Journal of Oral & Facial Pain and Headache, 03/2008

This work was partially presented at the Congress of the Continental European Division of the IADR in Thessaloniki, Greece, 26-29 September 2007.Aims: To provide a snapshot of the scientific literature on orofacial pain. Methods: The authors identified 975 papers related to orofacial pain in the Current Contents Life Sciences and Clinical Medicine collections of the Thomson Scientific database that were published during 2004 and 2005 and analyzed them using bibliometric indicators. Results: Among the 54 countries involved, the United States ranks first by number of papers (293), followed by Japan (107), and the United Kingdom (90). The high volume of research activity in some Northern European countries is highlighted, along with that of the European Union (384 papers). The scientific literature on orofacial pain was published in 247 journals; 13 of the top 15 most prolific journals for articles on orofacial pain were found in the Dentistry, Oral Surgery and Medicine subdiscipline of Current Contents/Clinical Medicine, and the Journal of Orofacial Pain was the highest ranked for such articles. Conclusion: This study complements subject reviews of orofacial pain research and provides a more complete picture of the research activity in this field. Keywords: bibliometrics, journals, orofacial pain, scientific literature

Aims: To test for an association between rhythmic masticatory muscle activity during sleep, as assessed according to polysomnographic criteria for sleep bruxism (RMMA-SB), and myofascial pain (MFP), as well as the chance of occurrence of MFP in patients with RMMA-SB. Methods: Thirty MFP patients (diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders) and 30 age- and gender-matched asymptomatic controls underwent a polysomnographic examination. Also, any self-reporting of daytime clenching (DC) was registered in 58 of these subjects. Results: Most MFP patients reported mild or moderate pain (46.67% and 43.33%, respectively), and only 3 (10%) reported severe pain. Pain duration ranged from 2 to 120 months (mean 34.67 ± 36.96 months). Significant associations were observed between RMMA-SB and MFP as well as between DC and MFP. Conclusions: (1) RMMA-SB is significantly associated with MFP; (2) although RMMA-SB represents a risk factor for MFP, this risk is low; and (3) DC probably constitutes a stronger risk factor for MFP than RMMA-SB. Keywords: myofascial pain syndromes, polysomnography, risk, sleep bruxism

Aims: To compare the prevalence of psychologic, dental, and temporomandibular disorder (TMD) signs and symptoms between young women suffering from chronic eating disorders (ED) and a control group of age-matched, healthy women, and to evaluate the impact of frequent vomiting on these signs and symptoms among the ED group. Methods: Clinical examination and self-administered questionnaires were used to evaluate psychologic, dental, and TMD signs and symptoms among 79 women hospitalized because of chronic ED and 48 age-matched healthy women (as controls). ED patients were further analyzed according to their habit of daily vomiting (43 vomiting versus 36 nonvomiting patients). Pearson chi-square and analysis of variance were used to analyze categorical differences between study groups. Results: Women with ED showed a significantly higher sensitivity to muscle palpation (P .001) and higher levels of depression, somatization, and anxiety (P .001), as well as a higher prevalence of intensive gum chewing (P .001), dental erosions (P .001), and attrition (P .001), than the healthy controls. Vomiting patients showed higher muscle sensitivity to palpation than nonvomiting patients (P .001) and greater emotional and psychologic distress (P .001). Conclusion: Women with chronic ED suffer from higher muscular sensitivity to palpation, greater emotional distress, and more hard tissue destruction (dental erosions, dental sensitivity) than healthy women. Keywords: anorexia nervosa, bruxism, bulimia nervosa, dental erosion, eating disorders, stress, TMD, vomiting

Aims: To compare the short-term effectiveness of a stabilization appliance with a prefabricated occlusal appliance in myofascial pain patients in a randomized controlled trial. Methods: Sixty-five patients at 2 centers were assigned to a stabilization appliance group (S group, n = 33) or a prefabricated appliance (Relax) group (R group, n = 32). The patients had been suffering from temporomandibular disorder (TMD) pain for 3 months to 40 years. The patients were examined for symptoms and signs of temporomandibular disorders according to the Research Diagnostic Criteria for TMD and treated by a general practitioner. Treatment outcomes regarding pain, registered on a visual analog scale, and overall ratings of pain, registered on a verbal scale, were evaluated at 6- and 10-week follow-up appointments, and the data from the groups were compared statistically. Results: The main treatment outcome in the 2 groups was a positive improvement of overall symptoms without any statistically significant differences between groups at either 6 or 10 weeks. At the 6-week follow-up, 72% of all patients reported a 30% reduction of the worst pain, and 55% of the patients reported a 50% reduction of the worst pain, whereas at the 10-week follow-up, the percentages were 69% and 61%, respectively. According to the verbal scale, 85% of all patients reported themselves to be "better," "much better," or "symptom-free" at the 6-week follow-up, and 83% reported this at the 10-week follow-up. Conclusion: The effectiveness of the prefabricated occlusal appliance seemed to be the same as that of the stabilization appliance. The prefabricated appliance can therefore be recommended as a short-term therapy in adult patients with myofascial pain. Keywords: myofascial pain, occlusal appliances, pain, randomized controlled trial, temporomandibular disorders

Aims: To develop the Jaw Functional Limitation Scale (JFLS), comprising 3 constructs and a global scale, based on a preliminary instrument, and to investigate content validity of the overall functional limitation construct, reliability, and generalizability. A temporomandibular disorders (TMD) patient group, compared to other diagnostic groups, was hypothesized to report further limitation in each of the 3 new proposed constructs. Methods: One hundred thirty-two consecutive patients from 5 diagnostic groups (TMD, primary Sjögren syndrome, burning mouth syndrome, skeletal malocclusion, and healthy controls) participated in a known-groups validity design. Fifty-two jaw functional limitation items were identified by an expert panel for content validity. Rasch methodology was used for item reduction and assessment of model fit. The instrument was retested 1 to 2 weeks later. Results: Three constructs (mastication, vertical jaw mobility, and emotional and verbal expression) comprising a total of 20 items were identified along with a global scale (the JFLS-20), and each exhibited excellent psychometric properties with respect to modeled variance, item fit, reliability, and internal consistency. The psychometric properties of each construct remained satisfactory when analyzed separately among the 5 diagnostic groups. Temporal stability was satisfactory. A shorter 8-item form (JFLS-8) also proved useful for assessing global functional jaw limitation. Conclusion: The JFLS-20 is an organ-specific instrument comprising 3 constructs for assessing functional status of the masticatory system; the 3 scales exhibit properties that are ideal for both research and patient evaluation in patient groups with a range of functional limitations of the jaw. The JFLS-8 emerged as a short form for measuring global functional limitation of the jaw. Keywords: functional limitation, masticatory system, oral health-related quality of life, reliability, validity

Aims: To investigate the relative importance of systemic and local inflammatory mediators (serotonin: 5-HT; tumor necrosis factor: TNF; soluble interleukin-1 receptor II: IL-1sRII) in the modulation of temporomandibular joint (TMJ) pressure pain threshold in patients with seropositive or seronegative rheumatoid arthritis (RA) and to investigate to what extent TMJ pressure pain threshold is related to other TMJ pain parameters. Methods: Sixty patients with seropositive RA for rheumatoid factor and 74 patients with seronegative RA involving the TMJ were investigated regarding synovial fluid and plasma levels of IL-1sRII, 5-HT, and TNF as well as erythrocyte sedimentation rate, C-reactive protein, thrombocyte particle count, and rheumatoid factor in blood. TMJ resting pain, movement pain, tenderness, and palpebral pain reflex to digital palpation and TMJ pressure pain threshold were examined. Results: Statistical analyses indicated that TMJ pressure pain threshold was only correlated to systemic factors. TMJ movement pain was in turn mainly correlated to systemic mediators in the seropositive patients but to local mediators in the seronegative patients where synovial fluid IL-1sRII was positively correlated to TMJ pain on mouth opening. Seropositive patients had higher systemic inflammatory activity but lower TMJ movement pain intensities than seronegative patients. Conclusion: The results indicate that TMJ pressure pain threshold is modulated by systemic rather than local inflammatory mediators and suggest that it is unrelated or only weakly related to other TMJ pain entities in RA patients. A rheumatoid factor-dependent systemic modulation, in combination with local factors, seems to account for TMJ pain in RA patients. Keywords: pain, pain threshold, serotonin, temporomandibular joint, tumor necrosis factor

Aim: To identify associations between clinical symptoms of temporomandibular joint disorders and radiographic findings. Methods: Two hundred four adult patients (156 women, 48 men, mean age 40 years) with temporomandibular joint (TMJ) pain/sounds or changes in mandibular motion were examined according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Bilateral sagittal corrected TMJ tomograms in closed and open positions were assessed for the presence of flattening, erosion, osteophytes, and sclerosis in the joint components and the range of mandibular motion. Logistic regression analyses were performed with the radiographic findings as the dependent variables and the following clinical variables as independent variables: opening pattern, maximal jaw opening, TMJ sounds, number of painful muscle/TMJ sites, duration of pain, presence of arthritic disease, depression and somatization scores, graded chronic pain, and age and gender. Results: Coarse crepitus on opening/closing (odds ratio [OR] >= 3.12), on lateral excursions (odds ratio >= 4.06), and on protrusion (OR >= 5.30) was associated with increased risk of degenerative findings in tomograms. A clinical diagnosis of osteoarthritis increased the risk of radiographic findings (OR >= 2.95) and so did increasing age (OR >= 1.03 per year) and the female gender (OR >= 2.36). Maximal assisted opening and maximal opening without pain ( 40 mm) was associated with a posterior condyle-to-articular tubercle position (OR >= 2.60). No other significant associations were observed. Conclusion: Age, gender, and coarse crepitus, but no pain-related variables, were associated with increased risk of degenerative findings in TMJ tomograms. Maximal opening 40 mm was associated with a posterior condyle-to-articular tubercle relation on opening. Keywords: clinical investigation, radiography, Research Diagnostic Criteria for Temporomandibular Disorders, temporomandibular joint, tomography

Pigmented villonodular synovitis (PVNS) is a relatively rare disease affecting synovium-lined joints. PVNS was first fully described in 1941 by Jaffe et al, who considered it a benign inflammatory state of the synovium of uncertain etiology. Reports of this disease in the temporomandibular joint (TMJ) are extremely rare. This report describes a case of a 78-year-old man affected by PVNS of the right TMJ. Clinical examination revealed the presence of a right-sided preauricular mass; a magnetic resonance imaging scan showed a mass located lateral to the right mandibular condyle, close to the TMJ capsule. The clinical and pathologic features of the case are described. Keywords: pigmented villonodular synovitis, temporomandibular joint diseases