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BACKGROUND: Recent evidence suggests neuro-immune mechanisms may link dietary patterns to chronic painful conditions (CPC). In the research field of oro-facial pain (OFP), studies focuses primarily on dietary mechanical limitations due to pain and dysfunction. OBJECTIVE: This narrative review aimed to overview the role of nutrition on CPC, with emphasis on temporomandibular disorder (TMD), enlightening OFP researcher on dietary assessment possibilities and providing directions for studies in the field of OFP and nutrition. METHODS: A PubMed database search was performed using the MeSH and non-MeSH descriptors: "temporomandibular joint disorder"; "orofacial pain"; "musculoskeletal pain"; "chronic pain disorders"; "nutrition"; "diet"; "dietary therapy"; "dietary intake" and "inflammation". No time restrictions were applied. Literature reviews, systematic reviews, meta-analyses and clinical and pre-clinical trials were included. RESULTS: Exogenous oxidants from unhealthy dietary patterns may contribute to peripheral and central pro-inflammatory immune signalling leading to peripheral and central sensitization. Furthermore, diets rich in bioactive compounds are suggested to contribute to pain management of CPC. High dietary intake of ultra-processed foods impacts the quality of the diet and shows adverse health outcomes. In this context, the role of nutrition on TMD remains overlooked. CONCLUSION: Considering diet may influence CPC, allied with the scarcity of studies evaluating the role of nutrition on TMD, well-designed clinical trials based on dietary assessments and measurements capable of evaluating food quality, UPF consumption and nutrient adequacy-added to serum nutrient levels evaluation-are suggested.

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Objetivo: Avaliar o conhecimento dos odontopediatras sobre o bruxismo em crianças e discutir o tema de acordo com as evidências científicas atuais. Material e Métodos: 425 odontopediatras preencheram um formulário online composto por 17 afirmações sobre bruxismo em crianças durante a vigília e o sono. Os dados foram interpretados de duas formas distintas: conhecimento do participante e conhecimento das afirmações. O conhecimento do participante foi considerado aceitável quando pelo menos 10 das 17 afirmações foram respondidas corretamente. O conhecimento das afirmações foi considerado satisfatório quando foi respondido corretamente por, pelo menos, 70% dos participantes. Resultados: O número médio de respostas corretas foi de 9,73 (±3,41). Cinquenta e dois por cento dos participantes demonstraram conhecimentos aceitáveis e apenas 4 afirmações obtiveram uma percentagem de respostas consideradas satisfatórias. Conclusão: O conhecimento dos odontopediatras sobre o bruxismo em crianças em vigília e durante o sono é deficiente, sugerindo-se a educação continuada sobre o tema, a fim de evitar diagnósticos equivocados e condutas inadequadas (AU)

Objective: To evaluate the knowledge of pediatric dentists concerning bruxism in children and explore the subject according to the latest scientific evidence. Material and Methods: Four hundred and twenty-five pediatric dentists filled out an online form comprising 17 statements regarding awake and sleep bruxism in children. Data was analyzed in two distinct ways: participant's knowledge and statements knowledge. Participant ́s knowledge was considered acceptable when at least 10 out of 17 statements were correctly answered. Statements knowledge was considered satisfactory when correctly answered by, at least, 70% of the participants. Results: The average of correct answers was 9.73 (±3.41). Fifty-two percent of the participants showed acceptable knowledge and only 4 statements obtained a percentage of answers considered satisfactory. Conclusion: The knowledge of pediatric dentists regarding awake and sleep bruxism in children is deficient, and continuous education concerning this topic is suggested to avoid misdiagnosis and inadequate management (AU)

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PURPOSE: To evaluate the vertical misfit, stress distribution around dental implants, and cantilever fracture strength of 3-unit implant-supported cantilever fixed partial dentures (FPDs) using frameworks made from different materials and manufacturing techniques. MATERIALS AND METHODS: Forty FPDs were fabricated and divided into 5 groups (n = 8) based on the framework material used: LAS Co-Cr (Conventional casting-laser welding); TIG Co-Cr (Conventional casting -TIG welding); OP Co-Cr (Conventional casting-one-piece); CAD Co-Cr (CAD-CAM); and CAD Zr (CAD-CAM ZrO2 ). The vertical misfit was evaluated before porcelain application (T1) and before (T2), and after thermomechanical cycling (T3) by stereomicroscopy. Cantilever fracture strength was tested with a 50 kN (5000 kgf) load cell at a crosshead speed of 0.5 mm/min. Qualitative and quantitative photoelastic analysis was performed to evaluate stress distribution at seven specific points in five FPDs (n = 1/group) subjected to occlusal loading. RESULTS: Only the molar showed interaction among the three factors (G × S × T; F(20.932) = 1.630; p = 0.044). Thermomechanical cycling (T2 vs. T3) had a significant effect on intra-group vertical misfit in molar, especially in LAS Co-Cr (Δ = 5.87; p = 0.018) and OP Co-Cr (Δ = 5.39; p = 0.007), with no significant effect in premolar (p > 0.05). Ceramic application combined with thermomechanical cycling (T1 vs. T3) caused a significant intra-group increase in vertical misfit in all groups, both in the molar and premolar (p < 0.05). OP Co-Cr was associated with greater vertical misfit and stress concentration. Frameworks manufactured by the CAD-CAM system exhibited lower vertical misfit and better stress distribution. FPDs with metal frameworks (>410.83 ± 72.26 N) showed significantly higher fracture strength (p < 0.05) than zirconia (277.47 ± 39.10 N), and the first signs of ceramic veneering fracture were observed around 900 N. CONCLUSIONS: FPDs with frameworks manufactured using a CAD-CAM system appear to be associated with lower vertical misfit and better stress distribution, although the section of the frameworks followed by welding may be a viable alternative. In addition, metal frameworks exhibit high fracture strength.

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OBJECTIVE: This study aimed to evaluate and compare pain intensity and Oral Health-related Quality of Life (OHRQoL) in women with temporomandibular disorder (TMD) before (T1) and during (T2) COVID-19 pandemic. MATERIALS AND METHODS: Sample was composed of forty-one female participants with painful TMD, who presented for TMD treatment. Subjects were asked to indicate their pain intensity and to answer the Oral Health Impact Profile-14 (OHIP-14). Participants data were collected twice: T1 (evaluation of medical records fulfilled before COVID-19 pandemic) and T2 (by means of an online form). Socio-demographic data were assessed in T1. Statistical analysis was performed with a significance level of 5% (Wilcoxon, chi-square or Fisher's exact tests, multiple linear regressions). RESULTS: No difference was found in pain intensity (p=0.26) and OHIP-14 global scores (p=0.53). Physical pain (p=0.03) and social disability (p=0.05) domains improved. In T1, subject's occupation was associated with OHIP-14 global score, physical pain, and physical disability domains. In T2, age was associated with OHIP-14 global scores as well as physical pain, psychological discomfort, and psychological disability domains. CONCLUSION: COVID-19 pandemic did not worsen pain intensity and OHRQoL in women with painful TMD, and it is suggested that socio-demographic characteristics influenced TMD patients coping skills during pandemic.

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ABSTRACT Objective: This study aimed to evaluate and compare pain intensity and Oral Health-related Quality of Life (OHRQoL) in women with temporomandibular disorder (TMD) before (T1) and during (T2) COVID-19 pandemic. Materials and Methods: Sample was composed of forty-one female participants with painful TMD, who presented for TMD treatment. Subjects were asked to indicate their pain intensity and to answer the Oral Health Impact Profile-14 (OHIP-14). Participants data were collected twice: T1 (evaluation of medical records fulfilled before COVID-19 pandemic) and T2 (by means of an online form). Socio-demographic data were assessed in T1. Statistical analysis was performed with a significance level of 5% (Wilcoxon, chi-square or Fisher's exact tests, multiple linear regressions). Results: No difference was found in pain intensity (p=0.26) and OHIP-14 global scores (p=0.53). Physical pain (p=0.03) and social disability (p=0.05) domains improved. In T1, subject's occupation was associated with OHIP-14 global score, physical pain, and physical disability domains. In T2, age was associated with OHIP-14 global scores as well as physical pain, psychological discomfort, and psychological disability domains. Conclusion: COVID-19 pandemic did not worsen pain intensity and OHRQoL in women with painful TMD, and it is suggested that socio-demographic characteristics influenced TMD patients coping skills during pandemic.

RESUMO Objetivo: O presente estudo objetivou avaliar e comparar a intensidade da dor e a Qualidade de Vida Relacionada à Saúde Bucal (QVRSB) de mulheres com disfunção temporomandibular (DTM), antes (T1) e durante (T2) a pandemia de COVID-19. Métodos: A amostra foi composta por quarenta e uma mulheres com DTM dolorosa, que se apresentaram para manejo da DTM. As participantes informaram a intensidade da dor por meio de escala numérica, e responderam ao questionário Perfil de Impacto na Saúde Oral - 14 (Oral Health Impact Profile, OHIP-14). Os dados das participantes foram coletados duas vezes: T1 (avaliação de prontuários odontológicos preenchidos previamente à pandemia de COVID-19) e T2 (por meio de formulário on-line). Dados sociodemográficos foram coletados em T1. A análise estatística foi realizada com nível de significância de 5% (testes de Wilcoxon, qui-quadrado ou exato de Fisher, e regressões lineares múltiplas). Resultados: Nenhuma diferença foi encontrada para a intensidade da dor (p = 0,26) e o escore global do OHIP-14 (p = 0,53). Os domínios relativos à dor física (p = 0,03) e incapacidade social (p = 0,05) melhoraram. Em T1, a ocupação das participantes foi associada ao escore global do OHIP-14 e aos domínios de dor e incapacidade física. Em T2, a idade foi associada aos escores globais do OHIP-14, bem como aos domínios dor física, desconforto psicológico e incapacidade psicológica. Conclusão: A pandemia de COVID-19 não piorou a sensibilidade à dor e a QVRSB das mulheres com DTM dolorosa, e as características sociodemográficas influenciaram suas habilidades de enfrentamento.

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OBJECTIVE: The aim of this study was to assess the correlation of inflammatory and pain genes polymorphisms with the presence of temporomandibular disorder (TMD) patients and with pressure pain sensitivity. DESIGN: Data was collected from 268 consecutive subjects at Bauru School of Dentistry. Subjects aged younger than 20 years, with dental and neuropathic pain, sinusitis, cognitive and neurologic disorder were excluded. Included subjects were evaluated using the Research Diagnostic Criteria for Temporomandibular disorders and divided into two groups: TMD cases and healthy controls. Groups were submitted to pressure pain threshold (PPT) test for the temporomandibular joint, anterior temporalis and masseter muscles and genotyped for Val158Met, IL6-174, IL-1ß-3954 and TNFA-308. Student's t-test and Pearson chi-square test were used to comparisons between groups. A linear multiple regression was used to evaluate the influence of genetics variables on the PPT and a bivariate analysis was used to assesses the influence of genetics variables on pain sensitivity below the PPT cut off of the structures in TMD group. RESULTS: TMD group showed significantly lower PPT values for all structures when compared with control group (p < 0.001). SNP IL6-174 predicted higher pain sensitivity in the temporomandibular joint (p < 0.005) and in anterior temporalis muscle (p < 0.044) and SNP Val158Met in the masseter muscle (p < 0.038); when TMD group was divided according to PPT cut-off values the SNP Val158Met influenced increase pain sensibility in the masseter muscle. CONCLUSION: TNFA-308 was associated with TMD and SNP IL6-174 and SNP Val158Met influenced pain sensitivity of patients with TMD.

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AIM: The present study aimed to report a case of orofacial pain secondary to acoustic neuroma (AN). METHODS AND RESULTS: A 66-year-old female presented with unilateral facial pain and odontalgia. The pain was described as throbbing, dull, and constant. Tinnitus, hearing loss, dizziness, and others symptoms were also present. Due to the characteristics of the pain and clinical or radiographic findings, other possible diagnoses, such as temporomadibular disorder, tooth-related pain, sinusitis, and primary headaches, were excluded. Somatosensory tests for allodynia and hyperalgesia showed extraoral and intraoral hypersensitivity. Magnetic resonance imaging revealed a lesion located on the right cerebellopontine angle extending into and obliterating the internal auditory canal and compressing the middle cerebral peduncle, the pons, and the cisternal segment of cranial nerve V. The patient was diagnosed with a brainstem tumor compatible with AN and trigeminal neuralgia secondary to cranial nerve V compression. CONCLUSION: Although uncommon, intracranial tumors should be considered during orofacial pain evaluation to avoid iatrogenic treatment and delayed diagnosis.

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Oral rehabilitations in esthetic regions may be challenging when different prosthodontic modalities must be combined with interventions on gingival tissues to create a harmonious smile for the patient. This case report describes the treatment of a 36-year-old man with an esthetically compromised maxillary anterior region by means of periodontal microsurgery, an implant-supported dental prosthesis, and tooth-supported crowns. Combined esthetic-functional planning based on clinical and radiographic examinations, photographs, and a diagnostic wax-up led to correction of the gingival contour and thickness by means of periodontal microsurgery; customization of an implant-supported zirconia abutment with the application of feldspathic porcelain; fabrication of a lithium disilicate ceramic infrastructure to mask darkened substrate; and fabrication of lithium disilicate ceramic definitive restorations. Five years after cementation of the restorations, the results remained stable. Careful treatment planning allowed the achievement of a satisfactory, predictable, and long-lasting esthetic result.

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ABSTRACT BACKGROUND AND OBJECTIVES: Several studies have shown the importance of biopsychosocial strategies, including pharmacological and non-pharmacological therapies, to decrease pain in orofacial pain patients. The involvement of pain modulation during aerobic exercise contributes to the use of such modality as part of rehabilitation programs for chronic pain patients. Studies have shown that aerobic exercise may increase the level of several neurotransmitters, such as serotonin, dopamine, acetylcholine and norepinephrine. The reality is that it activates endocannabinoid and endogenous opioid systems, involved in pain modulation. The effect of physical activity on pain perception is often called exercise-induced hypoalgesia. This study aimed at discussing the use of exercise-induced hypoalgesia as part of chronic pain management, including orofacial pain. CONTENTS: Comprehensive search on Pubmed, Medline, Web of Science and Scopus databases was carried out using the keywords: physical exercise, aerobic exercise, exercise-induced hypoalgesia, exercise-induced analgesia and orofacial pain/chronic orofacial pain. CONCLUSION: Exercise does not need to be of high-intensity to have an effect on pain management. Although there is evidence that some chronic pain patients may have the capacity to exercise at intensities and durations that appear to be required to elicit exercise-induced hypoalgesia in healthy subjects, the exercise tolerance of other unhealthy populations requires study. Additional research is needed to clarify and expand the understanding of the mechanisms responsible for exercise-induced hypoalgesia and how it can be used in chronic pain conditions such as chronic orofacial pain.

RESUMO JUSTIFICATIVA E OBJETIVOS: Vários estudos têm demonstrado a importância de utilização de estratégias biopsicossociais, incluindo terapias farmacológicas e não farmacológicas, para reduzir a dor em pacientes com dor orofacial. O envolvimento da modulação da dor durante o exercício aeróbico contribui para o uso dessa modalidade como parte de programas de reabilitação para pacientes com dor crônica. Estudos demonstram que o exercício aeróbico pode aumentar o nível de vários neurotransmissores tais como serotonina, dopamina, acetilcolina e norepinefrina. A realidade é que ele ativa os sistemas endocanabinóide e opioide endógeno, envolvidos no sistema de modulação de dor. O efeito da atividade física na percepção da dor é comumente denominado hipoalgesia induzida por exercício. O objetivo deste estudo foi discutir o uso do fenômeno da hipoalgesia induzida por exercício como parte do tratamento da dor crônica, incluindo a dor orofacial. CONTEÚDO: Pesquisas abrangentes na base de dados Pubmed, Medline, Web of Science e Scopus foram realizadas utilizando as palavras-chave: exercício físico, exercício aeróbico, hipoalgesia induzida por exercício, analgesia induzida por exercício e dor orofacial/dor orofacial crônica. CONCLUSÃO: O exercício não precisa ser de alta intensidade para se obter efeito sobre o controle da dor. Embora alguns estudos comprovem que alguns pacientes com dor crônica tem a capacidade de se exercitarem em intensidades e durações de exercício que induzem a hipoalgesia induzida por exercício, a tolerância ao exercício e seus efeitos em populações de pacientes crônicos ainda exigem mais estudos e investigações para esclarecer e ampliar a compreensão do mecanismo da hipoalgesia induzida por exercício.

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Atualmente, a utilização de implantes dentários tem sido considerada o padrão-ouro para reabilitação de arcos parcial ou totalmente edêntulos. Devido aos recursos avançados de exame por imagem, principalmente da tomografia computadorizada de feixe cônico, esses procedimentos apresentam altas taxas de sucesso; no entanto, algumas complicações trans- e pós-cirúrgicas ainda são passíveis de ocorrer, sendo uma delas a neuropatia pós-implante. A neuropatia pós-implante se trata de uma neuropatia traumática orofacial secundária a traumas diretos ou indiretos aos nervos da face, sendo os nervos alveolar inferior e lingual os mais acometidos. Essa condição pode apresentar diferentes formas clínicas, sendo elas a anestesia, parestesia, hipoestesia, hiperestesia e/ou disestesia. Por se tratar de uma complicação pouco frequente, porém de alto impacto social para o paciente e de difícil diagnóstico e tratamento, o presente artigo tem como objetivo, por meio de uma revisão de literatura dos estudos mais relevantes na área, esclarecer o que é a neuropatia pós-implante, como ela pode ser desencadeada, bem como as melhores formas de diagnóstico e tratamento.

Nowadays, the use of dental implants in partial or total edentulous arch is considered the gold standard in oral rehabilitation. This procedure has high success rates mainly due to the advanced features of radiograph exams like the cone beam computerized tomography (CBCT). However, some intra- and post-operative complication may occur. One of the possible complications is post implant neuropathy (PIN). PIN is a traumatic trigeminal neuropathy that can be due to direct or indirect nerve trauma. The most affected nerves are inferior alveolar nerve and lingual nerve. This condition can be clinically reported as anesthesia, paresthesia, hypoesthesia, hyperesthesia and/or dysesthesia. PIN is not a frequent condition but has a major impact on everyday social life and it is a very difficult pathology to diagnose and to treat. Based on that, the aim of this article is to review the most relevant studies in the field and to clarify what is PIN and what are the possible causes of it. As well as identify the best diagnostic and treatment approach.

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AIMS: To assess the influence of myofascial temporomandibular disorder (TMD) pain on the pressure pain threshold (PPT) of masticatory muscles in women during a migraine attack. METHODS: The sample comprised 34 women, 18 to 60 years of age, with a diagnosis of episodic migraine previously confirmed by a neurologist. All subjects were evaluated using the Research Diagnostic Criteria for TMD (RDC/TMD) to determine the presence of myofascial pain. They were divided into two groups: group 1 (n = 18) included women with migraine; group 2 (n = 16) included women with migraine and myofascial TMD pain. Participants were evaluated by measuring PPT values of the masseter and anterior temporalis muscles and Achilles tendon with a pressure algometer at two moments: pain free and during a migraine attack. A three-way analysis of variance with a 5% significance level was used for statistical purposes. RESULTS: Significantly lower PPT values were found during the migraine attack, especially for women with concomitant myofascial pain, regardless of the side of the reported pain. CONCLUSION: Migraine attack is associated with a significant reduction in PPT values of masticatory muscles, which appears to be influenced by the presence of myofascial TMD pain.

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Many conditions may cause painful symptoms in orofacial structures. Among the chronic conditions that affect this area, temporomandibular disorders are the most common. Temporomandibular Disorder is a collective term that includes a number of clinical complaints involving the masticatory muscles, the Temporomandibular Joint and associated structures. In some cases, these complaints can be associated with depression, catastrophizing behavior and impact on quality of life. The present study aims to explain the relationship between Temporomandibular Disorders and pain chronification and their relation to a variety of psychosocial and behavioral comorbid conditions. The mechanisms of pain conduction and suggestions for management are also addressed.

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Many conditions may cause painful symptoms in orofacial structures. Among the chronic conditions that affect this area, temporomandibular disorders are the most common. Temporomandibular Disorder is a collective term that includes a number of clinical complaints involving the masticatory muscles, the Temporomandibular Joint and associated structures. In some cases, these complaints can be associated with depression, catastrophizing behavior and impact on quality of life. The present study aims to explain the relationship between Temporomandibular Disorders and pain chronification and their relation to a variety of psychosocial and behavioral comorbid conditions. The mechanisms of pain conduction and suggestions for management are also addressed.

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