Psychological treatments for temporomandibular disorder pain-A systematic review.

OBJECTIVE: Temporomandibular disorders (TMD) are common. They affect abilities for carrying out daily tasks and influence different psychological aspects. In addition to standard treatment, psychological treatments have been suggested. The aim was to investigate the effects of psychological treatments on patients with painful TMD in a short- and long-term perspective. MATERIALS AND METHODS: An electronic search was conducted in the databases MEDLINE, CINAHL, EMBASE, the Cochrane Central Registry of Controlled Trials (CENTRAL), and Web of Science for randomized clinical trials (RCTs) reporting psychological interventions for TMD. Registered beforehand in PROSPERO (CRD42022320106). In total, 18 RCTs were included; six RCTs that could be used in the meta-analysis, and all 18 RCTs were used in the narrative synthesis. Risk of bias was assessed by the Cochrane's tool for assessing risk of bias and certainty of evidence by GRADE. RESULTS: The narrative synthesis indicates that psychological treatment options seem equivalent to standard treatment for painful TMD. The meta-analysis showed that a combination of psychological treatment and standard treatment and manual treatment (very low-quality evidence) are significantly better in pain reduction than just counselling and standard treatments of TMD. CONCLUSION: This study indicates that psychological treatments seem to reduce pain intensity in individuals with painful TMD, and that the effect seems to be equally good as standard treatment. However, a combination of psychological treatments and standard treatments seems to have an even better effect. This indicates that psychological treatments are promising as an additional treatment approach for painful TMDs.

Quantitative and qualitative condylar changes following stabilization splint therapy in patients with temporomandibular joint disorders with and without skeletal lateral mandibular asymmetry: a cone beam computed tomographic study.

BACKGROUND: Temporomandibular disorders (TMDs) encompass pain and dysfunction in the jaw, muscles, and adjacent structures. This study aimed to explore the quantitative (condylar position, morphology) and qualitative (bone mineral density (BMD)) therapeutic outcomes following a stabilization splint (S.S.) therapy in adult patients diagnosed with TMD (Arthralgia) with/without lateral mandibular asymmetry (MA) using cone beam computed tomography (CBCT). METHODS: In this retrospective clinical study, 60 adult TMD patients who received S.S. therapy were enrolled and allocated into the TMD group (TMDG) and TMD with MA group (TMD + MAG). The diagnosis was made according to the Diagnostic Criteria for TMD (DC/TMD) AXIS I. MA was measured from the mid-sagittal plane to the Menton point. CBCT was used to scan the temporomandibular joints pre- (T0) and post- (T1)-treatment for three-dimensional analysis. Intra- and intergroup statistical comparisons were performed using the Wilcoxon signed ranks and the Kruskal‒Wallis test. RESULTS: For quantitative comparisons, there was a statistically significant difference between T0 and T1 in the joint spaces of TMD + MAG (anterior, superior, posterior, and coronal lateral on the deviated side as well as in the superior, coronal medial joint space of the contralateral side). Morphologically, the deviated side had a narrower condylar width, reduced condylar height, and a steeper eminence angle. In contrast, the contralateral side tended to have a greater condylar length. For qualitative measurements, BMD also showed statistical significance between T0 and T1 in the majority of the condyle slopes (AS, SS, PS, and LS on the deviated side and in AS and MS on the contralateral side) of TMD + MAG. Additionally, only the AS and PS showed significance in TMDG. CONCLUSION: Multiple joint space widening (AJS and CMS) and narrowing (SJS, PJS, and CLS) could characterize the deviated side in TMD + MA. Factors like narrower condylar width, reduced condylar height, and steeper eminence angle on the deviated side can worsen TMD + MA. Proper alignment of the condyle-disc position is essential for optimal function and load distribution, potentially affecting bone mineral density (BMD). MA plays a prominent role in disturbing bone densities. S.S. therapy shows more evident outcomes in TMD + MAG (on the deviated side compared to the contralateral side) than the TMDG.

Impact of professional, recreational and nonsinging on temporomandibular disorders - a comparative study based on a self-assessment questionnaire.

BACKGROUND: This study investigates the relationship between professional and recreational singing on temporomandibular disorders (TMDs) in women compared to a nonsinging control group. METHODS: A total of 288 female subjects between the ages of 18 and 45 participated in the self-assessment questionnaire including demographic data, as well as questions on vocal practice and TMDs symptoms. Depending on the singing time per week, the (non)vocalists were assigned to the groups professional (n = 96), recreational (n = 96) and nonsingers (n = 96). RESULTS: The TMDs prevalence in professional singers (42%) was higher than that in recreational singers (31%) and noticeably higher than that in nonsingers (25%). The Fisher-Freeman-Halton exact test showed that the differences between the groups were not noticeable (p = .053) but could be formulated as tendencies. The professionals suffered much more from restricted jaw movement (p = .004; OR = 2.718; 95% CI = 1.409-5.242), temporomandibular joint sounds (p < .009; OR = 2.267; 95% CI = 1.264-4.064) and temporomandibular pain (p = .010; OR = 2.333; 95% CI = 1.264-4.308) than nonsingers. CONCLUSIONS: Singing might have an enhancing effect on the appearance of TMDs. In particular, professional singers suffered more from self-reported TMDs than recreational singers and nonsingers. In addition to the high level of physical workload if participating in professional singing, the psychosocial impact should be investigated more in further studies. No new treatment strategies resulted from this study, as the etiological significance of singing is still unclear. Knowledge about risk factors for multifactorial TMDs can help practitioners and patients prevent and treat TMDs.

Arthroscopy versus arthrocentesis and versus conservative treatments for temporomandibular joint disorders: a systematic review with meta-analysis and trial sequential analysis.

The aim of this systematic review was to assess the efficacy of arthroscopy compared to arthrocentesis and to conservative treatments for temporomandibular joint disorders. Thirteen controlled studies on various patient outcomes were included after a systematic search in seven electronic databases. Meta-analyses were conducted separately for arthroscopic surgery (AS) and arthroscopic lysis and lavage (ALL), and short-term (<6 months), intermediate-term (6 months to 5 years), and long-term (≥5 years) follow-up periods were considered. No significant differences in pain reduction and complication rates were found between AS or ALL and arthrocentesis. Regarding improvement in maximum mouth opening (MMO), both AS at intermediate-term and ALL at short-term follow-up were equally efficient when compared to arthrocentesis. However, at intermediate-term follow-up, ALL was superior to arthrocentesis for MMO improvement (mean difference 4.9 mm, 95% confidence interval 2.7-7.1 mm). Trial sequential analysis supported the conclusion of the meta-analysis for MMO improvement for ALL versus arthrocentesis studies at intermediate-term follow-up, but not for the other meta-analyses. Insufficient evidence exists to draw conclusions regarding other patient outcomes or about comparisons between arthroscopy and conservative treatments. Due to the low quality of the primary studies, further research is warranted before final conclusions can be drawn regarding the management of temporomandibular joint disorders.

Is low back pain a risk/prognostic factor for the development and/or progression of temporomandibular disorders? A systematic review with meta-analysis.

OBJECTIVES: To evaluate the association between low back pain (LBP) and painful temporomandibular disorders (TMDs). METHODS: Systematic review of observational studies. Searches were conducted using OVID MEDLINE, CINHAL, Web of Science and PUBMED databases up to 21 October 2022. Qualitative and quantitative analyses were performed. Risk of bias (RoB) was assessed using the Quality in Prognosis Studies tool (QUIPS). RESULTS: Eight studies were included in the present review with meta-analysis. The first onset of TMDs was more likely in patients with previous chronic LBP (hazard ratio (HR) 1.53 [95% confidence interval (CI): 1.28; 1.83, p < .00001]). In addition, patients with chronic LBP had 3.25 times the odds (OR) [95% CI: 1.94; 5.43, p < .00001] of having chronic TMDs than those who did not have chronic LBP. In addition, the higher the exposure to chronic LBP, the higher the risk of developing a first onset of TMDs. CONCLUSIONS: Chronic LBP can be considered a risk/contributing factor for painful TMDs. Although there is a high certainty in the evidence linking chronic LBP with the risk of a first onset of TMDs, there are insufficient studies to draw definitive conclusions. Furthermore, while an association between chronic LBP and chronic TMDs and a dose-effect was observed between these two conditions, a limited number of studies and evidence exist to support these findings. Future studies are needed to increase the body of evidence.

[Somatosensory tinnitus]. / Somatosensorischer Tinnitus.

BACKGROUND: Somatosensory tinnitus represents a clinically significant subgroup of chronic tinnitus. Although not completely understood, increasing evidence suggests interactivity between the somatosensory and auditory systems is responsible for both the development and maintenance of tinnitus. OBJECTIVES: The aim of this study is to provide an overview of the evaluation of somatosensory tinnitus and to propose an examination protocol to support the diagnosis and treatment of this patient group. MATERIALS AND METHODS: In addition to patient history, various clinical examination maneuvers are presented to establish the diagnosis of somatosensory tinnitus. RESULTS: The maneuvers can be divided into examinations of the cervical spine, temporomandibular joint, and soft tissue near the jaw. The maneuvers should be performed in a quiet environment and usually in comparison between sides. CONCLUSION: Accurate and efficient diagnosis of somatosensory tinnitus is essential to initiate appropriate treatment. The clinical maneuvers presented here are well suited for this purpose.

Comparison of the efficacy of occlusal splint and botulinum toxin therapies in patients with temporomandibular disorders with sleep bruxism.

PURPOSE: This study aims to evaluate the efficacy of occlusal splint and botulinum toxin (BTX) therapies for improving the pain scores and mouth opening in patients with temporomandibular disorders (TMD) with sleep bruxism (SB). MATERIALS AND METHODS: A retrospective cohort study was conducted based on clinical record reviews of patients with TMD symptoms (e.g., temporomandibular joint [TMJ] pain, masticatory muscle pain, TMJ internal derangements, joint sounds, and limited mouth opening) and SB. The patients were divided into two groups: occlusal splint group and BTX group. Maximum unassisted mouth opening (MMO) and pain score on a visual analogue scale (VAS) before treatment and at 1­, 3­, and 6­month follow-up were analyzed to evaluate the clinical outcomes. RESULTS: A total of 60 patients (49 women and 11 men, mean age 34.63 ± 11.85 years) were enrolled. Each group had 30 patients. The comparisons of the groups at 1 and 3 months after treatment indicated that the BTX group had higher MMO values (P = 0.013 and 0.034, respectively) and lower VAS scores than the occlusal splint group (P = 0.000 and 0.001, respectively). No difference between the two groups was observed 6 months after treatment (P > 0.05). CONCLUSIONS: Both occlusal splint and BTX treatment methods were successful in treating TMD with SB. BTX provided patients with rapid relief in the early period; therefore, BTX can be recommended as a primary treatment option in patients with greater pain.

Quantitative and qualitative condylar changes following stabilization splint therapy in patients with temporomandibular joint disorders.

OBJECTIVE: This study aimed to explore the quantitative and qualitative condylar changes following stabilization splint (S.S) therapy, including condylar position, morphology, and bone mineral density (BMD) in subjects with temporomandibular disorders (TMD). MATERIALS AND METHODS: In this retrospective clinical study, we enrolled 40 TMD subjects (80 joints) aged 18 to 35 years, for whom a S.S was used to treat TMD. The 80 TMD consists of 32 masticatory muscle disorders (myalgia) and 48 TMJ disorders (arthralgia). Cone beam computed tomography (CBCT) was used to scan the TMJs of subjects pre- and post-treatment for three-dimensional analysis (3D). Using Mimics software v.21.0, quantitative (3D condylar and joint spaces dimensions parameters were measured using linear measurements in millimeters, according to the Kamelchuk method and Ikeda method, while the assessment of anteroposterior condyle position within the glenoid fossa was based on the method of Pullinger and Hollender), and qualitative (a round bone tissue with an area of 2 mm2 in three representative areas according to the Kamelchuk method to measure condylar BMD) pre- and post-treatment. Intra- and inter-group statistical comparisons were performed using the Wilcoxon signed ranks and the Kruskal-Wallis test, respectively. RESULTS: The course of treatment was 6-12 months, with an average of 9.1 months. For the pre- and post-treatment quantitative comparisons, there was a statistically significant difference in the anterior joint space (AJS) and coronal medial space, as well as the condyle length in the myalgia group and condylar width in the arthralgia group. For qualitative measurements, a significant difference was observed in the posterior slope of the myalgia group and the arthralgia group's anterior, superior, and posterior slopes. The inter-group comparisons revealed significant differences in AJS, condylar length, and anterior slope density. CONCLUSION: In short-term follow-up, the S.S influenced patients with TMD from different origins; it changes anterior and coronal medial joint space, condyle length in myalgia, and width in arthralgia. Furthermore, it improved the condyle bone density more evidently in arthralgia. CLINICAL RELEVANCE: This study highlights the influence of S.S on symptomatic populations with TMD of different origins from a qualitative and quantitative perspective.

Arthrocentesis versus non-surgical intervention as initial treatment for temporomandibular joint arthralgia: a randomized controlled trial with long-term follow-up.

Arthrocentesis for arthralgia of the temporomandibular joint (TMJ) is often only indicated when conservative, non-surgical interventions have failed. However, performing arthrocentesis as initial therapy may facilitate earlier and better recuperation of the joint. The aim of this study was to assess the efficacy of this therapy with a long-term follow-up. Eighty-four patients were randomly allocated to receive either arthrocentesis as initial treatment (n = 41) or non-surgical intervention (n = 43). Pain (100-mm visual analogue scale, VAS) and mandibular function impairment questionnaire scores (MFIQ, 0-100) were recorded at 3, 12, and 26 weeks, and ≥ 5 years (median 6.2, interquartile range 5.6-7.4 years). Univariable analyses were performed and linear mixed-effect models were constructed. Patients in the arthrocentesis group experienced significantly lower TMJ arthralgia compared to those treated non-surgically (pain during movement: -10.23 mm (95% confidence interval -17.86; -2.60); pain at rest: - 8.39 mm (95% confidence interval -13.70; -3.08)), while mandibular function remained similar in the two groups (MFIQ -2.41 (95% confidence interval -8.61; 3.78)). Of the final sample, 10 patients (10/39, 26%) in the non-surgical intervention group and two patients (2/34, 6%) in the arthrocentesis group received additional treatment during follow-up. Thus, initial treatment with arthrocentesis reduced TMJ arthralgia more efficaciously than non-surgical intervention in the long term, while maintaining similar mandibular function.

Analysis of Cervical Range of Motion in Subjects Affected by Temporomandibular Disorders: A Controlled Study.

Background and Objectives: The aim of this study were to compare the cervical ROM data obtained from accelerometer exams between patients suffering from TMDs (study group) and healthy patients (control group). Material and Methods: A sample of 43 young adult subjects (23 control subjects and 20 TMD patients) were included in this study and analyzed with the accelerometer (Baiobit™, BTS, Garbagnate Milanese, Milan, Italy) to assess cervical ROM using a standardized protocol, including the following occlusal conditions: mandibular rest position, clenching, clenching with cotton rolls, maximal intercuspation, and mandibular position with cotton rolls. The cervical ROM was measured in degrees and expressed as the mean and standard deviation. Results: TMD patients showed a reduced cervical extension compared to control subjects in all the conditions, with statistically significant relevance. Regarding the other movements, the differences were not statistically or clinically significant. Conclusions: Based on the results of the present study, it can be observed that temporomandibular disorders are associated with a decreased cervical extension range, while the remaining components of ROM do not seem to be significantly associated. The use of accelerometers in ROM analysis could be helpful in improving interdisciplinary communication between dentists and physiotherapists.

Effectiveness of the therapeutic laser in the syndrome of dysfunction of the temporomandibular joint of arthrogenic origin / Eficacia del láser terapéutico en el síndrome de disfunción de la articulación temporomandibular de origen artrogénico

Abstract Temporomandibular joint dysfunction syndrome (TMD), is a collective term characterized by symptoms involving chewing muscles, temporomandibular joint and orofacial structures. The efficacy of low intensity laser (LLLT) Gallium arsenide, in combination with a non-steroidal anti-inflammatory drug (NSAID) was evaluated. The main objective was to evaluate the maximum mouth opening without pain (ABM), arthralgia in the joint capsule through visual analog scale (VAS), laterality, protrusion, joint noises and count of tablets ingested per group. A controlled clinical trial (double-blind-randomized) was carried out in 30 subjects, who presented DTM of arthrogenic etiology; 5 applications of LLLT were made with wavelength of 810 nm, output optical power of 100-200 mw, emission PW=Pulsed (1-10,000Hz), dose of 10 jouls-cm², time of 1.44 minutes in mouth closed and with the mouth half open. One more follow-up appointment per month. There were two groups: experimental and control group, where different variables were analyzed (ABM, laterality, protrusion, VAS and sociodemographic). In the control group, a supposed LT application (not active) was made, for later comparison. Pain-free ABM was assessed in all appointments in addition to the other clinical parameters. Repeated measures analysis was performed with mixed models. Thirty patients were included of which 28 finished the treatment, two of them were lost during follow-up. The groups were similar in all their baseline variables. There were no statistically significant differences when applying the final multiple regression analysis, in the ABM, or in any other of the clinical parameters analyzed. LT was not effective in treating arthrogenic DTM.

Resumen El síndrome de disfunción de la articulación temporomandibular (DTM) es un término colectivo caracterizado por síntomas que involucran músculos de la masticación, articulación temporomandibular y estructuras orofaciales. Se evaluó la eficacia del láser de baja intensidad (LLLT) Arseniuro de galio, en combinación con un antiinflamatorio no esteroideo (AINE). El objetivo principal fue evaluar la apertura bucal máxima sin dolor (ABM), la artralgia en cápsula articular a través de escala visual análoga (EVA), lateralidades, protrusión, ruidos articulares y conteo de tabletas ingeridas por grupo. Se realizó un ensayo clínico controlado (doble ciego-aleatorizado) en 30 sujetos, que presentaban DTM de etiología artrogénica; se les realizaron 5 aplicaciones de LLLT con longitud de onda de 810 nm, potencia óptica de salida de 100-200 mw, emisión PW=Pulsed (1-10,000Hz), dosis de10 jouls-cm², tiempo de1.44 minutos a boca cerrada y con la boca semiabierta. Una cita más de seguimiento al mes. Se tuvieron dos grupos: experimental y grupo control, donde se analizaron diferentes variables (ABM, lateralidades, protrusión, EVA y sociodemográficas). En el grupo control se hizo una supuesta aplicación LT (no activo), para posterior comparación. En todas las citas se valoró la ABM sin dolor además de los otros parámetros clínicos. Se realizó análisis de medidas repetidas con modelos mixtos. Se incluyeron 30 pacientes de los cuales 28 finalizaron el tratamiento, dos de ellos se perdieron en el seguimiento. Los grupos fueron similares en todas sus variables basales. No hubo diferencias estadísticas significativas al aplicar los análisis de regresión múltiple finales, en la ABM, ni tampoco en ningún otro de los parámetros clínicos analizados. El LT no fue eficaz en el tratamiento de la DTM de origen artrogénico.

[Features of the formation of typical motor patterns of the craniocervical zone in functional disorders in the craniomandibular system]. / Osobennosti formirovaniya tipichnykh motornykh patternov kraniotservikal'noi zony pri funktsional'nykh narusheniyakh v kraniomandibulyarnoi sisteme.

OBJECTIVE: The aim of the study is to analyze the features of motor patterns formation in the craniocirvical zone with occlusal and functional disorders of the craniomandibular system. MATERIALS AND METHODS: 281 patients (201 women and 80 men) were examined at the age from 21 to 32 years. Two groups of individuals were identified based on the short Gambur test. The first group (I) included persons with intact dentition and without signs of functional disorders (n=30). The second group (II) included persons with intact dentition and dysfunction of the craniomandibular system (CMS) (n=30). All patients were examined by a digital analysis of the occlusal relationship. A digital method of capturing and reconstructing movement was used to assess the motor patterns of the craniocervical zone. Analysis of functional occlusion showed that the first contact in persons with functional impairment is predominantly localized on the molars region (χ2=44.1; df=11, p=0.00001). RESULTS: In analysis of dynamic occlusion, the time exceed for reaching maximum intercuspation position significantly in group II instead of group I 0.127±0.072 sec and 0.261±0.091 sec (p<0.05). Disconnection time in group II was 0.443±0.096 sec, Which significantly differed from group I (p<0.05). Persons with CCM dysfunction head flexion was 11.00° [9.00°; 13.00°], which is significantly higher than in the comparison group 5.00° [5.00°; 5.50°]. In the transverse plane, an increase in the angle of lateroflexion in persons with functional impairments up to 11.00° [10.00°; 11.00°]. Correlation analysis showed the presence of a direct strong connection between the angle of flexion and the time of separation (r=0.76), as well as the time to reach the maximum intercuspation position (r=0.63). CONCLUSION: Thus, functional disorders in the form of occlusal aberrations lead to changes in the cervical spine and head position through the formation of new motor patterns.

Psychometric Evaluation of the Krogh-Poulsen Test for the Diagnosis of the Temporomandibular Disorders.

The Krogh-Poulsen Test is a classic instrument to measure dysfunction of the stomatognathic system whose psychometric properties are unknown. This study aimed to evaluate the psychometric properties of the Krogh-Poulsen Test for the diagnosis of temporomandibular disorders (TMDs). A cross-sectional study was designed, including 119 patients (63 patients with TMD and 56 healthy controls). Factorial validity, inter-rater reliability, error of measurement, diagnostic validity of the Krogh-Poulsen Test, and concurrent validity were analyzed. The Krogh-Poulsen Test showed a three-factor structure. The inter-rater agreement could be considered very good with a kappa index of 0.87 (95% CI 0.83-0.90) and Standard Error of Measurement of 0.79. Correlations were strong with other orofacial instruments, moderate with instruments measuring TMD-related disorders such as neck pain, headache, or dizziness, and poor with generic quality of life instruments. The Area Under the Curve ROC was 0.928 showing, for a cut-off point >1, a sensitivity of 90.48 (95% CI 80.4-96.4) and a specificity of 85.71 (95% CI 73.8-93.6) for the diagnosis of TMD disorders. The Krogh-Poulsen Test showed a three-factor structure, very good inter-rater reliability, a strong correlation with other orofacial instruments, and an excellent capacity to discriminate between patients with or without TMD.

Relationship between Oral Parafunctions and Signs and Symptoms of Craniomandibular Dysfunction in Children with Cleft Lip and Palate / Relação Entre Parafunções Orais e Sinais e Sintomas de Disfunção Craniomandibular em Crianças com Fissura Labiopalatina

The aim of this study was to evaluate the association of oral parafunctions with the presence of signs and symptoms of craniomandibular disorder in children with cleft lip and palate (CLP). A cross-sectional study was performed in which one hundred and eighty-eight children with CLP and absence of associated syndromes or malformations were investigated. During clinical examination, the presence of wear facets and dental occlusion were observed and palpation was performed in the temporomandibular joint region (TMJ) and orofacial musculature . The children and their guardians were interviewed regarding the presence of oral parafunctional habits (bruxism, the act of biting the lips and/or cheeks, nail biting, sucking of fingers and pacifiers) and signs and symptoms of craniomandibular dysfunction (headache, ear and/or neckache, tiredness or crack in the TMJ during mouth opening and chewing movements). The data were analyzed by means of absolute and relative frequency measurements, and bivariate analysis using Pearson's chi-square test and likelihood ratio test were performed, considering the significance level of 5%. A higher prevalence of cleft lip and palate type (76.0%) and the presence of malocclusion (61.7%) was observed, highlighting the anterior crossbite (58.7%) and midline deviation (48.9%). There was a higher occurrence of teeth grinding (40.4%), onychophagy (28.7%) and biting lips and/or cheeks (28.7%). Onychophagia was associated with headache (p <0.05) and with pain or cracking during mouth opening (p <0.05). It was concluded that parafunctional oral habits may be associated with signs and symptoms of craniomandibular disorder in children with cleft lip and palate.

O objetivo do estudo foi avaliar a associação de parafunções orais com sinais e sintomas da disfunção craniomandibular em crianças com fissuras labiopalatinas (FLP). Um estudo transversal foi realizado, no qual cento e oitenta e oito crianças com FLP e ausência de síndromes ou malformações associadas, foram investigadas. Durante exame clínico, a presença de facetas de desgaste e a oclusão dentária foram observadas e foi realizada a palpação na região da articulação temporomandibular (ATM) e musculatura orofacial. As crianças e seus responsáveis foram entrevistados com relação à presença de hábitos orais parafuncionais (bruxismo, ato de morder os lábios e/ou bochechas, onicofagia, sucção de dedos e de chupeta) e sinais e sintomas de disfunção craniomandibular (cefaléia, ouvido, dor, cansaço ou estalo na ATM durante movimentos de abertura bucal e de mastigação). Os dados foram analisados por meio de medidas de frequência absoluta e relativa e a análise bivariada foi realizada por meio dos testes do Qui-quadrado de Pearson (χ2) e a Razão de verossimilhança, considerando o nível de significância de 5%. Uma maior prevalência das fissuras envolvendo lábio e palato (76,0%) e presença de maloclusão (61,7%) foi observada, com destaque para mordida cruzada anterior (58,7%) e desvio de linha média (48,9%). Houve uma maior ocorrência do ato de ranger os dentes (40,4%), da onicofagia (28,7%) e do hábito de morder lábios e/ou bochechas (28,7%). A onicofagia foi associada à cefaléia (p<0,05) e à dor ou estalo durante abertura bucal (p<0,05). Conclui-se que hábitos orais parafuncionais podem estar associados a presença de sinais e sintomas da disfunção craniomandibular em crianças com FLP.

"What if it doesn't unlock?": A qualitative study into the lived experiences of adults with persistent intra-articular temporomandibular disorders.

BACKGROUND: Temporomandibular disorders (TMD) are associated with increased self-reported disability and psychosocial issues, although little is known about those who specifically experience mechanical signs and symptoms such as clicking and locking. Understanding the lived experiences of individuals with persistent intra-articular TMD is an important first step to gaining insight into specific domains of self-reported disability associated with these conditions. This information can be helpful to improve clinical management of this subgroup. OBJECTIVES: To explore the lived experiences of adults with persistent intra-articular TMD, including its impact on activity, participation and psychological wellbeing, and the influence of contextual factors on disability. DESIGN: Qualitative study. METHODS: Semi-structured interviews explored the lived experiences of adults with persistent intra-articular TMD, and data were analysed using thematic analysis. Participants were recruited via convenience sampling from private physiotherapy and dental practices, and the community. RESULTS: Sixteen participants were interviewed. Four themes emerged from the data: i) The challenge of living with intra-articular TMD, ii) Living with uncertainty, iii) Seeking control, and iv) Learning to live with it. Novel findings included the impact of persistent intra-articular TMD on dreams, work, intimacy and socialising; and the role of non-pain symptoms (e.g. locking) in disability. CONCLUSIONS: Persistent intra-articular TMD are associated with numerous activity limitations, participation restrictions and psychological issues. Disability is complex and multi-directional, and influenced by various contextual factors including individuals' thoughts, beliefs and support networks. These findings emphasise the need for biopsychosocial and person-centred care in clinical practice.

Temporomandibular Disorders: Current Concepts and Controversies in Diagnosis and Management.

Temporomandibular disorders (TMD) are a group of orofacial pain conditions which are the most common non-dental pain complaint in the maxillofacial region. Due to the complexity of the etiology, the diagnosis and management of TMD remain a challenge where consensus is still lacking in many aspects. While clinical examination is considered the most important process in the diagnosis of TMD, imaging may serve as a valuable adjunct in selected cases. Depending on the type of TMD, many treatment modalities have been proposed, ranging from conservative options to open surgical procedures. In this review, the authors discuss the present thinking in the etiology and classification of TMD, followed by the diagnostic approach and the current trend and controversies in management.

Patients referred to a German TMD-specialized consultation hour-a retrospective on patients without a diagnosis according to RDC/TMD decision trees.

OBJECTIVES: The objective was to describe the physical and psychosocial features of patients attending a specialized consultation hour for temporomandibular disorders (TMD). This investigation focused on those patients who did not receive a diagnosis according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). MATERIALS AND METHODS: From 2004 to 2017, patients seeking care during a TMD-specialized consultation hour were consecutively recruited. Each patient completed a TMD-related questionnaire, psychosocial questionnaires (Graded Chronic Pain Scale, Hospital Anxiety and Depression Scale, Beschwerden-Liste), and the Oral Health Impact Profile-49. The clinical examination was performed according to the RDC/TMD. RESULTS: The mean age of the 1020 patients was 43.3 years (75.3% female). According to the RDC/TMD decision trees, 351 patients were categorized without a TMD diagnosis (NoTMDdx). The most frequent reasons for seeking care were orofacial pain/TMJ pain or headaches revealing an OR of 1.89 (for TMDdx group). A relevant proportion of patients was categorized as positive for anxiety (NoTMDdx/TMDdx 30.8/41.2%; p = 0.072), depression (20.8/23.9%; p = 0.433), non-specific physical symptoms (31.4/44.1%; p < 0.001), or dysfunctional chronic pain (11.5/18.2%; p < 0.001). In both patient groups, the oral health-related quality of life was impaired (42.9/52.7 points; p < 0.001), and the frequency of therapy measures prior to the consultation hour was high. CONCLUSIONS: Patients seeking care from TMD specialists were usually referred with TMD-associated symptoms. Of those, a relevant proportion did not receive a diagnosis according to RDC/TMD decision trees. CLINICAL RELEVANCE: Psychosocial screening and the avoidance of overtreatment are recommended for patients with TMD-related symptoms.

Timing of arthrocentesis in the management of temporomandibular disorders: an integrative review and meta-analysis.

The aim of this study was to assess the best timing to perform arthrocentesis in the management of temporomandibular disorders with regard to conservative treatment. A systematic search based on PRISMA guidelines, including a computer search with specific keywords, reference list search, and manual search was performed. Relevant articles were selected after three search rounds for final review based on six predefined inclusion criteria, followed by a round of critical appraisal. Eleven publications, including eight randomized controlled trials and three prospective clinical studies, were included in the review. The studies were divided into three groups based on the timing of arthrocentesis: (1) arthrocentesis as the initial treatment; (2) early arthrocentesis; and (3) late arthrocentesis. Meta-analysis was carried out to compare the efficacy of improvement in mouth opening and pain reduction in the three groups. All three groups showed improvement in mouth opening and pain reduction, with forest plots suggesting that arthrocentesis performed within 3 months of conservative treatment might produce beneficial results. We conclude that there is a knowledge gap in the current literature regarding the preferable timing to perform arthrocentesis in the management of temporomandibular disorders, and more high-quality randomized controlled trials are required to shed light on this subject.

["A picture is worth a thousand words " : Diagnosis of orofacial pain using Dolografie®]. / "Ein Bild sagt (noch) mehr " : Diagnostik orofazialer Schmerzen mittels Dolografie®.

BACKGROUND: Since 2017, the diagnosis of patients with orofacial pain at the University Center for Dental Medicine Basel has been supplemented by using standardized image graphics (Dolografie® [Affolter/Rüfenacht, Bern, Switzerland]). For this purpose, patients select from a set of 34 cards those that visually best match their pain and then explain the reason for their choice. OBJECTIVES: (1) How many cards are selected on average? (2) Do sex and age influence the choice of cards? (3) Are there preferences in the choice of cards? (4) Are there correlations between pain diagnostic categories (e.g., musculoskeletal versus neuropathic orofacial pain) and the cards selected? (4) Are there correlations between pain diagnostic categories (e.g., musculoskeletal versus neuropathic orofacial pain) and the selected cards? METHODS: The available complete pain anamnestic data of 143 patients were evaluated. RESULTS: (1) Patients selected an average of 3.5 cards to describe their pain. Up to six cards were sufficient for a detailed description of pain in almost all patients. With the 16 most frequently chosen cards, the majority of patients were able to adequately describe their pain. (2) Sex and age had no influence on the number of selected cards. (3) There were clear preferences: Card 02 was chosen most often (45 times), followed by cards 05 and 13 (27 times each). (4) A differentiating choice was made most clearly in neuropathic pain by a strong preference for card 28 and a disregard of card 18. CONCLUSION: The use of standardized image cards as a "visual communication tool" has proven to be a time-efficient procedure in the context of history taking, which helps to obtain clinically relevant information not previously expressed by the patient.

Myogenous temporomandibular disorders and salivary markers of oxidative stress-A cross-sectional study.

BACKGROUND: The clinical care of chronic pain requires personalised understanding of the mechanisms involved. Temporomandibular disorders (TMD) are the most common chronic orofacial pain conditions, and oxidative stress has been proposed to be implicated in their pathophysiology, especially in arthrogenous TMD. However, few studies have explored oxidative stress in myogenous TMD (TMDM). OBJECTIVE: The aims of this study were to compare the salivary oxidative stress profiles between individuals with TMDM and healthy controls, and to explore associations of these markers with clinical characteristics. METHODOLOGY: Saliva samples were collected from 39 individuals with TMDM and 37 age and sex-matched healthy volunteers. Psychological stress levels and clinical characteristics were assessed in all participants. The samples were analysed for total oxidant status (TOS), total antioxidative capacity (TAC) and superoxide dismutase activity (SODa). Comparisons between groups were performed using parametric and non-parametric tests depending on data distribution. RESULTS: Psychological stress was higher in TMDM compared to controls (P < .001). TAC levels were significantly higher (P < .05) whereas TOS levels were significantly lower (P < .05) in TMDM compared to controls. There were no differences in SODa levels between groups and no correlations were found between clinical characteristics and oxidative stress markers. CONCLUSION: Individuals with TMDM showed higher levels of antioxidative markers, but lower levels of oxidative markers. These results can be explained in part by chronicity and adaptation to the disease and other factors, such as psychological stress. Longitudinal studies must be conducted to clarify the role of oxidative stress in TMDM.