Psychological factors in oral mucosal and orofacial pain conditions

The Positive Effect of Psychotherapy in the Treatment of an Erosive Oral and Dermal Lichen Planus Case

Lichen planus (LP) is an autoimmune disease that may affect the oral cavity and the skin, and it has the potential to change to malignancy. In this paper we report a LP case in a 42-year-old male patient in which anxiety and depression were apparently the only possible risk factors of LP. Due to this apparent comorbidity and the risk of not responding well to conventional medication (topical and systemic corticosteroids) or the risk of relapse in the case of ongoing stress, we decided to integrate psychotherapy (without psychotropic drugs) as an adjunct into the management strategy. Psychotherapy sessions, reassuring the patient and stress alleviation, proved to be a very useful alongside the standard corticosteroid medication.

Prevalence and associated factors of health anxiety in patients with temporomandibular disorders

OBJECTIVES

To investigate the prevalence and associated factors of health anxiety (HA) in patients with Temporomandibular Disorders (TMDs) using the 8-item Whiteley Index (WI-8) scale.

MATERIALS AND METHODS

Three hundred and twenty-nine TMDs patients completed the Visual Analog Scale (VAS), WI-8, Jaw Functional Limitation Scale-8 (JFLS-8), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) scales. Clinical examinations were conducted following the Diagnostic Criteria for TMDs Axis I.

RESULTS

The prevalence of HA among TMDs patients was 18.54%. Patients with HA had higher scores of VAS-current (p = 0.026), VAS-maximum (p = 0.024), VAS-average (p = 0.030), JFLS-8 (p < 0.001), GAD-7 (p < 0.001) and PHQ-9 (p < 0.001), lower maximum mouth opening (p = 0.016), lower proportion of structure-related TMDs (p = 0.028), and higher proportion of pain-related TMDs (p < 0.001) compared to those without HA. The correlation coefficient was 0.61 (p < 0.001) between WI-8 and GAD-7 and 0.64 (p < 0.001) between WI-8 and PHQ-9.

CONCLUSION

Approximately one-fifth of patients with TMDs experienced HA. HA was associated with pain perception, functional limitations, depressive, and anxiety symptoms in individuals with TMDs. HA may contribute to heightened subjective pain experiences rather than structural changes in the TMJ.

Relationships between personality factors and DC/TMD Axis II scores of psychosocial impairment among patients with pain related temporomandibular disorders

This cross-sectional analytical study aimed to assess the relationship between personality factors and the DC/TMD Axis II scores of psychosocial impairment among patients with pain related temporomandibular disorders (TMD). 120 participants (60 females and 60 males) who were diagnosed with pain related TMD according to the Axis I DC/TMD protocol were recruited. The participants were requested to complete four tests including the NEO Five Factor Inventory (NEO-FFI) to assess personality factors and three Axis II DC/TMD tools; the Graded Chronic Pain Scale (GCPS) Version 2.0 to assess TMD pain intensity and pain-related disability, Patient Health Questionnaire-4 (PHQ-4) to assess psychological distress due to TMD pain, and Generalized Anxiety Disorder-7 (GAD-7) to assess patients' stress reactivity. Results showed that 49.2% of the participants experienced high intensity of characteristic pain, 14.2% reported pain related disability more than 30 days (grade 3 disability days) and had disability scores of 70 or above (grade 3 disability scores), 16.7% demonstrated severe distress, and 18.3% reported severe anxiety due to TMD pain. Females scored higher on all these variables than males (P < .05). Multiple regression analyses indicated that higher extraversion scores, higher agreeableness scores and being a female were associated with higher intensity of characteristic pain (p < .05). Also, higher neuroticism and agreeableness scores were associated with more disability days (p < .05). In addition, higher agreeableness scores were associated with higher disability scores and disability point values (p < .05). Furthermore, lower neuroticism scores and being a female were associated with higher PHQ total scores, while being a female and having a lower level of education were associated with higher GAD total scores (p < .05). In conclusion, personality profiles and gender significantly impact the DC/TMD Axis II scores of psychosocial impairment among patients with pain related TMD.

Counselling for patients with a temporomandibular disorder: A scoping review and concept analysis

BACKGROUND

An integral component of comprehensive temporomandibular disorder (TMD) treatment involves what is commonly referred to in literature as patient counselling or patient education. Despite its importance, a clear definition of the concept is lacking.

OBJECTIVES

To describe the concept of counselling (i.e. what is it, what should it consist of, and when should it be given) through a concept analysis of the literature.

ELIGIBILITY CRITERIA

All papers that include a description of counselling or education for TMD are included.

SOURCES OF EVIDENCE

Literature searches were performed in the electronic databases PubMed, Cinahl, and PsycInfo.

CHARTING METHODS

A qualitative analysis was done using the principle-based concept analysis approach, where descriptions of counselling from the included papers were analysed by the researchers.

RESULTS

A total of 71 articles were included. Based on the qualitative analysis of the included articles and descriptions of counselling, the following content themes were identified: (1) general information on TMD; (2) overuse of the masticatory system; (3) posture education; (4) lifestyle and psychosocial factors; (5) exercise- and thermotherapy; and (6) additional information and therapies.

CONCLUSIONS

A definition and framework of counselling for TMD has been provided, which can be used in the clinic, research, and educational programs.

Psychological problems and their impact on oral mucosal disease patients' quality of life: A cross-sectional study in the Chinese population

Objectives

We aimed to investigate the presence of common psychological factors (i.e., stress, depression, anxiety) and their impact on the Oral health-related quality of life (OHRQoL) in patients diagnosed with four oral mucosal diseases (OMDs): recurrent aphthous ulcers (RAU), oral lichen planus (OLP), oral leukoplakia (OLK), and oral submucous fibrosis (OSF).

Methods

A total of 229 patients with clinically diagnosed OMDs were enrolled in this study, consisting of 55 RAU, 68 OLK, 50 OLP, and 56 OSF patients. The patients were statistically analyzed for psychological problems and OHRQoL using the Visual Analog Scale (VAS)､ the 5-item Oral Health Impact Profile (OHIP-5) and the Depression Anxiety Stress Scale-21 (DASS-21) scales.

Results

There were 229 valid questionnaires collected, consisting of 83 females and 146 males with a mean age of 45.24 (SD = 11.88) years. Multiple regressions between DASS-21 scores and OHIP-5 scores revealed generally negative impacts of psychological problems on OHRQoL, with depression on OLP (β = 0.47), OLK (β = 0.65) and OSF (β = 0.38), stress on RAU (β = 0.29), OLP (β = 0.72), OLK (β = 0.38) and OSF (β = 0.60), and anxiety on OLP (β = 0.33), OLK (β = 0.49) and OSF (β = 0.51).

Conclusions

Psychological problems like depression, stress, and anxiety were found to be prevalent in OMDs patients and adversely affected their OHRQoL. The results support the biopsychosocial medical model in the treatment of OMDs patients.

Clinical significance

The present study reinforced the crucial roles of psychological factors in impacting OMDs patients' OHRQoL. Therefore, it is necessary to monitor patients' psychological status and OHRQoL using questionnaires like DASS-21 and OHIP-5. Followed by psychological interventions, the treatment is expected to be enhanced.

Photobiomodulation Therapy in the Management of Oral Lichen Planus: A Systematic Review and Meta-Analysis

Photobiomodulation therapy (PBMT) is a non-invasive and the latest form of therapy used in the treatment of non oncological diseases as well as cancers of various types and locations. The aim of this study was to systematically review and assess the efficacy of PBMT in managing oral lichen planus (OLP) compared to the interventions. A systematic review and meta-analysis were implemented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search using PubMed, Scopus, and Cochrane was conducted to retrieve relevant studies published until June 2023. The outcomes evaluated included the reduction in pain score and clinical severity scores (Prospero No CRD42023428626). A total of eight studies were identified for qualitative synthesis. The pooled analysis incorporating six studies revealed that there are no significant differences for both mean pain score (mean difference [MD] = 0.21, 95% confidence interval [CI] = -0.51, 0.93) as well as clinical score (MD = -0.08, 95% CI = -0.4, 0.25) between PBMT and comparison groups. Subgroup analysis based on corticosteroids as controls showed that there was no significant difference in mean reduction in pain score between PBMT and topical steroids (MD = 0.38, 95% CI = -0.54, 1.31). PBMT is as effective as other interventions in the treatment of OLP, though not superior, and can be a promising alternative treatment for cases resistant to steroids or when steroids are contraindicated. Further studies are recommended to standardize the optimal settings for the treatment of OLP.

The Relationships Between Psychosocial Factors and Short-Term Treatment Outcomes of Massage Therapy in Patients with Myogenic Temporomandibular Disorders: A Single-Arm Preliminary Study

Background

Massage therapy is included as part of a comprehensive treatment plan for patients with temporomandibular disorders (TMDs). However, it displayed varying degrees of success. Preexisting psychosocial impairments may be one of the possible factors affecting the treatment response. This preliminary study aimed to investigate the relationships between psychological factors and treatment outcomes of massage therapy in myogenous TMD patients.

Methods

Twenty-two myogenous TMD patients were enrolled in this single-arm preliminary study. Baseline psychosocial assessment was done using self-report measures associated with chronic pain severity, depression, anxiety, and non-specific physical symptoms. Massage therapy including the intraoral and extraoral massage of the face and neck muscles was performed twice a week for 4 weeks. Pain intensity and quality of life related to oral health were evaluated as treatment outcomes before and immediately after eight sessions of massage therapy.

Results

Regression analyses showed a significant effect of depression on changes in the quality of life after massage (β = 0.35, p-value = 0.026). In addition, results showed a significant effect of chronic pain severity on changes in the pain intensity following massage (β = 1.50, p-value = 0.027).

Conclusion

Our findings suggested that psychosocial characteristics of myogenous TMD patients should be considered as important factors that may adversely affect pain intensity reduction and quality-of-life improvement after short-term massage therapy.

The Correlation between Oral Lichen Planus and Thyroid Pathologies: A Retrospective Study in a Sample of Italian Population

OBJECTIVES

 The association between oral lichen planus and thyroid disorders, especially hypothyroidism and Hashimoto's thyroiditis, has been discussed in current literature with conflicting outcomes.

MATERIALS AND METHODS

 The study retrospectively evaluated the thyroid status in patients diagnosed with oral lichen planus and oral lichenoid lesions. A case-control approach was used to prove that thyroid disorders were statistically significant risk factors for oral lichen planus and oral lichenoid lesions.

STATISTICAL ANALYSIS

 To evaluate these associations, odds ratios (ORs) were used. ORs precision and statistical significance were estimated using a 95% confidence interval (CI) and p-value, respectively.

RESULTS

 A total of 307 patients were involved in the study: 158 females and 149 males. OR, 95% CIs, and p-values were analyzed. Patients with thyroid diseases showed an increased risk of developing oral lichen planus (OR: 4.29, 95% CI: 1.85-9.96, p-value: 0.0007) and oral lichenoid lesions (OR: 2.76, 95% CI: 1.24-6.13, p-value: 0.0129). This association was maintained in patients with oral lichen planus, while also considering hypothyroidism (OR: 3.74, 95% CI: 1.46-9.58, p-value: 0.0059) and Hashimoto's thyroiditis (OR: 4.57, 95% CI: 1.58-13.23, p-value: 0.005) alone. The correlation of hypertension, diabetes, dyslipidemia, and smoking status with oral lichen planus and oral lichenoid lesions was also evaluated but no statistical significance was found.

CONCLUSION

 Even if further investigations are needed, the association between oral lichen planus and oral lichenoid lesions with thyroid pathologies should be taken into consideration by endocrinologists due to the potential malignancy of these disorders.

Bibliometric Analysis and Visualization of Clinical Trials on Psychological Stress and Oral Health (1967-2024)

Stress is ubiquitous in modern life, influencing various facets of human health and well-being. While the impact of stress on mental and physical health is well-documented, its effects on oral health have garnered increasing attention in recent years. This bibliometric analysis explores the literature on the impact of stress on oral health. The study utilizes data from the PubMed database, focusing on publication trends, influential contributors and the temporal analysis of their publications, coauthorship analysis of authors and institutions, key thematic clusters, thematic evolution, and collaboration between various countries. Examining clinical trials investigating the impact of stress on oral health unveils significant trends and insights. Over time, there has been a steady rise in publication frequency, although with occasional fluctuations, indicating an increasing interest in the subject. The University of California has been identified as a leading institution, while Psychoneuroendocrinology emerges as a pivotal journal for disseminating research findings in the field. Keyword analysis reveals diverse thematic clusters, reflecting the multifaceted nature of the impact of stress on oral health. The analysis of topic trends showcases significant shifts over different periods, from basic correlations between mental health conditions and physiological indicators to a broader exploration of psychological interventions and social contexts in recent years. Thematic evolution analysis further elucidates this progression, categorizing themes into motor, basic, niche, and emerging or declining categories. Additionally, the analysis of corresponding authors' countries uncovers patterns of collaborative efforts, with the United States leading in collaboration levels. In summary, these analyses collectively highlight an evolving comprehension of the impact of stress on oral health, providing valuable insights for clinical practice and guiding future research endeavors.

Bridging the gaps: management of lichen planus subtypes in a joint dermatology-oral surgery clinic

Lichen planus (LP) presents with a range of clinical subtypes. It can affect the outer skin, involve the nails and present with alopecia and mucosal symptoms to varying degrees. LP of the outer skin mostly shows a self-limiting course; however, this is not the case for lichen planopilaris and the mucosa-affecting subtypes. The pathogenesis of LP is still incompletely understood. As a result, an effective, targeted therapy is currently lacking and different immunomodulatory approaches are being used in clinical practice. The management of patients with severe oral LP mucosae can be particularly challenging. Although the true risk remains controversial, oral LP is considered a risk factor for the development of squamous cell carcinoma and there is a need for regular screening. The quality of life in patients with LP is significantly impaired because of frequent clinical visits, pain, soreness, inability to eat certain foods, side effects to medication, frustrating therapy attempts and worry regarding cancer risk. We highlight here the advantages of an interdisciplinary dermatology and oral surgery clinic, which can address the domains of tooth status, nutrition, pain and malignant transformation and optimized patient management.

Thai version of shortened Oral Impact on Daily Performances index for evaluating oral lichen planus patients

BACKGROUND

Patients' perceptions and Oral Health-related Quality of life (OHRQoL) are important parts of dental treatment in all fields, including oral lichen planus (OLP) patients. A shortened version of the Oral Impact on Daily Performances (OIDP) might be more practical and feasible in clinical setting due to the busy nature of oral medicine clinics and staff availability to conduct the interview for data collection. The aim of the study was to develop a Thai version of shortened OIDP for assessing the OHRQoL in OLP patients.

METHODS

Two types of shortened OIDP versions were tested in 69 OLP patients, one comprising the most commonly interfered with daily performances (OIDP-3 and OIDP-2) and another comprising either the highest frequency (OIDP frequency) or severity score (OIDP severity). The Numeric Rating Scale (NRS) and Thongprasom sign score were used to assess oral pain and clinical severity. Spearman rank-order correlation coefficients (r_s) were used to demonstrate the associations between the shortened and original OIDP, pain, and clinical severity.

RESULTS

OIDP-3 (Eating, Cleaning, and Emotional stability) and OIDP-2 (Eating and Emotional stability) were developed. The associations of the original OIDP with OIDP-3 and OIDP-2 (r_s = 0.965 and 0.911) were significantly higher than those of the original OIDP with OIDP frequency and OIDP severity (r_s = 0.768 and 0.880). The original OIDP, OIDP-3, and OIDP-2 were more significantly associated with pain compared with OIDP frequency and OIDP severity. The association between the clinical severity and oral impacts assessed by the original OIDP, OIDP-3, and OIDP-2 were similar and had higher correlation coefficients compared with those of OIDP frequency and OIDP severity.

CONCLUSION

OIDP-3 and OIDP-2 performed more similarly to the original OIDP than OIDP frequency and OIDP severity in assessing the OHRQoL of OLP patients.

TRIAL REGISTRATION

The trial was registered at the Thai Clinical Trials Registry (TCTR identifier: TCTR 20190828002).

Depression, somatization, and sleep disorders as risk factors for temporomandibular disorders development

The objective of this study was to determine the association between temporomandibular disorders (TMD) with depression, somatization and sleep disorders in the city of Maringá, Brazil. A total of 1,643 participants were selected from the Brazilian Unified Health System (SUS). Of these, the test group consisted of 84 participants who had moderate or severe limitations due to TMD pain and the control group consisted of 1,048 participants with no pain. There was a highly statistically significant difference (p<0.001) between cases and controls regarding depression (82.1 versus 37.4%), somatization (84.5 versus 31.4%), and sleep disorders (84.6 versus 36.4%), in moderate to severe levels. The levels of moderate to severe depression, somatization and sleep disorders were significantly higher in TMD subjects with high TMD pain disability. The risk of developing TMD increased 4 to 5 times when the individual has moderate to severe levels of depression, somatization, and sleep disorders. 

Oral Mucosal Lesions in Childhood

Childhood diseases are a continuous source of interest in all areas of general and dental medicine. Congenital, developmental, and hereditary diseases may either be present upon birth or appear in early childhood. Developmental anomalies, although often asymptomatic, may become grounds for different infections. Furthermore, they can indicate certain systemic disorders. Childhood age frequently brings about benign tumors and different types of traumatic lesions to the oral mucosa. Traumatic lesions can be caused by chemical, mechanical, or thermal injury. Mucocele and ranula are, by definition, traumatic injuries of the salivary glands or their ducts. Recurrent aphthous lesions are the most common type of ulcerations in childhood, and their etiology is considered multifactorial. Oral mucosal lesions in children require different treatment approaches depending on etiological factors and clinical presentation. Clinicians should have adequate knowledge of oral anatomy in order to diagnose and treat pathological conditions.

The association of recurrent aphthous stomatitis with general health and oral health related quality of life among dental students

BACKGROUND

Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosa diseases. This study aimed to investigate the association of RAS with general health and oral health-related quality of life among dental students of Shahrekord University of Medical Sciences in 2020.

METHODS

In this cross-sectional study, a researcher-made checklist about the type, size, location, number, and recurrence rate of ulcers, oral health-related quality of life questionnaire (OHIP-14), and a 28-item general health questionnaire (GHQ-28) were completed by 100 dental students.

RESULTS

The proportion of RAS was significantly higher among females than males (61.1 versus 38.9, P=0.03) and was associated with family involvement history (P<0.001) and a Tendency to eat spicy foods (P=0.02). Moreover, the oral health-related quality of life was significantly lower among students with a history of RAS (8.17 ± 8.33 versus 4.22 ± 4.10, P=0.003). The results showed that GHQ-positive status was significantly associated with ulcer size (P=0.01). The general health status was positively correlated with RAS prevalence (p=0.04). Also, an investigation of the OHIP questionnaire showed that there was a significant correlation between physical status (r=0.31, P<0.001), insomnia, and mental status (r=0.33, P<0.001) with OHIP total score.

CONCLUSION

The results of this study confirmed a significant association between aphthous stomatitis and general health and oral health-related quality of life. So possibly improving general health and oral health-related quality of life may be effective in preventing aphthous stomatitis.

"I Still Suffer Every Second of Every Day": A Qualitative Analysis of the Challenges of Living with Chronic Orofacial Pain

Objective

Chronic orofacial pain is prevalent and debilitating. Psychological and social factors place a heavy burden on this population but are often overlooked. Here, we offer the first comprehensive qualitative conceptualization of the challenges of living with chronic orofacial pain through a biopsychosocial perspective to inform multifaceted care for this population.

Design

We employed a qualitative thematic analysis of open text responses using a hybrid inductive-deductive approach and a biopsychosocial framework.

Methods

Two hundred and sixty participants with chronic orofacial pain responded to an open-ended question: "What is the biggest challenge you face in managing your condition?" by typing their responses into a text box as part of an online survey. We mapped responses onto biomedical, psychological, and social themes (deductive) and concurrently identified findings within each theme that emerged directly from the data (inductive).

Results

Subthemes within the biomedical theme included challenges with biomedical pain management, medication side effects, sensory triggers, physical symptoms of stress/tension, and biological functions and related activities of daily living. Subthemes within the psychological theme included anxiety, depression, emotional symptoms of stress, unpredictability/uncertainty of pain, and psychological and cognitive aspects of medication management. Subthemes within the social theme included social relational, experience with providers, socioeconomics and access to care, and roles and responsibilities.

Conclusion

Chronic orofacial pain is associated with multifaceted challenges. Consideration of individuals' experiences of biomedical, psychological, and social challenges in the assessment, referral, and treatment of chronic orofacial pain holds the potential to promote more comprehensive, patient-centered care for this population.

Impact of the COVID-19 pandemic upon patients with burning mouth syndrome

INTRODUCTION

The global COVID-19 pandemic has caused changes in the daily life of people, with a particularly relevant impact upon certain groups of individuals that have difficulties in facing stress. A study is made of the impact of the pandemic upon patients with burning mouth syndrome (BMS).

MATERIAL AND METHODS

A total of 40 patients with BMS diagnosed in the Unit of Oral Medicine (University of Murcia, Spain) were included. In all cases the study comprised a standardized clinical interview by the same professional and an exploration of the oral cavity. The first visit took place before the pandemic and consisted of the evaluation of anxiety (Hospital and Anxiety Depression Scale [HADS]), the Pain Catastrophizing Scale (PCS), pain intensity (visual analog scale [VAS]) and sleep quality (Pittsburg Sleep Quality Index [PSQI]), while the second visit took place one and a half months after the start of lockdown due to the pandemic in Spain.

RESULTS

The study sample consisted of 36 women (90%) and four men (10%) aged between 39 and s86 years. Statistically significant differences were recorded between the two visits in terms of anxiety (p < 0.001), sleep quality (p < 0.001) and pain intensity (p < 0.001).

CONCLUSIONS

The appearance of the COVID-19 pandemic has triggered worsening of anxiety, sleep quality and pain intensity in patients with BMS.

Prosthetic Surgical Templates and Dental Implant Site Time Preparation: An In Vitro Study

Numerous types of prosthodontics surgical guides, with and without metallic sleeves, have been found to be useful in clinical studies. The aim of this in vitro research was to compare the time required to complete the surgical procedure with two differently designed surgical prosthetic templates. Ten identical prototype models of mandible based on a CBCT and optical scan of a partially edentulous patient with missing teeth numbers 37, 46, and 47 were prepared and then printed. Five of these models were used for implant site preparation with a surgical guide without metal sleeves and dedicated surgical kit, and the other five models were used for the same procedure performed with a surgical guide with metal sleeves and a dedicated surgical kit. The time of implant site preparation was measured and recorded. Statistical analysis was performed using Student’s t-test for independent samples. Differences between groups were found to be statistically significant (t = −9.94; df = 28; p = 0.0000) with a lower value in favor of the surgical templates without metallic sleeves. Different types of prosthodontics surgical guides, with or without metallic sleeves, seemed to be an important factor which can significantly impact the time of implant site preparation and, therefore, the overall surgical procedure.

Relationship of Malocclusions with Disorders of the Temporomandibular Joint in Children of CALI-Colombia

OBJECTIVE

 The aim of this study was to determine the relationship of malocclusion with the presence and severity of temporomandibular disorders (TMDs) in children.

MATERIALS AND METHODS

 A clinical examination was performed in 87 patients (from 4 to 14 years of age) who attended the dentistry clinics of Universidad del Valle.

RESULTS

 The 77 patients studied had malocclusions; 55 patients had TMD and 67.3% were female. The most frequent symptom of TMD was articular unilateral noise with 33.8%, followed by pain in at least one masticatory muscle with 26%. TMJ pain was observed in 24.7% of the patients. There was a statistically significant relationship between the presence and severity of TMD with type of dentition and transverse malocclusion, respectively.

CONCLUSION

 The presence of TMD in children with malocclusion presented in a high frequency. TMD depends on the type of dentition and its severity is dependent on transverse malocclusion.

Unsupervised Machine Learning Identified Distinct Population Clusters Based on Symptoms of Oral Pain, Psychological Distress, and Sleep Problems

Objectives:

The aims of this study were to explore the use of unsupervised machine learning in clustering the population based on reports of oral pain, psychological distress, and sleep problems and to compare demographic and socio-economic characteristics as well as levels of functional domains (work, social, and leisure) between clusters.

Materials and Methods:

In this cross-sectional study, a total of 1613 participants from the National Health and Nutrition Examination Survey in 2017–2018 were analyzed. Five variables, including oral pain, depression, anxiety, sleep apnea, and excessive daytime sleepiness, were selected for cluster analysis using the k-medoids clustering algorithm. The distribution of categorical variables between clusters was assessed using χ² test. One-way analysis of variance and Kruskal–Wallis H test were used to compare numerical variables as appropriate.

Results:

Five distinct clusters were identified: healthy, norm, anxiety, apnea-comorbid, and pain-comorbid. The apnea-comorbid cluster had mean age of 59 years and higher proportion of men. The pain-comorbid cluster had mean age of 56 years and higher proportion of women. Whites constituted a majority of both comorbid clusters. The pain-comorbid cluster demonstrated the least percentage of individuals with college degree, the lowest income, and significant impairment in all functional domains.

Conclusion:

Through the use of unsupervised machine learning, the clusters with comorbidity of oral pain, psychological distress, and sleep problems have emerged. Major characteristics of the comorbid clusters included mean age below 60 years, White, and low levels of education and income. Functional domains were significantly impaired. The comorbid clusters thus call for public health intervention.

Case Report: Treatment of Oral Lichen Planus With a Focus on Psychological Methods

Oral lichen planus (OLP) is one of the most common chronic diseases; however, its etiology remains unknown. More and more studies have revealed that emotional instability is one of the risk factors for the onset and expansion of OLP, especially in patients suffering from depression, anxiety disorder, and acute stress. In this case report, we had a 32-year-old female OLP patient who had no obvious response to conventional OLP drugs. Then we switched to a combination of psychotropic drugs and psychotherapies. By regulating mood through drugs and psychological counseling, the patient's oral disease was alleviated. Our case shows that clinicians should consider the mental problems of OLP patients. It also emphasizes the importance of medications and psychological counseling in the treatment of somatic diseases.

Acupuncture in Temporomandibular Disorders Painful Symptomatology: An Evidence-Based Case Report

Temporomandibular dysfunction (TMD) is complex and multifactorial. Its etiology involves various factors, such as malocclusion, psychological patterns, parafunctional habits, and the temporomandibular joint anatomy. Symptoms include myofascial pain, joint clicking, mouth opening limitation, headaches, earaches, and neck pain, comprising one of the greatest causes of nondental pain. Acupuncture has been used to treat these conditions by acting locally both in muscle relaxation and pain management as well as reaching physical, mental, and emotional balance. The aim of this study is to present a brief literature review reporting the efficacy of acupuncture on TMDs and a case report in which the painful symptomatology of TMD was treated with a systemic protocol, based on scientific evidence and concepts of traditional Chinese medicine. Acupuncture may be a complementary treatment for TMD, and in this case report, it eliminated the patient's painful symptomatology.

[Characteristics of orofacial operant test for orofacial pain sensitivity caused by occlusal interference in rats]

OBJECTIVE

To compare the orofacial pain sensitivity with operant test and mechanical hyperalgesia with von Frey filaments of two orofacial pain models (EOI: experimental occlusal interference; pIONX: partial infraorbital nerve transection). To investigate the operant and evoked characteristics of EOI-rats.

METHODS

The orofacial operant behaviors were tested by Ugo Basile Orofacial Stimulation Test System. The mechanical thresholds of vibrissal pads were tested by von Frey filaments. Male Sprague-Dawley rats were randomly divided into eight groups: von Frey group: sham-EOI, EOI, sham-pIONX, pIONX (sham: sham-operated group); operant test group: sham-EOI, EOI, sham-pIONX, pIONX (sham: sham-operated group). The mechanical thresholds and orofacial operant behaviors were tested on pre-operation and post-operation days l, 3, 7, 10, 14 and 21.

RESULTS

In pIONX of von Frey group, the mechanical withdrawal threshold decreased from days 1 to 21 (P<0.05), peaking from days 7 to 10, and lasted until the end of the experiment. There was no significant difference between the bilateral sides. In pIONX of operant test group, the total contact time decreased from days 10 to 21 (P<0.05), peaking from days 10 to 14, and lasted until the end of the experiment. In EOI of von Frey group, the mechanical withdrawal threshold decreased from days 3 to 21 (P<0.05), peaking on day 7, and lasted until the end of the experiment. There was no significant difference between the bilateral sides. In EOI of operant test group, the total contact time decreased from days 1 to 21 (P<0.05), peaking from days 7 to 10, and lasting until the end of experiment.

CONCLUSION

Orofacial operant test is a stable method to evaluate orofacial pain behaviors, which could discriminate the feature of neuropathic and EOI orofacial pain. In these two animal models, both of the operant behaviors and the mechanical hyperalgesia exhibited different time courses. Orofacial operant test provides a novel method for evaluating the orofacial pain sensitivity and studying the orofacial pain mechanism thoroughly.

Temporomandibular disorders: improving outcomes using a multidisciplinary approach

Patients with temporomandibular disorders (TMD) can become very complex. This article aims to highlight the importance of the multimodal and multidisciplinary approach in this type of patients to improve clinical outcomes. At present we have innumerable techniques and tools to approach this type of patients from a biopsychosocial model where active and adaptive type treatments are fundamental. There are various health professions that have competence in the treatment of TMD, however, although in the most complex cases should be treated simultaneously, still too many patients receive unique treatments and only from one point of view. This review exposes the treatments available from a clinical-scientific perspective and also emphasizes the importance of working in specialized units with those professionals who have competencies on the different conditions that may occur.

Polarized Polychromatic Noncoherent Light (Bioptron Light) as Adjunctive Treatment in Chronic Oral Mucosal Pain: A Pilot Study

Objective: Aim of this study was to assess the efficacy of polarized polychromatic noncoherent light (Bioptron light) in the treatment of chronic oral mucosal pain (COMP). Patients and methods: Twenty-two patients affected by COMP were treated with standardized pharmacological protocols in association with Bioptron light (90 W; light wavelength = 480-3400 nm; degree of polarization = 95%; specific power density = 40 mW/cm²; energy density = 2.4 J/cm). The outcome measures were intensity of pain [measured by visual analog scale (VAS) score] and signs reduction (measured by Eisen score) recorded at baseline (t₀), after 4 weeks (t₁), and after 8 weeks (t₂). Signs and symptoms scores were compared with those of a cohort of comparable patients selected from institutional medical record files. Results: Patients in pharmacological treatment associated with Bioptron showed a significant VAS score decrease at t₁ and t₂ (t₀ = 6.9, t₁ = 3.9, t₂ = 1.8, p < 0.05), whereas the patients in exclusive pharmacological treatment showed a significant VAS score improvement only at t₂. Comparing the VAS score at t₁ and t₂ in the two groups, a significant improvement was recorded in patients undergoing Bioptron adjunctive treatment (t₁ = 3.9 vs. 5.9; p < 0.05 and t₂ = 1.8 vs. 3.6; p < 0.05). In both groups Eisen score improved at t₁ and t₂, but in the Bioptron-treated patients the improvement was statistically better at t₁ (1.9 vs. 0.8; p < 0.05) and at t₂ (2.7 vs. 1.4; p < 0.05). Conclusions: In COMP patients, Bioptron use associated with pharmacological treatment allows a better and faster signs and symptoms reduction when compared with the exclusive pharmacological treatment. Further controlled studies are needed to establish the relative and absolute effectiveness of Bioptron in COMP management.

Somatosensory profiles of patients with chronic myogenic temporomandibular disorders in relation to their painDETECT score

BACKGROUND

The purpose of this study was to characterize patients with chronic temporomandibular disorders (TMD) in terms of existing hyperalgesia against cold, heat and pressure.

METHODS

The extent of hyperalgesia for pressure and thermal sensation in TMD patients was determined by the use of the painDETECT questionnaire ("Is cold or heat in this area occasionally painful?" "Does slight pressure in this area, e.g., with a finger, trigger pain?") and experimental somatosensory testing against thermal and pressure stimuli (Quantitative Sensory Testing; QST). In addition, we explored psychological comorbidity among the chronic TMD patients (hospital anxiety and depression scale, HADS-D and coping strategies questionnaire, CSQ).

RESULTS

Nineteen patients with chronic TMD and 38 healthy subjects participated in the study. N = 12 patients had a painDETECT score ≤ 12, n = 3 patients had a painDETECT score of 13-18 and n = 4 patients had a painDETECT score ≥ 19. TMD patients with painDETECT scores ≥19 had moderately, strong or very strong enhancement of thermal and pressure pain perception, whereas patients with painDETECT scores 13-18 and ≤ 12 responded these questions with "never", "hardly noticed" or "slightly painful" (p < 0.05-0.01). With increasing painDETECT scores we found increased hyperalgesia for pressure (p < 0.01) and thermal stimuli (p < 0.05) in QST. The patients with a painDETECT score ≥ 19 showed increased signs of anxiety (p < 0.05), depression (p < 0.01), praying and hoping (p < 0.05).

CONCLUSION

The present study has shown that the PainDETECT questionnaire can be a helpful additional diagnostic tool. Together with QST, the PainDETECT questionnaire detected hyperalgesia for pressure and thermal sensation. Therefore the PainDETECT questionnaire is helpful to decide which TMD patients should undergo QST.