Oromandibular dystonia and temporomandibular disorders

BackgroundThe aim of this study was to characterize clinical features of patients with oromandibular dystonia (OMD) who had temporomandibular disorder (TMD) symptoms.MethodsA retrospective chart review of patients seeking treatment at a tertiary-level orofacial pain clinic from January 2015 through December 2020 was undertaken. The inclusionary criteria consisted of a diagnosis of OMD (International Classification of Diseases, Revision 10 code G24.4), which had been confirmed by a neurologist.ResultsEleven patients met the inclusion criteria. Focal dystonia and jaw deviation OMD were the most frequent diagnoses. A dental procedure was a triggering or aggravating factor in 36.4% of patients. All but 2 patients had a sensory trick, or tactile stimulus to a particular body part, and approximately one-half of the patients used an oral appliance as a sensory trick device. All but 1 patient had received a diagnosis of TMD, with myofascial pain of the masticatory muscles being the most prevalent diagnosis. Four patients had received a recommendation for orthodontic treatment. About one-half of the patients had undergone 1 or more invasive dental or maxillofacial surgical interventions to address their dystonia. Anxiety was the most common psychological comorbidity.ConclusionsBecause patients with OMD commonly experience TMD symptoms, they can receive a misdiagnosis of TMD while the OMD is overlooked.Practical ImplicationsOwing to concomitant TMD symptoms, patients most often seek dental consultations and undergo treatments such as orthodontic interventions and temporomandibular joint surgeries. A dentist’s competency in recognizing these patients can prevent unnecessary procedures and facilitate appropriate patient care.     

Understanding the pathophysiology of sleep bruxism based on human and animal studies: A narrative review

BackgroundSleep bruxism (SB) is a common sleep disorder that affects approximately 20% of children and 10% of adults. It may cause orodental problems, such as tooth wear, jaw pain, and temporal headaches. However, the pathophysiological mechanisms underlying SB remain largely unknown, and a definitive treatment has not yet been established.HighlightHuman studies involving polysomnography have shown that rhythmic masticatory muscle activity (RMMA) is more frequent in otherwise healthy individuals with SB than in normal individuals. RMMA occurs during light non-rapid eye movement (non-REM) sleep in association with transient arousals and cyclic sleep processes. To further elucidate the neurophysiological mechanisms of SB, jaw motor activities have been investigated in naturally sleeping animals. These animals exhibit various contractions of masticatory muscles, including episodes of rhythmic and repetitive masticatory muscle bursts that occurred during non-REM sleep in association with cortical and cardiac activation, similar to those found in humans. Electrical microstimulation of corticobulbar tracts may also induce rhythmic masticatory muscle contractions during non-REM sleep, suggesting that the masticatory motor system is activated during non-REM sleep by excitatory inputs to the masticatory central pattern generator.ConclusionThis review article summarizes the pathophysiology of SB based on the findings from human and animal studies. Physiological factors contributing to RMMA in SB have been identified in human studies and may also be present in animal models. Further research is required to integrate the findings between human and animal studies to better understand the mechanisms underlying SB.     

Factors associated with masticatory performance in community-dwelling older adults: A cross-sectional study

BackgroundDecreased masticatory performance leads to deterioration of overall health among older adults. However, maintaining and improving masticatory performance in ways other than maintenance of natural teeth and appropriate prosthodontic treatment remains unclear. If the factors related to the mixing and shearing abilities for masticatory performance are clarified, it may be possible to maintain and improve the masticatory performance of older adults. We aimed to clarify the association among mixing ability, shearing ability, and masticatory performance-related factors.MethodsOf the 707 community-dwelling older adults in Kusatsu Town, Japan, 344 who had been treated for any dental defects were enrolled in this study. Masticatory performance was evaluated on the basis of mixing ability and shearing ability. The number of natural teeth and artificial teeth, occlusal force, tongue pressure, and oral diadochokinesis /ta/ were measured as masticatory performance-related factors. Their relationship with mixing ability, shearing ability, and masticatory performance-related factors was examined by means of Spearman rank correlation coefficient and path analysis.ResultsAmong masticatory performance-related factors, the number of natural teeth, occlusal force, and tongue pressure were directly associated with both mixing ability and shearing ability. Moreover, mixing ability was also directly associated with shearing ability.ConclusionsTongue pressure, which can be improved by means of training, is a masticatory performance-related factor associated with both mixing and shearing abilities.Practical ImplicationsTraining for tongue pressure after proper prosthetic treatment may provide an effective means of maintaining and improving masticatory performance in older adults.     

The prevalence of comorbid chronic pain conditions among patients with temporomandibular disorders: A systematic review

BackgroundThis systematic review was designed to evaluate the presence of comorbid conditions among patients with temporomandibular disorders (TMDs).Types of Studies ReviewedThe authors reviewed studies that reported the prevalence or incidence of chronic pain conditions or psychiatric disorders (anxiety, mood, personality disorders) among patients with any type of TMD. The authors calculated sample size–weighted prevalence estimates when data were reported in 2 or more studies for the same comorbid condition.ResultsA total of 9 prevalence studies and no incidence studies were eligible for review; 8 of the studies examined chronic pain comorbidities. Weighted estimates showed high prevalence of pain comorbidities across studies, including current chronic back pain (66%), myofascial syndrome (50%), chronic stomach pain (50%), chronic migraine headache (40%), irritable bowel syndrome (19%), and fibromyalgia (14%). A single study examined psychiatric disorders and found that current depression was the most prevalent disorder identified (17.5%).Conclusions and Practical ImplicationsThere is a high prevalence of comorbid chronic pain conditions among patients with TMDs, with more than 50% of patients reporting chronic back pain, myofascial syndrome, and chronic stomach pain. Psychiatric disorders among patients with different types of TMDs were studied less commonly in this pain population. Knowledge of the distribution of these and other comorbid disease conditions among patients with different types of TMDs can help dentists and other health care providers to identify personalized treatment strategies, including the coordination of care across medical specialties.     

Management of painful temporomandibular disorders: Methods and overview of The National Dental Practice-Based Research Network prospective cohort study

BackgroundPatients often seek consultation with dentists for temporomandibular disorders (TMDs). The objectives of this article were to describe the methods of a large prospective cohort study of painful TMD management, practitioners’ and patients’ characteristics, and practitioners’ initial treatment recommendations conducted by The National Dental Practice-Based Research Network (the “network”).MethodsParticipating dentists recruited into this study treated patients seeking treatment for painful TMDs. The authors developed self-report instruments based on well-accepted instruments. The authors collected demographics, biopsychosocial characteristics, TMD symptoms, diagnoses, treatments, treatment adherence, and painful TMDs and jaw function outcomes through 6 months.ResultsParticipating dentists were predominately White (76.8%) and male (62.2%), had a mean age of 52 years, and were general practitioners (73.5%) with 23.8% having completed an orofacial pain residency. Of the 1,901 patients with painful TMDs recruited, the predominant demographics were White (84.3%) and female (83.3%). Patients’ mean age was 44 years, 88.8% self-reported good to excellent health, and 85.9% had education beyond high school. Eighty-two percent had pain or stiffness of the jaw on awakening, and 40.3% had low-intensity pain. The most frequent diagnoses were myalgia (72.4%) and headache attributed to TMDs (51.0%). Self-care instruction (89.4%), intraoral appliances (75.4%), and medications (57.6%) were recommended frequently.ConclusionsThe characteristics of this TMD cohort include those typical of US patients with painful TMDs. Network practitioners typically managed TMDs using conservative treatments.Practical ImplicationsThis study provides credible data regarding painful TMDs and TMD management provided by network practitioners across the United States. Knowledge acquired of treatment recommendations and patient reports may support future research and improve dental school curricula.     

Effect of botulinum toxin A on pain,bite force,and satisfaction of patients with bruxism: A randomized single-blind clinical trial comparing two protocols

PurposeThe current study aims to evaluate bite force, perception of orofacial pain, and treatment satisfaction of patients with bruxism using two protocols of botulinum toxin A (BTX-A) injections.Material and MethodsTwo groups of patients seeking bruxism treatment and presenting bilateral orofacial pain of muscle origin were randomly created according to BTX-A injection sites: masseter muscle only, bilaterally (3 points in each muscle, 10 U per point), and masseter and temporal muscles (3 points in each masseter muscle and 2 points in each temporal muscle, 10 U per point). The patients were evaluated preoperatively and longitudinally at 15, 90, 120, and 180 days by the use of visual analog scales for pain and treatment satisfaction and a gnathodynamometer for bite force recording.ResultsThe final sample included 10 participants in each group. Both groups presented mitigation of pain at 15, 90, 120, and 180 days in comparison with baseline; however, reduction in the posterior bite force was noted only at 15, 90, and 120 days. Quite high treatment satisfaction was reported from both groups at 15, 90, 120, and 180 days. No differences were observed between the groups in all evaluations and study periods.ConclusionIn general, considering pain relief, reduction in bite force, and treatment satisfaction, both protocols of BTX-A seem to be somewhat equally effective in the short-term management (up to 120 days) of bruxism.     

Comparison of treatment outcomes and time efficiency between a digital complete denture and conventional complete denture: A pilot study

BackgroundThe authors of this study aimed to compare the treatment outcomes and time efficiency between digital and conventional complete denture restorations and propose suggestions for clinical use.MethodsThe authors used digital (functionally suitable digital complete denture [FSD]) and conventional complete denture restorations to make 2 dentures each for 10 edentulous patients. All the operations of both techniques before denture delivery were completed in the first 4 visits, and then 2 dentures were delivered successively for the patients. The clinical and laboratory times were recorded to evaluate the time efficiency; treatment outcomes were evaluated via scoring the denture satisfaction of the dentist and patients in a double-blind manner.ResultsThe satisfaction scores of FSDs (7.6-9.6 [dentist's scores], 8.4-10 [patients' scores]) were higher than those of conventional dentures (7.2-9.7 [dentist's score], 7.4-9.8 [patients' scores]), but there were no significant differences. The clinical and laboratory operation times of the FSD group were less than those of the conventional group, saving an average of 28.0 minutes and 64.3 minutes in the clinic and laboratory, respectively.ConclusionsFSD technology can improve the efficiency of clinical and laboratory operations and shorten the manufacturing cycle of dentures. The occlusion stability of FSDs was statistically better than that of traditional dentures, but there was no statistical difference in other clinical indicators.Practical ImplicationsFSD technology is low cost and easy to operate and has several applications. Compared with conventional complete denture restoration technology, FSDs can save time and have a comparable clinical effect.This clinical trial was registered at the Chinese Clinical Trial Registry. The registration number is ChiCTR1900021722.     

Effect of virtual reality and music therapy on anxiety and perioperative pain in surgical extraction of impacted third molars

BackgroundThe objective of this study was to evaluate the effect of virtual reality (VR) and music therapy on anxiety and perioperative pain in patients undergoing extraction of impacted third molars.MethodsA total of 275 patients who had to undergo surgery for third-molar extraction participated in a randomized controlled trial and were divided into 3 parallel groups: music therapy intervention (n = 91), VR intervention (n = 93), and control (n = 91). The Spielberger State-Trait Anxiety Inventory and the visual analog scale of pain intensity were used as measurements in this study.ResultsPatients in the music therapy and VR groups showed a greater reduction in anxiety level scores after third-molar extraction surgery (reduction in total anxiety in music group: 15.12; 95% CI, 13.16 to 17.08; Rosenthal r, 1.61; P < .001; reduction in total anxiety in VR group: 9.80; 95% CI, 7.66 to 11.95; Rosenthal r, 0.97; P < .001; reduction in total anxiety in control group: 9.80; 95% CI, 7.66 to 11.95; Rosenthal r, 0.97; P < .001). The intensity of pain after the intervention was lower in patients in the music therapy group than patients in the control group (P = .04). After the intervention, the music therapy and VR groups presented a significant decrease in systolic blood pressure (P < .05), diastolic blood pressure (P < .05), and heart rate (P < .05) compared with the control group.ConclusionsThese findings suggest that the use of music therapy and VR during third-molar extraction surgery reduces anxiety and improves the patient’s physiological parameters.Practical ImplicationsImplementation of these interventions (noninvasive, nonpharmacologic, economic) in the field of oral and maxillofacial surgery and dentistry could improve procedures performed under local anesthesia, improving the clinical experience of patients. This clinical trial was registered with the Australian New Zealand Clinical Trials Registry. The registration number is ACTRN12622000384752.     

Efficacy of adjuvant ozone therapy in reducing postsurgical complications following impacted mandibular third-molar surgery: A systematic review and meta-analysis

BackgroundResults from several randomized controlled trials have shown a beneficial effect of ozone in reducing postsurgical complications after impacted mandibular third-molar surgery, but the literature is lacking a systematic review and meta-analysis.MethodsThe authors conducted this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines after exclusion and inclusion criteria were applied and the following outcome parameters were evaluated: pain, swelling, trismus, quality of life, number of analgesics consumed, and adverse events. RevMan Cochrane Collaboration software, Version 5.3, was used to perform meta-analysis and the Grading of Recommendation Assessment, Development and Evaluation approach was used to rate the certainty of evidence.ResultsPatients who underwent adjuvant ozone application reported lower pain scores than patients in the control group at 24 hours after surgery (95% CI, –3.94 to –1.56) and at 7 days (95% CI, –1.67 to –0.78). Pooled analysis of all 4 included trials revealed a standardized mean difference (SMD) in swelling of –0.44 at 24 hours, 0.63 at 72 hours, and –0.87 at 7 days after surgery in the experimental group. Higher mean estimates in mouth opening were experienced by patients who received ozone at 24 hours (SMD, 2.74; 95% CI, –1.93 to 7.41; 4 studies, 133 patients), 72 hours (SMD, 2.77; 95% CI, –0.63 to 6.17; 4 studies, 133 patients), and 7 days after surgery (SMD, 1.42 SMD; 95% CI, –1.34 to 4.18; 4 studies, 133 patients).Practical ImplicationsEvidence suggests that adjuvant ozone application can offer some benefit for reducing pain, improving quality of life, and decreasing mean intake of analgesics after impacted mandibular third-molar surgery, but it is not effective in reducing facial swelling and trismus, which paves the way for future research.     

Alternatives to opioids for acute pain management after dental procedures: A Department of Veterans Affairs consensus paper

BackgroundOpioid misuse is a widespread public health problem, and opioids are often prescribed in the dental environment. These recommendations provide alternatives to opioids to reduce or eliminate dental procedure–related acute pain.MethodsA multidisciplinary working group developed these clinical recommendations to specifically address procedure-related acute pain. These recommendations, which are based on published peer-reviewed research and guidelines, include therapies used before, during, and after dental procedures. When evidence is not definitive, the best practices, which are based on experts’ consensus, are included. The recommendations are not intended to be exhaustive.ResultsThese recommendations are a summary of the evidence and best practices for opioid alternatives to treat acute pain related to dental procedures.ConclusionsDental providers should prioritize opioid stewardship when managing procedure-related pain with strategies such as thorough preprocedure pain assessment, minimally invasive techniques, preemptive analgesia, intraprocedure pain management, and appropriately selected postprocedure pharmacologic therapy.Practical ImplicationsThese recommendations are a concise resource for clinical providers. It is important to address patients’ procedure-related pain, using nonopioids whenever possible. Alternatives are outlined, allowing providers to make informed decisions.     

The role of hemostatic agents after tooth extractions: A systematic review and meta-analysis

BackgroundHemostatic agents are used to control bleeding after tooth extraction and have been compared with conventional measures (that is, sutures or gauze pressure) in several studies. The objective of this systematic review was to evaluate the benefits of topical hemostatic agents for controlling bleeding after tooth extractions, especially in patients receiving antithrombotic therapy.Types of Studies ReviewedThe authors conducted a literature search in MEDLINE (PubMed), Scopus, and the Cochrane Central Register of Controlled Trials, including prospective human randomized clinical trials in which researchers compared hemostatic agents with conventional methods and reported the time to achieve hemostasis and postoperative bleeding events.ResultsSeventeen articles were eligible for inclusion. Hemostatic agents resulted in a significantly shorter time to achieve hemostasis in both healthy patients and patients taking antithrombotic drugs (standardized mean difference, –1.02; 95% CI, –1.70 to –0.35; P = .003 and standardized mean difference, –2.30; 95% CI, –3.20 to –1.39; P < .00001, respectively). Significantly fewer bleeding events were noted when hemostatic agents were used (risk ratio, 0.62; 95% CI, 0.44 to 0.88; P = .007). All forms of hemostatic agents (that is, mouthrinse, gel, hemostatic plug, and gauze soaked with the agent) had better efficacy in reducing the number of postoperative bleeding events than conventional hemostasis measures, except for hemostatic sponges. However, this was based on a small number of studies in each subgroup.ConclusionsThe use of hemostatic agents seemed to offer better bleeding control after tooth extractions in patients on antithrombotic drugs than conventional measures.Practical ImplicationsFindings of this systematic review may help clinicians attain more efficient hemostasis in patients requiring tooth extraction. This systematic review is registered in the PROSPERO database. The registration number is CRD42021256145.     

A retrospective,single-center cohort study on complications after dental extractions in patients taking biologic agents

BackgroundAlthough biologic agents represent a growing class of therapeutics, little is known about how these agents affect the provision of dental treatment.MethodsThis retrospective case-control study analyzed patients undergoing dental extraction treated with biologic agents from 2017 through 2020. Complications within 30 days postextraction were recorded.ResultsOne-hundred twenty-one patients were treated during 147 encounters. Fifteen patients experienced complications during 16 encounters. Notable or excessive pain was most common (14/16; 88%). Patients who experienced complications were treated with 7 biologic agents: dulaglutide, belimumab, adalimumab, aflibercept, tofacitinib, ranibizumab, and ixekizumab. Complication after extraction—specifically, pain—was elevated for patients receiving aflibercept and ranibizumab. When grouped by class, complications were more common with vascular endothelial growth factor antagonism.ConclusionsThe impact of biologics on the provision of and recovery after dental treatment remains unknown. Pain was most commonly reported. Patients treated with vascular endothelial growth factor antagonists experienced an elevated rate of complications.Practical ImplicationsThis study provides preliminary data on how patients taking biologic agents heal after dental extraction. It is limited by small sample sizes. Further work will build on this data to determine appropriate management of patients taking biologics in the dental setting.     

Tooth loss in patients with and without diabetes: A large-scale,cross-sectional study of Mexican adults

BackgroundThe objective of this study was to compare the experience and distribution of tooth loss in people with and without diabetes.MethodsThe authors conducted a comparative cross-sectional study of patients at a public university. Analysis included medical records of those treated from 2013 through 2017. The dependent and main independent variables were the number of missing teeth and a diagnosis of diabetes, respectively. As covariables, the authors analyzed the sociodemographic and socioeconomic characteristics, as well as the general and oral health status of patients. A multivariate model based on negative binomial regression was constructed.ResultsOf the 3,406 medical records analyzed, 64.2% (n = 2,185) pertained to women, the mean age was 42.45 years, 87.9% did not have diabetes, and 12.1% had received a diagnosis of diabetes. The mean (standard deviation) number of missing teeth was 7.46 (7.89), 7.09 (7.60) in patients without diabetes, and 10.12 (9.32) in patients with diabetes. According to our final multivariate model, the expected mean number of missing teeth was 11.4% higher in patients with diabetes than in those without (P = .006). For every 1-year increase in age, the expected mean number of missing teeth increased by 3.9% (P < .001). Other variables related to tooth loss included occupation, marital status, and type of insurance.ConclusionsThe results of the study indicate that the mean number of missing teeth is higher in people with diabetes and suggest that certain socioeconomic inequalities exist in the area of oral health.Practical ImplicationsThe population needs to be apprised of the impact of diabetes on oral health.     

Stainless steel crowns as a restoration for permanent posterior teeth in people with special needs: A retrospective study

BackgroundLimited information exists regarding the use of stainless steel crowns (SSCs) in permanent teeth. The objective of this retrospective cohort study was to present the long-term clinical outcomes of the SSC compared with those of amalgam and composite resin restorations and the SSC radiographic outcomes in a special-needs population.MethodsThis study included 271 patients with at least 1 SSC restoration from the Mount Sinai Hospital Dentistry Clinic for Persons with Special Needs in Toronto, Ontario, Canada. A total of 2,621 posterior permanent tooth restorations were documented: 766 SSCs, 1,651 amalgam restorations, and 204 composite resin restorations. Clinical analysis included patient demographics, treatment parameters, and outcome assessments for each restoration recorded. Radiographic analysis of SSC restorations included 127 bite-wing radiographs and 118 periapical radiographs, measurement of interproximal bone loss, and assessment of periapical status using the Periapical Index Scale.ResultsThe 10-year survival rates for new SSC and amalgam restorations were 79.2% and 63.5%, respectively. The 91 SSC failures included 2 recementations, 33 replacements, and 56 extractions. Primary diagnoses at the time of failure included chronic periodontal disease (25) and loose or lost SSCs (24). Of the 528 failed conventional restorations that were replaced, 60% were replaced with SSCs. The mean alveolar bone loss from mesial and distal sites was 1.36 millimeters and 1.40 mm, respectively. Therefore, 93% of the sites recorded were less than 2 mm and classified as healthy. All pre-SCC and post-SSC periapical radiographs had healthy Periapical Index Scale scores (1 or 2) recorded over an average duration of 8.4 years (1-29.1 years).ConclusionsSSCs are a durable treatment option for the restoration of the posterior permanent dentition.Practical ImplicationsPosterior permanent teeth restored with stainless steel crowns can be expected to last for 10 years and represent a viable treatment choice for severely carious or fractured posterior permanent teeth.     

Extractions in kidney transplant recipients: A prospective observational pilot study

BackgroundThe authors undertook a prospective study to determine whether kidney transplant recipients had an increased risk of developing complications, such as local acute infection, alveolitis, increased bleeding, pain, and delayed healing, after tooth extraction.MethodsThe authors selected patients who underwent kidney transplants more than 6 months ago (study group) and patients who had not (control group) older than 18 years who needed to undergo extraction of erupted teeth. The same oral surgeon performed all tooth extractions while the patients were under local anesthesia. Another blind researcher examined the patients 3, 7, and 21 days after tooth extraction. The first end point was occurrence of complications (local acute infection, alveolitis, increased bleeding), and the second end point was socket reepithelialization on day 21.ResultsForty-five tooth extractions were performed on 38 study group participants and 61 on 57 control group participants. There was no statistical difference between the groups regarding the incidence of any complication or delayed socket epithelialization.ConclusionsThe results of this pilot study suggest that there is no difference in postoperative healing after tooth extractions between stable kidney transplant patients and control patients.Practical ImplicationsThis is the first prospective study assessing the frequency of postoperative complications after tooth extraction in kidney transplant recipients.This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT02547753.     

A survival analysis of primary second molars in children treated under general anesthesia

BackgroundThe authors examined time to need new treatment of primary second molars in very young children treated under general anesthesia (GA).MethodsDuring this retrospective chart review, the authors examined patients aged 2 through 4 years with severe early childhood caries (ECC) who received dental treatment under GA. Primary second molars were tracked in periodic recall visits after GA for 6 through 89 months. Using a random-effects Cox proportional hazards model, the authors compared hazards of teeth requiring new treatment based on treatments received at GA.ResultsOf 3,166 primary second molars included in the study, 367 (12%) were not erupted, 77 (2%) received topical fluoride only, 873 (28%) received a pit and fissure sealant, 242 (8%) received a composite restoration, and 1,607 (50%) received a stainless steel crown (SSC) at GA. SSCs had a survival probability of 98% by 84 months after GA, significantly higher than all other groups (P < .0001). The second molars that were not erupted at GA had the highest hazard, especially within the first 24 months after GA. Teeth that received sealant had longer time to need new treatment than nonsealed teeth; however, at 84 months after GA, only 33% of the sealed teeth did not require additional treatment.ConclusionsPreventive or restorative treatments other than SSCs resulted in need for new treatment in a substantial number of teeth. SSCs had the highest success in this population with severe ECC treated under GA and should be chosen over other restorative options to reduce risk of undergoing repeat dental treatment.Practical ImplicationsAggressive treatment with SCC should be considered for young children with severe ECC especially those who are treated under GA at a young age.     

Photobiomodulation vs NSAIDs in the management of postoperative dentoalveolar pain

BackgroundPostoperative pain, the most common complication of dentoalveolar surgery, is routinely controlled by non-steroidal anti-inflammatory drugs (NSAIDs). However, despite its proven efficacy, the long-term consumption of NSAIDs is associated with several serious and adverse effects. As a result, photobiomodulation (PBM) or low-level laser therapy (LLLT) is used in many treatment modalities to reduce pain, inflammation, and promote healing.Aim of the studyTo compare the analgesic effects of LLLT and Ibuprofen after surgical dental extraction.Materials and methodsA clinical trial study was conducted at Umm Al-Qura University Dental Clinics, involving 46 healthy patients between 20 and 60 years of age. The recruited patients were divided into two groups of 23 patients each. Group 1 (positive control group) was prescribed Ibuprofen and Group 2 (experimental group) was treated with LLLT. The pain was measured on days 1, 2, and 7 using the Numeric Pain Rating Scale (NPRS).ResultsThe mean level of pain decreased with both treatments. On the first postoperative day, the pain level in the laser therapy group was significantly lower than in the control group (U = 62.5, p = 0.024). The results indicated a significant decrease in pain level on the second postoperative day for both the control and experimental groups (Z = ?3.61, p < 0.005, and Z = ?3.1, p = 0.002, respectively). However, the pain level was lower in the control group, although the difference was not statistically significant (U = 79, p = 0.102).ConclusionConsidering the constraints of this study, NSAIDs were found to be significantly better at reducing pain than LLLT.     

Association between primary headaches and temporomandibular disorders: A systematic review and meta-analysis

BackgroundThe primary objective of this systematic review was to answer the following question systematically: Is there any association between primary headaches (PHs) and temporomandibular disorders (TMDs) in adults?Types of Studies ReviewedThe protocol was registered with the International Prospective Register of Systematic Reviews. The authors performed the search in 6 main databases and 3 gray literature sources. The included articles had to have adult samples. PHs must have been diagnosed using the International Classification of Headache Disorders, and TMDs must have been diagnosed using Research Diagnostic Criteria for Temporomandibular Disorders, Diagnostic Criteria for Temporomandibular Disorders, or International Classification of Orofacial Pain. Risk of bias was evaluated using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument tools. The meta-analysis was performed using Review Manager software, Version 5.4. Certainty of evidence was screened according to Grading of Recommendations Assessment, Development and Evaluation.ResultsNine of 2,574 articles reviewed met the inclusion criteria for qualitative analysis and, of these, 7 met the inclusion criteria for quantitative analysis. Odds ratios (ORs) for painful TMD and tension-type headache (OR, 1.94 [95% CI, 0.56 to 6.76] to OR, 7.61 [95% CI, 1.84 to 31.48]), migraines (OR, 4.14 [95% CI, 1.38 to 12.43] to OR, 5.44 [95% CI, 3.61 to 8.21]), and chronic headaches (OR, 40.40 [95% CI, 8.67 to 188.15] to OR, 95.93 [95% CI, 12.53 to 734.27]) were calculated. Articular TMDs without pain were evaluated in 2 articles, and both did not show positive association with tension-type headache nor migraine. Three studies were classified as moderate risk of bias and 6 as low risk of bias. The certainty of evidence varied between very low and low.Conclusions and Practical ImplicationsRecognizing the positive association between painful TMD and PHs can help dentists and physicians treat the pain and avoid it, or recommend the patient to a specialist.