Construction of the chronic temporomandibular disorder patients: the association between neural and psychological pathways.

Chronic temporomandibular disorder (cTMD) as a term based on the diagnostic criteria for temporomandibular disorders (DC/TMD) classification refers, in this paper, to the condition listed that has a non-mechanical association without any obvious organic cause. Specifically, this is the condition that falls under the International Classification of Diseases 11th revision (ICD-11) classification of chronic primary and chronic secondary pains. This implies that there is increased responsiveness of nociceptive neurons in the central nervous system, a phenomenon known as central sensitisation. cTMD patients may have their beginning with genetic susceptibility to pain. Although no single gene is exclusively linked to cTMD, various genes associated with nervous and musculoskeletal systems are believed to play a role. Environmental triggers and epigenetic changes are also thought to contribute to cTMD development. The biopsychosocial model emphasises the need to comprehensively address biological, psychological and social factors in cTMD assessment and management. In this study, we leverage the cyclic causation framework within the biopsychosocial model to illuminate the intricate interplay between biological and psychosocial factors in the context of cTMD. The conceptualisation of cTMD involves the dynamic evolution of genetic predispositions, influenced by life events and other biological susceptibilities. These factors collectively contribute to the emergence of nociplastic changes, ultimately manifesting as the distinctive features observed in individuals afflicted with cTMD.

The deconstruction of chronic orofacial pain and a hiding inhibition pathway of orofacial pain: the trigeminal proprioceptive mesencephalic periaqueductal gray pathway.

Chronic orofacial pain has a significant negative impact that influences individuals' quality of life and our society. The prevalence is around 11.2% to 33.2% and remains high in females. Currently, there are two main diagnostic classification systems that are used internationally for chronic pain: the International Classification of Diseases, 11th Revision (ICD-11), which was published by the World Health Organization (WHO) in 2018, and the International Classification of Orofacial Pain, which was published by the International Association for the Study of Pain (IASP) in 2020. Deficits in ascending and descending pain modulation pathways may be involved in the chronic pain pathophysiology. A newly described "trigeminal proprioceptive mesencephalic periaqueductal gray pathway" is considered to be the mechanism of action of occlusal appliance in managing orofacial pain. The genetic basis of chronic orofacial pain is not yet fully understood, but a genetic susceptibility involving multiple genes among the peripheral nerves, brainstem and higher brain regions to regulate and suppress the transmission of pain signals, thereby modulating the perception of pain, is likely.

Teledentistry from research to practice: a tale of nineteen countries.

Aim: The COVID-19 pandemic has accelerated teledentistry research with great interest reflected in the increasing number of publications. In many countries, teledentistry programs were established although not much is known about the extent of incorporating teledentistry into practice and healthcare systems. This study aimed to report on policies and strategies related to teledentistry practice as well as barriers and facilitators for this implementation in 19 countries. Methods: Data were presented per country about information and communication technology (ICT) infrastructure, income level, policies for health information system (HIS), eHealth and telemedicine. Researchers were selected based on their previous publications in teledentistry and were invited to report on the situation in their respective countries including Bosnia and Herzegovina, Canada, Chile, China, Egypt, Finland, France, Hong Kong SAR, Iran, Italy, Libya, Mexico, New Zealand, Nigeria, Qatar, Saudi Arabia, South Africa, United Kingdom, Zimbabwe. Results: Ten (52.6%) countries were high income, 11 (57.9%) had eHealth policies, 7 (36.8%) had HIS policies and 5 (26.3%) had telehealth policies. Six (31.6%) countries had policies or strategies for teledentistry and no teledentistry programs were reported in two countries. Teledentistry programs were incorporated into the healthcare systems at national (n = 5), intermediate (provincial) (n = 4) and local (n = 8) levels. These programs were established in three countries, piloted in 5 countries and informal in 9 countries. Conclusion: Despite the growth in teledentistry research during the COVID-19 pandemic, the use of teledentistry in daily clinical practice is still limited in most countries. Few countries have instituted teledentistry programs at national level. Laws, funding schemes and training are needed to support the incorporation of teledentistry into healthcare systems to institutionalize the practice of teledentistry. Mapping teledentistry practices in other countries and extending services to under-covered populations increases the benefit of teledentistry.

Review of taste and taste disturbance in COVID-19 patients.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for the coronavirus disease 2019 (COVID-19) pandemic that has become a significant global public health concern. The virus gains entry to cells via angiotensin-converting enzyme-2 (ACE2) receptors, which have been found to be the functional receptor for SARS-CoV-2 infection. High expression of ACE2 is found in type II alveolar cells, macrophages, bronchial and tracheal epithelial cells and in the oral cavity, particularly on the tongue. Taste disturbance is one of the early symptoms of COVID-19, suggesting that taste cells in taste buds are vulnerable to SARS-CoV-2 infection. Taste is modulated by hormones that are regulated in the renin-angiotensin-aldosterone system. Hypothetical causes of taste disturbance by SARS-CoV-2 may be due to direct cell and/or neuronal injuries, inflammatory responses and dysregulation of ACE2.

Management of oral medicine emergencies during COVID-19: A study to develop practise guidelines.

Coronavirus disease (COVID-19) pandemic has become a significant global public health concern. Since the announcement of the Public Health Emergency of International Concern, many countries have implemented lockdown and restrictive quarantines; therefore, routine dentistry, as well as oral medicine practise, have been suspended in several countries. However, urgent oral cares and emergencies are still operated and delivered by on-call dental practitioners. The objective of this study was to investigate the management of oral medicine emergency during a viral pandemic such as COVID-19. During the lockdown period, digital technologies, such as video conferencing with Zoom, Google Meeting or WhatsApp, are useful and efficient tools that oral medicine practitioners could consider to use for patient triage, managing emergencies, reassure, and follow patients remotely. Oral medicine emergencies can be carefully evaluated and triaged via video conferencing and sometimes phone contact, to avoid life-threatening risks while realising the limitations by both patient and clinician.

Can the Measurement of Jaw-Opening Forces Assist in the Diagnosis of Temporomandibular Disorders?

AIMS: To investigate the effectiveness of a novel jaw-opening-force measuring device as a screening tool to aid in the diagnosis of temporomandibular disorders (TMD). METHODS: Symptomatic TMD patients (n = 58) and control TMD-free participants (n = 56) were screened by an oral medicine specialist according to the Diagnostic Criteria for TMD (DC/TMD). TMD patients were divided into three subcategories based on TMD symptoms (myofascial pain, disc displacement, and both combined). Jaw-opening forces were measured in both groups with an adjustable head device connected to a 1,000-N-load cell. Seven attempts were recorded at 10-second intervals by a data-capturing system. The geometric mean force values were obtained after discarding the first and last attempts. RESULTS: TMD-free participants had greater jaw-opening forces than TMD patients both without and with adjustments for age, sex, height, and weight (both P < .001). The geometric mean ± standard deviation values for TMD patients were 18.5 ± 1.62 N and 47.7 ± 1.53 N for TMD-free participants. Differences in jaw-opening forces among the three TMD subcategories were not statistically significant; however, patients with disc displacement (23.7 ± 1.46 N) had greater jaw forces than patients with myofascial pain (17.0 ± 1.74 N) and both myofascial pain and disc displacement (17.0 ± 1.56 N). CONCLUSION: This study demonstrated that differences in jaw-opening forces could be used as a diagnostic tool for TMD. Future studies should explore the potential of this device to measure improvement in jaw-opening forces following TMD treatment.

Malignant transformation in oral lichen planus and lichenoid lesions: a 14-year longitudinal retrospective cohort study of 829 patients in New Zealand.

OBJECTIVE: The aim of this study was to identify the rate of malignant transformation in a longitudinal cohort of patients with oral lichen planus and oral lichenoid lesion (OLP/OLL) and to assess the associations between clinicopathologic aspects and malignant transformation. STUDY DESIGN: Data were taken from the records of 829 patients histologically diagnosed with OLP/OLL in the years 2005 to 2018. RESULTS: Of the study patients, 548 (66.1%) were females and 281 (33.9%) were males. The average age at diagnosis was 57.3 years. The hyperplastic type was the most frequent (58.5%). Most patients had multiple sites of involvement, with the buccal mucosa being the most frequent site of biopsy. Oral epithelial dysplasia developed in 5 (0.6%) patients with a previous histologic diagnosis of OLP/OLL and developed oral squamous cell carcinoma (OSCC) in 23 patients (2.8%) during the follow-up period. The atrophic/ulcerative forms are 25.8 times more likely to progress to OSCC compared with the hyperplastic types (hazard ratio [HR] 25.8; P < .05). The HR increases by 5% with every year of age (HR 1.05; 95% confidence interval; P < .05). CONCLUSIONS: In our study, oral epithelial dysplasia developed in less than 1% of patients with OLP/OLL, and OSCC in 2.8%during the follow-up period. The atrophic/ulcerative forms are 25.8 times more likely to progress to OSCC compared with the hyperplastic types. The HR increases by 5% with every year of age.

Referrals by general dental practitioners and medical practitioners to oral medicine specialists in New Zealand: a study to develop protocol guidelines.

OBJECTIVE: The aim of this study was to examine the awareness level among general dental practitioners and medical practitioners with regard to common oral mucosal diseases and orofacial pain, investigate their orofacial screening and oral medicine referral practices, assess the information to be included in the referral, and evaluate the perceived need for supplementary resources and guidelines for referral. STUDY DESIGN: In total, 51 general dental practitioners and medical practitioners were recruited to investigate their orofacial screening and oral medicine referral practices. Three oral medicine specialists were interviewed to understand the referrals received from dentists and physicians. RESULTS: Of the participants, 87.5% dentists and 52.6% physicians considered orofacial screening as treatment priority. However, 71.9% dentists performed orofacial screening routinely, whereas none of the physicians did. Of the dentists, 50% referred relevant patients to oral medicine specialists every time they encountered such cases, and 31.6% of the physicians did so. Referrals should include the patient's background and medical history, full descriptions of the lesions, and results and photos from special tests. Of the participants, 65.6% of the dentists and 78.9% of the physicians believed that continuing professional development courses in oral medicine would be beneficial, and 93.8% of the dentists and 89.5% of the physicians agreed that standardized national referral guidelines would be useful. CONCLUSIONS: Standardized national referral guidelines, as well as continuing professional development courses in oral medicine, would be helpful to dental practitioners in the management of patients.

Clinical efficacy of a simplified approach to managing chronic temporomandibular disorders: evidence from a 1-year case series.

OBJECTIVE: Chronic temporomandibular disorder (cTMD) produces orofacial pain and limited jaw function and impacts on quality of life. A clinical case series of patients referred to a hospital specialist service is described here. STUDY DESIGN: In a 1-year consecutive case series of 162 patients with cTMDs, each patient had been managed with self-awareness and jaw exercises, as well as oral appliances. Pain severity and chewing function were scored by using a visual analogue scale (VAS), and quality of life was assessed by using the Oral Health Impact Profile-Temporomandibular Dysfunction (OHIP-TMD). RESULTS: Females comprised 87% (average age 49 years). Treatment time averaged 20.8 months, and the average pain duration was 2.8 years. The mean VAS pain score fell from 6.9 (standard deviation [SD] 1.6) to 2.0 (SD 1.9) after treatment, giving a "large" effect size of 3.1. Chewing difficulty improvement also showed a "large" effect size (2.5). For the 33 patients for whom longitudinal OHIP-TMD data were available, the mean pretreatment and posttreatment scores of 51.2 (SD 20.9) and 26.2 (SD 17.7) showed a "large" effect size of 1.2. CONCLUSIONS: A simple noninvasive protocol for managing cTMD with self-help, exercises, and oral devices resulted in clinically and statistically meaningful improvements in pain, function, and quality of life.

Dilemmas in managing oral dysplasia: a case report and literature review.

Oral epithelial dysplasia (OED) is a premalignant lesion which has an unpredictable course of progression. Its management has remained controversial due to a lack of high-quality prospective studies evaluating the different treatment modalities.1 We present a patient with a long history of OED which subsequently transformed into malignancy. The clinical features of OED and the controversies surrounding its management, as they present in the current literature, will also be reviewed and discussed.

Oral white lesions: pitfalls of diagnosis.

General practitioners are often the first point of contact for patients with oral white lesions, which represent a wide spectrum of diagnoses of varying seriousness. Some clinical features are classical and others overlap between different diagnoses; they should be correlated with patient history, and sometimes other investigations, for diagnosis. Leukoplakia is a clinical term, and is a diagnosis of exclusion with no histopathological connotation. It has been redefined to describe a predominantly white lesion with premalignant potential. Patients with lesions that are potentially malignant should be referred to an oral medicine specialist or oral maxillofacial surgeon for systematic management.

A case of recurrent pyogenic granuloma.

Dental practitioners are usually the first health professionals to examine and diagnose patients with oral pyogenic granuloma. Usually of traumatic origin, the lesion results from an overly aggressive immune response. Despite several accepted methods of treatment, recurrence is common. This paper reports on a case of recurrent pyogenic granuloma and reviews the relevant literature.