Temporomandibular Disorders Related Pain among Sleep & Awake Bruxers: A Comparison among Sexes and Age.

According to the current international consensus [...].

Controlling postoperative pain after third molar extraction with a dexamethasone and articaine injection: a double-blind randomized controlled trial.

OBJECTIVES: To evaluate the benefits of submucosal administration of a dexamethasone and articaine mixture on postoperative pain after mandibular third molar extraction. METHOD AND MATERIALS: This was a double-blind randomized controlled pilot trial of consecutive patients requiring surgical removal of mandibular third molars. Immediately post extraction, the surgeon administered a submucosal injection. The surgeon was masked to the content of the injection, which contained either a mixture of 10 mg dexamethasone and 68 mg articaine ("study group") or the same volume of saline only ("control group"). Pain severity was assessed by questionnaire (postoperative symptom severity [PoSSe] scale) 7 days after the procedure. RESULTS: Sixty subjects were enrolled. Patients in the study group had significantly lower PoSSe pain intensity scores than subjects in the control group (P = .004). The combined postoperative PoSSe pain score was significantly lower in the study group than in the control group (P = .016). There was no significant difference in pain duration between the two groups (P = .237). CONCLUSION: Submucosal injection of dexamethasone/articaine solution after surgical extraction of mandibular third molars is effective in reducing pain intensity.

The association between specific temporomandibular disorders and cervicogenic headache.

BACKGROUND AND AIMS: Upper neck signs, symptoms and hypomobility have been shown to present with a higher prevalence in patients with temporomandibular disorders (TMDs). However, there is currently no evidence of an association between specific TMDs and cervicogenic headache (CGH). Therefore, the aim of this study was to evaluate the odds ratio and the relative risk of CGH in patients with specific TMDs. METHOD: 116 participants, including 74 patients with TMD (pain-related/intraarticular/mixed TMD) and 42 healthy controls took part in this study. The TMD diagnosis was made by senior faculty members of the Dental School according to the Diagnostic Criteria for TMD, while the cervical diagnosis was made by a qualified senior physical therapist. The analysis comprised the evaluation of the odds ratio of CGH among patients with TMD and the relative risk (RR) for CGH during 14-24 months of follow-up. RESULTS: Significantly higher odds ratios of cervicogenic headache were found among pain-related and mixed TMD (12.17 and 10.76, respectively) versus healthy controls. During the 14-24 months of follow-up, there was no significant difference of relative risk for CGH among patients with TMD versus healthy controls. SUMMARY AND CONCLUSIONS: The results support a clear clinical association between painful TMD (pain-related and mixed TMD) and cervicogenic headache.

Medications and addictive substances potentially inducing or attenuating sleep bruxism and/or awake bruxism.

Bruxism is a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. It can occur during sleep, indicated as sleep bruxism, or during wakefulness, indicated as awake bruxism. Exogenous risk indicators of sleep bruxism and/or awake bruxism are, among others, medications and addictive substances, whereas also several medications seem to have the potential to attenuate sleep bruxism and/or awake bruxism. The objective of this study was to present a narrative literature on medications and addictive substances potentially inducing or aggravating sleep bruxism and/or awake bruxism and on medications potentially attenuating sleep bruxism and/or awake bruxism. Literature reviews reporting evidence or indications for sleep bruxism and/or awake bruxism as an adverse effect of several (classes of) medications as well as some addictive substances and literature reviews on medications potentially attenuating sleep bruxism and/or awake bruxism were used as starting point and guidelines to describe the topics mentioned. Additionally, two literature searches were established on PubMed. Three types of bruxism were distinguished: sleep bruxism, awake bruxism and non-specified bruxism. Generally, there are insufficient evidence-based data to draw definite conclusions concerning medications and addictive substances inducing or aggravating sleep bruxism and/or awake bruxism as well as concerning medications attenuating sleep bruxism and/or awake bruxism. There are insufficient evidence-based data to draw definite conclusions concerning medications and addictive substances inducing or aggravating sleep bruxism and/or awake bruxism as well as concerning medications attenuating sleep bruxism and/or awake bruxism.

Association between posterior crossbite and/or deep bite and temporomandibular disorders among Palestinian adolescents: A sex comparison.

Objective: To assess the prevalence of temporomandibular disorders (TMDs) and posterior crossbite and/or deep bite and any possible association between them. Methods: One thousand-nineteen adolescents responded to a questionnaire regarding oral habits and TMD symptoms. Afterwards, they were diagnosed according to the Axis I of the DC/TMD and underwent a dental examination. The chi-square test was used for statistical analysis. Results: A significant association  was found between posterior crossbite and some TMD diagnosis, but no association was found between deep bite and TMD, nor between occlusal diagnosis and bruxism. TMDs were more prevalent in girls. There was a significant sex difference (more among females) in the prevalence of painful TMDs. Conclusion: Posterior crossbite in the adolescent population analyzed may be related to TMDs, in contrary to deep-bite. The presence of posterior crossbite may have different impact on TMD findings between the sexes.

The prevalence of posterior crossbite, deep bite, and sleep or awake bruxism in temporomandibular disorder (TMD) patients compared to a non-TMD population: A retrospective study.

Objective: To assess the prevalence of posterior crossbite and/or deep bite among patients diagnosed with temporomandibular disorders (TMD) compared to a non-TMD population.Methods: Four hundred ninety-four patients were enrolled: 345 with TMD according to the diagnostic criteria for TMD and 149 without TMD (control group). The chi-square test was used for statistical analysis.Results: A statistically significant association was found between sleep and awake bruxism and painful TMDs (p < .001 for both), but not with disc displacement. There was no association between posterior crossbite and/or deep bite with either painful TMD or disc displacement.Conclusion: Within the study limitations, sleep bruxism and awake bruxism may be related to pain in the TMD, and the severity of a deep overbite and presence of a unilateral or bilateral posterior crossbite should not be considered risk factors or as having any effect on the pain associated with TMD and/or disc displacement.

Tinnitus in Temporomandibular Disorders: Axis I and Axis II Findings According to the Diagnostic Criteria for Temporomandibular Disorders.

AIMS: To examine the associations of self-reported presence of tinnitus with subtypes of temporomandibular disorders (TMD) as assessed by Axis I of the Diagnostic Criteria for TMD (DC/TMD) and with psychologic characteristics as assessed by Axis II. METHODS: This retrospective controlled study included 108 consecutive TMD patients referred to the Tel Aviv University Orofacial Pain Clinic. Each patient received full Axis I and Axis II diagnoses according to the DC/TMD. The patients were asked about currently experiencing tinnitus. Pearson chi-square test and Fisher exact test were used to test the associations between categorical variables. Mann-Whitney test was used to assess differences in continuous variables between categories. A P value < .05 was considered statistically significant. RESULTS: Thirty-three (30.6%) TMD patients reported experiencing tinnitus. There was a significantly higher prevalence of myofascial pain with referral (P = .008) and nonspecific physical symptoms (P = .014) among the TMD patients who reported tinnitus. In addition, those patients reported significantly longer pain duration compared to TMD patients without tinnitus (P = .039). CONCLUSION: This study emphasizes the necessity of assessing both Axes I and II according to the DC/TMD in future studies and supports creating a standardized tinnitus screener tailored to TMD patients for future studies on tinnitus in TMD patients.

Relationship between specific temporomandibular disorders and impaired upper neck performance.

Upper neck impairments are more prevalent in patients with temporomandibular disorders (TMDs) but the differences between specific types of TMDs are unclear. This study evaluated the distribution of such impairments among different forms of TMD. In total, 116 participants (86 women and 30 men, age range 21-75 yr) were investigated. Forty-two individuals had no TMDs and were assigned to the control group. The remaining 74 patients were assigned to one of three groups based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) findings: pain-related (n = 37); intra-articular (n = 17); or mixed (combined pain-related and intra-articular) (n = 20). Analyses of impairments included between-group comparisons of key parameters of upper neck performance (active/passive mobility and muscular capabilities) and pain (subjective neck disability and pain sensitivity). Patients in the pain-related and mixed TMD groups were found to have decreased upper neck mobility in the cervical flexion-rotation test compared with patients in intra-articular and control groups, as well as poorer capabilities of the deep neck flexor muscles in the cranio-cervical flexion test compared to the control group. It was concluded that patients with pain-related TMD diagnoses are more likely to experience significant upper-neck hypomobility and poor muscular capabilities than patients with intra-articular diagnoses of TMD.

The effect of tooth wear, age and sex on facial height assessed by soft tissue analysis.

AIM: The aim of the study was to evaluate the effects of tooth wear, age and sex on facial height measurements based on soft tissue analysis. METHODS: One hundred and twelve subjects (45 males and 67 females), 19-80 years of age (mean 43 ± 0.9 years), which were divided into three age groups, met the inclusion criteria. Tooth wear was assessed using a 5-point ordinal scale (0-4). Based on the tooth wear score, three groups were defined: mild, moderate and severe wear. Facial height was evaluated based on soft tissue measurements using frontal facial photographs. The dimension of the upper facial height (UFH) and lower facial height (LFH) and the ratio between the two (R-U-L) were measured. RESULTS: Facial height dimensions (UFH, LFH) were significantly different between the three age groups and between the three tooth wear groups. Both the UFH and LFH measurements had a weak positive correlation with age (r = .40; r = .41, respectively) and with tooth wear (r = .40; r = .41, respectively). The R-U-L showed a significant difference (P < .001) between sexes as males showed slightly lower ratio compared with females; however, the R-U-L was not dependent upon age or tooth wear. CONCLUSIONS: This study demonstrated that although facial height is affected by age and tooth wear, the proportion between the upper to lower facial segments is constant and is not affected by the same parameters. A statistically significant difference in the R-U-L relative to sexes was noted.

Awake and Sleep Bruxism Among Israeli Adolescents.

Introduction: Sleep and awake bruxism are potential risk factors for oral hard tissue damage, failure of dental restorations and/or temporomandibular disorders. Identifying the determinants of sleep and awake bruxism among adolescents will enable development of preventive interventions for those at risk. Objectives: To determine emotional, behavioral and physiological associations of sleep and awake bruxism among Israeli adolescents. Methods: Two thousand nine hundred ninety-three Israeli high school students, from five different high schools in Israel, were approached in the classroom and requested to complete online questionnaires on sleep and awake bruxism, emotional aspects, smoking, alcohol consumption, oral habits, facial pain, and masticatory disturbances. The final study sample concerning awake and sleep bruxism included 2,347 participants. Results: 1,019 (43.4%) participants reported not experiencing any form of bruxism (neither sleep nor awake), 809 (34.5%) reported awake bruxism, 348 (14.8%) reported sleep bruxism and 171 (7.3%) reported both sleep and awake bruxism. Multivariate analyses (Generalized Linear Model with a binary logistic dependent variable) showed that one of the prominent variables affecting the occurrence of sleep bruxism was anxiety (mild, moderate and severe anxiety, Odds Ratios (OR) of 1.38, 2.08, and 2.35, respectively). Other variables associated with sleep bruxism were stress (each point in the stress scale increased the risk of SB by 3.2%), temporomandibular symptoms (OR = 2.17) and chewing difficulties (OR = 2.35). Neck pain showed a negative association (OR = 0.086). Multivariate analyses for awake bruxism showed an effect of moderate anxiety (OR = 1.6). Other variables associated with awake bruxism were stress (each point in stress scale increased the risk of AB by 3.3%), high and low levels of facial pain (OR = 2.94 and 1.53, respectively), creaks (OR = 1.85) and oral habits (OR = 1.36). Sleep bruxism was found to be a predictor for awake bruxism, and vice versa. In both cases ORs were 8.14. Conclusions: Among adolescents, sleep and awake bruxism are associated with emotional aspects as well as with facial pain symptoms and/or masticatory system disturbances. Awareness is recommended to decrease potential risks to teeth, dental restorations, and the masticatory system.

Bruxism: An umbrella review of systematic reviews.

OBJECTIVES: To synthesise available knowledge about both sleep (SB) and awake bruxism (AB) as depicted by previous published systematic reviews (SR). METHODS: SR investigating any bruxism-related outcome were selected in a two-phase process. Searches were performed on seven main electronic databases and a partial grey literature search on three databases. Risk of bias of included SR was assessed using the "University of Bristol's tool for assessing risk of bias in SR". RESULTS: From 1038 studies, 41 SR were included. Findings from these SR suggested that (a) among adults, prevalence of AB was 22%-30%, SB (1%-15%), and SB among children and adolescents (3%-49%); (b) factors consistently associated with bruxism were use of alcohol, caffeine, tobacco, some psychotropic medications, oesophageal acidification and second-hand smoke; temporomandibular disorder signs and symptoms presented a plausible association; (c) portable diagnostic devices showed overall higher values of specificity (0.83-1.00) and sensitivity (0.40-1.00); (d) bruxism might result in biomechanical complications regarding dental implants; however, evidence was inconclusive regarding other dental restorations and periodontal impact; (e) occlusal appliances were considered effective for bruxism management, although current evidence was considered weak regarding other therapies. CONCLUSIONS: Current knowledge from SR was mostly related to SB. Higher prevalence rates were found in children and adolescents than in adults. Associated factors and bruxism effects on stomatognathic structures were considerably heterogeneous and inconsistent. Overall good accuracy regarding portable diagnostic devices was found. Interventions' effectiveness was mostly inconclusive regarding the majority of available therapies, with the exception of occlusal appliances.

Management of the Dentally Anxious Patient: The Dentist's Perspective.

PURPOSE: To evaluate dental anxiety from the dentist's perspective. MATERIALS AND METHODS: A cross-sectional study was performed on a convenience sample. Data were gathered using questionnaires that included general information and specific questions concerning dentally anxious patients. RESULTS: Three hundred ten practicing dentists completed the survey. Participants estimated that 27% of their adolescent/adult patients and 35% of their child patients suffer from dental anxiety. Dentists reported devoting about a quarter of their weekly work hours to treating such patients. The most common anxiety management techniques used for adults and children alike were nitrous oxide and/or behavioural techniques (such as distraction, reinforcement, gradual exposure, and relaxation). Dentists generally agreed that it is their responsibility to help dentally anxious patients. Eighty-one percent expressed interest in taking part in dental anxiety management courses. The consensus was that treating dentally anxious patients involves long treatment times, insufficient payment, and frequent appointment cancellations. CONCLUSIONS: According to practicing dentists, over one-quarter of their patients suffer from dental anxiety. Most dentists perceive themselves as responsible for treating these patients and are willing to receive appropriate training. Incorporating behavioural and pharmacological management techniques in the undergraduate dental curriculum and expanding postgraduate training programmes in this field are important issues that can improve the well-being of both dentally anxious patients and their dentists.

Potential orofacial hazards of resistance training: A controlled comparative study.

OBJECTIVE: To evaluate the effect of resistance training (RT) regarding potential hazard for dental wear, tooth abfractions, temporomandibular joint disc displacement, limitation in mouth opening, and existence of cervical spine disorders. The initial study hypothesis was that extensive resistance trainees (ExRT) would suffer from the above-mentioned symptoms more often than recreational trainees (RcT). METHODS: A controlled comparative study among male gym members via questionnaires and a clinical examination. RESULTS: ExRT had a higher prevalence of teeth indentations on the tongue (26% vs. 2% p < 0.001) and a higher prevalence of tooth abfractions than RcT (28% vs. 4% p < 0.005). ExRT exhibited a higher prevalence of cervical movement limitations (p < 0.05) and inadequate posture (p < 0.001). CONCLUSION: RT by itself may not be a risk factor for disc displacement. Nevertheless, it may act as a potential risk factor for irreversible hard tooth tissue damage and contribute to neck postural and mobility impairments.

Preliminary Study to Evaluate Marginal Bone Loss in Cases of 2- and 3-Implant-Supported Fixed Partial Prostheses of the Posterior Mandible.

PURPOSE: The purpose of this study was to evaluate, by radiographic examinations, the marginal bone resorption around implants in cases of 2 and 3 implant-supported fixed partial prostheses (FPPs) at the posterior mandible. METHODS: A retrospective study of 41 patients (23 males, 18 females) of an average age of 67 years (range, 53-85), with 2 and 3 implants-supported FPPs in the posterior mandible that were treated during 2006 to 2015. The mean follow-up time was 6.32 years (range, 2-10). Twenty-four patients had FPPs on 2 implants (a total of 48 implants). Seventeen patients had FPPs on 3 implants (a total of 51 implants). Clinical and radiographic follow-up examinations were performed. All radiographs were analyzed for changes in marginal bone height surrounding the implants. RESULTS: The mean marginal bone loss around the most mesial implant was slightly higher in the 2-implant group (0.833 mm) compared with the 3-implant group (0.431 mm). The correlation between the mean marginal bone loss around the most mesial implant and the number of implants was of borderline value (P = 0.055). CONCLUSIONS: Considering the limitations of this preliminary study, the authors found that the mesial implant in the 2-implant group is more susceptible to marginal bone loss.

Pain Catastrophizing and Pain Persistence in Temporomandibular Disorder Patients.

AIMS: To describe pain catastrophizing in temporomandibular disorder (TMD) patients in relation to disability and pain persistence. METHODS: A total of 163 TMD patients underwent a complete TMD evaluation according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), including the Pain Catastrophizing Scale (PCS). Patients were divided into subgroups according to their PCS, Graded Chronic Pain Scale (GCPS), and pain persistence scores. The GCPS and pain persistence subgroups were assigned as dependent variables in a stepwise multiple logistic regression model. The ability of the DC/TMD Axis II parameters and of the PCS to discriminate between patients of low and high disability (according to the GCPS) and low and high pain persistence were examined using area under the receiver operating characteristic (ROC) curve. α < .05 was considered to reflect statistical significance. RESULTS: Significant differences were found between high and low pain catastrophizing patients as to socioeconomic parameter, Axis I diagnoses, pain persistence, and Axis II evaluation. The parameters with significant discriminant ability for pain persistence were pain catastrophizing, depression, and nonspecific physical symptoms, with no significant differences between them. Depression increased the odds of high disability by 1.2, while pain catastrophizing increased the odds for high pain persistence more than 6-fold. Pain catastrophizing was not significantly associated with pain disability, and depression was not significantly associated with pain persistence. CONCLUSION: High-pain catastrophizing TMD patients were similar to patients with other chronic pain conditions, but differed from TMD patients as a group. The findings of this study support the addition of an assessment for pain catastrophizing to the DC/TMD for early identification of TMD patients who might be at higher risk for developing chronic pain.

Prevalence of bruxism and temporomandibular disorders among orphans in southeast Uganda: A gender and age comparison.

OBJECTIVES: The aims of the current study were: (1) to assess the prevalence of oral habits, bruxism, and temporomandibular disorders (TMDs) among children living in Uganda; (2) to establish whether parafunctional activities are associated with TMDs; and (3) to examine the possible impact of gender and age on the prevalence of bruxism, oral habits, and TMDs. METHODS: This study included 153 children aged 6-17 years. The study consisted of a questionnaire and a clinical examination. RESULTS: TMDs were moderately prevalent (35%). Parafunctional habits were performed by 93% of the participants. When performed extensively, they were significantly related to myalgia. No gender or age significant differences were found. CONCLUSIONS: 1. Only extensive masticatory parafunctional oral activity is significantly related to myalgia. 2. Gender and age had no impact on the prevalence of bruxism, oral habits, or TMDs. 3. Sleep and awake bruxism were not related to anamnestic symptoms or clinical findings in TMD.

Comparing Axis II Scores According to the RDC/TMD and DC/TMD in Israeli Patients.

AIMS: To use the Symptom Checklist-90-Revised (SCL-90-R)-based instruments of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and the Primary Care Evaluation of Mental Disorders (PRIME-MD)-based instruments of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) in order to compare these Axis II scores in temporomandibular disorder (TMD) patients. METHODS: Demographic and socioeconomic data, Axis I diagnoses, and Axis II evaluations (depression, nonspecific physical symptoms, anxiety, and Graded Chronic Pain Scale [GCPS]) were compared between two groups of patients-142 TMD patients diagnosed according to the RDC/TMD (RDC group) and 157 TMD patients diagnosed according to the DC/TMD (DC group). Pearson's chi-square test, Fisher's exact test, and Mann-Whitney test were used, and P values were adjusted for multiple comparisons. RESULTS: The prevalences of severe depression, nonspecific physical symptoms, and anxiety were significantly lower in the DC group than in the RDC group, with no differences between groups for Axis I diagnoses, characteristic pain intensity (CPI), or GCPS. CONCLUSION: Within the limitations of this study, the present findings reveal differences in the presence of severe depression, nonspecific physical symptoms, and anxiety between the RDC and DC groups. The differences may reflect the cut-off scores of the SCL-90-R and the PRIME-MD tools.

Cervical flexion-rotation test and physiological range of motion - A comparative study of patients with myogenic temporomandibular disorder versus healthy subjects.

BACKGROUND: Temporomandibular Disorders (TMD) refer to several common clinical disorders which involve the masticatory muscles, the temporomandibular joint (TMJ) and the adjacent structures. Although neck signs and symptoms are found with higher prevalence in TMD patients compared to the overall population, whether limitation of cervical mobility is an additional positive finding in this cohort is still an open question. OBJECTIVE: To compare the physiological cervical range of motion (CROM) and the extent of rotation during cervical flexion (flexion-rotation test, FRT) in people with TMD (muscular origin) and healthy control subjects. METHOD: The range of motion of the neck and FRT was measured in 20 women with myogenic TMD and 20 age matched healthy controls. RESULTS: Women with myogenic TMD had significantly lower FRT scores compared to their matched healthy women. No difference was found between groups in CROM in any of the planes of movement. The FRT was positive (less than 32°) in 90% of the TMD participants versus 5% in the healthy control but the findings were not correlated with TMD severity. CONCLUSION: The results point out a potential involvement of the upper cervical joints (c1-c2) in women with myogenic TMD.

Dental Treatment Needs among Children and Adolescents Residing in an Ugandan Orphanage.

BACKGROUND: Previous studies focused on the dental caries status of East African children and not on their overall dental needs. Urban children consume more sugar-rich foods. OBJECTIVES: To assess overall dental treatment needs of children living in an orphanage in Uganda. STUDY DESIGN: Teeth were diagnosed as needing treatment by obvious frank carious lesions (WHO criteria), temporary fillings, staining, or very deep pit and/or fissures possibly requiring sealants. Calculus or crowding in the mandibular anterior region and evidence of tooth fractures were recorded, as were signs of wear on the mandibular molars and canines and the maxillary incisors. RESULTS: Most of the primary teeth (64%) required no dental treatment, but almost all (98%) of the permanent teeth did. A mean (±standard deviation) of 4.81±1.92 permanent teeth required treatment. The mean number of missing teeth was 0.47. Thirty-one children (20.2%) had crowding, 52 (34%) had calculus, and 49 (32%) had signs of attrition on primary and permanent molar teeth (45 enamel only and 4 enamel and dentin). CONCLUSIONS: Most of the primary teeth required no dental treatment, while the vast majority of permanent teeth did, possibly in association with high sugar cane consumption and poor brushing habits among older children.