Treatment of chronic pain associated with bruxism through Myofunctional therapy

Differences between the Perilaryngeal Pressure Pain Thresholds in Asymptomatic Women, Women With Bruxism, and Women With Odynophonia

OBJECTIVE

This study was aimed at comparing perilaryngeal pressure pain thresholds (PPT) among asymptomatic women, women with bruxism, and women with odynophonia.

DESIGN

Observational cross-sectional study.

METHODS

Eighty-four women whose age mean was 23.75 (SD, 3.02) years were grouped according to inclusion and exclusion criteria into a group of asymptomatic women (G1), another group of women with bruxism (G2), and another of women with odynophonia (G3). Palpation was used to identify regions of interest for this study, and an analog algometer was used to evaluate perilaryngeal PPT in the previously localized regions. Each PPT evaluation was done twice.

RESULTS

G1 PPT mean were between 1.35 (SD, 0.20) and 2.29 (SD, 0.28) kg/cm2, G2 PPT mean were found between 0.85 (SD, 0.12) and 1.78 (SD, 0.23) kg/cm2, and G3 PPT mean were located between 0.71 (SD, 0.11) and 1.45 (SD, 0.19) kg/cm2. Differences were observed between PPT in the three groups evaluated (P < 0.05). The intra-evaluator agreement between the evaluations performed fluctuated between 60.71% (κ = 0.51) and 92.86% (κ = 0.91).

CONCLUSIONS

There are significant differences between the perilaryngeal PPT of asymptomatic women, women with bruxism, and women with odynophonia. Asymptomatic women had the highest PPT, while odynophonia sufferers had the lowest.

The Association between Masticatory Muscles Activation and Foot Pressure Distribution in Older Female Adults: A Cross-Sectional Study

The association between craniofacial muscles and postural control is well-known because of numerous anatomical connections. However, there are a few conflicting studies that correlated the activity of the masticatory muscles with the distribution of body weight pressure on the feet, which can strongly influence balance. Therefore, the purpose of our study was to evaluate the association between the masseter and temporalis muscle activity and foot pressure distribution. Fifty-two women were recruited, and baropodometric and EMG analyses of the masseter and temporalis baseline activities were analyzed. An ipsilateral association was found between the right temporal muscle activity and the right rearfoot load (r = 0.29, p < 0.05) and right forefoot load (r = -0.29; p < 0.05), as well as the percentage of muscle activation of the right masseter muscles with the percentage of pressure on the right forefoot (r = 0.31, p < 0.05) and right rearfoot (r = -0.31, p < 0.05). While further studies are needed, an ipsilateral association was found between masticatory muscles and foot pressure distribution.

Neuromuscular Stability of Dental Occlusion in Patients Treated with Aligners and Fixed Orthodontic Appliance: A Preliminary Electromyographical Longitudinal Case-Control Study

The aim of the present study was to evaluate if, after treatment with aligners (ALIGN) and fixed orthodontic appliance (FOA), alterations of the neuromuscular activity may occur and if differences in these changes can be detected between the two treatments. Sixteen healthy patients (7 FOA, 9 ALIGN) with class I or class II molar relation were recruited. Standardized surface electromyography (ssEMG) was used to evaluate the activity of the masticatory muscles (masseters-MM and temporalis-TM) before the beginning of the orthodontic treatment (T1), at the end (T2), and 3 months (T3) after the end of the treatment. Intragroup (within timepoints) and intergroup differences were statistically analyzed. At T1, the mean values of each ssEMG index were within the normal range in both groups. At T2, the FOA group showed larger differential recruitment of the MM than TA muscles with a value slightly over the normal range. All the indexes were normalized at T3, and no differences emerged between groups. In the FOA group, the index of MM symmetrical contraction increased significantly at T3 compared to T1 and T2. In the ALIGN group, no significant changes were observed between each timepoint. In FOA subjects, a slight alteration of the muscular activity appeared immediately after bracket removal and this alteration normalized after 3 months of rescue. In subjects treated with aligners, no significant alteration of the muscular activity was assessed.

The Refraction Assessment and the Electronic Trial Frame Measurement during Standing or Sitting Position Can Affect Postural Stability

Vision has been shown to influence body posture. The purpose of this study is to investigate the correlations between visual acuity and body postural control both in a standing and seated position. This cohort study included 37 patients examined using Adaptica’s (Italy) Kaleidos and VisionFit. Objective refraction was measured with Kaleidos both in a standing and seated position by the same operator and in the same environmental conditions. The parameters obtained with the device were binocular refraction, monocular refraction, pupil distance, pupil size, head tilt, gaze, phorias, and tropias. The results obtained were then subjectively tested using VisionFit: an electronic trial frame with phoropter functionalities. The study’s outcome revealed that the differences in the visual acuity parameters obtained in standing and seated positions were statistically significant; the Student’s t-test showed a p-value < 0.001 in all parameter averages. Automated refraction is widely being performed and postural control can affect the visual acuity parameters; therefore, it is relevant to consider the possibility of measuring in orthostatism. It might be appropriate to take into account the possibility of measuring in orthostatism and wearing trial frames in orthostatic conditions as well as walking freely around the room, looking outside of a window, sitting, and reading.

The role of the styloid apophysis of the temporal bone in the biomechanics of the tongue, mandible, hyoid system: a case study

Temporomandibular disorders are characterized by ear pain, tinnitus, difficulty in chewing, dysphagia and dizziness, cervical limitation of range of movement (ROM) and other less common disorders. Numerous recent studies associate the presence of these signs and symptoms with an elongated styloid apophysis, as in the case of Eagle syndrome. The purpose of this clinical case is to support the thesis of a common syndrome that temporomandibular joint (TMJ) disorders with an elongated styloid process affirming the relationship between temporal bone, mandible, hyoid bone and tongue. The patient was a 57-year-old woman who reported having ear algia and tinnitus all on the right side with difficulty chewing accompanied by odynophagia and dysphagia of solid and liquid foods, as well as cervical disorders. Computed tomography (CT) scans of the neck showed elongation and ossification of the styloid processes of the temporal bone. Magnetic resonance imaging (MRI) showed an anterior right dislocation of the TMJ articular disc. The patient presented classic symptoms of temporomandibular disorders, with the primary examinations showing an anterior right dislocation of the articular disc of the TMJ, as well as a longer styloid process on the same side. We therefore suggested that, in this case report, TMJ disorders might be associated with a longer styloid process on the same side.

Oral myofunctional therapy for the treatment of temporomandibular disorders: A systematic review

Objective: To investigate the role of oral myofunctional therapy for the treatment of temporomandibular disorders. Methods: A search of the literature was carried out looking for randomized controlled trials performed on humans and written in English, Italian, French, and Arabic. Results: Four randomized controlled trials were found and evaluated by using the Study Quality Assessment Tool of the National Institute for Health and Clinical Excellence. Oral myofunctional therapy was shown to be effective for the treatment of temporomandibular disorders, alone or associated with other treatments, in three out of four studies, with significant reduction of pain intensity when compared to other conservative treatments and no treatment. Discussion: Even though scientific evidence is weak, oral myofunctional therapy appears to be effective for the treatment of temporomandibular disorders with favorable cost-benefit and risk-benefit ratios.

Relevance of lactate level detection in migrane and fibromyalgia

The aim of this study was to determine the blood lactate levels in healthy and pathological subjects, particularly with migraine and fibromyalgia. Moreover we investigated the possible correlation between lactate concentration, postural stability and balance disorders; the composition of the groups were: migraine (n = 25; age 49.7 ± 12.5), fibromyalgia (n = 10; age 43.7 ± 21.2), control group (n = 16 age 28.52 ± 2.4). The results showed that patients with fibromyalgia (FG) had higher lactate levels compared to migraine (MG) and control group (CG) (mean ± sd: FG = 1.78 ± 0.9 mmol/L; MG = 1.45±1 mmol/L; CG = 0,85 ± 0,07 mmol/L). The same situation was highlighted about the sway path length with eyes closed (FG = 518 ± 195 mm; MG = 465 ± 165 mm; CG = 405 ± 94,72 mm) and with eyes open (FG = 430 ± 220 mm; MG = 411 ± 143 mm; CG = 389 ± 107 mm). This can be explained by the fact that energy-intensive postural strategies must be used to optimize both static and dynamic coordination, in particular with repeated contractions of tonic oxidative muscle cells responsible for postural control.

Sleep Bruxism and Occurrence of Temporomandibular Disorders-Related Pain: A Polysomnographic Study

Introduction: The diagnosis of sleep bruxism is challenging due to the difficulties involved. Sleep bruxism can lead to clinical consequences, including pain in masticatory muscles, limitation of jaw mobility, headache, and the spectrum of symptoms associated with damage to the teeth and oral mucosa. Currently, only video-polysomnography can definitely diagnose sleep bruxism. Due to the risk of painful temporomandibular disorders (TMD) in sleep bruxers, early diagnosis of pain in the temporomandibular region using questionnaires is recommended. Therefore, this study aimed to assess the relationship between the intensity of sleep bruxism and the occurrence of pain related to TMD.

Materials and Methods: This study was conducted on the patients of the Clinic of Prosthetic Dentistry operating at the Department of Prosthetic Dentistry at the Wroclaw Medical University. Based on a positive medical history, a thorough examination for the diagnosis of probable sleep bruxism was carried out in the enrolled patients. Eligible patients were then subjected to a video-polysomnographic study. Each patient was asked to complete the TMD Pain Screener questionnaire to assess the occurrence of pain in jaw and temple area.

Results: The results of the study showed that increased bruxism episode index (BEI) was statistically significantly correlated with increase of all types of bruxism episodes—phasic, tonic, and mixed—in all the studied patients; a significant correlation was also found with respect to division of patients into studied and control groups. The study also showed that there was no statistically significant difference between BEI values and scores of TMD Pain Screener. In all the studied patients, a higher BEI was not found to be correlated with the occurrence of TMD-related pain assessed by TMD Pain Screener; similarly, no correlation was found with respect to division of patients into studied and control groups.

Conclusions: The occurrence of TMD-related pain is not related to the intensity of sleep bruxism. TMD Pain Screener may be used as an auxiliary tool in the diagnosis or risk of occurrence of TMD-related pain, whereas in the case of sleep bruxism, it has only limited diagnostic value.

Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03083405

2019 Ejtm Special on Muscle Fascia

For many years the fasciae have been considered by the anatomists only as a "white envelope for the muscles", that is generally removed in anatomical tables, to recognize muscle nerves and vessels. This is one of the reasons that different descriptions of the fasciae exist. On the other hand, in the last years the fasciae and their properties are becoming of central importance to clinicians practicing in various conventional and alternative therapies. The results from the worldwide research activities constitute a body of significant and important data, but this clinical interest is not supported by in-depth comprehension to how integrate the new knowledge about fasciae with the classical biomechanical models based on muscles, tendons and bones. To close this gap an Ejtm Special on "Muscle Fascia" will be published September 30, 2019, but the typescripts will be added to the Ejtm Early Release list as soon as all authors will approve their Epub papers. Deadline for original articles and reviews is June 1st, 2019, but the Editors hope that authors submit their typescripts much earlier.

Collection of the Abstracts of the 2019Sp PMD: Translational Myology and Mobility Medicine

The Interdepartmental Research Centre of Myology (CIR-Myo), Department of Biomedical Sciences, University of Padova, Italy and the A&C M-C Foundation for Translational Myology, Padova, Italy organized with the scientific support of Helmut Kern, Jonathan C. Jarvis, Viviana Moresi, Marco Narici, Feliciano Protasi, Marco Sandri and Ugo Carraro, the 2019SpringPaduaMuscleDays: Translational Myology and Mobility Medicine, an International Conference held March 28-30, 2019 in Euganei Hills and Padova (Italy). Presentations and discussions of the Three Physiology Lectures and of the seven Sessions (I: Spinal Cord Neuromodulation and h-bFES in SC; II: Muscle epigenetics in aging and myopathies; III: Experimental approaches in animal models; IV: Face and Voice Rejuvenation; V: Muscle Imaging; VI: Official Meeting of the EU Center of Active Aging; VII: Early Rehabilitation after knee and hip replacement) were at very high levels. This was true in the past and will be true in future events thanks to researchers and clinicians who were and are eager to attend the PaduaMuscleDays.

EJTM3 is also covering Mobility and Medicine at large, an update

Since the first 2018 issue, the European Journal of Translational Myology expanded its authorship and readership from the strict topics of biology, physiology, diagnostic, management and rehabilitation of skeletal muscle to the more clinically relevant fields of human mobility to those of general medicine. This third issue opens with a review on Chronic Fatigue Syndrome, a very complex medical problem, as its other names testify (Myalgic Encephalomyelitis or Systemic Exertion Intolerance Disease). A more typical molecular myology original article follows (Increasing autophagy does not affect neurogenic muscle atrophy), but then several Rapid Reports cover different Medical Specialties fields, related or unrelated to neuromyology, mobility problems and their potential solutions. The Advisors of EJTM invite Authors to submit typescripts, taking into account that the journal is keen to publish high-level papers in the fields of Translational Myology, Mobility and Medicine at large.