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A Multidisciplinary Approach on the Diagnosis and Treatment of Orofacial Pain Associated to Temporomandibular Disorders

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Oral Health".

Deadline for manuscript submissions: closed (12 April 2023) | Viewed by 32395

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Assoc. Prof. Dr. Joaquim Gabriel Mendes

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Guest Editor

Faculdade de Engenharia, Universidade do Porto, 4200-465, Portugal
Interests: instrumentation; biomechanical devices; automation; medical devices; thermography

Prof. Dr. José Manuel Amarante

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Assistant Guest Editor

Departmento de Cirurgia e Fisiologia, Faculdade de Medicina, Universidade do Porto, 4200 - 319 Porto, Portugal
Interests: plastic surgery; maxillofacial surgery

Prof. Dr. Afonso Pinhão Ferreira

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Assistant Guest Editor

Department of Orthodontics, Faculdade de Medicina Dentária, Universidade do Porto, 4200-393, Portugal
Interests: orthodontics

Dr. Miguel Pais Clemente

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Associate Guest Editor

Department of Surgery and Physiology, Faculdade de Medicina, Universidade do Porto, 4200 - 319 Porto, Portugal
Interests: occlusion; temporomandibular disorders; orofacial pain; oral rehabilitation
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Dear Colleagues,

The application of techniques that can assist the modulation of orofacial pain associated with temporomandibular disorders (TMD) is an emerging field in the area of dentistry. TMD can involve the presence of pain or dysfunction in certain areas of the cranio-cervico-mandibular complex (CCMC), such as the masticatory muscles, the temporomandibular joint (TMJ), and associated structures like the postural muscles of the cervical region. Understanding the comorbidity of orofacial pain associated with TMD and other pain conditions is fundamental to obtaining a correct diagnosis related to the patient symptomatology, since TMD is the main cause of nondental pain in the orofacial region.The etiology of TMD can be multifactorial, with contributing factors such as trauma and pathophysiologic, anatomic, and psychosocial aspects. Complementary examinations methods for its diagnosis may be used when indicated, such as imaging of hard and soft tissues, e.g., through panoramic X-ray, tomography, magnetic resonance imaging (MRI), or infrared thermography. Therefore, an oral health professional can understand the boundaries and scope of his/her clinical action when implementing a treatment plan that may adopt different kinds of approaches.These facts can have a huge impact in terms of public health, where orofacial pain associated with TMD should be treated within the scope and attention of a multidisciplinary group.

Prof. Dr. Joaquim Gabriel Mendes
Prof. Dr. José Manuel Amarante
Prof. Dr. Afonso Pinhão Ferreira
Prof. Dr. Miguel Pais Clemente
Guest Editors

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Keywords

Orofacial pain
Temporomandibular disorders
Differential diagnosis
Craniofacial morphology
Parafunctional habits—bruxism
Orofacial trauma
Oral and maxillofacial pathology
Complementary methods of diagnosis
Therapeutic modalities
Infrared thermography

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Research

13 pages, 354 KiB

Open AccessArticle

Effect of Personality Type on the Occurrence of Temporomandibular Disorders—A Cross-Sectional Study

by Magdalena Mitrowska-Guźmińska, Magdalena Gębska, Kinga Jonko, Bartosz Dalewski, Łukasz Pałka, Magdalena Chęć and Ewa Sobolewska

Int. J. Environ. Res. Public Health 2023, 20(1), 352; https://doi.org/10.3390/ijerph20010352 - 26 Dec 2022

Cited by 4 | Viewed by 2193

Abstract

Background: Personality traits are one of the major factors influencing the behavior and functioning of an individual, and they play a crucial role in the development of psychosomatic disorders and diseases. This paper aimed to evaluate the importance of personality traits in temporomandibular disorder (TMDs) development using the NEO-FFI Personality Inventory by Paul Costa and Robert McCrae (the Five-Factor Model of Personality, known as the Big Five). Moreover, the relationship between personality type and the intensity of dysfunctional changes in the stomatognathic system was assessed using the NEO-FFI Personality Inventory by Paul Costa and Robert McCrae (the Five-Factor Model of Personality, known as the Big Five). Material and Methods: The study included a group of 75 adult participants (aged 19–52) with TMD diagnosed according to DC/TMD criteria and a control group of 75 participants without symptoms of dysfunction. The study consisted of a questionnaire and clinical study; the questionnaire included the NEO-FFI psychological questionnaire and a self-authored one. The clinical part consisted of extra- and intraoral dental examinations. Results: Participants who clenched their teeth showed a greater degree of conscientiousness than those who did not exhibit this symptom (p = 0.048). Presence of headaches was correlated with greater severity of neuroticism (p = 0.001). Moreover, participants with enamel cracks showed a lower intensity of extraversion (p = 0.039), and those with worn hard dental tissues showed a higher intensity of neuroticism (p = 0.03), a lower intensity of conscientiousness (p = 0.01), and a lower intensity of extroversion (p = 0.046). Acoustic symptoms during mandibular movements were found to be linked with a higher level of neuroticism (p = 0.020), a lower level of extraversion (p = 0.035), and a lower level of conscientiousness, whereas pain upon mandibular movements were linked to a lower level of conscientiousness (p = 0.025). Participants with pain upon palpation of the masticatory muscles showed a lower level of conscientiousness (p = 0.01) compared to those without pain symptoms. Episodes of mandibular blockage or problems with its adduction depend on the intensity of conscientiousness (p = 0.007). Moreover, people from the study group with high levels of neuroticism showed lower protrusion values (p = 0.016). Conclusion: The intensity of individual personality traits was found to be associated with some TMDs in comparison to healthy controls. Full article

(This article belongs to the Special Issue A Multidisciplinary Approach on the Diagnosis and Treatment of Orofacial Pain Associated to Temporomandibular Disorders)

15 pages, 1761 KiB

Open AccessArticle

A Randomized Controlled Trial Evaluating the Levels of the Biomarkers hs-CRP, IL-6, and IL-8 in Patients with Temporomandibular Disorder Treated with LLLT, Traditional Conservative Treatment, and a Combination of Both

by Abdalwhab MA Zwiri, Wan Muhamad Amir W. Ahmad, Jawaad Ahmed Asif, Khoo Suan Phaik, Adam Husein, Nur Karyatee Kassim and Zuryati Ab-Ghani

Int. J. Environ. Res. Public Health 2022, 19(15), 8987; https://doi.org/10.3390/ijerph19158987 - 23 Jul 2022

Cited by 7 | Viewed by 2713

Abstract

Temporomandibular disorders (TMDs) are a type of idiopathic orofacial pain. Inflammation, particularly elevated circulating levels of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and interleukin-8 (IL-8), has been linked to pain symptoms. The purpose of this study was to compare hs-CRP, IL-6, and IL-8 biomarkers and pain intensity with different treatment strategies (LLLT, standard conservative treatment, and combination) for TMD patients. Methods: A total of 32 participants were randomly included in the study and divided into three groups (Group I, Group II, and Group III) referred from the Dental Clinic, School of Dental Science, HUSM. Patients received LLLT (Groups II and III) in five sessions for the duration of 10 days. Patients in Groups I and III received standard conservative TMD treatment (diet and stress counseling, jaw exercises, physical therapy, which was a hot towel application) by the principal investigator. All blood samples for biomarkers were performed before starting treatments and directly after finishing the treatment protocols, where all results were recorded. Results: The result showed a significant difference in the mean IL-8 (p = 0.001) between the three intervention groups (LLLT, standard treatment, and combined treatment). IL-6 showed an increase in the mean of IL-6 levels from baseline to post-treatment with a better mean in the LLLT treatment group without any significant differences. Additionally, there were no significant mean differences found between the groups and in the group for the hs-CRP biomarker. Conclusions: A statistically non-significant difference was found in hs-CRP and IL-6 before and after LLLT, conservative, and combined treatment strategies of TMD. A statistically significant difference was observed in the mean levels of IL-8 between the LLLT intervention group and the combined treatment group. Although there was no statistically significant correlation between pain intensity and biomarkers, a statistically significant difference was found in pain intensity before and after LLLT, conservative, and combined treatment strategies. TMJ degeneration could be exacerbated by elevated IL-8 levels. Thus, this can be an important biomarker to mark or identify the painful condition of TMJ. Full article

(This article belongs to the Special Issue A Multidisciplinary Approach on the Diagnosis and Treatment of Orofacial Pain Associated to Temporomandibular Disorders)

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15 pages, 742 KiB

Open AccessArticle

The Role of Pain Inflexibility and Acceptance among Headache and Temporomandibular Disorders Patients

by Vanessa Marcelino, Maria Paço, Andreia Dias, Vera Almeida, José Carlos Rocha, Rui Azevedo, Miguel Alves-Ferreira, Carolina Lemos and Teresa Pinho

Int. J. Environ. Res. Public Health 2022, 19(13), 7974; https://doi.org/10.3390/ijerph19137974 - 29 Jun 2022

Cited by 1 | Viewed by 2031

Abstract

Temporomandibular disorders (TMD) and headache are complex. This study aims to assess the association between TMD, headache, and psychological dimensions such as psychological inflexibility and pain acceptance. The sample consisted of 120 participants following a non-probabilistic convenience sampling strategy through a direct invitation to the patients attending our facilities and their relatives (n = 61 diagnosed with headache, n = 34 diagnosed with TMD-headache, n = 25 control group). Diagnostic Criteria for Temporomandibular Disorders (DC-TMD), International Classification of Headache Disorders (ICHD-3 beta version), Chronic Pain Acceptance Questionnaire (CPAQ-8), and Psychological Inflexibility in Pain Scale (PIPS) were used as assessment tools. One-way ANOVA, multiple regression analysis (MRA), and the Johnson-Neyman approach were run by IBM SPSS, version 27 (IBM^® Company, Chicago, IL, USA). The significance level was 0.05. One third of our sample presented with headache with TMD. Females were predominant. Males with headache, no systemic disease, less pain severity but higher frequency, living longer with the disease and having sensitive changes, showed higher pain acceptance. When headache occurs with TMD, women with higher education, no headache family history, less pain, and no motor changes showed higher pain acceptance. Patients with both conditions are more liable to have chronic pain and pain inflexibility. Pain intensity and willingness explain 50% of the psychological inflexibility in the headache group. In our sample, individuals suffering from both conditions show greater pain inflexibility, implicating more vivid suffering experiences, leading to altered daily decisions and actions. However, further studies are needed to highlight this possible association. Full article

(This article belongs to the Special Issue A Multidisciplinary Approach on the Diagnosis and Treatment of Orofacial Pain Associated to Temporomandibular Disorders)

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7 pages, 336 KiB

Open AccessArticle

Prevalence of Sleep Bruxism Reported by Parents/Caregivers in a Portuguese Pediatric Dentistry Service: A Retrospective Study

by André Brandão de Almeida, Rita Salgado Rodrigues, Carina Simão, Raquel Pinto de Araújo and Joana Figueiredo

Int. J. Environ. Res. Public Health 2022, 19(13), 7823; https://doi.org/10.3390/ijerph19137823 - 25 Jun 2022

Cited by 9 | Viewed by 2510

Abstract

The definition of sleep bruxism (SB) has changed over the years, and although it is no longer defined as a disorder, it is considered a risk factor that can result in prejudicial systemic and stomatognathic issues. The prevalence of SB in children is variable among studies, and its decrease during adolescence is a controversial matter among authors. We aimed to determine SB prevalence and assess its trend with age in a sample of pediatric patients who frequented the Lisbon Pediatric Dentistry Service. We conducted a retrospective observational study based on information provided by patients’ parents/caregivers and without examination or polysomnography examination. Data were collected between August 2019 and December 2020 by five dentists. A total of 1900 patients were included, 50.6% and 49.4% of which were male and female, respectively. Of the total sample, 334 (17.6%, 95% confidence interval of 15.9–19.4%) had bruxism, corresponding to 18.9% and 16.2% of male and female patients, respectively (p = 0.121). SB was reported in 20.7% of patients 0–6 years old, in 19.4% of those 7–11 years old, and in 14.6% of those 12–17 years old. In conclusion, SB showed a slightly higher prevalence among male pediatric patients, but further studies are needed to rule out confounding factors. Full article

(This article belongs to the Special Issue A Multidisciplinary Approach on the Diagnosis and Treatment of Orofacial Pain Associated to Temporomandibular Disorders)

10 pages, 1950 KiB

Open AccessArticle

The Thermal Influence of Oral Rehabilitation on the Cranio-Cervico-Mandibular Complex: A Thermographic Analysis

by André Moreira, Ricardo Batista, Susana Oliveira, Joaquim Mendes, Margarida Sampaio-Fernandes and Maria Helena Figueiral

Int. J. Environ. Res. Public Health 2021, 18(19), 10441; https://doi.org/10.3390/ijerph181910441 - 4 Oct 2021

Cited by 2 | Viewed by 2045

Abstract

Purpose: Assess the thermal effect of prosthodontic treatment on the cranio-cervico-mandibular complex using infrared thermography. Methods: The treatment group was composed of adults of both sexes who underwent a prosthodontic treatment in which at least posterior occlusal contacts were added and/or the vertical dimension of occlusion was reestablished. The control group (CG) was constituted of adult subjects of both sexes, with no more than a single missing posterior tooth, excluding third molars. Thermograms were taken of the treatment group with a Flir i7 IR camera both before oral rehabilitation (TGB; n = 33) and two months after treatment was concluded (TGA; n = 19). CG (n = 33) had only one occasion for data acquisition. Results: Statistically significant differences were found when the thermal difference (ΔT) and the health status of the orbicularis oris muscle were compared between the TGB and the TGA groups (p = 0.020 and p = 0.003, respectively). By comparing the health status of the masseter muscle between the CG and TGB, statistically significant differences were also observed (p = 0.030). Conclusion: A prosthodontic treatment appears to have a minimum or null effect on the ΔT and/or on the health status of the TMJ and the temporal muscle. In contrast, orbicularis oris muscles exhibited significant thermal variations. Full article

(This article belongs to the Special Issue A Multidisciplinary Approach on the Diagnosis and Treatment of Orofacial Pain Associated to Temporomandibular Disorders)

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12 pages, 382 KiB

Open AccessArticle

Orthodontic Treatment and Craniocervical Posture in Patients with Temporomandibular Disorders: An Observational Study

by Maria Paço, José Alberto Duarte and Teresa Pinho

Int. J. Environ. Res. Public Health 2021, 18(6), 3295; https://doi.org/10.3390/ijerph18063295 - 23 Mar 2021

Cited by 13 | Viewed by 3898

Abstract

Orthodontic treatment acts through the application of forces and/or by stimulating and redirecting the functional forces within the craniofacial complex. Considering the interrelationship between craniomandibular and craniocervical systems, this intervention may alter craniocervical posture. Thus, our aim is to (a) compare craniocervical posture, hyoid bone position, and craniofacial morphology before, after, and also in the contention phase at least one year after the orthodontic treatment, in patients with temporomandibular disorders and (b) to verify whether the presence of condylar displacement, the skeletal class, or the facial biotype interferes with the abovementioned outcomes. To do so an observational, analytical, longitudinal, and retrospective design study was carried out. A non-probabilistic convenience sampling method was applied. The sample consisted of clinical records of patients diagnosed with temporomandibular disorders in order to compare pre-orthodontic treatment with post-orthodontic treatment (n = 42) and contention phase data (n = 26). A cephalometric analysis of several variables was performed. The p-value was set as 0.05. When the pre- and post-orthodontic treatment data were analyzed, there were statistically significant changes in variables concerning craniocervical posture (CV angle, C0-C1, and AA-PNS) and also concerning hyoid bone position (C3-Rgn). When pre- and post-orthodontic treatment and contention phase data were analyzed the variables concerning craniocervical posture (C0-C1, CVT/Ver, NSL/OPT, NSL/CVT, NSL/Ver; OPT/CVT, OPT/Ver) and facial biotype had statistically significant changes. This allowed us to conclude that in the sample studied, there were significant differences regarding hyoid bone position (pre- versus post-orthodontic treatment) and craniocervical posture (pre- versus post-orthodontic versus contention), with the craniocervical posture being prone to return to basal values. The presence of condylar displacement was found to significantly increase the H-H1 distance in the three moments of evaluation. Facial biotype was found to significantly increase the NSL/Ver angle on hypodivergent compared to hyperdivergent in the contention phase. Full article

(This article belongs to the Special Issue A Multidisciplinary Approach on the Diagnosis and Treatment of Orofacial Pain Associated to Temporomandibular Disorders)

10 pages, 966 KiB

Open AccessArticle

Temporomandibular Joint and Cervical Spine Mobility Assessment in the Prevention of Temporomandibular Disorders in Children with Osteogenesis Imperfecta: A Pilot Study

by Kulesa-Mrowiecka Małgorzata, Pihut Małgorzata, Słojewska Kinga and Sułko Jerzy

Int. J. Environ. Res. Public Health 2021, 18(3), 1076; https://doi.org/10.3390/ijerph18031076 - 26 Jan 2021

Cited by 6 | Viewed by 3360

Abstract

Osteogenesis imperfecta is a heterogeneous group of hereditary disorders of connective tissue diseases characterized by increased bone fragility, low growth, sometimes accompanied by abnormalities within the dentine, blue sclera, and partial or total hearing impairment. The changes may affect all joints, including the cervical spine and temporomandibular joints in the future, resulting in pain. The aim of the present study was to assess whether there is a relationship between the active range of motion of the cervical spine and the mobility of temporomandibular joints due to differential diagnosis in children with osteogenesis imperfecta, and to present a prevention algorithm for temporomandibular disorders. The study involved a group of 34 children with osteogenesis imperfecta, and the control group included 23 children (age 9.1 ± 3.8 years). Data were collected through an interview based on the author’s questionnaire, and the physical examination consisted in measuring the mobility of the cervical spine using an inclinometer (Cervical Range of Motion Instrument), the Helkimo scale, and linear measurements. In children with congenital bone fragility, there were acoustic symptoms from the temporomandibular joints more often than in healthy children. A correlation was found between the mobility of the cervical spine and temporomandibular joints in the study group. In the case of detecting irregularities in the temporomandibular joints, children were ordered to perform jaw-tongue coordination exercises. Full article

(This article belongs to the Special Issue A Multidisciplinary Approach on the Diagnosis and Treatment of Orofacial Pain Associated to Temporomandibular Disorders)

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19 pages, 4087 KiB

Open AccessArticle

Orofacial Trauma on the Anterior Zone of a Trumpet’s Player Maxilla: Concept of the Oral Rehabilitation—A Case Report

by Miguel Pais Clemente, André Moreira, Nádia Carvalho, Gilberto Bernardes, Afonso Pinhão Ferreira, José Manuel Amarante and Joaquim Mendes

Int. J. Environ. Res. Public Health 2020, 17(24), 9423; https://doi.org/10.3390/ijerph17249423 - 16 Dec 2020

Cited by 3 | Viewed by 3592

Abstract

Background: The occurrence of an orofacial trauma can originate health, social, economic and professional problems. A 13-year boy suffered the avulsion of tooth 11 and 21, lost at the scenario. Methods: Three intraoral appliances were manufactured: A Hawley appliance with a central expansion screw and two central incisors (1), trumpet edentulous anterior tooth appliance (2) and a customized splint (3) were designed as part of the rehabilitation procedure. Objectively assessing the sound quality of the trumpet player with these new devices in terms of its spectral, temporal, and spectro-temporal audio properties. A linear frequency response microphone was adopted for precision measurement of pitch, loudness, and timbre descriptors. Results: Pitch deviations may result from the different intra-oral appliances due to the alteration of the mouth cavity, respectively, the area occupied and modification/interaction with the anatomy. This investigation supports the findings that the intra-oral appliance which occupies less volume is the best solution in terms of sound quality. Conclusions: Young wind instrumentalists should have dental impressions of their teeth made, so their dentist has the most reliable anatomy of the natural teeth in case of an orofacial trauma. Likewise, the registration of their sound quality should be done regularly to have standard parameters for comparison. Full article

(This article belongs to the Special Issue A Multidisciplinary Approach on the Diagnosis and Treatment of Orofacial Pain Associated to Temporomandibular Disorders)

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18 pages, 1788 KiB

Open AccessArticle

The Relationship between Simple Snoring and Sleep Bruxism: A Polysomnographic Study

by Monika Michalek-Zrabkowska, Mieszko Wieckiewicz, Piotr Macek, Pawel Gac, Joanna Smardz, Anna Wojakowska, Rafal Poreba, Grzegorz Mazur and Helena Martynowicz

Int. J. Environ. Res. Public Health 2020, 17(23), 8960; https://doi.org/10.3390/ijerph17238960 - 2 Dec 2020

Cited by 33 | Viewed by 4593

Abstract

Simple snoring is defined as the production of sound in the upper aerodigestive tract during sleep, not accompanied by other pathologies. Sleep bruxism (SB) refers to repetitive phasic, tonic, or mixed masticatory muscle activity during sleep. In this study, we investigated the relationship between simple snoring and SB in patients without obstructive sleep apnea (OSA). A total of 565 snoring subjects underwent polysomnography. After examination, individuals with OSA were excluded from the study group. Finally, 129 individuals were analyzed. The bruxism episode index was positively correlated with maximum snore intensity. Phasic bruxism was positively correlated with snore intensity in all sleep positions. Bruxers had a significantly decreased average and minimum heart rate compared with non-bruxers. Supine sleep position seemed to have a significant impact on snore intensity and SB. In summary, our study showed the relationship between SB, snore intensity, and body position. Phasic bruxism was positively correlated with snore intensity despite the body position, which is an interesting and novel finding. Full article

(This article belongs to the Special Issue A Multidisciplinary Approach on the Diagnosis and Treatment of Orofacial Pain Associated to Temporomandibular Disorders)

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9 pages, 331 KiB

Open AccessArticle

by Nguyen Thi Thu Phuong, Vo Truong Nhu Ngoc, Le My Linh, Nguyen Minh Duc, Nguyen Thu Tra and Le Quynh Anh

Int. J. Environ. Res. Public Health 2020, 17(20), 7408; https://doi.org/10.3390/ijerph17207408 - 12 Oct 2020

Cited by 21 | Viewed by 3937

Abstract

Although bruxism is a common issue with a high prevalence, there has been a lack of epidemiological data about bruxism in Vietnam. This cross-sectional study aimed to determine the prevalence and associated factors of bruxism and its impact on oral health-related quality of life among Vietnamese medical students. Bruxism was assessed by the Bruxism Assessment Questionnaire. Temporomandibular disorders were clinically examined followed by the Diagnostic Criteria for Temporomandibular Disorders Axis I. Perceived stress, educational stress, and oral health-related quality of life were assessed using the Vietnamese version of Perceived Stress Scale 10, the Vietnamese version of the Educational Stress Scale for Adolescents, and the Vietnamese version of the 14-item Oral Health Impact Profile, respectively. The prevalence of bruxism, sleep bruxism, awake bruxism, and both conditions in Vietnamese medical students were 51.2%, 38.2%, 23.4%, and 10.4% respectively. Stress, temporomandibular joint pain, masticatory muscle pain, and tooth attrition were associated with the presence of bruxism. Vietnamese medical students were negatively affected by bruxism in terms of oral health-related quality of life. Full article

(This article belongs to the Special Issue A Multidisciplinary Approach on the Diagnosis and Treatment of Orofacial Pain Associated to Temporomandibular Disorders)

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A Multidisciplinary Approach on the Diagnosis and Treatment of Orofacial Pain Associated to Temporomandibular Disorders

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