Predictability and Accuracy of the Short-Form Fonseca Anamnestic Index in Relation to the Modified Helkimo Index for the Diagnosis of Temporomandibular Disorders: A Cross-Sectional Study

Association Between Impacted Mandibular Third Molars and Temporomandibular Dysfunction: An Analysis Based on the Modified Helkimo Index

Background and Objectives: To evaluate the impact of impacted mandibular third molars on temporomandibular joint dysfunction using the Modified Helkimo Index, analyzing symptom severity across age groups. Materials and Methods: A cohort of 140 patients (70 with impacted molars, 70 without) was assessed using the Modified Helkimo Index. Patients were categorized by age (<25, 26-30, 31-35, >36 years), and statistical comparisons between Icdi (with impacted molars) and Icda (without impacted molars) were performed. Key parameters included mandibular movement limitation, joint noises, and pain scores. Data were analyzed using descriptive statistics and statistical tests, with significance set at p < 0.05. Results: TMJ dysfunction was significantly more prevalent in patients under 25 years (Icdi = 13.5, Icda = 11.0; p = 0.045), with a progressive decrease in severity in older groups (>36 years: Icdi = 3.5, Icda = 4.5; p = 0.072). Women exhibited a higher prevalence across all age categories (female-to-male ratio: <25 years = 2.7, >36 years = 3.0). The most frequent symptoms were mandibular movement restriction (42.5%), joint noises (38.2%), and pain (35.7%). Conclusions: Impacted third molars may significantly exacerbate TMJ dysfunctions, particularly in younger individuals and females, with a strong association between impacted molars and increased Modified Helkimo Index scores. Early extraction might mitigate symptoms, emphasizing the need for proactive clinical management.

Fonseca's Questionnaire Is a Useful Tool for Carrying Out the Initial Evaluation of Temporomandibular Disorders in Dental Students

Background: Temporomandibular disorders (TMDs) represent a prevalent multifactorial condition that impacts a significant portion of the global population. The objective of this study was to employ Fonseca's questionnaire for an initial assessment of TMDs. Methods: A cross-sectional study was conducted on a sample of 250 undergraduates from the Dental School of the University of Perugia, Italy. The chi-square test, with a significance level set at p < 0.05, was used to evaluate a statistically significant relationship between TMDs and several variables such as gender, age, employed/unemployed, and physically active or not. Results: The data obtained through the questionnaire indicated that a considerable percentage of students (78%) exhibited signs consistent with TMDs. The most frequently reported signs and symptoms included psychological stress (49.6%), dental clenching and grinding (34%), joint clicking (33.6%), frequent headaches (15.2%), and neck pain (23.2%). Notably, when considering moderate to severe symptoms of TMDs, females were more significantly affected than males. Furthermore, factors such as age, employment status, and physical activity did not appear to influence the prevalence of TMDs. Conclusions: The high prevalence of TMDs identified within this young population (university students), as measured by this questionnaire (albeit warranting validation through more rigorous methodologies) underscores the necessity for the implementation of new preventive strategies that specifically address this demographic.

Impact of Fear of COVID-19, Depression, Anxiety and Stress on Temporomandibular Disorders in Peruvian Dental Students in the Post-Pandemic Period: A Multivariable Regression Analysis

Background: Dentists, who frequently encounter potentially infected patients, have experienced significant changes worldwide due to the COVID-19 pandemic. The aim of this study was to evaluate the impact of the fear of COVID-19, depression, anxiety and stress on the presence of temporomandibular disorders (TMD), taking into account possible confounding variables, in Peruvian dental students during the post-pandemic period. Methods: This analytical cross-sectional study assessed 607 Peruvian dental students from two regions of Peru. The study utilized the Depression Anxiety Stress Scales-21 (DASS-21), the Fear of COVID-19 Scale (FCV-19S) and the Short Form of the Fonseca Anamnestic Index (SFAI). Possible confounding variables were sex, age, year of study, marital status, place of origin, area of residence, history of mental illness and living with people vulnerable to COVID-19. For the multivariable analysis, we utilized a Poisson regression model with an adjusted robust variance. The significance level was set at p < 0.05. Results: The rates of depression, anxiety, stress, fear of COVID-19 and temporomandibular disorders were 47.0%, 50.4%, 35.9%, 30.6% and 54.2%, respectively. Moreover, the study revealed that students with depression and anxiety were 38% and 75% more likely to have temporomandibular disorders compared to those without depression (APR = 1.38, 95% CI: 1.15-1.66) and anxiety (APR = 1.75, 95% CI: 1.44-2.13), respectively. Similarly, the likelihood of presenting temporomandibular disorders was 55% higher in women than in men (APR = 1.55, 95% CI: 1.28-1.87). Furthermore, we found that stress and fear of COVID-19 did not determine the development of temporomandibular disorders (p > 0.05). Conclusions: Almost half of the dental students experienced depression, anxiety and TMD in the post-pandemic period. In addition, depression and anxiety were influential factors in the occurrence of TMDs, with the female gender being a risk factor. However, factors such as fear of COVID-19, stress, age, year of study, marital status, place of origin, area of residence, history of mental illness or living with people vulnerable to COVID-19 were not significant.

Temporomandibular Disorder Prevalence and Its Association with Lifestyle Habits in Biomedicine Students-A Cross-Sectional Study

This study aimed to examine the frequency of temporomandibular disorder among biomedical students and relate its occurrence to lifestyle habits. A cross-sectional collection of data was carried out and included a total of 676 examinees through a questionnaire that had 73 questions: general information and lifestyle habits, the Fonseca Anamnestic index (FAI), the Jaw Function Limitation Scale (JFLS), and the Perceived Stress Questionnaire (PSQ). The statistical analyses between three or more groups were conducted using the one-way analysis of variance (ANOVA) with post hoc Scheffé test or Kruskal-Wallis test with post hoc Dunn's test for quantitative variables. The comparison of qualitative variables was conducted using the Chi-square test, while the correlations were determined using Spearman's correlation test. The analysis showed that a higher frequency of moderate or severe TMD was observed in subjects who were smokers (p < 0.001) compared to non-smokers. Subjects who consumed more coffee had moderate to severe TMD compared to subjects who consumed a lesser amount (p < 0.001). Furthermore, a positive correlation between the amount of stress and the severity of TMD was found. Our study implies that students of biomedical studies have an increased risk for TMD and that there is a link with their lifestyle habits.

Craniofacial disorders and headaches. A narrative review

OBJECTIVES

Craniofacial- and headache disorders are common co-morbid disorders. The aim of this review is to provide an overview of the research discussing craniofacial pain, especially temporomandibular disorders, and its relationship and impact on headaches, as well as suggestions for diagnostic assessment tools and physical therapeutic management strategies.

METHOD

A narrative structured review was performed. A search was conducted in MEDLINE using terms related to craniofacial pain and headaches. Additionally, papers regarding this topic were also extracted from the authors' personal libraries. Any study design (i.e., RCT, observational studies, systematic review, narrative review) that reported the concepts of interest was included, using Covidence. Results were narratively synthesized and described.

RESULTS

From an epidemiological perspective, craniofacial pain and headaches are strongly related and often co-existing. This may be due to the neuroanatomical connection with the trigeminal cervical complex, or due to shared predisposing factors such as age, gender, and psychosocial factors. Pain drawings, questionnaires, and physical tests can be used to determine the cause of pain, as well as other perpetuating factors in patients with headaches and craniofacial pain. The evidence supports different forms of exercise and a combination of hands-on and hands-off strategies aimed at both the craniofacial pain as well as the headache.

CONCLUSION

Headaches may be caused or aggravated by different disorders in the craniofacial region. Proper use of terminology and classification may help in understanding these complaints. Future research should look into the specific craniofacial areas and how headaches may arise from problems from those regions. (249 words).

Patient-Reported Quality of Life versus Physical Examination in Treating Temporomandibular Disorders with Intra-Articular Platelet-Rich Plasma Injections: An Open-Label Clinical Trial

Temporomandibular disorders, often manifested by articular pain, limitation of the mouth opening range, and unpleasant acoustic symptoms originating from inside the joint, have been associated with reduced quality of life. These symptoms, among others, can be treated with intra-articular injections of various substances, including repeated platelet-rich plasma (PRP) administration. The reported study was designed as an uncontrolled open-label clinical trial of consecutive cases. The participants completed a Fonseca questionnaire and evaluated acoustic symptoms, and spontaneous and provoked pain on VAS, and were subjected to a physical examination before, during, and after PRP therapy. The total Fonseca questionnaire results were statistically significantly (p < 0.05) correlated with 340 out of 348 (98%) other variables. The fully subjective assessment of the presence and intensity of acoustic symptoms coming from the temporomandibular joints was correlated with the physical examination results (0.45-0.63) and the maximum mouth opening with the maximum pain-free mouth opening (0.73-0.87). There were no correlations observed between the patient's and the physician's assessment of mandibular mobility. The Fonseca questionnaire seems to cover the entire spectrum of temporomandibular disorders, making it a balanced tool for assessing the quality of life in TMDs. However, it is worth considering extending the standard 3-point response scale to an 11-point one. The patient is somewhat able to perform a self-diagnosis with regard to the acoustic symptoms, but it is not possible for them to determine without measurement whether the range of mandibular mobility is appropriate..