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BACKGROUND: Patients with temporomandibular disorders (TMD) mostly suffer from muscle-related pain. Several conservative interventions have been suggested as treatments for TMD in the last years. OBJECTIVE: The aim of this systematic review with meta-analysis was to assess the efficacy of rehabilitative approaches in reducing pain in patients with muscle-related TMD. METHODS: PubMed, Scopus, and Web of Science were systematically searched from inception until April 28th, 2021 to identify randomized controlled trials (RCTs) presenting: patients with painful muscle-related TMD; rehabilitative approaches as interventions; placebo or sham treatment as comparisons; pain intensity, using visual analogue scale as outcome. A meta-analysis was performed to evaluate the overall effect on painful muscle-related TMD patients. PROSPERO registration number of this systematic review is CRD42021251904. RESULTS: Out of 1997 papers suitable for title/abstract screening, 189 articles were assessed for eligibility. Sixteen RCTs were included and most of them (n= 6, 37.5%) investigated the effects of the laser therapy. The meta-analysis revealed that rehabilitative interventions had a significant overall effect size (ES) of 1.44 (p< 0.0001) in decreasing pain in patients with muscle-related disorders. CONCLUSION: Findings of this systematic review with meta-analysis suggested that rehabilitative approaches might be effective in reducing pain in muscle-related TMD patients. However, the low number of RCTs evaluating conservative approaches might impair the synthesis of evidence regarding the different techniques, calling for caution in the interpretation of these results.

Aims: To evaluate the short-term effects of a standardized first-line noninvasive approach (FL-A) including counseling and self-management strategies on pain, masticatory muscle tenderness, and awake bruxism in women with chronic temporomandibular disorder myalgia (mTMD) and to test whether patients' trait anxiety predicted their response to treatment. Methods: FL-A was administered to 14 women with chronic mTMD (mean age ± SD = 33.8 ± 11.1 years; 8 with Graded Chronic Pain Scale [GCPS] grade I and 6 with grade II). Its effects on facial pain, masticatory muscle tenderness, and spontaneous awake bruxism episodes were evaluated using questionnaires, surface electromyography, and quantitative sensory testing. General linear models were used to test FL-A efficacy after 1 (T1) and 2 (T2) months. Results: FL-A reduced pain (from baseline [T0] to T2, P = .010), the frequency of awake bruxism episodes (T0 to T1, P = .024), and their intensity by about 30% (T0 to T1, P < .001). Pressure pain thresholds at the masticatory muscle locations increased significantly from T0 to T2 (P < .001). Patients' trait anxiety decreased significantly from T0 to T2 (P = .030). Trait anxiety measured at baseline was not correlated with relative changes in pain (T0 to T2, P = .248). Conclusion: In the short term, FL-A reduces facial pain, masticatory muscle tenderness, and awake bruxism in women with chronic mTMD with low disability. A conservative management strategy should be prioritized for the initial management of these patients.

Aims: To investigate how trait anxiety and stress jointly affect the sensory and jaw motor responses to a tonic orofacial nociceptive stimulus. Methods: Orthodontic separators were placed between the first molars in 45 adults with low (n = 14), intermediate (n = 17), and high (n = 14) trait anxiety. Tooth pain, occlusal discomfort, tooth clenching (as a jaw motor behavior), and situational stress were measured three times a day for 5 days using visual analog scales. Mixed-effects regression models were used to evaluate the sensory and motor outcome measures. Results: Pain, discomfort, and frequency of tooth-clenching trajectories were affected by trait anxiety (P =.007, P

OBJECTIVES: Involvement of the temporomandibular joint (TMJ) is common in juvenile idiopathic arthritis (JIA). TMJ arthritis can lead to orofacial symptoms, dysfunction and dentofacial deformity with negative impact on quality of life. Management involves interdisciplinary collaboration. No current recommendations exist to guide clinical management.OBJECTIVES: 1) To develop consensus-based interdisciplinary recommendations for management of orofacial manifestations of JIA. 2) To create a future research agenda related to management of TMJ arthritis in children with JIA.METHODS: The recommendations were developed using online surveying of relevant stakeholders, systematic literature review, evidence-informed generation of recommendations during two consensus-meetings, and Delphi study iterations involving external experts. The process included disciplines involved in the care of orofacial manifestations of JIA: Pediatric rheumatology, radiology, orthodontics, oral and maxillofacial surgery, orofacial pain specialists and pediatric dentistry. Recommendations were accepted if agreement was >80% during a final Delphi study.RESULTS: Three overarching management principles and 12 recommendations for interdisciplinary management of orofacial manifestations of JIA were outlined. The 12 recommendations pertained to: diagnosis (n=4), treatment of TMJ arthritis (active TMJ inflammation) (n=2), treatment of TMJ dysfunction and symptoms (n=3), treatment of arthritis-related dentofacial deformity (n=2), and other related aspects to JIA (n=1). Additionally, a future interdisciplinary research agenda was developed.CONCLUSIONS: These are the first interdisciplinary recommendations to guide clinical management of TMJ JIA. The 3 overarching principles and 12 recommendations fill an important gap in current clinical practice. They emphasize the importance of an interdisciplinary approach to diagnosis and management of orofacial manifestations of JIA. This article is protected by copyright. All rights reserved.

Il est important pour les orthodontistes, selon les recommandations internationales, de dépister les patients à risque de dysfonctionnements temporomandibulaires (DTM). Plusieurs questions se posent : quel patient est à risque ? Quel patient dépister ? Que doit dépister l’orthodontiste ? La littérature montre que l’occlusion a un rôle étiologique insignifiant; mais cependant, certains patients peuvent présenter des difficultés à s’adapter aux modifications occlusales. Ceci peut être lié à des facteurs comme l’hypervigilance, la somatisation, l’amplification sensorielle, une mauvaise attribution de stimuli normaux comme causes de maladie ainsi que des conditions biopsychosociales défavorables, lesquels doivent tous être évalués en préalable. En cas de présence de DTM, sa prise en charge est à envisager avant un traitement orthodontique. La correction orthodontique des asymétries est décidée après ce bilan initial et en accord avec le patient sur ses besoins réels, les bénéfices attendus et les résultats fonctionnel et esthétique espérés.

Objective: To compare the dental and skeletal effects of intermaxillary elastics on the correction of mild Angle's Class II division 1 malocclusion with clear aligner treatment (CA) versus fixed multibracket (FMB) in growing patients. Settings and sample population: The study sample consisted of 49 consecutively patients (mean age ± SD 12.9 ± 1.7 years), 32 females and 17 males referred from the School of Orthodontics of the University of Bratislava Comenius (Slovakia). All patients were treated with a non-extraction orthodontic treatment, 25 with FMB and 24 with CA. Methods: The cephalometric analysis was performed at the beginning (T0) and the end of the treatment (T1). The t test for unpaired data was carried out to compare cephalometric values at T0 and changes at T1-T0 between the two groups. The level of significance was set as P

Un projet de correction d’une asymétrie doit-il être fondé seulement sur la référence à une normalité ? L’asymétrie faciale est globalement la règle, tant sur le plan anatomique que fonctionnel. Les caractéristiques des asymétries doivent être abordées et traitées avec discernement. Lorsqu’il s’agit de pratiquer des interventions esthétiques, il est nécessaire de bien appréhender les désirs et les besoins du patient. Sur le plan fonctionnel, le seuil de prise en charge dépend des capacités d’adaptation de l’appareil manducateur. Pour cela, l’orthodontiste doit prévoir dans son examen clinique une étape de dépistage des signes et symptômes des dysfonctionnements temporo-mandibulaires (DTM), pour apprécier les limites de ce potentiel d’adaptation neurophysiologique. Le praticien prendra soin d’associer le patient dans une « décision partagée », ce qui favorisera l’observance du patient durant le traitement, pour obtenir un bon niveau d’alliance thérapeutique, gage de satisfaction du résultat obtenu. La prise de décision thérapeutique se basera donc sur la demande du patient, l’évaluation diagnostique et l’estimation pronostique, et tiendra compte de la notion de médecine fondée sur les valeurs.

Objective: To compare the smallest thickness that can be perceived between occluding teeth (occlusal tactile acuity, OTA) of temporomandibular disorder pain (TMD-P) patients with that of control (CTR) individuals. Methods: Twenty TMD-P patients (17 women and 3 men, mean age: 31.3 ± 10.4 years) diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) protocol and 20 age- and gender-matched controls (17 women and 3 men, mean age: 31.4 ± 10.5 years) were enrolled. The OTA was tested with 10 different thicknesses: 9 aluminium foils (8 µm-72 µm with a constant increment of 8 µm) and 1 sham test (without foil), each thickness being tested 10 times in random order (100 tests in total). The participants were instructed to close their mouth once and to report whether they felt the foil between their molar teeth. A between-group comparison (TMD-P vs CTR) was performed for each testing thickness (analysis of variance for repeated measurements, with Bonferroni multiple correction) (P

Within physical therapy, manual therapy is known to be effective for managing temporomandibular disorders (TMDs). However, manual therapy is a broad term including different approaches applied to different body regions.This is the first systematic review that aims to evaluate the effectiveness of manual therapy applied specifically to the craniomandibular structures (Cranio-Mandibular Manual Therapy [CMMT]) on pain and maximum mouth opening in people with TMD.This systematic review was developed based on a pre-determined published protocol which was prospectively registered with PROSPERO (CRD42019160213). A search of MEDLINE, Embase, CINAHL, ZETOC, Web of Science, SCOPUS, PEDro, PubMed, Cochrane Library and Best Evidence, EBM reviews-Cochrane Central Register of Controlled Trials, Index to Chiropractic Literature ChiroAccess and Google Scholar databases was conducted from inception until October 2020. Randomised controlled trials comparing the effect of CMMT on pain and maximum mouth opening versus other types of treatment in TMDs were included. Two reviewers independently screened articles for inclusion, extracted data, assessed risk of bias with the revised Cochrane risk of bias tool for randomised trials and evaluated the overall quality of evidence with the Grading of Recommendations, Assessment, Development and Evaluations.A total of 2720 records were screened, of which only 6 (293 participants) satisfied the inclusion criteria. All studies showed some concerns in risk of bias, except for one, which was high risk of bias. The overall quality of evidence was very low for all outcomes because of high heterogeneity and small sample sizes. All studies showed a significant improvement in pain and maximum mouth opening for CMMT from baseline in the mid-term, but only two showed superiority compared to other interventions. Given the high heterogeneity and small sample sizes of the included studies, a quantitative synthesis was not performed.There is the need for future high methodology research investigating different manual therapy techniques applied to different regions and different populations (e.g., chronic versus acute TMD) to determine what is most effective for pain and maximum mouth opening in patients with TMDs.

AIMS: To investigate whether an international consensus exists among TMD experts regarding indications, performance, follow-up, and effectiveness of jaw exercises. METHODS: A questionnaire with 31 statements regarding jaw exercises was constructed. Fourteen international experts with some geographic dispersion were asked to participate in this Delphi study, and all accepted. The experts were asked to respond to the statements according to a 5-item verbal Likert scale that ranged from "strongly agree" to "strongly disagree." The experts could also leave free-text comments, which was encouraged. After the first round, the experts received a compilation of the other experts' earlier responses. Some statements were then rephrased and divided to clarify the essence of the statement. Subsequently, the experts were then asked to answer the questionnaire (32 statements) again for the second round. Consensus was set to 80% agreement or disagreement. RESULTS: There is consensus among TMD experts that jaw exercises are effective and can be recommended to patients with myalgia in the jaw muscles, restricted mouth opening capacity due to hyperactivity in the jaw closing muscles, and disc displacement without reduction. The patients should always be instructed in an individualized jaw exercise program and also receive both verbal advice and written information about the treatment modality. CONCLUSION: This Delphi study showed that there is an international consensus among TMD experts that jaw exercises are an effective treatment and can be recommended to patients with TMD pain and disturbed jaw function. ispartof: JOURNAL OF ORAL & FACIAL PAIN AND HEADACHE vol:33 issue:4 pages:389-398 ispartof: location:United States status: published

ZusammenfassungDie obstruktive Schlafapnoe (OSA) ist gekennzeichnet durch wiederholte Episoden mit totalem oder partiellem Verschluss der oberen Atemwege während des Schlafs mit resultierender Schlaffragmentierung und Sauerstoffentsättigung. Diese schlafbezogene Atmungsstörung ist mit Müdigkeit während des Tages, verminderter Lebensqualität, eingeschränkter Arbeitsleistung, neurokognitiven Einschränkungen, einem erhöhten Risiko von Unfällen mit Kraftfahrzeugen und langfristig mit einem erhöhten Risiko kardiovaskulärer Morbidität und Mortalität verbunden.Die nasale kontinuierliche Überdruckbeatmung (nasal Continuous Positive Airway Pressure, nCPAP) erhält über eine Nasenmaske, die während des Schlafs getragen wird, einen Überdruck in den oberen Atemwegen aufrecht und stellt aktuell die wirksamste Behandlungsoption für OSA-Patienten dar. Die Therapieadhärenz ist jedoch gering. Die Verfügbarkeit alternativer Behandlungsoptionen ist deshalb von größter Bedeutung. Unterkieferprotrusionsschienen (UPS), die den Unterkiefer in einer nach vorn verlagerten Position halten, um so einen Verschluss der oberen Atemwege während des Schlafs zu verhindern, stellen eine weniger invasive, angenehmere und kostengünstigere Behandlungsalternative für Patienten mit leichter bis mäßiger OSA dar, die die nCPAP-Therapie nicht tolerieren, nicht auf sie ansprechen oder für die sie nicht infrage kommt. Die Vorverlagerung des Unterkiefers führt zu einer Volumenvergrößerung der oberen Atemwege, einer Erweiterung der lateralen Ausdehnung des Velopharynx, einer Straffung der Zungenmuskulatur, die dem Zurückfallen der Zunge während des Schlafs entgegenwirkt, sowie zu einer Vorverlagerung des Zungenbeins und einer Stabilisierung der Epiglottis und des Gaumensegels, was einer posterioren Kieferrotation vorbeugt. Die Behandlung mit einer Unterkieferprotrusionsschiene (UPS) stellt eine therapeutische Möglichkeit dar, um eine solche Vorverlagerung des Kiefers zu erzielen.In diesem Artikel untersuchen wir die Anwendungsgebiete, die Wirksamkeit, die Bedeutung in der klinischen Praxis und die unerwünschten Wirkungen von Protrusionsschienen zur Behandlung der OSA.

BackgroundOral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the four oral health-related quality of life (OHRQoL) dimensions (4D) or areas in which oral disorders impact pediatric patients. Using their dentists' assessment, the study aimed to evaluate whether pediatric dental patients' oral health concerns fit into the 4D of the Oral Health-Related Quality of Life (OHRQoL) construct.MethodsDentists who treat children from 32 countries and all WHO regions were selected from a web-based survey of 1580 international dentists. Dentists were asked if their pediatric patients with current or future oral health concerns fit into the 4D of the Oral Health-Related Quality of Life (OHRQoL) construct. Proportions of all pediatric patients’ oral health problems and prevention needs were computed.FindingsData from 101 dentists treating children only and 523 dentists treating children and adults were included. For 90% of pediatric patients, their current oral health problems fit well in the four OHRQoL dimensions. For 91% of oral health problems they intended to prevent in the future were related to these dimensions as well. Both numbers increased to at least 96% when experts analyzed dentists´ explanations of why some oral health problems would not fit these four categories.ConclusionsThe study revealed the four fundamental components of dental patients, i.e., the four OHRQoL dimensions (Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact) are also applicable for pediatric patients, regardless of whether they have current or future oral health concerns, and should be considered when measuring OHRQoL in the pediatric dental patient population.

Background Pain experienced at teeth during orthodontic treatment varies largely over time, with the reasons for its interindividual variability being largely unknown: age, sex, clinical activations, psychosocial factors and genetic polymorphisms of candidate genes are putative factors that may account to explain this variability. We aimed to investigate the effect of clinical, demographic, psychological and genetic factors on pain levels experienced during fixed orthodontic treatment. Methods A convenience sample of 183 patients undergoing full-fixed orthodontic treatment were recruited. Participant's pain levels were assessed seven times over a three-day period via a smartphone app. Clinical, demographic and psychological data were collected via questionnaires. This included the Pain Catastrophising Scale (Child version), the Corah Dental Anxiety Scale and the State and Trait Anxiety Inventory. Participants provided a DNA sample either in the form of blood or saliva, which were used for genotyping COMT gene rs6269, rs4680, rs4646310, NR3C1 gene rs2963155 and the HTR2A gene rs9316233. Results Bond ups had the greatest influence on perceived levels of pain experienced on teeth during orthodontic treatment, accounting for over 20% of total variance in pain response. High-pain responders had higher scores on pain catastrophising (magnification subscale). Self-reported pain during fixed orthodontic treatment was not influenced by sex, age, time into treatment, anxiety, nor by polymorphisms of COMT, HTR2A or NR3C1 genes. Conclusions Pain on teeth resulting from orthodontic fixed appliances is stronger during bonds-up and in patients with high catastrophising scores. Demographics, type of clinical activations and the genetic polymorphisms investigated in this research had little or no impact on perceived pain levels.

Background Since in children and adolescence prevalence is assessed mainly on self‐reported or proxy‐reported signs and symptoms; there is a need to develop a more comprehensive standardised process for the collection of clinical information and the diagnosis of TMD in these populations. Objective To develop new instruments and to adapt the diagnostic criteria for temporomandibular disorders (DC/TMD) for the evaluation of TMD in children and adolescents. Method A modified Delphi method was used to seek international consensus among TMD experts. Fourteen clinicians and researchers in the field of oro‐facial pain and TMD worldwide were invited to participate in a workshop initiated by the International Network for Orofacial Pain and Related Disorders Methodology (INfORM scientific network) at the General Session of the International Association for Dental Research (IADR, London 2018), as the first step in the Delphi process. Participants discussed the protocols required to make physical diagnoses included in the Axis I of the DC/TMD. Thereafter, nine experts in the field were added, and the first Delphi round was created. This survey included 60 statements for Axis I, and the experts were asked to respond to each statement on a five‐item Likert scale ranging from ‘Strongly disagree’ to ‘Strongly agree’. Consensus level was set at 80% agreement for the first round, and at 70% for the next. Results After three rounds of the Delphi process, a consensus among TMD experts was achieved and two adapted DC/TMD protocols for Axis I physical diagnoses for children and adolescents were developed. Conclusion Through international consensus among TMD experts, this study adapted the Axis I of the DC/TMD for use in evaluating TMD in children and adolescents., The Delphi process included three round and was used to was used to seek international consensus for Axis I assessment among 23 TMD experts. Thanks to this Delphi study, experts developed new instruments that aim to assess physical diagnoses (Axis I) of TMDs in children and in adolescents, by modifying the DC/TMD for adults.

To compare the frequency of patients' oral health problems and prevention needs among Slovenian and international dentists with the aim to validate the four oral health-related quality of life (OHRQoL) dimensions across six clinical dental fields in all World Health Organization (WHO) regions.An anonymous electronic survey in the English language was designed using Qualtrics software. A probability sampling for Slovenia and a convenience sampling strategy for dentist recruitment was applied for 31 countries. Dentists engaged in six dental fields were asked to categorize their patients' oral health problems and prevention needs into the four OHRQoL dimensions (Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact). Proportions of patients' problems and prevention needs were calculated together with the significance of Slovenian and international dentists' differences based on dental fields and WHO regions.Dentists (n=1,580) from 32 countries completed the survey. There were 223 Slovenian dentists (females: 68%) with a mean age (SD) of 41 (10.6) years and 1,358 international dentists (females: 51%) with a mean age (SD) of 38 (10.4). Pain-related problems and prevention needs were the most prevalent among all six dental fields reported by dentists; Slovenian (37%) and 31 countries (45%). According to Cohen, differences between Slovenia, the broader European Region, and 31 countries were considered non-significant (0.1).According to the dentists' responses, the frequency of patients' oral health problems and prevention needs are proportionate between Slovenia and 31 countries, regionally and globally. The four OHRQoL dimensions can be considered universal across all dental fields.V raziskavi smo želeli primerjati pogostost ustno-obraznih težav in potreb po preventivnem zdravju zobozdravstvenih pacientov med slovenskimi in mednarodnimi zobozdravniki s pomočjo spletne ankete, ki bi potrdila veljavnost štirih dimenzij oralnega zdravja v šestih kliničnih zobozdravstvenih specialnostih iz vseh svetovnih regij, kot jih določa Svetovna zdravstvena organizacija.V programski opremi Qualtrics smo v angleškem jeziku izdelali anonimno spletno anketo z namenom kategorizirati ustno-obrazne težave in preventivne ukrepe zobozdravstvenih pacientov v štiri dimenzije oralnega zdravja (funkcionalna, bolečinska, estetska in psihosocialna) na osnovi šestih stomatoloških specialnosti. Naključno vzorčenje smo uporabili za slovenske zobozdravnike, medtem ko smo za zobozdravnike iz 31 držav uporabili priložnostno vzorčenje. Za preverjanje pacientovih ustno-obraznih težav ter njihove potrebe po zdravljenju na osnovi zobozdravnikove ocene smo uporabili razmerja v odstotkih. Velikost učinka smo računali za preverjanje razlik med slovenskimi in tujimi zobozdravniki iz vseh regij po razdelitvi Svetovne zdravstvene organizacije in na osnovi šestih zobozdravstvenih specialnosti.Tisoč petsto osemdeset zobozdravnikov iz 32 držav je izpolnilo spletno anketo. Od tega je bilo 223 slovenskih (68 % žensk) s povprečno starostjo (SD) 41 (10,6) let in 1.358 tujih zobozdravnikov (51 % žensk) s povprečno starostjo (SD) 38 (10,4) let. Slovenski (37 %) in tuji (45 %) zobozdravniki so izbrali ustnoobrazno bolečino kot najpogostejšo težavo in preventivni ukrep pri zobozdravstvenih pacientih v vseh šestih zobozdravstvenih specialnostih. Po Cohenu so bile razlike med slovenskimi in pacienti iz drugih držav z ustnoobraznimi težavami in pri preventivnih ukrepih zelo majhne (0,1).Ustno-obrazne težave zobozdravstvenih pacientov in njihove potrebe po zdravljenju znotraj vseh šestih zobozdravstvenih specialnosti so v Sloveniji in drugih 31 državah, regionalno in globalno, primerljive. Vse štiri dimenzije podpirajo zobozdravnikov celostni pogled na oralno zdravje in preventivne ukrepe zobozdravstvenih pacientov po svetu in zobozdravstvenih specialnostih.

Objective The dimensions of oral health–related quality of life (OHRQoL) Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the major areas where patients are impacted by oral diseases and dental interventions. The aim of this study was to evaluate whether dental patients' reasons to visit the dentist fit the 4 OHRQoL dimensions. Methods Dentists (N = 1580) from 32 countries participated in a web-based survey. For their patients with current oral health problems, dentists were asked whether these problems were related to teeth, mouth, and jaws' function, pain, appearance, or psychosocial impact or whether they do not fit the aforementioned 4 categories. Dentists were also asked about their patients who intended to prevent future oral health problems. For both patient groups, the proportions of oral health problems falling into the 4 OHRQoL dimensions were calculated. Results For every 100 dental patients with current oral health problems, 96 had problems related to teeth, mouth, and jaws' function, pain, appearance, or psychosocial impact. For every 100 dental patients who wanted to prevent future oral health problems, 92 wanted to prevent problems related to these 4 OHRQoL dimensions. Both numbers increased to at least 98 of 100 patients when experts analyzed dentists' explanations of why some oral health problems would not fit the four dimension. For the remaining 2 of 100 patients, none of the dentist-provided explanations suggested evidence against the OHRQoL dimensions as the concepts that capture dental patients' suffering. Conclusion Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact capture dental patients' oral health problems worldwide. These 4 OHRQoL dimensions offer a psychometrically sound and practical framework for patient care and research, identifying what is important to dental patients.

Background and objectives: The aim of the present paper is to use low-dose computed tomography (CT) to evaluate the changes in the midpalatal suture density in patients treated with rapid maxillary expansion (RME) and slow maxillary expansion (SME). Materials and Methods: Thirty patients (mean age 10.2 &plusmn, 1.2 years) were retrospectively selected from the existing sample of a previous study. For each patient, a low-dose computed tomography examination was performed before appliance placement (T0) and at the end of retention (T1), seven months later. Using the collected images, the midpalatal suture density was evaluated in six regions of interest. Results: No significant differences were found between the timepoints in the rapid maxillary expansion group. Three out of six regions of interest showed significant decreases between the timepoints in the slow maxillary expansion group. No significant differences were found in comparisons between the two groups. Conclusions: The midpalatal suture density showed no significant differences when rapid maxillary expansion groups were compared to slow maxillary expansion groups, suggesting that a similar rate of suture reorganization occurs despite different expansion protocols.

The aim of this cross-sectional epidemiologic study was to estimate the prevalence of temporomandibular disorders (TMDs) and oral parafunctions in Italian adolescents and to assess the associations between age, gender, oral habits, and TMD.

The biopsychosocial model is advocated as part of a more comprehensive approach in both medicine and dentistry. However, dentists have not traditionally been taught psychosocial screening as part of their predoctoral education. The aim of this systematic review was to provide an overview of published studies on the implementation of screening for psychological comorbidity in dental and dental hygiene education. The term "psychological comorbidity" refers to the degree of coexisting anxiety, depression, or other mental health problems in a patient presenting with a physical condition. The review followed a protocol registered in PROSPERO (CRD42016054083) and was carried out in accordance with the PRISMA guidelines. The methodological quality of the included studies was assessed using a ten-item tool developed for medical education. The electronic search in PubMed, Scopus, and PsycINFO from the inception of each database until December 31, 2016, together with a hand search, identified 1,777 articles. After abstracts were screened, 52 articles were reviewed in full text applying inclusion and exclusion criteria; four articles remained for the qualitative synthesis. Generally, the reported data on specific methods or instruments used for psychological screening were limited. Only one of the included articles utilized a validated screening tool. The results of this systematic review show that published data on the implementation of psychological patient assessment in dental and dental hygiene education are limited. To address this gap, the authors recommend short screening tools such as the Graded Chronic Pain Scale and the Patient Health Questionnaire for Depression and Anxiety. Educating dental and dental hygiene students about easy-to-use, reliable, and validated screening tools for assessing psychological comorbidity warrants more research attention and greater implementation in educational curricula.

Several orthodontic procedures induce pain at some degree during the treatment. Even though orthodontic pain has been extensively studied from the clinical perspective, the spreading of standardized somatosensory examination of the oro-facial structures opens a window on the knowledge of the neurophysiological mechanisms underlying such pain. This article provides an overview on the chairside and comprehensive intraoral somatosensory testing, and summarizes the current findings on the somatosensory changes in orthodontic and orthognathic surgery patients. Signs of sensitization have been reported both during orthodontic treatment and after orthodontic-surgical treatment; therefore, clinicians should be aware of the available psychophysical methods to adequately assess the oro-facial somatosensory functions.

Background Evidence in the field of dentistry has demonstrated the importance of pain-related disability and psychological assessment in the development of chronic symptoms. The Diagnostic Criteria for Temporomandibular Disorders offer a brief assessment for the diagnostic process in patients with orofacial pain (Axis II). The authors describe relevant outcomes that may guide general oral health care practitioners toward tailored treatment decisions and improved treatment outcomes and provide recommendations for the primary care setting. Methods The authors conducted a review of the literature to provide an overview of knowledge about Axis II assessment relevant for the general oral health care practitioner. Results The authors propose 3 domains of the Axis II assessment to be used in general oral health care: pain location (pain drawing), pain intensity and related disability (Graded Chronic Pain Scale [GCPS]), and psychological distress (Patient Health Questionnaire-4 [PHQ-4]). In the case of localized pain, low GCPS scores (0-II), and low PHQ-4 scores (0-5), patients preferably receive treatment in primary care. In the case of widespread pain, high GCPS scores (III-IV), and high PHQ-4 scores (6-12), the authors recommend referral to a multidisciplinary team, especially for patients with temporomandibular disorder (TMD) pain. Conclusions The authors recommend psychological assessment at first intake of a new adult patient or for patients with persistent TMD pain. The authors recommend the pain-related disability screening tools for all TMD pain symptoms and for dental pain symptoms that persist beyond the normal healing period. Practical Implications A brief psychological and pain-related disability assessment for patients in primary care may help the general oral health care practitioner make tailored treatment decisions.

AIMS: To identify in a systematic review with meta-regression the dental and skeletal long-term side effects of mandibular advancement device (MAD) therapy and to evaluate the influence of time. MATERIALS AND METHOD: An electronic search was performed in Medline, Cochrane Database of Systematic Reviews, Google Scholar Beta, ISI Web of Knowledge, Scopus and Lilacs to select randomized controlled trials and cohort studies investigating dental and/or skeletal side effects in adult patients wearing a MAD for obstructive sleep apnoea or snoring treatment for at least two years. The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). For each study included and for each dental and/or skeletal parameter, the mean difference and 95 per cent confidence interval was calculated between baseline and follow-up. RESULTS: Twenty studies with a follow-up between 2 and 11 years were included. The side effects identified were a decrease of overjet, overbite and upper incisor inclination, and an increase of lower incisor inclination, ANB and anterior face height. Meta-regression analysis showed that the side effects were influenced by the therapy duration for all parameters (P < 0.05). According to GRADE, the quality of evidence was moderate for all the outcomes except for lower incisor inclination which was low. CONCLUSION: MAD therapy produced both dental and skeletal side effects which are influenced by the duration of therapy. The dental side effects could be clinically relevant, while the clinical importance of skeletal side effects seems to be questionable. Since the side effects are progressive, patients need to be continuously monitored over time.

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.

To evaluate the prevalence of temporomandibular disorder pain (TMD‐pain), temporomandibular joint (TMJ) noises, oral behaviours in an Italian adult population sample, their possible association with gender, oral behaviours, self‐reported facial trauma and orthodontic treatment. Subjects older than 18 years were recruited from general population in public spaces during their daily life. A specific questionnaire was developed to collect data on TMD‐pain, TMJ noises, oral behaviours, orthodontic treatment and facial trauma. A total of 4299 subjects were included in the study. The most common symptom in the sample was TMJ clicking (30.7%), followed by TMD‐pain (16.3%) and TMJ crepitus (10.3%). Oral behaviours were reported in 29% of the sample; 43.6% of the sample reported a previous or ongoing orthodontic treatment. TMD‐pain and TMJ clicking were significantly associated to gender, oral behaviours and a positive history of previous facial trauma. Crepitus was significantly associated to oral behaviours, facial trauma and higher age. Ongoing orthodontic treatment was significantly associated to TMD‐pain and TMJ sounds. In a general Italian adult population sample, TMD‐pain is associated to female gender and is less prevalent than TMJ clicking. TMDs are associated to trauma and oral behaviours.

Statement of problem. Oral parafunctional behaviors are characterized by an overuse of the masticatory muscles, thus applying aberrant occlusal force to the teeth for prolonged periods. However, whether increased periodontal receptor activity in individuals with a high degree of oral parafunction alters the occlusal sensitivity is unclear. Purpose. The purpose of this clinical study was to evaluate occlusal sensitivity in adults reporting a high or low frequency of awake oral parafunctional behaviors, as assessed with the short version of the oral behavior checklist (OBC-It 6). Material and methods. Self-reporting questionnaires (N=212) were distributed among dental and medical students. Individuals with an OBC-It 6 score below the 20th percentile (low-frequency parafunction (LFP) group: 13 men and 15 women) and above the 80th percentile (high-frequency parafunction [HFP] group: 11 men and 17 women) were selected for the occlusal sensitivity assessment. The occlusal sensitivity was tested with 10 different thicknesses: 9 aluminum foils ranging from 8 μm to 72 μm with a constant increment of 8 μm and 1 sham test without any foil. The testing foils were presented 10 times in random order (100 tests in total). The participants were instructed to close their mouth only once and to report whether they felt the aluminum foil between their teeth. A between-group comparison (HFP versus LFP) was performed for each testing thickness (Student t test for unpaired data, Bonferroni correction) (α=.005). Results. For the sham test and for the testing thicknesses between 8 μm and 48 μm, no statistically significant differences were found between the 2 groups. The thicknesses 0.56 mm, 0.64 mm, and 0.72 mm were significantly better perceived in the HFP group than in the LFP group (P

The clinical practice guidelines do not give precise indications on the use of mandibular advancement devices (MAD) for obstructive sleep apnea (OSA) patients when they suffer from temporomandibular disorders (TMD). The aim of this systematic review was to evaluate the effects of MADs on prevalence of TMD signs and symptoms in adult OSA patients. The study protocol was registered under the PROSPERO register and an electronic search was performed in several databases. All types of studies evaluating TMD prevalence on adult patients wearing MAD for OSA were included and independently evaluated by two investigators. The quality of evidence was evaluated using the grading of recommendations assessment, development and evaluation and the risk of bias by the risk of bias in non-randomized studies of interventions tool or the Cochrane collaboration's tool. For each study included, the difference in means and 95% CI was calculated between baseline and follow-up. Twelve studies were included. The meta-regression analysis showed that patients with pre-existing signs and symptoms of TMD do not experience significant exacerbation of symptoms using the MAD. The presence of TMD does not appear to be routine contraindication for the use of MAD used for the management of OSA.

Background The prevalence of malocclusion, temporomandibular disorders (TMD) and oral parafunctions is highly debated in children population. Objectives To investigate the prevalence of malocclusion, self-reported oral parafunctions and TMD-pain in Italian schoolchildren and to assess the association between the examined factors. Methods A total of 700 children aged 9-11 years were selected among six public schools in Campania region (Italy). Molar relationship, overjet, overbite and cross-bite were assessed through a clinical examination. Furthermore, the subjects were demanded to fill in a validated questionnaire for TMD-pain screening and the short form of the Oral Behaviours Checklist. Descriptive statistics were used to report the frequencies. The associations between occlusal traits, oral parafunctions and TMD-pain were analysed with a Pearson chi-square test, as expressed by odds ratio and 95% confidence intervals. The significance level was set at P < 0.05. Results Molar Class I was the most frequently encountered molar relationship, followed by molar Class II, subdivision and molar Class III. Increased overjet was more common than negative overjet. Posterior cross-bite was observed in 12% of children. TMD-pain was recorded in 14.7% of subjects. High frequency of oral parafunctions was reported in 21.3% of subjects. A significant association was found between TMD-pain and negative overbite. Cross-bite and high frequency of oral parafunctions were associated with TMD-pain. Conclusion The current results show that malocclusion, self-reported oral parafunctions and TMD-pain are frequent findings among Italian schoolchildren and that some occlusal factors and high frequency of oral parafunctions might be associated with TMD-pain.

This is a pre-copyediting, author-produced PDF of an article accepted for publication in The Journal of Rheumatology following peer review. The definitive publisher-authenticated version Stoustrup, P., Resnick, C.M., Pedersen, T.K., Abramowicz, S., Michelotti, A., Küseler, A. ...Twilt, M. (2019). Standardizing Terminology and Assessment for Orofacial Conditions in Juvenile Idiopathic Arthritis: International, Multidisciplinary Consensus-based Recommendations. The Journal of Rheumatology, 46(5), is available online at: https://doi.org/10.3899/jrheum.180785. Objective - To propose multidisciplinary, consensus-based, standardization of operational terminology and method of assessment for temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA). Methods - Using a sequential expert group–defined terminology and methods-of-assessment approach by (1) establishment of task force, (2) item generation, (3) working group consensus, (4) external expert content validity testing, and (5) multidisciplinary group of experts final Delphi survey consensus. Results - Seven standardized operational terms were defined: TMJ arthritis, TMJ involvement, TMJ arthritis management, dentofacial deformity, TMJ deformity, TMJ symptoms, and TMJ dysfunction. Conclusion - Definition of 7 operational standardized terms provides an optimal platform for communication across healthcare providers involved in JIA-TMJ arthritis management.

Aim. To evaluate the biomechanical effects of four different auxiliary-aligner combinations for the extrusion of a maxillary central incisor and to define the most effective design through finite element analysis (FEA). Materials and Methods. A full maxillary arch (14 teeth) was modelled by combining two different imaging techniques: cone beam computed tomography and surface-structured light scan. The appliance and auxiliary element geometries were created by exploiting computer-aided design (CAD) procedures. The reconstructed digital models were imported within the finite element solver (Ansys® 17). For the extrusion movement, the authors compared the aligner without an attachment with three auxiliary-aligner designs: a rectangular palatal attachment, a rectangular buccal attachment, and an ellipsoid buccal attachment. The resulting force-moment (MF) system delivered by the aligner to the target tooth and the tooth displacement were calculated for each scenario. Results. The maximum tooth displacement along the z-axis (0.07 mm) was obtained with the rectangular palatal attachment, while the minimum (0.02 mm) was obtained without any attachments. With the ellipsoid attachment, the highest undesired moments Mx and My were found. The rectangular palatal attachment showed the highest Fz (2.0 N) with the lowest undesired forces (Fx = 0.4 N; Fy = −0.2 N). Conclusions. FEA demonstrated that the rectangular palatal attachment can improve the effectiveness of the appliance for the extrusion of an upper central incisor.

It is strongly recommended that the gold standard for the diagnosis of TMD according to the DC/TMD and the differential diagnosis of orofacial pain conditions should be based primarily on information obtained from a comprehensive history together with a clinical examination and, when indicated, TMJ imaging (Schiffman and Ohrbac, JADA 147(6):438–445, 2016). Indeed for the TMJ disorders, the reference standard was established by board-certified radiologists using bilateral TMJ magnetic resonance imaging (MRI) and computed tomography (CT). Together with the physical diagnosis (Axis I), questionnaires for the evaluation of psychosocial factors were identified to assess a reliable and valid Axis II profile [Ohrbach, J Oral Rehabil 37:784–798, 2010). When the clinician uses the Axis I, diagnoses must first exclude odontogenic disease and other pain disorders that can occur in the masticatory system.

Background Constricted maxilla is frequently associated with reduced nasal airway dimensions. Wheatear skeletal maxillary expansion (ME) is effective on the dimension of the upper airways is still a debated issue. Objectives This overview aimed to report the evidence provided by systematic reviews (SRs) on the effect of ME on the upper airways and to assess the methodological quality of the included SRs. Methods Six electronic databases have been explored up to November 2017. After title and abstract screening, SRs addressing the effects of fixed palatal expanders on the dimension and function of the nasal airways were included. The methodological quality of the included SRs was assessed using the updated version of A Measurement Tool to Assess Systematic Review (AMSTAR-2). Results Eight SRs were included. The methodological quality of most of the included SRs ranged between low and critically low. One SR was rated of high quality. A significant increase in nasal linear dimensions was reported both in the short and long term, but supported by low-/critically low-quality SRs. The significant increase in nasal cavity volume was the only outcome supported by a high-quality SR Controversial results were found with regards to nasal function. Conclusion Whenever a constricted maxilla is present general dentists, paediatricians and ENTs should be familiar with the potential improvement provided by ME. However, due to the low/critically low quality of SRs supporting these results, ME cannot be indicated only for upper airways enhancement, but should be supported by an orthodontic indication.

Background: Of the various malocclusions, unilateral posterior crossbite has often been associated to skeletal and muscular asymmetrical growth and function. Objective: To assess, by systematically reviewing the literature, the association between unilateral posterior crossbite (UPCB) and morphological and/or functional asymmetries (i.e. skeletal, masticatory muscle electromyographic (EMG) performance, bite force, muscle thickness, and chewing cycle asymmetries). Materials and Methods: A literature survey covering the period from January 1965 to June 2015 was performed. Two reviewers extracted the data independently and assessed the quality of the studies. Results: The search strategy resulted in 2184 citations, of which 45 met the inclusion criteria. The scientific and methodological quality of these studies was medium–low, irrespective of the association reported. In several studies, posterior crossbite is reported to be associated to asymmetries in mandibular skeletal growth, EMG activity, and the chewing cycle. Fewer data are available on bite force and masticatory muscle thickness. Conclusions: The relationship between unilateral posterior crossbite and skeletal asymmetry is still unresolved. To date, most of the studies available report a skeletal asymmetric growth. EMG activity of masticatory muscles is different between crossbite and non-crossbite sides. Subjects with UPCB show smaller bite force than non-crossbite subjects. There is no consistency of studies reporting masticatory muscle thickness asymmetry in UPCB subjects. UPCB is associated to an increase in the reverse chewing cycle. The literature available on the subject is of medium–low scientific and methodological quality, irrespective of the association reported. Further investigations with higher sample size, well-defined diagnostic criteria, rigorous scientific methodologies, and long-term control are needed.

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.

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.

Oral parafunction during waking comprises possible behaviors that can be measured with a comprehensive checklist or behavioral monitoring. Multiple studies lead to largely consistent findings: stressful states can trigger parafunctional episodes that contribute to myofascial pain. However, this simple causal pathway coexists with at least 3 other pathways: anxiety and stress are potent direct contributors to pain, pain results in maladaptive behaviors such as parafunction, and parafunction may be a coping response to potential threat coupled with hypervigilance and somatosensory amplification. Awake parafunction remains an important risk factor for myofascial pain onset and overuse models alone of causation are insufficient.