Micronized palmitoylethanolamide reduces joint pain and glial cell activation.

OBJECTIVE AND DESIGN: Temporomandibular disorder (TMD) is a common painful condition in the temporomandibular joint (TMJ). Joint inflammation is believed to be a chief cause of pain in patients with TMD, through the release of pro-inflammatory cytokines that induce peripheral sensitization of nerve terminals followed by microglial stimulation. MATERIALS AND SUBJECT: TMJ was induced in rats with the injection of complete Freund's adjuvant (CFA) emulsion into the left TMJ capsule. TREATMENT: The present study would assess the effects of micronized palmitoylethanolamide (m-PEA) on glial activation and trigeminal hypersensitivity. METHODS: Ten mg/kg m-PEA or corresponding vehicle was administered 1 h after CFA and mechanical allodynia and edema were evaluated at 24 and 72 h after CFA injection. RESULTS: CFA-injected animals showed TMJ edema and ipsilateral mechanical allodynia accompanied by a robust growth in GFAP protein-positive satellite glial cells and activation of resident macrophages in the TG. Moreover, m-PEA administration significantly reduced the degree of TMJ damage and pain, macrophage activation in TG and up-regulation of Iba1. CONCLUSIONS: The results confirm that m-PEA could represent a novel approach for monitoring pain during trigeminal nerve sensitization.

The Effects of Mandibular Advancement Device on Pressure Pain Threshold of Masticatory Muscles: A Prospective Controlled Cohort Study.

AIMS: To determine if pressure pain thresholds (PPTs) of masticatory and neck muscles change after the application of a mandibular advancement device (MAD) in patients with obstructive sleep apnea (OSA). METHODS: A prospective study was conducted in a sample of 27 OSA patients (24 males and 3 females; mean age ± standard deviation [SD]: 54.8 ± 11.8, mean apnea-hypopnea index ± SD: 23.5 ± 13.3) and 27 age- and sex-matched healthy controls. Exclusion criteria were signs and symptoms of temporomandibular disorders (TMD), metabolic diseases, and use of antidepressants, analgesics, or anti-inflammatory drugs. A calibrated examiner evaluated PPTs of seven head and neck muscles bilaterally by using a Fischer algometer. In the OSA group, PPTs were recorded immediately before the MAD application (T0), after 15 days (T1), and after 6 months (T2) of therapy; in the control group, PPTs were recorded at the same time intervals. PPT differences at baseline and over time within each group and between OSA and control groups were analyzed by Friedman and Mann-Whitney tests. RESULTS: There were no PPT differences between groups at baseline. In the OSA group, PPTs of temporalis and masseter muscles decreased significantly at T1 compared with T0 (P < .05), but no differences were found at T2. No significant PPT differences were found in the neck muscles or over time in the control group. CONCLUSION: MAD application induces a decrease of PPTs of masticatory muscles at the beginning of the therapy, but a physiologic adaptation occurs by 6 months.

Effects of experimental insoles on body posture, mandibular kinematics and masticatory muscles activity. A pilot study in healthy volunteers.

BACKGROUND: It has been hypothesized that different plantar sensory inputs could influence the whole body posture and dental occlusion but there is a lack of evidence on this possible association. OBJECTIVES: To investigate the effects of experimental insoles redistributing plantar pressure on body posture, mandibular kinematics and electromyographic (EMG) activity of masticatory muscles on healthy subjects. METHODS: A pilot study was conducted on 19 healthy volunteers that wore custom-made insoles normalizing the plantar pressure distribution for 2 weeks. Body posture parameters were measured by means of an optoelectronic stereophotogrammetric analysis; mandibular kinematics was analyzed by means of gothic arch tracings; superficial EMG activity of head and neck muscles was performed. Measurements were carried out 10 days before the insertion of the insoles, immediately before the insertion, the day after, 7 and 14 days after, in four different exteroceptive conditions. RESULTS: The outcomes of the present study show that insoles do not modify significantly over time the parameters of body posture, SEMG activity of head and neck muscles and mandibular kinematics. CONCLUSIONS: In this pilot study the experimental insoles did not significantly influence the body posture, the mandibular kinematics and the activity of masticatory muscles during a 14-day follow up period.

Pressure pain threshold of the cervico-facial muscles in healthy elderly people: the role of gender, age and dominance.

OBJECTIVE: The aim of this study was to assess the impact of age on pressure pain threshold (PPT) of cervico-facial muscles in healthy geriatric subjects and to investigate the role of gender and dominance on nociception. BACKGROUND: Musculo-skeletal pain is common in the elderly, but being subjective, it risks to be underdiagnosed and undertreated. A useful method for assessment of local pain is determining PPT through pressure algometry. Ageing process seems to increase PPTs, but reference values for the assessment of pain in geriatric subjects are lacking. METHODS: In this study, PPTs in temporal muscle, masseter, sternocleidomastoid, occipital and splenius capitis of 97 healthy elderly subjects were measured using Fischer algometer. Participants were divided by age in four classes (years 65-69; 70-74; 75-79; ≥80). RESULTS: Women had lower PPTs in all muscles compared with men. Comparing PPTs obtained from the right and the left side, no significant differences were recorded neither in men nor in women. When dividing subjects by age class and education, in both genders no significant differences were observed in PPTs among the groups, neither in the right nor in the left sides. CONCLUSION: In conclusion, the present study reports reference PPT values for the cervico-facial muscles that can be applied to a population of healthy elderly subjects. After 65 years of age, further ageing does not influence PPTs in cervico-facial muscles whereas female gender has lower PPTs.

The effect of diode superpulsed low-level laser therapy on experimental orthodontic pain caused by elastomeric separators: a randomized controlled clinical trial.

The aim of this study was to evaluate the efficacy of diode superpulsed low-level laser therapy (SLLLT) in reducing experimentally induced orthodontic pain. Overall, 120 subjects (23.01 ± 1.39 years) were enrolled for a clinical trial. Subjects were randomly assigned to upper (U, N = 60) or lower (L, N = 60) jaw groups. All subjects received 4 elastomeric separators mesial and distal to the upper (U group) or lower (L group) right first molar and bicuspids. Each subject of the U and L groups was randomly assigned to laser (Ul, N = 20 and Ll, N = 20), placebo (Up, N = 20 and Lp, N = 20) or control (Uc, N = 20 and Lc, N = 20) sub-groups. Subjects in laser groups received a single GaAs diode SLLLT application (910 nm, 160 mW, beam diameter of 8 mm, applied for 340 s) immediately after placing orthodontic separators. Placebo groups received a simulated SLLLT and controls did not receive any therapy. All participants compiled a survey on pain duration and a 100-mm visual analogue scale immediately after the separators placement and after 12, 24, 36, 48, 72, and 96 h. Pain intensity of laser groups was significantly lower compared to placebo and control groups (p = 0.0001). In the laser group, 70% of subjects felt pain, while in the placebo and control groups all subjects felt pain (p = 0.0001). The end of pain occurred earlier in laser compared to placebo and control groups (p = 0.021). A single-diode SLLLT application appeared to be effective in reducing the intensity and duration of experimentally induced orthodontic pain and could be used in daily orthodontic practice.

Preeruptive changes in maxillary canine and first premolar inclinations: a retrospective study on panoramic radiographs.

INTRODUCTION: Because of the close anatomic proximity of the maxillary permanent canine and first premolar, we investigated the relationship between their preeruptive positional changes in this retrospective study. METHODS: Sixty-three pairs of panoramic radiographs obtained 12 to 24 months apart from nonorthodontic subjects between 8 and 10 years old were collected. Canine and premolar inclinations to the midline and mesiodistal sector locations were measured, and their changes over time were estimated. The relationship between changes in canine (Δα) and premolar inclinations (Δπ) was explored alone and after adjustment for intraosseous distance between the teeth (Sc-p) and months between radiographs (ΔM). RESULTS: Except for right canine sector, both canine and premolar inclinations and sectors showed significant differences between time points. Pearson partial correlation analysis showed a strong, positive correlation between Δα and Δπ after adjusting for Sc-p and ΔM (right: r = 0.766, P <0.05; left: r = 0.785; P <0.05). CONCLUSIONS: Canine and premolar inclinations and mesiodistal locations varied significantly between 8 and 10 years of age. The strong positive correlation between the preeruptive positional changes of the maxillary canine and the first premolar suggested that with a greater uprighting movement of the long axis of the premolar over time, there was greater uprighting of the long axis of the canine.

Combined effects of repeated oral hygiene motivation and type of toothbrush on orthodontic patients: a blind randomized clinical trial.

OBJECTIVE: To investigate the effects on plaque index (PI) scores of manual or electric toothbrush with or without repeated oral hygiene instructions (OHI) and motivation on patients wearing fixed orthodontic appliances. MATERIALS AND METHODS: One month after the orthodontic fixed appliance bonding on both arches, 60 patients were randomly assigned to four groups; groups E1 (n  =  15) and E2 (n  =  15) received a powered rotating-oscillating toothbrush, and groups M1 (n  =  15) and M2 (n  =  15) received a manual toothbrush. Groups E1 and M1 received OHI and motivation at baseline (T0) and after 4, 8, 12, 16, and 20 weeks (T4, T8, T12, T16, and T20, respectively) by a Registered Dental Hygienist; groups E2 and M2 received OHI and motivation only at baseline. At each time point a blinded examiner scored plaque of all teeth using the modified Quigley-Hein PI. RESULTS: In all groups the PI score decreased significantly over time, and there were differences among groups at T8, T12, T16, and T20. At T8, PI scores of group E1 were lower than those of group E2, and at T12, T16, and T20, PI scores of groups M1 and E1 were lower compared to those of groups M2 and E2. A linear mixed model showed that the effect of repeated OHI and motivation during time was statistically significant, independently from the use of manual or electric toothbrush. CONCLUSIONS: The present results showed that repeated OHI and motivation are crucial in reducing PI score in orthodontic patients, independent of the type of toothbrush used.

The prevalence of temporomandibular disorders in patients with late whiplash syndrome who experience orofacial pain: a case-control series study.

BACKGROUND: The authors conducted a study to compare the frequency of specific temporomandibular disorder (TMD) diagnoses in patients who had late whiplash syndrome (LWS) with that in a control group. METHODS: The authors recruited 65 patients who had orofacial pain and a previous diagnosis of LWS and 65 age- and sex-matched control patients who had chronic orofacial pain without a history of whiplash injury (WI) for a case-control series study. All patients completed a questionnaire pertaining to the Research Diagnostic Criteria for Temporomandibular Disorders and underwent a clinical examination. RESULTS: The authors compared the frequency of TMD diagnoses in case patients with that in control patients by using a χ(2) test; they set the α level a priori at .05. The number of patients diagnosed with myofascial pain (MP) and disk displacement with reduction (DDWR) was significantly higher in the case group than in the control group (P = .002 and P = .001, respectively). CONCLUSIONS: The results of this study show a higher frequency of MP and DDWR in patients with LWS than in patients with chronic orofacial pain and no history of WI. Practical Implications. Clinicians should be knowledgeable about the correlation between WI and TMD so they can inform and treat patients accurately.

Palmitoylethanolamide versus a nonsteroidal anti-inflammatory drug in the treatment of temporomandibular joint inflammatory pain.

AIMS: To carry out a randomized clinical trial to compare the effect of palmitoylethanolamide (PEA) versus ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), for pain relief in temporomandibular joint (TMJ) osteoarthritis or arthralgia. PEA acts as an endogenous agent with an autacoid local inflammation antagonism and modulates mast cell behavior controlling both acute and chronic inflammation. METHODS: A triple-blind randomized clinical trial was conducted on 24 patients (16 women and 8 men) aged 24 to 54 years and suffering from TMJ osteoarthritis or arthralgia. The patients were enrolled from a group of 120 consecutive patients referred to the University of Bologna's Department of Orthodontics. Patients were randomly divided into two groups: group A (12 subjects) received PEA 300 mg in the morning and 600 mg in the evening for 7 days and then 300 mg twice a day for 7 more days. Group B (12 subjects) received ibuprofen 600 mg three times a day for 2 weeks. Every patient recorded the intensity of spontaneous pain on a visual analog scale twice a day. Maximum mouth opening was recorded by a blind operator during the first visit and again after the 14th day of drug treatment. A t test was used for data comparisons. RESULTS: Pain decrease after 2 weeks of treatment was significantly higher in group A than in group B (P = .0001); maximum mouth opening improved more in group A than in group B (P = .022). CONCLUSION: These data suggest that PEA is effective in treating TMJ inflammatory pain.

Aging effect on pressure pain thresholds of head and neck muscles.

BACKGROUND AND AIMS: Aging implies a physiological decline in skeletal muscle mass and strength, pain perception, transmission and processing, causing pain thresholds to increase (presbyalgesia). This study compares the pressure pain thresholds (PPTs) of 18 head and neck muscles in groups of young and elderly subjects. METHODS: A cross-sectional study was conducted on 40 subjects, selected from a group of 97, referred for dental consultation. The inclusion criterion was subjects' age (from 20 to 30, and over 65 years). Exclusion criteria were all conditions which may alter PPTs. In two groups, A (young subjects; 10 men, 10 women) and B (elderly subjects; 11 men, 9 women) PPTs were evaluated by one calibrated examiner with a Fischer algometer. Data are described with mean values ± standard error and the 95% confidence interval. The Mann-Whitney test was used to compare PPT values between the two groups (α=0.05). RESULTS: There was a significant difference between the PPTs of group A and B, which were higher in the elderly group in all muscles except five. CONCLUSIONS: These preliminary data demonstrate that PPTs increase with aging in the muscles examined. Other confirmatory studies with a larger sample size are necessary.

Preventive treatment of ectopically erupting maxillary permanent canines by extraction of deciduous canines and first molars: A randomized clinical trial.

INTRODUCTION: In this research project, we aimed to compare the effectiveness of single (1 deciduous canine) and double (deciduous canine and first molar) extractions in subjects with retained maxillary permanent canines positioned palatally or centrally in the alveolar crest, at risk for root resorption of adjacent permanent teeth. METHODS: Subjects at risk for canine impaction or resorptive situations were randomly assigned to 1 of 2 treatment modalities: single extraction (17 patients, 28 canines) or double extraction (20 patients, 37 canines). Thirty-one patients with 53 canines judged to be not at risk constituted the untreated control group. Panoramic radiographs were taken at the initial observation and after 18 months on average. Between-group statistical comparisons were carried out on the changes in canine inclination and sector location (measured on panoramic radiographs) and on the percentages of successful permanent canine eruptions. RESULTS: The double-extraction group showed significant improvements in the success rate and the intrabony position of the permanent canine, in terms of uprighting the canine's long axis with a crown movement in a distal direction. CONCLUSIONS: Concomitant deciduous canine and first molar extractions proved to be more effective as a preventive approach to promote eruption of retained maxillary permanent canines positioned palatally or centrally.

Association between the inclination of the lateral incisors and the position of the erupting canines on panoramic radiographs.

OBJECTIVE. To analyze correlations between the inclination of the permanent maxillary lateral incisors and the intraosseous position of the erupting permanent maxillary canines on panoramic radiographs. MATERIAL AND METHODS. The inclination of the lateral incisor to the midline, the mesiodistal position of the crown of the canine, and the inclination of the canine to the midline and to the long axis of the adjacent incisor were measured on panoramic radiographs of 1013 subjects aged 8-11 years. RESULTS. The distal inclination of the lateral incisor crown increased until 10 years, after which no significant changes occurred. The canine erupted with increasing mesial inclination of the crown until 9 years, after which it began to progressively right itself. As a result, inclination of the canine to the adjacent incisor increased between 8 and 9 years and decreased between 10 and 11 years. Until the children reached 9 years of age, the more mesial the crown of the unerupted canine, the greater the decrease in the distal inclination of the lateral incisor crown. CONCLUSIONS. The inclination of the crown of the lateral incisor varies during eruption of the canine, increasing distally until 10 years as a physiological stage in the mixed dentition. The inclination of the lateral incisor is also associated with the mesiodistal position of the canine crown. The mesial intraosseous location of the canine crown results in righting of the lateral incisor.

Double vs single primary teeth extraction approach as prevention of permanent maxillary canines ectopic eruption.

PURPOSE: To compare the effects of extraction of primary maxillary canines and first molars (double extraction approach) vs primary maxillary canines extraction (single extraction approach) in cases of ectopic permanent maxillary canines (PMCs). METHODS: Palatally or centrally displaced PMCs were randomly assigned as follows: single extraction (Group 1=29 patients, 52 canines); double extraction (Group 2=30 patients, 56 canines). PMCs inclination to the midline and to the long axis of the lateral incisor, mesiodistal position of the PMCs crown, and first premolars angulation to the midline were measured on panoramic radiographs at T0 and after 18 months (T1), on average. Between-group statistical comparison was carried out on T0-T1 changes for all the radiographic variables. Eruption/noneruption of the PMCs was also assessed. RESULTS: Group 2 exhibited improvements in PMCs intrabony position among all the examined variables (P<.001), obtaining a greater parallelism between the roots of the PMCs and the adjacent lateral incisors (P<.001). An improved position of the first premolars due to a reduced angulation (P<.001) was also observed. Clinical success rates showed no statistically significant difference. CONCLUSIONS: The double extraction approach proved to be a more effective procedure vs the single extraction approach in improving permanent maxillary canines' intraosseous position.

Effects of superpulsed low-level laser therapy on temporomandibular joint pain.

OBJECTIVES: A randomized double-blind study was conducted to compare the efficacy of superpulsed low-level laser therapy (SLLLT) with nonsteroidal anti-inflammatory drugs in the treatment of pain caused by temporomandibular joint disorders. METHODS: A total of 99 patients with temporomandibular joint disorders, secondary to disc displacement without reduction or osteoarthritis were randomly divided into 3 groups. Thirty-nine patients received SLLLT in 10 sessions over 2 weeks, 30 patients received ibuprofen 800 mg twice a day for 10 days, and 30 patients received sham laser as placebo in 10 sessions over 2 weeks. Pain intensity was measured by visual analog scale at baseline, 2, 5, 10, and 15 days of treatment. Mandibular function was evaluated by monitoring active and passive mouth openings and right and left lateral motions at baseline, 15 days, and 1 month of treatment. Magnetic resonance imaging was performed at baseline and the end of therapy. RESULTS: Mean visual analog scale pain scores in SLLLT group was significantly lower than in nonsteroidal anti-inflammatory drug group and control group (P=0.0001) from fifth day up to the end of the observation period. As for active and passive mouth openings and right and left lateral motions, superiority of SLLLT was evident 1 month after treatment (interaction time treatment, P=0.0001). DISCUSSION: Mandibular function improved in all SLLLT patients proving the effectiveness in the treatment of pain, as demonstrated by a significant improvement in clinical signs and symptoms of temporomandibular joint disc displacement without reduction and osteoarthritis at the end of treatment and stability over a period of 1 month.

Obstruction of the eruption pathway by peripheral odontogenic fibroma: report of a patient.

The diagnostic process and interdisciplinary treatment of a healthy 12-year-old boy with impactions due to a localized peripheral odontogenic fibroma are presented. The treatment consisted of the surgical excision of the peripheral odontogenic fibroma and interceptive orthodontic treatment with an activator appliance to allow the passive eruption of the impacted teeth. Complete orthodontic treatment with fixed appliances was used later to level and coordinate the arches. This report illustrates the importance of early diagnosis and treatment of tooth impactions associated with diffuse gingival enlargement. The cooperation of various specialists in making a differential diagnosis, developing a comprehensive plan for conservative treatment, and delivering excellent care led to a successful result for this patient.

Orthodontic treatment of TMJ disc displacement with pain: an 18 year follow-up.

OBJECTIVES: To assess the effects of mandibular repositioning-stabilization splints concluded by occlusal orthodontic therapy in patients affected with TMJ internal derangement (with and without disc reduction), all suffering from severe pain, with a follow-up of 18 years from treatment. SUBJECTS AND METHODS: A group of 68 patients, (58 women and 10 men, average age 22, range 14 to 55 years) was considered. The evaluated parameters were: a) mandibular dynamics, b) subjective symptoms (intensity of facial pain perceived through VAS), c) articular noises, d) condylar position via radiography. These were determined before treatment, immediately after completion and 5, 10 and 18 years after treatment. RESULTS: At the end of treatment there was a significant improvement of the manibular function (p < 0.001), a significant reduction of spontaneous pain (8 patients vs all patients, p < 0.001) and disappearance of joint noises in all cases. In the course of the 18-year period subsequent to the treatment only minor relapse of symptoms/signs was noted; spontaneous pain was present in 13 patients, with a pain intensity at TMJ level significantly lower than at baseline (p < 0.001). Clicking was present systematically in 3 patients and only occasionally in 19 patients (p < 0.001). A relapse of condylar dislocation was found only in 11 cases at the X-ray examination. CONCLUSIONS: It is suggested that a permanent occlusal orthodontic treatment be used in subjects suffering from disc displacement with pain, particularly if patients need that for malocclusion and if orthopaedic joint instability is present after a change in the mandibular positioning with a stabilization splint.

A photogrammetric technique for the analysis of palatal three-dimensional changes during rapid maxillary expansion.

The aim of this study was to assess, by a digital photogrammetric technique, the relative dimensional changes before and after rapid maxillary expansion (RME). The transverse diameters and volumetric variations of the palate were measured by photogrammetry on study casts taken at three different phases of therapy: at the beginning of treatment (T1), on removal of the rapid expander, after expansion and retention for three months (T2), and six months after appliance removal (T3). The sample consisted of 30 children, (age range 7-8 years), all with a crossbite; 15 were angle Class I, six Class II and nine Class III. They were treated with an acrylic splint expander with two turns per day until the maxillary molar palatal cusps were in contact with the mandibular molar buccal cusps. The RME device was used as a passive retainer for three months, after which it was removed. During the following six months, no retention was used and no orthodontic treatment was undertaken. The findings demonstrated a significant relapse (P < 0.001) in the dental transverse diameter in all patients six months after appliance removal, although the palatal volume remained stable.

A technique to remove epulis: case reports.

The purpose of this study was to describe an alternative surgical approach to removing epulis while preserving and improving the mucogingival complex. After scaling and root planing, six patients underwent surgical treatment to remove the growths. A subepithelial connective tissue graft was interposed between the bone and epulis using a pedicle flap. The lesion was always preserved. The epulis disappeared after several months, with minor variations in healing time among patients. At 60-month follow-up visits, all patients exhibited good gingival health, with no recurrence.