OBJECTIVE: To compare the effects of two transcutaneous electrical stimulation (TES) patterns applied to the auricular branches of the auriculotemporal nerve on nociceptive processing. METHODS: Twelve asymptomatic volunt...OBJECTIVE: To compare the effects of two transcutaneous electrical stimulation (TES) patterns applied to the auricular branches of the auriculotemporal nerve on nociceptive processing. METHODS: Twelve asymptomatic volunteers received continuous-pattern and intermittent-pattern TES in a randomized crossover design. Each intervention was applied for 30 minutes, with a 72-hour washout period. Pressure pain threshold, temporal summation of pain, and conditioned pain modulation were assessed before and after each session. RESULTS: Between-condition differences were small, with adjusted mean differences close to zero and wide 95% confidence intervals (e.g. PPT left TMJ: 0.18 kg/cm, 95% CI - 0.52 to 1.20), indicating inconclusive results due to limited statistical power. CONCLUSION: In this pilot crossover study, no clear between-intervention differences were detected. The findings should be interpreted as inconclusive and do not support claims of equivalence between continuous and intermittent TES.
BACKGROUND: Temporomandibular disorders (TMDs) are primarily diagnosed clinically using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), while the role of magnetic resonance imaging (MRI) remains selecti...BACKGROUND: Temporomandibular disorders (TMDs) are primarily diagnosed clinically using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), while the role of magnetic resonance imaging (MRI) remains selective. This study evaluated agreement between DC/TMD-based clinical diagnoses and MRI findings in symptomatic patients. METHODS: In this prospective diagnostic agreement study, 85 symptomatic patients diagnosed with TMJ internal derangement using DC/TMD criteria underwent standardized bilateral TMJ MRI. Clinical and imaging findings were compared using sensitivity, specificity, diagnostic accuracy, and Cohen's kappa statistics. Inter-observer reliability for MRI interpretation was also assessed. RESULTS: MRI identified no disc displacement in 30.6%, anterior disc displacement with reduction in 37.6%, anterior disc displacement without reduction in 20.0%, and other findings in 11.8%. Clinical assessment showed sensitivity of 88.6%, specificity of 70.9%, and diagnostic accuracy of 85.9%. Inter-observer MRI agreement was substantial (κ = 0.71). CONCLUSION: DC/TMD clinical assessment demonstrates good agreement with MRI findings; however, MRI provides complementary anatomical information and is best reserved for selected clinical scenarios.
OBJECTIVES: To develop a 3D measurement for horizontal condylar angle (HCA) and investigate its distribution across skeletal patterns and changes following orthognathic and disc repositioning sur-geries. MATERIALS AND ME...OBJECTIVES: To develop a 3D measurement for horizontal condylar angle (HCA) and investigate its distribution across skeletal patterns and changes following orthognathic and disc repositioning sur-geries. MATERIALS AND METHODS: Using a 3D reconstruction approach, 90 non-surgical patients were analyzed for HCA distribution. Surgical effects were evaluated in 50 orthognathic patients (preoperative, post-operative, and follow-up) and 30 disc repositioning patients (preoperative and >1 year postoperative). RESULTS: HCA differed significantly among skeletal patterns (Class II: 23.97±11.81°; Class I: 19.05±11.03°; Class III: 13.61±7.35°). Mandibular advancement caused no immediate change but showed a reduction at follow-up, whereas mandibular setback resulted in a significant immediate increase that remained stable over time. In the disc repositioning group, HCA decreased significantly after surgery. CONCLUSIONS: HCA exhibits a skeletal pattern-specific distribution and adaptive changes following surgery. HCA serves as a simple and reproducible imaging descriptor for documenting morphological adaptation.
OBJECTIVE: This methodological study aimed to evaluate the technical feasibility and accuracy of a semi-automatic cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI) registration technique for the a...OBJECTIVE: This methodological study aimed to evaluate the technical feasibility and accuracy of a semi-automatic cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI) registration technique for the anatomical classification of TMJ disc displacement. METHOD: A total of 61 patients (122 TMJ images) with existing clinical indications for both CBCT (suspected osseous pathology) and MRI examinations were included. Images were processed using a semi-automatic registration system (3D Slicer version 5.2.1, integrated with the Insight Segmentation and Registration Toolkit), combining rigid and elastic transformation algorithms with mutual information metrics. Manual adjustments were required in cases where automatic registration did not meet predefined accuracy thresholds. Diagnostic performance was evaluated by comparing fused CBCT-MRI images with traditional MRI-only assessments. RESULT: The registration accuracy showed high precision, with a Dice similarity coefficient of 0.89 ± 0.04 (range 0.85-0.95) and target registration error of 0.72 ± 0.14 mm (range 0.45-0.79 mm). Manual adjustment was required in 18% of cases to achieve these accuracy levels. The fused images demonstrated superior diagnostic performance, with a sensitivity of 95%, specificity of 93% and area under the receiver operating characteristic curve (AUC) of 0.94, significantly outperforming the MRI-only diagnosis (sensitivity 80%, specificity 89%, AUC 0.82; < 0.05). Based on the disc-condyle angle and disc-condyle distance, the proposed four-grade classification system showed excellent inter-observer consistency (Cohen's Kappa = 0.85) and an intraclass correlation coefficient of 0.88. . CONCLUSION: This methodological study demonstrates the technical feasibility of semi-automatic CBCT-MRI registration for the anatomical characterisation of TMJ disc displacement. Although the technique offers improved anatomical visualisation and measurement objectivity compared with single-modality imaging, its clinical implementation requires careful consideration of radiation exposure (particularly in young patients), cost-benefit analysis and alignment with current evidence indicating that clinical symptoms rather than disc position primarily guide TMD treatment decisions. This approach may have utility in research settings, complex diagnostic scenarios or surgical planning, where both osseous and soft tissue visualisation is already clinically indicated; however, it should not be adopted as routine diagnostic practice for patients with TMD.
OBJECTIVE: To investigate the preliminary adjunctive effects of the Fascial Distortion Model (FDM) and Pilates-based core stability training (CST) as adjuncts to a structured home exercise program (SHEP) for temporomandi...OBJECTIVE: To investigate the preliminary adjunctive effects of the Fascial Distortion Model (FDM) and Pilates-based core stability training (CST) as adjuncts to a structured home exercise program (SHEP) for temporomandibular disorders. METHODS: Thirty patients were allocated to the FDM+SHEP, CST+SHEP, or a control group. Outcome measures included head posture, mandibular mobility, pain intensity, severity, dysfunction, and disability. RESULTS: The FDM+SHEP group demonstrated improvements in jaw function versus the control group and in head posture versus the CST+SHEP group. The FDM intervention led to improvements in laterotrusion and feeding. Both interventional groups showed reductions in pain over time, but the FDM+SHEP group exhibited earlier or more pronounced improvements across various pain intensities versus the CST+SHEP group. CONCLUSION: A larger trial comparing the FDM and CST as adjunctive therapies is feasible. Both approaches, particularly the FDM, show promise for providing adjunctive benefits in reducing pain intensity and improving function. ClinicalTrials.gov: NCT06134310.
OBJECTIVE: To examine sex differences in pain, symptom burden, and psychological distress among adolescents with and without temporomandibular disorders (TMD), and to evaluate these differences in youth reporting or not...OBJECTIVE: To examine sex differences in pain, symptom burden, and psychological distress among adolescents with and without temporomandibular disorders (TMD), and to evaluate these differences in youth reporting or not comorbid headache. METHODS: In this cross-sectional case-control study ( = 115; 57.4% females; age 14.6 ± 2.4 years), adolescents were classified as having TMD or non-TMD based on the validated 3 screening questions for TMD. Participants completed validated measures of pain intensity , symptom burden, and anxiety/depression and stress symptomatology. Sex differences were assessed using t-tests, chi-square tests, correlations, and two-way ANOVA. RESULTS: Compared to males, females reported higher pain intensity (30.7 ± 24.3 vs. 21. ± 21.9; = .032), symptom burden (7.9 ± 3.8 vs. 1.2 ± 1.5; = .006), anxiety/depression (16.3 ± 12.4 vs. 10.8 ± 9.8; = .012) and stress (13.4 ± 5.4 vs. 11.3 ± 4.7; = .030). Within the TMD group ( = 65), females showed higher pain (45.8 ± 16.5 vs. 33.7 ± 19.6; = .010), headache intensity (4.4 ± 2.7 vs. 3.0 ± 2.2, = .036), and symptom burden (7.9 ± 3.8 vs. 1.2 ± 1.5, = .017), whereas males with TMD demonstrated stronger correlations between pain and psychological symptoms (anxiety: r(47) = 0.399, = .006; depression: r(47) = 0.312, = .033). Anxiety/depression scores were higher in participants with TMD and in females, with similar TMD-related increases across sexes. Among youth reporting headache ( = 50), females exhibited greater symptom burden ( = .035), anxiety ( = .017), and stress ( = .040). CONCLUSIONS: Adolescent females show greater pain and psychosocial burden overall and among those with TMD or headache, while in males with TMD, pain intensity was more strongly correlated with anxiety and depression symptoms.
OBJECTIVE: Facial pain attributed to lung cancer (FPLC) is frequently misclassified as persistent idiopathic facial pain (PIFP). This study reviewed published cases, retrospectively applied existing criteria for PIFP to...OBJECTIVE: Facial pain attributed to lung cancer (FPLC) is frequently misclassified as persistent idiopathic facial pain (PIFP). This study reviewed published cases, retrospectively applied existing criteria for PIFP to evaluate misclassification, characterized clinical features of FPLC, and proposed a diagnostic framework. METHODS: A structured search of MEDLINE, Embase, and Web of Science through December 13, 2025, identified 51 English-language case reports of orofacial or pharyngeal pain secondary to lung cancer. Thirty-three cases contained sufficient detail to allow retrospective application of PIFP criteria from leading classification systems. RESULTS: Twenty-seven cases, 81.8%, met criteria for PIFP despite an underlying malignancy. Adding a requirement to exclude systemic disease substantially reduced misclassification. The proposed diagnostic criteria for FPLC demonstrated an 87.9% diagnostic accuracy. CONCLUSION: Idiopathic orofacial pain phenotypes overlap with FPLC. Excluding systemic causes improves the diagnostic validity of classification systems. The consistent clinical profile of FPLC supports the use of defined diagnostic criteria.
OBJECTIVE: This study investigated the effects of laughter on chronic head and neck pain. METHODS: Subjects with chronic head and neck pain of ≥ six months duration occurring at least four days per week participated in t...OBJECTIVE: This study investigated the effects of laughter on chronic head and neck pain. METHODS: Subjects with chronic head and neck pain of ≥ six months duration occurring at least four days per week participated in this pilot cohort study. Differences in self-reported pain were assessed at baseline, Day 7, Day 14, Day 21 and Day 28 using the Short Form McGill Pain Questionnaire (SF-MPQ), Present Pain Intensity (PPI), and Visual Analog Scale (VAS). Self-reported daily compliance with using the LaughMD™ app for laughter therapy was assessed. A generalized estimating equations approach was used to compare pain scores across study timepoints. RESULTS: Thirty-five subjects completed the protocol. Pain scores showed a statistically significant reduction over time. Most [71.4% (n=25)] were compliant with app use. CONCLUSION: Using laughter therapy via an app may be an effective adjunct for managing chronic head and neck pain which are frequent symptoms of orofacial pain.
BACKGROUND: The systemic and psychosocial associations of temporomandibular disorders (TMD) in youth are poorly defined. This study assessed distribution of TMD-related symptoms by age and sex and examined associations w...BACKGROUND: The systemic and psychosocial associations of temporomandibular disorders (TMD) in youth are poorly defined. This study assessed distribution of TMD-related symptoms by age and sex and examined associations with comorbidities in children and adolescents from multiple academic centers. METHODS: Data from BigMouth repository (01/2014-05/2025) included 5-to-17-year-old children and adolescents with completed TMD-related intake items. Painful TMD was defined as self-reported pain upon chewing/talking/jaw use. Symptom distribution was compared by age and sex; associations with comorbidities were assessed using chi-square and multivariable logistic regression. RESULTS: Among 13,678 children and adolescents (12.9±3.5 years, 53.1% female), common symptoms included grinding (13.1%), headaches (11.3%), and temporomandibular joint noises (8.2%). Adolescents (10-17 years) more frequently reported painful TMD (4.2% vs. 2.7%, <.001) and self-reported joint sounds (16.7% vs. 12.02%, <.001) compared to 5-to-9-years-old children. Females reported more painful TMD than males (58.5% vs. 52.8%, =.012). Painful TMD co-occurred with higher prevalence of headaches (29.9% vs. 12.5%), sleep apnea (10.1% vs. 4.3%), depression (39.4% vs. 12.4%) and anxiety (39.7% vs. 23.5%, all p's<0.001) than with non-painful TMD. Youth with higher psychological comorbidity had higher odds of painful TMD (<.001, OR=2.37, 95%CI 1.76, 3.19). CONCLUSIONS: TMD symptoms increase during adolescence. Painful TMD is associated with somatic and psychological comorbidities, highlighting need for early identification and targeted intervention.
OBJECTIVE: Temporomandibular Disorders (TMDs) are debilitating orofacial pain conditions caused by extrinsic or intrinsic injury to the temporomandibular joint (TMJ) with higher prevalence reported in women. Changes in...OBJECTIVE: Temporomandibular Disorders (TMDs) are debilitating orofacial pain conditions caused by extrinsic or intrinsic injury to the temporomandibular joint (TMJ) with higher prevalence reported in women. Changes in innociception, protein expression, and joint structure were investigated in a preclinical TMD model caused by TMJ hyperextension in male and female rats. METHODS: Mechanical nociception was determined using von Frey filaments, protein expression investigated by immunohistochemistry, synovial levels of TNF-α and IL-6 by ELISA, and TMJ morphology by micro-computed tomography. RESULTS: Only female rats exhibited enhanced nociception and TMJ guarding behavior. TMJ hyperextension increased expression of proteins implicated in ascending pain signaling and modulation of proteins associated with the descending pain inhibitory pathway. TNF-α levels were elevated in males and females, while IL-6 was only increased in males. No changes in bone morphology were observed. CONCLUSION: Our findings provide evidence of sexual dimorphism in a novel TMD model caused by a single, transient hyperextension event.
OBJECTIVE: Over the past three decades, temporomandibular joint (TMJ) arthrocentesis has evolved from a mechanical lavage procedure into a sophisticated treatment standard incorporating principles of biological modulatio...OBJECTIVE: Over the past three decades, temporomandibular joint (TMJ) arthrocentesis has evolved from a mechanical lavage procedure into a sophisticated treatment standard incorporating principles of biological modulation and regenerative medicine. The aim of this study is to analyze the global TMJ arthrocentesis literature between 1989 and 2025 using bibliometric methods, thereby objectively mapping the procedure's technical evolution, clinical paradigm shifts (the transition from Axis I to Axis II), and the migration of research focus from surgical technique to biopsychosocial management. MATERIALS AND METHODS: Data were retrieved from the Web of Science Core Collection (WoSCC) database on January 13 2026. A total of 792 original articles and reviews, identified through a comprehensive search strategy, were analyzed using VOSviewer and R-Bibliometrix software regarding annual growth rate, citation networks, conceptual structure, and global collaboration dynamics. RESULTS: The literature was found to be expanding with an annual growth rate of 12.1%, peaking in 2024 in terms of both publication count ( = 74) and citations ( = 1952). While the USA ( = 111) remains the most productive country, Turkey ( = 107) ranks second, demonstrating its strong clinical activity in the field. In citation networks, Nitzan's "anchored disc" theory ( = 314 citations) maintains its central position; however, the rise of Schiffman's DC/TMD criteria ( = 125 citations) and Manfredini's psychosocial studies indicates that success is now contingent more upon patient phenotype than physical parameters. Furthermore, the concepts of "ultrasound guidance" and "regenerative agents" (PRP, HA) have dominated the literature in recent years. CONCLUSION: The TMJ arthrocentesis literature is undergoing a dynamic transformation characterized by surgical minimization and technological integration. Research trends corroborate that the concept of "mechanical success" has yielded to a holistic treatment model constituted by accurate patient selection (Axis II), imaging guidance, and biological regeneration.
OBJECTIVE: TMJ arthritis is common in juvenile idiopathic arthritis (JIA). Condylar height loss can shift mandibular loading and increase compressive TMJ stress, which may persist even when synovitis is controlled with b...OBJECTIVE: TMJ arthritis is common in juvenile idiopathic arthritis (JIA). Condylar height loss can shift mandibular loading and increase compressive TMJ stress, which may persist even when synovitis is controlled with biologics. We hypothesize that light elastics delivered via anchorage devices (TADs) can partially unload the joint. METHODS: This hypothesis driven biomechanical model integrates condylar support loss, lever geometry, hyperdivergent susceptibility, and feasibility of routing low forces through a perioral soft tissue corridor. A cephalad inter implant elastic vector of ~25 to 50 g is evaluated. RESULTS: Condylar height loss is predicted to promote backward mandibular rotation about the pterygomasseteric sling, increasing compression and vertical destabilization, especially in leptoprosopic patterns. The cephalad elastic vector is predicted to generate a counter moment, support posterior vertical neutrality, and reduce joint reaction forces. CONCLUSION: A low force, TAD based adjunct may complement systemic therapy by addressing loading. Imaging studies are needed to confirm.
OBJECTIVE: To conduct the cross-cultural adaptation and psychometric validation of the OHIP-TMDs for Portuguese-speaking populations, developing a unified version that encompasses both European and Brazilian Portuguese v...OBJECTIVE: To conduct the cross-cultural adaptation and psychometric validation of the OHIP-TMDs for Portuguese-speaking populations, developing a unified version that encompasses both European and Brazilian Portuguese variants. METHODS: A bicentric observational study was conducted according to Beaton's guidelines and COSMIN standards. The instrument underwent translation, expert review, and pre-testing. Psychometric validation included 211 individuals with TMD (Portugal: n=98; Brazil: n=113). Internal consistency (Cronbach's α, McDonald's ω), test-retest reliability (ICC), structural validity (CFA), convergent validity (Fonseca Anamnestic Index), and known-groups validity were assessed separately for each country. RESULTS: The OHIP-TMDs-PT demonstrated excellent internal consistency (α=0.98 PT; α=0.96 BR) and reliability (ICC=0.96 PT; ICC=0.94 BR). CFA supported a unidimensional structure in Portugal and a second-order model in Brazil. Strong convergent validity and significant known-groups differences were observed. CONCLUSION: The OHIP-TMDs-PT is a reliable and valid instrument for assessing oral health-related quality of life in individuals with TMD across Lusophone populations.
OBJECTIVE: This study examined the associations between perceived stress, sociodemographic and health-related factors, temporomandibular disorders (TMD), and masticatory muscle thickness assessed by ultrasonography. METH...OBJECTIVE: This study examined the associations between perceived stress, sociodemographic and health-related factors, temporomandibular disorders (TMD), and masticatory muscle thickness assessed by ultrasonography. METHODS: Forty participants were classified into high- and normal-stress groups. Perceived stress, TMD status, and ultrasonographic thickness of the masseter, anterior temporalis, and anterior digastric muscles were assessed. RESULTS: Higher perceived stress was associated with greater TMD prevalence and reduced anterior digastric muscle thickness. Male participants showed greater masseter and digastric muscle thickness. In regression analyses, female gender and high perceived stress were associated with reduced anterior digastric thickness. However, group differences in TMD prevalence and the absence of bruxism assessment limit causal inference. CONCLUSION: Perceived stress and gender were associated with anterior digastric muscle thickness in this exploratory, cross-sectional sample of young adults.
OBJECTIVE: To investigate the association between tinnitus impact and craniofacial and cervical disability, dizziness, anxiety, and depression in individuals with Temporomandibular Disorders (TMDs) and self-reported tinn...OBJECTIVE: To investigate the association between tinnitus impact and craniofacial and cervical disability, dizziness, anxiety, and depression in individuals with Temporomandibular Disorders (TMDs) and self-reported tinnitus. METHODS: A cross-sectional study. Fifty individuals with TMDs and tinnitus completed the Tinnitus Handicap Inventory (THI), Neck Disability Index (NDI), Craniofacial Pain and Disability Inventory (CF-PDI), Dizziness Handicap Inventory (DHI), and Hospital Anxiety and Depression Scale (HADS). Prevalence, correlation. and a multiple linear regression were calculated to verify the association between THI and variables assessed. RESULTS: Individuals with TMD and tinnitus impact have higher prevalence of cervical disability, higher prevalence of dizziness-related impact and higher prevalence of depressive symptoms than those with TMD and no tinnitus impact. THI scores presented positive and moderate correlations with NDI and HADS and 22% of its variance was explained by anxiety symptoms. CONCLUSION: Findings highlight the interplay between emotional and musculoskeletal factors, suggesting comprehensive and multidisciplinary management.
To evaluate signs and symptoms of temporomandibular disorders (TMD) and bruxism in aligner wearers. 87 participants were assessed through virtual questionnaire, while 20 aligner users and 20 controls were clinically foll...To evaluate signs and symptoms of temporomandibular disorders (TMD) and bruxism in aligner wearers. 87 participants were assessed through virtual questionnaire, while 20 aligner users and 20 controls were clinically followed-up for three months. Cluster analysis identified three patient profiles differing in age, pain, and oral behaviors. No association was observed between aligner use and TMD or self-reported bruxism onset. Aligner and control groups showed reduced oral habits over time, suggesting that clear aligner therapy does not increase the risk of TMD or bruxism but may contribute to greater awareness and control of oral parafunctional behaviors.
OBJECTIVES: To investigate the relationship between Type D personality and temporomandibular disorders. METHODS: A cross-sectional study was conducted with 50 participants (25 TMD patients and 25 healthy controls) aged 1...OBJECTIVES: To investigate the relationship between Type D personality and temporomandibular disorders. METHODS: A cross-sectional study was conducted with 50 participants (25 TMD patients and 25 healthy controls) aged 17-61 years. TMD diagnosis was established according to the DC-TMDs. Psychological status was assessed using the GAD-7, PHQ-9, OHIP-14, and DS-14. RESULTS: A significant difference was found between the TMD and control groups in terms of gender. The presence of type D personality disorder showed no significant differences regarding age, gender, education level, occupation and marital status. However, the presence of type D personality disorder showed significant differences regarding GAD-7, PHQ-9, OHIP-14 scores. CONCLUSION: Type D personality was not found to be a significant risk factor for the presence of TMD in this sample. Future studies with larger, more diverse populations are warranted to further clarify the complex interaction between personality traits and TMD pathophysiology.
BACKGROUND: The lateral pterygoid muscle is important for temporomandibular joint function and is closely related to the maxillary artery, which is clinically significant during procedures like botulinum toxin injections...BACKGROUND: The lateral pterygoid muscle is important for temporomandibular joint function and is closely related to the maxillary artery, which is clinically significant during procedures like botulinum toxin injections and infratemporal fossa surgery. METHODS: Thirty hemifaces from human cadavers were dissected. The study documented the number of muscle heads, insertion sites, and the course of the maxillary artery in relation to the muscle (superficial, deep, or transitional). Morphometric measurements included the distance between the maxillary artery and surface landmarks. RESULTS: A two-headed lateral pterygoid muscle was observed in 93.3% of specimens. The superior head most commonly inserts into both the articular disc and joint capsule (60%). The maxillary artery most frequently follows a superficial course (53.3%). The mean vertical distance to the tragus is 13.5 mm, the transverse distance is 34.1 mm, and the mean depth from the zygomatic arch is 23.3 mm. CONCLUSIONS: The observed anatomical variability and morphometric data offer clinically practical guidance to minimize the risk of vascular injury during temporomandibular joint procedures.