Dental arch form and interdental widths evaluation in adult Caucasian patients with obstructive sleep apnea syndrome.

OBJECTIVE: To evaluate the hypothesis that dental arch form and inter-canine, inter-premolar, and inter-molar widths differ between OSAS patients and non-snoring, non-apneic controls. METHODS: Dental digital models from 64 OSAS patients and 64 control subjects were used to obtain dental arch forms and to compare them between the two groups. Arch forms were extracted from the lower arch models using a professional graphics program and an orthodontic digital template. Through an orthodontic software, inter-molar, inter-premolar, and inter-canine widths were measured for both upper and lower arches. RESULTS: The dental arch forms distribution differed between OSAS patients and controls. OSAS patients had reduced inter-canine, inter-premolar, and inter-molar widths for both arches compared to controls. DISCUSSION: These results suggest that OSAS patients have narrower and more tapered arches than controls. Dental arch morphology and interdental widths differ between OSAS and control groups, supporting the hypothesis that they are an etiological factor.

Oral myofunctional therapy for the treatment of temporomandibular disorders: A systematic review.

Objective: To investigate the role of oral myofunctional therapy for the treatment of temporomandibular disorders.Methods: A search of the literature was carried out looking for randomized controlled trials performed on humans and written in English, Italian, French, and Arabic.Results: Four randomized controlled trials were found and evaluated by using the Study Quality Assessment Tool of the National Institute for Health and Clinical Excellence.Oral myofunctional therapy was shown to be effective for the treatment of temporomandibular disorders, alone or associated with other treatments, in three out of four studies, with significant reduction of pain intensity when compared to other conservative treatments and no treatment.Discussion: Even though scientific evidence is weak, oral myofunctional therapy appears to be effective for the treatment of temporomandibular disorders with favorable cost-benefit and risk-benefit ratios.

Applied kinesiology and dentistry - A narrative review.

OBJECTIVE: To investigate the use of applied kinesiology in the field of dentistry. METHODS: A review of the literature was carried out looking for all articles written on the topic. PubMed, Ovid Medline, and The Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched. RESULTS: Only one study was retrieved on the use of applied kinesiology in temporomandibular disorder patients, and only one study was published on dental material testing. A change in muscle strength associated with changes in dental occlusion has been observed in many of the articles selected. DISCUSSION: The use of applied kinesiology for the diagnosis and treatment of pathologies in the field of dentistry is not supported by scientific evidence. However, a relationship between dental occlusion or maxillo-mandibular relationship and isometric muscle strength has been noted.

Efficacy and safety of propranolol for treatment of temporomandibular disorder pain: a randomized, placebo-controlled clinical trial.

Propranolol is a nonselective beta-adrenergic receptor antagonist. A multicenter, randomized, double-blind, placebo-controlled, parallel-group, phase 2b trial enrolled participants aged 18 to 65 years with temporomandibular disorder myalgia to evaluate efficacy and safety of propranolol compared with placebo in reducing facial pain. Participants were randomized 1:1 to either extended-release propranolol hydrochloride (60 mg, BID) or placebo. The primary endpoint was change in facial pain index (FPI = facial pain intensity multiplied by facial pain duration, divided by 100). Efficacy was analyzed as a mean change in FPI from randomization to week 9 and as the proportion of participants with ≥30% or ≥50% reductions in FPI at week 9. Regression models tested for treatment-group differences adjusting for study site, sex, race, and FPI at randomization. Of 299 participants screened, 200 were randomized; 199 had at least one postrandomization FPI measurement and were included in intention-to-treat analysis. At week 9, model-adjusted reductions in mean FPI did not differ significantly between treatment groups (-1.8, 95% CL: -6.2, 2.6; P = 0.41). However, the proportion with a ≥30% reduction in FPI was significantly greater for propranolol (69.0%) than placebo (52.6%), and the associated number-needed-to-treat was 6.1 (P = 0.03). Propranolol was likewise efficacious for a ≥50% reduction in FPI (number-needed-to-treat = 6.1, P = 0.03). Adverse event rates were similar between treatment groups, except for more frequent fatigue, dizziness, and sleep disorder in the propranolol group. Propranolol was not different from placebo in reducing mean FPI but was efficacious in achieving ≥30% and ≥50% FPI reductions after 9 weeks of treatment among temporomandibular disorder participants.

Ancillary factors in the treatment of orofacial pain: A topical narrative review.

Ancillary factors, not directly related to treatment, often play a significant role by affecting therapeutic outcome. A search of the literature was conducted including words related to the placebo phenomenon and orofacial diseases. Therefore, critical factors have been grouped into three major categories: (a) the natural course of the diseases; (b) the regression of the symptoms to their mean intensity; and (c) placebo response. This topical narrative review describes the elements mentioned above, provides an up-to-date overview of the hot topics and gaps in the field and indicates developing and future research direction of the orofacial pain field. Such a knowledge might be positively used during daily clinical practice to optimise the management of orofacial pain diseases, as well as in conducting future clinical trials for validating new interventions.

Headache attributed to TMD Is Associated With the Presence of Comorbid Bodily Pain: A Case-Control Study.

Headache attributed to temporomandibular disorders (TMDH) is defined as a secondary headache by the International Classification of Headache Disorders 3rd edition (ICHD-3). OBJECTIVE: The objective of this case-control study is to investigate the phenotypic characteristics of chronic TMD with and without TMDH. We hypothesize that chronic TMD with TMDH is associated with increased number of bodily pain conditions, more painful sites in the head and neck region, and greater TMD pain intensity. METHODS: This is a retrospective cross-sectional review of the medical records of consecutive patients who sought treatment at the University of North Carolina Orofacial Pain Clinic between 2013 and 2014. The inclusion criterion was a diagnosis of myalgia or arthralgia according to the Research Diagnostic Criteria for Temporomandibular Disorders. In addition, cases had a diagnosis of TMDH according to the ICHD-3 criteria. Data on the presence and the number of self-reported bodily pain conditions (such as fibromyalgia and low back pain), pain intensity, number of painful sites in the head and neck upon palpation, and TMD pain onset were analyzed. RESULTS: A total of 295 records were reviewed. Thirty-four (29.3%) patients fulfilled inclusion criteria for cases (TMD+TMDH) and 82 (70.7%) for controls (TMD-TMDH). Cases reported greater number of bodily pain conditions than controls, with a mean of 1.97 ± 1.50 and 1.26 ± 1.28 of bodily pain conditions, respectively (P = .012, OR = 1.43 [95% CI 1.07-1.92]). In fact, 55.9% of cases reported at least 2 comorbid pain conditions compared to 37.8% controls (P = .044). Compared to controls (8.65 ± 5.32), cases (13.05 ± 4.46) exhibited greater number of painful sites upon palpation in the head and neck region (P < .0001, OR = 1.18 [95% CI 1.09-1.30]), and greater TMD pain intensity, with a mean of 6.00 ± 2.17 for cases and 5.09 ± 2.14 for controls (P = .041, OR = 1.22 [95% CI 1.01-1.47]). CONCLUSION: In a population of patients with chronic TMD seeking pain management, TMDH was significantly associated with an increased number of self-reported bodily pain conditions, a greater number of painful sites in the head and neck regions, and higher TMD pain intensity.

Low level laser therapy for the treatment of temporomandibular disorders: a systematic review of the literature.

The authors performed a review of the literature to evaluate the efficacy of low level laser therapy (LLLT) for the treatment of temporomandibular disorders (TMD). Selection criteria included: 1) human subjects, 2) articles written in English, and 3) randomized placebo-controlled trials. Evaluation was performed according to the CONSORT 2010 criteria. A total of 14 articles were included in the review. Studies varied considerably in terms of methodological design, particularly regarding the site of application of the laser beam, the number of applications performed, their duration, the laser beam features (wavelength, frequency, output, dosage), and outcome measures. The outcome of the trials was controversial and not particularly related to any features of the laser beam, to the number of laser applications, and their duration. Based on the results of this review no definitive conclusions can be drawn on the efficacy of LLLT for the treatment of TMD. Many methodological differences among the studies, especially regarding the number and duration of laser applications and characteristics of the laser beam (wavelength, frequency, output), do not allow for standardized guidelines for effective treatment with LLLT. The only indication seems to be that LLLT is probably more effective for the treatment of TMJ disorders, and less effective for the treatment of masticatory muscle disorders.

Temporomandibular joint disk fracture: a case report.

A case of a patient with a fracture of the temporomandibular joint (TMJ) disk is reported. The patient presented with posterior bilateral open-bite and difficulty to chew due to lack of contact between the posterior teeth. Diagnosis of disk fracture of the right TMJ was made based on magnetic resonance imaging (MRI), with posterior displacement of the posterior fragment of the disk, causing the posterior open-bite, and anterior displacement of the anterior fragment of the disk. TMJ manipulation failed to reposition the posterior fragment of the disk, and the patient refused to undergo TMJ arthroscopy to try to remove it. After four months, the posterior open-bite was reduced, probably because of remodeling of the posterior TMJ capsule and extrusion of the molars and premolars. Contact with the patient was lost after that time.