Impact of Academic Stress on Temporomandibular Disorders in Teenagers - A Physiology Based Management

Temporomandibular disorders

ABSTRACTIntroduction: The use of antidiabetic drugs is expected to substantially increase since diabetes mellitus incidence rises. Currently used antidiabetic drugs have a positive safety profile, but they are associated with certain acid-base and electrolyte abnormalities. The aim of the review is to present the current data regarding the antidiabetic drugs-associated acid-base and electrolyte abnormalities.Areas covered: Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been linked with the scarce, but serious, complication of euglycemic diabetic ketoacidosis, as well as with an increase in serum potassium, magnesium and phosphorus levels. Metformin use has been associated with the development of lactic acidosis, although many studies have doubt the direct link with this serious complication. Additionally, metformin in some studies has been linked with a decrease in serum magnesium levels. Insulin administration is associated with a reduction in serum potassium, magnesium and phosphorus concentration, along with reduced renal magnesium excretion. Pioglitazone is associated with an increase in serum magnesium levels. Current data regarding the pathophysiological mechanisms, precipitants, risk factors and presentation of the above abnormalities are discussed in the present review.Expert opinion: Clinicians should choose appropriately between antidiabetic drugs based not only on their hypoglycemic efficacy and effects on cardiovascular risk but also based on the patient’s specific risk to develop acid-base or electrolyte derangements.

Temporomandibular disorders (TMDs) encompass numerous clinical complications that involve the temporomandibular joint (TMJ), masticatory musculature, and its associated structures, or both. Abundant research in this field has been conducted; however, there is no conclusive evidence reported in the effective management of TMD using physical therapy such as Transcutaneous Electric Nerve Stimulation (TENS). The systematic review and meta-analysis aimed to compare and evaluate the efficacy of transcutaneous electric nerve stimulation over systemic pharmacotherapies in the management of symptomatic patients with temporomandibular joint disorders. The present review has been registered with PROSPERO – An international prospective register of systematic review (CRD42021233019). An electronic search was done in PubMed, Cochrane Library, Science Direct, Google Scholar, Latin American and Caribbean Health Sciences Literature (LILACS), ClinicalTrial.gov, and sci-hub.se. Manual electronic searches were also carried out and articles were handpicked. The assessments of articles were done using selection criteria. There are a vast number of studies done in this subject of interest and hence, only prospective clinical trials like Randomized clinical trials (RCTs) and controlled clinical trials (CCTs) were included in this review. A total of three studies were included in this review, which consisted of prospective RCTs and CCTs. Two studies have been reported for meta-analysis. The included studies show TENS is proven to be effective in the management of TMD. The currently available evidence was insufficient to conclude the effectiveness of transcutaneous electric nerve stimulation and systemic pharmacotherapies in temporomandibular joint disorders. Based on the results of the meta-analysis, we can conclude that there was a significant reduction in pain encountered due to TENS.

Background: Academic stress significantly influences students' mental and physical health. Despite extensive research on its psychological effects, the impact on oral health, particularly temporomandibular disorders (TMD) and bruxism, remains underexplored. This study addresses this gap by investigating the correlation between academic stress, TMD, and bruxism, emphasizing gender differences among Palestinian university students. Methods: We conducted a cross-sectional survey involving 10,000 students from the University of Palestine. Participants responded to a structured questionnaire assessing the prevalence of TMD and bruxism symptoms and their perceived academic stress levels. We utilized chi-square tests and logistic regression, controlling for age, gender, and academic year, to analyze the data. Results: The findings indicate a robust association between heightened academic stress and increased reports of bruxism and TMD, particularly among female students. These conditions were more prevalent among upper-year students, suggesting a link with escalating academic obligations and stress. Conclusions: Academic stress is a critical factor affecting oral health, manifesting in significant bruxism and TMD prevalence, especially in female students and those in later academic stages. The study underscores the necessity for targeted stress management and oral health initiatives within academic settings. Keywords: Academic Stress, Bruxism, Temporomandibular Disorders, Oral Health, Gender Differences, Palestinian Universities

Regression to the mean in treated versus untreated chronic pain

Differential diagnosis of facial pain and guidelines for management

Background: Since the historical era, natural herbs and extracts have been utilized against many illnesses. Temporomandibular disorders (TMDs) are an assemblage of painful symptoms credited as the second most common musculoskeletal chronic pain disorder requiring long-term treatment. Thus, an effective sustainable cost-efficient protocol for maintenance therapy of herbal origin is the mandate of the hour. Objective: The objective is to evaluate the efficacy of medications of herbal origin in the management of TMD. Methods: Of the randomized controlled trials published, a systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines to quantify the efficacy of alternative topical medicaments in the TMD pain management. MEDLINE, Cochrane, Scopus, Web of Science, and Google Scholar were systematically searched to September 9, 2024. Results: Seven articles conforming to the inclusion and exclusion criteria were selected. The data were segregated, and Forest plot was derived. It was determined the efficacy of herbal origin medicaments is as effective as the standard topical analgesics in pain management. The costs of the treatments were estimated and found to be an economic sustainable option for the future. Conclusion: Topical medicaments of natural/herbal origin are as effective as conventional therapies in TMD pain control. Their ease on the patient pocket and the ability to contribute to economy building sustainably is an incentive for further development in this area of limited exploration and innovation. Registration: This systematic review and metanalysis is registered with PROSPERO.

There has been a long history of using occlusal adjustment in the management of temporomandibular disorders (TMD). It is not clear if occlusal adjustment is effective in treating TMD. To assess the effectiveness of occlusal adjustment for treating TMD in adults and preventing TMD. We searched the Cochrane Oral Health Group's Trials Register (April 2002); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2002); MEDLINE (1966 to 8th April 2002); EMBASE (1980 to 8th April 2002) and handsearched journals of particular importance to this review. Additional reports were identified from the reference lists of retrieved reports and from review articles of treating TMD. There were no language restrictions. Unpublished reports or abstracts were considered from the SIGLE database. All randomised or quasi-randomised controlled trials (RCTs) comparing occlusal adjustment to placebo, reassurance or no treatment in adults with TMD. The outcomes were global measures of symptoms, pain, headache and limitation of movement. Data were independently extracted, in duplicate, by two reviewers, Holy Koh (HK) and Peter G Robinson (PR). Authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out. The Cochrane Oral Health Group's statistical guidelines were followed and relative risk values calculated using random effects models where significant heterogeneity was detected (P<0.1). Over 660 trials were identified by the initial search. Six of these trials, which reported results from a total of 392 patients, were suitable for inclusion in the review. From the data provided in the published reports, symptom-based outcomes were extracted from trials on treatment. Data on incidence of symptoms were extracted from trials on prevention. Neither showed any difference between occlusal adjustment and control group. There is an absence of evidence, from RCTs, that occlusal adjustment treats or prevents TMD. Occlusal adjustment cannot be recommended for the management or prevention of TMD. Future trials should use standardised diagnostic criteria and outcome measures when evaluating TMD.

Objectives. This trial aimed to test the effectiveness of a wearable pulsed electromagnetic fields (PEMF) device in the management of pain in knee OA patients.Methods. In this randomized [with equal randomization (1:1)], double-blind, placebo-controlled clinical trial, patients with radiographic evidence of knee OA and persistent pain higher than 40 mm on the visual analog scale (VAS) were recruited. The trial consisted of 12 h daily treatment for 1 month in 60 knee OA patients. The primary outcome measure was the reduction in pain intensity, assessed through VAS and WOMAC scores. Secondary outcomes included quality of life assessment through the 36-item Medical Outcomes Study Short-Form version 2 (SF-36 v2), pressure pain threshold (PPT) and changes in intake of NSAIDs/analgesics.Results. Sixty-six patients were included, and 60 completed the study. After 1 month, PEMF induced a significant reduction in VAS pain and WOMAC scores compared with placebo. Additionally, pain tolerance, as expressed by PPT changes, and physical health improved in PEMF-treated patients. A mean treatment effect of −0.73 (95% CI − 1.24 to − 0.19) was seen in VAS score, while the effect size was −0.34 (95% CI − 0.85 to 0.17) for WOMAC score. Twenty-six per cent of patients in the PEMF group stopped NSAID/analgesic therapy. No adverse events were detected.Conclusion. These results suggest that PEMF therapy is effective for pain management in knee OA patients and also affects pain threshold and physical functioning. Future larger studies, including head-to-head studies comparing PEMF therapy with standard pharmacological approaches in OA, are warranted.Trial registration: ClinicalTrials.gov, http://www.clinicaltrials.gov, NCT01877278

AimThe first step in the management of Temporomandibular Disorders (TMD) is usually noninvasive, especially if the disorder is in the early stages. Clinically, pain and clicking are early signs and symptoms of TMD. The management of TMD usually includes “splint therapy” and analgesics. In this study, we report our long-term outcomes in the treatment of patients suffering from early TMD.Materials and Methods:We assessed the records of 138 patients who were referred for management of TMD. Selection was based on pain and/or clicking of the Temporomandibular Joint (TMJ), no pathologic lesions of the TMJ, no anterior disc displacement without reduction (closed lock), no Degenerative Joint Disease, no history of migraine, trauma, osteoarthritis, metabolic disease, or malocclusion (deep bite, cross bite, jaw deformity, etc). The patients were treated with an acrylic maxillary Interocclusal Splint (IOS) cuspid-rise type and were told to refrain from biting, yawning and chewing hard food. The outcome of the treatment, potential etiologic factors (Bruxism), signs and symptoms and patient demographics (such as age, sex, treatment duration, etc.) were assessed. The data were analyzed using the Chi-square test to correlate significance.Results:One hundred thirty-eight patients (26 males and 112 females) with early signs and symptoms of TMD (pain and/or click of the TMJ) were treated from 2001 to 2010; 81% were females and 19% were males. All the 138 patients used the IOS at night only. The patients were followed-up for 1–9 years. Data analysis showed that 64% of the patients were completely relieved of signs and symptoms; 22% were moderately relieved (decreased severity of signs and symptoms) and 14% had no noticeable post-treatment changes in clicking or pain (P = 0.001). Patients with bruxism and those presenting with both pain and clicking showed a better response to IOS treatment (P = 0.046 and P = 0.001, respectively). The results also showed that age, sex, severity of symptoms and duration of the treatment did not influence treatment results in this group of patients with early TMD.Conclusion:In this population, TMD was significantly higher in females. Treatment of early TMD with IOS was effective and moderately effective in long-term in over 80% of the patients during the follow-up period of 1–9 years. Bruxism had a significant etiologic role in TMD; occlusal attrition of the dentition, pain of all the teeth, early morning pain of the masticatory muscles and the TMJ are signs and symptoms to suspect nocturnal bruxism. Use of an IOS is recommended to prevent potential damage to the dentition, periodontium and the TMJ in early TMD.

An inadequate and imbalanced intake of protein and energy results in protein-energy malnutrition (PEM). It is known that bone mineral density and serum magnesium levels are low in malnourished children. However, the roles of serum magnesium and endothelin-1 (ET-1) levels in the pathophysiology of bone mineralization are obscure. Thus, the relationships between serum magnesium and ET-1 levels and the changes in bone mineral density were investigated in this study. There was a total of 32 subjects, 25 of them had PEM and seven were controls. While mean serum ET-1 levels of the children with kwashiorkor and marasmus showed no statistically significant difference, mean serum ET-1 levels of both groups were significantly higher than that of the control group. Serum magnesium levels were lower than normal value in 9 (36%) of 25 malnourished children. Malnourished children included in this study were divided into two subgroups according to their serum magnesium levels. While mean serum ET-1 levels in the group with low magnesium levels were significantly higher than that of the group with normal magnesium levels (p < 0.05), mean bone mineral density and bone mineral content levels were significantly lower (p < 0.05). In conclusion, many factors play a role in the pathophysiology of changes in bone mineral density in malnutrition. Our study suggested that lower magnesium levels and higher ET-1 levels might be important factors in changes of bone mineral density in malnutrition. We recommend that the malnourished patients, especially with hypomagnesaemia, should be treated with magnesium early.

Effect of potassium magnesium citrate on thiazide-induced hypokalemia and magnesium loss.

At present, college students mental health issues have caught the social attention. A large number of studies found that mental health issues among college students are related to academic pressure. Thus, this study aims to understand how uncertainty of tolerance and future time perspective affect academic pressure..This study has 309 participants from China. They need to fill in four questionnaires, including the future time perspective questionnaire, academic stress questionnaire, uncertainty of tolerance questionnaire, and mental health questionnaire. Using structural equation modelling (SEM), the result showed that the association between academic stress and mental health was mediated by uncertainty of tolerance and future time perspective separately. The relationship between academic stress and mental health may then be impacted by uncertainty of tolerance, which could as chain mediation to forecast future time perspectives. This study focuses on the effects of uncertainty tolerance and future time perspective between college students academic stress and mental health. Mental health is directly affected by academic stress, but uncertainty of tolerance and future time perspective play a mediating role, predisposing to anxiety to some extent.

The objective of this study was to analyze the effectiveness of two nonpharmacological interventions—traditional Brazilian diet (DieTBra), and extra-virgin olive oil (EVOO)—in terms of the reduction in pain and pain intensity in individuals with severe obesity. We conducted a 12-week parallel randomized clinical trial with 149 individuals (body mass index (BMI) ≥ 35 kg/m2) who were randomized into three groups: supplementation with EVOO (n = 50), DieTBra (n = 49), and EVOO + DieTBra (n = 50). Of the total, 133 individuals with a mean BMI of 46.04 kg/m2 completed the study. By the end of the follow-up, there was a reduction in severe pain in the EVOO + DieTBra group (p = 0.003). There was a significant reduction in severe pain in the EVOO + DieTBra group (−22.7%); pain in the wrist and hand (−14.1%), upper back (−26.9%), and knees (−18.4%) in the DieTBra group; and reduction in hip pain (−11.1%) with EVOO consumption. We conclude that EVOO and DieTBra, either alone or in combination, are effective interventions to reduce pain intensity and pain in different regions in individuals with severe obesity, and have great potential for clinical application.

Clinical studies have shown that sevelamer hydrochloride improves lipid profiles and attenuates the progression of the cardiovascular calcifications in haemodialysis patients. It is known that both of these properties are associated with increased magnesium levels. The effect of sevelamer on serum magnesium level is not well documented. The aim of this study was to determine the effects of sevelamer treatment on serum magnesium in haemodialysis patients and to assess the association of magnesium levels with lipid profiles and intact parathyroid hormone (iPTH). Phosphate binders were discontinued during a two week washout period. Forty-seven patients, whose serum phosphate was greater than 6.0 mg/dl at the end of washout, received sevelamer hydrochloride for eight weeks. The patients were then washed off sevelamer for another two weeks. Mean serum phosphorus concentration declined from 7.5 +/- 1.3 to 6.4 +/- 1.2 mg/dl (P < 0.001), mean serum magnesium levels increased from 2.75 +/- 0.35 to 2.90 +/- 0.41 mg/dl (P < 0.001) and median serum iPTH levels decreased from 297 to 213 pg/ml (P=0.001) during the eight weeks of sevelamer treatment. After the two week post-treatment washout phosphorus levels increased to 7.3 +/- 1.3 mg/dl (P < 0.001), magnesium levels were reduced to 2.77 +/- 0.39 mg/dl (P < 0.001) and iPTH levels increased to 240 pg/ml (P=0.012). No change was observed in serum calcium levels during the sevelamer treatment period and the subsequent washout period. The mean decline in total and low density lipoprotein (LDL) cholesterol during sevelamer treatment was 16.3 and 28.3 (P < 0.001), respectively. The mean increase in high density lipoprotein (HDL) cholesterol and in apolipoprotein A1 was 2.9 +/- 5.8 mg/dl (P=0.004) and 6.8 +/- 11.1 mg/dl (P=0.001), respectively. Multivariate analysis showed that the rise in serum magnesium concentration significantly correlated with reductions in iPTH levels (r=-0.40, P=0.016), but did not have any significant correlation with the changes in lipid profiles. Our findings indicate that patients on haemodialysis receiving sevelamer have a significant increase in serum magnesium concentrations. This increase in serum magnesium is associated with reduction in iPTH levels. The changes in lipid profiles of these patients however are not related to changes in serum magnesium levels.