Analysis of risk factors and interactions for pain in temporomandibular disorder: A cross-sectional study.

BACKGROUND: Risk factors for temporomandibular disorder (TMD) pain remain unclear. OBJECTIVES: This study aimed to identify risk factors for TMD pain using a biopsychosocial model and to investigate interactions between potential risk factors-oral behaviours (OBs), psychological factors and sleep quality-and their direct and indirect effects on TMD pain. METHODS: This was a cross-sectional study of 488 patients with TMDs (422 women; 30.8 ± 9.4 years). Pain was assessed using the Numerical Rating Scale. Demographic, behavioural, psychological and biomedical data were collected through clinical examination, face-to-face interviews and questionnaires. Multiple linear regression analysis was used to identify factors associated with TMD pain. Mediation and moderation analysis were used to evaluate interactions between variables. Significant mediation ('0' not included in the 95% confidence interval (CI)) and moderation (p < .05) effects on TMD pain were identified. RESULTS: Marital status, diagnosis subgroup, previous medication use, depression and sleep quality were significant risk factors for TMD pain (p < .05). Significant mediation effects were observed as follows: depression and sleep quality mediated the association between OBs and pain; sleep quality mediated the association between somatization, depression, anxiety and pain; and depression mediated the association between sleep quality and pain (all 95% CI did not contain '0'). CONCLUSIONS: (1) Marital status, diagnosis subgroup, previous medication use, depression and sleep quality were associated with TMD pain. (2) OBs can exacerbate pain by promoting depression and reducing sleep quality. Psychological factors and sleep quality can interact to exacerbate pain.

Mental health and jaw function of patients with anterior disc displacement with reduction.

BACKGROUND: The mental health of patients with temporomandibular disorder or other jaw dysfunction is a primary concern in clinical practice, but the extent of these symptoms in this patient subset is not yet well understood. OBJECTIVES: This cross-sectional study aimed to compare the mental health and jaw function between patients with anterior disc displacement with reduction (ADDWR) and healthy individuals. METHODS: In total, 170 patients with ADDWR and 163 healthy participants enrolled in this study from March 2020 to December 2021. All participants completed a single assessment, including a pain rating and several questionnaires to assess jaw dysfunction, depression, and anxiety. All scores and the grade distribution of somatization, depression and anxiety were analysed between groups. RESULTS: Significant differences were found in measures of pain, jaw function and somatization; the ADDWR group had significantly higher pain and functional jaw limitations than the healthy group. The grade distribution of somatic symptoms also differed between groups: the distribution of patients who reported mild and above scores in the ADDWR group was significantly higher than that of the healthy group. Depression and anxiety scores or grade distributions were not significantly different by group. CONCLUSION: The jaw function of patients seeking treatment for ADDWR was lower than that of non-TMD individuals. They did not show high anxiety and depression symptoms, but their somatic symptoms were more apparent.

[A long-term clinical evaluation of comprehensive physiotherapy for patients with chronic anterior disc displacement of the temporomandibular joint without reduction].

PURPOSE: To observe the long-term clinical efficacy of comprehensive physiotherapy for patients with chronic anterior disc displacement of the temporomandibular joint (TMJ) without reduction (ADDWoR). METHODS: A total of 256 patients with chronic ADDwoR (the course of disease was 8.4±9.6 months) who completed the treatment in our hospital from January 2014 to December 2015 were followed up. Symptoms and function pre-treatment, post-treatment and during follow-up including the maximum active mouth opening (mm), visual analog scale(VAS), mandibular function impairment questionnaire (MFIQ) score were recorded and compared; recurrent frequency and symptoms were recorded and compared, too. SPSS 17.0 software package was used for analysis of variance of repeated measurement. RESULTS: The follow-up period was 30.5±4.6 months, the patients' maximum mouth opening: pre-treatmentpost-treatment>follow-up (P<0.05); the patients' MFIQ: pre-treatment>post-treatment> follow-up (P<0.05). 82.8% patients didn't have recurrent symptoms, 14.5% had recurrence and the symptoms were not improved in 2.7% of patients. Among 37 patients with symptomatic recurrent disease, 70.3% had pain, 13.5% had mouth opening limitation, and 13.6% had pain with mouth opening limitation. CONCLUSIONS: Comprehensive physical therapy can significantly relieve pain and improve mouth limitation in patients with chronic ADDwoR of TMJ, and long-term efficacy was good. The causes of recurrence in some patients need further study.

[Mandibular manipulation technique followed by exercise therapy and occlusal splint for treatment of acute anterior TMJ disk displacement without reduction].

PURPOSE: This study aimed to evaluate the short-term efficiency of mandibular manipulation technique combined with exercise therapy and splint treatment of acute anterior TMJ disc displacement without reduction (ADDW), and TMJ disc-condyle relationship by magnetic resonance imaging (MRI). METHODS: Forty-four patients (37 females, 7 males) were diagnosed as acute ADDW and confirmed by MRI. All patients underwent mandibular manipulation, combined with exercise therapy, including jaw movement exercise, stabilization exercise, disc reposition exercise, and splint treatment. Anterior repositioning splint was wore only at night during sleep, while the mandible was kept in rest position during the day. The treatment was continued for 2 weeks. The baseline and endpoint outcome assessment measures were maximum active mouth opening, visual analogue scale (VAS) score of TMJ pain. Consecutive MRI was performed 1~3 months after treatment. SPSS 17.0 software package was used for statistical analysis. RESULTS: Two weeks after treatment, the patients' maximum active mouth opening increased from(22.6±6.1) mm to (43.9±3.3) mm, VAS score of pain decreased from 3.6±1.5 to 0.7±0.25. After treatment of 4.6±4.7 weeks on average, 20 patients (46%) displayed normal dis-condyle relationship, 16 patients(36%) had displacement with reduction, and 8 patients（18%) had displacement without reduction on MRI. CONCLUSIONS: Mandibular manipulation technique combined with exercise therapy and splint treatment seems to be useful in the treatment of anterior TMJ disc displacement with reduction, which can help to maintain the complete anatomic disc-condyle relationship.

Effects of Baduanjin () exercise on knee osteoarthritis: a one-year study.

OBJECTIVES: Knee osteoarthritis (OA) is a major cause of pain and functional limitation. Short-term Baduanjin () exercise had been testified to be beneficial to the disease. This study conducted an initial assessment of the one-year Baduanjin exercise on knee OA. METHODS: The recruited patients practiced Baduanjin at the community recreational center. Sessions were held for 30 min five times a week for one year. Knee pain, stiffness, physical disability, general health, knee extensors and flexors strength, and aerobic ability were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Medical Outcomes Study Short Form-36 (SF-36), the 6-Minute Walk Test (6-MWT), and the Isokinetic Strength of the Knee Extensors and Flexors (ISKEF). Body mass index (BMI) was also calculated before and after the study period for comparison. RESULTS: Twenty-eight patients signed the informed consent. Six patients withdrew from the trial. Twenty-two patients (29 knees) completed the one-year study. After one-year Baduanjin exercise, WOMAC pain (132.0±69.6 vs. 56.2±67.6, P=0.000), stiffness (64.7±54.8 vs. 22.3±34.6, P=0.000), and physical function subscales (386.1±275.8 vs. 182.0±235.7, P=0.003); SF-36 body pain (45.7±20.0 vs. 57.4±17.9, P=0.005), general health (50.5±20.0 vs. 62.1±16.1, P=0.004), role emotional (64.4±26.1 vs. 73.5±21.3, P=0.047), and health transition (3.3±1.0 vs. 2.6±1.0, P=0.008); BMI (25.0±2.9 vs. 24.4±2.9, P=0.032); 6-MWT (565.7±94.6 vs. 610.5±66.7, P=0.036); and ISKEF Peak Torque (the Knee Extensors: 60.5±25.5 vs. 76.8±31, P=0.000; the Knee Flexors: 29.3±15.9 vs. 37.1±15.8, P=0.001) were significantly improved. No adverse effects resulted from the exercise. CONCLUSIONS: It suggested that the long-term Baduanjin could be a feasible and safe exercise option for knee OA.