Awake bruxism in temporomandibular disorders patients referred to tertiary care: A retrospective study on its assessment and TMD management

Trauma and TMD: The association between orofacial trauma and temporomandibular disorders in a tertiary referral clinic

OBJECTIVE

Between 5-12% of the population suffers from Temporomandibular disorders (TMDs). TMDs are known for their multifactorial aetiology and one of the proposed associated factors is orofacial trauma. This study investigated the possible association between orofacial trauma and TMD in a tertiary referral clinic.

METHODS

Patients were diagnosed with one or more TMD diagnoses; myalgia, arthralgia, headache associated with TMD and/or a TMD function diagnosis. 659 consenting patients were included. The majority were female. Ages ranged between 18 and 86 years. All patients were included in a logistic regression analysis, and 236 were included in a network analysis.

RESULTS

Neither analysis yielded a statistically significant association between orofacial trauma and TMD. Results showed associations between psychosocial variables and TMD diagnoses.

DISCUSSION

These results are contradictory to a recent review, where an association between orofacial trauma and TMD was found. The results on psychosocial variables and TMD diagnoses are corroborated by literature.

CONCLUSION

In conclusion, in this tertiary referral clinic, no association between orofacial trauma and TMD was found.

The Influence of Temporomandibular Joint Disorders and Mandibular Position on Visual Capacities: A Case-Control Study

Aims

To verify the possible association between the stomatognathic and the visual system by analyzing the effects that different mandibular postures may have on the accommodative capacity and ocular convergence and by assessing whether temporomandibular disorders (TMD) can influence visual abilities.

Materials and Methods

A case-control study was performed during a 1-year period on a sample of 100 subjects (50 cases and 50 controls). The subjects underwent a gnathological examination, and two visual tests were performed in three different jaw positions: maximum intercuspation, resting position, and open mouth. The statistical analyses were performed using the software SPSS program based on t-test to compare the different jaw positions and the odds ratio to understand the prevalence of visual defects in TMD patients.

Results

A statistically significant worsening was observed comparing the visual capacities measurements from the maximum intercuspation to the open mouth position; "case group" measurements showed a worsening trend compared to the "control group" (P value < 0.05 in all comparisons). Furthermore, the examinations showed statistically significant results with reference to the relationship between TMD and their negative influence on visual abilities (P value = 0.007 for convergence and P value = 0.012 for accommodation).

Conclusions

Based on our data, TMD individuals performed worse in vision tests compared to healthy subjects and the presence of occlusal contacts appears to improve convergence and accommodation. The reduced reproducibility and accuracy of the orthoptic tests and the small sample number were the principal limitations of our study. The future perspective could be to investigate whether the visual apparatus could benefit from the treatment of stomatognathic disorders.

Clinical benefit of botulinum toxin for treatment of persistent TMD-related myofascial pain: A randomized, placebo-controlled, cross-over trial

BACKGROUND

Injections of botulinum toxin type A (BoNT-A) have been proposed as an additional treatment modality for patients suffering chronic temporomandibular disorder (TMD)-related myofascial pain (MFP). BoNT-A impairs muscle function, along with its analgesic effect, and a minimal effective dose should be used. The objective of this randomized placebo-controlled crossover study was to evaluate the clinical benefit of a moderate dose (50 U) of BoNT-A.

METHODS

Sixty-six subjects were randomized into two groups, one which received BoNT-A first and a second which received a saline solution (SS) first. Follow-ups were performed 2, 11, and 16 weeks after the injections. Diagnostic criteria for temporomandibular disorders (DC/TMD) diagnostic algorithms were used to evaluate characteristic pain intensity (CPI) and pain-related disability based on the Graded Chronic Pain Scale (GCPS). Electromyographic and bite force were also evaluated.

RESULTS

The within-group analysis showed a significant improvement in pain intensity and pain-related disability after BoNT-A (p < 0.001, p = 0.005, p = 0.011) and SS (p = 0.003, p = 0.005, p = 0.046) injections up to week 16. The between-group analysis of pain-related variables revealed no differences between groups at any time. Nonetheless, BoNT-A, but not SS, caused a significant decline in muscle performance. The number needed to treat (NNT) regarding a clinically significant pain reduction (≥30%) was 6.3, 57.0, and 19.0 at 2, 11, and 16-week follow-ups favoring BoNT-A.

CONCLUSIONS

Injections of 50 U of BoNT-A might improve MFP symptoms, but the specific effect of the drug on pain compared to the placebo is not obvious.

Prevalence of obstructive sleep apnoea syndrome in oncological patients: A systematic review and meta-analysis

BACKGROUND

Obstructive sleep apnoea syndrome (OSAS) has garnered increasing attention in recent years due to its potential association with cancer. This systematic review and meta-analysis aimed to assess the prevalence of OSAS in cancer patients through a comprehensive analysis of existing literature.

METHODS

This systematic review and meta-analysis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, aimed to evaluate the prevalence of OSAS in cancer patients. A comprehensive search of electronic databases was performed to identify relevant studies published up to September 2021. Eligible studies reporting on the prevalence of OSAS in cancer patients, encompassing various study designs, were included in the analysis. Pooled estimates of the odds ratios (OR) with 95% confidence intervals (CIs) were calculated using a random effects model. Heterogeneity among the studies was assessed using the I2 statistic.

RESULTS

Seventeen studies fulfilled the inclusion criteria and were subsequently included in the review. The prevalence of OSAS in cancer patients was estimated to have an overall OR of 0.80 (95% CI: 0.75-0.85). In comparison with non-cancer patients, cancer patients had a statistically significant greater risk of OSAS, as indicated by the total estimated RR for the prevalence of OSAS in cancer patients, which was 0.89 (95% CI: 0.86-0.92). Nonetheless, there was a significant amount of heterogeneity (I2 = 96%) among the studies.

CONCLUSION

The overall data analysed in this review indicates that patients with cancer had far reduced likelihood of developing OSAS than individuals without cancer. However, the significant variation across the included studies highlights the need for additional investigation to fully clarify the complex association between OSAS and cancer incidence. These results emphasise how critical it is to identify OSAS as a possible comorbidity in cancer patients, one that should be taken into account for clinical management and ongoing research.

Prevalence of temporomandibular disorders diagnosis in patients treated with Herbst appliance: a systematic review and meta-analysis

BACKGROUND

The Herbst appliance is an excellent therapy for treating class II malocclusions with increased overjet. Its mechanics involve propelling the mandibular bone using two pistons the patient cannot remove. The so-called bite-jumping keeps the mandible in a more anterior position for a variable period, usually at least 6 months. This appliance does not inhibit joint functions and movements, although there are scientific papers in the literature investigating whether this appliance can lead to temporomandibular disorders. This systematic review aims to evaluate whether Herbst's device can cause temporomandibular diseases by assessing the presence of TMD in patients before and after treatment.

METHODS

A literature search up to 3 May 2023 was carried out on three online databases: PubMed, Scopus and Web of Science. Only studies that evaluated patients with Helkimo scores and Manual functional analysis were considered, as studies that assessed the difference in TMD before and after Herbst therapy. Review Manager version 5.2.8 (Cochrane Collaboration) was used for the pooled analysis. We measured the odds ratio (OR) between the two groups (pre and post-Herbst).

RESULTS

The included papers in this review were 60. Fifty-seven were excluded. In addition, a manual search was performed. After the search phase, four articles were considered in the study, one of which was found through a manual search. The overall effect showed that there was no difference in TMD prevalence between pre-Herbst and post-Herbst therapy (OR 0.74; 95% CI: 0.33-1.68).

CONCLUSION

Herbst appliance seems not to lead to an increase in the incidence of TMD in treated patients; on the contrary, it appears to decrease it. Further studies are needed to assess the possible influence of Herbst on TMDs.