Temporomandibular Disorder Pain Research Articles

Psychologic Impact of Chronic Orofacial Pain: A Critical Review.

To explore the prevalence of clinically significant anxiety and depression in adult patients with chronic orofacial pain (COFP) conditions. A systematic online search of the Medline (PubMed) and Ovid databases was performed for articles published from 2006 to 2019. Observational studies- including cross-sectional, case-control, and case series-and longitudinal prospective studies were included. A total of 118 articles were selected for inclusion, and the prevalence rates of clinically significant anxiety and depression were summarized. Most studies focused on temporomandibular disorder (TMD) pain and less often on neuropathic COFP conditions. Prevalence rates varied widely across studies according to OFP condition and assessment measure; most questionnaire-based assessments yielded rates of clinically significant depression and anxiety in, respectively, 40% to 60% and 40% to 65% of individuals with TMD and in 20% to 50% and 25% to 55% of patients with neuropathic, mixed, or idiopathic/atypical COFP conditions. Rates of anxiety and depression were lower in studies using diagnostic instruments and in TMD studies with nonpatient samples. Most controlled studies showed a higher prevalence of anxiety and depression in individuals with COFP than in those without. Higher COFP pain levels and the presence of comorbid conditions such as migraines or widespread pain increased the likelihood of anxiety and/or depressive symptoms in individuals. Clinically significant anxiety and depression were commonly observed in patients with COFP, were present at higher rates than in pain-free participants in controlled studies, and were closely linked to pain severity. More research is needed to evaluate the psychologic impact of multiple COFP conditions in an individual and the prevalence of precondition psychologic morbidity.

High Pain Intensity is a Risk Factor of Non-Resolving TMD: A Three-Year Follow-Up of a Patient Group in a Norwegian Interdisciplinary Evaluation Program

PurposeTo investigate the outcome of patients with long-term refractory temporomandibular disorders (TMD) three years after a Norwegian interdisciplinary evaluation program with attention to patient satisfaction, function, pain, and psychosocial variables.Patients and MethodsThe study population consisted of 60 long-term refractory TMD patients who were investigated by a Norwegian interdisciplinary team. A questionnaire that covered medical history, function, pain, lifestyle factors, TMD-status and follow-up from their general medical practitioner (GMP) was sent to the patients three years after the evaluation. Questionnaires that assessed function (Mandibular Functional Index Questionnaire [MFIQ] and Roland Morrison Scale [RMS]), pain intensity (General Pain Intensity questionnaire [GPI]) and psychosocial factors (Hospital Anxiety and Depression scale [HADS]); a 2-item version of the Coping Strategies Questionnaire [CSQ]) were included in the package.ResultsThirty-nine out of 60 TMD patients completed the questionnaires. Improvements in TMD symptoms were reported in 10 patients (26%), were unchanged in 16 patients (41%) and worsened in 13 patients (33%). Only 8 patients (21%) were satisfied with the follow-up of the suggested treatments from their GMP. Significant improvements of symptoms were noted in MFIQ (jaw function), GPI (including pain intensity at maximum and suffering from pain), and CSQ (pain related catastrophizing), in all 39 TMD patients as one group. However, a subgroup analysis showed that the significant improvements were mostly within patients who reported improvement of TMD symptoms. A high pain intensity at baseline was a significant risk factor (OR = 5.79, 95% CI: 1.34, 24.96) for patients who reported worsening of TMD symptoms at follow-up.ConclusionHigh pain intensity at baseline was a significant risk factor for poorer recovery three years after an interdisciplinary evaluation. Our data support the notion that improved coping with TMD pain includes both decreased pain intensity, CSQ and MFIQ scores.

Ratio of Omega-6/Omega-3 Polyunsaturated Fatty Acids Associated With Somatic and Depressive Symptoms in People With Painful Temporomandibular Disorder and Irritable Bowel Syndrome

Somatic symptom disturbance is among the strongest predictors of painful temporomandibular disorder (TMD). Related psychological constructs, such as anxiety and depression, respond therapeutically to omega-3 polyunsaturated fatty acids (PUFAs) in clinical trials. This cross-sectional study investigated associations between the omega-6/omega-3 PUFA ratio and somatic symptom disturbance and depressive symptoms in a community-based sample of 501 adults and determined whether these associations differed between adults with and without TMD or irritable bowel syndrome (IBS). Liquid chromatography tandem mass spectrometry quantified PUFAs in circulating erythrocytes. Somatic symptoms and depression were quantified using Symptom Checklist-90-Revised subscales. Presence or absence of TMD and IBS, respectively, were determined by clinical examination and Rome III screening questions. The standardized beta coefficient for the omega-6/omega-3 long-chain PUFA ratio was 0.26 (95% confidence limits (CL): 0.08, 0.43) in a multivariable linear regression model in which somatic symptom disturbance was the dependent variable. When modelling depressive symptoms as the dependent variable, the standardized beta coefficient was 0.17 (95% CL:0.01, 0.34). Both associations were stronger among TMD cases and IBS cases than among non-cases. Future randomized control trials that lower the omega-6/omega-3 PUFA ratio could consider somatic or depressive symptoms as a therapeutic target for TMD or IBS pain. PerspectiveIn people with TMD or IBS, a high n-6/n-3 PUFA ratio was positively associated with somatic symptom disturbance and depressive symptoms. Both measures of psychological distress were elevated in people with painful TMD and IBS. Future randomized clinical trials will determine whether lowering the n-6/n-3 ratio is therapeutic for pain.

COMPARING SHORT- AND LONG-TERM TMD PAIN COMORBIDITIES: A CROSS-SECTIONAL STUDY AMONG ADOLESCENTS

<h3>Objectives</h3> The primary aim of this study was to compare painful and nonpainful comorbidities between short- and long-term temporomandibular disorder (TMD) pain. The secondary aim was to assess the impact of persistent TMD pain on school absence. <h3>Study Design</h3> Adolescents were enrolled in Montreal (Canada), Nice (France), and Arceburgo (Brazil). The presence of TMD pain, comorbidities (i.e., asthma, allergies, back pain, neck pain, stomach pain, and headache), and school absence were assessed using reliable and validated questionnaires. TMD pain lasting <6 months was considered short-term, and that lasting ≥6 month was deemed long-term. Chi-square tests and analysis of variance were used to test statistical differences between adolescents with short- and long-term TMD pain and those without (controls). Univariate and multivariate unconditional nominal logistic regression analyses were used to assess the association between TMD pain (dependent variable) and the independent variables. <h3>Results</h3> This study enrolled 1400 adolescents with short-term (n = 312, 22.29%) and long-term (n = 139, 9.93%) TMD pain and controls (n = 949, 67.79%). The number of comorbidities was associated with short-term (odds ratio [OR] = 1.71; 95% confidence interval [CI], 1.53-1.90) and long-term (OR = 1.79; 95% CI, 1.55-2.08) TMD pain compared with controls. Allergies were only associated with short-term TMD pain (OR = 1.54; 95% CI, 1.13-2.10). In comparison to controls, adolescents with long- and short-term TMD pain were more likely to have frequent headaches (≥once a week; OR short-term = 4.39; 95% CI, 3.23-5.98; OR long-term = 3.69; 95% CI, 2.45-5.57) and frequent back pain (OR short-term = 1.46; 95% CI, 1.06-2.03; OR long-term = 1.69; 95% CI, 1.11-2.59). Frequent stomach pain was only associated with long-term TMD pain (OR = 2.01; 95% CI, 1.35-3.26), whereas frequent neck pain was only associated with short-term TMD pain (OR = 2.23; 95% CI, 1.53-3.26). Adolescents with long-term TMD pain had higher rates of missing school than those with short-term TMD pain (n long-term = 39, 28.26%; n short-term = 48, 15.43%; <i>P</i> = .0015). <h3>Conclusions</h3> Frequent headache and back pain are very common among adolescents with both short- and long-term TMD pain. The specific association between stomach pain and long-term TMD pain suggests a central dysregulation mechanism.

452 An Intrinsic Pathway in the Brain Underlying the Relationship Between Pain Catastrophizing and Chronic Pain in Temporomandibular Disorders

OBJECTIVES/GOALS: Pain Catastrophizing is a negative coping mechanism involving rumination, magnification, and helplessness and is associated with worse chronic pain. The neurobiological mechanisms underlying this relationship are poorly understood. We aim to examine the intrinsic activity of a functional pathway in patients with chronic orofacial pain. METHODS/STUDY POPULATION: This is the second phase of a parent study examining genetics, placebos, and the brain in temporomandibular disorders (TMD). We intend to recruit 120 of the original 398 TMD patients for this phase. Participants completed the Graded Chronic Pain Scale to assess TMD pain intensity and disability and the Pain Catastrophizing Scale. Behaviorally, pain catastrophizing scores and pain intensity and disability will be analyzed using structural equation modeling. Resting-state functional magnetic resonance imaging will be used to record intrinsic brain activity. The functional connectivity between the posterior cingulate, anterior insula, and periaqueductal grey will be assessed as a causal pathway relating pain catastrophizing to pain intensity and disability. Mediation analyses will be used to test causality. RESULTS/ANTICIPATED RESULTS: We anticipate that greater engagement in catastrophic thinking about pain increases the functional connectivity strength between the posterior cingulate, anterior insula, and periaqueductal grey, which ultimately leads to heightened perception of pain intensity and disability. Therefore, we expect to see increased functional connectivity in those with high pain catastrophizing levels as compared to those with low pain catastrophizing levels, and that this pathway will mediate the relationship between pain catastrophizing and pain intensity and disability. Further, we predict that helplessness will most strongly correlate with the change in functional connectivity as compared to rumination and magnification. Results will be presented in full at the conference. DISCUSSION/SIGNIFICANCE: Understanding how pain catastrophizing can influence chronic pain pathways will not only promote a more integrative approach to chronic pain management but will also help identify the mechanisms by which pain itself develops and persists in the particularly vulnerable pain population of TMD.

Parkinson’s disease, temporomandibular disorder pain and bruxism and its clinical consequences: a protocol of a single-centre observational outpatient study

IntroductionA recent questionnaire-based study suggested that bruxism and painful temporomandibular disorders (TMD pain) may be more prevalent in patients with Parkinson’s disease (PD) compared with controls. The presence of both...

Nonpharmacological Interventions for Pain in Patients with Temporomandibular Joint Disorders: A Systematic Review.

This systematic review aimed to compare the efficacy of nonpharmacological therapies for painful temporomandibular joint disorders. The protocol was registered on International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42020171364). The search was performed on the electronic databases PubMed, Google Scholar, Clinical Trials, and Web of Science. The eligibility criteria were randomized controlled trials in patients diagnosed with painful temporomandibular joint disorders comparing the pain relief between conventional treatment and nonpharmacological therapies such as acupuncture, physiotherapy, low-level laser, and massage. Fourteen articles were included in this review. At the overall bias of the studies included, 71.42% exhibited some concerns and 28.57% had high risk. The efficacy of nonpharmacological interventions was found to be moderate in the short term and variable in the long term for pain reduction in patients with temporomandibular joint disorders. The evidence pointed out that acupuncture, laser therapy, and physiotherapy are potentially useful interventions for pain relief in patients with temporomandibular joint disorders. However, there is a lack of consistency and short-term follow-up in the studies to determine the lasting of such effect.

Association of oral behaviours’ frequency with psychological profile, somatosensory amplification, presence of pain and self-reported pain intensity

Objective To investigate the association of the frequency of oral behaviours with psychological (anxiety, depression) and psychosomatic factors (somatosensory amplification) as well as with pain presence (Temporomandibular disorders-pain (TMDp) patients and control (CTR) participants) and pain intensity (no_low pain intensity (nLPI)/high pain intensity (HPI)). Material and methods Fifty-four TMDp patients (48 females and 6 males; 29.13 ± 10.46 years) and 46 controls (29 females and 17 males; 28.54 ± 9.71 years) were administered Oral Behaviours Checklist (OBC), Generalized Anxiety Disorder-7 Scale, Patient Health Questionnaire-9 for depression and Somatosensory Amplification Scale. Data were analysed with respect to the presence of TMD pain and to pain intensity. Mann–Whitney test and Spearman’s rank correlation were used for analyses. Results No significant differences in examined variables between TMDp patients and CTR individuals were found. The frequency of oral behaviors (OBC total score and sleep‐related oral behaviours) as well as anxiety, depression and somatosensory amplification scores were higher in HPI group when compared to nLPI group (p < .05). In univariate correlations, oral behaviours were positively correlated with somatosensory amplification (p = .001), anxiety (p < .05), depression (p < .05), female sex (p < .05) and pain intensity (p < .05) but not with pain presence. Multiple linear regression models showed that predictors for the higher frequency of oral behaviours were anxiety and female sex. Conclusions Oral behaviours were associated with pain intensity but not with pain presence and were primarily influenced by anxiety and female sex, suggesting that therapeutic approach should consider both, reducing pain intensity and management of the impact of psychological factors. Trial registration: ClinicalTrials.gov NCT04694274. Registered on 01/04/2021

Oral nonsteroidal anti-inflammatory drugs as treatment of joint and muscle pain in temporomandibular disorders: A systematic review

ABSTRACT Objective To evaluate pain control in patients with joint and muscle pain in temporomandibular disorder (TMD) diagnosis treated with oral non-steroidal anti-inflammatory drugs (NSAIDs). Methods The systematic research was conducted via Pubmed, Scopus, Web of Science, Google Scholar, and Cochrane databases. Results Four full-text randomized-controlled trials (RCTs) were considered eligible. This systematic review included 164 patients whose VAS scores were assessed before and after therapy. In the selected studies, a strong heterogeneity in the diagnosis and in the use of different types and prescriptions of NSAIDs was highlighted. These limitations had to be considered to understand whether a clinical recommendation could be made. Eventually, all patients treated with NSAIDs showed an improvement in pain. Conclusion The use of oral NSAIDs as the first approach to control joint and muscle pain is sustained by the current scientific literature, but further investigations on this topic are still needed.

Patients\u2019 perceptions on temporomandibular disorder treatment with hydrostatic oral splints - a pilot study

ObjectiveTo evaluate temporomandibular disorder (TMD) treatment with a prefabricated, hydrostatic oral splint (HOS) based on self-reported patient’s symptoms using a standardized questionnaire.MethodsTwo hundred fifty-eight questionnaires from patients diagnosed with TMD and subsequently treated with HOS were collected from two independent private practices. Based on patient’s comfort the questionnaire recorded TMD symptoms and symptom regression. Descriptive and comparative statistics was carried out using SPSS.ResultsA total of 221 questionnaires were analyzed. Patients reported TMD symptoms such as pain (93.2%), TMJ clicking (66.1%), headache (25.8%), cervical spine disorders (23.5%), restricted mouth opening (22.6%) and tinnitus (11.8%). For most symptoms, improvement was reported mostly after two weeks, except for tinnitus, where positive effects were usually reported after four weeks.ConclusionHOS seem to be effective for immediate treatment of pain and other TMD symptoms. Based on the available data, a treatment period of four weeks can be recommended.

Temporomandibular disorders cases with high-impact pain are more likely to experience short-term pain fluctuations

Temporomandibular disorders (TMD) patients can present clinically significant jaw pain fluctuations which can be debilitating and lead to poor global health. The Graded Chronic Pain Scale evaluates pain-related disability and its dichotomous grading (high/low impact pain) can determine patient care pathways and in general high-impact pain patients have worse treatment outcomes. Individuals with low-impact TMD pain are thought to have better psychosocial functioning, more favorable disease course, and better ability to control pain, while individuals with high-impact pain can present with higher levels of physical and psychological symptoms. Thereby, there is reason to believe that individuals with low- and high-impact TMD pain could experience different pain trajectories over time. Our primary objective was to determine if short-term jaw pain fluctuations serve as a clinical marker for the impact status of TMD pain. To this end, we estimated the association between high/low impact pain status and jaw pain fluctuations over three visits (≤ 21-day-period) in 30 TMD cases. Secondarily, we measured the association between jaw pain intensity and pressure pain thresholds (PPT) over the face and hand, the latter measurements compared to matched pain-free controls (n = 17). Jaw pain fluctuations were more frequent among high-impact pain cases (n = 15) than low-impact pain cases (n = 15) (OR 5.5; 95% CI 1.2, 26.4; p value = 0.033). Jaw pain ratings were not associated with PPT ratings (p value > 0.220), suggesting different mechanisms for clinical versus experimental pain. Results from this proof-of-concept study suggest that targeted treatments to reduce short-term pain fluctuations in high-impact TMD pain is a potential strategy to achieve improved patient perception of clinical pain management outcomes.

The impact of the lockdown by COVID-19 on Temporomandibular Disorder related pain intensity, distress and post-traumatic stress disorder - A case-control study

The events related to the COVID-19 pandemic are having a strong impact on public mental health. However, there are few studies focusing on these aspects in patients with temporomandibular disorders (TMD). The aim of this study was to evaluate the painful intensity, distress and symptoms of post-traumatic stress disorder (PTSD) in a population with and without TMD during the COVID-19 pandemic. This case-control study evaluated electronic questionnaires from 197 participants (105 with TMD and 92 controls), that were carried out during and after the first lockdown due to COVID-19 pandemic. To assess the presence of possible TMD, painful intensity, distress, and PTSD symptoms the respective questionnaires were used: TMD Pain Screener, Numeric Rating Scale, Patient Health Questionnaire – 4 and PTSD Checklist - Civilian Version. TMD participants showed higher levels of distress during (p = 0.027) and after (p &lt; 0.001) the lockdown compared to the control group. The TMD group also reported increased levels of distress in the post-lockdown period in relation to the period during the lockdown (p = 0.002), although the same intensity of pain was observed at both evaluated periods. Furthermore, participants with TMD were 3.91 × more likely to be female (CI 95% = 1.88-8.13) and 3.82 × more likely to show PTSD symptoms (CI95% = 1.61-9.08) after the lockdown. These data suggest that a pre-existing painful condition can lead to increased distress and symptoms of PTSD as a result of stressful situations, such as the COVID-19 pandemic lockdown.

Painful Temporomandibular Disorders, Bruxism and Oral Parafunctions before and during the COVID-19 Pandemic Era: A Sex Comparison among Dental Patients.

Aim: To evaluate the effect of the current coronavirus pandemic on the prevalence of bruxism, oral parafunctions and painful Temporo-Mandibular Disorders (TMDs) and to evaluate the influence of the pandemic on both sexes. Methods: This retrospective study included 288 dental patients who underwent complete anamnesis and examination according to the Diagnostic Criteria for TMD. The study evaluated two patient populations according to the date of examination: (a) pre-COVID-19 pandemic era (108 patients); (b) COVID 19 pandemic era, where 180 patients were examined during the pandemic. Results: A significant increase in parafunction activity was found in both men and women (p < 0.001) during the COVID-19 pandemic. Awake bruxism (AB) and sleep bruxism (SB) was more prevalent during the COVID-19 pandemic solely in women (AB-p < 0.001; SB-p = 0.014). Conclusions: Men and women were affected by the ongoing stress due to the COVID-19 pandemic, yet women showed a higher influence as compared to men. The long-term exposure to elevated levels of anxiety and stress may aggravate or trigger stomatognathic detrimental conditions. Dentists should be aware and regularly monitor their patients regarding the possible existence and consequences of bruxism and TMD.

Autonomic responses to tooth clenching and handgrip test

Objective The aim was to study the differences in autonomic nervous system activation between maximal tooth clenching task and handgrip test during and after the tasks. Also, the possible activation of trigeminocardiac reflex during the clenching task was explored. Material and methods We compared autonomic responses to maximal tooth clenching and handgrip in 28 participants. Responses in heart rate variability, heart rate, and blood pressure were evaluated before, during, and after tests. Although all study participants were considered healthy during recruitment, 14 of them showed painful temporomandibular disorders in the clinical examination, which was taken into account in the analyses. Results Handgrip and tooth clenching caused similar autonomic responses. However, tooth clenching seemed to activate the trigeminocardiac reflex shown as clenching-related vagal activation. The painful signs of temporomandibular disorders may interfere with the heart rate variability both at the baseline and during both tests causing significant variation in them. Conclusions Both handgrip and tooth clenching affect the autonomic nervous system function. Tooth clenching differs from the handgrip due to trigeminocardiac reflex. Painful signs of temporomandibular disorders are interfering with the results of the tests and maybe underestimated in the studies of autonomic responses to both tasks.

Reduction of Somatic Tinnitus Severity is Mediated by Improvement of Temporomandibular Disorders.

Successful orofacial treatment can reduce tinnitus severity in patients with somatic tinnitus (ST). However, it is still unclear to what extent the degree of reduction in temporomandibular disorders (TMD) actually contributes to the decrease in tinnitus severity after orofacial treatment. Therefore, the aim of this study was to analyze the mediating effect of reduction in TMD pain on the improvement of tinnitus severity after multidisciplinary orofacial treatment. A total of 80 patients with moderate to severe ST attributed to the temporomandibular region, were recruited from a tertiary tinnitus clinic. At baseline, patients were randomly assigned to the orofacial treatment group or to the control group. Both groups received a minimum of information and advice regarding their tinnitus complaints. The orofacial treatment group received orofacial physical therapy complemented with occlusal splints when needed, while the control group received no other treatment. A mediation analysis was performed according to the steps described by Baron and Kenny and the proportion of the mediating effect was calculated for the potential mediator: "change in TMD pain," measured by a one-point decrease in TMD pain screener score. Our analysis showed that 35% of the observed decrease in tinnitus severity can be attributed to a reduction in TMD pain. A significant total effect of orofacial treatment compared with control on the change in tinnitus functional index (TFI) score was found (B = 0.253 p = 0.025 Cl for B = 1.265-18.576). Orofacial treatment was also significantly related to the change in TMD pain (Exp (B) = 2.800, p = 0.034 Cl for Exp B 1.081-7.251). Additionally, the change in TMD pain screener score was significantly related to the change in TFI score (B = -0.273 p = 0.016 Cl for B = -19.875 to -2.119). Reduction of TMD pain is a mediating factor in the decrease of tinnitus severity after multidisciplinary orofacial treatment. Orofacial treatment can be used to decrease tinnitus severity in patients with TMD related somatic tinnitus.

Thermal ultrasound, manipulation and exercise on pain and mouth opening in Chronic temporomandibular joint disorder

A 60-year-old female patient reported with a chief complaint of pain in bilateral temporomandibular joints (TMJ) region since 11/2 years. The pain was initially reported to be insidious in onset, moderate in intensity, aggravated on chewing food and during excessive mouth opening. On examination her mouth opening was found to be less than 8mm and standard head and neck examination showed grade 2 tenderness with swelling on bilateral TMJ and forward neck posture with rounded shoulders. The patient reported her pain to be 6 at rest in NPRS (with 0 being no pain and 10 being maximum) and 8 out of 10 on mouth opening. A 4-week Physiotherapy Intervention program, which consisted of Ultrasound Therapy at varying intensity, TMJ manipulation, Cervical Range of Motion Exercises and Manual Cervical traction was administered. Repeated evaluation of pain and other functional outcomes were done on a weekly basis. There was significant improvement in her mouth opening (41mm), restoration of masticatory functions, complete resolution of pain and overall improvement in quality of life after the 4weeks intervention program. A structured Physiotherapy intervention program consisting of Non-thermal Ultrasound, Manipulation and exercise targeting TMJ and Upper quarter, proved to be highly effective in increasing functions and reducing signs and symptoms in Chronic TMJ Dysfunction which can be highly disabling. The recovery observed in this patient, who was not on any standard treatment for almost 18months, hence the severe limitations she encountered, is a testament to the need of designing individualized treatment protocols addressing the many facets of impairment in TMJ Disorders.

Fear of Movement and Catastrophizing in Participants with Temporomandibular Disorders.

To assess differences in catastrophizing and kinesiophobia in relation to areas of pain and somatic symptoms among participants with temporomandibular disorders (TMDs) and controls. In total, 401 participants (333 women, 68 men, mean age: 45.8 years) in the TMJ Impact Project were examined in accordance with the Diagnostic Criteria for TMD, including clinical examination (Axis I) and psychosocial assessment (Axis II) augmented with imaging of the temporomandibular joint (TMJ). Of these, 218 participants had a painful TMD pain diagnosis, 63 had a nonpainful TMD diagnosis, and 111 had no TMD. Nine participants had missing data. Participants completed the Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, Areas of Pain figure, and the Patient Health Questionnaire-15 for assessing somatic symptoms. Compared to controls, participants with TMD pain showed higher levels of catastrophizing (P = .017), kinesiophobia (P < .001), areas of pain (P < .001), and somatic symptoms (P < .001). Participants with nonpainful TMD showed a higher level of kinesiophobia (P < .001) than controls. There was a positive correlation between catastrophizing and kinesiophobia for participants with TMD pain (r = 0.33, P < .001) and nonpainful TMD (r = 0.42, P < .001). The results suggest more fear of movement, as well as an association between catastrophizing and fear of movement, in participants with TMD pain and in participants with nonpainful TMD compared to controls. Assessment and management of fear of movement as well as catastrophizing may be useful as part of individualized treatment strategies for patients with TMD.

Influence of the COVID-19 pandemic on pain and oral health-related quality of life in women with temporomandibular disorder.

ABSTRACTObjective: This study aimed to evaluate and compare pain intensity and Oral Health-related Quality of Life (OHRQoL) in women with temporomandibular disorder (TMD) before (T1) and during (T2) COVID-19 pandemic. Materials and Methods: Sample was composed of forty-one female participants with painful TMD, who presented for TMD treatment. Subjects were asked to indicate their pain intensity and to answer the Oral Health Impact Profile-14 (OHIP-14). Participants data were collected twice: T1 (evaluation of medical records fulfilled before COVID-19 pandemic) and T2 (by means of an online form). Socio-demographic data were assessed in T1. Statistical analysis was performed with a significance level of 5% (Wilcoxon, chi-square or Fisher’s exact tests, multiple linear regressions). Results: No difference was found in pain intensity (p=0.26) and OHIP-14 global scores (p=0.53). Physical pain (p=0.03) and social disability (p=0.05) domains improved. In T1, subject’s occupation was associated with OHIP-14 global score, physical pain, and physical disability domains. In T2, age was associated with OHIP-14 global scores as well as physical pain, psychological discomfort, and psychological disability domains. Conclusion: COVID-19 pandemic did not worsen pain intensity and OHRQoL in women with painful TMD, and it is suggested that socio-demographic characteristics influenced TMD patients coping skills during pandemic.

Clinical Factors Affecting Depression in Patients With Painful Temporomandibular Disorders During the COVID-19 Pandemic

Clinical Factors Affecting Depression in Patients With Painful Temporomandibular Disorders During the COVID-19 Pandemic

Botulinum Toxin for Treating Temporomandibular Disorders: What is the Evidence?

To systematically review the scientific literature for evidence concerning the clinical use of botulinum toxin (BTX) for the management of various temporomandibular disorders (TMDs). A comprehensive literature search was conducted in the Medline, Web of Science, and Cochrane Library databases to find randomized clinical trials (RCT) published between 2000 and the end of April 2021 investigating the use of BTX to treat TMDs. The selected articles were reviewed and tabulated according to the PICO (patients/problem/population, intervention, comparison, outcome) format. A total of 24 RCTs were selected. Nine articles used BTX injections to treat myofascial pain, 4 to treat temporomandibular joint (TMJ) articular TMDs, 8 for the management of bruxism, and 3 to treat masseter hypertrophy. A total of 411 patients were treated by injection of BTX. Wide variability was found in the methods of injection and in the doses injected. Many trials concluded superiority of BTX injections over placebo for reducing TMD pain levels and improving maximum mouth opening; however, this was not universal. There is good scientific evidence to support the use of BTX injections for treatment of masseter hypertrophy and equivocal evidence for myogenous TMDs, but very little for TMJ articular disorders. Studies with improved methodologic design are needed to gain better insight into the utility and effectiveness of BTX injections for treating both myogenous and TMJ articular TMDs and to establish suitable protocols for treating different TMDs.