OBJECTIVE: This study aimed to determine the prevalence of sleep disturbance among patients with temporomandibular disorders (TMDs) and to identify clinical and psychological predictors associated with its presence. METH...OBJECTIVE: This study aimed to determine the prevalence of sleep disturbance among patients with temporomandibular disorders (TMDs) and to identify clinical and psychological predictors associated with its presence. METHODS: This retrospective cross-sectional study analyzed clinical records of 299 adult patients diagnosed with TMDs at a tertiary orofacial pain clinic between 2016 and 2021. Sleep disturbance was defined as the presence of pain-related sleep interference based on the Thai Brief Pain Inventory and clinical documentation. Variables included TMDs subtypes, pain intensity, number of facial pain sites, presence of widespread pain, fibromyalgia risk, bruxism, and psychological distress. Multivariable logistic regression then was performed to identify independent predictors. RESULTS: Sleep disturbance was reported by 62.2% (113/299) of patients. Univariable analyses showed significant associations with muscle pain - related TMDs (OR = 2.08, < .001), widespread pain (OR = 1.70, = .001), and anxiety/depression (OR = 2.23, < .001). TMJ disorders were inversely associated with sleep disturbance (OR = 0.64, = .002). Patients with sleep disturbance also demonstrated higher pain intensity and a more facial pain sites ( < .001for both comparisons). In multivariable analysis, anxiety/depression remained the only independent predictor (OR = 2.55, 95%, = .023). CONCLUSION: Sleep disturbance was common among patients with TMDs. Psychological distress was strongly associated with sleep disturbance. These findings suggest that routine assessment of sleep and psychological factors may be useful in the management of TMDs.
OBJECTIVES: All arthrocentesis techniques relied on fixed points measured from the cantho-tragal line. However, joint anatomy differs substantially in the different temporomandibular joint disorders (TMD). This study int...OBJECTIVES: All arthrocentesis techniques relied on fixed points measured from the cantho-tragal line. However, joint anatomy differs substantially in the different temporomandibular joint disorders (TMD). This study introduces a novel technique, uses patient-specific points without reference to cantho-tragal line, and compares it with two conventional techniques. METHODS: A total of 144 TMJs were divided into group A (disc displacement without reduction with limitation) and group B (degenerative joint disease). Each group was subdivided into 3 groups according to the technique applied. Nitzan et al. technique (10/2, 20/10 points) in group 1; Alkan and Etöz technique (10/2, 7/2 points) in group 2; and the novel technique (two points in glenoid fossa summit) in group 3. RESULTS: Group 3 showed better results than groups 1 and 2 in success rate, relocations number, procedure duration, and early pain and maximum mouth opening. CONCLUSION: The novel technique may be more promising in TMD.
OBJECTIVES: To investigate the association between early smoking onset (SO) and TMD symptoms among adults, and assess whether smoking intensity mediates this association. METHODS: This secondary analysis used data from t...OBJECTIVES: To investigate the association between early smoking onset (SO) and TMD symptoms among adults, and assess whether smoking intensity mediates this association. METHODS: This secondary analysis used data from the Brazilian Longitudinal Study of Ageing (ELSI-Brazil). TMD symptoms were assessed using the Fonseca Anamnestic Index. Inverse probability weighting balanced early-life confounders and estimated risk differences (RD) and risk ratios (RR). Robustness was evaluated using positive (POC) and negative (NOC) outcome controls outcomes and E-values. Mediation analysis was conducted among smokers. RESULTS: 7,103 individuals were assessed. The RD comparing initiation before age 15 with never smoking was 0.06 (95% CI: 0.01, 0.11), corresponding to an RR of 1.37 (95% CI: 1.08, 1.72). POC, NOC, and E-values suggested residual confounding was unlikely to explain findings. No mediation via smoking intensity was observed. CONCLUSION: Early SO is associated with higher TMD risk overall. Preventing early initiation, especially before age 15, may reduce TMD burden.
OBJECTIVE: The relationship between craniofacial pattern and upper airway function remains incompletely understood. METHODS: This study investigated differences in upper pharyngeal airway morphology and airflow character...OBJECTIVE: The relationship between craniofacial pattern and upper airway function remains incompletely understood. METHODS: This study investigated differences in upper pharyngeal airway morphology and airflow characteristics among young adults with skeletal Classes I, II, and III according to the ANB angle. Three-dimensional (3D) models were reconstructed from CBCT images. Morphological parameters, including total airway volume and minimum cross-sectional area (mCSA), were measured. Computational fluid dynamics simulations were performed to evaluate airflow velocity and maximum pressure within the human upper airway (HUA). RESULTS: Class II subjects exhibited significantly reduced airway volume and mCSA, compared with Class I and Class III subjects. These anatomical differences were associated with higher airflow velocity and increased airway suggesting greater airflow resistance. In contrast, individuals with Class III demonstrated larger airway spaces with lower airflow velocity and pressure. CONCLUSION: Skeletal pattern significantly influences both airway morphology and airflow behavior. Class II individuals exhibit narrower airways and higher resistance, whereas Class III individuals present more favourable airway characteristics.
BACKGROUND AND OBJECTIVE: Insomnia, a highly prevalent sleep disorder, adversely affects daytime functioning, cognitive performance, and overall health, increasing the risk of cardiovascular, metabolic, and psychiatric c...BACKGROUND AND OBJECTIVE: Insomnia, a highly prevalent sleep disorder, adversely affects daytime functioning, cognitive performance, and overall health, increasing the risk of cardiovascular, metabolic, and psychiatric conditions. While pharmacotherapy offers short-term relief, it carries risks of side effects and dependence. Cognitive-behavioral therapy for insomnia, though effective, faces accessibility challenges. This review evaluates EEG-based neurofeedback (EEG-NF) as a non-pharmacological alternative for insomnia management. METHODS: A systematic literature search was conducted in PubMed, Scopus, and PsycNet databases over the past decade (2014-2025) to inform this narrative review. From 179 initially identified records, 16 original studies were selected for descriptive synthesis. RESULTS: Analysis indicates that EEG-NF protocols are promising for improving sleep. Studies report significant enhancements in both subjective sleep quality (measured by tools like the PSQI) and objective parameters such as sleep onset latency and total sleep time. The method facilitates self-regulation of brain activity to counter hyperarousal, demonstrating a favorable safety profile with benefits most pronounced in primary insomnia. Key advantages include non-invasiveness, personalization, and potential for home-based use. Current limitations involve small sample sizes, protocol heterogeneity, and a lack of long-term efficacy data. CONCLUSION: EEG-NF represents a promising and safe non-pharmacological approach that warrants further investigation as a potential component of personalized insomnia management. However, larger controlled trials with standardized protocols are needed to establish its comparative efficacy relative to established treatments such as CBT-I. Future research should prioritize standardized protocols, large-scale multicenter trials, and technological advancements to enhance accessibility and confirm long-term benefits.
BACKGROUND: Temporomandibular joint (TMJ) arthrocentesis is a minimally invasive procedure widely used for internal derangement and inflammatory TMJ disorders. PURPOSE: To analyze publication trends, leading contributors...BACKGROUND: Temporomandibular joint (TMJ) arthrocentesis is a minimally invasive procedure widely used for internal derangement and inflammatory TMJ disorders. PURPOSE: To analyze publication trends, leading contributors, and thematic evolution in TMJ arthrocentesis research. MATERIALS AND METHODS: A retrospective bibliometric analysis was performed using the Web of Science Core Collection, including 822 publications published between 1990 and 2025. RESULTS: Publication output increased markedly after 2010, with the United States and Turkey as leading contributors. Early research focused on mechanical lavage and lysis, whereas recent studies emphasize biologic adjuncts such as platelet-rich plasma and hyaluronic acid. CONCLUSION: TMJ arthrocentesis research has shifted toward biologically oriented strategies, reflecting a significant shift in research focus and publication trends within the field of TMD management.
OBJECTIVE: TMJ arthrocentesis is a minimally invasive treatment for temporomandibular disorders, but its complication profile is not fully defined. This study evaluated the incidence and spectrum of associated adverse ev...OBJECTIVE: TMJ arthrocentesis is a minimally invasive treatment for temporomandibular disorders, but its complication profile is not fully defined. This study evaluated the incidence and spectrum of associated adverse events. METHODS: PubMed/MEDLINE, Embase, and Scopus were systematically searched for human studies reporting complications, including trials, observational studies, case series, and case reports. All were qualitatively reviewed; only studies with extractable numerical data were meta-analyzed. RESULTS: Forty-six studies were included; 23 reported numerical data and 13 entered the meta-analysis. The pooled complication rate was ~11% (95% CI 5-18%) with high heterogeneity; excluding isolated post-procedural pain gave ~9%. Most events were minor and transient, especially periarticular swelling and temporary facial nerve dysfunction. Clinically significant complications (hematoma, infection, vascular injury) were rare (<1%), while severe events were limited to case reports. CONCLUSION: TMJarthrocentesis is a low-risk procedure. Substantialheterogeneity warrant cautious interpretation and highlight the needfor standardized assessment.
BACKGROUND: Temporomandibular disorders (TMDs) have been the subject to controversy for over a century, with early theories focusing on anatomical structures and their relationships. OBJECTIVE: The paper aims to examine...BACKGROUND: Temporomandibular disorders (TMDs) have been the subject to controversy for over a century, with early theories focusing on anatomical structures and their relationships. OBJECTIVE: The paper aims to examine the historical evolution of TMD concepts and the transition from mechanistic to biopsychosocial models, exploring the impact on diagnosis and therapy. RESULTS: Studies have either disproven or failed to support the early mechanistic models, thus leading to the establishment of the current evidence-based approach. The advent of postgraduate programs in orofacial pain and clinical practice guidelines has contributed to the standardization of TMD training on a global scale. DISCUSSION: Despite the compelling evidence supporting the modern model, some practitioners continue to resist these changes. The authors argue that this resistance can be construed as a denial of the well-established scientific findings that have emerged in this field. CONCLUSION: TMD diagnosis and management undergone significant advancements; however, ongoing research is imperative. The authors advocate for the broader acceptance of the evidence-based biopsychosocial model to ensure ongoing progress in the field.
OBJECTIVE: To compare rotation of the C2 vertebra in axial CBCT sections of adults with mandibular asymmetry. METHODS: CBCTs of 66 individuals obtained with an iCAT-Q Vision device were classified into three groups (22 e...OBJECTIVE: To compare rotation of the C2 vertebra in axial CBCT sections of adults with mandibular asymmetry. METHODS: CBCTs of 66 individuals obtained with an iCAT-Q Vision device were classified into three groups (22 each) according to menton deviation from the midsagittal plane (mild, moderate, severe). Coronal, axial, and three-dimensional linear measurements were obtained. Data were analyzed using the Shapiro-Wilk test. Differences between the chin deviation side and the contralateral side were assessed with paired t-test, and among groups with ANOVA followed by Tukey's post hoc test. RESULTS: A statistically significant difference in C2 rotation was observed between groups (p = .031) and in contralateral Co-Go measurements between mild and severe groups (p = .034). Within-group analysis showed a difference in the severe group (p < .05). CONCLUSIONS: Individuals with severe mandibular asymmetry exhibit greater C2 vertebral rotation relative to the coronal plane than those with mild asymmetry.
OBJECTIVE: Obstructive sleep apnea is a sleep-related breathing disorder characterized by complete/partial upper airway obstruction. The majority of patients with OSA remain undiagnosed. A screening tool is necessary to...OBJECTIVE: Obstructive sleep apnea is a sleep-related breathing disorder characterized by complete/partial upper airway obstruction. The majority of patients with OSA remain undiagnosed. A screening tool is necessary to stratify patients based on their clinical symptoms, physical examination findings, and risk factors. Therefore, this study was conducted using the modified STOP-Bang questionnaire to investigate the risk of OSA in addition to chronic mouth breathing among adults in the Gaza Strip in Palestine who are living in very difficult circumstances as a result of the war. METHODS: 1000 participants (500 males and 500 females) were selected in the Gaza Strip. The participants were asked to fill in the modified STOP-Bang questionnaire. Data were subjected to statistical analysis using tests including the Chi-Square test, Fisher's Exact test, Independent Sample t-test, and Binary Logistic Regression. RESULTS: The proportion of participants identified at intermediate risk for obstructive sleep apnea (OSA) was 20.9%, whereas the proportion at high risk was 6.1%, as determined by the modified STOP-Bang questionnaire. The prevalence of OSA was highest in the older age group ≥ 50 years, especially among males. 25.1% of the participants complained of loud snoring. The results also revealed that snorers were more likely to experience trouble breathing through their nose and breathing through their mouth during sleep and had a substantially higher risk of OSA with an increased propensity for upper airway collapse. CONCLUSION: The modified STOP-Bang screening method showed a proportion of 6.1% of high-risk OSA, especially in old age; males had a higher prevalence of OSA than females. The study also concluded that chronic mouth breathing may contribute to sleep-disordered breathing and obstructive sleep apnea (OSA).
OBJECTIVE: To assess early temporomandibular joint (TMJ) adaptation by evaluating angular and volumetric changes of the mandibular condyle relative to the cranial base in skeletal Class III patients following orthognathi...OBJECTIVE: To assess early temporomandibular joint (TMJ) adaptation by evaluating angular and volumetric changes of the mandibular condyle relative to the cranial base in skeletal Class III patients following orthognathic surgery using computed tomography (CT). METHODS: Forty-five skeletal Class III patients treated with bilateral sagittal split ramus osteotomy and Le Fort I osteotomy were retrospectively evaluated. Preoperative and postoperative CT scans were reconstructed into three-dimensional models and superimposed using stable cranial base references. Angular changes of the proximal segment in the sagittal, coronal, and axial planes, along with regional and total condylar volume changes, were analyzed. RESULTS: A statistically significant but limited bilateral decrease in condylar volume was observed postoperatively ( < .05). Regional analysis demonstrated predominant resorption in the posterior and anterolateral regions and apposition in the anteromedial and anterior-central regions. Increased axial condyle - coronoid angles and decreased sagittal posterior condylar angles indicated medial and counterclockwise rotation of the proximal segment. No significant correlation was found between angular and volumetric changes. CONCLUSION: Early TMJ adaptation after Class III orthognathic surgery appears predictable and remains within physiological limits, emphasizing the multifactorial nature of condylar remodeling.
OBJECTIVE: To investigate whether fixed orthodontic treatment affects sleep and awake bruxism activities, temporomandibular disorder (TMD) prevalence, and pressure pain thresholds (PPTs) of masticatory muscles in healthy...OBJECTIVE: To investigate whether fixed orthodontic treatment affects sleep and awake bruxism activities, temporomandibular disorder (TMD) prevalence, and pressure pain thresholds (PPTs) of masticatory muscles in healthy adults. METHODS: In this prospective controlled cohort study, 10 orthodontically treated adults and 10 age- and sex-matched untreated controls were assessed at baseline, 14 days, 1 month, and 6 months using 24-h electromyographic recordings of the masseter muscle, diagnostic criteria for TMD, and PPTs of masticatory muscles. RESULTS: No significant intra- or inter-group differences emerged in sleep or awake bruxism indices or TMD prevalence. However, orthodontic patients showed greater jaw functional limitation at 1 and 6 months, together with reduced masseter, occipital, and sternocleidomastoid PPTs between 1 and 6 months. CONCLUSIONS: Fixed multibracket therapy did not affect bruxism indices or TMD prevalence over 6 months, but was associated with transient jaw functional limitation and a modest reduction in cranio-cervical PPTs.
Bruxism should be conceptualize as a plural, since it groups different oral motor behaviors that are performed by all individuals during sleep and wakefulness.In the early era, bruxism was considered a synonym of teeth g...Bruxism should be conceptualize as a plural, since it groups different oral motor behaviors that are performed by all individuals during sleep and wakefulness.In the early era, bruxism was considered a synonym of teeth grinding linked to the psychological sphere, thus having a specific meaning (e.g. manifestation of anxiety, anger, frustration). Since the '90s, focus has progressively shifted towards the identification of generator patterns for a rhythmic masticatory muscle activity (RMMA) associated with sleep arousals, considered a biomarker for sleep bruxism (SB). This model lacks validity.In this commentary, a biopsychosocial model of bruxism is presented, based on the hypothesis of a neural load discharge that may explain the multifaceted bruxism activities over the 24 hours. They may be just a purposeless sign of motoneuronal activation, or purposeful, goal-oriented behaviors from the perspective of the human being, regardless of the clinical consequences, if any.
OBJECTIVE: This study evaluated whether ultrasound (US) guidance improves the effectiveness of arthrocentesis combined with platelet-rich plasma (PRP) in treating temporomandibular joint (TMJ) internal derangements, base...OBJECTIVE: This study evaluated whether ultrasound (US) guidance improves the effectiveness of arthrocentesis combined with platelet-rich plasma (PRP) in treating temporomandibular joint (TMJ) internal derangements, based on MRI and clinical outcomes. METHODS: In this prospective randomized study (October 2023-March 2024), 42 patients were equally divided into US-guided and conventional groups. All underwent Type II single-puncture arthrocentesis. Clinical assessments included Visual Analog Scale (VAS) and maximum mouth opening (MMO). Procedure times were recorded separately. MRI evaluated disc-condyle alignment, joint effusion, capsular width, and bone marrow edema. Follow-ups were conducted preoperatively and at 1 week, 1 month, and 3 months, with MRI at 3 months. . RESULTS: The US group showed faster early improvement in MMO. However, no significant differences were found between groups in VAS or MMO at 3 months ( > .05). Procedure time was longer in the US group ( < .05). MRI findings were similar between groups. CONCLUSION: US guidance enabled faster early recovery, but both methods showed comparable clinical and radiological outcomes at 3 months.
OBJECTIVE: To evaluate side-specific bone growth and remodeling of the mandibular joint structures in adolescents with unilateral temporomandibular joint osteoarthritis after stabilization splint therapy. METHODS: This r...OBJECTIVE: To evaluate side-specific bone growth and remodeling of the mandibular joint structures in adolescents with unilateral temporomandibular joint osteoarthritis after stabilization splint therapy. METHODS: This retrospective study analyzed paired baseline and follow-up cone-beam computed tomography images from 132 adolescents treated with stabilization splints. Changes over time were calculated for linear and volumetric measurements of the mandibular condyle and articular eminence. Differences between affected and contralateral sides were statistically compared, with additional analyses adjusting for age and sex. Measurement reliability was assessed. RESULTS: The contralateral side demonstrated greater increases in condylar dimensions, whereas the affected side showed limited condylar change with compensatory remodeling of the articular eminence. CONCLUSION: Stabilization splint therapy was associated with asymmetric but complementary skeletal responses during adolescence.
OBJECTIVE: The purpose of this study was to evaluate whether menopause is associated with symptoms related to central sensitization, pressure pain threshold, and conditioned pain modulation in women with painful TMD. MET...OBJECTIVE: The purpose of this study was to evaluate whether menopause is associated with symptoms related to central sensitization, pressure pain threshold, and conditioned pain modulation in women with painful TMD. METHODS: This cross-sectional study evaluated 45 women with painful TMD, divided into three groups: regular menstrual cycle ( = 15), menopause with hormone replacement ( = 16), and menopause without hormone replacement ( = 14). The Central Sensitization Inventory and the pressure pain threshold and conditioned pain modulation tests were applied. RESULTS: The group without hormone replacement had lower pressure pain threshold in the right masseter ( = .008) and left masseter ( = .007) compared to the regular cycle group. Pain modulation was impaired in the without hormone replacement group when assessing the right masseter ( = .019), left masseter ( = .005), and tenar of the nondominant hand ( = .046). The Central Sensitization Inventory score did not differ between groups. CONCLUSION: This study suggests that menopause without hormone therapy is associated with increased pain sensitivity within the trigeminal territory.
BACKGROUND: Temporomandibular joint (TMJ) disc displacement has an unclear clinical importance in temporomandibular disorders (TMD), which has been shown to vary depending on the presence of concomitant muscle disorders....BACKGROUND: Temporomandibular joint (TMJ) disc displacement has an unclear clinical importance in temporomandibular disorders (TMD), which has been shown to vary depending on the presence of concomitant muscle disorders. OBJECTIVE: Determine differences in associations between disc displacement/muscle disorders and pain/function and quality of life (QoL). METHODS: Clinical data from 100 TMD patients were analyzed. Patients were separated into disc displacement (DD) (n = 35), muscle disorder (MD) (n = 30), and DD+MD (n = 35) groups. Pain (visual analog scale [VAS]), function (Helkimo Index), and QoL (OHIP-14) scores were compared among groups using regression models adjusted for relevant covariates. RESULTS: The DD+MD group had significantly worse pain scores, functional limitation, and QoL (p < 0.001). DD was independently associated with pain and function (but not QoL) after controlling for covariates. CONCLUSION: TMJ DD is not an independent driver of pathology but is instead amplified in the presence of muscle disorders.