The role of nutraceuticals in the management of temporomandibular disorders.

OBJECTIVES: Temporomandibular disorders (TMDs) are usually treated with occlusal appliances and supportive treatments such as physical therapy and drugs. Supplements can be included among potential supportive therapies, with the aim of reducing the use of drugs. To evaluate the efficacy of nutraceuticals' short-term treatment in subjects with temporomandibular disorders. METHODS: The study started in January 2021 and ended in January 2022. Subjects with temporomandibular disorders and a verbal numeric scale >40 were recruited and randomly assigned to one of the following groups. If waiting to start a therapy, to the nutraceutical group or to the no treatment group, while if already undergoing splint therapy, to nutraceautical+splint group or to splint therapy group. Nutraceutical used was composed by Boswellia Serrata Casperome, Magnesium, Tryptophan and vitamins B2 and D with a posology of one tablet/day before sleep for 40 days. Presence of temporomandibular pain, headache, neck pain and sleep/emotional disorders were assessed at T0 and at T1, after 40 days. ANOVA was performed to compare treatments with nutraceuticals and their respective controls, as for the variables related to painful symptomatology. Chi- Squared was conducted to assess differences in sleep/emotional disorders between groups. The statistical significance was p<0.05. RESULTS: The groups using nutraceuticals showed statistically significant improvements over controls for most of the variables analyzed. CONCLUSIONS: The use of nutraceutical seems to be a valuable support for TMD therapy in the short term either alone or combined with occlusal splint therapy.

RA.DI.CA. Splint Therapy in the Management of Temporomandibular Joint Displacement without Reduction.

BACKGROUND: The purpose of this study is to report clinical and instrumental changes after RA.DI.CA splint therapy for temporomandibular joint disc displacement without reduction. METHODS: Subjects affected by disc dislocation without reduction were recruited between July 2020 and May 2022 based on inclusion and exclusion criteria and treated with RA.DI.CA. splints over a period of 6 months. Clinical data were collected at each phase of the study (T0, T1, T2). Magnetic resonance imaging and electrognathography data were recorded at the beginning (T0) and at the end (T2) of the study. ANOVA with post-hoc contrasts was performed to assess differences in outcome measures over time. The Wilcoxon test was used to evaluate changes in disc-condyle angle between before- and after-treatment MRI. A two-tailed value of p < 0.05 was regarded as significant. METHODS: Ten patients completed the study. There were statistically significant differences over time for arthralgia, headache, neck pain, and mouth opening. Disc recapture and an improved quality of mandibular movement were recorded in 70% of subjects. The clinical and instrumental improvements are probably due to the orthopedic action of RA.DI.CA splint treatment, which allows for a greater degree of joint mobilization. CONCLUSIONS: The purpose of this therapy is to recover the disc position if possible and achieve an adequate joint functional adaptation that avoids the progression of the structural damage and the recurrence of symptoms.

Friedman Tongue Position and the Anthropometric Parameters in Adult Patients with Obstructive Sleep Apnea: An Observational Study.

INTRODUCTION: Obstructive Sleep Apnea Syndrome (OSAS) is a relevant public health problem; dentists can play an important role in screening patients with sleep disorders by using validated tools and referring patients to a specialist, thereby promoting an interdisciplinary approach. The aim of the study is to identify if the OSAS severity, measured by the apnea-hypopnea index (AHI), and some anthropometric measurements are associated with the Friedman Tongue Position (FTP) within a population with dysmetabolic comorbidities. MATERIALS AND METHODS: A questionnaire containing information about clinical data including height, weight, Body Mass Index (BMI), neck circumference, waist circumference, hip circumference and FTP was administered. The AHI value was measured by means of an unattended home polysomnography device. Pearson correlation coefficients were calculated, and Kruskal-Wallis, Kolmogorov-Smirnov (both nonparametric) and independence tests were performed to probe the possible relationships. The significance was set at p ≤ 0.05. RESULTS: A total of 357 subjects were analyzed. The association between the FTP and AHI was not statistically significant. On the contrary, the AHI showed a positive correlation with BMI and neck circumference. A statistically significant association between the number of subjects with a larger neck and an increasing FTP class was found. BMI, neck, hip and waist circumference was associated with the FTP scale. CONCLUSIONS: although the FTP was not directly associated with OSAS severity, there was also evidence that an FTP increase is associated with an increase in the considered anthropometric parameters, and FTP can be a clinical tool used in the assessment of risk for OSAS risk factors.

Conservative Therapies for TMJ Closed Lock: A Randomized Controlled Trial.

Background. Acute anterior disc displacement without reduction (ADDWoR) is characterized by permanent TMJ disc displacement, pain and functional limitations. Occlusal appliances (OA) are among the therapies of choice. Methods. A single-blind randomized study was carried out to compare the therapeutic success of two different types of splints in patients with ADDWoR. A total of 30 subjects were eligible for the study out of the 330 screened. Group I (n = 15) received RA.DI.CA splint therapy and Group II (n = 15) received stabilization splint therapy. Temporomandibular pain, headache, neck pain and functional excursions were evaluated at baseline (T0), after 4 weeks (T1) and after 6 months (T2). Descriptive and inferential statistics were performed. Results. There was a significant increase in maximum jaw opening and a reduction in pain in both groups (p < 0.05), except for neck pain in Group II. Significant differences in between- and within-subject factors emerged in all of the parameters evaluated, especially between T1 and T2 scores, with a greater trend of improvement in Group I than Group II. Conclusion. RA.DI.CA splints were found to be more effective for the considered sample, especially in the treatment of comorbidities and functional movements, probably due to the greater orthopedic action and joint mobilization.

OSAS Severity and Occlusal Parameters: A Prospective Study among Adult Subjects with Comorbidities.

INTRODUCTION: OSAS is an emerging public health problem. Early diagnosis in adults with comorbidities is the gold standard to avoid complications caused by a late diagnosis. The aim of the study, part of the SLeeP@SA project, was to identify within a population with dysmetabolic comorbidities the association of occlusal clinical signs, defined by orthodontic parameters, and of the anthropometric phenotype, with the severity of OSAS. MATERIALS AND METHODS: A dedicated questionnaire containing questions regarding the presence of deep bite, augmented overjet, partial edentulism, and bruxism was completed by clinic staff. OSAS was evaluated using an unattended home PSG device, which recorded the AHI value. BMI and neck circumference were also measured. The Kolmogorov-Smirnov test was performed to evaluate the association of the AHI with occlusal clinical signs. The significance was set at p ≤ 0.05. The association of AHI with BMI and neck circumference was evaluated with the Pearson correlation coefficient. RESULTS: In total, 199 subjects were evaluated. No statistically significant association between occlusal parameters and AHI was found, while the AHI showed a positive correlation with BMI and neck circumference. The neck circumference seemed to be a better clinical predictor for OSAS severity than BMI, especially for females. CONCLUSIONS: These results highlight how the orthodontic clinical data alone are not sufficient to establish an association between occlusal anomalies and OSAS severity, but further investigation involving a specialist orthodontic diagnosis is necessary.

Comparison of the Effectiveness of Three Different Acupuncture Methods for TMD-Related Pain: A Randomized Clinical Study.

PURPOSE: This study aimed to compare the effectiveness of three acupuncture methods for temporomandibular disorders- (TMDs-) related pain. MATERIALS AND METHODS: Different locations of pain, according to DC/TMD clinical assessment, were considered: temporomandibular joint (TMJ), masticatory muscles, head, and neck. Sixty patients were assigned randomly to one of three treatment groups (20 patients in each): group BA received body acupuncture, group EA received electroacupuncture, and group CA received acupuncture + cupping. The groups were compared in terms of pain (verbal numeric scale), pain-related disability (Brief Inventory Pain, BPI), and impression of the treatment's effectiveness (Patients' Global Impression of Improvement Scale, PGI-I). These were recorded before sessions of acupuncture treatment (T0), after 8 sessions of acupuncture treatment (T1), and after 4 weeks of follow-up after treatment (T2). The between-group and within-group differences in the data were analyzed statistically. The baseline characteristics were similar in all groups (p > 0.05). RESULTS: Significant improvements were noted in all types of pain compared to baseline values in all groups (all p < 0.05). No significant differences were noted in the improvement of TMDs-related pain according to the different acupuncture techniques (all p > 0.05). All acupuncture methods used resulted to be significantly effective in improving the pain-related interference in the patient's common activities and quality of life. EA resulted to be significantly more effective than BA and CA in improving the interference of pain with patients' mood (p=0.015) and quality of sleep (p=0.014). CONCLUSION: BA, EA, and CA are all effective acupuncture methods in reducing pain and pain interference with common activities and quality of life in patients affected by TMD.

COVID-19 AND DENTAL DISTANCE-BASED EDUCATION: students' perceptions in an Italian University.

BACKGROUND: The aim of the study was to analyze the perception of dental faculties students regarding the complete transition to distance-based education (DE) and the adaptation of this educational strategy, due to Covid-19 pandemic. A questionnaire to be completed anonymously was submitted online to students attending the faculties of Dentistry and Oral Hygiene at Sapienza, University of Rome, after the end of distance lessons. The collected data were processed statistically, providing descriptive data and analysis of correlation of the most significant parameters, using Chi-squared test, Cramér V and Pearson φ2, Goodman and Kruskal's γ and λ and Kendall's τb. The level of statistical significance was p < 0.05. RESULTS: A total of 314 students participated in the survey. The overall level of satisfaction on a ten- point scale was 5.39 ± 2.59 for Oral Hygiene students and 6.15 ± 2.98 for Dentistry students. The most common complaints were the lack of a structured online curriculum, less interaction with professors and a lower level of attention. On the basis of the responses, scored using Likert-type Scale, oral Hygiene students reported statistically higher level of physical fatigue(p = 0.0189), a lower level of attention (p = 0.0136) and of the quality and quantity of acquired knowledge during distance education (p = 0.0392), compared to Dentistry students. Level of perceived stress and quality and quantity of acquired knowledge (γ = 0.81 and τb =0.56) and quality and quantity of acquired knowledge and fear of a decrease in knowledge (γ = 0.76 and τb =0.54) are associated variables. CONCLUSION: Students' feedback is essential to solve the key issues emerged from the questionnaire. New educational models should be define in order to ensure that distance education could be effective, meeting the learning needs of the students, and could not be a merely "online shift" of traditional methods, used as an alternative of live education.

"RA.DI.CA." Splint for the Management of the Mandibular Functional Limitation: A Retrospective Study on Patients with Anterior Disc Displacement without Reduction.

The study aimed at assessing the effectiveness of the RA.DI.CA. splint in the management of temporomandibular joint disc displacement without reduction (ADDwoR) and jaw functional limitation. The authors developed a retrospective clinical study. A total of 2739 medical records were screened. One hundred and forty-one patients with chronic unilateral disc displacement without reduction and jaw limitation, treated with a multifunctional RA.DI.CA. splint, were enrolled. Temporomandibular pain, headache, familiar pain, neck pain, and emotional strain, maximum spontaneous mouth opening, and lateral excursions were evaluated at baseline (T0), after therapy (T1), and during the follow-up (T2). Descriptive statistical analysis was performed. Wilcoxon test assessed changes in symptomatology and functional aspects before and after treatment and between T1 and T2, with p < 0.05. Ninety-nine patients (70%) declared themselves "healed" from jaw functional limitation with no residual painful symptoms, 31 (22%) improved their symptoms and jaw function, 11 (8%) reported no changes compared to T0 and no one worsened. As for all parameters analyzed, the comparison between the ones before and after treatment was statistically significant (p < 0.05). The RA.DI.CA. splint proved to be highly performing and promoting functional and symptomatologic recovery, also in the medium and long term, through the restoration of the functional disc-condyle relationship and the healing of joint tissues.

Local Vibratory Stimulation for Temporomandibular Disorder Myofascial Pain Treatment: A Randomised, Double-Blind, Placebo-Controlled Preliminary Study.

Several methods are currently used to manage pain related to temporomandibular disorder (TMD). Vibratory stimulation is applied as a pain treatment for several musculoskeletal disorders, but it has not yet been studied in-depth for TMD symptoms. The aim of this study is to analyse the effectiveness of at-home local vibration therapy (LVT) for the management of TMDs-related myofascial pain. Methods. Fifty-four TMD patients (43 F, 11 M) with an average age of 40.7 (age range: 29-54 yr.) were randomly subdivided into two groups. The study group (AG) received 1 week of at-home LVT treatment with the NOVAFON Pro Sk2/2 : 50/100 Hz, bilaterally applied to the pain area for 16 minutes daily. The placebo group (IG) followed the same protocol using inactive devices. Temporomandibular joint pain (TMJ), muscular pain (MM), and headache (HA) were assessed. Pain was evaluated using the visual analogue scale (VAS) before (T0) and after therapy (T1). Statistical analysis and Student's t-tests were applied (statistical significance for P < 0.05). Results. AG patients reported decreased average values for all types of pain considered between T0 and T1, with a statistically significant difference for TMJ pain (P < 0.05), MM pain, and HA (P < 0.001). IG patients reported a no statistically significant decrease in the average values of MM pain and an increase in the average values of TMJ pain and HA. Conclusion. The study supports the use of local vibration therapy in the control of TMD-related TMJ pain, local muscular pain, and headache.

Okada Purifying Therapy in combination with duloxetine vs. duloxetine alone in patients with TMD and fibromyalgia: a randomized clinical study.

OBJECTIVES: This randomized study was aimed at evaluating the additional analgesic effect of Okada Purifying Therapy (OPT) when administered in combination with duloxetine in patients with Temporomandibular Disorders (TMDs) and Fibromyalgia (FM). METHODS: Patients with TMDs visited at Department of Oral and Maxillofacial Sciences, Sapienza University of Rome who were diagnosed with FM were selected for the study. The final sample was composed of 31 patients: 15 patients were treated only with duloxetine (Group I) and 16 patients underwent also OPT treatment (Group II), for eight weeks. Craniomandibular index, total tenderness score, Brief Pain Inventory Modified Short Form, Fibromyalgia Impact Questionnaire, Beck Depression Inventory and State and Trait Anxiety Inventory-1 were assessed at the beginning (T0), during the course (T1) and after therapy (T2). Descriptive and inferential statistics were performed. RESULTS: In all the data analyzed, both groups showed an improvement in particular between T0 and T1. No statistically significant differences were observed between the two groups during the trial, except for the interaction between treatment and time as to the ability of walking at the BPI-I (F=7.57, p=0.002). No side effects due to the duloxetine were recorded in group II compared to group I. CONCLUSION: The additional complementary treatment (OPT) did not appear to give the patients with TMDs and FM any further benefit but it might improve pharmacological tolerability of the traditional medication.

Application of a Systematic Protocol in the Treatment of TMDs With Occlusal Appliances: Effectiveness and Efficiency in a Longitudinal Retrospective Study With Medium-Term Follow-Up.

OBJECTIVES: This study aimed to assess effectiveness, efficiency, and feasibility of a systematic protocol for the choice and management of occlusal splints (OA) in the treatment of temporomandibular disorders (TMDs). MATERIALS AND METHODS: A longitudinal retrospective study was conducted. Two different samples, G1 + G2 (337 patients), between January 2011 and January 2014, were selected according to inclusion and exclusion criteria. G1 was composed of patients visited at Policlinico Umberto I, Head-Neck Department, Sapienza University of Rome, Italy, and patients in G2 visited at a private structure in Rome. Pain records and functionality were compared before (T0) and at the end of therapy (T1). A follow-up group, composed of 100 patients randomly selected among those who completed treatment for at least 1 year (T2), was analyzed and symptomatology records were compared. Descriptive statistical analysis was performed. RESULTS: In the entire sample, joint and muscular pain, joint noises and mandibular functionality, headache, and neck pain improved from T0 to T2. The average time for articular and muscular recovery was 6.4 months. Comparing treatment outcomes, there were not statistically significant differences between the two groups. CONCLUSIONS: Treatment outcomes using this setting of protocol showed a positive trend also in the medium term. The use of a systematic protocol seems to reduce operator-dependent factors.

Relationship between Cervical Spine and Skeletal Class II in Subjects with and without Temporomandibular Disorders.

Aim: To assess changes in the craniocervical structure and in hyoid bone position in skeletal Class II subjects with and without temporomandibular disorders (TMD). Materials and Methods: The cephalometric analysis of 59 subjects with skeletal Class II was evaluated and compared. The measurements considered were ANB as a parameter of Class II and C0-C1 distance, C1-C2 distance, craniocervical angle, and hyoid bone position for the cervical spine analysis. Patients were divided into patients with TMD (group A) and patients without TMD (group B). TMD were evaluated with Diagnostic Criteria for TMD (DC/TMD). Descriptive statistics and Pearson's and Spearman's correlation analysis, with p value <0,005, were performed. Results: C0-C1 and C1-C2 distance values and hyoid bone position resulted within the normal range in the majority of patients examined. Craniocervical angle was altered in 33 patients. The reduction of this angle with the increase of the ANB value resulted to be statistically significant in group A, according to Pearson's correlation index. No other data were statistically significant. Conclusions: The significant relationship between skeletal Class II and cervical spine cannot be highlighted. The alteration of craniocervical angle seems to be mildly present, with backward counterclockwise rotation of the head upon the neck in the sample (groups A and B). The presence of TMD as a key factor of changes in neck posture could explain the different result between the two groups about the relationship between ANB and craniocervical angle. This result should be further analyzed in order to better understand if cervical spine changes could be related to mandibular postural ones in the craniocervical space or to temporomandibular joint retropositioning, more recognizable in Class II with TMD, which could determine functional changes in other structures of this unit; neck posture could be the result of a compensatory/antalgic mechanism in response to TMD.

Evaluation of Temporomandibular Disorders and Comorbidities in Patients with Ehler--Danlos: Clinical and Digital Findings.

OBJECTIVE: The objective of this study is to recognize representative cranio-cervico-mandibular features of patients with Ehler-Danlos syndrome and associated temporomandibular disorders (TMDs), to assess a targeted and integrated treatment plan. MATERIALS AND METHODS: After a diagnosis of disease, 38 individiuals with Ehler-Danlos syndrome and temporomandibular symptomatology referred were evaluated. Gnathological evaluation, according to the Diagnostic Criteria for TMDs, and radiographic imaging was performed. In addition, digital evaluation of occlusal and muscular balance, using surface electromyography of jaw muscles, was conducted. Statistical software for data analysis - STATA (StataCorp, College station, Texas, USA) - was used. RESULTS: Most common temporomandibular dysfunctions were arthralgia, myalgia, disc displacement with reduction and subluxation. Headache and neck pain were the most frequent comorbidities. Somatization, depression, anxiety, and obsessive-compulsive behavior were the most recurrent psychological disorders. Electromyographic analysis showed out of normal range data. CONCLUSION: Early diagnosis and interception are requested to avoid injuries and repeated traumatism. Multidisciplinary treatments are available to approach all the aspects of the syndrome.

A Method to Measure the Reduction of CO2 Emissions in E-Health Applications.

Climate change is perhaps the topmost challenge of our time. To prevent climate change from severely impacting almost every facet of life on the planet, scientific consensus points to a need to reduce the emissions of greenhouse gases (GHG), measured in terms of CO2 equivalents (CO2e), by as much as 80 percent by 2050. So far the focus has centered on incremental reductions of CO2 e emissions in areas in which they are highest, without negatively impacting the economy. But there is also a large untapped opportunity to drive economic growth by applying transformative solutions. In this paper, a method to evaluate CO2e reduction in the e-health applications is presented.

A multi-agent approach to the design of an e-health system.

E-medicine covers the whole range of medical process and service. Multi-agent approach is suitable for the development of e-medicine systems. In this paper, firstly the requirements of e-medicine are analyzed and taxonomy is proposed for e-medicine systems. Secondly multi-agent approach is introduced for developing e-medicine systems, and the design of agents and the design of multi-agent structure are presented for e-medicine systems. Finally a case study is presented on a telemedicine for diabetes to illustrate the development of e-medicine systems. Then, our future work is to implement the proposed system.

ECG and XML: an instance of a possible XML schema for the ECG telemonitoring.

Management of many types of chronic diseases relies heavily on patients' self-monitoring of their disease conditions. In recent years, Internet-based home telemonitoring systems allowing transmission of patient data to a central database and offering immediate access to the data by the care providers have become available. The adoption of Extensible Mark-up Language (XML) as a W3C standard has generated considerable interest in the potential value of this language in health informatics. However, the telemonitoring systems often work with only one or a few types of medical devices. This is because different medical devices produce different types of data, and the existing telemonitoring systems are generally built around a proprietary data schema. In this paper, we describe a generic data schema for a telemonitoring system that is applicable to different types of medical devices and different diseases, and then we present an architecture for the exchange of clinical information as data, signals of telemonitoring and clinical reports in the XML standard, up-to-date information in each electronic patient record and integration in real time with the information collected during the telemonitoring activities in the XML schema, between all the structures involved in the healthcare process of the patient.

Generic data modelling and use of XML standard for home telemonitoring of chronically ill patients.

In recent years, internet-based home telemonitoring systems that allow transmission of patient data to a central database and offer immediate access to the data by the care providers have become available. The adoption of Extensible Mark-up Language (XML) as a W3C standard has generated a lot of interest in the potential value of this language in health informatics. However the telemonitoring systems often work with only one or a few types of medical devices and thus are limited in the types of diseases they can monitor. This is because different medical devices produce different types of data and the existing telemonitoring systems are generally built around a proprietary data schema specific for the device used. In this paper, we describe a generic data schema for a telemonitoring system that is applicable to different types of medical devices and different diseases, and then we present an architecture for the exchange of clinical information as data, signals of telemonitoring and clinical reports in the XML standard, up-to-date information in each electronic patient record and integration in real time with the information collected during the telemonitoring activities in the XML schema, between all the structures involved in the health care process of the patient.

Health websites in Italy: use, classification and international policy.

In this paper, we discuss international policy in relation to the use of health websites and we describe the results obtained from application of a search engine to the recognition and classification of health websites in Italy. We then compare the results with health websites in other countries. Effective use of technology has led to medical advances that have not only extended life expectancy, but also fuelled an increasingly well-informed public to expect more and more from today's healthcare providers. As a consequence of the Web's rapid, chaotic growth, the resulting network of information lacks organization and structure and the quest for a method of quickly finding relevant and reliable information is spawning the growth of Internet portal sites. The US and the European Union and now Italy, have established the importance of rules to check the quality of health sites both for the non-professional users (citizens), mainly for privacy and security (for example, of medical records); and for health operators (physicians and others), where the most important thing is to evaluate the quality of content. In June 2001, the search engine used here found 2627 Italian health sites, of which only 46 exhibited the HON Code, and they can be classified into: 1% personal medical sites, 17% health portals, 18%, metasites, 27% documental sites and 37% information sites for health operators and/or for citizens.