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Summary Background Pain can discourage patients from seeking orthodontic treatment or compromise their compliance during therapy. Objectives To determine the effects of verbal and written information on orthodontic pain after fixed appliance placement. Trial design Two-arm parallel design randomized controlled trial. Methods Healthy adolescents with permanent dentition enrolled for orthodontic treatment were assigned to the study or control group using computer-generated random lists and allocation concealment with sealed envelopes. Participants completed baseline questionnaires to assess anxiety (State-Trait Anxiety Inventory Trait Version, Form X-2) and somatosensory amplification (Somatosensory Amplification Scale). Brackets were placed in the maxillary arch, from first molar to first molar, and an Australian archwire 0.012 inch was used for alignment. General verbal information on orthodontic treatment was given to all patients by the same clinician. Participants included in the study group received also detailed verbal instructions on orthodontic pain together with a take-home information leaflet by another clinician. Outcome included assessments of pain intensity with a Numerical Rating Scale (NRS) on the day of appliance placement (Day 1, bedtime) and twice a day for the following 6 days (Day 2 to Day 7, morning, bedtime), and analgesic consumption. Participants, statistician, and clinicians who gave general verbal information on orthodontic treatment and instructions about how to score pain intensity were blinded to group assignment. Results Sixty patients were assigned to the study (n = 30, mean age: 15.4 ± 1.3 years) or control group (n = 30, mean age: 14.7 ± 3.2 years). At baseline, no significant between-group differences were present in terms of anxiety and somatosensory amplification. Orthodontic pain scores were significantly lower in the study group compared with the control one, at bedtime on Day 1 (P < 0.05) and in the morning of Day 2 (P < 0.01). No significant between-group differences were found in following measurements. Overall, analgesic consumption was significantly lower in study compared with the control (P < 0.01). Conclusion A combination of verbal and written information on orthodontic pain after placement of fixed appliances reduced patient’s self-reported pain in the early stages. Registration This study was not registered.

Background: Mandibular advancement devices (MAD) are effective in reducing apnea episodes and they are frequently used as first-line therapy in obstructive sleep apnea (OSA) patients. Objectives: The MAD must be used every night for a lifetime and since it performs its function discharging the forces on dental elements the aim of this systematic review was to identify the dental and skeletal long-term side effects of MAD therapy and to evaluate the influence of time on them in OSA or snoring patients. Search Methods: An electronic search was performed in MEDLINE, Cochrane Database, Google Scholar Beta, Scopus, and LILACS. Studies until 4 April 2018 were analysed, without language restrictions. Selection Criteria: Randomized controlled trials and cohort studies investigating dental and/or skeletal side effects on adult patients wearing MAD for OSA or snoring treatment with at least 2 years follow-up were included and independently evaluated by two investigators. Data Collection and Analysis: The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the risk of bias by means of Cochrane's tools. For each study included and for each dental and/or skeletal parameter, the difference in means and 95% CI was calculated between baseline and follow-up. Results: Twenty-one studies with follow-up between 2 and 11 years were included. The side effects reported were a reduction in overjet, overbite, and in the upper incisor inclination, and an increase in lower incisor inclination, A point-Nasion-B point, and anterior facial height. The meta-regression analysis showed that the side effects were influenced by the therapy duration for all parameters (P < 0.05). The quality of evidence was low/moderate. Conclusions: MAD therapy produces time-related dental and skeletal side effects. After a long period of treatment, the dental side effects are clinically relevant and therefore the clinician should inform the patients about this issue. Since the side effects are progressive, patients need to be continuously monitored over time. Registration: The study protocol was not registered.

SUMMARY BACkGROUND Among different malocclusions, posterior crossbite is thought to have a strong impact on the correct functioning of the masticatory system. OBjECtIVE to assess, by systematically reviewing the literature, the association between posterior crossbite and different temporomandibular disorder ( tMD) diagnosis: disc displacement and masticatory muscle pain. MAtERIAlS AND MEthODS A literature survey covering the period from january 1965 to April 2012 was performed. two reviewers extracted the data independently and assessed the quality of the studies. RESUltS the search strategy resulted in 2919 citations, of which 43 met the inclusion criteria. the scientific and methodological quality of these studies was found to be medium-low, independently by association reported. In several studies, posterior crossbite is reported to be associated to the develop - ment of disc displacement, muscular pain, and tenderness, possibly linked to a skeletal and muscular adaptation of the stomatognathic system. however, the lack of consistency of the results reported deeply reduces the external validity of the studies, with a consequent impossibility to draw definite conclusions. CONClUSIONS It is not possible to establish an association between posterior crossbite, muscle pain, and disc displacement because the distribution of the studies supporting or not supporting the association is similar. the consequences of posterior crossbite on the development of tMDs deserve further inves- tigations, with high sample size, well-defined diagnostic criteria, and rigorous scientific methodologies. Finally, long-term controlled studies are needed to identify posterior crossbite as a possible risk factor for tMDs.

Orofacial pain is one the main reasons for patients to seek treatment. Pain in the face and mouth has a significant psychological meaning since a good interplay of orofacial structures is essential for correct jaw function, communication and body image. Unfortunately, diagnosis and treatment of orofacial pain is not an easy task. This textbook represents a good start for those interested in orofacial pain conditions. It is an extended revision of Dr Welden Bell's classic text, reporting the latest findings related to pain supported by an updated text including …