INTRODUCTION: A bidirectional interaction may exist between temporomandibular disorders (TMD) and otologic symptoms. This study aimed to evaluate changes in patient-reported otologic symptoms following temporomandibular...INTRODUCTION: A bidirectional interaction may exist between temporomandibular disorders (TMD) and otologic symptoms. This study aimed to evaluate changes in patient-reported otologic symptoms following temporomandibular joint (TMJ) arthrocentesis. MATERIALS AND METHODS: This retrospective cohort study included 40 patients who underwent TMJ arthrocentesis. Demographic data, TMJ-related clinical findings, otologic symptoms, and visual analog scale (VAS) scores were assessed preoperatively and at a 30-day follow-up. RESULTS: .The majority of patients were female (82.5%), with a mean age of 35.4 ± 11.03 years. Significant reductions were observed in otalgia and tinnitus after arthrocentesis (p < .05). No significant changes were detected in hearing loss or vertigo (p > .05). VAS scores showed significant improvement in TMD symptoms, otalgia, and tinnitus, while hearing loss and vertigo remained unchanged. CONCLUSION: TMJ arthrocentesis was associated with subjective improvement in otalgia and tinnitus in patients with TMD, whereas hearing loss and vertigo showed no significant change.
OBJECTIVE: To evaluate supervised machine learning (ML) models for classifying temporomandibular joint (TMJ) disc displacement on MRI using morphometric and signal intensity features. METHODS: This retrospective study an...OBJECTIVE: To evaluate supervised machine learning (ML) models for classifying temporomandibular joint (TMJ) disc displacement on MRI using morphometric and signal intensity features. METHODS: This retrospective study analyzed 324 TMJs from 162 individuals who underwent 3T MRI. Extracted features included condylar anteroposterior and mediolateral diameters, disc and condyle morphology, and lateral pterygoid muscle signal intensity ratios. Six ML algorithms (Random Forest, Gaussian Naïve Bayes, Logistic Regression, AdaBoost, Gradient Boost, and k-Nearest Neighbor) were evaluated using stratified 5-fold cross-validation. Performance was assessed with accuracy, macro-averaged recall, precision, F1-score, and ROC-AUC. RESULTS: All models demonstrated good classification performance (ROC-AUC >0.80). AdaBoost achieved the highest ROC-AUC (0.88), while Gaussian Naïve Bayes showed the most balanced overall metrics. Mediolateral condylar diameter and disc morphology were key features associated with disc displacement categories. CONCLUSIONS: ML models can identify MRI-based morphometric patterns related to TMJ disc displacement and may support radiologic assessment, while clinical diagnosis should continue to rely on established standards of care.
OBJECTIVE: This study utilized a meta-analysis of two-sample Mendelian randomization (MR) to investigate the causal link between multiple sclerosis (MS) and trigeminal neuralgia (TN). METHODS: Using genetic summary data...OBJECTIVE: This study utilized a meta-analysis of two-sample Mendelian randomization (MR) to investigate the causal link between multiple sclerosis (MS) and trigeminal neuralgia (TN). METHODS: Using genetic summary data from the OpenGWAS database (European descent), researchers identified eight MS GWAS studies as exposures and one TN study as the outcome. Ten MR approaches, including IVW and MR-Egger, were employed. Pooled estimates were calculated using a fixed-effects inverse-variance model, with significance set at P < 0.05. RESULTS: Seven of the eight MS exposures showed a positive causal association with TN. The meta-analysis confirmed that MS significantly increases TN risk by 11% (IVW: 95% CI = 1.05-1.16; P < 0.001). Sensitivity analyses indicated no evidence of pleiotropy or heterogeneity, ensuring robust findings. CONCLUSION: Genetic predisposition to MS is a causal factor for TN. Further research is required to explore underlying biological pathways and validate these results across diverse populations.
OBJECTIVE: To assess associations between temporomandibular disorder (TMD) subtypes and oral health-related quality of life (OHRQoL) using meta-analysis. METHODS: A systematic search of MEDLINE, PubMed, Web of Science, a...OBJECTIVE: To assess associations between temporomandibular disorder (TMD) subtypes and oral health-related quality of life (OHRQoL) using meta-analysis. METHODS: A systematic search of MEDLINE, PubMed, Web of Science, and the Cochrane Library identified studies up to 6 March 2024 using DC/TMD for TMD diagnosis and OHIP-based OHRQoL outcomes. Two reviewers independently screened records, extracted data, and assessed risk of bias. Standardized mean differences (SMDs) were pooled, and sensitivity analyses were performed. RESULTS: Five studies comprising 3,267 participants were included. Compared with intra-articular TMD (IT), pain-related TMD (PT) and combined TMD (CT = PT + IT) were associated with poorer overall OHRQoL (SMD = 0.74, P < 0.001 for PT; SMD = 0.84, P < 0.001 for CT). Direct comparison showed CT had a more pronounced negative impact than PT (SMD = 0.13, P < 0.01). PT and CT also showed greater impairments in functional and psychosocial OHRQoL domains. Sensitivity analyses supported the robustness of findings. CONCLUSION: Patients with PT and CT symptoms exhibit significantly greater impairments in overall and domain-specific OHRQoL compared with those with IT symptoms, despite the limited number of studies included, highlighting the need for tailored treatment strategies based on TMD subtype. REGISTRATION: PROSPERO (CRD42024544762).
BACKGROUND: Patient-Reported Outcome Measures (PROMs) serve as critical tools for quantifying patient's subjective experience. The aim of this study was to systematically identify and synthesize the psychometric properti...BACKGROUND: Patient-Reported Outcome Measures (PROMs) serve as critical tools for quantifying patient's subjective experience. The aim of this study was to systematically identify and synthesize the psychometric properties of TMD-specific PROMs. METHODS: A systematic search was conducted until September 15, 2025. Studies reporting on the development, validation, or cross-cultural adaptation of TMD-specific PROMs were included. Data on psychometric properties were narratively synthesized. RESULTS: The review of 91 studies yielded 43 PROMs. The Fonseca Anamnestic Index was the most extensively validated screening tool. Jaw Functional Limitation Scale, Tampa Scale for Kinesiophobia, and the Oral Health Impact Profile for TMD demonstrated excellent reliability (Cronbach's α often >0.85-0.95) and cross-cultural validity. Test-retest reliability was strong for most tools (ICCs commonly >0.80), and convergent validity showed moderate-to-strong correlations with established measures. CONCLUSION: Numerous validated PROMs for TMDs are available, however future work should focus on developing integrated tools with extensive validation.
OBJECTIVES: To evaluate the long-term effectiveness of arthrocentesis in patients with TMJ disc displacement without reduction (DDWoR) and to identify prognostic factors that may influence treatment outcomes. METHODS: T...OBJECTIVES: To evaluate the long-term effectiveness of arthrocentesis in patients with TMJ disc displacement without reduction (DDWoR) and to identify prognostic factors that may influence treatment outcomes. METHODS: This study comprised 78 patients diagnosed with TMJ/DDWoR according to the DC/TMD and treated with arthrocentesis between 2014 and 2022. Patients were evaluated preoperatively, postoperatively, and at long-term follow-up using the Visual Analog Scale (VAS) for pain and maximum mouth opening (MMO) for function. Treatment success was assessed according to clinician-assessed criteria and patient self-evaluation. RESULTS: Significant improvements in both pain and function were observed postoperatively and sustained through long-term follow-up (both < .001). The success rate was 53.85% according to clinician-assessed criteria and 56.41% based on patient-reported outcomes. VAS scores were significantly associated with success outcomes across all time points ( < .05). Age showed a statistically significant positive association with self-evaluation success ( = .035). CONCLUSION: Results support that arthrocentesis is an effective treatment option for patients with TMJ/DDWoR.
BACKGROUND: Bruxism, the most common repetitive oral behavior, is reported widely in young adults due to excessive stress and sleep abnormalities. If left undiagnosed, it may cause pathologic alteration in condylar morph...BACKGROUND: Bruxism, the most common repetitive oral behavior, is reported widely in young adults due to excessive stress and sleep abnormalities. If left undiagnosed, it may cause pathologic alteration in condylar morphology. METHODS: This Institutional Ethics Committee approved cross-sectional comparative study comprised of 100 patients, equally divided into groups. The study group diagnosed based on the self-reported questionnaire while control group patients were recruited retrospectively. The patients were evaluated using CBCT. RESULTS: Flattening 26 (52%) and sclerosis 31 (62%) were more frequent in bruxers than non-bruxers ( < .05). Surface erosion 4 (8%) and osteophytes 14 (28%) were also noted in bruxers. Interestingly, non-bruxers also showed osteophytes 16 (32%) and surface erosion 9 (18%), which became the point to be focused on. CONCLUSION: Condylar alterations were more frequently observed in participants with possible bruxism. Prompt intervention can be inculcated to halt progress of the condition. TRIAL REGISTRATION: The study has been registered under Clinical trial registry - India (CTRI registration number: CTRI/2023/05/052782) on May 17, 2023.
OBJECTIVE: To review and synthesize published case reports on the use of sphenopalatine ganglion (SPG) block in orofacial and headache disorders, focusing on techniques and clinical outcomes. METHODS: A review of 55 case...OBJECTIVE: To review and synthesize published case reports on the use of sphenopalatine ganglion (SPG) block in orofacial and headache disorders, focusing on techniques and clinical outcomes. METHODS: A review of 55 case reports and series extracted data on 29 papers, including diagnoses, SPG block technique, anesthetic or drug, outcomes, and adverse effects. RESULTS: SPG block was reported in trigeminal neuralgia and neuropathies, burning mouth syndrome, non-specified facial pain, autonomic cephalalgias, migraine, tension type headache, COVID related headache and acute cephalalgias. The most frequently used technique was intranasal with cotton tip applicators, with lidocaine 2-10% as the most common agent. Most reports document relief, but long-term data is not available. Neurogenic pain conditions and migraine showed superior therapeutic responses to the SPG block procedure. CONCLUSION: SPG block appears effective and safe, though higher-level evidence is still needed.
INTRODUCTION: Oral dysesthesia (OD) is a chronic orofacial pain disorder characterized by abnormal sensations - burning, tingling, altered taste, or phantom foreign body perception without identifiable mucosal pathology....INTRODUCTION: Oral dysesthesia (OD) is a chronic orofacial pain disorder characterized by abnormal sensations - burning, tingling, altered taste, or phantom foreign body perception without identifiable mucosal pathology. Frequently conflated with Burning Mouth Syndrome, OD exhibits a heterogeneous clinical profile warranting distinct diagnostic consideration. METHODS: This narrative review explored potential mechanisms underlying OD, including peripheral and central sensitization, neurotransmitter imbalances, hormonal and psychosomatic influences, and proprioceptive dysregulation, particularly neurosensory mismatch involving trigeminal proprioceptive and nociceptive convergence. RESULTS: Proprioceptive dysregulation may contribute to OD through processes analogous to phantom limb phenomena. Current management - pharmacologic, behavioral, and neuromodulatory - remains limited by mechanistic non-specificity. Preliminary concepts of a custom-fabricated oral device suggest it may modulate proprioception, provide sensory gating, mechanical protection, and potential drug delivery as a non-pharmacologic adjunct. CONCLUSION: Theoretical application of such a device could influence maladaptive feedback loops, representing a potential multimodal therapeutic approach that warrants further investigation.
OBJECTIVE: To evaluate the knowledge of Italian physiotherapists regarding temporomandibular disorders (TMD) management and to investigate the use of evidence-based strategies. METHODS: A survey was distributed to 412 It...OBJECTIVE: To evaluate the knowledge of Italian physiotherapists regarding temporomandibular disorders (TMD) management and to investigate the use of evidence-based strategies. METHODS: A survey was distributed to 412 Italian physiotherapists collecting data on demographics, education, TMD knowledge, assessment, and treatment strategies. RESULTS: Most respondents (73.3%) reported no formal TMD training during their bachelor, and more than half (51.0%) treated no TMD patients in an average month. 67.2% provided a TMDs definition according to literature, and 92.0% recognized the primary structural pain generators. 21.8% were familiar with the DC/TMD diagnostic criteria, while misconceptions persisted regarding occlusion (26.7% endorsing a causal role) and posture (28.6%). 81.1% used education , and 88.3% adopted a multimodal strategy consistent with guidelines. CONCLUSIONS: Italian physiotherapists showed good general TMDs knowledge and frequent use of guideline-consistent treatment. However, limited undergraduate exposure, variable postgraduate education, and persisting misconceptions highlight the need for more standardized and evidence-based training in this context.
OBJECTIVE: To evaluate whether phenotypic classification according to the PALM framework (pharyngeal collapsibility, arousal threshold, loop gain, and muscle responsiveness) can predict postoperative outcomes in patients...OBJECTIVE: To evaluate whether phenotypic classification according to the PALM framework (pharyngeal collapsibility, arousal threshold, loop gain, and muscle responsiveness) can predict postoperative outcomes in patients with obstructive sleep apnea (OSA) undergoing maxillomandibular advancement (MMA). Secondary objectives were to explore its usefulness in preoperative planning and to assess the influence of body mass index (BMI) on surgical response. METHODS: A retrospective study was conducted on 59 patients with OSAS who underwent MMA between 2017 and 2023. Patients were classified using a modified PALM system based on preoperative AHI and therapeutic CPAP pressure requirements. Postoperative outcomes were assessed by polysonnography, and regression analyses examined the relationship between percentage changes in AHI and BMI. RESULTS: PALM 1 patients showed a significantly greater reduction in AHI compared with PALM 2 patients and higher rate of surgical success.No significant correlation was found between changes in AHI and BMI. CONCLUSION: PALM phenotyping demonstrated predictive value for MMA outcomes, supporting a more personalized approach to OSA management.
OBJECTIVE: To compare asymmetry in occlusal contact area, number of occlusal contact points, and number of occluding tooth pairs between healthy individuals and patients with temporomandibular disorders (TMDs) categorize...OBJECTIVE: To compare asymmetry in occlusal contact area, number of occlusal contact points, and number of occluding tooth pairs between healthy individuals and patients with temporomandibular disorders (TMDs) categorized by the DC/TMD. METHODS: A cross-sectional analytical study was conducted on 49 participants aged 18-45 years, divided into five groups: healthy, muscle pain, joint pain, combined muscle and joint pain, and joint disorder. Occlusal contacts at maximum intercuspation were recorded using an intraoral scanner. STL files were analyzed to quantify occlusal contact area, contact points, and occluding tooth pairs. Clinical and psychosocial variables were assessed using standardized questionnaires. RESULTS: Intra-examiner reliability was high (ICC = 0.90). No significant between-group differences were found in demographic characteristics or occlusal asymmetry measures ( ≥ .05). CONCLUSION: No statistically significant differences in occlusal asymmetry were found among TMD subgroups or healthy individuals. Current evidence does not support the use of intraoral scanning of occlusal contacts for diagnosing or differentiating TMDs.
OBJECTIVE: This study aimed to assess consensus on various Temporomandibular Disorders (TMD) knowledge statements and examined differences in TMD knowledge among Lebanese licensed dentists based on demographic and profes...OBJECTIVE: This study aimed to assess consensus on various Temporomandibular Disorders (TMD) knowledge statements and examined differences in TMD knowledge among Lebanese licensed dentists based on demographic and professional characteristics. METHODS: A cross-sectional study was conducted using an electronic self-administered questionnaire comprising 36 TMD knowledge statements derived from existing literature and refined by TMD experts. Consensus was defined as ≥ 70% agreement or disagreement. Associations between knowledge statements and demographic or professional characteristics were analyzed using Chi-square or Fisher's exact tests for categorical variables and Kruskal-Wallis tests with Dunn's post-hoc comparisons for continuous variables, with Bonferroni correction for multiple comparisons. RESULTS: A total of 368 dentists participated. Consensus was achieved for 20 statements, of which 15 statements reflected correct, evidence-based knowledge. Significant associations (p < 0.007) were found between several demographic and professional characteristics and response patterns. CONCLUSION: The findings revealed shared misconceptions and gaps in evidence-based TMD knowledge among Lebanese dentists, highlighting the need for targeted educational interventions.
OBJECTIVE: To present a rare presentation of paroxysmal hemicrania (PH) in the orofacial region. METHODS: A retrospective record review was performed using the International Classification of Headache Disorders criteria...OBJECTIVE: To present a rare presentation of paroxysmal hemicrania (PH) in the orofacial region. METHODS: A retrospective record review was performed using the International Classification of Headache Disorders criteria for PH. Inclusion criteria were initial diagnosis of PH and at least one confirmatory diagnosis at follow-up. RESULTS: Four patients were diagnosed with orofacial PH 2015-2021. Average age was 56.5 years. Patients were most seen by dentists (=7) and neurologists (=5) and had a median of 19.5 months of diagnostic delay. Pain intensity was severe, episodes occurring daily and lasting 4-90 minutes. Lacrimation was the most common autonomic feature. All patients presented with intraoral pain and temporomandibular disorders. Maximum indomethacin dosage ranged from 75-225 mg/day. Verapamil was the most effective adjuvant therapy. CONCLUSIONS: Orofacial PH presents a diagnostic challenge with significant delays, multiple referrals and unconventional pain locations. Intolerance to indomethacin resulted in the need for adjuvant treatment modalities.
da Costa Barreto LS, das Neves BM, Kuhlman DC
… +7 more, Palomares NB, de Assis Ribeiro Carvalho F, Suh H, Bianchi J, Oh H, Dos Santos Lopes Batista KB, Mendes Miguel JA
OBJECTIVE: To evaluate changes in the oropharyngeal airway (OP) with Herbst appliances using either dental or skeletal anchorage (HDA vs. HSA) in growing patients with Class II division 1 malocclusion. DESIGN, SETTING, A...OBJECTIVE: To evaluate changes in the oropharyngeal airway (OP) with Herbst appliances using either dental or skeletal anchorage (HDA vs. HSA) in growing patients with Class II division 1 malocclusion. DESIGN, SETTING, AND PARTICIPANTS: Forty patients (12.6 ± 1.4 years) at the peak of pubertal growth were randomized (HDA= 20; HSA= 20), for 12 months. Outcomes: change in OP volume, airway length and cross-sectional areas (minimum, maximum, average), by CBCT. RESULTS: Thirty-four patients completed the study (HDA= 19; HSA= 15); and intention-to-treat (ITT) analysis was applied. Within-group analysis revealed a significant improvement for minimum axial area (HDA, p = .0061). Between-group comparisons showed significantly higher mean values in the HSA group for volume (p = .0044), airway length (p = .004), maximum cross-sectional area (p = .0188), and average area (p = .0122). CONCLUSIONS: HSA and HDA increased OP dimensions in growing Class II patients. Although HSA did not demonstrate a statistically superior effect, the dimensional changes represent morphological adaptations. Long-term studies are required to determine respiratory benefits.
OBJECTIVE: This double-blinded randomized controlled trial investigated the immediate effects of myofascial release (MFR) and post-isometric relaxation (PIR) on muscle stiffness, tone, pain, and maximum mouth opening (MM...OBJECTIVE: This double-blinded randomized controlled trial investigated the immediate effects of myofascial release (MFR) and post-isometric relaxation (PIR) on muscle stiffness, tone, pain, and maximum mouth opening (MMO) in individuals with bruxism, compared with a control group. METHODS: Sixty participants were randomized into MFR ( = 20), PIR ( = 20), or control groups ( = 20). Each intervention was a single standardized session. The primary outcomes were muscle stiffness and tone, while secondary outcomes included pain severity (VAS), and MMO. RESULTS: Both MFR and PIR significantly reduced masseter and sternocleidomastoid stiffness and tone ( < .05), except left sternocleidomastoid stiffness in MFR, with no changes in controls. MFR was superior to control for pain ( = .010) and masseter stiffness ( = .030), while PIR showed superiority only for left tone ( = .034). Both interventions reduced VAS scores ( < .001) and improved MMO ( < .05). CONCLUSION: A single MFR or PIR session reduced stiffness, tone, and pain and improved MMO in bruxism. MFR showed stronger effects, whereas PIR yielded limited benefits.
OBJECTIVE: This scoping review is intended to identify and synthesize global evidence on barriers and facilitators influencing referral pathways for TMD management, highlighting implications for oral and maxillofacial su...OBJECTIVE: This scoping review is intended to identify and synthesize global evidence on barriers and facilitators influencing referral pathways for TMD management, highlighting implications for oral and maxillofacial surgeons (OMS) and interprofessional care models. METHODS: Following Joanna Briggs Institute and PRISMA-ScR guidelines, comprehensive searches were performed. Eligible studies discussed factors affecting the diagnosis, management, or referral of TMD patients. Data were extracted and synthesized using inductive thematic analysis. RESULTS: Six thematic domains emerged: educational, structural/institutional, communicational, systemic, cultural/professional, and technological. The most recurrent barriers were insufficient undergraduate training, fragmentation between dental and medical services, and lack of standardized referral criteria. Facilitators included interprofessional education, use of evidence-based clinical pathways, and digital referral systems. CONCLUSION: Referral systems for TMD remain fragmented worldwide. Strengthening interprofessional education, implementing structured referral criteria, and integrating digital decision-support within OMS services are crucial steps to align clinical practice with evidence and reduce surgical overtreatment.
BACKGROUND: Referred facial pain is a rare but important presentation of systemic disease. This paper describes orofacial pain associated with lung cancer, discusses key diagnostic considerations, and illustrates phenoty...BACKGROUND: Referred facial pain is a rare but important presentation of systemic disease. This paper describes orofacial pain associated with lung cancer, discusses key diagnostic considerations, and illustrates phenotype-based management. i. CLINICAL PRESENTATION: Two patients with known pulmonary malignancy developed unexplained orofacial pain. Case 1 involved a 37-year-old male with dull, intermittent pain in the left ear and face. Case 2 involved a 63-year-old female with episodic, burning pain radiating from the right pharynx, right face and ear. Both were misdiagnosed, one as persistent idiopathic facial pain (atypical facial pain), the other as glossopharyngeal neuralgia. Clinical examination and imaging revealed no local pathology. Their pain was attributed to referred pain from lung cancer. Both responded to phenotype-guided management, including tricyclic antidepressants, gabapentinoids, and carbamazepine. CONCLUSION: These cases highlight the diagnostic challenges of facial pain attributed to lung cancer (FPLC), its frequent misdiagnosis, the need for dedicated diagnostic criteria and phenotype-based management.
OBJECTIVE: To explore the influence of bullying, self-esteem and sleep-disordered breathing on awake bruxism in a case-control study. METHODS: This case-control study associated awake bruxism with bullying, self-esteem,...OBJECTIVE: To explore the influence of bullying, self-esteem and sleep-disordered breathing on awake bruxism in a case-control study. METHODS: This case-control study associated awake bruxism with bullying, self-esteem, and sleep-disordered breathing in 436 children. The cases ( = 218) had awake bruxism, while the controls ( = 218) were matched for age and sex. Data were collected through validated questionnaires and clinical examinations. RESULTS: Logistic regression showed no significant associations between awake bruxism and race, family income, self-esteem, sleep-disordered breathing, or bullying ( > .05). Bullying was highly prevalent in both groups (81.2% vs. 78.4%), with similar odds ratios (OR = 1.19; 95% CI: 0.74-1.90). CONCLUSION: These psychosocial and socioeconomic variables do not influence awake bruxism.
OBJECTIVE: To evaluate the relationship between self-reported sleep bruxism and temporomandibular joint (TMJ) alterations on MRI, focusing on disc morphology, disc position, and condylar changes. METHODS: A total of 162...OBJECTIVE: To evaluate the relationship between self-reported sleep bruxism and temporomandibular joint (TMJ) alterations on MRI, focusing on disc morphology, disc position, and condylar changes. METHODS: A total of 162 patients (135 females, 27 males; mean age 37.6 ± 13.9 years) were categorized into bruxism (n=100) and non-bruxism (n=62) groups. MRI examinations were assessed for disc morphology, disc displacement, and condylar bone changes. Logistic regression analyses were performed, adjusting for age and gender. RESULTS: Sleep bruxism was independently associated with anterior disc displacement without reduction (ADDwoR). No significant associations were found between bruxism and disc morphology or condylar degenerative changes, including erosion, sclerosis, flattening, or osteophytes. CONCLUSION: .Sleep bruxism appears specifically associated with ADDwoR, rather than with morphological or degenerative TMJ alterations. These findings indicate that bruxism may primarily influence joint dysfunction through functional loading of the disc, whereas osseous remodeling likely reflects multifactorial processes. Further longitudinal studies are needed.