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Sadeghlo N, Selvanathan J, Koshkebaghi D, Cioffi I. Aberrant occlusal sensitivity in adults with increased somatosensory amplification: a case-control study. Clin Oral Investig 2024; 28:250. [PMID: 38613726 DOI: 10.1007/s00784-024-05628-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/20/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVES Occlusal sensitivity (OS)-the ability to detect fine objects between opposing teeth-mainly relies on the activity of mechanoreceptors located in the periodontal ligament. We tested whether somatosensory amplification (SSA)-the tendency to perceive normal somatic sensations as being intense, noxious, and disturbing, which plays a critical role in hypervigilance-affects OS. MATERIALS AND METHODS We measured OS in 66 adults divided into three groups based on their SSA scores (LowSSA, Intermediate - IntSSA, HighSSA) by asking them to bite on aluminum foils (8 to 72 μm thick) and a sham foil, and report whether they felt each foil. We performed 20 trials for each thickness and sham condition (each participant was tested 120 times), and compared the frequency of correct answers (%correct) among groups after adjusting for participants' trait anxiety, depression, self-reported oral behaviors, and masseter cross-sectional area. RESULTS %correct was affected by the interaction Foil Thickness-by-SSA (p = 0.007). When tested with the 8 μm foil, the HighSSA group had a lower %correct than the IntSSA (contrast estimate [95% CI]: -14.2 [-25.8 - -2.6]; p = 0.012) and the LowSSA groups (-19.1 [-31.5 - -6.6]; p = 0.001). Similarly, with the 24 μm foil, the HighSSA group had a lower %correct compared to the IntSSA (-12.4 [-24.8-0.1]; p = 0.048) and the LowSSA groups (-10.8 [-22.5-0.8]; p = 0.073). CONCLUSION Individuals with high SSA present with an aberrant occlusal sensitivity. CLINICAL RELEVANCE Our findings provide novel insights into the relationship between occlusal perception and psychological factors, which may influence an individual's ability to adapt to dental work.
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Affiliation(s)
- Negin Sadeghlo
- Faculty of Dentistry, Centre for Multimodal Sensorimotor and Pain Research, University of Toronto, 124 Edward Street, Toronto, ON, M5G 1X3, Canada
| | - Janannii Selvanathan
- Faculty of Dentistry, Centre for Multimodal Sensorimotor and Pain Research, University of Toronto, 124 Edward Street, Toronto, ON, M5G 1X3, Canada
| | - Dursa Koshkebaghi
- Faculty of Dentistry, Centre for Multimodal Sensorimotor and Pain Research, University of Toronto, 124 Edward Street, Toronto, ON, M5G 1X3, Canada
| | - Iacopo Cioffi
- Faculty of Dentistry, Centre for Multimodal Sensorimotor and Pain Research, University of Toronto, 124 Edward Street, Toronto, ON, M5G 1X3, Canada.
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Pittar N, Firth F, Bennani H, Farella M. The effect of passive clear aligners on masticatory muscle activity in adults with different levels of oral parafunction. J Oral Rehabil 2023; 50:1409-1421. [PMID: 37615269 DOI: 10.1111/joor.13575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/13/2023] [Accepted: 08/11/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND There is limited knowledge of the possible side-effects of clear aligners on jaw function. OBJECTIVES To determine the short-term effect of passive clear aligners (PCAs) on masticatory muscle activity (MMA), occlusal discomfort (OD) and temporomandibular disorder (TMD) symptoms in adults with different levels of self-reported oral parafunction. MATERIALS AND METHODS Participants were screened for oral parafunctional behaviours using the oral behavioural checklist. Respondents in ≥85th and ≤15th percentiles were invited to participate and allocated to a high (HPF: N = 15) or low (lower parafunction [LPF]: N = 16) parafunction group. Participants underwent a TMD clinical examination; somatisation and somatosensory amplification were assessed by questionnaires; OD and stress were assessed by visual analogue scales. While wearing PCAs, awake-time MMA was assessed three times over 9 days using a wearable electromyography device, along with OD, stress and TMD symptoms. RESULTS The wearing of PCAs was associated with a significant decrease in mean contraction episode amplitude in both groups (p = 0.003). OD levels increased and remained raised in all participants after insertion of the PCAs (p < 0.001), more so in the HPF group (p = 0.048). The HPF group had higher somatisation scores (p = 0.006) and reported more TMD symptoms at all time points (p ≤ 0.004). No significant changes in stress or TMD symptoms were found in either group during the study period. CONCLUSIONS PCAs were associated with a decrease in MMA in all participants. HPF individuals had greater somatisation and reported greater discomfort when wearing PCAs than LPF individuals.
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Affiliation(s)
- Nicholas Pittar
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Fiona Firth
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Hamza Bennani
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Mauro Farella
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
- Discipline of Orthodontics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Cioffi I. Biological and psychological factors affecting the sensory and jaw motor responses to orthodontic tooth movement. Orthod Craniofac Res 2023; 26 Suppl 1:55-63. [PMID: 37395347 DOI: 10.1111/ocr.12688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 06/03/2023] [Accepted: 06/17/2023] [Indexed: 07/04/2023]
Abstract
Orthodontic tooth movement (OTM) is associated with an inflammatory response, tooth pain (i.e. orthodontic pain) and changes in dental occlusion. Clinical realms and research evidence suggest that the sensory and jaw motor responses to OTM vary significantly among individuals. While some adjust well to orthodontic procedures, others may not and can experience significant pain or not adjust to occlusal changes. This is of concern, as clinicians cannot anticipate an individual's sensorimotor response to OTM. Converging evidence shows that some psychological states and traits significantly affect the sensorimotor response to OTM and may considerably affect an individual's adaptation to orthodontic or other dental procedures. We performed a topical review to synthesize the available knowledge about the behavioural mechanisms regulating the sensorimotor response to OTM, with the intent of informing orthodontic practitioners and researchers about specific psychological states and traits that should be considered while planning orthodontic treatment. We report on studies focusing on the role of anxiety, pain catastrophising, and somatosensory amplification (i.e. bodily hypervigilance), on sensory and jaw motor responses. Psychological states and traits can significantly affect sensory and jaw motor responses and a patient's adaptation to orthodontic procedures, although large interindividual variability exists. Clinicians can use validated instruments (checklists or questionnaires) to collect information about patients' psychological traits, which can assist in identifying those individuals who may not adjust well to orthodontic procedures. The information included in this manuscript also assists researchers investigating the effect of orthodontic procedures and or/appliances on orthodontic pain.
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Affiliation(s)
- I Cioffi
- Faculty of Dentistry, Centre for Multimodal Sensorimotor and Pain Research, University of Toronto, Toronto, Ontario, Canada
- Discipline of Orthodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
- University of Toronto Centre for the Study of Pain, Toronto, Ontario, Canada
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Sultan H, Pervez H, Maqsood S, Zeeshan WS. Evaluation of pain experienced by orthodontic patients following elastomeric separator insertion: A cross-sectional study. Korean J Orthod 2023; 53:298-306. [PMID: 37746775 PMCID: PMC10547595 DOI: 10.4041/kjod22.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 07/27/2023] [Accepted: 08/07/2023] [Indexed: 09/26/2023] Open
Abstract
Objective Pain following the insertion of separators and archwires varies with age, sex, race, ethnicity, threshold, and health status. This study aimed to evaluate the characteristics of pain in orthodontic patients after the insertion of elastomeric separators, its effects on daily life, and its association with age and sex in a population not previously studied in this regard. Methods A cross-sectional study of 130 patients undergoing orthodontic treatment included collecting data on demographics, pain experienced following the placement of separators, time of onset, duration, characteristics, change in dietary pattern or chewing side, intake of analgesics, and severity of pain on the Wong Baker's scale. The results are reported as counts and percentages. Associations between sex and age were evaluated using Pearson's chi-square test. Results Among the 130 patients, 56.2% were 9-20 years old, 63.8% experienced pain following the insertion of separators, 22.9% had their first episode of pain at 4 hours, 56.6% experienced intermittent pain, and 37.3% experienced discomfort; 18.1% males and 81.9% females experienced pain following the insertion of separators. Pearson's chi-square test showed a significant association between pain and sex (P = 0.04). Most patients (37.3%) reported "hurts little more" for pain intensity on Wong Baker's scale and 21.7% reported all four quadrants as sites of pain. Conclusions The pain experienced after separator insertion was associated with sex and age. Females experienced more pain than males and patients between the age range of 21 and 36 years suffered more pain during mastication than between 9 and 20 years old.
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Affiliation(s)
- Hareem Sultan
- Department of Orthodontics, Dow International Dental College, Dow University of Health Sciences, Karachi, Pakistan
| | - Hana Pervez
- Department of Orthodontics, Jinnah Medical and Dental College, Karachi, Pakistan
| | - Sidra Maqsood
- Department of Orthodontics, Dow Dental College, Dow University of Health Sciences, Karachi, Pakistan
| | - Wajeeh Syed Zeeshan
- Department of Orthodontics, Dow International Dental College, Dow University of Health Sciences, Karachi, Pakistan
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Inauen DS, Papadopoulou AK, Eliades T, Papageorgiou SN. Pain profile during orthodontic levelling and alignment with fixed appliances reported in randomized trials: a systematic review with meta-analyses. Clin Oral Investig 2023; 27:1851-1868. [PMID: 36879148 PMCID: PMC10159949 DOI: 10.1007/s00784-023-04931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/22/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE To assess the pain profile of patients in the levelling/alignment phase of orthodontic treatment, as reported from randomized clinical trials. MATERIALS AND METHODS Five databases were searched in September 2022 for randomized clinical trials assessing pain during levelling/alignment with a visual analogue scale (VAS). After duplicate study selection, data extraction, and risk-of-bias assessment, random effects meta-analyses of mean differences (MDs) and their 95% confidence intervals (CIs) were performed, followed by subgroup/meta-regression, and certainty analyses. RESULTS A total of 37 randomized trials including 2277 patients (40.3% male; mean age 17.5 years) were identified. Data indicated quick pain initiation after insertion of orthodontic appliances (n = 6; average = 12.4 mm VAS), a quick increase to a peak at day 1 (n = 29; average = 42.4 mm), and gradually daily decrease the first week until its end (n = 23; average = 9.0 mm). Every second patient reported analgesic use at least once this week (n = 8; 54.5%), with peak analgesic use at 6 h post-insertion (n = 2; 62.3%). Patients reported reduced pain in the evening compared to morning (n = 3; MD = - 3.0 mm; 95%CI = - 5.3, - 0.6; P = 0.01) and increased pain during chewing (n = 2; MD = 19.2 mm; 95% CI = 7.9, 30.4; P < 0.001) or occlusion of the back teeth (n = 2; MD = 12.4 mm; 95% CI = 1.4, 23.4; P = 0.3), while non-consistent effects were seen for patient age, sex, irregularity, or analgesic use. Subgroup analyses indicated increased pain among extraction cases and during treatment of the lower (rather than the upper) arch, while certainty around estimates was moderate to high. CONCLUSIONS Evidence indicated a specific pain profile during orthodontic levelling/alignment, without signs of consistent patient-related influencing factors.
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Affiliation(s)
- Deborah Susanne Inauen
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Plattenstr. 11, 8032, Zurich, Switzerland
| | - Alexandra K Papadopoulou
- Division of Orthodontics, Faculty of Medicine, University Clinics of Dental Medicine, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland
- Discipline of Orthodontics and Paediatric Dentistry, Sydney Dental School, The University of Sydney, Sydney, Australia
| | - Theodore Eliades
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Plattenstr. 11, 8032, Zurich, Switzerland
| | - Spyridon N Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Plattenstr. 11, 8032, Zurich, Switzerland.
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Kudubes AA, Bektas M. Psychometric Properties of the Turkish Version of the Pain Flexibility Scale for Parents of Children with Cancer. Compr Child Adolesc Nurs 2022. [DOI: 10.1080/24694193.2021.1962432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Aslı Akdeniz Kudubes
- Department of Pediatric Nursing, Bilecik Şeyh Edebali University Faculty of Health, Bilecik, Turkey
| | - Murat Bektas
- Department of Pediatric Nursing, Dokuz Eylul University Faculty of Nursing, Izmir, Turkey
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ROSSI S, SANTAMARIA JUNIOR M, VENEZIAN GC, MENEZES CCD, SOUZA JEPD, VEDOVELLO SAS. A double-blinded randomized clinical trial of pain perception during orthodontic treatment. REVISTA DE ODONTOLOGIA DA UNESP 2022. [DOI: 10.1590/1807-2577.00722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction Orthodontic movement can cause painful symptoms, especially in the early stages of treatment. Objective This study aimed to compare the performance of chewing gum and ibuprofen in pain control during the initial period of orthodontic treatment. Material and method A randomized blind clinical trial, with an allocation ratio of 1:1, was developed with patients aged ≥18 years old. The sample size was established considering a significance level of 5% and test power of 80%, resulting in a minimum of 30 volunteers per group (n=90). Participants were paired regarding sex, age, the severity of malocclusion, defined by the Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN), and crowding, determined by Little’s irregularity index. The sample was randomly allocated to three groups: Group I (control) placebo; Group II chewing gum; and Group III Ibuprofen. Pain perception was evaluated by the Visual Analog Scale (VAS) in the first 24, 36, and 48 hours after activation of the orthodontic appliance. The data were analyzed by generalized linear models for repeated measures in time. Result No statistically significant difference (p>0.05) was observed among the groups for the methods of pain therapy evaluated in 24, 36, and 48 hours post-activation. Conclusion There was no difference among the method used for pain control during the orthodontic treatment.
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Psychometric characteristics of the Turkish version of the pain flexibility scale for children with cancer. J Pediatr Nurs 2022; 62:84-90. [PMID: 34561131 DOI: 10.1016/j.pedn.2021.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE This study was conducted to evaluate the validity and reliability of the Pain Flexibility Scale for children with cancer in Turkey. DESIGN AND METHOD This was a methodological-descriptive-correlational study conducted on 211 children with cancer. Data were collected using the information form and Pain Flexibility Scale for children with cancer. The data were evaluated using explanatory and confirmatory factor analysis, Cronbach's alpha, split-half, item-total score correlation, and test-retest analysis. RESULTS The explained variance rate of the scale, in which factor analysis confirmed the two-dimensional structure, was 85.31%. The factor loads were greater than 0.30, and all fit indices were greater than 0.90. In addition, RMSEA was less than 0.080 and was significant. The total Cronbach's alpha value of the scale was 0.82, and the Cronbach's alpha values of its sub-dimensions were 0.82 and 0.79. CONCLUSIONS The Pain Flexibility Scale for children with cancer is a valid and reliable measurement tool for the Turkish sample. PRACTICE IMPLICATIONS Pain Flexibility Scale facilitates the development of psychological interventions based on acceptance, which can enable children with cancer to cope more successfully with pain.
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Bucci R, Koutris M, Simeon V, Lobbezoo F, Michelotti A. Effects of acute pain and strain of the periodontium due to orthodontic separation on the occlusal tactile acuity of healthy individuals. Clin Oral Investig 2021; 25:6833-6840. [PMID: 33954851 PMCID: PMC8602128 DOI: 10.1007/s00784-021-03971-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/26/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to assess whether pain and strain of the periodontal ligament (PDL), induced by orthodontic separation, alter the somatosensory ability to perceive small thicknesses between occluding teeth (occlusal tactile acuity, OTA). METHODS The OTA was tested at baseline (T0), using 9 aluminum foils (range 8-72 μm), randomly placed between the molar teeth, and 1 sham test (without foil), asking the participants whether they felt the foil between their teeth. Afterwards, orthodontic separators were placed, and subjects were randomly assigned to one of the two experimental groups: Group Pain (GP: 18 males; 14 females mean age 25.22 ± 2.28 years) had separators removed after 24 h; Group Strain (GS: 14 males; 17 females, mean age 24.03 ± 3.06 years) had separators removed after 7 days. The OTA measurement was repeated in both groups immediately after orthodontic separators removal (T1). A within-group comparison (T1 vs T0) was performed for each testing thickness (ANOVA for repeated measurements, with Bonferroni correction for multiple testing) (p < 0.005). RESULTS GP showed statistically significant reduction of the OTA at T1, as compared to T0, for the thicknesses 24 μm (p = 0.004) and 32 μm (p = 0.001). No significant reduction was observed in GS (all p > 0.005). CONCLUSIONS Acute periodontal pain tends to disturb the tactile ability of the teeth, while strain of the PDL in absence of painful sensation determines a return to OTA baseline values. CLINICAL RELEVANCE The reduction of OTA might explain the uncomfortable occlusal sensation referred by patients during acute periodontal pain.
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Affiliation(s)
- Rosaria Bucci
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, School of Orthodontics and Temporomandibular Disorder, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
| | - Michail Koutris
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Vittorio Simeon
- Department of Public, Clinical and Preventive Medicine, Medical Statistics Unit, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Frank Lobbezoo
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Ambrosina Michelotti
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, School of Orthodontics and Temporomandibular Disorder, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
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Tang Z, Zhou J, Long H, Gao Y, Wang Q, Li X, Wang Y, Lai W, Jian F. Molecular mechanism in trigeminal nerve and treatment methods related to orthodontic pain. J Oral Rehabil 2021; 49:125-137. [PMID: 34586644 DOI: 10.1111/joor.13263] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/02/2021] [Accepted: 09/23/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Orthodontic treatment is the main treatment approach for malocclusion. Orthodontic pain is an inevitable undesirable adverse reaction during orthodontic treatment. It is reported orthodontic pain has become one of the most common reason that patients withdraw from orthodontic treatment. Therefore, understanding the underlying mechanism and finding treatment of orthodontic pain are in urgent need. AIMS This article aims to sort out the mechanisms and treatments of orthodontic pain, hoping to provide some ideas for future orthodontic pain relief. MATERIALS Tooth movement will cause local inflammation. Certain inflammatory factors and cytokines stimulating the trigeminal nerve and further generating pain perception, as well as drugs and molecular targeted therapy blocking nerve conduction pathways, will be reviewed in this article. METHOD We review and summaries current studies related to molecular mechanisms and treatment approaches in orthodontic pain control. RESULTS Orthodontics pain related influencing factors and molecular mechanisms has been introduced. Commonly used clinical methods in orthodontic pain control has been evaluated. DISCUSSION With the clarification of more molecular mechanisms, the direction of orthodontic pain treatment will shift to targeted drugs.
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Affiliation(s)
- Ziwei Tang
- State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jiawei Zhou
- State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hu Long
- State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yanzi Gao
- State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qingxuan Wang
- State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiaolong Li
- State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yan Wang
- State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wenli Lai
- State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Fan Jian
- State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Baseline resting-state functional connectivity determines subsequent pain ratings to a tonic ecologically valid experimental model of orofacial pain. Pain 2021; 162:2397-2404. [PMID: 34448753 DOI: 10.1097/j.pain.0000000000002225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/11/2021] [Indexed: 12/11/2022]
Abstract
ABSTRACT Pain is a subjective experience with significant individual differences. Laboratory studies investigating pain thresholds and experimental acute pain have identified structural and functional neural correlates. However, these types of pain stimuli have limited ecological validity to real-life pain experiences. Here, we use an orthodontic procedure-the insertion of an elastomeric separator between teeth-which typically induces mild to moderate pain that peaks within 2 days and lasts several days. We aimed to determine whether the baseline structure and resting-state functional connectivity of key regions along the trigeminal nociceptive and pain modulatory pathways correlate with subsequent peak pain ratings. Twenty-six healthy individuals underwent structural and resting-state functional MRI scanning before the placement of a separator between the first molar and second premolar, which was kept in place for 5 days. Participants recorded pain ratings 3 times daily on a 100-mm visual analogue scale. Peak pain was not significantly correlated with diffusion metrics of the trigeminal nerve or gray matter volume of any brain region. Peak pain did, however, positively correlate with baseline resting-state functional connectivity between the thalamus contralateral to the separator and bilateral insula, and negatively correlated with connectivity between the periaqueductal gray (PAG) and core nodes of the default mode network (medial prefrontal and posterior cingulate cortices). The ascending (thalamic) nociceptive and the descending (PAG) pain modulatory pathways at baseline each explained unique variation in peak pain intensity ratings. In sum, preinterventional functional neural architecture of both systems determined the individual pain experience to a subsequent ecologically valid pain stimulus.
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Gao M, Yan X, Zhao R, Shan Y, Chen Y, Jian F, Long H, Lai W. Comparison of pain perception, anxiety, and impacts on oral health-related quality of life between patients receiving clear aligners and fixed appliances during the initial stage of orthodontic treatment. Eur J Orthod 2021; 43:353-359. [PMID: 32613250 DOI: 10.1093/ejo/cjaa037] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Clear aligner is an advanced orthodontic method with benefits of comfort, aesthetics, and convenience. This study aimed to compare pain perception, anxiety, and impacts on oral health-related quality of life (OHRQoL) between adult patients receiving clear aligners and fixed appliances during the initial stage of orthodontic treatments. MATERIAL AND METHODS The two groups were well matched by ages, gender, and levels of malocclusion severity. Pain perception, anxiety, and OHRQoL were assessed through visual analogue scale, state-trait anxiety inventory, and oral health impact profile-14 (OHIP-14), respectively. And the comparison of above scores was performed by two-way analysis of variance. RESULTS A total of 110 patients (55 pairs) were enrolled in this study. Orthodontic pain levels peaked on the first day and decreased gradually afterwards in both groups, which were significantly higher in the fixed group on the first, second, fourth, and fifth days. Likewise, anxiety levels peaked on the first day and decreased thereafter, with significant difference on the 1st, 3d, 5th, 7th, and 14th days. Moreover, the OHIP-14 scores increased and peaked on the first day and then gradually decreased for both groups, which were also significantly higher in the fixed group on the 1st, 7th, and 14th days. LIMITATIONS More malocclusion types should be used for group matching. The effect of exclusion of small groups should be taken into consideration in sample size calculation. Income was significantly unbalanced between two groups due to higher cost of clear aligners, and random assignment of treatment modalities was unfeasible. CONCLUSIONS Patients treated with clear aligners experienced lower pain levels, less anxiety, and higher OHRQoL as compared to those receiving fixed appliances.
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Affiliation(s)
- Meiya Gao
- Department of Orthodontics, State Key Laboratory of Oral Diseases and National Clinical Center for Oral Research, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Orthodontics, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Xinyu Yan
- Department of Orthodontics, State Key Laboratory of Oral Diseases and National Clinical Center for Oral Research, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Rui Zhao
- Department of Orthodontics, State Key Laboratory of Oral Diseases and National Clinical Center for Oral Research, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yue Shan
- Department of Orthodontics, State Key Laboratory of Oral Diseases and National Clinical Center for Oral Research, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yiyin Chen
- Department of Orthodontics, State Key Laboratory of Oral Diseases and National Clinical Center for Oral Research, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Fan Jian
- Department of Orthodontics, State Key Laboratory of Oral Diseases and National Clinical Center for Oral Research, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hu Long
- Department of Orthodontics, State Key Laboratory of Oral Diseases and National Clinical Center for Oral Research, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wenli Lai
- Department of Orthodontics, State Key Laboratory of Oral Diseases and National Clinical Center for Oral Research, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Jin Y, Yang H, Zhang F, Wang J, Liu H, Yang X, Long H, Li F, Gong Q, Lai W. The Medial Thalamus Plays an Important Role in the Cognitive and Emotional Modulation of Orofacial Pain: A Functional Magnetic Resonance Imaging-Based Study. Front Neurol 2021; 11:589125. [PMID: 33551953 PMCID: PMC7859266 DOI: 10.3389/fneur.2020.589125] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/23/2020] [Indexed: 02/05/2023] Open
Abstract
The thalamus plays a critical role in the perception of orofacial pain. We investigated the neural mechanisms of orofacial pain by exploring the intrinsic functional alterations of the thalamus and assessing the changes in functional connectivity (FC) between the thalamic subregions with significant functional alterations and other brain regions in orofacial pain using the seed-based FC approach. There were 49 participants in the orofacial pain group and 49 controls. Orofacial pain was caused by orthodontic separators. The resting-state functional magnetic resonance imaging data of the two groups were analyzed to obtain the fractional amplitude of low-frequency fluctuations (fALFF) of the thalamus; the thalamic subregions with significant fALFF abnormalities were used as seeds for FC analysis. Student's t-tests were used for comparisons. Pearson's correlation analysis was performed using SPM software. Forty-four participants with orofacial pain (mean age, 21.0 ± 0.9 years; 24 women) and 49 age- and sex-matched controls (mean age, 21.0 ± 2.6 years; 27 women) were finally included. Compared with the control group, the orofacial pain group demonstrated the following: (1) increased function in the dorsal area of the thalamus and decreased function in the medial thalamus; (2) decreased FC between the medial thalamus and 12 brain regions (p < 0.05, family-wise error corrected, voxel > 100); and (3) potential positive and negative correlations between the medial thalamus-seeded FC and visual analog scale score changes (p < 0.05, AlphaSim corrected). The findings show that the medial and dorsal thalami play important roles in orofacial pain perception, and that the medial thalamus likely plays an important role in the cognitive and emotional modulation of orofacial pain.
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Affiliation(s)
- Yu Jin
- State Key Laboratory of Oral Disease, Department of Orthodontics, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Hong Yang
- State Key Laboratory of Oral Disease, Department of Orthodontics, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Feifei Zhang
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Jue Wang
- West China School of Stomatology, Sichuan University, Chengdu, China
| | - He Liu
- Department of Orthodontics, China-Japan Friendship Hospital, Beijing, China
| | - Xin Yang
- Department of Stomatology, Shanghai Jiao Tong University School of Medicine Xinhua Hospital, Shanghai, China
| | - Hu Long
- State Key Laboratory of Oral Disease, Department of Orthodontics, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Fei Li
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Qiyong Gong
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China.,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, China
| | - Wenli Lai
- State Key Laboratory of Oral Disease, Department of Orthodontics, West China School of Stomatology, Sichuan University, Chengdu, China
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Medeiros RAD, Vieira DL, Silva EVFD, Rezende LVMDL, Santos RWD, Tabata LF. Prevalence of symptoms of temporomandibular disorders, oral behaviors, anxiety, and depression in Dentistry students during the period of social isolation due to COVID-19. J Appl Oral Sci 2020; 28:e20200445. [PMID: 33263648 PMCID: PMC7714260 DOI: 10.1590/1678-7757-2020-0445] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/05/2020] [Indexed: 12/26/2022] Open
Abstract
Temporomandibular dysfunction (TMD), anxiety, and depression are disorders that, due to the current lifestyle, are affecting an increasing portion of the population. Investigating the prevalence of the symptoms of these disorders during the quarantine due to the coronavirus 2019 pandemic (COVID-19) is important to outline clinical strategies for patient care.
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Affiliation(s)
- Rodrigo Antonio De Medeiros
- Universidade de Brasília, Faculdade de Ciências da Saúde, Departamento de Odontologia, Brasília, Distrito Federal, Brasil
| | - Danielle Leal Vieira
- Universidade de Brasília, Faculdade de Ciências da Saúde, Departamento de Odontologia, Brasília, Distrito Federal, Brasil
| | - Emily Vivianne Freitas Da Silva
- Universidade Estadual Paulista, Faculdade de Odontologia de Araçatuba, Departamento de Materiais Odontológicos e Prótese, Araçatuba, São Paulo, Brasil
| | | | | | - Lucas Fernando Tabata
- Universidade de Brasília, Faculdade de Ciências da Saúde, Departamento de Odontologia, Brasília, Distrito Federal, Brasil
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15
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Montebugnoli F, Incerti Parenti S, D'Antò V, Alessandri-Bonetti G, Michelotti A. Effect of verbal and written information on pain perception in patients undergoing fixed orthodontic treatment: a randomized controlled trial. Eur J Orthod 2020; 42:494-499. [PMID: 31504390 DOI: 10.1093/ejo/cjz068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pain can discourage patients from seeking orthodontic treatment or compromise their compliance during therapy. OBJECTIVES To determine the effects of verbal and written information on orthodontic pain after fixed appliance placement. TRIAL DESIGN Two-arm parallel design randomized controlled trial. METHODS Healthy adolescents with permanent dentition enrolled for orthodontic treatment were assigned to the study or control group using computer-generated random lists and allocation concealment with sealed envelopes. Participants completed baseline questionnaires to assess anxiety (State-Trait Anxiety Inventory Trait Version, Form X-2) and somatosensory amplification (Somatosensory Amplification Scale). Brackets were placed in the maxillary arch, from first molar to first molar, and an Australian archwire 0.012 inch was used for alignment. General verbal information on orthodontic treatment was given to all patients by the same clinician. Participants included in the study group received also detailed verbal instructions on orthodontic pain together with a take-home information leaflet by another clinician. Outcome included assessments of pain intensity with a Numerical Rating Scale (NRS) on the day of appliance placement (Day 1, bedtime) and twice a day for the following 6 days (Day 2 to Day 7, morning, bedtime), and analgesic consumption. Participants, statistician, and clinicians who gave general verbal information on orthodontic treatment and instructions about how to score pain intensity were blinded to group assignment. RESULTS Sixty patients were assigned to the study (n = 30, mean age: 15.4 ± 1.3 years) or control group (n = 30, mean age: 14.7 ± 3.2 years). At baseline, no significant between-group differences were present in terms of anxiety and somatosensory amplification. Orthodontic pain scores were significantly lower in the study group compared with the control one, at bedtime on Day 1 (P < 0.05) and in the morning of Day 2 (P < 0.01). No significant between-group differences were found in following measurements. Overall, analgesic consumption was significantly lower in study compared with the control (P < 0.01). CONCLUSION A combination of verbal and written information on orthodontic pain after placement of fixed appliances reduced patient's self-reported pain in the early stages. REGISTRATION This study was not registered.
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Affiliation(s)
- Francesca Montebugnoli
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Orthodontics, University of Naples 'Federico II'
| | - Serena Incerti Parenti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Section of Orthodontics, University of Bologna, Italy
| | - Vincenzo D'Antò
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Orthodontics, University of Naples 'Federico II'
| | - Giulio Alessandri-Bonetti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Section of Orthodontics, University of Bologna, Italy
| | - Ambra Michelotti
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Orthodontics, University of Naples 'Federico II'
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16
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Spano VE, Imbriglio TV, Ho KCJ, Chow JCF, Cioffi I. Increased somatosensory amplification is associated with decreased pressure pain thresholds at both trigeminal and extra-trigeminal locations in healthy individuals. J Oral Rehabil 2020; 48:10-17. [PMID: 32979854 DOI: 10.1111/joor.13101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The diagnosis of temporomandibular disorders (TMD) is based on patient history and physical examination, and may require medical imaging. Masticatory muscle palpation is essential to make a diagnosis of TMD. However, the response of masticatory muscles to mechanical pressure stimuli depends on many physical and psychological factors. OBJECTIVE This study aimed at determining the impact of somatosensory amplification (SSA)-an estimate of somatic awareness and bodily hypervigilance-on pressure pain thresholds (PPTs) measured at both trigeminal and extra-trigeminal locations in healthy individuals. METHODS PPTs were measured at the right anterior temporalis and superficial masseter, and the thenar eminence of the right hand in one hundred healhty individuals (69F, 31M), divided in three groups based on their SSA scores: low (N = 32), intermediate (N = 34) and high (N = 34). General linear models were used to test between-group differences in PPTs including sex as a covariate. The level of significance was set at P < .05. RESULTS Individuals with high SSA had lower PPTs at the anterior temporalis than individuals with low (P = .006) and intermediate (P = .001) SSA. No significant between-group differences were found in PPTs measured at the masseter (P = .372). PPTs measured at the thenar eminence were significantly lower in the high than the low SSA group (P = .009). Females had lower PPTs at the masseter than males (P = .021) but not at other muscle locations (all P > .05). CONCLUSION Increased somatosensory amplification is associated with decreased pressure pain thresholds at both trigeminal and extra-trigeminal locations in healthy individuals. SSA could be a potential confounder while diagnosing TMD and evaluating treatment outcomes.
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Affiliation(s)
- Valerie E Spano
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.,University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada.,Centre for Multimodal Sensorimotor and Pain Research, University of Toronto, Toronto, ON, Canada
| | - Tina V Imbriglio
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.,University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada.,Centre for Multimodal Sensorimotor and Pain Research, University of Toronto, Toronto, ON, Canada
| | - Ka Chun Jeremy Ho
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.,University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada.,Centre for Multimodal Sensorimotor and Pain Research, University of Toronto, Toronto, ON, Canada
| | - Jeffrey C F Chow
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.,University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada.,Centre for Multimodal Sensorimotor and Pain Research, University of Toronto, Toronto, ON, Canada
| | - Iacopo Cioffi
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.,University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada.,Centre for Multimodal Sensorimotor and Pain Research, University of Toronto, Toronto, ON, Canada.,Department of Dentistry, Mount Sinai Hospital, Toronto, ON, Canada
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17
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Tran J, Lou T, Nebiolo B, Castroflorio T, Tassi A, Cioffi I. Impact of clear aligner therapy on tooth pain and masticatory muscle soreness. J Oral Rehabil 2020; 47:1521-1529. [PMID: 32898936 DOI: 10.1111/joor.13088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/18/2020] [Accepted: 08/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Clinical findings suggest that orthodontic treatment with clear aligners (clear aligner therapy/CAT) may cause masticatory muscle soreness in some patients. OBJECTIVE This multi-site prospective study investigated tooth pain and masticatory muscle soreness and tenderness in patients undergoing CAT and explored whether psychological traits affected these outcomes. METHODS Twenty-seven adults (22F, 5M; mean age ± SD=35.3 ± 17.6 years) about to start CAT were recruited at three clinics. During CAT, they reported on 100-mm visual analogue scales their tooth pain, masticatory muscle soreness and stress three times per day over 4 weeks (week 1 = baseline; week 2 = dummy aligner; week 3 = first active aligner; week 4 = second active aligner). Pressure pain thresholds (PPTs) were measured at the masseter and temporalis at baseline and after week 4. Mixed models were used to evaluate the outcome measures over time. RESULTS Clear aligner therapy caused mild tooth pain, which was greater with the passive than the first and second active aligners (both P < .001). Mild and clinically not relevant masticatory muscle soreness was produced by all aligners (all P < .05), with the first active aligner producing less soreness than the dummy aligner (P < .001). PPTs did not change significantly after 4 weeks. Both tooth pain and masticatory muscle soreness were affected by stress and trait anxiety, whilst muscle soreness was affected also by oral behaviours. CONCLUSIONS In the short term, CAT produces tooth pain and masticatory muscle soreness of limited significance. Frequent oral behaviours are related to increased masticatory muscle soreness during CAT. The medium- and long-term effects of CAT should be further explored.
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Affiliation(s)
- Johnny Tran
- Division of Graduate Orthodontics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Tiantong Lou
- Faculty of Dentistry, Discipline of Orthodontics and Centre for Multimodal Sensorimotor and Pain Research, University of Toronto, Toronto, ON, Canada
| | - Bianca Nebiolo
- Department of Orthodontics, Dental School, University of Turin, Turin, Italy
| | | | - Ali Tassi
- Faculty of Dentistry, Discipline of Orthodontics and Centre for Multimodal Sensorimotor and Pain Research, University of Toronto, Toronto, ON, Canada
| | - Iacopo Cioffi
- Faculty of Dentistry, Discipline of Orthodontics and Centre for Multimodal Sensorimotor and Pain Research, University of Toronto, Toronto, ON, Canada.,Centre for The Study of Pain, University of Toronto, Toronto, ON, Canada.,Department of Dentistry, Mount Sinai Hospital, Toronto, ON, Canada
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18
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Saki M, Zarif Najafi H. The COVID-19 pandemic suggests opportunities for researchers to investigate pertinent topics in orthodontics. Angle Orthod 2020; 90:742-744. [PMID: 32937660 DOI: 10.2319/0003-3219-90.5.742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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19
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Valentino R, Cioffi I, Vollaro S, Cimino R, Baiano R, Michelotti A. Jaw muscle activity patterns in women with chronic TMD myalgia during standardized clenching and chewing tasks. Cranio 2019; 39:157-163. [DOI: 10.1080/08869634.2019.1589703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Roberta Valentino
- Department of Neuroscience, Reproductive Sciences and Oral Sciences, University of Naples “Federico II”, Naples, Italy
| | - Iacopo Cioffi
- Faculty of Dentistry, University of Toronto Centre for the study of Pain, Toronto, ON, Canada
| | - Stefano Vollaro
- Department of Neuroscience, Reproductive Sciences and Oral Sciences, University of Naples “Federico II”, Naples, Italy
| | - Roberta Cimino
- Department of Neuroscience, Reproductive Sciences and Oral Sciences, University of Naples “Federico II”, Naples, Italy
| | - Roberta Baiano
- Department of Neuroscience, Reproductive Sciences and Oral Sciences, University of Naples “Federico II”, Naples, Italy
| | - Ambrosina Michelotti
- Department of Neuroscience, Reproductive Sciences and Oral Sciences, University of Naples “Federico II”, Naples, Italy
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20
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Tang X, Tong Q, Li Z, Chen Z, Weng M, Zhang X, Huang S, Chen Y, Chen Z. Difference and Commonness Among CLP, NON-CLP Patients and Their Parents Seeking for Orthodontic Treatment: A Questionnaire Applying Q Methodology to Investigate Motives. Patient Prefer Adherence 2019; 13:2047-2060. [PMID: 31827321 PMCID: PMC6902877 DOI: 10.2147/ppa.s224254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/18/2019] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Based on Q methodology, this study investigated the motivation of orthodontic treatment for patients and their parents. Through investigation, this paper attempts to explore the motivational factors of CLP and NON-CLP children and their parents, which are different or general. PATIENTS AND METHODS Q methodology involves 4 phases. (1) Interviews of CLP (N=5), NON-CLP (N=5) patients generated 30 statements (Q-set 1) and CLP (N=5), NON-CLP (N=5) patients' parents produced 36 statements (Q-set 2) about different reasons to pursue orthodontic care. (2) P-set: recruitment participants. The sample comprised 40 CLP patients (G1) and 40 NON-CLP patients (G2) aged 9-16 years, 40 CLP patients' parents (G3) and 40 NON-CLP patients' parents (G4) wanting their children to have orthodontic treatment. (3) Q-sort: 4 groups ranked statements in order of comparative significance using enforced distribution grids (G1, G2 ranked Q-set 1; G3, G4 ranked Q-set 2). (4) Analysis: using the PQMehtod 2.35 vision to analyze data. RESULTS Three factors in each group were identified as representing the most widespread views of the majority of the participants, described as G1: (1) aesthetics, (2) preparation for other oral treatments, (3) timely. G2: (1) admiration of others, aesthetics, (2) oral function, (3) oral hygiene and improvement of smile. G3: (1) worrying about the future of children, parents' responsibilities, children's feelings; (2) mental health, timely; (3) parents' responsibilities, ready for treatment. G4: (1) aesthetics, children's will; (2) future problems, timely; (3) timely, parents' responsibility and no need to worry about physical problems. CONCLUSION CLP and NON-CLP patients and parents have different orthodontic treatment motives, yet, they still shared 3 global motivation themes, respectively. Consideration of these motives may help clinicians develop their treatment discussions with patients and parents, which could consequently improve their cooperation and may achieve a more satisfactory outcome.
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Affiliation(s)
- Xia Tang
- Department of Orthodontics, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Department of Orthodontics, Shanghai Xu Hui Dental Clinic, Shanghai, People’s Republic of China
| | - Qian Tong
- Department of Pediatric Dentistry, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Zhujun Li
- Department of Orthodontics, Shanghai Jing-an Dental Clinic, Shanghai, People’s Republic of China
| | - Zhiyi Chen
- Department of Orthodontics, Shanghai Xu Hui Dental Clinic, Shanghai, People’s Republic of China
| | - Mengjia Weng
- Department of Orthodontics, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Xiaoyu Zhang
- Department of Orthodontics, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Sijing Huang
- Department of Orthodontics, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yang Chen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, People’s Republic of China
- Correspondence: Zhenqi Chen; Yang Chen Shanghai Ninth People’s Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, No. 639, Zhi Zao Ju Road, Huangpu District, Shanghai200001, People’s Republic of ChinaTel/Fax +86-021-23271699-5056 Email ;
| | - Zhenqi Chen
- Department of Orthodontics, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, People’s Republic of China
- Correspondence: Zhenqi Chen; Yang Chen Shanghai Ninth People’s Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, No. 639, Zhi Zao Ju Road, Huangpu District, Shanghai200001, People’s Republic of ChinaTel/Fax +86-021-23271699-5056 Email ;
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21
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Effects of trait anxiety, somatosensory amplification, and facial pain on self-reported oral behaviors. Clin Oral Investig 2018; 23:1653-1661. [PMID: 30151704 DOI: 10.1007/s00784-018-2600-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/21/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Oral behaviors are activities, like gum chewing, teeth clenching, and biting of objects, that go beyond normal functioning demands and contribute to the onset of temporomandibular disorders (TMD). Somatosensory amplification refers to the tendency to experience somatic sensations as intense, noxious, and disturbing and is related to bodily hypervigilance. Clinical experience suggests that individuals with bodily hypervigilance also present with occlusal hypervigilance and continuously check their occlusion. This study aimed at investigating whether somatosensory amplification and trait anxiety, a characteristic correlated with hypervigilance, are associated with a greater incidence of oral behaviors, and verifying how self-reported facial TMD pain affect this relationship. MATERIALS AND METHODS The State-Trait Anxiety Inventory, the Somatosensory Amplification Scale, the Oral Behavior Checklist (OBC), and the TMD-Pain Screener Questionnaire were filled out by 255 University students with self-reported facial TMD pain (PAIN group; 47 subjects, 24.8 ± 4.2 years) and without pain (CTR group; 208 subjects, 26.0 ± 4.8 years) using a web survey. RESULTS Trait anxiety, somatosensory amplification, and OBC scores were greater in the PAIN than CTR group (all p < 0.05). Trait anxiety and somatosensory amplification were positively associated with the frequency of oral behaviors, as measured with the OBC (all p < 0.05). A significant effect of the interaction study group*trait anxiety (p = 0.028) on OBC scores was found. CONCLUSIONS Individuals with greater trait anxiety and somatosensory amplification report more frequent oral behaviors. The relationship between anxiety and oral behaviors is affected by concurrent facial pain. CLINICAL RELEVANCE Individuals with increased trait anxiety and concurrent facial pain report more frequent oral behaviors than those without pain. Clinicians should evaluate patients' anxiety and somatosensory amplification before starting dental treatment.
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23
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The Role of Stress in the Etiology of Oral Parafunction and Myofascial Pain. Oral Maxillofac Surg Clin North Am 2018; 30:369-379. [PMID: 29866454 DOI: 10.1016/j.coms.2018.04.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Oral parafunction during waking comprises possible behaviors that can be measured with a comprehensive checklist or behavioral monitoring. Multiple studies lead to largely consistent findings: stressful states can trigger parafunctional episodes that contribute to myofascial pain. However, this simple causal pathway coexists with at least 3 other pathways: anxiety and stress are potent direct contributors to pain, pain results in maladaptive behaviors such as parafunction, and parafunction may be a coping response to potential threat coupled with hypervigilance and somatosensory amplification. Awake parafunction remains an important risk factor for myofascial pain onset and overuse models alone of causation are insufficient.
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24
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Liu AN, Wang LL, Yan TT, Gong J, Liu HY, Jiang Y, Pan ZW, Liu XH. Attentional bias toward emotional stimuli in accidentally injured Chinese patients with different posttraumatic growth levels. PSYCHOL HEALTH MED 2018; 23:1125-1136. [PMID: 29763571 DOI: 10.1080/13548506.2018.1465575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- An-Nuo Liu
- School of Nursing, Second Military Medical University, Shanghai, China
- School of Nursing, Anhui Medical University, Hefei, China
| | - Lu-Lu Wang
- Department of Osteology, First Affiliated Hospital of Anhui Medical University, Hefei, China
- School of Nursing, Anhui Medical University, Hefei, China
| | - Ting-Ting Yan
- School of Nursing, Second Military Medical University, Shanghai, China
| | - Juan Gong
- Department of Nursing, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hong-Yan Liu
- School of Nursing, Anhui Medical University, Hefei, China
| | - Yan Jiang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Zheng-Wen Pan
- School of Nursing, Anhui Medical University, Hefei, China
| | - Xiao-Hong Liu
- School of Nursing, Second Military Medical University, Shanghai, China
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25
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Visscher CM, Baad-Hansen L, Durham J, Goulet JP, Michelotti A, Roldán Barraza C, Häggman-Henrikson B, Ekberg E, Raphael KG. Benefits of implementing pain-related disability and psychological assessment in dental practice for patients with temporomandibular pain and other oral health conditions. J Am Dent Assoc 2018; 149:422-431. [PMID: 29653670 DOI: 10.1016/j.adaj.2017.12.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 12/15/2017] [Accepted: 12/20/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND Evidence in the field of dentistry has demonstrated the importance of pain-related disability and psychological assessment in the development of chronic symptoms. The Diagnostic Criteria for Temporomandibular Disorders offer a brief assessment for the diagnostic process in patients with orofacial pain (Axis II). The authors describe relevant outcomes that may guide general oral health care practitioners toward tailored treatment decisions and improved treatment outcomes and provide recommendations for the primary care setting. METHODS The authors conducted a review of the literature to provide an overview of knowledge about Axis II assessment relevant for the general oral health care practitioner. RESULTS The authors propose 3 domains of the Axis II assessment to be used in general oral health care: pain location (pain drawing), pain intensity and related disability (Graded Chronic Pain Scale [GCPS]), and psychological distress (Patient Health Questionnaire-4 [PHQ-4]). In the case of localized pain, low GCPS scores (0-II), and low PHQ-4 scores (0-5), patients preferably receive treatment in primary care. In the case of widespread pain, high GCPS scores (III-IV), and high PHQ-4 scores (6-12), the authors recommend referral to a multidisciplinary team, especially for patients with temporomandibular disorder (TMD) pain. CONCLUSIONS The authors recommend psychological assessment at first intake of a new adult patient or for patients with persistent TMD pain. The authors recommend the pain-related disability screening tools for all TMD pain symptoms and for dental pain symptoms that persist beyond the normal healing period. PRACTICAL IMPLICATIONS A brief psychological and pain-related disability assessment for patients in primary care may help the general oral health care practitioner make tailored treatment decisions.
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26
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Donnarumma V, Cioffi I, Michelotti A, Cimino R, Vollaro S, Amato M. Analysis of the reliability of the Italian version of the Oral Behaviours Checklist and the relationship between oral behaviours and trait anxiety in healthy individuals. J Oral Rehabil 2018; 45:317-322. [DOI: 10.1111/joor.12614] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2018] [Indexed: 12/24/2022]
Affiliation(s)
- V. Donnarumma
- Department of Neurosciences, Reproductive Sciences and Oral Sciences; Division of Orthodontics; University of Naples ‘Federico II’; Naples Italy
| | - I. Cioffi
- Department of Neurosciences, Reproductive Sciences and Oral Sciences; Division of Orthodontics; University of Naples ‘Federico II’; Naples Italy
- Faculty of Dentistry; Discipline of Orthodontics; Centre for the Study of Pain; University of Toronto; Toronto ON Canada
| | - A. Michelotti
- Department of Neurosciences, Reproductive Sciences and Oral Sciences; Division of Orthodontics; University of Naples ‘Federico II’; Naples Italy
| | - R. Cimino
- Department of Neurosciences, Reproductive Sciences and Oral Sciences; Division of Orthodontics; University of Naples ‘Federico II’; Naples Italy
| | - S. Vollaro
- Department of Neurosciences, Reproductive Sciences and Oral Sciences; Division of Orthodontics; University of Naples ‘Federico II’; Naples Italy
| | - M. Amato
- Department of Medicine; Surgery and Dentistry; Faculty of Medicine and Surgery; University of Salerno; Fisciano Salerno Italy
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Thorsell Cederberg J, Weineland Strandskov S, Dahl J, Ljungman G. Children's and adolescents' relationship to pain during cancer treatment: a preliminary validation of the Pain Flexibility Scale for Children. J Pain Res 2017; 10:1171-1178. [PMID: 28553138 PMCID: PMC5440011 DOI: 10.2147/jpr.s137871] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Children with cancer often suffer from pain. Pain is associated with psychological distress, which may amplify the pain experience. In chronic pain, it has been shown that psychological acceptance is helpful for both adults and children. For experimentally induced pain, interventions fostering psychological acceptance have been shown to predict increases in pain tolerance and reductions in pain intensity and discomfort of pain. A single subject study aiming to nurture psychological acceptance for children with cancer experiencing pain has shown promising results. No instruments measuring psychological acceptance in acute pain are yet available. The aim of the current study was to develop and preliminarily evaluate an instrument to measure psychological acceptance in children experiencing pain during cancer treatment. METHODS A test version of the Pain Flexibility Scale for Children was sent to all children aged 7-18 years undergoing cancer treatment in Sweden at the time of the study. Exploratory factor analysis was used. Internal consistency, test-retest reliability, and convergent validity were examined. RESULTS Sixty-one children participated in the study. A two-factor solution with Promax rotation was found to best represent the data. Internal consistency was good to excellent (a =0.87-0.91). The total scale and the subscales demonstrated temporal stability (Intraclass correlation coefficient =0.56-0.61) and satisfactory convergent validity (r=-0.27 to -0.68). DISCUSSION The Pain Flexibility Scale for Children measuring psychological acceptance in children with cancer experiencing pain is now available for use. This enables the evaluation of acceptance as a mediator for treatment change in the context of acute pain in children with cancer, which in turn is a step forward in the development of psychological treatments to help children cope with the pain during these difficult circumstances. The scale shows good psychometric properties but needs further validation, particularly considering the small sample size.
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Affiliation(s)
- Jenny Thorsell Cederberg
- Department of Women's and Children's Health, Pediatric Oncology, Uppsala University, Uppsala, Sweden
| | | | - JoAnne Dahl
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Gustaf Ljungman
- Department of Women's and Children's Health, Pediatric Oncology, Uppsala University, Uppsala, Sweden
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Thorsell Cederberg J, Weineland Strandskov S, Dahl J, Ljungman G. Parents' relationship to pain during children's cancer treatment - a preliminary validation of the Pain Flexibility Scale for Parents. J Pain Res 2017; 10:507-514. [PMID: 28424558 PMCID: PMC5344409 DOI: 10.2147/jpr.s127019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Pain is one of the most frequent and burdensome symptoms for children with cancer. Psychological acceptance has been shown to be beneficial in chronic pain. Acceptance-based interventions for experimentally induced pain have been shown to predict increased pain tolerance and decreased pain intensity. An acceptance-based pilot study for children with cancer experiencing pain has shown promising results. Further, parental acceptance has been shown to predict decreased child distress. To date, no instruments measuring acceptance in the context of acute pain in children are available. The aim of this study was to develop and evaluate an instrument to measure acceptance in parents of children experiencing pain during cancer treatment. METHODS A test version of the Pain Flexibility Scale for Parents (PFS-P) was sent to parents of all children undergoing cancer treatment in Sweden at the time of the study. Exploratory factor analysis (n=243) examined numerous solutions. Internal consistency, test-retest reliability and convergent validity were calculated. RESULTS A three-factor Promax solution best represented the data. The subscales were pain resistance, valued action and pain fusion. Internal consistency was good (α=0.81-0.93), and the total scale and the subscales demonstrated temporal stability (r=0.76-0.87) and good convergent validity (-0.40 to -0.84). DISCUSSION The PFS-P measuring acceptance in parents of children experiencing pain during cancer treatment is now available, enabling evaluation of acceptance in the context of acute pain in children. The scale shows good psychometric properties but needs further validation.
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Affiliation(s)
| | | | - JoAnne Dahl
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Gustaf Ljungman
- Department of Women's and Children's Health, Uppsala University, Uppsala
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Long H, Gao M, Zhu Y, Liu H, Zhou Y, Liao L, Lai W. The effects of menstrual phase on orthodontic pain following initial archwire engagement. Oral Dis 2017; 23:331-336. [PMID: 27873444 DOI: 10.1111/odi.12612] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/25/2016] [Accepted: 11/02/2016] [Indexed: 02/05/2023]
Affiliation(s)
- H Long
- Department of Orthodontics; State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Chengdu China
| | - M Gao
- Department of Orthodontics; State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Chengdu China
| | - Y Zhu
- Department of Orthodontics; State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Chengdu China
| | - H Liu
- Department of Orthodontics; State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Chengdu China
| | - Y Zhou
- Department of Orthodontics; State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Chengdu China
| | - L Liao
- Department of Orthodontics; State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Chengdu China
| | - W Lai
- Department of Orthodontics; State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Chengdu China
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30
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Al-Balbeesi HO, Bin Huraib SM, AlNahas NW, AlKawari HM, Abu-Amara AB, Vellappally S, Anil S. Pain and distress induced by elastomeric and spring separators in patients undergoing orthodontic treatment. J Int Soc Prev Community Dent 2016; 6:549-553. [PMID: 28032047 PMCID: PMC5184389 DOI: 10.4103/2231-0762.195519] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims and Objectives: The objective of the present investigation is to evaluate patients’ pain perception and discomfort, the duration of pain and the level of self-medication over time during tooth separation, and the effectiveness of elastomeric and spring types of orthodontic separators in Saudi population. Materials and Methods: The study group consisted of 30 female adolescent patients who had elastomeric/spring separators as part of their orthodontic treatment. A self-administrated questionnaire comprising 16 multiple choice questions and another with visual analog scale were used to record the patient's pain perceptions at 4 hours, 24 hours, 3 days, 5 days, and 7 days from the time of insertion. The level of pain and discomfort during these time periods were assessed by a visual analog scale. After a separation period of 7 days, the amount of separation was measured with a leaf gauge. Type and frequency of analgesic consumption was also recorded. The Statistical Package for the Social Sciences (SPSS) version 20 (IBM SPSS -Chicago, IL: SPSS Inc.,) was used for statistical analysis. Results: The data showed significant increase in the level of pain at 4 hours, 24 hours, and 3 days from separator placement. The elastomeric separators produced significantly more separation than the spring separators and also caused maximum pain during the first 3 days after insertion. However, there was no significant difference between the score of pain between two separators at all time intervals. Conclusion: Both elastomeric and spring separators showed comparative levels of pain and discomfort during the early phase of separation. Elastomeric separators were found to be more effective in tooth separation than spring separators. However, further studies are necessary to substantiate this preliminary observation.
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Affiliation(s)
- Hana O Al-Balbeesi
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Sahar M Bin Huraib
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Nadia W AlNahas
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Huda M AlKawari
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | | | - Sajith Vellappally
- Department of Dental Health, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Sukumaran Anil
- Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
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Somatic Awareness and Tender Points in a Community Sample. THE JOURNAL OF PAIN 2016; 17:1281-1290. [PMID: 27589911 DOI: 10.1016/j.jpain.2016.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/18/2016] [Accepted: 08/19/2016] [Indexed: 02/05/2023]
Abstract
Somatic awareness (SA) refers to heightened sensitivity to a variety of physical sensations and symptoms. Few attempts have been made to dissociate the relationship of SA and affective symptoms with pain outcomes. We used a validated measure of mood and anxiety symptoms that includes questions related to SA to predict the number of tender points found on physical examination in a large cross-sectional community sample (the Midlife in the United States [MIDUS] Biomarker study). General distress, positive affect, and SA, which were all significantly associated with tender point number in bivariate analyses, were used as predictors of the number of tender points in a multivariate negative binomial regression model. In this model a greater number of tender points was associated with higher levels of SA (P = .02) but not general distress (P = .13) or positive affect (P = .50). Follow-up mediation analyses indicated that the relationship between general distress and tender points was partially mediated by levels of SA. Our primary finding was that SA is strongly related to the number of tender points in a community sample. Mechanisms linking SA to the spatial distribution of pain sensitivity should be investigated further. PERSPECTIVE This article presents an analysis of 3 overlapping psychological constructs and their relationship to widespread pain sensitivity on palpation. The findings suggest that SA is most strongly related to the spatial distribution of pain sensitivity and that further assessing it may improve our understanding of the relationship between psychological factors and pain.
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