OBJECTIVE: This study aimed to determine the relationship between sleep bruxism behaviors and jaw symptoms in healthy young adults. METHODS: This cross-sectional study included 99 dental students. Participants completed...OBJECTIVE: This study aimed to determine the relationship between sleep bruxism behaviors and jaw symptoms in healthy young adults. METHODS: This cross-sectional study included 99 dental students. Participants completed the Oral Behavior Checklist and the BruxScreen protocol and wore a BruxChecker for three nights. RESULTS: We found a positive correlation between self-reported awake and sleep bruxism and both painful and non-painful jaw symptoms. BruxChecker perforation, jaw symptoms, and tooth wear predicted self-report frequency of sleep bruxism on ordinal regression. However, sleep bruxism assessed with the BruxChecker or clinical examination was not associated with the frequency of any jaw symptoms. CONCLUSION: In healthy young adults, the grinding component of sleep bruxism evaluated at the dental level is not associated with the frequency of either painful or non-painful jaw symptoms. Tooth wear and non-painful jaw symptoms might contribute to the self-reported frequency of sleep bruxism.
OBJECTIVE: To investigate the effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with cognitive behavioral therapy (CBT) on neuropsychological status, cognitive function, and sleep micr...OBJECTIVE: To investigate the effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with cognitive behavioral therapy (CBT) on neuropsychological status, cognitive function, and sleep microstructure in first-episode depression patients with insomnia. METHODS: The clinical data of 95 first-episode depression patients with insomnia were retrospectively analyzed. The patients were divided into groups according to the different therapeutic regimens, 45 cases in the control group received conventional treatment, and 50 cases in the research group received rTMS combined with CBT on the basis of conventional treatment. The clinical efficacy, depression level, cognitive function, neuropsychology and sleep quality of the two groups were compared. RESULTS: The overall efficacy rate was higher in the research group compared to the control group (96.00% vs. 80.00%) ( < .05). CONCLUSION: In addition to conventional pharmacological treatment, the combination of rTMS and CBT may serve as a promising adjunctive intervention for first-episode depression patients with insomnia, demonstrating potential benefits in improving neuropsychological status, cognitive function, and sleep microstructure.
OBJECTIVE: This study aimed to evaluate the level of knowledge and attitude toward obstructive sleep apnea (OSA) in Palestinian Authority. METHODS: An online cross-sectional questionnaire was conducted from January 2025...OBJECTIVE: This study aimed to evaluate the level of knowledge and attitude toward obstructive sleep apnea (OSA) in Palestinian Authority. METHODS: An online cross-sectional questionnaire was conducted from January 2025 to March 2025 and targeted senior dental students at Arab American University and Palestinian dental practitioners. A 37-item questionnaire including demographics, knowledge, and attitude categories was created using Google Drive. RESULTS: A total of 585 senior dental students and dental practitioners responded to the survey, with a mean total knowledge score of 17.9 ±4.72 out of 23, and attitude score of 21.49 ±3.41 out of 28. Senior dental students revealed the highest knowledge level while the general dental practitioners showed the lowest. CONCLUSIONS: Dental practitioners had insufficient knowledge about OSA and a neutral attitude regarding OSA patients' management and referrals. Thus, revision of curricula in dental schools and organizing more educational programs about OSA are needed.
OBJECTIVE: To describe the characteristics of trigeminal autonomic cephalalgias (TAC) presenting as orofacial pain. METHODS: A web search was performed on various databases to find relevant case reports or series reporti...OBJECTIVE: To describe the characteristics of trigeminal autonomic cephalalgias (TAC) presenting as orofacial pain. METHODS: A web search was performed on various databases to find relevant case reports or series reporting TAC presenting in V2 and/or V3 of the trigeminal nerve distribution. Headaches were classified according to the International Classification of Headache Disorders III and the International Classification of Orofacial Pain. Descriptive analyses were employed, and multivariable linear regression models assessed the factors associated with (i) longer time since the onset of TAC and (ii) a higher number of previous providers at the time of report. RESULTS: Intraoral/tooth pain was reported by 47% ( = 34) of cases, with 11 without headache or V1 involvement. Cases had an average of 2.2 autonomic symptoms (standard deviation (SD) = 1.3), 4.5 years since onset (SD = 5.3), and 2.6 previous providers (SD = 1.5) at the time of the report. Autonomic symptoms increased as the time since pain onset ( = 50, β = 1.30, = .026) and age (β = 0.13, = .032) increased when adjusted for sex and the trigeminal distribution of involvement. The number of previous providers tended to be lower for TAC with shorter episodes (β = -1.48, SD = 0.47, = .004) than for TAC with long attacks or continuous pain. CONCLUSION: Orofacial TAC present a diagnostic challenge for clinicians. Multidisciplinary care and more education are recommended. Further research is needed to properly understand them.
OBJECTIVE: To investigate possible correlations between depression, anxiety and stress in subjects with instrumental diagnosis of sleep bruxism (SB) and to identify a link between clinical data and sleep-time muscular ac...OBJECTIVE: To investigate possible correlations between depression, anxiety and stress in subjects with instrumental diagnosis of sleep bruxism (SB) and to identify a link between clinical data and sleep-time muscular activity. METHODS: 170 subjects underwent clinical investigation and instrumental night recordings for SB assessment with a portable electromyographyic (EMG) device. The Hospital Anxiety and Depression Scale (HADS) and the Perceived Stress Scale (PSS) were used for psychological evaluation. RESULTS: Anxiety was statistically associated with SB index and SB-related tonic contractions. Subjects with high perceived stress scores showed higher numbers of total masseter contractions and SB-related phasic contractions. CONCLUSION: Emotional states showed a statistically significant association with SB events, as assessed based on the count of episodes over 10% of the maximum voluntary contraction (MVC) preceded by a 20% increase of heart rate.
OBJECTIVE: This commentary critically examines the validity of the Canine Protected Occlusion concept, from both biological and evidence-based perspectives. METHODS: An extensive review of the pertinent literature relate...OBJECTIVE: This commentary critically examines the validity of the Canine Protected Occlusion concept, from both biological and evidence-based perspectives. METHODS: An extensive review of the pertinent literature related to the topic of Canine Protected Occlusion was conducted by the authors. RESULTS: Canine Protected Occlusion is neither the optimal or preferred functional occlusion in dentistry. The foundational principles of this concept are not supported by any biologic reasoning or scientific evidence. Furthermore, Canine Protected Occlusion recordings fail to reflect or represent any type of physiologic mandibular motion and function or occlusal loading in humans. CONCLUSIONS: The functional occlusion contacts that clinicians should focus on most are those in or close to maximum intercuspation. This perspective aims to discourage practitioners from undertaking unnecessary extensive and invasive procedures to establish Canine Protected Occlusion in all patients, especially when this is not substantiated by evidence-based literature.
OBJECTIVE: This research aims to introduce using antegonial notch angular measurements on lateral cephalometry as a simple low-dose radiographic approach for monitoring mandibular growth in children after TMJA treatment....OBJECTIVE: This research aims to introduce using antegonial notch angular measurements on lateral cephalometry as a simple low-dose radiographic approach for monitoring mandibular growth in children after TMJA treatment. METHODS: This retrospective cohort study used dental records to identify eligible patients: healthy children with true unilateral TMJA who underwent conservative gap arthroplasty followed by post-operative physiotherapy. The primary outcome was changes in antegonial notch angular measurements over time. Secondary outcomes included correlations between antegonial notch angular measurements and two growth-related conventional cephalometric angles (SNB and ANB). We also explored the relationship between changes in antegonial notch angle over time and study covariates. RESULTS: Eleven patients aged 4 to 9.5 years with unilateral bony TMJA for periods ranging from 9 to 20 months who had undergone conservative gap arthroplasty followed by physiotherapy were included. Significant increases were observed in antegonial notch angles on both the affected and non-affected sides after treatment ( < .05), indicating resumed mandibular growth. Although the affected side remained significantly smaller than the non-affected side at both timepoints (= 0.033 and 0.005), asymmetry did not change significantly over time (= 0.273), suggesting parallel bilateral growth. Positive correlations were found between antegonial notch changes and SNB (= 0.039-0.047). Multivariate regression indicated that TMJA duration significantly influenced changes in the affected-side notch angle (= 0.004). CONCLUSION: Based on these preliminary data, antegonial notch angular measurements on lateral cephalometric radiographs may offer a simple, reliable, and low-radiation alternative for monitoring mandibular growth in children after TMJA treatment. Further studies with larger sample sizes are required to support our findings.
BACKGROUND: The MyotonPRO is a valid, portable device to assess musculoskeletal tissue properties, but its reliability for cervico-mandibular muscles remains unclear. OBJECTIVE: To evaluate the intra/inter-rater and intr...BACKGROUND: The MyotonPRO is a valid, portable device to assess musculoskeletal tissue properties, but its reliability for cervico-mandibular muscles remains unclear. OBJECTIVE: To evaluate the intra/inter-rater and intra/inter-session reliability of the MyotonPRO in cervico-mandibular muscle assessment. METHODS: A total of 30 measurements were performed on 15 healthy participants by two raters at two moments. MyotonPRO evaluated tone, stiffness, elasticity, relaxation time, and creep. Reliability was calculated using intraclass correlation coefficients (ICC), standard error of measurement, and minimal detectable change. RESULTS: Intra-rater intra-session reliability was good to excellent (ICC = 0.753-0.976). Inter-session values were moderate to good (ICC = 0.585-0.888), with excellent reliability for ECOM relaxation time (ICC = 0.955) and masseter elasticity (ICC = 0.910). Inter-rater reliability was moderate to good (ICC = 0.686-0.896). CONCLUSION: The MyotonPRO is a reliable tool for assessing cervico-mandibular muscle mechanical properties across different raters and sessions.
OBJECTIVE: Temporomandibular joint degenerative disease (TMJ-DJD) is a progressive disorder marked by cartilage loss, pain, and dysfunction. This systematic review aimed to evaluate the efficacy and safety of platelet-ri...OBJECTIVE: Temporomandibular joint degenerative disease (TMJ-DJD) is a progressive disorder marked by cartilage loss, pain, and dysfunction. This systematic review aimed to evaluate the efficacy and safety of platelet-rich plasma (PRP) injections without arthrocentesis in adults with TMJ-DJD. MATERIALS AND METHODS: Following PRISMA guidelines (PROSPERO: CRD42020183384), we included randomized controlled trials (RCTs) assessing PRP in adults with TMJ-DJD. Searches were conducted in six databases up to June 2024. Two reviewers independently selected studies, extracted data, and assessed bias. Meta-analyses and GRADE evaluations were performed. RESULTS: Six RCTs were included. PRP showed comparable effects to arthrocentesis and arthrocentesis + PRP in reducing pain and improving mouth opening. At 3 months, PRP may offer greater pain relief than hyaluronic acid. No trials assessed quality of life. Evidence certainty ranged from moderate to low. CONCLUSIONS: PRP appears to be a safe and potentially effective treatment for TMJ-DJD, though further high-quality studies are needed.
OBJECTIVE: The study aims to translate, culturally adapt and validate the Berlin questionnaire into Malayalam. METHODS: The cultural adaptation process included translation, expert review, and pre-testing with 20 partici...OBJECTIVE: The study aims to translate, culturally adapt and validate the Berlin questionnaire into Malayalam. METHODS: The cultural adaptation process included translation, expert review, and pre-testing with 20 participants. Psychometric properties were assessed in 100 participants who completed the Malayalam Berlin questionnaire (M-BQ), underwent polysomnography, and provided sociodemographic and clinical data. Reliability, criterion validity, and psychometric properties were evaluated compared to Apnea Hypopnea Index (AHI). RESULTS: The M-BQ presented conceptual and cultural equivalence. Reliability assessed using Cronbach's alpha was 0.61. The instrument showed a sensitivity of 83.05%, 54.24%, 30.51%, and specificity of 78.05%, 97.56%, 100% for the risk stratification of obstructive sleep apnea according to the AHI scores. CONCLUSION: The study confirmed the reliability and validity of the Malayalam version of the Berlin Questionnaire in the study population.
OBJECTIVE: The aim of the present study was to evaluate the effects of occlusal splint therapy in addition to physical therapy in improving pain in patients affected by myogenous temporomandibular disorders (TMD). METHOD...OBJECTIVE: The aim of the present study was to evaluate the effects of occlusal splint therapy in addition to physical therapy in improving pain in patients affected by myogenous temporomandibular disorders (TMD). METHODS: In this pilot trial, myofascial pain patients were randomly allocated into experimental group (education, physical therapy, and occlusal splint - PT+OS) and control group (education and physical therapy - PT). The primary outcome was the TMD pain intensity. All outcomes were assessed at baseline (T0), at the end of the physical therapy (T1), after 6 months from the end of the physical therapy (T2). RESULTS: Twenty-seven subjects (7 male and 20 females, mean aged 35.81 ± 16.57 years) were enrolled and allocated into two groups: 14 patients in the PT+OS group and 13 patients in the PT group. The RM ANOVA showed statistically significant differences between groups from T0 to T2 in favor of the PT+OS group in terms of TMD pain ( = .033), Neck Disability Index (NDI) ( = .025), and EuroQol-Visual Analogue Scale ( = .039). CONCLUSION: Findings from the present study demonstrated that pain, NDI, and health-related quality of life improved in both groups after therapy, but only in the experimental group these outcomes improved significantly further after 6-months follow-up. Thus, our results showed that adding occlusal splint therapy to the physical therapy may produce higher positive effects in patients affected by myogenous TMD. Further studies with a larger sample size should be carried out to confirm our results.
OBJECTIVE: This study aimed to examine the dimensional characteristics of the condylar head in 3D models of dry human mandibles using two different measurement methods. METHODS: A total of 46 condylar heads from 29 dry h...OBJECTIVE: This study aimed to examine the dimensional characteristics of the condylar head in 3D models of dry human mandibles using two different measurement methods. METHODS: A total of 46 condylar heads from 29 dry human mandibles were scanned using a 3D scanner. Two perpendicular reference planes were used to identify the most medial, lateral, anterior, and posterior points. Measurements in the mediolateral and anteroposterior dimensions were taken using the direct measurement method, and the proposed method using the two reference planes. Paired t-tests were performed to compare the results. RESULTS: Significant differences were observed, particularly in anteroposterior dimensions, which were smaller when using the proposed method ( < .001). CONCLUSION: Measurements of the condylar head should be taken from the outermost points. Given the nature of bone remodeling, relying solely on a single cut from CBCT images for dimensional evaluation may result in missing potentially significant changes.
OBJECTIVE: To determine the Fractal Dimension (FD) and Mean Gray Value (MGV) changes caused by TMJ-OA on Cone-Beam Computed Tomography (CBCT) images. METHODS: Ninety patients were divided into three groups: Control group...OBJECTIVE: To determine the Fractal Dimension (FD) and Mean Gray Value (MGV) changes caused by TMJ-OA on Cone-Beam Computed Tomography (CBCT) images. METHODS: Ninety patients were divided into three groups: Control group (bilateral unaffected joints), Unilateral group (one affected joint), and Bilateral group (bilaterally affected joints). Histogram Analysis (HA) and Fractal Analysis (FA) were performed on coronal slices of the condyles. p<0.05 was considered statistically significant. RESULTS: There was no statistically significant difference between the groups, and also total affected and total unaffected condyles in terms of both MGV and FD (p>0.05). There was a statistically significant difference between MGV and FD of the unaffected condyles in the Control and Unilateral groups (p<0.05). CONCLUSION: Both MGV and FD of the unaffected condyles in the Unilateral group were significantly different from those in the Control group indicates that these patients may be potentially at risk for TMJ-OA in the advanced stage.
OBJECTIVES: Given the expanding role of dental providers in screening, referral, and management of sleep-related breathing disorders (SRBD), dental students should receive adequate training. This study assessed the curre...OBJECTIVES: Given the expanding role of dental providers in screening, referral, and management of sleep-related breathing disorders (SRBD), dental students should receive adequate training. This study assessed the current state of sleep medicine education in U.S. predoctoral dental schools during 2024-2025 academic year. METHODS: A survey was distributed to 72 CODA-accredited U.S. predoctoral dental programs, investigating sleep education, screening, and clinical management. Teaching time and content between programs were compared with independent t-tests and Mann-Whitney U tests. RESULTS: Thirty-three of 72 dental programs responded (51.6% response rate). Twenty-nine programs (87.9%) reported sleep medicine instruction for a mean total of 8.0 hours (ranging from 1 to 32 hours with a mean total of 7.2 hours after removing one outlier), with more recent curriculum adoption associated to greater teaching time ( = .001). Instruction was primarily provided by orofacial pain (45.5%) and prosthodontics/restorative (27.3%) departments, mainly covering obstructive sleep apnea (87.9%), sleep bruxism (81.8%), and snoring (66.7%). Screening of SRBD was reported by 56.7% of the 29 schools and exposure to SRDB-clinical management by 45.5%. Programs that included screening and/or treatment incorporated more comprehensive curriculum and wider range of management options ( = .007). CONCLUSIONS: Sleep medicine education hours in U.S. dental curricula has more than doubled over the past 16 years, with ~88% of responding programs including sleep medicine instruction for an average of ~8 hours. Gaps remain in screening, triage and clinical management, which were lacking in about 50% of programs, highlighting areas for improvement.
OBJECTIVE: In maxillofacial trauma, injuries are known to predominantly affect the left side of the face. This study aimed to investigate the relationship between hand dominance and the laterality of craniofacial fractur...OBJECTIVE: In maxillofacial trauma, injuries are known to predominantly affect the left side of the face. This study aimed to investigate the relationship between hand dominance and the laterality of craniofacial fractures. METHODS: Clinical records of 513 patients with maxillofacial fractures from January 2019 to December 2022 were retrospectively analyzed. UNLABELLED: A total of 401 right-handed and 112 left-handed patients were evaluated. Accidental falls were the most common cause of injury (50.4%). In patients with fractures on the side opposite the hand dominat, accident falls (78%) and assaults (71%) were the leading causes. The average Facial Injury Severity Score (FISS) was 1.93. A statistically significant association between hand dominance and fracture laterality was found (p-value <0.01) with a phi coefficient of 0.566, indicating a moderate correlation. CONCLUSION: The results suggest that hand dominance may play a significant role in determining fracture laterality with 86.5% of patients sustained trauma on the side of their non-dominant hand.
OBJECTIVE: Studies have highlighted variability and deficiencies in temporomandibular disorders (TMD) predoctoral education, with limited student clinical exposure. However, no research has examined changes following COD...OBJECTIVE: Studies have highlighted variability and deficiencies in temporomandibular disorders (TMD) predoctoral education, with limited student clinical exposure. However, no research has examined changes following CODA inclusion of TMD instruction in predoctoral curricula. We investigated current scope, instructional modalities, and extent of TMD curricula in U.S. predoctoral dental programs. METHODS: A 17-item REDCap survey was distributed in September-October 2024 to deans/associate deans of academic affairs at 72 CODA-accredited U.S. predoctoral dental schools, investigating TMD curricula, modalities, and extent. RESULTS: All 33 responding programs (53.2% response rate) included TMD instruction. Formal teaching accounted for 70.6±24.9% of instruction, while patient exposure constituted 22.5±21.0%. Programs dedicated 15.7±7.1 h on average (range 4-34) to TMD instruction . About 25.0% of programs had no board-certified orofacial pain (OFP) specialist on faculty. Instruction was mostly provided by OFP (75.8%), oral medicine specialists (36.4%), prosthodontists (30.3%), and oral surgeons (27.3%). Most programs (87.9%) treated TMD patients, yet 9.1% reported no student clinical exposure to these patients. In programs offering clinical exposure, patient interactions included direct evaluation and treatment (60.6%), rotations in OFP clinics (42.4%), observation (36.4%), or elective courses (3.0%). Management of OFP patients expanded to neuropathic pain (54.5%) and primary headache (33.3%), especially among programs with OFP specialists on faculty. CONCLUSIONS: TMD instruction varies widely across responding programs, but recent curricula have expanded instructional hours, broadened scope, and increased opportunities for patient interaction compared to previous reports.
OBJECTIVE: To investigate the effect of parathormone and thyroid hormones, along with their associated biochemical factors in individuals with and without symptoms indicative of temporomandibular disorder (TMDs) admitted...OBJECTIVE: To investigate the effect of parathormone and thyroid hormones, along with their associated biochemical factors in individuals with and without symptoms indicative of temporomandibular disorder (TMDs) admitted to the internal medicine department. METHODS: The study involved 416 participants with symptoms indicative of TMDs and 415 controls. Serum concentrations of anti-thyroid peroxidase antibody (Anti-TPO Ab), free triiodothyronine, free thyroxine, thyroid-stimulating hormone, parathyroid hormone, calcium, sodium, potassium, magnesium, phosphorus, vitamin D, vitamin B12, folate, creatine kinase, haemoglobin, ferritin, C-reactive protein and sedimentation rate were analysed. RESULTS: The serum level of anti-TPO Ab was found to be elevated in participants with symptoms indicative of TMDs in comparison to controls ( < .001). However, no significant differences were observed in the other parameters assessed between the two groups ( > .05). CONCLUSION: Serum concentrations of parathormone and thyroid hormones associated biochemical factors are not affected in participants with symptoms indicative of TMDs except Anti-TPO Ab.
OBJECTIVE: To evaluate the impact of occlusal splint (OS) therapy on clinical parameters, masticatory muscle morphology and arterial blood flow using ultrasonography (USG) in female probable bruxist individuals with myof...OBJECTIVE: To evaluate the impact of occlusal splint (OS) therapy on clinical parameters, masticatory muscle morphology and arterial blood flow using ultrasonography (USG) in female probable bruxist individuals with myofascial pain syndrome (MPS). METHODS: 24 female probable bruxist patients with MPS underwent OS therapy for three months. USG assessed masseter and temporalis muscle length, thickness (at rest and maximum clenching) and elastography. Doppler ultrasound measured facial, external carotid, temporal and maxillary artery blood flow. Clinical evaluations included maximum mouth opening (MMO), Jaw Functional Limitation Scale (JFLS) and Visual Analog Scale (VAS) scores. All measurements were conducted before and after treatment. RESULTS: OS therapy significantly reduced muscle length, thickness and elastography, except for right masseter elastography. Temporal artery flow parameters showed a significant decrease. MMO increased, while JFLS and VAS scores decreased. CONCLUSION: OS therapy reduces muscle dimensions and stiffness while improving clinical outcomes, with limited impact on arterial blood flow.