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SUMMARY OBJECTIVE: This study aimed to assess the prevalence of temporomandibular dysfunction in ankylosing spondylitis patients and healthy controls, examining the relationship between temporomandibular dysfunction and disease activity in ankylosing spondylitis patients, as well as associations with psychosocial factors. METHODS: The study included 113 ankylosing spondylitis patients and 110 healthy individuals aged 18-75. Temporomandibular dysfunction presence was evaluated using Diagnostic Criteria for Temporomandibular Disorders Axis I. Disease activity was assessed with the Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Metrology Index, and Bath Ankylosing Spondylitis Functional Index. RESULTS: Among healthy individuals, 60.9% did not receive a temporomandibular dysfunction diagnosis, while 39.1% received at least one diagnosis. In contrast, 69.9% of the 113 ankylosing spondylitis patients received at least one temporomandibular dysfunction diagnosis, and only 30.1% were not included in any diagnosis group (p<0.001). Joint (p=0.001) and pain disorders (p=0.008) were significantly more common in the ankylosing spondylitis group than in the healthy controls. Significant associations emerged between Bath Ankylosing Spondylitis Disease Activity Index (p<0.001) and Bath Ankylosing Spondylitis Functional Index (p=0.005) scores and pain disorders. CONCLUSION: Temporomandibular dysfunction is more prevalent in ankylosing spondylitis patients than in healthy individuals, linked to increased joint issues and pain associated with disease activity. ClinicalTrials.gov ID: NCT05839925.
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OBJECTIVE: This study aimed to evaluate the cost-effectiveness (CE) of minimally invasive interventions for pain associated with articular temporomandibular dysfunction from the Brazilian Public Health System (SUS) perspective. METHODS: This is a CE study with a 1-year time horizon. Effectiveness data were extracted from a network meta-analysis, and 2 treatments with moderate levels of evidence certainty were evaluated: arthrocentesis (ARTRO) plus intra-articular corticosteroid (CO) injection and ARTRO plus intra-articular injection of sodium hyaluronate (SH). For CE analysis, the costs of 2 types of SH (low and high molecular weight) and 4 COs (betamethasone [B], dexamethasone acetate [D], methylprednisolone sodium succinate [M], or triamcinolone hexacetonide [T]) were considered. Modeling was conducted using TreeAge Pro Healthcare software, with the construction of a decision tree representing a hypothetical cohort of adults with articular temporomandibular dysfunction. Deterministic and probabilistic sensitivity analyses were performed. In addition, an acceptability curve was developed. RESULTS: The total costs per joint for ARTRO plus low- and high-molecular-weight SH and ARTRO plus COs B, D, M, and T were, respectively, R$583.32, R$763.85, R$164.39, R$133.93, R$138.57, and R$159.86. ARTRO plus dexamethasone acetate was considered cost-effective, with lower cost and higher net monetary benefit than other technologies. In all sensitivity analysis scenarios, it remained cost-effective. It also showed greater acceptability. CONCLUSION: ARTRO plus dexamethasone acetate was considered the cost-effective technology, exhibiting higher net monetary benefit and higher acceptability from the SUS perspective.
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Análisis Costo-Beneficio , Humanos , Análisis Costo-Beneficio/métodos , Análisis Costo-Beneficio/estadística & datos numéricos , Brasil , Inyecciones Intraarticulares/economía , Artrocentesis/métodos , Artrocentesis/economía , Trastornos de la Articulación Temporomandibular/tratamiento farmacológico , Trastornos de la Articulación Temporomandibular/terapia , Trastornos de la Articulación Temporomandibular/economía , Ácido Hialurónico/economía , Ácido Hialurónico/administración & dosificación , Ácido Hialurónico/uso terapéutico , Ácido Hialurónico/análogos & derivados , Corticoesteroides/uso terapéutico , Corticoesteroides/economíaRESUMEN
INTRODUCTION: Pain associated with temporomandibular dysfunction (TMD) is often confused with odontogenic pain, which is a challenge in endodontic diagnosis. Validated screening questionnaires can aid in the identification and differentiation of the source of pain. Therefore, this study aimed to develop a virtual assistant based on artificial intelligence using natural language processing techniques to automate the initial screening of patients with tooth pain. METHODS: The PAINe chatbot was developed in Python (Python Software Foundation, Beaverton, OR) language using the PyCharm (JetBrains, Prague, Czech Republic) environment and the openai library to integrate the ChatGPT 4 API (OpenAI, San Francisco, CA) and the Streamlit library (Snowflake Inc, San Francisco, CA) for interface construction. The validated TMD Pain Screener questionnaire and 1 question regarding the current pain intensity were integrated into the chatbot to perform the differential diagnosis of TMD in patients with tooth pain. The accuracy of the responses was evaluated in 50 random scenarios to compare the chatbot with the validated questionnaire. The kappa coefficient was calculated to assess the agreement level between the chatbot responses and the validated questionnaire. RESULTS: The chatbot achieved an accuracy rate of 86% and a substantial level of agreement (κ = 0.70). Most responses were clear and provided adequate information about the diagnosis. CONCLUSIONS: The implementation of a virtual assistant using natural language processing based on large language models for initial differential diagnosis screening of patients with tooth pain demonstrated substantial agreement between validated questionnaires and the chatbot. This approach emerges as a practical and efficient option for screening these patients.
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AIM: Auriculotemporal neuralgia (AN) is a rare condition characterized by severe, stabbing, unilateral pain inadequately described in the literature. Often coexisting with other conditions sharing the same innervation, and this overlap complicates clinical interpretation, leading to diagnostic errors and inappropriate therapeutic choices. The absence of AN in headache and facial pain diagnostic criteria hampers access to crucial information for diagnostic reasoning.Thus, we aimed to report a case of AN overlapped with another orofacial pain condition. METHOD AND RESULT: We present a case of overlap between chronic orofacial myofascial pain (MP) and AN, where conservative MP treatment did not provide the patient with complete pain relief. After diagnosing AN, a single anesthetic block induced complete pain remission over a 2-year follow-up. CONCLUSION: These findings support reintroducing AN into diagnostic criteria, aiding clinicians in diagnostic reasoning, and preventing unnecessary interventions.
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This study aimed to assess the effects of High-intensity laser therapy (HILT) on individuals suffering from temporomandibular joint disorders (TMDs). A search was conducted across six electronic databases for randomized controlled trials (RCTs) focusing on HILT for TMDs: PubMed, Scopus, Web of Science, ScienceDirect, EBSCOhost, Cochrane Library, the PEDro database and Google Scholar (last updated on July 18, 2024). Eligible studies were chosen by independent reviewers, and their quality was assessed with the Cochrane risk of bias tool (RoB). The main outcome was pain intensity (VAS), with secondary outcomes including mouth opening (mm), disability (JFLS-20), and quality of life (OHIP-14). A meta-analysis was conducted to assess the pooled effect by calculating mean differences (MD) for these variables (95% confidence level). The heterogeneity of the meta-analyses was explored using the I2 statistic. Three studies met the selection criteria and were included in the meta-analysis. The main RoB was the blinding of participant and treaters. Statistically significant differences (p < 0.05) in favor of HILT were observed for VAS and maximum mouth opening. The pooled effect showed an MD of -14.8 mm (95% CI:-27.1,-2.5) for pain intensity and 3.7 mm (95% CI:0.9,6.5) for mouth opening, changes that were assessed as clinically important. According to GRADE, the evidence was rated as important, and the certainty was moderate due to the heterogeneity between studies. A sensitivity analysis was not performed to address heterogeneity, primarily due to the limited availability of RCTs. HILT has been found effective in short-term pain relief and improvement of jaw opening in TMDs, potentially enhancing quality of life by facilitating activities such as chewing, jaw mobility, and communication. However, further research is needed to confirm its long-term effectiveness. Combining HILT with interventions such as occlusal splints or therapeutic exercises could potentially enhance its effects, leveraging the existing evidence supporting these treatments. It is important to note that the high RoB associated with the lack of blinding of participants and treaters may influence data collection, compromising the internal validity of findings in some studies.
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Trastornos de la Articulación Temporomandibular , Humanos , Trastornos de la Articulación Temporomandibular/radioterapia , Trastornos de la Articulación Temporomandibular/terapia , Resultado del Tratamiento , Calidad de Vida , Terapia por Láser/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Dimensión del DolorRESUMEN
Background: We evaluated the comparative effectiveness of all intra-articular injection corticosteroids for treating internal temporomandibular joint (TMJ) disorders. Methods: We searched MEDLINE, CENTRAL, EMBASE, SCOPUS, and LILACS through December 2023. We included randomized clinical trials (RCTs) enrolling patients with symptomatic internal disorders of the TMJ comparing any type of intra-articular corticosteroid therapy against another or to another minimally invasive therapy. The outcomes of interest were pain, range of mandibular motion (RoM), quality of life (QoL) and adverse effects at 1, 3, 6, and 12 months. We assessed the risk of bias using the Cochrane Collaboration's tool. We conducted a frequentist network meta-analysis and assessed the certainty of the evidence (CoE) using GRADE. Results: We included 20 RCTs enrolling 810 participants, which assessed five corticosteroids alone or combined with arthrocentesis or hyaluronic acid. Based on moderate CoE, betamethasone is among the most effective corticosteroids for reducing pain at one (mean difference compared to arthrocentesis [MD], -3.80; 95% confidence interval [CI], -4.55 to -3.05) and three months (MD, -2.74; 95%CI, -3.42 to -2.06), and arthrocentesis plus dexamethasone at six months (MD, -0.80; 95%CI, -1.57 to -0.03). There was no convincing evidence that any intervention was better than arthrocentesis for improving the RoM and QoL at any follow-up time. Methylprednisolone may be more harmful than arthrocentesis for adverse effects. Discussion: Betamethasone and arthrocentesis plus dexamethasone are the most effective in managing pain in the short and medium term compared to arthrocentesis (moderate CoE). Decisions about their use should consider other factors, such as costs, feasibility, and acceptability. Future research should consider QoL as an outcome and assess participants at longer follow-up periods.
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OBJECTIVES: Verify whether hypervigilance to pain (HP) and sleep quality (SQ) are confounding variables in the infrared thermography (IT) examination of the temporomandibular joint and temporal and masseter muscles. METHODS: A cross-sectional and analytical study was conducted, collecting HP and SQ data from 80 participants without temporomandibular disorders (TMD), performing their IT and another 40 participants with TMD. For the selection of participants with and without TMD, the TMD Pain Screener questionnaire and axis I of the Diagnostic Criteria for Temporomandibular Disorders were applied. SQ was verified using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. For the HP assessment the Pain Vigilance and Awareness Questionnaire (PVAQ) was applied. And the IT was performed through a FLIR infrared sensor camera, model T650 Infrared. RESULTS: No significant correlations were found between SQ and the temperatures of the areas of interest (P > .05), and regarding HP, a statistically significant positive correlation was found with the dimensionless (ρ = 0.289) and non-dimensionless (ρ = 0.223) asymmetries of temporal muscle temperatures. In the temperature comparisons between the participants without TMD and the participants with TMD, significant differences were found (P < .05), also when the group without TMD was controlled according to both HP and SQ (P < .05), with higher temperatures found in the TMD group. CONCLUSIONS: HP and SQ can be considered confounding variables in IT examination of the temporomandibular region.
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Músculo Masetero , Trastornos de la Articulación Temporomandibular , Termografía , Humanos , Termografía/métodos , Femenino , Masculino , Estudios Transversales , Músculo Masetero/fisiopatología , Músculo Masetero/diagnóstico por imagen , Adulto , Trastornos de la Articulación Temporomandibular/fisiopatología , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Dolor Facial/fisiopatología , Rayos Infrarrojos , Encuestas y Cuestionarios , Dimensión del Dolor , Músculo Temporal/fisiopatología , Músculo Temporal/diagnóstico por imagen , Articulación Temporomandibular/fisiopatología , Articulación Temporomandibular/diagnóstico por imagen , Persona de Mediana Edad , Ansiedad/fisiopatología , Sueño/fisiologíaRESUMEN
OBJECTIVE: To identify the available evidence on the ultrasonographic characteristics of masticatory muscles in subjects with myogenous TMD, as well as the potential use of ultrasonography as a diagnostic and treatment assessment outcomes tool. METHOD: An electronic search of the PubMed, Web of Science and Scopus databases was performed using the following terms: 'ultrasonography', 'ultrasound', 'masseter', 'temporal', 'masticatory muscles', 'temporomandibular disorders', 'temporomandibular joint disorders'. Full-text articles were obtained from the records after applying the inclusion/exclusion criteria. RESULTS: Thirteen articles were included for analysis: one comparative cross-sectional study, five case-control studies, six clinical trials and one randomised clinical trial. Main ultrasonographic characteristic assessed were local cross-sectional dimension and intramuscular ultrasonographic appearance. Retrieved studies reported the use ultrasonography for diagnosis or treatment assessment purposes showing heterogeneous results. For diagnosis purposes, the results of local cross-sectional dimension are not consistent; therefore, its diagnostic value for myogenous TMD diagnosis is weak. However, more homogeneous results were observed for intramuscular ultrasonographic appearance showing a higher prevalence of type-II pattern in myogenous TMD subjects than non-TMD subjects. On the other hand, for treatment assessment purposes, muscles were observed thinner after treatment compared to pre-treatment. Also, results of intramuscular ultrasonographic appearance show disappearance or reduction of anechoic areas, higher prevalence of type-II pattern and significant distinction of echogenic bands were observed after treating TMD subjects. CONCLUSION: Ultrasonography cannot be considered as a diagnostic instrument, but maybe as a complementary tool for treatment assessment of myogenous TMD subjects, even though future research is required to confirm its utility.
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Músculos Masticadores , Trastornos de la Articulación Temporomandibular , Ultrasonografía , Humanos , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/fisiopatología , Ultrasonografía/métodos , Músculos Masticadores/diagnóstico por imagen , Músculos Masticadores/fisiopatologíaRESUMEN
OBJECTIVES: This study aimed to verify the accuracy of clinical protocols for the diagnosis of disc displacement (DD) compared with MRI, considering examiners' calibration. METHODS: PubMed, Cochrane (Central), Scopus, Web of Science, LILACS, Embase, Science Direct, Google Scholar, and DANS EASY Archive databases were searched. Two reviewers independently screened and selected the studies. A meta-analysis was conducted using the R Statistical software. Results are shown using sensitivity and specificity, and 95% confidence intervals. RESULTS: Of the 20 studies included in the systematic review, only three were classified as low risk of bias. Seventeen studies were included in the meta-analysis. Compared to MRI, clinical protocols showed overall sensitivity and specificity of 0.75 (0.63-0.83) and 0.73 (0.59-0.84) for DD diagnosis, respectively. For DD with reduction, sensitivity was 0.64 (0.48-0.77) and specificity was 0.72 (0.48-0.87). For DD without reduction, sensitivity was 0.58 (0.39-0.74) and specificity 0.93 (0.83-0.97). Only 8 studies reported examiner calibration when performing clinical and/or MRI evaluation; nevertheless, calibration showed a tendency to improve the diagnosis of DD. CONCLUSION: The sensitivity and specificity of clinical protocols in the diagnosis of DD are slightly below the recommended values, as well as the studies lack calibration of clinical and MRI examiners. Examiner calibration seems to improve the diagnosis of DD.
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Luxaciones Articulares , Imagen por Resonancia Magnética , Disco de la Articulación Temporomandibular , Trastornos de la Articulación Temporomandibular , Humanos , Calibración , Luxaciones Articulares/diagnóstico por imagen , Luxaciones Articulares/patología , Imagen por Resonancia Magnética/métodos , Imagen por Resonancia Magnética/normas , Sensibilidad y Especificidad , Disco de la Articulación Temporomandibular/diagnóstico por imagen , Disco de la Articulación Temporomandibular/patología , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/patologíaRESUMEN
BACKGROUND: The use of communication technologies has allowed a substantial improvement in telediagnosis. OBJECTIVES: To evaluate the feasibility and diagnostic agreement of synchronous teleconsultation compared to physical standard examination for temporomandibular disorders (TMD) and orofacial pain. METHODS: Sixty-one patients (50 women, 11 men) with a mean age of 46.07 years referred to the Orofacial Pain Ambulatory Service (SAMDOF -UFPR) were evaluated remotely. They were then examined in person by another evaluator, blinded for the first evaluation. Data on the experience and level of satisfaction with the teleconsultation were also collected. RESULTS: For each type and subtype of TMD, diagnostic agreement values, sensitivity, specificity, positive predictive values and negative predictive values were calculated with a 95% confidence interval. 'Almost perfect' agreement was found for Myalgia (k = 0.915), Arthralgia (k = 0.863), disc displacement without reduction without limited opening (k = 0.955) and no TMD (k = 1.00). 'Substantial' agreement for the subtypes headache attributed to TMD (k = 0.761), disc displacement without reduction with limited opening (k = 0.659) and subluxation (k = 7.82). The diagnoses of local myalgia (k = 0.573), myofascial pain with referral (k = 0.524) and disc displacement with reduction (k = 0.563) obtained 'moderate' agreement. Degenerative joint disease (k = 0.170) and disc displacement with reduction with intermittent locking (k = 0.000) obtained 'weak' and 'no agreement', respectively. More than 90% of the participants were satisfied and reported no discomfort during the assessment, agreeing to participate in another teleconsultation. CONCLUSION: Synchronous teleconsultation proved to be feasible and presented adequate diagnostic agreement for the main painful TMDs, especially for the diagnosis of myalgia and arthralgia. This format was also well accepted among patients.
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Dolor Facial , Estudios de Factibilidad , Trastornos de la Articulación Temporomandibular , Humanos , Trastornos de la Articulación Temporomandibular/diagnóstico , Femenino , Masculino , Persona de Mediana Edad , Dolor Facial/diagnóstico , Adulto , Consulta Remota , Sensibilidad y Especificidad , Examen Físico/métodos , Anciano , Reproducibilidad de los ResultadosRESUMEN
This cross-sectional study aimed to compare, by using Cone-Beam Computed Tomography (CBCT), temporomandibular joint (TMJ) morphology among patients with degenerative joint disease (DJD) with or without arthralgia, as well as a control group. METHODS: Thirty-one patients and their respective CBCT TMJ exams were assessed. These individuals were selected from an Orofacial Pain Service and classified into three groups based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD): group 1 (10 patients with TMJ DJD and arthralgia), group 2 (11 patients with TMJ DJD without pain), and group 3 (the control group, consisting of 10 healthy individuals without any signs or symptoms of TMD). A second examiner, who was calibrated and blinded for the patient's diagnosis, evaluated the CBCT images. RESULTS: Group 1 showed a statistically significant association with the variables of erosion (p = 0.003) and osteophyte (p = 0.04) on the condyle surface, as well as concentric condyle position with reduced joint space (p = 0.01). The Kappa concordance index between the clinical diagnosis of DC/TMD and CBCT images was k = 0.134 (p ≤ 0.001). CONCLUSION: The presence of erosion, osteophyte, and concentric condyle position with reduced joint space was statistically associated with DJD and ongoing TMJ joint pain.
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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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Dolor Crónico , Dolor Musculoesquelético , Trastornos de la Articulación Temporomandibular , Humanos , Trastornos de la Articulación Temporomandibular/terapia , Trastornos de la Articulación Temporomandibular/dietoterapia , Trastornos de la Articulación Temporomandibular/fisiopatología , Dolor Crónico/terapia , Dolor Crónico/dietoterapia , Dolor Musculoesquelético/dietoterapia , Dolor Musculoesquelético/terapia , Dolor Facial/terapia , Dolor Facial/dietoterapia , Dolor Facial/fisiopatología , Dolor Facial/etiología , Estado Nutricional , Dieta , Manejo del Dolor/métodosRESUMEN
OBJECTIVE: Evaluate the association between oral health-related quality of life (OHRQoL) and self-reported symptoms of TMD. METHODS: Representative samples of older adults (≥60 years) were included (n = 569). Both TMD symptoms and OHRQoL were assessed by Fonseca Anamnestic Index (FAI) and Oral Health Impact Profile-14 (OHIP-14), respectively. Prevalence (those answering "frequently" or "always" in at least one question), severity (total means scores), and extent (number of questions answered as "frequently" or "always") of OHRQoL were estimated. RESULTS: Overall, 33.4% and 9.5% had mild or moderate/severe TMD symptoms. Those with any symptom of TMD had a prevalence ratio (PR) 38% higher for the worst OHRQoL (95% confidence interval [95%CI]:1.04-1.82) compared to those without TMD symptoms. Worst OHRQoL were observed for those with mild (PR:1.35; 95%CI:1.01-1.81) and moderate/severe TMD (PR:1.53; 95%CI:1.04-2.26). Similar results were detected in the severity and extent of OHRQoL. CONCLUSION: Severity TMD was associated with worse ORHQoL.
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BACKGROUND AND OBJECTIVES: This global bibliometric review aimed to investigate trends in publications relating to tinnitus and TMD. METHODS: A search was performed in eight databases (June/2022), by independent researchers with relevant keywords about tinnitus and TMD, without restriction of date or language. Original research or case report/series evaluating prevalence, association and risk related to tinnitus and TMD were included. Independent examiners selected studies by title and abstract and performed data extraction. Data about publication and researchers, study population, objective, study design and diagnostic criteria for tinnitus and TMD were exported to VintagePoint® for bibliometric analyses. Data about the direct association between tinnitus and TMD were extracted. RESULTS: One hundred and seventeen articles from 25 countries were included, most observational (68.4%) and evaluating association (N = 60; 44.8%). Among the 60 studies of association, 22 (36.6%) presented results of a direct association between the presence/absence of tinnitus and the presence/absence of TMD. Brazil (19.5%) and the United States (12.7%) were the countries with the most publications, and Dentistry (48.6%) was the main publication area. A growth in publications in Dentistry was observed in the past 30 years and in the past 10 years in Medicine. Half of the studies included the elderly population (50.2%). The main diagnostic criterion for both tinnitus (37.8%) and TMD (28%) was general questionnaires and/or self-report. CONCLUSION: There is a growing trend in publications relating to tinnitus and TMD, especially in Dentistry, with a predominance of observational and association studies in the elderly population using questionnaires and/or self-report. More research with robust diagnostic methods and other study designs should be encouraged in the future.
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Bibliometría , Trastornos de la Articulación Temporomandibular , Acúfeno , Humanos , Acúfeno/epidemiología , Trastornos de la Articulación Temporomandibular/epidemiología , Trastornos de la Articulación Temporomandibular/complicaciones , Trastornos de la Articulación Temporomandibular/fisiopatología , Prevalencia , Salud GlobalRESUMEN
OBJECTIVES: This cross-sectional school-based study explored the influence of malocclusion on temporomandibular disorders (TMD) pain complaints, and whether this association would be mediated by sleep bruxism in a representative sample of 7- to 8-year-old children. METHODS: Path analysis estimated direct, indirect, and total effects of occlusal features on sleep bruxism and TMD pain in 7- to 8-year-old children. Occlusal features were assessed with Dental Aesthetic Index (DAI), orofacial pain complaints using the TMD pain screener, possible sleep bruxism based on self-reports, and probable sleep bruxism based on self-reports combined with clinical findings. Structural equation modeling analyzed data with confounding factors. RESULTS: From 580 participants, possible sleep bruxism was observed in 136 children (31.5%), probable sleep bruxism in 30 children (6.7%), and TMD pain complaints in 78 children (13.8%). Malocclusion had no direct effect on either possible sleep bruxism [standardized coefficient (SC) 0.000; p = 0.992], or TMD pain complaints (SC - 0.01; p = 0.740). When probable sleep bruxism was set as the mediator of interest, malocclusion did not directly affect probable sleep bruxism (SC 0.01; p = 0.766), nor TMD pain complaints (SC - 0.02; p = 0.515). A direct effect of probable sleep bruxism on TMD pain complaints was observed with an SC of 0.60 (p < 0.001). However, in neither case, malocclusion indirectly affected TMD pain complaints via bruxism. CONCLUSION: Malocclusion in 7- to 8-year-old children did not directly influence possible or probable sleep bruxism or TMD pain complaints. Instead, probable sleep bruxism was strongly associated with TMD pain complaints. CLINICAL SIGNIFICANCE: The impact of occlusal features on TMD pain complaints and bruxism has been a long-standing controversy in dentistry. However, the scientific literature linking this association may be inconsistent, mainly due to biased sample selection methods with inadequate consideration of confounders. Further research should try to identify additional risk factors for TMD pain in addition to probable sleep bruxism in children.
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Bruxismo , Maloclusión , Bruxismo del Sueño , Trastornos de la Articulación Temporomandibular , Niño , Humanos , Bruxismo del Sueño/complicaciones , Bruxismo/complicaciones , Estudios Transversales , Dolor Facial/complicaciones , Autoinforme , Trastornos de la Articulación Temporomandibular/complicaciones , Maloclusión/complicacionesRESUMEN
OBJECTIVE: The present study aimed to investigate the association between self-reported awake/sleep bruxism, and orofacial pain with post-traumatic stress disorder (PTSD). METHODS: A case-control study with a convenience sample was designed. Participants were recruited from a university-based Trauma Ambulatory. The diagnosis of PTSD was established through a clinical interview and the Structured Clinical Interview (SCID-I/P). Thirty-eight PTSD patients and 38 controls completed the Research Diagnostic Criteria for Temporomandibular Disorders Axis-II to categorize awake/sleep bruxism and orofacial pain. Following this, we performed a short clinical examination of the temporomandibular joint and extraoral muscles. RESULTS: Adjusted logistic regression analysis showed that awake bruxism was associated with PTSD (OR = 3.38, 95% CI = 1.01-11.27, p = 0.047). Sleep bruxism was not associated with any covariate included in the model. In a Poisson regression model, PTSD (IRR = 3.01, 95% CI = 1.38-6.55, p = 0.005) and the muscle pain/discomfort (IRR = 5.12, 95% CI = 2.80-9.36, p < 0.001) were significant predictors for current orofacial pain. CONCLUSIONS: PTSD was associated with self-reported awake bruxism and low-intensity orofacial pain. These conditions were frequent outcomes in patients previously exposed to traumatic events. CLINICAL RELEVANCE: We suggest including a two-question screening for bruxism in psychiatry/psychology interviews to improve under-identification and to prevent harmful consequences at the orofacial level.
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Bruxismo , Bruxismo del Sueño , Trastornos por Estrés Postraumático , Humanos , Bruxismo/complicaciones , Bruxismo/diagnóstico , Bruxismo del Sueño/complicaciones , Autoinforme , Trastornos por Estrés Postraumático/epidemiología , Estudios de Casos y Controles , Dolor Facial/etiología , Dolor Facial/diagnósticoRESUMEN
This study aimed to evaluate the effects of inhibitors of the fractalkine pathway in hyperalgesia in inflammatory and neuropathic orofacial pain in male rats and the morphological changes in microglia and satellite glial cells (SGCs). Rats were submitted to zymosan-induced arthritis of the temporomandibular joint or infraorbital nerve constriction, and treated intrathecally with a P2 X7 antagonist, a cathepsin S inhibitor or a p-38 mitogen-activated protein kinase (MAPK) inhibitor. Mechanical hyperalgesia was evaluated 4 and 6 h following arthritis induction or 7 and 14 days following nerve ligation. The expression of the receptor CX3 CR1 , phospho-p-38 MAPK, ionized calcium-binding adapter molecule-1 (Iba-1), and glutamine synthetase and the morphological changes in microglia and SGCs were evaluated by confocal microscopy. In both inflammatory and neuropathic models, untreated animals presented a higher expression of CX3 CR1 and developed hyperalgesia and up-regulation of phospho-p-38 MAPK, which was prevented by all drugs (p < .05). The number of microglial processes endpoints and the total branch length were lower in the untreated animals, but the overall immunolabeling of Iba-1 was altered only in neuropathic rats (p < .05). The mean area of SGCs per neuron was significantly altered only in the inflammatory model (p < .05). All morphological alterations were reverted by modulating the fractalkine pathway (p < .05). In conclusion, the blockage of the fractalkine pathway seemed to be a possible therapeutic strategy for inflammatory and neuropathic orofacial pain, reducing mechanical hyperalgesia by impairing the phosphorylation of p-38 MAPK and reverting morphological alterations in microglia and SGCs.
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Artritis , Neuralgia , Masculino , Animales , Ratas , Hiperalgesia/tratamiento farmacológico , Quimiocina CX3CL1 , Neuroglía , Neuralgia/tratamiento farmacológico , Proteínas Quinasas Activadas por Mitógenos , Inhibidores de Proteínas Quinasas , Dolor Facial/tratamiento farmacológico , Proteínas Quinasas p38 Activadas por MitógenosRESUMEN
PURPOSE: To perform a scoping review to identify the available evidence regarding osteochondritis dissecans (OCD) of the temporomandibular joint (TMJ). METHODS: An electronic search of the PubMed, Web of Science and Scopus databases was performed using the following terms: 'Temporomandibular Joint Disorders', 'Osteochondritis Dissecans', 'Joint Loose Bodies' and 'Temporomandibular Joint'. Full-text articles were obtained from the records after applying the inclusion/exclusion criteria. RESULTS: Ten articles were included in the analysis - six case reports, one case series, one retrospective study, one comparative study and one correlational study - with a total of 39 patients. The most frequently reported clinical presentation involved TMJ pain, locked jaw and articular noises (clicking and crepitus). The imaging methods used to identify OCD were radiographs, tomography, arthrography and magnetic resonance imaging. The reported imaging findings varied widely, but the most frequent were (single or multiple) calcified intra-articular loose bodies, signs of degenerative osseous changes, disc displacements, widening of the joint space and alterations in condylar morphology. Seven articles reported treatments (surgical or conservative), but the treatment outcome was not reported in all of the articles, which makes it difficult to make comparisons. CONCLUSION: OCD of the TMJ may present various non-specific clinical characteristics, and given the heterogeneous imaging findings, multiplanar images are required for an accurate diagnosis. Finally, the results do not allow recommending a standard treatment for OCD of the TMJ.
Asunto(s)
Cuerpos Libres Articulares , Osteocondritis Disecante , Trastornos de la Articulación Temporomandibular , Humanos , Osteocondritis Disecante/diagnóstico por imagen , Osteocondritis Disecante/terapia , Estudios Retrospectivos , Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/cirugía , Radiografía , Imagen por Resonancia Magnética/métodos , Cuerpos Libres Articulares/diagnóstico por imagen , Cuerpos Libres Articulares/patología , Cuerpos Libres Articulares/cirugíaRESUMEN
BACKGROUND: The diagnosis of chronic primary pain (CPP), according to the recently released International Classification of Disease (ICD-11) criteria, refers to conditions with complex aetiologies. CPP is characterized by specific clinical features such as generalized sensory hypersensitivity and widespread pain, and is associated with functional disability and emotional distress. OBJECTIVE: This study investigated clinical features of CPP in individuals with painful temporomandibular disorders (TMD) and comorbidities (fibromyalgia, migraine and/or tension-type headache). METHODS: This cross-sectional study was conducted with a sample of 129 individuals. Painful TMD, fibromyalgia and primary headaches were evaluated based on well-established international criteria. Generalized sensory hypersensitivity was assessed using psychophysical tests. Symptoms of anxiety and depression were assessed by the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9. The Central Sensitization Inventory was applied to assess central sensitization-related symptoms and the Pittsburg Sleep Quality Index to evaluate the quality of sleep. The presence of widespread pain was assessed using a body map. The sample was stratified into three groups: control (n = 25), TMD-painful TMD only (n = 35) and TMD + Cm-painful TMD and comorbidities (n = 69). Statistical analysis was performed using one-way ANOVA, chi-squared test and ANCOVA, considering gender as a covariate (α = .05). RESULTS: Compared to controls, individuals presenting painful TMD and comorbidities showed lower pressure pain thresholds in all evaluated areas (p ≤ .012) and a higher number of painful areas in the body (p = .001). They presented more symptoms of anxiety (p = .040) and depression (p = .018), and a higher score in the Central Sensitization Inventory (p ≤ .006) than the other groups. CONCLUSION: Individuals with painful TMD and comorbidities presented more clinical features of CPP compared to those affected by TMD only.
Asunto(s)
Dolor Crónico , Fibromialgia , Trastornos de la Articulación Temporomandibular , Humanos , Fibromialgia/complicaciones , Fibromialgia/epidemiología , Estudios Transversales , Dolor Crónico/epidemiología , Dolor Facial/epidemiología , Dolor Facial/etiología , Trastornos de la Articulación Temporomandibular/complicaciones , Trastornos de la Articulación Temporomandibular/epidemiología , Trastornos de la Articulación Temporomandibular/diagnósticoRESUMEN
Introduction: COVID-19 continues to drive research aimed at elucidating the disease's behavior and clinical aspects for improved diagnosis. Objective: To describe oral manifestations reported through a survey by dentate and denture-wearing Cuban individuals hospitalized due to confirmed COVID-19 infection. Methods: A cross-sectional descriptive study was conducted through a survey, involving Cuban individuals aged 18 years and above, confirmed COVID-19 positive by PCR. Exclusions encompassed smokers, alcoholics, regular medication users, those with poor oral hygiene, and individuals with pre-existing oral manifestations. A questionnaire was administered to over a thousand individuals, of which 264 met the criteria. Variables related to COVID-19 infection and oral hygiene were assessed. Data were processed using SPSS, adhering to ethical principles. Results: The study comprised 264 participants with an average age of 39.96 years. Xerostomia emerged as the most prevalent oral manifestation (40.2 por ciento), followed by mandibular pain, TMJ, or bone pain (18.9 por ciento), and non-dental mouth pain (12.5 por ciento). Xerostomia was more prevalent in the 35 to 39 age group, while mandibular pain predominated in the 50 to 54 age group. No statistically significant evidence was found for dentate individuals or denture wearers, but significance was observed for those requiring hospitalization, exhibiting painless tongue lesions, single ulcers, and painful tongue lesions. Conclusions: Xerostomia was the most prevalent oral manifestation, followed by mandibular pain, TMJ or bone pain, and non-dental mouth pain. A statistically significant association was noted between the need for hospitalization and certain oral manifestations. The use of dentures was not significantly related to the studied manifestations(AU)
Introducción: La COVID-19 continúa generando interés en investigaciones que buscan esclarecer el comportamiento de la enfermedad y sus aspectos clínicos para facilitar el diagnóstico. Objetivo: Describir las manifestaciones orales informadas por individuos cubanos dentados, con prótesis, que fueron hospitalizados al dar positivo por COVID-19. Métodos: Se llevó a cabo un estudio descriptivo transversal a través de una encuesta con una muestra de individuos cubanos mayores de 18 años, infectados por COVID-19 y confirmados mediante PCR. Se excluyeron fumadores, alcohólicos, usuarios regulares de medicamentos, personas con mala higiene bucal y aquellos con manifestaciones bucales previas a la infección. Se aplicó un cuestionario a más de mil individuos, de los cuales 264 cumplieron con los criterios. Se utilizaron variables relacionadas con la infección por COVID-19 y la higiene bucal. Los datos se procesaron con SPSS, respetando los principios éticos. Resultados: El estudio incluyó a 264 participantes con una edad promedio de 39,96 años. La xerostomía fue la manifestación bucal más prevalente (40,2 percent), seguida por el dolor mandibular, ATM o hueso (18,9 percent) y el dolor de boca no dental (12,5 percent). La xerostomía fue más frecuente en el grupo de 35 a 39 años, mientras que el dolor mandibular predominó en el grupo de 50 a 54 años. No se encontró evidencia estadística significativa para pacientes dentados o portadores de prótesis, pero sí para aquellos que necesitaron hospitalización, con lesiones en la lengua sin dolor, úlceras únicas y lesiones en la lengua con dolor. Conclusiones: La xerostomía fue la manifestación bucal más prevalente, seguida por el dolor mandibular, ATM o hueso, y el dolor de boca no dental. Se observó una asociación estadísticamente significativa entre la necesidad de hospitalización y ciertas manifestaciones bucales. No se encontró significativo el uso de prótesis en relación con las manifestaciones estudiadas(AU)