Temporomandibular Disorder-related Pain Research Articles

Genome-Wide Association Study of Temporomandibular Disorder-Related Pain in Finnish Populations.

Temporomandibular disorders (TMD) are multifactorial musculoskeletal pain and dysfunctions in temporomandibular joints (TMJs) and masticatory muscles. Genetic factors play a role in TMD-related pain, but only a few genome-wide association studies (GWAS) have been conducted. The aim of this GWAS was to explore genetic factors associated with painful TMD in Finnish populations. Data from two epidemiological surveys, the Northern Finland Birth Cohort 1966 (NFBC1966) and the Health 2000 Survey in Finland, including altogether 468 cases and 6833 controls, were used. Case definition was based on pain on palpation of masticatory muscles and/or TMJs. GWASs of the whole data and stratified by sex were conducted from both cohorts using additive models, followed by meta-analysis of the two cohorts. Replications of the previously reported TMD risk loci (rs73460075, DMD; rs4794106, SGCA; rs73271865, SP4; rs60249166, RXP2; rs1531554, BAHCCI; rs5862730, OTUD4/SMAD1; rs10092633, SFRP1; rs34612513, SOX14/CLDN18; rs878962, TSPAN9) were also investigated. Four genome-wide significant loci were found in sex-stratified analysis of NFBC1966, including associations at three loci in males (rs1023114, PRIM2, p = 5 × 10-9; rs4244867, ALG10, p = 3 × 10-8; rs79841648, ADCYAP1, p = 4 × 10-9) and one locus in females (rs148476652, DNER, p = 4 × 10-9). However, the results could not be replicated in the Health 2000 Survey or in the meta-analysis of these two cohorts. The previous TMD GWAS associations did not replicate in our data either. Several TMD pain-associated variants were found in sex-stratified analysis of NFBC1966, suggesting the role of neuroendocrine stress responses and central nervous system. These findings need to be confirmed in future studies.

Interpretation of a clinical practice guideline on the management of chronic pain associated with temporomandibular joint disorders

Temporomandibular disorders (TMD) are a heterogeneous group of diseases that affect the temporomandibular joint, chewing muscle system, dental occlusion, and even various structures throughout the body, with significant characteristics of biological-psychological-social pattern. TMD related chronic pain, as the most important clinical symptom, can result in negative emotions seriously affecting patients' quality of life and physical and mental health. Although a variety of therapies have been previously reported to treat TMD related chronic pain, there is a lack of widely recognized therapies. Professor Jason W Busse (from Michael G DeGroote National Pain Centre, McMaster University, Hamilton ON, Canada) took the lead and collaborated with multiple internationally renowned schools/hospitals of stomatology to develop an international consensus on the management of chronic pain associated with TMD, a clinical practice guideline, which took two years and was published in December 15th, 2023 in a global top journal of clinical research The British Medical Journal. This clinical practice guideline explored the comparative effectiveness of available therapies for chronic pain associated with TMD, conditionally recommended the specific intervention for different treatment or pain relief, proposed a comprehensive, agreed, and standardized clinical practice guideline. This present article describes the methodology and key elements of the clinical practice guideline to help clinicians fully understand and appropriately apply this guidance, which could provide the references for clinical practice of TMD associated chronic pain in China.

Association of temporomandibular disorder-related pain with severe headaches\u2014a Bayesian view

ObjectivesAssociation of temporomandibular disorders (TMD)-related pain with severe headaches (migraine and tension-type headaches [TTH]) was studied over a follow-up period of 11 years.Materials and methodsThe data used was from two nationally representative health surveys in Finland—the Health 2000 Survey (baseline) and the Health 2011 Survey (follow-up) (Bioresource Research Impact Factor [BRIF] 8901)—conducted by the Finnish Institute for Health and Welfare (THL). The primary dataset of the current study included a subset of the population undergoing a clinical oral examination, including TMD examination, at baseline, and answering the questions related to severe headaches, both at baseline and at follow-up (n = 530). From the primary dataset, two datasets were created to study the onset of migraine (dataset 1) and TTH (dataset 2) separately. Dataset 1 included participants healthy of migraine, but not other headaches, at baseline (n = 345), and dataset 2 participants healthy of TTH and other headaches, except migraine, at baseline (n = 464). Bayesian logistic regression models with weakly informative priors were utilized to assess the association of muscle-related TMD pain (mTMD) at baseline and temporomandibular joint-related TMD pain (jTMD) at baseline with the presence of migraine and TTH at follow-up.ResultsNeither of the baseline TMD-related pain variables were associated with the presence of migraine at follow-up (posterior effect estimates-0.12, 95% credible interval [CI] -0.49–0.24, and 0.11, 95% CI -0.38–0.59, for mTMD and jTMD, respectively), whereas mTMD at baseline (posterior effect estimate 0.36, 95% CI 0.02–0.69), but not jTMD at baseline (posterior effect estimate -0.32, 95% CI -0.94–0.25), was associated with the presence of TTH at follow-up. Bayesian sensitivity analyses revealed that the estimates of the regression models were stable, demonstrating sufficient validity and consistency of the estimates.ConclusionThese results indicate that diverse mechanisms may exist behind the associations of TMD-related painful conditions with different types of severe headaches.Clinical relevanceTMD-related pain is a frequent comorbidity of severe primary headaches. Therapy of severe primary headaches may thus benefit significantly with the incorporation of a multi-disciplinary clinical team.

Electromyography-Guided Adjustment of an Occlusal Appliance: Effect on Pain Perceptions Related with Temporomandibular Disorders. A Controlled Clinical Study.

Background: The purpose of this study is to evaluate the effect of an electromyography-guided adjustment of an occlusal appliance on the management of Temporomandibular disorder-related pain. Methods: Data from 40 adult patients (20 males and 20 females), who underwent treatment with occlusal appliances, were recorded. A total of 20 appliances were adjusted according to electromyographic data (group 1), while the others were adjusted by a clinical conventional procedure (group 2). Muscle pain to palpation, pain during articular movements and headache were recorded by a VAS score (from 0 to 100) before the beginning of treatment (T0), at T1 (4 weeks) and T2 (8 weeks). Results: Results showed a reduction of pain in both groups, with a better trend for group 1, where better results were achieved at T1 and maintained stability at T2, with an improved mean value regarding all parameters studied. After 8 weeks, only small recurrences started to occur in muscle pain to palpation in group 2. Conclusions: An occlusal appliance seems to be able to achieve a clinical improvement of Temporomandibular disorder (TMD)-related pain and headache, independently from the adjustment procedure adopted. However, the use of a surface electromyographic activity of masticatory muscles (sEMG) device as an aid in the calibration procedure seems to allow a better trend because the improvement of symptoms was obtained before, after the first four weeks, with an improvement in percentages of all the variables investigated. While the conventional procedure obtained later the improvement.

Effectiveness of Photobiomodulation in Temporomandibular Disorder-Related Pain Using a 635 nm Diode Laser: A Randomized, Blinded, and Placebo-Controlled Clinical Trial.

Objective: We aimed to evaluate the efficacy of photobiomodulation (PBM), using an 635 nm diode laser, to provide pain relief for temporomandibular disorder (TMD). Background data: TMD involves a set of multiple clinical manifestations where pain is prevalent. Treatment ideally should be noninvasive and innocuous such as PBM. Methods: A randomized, placebo-controlled, clinically blinded trial was performed on 42 patients with painful TMD diagnosed according the Research Diagnostic Criteria for Temporomandibular Disorders. They were randomly placed into two groups: an intervention group (n = 22) subjected to the application of a 635 nm wavelength diode laser (using a 8-mm diameter handpiece in contact mode, delivering 8 J/cm2 over a period of 20 sec applied over the sensitive points where the pain was reported by the participants) and a placebo group (n = 20) following the same protocol but without laser activation. All patients received four sessions of treatment over 4 weeks. Personal pain perception, nonassisted pain-free maximum mouth opening and tenderness elicited during palpation of muscles were used as primary outcomes, evaluated at baseline and at follow-up 1 month later by blinded, calibrated evaluators. Results: There was a significant reduction in the degree of pain recorded in the laser group after treatment (0.63 ± 0.36) compared with the baseline evaluation (4.59 ± 2.36; p < 0.001), which was not observed in the placebo group. Reduction of pain during palpation of most masticatory muscles was significant following treatment in the intervention group. A significant increase in the nonassisted painless mouth opening was observed after treatment (42.14 ± 5.8 mm) compared with baseline values (36.73 ± 9.91 mm) only among the laser group (p = 0.007). There were no reported adverse events or side effects among the patients in the intervention group. Conclusions: Our results suggest that PBM using a 635 nm laser was effective on the remission of painful TMD, without complications.

Advances in application of functional magnetic resonance imaging in patients with painful temporomandibular disorders

Temporomandibular disorders (TMD), characterized by pain and dysfunction of the temporomandibular joint, are the most common chronic orofacial pain. However, the etiologies and pathologies of TMD related chronic pain are poorly understood. Functional magnetic resonance imaging (fMRI) measures brain activity by detecting changes associated with blood flow without invasiveness, and has been widely used in chronic pain research. We reviewed recent fMRI studies exploring the brain changes of patients with painful TMD to investigate the role of central nervous system in abnormal pain perception and impaired pain modulation, and to summarize the effects of splint therapy, in the hope of facilitating the clinical diagnosis and treatment of TMD.

Burden of orofacial pain in a socially deprived and culturally diverse area of the United Kingdom.

Little is known about the burden and impact of orofacial pain in deprived areas, and whether it mediates the relationship between socioeconomic position and impacts on daily life. We analysed data from a representative sample of 2168 adults, aged 16 to 65 years, from the East London Oral Health Inequality study. Participants completed a validated questionnaire on demographics, socioeconomic position (area deprivation), orofacial pain (by anatomical site) in the past month, and impacts related to oral conditions on daily life. Negative binomial regression models with robust variance estimator were fitted. The prevalence of orofacial pain was high (30.2%). The most common subset of orofacial pain was intraoral pain (27.5%). The prevalence of pain related to temporomandibular disorders was 6.8%. The most common subsets of intraoral pain were tooth (20.4%) and gingival (11.4%) pain. Orofacial pain, its subsets (intraoral and temporomandibular disorder-related pain), and intraoral pain subsets (tooth and gingival pain) consistently showed associations with all dimensions of impacts on daily life that were highly statistically significant: functional limitation, psychological discomfort, disabilities, and handicap. Socioeconomic inequalities were present in orofacial pain and some dimensions of impacts on daily life. Orofacial pain did not mediate the relationship between area deprivation and impacts on daily life. Our study demonstrated a substantial burden and impact of orofacial pain in a socially deprived and culturally diverse area of the United Kingdom. To address this burden, interventions that lie within the remit of health services are needed to improve access to dental care for adults with orofacial pain.

Estradiol upregulates voltage-gated sodium channel 1.7 in trigeminal ganglion contributing to hyperalgesia of inflamed TMJ.

BackgroundTemporomandibular disorders (TMDs) have the highest prevalence in women of reproductive age. The role of estrogen in TMDs and especially in TMDs related pain is not fully elucidated. Voltage-gated sodium channel 1.7 (Nav1.7) plays a prominent role in pain perception and Nav1.7 in trigeminal ganglion (TG) is involved in the hyperalgesia of inflamed Temporomandibular joint (TMJ). Whether estrogen could upregulate trigeminal ganglionic Nav1.7 expression to enhance hyperalgesia of inflamed TMJ remains to be explored.MethodsEstrous cycle and plasma levels of 17β-estradiol in female rats were evaluated with vaginal smear and enzyme linked immunosorbent assay, respectively. Female rats were ovariectomized and treated with 17β-estradiol at 0 μg, 20 μg and 80 μg, respectively, for 10 days. TMJ inflammation was induced using complete Freund’s adjuvant. Head withdrawal thresholds and food intake were measured to evaluate the TMJ nociceptive responses. The expression of Nav1.7 in TG was examined using real-time PCR and western blot. The activity of Nav1.7 promoter was examined using luciferase reporter assay. The locations of estrogen receptors (ERα and ERβ), the G protein coupled estrogen receptor (GPR30), and Nav1.7 in TG were examined using immunohistofluorescence.ResultsUpregulation of Nav1.7 in TG and decrease in head withdrawal threshold were observed with the highest plasma 17β-estradiol in the proestrus of female rats. Ovariectomized rats treated with 80 μg 17β-estradiol showed upregulation of Nav1.7 in TG and decrease in head withdrawal threshold as compared with that of the control or ovariectomized rats treated with 0 μg or 20 μg. Moreover, 17β-estradiol dose-dependently potentiated TMJ inflammation-induced upregulation of Nav1.7 in TG and also enhanced TMJ inflammation-induced decrease of head withdrawal threshold in ovariectomized rats. In addition, the estrogen receptor antagonist, ICI 182,780, partially blocked the 17β-estradiol effect on Nav1.7 expression and head withdrawal threshold in ovariectomized rats. ERα and ERβ, but not GPR30, were mostly co-localized with Nav1.7 in neurons in TG. In the nerve growth factor-induced and ERα-transfected PC12 cells, 17β-estradiol dose-dependently enhanced Nav1.7 promoter activity, whereas mutations of the estrogen response element at -1269/-1282 and -1214/-1227 in the promoter completely abolished its effect on the promoter activity.ConclusionEstradiol could upregulate trigeminal ganglionic Nav1.7 expression to contribute to hyperalgesia of inflamed TMJ.

Evaluation of Low-Level Laser Therapy in TMD Patients.

Light amplification by stimulated emission of radiation (laser) is one of the most recent treatment modalities in dentistry. Low-level laser therapy (LLLT) is suggested to have biostimulating and analgesic effects through direct irradiation without causing thermal response. There are few studies that have investigated the efficacy of laser therapy in temporomandibular disorders (TMD), especially in reduced mouth opening. The case report here evaluates performance of LLLT with a diode laser for temporomandibular clicking and postoperative findings were evaluated in two cases of TMD patients. First patient had a history of limited mouth opening and pain in temporomandibular joint (TMJ) region since nine months. Second patient's main complaint was his restricted mouth opening, which was progressed in one year. LLLT was performed with a 685 nm red probed diode laser that has an energy density of 6.2 J/cm2, three times a week for one month, and application time was 30 seconds (685 nm, 25 mW, 30 s, 0.02 Hz, and 6.2 J/cm2) (BTL-2000, Portative Laser Therapy Device). The treatment protocol was decided according to the literature. One year later patients were evaluated and there were no changes. This application suggested that LLLT is an appropriate treatment for TMD related pain and limited mouth opening and should be considered as an alternative to other methods.

Effect of water-soluble titanium microparticle-permeated tape on temporomandibular disorders-related pain: A preliminary study

Objective. Recent research has focused on the applicability of titanium particle-impregnated materials in healthcare and medical products. This preliminary study was undertaken to investigate the effect of water-soluble titanium microparticle-permeated (WSTi) tape on temporomandibular disorder (TMD)-related pain. Materials and methods. The study included 32 patients (41.5 ± 14.4 years, 26 women) who had visited the Temporomandibular Joint Clinic, Tokyo Medical and Dental University, for treatment of TMD-related pain. The subjects were instructed to apply the WSTi tape (AquaTitan tape) on the most painful area before going to sleep and remove the tape on awakening daily for 2 weeks. Seven outcome variables were statistically analyzed: maximum mouth-opening ranges with and without pain, spontaneous pain intensity, mouth-opening pain intensity, chewing pain intensity, TMD-related limitation of daily functions (LDF-TMD) and subjective evaluation of any change in TMD-related pain. Results. The mean maximum mouth-opening ranges with (p = 0.011) and without (p = 0.002) pain were significantly greater and mean pain intensities on mouth opening (p < 0.001) and chewing (p = 0.001) were significantly lower at the 2-week follow-up than at the baseline. The mean LDF-TMDQ scores were also significantly lower at the 2-week follow-up (p = 0.004). After 2 weeks of using the WSTi tape, 53.1% and 12.5% of the subjects reported a slight improvement and an improvement, respectively, in TMD-related pain. Conclusion. WSTi tape seems to have beneficial effects on TMD-related pain and LDF.

Efficacy of appliance therapy on temporomandibular disorder related facial pain and mandibular mobility: a randomized controlled study.

There is limited evidence supporting the role of occlusal splints in Temporomandibular disorder (TMD) therapy. The aim of this randomized controlled clinical trial was to assess the efficacy of stabilization splint therapy on TMD related facial pain and mandibular mobility. The sample of study consisted of eighty consecutive patients diagnosed with TMD. Patients were randomly assigned into two groups: a splint group (n=40) comprising of patients treated with stabilization splint, councelling and masticatory muscle exercises, and a control group (n=40), comprising of patients treated with councelling and masticatory muscle exercises alone. Data from both the groups were collected at the beginning of the study and after a 6-month follow up. The outcome variables were visual analogue scale on facial pain intensity and clinical findings for TMD (anterior maximal opening, mandibular right laterotrusion, mandibular left laterotrusion, mandibular protrusion, and number of painful muscle sites). Changes within the splint and control groups (before treatment and 6months after treatment) were analyzed using paired samples t test. Differences in change between the splint and control groups were analyzed using independent samples t-test. The level of significance was set at p<0.05. Facial pain and number of painful muscle sites decreased, and the mandibular mobility increased significantly in both groups after treatment; however the differences in changes in VAS or clinical TMD findings between the two groups were not statistically significant. The findings of this study show that stabilization splint treatment in combination with counselling and masticatory muscle exercises has no additional benefit in relieving facial pain and increasing the mobility of the mandible than counselling and masticatory muscle exercises alone over a 6-months' time interval.

Involvement of trigeminal ganglionic Nav1.7 in hyperalgesia of inflamed temporomandibular joint is dependent on ERK1/2 phosphorylation of glial cells in rats

Inflammation is a major cause of temporomandibular disorder-related pain. The Nav 1.7 sodium channel has a critical function in pain perceptions. However, whether and how Nav 1.7 in the trigeminal ganglion is involved in temporomandibular joint (TMJ) inflammatory pain remains to be examined. TMJ inflammation was induced by complete Freund's adjuvant in female rats. The expression of trigeminal ganglionic Nav 1.7 and other sodium channels was examined using real-time polymerase chain reaction or Western blotting. Immunohistofluorescence with fluorescent retrograde neuronal tracer DiI was used to confirm Nav 1.7 in the trigeminal neurons innervating TMJ. The functions of trigeminal ganglionic Nav 1.7 and extracellular signal-regulated kinase 1/2 (ERK1/2) phosphorylation were blocked with the microinjection of the Nav 1.7 antibody or U0126 into the trigeminal ganglion. Head withdrawal threshold and food intake was measured to evaluate TMJ nociceptive responses. TMJ inflammation significantly up-regulated Nav 1.7 mRNA and protein; however, the mRNA of Nav 1.3 was not affected and those of Nav 1.8 and Nav 1.9 were only slightly up-regulated. TMJ inflammation specifically induced Nav 1.7 in the neurons innervating TMJ. In addition, blocking the Nav 1.7 function significantly attenuated the hyperalgesia of the inflamed TMJ. Moreover, TMJ inflammation up-regulated ERK1/2 phosphorylation only in the glials; blocking ERK1/2 phosphorylation in the glials blocked Nav 1.7 up-regulation in the neurons and correspondingly attenuated the hyperalgesia of the inflamed TMJ. Trigeminal ganglionic Nav 1.7 has an important function in the hyperalgesia of the inflamed TMJ, which is dependent on the communication with the satellite glials.

Laser Phototherapy in Dentistry

Photomedicine and Laser SurgeryVol. 27, No. 4 Guest EditorialLaser Phototherapy in DentistryAldo Brugnera JuniorAldo Brugnera JuniorSearch for more papers by this authorPublished Online:1 Jul 2009https://doi.org/10.1089/pho.2009.9952AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail "Laser Phototherapy in Dentistry." , 27(4), pp. 533–534FiguresReferencesRelatedDetailsCited byEffectiveness of Photobiomodulation in Temporomandibular Disorder-Related Pain Using a 635 nm Diode Laser: A Randomized, Blinded, and Placebo-Controlled Clinical Trial Luís Monteiro, Raquel Ferreira, Tiago Resende, José Júlio Pacheco, and Filomena Salazar19 May 2020 | Photobiomodulation, Photomedicine, and Laser Surgery, Vol. 38, No. 5Clinical study on the efficacy of LED phototherapy for pain control in an orthodontic procedure18 August 2018 | Lasers in Medical Science, Vol. 34, No. 3Low-level laser therapy for orthodontic pain: a systematic review26 September 2014 | Lasers in Medical Science, Vol. 30, No. 6Histomorphometric Assessment of the Influence of Low-Level Laser Therapy on Peri-Implant Tissue Healing in the Rabbit Mandible9 March 2015 | Photomedicine and Laser Surgery, Vol. 33, No. 3Herpes20 February 2015The effect of two phototherapy protocols on pain control in orthodontic procedure—a preliminary clinical study31 May 2011 | Lasers in Medical Science, Vol. 26, No. 5 Volume 27Issue 4Aug 2009 InformationCopyright 2009, Mary Ann Liebert, Inc.To cite this article:Aldo Brugnera Junior.Laser Phototherapy in Dentistry.Photomedicine and Laser Surgery.Aug 2009.533-534.http://doi.org/10.1089/pho.2009.9952Published in Volume: 27 Issue 4: July 1, 2009PDF download

Patients with Acute Painful TMD at High Risk for Developing a Chronic Condition Report Less Pain, Emotional Distress, and Health Care Use after a Psychological Intervention Using Cognitive-Behavioral Skills Training and Biofeedback

Article Title and Bibliographic Information Efficacy of an Early Intervention for Patients with Acute Temporomandibular Disorder-Related Pain: A One-Year Outcome Study Gatchel RJ, Stowell AW, et al. J Am Dent Assoc 2006;137(3):339-47 Level of Evidence 1b Purpose/Question To assess the ability of a 6-session intervention using cognitive-behavioral skills training and biofeedback to reduce pain, improve emotional functioning, reduce health care use, and prevent progression to chronic status in patients with acute temporomandibular disorder (TMD) pain. Source of Funding Government (National Institutes of Health) Type of Study/Design Randomized Controlled Trial

Efficacy of an early intervention for patients with acute temporomandibular disorder-related pain: A one-year outcome study

Efficacy of an early intervention for patients with acute temporomandibular disorder-related pain: A one-year outcome study

Temporomandibular disorders related pain interaction with age, sex and imaging changes of osteoarthrosis

To investigate the relationship of temporomandibular disorders (TMD) related pain with age, sex and imaging changes of osteoarthrosis (OA). All the patients were grouped based on age, sex, imaging changes of OA and TMD related pain. Craniomandibular index (CMI) was calculated for all the patients. TMD related pain was common in females. Significant differences of CMI were existed in all groups under the age of 45 years old. The occurrence of imagine changes of OA was higher in females than in males (P < 0.001). TMD related pain and imaging changes of OA were more common in females, especially in 16 - 30 years old females.