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Background: Several studies have shown that both acupuncture and dry needling are effective in the treatment of musculoskeletal pains. Therefore, the aim of this network meta‐analysis (NMA) was to investigate the treatment outcome of acupuncture and dry‐needling for masticatory muscle pain (TMD‐M) and to compare with active and inactive placebo. Material and Method: An electronic search was performed to identify randomised controlled trials (RCTs) published until September 2019, comparing dry‐needling, acupuncture, and inactive as well as active placebo in patients with TMD‐M. Outcome variables were post‐treatment pain intensity, pressure pain threshold (PPT), and maximum mouth opening (MMO). The quality of evidence was rated according to Cochrane's tool for assessing the risk of bias. Mean difference was used to analyse via frequentist NMA using STATA‐software. Results: Both NMA and direct pairwise meta‐analysis have shown that there was no difference between active treatment with either acupuncture or dry‐needling when compared to active and inactive placebo in patients with TMD‐M with respect to pain intensity, and PPT (p >.05). However, there was a significant increase in MMO following dry‐needling when compared to the placebo (very low‐quality evidence). Conclusion: Despite the short‐term positive effect of MMO by dry‐needling, this NMA could not show any pain‐reducing effect in patients with TMD‐M by acupuncture or dry‐needling when compared to an active or inactive placebo. Taken together, this NMA indicates that it is the placebo effect that accounts for the majority of the treatment effect of TMD‐M, rather than a real therapeutic effect of acupuncture/dry‐needling. [ABSTRACT FROM AUTHOR]

Background: Although many children with juvenile idiopathic arthritis (JIA) develop arthritis and deformity of the temporomandibular joint (TMJ), many go undetected. Objective: This study investigates whether findings from patient history and clinical examination using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) can be used to diagnose TMJ involvement. Methods: As a part of the screening program, 59 consecutive JIA patients age 7–14 years underwent a clinical examination according to RDC/TMD including self‐reported orofacial pain and pain related to jaw function, and cone beam computer tomography (CBCT). Data were obtained from the patient's medical charts. Patients were divided into two groups based on the presence or absence of TMJ deformities on CBCT. Results: Self‐reported TMJ symptoms before inclusion were reported by 52% of children with and 18% of children without TMJ deformities on CBCT (p =.020). On a group level, the maximum unassisted (mouth) opening (MUO) with and without pain was within the normal range, but children with TMJ deformities showed a significantly smaller MUO with pain (p =.035). A diagnosis of osteoarthritis and osteoarthrosis was more prevalent in children with TMJ deformities. Conclusion: Although there were few differences between children with and without radiographic TMJ deformities, self‐reported previous TMJ symptoms and reduced MUO with pain could indicate the presence of TMJ involvement. However, radiographic examinations are needed to confirm TMJ involvement. Thus, this study indicates that the RDC/TMD protocol is a blunt tool when targeting TMJ involvement in JIA. [ABSTRACT FROM AUTHOR]

Background: In skeletal muscle, free nerve endings are mostly located within the connective tissue. However, the distribution of sensory afferent fibres in healthy human masseter muscle tissues has not been studied. Objectives: Primarily to investigate human masseter muscle nerve fibre densities as well as expression of NR2B receptors, substance P (SP) and nerve growth factor (NGF), and secondarily to compare this between a) nerve fibres associated with myocytes and within connective tissue; b) sexes; and c) ages. Methods: Microbiopsies of the masseter muscle were obtained from 60 sex‐ and age‐matched healthy participants. Biopsy sections were analysed using immunohistochemistry and were visualised with a Leica TCS SPE confocal microscope. The Mann‐Whitney U test was used for statistical analyses. Results: The density of nerve fibres within connective tissue was significantly greater than in nerve fibres associated with myocytes (P <.001). Nerve fibres within connective tissue expressed SP alone or together with NR2B significantly more often than those associated with myocytes (P <.001). The frequency of nerve fibres, which expressed SP alone or in combination with NR2B or NGF, was significantly greater in women than in men (P <.050). Moreover, the co‐expression of the three markers together was inversely correlated with age in women (P <.002). Conclusions: There is a higher density and greater expression of sensory nerve fibres within the connective tissue than associated with myocytes in healthy human masseter muscle. This suggests that nerve fibres within connective tissue are more involved in nociception than nerve fibres associated with myocytes. [ABSTRACT FROM AUTHOR]