Temporomandibular Disorders Research Articles

Effects of Hyaluronic Acid (HA) and Platelet-Rich Plasma (PRP) on Mandibular Mobility in Temporomandibular Joint Disorders: A Controlled Clinical Trial.

Hyaluronic acid (HA) is a glycosaminoglycan composed of D-glucuronic acid and N-acetylglucosamine with an up-to-several-million-Daltons chain-length responsible for the lubricating properties of the temporomandibular joint (TMJ) synovial fluid. Arthritis results in the predominance of HA degradation over synthesis leading to temporomandibular disorders (TMDs). TMD injection treatments are divided into HA supplementation and platelet-rich plasma (PRP) inflammation suppression. We questioned whether either approach lubricated the TMJ better and answered it in a two-arm equal-allocation trial with a non-concurrent active treatment control (two groups of 39 patients each). HA statistically significantly improved (p < 0.01) and PRP did not statistically significantly change (0.06 ≤ p ≤ 0.53) articular mobility compared to baselines in 128 TMJs. Statistically significant inter-group discrepancies were observed for abduction (MD = -4.05 mm; SE = 1.08; p = 0.00; d = -0.85) and protrusion (MD = -0.97 mm; SE = 0.43; p = 0.03; d = -0.51) but not for rightward (MD = -0.21; SE = 0.43; p = 0.63; d = -0.11) and leftward (MD = -0.30; SE = 0.42; p = 0.47; d = -0.16) movements. HA supplementation proved superior to PRP autografting in ad hoc TMJ lubrication and hence is more appropriate in hypomobile TMD cases of symptomatic treatment.

Effects of acupuncture and related techniques in temporomandibular disorders (TMD): A systematic review

Acupuncture has shown promise as a therapeutic option in temporomandibular disorders (TMD). Its benefits include pain relief, reduction of muscle tension and improvement of jaw function. Several alternative approaches, including dry needling and laser acupuncture, were also reported to improve TMD symptoms. This review aims to summarise the most recent studies available on these alternative therapies for TMD. An electronic literature search was conducted in 3 databases, PubMed, Web of Science, and Scopus, in order to identify articles on acupuncture, dry needling, or laser acupuncture. Search development, process, and two-step article selection were conducted by independent researchers. Data was extracted regarding study characteristics, population characteristics, acupuncture points or techniques used, and assessment methods for diagnosis and effects. Out of 431 identified results, 20 were selected for inclusion. We identified 11 studies on acupuncture, 3 studies on laser acupuncture and 6 studies on dry needling. Most studies showed improvement of TMD symptoms post-intervention, assessed by pain scales and maximum mouth opening. Overall, most studies showed promising results for acupuncture as an alternative, minimally invasive treatment method for TMD. When compared to controls or placebo, acupuncture, and related techniques result in significant relief of TMD symptoms.

Temporomandibular Disorder and Psychological Distress Relationships in Air Traffic Controllers

Temporomandibular Disorder and Psychological Distress Relationships in Air Traffic Controllers

Magnetic Resonance Imaging of Temporomandibular Joint and Aortic Root Score in Fibrillinopathies.

Background and Objectives: Fibrillinopathies have different phenotypic expression: Marfan-like skeleton features, MLSF; mitral valve prolapse syndrome, MVPS; MASS phenotype, M = mitral valve prolapse, MVP, A = aortic root dilation, S = skeletal features, and the second S = (cutaneous) striae; Marfan Syndrome, MS. The study had the following main objectives: the correlation between disc displacement, DD (a major sign for temporomandibular joint dysfunction, TMDs) on magnetic resonance imaging, MRI, and aortic Z score (a major sign for aortic root dilation) on echocardiography; the predictive value of DD towards aortic Z score. DD had 2 types of severity: DD with reduction (the mild type, DDwR), and DD without reduction (the severe type, DDwoR). Materials and Methods: The type of fibrillinopathy was precised by clinical exam (systemic score), ophthalmic exam (for ectopia lentis), and echocardiography (aortic Z score, MVP). Medical treatment consisted of betablockers, BB (for patients with tachycardia), or angiotensin II receptor blockers, ARB. Surgical treatment was addressed to aortic root aneurysm, and severe mitral regurgitation, MR. DD benefited from dental conservatory treatment or surgical restoration. Results: DD-Z score had a powerful correlation in MASS (Rho = 0.787, p < 0.01), and in MS patients (Rho = 0.819, p < 0.01). For the entire sample, both DDwR-Z score and DDwoR-Z score had a moderate correlation (Rho = 0.469, and respectively 0.669). Furthermore, DD was an important predictor for Z score. DDwoR had a double power of prediction for the Z score compared with DDwR (B coefficient = 1.661 for DDwR and 3.281 for DDwoR). Conclusions: TMDs had a powerful correlation with aortic root dilation in MASS and MS patients from the sample. Likewise, TMDs was a major predictor for aortic root dilation, in the entire sample. In clinical practice, we can utilize an extracardiac finding, TMDs, obtained by a non-invasive technique, MRI, for cardiac severity stratification of fibrillinopathies.

Ultrasound Elastography in Temporomandibular Disorders: A Narrative Review.

A class of intricate musculoskeletal diseases known as temporomandibular disorders (TMDs) affects the temporomandibular joint (TMJ) and its supporting structures. The majority of individuals will at some point in their lives experience some degree of TMD symptoms, as these diseases are highly prevalent in the general population. TMDs are multifactorial and are attributed to various physical and biopsychosocial factors. The TMD patients typically experience preauricular pain, tenderness of masticatory muscles, and joint sounds, and these in turn affect their quality of life. To carry out the appropriate course of treatment, it is critical to make an accurate and timely diagnosis. The TMDs are classified as myofascial pain, internal disc derangement, and degenerative disorders of TMJ. Myofascial pain, which is identified by palpating the affected muscles of mastication and tenderness, is one of the most common findings. The muscles in this condition become stiff due to the contraction of myofibrils and are known as trigger bands. The diagnosis of trigger bands involving the masticatory muscles commonly involving the masseter muscle in myofascial pain to date is subjective, and palpation is the only tool used for its diagnosis. An objective assessment of the masticatory muscles is desirable for accurate diagnosis and treatment planning. Various tools like electromyography and hardness meters have been for assessing muscle stiffness, but their application in TMJ muscle disorders has not yielded valuable results. A novel diagnostic method called ultrasound elastography evaluates muscle stiffness both qualitatively and quantitatively using an elastogram and the muscular elasticity index. In this paper, we will review the ultrasound elastographic techniques utilized for the diagnosis and management of TMDs.

The effectiveness of aerobic exercise compared to other types of treatment on pain and disability in patients with orofacial pain: A systematic review.

To compile and synthesise the evidence regarding the effectiveness of aerobic exercise (AE) compared with other treatments to reduce pain and disability of individuals with orofacial pain (OFP). Electronic searches were conducted on five databases (MEDLINE, Embase, CINAHL, Cochrane Library, and Scopus). Randomised controlled trials (RCT) or controlled trials including adults of both sexes with painful OFP diagnoses were targeted. The intervention of interest was AE (e.g., walking, cycling, running, among others), compared to any other conservative and non-conservative therapy. The primary outcome was pain intensity. The risk of bias (RoB) was determined using a compiled set of items and the Cochrane RoB-2 tools. The overall certainty of the evidence was evaluated with the GRADE approach. Out of 4.669 records screened, four manuscripts were included. However, three of them used the same population but presented different outcomes. These studies included subjects with headache associated with temporomandibular disorders (TMD) and general TMD. Both studies used aerobic exercise (AE) as the intervention of interest. Manual therapy (MT) plus exercise (Ex) (strengthening exercise (Str ex) or general exercises) were used as a comparison group. The combined treatment, including a multimodal therapy (AE + MT + Str ex), was superior to MT + Ex (MD: -8.65 points [95% CI -13.73, -3.57]) on pain intensity (orofacial pain [OFP] and headache intensity) at the end of the treatment and also after 12-week follow-up (MD: -9.43 points [95% CI -14.97, -3.89]). Also, the combination of three treatment modalities (AE + MT + Ex) was better on quality of life than AE alone (MD: -14.60 points [95% CI -16.74, -12.46]) and MT + Ex (MD: -12.30 point [95% CI -14.50, -10.10]) at the end of the treatment. Aerobic exercise plus MT and general exercises achieved the greatest positive effects on pain and other outcomes in the short/medium term in patients with OFP. However, the scientific evidence supporting the isolated effects of AE for OFP is limited, indicating the need for more studies. Further studies are also needed to elaborate guidelines when using AE for individuals with OFP.

Stress is simultaneously related to sleep and temporomandibular disorders

Stress is simultaneously related to sleep and temporomandibular disorders

Pain, Function and Quality of Life in Temporomandibular Disorder Patients With Different Disc Positions

ABSTRACTBackgroundWhether pain, jaw function and quality of life are correlated with disc positions is controversial, and similar studies evaluating disc positions by magnetic resonance imaging (MRI) are very limited.ObjectiveThis study evaluated the pain, mandibular function and quality of life of the temporomandibular disorders (TMDs) patients with different disc positions according to MRI, and the relationship among them.MethodsThree hundred and thirty‐five participants were included. Patients completed questionnaires included the Numeric Rating Scale (NRS), Jaw Functional Limitation Scale 8‐item (JFLS‐8), the Generalised Anxiety Disorder 7‐item (GAD‐7), Patient Health Questionnaire 9‐item (PHQ‐9) and Oral Health Impact Profile for TMD (OHIP‐TMD). MRI was conducted to evaluate these diagnoses, resulting in the identification of three distinct categories: normal positioning (NP), disc displacement with reduction (DDwR) and disc displacement without reduction (DDwoR).ResultsParticipants had the mean age of 28.55 ± 11.10 years (80.90% women). DDwR and DDwoR had a higher percentage of females compared with NP. Significant differences existed among patients in all questionnaires. The DDwoR group had significantly the highest pain, functional limitation and the worst quality of life. Moreover, they experienced the most difficulties in chewing tough foods, yawning, experiencing pain and psychological discomfort. Moreover, the multivariate regression showed that age, female gender, diagnosis as DDwoR, GAD‐7 and PHQ‐9 were significantly linked to higher functional limitation. Worse quality of life was associated with age, diagnosis as DDwoR, GAD‐7 and PHQ‐9.ConclusionsAmong patients with different disc positions, DDwoR showed the highest pain, functional limitation and the worst quality of life. Also, NP showed a proportion of chronic pain. Physical pain, psychological discomfort and chewing tough food were regarded as the most impaired. Women who experience anxiety and depression tended to have a higher propotion of dysfunction and a lower quality of life.

Effectiveness of results of complex treatment of pathological wear of hard tissues of teeth

Background:Tooth wear is a multifactorial condition that results in the loss of hard dental tissue. Physiological wear does not usually result in any subjective symptoms. Pathological abrasion of hard dental tissues is accompanied by both morphological and functional disorders of the dental system Objective: To evaluate the functional and aesthetic results of complex treatment of pathological abrasion of dental hard tissues. Materials and methods: This is a prospective controlled study that included 82 patients with a clinically confirmed diagnosis of Increased tooth wear of the first and second degree of severity (from 2020 to 2024). The age of the patients ranged from 34 to 68 years (48 men, 34 women). The examination of patients included: collecting complaints and identifying concomitant somatic diseases, X-ray examination, photographs of the patient's face, bite height, and nasolabial folds. Distribution of the group: Group 1 included patients with the first degree of hard tissue loss 47 (29 men, 18 women) Group 2 included patients with the second degree of hard tissue damage 35 (21 men, 14 women). During examination, patients complained of aesthetic defects caused by tooth wear and discoloration, discomfort when closing, chewing and phonetic disorders, typical symptoms of TMJ dysfunction, such as pain and crunching in the joints, fatigue of the masticatory muscles and muscle pain, displacement of the lower jaw to the side during vertical movements, a feeling of distension in the ears, headaches and bruxism. In patients of group 1: tooth wear was restored with orthopedic structures. In patients of group 2: temporary prosthetic structures and occlusal splints were used to normalize occlusal relationships in case of TMJ and masticatory muscle dysfunction. Gradual raising of the bite was carried out by means of a set of kappa-splints for 14 days, 1 month and 3 months from 1.0 to 5.0 mm until complete restoration of the occlusal height depending on the severity of pathological abrasion of teeth, abrasion of teeth restored by orthopedic structures. Dynamic observation of the clinical condition of the prosthesis structure was carried out in the following periods: 1 week, 1, 6, 12, 24 months,assessment of the condition of the performed restorations were recorded in the medical record of the dental patient. Results:Clinical radiological results showed satisfactory results and are encouraging in patients of groups 1 and 2. After treatment in patients of groups 2, according to the analysis of the lateral teleroentgenogram of the head, an increase in the height of the lower third of the face is noted, in 28 patients the nasolabial folds were smoothed out. Patients were satisfied with the aesthetic and functional results of the treatment Conclusions: The results of the study showed that treatment using occlusal splints at the preparatory stage in patients of group 2 with occlusion disorders due to pathological abrasion of hard dental tissues and restoration with orthopedic structures is relevant for normalizing the occlusal relationships of the jaws and this complex treatment method provides a good aesthetic and functional result.

Critical Appraisal of Clinical Trials Evaluating Physical Therapy Treatments for Temporomandibular Disorders: A Scoping Review

ABSTRACTBackgroundPhysical therapy seems the most promising treatment for temporomandibular disorders (TMD), although their effectiveness is controversial in general, due to high heterogeneity regarding study designs, applied treatments and outcomes measures.ObjectivesThe aim of this scoping review is to analyse the methodological characteristics of clinical trials evaluating physical therapy treatments in subjects with TMD.MethodsA systematic search was conducted in Medline/PubMed, SPORTDiscus, Scopus, Web of Science, SciELO, Cochrane, ScienceDirect and EMBASE databases on 31 October 2023. Clinical trials evaluating physical therapy interventions in patients older than 18 years with TMD, published in English or Spanish languages. Data regarding content reporting of study designs, sample characteristics, interventions and outcome measures was extracted. Descriptive summary statistics were reported.ResultsThe search retrieved 15 322 records, and 136 were included. There were 107 randomised clinical trials, 5 non‐randomised controlled trials and 24 non‐controlled trials. Most studies had moderate to high risk of bias, small sample sizes (median, 44 subjects) and short follow‐up periods (1–3 months). The most common diagnostic criteria used was the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) (48.9%). The most reported experimental interventions were manual therapy (40.4%), exercise (30.2%) and electrotherapy modalities (27.2%), and the most common outcome measure domains were pain (83.8%), range of movement (61.8%), disability (45.6%) and mechanosensitivity (29.4%). There was poor content reporting of experimental interventions.ConclusionsCurrent literature of clinical trials of physical therapy interventions for TMD has moderate to high risk of bias, poor content reporting, small sample size and short‐term follow‐ups which limit internal and external validity, as well as applicability into clinical practice.

Incidence of Dentoalveolar Trauma and its Correlation with Temporomandibular Disorders – A Systematic Review

Abstract Temporomandibular disorders (TMDs) represent a diverse set of conditions affecting the temporomandibular joint, masticatory muscles and associated structures. Previous studies suggested a notable correlation between dentoalveolar trauma (DAVT) and the incidence of TMDs. This systematic review aims to further elucidate this relationship. A comprehensive search was conducted in electronic databases to identify relevant studies published up to 2023. The included studies investigated the association between DAVT and TMDs in diverse populations. Data were extracted based on study characteristics, participant demographics and key findings. The quality of the included studies was evaluated using the established assessment tools. Five studies were included in the final review. The studies revealed a strong association between DAVT and TMDs across different populations, including adolescents, students and high-contact sports practitioners. The correlation was evident in the form of significantly higher odds ratios, increased prevalence of specific TMD subtypes and more severe symptoms in individuals with a history of DAVT. Furthermore, the studies highlighted the significant role of high-contact sports and trauma history in TMD’s prevalence and severity. The findings from this systematic review provide compelling evidence of the significant correlation between DAVT and TMD. The results underline the importance of early detection and management of DAVT, particularly in high-risk groups such as high-contact sports practitioners, to prevent the development and progression of TMDs. Future research should focus on understanding the underlying mechanisms of this association and developing effective preventive and therapeutic strategies.

Condylar Remodeling and Skeletal Changes Following Occlusal Splint and Manual Therapy: A Cone Beam Computed Tomography Study in Temporomandibular Disorders.

Background: Temporomandibular disorders (TMD) may be associated with degenerative disease of temporomandibular joint (TMJ), such as condyle erosion and subchondral cysts. Occlusal splint and cranio-mandibular manual therapy, or combined therapy, is recommended as a conservative treatment to alleviate pain-related signs and symptoms in TMD. This study aimed to assess osseous condylar changes and skeletal changes following occlusal splint and cranio-mandibular manual therapy in TMD using cone beam computed tomography (CBCT). Methods: A retrospective cohort study included 24 patients diagnosed with TMD. Combined therapy was performed until pain-related signs and symptoms disappeared. CBCT scans were performed before and after therapy. Osseous structure of condyles and their subsequent modifications were analyzed on CBCT images: flattening, erosion, and subchondral cyst. Sella-Nasion-A point (SNA), Sella-Nasion-B point (SNB), A point-Nasion-B point (ANB), Sella-Articulare-Gonion (Condylar angle), and anterior and posterior facial height (AFH, PFH) were measured on CBCT-generated lateral cephalograms. A paired t-test, Wilcoxon rank-sum test, McNemar test, and Stuart-Maxwell test were used for the statistical analyses. Results: The treatment period with combined therapy was 7.42 ± 3.27 months, and 21 out of 33 TMJ presenting degenerative disease (63.6%) had significant complete remodeling (p < 0.05). Following therapy, SNB significantly decreased from 75.61 ±3.47° to 74.82 ± 3.41° (p = 0.02), ANB significantly increased from 4.05° (3.35-4.9°) to 4.8° (3.3-6.12°) (p < 0.001), AFH significantly increased from 112.85 mm (109.28-118.72) to 115.3 mm (112.58-118.88) (p < 0.001), PFH/AFH significantly decreased from 64.17 (61.39-66.1) to 63 (59.68-64.51) (p = 0.012), and condylar angle significantly increased from 140.84 ± 8.18° to 144.42 ± 8.87° (p = 0.007). Conclusion: Combined therapy promoted significant condylar remodeling in TMJ degenerative disease, along with skeletal changes (mandibular retrusion and increase in facial height). Therapeutic strategies should consider condylar remodeling in TMD. Skeletal and dental parameters should be evaluated prior to occlusal splint therapy.

Digital methods for diagnosing dental occlusion disorders

Relevance. Occlusal disorders are not only predictors of oral diseases but are also associated with systemic conditions such as endocrine, cardiovascular, and cognitive disorders, highlighting their broader significance in medicine. The digitization of diagnostic processes and the integration of computer technologies into traditional methods offer promising advancements in assessing occlusal status. This makes the analysis of digital methods for diagnosing occlusal relationship disorders particularly relevant.Purpose. To evaluate digital methods and devices used for diagnosing occlusal relationship disorders.Material and methods. A systematic review was conducted, analyzing 40 scientific publications from 2016 to 2024 that focus on digital methods for diagnosing occlusal imbalance. The study assessed electronic devices that measure occlusal force by converting mechanical force into electrical signals using various sensors. These digital methods are employed to evaluate the functional state of the masticatory system, including the detection of temporomandibular joint disorders, mandibular fractures, and occlusal deformities, as well as to monitor occlusal force dynamics during treatment. Recent advancements in portable electronic sensors suggest potential applications for their integration with control chips into dental prostheses or occlusal stabilization splints, allowing real-time monitoring of tooth compression forces, potentially enhanced by artificial intelligence.Results. The development of new diagnostic methods and devices equipped with highly sensitive sensors for measuring masticatory pressure opens new avenues for identifying clinical parameters that were previously difficult to analyze. Recent advances in hardware technology, particularly those utilizing neural network analysis, have the potential to expedite accurate diagnosis and predict the risk of complications.Conclusion. Both in Russia and internationally, significant progress is being made in the development of digital methods for diagnosing occlusal imbalance. These methods are poised to become a priority in the future of dental practice. However, the adoption of digital occlusal methods into routine dental practice is currently hindered by challenges related to the availability of digital equipment in clinics and the insufficient digital skills of many dentists. Addressing these challenges is crucial for improving the quality of dental care for patients with occlusal disorders.

An Overview of Diagnosis and Management of Temporomandibular Disorders

An Overview of Diagnosis and Management of Temporomandibular Disorders

The Association Between the Central Sensitisation Inventory and Temporomandibular Disorders Is Confounded by Migraine, Depression, Widespread Pain and Parafunction. A Cross-Sectional Telehealth Study.

Temporomandibular disorders (TMDs) are conditions that involve the temporomandibular joints, masticatory muscles, and associated tissues, causing orofacial pain. Central sensitisation (CS) is a relevant part of the TMD pathophysiology. Migraine, psychological aspects, parafunctional oral habits and widespread pain are commonly associated with both TMD and CS and could confound the association between them. To investigate the association between painful TMD and the Central Sensitisation Inventory (CSI) score, and to assess the presence of confounders in this association. Cross-sectional study that assessed women with and without orofacial pain complaints using telehealth. The TMD Pain Screener and an online physical examination determined the presence of painful TMD. The following questionnaires were applied: CSI, Headache Screening Questionnaire, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Oral Behavior Checklist, Jaw Functional Limitation Scale and the Nordic musculoskeletal questionnaire. A single regression investigated the association between the CSI score and TMD, and a multiple regression investigated the effect of the other outcomes as possible confounders. Confounding was considered present when the association between TMD and the CSI score changed more than 10% after adding a possible confounder to the regression model. Forty-two women with painful TMD and 53 without TMD were included. There was a significant association between the CSI score and the presence of painful TMD (R2 = 0.639; p < 0.001). This association changed when the following outcomes were added to the model: presence of migraine, symptoms of depression, widespread pain and parafunctional oral habits. The positive association between TMD and the CSI score was confounded by migraine, symptoms of depression, widespread pain and parafunctional oral habits.

Exploring the Relationship Between Somatisation, Facial Pain and Psychological Distress in East Asian Temporomandibular Disorder Patients.

The relationship of somatisation with facial pain duration/intensity, pain-related interference/disability and psychological distress was investigated in East Asian temporomandibular disorder (TMD) patients. Correlations between somatisation, facial pain and psychological characteristics were also explored alongside the demographic/physical factors associated with moderate-to-severe depression and anxiety. Anonymised data were acquired from records of consecutive 'first-time' patients seeking TMD care at a tertiary oral medicine clinic. Axis I physical TMD diagnoses were established utilising the diagnostic criteria for TMDs (DC/TMD) protocol and patients with TMD pain were stratified into those with pain-related (PT) and combined (CT) conditions. Axis II measures administered encompassed the Patient Health Questionnaire-15 (PHQ-15), Graded Chronic Pain Scale (GCPS), Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder Scale-7 (GAD-7). Individuals with PT and CT were further categorised into those without (Pain - Som/Comb - Som) and with somatisation (Pain + Som/Comb + Som). Statistical evaluations were performed with nonparametric and logistic regression analyses (α = 0.05). The final sample comprised 473 patients (mean age 36.2 ± 14.8 years; 68.9% women), of which 52.0% had concomitant somatisation. Significant differences in pain duration (Comb + Som > Pain - Som), pain-related interference/disability (Comb + Som > Comb - Som) and depression/anxiety (Pain + Som, Comb + Som > Pain - Som, Comb - Som) were discerned. Depression/anxiety was moderately correlated with somatisation (rs = 0.64/0.52) but not facial pain characteristics. Multivariate modelling revealed that somatisation was significantly associated with the prospects of moderate-to-severe depression (OR 1.35) and anxiety (OR 1.24). Somatisation exhibited a strong association with psychological distress when contrasted with facial pain in East Asian TMD patients.

Comparison of the effects of acupuncture methods on the temporomandibular disorder: A network meta-analysis.

A network meta-analysis (NMA) was applied to compare the therapeutic effect of different acupuncture methods on temporomandibular disorder (TMD). A computer retrieval was carried out in the English databases of Cochrane, PubMed, Embase and Web of Science, as well as the Chinese databases of CNKI, Wanfang and VIP for randomized controlled trials on the effect of acupuncture on TMD, with a retrieval deadline of January 21, 2024. Data analysis was conducted using R software and Bayesian method. The pain score served as the primary outcome measure, with the mouth opening as the secondary outcome measure. Thirty-five articles were included in the analysis, involving 1937 TMD patients. The NMA results suggested that DN-PT had the best effect on relieving pain and improving mouth opening. (Description of all abbreviations in Supplementary Material S3). Based on the available evidence, the results of the NMA suggest that DN-PT is most effective in relieving TMD pain and increasing mouth opening. However, due to the fact that some acupuncture therapies are only reported in a small number of research reports, this may lead to an increase in the randomness of the results and a decrease in the reliability.

Diagnosis and management of bruxism. A literature review

Bruxism, characterized by involuntary grinding or clenching of teeth, is a widespread condition with multifaceted implications for oral health, physical well-being, and quality of life. This comprehensive review aims to provide an in-depth study of bruxism, encompassing its definition, classification, etiology, pathophysiology, clinical manifestations, and consequences. Bruxism is classified based on its timing (sleep bruxism or awake bruxism). The etiology of bruxism is multifactorial, involving physiological factors such as central nervous system (CNS) pathways, sleep disorders, and occlusal factors, as well as psychological factors like stress, anxiety, personality traits and environmental factors including medications, substances, and stressors. Clinically, bruxism can result in various dental consequences, including tooth wear, fractures and damage to restorations, as well as temporomandibular disorders (TMDs) such as myofascial pain. These manifestations can negatively impact individual's oral health, physical well-being, and overall quality of life. Management strategies include behavioral and lifestyle changes, oral appliances, dental treatments for tooth damage, and, in certain instances, pharmacological interventions. While the current understanding of bruxism has advanced, further research is needed to fully elucidate its etiology, pathophysiology, and effective management strategies.

Establishing a CAD-CAM workflow for stabilization appliances (Michigan splints).

Stabilization appliances (Michigan splints) are considered well-studied and widely adopted for managing bruxism and temporomandibular disorders (TMDs). Traditionally, these appliances have been fabricated by wax modeling and pressing resin onto casts made from irreversible hydrocolloid or silicone impressions. This article provides a detailed description of an all-digital workflow that uses intraoral scanning and computer-aided design (CAD) software to design a stabilization splint on a digital cast that can be manufactured autonomously by a computer-aided manufacturing (CAM) grinding machine in a subtractive procedure. The workflow is applicable to both dentists and technicians. Special attention is given to aspects and procedures that are important for the successful fabrication of the splint. Working without a cast can save time and money, and the use of CAD-CAM technology provides a homogeneous splint material quality.

Hematological biomarkers of systemic inflammation in predicting long-term treatment response of temporomandibular disorders

BackgroundChronic systemic inflammation has been proposed as the underlying mechanism of pain chronicity in several pain conditions. In spite of the growing evidence supporting the role of systemic inflammatory markers as a diagnostic tool, their role has not been analyzed in a well-defined group of temporomandibular disorders (TMD) patients until now. This study aimed to investigate the association between various clinical features and comorbidity levels of TMD in relation to hematological markers and seek its association with long-term treatment response.MethodsClinical features and hematological indices including those for systemic inflammation were assessed in TMD patients (n = 154). Examinations were re-done after 6 months of conservative treatment. Patients were divided into pain improved and unimproved groups based on ≥ 2 numeric rating scale improvement in pain intensity at 6 months for final analysis.ResultsThe portion of patients with low lymphocyte-to-monocyte ratio (p = 0.026), total protein (p = 0.014), hemoglobin (p = 0.040), and mean corpuscular hemoglobin concentration (p = 0.042) values showed significant differences according to prognosis groups. Low hemoglobin levels were significantly associated with unfavorable response to long-term treatment (β = 1.706, p = 0.018). High pre-treatment pain intensity (β=-0.682, p < 0.001) and low Graded Chronic Pain Scale (β = 1.620, p = 0.002) could predict significant pain improvement with long-term treatment.ConclusionsHematologic assessment could be considered in addition to clinical examination to better determine long-term prognosis in TMD patients.