Sleep duration and inflammatory mediator levels associated with long-term prognosis in temporomandibular disorders.

BACKGROUND: Sleep disturbance is a systemic symptom and at the same time a major modulating factor of temporomandibular disorders (TMD). Inflammation is known as a underlying mechanism involved in both poor sleep and increased pain. OBJECTIVE: The relationship between long-term clinical characteristics and hematologic biomarkers of hypothalamic-pituitary-adrenal axis activity and inflammation in TMD patients according to sleep duration was investigated to verify the possible role of sleep disturbance and systemic inflammation in TMD. MATERIALS AND METHODS: Inflammatory and stress mediator levels of venous blood samples were investigated in 63 female TMD patients along with comorbidity levels including stress, somatization, autonomic symptoms and sleep quality based on structured questionnaires. Differences in long-term clinical characteristics and hematologic variables following conservative treatment were analysed according to total sleep time as normal, short and long sleep groups. Also, clinical and hematologic indices related to favourable treatment response were sought out. RESULTS: Significantly less patients in the long sleep group reported pain on voluntary mandibular movement (p = .042) while depression (p = .043) and somatization levels (p = .002) were significantly higher in the short sleep group. Norepinephrine levels of the long sleep group were significantly lower than other groups. Decrease in pain intensity with treatment was smallest in the short sleep group. Erythrocyte sedimentation rate was associated with significant pain improvement at 3 months post-treatment and interleukin-1ß, -4, and -8 levels could predict favourable treatment response. CONCLUSION: Short sleep is associated with more comorbidities and unfavourable long-term treatment response in TMD which may be mediated by systemic inflammation. Effective management of sleep is necessary for successful TMD management.

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.

Long-term evaluation of temporomandibular disorders in association with cytokine and autoantibody status in young women.

Temporomandibular disorders (TMD) is a chronic pain disease affecting 4-60% of general population. Its suggested etiology includes mechanical overloading to related structures, psychosocial factors, and genetic vulnerability. However, its pathogenesis is yet to be fully understood, especially in cases with a higher level of pain and more associated comorbidities. Recently chronic systemic inflammation and possible autoimmunity has been indicated in several pain conditions as the underlying mechanism of chronicity but this aspect has not been rigorously investigated in TMD. This article focuses on analyzing the levels of cytokines, chemokines, autoantibodies and nonspecific inflammatory markers and comparing their levels according to pain severity and duration in 66 female TMD patients in their 20 s and investigating their association with clinical indices of TMD and comorbidities. The high pain disability group showed decreased range of jaw function and more pain on palpation of capsule areas compared to the low pain disability group. Comorbidities such as anxiety and sleep disturbance were also significantly more prevalent. The level of IL-8 and IgG were significantly higher in the high pain disability group. IL-2, -8, -13, IFN- γ, RANTES, PGE2, and thrombopoietin levels showed a significant effect on indices reflecting jaw function, generalized pain intensity, and health related quality of life. Such results imply that longer pain duration and higher pain intensity is associated with higher levels of systemic inflammation suggesting the possible role of immunologic disturbance as an underlying factor of chronic TMD pain and warranting further investigation for its consideration in diagnosis and treatment.

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.