Orofacial Pain Symptoms Research Articles

Evaluation of orofacial pain and psychological comorbidities in health sciences university students

Introduction: Orofacial pain (OP) is a common public health problem among the general population however, its distribution among the young population like students has not been evaluated so far. The objectives of this study were to investigate the self-reported prevalence, and characteristics of OP, and to evaluate its association with psychological comorbidities such as anxiety and depression. Materials and Methods: A questionnaire-based study was conducted on students studying health sciences programs at SEGi University, Malaysia. A well-designed, structured questionnaire was utilized to assess the prevalence and characteristics of OP. Hospital Anxiety and Depression (HAD) scale was used to evaluate the psychological status of the students. The collected data was subject to statistical analysis by using the SPSS version 22 software. Results: Overall 494 university students had participated in the study of which, 78% (n = 375) of students had suffered from OP and it was significantly higher among the female students (p < 0.03). Headache was the most common type of OP (66.2%) followed by pain in temple region (47.2%), in and around eyes (29.1%), facial region (23.3%), and tooth/gingival pain (20.9%). The association between the prevalence of OP and anxiety was statistically significant (p < 0.019). About 35.4% of the health sciences students had first OP episode started three months ago, 4.2% had daily pain, 14.3% suffered from continuous pain, and only 14% of the students had consulted professionals and 36.1% of them took medication. Conclusion: A significantly higher prevalence of self-reported OP was evident among the health sciences university students and students with different types of OP had higher anxiety and depression scores. Early recognition of OP symptoms and associated comorbidities must be considered for the prevention and successful management of these conditions to circumvent its negative academic impact on the students.

Integrative treatment concept for chronic orofacial pain and temporomandibular disorders

The interdisciplinary Orofacial Pain Unit at the Center of Dental Medicine of the University of Zurich celebrates its 15th anniversary. This article outlines the evidence-based integrative treatment concept with a focus on psychosocial aspects of pain. We exemplify how the evaluation and treatment by a pain psychologist complements the dental therapy. For example, self-management techniques can assist in reducing apprehension, worries and fears, which are often associated with an increased tone of the masticatory muscles. Manifestations include clenching and grinding of teeth, orofacial pain, and other less specific symptoms such as tinnitus. The clinical relevance is illustrated by selected case studies from routine clinical practice.

The differential impact of neuropathic, musculoskeletal and neurovascular orofacial pain on psychosocial function.

While the psychosocial morbidity of orofacial pain (OFP) is widely recognized, the differential impact of musculoskeletal, neuropathic and neurovascular symptoms on pain and psychosocial function in individuals with and without coexisting OFP conditions is unclear. This was a comparative cross-sectional study of 350 consecutive patients attending an OFP clinic; 244 completed standardized self-report measures of pain experience, mood, and generic and oral health-related quality of life (HRQoL). The impact of musculoskeletal, neuropathic and neurovascular symptoms on measures was assessed using linear and logistic generalized linear models. Two hundred patients were diagnosed with a neuropathic condition: 125 with musculoskeletal pain and 101 with (neurovascular) headache disorders. 23% of patients presented with multiple OFP conditions; this was more common in patients with neurovascular (62%) than neuropathic (21%) and/or musculoskeletal orofacial symptoms (28%). Patients with neurovascular symptoms experienced significantly higher levels of pain, evidenced less pain self-efficacy and had poorer overall health. Neuropathic OFP was significantly associated with greater psychological and social oral health disability. Multiple OFP symptoms were not linked to pain severity or psychosocial function, although health scores were worse for patients with neurovascular pain and neuropathic/musculoskeletal symptoms compared with patients with only neurovascular symptoms. The profile and degree of psychosocial morbidity in patients with OFP is significantly related to the types of presenting orofacial symptoms. Patients with neurovascular pain present with higher pain levels and have poorer health while those with neuropathic pain have higher oral functional morbidity; both may require more complex multidisciplinary management.

Temporomandibular disorders: Guidelines and Self-Care for Patients During COVID-19 Pandemic

Background: Temporomandibular disorder (TMD) belongs to a heterogeneous group of musculoskeletal and neuromuscular conditions involving the temporomandibular joint complex, musculature and adjacent components. These conditions can generate signs and symptoms and be influenced by an altered biopsychosocial condition. Objective: This study aims to seek information to assist the patient in the presence of TMD signs and symptoms and Orofacial Pain, associated with the period of social isolation during the COVID-19 pandemic. Material and methods: For the preparation of this manual, a bibliographic search was performed in the databases PubMed, Latin American and Caribbean Health Sciences Literature (LILACS), BBO (BVS), Scopus, Web of Science and The Cochrane Library, using the keywords: orofacial pain, temporomandibular disorders, bruxism, stress, anxiety, biopsychosocial, diagnosis, self-care with important information on how to reduce and control the signs and symptoms of TMD and Orofacial Pain in this moment of pandemic that we are experiencing a social detachment. Results: The results show that the pandemic of COVID-19 and the need for social isolation, generates psychological impact that raises the pattern of anxiety and can directly affect patients with bruxism and TMD. Conclusion: Psychological factors associated with the pandemic can lead to an increased risk of developing, worsening and perpetuating bruxism, especially waking bruxism and TMD, so dentists should be aware of the occurrence of signs and symptoms to manage the multifactorial aspects of this condition. At that time, individual self-management strategies are advised for the patient, which consist of self-massage techniques, body education, exercise practices, sleep hygiene, meditation and making available the use of tools and online devices that facilitate this activity.KeywordsOrofacial pain; Temporomandibular disorders; Bruxism; Stress; Anxiety; Biopsychosocial; Diagnosis; Self-care; COVID-19.

Orofacial pain in juvenile idiopathic arthritis is associated with stress as well as psychosocial and functional limitations

BackgroundThe aim of this study was to investigate relations between psychosocial factors, signs and symptoms of orofacial pain and jaw dysfunction in patients with juvenile idiopathic arthritis (JIA).MethodsForty-five patients with JIA (median age 12 years) and 16 healthy matched controls (median age 13 years) were examined according to the diagnostic criteria for temporomandibular disorders (DC/TMD). The subjects answered the DC/TMD questionnaires regarding psychosocial factors (pain intensity, pain–related disability, depression, stress, catastrophizing, pain locations and jaw function).ResultsJIA patients with orofacial pain had higher degree of stress, depression, catastrophizing and jaw dysfunction compared to subjects without. In turn, these factors were associated with orofacial pain intensity. Also, patients with orofacial pain had higher systemic inflammatory activity.ConclusionsOrofacial pain in patients with JIA is associated with stress, psychological distress, jaw dysfunction and loss of daily living activities. Pain intensity seems to be the major pain aspect related to these factors. In addition, systemic inflammatory activity appears to be an important factor contributing to orofacial pain in JIA.

Orofacial pain and its relationship with oral health-related quality of life and psychological distress in middle-aged women

Objective: To investigate the relationship between subjective symptoms of orofacial pain and oral health-related quality of life (OHRQoL), as well as psychological distress in population-based middle-aged women.Material and methods: The two study samples comprised 1059 women, 38 and 50 years old, in representative cross-sectional studies. Women with long-lasting, frequent pain or headaches, related to temporomandibular disorders (TMD), with moderate-to-high estimates were analysed in relation to the non-case group. OHRQoL was measured using the Oral Health Impact Profile (OHIP-5). Psychological distress was measured using the Hospital Anxiety and Depression Scale (HADS) and Sense of Coherence (SOC-13).Results: Women with orofacial pain (n = 82, 7.7%) had a significantly higher mean score on the OHIP-5, HADS-A and HADS-D and a lower mean score for SOC-13. In a multivariable logistic regression, orofacial pain was statistically significantly associated with poorer OHRQoL (OR = 1.2) and signs of depression (HADS-D) (OR = 2.0). A higher score for SOC-13 protected from the experience of orofacial pain (OR = 0.95).Conclusion: Orofacial pain was associated with poorer OHRQoL and signs of psychological distress. In interpreting the value of SOC, women with orofacial pain also appear to have a poorer adaptive capacity.

Interdisciplinary care in the treatment of orofacial pain. Case report

ABSTRACT BACKGROUND AND OBJECTIVES: The importance of interdisciplinary action has been increasingly recognized in the area of health due to the global effect that has on the various symptoms of the patient. Interdisciplinarity is possible when professionals allow the exchange of knowledge through clinical meetings and jointly follow-up of the case. The objective of this study was to document the interdisciplinary care of patients with orofacial pain symptoms and comorbidities. CASE REPORT: Female patient, 48 years old, diagnosed with muscular temporomandibular disorder and oral opening limitation, labyrinthine cervicalgia, tinnitus, sleep disorder, eating disorders and anxiety after evaluation with an odontologist, otorhinolaryngologist, physiotherapist, acupuncturist, psychologist and nutritionist. The 1-year follow-up with monthly visits with the dentist and nutritionist, and biweekly visits with a psychologist, physiotherapist, and acupuncturist showed symptoms control with total remission of the orofacial pain, cervicalgia, labyrinthitis. Tinnitus did not improve in the sense of frequency that remained constant, but according to the patient, there was an improvement in the adaptation to tinnitus in places with excessive noise, thus allowing a better social interaction. Nutrition and psychology made a great contribution to self-esteem and social routine as well as to seek for a better quality of life. CONCLUSION: The interdisciplinary work promoted a global approach to the patient’s symptoms.

Interpretation of Orofacial Pain Symptoms in the Basis of New Findings in Central and Peripheral Sensitizations

Interpretation of Orofacial Pain Symptoms in the Basis of New Findings in Central and Peripheral Sensitizations

Anterior Bite Opening in Adulthood.

Objectives:To study anterior bite opening of unknown cause presenting in adulthood regarding prevalence, symptoms of Temporomandibular Dysfunction (TMD) and possible causes of the bite opening.Methods:Patients referred to two Orofacial Pain and TMD clinics with the complaint of recent anterior bite opening, presenting in adulthood and of unknown cause, were considered for the study. Patients with systemic rheumatic or neuromuscular diseases, degenerative joint disease, previous fractures of the jaws or orthodontic treatment, were excluded. The clinical examination was according to DC/TMD and extended for the occlusion. Reported symptoms, clinical signs, the occlusion and diagnoses found are presented. According to the information gained from the patient’s history, previous occlusion and appearance, and present signs of parafunction, a possible association with the bite opening was suggested.Results:Anterior bite opening was found in 1.6% of the referred patients. Symptoms of tiredness and/or orofacial pain were reported by 62%, headache by 41%, TMJ clicking by 24% and sensitive/tender teeth by 41%. Parafunction or bruxism was reported by 2/3 of the patients. A previous period in life of TMD symptoms, before the bite opening, was reported by 66%. Myalgia and headache associated with TMD were frequently diagnosed. The use of a partial dental splint, tongue pressure and pregnancy were possible causes found for the bite opening.Conclusion:Anterior bite opening can occur in adulthood without organic or systemic disease of the TMJ or masticatory muscles, and was frequently associated with muscle TMD symptoms.

Bruxism: a practical guide to treatment with botulinum toxin type A

Bruxism is a prevalent oral parafunctional activity, affecting up to 31% of adults, and causing symptoms of orofacial pain, headache, jaw stiffness and tooth damage. While oral appliances remain the mainstay of symptomatic relief, emerging evidence surrounding the use of botulinum toxin type A (BTX-A) injections has shown this treatment option to be effective and long-lasting for both bruxism and the broader temporomandibular disorder. This review summarises the evidence for the use of BTX-A in patients with bruxism, provides a guide to the dosages and injection points recommended to minimise adverse events, and discusses the important anticipated side effects of reduced mastication ability and changes in the aesthetic appearance of the lower face following injections to the masseter muscles.

ELECTROMYOGRAPHIC ANALYSIS OF THE MASSETER AND TEMPORALIS MUSCLES AND BITE FORCE IN A PATIENT TREATED BY FUNCTIONAL MAXILLARY ORTHOPEDICS: A CASE REPORT

This case report evaluated electromyographic activity of the masseter and temporalis muscles and molar bite force, before and after with functional orthopedic. A 65 years woman presenting with orofacial pain symptoms, cervical tension, condyle subluxation and osteoarthrosis. The patient was diagnosed with temporomandibular dysfunction and treated with use of a Simoes Network 9 modified type functional maxillary orthopedics appliance. The Myosystem BR1 apparatus was used to analyze the electromyographic activity of the masseter and temporalis muscles. The maximum molar bite force was measured with the digital dynamometer (Kratus). This study showed increased EMG activity of the masseter and temporalis muscles in postural conditions of mandible and molar bite force after 12 months of treatment. After twelve months of treatment, the patient had lack of pain symptoms as well as an improvement in the balance of the mastication muscles, as demonstrated by EMG activity and maximum molar bite force.

Obstructive sleep apnea in a patient with orofacial pain secondary to cervical fixation

Orofacial pain symptoms associated with obstructive sleep apnea (OSA) include morning headaches and facial pain. 1 Giannasi L.C. Almeida F.R. Magini M. et al. Systematic assessment of the impact of oral appliance therapy on the temporomandibular joint during treatment of obstructive sleep apnea: long-term evaluation. Sleep Breath. 2009; 13: 375-381 Crossref PubMed Scopus (29) Google Scholar The upper airway is blocked in OSA when the muscles of the throat relax during sleep, causing the soft tissues in the back of the throat to collapse. OSA also can result from a physical obstruction that has the potential to compress the airway. The placement of anteriorly positioned cervical fixation has this capability. Dr. Kanti is an orofacial pain master’s degree candidate, Center for Temporomandibular Disorders and Orofacial Pain, Department of Diagnostic Sciences, Rutgers School of Dental Medicine, 110 Bergen St., Room D880, Newark, NJ 07101. Dr. Aparna is a fellow, Advanced Education in Orofacial Pain Postgraduate Program, Center for Temporomandibular Disorders and Orofacial Pain, Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Newark, NJ.

Temporomandibular disorder in otolaryngology: systematic review.

Temporomandibular disorder poses a diagnostic challenge to otolaryngologists as orofacial pain, headache and otology symptoms are very common in temporomandibular disorder, and mimic a number of otolaryngological conditions. Missed diagnosis of temporomandibular disorder can lead to unnecessary investigation and treatment, resulting in further patient suffering. To review the current literature and propose management pathways for otolaryngologists to correctly differentiate temporomandibular disorder from other otolaryngological conditions, and to initiate effective treatment for temporomandibular disorder in collaboration with other health professionals. A systematic review using PubMed and Medline databases was conducted, and data on temporomandibular disorder in conjunction with otolaryngological symptoms were collected for analysis. Of 4155 potential studies, 33 were retrieved for detailed evaluation and 12 met the study criteria. There are questionnaires, examination techniques and radiological investigations presented in the literature to assist with distinguishing between otolaryngological causes of symptoms and temporomandibular disorder. Simple treatment can be initiated by the otolaryngologist. Initial temporomandibular disorder treatment steps can be undertaken by the otolaryngologist, with consideration of referral to dentists, oral and maxillofacial surgeons, or physiotherapists if simple pharmacological treatment or temporomandibular disorder exercise fails.

How do Australians living with MS experience oral health and accessing dental care? A focus group study.

The symptoms of multiple sclerosis (MS) can affect oral care and access to dental services, but there is limited literature describing the oral health and perceived oral healthcare needs of people with MS. This study aimed to explore the oral health experiences, oral health behaviours and barriers to accessing dental care perceived by people living with MS in Australia. Six focus groups were held across two metropolitan areas (Brisbane, Queensland and Melbourne, Victoria) and one regional area (Toowoomba, Queensland). Focus group data were analysed using thematic analysis. Living with MS was a highly individual experience due to the range of symptoms that may be experienced. In addition to having different symptom experiences to others with MS, individual symptoms also differed on a daily basis as the disease relapsed and remitted. The physical expressions of MS directly and indirectly affected the oral health of participants. Additionally, oral health was affected by the side effects of medications and orofacial pain symptoms. Depending on the symptoms experienced by the individual, personal oral hygiene was affected and professional dental appointments were difficult. Participants also experienced structural barriers to accessing professional dental care including difficulty accessing transport to-and-from dental appointments, space limitations in the dental surgery and financial barriers to care. Dental care was perceived to be inflexible and was not tailored to individual experiences of MS, which contributed to perceptions of poor quality and appropriateness of care. It is important for dental professionals to offer tailored and individualized dental care when treating people with MS. Our findings suggest that there needs to be greater interprofessional communication and referral to manage atypical dental pain symptoms. Oral health education for people with MS should include altered strategies to performing daily oral hygiene, the management of xerostomia and advice regarding low cariogenic diets suitable for dysphagia. Additionally, policy and strategies to improve the oral health of people with MS should focus on enhancing access through transport, reducing the cost of dental services to the individual and providing domiciliary oral health care.

An investigation of the simultaneously recorded occlusal contact and surface electromyographic activity of jaw-closing muscles for patients with temporomandibular disorders and a scissors-bite relationship

Surface electromyographic (SEMG) activity of the masseter and anterior temporalis (TA) muscles has been reported to be associated with occlusion and orofacial pain. However, our recent report did not reveal an association between the side of orofacial pain and the side showing higher or lower level of SEMG activity of masseter or TA. The present purpose was to re-test this association in patients who had unilateral scissors-bite relationship. Thirty-two unilateral scissors-bite femalepatients complaining of unilateral orofacial pain (n=15) or TMJ sounds (n=17) were enrolled to simultaneously record contacts, force distribution of occlusion, and SEMG activity of masseter and TA during centric maximal voluntary clenching (MVC). The results indicated that neither orofacial pain nor the TMJ sounds had an association with the masseter’s SEMG values, while scissors-bite had (P<0.05). A lower SEMG value for masseter was found on the scissors-bite side where there was a smaller number of contacts and a lower biting force distribution (P<0.05). No such association was revealed in TA. In conclusion, in patients with unilateral TMD symptom(s) and scissors-bite, the jawclosing muscles’ SEMG activity during centric MVC was associated with the scissors-bite rather than the symptoms of orofacial pain or TMJ sounds.

Confection of an Occlusal Stability Intra-Oral Device for Violin Players

Confection of an Occlusal Stability Intra-Oral Device for Violin Players Idealization and confection of an intra-oral device capable of providing occlusal stability and muscle tension relief referred by the violin players. Dental impression of both teeth arches, face bow register as well as a register of the intermaxillary relation, in their most usual playing position, were made from the violinists for assemble of the teeth casts in the Protar 7 articulator. The individualized intra-oral device was made with the Erko-Loc Pro 3mm plates. The device was adjusted in the articulator at first and then intra orally with the T-scan device during violin playing. We achieved a device capable of avoiding teeth grinding, muscular tension relief, during violin playing, and a sensation of stability by having all teeth contacting. We concluded that the usage of an intra-oral device might prove to be effective in reducing muscle hypertonia and preventing temporomandibular disorders, due to the improvements in occlusal stability given with same intensity contacts throughout all the teeth as well as a relief in symptoms of orofacial muscle pain. To clarify these concepts there is a need for more studies. The study of the mandibular cinematic has implications on different areas of dental medicine. Movement patterns depend on the muscles, temporomandibular joint and associated structures. Violin players rotate the mandible to the side in which they rest the violin to better stabilize it with the shoulder. This lateral position can be harmful to the masticatory muscles and to the temporomandibular joint.

Orofacial pain and symptoms of temporomandibular disorders in Finnish and Thai populations

Objective. Cultural or ethnic factors may play an important role in subjects’ pain reports. The aim of the study was to compare the prevalence of orofacial pain symptoms between Finnish and Thai populations. Materials and methods. The Finnish study population comprised the Northern Finland Birth Cohort 1966, of which 5696 subjects participated in the present study. The Thai sample consisted of 1501 randomly selected people living in 10 different districts in Bangkok. Data on orofacial pain was collected based on questionnaires. Results. After adjusting for age, gender and education, the logistic regression analysis showed that Thai subjects had an increased risk for reporting oral pain (OR = 4.5, 95% CI = 3.7–5.4), tooth pain (OR = 2.0, 95% CI = 1.8–2.4) and pain in the face (OR = 1.5, 95% CI = 1.2–1.7). Conclusions. It can be concluded that Thai people report more orofacial pain symptoms than Finnish subjects. Cross-cultural factors exist in the background of reporting pain symptoms in the oral and facial area.

Natural History of Comorbid Orofacial Pain Among Women With Vestibulodynia

We evaluated the stability of the comorbidity between vulvodynia and orofacial pain (OFP) and its associated clinical characteristics over a 2-year follow-up period. In an earlier study of vestibulodynia patients, we administered questionnaires assessing demographic data, self-reported pain, anxiety, somatic awareness, and presence of signs and symptoms suggestive of clinical and subclinical OFP. The present study readministered the same surveys to a subset of the original cohort after a 2-year follow-up period. Of the 138 women in the previous study, 71 (51%) agreed to participate in the present study. We confirmed our earlier findings that (1) OFP is a highly prevalent (66%) condition among women with vestibulodynia, and (2) compared with women with no OFP symptoms, those with OFP symptoms experience higher levels of anxiety (P=0.005) and somatic awareness (P<0.001). Although OFP symptoms showed improvement in many of the vestibulodynia patients (33%) with OFP symptoms at baseline, 13% had either developed new symptoms or transitioned from subclinical to clinical OFP classification. Intercourse-related pain decreased in 69% of patients and increased in 24% of patients. Consistent with our earlier report, we did not observe significant differences with respect to demographics or severity of pain during intercourse among the subgroups. OFP is a common comorbidity among women with vestibulodynia, although the presence of OFP can vary over time. The comorbidity between vestibulodynia and OFP suggests that common underlying mechanisms may mediate both conditions.

Treatment seeking behaviour in southern Chinese elders with chronic orofacial pain: a qualitative study

BackgroundChronic orofacial pain (OFP) is common in general adult populations worldwide. High levels of psychological distress and impaired coping abilities are common among Western people with chronic OFP but limited information was found in southern Chinese people. This study aimed to explore the perceptions and experiences of community dwelling elderly people with chronic OFP symptoms and their treatment seeking behaviour in Hong Kong.MethodsAn exploratory qualitative interview study was conducted. Elderly people experiencing chronic OFP symptoms were invited to take part in an individual semi-structured interview. A total of 25 semi-structured interviews were performed for 25 participants.ResultsPertinent issues relating to the treatment seeking behaviour emerged from the interviews, many of which were inter-related and overlapping. They were organized into three major themes: (i) Impact of chronic OFP on daily life; (ii) Personal knowledge and feeling of chronic OFP; (iii) Management of chronic OFP. The participants were found to have the intention to seek professional treatment, but there were barriers which discouraged them continuing to seek professional treatment. They also received complementary treatment for chronic OFP, such as acupuncture, massage and “chi kung”. Moreover, a wide range self-management techniques were also mentioned. On the other hand, those who did not seek professional treatment for the chronic OFP claimed that they had accepted or adapted to the pain as part of their lives.ConclusionsThis qualitative study observed that elderly people affected by chronic OFP symptoms in Hong Kong sought many different ways to manage their pain including traditional and complementary approaches. The role of the dentist in dealing with chronic OFP is unclear. Multiple barriers exist to accessing care for chronic OFP. The findings may be used to inform future chronic OFP management strategies in Hong Kong.

The association between self-report of orofacial pain symptoms with age, gender, interference in activities, and socioeconomic factors surveyed in Indonesian community health centers

The association between self-report of orofacial pain symptoms with age, gender, interference in activities, and socioeconomic factors surveyed in Indonesian community health centers