to some of the subjective pain parameters.