ZleepAnlystNet: a novel deep learning model for automatic sleep stage scoring based on single-channel raw EEG data using separating training.

Numerous models for sleep stage scoring utilizing single-channel raw EEG signal have typically employed CNN and BiLSTM architectures. While these models, incorporating temporal information for sequence classification, demonstrate superior overall performance, they often exhibit low per-class performance for N1-stage, necessitating an adjustment of loss function. However, the efficacy of such adjustment is constrained by the training process. In this study, a pioneering training approach called separating training is introduced, alongside a novel model, to enhance performance. The developed model comprises 15 CNN models with varying loss function weights for feature extraction and 1 BiLSTM for sequence classification. Due to its architecture, this model cannot be trained using an end-to-end approach, necessitating separate training for each component using the Sleep-EDF dataset. Achieving an overall accuracy of 87.02%, MF1 of 82.09%, Kappa of 0.8221, and per-class F1-socres (W 90.34%, N1 54.23%, N2 89.53%, N3 88.96%, and REM 87.40%), our model demonstrates promising performance. Comparison with sleep technicians reveals a Kappa of 0.7015, indicating alignment with reference sleep stags. Additionally, cross-dataset validation and adaptation through training with the SHHS dataset yield an overall accuracy of 84.40%, MF1 of 74.96% and Kappa of 0.7785 when tested with the Sleep-EDF-13 dataset. These findings underscore the generalization potential in model architecture design facilitated by our novel training approach.

The effect of different pain characteristics on jaw functional limitations in patients with temporomandibular disorders.

BACKGROUND: Patients with painful temporomandibular disorders (TMD) more often experience jaw functional limitations. The study of jaw functional limitations should be primarily focused on painful TMD. OBJECTIVES: The impact of TMD pain characteristics (source, chronicity and intensity) on jaw functional limitations were evaluated using Jaw Functional Limitation Scale (JFLS). METHODS: This cross-sectional study reviewed the dental records and self-report questionnaires of patients with painful TMD. The pain source, chronicity and intensity were evaluated to study the TMD pain characteristics. The jaw functional limitations were analysed using the Thai version of the JFLS. RESULTS: A total of 176 patients with painful TMD were included in this study. The jaw functional limitations were affected only by pain intensity. Patients with TMD with severe pain intensity had significantly higher jaw functional limitations than those with mild-to-moderate pain intensity (p < .05). A significant association was observed between pain intensity and jaw functional limitations (p < .05). Mastication was highly restricted by pain intensity (odd ratio = 1.39, 95% confidence interval = 1.16-1.67). CONCLUSION: The present study found a significant effect of TMD pain intensity on jaw functional limitations. Patients with severe TMD pain intensity were more likely to experience jaw functional limitations, particularly mastication limitation. Management focusing on reduction of pain intensity may improve jaw functions in patients with TMD.

Awake and Sleep Oral Behaviours in Patients With Painful Temporomandibular Disorders.

OBJECTIVES: The aim of this research was to explore the oral behaviours exhibited by individuals with and without temporomandibular disorders (TMD) pain, and with various pain characteristics; and to determine which oral behaviour is correlated with painful TMD. METHODS: 328 patients with TMD who visited Orofacial Pain Clinic were included in this retrospective cross-sectional study. The patients were categorised into 2 groups-painful TMD and non-painful TMD-based on pain status; their other pain characteristics were recorded. To evaluate oral behaviours, researchers utilised the Oral Behaviors Checklist (OBC) and categorised into 3 levels based on the Diagnostic criteria for TMD scoring manual. To investigate the associations amongst demographic information, oral behaviour levels, and TMD pain status and characteristics, logistic regression was employed, whilst t tests were used to analyse OBC scores. Logistic regression was also used to examine individual oral behaviours in relation to specific pain characteristics. RESULTS: Age and marital status were associated with TMD pain status. Significantly higher OBC scores were observed in chronic pain compared to acute pain group, but the scores were not significantly different for pain status and other pain characteristics. OBC score and level were associated solely with TMD pain chronicity. According to multivariate logistic regression, "clench or grind teeth when sleeping" was the strongest predictor of TMD pain and "place tongue forcibly against teeth" was the strongest predictor of chronic painful TMD. CONCLUSIONS: High oral behaviour level and OBC scores were associated with chronic painful TMD. Sleep bruxism was the strongest predictor of TMD pain. Age and marital status were correlated with TMD pain status. In the treatment of TMD, there can be potential benefits in addressing and managing oral parafunctional behaviours.

Effect of 1% H2O2 on Three Salivary Stress Biomarkers, Cortisol, Alpha-Amylase, and sIgA.

BACKGROUND: Due to the COVID-19 pandemic, several associations worldwide have been recommending the use of 1% hydrogen peroxide solution as a preprocedural mouth rinse before dental treatments to reduce viral load in saliva. This protocol is also employed in stress studies, especially in the context of dental treatment that uses salivary biomarkers as an indicator. However, the effect of 1% hydrogen peroxide as mouth rinse on salivary biomarkers remains unclear. OBJECTIVE: This study aims to investigate the effects of 1% hydrogen peroxide solution as a preprocedural mouth rinse on 3 salivary stress biomarkers-salivary cortisol, salivary secretory IgA, and salivary α-amylase-both on chemical influence and mechanical irrigation. MATERIALS AND METHODS: Ninety healthy participants with confirmed negative Reverse Transcription Polymerase Chain Reaction results for COVID-19 at most 2 days prior to the experiment were included in this study. All participants were randomly allocated into 3 groups: experimental (1% hydrogen peroxide solution), positive control (distilled water), and negative control (no mouth rinse). Saliva samples were collected before and after mouth rinsing with the respective solutions. Salivary biomarkers were analysed using specific enzyme-linked immunosorbent assay kits. RESULTS: Salivary cortisol and salivary α-amylase did not significantly differ before and after rinsing, whilst salivary sIgA levels decreased in all 3 groups. Nonetheless, there were no significant differences in the changes of these biomarkers across the 3 groups. CONCLUSIONS: This study shows that using 1% hydrogen peroxide solution as a preprocedural mouth rinse for universal precaution does not alter the levels of these 3 salivary biomarkers.

The association of self-reported awake bruxism and sleep bruxism with temporomandibular pain and dysfunction in adult patients with temporomandibular disorders.

OBJECTIVE: To investigate the association of the severity of temporomandibular disorders (TMD) pain and dysfunction with the frequency of self-reported awake bruxism (AB), sleep bruxism (SB), and stress in an adult TMD-patient population. MATERIALS AND METHODS: This cross-sectional study included 237 TMD patients based on the Diagnostic Criteria for TMD. Age, sex, frequency of self-reported AB and SB, and stress were included as independent variables. TMD pain and TMD dysfunction were included as dependent variables in regression analyses. Univariate and multivariable linear regression analyses were used to predict TMD pain and TMD dysfunction in two separate models. Finally, network analysis was performed to investigate the associations between all variables. RESULTS: In the univariate analyses, TMD pain was significantly associated with self-reported AB-frequent (unstandardized coefficient (B) = 3.196, 95%CI 1.198-5.195, p = 0.002). TMD dysfunction was significantly associated with AB-frequent (B = 2.208, 95%CI 0.177-4.238, p = 0.033) and SB-sometimes (B = 1.698, 95%CI 0.001-3.394, p = 0.050). In the multivariable analyses, TMD pain was significantly associated with TMD dysfunction (B = 0.370, p < 0.001), stress (B=0.102, p < 0.001). TMD dysfunction was significantly associated with TMD pain (B = 0.410, p < 0.001) only. Network analysis showed that TMD pain is a bridge factor between AB, stress, and TMD dysfunction. CONCLUSIONS: TMD pain is directly associated with AB, stress, and TMD dysfunction, while TMD dysfunction is only associated with TMD pain. CLINICAL RELEVANCE: Reducing pain may improve pain-related dysfunction, and the management of AB and stress may improve TMD pain and dysfunction, and vice versa.

Effect of GuttaClear on Postoperative Pain After Root Canal Retreatment: A Randomized Clinical Trial.

OBJECTIVE: The aim of this study was to evaluate postoperative pain after non-surgical root canal retreatment with or without GuttaClear. METHODS: Sixty participants were randomly distributed in this non-inferiority trial into two parallel singleblinded experimental groups (Group1: non-solvent, Group2: solvent). After root canal retreatment, the participants completed questionnaires using direct (numerical rating scales) and indirect (number of analgesics taken) measurements of postoperative pain at immediate, 6, 12, 24, 48, and 72 h post-retreatment. The predisposing postoperative pain factors were recorded and analysed using Generalized Estimating Equations to identify correlated factors (α=0.05). RESULTS: The pain incidence was not significantly different between the groups at any time point. The highest incidence of postoperative pain occurred immediately after retreatment (35%) and then decreased to 15% at 24 h (P<0.05). The number of participants requiring analgesics was 6.67% in the non-solvent group and 9.99% in the solvent group which were similar between the groups. Patients with a history of previous postoperative pain were 21.6-fold more likely to have postoperative pain than those without (P<0.05). CONCLUSION: There was no difference in postoperative pain or analgesics required after root canal retreatment with or without using GuttaClear. This study is registered in ClinicalTrial.gov (NCT04326998). (EEJ-2022-05-069).

Understanding the mandibular condyle morphology on panoramic images: A cone beam computed tomography comparison study.

OBJECTIVE: To compare variations in condylar morphology (CM) in panoramic images with those demonstrated in cone beam computed tomography (CBCT) and to investigate factors related to the variations. METHODS: Three thousand panoramic images were analyzed for CM classification and relationship between CM and patient factors. Then, CM of 178 cases of panoramic and CBCT images were compared. RESULTS: CM was classified into five types: round (70.63%), pointed (15.12%), angled (8.43%), flat (4.53%), and irregular (1.28%). CM was significantly related to all patient factors (p < 0.001). Round CM in panoramic images presented as round in CBCT images. Pointed and flat CM were observed mainly in the lateral aspect of the condyle, and no angle-shaped CM was found, according to CBCT images. CONCLUSION: Round, flat, and pointed CM seen on panoramic images possibly reflected the actual shape of the condyle, as confirmed by CBCT, whereas angled CM appeared not to exist.

Influence of functional and esthetic expectations on orthodontic pain.

OBJECTIVES: To investigate the effect of orthodontic treatment outcome (OTO) expectations on the level of pain intensity experienced after orthodontic elastomeric separation (OES). MATERIALS AND METHODS: A total of 100 orthodontic patients (74 female and 26 male, age 14 years and above) from the Faculty of Dentistry, Mahidol University were enrolled. Before OES, questionnaires were administered to obtain patients' expectations regarding various aspects of OTO as well as OES pain expectations. Real-time self-reported pain intensity from OES at the maxillary and mandibular first permanent molars was obtained before and immediately after separator placement and at 6 h, 24 h, and then every day until day 7 after OES. Data were analyzed for the relationship between OTO expectations and OES pain intensity. The level of significance was set at 0.05. RESULTS: The maximum OES pain intensity occurred on day 2 after OES and gradually decreased to the pretreatment level on day 7. The degree of facial, tooth alignment, masticatory function improvement expectations, and a high level of OES pain expectations were significantly associated with the severity of OES pain after separator placement. CONCLUSION: Esthetic and functional expectations of OTO were significantly associated with OES pain intensity. Thus, knowledge about esthetic and functional expectations may help to predict patient's pain response to orthodontic treatment.

Accuracy of the Intraoral Scanner for Detection of Tooth Wear.

OBJECTIVE: The aim of this work was to study the accuracy of the intraoral scanner for detection of tooth wear in natural teeth by using micro-computed tomography (micro-CT) as a gold standard. MATERIALS AND METHODS: Twenty premolars were prepared, fixed in acrylic blocks, and scanned with an intraoral scanner (iTero Element® 2) and micro-CT for baseline reference images before artificial tooth wear induction. The samples were then scrubbed with abrasive sandpaper 20 times and scanned with the intraoral scanner. They were then superimposed with the reference images utilising the "TimeLapse" feature of the scanner until the abraded area appeared yellow, indicating tooth surface loss in the 50-200 µm range. The same samples were then rescanned by micro-CT to measure the actual tooth surface loss. This procedure was repeated for the subsequent experimental tooth surface loss of 200-400 µm range (orange areas) and 400-750 µm range (red areas). The collected data were analysed for sensitivity, positive predictive value (PPV), and accuracy. Level of statistical significance was set at .05. RESULTS: In the detection of experimental tooth surface loss, the specificity, PPV, and accuracy of the intraoral scanner were 98%, 98%, and 97%, respectively. CONCLUSIONS: The iTero® intraoral scanner can be recommended to be a suitable screening tool for tooth wear in routine dental practice.

Bite force of patients with tooth pain.

OBJECTIVES: The aim of this study was twofold: (i) to measure the bite force of healthy adults and patients with tooth pain and (ii) to evaluate the influence of bite force and age on tooth pain and both genders. It is hypothesized that patients with tooth pain would have lesser bite forces as compared to healthy individuals. MATERIAL AND METHODS: Two groups of participants were, the first group comprised 18 healthy adults (9 males, 9 females), while the second group comprised 18 patients with tooth pain (9 males, 9 females), recruited from the Faculty of Dentistry, Universiti Teknologi MARA. Their maximum bite forces were recorded using the Prescale system that consists of pressure-sensitive films and a precalibrated scanning device. Logistic regression models were used using bite force and age on dichotomous responses of tooth pain status and gender. RESULTS: The mean bite force of patients with tooth pain was 684.77 ± 501.13 N, which was lesser than 798.33 ± 492.16 N of the healthy adults. The reduced gender logistic regression model on gender with age was found to be statistically significant (p ≤ .05). CONCLUSIONS: Even though the mean bite force was smaller in the group with dental pain, this difference was not statistically significant.

Effect of post-polymerization with autoclaving treatment on monomer elution and mechanical properties of 3D-printing acrylic resin for splint fabrication.

OBJECTIVES: To evaluate the effect of post-treatment autoclaving on monomer elution and mechanical properties of three-dimensionally (3D) printed resin for splint fabrication. METHODS: Photopolymer resin specimens (Dental LT Clear) were 3D-printed and processed according to the manufacturer's instructions. The specimens were randomly divided to different post-treatment protocols: water storage, autoclaving at different temperatures (121 °C or 132 °C), times (4 or 30 min) and no treatment as a control. The elution of UDMA, HEMA, and EGDMA monomers was determined using high-performance liquid chromatography (HPLC) by immersing the specimens in 75% ethanol for 72 h. The flexural modulus, surface microhardness and linear dimensional changes were measured. The monomer elution and flexural modulus were statistically analyzed using Welch's ANOVA followed by Dunnett's T3 tests, while the surface microhardness and dimensional changes were analyzed using one-way ANOVA followed by Bonferroni tests (α = 0.05). RESULTS: The overall monomer elution concentrations were significantly highest for the control group and lowest for specimens treated in an autoclave at 132 °C for 4 min. The flexural modulus was not significantly different between all groups. The surface microhardness was significantly higher for all autoclaved groups than the control and water storage groups. The linear expansion was significantly higher after post-treatment autoclaving in contrast to water storage. SIGNIFICANCE/CONCLUSIONS: Post-polymerization autoclave treatment of the 3D-printed resin reduced monomer elution and improved surface microhardness without deteriorating the flexural modulus. Post-treatment with an autoclave at 132 °C for 4 min can be recommended for 3D-printed resin for splint fabrication.

Temporomandibular joint findings in CBCT images: A retrospective study.

OBJECTIVE: To evaluate radiological characteristics of the temporomandibular joint. METHODS: Retrospective study of images of 20-80 year-old patients. Two independent clinicians analyzed the images, and a radiological score was obtained, considering sclerosis, osteophites, cysts, and erosion. RESULTS: Seventy eight percent of the joints belonged to females. The main complaints were pain and headache (54.5%) and reduced motion (21.2%). The most common diagnoses were disc dislocation with reduction (35.9%), myofascial pain (20.7%), and osteoarthritis (15.2%). The majority of the joints (96.5%) showed degeneration, with an average radiological score of 3.86 ± 1.47 (0-8). Non-parametric tests showed that females had significantly higher radiological scores (p = 0.014), and TMD-joint patients had higher scores than TMD-muscle patients (p = 0.013). No statistically significant association between radiological scores and chief complaint. CONCLUSION: There were differences among the radiological findings between genders and joint/ muscle TMD, as well as across diagnoses, as expected.

Physical, psychological and socio-demographic predictors related to patients' self-belief of their temporomandibular disorders' aetiology.

BACKGROUND: The aetiology of temporomandibular disorders (TMDs) has been widely discussed in literature, but little is known about patients' self-belief of their TMD aetiology. OBJECTIVE: For six categories of self-believed aetiology of the TMD complaint (viz., occlusal factors, physical trauma, emotional stress, deep pain input, parafunctions and unknown), associations with physical, psychological and socio-demographic predictors were assessed. METHODS: In this retrospective study, medical records of 328 TMD patients who had visited a clinic for Orofacial Pain and Dental Sleep Medicine were analysed. RESULTS: The most frequently reported self-believed TMD aetiology was 'unknown' (42.3%). The category 'occlusal factors' was associated with pain worsening with emotion. 'Physical trauma' as self-believed aetiology was associated with TMD dysfunction score. 'Emotional stress' was associated with awake bruxism and age 18-49 years. 'Deep pain input' was associated with TMD dysfunction score, sleep bruxism, and arthritis or joint pain. 'Parafunctions' were associated with sleep bruxism. 'Unknown' was associated with TMD symptoms severity and work disability. CONCLUSION: For each category of self-believed aetiology of the TMD complaint, different associations with physical, psychological and socio-demographic predictors were identified. This may suggest that individual phenotypes play a role in the patient's belief in the cause of the TMD complaint. Determination of phenotypic risk factors associated with aetiological self-belief might help clinicians to provide better treatment, including counselling, to their patients.

Excessive daytime sleepiness in temporomandibular disorder patients.

Objective: To investigate the relationship between excessive daytime sleepiness (EDS) and associated factors in temporomandibular disorder (TMD) patients. Methods: Medical records of 350 TMD patients were collected. The EDS status was measured by Epworth Sleepiness Scale (ESS). TMD patients were classified according to ESS scores into TMD patients with EDS (ESS ≥10) and without EDS (ESS <10). The relationship between EDS status and associated factors, such as demographic, TMD symptom severity, and psychological status was analyzed using chi-square and t-test. The level of statistical significance was set at 0.05. Results: Approximately 28.57% of TMD patients presented with EDS. These patients possessed a significantly higher level of TMD symptom severity, stress, anxiety, and depression, compared to TMD patients without EDS. Discussion: TMD patients with EDS distinctively suffer both physically and psychologically. This warrants further investigation for the causes and effects as well as underlying mechanisms of EDS in TMD.

Dental treatment as perceived etiology of temporomandibular disorders.

Objective: To characterize patients who believe their temporomandibular disorders (TMD) symptoms are caused by their prior dental treatment. Methods: A sample of 337 patients were selected and classified into dental treatment-related and non-dental treatment-related groups, according to their personal belief of their TMD etiology. The relationship between patients' perceived etiology and patient characterization was analyzed using Chi-square and t-test. Results: One-hundred and thirty-one patients perceived that the cause of their TMD was dental-related. Within this group, 27.5% of the 131 patients considered that their TMD was specifically caused by prior dental treatment. These patients possessed significantly greater disability (self-reported work disability, family interference, and higher level of depression) compared to the patients who did not believe their TMD was caused by dental treatment. Conclusion: Dentists should recognize that their dental treatments could possibly be the cause of patients' TMD symptoms, according to patients' beliefs.

Association of radiographic and clinical findings in patients with temporomandibular joints osseous alteration.

OBJECTIVES: To characterize the relationship between radiographic and clinical characteristics of patients with temporomandibular joint (TMJ) osseous changes. MATERIALS AND METHODS: TMJ cone beam computed tomography (CBCT) images of 73 patients (142 joints) with changes in osseous component of TMJ were included in this study. Based on both clinical and radiographic findings, each TMJ was diagnosed as either non-degenerative joint disease (non-DJD) or degenerative joint disease (DJD) according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) criteria. The DJD group was further classified into two subgroups of osteoarthritis and osteoarthrosis. The data were analyzed using t test and Pearson's correlation. Level of statistical significance was set at 0.05. RESULTS: Statistically significant relationships were found between TMJ crepitation sound and 4 radiographic characteristics of DJD. DJD group demonstrated statistically significant higher CBCT bone change score (BCS) and age. In contrast, there was no significant difference of BCS between osteoarthrosis and osteoarthritis groups within the DJD group. CONCLUSIONS: Crepitation sounds and osseous changes in TMJ radiograph are confirmed to be important diagnostic criteria for TMJ DJD. However, degree of TMJ osseous changes does not correlate significantly with clinical pain symptom. CLINICAL RELEVANCE: For TMJ DJD diagnosis, dentists should consider both clinical examination for TMJ crepitation and radiographic assessment for TMJ bony changes.

Orofacial pain and symptoms of temporomandibular disorders in Finnish and Thai populations.

OBJECTIVE: Cultural or ethnic factors may play an important role in subjects' pain reports. The aim of the study was to compare the prevalence of orofacial pain symptoms between Finnish and Thai populations. MATERIALS AND METHODS: The Finnish study population comprised the Northern Finland Birth Cohort 1966, of which 5696 subjects participated in the present study. The Thai sample consisted of 1501 randomly selected people living in 10 different districts in Bangkok. Data on orofacial pain was collected based on questionnaires. RESULTS: After adjusting for age, gender and education, the logistic regression analysis showed that Thai subjects had an increased risk for reporting oral pain (OR = 4.5, 95% CI = 3.7-5.4), tooth pain (OR = 2.0, 95% CI = 1.8-2.4) and pain in the face (OR = 1.5, 95% CI = 1.2-1.7). CONCLUSIONS: It can be concluded that Thai people report more orofacial pain symptoms than Finnish subjects. Cross-cultural factors exist in the background of reporting pain symptoms in the oral and facial area.

Is low level laser effective for the treatment of orofacial pain?: A systematic review.

The aim of this study was to assess the effectiveness of low level laser therapy (LLLT) as a treatment for orofacial pain considering the methodology of the studies. PubMed (1983-2009) and one conference proceeding were searched. Studying quality was assessed using a validated instrument. A high-quality score was defined as high or low. Outcomes were defined as either positive (+), neutral (0), or negative (-). Thirty-three studies met inclusion criteria. The best evidence synthesis method was used to formulate outcome of LLLT for each type of control group. LLLT vs. placebo pooling revealed high-quality trials in three of eight positive studies. In LLLT vs. other active treatment pooling, two high-quality studies out of nine neutral trials were found. Quality of the trial was not significantly associated with neutral results (p=0.05). Only limited evidence indicated that LLLT is more effective than placebo, sham laser, and other active treatments.

Occlusal scheme in a group of Thais.

PURPOSE: To study the distribution of various occlusal schemes as well as associated static occlusal relationship among Thais. MATERIALS AND METHODS: The subjects' occlusal schemes on the left and right sides were classified as canine protected occlusion, group function, or unclassified according to the definition from Glossary of Prosthodontic Terms (8(th) edition). In addition, the presence of occlusal interferences during mandibular excursions were recorded. The measurement of the horizontal overlap and vertical overlap was also performed. Chi-square, One-way ANAVA and Mann-Whitney U statistical tests were used with level of significance set at P=.05. RESULTS: Total of 104 subjects were included in this study. The ratio for male to female was 1.8 to 1. Average age of the population was 25.01±6.87 years old. The mean vertical overlap and horizontal overlap were 1.94±1.20 and 2.41±1.32 mm respectively. The majority of the populations (68.3%) possessed group function occlusal scheme. For the remaining, 17.3% possess canine protected occlusion and 12.5% possess combination of both occlusal schemes. We also found that occlusal interference was presented in 20.2% of the population. The most common was protrusive interference (57.14%), the second was balancing interference (38.1%) and the third was working interference (4.1%). CONCLUSION: Among Thais, the most common occlusal scheme was group function, however there were no significant occlusal factors related to any particular occlusal scheme.

Estudo do impacto da enxaqueca na severidade da dor miofascial da musculatura mastigatória / Muscle pain intensity of patients with myofascial pain with different additional diagnoses

OBJETIVO: comparar a severidade da dor subjetiva e objetiva, além de outras características associadas entre pacientes com dor miofascial com e sem o diagnóstico adicional de enxaqueca. MÉTODOS: foram selecionados 203 pacientes, com idade média de 40,3 anos (89,2 por cento do sexo feminino), que se apresentaram à Clínica de Dor Orofacial da Universidade da Califórnia, Los Angeles, EUA - todos com diagnóstico primário de dor miofascial. Pacientes com diagnóstico secundário de enxaqueca foram incluídos (n=83) e formaram o grupo 2. O teste de Mann-Whitney foi utilizado para comparar o grupo 1 (dor miofascial) com o 2 (dor miofascial + enxaqueca) quanto à intensidade de dor à palpação e subjetiva, através de Escalas Analógicas Visuais (EAV). Também com o auxílio de EAV, foram comparados estado de humor, problemas com a função, qualidade do sono e incapacidade. Em todos os testes foi adotado um nível de significância de 5 por cento. RESULTADOS: o grupo 2 apresentou níveis de dor à palpação muscular estatisticamente maiores que o grupo 1 (p<0,05). Ao se analisar a intensidade de dor subjetiva obtida através da EAV, o grupo 2 apresentou níveis maiores de dor subjetiva (EAV) em todas as medições, com significância estatística para "dor no momento" e "dor máxima" (p<0,05). Da mesma maneira, o grupo 2 mostrou níveis maiores, obtidos através da EAV, de problemas com humor, incapacidade, problemas com a função mandibular e problemas com sono/descanso, sendo que apenas o último apresentou significância estatística (p<0,05). CONCLUSÕES: a comorbidade enxaqueca exerce forte impacto na severidade da dor e na qualidade de vida de pacientes que apresentam diagnóstico primário de dor miofascial.

OBJECTIVES: To compare subjective and objective pain intensity and associated characteristics in myofascial pain (MFP) patients with and without migraine. METHODS: The sample was comprised by 203 consecutive patients, mean age of 40.3 (89.2 percent of females), primarily diagnosed with MFP, who presented to the UCLA Orofacial Pain Clinic. Patients with secondary diagnosis of migraine (n=83) were included and comprised group 2. In order to compare group 1 (MFP) with group 2 (MFP + migraine) regarding objective pain (palpation scores) and subjective by means of visual analog scales (VAS) pain levels. Also, comparisons of mood problems, jaw function problems, sleep quality and disability levels using VAS were performed using the Mann-Whitney test. A significance level of 5 percent was adopted. RESULTS: Mann-Whitney test revealed that group 2 presented significantly higher pain levels on palpation of masticatory and cervical muscles in comparison to group 1 (p<0.05). Group 2 also presented higher levels of subjective pain, with statistical significance for "pain at the moment" and "highest pain" (p<0.05). Additionally, group 2 showed higher levels of mood problems, disability, jaw function impairment and sleep problems than group 1 with statistical significance for the later (p<0.05). CONCLUSIONS: Migraine comorbidity demonstrated a significant impact on pain intensity and life quality of patients with MFP. Clinicians should approach both conditions in order to achieve better treatment outcomes.