Temporomandibular Joint Pain Research Articles

Effects of Transcutaneous Electrical Nerve Stimulation, Laser Therapy, and Ultrasound in Managing Temporomandibular Disorders: A Randomised Clinical Study

Introduction: Temporomandibular Joint Disorders (TMDs) are considered multifactorial, and several treatment approaches have been proposed for their effective management. The use of non invasive treatment modalities is recommended, which includes Transcutaneous Electric Nerve Stimulation (TENS), Low-Level Laser Therapy (LLLT), acupuncture, ultrasound, and manual therapies. Aim: To evaluate the effectiveness of TENS, LLLT, and ultrasound therapy in patients suffering from TMDs. Materials and Methods: This prospective, randomised clinical trial was conducted on thirty patients (11 males, 19 females) clinically diagnosed with TMD associated with Temporomandibular Joint (TMJ) pain, clicking joint sound, pain in the muscles of mastication, and limited mouth opening. Patients were sequentially randomised into three groups to be treated with TENS, laser beam, and ultrasound therapies, respectively. The Visual Analog Scale (VAS) Score and painfree mouth opening were recorded before, during, and after treatment. Data were analysed using Statistical Package for Social Sciences(SPSS) version 16.0 statistical software. Statistical tests such as the paired sample t-test, Analysis of Variance (ANOVA), and post-hoc Tukey test were performed. Results: There was a significant reduction in the VAS score in the TENS group (3.15), LLLT group (5.75), and ultrasound group (5.50) post-treatment (p<0.001). In addition, improvements in Mean Mouth Opening (MMO) levels were observed with TENS (7.80 mm), LLLT (9.09 mm), and ultrasound therapy (7.15 mm). These differences were found to be statistically significant (p<0.05). The laser and ultrasound groups fared better than the TENS group in the reduction of VAS scores (p<0.05), and there was no significant difference in MMO among the three therapies. Conclusion: Reductions in VAS scores and improvements in mouth opening were noticed in all three groups post-treatment. The laser and ultrasound therapies were more effective in reducing pain compared to TENS therapy. Comparing pretreatment and mid-treatment values, laser beam therapy proved to be more effective in reducing pain scores compared to TENS and ultrasound therapy.

Mitochondria-targeting nanozyme alleviating temporomandibular joint pain by inhibiting the TNFα/NF-κB/NEAT1 pathway.

Inflammatory cytokines that are secreted into the spinal trigeminal nucleus caudalis (Sp5C) may augment inflammation and cause pain associated with temporomandibular joint disorders (TMD). In a two-step process, we attached triphenylphosphonium (TPP) to the surface of a cubic liposome metal-organic framework (MOF) loaded with ruthenium (Ru) nanozyme. The design targeted mitochondria and was designated Mito-Ru MOF. This structure scavenges free radicals and reactive oxygen species (ROS) and alleviates oxidative stress. The present study aimed to investigate the effects and mechanisms by which Mito-Ru MOF ameliorates TMD pain. Intra-temporomandibular joint (TMJ) injections of complete Freund's adjuvant (CFA) induced inflammatory pain for ≥10 d in the skin areas innervated by the trigeminal nerve. Tumor necrosis factor-alpha (TNF-α), nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), long non-coding RNA nuclear paraspeckle assembly transcript 1 (lncRNA NEAT1), and ROS also have been proved to be significantly upregulated in the Sp5C of TMD mice. Moreover, a single Mito-Ru MOF treatment alleviated TMD pain for 3 d and downregulated TNF-α, NF-κB, lncRNA NEAT1, and ROS. NF-κB knockdown downregulated NEAT1 in the TMD mice. Hence, Mito-Ru MOF inhibited the production of ROS and alleviated CFA-induced TMD pain via the TNF-α/NF-κB/NEAT1 pathway. Therefore, Mito-Ru MOF could effectively treat the pain related to TMD and other conditions associated with severe acute inflammatory activation.

Prevalence and Clinical Characteristics of Temporomandibular Disorders in Adults: An Epidemiological Study in the Mediterranean Region of Turkiye

The prevalence and clinical characteristics of temporomandibular disorders (TMD) in the Mediterranean region of Türkiye have not yet been thoroughly investigated. Objective: This study aimed to determine the prevalence and severity of TMD in a sample of the population in this region and to characterize the clinical findings related to TMD. Methods: Four hundred and one participants were included in this study. “Presence of TMD” in the participants was evaluated using the Fonseca Anamnestic Index. Through clinical examination, the findings in the participants were classified as limited mouth opening, deviation, temporomandibular joint (TMJ) sounds, TMJ pain, and muscle pain. Results: The prevalence of TMD was found to be 66.8%, with “Mild TMD” being the most frequent diagnosis among the participants. Clinical findings related to TMD were detected in 48.6% of the participants, and TMJ sounds were the most common clinical finding. TMD was most commonly found in participants over the age of 52, and clinical findings related to TMD were most common in participants between the ages of 25 and 38. In addition, a relationship was found between “Presence of clinical findings” and the gender and age of the participants (p < 0.001 for both comparisons). Conclusion: The results show that females may be more prone to TMD than males. During clinical examinations, it should be considered that “Presence of clinical findings” may be related to gender and age.

Temporomandibular Eklem Ağrısı için Egzersizle ilgili Çevrimiçi Bilgilerin İçeriğinin, Kalitesinin ve Okunabilirliğinin İncelenmesi

Temporomandibular joint (TMJ) pain is a widespread health issue causing discomfort, pain, and distress in the jaw joint and surrounding muscles. It significantly impacts daily activities and diminishes the overall quality of life. As individuals increasingly turn to online platforms for health information, the accuracy and reliability of such information become pivotal. The accuracy, quality, and reliability of online information, especially concerning therapeutic exercises like those for TMJ pain, are of paramount importance. This study aims to assess the content, quality, and readability of online information related to TMJ pain exercises in the Turkish language. A total of 54 websites obtained from Google searches using the keyword "jaw pain exercises" were examined. Evaluation criteria included Ateshman Readability Scale, DISCERN, and JAMA, which were employed to assess medical accuracy, content quality, clarity, and suitability for the general readership. The results revealed that the online information on these platforms generally lacked quality and was not sufficiently understandable for the intended audience, particularly patients. Many sites provided incomplete or vague information about the correct techniques for exercises, potentially leading to incorrect applications by patients, adversely affecting their treatment outcomes. These findings highlight the deficiency and inaccuracy of exercise guidelines available on online platforms, posing a potential risk to patients' treatment processes. It emphasizes the importance of healthcare professionals monitoring online resources, ensuring their accuracy, and making them more comprehensible. Access to accurate and reliable information is crucial for patients, empowering them to make informed decisions about their health and treatment options.

Performance of key physical tests for temporomandibular disorder via telehealth: Establishing validity and reliability.

During the COVID-19 pandemic, many individuals sought healthcare virtually. Physiotherapy is integral in managing temporomandibular disorders (TMDs); therefore, establishing how key physical tests can be appropriately adapted to telehealth is paramount. To establish the validity and reliability of telehealth (specifically videoconferencing) assessments against in-person assessments on a battery of TMD physical tests. A repeated-measures study design was undertaken. Thirty-six adult participants (19 healthy and 17 TMD) underwent concurrent temporomandibular joint (TMJ) physiological movement measurements via videoconferencing and in-person as per standard clinical practice. Inclusion criteria included the presence of central incisors and no significant comorbidities precluding a safe telehealth examination. Participants with TMD completed seven additional pain provocation physical tests. Agreement between telehealth and in-person physiological movement measures was excellent (ICC >0.90, 95% CI: 0.53 to >0.99). Inter- and intra-rater reliability for telehealth measures indicated excellent reliability (ICC >0.97, 95% CI: 0.91 to >0.99). Exact agreement between telehealth and in-person for provocation tests ranged between 58.8% and 94.1%. Fourteen of the twenty-six individual measures produced substantial to near perfect agreement (PABAK = 0.65-0.88), seven produced moderate agreement (PABAK = 0.53), while five produced poor to fair agreement (PABAK = 0.18-0.29). There is high level of agreement between telehealth and in-person measurements of TMJ physiological movement and pain provocation tests.

Objectively measured adherence may affect side effects of mandibular advancement therapy in subjects with obstructive sleep apnea

PurposeThe purpose of this study was to determine if objectively measured adherence to oral appliance (OA) treatment may affect dental changes and temporomandibular disorders (TMD) in patients with obstructive sleep apnea (OSA).MethodsThe original study group consisted of adults with OSA who were referred for OA therapy. Eight indicators of subjective side effects of using OA (temporomandibular joint (TMJ) and muscle pain, pain in teeth, jaw stiffness in the morning, clicking, dry mouth, hypersalivation, gingival irritation) were evaluated by a questionnaire. Three occlusal indicators (overjet, overbite, molar occlusion) and clinical TMD signs (TMJ pain, muscle pain, clicking, jaw deviation on opening) were evaluated at baseline and at the 3-, 6-, and 12-month follow-up. In addition, objective adherence monitoring for OA was registered. Statistical analyses included the chi-square test, Fisher’s exact test, paired sample t-test, and linear regression analyses.ResultsA total of 58 adults with OSA were referred for OA therapy. Mean (SD) age was 50.7 (11.7) and mean apnea-hypopnea index (AHI) was 19.5 (10.0). At 1-year follow-up, the study group consisted of 28 men and 12 women. Overjet but not overbite reduced significantly after 1-year OA therapy. The average nightly wear of OA was related to overjet and overbite reduction, and to TMD signs. Hypersalivation, dry mouth, and tooth discomfort were the most common subjective side effects of OA therapy.ConclusionThere was a time-dependent relationship with the nightly wear of OA and reduction in overjet and overbite, and clinical TMD signs. With 60% of mandibular advancement, dental changes and TM-disorders were considered mild/minor in the 1‐year study period.

Degenerative disorders of temporomandibular joint- Current practices and treatment modalities

Degenerative Joint Disorders (DJD) of the Temporomandibular Joint (TMJ) represent a challenging and multifaceted group of conditions that severely impact the joint's function and quality of life. This comprehensive review delves into the etiology, pathogenesis, clinical manifestations, and contemporary management strategies of TMJ-OA. While systemic illnesses, aging processes, hormonal factors, and behavioral factors have been implicated in its development, recent evidence highlights the pivotal role of mechanical overloading in initiating a series of degenerative changes within the TMJ.Painful joints, a hallmark of TMJ-OA, result from the soft tissues around the affected joint and reflexive muscle spasm, following Hilton's law, which innervates the joint's muscles and overlying skin. This self-preservation reflex protects against further joint damage. Moreover, painful symptoms may arise from subchondral bone destruction.Recognizing the importance of understanding the biomechanical environment within the TMJ, this review underscores its relevance in identifying the mechanisms behind TMJ pain and disability. Furthermore, it discusses the potential application of tissue engineering in TMJ reconstruction, emphasizing the need to learn from past TMJ implant experiences.In the context of treatment, the review highlights the significance of managing TMJ-OA, focusing on restoring function and reducing pain. Treatment modalities span from non-invasive therapies to surgical options, with the latter reserved for cases unresponsive to conservative approaches and severely affecting an individual's quality of life.This review serves as a vital resource for both clinicians and researchers, offering insights into the multifaceted nature of TMJ-OA and the evolving landscape of its diagnosis and management, incorporating biomechanical considerations and potential advances in tissue engineering. Understanding the complexities of TMJ-OA is instrumental in enhancing the care and well-being of individuals affected by this condition.

The association of gene polymorphisms in catechol-O'methyltransferase (COMT) and β2-adrenergic receptor (ADRB2) with temporomandibular joint disorders

ObjectiveTemporomandibular disorder (TMD) has a multifactorial etiology that includes environmental, psychological, and genetic factors. This study aimed to evaluate the possible relationship between polymorphisms in Catechol-O-methyltransferase (COMT) and β2-adrenergic receptor (ADRB2) genes with TMD. DesignThis observational case-control study included 80 patients and 70 healthy controls. The diagnosis of TMD was made using the diagnostic criteria for TMD and the following TMD categories were used for the case group: muscular TMD and articular TMD (disc displacement and arthralgia). A genotyping study of gene polymorphisms in COMT (rs 9332377) and ADRB2 (rs20530449) was performed from genomic DNA isolated from blood. The chi-square test was used to analyze the relationships. P < 0.05 was accepted as a significant difference. ResultsThe polymorphic TT and CT genotype for COMT (rs rs9332377) was significantly higher in the articular TMD group while the non-polymorphic CC genotype was significantly lower in the articular TMD group (P < 0.05). Regarding ADRB2 (rs20530449), the polymorphic GG genotype was similarly considerably more common in the articular TMD group (p < 0.05). In addition, the T allele in the COMT (rs rs9332377) gene was found to be significantly higher in the articular TMD group (p < 0.05). ConclusionsIn the Turkish population, gene polymorphisms in COMT (rs9332377) and ADRB2 (rs2053044) were associated with articular TMD. This study supports the hypothesis that changes in COMT and ADRB2 genes may play a role in temporomandibular joint pain and predisposition to TMD.

The Effect of Corrective Exercise on Pain Referred to The Jaw Joint (TMJ) in Elderly Women With Upper Crossed Syndrome

Background: Upper crossed syndrome is a muscular imbalance disorder associated with various referred pains, especially jaw discomfort. Complications like temporomandibular joint (TMJ) osteoarthritis may link to forward head posture and mechanical head pains resulting from this syndrome.&#x0D; Objectives: The objective of this study was to compare the impact of corrective exercise on pain of TMJ in elderly women with upper cross syndrome.&#x0D; Methods: A total of 30 elderly women with upper crossed syndrome were enrolled at the Kahrizak Elderly Care Center and randomly assigned to either a corrective exercise group or a control group. The experiment group underwent an eight-week training program. Pain levels and neck range of motion were assessed using a pain ruler and goniometer, respectively. In order to measure neck extension, the mean difference and effect size were determined using paired t-test and Cohen’s d, respectively. Referred pain ratings were analyzed using Mann-Whitney U and Wilcoxon signed-rank tests, with effect size calculations, to further understand the intervention’s effect on pain perception.&#x0D; Results: Both groups demonstrated significant changes in referred pain perceptions (P = 0.0441) post-intervention. However, regarding neck extension, neither the control nor the experiment group exhibited statistically significant alterations in neck extension (P = 0.4309)&#x0D; Conclusions: These findings indicate that corrective exercises have a positive effect on alleviating referred pain in the jaw joint caused by muscle imbalance. Given the merits of corrective exercises as a non-pharmacological intervention, they are recommended as an effective approach for improving referred pain in the jaw.

TET1-mediated epigenetic regulation of tumor necrosis factor-α in trigeminal ganglia contributes to chronic temporomandibular joint pain

Chronic temporomandibular joint (TMJ) pain profoundly affects patients' quality of life. Trigeminal tumor necrosis factor-α (TNFα) plays a pivotal role in mediating TMJ pain in mice, yet the underlying epigenetic mechanisms remain enigmatic. To unravel these epigenetic intricacies, we employed a multifaceted approach. Hydroxymethylated DNA immunoprecipitation (hMeDIP) and chromatin immunoprecipitation (ChIP) followed by qPCR were employed to investigate the demethylation of TNFα gene (Tnfa) and its regulation by ten-eleven translocation methylcytosine dioxygenase 1 (TET1) in a chronic TMJ pain mouse model. The global levels of 5-hydroxymethylcytosine (5hmc) and percentage of 5hmc at the Tnfa promoter region were measured in the trigeminal ganglia (TG) and spinal trigeminal nucleus caudalis (Sp5C) following complete Freund's adjuvant (CFA) or saline treatment. TET1 knockdown and pain behavioral testing were conducted to ascertain the role of TET1-mediated epigenetic regulation of TNFα in the pathogenesis of chronic TMJ pain. Our finding revealed an increase in 5hmc at the Tnfa promoter region in both TG and Sp5C of CFA-treated mice. TET1 was upregulated in the mouse TG, and the ChIP result showed TET1 direct binding to the Tnfa promoter, with higher efficiency in the CFA-treated group. Immunofluorescence revealed the predominant expression of TET1 in trigeminal neurons. TET1 knockdown in the TG significantly reversed CFA-induced TNFα upregulation and alleviated chronic TMJ pain. In conclusion, our study implicates TET1 as a vital epigenetic regulator contributing to chronic inflammatory TMJ pain via trigeminal TNFα signaling. Targeting TET1 holds promise for epigenetic interventions in TMJ pain management.

Comparative efficacy of different thicknesses of soft and hard splints in reducing clinical symptoms in patients with temporomandibular disorders

Introduction: The effectiveness of two soft and hard splint thicknesses in reducing temporomandibular joint (TMJ) pain and dysfunction was compared.&#x0D; Materials and Methods: Sixty patients with TMJ pain and dysfunction were randomly assigned to four groups (n=15); the patients treated with hard occlusal splints of 1 and 3mm thicknesses were assigned to Groups A and B, respectively, and those treated with soft occlusal splints of 1 and 3mm thicknesses were assigned to Groups C and D, respectively. Maximum mouth opening (MMO) and the severity of pain based on the visual analog scale (VAS) were assessed before treatment and after 7, 30 and 90 days.&#x0D; Results: After both 7 and 30 days, no significant differences were found between the groups for any variable (P&gt;0.05). However, Group C had a significantly lower MMO compared to Groups A and B after 90 days (P=0.001). Additionally, and in relation to masticatory muscle pain, Group C had a significantly higher VAS score than other groups (P&lt;0.05). The VAS score for TMJ pain at rest was also significantly higher in Group C compared to Groups A and B (P&lt;0.05).&#x0D; Conclusion: A 3-mm hard occlusal splint seems to be the best treatment to reduce pain and dysfunction of the TMJ.&#x0D;

Temporomandibular Joint Pain: An Unusual Initial Manifestation of Rheumatoid Arthritis

We present a 39-year old housewife with temporomandibular joint pain of more than a month duration prior to the development of symmetrical polyarthritis of the small joints of the hands, as an unusual first manifestation of rheumatoid arthritis. &#x0D; A raised acute phase reactant such as ESR is a very helpful indicator of an underlying inflammatory condition, hence the need for early referral to the Rheumatologist.

Serum 3-Hydroxybutyrate is Expected to Serve as One of the Supportive Diagnostic Markers of Persistent Idiopathic Dentoalveolar Pain (PDAP).

Persistent idiopathic dentoalveolar pain (PDAP), previously referred to as atypical odontalgia, is a chronic dental pain that occurs without signs of pathology. PDAP is considered a diagnosis of exclusion, and its definition is currently under refinement and remains ambiguous. The metabolite known as 3-hydroxybutyrate (3HB) has garnered significant interest as a potential indicator for both depression and chronic psychogenic pain. We investigated the characteristics of patients with PDAP and hypothesized that serum 3HB could support the diagnosis of PDAP. Forty-one patients with PDAP and 167 patients with odontogenic toothache were investigated regarding depression and anxiety scales in addition to the general dental evaluation. Blood tests including high-sensitivity CRP, HbA1c, and 3HB were performed for all patients. Associations between PDAP and patients' varying characteristics were investigated using hierarchical multivariate logistic regression analyses. There were more females, current smokers, patients with orofacial pain (such as temporomandibular joint pain, glossalgia, and headache), and people with elevated 3HB levels among patients with PDAP than among control participants. Multivariate logistic regression analyses predicting patients with PDAP identified the female sex (odds ratio [OR]: 4.16), current smoking (OR: 14.9), glossalgia (OR: 19.8) a high CES-D score (≥16) (OR: 5.98), and elevated serum 3HB (≥80 μmol/L) (OR: 18.4) factors significantly associated with PDAP. Our results demonstrated that serum 3HB levels could be elevated in patients with PDAP compared to other types of odontogenic pain, although 3HB was not specific to PDAP. Based on our findings, five factors - female sex, current smoking, depressive tendencies, chronic orofacial pains, and high serum 3HB levels - could be useful for diagnosing PDAP.

Effect of propranolol on temporomandibular joint pain in repeatedly stressed rats.

Stress substantially increases the risk of developing painful temporomandibular disorders (TMDs) by influencing the release of endogenous catecholamines. Propranolol, an antagonist of β-adrenergic receptors, has shown potential in alleviating TMD-associated pain, particularly when the level of catecholamines is elevated. The aim of this study was to explore whether intra-articular propranolol administration is effective in diminishing temporomandibular joint (TMJ) pain during repeated stress situations. Additionally, we investigated the effect of repeated stress on the expression of genes encoding β-adrenoceptors in the trigeminal ganglion. In the present study, rats were exposed to a stress protocol induced by sound, then to the administration of formalin in the TMJ (to elicit a nociceptive response), followed immediately afterward by different doses of propranolol, after which the analgesic response to propranolol was evaluated. We also assessed the levels of beta-1 and beta-2 adrenergic receptor mRNAs (Adrb1 and Adrb2, respectively) using reverse transcription-quantitative PCR (RT-qPCR). Our findings revealed that propranolol administration reduces formalin-induced TMJ nociception more effectively in stressed rats than in non-stressed rats. Furthermore, repeated stress decreases the expression of the Adrb2 gene within the trigeminal ganglion. The findings of this study are noteworthy as they suggest that individuals with a chronic stress history might find potential benefits from β-blockers in TMD treatment.

A Case Report of Korean Medicine Treatment for a Patient with Left Facial Paraesthesia, Temporomandibular Joint Pain, and Post-traumatic Neck Pain induced by Cerebral Infarction

Objectives: The aim of this case report is to present the effects of Korean medicine treatment in a patient with left facial paraesthesia, temporomandibular joint (TMJ) pain, and post-traumatic neck pain induced by cerebral infarction.Methods: A 26-year-old male patient was treated with Cheongpa-Jeon H, acupuncture, pharmacopuncture (Shinbaro2), and Chuna Therapy for 24 days of hospitalization. Left facial paraesthesia, TMJ pain, and post-traumatic neck pain were assessed with a Numeric Rating Scale (NRS) and EuroQoL-5 Dimension (EQ-5D). Post-traumatic neck pain was assessed using the Neck Disability Index (NDI).Results: After 24 days of treatment, the patient’s left facial paraesthesia and left arm tingling sensation were relieved from NRS 6 to NRS 2. Left TMJ pain was reduced from NRS 5 to NRS 2. The EQ-5D score increased from 0.138 to 0.73. The NDI score decreased from 71.11 to 37.78.Conclusion: These results show that left facial paraesthesia, TMJ pain, and post-traumatic neck pain can be relieved with Korean medicine treatment. However, further well-designed studies are required to confirm these findings.

Investigating the effect of obsessive-compulsive disorder on clinical symptoms of temporomandibular joint disorders.

Temporomandibular disorders (TMD) are a group of clinical conditions involving muscles of mastication, temporomandibular joint (TMJ), and related structures or both. TMD is characterized by facial pain in TMJ and muscles of mastication, limitation or deviation of jaw movement, and TMJ sounds during jaw movement and function. The highest risk of TMD prevalence is between 18 and 24 years, and a relationship is between chronic TMD and psychological disorders such as stress and depression. The knowledge of the function of this joint and those with TMD symptoms when visiting the dentist will help to provide an ideal treatment plan for the patient. Therefore, if the therapist is familiar with the various etiological factors of this disorder, he will provide better treatment, especially if the simultaneous effect of psychological factors such as stress and obsessive-compulsive disorder (OCD) along with occlusal factors such as posterior cross-bite, overjet, and overbite is measured, it can be a valuable guide for clinicians. In this study, 385 patients were examined by DASS42 and Maudsley's test and classified into normal, with stress, and stress plus OCD groups. TMJ was examined for each of them by the TMD-RDC test. The presence or absence of TMD was noted in their file. The prevalence of TMD was 20.7% in the normal group, 30.70% in the stress group, and 44.68% in the stress and OCD group. After analyzing the data by SPSS 24 and performing analysis of variance and Duncan tests, no significant difference was found between the probability of TMD in normal and stressed groups, but the stress and OCD group has a higher chance of TMD. Although the co-occurrence of stress and OCD is associated with the prevalence of TMD, it cannot be considered a cause of TMD.

Effectiveness of double-puncture temporomandibular joint arthrocentesis with viscosupplementation in different categories of severity – a prospective study

This 3-year prospective study evaluated the efficacy of temporomandibular joint (TMJ) arthrocentesis with viscosupplementation in different severity stages based on the Dimitroulis classification (categories 2–4 were included). TMJ arthrocentesis was performed under local anaesthesia, and the protocol consisted of a double-puncture technique with lavage of ≥150 cc Ringer Lactate plus viscosupplementation. Incobotulinum toxin A was administered 10–15 days preoperatively in patients with concomitant masticatory myalgia. The primary outcome was TMJ pain, assessed by visual analogue scale (VAS, 0–10), and the secondary outcomes were the maximum mouth opening (MMO, mm) and myalgia degree (0–3). All outcomes were assessed on the intervention day (T0) and after the procedure (T1) (minimum 1 month and then 3 months, 6 months, 1 year and every year since). A total of 108 patients were enrolled (mean age of 43.1 ± 18.9 years); 86 (80%) were women and 22 (20%) were men. Preoperative pain was 4.02 ± 3.12 (mean ± SD), MMO was 38.10 ± 9.56 (mean ± SD) and myalgia degree was 1.80 ± 1.18 (mean ± SD). After an average of 215.4 days (31–1253 days), a statistically significant improvement of pain (P < 0.0001), MMO (P = 0.005) and myalgia degree (P < 0.0001) was observed. The overall successful outcome of TMJ arthrocentesis with viscosupplementation was 76%. The authors observed increased arthrocentesis effectiveness and success rate with viscosupplementation in Dimitroulis category 2 (88.6%) compared to 3–4 (71.4%). An association was found between arthrocentesis with viscosupplementation failure and painful myalgia (ρ = 0.477; P < 0.0001). Thirteen patients (12%) underwent a second TMJ intervention after finalising the present trial. With a low complication rate, TMJ arthrocentesis with viscosupplementation led to an overall benefit for all the included patients. This study reinforces the important role of minimally invasive TMJ arthrocentesis as a first treatment option, with better results in the early stages compared to more severe stages.

Impact of the COVID-19 pandemic on facial pain, anxiety, depression, quality of life, and awake bruxism in sleep bruxism patients, occlusal splint users

Introduction: The COVID-19 pandemic may lead to increased risk of developing or worsening bruxism and facial pain. Objective: To evaluate the influence of pandemic on adults with Sleep Bruxism (BS), both sexes, rigid occlusal splint users. Methods: Longitudinal observational study conducted in adults, both sexes, with Possible BS (n= 50), mean age 35.95 ± 10.35 years, before (T1) and during (T2) COVID-19 pandemic, in person and remotely, respectively. Presence and intensity of pain (Visual Analog Scale) in the masseter and temporal muscles and temporomandibular joint (TMJ) region, anxiety and depression (HADS), quality of life (QoL) (WHOQOL - Brief) and Awake Bruxism (AB) were assessed. Student's t- test, Mann-Whitney U-test, Wilcoxon, Pearson's chi-square and Mc-Nemar tests were applied (p&lt;0.05). Results: The frequency of subjects with masseter, temporal and TMJ pain was 72%, 22%, 42% at T1 and 44%, 26%, 60% at T2, respectively; AB was 78% at T1 and 70% at T2. At both times pain intensity was moderate, there was absence of anxiety and depression, and QoL was regular. At T2, the frequency of subjects with masseter pain decreased 28%, domains physical, psychological and QoL mean worsened (p&lt;0.05). The other variables showed no difference between times (p&gt;0.05). Conclusions: During the COVID-19 pandemic, the use of rigid occlusal splints contributed to pain control in masseter muscle; anxiety and depression were absent, QoL worsened, and AB frequency remained high.

The relationship between the oral behavioral checklist and the jaw functional limitation scale in temporomandibular joint pain

The relationship between the oral behavioral checklist and the jaw functional limitation scale in temporomandibular joint pain

Enhancing Pain Relief in Temporomandibular Joint Arthrocentesis: Platelet-Rich Plasma and Hyaluronic Acid Synergy.

Temporomandibular joint (TMJ) disorders present complex challenges in pain management and functional restoration. This review delves into the innovative approach of using platelet-rich plasma (PRP) and hyaluronic acid (HA) combination therapy in TMJ arthrocentesis to address these issues. The potential benefits of this approach are highlighted through an exploration of mechanisms, clinical studies, safety considerations, and future directions. PRP's regenerative properties and HA's lubrication and anti-inflammatory effects offer a comprehensive solution to multifactorial TMJ pain and dysfunction. Clinical studies reveal significant pain reduction, improved mobility, and enhanced satisfaction in patients treated with PRP and HA. Although mild and transient adverse effects have been reported, the safety profile remains favorable. While the evidence is promising, more extensive randomized controlled trials are needed to establish sustained efficacy and safety. As research evolves, collaborative efforts among clinicians and researchers are crucial in realizing the potential of PRP and HA combination therapy, ultimately providing a novel pathway to alleviate TMJ-related pain and enhance patient well-being.