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Zou Z, Fan W, Liu H, Liu Q, He H, Huang F. The roles of 5-HT in orofacial pain. Oral Dis 2024. [PMID: 38622872 DOI: 10.1111/odi.14960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/10/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES Acute and chronic orofacial pain are very common and remain a vexing health problem that has a negative effect on the quality of life. Serotonin (5-HydroxyTryptamine, 5-HT) is a kind of monoamine neurotransmitter that is involved in many physiological and pathological processes. However, its role in orofacial pain remains inconclusive. Therefore, this review aims to summarize the recent advances in understanding the effect exerted by 5-HT on the modulation of orofacial pain. SUBJECTS AND METHODS An extensive search was conducted on PubMed and Web of Science for pertinent studies focusing on the effects of 5-HT on the modulation of orofacial pain. RESULTS In this review, we concisely review how 5-HT mediates orofacial pain, how 5-HT is regulated and how we can translate these findings into clinical applications for the prevention and/or treatment of orofacial pain. CONCLUSIONS 5-HT plays a key role in the modulation of orofacial pain, implying that 5-HT modulators may serve as effective treatment for orofacial pain. However, further research on the precise mechanisms underlying the modulation of orofacial pain is still warranted.
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Affiliation(s)
- Zhishan Zou
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Wenguo Fan
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Haotian Liu
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Qing Liu
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong, SAR, China
| | - Hongwen He
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Fang Huang
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
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Penlington C, Palmer J, Martinez-Telchi D, Durham J, Valentine TL, Casals MJ, Oyarzo JF. Presentation and primary care management of temporomandibular disorders: A survey of primary care dentists in Santiago and Newcastle. J Oral Rehabil 2024; 51:241-246. [PMID: 37675953 DOI: 10.1111/joor.13587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 04/05/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Primary care dentists are often the first point of call for people with temporomandibular disorders (TMD) but it is not known how many people present to their dentist with TMD or the forms of first-line management that are routinely offered. OBJECTIVES To report rates of presentation of TMD and management offered in primary care by general dental practitioners in two similarly urban areas, Santiago, Chile and North-East England. METHODS An online survey was developed and distributed to primary care dentists in both regions. Descriptive data were presented to quantify presentation rates and forms of management offered. RESULTS Responses were received from 215 dentists practising in Chile and 46 in Newcastle. The majority reported seeing 1-2 patients weekly with TMD and less than one new presentation each week. Symptoms were most often treated conservatively and with self-management according to international guidelines. The form of self-management varied however and verbal instructions were often not backed up by written information. CONCLUSIONS This research provides a useful starting point in understanding the presentation to, and initial treatment of TMD in primary care internationally. Limitations included the method of recruitment and potentially non-representative samples. Further research could build on this work by including more countries and using more structured sampling methods. The work will be useful in understanding and planning early care pathways for people experiencing TMD.
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Affiliation(s)
- Chris Penlington
- Faculty of Medical Sciences, Newcastle University School of Dental Sciences, Framlington Place, Newcastle, UK
| | - Julia Palmer
- Faculty of Medical Sciences, Newcastle University School of Dental Sciences, Framlington Place, Newcastle, UK
| | - Daniela Martinez-Telchi
- Temporomandibular Disorders and Orofacial Pain Program, Faculty of Dentistry, Andrés Bello University, Santiago, Chile
| | - Justin Durham
- Faculty of Medical Sciences, Newcastle University School of Dental Sciences, Framlington Place, Newcastle, UK
| | - Tobar Lahosa Valentine
- Temporomandibular Disorders and Orofacial Pain Program, Faculty of Dentistry, Andrés Bello University, Santiago, Chile
| | - Maria Jose Casals
- Temporomandibular Disorders and Orofacial Pain Program, Faculty of Dentistry, Andrés Bello University, Santiago, Chile
| | - Juan Fernando Oyarzo
- Temporomandibular Disorders and Orofacial Pain Program, Faculty of Dentistry, Andrés Bello University, Santiago, Chile
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Rentsch M, Zumbrunn Wojczyńska A, Gallo LM, Colombo V. Prevalence of Temporomandibular Disorders Based on a Shortened Symptom Questionnaire of the Diagnostic Criteria for Temporomandibular Disorders and Its Screening Reliability for Children and Adolescents Aged 7-14 Years. J Clin Med 2023; 12:4109. [PMID: 37373802 DOI: 10.3390/jcm12124109] [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: 05/24/2023] [Revised: 06/08/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
The prevalence and adequacy of diagnostic approaches for temporomandibular disorders (TMD) in children and adolescents are still matters of debate. This study aimed to determine the prevalence of TMD and oral habits in children and adolescents aged 7-14 years and evaluate the consistency between self-reported TMD symptoms and clinical findings using a shortened Axis I of Diagnostic Criteria for TMD (DC/TMD). Children (aged 7-10) and adolescents (aged 11-14) of both sexes were invited to participate in this study (n = 1468). Descriptive statistics for all observed variables and Mann-Whitney U-Tests for the clinical examination were performed. A total of 239 subjects participated in the study (response rate 16.3%). The self-reported prevalence of TMD was found to be 18.8%. The most frequently reported oral habit was nail biting (37.7%), followed by clenching (32.2%) and grinding (25.5%). Self-reported headache increased with age, while clenching and grinding decreased. Based on the answers to the DC/TMD Symptom Questionnaire, subgroups of asymptomatic and symptomatic participants (n = 59; 24.7%) were established and randomly selected for the clinical examination (f = 30). The shortened Symptom Questionnaire showed a sensitivity of 0.556 and a specificity of 0.719 for pain during the clinical examination. Although the Symptom Questionnaire exhibited high specificity (0.933), its sensitivity (0.286) for temporomandibular joint sounds was low. Disc displacement with reduction (10.2%) and myalgia (6.8%) were the most common diagnoses. In conclusion, the self-reported prevalence of TMD in children and adolescents in this study was comparable to that reported in the literature for adults. However, the accuracy of the shortened Symptom Questionnaire as a screening tool for TMD-related pain and jaw sounds in children and adolescents was found to be low.
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Affiliation(s)
- Mathias Rentsch
- Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland
- Public-School Dental Services of the City of Zurich, 8002 Zurich, Switzerland
| | | | - Luigi M Gallo
- Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland
| | - Vera Colombo
- Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland
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Herpel C, Drusko A, Schwindling FS, Rammelsberg P, Tesarz J. Head and Neck Pain Drawing Area Correlates With Higher Psychosocial Burden But Not With Joint Dysfunction in Temporomandibular Disorders: A Cross-Sectional Study. THE JOURNAL OF PAIN 2023; 24:970-979. [PMID: 36682594 DOI: 10.1016/j.jpain.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/31/2022] [Accepted: 01/12/2023] [Indexed: 01/22/2023]
Abstract
Head and neck pain drawings have been introduced as part of the diagnostic gold standard for temporomandibular disorders (TMD). We aimed to quantify the spatial extent of pain in TMD patients and to analyze its association with further clinical findings. In a cross-sectional study, 90 patients (median age = 38 years; n women = 68) were diagnosed according to the DC/TMD. Intra-articular disorders were either confirmed or rejected by magnetic resonance imaging. The patients shaded all painful areas in a sketch of the left and right side of a face. A grid template was placed over the drawings and each region that contained markings was scored as painful. The correlation between the calculated area and the psychosocial variables (DC/TMD axis II) as well as the influence of pain lateralization were investigated using Spearman correlation, Mann-Whitney-U and chi-square tests. Pain affected all facial areas but concentrated on the regions of the temporomandibular joint and masseter origin. Thirty-nine percent reported purely unilateral pain, which was associated with structural TMJ findings in 77% of cases. Individuals with bilateral pain and those with greater spatial spread of pain had significantly higher scores on all axis II variables, except for functional limitation of the jaw. PERSPECTIVE: Head and neck pain drawings can contribute to a stratification of TMD patients. A greater extent of pain as well as pain bilateralization is associated with higher levels of emotional distress, pain chronicity and somatization, but not with functional impairment. Unilateral reporting of pain is associated with more intra-articular disorders.
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Affiliation(s)
- Christopher Herpel
- Department of Prosthodontics, Heidelberg University Hospital, Heidelberg, Germany.
| | - Armin Drusko
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Peter Rammelsberg
- Department of Prosthodontics, Heidelberg University Hospital, Heidelberg, Germany
| | - Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
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Gressler LE, Cowley T, Velezis M, Aryal S, Clare D, Kusiak JW, Cowley AW, Sedrakyan A, Marinac-Dabic D, Reardon M, Schmidt L, Feldman JG, DiFabio V, Bergman S, Simonyan V, Yesha Y, Vasiliu-Feltes I, Durham J, Steen AI, Woods P, Kapos FP, Loyo-Berrios N. Building the foundation for a modern patient-partnered infrastructure to study temporomandibular disorders. Front Digit Health 2023; 5:1132446. [PMID: 37255961 PMCID: PMC10226081 DOI: 10.3389/fdgth.2023.1132446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/25/2023] [Indexed: 06/01/2023] Open
Abstract
Background Conflicting reports from varying stakeholders related to prognosis and outcomes following placement of temporomandibular joint (TMJ) implants gave rise to the development of the TMJ Patient-Led RoundTable initiative. Following an assessment of the current availability of data, the RoundTable concluded that a strategically Coordinated Registry Network (CRN) is needed to collect and generate accessible data on temporomandibular disorder (TMD) and its care. The aim of this study was therefore to advance the clinical understanding, usage, and adoption of a core minimum dataset for TMD patients as the first foundational step toward building the CRN. Methods Candidate data elements were extracted from existing data sources and included in a Delphi survey administered to 92 participants. Data elements receiving less than 75% consensus were dropped. A purposive multi-stakeholder sub-group triangulated the items across patient and clinician-based experience to remove redundancies or duplicate items and reduce the response burden for both patients and clinicians. To reliably collect the identified data elements, the identified core minimum data elements were defined in the context of technical implementation within High-performance Integrated Virtual Environment (HIVE) web-application framework. HIVE was integrated with CHIOS™, an innovative permissioned blockchain platform, to strengthen the provenance of data captured in the registry and drive metadata to record all registry transaction and create a robust consent network. Results A total of 59 multi-stakeholder participants responded to the Delphi survey. The completion of the Delphi surveys followed by the application of the required group consensus threshold resulted in the selection of 397 data elements (254 for patient-generated data elements and 143 for clinician generated data elements). The infrastructure development and integration of HIVE and CHIOS™ was completed showing the maintenance of all data transaction information in blockchain, flexible recording of patient consent, data cataloging, and consent validation through smart contracts. Conclusion The identified data elements and development of the technological platform establishes a data infrastructure that facilitates the standardization and harmonization of data as well as perform high performance analytics needed to fully leverage the captured patient-generated data, clinical evidence, and other healthcare ecosystem data within the TMJ/TMD-CRN.
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Affiliation(s)
- Laura Elisabeth Gressler
- Center for Devices and Radiological Health (CDRH), Food and Drug Administration, Silver Spring, MD, United States
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | | | - Marti Velezis
- Center for Devices and Radiological Health (CDRH), Food and Drug Administration, Silver Spring, MD, United States
| | - Suvekshya Aryal
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | | | | | - Allen W. Cowley
- Department of Physiology, Medical College of Wisconsin, Madison, WI, United States
| | - Art Sedrakyan
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Danica Marinac-Dabic
- Center for Devices and Radiological Health (CDRH), Food and Drug Administration, Silver Spring, MD, United States
| | | | | | | | - Vincent DiFabio
- Oral and Maxillofacial Surgery, University of Maryland Medical System, Baltimore, MD, United States
| | - Suzie Bergman
- Dentistry on Officers Row, Vancouver, WA, United States
| | | | - Yelena Yesha
- Department of Computer Science, University of Miami, Miami, FL, United States
| | | | - Justin Durham
- School of Dental Sciences, NewcastleUnited Kingdom
- Newcastle-Upon Tyne Hospitals’ NHS Foundation Trust, Newcastle, United Kingdom
| | - Andrew I. Steen
- Center for Devices and Radiological Health (CDRH), Food and Drug Administration, Silver Spring, MD, United States
| | - Phillip Woods
- Center for Devices and Radiological Health (CDRH), Food and Drug Administration, Silver Spring, MD, United States
| | - Flavia P. Kapos
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Nilsa Loyo-Berrios
- Center for Devices and Radiological Health (CDRH), Food and Drug Administration, Silver Spring, MD, United States
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Ou-Yang ZY, Feng Y, Xie DD, Yang YF, Chen Y, Chen NX, Su XL, Kuang BF, Zhao J, Zhao YQ, Feng YZ, Guo Y. Development, validation and psychometric evaluation of the Chinese version of the biopsychosocial impact scale in orofacial pain patients. Front Psychol 2023; 14:1101383. [PMID: 36960011 PMCID: PMC10029920 DOI: 10.3389/fpsyg.2023.1101383] [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: 11/17/2022] [Accepted: 02/06/2023] [Indexed: 03/09/2023] Open
Abstract
Background The objective of this study was to develop the Chinese version of the biopsychosocial impact scale (BPIm-S) to assess functional limitation and psychosocial distress in orofacial pain (OFP) patients in mainland China, and investigate the factor structure, reliability and validity, measurement invariance, as well as scores differences across genders, age and educational status among OFP patients. Methods The BPIm-S was developed and evaluated in four stages: (1) concept selection and item generation; (2) a pilot study assessing face and content validity; (3) the factors structure, reliability, convergent validity, and measurement invariance; and (4) concurrent validity and clinical responsiveness. Exploratory (EFA) and confirmatory factor analyses (CFA) were performed on data gathered from 406 OFP patients to assess construct validity. Composite Reliability (CR) and the Average Variance Extracted (AVE) were used to assess internal convergent validity. CR, internal consistency, and split-half reliability were also performed to determine the reliability. Multigroup CFA (MGCFA) was used to assess measurement invariance across genders, age and educational status. Mann-Whitney test compared scores across different genders, age and educational status. Participants completed the BPIm-S, visual analog scale (VAS), brief pain inventory facial (BPI-F), General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9), and spearman's correlation coefficient was used to evaluate the concurrent validity and item-total correlations. A total of 12 patients with OFP completed the BPIm-S twice to test clinical responsiveness. To conduct the CFA and measurement invariance analysis, Mplus 8.4 was used. IBM SPSS Statistics 21 software and SPSSAU, a web-based data science algorithm platform tool, were used for all additional studies. Results For the preliminary version, 17 items were chosen. A total of four items were removed following the pilot research. The remaining 13 items of the BPIm-S comprised an overall summary scale. Excellent reliability (Item-to-total correlations ranged from 0.763 to 0.912) and strong internal consistency (Cronbach's α = 0.970, functional limitation, 0.962, and psychosocial distress, 0.977) were discovered. CFA also validated the structural validity of the 13-item scale. EFA was performed and a two-factor structure was investigated. In addition, MGCFA corroborated the measurement invariance of the BPIm-S across gender, age, and educational status. Patients over the age of 30, those with a medium level of education, and those with a low level of education showed substantially greater levels of functional limitation and psychological distress (Wilcoxon test, p < 0.001). Both concurrent validity and clinical responsiveness were assessed to be of good quality. Conclusion The BPIm-S demonstrated good psychometric qualities and is a reliable tool that can now be used by clinicians to evaluate functional limitation and psychosocial distress among OFP patient.
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Affiliation(s)
- Ze-Yue Ou-Yang
- Department of Stomatology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yao Feng
- Department of Stomatology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Dong-Dong Xie
- The Medical Psychological Institute, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yi-Fan Yang
- Department of Stomatology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yun Chen
- Department of Stomatology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ning-Xin Chen
- Department of Stomatology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiao-Lin Su
- Department of Stomatology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Bi-Fen Kuang
- Department of Stomatology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jie Zhao
- Department of Stomatology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ya-Qiong Zhao
- Department of Stomatology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yun-Zhi Feng
- Department of Stomatology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yue Guo
- Department of Stomatology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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Is Surgical Repair With Nerve Allograft More Cost-Effective Than Non-Surgical Management for Persistent Trigeminal Neuropathy? Initial Assessment With Markov Model. J Oral Maxillofac Surg 2023:S0278-2391(23)00176-3. [PMID: 36893794 DOI: 10.1016/j.joms.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/07/2023] [Accepted: 02/12/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE Persistent trigeminal neuropathy (PTN) is associated with high rates of depression, loss of work, and decreased quality of life (QoL). Nerve allograft repair can achieve functional sensory recovery in a predictable manner; however, it bears significant upfront costs. In patients suffering from PTN, is surgical repair with allogeneic nerve graft, when compared to non-surgical therapy, a more cost-effective treatment option? MATERIALS AND METHODS A Markov model was constructed with TreeAge Pro Healthcare 2022 (TreeAge Software, Massachusetts) to estimate the direct and indirect costs for PTN. The model ran for 40 years with 1-year-cycles on a 40-year-old model patient with persistent inferior alveolar or lingual nerve injury (S0 to S2+) at 3 months without signs of improvement, and without dysesthesia or neuropathic pain (NPP). The 2 treatment arms were surgery with nerve allograft versus non-surgical management. There were 3 disease states, functional sensory recovery (S3 to S4), hypoesthesia/anesthesia (S0 to S2+), and NPP. Direct surgical costs were calculated using the 2022 Medicare Physician Fee Schedule and verified with standard institutional billing practices. Non-surgical treatment direct costs (follow-up, specialist referral, medications, imaging) and indirect costs (QoL, loss of employment) were determined from historical data and the literature. Direct surgical costs for allograft repair were $13,291. State-specific direct costs for hypoesthesia/anesthesia were $2,127.84 per year, and $3,168.24 for NPP per year. State-specific indirect costs included decreased labor force participation, absenteeism, and decreased QoL. RESULTS Surgical treatment with nerve allograft was more effective and had a lower long-term cost. The incremental cost-effectiveness ratio was -10,751.94, indicating surgical treatment should be utilized based on efficiency and cost. With a willingness-to-pay threshold of $50,000, the net monetary benefits of surgical treatment are $1,158,339 compared to $830,654 for non-surgical treatment. With a standard threshold incremental cost-effectiveness ratio of 50,000, the sensitivity analysis shows that surgical treatment would remain the preferred choice based on efficiency even if surgical costs were doubled. CONCLUSION Despite high initial costs of surgical treatment with nerve allograft for PTN, surgical intervention with nerve allograft is a more cost-effective treatment option when compared to non-surgical therapy.
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Currie C, Palmer J, Stone S, Brocklehurst P, Aggarwal V, Dorman P, Pearce M, Durham J. Persistent Orofacial Pain Attendances at General Medical Practitioners. J Dent Res 2023; 102:164-169. [PMID: 36314491 PMCID: PMC9896262 DOI: 10.1177/00220345221128226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Patients with persistent orofacial pain (POFP) can go through complex care pathways to receive a diagnosis and management, which can negatively affect their pain. This study aimed to describe 44-y trends in attendances at Welsh medical practices for POFP and establish the number of attendances per patient and referrals associated with orofacial pain and factors that may predict whether a patient is referred. A retrospective observational study was completed using the nationwide Secure Anonymised Information Linkage Databank of visits to general medical practices in Wales (UK). Data were extracted using diagnostic codes ("Read codes"). Orofacial and migraine Read codes were extracted between 1974 and 2017. Data were analyzed using descriptive statistics and univariate and multivariable logistic regression. Over the 44-y period, there were 468,827 POFP and migraine diagnostic codes, accounting for 468,137 patient attendances, or 301,832 patients. The overall attendance rate was 4.22 attendances per 1,000 patient-years (95% confidence interval [CI], 4.21-4.23). The attendance rate increased over the study period. Almost one-third of patients (n = 92,192, 30.54%) attended more than once over the study period, and 15.83% attended more than once within a 12-mo period. There were 20,103 referral codes that were associated with 8,183 patients, with over half these patients being referred more than once. Odds of receiving a referral were highest in females (odds ratio [OR], 1.23; 95% CI, 1.17-1.29), in those living in rural locations (OR, 1.17; 95% CI, 1.12-1.22), and in the least deprived quintile (OR, 1.39; 95% CI, 1.29-1.48). Odds also increased with increasing age (OR, 1.03; 95% CI, 1.03-1.03). The increasing attendance may be explained by the increasing incidence of POFP within the population. These patients can attend on a repeated basis, and very few are referred, but when they are, this may occur multiple times; therefore, current care pathways could be improved.
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Affiliation(s)
- C.C. Currie
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK,Newcastle Upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK,C.C. Currie, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4BW, UK.
| | - J. Palmer
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK,Newcastle Upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - S.J. Stone
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK,Newcastle Upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | - P.J. Dorman
- Newcastle Upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - M.S. Pearce
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - J. Durham
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK,Newcastle Upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
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9
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Hietaharju M, Näpänkangas R, Ahtonen P, Kuoppala R, Sipilä K. The role of pain-related disability on treatment outcome and psychosocial symptoms in patients with temporomandibular disorders - a pilot study. Acta Odontol Scand 2023:1-6. [PMID: 36592379 DOI: 10.1080/00016357.2022.2162575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of the pilot study was to investigate the association of pain-related disability with the outcome of conservative treatment of temporomandibular disorders (TMD) and with depressive and non-specific physical symptoms among TMD pain patients utilizing Graded Chronic Pain Scale 1.0 (GCPS1.0) as a screening instrument. MATERIAL AND METHODS The study included 80 adult patients who were referred to the Oral and Maxillofacial Department, Oulu University Hospital, Finland, due to TMD pain. At baseline, pain-related disability was assessed by using the GCPS1.0 according to the Research Diagnostic Criteria for TMD (RDC/TMD), and the patients were categorized into three TMD subtypes, 1-3. Patients were given conservative TMD treatment. At follow-up visits (1, 3, 6, and 12 months), patients evaluated the pain intensity on an NRS and described the treatment outcome and the severity of the TMD symptoms on a numerical scale. RESULTS AND CONCLUSIONS Patients with TMD subtype 3 (moderate/severe disability) had the highest NRS scores and described their symptoms as most severe at each time point, statistically significantly so at 1-month and 6-month follow-up (p < .05). The highest proportion of depressive symptoms was found in TMD subtype 3 (p < .05). The current pilot study showed that moderate/severe TMD-related disability, based on the GCPS 1.0 as a screening tool, may be linked with poor treatment outcome and depressive symptoms. Studies with larger samples are needed to confirm the results.
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Affiliation(s)
- Maria Hietaharju
- Research Unit of Oral Health Sciences Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Ritva Näpänkangas
- Research Unit of Oral Health Sciences Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Pinja Ahtonen
- Research Unit of Oral Health Sciences Faculty of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ritva Kuoppala
- Research Unit of Oral Health Sciences Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Kirsi Sipilä
- Research Unit of Oral Health Sciences Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
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10
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Grunberg VA, Reichman M, Lovette BC, Vranceanu AM, Greenberg J. "No One Truly Understands What We Go through and How to Treat It": Lived Experiences with Medical Providers among Patients with Orofacial Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10396. [PMID: 36012029 PMCID: PMC9408497 DOI: 10.3390/ijerph191610396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
UNLABELLED Orofacial pain affects 10-15% of adults, yet treatments are limited. The gaps in care are frustrating for both patients and providers and can negatively impact patient-provider interactions. These interactions are key because they impact patient-reported outcomes and satisfaction with care. PURPOSE Our study aims to understand the nuanced experiences with medical providers among patients with orofacial pain. METHODS In a cross-sectional survey, 260 patients provided written responses describing their experiences with medical providers. Using an inductive-deductive approach to thematic analysis, we identified themes and subthemes and organized them into four domains based on the Patient-Centered Model of Communication. RESULTS Patients reported feeling hopeless about treatment options, frustrated with lack of provider knowledge, disappointed in ineffective care, and stigmatized and dismissed by providers. Patients also said they learned to advocate for their health, were grateful for effective care, and felt lucky when providers listened and showed compassion. Patients identified key barriers that interfere with care (e.g., insurance, transportation, limited providers, lack of team coordination). CONCLUSIONS Findings can help inform training programs and psychoeducation that target patient-provider communication to improve patient-reported outcomes, the quality of care delivered, and health care utilization and costs.
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Affiliation(s)
- Victoria A. Grunberg
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA
- Division of Newborn Medicine, MassGeneral for Children, Boston, MA 02114, USA
| | - Mira Reichman
- Department of Psychology, University of Washington, Seattle, WA 98195, USA
| | - Brenda C. Lovette
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA 02129, USA
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA
| | - Jonathan Greenberg
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA
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11
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Durham J, Greene C, Ohrbach R. A commentary on Temporomandibular disorders: priorities for research and care - bridging from the US to the UK. Br Dent J 2022; 233:232-233. [PMID: 35962105 PMCID: PMC9372950 DOI: 10.1038/s41415-022-4501-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/28/2021] [Indexed: 12/05/2022]
Abstract
In January 2019, the United States National Academy of Medicine initiated a comprehensive study of the status of current knowledge and clinical practices associated with temporomandibular disorders (TMDs). The National Academy of Sciences, which includes the National Academy of Medicine, was chartered by the US Government in the late 1800s as a non-profit institution working outside of government in order to provide unbiased, objective opinions on matters including healthcare. In this brief paper, we will discuss the open access 2020 report Temporomandibular disorders: priorities for research and care, available online. While the main focus of this report was the situation of TMDs in the US, the evidence base, authorship, expertise and literature scope was international and the findings therefore are at least in part generalisable to and important for the UK. The authors of this commentary were directly involved in the National Academy process, with RO a panel member, JD a consultant and CG one of 15 reviewers of the draft report. There was a wide variety of clinical and research fields involved in gathering the evidence and constructing the report. In addition, there was extensive involvement from affected patients with TMDs and their families, which is critical because their perspective is typically omitted in textbooks and professional consensus meetings. The report on TMDs from the US National Academy of Medicine is a seminal book describing the problems that individuals with TMDs confront for diagnosis and treatment. The situation in the UK, according to UK colleagues, is similar with regards to challenges. The UK has implemented a number of initiatives to provide better diagnosis and treatment; identifying these excellent efforts in relation to the disease challenges is valuable.
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Affiliation(s)
- Justin Durham
- Head and Professor/Honorary Consultant Oral Surgeon, School of Dental Sciences, Newcastle University, UK
| | - Charles Greene
- Clinical Professor Emeritus, Department of Orthodontics, UIC College of Dentistry, Chicago, Illinois, USA
| | - Richard Ohrbach
- Professor, Oral Diagnostic Sciences, University at Buffalo School of Dental Medicine, Buffalo, New York, USA.
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12
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Lobbezoo F, Aarab G, Kapos FP, Dayo AF, Huang Z, Koutris M, Peres MA, Thymi M, Häggman-Henrikson B. The Global Need for Easy and Valid Assessment Tools for Orofacial Pain. J Dent Res 2022; 101:1549-1553. [PMID: 35883282 DOI: 10.1177/00220345221110443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The World Health Organization recently adopted a historic resolution (WHA74.5) on the urgent need for global oral health improvement. This resolution is particularly relevant in the perspective of the high prevalence of untreated oral diseases. However, one important aspect has been mentioned only in passing, namely that poor oral health often leads to orofacial pain, which is the most common reason for emergency dental visits worldwide. Therefore, an evidence-based decision-making process on oral health should include data related to orofacial pain complaints. To that end, the availability of reliable and valid assessment tools of orofacial pain and related treatment outcomes is essential. INfORM (International Network for Orofacial Pain and Related Disorders Methodology) of the International Association for Dental Research has been one of the driving forces behind the development and implementation of comprehensive sets of tools for such assessments. However, as a prerequisite for the desired global implementation, reliable and valid tools that are also brief, easy to translate, and culturally adaptable need to be further developed and tested. Some of the groundwork to facilitate this process has already been carried out. In addition, a working group within INfORM has developed a short clinical assessment tool for orofacial pain diagnostics that is near completion and will soon be ready for dissemination. Ultimately, reliable and valid orofacial pain assessment is a necessary step toward the development and implementation of appropriate "best buy" interventions that address this major driver of need for oral health care worldwide.
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Affiliation(s)
- F Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - G Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - F P Kapos
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - A F Dayo
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Z Huang
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - M Koutris
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - M A Peres
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore.,Oral Health ACP, Health Services and Systems Research Programme, Duke-NUS Medical School, Singapore
| | - M Thymi
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - B Häggman-Henrikson
- Department of Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden
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13
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Healthcare costs of post-traumatic trigeminal neuropathy in Belgium - A retrospective analysis. J Craniomaxillofac Surg 2022; 50:627-636. [PMID: 35840459 DOI: 10.1016/j.jcms.2022.07.002] [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: 05/18/2022] [Revised: 06/26/2022] [Accepted: 07/01/2022] [Indexed: 11/21/2022] Open
Abstract
The present aim was to estimate direct health care costs of patients suffering from post-traumatic trigeminal neuropathy (PTTN) and to compare the use of health care services, medications, and costs between temporary and persistent (>3 months) PTTN cohorts. A pre-existing clinical dataset of PTTN patients visiting a tertiary orofacial pain clinic in Belgium was utilized, including symptoms and quality of life measurements. Cost and resource utilization data were obtained by Belgium's largest health insurance provider for a period of 5 years after onset. Data from 158 patients was analyzed. The average cost per patient in the first year after injury was €2353 (IQR 1426-4499) with an out-of-pocket expense of 25% of the total cost. Hospitalization and technical interventions were the main drivers of cumulative costs, followed by consultation costs. For each cost category, expenditure was significantly higher in patients with persistent PTTN than in those with temporary PTTN (median 5-year total costs in persistent PTTN patients yielded €8866 (IQR 4368-18191) versus €4432 (IQR 2156-9032) in temporary PTTN, p <0.001) PTTN patients received repeated and frequent head and neck imaging (mean number of imaging investigations per patient was 10 ± 12). Medication consumption was high, with an unwarranted higher use of opioids and antibiotics in persistent PTTN patients. Within the limitations of this study, it seems there is a need for informing patients in detail on the inherent risks of nerve damage during dental and oromaxillofacial procedures. Every surgery should be preceded by a risk-benefit assessment in order to avoid unnecessary nerve damage.
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14
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Lövgren A, Visscher CM, Lobbezoo F, Yekkalam N, Vallin S, Wänman A, Häggman-Henrikson B. The association between myofascial orofacial pain with and without referral and widespread pain. Acta Odontol Scand 2022; 80:481-486. [PMID: 35776512 DOI: 10.1080/00016357.2022.2036363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Pain referral on palpation has been suggested to be a clinical sign of central sensitization potentially associated with widespread pain conditions. Our aim was to evaluate if myofascial pain with referral is a better predictor for widespread pain when compared to no pain or local myofascial pain. MATERIALS AND METHODS Individuals at the Public Dental services in Västerbotten, Sweden, were randomly invited based on their answers to three screening questions for temporomandibular disorders (TMD). In total, 300 individuals (202 women, 20-69 yrs) were recruited, and examined according to the Diagnostic Criteria for TMD (DC/TMD) after completion of a body pain drawing. Widespread pain was considered present when seven or more pain sites were reported on the widespread pain index. A binary logistic regression model, adjusted for the effect of age and gender were used to evaluate the association between myofascial orofacial pain and widespread pain. RESULTS Widespread pain was reported by 31.3% of the study sample. There was a 57.3% overlap with myofascial pain. Widespread pain was associated to myofascial orofacial pain with and myofascial orofacial pain (OR 4.83 95% CI 2.62-9.05 and OR 11.62 95% CI 5.18-27.88, respectively). CONCLUSION These findings reinforce the existing knowledge on the overlap between painful TMD and other chronic pain conditions.
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Affiliation(s)
- Anna Lövgren
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, University of Umeå, Umeå, Sweden
| | - Corine M Visscher
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, the Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, the Netherlands
| | - Negin Yekkalam
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, University of Umeå, Umeå, Sweden
| | - Simon Vallin
- Northern Register Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anders Wänman
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, University of Umeå, Umeå, Sweden
| | - Birgitta Häggman-Henrikson
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, University of Umeå, Umeå, Sweden.,Department of Orofacial Pain and Jaw function, Faculty of Odontology, Malmö University, Malmö, Sweden
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15
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Lovette BC, Bannon SM, Spyropoulos DC, Vranceanu AM, Greenberg J. “I Still Suffer Every Second of Every Day”: A Qualitative Analysis of the Challenges of Living with Chronic Orofacial Pain. J Pain Res 2022; 15:2139-2148. [PMID: 35935679 PMCID: PMC9346146 DOI: 10.2147/jpr.s372469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/17/2022] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Brenda C Lovette
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah M Bannon
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | | | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jonathan Greenberg
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Correspondence: Jonathan Greenberg, Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA, Email
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16
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Botros J, Gornitsky M, Samim F, der Khatchadourian Z, Velly AM. Back and neck pain: A comparison between acute and chronic pain-related Temporomandibular Disorders. Can J Pain 2022; 6:112-120. [PMID: 35799959 PMCID: PMC9255212 DOI: 10.1080/24740527.2022.2067032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Temporomandibular disorders (TMDs) are common and cause persistent pain. Comorbidities are associated with TMDs and can affect the effectiveness of their treatments. The literature is lacking enough evidence on the difference between acute and chronic pain, particularly in TMDs. Investigating this difference could highlight potential risk factors for the transition from acute to chronic pain–related TMDs. Aim To compare the likelihood of back and neck pain (BP, NP) between acute and chronic pain–related TMDs (AP-TMD, CP-TMD) as defined by pain duration and pain-related disability. Methods Participants with AP-TMDs (≤3 months) and CP-TMDs (>3 months) were recruited according to the diagnostic criteria and research diagnostic criteria of TMD. BP and NP were assessed using a self-reported checklist. CP-TMDs defined by disability (chronic disability) and depression and anxiety symptoms were assessed using validated instruments. Logistic regression analyses were employed. Results This study enrolled 487 adults with AP-TMD (n = 118) and CP-TMD (n = 369). Relative to AP-TMD, participants with CP-TMD had twice the odds of reporting NP (odds ratio [OR] = 2.17, 95% CI 1.27–3.71) but not BP (OR = 0.96, 95% CI 0.57–1.64). Participants with chronic disability were twice as likely to report NP (OR = 1.95, 95% CI 1.20–3.17) but not BP (OR = 1.13, 95% CI 0.69–1.82) compared to those without. All analyses were adjusted for age, sex, and anxiety and depression symptoms. Conclusions Within the limitations of this study, results suggest that central dysregulation or trigeminocervical convergence mechanisms are implicated in the process of pain-related TMD chronification and highlight the relevance of considering disability when defining CP-TMDs.
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Affiliation(s)
- Jack Botros
- Department of Dentistry, Jewish General Hospital, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - Mervyn Gornitsky
- Department of Dentistry, Jewish General Hospital, Montreal, QC, Canada
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - Firoozeh Samim
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
- Department of Dentistry, Montreal General Hospital, Montreal, QC, Canada
| | - Zovinar der Khatchadourian
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
- Alan Edwards Pain Management Unit, Montreal General Hospital, Montreal Quebec
| | - Ana Miriam Velly
- Department of Dentistry, Jewish General Hospital, Montreal, QC, Canada
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Alan Edwards Pain Management Unit, Montreal General Hospital, Montreal Quebec
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17
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Cintra DN, de Oliveira SAS, Lorenzo IA, Costa DMF, Bonjardim LR, Costa YM. The detrimental impact of temporomandibular disorders (mis)beliefs and possible strategies to overcome. J Oral Rehabil 2022; 49:746-753. [PMID: 35388515 DOI: 10.1111/joor.13330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/25/2022] [Accepted: 03/30/2022] [Indexed: 11/27/2022]
Abstract
AIM This topical review presents common patients' misbeliefs about temporomandibular disorders (TMD) and discusses their possible impact on the diagnosis, treatment and prognosis. We also discussed the possible influence of the beliefs and behaviors of health care providers on the beliefs of patients with TMD and present possible strategies to overcome the negative impacts of such misbeliefs. METHODS This topical review was based on a non-systematic search for studies about the beliefs of patients and professionals about TMD in PubMed and Embase. RESULTS Patients' beliefs can negatively impact the diagnosis, treatment, and prognosis of TMD. These beliefs can be modulated by several factors such as culture, psychosocial aspects, gender, level of knowledge, and previous experiences. Moreover, primary health care professionals, including dentists, may lack sufficient experience and skills regarding TMD diagnosis and treatment. Misbeliefs of the health care professionals can be based on outdated evidence that is not supported by rigorous methodological investigations. Education and dissemination of knowledge to patients and the general population are effective for prevention, promotion of health and disruption of the cycle of misinformation and dissemination of misbeliefs. CONCLUSION The lack of basic information about TMD and the dissemination of mistaken and outdated concepts may delay the diagnosis, hinder the treatment, and consequently increase the risk of worsening the condition. Education is key to overcome TMD misbeliefs.
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Affiliation(s)
- Débora N Cintra
- Department of Biosciences, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Sara A S de Oliveira
- Department of Biosciences, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Isadora A Lorenzo
- Department of Biosciences, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Dyna Mara F Costa
- Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Leonardo R Bonjardim
- epartment of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Yuri M Costa
- Department of Biosciences, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
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18
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Velly AM, Anderson GC, Look JO, Riley JL, Rindal DB, Johnson K, Wang Q, Fricton J, Huff K, Ohrbach R, Gilbert GH, Schiffman E. Management of painful temporomandibular disorders: Methods and overview of The National Dental Practice-Based Research Network prospective cohort study. J Am Dent Assoc 2022; 153:144-157. [PMID: 34973705 PMCID: PMC8799528 DOI: 10.1016/j.adaj.2021.07.027] [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: 12/16/2020] [Revised: 07/14/2021] [Accepted: 07/26/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients often seek consultation with dentists for temporomandibular disorders (TMDs). The objectives of this article were to describe the methods of a large prospective cohort study of painful TMD management, practitioners' and patients' characteristics, and practitioners' initial treatment recommendations conducted by The National Dental Practice-Based Research Network (the "network"). METHODS Participating dentists recruited into this study treated patients seeking treatment for painful TMDs. The authors developed self-report instruments based on well-accepted instruments. The authors collected demographics, biopsychosocial characteristics, TMD symptoms, diagnoses, treatments, treatment adherence, and painful TMDs and jaw function outcomes through 6 months. RESULTS Participating dentists were predominately White (76.8%) and male (62.2%), had a mean age of 52 years, and were general practitioners (73.5%) with 23.8% having completed an orofacial pain residency. Of the 1,901 patients with painful TMDs recruited, the predominant demographics were White (84.3%) and female (83.3%). Patients' mean age was 44 years, 88.8% self-reported good to excellent health, and 85.9% had education beyond high school. Eighty-two percent had pain or stiffness of the jaw on awakening, and 40.3% had low-intensity pain. The most frequent diagnoses were myalgia (72.4%) and headache attributed to TMDs (51.0%). Self-care instruction (89.4%), intraoral appliances (75.4%), and medications (57.6%) were recommended frequently. CONCLUSIONS The characteristics of this TMD cohort include those typical of US patients with painful TMDs. Network practitioners typically managed TMDs using conservative treatments. PRACTICAL IMPLICATIONS This study provides credible data regarding painful TMDs and TMD management provided by network practitioners across the United States. Knowledge acquired of treatment recommendations and patient reports may support future research and improve dental school curricula.
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Affiliation(s)
- Ana Miriam Velly
- McGill University, Faculty of Dental Medicine and Oral Health Sciences, Research Department of Dentistry SMBD - Jewish General Hospital; Network for Canadian Oral Health Research (NCOHR); Orofacial Pain Working Group, NCOHR
| | - Gary C. Anderson
- Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN
| | - John O. Look
- Division of TMD and Orofacial Pain, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN
| | - Joseph L. Riley
- College of Dentistry, University of Florida; Pain Clinical Research Unit, University of Florida Clinical and Translational Science Institute, Gainesville, FL
| | | | | | - Qi Wang
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | - James Fricton
- School of Dentistry, University of Minnesota, Minneapolis, MN; HealthPartners Institute, Bloomington, MN; Minnesota Head and Neck Pain Clinic, Minneapolis, MN
| | | | - Richard Ohrbach
- Department of Oral and Diagnostic Sciences, School of Dental Medicine, State University of New York, University at Buffalo, Buffalo, NY
| | - Gregg H. Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
| | - Eric Schiffman
- Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN
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Temporomandibular disorders cases with high-impact pain are more likely to experience short-term pain fluctuations. Sci Rep 2022; 12:1657. [PMID: 35102207 PMCID: PMC8803984 DOI: 10.1038/s41598-022-05598-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/11/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractTemporomandibular disorders (TMD) patients can present clinically significant jaw pain fluctuations which can be debilitating and lead to poor global health. The Graded Chronic Pain Scale evaluates pain-related disability and its dichotomous grading (high/low impact pain) can determine patient care pathways and in general high-impact pain patients have worse treatment outcomes. Individuals with low-impact TMD pain are thought to have better psychosocial functioning, more favorable disease course, and better ability to control pain, while individuals with high-impact pain can present with higher levels of physical and psychological symptoms. Thereby, there is reason to believe that individuals with low- and high-impact TMD pain could experience different pain trajectories over time. Our primary objective was to determine if short-term jaw pain fluctuations serve as a clinical marker for the impact status of TMD pain. To this end, we estimated the association between high/low impact pain status and jaw pain fluctuations over three visits (≤ 21-day-period) in 30 TMD cases. Secondarily, we measured the association between jaw pain intensity and pressure pain thresholds (PPT) over the face and hand, the latter measurements compared to matched pain-free controls (n = 17). Jaw pain fluctuations were more frequent among high-impact pain cases (n = 15) than low-impact pain cases (n = 15) (OR 5.5; 95% CI 1.2, 26.4; p value = 0.033). Jaw pain ratings were not associated with PPT ratings (p value > 0.220), suggesting different mechanisms for clinical versus experimental pain. Results from this proof-of-concept study suggest that targeted treatments to reduce short-term pain fluctuations in high-impact TMD pain is a potential strategy to achieve improved patient perception of clinical pain management outcomes.
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Durham J, Breckons M, Vale L, Shen J. DEEP Study: Modeling Outcomes and Costs of Persistent Orofacial Pain. JDR Clin Trans Res 2021; 8:23800844211063870. [PMID: 34915751 PMCID: PMC9773005 DOI: 10.1177/23800844211063870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
KNOWLEDGE OF TRANSFER STATEMENT Despite a substantial number of consultations, individuals experiencing the care pathways in this study continued to have far from perfect health over their life course. The modeling suggests they would only experience 18 y in "perfect health." There is considerable scope to improve current care/outcomes and patient experience.
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Affiliation(s)
- J. Durham
- School of Dental Sciences, Newcastle University, Newcastle, UK
- Health Economics Group, Newcastle University Population Health Sciences Institute, Newcastle, UK
- Newcastle Dental Hospital, Newcastle-Upon-Tyne Hospitals’ NHS Foundation Trust, Newcastle, UK
| | - M. Breckons
- Health Economics Group, Newcastle University Population Health Sciences Institute, Newcastle, UK
| | - L. Vale
- Health Economics Group, Newcastle University Population Health Sciences Institute, Newcastle, UK
| | - J. Shen
- Health Economics Group, Newcastle University Population Health Sciences Institute, Newcastle, UK
- Current affiliation: GSK Belgium, Wavre, Belgium
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21
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Evidence That a TRPA1-Mediated Murine Model of Temporomandibular Joint Pain Involves NLRP3 Inflammasome Activation. Pharmaceuticals (Basel) 2021; 14:ph14111073. [PMID: 34832855 PMCID: PMC8622821 DOI: 10.3390/ph14111073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022] Open
Abstract
This study investigates the role of transient receptor potential ankyrin 1 (TRPA1) in murine temporomandibular joint (TMJ) inflammatory hyperalgesia and the influence of the NLR family pyrin domain-containing 3 (NLRP3) inflammasome. Two distinct murine models of TMJ pain and inflammation (zymosan and CFA) were established. Spontaneous pain-like behaviours were observed as unilateral front paw cheek wipes. Ipsilateral cheek blood flow was used as a measure of ongoing inflammation, which, to our knowledge, is a novel approach to assessing real-time inflammation in the TMJ. Joint tissue and trigeminal ganglia were collected for ex vivo investigation. Both zymosan and CFA induced a time-dependent increase in hyperalgesia and inflammation biomarkers. Zymosan induced a significant effect after 4 h, correlating with a significantly increased IL-1β protein expression. CFA (50 µg) induced a more sustained response. The TRPA1 receptor antagonist A967079 significantly inhibited hyper-nociception. The NLRP3 inhibitor MCC950 similarly inhibited hyper-nociception, also attenuating inflammatory markers. In the trigeminal ganglia, CFA-induced CGRP expression showed trends of inhibition by A967079, whilst lba1 immunofluorescence was significantly inhibited by A967079 and MCC950, where the effect of TRPA1 inhibition lasted up to 14 days. Our results show that stimulation of TRPA1 is key to the TMJ pain. However, the inflammasome inhibitor exhibited similar properties in attenuating these pain-like behaviours, in addition to some inflammatory markers. This indicates that in addition to the therapeutic targeting of TRPA1, NLRP3 inhibition may provide a novel therapeutic strategy for TMJ inflammation and pain.
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22
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Prodoehl J, Kraus S, Buros Stein A. Predicting the number of physical therapy visits and patient satisfaction in individuals with temporomandibular disorder: A cohort study. J Oral Rehabil 2021; 49:22-36. [PMID: 34674278 DOI: 10.1111/joor.13272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/21/2021] [Accepted: 10/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Temporomandibular disorders (TMD) can be challenging to manage for clinicians and patients alike. It is unclear which factors are associated with prolonging conservative care and patient dissatisfaction with treatment outcomes. OBJECTIVES To examine factors collected during a physical therapy (PT) evaluation in a cohort of individuals with TMD to determine factors associated with an increased number of PT visits and reduced patient satisfaction. METHODS Records of 511 patients referred to PT over 18 months were reviewed to extract 27 variables to develop a predictive model. Outcomes were patient satisfaction following PT and number of PT visits. Linear and zero inflated negative binomial regressions were used, and a multivariate regression model was built for both outcomes. RESULTS Two factors were associated with both lower patient satisfaction and an increased number of PT visits: higher patient rated functional neck disability and a greater number of healthcare professionals seen. Other factors associated with patient satisfaction were duration of symptoms, subluxation, and referral from an oral surgeon. Only patient rated functional neck disability score was a significant predictive factor in the multivariate model. Factors associated with number of PT visits were gender, educational level, time between initial visit and discharge, number of pain areas, bruxism, biopsychosocial factors, dizziness, pain rating, and presence of neck pain. In the multivariate model, gender, number of healthcare professionals seen, and resting pain rating were significant predictors of number of PT visits. CONCLUSION Considering key factors on initial evaluation, specifically functional neck disability and the number of prior healthcare professionals seen before starting PT, can help to predict a higher number of PT visits and reduced patient satisfaction with outcomes.
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Affiliation(s)
- Janey Prodoehl
- Physical Therapy Program, Midwestern University, Downers Grove, Illinois, USA
| | - Steven Kraus
- Horizon Physical Therapy LLC, Atlanta, Georgia, USA
| | - Amy Buros Stein
- Office of Research and Sponsored Programs, Midwestern University, Glendale, Arizona, USA
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Costa YM, Bonjardim LR, Conti PCR, Svensson P. Psychophysical evaluation of somatosensory function in oro-facial pain: achievements and challenges. J Oral Rehabil 2021; 48:1066-1076. [PMID: 34213796 DOI: 10.1111/joor.13223] [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: 04/28/2021] [Accepted: 06/03/2021] [Indexed: 11/30/2022]
Abstract
AIM This critical review describes key methodological aspects for a successful oro-facial psychophysical evaluation of the somatosensory system and highlights the diagnostic value of somatosensory assessment and management perspectives based on somatosensory profiling. METHODS This topical review was based on a non-systematic search for studies about somatosensory evaluation in oro-facial pain in PubMed and Embase. RESULTS The recent progress regarding the psychophysical evaluation of somatosensory function was largely possible due to the development and application of valid, reliable and standardised psychophysical methods. Qualitative sensory testing may be useful as a screening tool to rule out relevant somatosensory abnormalities. Nevertheless, the patient should preferably be referred to a more comprehensive assessment with the quantitative sensory testing battery if confirmation of somatosensory abnormalities is necessary. Moreover, the identification of relevant somatosensory alterations in chronic pain disorders that do not fulfil the current criteria to be regarded as neuropathic has also increased the usefulness of somatosensory evaluation as a feasible method to better characterise the patients and perhaps elucidate some underpinnings of the so-called 'nociplastic' pain disorders. Finally, an additional benefit of oro-facial pain treatment based on somatosensory profiling still needs to be demonstrated and convincing evidence of somatosensory findings as predictors of treatment efficacy in chronic oro-facial pain awaits further studies. CONCLUSION Psychophysical evaluation of somatosensory function in oro-facial pain is still in its infancy but with a clear potential to continue to improve the assessment, diagnosis and management of oro-facial pain patients.
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Affiliation(s)
- Yuri M Costa
- Department of Biosciences, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.,Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark.,Bauru Orofacial Pain Group, Bauru, Brazil
| | - Leonardo R Bonjardim
- Bauru Orofacial Pain Group, Bauru, Brazil.,Section of Head and Face Physiology, Department of Biological Sciences, Bauru School of Dentistry, University of Sao Paulo, Bauru, Brazil
| | - Paulo César R Conti
- Bauru Orofacial Pain Group, Bauru, Brazil.,Department of Prosthodontics, Bauru School of Dentistry, University of Sao Paulo, Bauru, Brazil
| | - Peter Svensson
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark.,Faculty of Odontology, Malmo University, Malmo, Sweden
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Aggarwal VR, Wu J, Fox F, Howdon D, Guthrie E, Mighell A. Implementation of biopsychosocial supported self-management for chronic primary oro-facial pain including temporomandibular disorders: A theory, person and evidence-based approach. J Oral Rehabil 2021; 48:1118-1128. [PMID: 34273180 DOI: 10.1111/joor.13229] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Aims of the study were to: Implement supported self-management for chronic primary oro-facial pain in a clinical setting. Evaluate its impact on consultation rates, pain severity, interference with life and patient experience. METHODS Sixty-six patients with chronic primary oro-facial pain received the intervention at a facial pain clinic at Leeds Dental Institute, UK. Brief Pain Inventory (BPI) scores measured pain severity and interference with life before and after the intervention. Process mining outlined patient care pathways. Monthly consultation rates measured 12 months before and after the intervention were used to evaluate burden on healthcare services and economic impact. Patient feedback was assessed via Patient and Public involvement discussion groups. RESULTS Mean BPI scores significantly improved after intervention-from 5.70 (SD 1.89) to 3.78 (SD 2.34) (p < .001); mean pain interference score reduced from 19.95 (SD 9.41) to 12.05 (SD 9.64) (p < .001). Average monthly consultations significantly (p = .001) reduced from 0.42/month before the intervention to 0.16/month after the intervention. Economic assessment showed cost savings of £293 per patient per year. Process mining showed high rates of service usage with 31 patients also attending 51 other specialist services between them. Patient and Public Involvement discussion groups with 5 patients identified that the intervention was a 'constant companion' and should be implemented at the outset in the care pathway. CONCLUSION Supported self-management for chronic primary oro-facial pain has a positive impact on health outcomes (physical functioning, pain intensity and patient experience), as well as service usage and healthcare costs when implemented in a secondary care clinical setting. Reconfiguring current care pathways to upscale early implementation of such interventions should be a priority for future testing.
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Affiliation(s)
- Vishal R Aggarwal
- School of Dentistry, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - Jianhua Wu
- School of Dentistry, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - Frank Fox
- School of Dentistry, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - Daniel Howdon
- Faculty of Medicine & Health, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Elspeth Guthrie
- Faculty of Medicine & Health, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Alan Mighell
- School of Dentistry, Faculty of Medicine & Health, University of Leeds, Leeds, UK
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25
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Understanding the relationship between features associated with pain-related disability in people with painful temporomandibular disorder: an exploratory structural equation modeling approach. Pain 2021; 161:2710-2719. [PMID: 32639367 DOI: 10.1097/j.pain.0000000000001976] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pain-related disability is a multifaceted construct that refers to the impact of pain on an individual's capacity to fulfill their self-defined and social roles. This research examined the relationship between clinical, psychological, and pain sensitivity factors and pain-related disability among adults with chronic temporomandibular disorder (TMD). We analyzed data from a cross-sectional community-based sample of 1088 men and women with chronic TMD. We first constructed and tested a measure of pain-related disability (ie, pain impact), including a variable assessing presenteeism, created measurement models of jaw limitation, psychological unease (negative affect, somatic symptoms, and catastrophizing), and experimental pain sensitivity (eg, pressure pain threshold, thermal tolerance, and mechanical pressure pain threshold). Subsequently, latent variables were combined in a structural equation model. Participants (n = 1088) were 18 to 44 years old (mean 29.2, SD ± 7.8) whose chronic TMD had persisted, on average, for 6.9 years (SD ± 6.4). A model of pain-related disability, jaw limitation, and psychological unease was created and refined with exploratory model revisions to account for correlation among variables. Estimation of the final model indicated excellent fit with the data (root-mean-square error of approximation = 0.048, root-mean-square error of approximation 90% confidence interval [CI] 0.043-0.053, comparative fit index = 0.956, standardized root-mean-square residual = 0.040). Jaw functional limitation and psychological unease was strongly related to pain-related disability. Experimental pain sensitivity was removed from our model because of weak direct effect and the burden of performing experimental pain sensitivity testing in a clinical setting. The final model explained 78% of the variance in pain-related disability.
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26
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Kanzow P, Krois J, Wiegand A, Schwendicke F. Long-term treatment costs and cost-effectiveness of restoration repair versus replacement. Dent Mater 2021; 37:e375-e381. [PMID: 33663883 DOI: 10.1016/j.dental.2021.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/26/2021] [Accepted: 02/12/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES When managing partially defective restorations, dentists can choose between repair and replacement. We aimed to assess the long-term treatment costs of repairs and replacements. METHODS Partially defective anterior and posterior composite restorations in permanent teeth had been repaired or replaced in a German university hospital and were retrospectively followed until censoring or one of the following events: (1) Extraction, (2) Major complications including placement of indirect restorations, endodontic treatments and extractions, or (3) Any complications including major complications and further direct restorations. Costs were estimated from a German mixed public-private-payer perspective. Cost-effectiveness differences were described using median-based incremental-cost-effectiveness ratios (ICERMEDIAN). Statistical analysis was performed using generalized linear mixed modeling (GLM), Chi2-test, and Wilcoxon rank-sum test (p < 0.05). RESULTS A total of 616 repairs in 468 patients (follow-up: 4.9 ± 4.1 years) and 264 replacements in 218 patients (follow-up: 4.8 ± 4.3) were included. While replacements were associated with higher initial treatment costs, median annualized treatment costs did not significantly differ between repair (47.58 Euro [IQR: 24.41-107.04]) and replacement (50.64 Euro [IQR: 26.30-118.78]; p > 0.05), but were higher for molars (75.53 Euro [IQR: 24.41-92.18]) than incisors (45.03 Euro [IQR: 28.19-168.50]; p = 0.011). The difference in the % of extractions, major and any complications were minimal between both groups. The mean ICERMEDIAN of replacement vs. repair was -146.8 Euro/% when extractions were considered as outcomes. Regarding major and any complications, mean ICERMEDIAN amounted to 67.6 Euro/% and 23.9 Euro/%, respectively. SIGNIFICANCE Repairs and replacements of partially defective restorations showed similar long-term costs and cost-effectiveness.
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Affiliation(s)
- Philipp Kanzow
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Germany.
| | - Joachim Krois
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Germany
| | - Annette Wiegand
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Germany
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Germany
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Bhalang K, Steiger B, Lukic N, Zumbrunn Wojczyńska A, Hovijitra RS, Ettlin DA. The Pain-to-Well-Being Relationship in Patients Experiencing Chronic Orofacial Pain. Front Neurol 2020; 11:557415. [PMID: 33343482 PMCID: PMC7744627 DOI: 10.3389/fneur.2020.557415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 10/26/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction: Orofacial pain features may negatively influence a person's well-being and vice versa. Some aspects of well-being can be measured with axis II instruments that assess patients' psychosocial and behavioral status. The aim of this study was to investigate associations between pain features and psychosocial variables as indicators of well-being. Materials and Methods: Seven hundred ninety-nine anonymized datasets collected using the Web-based Interdisciplinary Symptom Evaluation (WISE) of patients reporting to the Interdisciplinary Orofacial Pain Unit, University of Zurich, between March 19, 2017 and May 19, 2019, were analyzed. Pain features including intensity, number of locations, impact, and duration were evaluated. Psychometric measures assessed pain-related catastrophizing and disability, illness perception, distress, anxiety, depression, injustice experience, dysmorphic concerns, and insomnia. Results: Most patients were between 30 and 59 years old (58.3%), female (69.8%), working (66.0%), and experienced pain for more than 6 months (68.5%). Pain intensities were higher in women than men and higher in disabled than working patients. Scores indicating elevated stress and depression were also observed in disabled patients. The sample prevalence rates of clinically relevant axis II instrument scores were as follows: Graded Chronic Pain Scale for the Head (GCPS-H), 27%; Patient Health Questionnaire 4 (PHQ4), 21%; PHQ9, 21%; Pain Catastrophizing Scale (PCS), 20%; General Anxiety Disorder 7 (GAD7), 15%; Insomnia Severity Index (ISI), 15%; Injustice Experience Questionnaire (IEQ), 14%; GCPS for the Body (GCPS-B), 13%; PHQ for Stress (PHQstr), 6%; and Dysmorphic Concern Questionnaire (DCQ), 2%. Noteworthy results of correlation analysis of the clinically relevant axis II scores and pain measures were as follows: the PHQstr had moderate associations (0.34-0.43) with the sum of pain intensity at rest and during function, number of pain locations, and typical pain intensity. The IEQ scores were moderately associated with typical pain intensity at 0.39. The DCQ scores were moderately associated with pain extension at 0.41. Conclusions: Moderate correlations of certain pain and well-being measures were found in patients reporting clinically relevant stress, injustice experience, and dysmorphic concern, all of which reflect impaired well-being. PHQ4 is suitable for routine distress screening in the clinical setting.
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Affiliation(s)
- Kanokporn Bhalang
- Department of Oral Medicine, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Beat Steiger
- Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Aarau, Switzerland
| | - Nenad Lukic
- Orofacial Pain Unit, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | | | - Ray S Hovijitra
- Dental Center, Bumrungrad International Hospital, Bangkok, Thailand
| | - Dominik A Ettlin
- Orofacial Pain Unit, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.,São Leopoldo Mandic Institute and Research Center, São Paulo, Brazil.,Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Berne, Berne, Switzerland
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28
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Kapos FP, Exposto FG, Oyarzo JF, Durham J. Temporomandibular disorders: a review of current concepts in aetiology, diagnosis and management. ORAL SURGERY 2020; 13:321-334. [PMID: 34853604 PMCID: PMC8631581 DOI: 10.1111/ors.12473] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/18/2020] [Indexed: 12/18/2022]
Abstract
Temporomandibular disorders (TMD) is a collective term for a group of musculoskeletal conditions involving pain and/or dysfunction in the masticatory muscles, temporomandibular joints (TMJ) and associated structures. It is the most common type of non-odontogenic orofacial pain and patients can present with pain affecting the face/head, TMJ and or teeth, limitations in jaw movement, and sounds in the TMJ during jaw movements. Comorbid painful and non-painful conditions are also common among individuals with TMD. The diagnosis of TMD have significantly improved over time with the recent Diagnostic Criteria for TMD (DC/TMD) being reliable and valid for most common diagnoses, and an efficient way to communicate in multidisciplinary settings. This classification covers 12 most common TMD, including painful (myalgia, arthralgia and headache attributed to TMD) as well as the non-painful (disc displacements, degenerative joint disease and subluxation) TMD diagnoses. Recent studies have demonstrated that the pathophysiology of common painful TMD is biopsychosocial and multifactorial, where no one factor is responsible for its development. Importantly, research has suggested different predisposing, initiating and perpetuating factors, including both peripheral and central mechanisms. This is an active field of investigation and future studies will not only seek to clarify specific causal pathways but translate this knowledge into mechanism-directed diagnosis and treatment. In accordance with this complex aetiology, current evidence supports primarily conservative multidisciplinary treatment including self-management strategies, behavioural therapy, physical therapy and pharmacotherapy. The aim of this review is to present an overview of most recent developments in aetiology, pathophysiology, diagnosis and management of TMD.
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Affiliation(s)
- Flavia Penteado Kapos
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, United States
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, United States
| | - Fernando Gustavo Exposto
- Section of Orofacial Pain and Jaw Function, Department of Dentistry, Health, Aarhus University, Aarhus, Denmark
- Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - Juan Fernando Oyarzo
- Orofacial Pain and TMD Program, Faculty of Odontology, Universidad Andres Bello, Santiago, Chile
| | - Justin Durham
- Centre for Oral Health Research & Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
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29
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Costa YM, De Koninck BP, Elsaraj SM, Exposto FG, Herrero Babiloni A, Kapos FP, Sharma S, Shimada A. Orofacial pain education in dentistry: A path to improving patient care and reducing the population burden of chronic pain. J Dent Educ 2020; 85:349-358. [PMID: 33098113 DOI: 10.1002/jdd.12461] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/31/2020] [Accepted: 10/02/2020] [Indexed: 12/30/2022]
Abstract
Dentists stand in an optimal position to prevent and manage patients suffering from chronic orofacial pain (OFP) disorders, such as temporomandibular disorders, burning mouth syndrome, trigeminal neuralgia, persistent idiopathic dentoalveolar pain, among others. However, there are consistent reports highlighting a lack of knowledge and confidence in diagnosing and treating OFP among dental students, recent graduates, and trained dentists, which leads to misdiagnosis, unnecessary costs, delay in appropriate care and possible harm to patients. Education in OFP is necessary to improve the quality of general dental care and reduce individual and societal burden of chronic pain through prevention and improved quality of life for OFP patients. Our aims are to emphasize the goals of OFP education, to identify barriers for its implementation, and to suggest possible avenues to improve OFP education in general, postgraduate, and continuing dental education levels, including proposed minimum OFP competencies for all dentists. Moreover, patient perspectives are also incorporated, including a testimony from a person with OFP. General dentists, OFP experts, educators, researchers, patients, and policy makers need to combine efforts in order to successfully address the urgent need for quality OFP education.
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Affiliation(s)
- Yuri M Costa
- Department of Biosciences, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Beatrice P De Koninck
- Research Center, Sacré-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Sherif M Elsaraj
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.,Department of Dentistry, Jewish General Hospital, Montreal, Quebec, Canada
| | - Fernando G Exposto
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - Alberto Herrero Babiloni
- Research Center, Sacré-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada.,Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Flavia P Kapos
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Sonia Sharma
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.,Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, New York, USA
| | - Akiko Shimada
- Department of Geriatric Dentistry, Osaka Dental University, Osaka, Japan
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30
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Wilson CL, Mahmood H, Loescher A. Clinical presentations on a facial pain clinic. Br Dent J 2020:10.1038/s41415-020-1989-5. [PMID: 32918059 DOI: 10.1038/s41415-020-1989-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction The complex nature of facial pain conditions creates a diagnostic challenge which may necessitate specialist referral.Aim To identify the case mix presenting to a specialist tertiary care facial pain clinic.Methods A retrospective review of 112 patient records was undertaken. Trends in provisional diagnoses from referrers and the correlation to diagnoses made following specialist consultation were reviewed.Results The most common provisional diagnoses recorded in referral letters were painful temporomandibular disorders, trigeminal neuralgia and persistent idiopathic facial pain (PIFP). Over a quarter of referrals did not include a provisional diagnosis. Following assessment, only one case was not given a definitive diagnosis and no patients were diagnosed with PIFP. A causative factor was identified in all the initially queried PIFP cases, and painful post-traumatic trigeminal neuropathic pain was found in multiple patients.Conclusions Painful post-traumatic trigeminal neuropathic pain should be considered if pain onset coincides with dental treatment or other traumatic events. PIFP is a rare facial pain diagnosis and may be over-diagnosed by dental and medical practitioners. It is important to systematically exclude other causes before reaching this diagnosis. This will facilitate effective treatment, manage patient expectations and potentially reduce unnecessary referrals.
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Affiliation(s)
- Claire L Wilson
- Sheffield Teaching Hospitals NHS Foundation Trust, Oral Surgery, Charles Clifford Dental Hospital, 76 Wellesley Road, Sheffield, South Yorkshire, S10 2SZ, UK; Department of Oral and Maxillofacial Surgery, School of Clinical Dentistry, University of Sheffield, Charles Clifford Dental Hospital, Wellesley Road, Sheffield, S10 2TA, UK.
| | - Hanya Mahmood
- Sheffield Teaching Hospitals NHS Foundation Trust, Oral Surgery, Charles Clifford Dental Hospital, 76 Wellesley Road, Sheffield, South Yorkshire, S10 2SZ, UK; Department of Oral and Maxillofacial Surgery, School of Clinical Dentistry, University of Sheffield, Charles Clifford Dental Hospital, Wellesley Road, Sheffield, S10 2TA, UK
| | - Alison Loescher
- Sheffield Teaching Hospitals NHS Foundation Trust, Oral Surgery, Charles Clifford Dental Hospital, 76 Wellesley Road, Sheffield, South Yorkshire, S10 2SZ, UK; Department of Oral and Maxillofacial Surgery, School of Clinical Dentistry, University of Sheffield, Charles Clifford Dental Hospital, Wellesley Road, Sheffield, S10 2TA, UK
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31
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Bendtsen L, Zakrzewska JM, Heinskou TB, Hodaie M, Leal PRL, Nurmikko T, Obermann M, Cruccu G, Maarbjerg S. Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia. Lancet Neurol 2020; 19:784-796. [PMID: 32822636 DOI: 10.1016/s1474-4422(20)30233-7] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023]
Abstract
Trigeminal neuralgia is a very painful neurological condition with severe, stimulus-evoked, short-lasting stabbing pain attacks in the face. The past decade has offered new insights into trigeminal neuralgia symptomatology, pathophysiology, and treatment, leading to a change in the classification of the condition. An accurate diagnosis is crucial because neuroimaging interpretation and clinical management differ among the various forms of facial pain. MRI using specific sequences should be a part of the diagnostic workup to detect a possible neurovascular contact and exclude secondary causes. Demonstration of a neurovascular contact should not be used to confirm a diagnosis but rather to facilitate surgical decision making. Carbamazepine and oxcarbazepine are drugs of first choice for long-term treatment, whereas microvascular decompression is the first-line surgery in medically refractory patients. Advances in neuroimaging techniques and animal models will provide further insight into the causes of trigeminal neuralgia and its pathophysiology. Development of more efficacious treatment options is highly warranted.
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Affiliation(s)
- Lars Bendtsen
- Department of Neurology, Danish Headache Center, Rigshospitalet, Glostrup, Denmark.
| | - Joanna Maria Zakrzewska
- Pain Management Centre, National Hospital for Neurology and Neurosurgery, London, UK; Eastman Dental Hospital, UCLH NHS Foundation Trust, London, UK
| | - Tone Bruvik Heinskou
- Department of Neurology, Danish Headache Center, Rigshospitalet, Glostrup, Denmark
| | - Mojgan Hodaie
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Krembil Brain Institute, Toronto Western Hospital, Toronto, ON, Canada
| | - Paulo Roberto Lacerda Leal
- Department of Neurosurgery, Faculty of Medicine of Sobral, Federal University of Cearà, Sobral, Brazil; University of Lyon, Lyon, France
| | - Turo Nurmikko
- Neuroscience Research Centre, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Mark Obermann
- Center for Neurology, Asklepios Hospitals Schildautal, Seesen, Germany
| | - Giorgio Cruccu
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Stine Maarbjerg
- Department of Neurology, Danish Headache Center, Rigshospitalet, Glostrup, Denmark
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32
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Long-term costs of post-restorations: 7-year practice-based results from Germany. Clin Oral Investig 2020; 25:2175-2181. [PMID: 32857211 PMCID: PMC7966625 DOI: 10.1007/s00784-020-03529-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 08/14/2020] [Indexed: 11/26/2022]
Abstract
Objectives We evaluated the initial and follow-up treatment costs of different post-restorations in a practice-based German healthcare setting. Methods A total of 139 incisors, canines, or premolars received post-restorations placed by eight general dental practitioners in Germany, and were followed over a mean ± SD 7.1 ± 4.5 years. Preformed metal (MP, n = 68), glass-fiber (GF, n = 28), or cast post-and-core buildups (MC, n = 23) had been used to retain crowns or bridge anchors. Preformed metal and glass-fiber had also been used to retain directly built up post-retained composite restorations (PC, n = 20). Material and treatment costs for the initial post-restorations as well as restorative, endodontic, or surgical re-treatments were estimated from a public-payer-perspective in Germany. Associations between total and annualized total costs and covariates were assessed using generalized linear modeling. The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00012938). Results MC showed highest initial treatment costs (557.23 Euro), but the least re-treatments (6/23, 26%), while PC showed lowest initial costs (203.52 Euro) but the most re-treatments (11/20, 55%). Costs for MP/GF post-crowns were initially similarly costly (496.47/496.87 Euro), and both also showed similar re-treatments (35%/36%). The overall annual failure rate was 5.2% (MC: 3.5%, MP: 4.6%, GF: 5.3%, PC: 10.3%). Including costs for the resulting re-treatments, mean total costs were 591.66 Euro (MC), 548.31 Euro (MP), 526.37 Euro (GF), and 361.81 Euro (PC). Annualized total costs were 171.36 Euro (MC), 141.75 Euro (MP), 146.12 Euro (GF), and 135.65 Euro (PC). Total and annualized total costs were highest for MC, with PC being the significantly less costly option (p < 0.001). Conclusions Within German healthcare, both initial and follow-up costs for post-restorations were considerable. Saving costs initially may, at least partially, be offset by more complications long-term. Clinical relevance Dentists need to be aware that the placement of posts is not only initially costly but also comes with significant long-term costs for treating occurring complications. This should be communicated with patients and considered during treatment planning. Electronic supplementary material The online version of this article (10.1007/s00784-020-03529-5) contains supplementary material, which is available to authorized users.
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Häggman-Henrikson B, Liv P, Ilgunas A, Visscher CM, Lobbezoo F, Durham J, Lövgren A. Increasing gender differences in the prevalence and chronification of orofacial pain in the population. Pain 2020; 161:1768-1775. [PMID: 32701837 PMCID: PMC7365674 DOI: 10.1097/j.pain.0000000000001872] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/12/2020] [Accepted: 03/12/2020] [Indexed: 12/17/2022]
Abstract
Although a fluctuating pattern of orofacial pain across the life span has been proposed, data on its natural course are lacking. The longitudinal course of orofacial pain in the general population was evaluated using data from routine dental check-ups at all Public Dental Health services in Västerbotten, Sweden. In a large population sample, 2 screening questions were used to identify individuals with pain once a week or more in the orofacial area. Incidence and longitudinal course of orofacial pain were evaluated using annual data for 2010 to 2017. To evaluate predictors for orofacial pain remaining over time, individuals who reported pain on at least 2 consecutive dental check-ups were considered persistent. A generalized estimating equation model was used to analyze the prevalence, accounting for repeated observations on the same individuals. In total, 180,308 individuals (equal gender distribution) were examined in 525,707 dental check-ups. More women than men reported orofacial pain (odds ratio 2.58, 95% confidence interval [CI] 2.48-2.68), and there was a significant increase in the prevalence of reported pain from 2010 to 2017 in both women and men. Longitudinal data for 135,800 individuals were available for incidence analysis. Women were at higher risk of both developing orofacial pain (incidence rate ratio 2.37; 95% CI 2.25-2.50) and reporting pain in consecutive check-ups (incidence rate ratio 2.56; 95% CI 2.29-2.87). In the northern Swedish population studied, the prevalence of orofacial pain increases over time and more so in women, thus indicating increasing differences in gender for orofacial pain.
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Affiliation(s)
- Birgitta Häggman-Henrikson
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, University of Umeå , Umeå , Sweden
| | - Per Liv
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Aurelia Ilgunas
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, University of Umeå , Umeå , Sweden
| | - Corine M. Visscher
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, the Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, the Netherlands
| | - Justin Durham
- Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Newcastle, United Kingdom
| | - Anna Lövgren
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, University of Umeå , Umeå , Sweden
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McCloy K, Peck C. Common factors in the presentation and management of chronic temporomandibular disorders and chronic overlapping pain disorders. J Oral Pathol Med 2020; 49:454-460. [DOI: 10.1111/jop.13079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - Christopher Peck
- Westmead Initiative The University of Sydney Sydney NSW Australia
- Pain Management Research Institute Royal North Shore HospitalSt Leonards NSW Australia
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Riley P, Glenny AM, Worthington HV, Jacobsen E, Robertson C, Durham J, Davies S, Petersen H, Boyers D. Oral splints for patients with temporomandibular disorders or bruxism: a systematic review and economic evaluation. Health Technol Assess 2020; 24:1-224. [PMID: 32065109 PMCID: PMC7049908 DOI: 10.3310/hta24070] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Splints are a non-invasive, reversible management option for temporomandibular disorders or bruxism. The clinical effectiveness and cost-effectiveness of splints remain uncertain. OBJECTIVES The objectives were to evaluate the clinical effectiveness and cost-effectiveness of splints for patients with temporomandibular disorders or bruxism. This evidence synthesis compared (1) all types of splint versus no/minimal treatment/control splints and (2) prefabricated versus custom-made splints, for the primary outcomes, which were pain (temporomandibular disorders) and tooth wear (bruxism). REVIEW METHODS Four databases, including MEDLINE and EMBASE, were searched from inception until 1 October 2018 for randomised clinical trials. The searches were conducted on 1 October 2018. Cochrane review methods (including risk of bias) were used for the systematic review. Standardised mean differences were pooled for the primary outcome of pain, using random-effects models in temporomandibular disorder patients. A Markov cohort, state-transition model, populated using current pain and Characteristic Pain Intensity data, was used to estimate the incremental cost-effectiveness ratio for splints compared with no splint, from an NHS perspective over a lifetime horizon. A value-of-information analysis identified future research priorities. RESULTS Fifty-two trials were included in the systematic review. The evidence identified was of very low quality with unclear reporting by temporomandibular disorder subtype. When all subtypes were pooled into one global temporomandibular disorder group, there was no evidence that splints reduced pain [standardised mean difference (at up to 3 months) -0.18, 95% confidence interval -0.42 to 0.06; substantial heterogeneity] when compared with no splints or a minimal intervention. There was no evidence that other outcomes, including temporomandibular joint noises, decreased mouth-opening, and quality of life, improved when using splints. Adverse events were generally not reported, but seemed infrequent when reported. The most plausible base-case incremental cost-effectiveness ratio was uncertain and driven by the lack of clinical effectiveness evidence. The cost-effectiveness acceptability curve showed splints becoming more cost-effective at a willingness-to-pay threshold of ≈£6000, but the probability never exceeded 60% at higher levels of willingness to pay. Results were sensitive to longer-term extrapolation assumptions. A value-of-information analysis indicated that further research is required. There were no studies measuring tooth wear in patients with bruxism. One small study looked at pain and found a reduction in the splint group [mean difference (0-10 scale) -2.01, 95% CI -1.40 to -2.62; very low-quality evidence]. As there was no evidence of a difference between splints and no splints, the second objective became irrelevant. LIMITATIONS There was a large variation in the diagnostic criteria, splint types and outcome measures used and reported. Sensitivity analyses based on these limitations did not indicate a reduction in pain. CONCLUSIONS The very low-quality evidence identified did not demonstrate that splints reduced pain in temporomandibular disorders as a group of conditions. There is insufficient evidence to determine whether or not splints reduce tooth wear in patients with bruxism. There remains substantial uncertainty surrounding the most plausible incremental cost-effectiveness ratio. FUTURE WORK There is a need for well-conducted trials to determine the clinical effectiveness and cost-effectiveness of splints in patients with carefully diagnosed and subtyped temporomandibular disorders, and patients with bruxism, using agreed measures of pain and tooth wear. STUDY REGISTRATION This study is registered as PROSPERO CRD42017068512. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Philip Riley
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Anne-Marie Glenny
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Elisabet Jacobsen
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Justin Durham
- Centre for Oral Health Research and School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Davies
- TMD Unit, University Dental Hospital of Manchester, Manchester, UK
| | - Helen Petersen
- University Dental Hospital of Manchester, Manchester, UK
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
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Forssell H, Sipilä K, Teerijoki-Oksa T, Vartiainen P, Kautiainen H, Sintonen H, Kalso E. The impact of chronic orofacial pain on health-related quality of life. Scand J Pain 2019; 20:329-338. [DOI: 10.1515/sjpain-2019-0131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/17/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Background and aims
Health-related quality of life (HRQoL) assessments have been widely used in pain medicine as they are able to reflect the subjective and multidimensional nature of chronic pain. Studies have shown a consistent impairment in HRQoL in different chronic pain conditions. However, it is not known whether HRQoL is impaired in chronic orofacial pain (OFP). The generic 15D HRQoL instrument has been shown to fare as well as or better than other generic HRQoL instruments in the study of chronic pain. The aim was to investigate HRQoL in patients with chronic OFP using the generic 15D HRQoL instrument. The validity of the instrument was tested by studying the association of the 15D data with pain interference.
Methods
One hundred fifty-one patients (mean age 50 years, SD 15 years, 119 females) were recruited from three tertiary facial pain clinics. HRQoL data of the participants were contrasted with that of an age- and gender- standardized sample of general population by comparing the mean 15D scores and profiles. The data for the general population came from the National Health 2011 Survey representing Finnish population aged 18 years and older. Pain interference was assessed using Brief Pain Inventory. Based on pain interference distribution the participants were divided into tertiles. Statistical comparison between patient and population HRQoL values were performed using Monte-Carlo-type simulations. Statistical significance for the hypothesis of linearity was evaluated by using generalized linear models.
Results
The mean 15D score of OFP patients (0.824, SD 0.113) was statistically significantly lower than that of the age- and gender-standardized general population (0.929, SD 0.019) (p < 0.001). The difference between the patients and the general population was also clinically important, i.e. over the minimum clinically important difference in the 15D score. All mean 15D dimension values were significantly lower compared with the general population values (p < 0.001 for all dimensions). The largest differences were seen in the dimensions of discomfort and symptoms (0.418, SD 0.222 vs. 0.816, SD 0.027), sleeping (0.693, SD 0.258 vs. 0.838, SD 0.029), and vitality (0.702, SD 0.221 vs. 0.884 SD 0.026). There was a statistically significant linear decrease in the 15D dimension values (p < 0.001) with increasing pain interference. The greatest differences were found on the dimensions of discomfort and symptoms, sleeping and vitality.
Conclusions
HRQoL is significantly impaired in patients with chronic OFP. A decrease in the 15D dimension values with increasing pain interference indicated convergent validity between 15D and pain interference.
Implications
The findings suggest that 15D is an appropriate instrument for use in the assessment of HRQoL in OFP patients. By showing the usefulness of the 15D, the present study may encourage further use of generic HRQoL assessments in the study of chronic OFP, and contribute e.g. to the implementation of HRQoL as one of the core outcome measures in future treatment studies on chronic OFP.
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Affiliation(s)
- Heli Forssell
- Institute of Dentistry, University of Turku , Lemminkäisenkatu 2 , FIN-21520 Turku , Finland , Phone: +358 405392030
| | - Kirsi Sipilä
- Research Unit of Oral Health Sciences, University of Oulu , Box 5000 , FIN-90014, University of Oulu , Finland
- Oral and Maxillofacial Department, Medical Research Center Oulu , Oulu University Hospital , Box 5000 , FIN-90014, University of Oulu , Finland
| | - Tuija Teerijoki-Oksa
- Department of Oral and Maxillofacial Diseases , Turku University Hospital , Lemminkäisenkatu 2 , FIN-20520 Turku , Finland
| | - Pekka Vartiainen
- Pain Clinic, Division of Pain Medicine, Department of Anaesthesiology , Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki , Haartmaninkatu 2A , FIN-00029 HUS , Finland
| | - Hannu Kautiainen
- Folkhälsan Research Center , Helsinki , Finland
- Primary Health Care Unit, Kuopio University Hospital , Kuopio , Finland
| | - Harri Sintonen
- Department of Public Health , University of Helsinki , PO Box 20 (Tukholmankatu 8 B) , FIN-00014 University of Helsinki , Finland
| | - Eija Kalso
- Pain Clinic, Division of Pain Medicine, Department of Anaesthesiology , Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki , Haartmaninkatu 2A , FIN-00029 HUS , Finland
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Schwendicke F. Less Is More? The Long-Term Health and Cost Consequences Resulting from Minimal Invasive Caries Management. Dent Clin North Am 2019; 63:737-749. [PMID: 31470927 DOI: 10.1016/j.cden.2019.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Caries is a chronic disease, with long-term sequelae, often initiated early in life. Managing caries and carious lesions often has long-term consequences. These consequences involve the health (or its absence) generated by a caries management strategy, but also costs. This article discusses the long-term health and costs consequences resulting from different caries management strategies. It is demonstrated why, and under which circumstances, minimal invasive caries management may be beneficial for patients, but also for health services, with regard to both health gained and costs generated. Moreover, possible factors influencing the cost-effectiveness of different caries management strategies will be discussed.
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Affiliation(s)
- Falk Schwendicke
- Department for Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, Berlin 14197, Germany.
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Awal D, Amin K, Venda-Nova C, Naqvi A, Zakrzewska J. The specialist management of non-temporomandibular orofacial pain: maxillofacial surgery’s known unknown? Br J Oral Maxillofac Surg 2019; 57:749-754. [DOI: 10.1016/j.bjoms.2019.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 06/21/2019] [Indexed: 11/26/2022]
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Penlington C, Araújo-Soares V, Durham J. Predicting Persistent Orofacial Pain: The Role of Illness Perceptions, Anxiety, and Depression. JDR Clin Trans Res 2019; 5:40-49. [PMID: 31063437 DOI: 10.1177/2380084419846447] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Persistent orofacial pain (POFP) can be caused by a range of conditions affecting the mouth and face and is often associated with significant disability. Biopsychosocial factors are known to be important predictors and have not yet been fully explored in this population. OBJECTIVES This study aimed to explore whether illness perceptions and psychological distress (anxiety and depression) could predict long-term outcome in a community-based sample of patients receiving routine care for POFP. METHODS A longitudinal cohort design study assessed 198 patients recruited from primary or secondary health care settings on 5 separate occasions over a 2-y period. Outcome was measured by the Graded Chronic Pain Scale and dichotomized into good or poor outcome categories. Independent variables included subscale scores of the psychometrically shortened Illness Perception Questionnaire and the Patient Health Questionnaire-4 (PHQ-4, assessing anxiety and depressive symptomatology). Logistic regressions were performed to test whether scores on each subscale would be associated with different outcomes for patients at 12 and 24 mo and overall. RESULTS Beliefs about consequences predicted outcome category (good vs. poor) above and beyond other illness perception subscales, anxiety, and depressive symptomatology (z = 3.78; P < 0.000; odds ratio [OR], 3.05; 95% confidence interval [CI], 1.71-5.43). Both depressive symptomatology, measured by the PHQ-2 (P = 0.001; OR, 4.06; 95% CI, 1.74-9.52), and psychological distress (mixed anxiety and depression; P = 0.029; OR, 2.88; 95% CI, 1.12-7.41), measured by the PHQ-4, were also predictive of poor outcome, but these effects were no longer significant once measures of illness perceptions were added. CONCLUSION Beliefs about the consequences of POFP are important predictors of outcome independent of other variables and can easily and briefly be included in assessments to inform management decisions. KNOWLEDGE TRANSFER STATEMENT The results of this study are relevant because they will allow clinicians to consider the use of brief and easy-to-administer self-report measures to identify POFP patients at higher risk of poor outcome so that management can be planned accordingly.
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Affiliation(s)
- C Penlington
- Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Newcastle, UK.,Newcastle upon Tyne Hospitals' NHS Foundation Trust, Newcastle upon Tyne, UK
| | - V Araújo-Soares
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - J Durham
- Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Newcastle, UK.,Newcastle upon Tyne Hospitals' NHS Foundation Trust, Newcastle upon Tyne, UK
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40
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Aggarwal VR, Fu Y, Main CJ, Wu J. The effectiveness of self‐management interventions in adults with chronic orofacial pain: A systematic review, meta‐analysis and meta‐regression. Eur J Pain 2019; 23:849-865. [DOI: 10.1002/ejp.1358] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/20/2018] [Accepted: 12/30/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Vishal R. Aggarwal
- Faculty of Medicine & Health, School of Dentistry University of Leeds Leeds UK
| | - Yu Fu
- Faculty of Medicine & Health, School of Healthcare University of Leeds Leeds UK
| | - Chris J. Main
- Research Institute for Primary Care & Health Keele University Keele UK
| | - Jianhua Wu
- Faculty of Medicine & Health, School of Dentistry University of Leeds Leeds UK
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Miller VE, Poole C, Golightly Y, Barrett D, Chen DG, Ohrbach R, Greenspan JD, Fillingim RB, Slade GD. Characteristics Associated With High-Impact Pain in People With Temporomandibular Disorder: A Cross-Sectional Study. THE JOURNAL OF PAIN 2018; 20:288-300. [PMID: 30292793 DOI: 10.1016/j.jpain.2018.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/16/2018] [Accepted: 09/25/2018] [Indexed: 12/21/2022]
Abstract
High-impact (disabling) pain diminishes the quality of life and increases health care costs. The purpose of this study was to identify the variables that distinguish between high- and low-impact pain among individuals with painful temporomandibular disorder (TMD). Community-dwelling adults (N = 846) with chronic TMD completed standardized questionnaires that assessed the following: 1) sociodemographic characteristics, 2) psychological distress, 3) clinical pain, and 4) experimental pain. We used high-impact pain, classified using the Graded Chronic Pain Scale, as the dependent variable in logistic regression modeling to evaluate the contribution of variables from each domain. Cross-validated area under the receiver operating characteristic curve (AUC) quantified model discrimination. One-third of the participants had high-impact pain. Sociodemographic variables discriminated weakly between low- and high-impact pain (AUC = .61, 95% confidence interval [CI] = 0.57, 0.65), with the exception of race. An 18-variable model encompassing all 4 domains had good discrimination (AUC = 0.79, 95% CI = 0.75, 0.82), as did a simplified model (sociodemographic variables plus catastrophizing, jaw limitation, and number of painful body sites) (AUC = 0.79, 95% CI = 0.76, 0.82). Duration of pain, sex, and experimental pain testing results were not associated. The characteristics that discriminated most effectively between people with low- and high-impact TMD pain included clinical pain features and the ability to cope with pain. PERSPECTIVE: This article presents the results of a multivariable model designed to discriminate between people with high- and low-impact pain in a community-based sample of people with painful chronic TMD. The findings emphasize the importance of catastrophizing, jaw limitation, and painful body sites associated with pain-related impact.
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Affiliation(s)
- Vanessa E Miller
- Program on Integrative Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Charles Poole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yvonne Golightly
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Deborah Barrett
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ding-Geng Chen
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York
| | - Joel D Greenspan
- Department of Neural and Pain Sciences, University of Maryland, Baltimore, Maryland
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Gary D Slade
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Häggman-Henrikson B, Ekberg E, Ettlin DA, Michelotti A, Durham J, Goulet JP, Visscher CM, Raphael KG. Mind the Gap: A Systematic Review of Implementation of Screening for Psychological Comorbidity in Dental and Dental Hygiene Education. J Dent Educ 2018; 82:1065-1076. [DOI: 10.21815/jde.018.104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 03/06/2018] [Indexed: 12/16/2022]
Affiliation(s)
| | - EwaCarin Ekberg
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology; Malmö University; Malmö Sweden
| | | | - Ambra Michelotti
- Department of Neurosciences, Reproductive Sciences, and Oral Sciences, Division of Orthodontics; University of Naples; Naples Italy
| | - Justin Durham
- School of Dental Sciences and Centre for Oral Health Research, Newcastle University; Newcastle-Upon-Tyne Hospitals’ NHS Foundation Trust; Newcastle-Upon-Tyne UK
| | | | - Corine M. Visscher
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam; University of Amsterdam, and Vrije Universiteit Amsterdam; The Netherlands
| | - Karen G. Raphael
- Department of Oral and Maxillofacial Radiology, Pathology, and Medicine; New York University College of Dentistry; New York USA
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Schwendicke F, Krois J, Robertson M, Splieth C, Santamaria R, Innes N. Cost-effectiveness of the Hall Technique in a Randomized Trial. J Dent Res 2018; 98:61-67. [PMID: 30216734 DOI: 10.1177/0022034518799742] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Clinical and patient-reported outcomes were reported for carious primary molars treated with the Hall technique (HT) as compared with conventional carious tissue removal and restorations (i.e., conventional restoration [CR]) in a 5-y randomized controlled practice-based trial in Scotland. We interrogated this data set further to investigate the cost-effectiveness of HT versus CR. A total of 132 children who had 2 matched occlusal/occlusal-proximal carious lesions in primary molars ( n = 264 teeth) were randomly allocated to HT or CR, provided by 17 general dental practitioners. Molars were followed up for a mean 5 y. A societal perspective was taken for the economic analysis. Direct dental treatment costs were estimated from a Scottish NHS perspective (an NHS England perspective was taken for a sensitivity analysis). Initial, maintenance, and retreatment costs, including rerestorations, endodontic treatments, and extractions, were estimated with fee items. Indirect/opportunity costs were estimated with time and travel costs from a UK perspective. The primary outcome was tooth survival. Secondary outcomes included 1) not having pain or needing endodontic treatments/extractions and 2) not needing rerestorations. Cost-effectiveness and acceptability were estimated from bootstrapped samples. Significantly more molars in HT survived (99%, 95% CI: 98% to 100%) than in CR (92%; 87% to 97%). Also, the proportion of molars retained without pain or requiring endodontic treatment/extraction was significantly higher in HT than CR. In the base case analysis (NHS Scotland perspective), cumulative direct dental treatment costs (Great British pound [GBP]) of HT were 24 GBP (95% CI: 23 to 25); costs for CR were 29 (17 to 46). From an NHS England perspective, the cost advantage of HT (29 GBP; 95% CI: 25 to 34) over CR (107; 86 to 127) was more pronounced. Indirect/opportunity costs were significantly lower for HT (8 GBP; 95% CI: 7 to 9) than CR (19; 16 to 23). Total cumulative costs were significantly lower for HT (32 GBP; 95% CI: 31 to 34) than CR (49; 34 to 69). Based on a long-term practice-based trial, HT was more cost-effective than CR with HT retained for longer and experiencing less complications at lower costs.
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Affiliation(s)
- F Schwendicke
- 1 Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - J Krois
- 1 Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - M Robertson
- 2 Child Dental Health, School of Dentistry, University of Dundee, Dundee, Scotland
| | - C Splieth
- 3 Department of Preventive and Paediatric Dentistry, University of Greifswald, Greifswald, Germany
| | - R Santamaria
- 3 Department of Preventive and Paediatric Dentistry, University of Greifswald, Greifswald, Germany
| | - N Innes
- 2 Child Dental Health, School of Dentistry, University of Dundee, Dundee, Scotland
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Breckons M, Shen J, Bunga J, Vale L, Durham J. DEEP Study: Indirect and Out-of-pocket Costs of Persistent Orofacial Pain. J Dent Res 2018; 97:1200-1206. [DOI: 10.1177/0022034518773310] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Persistent orofacial pain (POFP) is common and caused by a group of conditions affecting the face, head, or mouth. Recent research highlighted a problematic care pathway with high costs to the health care provider, but the financial impact on patients and employers is not understood. This study aimed to describe patient (out-of-pocket) and employer (indirect) costs of POFP and to identify whether the dichotomized Graded Chronic Pain Scale (GCPS) was predictive of costs. A cohort of 198 patients was recruited from primary and secondary care settings in North East England and followed over a 24-mo period. Patients completed the GCPS and Use of Services and Productivity Questionnaire every 6 mo and a Time and Travel Questionnaire at 14 mo. Questionnaires examined the implications of health care utilization on patients’ everyday lives and personal finances. Time and travel costs were calculated and applied to use-of-services data to estimate out-of-pocket costs, while the human capital method and QQ method (quantity and quality of work completed) were used to estimate absenteeism and presenteeism costs, respectively. Per person per 6-mo period (in 2017 pounds sterling), mean out-of-pocket costs were £333 (95% CI, £289 to £377), and indirect costs were £1,242 (95% CI, £1,014 to £1,470). Regression analyses indicated that over 6 mo, the GCPS was predictive of the following: out-of-pocket costs—a difference of £311 between low and high GCPS per person per 6-mo period (95% CI, £280 to £342; P < 0.01, n = 705 observations over 24 mo); indirect costs—a difference of £2,312 between low and high GCPS per person per 6-mo period (95% CI, £1,886 to £2,737; P < 0.01; n = 352 observations over 24 mo). This analysis highlights “hidden” costs of POFP and supports the use of the dichotomized GCPS to identify patients at risk of higher impact and associated costs and thereby stratify care pathways and occupational health support appropriately.
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Affiliation(s)
- M. Breckons
- Health Economics Group, Institute of Health and Society, Newcastle upon Tyne, UK
| | - J. Shen
- Health Economics Group, Institute of Health and Society, Newcastle upon Tyne, UK
| | - J. Bunga
- Health Economics Group, Institute of Health and Society, Newcastle upon Tyne, UK
| | - L. Vale
- Health Economics Group, Institute of Health and Society, Newcastle upon Tyne, UK
| | - J. Durham
- Health Economics Group, Institute of Health and Society, Newcastle upon Tyne, UK
- Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
- Newcastle Upon Tyne Hospitals’ NHS Foundation Trust, Newcastle upon Tyne, UK
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45
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Al-Harthy M, List T, Ohrbach R, Michelotti A. Cross-cultural differences in types and beliefs about treatment in women with temporomandibular disorder pain. J Oral Rehabil 2018; 45:659-668. [DOI: 10.1111/joor.12683] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/17/2018] [Accepted: 06/30/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Mohammad Al-Harthy
- Department of Oral Basic and Clinical Sciences; Faculty of Dentistry; Umm Al-Qura University; Makkah Saudi Arabia
- Department of Orofacial Pain and Jaw Function; Faculty of Odontology; Malmo University; Malmö Sweden
- Scandinavian Center for Orofacial Neurosciences (SCON); Malmö Sweden
| | - Thomas List
- Department of Orofacial Pain and Jaw Function; Faculty of Odontology; Malmo University; Malmö Sweden
- Scandinavian Center for Orofacial Neurosciences (SCON); Malmö Sweden
- Department of Rehabilitation Medicine; Skane University Hospital; Lund Sweden
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences; University at Buffalo; Buffalo New York
| | - Ambra Michelotti
- Department of Orthodontics and Temporomandibular disorders; University of Naples Federico II; Naples Italy
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46
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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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47
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Suzuki S, Arima T, Kitagawa Y, Svensson P, Castrillon E. Influence of glutamate-evoked pain and sustained elevated muscle activity on blood oxygenation in the human masseter muscle. Eur J Oral Sci 2017; 125:453-462. [DOI: 10.1111/eos.12383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Shunichi Suzuki
- Section of Orofacial Pain and Jaw Function; Department of Dentistry and Oral Health, Health; Aarhus University; Aarhus Denmark
- Division of Oral Diagnosis and Medicine; Department of Oral Pathobiological Science; Faculty of Dental Medicine and Graduate School of Dental Medicine; Hokkaido University; Sapporo Japan
- Scandinavian Center for Orofacial Neurosciences (SCON); Aarhus Denmark
| | - Taro Arima
- Section of International Affairs; Faculty of Dental Medicine and Graduate School of Dental Medicine; Hokkaido University; Sapporo Japan
- Clinical Division of Temporomandibular Disorders; Hokkaido University Hospital; Sapporo Japan
| | - Yoshimasa Kitagawa
- Division of Oral Diagnosis and Medicine; Department of Oral Pathobiological Science; Faculty of Dental Medicine and Graduate School of Dental Medicine; Hokkaido University; Sapporo Japan
| | - Peter Svensson
- Section of Orofacial Pain and Jaw Function; Department of Dentistry and Oral Health, Health; Aarhus University; Aarhus Denmark
- Scandinavian Center for Orofacial Neurosciences (SCON); Aarhus Denmark
- Department of Dental Medicine; Karolinska Institutet; Huddinge Sweden
| | - Eduardo Castrillon
- Section of Orofacial Pain and Jaw Function; Department of Dentistry and Oral Health, Health; Aarhus University; Aarhus Denmark
- Scandinavian Center for Orofacial Neurosciences (SCON); Aarhus Denmark
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Abstract
The diagnosis and management of orofacial pain may be challenging due to complex histories, pathophysiology and associated psychosocial co-morbidities such as depression and anxiety. Neuropathic facial pain conditions such as burning mouth syndrome (BMS), persistent idiopathic facial pain (PIFP), atypical odontalgia (AO) and trigeminal neuralgia (TN) require early recognition by primary care clinicians and referral to secondary care. Acute pain-related temporomandibular disorder (TMD) may be managed in the primary care setting, with identification of those at risk of developing chronic TMD receiving an early referral to secondary care. Adopting a biopsychosocial approach, consisting of physical therapies, pharmacotherapy and psychological support can lead to effective management and may limit the negative impact of facial pain upon quality of life and daily functioning.
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49
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Almoznino G, Haviv Y, Sharav Y, Benoliel R. An update of management of insomnia in patients with chronic orofacial pain. Oral Dis 2017; 23:1043-1051. [DOI: 10.1111/odi.12637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/26/2016] [Accepted: 01/03/2017] [Indexed: 01/03/2023]
Affiliation(s)
- G Almoznino
- Department of Oral Medicine; Hebrew University-Hadassah School of Dental Medicine; Jerusalem Israel
- Department of Oral Medicine; Oral and Maxillofacial center; Medical Corps; Israel Defense Forces; Tel-Hashomer Israel
| | - Y Haviv
- Department of Oral Medicine; Hebrew University-Hadassah School of Dental Medicine; Jerusalem Israel
| | - Y Sharav
- Department of Oral Medicine; Hebrew University-Hadassah School of Dental Medicine; Jerusalem Israel
| | - R Benoliel
- Rutgers School of Dental Medicine; Rutgers, The State University of New Jersey; Newark NJ USA
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50
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Breckons M, Bissett SM, Exley C, Araujo-Soares V, Durham J. Care Pathways in Persistent Orofacial Pain: Qualitative Evidence from the DEEP Study. JDR Clin Trans Res 2016; 2:48-57. [PMID: 28879244 DOI: 10.1177/2380084416679648] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Persistent orofacial pain is relatively common and known to have an adverse effect on quality of life. Previous studies suggest that the current care pathway may be problematic, but it is not well understood which health services patients access and what their experience is. The aim of this study was to explore care pathways and their impact from the perspective of patients. Qualitative interviews were conducted with a maximum variation sample of patients recruited from primary (community based) and secondary (specialist hospital based) care in the United Kingdom. Questions focused on the stages in their pathway and the impact of the care that they had received. Interviews were digitally recorded and transcribed verbatim, and analysis followed principles of the constant comparative method. NVivo 10 was used to help organize and analyze data. Twenty-two patients were interviewed at baseline, and 18 took part in a second interview at 12 mo. Three main themes emerged from the data: the "fluidity of the care pathway," in which patients described moving among health care providers in attempts to have their pain diagnosed and managed, occurring alongside a "failure to progress," where despite multiple appointments, patients described frustration at delays in obtaining a diagnosis and effective treatment for their pain. Throughout their care pathways, patients described the "effects of unmanaged pain," where the longer the pain went unmanaged, the greater its potential to negatively affect their lives. Findings of this study suggest that the current care pathway is inefficient and fails to meet patient needs. Future work needs to focus on working with stakeholder groups to redesign patient-centered care pathways. Knowledge Transfer Statement: Data from qualitative interviews conducted with patients with persistent orofacial pain suggest significant problems with the existing care pathway, consisting of delays to diagnosis, treatment, and referral. Patients describing their struggle to progress through the current care pathway highlighted the difficulties occurring while living with orofacial pain. This study suggests a need for a revised care pathway, which better meets the needs of people with persistent orofacial pain.
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Affiliation(s)
- M Breckons
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - S M Bissett
- Centre for Oral Health Research, School of Dental Sciences, Newcastle University, UK
| | - C Exley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - V Araujo-Soares
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - J Durham
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Centre for Oral Health Research, School of Dental Sciences, Newcastle University, UK
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