Preclinical orofacial pain assays and measures and chronic primary orofacial pain research: where we are and where we need to go.

Chronic primary orofacial pain (OFP) conditions such as painful temporomandibular disorders (pTMDs; i.e., myofascial pain and arthralgia), idiopathic trigeminal neuralgia (TN), and burning mouth syndrome (BMS) are seemingly idiopathic, but evidence support complex and multifactorial etiology and pathophysiology. Important fragments of this complex array of factors have been identified over the years largely with the help of preclinical studies. However, findings have yet to translate into better pain care for chronic OFP patients. The need to develop preclinical assays that better simulate the etiology, pathophysiology, and clinical symptoms of OFP patients and to assess OFP measures consistent with their clinical symptoms is a challenge that needs to be overcome to support this translation process. In this review, we describe rodent assays and OFP pain measures that can be used in support of chronic primary OFP research, in specific pTMDs, TN, and BMS. We discuss their suitability and limitations considering the current knowledge of the etiology and pathophysiology of these conditions and suggest possible future directions. Our goal is to foster the development of innovative animal models with greater translatability and potential to lead to better care for patients living with chronic primary OFP.

Clinical predictors of persistent temporomandibular disorder in people with first-onset temporomandibular disorder: A prospective case-control study.

BACKGROUND: When patients first develop a painful temporomandibular disorder (TMD) and seek care, 1 priority for clinicians is to assess prognosis. The authors aimed to develop a predictive model by using biopsychosocial measures from the Diagnostic Criteria for Temporomandibular Disorders (DC-TMD) to predict risk of developing TMD symptom persistence. METHODS: At baseline, trained examiners identified 260 participants with first-onset TMD classified by using DC-TMD-compliant protocols. After follow-up at least 6 months later, 72 (49%) had examiner-classified TMD (persistent cases), and 75 (51%) no longer had examiner-classified TMD (transient cases). For multivariable logistic regression analysis, the authors used blocks of variables selected using minimum redundancy maximum relevance to construct a model to predict the odds of TMD persistence. RESULTS: At onset, persistent cases had multiple worse TMD clinical measures and, among Axis II measures, only greater baseline pain intensity (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.04 to 2.2; P = .030) and more physical symptoms (OR, 1.8; 95% CI, 1.2 to 2.9; P = .004) than did transient cases. A multivariable model using TMD clinical measures showed greater discriminative capacity (area under the receiver operating characteristic curve, 0.74; 95% CI, 0.73 to 0.75) than did a model involving psychosocial measures (area under the receiver operating characteristic curve, 0.63; 95% CI, 0.62 to 0.64). CONCLUSIONS: Clinical measures that clinicians can assess readily when TMD first develops are useful in predicting the risk of developing persistent TMD. Psychosocial measures are important predictors of onset but do not add meaningfully to the predictive capacity of clinical measures. PRACTICAL IMPLICATIONS: When TMD first develops, clinicians usefully can identify patients at higher risk of developing persistence by using clinical measures that they logically also could use in treatment planning and for monitoring outcomes of intervention.

Low back pain.

Low back pain affects individuals of all ages and is a leading contributor to disease burden worldwide. Despite advancements in assessment and treatment methods, the management of low back pain remains a challenge for researchers and clinicians alike. One reason for the limited success in identifying effective treatments is the large variation in the manifestations, possible causes, precipitating and maintaining factors, course, prognosis and consequences in terms of activity interference and quality of life. However, despite these challenges, steady progress has been achieved in the understanding of back pain, and important steps in the understanding of the psychological and social risk factors, genetics and brain mechanisms of low back pain have been made. These new findings have given impetus to the development of new diagnostic procedures, evidence-based screening methods and more targeted interventions, which underscore the need for a multidisciplinary approach to the management of low back pain that integrates biological, psychological and social aspects.

Prevalence of temporomandibular disorders in postmenopausal women and relationship with pain and HRT.

The prevalence of temporomandibular disorders (TMD) is higher in females, reaching their high peak during reproductive years, probably because of the action of some female hormones, which alter pain threshold. This study aimed to investigate the prevalence of TMD in postmenopausal women and its relationship with pain and hormone replacement therapy (HRT). In total, 284 patients were evaluated and classified using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Pain was measured using the Visual Analogue Scale (VAS), and patients were also asked about the use of HRT. All data was analyzed using analysis of variance (ANOVA) and chi-square test. In total, 155 subjects did not have TMD and 129 had TMD; TMD group patients were classified according to RDC/TMD axis I classification as follows: muscle disorder group (1.6%), disk displacement group (72.87%), and arthralgia, osteoarthritis, and osteoarthrosis group (37.98%). Pain was registered in 35 patients who belonged to the TMD group, while 48 patients reported the use of HRT. There was a similar percentage of TMD and non TMD patients; moreover, the use of exogenous hormones was no associated with TMD, suggesting that there is no influence on the pain threshold.

Counseling and oral splint for conservative treatment of temporomandibular dysfunction: preliminary study / Aconselhamento e dispositivo interoclusal para tratamento conservador da disfunção temporomandibular: estudo preliminar

Introduction: Temporomandibular Disorders (TMD) involve the masticatory muscles, temporomandibular joint (TMJ) or both. The most common symptom is pain, which is usually located in the muscles of mastication, pre-auricular region, and / or ATM, especially during mandibular function. The main treatment for TMD is related to pain relief. Objective: The purpose of this case report was to evaluate the reduction of pain symptoms using Visual Analogue Scale (VAS) of patients with TMD treated with counseling and use of occlusal splint (OS). Material and method: 16 subjects had participated in this study, that was composed by 4 appointment with 7-day interval between each (CEP FOP / Unicamp - 137/2009). In the first, an examiner used the Research Diagnostic Criteria for Temporomandibular Disorders (RDC / TMD) to diagnose each patient and delivered a VAS to register the intensity of daily pain. In the second, counseling, molding of both dental arcs to fabricate the OS and the delivery of new VAS were performed. In the third, there was the installation and adjustment of the OS and the delivery of another scale, and in the last, possible adjustments on the OS were done. Data were analyzed by ANOVA two way and Tukey post-test at 5% significance level. Result: There was significant difference when comparing the intensity of pain of individuals after installation of splint with the baseline data and after counseling (p = 0.05). Conclusion: According to the result of this study, the treatment of TMD associating counseling occlusal splint is effective in reducing pain intensity.

Introdução: As desordens temporomandibulares (DTM) envolvem a musculatura mastigatória, as articulações temporomandibulares (ATM) ou ambas. O sintoma mais frequente é a dor, geralmente localizada nos músculos da mastigação, na região pré-auricular, e/ou na ATM, principalmente durante as funções mandibulares. O tratamento principal para pacientes com DTM consiste no alívio da dor. Objetivo: O objetivo deste estudo de relato de casos foi avaliar a redução da sintomatologia dolorosa, utilizando Escala Visual Analógica (EVA), de pacientes com DTM por meio do aconselhamento e utilização de dispositivos interoclusais (DI). Material e método: Um total de 16 indivíduos participaram deste estudo, composto de 4 consultas com intervalo de 7 dias entre cada uma delas (CEP FOP/Unicamp - 137/2009). Na primeira consulta, foi realizado o diagnóstico através do questionário para diagnóstico de DTM, o Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) e entregue a EVA para registrar a intensidade de dor diária. Na segunda consulta, foi realizado o aconselhamento, moldagem para confecção dos DI e a entrega de nova EVA. Na terceira, houve a instalação e ajuste dos DI e a entrega de outra escala, e na última, realização de possíveis ajustes dos DI. Os dados foram analisados por meio do ANOVA a 2 critérios e utilizado o pós-teste de Tukey, com nível de significância de 5%. Resultado: Observou-se diferença significante quando se comparou a intensidade de dor dos indivíduos após instalação dos DI com as informações inicias da pesquisa e após o aconselhamento (p=0,05). Conclusão: A partir dos dados obtidos, pode-se concluir que o tratamento de DTM por meio do DI, seguido do aconselhamento, é eficaz na redução da intensidade da dor.

Prevalence of temporomandibular disorders in postmenopausal women and relationship with pain and HRT

Abstract The prevalence of temporomandibular disorders (TMD) is higher in females, reaching their high peak during reproductive years, probably because of the action of some female hormones, which alter pain threshold. This study aimed to investigate the prevalence of TMD in postmenopausal women and its relationship with pain and hormone replacement therapy (HRT). In total, 284 patients were evaluated and classified using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Pain was measured using the Visual Analogue Scale (VAS), and patients were also asked about the use of HRT. All data was analyzed using analysis of variance (ANOVA) and chi-square test. In total, 155 subjects did not have TMD and 129 had TMD; TMD group patients were classified according to RDC/TMD axis I classification as follows: muscle disorder group (1.6%), disk displacement group (72.87%), and arthralgia, osteoarthritis, and osteoarthrosis group (37.98%). Pain was registered in 35 patients who belonged to the TMD group, while 48 patients reported the use of HRT. There was a similar percentage of TMD and non TMD patients; moreover, the use of exogenous hormones was no associated with TMD, suggesting that there is no influence on the pain threshold.

Subgrouping of low back pain patients for targeting treatments: evidence from genetic, psychological, and activity-related behavioral approaches.

INTRODUCTION: Many patients with low back pain (LBP) are treated in a similar manner as if they were a homogenous group. However, scientific evidence is available that pain is a complex perceptual experience influenced by a wide range of genetic, psychological, and activity-related factors. The leading question for clinical practice should be what works for whom. OBJECTIVES: The main aim of the present review is to discuss the current state of evidence of subgrouping based on genetic, psychosocial, and activity-related factors in order to understand their contribution to individual differences. RESULTS: Based on these perspectives, it is important to identify patients based on their specific characteristics. For genetics, very promising results are available from other chronic musculoskeletal pain conditions. However, more research is warranted in LBP. With regard to subgroups based on psychosocial factors, the results underpin the importance of matching patients' characteristics to treatment. Combining this psychosocial profile with the activity-related behavioral style may be of added value in tailoring the patient's treatment to his/her specific needs. CONCLUSIONS: For future research and treatment it might be challenging to develop theoretical frameworks combining different subgrouping classifications. On the basis of this framework, tailoring treatments more specifically to the patient needs may result in improvements in treatment programs for patients with LBP.

Aging and the periodontium: [review]

The geriatric population has been growing fast over the last decades in Brazil and all over the world, changing demographics. Additionally, increased knowledge and the advances of modern dentistry have led the old population to retain more natural teeth, needing specialized dental services for a longer time. Changes in biochemical and physiological processes occur with aging in all body tissues, including the periodontium. The association between periodontal and systemic diseases has also been widely discussed, suggesting the need of a multidisciplinary care, especially in older adults, who are frequently affected by chronic systemic conditions and multiple drug therapy. These features lead to a highly complex management of the geriatric population, challenging the dental care providers. The aim of this study is to review the age-related changes and the consequences of other factors, such as systemic diseases and drugs, on the periodontium of aged patients.

Dental practice implications of systemic diseases affecting the elderly: a literature review

According to the 2000 Brazilian Census, elderly people are over 14 million habitants. In consonance with what occurs worldwide, the Brazilian population is growing older and the elderly are expected to be over 33 million by the year of 2025. Although geriatric dentistry has already been recognized as a dental specialty, there is a lack of specialists in this branch of dentistry, which means that general dentists and other dental specialists will be dealing more and more with these patients. Aged individuals are commonly affected by a number of systemic diseases that have an impact on their oral health, such as cardiovascular and cerebrovascular diseases, diabetes mellitus, oral cancer, osteoporosis, Alzheimer’s and Parkinson’s diseases. Dental professionals must be prepared to treat properly these special patients. Therefore, the aim of this review article is to instruct dentist about these highly prevalent diseases affecting the elderly, as well as discuss their oral manifestations and dental implications, in order to propose a safe and adequate oral health care for these patients. Here we will shortly describe the diseases’ etiology, main signs/symptoms and medical treatment and will discuss about how to proceed with dental treatment in patients suffering from these pathological conditions.